Aims. This in vitro study was to evaluate the effect of three type provisional restorative material on micromovement of immediate loading implant. Methods. Thirty samples of provisional bridges were fabricated using three different restorative materials A- Resinous CAD/ CAM. B- Dual cure composite .C- Conventional heat cure resin, fixed-fixed bridge cemented over implant by zinc oxide eugenol free based temporally cement. All samples were mounted in a computer-controlled materials testing machine with a loaded up to50N ,100N,150N,200N and data were recorded using computer software. Vertical displacement was measurement by using the image analysis software. Results. It was found that heat cure acrylic resin group recorded statistically significant highest (p<0.05), µ -movement mean value (75.70±7.615 µm) followed by dual cure composite group (53.15±5.330 µm). While, CAD/CAM resin group recorded statistically significant (p<0.05) lowest µ -movement mean value (39.66±3.325 µm) as indicated by ANOVA test followed by pair –wise Tuke's tests. Conclusion. Ceramill Temp (acrylic resin) implant supported bridges showed the lowest vertical micromovement compared to composite resin and heat cure acrylic resin provisional restorations.
Introduction: One of the most challenging aspects of treating gingival recession type 3 (RT3) is reconstructing lost interdental papilla, which is directly related to the loss of interproximal bone. Free gingival graft (FGG) has been successfully used to increase the width of keratinized tissue (KTW) with minimal trauma to the interdental papilla; creeping attachment also plays an additional role in improving the results. Case presentation: The included two case reports suggest a novel technique using a FGG that shaped in an inverted T-shape to achieve partial root coverage, improve the compromised interdental papilla, and increase the keratinized tissue width in RT3 defects. Conclusions: This report presents a novel yet intuitive surgical technique for partial coverage of RT3 defects and reconstruction of the interdental papilla. Summary: The inverted T-shape soft tissue graft may be a valuable technique for papillary reconstruction in the challenge RT3 recessions. This article is protected by copyright. All rights reserved.
The present paper explores the TL characteristics of Ag, Cu and Ni doped and co-doped Li2B4O7 nano-composites (NCs). These NCs were synthesized via a Sol–gel process. The influence of doping agents on the optical and TL properties of Li2B4O7 NCs was investigated. Obtained nano-composites were calcined at 700 °C for 8 h. The incorporation of Ag, Cu and Ni impurities in Li2B4O7 lattice has been confirmed by the FT-IR spectra; this may be explained by the formation of Ag–O (513 cm⁻¹), Cu–O (497 cm⁻¹) and Ni–O (419 cm⁻¹) bonds. XRD diffractograms have shown the only crystallographic phases tetragonal. The crystallite size was found to be in the range from 355 to 463 Å. The set of kinetic parameters have been calculated. TL glow curves showed a multiple TL peaks after various beta irradiation. The addition of Ag, Cu and Ni ions induced changes in the structure and the kinetic properties of the TL glow curves, modifying the radiative recombination efficiency. TL response results suggest that the Ag, Cu, Ni co-doped Li2B4O7 nano-composites phosphor present a good potential for beta irradiation dosimeter applications.
Background Colorectal cancer significantly affects the quality of life of patients, while at the same time contributing to the development of symptoms of psychopathology. The aim of this prospective study, is to investigate the role of the disease in the quality of life of patients with colon cancer and in the appearance of symptoms of anxiety and depression, as well as the connection of the above characteristics during the recovery process, given the distress symptoms experienced by the patients Methods In the present study, HADS, FACT – C, well as the DT are use, in a sample of 118 patients of an average age of 70.5 ± 8.5 years, which were submitted to partial or total colectomy surgery. Results Moderate levels of anxiety (M = 8.25, SD = 3.87) and low levels of depression (M = 6.90, SD = 2.97) and distress (M = 5.84, SD = 2.60) emerged preoperatively, while the improvement was significant of patients’ quality of life level 6 months after surgery. At the same time, a significant negative effect of the patients’ distress level preoperatively on their quality of life, during the recovery process was observed. Conclusion Preoperative anxiety is not considered to be an element that affects the functionality and the psychological and physical adaptation to the disease of patients with colon cancer. On the contrary, the feelings of distress they experience can be a predictive factor of their quality of life after the partial or total colectomy surgery.
The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya’s NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya’s complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.
