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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 5 | Issue 2
Page Nos. 41-103

Online since Friday, July 23, 2021

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EDITORIAL  

Performance evaluation of seven commercial reverse transcription polymerase chain reaction assays for SARS-COV-2 detection: Real time polymerase chain reaction assays and the COVID-19 pandemic p. 41
Mohammed I Danjuma, Shahda Mohamed Alahsan
DOI:10.4103/ljms.ljms_36_21  
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ORIGINAL ARTICLES Top

Predictors of clinical relapse in patients with new-onset inflammatory bowel disease: A retrospective single-center study p. 42
Hao Wu, Delin Tian, Hao Cai, Renjie Gong, Kaixiao Kun, Can-Xia Xu
DOI:10.4103/LJMS.LJMS_106_20  
Background and Aims: Inflammatory bowel disease (IBD) usually follows a pattern of more or less frequent relapses of alterable duration, interspersed with periods of remission. Various clinical predictors have been broadly studied, but the research study populations reported are mostly from Western countries. Methods: From January 2013 to December 2018, 106 new-onset Crohn's disease (CD) patients and 76 new-onset ulcerative colitis (UC) patients were followed up for a median of 12 months or until relapse. The predictors of clinical relapse were analyzed according to demographic, clinical, histological, endoscopic, and imaging variables. Results: In multivariate analysis, predictors of relapse were age of onset <35 years (hazard ratio [HR] = 5.236; 95% confidence interval [CI] 1.252–22.222; P = 0.023) in CD patients and poor medication adherence (HR = 2.070; 95% CI 1.018–4.202; P = 0.044) in UC patients. Conclusion: Younger age of onset and poor medication adherence increases the risk of clinical relapse in CD and UC, respectively.
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Prevalence of H63D and C282Y mutations in hereditary hemochromatosis (HFE) gene in Tripoli region of Libya p. 49
Laila Mohamed Elghawi, Kaltoom Hassan Mahanna, Abdulla M Bashein
DOI:10.4103/ljms.ljms_27_21  
Background and Aims: Hereditary hemochromatosis (HH) is an autosomal recessive disorder, characterized by increased intestinal absorption of iron. Excessive amount of iron accumulates in the liver, pancreas, and heart, etc., and eventually leading to organ failure due to iron toxicity and death if untreated. The most common causes of HH are the C282Y and H63D mutations in HFE gene. This study aimed to identify the prevalence of H63D and C282Y alleles among the Libyan population in Tripoli region and to compare the results with other published data. Materials and Methods: This study included 300 randomly selected unrelated Libyan male blood donors, aged between 18 and 50 years. In-house hydrolysis probe real-time polymerase chain reaction and high-resolution melting analysis protocols were developed and employed as screening tools for H63D and C282Y genotyping, respectively, and direct DNA sequencing was used to confirm the results. Results: Seven subjects (2.33%) were detected as homozygous H63D mutation and 72 (24%) were detected as heterozygous, and only one subject was detected as a heterozygous C282Y mutant (0.33%) and no homozygous C282Y mutation was detected. Conclusion: In Libyans residing in Tripoli region, the allele frequency of C282Y was very rare and allele frequency of H63D was common.
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Performance evaluation of seven commercial real-time polymerase chain reaction assays for SARS-COV-2 detection p. 56
Mouna Mohamed ElJilani, Mohamed Abdusalam, Adel Abdalla, Tarek Dalyoum, Salah Ahmad, Inas Alhudiri, Adam Elzagheid
DOI:10.4103/ljms.ljms_5_21  
Background/Aim: Since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) pandemic in Wuhan, China, several efforts are being focused on the development of fast and reliable diagnostic molecular tests. Real-time polymerase chain reaction (RT-PCR) based assay on respiratory specimens was recommended by the World Health Organization as the gold standard for early diagnosis of infection spread. Our study aimed to compare the analytical performance of seven commercially available RT-PCR assays. Materials and Methods: A total of 33 nasopharyngeal swabs were analyzed by: Da An, PerkinElmer, Norgen, Prestige, PhoenixDX, Bio-Speedy, and Xpert Xpress RT-PCR assays. Sensitivity and detection rates of SARS-COV-2 target genes were analyzed. Results: Da An and Xpert Xpress assays showed the highest detection rate and percentage for SARS-COV-2 target genes; (16/33) 48.5%, followed by PerkinElmer and Norgen kits (13/33) 39.4%, (10/33) 30.3%, respectively. However, Prestige, PhoenixDx, and Bio-speedy displayed the same performance (6/33) 18.2%. Conclusion: The analyzed assays showed inconsistent analytical performance. Overall, findings reported in our study may not be applicable to other RT-PCR assays or thermocyclers; analytical sensitivities and positive-negative cut-off values should be locally validated.
