FRACTURES OF THE PROXIMAL HUMERUS: MANAGEMENT AND EVALUATION (GENERAL OVERVIEW)

Abstract:

Fractures of the proximal humerus are a common phenomenon, while low-energy injuries occur in the elderly, and less frequent fractures with higher energy affect young people. The decision to perform surgical or nonsurgical treatment is determined by the functional goals and the degree of displacement of the proximal anatomical parts of the humerus. Surgical treatment is based on the ability to achieve and maintain the reduction, the vascularity of the articular segment, the quality of attachment of soft tissues and bone porosity. Despite numerous studies, the optimal treatment of significantly displaced fractures remains controversial. Keywords: fracture, humerus, fracture treatment.

Medical students have been shown to be more susceptible to stress and depression than the rest of the population. Libyan students specifically have to undergo the challenges of becoming a doctor while living with the stressful outcomes of the Libyan civil war. And the spread of COVID-19 has added to these stressors. This study aimed to determine prevalence of depression and anxiety among Libyan medical students and analyze the

causing factors. A cross-sectional study was conducted using an online survey. We used the Kessler psychological distress scale to measure the level of distress. A total of 1348 students from 16 Libyan medical schools across the 5 years of study completed the survey. The number of females was 992 (73.6%), and males were 356 (26.4%). The mean age (SD) was 22.09 (2.56). Out of the 1348 participants, 638 (47.3%) scored for severe mental disorder. A moderate mental disorder was presented by 213 (15.8%), and 200 (14.8%) presented with a mild one. Students are likely to be well according to the K-10 scale, which is 297 (22%). Out of the students whose houses have been displaced. In the war, 66.3% have presented with moderate to severe mental disorders. Students that have reported having suicidal thoughts throughout their time in medical school are 235 (17.4%). In comparison to similar studies done in other countries, Libyan students scored a higher prevalence of depression. The current political state of the country and the COVID-19 pandemic were shown to be contributing factors.

Aims. To estimate the prevelance of Generalized anxiety disorder (GAD) in adult patients with diabetes mellitus (T1DM or T2DM) during COVID-19 pandemic. Method. Random sample of 115 Adult Libyan patients (≥18 years) were drawn from 1200 Medical records of diabetic patients previously diagnosed in a primary care clinic (Gharyan polyclinic,South of Tripoli,West of Libya). Patients were recruited and diagnostically interviewed through outpatient visits and through Phone calls. Anxiety was assessed using Generalized Anxiety Disorder 7-item instrument (GAD-7), personal information, Co morbidities and History of COVID-19 infection within period of 3 weeks. Result. The statistical analysis done by SPSS version 23, using ANOVA test. The GAD-7 scores ranged from 0 to 19 for the diabetic patient, 82 patients scores ranged from 0 to 4 with varying degrees of non-signifacant to subsyndromal symptopms of Generalized anxiety disorder, 24 patient with Mild GAD, 7 patients with moderate GAD and 2 patients with severe GAD. (P value = 0.000) Conclusion. GAD is present in 28% of the patients who participated in the study. Additional epidemiological studies are needed to determine the prevalence of anxiety in the broader population of persons with diabetes

ABSTRACT Chronic rheumatoid arthritis (RA) is a systemic inflammatory disease that leads to cartilage and bone erosion. Untreated disease is linked with joint deformity and substantial health care related costs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) are the main tool to treat any form of RA. Methotrexate (MTX) is the key conventional DMARDs. It is recommended as a first-line treatment for patients with RA. However, MTX is potentially associated with various toxicities. No clear pattern of MTX use in patients with RA in Libya, since no national guideline has been implanted so far. The aim was to investigate the prescribing patterns of MTX in Libya. A hundred and twenty patients who were on treatment with MTX and follow up in RA clinic of Tripoli University hospital were evaluated for therapy during the period of 2018 and 2019. Patient distribution data, disease duration, other related diseases and drug prescribed as well as adverse drug reactions were considered to analyze the pattern of drug use. The demographic distribution findings indicate that female patients are more than male patients and the ratio of disease among female to male was 1:9. A range of age between 41 - 60 years was the highest affected compared with other ages. Among of these about 75% of patients were no occupational works. RA related diseases were found to be more with diabetes mellitus, hypertension and osteoporosis. Low use of NSAIDs in this group of patients but with high use of steroid. A high group of patient's use of low dose of MTX for up to five years. This study concludes that MTX is an effective drug in controlling the disease with less and tolerated incidence of side effects. 

