ABSTRACT

Background: Incisional hernia is a common complication following abdominal surgery, and mesh reinforcement has become

the standard of care. This study aimed to compare the clinical outcomes of sublay versus onlay mesh repair in patients with

incisional her

nia.

Methods: This prospective randomized controlled clinical trial was conducted at the General Surgery Department, Faculty

of Medicine, ..... Hospitals. A total of 60 patients diagnosed with incisional hernia and scheduled for elective surgical repai

r

were recr

uited from general surgery outpatient clinics and the emergency department. Patients were randomly assigned into

two equal groups: Group A (Onlay Group, n=30) underwent onlay mesh repair, and Group B (Sublay Group, n=30)

underwent sublay (retrorectus) mesh

repair. Baseline demographic, clinical, laboratory, and radiological characteristics were

recorded. Operative parameters, postoperative pain scores (Visual Analogue Scale), hospital stay, return to normal activity,

postoperative complications (seroma, hem

atoma, surgical site infection), and hernia recurrence at 12 months were compared

between the two groups.

Results: Operative time was significantly shorter in the onlay group (88.93 ± 7.93 minutes) compared to the sublay group

(99.67 ± 7.74 minutes) (p < 0.001). Postoperative pain scores were significantly lower in the sublay group at day 1 (4.70 ±

0.76 vs. 6.

10 ± 0.79), 1 week (2.39 ± 0.75 vs. 3.99 ± 0.82), 1 month (0.85 ± 0.74 vs. 2.41 ± 0.88), 3 months (0.30 ± 0.49 vs.

1.41 ± 0.86), 6 months (0.16 ± 0.36 vs. 1.02 ± 0.82), and 12 months (0.14 ± 0.48 vs. 0.82 ± 0.86) (p < 0.001 for all). Hospit

al

stay was sign

ificantly shorter in the sublay group (3.47 ± 1.11 days vs. 4.40 ± 0.93 days, p < 0.001), and return to normal

activity was significantly earlier (21.53 ± 3.41 days vs. 26.07 ± 4.73 days, p < 0.001). No significant difference was found

in drain removal day

(p = 0.257). Postoperative complications including seroma (10.0% vs. 23.3%, p = 0.299), hematoma

(3.3% vs. 6.7%, p = 1.000), and surgical site infection (6.7% vs. 16.7%, p = 0.424) were directionally lower in the sublay

group but did not reach statistical

significance. Hernia recurrence at 12 months was 3.3% in the sublay group versus 10.0%

in the onlay group (p = 0.612). All patients completed the 12

-

month follow

-

up.

Conclusion: Sublay (retrorectus) mesh repair offers significant clinical advantages over onlay mesh repair for incisional

hernia, including superior postoperative pain control, shorter hospital stay, and earlier return to normal activity. Postoper

ative

com

plications and recurrence showed consistent trends favoring sublay repair. These findings support sublay mesh repair as

the preferred technique for elective incisional hernia repair in appropriately selected patients.

.

Keywords

: Incisional hernia, mesh repair, sublay, retrorectus, onlay, postoperative pain, randomized controlled trial.

.

Medical education is being reshaped by two major technological disruptions: the rapid expansion of online learning since the COVID-19 pandemic and the equally rapid adoption of artificial intelligence (AI) in teaching, assessment, and clinical training. These developments are often treated as distinct phases of change. In reality, they are part of the same broader challenge: educational institutions have repeatedly adopted new technologies faster than they have developed the pedagogic, ethical, and regulatory frameworks needed to use them well. 1-3

Abstract

Global research still reveals a critical gap in breast cancer (BC) awareness. This study was performed during educational activities in Gharyan governorate in Libya during 2013 as a cross sectional survey assessing BC and breast self-examination (BSE) awareness, BSE practice and attitudes toward BSE in school and collegiate female students and teachers targeted 1027 participants and revealed 97.4% awareness of BC, 42.3% awareness of BSE, 13.4% practice of BSE and only 3.2% regular practice of BSE. Among those who were aware about BC, 97.7% were interested to know, 94.2% exhibited the will to know and excel BSE, 88.0% exhibited the will to educate BSE and 85.9% exhibited the will to participate in BC awareness activities. The first three attitudes seem to be driven by awareness about BC. Anyhow, education and awareness of BSE were found independent predictors for the will to learn and excel the practice of BSE, working woman status was an independent predictor for the proactivity in educating others while having an affected family member was the independent predictor for the will in participation in taskforces. The selective targeting of the proactive groups in the future may enhance the program and save resources.

ABSTRACT

Background: Childhood overweight and obesity are rising public health concerns worldwide, including in urban areas of Libya. Data on prevalence in school-aged children in Gharyan are scarce.

Objectives: To assess the prevalence of overweight and obesity among schoolchildren aged 7–12 years in Gharyan City, Libya, and explore variations by age, gender, and school grade.

Methods: A cross-sectional study was conducted among 632 children from public and private schools. Anthropometric measurements were performed, and BMI was classified using WHO BMI-for-age reference charts. Data were analyzed using descriptive statistics and stratified prevalence assessments.

