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. Editorial contact amjeditorial@gmail.com 0910737929
Estimating Minerals, Antioxidant Activity, Total Phenols, and Carbohydrates in Salvia fruticosa Mill., Urtica urens L., and Urtica pilulifera L. Plants
In this, the mineral (Sodium, potassium, and Calcium) contents, antioxidant activity, total phenols, and Carbohydrate concentrations were estimated in the leaves and stems of Salvia fruticosa. Mill. Gard Dict. ed, Urtica urens L.Sp.Pl. and Urticapilulifera L. Sp.Pl. plants. The plant samples were collected from the Al-Gabal Al-Akhder region, around Al-Quba and Derna areas. Some of the instruments used in this study included a Flame photometer for evaluating the mineral contents and a Spectrophotometer for determining the concentrations of Carbohydrate, anti-oxidant, and Total phenols. The results of this study stated that the potassium showed higher values compared with sodium and calcium minerals, where their values were fluctuated in the ranges of (5.56 –36.56) and (32.76 -84.36 ppm) in leaves and stems, respectively. In contrast, the contents of sodium and calcium did not show wide variations and ranged as follows: (0.48- 0.88) and (0.291–1.041 ppm) for calcium in leaves and stems, respectively. While for sodium, the contents fluctuated in the ranges of (1.125 – 2.95 ppm) in leaves and from 7.28 ppm to 20.08 in stems. Also the results showed that there are higher values of total phenols in the selected plants in this study, their contents were ranged as follows (182.88 - 275.939 ppm )in leaves and from (298.148 - 323.501 ppm) in stems, while the Anti-oxidant activity values were ranged between (7.476 to 9.996 ppm) in leaves and between (9.707-10.117 ppm) in stems, on the other side the contents of Carbohydrate were fluctuated in the ranges between( 0.029 – 0.114ppm) in leaves and between (0.177 to 0.177 ppm) in stems, respectively
Minerals, Anti-Oxidant, Total Phenols, Plants, Libya
Copyright (c) 2026 Attahadi Medical Journal
Chemical Characterization of Commercial Fruit Juices: Quantitative Determination of Vitamin C and Major Constituents
This study aimed to evaluate the chemical composition of locally produced canned fruit juices available in Tripoli, Libya, with a focus on vitamin C (ascorbic acid), citric acid, sucrose, sodium chloride, and pH. A total of 15 juice samples representing three local companies were collected and analyzed using standardized titrimetric and density measurement methods. The results indicated considerable variation among samples, which can be attributed to differences in fruit type, processing conditions, and formulation practices. Vitamin C content ranged from 16 to 82 mg/100 mL, with higher levels observed in less processed products. Citric acid concentrations varied between 0.00% and 0.90%, reflecting both natural fruit acidity and possible industrial addition. Sucrose content ranged from 3.21% to 26.78%, highlighting potential nutritional concerns related to high sugar intake. Sodium chloride levels were negligible (≤0.00069%). The pH values ranged from 3.5 to 6.3, indicating acceptable acidity levels for product stability. Overall, the analyzed samples were generally consistent with Codex Alimentarius guidelines; however, the observed variability in sugar content and vitamin C suggests the need for improved quality control and labeling practices. These findings provide useful baseline data on the composition of locally available fruit juices and support the need for continuous monitoring to ensure product quality and consumer awareness
Vitamin C, Citric Acid, Sucrose, Sodium Chloride, Canned Fruit Juices
Thermal Decomposition Using TG–FTIR Coupled Analysis
Thermal decomposition analysis is fundamental for evaluating the stability, degradation pathways, and safety profile of materials exposed to elevated temperatures. Thermogravimetric analysis (TG) provides quantitative information on mass loss, while Fourier-transform infrared spectroscopy (FTIR) identifies evolved gaseous products. The coupling of TG with FTIR (TG–FTIR) offers a comprehensive analytical platform capable of correlating weight-loss events with chemical species released during thermal degradation. This integrated technique has gained increasing importance in polymer science and pharmaceutical research. Selected polymeric and pharmaceutical samples were subjected to TG–FTIR analysis under a nitrogen atmosphere. Approximately 8–10 mg of each sample was heated from 25°C to 800°C at a constant heating rate of 10°C/min. The evolved gases were transferred through a heated interface to the FTIR gas cell to prevent condensation. TG and DTG curves were recorded and synchronized with FTIR spectra to identify volatile degradation products and correlate them with specific thermal events. Distinct multi-stage decomposition patterns were observed for all samples. Polymeric materials demonstrated higher onset degradation temperatures compared to pharmaceutical compounds. FTIR analysis revealed the evolution of CO₂, CO, H₂O, and volatile organic compounds at characteristic temperatures corresponding to dehydration, bond cleavage, and oxidative degradation phases. The integration of TG and FTIR data enabled accurate identification of decomposition pathways and estimation of kinetic parameters. TG–FTIR coupling provides a robust and informative technique for comprehensive thermal characterization. The method enhances mechanistic understanding of degradation behavior and supports the development of thermally stable materials in industrial and pharmaceutical applications.
