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PURPOSE: To assess the role of radiomics in detection of high-risk (pT3-4) colon cancer and develop a combined model that combines both radiomics and CT staging of colon cancer.METHODS: We included 292 colon cancer patients who underwent pre-operative CT and primary surgical resection within 2 months. Three-dimensional segmentations and CT staging of primary colon tumors were done. From each 3D segmentation of colon tumor, radiomic features were automatically extracted. Logistic regression analysis was performed to identify associations between radiomic features and high-risk (pT3-4) colon tumors. A combined model that integrated both radiomics and CT staging was developed and their diagnostic performance was compared with that of conventional CT staging. Tenfold cross-validation was used to validate the performance of the model and CT staging.RESULTS: The model that combined radiomic features and CT staging demonstrated a significantly better performance in detection of high-risk colon tumors in training set (AUC = 0.799, 95% CI: 0.720-0.839 for combined model and AUC = 0.697, 95% CI = 0.538-0.756 for CT staging only, p CONCLUSION: CT radiomic features of primary colon cancer, combined with CT staging, can improve the detection of high-risk colon cancer patients.

Objectives In many countries, workers who developed asbestosis due to their occupation are eligible for government support. Based on the results of clinical examination, a team of pulmonologists determine the eligibility of patients to these programs. In this Dutch cohort study, we aim to demonstrate the potential role of an artificial intelligence (AI)-based system for automated, standardized, and cost-effective evaluation of applications for asbestosis patients. Methods A dataset of n = 523 suspected asbestosis cases/applications from across the Netherlands was retrospectively collected. Each case/application was reviewed, and based on the criteria, a panel of three pulmonologists would determine eligibility for government support. An AI system is proposed, which uses thoracic CT images as input, and predicts the assessment of the clinical panel. Alongside imaging, we evaluated the added value of lung function parameters. Results The proposed AI algorithm reached an AUC of 0.87 (p < 0.001) in the prediction of accepted versus rejected applications. Diffusion capacity (DLCO) also showed comparable predictive value (AUC = 0.85, p < 0.001), with little correlation between the two parameters (r-squared = 0.22, p < 0.001). The combination of the imaging AI score and DLCO achieved superior performance (AUC = 0.95, p < 0.001). Interobserver variability between pulmonologists on the panel was estimated at alpha = 0.65 (Krippendorff’s alpha). Conclusion We developed an AI system to support the clinical decision-making process for the application to the government support for asbestosis. A multicenter prospective validation study is currently ongoing to examine the added value and reliability of this system alongside the clinic panel. Key Points • Artificial intelligence can detect imaging patterns of asbestosis in CT scans in a cohort of patients applying for state aid. • Combining the AI prediction with the diffusing lung function parameter reaches the highest diagnostic performance. • Specific cases with fibrosis but no asbestosis were correctly classified, suggesting robustness of the AI system, which is currently under prospective validation.

In many countries, workers who developed asbestosis due to their occupation are eligible for government support. Based on the results of clinical examination, a team of pulmonologists determine the eligibility of patients to these programs. In this Dutch cohort study, we aim to demonstrate the potential role of an artificial intelligence (AI)-based system for automated, standardized, and cost-effective evaluation of applications for asbestosis patients.A dataset of n = 523 suspected asbestosis cases/applications from across the Netherlands was retrospectively collected. Each case/application was reviewed, and based on the criteria, a panel of three pulmonologists would determine eligibility for government support. An AI system is proposed, which uses thoracic CT images as input, and predicts the assessment of the clinical panel. Alongside imaging, we evaluated the added value of lung function parameters.The proposed AI algorithm reached an AUC of 0.87 (p0.001) in the prediction of accepted versus rejected applications. Diffusion capacity (DLCO) also showed comparable predictive value (AUC = 0.85, p0.001), with little correlation between the two parameters (r-squared = 0.22, p0.001). The combination of the imaging AI score and DLCO achieved superior performance (AUC = 0.95, p0.001). Interobserver variability between pulmonologists on the panel was estimated at alpha = 0.65 (Krippendorff's alpha).We developed an AI system to support the clinical decision-making process for the application to the government support for asbestosis. A multicenter prospective validation study is currently ongoing to examine the added value and reliability of this system alongside the clinic panel.• Artificial intelligence can detect imaging patterns of asbestosis in CT scans in a cohort of patients applying for state aid. • Combining the AI prediction with the diffusing lung function parameter reaches the highest diagnostic performance. • Specific cases with fibrosis but no asbestosis were correctly classified, suggesting robustness of the AI system, which is currently under prospective validation.

