Tripoli University Research Articles

Assessment of Gingival Biotype in the Esthetic Zone among Dental Students at University of Tripoli

The form and structure of the soft tissue and maxillary anterior teeth at the esthetic zone play an important role in determining the outcome. The gingival biotype is important because of the structural characteristics of the periodontics. This study targeted to determine gingival biotype prevalence and characteristics in the esthetic zone among Libyan dental students. A cross-sectional study was done for 220 students aged between 20 and 30 years. In the periodontal department, healthy periodontal tissues with no loss of attachment and the presence of all upper anterior teeth were selected. Clinically, gingival biotype was examined and recorded according to the transparency of the periodontal probe and visual inspection. The present study evaluated the frequency of gingival biotype and its association with gender and crown shape. All measurements were made for a total of students according to gingival transparency and were statistically evaluated. This study has shown that gingival biotype varies among different genders, ages, and tooth forms in our population. Understanding tissue biotypes can help dentists choose the correct dental treatment for better results.

Correlation between Blood Glucose Level and Anthropometric Measurements among University Students at the University of Tripoli

The detection of risk factors associated with type 2 diabetes mellitus (T2DM) at an earlier age may help reduce or even prevent the future outcomes of this disease. To date, there has been no research conducted on university students regarding associated risk factors such as being overweight or obese in Libya. The aim of this study was to determine any correlation between serum glucose level and anthropometric measurements, age and family history of T2DM in students of the University of Tripoli. A cross-sectional study involving a survey questionnaire, anthropometric measurement and blood glucose levels taken from 246 University students (aged 18-43). Recruitment was carried out from July 15 to August 1, 2024 at the research laboratory in the Faulty of Medical Technology at the University of Tripoli. The Pearson correlation test showed a positive correlation between the level of blood glucose and hip circumference [r= 0.139, P= 0.029]. The only other two risk factors that were close to the level of statistically significance were weight [r= 0.115, P= 0.071] and BMI [r= 0.117, P= 0.067]. T2DM might be prevented or mitigated by encouraging young adults in particular to keep hip circumference in the normal range.

Language Barriers in Studying Medicine in English: Concerns and Attitudes of Clinical Phase Medical Students at the University of Tripoli

Despite being a foreign language, English is the medium of instruction in many Arab medical schools, creating language barriers and difficulties for students. The aim of this study was to assess the concerns and attitudes of students towards English as a medium of instruction (EMI) and to explore the barriers as well as opinions of students. This was a cross-sectional descriptive study that targeted students enrolled at the clinical phase at the faculty of medicine in the University of Tripoli using a self-administered questionnaire during the period from the 10th of March 2024 to the 24th of March, 2024. About 61 (36.1%) medical students were moderately comfortable with the English language, followed by 45 (26.6%) who were comfortable as opposed to 10 (5.9%) who were very uncomfortable. The majority 102 (60.4%) recommended changes to address the language concerns in the curriculum. Among the 66 participants who responded to this section, 33.3% recommended that the university should provide free English language courses and 161 (95.3%) stated they would choose to study medicine in English again. The study revealed that the majority of the participants did not feel that English is a significant barrier in their studies with 62.7% disagreeing with the existence of language barriers.

Obstacles to Scientific Research from the Point of View of Graduate Students at the Faculty of Physical Education and Sport Sciences, University of Tripoli

This research aimed to identify the obstacles to scientific research from the point of view of graduate students at the Faculty of Physical Education and Sport Sciences at Tripoli University related to faculty members, related to graduate students, and related to the administrative side and supervision, the researcher used the descriptive method by survey method due to its suitability to the nature of this research, the research sample was selected randomly, where the total number of the sample amounted to (77) students with a percentage of (48%), and the most important findings of this research were that the responses of the sample members towards the dimensions of The most important findings of this research were that the responses of the sample members towards the dimensions of the axis of obstacles to scientific research from their point of view were realistic and were not due to chance, and the results of the responses of the research sample towards the stability coefficients of the axis of obstacles to scientific research ranged from (73% to 83%), and that the overall stability scores for the axis as a whole amounted to (84%), which are high stability scores.

