Libyan Medical Journal

Cigarette Smoking Among Libyan Adolescents: Prevalence, Initiation Factors, And Prevention Implications

Halima Buni — 2025-07-12

Tobacco smoking among adolescents remains a critical public health challenge, with profound implications for long-term health outcomes and societal well-being. This study aimed to assess the prevalence of cigarette smoking among school students in Tripoli-Libya and explore the key initiation factors to inform locally tailored prevention strategies. A school-based cross-sectional study was conducted across six randomly selected governmental middle and high schools in one of the largest Municipalities in Tripoli, targeting 379 students aged 10–18 years. A pretested, anonymous, self-administered questionnaire was administered to assess current and lifetime cigarette smoking, sociodemographic characteristics, and self-reported reasons for initiation. Data were analyzed using the SPSS version 22. The total prevalence of current cigarette smoking was 10%, while the prevalence of cigarette smoking ever use was 26.6%. Ever use of cigarette smoking was significantly higher among male students (32%) compared to females (3%). Students in grades ten and twelve had the highest prevalence, followed by those in grade nine. Male gender was a statistically significant factor associated with cigarette smoking (p<0.05). The most common self-reported reasons for cigarette smoking included imitating smokers, curiosity, and expressing masculinity (p<0.05). This study contributes to the growing body of evidence on adolescent cigarette smoking patterns, with higher rates among males and older students, suggesting smoking may symbolize a transition to adulthood.

Anatomy and Biomechanics of the Knee

Mohamed Rashed — 2025-07-13

The knee joint, as the largest synovial joint in the human body, functions as a pivotal component for lower extremity motion and load bearing. Its intricate anatomy and biomechanics are essential for maintaining stability, mobility, and overall limb function. This chapter will elaborate on the anatomical structures, biomechanical principles, and clinical implications pertinent to the knee, providing a comprehensive framework for board candidates in orthopedics and sports medicine. The knee joint's stability is a product of interacting factors, including ligaments, muscular forces, bony structure, and load. The joint, one of the body's largest and most complex, involves four bones and an extensive network of ligaments and muscles. These elements work together to facilitate movement and bear weight while maintaining stability. Understanding these components is crucial for comprehending knee function and the potential for injury. The interplay between the static and dynamic elements is particularly important in biomechanics.

Role of Doppler Ultrasound in Diagnosis of Invasion of Placentation Tissue

Huda Khalif — 2025-07-22

Placenta previa is a severe complication of pregnancy and is the most common cause of postpartum hemorrhage, which often endangers the lives of pregnant women. In patients with malignant placenta previa and placenta accreta, ultrasound can display obvious blood flow changes, such as abnormal blood flow in the placental cavity, abundant blood flow signals, placenta accreta, a thinned echo zone between the uterus and placenta, an enlarged cervix, and thinned myometrium. Color Doppler ultrasound can accurately identify whether it is complete placenta previa. This study was conducted to assess the role of Doppler ultrasound in the diagnosis of invasion of the placental tissue. The study was a retrospective descriptive study conducted at Aljala Maternity Hospital in Tripoli during the years 2020-2021. Among 120 pregnant women were selected from medical files, and a predesigned questionnaire was formed to collect data from patients by simple random sampling methods. The data was coded and analyzed by using SPSS (Statistical Package for the Social Sciences) version 20. All variable results were considered statistically significant with a P value less than 0.05. Among 120 pregnant women who were diagnosed with placental invasion, the mean age group was 29.45 ± 5.345 SD, the minimum age was 18 years, and the maximum age was 45 years. Regarding the obstetric history, the mean gravidity was 3.37 ± 1.942 SD, the mean parity was 1.76 ± 1.559 SD, the mean miscarriage rate was 1.71 ± 0.454 SD, and the mean gestational age at time of diagnosis was 6.21 ± 2.111 SD. Regarding the prior experience with abnormal placentation in previous pregnancy, 66.3% had experienced it. Regarding the Doppler ultrasound approach, 73% of patients had abnormal Doppler findings on assessment. Regarding the prevalence of complications among participants who were diagnosed with placental invasion and the most commonly recognized complications were wound infection and thromboembolism, which both account for 63.5%. On assessing the placental invasion by Doppler ultrasound, this approach had a significant impact on evaluating pregnancy. Therefore, early utilization of Doppler is recommended, particularly in high-risk groups, to evaluate and detect serious health outcomes related to placental invasion.

