Sultan Qaboos University Medical Journal最新文献

Objectives: This study primarily aimed to compare the mechanical ventilation durations between pulmonary valve-sparing and transannular patch repair techniques in the surgical correction of Tetralogy of Fallot. Secondary objectives included comparison of demographic characteristics, cardiopulmonary bypass parameters, postoperative vasoactive inotrope requirements, incidence of cardiac conduction abnormalities, echocardiographic findings, intensive care unit and hospitalisation durations, reoperations rates, morbidity and mortality between the 2 approaches.

Methods: This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, between January 2016 and December 2019. This study included 102 paediatric patients who underwent complete surgical correction of Tetralogy of Fallot over 3 years, either by a pulmonary valve-sparing technique (Group 1, n = 43) or by transannular patch repair (Group 2, n = 59). Data for both primary and secondary outcomes were extracted from hospital records.

Results: Mechanical ventilation duration was significantly shorter in Group 1 (P = 0.039). Patients in Group 1 were generally older, with shorter cardiopulmonary bypass and aortic clamp times, lower inotrope scores, and shorter chest tube retention, intensive care unit and hospitalisation periods. Junctional ectopic tachycardia and severe pulmonary regurgitation were significantly more common in Group 2, while right ventricular outflow tract peak pressure gradients were higher in Group 1. Multivariate analysis identified patient weight as the only independent predictor of mechanical ventilation duration.

Conclusion: Pulmonary valve preservation was associated with better early outcomes, including reduced mechanical ventilation duration, lower vasoactive inotrope scores, decreased postoperative arrhythmias and shorter hospital stay.

Objectives: Little is known about the profile of perinatal infections among abandoned neonates, and there are no specific evidence-based guidelines on how to screen and manage these neonates. This study aimed to report the rate of perinatal infections among abandoned babies managed at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, over 15 years (2006-2021).

Methods: This retrospective cohort study included all abandoned babies admitted at SQUH from January 2006 to December 2021. Demographic data, the area where they were found, anthropometric parameters, symptoms, investigations and management were included in the study.

Results: Of the 20 neonates included in this study, 11 (55%) were male and 9 (45%) were female; only 1 baby looked preterm. The estimated median age at admission was 1 day, while the median length of hospitalisation was 30 days. Infectious disease screening was not optimal for syphilis. Among the babies who were tested for perinatal infections such as HIV (n = 20), syphilis (n = 7), hepatitis B (n = 20) and hepatitis C (n = 19), none tested positive and all babies received the hepatitis B vaccine. Overall, 13 out of 20 babies received antibiotics for presumed sepsis. Zidovudine was given prophylactically to 3 neonates until the HIV test result was received. A total of 2 neonates were managed for gastroenteritis, 2 for sepsis and 1 for pneumonia; no death was recorded.

Conclusion: A national protocol on what should be included in the screening and how to manage these babies is urgently needed to avoid adverse outcomes in this disadvantaged population.

Objectives: This study aimed to identify the impact of the COVID-19 pandemic on the frequency, clinical characteristics and outcomes of patients with acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL).

Methods: This retrospective cohort study included all patients treated at Sultan Qaboos University Hospital in Muscat, Oman with AML or ALL from January 2017 to December 2021. Data were obtained from the electronic medical record, and patients diagnosed before the start of the COVID-19 pandemic were compared with those diagnosed during the pandemic using appropriate statistical tests.

Results: A total of 151 patients with ALL (n = 58) and AML (n = 93) were included, of whom 78 were diagnosed before the COVID-19 pandemic and 73 during the pandemic. The rate of acute leukaemia increased during the pandemic (P = 0.039). The clinical characteristics and molecular profiles were similar between the 2 periods, except for platelet count which was higher during the pandemic compared to before the pandemic (median platelet count: 55 × 10⁹/L versus 47 × 10⁹/L; P = 0.02). No significant difference was found in the number of FLT3-positive AML; however, the number of NPM1-mutated AML cases was higher during the pandemic (P = 0.02). The number of Philadelphia-positive ALL cases remained consistent between the 2 time periods. The complete remission (P = 0.48) and the overall survival rates were similar (P >0.05).

Conclusion: Except for an increased rate of acute leukaemia and a lower platelet count, the COVID-19 pandemic did not impact the presentation and outcomes of acute leukaemia.

