Khalij-Libya Journal of Dental and Medical Research

A Maxillofacial Surgical Approach to Pediatric Schwartz-Jampel Syndrome: A Study of Jordanian Children

Oseyd Khashshan — 2025-07-01

Schwartz-Jampel syndrome (SJS) is a rare neuromuscular disorder with autosomal recessive inheritance, characterized by defective muscle stiffness (myotonia) and cartilage development. The clinical manifestations of this syndrome include permanent generalized myotonia and distinctive facial features such as blepharophimosis, a puckered chin, pursed lips, and a fixed facial expression. Skeletal abnormalities include short stature, skeletal dysplasia, and joint contractures. Objective: We report four Jordanian children with SJS, who were referred to the maxillofacial surgery section for the management of mentalis muscle overactivity after carbamazepine medication and physiotherapy were not successful. The patients underwent Botulinum toxin A injections in the mentalis muscle under general anesthesia. One patient also underwent additional surgical intervention in the form of mentalis muscle myotomy. The laryngeal mask airway technique was used for general anesthesia, and precautions for malignant hyperthermia were taken. The patients were reviewed for up to eight months with satisfactory results. Mentalis muscle Botulinum toxin A injections for pediatric SJS patients under general anesthesia have satisfactory outcomes in controlling the muscle overactivity. The procedure can be performed safely with modified anesthetic techniques, provided precautions are taken for malignant hyperthermia.

Infection Control Practices Among Undergraduate Dental Students at Sebha University, Libya

Asma Abogara — 2025-07-03

This study was conducted to find out how well undergraduate dental students at Sebha University followed advised infection control procedures. This cross-sectional study was performed among dental students at Sebha University. A self-administered anonymous questionnaire comprising 18 closed-ended questions has been distributed among 120 dental students in the period of 25 Sept through 30 December 2024. For analysis the data, descriptive statistical analysis and the chi-square test were applied using IBM SPSS Statistics version 17.0. Response rate was (91.6%). All participants reported that they wear gloves during dental procedures (100%), and the majority of them (90%) reported that they replace their hand instruments, burs, saliva ejectors, and handpieces between patients and disinfect prosthesis and impressions. A reduced rate of use was noted for recording patients' medical histories (83.6%), vaccinated against hepatitis B (70.9%), wearing face mask (87.3%), changing face mask (62%), wearing faces Hield (50%), wearing gown (68.2%), using rubber dam (79%) and storing sharp objects in containers (86.4%). Most of the examined infection control strategies were found to be followed by the majority of dental students at Sebha University. However, more education and training are required to enhance some infection control methods, such as recording patients' history, Hepatitis B virus (HBV) vaccination, donning facemasks, gowns, and face shields, and storing sharp objects in special containers.

The Relationship Between Insulin Resistance and Polycystic Ovary Syndrome in Libyan Women

Maryouma Aghil — 2025-07-12

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disease that is common in women of reproductive age and is usually caused by androgen excess and ovarian dysfunction. It is often accompanied by insulin resistance (IR) and some manifestations such as hirsutism and fertility problems. The current study was conducted to evaluate the prevalence of polycystic ovary syndrome and its relationship to insulin resistance among Libyan women, Tripoli. This study included 69 patients: 52 diagnosed with PCOS and 17 control women between the ages of 20 and 40. The study was conducted over three months, from January 2024 to March 2024, at Nour Al Hayat Fertility Hospital in Tripoli. a structured questionnaire was utilized to gather data on patient demographics, such as insulin resistance values, HbA1c levels, and various hormone levels, including TSH, FSH, Prolactin, and Testosterone. A 2 ml venous blood sample was collected from each patient for analysis. Insulin and fasting glucose levels were measured using two different assays to calculate the equation: Insulin FBS /450. Statistical analysis was performed using IBM SPSS version 22 software. The prevalence of polycystic ovary syndrome was 75%, compared to the control group, 25%. Furthermore, there was a significant increase in HOMA IR, HbA1c, Prolactin, and Testosterone levels (p < 0.05), as well as in FSH and TSH levels in the PCOS group compared to the control (P > 0.05). The results also showed that insulin resistance, HOMA IR, was positively correlated with HbA1c levels among both study groups (p < 0.05). In conclusion, Insulin resistance is a common feature of women with PCOS. This study highlights the importance of Insulin resistance and hyperandrogenism, which appear to be interrelated key factors in the pathogenesis of PCOS. Addressing insulin resistance can help improve symptoms and outcomes for individuals with PCOS.

