Field Evaluation of Outdoor Ultra-Low Volume (ULV) Applications against Phlebotomine Sand Flies (Diptera: Psychodidae) in Al Rabta, North-West of Libya

BACKGROUND

Al Rabta is a rural area in the North-West of Libya that represents an important focus of zoonotic cutaneous leishmaniasis. This study aimed to evaluate the effect of Ultra Low Volume (ULV) applications in controlling sand flies and its impact on leishmaniasis transmission in this area.

METHODS

Two neighboring villages were selected: Al Rabta West (RW) as cypermethrin treated village and Al Rabta East (RE) as check one. The ULV was evaluated through 3 spraying cycles during Apr, Jun and Sep 2013. In the two villages, a number of outdoor sites were selected for sampling of sand flies (twice a month) using the CDC light traps. The cases of CL reported in the two villages during the study period were obtained from Al Rabta health center.

RESULTS

The two villages were similar where 9 species of sand flies (6 of Phlebotomu and 3 of Sergentomyia) were collected of which S. minuta and P. papatasi were the abundant species. As compared to the pre- ULV spraying, during the post- spraying periods: i) the reduction in abundance of the different species ranged from 20.85 to 77.52% with 46.69% as an overall reduction for all species altogether and, ii) in significantly (P> 0.05) higher mean ratio of males: females for all species altogether (1:2.41). Moreover, ULV spraying resulted in the absence of CL (Leishmania major) cases (Passive Case Detection).

CONCLUSION

The efficiency of ULV spraying in reducing sand fly population, CL cases and consequently limits the disease transmission.

The purpose of United Nations Security Council practice: Contesting competence claims in the normative context created by the Responsibility to Protect

Practice theory provides important insights into the workings of the Security Council. The contribution is currently limited, however, by the conjecture that practice theory operates on 'a different analytical plane' to norm/normative theory. Building on existing critiques, we argue that analysing practices separately from normative positions risks misappropriating competence and reifying practice that is not fit for purpose. This risk is realized in Adler-Nissen and Pouliot's practice-based account of the Libya crisis. By returning the normative context created by the Responsibility to Protect to the analytical foreground, and by drawing on a pragmatic conception of 'ethical competence', we find that pre-reflexive practices uncritically accepted as markers of competence - for example, 'penholding' - can contribute to the Council's failure to act collectively in the face of mass atrocity. Drawing on extensive interview material, we offer an alternative account of the Libya intervention, finding that the practices of the permanent three (France, the UK and the US) did not cultivate the kind of collective consciousness that is required to implement the Responsibility to Protect. This is further illustrated by an account of the Security Council's failure in Syria, where the permanent three's insistence on regime change instrumentalized the Council at the expense of Responsibility to Protect-appropriate practice. This changed when elected members became 'penholders'. Practice theory can facilitate learning processes that help the Council meet its responsibilities, but only through an approach that combines its insights with those of norm/normative theory.

Deduced probable human leukocyte antigen haplotypes associated with human leukocyte antigen DRB1*04:36 identified by case analysis of Taiwanese individuals

Objective:

Human leukocyte antigen (HLA) DRB1*04:36 is a low-frequency HLA-DRB1 allele. The aim here is to report the ethnicity of DRB1*04:36 and its associated HLA haplotypes among Taiwanese individuals.

Materials and Methods:

A sequence-based typing method was employed to confirm this low incidence allele. Polymerase chain reaction was performed to amplify exons 2 and 3 of the HLA-A and HLA-B loci and exon 2 of the HLA-DRB1 locus using group-specific primer sets. The amplicons were sequenced in both directions using BigDye Terminator Cycle Sequencing Ready Reaction kits and the manufacturer's protocols. One group of unrelated blood donors used in this study consists of randomized individuals with Taiwanese ethnicity who participate in the Tzu Chi Bone Marrow Donor Registry and the other group are randomized unrelated individuals from mainland China. The family members in the family part of the study are volunteer blood donors.