Prevalence and Predictors of Depression and Anxiety among Healthcare Workers in Benghazi Hospitals in the Context of the COVID-19 Pandemic

Asma Alfallah — 2025-07-25

During the COVID-19 outbreak, health care workers faced significant psychological challenges while fighting the pandemic on the front lines. This research evaluated the mental health of front-line health workers following four years of COVID-19 efforts. This study aimed to investigate the anxiety levels and depression in HCWs in Libya after the COVID-19 pandemic and to assess the main predictors of elevated anxiety levels among them. A cross-sectional study included healthcare workers (doctors and nurses) in Benghazi hospitals who had been working during the COVID-19 pandemic and were willing to give consent. Female nurses reported the highest level of anxiety, followed by doctors. The three most critical variables that may explain the distress level were loss of control or vulnerability, worry for one's health, and the spread of the infection. Strategies for early detection and treatment of depression and anxiety should be developed for medically ill people.

Prognostic, Clinical, and Demographic Features in SCN1A Mutation-positive Dravet Syndrome

Eman Awen — 2025-07-25

Dravet syndrome typically manifests after the first year of life with prolonged febrile and afebrile seizures in previously developmentally normal children. The epilepsy is often refractory to standard anti-seizure medications, and by age two, most children develop epileptic encephalopathy. This retrospective study aimed to identify predictors of treatment response and developmental outcomes, as well as characterise demographic and clinical features in patients with SCN1A mutations. We reviewed clinical records of patients meeting Dravet syndrome diagnostic criteria, extracting data on demographics, clinical phenotype, and treatment history. Seventeen patients were included (male-to-female ratio 0.54:1; mean age 10.03 ± 5.8 years). All had normal birth histories, and 94.1% experienced their first seizure before six months of age, with fever as the precipitating factor in 70.6%. All patients had a history of prolonged seizures or status epilepticus. Initial interictal EEGs were normal in 76.5% during the first two years, and brain MRI was normal in 88.2%. While all children were developmentally normal before seizure onset, 76.5% later exhibited developmental delay and cognitive decline. Seizures worsened in 52.9% of patients when treated with phenobarbital, carbamazepine, lamotrigine, or vigabatrin (as mono- or polytherapy). After genetic confirmation, 94.1% received a combination of stiripentol, valproate, and clobazam, resulting in >50% seizure reduction in 88.2%. Dravet syndrome should be considered in children with refractory epilepsy, infantile-onset recurrent seizures (including febrile seizures/status epilepticus), and normal early development. Genetic testing enables early diagnosis and guides appropriate treatment, improving outcomes. However, no statistically significant predictors of treatment response or developmental outcomes were identified in this cohort

Prevalence and Associated Risk Factors for Anaemia amongst Pregnant Women Attending Gynecology and Obstetrics Department in Tobruk Medical Center, Tobruk, Libya

Salem Zaed — 2025-08-03

Anemia during pregnancy is a major public health issue, particularly in developing countries, with significant health, social, and economic consequences. This study aimed to assess the prevalence of anemia among pregnant women attending the Tobruk Medical Center and identify associated factors. A cross-sectional analytical study was conducted from January 2024 to June 2024 on 2187 pregnant women attending the Gynecology Department at Tobruk Medical Center in Tobruk, Libya, to gather data on social and demographic characteristics, reproductive health status, and the prevalence of anemia. Logistic regression was used for statistical analysis. The overall prevalence of anemia among pregnant women was 49.7%, with 42.9% experiencing mild anemia. Parity and gravidity were significantly associated with anemia. The anemia prevalence was higher among multiparous women (51.4%). Other factors, such as age, employment status, and abortion history, did not show a strong association. The prevalence of anemia among pregnant women in Tobruk is high and coincides with WHO’s definition of a severe public health problem. This highlights the need for greater awareness of balanced diets, regular antenatal checkups, and the consistent use of iron and folic acid supplements to address anemia in pregnancy in Libya. Future research should explore these additional factors to better address maternal anemia.

