Gunshot injuries in Benghazi–Libya in 2011: The Libyan conflict and beyond

BackgroundSince independence, Libya has never experienced personal ownership of arms. That changed during the Libyan conflict where weapons became widespread in the society. As a result gunshot injuries became a concern for surgeons at our principal surgical hospital (Al-Jalaa). This study aims at analyzing the gunshot injuries that took place during 2011 and highlighting the peculiarities in the Libyan scenario.MethodsPatient records were obtained and gunshot injuries were analyzed for various parameters. Statistical analyses were made taking into consideration situations faced by neighbouring countries.ResultsIn 2011, 1761 patients were admitted with over 95% being male and over 97% were Libyan. The average age of a GSI patient was 28.32 ± 10.01 years. Patients aged 18–35 formed over 70% of the cases with half of all cases being treated by the orthopedics department. Sixty-eight percent of cases were injured in the extremities followed by chest (12.5%) and abdomen injuries (7.8%). The mortality rate for GSI's was found to be 5.6% overall with young age, site of injury (i.e. chest and head) and cause of injury (i.e. war or civilian fighting) being important risk factors.ConclusionsTaking into consideration the difficult operating conditions and limited resources, surgeons at our hospital were able to maintain a low mortality rate. Disarmament needs to begin as soon as possible because these injuries will continue to occur so long firearms are available in society.     

Membrane technology for sustainable water resources management: Challenges and future projections

Although water is essential for human survival and has always been critical to the social and economic growth of the world, it is unfortunately distributed irregularly worldwide and is threatened by countless source of pollution. Addressing the issue of water resources sustainability is extremely crucial for societies in order to maintain safety as well as social, ecological and economic progress. The issue of water scarcity has pushed the world to develop adequate technologies and approaches for sustainable water resources management. In addition, to seawater and brackish water, industrial and municipal wastewater are also considered to be important available resources that need to be taken into consideration to increase sustainability and at the same time to meet SDGs. Indeed, as the population grows, agricultural, domestic and industrial activities produce large amounts of wastewaters that can be treated and reused in variety of purposes considering circular economy philosophy. Nowadays, wastewaters are treated in order to be reused for industrial, agricultural and other domestic purposes. In this context, membrane technology is a preferred choice for treatment of water from different wastewater streams for reuse in a more sustainable way, taking into account the philosophy of circular economy and the targets set from UN. This review discusses the links between the concept of sustainability and the treatment of water resources, including wastewaters with membrane technology. It provides a tangible framework for presenting the relevant challenges and future prospects but also the benefits that will come. The practical results of the research serve as reference point for stakeholders, policy makers dealing with sustainable water development strategies considering SDGs and circular economy.     

Kinetics of antibody and memory B cell responses after MMR immunization in children and young adults

The persistence of antigen-specific memory B-cells (MBCs) in children and young adults long time after vaccination against measles, mumps and rubella (MMR) is not known. Here we have looked at the Swedish immunization program and examined children 1–10 years after the first MMR dose in early childhood, as well as young adults 7–18 years after the second dose of MMR. We show that Ab titers and MBCs against measles and rubella have different kinetics, indicating that the MBC pool and the corresponding Ab titers are regulated independently. These data fit well with other findings that continuous IgG secretion comes from long-lived plasma cells and not MBCs. We also demonstrate that individuals with low post-vaccination Ab titers might have an adequate MBC response. It remains to be shown if memory B-cells provide the same protection as specific antibodies, but our data is a valuable complement to the incomplete knowledge about correlates of protection after vaccination.     