Results:

In exon 2, the DNA sequence of DRB1*04:36 is identical to DRB1*04:03:01 except for a nucleotide segment from residue 286 to residue 308. The nucleotide segment from residue 286 to residue 308, incidentally, is identical to that of DRB1*11:01:01:01. These observations suggest that DRB1*04:36 may have been derived through a gene recombination event involving DRB1*04:03:01 and DRB1*11:01:01:01. Our family study indicated that the HLA haplotype in association with DRB1*04:36 can be deduced to be A*24:02-B*39:01-DRB1*04:36. A randomized population study using Taiwanese suggests that additional DRB1*04:36 associated HLA haplotypes seem to exist.

Conclusion:

The information on the ethnicity of the DRB1**04:36 allele, and the deduced probable HLA haplotypes associated with the low incidence DRB1*04:36 allele that we report here, is of value to HLA testing laboratories for reference purposes. In addition, they can be used by stem cell transplantation donor search coordinators to aid the creation of strategy for finding compatible donors who are part of unrelated bone marrow donor registries when a patient carries this uncommon HLA allele.

Spa typing and identification of pvl genes of meticillin-resistant Staphylococcus aureus isolated from a Libyan hospital in Tripoli

OBJECTIVES

The purpose of the study was to investigate the molecular characteristics of meticillin-resistant Staphylococcus aureus (MRSA) isolated from clinical sources in Tripoli, Libya.

METHODS

A total of 95 MRSA strains collected at the Tripoli medical Centre were investigated by spa typing and identification of the Panton-Valentine Leukocidin (pvl) genes.

RESULTS

A total of 26 spa types were characterized and distributed among nine clonal complexes; CC5 (n=32), CC80 (n=18), CC8 (n=17) and CC22 (n=12) were the most prevalent clonal complexes. In total, 34% of the isolates were positive for PVL.

CONCLUSIONS

This study demonstrated the presence of CA-MRSA and pvl positive strains in hospital settings and underlines the importance of using molecular typing to investigate the epidemiology of MRSA. Preventative measures and surveillance systems are needed to control and minimize the spread of MRSA in the Libyan health care system.

Clonal spread of methicillin-resistant Staphylococcus aureus-t6065-CC5-SCCmecV-agrII in a Libyan hospital

OBJECTIVES

The aim of this study was to characterize 32 MRSA isolates recovered from wound specimens of patients in a Hospital in Tripoli, Libya, during 2013.

METHODS

MRSA isolates were characterized by determining their antibiotic susceptibilities, genes encoding antibiotic resistance and virulence factors, the SCCmec class, agr type, spa typing, PFGE and MLST.

RESULTS

PFGE and MLST revealed that all isolates were clonal and belonged to the Clonal Complex 5 (CC5). They harboured the SCCmecV and the agrII and the spa type was t6065. The majority of isolates were resistant to cefoxitin (32, 100%), penicillin (32, 100%), ampicillin (32, 100%), enrofloxacin (32, 100%), ciprofloxacin (32, 100%), fusidic acid (32, 100%), gentamicin (32, 100%), kanamycin (32, 100%), trimethoprim (32, 100%), and erythromycin (30, 93.7%). The main genes encoding antibiotic resistance were: blaZ (31, 96.8%), ermC (30, 93.7%), aph(3')-III a (3, 9.4%), aac6-aph2 (32, 100%), InuA (3, 9.4%), tetM (3, 9.4%), tetL (3, 9.4%), dfrG (28, 87.5%), fusC (32, 100%). All isolates were PVL negative; however, exfoliative-encoding genes (eta: 25) and enterotxin genes (seb: 32, seo: 32, sei: 32, ser: 32, seu: 32, seg: 32, sej: 32, sed: 31, sen: 29, seh: 26, sec: 26, sea: 6, sek: 5), haemolysin (hla (32), hld (32), hlg (32)) and immune evasion cluster proteins (scn: 32, sak: 32) were relevant.

CONCLUSION

To the best of our knowledge this is the first report of a specific clonal spread of a multi-drug resistant MRSA-CC5- SCCmecV in a Libyan Hospital.

