Libyan Medical Journal

Investigation of the Effect of Two Different Solvents (Aqueous and Alcoholic) on Phytochemical Screening and Antimicrobial Activities for the Globularia Repens Plant

2025-10-09T17:46:50+02:00

This study aimed to investigate and evaluate the antimicrobial potential of leaves and stems of the Globularia repens plant growing in the Al-Jabal Al-Akhdar region, Libya. Plant parts were extracted using two solvents (aqueous and methanol). Phytochemical screening and paper chromatography were conducted to identify major classes of secondary metabolites. The antimicrobial activity was tested against six bacterial species (including Bacillus cereus, Streptococcus pneumoniae, Escherichia coli, and Pseudomonas aeruginosa) and two fungal species (Alternaria alternata and Penicillium sp.) using the agar well diffusion method. Phytochemical screening revealed the presence of carbohydrates, glycosides, tannins, flavonoids, sterols, and saponins. The antimicrobial assays demonstrated that the methanol extracts exhibited significant inhibitory activity against some tested pathogens, while the aqueous extracts were less effective. The potency of the extracts also varied between the leaves and stems

Detection of Radioactive Element Contents and their Hazard indices in Composite Soil and Rock Samples from the Southern Al Jabal al Akhdar Region (Between Aslunta and Al Makhili), Libya

2025-10-11T17:11:47+02:00

The current study aims to reveal the contents of radioactive elements in soil and rock samples collected from the southern area of the Green Mountain, extending between Al-Salanta and Al-Makhili. Soil samples were taken from 20 areas, and the experimental design was a completely randomized block design with three replications. The most important results obtained are as follows: The results of this study showed the presence of several natural radioactive elements with various uses, which can be considered important natural resources. The presence of radioactive potassium (40K), uranium (238U), thorium (232Th), and radium (226Ra) were recorded, and these are natural radioactive elements that can be found in many soils. The results of this study recorded radioactive potassium concentrations ranging between (63.65– 403.56 Bq/kg), with the highest concentration found at site number 11, known as the (Al-Qarrah Al-Hamra area near the Tanmalo region), while the lowest concentration was at site 13, known as the (Tanmalo area). Regarding the results related to radioactive uranium 238, this study recorded concentrations ranging between (38.34–82.66 Bq/kg), with the highest concentrations found at site number (2), in the area of Wadi A'teer near the Aslanta area, while the lowest concentrations were at site number (9), in the area of Qlay'at near the Crushers area. Generally, the study results recorded highly significant changes at the level of 0.0001. The results related to radioactive radium showed that its concentrations ranged between (32.005–96.48 Bq/kg), with the highest concentrations found at site number (2), in the area of Wadi A'teer near the Aslinta area, while the lowest concentrations were at site number (9), in the area of Qlay'at near the quarries. Generally, the study results recorded highly significant changes at the level of 0.0001. Regarding the results related to radioactive thorium-232, this study recorded concentrations ranging between (31.15-63.18 Bq/kg), with the highest concentrations found at site number (6), in the area of (Mas'ada near Jirdas), while the lowest concentrations were at site number (20), in the area of (North Gate 1 near Al-Mukhayli). In general, the study results showed highly significant changes at the level of 0.0001. The study results recorded a clear variation in the concentrations of natural radioactive elements in the study areas. The results showed the presence of natural radioactive elements in all soils of the study sites. The following figures illustrate the distribution of radioactive elements in the study areas. When comparing the recorded results of the current study with others in different parts of the world, we find that the potassium concentration rate recorded an increase compared to the other radioactive elements in the study area, but was lower than the global average value. Additionally, the activity concentration rates of radium and thorium were lower than the global average value.

Bacterial Etiology and Antimicrobial Resistance in Ear Infections: A Cross-Sectional Study from Tripoli, Libya

