A Study of Risk Factors for Breast Cancer in a Primary Oncology Clinic in Benghazi-Libya

Introduction: Libya is a North African country classified under the Eastern Mediterranean Regional Office. In response to the general paucity of literature regarding cancer in Libya, this study aims to analyze various risk factors for breast cancer among patients in Benghazi, Libya. Material and Methods: Using records from a major primary oncology clinic, data was gathered from breast cancer patients. A total of 301 patients were diagnosed with breast cancer in the study period. For the purpose of risk factor determination, this hospital-based case control study consisted of 212 recently diagnosed cases of breast cancer attending the oncology clinic at Al-Jamhouria hospital in Benghazi. Age matched controls (n=219) were randomly enrolled from other medical departments of Al-Jamhouria hospital and the general population visiting the hospital. Chi square was used to assess significance of the risk factors and the corresponding odds ratio (O.R.) and 95% CI were calculated to assess the magnitude of associations. Results: A total of 1478 cases presented to the gynecological oncology clinic at Al-Jamhouria hospital during the period of 2007-2008. Of these cases, around 20% (n=301) were breast cancer patients. The average age of presentation was 49 years + S.D 13 years, with most of the cases (61%, n=184) being premenopausal. Over 90% (n=273) of breast cancer patients are diagnosed at stage II or later. More than 16% of cases seek medical attention when the malignancy has already reached stage IV. Diabetes, hypertension and family history of other malignancies were found to significantly increase the risk of developing breast cancer. Discussions: A range of socioeconomic risk factors were also analyzed (i.e. parity, breastfeeding etc...) and some were found to be protective. Libyan breast cancer cases are slightly older compared to the rest of the Arab world, but are younger than their counterparts in the West. The major issue in the Libyan scenario is delayed presentation which significantly worsens the prognosis. Hence, all the recommendations focus on increased awareness, the implementation of a national cancer control plan and a national screening program and training healthcare professions in palliative care

Artificial Intelligence-based Quantification of Pleural Plaque Volume and Association with Lung Function in Asbestos-exposed Patients

Purpose: Pleural plaques (PPs) are morphologic manifestations of long-term asbestos exposure. The relationship between PP and lung function is not well understood, whereas the time-consuming nature of PP delineation to obtain volume impedes research. To automate the laborious task of delineation, we aimed to develop automatic artificial intelligence (AI)-driven segmentation of PP. Moreover, we aimed to explore the relationship between pleural plaque volume (PPV) and pulmonary function tests.Materials and Methods: Radiologists manually delineated PPs retrospectively in computed tomography (CT) images of patients with occupational exposure to asbestos (May 2014 to November 2019). We trained an AI model with a no-new-UNet architecture. The Dice Similarity Coefficient quantified the overlap between AI and radiologists. The Spearman correlation coefficient (r) was used for the correlation between PPV and pulmonary function test metrics. When recorded, these were vital capacity (VC), forced vital capacity (FVC), and diffusing capacity for carbon monoxide (DLCO).Results: We trained the AI system on 422 CT scans in 5 folds, each time with a different fold (n = 84 to 85) as a test set. On these independent test sets combined, the correlation between the predicted volumes and the ground truth was r = 0.90, and the median overlap was 0.71 Dice Similarity Coefficient. We found weak to moderate correlations with PPV for VC (n = 80, r = -0.40) and FVC (n = 82, r = -0.38), but no correlation for DLCO (n = 84, r = -0.09). When the cohort was split on the median PPV, we observed statistically significantly lower VC (P = 0.001) and FVC (P = 0.04) values for the higher PPV patients, but not for DLCO (P = 0.19).Conclusion: We successfully developed an AI algorithm to automatically segment PP in CT images to enable fast volume extraction. Moreover, we have observed that PPV is associated with loss in VC and FVC.</p

A study of a decade of road traffic accidents in Benghazi-Libya: 2001 to 2010.

