Attahadi Medical Journal (AMJ) ISSN: 3078-6991, is a peer-reviewed journal published by Attahdi University, Tripoli, Libya. The journal's full text is available online at https://attahadi.ly/journal/index.php/amj/index. The journal allows free access (Open Access) to its contents and permits authors to self-archive the final accepted version of the articles on any OAI-compliant institutional/subject-based repository. The journal publishes in continuous mode, gathered into 4 issues per year (March, June, September, and December) The purpose of the Journal is to promote excellence in the practice of medicine and medical sciences. The Journal aims to promote the knowledge, attitudes and practice of all aspects of comprehensive health care (preventive, curative and rehabilitative) as well as facilitate the development of medical research, education and health services. Original papers, review articles (both systematic and narrative), short communications, brief reports and letters to the editor are all welcomed. Case reports with substantial significance may also be considered for publication. Most of the content of AMJ is submitted at the authors' initiative, but all editorials are solicited by the Editors. Editor-Office-In-Charge Dr. Ahmed Atia 0910737929 - amjeditorial@gmail.com
Influence of Anemia Status and ABO Blood Group on Hematological Parameters Among Pregnant Women
Pregnancy is a typical physiological condition that involves widespread changes throughout the body and in the blood system. Nevertheless, variations in certain blood-related measurements during this time can impact the mother's health and increase the risk of pregnancy-related complications. The study aims to examine the connection between hematological parameters in pregnant women and the condition of anemia, as well as to explore how these parameters relate to different blood group types. This cross-sectional study was conducted in the Gynecology Department of Tobruk Medical Centre, Tobruk, Libya. All pregnant women who were more than 28 weeks pregnant and at least 18 years old were included in this study. A total of 2141 pregnant women were enrolled. Clinical data for these women were collected using hospital electronic records. Blood samples were tested for complete blood count using the Sysmex Automated Hematology Analyzer, and blood group determination using indirect and reverse grouping tubes. Statistical analysis was performed using SPSS software, with independent samples t-tests comparing various hematological parameters and a p-value used to determine statistical significance. The Fisher–Freeman–Halton was used to analyze the association between two categorical variables, and the Phi coefficient was used to calculate to evaluate the strength of associations. Hemoglobin and hematocrit levels were significantly lower in the anemic group, showing a large difference in hemoglobin (d = 0.82) and a moderate effect for hematocrit (d = 0.43). Platelet counts were higher in 3.9% of anemic women compared to 1.2% of non-anemic women. Although this association was statistically significant (χ² = 18.965, p = 0.0001), the Phi coefficient (φ = 0.094) indicates that the relationship is weak. Similarly, there was a statistically significant but weak association between white blood cell (WBC) distribution and anemia (χ² = 5.041, p = 0.046; φ = 0.080) with 14.9% of anemic women having elevated WBCs versus 11.9% of non-anemic women. No association was found between ABO blood groups and red blood cell (RBC) or platelet counts, although a weak but statistically significant association was observed with WBC levels (χ² = 33.476, p = 0.006; φ = 0.125). The study found that pregnant women with blood group B were more likely to exhibit elevated white blood cell counts, followed by those with blood group O+ and AB+. This paper's findings help improve our understanding of how anemia status and ABO blood group traits affect important blood-related measurements such as white blood cell count, red blood cell count, and platelet count. The results highlight the need for more research in bigger and more varied groups of people to better understand the biological and genetic reasons behind these connections.
Hematological, Pregnant Women, Anemia, Blood Group
Copyright (c) 2025 Attahadi Medical Journal
Comparative in vitro Evaluation of Three Brands of Hydrochlorothiazide Tablets in Libya
Hydrochlorothiazide (HCTZ) is a diuretic of the thiazide class, which is used in the treatment of hypertension, edema, congestive heart failure, and different forms of renal and hepatic dysfunction. The aim and the objective of our present study are to evaluate the quality parameters of some marketed hydrochlorothiazide tablets and to compare the parameters among them. To assess the quality, three different marketed hydrochlorothiazide 25 mg tablets available on private pharmacies of Tripoli, Libya, are selected, and in vitro dissolution test, potency, and disintegration time are carried out. Other general quality parameters of these tablets, like weight variation, hardness, and friability, are also determined according to established protocols. All the brands comply with the requirements of the United States Pharmacopoeia as they show an acceptable weight variation range. Friability of Brand A brands is more than 1% so it does not pass the friability test. The hardness of all brands was below 4 kg/cm2. The limitation of the potency must be within 92.5- 107.5%. All three brands meet this specification. The mean disintegration times of all tested brands were within the pharmacopeia specification (30 minutes). In the case of dissolution profile, all brands show better dissolution time as they release more than 90% of the drug in 30 minutes. The difference factor (f1) and similarity factor (f2) values revealed that all brands maintained the quality and complied with the USP specifications, and are like the comparator product and could be used interchangeably in clinical practice
Hydrochlorothiazide, In Vitro, Quality Control, Dissolution, Pharmacopoeial Specification.
Advances in the Diagnosis and Management of Shoulder Instability: A Review
Shoulder instability, particularly anterior dislocation, is a common issue in younger, active individuals. The goals of nonoperative care include restoring mobility, alleviating discomfort, and preventing recurrence. After a brief period of sling immobilisation, intravenous analgesics, and intra-articular injections, physical therapy focusing on the rotator cuff and periscapular muscles is usually administered. Although they need further study, new tactics like immobilisation in external rotation show promise. The goals of nonoperative care include restoring mobility, alleviating discomfort, and preventing recurrence. After a brief period of sling immobilisation, intravenous analgesics, and intra-articular injections, physical therapy focusing on the rotator cuff and periscapular muscles is usually administered. Although they need further study, novel methods like immobilisation in external rotation show promise. Recurrent instability, particularly in athletes, should be treated surgically. Good results are obtained with less invasive arthroscopic techniques as well as open operations like Bankart repair. Following surgery, rehabilitation is crucial to regaining function and averting further instability.
Diagnosis, Management, Shoulder Instability.
