Road Traffic Accidents The Number One Killer in Libya

To The Editor: It is estimated that 1.26 million people worldwide died in 2000 from road traffic accidents, 90% of them in low and middle-income countries. In 2000, the road traffic injury mortality rate for the world was 20.8 per 100,000 populations (30.8 in males, 11.0 in females) [1].The Arab population constitutes 3.6% of the world’s population and it owns 1% of the world’s vehicles. Its human losses as a result of road traffic accidents (RTA) account for 4.8% of that of the world’s losses [2]. It is estimated that the annual cost of road crashes is about 1% of the Gross National Product (GNP) in developing countries, 1.5 in transitional countries and 2% in highly motorised countries [3].In Libya the situation is worse. It is a sad fact that road traffic accidents are the number one killer in Libya. As a matter of fact I consider it to be an ‘epidemic’ in all sectors of the Libyan society. There is not a day that goes by in Libya without us hearing about families, young men, women and children getting killed in horrific car accidents.It is alarming that young children are knocked down on a daily basis by speeding young drivers, whose understanding of driving skills may have been acquired from "playstation games"! (You can watch some of the shameful video clips sent by some of these drivers on this link http://www.youtube.com/watch?v=doWEDjiHlVo)I feel it is our responsibility as physicians observing the situation to raise awareness about the scale of the problem, possible causes, and how to tackle it. POSSIBLE CAUSES:• A driving licence in Libya is not issued on the basis of how much you know. Therefore the majority of drivers know little or nothing about the law.• Wearing seat belts is not compulsory in most parts of Libya. In some places, especially in the Eastern part of Libya, you could be penalised for wearing one. I was stopped many years ago by the traffic police in the Eastern part of Libya because I was wearing sunglasses and a seatbelt. I had to apologize profusely to the young traffic policeman and explain that I was wearing sunglasses because I was driving facing the sun! The reason for wearing the seatbelt was a habit from living abroad for many years and I was not a "show off" as he put it! This incidence made me wonder how much the traffic police knew about the law?• In Libya the way we behave in the street, the way we drive and our attitude towards pedestrians is not taught in schools at an early age. As a matter of fact, many drivers think it is "cool" to scare pedestrians.• Most of the accidents in Libya occur at school times but unfortunately no measures are taken by the traffic police to help young children to cross roads safely.• Most of the road traffic accidents happen at the same areas but these are never identified as "black spots" to warn drivers of the possible dangers.• Although Zebra Crossings exist in some parts of Libya, they actually do not serve the purpose. We just need to count how many pedestrians (especially foreign visitors) have been knocked down at Zebra Crossings.• There is a need for new road signs, clear road markings (lanes), and new traffic lights to replace old and often non-functioning ones.• One study demonstrated that speeding was responsible for about 70% of accidents [4]. There are no speed cameras or road humps to slow down speeding cars, therefore residents who have lost children to road traffic accidents resort to building their own version of street humps made from old pipes, thick ropes or cement.• Most of the main roads are full of holes and in desperate need of maintenance.• Car seats for children are not compulsory.• When accidents happen in Libya, what number do we dial? Do emergency services exist?• It is a known fact that most of the deaths and permanent disabilities in road traffic accidents are caused by people trying to help due to the lack of Advanced Trauma and Life Support (ATLS) trained personnel [5,6].• It is well documented that Advanced Trauma and Life Support (ATLS) and Advanced Life Support (ALS) courses improve survival [5].Unfortunately in Libya they are not compulsory for nurses or doctors. Some doctors and nurses working in the Emergency department are even unaware that these courses exist. Therefore, it is no surprise that the majority of car accident causalities dies or sustain permanent disabilities despite reaching the hospital in redeemable condition.WHAT CAN WE DO TO HELP?A. Ministry of Health:1. We must put pressure on the ministry of health and offer our services in running ATLS, ALS and Trauma courses to all medical personnel and paramedics. These courses should become a prerequisite for qualifying to work in the Medical field especially for those who directly deal with trauma patients.2. All hospitals dealing with trauma must have well trained and well equipped trauma and cardiac arrest teams whose ATLS/ ALS knowledge is revalidated periodically.3. Emphasise the importance of introducing the Bleep/Page System.4. Train paramedics and improve the Emergency Service [5,6].5. Emergency phone numbers should exist and should be made free of charge to dial.B. Ministry of Education:1. Educate children at an early age about behaviour in the street and dangers on the road.2. The schools should share the responsibilities with the traffic police in ensuring the safety of pupils.3. Supply posters and educate the public.4. The United Nations invited member states and the international community to recognize the third Sunday in November of every year as the World Day of Remembrance for Road Traffic Victims as the appropriate acknowledgement for victims of road traffic crashes and their families.I think a union should be formed in Libya, of people who have lost relatives to car accidents to campaign and educate drivers as per recommendation of the UN [7].C. Ministry of Transport:1. Re-validate the traffic police on their behaviour and knowledge of the law.2. Revise and re-enforce the traffic law with strict monitoring and speed cameras.3. Re-enforce Zebra Crossings with lights and give penalties to drivers who do not adhere.4. It is a well known fact that financial penalties are more effective than other forms of penalties on re-enforcing the law.5. Improve the conditions of the roads i.e. regular maintenance, road markings, road humps, traffic lights, road mirrors and road signs.6. Re-validate the driving licences with written and practical exams.7. Roadside assistance through a mobile workshop / emergency phones by the roadside.8. Only road-worthy vehicles should be allowed on the road through re-enforcement of a safety certification system for vehicles.9. Regulate the issue and distribution of driving licences and vehicle safety certification through the use of IT (Information Technology) systems.10. It is about time that a national policy for injury prevention and control in Libya should be formed thorough the coordination between different ministries, departments and the various agencies concerned.These are the suggestions and visions of one person but I am sure that many of you will share my views