This paper aims to observe and to study the trends of road traffic accidents (RTA's) for the past ten years in Benghazi-Libya. A retrospective analysis was done using the patient records of Al-Jalaa hospital (the main trauma center in Benghazi) from over 21,753 RTA cases. The annual data were compared to each other and changes of trends were observed. RTA's represented an increasing percentage of Al-Jalaa's case load across the years. Around 41% of these cases needed to undergo surgery. The younger age group (20-29 years of age) formed the majority of cases while there was a trend towards an increasing average age of patients involved in an accident. Male patients were found to be younger than their female counterparts. Males comprised 81.5% while females formed 18.5% of RTA patients. In terms of inpatient duration, most patients stayed in the hospital for less than 1 week. Vehicle occupants (drivers and passengers) were admitted more often than pedestrians. There was a trend across the years towards an increased involvement of vehicle occupants and decrease in the proportion of pedestrians that had to be hospitalized. Additionally, there was a decrease in the fatalities of pedestrians. Overall, most RTA patients were discharged and made to follow-up in outpatient clinics however there was a startling trend towards increased LAMA and absconded patients. There were both encouraging findings as well as points that needed further emphasis and action. Public education, life support training and diversification of transport (apart from the use of the roads) should be looked into, as possible means of improving the current situation

Radiomics: a critical step towards integrated healthcare

Abstract Medical imaging is a vital part of the clinical decision-making process, especially in an oncological setting. Radiology has experienced a great wave of change, and the advent of quantitative imaging has provided a unique opportunity to analyse patient images objectively. Leveraging radiomics and deep learning, there is increased potential for synergy between physicians and computer networks—via computer-aided diagnosis (CAD), computer-aided prediction of response (CARP), and computer-aided biological profiling (CABP). The ongoing digitalization of other specialties further opens the door for even greater multidisciplinary integration. We envision the development of an integrated system composed of an aggregation of sub-systems interoperating with the aim of achieving an overarching functionality (in this case‚ better CAD, CARP, and CABP). This will require close multidisciplinary cooperation among the clinicians, biomedical scientists, and (bio)engineers as well as an administrative framework where the departments will operate not in isolation but in successful harmony. Key Points • The advent of quantitative imaging provides a unique opportunity to analyse patient images objectively. • Radiomics and deep learning allow for a more detailed overview of the tumour (i.e., CAD, CARP, and CABP) from many different perspectives. • As it currently stands, different medical disciplines have developed different stratification methods, primarily based on their own field—often to the exclusion of other departments. • The digitalization of other specialties further opens the door for multidisciplinary integration. • The long-term vision for precision medicine should focus on the development of integration strategies, wherein data derived from the patients themselves (via multiple disciplines) can be used to guide clinical decisions

Impact of the 2011 Libyan conflict on road traffic injuries in Benghazi, Libya

Background: Road traffic injuries (RTIs) are a major public health concern in Libya. In the light of the armed conflict in Libya that broke out on February 2011 and the subsequent instability, the rate and pattern of RTIs was studied. Methods: RTI patient data were gathered from Al-Jalaa hospital, the main trauma center in Benghazi, from 2010 to 2011. Various parameters [i.e. age, gender, nationality, method of entry, receiving department, intensive care unit (ICU) admission, duration of stay, method of discharge, and fatalities] were compared with data from the previous year (2010), and statistical analyses were performed (t-test, chi-square, and Poisson regression). Results: During the conflict period, 15.8% (n=2,221) of hospital admissions were RTIs, that is, a rate of 6.08 RTI cases per day, levels not seen for 5 years (t=−5.719, p<0.001). The presence of armed conflict was found to have caused a significant 28% decrease in the trend of RTIs over the previous 10 years (B=−0.327, CI=−0.38–−0.28, p<0.001). February and March, the peak period of active combat in Benghazi, witnessed the lowest number of RTIs during the conflict period. The average age of an RTI decreased to 28.35±16.3 years (t=−7.257, p<0.001) with significantly more males (84.1%, n=1,755) being affected (χ2=4.595, p=0.032, df=1). There was an increase in the proportion of younger aged patients (from 0 to 29 years) (χ2=29.874, p<0.001, df=8). More patients required admission to the ICU (χ2=36.808, p<0.001, df=8), and the mortality of an RTI increased to 5.2% (n=116) (χ2=48.882, p<0.001, df=6). Conclusion: There were fewer RTIs during the conflict period; however, those that occurred had higher morbidity and mortality. The profile of an RTI victims also changed to an increased prominence of young males and motorcyclists. Further research is required to propose and analyze possible interventions

Display of the total number of cases per year/day as well as the contribution of road traffic accidents to the total admissions at Al-Jalaa hospital.

<p>Display of the total number of cases per year/day as well as the contribution of road traffic accidents to the total admissions at Al-Jalaa hospital.</p

Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty

Background: Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA. Methodology: Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI. Results: A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI. Conclusion: Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI