Libyan Medical Journal

Amyand's Hernia: A Case Report

Ahmed Albujdidi — 2025-04-01

An Amyand's hernia is a rare type of inguinal hernia in which the appendix is trapped within the hernial sac. It is named after Claudius Amyand, a French surgeon who performed the first successful appendectomy in 1735 on a patient with an Amyand's hernia. In this case report, we highlight a rare case that contributes less than 1% of all inguinal hernias and how it should be managed by the surgeon. As surgeons, we should expect even the rarest cases, although this condition may remain asymptomatic and behave like a normal inguinal hernia. As a result, this type of hernia is most of the times diagnosed during the procedure management of this type of hernia should be individualized according to the appendix's inflammation stage.

فتق أمياند هو نوع نادر من الفتق الإربي، حيث تكون الزائدة الدودية محصورة داخل كيس الفتق. سُمي هذا النوع تيمنًا بكلوديوس أمياند، الجراح الفرنسي الذي أجرى أول عملية استئصال ناجحة للزائدة الدودية عام 1735 لمريضة مصابة بفتق أمياند. في تقرير الحالة هذا، نسلط الضوء على حالة نادرة تُمثل أقل من ١٪ من جميع حالات الفتق الإربي، وكيفية إدارتها من قبل الجراح. بصفتنا جراحين، يجب أن نتوقع حتى الحالات النادرة، على الرغم من أن هذه الحالة قد تبقى بدون أعراض وتتصرف مثل الفتق الإربي الطبيعي. ونتيجة لذلك، غالبًا ما يتم تشخيص هذا النوع من الفتق أثناء العملية الجراحية. يجب أن يُخصص علاج هذا النوع من الفتق لكل حالة على حدة وفقًا لمرحلة التهاب الزائدة الدودية

Open Heminephrectomy in Unilateral Duplex Collecting System: A Case Report

Alaa Emtir — 2025-04-01

A duplicated collecting system, characterized by the presence of two separate pelvicalyceal systems within a single kidney, is a rare congenital anomaly. Surgical intervention, such as open heminephrectomy, is often required in cases where complications arise, including recurrent infections, significant obstruction, or reflux. We report the case of a 29-year-old female who presented with recurrent urinary tract infections and flank pain with reflux. Imaging studies revealed a duplicated collecting system on the right side with significantly poor functioning upper moiety while preserving the healthy lower moiety. The patient tolerated the procedure well, with no intraoperative complications. Postoperative recovery was uneventful, and follow-up imaging confirmed the successful removal of the affected renal segment. The patient remained symptom-free at the two-month follow-up. Open heminephrectomy remains a viable surgical option for managing a symptomatic duplicated collecting system.

يُعدّ ازدواج نظام التجميع، الذي يتميز بوجود نظامين منفصلين للكلية الحوضية داخل كلية واحدة، عيبًا خلقيًا نادرًا. غالبًا ما يكون التدخل الجراحي، مثل استئصال نصف الكلية المفتوح، ضروريًا في الحالات التي تظهر فيها مضاعفات، بما في ذلك الالتهابات المتكررة أو الانسداد الشديد أو الارتجاع. نُبلغ عن حالة امرأة تبلغ من العمر 29 عامًا عانت من التهابات متكررة في المسالك البولية وألم في الخاصرة مع ارتجاع. كشفت دراسات التصوير عن وجود نظام تجميع مكرر على الجانب الأيمن مع ضعف كبير في أداء الجزء العلوي مع الحفاظ على سلامة الجزء السفلي. تحمّلت المريضة الإجراء جيدًا، دون أي مضاعفات أثناء الجراحة. كان التعافي بعد الجراحة هادئًا، وأكدت صور المتابعة نجاح إزالة الجزء الكلوي المصاب. ظلت المريضة خالية من الأعراض في فترة المتابعة التي استمرت شهرين. يظل استئصال نصف الكلية المفتوح خيارًا جراحيًا فعالًا لإدارة نظام التجميع المكرر المصحوب بأعراض