2025-10-08T21:30:24+02:00

This cross-sectional study included 100 patients aged 18 to 60 from a teaching hospital in Tripoli, Libya, with an ear infection. Following normal bacteriological procedures, sterile ear swabs were used to collect middle ear secretions from study participants for culture and antimicrobial susceptibility testing. A total of eight bacterial species and one fungal species were recovered. The microbiological analysis of the clinical isolates demonstrated a predominance of Gram-negative bacteria (48.0%), followed by Gram-positive bacteria (34.0%) and fungal isolates (14.0%), while 4.0% of samples showed no microbial growth. Among Gram-negative organisms, Pseudomonas aeruginosa was the most frequently recovered pathogen, accounting for 28.0% of all isolates. Gram-positive bacteria were primarily represented by Staphylococcus epidermidis (16.0%) and Staphylococcus aureus (11.0%). Candida albicans was the only fungal pathogen identified in this cohort. Cefotaxime showed 100% resistance in Pseudomonas and Klebsiella spp., while gentamicin (100% efficacy in Gram-positive cocci; 85.7% in Pseudomonas) and amikacin (100% in Klebsiella; 92.9% in Pseudomonas) were the most effective agents, underscoring the urgent need for targeted antibiotic selection. Gram-negative bacteria, Gram-positive bacteria, and fungi in samples were the leading cause of ear infections, and they were generally susceptible to most of the antibiotics tested. Amikacin, cefepime, gentamicin, ciprofloxacin, and meropenem could be valuable in the empirical management of ear infections

Assessment of Natural Radioactive Elements and Health Risk Values in Imported Cocoa Samples at Some Libyan Markets

2025-10-20T18:55:56+02:00

This study investigated the presence of natural radioactive isotopes in imported cocoa samples collected from Derna, Libya, using gamma-ray spectrometry with a Sodium Iodide (NaI) detector. The analysis focused on the activity concentrations of radionuclides such as ²²⁶Ra, ²³⁸U, ²³²Th, and ⁴⁰K. The average activity concentrations were 46.96 Bq/kg (²²⁶Ra), 49.77 Bq/kg (²³⁸U), 53.57 Bq/kg (²³²Th), and 123.75 Bq/kg (⁴⁰K). Values for ²²⁶Ra, ²³⁸U, and ²³²Th exceeded the global recommended limits, while ⁴⁰K remained below the permissible limit. The absorbed dose rate (DR) ranged from 42.42 to 80.50 nGy/h, with an average of 58.27 nGy/h, lower than the global reference of 84 nGy/h. Internal and External annual effective doses were 0.29 mSv/y and 0.07 mSv/y, respectively, both within safe limits. The Excess Lifetime Cancer Risk (ELCR) averaged 0.26 × 10⁻³, slightly higher than the global recommended threshold (0.29 × 10⁻³). The Annual Gonadal Equivalent Dose (AGED) averaged 0.41 mSv/y, which is above the safety limit of 0.3 mSv/y. Hazard indices (Radium Equivalent, Gamma Index, Alpha Index, Hin, Hex) were all below international safety limits, indicating no immediate health risk

Assessment of Serum Triglyceride and Cholesterol level among Sudanese Epileptic Patients using Antiepileptic Drugs in Khartoum State - Sudan

2025-10-12T11:49:52+02:00

Antiepileptic drugs such as Phenytoin (PHE), Valproic acid (VPA) and carbamazepine (CBZ) is disrupting Triglyceride and Cholesterol level. Our study aimed to assess the level of serum Triglyceride and Cholesterol among Sudanese patients using antiepileptic drugs more than one year at Khartoum State - Sudan. This analytical case control study was conducted from November, 2019 to May, 2020 in National Center for Neurological Diseases and Sciences- Omdurman Teaching Hospital, Bahri Teaching Hospital and Academic Educational Hospital at Khartoum State, Sudan. A total of 64 patients enrolled in this study, 32 out of them were diagnosed as epileptic patients on antiepileptic drugs for more than one year (case group), and the other 32 patients (control group) diagnosed with epilepsy but not used antiepileptic drugs. Analysis of serum Triglyceride and Cholesterol were done by fully automated machine (Mindray BS 240 clinical chemistry analyzer). The study showed that, the patients used Carbamazepine, Valproate and Phenytoin drugs, were significant decrease in mean serum concentration of Triglyceride (86.1±38.8) when compare of main of control group (127.6±60.2) with p- value (0.002), and were significant increase in mean serum concentrations of Cholesterol (158.5±54.7) when compared of main of control group (150.5±75.2) with p- value (0.044) from data suggest that antiepileptic drugs have effect on serum Triglycerides and Cholesterol level. There were increased in mean of Triglyceride among patients used Carbamazepine when compared to Valproic Acid and Phenytoin and there was decreased in mean of Cholesterol among patients used Phenytoin when compared to Valproic Acid and Carbamazepine therapy. From the present study we concluded that serum Triglycerides and Total Cholesterol level should be regularly monitored in patients using antiepileptic drugs for more than one year.

