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   Table of Contents - Current issue
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January-March 2021
Volume 5 | Issue 1
Page Nos. 1-39

Online since Saturday, April 10, 2021

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EDITORIAL  

Does COVID-19 influence the platelet indices? Highly accessed article p. 1
Bashir Abdrhman Bashir
DOI:10.4103/LJMS.LJMS_108_20  
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REVIEW ARTICLE Top

Coeliac disease etiology and pathogenesis p. 2
Ali Khalifa A. Elmdaah
DOI:10.4103/LJMS.LJMS_87_20  
Coeliac disease is a chronic inflammatory autoimmune enteropathy that affects around 1% of people worldwide. It is caused by ingestion of gluten products in people who are genetically predisposed. The pathogenesis involves multifactorial factors of genetic, gluten exposure, and environmental triggers. HLA-DQ2 and HLA-DQ8 are the main responsible genes that contribute to the development of coeliac disease. Both innate and adaptive immune plays role in the pathogenesis. In this article, we will review the causes and pathogenesis of coeliac disease development.
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ORIGINAL ARTICLES Top

Effect of renin-angiotensin-aldosterone system blockade on intestinal injury induced by indomethacin in rats p. 6
Asmaa Abdulaziz A. Rabee, Yahya Saber E. Mansour, Huda A Mariz, Salwa Muftah Eljamay
DOI:10.4103/LJMS.LJMS_95_20  
Aim: The aim of this experimental study was to evaluate the possible cytoprotective effects of renin-angiotensin-aldosterone system (RAAS) blockade, captopril (10 mg/kg), telmisartan (10 mg/kg), and a proton-pump inhibitor (lansoprazole) on intestinal injury induced by indomethacin in rats. Materials and Methods: This effect was evaluated through the assessment of intestinal inflammatory biomarkers and oxidative stress parameters. Forty adult male albino rats weighing 170–200 g were used and divided equally into five groups. After the treatment, the following were assessed: Myeloperoxidase (MPO) enzyme activity, pro-inflammatory (interleukin-1beta [IL-1 β]) content and anti-inflammatory (IL-10) content, malondialdehyde (MDA) content, reduced glutathione (GSH) content, and superoxide dismutase (SOD) enzyme activity, and histopathological examination of the intestinal tissues was conducted. Results: Indomethacin group induced a significant increase in MDA content, also in inflammatory biomarker (MPO enzyme activity, IL-1 β content, and IL-10 content) compared to normal control, while indomethacin group induced a significant decrease in GSH content, SOD enzyme activity compared to normal control group. Captopril, telmisartan, lansoprazole administration before indomethacin-induced significant increase in GSH content, SOD enzyme activity, while induced significant decrease in MDA content as well as in inflammatory biomarker compared to indomethacin group, which indicate the antioxidant, anti-inflammatory effects, and the gastroprotective properties of RAAS blockers, which also shown in the histopathological examination of intestinal tissues. Conclusion: This study showed the possible antioxidant and anti-inflammatory effects as well as the gastroprotective properties of RAAS blockers. Telmisartan has more antioxidant and anti-inflammatory effect as well as cytoprotective action than captopril.
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Cancer incidence in Southern Libya: Updated report from 2016 to 2018 p. 11
Eman Gusbi, Farag I Eltaib, Abrahem F Abrahem, Walid M Benbubaker, Inas M Alhudiri, Sameera Ahmad Al-dabea, Hafsa A Alemam, Nada Elgriw, Adel M Elshukri, Ahmed O Hamil, Latifa bettamer, Nabil Enattah, Adam Elzagheid
DOI:10.4103/LJMS.LJMS_74_20  
Background/Aim: Cancer is a major public health problem worldwide with significant association with deaths and disabilities. Monitoring the cancer incidence is important, but it has never been assessed prospectively in southern part of Libya. The aim of this study was to estimate the cancer incidence and incidence rates in southern part of Libya as part of the monitoring of the cancer incidence in Libya. Materials and Methods: This was a retrospective study based on data collected between January 2016 and December 2018, the total number of cases diagnosed with different types of cancer reported to the Sabha Cancer Center was 665. All Libyan males and females who were diagnosed with any type of cancer were included in this study. Results: Overall cancer was more among female than male; it affected 414 (62.3%) females and 251 (37.7%) males. With 374 (56.2%) of all recorded cases being found in Sabha, the city documented the highest percentage of all cases found in these regions. According to the study analysis, the most diagnosed type of cancer in southern Libya was breast cancer, with 318 (47.8%) cases, followed by colorectal cancer (118, 17.7%), prostate cancer (60, 9%), leukemia (31, 4.7), lung cancer (23, 3.5), ovarian cancer (18, 2.7%), and lymphoma (17, 2.6%). Among females, breast cancer remained the most reported cancer site, with a decrease in the incidence rate from 146 (45.9%) in 2016 – 73 (23%) cases in 2018. Colorectal cancer was the second most common cancer with a slight increase in the incidence rate from 34 (28.8%) in 2016 to 43 (36.4%) cases in 2018. Leukemia and ovarian cancer ranked third and fourth most-reported cancer sites, respectively. For males, colorectal cancer remained the most reported cancer site during the study period with a slight increase in the incidence rate from 23 (9.16%) in 2016 to 32 (12.7%) cases in 2018. Prostate cancer was the second most common cancer and decreased in the incidence rate from 34 (13.5%) in 2016 to 14 (5.57%) cases in 2018, followed by leukemia and lymphoma. The elderly age groups of ≥70 years account for 17% of the cancer cases. There was a steady rise in incidence rate of all cancers from age <14 years to 69 years and was greater in women. In elderly people (≥70 years), cancer rate was higher in male than female. Conclusion: The results of this study suggest the importance of further epidemiological and etiological studies to further reveal factors contributing to the cancer incidence trends in Libya.
