Sultan Qaboos University Medical Journal最新文献

Dexmedetomidine (DEX), a selective α2-adrenergic receptor agonist, has gained recognition for its sedative, anxiolytic, and sympatholytic properties, making it a valuable perioperative agent. This report describes the anaesthetic management of an elderly 75-year-old male patient with septic shock, multi-organ dysfunction, delirium and significant ventricular arrhythmias who presented in 2025 to a tertiary care teaching hospital in Oman and was scheduled for an emergency below-knee amputation. DEX was utilised for intraoperative sedation and its antiarrhythmic effects. Traditional sedatives often exacerbate delirium or pose cardiorespiratory risks; however, DEX provides effective sedation while preserving respiratory function and promoting haemodynamic stability. Notably, its use contributed to a marked suppression of ventricular ectopy and arrhythmias during surgery, likely through attenuation of the catecholamine surge and reduced myocardial excitability. This case highlights the dual benefit of DEX in managing complex surgical patients with neuropsychiatric and cardiac comorbidities, underscoring its potential as a preferred agent in similar clinical scenarios. Further studies are warranted to explore its broader application in arrhythmia-prone, delirious patients undergoing noncardiac surgeries.

Cerebral malaria is a life-threatening complication most commonly associated with Plasmodium falciparum. To the best of the authors' knowledge, this is the first documented case in Oman of a previously healthy 38-year-old Pakistani male who presented to the Emergency Department of a tertiary care hospital in 2025 with cerebral malaria and multi-organ dysfunction syndrome (MODS) caused by Plasmodium vivax, confirmed by peripheral blood smear and polymerase chain reaction (PCR). The patient was treated with intravenous (IV) artesunate and supportive intensive care, resulting in full neurological recovery. This case highlights the importance of considering P. vivax as a potential cause of severe malaria, even in non-endemic regions.

A caesarean section (CS) is a lifesaving procedure. With rising rates, women's delivery choices have become a global concern. This review assesses global CS preference and determinants. A search of 6 databases was conducted (PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care) in accordance with PRISMA guidelines, including papers published between 2013 and 2024. Egger's test and funnel plot assessed publication bias, while the I² statistic and Cochrane Q-test evaluated heterogeneity. Subgroup analysis considered sample size, publication year and economic condition. Initially, 73 articles were identified, of which 13 were deemed suitable, with a total sample size of 22,238. The pooled global CS preference was 26%. Subgroup analysis considered economic status, publication year and sample size. Variables associated with CS preference included age >25 years (adjusted odds ratio [AOR] = 4.9, 95% confidence interval [CI]: 1.4-8.4), higher education (AOR = 1.7, 95% CI: 1.05-2.3), urban residency (AOR = 1.9, 95% CI: 1.4-2.4), lack of knowledge of CS (AOR = 2.1, 95% CI: 1.5-3.6) and prior pregnancy complications (AOR = 4.8, 95% CI: 1.4-10). The pooled global CS preference was nearly one-fourth. This review found that an age greater than 25 years, higher education, urban residency, lack of knowledge about CSs and history of previous pregnancy complications were determinant factors for preference for caesarean delivery. As a result, strengthening healthcare systems is essential to improve women's decision-making regarding mode of delivery.

Objectives: This study aimed to evaluate the effect of prophylactic intravenous tranexamic acid on postpartum haemoglobin (Hb) concentration values compared to a control group.

Methods: This randomised controlled study took place from May to July 2023 and included parturients with no apparent risk for postpartum haemorrhage from the University of Calabar Teaching Hospital in Calabar, Nigeria. Participants were divided equally into 2 groups. Group A (intervention group) received 10 IU of intramuscular oxytocin along with 1,000 mg of intravenous tranexamic acid within 1 minute of vaginal delivery, while Group B (control group) received 10 IU of intramuscular oxytocin with 10 mL of sterile water. The primary outcome measure was the difference in admission and postpartum Hb concentration.

Results: A total of 80 parturients were included in this study; 40 were allocated to each study arm. The demographic characteristics and admission parameters of the 2 groups showed no significant statistical difference (P >0.05). The mean postpartum Hb concentration was significantly higher in Group A compared to Group B (10.28 ± 0.59 mL versus 9.44 ± 0.62 mL; P <0.001). No major maternal side effects were reported in either group.

Conclusions: Compared to the placebo plus oxytocin, tranexamic acid plus oxytocin exhibited effectiveness in reducing postpartum Hb drop after vaginal delivery. Therefore, the use of tranexamic acid plus oxytocin is recommended as part of the active management of the third stage of labour.

Objectives: This study aimed to explore the clinical, histopathological and demographic characteristics of female Omani breast cancer (BC) patients to identify possible predictors of a positive test result. Additionally, it aimed to evaluate the applicability of the National Comprehensive Cancer Network (NCCN) guidelines for germline genetic testing in risk assessment.

Methods: This study was conducted at the Sultan Qaboos Comprehensive Cancer Centre, Oman, between September 2021 and September 2022. The variables examined included age, disease stage, presence of metastasis at diagnosis, hormone receptor status, human epidermal growth factor receptor 2 status, histopathological type, Ki-67 levels, family history of cancer (presence/absence) and the applicability of NCCN guidelines. Data were retrieved and summarised using electronic patient files and family pedigrees collected by geneticists and genetic counsellors. Logistic regression analysis was used to identify predictors of a positive test result.