Sero-prevalence and epidemiology of peste des petits ruminants in Libya

We conducted a cross-sectional study during 2013 to quantify the serological prevalence of peste des petits ruminants (PPR) infection and to investigate host factors associated with PPR infection in small ruminants in Libya. A two-stage sampling design was carried out. A total number of 148 flocks owning at least 100 heads each were randomly selected. Sixteen to forty-eight samples were collected from each selected flock. A total number of 3,508 serum samples from unvaccinated animals were collected and analysed at IZSLER Brescia, Italy, by using competitive ELISA, IDvet innovative diagnostics (IDvet 310, France). The overall serological prevalence among SR was 33% (95% CI: 31.4-34.5). Significant differences between the prevalence in the geographical branches were observed. The lowest prevalence level was observed in Zawiyah branch (16.1%), whereas the highest value was obtained for the Sabha branch (56.8%). Considering the age, a serological prevalence of 24.7%, 31.5% and 42.1% was observed in SR <1 year, between 1 and 2 years and more than 2 years, respectively. Statistically significant differences (p < .001) in the sero-prevalence levels were also observed between the age groups. Our findings suggest that the southern part of Libya could be more exposed to the infections coming from the neighbouring countries and this should be better investigated to correctly identify wherever specific entry points can be considered at higher risk than others. The results also confirmed the endemic status of PPR in Libya, with a constant exposure to the infection of the animals during their life. In the framework of the global strategy for control and eradication of PPR, our results, even if obtained by a preliminary study, can contribute to the assessment of the epidemiological situation of PPR in Libya as required by the Stage 1 of the plan.

Detection of CTX-M-15 Among Uropathogenic Escherichia coli Isolated from Five Major Hospitals in Tripoli, Libya

OBJECTIVES

Multidrug resistance (MDR) and emergence of extended-spectrum β-lactamases (ESBLs) among uropathogenic Escherichia coli have been reported worldwide, but there was no information on the detection of bla_CTX-M-15 in major teaching hospitals in Libya. The aim of the study was to investigate the occurrence of CTX-M-15 β-lactamases producers isolated from five teaching hospitals in Tripoli, Libya.

METHODS

A total of 346 urine samples were collected from hospitalized patients in five teaching hospitals with a diagnosis of urinary tract infection (UTI). Phenotypic confirmation of ESBLs was confirmed by E-test strip; all ESBL-producing E. coli isolates were screened for the bla_CTX-M-15 gene.

RESULTS

The distribution of ESBL-producing E. coli varied among the five hospitals. The highest proportion was identified in Tripoli Medical Centre (67.6%). There were extremely high proportions of isolates resistant to ceftriaxone, cefepime, and ceftazidime (93.0-100.0%) among ESBL producers compared to non-ESBL producers (2.2-4.7%). MDR was detected in 22.2% of isolates. The majority of isolates (85.9%) in which bla_CTX-M-15 was identified were ESBL producers. There was a correlation (p < 0.001) between expression of CTX-M-15 and resistance to ceftazidime.

CONCLUSIONS

The isolation of MDR ESBL-producing uropathogens expressing the CTX-M-15 gene will limit the choices clinicians have to treat their patients with UTIs. Continued surveillance and implementation of efficient infection control measures are required.

Disease Mapping for Stomach Cancer in Libya Based on Besag– York– Mollié (BYM) Model

Globally, Cancer is the ever-increasing health problem and most common cause of medical deaths. In Libya, it is an important health concern, especially in the setting of an aging population and limited healthcare facilities. Therefore, the goal of this research is to map of the county’ cancer incidence rate using the Bayesian method and identify the high-risk regions (for the first time in a decade). In the field of disease mapping, very little has been done to address the issue of analyzing sparse cancer diseases in Libya. Standardized Morbidity Ratio or SMR is known as a traditional approach to measure the relative risk of the disease, which is the ratio of observed and expected number of accounts in a region that has the greatest uncertainty if the disease is rare or small geographical region. Therefore, to solve some of SMR’s problems, we used statistical smoothing or Bayesian models to estimate the relative risk for stomach cancer incidence in Libya in 2007 based on the BYM model. This research begins with a short offer of the SMR and Bayesian model with BYM model, which we applied to stomach cancer incidence in Libya. We compared all of the results using maps and tables. We found that BYM model is potentially beneficial, because it gives better relative risk estimates compared to SMR method. As well as, it has can overcome the classical method problem when there is no observed stomach cancer in a region.

