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The New World screwworm fly in Libya: a review of its introduction and eradication.

The New World screwworm fly, Cochliomyia hominivorax (Coquerel) (Diptera: Calliphoridae), became established in the Old World for the first time during 1988, in the Socialist People's Libyan Arab Jamahiriya. An obligate parasite of mammals in its larval stages, causing wound myiasis, it is one of the most serious insect pests of livestock in the Americas. To avert a major disaster for the livestock industry and wildlife of Africa and southern Europe, the Libyan Government and the Food and Agriculture Organization of the United Nations launched a massive screwworm eradication programme, based on the sterile insect technique, SIT. An initial containment operation involved veterinary teams working in the infested area (25,000 km2 around Tripoli), regularly inspecting livestock and, if necessary, treating them with insecticide. Quarantine stations were also set up, to prevent the movement of infested livestock out of the area. Sterile flies from the Mexican-American Commission for Eradication of Screwworms were first released in December 1990 at the rate of 3.5 million per week. This built up to 40 million per week by May 1991. The release of sterile flies was terminated on 17 October 1991, 6 months after the last detected case of screwworm myiasis in Libya. Intensive surveillance and quarantine activities will, however, continue through 1992. During 1992 the Libyan Government should be able to officially declare the New World screwworm eradicated from Libya, making it one of the most important success stories of pest control.

Animals↗

Incidence and prevalence of type 1 diabetes in children and adolescents in Benghazi, Libya.

The mean annual incidence rates of Type 1 diabetes mellitus in Arab children and adolescents in Benghazi, Libya were assessed as based on prospective registration of patients during the period 1981-1990. Results showed an annual incidence (per 100,000) of 7.0 (6.0-8.2) (males 6.3(5.0-7.9) females 7.8(6.3-9.7)) in 0-14 year olds and 8.8(7.8-10.0) (males 8.3(6.9-10.0), females 9.2(7.7-11.0)) in 0-19 year olds. There were no significant differences between males and females or between season of onset. The commonest age of onset was 15-19 years. Annual variations were significant in the 0-14 years age group (p < 0.001) and non-significant in the 0-19 years age group. In 1981 the age adjusted prevalence rates of Type 1 patients (per 100,000) were 23.5 (17.1-31.5) (males 21.2(13.1-32.3), females 25.9(16.8-38.3)) in 0-14 year olds and 36.2(29.1-45.1) (males 31.4(22.2-43.2), females 41.0(30.2-54.5)) in 0-19 year olds. In 1990 the prevalence rates had increased to 37.3(30.5-45.5) (males 40.7(30.8-53.3), females 33.8 (24.6-45.3)) in 0-14 year olds and 59.5(51.6-58.5) (males 60.3(49.3-73.6), females 58.6 (47.7-72.1)) in 0-19 year olds. Increase in prevalence rates was significant in both sexes and in both age groups (p < 0.001). Increase in prevalence rates in girls in 1981 and in boys in 1990 were not significant. It is concluded that Type 1 diabetes is a common chronic disease of children and adolescents in Benghazi, Libya.

Adolescent↗

Prevalence and pattern of renal disease in eastern Libya.

A prospective study was conducted to identify the pattern and aetiology of kidney disease in children living in eastern Libya. A total of 343 patients was studied, representing 3% of annual admissions to the children's hospital. The major renal diseases were post-streptococcal glomerulonephritis (in 116), acute renal failure (in 93), and idiopathic nephrotic syndrome (in 65). Less common diseases were tubular transport defect (in 3) and end-stage renal disease (in 3). The mortality rate (excluding neonates) was below 1%. The pattern of kidney disease referred to this hospital in Libya was different from that reported in other parts of Africa.

Acute Kidney Injury↗

Pseudotumour cerebri: incidence and pattern in North-Eastern Libya.

