Medical Sciences

Environmental practices and serum Vitamin D deficiency Mohammed Ibn-Mas'ud Danjuma Libyan Journal of Medical Sciences 2020 4(4):157-158

Provision of pharmaceutical services in time of COVID-19 crisis: A libyan vision Amal Yousef Benkorah Libyan Journal of Medical Sciences 2020 4(4):159-163 Pharmaceutical services play a crucial role in any health system. Pharmacists are the main health professionals to ensure that people have access to good and safe medicines and to make certain that these medicines are used rationally. While the role of pharmacists in providing health-care services in Libya remains restricted, the scope of pharmacy practice is vast and encompasses a variety of roles and functions. Most of today's pharmacists' services are oriented toward clinical outcomes using medicines. Therefore, pharmacists are focusing on optimizing the use of medications, promoting health, wellness, and preventing diseases. Pharmaceutical services are currently being tailored to be event driven to fit the current COVID-19 pandemic crisis and to help combat this disease and its consequences. This article discusses different pharmaceutical services that can be provided by pharmacists in all practice settings, for the Libyan healthcare system and to the society in general during COVID-19 crisis.

Insulin analogs versus human insulins for the management of diabetes: An evidence-based review Mohsen S Eledrisi Libyan Journal of Medical Sciences 2020 4(4):164-168 Insulin analogs are preferred by many physicians over human insulins in the management of Type 1 diabetes and in patients with Type 2 diabetes who require insulin. Insulin analogs have a pharmacological profile that is close to the normal physiological action of insulin. There is a notion among some clinicians that insulin analogs offer advantages over human insulins, including better glucose control, less hypoglycemia, and flexibility. A large number of clinical studies, along with systematic reviews, have compared insulin analogs to human insulins in regard to glucose control, rates of hypoglycemia, quality of life, and cost-effectiveness. For Type 1 diabetes, rapid-acting insulin analogs offer better glucose control and less rates of hypoglycemia compared to regular human insulin. Long-acting basal insulins result in less nocturnal hypoglycemia compared to neutral protamine Hagedorn (NPH) insulin but no difference in glucose control in patients with Type 1 diabetes. For patients with Type 2 diabetes, rapid-acting insulins offer no advantage for glucose control or rates of hypoglycemia when compared to regular insulin. There was only a reduction in rates of nocturnal hypoglycemia with no difference in glucose control with the use of basal insulin analogs compared to NPH insulin in Type 2 diabetes. The cost of insulin analogs is considerably higher than human insulins and favorable cost-effectiveness was only demonstrated with rapid-acting insulin analogs in Type 1 diabetes. The available evidence does not support the routine use of insulin analogs over human insulins. There are only few situations where insulin analogs have shown clear benefit over human insulin. In a large percentage of patients cost consideration and lack of better glucose control would favor the use of human insulins.

Serum Vitamin D levels and associated risk factors among libyan females living in Tripoli, Libya: A cross-sectional study Manal Hassan Al-Graiw, Marwan Mustafa Draid, Aisha Muftah Zaidi, Huda Hassan Al-Griw Libyan Journal of Medical Sciences 2020 4(4):169-173 Background: Vitamin D deficiency is a worldwide health problem and has been associated with religion, faith, caste, education, and socioeconomic status. Scientific evidence indicates that adequate levels of Vitamin D have important implications for the management of health problems. Aim: The aim of this study is to investigate the prevalence of Vitamin D deficiency and associated risk factors among Libyan females. Patients and Methods: This cross-sectional study included 262 female patients presented with nonspecific musculoskeletal and bone pain at Seoul Hospital in Tripoli, Libya. Vitamin D status was measured and risk factors for Vitamin D deficiency were assessed. Results: The mean age ± standard error of mean (SEM) of participants was 40.8 ± 0.9 years (range 18-80 years). In general, approximately 87.7% of the patients (n = 262) have serum Vitamin D concentrations below normal (<30 ng/mL). The mean serum 25-hydroxyvitamin D (25(OH)D) concentration of patients was 13.98 ± 10.2 ng/ml. About 50.8% had 25(OH)D-levels <10 ng/mL which is characterized as severe Vitamin D deficiency, 27.5% had 25(OH)D-levels <20 ng/ml, defined as Vitamin D deficiency. About 9.1% of patients had insufficient Vitamin D, and only 12.6% had sufficient Vitamin D status defined as 25(OH)D-levels ≥30 ng/ml. Conclusions: Our data show that patients with generalized body aches, fatigue, and nonspecific bone pains, all have a significant relationship with Vitamin D deficiency strongly related to risk factors such as inadequate exposure to sunlight, wearing covering clothes, niqab, hijab, low dietary Vitamin D intake, and Vitamin D supplementation.

