مجلة البحوث الأكاديمية

Adapting Global Diabetes Management Guidelines for Low Resource Settings

2026-08-05T11:33:49+02:00

Background: Type 2 diabetes mellitus (T2DM) is increasing rapidly in low- and middle-income countries (LMICs), where limited resources often restrict the implementation of international diabetes management guidelines. Adapting these recommendations to local healthcare systems is essential to improve patient outcomes.

Objective: To evaluate the applicability of current diabetes management guidelines in low-resource settings and identify practical strategies that balance clinical effectiveness with affordability and accessibility.

Methods: A narrative review of international guidelines and published literature was conducted to compare evidence-based recommendations with the realities of diabetes care in LMICs. The review focused on treatment efficacy, safety, cost-effectiveness, medication accessibility, and healthcare delivery models.

Results: Metformin remains the preferred first-line therapy because of its proven efficacy, safety, and affordability. Second-generation sulfonylureas continue to provide a practical and cost-effective second-line option where access to newer agents is limited. Although SGLT2 inhibitors and GLP-1 receptor agonists offer important cardiovascular and renal benefits, their high cost limits widespread use. Strengthening primary care, ensuring access to essential medicines, implementing simplified treatment protocols, and expanding community-based care can substantially improve diabetes management.

Conclusion: Diabetes care in LMICs requires pragmatic adaptation of international guidelines. Prioritizing affordable therapies and context-specific care models can improve glycemic control, reduce complications, and support sustainable diabetes management.

ESWL of Solitary Renal Stones at Different Anatomical Sites with Piezoelectric Lithotripsy. Does it Affect the Results?

2026-08-05T11:33:41+02:00

Introduction: Kidney stone disease is a common health problem which increasing prevalence in industrialized countries. Extracorporeal Shockwave Lithotripsy (ESWL) is an important, effective, non-invasive, treatment option for kidney stones.

Aims: This study aimed to investigate the effect of stone location within the kidney on the outcome of ESWL in renal solitary stones.

Methods: A single center study that assessed the effect of stone location inside the kidney on the result of treatment with ESWL. It was conducted in the urology department in Ibn Sina teaching hospital – Sirte – Libya in a four year period that extended from January 2010 to December 2013. Results: 129 patients with solitary renal stones were enrolled in the study, of whom 79 males (61%) and 50 females (39%). Patients' age ranged from 5 to 74 years old. Average stone size was 13.2 mm. There were 18 patients (14%) with stones in the upper calyx, 15 (12%) in the middle, 38 (29%) in the lower renal calyx and 58 (45) patients with stones in renal pelvis. Stone free rate was 72% in stones located in upper renal calyx, 80% in middle calyx, 53% in lower calyx and 81% in stones located in renal pelvis. Discussion: the finding of the current study is consistent with growing body of evidence that indicate that ESWL is least effective in case of stones located in the lower renal calyx. Therefore, early stone localization might help in the decision making and selection of the best option for the stones located in sites less responsive to ESWL. Conclusion: patients' selection and stone site localization are important points to help in decision making before ESWL since other treatment options should be considered in patients with lower renal calyceal stones, or any other patients who may not benefit from ESWL.

Double lift loop system to suspend the thumb after a trapeziectomy

2026-08-05T11:33:43+02:00

Background: The unique anatomy of the carpometacarpal (CMC) joint of the thumb allows the human hand to make a myriad of movements and functions, which can be severely compromised by osteoarthritis.

Aims: This study aimed to determine clinical outcomes and assess the functional outcome of a double lift loop system to suspend the thumb after a trapeziectomy.

Methods: A single-center retrospective study reviewing patient files in a level one trauma center (Misrata Medical Center) over a two-year follow-up period. Results: 25 patients diagnosed with varying degrees of CMC joint arthritis were evaluated, with a 1:5 male-to-female ratio and a mean age of 62 years. Excellent results were recorded in 89% of patients, showing significant improvement in pain scores and mild improvements in range of motion. Discussion: Trapeziectomy remains the gold standard for pain relief in CMC arthritis, but traditional K-wire stabilization introduces complications that are bypassed by the early mobilization permitted by the double lift loop technique. Conclusion: Trapeziectomy with a double lift loop system proves to be an excellent surgical treatment option due to short immobilization periods, high satisfactory outcomes, and lack of revision surgeries.

Conclusion: Thumb CMC arthritis is common and disruptive to daily life. When conservative treatment fails, trapeziectomy with a double lift loop system is an excellent surgical option due to a short immobilization period (10–14 days), high satisfaction rates, and no need for revision surgery.

Congenital Duodenal Obstruction: Diagnostic Challenges and Surgical Outcomes in Libya Case Series

2026-08-05T11:33:46+02:00

Background: Congenital duodenal obstruction [CDO] is a rare cause of upper intestinal obstruction in children. While most cases are diagnosed during the neonatal period, partial obstruction may remain undetected until later infancy or childhood, leading to delayed diagnosis and chronic gastrointestinal symptoms.

