Libyan Medical Journal

Pseudomass-like CNS Lesions in Neuro-Behçet’s Syndrome: A Narrative Review of a Rare Radiological Entity and Its Diagnostic Challenges

Seraj Ajaj — 2026-05-01

Neuro-Behçet’s syndrome (NBS) is an uncommon but potentially disabling manifestation of Behçet’s disease. While typical parenchymal NBS predominantly affects the brainstem, basal ganglia, and diencephalon, a rare subset presents as tumefactive or pseudomass-like lesions that mimic neoplasm, infection, and demyelinating disorders. These lesions create substantial diagnostic uncertainty and may lead to unnecessary neurosurgical intervention if misinterpreted. This narrative review synthesizes published evidence on pseudomass-like NBS, focusing on clinical context, neuroimaging patterns, pathological correlates, differential diagnosis, and treatment response to immunosuppressive therapy. A representative clinical vignette is included to illustrate typical radiological evolution and regression after therapy. Improved awareness of this rare radiological entity may facilitate timely diagnosis, avoid invasive procedures, and improve outcomes.

Knowledge, Attitude, and Practice Study About Covid- 19 Vaccine Hesitancy in Libya

Marwa Daw — 2026-05-01

The COVID-19 pandemic has profoundly impacted global health and economies, underscoring the importance of vaccination in controlling the virus's spread. This study aims to assess the level of knowledge, attitude, and practice of COVID-19 vaccine hesitancy among anyone residing within the state of Libya, regardless of their nationality, across all age groups, and who has reliable access to the internet. For three months from November 2023 to February 2024, a descriptive study of knowledge, attitude, and practice (KAP) was undertaken. Non-probability convenience sampling was used, and participants completed online questionnaires sent via social media, meeting specific inclusion and exclusion criteria. The main instrument for data collection was a standardized, self-administered questionnaire designed based on previous validated instruments from 404 participants. A total of 404 participants completed the questionnaire, with most of them being Libyan (n=393, 97.3%), over the age of 18 (n=388, 96%), and living outside of Tripoli (n=243, 60.1%). Female respondents (n=266, 65.8%) with higher qualifications (n= 262, 64.9%), with many responses coming from the medical sector (n= 241, 59.6%). The most prevalent source of information was numerous sources (n=177, 43.8%). The current results gathered through seven questions designed to evaluate participants' understanding of the vaccine's efficacy in preventing the disease showed that 18.1% of respondents believed the vaccine prevents COVID-19, 20.3% were unsure, and 61.6% disagreed. Despite this, 74.5%, 91.3%, and 69.6%, respectively, of participants had adequate knowledge, attitude, and practice about the vaccine. Additionally, 43% of the study population expressed willingness to receive the vaccine, and 69.1% understood that infection with the coronavirus is more dangerous than the vaccine itself. In conclusion, this study underscores the necessity of public health promotion to improve vaccine acceptance and address misconceptions. Suggest the need for targeted communication strategies to enhance public trust in the vaccine.

Nevus Lipomatosus Cutaneous Superficialis: A Case Report from Tripoli, Libya

Yaser Mustafa Garmadi — 2026-05-01

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare benign hamartomatous lesion characterized by ectopic mature adipocytes within the dermis. We present the case of a 24‑year‑old Libyan male with asymptomatic, multiple, soft, yellowish papules and nodules localized to the left buttock. The lesions had been present for several years and gradually increased in size. Systemic examination and laboratory findings were unremarkable. Histopathological analysis revealed clusters of mature adipocytes interspersed among dermal collagen bundles and surrounding subpapillary vessels, extending into the papillary dermis. The clinical and histological features were consistent with classical NLCS. The condition is benign, with no systemic associations or malignant potential. Treatment is unnecessary unless for cosmetic reasons, with surgical excision or CO₂ laser ablation as options. To the best of our knowledge, this is the second case reported in Tripoli, contributing to the limited regional literature and reinforcing the importance of recognizing NLCS to avoid misdiagnosis and unnecessary interventions