Estimate the Antioxidant Capacity, Total Phenol Contents, Mineral Concentrations, and Total Carbohydrate of Capparis Spinosa L. (Kabbar), Ceratonia Siliqua L. (Kharuwb), and Juniperus Phoenicea L (Arar) Plants
In this research, some of the phytochemical compounds were detected by using phytochemical screening in leaves and stems of three different plants collected from Al-Gabal Al-Ahder region, Libya, and the concentrations of anti-oxidant capacity, total phenol content, minerals, and total carbohydrate were measured for the selected plants of Capparis spinosa L. (Kabbar), Ceratonia siliqua L. (Kharuwb), and Juniperus phoenicea L (Arar). The spectrophotometer was used to estimate the contents of antioxidants, total phenols, and total carbohydrates, whereas the Flame photometer was used to determine the contents of sodium, calcium, and potassium. The outcomes of this study found that, the levels of anti-oxidant were ranged as follows:(222.72 -302.64 ppm) in leaves and (307.62 -319.03 ppm) in stems, while the contents of total phenols were ranged from 307.62 to 319.03 ppm in stems, the total phenols contents were ranged from 9.07 to 10.59 ppm and from 9.95 to 10.65 ppm in stems, respectively while the concentrations of carbohydrate were ranged from 0.039 to 0.155 ppm and from 0.070 to 0.123 ppm for leaves and stems, respectively. . whereas the sodium, potassium, calcium were ranged from 0.958 to 2.625 ppm in leaves and from 0.88 to 4.08 ppm in stems, for potassium the values were ranged from 3.56 to 77.16 ppm in leaves, but for stems the values of potassium were ranged from 42.96 to 76.96 ppm. While the calcium contents ranged from 0.08 to 0.28 ppm in leaves, and for stems ranged from 0.375 to 0.875 ppm in stems. The phytochemical investigation showed the present important quantiles of sterols, flavonoids, alkaloids, tannins, anthraquinones, saponins, and phenols
Phytochemical. Carbohydrate, Antioxidant, Phenols, Minerals, Plants, Libya
Outcomes of Soft Palate Lengthening for Persistent Nasal Speech in Post-Palatoplasty Patients Over Five Years of Age
Having nasal speech due to velopharyngeal insufficiency (VPI) remains one of the most difficult complications to manage after cleft palate repair. Over early childhood, persistent hypernasality can impede the psychosocial and communicative development of a child. The purpose of this study was to assess the results of secondary soft palate lengthening surgery on children older than five years with a history of primary palatoplasty and persistent nasal speech. In this study, 60 non-syndromic patients with cleft palate whose nasal speech was persistent after cleft palate repair were included from January 2018 to December 2024 at Misurata Medical Center, Libya. Each of them underwent soft palate lengthening, most by intravelar veloplasty, and some by posterior pharyngeal flap. All the patients had preoperative and 12-month postoperative speech evaluation from both perceptual (Pittsburgh Weighted Speech Scale) and instrumental (nasometry) analysis. For statistical analysis, paired t-tests were used, with P < 0.05 considered significant. Of the total, 80% of patients had complete hypernasality correction, and 13.3% had partial correction. There was a significant improvement postoperatively on nasalance scores (48.5 ± 9.2% to 24.1 ± 6.8%, P < 0.001). 85% of the patients had improved speech intelligibility, with more than 86% of parents satisfied with the overall results. 10% had transient snoring and 5% had wound dehiscence, both classified as minor complications and were conservatively managed. For patients older than five years, soft palate lengthening is a secondary procedure that is both safe and effective for persistent nasal speech after cleft palate repair. It shows remarkable positive outcomes in resonance, intelligibility, and psychosocial confidence
Velopharyngeal Insufficiency (VPI); Hypernasality; Soft Palate Lengthening; Intravelar Veloplasty; Posterior Pharyngeal Flap.
Optimizing Sedation for Upper GI Endoscopy: Propofol versus Midazolam: A Clinical Study at Sirte Oncology Central
Upper gastrointestinal (GI) endoscopy is a common diagnostic and therapeutic procedure, typically performed under conscious sedation to improve patient comfort and cooperation. However, the choice of sedative remains a topic of ongoing debate. This study aimed to compare the safety and efficacy of midazolam and propofol for sedation during upper GI endoscopy. A total of 80 patients scheduled for elective upper GI endoscopy at the Endoscopy Unit of our hospital between February 2023 and October 2023 were recruited for this prospective, randomized controlled trial. Patients were randomly assigned to two equal groups: one group received propofol, while the other received midazolam. The anesthesiologist was aware of the sedative agent being administered, but the patients were blinded to the treatment. Both sedatives were administered via intravenous bolus, with dosages adjusted as needed to maintain an appropriate level of sedation. The recovery time was significantly shorter in the propofol group compared to the midazolam group. While the propofol group exhibited a decrease in systolic blood pressure, this was transient and did not result in significant adverse effects. In contrast, the midazolam group experienced a notable reduction in oxygen saturation, with a higher incidence of hypoxia compared to the propofol group. No major adverse events, such as cardiac arrhythmias or respiratory depression, were observed in either group during the procedure. The sedation quality, as assessed by the Observer's Assessment of Alertness and Sedation (OAA/S) scale, was stable throughout the procedure in the propofol group, while some variability was noted in the midazolam group. The results of this study suggest that propofol is a more effective and safer sedative agent than midazolam for upper GI endoscopy. Propofol offers faster recovery times and more stable sedation, with fewer complications related to oxygen saturation. It is therefore recommended as the sedative of choice for upper GI endoscopy, although careful monitoring of blood pressure is essential
Upper gastrointestinal endoscopy, Propofol, Midazolam, Sedation, Recovery time, Oxygen saturation
Early-Life Antibiotic Exposure and Asthma-Like Symptoms Among Children in Sebha, Libya
Evidence links infant antibiotic exposure to asthma, but data from North Africa are limited. Methods: We conducted a cross-sectional survey of 100 children aged 0–5 years in Sebha, Libya. Early exposure was defined as any systemic antibiotic use before the age of 2 years, and intensity was grouped as 0, 1, 2–3, or ≥4 courses. The primary outcome was the presence of current asthma-like symptoms (wheezing, persistent cough, nocturnal cough, or shortness of breath). Proportions were compared using chi-square tests, and multivariable logistic regression was adjusted for age, sex, family history of atopy, household smoking, and residence. Sensitivity analysis excluded children with physician-diagnosed asthma. Results: Seventy percent of children received antibiotics by the age of 2. Overall, 25% had current asthma-like symptoms; the prevalence was 30% among the exposed and 10% among the unexposed (unadjusted OR 3.86, 95% CI 1.05–14.2; adjusted OR 3.5, 95% CI 1.11–11.2). A dose–response relationship was observed: symptoms in 15% with 1 course, ~30% with 2–3 courses, and 50% with ≥4 courses (p-trend <0.01). The first antibiotic before 6 months showed a higher symptomatic proportion among the exposed, but this was not statistically significant. Family history was strongly associated with symptoms (aOR ~4.0), whereas household smoking showed a non-significant trend (aOR ~1.8). The model fit was acceptable (Hosmer–Lemeshow p=0.88). The sensitivity results were similar (25% vs. 8%, p=0.04). Respiratory infections were the most common indication for use, and 57% of exposed children received broad-spectrum agents. In this Libyan cohort, early-life antibiotics were associated with a higher burden of asthma-like symptoms by age five years, with a graded increase across course counts. Although confounding by indication and cross-sectional design limit causal inference, the findings are biologically plausible and clinically relevant. Prudent stewardship in infancy and targeted respiratory follow-up for repeatedly treated children are warranted, and larger prospective cohorts with validated exposure and microbiome profiling are needed
Early-Life Antibiotic Exposure, Asthma-Like Symptoms, Children in Sebha, Libya
Renal and Metabolic Biomarker Profiles in Dialysis vs. Non-Dialysis CKD Patients: A Cross-Sectional Study.
