مجلة تريبوليتانا الطبية

Anticoagulant Therapy for Non- Valvular Atrial Fibrillation Patients, How Close Are We to the Guidelines?

Elham O Elgdhaf — 2025-11-29

Atrial Fibrillation (A-fib) is strongly associated with cerebrovascular accident CVA, transient ischemic attacks, and peripheral
vascular embolic events, oral anticoagulants are widely prescribed for the prevention of these events associated with AF.
The study aimed to assess the adherence of physicians providing care to A-fib patients with the European Society of Cardiology
(ESC) guidelines of (A-fib) treatment regarding anticoagulation therapy.
This audit was carried out with a case series design by reviewing the medical records and discharge papers of 100 Libyan
patients diagnosed with Non-Valvular atrial fibrillation (NVAF) who were admitted to the cardiology department at Tripoli
University Hospital from (Jan - Dec 2021).
The files of 100 Libyan patients with NVAF were evaluated 60 were females (60%), the mean age was 65.6 ± 14 years, 57%
were elderly older than 65 yrs. 32% live outside Tripoli. Regarding the cause of A-fib, ischemic heart disease (IHD) was the
commonest cause 37%, hypertension 36%, Non Ischemic cardiomyopathy 22%. Regarding the other comorbidities, diabetes
mellitus was found in 44% of patients, History of cerebrovascular accident (CVA) was documented for 17% of patients. Anti -arrhythmic drugs were prescribed for 75.4% of patients at discharge; Antiplatelet drugs (Aspirin and clopidogrel) were prescribed
for 27% of the patients, Anticoagulants were prescribed for 57 patients (57%) at discharge, warfarin in 83.3% of them and Direct
Oral Anticoagulant (DOACs) in the form of Rivaroxaban (Xarelto) in 16.7%. and no anticoagulant prescribed to the other 43
patients (43%), 40 patients of them (93%) were with CHA2DS2-VA score≥2 which according to the new ESC guidelines of
the management of AF they recommended to be on oral anticoagulants, from these 40 patients; Aspirin prescribed to 14 (35%),
Aspirin and clopidogrel prescribed to 13 (32.5%) and the other 13 patients (32.5%%) discharged with no anticoagulant nor anti
platelets, with no clear cause documented in the medical records.
Conclusion: 40% of the patients under study were discharged without a prescription of any anticoagulant, although they were
fulfilling the ESC guideline of AF treatment.
Recommendation: additional study on the knowledge, attitude, and practice of physician about the importance of anticoagulants
in preventing thromboembolic complications in A-fib patients.

Analgesic and Anti-Inflammatory Effects of Cele coxib in the Presence of Lithium Carbonate Using the Formalin Test in Albino Mice

Suhera Aburawi — 2025-11-29

Drug-drug interactions occur when a drug’s effect on the body changes in the presence of another drug. Drug-drug interactions
can be either pharmacokinetic or pharmacodynamic. The clinical consequences of drug-drug interactions could lead to reduced
efficacy or increased toxicity. Lithium carbonate is a monovalent cation with a narrow therapeutic index. Lithium is a first
line treatment for Bipolar Affective Disorder. Celecoxib is a selective COX-2 non-steroidal anti-inflammatory drug, which
is responsible for prostaglandin synthesis, an integral part of the pain and inflammation pathway.
It is indicated in conditions like osteoarthritis, rheumatoid arthritis, acute pain, and familial adenomatous polyposis. This work
aims to investigate the effects of lithium carbonate on the analgesic and anti-inflammatory action of celecoxib by applying a
formalin test using albino mice.
Mice were divided into 6 groups. Group 1 (control) administered 1% tween 80 at a dose of 5ml/kg; group 2 received celecoxib
(50mg/kg); group 3 received lithium carbonate (10 mg/kg); while group 4 received lithium carbonate (50mg/kg); group 5 received
combined treatment of lithium carbonate (10mg/kg) with celecoxib; while group 6 received combined treatment of lithium carbonate
(50mg/kg) with celecoxib. Drugs used in mice as a standard, Tramadol (5 mg/kg) for phase I (analgesic), and Acetylsalicylic acid
(200 mg/kg) for phase II (anti-inflammatory), for the formalin test. All drugs were injected subacutely (three doses); mice were
intraperitoneally administered at 24, 5, and 1 hours before scoring. All drugs were administered as a suspension in 1% Tween 80. It
was injected in a volume of 5ml/kg. All drugs were prepared freshly before use. Celecoxib exerts analgesic and anti-inflammatory
effects as it decreases the duration of licking in both early and late phases after s.c. administration of formalin in the left hind paw.
Lithium carbonate exerts analgesic and anti-inflammatory effects, and it decreased the duration of licking in both the early and late
phases after s.c. administration of formalin in the left hind paw. The combined treatment of lithium and celecoxib has analgesic and
anti-inflammatory action, but less than the additive effect; both partially antagonize each other.
Conclusion: Celecoxib and lithium carbonate each produce analgesic and anti-inflammatory effects. Lithium in the presence
of celecoxib, and as a result of celecoxib›s effect on the renal system, lithium may partially act as a proinflammatory and
nociceptive agent. Understanding and managing drug interactions is critical for optimizing patient outcomes and minimizing
risks associated with pharmacotherapy