Medical waste management in dental clinics in Tripoli/Libya Rema A. E Shampe, Raga A Elzahaf, Madi Tawfiq Abd-Elwali Al-Jaghbir, Abdelkader Battah Libyan Journal of Medical Sciences 2020 4(4):174-178 Background: Dental clinics are important and essential for the health and safety of individuals in the community and they are indispensable for the provision of medical and therapeutic services for the diagnosis of oral diseases, gum and teeth. As important as the other health centers, good and appropriate management of medical waste in dental clinics is very important to ensure safety for staff in the clinic. Objectives: Evaluating the level of medical waste management in dental clinics in Tripoli/ Libya. Methods: A cross-sectional study was conducted on 201 respondents: dentists, nurses, and assistants dentist chosen from 67 clinics out of 135 clinics. A questionnaire was used to two sections. The data were analyzed by using the IBM Statistical Package for Social Sciences (IBM SPSS) software, version 19.0 (SPSS Inc.). Results: 39.8% of respondents who were separating contaminated blood from non-contaminated waste and 82.1% of respondent's disposal liquid waste such as blood and saliva through the sewage network. However, there was no statistically significant difference in medical waste management between male and female dental staff in Tripoli, Libya (t = 0.376, P = 0.170). Conclusions: The methods of medical waste management practiced in the most dental clinics were inappropriate. The study demonstrated that there was lack of knowledge among workers in dental clinics regarding the disposal procedures and dealing with waste. Therefore, it is necessary to re-assess safety protocols by authorities and intervene quickly by introducing spread awareness of health and safety in dental clinics and in forcing regulations.

Assessment of patient safety culture in benghazi children's hospital from the viewpoint of nursing staff Ainas Salem Eltarhuni, Hajir Omar Tawfeeq, Jebril S El-Abidi Libyan Journal of Medical Sciences 2020 4(4):179-183 Background: patient safety is a critical component of health-care quality, and it is considered as an important issue worldwide. This study aimed to assess patient safety culture (PSC) among nurses and to investigate the areas of deficiencies for improvement. Methods: A descriptive cross-sectional study was conducted on nurses working at Benghazi Children's Hospital. A self-administered questionnaire containing 12 dimensions was used to assess the Hospital Survey on PSC including patient safety grade and number of events reported. Results: Only 87 of the total 118 distributed questionnaires were returned, giving a response rate of 73.7%. The overall positive response rate of PSC was 47%. The dimension with the highest positive score and considered areas of strength were teamwork within units (72%). The dimension with the lowest percentage of positive response rate was nonpunitive response to error (30%). Conclusion: Improving PSC should be a priority among hospital administrators. Staff should be encouraged to report errors spontaneously and without any fear.