First report of two cases of cryptococcosis in Tripoli, Libya, infected with Cryptococcus neoformans isolates present in the urban area

Cryptococcosis is a potentially fatal fungal disease caused by the basidiomycetes yeasts Cryptococcus neoformans and C. gattii with high predilection to invade the central nervous system mainly in immunocompromised hosts. Skin can be secondarily involved in disseminated infection or be exceptionally involved as primary cutaneous infection by inoculation with contaminated materials. We report the first two Libyan cases of cryptococcal meningitis in HIV patients, in which one of them presented a secondary cutaneous involvement due to systemic dissemination. The first patient was a 17-year-old female, had fever, cough, headache and intractable vomiting as well as itchy water bumps on her skin and upper limbs. The cutaneous eruption prompted the accurate diagnosis. Cultures were positive for C. neoformans in both cerebrospinal fluid and skin specimens, as well as cryptococcal antigen was detected in serum. The isolate was identified, by molecular analysis, as C. neoformans AD-hybrid belonging to molecular type VNIII and mating type αAAα, the same genotype found for some environmental isolates recovered from olive trees in Tripoli. The second patient was a 36-years-old male with a long history of HIV on irregular treatment. Cryptococcal antigen in serum was positive and cultures yielded the growth of C. neoformans var. grubii, molecular type VNI and mating type αA. Both patients did not respond adequately to treatment and died of impaired central nervous system function and respiratory failure, respectively.

Molecular and epidemiological characterization of HIV-1 subtypes among Libyan patients

Background

The epidemiological and clinical aspects of human immunodeficiency virus subtypes are of great interest worldwide. These subtypes are rarely studied in North African countries. Libya is a large country with the longest coast on the Mediterranean Sea, facing the Southern European countries. Studies on the characterization of HIV-1 subtypes are limited in Libya. This study aimed to determine the magnitude of the HIV problem among the Libyan population and to better understand the genetic diversity and the epidemiologic dynamics of HIV 1, as well as to correlate that with the risk factors involved.

Methods

A total of 159 HIV-1 strains were collected from 814 HIV positive patients from the four Libyan regions during a 16-year period (1995–2010). To determine the HIV-1 subtypes, genetic analysis and molecular sequencing were carried out using provirus polygene. Epidemiologic and demographic information was obtained from each participant and correlated with HIV-1 subtypes using logistic regression.

Results

The overall prevalence of HIV among Libyans ranged from 5 to 10 per 100,000 during the study period. It was higher among intravenous drug users (IVDUs) (53.9%), blood recipients (25.9%) and heterosexuals (17.6%) than by vertical transmission (2.6%). Prevalence was higher among males aged 20–40 years (M:F 1:6, P > 0.001). Among the 159 strains of HIV-1 available for typing, 117 strains (73.6%) were subtype B, 29 (18.2%) were CRF02_AG, and 13 (8.2%) were subtype A. HIV-1 subtype B was the most prevalent all over the country, and it was more prevalent in the Northern region, particularly among IVDUs (P < 0.001). GRF02_AG was common in the Eastern region, particularly among blood recipients while subtype A emerged in the Western region, particularly among IVDUs.

Conclusions

HIV-1 infection is emerging in Libya with a shifting prevalence of subtypes associated with the changing epidemiology of HIV-1 among risk groups. A genetic analysis of HIV-1 strains demonstrated low subtype heterogeneity with the evolution of subtype B, and CRF_20 AG, as well as HIV-1 subtype A. Our study highlights the importance of expanded surveillance programs to control HIV infection and the necessity of introducing public health strategies to target the risk groups, particularly IVDUs.

