University of Science and Technology Journal for Medical Sciences
The UST Journal for Medical Sciences is a peer-reviewed journal officially published by the Medical Faculties of the University of Science and Technology, Sana’a, Yemen. The journal supports open-access publishing, and accepted articles are published online soon after acceptance. A volume is issued once a year in print. Online ISSN: 2959-4146 Print ISSN: 2959-4138
University of Science and Technology, Yemen
Hepatoprotective Effects of Two Vitamin D3 Formulations on Letrozole-Induced Polycystic Ovary Syndrome in Female Rats: An Experimental Study
Background: Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder that disrupts the hypothalamic-pituitary-ovarian axis, leading to ovarian dysfunction and hyperandrogenism. This experimental study aimed to compare the hepatoprotective effects of micellized vitamin D3 (MVD3) and conventional vitamin D3 (CVD3) compared to metformin (MET) in a rat model of letrozole (LTZ)-induced PCOS. Methods: An experimental study was conducted over 90 days using 30 healthy female albino rats with regular estrous cycles. Rats were randomly assigned to five groups (six per group): control, LTZ-induced PCOS, LTZ + MET (155 mg/kg), LTZ + CVD3 (1000 IU/kg), and LTZ + MVD3 (1000 IU/kg). PCOS was induced using oral LTZ (200 µg/day), and treatments were administered daily by gavage. Estrous cycle was assessed by vaginal cytology. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) levels were measured to evaluate hepatic function, and liver tissues were examined histopathologically after hematoxylin and eosin staining. The mean levels of liver enzymes were compared using the independent samples t-test, with significance set at P <0.05. Results: LTZ-induced PCOS caused significant elevations in serum ALT, AST, and ALP levels compared with controls (P <0.001). MET treatment partially reduced liver enzyme levels, but the mean levels remained higher than controls. In contrast, treatment with either MVD3 or CVD3 resulted in marked normalization of ALT, AST, and ALP levels compared with controls, being comparable to controls. Histopathological analysis supported these findings, showing severe hepatic structural damage in rates with LTZ-induced PCOS, partial improvement with MET, and restoration of normal hepatic architecture with MVD3 and CVD3. Conclusion: MVD3 or CVD3 markedly alleviate LTZ-induced hepatic injury in PCOS rats, outperforming MET in normalizing ALT, AST, and ALP levels and restoring hepatic architecture. These findings highlight vitamin D3 as a promising adjunct for managing PCOS-related liver injury, warranting further mechanistic and clinical studies.
Copyright (c) 2026 University of Science and Technology Journal for Medical Sciences
Quality of Life among Yemeni Women Utilizing Intrauterine Devices and Oral Contraceptives in Selected Primary Healthcare Centers in Sana'a City, Yemen
Background: Various contraceptive methods are available, with intrauterine devices (IUDs) and oral contraceptive pills (OCPs) being the most widely used for fertility reduction. However, underlying health conditions may compromise the safety and effectiveness of these methods. Family planning programs primarily target women, but their impact on women's quality of life (QoL) has received limited attention. This study aimed to evaluate the influence of IUDs and OCPs on the QoL of Yemeni women attending primary healthcare (PHC) centers in Sana’a City and to examine the associations between these factors. Methods: A cross-sectional study was conducted in 2024 among 354 married women aged 14–49 years attending selected PHC centers in Sana’a City. A multi-stage cluster sampling technique was applied, where three districts were randomly selected, followed by the selection of nine PHC centers. Then, eligible women were proportionally allocated to centers and selected via systematic random sampling. Sociodemographic and contraceptive-related data were collected using a structured questionnaire, and the Arabic version of the WHO QoL Instrument (WHOQOL-BREF) was used to evaluate the influence of contraceptive use on women’s QoL across physical, psychological, social, and environmental domains. QoL scores were computed for physical, psychological, social, and environmental domains, categorized as high (> median) or low (≤ median). Associations between QoL and women’s characteristics were examined using the chi-square test, with statistical significance set at a P-value of <0.05. Results: Among the participants, 56.8% used oral contraceptive pills (OCPs), predominantly combined estrogen–progesterone formulations (45.8%), while 11% used progesterone-only pills; the remaining 43.2% used IUDs. Age was significantly associated with method choice (P <0.001), as OCPs were more frequently used by women <30 years (47.5% for combined and 59% for progesterone-only OCPs), whereas IUDs were predominant among those ≥30 years (71.2%). A significant association was also found between women’s level of education and the type of contraceptive used (P = 0.007), where illiteracy was more common among IUD users (17.6%), compared to the high literacy rates among the users of combined OCPs (89.5%) and progesterone-only OCPs (100%). Regarding QoL, the median overall score was 2.68 (range: 1.07–3.71), with nearly equal proportions of women reporting low (50.3%) and high (49.7%) QoL. Domain-specific analysis revealed the lowest perceived QoL in the environmental domain (median 3.00; 62.7% low), while the physical domain had the highest median (3.75), though more than half (55.4%) still reported low QoL. Similarly, more than half of women showed low QoL in the psychological (54.8%) and social (54.5%) domains. Illiteracy (OR = 3.9, 95% CI: 1.87–8.21; P <0.001) and rural residence (OR = 2.1, 95% CI: 1.02–4.45; P = 0.038) were significantly associated with low QoL. Conclusion: Both OCPs and IUDs are linked to low QoL among Yemeni women, particularly in the environmental domain, with no significant difference between methods. Illiteracy and rural residence show a significant influence on the well-being of women using contraceptives, underscoring the need for family planning programs to be integrated with policies that address poverty, education, and healthcare access to improve women’s overall QoL.