Variation in the branching pattern of the anterior branches of the external carotid artery Mohamed Elsllabi, Sabri Garoushi, Khaled Aneiba, Osama A Tashani Libyan Journal of Medical Sciences 2020 4(4):184-187 Background/Aim: External carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study was to investigate the variations in the origin of the three primary anterior branches of the ECA: superior thyroid artery (STA), lingual artery (LA), and facial artery (FA). Methods: The branching pattern of the ECA was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally to uncover the common carotid artery (CCA), internal carotid artery and ECA. The level of carotid artery bifurcation (CB) was located. Variation of the branching patterns of the ECA was assessed. Moreover, the distances between the origin sites of these vessels and the site of the CB were measured. Results: The STA was found to arise more frequently from the ECA (60%) than from the CCA (40%), with no differences in distribution between sexes or sides. Regarding the assessment of the branching patterns of the ECA, the specimens where the STA, LA, and FA emerged as individual branches were 90% of cases, linguofacial trunk cases were 6.7%, and thyrolinguofacial trunk cases were 3.3%. The distances from the vessel origin site to the CB were found to be 8.11 ± 2.77 mm, 19.38 ± 8.85 mm, and 27.95 ± 10.15 mm, for the STA, LA, and FA, respectively. Conclusions: The current findings have confirmed that the ECA branching pattern is highly variable in Thiel embalmed cadavers of Scottish population. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region could be vital to prevent iatrogenic injuries.

Pro-inflammatory cytokine profile of pulmonary tuberculosis patients in central hospital, Agbor Nigeria Clement Ndudi Isibor, Racheal O Okojie, Endurance A Ophori, Solomon E Omonigho Libyan Journal of Medical Sciences 2020 4(4):188-191 Background: The aim is to determine the pattern of cytokines secretion by assessing interleukins (IL-1, IL-6, and tumor necrosis factor-alpha (TNF-α) in pulmonary tuberculosis patients. Materials and Methods: A cross-sectional study was conducted on 146 consecutive (54 males and 92 females) sputum positive for tuberculosis and 38 apparently healthy age- and sex-matched sputum negative for tuberculosis as control were recruited between May 2016 and June 2017. A volume of 5 mL of blood samples was collected for the determination of serum IL-1, IL-6 and TNF-α using the ELISA method. Results: There was a higher cytokine mean ± standard error of the mean for tuberculosis subjects (95.77 ± 6.68 pg/mL; 107.54 ± 14.76 pg/mL, 122.09 ± 16.55 pg/ml) and controls (79.88 ± 3.53 pg/ml; 78.35 ± 6.82 pg/ml; 94.11 ± 14.08 pg/ml) for interleukin-1, interleukin-6, and TNF-α, respectively, when compared. There was strong correlation between mean values of IL-6 and TNF-α (r = 0.72315, P < 0.05). There was significance difference (P < 0.05) observed in the mean serum concentrations of cytokines among the genders (P < 0.05). Conclusion: The study revealed that IL-1, IL-6, TNF-α are important biological markers for tuberculosis disease.

Primary salivary gland lymphomas: A case series Sohaila Fatima, Rabab Nasir Mohamed Badri, Wajih Ahmed Siddiqui, Abdulrahman Alshehri Libyan Journal of Medical Sciences 2020 4(4):192-195 Salivary gland lymphomas are rare, constituting 1.7% of all salivary gland neoplasms. They are uncommon before 50 years of age predominantly involving parotid gland. The most common histopathological forms of non Hodgkin lymphoma include mucosa associated lymphoid tissue lymphoma followed by follicular lymphoma and diffuse large B cell lymphoma. A retrospective study was conducted in a tertiary health care centre over a span of six years on patients with salivary gland lymphomas. Their clinicopathological features, staging and treatment modalities were determined. The mean age was 63.3 years with four males and two females. All patients had parotid gland involvement with one showing simultaneous involvement of submandibular gland. Histopathologically there were three cases of low grade B-cell lymphoma, two cases of high grade lymphoma and one case of Hodgkin lymphoma. Three patients were found in early stage and three in advanced stage disease. Lymphomas must be considered in the differential diagnosis of a salivary gland swelling although they are quite uncommon. They predominantly involve parotid gland. The selection of treatment modalities is based on histologic subtyping and staging of lymphoma with better prognosis as compared to other extranodal non Hodgkin lymphoma.

