Zuhir Bodalal

Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty.

Background: Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA. Methodology: Nutritional markers were gathered retrospectively utilizing patients records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI. Results: A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI. Conclusion: Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI.

A Study of a Decade of Road Traffic Accidents in Benghazi - Libya: 2001 to 2010

This paper aims to observe and to study the trends of road traffic accidents (RTA’s) for the past ten years in Benghazi – Libya. A retrospective analysis was done using the patient records of Al-Jalaa hospital (the main trauma center in Benghazi) from over 21,753 RTA cases. The annual data were compared to each other and changes of trends were observed. RTA’s represented an increasing percentage of Al-Jalaa’s case load across the years. Around 41% of these cases needed to undergo surgery. The younger age group (20–29 years of age) formed the majority of cases while there was a trend towards an increasing average age of patients involved in an accident. Male patients were found to be younger than their female counterparts. Males comprised 81.5% while females formed 18.5% of RTA patients. In terms of inpatient duration, most patients stayed in the hospital for less than 1 week. Vehicle occupants (drivers and passengers) were admitted more often than pedestrians. There was a trend across the years towards an increased involvement of vehicle occupants and decrease in the proportion of pedestrians that had to be hospitalized. Additionally, there was a decrease in the fatalities of pedestrians. Overall, most RTA patients were discharged and made to follow-up in outpatient clinics however there was a startling trend towards increased LAMA and absconded patients. There were both encouraging findings as well as points that needed further emphasis and action. Public education, life support training and diversification of transport (apart from the use of the roads) should be looked into, as possible means of improving the current situation.

Cancers in Eastern Libya: first results from Benghazi Medical Center.

AIM To study the pattern of cancer incidence and determine the incidence rates in Eastern Libya (for the first time in a decade). METHODS A hospital-based registry of cancer patients was formed using records from the primary oncology center in eastern Libya - focusing on those diagnosed in the year 2012. RESULTS The most common malignancies in men were cancers of the colon (22.3%, n = 90), lung (20.3%, n = 82), prostate (16.1%, n = 65), pancreas (4.2%, n = 17) and liver (4.2%, n = 17). For women, they were found to be cancers of the breast (41.5%, n = 213), colon (16.4%, n = 84), uterus (8%, n = 41), ovary (5.5%, n = 28) and pancreas (3.1%, n = 16). Additionally age-standardized rates (ASR) were determined for Libya. The different cities and towns in eastern Libya were compared for any variation. The city of Beida in particular was found to have a remarkably high incidence of gastric cancer. The different findings were discussed and comparisons were made with past literature as well as the incidence rates for neighbouring countries. The incidence rates given for the eastern region showed differences from previously reported values (i.e., the rate of colon cancer was the highest in North Africa whereas other malignancies occurred less frequently). Potential explanations for the urban-rural difference as well as the difference in incidence rates were put forth. The significance of this study is that it establishes a baseline of cancer incidence which should be the backbone for any future national cancer plan in Libya. CONCLUSION Proper surveillance programs need to be in place and healthcare policy should be adjusted to take into account the more prevalent and pressing cancers in society.

