The healthcare system in Libya faces significant challenges due to political instability, fragmented infrastructure, and inconsistent medical practices. Clinical Practice Guidelines (CPGs) serve as essential tools for standardising care, ensuring evidence- based treatment, and optimising healthcare resources. In Libya, the lack of structured guidelines has contributed to disparities in disease management, affecting patient outcomes and overall healthcare efficiency. This commentary explores the critical need for CPGs in Libya, highlighting their potential to improve healthcare delivery, minimise variability in treatment, and enhance patient safety. While implementation poses challenges, including centralisation, limited research capacity, and resource constraints, integrating CPGs through a phased implementation framework could be a transformative step toward a more resilient and equitable healthcare system. By fostering collaboration among policymakers, healthcare professionals, and international organisations, Libya can lay the foundation for a systematic approach to disease management, ultimately improving the quality of care for its population. Healthcare reform in Libya is urgently needed, and strategic investments in CPG development and dissemination could drive the necessary transformation in Libyan healthcare.

Abstract Micro-hardness is a fundamental property of prosthodontic restorative materials, as it affects their resistance to surface deformation, wear, and long-term clinical performance. This study aimed to compare the Vickers micro-hardness of three widely used CAD/CAM materials: lithium disilicate, monolithic zirconia, and multilayered zirconia. A total of 30 specimens (N = 30) were fabricated, with 10 samples allocated to each material group. Lithium disilicate specimens were prepared as rectangular plates (18 × 15 × 1 mm), whereas zirconia specimens—both monolithic and multilayered—were fabricated as discs (10 mm in diameter and 1.5 mm in thickness) following standardized CAD/CAM milling and sintering protocols. Vickers micro-hardness testing was conducted using a digital micro-hardness tester under material-specific conditions: a load of 1 kg and a dwell time of 10 s for lithium disilicate, and a load of 500 g with a 20 s dwell time for zirconia. Statistical analysis was performed using one-way ANOVA followed by Tukey’s post-hoc test, with the significance level set at p < 0.05. Significant differences in micro-hardness were identified among the three materials (p < 0.001). Monolithic zirconia demonstrated the highest mean hardness (680 ± 19 HV), followed by multilayered zirconia (623 ± 47 HV), while lithium disilicate exhibited the lowest values (553 ± 32 HV). Post-hoc analysis confirmed that all pairwise comparisons were statistically significant. The findings indicate that monolithic zirconia possesses superior micro-hardness compared to multilayered zirconia and lithium disilicate, supporting its suitability for high-stress clinical applications. Multilayered zirconia offers a balance between mechanical performance and esthetics, whereas lithium disilicate remains optimal for highly esthetic anterior restorations. These results provide clinicians with evidence-based guidance for selecting CAD/CAM materials in fixed prosthodontic rehabilitation. 

The surface integrity of CAD/CAM restorative materials is critical for their esthetic and mechanical performance. Acidic challenges in the oral environment can degrade ceramic surfaces, increasing roughness and potentially compromising restoration longevity. This study aimed to evaluate and compare the effect of 4% acetic acid immersion on the surface roughness (Ra) of lithium disilicate glass-ceramic and hybrid ceramic (Vita Enamic) CAD/CAM restorative materials. A total of 40 rectangular specimens (18×15×1 mm) were fabricated, 10 per material per condition. Specimens were polished according to manufacturer protocols and immersed in 4% acetic acid (v/v) at 80∘C for 16 hours, following ISO 6872 standards. Surface roughness was measured using a Roughness Tester (PCE-RT 2000). Data were analyzed using independent t-tests, and effect sizes were calculated (Cohen’s d). Both materials exhibited significant increases in surface roughness after acid exposure. Lithium disilicate showed Ra values increasing from 0.0676±0.0187 µm to 0.5129±0.0912 µm (p<0.001, d=4.79). The hybrid ceramic exhibited a larger increase, from 0.2063±0.0568 µm to 1.4409±0.4951 µm (p<0.001, d=2.48). The hybrid material was therefore more susceptible to acid-induced degradation than lithium disilicate. Immersion in 4% acetic acid significantly deteriorates the surface of both lithium disilicate and hybrid ceramic, with hybrid ceramic showing greater roughness changes. Lithium disilicate may be preferred for patients at high risk of acidic challenges. These findings emphasize the importance of material selection and surface management to optimize restoration longevity.

