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   2021| October-December  | Volume 13 | Issue 4  
    Online since December 16, 2021

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Common complications of hemodialysis: A clinical review
Elmukhtar M Habas, Aml Habas, Mohamed E Elgamal, Bara A Shraim, Moaz O Moursi, Ayman R Ibrahim, Mohamed Danjuma, Abdel-Naser Y Elzouki
October-December 2021, 13(4):161-172
Long-term hemodialysis (HD) is the main modality used in the treatment of end-stage renal disease (ESRD). It is associated with a variety of complications such as infection, amyloidosis, anemia, undernutrition, as well as musculoskeletal, and cardiovascular system (CVS) morbidities. CVS complications and HD-related infection are the main causes of death in ESRD patients on HD. Other complications such as stroke, disequilibrium syndrome occur during or post-HD. Missing dialysis sessions may lead to amongst others; death due to sudden cardiac arrhythmias; cardiac arrest due to electrolyte disturbance and/or severe overload. This review discusses the common complications of HD as well as recent advances that are likely to impact its outcome.
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Goodbye 2021
Elmahdi A Elkhammas
October-December 2021, 13(4):155-155
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Charity starts at home: Emerging Journals should receive “positive discrimination” by their regional academia
Salem A Beshyah
October-December 2021, 13(4):156-160
Scientific journals are published by commercial, no-profit, or society publishers. Most of these publishers and journals are based on the West, with the resulting gap between North and South in research work and literature productivity. This situation has resulted in a falsely perceived doubt about the value and validity of the submissions to international journals from developing regions. However, a recent increase in scientific productivity resulting from some countries' investments made into research was associated with developing many emerging national or regional journals. These journals aim to overcome barriers facing authors from producing regions to get their scholarly work published. They also aim to increase the research capacity and foster a culture of South-South collaboration. However, emerging journals face many challenges including a lack of recognition on their grounds. In this personal paper, the challenges facing emerging journals are highlighted, and the proposed urgent need for “positive discrimination” for emerging journals by regional academia is argued.
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Pharmacy practice in COVID-19 from a Middle Eastern and African perspective: A narrative review
Haider Al-Saffar, Rasha Aljazzar, Amina Al-Saffar
October-December 2021, 13(4):173-182
The coronavirus disease 2019 (COVID-19) had a worldwide impact on all aspects of life and primarily on clinical practice involving all health-care professionals. Pharmacists are at the forefront of all clinical facilities in hospitals and the community. We aimed to provide a narrative overview of the global literature on the impact of COVID-19 changing roles and pharmacists' contribution to the overall clinical care during the COVID-19 pandemic. We conducted a narrative, nonsystematic review of the international literature from a single major medical online database, PubMed, between February 1, 2020, and June 30, 2021. The relevant articles were narrated in a concise thematic account. During the COVID-19 pandemic, pharmacists had to serve their responsibilities alongside other activities while the entire world was fighting an invisible virus. However, it was much more complicated than before because the novel coronavirus is intractable. There was no vaccine or established therapeutic guidelines when it manifested suddenly. As part of an interdisciplinary team, community pharmacists may carry out their responsibilities and play an essential role in disease control and management. However, they may need to be appropriately prepared, trained, and equipped to deal with pandemic and postpandemic situations.
