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Published Articles

Dr. Hazem is publishing regularly articles in the community magazines beside his scientific articles and researches in medical magazines & journals. In the following posts you will find some; these were published in the magazines of the Red Sea in Hurghada. The subjects of these articles were chosen based on the questions we received by email or letters from our readers about the specific illness.

Please, if you have any questions or you want the doctor to talk about any special disease, do not hesitate to contact us!

Article published in the Hurghada Tours Magazine 2005

Headaches: Almost everyone has had a headache some time in their lifetime. Recurring headaches may be the most common reason for seeking medical care. Headaches account for about 10 million visits to physicians' offices each year not counting visits to no physicians, chiropractors, hypnotists, or other health care providers who offer headache relief. You've probably heard headaches described in various ways; terms often used include tension headache, muscle contraction headache, stress headache, daily chronic headache, migraine headache, and cluster headache. Specialists also deal with post-traumatic headache and disease-related headache.

Type of Headaches:

There are two main types of headache: primary and secondary;

Primary headaches include tension-type, migraine, and cluster headaches and are not caused by other underlying medical conditions. More than 90% of headaches are primary.

Secondary headaches result from other medical conditions, such as infection or increased pressure in the skull due to a tumor. These account for fewer than 10% of all headaches. Tension Type Headache is the commonest form of headache with up to two thirds of people experiencing it at some stage in their lives. Tension headaches are usually felt on both sides of the head. The pain is dull and persistent, varying in intensity. It is often described as a feeling of pressure, heaviness or tightness in a band around the head;

Migraine (Vascular Headache) affects one in eight adults in the developed world. People of any age can suffer, although adults aged 25-34 are most commonly affected, and women are two to three times as frequently as men. The main migraine symptom is a moderate to severe throbbing pain, usually on just one side of the head. This is often accompanied by nausea (feeling sick), cold hands, vomiting and sensitivity to light and sound. A migraine where people suffer an 'aura' or warning, 10 to 30 minutes before the migraine begins, only occurs in one in five cases. The aura may take many forms: lines or spots before the eyes, total darkness, tingling or numbness in the limbs and speech impairment. This can be a frightening experience.

Cluster Headaches are rare, severe and mainly affect men. It's a severe pain developing around or behind one eye, which usually occurs at nights and wakes the sufferer from sleep. Congestion of the eye and nose on the affected side produces tears and nasal blockage and discharge on that side.

Sinus Headaches, Many people falsely suspect they suffer from "sinus headaches" since they feel headache pain in the facial area. Similarly, a blocked nostril or stuffy feeling leads many sufferers to self-diagnose the condition, sinus headache. Most often this description does not prove to be sinus headache. Headaches caused from sinus infection are usually associated with a low-grade fever and can be detected from an x-ray of the sinus cavity.

Rebound Medication headaches; many sufferers develop it from taking too much pain medicine, too often. The daily or frequent use of over-the-counter (OTC) medicines can often lead to this condition. Researchers suggest medication with caffeine or ergotamine is particularly at fault. The pain associated with rebound headaches is a pressing, dull, diffuse pain that is typically felt all over the head (much like tension-type). Rebound headaches are usually worse in the morning hour and often can be felt on the front or top of the head.

What Triggers Headaches?

If you've had headaches for some time, you're probably already aware of some things that can trigger them. Although everyone's situation is different, there are several factors that are almost universal when it comes to bringing on a headache. And the best way for you to control your headaches is to determine what triggers them. Here are some other factors known to trigger headaches:

-Emotions (anxiety, anger)
-Sleeping patterns, sleep deprivation and poor sleep habits
-Diet (Chocolate, cheese, caffeine)

When to Call your Doctor?

Although very few headaches are signs of serious underlying medical conditions, you should call the doctor if any of the items below apply to you:

-You have a stiff neck and/or fever in addition to a headache
-You are dizzy, unsteady, or have slurred speech
-You feel weak
-You notice changes in sensation (numbness and/or tingling)
-You experience confusion or drowsiness with your headache
-Your headaches begin and persist after head trauma
-Your headache is triggered by exertion, coughing or bending
-Your headaches have changed in character persistent
-Your headache accompanies severe vomiting
-You have your "first and/or worse" headache

And, finally, keep in mind that no matter how painful the headache, most headaches don't signal serious illness. However it should not be ignored and it's still possible to develop a new and possibly more serious type of headache. You don't have to just 'live with' headaches. Effective treatment is available for all types of headache, even migraine and by recording when and how your headaches occur, you can help your doctor diagnose and find the right treatment for them.

