Sultan Qaboos University Medical Journal最新文献

Objectives: This study aimed to assess the prevalence of aberrant opioid-related behaviours (AORB) among patients with sickle cell disease (SCD) in Oman and identify associated risk factors.

Methods: This cross-sectional analytical study was conducted at Sultan Qaboos University Hospital, Muscat, Oman from June to December 2022. Patients with SCD aging 18-65 years old were included and clinically observed for more than 3 months. The Current Opioid Misuse Measure (COMM) was used to evaluate AORB with scores of ≥9 indicating high risk. Demographic and clinical data were collected. The association between AORB and clinical-demographic variables was examined using the Chi-square test.

Results: A total of 144 SCD patients were included in this study; 58.3% of the participants were at high risk of AORB with a mean COMM score of 12.08. A significant relationship was found between perceived lack of family social support and AORB (P <0.001). No significant associations were observed between AORB risk and other studied factors.

Conclusion: This study was the first to document a high prevalence of AORB among SCD patients in Oman. The findings underscore the critical role of family support in mitigating this risk of opioid misuse among this vulnerable population.

Objectives: The incidence of acute pancreatitis (AP) in the paediatric population has increased over the past two decades, with an estimated annual rate of 0.78 per 100,000 children. This study aimed to describe the risk factors and characteristics of AP in Omani children.

Methods: A retrospective cohort study was conducted, including all children <14 years who were admitted and treated with AP at Sultan Qaboos University Hospital in Muscat, Oman, from January 2010 to December 2020. Case presentations, aetiology, management, and outcomes were reviewed.

Results: During the 11-year study period, 55 cases were identified (male: female, 1.2:1). The most frequently reported risk factors were toxic/metabolic (49.1%). Abdominal pain was the predominant symptom (76.4%). Conservative treatment was administered in 74.5% of cases, while the remaining patients required surgery or endoscopic retrograde cholangiopancreatography. Of the 55 patients, 51 fully recovered. The number of risk factors per case was not associated with patient outcomes or length of hospital stay.

Conclusion: Future multicentre and prospective studies with comprehensive data collection are crucial to further understand paediatric AP in Oman and inform potential modifications to treatment guidelines.

Objectives: Spina bifida occulta (SBO) is a congenital spinal defect characterised by incomplete closure of the posterior neural arch. Despite its clinical relevance, discrepancies remain in the published literature. This study aimed to determine the distribution pattern and prevalence of SBO in the Northern Indian population using three-dimensional reconstructed specimens of the lumbosacral spine.

Methods: This retrospective study was conducted between March 2023 and November 2024 at the All India Institute of Medical Sciences Patna, India. A total of 241 computed tomography (CT) scans of the spine from patients aged over 18 years were analysed. Three-dimensional images were reconstructed using DICOM to Print and Geomagic Freeform Plus software to assess the presence of SBO in the lumbosacral spine.

Results: SBO was identified in 48 specimens. Of these, 30 involved the S1 vertebral level, while 8 demonstrated a defect extending from S1 to S5. The overall prevalence of SBO was 19.91% (95% confidence interval: 15.18-25.64%). The defect was significantly more common in males (P = 0.042). A statistically significant association was also observed between SBO and transitional vertebrae (P = 0.00001).

Conclusion: Awareness of SBO has important implications for surgical practice. A comprehensive understanding of fusion failure in the spinal column is essential for accurate diagnosis and effective treatment. This congenital defect should be carefully considered before performing caudal epidural blocks to reduce the risk of dural puncture.

Objectives: Emergency department (ED) staff are disproportionately affected by workplace violence (WPV). Despite its prevalence, qualitative insights into ED staff experiences remain limited, particularly in Oman. As part of the national Workplace Violence against Emergency Department Workers in Oman study (WPV-EDOM), this article explores the perceptions, experiences, and attitudes of ED doctors and nurses towards WPV.

Methods: The study was conducted in Oman between June and October 2021. Doctors and nurses from EDs at secondary and tertiary hospitals across nine governorates who had participated in a validated online WPV survey were invited to respond to an open-ended question: "Free comments on workplace violence against emergency nurses and doctors." Responses were analysed using inductive thematic analysis.

Results: Of the 117 respondents (72.6% nurses, 58.1% female, 61.5% non-Omani), 55% reported experiencing non-physical WPV and 9% reported physical WPV in the preceding 12 months. Five themes were identified: perceptions and attitudes towards WPV, causes, consequences, proposed solutions, and responses to violent incidents. WPV was frequently regarded as inevitable, with underlying causes including long waiting times, resource shortages, and poor communication. Recommendations included public education, improved organisational policies, and enhanced staff training.

Conclusion: ED staff in Oman frequently encounter WPV, often perceiving it as inevitable. This normalisation is rooted in systemic factors such as understaffing, prolonged waiting times, communication barriers, and insufficient institutional support. Addressing WPV requires context-specific strategies including stricter policy enforcement, comprehensive staff training, and public education. These findings highlight the urgent need for initiatives to improve ED workplace safety and for further research to guide effective policy and practice reforms.

Hypertrophic cardiomyopathy is a genetic disorder in which the interventricular septum is typically more severely hypertrophied compared to other segments of the myocardium. We report a 18-year-old woman who presented in 2024 to a tertiary cardiac care centre in Muscat, Oman, with a history of anterolateral accessory pathway ablation who developed burning chest pain after stress. Transthoracic echocardiography revealed generalised left ventricular hypertrophy with maximal thickness in the infero-lateral wall with mid-cavity obstruction. The symptoms necessitated bisoprolol and disopyramide treatment. As there was an increased risk of sudden cardiac death due to left ventricular wall thickness of more than 30 mm and presence of excessive scarring on magnetic resonance imaging, an implantable cardioverter-defibrillator was placed. Failure of medical therapy led to a myectomy referral. Genetic testing identified a rare Titin gene mutation linked to her cardiomyopathy.