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The prevalence of short stature among school children and adolescents in Tripoli, Libya in 2009-2010
Mabruka Ramadan, Rowida Khashebi, Faten Ben Rajab
October-December 2021, 13(4):183-188
Background: Short stature has an impact on children's physical and mental health. Data on the prevalence of short stature in Libyan children are limited. Objectives: We aimed to ascertain the prevalence of short stature among school children in Tripoli, Libya. Patients and Methods: In this cross-sectional study, we included 419 school children (235 boys and184 girls) selected from different primary and preparatory schools in the City of Tripoli. The study was conducted between April 2009 and October 2010. Trained pediatricians took their anthropometric measurements (i.e., height and weight). The WHO-2007 Z-score charts and UK-WHO growth charts were used to calculate the prevalence of short stature (defined as standard deviation score of height <2 in same gender and age). Results: The overall prevalence of short stature using WHO-2007 Z-score and UK-WHO growth charts were 5.0% and 5.7%, respectively. (4.3% was moderate and 0.7% was severe). Boys and girls had no significant difference in the prevalence of short stature using 2007 WHO reference data (5.5% vs. 4.3%; P = 0.656). Similarly, there was no difference between the prevalence of short stature between boys and girls when applying UK-WHO growth charts (6.8% vs. 4.3%; P = 0.3). There is a statistically significant relationship between the prevalence of short stature (increase) and students' increasing age. Conclusions: Short stature is not an uncommon problem in children; they need early assessment because intervention time is crucial in this condition.
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Plasmacytoma of the ovary
Jamila Salem Elamouri, Adel Younus Shaffouh, Fairouz Abdelhadi Torjman
October-December 2021, 13(4):227-230
Extramedullary plasmacytoma is a rare plasma cell neoplasm that involves the ovary very rarely. Here, I report a case of primary ovarian plasmacytoma in a 42-year-old patient. The patient presented with abdominal distention, and workup showed a left ovarian mass (6.5 cm × 8 cm) with marked ascites. The patient had a hysterectomy with bilateral salpingo-oophorectomy. Histopathologic, immunohistochemical, bone marrow examination, and other relevant examinations established the diagnosis of primary ovarian plasmacytoma with kappa light chain restriction. No evidence of malignancy in the omentum and ascitic fluid was detected. The patient did not need postoperative chemotherapy or radiotherapy, and 6-month follow-up was uneventful. Due to the scarcity of information on these extremely rare tumors with abdominal masses, the diagnosis should be considered if complete surgical resection is achieved and no evidence of multiple myeloma is found.
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Diagnosis, staging, and associated conditions of cardiovascular autonomic neuropathy in Libyan patients with diabetes
Samia A Elmiladi, Elham O Elgdhafi, Ahmed A Shukri
October-December 2021, 13(4):215-221
Background: Cardiovascular autonomic neuropathy (CAN) can affect daily activities and patients' quality of life and evoke potentially life-threatening outcomes in diabetes mellitus (DM). Objectives: We aimed to identify and characterize CAN and associated disorders in Libyan patients with DM at National Diabetes Hospital. Patients and Methods: Ninety-nine patients with DM seen in the outpatient clinics from October 2017 to April 2018 at National Diabetes Hospital were prospectively evaluated. Assessments for CAN were made by clinical symptoms and signs, cardiovascular autonomic reflex tests, and echocardiogram. Patients with potentially confounding concomitant medical conditions were excluded. CAN is defined as possible (one abnormal cardiovagal test), confirmed (two abnormal such tests), and severe (with concomitant orthostatic hypotension and heart rate abnormality). Results: Sixty-two percent of the studied patients (mean age: 52 ± 1.5 years, 53% – female) with DM had CAN. CAN diagnosis was possible in 18% of these patients, confirmed in 6%, and severe in 38%. The presence of severe CAN was associated with hypoglycemic unawareness (P = 0.01), dyslipidemia (P = 0.012), and microvascular diabetic complications (P = 0.04). Conclusions: In this cohort of relatively old and high-risk cardiovascular disease, patients with diabetes, uncontrolled blood pressure, associated dyslipidemia, presence of microvascular complication of diabetes, and history of hypoglycemic unawareness were strongly associated with a severe form of cardiac autonomic neuropathy with potentially serious clinical consequences. Larger and more detailed studies are needed to elucidate further the complex association between hypoglycemia and cardiac autonomic dysfunction.