Determining the Contents of Chromium and Copper Metals in Some Nail Polish Samples

Ahlaam Ali — 2026-05-05

The contents of Chromium and Copper were estimated in different samples of nail polish collected from cosmetic and pharmacies in some Libyan cities. In this study, the atomic absorption spectroscopy (AAS)Technique was used for the determination of the selected metals. The results of this study showed small variations in concentrations of Chromium and Copper. Generally, the ranges of chromium and Copper were fluctuated in the following ranges (1.43-2.01 µg/g), where the high content was recorded in sample D(none), while the low content was recorded in sample B(Top lady). On the side, the concentration of chromium ranged between (2.83-3.01 µg/g). The high content of chromium was recorded in A (Flormar), while the low value was found in sample D (None). The study concluded that the presence of toxic metals in the nail polish samples gave negative impact on human health.

Massive Pulmonary Embolism Presenting as Septic Shock Despite Repeatedly Negative D-dimer and Negative Lower Limb Doppler: A Diagnostic Challenge

Mohamed Elhamedi — 2026-05-07

Pulmonary embolism (PE) may present atypically and mimic septic shock, posing a significant diagnostic challenge in critically ill patients. A 45-year-old woman initially presented with symptoms suggestive of acute gastroenteritis and was discharged. She re-presented within 24 hours with hypotension, tachycardia, and hypoxemia. Laboratory findings revealed severe anemia (hemoglobin 6.5 g/dL), leukocytosis (14 ×10⁹/L), platelet count 153 ×10⁹/L, elevated lactate (7.6 mmol/L), and metabolic acidosis (pH 7.23, HCO₃⁻ 12 mmol/L, PaCO₂ 24 mmHg, PaO₂ 56 mmHg). No clear infectious source was identified apart from the initial gastrointestinal presentation. Early transthoracic echocardiography demonstrated right ventricular dilatation and dysfunction suggestive of acute pressure overload. Lower limb Doppler ultrasound was negative. Computed tomography pulmonary angiography confirmed a massive saddle pulmonary embolism. Thrombolysis was withheld due to high bleeding risk. The patient improved with anticoagulation and was discharged on apixaban. Further evaluation for underlying prothrombotic conditions, including thrombophilia and rheumatologic screening, was unremarkable. This case highlights the limitations of D-dimer and Doppler ultrasound in high-risk patients and underscores the critical role of clinical judgment and early echocardiography in diagnosing PE.

Inhaler Misconceptions Among Adult Asthma Patients in Sebha, Libya: A Cross-Sectional Study

‪Aisha Eltaher — 2026-05-09

Asthma is a chronic inflammatory airway disease responsible for substantial global morbidity, and inhaled pharmacotherapy remains the cornerstone of its management. Despite the proven efficacy of inhaler therapy, adherence remains suboptimal, with patient-held misconceptions a major modifiable barrier. A cross-sectional study was conducted from May 2025 to March 2026 at Sebha Medical Centre and the affiliated outpatient respiratory clinic in Sebha, Libya. Forty-eight adults with a confirmed diagnosis of mild-to-moderate bronchial asthma who were currently prescribed an inhaler were recruited by convenience sampling. A structured, four-section questionnaire assessed demographics, asthma disease history, inhaler use patterns, and beliefs about inhaler therapy (eight items rated on a three-point Likert scale). Descriptive statistics were computed in Minitab 21.1; inferential analyses—Chi-square tests of independence, Mann–Whitney U tests, and Spearman rank correlations—were performed in R 4.2.1 at α = 0.05. The mean participant age was 42.0 years (SD = 15.9); 64.6% were female. The most prevalent misconception was that inhalers should be reserved for emergencies, endorsed by 66.7% of respondents. Side-effect avoidance was reported by 54.2%, and 33.3% believed inhalers to be addictive. Although only 14.6% explicitly agreed that inhalers cause cardiac or pulmonary damage, 43.8% remained uncertain. Despite these misconceptions, 64.6% acknowledged that regular inhaler use helps control asthma, and 83.3% expressed a desire for additional education. Chi-square analyses revealed no statistically significant association between any assessed belief or demographic variable and current inhaler use (all p > 0.05). Spearman correlation analysis identified one significant finding: public embarrassment about using an inhaler in public was positively correlated with the presence of chronic cough (r = 0.290, p = 0.046). Misconceptions regarding inhaler therapy are highly prevalent among asthma patients in Sebha, even among those with higher educational attainment. The significant association between social embarrassment and chronic cough underscores the clinical relevance of psychosocial barriers to adherence. The near-universal desire for further education provides a compelling mandate for structured, culturally adapted patient education programs.