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Clinical indications and arrhythmic patterns of 24-h holter electrocardiography among cardiovascular disease patients p. 61
Rerdin Julario, Eka Prasetya Budi Mulia, Ivana Purnama Dewi, Ruth Irena Gunadi, Budi Baktijasa Dharmadjati
DOI:10.4103/ljms.ljms_11_21  
Background: This study aimed to evaluate the clinical indications and arrhythmic patterns in cardiovascular disease patients who were referred for Holter electrocardiography (ECG) in Dr. Soetomo General Hospital, Surabaya, Indonesia. Methods: A retrospective cross-sectional study was held at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Patient's data, including Holter ECG, was obtained from the local Holter Registry between July 2019 and December 2019. Results: A total of 89 patients were included in this study. The mean age was 50.1 ± 16.0 years old, and 48 patients (53.9%) were females. The most common indication was palpitation (39.3%) followed by the history of arrhythmia (14.6%), shortness of breath (13.5%), and chest pain (12.4%). Ventricular ectopic (VE) and supraventricular ectopic (SVE) were the most common arrhythmia in 70.8% and 12.4% of subjects, respectively. About 20.2% of patients had frequent VE, and Lown's Grade 4 was the most prevalent VE accounting for 45.9% of patients among all VE events. A total of 5.6% of patients had episodes of atrial fibrillation. Frequent SVE was found in 4.5% of patients, whereas 5.6% had supraventricular tachycardia. About 3.4% of patients had abnormal atrioventricular conduction, and 4.5% had chronotropic incompetence. Conclusions: Palpitation of unknown etiology was the most common clinical indication for Holter ECG among our patients. The most prevalent arrhythmias were VEs and SVEs, with Lown's Grade 4 being the most prevalent VEs. Holter ECG in patients with that indication was reasonably high diagnostic yield in detecting arrhythmia.
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Clinical characteristics and management practice among patients diagnosed with atrial ibrillation in Benghazi Libya, A cross sectional study p. 66
Abdelhadi H Elkadiki, Mohammed A Ali, Khaled D Alsaeiti
DOI:10.4103/LJMS.LJMS_3_21  
Introduction: There are no data so far regarding the frequency and outcome of the different types of atrial fibrillation (AF) in the clinical setting for Libyan patients. Furthermore, it is unknown whether the actual clinical management and therapy of AF in Libya conform to the international guidelines. The aim of this study was to determine the frequency, demographic, and clinical characteristics of AF patients. Patients and Methods: Three hundred patients attending the outpatient clinic and cardiology department at Benghazi Medical Center and National Cardiac Center between May 2020 and October 2020 were included. Patients' data were obtained through medical records using the chart review. Patients were categorized into a clinical type of AF, based on the physician's perception of the AF at the time of presentation. Results: Three hundred patients with an established diagnosis of AF were enrolled, including 210 (70%) females and 90 (30%) males. The mean age at the time of diagnosis was 49.5 ± 21.5 years, with an age range of 29–79 years. Of them 139 (46.3%) were diagnosed as permanent AF, 132 (44%) paroxysmal AF, while new-onset AF was diagnosed in 29 (9.7%). The three clinical categories of AF were enrolled under the care of both cardiologists and internal medicine physicians, but permanent AF patients were more often enrolled under the care of a cardiologist. Patients with permanent AF were older compared with those with paroxysmal subtype (61.8 ± 9 and 50.1 ± 12, respectively), with significant female predominance (P = 0.03), and more often had coronary artery disease (CAD), valvular heart disease, and a previous stroke/TIA (P = 0.01, P = 0.124, and P = 0.002, respectively). Diabetes was the most prevalent associated medical condition, followed by hypertension and hyperlipidemia. CAD was diagnosed among 122 patients. Of permanent AF patients, 28 patients (20.1%) previously suffered from a stroke, mostly TIA, in contrast to 14 patients (10.6%) of the other AF patients. Conclusion: Our AF patients were characterized by an unfavorable cardiovascular risk profile. We recognize a lower rate of oral anticoagulation prescription, which needs further evaluation.