Copyright (c) 2025 University of Science and Technology Journal for Medical Sciences
Patterns and Characteristics of Uterine Fibroids among Women Attending a Tertiary Maternity Hospital in Sana'a City, Yemen
Background: Uterine fibroids are the most common benign pelvic tumors in women of reproductive age and a major cause of gynecologic morbidity. While global and regional prevalence data exist, no published studies have described their patterns and characteristics in Yemen. Therefore, this study aimed to describe the demographic, reproductive, and clinical features of uterine fibroids among women attending a tertiary maternity hospital in Sana’a City, Yemen. Methods: A descriptive cross-sectional study was conducted using retrospective data from January 1 to December 31, 2022, at Al-Sabeen Maternity Hospital in Sana’a. Medical records of 171 women diagnosed with uterine fibroids who underwent hysterectomy or myomectomy were reviewed. Data on demographic factors, reproductive history, fibroid characteristics, and surgical management were extracted and analyzed. Results: Of the 171 women with uterine fibroids, most were aged >40 years (45%), followed by 30–40 years (35.7%), with 19.3% younger than 30 years. Menarche under the age of 12 years was reported by 52.6% of women, and most were multiparous (64.3%). A positive family history was uncommon (2.3%). More than half of women (54.4%) had a single fibroid, while 45.6% had multiple fibroids. Intramural fibroids predominated (81.3%), followed by subserosal (21.1%) and submucosal (17.5%) types, with broad ligament (4.7%) and cervical (1.8%) sites being rarely affected. Myomectomy was performed in 62.6% of cases and hysterectomy in 37.4%. Multiple and submucosal fibroids were more frequent in women with early menarche, whereas single and intramural fibroids were more common in those with later menarche. Multiple fibroids were more common in nulliparous women, whereas single fibroids predominated among multiparous women. Conclusion: Uterine fibroids are most frequently found in women over 40 years of age, suggesting a potential association between advancing age and fibroid development. Early menarche and nulliparity are more commonly linked to multiple fibroids, particularly subserosal and submucosal types, whereas multiparous women more often present with single and intramural fibroids. These patterns indicate that both age at menarche and reproductive history may influence fibroid number and anatomical location. Recognizing these trends can enhance clinical assessment and guide more tailored, patient-centered management strategies.
Assessing Physicians' Knowledge Concerning Food-Drug Interactions in Sana'a City, Yemen
Background: Certain foods and specific nutrients can interact with some drugs, potentially affecting their therapeutic efficacy and safety. A thorough understanding of food-drug interactions (FDIs) across various medical specialties is crucial in preventing these interactions in patients. Physicians have a key role in preventing these issues, as they are responsible for prescribing drugs and advising patients on dietary management. This study, therefore, aimed to investigate the knowledge of common FDIs and appropriate timing for drug administration among physicians in Sana’a City, Yemen. Methods: A cross-sectional study was conducted from May to June 2021 among 499 physicians working in four public and two private hospitals in Sana’a City, Yemen. Data about physicians’ FDIs and the timing of drug administration in relation to food intake were collected using a self-administered questionnaire. The Mann-Whitney U and Kruskal-Wallis H tests were used to determine the factors influencing physicians’ knowledge of FDIs and appropriate timing of drug administration. Results: Of the 499 physicians surveyed, 26.3% perceived that they had sufficient knowledge of FDIs. Most physicians correctly identified the interaction between caffeine and diazepam (79.6%) and the need to avoid potassium-rich foods with spironolactone (64.9%), followed by those who recognized interactions involving theophylline (59.3%) and tetracycline with milk (51.9%). Fewer physicians were aware of interactions such as grapefruit with amiodarone (30.3%) and atorvastatin (28.7%), wheat bran with digoxin (24.2%), and aged cheeses with monoamine oxidase inhibitors (27.7%). Most respondents correctly identified the appropriate timing for administering omeprazole (79.8%) and erythromycin (71.7%), followed by metformin (58.7%) and methotrexate (46.0%). Fewer answered correctly for propranolol (37.7%), levothyroxine (32.5%), calcium carbonate supplements (32.5%), isotretinoin (26.5%), glipizide (23.2%), griseofulvin (20.3%), and carbamazepine (12.8%). Physicians’ knowledge of FDIs was significantly higher among physicians aged over 40 (P = 0.046) and consultants compared to their counterparts. Conversely, there were no statistically significant differences in physicians’ knowledge of FDIs with respect to their gender, type of health facility, years of experience, or perceived knowledge of FDIs. On the other hand, physicians’ knowledge of appropriate drug administration timing was significantly higher among older physicians, males, consultants, those working in private clinics, and those having 5–10 years of experience compared to their counterparts. Conclusion: Physicians in Sana’a show insufficient knowledge of common FDIs, highlighting the need for targeted educational initiatives. Training should focus on interaction mechanisms, common examples, and prevention strategies, using case studies to promote practical application in clinical practice.