This study investigated key renal and biochemical parameters in Chronic Kidney Disease (CKD) patients by comparing a cohort of 147 non-dialysis patients with 147 patients undergoing dialysis. Key findings indicate that while both groups exhibited elevated urea and creatinine levels, urea was lower in dialysis patients, whereas creatinine was significantly higher. Blood pressure was minimally increased in both groups, but was higher in the non-dialysis cohort. Uric acid levels were notably lower in patients on dialysis. Regarding electrolytes, potassium levels were higher in the dialysis group, while sodium levels remained normal and stable across both cohorts. Serum phosphorus was elevated in both groups, with slightly higher levels in non-dialysis patients. A significant difference was observed in serum calcium, which was normal in non-dialysis patients but below the normal range in the dialysis group. Both groups also showed elevated fasting blood sugar. As expected, Glomerular Filtration Rate (GFR) was sharply decreased in all patients, most severely in the dialysis group, consistent with end-stage renal disease. The results underscore the profound metabolic and physiological changes in CKD patients. The study concludes that enhancing dialysis efficiency and providing comprehensive patient education on medication, diet, and lifestyle are critical for improving quality of life, reducing complications, and lowering healthcare costs associated with CKD management
Chronic Kidney Disease, Electrolytes Urea, Creatinine Uric Acid, Glomerular Filtration Rate, Dialysis.
Comparison of Height and Dominant Hand Grip Strength Among Female Physiotherapy Staff: A Cross-Sectional Study
This cross-sectional study investigated the relationship between dominant hand grip strength and height among female physiotherapists. Hand grip strength is a fundamental function for daily activities and a common measure of upper limb function and general muscular health. The study included a small sample size (n) of 18 female physiotherapists. Two observers recorded participant height (in centimetres) and dominant hand grip strength (in kilograms) using a JAMAR hand dynamometer across three consecutive tests. Statistical analyses included descriptive statistics, correlation coefficients, and linear regression. A strong, significant positive correlation was found between the participants' height and their dominant hand grip strength, with correlation coefficients (r) ranging from 0.730 to 0.838 (p <0.005). This indicates that taller participants generally had stronger grip strength. However, linear regression analysis showed that height only accounted for a small amount of the variance in grip strength, with an R2 of 0.134. This suggests that while there is a positive relationship, height is a weak predictor of grip strength. The study also found that grip strength measurements varied moderately between the three tests, indicating variability in measurement. The results suggest that height may influence grip strength, but it is not the primary factor. Future research should employ larger samples and include additional variables to fully understand the factors determining grip strength in this population
Hand Grip Strength, Height, Dominant, Correlation, Dynamometer, Physiotherapist, Cross-sectional
Medical Waste Management in Primary Health Care Centers, Tripoli
Medical waste management (MWM) is a critical public health and environmental concern, given the potential hazards posed by improperly handled biomedical materials. Inadequate management of such waste can lead to severe consequences, including disease transmission, environmental contamination, and occupational risks for healthcare workers and waste handlers. To assess different medical waste management practices in primary health care centers (PHCCs) in Tripoli, Libya. A cross-sectional study for 35 primary health care centers in the seven municipalities of the Tripoli district was conducted between 1st February 2023 and to end of June 2023. The Majority of PHC (97%) have at least one trash bag in each room; however, only 20% of them use colored trash bags to collect infected medical wastes. Also, the majority of primary health care facilities use safety boxes for the collection of sharp medical wastes; however, they also use plastic tanks instead of or in addition to safety boxes. In addition, to majority of safety boxes were filled more than three-quarters. Medical waste management practices in Tripoli's PHCCs are inadequate, posing significant risks. Urgent intervention is needed, focusing on training, provision of supplies, and establishing a centralized waste management system
Medical Waste Management, Primary Health Care Centers, Tripoli.
Antibacterial Properties of Alchemilla vulgaris and Euphorbia helioscopia: Potential Natural Alternatives for the Treatment of Conjunctivitis
The emergence of antibiotic-resistant bacteria necessitates the exploration of alternative therapeutic agents. This study investigates the antibacterial potential of Alchemilla vulgaris and Euphorbia helioscopia extracts against bacterial strains associated with conjunctivitis, including Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus spp. Plant extracts were prepared using water, ethanol, hexane, and chloroform as solvents, and their antibacterial efficacy was assessed via agar well diffusion and broth microdilution minimum inhibitory concentration (MIC) assays. Ethanol extracts demonstrated the highest antibacterial activity in agar diffusion, with inhibition zones up to 17 mm for E. helioscopia and 12 mm for A. vulgaris (against Streptococcus spp.). Chloroform extracts showed moderate activity (zones ranging from 9–19 mm across both plants), while hexane extracts exhibited lower activity. Water extracts displayed no antibacterial effects. MIC analysis revealed that the ethanol extracts had the lowest MIC values (approximately 280 mg/mL) among all extracts, notably against S. aureus (for A. vulgaris) and P. aeruginosa (for E. helioscopia). All other solvent extracts showed higher MICs (≥550–750 mg/mL). Statistical analysis confirmed significant differences in the antibacterial activity of the extracts compared to the control antibiotic gentamicin (30 µg) (p < 0.05). These findings highlight the potential of Alchemilla vulgaris and Euphorbia helioscopia as sources of natural antibacterial agents. Future studies should focus on isolating bioactive compounds and evaluating their pharmacological properties to develop alternative treatments for ocular bacterial infections
Alchemilla vulgaris, Euphorbia helioscopia, Conjunctivitis.
