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
Comparative Analysis of Breast Cancer According to Age, Histological Type, Hormonal Status, and Disease Characteristics
Breast cancer (BC) is the most common cancer among women worldwide and a significant public health concern in Libya. The incidence of BC, particularly among younger women in Libya, has been increasing, urging further investigation into the disease's characteristics, early detection, and treatment strategies. This study aimed to compare the clinicopathological and molecular characteristics of breast cancer patients from two datasets of women of different ages. This descriptive retrospective study utilized two datasets containing the medical records of breast cancer patients diagnosed and treated at Tripoli Medical Center. Data were analyzed using descriptive statistics. The variables assessed included age, histological type, molecular subtype, tumor stage, hormone receptor status, lymph node metastasis, and family history of BC. Patients were divided into two age groups to facilitate comparison between young and older women. Frequency distribution and comparative analyses were performed to identify associations with predominant disease patterns. The first group of participants included 524 patients with a mean age of 34.5 years, while the second cohort included 499 patients with a mean age of 43.6 years. Younger women comprised the majority of the first cohort, while the second cohort exhibited a broader age distribution. The results showed that invasive ductal carcinoma (IDC) was the predominant histological pattern in both cohorts. Younger patients were more likely to have aggressive tumor characteristics, higher rates of lymph node metastasis, and more advanced disease stages. Older patients showed a higher prevalence of hormone receptor-positive tumors, particularly luminal molecular patterns, which are generally associated with a better prognosis. In conclusion, this comparative study demonstrates that age significantly influences the distribution of BC subtypes, disease severity, and tumor biology. These findings underscore the importance of increased public awareness about breast cancer causes, especially the effect of nutrition and lifestyle, early BC detection, and individualized treatment strategies to improve BC treatment outcomes.
Breast Cancer, Libyan Women, Invasive Ductal Carcinoma
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Association Between Hyperlipidemia and Uterine Fibroid Size
Uterine fibroids (leiomyomas) are common benign tumors affecting women, mostly throughout their reproductive years and menopause. Their development is influenced by multiple factors, including age, race, metabolic conditions, lifestyle, reproductive history, genetics, and hormonal exposures. Although often asymptomatic, fibroids can cause uterine bleeding and pain. Lipid metabolism alterations have been implicated in fibroid pathogenesis, with estrogen and progesterone playing key roles in tumor growth and maintenance. This study aimed to investigate the association between uterine fibroid size and lipid profile abnormalities. A cross-sectional study enrolled 70 reproductive-age women with gynecological complaints from Albida City clinics (Nov 2023–Jan 2026). Cases had ultrasound-confirmed uterine fibroids; controls had normal ultrasounds. Data on medical history, BMI, and fibroid characteristics were collected. Fasting lipid profiles were measured. Analysis was done using SPSS v26, reporting percentages and means ± SD. This research involved 70 women with an average age of 34.8 years, predominantly aged 31–40 years. Most participants were overweight or obese (mean BMI 29.4 kg/m²). Over half reported no significant medical history, and the majority were not on regular medication. Lipid profiles revealed elevated cholesterol and triglyceride levels in a considerable portion of the sample. Submucous fibroids were the most common type (45.7%), followed by intramural fibroids (28.6%). No significant associations were found between fibroid size and age or BMI categories. Similarly, total cholesterol, HDL, LDL, and VLDL levels showed no significant relationship with fibroid size. However, triglyceride levels were significantly higher in women with large fibroids (≥5 cm) compared to those with smaller fibroids (p = 0.020). Pearson correlation analysis identified a weak but statistically significant positive correlation between LDL cholesterol levels and fibroid size (r = 0.257, p = 0.032), while other lipid parameters and BMI showed no meaningful correlations.
