Sultan Qaboos University Medical Journal最新文献

Objectives: This study evaluated the efficacy and safety of misoprostol, letrozole and their combination in first trimester missed miscarriage.

Methods: This single-blind, randomised controlled trial was conducted between March 2023 and August 2024 among women diagnosed with first trimester missed miscarriage at Kasr Al-Aini Hospital, Cairo, Egypt. Participants were randomly assigned to three groups: misoprostol-only (Group A), letrozole plus misoprostol (Group B) and letrozole-only (Group C). The primary outcome was the rate of complete miscarriage. Secondary outcomes included abortion timing, adverse effects, need for surgical evacuation and the effect of age, body mass index (BMI) and gestational age on success.

Results: A total of 225 women were included in this study. Group B had the highest cumulative complete miscarriage rate by day 7 (76.0%) compared with Group A (53.5%) and Group C (62.5%) (P = 0.0005). Early abortion (by day 4) occurred in 68.4% (group B), 46.5% (group A) and 37.5% (group C). Group B also had the highest incidence of adverse effects, particularly bleeding (85.3%) and pain (92.0%), although severe events were rare. Letrozole-only (group C) had the fewest side effects (26.7%) and required no surgical evacuations. Combination therapy proved most effective across subgroups by age, BMI and gestational age.

Conclusion: Combining letrozole with misoprostol significantly improves complete miscarriage rates with tolerable safety. Letrozole alone is safer but less effective. Thus, combination therapy may offer an optimal non-surgical strategy for individualised management.

Objectives: Anorectal complications are common and serious issues among patients with haematological malignancies, leading to significant morbidity and mortality. Limited data are available on their incidence, microbiology screening and management. This study aimed to improve the understanding of these complications in patients diagnosed with acute leukaemia in Oman.

Methods: This retrospective study was conducted at Sultan Qaboos University Hospital, Muscat, Oman and included patients diagnosed with acute leukaemia who developed anorectal complications over the past decade (2015-2024).

Results: A total of 100 patients were included in this study; 50% had acute myeloid leukaemia (AML), 35% had acute lymphoblastic leukaemia (ALL) and 36% were newly diagnosed. Of the 119 anorectal complications, fissures were the most common (n = 48/119). Only 19 patients had culture-proven anorectal infections, most commonly caused by Pseudomonas. Both the Surgery and Infectious Diseases teams were involved in management, especially for abscesses. The majority of patients were treated with meropenem (n = 44/176) and metronidazole (n = 39/176). The recurrence rate was 40% and found to be higher among AML patients. A total of 16% of the patients died within 30 days of diagnosing anorectal complications. But their mortality was indirectly related to the anorectal complications.

Conclusion: Anorectal complications were prevalent among these patients, particularly in those with AML and were more common among newly diagnosed individuals. Fissures were the most frequently observed complication, while abscesses posed the most significant management challenge, requiring collaboration between Surgery and Infectious Diseases teams. Close monitoring of patients can facilitate early detection and intervention of these complications.

Abiotrophia defectiva, a nutritionally variant streptococcus, is an uncommon yet significant pathogen primarily associated with infective endocarditis and, more rarely, septic arthritis. We report a 23-year-old male patient who presented to a tertiary care centre in Rustaq, Oman, in 2024 with right knee pain and fever following an anterior cruciate ligament reconstruction. Standard cultures remained negative, but enrichment broth and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry enabled prompt identification of A. defectiva. Subsequently, the patient was diagnosed with native knee septic arthritis due to A. defective. Following surgical debridement, the patient completed a 4-week course of targeted antibiotic therapy, resulting in full recovery and normalisation of inflammatory markers. This case highlights the value of enrichment media and advanced diagnostic techniques in detecting fastidious pathogens in postoperative joint infections.

Objectives: This study aimed to assess the risks associated with infant botulism in Oman by examining honey-feeding practices among infants and related sociodemographic and clinical factors.

Methods: This cross-sectional study included Omani mothers with children under 5 years and were conveniently recruited from health centres. Mothers completed an infant feeding practices and beliefs survey between October 2023 and March 2024. Data were represented as frequencies and percentages and analysed via Chi-square test and logistic regression.

Results: A total of 3,222 participants were included of which 58.8% were aged 26-35 years. The study found that 38.7% of children were fed honey during their first year. Local Omani honey was used by 34.6%, often for reasons including cough relief (15.2%), boosting immunity (11.6%) and Tahneek (8.6%). Additionally, 16.7% of mothers felt pressured to introduce honey and 45.9% viewed early honey feeding as acceptable. Multivariate logistic regression analysis revealed that infant honey feeding was negatively and significantly associated with maternal education (odds ratio [OR] = 0.77, 95% confidence interval [CI]: 0.65-0.91; P <0.001), family income (OR = 0.61, 95% CI: 0.51-0.74; P <0.001) and receipt of infant feeding counseling (OR = 0.83, 95% CI: 0.72-0.97; P = 0.007). Additionally, results indicated that infants who were fed honey had a higher likelihood of experiencing constipation (OR = 1.29, 95% CI: 1.10-1.51; P = 0.001) and muscle weakness (OR = 1.84, 95% CI: 1.15-2.95; P = 0.011).

Conclusion: This study highlights the potential risks of infant botulism in Oman, emphasising the importance of following updated clinical guidelines for optimal infant care and effective reporting.

Objectives: This study aimed to evaluate the effectiveness of an established respiratory syncytial virus (RSV) prophylaxis programme by assessing RSV-related hospitalisations (RSVH) and identify associated risk factors among preterm infants born at <32 weeks' gestation.

Methods: This retrospective cohort study was conducted at Sultan Qaboos University Hospital, Muscat, Oman. Eligible participants were preterm infants <32 weeks' gestation, born between January 2015 and December 2020, who received RSV prophylaxis. Data were extracted from electronic medical records and analysed.

