Sultan Qaboos University Medical Journal最新文献

Objective: Carboxyhaemoglobin (COHb), which represents the fraction of carbon monoxide bound to haemoglobin, is available as a point-of-care test in the emergency department. This study aimed to assess the role of COHb in the diagnosis of invasive bacterial infections (IBI) in a paediatric emergency department.

Methods: This retrospective study examined a single reading of venous COHb values in otherwise healthy neonates who presented with febrile illness at the paediatric emergency department at Royal Hospital, Muscat, Oman, between December 2019 and December 2022. The optimal COHb level for the diagnosis of IBI was determined using receiver operating characteristic curve analysis. Multivariate regression analysis was applied to assess the effect of age, birth weight and sex as cofounders for the diagnosis.

Results: A total of 336 neonates presented to the paediatric emergency department with febrile illnesses and 201 neonates met the inclusion criteria; 43 neonates were culture-confirmed to have IBI. A COHb level ≥1.4% carries a sensitivity of 74% and a specificity of 69% for the diagnosis of IBI. Moreover, it was strongly independent of the diagnosis when adjusted for the confounding factors of birth weight, sex, pediatric early warning score, type of admission and gestational age (odds ratio = 6.080, 95% confidence interval: 2.810-13.155; P <0.001).

Conclusion: This is the first study to examine COHb as a biomarker for IBI in a pediatric emergency setting. COHb may be a useful biochemical marker for risk stratification in febrile neonates. Further studies are required to better delineate its clinical utility.

Objectives: Activation of IL-6 facilitates CD45 expression in myeloma cells, but little has been reported for myeloid malignancies. This study aimed to investigate whether IL-6 enhances CD45 expression on myeloid malignancies and whether myeloid cells are dependent on IL-6 activation to express CD45 on their cell membrane.

Methods: This study was conducted from January to March 2022 at the Queen's University Belfast, UK. Myeloid cell lines such as HEL and OCI-AML3 which expressed higher levels of CD45, and UT-7 and the pro-B NALM-6 cell lines that had lower CD45 levels as well as primary cells were used. The correlation between CD45 expression and IL-6 activation in myeloid cells was studied in terms of survival and response to chemotherapy such as cytarabine.

Results: It was found that IL-6 enhances cellular survival in myeloid leukaemia cells. Expression of CD45 could be correlated with IL-6 activation in myeloid leukaemia cells. Quantification of IL-6 confirms the significant effect on cellular proliferation. More importantly, IL-6 significantly alters CD45 expressed myeloid leukaemia cellular response to chemotherapy such as cytarabine.

Conclusion: IL-6 significantly induced alteration to cytarabine cellular response in those cells of higher CD45 expression, while its effect on cells of lower CD45 expression was minimal. This suggests the importance of CD45 in the activation of IL-6 pathway and initiation of cellular proliferation events with its consequences of cytarabine chemo resistance and enhancement of leukaemia cells survival and proliferation by inhibiting the apoptotic activities of cytarabine.

Objectives: This study aimed to evaluate the efficiency of the healthcare facilities in the Oman to guide the decision-making process and benchmarking.

Methods: Input-oriented data envelopment analysis (DEA) was used to assess the relative efficiency of governorate hospitals in Oman using 2022 data extracted in December 2023. In the second stage of data analysis, the Tobit model was applied to assess determinants of governorate hospital inefficiency; 3 DEA models were created (staffing, structure and budget).

Results: A total of 10 governorate hospitals were included in this study. The efficiency score change was small for the governorate hospitals and no hospital shifted from full efficiency to very low efficiency between the 3 models. The only explanatory variables that are significantly correlated with efficiency score in the structure model were bed occupancy rate (P = 0.007, 95% confidence interval [CI]: 0.010 to 0.037) and nurse-to-bed ratio (P = 0.099, 95% CI: -1.219 to 0.146). The results of the Tobit regression for the staffing model of DEA show that there are 3 variables which are positively correlated to efficiency score: bed occupancy rate, nurse-to-bed ratio and expenditure. The third model evaluated efficiency by comparing resource utilisation to service outputs, identifying 6 fully efficient hospitals and opportunities for enhancing resource allocation.

Conclusions: These results allow for benchmarking against best-performing hospitals, facilitating the identification of areas for sustained improvement. Reallocating resources from overperforming to underperforming hospitals, streamlining workflows and implementing a continuous performance evaluation system can help bridge efficiency gaps.

Chondromyxoid fibroma (CMF) is a rare, benign metaphyseal bone tumour characterised by a combination of chondroid, myxoid, and fibrous elements. It can affect any bone at any age, with no gender predilection. We report a case of CMF in a 47-year-old female patient who presented with swelling of the left little finger at a tertiary care hospital in Kolkata, India, in 2024. Imaging revealed a lobulated lesion originating from the middle phalanx of the left little finger, extending to involve the base of the distal phalanx. Fine needle aspiration cytology indicated a moderately cellular myxoid lesion. Histopathology, which remains crucial for diagnosis, showed a lobulated tumour with zones of spindle to stellate cells, associated with an abundant myxoid and chondroid matrix in the intercellular spaces. Treatment involves complete local excision with tumour-free margins, as recurrence may occur with local curettage.

Objectives: This study aims to investigate the influence of dietary heat intensity in maternal diets on the incidence of neonatal jaundice. Specifically, we examine whether maternal consumption of "dietary heat intensity" foods affects neonatal bilirubin levels, while controlling for potential demographic and obstetric confounding factors.

Methods: This retrospective case-control study was conducted between October 2023 and September 2024. The study population consisted of mothers and their newborns attending healthcare centers in Alborz Province, Iran. Based on predefined inclusion and exclusion criteria, 152 newborns were enrolled, comprising 75 non-jaundiced and 77 jaundiced infants. Data were collected using an information-gathering form and a food frequency questionnaire. A total bilirubin level of ≥5 mg/dL was defined as the threshold for jaundice. The collected data were subsequently analyzed using SPSSv16 software.

Results: Statistical analysis revealed significant differences between the two groups in several variables, including the number of pregnancies, delivery type, infant birth weight, gestational age, infant nutrition type, use of herbal medications in infants, and maternal age. Logistic regression analysis demonstrated a significant association between neonatal bilirubin levels and maternal consumption of "dietary heat intensity" foods, particularly warm-classified carbohydrates, fruits, and vegetables.

Conclusion: The study results demonstrated that increased maternal consumption of hot-nature foods was significantly correlated with elevated bilirubin levels, suggesting a potential influence of maternal diet on neonatal jaundice incidence.

This systematic review and meta-analysis aimed to evaluate the effectiveness of vaginal magnesium sulfate (MgSO₄) administration during labour. A comprehensive search was conducted across six databases up to 30 July 2024, and updated on 13 January 2025, with no restrictions on time, language, or geographical region. The risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using GRADEpro. A total of seven randomised controlled trials were included. The meta-analysis demonstrated that topical magnesium sulfate significantly increased cervical dilatation by 2.27 cm (95% confidence interval [CI]: 1.98 to 2.56; P <0.00001) and cervical effacement by 15.3% (95% CI: 7.79 to 22.82; P <0.0001) two hours after administration, compared to control groups. Furthermore, it shortened the active phase of labour by 1.63 hours (95% CI: -2.15 to -1.11; P <0.00001) and reduced reported pain levels. These findings suggest that vaginal magnesium sulfate may be a promising and easily administered intervention, warranting further investigation in clinical practice.