مجلة تريبوليتانا الطبية

A Comparative Study Between Intermittent Auscultation and Cardiotocogram in Low Risk Pregnancy During Labour

2024-09-13T17:46:27+00:00

The goal of foetal heart rate (FHR) monitoring has been early identification of the foetus at risk for hypoxic insult. The aim
of this study is to establish the relation between FHR monitoring (cardiotocogram (CTG) and intermittent auscultation)
and foetal outcome and mode of delivery. It is a prospective observational comparative study carried out on the maternity
ward of the Zawia hospital.
Study population consists of 200 women in labour having the criteria of low risk group including singleton pregnancies
between 37-40 weeks gestation, in 100 of them foetal monitoring was done by continuous electronic monitoring by CTG,
the other 100 was monitored using intermittent auscultation by Pinard stethoscope (foetoscope). Caesarean sections were
performed for both groups (31% of electronic monitoring group and 6% of Pinard stethoscope monitoring group) (P =
0.000 which is statistically significant).
Three cases were delivered by instrumental delivery (ventose), one in CTG and 2 in (foetoscope) group. Abnormalities
in foetal heart rate were detected in 12% of electronic monitoring group and in 3.5% of the Pinard stethoscope group.
The Apgar score of babies in both groups nearly the same (P = 0.411). The number of babies transferred to intensive care
unit is higher in CTG group (26%) than the other group (20%) P = 0.374. One baby in CTG group had neonatal seizure.
We conclude that, abnormalities in foetal heart rate were more reliably detected by electronic monitoring than with Pinard
foetoscope. However, use of continuous electronic monitoring carry higher rate of caesarean section with no significant
difference in neonatal outcome

Antinociceptive Activity of the Methanol Extract of Balanites Aegyptiaca (Aerial Part) in Experimental Animal Models

2024-09-13T17:52:46+00:00

Balanites aegyptiaca L. (Zygophyllaceae) has been used in a variety of folk medicines in Malaysia, Bengal, India and
Myanmar, for the treatment of various complaints. The tribal people use the aqueous juice of B. aegyptiaca for relieving
pain. Herein, the fractions and aqueous residue of the methanol extract of the aerial part of B. aegyptiaca were evaluated
for their antinociceptive activity in mice. Two different animal models, hot-plate method and acetic acid-induced writhing
test, were adopted. The present study showed that the butanol fraction of the methanol extract of B. aegyptiaca, at the
oral doses 100 and 200 mg/kg/day, produced significant (P <0.001) analgesic effects in both the tests compared to control
group. No analgesic activities were observed with dichloromethane fraction and the aqueous residue. The observed results
provide the scientific basis and safe folk use of this plant in treatment of mild pain, that may possibly be mediated centrally
and peripherally.

Effect of Vitamin C on Penicillin G Efficacy to Inhibit Bacterial Populations

2024-09-13T18:03:04+00:00

Bacterial resistance to antibiotics may have evolved from either the natural resistance mechanism associated with bacterial
structure and/or related to various bacterial strategies, ranging from the enzymatic inactivation of the antibiotic, to drug
efflux and to the development of multidrug resistance clones. There is increasing interest in some vitamins, such as
Vitamin C, as potential agents for reducing bacterial persistence and, therefore, these may help in treating many infectious
diseases of bacterial origin.
This study was designed to determine the possible effect of Vitamin C in inactivating bacterial populations of
Staphylococcus aureus and Escherichia coli, alone and in combination with Penicillin G. Potential antibacterial effect
was evaluated using the Cup Cut Agar diffusion method. Inoculated with about 1x108 cfu.ml-1 from a 16 to 18 hr culture
of bacteria. A Vitamin C concentration, calculated to 10 mg, was added to a range of Penicillin G concentrations of 30,
60 and 120 mg. Plates were then incubated overnight at 37o
C. All experiments were performed in 5 replicates, where the
mean was used to extrapolate our data.
The results showed that Vitamin C displayed a similar antibacterial effect to that of Penicillin G (at 120 mg) on E. coli
populations where this effect was significantly (P < 0.05) enhanced with the three Penicillin G concentrations employed.
S. aureus responded to the effect of the combined Vitamin C and Penicillin G more than E. coli. Therefore, Vitamin C
potentiated the effect of the Penicillin G antibiotic to an extent that the combined sub-effective or sub-therapeutic dose of
Penicillin G (30 mg) with Vitamin C (10 mg) displayed a similar effect to that of 120 mg Penicillin G alone.
It may be elucidated that Vitamin C facilitates access of the treatment agent to its target, resolving some aspects of the
problem of bacterial resistance. This study provides evidence that Vitamin C displays a crucial role in inactivating
bacterial populations and has the ability to maximize the effect of some antibiotics deployed at a lower concentration that
might help in minimizing some undesirable side effects. Vitamin C, in addition to its role in maintaining human immunity
against the cold virus and its antioxidant role can, therefore, contribute to the treatment of bacterial infectious diseases that
are non-responsive to a variety of antibiotics.

