21umas.edu.yeفي هذا الاصدار
- Comminuted Intraarticular Distal Radius Fractures: Functional Outcome and Short-term Follow-up after Surgical Treatment with Spanning External Fixation AlSaifi1Mohammed, et al.
- Incidence, Clinical Profile and Prognostic Indicators for Visual Outcome in Traumatic Cataract Surgery in Yemen Alakhlee Hisham, et al.
- Clinical Presentation Variants of Chronic Subdural Hematoma Cases Me’asar Mojahed, et al.
- Epidemiological Description of Primary Brain Tumors: A Single-Center Retrospective Study of 75 Cases, Yemen Shamsaldin Mohamed, et al.
- The Role of Clinical Pharmacists in the Detection and Evaluation of Adverse Drug Events: A Review Article Al-Akhali Khaled and Alyahawi Ali.
- Application of Genome-Based Therapy in Clinical Pharmacy Practice: Prospects and Challenges Al-kaf Ali G. and Alyahawi Ali.
- Lumbosacral Nerve Root Compression by Gravid Uterus as a Cause of Sciatica in Pregnancy: Diagnosis by Exclusion.Al-Dofri Saif.
- A study of drug-drug interactions involving direct oral anticoagulants for discharged patients in Sana’a city, Yemen.Ali Alyahawi, et al.
v4_i1_merged
# Comminuted Intraarticular Distal Radius Fractures: Functional Outcome and Short-term Follow-up after Surgical Treatment with Spanning External Fixation
AlSaifi1Mohammed, et al
Background: Treating a severely comminuted distal radius intraarticular fracture is challenging
as it can lead to disability, unless the alignment of the fractured bones is restored as accurately as
possible and maintained in an anatomical position.
Objective: This study aims to assess the efficacy of utilizing an AO spanning external fixator in the treatment of comminuted distal radius intraarticular fracture.
Methods: Between January 2020 and September 2022, 38 individuals with isolated closed comminuted intraarticular distal radius fractures (DRFs) were enrolled in this research. The patients underwent clinical and radiological evaluations using the AO classification system in the emergency department. The patients were taken to the operating theatre, where closed reduction techniques and a stable mini-AO spanning external fixator were employed to restore the radiological parameters of the distal radius. The functional status of the patients was assessed at 3,6, and 12 months using the modified Green and O’Brien scale. The collected data were then analyzed to evaluate treatment outcomes.
Results: 32 (84%) patients were males with an average age of 32. Among the cases, 45% of the
patients had AO-23C3 fractures, while 55% had AO-23C2 fractures. The procedure duration
ranged from 15 to 25 minutes. The external fixator was removed after a median period of seven
weeks. Additional percutaneous K-wires were used in 6 patients for enhanced stability. Three patients experienced pin tract infections during treatment. Radiographic measures of the distal
radius showed normal values. Functional outcomes were favorable; with 55% of patients had
excellent results, 29% experienced good outcomes, and 11% and 5% presented fair and bad
outcomes respectively.
Conclusion: Severely comminuted DRFs can be effectively treated with minimally invasive
spanning external fixation, restoring anatomical and radiological parameters and achieving
favorable functional outcomes.
Keywords: Distal Radius Fracture, External Fixation, Radiological Parameters, Anatomical
Parameters, Surgical Treatment
# Incidence, Clinical Profile and Prognostic Indicators for Visual Outcome in Traumatic Cataract Surgery in Yemen
Alakhlee Hisham, et al
Background: Traumatic cataract is an important cause of monocular blindness. It poses a
formidable challenge to ophthalmologists for achieving optimal visual acuity as visual prognosis
shows highly unpredictability and the injured lens is not the only determining of visual outcome.
Objective: The study was conducted to assess the incidence, clinical characteristics, and prognostic
indicators for visual outcomes in traumatic cataract surgery.
Methodology: Medical records of 832 patients presented with traumatic cataract and underwent
surgical intervention during the study period at Magrabi Eye Hospital, Sana’a, Yemen were
reviewed retrospectively. χ2 test, odds ratios, and 95% confidence intervals were used to figure out
the prognostic factors for visual acuity ≥ 6/18 at final follow-up after cataract surgery.