Assessment of Carbapenem-Resistant Enterobacteriaceae and Other Gram-Negative Bacteria on Intensive Care Unit Surfaces and Among Healthcare Workers at Tobruk Medical Center
The emergence of carbapenem-resistant Enterobacteriaceae (CRE) and other multidrug-resistant Gram-negative bacteria (GNB) presents a serious threat to infection control, particularly in high-risk environments such as Intensive Care Units (ICUs). ICU surfaces and healthcare workers (HCWs) may serve as reservoirs and transmission routes for these pathogens. This study aimed to assess the prevalence and distribution of CRE, and other Gram-negative bacteria isolated from ICU environmental surfaces and from the nasal swab of healthcare workers. A descriptive cross-sectional study was used to study 127 collected samples: 36 from healthcare workers and 91 from surface smears. Samples were collected from four units of intensive care: Intensive Care Unit (ICU), Cardiac Care Unit (CCU), Pediatric Care Unit (PICU), and Neonatal Intensive Care Unit (NICU). Identified Enterobacteriaceae were confirmed by biochemical methods, and tested for carbapenemase production using three discs (EME, IMP, ETP). Resistance to Ertapenem, Imipenem, and Meropenem was considered carbapenem resistance. A total of 13 (36.1%) out of 36 HCW samples yielded clinical isolates: 3 Pantoea sp., 3 Klebsiella pneumoniae, 2 Acinetobacter baumannii, 2 Escherichia coli, 2 Flavimonas oriyzihabitans, and 1 Serratia marcescens. One (7.69%) isolate showed carbapenem resistance: 1 Klebsiella pneumonia. From 91 surface samples, 39 (43%) yielded isolates: 13 Flavimonas oriyzihabitans, 6 Acinetobacter baumannii, 5 Pantoea sp., 4 Escherichia coli, 3 Enterobacter cloacae, 2 Serratia marcescens, 2 Shigella sp., 1 Klebsiella pneumonia, 1 Leclercia adecarboxylata, and 1 Salmonella sp. Of these, 11 (28.2%) were carbapenem-resistant: 3 Escherichia coli, 3 Acinetobacter baumannii, 2 Pantoea sp., 1 Klebsiella pneumonia, 1 Citrobacter freundii, and 1 Enterobacter cloacae
ICUs, Enterobacteriaceae, CRE, Gram negative bacteria, Antibiotic resistance.
Consultant Physicians’ Awareness, Prescribing Practices, and Safety Measures of SGLT2 Inhibitors in Tripoli, Libya: A Unicenter Domestic Study
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve glycemic control and provide cardiorenal benefits in type 2 diabetes mellitus (T2DM). Physician awareness and safe prescribing practices are critical to optimize outcomes. This study was conducted to evaluate consultant physicians’ awareness, prescribing practices, and safety considerations regarding SGLT2i in Tripoli, Libya. A cross-sectional study included 39 consultant physicians (21 cardiologists, 18 endocrinologists) with ≥1 year of SGLT2i prescribing experience. Data were collected via a validated self-administered questionnaire assessing demographics, prescribing patterns, observed benefits, adverse effects, monitoring practices, and awareness levels. Continuous variables were reported as median ± interquartile range (IQR); categorical variables as n (%). Associations were analyzed using chi-square, Fisher's exact test, and Spearman’s rho correlation; P < 0.05 was significant. Median prescribing experience was 5 years (IQR 3–8). High awareness was observed in 64% and moderate in 36%. Most physicians prescribed SGLT2i for both cardiac and diabetes indications (72%), predominantly empagliflozin (82%). Observed benefits included cardiovascular, renal, and metabolic outcomes. Awareness significantly correlated with safety measure implementation (r = 0.628, P = 0.038) and reporting of adverse effects (r = 0.661, P = 0.027). Specialty correlated with short-term risk perception (P < 0.002), while years of experience inversely correlated with long-term risk perception (r = -0.682, P = 0.021). Consultant physicians in Libya demonstrate moderate to high awareness of SGLT2i, strongly influencing safety practices and patient benefits. Clinical pharmacists play a pivotal role in updating healthcare professionals, supporting safe prescribing, and optimizing therapeutic outcomes
SGLT2 Inhibitors, Type 2 Diabetes, Physician Awareness, Safety Measures, Clinical Pharmacists.
Comparative Analysis of Flexural Strength between Heat Polymerized PMMA, Injectable Flexible Nylon-Based Resin, and CAD/CAM (PEEK) Denture Base Materials: An In-Vitro Study
This study aimed to compare the flexural strength of Heat Polymerized PMMA, Injectable Flexible Nylon-Based Resin, and CAD/CAM Polyether Ether Ketone (PEEK) denture base materials. A total of 36 rectangular samples with dimensions of (64mm x 10 mm x 3.3mm) were fabricated from Heat Polymerized PMMA, Injectable Flexible Nylon-Based Resin, and CAD/CAM (PEEK). These samples were divided into three groups of 12 samples. The three-point flexural strength test was carried out using a universal testing machine. A one-way analysis of variance (ANOVA) test was used for statistical analysis. Statistical significance was set at P ≤ 0.05. The flexural strength of CAD/CAM (PEEK) (137.92 ± 8.92555 MPa) was the highest, followed by Heat Polymerized Acrylic Resin (75.162 ± 9.40870 MPa), and the lowest was for Injectable Flexible Nylon-Based Resin (54.01 ± 20.29325 MPa). Considering the study’s limitations, CAD/CAM PEEK showed the highest flexural strength, followed by heat-polymerized PMMA, while injectable flexible nylon-based resin exhibited the lowest strength. These findings suggest that PEEK may provide more durable and reliable denture bases, potentially improving prosthesis longevity and patient satisfaction
Denture Base Material, Flexural Strength, Heat Polymerized PMMA, Injectable Flexible Nylon-Based Resin.
