Sana’a University Journal of Medicine and Health Sciences

Background: Obstructive jaundice is among the most challenging conditions managed by general surgeons and significantly contributes to high morbidity and mortality.

Objectives: This study evaluated the short-term outcomes of surgical treatment for benign obstructive jaundice.

Methods: A cross-sectional descriptive study was conducted prospectively at Al-Thawra Modern General Hospital between January 2019 and December 2021, including all patients with benign obstructive jaundice who underwent open surgical treatment.

Results: The study included 36 patients with a median age of 55 years, and female predominance (63.9%) compared with male predominance (36.1%). The most common preoperative diagnosis was common bile duct stones (66.7%), followed by postcholecystectomy biliary strictures (25%). Abdominal pain (91.7%) and jaundice (83.3%) were the most frequent symptoms. Twenty-four patients with CBD stones underwent cholecystectomy with CBD exploration with either T-tube drainage (17 patients) or choledochoduodenostomy drainage (5 patients), and only two patients underwent cholecystostomy tube drainage. However, all 9 patients with postcholecystectomy biliary strictures underwent hepaticoenterostomy drainage procedures. Postoperatively, the median length of hospital stay was 6.33 (2-15) days, and direct bilirubin levels decreased in most patients by the 7^th day (88.9%). Wound infection (27.8%), mild pulmonary complications (19.4%), and moderate pulmonary complications requiring ICU admission (13.9%) were the most common complications. No mortality was recorded. Conclusions: Open surgical treatment of benign obstructive jaundice is safe and effective because improved abdominal pain, subsidence of obstructive jaundice features, and postoperative bilirubin level drop were observed in almost all patients. Wound infection and pulmonary complications were the most common complications. Common bile duct stones were the leading cause of this condition, and female preponderance was observed. Future studies should focus on optimizing the management of these patients, including minimizing postoperative complications such as wound infections.

Background and aim: TMJ arthralgia is a painful ailment that is thought to be related to local inflammation in the jaw joint. The purpose of the current study was to evaluate the effectiveness of a single intra-articular (IA) injection of butorphanol into the TMJ for lowering pain and improving mouth opening. The concept was that butorphanol would significantly lessen TMJ pain and improve mouth opening.

Methods: Eleven patients were treated in this serie, which was followed up on for three months. Participants in the study had to be at least 18 years old and have a unilateral TMJ arthralgia diagnosis. Butorphanol IA injections weighing 1 mL were given to all individuals. The main result was an analysis of the per protocol population's change in recorded pain intensity on a visual analogue scale (VAS) at maximum jaw opening.

Results: Mouth opening improved after treatment as values ​​increased: 1 week after treatment mean ± SD = 3.072 ± 0.373, after 1 month of treatment the values of mouth opening ​​increased significantly, the highest values ​​occurred after 3 months of treatment where the mouth-opening values ​​were twice the pre-treatment period.   Pre-treatment central trend measures of pain score were:  the mean ± SD =7.364 ± 1.12, the pain score decreased after treatment, one week after treatment the mean ± SD =3.636 ± 1.748, one month after treatment values decreased   significantly, the lowest pain scores occurred after 3 months of the treatment in which 25% of patients recorded 0 pain and 75% of patients recorded 1 or less pain score.

Conclusion: Following a single-dose IA injection, butorphanol was beneficial for lowering pain and improving mouth opening in individuals with TMJ arthralgia.

Background: The available data on the effect of Khat chewing on hematological indices are conflicted and mainly based on animal studies. The aim of this study was therefore to investigate the effect of Khat chewing on hematological indices in humans as well as the possible association of Khat chewing with H. pylori infection and blood loss in the gastrointestinal tract.

Patients and Methods: This study was a comparative cross-sectional study, carried out on 140 participants aged 18 - 55 years old; 71 were healthy non-Khat chewers serving as a control group and 69 were regular Khat chewers. Complete blood count was analyzed as well as H. pylori antigen and occult blood in stool were investigated.

Results: Hemoglobin concentration, MCV, MCH, and PCV were significantly (p = 0.037, 0.034, 0.043, and 0.019 respectively) lower in Khat chewers as compared with non-Khat chewers, whereas platelets count and white blood cells count were significantly (p = 0.006 and 0.007 respectively) higher in Khat chewers. Khat chewing was also associated with H. Pylori infection (OR: 2.7) and blood loss in the gastrointestinal tract (OR: 3.2).

Conclusion: Khat chewing adversely affects hematological indices and increases the risk of H. Pylori infection and blood loss in the gastrointestinal tract.

Caesarean section is a life-saving surgical procedure that can prevent complications and mortality of maternal and new-born when used for clinically indicated reasons. this study aimed to describe trends in caesarean section in private hospital under study from 2014 to 2019 Sana’a, Yemen. This study conducted as a retrospective observational study, The study population was all pregnant women admitted to labour room and gave birth between March 2014 and September 2019, and used secondary data on defined period, for 3,740 pregnant women admitted to labour room and gave birth by vaginal delivery or caesarean section. The data were analysed using Microsoft Excel and IBM SPSS Statistics software version 26.0.   The results of this study found that the total mean of CS rate for period of 2014 to 2019 was 65% of total deliveries, the associated factor with the caesarean section was the maternal age (P-value <,000). Also, there was a significant relationship exists between Length of Stay and mode of delivery across various age groups. Further, studies are recommended to identify determinants, indications of CS and nonclinical factors, affecting CS rate in the same hospital and others.