Fracture toughness is a critical mechanical property influencing the clinical durability of prosthodontic materials, especially those used in high-stress posterior regions. Differences in composition, microstructure, and fabrication technologies can significantly affect resistance to crack propagation. This experimental study evaluated the fracture toughness of three prosthodontic material groups (n = 10 each). Standardized samples were prepared and tested using the Vickers indentation technique under controlled laboratory conditions. Descriptive statistics were calculated for each group, and a one-way analysis of variance (ANOVA) was performed to determine significant differences among the groups. Post-hoc pairwise comparisons were conducted using Tukey’s Honest Significant Difference (HSD) test. Statistically significant differences in fracture toughness were observed among the three groups (p < 0.001). Group II demonstrated the highest mean fracture toughness (5.39 ± 0.34 MPa·m^1/2), followed by Group III (4.34 ± 0.36 MPa·m1/2). Group I recorded the lowest mean value (2.82 ± 0.56 MPa·m1/2). Tukey’s post-hoc analysis confirmed that all pairwise comparisons were significant (p < 0.001), indicating that each material group exhibited distinct mechanical performance profiles. The findings show that the fracture toughness of prosthodontic materials vary significantly depending on their composition and manufacturing technology. Materials in Group II outperformed the other groups, suggesting greater suitability for clinical situations where high resistance to fracture is required. Further studies incorporating additional mechanical tests and long-term clinical evaluation are recommended to validate these results under functional oral conditions. 

A diabetic foot ulcer is one of the most significant and devastating complications of diabetes. DFU is considered a major source of morbidity and mortality in patients with diabetes. Therefore, this study aimed to test the possibility of using Aloe Vera resin extract as an antibacterial agent (Libyan remedy) against isolated bacteria from a patient's foot. This study was concerned with the determination of the possible microbial cause of the diabetic foot ulcer; therefore, its design included microorganism isolation, identification, and finally, testing of the antibacterial activity of Aloe Vera resin against bacteria isolated from diabetic foot ulcers. Curiously, the results demonstrated that every antibiotic used in this experiment created inhibition zones against the bacteria that were isolated from patients' feet and had a pronounced resistance to the extract from aloe vera resin. In contrast, aloe vera resin extract created inhibition zones against bacteria isolated from healthy feet in comparison to the other widely used, well-known broad-spectrum antibiotics. The pathogen that was isolated from the patient's feet, according to our lab results, was Staphylococcus bacteria. Aloe Vera resin extract had no inhibition zones against Staphylococcus species bacteria that were collected from patient feet, which contradicted the hypothesis that Aloe Vera is a good antibacterial agent that could be used to prevent diabetic foot ulcers. Nonetheless, it demonstrated a slight antibacterial effect on normal flora foot bacteria. Bacterial resistance due to possible mutations could be the cause of this. It is also important to take into account the anti-inflammatory properties of aloe Vera resin extract.

The global pandemic Coronavirus Disease 19 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Many patients with life-threatening illness due to COVID-19 die from hypoxic respiratory failure, which appears to be related to a cytokine storm syndrome leading to Acute Respiratory Distress Syndrome (ARDS). While steroids have some demonstrated benefits, supportive care remains the mainstay of treatment. However, in the absence of vaccines and proven treatments, during this current pandemic, we are considering repurposing currently available medications; one of the first is cotrimoxazole (CTX), which was one of the earliest medications for treating and preventing opportunistic infections caused by the human immunodeficiency virus (HIV), among other things. Cotrimoxazole in combination with folic acid is inexpensive, familiar to the public, and generally well tolerated, and treats secondary infections. Low cost and a good safety profile can make it an ideal candidate for the treatment of COVID-19 in a low-resource country like Libya. Here we report our observations with cotrimoxazole added to standard therapy in patients with severe COVID-19. Prospective data were gathered from consecutive newly diagnosed patients who presented to the Msallatah Isolation Center (Corona Center), Msallatah, Libya, between June and September of 2021 with critical COVID-19 on non-invasive ventilation and receiving standard therapy (ST) along with 480 mg oral cotrimoxazole (CTX). The first four days served as a control period during which patients with critical COVID-19 received only standard treatment. After a 4-day control period during which the patients received ST alone, nine patients (mean age ± SEM 40.5 ± 10.5 years, 66.66 percent male) were identified because they received CTX in addition to ST. We found that patients with critical COVID-19 who received CTX in addition to ST experienced significantly better outcomes, such as lower in-hospital mortality (0%), higher blood levels of D-Dimer (3735±579.9 mg/L versus 444.82±182.14 mg/L, p˂0.05), and improvements in respiratory rate (36.42±3.9 mg/L versus 25.6±2.9 mg/L, p˂0.05) and CRP at the fourth day of the experiment (142.12±34.7 mg/L versus 72.4±19.26 mg/L, p˂0.05). These results demonstrate the beneficial effects of using cotrimoxazole in patients with severe COVID-19; it could help to reduce the need for respiratory support for thousands of patients, saving valuable lives and decreasing the burden on the healthcare system in countries with limited resources. The mechanism of action of cotrimoxazole in this situation is not clear; however, these outcomes may be due to the antibiotic activity and/or the anti-cytokine effects of cotrimoxazole. Further trials are needed to test our observations.