Uterine Fibroid, Leiomyomas, Fibroid Size, Hyperlipidemia
Experimental and Computational Evaluation of Alloy-Reinforced Glass Ionomer Cement: Erosion Resistance, Maturation Behavior, and Predictive Modeling
Glass ionomer cements (GICs) are widely used restorative materials due to their chemical adhesion, fluoride release, and biocompatibility. However, their susceptibility to acid erosion—particularly during early maturation—remains a significant limitation affecting long-term clinical performance. Recent developments in reinforced GIC formulations aim to improve resistance to mechanical and chemical degradation, yet their behavior under dynamic erosive conditions requires further investigation. This study aimed to evaluate the erosion resistance of an experimental high powder-to-liquid ratio glass ionomer cement (EXPT) in comparison with a metal-reinforced glass ionomer cement (Hi-Dense), and to investigate the influence of maturation time on material performance using both experimental and computational approaches. Cylindrical specimens (4 mm diameter; n = 6 per group) were prepared and tested at three time intervals: 1 hour, 24 hours, and 6 months. Erosion resistance was assessed using a standardized lactic acid jet test (0.02 M, pH 2.7) under controlled temperature (37°C) and flow conditions (120 ± 4 ml/min) for 24 hours. Erosion rates were quantified using both weight loss (mg/h) and dimensional loss (µm/h). Statistical analysis was performed using the Mann–Whitney U test (α = 0.05). In parallel, computational simulations incorporating diffusion–reaction modeling and finite element analysis (FEM) were conducted to predict ion transport, stress distribution, and degradation behavior. At early maturation stages, EXPT exhibited significantly higher erosion rates compared to Hi-Dense (p ≤ 0.005). Mean height loss at 1 hour was 8.7 ± 1.0 µm/h for EXPT and 2.9 ± 0.3 µm/h for Hi-Dense, while corresponding weight loss values were 0.30 ± 0.04 mg/h and 0.16 ± 0.02 mg/h, respectively. A significant reduction in erosion rates was observed for both materials with increasing maturation time. After 6 months, no statistically significant differences were detected between the two materials (p > 0.05). Computational simulations demonstrated strong agreement with experimental data (correlation coefficient r ≈ 0.9), predicting higher initial diffusion rates and localized stress concentrations in EXPT, and more uniform stress distribution in Hi-Dense. The enhanced performance of Hi-Dense cement is attributed to alloy reinforcement, which improves stress redistribution and reduces crack initiation under erosive conditions. The convergence of erosion rates over time highlights the dominant role of matrix maturation, characterized by increased crosslink density and reduced ion mobility. The combined experimental–computational approach provides mechanistic insight into erosion processes and validates the predictive capability of simulation models. Metal-reinforced glass ionomer cement demonstrates superior early-stage erosion resistance compared to conventional formulations, while long-term performance is largely governed by maturation processes. The integration of experimental testing with computational modeling offers a robust framework for evaluating and optimizing dental materials, with potential implications for improving clinical durability and guiding future material development.
Glass Ionomer Cement, Erosion Resistance, Finite Element Analysis, Dental Materials, Maturation
Epidemiological Patterns of Oral Squamous Cell Carcinoma and Its Variants in the Libyan Population: A 20-Year Retrospective Study
Squamous cell carcinoma is the most common oral malignancy, accounting for more than 90% of all forms of oral cancer. This study aimed to determine the frequency and distribution of oral squamous cell carcinoma in the Libyan population, considering histological variants and grades. A retrospective analysis of all cases biopsied and diagnosed from 2000 to 2019 in the Department of Oral Medicine, Oral Pathology, Diagnosis, and Radiology was conducted. Information on the patient’s age and gender, tumour type, grade, and its anatomical site was recorded and analyzed. During the study period, 105 biopsies were histologically confirmed as oral squamous cell carcinoma. Males were more commonly affected than females, giving a male-to-female ratio of 1.67:1. Most patients were older than 50, with a mean age of 57.63 ± 14.569 years. The Lateral border of the tongue was the most common site for the lesion (39%), followed by the buccal mucosa (19%). The most common histological subtype was conventional oral squamous cell carcinoma (90%), primarily well and moderately differentiated. The other histological variants were uncommon (N=8): 4 cases of verrucous carcinoma, 2 of adenosquamous carcinoma, and 2 of spindle cell carcinoma. In conclusion, oral squamous cell carcinoma constituted a considerable proportion of oral and maxillofacial lesions, with the conventional type being the most common. A higher proportion has been noted in males aged 50 years and older, with the lateral border of the tongue being the most affected site.