Background: Unilateral vocal fold paralysis is common finding in otolaryngology practice. It is not a diagnosis by itself. The exact incidence of unilateral vocal fold paralysis has been difficult to find out because of multiple reasons. Various etiologies known to cause this condition are neck surgery, cancer, neck trauma, and neurological disorders.

Objective: The aim of this study was to determine the possible etiologies of unilateral vocal fold paralysis in adult patients.

Methods: A hospital-based study was conducted at OtoLaryngology Department, Al-Thawra Teaching Hospital, Sana'a, Yemen, between January 2014-June 2018. Patients have unilateral vocal fold paralysis were enrolling in this study. All patients underwent to history, clinical examination, laboratory investigations, and radiological studies, X- ray, CT, MRI).                                                                    

Results: A total of 80 patients with unilateral vocal fold paralysis, males59 (73.6%), females 21(26.4%). Age ranged from18-80 years, mean age 51.5years Left vocal fold paralysis (72.5%), while right side was (27.5%). Peripheral causes (93.7%). Idiopathic (32.5%), malignancy (31.2%), trauma (21.2%), TB (7.5%), while central causes were (6.3%), and Guillain Barre (GB) syndrome (1.3%).

Conclusion: Left vocal fold paralysis was the most common finding. Idiopathic was the most common cause, flowed by malignancies and trauma. Thyroidectomy continues to be the single most surgical procedures responsible for unilateral vocal fold paralysis. For this reason, pre and post thyroidectomy laryngoscopy should be considered in all patients undergoing thyroid surgeries

Background: Connective tissue is also called connectivum. Many autoimmune diseases affect the connective tissue and blood vessels, are often referred to as connective tissue disorders. Autoimmune diseases currently are estimated to affect 2-5% of the population in the developed countries.

Aim: The aim of this study was to determine the pattern of autoimmune inflammatory connective tissue diseases among patients attending Al-Thawra teaching general hospital, Sana'a-Yemen.

Method: This study is observational prospective study conducted at Al-Thawra hospital, Sana'a-Yemen, department of internal medicine, duration of the study was 12 months. Sample size was 137.

Results: The results showed that systemic lupus erythematosus, antiphospholipid syndrome and rheumatoid arthritis have the highest prevalence. The main clinical presentations are arthritis, leg swelling and dyspnea. The main drugs used are corticosteroids, low molecular weight heparin, and rituximab. The proportion of females to males is 3.55 to 1. The age range 20 – 30 years is the highest representing 47% of the total patients. Patients from Sana'a, Taiz, and Ibb being the most common. Illiterates represent 63%, housewives represent 72% of the total patients.

Conclusion: We conclude that autoimmune connective tissue diseases affect 8% of the total patients admitted to the internal medicine department. SLE is the most common autoimmune connective tissue disease encountered and represents 43% of total cases. Arthritis and leg swelling are the most common clinical presentations encountered; both represents 48% of the total presentations. Corticosteroids are the most common prescribed drugs, 45%. The aetiology of autoimmune connective tissue diseases is still not fully known. Immuno-modulators are needed to regulate the immune system. Physiotherapy is recommended beside medical therapy.

Objective: This study focuses on surgical technique, assessment of the outcomes and the recurrence rate of the disease. Patients and methods: This retrospective study was done on 18 patients with congenital choanal atresia at Azal specialized hospital and Al Kuwait University hospital, Sana’a, Yemen between 2014 and 2022. All patients underwent endoscopic repair with posterior septectomy, removal of atretic plate, lateral widening toward the pterygoid plate and creation of wide single neochoana with nasal stenting.

Results: Of 18 cases, 2 cases were excluded because of short period of follow up. Of the 16 remaining cases, 13 cases (81.25%) showed good results during the period of follow up (6 months to 9 years) from the initial surgery. Restenosis occurred in 3 (18.75%) bilateral choanal atresia cases which underwent revision surgery with good results. Conclusion: Endoscopic creation of wide single neochoana with stenting followed by close follow up and family education give good success rate.

Background: since the Community Health and Nutrition Volunteers (CHNVs) program established, the performance of CHNVs has never been evaluated.

Aims: to evaluate the performance of the CHNVs, and its associated factors.

Methods: a cross-sectional study design was conducted in Bani Qais and Al-Maghrabah districts, Hajjah governorate between January and April 2023. Odds ratios with 95% confidence intervals (CI) were calculated. A p-value < 0.05 was considered statistically significant.

Results: A total of 65 CHNVs participated in this study. Almost 53.8% of CHNVs had-high performance, 29.2% had moderate performance, and 16.9% had low performance level.

The multivariate regression analysis of factors associated with the performance of CHNVs revealed that the percentage of CHNVs who were involved in an occupation was high-performance compared to those not involved in any occupation (68.8% vs 39.4%). This association was statistically significant [adjusted odds ratio (aOR) = 10.8, 95% CI: 1.1-105.9, p value = 0.041].

Moreover, the percentage of CHNVs who serve 22 or less children under 24 months old was high-performance compared to those serving more than 22 children under 24 months old (69.7% vs 37.5%). This association was statistically significant (aOR = 7.9, 95% CI: 1.2 - 51.5, p value = 0.031).

Conclusions: the performance of CHNVs is inadequate. The main job and number of children under 24 months served were significantly affected the performance of CHNVs.