Retrospective study of the prevalence of acquired drug resistance after failed antiretroviral therapy in Libya.

The increasing rate of drug-resistant HIV mutations in Libya and other African countries threatens the efficacy of antiretroviral therapy (ART), thus necessitating urgent regional strategies to combat resistance and improve treatment outcomes. To characterize the frequency and pattern of acquired HIV drug resistance mutations in patients showing ART failure while using non-nucleoside reverse transcriptase inhibitors (NNRTI) prescribed by the Department of Infectious Diseases at Tripoli University Hospital, Libya. We collated retrospective data on 128 people living with HIV, aged 18 years or above, who experienced firstline treatment failure at Tripoli University Hospital, Libya, from 2014 to 2017. We analysed the extant HIV amino acid sequences to identify resistance mutations using algorithms from the Stanford University HIV drug resistance database. All included cases had at least one resistance mutation (n = 128; 100%) and 119 (93%) had both nucleoside reverse transcriptase inhibitors (NRTI) and NNRTI mutations. M184V/I was the most common NRTI mutation (n = 119; 93%) while K103N was the most common NNRTI mutation (n = 100; 78%). Thymidine analog mutations were detected in 51 cases (40%); featuring T215Y, D67N and M41L. Predicted full susceptibility was highest for Tenofovir (66.4%), followed by Etravirine (60%). We detected high level drug resistance and associated mutations among people living with HIV. Implementing drug regimens with high genetic barriers to resistance, coupled with rigorous monitoring and surveillance of HIV resistance development, could help mitigate such resistance in the future.

Knowledge and Attitudes Toward Premarital Screening Programs Among Students at the University of Tripoli, Libya.

Despite the increase in hereditary disease in Arab countries due to the high rates of consanguineous marriages, research on community awareness of premarital screening (PMS) for disease carriers is still scarce. To investigate knowledge and attitudes towardgenetic PMS programs among university students in Libya. A cross-sectional study was conducted using a self-administered questionnaire distributed to 421 Libyan students aged 18-25 years at the University of Tripoli. Most of the participants (79%, n=316) agreed that a PMS program is important and expressed willingness to have PMS programs if they were advised to do so. Two-thirds of participants (67%, n=268)had heard of PMS programs, of whom (27.2%, n=73) heard of them from social media. Most of the university students had good knowledge of PMS but poor knowledge of the hereditary disease targeted by PMS. Most of them had a positive attitude toward PMS.

Frequency of ABO and RhD Blood Groups in Patients with Celiac Disease

Celiac disease (CD) is a popular autoimmune disorder induced by gluten-containing foods and other environmental, and genetic factors. Every individual's red blood cell expresses over two million ABO blood-type antigens. Furthermore, the stomach and small intestine are major expression sites for the ABH antigens. This study was intended to assess the distribution of ABO and Rh blood types in Libyan patients with celiac disease as well as compare between CD and healthy control groups regarding complete blood count parameters. Samples from 250 CD patients and 45 healthy control groups represented by 80 males (27.1%) and 215 females (72.9%) were enrolled in the study. The samples of CD were collected from patients who attended the gastroenterology outpatient clinic at Tripoli University Hospital (TUH) for follow-up. Two hundred and fifty blood samples were serologically screened for ABO, and Rh antigens using a tube agglutination test. Another group of healthy subjects (n = 45) and CD patients (n = 45) were analyzed for CBC test. The findings showed that the most observed ABO blood group among celiac patients was blood group O 129 (51.6%), followed by blood group A 80 (32%), and Rh-positive 222 (88.8%). Furthermore, the heritable proportion was 33%, with 21% classified as first-degree and 12% as second-degree hereditary. Additionally, the result of the independent Sample (T) test to compare RBCs, HGB, HCT, and NUT levels in blood between CD patients and healthy control showed that there were significant differences in the RBCs, HGB, and HCT counts with p-value = 0.034, <0.001, and <0.001 respectively. In contrast, Mann-Whitney U test results revealed significant differences in the PLT, MCV, MCH, and MCHC counts with p-value = <0.001, and for LYM with p-value = 0.003. Future studies on these simple inflammatory markers can guide us in predicting the diagnosis and prognosis.