Determining The Residual Aluminum and Zinc in Food Wrapped by Aluminum Foil (Sandwich Samples) Collected from Some Restaurants in El Bayda City, Libya

2025-11-03T18:24:50+02:00

The wrapping of foods with aluminum foil may cause the transfer of some elements presence in the foil as Aluminum (Al), Zinc (Zn), which are found in high concentrations in this foil. At high concentrations, these elements may be toxic to human health. The main problem of these elements is, they are not. This study aims to estimate Aluminum and Zinc in some sandwich samples collected from Libyan restaurants in El-Bayda city. Ten samples of different types of wrapped sandwiches by aluminum foil were studied in this investigation, the selected metal contents were measured by the atomic absorption spectrometry (AAS) method. The samples were designed by nitric acid. The results of this study recorded that the concentrations of aluminum and zinc ranged between (0.012 – 0.079 ppm) and (4.35 -10.93 ppm), respectively. The study did not record high variations between the studied samples in their contents of heavy metals. Some of the samples contained higher levels of Aluminum compared to the levels recommended by WHO

Evaluation of Vitamin D Levels in A Sample of Healthy Children and Adolescents in the City of Zawia, Western Libya

2025-10-31T15:16:28+02:00

In this study, vitamin D levels were evaluated in a sample of children and adolescents in the city of Zawia, Libya, during the years 2021 and 2024. 500 children and adolescents participated in the study, at a rate of 250 participants per year. Laboratory examinations were conducted in some medical clinics in the city, and vitamin D levels were classified as follows: Vitamin D deficiency: ≥20 ng/ml; inadequacy: 21-29 ng/ml. adequacy: ≤30 ng/ml. Overall, 39.2% of participants had vitamin D insufficiency in 2021, with a mean value of 9.77±4.50 ng/ml, according to the data. In 2024, 52% of participants had vitamin D deficiency, with a mean value of 18.03±1.14 ng/ml. The prevalence of vitamin D deficiency was higher in both years among females than males (P<0.001), and it rose in both sexes in 2024 compared to 2021. Additionally, adolescents in the 13–18 age group had a significantly higher rate of vitamin D deficiency than those in the 1–6 age group (P<0.001), and the rate of deficiency increased in 2024 compared to 2021 across all age groups. The study concluded that vitamin D deficiency is common in the sample and became more prevalent in 2024 than in 2021, especially among adolescents and females. In light of this increase, awareness programmes highlighting the importance of adequate sun exposure, food fortification, and vitamin D supplements are required, especially for categories that are more vulnerable to deficiencies

Outcome of Retrograde Flexible URS in the Treatment of Renal Stones at Ibn Sina Teaching Hospital, Sirte, Libya

2025-11-26T17:07:41+02:00

Renal stones, with a global prevalence of 10%, pose significant challenges, particularly when 2–3 centimeters in size, because of limitations of treatments like percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopy (F-URS) provides a minimally invasive alternative. To investigate the result of retrograde flexible URS in the management of renal stones (2–3 centimeters) at Ibn Sina Teaching Hospital, Sirte, Libya. This was prospective observational research carried out at Ibn Sina Teaching Hospital in Sirte, Libya. A total of ninety-seven consecutive cases with renal stones of 2-3 centimeters were enrolled in the research. All cases provided informed consent before the procedure, and the research was permitted by the institutional ethics committee. The mean age of cases was 48.7 ± 11.3 years (63.9% male). The mean size of the stone was 2.3 ± 0.3 centimeters, predominantly in the renal pelvis (42.3%). SFR was 68.04% after one session, 88.6% after two, and 94.8% after three. Mean operative time was 102.01 ± 34.69 minutes, and hospitalization was 2.5 ± 1.3 days. Complications included mild hematuria (12.4%), fever (8.2%) (Clavien Grade I), urinary tract infections (6.2%, Grade II), and sepsis (4.1%, Grade IV). RIRS is an effective, safe choice for 2–3 cm kidney stones, offering higher SFR and reduced complication rates than PCNL.

