A novel RYR1 pathogenic variant - Common among Libyan Jews and associated with a broad phenotypic spectrum.

Mutated skeletal muscle ryanodine receptor-1 (RYR1) gene is associated with a spectrum of autosomal dominant and recessive RyR1-related disorders with a wide phenotype. This report describes a variable phenotype associated with a previously unreported RYR1 frameshift pathogenic variant, (NM_000540.2) c.12815_12825del; p.Ala4272Glyfs*307, common in Libyan Jews. Clinical and genetic features of 14 carriers from 8 unrelated families were collected. There were 12 heterozygotes and 2 compound heterozygotes. Six heterozygotes (median age 49.8) were asymptomatic, and six (median age 24.5) presented with myopathy (n = 3) or severe arthrogryposis-like features, severe scoliosis, pes planus, post-anesthesia malignant hyperthermia, or cystic hygroma (in a fetus) (n = 1 each). None had an abnormal echocardiogram study or elevated creatine phosphokinase (CPK) levels. One bi-allelic carrier had a severe skeletal phenotype and myopathy; the other was a fetus with a cystic hygroma. Assessment of variant frequency in 447 Libyan Jews who underwent exome testing for unrelated reason yielded a prevalence of 1:55. The RYR1 p.Ala4272Glyfs*307 variant is common in Libyan Jews. It is associated with a broad phenotypic spectrum, with possible presentation among heterozygotes. Further genotype-phenotype studies are essential to delineate the clinical significance of the variant in mono- and bi-allelic carriers.

Analysis of BRCA1 germline variants (exons 5, 11 and 20) in breast cancer families from Libya.

Breast cancer (BC) is a leading cause of cancer deaths in Libyan women. BRCA1 variants differ globally due to the diversity of genetic makeup and populations history. Their distribution, prevalence, and significance in Libyans remain largely unexplored. This study investigated the characteristics and distribution of BRCA1 variants in exons 5, 11, and 20 in Libyan families with BC. Thirty-six BC patients at ≤ 45 years, between 46-50 years and with a family history of breast, ovarian, pancreatic or prostate cancer in close relatives, or with triple-negative BC, were selected from 33 unrelated families during 2018-2020 at the National Cancer Institute, Sabratha, Libya. From these 33 families, 20 women (18 BC patients and two unaffected) were screened for BRCA1 exons 5, 11 and 20 using Sanger sequencing. All families completed an epidemiology and family history questionnaire. Twenty-seven variants (26 in exon 11 and 1 in exon 20, minor allele frequency of < 0.01) were detected in 10 of 18 unrelated families (55.6%.) Among the 27 variants, 26 (96%) were heterozygous. A frameshift pathogenic variant, c.2643del, and one novel variant c.1366A>G were identified. Furthermore, seven variants with unknown clinical significance were detected: c.1158T>A, c.1346C>G, c.1174C>G, c.3630 G>T, c.3599A>T, and c.3400 G>C in exon 11, and c.5244T>A in exon 20. Six variants with conflicting pathogenicity interpretations, c. 3460T>A, c. 3572 G>A, c. 3700 G>C, c. 1246C>G, c. 1344C>G, and c. 1054 G>A, were also identified. Twelve benign/likely benign variants were identified. Rare BRCA1 variants that have not been reported in North Africa were found in Libyan patients. These findings provide preliminary insights into the BRCA1 variants that could contribute to hereditary BC risk in Libyans. Further functional, computational, and population analyses are essential to determine their significance and potential impact on BC risk, which could ultimately lead to more personalized management strategies.

Impact of presynchronization and Ovsynch on early postpartum ovarian activity and fertility of dairy cows in Libya.

