Medical education is being reshaped by two major technological disruptions: the rapid expansion of online learning since the COVID-19 pandemic and the equally rapid adoption of artificial intelligence (AI) in teaching, assessment, and clinical training. These developments are often treated as distinct phases of change. In reality, they are part of the same broader challenge: educational institutions have repeatedly adopted new technologies faster than they have developed the pedagogic, ethical, and regulatory frameworks needed to use them well. 1-3

Dysfunctions and pain in the shoulder are a prevalent musculoskeletal condition and a key area for clinical research. This paper investigates the etiology, epidemiology, and risk factors associated with shoulder pathologies based on a data set from the Sydney Shoulder Research Institute (SSRI) that spans a cohort between the years 2015 and 2024. A cohort was retrospectively designed to analyze the demography of patients, their injury mechanisms, symptom durations, and the symptoms of joints that are associated with it. The findings pointed out that the male gender was more likely to encounter traumatic injuries when compared to the females, who reported degenerative conditions of the shoulder such as rotator cuff tendinitis. The age and symptom duration of the patients pointed to a significant correlation to chronic shoulder disorders, where above 42% experienced the symptoms for more than a year. Injury causes vary from trauma due to sports to degenerated conditions. The study pinpoints the role that hand dominance plays and the impact of contralateral shoulder and knee pathologies. Results highlighted the need for early diagnosis and

implementing of ideal management measures to handle the long-term healthcare impacts.

One of the most common problems seen in the office of a primary care physician is low back pain. Backache can have a variety of causes. The aim of this study is to assess the various etiological, occupational, and risk factors for low back pain, as well as its correlation with the patient's age, sex, and lifestyle. Materials and methods: This study collected patients from private clinics and hospitals in Libya between September and November 2024, admitted them, and treated them in the orthopedic department. Many people suffer from low back discomfort, which can be challenging to diagnose. In conclusion, orthopedists must acknowledge the diagnostic uncertainty that often accompanies this illness. The occurrence of incapacitating back pain can be significantly reduced by identifying the etiological and risk factors, the type of occupation, the origin of the pain, implementing preventive measures, and assisting patients in their recovery.

Ankle fracture-dislocations are complex injuries that pose significant challenges due to their association with severe functional impairments. Representing 9% of all fractures, these injuries predominantly affect young individuals experiencing high-energy trauma and elderly patients with conditions such as diabetes and osteoporosis. Younger patients are at risk of post-traumatic osteoarthritis and functional limitations, whereas older individuals often face complications such as wound infections, fixation failure, and, in severe cases, amputation. Classification systems provide a framework for categorizing fractures based on the mechanism of injury, guiding treatment decisions. Precise anatomical reduction of the talus within the ankle mortise and fibular length restoration are critical for maintaining joint congruity and preventing long-term complications.

Management strategies vary by fracture type. Posterior malleolus fractures typically benefit from surgical fixation, improving stability and reducing syndesmosis fixation requirements, while stable fractures are often managed conservatively. This review highlights the need for individualized treatment approaches to optimize recovery and minimize complications. Continued research is essential to refine fixation techniques and enhance the prognosis for patients with these challenging injuries.

Total Hip Replacement Outcomes in Alkhadra Hospital: A Retrospective Descriptive Epidemiological Study. We reviewed the outcomes of 77 total hip replacements done in Alkhadra Hospital from 1/9/1993 to 1/9/1997 using different types of prostheses and techniques. The mean age of the patients was 55 years, and the mean follow-up was four years. The most common complications were cup loosening (8%), hip dislocation (4%), and femoral neck fracture (3%). The mean hospital stay was 29 days. Our results suggest that total hip replacement is a safe and effective procedure for patients with hip arthritis in our setting. The aim of the study was to evaluate the clinical and radiological results, the complications, and the revision rates of the THR. Conclusions: The study shows that primary total hip replacement can be performed successfully in Libyan hospitals despite challenges. The complication rate and results were low, but careful patient selection, surgical technique, and follow-up are important to reduce complications and improve outcomes. Recommendation: Surgeons need proper training and resources for primary THR. A DVT prophylaxis protocol should be developed based on local risks. Further research is needed to investigate complications, risk factors, outcomes, and patient satisfaction in Libyan patients who undergo THR.

Teachers have also begun to take note of the new technology and investigate how it affects student performance and conduct. High smartphone penetration has sparked an increase in the usage of apps by groups of teachers and their students to help the learning process by granting direct access to many online resources. In addition, engagement and satisfaction with online learning are important factors in encouraging effective educational processes Aim: In this study, we try to access students’ acceptance of free apps and social media that can be used to launch a respectable kind of distance learning for students and teachers during a pandemic or crisis. Methodology: we took 68 students registered, divided into 4 groups and the course planned to teach orthopedic surgery. The electronic questionnaire was distributed to students using the SurveyMonkey application to assess their acceptance of distance learning As a result, the students showed acceptance of the course as well as the time, material, and clarity of the course. In addition, they found the supportive materials such as videos that were delivered during the course were very useful. Conclusion: Programs for education that are less expensive than customary education programs. This technology made schooling possible. Technology is cost-effective, which is significant in nations with inadequate infrastructure.