Thermal Decomposition, Thermogravimetric Analysis, TG–FTIR Coupling, Evolved Gas Analysis, Polymer
User-Centered Evaluation of Secondary Pharmaceutical Packaging in Libya: Insights from a Cross-Sectional Survey
Secondary pharmaceutical packaging is essential for medication safety and patient adherence, yet its performance in resource-constrained, import-dependent markets such as Libya remains underexplored. This study systematically evaluated the quality, regulatory compliance, and usability of carton packaging under real-world conditions. A cross-sectional survey of 201 end-users was designed to examine public perspectives on the usability, readability, and safety of pharmaceutical cartons that are used as secondary packaging in everyday use to identify practical challenges. This study revealed substantial variability in material quality, with notable deficiencies in moisture resistance and structural integrity. Survey findings highlighted widespread readability issues due to small fonts and poor layout, alongside strong demand for multilingual labeling and tamper-evident features. These insights informed the development of seven prototype designs that integrate enhanced mechanical robustness, high-contrast graphics, and intuitive access features. The study demonstrates that an evidence-based, user-centered approach can effectively bridge technical performance with patient needs, offering a practical framework for safer, more inclusive pharmaceutical packaging in challenging market contexts
Secondary Pharmaceutical Packaging, Patient Adherence, User-centered Design
The Impact of Bruxism on the Success and Longevity of Dental Restorations and Implants: A Systematic Review
Bruxism, characterized by repetitive jaw-muscle activity involving teeth clenching and grinding, generates occlusal forces far exceeding normal functional activities. This systematic review aims to assess the impact of bruxism on the success and longevity of dental restorations and implants. A systematic review was conducted following PRISMA 2020 guidelines. Electronic searches were performed in PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, and Science Direct for studies published between January 2000 and December 2025. Studies reporting outcomes of dental implants or restorations in patients with bruxism were included. Twenty-seven studies met the inclusion criteria. Meta-analyses demonstrated that bruxism significantly increases implant failure risk (OR 2.2-2.3, p<0.001). Mechanical complications predominate, including implant fractures, screw loosening, and ceramic chipping, occurring 2-10 times more frequently in bruxers. Anterior ceramic veneers showed dramatically increased failure risk (HR 7.74), while monolithic zirconia demonstrated favorable short-term outcomes. A critical geographical evidence gap was identified, with no clinical studies from Libya investigating bruxism and dental outcomes. Bruxism approximately doubles implant failure risk and substantially increases mechanical complications. Evidence-based management includes systematic screening, patient counseling, modified treatment planning, appropriate material selection, and occlusal splint therapy. Urgent research is needed in Libyan populations to verify the applicability of global evidence and guide region-specific clinical recommendations
Bruxism, Dental Implants, Dental Restorations, Systematic Review, Libyan Population.
Knowledge, Attitudes, and Practices of Community Pharmacists toward Herbal–Drug Interaction: A Cross-Sectional Study in Libya
The use of herbal medicines has increased globally, leading to a higher risk of herbal–drug interactions, particularly when patients take herbal products alongside conventional medicines. Community pharmacists play a crucial role in ensuring the safe use of herbal products; however, limited data are available concerning the pharmacists' knowledge of herbal –drug interactions in Libya. This study aimed to assess the knowledge, practices, and attitudes of community pharmacists regarding herbal medicines and herbal–drug interactions, focusing on Ashwagandha, Ginkgo biloba, curcumin, and echinacea in Libyan cities (Tripoli, Benghazi, and Al-Khums) and a small number from Canada and Germany. A cross-sectional descriptive study was conducted between May and October 2025 among 191 community pharmacists working in Libya, Canada, and Germany. Data were collected using a structured, self-administered questionnaire. Data were analyzed using SPSS version 27. Most pharmacists were from Libya (87.4%), with limited participation from Canada and Germany. Overall knowledge of herbal medicines and general awareness of herbal–drug interactions were rated as good. However, actual knowledge of targeted herbal medicines–drug interactions was low, particularly for echinacea. Higher educational level, longer professional experience, and city of practice were significantly associated with better knowledge of herbal medicines–drug interactions. Attitudes toward herbal medicines were mostly positive. Community pharmacists demonstrated acceptable general knowledge and positive attitudes toward herbal medicines; however, their actual knowledge of related herbal medicines–drug interactions was notably insufficient and low. These findings highlight the need for targeted educational programs and the development of national guidelines.
Ashwagandha, Ginkgo Biloba, Turmeric, Echinacea, Libyan Cities
Breast Cancer Awareness and Attitudes Toward Breast Self-Examination among Young Females: The Gharyan Experience and the Need for Review
Global research continues to reveal a critical gap in breast cancer (BC) awareness. This study was conducted in 2013 during educational activities in the Gharyan governorate of Libya as a cross-sectional survey. It assessed BC and breast self-examination (BSE) awareness, BSE practice, and attitudes toward BSE among school and collegiate female students and teachers. A total of 1,027 participants were targeted, and the findings showed 97.4% awareness of BC, 42.3% awareness of BSE, 13.4% practice of BSE, and only 3.2% regular practice of BSE. Among those aware of BC, 97.7% expressed interest in learning more, 94.2% demonstrated willingness to acquire proficiency in BSE, 88.0% showed willingness to educate others about BSE, and 85.9% expressed willingness to participate in BC awareness activities. The first three attitudes appeared to be driven primarily by BC awareness. However, education and awareness of BSE were identified as independent predictors of willingness to learn and become proficient in BSE practice. Employment status was an independent predictor of positive attitudes toward educating others, while having a family member affected by BC was an independent predictor of willingness to participate in awareness taskforces. Selective targeting of these proactive groups in future initiatives may enhance program effectiveness and optimize resource utilization.