Public Awareness of Gastric Cancer Symptoms and Risk Factors: A Cross-Sectional Study from Al-Zawia, Western Libya

Mufida Khetresh — 2025-07-12

Gastric carcinoma continues to be the fourth leading cause of cancer-related mortality globally. Disparity in incidence rates across different geographical regions has been ascribed to environmental factors predominantly, rather than genetic determinants. This study aims to evaluate the level of awareness about the symptoms and risk factors of gastric carcinoma among the general population in Libya, and to identify socio-demographic factors associated with varying levels of awareness. Data for this descriptive cross-sectional study were collected from the general population in Zawia, using a pretested, validated questionnaire. The collected data were analyzed by using SPSS software. The sample comprised 435 individuals, with a slightly higher proportion of females (55.4%) compared to males (44.6%). The majority (59%) were under the age of 40. Overall, 42.7% of participants demonstrated a moderate level of knowledge regarding gastric cancer. The most commonly recognized risk factors were alcohol consumption (82.5%) and smoking (74.9%), while the most frequently identified warning sign was abdominal pain (74%) followed by a loss of weight (71.3%). A statistically significant association was observed between educational level and awareness (p < 0.001). Moderate levels of knowledge regarding the risk factors and warning symptoms of gastric cancer were recorded in most of the population in Zawia. especially concerning lifestyle-related risk factors like smoking and alcohol use. However, a knowledge gap persists, particularly for less obvious risk factors (e.g.; partial gastrectomy, blood group, and vitamin B 12 deficiency).

Energy Drinks Consumption, Knowledge, and Beliefs among Medical University Students in University of Zawia: A Cross-Sectional Study

Hana Alazraq — 2025-07-21

Recently, energy drink consumption has become very common among teenagers and young adults. This study aimed to assess the frequency and usage pattern of energy drinks consumption among university students in Zawia, Libya, and their knowledge and beliefs about the effects of energy drinks. A cross-sectional survey of 180 students from three different medical colleges (medicine, dentistry, and pharmacy) at Zawia University was conducted, with data collection taking place through a self-administered questionnaire between October 2023 and January 2024. The majority of participants (52.2%) were aged 22–24 years, with females comprising 77.8% of the sample. Only about 12.2% consume them regularly, and 30.0% occasionally. About 72.7% of the students reported drinking one can of energy drink per day, with the most common reasons given by the respondents for using energy drinks being to enhance alertness, overcome apathy and lethargy, and approximately 10.0% used them to improve athletic performance before exercise. The major side effects experienced by this study were headaches (23.3%) and sleep disturbances (15.0%). College affiliation also showed a significant association, with medical students reporting the highest consumption, followed by students in dentistry and pharmacy. Exam periods were strongly associated with energy drink consumption of participants who consumed energy drinks during exams. The study reported that ED consumption among students at Zawia University was low, which might be due to gender differences. This study determined that consumption of EDs is relatively high among students at the medical college in comparison to dentistry and pharmacy colleges.