Prevalence and Antimicrobial Resistance of Gram-Negative Bacteria in Clinical and Environmental Samples: A Study from Libya

Jadalla Emhalhel — 2025-08-04

The prevalence of Gram-negative bacteria in hospital settings is a major public health concern, particularly in developing countries where healthcare infrastructure may be limited. This study aimed to determine the prevalence, distribution, and antimicrobial resistance patterns of Gram-negative bacteria in teaching hospitals in Libya. A total of [number] clinical samples were collected from hospitalized patients with suspected infections at [names of hospitals, if applicable] over a period of [duration of the study]. Standard microbiological procedures, including bacterial culturing, biochemical identification, and antibiotic susceptibility testing, were employed to identify and characterize the Gram-negative isolates. The results indicated a high prevalence of Gram-negative pathogens, with Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii being the most frequently isolated bacteria. A significant proportion of the isolates demonstrated resistance to commonly used antibiotics, including beta-lactams, aminoglycosides, and fluoroquinolones, with multidrug-resistant strains emerging as a major concern. The study emphasizes the urgent need for effective infection control measures, appropriate antibiotic stewardship, and regular surveillance to combat the spread of these resistant Gram-negative pathogens in Libyan healthcare settings. Further research is required to understand the underlying factors contributing to the high rates of antimicrobial resistance and to guide appropriate interventions

A Retrospective Analysis of FAST-Sonography Reliability for Blunt Abdominal Trauma Management at Abo-Slim Trauma Hospital: Surgi-cal Outcomes and CT Comparisons

Abdulhakim Glia — 2025-08-05

Blunt abdominal trauma (BAT) represents a significant cause of morbidity and mortality in emergency medicine. Accurate and timely diagnosis, along with appropriate intervention, is crucial in the effective management of trauma patients with BAT. Failure to identify occult injuries may result in preventable adverse outcomes. Focused Assessment with Sonography for Trauma (FAST) and computed tomography (CT-Scans) are essential diagnos-tic tools that aid clinicians in accurately diagnose and manage patients with BAT. This study aimed to evaluate the clinical utility of FAST-Scans performed by emergency surgeons at a regional trauma center (Abo-Slim Trauma Hospital) in the assessment of BAT patients. Additionally, it exam-ines the limitations of FAST and explores potential strategies to enhance its diagnostic efficacy. A hundred of consecutive BAT patients at a Level I trauma center from 2009-2012 were studied, retrospectively. FAST-Scan per-formance was evaluated against laparotomy/CT-Scan findings, with statis-tical analysis using Fisher's exact test and multivariate regression. FAST-Scan demonstrated excellent sensitivity (98.3%) and reliable accuracy (89.5%) for detecting hemoperitoneum, though with limited specificity (14.3%). While CT showed superior anatomical characterization (100% ac-curacy). FAST-Scan remains an indispensable first-line tool for rapid triage in blunt abdominal trauma when interpreted by trained clinicians.

Comparative Prospective Study on Prophylactic Antibiotics versus Empirical Antibiotics in the Prevention of Surgical Site Infection in Libya

Ahmad Abaidalla — 2025-08-10

Surgical site infections (SSIs) develop in or around a surgical wound after the operation depending on the type of procedure performed. One of the main strategies to prevent SSIs is the use of antimicrobial prophylaxis, which is the administration of antibiotics before, during, or after surgery to reduce the risk of wound infections. However, there is controversy about the optimal duration and regimen of antimicrobial prophylaxis. This study aims to investigate and compare the use of prophylactic antibiotics versus empirical antibiotics in preventing SSIs. A prospective observational study was conducted in secondary health center of Aljabal Alakhter in Libya from December 2020 to October 2022. A total of 96 cases were enrolled in the study. Out of whom,46 patients with a mean age of 40.59 (±13.848) years for Prophylactic group and 50 patients with a mean age 31.02 (±17.694) years for Empirical group. Prophylactic group had 17 males and 29 females, while Empirical group had 21 males and 29 females. There was statistically non-significant difference between gender distributions in the two groups. In conclusion: SSIs are one of the most common post operative complications in which a high risk of post operative morbidity and mortality, prolongs hospital stay and raises hospital cost to patients. In our study, the total incidence rate of SSI was 0.0%. While empirical use of antibiotics is of minimal benefit.

