Vol. 20 No. 1 (2026): Sana’a University Journal of Medicine and Health Sciences

Background: Nutritional assessment at diagnosis increases the clinician's awareness and guides them to refer malnourished patients who are at risk for early dietary intervention.

Aim: To assess the nutritional status at diagnosis in Pediatric Acute Lymphoblastic Leukemia, Sana’a, Yemen.

Methods: A prospective hospital-based cross-sectional study was conducted at the Leukemia Unit of Al-Kuwait University Hospital (KUH), Sana’a, Yemen. Nutritional assessment was performed through utilizing the Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids). Furthermore, body mass index (BMI) was calculated and plotted at BMI-for-age growth charts.

Results: Of the total 119 patients enrolled in the study, the mean age was 7.26  ±  (SD±3.14), (78.1%) were aged less than 10 years, with male predominance, (70.6%) of patients belonged to rural areas. Based on BMI for age, (54.6%) of patients were underweight, (42 %) were in a healthy weight, and (3.4%) of the patients were overweight. Based on the STRONGkids score, (56.3%) and (43.7%) of patients were at moderate and high risk for malnutrition, respectively.

Conclusion: Malnutrition emerges as a critical health concern at diagnosis in pediatric ALL. According to the CDC growth charts for BMI for age, (54.6%) of patients were underweight. On the other hand, the STRONGkids score showed (56.3%) and (43.7%) of patients were at moderate and high risk for malnutrition, respectively.

Abstract

Background and Objectives: Condylar shape varies among individuals and may be influenced by developmental, occlusal, and pathological factors. Condylar shape can aid in the diagnosis of temporomandibular disorders (TMD) when evaluated alongside clinical findings. This study aimed to investigate whether the shape of the temporomandibular joint (TMJ) is associated with habitual chewing in a sample of the Yemeni population, using panoramic radiographs. Materials and Methods: This retrospective, analytical, cross-sectional study included 200 participants (400 condyles) who attended dental clinics at the Faculty of Dentistry, Sana’a University, and private dental clinics. The habitual chewing side was determined using a self-report questionnaire included in the Case Record Form (CRF). Digital panoramic radiographs were analyzed, and the condyle was traced manually using the MicroDicom DICOM Viewer. Five condylar shape classifications were used: type 1 (round), type 2 (diamond), type 3 (bird beak), type 4 (crooked finger), and type 5 (bifid). Intra- and inter-examiner reliability were tested using Cohen’s kappa. The chi-square test was used to compare the associations among the study variables. The Fisher’s Exact Test was applied to a small sample of male participants. The data were analyzed using SPSS version 27. Results: Among the 200 participants (180 females, 20 males; aged 18–49 years), 52.5% preferred chewing on the right side. The round condylar shape was the most prevalent overall (males: 50%; females: 50.6%), whereas the bifid shape was the least common in both sexes (males: 7.1%; females: 3.3%). No statistically significant association was observed between the preferred chewing side and condylar morphology in males (p = 0.323), females (p = 0.148), or the overall study population for the right (p = 0.097) and left condyles (p = 0.388). Conclusion: Within the limitations of this study, it may be concluded that the round shape was the most common type among the selected group of Yemeni adults, regardless of sex or side. The least common type is bifid.
Additionally, there was no significant association between the preferred chewing side and condylar shape.

Malnutrition remains a major health issue in Yemen, particularly among children under five. It affects the hematopoietic system, leading to abnormal red blood cell parameters and anemia. This study aimed to assess RBC parameters and associated factors among malnourished children.
Methods: A cross-sectional study was conducted on 264 malnourished children diagnosed with moderate acute malnutrition (MAM) or severe acute malnutrition (SAM). We analyzed blood samples for complete blood counts. Data were collected for statistical analysis.
Results: Among the children, 51.1% had MAM, and 48.9% had SAM. Anemia was found in 59.5% of the participants. Children with SAM had significantly lower hemoglobin levels, RBC count, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and higher red cell distribution width (RDW-CV) (p=0.001). Abnormal RBC parameters are associated with socioeconomic and maternal factors.
Conclusion: Hematological abnormalities and anemia were prevalent among malnourished children in Sana’a, underscoring the need for targeted interventions that address family income, maternal education, and maternal health.