War-Related and Domestic Penetrating Head Injury in Benghazi During the Libyan Conflict

Abdalla Ben Hamid — 2026-05-09

Libya experienced a dramatic rise in penetrating brain injuries (PBI) due to armed conflict after 2011. There is limited published data on the pattern and outcome of these injuries in the eastern region. A descriptive cross-sectional study was conducted at Jala Trauma Hospital, Benghazi, from October 2014 to April 2015. All patients admitted with penetrating head injury due to gunshot (handgun, machine gun, shotgun, sniper) or explosive shrapnel were included. Data on demographics, injury type, Glasgow Coma Scale (GCS), CT findings, surgical intervention, and outcome were analyzed using SPSS v17. Of 293 total PBI cases registered, 122 (41.6%) died immediately from PBI alone, and 101 (34.5%) died from multiple injuries, including PBI. Only 70 patients (23.9%) arrived alive to the emergency department. Among these, 92.8% were male, with a mean age of 27.3±11 years. Machine guns (41.4%) and shrapnel (40%) were the leading causes. Perforating injuries accounted for 15.7% of cases and had a 91% mortality rate. Overall mortality among admitted patients was 28.6% (20/70). Operated patients had significantly lower mortality (9.4%) compared to non-operated patients (34.2%, p=0.028). Initial GCS 13–15 was associated with 4.3% mortality vs. 33% for GCS 3–8. Delayed surgical intervention was performed in 5 cases without infectious complications. PBI during the Benghazi conflict carried high immediate and delayed mortality. Early surgical intervention in selected patients, guided by initial GCS and CT findings, improved survival. Delayed surgery may be safe in select cases with localized brain edema.

Phytochemical Profile, Antibacterial Activity, and Antioxidant Potential of Cotula cinerea, a Libyan Medicinal Plant

Nouri Ermeli — 2026-05-10

Libyan medicinal plants are an important source of therapeutic agents, and Cotula cinerea, a plant collected from the southwestern desert of Libya, is evaluated in this study for its phytochemical composition, antibacterial activity, and antioxidant potential for the first time. Soxhlet extraction using three solvents (n‑hexane, chloroform, and methanol) was employed to compare the biological activities of the resulting extracts. The antibacterial activity was assessed using the disc diffusion method against Staphylococcus aureus and Escherichia coli, with ciprofloxacin as the positive control and DMSO as the negative control. Antioxidant activity was evaluated using the DPPH radical‑scavenging assay, with ascorbic acid serving as the positive control. The analysis identified tannins, flavonoids, cardiac glycosides, terpenoids, and steroids, while testing negative for coumarins, anthraquinones, alkaloids, and saponins. None of the extracts exhibited antibacterial activity against Escherichia coli. However, the n‑hexane extract showed the strongest activity against Staphylococcus aureus (23 mm) inhibition zone, followed by the chloroform extract (16 mm), while the methanolic extract demonstrated the lowest activity (11 mm). Only the chloroform and methanolic extracts demonstrated measurable antioxidant activity compared with the reference standard. This study provides the first phytochemical profiling and biological evaluation of Cotula cinerea growing in Libya. The study concludes that its antibacterial and antioxidant activities are solvent dependent