Knowledge, Attitudes and Practices of Physicians Regarding Brucellosis in Sana'a City, Yemen: Diagnostic Shortcomings Despite High Awareness
Background: Brucellosis is a widespread zoonotic infection that poses significant diagnostic and therapeutic challenges. However, it remains underdiagnosed due to nonspecific symptoms. Therefore, this study aimed to assess the knowledge, attitudes and practices (KAPs) of physicians regarding brucellosis in Sana'a City, Yemen. Methods: A descriptive, cross-sectional study was conducted among 264 physicians of various specialties in Sana’a City, Yemen, from March to May 2025. Data on physician characteristics and brucellosis-related KAPs were collected using a structured electronic questionnaire. Responses were scored and categorized into good/poor knowledge, positive/negative attitudes, and acceptable/unacceptable practices, based on predefined thresholds. Data were summarized and presented using descriptive statistics. Results: Among 264 surveyed physicians, 94% demonstrated good knowledge of brucellosis. Most identified animals (87.9%) as reservoirs and farmers (89%) as a high-risk group, though fewer recognized laboratory personnel (42.4%) as being at risk. Commonly known transmission routes included raw milk (89%), raw meat (69.3%), and direct contact with animals (66.3%), while awareness of occupational exposures—placentas (44.7%), aborted materials (42.4%), and aerosols (24.6%)—was limited. Clinical signs like fever (91.3%), gastrointestinal symptoms (85.2%), and neurological involvement (78.2%) were well recognized. Anemia (72.7%) was the most known hematological finding. While 72% correctly identified the doxycycline-rifampin regimen, only 51.1% knew the six-week treatment duration. A positive attitude prevailed among 92% of physicians, with strong support for increasing medical awareness (80.7%), recognizing frequent misdiagnosis (78.1%), and promoting continuing education (78%). About 71.3% trusted serological tests, and 69.7% supported referring cases to specialists, yet only 51.1% viewed brucellosis as a major public health issue in Yemen. Diagnostic practices were acceptable among 68% of physicians, though few routinely asked about raw milk (40.2%), raw meat (23.1%), or animal contact (42.8%). Only 32.6% consistently tested chronic fever cases for brucellosis, and testing was rarely ordered for lab workers (8.7%) or animal-exposed individuals (25%). Conclusion: Physicians in Sana'a City show good knowledge and attitudes toward brucellosis, but gaps remain in recognizing atypical exposures and applying consistent diagnostic practices. Limited perception of brucellosis as a major health issue hinders effective management, highlighting the need for standardized protocols and targeted continuing education to improve diagnosis and care.
Bacteriological Profile and Antibiotic Susceptibility Patterns of Wound Infections at a Public Tertiary Hospital in Sana'a Governorate, Yemen
Background: Wound infections are a leading cause of morbidity and mortality globally, representing one of the most prevalent nosocomial infections. The etiological agents vary by geographic region, and there is a growing incidence of antibiotic resistance among these pathogens. This study retrospectively analyzed the bacterial species isolated from patients with wound infections and their antibiotic susceptibility patterns at a public tertiary hospital in Sana'a Governorate, Yemen. Methods: A retrospective cross-sectional study was conducted to identify the bacterial species causing wound infections and their antibiotic susceptibility patterns among patients admitted to the 48 Model Hospital in Sana’a Governorate from January 2020 to December 2020. This study included all patients diagnosed with wound infections and undergoing culture and antibiotic susceptibility testing during the study period. Results: Of the 386 patients with wound swab cultures, 290 (75.1%) had infections caused by a single bacterial species, most frequently among males (98.6%). Among the isolates, Gram-negative bacilli accounted for 61.4%, while Gram-positive cocci comprised 38.6%. Staphylococcus aureus was the most frequently isolated bacterial species (38.3%), followed by Pseudomonas aeruginosa (36.6%) and Klebsiella spp. (11.7%). Vancomycin showed the highest efficacy against Gram-positive isolates (100% sensitivity), followed by moxifloxacin (90.9%), linezolid (86.2%), and methicillin (68.5%), whereas amoxicillin/clavulanic acid and amoxicillin showed the lowest activity. Among Gram-negative isolates, imipenem demonstrated the highest activity (90.4%), followed by ceftriaxone/tazobactam (80.2%), amikacin (78.1%), and gentamicin (77.1%). However, cefotaxime, ceftazidime, and cefuroxime showed limited efficacy. For P. aeruginosa, imipenem remained the most effective agent (90.5%), followed by amikacin (78.6%) and tazobactam/piperacillin (70%). Conclusion: Wound infections are predominantly caused by Gram-negative bacilli, particularly P. aeruginosa and Klebsiella spp., with S. aureus being the most common Gram-positive isolate. The majority of infections occur among male patients. While high levels of resistance to commonly used antibiotics are observed, vancomycin remains fully effective against Gram-positive isolates, and imipenem demonstrates the highest efficacy against Gram-negative bacteria, including P. aeruginosa. The high level of antibiotic resistance of bacterial species isolated from wound infections emphasizes the need for evidence-based empirical treatment guided by local susceptibility patterns.
Knowledge, Attitudes and Practices Regarding Diabetes-Related Ocular Complications among Type 2 Diabetics in Sana’a City, Yemen
Background: Ocular complications of diabetes mellitus (DM), including diabetic retinopathy (DR), progress silently, underscoring the need for patient awareness and screening. However, there is a lack of studies assessing diabetic patients’ knowledge, attitudes, and practices (KAPs) regarding the ocular complications of DM. Therefore, this study assessed KAPs regarding diabetes-related ocular complications among type 2 DM patients in Sana’a city to inform preventive strategies. Methods: A descriptive cross-sectional study was conducted in 2024 among 400 type 2 diabetic patients recruited via convenience sampling from public and private healthcare facilities in Sana’a city, Yemen. A pilot-tested, structured questionnaire was used to collect patients’ demographic and clinical characteristics, as well as their KAPs regarding diabetes-related ocular complications. Data were then summarized using descriptive statistics. Results: Most patients (88%) recognized the ocular effects of DM, primarily visual impairment (31%) and DR (22.4%), with fewer identifying cataracts (5.7%) or eye infections (4%). While 74.3% acknowledged the importance of regular eye exams, 39.3% were unaware of recommended frequencies, and 63% reported not undergoing regular screenings. Notably, 52.8% had never undergone dilated eye exams, 57% consulted optometrists/opticians, 37.7% never examined their eyes, and 52.8% never underwent dilated exams. Among 57 patients with DR, 98.2% received treatment recommendations, with 73.7% adhering to them and 97.6% attending follow-ups. Conclusion: In Sana’a, most type 2 diabetes patients are generally aware of diabetes’ ocular effects but lack specific knowledge of complications like DR. Many value regular eye exams, but few adhere to guidelines, rarely undergoing routine or dilated screenings. Addressing the gap between awareness and practices requires targeted education to improve preventive practices and reduce the risk of blindness.