Background: Anemia during pregnancy is a widespread public health concern that can lead to serious complications, including maternal and fetal morbidity and mortality. Aim: This study aimed to determine the prevalence of anemia and its associated factors among pregnant women in Bajil City, Yemen. Materials and methods: Analytical cross-sectional study was conducted among 382 pregnant women aged 16–47 years who attended Bajil Regional Hospital and public health centers from August 1, 2024, to May 31, 2025. Data were collected using a structured questionnaire, and hemoglobin concentration was estimated using hematology analyzers. Data were analyzed using SPSS version 20. Results: The prevalence of anemia among pregnant women was 80.1%. Moderate anemia was most common (64.05%), followed by mild (29.41%) and severe anemia (6.54%). Univariate analysis revealed significant associations between anemia and young age (p = 0.007), rural residence (p = 0.040), low income (p = 0.038), gravidity (p = 0.001), history of abortion (p =0.024), short pregnancy spacing (p = 0.011), and second trimester (p = 0.006). After adjustment, only income (p = 0.016) and second trimester (p = 0.010) remained significant. Conclusion: Anemia prevalence was very high, with moderate anemia predominating. Lower income and being in the second trimester were significantly associated factors. Interventions targeting nutrition, supplementation, health education, and antenatal follow-up are crucial. Keywords: prevalence; associated factors; anemia; pregnant women; Bajil City; Yemen.

Background: Unstable pelvic fractures are severe injuries resulting from high-energy trauma that often led to significant morbidity and mortality. Surgical management aims to restore stability and improve functional outcomes; however, data from conflict-affected regions such as Yemen are scarce. This study aimed to prospectively evaluate the functional outcomes and complications of the surgical management of unstable pelvic fractures in a Yemeni patient cohort.

Methods: This prospective cohort study was conducted at the Military General Hospital and Al-Thawra Modern General Hospital in Sana’a, Yemen, between April 2019 and April 2023. We enrolled 76 patients aged 16– 60 years with unstable pelvic ring fractures that required surgical intervention (Tile type B/C). Data on patient demographics, mechanism of injury, fracture classification (Tile and Young-Burgess), surgical approach, and complications were collected and analyzed. Anatomical reduction was assessed using the Matta and Tornetta criteria, respectively. Functional outcomes were evaluated using the Majeed scoring system at a mean follow-up of four years.

Results: The mean patient age was 34 years, and the majority of patients were male (68.4%). The most frequent mechanisms of injury were motorcycle accidents (30.3%) and car accidents (27.6%), followed by falls from a height (26.3%). According to the Tile classification, the most frequent fracture patterns were C2 (36.8%) and C1 (34.2%). Postoperative radiological assessment revealed excellent reduction in 69.7% of patients. The overall complication rate was 30.3%, with wound infections (9.2%) being the most common. According to the Majeed Functional Outcome Score, 63.2% of the patients achieved excellent results. Statistical analysis revealed a significant positive correlation between the quality of radiological reduction and final functional outcomes (p < 0.05).

Conclusion: Surgical management of unstable pelvic fractures in the challenging setting of Yemen can yield good-to-excellent functional outcomes. Despite resource limitations, anatomical reduction and stable fixation lead to satisfactory results, although complication rates remain a concern. This study highlights the feasibility and effectiveness of modern orthopedic trauma care in conflict zones.

Background: Helicobacter pylori is a widespread gastric pathogen associated with various gastrointestinal disorders. In Yemen, khat chewing is a common social practice; however, its association with H. pylori infection remains unclear. Therefore, this study aimed to determine the prevalence of H. pylori infection among khat chewers and non-chewers in Sana’a, Yemen, and to identify associated risk factors.

Methods: A cross-sectional analysis was conducted on 100 adults presenting with dyspeptic symptoms at healthcare facilities in Sana’a between June and December 2021. Participants were interviewed about their demographic characteristics, khat chewing, dietary habits, and other lifestyle factors. Stool samples were collected and tested for H. pylori antigen using enzyme-linked immunosorbent assay (ELISA). The association between H. pylori infection and potential risk factors was evaluated statistically.