Background: Reproductive efficiency affects dairy cow profitability. Ovarian function in postpartum (P.P.) has been better understood using ultrasound and hormonal assays. Optimizing ovulation synchronization and carefully timing artificial insemination (TAI) can greatly enhance reproductive rates in dairy cows. Aim: This experiment was designed to investigate the reproductive performance and ovarian activity in early postpartum lactating dairy cows using the Presynch-PGF2α, Ovsynch protocol, and TAI. Methods: Randomly the cows were assigned to a control group and a treatment group, based on the chronological order of their calving date. On day 14 P.P., both groups received two cloprostenol treatments, 14 days apart. Ultrasonographic inspections were conducted on day 14 to check ovarian activity and uterine contents. On day 11, after presynchronization, cows in the treatment group were given 100 µg IM. of cystorelin, followed by a luteolytic dose of 500 µg IM., cloprostenol on day 7, and a second dose of cystorelin on day 8 (36 hours later). After the second cystorelin injection by 16-20 hours, cows were inseminated, while the control group had all cows displaying spontaneous estrus between day 0 and day 28 were artificially inseminated. Results: Ovarian activity began to improve at 82.61% on day 19 P.P., with complete recovery between days 24 and 27 P.P. The second cloprostenol injection approached, causing follicular size to reach 8.41 ± 1.04 mm. After the second injection, ovarian activity switched from follicular to luteal, with corpus luteum rates of 23.91% and 26.1%. The presynchronized PGF2α regimen significantly enhanced ovarian activity from days 19-35 P.P. Ovulation and pregnancy rates in the Ovsynch group were 54.2% and 41.7% at the first timed artificial insemination (TAI), compared to 54.5% and 31.8% in the control group. There was no significant impact between them; it was just high in the presynchronized Ovsynch group. However, the P.P. period was minimized to 47-49 days till the first AI reached a 41.7% pregnancy rate and 20.8% at the second AI, for an overall 62.5%. Conclusion: The current study concludes that presynchronization during preservice in clinically normal P.P. dairy cows reduces P.P. duration, increases ovarian activity performance, and reduces ovarian dysfunctions from day 19 to day 35 P.P., as well as improves the pregnancy rate.

Flow cytometric detection of leukemic blasts in Libyan pediatric patients with acute lymphoblastic leukemia.

The diagnosis of acute lymphoblastic leukemia (ALL), which is the most common type of cancer in children, has become more accurate with the use of flow cytometry. Here, this technology was used to immunophenotype leukemic cells in peripheral blood samples from Libyan pediatric ALL patients. We recruited 152 newly diagnosed patients at Tripoli Medical Center (Tripoli, Libya) by morphological examination of blood and bone marrow. Twenty-three surface and cytoplasmic antigen markers were used to characterize B and T cells in circulating blood cells by four-color flow cytometry. Six children (3.9%) turned out to have biphenotypic acute leukemia, 88 (57.9%) had B ALL, and 58 (38.1%) had T ALL. There were 68 cases of pro-B ALL CD10-positive (44.7%), 8 cases of pro-B ALL CD10-negative (5.2%), 6 cases of pre-B ALL (3.9%), and 6 of mature-B ALL (3.9%). CD13 was the most commonly expressed myeloid antigen in ALL. We present immunophenotypic data for the first time describing ALL cases in Libya. The reported results indicate that the most common subtype was pro-B ALL, and the frequency of T-ALL subtype was higher compared to previous studies. Six cases were positive for both myeloid and B lymphoid markers. Our findings may provide the basis for future studies to correlate immunophenotypic profile and genetic characteristics with treatment response among ALL patients.

Pathological lesions associated with Vibrio infection in Atlantic horse mackerel (Trachurus trachurus L., 1758) from the western coast of Tripoli, Libya.

