Benghazi University Medical Journal

Laboratory parameters characterizing chronically infected HCV patients attending viral hepatitis clinic at Benghazi Medical Centre.

Ahmed Elhaddad, Ahmed Elhassi, Emad Daw — Tue, 01 Sep 2020 00:00:00 +0000

Background: Chronic hepatitis C is one of the leading causes of chronic liver disease. There are approximately 7 million chronically infected individuals worldwide, many of whom are unaware of their infection, with import ant variations according to the georraphical area. Hepatitis C is predominantly or almost exclusively acquired through percutaneous Exposure to blood. Genotype 4 is closely related to cont and northern Africa while there sa predominance of genotype lb in Western Europe and I in North America. The severity of disease varies from asymptomatic chronic infection to cirrhosin and hepatocellular carcinoma (HCC), Currently, hepatitis C is the leading cause for liver transplantation worldwide. Out of 100 people that contract the infection, 75-85 people will develop chronie infection, 60-70 people will develop chronic liver disease, and 5 to 20 people will develop cirrhosis over the course of their chronic infection and one to five people will die of complications including hepe tocellular carcinoma (HCC). Treatments for hepatitis Chave progressed to the point that more than 90% of the people who take the treatments can be cured, and, for many people, the treatment duration is much shorter than before. Now, we have interferon-free therapy. Importantly, the side effects of the newer treatments will be much less than the side effects of interferon based therapies. Antiviral therapy now allows many patients infected with hepatitis C virus (HCV to achieve a sustained virological response (SVR) which is namely the clearance of serum HCV RNA after therapy withdrawal, which is equivalent to cure.
Aim: To evaluate the Laboratory parameters characterizing chronically infected HCV patients attending viral hepatitis cline at Benghazi Medical Centre.
Patients and method: The cohort in our study was chronic HCV infected patients followed viral hepatitia clinic at Benghazi medical center. Inclusion criteria were are, sex, mode of infection, ALT, AST, PT, INR, Serum abumin, Alpha fetoprotein, HCV RNA level and grade of fibrosis using ultrasonography (USSL Procan or Fibro-ACi test. Patients co-infected with HBV or HIV were excluded. Data were analyzed using the SPSS Statistics (SPSS Inc., Chicago, US]version 17.0.
Results: out of 161 patient, 77 are male (47.8%) and 84 are female (52.2%). The people are grouped into two groups, cirrhotic and non-cirrhetic based on USS abdomen, fibeo scan or bro-ACTi test. The mean PCR for dir thesis is 5.99 log and for non-cirrhosis 5.97 lor (P=0.82). The mean albumin for cirrhosis is 3.73mand for noncirrhosis 4 (P<0.001). The mean platelet for cirrhotie 168,108/micre litter and for non-c hote 223,80/ micro litter (P<0.001). The INR for cirrbotic 1.23 and for non-cinthos 1.16 with P=0.89. The mean bilirubin for cirrhot 0.75 mg/dl and 0.73 mg/dl for non-cirrhosis P-0.87). The mean fasting blood glucose for cirrhosis 119.4 m and for non-cirrhosis102mg%(P=008).
Conclusion: because of the big burden of HCV infection world wide where millions of people have chronie HCV infection with a significant number of them go to cirrhosis and liver cancer, therefore the efforts to encourage HCV testing access to care and the improvement in HCV therapy have a positive impact on patients presenting for care.

Materials and Techniques used by General Dental Practitioners in Libya during Endodontic Treatment of Permanent Molar Teeth

Randa F Salih, Khadeejah S Buzaripah, Fatma Asheibi, Naeima M Betamar — Tue, 01 Sep 2020 00:00:00 +0000

Aim: To investigate the current trends in routine endodontic treatment of molar teeth performed by Labyan genral dental practitioners (GDPs).
Materials and methods: A total of 750 structured questioners enquiring about various aspects of endodontie Treatment were dispersed among GDPs who work in public and private clinics in five major Libyan cities (Tripoli, Benghazi, Sabha, Misrata, Albida).
Results: of the 750 questionnaires, 337 completed replies were received. The response rate was 44.9%. Amongst those 88.1% performed endodontic treatment for molar teeth, while 11.9% mentioned that they refe difficult clin cal cases to endodontie specialists. 21.1% of GDPs used rubber dam for isolation About 95.3% used radiograph for working length determination and only 4.7% used apex locater. More than half of participants (58.2 never found MB2 canal in upper molars, and only 2% of them used magnification tools during root canal treatment. The majority of GDPs 190.89.) used sodium hypochlorite as an intra-canal irrigant, while calcium hydroxide was used by 60.5% of GDPs as an intra-canal medicament, followed by formecresol (39.5%. The step-back and crown down preparation techniques were the methods of choice in this study with a percentage of 61.4% and 24.9% respec tively. Hand instruments were used by 64.4% and rotary instruments were used by 35.6% of the GDPs. Cold lat eral condensation was used by 76.6%, while the rest used single cone technique for obturation. Zinc oxide eugenol was used by 73.9%. The majority of the GDPs completed root canal treatment in three visits or even more (85.4%).
Conclusions: Majority of Libyan GDPs performed root canal treatment for molar teeth starting with pre-operative radiograph, used variety of endodontic materials and techniques, and implemented new materials and technol ogies when they became obtainable. Yet, most GDPs used step-back technique for canal preparation and lateral condensation for obturation. Few GDP's used rubber dam which highlights the importance of applying policy and regulations for good-quality practice.