Identification and Evaluation of Drug-Related Problems in Elderly Hypertensive Patients

Nadia Alrawaiq — 2025-08-14

The phrase "Problems related to the drug" serves as a comprehensive term for any condition or care related to the patient, whether it is currently or potentially obstructing the best possible results for the patient. Individuals diagnosed with high blood pressure have an increased risk of experiencing drug-related problems, largely due to their regular drug intake and the existence of many concurrent health issues. Thus, there has been a significant decrease in research focused on elderly patients with high blood pressure till now. The purpose of this investigation is to evaluate drug-related problems and identify the determinants affecting these issues within this demographic. The retrospective analysis was done from January 2021 to February 2021 at a healthcare facility in Libya. The sample included patients diagnosed with chronic high blood pressure. The study identified a total of 70 persons associated with problems related to 404 drugs. Within the investigated population, 81.4% displayed a drug-related problem, with an average of 5. 7 were per capita on issues. Adverse events emerged as a leading category of drug-related problems, which represent 59.29% in total cases. The second most commonly found type of drug-related problem was indicated, which was 18.6% of all recorded issues. Monitoring problems were the third most often, including 17. 3%of the overall count. In contrast, dosage-related complications were at least as frequent, which contribute only 4.7%of all medicines related to medicines. It is important to identify the types and trends of drug-related problems in patients suffering from high blood pressure to prevent and improve management of these issues. It is necessary to apply effective strategies to reduce the incidence of complications related to treatment within this susceptible group

Using GC –Mass Method for Determination the Hydrocarbon Compounds in Some Vegetable Samples at Derna City, Libya

Zaenab Habil — 2025-08-16

The purpose of this study was to identify and quantify the polycyclic aromatic hydrocarbons (PAHs) in a variety of vegetables from various places in Derna City, Libya. The GC-MS equipment was used to identify and determine the types of aromatic hydrocarbon molecules. The findings demonstrated that polycyclic aromatic hydrocarbons were present in every vegetable sample that was analyzed. The findings indicated that the vegetables' total amounts of polycyclic aromatic hydrocarbons varied as follows: 8.257 µg/g for tomato, 8.258 µg/g for pepper, 7.841 µg/g for eggplant, and 8.216 µg/g for zucchini. The origin and sources of the investigated polycyclic aromatic hydrocarbons in vegetable samples were estimated using a few computed ratios, as the ratio (LMW/HMW) of low molecular weight (LMW) to high molecular weight (HMW) chemical composition. Diagnostic ratios of the concentrations of specific pairs of aromatic hydrocarbons, such as (∑COMB/∑PAHs), Phe/Ant, Flu/Pyr, Inp/ (Inp + Bghip), Bap/(Bap + Chr), and Ant/(Ant + Phe), were also employed to investigate the origin of the polycyclic aromatic hydrocarbons. The findings showed that petrogenic and pyrolytic sources were the primary sources of PAHs in vegetables. The investigation came to the conclusion that the majority of the PAHs in the study samples came from either pyrolytic or direct petroleum sources

The Hall Technique: A Mini Review

Samia Salama — 2025-08-20

In pediatric dentistry, the development of techniques that are both effective and minimally invasive has become a priority. These approaches not only reduce the level of discomfort experienced by young patients but also facilitate cooperation during dental visits, thereby decreasing the need for extensive behavior management. Moreover, such techniques allow clinicians to provide care more efficiently, saving time and effort while improving the overall treatment experience. This is particularly important for younger children, who often face challenges in tolerating conventional restorative procedures. The present study aims to examine one of these innovative techniques and its role in enhancing the management of dental caries in primary teeth

Physiotherapy Interventions for Breast Cancer Survivors: Practice Patterns and Perceived Barriers in Tripoli, Libya

