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   Table of Contents - Current issue
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April-June 2019
Volume 3 | Issue 2
Page Nos. 35-72

Online since Monday, June 24, 2019

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EDITORIAL  

Moving toward elimination of hepatitis C in Libya: Shaping tomorrow together p. 35
Abdel-Naser Elzouki
DOI:10.4103/2588-9044.261137  
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COMMENTARY Top

Overview of leukocyte leukemoid reaction p. 37
Bashir Abdrhman Bashir Mohammed
DOI:10.4103/LJMS.LJMS_21_19  
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ORIGINAL ARTICLES Top

Efficacy and tolerability of ledipasvir/sofosbuvir on chronic hepatitis C virus patients attending viral hepatitis clinic at Benghazi medical center, Libya p. 38
Ahmed B Elhaddad, Fatimah A Nouh, Ahmed Elhassi, Samira Taher, Emad Daw
DOI:10.4103/LJMS.LJMS_8_19  
Background: The prevalence of hepatitis C virus (HCV) infection in Libya is 1.3%. It is considered now a curable disease due to the availability of effective DAAs which open a new horizon for HCV elimination. The aim of this study was to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) (Harvoni) on patients with chronic hepatitis C infection. Patients and Methods: The cohort comprises 266 HCV-infected patients followed from May 2016 to October 2017. The inclusion criteria were treatment experienced or naïve and 18 years or older. Cirrhotic patients included were Child–Pugh A and B whereas Child–Pugh C patients were excluded. All patients had been treated with LDV/SOF 90/400 mg. The primary endpoint was sustained virological response (SVR) at week 12 and significant adverse events. Results: Of 266 patients who participated in the study, it's found that 126 were males(47.3%) and 140 were female (52.7%). The average age of the patients was 45 years for both genders. Ninety percent of patients were Libyan. The predominate genotype was 4 (81.3. %), genotype 1 (15.3%), and genotype 2 (3.2%). One hundred and seventy-eight (66.9%) patients were treatment naïve and 88 (33.1%) patients were treatment experienced. Alanine aminotransferase elevated in 37% of patients at baseline. HCV RNA >5 log at the start of treatment was found in 67.2% of patients. Eighty-eight patients were cirrhotic. The adverse effects of the drug were reported in 38/266 (14.2%); the most commonly reported side effects were headache, gastrointestinal upset, and dizziness, whereas hepatic decompensation occurred in 5 patients and all were cirrhotic. Undetectable viremia at the end of treatment (week 12) was observed in 263 patients (98.5%) and 3 patients have been labeled as nonresponders. SVR at week 12 was available in 263 patients and achieved in 261 patients (98.1%), and only two relapsed. Conclusion: Excellent treatment outcomes among our cohort of HCV-infected patients were achieved with LDV/SOF. Testing for chronic HCV patients and availability of care will help in cure and a step toward eradication of HCV in near future.
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Prevalence of hepatitis C infection in hemodialysis patients: Report from 37 hemodialysis centers in Libya p. 42
Eman Gusbi, Islam Elzouki, Hafsa A Alemam, Majda Musa, Inas M Alhudiri, Nabil Enattah, Mokhtar Gusbi, Adam Elzagheid
DOI:10.4103/LJMS.LJMS_33_19  
Background/Aims: Data on the prevalence of hepatitis C virus (HCV) infection in Libya, and particularly among hemodialysis patients, are scarce. The aim of this study was to assess the prevalence of HCV infection among hemodialysis patients at 37 dialysis centers in Libya and review the demographic features in this group of patients. Patients and Methods: The present cross-sectional study included a total of 2325 patients who had spent at least 3 months in hemodialysis at 37 dialysis centers in different cities across the three main regions of Libya (Western, Eastern, and Southern regions). There were 1028 (44.2%) female and 1297 (55.8%) male with mean age 53.4 ± 15 years. Hypertension (36.4%), diabetes mellitus (33.3%), renal diseases (10.9%), genetic diseases (7.5%), and unclear reasons (12%) were diverse underlying causes of end-stage renal disease in these patients. Anti-HCV antibody was screened by a third-generation enzyme-linked immunosorbent assay technique. Results: The overall seroprevalence of HCV infection among hemodialysis patients in Libya was 16.7% (388/2325), ranging from 0% to 26.3% at different centers. The overall frequency of anti-HCV antibodies was higher in Western region (18.9%) than Eastern (18.3%) and Southern (6.1%) regions of Libya. It is noteworthy that the prevalence of HCV was 0% in numbers of dialysis centers across the three regions. The duration of hemodialysis was significantly longer in HCV-positive hemodialysis patients than in HCV-negative patients (P = 0.01). Hepatitis B surface antigen was positive in 92 hemodialysis patients (4%), of them 8 patients (8.7%) had coinfection with HCV infection. Conclusion: The present study showed an intermediate-prevalence rate of HCV infection among hemodialysis patients in Libya. The relatively low prevalence of HCV infection in the general Libyan population and HCV infection associated with a longer duration of hemodialysis indicate nosocomial transmission due to inappropriate infection control practices as the main HCV route of infection in these health-care settings.
