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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 4 | Issue 4
Page Nos. 157-203

Online since Monday, December 28, 2020

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EDITORIAL  

Environmental practices and serum Vitamin D deficiency Highly accessed article p. 157
Mohammed Ibn-Mas'ud Danjuma
DOI:10.4103/LJMS.LJMS_102_20  
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COMMENTARY Top

Provision of pharmaceutical services in time of COVID-19 crisis: A libyan vision Highly accessed article p. 159
Amal Yousef Benkorah
DOI:10.4103/LJMS.LJMS_48_20  
Pharmaceutical services play a crucial role in any health system. Pharmacists are the main health professionals to ensure that people have access to good and safe medicines and to make certain that these medicines are used rationally. While the role of pharmacists in providing health-care services in Libya remains restricted, the scope of pharmacy practice is vast and encompasses a variety of roles and functions. Most of today's pharmacists' services are oriented toward clinical outcomes using medicines. Therefore, pharmacists are focusing on optimizing the use of medications, promoting health, wellness, and preventing diseases. Pharmaceutical services are currently being tailored to be event driven to fit the current COVID-19 pandemic crisis and to help combat this disease and its consequences. This article discusses different pharmaceutical services that can be provided by pharmacists in all practice settings, for the Libyan healthcare system and to the society in general during COVID-19 crisis.
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REVIEW ARTICLE Top

Insulin analogs versus human insulins for the management of diabetes: An evidence-based review p. 164
Mohsen S Eledrisi
DOI:10.4103/LJMS.LJMS_96_20  
Insulin analogs are preferred by many physicians over human insulins in the management of Type 1 diabetes and in patients with Type 2 diabetes who require insulin. Insulin analogs have a pharmacological profile that is close to the normal physiological action of insulin. There is a notion among some clinicians that insulin analogs offer advantages over human insulins, including better glucose control, less hypoglycemia, and flexibility. A large number of clinical studies, along with systematic reviews, have compared insulin analogs to human insulins in regard to glucose control, rates of hypoglycemia, quality of life, and cost-effectiveness. For Type 1 diabetes, rapid-acting insulin analogs offer better glucose control and less rates of hypoglycemia compared to regular human insulin. Long-acting basal insulins result in less nocturnal hypoglycemia compared to neutral protamine Hagedorn (NPH) insulin but no difference in glucose control in patients with Type 1 diabetes. For patients with Type 2 diabetes, rapid-acting insulins offer no advantage for glucose control or rates of hypoglycemia when compared to regular insulin. There was only a reduction in rates of nocturnal hypoglycemia with no difference in glucose control with the use of basal insulin analogs compared to NPH insulin in Type 2 diabetes. The cost of insulin analogs is considerably higher than human insulins and favorable cost-effectiveness was only demonstrated with rapid-acting insulin analogs in Type 1 diabetes. The available evidence does not support the routine use of insulin analogs over human insulins. There are only few situations where insulin analogs have shown clear benefit over human insulin. In a large percentage of patients cost consideration and lack of better glucose control would favor the use of human insulins.
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ORIGINAL ARTICLES Top

