Swallowing Problems after Thyroidectomy

Abstract Introduction Thyroidectomy is a common procedure. Certain swallowing problems could happen after this surgery and affect the quality of life of the patient. Objective To evaluate swallowing after thyroidectomy in the early and late postoperative periods and to correlate subjective and objective parameters. Methods A prospective study with100 patients who underwent total thyroidectomy at our institution from April 2018 to September 2019. Each patient was assessed by the Arabic version of the Eating Assessment Tool (EAT-10) questionnaire and the fiberoptic endoscopic evaluation of swallowing (FEES) preoperatively, and in the early postoperative (EPO) and late postoperative (LPO) periods. Results The rate of dysphagia was of 82% in the EPO period, and of 36% in the LPO period. Two groups were compared regarding vocal fold mobility using the FEES. Group I included 89 patients with normal vocal fold mobility, 42% of whom had early dysphagia, and only 22% had late dysphagia. Regarding swallowing, we found that in the EPO period, the rates of delayed triggering, aspiration, penetration and residue were of 12.4%, 0%, 0%, and 42.7% respectively. Group II (unilateral immobile vocal fold) included 11 patients in the EPO evaluation, and all of them had early dysphagia. Conclusion Swallowing problems can occur in patients after thyroidectomy regardless of alterations in larynx mobility, and they are characterized by delayed triggering and stasis of food, which are also noticed in the LPO period, though more frequently in the EPO period. Moreover, there is a highly significant correlation between the subjective and objective parameters of swallowing in both EPO and LPO periods.

Assessing awareness about diabetes mellitus among attendees of primary health care centers, Makkah, Saudi Arabia

Background: diabetes is well studied in Saudi Arabia; however, there seems to be little research in the area of awareness, education and health care delivery

Objectives: to assess the awareness about diabetes mellitus among attendees of primary health care centers, Makkah, Saudi Arabia

Subjects and Methods: a cross-sectional study was conducted among a representative random sample of adult attendees of primary health care centers [diabetic and non-diabetics], Makkah Al-Mokkaramah, the kingdom of Saudi Arabia during the study period [1-31 November, 2016]. An Arabic self-administered questionnaire was used for data collection. It includes 31 questions with sections of demographic data, community awareness regarding diabetes definition, risk factors, signs and symptoms, and complications community awareness regarding diabetes prevention

Results: the study included 662 adult patients. Approximately one-third of them [32.2%] aged 60 years or more. Females represent 51.1% of them. More than one-fifth of them [21%] were university graduated whereas 6.3% were illiterates. Prevalence of diabetes among the participants was 33.7% and majority of them [97.9%] had family history of diabetes. The most frequent sources were mass media [57.4%], health sector [29.9%] and educational sector [10.6%]. Overall sufficient awareness regarding diabetes mellitus was reported among majority of the participants [91.2%]. Among studied factors, only marital status and income were significantly associated with sufficient awareness

Conclusion: population in Makkah AL-Mokkaramah has enough knowledge of the general knowledge of diabetes regarding risk factors, symptoms, etc. However, they are not very well aware of the diabetes associated secondary complications

Study factors affecting academic achievement among female students at Ibn Sina national college

Background: A good social environment is a key strategy to improve the level of education and achievement in medical college students. However, survey data from Jeddah, Saudi Arabia have indicated that a large number of medical students are affected negatively by their social status. This article comparatively explores the impact of four main factors: Social class/Background, Students' Personality, Health Status, and Psychological health on their achievement. Data were collected as part of a program of qualitative and quantitative research investigating the prevalence of bad environment effect on the psychological level of the students

Objectives: To study the four main factors Social class/Background, Students' Personality, Health Status, and Psychological health affecting academic achievement among Female Students at Ibn Sina National College

Methods: The study was conducted among 1315 female students attending colleges of Ibn Sina-Jeddah-Saudi Arabia between 1[st] of April - 31[th] of May 2016. An open-ended questionnaire was developed to cover the objectives

Conclusion: After assessment of the factors and variables across the targeted sites about the academic achievement were often conclude that overall achievement were very good regardless the factor

Role of electrocardiogram-gated multidetector computed tomography in diagnosis of congenital heart disease

Aim of the work: this study aimed to assess the role of ECG gated multidetector computed tomography in detection and characterization of congenital heart diseases

Patients and method: this study was carried out in the Radiology Department of Ain Shams University Hospitals. A total of 30 patients presented with clinically/echocardiographically known to have congenital heart disease. They were 17[56.7%] females and 13 [43.3%] males. Their age was ranged from 3 days -18 year old

Results: Regarding the cardiac abnormalities, we found good agreement between Echo and ECG gated MDCT as regard cardiac abnormalities with kappa value measuring 0.771. Regarding great vessels anomalies, we found overall good agreement between Echo and MDCT where k measuring 0.790. As regard extracardiac findings, lung changes that were seen in MDCT only in form of lung consolidation in three cases [10%] and one case of unilateral lung hypoplasia [3.3 %]