A rare cause of hypocalcemia: Hypoparathyroidism, sensorineural deafness, and renal disease syndrome Sufyan Benamer, Paul Jennings Libyan Journal of Medical Sciences 2020 4(4):196-197 Hypocalcemia is a common electrolyte disturbance with a variety of causes. Hypoparathyroidism, sensorineural deafness, and renal disease (HDR) syndrome is a rare autosomal-dominant genetic disorder characterized by hypoparathyroidism, sensorineural deafness, and renal disease. This is a case presentation of HDR syndrome that had been referred to a hospital with hypocalcemia. This case has a unique feature as it has been diagnosed in adult age because usually HDR syndrome is diagnosed in pediatric age group.

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Dexmedetomidine Provides Cardioprotection During Early or Late Reperfusion Mediated by Different Mitochondrial K+-Channels

xloma.fota13 shared this article with you from Inoreader Dexmedetomidine Provides Cardioprotection During Early or Late Reperfusion Mediated by Different Mitochondrial K+-Channels Via Anesthesia & Analgesia - Current Issue Background: Cardioprotective interventions—such as pharmacological postconditioning—are a promising strategy to reduce deleterious consequences of ischemia and reperfusion injury (I/RI) in the heart, especially as timing and onset of myocardial infarction are unpredictable. Pharmacological postconditioning by treatment with dexmedetomidine (Dex), an α2-adrenoreceptor agonist, during reperfusion protects hearts from I/RI, independently of time point and duration of application during the reperfusion phase. The mitochondrial ATP-sensitive K+ (mKATP) and mitochondrial large-conductance calcium-sensitive potassium channel (mBKCa) play a pivotal role in mediating this cardioprotective effect. Therefore, we investigated whether Dex-induced cardioprotection during early or late reperfusion is mediated variously by these mitochondrial K+-channels. METHODS: Hearts of male Wistar rats were randomized into 8 groups and underwent a protocol of 15 minutes adaption, 33 minutes ischemia, and 60 minutes reperfusion in an in vitro Langendorff-system. A 10-minute treatment phase was started directly (first subgroup, early reperfusion) or 30 minutes (second subgroup, late reperfusion) after the onset of reperfusion. Control (Con) hearts received vehicle only. In the first subgroup, hearts were treated with 3 nM Dex, 100 µM mKATP-channel blocker 5-hydroxydecanoate (5HD) or 1 µM mBKCa-channel blocker Paxilline (Pax) alone or with respective combinations (5HD + Dex, Pax + Dex). Hearts of the second subgroup received Dex alone (Dex30') or in combination with the respective blockers (5HD + Dex30', Pax + Dex30'). Infarct size was determined with triphenyltetrazoliumchloride staining. Hemodynamic variables were recorded during the whole experiment. RESULTS: During early reperfusion (first subgroup), the infarct size reducing effect of Dex (Con: 57% ± 9%, Dex: 31% ± 7%; P View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis

xloma.fota13 shared this article with you from Inoreader Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis Via Anesthesia & Analgesia - Current Issue Background: Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients. METHODS: This study involved a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of RAP in cardiac surgery involving CPB. The primary outcome was intraoperative allogeneic red cell transfusion. Secondary outcomes included whole hospital allogeneic transfusions and adverse events such as acute kidney injury (AKI) and stroke. RESULTS: A total of 11 RCTs (n = 1337 patients) were included, comparing RAP patients (n = 674) to control (n = 663). In addition, 10 observational studies (n = 2327) were included, comparing RAP patients (n = 1257) to control (n = 1070). Overall, RAP was associated with a significantly reduced incidence of intraoperative red cell transfusion (n = 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI], 0.22–0.55, P View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effects of Nitroglycerin on the Oxytocin Dose–Response Profile in Oxytocin-Desensitized and Naïve Human Myometrium: An In Vitro Study

