AlQalam Journal of Medical and Applied Sciences
AlQalam Journal of Medical and Applied Sciences (AJMAS), eISSN:2707-7179, is an international peer-reviewed open access journal that provides a high-quality peer review process for original research articles, review articles, short communications, and case reports in all areas of Medical and Applied Sciences. AJMAS operates under an open access publication model, meaning that all interested readers are able to freely access the journal online without the need for a subscription fee. Please note that there is an article processing and publishing charge of 100 US Dollars for each accepted manuscript in order for the journal to continue its high performance. All papers are subjected to a peer-review process. Moreover, with the presence of international referees, the process of decision-making on the acceptance/rejection of all submitted manuscripts will be done rapidly and to the highest standards. The journal is owned by the University of Tripoli Alahlia, and the management of the journal is made by the editorial team Editorial Office in Charge Dr. Ahmed Atia editorajmas@gmail.com 00218910737929
On Generalized δ- Pre-Closed Set in Topological Spaces
In his 1970 [1] work, Levine introduced generalized closed sets (g-closed), from which the notion of generalized open sets (g-open) follows by defining them as the complements of generalized closed sets. This study presents and examines a newly defined class of sets, denoted by generalized Pre–closed sets (g P- closed). It builds upon our earlier research on generalized semi - closed sets (gs - closed) [2] by extending the underlying framework and introducing a different generalized class. The paper establishes several essential properties of the proposed sets, including their behavior with respect to intersections, unions, and set inclusion, and investigates their connections with related generalized topological concepts. To demonstrate the validity of the theoretical results, a collection of illustrative examples together with counterexamples is provided.
Copyright (c) 2026 Nadiy A. ltoumi, Asma Sarbout, Fatma Toumi https://creativecommons.org/licenses/by/4.0
Knowledge, Attitudes, and Practices Regarding Artificial Intelligence Among Dental Professionals and Students
Abstract Artificial intelligence (AI) is increasingly integrated into dental diagnostics, treatment planning, and education, yet the extent of awareness and engagement among dental professionals remains largely unexplored. This study assessed the knowledge, attitudes, and practices (KAP) regarding AI among a diverse sample of dental students, postgraduate trainees, practicing dentists, and faculty members. A cross-sectional, self-administered online questionnaire was distributed to 109 respondents between January 17 and February 6, 2026, capturing demographic data, AI familiarity, attitudinal perceptions, and views on accountability for AI-related errors. Results indicate that while 57.8% of respondents were familiar with the general concept of AI, knowledge of specific clinical applications like orthodontic planning (29.4%) and automated caries detection (36.7%) was notably lower. Participants demonstrated cautious optimism; 59.6% agreed that AI would drive professional advancements, and a similar percentage (59.6%) disagreed that AI would replace dentists. However, only 13.7% trusted AI outputs over human second opinions, and 50.5% expressed concerns regarding the loss of manual clinical skills. Furthermore, 69.7% of respondents advocated for shared accountability between dentists and software developers for AI-related misdiagnoses. In conclusion, dental professionals show a preference for using AI as a diagnostic aid rather than a replacement, supported by a desire for shared responsibility. These findings highlight a critical need to integrate applied AI content into dental curricula to bridge the gap between general awareness and deep clinical application.
Copyright (c) 2026 Ghada Ahmed, Roba EL-Refadi https://creativecommons.org/licenses/by/4.0
The Possible Relation Between Low Weight and Anemia Among School Children in Surman Area
Anemia is a common nutritional disorder among school-aged children, often associated with low body weight and inadequate dietary intake. Understanding the relationship between body weight and hematological status is essential for early detection and prevention of anemia. This study aimed to investigate the possible relationship between low weight and anemia among school children aged 6–12 years in the Surman area, Libya. A cross-sectional study was conducted among 100 school children (55 males, 45 females). Data on demographics, dietary habits, and medical history were collected using structured questionnaires. Anthropometric measurements (weight, age) were recorded, and complete blood count (CBC) parameters, including hemoglobin (Hb), hematocrit (Hct), red blood cells (RBC), and related indices, were analyzed. Descriptive statistics, correlation analysis, and gender comparisons were performed using SPSS. The mean age and weight of participants were 9.3 ± 2 years and 28 ± 8.2 kg, respectively, with males and females showing comparable anthropometric values. Dietary assessments revealed frequent consumption of meat and fruits/vegetables, while tea consumption was low. Most children were healthy with minimal chronic illnesses or medication use. The overall mean CBC parameters were within normal ranges (Hb: 12.6 ± 0.9 g/dL; Hct: 36.4 ± 5.2%; RBC: 4.5 ± 1.13 ×10⁶/µL). Additionally, the prevalence of anemia was 5% and 6% among females and males, respectively, whereas the overall prevalence rate was approximately 5.5%. These results imply that severe anemia is not generally common in this population. Weight and age were positively correlated with hemoglobin and hematocrit, indicating that underweight and younger children were at higher risk of anemia. Gender-specific analysis showed no significant differences in CBC parameters. Although severe anemia was uncommon, low body weight was associated with lower hematological indices in some participants. These findings underscore the importance of routine nutritional monitoring, anemia screening, and targeted interventions to promote optimal growth and prevent anemia in school-aged children.