Current problematic and emergence of carbapenemase-producing bacteria: a brief report from a Libyan hospital

A collection of 94 Gram-negative bacteria isolates, showing different antimicrobial resistance phenotypes including to the carbapenem classes was investigated. Strains were originated form clinical sources from a single hospital in Tripoli, Libya during 2015 and were identified based on cultural and phenotypic characteristics, and fully characterized by the VITEK automated system. Forty-eight percent (48%) of the collection was identified as Acinetobacter baumannii, 50% Klebsiella pneumoniae and 2% Escherichia coli. Resistance to the carbapenem classes was reported in 96% of the A. baumannii strains and 94% of the K. pneumonia strains. Seventy-eight percent (78%) of the isolates showed different multidrug-resistant (MDR) phenotypes, of which K. pneumoniae expressing the highest rates of MDRs(i.e. 91%). Emergence of resistance to carbapenems in the Gram-negative bacteria is a challenging global problem, particularly for Africa. Surveillance of these pathogens and appropriate actions are urgently required in Libyan healthcare settings.

Assessment of the Knowledge of Blast Injuries Management among Physicians Working in Tripoli Hospitals (Libya)

Introduction No study on hospital staff preparedness for managing blast injuries has been conducted in Libya. The internal conflict in Libya since 2011 and the difficulties faced by the hospitals has highlighted the need for such studies. Hypothesis Physicians working in Tripoli (capital city Libya) hospitals are inadequately prepared for the management of blast injuries.

METHODS

A survey was conducted in all 13 hospitals in Tripoli between June 2014 and May 2015 by using interviews based on a questionnaire consisting of 29 questions covering physicians' education related to blast injury, hospital management of mass casualties, and aspects of hospital preparedness for such incidents.

RESULTS

Of 3,799 physicians working in Tripoli hospitals, 607 physicians were interviewed (16.0%). All but one of the physicians reported that there was no disaster response plan, none of them had read such a plan, 496 (81.7%) reported that hospitals were not prepared, and 471 (77.6%) that hospitals were not equipped for blast injuries. Though 414 (68.2%) reported that radiological equipment was available, 597 (98.3%) revealed that hospitals do not adopt training for blast injury. Only 39 (6.4%) had received professional training, though 183 (30.1%) were seeing blast injury patients at least once a week in their daily practice. Nevertheless, 185 (30.5%) had previous knowledge and experience in blast injuries management and 338 (55.70%) were aware of the major physical findings, but only 75 (12.4%) were following specific guidelines. According to approximately one-third of the physicians (192; 31%), staff and patient safety were not priorities for the hospital administration. Almost all (606; 99.9%) revealed that personal protective equipment for chemical and nuclear accidents was not available.

CONCLUSION

Preparedness for blast injuries in Tripoli hospitals is seriously deficient. Planning optimized blast and disaster management in Libya is essential. Oun AM , Hadida EM , Stewart C . Assessment of the knowledge of blast injuries management among physicians working in Tripoli hospitals (Libya). Prehosp Disaster Med. 2017;32(3):311-316.

Louse-borne relapsing fever in a refugee from Mali

INTRODUCTION

Due to the increasing number of refugees from East Africa, louse-borne relapsing fever (LBRF) has become an emergent disease in Europe. No single case of LBRF has been reported in Europe in refugees from other parts of Africa.

CASE REPORT

We report a case of LBRF in a refugee from Mali, likely acquired in Libya, where several migration routes into Europe meet. The disease must be considered in any febrile refugee regardless the country of origin.

Exploiting serological data to understand the epidemiology of foot-and-mouth disease virus serotypes circulating in Libya