Impact of the 2011 Libyan conflict on road traffic injuries in Benghazi, Libya

Background Road traffic injuries (RTIs) are a major public health concern in Libya. In the light of the armed conflict in Libya that broke out on February 2011 and the subsequent instability, the rate and pattern of RTIs was studied. Methods RTI patient data were gathered from Al-Jalaa hospital, the main trauma center in Benghazi, from 2010 to 2011. Various parameters [i.e. age, gender, nationality, method of entry, receiving department, intensive care unit (ICU) admission, duration of stay, method of discharge, and fatalities] were compared with data from the previous year (2010), and statistical analyses were performed (t-test, chi-square, and Poisson regression). Results During the conflict period, 15.8% (n=2,221) of hospital admissions were RTIs, that is, a rate of 6.08 RTI cases per day, levels not seen for 5 years (t=-5.719, p<0.001). The presence of armed conflict was found to have caused a significant 28% decrease in the trend of RTIs over the previous 10 years (B=-0.327, CI=-0.38--0.28, p<0.001). February and March, the peak period of active combat in Benghazi, witnessed the lowest number of RTIs during the conflict period. The average age of an RTI decreased to 28.35±16.3 years (t=-7.257, p<0.001) with significantly more males (84.1%, n=1,755) being affected (χ2=4.595, p=0.032, df=1). There was an increase in the proportion of younger aged patients (from 0 to 29 years) (χ2=29.874, p<0.001, df=8). More patients required admission to the ICU (χ2=36.808, p<0.001, df=8), and the mortality of an RTI increased to 5.2% (n=116) (χ2=48.882, p<0.001, df=6). Conclusion There were fewer RTIs during the conflict period; however, those that occurred had higher morbidity and mortality. The profile of an RTI victims also changed to an increased prominence of young males and motorcyclists. Further research is required to propose and analyze possible interventions.Background Road traffic injuries (RTIs) are a major public health concern in Libya. In the light of the armed conflict in Libya that broke out on February 2011 and the subsequent instability, the rate and pattern of RTIs was studied. Methods RTI patient data were gathered from Al-Jalaa hospital, the main trauma center in Benghazi, from 2010 to 2011. Various parameters [i.e. age, gender, nationality, method of entry, receiving department, intensive care unit (ICU) admission, duration of stay, method of discharge, and fatalities] were compared with data from the previous year (2010), and statistical analyses were performed (t-test, chi-square, and Poisson regression). Results During the conflict period, 15.8% (n=2,221) of hospital admissions were RTIs, that is, a rate of 6.08 RTI cases per day, levels not seen for 5 years (t=−5.719, p<0.001). The presence of armed conflict was found to have caused a significant 28% decrease in the trend of RTIs over the previous 10 years (B=−0.327, CI=−0.38–−0.28, p<0.001). February and March, the peak period of active combat in Benghazi, witnessed the lowest number of RTIs during the conflict period. The average age of an RTI decreased to 28.35±16.3 years (t=−7.257, p<0.001) with significantly more males (84.1%, n=1,755) being affected (χ2=4.595, p=0.032, df=1). There was an increase in the proportion of younger aged patients (from 0 to 29 years) (χ2=29.874, p<0.001, df=8). More patients required admission to the ICU (χ2=36.808, p<0.001, df=8), and the mortality of an RTI increased to 5.2% (n=116) (χ2=48.882, p<0.001, df=6). Conclusion There were fewer RTIs during the conflict period; however, those that occurred had higher morbidity and mortality. The profile of an RTI victims also changed to an increased prominence of young males and motorcyclists. Further research is required to propose and analyze possible interventions.

Colorectal carcinoma in a Southern Mediterranean country: The Libyan scenario.

AIM To study the salient features of colorectal cancer (CRC) in Libya. METHODS Patients records were gathered at the primary oncology clinic in eastern Libya for the period of one calendar year (2012). Using this data, various parameters were analyzed and age-standardized incidence rates were determined using the direct method and the standard population. RESULTS During 2012, 174 patients were diagnosed with CRC, 51.7% (n = 90) male and 48.3% (n = 84) females. The average age was 58.7 (± 13.4) years, with men around 57.3 (± 13) years old and women usually 60.1 (± 13.8) years of age. Libya has the highest rate of CRC in North Africa, with an incidence closer to the European figures. The age-standardized rate for CRC was 17.5 and 17.2/100000 for males and females respectively. It was the second most common cancer, forming 19% of malignancies, with fluctuation in ranking and incidence in different cities/villages. Increasingly, younger ages are being afflicted and a higher proportion of patients are among the > 40 years subset. Nearly two-thirds presented at either stage III (22.4%) or IV (38.4%). CONCLUSION Cancer surveillance systems should be established in order to effectively monitor the situation. Likewise, screening programs are invaluable in the Libyan scenario given the predominance of sporadic cases.

Cervical cancer in north-eastern Libya: 2000 - 2008

Abstract Libya is a country with a low population, listed under the EMRO. Using registers and patient records from a major primary oncology clinic, data was gathered from Libyan cervical cancer patients and various parameters were studied across 9 years. Out of 4,090 female cancer cases during the study period, 1.8% were cervical cancer (n = 74). The average age of presentation was 53 years, with most of the cases (60%, n = 44) being premenopausal. Approximately 65% (n = 48) of cervical cancer patients are diagnosed at later stages (i.e. stages III and IV). The majority of these cases are squamous cell carcinoma (83.8%, n = 62), while 16.2% (n = 12) were found to be adenocarcinoma. Patients with squamous cell carcinoma presented at later stages more often than those with adenocarcinoma. Human papilloma virus was strongly implicated in cervical cancer, with 94% (n = 63) of those who were tested being positive for HPV-16 (82.5%, n = 52) and HPV-18 (12.7%, n = 8). Diagnosis was most frequently made through biopsy (97.3%, n = 72) as opposed to Pap smears (2.7%, n = 2). Most Libyan patients were put through chemotherapy (75%, n = 55) and triple therapy (surgery with combined chemotherapy and radiotherapy) was the most common (38%, n = 28) modality of treatment. Comparisons were made between Libya and other nations, either in the developed world or neighbouring countries. The major problem of cervical cancer in Libya is delayed presentation and hence, all the recommendations focus on increased awareness for the populace, implementation of a national cancer control plan and a national screening programme.