Ahlam Elkheshebi — 2025-08-26

Post-operative physiotherapy is a cornerstone in enhancing the quality of life and functional recovery of breast cancer survivors. Despite its recognized importance, there is a paucity of data regarding physiotherapy practices, referral patterns, and clinical challenges in the management of post-operative breast cancer patients in Libya. This study aimed to investigate the clinical practices, referral trends, and therapeutic interventions employed by physiotherapists in Tripoli, Libya, in managing post-operative breast cancer patients. Additionally, it sought to identify key barriers hindering the delivery of optimal physiotherapy care in this population. A descriptive cross-sectional study was conducted from June 4 to July 4, 2022, involving 35 physiotherapists working in major public hospitals and private rehabilitation centers across Tripoli. Participants were selected based on their prior experience with breast cancer patients. Data were collected using a structured, pre-validated questionnaire adapted from international sources, and data were analyzed using SPSS version 26. Most of the physiotherapists surveyed were female (74.3%) and between the ages of 25 and 35. While 60% had less than five years of experience managing breast cancer cases, nearly two-thirds (62.9%) reported not having received any formal training in oncology rehabilitation. Most participants treated fewer than 20 breast cancer patients per year, and 60% indicated that physiotherapy referrals were typically made only after surgery. The most reported barriers to effective care included patients’ psychological distress (77.1%), followed by low adherence to treatment and insufficient professional training. Regarding treatment methods, passive mobilization, postural correction, and manual therapy were frequently used during the first two weeks post-surgery. Strengthening and range-of-motion exercises were usually introduced later in the subacute recovery phase, while electrotherapy was the least commonly applied. A statistically significant difference (p < 0.001) in the timing and frequency of interventions points to a lack of standardized physiotherapy practices across facilities. The findings underscore a pressing need for structured training programs, the development of standardized physiotherapy protocols, and the integration of physiotherapy services into the early stages of breast cancer care in Libya. Improving education for physiotherapists and refining referral mechanisms may substantially enhance rehabilitation outcomes and overall quality of life for breast cancer survivors. Furthermore, future research is recommended to assess the long-term effects of physiotherapy on physical and psychological outcomes in post-operative breast cancer patients. Larger, multi-center studies are needed to develop evidence-based guidelines suited to the Libyan context

Mental Health in Visible Skin Disorders: Assessing Anxiety and Depression in vitiligo and alopecia areata patients compared to Healthy Peers

Suad Altubouli — 2025-08-27

Alopecia areata is characterized by non-scarring scalp complete terminal hair loss, and vitiligo is characterized by skin pigment loss. Alopecia and vitiligo are distinct, heterogeneous, and complex diseases, in most cases resistance to treatment. The current study aimed to evaluate and compare the Anxiety and Depression levels within patients who were diagnosed with Vitiligo and Alopecia-areata against the control group of healthy individuals. A total of 150 participants were recruited: 50 with vitiligo, 50 with alopecia areata, and 50 healthy controls. Patients who visited the outpatient dermatology clinic at Medical Centre at Al-Beyda City from January to December 2023 have been included in this Study. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate ''Depression and Anxiety''. The findings showed that elevated anxiety and despair scores in both patient groups relative to the healthy control group (p < 0.001). However, current results showed that no significant difference was observed between the vitiligo and alopecia areata groups (p > 0.05). These findings highlight the psychological burden associated with chronic dermatological conditions and emphasize the need for integrated mental health support in dermatological care

Use of CT Scout Radiographs in the Management of Urolithiasis

Hajer Alfadeel — 2025-08-28

Unenhanced CT is the gold standard imaging for patients with suspected urolithiasis. The aim of this study was to determine the sensitivity of CT scout radiographs in detecting urinary stones in patients with confirmed urolithiasis on unenhanced CT. A retrospective study was carried out with data collected consecutively from January to November 2021. The included cases were those with confirmed urinary stones on unenhanced CT. CT scout radiographs were read and cross-referenced with unenhanced CT. Stones were classified as visible and non-visible on scout radiographs. The location and size of stones on axial CT were recorded. Means of size of visible and non-visible stones and frequency of detection by scout radiographs between proximal stones and distal stones were tested for significance. 117 stones were analyzed. The sensitivity of CT scout radiographs was 56%. There was a direct correlation between stone size and stone visibility on CT scout radiographs. There was a statistically significant difference between the means of sizes of visible and non-visible stones on scout radiographs (P < 0.001). 54% (41/76) of proximal stones and 59% (24/41) of distal stones were visible on CT scout radiographs. There was no statistically significant difference between visibility and stone location (P = 0.6). Conclusion: CT scout radiography could detect stones in 56% of patients with urolithiasis diagnosed on unenhanced CT. Therefore, it could serve as a baseline investigation to detect stone radio-opacity and should be reported in conjunction with the findings of unenhanced CT for guiding treatment/follow-up decision options.