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Regular use or on demand of inhaled corticosteroids for the management of asthma among Libyan patients in Tripoli p. 47
Walid Tarsin, Hanin Abdulgader, Esra Eshmandi, Ishraq Elshamli, Yousef A Taher
DOI:10.4103/LJMS.LJMS_71_18  
Background: A step-wise approach for the use of inhaled corticosteroids (ICSs) in the management of bronchial asthma is recommended by all the medical guidelines. However, often, ICS are used intermittently by patients and/or recommended by physicians to be used during the onset of exacerbations. Hence, the present study was aimed to evaluate whether Libyan asthmatic patients are using ICS regularly or on demand and their outcomes. Methods: The present study was conducted in Tripoli city, along a period of 10 months, May 2013–February 2014. Three hundred patients of either sex recruited from different areas of Tripoli City, diagnosed with asthma and received treatment at Tripoli Medical Center and Abouseta Hospital were participated in this study. Results: The mean age of patients (±standard deviation) was 51 years (±29.1). Our results showed that 156 patients (52%) used ICS regularly (male: 35% and female: 65%), whereas 48% (144 patients) used ICS only during attack (male: 35% and female: 65%). Of the total participants, 61% of patients stated that they had asthmatic exacerbation symptoms within 1 month after discontinued ICS use (male: 32% and female: 68%). Furthermore, 39% of patients reported that they experienced the first exacerbation of symptom after 30 days of ceased ICS use (male: 38% and female: 62%). Exposure to cold, contact with dust, and inhaler misuse were the most common reported causes of exacerbations, respectively by 71% (212 patients), 12% (37 patients), and 5% (15 patients). Conclusion: The present findings demonstrate that, practically, half of the Libyan asthmatic patients, living in Tripoli city, are using ICS on demand and few of them had experienced asthma exacerbations after ICS pause use. Hence, in order to reduce the long-term exposure to ICS and patients' cost, our present study suggests, in contrast to international standards of asthma care, the use of ICS just during attack as a new potential treatment option.
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Infection prevention and control practices among health-care workers in tuberculosis clinics in Ondo State, Nigeria p. 51
Wasiu Olalekan Adebimpe, Waheed Folayan, Abdulwahab Adewale Shittu, Maryam Abisola Adebimpe, Demilade Ibirongbe
DOI:10.4103/LJMS.LJMS_64_18  
Background: Healthcare-acquired infections are significant causes of morbidity and mortality among hospitalized patients worldwide, most especially in resource-limited settings. Similarly, the tuberculosis (TB) clinic is a high-risk area due to the nature of the clients being managed, and the infectivity of the implicated microorganism. TB infection control is an essential, but often-overlooked, component of a comprehensive infection control program in developing countries like Nigeria. The knowledge and attitude of the relevant health workers would be a determinant of their preventive practice toward preparedness and infection prevention and control (IPC) Objectives: The study assessed IPC practices among health-care workers in TB Clinic, in Ondo State, Nigeria. Methodology: A descriptive crosssectional study was carried out among 400 healthcare workers in selected TB clinics in Ondo State Nigeria, and these were selected using the multistage sampling method. Research instruments used were semi-structured self-administered pretested questionnaire. Data were analyzed using the SPSS software version 23.0. Mean scores were generated for the major outcome variables of knowledge, attitude, and practice of IPC. The P value was assumed significant at values ≤0.05 for all inferential statistics. Results: Mean age of respondents was 34 years ± 8.1 years, majority (83%) of the health-care workers had good knowledge of IPC, another majority (80%) of the health-care workers interviewed had good attitude toward IPC, 314 (78.5%) have read the guideline, while 68% of the health-care workers had good practice. Year of experience, type of facility, and facility settings were statistically significantly associated with respondents' knowledge, attitude, and practice of IPC (P < 0.05). On binary logistic regression, having working experience of >1 year, and working in a TB facility were significant predictors of good knowledge, attitude, and practice of IPC. Conclusion: There are huge gaps between knowledge and practice of IPC among respondents in this study. Since TB clinics are major sources of cross infection within the hospital setting, stakeholders have significant roles to play in IPC in the health-care setting.
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SHORT COMMUNICATION Top