Inflammatory Bowel Disease Among a Sample of Libyan Patients in Tripoli University Hospital

2025-11-21T09:28:37+02:00

Inflammatory Bowel Disease (IBD) is a chronic gastrointestinal disorder with increasing global prevalence due to the westernization of lifestyles, with many advanced therapies adopted recently. This study aimed to characterize the patterns and management of IBD among Libyan patients attending Tripoli University Hospital (TUH). This descriptive study utilized registry data from the outpatient department at TUH, collecting anonymous information from 69 confirmed cases of IBD patients aged 16 years and older between June and October 2023. About 72.5% of the patients had Crohn's disease (CD), and 27.5% had UC, indicating a predominance of CD (ratio 0.38:1). The median age at diagnosis was 28 years for UC and 23.5 years for CD. Males predominated in both CD (84.4%) and UC (62.2%). All reported smokers were diagnosed with CD. Anemia was prevalent in 41.18% of all IBD patients (36% in CD, 52.6% in UC), a rate considerably higher than reported in European cohorts. Notably, the study observed a high remission rate of approximately 86% (by HBI). A predominance of Crohn’s disease over ulcerative colitis in Libyan patients was observed, with younger age at diagnosis, high anemia prevalence, and high remission rates linked to infliximab therapy and long-term follow-up. Larger multicenter studies are needed to confirm and generalize these findings

Assessment of Serum 25-Hydroxyvitamin D and Calcium Levels in Dental Clinic Attendees in Sabratha City, Libya

2025-12-01T06:42:20+02:00

Vitamin D plays a central role in calcium regulation and oral health, yet deficiency remains widespread in many regions, including North Africa, despite abundant sunlight. Limited data are available regarding vitamin D status among dental patients in Libya. This study aimed to assess serum vitamin D and calcium levels among patients attending a dental clinic in Sabratha City, Libya, and to examine differences by age, gender, and vitamin D category. A descriptive analytical cross-sectional design was implemented from September to November, during which serum 25-hydroxyvitamin D and calcium were measured, and demographic data were recorded. Data were analyzed using IBM SPSS Statistics version 21, applying descriptive statistics, independent-samples t-tests, and one-way ANOVA with significance set at p < 0.05. Participants ranged in age from 6 to 50 years, with a mean of 20.83 ± 11.22 years. Serum vitamin D levels showed considerable variation, ranging from 3 to 53.8 ng/mL, with a mean of 22.51 ± 10.67 ng/mL; deficiency was identified in 47.2% of patients, insufficiency in 30.6%, and sufficiency in 22.2%. Serum calcium concentrations ranged from 8.3 to 10.1 mg/dL, with a mean of 9.11 ± 0.43 mg/dL. No statistically significant differences in vitamin D or calcium were found between males and females, between age groups, or across vitamin D categories. In conclusion, a notable proportion of dental clinic attendees had low vitamin D levels, whereas serum calcium levels remained within normal limits across all groups. These findings provide useful baseline biochemical information for this population and highlight the broad presence of suboptimal vitamin D levels in the region

Deviations from Standard Disk Diffusion Protocols for Antimicrobial Susceptibility Testing in Medical Laboratories in Gharyan

2025-11-30T19:28:18+02:00

Antimicrobial susceptibility testing (AST) is essential for guiding appropriate antibiotic therapy. The disk diffusion method is widely used in Libya due to its low cost, yet deviations from standardized protocols can compromise result accuracy, affecting clinical decisions and patient outcomes. This study evaluated the performance of the disk diffusion AST method in medical laboratories in Gharyan, Libya, using EUCAST guidelines (version 12.0) as a benchmark. Seventy-five AST plates representing 122 clinical specimens were randomly collected from three pathology centers between September and November 2025. Plates were analyzed for the type of culture media, number of specimens per plate, number of antibiotic disks, and readability of results. All plates were 90 mm in diameter. Nutrient agar was used for 118 specimens, and blood agar for two; none used Mueller-Hinton agar as recommended. Only 17% of plates tested a single specimen per plate; the majority tested one specimen on half or a quarter of a plate. The number of antibiotic disks per specimen often exceeded EUCAST limits (up to 20 disks per plate), and only 8% of plates yielded readable results. Widespread deviations from EUCAST protocols—including inappropriate media, specimen overloading, and excessive disks—compromise AST reliability. These errors may lead to incorrect antibiotic prescriptions, delayed recovery, and increased antimicrobial resistance. Strict adherence to standardized guidelines is urgently required to ensure accurate, clinically meaningful AST results. Moreover, raising awareness of the importance of following standard guidelines is crucial for correcting the course.

