Abstract Introduction: Extended-spectrum β-lactamases (ESBLs), AmpC type, carbapenem resistant Enterobacteriaceae (CRE), are important mechanisms of resistance among Enterobacteriaceae. The aim of this study was to investigate the prevalence of ESBL, AmpC and CRE among Enterobacteriaceae isolates recovered from pediatric patients in Tripoli, Libya. Methods: This cross-sectional study was carried out in Tripoli Children Hospital (TCH), a total of 915 Gram negative bacteria isolates were evaluated for susceptibility to a panel of antimicrobials and were analyzed phenotypically for the ESBL, AmpC type and CRE using chromagen media, E-test and combination disc test. Results: The predominant organisms were Escherichia coli (56.8%) and Klebsiella spp. (21.4%). The overall prevalence of ESBL producing Enterobacteriaceae was 24.5% (224/915). Out of 224, Enterobacteriaceae proved ESBL producer, Klebsiella spp. (54%) and E. coli (34.4%) were the leading ESBL producers. ESBL-producers were more often resistant to major classes of antibiotics compared with non-ESBL producers, significantly high resistance rates (P < 0.001) were observed for ceftriaxone, cefepime, and ceftazidime (87.5 - 95.9%) among ESBL producers compared to non-ESBL producers (7.2 - 13.5%). MDR was documented for 50/224 (22.3%) of ESBL producers and was significantly higher (P < 0.0001) among ESBLs compared with non-ESBL producer isolates. Phenotypic detection of AmpC revealed 60/915 (6.6%) isolates as potential AmpC β-lactamase producers, E. coli exhibited a lower level of AmpC (8.3%) compared with Klebsiella spp. (56.6%). The overall prevalence of CRE was 9% (83/915). Carbapenemase-producing organisms in this study were as follows: Klebsiella spp. (44.6%); Acinetobacter spp. (24%); Pseudomonas spp. (9.6%). Conclusion: This study revealed that the prevalence of ESBL, AmpC, CRE and MDR Enterobacteriaceae isolates in Children hospital was within acceptable frequency. arabic 11 English 91
Abdulaziz Zorgani, Abdulla Bashein, (1-2017)

Objective: In Libya, no pertussis booster doses are administered to children after 18 months of age. In light of evidence of waning of vaccine-induced immunity to pertussis, this study aimed to evaluate the waning of immunity in vaccinated school-entry age children, as measured by susceptibility to infection at population level. For this purpose, IgG and IgA levels were measured as markers of recent (infection in the last 6 months) and non-recent infections (infection in the last 12 months). Material and Methods: This was a cross sectional study undertaken in Tripoli, in February 2015. Children of school-entry age (> 5 to ≤ 7 years) were recruited on convenience basis at vaccination centers. Sera were tested for antibodies to pertussis. Results: Samples from791 children (421 males and 370 females, mean age 6.50 were tested). All of the participants had received 4 doses of Whole cell pertussis containing vaccine in the first 2 years of life. The prevalence of recent and non-recent pertussis infection were 4.8% and 2.5%, respectively. The proportion of children with undetectable level of IgG was 76.1%. Conclusion: The findings of this study showed significant circulation of Bordetella pertussis among vaccinated children by school-entry age. The circulation of B. pertussis in this population may be an indirect sign of waned immunity, which is simply corroborated by the absence of detectable antibodies in 76.1% of the children. arabic 14 English 76
Suleiman Abusrewil, Abdulla Bashein(1-2019)

The pattern of diabetic deaths in the medical wards of Tripoli Medical Centre was retrospectively studied. During a three‐year period, 575 diabetic deaths occurred, accounting for 26.2% of all medical deaths. The mean age at death was 65.33±12.7 years. Cardiovascular disease (183 [31.8%]), cerebrovascular accidents (102 [17.7%]) and infection (83 [14.4%]) were the most common complications associated with diabetic deaths. Other causes were malignancy (10%), liver cirrhosis (5.6%), and acute diabetic complications (5%). Forty‐five (7.8%) deaths unaccountable for may be due to other unknown causes. Factors predictive of mortality, such as admission diagnosis of hyperosmolar non‐ketotic state, cerebrovascular disease, acute coronary syndromes or infection were associated with poor prognosis. Admission hyperglycaemia, old age, renal dysfunction and prior stroke were also associated with poor admission outcome. The excess mortality, mainly due to atherosclerotic complications, is potentially preventable through implementation of serious approaches to the management of cardiovascular risk factors. arabic 8 English 64
Hawa Juma El-Shareif(7-2010)