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The etiology of infertility in the western region of Libya: An investigation of medical records p. 70
Abdallah Eldib, Osama A Tashani
DOI:10.4103/ljms.ljms_21_21  
Aim: The aim of this study is to investigate the etiology of infertility in couples seeking medical help from the Infertility Clinics and gynecological departments in hospitals in Western Libya. Patients and Methods: Data were collected directly from patients' medical records. However, additional data were collected through interviews. Results: The total number of couples recruited was 135. Men (mean ± standard deviation of age = 41.7 ± 7.0 years) were significantly older than women (35.2 ± 6.5 years) (P = 0.001). Women were more likely to marry younger than men (mean difference = 6.5 years, 95% confidence interval [CI] =5.1–7.8 years) and the duration of all participant's marriages before the interviews was 9.0 ± 5.0 years. The causes of fertility were as follows: 33 (24.4%) (95% CI 17.16–31.64) cases were due to a female factor, 92 (68.1%) (95% CI = 60.24–75.96) cases were due to a male factor with 6 (4.4%) (95% CI 0.94–7.86) cases of combined male and female factor and 4 (3%) (95% CI = 0.12–5.88) cases without explained cause. Out of all patients, only 13 (4.8%) (95% CI = 2.25–7.35) were cases of secondary infertility and 257 (95.2%) (95% CI = 92.65–97.75) were cases of primary infertility. In females, the most common causes of infertility were ovulation disorders with 40 (23.4%) (95% CI = 17.05%–29.75%), polycystic ovary syndrome with 23 (13.5%) (95% CI = 8.38%–18.62%), irregular or no menstruation with 19 (11.1%) (95% CI = 6.39%–15.81%). The most frequent findings in males were 76 cases (31.0%) (95% CI = 25.21%–36.79%) asthenospermia, 75 cases (30.6%) (95% CI = 24.83%–36.37%) showing teratospermia and 56 (22.9%) (95% CI = 17.64%–28.16%) with oligospermia. Conclusions: Infertility due to male factor in Libya (approximately 70%), was very high compared to data from other regions of the world. Infertility due to the female factor is comparable to other regions of the world. The main cause for female factor infertility was ovulation disorders. Further research of infertility in other parts of the Middle Eastern and North African region is needed. This research must combine epidemiological, medical, and social investigations to find the main causes of infertility in the region.
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Frequency of rhabdomyolysis in patients treated with statins in hamad general hospital, Qatar p. 75
Abdelmonem Badawi Yousif, Ebtihal Abdelmoneim Hassan, Mutie Ullah Ahmed, Mona S Lashin, Neathu Maria Kunjumon, Theeb Osama Sulaiman, Maram Saliba, Amer A Shier, Mona M Babikir, Walaa A Saeed, Ahmed Ali Farghaly, Fahmi Yousef Khan
DOI:10.4103/ljms.ljms_13_21  
Background: Statins are well tolerated but associated with various statin-associated symptoms, including statin-associated rhabdomyolysis. Objectives: The aim of this study was to evaluate the frequency of rhabdomyolysis in patients treated with various statins and to describe their clinical features and outcomes in our local setting. Patients and Methods: This retrospective cross-sectional study was conducted at Hamad General Hospital and included all patients who received statins for the period between January 1, 2017, and November 31, 2017. Results: Out of 1000 cases involved in this study, 3 cases (0.3%) met the criteria for rhabdomyolysis. Two of them were males and the third was a female. Two cases received simvastatin and one case received rosuvastatin. All developed muscle pain and were hospitalized, during which all patients were treated with drug withdrawal and hydration. Upon discharge, rosuvastatin was replaced by atorvastatin, while simvastatins were replaced by atorvastatin and rosuvastatin. Conclusion: Rhabdomyolysis is a recognized but rare side effect of statins that should not be a reason to limit the use of life-saving statin therapy.