Strengthening of reinforced concrete beams using carbon fibre reinforced plastic

Abstract unavailable please refer to PD

Cholecysto-colonic fistula; a rare case

A 72 year old female was referred by her general practitioner (GP) on the urgent two- week waiting list with a history of weight loss, diarrhoea and a mass on the right upper quadrant with a possible underlying malignancy. She had a recent history of jaundice of one month’s duration. She was otherwise fit and well. On examination, she was afebrile, icteric, abdomen was soft, non-tender with fullness and possible mass in the right upper quadrant

50% failure rate in final year medical exams; Whose fault is it?

To The Editor: Having read Dr Benamer’s views on medical teaching, we remembered our days as medical students [1]. We share Dr Benamer’s and other’s views that teaching in Libyan medical schools should shift from being subject focused to being learning focused [1,2].We remember one incident when our professor showed us an ECG and asked about the diagnosis. He was so furious when none of us was able to make the diagnosis to the extent that he left the lecture room without completing the teaching session. This is just one example among many that illustrates the lack of teaching skills so common in our medical institutions and the poor state of the Teacher-Student relationship.Therefore, it is not surprising that many students prefer not to attend lectures. In our view and from our experience, the formats of the lectures were organised around information designed for students to be memorised rather than learnt (spoon feeding) Which is one of the reasons why many students have found the teaching sessions simply boring and useless.In their attempts to overcome this problem, students tried to find ways to learn; acquiring knowledge through the organisation of discussion groups and seeking the help of senior students when necessary. These discussion groups mimic what has been recently introduced as Problem Based Learning (PBL) [3]. Even though these discussion groups may have lacked direction, they were perceived to be an important factor in the success of many students.Given the poor attendance rates to the lectures, the teachers failed to investigate the reasons behind this and take proactive steps to correct the problem. Because of the lack of teacher analysis and reflection it comes as no surprise that the format and quality of teaching has continued along the same traditional lines with the same problems being continually encountered.The point here is that many of these students went on to become highly successful physicians and surgeons in their working life amongst more modern teaching systems and approaches in the west. So it is logical to conclude that should the methods of teaching and teaching skills improve, the success rate among final year medical students will undoubtedly follow suit.It is our recommendation that in order to improve the success rate amongst students, a more modern way of teaching is urgently required [3]. Teachers first need to recognise that problems exist, and then act proactively to address them [4]. One way is the provision of ‘Train The Trainer’ and other similar courses to increase teaching skills, coupled with more discussion groups, clinical clerks, case presentations, increased student involvement during medical rounds and within lectures, and increased attendance at common procedures. All of the above will surely result in increasing the success rate beyond the current 50% passing rate for final year students

New pH correlations for stainless steel 316L, alumina, and copper(I) oxide nanofluids fabricated at controlled sonication temperatures

This research investigates the pH value of stainless steel (SS) 316L/ deionised water (DIW), alumina (Al2O3)/DIW, and copper (I) oxide (Cu2O)/DIW nanofluids prepared using a two-step controlled sonication temperature approach of 10°C to 60°C. The nanoparticles volumetric concentration of each family of as-prepared nanofluid ranged from 0.1 to 1.0 vol%, using as-received nanopowders, of 18 – 80 nm average particles size. Furthermore, the pH measuring apparatus and the measurement procedure were validated by determining the pH of commercially supplied calibration fluids, of pH 4, 7, and 10. Following the validation, pH correlations were obtained from the experimental measurements of the 0.1, 0.5, and 1.0 vol% nanofluids in terms of varied sonication bath temperatures and volumetric concentrations. Those correlations were then combined into one robust pHnf correlation and validated using the pH data of the 0.3 and 0.7 vol% nanofluids. The new proposed correlation was found to have a 2.18%, 0.92%, and 0.63%, average deviation from the experimental pH measurements of SS 316L, Al2O3, and Cu2O nanofluids, respectively, with an overall prediction accuracy of ~ 92%