Copyright (c) 2026 J. M. Jbireal, Almutasem Alhabib https://creativecommons.org/licenses/by/4.0
Association of VDR ApaI and TaqI Polymorphisms with Breast Cancer Risk in Libyan Women
Vitamin D receptor (VDR) gene polymorphisms, particularly ApaI (rs7975232) and TaqI (rs731236), have been inconsistently associated with breast cancer (BC) risk across diverse populations. No data exist on their role in Libyan women. The objective of this study was to investigate the association between VDR ApaI and TaqI polymorphisms and BC susceptibility in a Libyan case-control cohort. Methods: This study included 56 histologically confirmed BC patients and 58 healthy controls. Genotyping was performed using PCR-Restriction Fragment Length Polymorphism (PCR-RFLP), validated by Sanger sequencing. Genetic association was tested under multiple inheritance models (codominant, dominant, recessive, over-dominant, log-additive). Linkage disequilibrium (LD) and haplotype analyses were conducted. Results: No statistically significant association was found for either polymorphism. Analysis of the ApaI polymorphism revealed a non-significant, protective trend for the homozygous variant (a/a) genotype (OR = 0.48, 95% CI: 0.15–1.54, P = 0.45, codominant model). Conversely, a non-significant trend toward higher risk was observed for the TaqI homozygous variant (t/t) genotype (OR = 2.40, 95% CI: 0.73–7.86, P = 0.28, codominant model). For both markers, the observed genotype distributions did not deviate significantly from Hardy-Weinberg equilibrium (P > 0.05). A significant moderate linkage disequilibrium was observed between the two SNPs (D’ = 0.7786, P = 0). Haplotype analysis revealed no significant association with BC risk. Conclusion: This first genetic association study of VDR ApaI and TaqI in Libyan women does not support a major role for these specific polymorphisms in BC etiology. The findings provide crucial baseline genetic data for North Africa and underscore the importance of population-specific studies to clarify the heterogeneous global patterns of association of VDR variants. Keywords: Vitamin D Receptor; ApaI and TaqI Polymorphisms; Breast Cancer; Genetic Association; Libyan Population.
Copyright (c) 2026 Mansur Shmela, Najwa Benfayed, Mufida Almusrati, Laila Elghawi, Mouna Abdunnabi, Hajer Almabrouk, Amnnah Buthaynah, Mohamed Albendag, Fahima Alnagar https://creativecommons.org/licenses/by/4.0
Surgical Wound Complications and Incision Site Infection in Caesarean Section versus Vaginal Delivery: A Meta-Analysis
Caesarean section (CS) accounts for over 20% of global deliveries, yet rigorous estimates comparing surgical site infection (SSI) risks between delivery modes remain limited. The study aims to synthesize global comparative evidence on SSI incidence and effect size and wound complications across eligible studies. Following PRISMA 2020 guidelines, eight databases (including regional and Arabic-language sources) were searched (2014–2026) for studies comparing post-delivery SSI rates with ≥30 days follow-up. Risk estimates were pooled using random-effects meta-analysis. Analysis of 63 studies (N = 1,247,819 deliveries) showed CS was associated with significantly higher SSI odds than vaginal delivery (pooled OR = 4.87, 95% CI: 3.94–6.02). Wound dehiscence risk was elevated sixfold (OR = 6.31, 95% CI: 4.88–8.17). CS carries a significant, neglected surgical infection burden. Implementing targeted standardised prevention protocols, optimised prophylaxis, structured post-discharge surveillance, and regional quality assurance monitoring are essential to mitigate postoperative maternal morbidity.
Copyright (c) 2026 Thuraya Aljibali, Hajer Elkout https://creativecommons.org/licenses/by/4.0
Comparative Performance Evaluation of Feedback Error Learning and Adaptive Neuron-PI Controllers for Small-Signal Stability Enhancement in a Single-Machine Infinite-Bus Power System
Small-signal stability remains a fundamental challenge in the operation of modern power systems, particularly as grid complexity increases with the integration of highly dynamic power sources. Conventional Power System Stabilizers (CPSSs) have been widely adopted to improve damping performance; however, their effectiveness deteriorates when the operating conditions deviate from the design point. Consequently, intelligent adaptive control techniques have attracted significant attention owing to their ability to adjust controller parameters online in response to system dynamics. This paper presents a comprehensive comparative investigation of two intelligent adaptive control strategies, namely the Feedback Error Learning (FEL) controller and the Adaptive Neuron-Proportional-Integral (Neuron-PI) controller, for enhancing the small-signal stability of a Single-Machine Infinite-Bus (SMIB) power system. Unlike previous studies that investigated each controller independently, the proposed work evaluates both controllers under identical operating conditions, using the same SMIB model, disturbances, and simulation parameters to ensure a fair and objective comparison. The performance of both controllers is evaluated using MATLAB-SIMULINK 2025 software for multiple operating conditions. The simulation results demonstrate that the FEL controller exhibits superior adaptive learning characteristics and excellent robustness under varying operating conditions.
Copyright (c) 2026 Issa Ali, Alyaseh Askir https://creativecommons.org/licenses/by/4.0
Diabetic Ketoacidosis in Libya: Clinical Characteristics, Triggers, and Hospital Outcomes from a Tertiary Care Center
Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes, most commonly associated with type 1 diabetes. Understanding the clinical profile, factors, and outcomes of DKA is essential for timely intervention and effective management. This study aims to assess the clinical profile and precipitating factors of DKA among patients admitted to Misurata Medical Center, to improve early recognition and management strategies. A retrospective descriptive study was conducted on 113 patients diagnosed with DKA. Data were collected from hospital records and included demographic details, type of diabetes, presenting symptoms, biochemical parameters, precipitating factors, treatment modalities, and hospital outcomes. The mean age of patients was 27.7 years, with nearly half aged 20 or younger. The majority were female (55.8%) and had type 1 diabetes (98.2%). Insulin omission (49.1%) and infections (26.8%) were the most common precipitating factors. Common symptoms included nausea and vomiting (42.7%) and abdominal pain (17.5%). Severe hyperglycemia (≥400 mg/dL) and metabolic acidosis (pH ≤ 7.2) were present in more than half of patients. The vast majority recovered with short hospital stays (≤3 days in 90.3%). Recurrent DKA was reported in 50 %( 39/78 ) of cases, and complication rates were low (1.8%), with no in-hospital mortality. DKA remains a common and preventable acute complication of diabetes, particularly among young individuals with diabetes. Insulin omission and infection were the leading precipitating factors, suggesting gaps in adherence and patient education. The findings support the development of localized DKA management protocols and further research into long-term outcomes and risk factors.
