Sultan Qaboos University Medical Journal最新文献

This review aimed to assess diagnostic accuracy of transabdominal ultrasonography (TAS) sliding sign in diagnosing severe intra-abdominal adhesions with repeated Caesarean delivery (CD). PubMed, Google Scholar, Web of Science and Scopus were searched for published studies until October 2022. Studies evaluating the sliding sign as a predictor of intra-abdominal adhesions after repeat CD were included. STATA and Comprehensive Meta-Analysis for meta-analysis was used. A total of 7 studies (1,318 patients) were included. For identifying severe intra-abdominal adhesions, sliding sign on TAS had a combined sensitivity (64%, 95% confidence interval [CI]: 55-71%), specificity (93%, 95% CI: 89-96%), positive likelihood ratio (9.5, 95% CI: 5.7-16), negative likelihood ratio (0.39, 95% CI: 0.31-0.49) and diagnostic odds ratio (24, 95% CI: 13-46). Prediction intervals for sensitivity and specificity were 0.444-0.786 and 0.711-0.985, respectively. Sliding sign on TAS is a simple, non-invasive, good negative and practical method to exclude severe intra-abdominal adhesions involving the uterus with low sensitivity and high specificity.

Objectives: Anthracyclines are widely used in the treatment of breast cancer. One of the known adverse effects of anthracyclines is anthracycline-induced cardiomyopathy. Studies done worldwide showed that the prevalence of chemotherapy-induced cardiomyopathy is approximately 9%. However, studies evaluating this complication prevalence, risk factors and cumulative dose are lacking in Oman. This study aimed to investigate the prevalence of anthracycline-induced cardiomyopathy among breast cancer patients in Oman.

Methods: This retrospective study included all breast cancer patients who received anthracycline-based chemotherapy exclusively between September 2008 and December 2020 at Sultan Qaboos University Hospital in Muscat. Patients with partial treatment, coexisting heart failure and who did not receive anthracycline as part of the chemotherapy regimen were excluded. Chemotherapy-induced cardiomyopathy was defined as a drop of left ventricular ejection fraction >10% from the patient's baseline during or after receiving anthracycline-based chemotherapy.

Results: A total of 385 patients were included in this study of which 39 (10.1%) developed cardiomyopathy after exposure to anthracyclines. The mean cumulative dose of doxorubicin among these patients was 239 mg/m² (epirubicin was converted to doxorubicin equivalent dose). Univariate analysis showed that the risk of anthracycline-induced cardiomyopathy was influenced by cardiovascular risk factors such as hypertension (33.3%), diabetes (25.6%), dyslipidaemia (20.5%) and previous cardiovascular medications use (10.3%). Trastuzumab exposure significantly correlated with an increased risk of developing cardiomyopathy (P < 0.001). However, multivariate analysis did not show any significant association.

Conclusions: Anthracycline-induced cardiomyopathy was influenced by various cardiovascular risk factors as well as trastuzumab exposure. Further studies are recommended to investigate the prevention and management of anthracycline-induced cardiomyopathy.

Deciduosis is a benign condition characterised by the transformation of subepithelial connective tissue into decidual-like cells, typically occurring in response to hormonal changes during pregnancy. Although benign, cervical deciduosis may macroscopically resemble malignant lesions, leading to diagnostic uncertainty. This report presents two cases of cervical deciduosis diagnosed in early pregnancy. Both patients presented with first-trimester vaginal bleeding, and speculum examination revealed extensive wart-like lesions covering the cervix. Histopathological examination of cervical biopsies confirmed decidual changes. In pregnant women presenting with threatened miscarriage, a thorough local examination and biopsy of atypical cervical lesions are essential to exclude malignancy. As cervical deciduosis is a benign and self-limiting condition, no further treatment is usually required.

We report a novel presentation of autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) in a 9-year-old Moroccan male patient born to consanguineous parents, expanding the known clinical spectrum of the disease. The patient presented to a tertiary care hospital in Rabat, Morocco, in 2023. This case presents an unusual phenotype with early-onset epilepsy beginning at age 5, significantly broadening the known phenotypic spectrum of ARSACS. While initial neuroimaging was unremarkable, the patient exhibited classical retinal involvement with bilateral nerve fibre layer thickening. Genetic analysis revealed a previously unreported homozygous frameshift mutation in the SACS gene (c.12429delT), representing the first documented case in the Moroccan population. This observation extends both the understanding of ARSACS' clinical heterogeneity and its geographical distribution in North Africa. The patient responded favourably to antiepileptic treatment and physiotherapy which underscores the importance of early recognition and multidisciplinary management in atypical presentations. This case highlights the necessity of considering ARSACS in the differential diagnosis of early-onset ataxia with epilepsy, particularly in consanguineous populations.

Objectives: This study aimed to assess the incidence of erectile dysfunction (ED) in male patients with ischaemic heart disease (IHD) and to assess the psychological impact on these patients.