xloma.fota13 shared this article with you from Inoreader The Effects of Nitroglycerin on the Oxytocin Dose–Response Profile in Oxytocin-Desensitized and Naïve Human Myometrium: An In Vitro Study Via Anesthesia & Analgesia - Current Issue Background: Nitroglycerin is used for acute reduction in uterine tone. Prolonged oxytocin exposure causes desensitization of oxytocin receptors. It is unknown if nitroglycerin exposure impacts the subsequent action of oxytocin in the setting of oxytocin receptor desensitization. This study investigated the effects of nitroglycerin on oxytocin-desensitized and oxytocin-naïve human myometrium and the subsequent response to oxytocin dose–response testing in vitro. METHODS: Myometrial samples from 17 elective cesarean deliveries were divided into strips and allocated to 1 of 4 groups: (1) oxytocin desensitized and no nitroglycerin; (2) oxytocin desensitized and nitroglycerin; (3) oxytocin naïve and nitroglycerin; and (4) oxytocin naïve and no nitroglycerin. Final analysis included 28 strips per group. Nitroglycerin groups were exposed to incremental concentrations of nitroglycerin, while no nitroglycerin groups were kept in control (physiological salt) solution. All groups then underwent oxytocin dose–response testing. Primary outcome was motility index (amplitude × frequency; grams × contractions per 10 minutes [g·c/10 min]). Secondary outcomes were amplitude (g), frequency (contractions/10 minutes), and area under the curve (g·s). All outcomes (nitroglycerin and oxytocin dose–response periods) were expressed as a percentage change from baseline. Values were log transformed, compared using regression modeling and reported as the ratio of 2 ge ometric means (relative difference). RESULTS: No significant difference was observed in motility index following nitroglycerin administration in oxytocin-desensitized versus oxytocin-naïve groups (relative difference = 19.0%; 95% confidence interval [CI], −32.6 to 109.9; P = .55). On oxytocin dose–response testing, motility index was highest in oxytocin-naïve and no nitroglycerin samples (group 4) (1.356 g·c/10 minutes) followed by oxytocin-naïve and nitroglycerin (group 3) (0.882 g·c/10 minutes), oxytocin-desensitized and no nitroglycerin (group 1) (0.769 g·c/10 minutes), and oxytocin-desensitized and nitroglycerin (group 2) (0.651 g·c/10 minutes) samples. Motility index was significantly reduced in group 1 vs 4 (relative difference = −43.3%; 95% CI, −66.5 to −4.1; P = .034) and group 2 vs 4 (relative difference = −52.0%; 95% CI, −70.9 to −20.8; P = .004). While in groups 3 vs 4, both amplitude (relative difference = −17.8%; 95% CI, −30.9 to −2.2; P = .27) and area under the curve (AUC; relative dif ference = −17.5%; 95% CI, −30.7 to −1.8; P = .030) were reduced. CONCLUSIONS: Nitroglycerin-induced relaxation was not different between oxytocin-desensitized and oxytocin-naïve human myometrial strips in vitro. However, oxytocin-induced contractility was attenuated after nitroglycerin exposure in both oxytocin-desensitized and oxytocin-naïve samples, with maximum attenuation observed in desensitized tissues. This finding warrants further clinical studies to explore uterine responsiveness to oxytocin in women with oxytocin-augmented labors after nitroglycerin administration. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity and Mortality in a Tertiary Care Center in a Low- and Middle-Income Country: A 25-Year Audit

xloma.fota13 shared this article with you from Inoreader Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity and Mortality in a Tertiary Care Center in a Low- and Middle-Income Country: A 25-Year Audit Via Anesthesia & Analgesia - Current Issue Background: The analysis of adverse events, including morbidity and mortality (M&M), helps to identify subgroups of children at risk and to modify clinical practice. There are scant data available from low- and middle-income countries. Our aim was to estimate the proportion of pediatric patients with various severe adverse events in the perioperative period extending to 48 hours and to describe the clinical situations and causes of those events. METHODS: We reviewed the M&M database of the Department of Anesthesiology between 1992 and 2016. A data collection tool was developed, and the outcomes were standardized. Each case was reviewed independently and subsequently discussed between 2 reviewers to identify a major primary causative factor. RESULTS: The total number of pediatric cases during this period was 48,828. Seventy-six significant adverse events were identified in 39 patients (8 patients [95% confidence interval {CI}, 5.7–10.9] per 10,000). Thirteen patients had multisystem involvement, and hence the total number of events exceeded the number of patients. Respiratory events were the most common (33.5%). Thirteen patients had perioperative cardiac arrest within 48 hours of surgery (2.6 [95% CI, 1.3–4.3] per 10,000), 7 of these were infants (54%), 5 of whom had congenital heart disease (CHD). Eleven of these 39 patients died within 48 hours (2.0 [95% CI, 1.1–4.0] per 10,000). In 13 cases, anesthesia was assessed to be the predominant cause of morbidity (2.6 per 10,000), whereas in 26 cases, it contributed partially (5.32 per 10,000). There was only 1 death solely related to anesthesia (0.2 per 10,000), and this death occurred before the start of surgery. CONCLUSIONS: Adverse events were uncommon. Respiratory complications were the most frequent (33%). Infants, especially those with CHD, were identified as at a higher risk for perioperative cardiac arrest, but this association was not tested statistically. Twenty-eight percent of the patients who suffered events died within 48 hours. Increased access to anesthesia drugs and practice improvements resulted in a decline in perioperative cardiac arrests. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Incidence of Anaphylaxis to Sugammadex