By Dr. Hazem Ahmed Mostafa M.D., Ph.D.

Article published in June 2004 in the Red Sea Bulletin - Hurghada Magazine

More about headaches: As many as 6% of all men and up to 18% of all women (about 12% of the population as a whole) experience a migraine headache at some time. Roughly three out of four migraine sufferers are female. It affects one in eight adults in the developed world and People of any age can suffer, although adults aged 25-34 are most commonly affected, "classic migraine", is a type of headache that is accompanied or preceded by an aura (neurological symptoms).

Approximately 10% of all migraine sufferers fall under the category "migraine with aura". The "aura" can be zigzag lines or spots in the field of vision, tingling of the skin, dizziness, confusion, or blurred vision. "Common migraine" is type that has a 75% rate among women - largely due to the hormonal connection with estrogen. Migraine associated directly with the menstrual period are referred to as "menstrual migraine". Migraine without aura typically is most-often one-sided, and is frequently associated with nausea and vomiting. The pain sensation is generally throbbing or pounding in nature, with a moderate to severe quality. Most migraine sufferers fall under this category. Studies at major headache clinics suggest 60% of migraine sufferers have never been properly diagnosed. Over-the-counter pain medicines (typically designed for tension-type headaches) used to treat migraines, can sometimes lead to rebound headaches or a new headache condition referred to as daily chronic headache.

We can say that no discussion of migraine is complete without mentioning of migraine triggers which could be one of the following:

Stress may be a trigger, but certain foods, odors, menstrual periods, and changes in weather are among many factors that may also trigger migraine. Emotional factors such as depression, anxiety, frustration, letdown, and even pleasant excitement may be associated with developing a headache.

Migraine and Diving: As far as diving with migraine is concerned there is mixed opinion as to the proper thing to do. Some think it to be an absolute contraindication to diving; others think it to not be a significant problem. The migraine following a dive might be difficult to distinguish from decompression sickness and can possibly be provoked by CO2 retention in a diver.

Dangers: Because migraine can cause fainting in adolescents, the loss of consciousness would be particularly dangerous underwater. It can also cause severe vertigo, nausea and vomiting and can be produced rapidly by swimming. Migraine with neurological symptoms or signs is a definite contraindication in the commercial diver. Migraine may be precipitated by a rise in barometric pressure, among a host of other things. Medications taken for migraine also might have adverse effects on the diver.

When to Call Your Doctor:

Although very few Migraines are signs of serious underlying medical conditions, call your doctor at once if any of the items below apply to you; You have two or more Migraine per week. You must take a pain reliever every day or almost daily. You need more than recommended doses of over-the-counter medications to relieve Migraine symptoms. You have a stiff neck and/or fever in addition to Migraine. Your Migraine is accompanied by shortness of breath, fever, and/or unexpected symptoms that affect your eyes, ears, nose, or throat. You are dizzy, unsteady, or have slurred speech, weakness, or changes in sensation (numbness and/or tingling) in addition to your Migraine. Your Migraine begin and persist after head trauma. Your Migraine is triggered by exertion, coughing, bending, or sexual activity. Your Migraine keeps getting worse and won't go away. You have your "first and/or worse" Migraine. Your Migraine began after you reached the age of 50.
And, finally, keep in mind that even if you have had Migraine for many years, it's still possible to develop a new and possibly more serious type of headache. You don't have to just 'live with' Migraine. Effective treatment is available for all types of migraine. And by recording when and how your migraine occurs, you can help your doctor diagnose and find the right treatment for it.

By Dr. Hazem Ahmed Mostafa M.D., Ph.D.

Back Pain

What you should know about Back Pain:

Dear readers, I'll tell you more about one of the most common complaints that most people may have. Low back pain is one of the most frequent problems treated by spine surgeons. Four out of five adults will experience significant low back pain sometime during their life. After the common cold, the lower back problems are the most frequent cause of lost work days in adults under the age of 45.