Efficiency of Commonly Used Disinfectants and Antiseptics against Pathogenic Bacteria Isolated from Tripoli University Hospital, Libya

Background and objectives: Disinfectants and antiseptics are widely used in hospitals and other healthcare centers to ensure the prevention of nosocomial infections and provide efficient infection control. Numerous studies have recently shown that hospital-acquired bacteria are developing resistance against such compounds. The purpose of this study is to examine the effectiveness of the commonly used disinfectants and antiseptics against a group of nosocomial bacteria isolated from Tripoli University Hospital, Libya. Material and Methods: Five bacterial pathogens isolated from different hospital departments are klebsiella spp., Proteus spp., Escherichia coli (E. coli), Acinetobacter spp., Staphylococcus aureus (S. aureus). These isolated bacterial species were subjected to disinfectants and antiseptics impregnated with filter paper discs (disk diffusion assay). The disinfectants and antiseptics used were; Hydrogen peroxide (H2O2), OROLIN® Multisept plus (Orolin), Chlorhexidine (CHX), 84 Disinfectant, ACTOSAL® Flache AF (Actosal) and Ethyl alcohol. Results: In the present study found that the most effective was H2O2 antiseptic against the tested bacterial pathogens with inhibition diameters of 10 to 26mm, except for Proteus bacteria which illustrated resistance at high concentrations. Similarly, Orolin disinfectant shows very excellent efficacy against tested bacteria, and even with low concentrations. Good efficacy was observed for Actosal disinfectant on all species with diameters of inhibition ranging from 10 to 15mm. S. aureus in particular was very sensitive to 70% Ethyl alcohol (20mm), while all tested species were slightly insensitive to both Ethyl alcohol and CHX. In contrast, no effect of the 84 disinfectant was observed on most of isolates. Conclusion: The results of this study indicated that Orolin disinfectant had comparable effects to H2O2 atiseptic but less than to Actosal, 70% Ethyl alcohol and CHX, whereas 84 disinfectant was the weakest one. This study suggests the necessity of applying continuous monitoring to determine the antimicrobial efficacy of these antimicrobial agents regularly.

Prevalence of Pregnancy Tumor in Tripoli, Libya: A Multicenter Cross-Sectional Study

Background and objectives. Pyogenic granuloma (pregnancy tumor) is one of the gingival inflammatory changes with an increased incidence during pregnancy. The present study aimed to determine the prevalence and characteristics of pregnancy tumors in pregnant Libyan women in Tripoli, Libya. Methods. In this descriptive cross-sectional study, pregnant Libyan women were assessed at the National Heart Center-Tajoura, Jalaa Maternity Hospital, and Tripoli University Hospital during the period from August to November 2023. Data were collected through interviewing and clinical examination of the participants and filling out a data form. Results. During four months period, of 402 pregnant Libyan women, 4 (1.0%) were clinically diagnosed with pregnancy tumors. The four cases were in their third trimester of pregnancy. Half (50%) of pregnancy tumor cases were more than 30 years old, and the other half (50%) were early 20 years old. The gingiva was the only site of the lesions, and were observed equally in the maxilla and the mandible. All pregnancy tumor cases have calculus on their teeth, bleeding gums, and poor oral hygiene status. All lesions were sessile had lobulated surfaces, and showed spontaneous and provoked bleeding. Conclusions. Although the results of this study indicate that the prevalence of pregnancy tumors in pregnant Libyan women is considered low (1.0%), oral health education programs are very important during pregnancy, and if pregnant women notice any abnormal growth during pregnancy in their mouth, they should consult a dentist.