Prevalence and Antibiotic Resistance of Vaginal Klebsiella pneumoniae Isolates in Reproductive-Age Women in Zawia, Libya

Ghada Moftah — 2025-07-24

Klebsiella pneumoniae is an opportunistic pathogen increasingly associated with vaginal infections and known for its multidrug resistance. Limited local data are available on its prevalence and resistance profiles among reproductive-age women in Libya. This study aimed to determine the prevalence of K. pneumoniae among vaginal isolates in reproductive-age women in Zawia, Libya, and to assess its antibiotic resistance patterns. Vaginal swabs were collected from women aged 20–49 years between October 2022 and March 2023. Isolates were identified using standard microbiological techniques, and antibiotic susceptibility testing was performed using the disk diffusion method. Data were analyzed using descriptive and inferential statistics. Out of 58 vaginal pathogen isolates, K. pneumoniae accounted for 23 cases (39.7%), with the highest prevalence observed in the 40–49 age group (65.3%). Antibiotic susceptibility testing revealed high resistance rates to multiple antibiotics, including 100% resistance to gentamicin and chloramphenicol, over 90% resistance to co-trimoxazole and cefixime, and notable resistance to cephalosporins and carbapenems. However, relatively higher susceptibility was noted for nitrofurantoin, ceftriaxone, meropenem, and colistin. The study demonstrates a notable prevalence of K. pneumoniae in vaginal infections among older reproductive-age women in Zawia, with alarming multidrug resistance patterns. These findings highlight the need for ongoing surveillance, appropriate antibiotic stewardship, and targeted preventive strategies to limit the spread of resistant strains and ensure effective treatment options remain available.

Context and Management Strategies for the Dental Care of Tourette’s Children

Ahmed Abulwefa — 2025-08-07

Tourette syndrome (TS) is a neurodevelopmental disorder that typically emerges in children between 6-8 years old. The syndrome was identified by Gilles de la Tourette in France in 1885. The syndrome refers to the combination of motor and vocal tics. TS affects individuals from all social, racial, and ethnic groups, with a prevalence of approximately 1% among school-age children. Recurrent and involuntary, non-rhythmic, sudden motor tics are the main symptom. Tics are more likely to affect boys than girls by a ratio of 1.5–4:1. It is classified as a multifaceted neurodevelopmental and neuropsychiatric disorder, believed to result from a complex interaction between social, environmental, and multiple genetic risk factors. This interaction highlights the complexity of management and points to the need for comprehensive therapeutic approaches. Maintaining routine daily oral hygiene is challenging due to this tic that affects the head, neck, shoulders, and arms, which hinders the oral hygiene process and increases the difficulty of providing dental treatment. Tourette's children suffer from consequences including tooth decay, gingival disease, grinding teeth, malocclusion, and trauma. These children often face difficulty accessing dental treatment due to multiple barriers, especially in Libya, where these patients face significant problems seeing a dentist. We zoomed in on the Tourette’s children and focused on their oral health. As far as we know, this is the first article published in Libya regarding this syndrome. We share with you updated and distinctive preparatory steps to participate in supporting this group of children to get rid of pain and inflammation This perspective article provides dental practitioners and oral health care professionals with essential insights into the context and management strategies for dealing effectively with children and adolescents affected by TS. When we have the opportunity to save a child from pain and suffering, effective symptom management is always easier than treating complications.

Prevalence of cytochrome P-450 2C9 (CYP2C9) alleles 2, and3 among the Libyan population of Tripoli region

Hana Shima — 2025-08-13

CYP2C9 gene encodes an enzyme that metabolizes a variety of drugs. Genetic variations in the CYP2C9 enzyme, particularly the CYP2C9*2 and CYP2C9*3 polymorphisms, can significantly impact enzyme activity, resulting in variations in drug metabolism and response among individuals who carry them. This study aimed to identify the prevalence of CYP2C9*2 and CYP2C9*3 alleles among the Libyan population in the Tripoli region and to compare the results with published data from other populations and ethnicities. This study included 300 randomly selected unrelated Libyan male blood donors, aged between 18 - 50 years. A high-resolution melting analysis (HRM) protocol was developed and employed as a screening tool for the detection of genetic variations, and direct DNA sequencing was used to confirm the presence of CYP2C9*2 and CYP2C9*3 polymorphisms. On one hand, 228 (73.33%) and 72 (24%) subjects were detected as wild-type and heterozygous CYP2C9*2, respectively, and on the other hand, 269 (98.66%), 29 (9.66%) and 2 (0.66%) subjects were detected as wild type, heterozygous and homozygous mutant CYP2C9*3, respectively. In conclusion, CY2C9*2 and *3 are prevalent in Libyans residing in Tripoli region.