The Impact of Low-Cost Antibiotic Cotrimoxazole in Patients With COVID-19

Ibrahim Al-Osta — 2025-08-28

The global pandemic Coronavirus Disease 19 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Many patients with life-threatening illness due to COVID-19 die from hypoxic respiratory failure, which appears to be related to a cytokine storm syndrome leading to Acute Respiratory Distress Syndrome (ARDS). While steroids have some demonstrated benefits, supportive care remains the mainstay of treatment. However, in the absence of vaccines and proven treatments, during this current pandemic, we are considering repurposing currently available medications; one of the first is cotrimoxazole (CTX), which was one of the earliest medications for treating and preventing opportunistic infections caused by the human immunodeficiency virus (HIV), among other things. Cotrimoxazole in combination with folic acid is inexpensive, familiar to the public, and generally well tolerated, and treats secondary infections. Low cost and a good safety profile can make it an ideal candidate for the treatment of COVID-19 in a low-resource country like Libya. Here we report our observations with cotrimoxazole added to standard therapy in patients with severe COVID-19. Prospective data were gathered from consecutive newly diagnosed patients who presented to the Msallatah Isolation Center (Corona Center), Msallatah, Libya, between June and September of 2021 with critical COVID-19 on non-invasive ventilation and receiving standard therapy (ST) along with 480 mg oral cotrimoxazole (CTX). The first four days served as a control period during which patients with critical COVID-19 received only standard treatment. After a 4-day control period during which the patients received ST alone, nine patients (mean age ± SEM 40.5 ± 10.5 years, 66.66 percent male) were identified because they received CTX in addition to ST. We found that patients with critical COVID-19 who received CTX in addition to ST experienced significantly better outcomes, such as lower in-hospital mortality (0%), higher blood levels of D-Dimer (3735±579.9 mg/L versus 444.82±182.14 mg/L, p˂0.05), and improvements in respiratory rate (36.42±3.9 mg/L versus 25.6±2.9 mg/L, p˂0.05) and CRP at the fourth day of the experiment (142.12±34.7 mg/L versus 72.4±19.26 mg/L, p˂0.05). These results demonstrate the beneficial effects of using cotrimoxazole in patients with severe COVID-19; it could help to reduce the need for respiratory support for thousands of patients, saving valuable lives and decreasing the burden on the healthcare system in countries with limited resources. The mechanism of action of cotrimoxazole in this situation is not clear; however, these outcomes may be due to the antibiotic activity and/or the anti-cytokine effects of cotrimoxazole. Further trials are needed to test our observations

Challenges in Parathyroidectomy in End-Stage Kidney Disease: Preoperative Preparation, Localisation, and Surgery. A Case Series and Evidence-Based Approach

Mohamed Addalla — 2025-08-29

Renal hyperparathyroidism is a frequent and serious complication of end-stage kidney disease (ESKD), contributing to vascular calcifications, bone pain, and cardiovascular morbidity. For patient’s refractory to medical therapy, parathyroidectomy (PTX) offers definitive treatment, alleviating symptoms, improving quality of life, and potentially enhancing survival. However, PTX in ESKD presents distinct intra-operative and post-operative challenges. This study evaluated the peri-operative and clinical considerations of PTX in ESKD, with emphasis on operative planning, gland localisation, post-operative hypocalcaemia, and recurrence risk. A literature review and retrospective analysis were conducted on eight dialysis-dependent patients with renal hyperparathyroidism unresponsive to medical treatment, all assessed by a multidisciplinary team prior to surgery. Three patients developed complications due to persistently elevated parathyroid hormone (PTH) levels, while the remainder were discharged in stable condition. These findings underscore the need for meticulous patient selection, comprehensive pre-operative counselling, and multidisciplinary decision-making. Surgical indications should be guided by symptom burden, biochemical derangements, and persistently elevated PTH. Although comparative evidence between surgical and medical approaches remains limited, PTX is associated with survival benefits and cost-effectiveness. Persistent post-operative PTH elevation may be linked to increased mortality, highlighting the importance of long-term follow-up and structured post-operative management