Bilateral Vesicoureteral Junction Obstruction: A Case Report

Alaa Emtir — 2025-04-01

Bilateral Vesicoureteral Junction obstruction (VUJO) is a rare urological condition characterized by the narrowing or blockage at the junction where the ureters meet the bladder, affecting both sides. This obstruction impedes the normal flow of urine from the kidneys to the bladder, leading to a buildup of hydroureteronephrosis. The condition can be congenital, often detected prenatally through ultrasound, or acquired due to factors such as scar tissue, infection, or kidney stones. Symptoms may include flank pain, urinary tract infections, hematuria, and in severe cases, impaired renal function. Diagnosis typically involves imaging studies such as renal bladder ultrasound, and mismanagement of bilateral VUJ obstruction aims to preserve renal function and alleviate symptoms. Treatment options range from conservative management with regular monitoring to surgical interventions like ureteral reimplantation, depending on the severity of the obstruction and the degree of renal impairment. We report a case of 3 years 3-year-old female who complains of recurrent pyelonephritis. Imaging studies revealed bilateral VUJO with bilateral megaureter and hydronephrosis. ureteroneocystostomy done. The patient tolerated the procedure well, with no intraoperative complications. Postoperative recovery was uneventful, and follow-up imaging confirmed the successful removal of the affected ureteral segment. Ureteroneocystostomy surgery is a viable surgical option for managing symptomatic VUJO.

انسداد الوصلة المثانية الحالبية الثنائية هو حالة بولية نادرة تتميز بتضيق أو انسداد عند نقطة التقاء الحالبين بالمثانة، مما يؤثر على كلا الجانبين. يعيق هذا الانسداد التدفق الطبيعي للبول من الكلى إلى المثانة، مما يؤدي إلى تراكم استسقاء الحالب والكلية. قد تكون هذه الحالة خلقية، وغالبًا ما تُكتشف قبل الولادة بالموجات فوق الصوتية، أو مكتسبة بسبب عوامل مثل النسيج الندبي أو العدوى أو حصوات الكلى. قد تشمل الأعراض ألمًا في الخاصرة، والتهابات المسالك البولية، وبيلة دموية، وفي الحالات الشديدة، ضعف وظائف الكلى. يتضمن التشخيص عادةً فحوصات تصويرية مثل الموجات فوق الصوتية للمثانة الكلوية، ويهدف سوء إدارة انسداد الوصلة المثانية الحالبية الثنائية إلى الحفاظ على وظائف الكلى وتخفيف الأعراض. تتراوح خيارات العلاج بين العلاج المحافظ مع المراقبة المنتظمة والتدخلات الجراحية مثل إعادة زرع الحالب، وذلك حسب شدة الانسداد ودرجة ضعف وظائف الكلى. نُبلغ عن حالة طفلة تبلغ من العمر 3 سنوات تشكو من التهاب الحويضة والكلية المتكرر. أظهرت دراسات التصوير وجود تضخم حالبي ثنائي مع تضخم حالبي ثنائي واستسقاء كلوي. أُجريت عملية استئصال كيس الحالب والبول. تحمل المريض الإجراء جيدًا، دون أي مضاعفات أثناء الجراحة. كان التعافي بعد الجراحة سلسًا، وأكدت صور المتابعة نجاح إزالة الجزء الحالبي المصاب. تُعد جراحة استئصال كيس الحالب والبول خيارًا جراحيًا فعالًا لإدارة حالات تضخم الحالب والبول المصحوبة بأعراض انسداد الوصلة المثانية الحالبية الثنائية

Psychological Factors and Their Influence on Neck Disability

Hisham Abodreheiba — 2025-04-09

This study was conducted to investigate the psychological factors that influence neck disability. By understanding the relationship between psychological aspects and neck pain, the study seeks to identify how mental health, stress, anxiety, and depression contribute to the severity and persistence of neck disability. This survey-based study was conducted online from December 10 to 16, 2024, involving 181 students from universities and institutes in the West Bank of Libya. Data collection occurred via social media using Microsoft Forms. Of the 181 participants, 96 reported experiencing neck pain, and 85 were excluded from the analysis. The study employed the Neck Disability Index (NDI) and the DASS-21 questionnaires, with the remaining data analyzed using SPSS to explore the relationships between neck disability, psychological factors, and demographic variables. Result: This study examines the relationship between neck pain severity, disability, and mental health among predominantly physiotherapy specialists (29%) and younger individuals (51% aged 18-24). Findings show that 54% experience neck pain, with 21% reporting disability. Males have significantly higher anxiety levels (mean = 3.17, p < 0.05). Pain severity correlates positively with depression (r = 0.309), anxiety (r = 0.398), and stress (r = 0.375). Notably, early psychological support is essential for those with moderate pain to mitigate worsening depressive and anxiety symptoms. Conclusion: This study highlights the strong link between neck pain severity, disability, and mental health, particularly among physiotherapy specialists and younger individuals. Increased pain correlates with elevated levels of depression, anxiety, and stress, with males showing significantly higher anxiety. The findings emphasize the urgent need for early psychological interventions for those with moderate pain to prevent worsening mental health outcomes. Addressing both physical and psychological factors is crucial for effective neck pain management and improving overall mental well-being in affected individuals.