The lower or lumbar spine is a complex structure that connects your upper body (including your chest and arms) to your lower body (including your pelvis and legs). This important part of your spine provides you with both mobility and strength. Pain in the lower back can restrict your activity and reduce your work capacity and quality of enjoyment of everyday living.

How is low back pain diagnosed?

Most cases of low back pain are not serious and respond to simple treatments. Your spine consultant can accurately diagnose and effectively treat most types of low back pain in the office. You will be asked about the nature of your symptoms and whether you sustained an injury. You also will have an examination of your spine and legs.

Imaging tests may be required. Plain X-rays will show arthritis and bone diseases, but will not show soft tissues such as the lumbar discs or nerves. For conditions or injuries that involve these soft tissues, CT scan (computerized tomography) or MRI (magnetic resonance imaging) may be needed. EMG (electromyography) may be needed in some cases to determine if the spine condition has caused nerve or muscle damage.

What are the common causes?

Low back pain can be caused by a number of factors from injuries to the effects of aging.Low Back Sprain and Strain; A sprain of the low back can occur when a sudden, forceful movement injures a ligament which has become stiff or weak through poor conditioning or overuse. These injuries, or sprain and strain, are the most common causes of low back pain. Poor conditioning improper use of the back, obesity and smoking. Aging "Wear and tear" and inherited factors will cause degenerative changes in the discs (disks), called degenerative disc disease, and arthritic changes in the small joints. These changes occur to some degree in everyone. When severe, they can cause low back stiffness and pain.

What is the best treatment?

Low back pain could be effectively treated following an examination by your spine surgeon and a prescribed period of activity modification with some medication to relieve the pain and diminish the inflammation. Although a brief period of rest may be helpful, it may not be necessary for you to discontinue all activities, including work. Instead, you may adjust your activity under your doctor's guidance.

When is surgery needed?

Most low back pain, whether acute or chronic, almost always can be treated without surgery. The most common reason for surgery on the lower back is to remove the pressure from a "slipped disk" when it causes nerve and leg pain and has not responded to other treatments. Some arthritic conditions of the spine, when severe, also can cause pressure and nerve irritation, and often can be improved with surgical treatment. And, finally, keep in mind that no matter how strong the back pain is, most of it doesn't signal serious illness. However it should not be ignored and it's still possible to develop possibly more serious complication. You don't have to just 'live with' your back pain. Effective treatment is available for all its causes, even serious one. And by recording when and how your back pain occurs, you can help your doctor diagnose and find the right treatment for you.

By Dr. Hazem Ahmed Mostafa M.D., Ph.D.

Published in the Red Sea Bulletin in August 2004

Disc disease and Diving: Dear readers, in one of the previous issues of the Red Sea Bulletin (October 2003) I discussed with you the low back pain and the lumbar disc disease. After that I received many phone calls and emails asking for more details abut the relation of disc disease with diving. That's why I am going to tell more about diving with un-operated herniated disc disease (i.e. part of the disc gets out of its place) this time. It could be of interest to most of you especially those who are experienced in diving. Diving with un-operated herniated disc disease is thought by some authorities not to allow scuba diving. However, after surgery and healed vertebral fusions generally are thought not to impose any restrictions on diving. In addition, there are some theories that there is an increased or decreased blood supply. There have been no studies to prove or disprove these theories. Divers with cervical disc problems causing arm pain should not dive until this has been surgically repaired. It would be our feeling that if you dive, you should discuss this with your surgeon in terms of weight-bearing, climbing and the hyper extended neck position that is required with scuba diving.

You would be wise to have a neurological examination carefully recorded and with you and your dives for comparison reference in case of a decompression accident. Divers with lumbar (i.e. lower back area) herniated discs without compression on the nerves can do dive however, there is a definite risk of acute herniation with the lifting activity and strain of getting back into the boat. Acute herniation can mimic a decompression accident. Return to diving after surgery There are no set guidelines that govern the return to diving after disc surgery, presence or absence of complications, whether or not a fusion has been done and if there have been any complicating factors, such as a wound infection or residual symptoms (i.e. neurological findings or deficits). Generally, a person may return to dive in three months with the approval of the operating surgeon. It is absolutely not allowed to dive after disc surgery that has failed and results in spinal stenosis. If there are major residua or deficit after the surgery one probably should wait at least 3 months and then dive only if there are no residua.