Results: The incidence rate of cataract was 0.78 %, or 7.8, patients per 1000 patients of eye OPD.
The mean age was 20.51 ± 13.16 SD years old with the majority (83.5%) were ≤ 30 years old and
42.9% ≤18 years old. Males were 82.6%. Open globe injury was the most prevalent trauma type
(70%). Cornea damage was the predominant concurrent injury in (58.2%). Anterior capsule rupture presented in 32.3% and was statistically indicator for presence in 46.7% of 122 eyes with posterior
capsule rupture (χ² = 13.64, p = < 0.001). Anterior surgical cataract removal approach performed
in 61.4% and 38.6% performed pars plana vitrectomy with lensectomy (PPLV). Intraocular lens
implanted 75.6%, with 89.5% placed at capsular bag. Posterior capsule opacity was the most late
postoperative complication (8.3%). 47% of eyes achieved ≥ 6/18 and 27% were blind in the injured
eye < 3/60. Better initial visual acuity (VA) was statistically significant indicator for achieving
final VA≥ 6/18, (χ²= 29.4, p = <0.001). Correlation was found between final VA ≥ 6/18 and age
and sex, female patients and younger than 18 years old had the best prognosis. Closed globe injury
had satisfactory final VA ≥ 6/18 in 58% comparing to open globe injury 46.3%, (χ²= 8.944, p =
0.003). Retinal detachment, endophthalmitis, vitreous hemorrhage, posterior capsule rupture or
IOFB and no IOL implanted carried the poorest prognosis for final VA ≥ 6/18, (p = <0.001). A
statistically favorable final VA ≥ 6/18 was obtained in anterior approach cataract removal than
PPLV (χ²= 102.3, p = < 0.001), capsular bag IOL than non PCIOL (χ²= 11.5, p = < 0.001) and
primary IOL than secondary IOL implantation (χ²= 9.9, p = 0.002). No difference was detected
between simultaneous globe repair with cataract removal and two-step surgical procedure (χ=
0.926, p = 0.336). Posterior segment complications and significant corneal scaring were
responsible for blind eyes (<3/60) in 72% and 39.1% respectively, (p = <0.001).
Conclusion: Traumatic cataract remains a frequent sequel of ocular injuries with nearly one third
of patients have monocular blindness with the overwhelming predominance of male, age group (1-
30) years old, and open globe injury. About half of cases have a satisfactory vision after surgical
intervention. The worst indicator factors for poor visual outcome are initial VA ≤ 1/60, open globe
injury, coexisting posterior segment pathology, posterior capsule rupture, and remained the eye
aphakia.
Keywords: Traumatic Cataract, Ocular Morbidities, Cataract Surgery, Visual Outcome, Yemen.
# Clinical Presentation Variants of Chronic Subdural Hematoma Cases
Me’asar Mojahed, et al
Background: Chronic subdural hematoma (CSDH) is a prevalent condition in neurosurgical
practice, predominantly affecting the elderly. However, there is a paucity of data concerning the
characteristics of CSDH patients within Middle Eastern populations including Yemen.
Aim of study: This study aims to systematically evaluate the clinical presentations of patients
diagnosed with chronic subdural hematoma.
Methodology: A retrospective descriptive study was obtained from registry medical records of
patients with CSDH in Al-Thawra Modern General Hospital (TMGH) over a period of six years
from January, 2017 to November, 2022. The collected data encompassed demographic and
clinical characteristics including clinical presentation, Glasgow Coma Scale (GCS) at admission,
etiology, laterality of the hematoma, management approaches and patient outcomes.