The present documentation of 23 female patients with pseudotumour cerebri seen in Benghazi, North-Eastern Libya, over a period of 2 years constituted 21 cases with idiopathic pseudotumour and 2 patients with associated endocrine diseases. The clinical, laboratory and CT scan findings indicated idiopathic hypoparathyroidism in 1 case. The association of pseudotumour and hypothyroidism in a 40-year-old woman is suggested to be more than coincidental. The patient group was significantly more obese. Moderate to severe visual loss occurred in 9 patients. The incidence and extent of visual impairment did not correlate with the duration of symptoms, degree of obesity, use of contraceptive pills, steroid treatment, the presence of systemic hypertension, menstrual irregularity or empty sella. The incidence of 1.7 per 100,000 for the total and 3.6 per 100,000 for the female population in Benghazi observed in the present study is believed to be more than the frequency (as assessed by the hospital incidence) reported from other regions. A high prevalence of obesity may partly explain the increased occurrence of pseudotumour cerebri in North-Eastern Libya.

Adult↗

Epidemiology and strain characteristics of Echinococcus granulosus in the Benghazi area of eastern Libya.

The incidence of surgically confirmed cystic echinococcosis in eastern Libya was estimated to be at least 4.2 cases/100,000, with significantly more female cases than male. The prevalences of infection with Echinococcus granulosus among 1087 sheep, 881 goats, 428 camels and 614 cattle from the same region, determined postmortem in abattoirs, were 20%, 3.4%, 13.6% and 11%, respectively. Infection in the livestock was age-dependent and, generally, the female animals were more often infected than the male. The measurements of rostellar hooks on protoscoleces collected from sheep and cattle were similar but significantly different from the corresponding measurements of parasites of human or camel origin. However, when a portion of the cytochrome c-oxidase subunit I (cox1) gene from each of 30 protoscolex samples from Libya (12 from cattle, three from humans, five from camels and 10 from sheep) was sequenced, the sequences were all found to be identical to that published for the common sheep strain of E. granulosus.

Adolescent↗

Serotypes, virulence factors, antibiotic sensitivity, beta-lactamase activity and plasmid analysis of Salmonella from children with diarrhea in Tripoli (Libya).

A total of 21 Salmonella strains isolated in Libya (16 from children with diarrhea and 5 from healthy controls) were serotyped and studied for their cell invasive ability, production of cytotoxin, antibiotic susceptibility, beta-lactamase activity and plasmid profiles. Eight different serotypes of Salmonella were identified: 6 S. saintpaul, 4 S. wien (1 from control), 2 S. newport, 2 S. muenchen (1 from control), 2 S. typhimurium (1 from control), 2 S. hadar (1 from control), 2 S. reading (1 from control), 1 S. kottbus. Twenty (95%) were positive in the invasiveness assay using HeLa cells, and all (100%) were negative for cytotoxin production in HT29 cells. More than 40% were resistant to ampicillin, cefalexin, cefamandole, cefoperazone, chloramphenicol, gentamicin, mezlocillin and trimethoprimsulphamethoxazole and 100% were susceptible to the new quinolones. Most (67%) of the strains harbored plasmids and 43% produced beta-lactamase. A strong association was observed between the presence of more than one plasmid, beta-lactamase activity, and multiple-resistance to antimicrobial agents and serotypes S. saintpaul and S. wien. Curing experiments with acridine orange showed that 2 plasmids (33 and 1.4 megadaltons) might be responsible for the resistance to chloramphenicol and gentamicin. The present study demonstrated that multiple-resistant salmonellae are widespread in Libya and the resistance is mainly plasmid mediated.

Anti-Bacterial Agents↗

Prevalence of diabetes mellitus and impaired glucose tolerance in Benghazi Libya.

OBJECTIVES: To assess, by a house to house study, the prevalence of diabetes, impaired glucose tolerance (IGT) and their associated risk factors in Benghazi, Libya using 75 gram oral glucose tolerance test (OGTT) and ADA 1997 and WHO 1998 diagnostic criteria. MATERIAL AND METHODS: A multistage cluster sampling was used to select the study population. A total of 314 men and 554 women underwent a standard 75 grams OGTT. The response rate was 77.7% for males and 89.2% for females. RESULTS: The overall prevalence of IGT was 8.5% (95% confidence interval (CI) 5.8 - 11.3) (men 8.6% 95% CI 7.7-9.6, women 8.5% 95% CI 5.0 -11.9), and that of diabetes was 14.1% (95% CI 10.9-17.1) (men 16.3% 95% CI 14.5-18.3 women 13.0% 95% CI 10.0 - 16.1). Diabetes was present in 19.4% (95% CI 15.4-20.5) (men 22.7% 95% CI 20.2-25.4, women 17.6% 95% CI 14.1-19.1) in 30-64 years age range. Prevalence of diabetes was slightly higher in urban than in rural areas (14.5% vs 13.5%). The prevalence of newly diagnosed diabetes in urban and rural areas were 3.6% and 7.3% respectively and that of known diabetes were 10.9% and 6.3% respectively. Associated risk factors with diabetes and IGT were age, family history of diabetes, hypertension, BMI, WHR and serum cholesterol. CONCLUSION: Diabetes is emerging as an important public health problem in Libya and should rank very high in the priority list of health planners.