Results: H. pylori was detected in 25% of patients with dyspeptic symptoms, with infection rate being significantly higher among khat chewers (33%) than among non-chewers (16%) (p = 0.049). Spicy food consumption and high coffee intake were significantly associated with infection. In contrast, no significant associations were found with water source, smoking, or educational level. Although symptoms such as abdominal pain, nausea, and loss of appetite were frequently reported, none showed a statistically significant association with H. pylori infection.

Conclusion: Khat chewing, spicy food consumption, and frequent coffee consumption appear to increase the risk of H. pylori infection among adults with dyspeptic symptoms in Sana’a. These findings highlight the importance of addressing local habits for the prevention and management of H. pylori infection.

Background and objective: Mandibular angle fractures are among the most common facial injuries and are often associated with impacted third molars (ITMs). While several studies have suggested a link between impacted mandibular third molars and the likelihood of mandibular angle fractures, the nature and strength of this relationship remain inconclusive, particularly in Yemen. Therefore, this study aimed to investigate the relationship between impacted mandibular third molars and mandibular angle fractures in Yemeni patients attending major hospitals in Sana’a City, Yemen.
Methods: A prospective case-control study included 52 patients with impacted mandibular third molars. They were divided into two equal groups: Group A included patients with mandibular angle fractures who had sustained trauma and were referred to the oral and maxillofacial surgery department of selected hospitals. Group B included patients without mandibular angle fractures who had sustained trauma and were referred to the oral and maxillofacial surgery departments of the selected hospitals. Data were collected through clinical and radiographic examinations, orthopantomograms, cone beam computed tomography ( CBCT), and written questionnaires. The condition of the mandibular third molars was assessed according to the Bell, Gregory, and Winter classification systems. Data were analyzed using chi-square tests, proportional hazards, and logistic regression to assess the association between impacted third molars and angle fractures using the SPSS program (Version. 26).
Results: Impacted lower third molars were present in 50% of the fracture cases and 42.3% of the controls, with a calculated RR of 1.18, indicating a slight but non-significant increase in the fracture risk. Missing third molars were significantly associated with mandibular angle fractures (OR = 2.4; p = 0.004), whereas erupted third molars appeared to have a protective effect (OR = 0.4; p = 0.011). No statistically significant differences were observed between the different impaction classifications.
Conclusion: The results indicated that impacted lower third molars may slightly increase the risk of mandibular angle fractures; however, this association was not statistically significant. In contrast, the absence of third molars was associated with an increased fracture risk, as erupted molars provide structural support. In addition, the limitations of the current study restrict the clinical application of such findings.

Background and Objective: The provisional phase in crown and bridgework significantly influences the success or failure of the final restoration. They protect the prepared teeth, maintain occlusal stability, and meet aesthetic and functional needs during the period between tooth preparation and the final crown placement. Inadequate marginal sealing of temporary restorations may result in various complications; however, advancements in digital dentistry have recently enhanced the precision and marginal integrity of these restorations. This study aimed to evaluate the microleakage of poly methyl methacrylate (PMMA) provisional crowns made using the computer-aided design/computer-aided manufacturing (CAD/CAM) technique.
Materials and Methods: This in vitro experimental study was conducted using 12 identical resin dies milled from one extracted, standardized human mandibular first molar after preparation. Provisional crowns were designed and fabricated using CAD/CAM techniques from pre-polymerized PMMA blocks. All crowns were cemented with non-eugenol zinc oxide temporary cement (GC Free eugenol, Japan), subjected to static artificial aging in distilled water at 55 °C for 5 days, and loaded with a 5 kg vertical force to simulate clinical seating. The samples were then immersed in 2% methylene blue solution for 24 h, buccolingually sectioned using a low-speed diamond disc, and examined under a stereomicroscope (Cambridge, UK) at 30× magnification. A total of 12 specimens were evaluated, with four distinct areas examined in each specimen (Buccal A, Buccal B, Lingual A, Lingual B), and a total of 48 areas were assessed for microleakage. Dye penetration was scored from 0 to 4 (0 = no penetration; 4 = penetration up to the occlusal surface). Data were analyzed using IBM SPSS Statistics (version 27). The Wilcoxon signed-rank test was used to compare the buccal and lingual surfaces within the same sample. Friedman tests were used to assess the variations across all surfaces, and the chi-square test was used to evaluate the association between fabrication technique and leakage score categories. The significance level was set at p < 0.05.
Results: The CAD/CAM provisional crowns showed significantly low microleakage scores. Moreover, the buccal surfaces showed less microleakage than the lingual surfaces. Regarding occlusal surface microleakage, the CAD/CAM provisional crowns showed no occlusal leakage. However, the differences in microleakage on the lingual surfaces were not statistically significant. Furthermore, comparisons within the same group of surfaces were not significant.
Conclusion: According to the findings of the present study, CAD/CAM-fabricated temporary crowns demonstrated good marginal integrity and low scores of microleakage. The lower values on the buccal surfaces and the lack of occlusal microleakage indicate improved CAD/CAM restorative accuracy and adaptability.

