Antimicrobial resistance and carbapenemase dissemination in Pseudomonas aeruginosa isolates from Libyan hospitals: a call for surveillance and intervention.

Pseudomonas aeruginosa is a multidrug-resistant bacterium capable of forming biofilms. This study aimed to assess resistance of clinical isolates from Libyan hospitals to antipseudomonal antibiotics, the prevalence of selected extended-spectrum ß-lactamases and carbapenemase genes among these isolates, and the microorganisms' capacity for alginate and biofilm production. Forty-five isolates were collected from four hospitals in Benghazi and Derna, Libya. Antimicrobial susceptibility was determined using agar disc diffusion. The presence of resistance genes (blaCTXM, blaTEM, blaSHV-1, blaGES-1, blaKPC, and blaNDM) was screened using PCR. Biofilm formation was quantified via the crystal violet assay, while alginate production was measured spectrophotometrically. Resistance to antipseudomonal antibiotics ranged from 48.9% to 75.6%. The most prevalent resistance gene was blaNDM (26.7%), followed by blaGES-1 (17.8%). Moreover, all isolates demonstrated varying degrees of biofilm-forming ability and alginate production. No statistically significant correlation was found between biofilm formation and alginate production. The dissemination of resistant genes in P. aeruginosa, particularly carbapenemases, is of great concern. This issue is compounded by the bacteria's biofilm-forming capability. Urgent intervention and continuous surveillance are imperative to prevent further deterioration and the catastrophic spread of resistance among these formidable bacteria.

Strategic choices of migrants and smugglers in the Central Mediterranean sea.

The sea crossing from Libya to Italy is one of the world's most dangerous and politically contentious migration routes, and yet over half a million people have attempted the crossing since 2014. Leveraging data on aggregate migration flows and individual migration incidents, we estimate how migrants and smugglers have reacted to changes in the border enforcement regime, namely the rise in interceptions by the Libyan Coast Guard starting in 2017 and the corresponding decrease in the probability of rescue to Europe. We find support for a deterrence effect in which attempted crossings along the Central Mediterranean route declined, and a diversion effect in which some migrants substituted to the Western Mediterranean route. At the same time, smugglers adapted their tactics. Using a strategic model of the smuggler's choice of boat size, we estimate how smugglers trade off between the short-run payoffs to launching overcrowded boats and the long-run costs of making less successful crossing attempts under different levels of enforcement. Taken together, these analyses shed light on how the integration of incident- and flow-level datasets can inform ongoing migration policy debates and identify potential consequences of changing enforcement regimes.

Patient-dentist communication and its impact on dental services utilisation as perceived by patients in Libya.

OBJECTIVES: To identify the factors influencing communication between patients and dentists in Libya and their effects on patient satisfaction and trust. We explored the impact of these interactions on the subsequent utilisation of dental health services from the patient's perspective. DESIGN: Qualitative descriptive study in a purposive sample of patients from oral health centres in Janzour city in Libya who were over eighteen years old. Sixteen semi-structured interviews (30-90 minutes) were conducted online. RESULTS: Trust was the prime concern among patients. Other factors also positively impacting communication and patient satisfaction included information interaction, active participation, moral support, explanation about processes and the dentists' comprehension of how a patient feels. The online interviews revealed four key thematic areas that reflected the patient-dentist communication phases: 1) Welcoming and establishing a good interpersonal rapport phase; 2) the Information-sharing phase; 3) Treatment decision-making phase, and 4) Satisfaction self-evaluation phase. CONCLUSION: These data emphasise the significance of soft skills, particularly effective communication, in the context of dental practice. The findings underscore the importance of personal values and interpersonal skills among dental professionals, as these factors play a pivotal role in shaping the success of dental healthcare provision.

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.

Cross-sectional study of attitudes toward online continuing dental education in Libya during the COVID-19 pandemic.

