Background Burnout syndrome is recognized as a global issue, and as medical practice is stressful, healthcare workers are found to be burnt out and exhausted very soon, which is reflected negatively on the medical staff well-being, patients' outcome, and the overall organizational performance. Aim This study is planned to assess the magnitude of burnout among physicians in Benghazi-Libya. Methods This cross-sectional study was carried out in 2020 on a total of 150 physicians working at different departments of internal medicine in Benghazi-Libya. The Maslach Burnout Inventory collection instrument was used to assess the three components of burnout syndrome: emotional exhaustion, depersonalization, and reduced personal accomplishment. High scores in emotional exhaustion and depersonalization and low scores in personal accomplishment are indicative of high burnout. The statistical analyses of the data were performed using the SPSS version 21. The level of statistical significance was considered as p-value less than 0.05. Results 60% of the respondents were females and 40% were males. About 14.7% had high emotional exhaustion, 92% had high depersonalization, and 87.3% had low personal accomplishment scores. Statistical analysis showed no significant relationship between gender and burnout. Alternatively, a significant association was found between degree certificate and emotional exhaustion, as moderate- and high-level burnout were more prevalent among MBCHB participants than those with masters and board degrees. No association was found between degree certificate and depersonalization or personal accomplishment. Conclusion Burnout is prevalent among internal medicine doctors in Benghazi, with the newly graduated medical personnel scoring higher rates of burnout than doctors with higher degrees. No relationship was found between gender and burnout.

Background: Systemic sclerosis (SSc) is a rare, heterogeneous autoimmune disease characterized by skin fibrosis, vasculopathy, and internal organ involvement. This study aims to determine the frequency of clinical manifestations of SSc among Libyan patients in Benghazi. Patients and Methods: Thirty patients (28 females) attended the Rheumatology Clinic at Benghazi Medical Center between January 2016 and December 2019. They were diagnosed to have SSc according to American College of Rheumatology/European League Against Rheumatism 2013 revised classification criteria and were classified into diffuse cutaneous systemic sclerosis (dcSSc) and localized systemic sclerosis (lcSSc) disease subsets. Results: We reviewed the data of the 30 patients, including 28 (93.3%) females and 2 (6.7%) males (female: male ratio 14:1); the mean age at diagnosis was 40.5 ± 21.5 years (17–62 years). Twenty-four (80%) patients were diagnosed as dcSSc, whereas 6 (20%) were diagnosed as lcSSc. On diagnosis, patients with dcSSc were comparatively younger than those with lcSSc. The frequency of musculoskeletal manifestations and organ involvement was more frequent among patients with dcSSc (P = 0.001). All the thirty patients had rheumatoid factor and anti-nuclear antibody positivity. Anti-Scl-70 was only positive in the dcSSC subset in all patients of dcSSc only, whereas anti-centromere Ab was positive in all patients of lcSSc only. Conclusions: This is the first study to assess the clinical manifestations of SSc in the Libyan population. Our disease cohort showed similarity to what was published in other cohorts with regard to the age at the time of diagnosis, gender, and autoimmune profile.

Background: We aimed to characterize the clinical presentation of primary and secondary Sjögren's syndrome (SS) among patients in Benghazi, Libya. Patients and Methods: Sixty consecutive patients (55 females and 5 males) diagnosed with SS according to 2016 European–American consensus criteria were studied. Patients with chronic hepatitis C virus, human immunodeficiency virus infection, and previous lymphoproliferative processes were excluded. Results: The mean age at the time of diagnosis was 41.9 ± 9.9 years (25–56 years). Seventeen patients (28.3%) had primary SS (pSS). At diagnosis, commonly reported symptoms included dry mouth (52; 86.7%), dry eyes (55; 91.7%), dental caries (25; 41.7%), and oral candidiasis (20; 33.3%). Schirmer's test was positive in seven patients (11.7%). The most common extraglandular manifestations were arthralgia and arthritis (49; 81.7%), Raynaud's phenomenon (23; 38.3%), and interstitial lung disease (9; 15%). Both pSS and secondary SS (sSS) were associated with lymphocytosis. Abnormal thyroid disease was reported in 14 (23.3%). sSS was mostly associated with rheumatoid arthritis 28 (46.7%), followed by systemic lupus erythematosus 11 (18.3%). Fifty-three patients (88.3%) had positive rheumatoid factor (RF) and 18 patients (30%) had positive antinuclear antibodies (ANAs). RF was strongly associated with sSS and Sicca symptoms with P = 0.004 and 0.001, respectively, while ANA positivity was strongly associated with pSS and extraglandular manifestations (P = 0.001 and P = 0.003, respectively). Conclusions: This is the first series of SS from Libya. It should help understanding the characteristics and associations that should help understand the global picture.