Cerebrovascular Accidents in Sana'a City, Yemen: Clinico-Epidemiologic and Neuroimaging Findings
Background: Cerebrovascular accidents (CVA) are acute neurologic injuries that represent a common cause of disability and mortality worldwide, with ischemic and hemorrhagic strokes being the most common forms. In Yemen, there has been limited research on CVA. Therefore, this study aimed to determine the clinical presentation, risk factors and different types of CVA based on head computed tomography (CT) scans among patients admitted to tertiary care hospitals in Sana'a. Methods: A descriptive cross-sectional study was conducted among 201 patients with CVA who underwent head CT scans at four tertiary hospitals in Sana'a from October 2023 to February 2024. Data about sociodemographic characteristics, clinical presentation and potential risk factors for CVA were collected using a questionnaire. Descriptive statistics were then used to summarize and present the data. Results: Most patients with CVA admitted to tertiary care hospitals were males (63.7%) and over 40 years old (81%), with a mean age of 56 ± 17 years. More than half of the patients were rural residents (56.7%), illiterate (57.2%), and unemployed (55.2%). Based on CT scan findings, 68.7% (138/201) of patients with CVA had ischemic strokes and 15.4% (31/201) had hemorrhagic strokes. However, the pattern of CVA was undetermined in 15.9% (32/201) of patients. Dysarthria (49.3%) was the most frequent presentation among patients with CVA, followed by left-sided hemiplegia (39.8%), headache (32.8%), right-sided hemiplegia (30.8%), and choking (30.3%). In contrast, fatigue and loss of vision were the least frequent presentations (0.5% each), followed by asphyxia (2.5%), diplopia (3%), chest pain (4.5%), and coma (5.5%). Other manifestations ranged from 7% for memory loss to 28.9% for decreased consciousness. Khat chewing was the most frequent potential risk factor among 64.2% of stroke patients, followed by HTN (46.8%), smoking (39.8%), DM (33.3%), and past history of stroke (23.4%). However, dyslipidemia (8.4%) and family history of stroke (15.9%) were the least frequent potential risk factors among stroke patients. Conclusion: Approximately two-thirds of patients admitted with CVA to tertiary care hospitals in Sana’a experience ischemic strokes in alignment with the global trends in CVA epidemiology. Clinical presentations in CVA patients vary, with dysarthria and hemiplegia being the most predominant. The high frequency of khat chewing and smoking as potential risk factors emphasizes the necessity of public health interventions to reduce these habits. Likewise, hypertension and diabetes mellitus are common potential risk factors that call for improving healthcare services to control these chronic diseases and lower the risk of CVA.
Celiac Disease among Outpatient Attendees with Gastrointestinal Complaints at a Tertiary Care Hospital in Sana’a City, Yemen: A Four-Year Retrospective Study
Background: Celiac disease (CD) is a chronic autoimmune enteropathy, which is caused by gluten in people with genetic predisposition regardless of age and gender. Its presentations can vary from asymptomatic nature to severe malnutrition. Diagnosis usually depends on serology and intestinal biopsy examination. This study aimed to determine the prevalence of CD and describe its clinical presentations and diagnostic approaches among patients with gastrointestinal complaints in Sana’a City, Yemen. Methods: A retrospective, cross-sectional study was conducted using the medical records of patients diagnosed with CD at the University of Science and Technology Hospital (USTH) from January 2020 to December 2023. Out of 350 records for CD patients diagnosed during the study period, 155 records were complete and were used in describing the clinical presentations and diagnostic methods of CD among Yemeni patients. Data about sociodemographic characteristics, clinical presentations and diagnostic methods were collected using a pre-designed data collection sheet. Descriptive statistics were used to summarize the collected data. Results: Out of 160,000 patients attending the Gastroenterology Outpatient Department at the USTH from 2020 to 2023, 350 were diagnosed with CD, yielding a prevalence of 0.22%. The mean age of CD patients was 26 ± 14.6 years, with a majority being female (71%) and over half (54.8%) falling within the 20-40 age group. Clinically, more than half of the patients presented with abdominal pain (52.9%) and diarrhea (50.3%), followed by abdominal distention (25.8%) and weight loss (21.9%). Less frequent typical symptoms included vomiting (17.4%), anorexia (12.9%), and constipation (7.7%). Among atypical manifestations, fatigue and failure to thrive (9% each) were the most common, followed by anemia (7.7%), while rickets, bruising, and delayed puberty were rare (0.6% each). Diagnostic evaluation revealed that 78.4% of 87 patients tested were positive for anti-tissue transglutaminase antibodies, and 91% of 111 patients who underwent intestinal biopsy showed characteristic mucosal changes consistent with CD. Conclusion: The prevalence of CD among patients with gastrointestinal complaints is low, compared to the global and regional trends of the disease, predominately affecting females. It mostly presents with typical gastrointestinal symptoms, particularly abdominal pain, diarrhea and distension. Although atypical non-gastrointestinal manifestations are infrequent, CD should be considered when dealing with patients having non-gastrointestinal problems. Healthcare providers should be educated about the importance of incorporating both serology and intestinal biopsy examination for the diagnosis of patients with suspected CD.