FRACTURES OF THE PROXIMAL HUMERUS: MANAGEMENT AND EVALUATION (GENERAL OVERVIEW)

Abstract:

Fractures of the proximal humerus are a common phenomenon, while low-energy injuries occur in the elderly, and less frequent fractures with higher energy affect young people. The decision to perform surgical or nonsurgical treatment is determined by the functional goals and the degree of displacement of the proximal anatomical parts of the humerus. Surgical treatment is based on the ability to achieve and maintain the reduction, the vascularity of the articular segment, the quality of attachment of soft tissues and bone porosity. Despite numerous studies, the optimal treatment of significantly displaced fractures remains controversial. Keywords: fracture, humerus, fracture treatment.

Medical students have been shown to be more susceptible to stress and depression than the rest of the population. Libyan students specifically have to undergo the challenges of becoming a doctor while living with the stressful outcomes of the Libyan civil war. And the spread of COVID-19 has added to these stressors. This study aimed to determine prevalence of depression and anxiety among Libyan medical students and analyze the

causing factors. A cross-sectional study was conducted using an online survey. We used the Kessler psychological distress scale to measure the level of distress. A total of 1348 students from 16 Libyan medical schools across the 5 years of study completed the survey. The number of females was 992 (73.6%), and males were 356 (26.4%). The mean age (SD) was 22.09 (2.56). Out of the 1348 participants, 638 (47.3%) scored for severe mental disorder. A moderate mental disorder was presented by 213 (15.8%), and 200 (14.8%) presented with a mild one. Students are likely to be well according to the K-10 scale, which is 297 (22%). Out of the students whose houses have been displaced. In the war, 66.3% have presented with moderate to severe mental disorders. Students that have reported having suicidal thoughts throughout their time in medical school are 235 (17.4%). In comparison to similar studies done in other countries, Libyan students scored a higher prevalence of depression. The current political state of the country and the COVID-19 pandemic were shown to be contributing factors.

Neonatal intensive care unit (NICU) is an ideal environment for transmission of many pathogens, which lead to high morbidity and mortality in neonates. Microbial pathogens that cause nosocomial infections are known to have high resistance to many antibiotics, which leads to economic burdens, in addition to social and psychological factors affecting the families due to long durations in hospitals. Prevention of infection requires identification of contaminated environments and equipment, effective infection control programs, and judicious use of antimicrobial agents.

Methods: 244 neonates, who were admitted to NICU, and 235 residing neonates at Special Care Baby Unit (SCBU) of Tripoli Medical Center (TMC) in the months of May to July 2013, who were found positive for pathogenic infection, were subjected to the study. Pathogenic organisms were isolated and identified according to Standard Microbiological Methods, and an antibiogram was assessed against common antibiotics.

Results: Acinetobacter baumannii was the most frequently isolated bacterium from neonates at NICU and SCBU at a rate of 40% and 48%, followed by Klebsiella pneumoniae at a rate of 33% and 31%, respectively, while the less frequently isolated organisms were Staphylococcus haemolyticus (9% NICU and 5% SCBU) and S. hominis (7% NICU and 3% SCBU). Infection sites were 2 ear, nose, and throat (53% NICU and 58% SCBU); CSF (33% NICU and 3.85% SCBU); urine; eye swab (30% NICU and 47% SCBU); vein catheter (29% NICU); skin swab catheter (30% NICU and 27% SCBU); blood (11% ICU and 12% SCBU); umbilical swab (7% NICU and 18% SCBU); nasal swab (4% NICU and 12% SCBU); and catheter (30.33% NICU and 27% SCBU).

Conclusion: Data indicate a significant infection problem in Tripoli Medical Center Hospital and inefficient infection control programs. A. baumannii and Klebsiella pneumonia were the predominant cause of neonatal infection at TMC. Antimicrobial-resistant pathogens isolated in Neonatal Intensive Care and Special Care Baby Units, respectively, were K. pneumoniae (ESBL) (ESBL)(56.52% and 44.44%), carbapenem-resistant K. pneumoniae (21.7% and 11.11%), and E. coli (ESBL) (13.04% and 5.56%).

Background: Obesity is a global epidemic resulting in major morbidity and premature death. It’s progressively increasing with age. Cases of obesity and overweight are increasing in Libya as well as all over the world, genetic and environmental factors playing a contributory role. With its known significant morbidity and mortality, obesity should draw the attention of the healthcare community, researchers, and policymakers in Libya. Aims of study: To identify the prevalence of obesity among secondary school students in Gharyian city and to study the relation between BMI and sex, education level, and food habit.

Conclusions: The prevalence of overweight and obesity in secondary school students in Gharyian City was relatively low (4.2%) compared with other Arabic countries. The relation between BMI and education level and eating habits was significant. The prevalence of overweight and obesity was higher in males than in females, and it was higher in the 1st-year and 2nd-year students.