Copyright (c) 2026 Amna Issa, Mohamed Altaib https://creativecommons.org/licenses/by/4.0
Histopathological Changes in Black Scorpionfish (Scorpaena porcus) from the Tripoli Coast, Libya: A Three-Season Baseline Study
The Mediterranean Sea experiences pronounced seasonal temperature changes and varied seafloor topography. Within this environment, the coastal waters of Tripoli, Libya, create physiological challenges for resident fish. This study aims to describe seasonal histopathological alterations of vital tissues (liver, kidney, muscle, and gill) in S. porcus collected from the Tripoli coast and discuss their potential relationship to environmental conditions. A total of 25 specimens of black scorpionfish (Scorpaena porcus) were randomly collected from the Tripoli coast across three distinct seasons. The specimens were dissected to extract the liver, kidney, gills, and dorsal muscle tissues for histological analysis. Histopathological analysis revealed seasonal differences in tissue lesions. The liver revealed moderate-to-severe vascular dilation, mild activation of Melanomacrophage centers (MMCs), and unidentified parasitic cysts. The kidney showed degenerative alterations in the renal tubular epithelium, focal interstitial fibrosis, granuloma-like structures, and frequent activation of Melanomacrophage centers (MMCs). Most gill and muscle tissues retained normal histological architecture in the majority of examined specimens. Integrating histopathological biomarkers provides a cost-effective, reliable baseline for monitoring deep-water benthic health and evaluating the long-term ecological trajectory of the Libyan coastline.
Copyright (c) 2026 Asma Elbahi, Shaima Mahgiubi, Khawla Bukha, Samira Shlayek https://creativecommons.org/licenses/by/4.0
Hemostatic Role of Local Anesthetic Techniques in Major Orthopedic Joint Surgery: Mechanisms, Adjuvants, and Clinical Applications. A Narrative Review
Intraoperative joint bleeding during major orthopedic surgeries, particularly total joint arthroplasty (TJA) and arthroscopic procedures, represents a clinically significant challenge that prolongs operative time, obscures the surgical field, and increases the risk of postoperative complications, including hematoma and the need for blood transfusion. Although systemic antifibrinolytics such as intravenous Tranexamic acid (TXA) remain the standard of care, local anesthetic (LA) techniques are increasingly recognized for their direct modulatory effects on surgical site microvasculature. This narrative review examines the pharmacological mechanisms, comparative hemostatic profiles, and synergistic potential of key local anesthetic delivery techniques, including Local Infiltration Analgesia (LIA), peripheral nerve blocks (PNBs), neuraxial anesthesia, and intra-articular injections, in reducing intraoperative joint bleeding.
Copyright (c) 2026 Rabe Altomi, Mesad Ghula, Ayoub Dhu, Abdulwhab Almahroug, Fadia Oshkondale https://creativecommons.org/licenses/by/4.0
The Influence of AI-Powered Learning Tools on Academic Student Performance in Higher Education
Academic learning has been transformed since the integration of Artificial Intelligence (AI) in education, offering opportunities for students’ development. This study aims to examine the effect of AI-powered tools on academic performance, conducted among students at the Faculty of Education at Ajilat city. Also, the analysis explores the potential benefits and challenges of AI technology in education. Data were collected using Google Forms via a 39-item questionnaire, as follows: 20 questions assessing AI-powered tools and 19 questions measuring academic student performance. The total number of respondents was 175 male and female students. The data analysis was conducted using the SPSS program and Smart Pls software. Quantitative data were analyzed using frequency and percentage (demographic variables) calculations by SPSS. The percentage of males was 16 (9.1%), and the percentage of females was 159 (90.9%). Descriptive analysis for academic performance and AI-powered tools showed that both of them had a positive effect on their studies, represented respectively as (3.53) and (3.67). Quantitative responses were subjected to thematic analysis using smart pls (SEM). This allows us to analyze both direct effects and test if relationships are linear or nonlinear (between the dependent variable and independent variable); there was a significant, large positive relationship between them, R2 (50%) and Beta (0.709). Also, evaluate the relationship's strength and significance through indicators like outer loadings, path coefficients, and Average Variance Extracted (AVE), as explained by CA (0.945) and (0.972) and AVE (0.567) and (0.683).
Copyright (c) 2026 Awatef Saad, Aziden Abokhwet, Reda Shaban https://creativecommons.org/licenses/by/4.0
Detection of Mitochondrial DNA Deletion in Medical Workers Occupationally Exposed to Ionizing Radiation in Tripoli, Libya
Occupational exposure to low-dose ionizing radiation poses chronic health risks to radiology personnel. While traditional monitoring captures recent damage, modern molecular epidemiology focuses on mitochondrial DNA (mtDNA) alterations. Due to limited repair mechanisms, the mitochondrial genome is highly sensitive to radiation, making mtDNA alterations valuable biomarkers for cumulative genetic injury. This study aimed to assess the potential induction of the mtDNA4977 deletion and variations in mtDNA-CN in the blood of staff members working in radiology departments across three medical facilities in Tripoli, Libya. A total of 72 participants were recruited from Metiga Military Hospital, Alkhadra General Hospital, and the National Center for Disease Control–Libya between July and October 2024. The study population included 50 radiation-exposed workers (Group A) and 22 non-exposed individuals (Group B). Data were obtained using a structured questionnaire and peripheral blood sampling. Quantitative real-time PCR was applied to evaluate mtDNA-CN and detect the mtDNA4977 deletion. ΔCt values for mtDNA4977 were significantly lower in the radiation-exposed group than in controls, indicating higher levels of mitochondrial DNA deletions among exposed workers. mtDNA-CN was also significantly reduced in the exposed group, suggesting possible radiation-induced mitochondrial depletion. Multivariable linear regression models further confirmed that occupational radiation exposure remained an independent and highly significant predictor of both mitochondrial alterations, even after adjusting for age and smoking status. These findings demonstrate a clear association between occupational exposure to ionizing radiation and alterations in mtDNA. Increased mtDNA4977 deletions and reduced mtDNA-CN among exposed workers highlight their potential as biomarkers of chronic radiation exposure. Consequently, these results underscore the critical importance of continuous biological monitoring and reinforcement of protective measures for radiology staff.