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Prevalence of bacterial vaginosis and their antibiotic susceptibility among women attending different private clinics in Tripoli, Libya p. 79
Ahmed Atia
DOI:10.4103/ljms.ljms_9_21  
Background: Bacterial vaginosis is a worldwide issue due to the raised risk of acquisition of sexually transmitted infections. The aim of the study was to assess the incidence of bacterial vaginosis and their antimicrobial pattern in women attending different private clinics in Tripoli, Libya. Methods: A cross-sectional study was conducted among 204 women between January and October 2020. Gram-stained vaginal swabs were examined microscopically, characterized by colony morphology, and their antimicrobial susceptibility pattern was determined. Results: The overall prevalence of bacterial vaginosis was 41%. Out of 48 bacterial isolates, 76.1% were gram-positive and 23.8% were Gram-negative bacteria. The overall drug resistance level of gram-positive bacteria was high against penicillin, co-amoxiclav, and amoxicillin. Vancomycin and imipenem were the most active drugs against Gram-positive bacteria. High level of drug resistance of Gram-negative bacteria against co-amoxiclav. Ceftriaxone, cefotaxime, and amikacin were the most active drugs against Gram-negative bacteria. Conclusions: The prevalence of bacterial vaginosis was high. Routine culture of vaginal samples should be performed on patients with vaginitis and the drug susceptibility pattern of each isolate should be determined.
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Which preoperative findings translate to a positive intraoperative cholangiogram? p. 83
Mohamed Ali M. Elmusbahi, Jacobus Christoffel Kloppers
DOI:10.4103/LJMS.LJMS_107_20  
Background: The most common investigations used in the preoperative diagnosis of choledocholithiasis are ultrasound and liver function tests (LFTs). These modalities have a low sensitivity for detecting common bile duct stones among the intermediate-risk groups. Aim: The aim of the study is to identify preoperative findings which predict choledocholithiasis in intermediate-risk groups. Describe the implications of a positive intraoperative cholangiogram (IOC). Materials and Methods: A retrospective study of all consecutive laparoscopic cholecystectomies with IOC performed. Data were collected over the past 2 years between January 1, 2015, and December 31, 2016. Standard demographic variables, preoperative symptoms, LFTs, IOC findings, abdomen ultrasound, and postoperative symptoms were included in the study. Results: Of 237 laparoscopic cholecystectomies 23 cases were planned for IOC. The median age was 41 years. Seventeen cases were female. Indications were 12 biliary colic, eight gallstone pancreatitis, two cases of acute cholecystitis, and one case was for ascending cholangitis. Four cases had a positive IOC, and in this group, the median age was 44.5 years with one male. The mean common bile duct diameter was 6.5 mm. Two patients had biliary colic, one patient gallstone pancreatitis, and one acute cholecystitis. One patient had a history of jaundice, and all four cases had elevated gamma-glutamyl transferase (GGT) above 40 mmol/l, three cases had alkaline phosphatase (ALP) above 98 mmol/l. Postoperative, out of 23 cases, five cases had an endoscopic retrograde cholangiopancreaticogram, repeated ultrasound in three cases, persistence symptoms in four cases. Conclusions: GGT was the strongest predictor of choledocholithiasis. A normal GGT seems to be quite good at ruling out Cannabidiol stones. ALP was less accurate. Gallstone pancreatitis is not a good predictor, but it is importance to exclude choledocholithiasis before/during cholecystectomy. There is no relation between the IOC and persistent symptoms.
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CASE REPORTS Top

A rare case of acute mechanical intestinal obstruction due to isolated mesenteric panniculitis p. 87
Ramazan Sari, Mehmet Zeki Buldanli
DOI:10.4103/ljms.ljms_34_21  
Mesenteric panniculitis is a rare benign fibrotic condition that manifests with acute or chronic inflammation. It commonly affects small bowels whereas the mesenteric adipose tissue of large bowels is less commonly (20%) involved. In literature, there cases, mostly children and adolescents, where surgery has been used to relieve compression symptoms. We present a rare case of an adult patient who presented with acute mechanical intestinal obstruction secondary to isolated mesenteric panniculitis. We present this case to highlight the fact that this rare condition can cause acute mechanical intestinal obstruction even in adult patients and should be factored into the differential diagnosis.