Results: A total of 113 CSDH cases were analyzed, with 77.9% of the patients being male. The
mean age was 61.8 years. Motor symptoms were the most common presenting feature, observed
in 79.6% of cases, followed by symptoms of increased intracranial pressure (54.0%) and altered
consciousness (46.0%). At admission, the majority of patients (54%) had a normal GCS score of
15, while 30.1% had GCS scores between 13 and 14. Left-sided hematomas were identified in 44.2% of patients, whereas 22.1% had bilateral presentations. The etiology remained unidentified
in 45.1% of cases, with 30.1% having a history of a ground-level fall and 16.8% having a history
of traffic accidents. Surgical intervention via burr hole was performed in 92.9% of patients, with
a favorable outcome observed in the majority. The mortality rate was 3.5%.
Conclusion: Chronic subdural hematoma exhibits a wide spectrum of clinical manifestations,
with motor symptoms being the most prevalent. The condition predominantly affects elderly
males. Most patients were successfully managed through burr hole surgery, with favorable
outcomes in the majority. This single-institution, retrospective study presents findings consistent
with global data. However, larger, multi-center studies are necessary to better elucidate the
epidemiological profile and variable clinical presentations of CSDH.
Keywords: Clinical Presentation, Chronic Subdural Hematoma, Yemen
# Epidemiological Description of Primary Brain Tumors: A Single-Center Retrospective Study of 75 Cases, Yemen
Shamsaldin Mohamed, et al
Background: Primary brain tumors represent one of the most devastating tumors, characterized by
high significant morbidity and mortality with a high rate of neurological sequelae. Only limited
studies have described the burden of CNS tumors in Yemen.
Objective: Description of the epidemiological trends of primary brain tumors in a single institution.
Materials and methods: A retrospective study was obtained from registry records of patients with
primary brain tumors based on clinical and radiological data or histopathological report at 48 Model
Hospital, Sana’a, over a period of 4 years from January 1, 2020 to December 31, 2023. The
collected data encompassed demographic and tumor characteristics including patient’s gender and
age, and type and site of tumor, as well as WHO grade.
Results: 75 cases of primary brain tumors were reviewed. There were 43 (57.3%) females. Adults
were the highest age group involved (68%). The majority of tumors (77.3%) were supratentorial.
Gliomas constituted the most common neoplastic category (48%). However, meningiomas was the
most common single entity (32%).
Conclusion: This is an institution-based, detailed, and descriptive epidemiological study of Yemeni
patients with primary brain tumors. In spite of our study’s matching with most worldwide studies
results, the definitive epidemiological rates in reality need a bigger multi-centric and
histopathological based studies to be carried out. Limitations of our study included the clinically
and radiologically based diagnosis of most cases.
Keywords: Primary Brain Tumor, Prevalence, Yemen
# The Role of Clinical Pharmacists in the Detection and Evaluation of Adverse Drug Events: A Review Article
Al-Akhali Khaled and Alyahawi Ali
Adverse drug events (ADEs) are a major healthcare systems issue in hospitals. They are difficult
to detect because of incomplete or unavailable medication history. Clinical pharmacists have an
important role to play in detection and evaluation of adverse drug reactions. The clinical
pharmacist’s role in medication management should extend beyond simply dispensing drugs, and
this article delineates the rationale and proactive approaches for clinical pharmacist detection and
assessment of adverse drug reaction (ADRs). This article was designed to overview the role of
clinical pharmacists in detecting and evaluating ADRs. Search and analysis of related articles in
web sites revealed that clinical pharmacists have an important role in evaluating, identifying, and
preventing ADRs, which leads to proper management and decreased number of morbidity and
mortality cases. Therefore, healthcare systems need to be redesigned to more fully utilize health
information technologies and clinical pharmacists in detecting and responding to ADRs.
Keywords: Adverse drug events, Clinical pharmacists, Detection, Evaluation, Role
# Application of Genome-Based Therapy in Clinical Pharmacy Practice: Prospects and Challenges
Al-kaf Ali G. and Alyahawi Ali
Genome-based therapy, an innovative approach to personalized medicine, utilizes insights from
genomic research to tailor treatments to individual patients. In clinical pharmacy practice, this
emerging field holds promise for improving therapeutic outcomes, minimizing adverse drug
reactions, and optimizing drug efficacy by integrating pharmacogenomics into patient care. Genome-
based therapies include gene editing technologies (e.g., CRISPR-Cas9), gene therapy for rare genetic
disorders, and the use of biomarkers for targeted treatments in oncology and other complex diseases.