Management of compound odontoma associated with impacted incisor in a female patient: A case report

Ahmed Abdesalam — 2025-08-13

Odontomas are the most common odontogenic lesions, generally regarded as developmental anomalies (hamartomas) rather than true neoplasms. Although often asymptomatic, they can interfere with the eruption of permanent teeth, particularly in children. This case report describes a compound odontoma in a 10-year-old girl that obstructed the eruption of the maxillary left central incisor. Clinical examination revealed a retained primary tooth and absence of its permanent successor, while radiographic imaging showed a well-defined radiopaque mass in the eruption pathway. Surgical removal of the odontoma was performed under local anesthesia. Due to limited resources, the patient’s mother declined orthodontic treatment, opting instead to wait for spontaneous eruption. However, after two years without eruption, a second surgical procedure was carried out to expose the tooth and initiate orthodontic traction. This case underscores the importance of early diagnosis, parental counseling, and interdisciplinary collaboration in managing odontoma-related eruption disturbances in the pediatric population.

Effects of Libyan Balanites aegyptiaca Extract on Steroid Hormone Levels in Male Rabbits

Fayrouz Khaled — 2025-08-17

Balanites aegyptiaca, commonly known as the desert date or Heglig, is a multifunctional tree native to arid and semi-arid regions of Africa and the Middle East, including Libya. Traditionally, it has been used to treat diabetes, liver disorders, skin infections, and reproductive problems due to its rich content of bioactive compounds such as flavonoids, saponins, alkaloids, and phenolic compounds. Phytochemical studies indicate that steroidal saponins in B. aegyptiaca are structurally similar to compounds involved in steroid hormone biosynthesis, potentially influencing male reproductive functions. Despite its ethnomedicinal relevance, limited research has investigated the effects of Libyan B. aegyptiaca on steroid hormone modulation in male rabbits. This study aimed to evaluate the effects of Libyan B. aegyptiaca extract on steroid hormone levels, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, and cortisol in male rabbits. Ripe fruits of B. aegyptiaca were collected from the Sebha region of southwest Libya, authenticated by a botany expert, and processed into a fine powder. Twenty healthy male rabbits were randomly assigned to four groups (n=5). The treatment group received 100 mg/kg body weight of B. aegyptiaca extract orally every other day for six weeks, while the control group received distilled water. Serum hormone levels were measured using ELISA kits. Statistical analysis was performed using ANOVA followed by Tukey’s multiple comparison test, with significance set at P < 0.05. Administration of B. aegyptiaca extract significantly increased plasma testosterone (2.158 ± 0.037 ng/L vs. 1.627 ± 0.077 ng/L) and LH levels (0.856 ± 0.005 mIU/ml vs. 0.780 ± 0.017 mIU/ml) compared to controls (p < 0.05). FSH showed a non-significant upward trend. Estrogen (27.415 ± 0.111 pg/ml vs. 28.691 ± 0.361 pg/ml) and cortisol (49.70 ± 3.487 ng/ml vs. 59.92 ± 1.244 ng/ml) levels were significantly reduced in treated rabbits (p < 0.05), suggesting adaptogenic and anti-stress effects. These hormonal changes indicate that B. aegyptiaca may positively modulate the hypothalamic-pituitary-gonadal (HPG) axis and stress-related endocrine pathways.