Familial hypertriglyceridemia is a genetic disorder marked by excessive production of very low-density lipoproteins, resulting in elevated serum triglyceride levels. This can lead to various medical conditions including acute pancreatitis. In cases of recurrence, it may progress to chronic pancreatitis. Cupping therapy, a traditional treatment practiced in numerous cultures worldwide, is utilised to address various medical conditions. We report a 34-year-old male patient who presented to a tertiary hospital, Muscat, Oman, in 2022. He was diagnosed with familial hypertriglyceridemia and subsequently developing chronic pancreatitis. During his last presentation with acute-on-chronic pancreatitis, his lipid profile revealed a notable reduction in serum triglycerides. This reduction coincided with the introduction of cupping therapy into his treatment regimen. Remarkably, following the initiation of cupping therapy, his hospital admissions for acute pancreatitis notably decreased. This case report highlights the potential impact of cupping therapy on familial hypertriglyceridemia, potentially mitigating the risk of acute pancreatitis.

Objectives: The goal of facial reanimation for facial palsy is to restore resting facial symmetry and dynamic facial motion that mirrors the opposite side as closely as possible. This study aimed to evaluate the restoration of oral commissure symmetry at rest and during excursion among patients with facial paralysis treated with free gracilis muscle transfer.

Methods: This study included 9 patients who underwent facial reanimation with free gracilis muscle transfer at Khoula Hospital, Muscat, Oman, from 2019 to 2022. Children under 14 underwent a 2-stage surgery, while those above 14 underwent single-stage reconstruction.

Results: The average age among the cohorts was 24 years. Overall, 5 cases underwent a 2-stage facial animation, 4 underwent single-stage reconstruction and 1 patient had free flap loss following the free gracilis muscle transfer. The mean time for noticing recovery was 3 months postoperatively. Early recovery was noted in patients who underwent single-stage free gracilis muscle transfer with motor innervation from the ipsilateral nerve to the masseter compared to the cross-facial nerve transfer. Good patient satisfaction (88.9%) was observed following the procedure.

Conclusion: This study observed earlier recovery in patients who had undergone single-stage free gracilis muscle transfer with motor innervation from the ipsilateral nerve to the masseter compared to the cross-facial nerve transfer. The oral commissure symmetry at rest and during excursion among patients with facial paralysis treated with free gracilis muscle transfer in Oman was found to be near normal.

Objectives: This study aimed to explore the effect of antiseizure medications (ASM) on thyroid function in children with epilepsy.

Methods: A prospective study involving children between 6 months and 12 years of age with new-onset seizures who took ASM within 2 months was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, between August 2019 to March 2022. Thyroid function tests-free T3, free T4 and thyroid stimulating hormone (TSH)-were done at baseline and after completing 3 months by competitive immunoassay using direct chemiluminescent technology. The primary outcome was the proportion of patients diagnosed with thyroid dysfunction (subclinical or overt hypothyroidism).

Results: In total, 126 patients were enrolled. Median (interquartile range [IQR]) age and follow-up months were 10 years (7-12) and 6 months (4-8), respectively. Most patients (n = 103, 81.7%) had generalised seizures, while the remaining (n = 23, 18.3%) had focal seizures. There was a significant difference noted in median (IQR) TSH (micro-IU/mL) at baseline (2.08 [1.41-3.31]) and follow-up (2.56 [1.65-4.14]; P ≤0.001). Thyroid dysfunction (subclinical hypothyroidism) was noted in 7 patients. Among the 7 children with subclinical hypothyroidism, 6 (4.8%) were on sodium valproate either as monotherapy (n = 3, 2.4%) or polytherapy (n = 3, 2.4%), while the remaining child was on phenytoin. No difference was noted between the monotherapy and polytherapy groups (4% versus 11.5%; P = 0.15).

Conclusion: The incidence of thyroid dysfunction (subclinical hypothyroidism) was 5.6% in children taking ASM with a median follow-up period of 6 months. A longer follow-up period and larger sample size study is warranted in the future.

Objectives: Propofol administration is associated with pain, mediated by the activation of vascular endothelium. Hydroxyethyl starch (HES) inhibits endothelial membrane activation by various nociceptive substances. Thus, this study hypothesised that pre-administration of HES can reduce pain on propofol administration. This study aimed to compare the proportion of patients with no pain on propofol administration and to compare the severity of pain and any change in pre- and post-induction haemodynamic variables.

Methods: This prospective, randomised, placebo-controlled clinical trial was conducted at Chirayu Medical College & Hospital, Bhopal, India, between August 2023 and December 2023 and included patients undergoing elective surgery under general anaesthesia. Patients were randomly assigned to 3 groups to receive either 100 mL of 6% HES followed by propofol (Group HES), 100 mL normal saline (NS) followed by propofol premixed with 2% lidocaine (Group L) or 100 mL NS followed by propofol induction (Group P).