Data resource basics The World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC) developed the Global School-based Student Health Survey (GSHS) in collaboration with United Nations Children’s Fund (UNICEF), United Nations Educational, Scientific and Cultural Organization (UNESCO) and Joint United Nations Programme on HIV/AIDS (UNAIDS). The aim of the GSHS was to generate comparable data from students aged 13 to 17 years which could inform school and youth health policies and programmes around the world.¹ Whereas global paediatrics has generally focused on infancy and childhood, adolescence is increasingly recognized as a critical period for health outcomes during adulthood.2–5 Presently, there are approximately 1.86 billion individuals aged 10 to 24 years old worldwide (24% of the global population).⁶ Although the adolescents’ right to health has been established in the United Nations Convention on the Rights of the Child, adolescent health, development and wellbeing have received little attention in global health and social policies.⁵,⁷ Adolescence, in particular, offers a window of opportunity to influence or prevent behaviours that contribute to diseases in adulthood and which commonly emerge and manifest between the ages of 11 and 24 years.⁸,⁹ In addition, adolescent mortality accounts for an increasing number of premature deaths, as a result of the epidemiological transition and a decline in infant mortality.
SARS-CoV-2 infection is widely spread over people, from youth to the elderly. Vaccination against SARS-CoV-2 is an important preventive measurement to help end the SARS-CoV-2 pandemic. From 30 April to 15 July, we collected the number of people infected with SARS-COV-2 and the mortality rate from daily reports issued by the National Center for Disease Control of Libya (NCDC). Approximately 445000 doses have been administered in Libya since 10 April, and 5 thousand doses are now being administered during this period on a daily basis. To estimate the rate of breakthrough vaccine infection of the SARS-COV-2 in Libya. We found that one dose of the three different types of vaccines had decreased the virus transmission across people and mortality rate until 10 weeks after the first dose. This study highlights the dramatic success of the early months of the nation's coronavirus vaccines rollout.
During analysis of a prospective multinational observation study of critically ill patients ≥80 years of age, the VIP2 study, we also studied the effects of differences in country consent for study inclusion. This is a post hoc analysis where the ICUs were analyzed according to requirement for study consent. Group A: ICUs in countries with no requirement for consent at admission but with deferred consent in survivors. Group B: ICUs where some form of active consent at admission was necessary either from the patient or surrogates. Patients' characteristics, the severity of disease and outcome variables were compared. Totally 3098 patients were included from 21 countries. The median age was 84 years (IQR 81-87). England was not included because of changing criteria for consent during the study period. Group A (7 countries, 1200 patients), and group B (15 countries, 1898 patients) were comparable with age and gender distribution. Cognition was better preserved prior to admission in group B. Group A suffered from more organ dysfunction at admission compared to group B with Sequential Organ Failure Assessment score median 8 and 6 respectively. ICU survival was lower in group A, 66.2% compared to 78.4% in group B (p<0.001). We hence found profound effects on outcomes according to differences in obtaining consent for this study. It seems that the most severely ill elderly patients were less often recruited to the study in group B. Hence the outcome measured as survival was higher in this group. We therefore conclude that consent likely is an important confounding factor for outcome evaluation in international studies focusing on old patients.
First hop redundancy protocols (FHRP) are an essential tool for improving IP networks' availability. FHRP are protocols used to manage and maintain the network default gateway router by using one or more redundant routers that will take over in case of default router failure. In this paper we present the first hop redundancy concept and the means for its realization in IPv6 network. We evaluate three FHRP protocols, namely, the Hot Standby Router Protocol (HSRPv6), Virtual Router Redundancy Protocol (VRRPv3), and Gateway Load Balancing (GLBPv6) using GNS3 tools. The First Hop Redundancy Protocols have been implemented, tested, optimized, and compared to one another in terms of convergence time, packet loss and convergence time. The comparison indicates which protocol is the best in each scenario and which is the best overall among the three protocols.
In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40–0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.