An Analytic Study of Blunt Chest Trauma

Mustafa Noman Sabet, Abdelkarim Bashir, Ahmed Faraj, Khalid. G. Hasan — Tue, 01 Sep 2020 00:00:00 +0000

Background: Thoracic injury is a common cause of mortality and maior disability. Fortunately, the vast majonty of chest trauma can be conservatively managed. This retrospective study was carried out to determine the magni bude of the condition, and the management of patients with blunt chest trauma at our center.

Methods: The records were reviewed of 163 patients seen at Al-Thora Teaching Hospital in El-Beida, Libya from October 2008 to December 2016. Demographic data, etioloev, mechanism and pattern of injury, associated injury management, and outcome data were analyzed.

Results: The data analysis showed that: chest trauma predominated among males with a percentage of 77.96 relative to the female group whose percentage was 22.1%. The commonest causes of chest trauma were road traffic accidents (RTA) representing 85.9%. The most frequent iniury was rib fracture (78.5%). Intercostal tube thoracostomy was the only therapy required in 71 patients 43.6%, whereas 78 patients (21.2%) had had conser Vative management, and only 14 patients (8.694 underwent thoracotomy. Mortality occurred in 9 patients (5.5%).

Conclusions: The study revealed that, road traffic accidents (RTAs) are the main cause of blunt chest trauma, mainly affecting young males. Mostly they required no invasive therapy or, at the most chest tube thoracostomy.

Evaluation of using urine strip in diagnosis of children's meningitis in Benghazi-Libya

Tue, 01 Sep 2020 00:00:00 +0000

Background: Bacterial meningitis is still considered as one of the most dangerous infectious diseases, which numerous complications and high mortality if not diagnosed and treated timely.

Objective: to evaluate the usefulness of urine reagent strip tests in the diagnosis of meningitis Patients and methods: ninety of children aged less than 11 years were included. They clinically suspected to have meningitis from Benghazi children's hospital in the period from February 2017 to April 2018. CSF samples were tested using both Combur-10 urinary reagent strip and CSF microscopy examination as reference standards. Combur-10 was used to estimate ten parameters including protein, glucose, and leukocytes.

Results: The diagnostic accuracy of protein estimation by reagent atrin show 91.7% sensitivity. 100% speciicity for detection of CSF proteins, Glucose reagent strip positivity had 97.5% sensitivity and 72.7% specificity for detection of CSF glucose. Leukocyte esterase positivity by test strip had sensitivity of 100% and specificity of 98.8% for the detection of CSF granulocytes of more than 10 granulocytea/mm. The majority of meningitis were found in children aged less than2 years 191.1%), and incidence of meningitis was found the same percentage in both males and females (41%) for each

Conclusions: our results suggest that reagent strips may be a useful additional resource in the diagnosis of bac terial meningitis, especially when it is difficult to collect a sufficient amount of cerebrospinal fluid or to indicate the initial treatment.

Ovarian torsion radiological pathological correlation using MRI. In cases with underlying common ovarian pathology

Tue, 01 Sep 2020 00:00:00 +0000

Ovarian torsion is one of the most challenge diagnosis in gynecological emergency, it is usually associated with varian pathology, as ovarian cysts, PCO, or ovarian tumors and it may be seen in the normal ovaries, replying only on clinical data and ultrasound findings is usually inconclusive. The objective of our study was to demonstrate the magnetic resonance imaging (MRI) features of ovarian torsion with underlying common ovarian retrospectively we reviewed the clinical and MRI features in 5 females with surgically proven ovarian polycystic ovaries, mature teratoma and one case of torsion in normal ovary.
MRI features of ovarian torsion in normal ovary include ovarian edema and enlargement, twisted ovarian pedicle ovarian hemorrhage all are a pathognomonic radiological features even in an ovarian torsion with underlying pathology which are giving specific radiological feature for each ovarian pathology