There are those who say that the possibility of Neurological DCX (Decompression Sickness) would be more likely with bubble formation at the site of the disruption of the blood supply in the operative area. No main studies bear this out. Some feel that there is clear evidence that minimizing bubble formation is essential for safe diving and to avoid long-term damage to the central nervous system. This goal can be achieved by conservative diving that reduces the total exposure to nitrogen under pressure. Retrospective studies of diving accidents have indicated that the threshold depth is arbitrarily 86 feet. If you have had successful surgery without residua (neurological findings) you can dive (sport but not commercial).

By Dr. Hazem Ahmed Mostafa M.D., Ph.D.

Article published in Hurghada Tours Magazine, December 2004

Epilepsy and Diving: Dear Readers, Hurghada is now one of the known diving spots at the red Sea and world wide and diving activity increased here in the last 20 years, and because epilepsy was found to be the second commonest neurological complaint, it resulted in physicians facing a lot of cases with epilepsy related to diving which could be caused by the interest of tourists who have epilepsy to try diving or even some of the divers who developed epilepsy earlier in their lives for some reason and did their dives weather they are still on treatment or stopped, and maybe the reason some divers asked me to talk about this issue and the possibility of diving with epilepsy. Epilepsy or epileptic seizures are disorders of the brain function causing episodic alterations of consciousness. Abnormal electrical discharges in the brain cause these episodes; they may occur without warning, and they may vary in character from a brief loss of attention to violent, prolonged convulsion.

People may outgrow the condition; it is often, but not always, controlled by medication. Current opinion among diving medicine physicians advises that individuals with epilepsy should not dive. The risks of having sudden seizure activity underwater are just too great. The regulator falls out of the mouth, there is a sudden intake of water into the lungs and the diver drowns. Compounding this is the fact that the diver then has to ascend in the water column - subjecting him/her to pulmonary barotrauma and gas embolism. In addition, one has to consider the increased risk placed on the diver's partner and other divers in the group required to rescue the individual. Those with childhood epilepsy, who have outgrown the condition and have been off medication for five years, still face a slightly increased risk of a seizure. To make an informed decision about diving, these individuals should discuss this with their physicians. As any form of unconsciousness under the surface at depth would be deadly and there is no such thing as a "little seizure" which could be tolerated, even if the person is "well-controlled on medication." There is a clear medical risk involved and you should direct your energy and knowledge toward surface related activities. Be sure that you are advised by a doctor who is "diving aware" of the extreme dangers involved before you make any decision. The difficulty comes with the assessment of the range of severity of these disorders and the nature and effectiveness of the controlling measures.

Another factor which has to be considered is the nature of the drugs used to control epilepsy, which are all, to some degree, sedative in nature and would thus increase the risk of nitrogen narcosis or cause it to come on at an unexpectedly shallow depth. For this reason, there are some who feel that it is considered unsafe for any epileptic to dive if he/she is currently taking any anti-epileptic medication. Persons with childhood epilepsy, who have been seizure free for five years, on no medication who chooses to dive should be advised in regard to a slightly increased risk that hyperventilation and oxygen toxicity might precipitate seizures. Individuals with controlled epilepsy, taking medication and seizure free for 2 years are advised that if they ignore the recommendation not to dive - they have to accept the increased accident risk which is estimated to be 1.3 to 2 times that of the general population. Even so, it is interesting that these same people (with epilepsy) who are allowed to 'drive' are not allowed to have a pilot's license - nor are they allowed to perform commercial, scientific or military diving.

Finally since many variables can cause transient alteration of consciousness. These alterations of consciousness don't always mean epilepsy but also may include fainting, a reduction of blood pressure, which is very common in young people, an alteration in heart rhythm that is more common in older people, effects of medication and psychological events, such as hallucinations. So the best advice is to get a precise diagnosis of the cause of altered states of consciousness: effective treatment is often available. You cannot make a reasonable fitness-to-dive decision till this is sorted out. It may take some time and a visit to a neurologist.

By Dr. Hazem Ahmed Mostafa M.D., Ph.D.