Mohammed Alhakami

Background: Identifying acute ischemic stroke (AIS) risk factors is crucial in risk stratification and prevention measures. Here, we conducted a gender-based analysis of AIS in resource-limited settings. Method: This retrospective study included 80 AIS patients (40 male and 40 female) who were admitted to Al-Thora General Hospital in Ibb, Yemen, between June and September 2023. Clinical characteristics and laboratory findings were obtained from patient medical records. Univariate analyses were conducted by analyzing factors associated with AIS between different genders using odds ratio (OR) and 95% confidence interval (CI). Results: The mean age of females and males were 55.5 ± 17.6 years and 67.2 ± 12.4 years, respectively. According to the results of the univariate analysis, the following factors were statistically significant predictors of stroke in males: age >60 years (OR: 9.06; 95% CI: 2.11–63.31, p = 0.008), history of hypertension (OR: 3.78; 95% CI: 1.34–11.84, p = 0.024), active smoking (OR: 9.00; 95% CI: 3.39–26.00, p < 0.001), Khat chewing (OR:12.67; 95% CI: 3.23–84.73, p = 0.001), history of cardiovascular disease (CVD) (OR: 5.67; 95% CI: 2.04–17.71, p = 0.001), and severe stroke as measured by the National Institutes of Health Stroke Scale (NIHSS) (OR: 3.84; 95% CI: 1.18–14.16, p = 0.032). In contrast, shortened activated partial thromboplastin time (APTT) =28.4 seconds (OR: 0.22; 95% CI: 0.08–0.56, p = 0.002) was statistically significantly associated with AIS in women. Conclusion: Our study reveals that males aged over 60 years were at a higher risk of experiencing strokes, particularly those with a history of hypertension, smoking, Khat chewing, CVD, and severe scores on the NIHSS. Conversely, females with shorter APTTs (≤28.4 seconds) were more vulnerable. Effective preventive measures and risk management can prevent the occurrence of most AIS, particularly in environments with limited resources.

Objective: This systematic review and meta‐analysis aimed to assess whether preoperative administration of calcium and vitamin D prevents postoperative hypocalcemia.Data Sources: A computerized search in Medline, Embase, and CENTRAL databases was performed.Review Methods: Trials comparing preoperative calcium and vitamin D administration with either placebo or nothing were eligible for inclusion. The primary outcomes were the occurrence of laboratory hypocalcemia, mean postoperative calcium level, and symptomatic hypocalcemia. The secondary outcomes were the development of permanent hypoparathyroidism and length of hospitalization. Continuous outcomes were represented as standardized mean difference (SMD), and dichotomous outcomes were represented as risk ratio (RR).Results: Nine trials that enrolled 1079 patients were found eligible. Postoperative laboratory hypocalcemia occurred less in patients who received preoperative calcium and vitamin D, but it was not statistically significant (RR = 0.77, 95% CI: 0.60‐1.00; P = .05). Mean postoperative calcium level was significantly higher in the intervention group (SMD = 0.10, 95% CI: 0.07‐0.12; P < .00001). The number of patients with symptomatic hypocalcemia was significantly lower in the intervention group (RR = 0.54, 95% CI: 0.38‐0.76; P = .0005). There was no significant difference between the 2 groups in cases of permanent hypoparathyroidism and length of hospitalization.Conclusion: Administration of calcium and vitamin D preoperatively achieves lower rates of postthyroidectomy symptomatic hypocalcemia in comparison with no intervention.

Background: Hypertonic saline (HS) and mannitol are hyperosmolar agents that are usually used to reduce intracranial pressure (ICP) and provide a satisfactory brain relaxation. The aim of the study was to perform a systematic review and meta-analysis to compare the efficacy of HS and mannitol on brain relaxation intraoperatively in patient undergoing craniotomies for supra-tentorial brain tumors. Methods: We included systematic review and meta-analysis of randomized control trials. We included randomized control trials that compared equiosmolar HS and mannitol in supratentorial tumors craniotomies and reported at least one of the following outcomes: degree of brain relaxation, ICP, central venous pressure, mean arterial pressure, perioperative fluid input, urine output, Na+ levels, and K+ levels. We searched Medline, Cochrane Central Register of Controlled Trials, and Embase using MESH terms and keywords. The bibliographic references of included studies and trial registries were also searched. Results: Seven articles were included. The degree brain of relaxation was comparable across the two groups with slight tendency toward HS (RR = 1.13, 95% CI 0.99–1.29; P = 0.08). Mannitol was associated with significantly higher urine output (standardized mean difference [SMD] = −1.33, 95% CI −1.56–−1.10; P < 0.001). Na⁺ levels were higher in HS group (SMD = 1.47, 95% CI 0.86–2.09; P < 0.001). Mannitol was associated with non-significant decrease in CVP and increase fluid input (SMD = 0.42, 95% CI 0.00–0.85 and SMD = −0.18, 95% CI −0.37–0.02, respectively). Conclusion: Both HS and mannitol are associated with satisfactory brain relaxation with a non-statistically significant tendency for HS to achieve better relaxation scores with mannitol resulting in higher urine output while HS with higher Na⁺ levels.

This study examined Hajj pilgrims’ knowledge and reported practice of hand hygiene. In Hajj 2019, a cross-sectional survey was undertaken in Mina, Makkah, Saudi Arabia, of domestic Saudi pilgrims aged ≥18 years by using a self-administered Arabic questionnaire that captured data on pilgrims’ socio-demographics, hand hygiene knowledge, and reported practices of hand cleaning following certain actions. A total of 348 respondents aged 18 to 63 (median 32) years completed the survey, of whom 200 (57.5%) were female. The mean (±standard deviation (SD)) hand hygiene knowledge score was 6.7 (±SD 1.9). Two hundred and seventy one (77.9%) and 286 (82.2%) of respondents correctly identified that hand hygiene can prevent respiratory and gastrointestinal infections respectively, but 146 (42%) were not aware that it prevents hand-foot-mouth disease. Eighty-eight (25.3%) respondents erroneously reported that hand hygiene prevents HIV. Washing hands with water and soap was the most preferred method practiced before a meal (67.5% (235/348)), after a meal (80.2% (279/348)), after toilet action (81.6% (284/348)), when hands were visibly soiled (86.2% (300/348)), and after waste disposal (61.5% (214/348)). Hajj pilgrims demonstrated a good knowledge and practice of hand hygiene, but there are gaps that are vital to control outbreaks such as COVID-19.