Methods: This questionnaire-based pilot study was conducted at the outpatient Cardiology Department of the Sultan Qaboos University Hospital, Muscat, Oman between January and December 2023. ED was assessed using the 5-item International Index of Erectile Function and the psychological state was assessed using the Depression Anxiety Stress Scale.

Results: A total of 100 patients were included in this study (mean age = 59.5 ± 10.4 years); 62 patients self-reported ED and 69 had some form of ED based on the questionnaire. Moderate to severe ED was found in 30 patients; these patients were older (66.7 ± 10.4 versus 56.4 ± 8.8; P <0.001), more likely to have hypertension (93.3% versus 65.7%; P = 0.004) and hyperlipidaemia (93.3% versus 70%; P = 0.01) and less likely to have undergone PCI (70% versus 88.6%; P = 0.02). There was no effect of drug therapy or other co-morbidities. By binary logistic regression, age was the only predictive factor for ED (odds ratio = 1.12, 95% confidence interval: 1.04-1.22; P = 0.003). Additionally, 32%, 14% and 13% had severe or very severe anxiety, stress and depression, respectively. The ED score corelated negatively and significantly with the anxiety score (r = -0.485; P <0.001), the stress score (r = -0.36; P <0.001) and depression score (r = -0.38; P <0.001).

Conclusion: This study found that ED is common in patients with IHD with significant psychological effects. Physicians should be aware of this while treating patients due to the effect on quality of life.

Unilateral pulmonary artery agenesis, typically affecting the right pulmonary artery, is a rare condition that may lead to congestive heart failure or pulmonary hypertension in infants and early surgical intervention improves outcomes. We report 5 cases from Muscat, Oman, of unilateral pulmonary artery agenesis who underwent surgical correction between November 2019 and August 2023, at an average age of 4.4 months. Most presented with cyanosis or respiratory distress and all had pulmonary hypertension confirmed by imaging. Surgical approaches included Gore-Tex conduit placement, autologous pericardial reconstruction and patent ductus arteriosus unifocalisation. All patients successfully restored pulmonary blood flow with no perioperative mortality. The median intensive unit care stay was 13 days and the median hospital stay was 20 days. Only 1 patient required repeat surgery for graft compression. Over a 27.6-month follow-up period, 4 patients showed regression of pulmonary hypertension and 2 underwent pulmonary angioplasty, reinforcing the benefits of timely intervention.

[This corrects the article DOI: 10.18295/2075-0528.2907.].

Brain abscess in neonates is rare but remains a severe, life-threatening complication of meningitis with significant morbidity and mortality. While Citrobacter koseri and Citrobacter freundii are commonly implicated in brain-abscess formation, Citrobacter sedlakii is an uncommon causative pathogen. To date, only two cases of neonatal brain abscess caused by C. sedlakii have been reported in the literature. Early diagnosis, timely surgical intervention and prompt antibiotic therapy are critical to achieving a favourable outcome. A third case of a C. sedlakii brain abscess in a preterm infant, presenting in 2024 to a tertiary-care hospital in Oman, is reported together with a brief review of the literature.

This review aimed to assess the prevalence of oncogenic and non-oncogenic viruses in odontogenic cysts and tumours. A comprehensive database search was performed for published articles regarding the presence of viruses in all odontogenic cysts and tumours, following guidelines without date constraints, and was registered with PROSPERO. After screening 164 articles, 24 studies were included for systematic evaluation. A meta-analysis was performed to determine the prevalence of human papillomavirus (HPV), revealing an overall pooled prevalence of HPV in ameloblastomas of 18.21% (95% confidence interval [CI]: 6.36-33.73) while the prevalence of HPV in odontogenic cysts was found to be 1.51% (95% CI: 0.00-9.46). The prevalence of Epstein-Barr virus in odontogenic tumours was 17.19% (95% CI: 4.62-34.49). Other viruses yielded varied results. Human carcinogenesis has previously been positively correlated with viruses; however, this systematic review's results indicate a very low prevalence in odontogenic pathoses and suggest a limited role in their aetiology.

Symmetrical peripheral gangrene (SPG) is an exceptionally uncommon complication of malaria, predominantly linked with Plasmodium falciparum and mixed infections. We report a 41-year-old female who presented to a tertiary care centre of eastern India in 2022 with complaint of fever with chills and rigor for 4 days along with pain and acrocyanosis of distal portions of bilateral upper and lower limbs for last 2 days. Investigations revealed anaemia and neutrophilic leucocytosis with thrombocytopaenia. The peripheral smear revealed trophozoites of P. vivax and the malaria rapid diagnostic test confirmed the presence of P. vivax antigen. D-dimer and fibrin degradation product was elevated and prothrombin time and activated partial thromboplastin time were prolonged; arterial colour doppler of all 4 extremities were within normal limits. A diagnosis of P. vivax malaria was made complicated with disseminated intravascular coagulation leading to SPG.