Effect of Khat Chewing on Helicobacter pylori Infection Treatment Outcome Following Standard Triple Therapy: A Single-Center Study in Sana'a City, Yemen
Background: Helicobacter pylori infection is a well-established risk factor for gastrointestinal diseases, affecting approximately half of the global population, with higher prevalence rates in developing countries. Chewing khat is a wide­spread habit in Yemen and has been suggested to affect the outcome of standard triple therapy (STT) for H. pylori infection. Therefore, this study aimed to assess the effect of khat chewing on H. pylori infection treatment outcome after STT at a single center in Sana'a city, Yemen. Methods: A single-arm longitudinal study was conducted among 123 H. pylori-infected patients at the internal medicine out­patient clinics of the Modern European Hospital in Sana'a, Yemen, from March to September 2024. Infection was confirmed using stool antigen testing, and all participants received STT twice daily for 14 days. Stool samples were collected at baseline and four weeks after completing STT to assess the cure rate of H. pylori infection. Additionally, the association between khat chewing and the outcome of STT for eradicating H. pylori infection was analyzed using the chi-square test, with a significance level set at P < 0.05. Results: Four weeks after completing STT, the overall cure rate was 65.9% (81/123). The cure rates of H. pylori infection with STT were 63.5% (40/63) among khat chewers and 68.3% (41/60) among khat non-chewers. However, no statistically significant association was found between khat chewing and the outcome of STT for H. pylori infection (P = 0.571). Conclusion: Approximately two-thirds of H. pylori infections among Yemeni patients can be successfully eradicated using STT. However, its effectiveness needs to be evaluated across different regions of Yemen. Furthermore, khat chewing appears to have no impact on the outcome of STT, highlighting the need for further studies to explore other factors that may influence the success of STT in treating H. pylori infection.
A National Antimicrobial Resistance Surveillance Network in Yemen: An Urgent Call for Action
Antimicrobial resistance (AMR) is a global health concern that requires well-coordinated surveillance systems. In Yemen, the lack of a surveillance network hampers efforts to combat AMR and make it difficult to collect and analyze AMR data for strategic interventions. To obtain reliable information about AMR emergence and patterns, an extensive surveillance system that includes hospitals, clinics and laboratories is crucial. The government’s adoption of this system, along with the nomination of an AMR steering committee, can facilitate standardization of protocols and data integration related to AMR. Strengthening surveillance is key to combating AMR, and establishing a national AMR network can serve as an early warning system for the emergence and patterns of AMR.
Association between Lifestyle Habits and Major Depression in Patients Attending Psychiatric Clinics in Sana’a City, Yemen: A Case-Control Study
Background: Depression is a serious mental disorder and is ranked as the fourth leading cause of disease burden worldwide, which can be multifactorial with unclear etiology. Therefore, this study assessed the association be­tween certain lifestyle habits and depression among psychiatric patients in Sana’a city, Yemen. Methods: An unmatched case-control study was conducted in October and November 2019 at Al-Amal Hospital for Psychiatric Diseases and outpatient clinics of the University of Science and Technology Hospital (USTH) in Sana’a. Thirty patients aged 18–65 years, with a mean age of 31.1 ± 10.4 years, who were diagnosed with major or unipolar depression for the first time in the past three months were conveniently selected as cases, while 90 adult subjects, with a mean age of 30.9 ± 10.5 years, were conveniently selected as non-depressed controls from various USTH clinics other than the psychiatric clinic during the study period. Data on sociodemographic characteristics and lifestyle habits were collected using a structured questionnaire. Univariate analysis using the chi-square or Fisher’s exact test was used to test the association between lifestyle habits and depression, with a confidence level of less than 0.05. Results: There was no statistically significant association between depression among patients attending psychi­atric clinics and current smoking status (OR = 0.9, 95% CI: 0.29–2.57; P = 0.785), khat chewing (OR = 1.0, 95% CI: 0.41–2.25; P = 0.913), or the frequency of khat chewing (OR = 0.8, 95% CI: 0.21–3.26; P = 0.932). Coffee drinking was not significantly associated with depression (OR = 1.1, 95% CI: 0.50–2.62; P = 0.750), while infrequent drinking of red tea was significantly associated with depression among patients compared to controls (OR = 16.8, 95% CI: 6.14–45.73; P <0.001). On the other hand, no significant association was found between hours of sleep per day and depression (OR = 1.7, 95% CI: 0.71–3.87; P = 0.245). However, sedentary lifestyle was significantly associated with depression among psychiatric patients compared to controls (OR = 5.2, 95% CI: 2.15–12.7; P <0.001). Conclusion: Drinking red tea and regular exercise may help reduce depression in psychiatric patients with de­pression. By encouraging the integration of red tea consumption and regular exercise into the daily routine of Yemeni patients with depression, healthcare providers can support the mental health and well-being of this pop­ulation.
Copyright (c) 2024 University of Science and Technology Journal for Medical Sciences
Effect of Catha edulis and Atorvastatin on Electrolyte Imbalance: An Experimental Study
Background: Chewing the leaves of Catha edulis, commonly known as khat, is a habitual practice embraced by individuals across various societal strata in Yemen and East Africa. The interaction of medications used to treat chronic diseases with khat has not been adequately studied, particularly in relation to electrolyte imbalances. Therefore, this study aimed to investigate the effect of khat extract and atorvastatin, either alone or in combination, on electrolyte imbalance in a rat model. Methods: Khat was extracted by the methanolic extraction protocol. A total of 24 healthy albino rats were randomly divided into four groups of six rats: control group, khat extract-treated group, atorvastatin-treated group, and khat plus atorvastatin-treated group. All drugs were administered orally using a metal gavage needle from day 1 to 28, and body weight was measured weekly. Blood samples were collected from the tail vein to measure serum levels of sodium, potassium, chloride, calcium, and ionized calcium. The mean values of body weight and serum electrolytes were compared using appropriate statistical tests. Results: On day 28, the mean body weights of rats treated with khat plus atorvastatin (153.17±30.30), atorvastatin (155.67±19.53) and khat extract (194.17± 26.73) were significantly lower than the mean body weight of the control group (246.50±39.73). In addition, significantly higher mean serum sodium levels (mmol/L) were observed in rats treated with khat extract (157±2.22), atorvastatin (161±7.21) and khat plus atorvastatin (167±4.14) compared to the control group (139±1.71). However, there were no statistically significant differences in the mean serum potassium levels (mmol/L) in rats treated with khat extract (5.07±0.33), atorvastatin (5.21±.036) and khat plus atorvastatin (5.48±0.68) compared to the control group (4.66±0.39). Regarding serum chloride, significantly higher mean levels (mmol/L) were observed in rats treated with khat extract (111±5.49), atorvastatin (114±3.31) and khat plus atorvastatin (120±2.64) compared to the control group (99±1.77) on day 28. However, significantly lower mean serum calcium and ionized calcium levels (mmol/L) were observed in rats treated with atorvastatin (2.68±0.16 and 1.24±0.09, respectively) and khat plus atorvastatin (2.61±0.10 and 1.23±0.05, respectively) compared to the control group (2.82±0.09 and 1.37±0.08, respectively). Conclusion: Khat and atorvastatin alone or in combination can reduce body weight and potentially induce hyper­natremia, hyperchloremia and hypocalcemia, with no obvious effects on serum potassium levels in the rat model. Therefore, clinicians should be aware of these electrolyte imbalances induced by khat and statins in people who chew khat. Clinical studies are needed to better understand the mechanisms behind these effects and to determine the extent of risk in the human population.