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Clinical appraisal of corpora cavernosa injuries (penile fracture): Retrospective review of 69 patients in Benghazi, Libya p. 17
Muftah Hamad Elkhafifi, Wael E Y. Alaorfi
DOI:10.4103/LJMS.LJMS_60_20  
Background and Aim: Penile fracture is a relatively rare urological emergency. The aim of this study was to review the experience with 69 consecutive cases in Benghazi, Libya. Patients and Methods: Records of 69 penile fracture cases who presented between January 1997 and December 2018 to Hawari Center for Urology, Benghazi, Libya were retrospectively reviewed. Penile fracture diagnosis was based on classic history and typical physical signs. Surgical exploration was performed for all patients under spinal anesthesia. Results: The most common mechanism of penile fracture was self-inflicted forceful bending (manipulation) of erected penis which account for 39 (56.5%) patients, followed by vigorous sexual intercourse in 19 (27.5%) patients, masturbation in five (7.2%) patients, rolling over an erect penis in bed in five (7.2%) patients, and slipping in WC in one (1.5%) patient. Clinical features at presentation include intense pain in 97%, sudden audible popping sound in 87%, rapid de tumescence in 94.2%, followed by development of swelling and ecchymosis in all patients (100%). All patients were treated surgically and no intraoperative or immediate postoperative complications were encountered. During the follow-up period, all patients had normal urinary steam and normal sexual function was experienced by 97.1% of the patients. Five patients (7.2%) had long-term complications: penile hypoesthesia (one patient), painful erection (one patient), penile curvature of <15o on erection (one patient), and mild erectile dysfunction (two patients). Most patients were discharged home on postoperative day 1. Conclusion: Penile fracture occurred mainly due to forceful sexual manipulation of erected penis, and diagnosis can be made clinically. Immediate surgical repair is the only option to avoid complications.
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Correlation between central venous pressure and peripheral venous pressure in medical intensive care unit patients p. 21
Mohamed A I. Hamedh, Abdelaziz A Al Shaari
DOI:10.4103/LJMS.LJMS_72_19  
Introduction: Central venous pressure (CVP) is a hemodynamic variable commonly used in the intensive care setting to estimate right arterial pressure for evaluation and monitoring a patient's volume status. Risks such as infection, arterial puncture, hematoma, and pneumothorax associated with central venous cannulation can outweigh its benefits. This study was undertaken to determine if peripheral venous pressure (PVP) predicts CVP in medical intensive care unit (ICU) patients. Materials and Methods: This study was conducted on patients admitted to the medical ICU at AlJamhoriya Teaching Hospital in the period from January to September 2009. Sixty-six patients (aged 40–70 years) who were required a central venous line (CVL) were included prospectively in the study. CVP measured through internal jugular vein or subclavian vein by three ways CVL set insertion; and CVL placement was confirmed by chest X-ray. We used the manometers for the measurement of PVP; and 66 paired recordings of CVP and PVP were made. The correlation and Bland-Altman analysis of agreement were performed. Results: The mean (standard deviation [SD]; range) CVP was 11.3778 cmH2O (±5.6; −1.0–27.0); the mean PVP was 15.80 cmH2O (±5.9; 0.0–33.0); offset (bias) of PVP > CVP was 4.42 cmH2O with SD ± 3.62. The correlation of PVP on CVP was r = 0.8059, ( r2 = 0.65), P < 0.0001. The 95% confidence intervals for the bias were 3.5352–5.3133 cmH2O. In the Bland-Altman analysis, lower and upper limits of agreement (95% LOA) were 2.7 (4.43–−7.20) and 11.63 (4.4–7.2) cmH2O. Four out of 66 points were outside the LOA. The dashed zero lies between the LOA. Conclusion: Measurement of PVP from both antecubital area and dorsum of the hand correlated with CVP measurement with acceptable agreement. PVP measurement may be a noninvasive alternative way for estimating CVP.
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Closed reduction for developmental hip dysplasia in lately diagnosed walking age children p. 25
Majdi Alakkari, Nabil A Alageli
DOI:10.4103/LJMS.LJMS_85_20  
Aim: The aim of the study was to assess the success and possible complications of closed reduction (CR) treatment of developmental hip dysplasia (DHD) in late-diagnosed children and explores its relation to the acetabular index (AI) measurement prior to treatment. Patients and Methods: Twenty-three consecutive patients with dislocated hips, 16 unilateral and 7 bilateral (30 hips), were retrospectively included in the study. They were admitted to the specialist pediatric orthopedic unit of the University Hospital (Tripoli Medical Center) in Tripoli, Libya. There were 21 females and 2 males with an average age at diagnosis of 17 months (range from 14 to 31 months). Their average follow-up period was 3 years (2–5 years), and none of them received treatment prior to diagnosis. All patients received prior inpatient skin traction for at least 2 weeks followed by CR with soft tissue release (adductor tenotomy), hip spica applied and maintained for an average of 3 months. Patients who had a failure of reduction or resubluxation at follow-up went for open reduction and a reconstruction procedure. Results: CR was successful in 27 hips (90%), failed in 3 (10%) other, the average age of the successful reduction group was 20.5 months, while that of the open reduction group, it was 23 months ( P = 0.25). The average AI of the CR group was 39.0°, while that of the open reduction group, it was 42.7° ( P = 0.15); 6.7% of patients with an AI of <40° had a failure of CR, while 16.7% of an AI of >40° had a failure of CR of the hip ( P = 0.46). No complications of treatment were recorded at follow-up. Conclusion: Staged CR of DHD in older children in the hands of experienced specialists is still a valid means of their treatment, especially in developing countries with limited resources. There is a relatively higher failure rate of CR, the older the child is and the higher the AI.
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SHORT COMMUNICATION Top