Case Presentation: We report three pediatric cases of congenital duodenal obstruction managed at Misrata Medical Center, Libya. The first case involved a 19-month-old female with chronic non-bilious vomiting, failure to thrive, and recurrent respiratory infections secondary to a congenital duodenal web associated with patent ductus arteriosus. The second case was a 6-month-old infant with Down syndrome and annular pancreas presenting with persistent vomiting and severe malnutrition. The third case involved a neonate with a congenital duodenal web presenting shortly after birth with vomiting and melena. All patients underwent successful surgical correction with excellent postoperative recovery.

Conclusion: Congenital duodenal obstruction [CDO] may present beyond the neonatal period with nonspecific symptoms, resulting in delayed diagnosis. Persistent vomiting and growth failure should prompt early radiological evaluation. Early recognition and timely surgical intervention are essential to improve nutritional and clinical outcomes.

Comparative Analysis of Clinical and Functional Outcomes

2026-08-05T11:33:48+02:00

Background: Elastic Stable Intramedullary Nailing (ESIN) using Nancy nails is the preferred treatment for pediatric diaphyseal forearm fractures failing conservative management. However, specialized implants can be costly and unavailable in resource-limited settings, prompting surgeons to use Kirschner-wires (K-wires) as an alternative.

Materials and Methods: A randomized trial was conducted over a one-year period at Misurata Central Hospital and Aljazeera Hospital, involving 32 pediatric patients (aged 5–12 years) with unstable diaphyseal both-bone forearm fractures. Patients were allocated to receive either intramedullary K-wire fixation ($n=17$) or elastic Nancy nail fixation ($n=15$). Functional and clinical outcomes were evaluated at six months postoperatively using the Price et al. criteria.

Results: Bony union was achieved in 100% of patients in both groups within 12 to 14 weeks. According to the Price et al. criteria, an 'Excellent' or 'Good' functional outcome was achieved by all patients, with 88.2% in the K-wire group and 86.7% in the Nancy nail group scoring 'Excellent'. Surgical duration, immobilization period, and time to implant removal were comparable. Complications were limited to minor, transient superficial skin irritation (11.8% for K-wires vs. 6.7% for Nancy nails) which resolved with conservative care. No deep infections or implant failures occurred.

Conclusion: Intramedullary K-wire fixation yields clinical and functional outcomes fully comparable to specialized elastic Nancy nails. Given their widespread availability and cost-effectiveness, carefully pre-bent K-wires serve as a highly reliable primary surgical treatment option, especially in resource-constrained healthcare settings

Severe Unilateral Cystic Bronchiectasis in a Child with Down Syndrome and Prior Congenital Diaphragmatic Hernia Repair

2026-08-05T11:33:40+02:00

Background: Congenital bronchiectasis is a rare but serious condition in the pediatric population and may be more challenging to diagnose in children with Down syndrome due to overlapping clinical features and communication difficulties. Bronchiectasis, characterized by irreversible bronchial dilatation, is often associated with recurrent infections and may be particularly severe in children with underlying genetic conditions.

Case Presentation: We report a 12-year-old girl with Down syndrome and prior congenital diaphragmatic hernia repair who presented with a long-standing history of productive cough and recurrent lower respiratory tract infections since infancy. Physical examination revealed underweight status, digital clubbing, and inspiratory crackles predominantly in the left lower lung zone. Imaging demonstrated extensive cystic bronchiectasis with left lung volume reduction, and the patient underwent left pneumonectomy. Histopathology confirmed severe acute and chronic bronchiectasis with patchy fibrosis and superimposed acute bronchopneumonia.

Conclusion: This case highlights the rare occurrence of severe unilateral cystic bronchiectasis in children with Down syndrome and prior congenital diaphragmatic hernia repair. Early recognition and surgical intervention may be necessary in cases with extensive lung destruction

Endovascular Management in Patient with Ischemic Diabetic Foot Ulcer and Digital Ischemia in General Surgery Department Misurata Medical Center

2026-08-05T11:33:42+02:00

Background: Peripheral arterial occlusive disease (PAOD) is a major cause of hospitalization, lower-limb amputation, and mortality worldwide. Patients with diabetes mellitus and peripheral artery disease (PAD) have significantly higher mortality rates than non-diabetic patients, with reported 5-year mortality exceeding 30%.

Objectives: To evaluate the outcomes of endovascular interventions in diabetic foot patients with femoropopliteal, infrapopliteal, and multilevel arterial occlusive disease.