Copyright (c) 2026 Nisreen Aqeelah, Mustafa Drah, Abdulla Bashein, Taher Shaibi, Hanan Aqeehal https://creativecommons.org/licenses/by/4.0
The Barkhausen Effect and Magnetization Dynamics in Ferromagnetic Materials: A Systematic Review
The Barkhausen effect, discovered by Heinrich Barkhausen in 1919, describes the discontinuous nature of magnetization in ferromagnetic materials, wherein magnetization proceeds through discrete microscopic jumps rather than as a continuous process. This review examines the theoretical foundations and experimental investigations of the Barkhausen phenomenon, with particular emphasis on the influence of magnetizing field amplitude on hysteresis loop characteristics and domain wall dynamics. The underlying physical mechanism arises from the interplay between elastic domain walls and quenched structural disorder, where defects such as dislocations, grain boundaries, and precipitates serve as pinning centers that induce avalanche-like magnetization jumps. Recent experimental advances have achieved single-pulse resolution of domain wall depinning events, revealing exponential relaxation dynamics with time constants of approximately 3.8 microseconds. Theoretical frameworks based on interface depinning in random media provide a comprehensive understanding of the critical behavior, characterized by power-law avalanche distributions and universal scaling exponents. The universality class is determined by the relative dominance of long-range dipolar versus short-range elastic interactions, with stress-induced anisotropy capable of shifting the system between universality classes. Hysteresis loops in Metglas 2605Sc demonstrate systematic variations with field amplitude: maximum induction increases monotonically toward saturation at approximately 1.6 T above 600 A/m, while losses exhibit non-monotonic behavior peaking at 450 A/m. These observations carry significant implications for understanding nonequilibrium magnetization dynamics and practical applications including non-destructive material characterization and industrial quality control.
Copyright (c) 2026 Sarah Alwashahi, Aiyada Alsalahi, Asma Elmahdi https://creativecommons.org/licenses/by/4.0
Why Do Dental Implants Fail?: A Single Center Experience
Dental implants demonstrate high long-term success; however, failures still occur because of multifactorial biological, mechanical, and patient-related factors. This retrospective single-center study evaluated implant failures at a private clinic in Benghazi, Libya, over eight years (2016–2023). Among 1,602 implants placed in 791 patients, 46 implants failed, yielding an overall failure rate of 2.8%. Early failures were primarily associated with smoking, impaired healing, poor bone quality, and compromised periodontal health, whereas late failures were predominantly related to parafunctional habits, particularly bruxism, resulting in prosthetic and mechanical complications. Careful preoperative assessment, periodontal management, smoking cessation, and long-term maintenance are essential to minimize implant failure and improve treatment outcomes.
Copyright (c) 2026 Nuora Alhassi, Aymen Elatrash, Ala Darrat https://creativecommons.org/licenses/by/4.0
Knowledge, Attitude, and Practice About Antibiotic Misuse and Antimicrobial Resistance Among the Libyan Community
Antimicrobial resistance (AMR) is an urgent, critical global health issue due to bacterial infections that are known as the second leading cause of death worldwide. Antibiotic overuse and misuse remain the main drivers of resistance development. The high rate of Antimicrobial Resistance (AMR) has been exacerbated worldwide, including in North Africa, and Libya is no exception. To assess the knowledge, attitudes, and awareness regarding antibiotic use among the Libyan population. A descriptive cross-sectional study was done online through Google Forms from August to October of 2025. A Questionnaire was sent to the general population across Libya by sharing a link through popular social media groups. A total of 260 responses were received from different cities across Libya. Most of the participants were well-educated (94.6%), in their middle age (31–45) years old (52.3%). The majority of them were female (77.3%). 65.8% of the participants correctly reported that antibiotics are not used to treat viral infections; most individuals are cautious and acknowledge the potential risks of using antibiotics without a prescription, with 62.7%, believing that it is acceptable only in rare cases. Despite a good level of knowledge, 71.9 % reported that they had previously purchased antibiotics without a prescription. The results also indicated that 58.1% have a good level of awareness of the term antibiotic resistance. Most respondents show responsible behavior by completing their antibiotic course, with just 15.4% admitting that they stop taking antibiotics once they feel better. A large majority, 72.3%, are supporters of stricter regulations. This finding will be useful in designing effective and targeted interventions to decrease misconceptions about antibiotic use and to increase awareness about the risks of inappropriate use of antibiotics in the community.
Copyright (c) 2026 Fathia Bougafa, Aisha Almgarbi, Mareia Elghalidh https://creativecommons.org/licenses/by/4.0
Comparative Analysis of Surgical Outcomes and Recurrence Rates Following TAPP, TEP, and Open Inguinal Hernia Repair: A Retrospective Cohort Study of 146 Patients at Al‑Jala Hospital and Taknis General Hospital, Libya
Inguinal hernia repair is one of the most frequently performed operations in general surgery. Open mesh repair and laparoscopic techniques, namely Transabdominal Pre-peritoneal (TAPP) and Totally Extra-peritoneal (TEP) repair, are widely accepted approaches. However, differences in postoperative outcomes and recurrence rates continue to be debated. This study was conducted to compare the surgical outcomes and recurrence rates of TAPP, TEP, and open inguinal hernia repair. A comparative study was conducted among patients who underwent inguinal hernia repair using TAPP, TEP, or open mesh repair. Patient demographics, operative time, length of hospital stay, postoperative pain, complications, time to return to normal activities, and recurrence rates were evaluated. Outcomes were compared among the three surgical groups. Among 146 patients, 40 (27.4%) underwent TAPP repair, 30 (20.5%) underwent TEP repair, and 76 (52.1%) underwent Open Lichtenstein repair. Mean operative time was significantly longer in the laparoscopic groups (TAPP: 85.4 ± 18.2 min; TEP: 78.6 ± 16.4 min) compared with open repair (58.3 ± 14.1 min; p < 0.001). Hospital stays, postoperative pain scores, and time to return to normal activities were significantly lower in the laparoscopic groups. No hernia recurrences were observed during a mean follow-up period of approximately 12 months. TAPP, TEP, and open inguinal hernia repair are safe and effective techniques with comparable recurrence rates. Laparoscopic approaches offer advantages in postoperative recovery, while open repair remains a reliable and cost-effective option. Surgical approach selection should be individualised according to patient characteristics, hernia complexity, available resources, and surgeon expertise.