Therapeutic response of patients with progressive macular hypomelanosis to narrowband ultraviolet B phototherapy at dermatology department, Tripoli Central Hospital, Tripoli, Libya (2008–2018) p. 28
Halima Arebi El-Megei, Nadia Omar El-Houni, Somaia Saleh Ezeddin
DOI:10.4103/LJMS.LJMS_91_20  
Background/Aim: Progressive macular hypomelanosis (PMH) is a common skin disorder, predominantly affected young adults, especially women. The aim of the study was to evaluate the therapeutic response of this skin disease to narrowband ultraviolet B (UVB) phototherapy. Methods: A case series study of a total of 100 patients with PMH who were treated in the Phototherapy Unit at Tripoli Central Hospital in the period between January 2008 and December 2018. Results: Out of 100 patients, 82% were female and 18% were male with the mean age of 24.45 ± 4 years. NB-UVB therapy was given three times a week starting with 0.2 J/cm2, with 20% dose increment every session. The maximum cumulative dose was 65.13 J/cm2 with a mean cumulative dose of 20.48 ± 15 J/cm2. The maximum number of sessions was 36 sessions. A satisfactory response was achieved without any complications in most of the patients (89%) after a mean of 17.21 ± 7.2 treatments. Conclusion: PMH occurs mainly in adolescence and young adults with female predominance mainly with skin types IV and V. NB-UVB phototherapy seems to be effective, well-tolerated, safe, and easily administered treatment for progressive PMH.
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CASE REPORTS Top

