Chronic kidney disease is a public health issue with significant humanitarian and economic implications. Between 2007 and 2009, the number of patients on dialysis in Libya increased from 2116 to 2417. It is projected that the number of patients on dialysis will increase from 2417 in 2009 to 7667 in 2024. The proportion of patients on peritoneal dialysis is projected to rise from 1.2% in 2014 to 16% in 2024. To maintain a patient to dialysis machine ratio of 1: 3.4, the number of dialysis machines will need to grow from 1045 in 2014 to 2255 in 2024. Hemodialysis units are better organized into main and satellite units, with a potential use of mobile hemodialysis units to deliver a local service to much smaller number of hemodialysis patients. The required number of general nephrology beds in 2014 is estimated around 468, with 59 additional regional transplant beds. These numbers are expected to be around 547 and 69 respectively by 2024. Required staff to deliver service to these rising numbers of patients is estimated to be 78 nephrologists, 9 vascular access surgeons, 4 transplant surgeons and 4 hepatologists in 2014. The corresponding numbers in 2024 are 123, 51, 18, and 7, respectively. The number of required renal nurses in 2014 is 1767, rising to 3400 by 2024. A steady increase in the number of required transplant coordinators, histocompatibility and immunogenetics laboratory consultants and scientists, dialysis technicians, renal dietitians, social workers, clinical psychologists and clinical renal pharmacists is to be expected. Recently published data showing great variability in patient mortality, hepatitis sero-conversion rates and the lack of consistent practice to check dialysis dose and adequacy are strong indicators for the nephrology community in Libya, the regulatory authorities and decision makers to urgently agree national nephrology clinical practice guidelines, and to adequately plan to train and develop the skills of the personnel required to cope with the rising number of end stage renal disease patients.

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Background: Pseudomonas. aeruginosa is an established cause of nosocomial infections among surgical patients and infants in neonatal intensive care units. Objective: We aimed, firstly to identify the prevalence of P. aeruginosa and other causative agents from wounds and other body sites (hands, groins, axillae, umbilicus and drains) and secondly to investigate the resistance patterns of antimicrobial susceptibility against various antibiotics. Materials and Methods: The study was carried out in Departments of General Surgery and Medical Laboratory in Tripoli Central Hospital, Tripoli, Libya over a period of 6 months from March through August 2007. A total of 792 clinical samples were taken during the examination from several sites of 150 patients and transported immediately to the laboratory then inoculated directly into selective on MacConkey agar and standard bacteriological media. The isolates were identified and antimicrobial susceptibility testing was performed by the disc diffusion method according to National Committee for Clinical and Laboratory Standards (NCCLS) guidelines. Results: 336 different bacterial isolates were identified in wounds and other body sites. In general, P. aeruginosa was the commonest isolate (35.7%) followed by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae (29.2%, 9.2%, and 8.9%) respectively. In particular, P. aeruginosa was the most common bacteria isolated in samples from diabetic foot disease reaching 80.6% of total isolates. Conclusion: P. aeruginosa was found to be quite common in our surgical patients and it has emerged as one of the most problematic Gram negative pathogens. Hands of the patients were commonly colonized by different bacteria. Resistance rates to frequently used antibiotics were high. Microbiology sensitivity results should guide the use of proper antibiotic drugs.

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Background: Health- care workers (HCWs) have a substantial risk of exposure to HIV. Effective post- exposure prophylaxis (PEP) must begin within 72 hours of possible HIV exposure. Objectives: To assess knowledge, attitudes and practices (KAP) among HCWs with regard to HIV post exposure prophylaxix (PEP) in Benghazi, Libya. Methodology: A cross-sectional study was conducted in seven medical centers. A convenience sample of HCWs were surveyed with a based on published international and national HIV/AIDS care guidelines. Demographic characteristics, knowledge about HIV PEP and information on work practices were collected. KAP data scores were classified as good, satisfactory or poor. Results: HCWs had a high level of knowledge about HIV transmission and risk groups. Forty percent of nurses believed that the transmission rate of HIV is lower than HBV& HCV. The majority of HCWs were offered PEP as soon as possible after HIV exposure, and flushed the wound with alcohol or antiseptics, but just over half of the nurses and less than quarter of the doctors had immediate HIV testing after exposure to potentially contaminated blood or body fluid. Nurses were observed to have variable practice in the use of gloves or protective clothing at work. The uptake of hepatitis B vaccine by HCWs was incomplete or absent in 41% of nurses and 59% of doctors. Conclusions: We conclude that the knowledge and attitude of HCWs about HIV PEP varied from satisfactory to good. Some misconceptions exist and need to be corrected. Health education for HCWs regarding HIV is essential to limit risk of transmission and to protecting staff and the welfare of the community. Occupational health clinics should be established in all hospitals to improve these attitudes and practices.

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Background: Patients with cirrhosis and early stage hepatocellular carcinoma (HCC) may not be candidates for surgical resection due to liver dysfunction. Two common alternative therapies to treat HCC are transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA). We compared outcomes between HCC patients within Milan criteria after initial treatment with these two therapies. Methods: The records of 58 patients diagnosed with HCC within Milan criteria and treated initially with either TACE or MWA were reviewed. Pre-treatment factors, perioperative outcomes and survival were compared between groups. Results: There were 36 patients treated with MWA and 22 with TACE. Pre-treatment AFP levels were higher in the TACE group. Treatment with MWA was associated with progression-free survival (PFS) of 17.1 months versus 8.9 months after TACE (p=0.56). Disease- specific survival (DSS) was higher in the MWA group (median not reached) than the TACE group (32.0 months, p=0.047). Nine (15.5%) patients in this cohort went on to receive liver transplantation. Conclusions: Treatment with either MWA or TACE for patients with cirrhosis and unresectable HCC within Milan criteria is generally safe and initially effective, but recurrence and eventual death due to HCC or cirrhosis is common. These therapies should be a bridge to transplantation for all appropriate candidates.