Background: Hypoparathyroidism is the most common complication after thyroidectomy and the main reason for frequent outpatients' visits; however, there is a poor understanding of its outcomes, and no clear follow-up strategies are available. We aimed to evaluate the frequency and risk factors of post-thyroidectomy hypocalcemia hypoparathyroidism in Libyan patients. Methods: A case series study was conducted. The serum calcium and parathyroid hormone level (PTH) were measured at least 8 months post thyroidectomy. Results: 124 patients were reviewed in this study; 19 (15.3 %) were males and 105 (84.7 %) were females. 30.6 % of males and 13.7% of females developed hypocalcemia and hypoparathyroidism. Total thyroidectomy (TT) was performed in 62.9 % of all patients, while 24.2% of all patients underwent near total thyroidectomy (NTT). 12.1% of all patients underwent bilateral subtotal thyroidectomy (BST) and 1 patient underwent hemi thyroidectomy (0.8%). The risk of hypocalcemia was higher in patients with malignant thyroid disease in comparison to benign thyroids (45.8 % vs. 27% of patients). Papillary thyroid carcinoma (PTC) was the most common cause of both hypocalcemia and hypoparathyroidism (45.5% for both) followed by Graves' disease (22.2% and 14.8% for hypocalcemia and hypoparathyroidism respectively). Hypocalcemia and hypoparathyroidism were more frequent in patients who underwent TT (19.2%), as compared to patients who underwent NTT (6.6 %). Among nine patients who were operated on twice, three patients had hypocalcemia, and two of them were found to be hypoparathyroid; one case is diagnosed with Graves' disease, while the other was diagnosed as PTC. Conclusion: Total thyroidectomy, and re-operation are associated with increased prevalence of permanent hypocalcemia and hypoparathyroidism when compared to less extensive thyroid resection modes.

Background Dialysis adequacy is an important and effective factor in reducing mortality and morbidity among patients with end-stage kidney disease. This study aims to assess the current clinical situation of hemodialysis (HD) patients, to monitor the established quality-of-care indicators, and to identify the unachieved quality-of-care goals. Patients and methods This is an observational study in which all patients underwent chronic HD program (>1 year) at the nephrology center in Benghazi, Libya. It was conducted between January and June 2018. Mean levels were collected for the following indicators: hemoglobin, dialysis dose, serum calcium and phosphorus, parathyroid hormone, systolic and diastolic blood pressure, interdialytic hypotension, and vascular access. Results A total of 292 dialysis patients were reviewed and followed over a 6-month period. Overall, 170 (58.2%) were males and 122 (41.8%) were females. Mean age was 51.1±14 years. Hypertension was the most common cause of end-stage kidney disease in 76 (26.0%) patients followed by diabetes mellitus in 32 (11.0%) patients. Our patients failed to achieve adequate HD, as laboratory value results were as follows: mean hemoglobin level less than 10 g/dl in 61% of patients, serum Ca+2 was less than 8.4 mg/dl in 48.6%, serum PhO4 was more than 5.5 mg/dl in 50%, and serum parathyroid hormone was more than 300 ng/dl in 60.3%. Conclusion Dialysis insufficiency was seen in a significant percent of patients in this study. More extensive research studies for finding the causes of low dialysis quality are suggested.