Results: A total of 339 patients were included. The proportion of patients with no pain on propofol injection was significantly higher in the HES group (n = 75) than in the lignocaine (n = 33) and placebo (n = 13) groups (P <0.0001 each). The median pain scores were 0 (interquartile range [IQR]: 0-1), 1 (IQR: 0-1) and 2 (IQR: 2-3) in the HES, lignocaine and placebo groups, respectively. The proportion of patients with moderate (n = 44) and severe (n = 48) pain scores was significantly higher in the placebo group than in the HES and lignocaine groups (P <0.0001 each).

Conclusion: The proportion of patients experiencing pain on propofol injection was found to be significantly less with the pre-administration of 100 mL 6% HES compared to the pre-administration of lidocaine.

Objectives: An early age of drinking onset is linked to a greater likelihood of alcohol-related problems. Alcohol use occurs in places featuring characteristic social groups, and different drinking contexts are associated with different levels of alcohol-related outcomes. Drinking context may affect drinking motives, expectations or alcohol-related outcomes in concert with individual-level variables. The study aimed to examine how the preferred drinking context and age of the first drink affects the occurrence and volume of alcohol use, drinking motives and alcohol-related expectations.

Methods: This cross-sectional study was conducted at Faculty of Veterinary Medicine, University of the Republic, Montevideo, Uruguay, from September 2020 to January 2021. Uruguayan citizens ≥18 years old were asked about their preferred drinking context, the age of first alcohol use and alcohol consumption frequency. In addition, the Drinking Motives Questionnaire and Alcohol Outcome Expectancies Questionnaire were used.

Results: A total of 752 Uruguayan citizens were included. The distribution of alcohol consumption across social contexts was not influenced by the age of first alcohol use. Those who began drinking early and endorsed solitary drinking reported higher frequency of drinking (P <0.05) and coping motives (P <0.05) than any other group. Those who drank at parties reported more conformity motives than most of the groups (P <0.01). An early age of drinking onset was associated with greater enhancement and social motives (P <0.05) and higher alcohol expectancies for stress reduction and social facilitation (P <0.005).

Conclusion: Solitary drinking as a high-risk drinking context is likely to interact with the age of first alcohol use, suggesting that drinking in specific contexts is associated with specific drinking motivations and expectancies. This study represents progress towards exploring factors that influence alcohol consumption among a broader range of socio-cultural populations.

Objectives: Frozen section is performed in sentinel lymph node biopsy (SLNB) for early breast cancer to prevent a second surgery, but it has certain disadvantages. Several trials have demonstrated the oncological safety of avoiding axillary dissection in patients with 1-2 positive nodes. This study aimed to assess the need for frozen section during SLNB in early breast cancer.

Methods: This retrospective study included patients with early-stage clinically node-negative breast cancer who underwent SLNB with frozen section at Salmaniya Medical Complex, Manama, Bahrain, between October 2021 and September 2023. Patients who had neoadjuvant chemotherapy, cT3-4 tumours, ductal carcinoma in situ, occult breast cancer and previous breast cancer were excluded.

Results: A total of 147 patients underwent breast cancer surgery with SLNB using frozen section. The sensitivity of frozen section was 84.6%, and the false-negative rate was 15.4%. Furthermore, 4.8% underwent immediate axillary dissection. In the remaining cases, there were only 1-2 positive sentinel nodes, and axillary dissection was omitted. Multifocal or multicentric disease was significantly associated with <3 positive sentinel nodes (71.4% versus 15.0%; P = 0.005). Patients with an indication for axillary dissection were also more likely to have tumours with lymphovascular invasion compared to patients with ≥3 positive sentinel nodes (85.7% versus 17.1%; P = 0.001).

Conclusion: There was no indication for frozen section is needed in most patients with early breast cancer. Routine frozen section is unnecessary during SLNB, and permanent section alone may be sufficient without compromising overall standard of care.

Inclusion body myositis (IBM) is a rare progressive myopathy affecting individuals older than 50 years. It is associated with significant morbidity by restricting the patient's mobility and it has a relatively low mortality risk with respiratory muscles involvement. Muscle biopsy is the gold standard method for diagnosis. We report a 72-year-old female patient who was admitted to a tertiary care hospital in Muscat, Oman, in 2023 with progressive weakness of lower limbs. Various diagnostic tests were performed and the patient was subsequently diagnosed with IBM. The patient was treated with methylprednisolone, immunoglobulins, rituximab and prednisolone; this resulted in moderate clinical improvement. This case highlights the intricate nature of the diagnostic journey, as diagnosing IBM remains a challenge in clinical practice, requiring a high degree of suspicion and precise application of available diagnostic tools with the guidance of a collaborative multidisciplinary approach in investigating and providing patient care. This case report contributes valuable insights to the understanding of this complex myopathy, facilitating more accurate diagnosis and enhancing patient care strategies.