xloma.fota13 shared this article with you from Inoreader Incidence of Anaphylaxis to Sugammadex in a Single-Center Cohort of 19,821 Patients Via Anesthesia & Analgesia - Current Issue Background: Sugammadex is a modified cyclodextrin that is being increasingly used in anesthetic practice worldwide for the reversal of the aminosteroid neuromuscular blockers rocuronium and vecuronium. Its safety profile, however, is incompletely understood. One such aspect is the incidence of anaphylactic reactions that occur after its administration. While several case reports exist in the literature, there is a paucity of information on the actual incidence of anaphylactic reactions. METHODS: A single-center retrospective chart review identified patients who experienced anaphylaxis to sugammadex in the institutional electronic medical record system. These charts were then reviewed to determine whether the etiology of anaphylaxis was sugammadex administration. RESULTS: Two patients experienced anaphylaxis to sugammadex, which occurred in a single institution cohort of 19,821 patients who received 23,446 total doses. This rate is markedly lower than the 1/300 that the manufacturer's package insert states and also lower than the 1/2500 that the only other large cohort study performed has reported. CONCLUSIONS: The incidence of anaphylaxis to sugammadex in this cohort of patients was 2 of 19,821 patients, who received a total of 23,446 doses. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Stickler Syndrome: Airway Complications in a Case Series of 502 Patients

xloma.fota13 shared this article with you from Inoreader Stickler Syndrome: Airway Complications in a Case Series of 502 Patients Via Anesthesia & Analgesia - Current Issue Background: Patients with Stickler syndrome often require emergency surgery and are often anesthetized in nonspecialist units, typically for retinal detachment repair. Despite the occurrence of cleft palate and Pierre-Robin sequence, there is little published literature on airway complications. Our aim was to describe anesthetic practice and complications in a nonselected series of Stickler syndrome cases. To our knowledge, this is the largest such series in the published literature. METHODS: We retrospectively identified patients with genetically confirmed Stickler syndrome who had undergone general anesthesia in a major teaching hospital, seeking to identify factors that predicted patients who would require more than 1 attempt to correctly site an endotracheal tube (ETT) or supraglottic airway device (SAD). Patient demographics, associated factors, and anesthetic complications were collected. Descriptive statistical analysis and logistic regression modeling were performed. RESULTS: Five hundred and two anesthetic events were analyzed. Three hundred ninety-five (92.7%) type 1 Stickler and 63 (96.9%) type 2 Stickler patients could be managed with a single attempt of passing an ETT or SAD. Advanced airway techniques were required on 4 occasions, and we report no major complications. On logistic regression, modeling receding mandible (P = .0004) and history of cleft palate (P = .0004) were significantly associated with the need for more than 1 attempt at airway manipulation. CONCLUSIONS: The majority of Stickler patients can be anesthetized safely with standard management. If patients have a receding mandible or history of cleft, an experienced anesthetist familiar with Stickler syndrome should manage the patient. We recommend that patients identified to have a difficult airway wear an alert bracelet. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.