Background: Vibrios are aquatic bacteria causing Vibriosis in humans and aquatic animals. Vibriosis is a significant disease of cultured and wild fish. Aim: The present study aimed to address the impact of Vibrios on the health status of Trachurus trachurus inhabiting the coastal area of Tripoli. Methods: A total of 100 samples of (T. trachurus) were collected randomly from the Western Coast of Tripoli and Bab Al-Baher market, throughout the period from spring 2019 to summer 2019. All the sampled fish were examined externally and internally and lesions were recorded. Bacterial isolation from the liver and kidney was carried out using the appropriate culture media. Tissue samples were taken from the liver, kidney, and spleen in 10% neutral buffered formalin for a histopathology examination. The tissue sections were stained with hematoxylin and eosin to assess morphologically and Perl's Prussian blue for the demonstration of ferric iron. Results: On average 69% of the infected fish exhibited at least one pathological lesion. Vibrios were recovered from 90% of the examined fish. The histopathological changes of the liver showed severe congestion of blood vessels (BVs), mononuclear cell infiltration surrounding a bile duct, granular degeneration and coagulative necrosis of hepatocytes in the centrilobular area, marked vacuolar degeneration of hepatocytes, activation of melano-macrophage centers (MMCs), multiple cysts of nematode in hepatic tissue (incidental finding). The histopathological alterations of the kidney showed severe congestion of BVs, vacuolar degeneration of the renal tubular epithelium, severe interstitial mononuclear cell infiltration, and marked activation of MMCs in the kidney. Moreover, congestion of BVs and marked activation of melano-macrophages (MMCs) were found in the spleen. The MMCs of most of the sampled tissues showed a strong positive reaction for ferric iron. Conclusion: The polluted aquatic environment by sewage at Tripoli Coast is an essential factor for triggering the pathogenicity and invasion of Vibrios to vulnerable Atlantic horse mackerel. Also, this study is a preliminary step to give a baseline for further future studies on epidemiology and control of Vibrio infection in Libyan fish.

First genetic characterization of Xeroderma pigmentosum in Libya: High frequency of XP-C founder mutation.

BACKGROUND: Xeroderma pigmentosum is an autosomal recessive disease characterized by a high sensitivity to UV radiations. The disease is clinically and genetically heterogeneous, thus making accurate early clinical diagnosis difficult. Although the disease is considered rare worldwide, previous studies have shown that it is more frequent in Maghreb countries. So far, no genetic study has been published on Libyan patients, except three reports limited to clinical descriptions. METHODS: Our study, which represents the first genetic characterization of XP in Libya, was conducted on 14 unrelated families including 23 Libyan XP patients with a consanguinity rate of 93%. Blood samples were collected from 201 individuals including patients and their relatives. Patients were screened for founder mutations already described in Tunisia. RESULTS: The two founder Maghreb XP mutations, XPA p.Arg228* associated with the neurological form and XPC p.Val548Alafs*25 in patients with only cutaneous manifestations, were homozygously identified. The latter was predominant (19 of 23 patients). In addition, another XPC homozygous mutation (p.Arg220*) has been identified in only one patient. For the remaining patient, the absence of founder XPA, XPC, XPD, and XPG mutations suggests mutational heterogeneity of XP in Libya. CONCLUSION: Identification of common mutations with other Maghreb populations is in favor of a common ancestor in North-African populations.

Attitudes, Knowledge, and Perceived Barriers Towards Cancer Pain Management Among Healthcare Professionals in Libya: a National Multicenter Survey.

Cancer pain presents in approximately 66% of patients in advanced stages. Although several guidelines and pharmacological options are available for cancer pain management (CPM), assessment and treatment of cancer pain remain inadequate globally, particularly in developing countries. Lack of knowledge and negative attitudes towards CPM among healthcare professionals (HCPs) are important barriers to CPM. This survey aimed to evaluate nurses' and physicians' knowledge, attitudes, and potential barriers regarding CPM in Libya. This cross-sectional survey involved a convenience sample of 152 oncology nurses and physicians working in six oncology settings in Libya. The response rate was 76%. The Barriers Questionnaire II (BQ-II) was used for data collection (higher scores signify greater attitudinal barriers and poorer knowledge). Data analysis was carried out using Statistical Package for Social Sciences (SPSS), version 26 software. An independent t-test (unadjusted estimate) indicated that Libyan nurses showed higher mean barrier scores (mean = 3.8, SD = 0.7) to CPM than physicians (mean = 2.9, SD = 0.8), p < 0.001. The six most common differences in attitudinal barriers between nurses and physicians were "opioid side effects," "poor tolerance," "strong patient endures pain," "distract the physician," "drug addiction," and "opioids impair immune function," p < 0.001. Multiple regression results (adjusted estimate) indicated that nurses had more barrier scores to CPM than physicians (B = - 0.530, p < 0.05), and participants with higher educational levels were associated with lower barrier scores to CPM (B = - 0.641, p < 0.05). Our results suggest that Libyan oncology HCPs hold perceived barriers, lack of knowledge, and negative attitudes towards CPM. Professional education and training in CPM, addressing phobia and myths on opioid usage, and the benefits and complications of using opioids are likely to result in reduced barriers to CPM in Libya.