Visual Acuity and Refraction of Libyan School Pupils in Comparison to Preschool Children

2024-09-13T18:14:58+00:00

Error of refraction is a socioeconomic problem of life, its effects vary from living with blurred vision, lost opportunities to
work in certain jobs, to risking becoming blind because of potential loss of the sound eye. This study is aimed to find the
prevalence of refractive error among school age children and compare it to that of preschool children by other statistics.
Visual acuity (VA) and auto refraction and correction of error of refraction by lenses were performed on 1127 students of
first year primary, preparatory and secondary school age in Tripoli schools (April 2008 to April 2009). Approximately one
third of students were found with defective vision due to an error of refraction with a high incidence of mixed myopia,
hyperopia, myopic astigmatism, myopia, then others with a power of refraction varies from zero to 4 D and increasing from
4 to 10 D. With increase incidence of marked difference between both eyes (anisometropia), which increases the chance
to develop lazy eye (amblyopia) in future which differs from preschool and other statistics. The study found that, high
incidence of error of refraction among school age in comparison to other statistics and same as preschool age.
We would like to recommend that, the checking of VA and refraction should be performed for preschool age children and
regularly for school age children to fully resolve this socioeconomic problem among students if detected early and treated.

Management of Ruptured Abdominal Aortic Aneurysm in Libya, a Single Centre Experience

2024-09-13T18:19:15+00:00

Without urgent repair, ruptured abdominal aortic aneurysm (AAA) is a fatal condition, with overall mortality rate exceeding
85%. About 50% of patients with ruptured AAA die before reaching the hospital; half of those arriving to emergency
department, do not reach the operating theatre and, only half of the operated cases survive. Twenty one patients (nineteen
males and two females) who underwent open repair for ruptured AAA, between January 2005 and December 2008, were
retrospectively evaluated at the vascular surgery department of Tripoli Medical Centre.
The perioperative mortality rate was 28.5% (six patients) and, the morbidity was 23.8% (five patients). Computed
tomography (CT) scan has been done for all patients in our study, this always led to delay in the management of the
ruptured AAA. Moreover, other delaying factors such as; not using the cell safer and, the delay in preparing blood for
transfusion during surgery, were also involved in the overall delay. Despite these negative factors, still mortality and
morbidity rates in our study matched the international standards.

Hemoglobin A1 Concentration of Diabetic Mother as a Predictor of Perinatal Morbidity and Mortality

2024-09-13T18:25:23+00:00

Prospective study of diabetic mothers delivered in obstetric department Alkhadra Hospital, Tripoli Libya during the period
from Jan 1st to Dec 31st 2005. 66 diabetic mothers were included in this study, 27 of them with gestational diabetes, 30
with insulin dependent diabetes (IDDM), and 9 with noninsulin dependent (NIDDM), mean age 31.6 years. They have
glycosylated hemoglobin (HbA1C) values > 8.5%. The study showed high values in early pregnancy were associated with
major neonatal congenital anomalies (2 cases), and in second and third trimesters were associated mainly with infants large
for gestational age (7 infants), and neonatal hypoglycemia (14 infants).

Sudden Sensorineural Hearing Loss

2024-09-13T18:33:28+00:00

The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone as salvage therapy
to treat sudden sensorineural hearing loss and discuss the correlation between outcomes of SSNHL with: patient’s age,
time to onset of disease and therapy, severity of HL presence of vertigo, diabetes. Prospective study of 7 patients with
unilateral sensorineural hearing loss that developed within 72 hr and presenting for 30 days of onset with no evidence of
any other identifiable etiology for sudden HL. In our study group after inclusion and exclusion 7 patients were available
for study. There were six male (86%) and one female (14%), the mean age of the patients was 53 years with a range from
32 to 67 years of age. Hearing improvement was occur in (57%) four patients, one had a complete hearing improvement,
while three of them represented partial hearing improvement, under 60 years of age the recovery rate (RR) were 66.6%
compared with RR 50% in patient with 60 years of age or older. RR was with losses greater than 90 dB RR (8.3%)
compared with losses that were less than or equal to 90 dB (35.7%). We conclude that, an application of ITDI significantly
improves the recovery outcomes in SSNHL, while the older age, sever hearing loss, associated with poorer recovery rate,
on other hand presences of DM or vertigo does not significantly change the recovery rate.