Determinants of Antibiotic Prescribing for Upper Respiratory Tract Infections in Sana’a City, Yemen
Background: Antibiotics are frequently overprescribed for upper respiratory tract infections (URTIs) in outpa­tient settings, especially in regions with fragile health systems. Therefore, the present study assessed the patterns and predictors of antibiotic prescribing for URTIs in Sana’a city, Yemen. Methods: A cross-sectional study was conducted among 453 conveniently sampled patients with URTIs in the pediatric and ear, nose and throat (ENT) clinics in six public and private referral hospitals in Sana’a from July to September 2019. Demographic characteristics of patients and physicians, as well as data on the likely types of URTIs and prescribed antibiotics, were collected using a validated questionnaire. The data were then analyzed using univariate and multivariable binary logistic regression, with a significance level of less than 0.05. Results: Of 453 patients with URTIs, 429 (94.7%) received antibiotics in the pediatric and ENT outpatient clinics of the study hospitals. More than half of antibiotic prescriptions were prescribed by physicians who were male (54.7%), experienced for 15 years or fewer (53.2%), and pediatricians (51.2%). On the other hand, most prescriptions (73.7%) were prescribed by physicians aged ≤45 years. Penicillins were the most frequently prescribed antibiotics (44.3%), followed by macrolides (25.9%), and cephalosporins (17.2%). However, antifolates (0.9%) and fluoroquin­olones (11.7%) were the least frequently prescribed. Amoxicillin-clavulanate (38.9%) was the most frequently prescribed antibiotic for URTIs, followed by azithromycin (16.1%), clarithromycin (9.8%), and cefdinir (5.7%). In multivariable analysis, female physicians were more likely to prescribe antibiotics than males (AOR = 4.5, 95% CI: 1.49–13.33; P = 0.007), while ENT specialists were less likely compared to pediatricians (AOR = 0.2, 95% CI: 0.07–0.84; P = 0.025). Conclusion: The rate of prescribing antibiotics for URTIs among outpatients in Sana’a is high, with a high proportion of inappropriate prescriptions for infections that are unlikely to be bacterial. Penicillins, particularly amoxicil­lin-clavulanate, are most often prescribed. Various factors related to patients and physicians can influence physicians’ prescribing behavior, emphasizing the need for targeted interventions to rationalize antibiotic pre­scribing for treating URTIs. Further research is needed to address antibiotic prescribing patterns in the clinical context.
Investigation of Bacterial Contaminants and Their Antibiotic Susceptibility on Yemeni Banknotes in Aden City, Yemen
Background: Banknotes are among the objects frequently exchanged between people and can serve as a vehicle for the transmission of infectious agents. Therefore, the present study aimed to isolate and identify potentially pathogenic bacteria on Yemeni banknotes collected from various municipal sources in Aden city, south of Yemen. In addition, the susceptibility of the isolated bacterial species to commonly used antibiotics was tested. Methods: A descriptive cross-sectional study was conducted on 240 Yemeni banknotes of various denominations randomly collected from people from different places in Aden city between November 2019 and February 2020. Swabs from the surfaces of banknotes were streaked onto blood agar, chocolate agar, mannitol salt agar and MacConkey agar and incubated at 37 °C for 48 hours. After isolation, bacterial species were identified and tested for their susceptibility to commonly used antibiotics using established techniques. Results: Out of 240 banknotes examined, 98.3% were found to be contaminated with bacteria, with a 95% confidence interval (CI) ranging from 96 to 99. Among the isolated bacteria, 17.4% were Gram-positive cocci, 33% were Gram-negative bacilli and 49.6% were a combination of both. The mean plate counts of bacterial colonies ranged from 163.6±51.0 colony-forming units (CFU)/ml (95% CI: 147.3–179.9) for banknotes with a denomination of 100 Yemeni rials (YRIs) to 257.1±52.0 CFU/ml (95% CI: 240.5–273.7) for banknotes with a denomination of 50 YRIs. Staphylococcus aureus was the most frequently isolated bacterial species, detected on 66.9% of contaminated banknotes, followed by Escherichia coli (60.6%) and Pseudomonas aeruginosa (42.8%). Regarding antibiotic resistance, most S. aureus isolates showed resistance to ceftazidime (80.1%), followed by ceftriaxone (78.2%), ampicillin (77.6%) and co-trimoxazole (69.3%). On the other hand, most E. coli isolates showed resistance to amoxicillin/clavulanate (84.6%), followed by ceftriaxone (79.7%), ceftazidime (76.9%), ampicillin (58.3%) and ciproﬂoxacin (58.1%), while most P. aeruginosa isolates showed resistance to ceftriaxone (83.5%), followed by ceftazidime (80.2%) and ciproﬂoxacin (54.9%). Conclusion: Most banknotes in circulation in Aden city are contaminated with bacteria, predominantly S. aureus and E. coli, with lower denomination banknotes tending to have higher contamination levels. The high contamination rate of banknotes raises concerns about their potential in transmitting infectious diseases and emphasizes the advantages of transitioning to cashless payments. A substantial proportion of bacterial species isolated from banknotes exhibit resistance to commonly used antibiotics, raising concerns about the possible transmission of multidrug-resistant bacteria through the exchange of banknotes. Therefore, it is necessary to raise awareness and improve hygiene practices to minimize the transmission of bacteria and antibiotic resistance through the exchange of banknotes.