Spectrophotometric Analysis of Carbohydrates, Proteins, Amino Acids, and Metals in Leaf and Stem Extracts of Cistaceae

2025-12-09T16:03:41+02:00

Although the plants of the Cistaceae family have historically been prized for their medicinal qualities, thorough comparative studies of various plant components are frequently lacking. The goal of this investigation was to estimate the total carbohydrate total protein by spectrophotometer, and to estimate the concentrations of Iron, Copper, and Nickel by atomic absorption, also to compare the phytochemical and biochemical makeup of leaf and stem extracts from a Cistus species to identify the most useful component of the plant for potential uses. Qualitative phytochemical screening for key secondary metabolites was performed on alcoholic and aqueous extracts of leaves and stems. In addition, quantitative analyses were carried out to ascertain the overall content of carbohydrates, proteins, amino acids, and specific minerals (Fe, Ni, and Cu). The phytochemical screening findings demonstrated that leaves have a substantially higher concentration of bioactive ingredients, with aqueous extracts containing high amounts of flavonoids and both extracts containing moderate amounts of tannins and saponins, as compared to stems. Compared to the stems (0. 541 and 0. 272), respectively, the quantitative analysis also confirmed the superiority of the leaves, which had much higher concentrations of total proteins (1. 983 ppm) and amino acids (0. 541 ppm). In contrast, the stems, which function in nutrient storage, had a greater total carbohydrate content (0. 359 ppm) than the leaves (0. 137 ppm). The iron content of the leaves was similar to that of the mineral analysis, but the copper and nickel levels were slightly higher. These data provide conclusive evidence of a distinct biochemical division between the two organs and establish the leaves as a better source of both vital nitrogenous molecules and secondary metabolites of medicinal value. Prioritizing the use of Cistus leaves in the creation of phyto pharmaceuticals and nutraceuticals is supported by this solid scientific argument

Hepatitis C Virus Seroprevalence and Associated Demographic Factors in Al-Jabal Al-Akhdar, Eastern Libya: A Cross-Sectional Laboratory Study

2025-12-20T22:05:56+02:00

Hepatitis C virus (HCV) infection is a global public health challenge, causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. Libya lacks comprehensive, localized epidemiological data, making identification of demographic risk factors critical for preventive strategies. To determine HCV seroprevalence and evaluate associations with age and gender among individuals attending a laboratory in Al Bayda, Libya. This cross-sectional laboratory-based study included 195 participants undergoing routine blood testing at a tertiary healthcare facility in Al Bayda, Libya, between 2023 and 2025. HCV serostatus was determined using a WHO-approved rapid immunochromatographic test. Demographic data (age and gender) were analyzed using descriptive statistics, chi-square or Fisher’s exact tests, and Welch’s t-test in R software (p < 0.05). HCV seroprevalence was 6.7% (n = 13). Among positive cases, 61.5% were male and 38.5% female. The mean age of HCV-positive individuals was 42.1 years versus 35.4 years for HCV-negative participants; the difference was not statistically significant (t = -1.3674, p = 0.194). HCV prevalence in Al Bayda is moderate. Males accounted for higher proportions of positive cases. Although age differences were not statistically significant, positive cases were older on average. These findings highlight the need for targeted screening and early intervention strategies.

Histomorphometric Evaluation of Wormwood Effects on Cellular Activity: An In‑Vitro Experimental Study

2025-12-23T17:54:29+02:00

Artemisia absinthium L. (Asteraceae), commonly known as wormwood in the United Kingdom and absinthe in France, is an aromatic, perennial small shrub. It is locally known as ‘chajret mariem’ in Tunisia. The herb has always been of great botanical and pharmaceutical interest and is employed in folk medicine against various pains [11]. Wormwood essential oil has been widely used mainly for its neuroprotective, antifungal, antimicrobial, and antidepressant properties. This study aimed this study to explain the beneficial effect of wormwood on inflammation in the oral tissue after extraction. A total of 24adult male rats aged about 6 months and weighing about 250 g were divided into 2 groups. Group I (12rats) non diabetic. Group II (12 rats). The study group, were exposed to surgical wounds (extracted lower right first molar). They were sacrificed as follows: 4 rats from each group at intervals of 3 days, 7 days, and 21 days after extraction for histomorphometric study. In the present study, significant changes were observed in the mean number of active cells during the study period between 3 days and 7 days (p1 = 0.043) and no significant changes between 3 days and 21 days (p1 = 0.109). Whereas, no significant changes were observed in the mean number of active cells during the study period between 7 days and 21 days p2 (= 0.588). The current results demonstrate that Wormwood decreased the inflammatory signs leading to shortening of the healing time, which means that the wormwood has a well-known antiseptic property