Efficacy and Safety of Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

Continuous subcutaneous insulin infusion (CSII) pump represents a treatment option that can aid in achieving an important goal to reduce the most frequent complications associated with treatment; hypoglycemic and hyperglycemic episodes, which have also a great impact on life quality of patients. This study was conducted to report the effect and safety of insulin pump therapy on glycemic control, hypoglycemia and diabetic ketosis (DKA) rates in Libyan type 1 diabetic (T1D) patients. A descriptive and retrospective study which included patients treated and followed up at Tripoli University Hospital. Fifty-seven T1D patients used CSII pump enrolled in this study. Assessment of hypoglycemia, DKA, measuring the glycosylated hemoglobin (HbAlc) values at time of diagnosis (prior to CSII) and at time of study conduction. Mean age was 12.72 year ± 3.8 SD. Mean duration of diabetes was 7.28 years ± 3.9 SD. The baseline mean HbA1c was 8.58 ± 1.73% during Multiple Daily Injections (MDI) at pre-pump and 7.76 ± 1.33% post initiation of CSII (p = 0.001), with higher proportion of patient’s post-pump treated had good metabolic control with HbA1c compared to pre-pump infusion 23, 40.4% and 16, 28.1%, respectively. Both the incidence of ketoacidosis and severe hypoglycemic episodes was improved compared with MDI pre-pump significantly during CSII (P<0.001). This study supports that CSII is an effective alternative in managing T1DM. In addition, therapy with insulin pump in children with diabetes is very efficient and safe with obvious reduction of HbA1c and significantly diminished rates of DKA and hypoglycemia.

Prevalence of multi-drug resistant bacteria in intensive care units at Tripoli University Hospital, Tripoli, Libya

ABSTRACT Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients’, healthcare workers’ and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment’s samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital.

Prevalence of Hypothyroidism and Cardiac Diseases Among Libyan Down Syndrome Patients

Hypothyroidism is among the commonest thyroid abnormality in patients with Down syndrome (DS). The purpose of this study was to determine the prevalence of hypothyroidism and cardiac defects among pediatric down syndrome patients attended Tripoli University Hospital. A retrospective study was conducted among children with DS seen at endocrine follow-up clinic in Tripoli University Hospital. Data were collected from patients' registration book and medical records. A total of 50 patients with DS were included in the study out of which 64% were females. Their median age at diagnosis was range between 10–14 years. Abnormal thyroid function was observed in 34 patients (68 %). Presence of chronic heart disease were seen in 30(60%) patients. Early diagnosis and management of thyroid abnormalities are important to decrease further impairment of cognition function in children with DS.

Assessment of Risk Factors of Type 2 Diabetes Among Teaching Staff in Tripoli University

Assessment of Risk Factors of Type 2 Diabetes Among Teaching Staff in Tripoli University

Antibiotics Self-Medication Among Students at Faculty of Medical Technology, University of Tripoli

Background and aim. Antibiotics self-medication is a global phenomenon that is prevalent in developing countries due to inadequate monitoring controls. The current study conducted to assess the practice of self-medication among paramedical students at Faculty of Medical Technology. Methods. A pre-validated questionnaire was dispersed through google forms, and students were asked to report antibiotic use with or without prescription in the year 2022. The questions enclosed demographic characteristics, course completion, frequency of antibiotic use, condition for which it was used, and type of antibiotic used were all covered. Results. A total of 168 forms were completed. Prevalence of antibiotic use with and without a prescription was relatively high (42.9%). Among the survey students who utilized an antibiotic without a prescription, 17.4% they stopped the use of antibiotic without finishing the treatment course. The most frequently obtained antibiotic without prescription was Augmentin®. Tonsillitis, flu, upper respiratory tract infection, and urinary tract infection were the conditions for which antibiotics were used. Conclusion. Irrational use of antibiotics is common among university students and need effective interventions directed to increase students understanding of the problems associated with such practice.

