The spread of “Arab Spring” revolutions throughout the region has resulted in atrocities and the rising of psychiatric problems. In Libya, there is no clear infrastructure for medical or mental care. A fullfledged war was waged to achieve the liberation of the country. The above makes Libya a country which presents a wonderful opportunity for improving the provision and delivery of medical and mental services. The “First National Conference on Mental Health” post-revolution took place July 2012 in Misrata, Libya under the theme “The Future of Mental Health in Libya”. The author reviews the current state of mental health in Libya and reflects on the recommendations of the conference.

Background: The use of malathion as an insecticide, is accompanied by the appearance of many adverse effects. Objective: To verify the immunological characteristics of malathion and to determine whether Bradykinin Potentiating Factor (BPF) is able to counteract these effects, and to emphasize the affected pathophysiological mechanisms. Material and methods: Juvenile rats were divided into three groups: animals received a vehicle (control group), malathion (malathion group), or malathion then BPF (BPF group). Each group included three subgroups, which were sacrificed two days after two, four, and six weeks of malathion exposure respectively. BPF subgroups were exposed to malathion, then treated with single, double, and triple successive IP injections of BPF respectively. Results: The concentration of total globulin, total immunoglobulins, IgG, IgM, circulatory immune complexes, total number of RBC & platelets, and hemoglobin concentrations decreased significantly in malathion-exposed animals. The number of total leucocytes and lymphocytes increased. Histopathological changes of bone marrow and spleen after malathion exposure were consistent with these findings. Recovery of bone marrow and splenic changes, normalization of peripheral blood elements, reduction of elevated proinflammatory markers (IL-2, IL-4 and TNF-α), total plasma peroxide and oxidative stress index (OSI) while increased total antioxidant capacity (TAC) were observed after double and triple injections of BPF. Our results suggest that exposure to malathion has negative effects on immune function that was mediated through alteration of cytokines, antioxidants and direct damage of BM. Also, BPF can ameliorate both physiological and morphological changes.

Background: Acute lung injury (ALI) is a syndrome with a diagnostic criteria based on hypoxemia and a classical radiological appearance, with acute respiratory distress syndrome at the severe end of the disease. Occurrence of rupture of the basement membranes and interstitial matrix remodeling during ALI. Matrix metalloproteinases (MMPs) participate in tissue remodeling related with pathological conditions such as acute lung injury. We hypothesized the interrelationships between extracellular matrix (ECM) turnover as MMP-9 and indicator of angiogenesis such as angiopoietin-2 (Ang-2) as well as plasma von Willebrand factor (vWF) and their correlation with arterial partial pressure of oxygen (PaO2), oxygen saturation (SaO2) and mortality in ALI/ARDS. Methods: Eighty eight mechanically ventilated patients (68 male, mean (SD) age 61 (10) years) were compared to 40 healthy controls (36 male, mean (SD) age 57 (10)). All biomarkers were measured by Enzyme linked immunosorbent assay (ELISA). Oxygenation, body temperature, leucocytes, and platelet counts were noted. Results: Plasma levels of all biomarkers were significantly different, among ALI/ARDS subjects (p<0.001). They were inversely related to PaO2 and SaO2 and positively related to mortality. In addition, increased MMP-9, Ang-2 and vWF levels were interrelated on the first day of admission. Conclusions: The observed diversity in plasma levels of MMP-9, Ang-2 and vWF in ALI/ARDS patients revealed the activity and severity of the disease, shedding more light onto the pathogenesis and/or presentation of ARDS.

Objectives: To determine the risk benefits of moderate intensity resistance training of upper limbs in type 2 diabetes mellitus patients using augmentation index as a measure of arterial stiffness. Patients and Methods: Twenty middle aged individuals (40-60 years) with type 2 diabetes mellitus volunteered to participate. They were assigned to two groups: an upper limb training group 51.0±6.3 years old and a sedentary group 53.7±3.1 years. The upper limb group performed 12 weeks of moderate intensity resistance training (3 days/week). Results: Fasting blood glucose decreased from 135±23 to 118±23 mg/dl, total cholesterol decreased from 191±14 mg/dl to 174±11 mg/dl, serum triglyceride decreased from 168±21 mg/dl to 149±23 mg/dl (p<0.001 ), high density lipoprotein increased from 51.8±4.05 mg/dl to 56.3±4.0 mg/dl (p<0.001) and glycosylated hemoglobin decreased from 9.3±0.8% to 8.3±0.6 % (p<0.001) in upper limb resistance training group. The resting heart rate was increased from 78±6 bpm to 84±9 bpm (p<0.01) and the systolic blood pressure was increased from 122±2 mmHg to 132±35 mmHg (p<0.01) and diastolic blood pressure was increased from 81±3 mmHg to 93±6 mmHg (p<0.001) in upper limb resistance training group. Upper limb group also showed significant increase in augmentation index (1.9±2.5 to 5.2±2.4 mmHg, p<0.001) and decrease in heart rate variability (17±6 to 11.6±3.5 msec; p<0.001). Conclusion: Upper limb resistance training may lead to increase in arterial stiffness in patients with type 2 diabetes mellitus. Whereas, aerobic upper limb activity could offset the increase in stiffness caused by resistance training.

Rhinocerebral mucormycosis is a rare but usually fatal infection caused by fungi from the order Mucorales. These fungi has strong predilection for growth into arteries, lymphatics and nerves and this is the reason for their rapid spread to adjacent tissues with accompanying tissue ischemia and infarction due to vascular occlusion after a fibrin reaction and mucor thrombus. We describe a 54 year old Thai national male with poorly controlled type 2 diabetes, ischemic heart disease, hypertension and renal impairment who presented to the emergency department with fever, vomiting and painful left eye swelling, which progressed rapidly leading to complete opthalmoplegia and vision loss. The diagnosis of mucormycosis was confirmed later and was the patient was started on Amphotericin B therapy. Despite stable clinical course, he suddenly developed a fatal intracerebral hemorrhage and died within 24 hours of the bleed. We wonder weather patients with cerebral fungal infection should perhaps have an early neurosurgical intervention to rule out the presence of mycotic aneurysm; particularly that many cases of fatal cerebral bleed have been reported in association with Rhinocerebral mucormycosis.

Gastroduodenal involvement occurs in only 0.3 to 2.3% of patients with tuberculosis (TB). Clinically, it may resemble peptic ulcer disease or malignancy. We present a 36 year old man with gastric outlet obstruction proven to be pyloric stricture due to primary pyloric tuberculosis. Diagnosis was established endoscopically and patient was successfully managed by standard anti-tuberculous therapy. Although rare, tuberculous involvement of the stomach should be considered in the differential diagnosis of gastric outlet obstruction especially in regions where tuberculosis is endemic. This case also emphasizes that medical management with anti-TB medications can be tried solely as the first line therapy for strictured pyloric stenosis. However, surgical intervention is required more often than none in cases where gastrointestinal obstruction is the main clinical problem.

These are abstracts of the presentations made during the annual “RAK Update in Nephrology and Transplantation” held on the 19th and 20th of October 2012. Over 2 days, several renowned national, regional and international experts addressed topical issues in clinical nephrology, transplantation and related subjects such as cardiovascular risk, vasculitides and diabetes as they relate to kidney disease. These presentations covered a wide range of subjects addressing the latest basic research findings, clinical trial results and recommendations of the latest clinical practice guidelines. In addition, special attention was paid to adapt the research findings and international clinical practice strategies to local circumstances.