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Introduction: Seckel's Syndrome, also called “Bird headed” syndrome was first described by Seckel in 1960. The very rare genetic and heterogeneous disorder, inherited in an autosomal recessive manner, is characterized by severe proportionate dwarfism of prenatal onset with mental retardation, dysmorphic facial features like a bird's with microcephaly, large beaked nose, and micrognathia. Our aim was to describe a typical case and give a focused literature review. Case report: A boy aged 7, with a birth weight of 1.9kg, whose parents are first cousins, was referred to our department for severe dwarfism. His mother reported hyperactivity and mental retardation. He weighed 8kg, measured 81cm (-6SD) and his cranial perimeter was 31 cm. He had a bird-like face with receding chin and forehead, large eyes, and prominent nose. In addition to his dysmorphic face, clinical examination showed kyphoscoliosis, flat feet, hypospadias and a systolic heart murmur heard in the pulmonic area of the chest, radiating into the back. There was no sign of right cardiac insufficiency. Echocardiography showed a large atrial-septal defect with enlarged right atrium and ventricle. Routine and haematological analyses were normal. Endocrine assessment was normal even for growth hormone and insulin growth factor (IGF-1). Psychological examination argued for severe mental retardation. Genetic screening was not available because of parents' low socioeconomic status. Conclusion: Consanguinity, intra and post natal severe dwarfism, mental retardation, body malformations with typical bird-headed aspect most likely indicate a diagnosis of Seckel's Syndrome worth being reported for its rarity.

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The first clinical congress of the Gulf Chapter of the American Association of Clinical Endocrinologists was held in October 2013. The declared educational objective of the congress is to give a “state of the art in endocrine practice”. To this end, the organizing committee invited international and regional key opinion leaders to meet the objectives of the congress. In this article, we present the abstracts of the congress as submitted by the authors after minimal restyling and editing to suit the publication requirements of the journal. Major issues and topical themes with wide interests in the profession were addressed in 6 plenary lectures. More focused issues were included in several parallel symposia to suite the specific educational needs of the target audience subgroups. Practical issues were addressed in “Meet the Expert” type of interactive workshops. A selection of free communications from abstracts submitted by delegates, reflecting mostly the regional epidemiology and clinical practice in diabetes care and endocrinology, were presented as either oral or poster presentations. The abstracts are presented under their relevant groups. We hope that by publishing them in this journal we extend the benefit to those who could not make it to the live presentations.

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Objectives: The aim of this study was to evaluate the prevalence of anemia among adolescent males and females in the far western part of Nepal. Patients and Methods: A hospital-based study was carried out in Nepalgunj Medical College, Kohalpur, Banke, Nepal to determine prevalence and distribution of anemia in terms of age and gender among adolescents population. A total of 2027 adolescent (10-19 years old) females and males were included in the study from March 2011 to December 2012. Hemoglobin level was determined by the Cyanmethaemoglobin method. Data were summarized using descriptive statistics. Results: The overall prevalence of anemia was 52% for both males and females. 29.7% of the females and 22.4% of the males were anemic. The proportion of mild anemia was 67.5% (38.4% in females and 29.0% in males), moderate anemia was 20.0% (10.9% in females and 9.1% in males) and severe anemia was 12.5% (7.7% in females and 4.8% in males). Analyzing data within age groups revealed that the highest prevalence of anemia in general occurred in the 18-19 year old subjects affecting 292 (82 males and 210 females). Conclusions: Anemia in Nepalese adolescents is mostly mild, occurs more in late teenage years and it mainly affects females. Nutritional improvement and oral iron supplementation is needed for curing of anemia.

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The desire and feasibility of fasting during Ramadan are sensitive issues for diabetic Muslims. The aim of this study was to describe the behavior of patients with type 2 diabetes towards fasting. A prospective longitudinal study was conducted including 100 patients with type 2 diabetes. Data collection was carried out using an anonymous questionnaire administrated by the attending physician during two visits before and after Ramadan. A total of seventy-nine of the hundred enrolled patients fasted, and 62% of uncontrolled patients fasted against medical advice. The reasons given by patients to justify their behavior referred to socio-cultural imperatives. Most of our patients practice Ramadan fasting under the pressure of socio- cultural habits, despite their doctors' disapproval. This fact highlights the difficulties to manage these patients.

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A 54 years old Libyan man presented with a long history of perineal mass, induration and passage of pus and purulent secretion; sometimes mixed with blood. It became increasingly painful over a short period of a few days prior to presentation. He had had a fistula-in-ano for ten years treated surgically 8 years previously. His past medical history included type 1 diabetes mellitus. He underwent digital rectal examination under anesthesia which disclosed edematous external skin tags, with induration of the posterior margin of the anal canal, multiple biopsies and scrapings of the fistulous track were taken. Histological examination revealed mucinous adenocarcinoma. Colonoscopy was done and showed no abnormality. Clinical and MRI characteristics are illustrated and discussed.

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