Oman Medical Journal最新文献

Objectives: Surfactant therapy is an established treatment for neonatal respiratory distress syndrome (RDS). We sought to compare two administration techniques, intubation-surfactant administration-extubation (INSURE) and minimally invasive surfactant therapy (MIST), for efficacy and safety in premature neonates with RDS.

Methods: In this randomized clinical trial, premature neonates with RDS admitted to a neonatal intensive care unit in Iran from July to December 2020 were randomly assigned either to INSURE or MIST. In the MIST group, the surfactant was administered during spontaneous breathing via a thin vascular catheter without intubation. In the INSURE group, infants were intubated, surfactant administered, and then extubated. The key outcomes were the frequency of surfactant administration, duration of oxygen support, need for mechanical ventilation in the first 72 hours, and complications arising.

Results: The baseline characteristics of the studied premature neonates (N = 82) were similar between the INSURE (n = 44) and MIST (n = 38) groups. The surfactant treatment time was much shorter for the INSURE group (10.5 ± 17.0 minutes) than for the MIST group (42.0 ± 42.5 minutes; p < 0.001). All infants received the first dose of surfactant, and requiring a second dose was obeserved in 17 (38.6%) in the INSURE group and 18 (47.4%) in the MIST group (p = 0.400). There were no significant differences between the groups in the incidence of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax, pulmonary hemorrhage, or disseminated intravascular coagulation. The duration of nasal continuous positive airway pressure and the need for mechanical ventilation were also similar.

Conclusions: Both INSURE and MIST techniques are effective and safe for administering surfactant therapy to premature infants with RDS, with no significant differences in outcomes or complications.

Objectives: To assess the knowledge levels, attitudes, practices, and associated factors regarding herpes zoster (HZ) vaccination among primary healthcare physicians in Jazan, Saudi Arabia.

Methods: A cross-sectional study was conducted in 2023, among 281 primary healthcare physicians in Jazan, Saudi Arabia. Data were collected using a self-administered questionnaire, which included a 15-point knowledge assessment scale and a Likert-type scale for attitudes and practices. Knowledge was deemed sufficient if the median score was achieved. Multivariate logistic regression analysis identified predictors of knowledge sufficiency.

Results: Of the 288 physicians invited, 281 participated with a response rate of 97.6%. The mean age was 35.2 ± 8.4 years, with a male majority (n = 164; 58.4%). Adequate knowledge of HZ vaccination was observed in 176 (62.6%) participants. Knowledge was associated with a professional level (p = 0.027); years of experience (p = 0.020)-especially those with ≥ 5 years of experience (p = 0.038)-were significant predictors of adequate knowledge. Most physicians (71.5%) perceived the vaccine as safe, and 65.8% considered it a clinical priority; however, 47.3% cited time constraints as a barrier to recommending it to patients.

Conclusions: While knowledge levels among primary healthcare physicians in Jazan are acceptable overall, gaps in vaccination practices persist. Experience was a significant determinant of knowledge sufficiency, whereas time constraints were the primary barrier to vaccine recommendation. Targeted educational interventions and systemic adjustments were recommended to address time management challenges.

Immunoglobulin A vasculitis, formerly known as Henoch-Schoenlein purpura, is a rare acute auto-immune condition often associated with infections. We describe an adolescent girl who had recently recovered from COVID-19 infection. She presented with painless hematuria, high blood pressure, purpuric skin rash, bilateral ankle pain and swelling, abdominal pain, and inability to walk. She was admitted and clinically diagnosed with immunoglobulin A vasculitis and started on steroid treatment, to which there was a dramatic response, only to relapse as the steroid was being tapered off. Treatment with azathioprine as a steroid-sparing agent led to complete remission without recurrence. This case also suggests that SARS-CoV-2 infection may trigger the development of autoimmune diseases.

Zoledronic acid is commonly used to treat osteoporosis and it is generally well tolerated. We describe the case of a woman with osteoporosis, who developed a flare-up of osteoarthritis hours after receiving a single dose of zoledronic acid. She developed fever with chills, generalized body aches, and severe low back pain. This was followed by severe bilateral knee pain, wrist pain, and minor joint pain in the hands. Radiography revealed signs of osteoarthritis in the following joints: proximal and distal interphalangeal joints of the hands, trapeziometacarpal joint, patellofemoral, and medial tibiofemoral joint on both sides. Investigations excluded septic arthritis, gout arthritis, and systemic infection. A diagnosis of a flare-up of osteoarthritis secondary to zoledronic acid infusion was made. Symptomatic treatment and supportive care led to the patient's recovery. Treating physicians need to be aware of the possibility of such rare symptom flare-ups following zoledronic acid infusion.