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Challenges in the diagnosis and management of gaucher's disease in a young adult libyan arab female
Nada B Fawaris, Mohamed E Esaadi, Ali Tumi, Aisha M Elhamedi, Ahmed Al Montasir
October-December 2021, 13(4):236-239
Gaucher's disease is a rare lysosomal storage disease that can present with a wide range of clinical symptoms according to type and severity, ranging from mild general wellbeing, organomegaly, pancytopenia, neurological symptoms, lung involvement, and even death, making the diagnosis and work up challenging to reach a diagnosis. We report a Libyan Arab female presented with bruises after minor trauma, bone aches, and fatigue. A 35-year-old female from Libyan–Arab ethnicity attended the hematology clinic complaining of bruises after minor trauma, bone aches, and undue fatigability. She mentioned and evident from her medical record that she has been suffering from these complaints for 5 years and does not have any definite diagnosis. Mild splenomegaly was the only finding on clinical examination this time. There was no fever and no lymphadenopathy. Thrombocytopenia with a platelet count 90 × 10 and quot; 3/ml, and splenomegaly of 16 cm was found on investigations. She was diagnosed with cryptogenic thrombocytopenia, and she was advised for a follow-up visit. Our patient attended a follow-up visit twice in the next 18 months with similar complaints of manageable bruising, bone pain, and fatigability. Hematology reports showed thrombocytopenia in each visit. An ultrasonogram of the abdomen revealed a gallbladder stone and spleen have a size of 17 cm. Bone marrow biopsy was done, and a blood test confirmed glucocerebrosidase enzyme deficiency. Considering the diagnosis of Gaucher's disease, treatment with imiglucerase infusion was started. Unfortunately, she failed to continue the treatment due to a shortage of supply of the medication. A few months later, she got pregnant and developed threatened abortion, which ended with a miscarriage. This case illustrates the need to consider this disease in the differential diagnoses when dealing with unexplained thrombocytopenia, anemia, hepatomegaly, and splenomegaly. There are several challenges in the diagnosis and treatment of Gaucher's disease, particularly in resource-limited settings.
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Severe hyperglycemia in an insulin-deficient patient with type 2 diabetes responding well to oral antidiabetic therapy
Akrem Y M. Elmalti, Mamoun Mukhtar, Sijomol Skaria, Wafa Harbagi
October-December 2021, 13(4):231-235
Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease characterized by a steady decline in beta-cell function and insulin resistance. As a result, most patients with T2DM may require treatment with insulin after 15–20 years of diagnosis. Various pathophysiological defects were identified leading to hyperglycemia, including reduced insulin secretion due to beta-cell failure. They reduced beta-cell mass and a defect in insulin secretion, which leads to a relative insulin deficiency in these patients requiring insulin treatment. Most international guidelines recommend starting insulin treatment in patients with poor glucose control, mainly if the glycated hemoglobin (HbA1c) is above 9% with the presence of symptoms, especially in relatively newly diagnosed patients with T2DM. We present a 45-year-old patient with T2DM of 5 years duration who attended our center with severe hyperglycemia with evidence of insulin deficiency both clinically and biochemically, who responded well to oral antidiabetic agents achieving adequate glycemic control.