Copyright (c) 2026 Khaled Alsherif https://creativecommons.org/licenses/by/4.0
Tumor-infiltrating Lymphocytes in Breast Cancer: Prognostic Significance, Spatial Heterogeneity, And Emerging AI-based Assessment Approaches
Tumor-infiltrating lymphocytes (TILs) represent a crucial component of the tumor microenvironment in breast cancer (BC), playing a significant role in tumor progression, immune surveillance, and therapeutic response. This review provides a comprehensive synthesis of current evidence regarding the prognostic and predictive significance of TILs across breast cancer molecular subtypes, with particular emphasis on luminal breast cancer and recent advances in artificial intelligence (AI)-based assessment approaches. A narrative review with a structured literature search was conducted using major biomedical databases, including PubMed, Scopus, and Web of Science, to identify relevant studies published between 2014 and 2025. Current evidence demonstrates that high stromal TIL levels are strongly associated with improved overall survival, disease-free survival, and pathological complete response in triple-negative breast cancer (TNBC) and HER2-positive breast cancer. In contrast, the prognostic role of TILs in luminal breast cancer remains controversial, largely due to lower baseline immune infiltration, biological heterogeneity, and methodological variability across studies. Novel computational approaches, including deep learning-based TIL assessment systems, may provide more consistent quantification of TIL density and spatial distribution patterns, with potential to improve prognostic stratification. Emerging evidence suggests that not only TIL density but also spatial organization, including aggregated and diffuse immune infiltration patterns, significantly influences clinical outcomes. Compared with conventional histopathological evaluation, AI-driven models have shown potential to improve reproducibility, quantitative precision, and spatial characterization. This review highlights the need for standardized TIL assessment methodologies and supports the integration of digital pathology and AI-based tools into clinical practice to improve prognostic accuracy and facilitate personalized therapeutic decision-making in breast cancer.
Copyright (c) 2026 Salem Harsha; Amina Al-Mahjoub https://creativecommons.org/licenses/by/4.0
Randomized Controlled Trial in the Libyan Population: Comparing Fetal Outcomes in Gestational Diabetes Mellitus Patients Treated with Metformin versus Insulin
The study aimed to evaluate the neonatal outcomes in patients with gestational diabetes mellitus (GDM) treated with metformin versus those treated with insulin. 140 participants diagnosed with GDM were included in this study. They were randomized into two groups: one group received metformin, and the other group received insulin. There were no adverse neonatal outcomes such as intrauterine growth retardation, premature labor, birth asphyxia, birth trauma, placental abnormalities, perinatal death, low birth weight, or any neonatal ward admission in patients treated with metformin. The incidence of premature labor and fetal distress was higher in patients treated with insulin.
Copyright (c) 2026 Omaima Getlawi, Salima Hawda, Salha Falgosh https://creativecommons.org/licenses/by/4.0
Paradoxical Hepatic-lipid Associations in Libyan Type 2 Diabetes: A Case-control Study
Prevalence of type 2 diabetes mellitus (T2DM) in Libya is high and often accompanied by the presence of metabolic dysfunction-associated steatotic liver disease (MASLD) and atherogenic dyslipidemia. This case-control study explored associations of liver biomarkers with lipid profile parameters in Libyan adults with T2DM versus non-diabetic controls. The study included 176 individuals (89 patients with T2DM and 87 age- and sex-matched controls). Levels of biochemical parameters, including ALP, ALT, AST, TB, DB, TP, Alb, TG, TC, HDL-C, and LDL-C, were measured using automated assays. Statistical methods used in this study include the Mann-Whitney U test, Spearman's correlation, MANOVA, and linear regression. The T2DM group demonstrated statistically significant decreases in ALP (p=0.030), TB (p=0.010), and DB (p=0.001) levels compared to the control group. No statistically significant difference was found for ALT, AST, TP, albumin, TG, TC, HDL C and LDL C levels. Inverse correlation was found between the following parameters: ALT with HDL C (r=−0.187, p=0.013); TB with HDL C (r=−0.153, p=0.043) and LDL C (r=−0.217, p=0.004); DB with TC (r=−0.215, p=0.004) and LDL C (r=−0.279, p<0.001); TP with HDL C (r=−0.226, p=0.003). FBS was found to be an independent predictor of ALP (B=−0.262, p=0.010), AST (B=−0.038, p=0.047) and TG (B=0.774, p=0.002). Gender had a significant impact on several parameters: males had higher ALT (p=0.032), TB (p=0.032), DB (p=0.002), and TG (p=0.015), whereas females had higher TC (p=0.039), HDL C (p=0.001) and LDL C (p=0.008). Neither age nor BMI category had a significant effect on any studied parameter (all p>0.05). Decreased levels of ALP and bilirubin in Libyan patients with T2DM and inverse correlation between liver biomarkers (ALT, bilirubin fractions, TP) and lipid parameters (HDL C, LDL C, TC) demonstrate an association of hepatic function with lipid metabolism independent of elevation of traditional liver biomarkers. Gender-specific changes underline the necessity of developing a sex-tailored monitoring strategy. Regular measurement of ALP, bilirubin, and FBS along with lipid profiles can help detect early stages of metabolic impairment in this population.