Ovarian Cancer Therapy in Transition, Innovation, Update, and Challenges: A Review Article
Ovarian cancer continues to be one of the deadliest cancers in women, with a poor prognosis despite many therapeutic advances; it has an ominous outcome. In the last decade, a giant leap in ovarian cancer therapy was made, which has reshaped ovarian cancer management and given hope for improved survival odds in some of the affected population. An online search was conducted through an electronic repository to find up-to-date reports and studies regarding newer and innovative therapies in ovarian cancer. We collected data regarding the method of action, efficacy, patient demographics, side effects, and suggested future work to address research gaps. Six therapeutic strategies were identified and discussed and comprehensively compared, including [Immune Checkpoint Inhibitors (ICIs, Poly (ADP-ribose) polymerase (PARP) Inhibitors, Anti-angiogenesis Drugs, Antibody-Drug Conjugates (ADCs), Oncolytic Viruses (OVs), and Cancer vaccines]. The analysis identified key areas that require attention, including biomarker development, rationale for combination therapy strategies, mechanisms of resistance development during treatment, immune modulation methods, and preventive approaches for ovarian cancer. Future studies are warranted to address the current gap in knowledge and validate optimistic cancer research results, especially for high-risk patients, to reduce ovarian cancer burden and improve survival odds.
Ovarian Cancers, Survival Rate, Mechanism of Action, Therapeutic Strategy, BRCA Mutation.
Assessment of the Efficacy of Aloe Vera Resin Extract as an Anti-Diabetic Foot Ulceration Agent
A diabetic foot ulcer is one of the most significant and devastating complications of diabetes. DFU is considered a major source of morbidity and mortality in patients with diabetes. Therefore, this study aimed to test the possibility of using Aloe Vera resin extract as an antibacterial agent (Libyan remedy) against isolated bacteria from a patient's foot. This study was concerned with the determination of the possible microbial causative of the diabetic foot ulcer; therefore, its design included microorganism isolation, identification, and finally, testing of the antibacterial activity of Aloe Vera resin against bacteria isolated from diabetic foot ulcers. Curiously, the results demonstrated that every antibiotic used in this experiment created inhibition zones against the bacteria that were isolated from patients' feet and had a pronounced resistance to the extract from aloe vera resin. In contrast, aloe vera resin extract created inhibition zones against bacteria isolated from healthy feet in comparison to the other widely used, well-known broad-spectrum antibiotics. The pathogen that was isolated from the patient's feet, according to our lab results, was Staphylococcus bacteria. Aloe Vera resin extract had no inhibition zones against Staphylococcus species bacteria that were collected from patient feet, which contradicted the hypothesis that Aloe Vera is a good antibacterial agent that could be used to prevent diabetic foot ulcers. Nonetheless, it demonstrated a slight antibacterial effect on normal flora foot bacteria. Bacterial resistance due to possible mutations could be the cause of this. It is also important to take into account the anti-inflammatory properties of aloe Vera resin extract
Studying Vertebral Column Cancer Cases in Tripoli Medical Center by Using PET/CAT Scan
Cancer remains one of the leading causes of morbidity and mortality worldwide. Among the most prevalent types are breast, lung, cervical, stomach, colorectal, and prostate cancers. This study aims to examine vertebral column cancer cases diagnosed at Tripoli Medical Center. Data were collected from patient records in the Radiology Department of Tripoli Medical Center, Libya, over a 12-month period from January to December 2023. The data were analyzed using Microsoft Excel. A total of 20 patients were identified with vertebral column cancer (100%),, comprising 15 males (75%) and 5 females (25%). The majority of patients were aged between 60 and 69 years (50%). Age distribution revealed that the sixth decade accounted for the highest number of cases (10 patients, 50%), followed by the fifth decade (6 patients, 30%) and the the fourth decade (4 patients, 20%). This epidemiological survey highlights 20 confirmed cases of vertebral column cancer at Tripoli Medical Center during the study period. Adhering to regional and national guidelines is essential to support the planning and development of cancer care services across Libya.
Cancer, Vertebral Column, Tripoli Medical Center
Post-COVID-19 Syndrome: Assessment of Short and Long-Term Post-Recovery Symptoms In Recovered Cases In Western Libya
The coronavirus disease 2019 (COVID-19) pandemic, first identified in late 2019, has caused extensive global morbidity and mortality. While most individuals recover from the acute illness, a considerable proportion develop post-COVID-19 syndrome, characterized by persistent symptoms lasting weeks to months. This study aimed to characterize the prevalence, type, and duration of persistent symptoms following COVID-19 recovery, and to examine their association with the severity of the acute infection. A cross-sectional, analytical observational study was conducted among 515 COVID-19 survivors in western Libya. Data were collected via face-to-face interviews and online questionnaires (Google Forms) comprising demographic information, COVID-19 illness details, comorbidities, and post-COVID-19 symptoms. Associations between symptom persistence and clinical/demographic factors were assessed using Chi-square tests. Persistent symptoms were reported by 72.0% of participants, with over 70% experiencing three or more symptoms. Recovery occurred within three months in 75.5% of respondents, within three to six months in 22.1%, and after more than six months in 2.4%. During acute illness, 78.8% required only home isolation, 21.2% were hospitalized, and 8.3% required intensive care. Most participants (91.7%) experienced mild-to-moderate acute disease, and 81.6% reported no comorbidities. Common persistent symptoms included fatigue, cough, anosmia, ageusia, joint pain, anxiety, and headache; less frequent but more severe sequelae included chest pain, pulmonary fibrosis, and myocarditis. A significant proportion of COVID-19 survivors experienced prolonged symptoms lasting up to 12 months post-recovery, independent of gender, smoking status, or vaccination history. Symptom severity correlated with the severity of the initial illness and the presence of comorbidities. Post-COVID-19 follow-up and targeted rehabilitation are recommended to address these long-term health effects.
COVID-19, Pandemic Coronavirus, Post recovery, Symptoms, Western Libya.