RECIST is grounded on the assumption that target lesion selection is objective and representative of the change in total tumor burden during therapy. A computer simulation model was designed to challenge this assumption, focusing on a particular aspect of subjectivity: target lesion selection. Disagreement among readers, and between readers and total tumor burden was analyzed, as a function of the total number of lesions, affected organs, and lesion growth. Disagreement aggravates when the number of lesions increases, when lesions are concentrated on few organs, and when lesion growth borders the thresholds of progressive disease and partial response. An intrinsic methodological error is observed in the estimation of total tumor burden (TTB) via RECIST. In a metastatic setting, RECIST displays a non-linear, unpredictable behavior. Our results demonstrate that RECIST can deliver an accurate estimate of total tumor burden in localized disease, but fails in cases of distal metastases and multiple organ involvement. This is worsened by the “selection of the largest lesions”, which introduce a bias that makes it hardly possible to perform an accurate estimate of the total tumor burden. Including more (if not all) lesions in the quantitative analysis of tumor burden is desirable.

Imaging plays an important role in many aspects of nodal colorectal cancer from diagnosis, staging, and treatment selection to fundamental research on the mechanisms driving lesion development. The range of modalities includes anatomical imaging such as computed tomography (CT), magnetic resonance imaging (MRI), and functional imaging with the development of novel tracer and contrast agents for use in positron emission tomography, in addition to dynamic contrast-enhanced and diffusion-weighted MRI. Traditionally, CT has been used for the assessment of colon tumors and rectal tumors that have metastasized to lymph nodes and further to other distant organs such as the liver. MRI is a versatile technique that offers low-radiation insights for diagnosis and lesion characterization. The high resolution of microscopy using resected and biopsied tissue samples, while not accounting for the heterogeneity of the entire tumor burden, is important in the characterization of primary tumors in terms of pathway analyses and will become increasingly important for patient treatment stratification. The use of imaging in routine clinical care has resulted in large amounts of patient data that may be exploited by artificial intelligence to achieve new scientific insights, as well as to improve cost efficiency through automation.

For the treatment of metastatic renal cell cancer several strategies are used among which the mTOR inhibitor everolimus. As mTOR plays an important role in the immune system, e.g., by controlling the expression of the transcription factor FoxP3 thereby regulating regulatory T cells (Tregs), it plays a key role in the balance between tolerance and inflammation. Previous reports showed stimulatory effects of mTOR inhibition on the expansion of Tregs, an effect that can be considered detrimental in terms of cancer control. Since metronomic cyclophosphamide (CTX) was shown to selectively deplete Tregs, a phase 1 clinical trial was conducted to comprehensively investigate the immune-modulating effects of several dosages and schedules of CTX in combination with the standard dose of everolimus, with the explicit aim to achieve selective Treg depletion. Our data show that 50 mg of CTX once daily and continuously administered, in combination with the standard dose of 10 mg everolimus once daily, not only results in depletion of Tregs, but also leads to a reduction in MDSC, a sustained level of the CD8+ T-cell population accompanied by an increased effector to suppressor ratio, and reversal of negative effects on three peripheral blood DC subsets. These positive effects on the immune response may contribute to improved survival, and therefore this combination therapy is further evaluated in a phase II clinical trial. Electronic supplementary material The online version of this article (10.1007/s00262-018-2288-8) contains supplementary material, which is available to authorized users.