Ovarian granulosa cell tumor in a Persian cat: Case report from Tripoli, Libya.

Background: Ovarian granulosa cell tumors (GCTs) are common neoplasms in domestic animals that originate from the sex-cord stromal cells of the ovary. The aim of the present paper was to report a case of ovarian GCT in a 5-year-old Persian female cat and to describe the histopathological pattern of this tumor. Case Description: The cat was brought for a routine diagnostic examination for pregnancy at Albaittar clinic in Tripoli, Libya with a history of 1 month mating before it was brought to the clinic for investigation of progressive behavioral changes. The cat external examination showed noticeable enlargement in the abdomen that was potentially suspected of pregnancy; however, the abdominal ultrasonography showed a great mass located on the right ovary. A therapeutic ovariohysterectomy was performed. The cat's clinical signs resolved, 6 months later it was diagnosed with a mass on the right kidney suspected as metastasis and one week later the cat died. Conclusion: In this case, macroscopic and microscopic studies are discussed and histopathological examination confirmed ovarian GCT with cystic endometrial hyperplasia and suspected metastasis in one kidney.

Correlation between maternal and fetal umbilical cord blood lead concentrations in Libya.

Background: People are exposed to lead from car exhaust fumes (leaded petrol), lead-based paints, plumbing systems, cigarette smoking, contaminated soil and dust, foods grown in polluted areas, and water sources. Among the vulnerable subpopulations are pregnant women, fetuses and infants. Aims: To estimate and correlate maternal and neonatal blood lead levels and compare these between neonates and their mothers in Tripoli and Ghadames. Methods: In this cross-sectional study, blood was collected from 120 and 116 mothers and their neonates from Tripoli and Ghadames, respectively. Lead levels were determined using atomic absorption spectrophotometry. A simple questionnaire was filled by the participants using face-to face interview. Data were analysed using SPSS version 20.0 and Excel. Results: Mean blood and umbilical cord lead levels were 6.83 (standard deviation 4.96) and 6.05 (4.89) µg/dl in mothers and neonates from Tripoli, respectively, and 5.91 (4.02) and 4.54 (4.09) µg/dl from Ghadames. There was no significant difference in blood lead level between mothers from Tripoli and Ghadames. However, there was a significant correlation between maternal blood and umbilical cord blood in Tripoli and Ghadames. Linear regression revealed that neonatal umbilical cord blood lead levels reflected the levels in maternal blood. Blood lead in this study was higher than that reported in industrialized western countries. Conclusion: We detected moderate blood lead levels among pregnant women in Tripoli and Ghadames. It is important to detect the source of lead in the Libyan population to treat this problem effectively.

First phalanx exostosis in traditional equestrian horses in Western Libya.

Background: Orthopedic diseases involving the forelimb fetlock joint of horses other than those used in professional racing have not been widely reported in the literature. One of these problems is the exostosis on the proximal forelimb phalanx (P1), which has not been reported previously in Western Libya. Aim: The study aimed to investigate the prevalence of P1 exostosis in traditional equestrian horses (known locally as Sarj horses) of different breeds in Libya that participated in a special social event and described its clinical findings radiographic appearance. Methods: The current study involved 60 horses admitted to private veterinary clinics with varied fetlock orthopedic problems. The studied horses were aged between 6 and 11 years old and galloped on hard grounds. Clinical and radiographic examinations were carried out on all horses. Lateromedial radiographs for one or both forelimb fetlock joints were acquired for each horse. Results: Clinical examination revealed that 21 horses (35%) had hard non-painful swelling on the dorsal aspect of fetlock with joint stiffness during flexion. In 19 of them, the swelling was bilateral. No forelimb lameness was noticed. Radiographically, hard swelling was diagnosed as bone exostosis, with various sizes, on the proximo-dorsal aspect of P1. There was also a new bone formation on the disto-dorsal part of third metacarpal bone in two cases. Conclusion: This study has documented the first report on bone exostosis on the proximo-dorsal aspect of the forelimb proximal phalanx as a common problem in Sarj horses that galloped on hard grounds in Western Libya. Although this bone lesion did not cause lameness in all reported cases, further investigations are warranted to identify its histopathological nature, potential etiology, and proper treatment.