Squamous Cell Carcinoma, Histological Variants, Verrucous Carcinoma
Determination of Carboxymethyl Cellulose, Total Dissolved Solids, pH, and Microbiological Quality of Ice Cream Samples Collected from Libyan Markets
Ice cream is one of the most food consumer during different seasons, it contains different chemical compounds and food additives. This study aimed to estimate the contents of Carboxyl Methyl Cellulose (CMC) in many ice cream which found in the major supermarkets in some Libyan cities. Also, the pH and total dissolved salts. This study aims to measure the levels of Carboxyl Methyl Cellulose (CMC) in various ice cream samples collected from the local markets (Libya), where twenty-one types were purchased from different supermarkets, including imported and local ice cream samples. The spectrophotometric methods were used in this study for carboxyl methyl cellulose, while the total dissolved solids (TDS) and PH values were estimated by PH mater, including a sensor for TDS values. The concentrations of CMC of the ice cream samples fluctuated in the range of (207.33 – 1250.66 ppm ), the high contents of ( 1250.66 ppm ) were recorded in the samples of (Ice Queen, Jordan), whereas the low contents were recorded in the samples of (SNICKERS CRISP, France). The results recorded wide variations in the CMC of the studied samples. (Table 2 and Figure 4). The contents of TDS values ranged between (26.1 – 191 ppm), the high contents were recorded in the samples of (SNICKERS, Poland), whereas the lower values were observed in the samples of (AlMADHAKSTRA WBERRY, Libya). For the pH values, most of the samples gave acidic values (5.3 – 7.14). According to the results recorded in this study, there are wide variations in Carboxyl methyl cellulose in the studied samples of ice cream. The values of Total Dissolved solids /Salts showed wide variations, on the other side the pH values showed that most of the studied are lied in the acidic scale, which may be harmful to human health. The presence of CMC in the samples is very dangerous for the human consumer, where most of the recorded values are above 100 ppm, which is recommended by the WHO. For the microorganism study, the results recorded the presence of some bacteria and Fugal species in the selected samples; these organisms are associated with many diseases and have a negative effect on human health. Ice cream is one of the most consumed foods by children and others.
Nephroprotective Effects of Ginger against Oxidative Stress
There have been growing indications of Zingiber officinale (ginger) acting as a nephroprotectant with antioxidant and anti-inflammatory effects. The extent and reproducibility of such effects in models of kidney injury, however, are unknown. The purpose of this systematic review and meta-analysis was to undertake a quantification of the impact of ginger on both renal performance and the levels of oxidative stress in experimental rat models of kidney injury. An extensive literature search was conducted to identify the preclinical research conducted on the actions of ginger supplementation in rat models of renal injury caused by diabetes, ethanol toxicity, exposure to cadmium, or ischemia/reperfusion. The information regarding the biomarkers of renal functions and antioxidant was extracted. Standardized mean differences (Hedges’ g) were pooled as the mean difference using a random-effects model. Between-study heterogeneity and risk of bias were measured according to the pre-established guidelines of preclinical meta-analysis. Quantitative synthesis showed that ginger therapy was indeed able to significantly change the renal functions through decreased serum creatinine, urea, blood urea nitrogen, cystatin C, and albuminuria when compared to injured controls. Meanwhile, ginger also augmented the antioxidant capacities of the kidneys notably, such as superoxide dismutase, catalase, and glutathione peroxidase. Although the heterogeneity between studies was moderate, sensitivity analyses revealed that the pooled estimates were strong, and no significant publication bias was found. This meta-analysis comprises unified preclinical studies that show that Zingiber officinale possesses considerable nephroprotective effects in various experimental kidney injury models, mainly by inhibiting the occurrence of oxidative stress. These results indicate the possible clinical translationability of ginger as a complementary therapeutic modality to protect against AKI and emphasize the necessity of properly designed clinical trials.