Assessment of Diagnostic and Clinical Facilities for Sickle Cell Disease at the National Institute of Oncology, Sabratha, Libya

Haleemah Abdulrahman — 2025-08-20

Sickle cell disease (SCD) is a global health challenge and has been recognized by the World Health Organization as a public health priority due to limited diagnostic and treatment services. In Libya, the prevalence of SCD varies widely across regions, yet little is known about available resources and management strategies, and treatment services. This study was conducted to document the existing facilities and assess current practices for SCD management at the National Institute of Oncology, Sabratha, which hosts the only dedicated SCD clinic in the region. A cross-sectional questionnaire survey was structured questionnaires completed by lab workers and physicians responsible for managing SCD patients at the SCD clinic at the National Institute of Oncology, Sabratha. The clinic registered only 10 patients, indicating a low reported incidence of SCD in the region. Patients had access to microbiology and chemistry laboratories, as well as CT and MRI imaging. However, several essential diagnostic and monitoring tools were absent. The clinic did not possess facilities for β-globin gene analysis, automated cell counters, haemoglobin electrophoresis, high-performance liquid chromatography (HPLC), or transcranial Doppler ultrasound. In addition, there were no new-born screening programs or photoelectric concentration equipment available. The findings highlight both a low prevalence of SCD in the region and significant gaps in diagnostic and laboratory capacity. Strengthening infrastructure and expanding diagnostic services are critical to improving early detection, monitoring, and comprehensive management of SCD in the region.

Impact of Hyperthyroidism on Liver Function: A Study of Serum Enzyme Variations

Safaa Ahmed — 2025-09-01

Hyperthyroidism is a clinical disorder marked by the excessive production and release of thyroid hormones by an overactive thyroid gland, leading to a hypermetabolic state that affects multiple organ systems, including the liver. This study aims to assess the serum ALT, AST, ALP, and GGT in patients with Hyperthyroidism. This cross-sectional study was conducted between January 1 and July 10, 2025, at Alshams Medical Laboratories in Diyala City. It included 100 participants: 70 patients with Hyperthyroidism and 30 healthy controls. Serum pituitary and thyroid hormone levels were measured using the cobas® e 411 analyzers, while liver enzymes were analyzed with a cobas® c 311 analyzer. Serum ALT, AST, and ALP were significantly higher in hyperthyroid compared to controls (P= 0.001 for all). Although GGT levels were slightly higher in the patient group than in controls, the difference did not reach statistical significance (P=0.274). ALP showed a significant negative correlation with TSH (P=0.038), and significant moderate positive correlations with Free T3 (P=0.003 and Free T4 (P=0.042). Hyperthyroid patients show elevated liver enzymes, with ALP inversely related to TSH and positively to Free T3 and T4. This may signal potential liver dysfunction and calls for further evaluation among these patients.

The Burden of Klebsiella Infections in Neonates: Incidence, Risk Factors, and Outcomes from Zawia Medical Center

Mufeeda Mansour — 2025-09-24

Klebsiella species are a major cause of late-onset sepsis and death in newborn intensive care units (NICUs), especially in resource-limited settings. The purpose of this study was to assess the prevalence, risk factors, and clinical outcomes of Klebsiella infections in a tertiary NICU in Libya. A retrospective cohort analysis was carried out, evaluating data of all neonatal patients admitted to the Neonatal/Pediatric ICU at Zawia Medical Center between January and December 2023. A positive culture verified the diagnosis from a sterile location. Data on demographics, clinical risk factors, and results were gathered and evaluated using acceptable statistical techniques. The incidence of Klebsiella infection was 15.4% (19/123). Mechanical ventilation was a significant risk factor, with 74% of infected neonates exposed compared to 24% in the uninfected group (OR: 8.85, 95% CI: 2.9–27.0, p<0.001). Crucially, the administration of blood products was strongly associated with infection: platelets (OR: 8.1, 95% CI: 2.8–23.7, p<0.001), fresh frozen plasma (OR: 5.6, 95% CI: 1.9–16.6, p<0.001), and red blood cells (OR: 4.0, 95% CI: 1.4–11.3, p=0.005). Preterm neonates were also at significantly higher risk (63% vs. 36.5%, p=0.003). All-cause in-hospital mortality was drastically higher in infected neonates (58% vs. 18%, p=0.001), with an attributable mortality of 42%. Kaplan-Meier analysis confirmed a significantly reduced median survival time in the infected group (7 vs. 22 days, log-rank p<0.02). Klebsiella infections are a common and fatal hazard in this context, and mechanical ventilation is an important modifiable risk factor. These findings underline the critical need for strict infection prevention strategies, particularly in ventilator care, as well as improved antibiotic stewardship to improve survival outcomes.