Relationship between body mass index and development of Varicocele

Muftah . H. Elkhafifi, walid . M. Beltamer — Tue, 01 Sep 2020 00:00:00 +0000

Introduction: Varicocele is characterized by abnormal elongation, dilatation and tortuosity of the pampiniform plexus within the spermatic cord and is the most commonly see and correctable cause of male factor infertility.
Objectives: Our study aimed to ind hy abnormal elongation, dilatation and tortuosity of the pampiniform and is the most commonly see and correctable cause of male factor infertility. to investigate the correlation between Body Mass Index (BMI) and development of Varicocele among a cohort of infertile patients as compared with the number of subject without Varicocele (control group).
Patents and methode: Between January 2016 and December 2017, atotal of 102 patients underwent surgerv underwent history taking careful physical examination and scrotal ultrasound scan Cand severity of Varicoceles. An age-matched controls group consisted of 103 subiects aricoceles according to physical examination only. The age, weight, height, and BMI Addition both grades and side were analyzed in patients group.
Results: The mean age was 33.38 ±5.68 in patients group and 38.63 ±7.150 in control group. Of the 102 patients 29(28.43%) were grade I, 70 (68.63%) were grade II, and 3(2.94%)were grade III. All 102 patients had left-side varicoceles and 18 of them had bilateral varicoceles. No cases with only right side involvement.
The BMI (mean ±SD)of 102 with varicoceles was (26.55± 4.4)while that of control group was (28.30± 4.3) which is clinically significant (p=0.0001).

Clinical presentation and treatment of urethral stricture in Hawari Hospital.

Younis M. Al bashari, Mohamed A. Elayan, Muftah H. Elkhafifi, Hussam H. Bakar — Tue, 01 Sep 2020 00:00:00 +0000

Urethral structure disease (USD) is a common urological problem and considered difficult to man to high recurrence rate and wide variety of management approach. The objective of this study was to the pattern of incidence, clinical presentation, causes, and treatment of urethral stncture in Hawari University Hospital Benghazi, Libya.
Patients and methods: This study was a retrospective cohort analysis conducted among consecutive individuals pre diagnosed and/or were treated for urethral stricture in Hawan University Hospital using medical data from January 1st 2017 to December 31st 2019.
Results: A total of 118 cases of urethral structure were recorded between 2017 and 2019, The mean age of all ents was 47.5 years, approximate 98.2% were males and 1.69% were female. However, the peak incidence of uring urethral stricture between 60-79 years of age and represents approximately 37.2%. The most common presenting symptoms were obstructive voiding symptoms and accounts about 50.8% of all cases. Eighty three of Strictures (70.3%) were due to trauma. The most common procedures used to manage urethral structures were visual urethrotomy (67.7%), cystoscopy and dilatation (19.4%), and urethroplasty (5%).
Conclusion: Trauma is the leading cause of urethral structure in urology center. Iatrogenic strctures were com mon. Urethroplasty gives satisfactory outcome. Efforts should be made to reduce urethral strcture.

Our Experience on The Use of Dimexid (Dimethyl Sulfoxide) in The Effective management of Lung abscess

Tue, 01 Sep 2020 00:00:00 +0000

A lung abscess is a localized area of pulmonar parenchymal necrosis caused by an infectious anism Primar lung abscesses occur in immunocompromised patients. Secondary lung abscesses occur in patients with an underlying pulmonary disease. Systemic broad spectrum antibiotics, pulmonary physiotherapy, postural drainage and interventional or surgical drainage and surgical pulmonary resection in selected cases, are main modalities in the management of lung abscesses. A distressing fact is the long course of recovery and complications encountered in the management of lung abscesses. Severe complications like massive haemoptysis, endobronchial spread, rupture into the pleural space, pyopneumothorax, empyema, broncho pleural fistula, septic shock and respiratory failure have been reduced with advances in treatment, as mentioned above. Dimexid Dimethyl Sulfoxide possesses strong anti inflammatory, analgesic, antioxidant and antimicrobial actions it changes the sensitivity of microflora resistant to antibiotics.