Sporadic outbreaks of foot-and-mouth disease (FMD) have occurred in Libya for almost fifty years. During the spring of 2013, a countrywide serosurvey was undertaken to assess the level of FMD virus circulation and identify FMD virus serotypes in the country. A total of 4221 sera were collected, comprising samples from large ruminants (LR; n=1428 samples from 357 farms) and small ruminants (SR; n=2793 samples from 141 farms). FMD sero-prevalence of NSP antibodies determined by ELISA were 19.0% (271/1428) with 95% CI (16.9 - 21.0) and 13.5% (378/2793) with 95% CI (12.3 - 14.8) for LR and SR samples, respectively. The sero-prevalence of NSP antibodies in LR was 12.3% and 19.8% for age group < 1 year and ≥ 1 year, respectively (X²= 4.95, P= 0.026), while in SR was 3.7%, 13.6% and 21.3% for age group < 1 year, 1-2 year and > 2 year, respectively (X²= 118.1, P= 0.000). These observed NSP serologic profiles support the hypothesis of an endemic level of FMD circulation in Libya. All positive sera were tested for SP antibodies for O, A and SAT-2 FMD virus serotypes. Serotype O was the dominant circulating serotype followed by serotype A, while evidence of SAT-2 was not found. These data provide an insight into the wider epidemiology of FMD in Libya, and contribute to field and laboratory investigations that during 2013 serotype O (O/ME-SA/Ind-2001 lineage) was isolated from clinical samples collected from the country.

Italian colonial psychiatry: outlines of a discipline, and practical achievements in Libya and the Horn of Africa

This article describes the establishment of psychiatry in Italy's former colonies during the period 1906-43, in terms of the clinical and institutional mechanisms, the underlying theories and the main individuals involved. 'Colonial psychiatry' (variously called 'ethnographic', 'comparative' or 'racial' psychiatry) - the object of which was both to care for mentally afflicted colonists and local people and also to understand and make sense of their pathologies - received most attention in colonial Libya, starting in the first months of the Italian occupation (1911-12) and then taking institutional form in the 1930s; in the colonies of what was known as 'Italian East Africa', on the other hand, less was said about psychiatric care, and practical achievements were correspondingly limited.

Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic

PURPOSE

The aim of this study was to cross-culturally adapt the PASS-20 questionnaire for use in Libya.

METHODS

Participants were 71 patients (42 women) attending the physiotherapy clinic, Ibn Sina Hospital, Sirt, Libya for management of persistent pain and 137 healthy unpaid undergraduate students (52 women) from the University of Sirt, Libya. The English PASS-20 was translated into Arabic. Patients completed the Arabic PASS-20 and the Arabic Pain Rating Scales on two occasions separated by a 14-day interval. Healthy participants completed the Arabic PASS-20 on one occasion.

RESULTS

The internal consistency (ICC) for pain patient and healthy participant samples yielded a good reliability for the total score, cognitive anxiety, fear of pain, and physiological anxiety. The test-retest reliability of the Arabic PASS-20 score showed high reliability for the total score (ICC = 0.93, p < 0.001), escape/avoidance (ICC = 0.93, p < 0.001), fear of pain (ICC = 0.94, p < 0.001), and physiological anxiety subscales (ICC = 0.96, p < 0.001) and good reliability for the cognitive anxiety (ICC = 0.85, p < 0.001). Inspection of the Promax rotation showed that each factor comprised of five items were consistent with the theoretical constructs of the original PASS-20 subscales.

CONCLUSION

The Arabic PASS-20 retained internal consistency and reliability with the original English version and can be used to measure pain anxiety symptoms in both pain and healthy individual samples in Libya.

The epidemiology of chronic pain in Libya: a cross-sectional telephone survey

Background

Chronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya.

Methods

A cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %).

Results

The prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled.

Conclusions

The prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management.

Prevalence of Entamoeba histolytica, Giardia lamblia, and Cryptosporidium spp. in Libya: 2000-2015

Introduction

The intestinal protozoa Entamoeba histolytica, Giardia lamblia, and Cryptosporidium spp. are the causative agents of giardiasis, amebiasis, and cryptosporidiosis, respectively. Adequate knowledge of the geographical distribution of parasites and the demographic variables that influence their prevalence is important for effective control of infection in at-risk populations.

Methods

The data were obtained by an English language literature search of Medline and PubMed for papers using the search terms ‘intestinal parasites and Libya, G. lamblia and Libya, E. histolytica and Libya and Cryptosporidium and Libya’ for the period 2000–2015.