Copyright (c) 2026 Zaid Jaber, Ahmed Menshaz, Salem Alarkat, Ali Shalaweh https://creativecommons.org/licenses/by/4.0
Clinical Diagnostic Performance of Panoramic Radiography and the Complementary Role of Cone Beam Computed Tomography in Maxillary Sinus Pathology
The maxillary sinus is closely related to the posterior maxillary teeth, making accurate radiographic evaluation essential for diagnosing odontogenic and non-odontogenic sinus pathologies and guiding appropriate treatment planning. This study aimed to evaluate the diagnostic performance of panoramic radiography (OPG) compared with cone beam computed tomography (CBCT) and to identify the maxillary sinus lesions that can be reliably detected on panoramic imaging. A retrospective cross-sectional study was conducted using 437 panoramic radiographs obtained from patients attending public dental clinics in Misurata, Libya. Among these, 316 patients underwent CBCT on the same day, allowing direct paired comparison between imaging modalities. CBCT served as the reference standard. Evaluated pathologies included mucosal thickening, odontogenic and non-odontogenic sinusitis, mucous retention cysts, mucosal polyps, foreign bodies, mucoceles, oroantral fistulas, fluid accumulation, and tumors. Statistical analysis was performed using the chi-square test and McNemar's test, with statistical significance set at P < 0.05. Mucosal thickening was the most common finding (26%), followed by non-odontogenic sinusitis (18%), odontogenic sinusitis (13%), mucosal polyps (10%), mucous retention cysts (8%), and foreign bodies (2%). OPG detection varied significantly according to lesion type (χ² = 71.38, P < 0.001). Compared with CBCT, panoramic radiography demonstrated significantly lower sensitivity for subtle inflammatory lesions, whereas well-defined lesions, including mucous retention cysts and mucosal polyps, were reliably identified. CBCT provided superior assessment of lesion morphology, disease extent, and tooth–sinus anatomical relationships. Panoramic radiography remains a valuable, accessible first-line imaging modality for the initial evaluation of maxillary sinus pathology. However, CBCT should be considered when subtle inflammatory disease, odontogenic extension, or detailed anatomical assessment is required. A stepwise imaging approach integrating both modalities may improve diagnostic accuracy and clinical decision-making.
Copyright (c) 2026 Ibtisam Senussi, Antisar Ben Amer, Aya Krayem, Salem Elgelaib https://creativecommons.org/licenses/by/4.0
Existence and Uniqueness of Solutions for the Bagley–Torvik Problem Involving the Hilfer Fractional Derivative
In this paper, we investigate the existence and uniqueness of solutions for the Bagley–Torvik equation involving the Hilfer fractional derivative. By transforming the original fractional integro-differential equation into an equivalent integral equation, the problem is reformulated in a framework suitable for fixed-point analysis. The existence of at least one solution is established by applying the Schauder fixed-point theorem, while the uniqueness of the solution is obtained under an appropriate Lipschitz-type condition using the Banach contraction principle. The proposed approach provides a rigorous theoretical framework for analyzing Bagley–Torvik equations with Hilfer fractional derivatives.
Copyright (c) 2026 Amna Al-Hawari, Masouda Al-Fadel https://creativecommons.org/licenses/by/4.0
Influence of Dietary and Non-Dietary Factors on Urticaria
Urticaria is a significant public health concern and common dermatological disease characterized by recurrent episodes of itching, redness, and wheals, which can be triggered by dietary and non-dietary factors, including food intake, psychological stress, vitamin D deficiency, and heat exposure, and have been implicated in triggering or exacerbating symptoms. A cross-sectional, self-reported survey was conducted in Zawia City, Libya, between November 2025 and February 2026 among patients attending multiple centers, including Alshorouk Clinic and Al Mutrad Hospital, as well as students from the Faculty of Medical Technology. The study aimed to identify the most commonly reported food allergens associated with urticaria and to evaluate the influence of non-dietary factors, including psychological stress, heat exposure, and vitamin D deficiency. Of 200 respondents with urticarial disease who completed the questionnaire, 92% were female. Nearly half of the participants had daily wheals, with half of the participants reporting three or more episodes per week; more than half of the participants reported a duration of wheals was 1- 12 h. Regarding associated symptoms, itching was reported by the majority of participants, followed by Redness and Angioedema. A significantly higher association between vitamin D deficiency and monthly episodes compared to those with normal levels (median: 4 vs 2 episodes, Mann-Whitney U test, p <0.001). Furthermore, severe itching was significantly associated with both spicy food consumption and psychological stress p <0.001. Environmental exposure was identified as a contributing factor, with 112 of the participants (56%) reporting heat exposure. In conclusion, urticaria is impacted by multiple dietary and non-dietary factors. Vitamin D deficiency, heat exposure, spicy food, and psychological stress were associated with more frequent urticaria episodes, while Food additives, Heavy meals, Tomatoes, and dairy were identified as important symptom triggers. Identifying these factors may help improve symptom control, and further studies are recommended to evaluate lifestyle.
Copyright (c) 2026 Fahima Albeshti, Ayah AL-Hanish, Waed Ghallab, Rawia Khair-Allah, Hamdi Aljabu https://creativecommons.org/licenses/by/4.0
Evaluation of Knowledge, Attitudes, And Practices of Thyroid Disorders and Risk Factors Among Women of Zawia City of the Western Region of Libya
The occurrence of thyroid disorders is a highly frequent health issue. Thyroid disorders represent one of the most prevalent medical conditions globally. In the North Africa and Middle East (NAME) region, a health systems evaluation has highlighted a higher prevalence of risk factors for thyroid disease, particularly those related to iodine deficiency. Thyroid issues are quite prevalent in women of reproductive age. Pregnancy has a notable effect on thyroid function, resulting in an almost 50% rise in the synthesis of thyroid hormones, thyroxine (T4) and triiodothyronine (T3), and a 50% rise in daily iodine needs. This study aimed to investigate the level of awareness and knowledge of thyroid disorders among the Libyan female population in Zawia Diabetic Center and the factors leading to increased rates of thyroid disorders in Zawia, Libya. This is a cross-sectional study conducted among females aged 18 years and older who currently reside in Zawia in the Western region of Libya. A total of 103 female participant, majority of the respondents were aged 41–55 years (39.8%), married (72.8%), and had a high educational level (62.1%). Most of them, 79 (76.7%), had thyroid disease before. Overall, 64 (62.1%) participants had poor knowledge, whereas 39 (37.9%) demonstrated good knowledge regarding thyroid disorders. Age was significantly associated with knowledge level (p = 0.011). We recommended doing activities that focus on increasing the knowledge and awareness of the public regarding thyroid disorders.