Diagnostic Significance of Tumor Markers CA 15-3, CA 125, TBARS, fasting blood sugar (RBS), and hemoglobin A1C (HbA1c) in Women with a Family History of Breast Cancer in Eastern Libya
Breast cancer remains one of the most prevalent malignancies among women worldwide, with family history being a major non-modifiable risk factor. Tumor markers such as cancer antigen 15-3 (CA15-3) and cancer antigen 125 (CA125), alongside oxidative stress indicators like thiobarbituric acid reactive substances (TBARS), can provide insights into subclinical molecular changes in at-risk populations. While CA15-3 is more closely associated with breast cancer progression, CA125 is primarily linked to gynecologic malignancies but may have secondary implications in breast pathology. Evaluating these biomarkers in women with a family history of breast cancer could reveal early molecular alterations preceding overt disease. This study was conducted to compare tumor marker levels (CA15-3, CA125), oxidative stress markers (TBARS), and glycemic indicators (fasting blood sugar [RBS] and hemoglobin A1C [HbA1c]) between women with and without a family history of breast cancer, and to assess correlations between these parameters from a molecular oncology perspective. This comparative cross-sectional study included two groups: women with a family history of breast cancer and matched controls without such a history. Serum levels of CA15-3 and CA125 were measured using immunoassay techniques, while TBARS concentrations were determined as a proxy for lipid peroxidation. RBS and HbA1c were quantified using enzymatic and chromatographic methods, respectively. Pearson’s correlation coefficients were calculated to examine relationships between tumor markers, glycemic status, and oxidative stress in both groups. CA15-3 levels were marginally higher in the family history group (15.07 ± 8.77 U/mL) compared to controls (12.81 ± 6.12 U/mL), suggesting subtle subclinical variations in mucin-1 antigen expression that may indicate early tumorigenic processes in genetically predisposed women. CA125 levels were notably lower in the family history group (9.56 ± 3.86 U/mL) versus controls (21.44 ± 22.44 U/mL), likely reflecting reproductive or hormonal factors rather than direct breast cancer risk modulation. TBARS levels were similar between groups (controls: 0.093 ± 0.009 µmol/mL; family history: 0.092 ± 0.010 µmol/mL), indicating comparable systemic oxidative stress. A strong positive correlation was observed between RBS and HbA1c (r = 0.809, p = 1.00), validating HbA1c as a reliable indicator of chronic glycemic exposure. Moderate positive correlations were observed between glycemic markers and CA15-3 (RBS: r = 0.417; HbA1c: r = 0.393), as well as between HbA1c and CA125 (r = 0.697); however, these associations did not reach statistical significance. TBARS showed weak negative correlations with most glycemic and tumor markers, suggesting that oxidative stress may be modulated by other biological or environmental factors.
Breast cancer, Family history, CA15-3, CA125, TBARS
B-Cell Non-Hodgkin’s Lymphomas of the Oral Maxillofacial Region: Narrative Review
B-cell non-Hodgkin lymphoma in the oral and maxillofacial region is a rare but serious condition that requires prompt diagnosis and aggressive treatment. Understanding the clinical features, staging, and treatment options is crucial for improving patient outcomes in this challenging area of oncology. This review aims to highlight the clinical presentation, diagnostic approach, etiology, and management of B-cell NHL in the oral and maxillofacial region, emphasizing the importance of early recognition in improving patient outcomes
B-cell NHL, Clinical Presentation, Etiology, Diagnosis, Management
Preclinical Evaluation of Dental Students' Performance in Fabricating Maxillary Wax Spacers and Light-Cured Special Trays
This study evaluated second-year dental students’ skills in fabricating upper special trays with wax spacers using a modified self-designed checklist to reduce preventable errors (PEs). Conducted at Attahadi University, Libya, the cross-sectional study involved three reviewers identifying common PEs in removable prosthodontics preclinical training. Ethical approval was obtained (SREC/010/74). Non-parametric statistical tests (Kruskal-Wallis, Mann-Whitney, Chi-square) were applied (significance: P ≤ 0.05). Results showed significant performance variations among groups and genders. Females outperformed males in Group 1 (P = 0.003) and Group 2 (P = 0.01), though gender differences were negligible in most groups, suggesting individual/group factors were more influential. High-performing groups (Group 6, 10, 12) excelled in adaptation, stopper placement, and finishing (P = 0.0001 for spacer wax; P = 0.001 for trays). Lower-performing groups (Groups 8, 9, and 11) had 20% "poor to be redone" scores. Most students (73.9–95.6%) achieved "excellent work," with none in "not accepted" or "minor modifications" categories. The study underscores the efficacy of structured checklists in improving preclinical performance. Tailored training and standardized tools are recommended to address skill gaps, ensuring better clinical preparedness.
Dental Education; Preclinical Training; Prosthodontics; Preventable Errors; Checklist Assessment
Ensuring Safety: Infection Control Compliance Among Healthcare Providers at Sabratha Teaching Hospital, Libya
Hospital-acquired infections (HAIs) pose a significant challenge to global healthcare systems, increasing patient morbidity, prolonging hospital stays, and escalating costs. Infection prevention and control (IPC) measures are critical, particularly in resource-limited settings like Libya, where gaps in compliance persist. Nurses play a pivotal role in IPC, yet studies in Libyan hospitals reveal inconsistencies in knowledge and adherence to protocols. This study assessed nurses’ compliance with IPC standards at Sabratha Teaching Hospital in western Libya, focusing on their knowledge, attitudes, and practices regarding HAIs. A descriptive-analytical study was conducted from October 2024 to April 2025, involving 50 nurses selected via purposive sampling. Data were collected using a validated, self-administered questionnaire covering demographics, IPC knowledge, and compliance with practices such as hand hygiene, PPE use, and waste management. Statistical analysis was performed using SPSS version 25. Findings indicated high overall compliance (mean scores: 1.76–1.85/2), with strong adherence to institutional policies, waste segregation, and vaccination documentation. However, minor gaps were noted in PPE usage and sanitation routines. Correlation analysis confirmed significant associations between IPC practices and institutional support (p < 0.05). While Sabratha Teaching Hospital demonstrates robust IPC infrastructure, targeted interventions—including continuous training, supervision, and resource reinforcement—are recommended to sustain and improve compliance. Strengthening safety culture and management involvement will further reduce HAIs and enhance patient care quality
Infection Prevention, Healthcare-Associated Infections, Nurses' Compliance.