During the COVID-19 pandemic, many educational institutions switched to e-learning educational platforms. This approach was essential but raised challenges, particularly in training practitioners for medical emergencies. This approach not only led to global challenges and a need for rapid adaptation, but also raised inequities across countries, with some facing far more technical challenges than others. In Libya, low investment in education technology and unpredictable internet connectivity limited its integration into schools and universities even before the pandemic. The current study reports feedback from an online continuing dental education (CDE) course for dental practitioners that was developed emergently during the pandemic and aimed to address the challenges posed by Libya's internet environment. Participants were recruited through social media and received an 8-hour online CDE course consisting of three modules. Participants were invited to complete a pre-course demographic/informational survey on a Google form. After passing all modules, students were prompted to complete a post-course survey consisting of 23, five-point Likert scale questions. Respondents included 43 females (74.1%) and 15 males (25.9%). For ~50% of the cohort (n = 32), this was their first online clinical course. 87.9% of post-course participants rated the course as a positive learning experience, while 90.9% agreed their learning outcomes had been achieved. Most participants (97%) agreed the course instructor explained all concepts clearly. In total, 81.8% agreed that the technology effectively supported their learning. Most agreed that a clear demarcation between each course module existed and that the language and depth of the material were adequate. Some students reported technical difficulties, and 33.3% saw repetitions in the modules. However, all post-course respondents said they would recommend the online course to colleagues. Libyan dental practitioners showed high satisfaction levels towards the e-learning process, course content, instructors' attitudes, and overall e-learning experience despite the inherent e-learning challenges posed in this country.

The specter of cholera in Libya and North Africa: Natural disasters and anthropization threaten human health during recent years.

Introduction: According to data from the World Health Organization (WHO), in the last year cholera has re-emerged in various areas of the planet, particularly in Africa. The resurgence of this disease is closely linked to poor hygiene, which is sometimes the result of wars or environmental disasters, as in Lebanon and Syria since autumn 2022 and today in Libya. Discussion: The spread of cholera is chiefly caused by the presence of contaminated water, in environments with inadequate hygiene and sanitation. Another cause, however, is the lack of access to adequate vaccination and treatment campaigns. Method: In this short paper, the authors highlight the possibility of a resurgence of epidemic cholera in Libya, especially in light of the consequences of the devastating cyclone Daniel and the simultaneous collapse of two dams upstream of the city of Derna. They also highlight the concern that cholera and other infectious diseases may also spread in Morocco, which was hit by a severe earthquake on 8 September last. The focus of the paper is the awareness that the spread of epidemic diseases is very often linked to human actions, which may trigger or exacerbate the effects of natural disasters. Conclusions: Since these events have devastating effects both on the environment and on people and their psychophysical balance, it is evident that we need to devote greater attention to the health of the planet, to which the health and survival of the human species is strictly and inextricably linked. Indeed, disasters related to phenomena of anthropization facilitate the spread of infectious diseases, placing a heavy burden on local and global health organizations and the health of entire populations. A change of course is therefore essential, in that human actions must be aimed at limiting rather than aggravating the spread of diseases.

Morphological and histological structure of hepatopancreas in rock goby Gobius paganellus on the western coast of Libya.

Background: The rock goby, Gobius paganellus, is not a commercial species. This species has an essential role in the coastal ecosystem as a biological indicator. Therefore, it has been selected as the study's model species. Aim: Due to the insufficient studies that have described the hepatopancreas of G. paganellus, this study aimed to provide information on the anatomical and histological structure of the hepatopancreas of the alimentary canal of this species on the western coast of Libya. Methods: Fifty mature G. paganellus specimens were collected from the northwest of Libya (Tajoura, Jodaem, and Farwa Island). Total length and total weight of the samples were measured and performed by using gross anatomy and histology. Then, the histological sections (3-5 µm) were stained with hematoxylin and eosin (H and E). Results: Morphologically, the liver has a large pyriform lobe. The dorsal surface of the liver is shiny and smooth, and the ventral surface contains shallow sulci; each sulus has a large blood vessel. Histologically, the liver is wrapped with a thin capsule of fibro-connective tissue. The hepatic parenchyma is made of hepatocytes with blood sinusoids. The hepatocytes are polygonal-shaped cells and have no hepatic lobules or portal triads. Melano-macrophage centers are distributed next to the blood vessels and bile ducts. The bile ducts are lined by columnar epithelial cells. The exocrine pancreatic tissue was observed in the liver parenchyma, and it consists of acini that are composed of pyramidal cells and contain zymogen granules. Conclusion: The liver of this species has both pancreatic and liver tissue, which was discovered in this investigation for the first time.

Comparative assessment of erythrocyte sphingolipid levels as potential cardiovascular health markers in women from Libya and Serbia: a small-scale study.