Patients and Methods: A retrospective study was conducted on 20 patients treated at Misrata Medical Center between January and December 2025. All patients had diabetic foot ulcers and/or digital ischemia associated with femoropopliteal, infrapopliteal, or multilevel arterial occlusions. Procedures were performed in the General Surgery and Vascular Surgery Departments.

Results: The study included 17 males (85%) and 3 females (15%), with a mean age of 62.5 years. Limb salvage, defined as freedom from major amputation, was achieved in 90% of patients at 3 months. Clinical success, defined as relief of rest pain, ulcer healing improvement, and limb preservation according to Rutherford categories, was also achieved in 90% of cases. Two patients (10%) developed complications: one underwent thromboembolectomy for arterial thrombosis but ultimately required above-knee amputation, while the other underwent femoro-distal bypass surgery.

Conclusions: Percutaneous Transluminal Angioplasty (PTA) was successfully performed in 18 patients (90%), resulting in effective limb salvage and significant clinical improvement. Endovascular intervention appears to be a safe and effective limb-preserving treatment for diabetic patients with lower-limb arterial occlusive disease.

Correlation of C‑Reactive Protein and White Blood Cell Count with Histopathologically Proven Acute Appendicitis Faculty of Medicine, University of Misurata at period between January 2025 to June 2025

2026-08-05T11:33:44+02:00

Background: Acute appendicitis is a common surgical emergency. Laboratory markers like white blood cell (WBC) count and C‑reactive protein (CRP) are widely used for diagnosis. This study evaluates the diagnostic performance and correlation of WBC and CRP with histopathology.

Methods: A Retrospective study was conducted at Misrata medical Centre (mmc) from January 2025 to June 2025 for 72 patients who underwent appendectomy. Histopathology served as the gold standard and cases were grouped as: normal appendix (n = 17), suppurative (n = 48), and perforated (n = 7). Preoperative WBC and CRP were recorded as “raised” or “not raised” using the local laboratory cutoffs used in the treating institution. Diagnostic performance measures (sensitivity, specificity, PPV, NPV) were calculated for WBC and CRP against histopathology.

Results: Of 72 patients, 17 (23.6%) had normal appendix, 48 (66.6%) suppurative appendicitis, and 7 (9.7%) perforated appendicitis. WBC sensitivity was 78.18% and specificity 82.35%; CRP sensitivity was 74.54% and specificity 70.58%.

Conclusion: Both CRP and WBC show significant correlation with histopathology, with WBC showing slightly superior diagnostic performance. Combined marker use increases diagnostic accuracy

Complex Regional Pain Syndrome Following Simultaneous Carpal Tunnel Release and Rotator Cuff Repair

2026-08-05T11:33:47+02:00

Background: Complex regional pain syndrome (CRPS) represents a rare yet debilitating complication following upper extremity surgery. While carpal tunnel release is one of the most performed orthopaedic procedures, the development of CRPS post-operatively remains an uncommon but clinically significant event that can profoundly impact patient outcomes and quality of life.

Case Presentation: We present the case of a 50-year-old right-handed Libyan female who developed CRPS following simultaneous open carpal tunnel release and right rotator cuff repair. The patient manifested classic hallmarks of CRPS type I within two weeks of surgery, including disproportionate pain, hand swelling, warmth, hyperalgesia, and progressive loss of range of motion. Radiographic examination revealed evidence of periarticular osteopenia. Despite conservative management with physiotherapy, gabapentin, and non-steroidal anti-inflammatory drugs over a two-month period, the patient demonstrated only modest clinical improvement with persistent functional limitations.

Conclusion: This case underscores the importance of early recognition and aggressive multimodal management of CRPS following upper extremity surgery. The development of CRPS in the context of simultaneous ipsilateral procedures raises important questions regarding surgical trauma burden and its potential role in CRPS pathogenesis. Clinicians must maintain a high index of suspicion for this complication, particularly when post-operative pain appears disproportionate to the surgical intervention performed.

Successful Perioperative Hemostatic Management in Type 3 von Willebrand Disease During Laparoscopic Repair of Giant Hiatus Hernia Complicated by Pneumothorax

2026-08-05T11:33:39+02:00

Background: Type 3 von Willebrand disease (vWD) is the most severe form of inherited bleeding disorders and carries a high perioperative hemorrhagic risk.

Case Presentation: A 33-year-old male with known type 3 vWD underwent elective laparoscopic repair of a grade IV hiatus hernia. Perioperative management included administration of von Willebrand factor/factor VIII (VWF/FVIII) concentrate. The postoperative course was complicated by left-sided pneumothorax requiring chest tube insertion. Replacement therapy continued for six days; no bleeding complications or transfusion were required.

Conclusion: Major laparoscopic surgery can be safely performed in patients with severe vWD when managed with appropriate replacement therapy and multidisciplinary coordination.

Keywords: von Willebrand disease; type 3; laparoscopic surgery; perioperative management; pneumothorax; hemostasis