Medical imaging is a vital part of the clinical decision-making process, especially in an oncological setting. Radiology has experienced a great wave of change, and the advent of quantitative imaging has provided a unique opportunity to analyse patient images objectively. Leveraging radiomics and deep learning, there is increased potential for synergy between physicians and computer networksvia computer-aided diagnosis (CAD), computer-aided prediction of response (CARP), and computer-aided biological profiling (CABP). The ongoing digitalization of other specialties further opens the door for even greater multidisciplinary integration. We envision the development of an integrated system composed of an aggregation of sub-systems interoperating with the aim of achieving an overarching functionality (in this case, better CAD, CARP, and CABP). This will require close multidisciplinary cooperation among the clinicians, biomedical scientists, and (bio)engineers as well as an administrative framework where the departments will operate not in isolation but in successful harmony.Key Points center dot The advent of quantitative imaging provides a unique opportunity to analyse patient images objectively.center dot Radiomics and deep learning allow for a more detailed overview of the tumour (i.e., CAD, CARP, and CABP) from many different perspectives.center dot As it currently stands, different medical disciplines have developed different stratification methods, primarily based on their own fieldoften to the exclusion of other departments.center dot The digitalization of other specialties further opens the door for multidisciplinary integration.center dot The long-term vision for precision medicine should focus on the development of integration strategies, wherein data derived from the patients themselves (via multiple disciplines) can be used to guide clinical decisions.

Soft tissue sarcomas (STS) represent a broad family of rare tumours for which surgery with radiotherapy represents first-line treatment. Recently, neoadjuvant chemo-radiotherapy has been increasingly used in high-risk patients in an effort to reduce surgical morbidity and improve clinical outcomes. An adequate understanding of the efficacy of neoadjuvant therapies would optimise patient care, allowing a tailored approach. Although response evaluation criteria in solid tumours (RECIST) is the most common imaging method to assess tumour response, Choi criteria and functional and molecular imaging (DWI, DCE-MRI and 18F-FDG-PET) seem to outperform it in the discrimination between responders and non-responders. Moreover, the radiologic-pathology correlation of treatment-related changes remains poorly understood. In this review, we provide an overview of the imaging assessment of tumour response in STS undergoing neoadjuvant treatment, including conventional imaging (CT, MRI, PET) and advanced imaging analysis. Future directions will be presented to shed light on potential advances in pre-surgical imaging assessments that have clinical implications for sarcoma patients.

From diagnostics to prognosis to response prediction, new applications for radiomics are rapidly being developed. One of the fastest evolving branches involves linking imaging phenotypes to the tumor genetic profile, a field commonly referred to as "radiogenomics." In this review, a general outline of radiogenomic literature concerning prominent mutations across different tumor sites will be provided. The field of radiogenomics originates from image processing techniques developed decades ago; however, many technical and clinical challenges still need to be addressed. Nevertheless, increasingly accurate and robust radiogenomic models are being presented and the future appears to be bright.

With the ongoing advances in imaging techniques, increasing volumes of anatomical and functional data are being generated as part of the routine clinical workflow. This surge of available imaging data coincides with increasing research in quantitative imaging, particularly in the domain of imaging features. An important and novel approach is radiomics, where high-dimensional image properties are extracted from routine medical images. The fundamental principle of radiomics is the hypothesis that biomedical images contain predictive information, not discernible to the human eye, that can be mined through quantitative image analysis. In this review, a general outline of radiomics and artificial intelligence (AI) will be provided, along with prominent use cases in immunotherapy (e.g. response and adverse event prediction) and targeted therapy (i.e. radiogenomics). While the increased use and development of radiomics and AI in immuno-oncology is highly promising, the technology is still in its early stages, and different challenges still need to be overcome. Nevertheless, novel AI algorithms are being constructed with an ever-increasing scope of applications.

Background: Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA. Methodology: Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI. Results: A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI. Conclusion: Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI.