Postintravenous immunoglobulins posterior reversible encephalopathy syndrome in a patient with miller fisher variant of guillain–barre syndrome: A case report and literature review p. 31
Ans Alamami, Rabee Tawel, Farah Zahra, Mohamed Abelaty
DOI:10.4103/LJMS.LJMS_103_20  
Guillain–Barre syndrome (GBS) is an autoimmune disorder of the peripheral nerves manifested as inflammatory polyneuropathy of acute onset. The posterior reversible encephalopathy syndrome (PRES) is composed of gradual-onset neurological characteristics with unique radiological distribution (at the posterior brain region). Several etiologies, including hypertension, renal insufficiency, autoimmune diseases, medication use, and immunodeficiency, immunotherapy with intravenous immunoglobulin (IVIG) for various immune-related conditions, were associated with renal impairment, thrombotic manifestation, and reported PRES occurrence. Herein, we report a 73-year-old male who developed a clinical manifestation of PRES on top of IVIG therapy for Miller Fisher variant of GBS; therefore, PRES to be considered in a patient with GBS who treated with IVIG and developed alteration in the state of consciousness.
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Ultrasonographic features of hypothenar region extra digital glomus tumor p. 34
Manohar Kachare, Alamgir Khan, Umesh Joshi, Sachin Patil
DOI:10.4103/LJMS.LJMS_93_20  
We report a case of a 32-year-old female with a 6-month history of excruciating pain in hypothenar region of the left hand. Pain was aggravated by pressure, touch, and cold temperature. Musculoskeletal ultrasonography revealed a well-defined, hypoechoic lesion in the deep dermis and subcutaneous fat in the left hypothenar eminence with mixed arterial and venous signals within on Doppler study, suggestive of subcutaneous vascular lesion, and a diagnosis of glomus tumor was suggested. The patient underwent excision of the lesion. Pathological examination of the specimen showed a glomus tumor and excluded malignant transformation to glomangiosarcoma. Extra digital glomus tumor can be diagnosed on ultrasound with high confidence in appropriate clinical setting.
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Steroid-responsive encephalopathy associated with thyroiditis: A diagnostic challenge p. 36
Aamir Shahzad, Phool Iqbal, Muhammad Bilal Jamshaid, Rubab Fatima Malik, Muhammad Tayyeb, Abdulaziz Zafar
DOI:10.4103/LJMS.LJMS_86_20  
steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is an autoimmune entity with a strong association with elevated antithyroid antibodies. It is a rare cause of encephalopathy and is usually a diagnosis of exclusion. Responsive to corticosteroids is required to make the diagnosis. Herein, we report a male patient presented with recurrent convulsive episodes not controlled well by anticonvulsant drugs and had drops in Glasgow coma scale (GCS). After unremarkable of extensive investigations, Hashimoto's encephalitis was suspected and antithyroid peroxidase antibodies test turned out to be positive, while thyroid function tests were normal and the diagnosis of steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) was made. He received a course of intravenous methylprednisolone for 5 days and responded very well to therapy, with an improvement of his GCS to 15/15.
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LETTER TO EDITOR Top

First epileptic seizure and electroencephalography: An overview p. 39
Jamir Pitton Rissardo, Ana Leticia Fornari Caprara
DOI:10.4103/LJMS.LJMS_4_21  
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