Outcomes of Conservative Management of Postoperative Adhesive Small Bowel Obstruction among Yemeni Patients
Background: Adhesive small bowel obstruction (ASBO) is a surgical emergency and represents the leading cause of small bowel obstruction, accounting for 60–75% of cases. Conservative management is the main approach for treating ASBO in the absence of complications. Therefore, the present study aimed to assess the success rate, outcomes and complications of conservative management for ASBO in Yemen. Methods: A prospective, case-series study of 102 patients with ASBO was conducted at two tertiary care hospitals in Sana’a city, Yemen; namely, Al-Thawra Modern General Hospital and Kuwait University Hospital, in the period from January 2021 to January 2023. A structured data collection sheet was used to collect pre- and postoperative data, including demographic characteristics, history of previous surgery, type of surgery, time of presentation from initial symptoms, presenting symptoms, details of non-surgical management, success or failure of conservative treatment, intraoperative findings, complications during hospital stay, and condition at discharge. Data were then analyzed and presented using descriptive statistics. Results: Of 102 patients with ASBO, 69 patients (67.6%) responded well to conservative management and did not require surgical management, while conservative management failed and surgical intervention was indicated for 33 patients (32.4%). The condition of most patients undergoing conservative management (88.4%) improved within 1–2 days, while five patients (7.3%) improved within one day and three patients (4.3%) improved after three days. For patients who required surgical intervention, continuous abdominal compromise was observed in 31 patients (93.9%), fever in 23 patients (69.7%), tachycardia in 28 patients (84.8%), tenderness in 31 patients (93.9%), and leukocytosis in 13 patients (39.4%). However, one patient was diagnosed with peritonitis, and one patient did not show any improvement within three days. During the surgical intervention for the 33 patients who failed conservative management, fibrous bands were identified in 51.5% of patients, while diffuse adhesions were observed in 45.4% of patients. On the other hand, 3.1% of patients showed gangrenous bowels. Out of patients undergoing surgical intervention, two patients (6%) experienced venous thromboembolism, three patients (9%) developed wound infections, two patients (6%) developed fistulas, one patient (3%) experienced a pulmonary complication, and one patient (3%) died. Conclusion: Conservative management of Yemeni patients with ASBO is safe and preferred over surgical intervention. This approach can be attempted for 72 hours unless signs or symptoms of bowel compromise or peritonitis develop. By opting for conservative management, the risk of surgical intervention can be reduced, and the length of hospital stay can be shortened. Therefore, conservative management should be considered the primary treatment option for ASBO. However, it is crucial to carefully evaluate and monitor patients to exclude any signs of bowel compromise or peritonitis that would require discontinuation of conservative management and prompt initiation of surgical intervention.
Congenital Anomalies in Yemeni Newborns: A Retrospective Study at a Tertiary Care Hospital in Sana’a City
Background: Congenital anomalies (CAs) are major causes of morbidity and mortality among newborns worldwide. Therefore, the present study aimed to determine the prevalence and types of CAs in Sana’a city, Yemen. Methods: This retrospective, cross-sectional study was conducted among newborns admitted to Al-Thawra Modern General Hospital in Sana’a from January to December 2017. Data were collected from 1100 medical records of newborns, besides data about their mothers, using a predesigned data collection sheet. Data were then analyzed, and the results were presented as frequencies and proportions. Results: Of 1100 newborns, 164 (14.9%; 95% confidence interval: 12.9–17.1) newborns had CAs. Of these, 74.4% had single-system CAs, and 25.6% had multiple-system CAs. Gastrointestinal tract anomalies (43.9%) were the most frequent CAs, followed by anomalies of the central nervous system (CNS) (18.9%), musculoskeletal system (17.1%), chromosomes (15.2%) and cardiovascular system (14%). However, orofacial anomalies of cleft lip and cleft palate (2.4%) were the least frequent CA, followed by urogenital anomalies (8.5%). Esophageal atresia (33.3%) and imperforated anus (25%) were the most frequent gastrointestinal CAs. On the other hand, meningocele (35.4%) was the most frequent CNS anomaly. Of musculoskeletal anomalies, limb defects were the most frequent (96.4%), while achondroplasia was observed among 3.6% of newborns with CAs. Congenital heart disease was the most frequent cardiovascular anomaly (95.7%), while dextrocardia was observed among 4.3% of newborns. Hypospadias (57.2%) was the most frequent urogenital anomaly, followed by ureteropelvic junction obstruction (21.5%). More than half of newborns with CAs died, while 35.4% of them were discharged from hospital without correction of CAs. On the other hand, CAs were corrected for 11.6% of newborns before discharge. Conclusion: The prevalence of CAs among Yemeni newborns is relatively high and can be observed in more than one in ten newborns. The majority of CAs usually affect a single system, most frequently affecting the gastrointestinal tract, followed by the CNS, musculoskeletal system, chromosomes and cardiovascular system. Half of newborns with CAs usually die in hospital before discharge. Therefore, it is necessary to educate parents and conduct regular antenatal screening by a pediatrician to detect these anomalies and manage them appropriately and in a timely manner.