Urological injuries in the civil war of Libya.

BACKGROUND: In this article, we aimed to evaluate results of patients who acquired various injuries during Libya civil war who then were transferred to our facility with genitourinary trauma for further assessment and treatment. METHODS: A total of 121 wounded patients, including 21 (17.3%) with 1 or more combined urogenital injuries, were treated at Yeni Yüzyil University Private Gaziosmanpasa Hospital from October 2014 to September 2016. RESULTS: Of the 21 patients, 13 (61.9%) were injured by explosive weapons, while the rest 8 (38.1%) had bullet wounds. The 21 urogenital injuries were to the kidney in 7 cases (33.4%), ureter in 5 (23.8%), bladder in 5 (23.8%), scrotum in 2 (9.5%), and penis in 2 (9.5%). There was associated damage to organs other than the urogenital system in 21 patients (100%). Two patients had nephrectomies performed on-site medical facility. The rest of patients had no urogenital organ resections. Urogenital trauma had higher rates of liver damage, generalized infection, blood transfusions, and longer hospital stay. CONCLUSION: Knowing that war related surgery patients should be approached as a distinct and non-standard category, every case must be evaluated individually. Patients should be evaluated in a multidisciplinary approach and physicians should be aware of infections affecting morbidity and mortality.

Cancer incidence in the middle region of Libya: Data from the cancer epidemiology study in Misurata.

BACKGROUND: Cancer incidence and cancer registries are essential for local epidemiological information. In Libya, scarce evidence exists with regard to incidence rates and distribution. AIM: To estimate cancer incidence in Libya and draw trends of cancer type distribution compared to regional and worldwide data. Such incidence data are needed to inform strategic decisions on cancer facilities, training, and research in the given geographical area of Misurata, the major city in the middle region and third largest in Libya. METHODS: This is an observational, multi-centre, city-wide study to account for all cancer cases. All radiology (computed tomography and magnetic resonance imaging) and pathology reports were examined across all public and private hospitals in and around Misurata. RESULTS: Four hundred and thirty cancer cases were identified to have been diagnosed during 12 months (July 2019-June 2020), yielding a cancer incidence of 71.7 per 100 000 population. Breast cancer (84, 19.5%), colorectal cancer (83, 19.3%), lung cancer (33, 7.7%), and prostate cancer (21, 4.9%) had the highest prevalence. CONCLUSION: Cancer incidence established in this study stands at 71.1, much lower than the worldwide reported incidence of 201.0. Several limitations lead to missing cancer cases from the survey period, mostly related to poor documentation, non-research friendly environment, and disorganised healthcare structure. Nevertheless, distribution by type represents a true contrast to the world cancer report. Finally, a national or regional inclusive cancer registry is essential to the flow of information that supports strategic planning and decision-making in developing cancer care in the country.

Cephalometrics of Libyan adults.

BACKGROUND: Cephalometric radiography enables a physician to identify specific areas of craniofacial disproportionality and decide on a treatment plan. Cephalometric analysis is a method for localizeing malocclusion with the facial skeleton and soft tissue structures. This study reports the results from the cephalometric analysis of Libyan adults, as a surrogate for the population of North Africa. METHODS: Lateral cephalometric radiographs were taken of 100 non-growing Libyan adults: 74 males and 26 females, aged 17-45 years. All subjects had no previous orthodontic treatment. The mean values and standard deviations of 92 parameters were determined. RESULTS: The hard tissue cephalometric analysis revealed lower variability in the length of vertical distances compared to those extending more horizontally. In adult Libyans, linear and angular midface measurements (hard tissue and soft tissue) exhibit less variability compared to other measurements taken. Libyans exhibit some of the structural deviations from Bolton's means that were previously found in Americans of African descent. Namely, they are characterized by the greater development of the maxillomandibular complex and by the presence of dentoalveolar protrusion, which must be taken into account when treating patients of this ethnic group. CONCLUSION: The current study once again confirmed the need to develop cephalometric norms for different ethnic groups, the Arab population in North Africa in particular.