Progressive Multifocal Leukoencephalopathy in AIDS Patients: A Report on 15 Cases

Progressive Multifocal Leukoencephalopathy (PML) is a degenerative disease of the central nervous system (CNS) caused by a polyoma virus called JC polyoma virus (JCPyV). It affects patients with some diseases like lymphoproliferative diseases and patients with advanced AIDS usually with a CD4 count of less than 100 cells/L and carries a poor prognosis. Its clinical and radiological features are suggestive but could be similar to other diseases like toxoplasmosis and tuberculosis that can affect the CNS in AIDS patients. Here we report on 15 cases of PML, attended and managed in Tripoli University Hospital in Tripoli, Libya. All of the patients were in advanced stages of HIV infection, and were not using medications at presentation. All the patients except one died within a period of 2 days- 2 months of presentation possibly due to associated opportunistic infections (OI). PML has not been reported in the Libyan medical literature and here we report its clinical and radiological features and the prognosis of its course.

Students' Transportation Problems in University Campus A Case Study, Tripoli University, Libya

University campuses are small cities in urban areas that are active and attractive destinations. This high level of activity causes severe congestion on campuses and in the surrounding area, especially in urban university locations. Tripoli University campuses are multi-modal and complicated, combining automotive traffic, public transportation, and pedestrians into a single transportation system. This poses a serious problem for university campuses. Vehicular congestion in a campus setting creates several significant conflict areas that range from pedestrian safety to traffic and transit operations. The university has the greatest influence on the surrounding neighborhoods. Innovative transportation approaches can diffuse from higher education to other parts of society.The aim of this study is to understand the main transportation system used at Tripoli University and document a systematic approach to analyze the problems associated with university campus transportation systems and develop solutions to this problem.The research question how can Tripoli University students reach the university campus in less time and more safely?The methodology used in the research will also generate a questionnaire online for students and staff collecting data from other studies and gain knowledge from other countries' solutions. Effective university campus design has the biggest impact in this area. The expected outcome will be a Based on the findings, this study proposed a mode of transportation that would aid in the discovery of effective solutions to the problem, reduce the amount of time spent traveling every day at the university, and create an integrated university campus.

Impact of Thyroid Cancers on Thyroid Hormones among Patients Attended Tripoli University Hospital

Thyroid cancer is one of the most common endocrine system malignancy, accounting for 3.8% of new cancer cases in the US and ranking ninth overall. The number of people diagnosed with thyroid cancer has increased dramatically over the last three decades, indicating the disease's global severity. The purpose of this study was to determine the effect different types of thyroid cancers on thyroid hormones (TSH, T4 and T3). This study was conducted in the Oncology and Endocrinology departments of Tripoli University Hospital (TUH). A total of 70 thyroid cancer patients were targeted, and data was collected using patient record file. TSH, T4 and T3 levels monitored and analyzed in biochemistry laboratory using Cobas e411 Fully Automated Machin. Thyroid cancer struck most females than males. Thyroid cancer incidence has increased among people aged 20 to 40. Most thyroid cancer cases are papillary thyroid carcinoma. Thyroidectomy was done with an 87.14% success rate. The level of TSH hormones increased in thyroid cancer patients. Also, the percentage of T4 hormone levels was mostly increased, whereas thyroid cancer had no proven effect on T3. Papillary thyroid carcinoma was the most common thyroid cancer. There was pronounced effect of thyroid cancer on the TSH and T4 hormone, however T3 hormone remained unchanged.

Awareness and Skills of Libyan Physicians in Delivering Bad News to Patients at Tripoli University Hospital