Macroalgae are a valuable source of highly bioactive primary and secondary metabolites that may have useful bioapplications. To investigate the nutritional and nonnutritional contents of underexploited edible seaweeds, proximate composition, including protein, fat, ash, vitamins A, C, and E, and niacin, as well as important phytochemicals, including polyphenols, tannins, flavonoids, alkaloids, sterols, saponins, and coumarins, were screened from algal species using spectrophotometric methods. Ash content ranged from 3.15-25.23% for green seaweeds, 5-29.78% for brown algae, and 7-31.15% for red algae. Crude protein content ranged between 5 and 9.8% in Chlorophyta, 5 and 7.4% in Rhodophyta, and between 4.6 and 6.2% in Phaeophyceae. Crude carbohydrate contents ranged from 20 to 42% for the collected seaweeds, where green algae had the highest content (22.5-42%), followed by brown algae (21-29.5%) and red algae (20-29%). Lipid content was found to be low in all the studied taxa at approximately 1-6%, except for Caulerpa prolifera (Chlorophyta), which had a noticeable higher lipid content at 12.41%. These results indicated that Phaeophyceae were enriched with a high phytochemical content, followed by that of Chlorophyta and Rhodophyta. The studied algal species contained a high amount of carbohydrate and protein, indicating that they could be considered as a healthy food source.
During the ongoing COVID-19 pandemic, healthcare systems around the world have had their limited surge capacity rapidly overwhelmed. In such a situation, pandemic risk reduction necessitates the employment of one or more alternative care sites (ACSs). This paper aims to investigate the siting of deployable field hospitals to reduce pandemic risk and support the staff involved in direct patient care. The present study used multiple case studies of space conversions and field hospitals in several countries. Informed by the existing literature, these cases shed light on their healthcare system responses to COVID-19 and allowed for a comparative analysis. Based on the case studies, the authors propose two ACSs in Abu Dhabi City: one in an urban setting and another in a suburban area. The authors identified expansive spaces and adaptable buildings according to a set of primary criteria, including the required level of structural alterations, budget, and time. The selected sites/buildings could be transformed into field hospitals to respond to the pandemic and/or disaster risk reduction whilst boosting critical care surge capacity. Devising such measures in siting field hospitals as ACSs would eventually enable Abu Dhabi’s (and the United Arab Emirates’) healthcare system and institutions to become more resilient in adequately responding to unprecedented demand and/or sudden disruptions to healthcare operations in the future.
Post-Acute COVID-19 syndrome (PACS) is considered to be one of the least understood post-infectious syndromes. We report a case of a 21-year-old female who had a history of SARS-CoV-2 infection and presented with a right atrioventricular thrombus associated with pulmonary embolism and thrombocytopenia. At the time of admission, she was not vaccinated against SARS-CoV-2, and her serological tests for IgG and IgM antibodies against SARS-CoV-2 were positive. The size of the thrombus measured approximately 6×8×4 cm, which also led to tricuspid valve insu ciency due to mechanical dilatation of the valve's ring. The right atrioventricular thrombus also extended up to the inferior vena cava, leading to mild congestive hepatomegaly. Moreover, during thrombectomy, the mass of the thrombus was attached to the interseptal right atrial wall. The histopathological assessment of the core mass revealed that it was a right atrial myxoma hidden inside that large thrombus. We suspect that the formation and propagation of the thrombus to that size occurs as a part of Post-Acute COVID-19 syndrome (PACS). This study reviews and discusses coronavirus disease 2019-relate to thrombus formation inside cardiac chambers in case of a cardiac tumor, like myxoma in the setting of post-acute phase COVID-19 syndrome.