Effect of Clay Pots Made from Red and White Clay on the Physicochemical Properties of Stored Water and Their Efficacy in Improving Water Alkalinity
This study aims to assess the impact of storage in earthenware vessels, fabricated from two distinct clay types (red and white), on the physicochemical properties of distilled water. A specific focus was placed on pH and alkalinity. The experimental procedure involved storing distilled water in both red and white clay vessels, with a glass container serving as a control sample. Measurements were subsequently acquired at predetermined intervals: 2, 6, 12, 24, and 48 hours. The analyses encompassed measurements of electrical conductivity, total dissolved solids, and the concentrations of various ions, including sodium, potassium, calcium, magnesium, chloride, sulfate, bicarbonate, and nitrate. Results demonstrated a notable increase in the pH of water stored in the clay pots when compared to the glass control, thereby indicating their capacity to modulate water alkalinity. Furthermore, measurements revealed alterations in the concentrations of certain ions and other physicochemical characteristics, attributable to the interaction between the water and the different clay types. This research contributes to the scientific documentation of the potential efficacy of clay pots as a sustainable and economical alternative for enhancing drinking water quality, particularly in terms of adjusting the water's basic properties.
Clay Pots, Water Alkalinity, Physicochemical Properties, Water Quality.
Evaluate Pentoxifylline Release from Polylactic Acid(PLA) Film
The objective of this study was to evaluate pentoxifylline release from polylactic acid (PLA) film. First, the polymeric film of polylactic acid of 50 % low and 50% high molecular weights with different drug loadings (20, 25, and 30%) was prepared without the plasticizer Dibutyl sebacate (DBS) to evaluate the drug (pentoxifylline) release from the polymeric matrix. Secondly, the plasticizer (DBS) with different levels (10, 20, and 30 %) was added to the formulation, and the drug release from the polymeric film was evaluated. Gel Permeation Chromatography GPC was used to characterize the molecular weight of the polylactic acid. Differential Scanning Calorimetry was used to characterize and study the thermal behavior of the film and the drug. Scanning Electron Microscopy was used to characterize the film surface at different drug loadings. X-ray powder diffraction was used to measure the crystal peaks of the drug and the polylactic acid. Since the drug release rate is dependent on drug loading and plasticizer level, different drug release rates can be obtained by controlling these parameters. The effect of the plasticizer on the drug release rate has a different effect based on the drug loading levels. At low drug loading levels (10 and 20%), as the plasticizer level increases, the drug release rate increases, while at high drug loading (60%), the drug release rate decreases as the plasticizer level increases.
Polylactic Acid, Drug Loading, Plasticizer, Drug Release.
Cinnamon Mitigates Gentamicin-Triggered Lipid Metabolic Disruptions: An Experimental Study in Male Rabbits
Gentamicin is a potent aminoglycoside antibiotic commonly used in clinical settings, yet it is associated with nephrotoxicity and disturbances in lipid metabolism. Previous studies have reported that gentamicin administration can significantly elevate serum lipid levels, while cinnamon (Cinnamomum verum) has been shown to possess lipid-lowering and antioxidant effects in experimental models. This study aimed to evaluate the protective effect of cinnamon on gentamicin-induced alterations in the blood plasma lipid profile in male rabbits. Twenty healthy male rabbits were randomly divided into four groups: control (distilled water), gentamicin (50 mg/kg orally, every other day for 14 days), cinnamon (200 mg/kg orally, every other day for 10 weeks), and a combined treatment group receiving both agents. Blood samples were collected at the end of the treatment period via cardiac puncture. Plasma was separated by centrifugation and analyzed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) using enzymatic colorimetric methods. Data were analyzed using one-way ANOVA followed by Tukey's post hoc test (p < 0.05). Results showed that gentamicin significantly increased TC (124.82±1.23 mg/dl), TG (65.41±2.58 mg/dl), and LDL (67.71±2.48 mg/dl), while decreasing HDL (40.90±1.66 mg/dl) compared to the control group. Cinnamon administration alone significantly reduced TC (109.07±4.52 mg/dl), TG (46.26±1.38 mg/dl), and LDL (59.15±1.37 mg/dl), and increased HDL (50.08±1.95 mg/dl). In the combined group, cinnamon partially mitigated gentamicin-induced lipid abnormalities, with values approaching those of the control group. These findings suggest that cinnamon may offer a protective effect against gentamicin-induced dyslipidemia, likely due to its antioxidant and hypolipidemic properties
Gentamicin, Cinnamon, Lipid Profile, Rabbits.
Phytochemical Screening and Antibacterial Activity of Libyan Mentha Piperita L. and Mentha Spicata L. Leaves
Medicinal plants are widely used worldwide and play an important role in their bioactive compounds. The Lamiaceae family contains many genera of medicinal plants that are used in traditional medicine. Among them are Mentha piperita L. (peppermint) and Mentha spicata L. (spearmint). This study investigates the phytochemical composition and antibacterial activity of different solvent extracts of Libyan M. piperita and M. spicata leaves. Petroleum ether, ethyl acetate, and methanol were used to extract bioactive components from selected Mentha species. Phytochemical screening was performed by standard methods. Antibacterial efficacy was evaluated using the agar well diffusion method against four bacterial strains, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were determined using a macrodilution method. Phytochemical analysis confirmed the presence of alkaloids, flavonoids, phenolic compounds, and essential oils in both Mentha species. The antibacterial assay illustrated varying inhibition levels among bacterial strains, with the petroleum ether extract of M. piperita exhibiting the strongest effect against E. coli, while M. spicata showed moderate inhibition against E. coli and K. pneumoniae. The methanol extract of M. piperita shows a moderate antibacterial effect on E. coli, while a low effect for the same extract of M. spicata. Regarding S. aureus bacteria, M. spicata methanol extract and M. piperita ethyl acetate extract had moderate effects. MIC and MBC values indicated that M. spicata petroleum ether extract had the strongest effect against K. pneumoniae (MIC = 50 mg/ml), while M. piperita ethyl acetate extract had a significant impact on S. aureus (MIC = 50 mg/ml). The study concludes the medicinal significance of Libyan M. piperita and M. spicata in bacterial infection treatment. These findings support their potential as natural antibacterial agents
Mentha Piperita L., Mentha Spicata L., Antibacterial Activity, Phytochemical Screening, Leaves.