Objectives: Selective immunoglobulin A deficiency (SIgAD) is characterized by an isolated deficiency of serum IgA while immunoglobulin G (IgG) and immunoglobulin M (IgM) levels remain normal. Symptoms range from asymptomatic to recurrent infections. We aimed to determine the prevalence of IgAD and SIgAD among Omani patients undergoing screening for celiac disease.

Methods: This cross-sectional study included Omani nationals aged above one year, who were screened for celiac disease with anti-tissue transglutaminase (anti-tTG) IgA at Royal Hospital, Muscat, from January 2005 to December 2023. IgAD was defined as a total serum IgA level below the age-dependent reference range. SIgAD was diagnosed when both IgG and IgM values were within their respective reference limits. The prevalence of IgAD and SIgAD was statistically reviewed.

Results: Of the 9615 individuals who underwent screening for celiac disease, 114 had low IgA levels. The prevalence of IgAD was 1.2%, and among these, 0.4% were confirmed to have SIgAD. The majority were > 14 years. Patients aged 6-14 years and > 14 years were more likely to have IgAD compared to 1-2 years old. Only 39 (34.2%) patients underwent further testing to confirm SIgAD, while the remaining 75 (65.8%) did not undergo follow-up IgG and IgM testing. Among the patients with confirmed SIgAD, 11 (28.2%) underwent further testing with anti-tTG IgG antibody, with only one (9.1%) testing positive for celiac disease as confirmed by esophagogastroduodenoscopy (EGD) and histopathology. Patients with anti-tTG IgG and EGD exhibited a significantly increased risk of low IgA levels. The remaining 28 (71.8%) patients did not undergo further celiac disease workup (anti-tTG IgG antibody, EGD, or genetic testing).

Conclusions: IgAD was present in 1.2% of Omani patients evaluated for celiac disease, and 0.4% had confirmed SIgAD. Referral to an immunologist is recommended when IgG/IgM levels are low or infections are recurrent.

Empyema caused by Streptococcus constellatus in e-cigarette or vaping product use-associated lung injury (EVALI) can result in fatal outcomes. Empyema as a presentation of EVALI is rarely reported. S. constellatus is a known causative pathogen in empyema, typically associated with the elderly and immunocompromised states. We report the case of a 13-year-old male with a history of active e-cigarette use who presented to our center with right lung empyema, complicated by a suspected bronchopleural fistula. Despite chest drainage, antibiotic therapy, inotropic support, and mechanical ventilation, the patient ultimately succumbed to his illness. This case highlights a rarely reported severe complication of EVALI. Clinicians should be vigilant about obtaining a history of e-cigarette use in patients presenting with unexplained empyema.

Objectives: This study aimed to assess the knowledge, attitudes, and experiences of physicians in delivering bad news and their adherence to the SPIKES protocol within the Directorate General of Health Services (DGHS) in Muscat, Oman.

Methods: A cross-sectional study was conducted from December 2023 to June 2024 at primary healthcare centers in Muscat. Data were collected through an online self-administered questionnaire completed by physicians at these centers.

Results: A total of 140 physicians completed the questionnaire (response rate = 100%). The vast majority of participants (n = 133, 95.0%) recognized the importance of training in breaking bad news and expressed a willingness to attend future training sessions. Nearly half of the participants (n = 67, 47.9%) reported negative experiences due to improper delivery of bad news. Overall, adherence to the SPIKES protocol was categorized as low (n = 2, 1.4%), medium (n = 25, 17.9%), and high (n = 113, 80.7%). No significant associations were found between adherence levels and any sociodemographic or clinical characteristics.

Conclusions: Physicians in primary care face challenges in delivering bad news, which are influenced by cultural factors, training, and adherence to protocol. These challenges can be mitigated through regular, targeted training programs, beginning at the undergraduate level and continuing throughout a physicians' careers.

Objectives: To examine the prevalence, characteristics, causes, and contributing factors of depression among university students to aid in the management of this condition through the identification of root causes and influencing factors.

Methods: This cross-sectional study surveyed students enrolled in various colleges of Sultan Qaboos University, Muscat, between 1 September and 20 November 2023. Depressive symptoms were assessed using the self-report Patient Health Questionnaire-9.

Results: Out of a total of 1036 participants, 349 had depression, revealing a prevalence rate of 33.7%. Most depressed students were female (n = 261, 74.8%) and lived on campus (n = 210, 60.2%). Depression was significantly more prevalent among female students (p < 0.001) and among those residing on campus (p = 0.028). The highest rate of depression was observed among students in the Colleges of Science (39.9%), Engineering (38.5%), and Agriculture and Marine Sciences (36.8%). There was no significant association between academic grade point average and depressive symptoms (p = 0.462).

Conclusions: Over one-third of Sultan Qaboos University students had depressive symptoms, which was more prevalent among female students and those residing on campus, though an over representation of women in university housing confounds the latter association. Further research, especially in collaboration with other educational institutions, is recommended to assess the nationwide prevalence, identify vulnerable groups, and develop effective treatment strategies.