A Comparative in Vitro Assessment of Contemporary Biomimetic Re-mineralization Agents on Artificial Enamel Lesions: A Standardized pH-Cycling Model

Abdulbaset Sherif — 2025-10-03

This study aimed to evaluate and compare the remineralizing efficacy of four contemporary biomimetic agents—Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), Functionalized Tricalcium Phosphate (f-TCP), Nano-Hydroxyapatite (n-HAp), and Nano-Bioactive Glass (n-BAG)—against a standard sodium fluoride (NaF) control and a negative control using a standardized pH-cycling model on primary tooth enamel. One hundred fifty enamel slabs were prepared from non-carious human primary molars. After baseline assessments of surface microhardness (Vickers Hardness Number, VHN) and elemental composition (Ca/P ratio via EDX), artificial caries-like lesions were created. Samples were randomly allocated into six groups (n=25) for a 21-day pH-cycling regimen. Treatment groups received daily applications of their respective agent, while the negative control received deionized water. Post-treatment, microhardness, EDX, and scanning electron microscopy (SEM) were repeated. Demineralization significantly reduced microhardness and Ca/P ratios in all groups (p<0.0001). After pH-cycling, all biomimetic agents significantly outperformed the NaF and negative controls (p<0.05). The negative control showed minimal recovery. NaF improved surface hardness but did not reach baseline levels. The biomimetic agents showed superior and deeper remineralization. n-BAG and n-HAp groups achieved VHN and Ca/P ratios statistically equivalent to sound enamel baseline (p>0.05), indicating near-complete recovery. CPP-ACP was significantly more effective than f-TCP (p<0.05). SEM revealed a dense, homogenous, well-integrated mineral layer for n-HAp and n-BAG, contrasting with the partially occluding deposits of other groups. Contemporary biomimetic remineralization agents, specifically n-BAG and n-HAp, were significantly more effective than traditional sodium fluoride in repairing artificial enamel lesions on primary teeth under in vitro conditions. The efficacy hierarchy was n-BAG ≈ n-HAp > CPP-ACP > f-TCP > NaF.

Evaluation of Pharmacovigilance Awareness Among Healthcare Providers and Patients: A Field Study

Wadiaa Benamer — 2025-10-04

People use medicines at some point in their lives, so they need to understand what they are taking and the risks involved. With about over half a million medicinal product groups on the worldwide market, there’s an almost infinite number of ways in which harm can arise from treatments themselves or from interactions between them, as well as, from dietary, environmental and gastric factors in addition, poor quality and fake medicines are also constant treats in many parts of the world, however, using of medicinal products have benefit and risk effects and, due to the many repeated mistakes and disasters that are associated with drugs' use and related products led the need of pharmacovigilance follow up. Pharmacovigilance (PV) supports safe and appropriate uses of drugs after marketing and use by a population. The spontaneous reporting system of Adverse Drug Reaction (ADR) is an essential component of pharmacovigilance; however, significant underreporting of ADR remains a major problem in developing countries. Knowledge of PV could form the basis for interventions aimed at improving reporting rates and consequently decreasing ADRs. This cross-sectional descriptive study was carried out to gain knowledge on how familiar health care providers and the relevant administration of the Ministry of Health are with the concept of pharmacovigilance. The study involved distributing a questionnaire form and interviews of 205 randomly selected persons (60 physicians, 75 pharmacists, 30 nurses, and 40 patients). The study showed significant number of health care providers have incomplete information on the concept of PV and how it is integrated into health care system, much less its purposes and the necessity to report ADRs during professional practice, in contrast, the pharmacists in general have much more information and awareness on PV, particularly those working with Ministry of Health in the Pharmacy and Medical Equipment Administration. Concerning the patients, unfortunately, neither the physicians nor the pharmacists were keen enough to advise their patients on how to differentiate between the expected side effects and the unexpected ADRs.