Sultan Qaboos University Medical Journal最新文献

Artificial intelligence (AI) has several potential applications in medicine, creating opportunities for reliable and evidence-based decision-making in disease management. To explore the practical aspects of AI in decision-making, this scoping review was conducted to identify AI applications in disease management using the PRISMA-ScR checklist. Data collection involved searching relevant keywords in Web of Science and Scopus databases in May 2023. Eligibility criteria for study inclusion and exclusion were established, and the review process adhered to the PRISMA-ScR checklist. A total of 80 extracted sub-themes were identified and categorised into 6 main themes: data processing and management, characterisation and analysis, prediction and risk stratification, screening, prognosis and diagnosis. The application of AI can enhance the reliability and confidence in medical decision-making, thereby improving the accuracy and effectiveness of medical interventions.

Objectives: This study aimed to investigate the prevalence of urine culture contamination, determine related factors and identify the most prevalent uropathogens among samples collected from outpatients attending a primary healthcare setting in Muscat, Oman.

Methods: This retrospective, cross-sectional study was conducted from June 2022 to July 2023 at the primary health clinic of Sultan Qaboos University Hospital, Muscat, Oman. All urine cultures requested by physicians for ambulatory outpatients who attended the clinic during the study period were included. Collected urine samples underwent microbiological analysis, with positive cultures defined as significant growth of ≥10⁵ colony forming unit (CFU)/mL. Samples exhibiting 2 organisms growing at 10⁴ CFU/mL or 1 organism at 10⁴ CFU/mL and another at <10⁴ CFU/mL were considered potentially contaminated, as were samples showing the isolation of 3 or more organisms.

Results: A total of 775 urine cultures were analysed. Of these, 72.8% demonstrated no growth, 10.7% exhibited significant growth and 16.5% showed mixed growth, which may indicate possible contamination. Significant correlations were identified between positive culture growth and the patient's gender, symptoms and pregnancy status (P < 0.05 each). Escherichia coli (56.6%) and Klebsiella pneumoniae (12.0%) were the most frequently identified bacteria in positive cultures. Antibiotics were prescribed for 17.8% of patients, primarily empirically (79.7%).

Conclusions: This study identified a significant rate of urine culture contamination among outpatients attending a primary care setting in Muscat. These findings underscore the importance of proper urine sample collection techniques and judicious antibiotic prescribing practices to optimise patient care, minimise unnecessary resource utilisation and reduce the likelihood of antimicrobial resistance.

This review compared the efficacy and safety of immediate oral feeding (initiated within 2 hours post-operation) versus on-demand feeding following caesarean section (CS). A systematic search of electronic databases up to 20 February 2025 identified three randomised controlled trials (RCTs) including a total of 1,158 patients. The quality of the included studies was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Statistical analysis was performed using Review Manager (RevMan) software to calculate mean differences (MDs), standardised mean differences (SMDs), and risk ratios (RRs). Immediate oral feeding was associated with a shorter time to first bowel sounds (MD -0.34 hours), although this difference was not statistically significant (P = 0.16). However, it significantly reduced the time to first flatus (MD: -1.27 hours, P <0.0009) and time to the second meal (MD: -1.76 hours, P = 0.0006). No significant differences were observed between the groups regarding nausea, vomiting, analgesia use, initiation of breastfeeding, patient satisfaction, or discharge time. These findings support the incorporation of immediate oral feeding into enhanced recovery protocols following CS.

Objectives: Community-acquired pneumonia (CAP) poses a significant risk of complications in cancer patients. However, limited studies have evaluated hospitalised cancer patients with CAP. This study aimed to evaluate the characteristics and outcomes of cancer patients hospitalised with CAP.

Methods: This retrospective study included adult cancer patients diagnosed with CAP admitted at the King Hussein Cancer Center, Jordan, from January 2021 to August 2022, following the Infectious Diseases Society of America guidelines. Patient characteristics, microbiological cultures, length of hospital stay, intensive care unit (ICU) transfers and all-cause mortality were recorded. Early clinical stability was defined as temperature ≤37.8°C, heart rate ≤100 beats/min, respiratory rate ≤24 breathes/min, systolic blood pressure ≥90 mmHg and oxygen saturation ≥90% while breathing room air on the third day of admission.