Abstract: Sitagliptin is a drug used in treatment of type 2 diabetes mellitus. Incretin hormones, including glucagonlike peptide-1 analogue and dipeptidyl peptidase-4 inhibitor have recently been found to regulate glucose metabolism. Thus, the aim of this study was to evaluate the effect of sitagliptin on glycemic control and it is associated side effects in Libyan patients with type 2 diabetes, who had inadequate response to existing anti-diabetic drugs. Hundred patients with a known history of type 2 diabetes were recruited in this study during the period of 2019 and 2020. Sitagliptin (100 mg daily) was added on to the pre-existing therapy for type 2 diabetes and the main outcome measures were a change from the base line in glycated hemoglobin and fasting plasma sugar as well as the incidence of symptomatic hypoglycemia. All patients were engaged from outpatient clinic of National Diabetes and Endocrinology Center at Tripoli, Libya. The findings show that the actions of dipeptidyl peptidase-4 inhibitors improve glycaemic control in the patients, and glycated hemoglobin as well as fasting plasma sugar. Thus, sitagliptin is a profound drug for a comprehensive treatment of patients with type 2 diabetes with a low incidence of hypoglycemia.

Abstract: The most effective treatment for severe acne is isotretinoin. However, it carries major side effects as teratogenicity, dryness, lipid profile disturbance and constipation. Although it is commonly prescribed with and without prescription in Libya, little date are available regarding patients understanding and awareness of isotretinoin. Aims: This study was conducted to explore the awareness of acne patients about the use of isotretinoin. It aims to measure how much acne patients know about the side effects of the drug especially the teratogenic effects, how to deal with them and how the drug influence their daily activities. Plus, to identify how patients get their information about the drug and whether they consult professional or ordinary people. Methods: A verified and validated questionnaire addressed to acne patients (n = 50, Sept. - Dec., 2019) who were under and over 20 years of age in Tripoli city was used in this study. Results: Data shows that acne patients do not have enough information about the drug. They take their information from other patients and do not usually consult doctors or pharmacists. The only side effects that the patients complained from are dryness. In addition, they are not aware that this drug can cause teratogenic effect. Conclusion: A good understanding and awareness the Libyan patients about isotretinoin help in increasing compliance and minimize adverse effects. 

Neonatal intensive care unit (NICU) is an ideal environment for transmission of many pathogens, which lead to high morbidity and mortality in neonates. Microbial pathogens that cause nosocomial infections are known to have high resistance to many antibiotics, which leads to economic burdens, in addition to social and psychological factors affecting the families due to long durations in hospitals. Prevention of infection requires identification of contaminated environments and equipment, effective infection control programs, and judicious use of antimicrobial agents.

Methods: 244 neonates, who were admitted to NICU, and 235 residing neonates at Special Care Baby Unit (SCBU) of Tripoli Medical Center (TMC) in the months of May to July 2013, who were found positive for pathogenic infection, were subjected to the study. Pathogenic organisms were isolated and identified according to Standard Microbiological Methods, and an antibiogram was assessed against common antibiotics.

Results: Acinetobacter baumannii was the most frequently isolated bacterium from neonates at NICU and SCBU at a rate of 40% and 48%, followed by Klebsiella pneumoniae at a rate of 33% and 31%, respectively, while the less frequently isolated organisms were Staphylococcus haemolyticus (9% NICU and 5% SCBU) and S. hominis (7% NICU and 3% SCBU). Infection sites were 2 ear, nose, and throat (53% NICU and 58% SCBU); CSF (33% NICU and 3.85% SCBU); urine; eye swab (30% NICU and 47% SCBU); vein catheter (29% NICU); skin swab catheter (30% NICU and 27% SCBU); blood (11% ICU and 12% SCBU); umbilical swab (7% NICU and 18% SCBU); nasal swab (4% NICU and 12% SCBU); and catheter (30.33% NICU and 27% SCBU).

Conclusion: Data indicate a significant infection problem in Tripoli Medical Center Hospital and inefficient infection control programs. A. baumannii and Klebsiella pneumonia were the predominant cause of neonatal infection at TMC. Antimicrobial-resistant pathogens isolated in Neonatal Intensive Care and Special Care Baby Units, respectively, were K. pneumoniae (ESBL) (ESBL)(56.52% and 44.44%), carbapenem-resistant K. pneumoniae (21.7% and 11.11%), and E. coli (ESBL) (13.04% and 5.56%).

Background: Obesity is a global epidemic resulting in major morbidity and premature death. It’s progressively increasing with age. Cases of obesity and overweight are increasing in Libya as well as all over the world, genetic and environmental factors playing a contributory role. With its known significant morbidity and mortality, obesity should draw the attention of the healthcare community, researchers, and policymakers in Libya. Aims of study: To identify the prevalence of obesity among secondary school students in Gharyian city and to study the relation between BMI and sex, education level, and food habit.

Conclusions: The prevalence of overweight and obesity in secondary school students in Gharyian City was relatively low (4.2%) compared with other Arabic countries. The relation between BMI and education level and eating habits was significant. The prevalence of overweight and obesity was higher in males than in females, and it was higher in the 1st-year and 2nd-year students.

Forty-five limb lengthening procedures are carried out in the Orthopedic department in Alkhadra Hospital in Tripoli the period between April 2006 and December 2010A retrograde study done Subjects and Methods A scanogram was used for measurement. All our cases

operated under general anesthesia. One bone at a time, for the tibia, we used the tourniquet. Distal or midshaft fibular osteotomy: If it was distal, we fix the distal segment to the tibia by a single screw for ankle stability. Two Schanz screws were inserted in the metaphyseal region above the proposed corticotomy site, another two screws just below it. As all our cases had proximal metaphyseal osteotomy, one skin incision was used, and two parallel periosteal incisions were performed. Gigli saw was used with or without drill holes, safeguarding the medulla. The Wagner apparatus was then installed. The wound was closed in layers over the drain. An antibiotic was given postoperatively; check if an x-ray was taken. On the second postoperative day, lengthening started and was recorded on the chart. In the other group the corticotomy was kept compressed for two weeks, and lengthening started in the same manner. We lengthen 1 mm per day, monitoring the patient's response. Some patients were taught how to use the apparatus on themselves, though most of the patients remained in the hospital until full length was achieved. Control x-ray prior to discharge unless complications were detected. Once the target length had been achieved, the frame was locked until a good quality of bone was seen radiologically; then the fixator was removed. All patients underwent vigorous physiotherapy from the first postoperative day Results from 45 patients include 10 males (22%) and 35 females (78%). Twenty-seven tibiae (60%), seventeen femora (37%), and one humerus were lengthened (3%). Lengthening ranged between 3 cm (18%) and 11 cm (3%). The cause of lengthening was residual poliomyelitis in 38 patients (84%), trauma in 4 patients (9%), and congenital shortening in 3 patients (7%). Complication: Only 5 cases (11%) had pin tract infection; malalignment of the longitudinal axis more than 5 degrees was noticed in 12 cases (27%); equinus deformity was noticed in 9 cases (20%) of tibial lengthening; and knee stiffness was observed in 11 cases (24%) of both femoral and tibial lengthening. There was neither serious infection nor deep venous thrombosis. With such an extended course of treatment, most of the patients had some problems that resolved with nonoperative intervention. Most patients experienced pain or discomfort during The course of treatment was managed by analgesics or by stopping the length for 1-2 days. Conclusion: In all patients the desired length was gained without any serious mechanical problems.