Introduction : Libya is a North African country classified under the Eastern Mediterranean Regional Office. In response to the general paucity of literature regarding cancer in Libya, this study aims to analyze various risk factors for breast cancer among patients in Benghazi, Libya. Material and Methods : Using records from a major primary oncology clinic, data was gathered from breast cancer patients. A total of 301 patients were diagnosed with breast cancer in the study period. For the purpose of risk factor determination, this hospital-based case control study consisted of 212 recently diagnosed cases of breast cancer attending the oncology clinic at Al-Jamhouria hospital in Benghazi. Age matched controls (n=219) were randomly enrolled from other medical departments of Al-Jamhouria hospital and the general population visiting the hospital. Chi square was used to assess significance of the risk factors and the corresponding odds ratio (O.R.) and 95% CI were calculated to assess the magnitude of associations. Results : A total of 1478 cases presented to the gynecological oncology clinic at Al-Jamhouria hospital during the period of 2007-2008. Of these cases, around 20% (n=301) were breast cancer patients. The average age of presentation was 49 years + S.D 13 years, with most of the cases (61%, n=184) being premenopausal. Over 90% (n=273) of breast cancer patients are diagnosed at stage II or later. More than 16% of cases seek medical attention when the malignancy has already reached stage IV. Diabetes, hypertension and family history of other malignancies were found to significantly increase the risk of developing breast cancer. Discussions : A range of socioeconomic risk factors were also analyzed (i.e. parity, breastfeeding etc…) and some were found to be protective. Libyan breast cancer cases are slightly older compared to the rest of the Arab world, but are younger than their counterparts in the West. The major issue in the Libyan scenario is delayed presentation which significantly worsens the prognosis. Hence, all the recommendations focus on increased awareness, the implementation of a national cancer control plan and a national screening program and training healthcare professions in palliative care. Â

Background : Total knee replacement (TKR) and total hip replacement (THR) are effective procedures for alleviating pain and improving hip and knee function. Literature has not covered the experience of developing countries with arthroplasty – especially in an unstable post-conflict setting. Methods : Patient records were obtained from a major surgical center in Benghazi where total joint arthroplasties (TJA) are performed for a period of twenty months and key parameters were analyzed. The patients were followed up on an outpatient basis at regular time intervals (one week, one month, three months and six months) and any complications were documented. Results : A total of 135 total knee (81.5%, n=110) and total hip (18.5%, n=25) replacements were done in Benghazi mostly on elderly (mean age=60.2 years) females (72.2%, n=100). The most common causative pathology in both groups was osteoarthritis (80.6%, n=108). The most common complication was superficial infection (4.4%, n=6) by Staph aureus . The Harris Hip Score and Knee Society Score were used to determine the functional outcomes of THR and TKR respectively – both showing high values. The Short form 36 (SF36) health survey was carried out to assess the patients' satisfaction levels. For all the axes, the obtained score was over 80%. Discussions : THR and TKR are major orthopedic surgeries that constitute an advancement in the treatment of chronic joint pain. Most of the demographic features of our patients match up well with previous literature – with certain exceptions. There was no difference in thromboembolic incidence between the group of patients who received LMWH and those who simply started early mobilization and physiotherapy. Despite a number of hindrances faced by the hospital due to the conflict (i.e. funding limitations and drug shortages), a low rate of complications was maintained. No thromboembolic incidents or mortalities occurred. Conclusions : Libyan surgeons have had a good experience with TJA and patients have been satisfied with the outcomes.

Background: Al-Jamhouria is the principal maternity hospital in eastern Libya, serving a population approaching two million people. In 2011, armed conflict broke out in Libya which was followed by subsequent civil unrest – placing a heavy strain on the healthcare service. This study aims at performing an observational analysis on the trends of delivery for over a decade while also taking civil unrest into consideration. Methods: Patient records were gathered retrospectively from the maternity ward for the twelve-year period between 2002 and 2013. The overall number of births and method of delivery were analyzed. Results: Al-Jamhouria hospital delivered nearly a quarter million deliveries (n=228,598) in slightly over a decade. The majority of deliveries were unassisted vaginal (74%, n=169,199), although as a trend the rate was decreasing. Cesarean sections have more than doubled in the last twelve years with particular increases during the conflict period (in favour of other methods). Intrauterine death rates have been fairly constant in the studied period. Since the start of armed conflict, the number of deliveries at Al-Jamhouria hospital has been declining (for the first time in its recorded history). Conclusion: Al-Jamhouria hospital has continued to provide healthcare services to pregnant women en masse in eastern Libya – in spite of a myriad of hindrances and a decreasing patient load. Cesarean sections have become more commonplace and their rate has doubled in the last twelve years. The private sector may have potentially helped to relieve the heavy burden on this sole maternity ward. Further studies are needed to determine the short term and long term impact on the health of the population.