Current knowledge,practice and attitude of preoperative fasting: A limited survey among Upper Egypt anesthetists

BackgroundPreoperative fasting aims at minimizing the risk of pulmonary aspiration. Anesthesia societies have officially recommended a fast of 2 h for clear fluids and 6 h for solid food before elective surgery.We conducted a limited (regional) survey to examine anesthetists’ preoperative fasting routines for adults undergoing elective surgery (primary endpoint). Further, we analyzed their familiarity with the new recommendations, knowledge of guidelines, and attitudes towards liberalized fasting (secondary endpoint).MethodStandardized questionnaires were mailed to 147 anesthetists in South valley, Aswan, Qena and Sohag governorates requesting anonymous response. We focused on the duration of preoperative fasting for solids and fluids as well as on the anesthetists’ knowledge and acceptance of new guidelines recommendations, and on their attitude towards this issue in general.ResultsThe overall response rate was 68% (n = 101). Of those, 92 respondents were familiar with the new recommendations. A total of 18 (18.9%) anesthetists reported that they usually recommend a preoperative fast for solid food of 6 h and for clear fluids of 2 h (N group). A total of 10 (9.9%), of anesthetists respondents fell into (P group). The traditional NPO after midnight is still practiced by the majority 73 (72.27%) (T group).ConclusionOur study showed that the majority of studied anesthetists are aware of the new preoperative fasting guidelines; however, they are still practicing strict preoperative NPO from midnight. Therefore, National published guidelines are needed to promote shorter durations.     

Gastric cancer and Helicobacter Pylori infection in the Eastern Libya: A descriptive epidemiological study

Background and study aimsThe aim of this study was to determine the pattern of histologically-proven gastric cancer in Eastern Libya and explore its association with Helicobacter pylori infection.Patients and methodsThe registries of the Departments of Histopathology, Faculty of Medicine, Benghazi University and Oncology, Al-Jomhoria Hospital, Benghazi, were reviewed for cases with primary gastrointestinal cancer from January 2000 to December 2002 (sole Histopathology and Oncology Departments in Eastern Libya). Slides of hematoxylin and eosin stain of gastric cancer patients were re-stained to detect H. pylori. The American Joint Committee on Cancer Tumor, Node, Metastasis staging was used for clinical and pathologic staging. Gastric cancer biopsy materials were classified into intestinal or diffuse type according to Lauren criteria.ResultsOne hundred and fourteen cases of gastric cancer were diagnosed. Tumor stages were: 2 (14%), 3 (21%), 4 (57%) and unknown (8%). Most common site of involvement was the antrum (48%). Diffuse adenocarcinoma occurred in 56 patients (49.1%), intestinal adenocarcinoma in 46 (40.4%) and malignant gastric lymphoma in 12 (10.5%). The overall frequency of H. pylori infection was 63.2% (72/114), more frequent in intestinal adenocarcinoma (71.7%) and malignant lymphoma (66.6%) than diffuse adenocarcinoma (55.3%). The frequency of gastric cancer increased throughout the three years of study.ConclusionThe majority of the patients were diagnosed in locally advanced or metastatic stage. Clearly more efforts need to be given to early detection. We showed a stronger association of H. pylori infection with intestinal type gastric adenocarcinoma and malignant lymphoma than diffuse adenocarcinoma suggesting that H. pylori infection is the most probable causal factor of gastric cancer in this part of Libya.     

Chronic neuroprotective effects of low concentration lithium on SH-SY5Y cells:possible involvement of stress proteins and gene expression

To investigate the molecular mechanism underlying the neuroprotective effect of lithium on cells, in this study, we exposed SH-SY5Y cells to 0.5 mmol/L lithium carbonate(Li2CO2) for 25–50 weeks and then detected the expression levels of some neurobiology related genes and post-translational modifications of stress proteins in SH-SY5Y cells. cDNA arrays showed that pyruvate kinase 2(PKM2) and calmodulin 3(CaM 3) expression levels were significantly down-regulated, phosphatase protein PP2A expression was lightly down-regulated, and casein kinase II(CK2), threonine/tyrosine phosphatase 7(PYST2), and dopamine beta-hydroxylase(DBH) expression levels were significantly up-regulated. Besides, western blot analysis of stress proteins(HSP27, HSP70, GRP78 and GRP94) showed an over-expression of two proteins: a 105 kDa protein which is a hyper-phosphorylated isoform of GRP94, and a 108 kDa protein which is a phosphorylated tetramer of HSP27. These results suggest that the neuroprotective effects of lithium are likely related to gene expressions and post-translational modifications of proteins cited above.