Adult↗

Incidence of type 1 diabetes in children (0-14 years) in Benghazi Libya (1991-2000).

BACKGROUND: Incidence of Type 1 diabetes in 0-14 year olds in Benghazi (Libya) during the period 1981-1990 was 7.0/10 5. The aim of this study is to report the incidence of Type 1 diabetes in 0-14 year olds in Benghazi Libya during the period 1991-2000. METHODS: Incidence data are based on prospective registration of Type 1 diabetes new cases for the period 1991-2000 in Type 1 register. RESULTS: A total of 276 (males 117, females 159) Type 1 diabetes new cases 0-14 years of age were identified during the period 1.01.1991-31.12.2000. Completeness of ascertainment was 100%. The average annual incidence per year was 7.8/100,000 population (95% CI 6.91-8.78). The standardized incidence rate (World standard) was 8.3/100,000 (95% CI 7.36-9.35). There was excess risk for females (9.1 95% CI 7.77-10.65) versus males (6.6 95% CI 5.45-7.89) (p<0.001). No significant temporal trend was observed, yet there was an increase in incidence rate over that reported for the period 1981-1990 (7.8 vs 7.0). Seasonal variation in incidence was significant. CONCLUSION: It was concluded that the incidence of Type 1 diabetes in Benghazi is in the middle of the worldwide range close to the incidence in Mediterranean countries.

Adolescent↗

Enterotoxins and phage typing of Staphylococcus aureus isolated from clinical material and food in Libya.

Enterotoxin was detected in 22 (61.1%) of the 36 S. aureus strains isolated from clinical materials and in 3 (13%) of the 23 S. aureus strains from food samples (P < 0.05). On the basis of individual types of enterotoxin, staphylococcal enterotoxin A (SEA) was produced by 11.1%, SEB by 38.9% and SEC by 22.2% of SS. aureus strains from clinical material. Of the food S. aureus strains, SEC and SED produced by 8.7% and 4.3% respectively. Of the clinical and food S. aureus strains, 52.8% and 39.1%, respectively, were typeable by the 23 phages of International Phage Set. The majority of the typeable S. aureus strains from clinical and food sources belonged to group II being at 22.2% and 17.4% respectively. Furthermore, of the 14 SEB-producing S. aureus, 42.9% were of phage group II. In conclusion, the results obtained indicate that enterotoxin-producing S. aureus strains from clinical materials in Libya are not uncommon; however, certain foods appear not to be the source of such strains. Because of the low susceptibility to bacteriophages shown by S. aureus isolated in Libya, compared to reports from several countries, other methods of typing should be used in conjunction with phage typing in epidemiological investigations concerning this organism.

Antigens, Bacterial↗

Kidney transplantation in Libya: a North African and Middle Eastern perspective.