Assessment of Knowledge, Attitudes, and Practices Regarding Dental Waste Management among Dentists in Benghazi, Libya

2025-12-17T04:18:43+02:00

Dental clinics generate potentially hazardous wastes (e.g., sharps, blood-contaminated materials, chemicals, and amalgam residues) that pose infection and environmental risks, making it important to assess dentists’ knowledge, attitudes, and everyday practices toward safe dental waste management in Benghazi, Libya. Aim: To evaluate knowledge, attitudes, and practices (KAP) related to dental waste management among dentists in Benghazi, Libya. A descriptive cross-sectional survey was administered to 118 registered dental practitioners using a structured, self-administered questionnaire. Associations between demographic variables (age, academic qualifications, employment type, and managerial role) and KAP scores were examined (p < 0.05). Higher knowledge was significantly associated with more favorable attitudes and better practices. Older age, lower academic qualifications, employment outside academia, and absence of managerial roles were linked with lower KAP scores (p < 0.05). Despite generally adequate knowledge and positive attitudes, gaps in routine waste-management practices persisted. Dentists in Benghazi show satisfactory knowledge and attitudes but suboptimal practical implementation. Targeted training and stronger policy enforcement are recommended to improve compliance and clinical safety.

Knowledge, Attitudes, and Practices Regarding Antimicrobial Resistance Among the General Public in Benghazi, Libya-2025.

2025-12-23T19:32:27+02:00

The overuse and misuse of antibiotics are primary drivers of antimicrobial resistance (AMR), resulting in a major global health problem that compromises the efficacy of these drugs and complicates the treatment of bacterial infections. A descriptive cross-sectional study was conducted over two months, from October 1 to November 30, 2025. A sample of 200 participants was selected via convenience sampling. Data were collected via a structured questionnaire adapted from a WHO survey tool. KAP scores were dichotomized (good/poor for knowledge and practice; positive/negative for attitude). Data were analyzed by SPSS version 25, using descriptive statistics, Chi-square tests, and multivariate logistic regression. The results indicated that 78.0% of participants had good knowledge, 85.0% had positive attitudes, while only 42.0% reported good practices. Prevalent misconceptions included the belief that antibiotics are effective against viral infections (32.0%) and the incorrect belief that AMR occurs when the human body becomes resistant (64.0%). The study revealed that 28.5% of respondents had used antibiotics without a prescription, and 48.0% reported stopping a prescribed course of antibiotics when their symptoms subsided. Multivariate analysis identified lower education as an independent predictor of poor knowledge (Adjusted Odds Ratio, AOR = 3.2) and younger age (18–34 years) as a strong independent predictor of poor practice (AOR = 4.1). Despite moderate knowledge and positive attitudes, dangerous practices regarding antibiotic use are common. This underscores an urgent need for context-specific public health interventions and stringent enforcement of dispensing regulations in Libya to combat AMR

Laparoscopic Repair of a Giant Hiatal Hernia with Nissen Fundoplication in a Patient with Dyspnea and Severe GERD: A Case Report

2025-12-15T17:03:18+02:00

Giant hiatal hernias (GHHs), defined as herniation of >30% to 50 % of the stomach into the thorax, are a type of paraesophageal hernia (Type III or IV) that can cause significant extraesophageal symptoms, including progressive dyspnea and cardiac compromise, due to mechanical compression of thoracic organs. We report the case of a 60-year-old female patient (weight 57 kg, height 161, BMI 22) who presented with severe, refractory gastroesophageal reflux disease (GERD) and progressive dyspnea on exertion. Diagnostic imaging (CT scan) confirmed a large, giant Type III/IV hiatal hernia containing most of the stomach, causing compression of the left lower lobe of the lung. The patient underwent successful laparoscopic repair of the GHH, which included complete sac excision, extensive mediastinal esophageal mobilization, tension-free crural repair using absorbable barbed suture, and a standard Nissen fundoplication. The postoperative course was uneventful. The patient reported immediate and complete resolution of dyspnea and improvement in GERD symptoms. Follow-up at 6 months confirmed no recurrence on barium swallow and a significantly improved quality of life. Laparoscopic repair with Nissen fundoplication is the standard of care and an effective definitive treatment for GHHs, providing dramatic symptomatic relief, particularly for patients presenting with atypical pulmonary symptoms like dyspnea.