A Review of Breast Cancer

Saeid omar alsoaeiti, Tahani S O Almazaq, Aya M M Jarboa, Yasmin NF Elmqawob — Sun, 01 Sep 2019 00:00:00 +0000

Breast cancer is the second most common cancer worldwide is the most common cancer among women. And it is the leading cause of Oncer mortality, and one of the leading causes of morbidity and mortality in women worldwide [1, 2].
Fifty years ago cancer of the cervix and child bearing complications were the leading health care problems of wom en Breast cancer is a multifactorial disease and various factors contribute to its currence.15! Hreast cancer occurs all over the world, its incidence, mortality, and survival rates vary considerably among different parts of the world, which could be due to many factors such as population structure, Mestyle, as well as both genetic and environmental factors.co The main risk factors are ape, low parity, and a low rate of breastfeeding. This is why it is common in high resource nations, however it is increasing in almost all countries. [4] Changes in risk factors have led to an increase in the prevalence of breast cancer.[7]
The world population continues to rise and the life expectancy for women has reached 80-plus year in most nations, especially western.
The single most important demographic factor determinine future health care burdens will be age. One oncolog cal disease certain to increase in all nations is breast cancer.
Breast cancer is an individual tragedy for those affected. It is a highly curable disease when detected early, and an inevitably fatal disease when discovered too late. Access to high-quality care leading to early diagnosis and proper surgical and medical treatment can mean the difference between lide and death. 17 Breast cancer is a major health care burden. Screening programs are costly and difficult to organise, involving major lopatie and quality control issues.
Proper surgical treatment requires appropriate operating roor facilities and highly qualified healthcare providers Local radiation requires facilities beyond the scope of most health care systems in low income countries. Adequate systemic treatment with chemotherapy and hormonal therapy is costly both in itself, as well as in mangement of their potentially severe adverse effects. All sophisticated breast cancer treatment requires the resour es of advanced pathological laboratory investigation including immunohistochemistry and molecular pathology analysis.
New targeted therapis remain an evolving field where only one thing is certain, individual treatment costs are already threatening the best founded healthcare system. Breast cancer is a challenge for all countries. Organizing and centraling breast cancer care around integrated breast Cancer Centers can potentially provide optimal care to individual patients within different health care sy tems the reverse wil strain healthcare systems.

Intraoperative Evaluation of Median Nerve Excursion in Carpal Tunnel Surgery

Khalid Ali, Esam Alnajar — Tue, 01 Sep 2020 00:00:00 +0000

Patients complaining of pain and or paraesthesia along the forearm and hand with or without abnormal functions in the small muscles of the hand present with a condition that must be anatomically localized, mecanically understood and pathologically classifed. Numerous causes can produse peopathy including non-surgical causes that must be excluded. This may cause difficulty in the diagnosis even after clinical and radiological evaluation, so we resort to electrophysiological examination to confirm the diagnosis.
Methods: The study was carried out on twenty patients, admitted to Benghazi Medical Centre during the period of one year. All patients had a detailed history taken, and complete phyical examination with neurological evaluation. The diagnosis was confirmed by electrophysiological studies. Subsequently, the appropriate surgical procedure was performed. All the cases were followed up clinically and electrophysiologically.
Results: The mean age of the patients was (41.55± 10.44) with a high frequency of 30 to 40 years, 80% of cases were females and 20% were males, 75% of Cases were workers, 55% of the patients presented with their right hand and 45% with their left hand, The duration of symptoms prior to operation ranged from 2 to 30 months with a bean of (10.1±7.38). The latter difference had a statistically significant effect on the results. Clinical analysis showed that pain and numbness in the distribution of the median nerve were the most common complaints. The most common physical finding was a positive Phalen's test 1854. Preoperatively 35% of cases were graded mild, 25% were graded moderate and 40% were graded severe. After 6 months of regular follow up we found that 75 our patients showed good improvement as regarded the nerve conduction study result.90% improvement of pain, 77% in lessening of numbness, 66% in lessening of weakness and 50% in lessening of wasting of thenar eminence. A statistically significant difference was found between the preoperative and postoperative nerve conduction studies (motor and sensory). Intraoperatively, there was an increase in the significant excursion of the median nerve in association with the three wrist positions (neutral, flexion, extension) after release of the transverse carpal ligament. Only 10% of our patients developed post-operative complications wound infection and scar tenderness) which were dealt with appropriately. The overall result was good in 75% of cases, fair in 15% of cases and poor in 10% of cases.
Conclusion: The finding of this study showed that the position and movement of wrist had a profound effect on an ex-cursion of the median nerve, and may aid in the understanding of the pathophysiology of the carpal tunnel syndrome. Moreover, we should be considering the limitation of median nerve excursion as one of the causes of carpal tunnel syndrome. Also the longer the duration of preoperative symptoms the worse in the result, so early surgery in moderate and or severe grades is recommended.

Rare presentation of meckel's diverticulum in pediatric (internal herniation) in Benghazi children hospital

Aziza alfakhri — Sun, 01 Sep 2019 00:00:00 +0000

Meckel's diverticulum common congenital abnormaleties in small intestine occur in about 2% to 3% of general population, we report rare presentation of MD in pediatric age in our hospital; who presented clinically with feature suggestive intestinal obstruction found at exploration to have MD with internal herniation of terminal ileum through unusual mesentery of MD