Oxidative Stress of Cyclosporine on Kidney Functions and Antioxidant Role of Cinnamon
In this study, the oxidative effect of cyclosporine A (Cyc A) with or without cinnamon extract on kidney functions and some antioxidant enzymes in male rabbits was investigated. Levels of Na and K were depressed significantly after treatment with cyclosporine A compared to the control. A significant increase was found for Ca levels during treatment with cyclosporine A. Levels of TBARS showed a significant increase after treatment with cyclosporine A compared to the control. Levels of GSH and GST were significantly lower after treatment with cyclosporine A. Levels of these parameters were affected by the effect of cinnamon extract. It is well known that glutathione-S-transferase (GST) and glutathione play an important role in the detoxification of toxic metabolites, where GSH is catalysed by GST. One of the hypotheses explaining the detoxifying function of GST is the binding between GSH and endogenous or exogenous toxic substances; it plays an important role in the storage and excretion of xenobiotic compounds
Cyclosporine A, Cinnamon Extract, Kidney Function, Antioxidant Enzymes
Needlestick Injury Exposure and Knowledge among Sudanese Healthcare Workers, in Khartoum State
Needle stick injuries (NSIs) are one of the most common routes for the spread of blood-borne infections, including HIV and hepatitis B and C is through needle stick injuries (NSIs), posing significant occupational risks to healthcare workers (HCWs). In environments where occupational safety practices are insufficient, these risks are heightened. This study aimed to assess the exposure and knowledge of NSIs among HCWs in Khartoum State. A hospital-based cross-sectional study was conducted between September 2022 and March 2023. A total of 300 healthcare workers participated by completing a structured questionnaire. The survey covered demographic data, exposure to needle stick injuries, and post-exposure actions. Data was analyzed using version 23 of SPSS. Frequencies and percentages were calculated for categorical variables. The Exposure of NSIs among healthcare workers in the past six months was 38.7% (116/300). Of those injured, 21.3% (64/300) experienced one injury, while 12.7% (38/300) had two injuries, and 5% (15/300) reported three or more injuries. A significant portion (58.3%) of injuries went unreported, mainly due to being too busy or perceiving the exposure as insignificant. The primary causes of NSIs were improper needle recapping and handling. Recapping needles with two hands was a common practice, with 37% of healthcare workers doing so incorrectly. The Exposure of NSIs among HCWs was moderate, but underreporting and unsafe practices, such as needle recapping, remain problematic. Strengthening awareness, improving reporting systems, and encouraging the use of personal protection equipment and other safety protocols are essential to reduce NSI risks and improve occupational safety.
Needle Stick Injury, Healthcare Workers, Exposure, Knowledge, Infection Prevention.
An In Vitro Prosthodontic Evaluation of the Effect of Mouth Rinses on the Translucency of Monolithic and Multi-layered Yttria-Stabilized Zirconia
The aesthetic performance of zirconia restorations depends greatly on their optical properties, particularly translucency, which can be influenced by various chemical exposures in the oral environment. This in vitro study aimed to evaluate the effect of different immersion solutions on the translucency of two types of zirconia materials. A total of 30 zirconia specimens (n = 15 per group) were prepared: Group A comprised monolithic zirconia, while Group B consisted of multilayered yttria-stabilized zirconia. Each group was divided into three subgroups (n = 5) and immersed in one of three solutions: distilled water (DW), chlorhexidine (CHX), or 0% alcohol mouthwash. Translucency parameters (TP) were measured before and after immersion using a spectrophotometer based on the CIELab system. Statistical analysis was conducted using GraphPad Instat software with significance set at p < 0.05. The results revealed that immersion in CHX caused the most significant increase in TP change in both groups, with monolithic zirconia (Group A) showing the highest overall change. Two-way ANOVA indicated that the immersion solution had a statistically significant effect on translucency (p < 0.0001), while the type of zirconia showed no significant main effect (p = 0.0779). These findings suggest that translucency changes are more dependent on the immersion media than the zirconia composition itself. Clinicians should consider the long-term aesthetic implications of chemical exposure on zirconia restorations, especially when prescribing disinfectant mouthwashes
Translucency, Chlorhexidine, Monolithic, Multilayer Zirconia, CAD/CAM, Mouthwashes.
Non-HDL-C and CRP: A Dual Approach to Unmask Hidden Cardiovascular Risk in Type 2 Diabetic Patients
Type 2 diabetes mellitus (T2DM) is associated with atherogenic dyslipidemia and heightened cardiovascular risk, even when low-density lipoprotein cholesterol (LDL-C) appears within normal limits. Non-high-density lipoprotein cholesterol (non-HDL-C) and highly sensitive C-reactive protein (hs-CRP) have emerged as more comprehensive markers reflecting lipid-related and inflammatory risk, respectively. This study aimed to evaluate non-HDL-C as a superior marker over LDL-C for identifying atherogenic dyslipidemia in T2DM and to explore its correlation with systemic inflammation as indicated by hs-CRP. A cross-sectional study was conducted on 142 T2DM patients at Albadry Diabetic Clinic in Tripoli, Libya. Anthropometric data, lipid profiles, and hs-CRP levels were measured. Pearson correlation was used to assess relationships between lipid markers and hs-CRP. 56.3% of patients had elevated non-HDL-C, and 45.1% had elevated triglycerides. Non-HDL-C showed a stronger correlation with triglycerides (r = 0.82), HDL-C (r = -0.54), and hs-CRP (r = 0.44) compared to LDL-C (r = 0.41, -0.28, and 0.18, respectively; p < 0.01). These findings indicate that non-HDL-C better captures atherogenic lipid burden and inflammatory status. Conclusion: Non-HDL-C is a more robust marker of atherogenic dyslipidemia than LDL-C in T2DM and correlates more strongly with hs-CRP. Integrating non-HDL-C and hs-CRP into routine risk assessment may enhance cardiovascular risk prediction and guide targeted interventions.
Type 2 Diabetes Mellitus, Atherogenic Dyslipidemia, Non-HDL-C, LDL-C, hs-CRP.