Sultan Qaboos University Medical Journal最新文献

Objectives: This study aimed to determine the clinical and microbiological profiles of patients with urinary tract infections (UTIs) in primary healthcare centres in Bahrain.

Methods: This retrospective cross-sectional study was conducted at 27 primary care centres in Bahrain between January and December 2022. All patients with positive urine cultures, defined as the presence of ≥100,000 colony-forming units/mL were included. Participants' sociodemographic characteristics, comorbidities, risk factors for resistant uropathogens, uropathogen types and antibiotic sensitivity outcomes were assessed. Descriptive and inferential statistics were analysed.

Results: A total of 1,985 patients were included, with an average age of 40.57 ± 20.18 years. Most participants were female (n = 1,802, 90.8%) and Bahraini (n = 1,699, 85.6%). Diabetes mellitus (20.1%) and hypertension (17.9%) were the most prevalent comorbidities among the participants. Escherichia coli (n = 1,220, 61.5%) and Klebsiella (n = 342, 17.2%) were the most common uropathogens identified. Nearly 1 in 5 patients had resistant uropathogens (n = 412, 20.8%), with extended-spectrum β-lactamase (ESBL) uropathogens being the most prevalent (n = 401, 20.2%). Patients with diabetes (P <0.001), hypertension (P <0.001), a history of previous ESBL infections (P <0.001), previous carbapenem-resistant Enterobacterales (P = 0.019), a history of antibiotic use (P <0.001) and recent hospitalisation (P <0.001) exhibited a higher prevalence of resistant uropathogens. Logistic regression analysis indicated that older patients (P = 0.002) and participants who had used antibiotics (odds ratio [OR] = 1.470; P = 0.002) or had been hospitalised (OR = 1.762; P = 0.017) had higher rates of resistant UTIs. A personal history of ESBL infections increased the risk of having resistant uropathogens by 3-fold (OR = 3.347; P <0.001).

Conclusions: Resistant uropathogens are common among patients with culture-positive UTIs in primary care settings in Bahrain, especially among older patients, those with recent antibiotic use and hospitalisation and those who had ESBL UTIs. Rational antibiotic use based on sensitivity patterns and ongoing surveillance is important to mitigate the risks of resistant UTIs.

This systematic review examines the effects of date fruit products on female health across different life stages. The quality of the included studies was assessed using the risk of bias tool. A total of 21 eligible studies were reviewed, demonstrating that date fruit consumption benefits puberty, reproductive health, and menopause. During puberty, date fruit intake was associated with improved hemoglobin levels in adolescent girls. In reproductive-age women, date fruits positively influenced fertility parameters and sexual function. Additionally, in menopause, they contributed to alleviating dyspareunia and supporting ovarian reserve maintenance. Providing women with proper nutrition and integrating date fruits into their diet may serve as a cost-effective preventive approach, reducing reliance on medical interventions. Simple dietary recommendations can enhance women's quality of life and support overall well-being.

Acute pancreatitis (AP), often requiring hospitalisation, is mild in most cases but severe in approximately 20% of cases. Early severity and mortality risk identification are crucial. This systematic review and meta-analysis evaluated the prognostic utility of red blood cell distribution width (RDW) for predicting mortality in AP. A comprehensive literature search from 1990 to 2023 was conducted across MEDLINE, SCOPUS and ScienceDirect databases along with Google Scholar. Methodological quality of included studies was assessed using the Quality in Prognostic Studies tool. Prognostic accuracy measures were pooled using a bivariate random-effects meta-analysis model, and hierarchical summary receiver operating characteristic (ROC) curve was constructed. Of the 1,207 studies identified, 20 were used for quantitative synthesis. The pooled sensitivity and specificity for mortality prediction were 87% and 81%, with an area under the summary ROC curve of 0.90. These findings highlight RDW's potential as a promising biomarker for mortality prediction in AP.

Objectives: This study aimed to compare pelvic floor muscle strength (PFMS) in women who had vaginal delivery with episiotomy and those who underwent planned caesarean section 1-3 years postpartum.

Methods: This retrospective cohort included 208 women from Taleghani Hospital, Arak, Iran, recruited by purposive sampling between May and August 2022. Participants were allocated to two groups: 104 with vaginal delivery and episiotomy and 104 with planned caesarean section. Data were collected using a sociodemographic questionnaire and a perineometer to assess PFMS. Statistical analyses used the independent-samples t test and multiple linear regression.