To study the pattern of cancer incidence and determine the incidence rates in Eastern Libya (for the first time in a decade).A hospital-based registry of cancer patients was formed using records from the primary oncology center in eastern Libya - focusing on those diagnosed in the year 2012.The most common malignancies in men were cancers of the colon (22.3%, n = 90), lung (20.3%, n = 82), prostate (16.1%, n = 65), pancreas (4.2%, n = 17) and liver (4.2%, n = 17). For women, they were found to be cancers of the breast (41.5%, n = 213), colon (16.4%, n = 84), uterus (8%, n = 41), ovary (5.5%, n = 28) and pancreas (3.1%, n = 16). Additionally age-standardized rates (ASR) were determined for Libya. The different cities and towns in eastern Libya were compared for any variation. The city of Beida in particular was found to have a remarkably high incidence of gastric cancer. The different findings were discussed and comparisons were made with past literature as well as the incidence rates for neighbouring countries. The incidence rates given for the eastern region showed differences from previously reported values (i.e., the rate of colon cancer was the highest in North Africa whereas other malignancies occurred less frequently). Potential explanations for the urban-rural difference as well as the difference in incidence rates were put forth. The significance of this study is that it establishes a baseline of cancer incidence which should be the backbone for any future national cancer plan in Libya.Proper surveillance programs need to be in place and healthcare policy should be adjusted to take into account the more prevalent and pressing cancers in society.

Libya is a country with a low population, listed under the EMRO. Using registers and patient records from a major primary oncology clinic, data was gathered from Libyan cervical cancer patients and various parameters were studied across 9 years. Out of 4,090 female cancer cases during the study period, 1.8% were cervical cancer (n = 74). The average age of presentation was 53 years, with most of the cases (60%, n = 44) being premenopausal. Approximately 65% (n = 48) of cervical cancer patients are diagnosed at later stages (i.e. stages III and IV). The majority of these cases are squamous cell carcinoma (83.8%, n = 62), while 16.2% (n = 12) were found to be adenocarcinoma. Patients with squamous cell carcinoma presented at later stages more often than those with adenocarcinoma. Human papilloma virus was strongly implicated in cervical cancer, with 94% (n = 63) of those who were tested being positive for HPV-16 (82.5%, n = 52) and HPV-18 (12.7%, n = 8). Diagnosis was most frequently made through biopsy (97.3%, n = 72) as opposed to Pap smears (2.7%, n = 2). Most Libyan patients were put through chemotherapy (75%, n = 55) and triple therapy (surgery with combined chemotherapy and radiotherapy) was the most common (38%, n = 28) modality of treatment. Comparisons were made between Libya and other nations, either in the developed world or neighbouring countries. The major problem of cervical cancer in Libya is delayed presentation and hence, all the recommendations focus on increased awareness for the populace, implementation of a national cancer control plan and a national screening programme.

To analyze the impact of the method of Gunshot Injury (GSI) (i.e. war injuries, stray bullets, and civilian fighting) on patient morbidity and mortality.An observational study.Biostatistics Department of Al-Jalaa Hospital in Benghazi, Libya, from January to December 2011.Patients' records were analyzed with the method of gunshot injury as a classifying/comparative parameter. Age, gender, site of injury, receiving department, ICU admission, city of origin, length of stay, morbidity and mortality were determined and compared between the different methods of GSI.During the conflict, 1761 gunshot injuries were treated at the hospital. The method of injury was recorded for 62% (n=1096) of the cases and were classified under war injuries (72.2%, n=791), stray bullets (14.1%, n=155), and civilian fighting (13.7%, n=150). Nearly all the patients being treated for civilian fighting (98%, n=147) were males, (stray bullets, 82.6%, n=128, and war injuries 98.4%, n=778). Women were significantly less involved in a war injury (1.6%, n=13, p0.001). Stray bullets affected the younger age groups i.e. ² 19 years (26.5%, n=41) more than either fighting injuries (8%, n=12) or war injuries (11.8%, n=93, p0.001). Civilian fighting injuries (83.3%, n=125) mostly involved the 20-39 years age group (p0.001). Fighting wounds and stray bullets were more common in an urban (82.7%, n=124) rather than rural setting (p0.001); the same was true for stray bullets (76.8%, n = 119). The number of GSI's showed a close relationship with major events in society (i.e. military campaigns, celebration and civilian unrest). Significantly higher mortality rates were observed in civilian fighting injuries (7.7%, n=12, p=0.003) and stray bullets (10%, n=15, p=0.003) compared to general GSI's (5.2%, n=91) and war injuries (4.4%, n=35).Surgeons and general physicians need to be aware that GSI's differ in their salient features and outcome based on the method of injury.