Background Juvenile inflammatory myositis are systemic autoimmune diseases of unknown aetiology that are characterized by inflammation of skeleton, muscles, skin, and internal organs. Studies from different regions have reported different incidence and age at onset suggesting that the clinical and demographic features may differ by race and geographic regions. This study aims to describe the characteristics of disease among Libyan children who have been treated in the main rheumatology unit covering most of the population in Libya Objectives To describe the demographic and clinical features of patients with juvenile dermatomyositis To determine the outcome of children with juvenile dermatomyositis and factors affecting the outcome. Patients and methods This is a retrospective descriptive study conducted by reviewing patient records diagnosed with juvenile dermatomyositis from 5/2000–2/2022. Results Twenty-one patients were included, female to male ratio was 6:1. Mean age at disease onset was 7.7 ± 2.8 years and their mean follow-up period was 4.36 ± 3.2 years. Most of the patients (14.7%) presented before 1 month of starting symptoms. Most of the patients (13,0.9%), were diagnosed as dermatomyositis, 2 (9.5%) as polymyositis, 2 (9.5%) as amyopathic myositis, and 4 (19%) as overlap syndrome. Family History of dermatomyositis was positive in 4 (19%) of patients and family history of other autoimmune diseases was positive in 5 (23.8%) patients. Around half of the patients had monocyclic disease course (11, 52.4%), 5 patients (23.8%) had polycyclic disease course and other 5 patients (23.8%) had chronic persistent disease course. MRI proximal muscles and EMG were used for diagnosis in 10 patients (48%) and 16 (76.1%) respectively, and muscle biopsy was used in 2 patients to confirm the diagnosis. One overlap patient had severe lung fibrosis on CT scan chest with restrictive lung disease and 4 patients (19%) had restrictive lung disease with normal CT scan chest. Methyleprednisolone pulses were used in 10 patients (50%) with 3 (15%) who required more than one pulse of intravenous prednisolone. Immunoglobulin was used in 12 (60%) of the patients. All patients needed oral prednisolone and methotrexate was used in 15 (75%) of the patients. Other drugs used were Azathioprine in 3 overlap patients, cyclophosphamide and Mycophenolate mofetil in one patient with overlap syndrome. Hydroxychroroquine was used in 6 (30%) of the patients. In the last visit, 12 patients (60%) were in remission, 7 (58%) of them presented before 1 month of disease onset. Fifty-eight percent of the females and 66.7% of the males were in remission. Five patients (25%) had short stature, 3 (15%) had chronic cutaneous changes, 1 (5%) had arrythmia, 2 (10%) had calcinosis, 2 (10%) had osteoporosis, and one patient died. Conclusion A female predominance was noted with age at presentation comparable to other studies. The most frequent manifestations were skin manifestations and musculoskeletal features were the second most frequent symptoms. Patients has low rate of complications with low rate of calcinosis and mortality and none of them had gastrointestinal manifestations. Males were more likely to be in remission.
Accurate identification of insect species is an indispensable and challenging requirement for every entomologist, particularly if the species is involved in disease outbreaks. The European MediLabSecure project designed an identification (ID) exercise available to any willing participant with the aim of assessing and improving knowledge in mosquito taxonomy. The exercise was based on high-definition photomicrographs of mosquitoes (26 adult females and 12 larvae) collected from the western Palaearctic. Sixty-five responses from Europe, North Africa and the Middle East were usable. The study demonstrated that the responders were better at identifying females (82% correct responses) than larvae (63%). When the responders reported that they were sure of the accuracy of their ID, the success rate of ID increased (92% for females and 88% for larvae). The top three tools used for ID were MosKeyTool (72% of responders), the ID key following Becker et al. [2010. Mosquitoes and their control, 2nd edn. Berlin: Springer] (38%), and the CD-ROM of Schaffner et al. [2001. Les moustiques d’Europe: logiciel d’identification et d’enseignement – The mosquitoes of Europe: an identification and training programme. Montpellier: IRD; EID] (32%), while other tools were used by less than 10% of responders. Responders reporting the identification of mosquitoes using the MosKeyTool were significantly better (80% correct responses) than non-MosKeyTool users (69%). Most responders (63%) used more than one ID tool. The feedback from responders in this study was positive, with the exercise being perceived as halfway between educational training and a fun quiz. It raised the importance of further expanding training in mosquito ID for better preparedness of mosquito surveillance and control programmes.
This research innovatively considers the Zero Point Structural Stress (ZPSS) approach to evaluate the stress concentration factors (SCFs) of the CFRP-reinforced T/Y-joints. To begin, multiple sets of credible experimental data and Finite Element (FE) results were selected to verify the accuracy of the proposed FE model. The comparison results showed that the ZPSS approach accurately estimated the SCF of tubular T/Y-joints reinforced with CFRP. Furthermore, the ZPSS approach, which considers the stress gradient through the thickness, shows more accurate results than the HSS approach, which considers only the stress at the outer surface of the chord. Then, 132 FE models were simulated to analyze the effects of the joint geometric dimensions and the CFRP laminates on the SCFs of the CFRP-reinforced tubular T/Y-joints. Finally, a parametric equation is proposed based on the FE results to predict the SCFs of tubular T/Y-joints reinforced with CFRP under axial compression loads.