Results: The mean (± standard deviation) PFMS was 28.6 ± 7.9 in the vaginal delivery group and 29.1 ± 7.1 in the caesarean section group (perineometer scale: 2-124 units). No significant between-group difference was observed (mean difference =-0.55; 95% confidence interval [CI]: -2.6 to 1.5; P = 0.595).

Conclusion: Mode of childbirth-vaginal delivery with episiotomy or planned caesarean section-did not significantly influence PFMS 1-3 years postpartum. Caesarean section did not demonstrate a protective effect on PFMS. These findings suggest that concerns about long-term PFMS should not be a primary factor when considering caesarean section over vaginal delivery.

Head and neck free flap surgery is associated with considerable morbidity and mortality. Goal-directed fluid therapy (GDFT) has been increasingly adopted in perioperative care; however, its benefit over conventional fluid therapy (CFT) in this setting remains uncertain. This systematic review and meta-analysis assessed the effect of GDFT versus CFT on post-operative outcomes. A comprehensive search of PubMed, Web of Science, Cochrane Library, Dental/Oral Science, and Google Scholar identified randomised controlled trials published between 2010 and 2023. Three studies involving 262 patients (130 GDFT, 132 CFT) were included. Pooled analysis showed no significant difference in flap failure between groups, but CFT was associated with higher risk of flap at risk (risk ratio 4.44; 95% confidence interval [CI]: 1.35-14.57; P = 0.01), reoperation (risk ratio 2.62; 95% CI: 1.01-6.79; P = 0.05), and longer intensive care unit stay (mean difference 0.94 days; P < 0.001). GDFT may improve outcomes, but larger studies are needed to confirm these findings.

Objectives: Osteomyelitis, characterised by bone inflammation due to microbial infection, presents significant healthcare challenges. While the protective role of biofilm in bacterial immunity and persistence is well-documented, its direct impact on bone degradation in osteomyelitis remains inadequately characterised. This study aimed to comprehensively examine the direct effects of biofilm-forming pathogens on human bone, providing new insights into the mechanisms of bone destruction associated with osteomyelitis.

Methods: Bone sections were collected from patients undergoing total knee replacement surgery at Sultan Qaboos University Hospital, Muscat, Oman, between January 2021 and December 2022. The samples were then inoculated with Staphylococcus aureus to simulate in vitro bone infection. Raman spectroscopy and scanning electron microscopy (SEM) were employed to analyse the bacterial interaction with bone tissue.

Results: Biofilm-forming pathogens directly contributed to bone degradation, as evidenced by SEM images showing marked trabecular destruction. Raman analysis showed a significant increase in the carbonate-to-phosphate ratio in inoculated samples (61.9%) compared to controls (47%). Additionally, mineral content decreased in inoculated samples, and the carbonate-to-amide I ratio reduced by 47% in inoculated samples and by 80% in controls. The inoculated samples exhibited an 82% shift in collagen cross-linking compared to a 72% shift in controls.

Conclusions: This research enhances the comprehension of the mechanisms underlying bone destruction in osteomyelitis and underscores the intricate role of biofilm in disease progression. These findings highlight the importance of biofilm in bone degradation and its potential implications for infection management.

We report a 34-year-old woman with severe scalp psoriasis presented to a dermatology clinic in San Diego, USA, in 2023. She developed acute self-harm ideations and major depressive symptoms shortly after initiating adalimumab treatment. The patient had a history of major depressive disorder, post-traumatic stress disorder and anxiety, all well-controlled with multiple medications. Following the administration of adalimumab, she experienced intrusive thoughts of self-harm and exacerbation of depressive symptoms, prompting immediate discontinuation of the drug. The patient's symptoms resolved completely 3 weeks after discontinuation. This case highlights the potential psychiatric risks associated with adalimumab therapy for psoriasis, especially in patients with pre-existing mental health conditions. Dermatologists should carefully evaluate patients for psychiatric disorders and suicide risk factors before initiating treatment and be vigilant in monitoring for adverse psychiatric events during therapy. Proper counselling and prompt identification of adverse events are crucial to prevent serious outcomes.