Conclusion: ECG gated MDCT is considered as an essential non-invasive diagnostic tool for the evaluation of congenital cardiac and extra cardiac great vessels. MDCT is complementary to the cardiac echocardiography especially in complex heart abnormalities

Juvenile idiopathic arthritis and the temporomandibular joint

The temporomandibular joint [TMJ] is one of the most underdiagnosed and undertreated conditions of juvenile idiopathic arthritis [JIA] because its involvement is often asymptomatic and the joint is difficult to examine. The aim of this study was to investigate clinical as well as magnetic resonance imaging findings of temporomandibular joint inflammation among juvenile idiopathic arthritis patients and to detect the correlation between them, moreover with different disease parameters. Forty patients with JIA and 10 apparently healthy control subjects underwent clinical and post contrast magnetic resonance imaging [MRI] examinations for TMJs. MRI findings were scored. Clinical and laboratory disease parameters were recorded. The clinical symptoms and signs of TMJ arthritis were detected in 35% and 62.5% of JIA cases, respectively. While TMJ disease was observed in 80% of patients using contrast enhanced MRI. The mean total MRI score was significantly higher in patients with active disease compared to those without activity. Patients with systemic and polyarticular JIA showed significant increase in the mean of synovial enhancement, effusion and total MRI scores compared to those with the oligoarticular type. MRI abnormalities revealed significant association with clinical signs of TMJ examination but not with symptoms. Synovial enhancement score showed significant positive correlation with disease activity score and C-reactive protein as a marker of inflammation. A significant positive correlation was found between total MRI score and disease activity, functional and pain scores in patients with JIA. TMJ arthritis is common among patients with JIA, therefore; examination of the TMJ is mandatory during the follow up of patients. Clinical signs of TMJ arthritis can be used as filter for MRI examination TMJ is an important joint which may be considered during categorizing JIA patients in different subtypes

Intracranial fusiform aneurysm, report of 9 cases, a clinico-radiological study

In the present shdy 9 patients with the radiological diagnosis of intracranial fusiform aneurysms are included. All patients were subjected to [1] Full clinical examination [2] Studies for diabetes, lipid profile and serum lipid electrophoresis, ECG [3] CT scan or MRI examination of the brain [4] Conventional 4 vessel angiography or magnetic resonance angiography. All fusiform aneurysms were nicely visualized by CT scan, MRI and angiography. According to the existing parenchymal brain pathology, patients were classified into three main groups as follows. Group [1] patients with ischemic parenchymal changes that are probably not causally related to the existing fusiform aneurysms [33%], group [2] patients with ischemic parenchymal changes that could be causally related to the existing fusiform aneurysms [33%] and group [3] patients without any parenchymal brain changes other than brain stem indentation by the aneuryms. Correlation between the fusiform aneuryms, the clinical picture of the patients and the associated parenchymal brain changes will be presented and discussed. Full description of the radiological picture of these extremely uncommon aneurysms and how they are implicated in pathogenesis and in symptom formation will be made. Also the impact of these aneurysms on patient's management will be discussed

Brain stem gliomas, clinico radiological study: a classification system with "prognostic significance" is suggested

In the present study 21 patients with the clinico-radiological diagnosis of brain stem glioma are included [13 males and 8 females]. Patients were subjected to [1] Full clinical examination [2] MRI and/or CT scan of the brain with and without intravenous contrast enhancement. CT myelography was also done to patients presented with cervicomedullary gliomas. According to the duration of symptomatology before clinical presentation, the anatomical localization of the brain stem gliomas [diffuse versus focal, Cystic versus sold], the pattern of contrast enhancement [non, diffuse, ring or patchy enhancement], the pattern of response to radiotherapy and the overall prognosis during a one year follow up, patients were classified into five groups. Group [1] patients with diffuse brain stem gliomas and with a relatively better prognosis [10 patients, 47.5%], group [2] patients with diffuse brain stem gliomas and with a relatively worse prognosis [4 patients, 19%], group [3] patients with focal pontine or midbrain gliomas [4 patients, 19%], group [4] patients with cervicomedullary gliomas [2 patients, 9.5%] and group [5] a single patient [5%] with probable brain stem metastasis. The clinical and radiological findings in the various groups will presented and discussed. Lines of treatment, clone to each group, and the result of a one year follow up will also be presented and discussed

Hepatic encephalopathy an approach using brainmapping and the quantitative pharmaco-EEG methology

In the present study 20 patients with stage II or stage III hepatic encephalopathy were examined by brainmapping and the quantitative pharmaco-EEG methodology. The spectral profile demonstrated in all patients was identical to the pharmaco-EEG profile of the Benzodiazepine [BNZ] receptor agonists [diazepam for example]. This spectral profile was instantanously normalised by injection of flumazenil [Anexate], which is a specific BNZ receptor antagonist. These findings indicate that functional increase in the GABA-ergic tone is the aetiopathogenic factor responsible for the clinical and etectrophysiological changes observed in hepatic enphalopthy and they also indicate that these functional increases in the GABA-ergic tone is mediated allosterically through pathological activation of the brain BNZ receptors probably by endogenous substances with diazepam-Like properties. The implication of these results on the management of hepatic encephalopathy will be discussed