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  Citation statistics : Table of Contents
   2020| April-June  | Volume 4 | Issue 2  
    Online since May 22, 2020

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Coronavirus disease 2019: The story so far
Ali S Omrani
April-June 2020, 4(2):52-57
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) emerged in China in late 2019 and became a global pandemic by March 2020. SARS-CoV-2 is a highly transmissible virus that causes a clinical illness known as Coronavirus Disease 2019. The clinical spectrum ranges from mild respiratory and generalized symptoms to severe pneumonia with multiple organ failure. Overall mortality is high in older patients and those with comorbidities such as obesity and cardiovascular disease. Diagnosis is usually confirmed by polymerase chain reaction on upper or lower airway samples. Clinical management is largely supportive; no specific therapeutic options are currently available. Public health interventions have thus far been centered around social distancing, large-scale testing, and isolation. An unprecedent global effort has been mounted for the rapid development of effective SARS-CoV-2 vaccines. Until such time, further waves of SARS-CoV-2 are likely, if the restrictive control measures are removed.
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Chondroma of the nose
Santosh Kumar Swain, Jatindra Nath Mohanty
April-June 2020, 4(2):87-89
Chondromas of the head-and-neck area are rare lesions and more rare over the nose. Chondroma is a benign neoplasm of cartilaginous origin. It is rarely seen over the dorsum of the nose. It causes cosmetic deformity of the nose and face if it arises from the nose. The diagnosis is confirmed by histopathological examination. The treatment is complete surgical excision. We report a case of chondroma arising at the dorsum of the nose which is slightly mobile. Computed tomography scan showed a mild enhancing lesion at the dorsum of the nose which was completely excised via transcolumellar route. Considering its rarity at the dorsum over the nose, we reported this solitary chondroma of the nose. Chondromas have to be kept in mind during evaluation of any mass over the nasal dorsum.
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Association between pterygium and dry eye among patients in Benghazi, Libya
Osama M Omran, Samar A Bukhatwa
April-June 2020, 4(2):80-83
Background and Aim: Pterygium is a relatively common condition of the conjunctiva that affects people at different stages of life. Dry eye disease (DED) is a well-known associated morbidity with pterygium. The aim of this study was to investigate the association between pterygium and dry eye among otherwise healthy Libyan people. Methods: A case–control study was conducted on patients attending Al-Keish Polyclinic in Benghazi. Two techniques have been applied individually, in parallel and in series for all of the study participants, Schirmer's test and break-up time (BUT) test. Results: This study included 50 eyes belonged to 35 patients with a median age of 37 (range 26–65) years, and among those, 18 (51.4%) cases (25 eyes) had pterygium and a group of 17 (48.6%) cases (25 eyes) were control. Rates of DED diagnosis were highest using parallel testing (positive results in any of the tests) than with BUT and Schirmer's test individually and lowest using series testing (positive results in both tests). Eyes with pterygium showed obviously and statistically significant higher rates of positive test results. All controls were normal testing with Schirmer's test and hence in series testing. Conclusion: Testing for DED using parallel combined testing (BUT and Schirmer's test) relying on positive result of any of the tests increases sensitivity and may increase the value of the test for screening for dry DED among particular high-risk groups.
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Management of diabetes in patients with coronavirus disease 2019: A practical approach
Mohsen S Eledrisi, Abdel-Naser Elzouki
April-June 2020, 4(2):58-64
Coronavirus disease 2019 (COVID-19) has emerged as a rapidly transmissible communicable disease around the globe. Diabetes is reported as a common morbidity in patients with COVID-19, has been associated with worse clinical outcomes, and may lead to higher mortality. Because the disease has variable presentations varying from mild respiratory symptoms to pneumonia and respiratory failure, proper care of patients with diabetes in this context should cover both outpatient and inpatient sectors. Outpatient management in acutely ill patients includes frequent home glucose monitoring; holding certain medications including metformin, sodium glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists that may cause unwanted side effects such as dehydration and resulting acute kidney injury; continuation and adjustment of insulin therapy; and patient education on indications to seek medical assistance. Inpatient glucose management of patients admitted with COVID-19 involves holding noninsulin medications, monitoring blood glucose, and starting insulin if glucose levels are not in target. Intravenous insulin is recommended for critically ill patients with uncontrolled glucose. Universal measures should include assurance of continuity of care, adherence to therapy, and self-management education using connected health models and telemedicine. Patients with diabetes are considered a vulnerable group during periods of epidemics, and clear recommendations and pathways are essential to assure patients' safety.