Results: Overall, 22.0% of children were overweight and 9.7% were obese, with no significant gender differences. Obesity peaked in 7-year-old boys (23.1%) and 12-year-old girls (14.3%). Overweight prevalence increased with age, peaking at 32.6% in boys aged 8 years. Combined overweight and obesity affected 31.7% of participants, highlighting a substantial urban burden.

Conclusion: Childhood overweight and obesity are highly prevalent among schoolchildren in Gharyan, Libya, across all ages and genders. These findings underscore the need for targeted school-based interventions and community health strategies, with collaboration between clinical pharmacists and community medicine physicians to prevent and manage obesity from an early age.

Keywords: Childhood obesity, overweight, BMI, school-aged children, Libya, urban health, WHO growth standards

.

Dysfunctions and pain in the shoulder are a prevalent musculoskeletal condition and a key area for clinical research. This paper investigates the etiology, epidemiology, and risk factors associated with shoulder pathologies based on a data set from the Sydney Shoulder Research Institute (SSRI) that spans a cohort between the years 2015 and 2024. A cohort was retrospectively designed to analyze the demography of patients, their injury mechanisms, symptom durations, and the symptoms of joints that are associated with it. The findings pointed out that the male gender was more likely to encounter traumatic injuries when compared to the females, who reported degenerative conditions of the shoulder such as rotator cuff tendinitis. The age and symptom duration of the patients pointed to a significant correlation to chronic shoulder disorders, where above 42% experienced the symptoms for more than a year. Injury causes vary from trauma due to sports to degenerated conditions. The study pinpoints the role that hand dominance plays and the impact of contralateral shoulder and knee pathologies. Results highlighted the need for early diagnosis and

implementing of ideal management measures to handle the long-term healthcare impacts.

One of the most common problems seen in the office of a primary care physician is low back pain. Backache can have a variety of causes. The aim of this study is to assess the various etiological, occupational, and risk factors for low back pain, as well as its correlation with the patient's age, sex, and lifestyle. Materials and methods: This study collected patients from private clinics and hospitals in Libya between September and November 2024, admitted them, and treated them in the orthopedic department. Many people suffer from low back discomfort, which can be challenging to diagnose. In conclusion, orthopedists must acknowledge the diagnostic uncertainty that often accompanies this illness. The occurrence of incapacitating back pain can be significantly reduced by identifying the etiological and risk factors, the type of occupation, the origin of the pain, implementing preventive measures, and assisting patients in their recovery.

ABSTRACT Background. Hydrocephalus is a prevalent condition in children, affecting both developed and developing countries. Neurosurgical interventions such as ventriculoperitoneal shunts are common, but are associated with a high risk of complications, including infections, which can lead to additional issues and costs. This study aims to review the incidence of infection in pediatric patients before and after ventriculoperitoneal shunt placement, in order to address this issue. Methods. A standard process of analyzing scientific questions using the Population, Intervention, Control, and Outcome (PICO) method was used to develop a protocol for searching research articles in online databases such as PubMed, Cochrane, POPLINE, and Sciencedirect. The articles selected for inclusion in this study met the following criteria: 1) described interventional ventriculoperitoneal shunt placement in pediatrics, 2) focused on cases of ventriculoperitoneal shunt complications with a focus on infection, 3) were published within the last 10 years, and 4) were published in English-language journals with peer review standards. Results. Sixteen articles were identified for review. Seven of these articles mentioned surgical or mechanical interventions as a means of preventing infections, while six articles discussed medical treatment for infection prevention. Three articles described the microorganisms found in cerebrospinal fluid. Conclusion. Future studies should focus on the issues related to ventriculoperitoneal shunt complications and interventions related to immunological, neuroendocrine, and biophysical factors to prevent infections, as well as surgical management and medication administration. Keywords: infection, pediatrics, ventriculoperitoneal, shunt, cerebrospinal fluid

Ankle fracture-dislocations are complex injuries that pose significant challenges due to their association with severe functional impairments. Representing 9% of all fractures, these injuries predominantly affect young individuals experiencing high-energy trauma and elderly patients with conditions such as diabetes and osteoporosis. Younger patients are at risk of post-traumatic osteoarthritis and functional limitations, whereas older individuals often face complications such as wound infections, fixation failure, and, in severe cases, amputation. Classification systems provide a framework for categorizing fractures based on the mechanism of injury, guiding treatment decisions. Precise anatomical reduction of the talus within the ankle mortise and fibular length restoration are critical for maintaining joint congruity and preventing long-term complications.

Management strategies vary by fracture type. Posterior malleolus fractures typically benefit from surgical fixation, improving stability and reducing syndesmosis fixation requirements, while stable fractures are often managed conservatively. This review highlights the need for individualized treatment approaches to optimize recovery and minimize complications. Continued research is essential to refine fixation techniques and enhance the prognosis for patients with these challenging injuries.