Background: Assessment of skin tone is a fundamental in esthetic dentistry. guiding the accurate selection of tooth shade for patients with missing or compromised dentition. While the Fitzpatrick Skin Type (FST) scale remains a widely used traditional method, digital skin tone sensors offer objective and reproducible alternatives. However, few studies have directly compared these approaches in dental contexts, particularly among underrepresented populations.
Objective: This study aimed to evaluate the reliability of a portable digital skin tone sensor compared to the Fitzpatrick Skin Type Scale in assessing skin tone among Yemeni dental patients.
Methods: This cross-sectional study was conducted among 200 Yemeni participants (equally distributed between males and females), aged from 18 to 50 years old. They were recruited from dental clinics at the Faculty of Dentistry, Sana’a University and affiliated private universities. Skin tone was assessed using the FST questionnaire and a calibrated digital skin-tone sensor. The intraclass correlation coefficient (ICC) was calculated to evaluate the agreement between the two methods.
Results: The ICC value between the digital and questionnaire-based assessments was 0.811, indicating moderate to good agreement. Although the digital method tended to yield slightly lower average skin tone scores, the difference was not statistically significant (p = 0.146).
Conclusion: The findings suggest that the digital skin tone sensor provides reliable measurements comparable to the traditional FST. Its integration into esthetic dental workflows may enhance shade-selection accuracy and support inclusive clinical decision-making.

Purpose: Tibial bone defects in total knee arthroplasty (TKA) pose a significant challenge for surgeons, potentially causing improper component balancing. We studied the outcomes of autogenous structural bone grafting with screws to address medial proximal tibial defects in primary TKA with varus deformity.
Methods: A prospective study was conducted at Elite Hospital’s Orthopedic Department in Sana’a City between 2020 and 2024. Patients with uncontained medial proximal tibial defects 10–25 mm in depth who underwent primary TKA for varus deformity were managed using autogenous structural bone grafts fixed with screws and followed up for at least 40 months. Patients were followed up clinically using the Knee Society Score (KSS). Radiological follow-up was performed to assess bone graft union and implant stability.
Results: The study included 29 patients with a mean age of 59.3 ± 7.2 years. Twenty (69%) were female, and nine (31%) were male. The median BMI was 28.3 (IQR, 26.30–29.30) kg/m2. The mean defect depth was 13.2 ± 3.0 mm, with a mean follow-up duration of 55.3 ± 1.3 months. The median (IQR) preoperative KSS increased from 27 (23–34) to 91 (90–93) points at the last follow-up (P < 0.05), and the median (IQR) knee ROM improved from 84.0° (67° –109°) to 128.9° (122.1° –140.9°) (P < 0.05). Flexion contractures and varus deformities were completely resolved postoperatively (P <0.05). The mean graft union time was 8.2 ± 1 months. The overall
complication rate was 13.7%.
Conclusion: The use of autogenous bone grafting fixed with screws to manage large uncontained medial proximal tibial defects in primary TKA with varus deformity is a viable and successful treatment option.