Results

The data obtained for the period 2000–2015 showed prevalence rates of 0.8–36.6% (mean 19.9%) for E. histolytica/dispar, 1.2–18.2% (mean 4.6%) for G. lamblia and 0.9–13% (mean 3.4%) for Cryptosporidium spp. among individuals in Libya with gastroenteritis (GE). On the other hand, prevalence rates of 0.8–16.3% (mean 8.3%), 1.8–28.8% (mean 4.8%), and 1.0–2.5% (mean=2.4), respectively, were observed for individuals without GE. The mean prevalence rate of E. histolytica/dispar was significantly higher among individuals with GE compared with those without GE (p<0.0000001, OR=2.74). No significant difference in prevalence rate of the three organisms was found according to gender, but most of infections were observed in children aged 10 years or younger.

Conclusion

The reviewed data suggest that E. histolytica, G. lamblia, and Cryptosporidium spp. may play a minor role in GE in Libya. The observed high prevalence rates of E. histolytica/dispar reported from Libya could be due mainly to the non-pathogenic E. dispar and E. moshkovskii. However, more studies are needed in the future using E. histolytica-specific enzyme immunoassays and/or molecular methods to confirm this observation.

Molecular diagnosis of Toxoplasma gondii infection in Libya

Background

Toxoplasma gondii infections are prevalent in humans and animals throughout Libya. Current diagnosis is based on detection of Toxoplasma-specific IgM and IgG. In this study, we established and optimized a diagnostic PCR assay for molecular diagnosis of T. gondii in Libya.

Methods

From January to December, 2010, 177 blood and serum samples were collected from suspected patients. This includes: 140 women who have had spontaneous abortions, 26 HIV-positive patients, nine patients with leukemia and lymphoma, and two infants with ocular infection. Samples were screened for anti-Toxoplasma IgG and IgM antibodies before DNA extraction. The surface antigen gene 2 (SAG2) was targeted in a semi-nested PCR to amplify a 999 bp and a 614 bp fragment in the first and the second run respectively.

Results

A total of 54/140 (38.5 %) women who have had spontaneous abortions, 23/26 (88 %) HIV patients, 6/9 (66.6 %) of the leukaemia and lymphoma patients, and one child with ocular infection were seropositive for anti-Toxoplasma IgG and/or IgM. Genomic DNA was extracted from 38 selected seropositive samples. The PCR was sensitive enough to detect DNA concentration of 12 ng/μL. PCR analysis was performed for 38 selected seropositive patients (16 women who have had spontaneous abortions, 15 positive HIV patients, six leukaemia patients and one child with ocular infection). Our designed primers were successfully amplified in 22/38 (57.9 %) samples; 5/12 (35.7 %) from serum and 17/26 (65.8 %) from whole blood samples. All PCR positive samples were IgG-positive except two samples which were IgM and IgG & IgM-positive serum samples respectively. The semi-nested PCR confirmed five more samples. These included two leukaemia and two HIV-positive whole blood samples and one serum sample from an aborted woman.

Conclusion

The ability of PCR to diagnose active toxoplasmosis is needed in immunocompromised patients and congenital toxoplasmosis cases, especially when serological techniques fail. For the first time in Libya, we established and optimized semi-nested PCR of SAG2 gene. The developed PCR method was able to detect as little as 12 ng/μL of T. gondii DNA and was useful to diagnose the diseases in women who have had spontaneous abortions, HIV-positive patients, patients with leukemia and lymphoma, and infants with ocular infection.

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

BACKGROUND

Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status.

METHODS

A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level.

RESULTS

Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94).

CONCLUSION

The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Isolation and molecular identification of Vibrio spp. by sequencing of 16S rDNA from seafood, meat and meat products in Libya