Introduction: A female in her late 30s from North Africa with no past medical history presented with four months of an expanding left face and neck mass that led to facial disfigurement (Viral screen HIV, HCV & HBV negative, EBV unknown). Ultrasound of the neck showed an enlarged left submandibular salivary gland with increased echogenicity with a surrounding inflammatory process and reactive lymphadenopathy, and no visible stone. Magnetic resonance imaging (MRI) of the neck revealed an infiltrating soft tissue enhancing mass surrounding the left side mandibular body, and it was locally infiltrating the left side submandibular, sublingual salivary gland left parotid, left side masseter muscle, myeloid muscle, and left side medial pterygoid muscle, and prominent bilateral cervical lymphadenopathy. Contrast tomography (CT) of the neck, chest, abdomen, and pelvis was unremarkable apart from cervical lymphadenopathy. Biopsy of the submandibular gland immunohistochemistry (LCA, BCL2, CD7 +VE, & focally for CD3 & CD5, while they are negative for PanCK. CD20, PAX5, CD79a, MUM1.BCL6.CD30, CD2, CD56, & TdT, Ki67 40%) suggested the diagnosis of high-grade T-cell lymphoma. Bone marrow biopsy was normal. The patient received five cycles of cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP). A follow-up CT scan and positron emission tomography (PET) scan showed stable disease size and hypermetabolism. Revision of immunohistochemistry was strongly positive for CD45, CD33, CD34, CD43 and CD107, and negative for CD3, CD4, CD8, CD30, CD68, CD11c, CD20, CD79a and MPO. The diagnosis was updated to myeloid sarcoma (granulocytic sarcoma). The patient received 7+3 doxorubicin and cytarabine with impressive results clinically, followed by 3 high-dose cytarabine consolidation. Three months following completion of treatment, facial swelling recurred, and a PET scan showed hypermetabolic activity consistent with recurrence. The patient is undergoing salvage therapy (cytosar & etoposide) in preparation for a bone marrow transplant. Conclusions: We present a challenging case of salivary gland myeloid sarcoma that was initially misdiagnosed as T-cell lymphoma; interestingly, her bone marrow was not involved at the time of diagnosis. A high index of suspicion is warranted in CD3 negative and CD20 negative lymphoma, and expanded immunohistochemistry earlier may improve diagnosis.
Objective This study sought to determine the magnetic resonance imaging (MRI) T staging and the rectal cancer (RC) distance to the anal verge in patients treated in radiotherapy department of Tripoli University Hospital. Methodology An observational study was conducted in Radiotherapy department at Tripoli University Hospital retrospectively from January 1, 2018 to December 31, 2020 for total number of 73 patients whom met the inclusion criteria; 18-year- old or more, male and female with primary RC, T2 or more. distance metastasis or secondary RC were excluded. Results Patients were 38 female and 35 male. Patient less than 50 years old was 25% and 38% was between 50-69 years old. patient at 70 years old or older was 10%. The low rectal cancer, less than 5 cm to the anal verge, is in 38.4% of the patients, with most of the patients at T2 staging (45.5%). While 19.2% was in the mid rectum, 5-10 cm to the anal verge, the T2 was 9%. Regarding the high rectum, more than 10 cm to the anal verge, it was present in 42.5%, of which 45.5% was in T4b. Conclusion Rectal cancer was less commonly in the mid rectum. in the low rectum it was commonly T2 stage and in high rectum T4b was predominant. Further studies are needed.
This scoping review provides overview on the historical and major developments, current status, quantitative magnetic resonance (MR) studies and the role of medical physics bodies in MR imaging in Africa. The study analyzed MRI availability in 32 (59 %) of the 54 African countries. South Africa and Egypt have the most dominant MR systems. Number of MR systems in the 4 northern countries (Egypt, Morocco, Algeria and Libya) alone constitute 53 % of the total number of machines in the studied countries. Less than one-third of the countries have 1 MR system serving less than a million population. Libya recorded the most MR systems per million population. The studied countries altogether have an average of 1 machine per million population. The private sector far dominates number of installed MR systems across the region, making up two-thirds of the distribution. A major challenge was revealed where less than 3 % of Medical Physicists in the studied countries are engaged in MRI facilities. Review of MRI published studies in the last 5 years indicates dominance of literature on brain studies and most of such published works coming from Nigeria. Only 7 out of 27 published studies reviewed were quantitative. The African region has no dedicated MRI physics societies; however, the regional medical physics body and national associations have big roles to play in developing MRI through education , research, training and leveraging on awareness creation. This review is the first of such wide scale study on MRI availability and quantitative studies in the African region.
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Sedi almasri, Tripoli, Libya
Head of institution
Prof Dr Mohamed A Daw, MD, PhD, MPS,MRCPath (1A),FTCDI