Background Since independence, Libya has never experienced personal ownership of arms. That changed during the Libyan conflict where weapons became widespread in the society. As a result gunshot injuries became a concern for surgeons at our principal surgical hospital (Al-Jalaa). This study aims at analyzing the gunshot injuries that took place during 2011 and highlighting the peculiarities in the Libyan scenario. Methods Patient records were obtained and gunshot injuries were analyzed for various parameters. Statistical analyses were made taking into consideration situations faced by neighbouring countries. Results In 2011, 1761 patients were admitted with over 95% being male and over 97% were Libyan. The average age of a GSI patient was 28.32 ± 10.01 years. Patients aged 18–35 formed over 70% of the cases with half of all cases being treated by the orthopedics department. Sixty-eight percent of cases were injured in the extremities followed by chest (12.5%) and abdomen injuries (7.8%). The mortality rate for GSI's was found to be 5.6% overall with young age, site of injury (i.e. chest and head) and cause of injury (i.e. war or civilian fighting) being important risk factors. Conclusions Taking into consideration the difficult operating conditions and limited resources, surgeons at our hospital were able to maintain a low mortality rate. Disarmament needs to begin as soon as possible because these injuries will continue to occur so long firearms are available in society.

AIM: To study the salient features of colorectal cancer (CRC) in Libya. METHODS: Patients records were gathered at the primary oncology clinic in eastern Libya for the period of one calendar year (2012). Using this data, various parameters were analyzed and age-standardized incidence rates were determined using the direct method and the standard population. RESULTS: During 2012, 174 patients were diagnosed with CRC, 51.7% (n = 90) male and 48.3% (n = 84) females. The average age was 58.7 (± 13.4) years, with men around 57.3 (± 13) years old and women usually 60.1 (± 13.8) years of age. Libya has the highest rate of CRC in North Africa, with an incidence closer to the European figures. The age-standardized rate for CRC was 17.5 and 17.2/100000 for males and females respectively. It was the second most common cancer, forming 19% of malignancies, with fluctuation in ranking and incidence in different cities/villages. Increasingly, younger ages are being afflicted and a higher proportion of patients are among the > 40 years subset. Nearly two-thirds presented at either stage III (22.4%) or IV (38.4%). CONCLUSION: Cancer surveillance systems should be established in order to effectively monitor the situation. Likewise, screening programs are invaluable in the Libyan scenario given the predominance of sporadic cases.

This paper aims to observe and to study the trends of road traffic accidents (RTA’s) for the past ten years in Benghazi – Libya. A retrospective analysis was done using the patient records of Al-Jalaa hospital (the main trauma center in Benghazi) from over 21,753 RTA cases. The annual data were compared to each other and changes of trends were observed. RTA’s represented an increasing percentage of Al-Jalaa’s case load across the years. Around 41% of these cases needed to undergo surgery. The younger age group (20–29 years of age) formed the majority of cases while there was a trend towards an increasing average age of patients involved in an accident. Male patients were found to be younger than their female counterparts. Males comprised 81.5% while females formed 18.5% of RTA patients. In terms of inpatient duration, most patients stayed in the hospital for less than 1 week. Vehicle occupants (drivers and passengers) were admitted more often than pedestrians. There was a trend across the years towards an increased involvement of vehicle occupants and decrease in the proportion of pedestrians that had to be hospitalized. Additionally, there was a decrease in the fatalities of pedestrians. Overall, most RTA patients were discharged and made to follow-up in outpatient clinics however there was a startling trend towards increased LAMA and absconded patients. There were both encouraging findings as well as points that needed further emphasis and action. Public education, life support training and diversification of transport (apart from the use of the roads) should be looked into, as possible means of improving the current situation.