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Identification of Microorganisms associated with intraamniotic infection among women with preterm birth at Ruhengeri Referral Hospital, Rwanda: A case control study
Callixte Yadufashije, Jasmine Umugwaneza, Liliane Muhimpundu, Cedrick Izere, Emmanuel Munyeshyaka, Albert O Mala, Niyonzima N Francois, Joseph Mucumbitsi, Georges B Sangano, Martin Ndayambaje, Lydia Mwanzia, Thierry Habyarimana
October-December 2021, 13(4):196-203
Background: Preterm birth is a global public health threat for maternal and child health. Each year, 15 million neonates are born preterm worldwide, with 40% resulting from intrauterine infections. Materials and Methods: This cross-sectional and case–control study was conducted from October to February 2019 at Ruhengeri Referral Hospital. A total of 120 swab samples were collected from 40 women, of which 20 were full-term delivery, while the other 20 were preterm delivery. The three samples, including the placental membranes, amniotic fluids, and fetal membranes, were collected immediately after birth. A sterile cotton swab was used to collect the samples and put into swab Stuart sterile plastic container to avoid sample contamination. Samples were transported in a tightly covered carrier to the clinical microbiology laboratory at INES Ruhengeri for microbiological investigation. Gram staining, culture, and biochemical tests were performed. The independent t-test was used to test for significant differences between the means of the two groups, while the Chi-square test (χ2) was used to test for significant association with microorganisms and intra-amniotic infections. Results: A half of the participants were in the age range of 24–29 years. Non-albicans candida (32.7%) and mold (27.9%) were the predominant microorganisms isolated. Non-albicans candida and mold were common to preterm and full-term samples. Staphylococcus species were observed in placental and fetal membrane samples. Escherichia coli, Klebsiella species, Streptococcus species, and Candida albicans were observed among women with preterm birth samples. There was a statistically significant difference between the two means in the amniotic fluid isolates (t = 4.023, P < 0.007), placental membrane isolates (t = 7.17, P < 0.0004), and fetal membrane isolates (t = 6.7, P < 0.0006). Association with microorganisms and intra-amniotic infection was statistically significant with E. coli2 = 3.98, P < 0.05), Streptococcus species (χ2 = 5.53, P < 0.019), non-albicans candida (χ2 = 8.37, P < 0.004), and C. albicans2 = 3.98, P < 0.05). Conclusions: Invasion of the amniotic fluid, placenta, and fetal membranes by pathogenic microorganisms may be associated with the incidence of preterm labor and birth. Early diagnosis is recommended to avoid both maternal and fetal complications.
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Motives for participation in physical activity among libyan adults
Sami S Elmahgoub, Hassan S Mohamed, Abduladim A Hmmier, Adel I Eltaguri
October-December 2021, 13(4):189-195
Objectives: The study aimed to determine motives for physical activity (PA) participation in Libyan adults and compare motives related to sex and places of participation (indoor vs. outdoor). Participants and Methods: A cross-sectional questionnaire-based study was conducted. The questionnaire was adapted from the Exercise Motivation Inventory version 2. Six hundred Libyan adults (300 males and 300 females) were involved in this study. Results: In general, positive health, activation, and avoiding ill-health (4.83 ± 0.89, 4.20 ± 0.93, 4.09 ± 1.00, mean ± standard deviation [SD]) were the most common motives for PA participation, respectively, while competition, affiliation, health pressure, and social status (2.73 ± 1.29, 2.69 ± 1.21, 2.59 ± 1.29, 2.50 ± 1.24, mean ± SD) were the least motivational factors, respectively. In males, enjoyment, social status, affiliation, competition, health pressure, strength, and endurance were significantly higher (P= 0.017, 0.000, 0.010, 0.000, 0.007, 0.024). In contrast, activation, positive health, weight control, appearance, and fitness were significantly higher in females (P= 0.002, 0.001, 0.000, 0.000, 0.005). In addition, health pressure, avoiding ill-health, and positive health motives were similar in adults practicing PA indoor and outdoor. In contrast, other motives tended to be significantly higher in indoor activities. Conclusions: Motives for PA participation differ across participants' sex and places of participation among Libyan adults. It is crucial to understand the motives for PA participation to capitalize on the positive motives to increase their participation and enhance the positive effects of increased PA in the community.