Screening of probable neuropathic pain in patients with diabetes in Derna, Libya p. 57
Raga A Elzahaf, Oasma A Tashani
DOI:10.4103/LJMS.LJMS_6_19  
Background: Neuropathic pain (NeP) is one of the most frequent complications of diabetes. There is a need to obtain data about the prevalence of NeP among patients with diabetes in Libya to plan appropriate national pain management strategies. Aim: The aim of this study is to estimate the prevalence of NeP in patients with diabetes and to determine the demographic factors associated with NeP. Methods: The linguistically validated Arabic version of the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was used to screen for probable NeP. Patients with diabetes were asked to fill the questionnaire while in the diabetic center from May 2015 to October 2015. Pain intensity was measured using a visual analog scale. Results: A total of 418 patients (mean ± standard deviation [SD] of age = 56.8 ± 11.8 years) participated in this study with more women (n = 248, 59.3%) taking part than men (n = 170, 40.7%). The overall prevalence of probable NeP among patients with diabetes in this sample, classified as S-LANSS positive with a score of ≥12, was estimated to be 28.5% (95% confidence interval = 24.3%–32.9%). The proportion of females in participants with NeP was 33.5%. The mean pain intensity ± SD was 5.67 ± 2.96. No statistically significant difference was found between different age groups with regard to the presence of NeP. Conclusion: NeP is a common complication associated with diabetes in Derna, Libya. There is a need to improve the assessment and management of NeP in this population.
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CASE REPORTS Top

Life-threatening adverse reaction to a commonly used drug (drug reaction with eosinophilia and systemic symptoms syndrome) p. 61
Mohamed Khalid A. Shariff, Gamal Bashir Alfitori, Mohamed Soliman, Mohamed Ben Gashir, Abdel-Naser Y Elzouki
DOI:10.4103/LJMS.LJMS_23_19  
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is one of the severe cutaneous adverse reactions with a mortality of 10% and is characterized by hematological abnormalities and organ involvement. Many drugs have been implicated in DRESS, and most often, it is related to aromatic anticonvulsants. We hereby report a case of DRESS syndrome precipitated due to allopurinol, the diagnostic challenge it presented, and the successful treatment with corticosteroids.
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Laryngeal synovial sarcoma: A rare location p. 66
Nesrine Chraiet, Yosr Zenzri, Azza Gabsi, Amel Mezlini
DOI:10.4103/LJMS.LJMS_4_19  
Synovial sarcoma is an aggressive malignant mesenchymal tumor. Its incidence in oto-rhino-laryngeal location is very rare. A multidisciplinary management is recommended. We report the case of a 37-year-old male with synovial sarcoma of the larynx. We analyze the clinical, morphological, and therapeutic characteristics of this neoplasia through this observation.
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Acute meningitis complicated by transverse myelitis: A rare complication p. 68
Ijaz Kamal, Bushra Minhas, Rania Mohamed Elhassan Eltahir, Abdel-Naser Elzouki
DOI:10.4103/2588-9044.261139  
Acute meningitis can be complicated by intracranial complications commonly and rarely by spinal cord dysfunction. The causes of spinal cord dysfunction are cord compression, ischemic infarction of the cord, and acute myelitis. Magnetic resonance imaging (MRI) of the cord is the choice of investigation which not only helps to rule out any compressive lesion but will also confirm the diagnosis of myelitis. The usual findings of myelitis on MRI spine are the hyperintensities in T2-weighted images that predominantly involve the gray matter and usually extend from the cervical to the lumbar cord. Usually, patients are left with some residual deficits including spasticity, weakness, walking difficulties, and bowel–bladder dysfunction. We report a case of acute meningitis which was complicated by acute transverse myelitis.
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Heterotopic pancreas in the jejunum: A case report and literature review p. 71
Souad Eldruki, Sami A Lawgaly
DOI:10.4103/LJMS.LJMS_70_18  
Ectopic pancreas is the presence of the pancreatic tissue outside its typical location; it is an uncommon developmental anomaly. It may occur at different sites in the gastrointestinal tract with the stomach being the most common site. Usually, it is a silent anomaly, but it may become symptomatic when complicated by inflammation, bleeding, obstruction, or malignant transformation. In this report, a 42-year-old male case of refractory immune thrombocytopenia was admitted for elective open splenectomy. During the operation, an incidental rounded mass lesion arising from the jejunum was resected, and the diagnosis of ectopic pancreas was made after the histopathology result. Despite being a rare condition, ectopic pancreas should remain in the differential diagnosis of any jejunal mass lesion.
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