Efficacy and Safety of Low-Dose Methotrexate in Pediatric Refractory Alopecia Areata: A Retrospective Case Series

Fauzia Musbah — 2025-11-29

Alopecia areata (AA) is a chronic autoimmune disorder causing non-scarring hair loss, with a significant psychosocial impact,
particularly in pediatric patients with severe, refractory forms. While various treatments exist, effective and well-tolerated
options for this population remain a clinical challenge. This study aimed to evaluate the safety and effectiveness of low-dose
methotrexate (MTX) in pediatric patients with refractory AA.
This retrospective case series included 24 pediatric patients (11 males, 13 females; mean age 9.1 ± 4.5 years) with severe refrac
tory AA. Patients received oral MTX (0.4 mg/kg weekly, with folic acid supplementation), 9 children were given dexamethasone
0.1mg in mini oral pulse at the Dermatology Department of Tripoli Central Hospital and a private clinic from December 2021
to January 2024. Hair regrowth was categorized as good (>75% regrowth), moderate (50-75% regrowth), little (<50% regrowth),
or no response. Recurrence rates and adverse effects, including liver enzyme levels, were documented.
Of the 24 patients, 5 missed follow-up appointments. Among the 19 patients who completed treatment and follow-up, 16
(84.2%) experienced good to moderate hair regrowth. The recurrence rate among the 19 patients who completed follow-up was
31.6% (6 patients). Minimal adverse effects were observed, with only one patient showing a mild increase in aspartate transami
nase (AST) levels. The study population included various forms of alopecia, with 41.7% having AA and 58.3% having Alopecia
universalis (AU). Associated conditions included low ferritin levels (25%) and hypothyroidism (12.5%).
Low-dose methotrexate appears to be a generally effective and well-tolerated treatment option for pediatric patients with severe
refractory Alopecia areata. These findings suggest MTX can induce significant hair regrowth with a low incidence of adverse
events. Further research with larger sample sizes, standardized outcome measures, and longer follow-up periods, ideally in pro
spective studies with control groups, is warranted to confirm these results and explore long-term outcomes.

Lactobacillus Species as a Potential Biomarker for Colorectal Cancer: Biopsy-Based Insights

Attiya Alatery — 2025-11-29

Colorectal cancer (CRC) is the third most prevalence type of cancer with the second mortality rate. CRC is a heterogenous
disease and several factors were correlated to its development such as diet, genetics, lifestyle and recently, accumulating
evidence advocate that the gut microbiota dysbiosis was an innovative and imperative player in the initiation and development
of colorectal cancer. On the other hands, many recent scientific research suggested the protective role of lactobacillus species
through different mechanisms. Such protective mechanisms ether by enhancing the immune response, suppressing the effect
of free radicals, control cell cycle and proliferations and etc. To study the correlation between Lactobacillus and CRC among
Libyan patients and wither such bactria play any role in the devolopment and progression in such cancer type This study was
conducted in the city of Tripoli, Libya. The study included, 20 CRC patients with colorectal cancer confirmed by colonoscopy
examination and evaluated histopathologically, 20 patients with large adenomas polyp and 20 people with healthy colonic mucosa
as control group. The sample of each patient which obtained by proximal to the colonoscopic part of the suction tube was sent to
the clinical microbiology. Laboratory for isolation according to the standard laboratory procedures guideline (CSLI, 2012). The
suspected positive colonies were isolated and identified by Gram staining technique and catalase test, and further confirmed by
the use of phoenix BD automated system. The results of this study revealing, significant declined of Lactobacillus salivarius
in polypic group (%5) and CRC groups (%5) while Lactobacillus salivarius of the normal mucosal group represent ( .(%35The
Lactobacillus rhamnosus also shown the same pattern of L. salivarius. The obtained result strongly affirming the protective role
of Lactobacillus species among Libyan CRC paients

Day-of-Surgery Cancellations: A Prospective Study at Abo-Slim Trauma Hospital, Tripoli, Libya