Impact of Varicocele Treatment on Sperm Recovery in Men with Non-Obstructive Azoospermia

2025-12-13T11:25:35+02:00

Varicocele, a condition characterized by dilated and tortuous veins within the pampiniform plexus, is observed in 10-20% of the general male population and is significantly more common in men with infertility, affecting 35-40% with primary infertility and up to 80% with secondary infertility. While its role in non-obstructive azoospermia (NOA) remains unclear, varicocele is present in approximately 5% of men with NOA, a severe form of male infertility that affects 10% of infertile men. to evaluate the improvement in semen quality and its outcome after varicocelectomy in non-obstructive azoospermic men. This study was a retrospective descriptive study; the study was conducted in Misurata Medical Center /Libya, and the National Infertility Center during the years January 2015 – January 2017. The study population was 20 patients diagnosed with non-obstructive azoospermia and varicocele. surgical varicocelectomy was performed in all cases, and after that, follow-up and sperm retrieval procedures were performed to retrieve sperm. The patients' ages ranged from 27 to 46 years; all of the cases were diagnosed with non-obstructive azoospermia and varicocele. there are 3 cases from the total 20 that got sperm on normal masturbation, and 5 cases got sperm by sperm retrieval procedures. the other 12 cases could not get sperm in the period from 3 to 24 months post-varicocelectomy. The results of our study indicate that infertile men with non-obstructive azoospermia NOA. and clinical and subclinical varicocele benefit from varicocelectomy and its harmless procedures for azoospermic patients. But in a high percentage, testicular sperm retrieval is mandatory

Pediatric Perforated Appendicitis: Clinical Characteristics, Risk Factors, and Anaesthetic Management at Misurata Medical Center, Libya

2025-12-28T13:38:36+02:00

Acute appendicitis remains the most common surgical emergency in pediatric populations worldwide. However, children face unique diagnostic challenges that frequently result in delayed presentation and higher perforation rates compared to adults. Appendiceal perforation significantly increases morbidity, healthcare costs, and hospital length of stay. Understanding local epidemiological patterns and modifiable risk factors is essential for optimizing clinical outcomes. To determine the prevalence of appendiceal perforation and identify pre-operative clinical factors associated with perforation in pediatric patients undergoing appendicectomy at Misurata Medical Center, Libya, with particular emphasis on anesthetic implications. We conducted a descriptive retrospective cohort study of 16 pediatric patients (aged 6-14 years) who underwent appendicectomy between October 1 and November 30, 2022. Patient records were systematically reviewed for demographic data, clinical presentation, symptom duration, pre-operative analgesia use, white blood cell (WBC) count, imaging findings, and intra-operative pathology. Statistical analysis using chi-square tests identified factors significantly associated with perforation (p<0.05). Anesthetic management and perioperative concerns were also evaluated. The cohort demonstrated male predominance (75% vs. 25% female) with a mean age of 10 years. Right iliac fossa pain was the predominant symptom (75%). Intra-operative findings revealed perforation in 43.75% of cases, advanced inflammation in 25%, and acute inflammation in 31.25%. Patients with perforated appendicitis were significantly younger (mean 6.8 vs. 11.6 years, p<0.05), more likely to present after 3 days of symptoms (71.4% vs. 11.1%, p<0.05), and more frequently had received pre-operative analgesia (57.1% vs. 22.2%, p<0.05). Leukocytosis was common but showed limited discriminatory value between groups. Anesthetic challenges included fluid and electrolyte imbalance, sepsis control, aspiration risk, and postoperative pain optimization. Appendiceal perforation occurred in nearly half of pediatric appendicitis cases at our institution. Younger age, delayed presentation beyond 72 hours, and preoperative analgesic administration were significantly associated with perforation. Anesthetists play a pivotal role in managing these cases through meticulous preoperative optimization, rapid sequence induction, intraoperative stability, and multimodal analgesia. These findings underscore the critical importance of early recognition, prompt surgical consultation, judicious analgesia use, and enhanced caregiver education to reduce perforation rates and improve outcomes in pediatric appendicitis.