Ginger, Zingiber Officinale, Nephroprotection, Kidney Injury, Oxidative Stress.
Diagnostic Utility of Complete Blood Count Parameters and C-Reactive Protein as Early Indicators in Febrile Children: An Outpatient Study from Tobruk, Libya
Fever is a common presenting complaint in pediatric outpatient settings, and differentiating between viral and bacterial infections remains a clinical challenge, particularly in resource-limited regions. Simple, cost-effective biomarkers such as complete blood count (CBC) parameters and C-reactive protein (CRP) may aid in early identification of bacterial infections. The Objective of this study is to evaluate the diagnostic utility of CBC parameters (white blood cell count, neutrophil count, lymphocyte count, hemoglobin, and platelet count) and CRP as early indicators of bacterial infection in febrile children presenting to an outpatient clinic in Tobruk, Libya. A prospective cross-sectional study was conducted on 290 febrile children aged 1 month to 14 years at an outpatient pediatric clinic in Tobruk, Libya, between January and April 2026. CBC parameters and CRP levels were measured at presentation. Associations between elevated CRP and CBC parameters were assessed using the Chi-square test. Sensitivity, specificity, and predictive performance were calculated for single and combined markers. Elevated CRP was observed in 64.1% of children, leukocytosis in 62.1%, and neutrophilia in 63.8%. Significant associations were found between elevated CRP and both leukocytosis (p = 0.0003) and neutrophilia (p = 0.0001). CRP alone achieved 74.0% sensitivity and 66.0% specificity. The combination of CRP, WBC, and neutrophil counts yielded the highest diagnostic performance, with 89.0% sensitivity and 80.0% specificity. Combining CRP with WBC and neutrophil counts significantly improves diagnostic accuracy for bacterial infection in febrile children compared to any single marker. This simple, cost-effective multiparametric approach may serve as a valuable tool for risk stratification in resource-limited outpatient settings.
Febrile Children, C-reactive Protein, Complete Blood Count, Bacterial Infection, Outpatient, Diagnostic Accuracy, Biomarkers, Tobruk, Libya, Pediatrics
Calciphylaxis in A Patient with Chronic Renal Failure: Report of A Libyan Patient and Review of the Literature
Calciphylaxis is a rare, life‑threatening disorder characterized by systemic arteriolar calcification, tissue ischemia, and painful ulceration, most commonly affecting patients with end‑stage renal disease and secondary hyperparathyroidism. We report the first documented case of calciphylaxis in Libya: a 54‑year‑old man with chronic renal failure on long‑term hemodialysis, who developed large painful ulcers on both calves. Laboratory findings revealed markedly elevated parathyroid hormone levels, while histopathology confirmed epidermal necrosis, vascular calcification, and ischemic fat necrosis. The patient responded to local wound care, systemic antibiotics, and debridement. This case highlights the importance of considering calciphylaxis in the differential diagnosis of chronic renal failure patients presenting with painful leg ulcers. Prompt recognition and aggressive management of mineral metabolism are essential to improve outcomes and reduce mortality associated with this devastating condition.