Omar Hamir — 2025-11-29

Same-day cancellations of elective surgeries compromise patient care and hospital efficiency. this study aimed to determine the
frequency and causes of such postponements in a tertiary trauma hospital.
A prospective observational study was conducted at Aboslim Trauma Hospital over a 6-month period (October 1, 2024 to March
31, 2025). All elective surgeries scheduled across five departments (General Surgery, Orthopedic Surgery, Neurosurgery, Plastic
Surgery, and Chest Surgery) were included. Postponements on the day of surgery were recorded by the chief scrub nurse, and
causes were categorized into: patient medical reasons, lack of operating time, administrative issues, patient no-shows, and changes
in surgical plan. A chi-square goodness-of-fit test was used to determine whether the distribution of causes differed significantly
from a uniform distribution.
Out of a total of 1,128 scheduled elective surgeries, 282 cases, representing 25% of the total, were postponed on the day of
operation. The most frequently cited reason for postponement was patient medical issues, accounting for 120 cases or 42.6%.
Lack of available operating time was responsible for 98 postponements, making up 34.8% of the total. Administrative issues,
such as scheduling errors or equipment unavailability, contributed to 43 cases (15.2%). Additionally, 12 patients (4.3%) failed
to attend on the day of surgery, and in 9 cases (3.1%), the surgical plan was altered, resulting in postponement. To determine
whether these reasons occurred with equal frequency or whether certain causes were disproportionately represented, a chi-square
goodness-of-fit test was conducted. The test yielded a chi-square statistic of 99.12 with four degrees of freedom and a P-value of
1.51 × 10⁻²⁰. This result indicates a highly significant deviation from a uniform distribution, confirming that some causes were
significantly more prevalent than others.
Most same-day surgery postponements were due to medical issues or scheduling inefficiencies, and were largely preventable.
Interventions aimed at improving preoperative assessments and realistic OR scheduling could substantially reduce cancellations.

Descriptive Cross-Sectional Assessment of Pharmacists’ Knowledge and Involvement in Sports Anti-Doping Initiatives in Albayda City, Libya

Yahya Saber E. Mansour — 2025-11-29

The worldwide abuse of performance-enhancing drugs (PEDs) continues to be a significant issue, with incidents of doping rising
consistently, as stated by the World Anti-Doping Agency (WADA). A significant proportion of unintentional doping incidents
arises from athletes’ limited awareness regarding the substances they consume. Although athletes hold the main responsibility
for the substances they take, healthcare professionals, such as pharmacists, are crucial in reducing the chances of accidental
doping. The purpose of this study is to assess the pharmacists’ knowledge, attitudes, and perceptions regarding doping and
anti-doping practices. A descriptive cross-sectional study was conducted involving 200 pharmacists in Albayda, Libya. Data
were collected using a structured 15-item questionnaire designed to assess pharmacists’ understanding and perspectives on
doping. Our findings revealed that only 7% of pharmacists were familiar with the term “doping,” and a mere 1% had previously
attended any formal training or lectures on the topic. Nevertheless, a significant majority (89%) concurred that utilizing banned
substances in sports is both unethical and unjust. The awareness regarding the potential presence of prohibited substances
in over-the-counter medications and dietary supplements was limited to 22%. Additionally, merely 1% of the participants
recognized the International Pharmaceutical Federation’s (FIP) official position concerning the involvement of pharmacists in
anti-doping efforts. On a positive note, 90% of the respondents indicated a strong desire to undergo formal training in the area
of anti-doping, while 75% favored the development of sports pharmacy as a specialized discipline. These findings highlight a
critical need for improved anti-doping education within pharmacy training programs to properly equip future pharmacists for
their responsibilities in promoting clean and ethical sports.

Knowledge, Attitudes, and Practices of Pharmacists toward Vitamin B12 Deficiency Associated with Metformin Use: A Cross-Sectional Survey Study

Fathia R. Almani — 2025-11-29

Metformin, a first-line therapy for type 2 diabetes mellitus (T2DM), is linked to vitamin B12 deficiency with long-term use
(≥1,500 mg/day), increasing risks of neuropathy and megaloblastic anaemia. Community pharmacists, as accessible healthcare
providers, are well-positioned to promote screening and education to mitigate these risks.
This cross-sectional survey was conducted among 100 pharmacists in Tripoli, Libya, using a structured self-administered
questionnaire to assess their knowledge, attitudes, and practices, (KAP) regarding metformin-associated vitamin B12 deficiency.
Descriptive statistics summarized responses, with chi-square tests and Pearson’s correlation used to examine associations (P <
0.05 was considered significant). Participants were predominantly young (mean age 28 ± 6.05 years) with a mean experience of
4.5 ± 5.2 years. Most (87%) recognized metformin’s link to B12 deficiency, and 77% identified reduced intestinal absorption.
Monitoring was frequent (57% always, 34% sometimes recommended screening; 65% observed deficiency cases). Awareness
was significantly associated with counselling frequency (χ² = 7.76, P = 0.041) and case observation (χ² = 8.27, P = 0.004),
while Practices were correlated with accurate symptom identification (χ² = 16.43, P < 0.001) and improved patient adherence to
monitoring (χ² = 8.22, P = 0.037). Positive attitudes (86% felt responsible for education) linked to better adherence outcomes (χ²
= 12.70, P < 0.001). Experience positively correlated with KAP (r > 0.22, P < 0.05). Barriers included patient disinterest (29%)
and time constraints (19%). While pharmacists demonstrated strong awareness and engagement, structured training programs
and national guidelines are needed to optimize counselling and improve patient outcomes