Strengthening Biomedical Research in Yemen: A Pressing Need for Raising Research Funding
This editorial emphasizes the need to secure funding for biomedical research in Yemen, considering the ongoing challenges faced by the research community in the country due to the war and humanitarian crises in the recent years and the lack of domestic research funding. It raises some issues related to improving the fundraising capacity of research institutions and highlights the success story of the University of Science and Technology in Sana’a in raising international funding for research projects on infectious diseases over the past decade.
Relationship of Adiponectin and High-Sensitivity C-Reactive Protein with Left Ventricular Dysfunction among Patients Undergoing Coronary Angiography
Background: Decreased levels of adiponectin (APN) and elevated levels of high-sensitivity C-reactive protein (hs-CRP) have been found as predictors of left ventricular dysfunction and cardiovascular events. Therefore, this study aimed to assess the relationship of APN and hs-CRP with the severity of left ventricular dysfunction among Egyptian patients undergoing coronary angiography (CAG). Methods: A cross-sectional study was conducted among 100 Egyptian patients who underwent clinically indicated CAG at Suez Canal University Hospital in Ismailia - Egypt, from May 2009 to December 2010. The left ventricular ejection fraction (LVEF) scoring system was used to assess left ventricular function based on echocardiographic findings. Pearson correlation was used to determine the relationship of APN and hs-CRP levels with echocardiographic LVEF score, and analysis of variance (ANOVA) was used to compare clinical and biochemical parameters among patients according to left ventricular function at P-value <0.05. Results: The mean hs-CRP level had a significant weak negative correlation with the mean HDL-cholesterol level (r = -0.222; P = 0.048), while the mean APN level had a significant weak negative correlation with BMI (r = -0.269; P = 0.007) but a significant weak positive correlation with the mean hs-CRP level (r = 0.215; P = 0.031) and a significant moderate positive correlation with the mean HDL-cholesterol level (r = 0.302; P = 0.002). Left ventricular function in patients undergoing CAG was normal in 34 (34%), mildly impaired in 41 (41%) patients and moderately impaired in 25 (25%), with significantly different mean hs-CRP levels among the three groups (P = 0.025) that increased from normal to moderately impaired left ventricular function. However, there was no statistically significant difference in left ventricular function according to the mean level of APN. Conclusion: The hs-CRP level is negatively correlated with HDL-cholesterol, while APN is negatively correlated with BMI and hs-CRP but positively correlated with HDL-cholesterol in Egyptian patients undergoing CAG. The hs- CRP level correlates with the severity of left ventricular dysfunction. However, left ventricular function does not appear to correlate with APN levels.
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Impact of Vitamin E on Reducing Primary Dysmenorrhea among University Students: A Single-Blind Randomized Controlled Trial
Background: Primary dysmenorrhea is a common complaint among adolescent girls and women of reproductive age, which can be severe enough to negatively affect the quality of their life. Therefore, the present study aimed to assess the impact of vitamin E on primary dysmenorrhea severity among university female students. Methods: This single-blind, randomized controlled trial was conducted on 82 female university students with primary dysmenorrhea, who were allocated to either an intervention group (vitamin E) or a comparison group (placebo) and treated during two successive menstrual cycles. Dysmenorrhea severity was measured using the Visual Analogue Scale at baseline and during the two cycles. Results: The median dysmenorrhea scores were not significantly different between both groups at baseline or during the first cycle after the intervention. However, the median dysmenorrhea score was significantly reduced in the vitamin E group during the second cycle. Most students in the vitamin E and placebo groups had moderate dysmenorrhea at baseline, being 73.2% and 85.4%, respectively. During the first and second cycles after the intervention, most students in the vitamin E group had mild dysmenorrhea (56.1% and 61%, respectively), while most students in the placebo group had moderate dysmenorrhea (58.5% and 56.1%, respectively). Conclusion: Vitamin E can significantly reduce the severity of primary dysmenorrhea when administered in doses of 200 mg twice daily for two days before menstruation and three days thereafter.
Inflammatory Markers for Prognosis of COVID-19 Mortality in Hospitalized Indian Patients: A Single-Center Retrospective Study
Background: Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic associated with poor outcomes and mortality. Therefore, the present study aimed to assess the prognostic value of inflammatory markers in predicting COVID-19 mortality among patients hospitalized at a tertiary care hospital in India. Methods: A retrospective cross-sectional study of 444 hospitalized patients with COVID-19 was conducted in Karnataka state, India from October 2020 to September 2021. Data on inflammatory markers for survivors and non-survivors of COVID-19 were retrieved and analyzed using the receiver operating characteristic (ROC) curve to determine their prognostic value for predicting mortality. Results: Compared to survivors, the median values of all studied serum inflammatory markers were significantly higher in non-survivors of COVID-19. ROC analysis showed that LDH, D-dimer and ferritin were the best predictive markers of COVID-19 mortality. Conclusion: Serum ferritin, LDH, CRP, PCT, IL-6 and D-dimer, are significantly elevated in non-survivors of COVID-19 than in survivors, with all can significantly predict disease mortality. Among these, LDH, D-dimer and ferritin are the best prognostic markers for predicting COVID-19 mortality, with good sensitivity and specificity.
Biomedical Journal Publishing in Yemen: Challenges and Prospects
This editorial highlights some of the challenges encountered by medical journal publishing in Yemen, considering the recent launch of many medical journals by academic institutions in the context of war and humanitarian crises over the past few years. Meanwhile, it also presents prospects for enhancing the quality of medical publishing in the country.