Despite its transformative potential, the application of genome-based therapies faces significant
challenges, including ethical concerns, high costs, limited accessibility, and the need for advanced
infrastructure and specialized training. Additionally, regulatory hurdles and the scarcity of robust
clinical data impede the widespread adoption of these therapies in routine clinical pharmacy practice.
This review explores the prospects of genome-based therapies in clinical pharmacy, emphasizing
their potential to revolutionize healthcare delivery. It also examines challenges such as ethical
dilemmas, policy gaps, and resource limitations, proposing strategies to address these barriers. The
integration of genomic tools into clinical pharmacy practice requires a multidisciplinary effort
involving pharmacists, clinicians, researchers, and policymakers to ensure equitable access and
effective implementation in diverse healthcare settings.
Keywords: Genome-Based Therapy, Clinical Pharmacy, Challenges, A multidisciplinary Effort.
# Lumbosacral Nerve Root Compression by Gravid Uterus as a Cause of Sciatica in Pregnancy: Diagnosis by Exclusion
Al-Dofri Saif
A 29-year-old pregnant woman presented with severe left sciatica for three days, which was
exacerbated by standing and walking. The patient, who was 11 weeks pregnant, was considering
termination of pregnancy due to the debilitating pain. The patient was referred by a neurosurgeon
for a lumbar spine MRI (Magnetic Resonance Imaging) as the analgesics did not help much. MRI
of the lumbar spine did not reveal any structural abnormalities. The patient’s symptoms were
significantly relieved by lying on her right side for a few hours. The diagnosis was made by
exclusion, as the patient’s symptoms were not attributable to any identifiable spinal pathology.
The patient was managed conservatively with positioning techniques, and her symptoms greatly
improved. This case highlights the importance of considering compression of the lumbosacral
nerve roots by the gravid uterus as a potential cause of sciatica in pregnant women, especially
when other spinal pathologies have been excluded.
Keywords: Sciatica, Female, Pregnancy, MRI
# A study of drug-drug interactions involving direct oral anticoagulants for discharged patients in Sana’a city, Yemen
Ali Alyahawi, Khaled Al-Akhali and Ali G. Al-kaf
Background: Direct oral anticoagulants (DOACs) are fast-acting agents for blood clots, offering a favorable risk-benefit profile with significant reductions in stroke, intracranial hemorrhage, and mortality compared to warfarin. However, combining treatments can lead to drug-drug interactions (DDIs), affecting DOACs’ exposure or pharmacological activities. The risk and
severity of DDIs vary among DOACs, and they are particularly concerning for patients with
major comorbidities requiring additional therapies.
Objective: To evaluate the prevalence and severity of the potential DDIs of DOACs among adult
patients (18 years or older) who have received DOACs therapy at hospital discharge.
Methodology: This cross-sectional study was conducted at two hospitals in Sana’a from January
2022 to January 2023. The study data included demographic, clinical, and drug-therapy-related
variables, which was collected from paper medical records. Drug interactions were identified
using updated Lexicomp online software.
Results: Out of 146 patients, there were 140 (95.9%) individuals who had a total of 733 clinically
significant DDIs. Specifically, 113 (77.4%) individuals had a total of 184 clinically significant
DDIs with DOACs. 165 (89.7%) of which were category D, 14 (7.6%) of which were category
X, and only 5 (2.7%) of which were category C DDIs with DOACs. There was also an
association between advanced age, co-morbidities, and concomitant drug with the presence of
DDI with DOACs.
Conclusion: The most potential drug interactions with DOACs was with aspirin (54.3%),
clopidogrel (33.2%), Enoxaparin (6%)) and diltiazem (1.1%). It was also noticed that category D DDIs with DOACs was the most common, followed by category X DDIs with DOACs.
Keywords: Sciatica, Female, Pregnancy, MRI