Results: Except for age, there were no statistically significant differences in the baseline characteristics between patients with positive and negative genetic testing results. Furthermore, age was found to be a poor screening tool for differentiating between positive and negative patients, as indicated by an area under the receiver operating characteristic curve of 0.67.

Conclusions: A strict application of the NCCN testing criteria in Omani BC patients may lead to underdiagnosis of hereditary BC. Universal testing of all BC patients could be appropriate for Omani individuals with BC, provided that careful consideration is given to cost-effectiveness and the testing methods employed.

Pseudomyxoma peritonei (PMP) is a rare clinicopathological condition characterised by mucin-producing peritoneal and omental deposits with an estimated incidence of 1-2 cases per million per year. We report a 42-year-old female patient who presented to a tertiary care hospital in Muscat, Oman, in 2023 due to a 7-year history of chronic diarrhoea associated with progressive abdominal distension over the past 2 years. Her assessment was significant for ascites. No neoplastic lesions were found on the upper and lower gastrointestinal scopes. A diagnostic ascitic tapping revealed a free flow of gel-like thick, yellowish fluid. A diagnostic laparoscopy showed a perforated appendicular mass with diffuse peritoneal nodules and mucin ascites. Subsequently, the patient underwent cytoreductive surgery with heated intraperitoneal chemotherapy. On follow-up, the patient's abdominal distension and diarrhoea had resolved. This case reports an unusual presentation of a very rare disorder and highlights the challenge of diagnosing PMP.

Objectives: This study aimed to examine the impact of glaucoma severity and socioeconomic factors on perceived vision-related quality of life (VRQoL) among glaucoma patients in Saudi Arabia.

Methods: This cross-sectional study included adult glaucoma patients attending the ophthalmology outpatient clinics at King Fahad Medical City and King Saud University Medical City in Riyadh, Saudi Arabia, from May 2022 to May 2023. The validated Arabic translation of the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39) was used to measure VRQoL. Multivariate linear regression analyses were performed to examine the factors associated with VRQoL.

Results: A total of 454 adult glaucoma patients participated in this study (response rate = 97.6%). The mean age of the patients was 60.8 ± 15.0 years. Most patients had severe glaucoma (42.5%), were female (54.2%), married (67.8%), unemployed (55.3%), had an income level of less than 10,000 Saudi Riyals per month (35.9%) and approximately one-third had lower secondary education (32.8%). A total of 24.4% of participants reported needing a care assistant, and 31.9% lived with caregivers. The mean overall composite score on the NEI VFQ-39 was 71.0 ± 21.3. Factors such as the severity of glaucoma, education level, employment status, needing care assistance and having care assistance from others were significant determinants of VRQoL in Saudi Arabian glaucoma patients.

Conclusions: Perceived VRQoL among Saudi adult glaucoma patients is influenced by glaucoma severity, education level, employment status and care needs. This study informs healthcare providers to enhance patient care and, consequently, improve patients' quality of life.

Objectives: Intratumoural budding (ITB) is an emerging entity in oral squamous cell carcinoma (OSCC) and serves as a prime histopathological predictor of aggressive potential. This study aimed to investigate the incidence of ITB in OSCC due to its limited representation in the literature.

Methods: This retrospective study was conducted in the Department of Oral Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Rohtak, India, between 2017 and 2021. A total of 73 haematoxylin and eosin-stained sections of various grades of OSCC were examined for ITB and tumour-associated macrophages (TAMs), focusing on correlating these findings with clinicopathological parameters. Immunohistochemical analysis using a cluster of differentiation 68 (CD68) was performed. Additionally, the expression of CD68+ TAMs was studied in the centre of the tumour mass and correlated with ITB to ascertain the biological behaviour of OSCC. The data obtained were analysed using chi-square and Pearson correlation tests (P < 0.05).

Results: ITB significantly increased in higher histopathological grades of OSCC (P = 0.000). Conversely, CD68+ TAMs in OSCC decreased significantly as the histopathological grades increased (P = 0.000), whereas on correlating with ITB, a non-significant difference was observed, revealing a negative correlation (r = -0.149; P = 0.208).

Conclusions: The inverse association between ITB and TAMs with increasing histopathological grades may help identify ITB as a precise histopathological parameter for evaluating the aggressive biological potential in OSCC. Additionally, this relationship suggests the involvement of the anti-tumour immune response of TAMs within tumour mass.

Chondromyxoid fibromas (CMFs) are rare tumours that comprise less than 2% of benign bone tumours; approximately 5-7.9% occur in the ribs. We report a 28-year-old female patient with CMF in the 4th rib that presented to a tertiary care hospital in Muscat, Oman, in 2023. She complained of pain in the right posterior chest wall for 6 months. A chest computed tomography showed posterior 4th rib expansile lesion measuring 3 × 2 cm without soft tissue involvement. A percutaneous biopsy suggested a diagnosis of chondomyxoid fibroma. The tumour was resected with a free-margin and assistance of video-assisted thoracic surgery approach. The diagnosis of CMF was confirmed postoperatively by histopathological studies. In terms of radiological feature, histopathological findings, and the treatment options, this data and the data of 11 other cases can contribute to guide the advancement of clinical decisions.