Periconceptional folic acid supplementation has been shown to decrease the occurrence of neural tube defects (NTD’s). In a cross-sectional study, the knowledge attitude and practice regarding the peri-conceptional use of folic acid were assessed among the pregnant women in Benghazi, Libya. 131 women attending antenatal clinics in three main polyclinics were interviewed through three polyclinics. Seventy-three percent of the participants had heard about folic acid, and only 37% could correctly identify the effect of folic acid when used periconceptionally. 27% of the pregnant women did not take folic acid during their present pregnancy. Only 6% of the women who took folic acid were taking it consistently before pregnancy with the aim of preventing NTDs. This study shows that the interviewed pregnant women reveal high positive attitude (88%) toward retaking folic acid supplements in their next pregnancy. The overall knowledge regarding the periconceptional use of folic acid was relatively low when compared to other studies worldwide. Health education regarding the periconceptional use of folic acid among newly married couples is recommended.

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Objectives: The objective of this study is to help identify the hematological profile of patients with diabetes Settings: The study was conducted at El-Beida Hospital, El-Beida City, Libya. Subjects and Methods: The study subjects selected for this study consist of 103 Libyan type 2 diabetic patients (79 males + 24 females) and 39 healthy non-diabetic subjects (29 males and 10 females) acted as controls. They were matched for age (56.1 ± 7.8 years vs. 55.0 ± 6.3 years. The hematocrit value (HCT), hemoglobin content, red blood cells count (RBCs) and mean corpuscular volume (MCV) concentration with increased white blood cells counts (WBCs), mean erythrocyte hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH), lymphocytes and neutrophils levels were performed. Results: Hematological studies in the diabetic patients showed significantly lower HCT values, hemoglobin content, RBCs count and MCV concentration than in the controls. Greater total WBC counts, MCHC concentrations, MCH, lymphocytes and neutrophils counts were observed in the patients than in the controls. No differences were found between platelets counts in the diabetic patients and the control. Conclusions: Significant aberrations in some hematological parameters associated with carbohydrate, protein and lipid metabolisms was identified in this selected group of people with diabetes.

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Background: Vitamin B12 deficiency can cause peripheral neuropathy. Metformin use is associated with vitamin B12 deficiency. Objective: To define the prevalence of vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM) and its possible relation to metformin therapy. Patients and Methods: A crosssectional study of T2DM patients on chronic metformin therapy was conducted at Benghazi Diabetic Center during 2011. Demographic data, type, and duration of treatment reported adherence, and vitamin B treatment were all documented. History and examination for evidence of peripheral neuropathy were recorded. Serum vitamin B12 levels were measured (reference value 159-1000 pg/ml). Results: 500 patients were included of whom 175 were males (35%). Mean (SD) age was 58.6 ± 9.9 years and duration of diabetes 13.6 ± 8.4 years. Of these 358 (71.8%) were on insulin and metformin' 93 (18.6%) on sulphonylureas and metformin, 26 (5.2%) were on insulin and sulphonylurea and metformin triple monotherapy. Mean serum B12 level for all patients was 439 ± 212 pg/ml with males having significantly higher levels than females (512 ± 226 vs. 399± 193; p=0.001). Vitamin B12 levels were <159 pg/ml in 2%, <200 p g/ml in 7.4%, and <300 pg/ml in 30.8% of the patients. There was no significant difference in the B12 levels among patients who were adherent to metformin therapy and those who were not (432 ± 206 vs. 448 ± 219 pg/ml; p=0.4). Serum B12 levels were not different in the patient with history and/or examination suggestive of neuropathy and patients who have any (443 ± 216 vs. 423 ± 204; p=0.5. Conclusions: The prevalence of vitamin B12 deficiency in diabetic patients attending Benghazi diabetic center was dependent on the cut off points used. This is comparable with previous studies. No clear relationship was evident with metformin therapy nor with neuropathy.

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Ventriculoperitoneal shunting is an established surgical treatment of hydrocephalus. However, the procedure may be associated with a variety of complications which can occur in immediate perioperative period or on follow-up. Migration of the peritoneal catheter can occur. We report an unusual case of per anal extrusion of shunt tubing in a 6-month-old infant.

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Introduction: Fasting during Ramadan is obligatory for all adult Muslims. Physicians have a pivotal role in educating and supporting patients regarding safe fasting. A few studies addressed the Ramadan specific knowledge of medical practitioners and how well equipped they are to be engaged in efficiently providing care to people with diabetes. Objectives: We aimed to appraise the knowledge, attitudes, and practices of medical practitioners regarding management of people with diabetes during Ramadan. Materials and Methods: The databases of PubMed and Google Scholar were searched using the relevant key search terms. All identified publications were reviewed. Challenges, concerns, and opportunities were identified, and proposals were made to bridge gaps in perceptions and practices. Emerging concepts: Many of the reports are either small or lacked depth. There is a remarkable degree of inconsistency in the levels of knowledge, attitudes, and practices among physicians between regions and within the same country. Lack of ethnic-competency was observed in some studies from the west. The current level of preRamadan educational activities remains patchy, inconsistent and too often mostly “ceremonial” as part of pre-Ramadan festivities organized by pharmaceutical companies. Recommendations: The call for improvement and harmonization is timely to translate guidelines into clinical practice. To this end, a widely-shared curriculum of an evidence-based syllabus is strongly recommended as the core education for physicians and other health care professions. These should be delivered by consortia of highly motivated clinicians and academics, organized by professional societies and patient advocacy bodies, accredited by national authorities and unconditionally supported by the pharmaceutical industry.

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Pancreas transplant is an important treatment option for insulin dependent diabetic patients as it may result in physiologic euglycemia. Improvements in surgical technique, graft preservation, immunosuppression, diagnosis and management of rejection, and management of post-transplant complications have led to improved patient survival. There are several technical variables to consider when performing a pancreas transplant. One is the type of exocrine drainage to be used. The most common types of exocrine drainage are enteric or bladder drainage. Gastric- exocrine drainage has also been recently introduced. The most commonly cited complications associated with bladder drainage include metabolic complications, urologic complications and the need for enteric conversion. Many complications related to bladder drainage can be managed non-operatively with Foley catheter drainage. For those complications that cannot be managed in this manner, enteric conversion is an option. Complications associated with enteric drainage include anastomotic leak and intra-abdominal abscess, although at rates lower than cited in the early literature on the topic. Bladder drainage of exocrine secretions and enteric drainage of exocrine secretions, or a staged procedure with bladder drainage followed by indicated or elective enteric conversion are reasonable options for drainage of the exocrine secretions of the pancreas. Gastric-exocrine drainage is a promising therapy deserving of future exploration.

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