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Benign tumor mimicking malignancy: Atypical presentation of hemorrhagic macroadenoma
Mohammed Yaseen Ahmed Siddiqui, Abdul Moqeeth Mohammed, Mohammed Al Fatih, Naseer Masoodi, Abdel-Naser Elzouki
April-June 2020, 4(2):84-86
Pituitary macroadenoma is a benign tumor of the pituitary gland usually presenting with headache, vomiting, visual symptoms, altered mental state, and hormonal abnormalities. Occasionally, it undergoes hemorrhagic transformation resulting in an acute presentation of severe headache and at times associated with visual impairment with ocular palsies. We present a patient with marked weight loss, fatigue, and dizziness and the workup for malignancy revealed a hemorrhagic macroadenoma; although there are many case reports of patients presenting with the above-mentioned common symptoms, according to the authors' review of literature, ours is a first case report of a patient with hemorrhagic macroadenoma, presenting with significant weight loss in the absence of other contributing factors.
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Clinical and histological features of primary pure large-cell neuroendocrine carcinoma of the ovary
Jihene Feki, Syrine Sghaier, Sana Ennouri, Manel Mellouli, Tahya Boudawara, Rafik Mzali, Afef Khanfir
April-June 2020, 4(2):90-93
Primary pure large-cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare entity which has been reported only through few cases. It is described as an aggressive tumor with the tendency to present at advanced stages and to cause death after a short postoperative time. Until nowadays, there is no standard therapeutic protocol that helps to guide the treatment of this malignancy. In this article, we report two cases of pure LCNEC of the ovary to make physicians aware of this entity and to show its clinical and pathological features in order to put emphasis on its aggressiveness. The first case was a 38-year-old patient diagnosed in 2015. The ovarian LCNEC was classified according to the International Federation of Gynecology and Obstetrics (FIGO) staging classification as FIGO Stage IV and was treated by surgery and chemotherapy. The second case was a 67-year-old patient diagnosed in 2017. The ovarian LCNEC was classified as Stage IIIB and not resectable and was treated by paclitaxel–carboplatin chemotherapy.
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Coronavirus disease 2019 pandemic: An overview of the event
Bashir Abdrhman Bashir Mohammed
April-June 2020, 4(2):49-51
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Patterns of injuries from road traffic crashes
Enos Ngungu Muguku
April-June 2020, 4(2):94-95
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Breast cancer in western part of Libya: Pattern and management (2003-2018)
Eman Gusbi, Nada Elgriw, Shiaa Zalmat, Hafsa Alemam, Sumia Khalil, Mokhtar Gusbi, Miluda Elhamadi, Taha Benyasaad, Nabil Enattah, Adam Elzagheid
April-June 2020, 4(2):65-71
Background: Breast cancer is the second most common cancer in the world; the most frequent cancer among women, and leading cause of cancer death in females worldwide. Aim: The aim of the study is to study the pattern and treatment modalities for breast cancer patients who registered in Tripoli University Hospital from 2003 to 2018. Patients and Methods: A retrospective, cross-sectional study was conducted at the Oncology Department of Tripoli University Hospital. A convenience sample of 1000 breast cancer patients from 2003 to 2018 was chosen. Demographic, clinic-pathological characteristics, and treatment modalities data were analyzed by SPSS program version 20. Results: Of 1000 breast cancer patients, there were 984 (98.4%) females and 16 (1.6%) males, mean age was 46.1 ± 11.7 years old, most of them from western region. Majority (64.3%) of female were early age at menarche and 46.2% not breastfed. Positive family history of first degree was 28.8%. The left side presentation was the predominant (60.3%); half of the cases were in Stage II. Invasive ductal carcinoma was diagnosed among 62.5% of the cases and 47% of them were in Grade III. Positive estrogen receptor recorded in 73.8% of cases compared to 69.5% positive progesterone. Furthermore, 76.8% of patients had human epidermal growth factor receptor 2 negative and 78.4% of cases had high Ki-67 level. Regarding management, a combination of surgery, radiation, chemotherapy, and hormonal were provided to 58% of cases, 45.5% of patients who received chemotherapy were treated with FEC regimen. Hormonal therapy was given to 67.7% and tamoxifen is the most drugs used. Conclusions: The frequency is higher among younger age (<50 years), early age at menarche, breastfed less than a year, nearly half presented in late Stage (III, IV), invasive ductal carcinoma is predominant histopathological type, most cases were HER2 negative and high Ki-67 expression. More efforts toward primary prevention and early detection are recommended to reduce locally advanced breast cancer.
