Sultan Qaboos University Medical Journal最新文献

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: 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.

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.

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.

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: The World Health Organization has reported concerns around the increase in vaping behaviour in adolescents. This study aimed to explore the perceptions of the faculty of secondary public schools in Muscat regarding: (a) reasons for vaping among students, (b) impact of this behaviour on school/class dynamics and families and (c) effective interventions within and beyond schools.

Methods: This qualitative study held 4 focus groups among secondary school faculty at 4 secondary public schools in the areas of A'Seeb, Al Amarat, Bausher and Muscat in Oman from February to March 2023. Discussions were transcribed verbatim, anonymised and thematically analysed.

Results: A total of 40 faculty members were included in this study. All participants expressed concern about the increase in vaping in students. There were 3 factors that emerged as driving forces behind this behaviour: (a) the perception that vaping is less harmful than traditional cigarettes, (b) inadequate support to prevent/control vaping and (c) the wide availability of various shapes and forms of vapes. The impacts of vaping were reported as negative manifestations in classrooms, disruptions in student-teacher relationships and undesirable consequences on families and society. Suggested interventions to prevent/control vaping in schools were themed around enforcing the national anti-tobacco policies and regulations, adapting a multi-sectoral approach within interventions against vaping, enhancing capacity-building anti-vaping activities and integrating social media in anti-vaping campaigns. Additionally, active involvement of the community including religious leaders, was deemed essential to effectively address vaping among school students.

Conclusion: Addressing vaping among school students requires a collaborative approach. Recommendations from this study include translating national anti-tobacco policies into practice through a multi-level and comprehensive strategy that involves schools, families and the broader community.

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.