Breast Cancer, Awareness, Attitudes Self-Examination
Prevalence and Correlates of Cardiovascular Risk Factors Among University Students in Libya: A Cross-Sectional Study
Cardiovascular diseases (CVDs) are the leading cause of global mortality, with modifiable lifestyle factors contributing significantly. University students represent a critical demographic for early intervention. This study assessed the prevalence of CVD risk factors among students at Attahadi University, Libya. A cross-sectional study was conducted in 2024 with 330 undergraduate students (mean age 22.7 ± 4.1 years). Data were collected via a validated Arabic questionnaire and clinical measurements (BMI, blood pressure). Lifestyle factors (diet, physical activity, smoking, stress) were analyzed for associations with health indicators. The study found 89% of students consumed fast food weekly, while only 11.5% met fruit/vegetable recommendations. Physical inactivity affected 48%, and smoking prevalence was 20.6% (48.3% males vs. 3.5% females). Overweight/obesity affected 44% (95% CI: 38.6–49.4) and elevated blood pressure affected 25% (95% CI: 20.4–29.6). Stress correlated with higher BMI (r = +0.18, 95% CI: 0.07–0.28, p = 0.002) and systolic blood pressure (r = +0.21, 95% CI: 0.10–0.31, p < 0.001). Unhealthy lifestyles are prevalent among Libyan university students, with significant gender disparities. Targeted interventions (nutrition education, smoking cessation, stress management) are urgently needed
Cardiovascular Risk, University Students, Lifestyle Factors, Libya, Obesity.
An Evaluation of the Effectiveness of Natural Honey Drops Compared to Synthetic Drops in the Treatment of Allergic Conjunctivitis
Allergic conjunctivitis (AC) is a common ocular inflammatory disease that has had limited conventional management and natural therapy. This report assessed the efficacy of natural honey drops versus olopatadine hydrochloride (sodium olopatadine) synthetic drops in managing moderate to severe allergic conjunctivitis. A randomized, prospective, parallel-group controlled, double-blind trial was carried out in 120 adult subjects aged 18-65 years with allergic conjunctivitis. Participants were randomly assigned (1:1) to 20% Manuka honey drops or 0.1% olopatadine drops twice daily for four weeks. The main outcome measure was the difference detected in the Allergic Conjunctivitis Symptom Score (ACSS). Their secondary outcomes were RQLQ score, TBUT, tear IgE level, patient satisfaction (VAS), and adverse-event data. Both groups demonstrated significant improvement in symptoms, but the honey group obtained better results than the control group, as evidenced by greater reductions in ACSS (−9.79 ± 3.02 vs −7.37 ± 2.89; p < 0.001), a larger increase of RQLQ (−30.88 ± 4.95 vs −26.79 ±5.12; p < 0.001), an increased TBUT (+3.01 ± 0.98 vs +2.26 ±1.02 seconds; ) and decreased levels of tear IgE t (-19.76 ± 4.87ng/ml vs -15.37 ± 5.03ng/ml). Use of natural honey drops was more efficacious and tolerated than synthetic drops, a potentially challenging therapeutic option in allergic conjunctivitis treatment.
Allergic Conjunctivitis, Natural Honey Drops, Manuka Honey, Olopatadine, Randomized Controlled Trial, Symptom Score
Induction of Labour: A Prospective Study of Drugs, Doses, and Routes
This study sought to determine the safety and effectiveness of various pharmacological labour induction techniques, dosages, and administration routes. Prospective study conducted from January 1 2017, to the end of Jan 2019 at the obstetric and gynaecological department at AL Bayda Medical Center. All women admitted for induction of labour who had a singleton pregnancy and a non-scarred uterus in their third trimester. Before induction, cervical ripening was assessed by Bishop score, induction of labour started by the use of dinoprostone, prostaglandin gel, and misoprostol (vaginal, oral). Data collected directly from patients' files and tabulated on the SPSS software program. The study includes 656 women that admitted for induction of labour during a period of two years. The rate of induction of labour was 5.9%. The mean age of women involved in the study was 29.57±5.89 years, and the mean gestational age was 39.8 ±2.2 weeks. Most of the women induced by vaginal misoprostol (90.7%) had successful vaginal delivery, followed by dinoprostone (85.7%), then oral misoprostol (81.8%) and prostaglandin gel (75%) with p-value =0.05. There were significant association between the method used for induction and for induction and number of doses, time needed to achieve delivery. This study shown significant association between the route of administration of misoprostol and Appearance (color), Pulse, Grimace (reflexes), Activity (muscle tone) (APGAR) score at first 5 minutes. There were significant association between the indication of induction and the mode of delivery. Mode of delivery and maternal and fetal complication not significantly affected by fetal presentation, but the APGAR score was significantly affected by fetal presentation. In conclusion, the most effective and safe pharmacological method of induction of labour was dinoprostone. The safety of vaginal and oral misoprostol was dose-dependent. Bishop's score at the time of induction was a good predictor of successful vaginal delivery. Indication of induction had an impact on the mode of delivery, maternal, fetal, and neonatal complications. Fetal presentation had no impact on mode of delivery, maternal and fetal complications, but fetal presentation had an impact on APGAR score at first 5 minutes.