Copyright (c) 2026 Mufida Khetresh, Hamzah Shaeroun, Fadya Shakhim, Hind Gazeti, Najah Ebrahim https://creativecommons.org/licenses/by/4.0
Blood Lead Levels among Gas Station Employees in Al Ajaylat City, Libya
A cross-sectional study was conducted in the city of Al Ajaylat, Libya, between June and August 2025. 30 randomly selected individuals from four fuel stations were selected among six fuel stations in the center of Al Ajaylat city. They provided verbal consent to give blood samples and complete a questionnaire designed to collect information on past and current medical records, including age, work duration, cigarette smoking, disease history, and total exposure time to lead. The first group (Case) was the study group, consisting of 15 fuel station workers randomly selected from those directly engaged in activities involving lead or gasoline exposure. The second group (Control) was the control group, consisting of 15 fuel station workers selected randomly from those who do not engage in activities involving lead. Their average weekly working hours were 12, and most had worked for at least six months. Blood samples were collected for analysis, and general characteristics of participants were assessed through interviews using the questionnaire. Exclusion criteria included participants unwilling to join the study, those younger than 15 or older than 65 years, and individuals reporting chronic diseases. Results indicate that every sample from the study group and every sample from the control group was reported as “<LOD”. As no measurable blood lead concentration data were obtained, statistical comparisons were not performed. The evaluation was therefore restricted to detection frequency, which was uniformly 0% across both groups. This finding suggests that no differences were observed between the fuel station workers study group (Case) and controls with respect to detectable blood lead levels, suggesting the absence of any measurable increase in exposure among the occupational group. The analysis showed that all blood samples in both groups were below the detection limit (1.0 µg/dL).
Copyright (c) 2026 Najah Althabit, Antisar Bashouk, Emabrok Masaoud https://creativecommons.org/licenses/by/4.0
Clinico‑Epidemiological Profile of Patients Attending the Sexually Transmitted Disease Clinics at Tripoli Central Hospital and Beer Usta Milad Hospital
Venereal diseases: historically used to refer to infections that are transmitted sexually, like condyloma acuminata, syphilis, herpes, gonorrhea, molluscum contagiosum, and HIV. These disorders are now referred to as sexually transmitted diseases (STDs) or sexually transmitted infections; terms that directly reflect recognition that they are caused mainly by sexual contact with an infected person. A retrospective case series study was conducted using the medical records of all STD patients who attended the STD clinic in Tripoli Central Hospital and Beer-Usta Milad Hospital during the time period from 2010 to 2020. The data were collected and analyzed using the SPSS program version 21. A series of 333 patients was studied and demonstrate that 122 (36.6%) of patients were males while 211 ( 63.4%) females with ratio of (1:1.73); On assessing their ages, the youngest age was 2 years and the oldest was 70 years old with the mean age of 33.47±11.32, most of the patients were Libyan (88.9%) and (11.1%) were non Libyan, the most frequent diagnosis was genital warts (84.68%) followed by syphilis (11.41%), Gonorrhea (1.20%), Molluscum Contagisum ( 0.6%) then Herpes Genitals (0.6%), only (1.2%) were homosexual, (9.01%) of the patients had more than one sexual partner, (6.31%) were confirmed to have HIV infection, ( 1.5%) were drug abusers and only ( 10.51%) gave history of using condom. In our study, we concluded that STDs are common in the young adults’ group between 21 and 30 years (42%), with female predominance 63.4% and most of our patients are heterosexual, having only one partner. Genital warts are recognized to be the most common diagnosis (84.68%), followed by syphilis (11.41%), and syphilis X is identified to be more frequent among non-Libyans. We recommend doing more studies with a large sample size from different geographical areas in Libya to assess the true burden of STDs and ensure a good survey leading to better diagnosis and adequate treatment of STDs.
Copyright (c) 2026 Halima El-Megei, Haneen Almagouz https://creativecommons.org/licenses/by/4.0
Prevalence, Risk Factors, Awareness, Treatment, and Control of Hypertension among Adults Attending Jadu Hospital, Libya: A Hospital-Based Study
Hypertension is the most critical modifiable risk factor for cardiovascular disease and a leading cause of premature mortality worldwide. Despite its increasing burden in Libya, data on hypertension prevalence, awareness, treatment, and control from hospital-based populations remain limited. This study aimed to determine the prevalence, awareness, treatment, control, and associated risk factors of hypertension among adults attending Jadu Hospital in western Libya. A cross-sectional study was conducted among 150 adults aged ≥35 years attending Jadu General Hospital over one year. Blood pressure was measured using standardized protocols. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication. Data on sociodemographic characteristics, medical history, and hypertension awareness were collected using a structured questionnaire. Multivariable logistic regression was performed to identify factors associated with hypertension awareness. The overall prevalence of hypertension was 84.7% (n=127). The mean age was 59.04 ± 12.14 years, with 60% female participants. Hypertensive participants were significantly older than non-hypertensive participants (60.54 ± 12.07 vs. 50.78 ± 8.87 years, p<0.001). Diabetes mellitus was significantly more prevalent among hypertensive participants (22.0% vs. 4.3%, p=0.048). Hypertension prevalence increased significantly with age, rising from 68.4% among participants aged 35-50 years to 97.7% among those aged >65 years (p<0.002). Among hypertensive participants, awareness and treatment rates were 63.0%, and blood pressure control was achieved in 41.3% of those treated. Older age was significantly associated with higher awareness and treatment rates (p=0.002). Multivariable analysis demonstrated that increasing age was independently associated with lower odds of lacking hypertension awareness (adjusted OR=0.962, 95% CI: 0.930-0.994; p=0.022). This study reveals a high prevalence of hypertension among adults attending Jadu Hospital, with advancing age being the strongest predictor. Although older participants demonstrated higher awareness and treatment rates, blood pressure control remained suboptimal. These findings highlight the urgent need for comprehensive public health strategies focusing on early detection, effective treatment, lifestyle modification, and regular follow-up, particularly among older adults and other high-risk populations in Libya.