Comparative Study of Rumen Ciliate Fauna of Goat and Sheep in Libya

Objective: This study aims to provide comparative information on the rumen ciliate fauna of goat (Capra aegagrus hircus) and sheep (Ovis aries) living in Zawiya, Libya. Methods: We obtained rumen samples from 16 goats and 17 sheep after the slaughter in Zawiya, Libya between June and August 2016. We immediately fixed the well-mixed samples with an equal volume of 18.5% formalin. We filtered and stained the samples in the laboratory with methyl green formalin saline solution to determine the nuclei and added 2% Lugol's iodine solution to visualize the skeletal plates. Results: We found that the mean number (± standard deviation) of ciliates in the rumen contents from goats and sheep was 70.9±61.6×104 cells mL-1 (minimum-maximum value, 4.0-187.0×104 cells mL-1) and 96.3±49.3×104 cells mL-1 (minimum-maximum value, 19.5-235.0×104 cells mL-1), respectively. Results also showed that the total number of species per goat and sheep was 1-17 (mean, 8.2±4.7) and 1-13 (mean, 7.9±3.8), respectively. We identified 10 genera, 19 species, and 11 morphotypes in goats and 9 genera, 16 species, and 13 morphotypes in sheep. Additionally, we found that Entodinium simulans prevalence in all goats and sheep was 100%. On the other hand, we observed Hsiungia triciliata and Ostracodinium gracile in only one goat (6.3% prevalence) and Polyplastron multivesiculatum in only one sheep (5.9% prevalence). Overall, the ruminal ciliate fauna of goat and sheep in Libya comprised Entodinium species (mean for goats, 85.9%; mean for sheep, 83.5%). Conclusion: This study recorded Hsiungia triciliata as a new endosymbiont in goats. To our knowledge, this study is the first to report all of the species detected in goats from Libya. Similarly, this is the first to detect Diplodinium anisacanthum, Entodinium bursa, E. ellipsoideum, E. longinucleatum, E. simulans, Isotricha prostoma, Ophryoscolex caudatus, Ostracodinium gracile, and Polyplastron multivesiculatum in sheep from Libya.

Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre.

OBJECTIVES: Cancer is a major cause of morbidity and mortality worldwide, and it is an increasing problem in developing countries. Estimation of the incidence of cancer is important, especially in regions with limited epidemiological data on cancer. Therefore, the aim of this study was to provide an updated report on the incidence of cancers in the Tobruk region in eastern Libya. METHODS: Data on cancer patients from the records of the Department of Histopathology of Tobruk Medical Centre from January 2013 to June 2020 were included. RESULTS: In total, 402 cases were recorded. Men patients accounted for 30.3% (n=122) of cases, and women patients represented 69.6% (n=280). The overall mean age at the time of the first diagnosis was 49.0±17.1 years. The most common malignancies were breast and uterine cancer in women (18.4%, n=74; 15.9%, n=64, respectively), colorectal cancer (11.6%, n=47; 26 in women and 21 in men), bladder cancer (8.2%, n=33; 8 in women and 25 in men), and thyroid cancer (8.0%, n=32; 23 in women and 9 in men). CONCLUSIONS: Breast and uterine cancers were the most common cancers in women, and bladder and colorectal cancer were the most common cancers in men, followed by colorectal cancer in both genders. These data will help health authorities launch preventive plans for cancer in the region. Further studies to identify aetiological factors and cancer-related risk factors need to be conducted in the region.

Value of antigranulocyte scintigraphy with Tc-99m-sulesomab in diagnosing combat-related infections of the musculoskeletal system.