Induction, Dinoprostone (Propess), Prostaglandin Gel, Misoprostol, APGAR Score
Impact of Preoperative Nutritional Optimization on Surgical Outcomes in Gastrointestinal Cancer Patients
A significant proportion of gastrointestinal cancer patients suffer from preoperative malnutrition due to the impact of the disease and its associated treatments on appetite, absorption, and metabolism. This is also linked to increased surgical complications, delayed wound healing, higher morbidity rates, and longer hospital stays. This study aimed to evaluate the impact of improved preoperative nutrition on surgical outcomes in gastrointestinal cancer patients by analyzing the relationship between preoperative nutritional intervention and complication rates, recovery speed, length of hospital stays, and overall surgical outcome quality. The study employed a descriptive-analytical approach, utilizing nutritional assessment tools, medical records, clinical follow-up, and appropriate statistical analyses to compare patients who received preoperative nutritional improvement with those who did not. The findings underscore the critical importance of preoperative nutrition as a modifiable factor contributing to better postoperative recovery, reduced complications, support for evidence-based medical practice, and improved healthcare quality for gastrointestinal cancer patients
Nutrition Before Surgery, Gastrointestinal Cancer, Surgical Outcomes, Post-Surgical Recovery, Nutritional Intervention
Comparative In-Vitro Efficacy of Chenopodium quinoa Seed and Eriobotrya japonica Fruit Extracts Against Methicillin-Resistant Staphylococcus aureus (MRSA)
The rise of antimicrobial resistance, particularly Methicillin-resistant Staphylococcus aureus (MRSA), necessitates the exploration of novel therapeutic agents from accessible and affordable sources. This study provides a direct comparative evaluation of the in-vitro antimicrobial efficacy of methanolic extracts from commercially available Chenopodium quinoa seeds and Eriobotrya japonica fruit against a clinical MRSA isolate. Plant materials were purchased from a local supermarket. Extracts were prepared using Soxhlet extraction with 100% methanol. The antimicrobial activity was assessed by determining the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) using the broth microdilution method according to CLSI guidelines. Data were analyzed using independent samples t-tests. The E. japonica fruit extract demonstrated significantly stronger anti-MRSA activity than the C. quinoa seed extract. The mean MIC and MBC for E. japonica fruit were 126.0 ± 2.8 µg/mL and 251.0 ± 2.4 µg/mL, respectively. In contrast, C. quinoa seeds exhibited a mean MIC of 501.6 ± 5.3 µg/mL and an MBC of 1005.0 ± 10.0 µg/mL. The differences were statistically significant (p < 0.0001), with the E. japonica fruit extract being approximately 4-fold more potent. The antimicrobial effects were dose-dependent. The methanolic fruit extract of Eriobotrya japonica, a commercially available product, is a potent source of bactericidal compounds against MRSA and shows significantly greater promise than Chenopodium quinoa seeds for the development of new phytotherapeutic agents to combat antibiotic-resistant infections. The accessibility and affordability of loquat fruit make it particularly attractive for large-scale development
Antimicrobial Resistance, Eriobotrya Japonica, Chenopodium Quinoa, MRSA, Minimum Inhibitory Concentration (MIC), Natural Products, Commercial Food Crops
Prevalence of Depression, Anxiety, and Stress among Medical Staff Workers in Tripoli using the DASS-21 Method
Depression, anxiety, and stress are common psychological conditions among healthcare workers, particularly in regions facing political instability and resource constraints. This study aimed to assess the prevalence and severity of these conditions among medical and paramedical staff in Tripoli, Libya, and to explore associated sociodemographic and professional factors. A cross-sectional design was employed between 25 October and 3 December 2025, targeting physicians, nurses, technicians, and pharmacists working in selected healthcare facilities. Data were collected using a structured, self-administered questionnaire that included sociodemographic information and the Depression, Anxiety, and Stress Scale-21 (DASS-21), a validated instrument available in Arabic and English. The required sample size was calculated as 260 using Epi Info, and 181 participants were ultimately enrolled. Descriptive and inferential statistics were performed using SPSS and Microsoft Excel, with a significance threshold of p < 0.05. The results revealed high prevalence rates of psychological distress, with depression affecting 70.2% of participants, anxiety 72.9%, and stress 65.7%. Severity analysis showed that moderate symptoms were most common for depression and stress, while extremely severe anxiety was reported by 34.8% of respondents. Gender differences were evident, with female healthcare workers reporting higher rates of anxiety, while technicians and doctors exhibited the highest prevalence across all conditions. Psychological symptoms were consistently observed across all categories of professional experience, with early-career staff slightly more affected. These findings highlight the substantial burden of mental health problems among healthcare workers in Libya and underscore the urgent need for targeted interventions, institutional support, and policies to safeguard their psychological well-being.