Aim: Cardiovascular diseases (CVDs) represent the major cause of morbidity and mortality worldwide including Libya, where they account for 43% of all deaths. Sphingolipids are involved in the pathology of numerous diseases including cardiovascular diseases and are proposed as potential biomarkers of cardiovascular health that could be more effective compared to traditional clinical biomarkers. The aim of this study was to determine the sphingolipid content in the erythrocyte membrane of Libyan migrant and Serbian resident women. In addition, to examine if sphingolipid levels could be used as a novel indicator of cardiovascular risk, we evaluated possible correlations with some well-established biomarkers of cardiovascular health.Materials and Methods: A total of 13 Libyan and 15 Serbian healthy women participated in the study. The high-performance version thin-layer chromatography (HPTLC) using the image analysis tool JustTLC was applied for quantification of erythrocytes' sphingolipids.Results: Lower mean values of erythrocytes' sphingolipids and cholesterol concentrations were found in the group of Libyan emigrants compared to Serbian resident women. Besides, in this group of apparently healthy women (n = 28), the sphingolipid content of erythrocytes was inversely related to the Omega-3 index (r =-0.492, p = 0.008) and directly linked to vitamin D status (r = 0.433, p = 0.021) and membrane cholesterol levels (r = 0.474, p = 0.011).Conclusion: The erythrocytes' sphingolipid levels should be measured/assessed as an additional biomarker of CV health, by applying a simple and routine method. Still, further investigation in a larger population-specific context is warranted.

Prevalence of Varroa mites (Varroa destructor Anderson & Trueman) and bee lice (Bruala coeca Nitzsch) in honey bee (Apis mellifera L.) colonies in Libya.

Background: Primary key pest affecting the apiculture business in many areas of the globe is the ecto parasite Varroa mite (Varroa destructor), recently, bee lice have become a considerable bee pest. Aim: In this study, the ecto parasites that infest honey bees, were investigated during the spring of 2013. Methods: A total of 66 apiaries were investigated from different geographical regions in Libya: 34 apiaries from the southern region, 21 apiaries from the north-eastern region, and 11 apiaries from the north-western region. Three bee colonies were randomly chosen from each apiary (316 colonies). From each colony, 300 worker bees were taken as samples, put in container filled with 100 ml of alcohol, and transported to the Honey bee Laboratory-Plant Protection Department at the University of Tripoli's. The parasites were separated from the bees and identified, and the infestation rates were calculated. Results: The study of the parasite distribution clearly showed that Varroa mites were present in all regions. However, the degree of mite density varies not only between apiaries but also between colonies in the same apiary, while the bee louse, Barulla coeca, was detected in 23.1% and 5.8% of apiaries in the western region and southern region of Libya, respectively. On the other hand, all the inspected apiaries in the northern region were not infested. Conclusion: Lack of knowledge about honey bee parasites, poor management practices, and the lack of proper distance between hives of migrated apiaries have been attributed as the possible reason for the spread of these two parasites, especially the Varroa mites in the country.

Impact of vaccination and risk factors on COVID-19 mortality amid delta wave in Libya: A single center cohort study.

INTRODUCTION: The Delta variant has led to a surge in COVID-19 cases in Libya, making it crucial to investigate the impact of vaccination on mortality rates among hospitalized patients and the critically ill. This study aimed to explore the risk factors for COVID-19 mortality and the mortality rates among unvaccinated and vaccinated adults during the Delta wave who were admitted to a single COVID-19 care center in Tripoli, Libya. METHODS: The study involved two independent cohorts (n = 341). One cohort was collected retrospectively from May 2021-August 2021 and the second cohort was prospectively collected from August 2021-October 2021. Most of the patients in the study became ill during the Delta wave. The two cohorts were merged and analysed as one group. RESULTS: Most patients were male (60.5%) and 53.3% were >60 years old. The vast majority of patients did not have a previous COVID-19 infection (98.9%) and were unvaccinated (90.3%). Among vaccinated patients, 30 had received one dose of vaccine and only 3 had received two doses. Among patients who received one dose, 58.1% (18/31) died and 41.9% (13/31) survived. Most patients (72.2%) had a pre-existing medical condition. A multivariable prediction model showed that age >60 years was significantly associated with death (odds ratio = 2.328, CI 1.5-3.7, p-value = <0.0001). CONCLUSION: Our results indicate that previous infection or full vaccination against COVID-19 significantly reduces hospitalization and death. However, a single vaccine dose may not be adequate, especially for older individuals and those with underlying medical conditions. High-risk older patients with comorbidities should be fully vaccinated and offered up to date bivalent COVID-19 booster doses.