Calciphylaxis, Chronic Renal Failure, Libyan Patient, Review of the Literature
Transforming the Patient-Pharmacist Relationship in Libya: A Perspective on Digital Health and AI Integration
The Libyan health sector faces structural challenges in regulating the patient-pharmacist relationship, most remarkably the overlapping roles in prescribing and dispensing medications, and the weak implementation of drug scheduling systems, which could pay attention to patients’ quality of life. This study aims to propose an integrated framework for regulating this relationship, grounded in recent technological developments and international standards, while respecting local specificities. The study employed a descriptive-analytical approach by reviewing the literature, previous studies, and media on the realities of pharmacy practice in Libya, analyzing recent national initiatives (such as the electronic insulin dispensing system), and aligning these initiatives with World Health Organization guidelines and pharmaceutical regulations in Arab, European, and American contexts. An integrated "Safe Dispensing" framework (Sarif Aaman integrated system) was established, built on five pillars: (1) Separation of prescribing and dispensing roles of the caregiver, (2) Implementation of a national drug scheduling system, (3) Expansion of the electronic system to cover all medications, (4) Legislation of an obligatory or commitment charter on the rights and duties of patients and pharmacists, (5) Incorporation of AI tools. Conclusions: The proposed framework is a viable solution that addresses current regulatory gaps, enhances patient safety, consolidates the pharmacist's professional role, and aligns with international standards, including those of the FDA, EMA, and WHO. Recommendations: It is recommended that the framework be adopted gradually, beginning with a pilot phase in the possible three main regions in Libya focused on high-risk medications, while developing digital infrastructure and continuous training programs for pharmaceutical personnel.
Pharmacy, Prescribing, Dispensing, Patient Rights, Medication Safety
Prevalence and Determinants of PSA Screening Among Men Aged 70 and Older in a Tripoli Outpatient Clinic: A Pilot Cross-Sectional Study
Prostate-specific antigen (PSA) screening remains a widespread practice among older men, despite current guidelines advising against routine screening in individuals aged 70 years and older (9). In Libya, particularly in urban centers such as Tripoli, data on PSA screening prevalence and patterns are scarce. Although guidelines recommend caution, international studies from Spain, the USA, and Brazil have documented persistent PSA testing among elderly men (1–5). This study aimed to explore the prevalence and determinants of PSA screening in a Libyan context, providing local evidence to inform clinical practice. A cross-sectional, pilot study was conducted at the urology outpatient clinic of Tripoli Central Hospital. Thirty men aged ≥70 years were recruited using purposive sampling. Data were collected via structured questionnaires, medical record reviews, and semi-structured interviews. Descriptive statistics and chi-square tests were used to analyze associations between sociodemographic variables and PSA screening behavior. The study was exploratory and aimed to generate hypotheses for larger, representative studies. Of the 30 participants, 50% reported undergoing PSA screening at least once, primarily due to physician recommendation (47%). Further diagnostic procedures were followed in 30% of screened cases. Only 40% of participants reported being informed about the risks and benefits of PSA screening, and 30% felt fully involved in decision-making. No statistically significant associations were observed between screening and sociodemographic variables, although higher educational attainment showed a positive, non-significant trend (p = 0.08). Notably, 80% of participants expressed a desire for more information regarding PSA testing. Despite international guidelines discouraging routine PSA screening in men ≥70, half of the participants had undergone testing, largely influenced by physicians. Limited shared decision-making and gaps in patient education were evident. These findings underscore the need for locally tailored educational interventions and structured physician–patient discussions to align screening practices with evidence-based recommendations and support informed decision-making in Libya.