OBJECTIVES: In August 2004, a national organ transplant program utilizing the latest policies, procedures, and protocols was begun in Libya. During the first year of the program, 50 kidney transplantations from living donors were performed. MATERIALS AND METHODS: Forty-nine patients (aged 7 to 65 years) received kidneys from living-related donors (aged 19 to 54 years), and 1 husband received a kidney from his wife. Donor selection was based on human leukocyte antigen compatibility. Renal failure was due to chronic glomerulonephritis in most patients, diabetes in 5 adults, systemic lupus erythematosus in 2 adults, and congenital anomalies in 2 children. Sixteen patients matched the human leukocyte antigens of their donors, 28 matched 1 haplotype, and 6 did not match any haplotype. Immunosuppression was accomplished with methylprednisolone and basiliximab. Maintenance therapy was with mycophenolate mofetil, cyclosporine, and prednisone. The latter was completely discontinued 1 month after transplantation. In patients with resistant hypertension, unilateral native nephrectomy was carried out during transplantation. Donor nephrectomy was performed through an open mini-incision using a Thompson retractor. RESULTS: At the time of this writing, 49 patients are alive and well, and 48 of them have had functioning kidneys for 10 to 22 months. Three patients had acute rejections that were successfully treated with methylprednisolone (n=1) or methylprednisolone and antithymocyte globulin (n=2). At the time of this writing, all 46 adults and 2 pediatric recipients have excellent renal function and are living normal lives. CONCLUSIONS: In terms of patient survival and quality of life, transplantation is superior to dialysis. Also, transplantation is less expensive than dialysis. In Libya, establishing an active and successful transplant program with early steroid withdrawal has brought many benefits to patients and their families and great financial savings to the government. Our program hopefully will provide a model for similar programs in Asia and Africa and encourage local governments to legalize organ procurement from cadaveric donors.

Adolescent↗

Haemoglobinopathies in Libya.

Electrophoretic study of haemolysates from five hundred and forty-five subjects from the University of Garyounis, Benghazi, was carried out to find out the incidence of abnormal haemoglobins in Libya. Abnormal haemoglobins were encountered in 23 subjects of unrelated families, giving an overall incidence of 4.2 per cent. Sixteen of these subjects had Hb-AS trait (3.0%), Five subjects had Hb-AC trait (0.9%) and two subjects had Hb-AD trait (0.36%). Present study indicates that the incidence of abnormal haemoglobins in the indigenous population of Libya is low.

Anemia, Sickle Cell↗

Visceral leishmaniasis: new foci of infection in Libya.

Although cases of visceral leishmaniasis in Libya have been reported for over 80 years, all these reports were from the northern coastal areas near Tripoli and the Green Mountain area. Since 1985, there have been new cases of the disease from the southern part of Libya in the Saharan and sub-Saharan areas, an area 250 km to the south-west of Sabha. This southern area has recently undergone much agricultural organization with increasing water supply and other environmental changes, which may be partially responsible for the establishment of these new foci. Twenty patients with hepatosplenomegaly and fever were referred from that area to the El-Fateh Children's Hospital in Benghazi for investigation. All had the clinical features and laboratory data indicative of the Mediterranean type of the disease. All were treated with sodium stibogluconate (10 mg kg-1 day-1), and responded well to this regime.

Anti-Bacterial Agents↗

Primary bone tumour in eastern Libya--a 10 year study.

In this study the frequency of primary bone tumours in the eastern part of Libya during a period of 10 years (1981 to 1990) is analysed. During this period 165 histologically proved primary bone tumours were seen. Out of these 165 tumours 40 were malignant and 125 were benign. Males were more frequently affected by the primary bone tumours. The second decade was the most common age of incidence for both benign and malignant tumours. The femur was the most common site. Comparison with similar studies from selected parts of the world indicated that the frequency of primary malignant bone tumours in Eastern Libya appears to be low.

Adolescent↗

Incidence of insulin-dependent diabetes mellitus in Benghazi, Libya (1991-1995).

This report concerns the incidence rate of insulin-dependent diabetes mellitus (IDDM) in the 0-14 year age group in Benghazi, Libya. Incidence data are based on prospective registration of patients as part of the WHO Diamond Project from 1991 to 1995. A total of 126 IDDM incident cases (73 girls, 53 boys) were identified during this 5-year period. All patients were Libyan Arab Benghazi residents. Case ascertainment was 100%. The overall yearly incidence was 8.1 cases/100,000 population (95%, CI 6.8-9.7). Incidence was slightly higher in girls (9.5, CI 7.5-12.0) than in boys (6.7, CI 5.1-8.8). Incidence rates increased steadily with age in both sexes and were slightly higher than those reported for Benghazi during the period 1981 to 1990 (girls 7.8, boys 6.3, both sexes 7.0). Annual variation of incidence was not significant, whereas seasonality of onset was significant (P < 0.05). The study shows that IDDM is as frequent in Libya as in other Mediterranean countries.