Correlation of avian influenza-H9N2 with high mortality in broiler flocks in the southwest of Tripoli, Libya.

Background: Low pathogenic H9N2 avian influenza (LPAI H9N2) caused by the influenza A virus which belongs to the family Orthomyxoviridae. It caused mild respiratory symptoms and a drop in egg production in poultry. Outbreaks of AI-H9N2 have occurred in poultry since the 1990s in many countries in USA, Europe, and Asia. Recently, outbreaks of H9N2 in commercial chicken were recorded in Morocco, Tunisia, Libya, and Egypt. Furthermore, numerous studies demonstrated that co-infection with AI H9N2 and other pathogens results in severe respiratory illness with high mortality in broiler chickens. Outbreaks of respiratory disease with variations in mortality rate were recorded in broiler flocks growing in the southwest of Tripoli in Libya. Aim: The present study was conducted to explain the variation of mortality rate on broiler flocks growing in the southwest area of Tripoli by detection of AI H9N2 antibodies and antigens. Methods: A total of 453 sera samples, 60 tracheal swabs, and 60 cloacal swabs were collected from unvaccinated broiler flocks against avian influenza. Specific avian influenza type A antibodies were detected by using the Elisa test, and specific AI-H9N2 antibodies were detected by using the HI test, whereas specific AI-H9N2 antigens were detected in tracheal and cloacal swabs by using One-Step RT-PCR (M gene) technique. Results: Respiratory diseases with high variations in mortality rate were recorded in broiler flocks growing in the southwest of Tripoli in Libya; the broiler mortality rate in Twisha farms was higher than other farms (62.2% and 11%, respectively). Whereas avian influenza type A antibodies were detected at a high level in Twisha and other farms (95.2%, and 76.7%, respectively). The positive samples for AI type A were tested for AI H9N2 using the HI test. Interestingly the percentage of AI-H9N2 antibodies was quite similar in high and low mortality regions (53.4% and 46.8%, respectively). Additionally, AI-H9N2 antigens were detected only in tracheal swabs in Twisha farm 3, Al-Maamoura, and Ber Al-Tota districts. Conclusion: This study confirmed the endemic of AI- H9N2 in broiler flocks in the southwest of Tripoli-Libya. Also, it clarified that AI-H9N2 was not responsible for the high mortality rate by itself in broiler flocks. Moreover, this study supported the presence of other subtypes of avian influenza in the studied area.

DepressIon AmoNg CardiovaScular Disease Patients in Libya-PrEvalenCe and AssociaTions: INSPECT Study.

OBJECTIVE: This study sought to assess the prevalence and identify factors associated with depression among patients with cardiovascular diseases and followed-up in a public teaching hospital. METHODS: A cross-sectional study was conducted with a systematic random sample of 302 out-patients with cardiovascular diseases and followed-up in the cardiology outpatient department at Tripoli University Hospital. Stable adults (>18 years of age) were eligible to be included in this study. Face-to-face interviews were conducted to complete a questionnaire comprising questions on demographic, medical, and lifestyle issues besides the Patient Health Questionnaire-9 tool. Statistical Package for the Social Sciences, Version 22, was used to analyze the data. RESULTS: Age ranged between 29 and 84 years with a mean age of 60.6 ± 10.4 years; 60.6% were females and 75.8% were married. The highest prevalent morbidity was hypertension (76.2%) followed by diabetes mellitus (48%), ischemic heart disease (39%), and different types of arrhythmias (22.8%). About 59.3% of screened patients had different degrees of depression from mild to severe. The participants with a positive history of psychological problems, those complicated with cardiomyopathy, those who were females, patients with a history of cerebrovascular accident, and patients who were living alone were more likely to be depressed. CONCLUSION: Prevalence of depression is found to be higher among patients with cardiovascular diseases and a family history of psychological illnesses, and cardiomyopathy had the highest contribution as independent predictor for depression. Screening of all patients with cardiovas-cular diseases is essential to identify and treat the patients at greater risk of depression.

Prevalence of Salmonella in poultry slaughterhouses located in Tripoli, Libya.

Background: Salmonella is a leading cause of severe economic losses in poultry and foodborne illness in humans worldwide. Aim: The aim of this study was to determine the prevalence and multidrug resistance of Salmonella Enteritidis (S. Enteritidis) in several chicken abattoirs in Tripoli, Libya. The study includes the South, East, and West regions of Tripoli. Methods: Each region was assigned five slaughterhouses. Each chicken slaughterhouse was visited three times to collect samples. Five samples were taken at random from the neck skin, crop, and spleen. The total number of samples collected from all regions was 675. Bacterial isolation and identification, as well as antibiotic sensitivity testing, were performed on these samples. Results: Salmonella spp. was found to be 15% prevalent, and S. Enteritidis was found to be 7% prevalent. The south region of Tripoli had the highest S. Enteritidis (9%), while the west region had the highest Salmonella spp. (22%). Salmonella prevalence increased significantly (p < 0.01) higher in the spleen (13%) as compared with the crop (5%) and neck (7%). Based on bacterial resistance pattern, Salmonella spp. isolated from the spleen had the highest multiple antibiotic resistance (MAR) index of 0.86 in the south region followed by MAR indexes of 0.8 and 0.46 in the West and East, respectively. Conclusion: Isolation of Salmonella from the spleen may indicate chickens' systemic infection and failure to control the most important microbe for public health. Thus, the control measures have to be revised and a national Salmonella control program should be put in place urgently.

Results of the eighteenth winter waterbird census in Libya in 2022.

Background: Libyan wetlands are diverse; the coastline of Libya, in particular, has different kinds of wetlands, such as salt marshes, bays, lakes, lagoons, and islands. These varieties in habitats provide good shelters and foraging sites for migratory birds during their journeys between Eurasia and Africa. Since the beginning of the Libyan winter census of waterbirds International waterbirds census (Libya IWC) in 2005, which continued regularly until 2012, it has had relatively the same performance in the number of covered sites. However, since 2013, due to the security situation that Libya has experienced due to wars and conflict, which negatively affected the quality of the IWC in Libya, the number of sites has dramatically decreased, reaching only six locations during the middle of the previous decade. Aim: The IWC 2022 aimed to count the birds along the Libyan coast from January 10 to 29. Methods: The census activities were conducted from dawn to dusk during the study period by using high-quality Telescopes, binoculars, and digital cameras for the documentation. Point transects method was used to cover the sites. Results: The results of this year showed that a total of 64 sites were covered, and 68 species of waterbirds were counted, with an abundance of 61,850 individuals. During the census period, a total of 52 non-waterbird species found in Wetlands were recorded, and the number of individuals was 14,836 birds. A total of 18 threatened species were observed during this survey, 12 of them are mentioned in the International Union for Conservation of Nature Red List, and nine species are mentioned in the regional activities center of specially protected areas annex II as threatened in the Mediterranean, where the species; Larus audouinii (Payraudeau, 1826), Larus genei (Breme, 1839), and Puffinus yelkouan (Acerbi, 1827) are mentioned in both of them. Conclusion: The lack of the number of ornithologists and bird watchers is still one of the factors affecting the quality of the IWC in Libya, as well as lack of funding remains an important factor that plays a major role in the success of the waterbirds census.

The Incidence Trend of Type 1 Diabetes among Children and Adolescents 0-14 Years of Age in the West, South, and Tripoli Regions of Libya (2009-2018)

Objective: To estimate the incidence rates (IR) and analyse the trend in type 1 diabetes (T1D) among children aged 0-14 years in the West, South, and Tripoli regions of Libya. Methods: A retrospective study was conducted on Libyan children aged 0-14 years with a new diagnosis of T1D who were admitted and/or had their follow-up at Tripoli Children's Hospital during the period 2004 to 2018. The data were used to estimate the IR and the age-standardized IR per 100,000 population in the studied region for the years 2009-2018. The IRs by sex and age group (0-4, 5-9, 10-14 years) for every calendar year were assessed. Results: A total of 1,213 children were diagnosed during the study period (2004-2018), 49.1% were males with a male-to-female ratio of 1:1.03. The mean age (±standard deviation) at diagnosis was 6.3±3.8 years. The distribution of incident cases according to age group 0-4, 5-9, and 10-14 years was 38.2%, 37.8%, and 24.1%, respectively. Poisson regression modelling in the period 2009-2018 revealed an overall trend of a 2.1% increase per annum. In the period 2014-2018, the overall age-adjusted IR was 31.7 (95% confidence interval: 29.2-34.2) per 100,000 population, the IRs of age groups 0-4, 5-9, and 10-14 years were 36.0, 37.4, and 21.6 per 100,000, respectively. Conclusion: The incidence of T1D in Libyan children in the West, South, and Tripoli regions appears to be rising, with a higher rate in the 0-4 and 5-9 year age groups.