Depression, Anxiety, Stress, Healthcare Workers, Libya
Using Atomic Absorption Spectrometry (AAS) for the Determination of Aluminum and Zinc in Wrapped Chocolate and Chips samples
This study was carried out to determine the contents of Aluminum and Zinc in wrapped Chocolate and Chips sample by atomic absorption instrument. Ten different samples of Chocolate collected from local markets in some Libyan cities. The concentrations of Aluminum in the selected samples in this study fluctuated in the range of 1.658 and 5.433 ppm. Whereas the concentrations of zinc ranged between 3.540 and 7.723 ppm. The higher concentration of Aluminum was recorded in sample No 10, whereas the lower concentration of Al was recorded in sample No 1. On the other side, the low contents of Zinc were recorded in sample 1. The results of this study recorded that most of the selected samples containing high values of Aluminum and Zinc than reported by the World Health Organization (WHO).
Epigenetic Regulation of Inflammatory and Regenerative Responses in Periodontal Supporting Tissues among Patients in Dental Clinics of Alexandria, Egypt: An Experimental Study
Periodontal disease is a multifactorial condition characterized by chronic inflammation and progressive destruction of supporting tissues, with significant implications for oral health and systemic well-being. This study investigated the correlation between inflammatory responses and regenerative outcomes in periodontal supporting tissues, emphasizing the role of epigenetic regulation. A mixed methods approach was employed, combining clinical assessments, patient-reported outcomes, and molecular analyses. Spearman correlation analysis revealed strong associations between clinical indicators of inflammation and perceived regenerative improvements, underscoring the interplay between destructive and reparative processes. Demographic and lifestyle factors, including smoking and systemic health conditions, were found to influence variability in responses. Regenerative therapies demonstrated favorable outcomes in terms of clinical attachment gain, alveolar bone support, and patient satisfaction. These findings highlight the importance of integrating epigenetic insights with clinical practice to develop personalized strategies for managing periodontal disease and enhancing tissue regeneration
Periodontal Inflammation, Epigenetic Regulation, Tissue Regeneration, Clinical Outcomes, Patient Satisfaction.
Multifactorial Risk Factors for Low Birth Weight: Insights from a Comparative Case Series in Libya
Low birth weight (LBW) remains a major determinant of neonatal morbidity and mortality worldwide, reflecting the interplay of biological, behavioral, and socio‑environmental factors. This comparative case series study was conducted at Aljalla maternity hospital, Libya, during 2024, to identify maternal and perinatal risk factors associated with LBW among term infants. A total of 200 mothers were included: 100 who delivered LBW infants (<2500 g) and 100 who delivered normal birth weight (NBW) infants (2500–4000 g). Data were collected using structured worksheets and analyzed with SPSS version 21. Results showed that younger maternal age, primigravidity, nulliparity, and irregular antenatal care were significantly associated with LBW (p<0.05). Maternal diseases such as pregnancy‑induced hypertension, chronic hypertension, urinary tract infections, and anemia were also significant contributors. Passive smoking exposure was more frequent among mothers of LBW infants. In contrast, maternal BMI and history of abortion showed no significant association. These findings are consistent with global evidence linking LBW to maternal age, parity, chronic disease, smoking exposure, and antenatal care utilization. The study underscores the multifactorial etiology of LBW and highlights the need for strengthening antenatal services, addressing maternal health conditions, and implementing public health interventions to reduce passive smoking exposure. Targeted strategies focusing on high‑risk groups may improve neonatal outcomes and reduce the burden of LBW in Libya.
Low Birth Weight, Maternal Age, Parity, Gravidity, Antenatal Care.
Groundwater Quality Assessment in Western Libya: Spotlight on Nitrate, Nitrites and Public Health Risks
Groundwater is the primary source of drinking water in Libya, especially in arid regions where surface water is scarce. However, increasing agricultural activities and poor environmental regulations have contributed to groundwater contamination, particularly by nitrates. This study evaluated the physicochemical properties of groundwater from four regions in western Libya—Janzour, Ain Zara, Gharyan, and the Artificial River—focusing on nitrate and nitrite levels due to their significant health risks. Water samples were collected and analyzed using standard methods for parameters such as pH, electrical conductivity, total hardness, and nutrient pollutants. Results showed that while samples from Ain Zara and Janzour met national standards, the Gharyan sample exhibited alarmingly high nitrate (111 mg/L), total hardness (780 mg/L), and electrical conductivity (1720 µS/cm), exceeding Libyan and WHO guidelines. Nitrite was not detected in any sample. Elevated nitrate levels pose a serious health threat, particularly to infants and pregnant women, due to risks of methemoglobinemia and carcinogenic nitrosamine formation. The findings underscore the urgent need for enhanced water monitoring, public education on fertilizer use, and implementation of treatment technologies. This study provides evidence-based recommendations to guide policymakers in safeguarding groundwater quality and protecting public health in Libya
Groundwater Contamination, Nitrate Pollution, Drinking Water Quality, Libya
Inguinal Hernia Containing Uterus and Adnexa in a Female Infant: A Rare Case Report from Libya
Inguinal hernias containing reproductive organs represent an exceptionally rare clinical presentation in female infants. While ovarian herniation occurs in approximately 15–20% of female inguinal hernias, concurrent uterine involvement is extraordinarily uncommon, with fewer than 50 cases documented worldwide. This presentation carries significant implications for long-term fertility and reproductive function. A 40-day-old term female infant presented with acute-onset painful right inguinal swelling. Ultrasonography with colour Doppler assessment revealed an irreducible inguinal hernia containing the right ovary, fallopian tube, and uterine fundus, with preserved vascular perfusion. The anesthetic management employed a rapid sequence induction with ketamine to ensure cardiovascular stability, complemented by rigorous thermoregulatory strategies to maintain neonatal normothermia. Surgical exploration via open inguinal approach confirmed complete herniation of Müllerian structures through a widely patent processus vaginalis. All organs were successfully reduced with meticulous preservation of vascular supply. Postoperative recovery was uneventful except for a superficial wound infection on postoperative day 5, managed successfully with conservative local care without systemic antibiotics. No hernia recurrence was observed at one-month follow-up. This rare presentation underscores the necessity of high clinical suspicion and prompt diagnostic imaging with Doppler assessment in female infants presenting with inguinal swelling. Urgent surgical intervention with organ-preserving techniques and specialized neonatal anesthesia management remains essential to prevent complications, including vascular compromise, torsion, and long-term reproductive morbidity. When managed appropriately, excellent outcomes can be achieved while preserving future fertility potential
Inguinal Hernia, Ovary, Uterus, Fallopian Tube, Female Infant
Clinical Profile, Management, and Outcomes of Pediatric Pneumonia Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study
Geographical and socioeconomic factors affect the incidence and outcomes of pneumonia, which is a major cause of severe illness and mortality in children globally. There is a dearth of information on the characteristics and consequences of severe pediatric pneumonia in Libya, a growing upper-middle-income nation with a healthcare system with limited resources. The purpose of this study was to describe the clinical characteristics, course of treatment, and results of pediatric pneumonia patients hospitalized to an intensive care unit (ICU) in Libya. 139 consecutive pediatric patients (age ≤18 years) hospitalized to the intensive care unit at Zawia Medical Center between January and December 2023 were the subject of a retrospective cohort study. Patients were split into two groups: those with pneumonia (n = 48) and those without (n = 91). Study variables focused on the outcomes, clinical course, and demographics. The main "severe outcomes" for the patients in this study were demand for mechanical ventilation or fatality. The cohort's median age was 24 months (IQR: 0-88). For 48 patients (34.5%), pneumonia was the main reason for admission. Patients with pneumonia exhibited a clear seasonal peak in the winter and were substantially younger than those without pneumonia (median age, 12.6 vs. 85.7 months, p < 0.001). The pneumonia group required more mechanical ventilation (25% vs. 6.6%, p = 0.004) and had a significantly higher mortality rate (20.8% vs. 6.6%, p = 0.012). younger age was the most significant risk factor for mortality, with an average age of 12.6 months vs. 85.7 months for mortalities and survival cases, respectively (p = 0.012). The presence of comorbidities (65.2% vs. 32.0%, p = 0.02) and a positive C-reactive protein (CRP) level> 30 mg/L were substantially linked to the pneumonia group, with worsening (p = 0.01). Pediatric pneumonia results in severe morbidity and high mortality and is a significant cause of ICU admission. Important risk factors for poor outcomes include younger age, elevated CRP, and underlying comorbidities. To improve patient treatment and inform national standards, these findings emphasize the need for further multicenter research, protocolized management, and improved seasonal planning.
Intensive Care Units, Critical Care Unit, Pediatric Pneumonia.
Biochemical Alterations in Liver Function Parameters among Entamoeba Histolytica–Positive Patients at Al-Bayda Medical Center, Libya
Entamoeba histolytica infection remains a major public health problem in endemic regions and may lead to extraintestinal complications, particularly hepatic involvement. While amoebic liver abscess is well recognized, biochemical alterations in liver function among E. histolytica–positive patients without clinically evident hepatic disease remain insufficiently characterized. This study aimed to evaluate liver function parameters and their interrelationships among patients diagnosed with Entamoeba histolytica at Al-Bayda Medical Center, Libya. A laboratory-based cross-sectional study was conducted in 2025 and included 30 patients with confirmed E. histolytica infection. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin, and direct (conjugated) bilirubin were measured using routine clinical chemistry methods. Data distribution was assessed using the Shapiro–Wilk test. One-sample t-tests or Wilcoxon signed-rank tests were applied to compare observed values with reference limits, and Spearman’s rank correlation analysis was used to assess associations among biochemical parameters. Elevated aminotransferases were common, particularly AST (56.7%) and ALT (40.0%), indicating frequent hepatocellular stress. In contrast, elevations in ALP (36.7%) and direct bilirubin (30.0%) were less frequent, while total bilirubin elevation was rare (6.7%). Strong positive correlations were observed among ALT, AST, and ALP, whereas total and direct bilirubin were strongly correlated with each other but showed weak associations with liver enzymes. In conclusion, Entamoeba histolytica infection was associated predominantly with hepatocellular enzyme alterations, with minimal disruption of bilirubin metabolism. Routine liver function testing may aid in the early detection of hepatic involvement in amoebiasis, even in the absence of overt liver disease
Entamoeba Histolytica, Liver Function Tests, Aminotransferases, Hepatic Involvement, Amoebiasis.
