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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 3 | Issue 4
Page Nos. 111-149

Online since Thursday, December 26, 2019

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REVIEW ARTICLE  

The risks and the benefits of early invasive strategy compared to conservative strategy in elderly patients with non-ST-elevated myocardial infarction or unstable angina: a systematic review and meta-analysis p. 111
Idris M Idris Elghazali, Sabri Garoushi, Osama A Tashani
DOI:10.4103/LJMS.LJMS_55_19  
Background and Aim: Compared with their younger counterparts, the elderly with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTMI) has been proven to have worse outcomes. People with UA/NSTEMI are managed with a combination of medical therapy, invasive angiography, and revascularization. A systematic review and meta-analysis was conducted to compare the effects and the benefits associated with the routine invasive approach versus a conservative or “selective invasive” approach for the management of UA/NSTEMI in the elderly. Methods: Data from randomized controlled trials (RCTs) were identified through search strategy filters. Five search engines and databases were searched systematically, namely PubMed, CINAHL, ScienceDirect, Web of Science, and Cochrane Library. The primary outcome of the analysis was the composite of all-cause death and myocardial infarction (MI). Results: Four RCTs with total of 3016 patients were eligible. We calculated the log risk ratio with 95% confidence intervals (CIs) for the primary endpoints of all-cause death and MI. The study analysis did not show appreciable risk reductions in all-cause mortality (log risk ratio: 0.142 and 95% CI = 0.363–0.78, 4 studies, 3016 participants, and low-quality evidence). However, it shows that there was a significant risk reduction in the incidence of MI (log risk ratio 0.519, 95% CI = 0.707–0.331, 4 studies, 3016 participants, and low quality of evidence). Conclusion: A routine invasive approach in the elderly with UA/NSTMI was not associated with any significance in terms of mortality compared with conservative approach. However, research suggests that the invasive strategy may have particular benefit in the elderly who are at high risk for recurrent events and that patients at low risk for a recurrent event may even suffer harm from such strategy approach.
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ORIGINAL ARTICLES Top

Sofosbuvir and daclatasvir in the treatment of chronic hepatitis c virus infection at benghazi medical center: Our experience p. 119
Ahmed Elhaddad, Ahmed Elhassi, Ghada M Hadiia, Samira Taher, Zineb Badr
DOI:10.4103/LJMS.LJMS_61_19  
Background: The treatment of hepatitis C virus (HCV) has changed dramatically with the rapid advent of numerous new antiviral agents, including direct-acting antivirals which become the standard of care for HCV infection. Our aim was to investigate the safety and efficacy of combined sofosbuvir (SOF)/daclatasvir (DCV) for HCV in our patients. Patients and Methods: The cohort comprises 157 HCV-infected patients followed from October 2016 to May 2018. The inclusion criteria were treatment experienced or naïve and 18 years or older. Cirrhotic patients included were Child-Turcotte-Pugh A (CTP-A) whereas CTP-B-C patients were excluded. All patients had been treated with SOF/DCV 400/60 mg with or without ribavirin. The primary endpoint was sustained virological response at week 12 (SVR12) and significant adverse events. Results: A total of 157 patients were enrolled in the study with a mean age of 47.74 ± 18.2 years including 48.2% males. Ninety percent of patients were Libyan. One hundred and fifteen (72.9%) patients were treatment naïve. Fifty-eight (36.9%) patients were cirrhotic. The adverse effects of the drug were reported in 25/157 (15.9%); the most commonly reported side effects were gastrointestinal upset and dizziness, whereas hepatic decompensation occurred in five patients and all were cirrhotic and none required drug cessation. Undetectable viremia at the end of treatment was observed in 156 patients (99.3%), and one patient had been labeled as nonresponder. Undetectable viremia 12 weeks after the end of treatment was achieved in 155 patients (98.8%), and only one relapsed. Conclusion: SOF and DCV are safe and efficacious with an SVR12 of about 99.0% among our cohorts. The next step is to improve screening and access to these therapies for eradication of hepatitis C infection from the world and Libya as well in the near future.
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Prevalence of high-risk human papillomavirus types 16 and 18 among libyan women in tripoli libya p. 125
Hani Alzaquzi, Lubna Almaghur, Ahmed Eshagrouni, Omar Elahmer, Abdulla Bashein
DOI:10.4103/LJMS.LJMS_44_19  
Background and Aims: Despite the well-known association between human papillomavirus (HPV) and cervical cancer, yet there are no available data concerning the prevalence of HPV and its type distribution among Libyan women. The aim of this study was to investigate the prevalence of the most common high-risk HPV types 16 and 18 among Libyan women in Tripoli and to compare it with the cytological findings of the cervix. Methods: A total of 132 cervical samples were collected from women who sought medical attention at the gynecology outpatient clinic of the Tripoli University Hospital and other gynecology private clinics in Tripoli region. Cervical cytological status was classified according to the Bethesda System 2014. Quantitative polymerase chain reaction was used to facilitate the specific detection of HPV types 16 and/or 18. Results: The cytopathological examination showed that 92.4% of women had normal cervical cytology (n = 122/132) and 7.5% (n = 10/132) of them had cervical lesions. The overall prevalence of the most common oncogenic HPV types was 4.5%, as only six samples (n = 6/132) were confirmed of harboring HPV-DNA. Concerning the cytological status of the cervix, HPV-DNA was not found (0%) in women with a normal cervix, and it was present in 60% of women with cervical lesions. The high-risk HPV type 16 was the exclusive type among our all positive samples, with no detection of HPV type 18 among all our recruited subjects. Conclusion: Even though our findings showed a low overall prevalence of high-risk HPV types among Libyan women, the burden of HPV 16 among women with cervical lesions highlights the need to raise attention toward expanding research about HPV and adopt measures to prevent cervical cancer by vaccination and national screening program. The introduction of HPV-DNA testing in cervical cancer management will greatly benefit early-stage HPV detection and help prevent cervical lesions from progression to cancer.
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Genotoxic risk evaluation of cleaning workers p. 131
Lale Donbak, Emine Kasan, Ahmet Kayraldiz, Erman Salih Istifli
DOI:10.4103/LJMS.LJMS_48_19  
Background and Aim: Cleaning agents are used in large quantities by millions of people throughout the world for disinfection and surface maintenance. Although there is a complex pattern of exposure to cleaning agents and resulting health problems among cleaners, genotoxic risks of cleaners as an occupational group are uncertain. In the present study, possible genotoxic effects of exposing to cleaning agents in peripheral lymphocytes of cleaners were investigated. Materials and Methods: In this study, possible genotoxic risks of cleaning workers were investigated by sister chromatid exchange (SCE) and chromosomal aberrations (CAs) tests. The frequencies of SCE and CA were determined in peripheral blood samples taken from 32 cleaning workers exposed to cleaning agents and 20 healthy controls as the control group. Cell kinetic parameters of mitotic index (MI) and proliferation index (PI) were also detected for determining the possible cytotoxic effects. Data analysis was perfomed using SPSS (17.0) package program. Results: A significant SCE formation was found in the peripheral blood of cleaners in comparison with the control group (P < 0.05). Similarly, the differences in the SCE values between nonsmoker cleaners and the nonsmoker control group were statistically significant (P < 0.05). However, CA value determined for cleaners did not show a statistically significant difference from that of control group (P > 0.05). The CA values were correlated with both the working period and the ages of the cleaning workers. No marked differences were detected concerning PI and MI indices between the workers and controls. Conclusion: The results of this study suggest that cleaning workers may have weak genotoxic risk due to occupational exposure.
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Colonoscopy appropriateness in a libyan hospital: The experience with a modified open-access system p. 136
Abdelhakim M Elbarsha, Yussef Al Ghoul, Mohamed F Ali
DOI:10.4103/LJMS.LJMS_53_19  
Background and Aim: In the absence of guidelines for referring patients for colonoscopy in the Benghazi Medical Center, the use of a modified open-access system of referral may decrease the rate of inappropriate colonoscopies. This study aimed to assess the impact of modified open-access system of referral on colonoscopy appropriateness using the American Society of Gastrointestinal Endoscopy guidelines as a reference. Subjects and Methods: In this observational, cross-sectional, and retrospective study, all colonoscopies performed in the Benghazi Medical Center during the period from January 1, 2015, to December 31, 2016, were retrospectively studied. Colonoscopy reports were retrieved from the paper-based hospital medical archives. Results: After exclusion of colonoscopy records with inadequate data, only 344 colonoscopies were included in the study. Three hundred and nine (89.8%) colonoscopies were found to be appropriate and 35 (10.2%) were inappropriate. The most common appropriate indication was rectal bleeding (61, 19.7%). Examination results were negative in 135 (39.2%) and positive in 209 (60.75%) colonoscopies. Among colonoscopies with positive findings, the number of colonoscopies with positive relevant findings was 126 (60.3%). Of these, the indication was appropriate in 122 (96.8%) and inappropriate in 4 (3.2%) colonoscopies. Appropriate colonoscopies were significantly more likely to be associated with positive relevant findings (P = 0.0029). Conclusion: Modified open-access system of colonoscopy referral increases the rate of appropriate colonoscopies, even if no definite guidelines for colonoscopy appropriateness are followed, neither by referring physicians nor endoscopists.
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CASE REPORTS Top

Unusual cause of seizure p. 141
Rania Mohamed Elhassan Eltahir, Nagham Sadik, Khalid Salem
DOI:10.4103/LJMS.LJMS_19_19  
Dural arteriovenous fistula (DAVF) manifestations vary from headache to serious intracranial bleed, but very rarely present with seizure. The presentation is usually in the adult period, but there are citied cases in childhood. The diagnosis is challenging and mainly radiological, plain computed tomography (CT) brain can be normal if no bleed, and therefore, CT angiography and magnetic resonance imaging are the most reliable tools in the diagnosis of DAVF. Here, we report a rare case of dural fistula in an old male who presented with seizures and treated by endovascular intervention, which is one of the rare cases in Qatar.
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Importance of single-photon emission computed tomography/computed tomography in detection of meckel's diverticulum in a 19-year-old female patient p. 144
Intidhar El Bez Ghanem, Mukhtar Alqadhi, Iqbal Munir, Rima Tulbah, Fahad Alghmlas, Mohammed Alharbi
DOI:10.4103/LJMS.LJMS_31_19  
Planar scintigraphy using technetium-99m pertechnetate is widely used in the diagnosis of Meckel's diverticulum. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging may help to localize the Meckel's diverticulum lesion. We present a case of a 19-yearold lady with recurrent lower gastrointestinal tract bleeding. She underwent Tc-99m pertechnetate scintigraphy. The planar images showed two foci of increased uptake located in the lower abdomen and at the level of the right kidney. The one located at the right kidney level could be physiological uptake or by an ectopic gastric mucosa. Using SPECT/CT technique, we confirmed that the lower part of the concentration was from a Meckel's diverticulum from the small intestine based on the functional and anatomical information together; however, the upper uptake was physiological right proximal ureteric uptake. Our case study suggests that SPECT/CT imaging needs to be considered to obtain a definitive diagnosis, mainly with cases with ambiguous planar scintigraphy images.
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X-ray and ultrasound findings in calcinosis cutis p. 147
Abhinav Aggarwal, Nidhi Bhatnagar, Akshay Kapila, Preeti Sharma, Ankit Dubey
DOI:10.4103/LJMS.LJMS_65_18  
Deposition of calcium and phosphorus in cutaneous or subcutaneous tissues is termed as calcinosis cutis. Clinical presentation extends from induration of skin to nodular swellings. The clinical presentation can lead to formulation of faulty diagnosis like infective etiology. Use of imaging modalities is often required to formulate correct diagnosis. We describe two cases of calcinosis cutis occurring in neonates.
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