Results: A total of 632 cancer patients were admitted with CAP. The mean age was 60 ± 13.9 years, with 55.2% of the patients being male. Breast cancer was the most prevalent malignancy (22.9%), and 48.6% had received cancer-related treatment within the last 2 months. Positive blood and sputum cultures were detected in 12.4% and 30.0% of patients, respectively. Early clinical stability was achieved in 48.9%, and 88.9% of those patients were discharged after a median stay of 6 days (range: 1-48). Among the included patients, 3.2% required ICU transfer, and 10.9% died.

Conclusions: Early clinical stability was achieved in approximately half of the patients, most of whom were discharged home. Future research should identify interventions to improve clinical outcomes for cancer patients with CAP.

Objectives: Sodium-glucose transport protein 2 (SGLT2) inhibitors are used in the treatment of patients with type 2 diabetes. Besides their beneficial metabolic effects, such as lowering glycated haemoglobin, body weight and blood pressure, these agents have shown favourable and protective effects on both the heart and kidneys. Notably, these cardio-renal benefits are even seen in individuals without diabetes. However, there is limited evidence regarding the safety and efficacy of SGLT2 inhibitors in cardiac transplant recipients. This study aimed to assess the safety and efficacy of empagliflozin in cardiac transplant recipients with diabetes.

Methods: This retrospective study was conducted at the King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia, from June 2003 to May 2024. Patients from the cardiac transplant recipient register who were taking empagliflozin or a combination of empagliflozin and metformin were included. Consequently, their safety and efficacy parameters were examined.

Results: A total of 20 patients were included in this study. There was an improvement in haemoglobin A1C (HbA1C) levels, body weight and stability in serum creatinine. Additionally, there was no increased risk of genitourinary infections, hypoglycaemia or diabetic ketoacidosis.

Conclusions: Although larger studies are needed to examine the use of empagliflozin in cardiac transplant patients, this small study provides assurance that empagliflozin is safe for use in cardiac transplant recipients.

Objective: Pulmonary embolism (PE) is a significant cause of maternal mortality, necessitating accurate clinical prediction tools to optimise diagnosis and reduce unnecessary imaging. This study aimed to examine the Wells score's (WS) predictive value for PE, the effect of incorporating sickle cell disease (SCD) on its predictive accuracy and to estimate prevalence of PE in pregnanct and postpartum women.

Methods: This retrospective study included pregnant and postpartum women who underwent computed tomography-pulmonary angiography (CTPA) for suspected PE at two tertiary hospitals (Sultan Qaboos University Hospital and Royal Hospital in Muscat, Oman) from 2013 to 2019. The relationship between WS and CTPA was evaluated before and after adding 3 points for SCD.

Results: A total of 193 pregnant and postpartum women with a mean age of 31.45 ± 5.60 years underwent CTPA for suspected PE. PE incidence was 0.31 in 1,000 deliveries and 28 women (14.5%) had PE confirmed in CTPA. WS stratified probability of PE as low in 44 (22.8%) patients, moderate in 142 (73.6%) patients and high in 7 (3.6%) patients. In the women with a low score, 2 (4.5%) had PE, giving 95.2% negative predictive value (NPV) of low WS. High WS had a sensitivity of 33.3% and a specificity of 87.0%. Women with SCD had a higher incidence of PE compared to those without (36.7% versus 10.4%, odds ratio = 4.9, 95% confidence interval: 2.0-12.1; P < 0.001). When modifying WS with additional SCD points, NPV for the low score patients was 94.4%, while for the high score group sensitivity and specificity were 72.3% and 85.7%, respectively.

Conclusion: The study confirms that low WS effectively excludes PE, reducing the need of imaging in pregnancy and postpartum. Incorporating SCD enhances sensitivity and specificity of a high score aiding to prioritise women for diagnostic imaging or empirical anticoagulation.

Osteoid osteomas (OO) are benign neoplasms commonly present during the second and third decade of life, showing a male predominance with classical nocturnal bone pain dramatically responding to nonsteroidal anti-inflammatory drugs. We report a 22-year-old female patient who presented at a teaching hospital, Baghdad, Iraq, in 2023. She presented with right leg bone pain that was exacerbated during menstruation, a presentation that had never been reported in the literature before. The pain intensity increased and interfered with her daily activity. A computed tomography scan showed OO signs and surgical excision and histopathology confirmed OO. The patient's pain reduced to 0 on the visual analog scale. She has no recurrence signs 2 years after the surgery. This novel OO presentation may increase physician awareness of atypical presentation. A careful evaluation of a challenging presentation added to an imaging study may reveal the underlying cause and exclude other diagnostic dilemmas.