Serum Vitamin D levels and associated risk factors among libyan females living in Tripoli, Libya: A cross-sectional study p. 169
Manal Hassan Al-Graiw, Marwan Mustafa Draid, Aisha Muftah Zaidi, Huda Hassan Al-Griw
DOI:10.4103/LJMS.LJMS_64_20  
Background: Vitamin D deficiency is a worldwide health problem and has been associated with religion, faith, caste, education, and socioeconomic status. Scientific evidence indicates that adequate levels of Vitamin D have important implications for the management of health problems. Aim: The aim of this study is to investigate the prevalence of Vitamin D deficiency and associated risk factors among Libyan females. Patients and Methods: This cross-sectional study included 262 female patients presented with nonspecific musculoskeletal and bone pain at Seoul Hospital in Tripoli, Libya. Vitamin D status was measured and risk factors for Vitamin D deficiency were assessed. Results: The mean age ± standard error of mean (SEM) of participants was 40.8 ± 0.9 years (range 18-80 years). In general, approximately 87.7% of the patients (n = 262) have serum Vitamin D concentrations below normal (<30 ng/mL). The mean serum 25-hydroxyvitamin D (25(OH)D) concentration of patients was 13.98 ± 10.2 ng/ml. About 50.8% had 25(OH)D-levels <10 ng/mL which is characterized as severe Vitamin D deficiency, 27.5% had 25(OH)D-levels <20 ng/ml, defined as Vitamin D deficiency. About 9.1% of patients had insufficient Vitamin D, and only 12.6% had sufficient Vitamin D status defined as 25(OH)D-levels ≥30 ng/ml. Conclusions: Our data show that patients with generalized body aches, fatigue, and nonspecific bone pains, all have a significant relationship with Vitamin D deficiency strongly related to risk factors such as inadequate exposure to sunlight, wearing covering clothes, niqab, hijab, low dietary Vitamin D intake, and Vitamin D supplementation.
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Medical waste management in dental clinics in Tripoli/Libya p. 174
Rema A. E Shampe, Raga A Elzahaf, Madi Tawfiq Abd-Elwali Al-Jaghbir, Abdelkader Battah
DOI:10.4103/LJMS.LJMS_25_20  
Background: Dental clinics are important and essential for the health and safety of individuals in the community and they are indispensable for the provision of medical and therapeutic services for the diagnosis of oral diseases, gum and teeth. As important as the other health centers, good and appropriate management of medical waste in dental clinics is very important to ensure safety for staff in the clinic. Objectives: Evaluating the level of medical waste management in dental clinics in Tripoli/ Libya. Methods: A cross-sectional study was conducted on 201 respondents: dentists, nurses, and assistants dentist chosen from 67 clinics out of 135 clinics. A questionnaire was used to two sections. The data were analyzed by using the IBM Statistical Package for Social Sciences (IBM SPSS) software, version 19.0 (SPSS Inc.). Results: 39.8% of respondents who were separating contaminated blood from non-contaminated waste and 82.1% of respondent's disposal liquid waste such as blood and saliva through the sewage network. However, there was no statistically significant difference in medical waste management between male and female dental staff in Tripoli, Libya (t = 0.376, P = 0.170). Conclusions: The methods of medical waste management practiced in the most dental clinics were inappropriate. The study demonstrated that there was lack of knowledge among workers in dental clinics regarding the disposal procedures and dealing with waste. Therefore, it is necessary to re-assess safety protocols by authorities and intervene quickly by introducing spread awareness of health and safety in dental clinics and in forcing regulations.
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Assessment of patient safety culture in benghazi children's hospital from the viewpoint of nursing staff p. 179
Ainas Salem Eltarhuni, Hajir Omar Tawfeeq, Jebril S El-Abidi
DOI:10.4103/LJMS.LJMS_79_20  
Background: patient safety is a critical component of health-care quality, and it is considered as an important issue worldwide. This study aimed to assess patient safety culture (PSC) among nurses and to investigate the areas of deficiencies for improvement. Methods: A descriptive cross-sectional study was conducted on nurses working at Benghazi Children's Hospital. A self-administered questionnaire containing 12 dimensions was used to assess the Hospital Survey on PSC including patient safety grade and number of events reported. Results: Only 87 of the total 118 distributed questionnaires were returned, giving a response rate of 73.7%. The overall positive response rate of PSC was 47%. The dimension with the highest positive score and considered areas of strength were teamwork within units (72%). The dimension with the lowest percentage of positive response rate was nonpunitive response to error (30%). Conclusion: Improving PSC should be a priority among hospital administrators. Staff should be encouraged to report errors spontaneously and without any fear.
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SHORT COMMUNICATION Top

Variation in the branching pattern of the anterior branches of the external carotid artery p. 184
Mohamed Elsllabi, Sabri Garoushi, Khaled Aneiba, Osama A Tashani
DOI:10.4103/LJMS.LJMS_53_20  
Background/Aim: External carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study was to investigate the variations in the origin of the three primary anterior branches of the ECA: superior thyroid artery (STA), lingual artery (LA), and facial artery (FA). Methods: The branching pattern of the ECA was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally to uncover the common carotid artery (CCA), internal carotid artery and ECA. The level of carotid artery bifurcation (CB) was located. Variation of the branching patterns of the ECA was assessed. Moreover, the distances between the origin sites of these vessels and the site of the CB were measured. Results: The STA was found to arise more frequently from the ECA (60%) than from the CCA (40%), with no differences in distribution between sexes or sides. Regarding the assessment of the branching patterns of the ECA, the specimens where the STA, LA, and FA emerged as individual branches were 90% of cases, linguofacial trunk cases were 6.7%, and thyrolinguofacial trunk cases were 3.3%. The distances from the vessel origin site to the CB were found to be 8.11 ± 2.77 mm, 19.38 ± 8.85 mm, and 27.95 ± 10.15 mm, for the STA, LA, and FA, respectively. Conclusions: The current findings have confirmed that the ECA branching pattern is highly variable in Thiel embalmed cadavers of Scottish population. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region could be vital to prevent iatrogenic injuries.
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Pro-inflammatory cytokine profile of pulmonary tuberculosis patients in central hospital, Agbor Nigeria p. 188
Clement Ndudi Isibor, Racheal O Okojie, Endurance A Ophori, Solomon E Omonigho
DOI:10.4103/LJMS.LJMS_41_19  
Background: The aim is to determine the pattern of cytokines secretion by assessing interleukins (IL-1, IL-6, and tumor necrosis factor-alpha (TNF-α) in pulmonary tuberculosis patients. Materials and Methods: A cross-sectional study was conducted on 146 consecutive (54 males and 92 females) sputum positive for tuberculosis and 38 apparently healthy age- and sex-matched sputum negative for tuberculosis as control were recruited between May 2016 and June 2017. A volume of 5 mL of blood samples was collected for the determination of serum IL-1, IL-6 and TNF-α using the ELISA method. Results: There was a higher cytokine mean ± standard error of the mean for tuberculosis subjects (95.77 ± 6.68 pg/mL; 107.54 ± 14.76 pg/mL, 122.09 ± 16.55 pg/ml) and controls (79.88 ± 3.53 pg/ml; 78.35 ± 6.82 pg/ml; 94.11 ± 14.08 pg/ml) for interleukin-1, interleukin-6, and TNF-α, respectively, when compared. There was strong correlation between mean values of IL-6 and TNF-α (r = 0.72315, P < 0.05). There was significance difference (P < 0.05) observed in the mean serum concentrations of cytokines among the genders (P < 0.05). Conclusion: The study revealed that IL-1, IL-6, TNF-α are important biological markers for tuberculosis disease.
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CASE SERIES Top