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Small bite closure in midline laparotomy; A practice to reduce the surgical site infection, wound dehiscence, and incisional hernia
Yaqoob Hassan, Shah Touseef Arajmand, Anayatullah Wani, Ishfaq Ahmad Gilkar, Syed Mushtaq Ahmad Shah
October-December 2021, 13(4):204-208
Background: Postoperative wound site complications are a significant source of morbidity after midline laparotomy. The study's objectives were to compare the two suture patterns for fascial closure in midline abdominal wounds and their effect on postoperative wound site complications. Materials and Methods: Over 4 years, the prospective comparative study was conducted at the Government Medical College Hospital, Srinagar. All the patients ≥18 years and ≤70 years of age underwent midline laparotomy for various indications were included. Patients were randomized to two groups using computer-generated numbers based on closure techniques. Group A; Large Tissue Bite closure (10 mm from the wound edge and 10 mm apart and Group B; Small Tissue Bite closure (5–7 mm from the wound edge and 5–7 mm apart). Effect of age, sex, body mass index (BMI), albumin, and suture bite on postoperative complications were analyzed. Results: Among 324 patients who met the inclusion criteria, the mean age was 39.17 years, 84.56% were male with a Male: Female ratio of 5.48. Two hundred and two (62.35%) patients had large tissue bite closure, and 122 (37.75%) had small bite closure. There was no statistically significant difference between the two groups concerning age, sex, albumin levels, BMI, and type of surgery. About 35.64% of patients in the large tissue bite closure group and 19.67% patients in small bite closure developed surgical site infection (SSI) (P = 0.002). The difference in wound dehiscence between the two groups (15.84% vs. 7.38%) was statistically insignificant (P = 0.29). In midline laparotomy closure, the small bites technique results in significantly less incisional hernias than the large bites technique (P = 0.00001). None of our patients expired during the study period. Conclusion: The small bite technique substantially reduces SSIs, wound dehiscence, and incisional hernia. The accident-emergency and general surgery residents, in particular, should be made familiar with this technique to avoid postoperative wound site complications and improve the quality of postoperative life.
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Ensuring smooth implementation of attitude, ethics, and communication module in medical colleges: SWOT analysis
Saurabh R Shrivastava, Prateek S Shrivastava
October-December 2021, 13(4):222-226
A successful medical practitioner is not only measured by the knowledge about the subject, ability to apply the learned knowledge, and the skillset, but also by their ability to communicate, empathize, and offer tender care and support to the patients and their caregivers. To prepare the medical practitioner to effectively discharge their roles, it is a must that active interventions are being taken during the period of medical training. In a targeted attempt to strategically bridge the existing gaps, the regulatory body in India has recommended to all the medical colleges to introduce attitude, ethics, and communication (AETCOM) module in the undergraduate training period. However, it is always nice to understand the strengths, weaknesses, opportunities, and threats (SWOT) involved in the implementation of training modules so that the intended learning outcomes can be accomplished in the due course. In conclusion, the decision to systematically introduce and expose the students to AETCOM module is a historical one in the undergraduate training period. It is the need of the hour that every medical institution performs the Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of their own setting and then devises a flexible plan to derive maximum benefit for the students.
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One-year analysis of trends of COVID-19 in Libya: Cases, deaths, and laboratory testing
Rafik R Elmehdawi, Sara A Glessa, Amal A Elfakhri, Ahmed B Elhaddad, Ahmed F Elhassi
October-December 2021, 13(4):209-214
Introduction: The coronavirus disease 2019 (COVID-19) epidemic in Libya started at the end of March 2020. Since then, the number of daily reported cases has progressively increased. Objectives: This study aims to analyze the trends and dynamics of the epidemic in Libya. Materials and Methods: The study analyzed the data reported daily by the Libyan national center of disease control. Results: The total number of tests performed per thousand people was 121.08 test/1000 people, which is a modest rate compared with countries categorized in the same income group. The overall positivity rate of all performed tests over 1 year was 18.1%. During most of the weeks, the positivity rate was far higher than the 5% rate indicating that the epidemic was out of control most of the year. The level of community transmission was moderate to substantial during most of the year, reflecting the weakness in applying the public health control measures. The calculated 1-year instant case-fatality rate of COVID-19 in Libya was 1.89%, comparable to that in other upper-middle-income countries. Conclusions: The number of performed tests in Libya during the 1st year of the COVID-19 epidemic is inadequate and must be at least doubled to increase the chances of diagnosing more potential cases. Based on the current positivity rate, the epidemic appears to be out of control since July 2021. This should urge the authorities to impose further enforcement of the standard public health measures.
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