PSA Screening, Prostate Cancer, Elderly Men, Tripoli, Cross-Sectional Study
Prevalence and Behavioral Trends of Electronic Nicotine Delivery System Use Among Youth in Tripoli, Libya
The rapid global increase in Electronic Nicotine Delivery Systems (ENDS) use among youth represents a critical public health challenge. However, there is a complete absence of city-level epidemiological data from Libya. This study aimed to determine the prevalence, patterns, and predictors of ENDS use among students in Tripoli. A cross-sectional online survey was administered to a sample of 420 students aged 15–25 years in Tripoli, Libya. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression in IBM SPSS version 28. The lifetime prevalence of ENDS use was 44.0% (95% CI: 39.3–48.9). The current (past 30-day) prevalence of use was 20.5% (95% CI: 16.8–24.6). Current use was significantly higher among males (31.3%) than among females (5.6%). Male was the sole strong independent demographic predictor (Adjusted Odds Ratio = 8.41, 95% CI: 4.07–17.37). The primary motivation for use was curiosity or experimentation (73.3%). While 82.6% of current users expressed a desire to quit, 33.7% reported physical difficulty abstaining for 24 hours. This first city-level study reveals alarmingly high ENDS use among youth in Tripoli, characterized by a pronounced gender disparity and primarily experimental motivations. These findings highlight an urgent need for targeted prevention, cessation support, and specific regulatory action in Libya
Electronic Cigarettes, Vaping, Adolescents, Young Adults, Prevalence
Operative versus Non-Operative Management of Adhesive Small Bowel Obstruction: A Prospective Study at Tobruk Medical Center
Adhesive small bowel obstruction (ASBO) is a common complication following abdominal surgery, affecting approximately 95% of patients with prior abdominal operations. This study aimed to determine the optimal timing for surgical intervention in ASBO patients and improve clinical management. A prospective comparative study was conducted at the General Surgery Department of Tobruk Medical Centre. Thirty patients with ASBO were randomly assigned to two equal groups: Group A (conservative, non-operative care) and Group B (operative care). In the operative group, 13 patients (86.6%) underwent early exploratory laparotomy. In the conservative group, 8 patients (53.3%) required surgery due to failure of conservative management. The most common prior procedure in both groups was open appendectomy, followed by caesarean section. Recurrence of SBO was significantly higher in the conservative group (7 patients, 46.7%) compared to the operative group (2 patients, 13.3%) (p = 0.0042). Early surgical intervention within 24 hours of admission significantly reduces recurrence rates in ASBO patients
Adhesive small bowel obstruction, operative treatment, non-operative treatment, recurrence, laparotomy
Organic Composition and Fatty Acid Profile of Macadamia Nut Oil and Its Impact on the Body Weight of Male Rabbits
This study investigated the organic composition and biological effects of macadamia nut oil using GC–MS analysis and an in vivo experimental model. The GC–MS results revealed that macadamia oil is predominantly composed of fatty acid derivatives, with a marked dominance of monounsaturated fatty acids. The principal compound identified was 9-octadecenoic acid (Z)-, methyl ester (26.86%), followed by oleic acid (18.83%) and hexadecanoic acid, ethyl ester (13.32%). Moderate levels of E-9-octadecenoic acid ethyl ester (7.00%) and 8,9,12-octadecatrienoic acid, methyl ester (3.12%) were also detected, indicating the presence of both mono- and polyunsaturated fatty acids. Minor constituents, including eicosapentaenoic acid (1.70%) and other long-chain unsaturated fatty acids (≤1.71%), suggest a diverse lipid profile with potential antioxidant and anti-inflammatory properties. Chromatographic analysis showed well-resolved peaks, with the most abundant compounds eluting between 29 and 31 minutes, confirming the predominance of long-chain fatty acids. Biologically, the results demonstrated a progressive increase in body weight in both control and treated groups. At baseline, no significant difference was observed between the control (1250 ± 45 g) and macadamia group (1245 ± 42 g) (P = NS). After two weeks, body weight increased to 1320 ± 38 g in the control group and 1355 ± 40 g in the treated group, with no significant difference (P > 0.05). However, by week 4, a significant increase (P < 0.05) was recorded in the macadamia-treated group (1480 ± 48 g) compared to the control group (1410 ± 50 g). These findings indicate that prolonged administration of macadamia nut oil may enhance weight gain, potentially due to its high content of bioactive monounsaturated fatty acids. Overall, the study highlights the rich fatty acid composition of macadamia oil and its potential physiological impact on growth performance
Organic Chemistry, GC-MS Analysis, Macadamia Integrifolia, Fatty Acids, Male Rabbits, Body Weight Gain, Oleic Acid, Growth Performance
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
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