A Study of Obese and Non-Obese University Students’ Blood Glucose Levels in Tripoli, Libya

Abdulwahb Al-Deib — 2025-04-29

In Libya, obesity and its associated conditions, such as diabetes, are serious health issues. Early identification of those who are obese may reduce the risk of developing T2DM. Thus, this study aimed to compare measurements of fasting blood glucose (FBS) and glycated hemoglobin (HbA1c) levels in obese or overweight and non-obese University of Tripoli students. The study included 53 obese and overweight students with a BMI greater than 25 kg/m2 and 64 non-obese who had a BMI less than 25 kg/m2. To measure the level of FBS and HbA1c, 4 ml of venous blood was drawn from each subject in the University Infirmary. The samples were transferred to the Tajoura Alwasat laboratory, and both the plasma blood level and HbA1c were measured using an automatic device, COBAS INTEGRA 400 plus. There were no significant differences obtained in blood glucose either in FBS or in HbA1c levels between obese or overweight and non-obese students (p>0.05). However, a strong positive correlation was obtained between HbA1c levels for both waist circumference and waist/hip ratio in the obese or overweight group [r=0.322, P=0.023] and [r=0.316, P=0.025], respectively. The incidence of T2DM might be diminished by encouraging young adults to keep both waist circumference and waist/hip ratio in the normal range

The Impact of Metformin Therapy on Liver and Kidney Function in Type 2 Diabetic Patients: A Comparative Study Between Men and Women in Al-Bayda City

Asmaa Salih — 2025-05-04

This study examines the impact of metformin therapy on fasting blood sugar (FBS), renal function (urea and creatinine), and liver function (GOT, GPT, and ALP) in male and female type 2 diabetic patients. FBS levels, while numerically lower in females (106.8 ± 9.7 mg/dL) compared to males (119.7 ± 19 mg/dL), showed no statistically significant difference (p = 0.561), suggesting similar glycemic control across genders. Renal function assessment revealed significantly higher urea levels in males (37.40 ± 9.91 mg/dL) than in females (29.37 ± 5.02 mg/dL, p = 0.041), potentially indicating subtle gender-specific differences in renal function or protein metabolism. Similarly, creatinine levels were significantly higher in males (0.950 ± 0.158 mg/dL) compared to females (0.73 ± 0.1636 mg/dL, p = 0.007), suggesting the need for closer renal monitoring in male patients. Liver function parameters, including GOT, GPT, and ALP, revealed no statistically significant differences between genders. Although males exhibited higher mean values of GOT (40.0 ± 74.2 U/L) and GPT (31.0 ± 18.05 U/L) compared to females (20.3 ± 8.60 U/L and 18.37 ± 8.77 U/L, respectively), the differences did not reach significance (p = 0.415 and p = 0.062). ALP levels were nearly identical between genders (p = 0.696), indicating no gender-based variations in biliary or bone metabolism. In conclusion, metformin therapy demonstrates comparable efficacy and safety in managing glycemic and hepatic parameters in both genders. However, higher renal biomarkers in males highlight the importance of gender-specific monitoring. Further studies are recommended to explore these trends with larger cohorts.

Anterior Teeth Fluorosis: Insights and Concepts about Prevalence, Pathogenesis, Diagnosis, and Prevention

Amina Almahrog — 2025-05-04

Dental fluorosis is a developmental disturbance of enamel caused by excessive fluoride intake during tooth formation, particularly between the ages of 20 to 36 months. This condition manifests primarily as aesthetic alterations, especially in anterior teeth, ranging from mild white striations to severe brown stains and enamel pitting. Fluoride, found naturally in water and various food sources, becomes harmful when ingested in excess, particularly in regions with high natural fluoride levels, such as parts of Pakistan. The severity of dental fluorosis depends on several factors, including fluoride concentration, duration of exposure, nutritional status, and genetic predisposition. The pathophysiology involves disrupted ameloblast function and altered calcium signaling, often resulting in porous, hypo-mineralized enamel. Despite fluoride’s well-documented benefits in caries prevention, its excessive intake has been epidemiologically linked to increased fluorosis prevalence. Accurate diagnosis involves clinical examination and consideration of systemic fluoride history. Preventive strategies include controlling fluoride exposure in early childhood, particularly through safe water consumption and appropriate use of fluoridated products. Current treatment is largely aesthetic, involving procedures like micro-abrasion and bleaching. Future research is needed to further understand the molecular mechanisms of fluorosis and explore novel prevention and therapeutic approaches.