AIM: Combat-related extremity injuries are regularly associated with long-term complications such as chronic infection, especially osteomyelitis. Clinical examination and laboratory parameters do not usually allow reliable diagnosis. In contrast, imaging techniques enable constructive assertions to be made about the location and extent of an infection of the peripheral musculoskeletal system. The aim of this study was therefore to determine the diagnostic reliability of three-phase bone scanning and antigranulocyte scintigraphy using Tc-99m-sulesomab (Leukoscan) in the diagnostic clarification of infections associated with combat-related extremity injuries. METHODS: Twenty-seven male patients (mean age 33.9 years) with suspected combat-associated infections of the extremities were included in this retrospective analysis. All patients underwent three-phase bone scanning using Tc-99m-HDP followed by antigranulocyte scintigraphy with Tc-99m-sulesomab. In 26 of the 27 patients, a CT scan of affected limb was obtained, where the secondary fusion with single photon emission CT data set was possible. The diagnostic reliability of imaging techniques was validated against microbiological samples obtained during surgery and used as gold standard. RESULTS: Three-phase bone scanning yielded a positive result in all patients, with 18 scans classified as true positive (TP) and nine scans as false positive (FP). This produced a sensitivity of 100%, a specificity of 0% and a positive predictive value (PPV) of 67%. Antigranulocyte scintigraphy recognised 13 patients as TP, 1 patient as FP, 8 patients as true negative (TN) and 5 patients as false negative (FN), which gave a sensitivity of 72%, a specificity of 88%, a PPV of 93%, a negative predictive value (NPV) of 62% and an accuracy of 78%. CT recognised in 7 cases a TP result, in 3 cases an FP, in 5 cases a TN and in 11 cases an FN result. This produced a sensitivity of 39%, a specificity of 63%, a PPV of 70%, an NPV of 31% and an accuracy of 46%. CONCLUSIONS: Three-phase bone scanning did not deliver any diagnostic benefit, since no result was able to differentiate unequivocally between infection-related and reactive changes. Antigranulocyte scintigraphy using Tc-99m-sulesomab represented a highly suitable technique for diagnostically clarifying combat-related infections of the extremities. It is superior to CT in sensitivity, specificity, PPV, NPV and accuracy.

Altitude impact on the chemical profile and biological activities of Satureja thymbra L. essential oil.

BACKGROUND: Several agricultural or environmental factors affect plants' chemical and pharmacological properties. METHODS: In this study, the essential oil of Libyan Satureja thymbra was isolated from plants collected during two successive years at two different altitudes; Wasita (WEO) and Safsaf (SEO), 156 and 661 m above sea level, respectively. RESULTS: GC/MS allowed the identification of 21 and 23 compounds, respectively. Thymol prevailed in WEO (26.69%), while carvacrol prevailed in SEO (14.30%). Antimicrobial activity was tested by agar-well diffusion method, and MIC/MLC values were determined by broth dilution method. Values of MIC/MLC were 0.125/0.25 µg/ml for SEO against S. aureus, P. mirabilis and K. pneumonia and for WEO against B. subtilus. It was observed that plants growing at lower altitude in Wasita locality had better antifungal activity, while those growing at higher altitude at Safsaf locality had better antibacterial activity. Both essential oils had a better anthelmintic activity than the standard piperazine citrate against a tested earthworm. However, SEO oil had a significantly higher anthelmintic activity than WEO. Cytotoxicity of the oils tested using SRB assay on human breast cancer (MCF-7) and colon cancer cell lines (HCT-116) showed better activity for SEO, especially against HCT-116 with IC50 2.45 ± 0.21 µg/ml. CONCLUSIONS: Thus, altitude is an important factor that should be considered as it affected the yield, composition and biology of the plant extracts.

Migrants rescued on the Mediterranean Sea route: nutritional, psychological status and infectious disease control.

INTRODUCTION: North Africa has become a key migratory hub where a large number of migrants attempt the journey by sea from the Libyan coastline to the south of Europe. In this humanitarian disaster scenario, the Mediterranean route has been one of the most used by illegal boats. METHODOLOGY: In this report, the state of physical and psychological health of a cluster of Eritrean migrants, escaped from Libya and rescued in the Mediterranean Sea after a shipwreck, was described by epidemiological, clinical and laboratory investigations. RESULTS: Data suggest that despite the majority  of the migrants being apparently in good health upon a syndromic surveillance approach, most of them suffered a decline in psychological status as well as severe malnutrition. The emergence of infectious diseases, related to poor living conditions during the journey, is not a rare event. CONCLUSION: The present report highlights the risks of failures of the syndromic medical approach in the setting of the extremely challenging migration route and underlines migrant frailties consequent to a prolonged journey and long period of detention. These stressors, which can degrade the initial health condition of traveling migrants, can lead to a premature "exhausted migrant effect" that should be carefully investigated in order to avoid the early emergence of diseases related to frailty.