Abstract

Aim of the study: To assess if the modified Mallampati score (MMS) can predict the presence and the severity of obstructive sleep apnea syndrome (OSA) in a group
of patients who had snoring and witnessed apnea from Al-Azhar university hospitals, Cairo, Egypt and Almoosa Hospital, Alhasa, Saudi Arabia.

Methods: A retrospective study was done for patients who had snoring and witnessed apnea referred to a sleep lab for the diagnosis of OSA by overnight full polysomnogram from January 2017 to November 2020. Apnea-hypopnea index (AHI) was used to categorize the severity of sleep apnea. Age, sex, MMS, body mass
index (BMI), comorbidities, sleep and laboratory parameters were recorded. Also, full Otorhinolaryngological, Neurological and Internal medicine examinations were recorded.

Results: The study was carried out on 350 patients fulfilling the inclusion criteria with a mean age 51.3 ± 14.3 years ranging from 14 to 81 years. More than half of them (58.6%) were males, the mean BMI was 35.1 ± 8.8 kg/m2 and the mean MMS was 4.7 ± 1.6 with about 65% of patients grouped in classes III and IV. OSA
(AHI>5) was diagnosed in 278 (79.4%) patients. Significantly, OSA was more detected among males, those with increased age, BMI, MMS, and those with type 2 diabetes mellitus (T2DM). Further evaluation showed a significant positive correlation between both BMI and MMS with the severity of OSA (ρ =0.23, P<0.001 and
ρ =0.36, P<0.001) respectively.

Conclusion: MMS is a useful tool to predict the presence as well as the severity of OSA in snoring patients. BMI and male gender are independent predictors.

Keywords: Snoring; Modified Mallampati Score; Body Mass Index; Obstructive Sleep Apnea

Background
Behçet’s disease (BD) is considered a chronic multisystem disorder, where
neurological manifestations are common. There is scarcity of investigations that
have assessed the autonomic nervous system dysfunction in BD, with conflicting
results.

Objectives
The current study aimed to identify presence of autonomic nervous system
dysfunction using neurophysiological assessment in BD and to investigate the
relationship between the indicators of autonomic function and the disease activity
parameters.

Patients and methods
The study involved 30 patients with BD in accordance with the Universal Criteria for
Behçet’s Diseases and 25 controls, who were subjected to clinical evaluation and
Palmar sympathetic skin response (SSR).

Results
Patients with BD had a significant difference in SSR (P<0.001) compared with
controls. Moreover, a significant positive association was found among neuropathic
pain and disease activity parameters.

Conclusion
The study confirms the presence of sympathetic autonomic dysfunction in BD,
which related to disease activity using a simple noninvasive test such as SSR.

Background: Shrinking lung syndrome (SLS) is an uncommon complication of systemic lupus
erythematosus (SLE) that has also been seen in other autoimmune diseases and is linked with a
high risk of acute or chronic respiratory failure. Alveolar hypoventilation in the presence of
obesity-hypoventilation syndrome, systemic lupus erythematosus (SLE), and myasthenia gravis
(MG) is uncommon and poses a diagnostic and therapeutic challenge.

Case report: We reported a 33-year-old female patient from Saudi Arabia who suffered from obesity,
bronchial asthma, newly diagnosed essential hypertension, type 2 diabetes mellitus, with
recurrent acute alveolar hypoventilation, secondary to obesity hypoventilation syndrome and
mixed autoimmune disease (systemic lupus erythematosus and myasthenia gravis), based on the
correct constellation of clinical findings and laboratory evidence.

Conclusion: The interesting aspect of this case report: is the presentation of the overlap of obesity
hypoventilation syndrome and shrinking lung syndrome due to systemic lupus erythematosus
with generalized and respiratory muscle dysfunction due to myasthenia gravis with good outcomes
after therapy.

Background: The increasing incidence of stroke in younger people underscores the urgent need for research to elucidate the underlying risk factors and causes. To date, the vast majority of studies of stroke in young people have been conducted in European and North American regions.

Aim of the work: To characterize the neurovascular findings and associated risk factors for stroke in young and middle-aged patients at Almoosa Hospital in Saudi Arabia.
Methods: We retrospectively analyzed data from consecutive patients with ischemic stroke and transient ischemic attack aged 25 to 60 years who underwent detailed cardiocerebrovascular examination.

Results: The study included 182 patients, most of whom [89%] presented with stroke and 11% with transient ischemic attack. The mean age was 51.2±8.4 years [25-60 years], 62.6% were men, mean BMI was 30.7±5.4, 41.2% were smokers, 52.7% were diabetic, 60.4% had hypertension, and 38.5% had dyslipidemia. Cardiac risk factors were valvular heart disease [34.1%], ischemic heart disease [16.5%], cardiac thrombi [8.8%], and septal defects [4.4%]. Magnetic resonance imaging revealed anterior circulation infarction in 47.3% and posterior circulation infarction in 14.3%, whereas both anterior and posterior circulation infarction were found in 27.5%. Neurovascular imaging of the neck was performed in 102 patients, with 16.5% having mild stenosis, 7.7% moderate stenosis, 9.9% severe stenosis 8.8%, and 5.5% complete stenosis. Carotid arteries duplex examination revealed insignificant stenosis in 15.4% and significant stenosis in 6.6%. Type 2 diabetes, hypertension, and dyslipidemia had a major impact on the extent of stenosis, whereas DM 2 and dyslipidemia were significantly more common in patients with increasing degrees of stenosis.

Conclusion: In this study young patients with ischemic stroke had different cerebro-vascular risk factors and etiologies compared with previous cohorts, indicating the need for tailored prevention interventions that take into account regional epidemiological data on cerebrovascular health.
Received:

Background

Tuberculosis (TB) is considered one of the most common causes of bronchiectasis. Bronchiectasis increases clinical and financial burden of patients with TB. Here, we aim to assess the prevalence of bronchiectasis and its characteristics in patients with TB.

Results

Over 1 year duration, 85 patients with confirmed TB were enrolled in the study. Those patients were clinically, laboratory, and radiologically evaluated. Any patient with other chest diseases was excluded from the study. Out of those patients, 19/85 (22.4%) patients had bronchiectasis. It was found that patients with bronchiectasis had higher frequency of urban residence, current cigarette or goza smoking, and diabetes mellitus. Hemoptysis and expectoration were the most frequent symptoms. Pulmonary function tests were significantly impaired in patients with bronchiectasis. Disease burden was significantly higher among bronchiectasis group …