Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism that threatens the continued effectiveness of antibiotics worldwide and causes a threat almost exclusively in hospitals and long-term care settings. This study investigated the prevalence of MRSA strains and their sensitivity patterns against various antibiotics used for treating hospitalized patients in a major tertiary surgical hospital in Benghazi, Libya. Methodology: We investigated 200 non-duplicate S. aureus strains isolated from different clinical specimens submitted to the Microbiology Laboratory at Aljala Surgical and Trauma Hospital, Benghazi, Libya from April to July 2007. Isolates were tested for methicillin resistance by the oxacillin disc-diffusion assay according to Clinical and Laboratory Standards Institute guidelines. MRSA strains were tested for antimicrobial resistance (i.e., vancomycin, ciprofloxacin, erythromycin, chloramphenicol and fusidic acid) using commercial discs. Information on patient demographics and clinical disease was also collected. Results: Of the isolates examined 31% (62/200) were MRSA. No significant differences were observed in the prevalence of MRSA among S. aureus from females or males or from different age groups. Most MRSA were isolated from burns and surgical wound infections. Antibiotic resistance patterns of 62 patients with MRSA to vancomycin, ciprofloxacin, fusidic acid, chloramphenicol and erythromycin were 17.7%, 33.9%, 41.9%, 38.7% and 46.8% of cases, respectively. Conclusion: MRSA prevalence in our hospital was high and this may be the case for other hospitals in Libya. A sound surveillance program of nosocomial infections is urgently needed to reduce the incidence of infections due to MRSA and other antimicrobial-resistant pathogens in Libyan hospitals.

Original Article introductionDiabetes mellitus (DM) is one of the common diseases worldwide. Diabetic foot ulcer and amputation are related to increased mortality, morbidity, as well as economic and psychological burden, among diabetic patients. The global incidence of diabetic foot ulcer is 6.3%, and its incidence in Africa is 7.2%. [1] There is a 30-fold greater risk of lower limb amputation and a 10-fold greater risk for foot infection among diabetic patients in comparison to individuals without diabetes. [2,3] In one study in Libya, 1.1% of diabetic patients had lower limb amputation. [4] Risk factors of diabetic foot ulcer include peripheral neuropathy, peripheral vascular disease, foot deformity, callus, previous foot ulcer, previous lower limb amputation, end-stage renal disease, poor vision, inability to reach feet, poor glycemic control, and tobacco smoking. [5] There are several risk stratification systems for predicting the development of diabetic foot. The Scottish Intercollegiate Guideline Network system (SIGN), which has a high diagnostic accuracy, is easy to use and inexpensive. [6,7] Early detection of diabetic foot risk factors and proper intervention can prevent the development of diabetic foot ulceration and amputation. The applicability of internationally developed risk assessment schemes and clinical management guidelines to local and regional circumstances is a prerequisite for their implementation. Hence, this study examined the characteristics and risk factors of diabetic foot disease in a new location. patiEntS and mEthodS DesignWe aimed to determine the characteristics and risk factors for diabetic foot ulceration and amputation among patients with type 2 DM (T2DM) at Benghazi Medical Center (BMC) diabetic clinic in a cross-sectional observational study. This Introduction: Diabetic foot ulcer and amputation are associated with an increased incidence of morbidity and mortality. Diabetic foot ulcer can be prevented by screening for risk factors and proper interventions. Objectives: We aimed to determine the risk of diabetic foot ulcer and amputation among patients with type 2 diabetes at Benghazi Medical Center diabetic clinic. Patients and Methods: A cross-sectional study of diabetic foot status and risk factors in diabetic patients attending a specialist diabetes clinic in Benghazi, Libya. Results: Eighty-seven (84.5%) patients wear inappropriate shoes, 37 (35.9%) had Tinea pedis, 26 (25.2%) had foot deformity, 13 (12.6%) patients had bilateral hallux valgus deformity, 8 (7.8%) patients had clawing of feet, 2 (1.9%) patients had Charcot joint, and one patient (0.97%) had amputated toes. Dorsalis pedis and posterior tibial arteries pulsations were not palpable in six (5.8%) patients, there was a loss of protective sensation among 20 (19.4%) patients, vibration sense was absent in 15 (14.6%) patients, and joint position sense was lost in five (4.9%) patients. According to Scottish Intercollegiate Guideline Network system, 59 (57.3%) patients were in the low-risk category, 18 (17.5%) were i...

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Background: Diabetes mellitus is one of the growing health problems worldwide. Comprehensive medical evaluation, screening for complications, and proper diabetes care are crucial to improve outcome. Objectives: We aimed to study the profile of diabetes in Benghazi city and assess the changes since the last study of 2002. Patients and Methods: This study is a descriptive cross-sectional study of 504 persons with diabetes who were following at Benghazi diabetes center during June and July in 2020. Results: The age was, mean ± standard deviation; 57.8 ±12.3 years. with equal sex split. A quarter (24.8%) of participants graduated from a university/college. About half of the patients were obese (48.4%) Hypertension and dyslipidemia were found in 35.1% and 42.1%. respectively. The mean glycated hemoglobin A1c (HbA1c) was 8.3% ±1.7%. Self-monitoring of blood glucose (SMBG) was practiced by 20.2% of all patients, Less than two thirds (63.5%) of all patients had diabetes eye screening within the previous year. However, none of the participants had ever had a comprehensive feet examination. Ramadan fasting was observed by most of participants (95.4%). Conclusions: There is an improvement regarding annual eye examination, taking the medications regularly, SMBG, assessment of lipid profile, and regular follow-up with HbA1c in comparison with the practice in 2002. On the other hand, there is a decline in having comprehensive feet examination, practicing regular exercise, and diet control. The uncovered gaps in diabetes care need urgent attention.

Background: Pancreatic neuroendocrine tumors (NETs) are rare; representing less than 10% of all primary pancreatic tumors. The minority of these tumors are functional producing a clinical syndrome according to the hormone secreted. ACTH production by pancreatic NETs is rare and even rarer, it occurs from liver metastasis later in the course of the disease. Case Report: We report a case of a 30-year-old Libyan man who presented with Cushing's syndrome due to ectopic ACTH production from liver metastases of a pancreatic NET. The pancreatic NET was diagnosed 7 years previously when it was considered a nonfunctional at the time of diagnosis; the tumor was resected completely then. In the current presentation there was no evidence of the primary tumor but multiple liver metastases were present. Conclusions: This report highlights the fact that initially non-functional pancreatic NETs may present later with a functional hormonal syndrome either from the primary tumor itself or from its metastatic secondary tumors elsewhere.