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Demographic, Seasonal, and Temporal Determinants of SARS-CoV-2 Infection and Serological Status in Al-Bayda City, Libya: A Cross-Sectional Study Employing Multinomial Logistic Regression
This cross-sectional study examined the demographic, seasonal, and temporal determinants of SARS-CoV-2 infection and serological status among individuals tested in Al-Bayda city, eastern Libya, between 2021 and 2025. Despite the global transition toward endemic circulation of SARS-CoV-2, region-specific evidence from North Africa remains limited, particularly with respect to multi-year serological patterns. By applying a multinomial outcome framework, this study aimed to provide a nuanced characterization of population-level exposure beyond binary infection classifications. Laboratory-based serological records were obtained from the Al-Bayda Specialized Diagnostic Laboratory. Individuals were classified into four mutually exclusive serological categories—no exposure, early infection, active infection, and past infection—based on combined IgM and IgG antibody results. Descriptive analyses summarized demographic characteristics and serological distributions, while age differences across outcome categories were evaluated using analysis of variance with post hoc testing. Seasonal and calendar-year patterns were assessed to capture temporal heterogeneity in testing and exposure. To evaluate independent associations of age, gender, season, and calendar year with serological outcomes, multinomial logistic regression with LASSO regularization was employed. Penalized modeling was used to address outcome imbalance, sparse event counts, and potential multicollinearity. Model tuning was conducted using cross-validation, and a conservative regularization parameter was selected to prioritize model stability and generalizability. A total of 309 individuals were included, with a mean age of 32.5 years and an approximately equal gender distribution. Past infection was the most prevalent serological outcome, whereas active and early infections were rare. Unadjusted analyses demonstrated significant age-related differences across serological categories, with older individuals more frequently classified as having active or past infection. However, after adjustment and penalization, none of the examined predictors showed strong independent associations with serological outcomes, as relative risk ratios were approximately unity. These findings suggest that SARS-CoV-2 serological status in this population reflects cumulative and multifactorial exposure processes rather than being driven by isolated demographic, seasonal, or temporal determinants. The use of multinomial ridge regression provides robust region-specific evidence and highlights the importance of advanced analytical approaches in interpreting serological data from resource-limited settings.
SARS-Cov-2; COVID-19 Seroprevalence; Multinomial Logistic Regression; Cross-Sectional Study, Libya.
The Contents of Fatty Acids, Phenolic Acids, Metals, and Antimicrobial Studies of Leaves and Fruits of Juniperus Phoenicea Plant
This study aims to determine of Fatty acids, phenolic acids, minerals, metals, and phytochemical screening in leaves and fruits of the Juniperus phoenicea plant. The extracts are also used for antimicrobial investigation against different species of bacteria. Different methods were used in the experimental part: the GC-MS instrument was used to analyze fatty acids and phenolic compounds, atomic absorption was used to estimate metals, and the spectrophotometer was used to determine phosphorus and Nitrogen in the extracts. The results of this study showed that some phenolic acids were detected in the samples, including: the types of phenolic acids in the leaves and fruits of Juniperus phoenicea were as follows: Juniperus phoenicea leaves: 4,5-Dicaffeoylquinic acid, Cinnamic acid, Gallic acid, Geraniol, Phloridzin, Quercetin, and Catechin. Juniperus phoenicea fruits: 3,4-Dicaffeoly guinic acid, Gallic acid and Catecin. On the other side some of fatty acids were detected and can show as following: The saturated fatty acid in leaves and fruits of Juniperus phoenicea as following: Juniperus phoenicea leaves: Hexanoic , Octanoic.Decanoic , Undecanoic ,Dodecanoic , Tridecanoic , Tetradecanoic , Pentadecanoic, Hexadecanoic , Octadecanoic and Eicosanoic Juniperus phoenicea fruits: Decanoic , Undecanoic , Decanoic , Tetradecanoic , Hexadecanoic and Octadecanoic .The high concentration of saturated fatty acid was recorded for Octadecanoic ,while the low concentration was recorded for Decanoic and Undecanoic in fruits of Juniperus pheonicea; and Octanoic in fruits of Pistacia lentiscus. The contents of metals were fluctuated as follows: the contents of Na, K, Ca P, and N were as follows 1.50, .40, 2.16, 2.40, and 0.02 in leaf samples, respectively; on the other hand, these mineral contents in fruits were 0.41, 14.44, 1.33, 2.41, and 0.11. The contents of metals of Zn, Cu, Cr, and µg in leaves were 012, 0.84, 0.076, and 1.64 ppm, where the contents of the same metals in fruit samples were 0.13, 0.91, 0.095, and 1.89 ppm, respectively. The antimicrobial activities showed different effects of the fruits and leaves of extracts against different species of bacteria, including Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Klebsiella Pneumoniae, Escherichia coli, and Salmonella typhimurium.
Leaves, Fruits Juniperus Phoenicea Plant, Chemical, Biological, Fatty Acids, Phenolic Acids.