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A descriptive study of inflammatory bowel disease in eastern regions of Libya: A based survey of Benghazi's hospitals
Asma Elsanussi Mohamed Abdelsalam, Salem Ishtewi Abdalla
April-June 2020, 4(2):72-75
Aim: The aim of this study was to determine the prevalence and the clinical characteristics of inflammatory bowel disease (IBD) in the eastern region of Libya. Patients and Methods: This cross-sectional and retrospective study was conducted in the gastroenterology clinic of the Internal Medicine Department of Aljumhouria Hospital and Benghazi Medical Center, which serves patients from Benghazi city as well as patients from most eastern regions of Libya. Data were obtained by searching in medical records of patients in whom the diagnosis of ulcerative colitis (UC) or Crohn's disease (CD) was confirmed by clinical, laboratory, endoscopic, histological, and radiological criteria over the period from 2000 to 2011. This descriptive epidemiologic study included the demographic and clinical characteristics of IBD patients. Results: A total of 243 patients were included in this study: 143 (59%) patients were diagnosed with UC and the other 100 (41%) patients had CD. The estimated prevalence of IBD in the Benghazi area, depending on these data, would at least be 24.3/100,000 population, which is much higher than the previously estimated prevalence (1.2–3.6/100,000 population). The mean age was 37.32 years, and the median was 37 years. Young adults were the most common, and the female-to-male ratio was 1.6:1 in CD and slightly lower in UC. The majority of patients had a mild form of the disease, whereas one-third had a moderate-to-severe illness. Abdominal pain and diarrhea were the most common presenting symptoms. Extraintestinal manifestation (most commonly arthralgia and backache) was seen in 135 patients (55.7%). Conclusion: The results of this study were similar to previous studies regarding demographic characteristics and disease patterns. Nevertheless, the prevalence of IBD has increased compared to previous national figures.
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Clinicopathological profile of primary gastric lymphoma: A single-center experience of 45 patients in Benghazi, Libya
Abdelhakim M Elbarsha, Muftah I Elsahati, Abdelhadi O Hawil
April-June 2020, 4(2):76-79
Background/Aim: Gastric lymphoma can be primary or secondary, and it comprises <5% of all patients with gastric primary neoplasms. The presenting symptoms of primary gastric lymphoma (PGL) are usually nonspecific and are similar to common upper gastrointestinal disease symptoms. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype, followed by marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). The present study aims to describe the clinicopathological characteristics of PGL. Patients and Methods: This was a cross-sectional and retrospective study of patients with PGL who were diagnosed in the Department of Oncology/Haematology, Benghazi Medical Centre, from January 2010 to December 2017. Results: A total of 45 cases of PGL were diagnosed. The mean age was 54 years, ranging from 17 to 83 years. The number of male and female patients was 26 (57.5%) and 19 (42.5%), respectively. Abdominal pain was the most common presenting symptom. The gastric antrum was the most common anatomical site of involvement (28 [62%]). DLBCL was the predominant histological subtype (28 [62%]). Serum Helicobacter pylori immunoglobulin G antibodies were raised in 19 (42.2%) patients. Half of the patients were in stage II1 at presentation (according to Lugano staging system). Conclusions: DLBCL and MALT lymphoma were the most common subtypes, and H. pylori infection was found in most of the patients with MALT lymphoma. Despite the clinical presentation being usually nonspecific, most of our patients were diagnosed with stage I or II disease.
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COVID-19 news and views
Khalid Farooqui, Adeel Ahmad Khan, Abdel-Naser Elzouki
April-June 2020, 4(2):43-48
The outbreak of Corona Virus disease 2019 (COVID-19) in December 2019 has spread around the world and become a global pandemic. It belongs to Beta coronavirus which also contains SARS-CoV and Middle East respiratory syndrome CoV (MERS-CoV). There are lots of new studies coming up with update in pathophysiology, clinical manifestation, diagnostic tools, and newer medications and its action along with ongoing clinical trials. We are presenting a fast review about the COVID-19 from origin of the virus to the latest updates in management, so that physicians and health care providers across the globe can review latest news and views about the COVID-19 till date which can help in understanding the diagnosis and management of disease in this challenging time.
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