A Study of Risk Factors for Breast Cancer in a Primary Oncology Clinic in Benghazi-Libya

Introduction : Libya is a North African country classified under the Eastern Mediterranean Regional Office. In response to the general paucity of literature regarding cancer in Libya, this study aims to analyze various risk factors for breast cancer among patients in Benghazi, Libya. Material and Methods : Using records from a major primary oncology clinic, data was gathered from breast cancer patients. A total of 301 patients were diagnosed with breast cancer in the study period. For the purpose of risk factor determination, this hospital-based case control study consisted of 212 recently diagnosed cases of breast cancer attending the oncology clinic at Al-Jamhouria hospital in Benghazi. Age matched controls (n=219) were randomly enrolled from other medical departments of Al-Jamhouria hospital and the general population visiting the hospital. Chi square was used to assess significance of the risk factors and the corresponding odds ratio (O.R.) and 95% CI were calculated to assess the magnitude of associations. Results : A total of 1478 cases presented to the gynecological oncology clinic at Al-Jamhouria hospital during the period of 2007-2008. Of these cases, around 20% (n=301) were breast cancer patients. The average age of presentation was 49 years + S.D 13 years, with most of the cases (61%, n=184) being premenopausal. Over 90% (n=273) of breast cancer patients are diagnosed at stage II or later. More than 16% of cases seek medical attention when the malignancy has already reached stage IV. Diabetes, hypertension and family history of other malignancies were found to significantly increase the risk of developing breast cancer. Discussions : A range of socioeconomic risk factors were also analyzed (i.e. parity, breastfeeding etc…) and some were found to be protective. Libyan breast cancer cases are slightly older compared to the rest of the Arab world, but are younger than their counterparts in the West. The major issue in the Libyan scenario is delayed presentation which significantly worsens the prognosis. Hence, all the recommendations focus on increased awareness, the implementation of a national cancer control plan and a national screening program and training healthcare professions in palliative care. Â

Colorectal carcinoma then and now: What we are learning by comparing two Libyan cancer studies

Avicenna Journal of Medicine / Apr-Jun 2015 / Vol 5 | Issue 2 To The Editor, In a previous issue, Elzouki et al. described the pattern of colorectal carcinoma (CRC) in two tertiary hospitals in Benghazi.[1] I applaud their impressive work in helping to fill the void that exists in Libyan cancer epidemiology. The data gathered by the research team covered 2007–2009, before a specialized Oncology department was established at the Benghazi Medical Center and was used as the focal point for all cancer patients in eastern Libya. Similarly, another study regarding colorectal carcinoma in eastern Libya was published dealing with patients diagnosed in the year 2012.[2] By looking at these two recent articles, we can ascertain certain trends regarding our cancer epidemiology: • In the 3‐year period between 2007–2009, 152 patients were collected as the cohort for CRC cases in Benghazi, whereas that figure jumped to 174 patients in a single year (i.e. 2012). This reflected on the ASR with the figure increasing from 16.14 and 13.89 to 17.5 and 17.2/100,000 for males and females, respectively. The current incidence rate for CRC in eastern Libya is the highest in North Africa[2,3] • Women are more likely to be affected by a right colon tumor while the opposite is true for men. Table 1 highlights some key comparisons between the two studies • While the mean age of diagnosis has increased for both genders, colorectal cancers are being caught at earlier stages (especially stage I which was non‐existent in 2007–2009). This is most likely a sequelae of the increased usage of colonoscopy services in Benghazi • Mirroring the change in stage of diagnosis, more malignancies are found to be well‐differentiated. These are all factors that positively influence the prognosis. The overall portrait painted by these studies is one where increased colonoscopy services are helping to diagnose more colorectal carcinoma cases at earlier Colorectal carcinoma then and now: What we are learning by comparing two Libyan cancer studies