Exploring the Hematological Risks of Diclofenac Sodium: An Experi-mental Study in Wistar Rats

Narmin Elbouri — 2025-05-04

This research study investigated hematological alterations associated with diclofenac sodium injection intraperitoneally at a dosage of 15 mg/kg for six weeks in male Albino Wistar rats. Twelve Albino Wistar rats were divided into two groups randomly: a control group and a diclofenac group, six rats in each group. Blood samples were taken from all rats at the end of the ex-periment, and a hematological evaluation was performed to measure red blood cell indices, white blood cell counts, and platelet indices. Results show a statistically significant decrease in hemoglobin, red blood cell counts, and hematocrit values in rats that received diclofenac compared to controls, indicating that anemia was potentially developed by the diclofenac treatment. Statistically significant increases in mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width (RDW) were found, which indicate macrocytic and anisocytic anemias. Though there was no statistically significant difference in total white blood cell counts, there was a distinct change in differential counts consistent with increased neu-trophil percentages and lower levels of lymphocytes, suggesting inflammato-ry or stress-type activity. The platelet count and mean platelet volume were unchanged, but there was reduced platelet distribution width (PDW) and increased plateletcrit (PCT), suggesting possible changes to platelet turnover or activation. These reports indicated that chronic exposure to diclofenac sodium may induce haematotoxicity characterized by anaemia, immune modulation, and changes to platelet parameters. The study highlights the need to use non-steroidal anti-inflammatory drugs cautiously because they have potential systemic impacts on blood profiles.

Insulin Pump Therapy in Libya: A Comparative Study on Glycemic Control and Patient Outcomes in Type 1 Diabetes

Khalid Milad — 2025-05-07

This study evaluated the clinical effectiveness of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) in managing type 1 diabetes mellitus (T1DM) among Libyan patients. Conducted in June 2022, the comparative cross-sectional study compared 32 CSII users (≥6 months therapy) with 30 MDI controls through structured questionnaires. The CSII group demonstrated significantly better outcomes, including superior glycemic control (mean HbA1c 6.97±0.61 vs 9.8±1.99), reduced acute complications (hypoglycemia: 31.3% vs 50%; DKA: 3.1% vs 20%), and higher treatment adherence (81.3% vs 43.3%). Glycemic improvement correlated strongly with pump duration, showing progressive HbA1c reduction from 7.2±0.2 at 6-12 months to 6.89±0.16 after >2 years of use. The CSII cohort also exhibited more favorable BMI distributions (78.1% healthy weight vs 33.3%) and reported enhanced quality of life. Despite these benefits, challenges in maintenance supply availability were reported. These findings provide compelling evidence for CSII's clinical superiority in Libya's context and support its wider implementation through national programs that address current supply chain limitations while ensuring proper patient training and follow-up support. The results highlight CSII as a valuable therapeutic advancement for T1DM management in resource-constrained settings

Risk Factors of Early Menopause: A Descriptive Study

Nagwa Ali — 2025-05-08

Menopause is an inevitable physical change experienced by women during the aging process. As the production of female hormones decreases and ovulation stops alongside the aging of the ovaries, regular menstruation disappears. Although menopause itself is not a pathological condition, menopausal transition is accompanied by negative physical changes. With the increase in life expectancy, the proportion of postmenopausal life also increases. Thus, the impact of menopause on women’s health has become more significant from both clinical and health perspectives. This study was conducted to identify the risk factors associated with early menopause in women in Tripoli. This was a retrospective case series study; it was conducted in Aljala maternity hospital, Tripoli, Libya, during the year 2017. Three hundred and thirty women who were diagnosed as cases of early menopause were randomly selected from the hospital files and from interviews with the women who attend the gynecology clinic. The following data were obtained from the files and the women: the age of menarche, menstrual cycle, marital state, education level, working status, smoking, parity, history of oral contraceptive, BMI, and history of pelvic surgery. Regarding the age of menarche, the mean age of menarche was 12 ± 1.14 years. The majority of the women had their menarche at age below 13 years (70.3%). Most of the women in the study had regular menstrual cycles (85.5%). Most of the women were educated, not working, and married. The current study showed that about 26% of the women who had early menopause had a history of passive smoking. Regarding the obstetric history, most of the women were multiparous, and most of them did not use contraceptive pills. The study concluded that the majority of the women who had early menopause had menarche at an early age, had regular cycles, were married, educated, not working, multiparous, and did not use oral contraceptives. Other factors, such as smoking, BMI, and history of pelvic surgery, showed lower percentages.