The aesthetic performance of zirconia restorations depends greatly on their optical properties, particularly translucency, which can be influenced by various chemical exposures in the oral environment. This in vitro study aimed to evaluate the effect of different immersion solutions on the translucency of two types of zirconia materials. A total of 30 zirconia specimens (n = 15 per group) were prepared: Group A comprised monolithic zirconia, while Group B consisted of multilayered yttria-stabilized zirconia. Each group was divided into three subgroups (n = 5) and immersed in one of three solutions: distilled water (DW), chlorhexidine (CHX), or 0% alcohol mouthwash. Translucency parameters (TP) were measured before and after immersion using a spectrophotometer based on the CIELab system. Statistical analysis was conducted using GraphPad Instat software with significance set at p < 0.05. The results revealed that immersion in CHX caused the most significant increase in TP change in both groups, with monolithic zirconia (Group A) showing the highest overall change. Two-way ANOVA indicated that the immersion solution had a statistically significant effect on translucency (p < 0.0001), while the type of zirconia showed no significant main effect (p = 0.0779). These findings suggest that translucency changes are more dependent on the immersion media than the zirconia composition itself. Clinicians should consider the long-term aesthetic implications of chemical exposure on zirconia restorations, especially when prescribing disinfectant mouthwashes. 

A recent years. They have evolved into analysis of tumor Abstract— Multiplexed platforms have become a standard feature of modern medicine in the field of histopathology in recent years. They have evolved into powerful technologies that enable image analysis of tumor tissues from formalin- fixed paraffin- embedded specimens, aiming for better assessment of morphology and distinctive alterations at the molecular level of the patient’s sample, which is critical for the pathologist’s diagnosis and classification, with significant implications for the following therapeutic options. And also, in order to gain a better understanding of the tumor microenvironment, which aids cancer prevention by simulating new therapy discoveries. And unlike traditional IHC, which can only identify one marker in a tissue sample, multiplex IHC may detect many markers in a single tissue sample while providing detailed information about the cell composition and spatial arrangement. Reviewing multiplexed technologies is to demonstrate their utility in the study of cancer tissue as well as their benefits for applications in cancer diagnosis, stratifying patients, and accuracy for treatment. Summary: Digital pathology plays a significant part in current clinical practice and becoming an increasingly critical technological necessity in the laboratory environment, Algorithms for image analysis and artificial intelligence have the potential to further increase the quality of diagnostics in pathology. Keywords— Digital pathology; Molecular diagnostics; IHC & MIHC Techniques; cancers. 

Abstract

Gall bladder cancers, predominantly adenocarcinomas, are associated with significant malignancy and are more common in women, especially in their seventh decade of life. This study aims to evaluate the prevalence, distribution, and histopathological characteristics of gall bladder tumors, emphasizing the need for early diagnosis and understanding the role of chronic cholecystitis in tumor development. A retrospective analysis was performed on 45740 surgical biopsies, including 3107 cholecystectomies, from 1994 to 2007 at Misurata Medical Center, Libya. Data collected included patient demographics, clinical details, and microscopic diagnoses. Biopsy samples were processed and stained, and histopathological evaluation was performed following standard criteria. The study showed a female predominance in gall bladder tumors with a female: male ratio of 3:1. Most tumors were adenocarcinomas (83.33%), with high and moderate differentiation being the most frequent. Tumor diagnoses were most prevalent in the 51-65 age group. The majority of tumors were diagnosed at advanced stages (3 and 4). Tumor invasion was common, with 75% showing perivascular, intravascular, or perineural involvement. Chronic cholecystitis was observed in more than two-thirds of the tumor cases. Chronic inflammation is closely linked to gallbladder carcinogenesis, with most tumors diagnosed at advanced stages due to vague symptoms and aggressive behavior. Early detection and multidisciplinary approaches are vital to improve outcomes, especially in high-risk groups.

Abstract

Microscopic diagnosis of gastrointestinal biopsies remains a challenge in surgical pathology, involving both neoplastic and non-neoplastic changes. This study aims to analyze the prevalence, histopathological features, and grading of gastrointestinal (GIT) tumors in biopsies collected over 12.5 years at Misurata Medical Center, Libya, while assessing demographic patterns and the correlation of Helicobacter pylori infection with gastric malignancies. A total of 753 GIT biopsies were retrospectively analyzed from 1995 to 2007. Clinical data, including age, sex, and microscopic diagnoses, were documented. Biopsies underwent histopathological evaluation using the World Health Organization (WHO) classification. Statistical analyses were performed using SPSS software to explore relationships between neoplastic lesions and demographic factors. Non-neoplastic diseases accounted for 559 cases, which constitute 74.24% of the total cases, while neoplastic lesions were identified in 194 cases (25.76%). with a statistically significant predominance of malignant tumors (68.6%) over benign ones (31.4%, p<0.001). A slight male predominance was observed in overall biopsies (52.2%), with the 61-70 age group showing the highest frequency (17.4%). Well-differentiated tumors were more common, correlating with better prognoses. The TNM staging analysis revealed a concerning trend toward late-stage diagnoses, particularly in stomach and colorectal cancers. The investigation into Helicobacter pylori positivity indicated a complex relationship with gastric malignancies, warranting further research. The findings reflect a high burden of GIT malignancies during the study period, with late-stage diagnosis and limited diagnostic resources. These results underscore the need for improved screening programs, early detection efforts, and enhanced diagnostic infrastructure in Libya. The study underscores the importance of understanding the multifactorial influences of Helicobacter pylori in gastric cancer development.