A review on nanofluids: Fabrication, stability, and thermophysical properties

Nanofluids have been receiving great attention in recent years due to their potential usage, not only as an enhanced thermophysical heat transfer fluid but also because of their great importance in applications such as drug delivery and oil recovery. Nevertheless, there are some challenges that need to be solved before nanofluids can become commercially acceptable. The main challenges of nanofluids are their stability and operational performance. Nanofluids stability is significantly important in order to maintain their thermophysical properties after fabrication for a long period of time. Therefore, enhancing nanofluids stability and understanding nanofluid behaviour are part of the chain needed to commercialise such type of advanced fluids. In this context, the aim of this article is to summarise the current progress on the study of nanofluids, such as the fabrication procedures, stability evaluation mechanism, stability enhancement procedures, nanofluids thermophysical properties, and current commercialisation challenges. Finally, the article identifies some possible opportunities for future research that can bridge the gap between in-lab research and commercialisation of nanofluids

Laparoscopic Repair of Penetrating Injury of the Diaphragm: an Experience from a District Hospital

In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients, all of whom were males 20-30 years of age, presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall, or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy, which resulted in identification and efficient treatment of eight patients with diaphragmatic injury, and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries

Determining ACE-2 Level and Some Relevant Biochemical Parameters and studying the effect of Gender in Iraqi Diabetic Patients with Glomeruli and Renal Tubules Fibrosis as Early Prediction Marker

مرض الكلى السكري هو مرض يصيب الكبيبات ويتداخل مع حاجز الترشيح الكبيبي ) (GFB والذي يعمل على تمكين الكلى من التنقية الانتقائية للماء والمذابات بالإضافة إلى الحد من حركة الجزيئات الكبيرة مثل الألبومين  . في البطانة الكبيبية ، والخلايا المسراق ، وخلايا القدم ، وحد الفرشاة للأنابيب القريبة ، يتم التعبير عن الإنزيم المحول للأنجيوتنسين 2 وأن الكلى تمثل المنطقة الأكثر تعبيرًا عن هذا الإنزيم. وبالتالي تهدف الدراسة الحالية إلى تقييم مستوى ACE-2 في هذه الحالة مقارنة بالحالة الصحية.اشتملت الدراسة على 120 ذكر وأنثى تتراوح أعمارهم بين (30-65) سنة. تم تقسيم تسعين مريضًا مصابًا بداء السكري من النوع 2 إلى ثلاث مجموعات على أساس معايير ACR تشمل البيلة الألبومينية الطبيعية والبيلة الألبومينية الدقيقة والبيلة الألبومينية الكبيرة (30 مريضًا لكل مجموعة) و 30 شخصًا يتمتعون بصحة جيدة كانوا بمثابة المجموعة الضابطة ، الذين زاروا مستشفى بغداد التعليمي / المدينة الطبية و مستشفى اليرموك التعليمي ، في الفترة ما بين ديسمبر 2021 ومايو 2022. تم تحديد مستويات ACE-2 باستخدام تقنية ELISA . اظهرت النتائج فروقات ذات دلالة ﺇ حصائية بين اعتلال االكلية السكري ومجموعة السيطرة في حالة الاناث .ولكن لاتوجد فروق ذات دلالة إحصائية في حالة الذكور تم الحصول على نتائج مماثلة في ايون البوتاسيوم كما أوضحت النتائج وجود فروق معنوية في أيون الصوديوم ، و ACR، و eGFR ، واليوريا ، و FBS ، والكرياتينين بين مجموعة اعتلال الكلية السكري والمجموعة الصحية. يمثل ACE-2 علامة جيدة للتنبؤ المبكر في حالة اعتلال الكلية السكري. عززت نتائج تحليل بيانات ROC أهمية ACE-2 في تشخيص حالة المرض المدروسة.                                                                Diabetic kidney disease is an illness of the glomerulus that interferes with the glomerular filtration barrier (GFB), which is worked to enable kidney to selective purification of water and solutes in addition to limiting the movement of large macromolecules such as albumin. In the glomerular endothelium, mesangial cells, foot cells, and the brush border of the proximal tubules, ACE-2 is expressed and that the kidneys represent the highest-expressing region of this enzyme. Thus, the current study aimed to evaluate ACE-2 level in this case compared to healthy condition. The study Conducted with 120 male and female ranging in age (30-65) years old. Ninety patients with type 2 diabetes subdivided into three groups on the basis of ACR criteria including normoalbuminuria, microalbuminuria, macroalbuminuria (30 patients for each group) and 30 healthy people served as the control group, all visited Baghdad Teaching Hospital / Medical City and Al-Yarmouk Teaching Hospital, at the period between December 2021 and May 2022.  ACE-2 levels were determined using the ELISA technique. Urea results showed significant differences between diabetic nephropathy in patient and control group in female cases but no significant differences in male patients with diabetic nephropathy and control group. Similar results were obtained in K ion. Also the results revealed significant differences in Na ion, ACR, eGFR, Urea, FBS, creatinine between diabetic nephropathy groups and healthy group.ACE-2 represents a good marker for early prediction in diabetic nephropathy case. ROC data analysis support the importance of ACE-2 in diagnosis of the studied disease case.