Primary salivary gland lymphomas: A case series p. 192
Sohaila Fatima, Rabab Nasir Mohamed Badri, Wajih Ahmed Siddiqui, Abdulrahman Alshehri
DOI:10.4103/LJMS.LJMS_51_20  
Salivary gland lymphomas are rare, constituting 1.7% of all salivary gland neoplasms. They are uncommon before 50 years of age predominantly involving parotid gland. The most common histopathological forms of non Hodgkin lymphoma include mucosa associated lymphoid tissue lymphoma followed by follicular lymphoma and diffuse large B cell lymphoma. A retrospective study was conducted in a tertiary health care centre over a span of six years on patients with salivary gland lymphomas. Their clinicopathological features, staging and treatment modalities were determined. The mean age was 63.3 years with four males and two females. All patients had parotid gland involvement with one showing simultaneous involvement of submandibular gland. Histopathologically there were three cases of low grade B-cell lymphoma, two cases of high grade lymphoma and one case of Hodgkin lymphoma. Three patients were found in early stage and three in advanced stage disease. Lymphomas must be considered in the differential diagnosis of a salivary gland swelling although they are quite uncommon. They predominantly involve parotid gland. The selection of treatment modalities is based on histologic subtyping and staging of lymphoma with better prognosis as compared to other extranodal non Hodgkin lymphoma.
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CASE REPORTS Top

A rare cause of hypocalcemia: Hypoparathyroidism, sensorineural deafness, and renal disease syndrome p. 196
Sufyan Benamer, Paul Jennings
DOI:10.4103/LJMS.LJMS_81_20  
Hypocalcemia is a common electrolyte disturbance with a variety of causes. Hypoparathyroidism, sensorineural deafness, and renal disease (HDR) syndrome is a rare autosomal-dominant genetic disorder characterized by hypoparathyroidism, sensorineural deafness, and renal disease. This is a case presentation of HDR syndrome that had been referred to a hospital with hypocalcemia. This case has a unique feature as it has been diagnosed in adult age because usually HDR syndrome is diagnosed in pediatric age group.
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SARS-CoV-2 infection associated-meningoencephalitis treated with acyclovir p. 198
Mohammad N Kloub, Mousa Ahmad AlHiyari, Jabeed Parengal, Elmahdi Errayes, Mohammed A Yassin
DOI:10.4103/LJMS.LJMS_97_20  
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection is now a pandemic distributed worldwide. All age groups are susceptible to infection, the elderly population, and those with a background of chronic medical comorbidities being particularly vulnerable for severe symptoms and complicated outcome. SARS-CoV-2 infection mainly targets 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, the viral infection is not solely confined to the respiratory system as many cases have been reported where the patients present with different bodily system symptoms without having respiratory symptoms as usual. We report a 51-year old male who presented with symptoms of fever and dry cough and was diagnosed as a case of COVID-19 pneumonia that was later complicated by meningoencephalitis. The patient underwent diagnostic neuroimaging and lumbar puncture; patient received therapy with intravenous acyclovir and intravenous ceftraixone and improved with a favorable outcome. Meningioencephalitis is a serious neurological complication of SARS-CoV-2 infection and should be suspected in patients who develop signs and symptoms suggesting this condition, and we aim from publishing this case to draw attention to this serious complication.
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Facial and oropharyngeal angioedema after tenecteplase treatment of acute myocardial infarction p. 201
Aboubaker Alzwi, Anis Abobaker, Ali Rageb Fietoury
DOI:10.4103/LJMS.LJMS_65_20  
Angioedema and type I allergic reactions are rare but recognized side effects of thrombolytic drugs. They are more commonly reported during or after the treatment of acute ischemic stroke with alteplase compared to myocardial infarction (MI). Herein, we present a 68-year-old male patient who developed oropharyngeal and facial angioedema and urticarial skin rash on the upper limbs after treatment of acute MI with tenecteplase.
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