Breaking bad news (BBN) to patients is a highly sensitive challenge that, sooner or later, all physicians must face. It is one of the most difficult responsibilities in the practice of medicine. Physicians should learn good communication techniques to assist patients in overcoming negative news. Therefore, the study is presented to evaluate the awareness and skills of Libyan physicians in delivering bad news to their patients. A cross-sectional study was carried out at Tripoli University Hospital (TUH) from the first of April 2021 until the last of July 2022. In Libya, a structured questionnaire based on the 6-step SPIKES protocol for BBN was administered to 150 physicians working at the TUH to assess their awareness and training. About 46% of the physicians had good awareness of the components of the 6-step SPIKES protocol, while 53% implemented the protocol at the accepted level. There was statistical significance between awareness level, age, and gender. There was no significant relation among physicians with regards to their qualifications, physicians with PhD degrees, or registrar, and medical officers about awareness and practice scores. There is a weak positive correlation between the awareness group score and the training group score (r=0.20. p=0.015). Physicians' BBN awareness is at an accepted level, and their method of practice is accepted as well. BBN is a neglected topic in medical education and training, especially among physicians under the age of 31.

Prevalence of Anemia in Libyan Patients with Celiac Disease Before and After a Gluten-free Diet

Abstract BACKGROUND: This study aimed to estimate the incidence of anemia among celiac patients before and after their intake of a gluten-free diet (GFD). METHODS: A retrospective cross-sectional study was conducted in different departments of internal medicine, gastroenterology, and pediatrics at Tripoli University Hospital, Tripoli, Libya. The study data were retrospectively extracted from the clinical files of 100 patients who were diagnosed with celiac disease (CD). Hematological results of complete blood count for each patient before and after induction of GFD for 1 year were collected from the medical records. The data were analyzed using IBM SPSS version 26 software. RESULTS: Out of 100 CD patients, 53 patients were female and 47 patients were male. The analysis showed that the values of red blood cell, hemoglobin, hematocrit, mean cell hemoglobin (MCH), and MCH concentration were significantly higher after treatment compared to before one (P < 0.05). However, the independent t-test analysis did not show a significant difference in the mean values of white blood cell and red cell distribution width before and after treatment (P > 0.05). In addition, the mean value of platelets was lower after treatment with a P = 0.047. CONCLUSION: Anemia was a common finding in the studied cases. Although the GFD improved CD symptoms, anemia persisted in a number of CD patients, even after a year of GFD treatment.

Association of ABO/Rh Blood Group with Hypertension in Pre and Postmenopausal Libyan women

BACKGROUND AND AIM: Hypertension is a prevalent and significant public health issue worldwide, affecting a substantial portion of the population. While various risk factors have been implicated in the development of hypertension, including genetics, lifestyle, and hormonal changes, the role of ABO/Rh blood groups in hypertension remains underexplored, particularly in different stages of Libyan women’s life. This research study aimed to investigate the potential association between ABO/Rh blood groups and hypertension in both pre- and post-menopausal Libyan women. METHODOLOGY: A cross sectional study was conducted over a four-month period on a diverse cohort of women aged 35 to 75 years. It involved a total of 200 hypertensive women divided into pre- (n=100) and post-menopausal (n=100) groups. It took place at Tripoli University Hospital, Tajoura Heart Centre and Total Care Clinic. Data were collected through structured interviews, clinical examinations, and blood sample analyses. Blood pressure (BP) measurements and blood group typing were performed using standard medical procedures. A statistical analysis was performed using SPSS program version 26.0. RESULTS: The distribution of ABO blood groups shows that blood group O is the most prevalent blood group among samples (58% in the pre-menopausal and 41% in post-menopausal hypertensives), whereas blood group AB is the least prevalent (only 9% in the pre-menopausal and 7% in post-menopausal hypertensives). One hundred and eighty-one (90.5%) were Rh +ve. Analysis of data revealed significant differences in age distribution as well as in the percentages of Rh +ve and Rh -ve blood groups among pre- and post-menopausal women (p<0.05). However, there was no statistically significant difference in the mean values of BP indices between ABO/Rh blood groups (p>0.05).CONCLUSION: This study showed that ABO/Rh blood group system does not significantly affect BP indices among the pre-menopausal and post-menopausal women. Findings of present study also illustrated that age could potentially influence the connection between blood groups and hypertension. Additionally, among ABO/Rh blood groups, the most observed type was 'O.' However, further investigation is necessary to validate these initial results and better understand the underlying mechanisms behind this relationship