Stressful life events experienced by pregnant women may lead to adverse obstetric outcomes. This study in Benghazi compared the rates of preterm, low-birth-weight and caesarean-section births at Al-Jamhouria hospital in the months before and during the armed conflict in Libya in 2011. Data were collected on all women admitted to the delivery ward during February to May 2011 (the months of the most active fighting in the city) (n = 7096), and October to December 2010 (the months immediately before the war) (n = 5935). Compared with the preceding months there was a significant rise during the conflict in the rate of deliveries involving preterm (3.6% versus 2.5%) and low-birth-weight (10.1% versus 8.5%) infants and caesarean sections (26.9% versus 25.3%). Psychosocial stress may have been a factor (among others) in an increase in negative pregnancy outcomes, and obstetric hospitals should be aware of these issues in times of war.زهير بودلال، خليل أقنبير، نيكو نيغلكيركه، بريدجيت ستيرلنغ، مارلين تمرمان، أوليفيه دغوماقد تؤدي أحداث الحياة الضاغطة التي تعاني منها الحوامل إلى حصائل توليدية ضائرة. وتقدم هذه الدراسة التي أجريت في بنغازي مقارنة لمعدلات الولادة قبل الأوان، والوزن المنخفض أثناء الولادة، والولادات القيصرية في مستشفى الجماهيرية قبل وخلال الشهور التي سبقت النزاع المسلح في ليبيا عام 2011. وقد جمع الباحثون البيانات عن جميع الحوامل اللاتي أدخلن إلى جناح الولادة خلال الأشهر من شباط/فبراير إلى أيار/مايو 2011، وهي الشهور التي اندلع فيها القتال الأكثر ضراوة في المدينة، وعددهن 7096 حاملاً، واللاتي أدخلن خلال الأشهر من تشرين الأول/أكتوبر إلى كانون الأول/ديسمبر 2010، وهي الأشهر التي سبقت القتال مباشرة، وعددهن 5935 حاملاً. وبالمقارنة مع الأشهر السابقة اتضح وجود ارتفاع يُعْتَدُّ به إحصائياً في معدلات الولادة قبل الأوان (3.6% مقابل 2.5%) ، ونقص الوزن عند الولادة (10.1% مقابل8.5%)، والعمليات القيصرية (26.9% مقابل 25.3%). إن الكَرْب النفسي قد يكون واحد من العوامل المتعددة التي تزيد من الحصائل السلبية للحمل، وينبغي أن تتنبه مستشفيات التوليد لهذه القضايا في أوقات الحروب.Les femmes enceintes qui vivent des événements stressants peuvent être plus à risque d’une issue obstétricale défavorable. L’étude menée à Benghazi a comparé les taux de prématurité, de faible poids de naissance et de césarienne à l’hôpital Al-Jamhouria dans les mois précédant et pendant le conflit armé en Libye en 2011. Les données recueillies auprès de toutes les femmes admises en salle d’accouchement entre février et mai 2011 (au plus fort des combats dans la ville) (n = 7096), et entre octobre et décembre 2010 (les mois précédant la guerre) (n = 5935). Par rapport aux mois précédents, une augmentation importante du taux d’accouchements impliquant une prématurité (3,6 % contre 2,5 %) et un faible poids de naissance (10,1 % contre 8,5 %) ainsi que des césariennes (26,9 % contre 25,3 %) a été observée pendant le conflit. Le stress psychosocial peut avoir été un facteur (entre autres) dans l’augmentation des issues négatives de la grossesse, et les établissements obstétricaux devraient être informés de ces problèmes en temps de guerre.