Intrathecal Neostigmine and Postoperative Analgesia in Cesarean Section

2024-09-14T05:16:07+00:00

Spinal anesthesia has become so commonly used in cesarean section (SC) that if there was no medical contraindication or
patients refusal, it will be the anesthetist’s first choice.
In an attempt to improve and prolong the spinal block and pain free time after cesarean section which is usually 1.5-2 hr,
with the use of Bupivacaine intrathecally led scientists to think of adding other drugs to Bupivacaine.
By adding drugs to Bupivacaine before injecting it intrathecally prolongs the pain free time after SC which decreases the
need for intravenous and intramuscular analgesics which in return decreases its side effects, toxicity, and expenses.
This study is aimed to compare between the intrathecal injection of Neostigmine and Bupivacaine and Bupivacaine alone
in cesarean section and time of onset of pain after and duration of spinal block.
A randomized controlled study of 40 pregnant women of ASA 1 physical status undergoing cesarean section in the
Maternity department of Tripoli Medical Center.
After obtaining consent from patients they were divided into two groups; Group A: consisting of 20 patients where
intrathecal Bupivacaine alone injected. Group B: consisting of 20 patients where Neostigmine 30 ug prepared immediately
and under aseptic technique with the use of insulin syringe and mixed with Bupivacaine prior to injecting it intrathecally.
Also this group is further subdivided into 2 groups each of ten patients and given Dexamethasone intravenously while
performing spinal block one subgroup given 4 mg and the other 8 mg as an attempt to minimize the nausea and vomiting
caused by Neostigmine.
In both groups aseptic technique used to perform the spinal anesthesia with the use of 27 G spinal needle and 12 mg (2.2
ml) of heavy 0.5% Bupivacaine at L3-L4 level of spinal cord. Blood pressure before and after spinal anesthesia obtained.
Bromage Scale and, Visual Analogue Pain Scale (VAS) of ten centimeters long starting with 0-no pain and ending with
10-most painful, are obtained from patients after operation and time recorded in each scale.
The study revealed that, Neostigmine as an adjunct to intrathecal anesthesia exhibits analgesic effects resulting in
prolongation of sensory blockade of up to 10+ hr and motor blockade of up to 4.5 hr with no other side effects besides
nausea and vomiting which still occurred in 40% of patients who received 8 mg I.V. Dexamethasone as an attempt to
minimize these side effects.

Diabetes Insipidus Associated with Localized Periodontitis in 10 Year Old Child: a Case Report

2024-09-14T05:20:21+00:00

Hereditary diabetes insipidus is a rare endocrine disorder caused by a deficiency of the anti-diuretic hormone vasopressin.
The disease is characterized by polyuria, extreme thirst and polydipsia. In the present case report, a 10 year old child
presented with moderate pain in the molar area. Medical history revealed that the patient was under medication for diabetes
insipidus. The patient also had a history of recurrent infection of the middle ear. Intra-oral examination revealed an early
loss of primary molars with early eruption of upper first premolars. The patient had poor oral hygiene with marginal
gingivitis and recession. While probing, there was severe pocketing related to the first permanent molars, especially the
upper. Fluorosis of the permanent teeth was also evident.

Diagnosis and Surgical Treatment of Carotid Body Tumor: a Case Report

2024-09-14T05:31:08+00:00

The study aimed to introduce our experience in the diagnosis and treatment of carotid body tumor (CBT). CBT was
confirmed by incisional biopsy under local anaesthesia and histopathology finding. Resection of the tumor under the
carotid adventitial plane was performed.
The result showed neither death nor any complication occurred in our case. Follow-up of the patient revealed neither
recurrence nor metastasis. CBT should be considered in the differential diagnosis of neck lumps. Although digital
subtraction angiography (DSA) is the gold standard for the diagnosis of CBT, it was not done in our case. We depended
on the histopathology results. After confirmation, thorough perioperative examination, sufficient perioperative preparation
and correct surgical approaches, will result in satisfactory surgical effect