Copyright (c) 2026 Sobhia Draibi, Fatma Alatrag, Hala Araibi, Ebtehal Eshiak, Entesar Judam https://creativecommons.org/licenses/by/4.0
Assessment of Oral Health Knowledge, Attitudes, and Practices Among Diabetic Patients: A Cross-Sectional Study in Gharyan, Libya
The present study aimed to assess the knowledge of diabetic patients regarding diabetes-related systemic and oral complications and to evaluate their attitudes toward maintaining good oral health and their oral hygiene practices, including regular dental visits. A cross-sectional study was conducted at Gharyan Educational Hospital, Gharyan, Libya, between November 2025 and January 2026. A total of 134 diabetic patients attending scheduled outpatient clinics were enrolled. The study found that 60.5% of participants were aware that diabetes increases the risk of oral disease, with a high awareness of xerostomia (91%). However, knowledge of specific complications was lower; only 46.2% identified dental caries and 42.6% identified oral fungal infections as related risks. Regarding systemic health, patients showed higher awareness of diabetic foot and eye complications than of nerve or kidney complications. While 73.9% of participants reported brushing their teeth, only 41.8% did so twice daily. Furthermore, 44.8% visited the dentist less than once a year, and 41% could not remember their last visit. The primary sources of information were diabetologists (52.9%) and various media (50%), with 98.5% of participants expressing a desire for more education on this topic. Diabetic patients in Gharyan demonstrated a moderate level of knowledge regarding diabetes-related oral health. While attitudes toward oral hygiene are generally positive, there are significant gaps in knowledge regarding specific oral complications. The findings suggest an urgent need to integrate oral health education into routine diabetic care and to strengthen collaboration between physicians and dentists to improve overall patient outcomes.
Copyright (c) 2026 Rajaa Fadel, Wafa Abozaid, Amal Daba, Hosam Elarabi https://creativecommons.org/licenses/by/4.0
Digital Genetic Diagnosis of Malaria Using Explainable Deep Learning
Malaria, caused by Plasmodium spp., remains a leading cause of mortality in sub-Saharan Africa, with an estimated 282 million cases and 610,000 deaths in 2024. The var gene family primarily drives the virulence of P. falciparum, encoding the polymorphic adhesin PfEMP1, which mediates cytoadherence and immune evasion while inducing a quantifiable morphological footprint on host erythrocytes, including knob formation and altered deformability. However, current diagnostic tools remain decoupled from this genotype–phenotype nexus, and conventional convolutional neural networks treat all infected cells as a homogeneous class while their "black-box" nature obstructs clinical translation. This study aimed to develop a lightweight, interpretable CNN framework that classifies malaria-infected erythrocytes and integrates explainable AI (XAI) to semi-quantitatively infer var gene expression activity (PfEMP1 surface density) directly from cellular morphology—a concept defined as digital genetic diagnosis. A streamlined CNN architecture was trained on the NIH malaria dataset (27,558 single-cell images) for binary classification, employing feature activation mapping for interpretability and developing a novel Digital Protein Expression Density (DPED) algorithm. The model achieved an overall accuracy of 90.8% (sensitivity: 96.2%; specificity: 86.6%; ROC-AUC: 0.9724), with XAI activation maps demonstrating selective attention to intra-erythrocytic parasites and membrane regions consistent with knob architecture, while DPED maps successfully delineated high-density regions spatially correlated with predicted PfEMP1 anchorage sites, establishing a quantifiable link between routine microscopy and inferred genetic activity. This study provides the first proof-of-concept that lightweight, interpretable CNNs can bridge molecular parasitology and digital pathology by enabling the inference of parasitic genetic activity from standard blood smear images, offering a scalable, low-cost diagnostic adjunct suitable for resource-limited settings and introducing a novel paradigm for digital genetic diagnosis in infectious disease pathology.
Copyright (c) 2026 Hana Husayn https://creativecommons.org/licenses/by/4.0
Prevalence of Cancer in the Middle Region of Libya According to the National Cancer Institute of Misurata In 2022
This study was conducted on data registered at the National Cancer Institute of Misurata in the year 2022. This study aimed to determine the most registered tumors and the most registered age groups, as well as the cities from which the cases were received. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) program, version 22. A total of 786 confirmed cases during the year 2022 were included in the analysis. The results of the statistical analysis revealed that the 51–60 age group exhibited the highest cancer frequency, accounting for 22.9%, whereas the 11–20 age group registered the lowest proportion, at just 1.9%. In terms of cities, the highest proportion of cases was in the city of Misurata, at a rate of 40.7%, where the number of cases reached 320, and the lowest proportion of cases was in the city of Misallata, where the number of cases reached 42. In terms of type, the highest frequency was observed for breast cancer, representing 23.3% (183), while the lowest frequency was noted for esophageal cancer, comprising merely 0.3%, reaching two. In terms of gender, the highest prevalence rate was for females, at a rate of 54.3%, where the number of cases reached 427 cases, and the lowest prevalence rate was for males, at a rate of 45.7%, where the number of cases reached 359 cases. According to the results obtained, it is recommended to hold a scientific seminar for community education about the symptoms of cancer and the importance of early diagnosis through the implementation of screening programs for cancer.
Copyright (c) 2026 Walid Naamat, Mohammed Abosalah, Ahmed Albakoush, Abdullah Aboughuffah, Naji Ishkartu, Muna Al-Mhashi, Huda Alahwal https://creativecommons.org/licenses/by/4.0