Adolescent↗

Fungal flora and aflatoxin contamination of feedstuff samples in Beida Governorate, Libya.

Fungi of 19 genera, 30 species, and one variety were isolated from 25 samples of sheep-, cattle- and camel feedstuffs collected from different farms in the Beida Governorate, Libya. Aspergillus, Penicillium and Fusarium were the most common genera in the three substrates tested. TLC was used to establish the identity of aflatoxins in the chloroform extract of all samples and the ability to produce aflatoxins by Aspergillus flavus in a synthetic liquid medium. Twenty samples out of 25 tested were naturally contaminated and 21 isolates of A. flavus out of 30 produced at least one of the following aflatoxins: B1; B1, G1; and B1, B2, G1, G2. This is the first report about the natural occurrence of aflatoxins and aflatoxins and aflatoxin-producers of the genus Aspergillus in Libya.

Animal Feed↗

Biochemical profiles of hydatid cyst fluids of Echinococcus granulosus of human and animal origin in Libya.

A comparative study on the biochemical parameters in hydatid cyst fluids of sheep, goats, camels, cattle and human cystic forms of Echinococcus granulosus has been made in Libya. Quantitative variations in the levels of sodium, potassium, calcium, cholesterol, glucose, urea, creatinine and gamma glutamyl transpeptidase (gamma GT) were found in the cystic fluids of different host origins although these differences were statistically insignificant compared with the hydatid fluids of sheep. However, the concentration of triglycerides and proteins were significantly elevated in the cyst fluids of sheep compared with the other fluids studied. Similarities in the biochemical composition of different hydatid cyst fluids suggest the existence of sheep strains of E. granulosus in human and other domestic animal intermediate hosts in Libya.

Animals↗

Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya.

A cluster of HIV-1 infection has been identified in Libya in 1999, involving 402 children admitted to "El-Fath" Children's Hospital in Benghazi (BCH) during 1998 and 19 of their mothers. Nosocomial transmission has been indicated as responsible for the spread of infection. Out of this group, 104 children and 19 adult women have been followed at the National Institute for Infectious Diseases L. Spallanzani in Rome during 1 year. At BCH, all children had received intravenous infusions but not blood or blood products. A single child receiving a blood transfusion in 1997 and the 17 infected mothers were never hospitalized in Benghazi. In addition, two nurses were diagnosed as HIV-1 infected. In 40 subjects out of this group HIV-1 gag, env, and pol fragments were amplified and sequenced. The phylogenetic analyses showed that a monophyletic recombinant HIV-1 form CRF02-AG was infecting all of the HIV-1-seropositive patients admitted at BCH with no close similarities to the other CRF02-AG reported to GenBank. A different strain was found in the child infected by blood transfusion. The data thus suggest a highly contagious nosocomial spread of HIV-1 infection and possibly transmission of the virus from child to mother during breastfeeding in connection with primary HIV-1 infection.

Adolescent↗

Nonalimentary tooth use in prehistory: an example from early Holocene in Central Sahara (Uan Muhuggiag, Tadrart Acacus, Libya).

Signs of nonalimentary tooth use were observed on the dentition of an adult male from a single burial excavated in an area close to the Uan Muhuggiag rock shelter (Tadrart Acacus, Libya), dated to more than 7800 uncalibrated years BP, that represents the most ancient human remain found in the Libyan Sahara, and provides a first glimpse of human adaptation in the early Holocene of this region. The wear pattern shows large grooves running across the occlusal surfaces of maxillary and mandibular anterior teeth and premolars. The results of macroscopic and microscopic observation, together with scanning electron microscope (SEM) examination and experimental tests, suggest that the microdamage might be due to repeated friction of vegetal fibers, probably as a consequence of basket making, net production, or mat processing. Further data are needed to allow us to distinguish among plant-oriented activities related to food acquisition (e.g., rope and net processing), food storage (e.g., basket making), or domestic handicraft (e.g., mat processing), whose implications may generate different interpretations of sexual division of labor.

Anthropology, Physical↗