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Posterior reversible encephalopathy syndrome: An acute neurological complication of blood transfusion p. 90
Madhavi Karri, Balakrishnan Ramasamy, Santhosh Perumal, Karthik Thamarai Kannan
DOI:10.4103/ljms.ljms_89_20  
Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition with characteristic clinical and radiological features. PRES occurring as a complication post blood transfusion is reported to be rare, irrespective of the presence of an underlying hematological disorder. Here, we describe a case of a 37-year old female known case of chronic anemia secondary to menorrhagia, who received three units of packed red blood cells transfusion and there was raise in hemoglobin from 6 gm/dl to 11 gm/dl. Four hours after the last transfusion, she developed occipital headache with neck pain and presented to us with two episodes of generalized tonic-clonic seizures after four days of symptoms onset. With this clinical picture in correlation with magnetic rsonance imaging findings, features were consistent with PRES. PRES is contemplated as one of the acute transfusion reactions but a rare entity, which is often preventable.
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Urogenital schistosomiasis in libya, a case report and evaluation of the current situation p. 93
Walid K Saadawi, Aisha S Gashout, Nadia M Aldobea, Ahmad Y Amro, Badereddin B Annajar
DOI:10.4103/ljms.ljms_17_21  
Urogenital Schistosomiasis is a parasitic worm disease caused by Schistosoma haematobium and transmitted through the penetration of the human skin by swimming infective larva (Cercaria). Here, we report a new sporadic case of Urinary schistosomiasis in Ubari city in South-West Libya. A 25-year-old male was presented with a history of hematuria, backpain, abdominal, and kidney pain since 2017. The diagnosis of urogenital Schistosomiasis was confirmed by microscopic identification of terminal-spined schistosome eggs and red blood cells in urine samples. The patient was treated with a single dose of 40 mg/kg Praziquantel. By follow-up, a complete recovery of urinary symptoms was observed with no evidence of schistosome eggs in urine. In conclusion, the local health authorities should take proper measures to establish new elimination programs of schistosomiasis, and to increased awareness of this especially in old endemic areas where reemerging of schistosomiasis is most likely.
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Psoriasis flare-up and new-onset psoriatic arthritis induced by severe acute respiratory syndrome coronavirus 2 infection p. 96
Mohammad N Kloub, Mousa Ahmad AlHiyari, Mohamed A Yassin
DOI:10.4103/LJMS.LJMS_98_20  
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, discovered in December 2019 in China is now a pandemic affecting >200 countries worldwide. The general population is susceptible to infection, however elderly people and those with a background of chronic medical illnesses are at increased risk for severe symptoms and complicated outcomes. The SARS-CoV-2 virus usually establishes itself and replicates in the respiratory system and can establish infection in the upper part of the respiratory tract as well as the lower part of the respiratory tract, presenting in a spectrum ranging from asymptomatic infection reaching up to severe acute respiratory distress syndrome,; however, SARS-CoV-2 infection can affect other systems of the human body as many cases have been reported where the patients present with different bodily system symptoms without having respiratory symptoms as usual. We report a case of a 44-year-old male patient who had a psoriasis flare-up and new-onset psoriatic arthritis likely induced by SARS-CoV-2 infection.
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Diffused alopecia followed by severe acute respiratory syndrome coronavirus-2 infection p. 100
Shatrughan Pareek, Nitesh Kumar, Chandraprakash Chouhan
DOI:10.4103/LJMS.LJMS_109_20  
Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection has a wide range of consequences of human body. In the literature, only a few cases with uncertain hair fall related to COVID-19 infection. In the case report, we enumerated a case of 33-year-old female with alopecia followed by SARS-Cov-2 infection. On the visit, the patient was afebrile; vitals were within normal range and breathing normally. The patient was not suffering from any stress, and her psychological status was sound. Physical examination revealed asymptomatic alopecia on the temporal region of her scalp. The scalp area was smooth, and there was no inflammation was there. The pull test outcome was positive. The patient was managed with topical lotions and biotin supplements. After 1 month, the hair fall was limited and pull test found negative. No cutaneous infection was observed on the scalp. The present case showed alopecia as a rare complication of SARS-Cov-2 infection. Early initiation of the therapy can decline the consequences of alopecia among SARS-Cov-2 patients.
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LETTER TO EDITOR Top

Tuberculous splenic abscess in a nonhuman immunodeficiency virus patient p. 102
Abhishek Juneja, Rajat Jhamb
DOI:10.4103/LJMS.LJMS_36_20  
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