Results: A total of 282 infants were included. The mean gestational age was 28.56 ± 2.03 weeks and the mean birth weight was 1.23 ± 0.35 kg. A total of 5 infants (1.8%) experienced RSV-related hospitalisation while receiving palivizumab prophylaxis. Infants with RSVH were significantly more likely to be born at <28 weeks' gestation than those who had not had a RSVH (60% versus 26.7%; P = 0.033). The rate of bronchopulmonary dysplasia was significantly higher in RSVH infants compared to those without RSVH (60% versus 14.1%; P = 0.026).

Conclusion: The RSV prophylaxis programme demonstrated effectiveness, with a low RSVH rate among high-risk preterm infants. Extreme prematurity and bronchopulmonary dysplasia are the most significant risk factors for RSVH. Despite being a single-centre retrospective study, this is the first evaluation of RSV immunoprophylaxis in Oman and supports the case for a nationwide programme targeting high-risk infants.

Objectives: This study aimed to determine the incidence, outcomes and risk factors of arrhythmia in children undergoing congenital heart disease (CHD) surgery in Oman.

Methods: This prospective cohort study was conducted between 2023 and 2024 at the National Heart Centre, Muscat, Oman. Paediatric patients who underwent CHD surgery were included; those with preoperative arrhythmia or permanent pacemakers were excluded. Demographic, intraoperative and postoperative variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of postoperative arrhythmia.

Results: A total of 346 patients were included in this study, of which 49 (14.2%, 95% confidence interval: 10.6-18.3%) developed postoperative arrhythmias. Junctional ectopic tachycardia (JET) was most frequent (57.1%), followed by atrioventricular block (20.4%) and supraventricular tachycardia (18.4%); 3 patients with complete heart block required permanent pacemaker implantation and 1 patient died after ventricular tachycardia. Patients with arrhythmia had significantly longer cardiopulmonary bypass (CPB; P = 0.005) and cross-clamp times (P = 0.040). On multivariate analysis, prolonged CPB time (P = 0.049) and a history of previous cardiac surgery (P = 0.041) were independent predictors. Arrhythmia patterns were lesion-specific: (1) JET after tetralogy of Fallot, atrioventricular septal defect (AVSD) and arterial switch repairs; (2) complete heart block after AVSD or inlet VSD repairs; and (3) atrial arrhythmias after atrial-level procedures.

Conclusion: Postoperative arrhythmias occurred in 14.2% of children after CHD surgery in Oman, with JET being the most common. Prolonged CPB duration and prior cardiac surgery independently predicted arrhythmia, emphasising the need for vigilant monitoring and targeted perioperative management in high-risk groups.

Objectives: Ischaemic stroke (IS) is a heterogeneous condition with varied mechanisms. Some patients have more than 1 stroke mechanism coexisting, irrespective of the mechanism of the incident stroke.~This study aimed to examine the association of coexisting dual stroke mechanisms among IS patients with risk factors and clinical outcomes.

Methods: This retrospective study included adult patients with IS diagnosed using the TOAST criteria in Sultan Qaboos University Hospital's stroke registry who were admitted and treated from January 2011 to December 2020. The records were reviewed for the presence of dual IS mechanisms (combinations involving small vessel disease [SVD], cardioembolism [CE] or large artery atherosclerosis [LA]). Outcomes were classified as modified Rankin score (mRS) = 0-3 (favourable) or mRS = 4-6 (poor). Univariate and multivariate methods of analysis were used.

Results: Among 1,220 patients with IS (age = 64 ± 13 years; male:female = 63:37), 177 (14.5%) had an additional mechanism of stroke. The most common second mechanism was SVD (53.1%), while CE stroke (23.7%) and LA stroke (23.2%) were similar in frequency. Patients with dual stroke mechanisms were significantly older (P <0.001), had a higher frequency of conventional risk factors (P <0.007), abnormal brain magnetic resonance imaging (P = 0.004) and worse outcomes (P = 0.058). Poor outcomes at hospital discharge or 12-month follow-up were independently associated with older age (P = 0.007), female gender (P = 0.017), poor sensorium (P <0.001) and type of primary stroke (P <0.001).

Conclusions: Up to 1 in 7 patients with IS may have an additional mechanism of stroke. Such patients are likely older, with poorly controlled risk factors, worse sensorium and possibly worse outcomes. SVD is the most common additional stroke mechanism. Studies to explore the influence of dual stroke mechanisms on outcomes, as well as strategies for secondary prevention, are indicated.

Objectives: This study aimed to examine the knowledge of Omani women of childbearing age concerning infant developmental care.

Methods: This cross-sectional study included 1,006 Omani women of childbearing age, recruited from outpatient clinics at Sultan Qaboos University Hospital (response rate = 71%). Their knowledge was evaluated using the Knowledge of Infant Development Inventory (KIDI), a validated self-report questionnaire. The KIDI scores were analysed to identify associations with demographic variables such as women's age, education level, employment status and number of children. Data were collected from June 2023 to October 2023.

Results: The mean age of the participating women was 31.6 ± 8.4 years. The majority were from Muscat (49.6%), with over half holding bachelor's degrees (57.1%) and 39% being employed. The mean correct response rate for KIDI was 0.63 ± 0.11, suggesting that, on average, the women answered 63% of the questions accurately. Higher education levels and employment status were significantly associated with better knowledge scores (P < 0.001). Misconceptions were prevalent in areas such as infant sensory capabilities and developmental milestones.

Conclusions: The findings reveal significant gaps in knowledge regarding child development among Omani women, particularly those with lower levels of educational attainment. Targeted educational interventions are needed to enhance maternal knowledge and support child development in Oman.