Isolated levocardia (ILC) is a developmental abnormality involving an abnormal abdominal situs with a normal cardiac situs. This abnormality is especially rare when it is associated with a normal cardiac anatomy. The prenatal diagnoses of seven cases were reported in the English literature. This report presents two cases referred to the authors' echocardiography laboratory for maternal diabetes mellitus in case 1 and suspected dextrocardia in case 2. In both cases, ILC with a structurally normal heart was diagnosed prenatally. The child in the first case was found to have a normal inferior vena cava (IVC) prenatally. Postnatally, he was found to have intestinal malrotation with duodenal obstruction and multiple splenules. Interruption of the IVC was shown by abdominal ultrasound. The child in the second case was found to have an interrupted IVC with azygos continuation prenatally. Postnatally, intestinal malrotation with no evidence of intestinal obstruction or asplenia was detected. Neither of the cases had reported cardiac arrhythmias. Early diagnosis is crucial in these cases due to the high incidence of associated anomalies and potential life-threatening conditions. Management of patients with ILC is dictated by the associated anomalies. Long-term follow-up assessment is recommended for these patients to monitor the development of rhythm abnormalities.

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A stroke is the leading cause of adult mortality and disability. It is the second most common cause of death globally and may soon become the first cause of death worldwide. Among the most important risk factors for stroke are advanced age, hypertension, diabetes, previous stroke or transient ischemic attack. Hypertension and diabetes are the most important and frequent modifiable risk factors of stroke. Objectives: Estimate the most important risk factors associated with stroke in African population by using CHADS2 method. Study Design: Was community based descriptive cross-section. Place and Duration of Study: North Africa (North west of Libya), among Individuals living in Tripoli area the capital, Duration of the study, five years from 1/1/2010 in to 31/12/2014. Methodology: Data collected among 7497 individuals do not have atrial fibrillation (52.8% males & 48.2% females) which contained detailed histories (present, past, medical, hospital admission), available investigations, discharge letters and medical reports. Medical examinations was performed when necessary.

Background: Nosocomial infections caused by methicillin-resistant Staphylococci could lead to increased morbidity and mortality, but little is known about the prevalence of infections with these organisms in healthcare facilities and in the community in Tripoli. This study investigated the in vitro susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) to antimicrobial agents, and determined the molecular characteristics of MRSA. Methods: This is a retrospective observational study aiming at determining the prevalence and antibiotic resistance pattern of (MRSA) and (MRCNS) isolated from non-duplicated clinical specimens in Tripoli Central Hospital (TCH) between June 2013 and June 2014. Isolates were identified using standard laboratory procedures. Antimicrobial susceptibility tests were carried out by disk diffusion method and automated systems. DNA of the MRSA isolates was used for PCR to determine the molecular analysis. Results: 218 isolates of Staphylococci were obtained, 71.6% were coagulase positive staphylococci (CPS) and 28.4% were coagulase negative staphylococci (CNS). 39.7% of CPS were MRSA, while 75.8% of CNS were MRCNS. The rates of hospital-acquired MRSA (HA-MRSA) and community-acquired MRSA (CA-MRSA) among MRSA isolates were 61.3% and 38.7% respectively. A similar trend was detected among MRCNS isolates, where 74.5% were HA-MRCNS and 25.5% were CA-MRCNS. All the MRSA and MRCNS isolates were susceptible (100%) to vancomycin, tigecycline, linezolid, quinupristin/dalfopristin, daptomycin and moxifloxacin. Generally, hospital-acquired strains showed higher resistance rates than community-acquired ones to the most commonly tested non-beta-lactam antibiotics. 35.5% of all staphylococcal isolates exhibited mecA + gene and 12.9% expressed mecC + . Meanwhile, 38.7% of MRSA isolates harbored both mecA and mecC. However, 12.9% of MSSA isolates were negative for both mecA and mecC. The mecA gene was detectable in 59.1% and 40.9 % of HA-MRSA and CA-MRSA isolates respectively. Conclusion: Hospital-acquired MRSA and MRCNS isolates had higher resistance rates to non-beta lactam antimicrobial drugs than the respective community-acquired isolates. This was shown by early detection of mecC gene among MRSA isolates.

Diabetes mellitus (DM) is a very common medical disorder and a major health problem in North Africa including Libya. DM is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate the importance of DM as a stroke risk factor among people living in Libyan community. Methodology: The study was community based descriptive cross-sectional study used CHADS2 Questionnaire, as well a local Libyan classification of stroke risk factors called Community Stroke Risk Classification (CSRC). Shambesh et al.; IJTDH, 10(2): 1-9, 2015; Article no.IJTDH.19028 2 Area: North Africa (North of Libya, the capital Tripoli). Time: Five years from 2010-2014. Population: Sampling was done from a large cohort of individuals living in the community, 7497 individuals were screened looking for risk factors of stroke. Results: The prevalence of DM among our participants (7497 individuals) was 39% (2908 patients), among males and females was 54.1% and 45.9% respectively (P =0.0001). Among different age groups, males have higher rates compared to females except in very young (10-19) and very old (>80) where females dominated. The male to female ratio among total population screened was 21%: 17.8% (1573:1335 respectively). DM prevalence increased with age, with higher rates among age over 40 (P <0.0001). 53% of DM patients had hypertension (1538 patients), 21.3% had Congestive Heart Failure (CHF) (618 patients), 13% had Atrial Fibrillation (AF) (382 patients), 22% had Transient Ischemic Attach (TIA) (643 patients), 12.3% had Prior Stroke (PS) (359 patients), All those risk factors accompanying DM increased with age increase (P<0.0001). 100% of DM patients had risk of stroke on CHADS2 and CSRC scores, which mainly concentrated in intermediate and high scores. Conclusion: DM is a major risk factor of stroke among Libyan population and had very high risk scores in CHADS2 and CSRC. Original Research Article