Epidemiological Landscape of Oral Tumors in Benghazi: A Retrospective Analysis
The oral mucosa can be affected by non-neoplastic and neoplastic lesions, which significantly contribute to patients' mortality and morbidity, particularly with late detection. The study aimed to evaluate the demographic features, clinical presentations, histopathological features, and risk factor associations of oral cavity tumors. The study was a retrospective study at the Faculty of Dentistry, University of Benghazi, using the records of 164 patients who had been diagnosed with oral cavity tumors, which were clinically and by biopsy in the period from 2016 to 2019. The results showed that benign oral cavity tumors accounted for 74.4%, and premalignant oral cavity tumors were 9.7%, while malignant oral cavity tumors15.9%. The mean age of patients was approximately 40 years old. The major clinical presentation of oral cavity tumors was painless swelling (73.8%), affecting the jaw (29.9%) commonly. According to the tumor origin, 75% of cases had non-odontogenic tumors, with benign tumors being predominantly of mesenchymal origin (98.1%), and premalignant lesions were more significantly associated with mixed tissue origin (26.7%). Malignant tumors occurred most commonly associated with tissues derived from salivary glands (68.7%). We conclude that histopathological analysis is important in the establishment of the definitive diagnosis and early detection of oral cavity tumors.
Oral Cavity Tumors, Histopathology, Biopsy, Squamous Cell Carcinoma
Antimicrobial Evaluations of Juglans Regia Bark Against Oral Pathogenic Microorganisms
Oral pathogenic microorganisms significantly contribute to various diseases, impacting both oral and systemic health, including chronic periodontitis and dental caries. Natural plants, including Juglans regia (walnut tree), have gained momentum for their therapeutic potential due to their antibacterial properties, offering a promising avenue to combat antibiotic resistance. This study fundamentally aimed to validate the traditional use of Juglans regia bark in maintaining oral health; it sought to evaluate the antibacterial and antifungal effects of Juglans regia bark. The methanolic extracts of Juglans regia bark, imported from China, were prepared using the maceration technique, various microorganisms procured from the American Type Culture Collection (ATCC), including Gram-positive bacteria (Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus (MRSA)), Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa), and the local fungal strain Candida albicans. Antimicrobial activity was assessed using the agar well diffusion assay at concentrations of 250 mg/ml and 125 mg/ml, with chlorhexidine and phenol serving as reference standards. Minimum inhibitory concentrations (MIC) were determined using the microdilution technique, with serial dilutions ranging from 125 mg/ml down to 3.9 mg/ml. At 250 mg/ml, Escherichia coli exhibited the largest zone of inhibition (27mm), followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans (25mm, 23mm, and 25mm, respectively). At 125 mg/ml, Candida albicans showed the best results (22mm). The lowest effective inhibitory concentration (MIC) for C. albicans was 15.6 mg/ml, while S. aureus and P. aeruginosa also showed equal MICs.
Juglans regia, Antimicrobial Activity, Oral Pathogens, Minimum Inhibitory Concentration, Phytochemicals, Natural Remedies.
CBCT Assessment of Root Canal Number in Maxillary Third Molars: A Retrospective Study in a Libyan Subpopulation (Zliten City)
This study aims to evaluate the number of roots of maxillary third molar teeth of the Libyan subpopulation at Zliten city, to compare the incidence of root number in different side locations, and to compare the prevalence of root number in different genders. Out of 2078 CBCT images, only 806 images that had been met the inclusion criteria of this study (the CBCT images were collected from Al-Tasneem Private Dental Poly-Clinics in Zliten city during the period January 2024 until May 2025). 432 (53.6%) of CBCT images were related to women, whereas 374 (46.4%) images were related to men. On another hand, 425 (52.7%) were right-sided teeth, while 381 (47.3%) were left-sided teeth. 367(45.5%) of CBCT images showed four root canals, which were the most common number of root canals of maxillary third molar teeth in the Libyan subpopulation at Zliten city, while five root canals were the lowest incidence. The incidences of single root canals and double root canals were higher in women than in men. Inversely, the prevalence of three and five root canals in men was higher than the women. The incidences of four root canals were almost equal in women and men (45.8% and 45.2% respectively). The incidences of all numbers of root canals were not significantly different based on tooth locations. The root canals of maxillary third molar teeth in the Libyan subpopulation at Zliten city ranged between 1 to 5 root canals. None of the five root canals had bilateral incidences.
Number of Root Canals, Cone Beam Tomography, Upper Third Molar, Libyan Subpopulation, Zliten.
Brief Review on Segregation and Treatment of Biomedical Waste in Medical Laboratories in light of WHO and CDC Guidelines
The proper management of biological waste in laboratory settings is a critical aspect of biosafety in microbiological and biomedical laboratories. Beyond protecting lab workers, biological waste management safeguards public health, protects the environment, and ensures compliance with legal and regulatory frameworks. Segregation, decontamination of liquid waste, decontamination of solid waste, and techniques for inactivating toxins are all main aspects of biological waste management that will be outlined, aligned, and summarised with the main institutional biosafety protocols for biological waste management, published by major authorities, including CDC and WHO. This research found that the information from the two institutions complements each other. Therefore, this brief review aimed to compile and unify information from both institutions to construct a single, coherent text that provides a practical summary for medical laboratory professionals seeking to enhance the implementation of international, harmonized protocols that strengthen biosafety, environmental stewardship, and regulatory compliance
Biomedical Waste Management, Segregation, Decontamination, CDC, WHO.
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
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