Objectives: This study assessed the knowledge, perceptions and use of ChatGPT and other large language models (LLMs) among physicians at Sultan Qaboos University Hospital (SQUH), Oman. It also explored perceived benefits, barriers and ethical concerns regarding artificial intelligence (AI) integration into clinical practice.

Methods: This cross-sectional study was conducted between September and December 2024 using a structured online questionnaire distributed to physicians across different specialties. The survey covered demographics, familiarity with LLMs, applications in medical education, research, clinical care, administrative tasks and ethical considerations.

Results: A total of 146 physicians were included (response rate = 48.7%); 65.1% were familiar with ChatGPT or other LLMs and 70.5% had used them, mainly for education (47.9%) and research (46.6%). Use in clinical practice (29.5%) and administrative tasks (18.5%) was less frequent. Most physicians perceived LLMs as enhancing research (82.9%), education (79.5%), administrative work (74.4%) and patient care (54.1%). While 89.8% believed LLMs could improve professional work, only 39.7% expressed confidence in integrating outputs while upholding academic standards. Ethical concerns were widespread (96.6%), focusing on reliability, accuracy and data privacy. Despite low awareness of ethical guidelines (15.1%), 87.0% expressed willingness to engage in AI-related training. Male physicians reported higher use for research and diagnostics (P <0.05 each), younger physicians (<30 years) more often used LLMs for education (P = 0.037) and senior physicians more frequently perceived bias in outputs (P = 0.045).

Conclusion: Physicians at SQUH demonstrated moderate familiarity and cautious optimism towards LLMs. Addressing gaps in training and ethical awareness is crucial for responsible AI adoption in clinical and academic practice.

Shoulder impingement syndrome can be defined as a collection of symptoms and signs in the shoulder caused by pathology within the intrinsic or extrinsic that cause pinching in the narrowed space between the acromion and the head of the humerus. Myofascial pain yndrome can occur because of shoulder impingement syndrome. We report a 66-year-old male patient who presented with complaints of limited motion in the right shoulder area accompanied by pain to a medical acupuncture clinic in Jakarta, Indonesia, in 2024. Leopard spot technique manual acupuncture was performed at the palpable myofascial trigger point area in each therapy session. After multiple sessions, the patient experienced a reduction in the NRS scale, improvement in range of motion in shoulder, increased pressure using an algometer and improvement in Shoulder Pain and Disability Index scores without side effects. Therefore, manual acupuncture using Leopard spot technique may effectively improve shoulder motion limitations in shoulder impingement syndrome accompanied by myofascial pain syndrome.

Objectives: This study aimed to evaluate the effectiveness and safety of fingolimod in Omani multiple sclerosis (MS) patients. Fingolimod is one of the oral drugs used to treat MS. However, there is limited information on its effectiveness and safety among the Omani population.

Methods: This retrospective real-world study included 65 Omani MS patients who received fingolimod therapy from 2012 to 2021 at a single tertiary centre in Oman. Data were collected between August and November 2021. Various measures were used to evaluate the effectiveness and safety of fingolimod.

Results: Out of 65 MS patients included in the study, 51 (79%) were female. The median duration of fingolimod use was 3.6 ± 2.5 years. The results of the last follow-up visit indicate that the median annualised relapse rate decreased by 84% and relapse-free rate (RFR) increased to 90%, with only a minimal (13%) increase in the expanded disability status. The median number of gadolinium-enhanced lesions in the brain and spine decreased significantly by 88% and 67%, respectively, while the new or enlarged T2 lesions in the brain significantly decreased by 62% (P < 0.050) over the treatment period. The most common side effect was bradycardia (32%). Patient age and age at treatment initiation were significant predictors of RFR (P < 0.050).

Conclusion: This study suggests that the effectiveness and safety profiles of fingolimod in Omani MS patients are similar to those determined by standard clinical trials and real-world retrospective studies.

Objectives: This study aimed to evaluate antibiotic prescription knowledge and practices among Oman Medical Specialty Board (OMSB) paediatric residents. The goal was to identify educational opportunities to reduce antimicrobial resistance and improve patient care.

Methods: A survey-based cross-sectional study was conducted among the OMSB paediatric residents from August 2023 to September 2023. The online survey involved three parts: residents' demographics, knowledge of 12 common paediatric infection scenarios and clinical practice. Participants were asked to choose the proper antibiotic choices and duration for each scenario. Data analysis was performed using SPSS.

Results: A total of 74 responses were obtained, resulting in an 84% response rate. No significant differences were observed in the knowledge of antibiotic prescriptions among paediatric residents at different stages of their residency. The highest knowledge-based adherence rate to local antibiotic guidelines was noted in the acute sinusitis scenario (n = 70; 94.6%), followed by the acute meningitis scenario (n = 68; 91.9%). Conversely, the lowest adherence was observed in the acute otitis media (n = 16; 21.6%), followed by cellulitis (n = 23; 31.1%). Residents exhibited proficient clinical judgement by consulting infectious disease specialists when required based on the scenarios provided.

Conclusions: The low knowledge-based adherence to antibiotic guidelines for common paediatric infections, coupled with the lack of significant differences in antibiotic knowledge between senior and junior paediatric residents, underscores the need for collective educational interventions. These interventions aim to advance knowledge and skills in antimicrobial stewardship and local antibiotic guidelines application.