The genus Vibrio includes several food-borne pathogens that cause a spectrum of clinical conditions including septicemia, cholera and milder forms of gastroenteritis. Several Vibrio spp. are commonly associated with food-borne transmission including Vibrio cholerae, Vibrio parahemolyticus, and Vibrio vulnificus. Microbiological analysis for enumeration and isolation of Vibrio spp. were carried out for a total of 93 samples of seafood, meat and meat products from different geographic localities in Libya (Tripoli, Regdalin, Janzour and Tobruk). Vibrio spp. were detected by conventional cultural and molecular method using PCR and sequencing of 16S rDNA. Out of the 93 cultured samples only 48 (51.6%) yielded colonies on Thiosulfate Citrate Bile Salt agar (TCBS) with culture characteristics of Vibrio spp. More than half (n=27) of processed seafood samples (n=46) yielded colonies on TCBS, while only 44.6 % of samples of meat and meat products showed colonies on TCBS. Among cultured seafood samples, the highest bacterial count was recorded in clam with a count of 3.8 ×10⁴ CFU\g. Chicken burger samples showed the highest bacterial count with 6.5 ×10⁴ CFU\g. Molecular analysis of the isolates obtained in this study, showed that 11 samples out of 48 (22.9%) were Vibrio spp. Vibrio parahemolyticus was isolated from camel meat for the first time. This study is an initial step to provide a baseline for future molecular research targeting Vibrio spp. foodborne illnesses. This data will be used to provide information on the magnitude of such pathogens in Libyan seafood, meat and meat products.

Modelling the prevalence of hepatitis C virus amongst blood donors in Libya: An investigation of providing a preventive strategy

AIM: To determine hepatitis C virus (HCV) seroprevalence among the Libyan population using blood donors and applying the autoregressive integrated moving average (ARIMA) model to predict future trends and formulate plans to minimize the burden of HCV infection.

METHODS: HCV positive cases were collected from 1008214 healthy blood donors over a 6-year period from 2008 to 2013. Data were used to construct the ARIMA model to forecast HCV seroprevalence among blood donors. The validity of the model was assessed using the mean absolute percentage error between the observed and fitted seroprevalence. The fitted ARIMA model was used to forecast the incidence of HCV beyond the observed period for the year 2014 and further to 2055.

RESULTS: The overall prevalence of HCV among blood donors was 1.8%, varying over the study period from 1.7% to 2.5%, though no significant variation was found within each calendar year. The ARIMA model showed a non-significant auto-correlation of the residuals, and the prevalence was steady within the last 3 years as expressed by the goodness-of-fit test. The forecast incidence showed an increase in HCV seropositivity in 2014, ranging from 500 to 700 per 10000 population, with an overall prevalence of 2.3%-2.7%. This may be extended to 2055 with minimal periodical variation within each 6-year period.

CONCLUSION: The applied model was found to be valuable in evaluating the seroprevalence of HCV among blood donors, and highlighted the growing burden of such infection on the Libyan health care system. The model may help in formulating national policies to prevent increases in HCV infection and plan future strategies that target the consequences of the infection.

Entomological studies of phlebotomine sand flies (Diptera: Psychodidae) in relation to cutaneous leishmaniasis transmission in Al Rabta, North West of Libya

Al Rabta in the North-West of Libya is a rural area where cutaneous leishmaniasis (CL) is endemic for long time. Few reports are available on sand flies in this area which is an important focus of CL. Therefore, this study aimed at updating the species composition, and monthly fluctuation of sand flies in this area. Sand flies were biweekly collected by CDC light traps from June to November 2012 and April to November 2013 in two villages, Al Rabta East (RE) and Al Rabta West (RW). Nine species (6 Phlebotomus and 3 Sergentomyia) were reported in the two villages. A total of 5605 and 5446 flies were collected of which Phlebotomus represented 59.30 and 56.63% in RE and RW, respectively. Sergentomyia minuta and Phlebotomus papatasi were the abundant species. Generally, more males were collected than females for all species. The overall ratios (males: females) for most of species were not deviated from the expected 1:1 ratio (Chi-squared, P>0.05). Sand fly abundance (fly/trap) is directly related to the temperature and RH (P<0. 01) while it inversely related to wind velocity (P>0.05). Flies were active from April to November with increased activity from June to October. Prominent peaks were in September and June. The abundance of P. papatasi and Phlebotomus sergenti, vectors of CL (August-October) coincided with the reported higher numbers of CL cases (August- November). The obtained results could be important for the successful planning and implementation of leishmaniasis control programs.