مجلة جامعة صنعاء للطب والعلوم الصحية

Background: The occurrence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a major contributor to morbidity and mortality. Hence, it is imperative to decrease the occurrence of clinically significant POPF to enhance the overall morbidity outcomes associated with PD. This study seeks to assess the outcomes of pancreatic fistula following PD.

Methods: This study was a combined prospective and retrospective analysis of patients who underwent PD at Al-Thawra Modern General Hospital between January 2016 and April 2021. A total of 42 patients were included in the analysis.

Results: Among the 42 patients who underwent PD, 40% were male and 60% were female. The age distribution showed that 5% of patients were under 20, 14% were between 20 and 40, and 81% were above 40. The primary indications for PD were malignant periampullary tumors in 83.3% of patients, solid pseudopapillary tumors of the pancreas in 7.1% of patients, chronic pancreatitis in 4.76% of patients, duodenal adenocarcinoma in 2.38% of patients, and trauma in 2.38% of patients. Among the patients, 30 (71.43%) had a successful recovery without evidence of pancreatic fistula (PF), whereas 12 (28.57%) developed POPF. Among the 12 patients with POPF, 3 (7.14%) had a biochemical leak, 5 (11.9%) had a grade B fistula, and 4 (9.53%) had a grade C fistula according to the revised ISGPS definition. Of the patients with POPF, those with a biochemical leak did not experience significant morbidity and were managed conservatively. Patients with grade B fistula (5 patients) had an extended hospital stay of approximately 2-3 weeks and received percutaneous drainage as an intervention. One patient (8.33%) with grade C fistula required reoperation because of bleeding, and 3 patients (25%) developed septic shock and subsequently died, resulting in an overall mortality rate of 25% among patients with POPF.

Conclusion: POPF following PD remains a serious complication of substantial morbidity and mortality. Further improvements in the prevention, early detection, and management of POPF are necessary to reduce postoperative morbidity and mortality. Using the ISGPS definition and grading of PF aids in the clinical assessment and management of PF.

Background and objective: The way we think about schizophrenia today is profoundly different from the way this illness was seen in the twentieth century. We now know that the etiology of schizophrenia is multifactorial and reflects an interaction between genetic vulnerability and environmental contributors. Environmental risk factors such as pregnancy and birth complications, childhood trauma, migration, social isolation, urbanicity, and substance abuse, alone and in combination, acting at a number of levels over time, influence the individual’s likelihood to develop the disorder. There are no studies on mental health in Yemen in general and schizophrenia in particular. Thus, the aim of this study was to study  the non-genetic risk  factors of  schizophrenia. The specific objectives were to compare exposure to suspected risk factors for schizophrenia in a cohort of schizophrenia patients with those randomly selected from the community.

Methods: The researchers approached inpatient in Al-Amal Hospital for Psychiatric Diseases with a diagnosis of schizophrenia. Patients from this list were then randomly selected using the card-shuffling technique. Patients were included in the study if a review of their records confirmed a diagnosis of schizophrenia according to DSM IV criteria, they were ≥18 years old, and had attended the clinics between the period January 2021 and December 2021.  Controls were from general population by selected randomly from the list of censuses by simple random selection from Sana’a governorate. 

Results: Regarding associated risk factors of schizophrenia, there was significant association with low income (OR= 7.1), loss work (OR=57), smoking  (OR=5.9) , Khat chewing (OR=12.4), birth complications (OR=7.2) , 1-6 Apgar scores (OR=1.8), older paternal age (OR=3.2), the spring birth  (OR=2.2), and winter birth (OR=1.9), childhood trauma (OR=1.9), cannabis  (OR=7.4), hypertension(OR=4.7) , and diabetics (OR=6.6).

Conclusion: Future research in Yemen should also explore potential protective factors in groups at risk for psychotic disorders. A new area of ​​research should involve big data and predictive models, by replacing traditional paper notes with electronic patient records.

Fast dissolving drug delivery systems offer a solution for patients having difficulty in swallowing tablets.  In this study, an attempt had been made to perform pre-formulation studies of bisoprolol as fast dissolve sublingual tablet, an antihypertensive by direct compression methods using sodium-starch-glycolate, croscarmellose-sodium, & crospovidone as superdisintegrant agent. The basic purpose of the pre-formulation activity is to provide a basis for the formulation approaches, to maximize the chances of success in formulating an acceptable product, optimizing drug product quality and performance. Preformulating activity including drug melting point; analytical wavelength (λ max) detections, drug-excipients physical & chemical compatibility by FT-IR, and Calibration curve of Bisoprolol were studied. It was discovered that the melting point was 100°C, and the UV spectral analysis revealed that the maximum value of λ was between 224 and 273 nm. The physicochemical compatibility studies results indicate that there was no interaction between bisoprolol and the excipients. Strong linear relationship obtained from calibration curve. Based on results, fast dissolving sublingual tablets of Bisoprolol can be prepared successfully by direct compression.

Background: Corneal lesions handicap all age groups and corneal grafts, provided by do-nors, treat most of the isolated corneal lesions that has wide diverse etiologies. Methods and patients: This study analyzed corneal lesion etiologies and determined the percentage of candidates that required corneal grafts.  This study was conducted in Al-Thawra Modern General hospital (ATGMH) in 2004. We enrolled all new patients with cor-neal lesions attending the clinic during the study period. The corneal lesions were either isolated or combined with other eye lesions. We determined the demography, etiology, and visual acuity by Snellen's E- chart, slit lamp, ultrasound, and accordingly documented the plan of treatment. Those that had trauma and/or inflammation were treated with followed up for two months to plan their potential need for corneal graft. Results: From 1440 ophthalmic patients visiting the eye clinic in 2004, the incidence rates of eyes affected by corneal lesions were 9.41% (N=135). Among the causes requiring primary and secondary level intervention were trauma (61) 4.236% and inflammation (18) 1.25%. Among the treated suffers, 15% obtained visual acuity 6/36 and better. Tertiary intervention by corneal graft was required among degenerative lesions (9) 0.625%, keratoconus (12) 0.833%, edema (12) 0.833%, dryness (7) 0.278%, dystrophy (6) 0.416%. Meanwhile, the fourth level required cosmetic treatment and rehabilitation. The lesions were bilateral in (27) 20%, congenital in (6) 0.416% and tumors found in (2) 0.138%.

Conclusion: The incidence of corneal lesions was high (9.4%) among our patients, 63.94% were due to preventable trauma and inflammation and 69% were candidates for corneal graft. 

Lead is a toxic element and has become a growing health concern in different countries which causes acute, subacute, or chronic poisoning through environmental and occupational exposure.  Up to now, no report is available on the assessment and evaluation of the health effects of lead exposure in petrol station workers. Therefore, this study aimed to assess the changes in hematological parameters associated with occupational lead exposure among petrol station workers in Sana'a city -Yemen. A comparative descriptive cross-sectional study was conducted from January to June 2020 among petrol station workers in Sana' a city. A total of 50 blood specimens were randomly collected from 38 workers and 12 control groups aged between 18 to 66 years. The hematological parameters and level of blood lead were measured by using fully automated Hematology and atomic absorption spectrophotometer, respectively. Also, the required information and associated risk factors were gathered by a standard questionnaire. The result revealed mean blood Lead levels are significantly higher among petrol station workers (17.80 ± 8.06 µg/dl) when compared to control groups (5.00 ± 2.34) (P =0.003). Also, a higher rate of blood Lead level was found among the age group of ≤ 20 years old, uneducated individuals working for 6-10 years, and working more than 12 h per day. The means of RBCs, HBG, HCT, and WBC in petrol station workers were insignificantly lower than those in control groups (P>0.05). There is a positive relationship between reticulocyte count and blood Lead level (r= 0.526; P=0.001). It can be concluded that high levels of blood Lead among petrol station workers consider seriously affect workers' health resulting from lack of personal protective equipment. The level of workers’ education seems to influence their practices of using personal protective equipment. Therefore, a clear educational and protection policy is required for those who are occupationally exposed to Lead.

Iron deficiency (ID) is a common cause of anemia worldwide. The importance of iron deficiency as a public health problem is based ultimately on the seriousness of its consequences on health. This case-control study aimed to evaluate the levels of immunoglobulins (IgM and IgG), and their association with hematological parameters, iron indices, total and differential leukocyte count among children with iron deficiency anemia (IDA). This study was conducted during a period of six months; starting in December 2021 and ending in May 2022. During this period, 136 samples were collected from preschool-aged children (<5 years) who attended outpatient pediatric clinics in Al-Sabeen hospital for maternity and childhood and other private pediatric clinics in Sana'a city, Yemen. Sixty-eight IDA and 68 age and sex-matched healthy children were enrolled and a complete history was obtained. Clinical examination, C-reactive protein, albumin test, complete blood count, iron profile tests and immunoglobulins assays were performed. The results of the present study revealed that, serum levels of IgM and IgG in IDA group were significantly lower than those in control group (p= 0.001). Total leukocyte count and percentage of eosinophils were significantly increased (p= 0.01, 0.001, respectively), in contrast, percentages of lymphocytes and monocytes were significantly decreased (p= 0.002, p= 0.04, respectively) in IDA than control group.  However, there were no statistically significant differences in percentages of neutrophils, basophils and platelets count between the two groups (p=0.47, 1.00, 0.07, respectively). Serum levels of IgM were correlated with levels of Hb, HCT, RBCs, MCV, MCH, RDW, iron indices and percentage of eosinophils (p<0.05). However, serum levels of IgG were correlated with levels of all hematological parameters, iron indices and percentage of eosinophils (p<0.05). It can be concluded from these results that the IDA is associated with humoral immunity and may predict increased susceptibility to infections.

Background: Heart Failure with all its types and presentation is the end result of acute coronary syndrome. Coronary artery disease and its acute manifestations of ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina are remarked as acute coronary syndromes (ACS). Yemeni patients usually present themselves to hospital late due to a lack of society awareness of the symptoms of ischemic heart disease, absence of medical insurance, poverty, lack of medical aid and intensive care units (ICU), absence of ambulance services, and long distance to the facilitated hospital with equipped ICUs. Late presentation prevents giving thrombolytic therapy or performing invasive interventions within the right time. These factors in addition to other factors may contribute to the large number of heart failure post ACS. We designed this study to study the heart failure complicating acute coronary syndrome.

Results: Out of 637 patients with ACS, 294 (39%) were in heart failure complicating ACS, with a median age of 51 years. Males represent 66% (194 patients) and females 34% (100 patients). Smoking represents 36%, khat chewing 88%, hypertension 53%, dyslipidemia 31%, past history of MI 29%, and diabetes mellitus 40%. Ischemic-type chest pain represents 49% and Dyspnea as primary symptom occurred in 29% with heart failure (HF). Late presentation of more than 12 hours represents 53% (111 patients) among patients with HF complicating STEMI or LBBB MI. These patients did not receive thrombolytic therapy or primary PCI. Patients who received thrombolytic therapy represent 45% (95 patients) of patients with HF-complicating ACS. No patients received primary PCI.

Conclusions: Heart failure complicating ACS is common among our patients and associated with high in-hospital death and is mainly among young patients and related to late presentation, management with non-fibrine specific thrombolytic agents (streptokinase), and lack of STEMI catheterization team for 24 hours, seven days a week.