Sultan Qaboos University Medical Journal最新文献

Objective: This study aimed to evaluate whether incorporating albuminuria (Alb) into the Child-Turcotte-Pugh (CTP) score improves the prediction of mortality in patients with hepatic encephalopathy (HE).

Methods: This prospective study was conducted between January 2013 and January 2015 at Al-Azhar University, Cairo, Egypt. Patients who were diagnosed with HE at the time of admission to the medical intensive care unit (MICU) were included. Upon admission, patients underwent HE grading, CTP classification, and an albumin-to-creatinine ratio (ACR) assessment. A novel scoring system, CTP-AlbU, was calculated by combining existing CTP scores with the admission degree of ACR. The primary outcome measure was MICU mortality.

Results: A total of 78 consecutive cirrhotic patients were included in this study with a mean age of 57.65 ± 12.9 years, with equal male and female distribution. HE grades were categorised as 2, 3, and 4 in 16 (20.5%), 44 (56.4%), and 18 (23.1%) patients, respectively. CTP classifications were B and C in 12 (15.4%) and 66 (84.6%) patients, respectively. The overall mortality rate was 32.1%. Statistical analysis revealed a significant association between increased mortality and both elevated ACR and higher CTP-AlbU scores. Furthermore, the CTP-AlbU score emerged as an independent risk factor for mortality.

Conclusion: This study demonstrates that incorporating albuminuria into the CTP score, resulting in the CTP-AlbU score, enhances the prediction of mortality in HE patients. This novel scoring system displayed superior sensitivity compared to the original CTP score, suggesting its potential as a tool for predicting short-term outcomes in this patient population.

[This corrects the article DOI: 10.18295/SQUMJ.6.2023.041.].

Objectives: Evidence-based medicine (EBM) provides a systematic method for navigating an extensive repository of information and making well-informed judgements regarding patient care. This study aimed to evaluate the clinical knowledge, attitudes and practices related to EBM among medical students and interns in Oman and to identify gaps between general awareness and comprehension.

Methods: This cross-sectional study was conducted from September 2023 to February 2024 at Sultan Qaboos University. An online survey incorporating the Noor Evidence-Based Medicine Questionnaire was used to evaluate knowledge, attitudes and practices related to EBM. Responses were scored using a 5-point Likert scale.

Results: A total of 230 medical students and interns completed the survey (response rate = 46%; the optimal sample size was determined to be 218 participants). The participants' mean age was 24.2 ± 1.5 years, with the majority being female (n = 124, 53.9%). Most participants (n = 191, 83%) indicated having previously received EBM training. Overall, participants demonstrated poor levels of EBM-related knowledge (mean percent score: 53.3 ± 5.7%), moderate attitudes (63.5 ± 7.6%) and poor practices (35.3 ± 7.4%). Specifically, 85.7% demonstrated moderate levels of EBM-related knowledge, 71.3% revealed neutral attitudes and 60% reported fair practices. No significant relationships were observed between prior EBM training history and knowledge, attitude or practice scores. However, a significant association was found between the knowledge domain and the level of study (P = 0.002).

Conclusions: The study's findings highlight the deficiencies in the current understanding of EBM among Omani medical students and interns. Further studies should investigate specific aspects such as the hours, topics and teaching methodologies used to provide EBM instruction. This will help identify gaps and devise mechanisms to improve knowledge retention.

Objectives: Lead can pass from a mother to her developing foetus and is associated with well-established risks for the foetus. This study aimed to evaluate maternal and cord iron and lead levels and study the association of maternal and cord blood lead levels (BLLs) with newborn anthropometric measurements.

Methods: This cross-sectional study was conducted at Basra Maternity and Children Hospital, Basrah, Iraq, and included women and their newborns over the period from January through June 2023. Blood samples from mothers and umbilical cords were collected and sent to determine the complete blood count and lead and iron levels. Linear regression and Pearson correlation were used to assess the association of maternal and cord BLLs with different maternal and neonatal variables.

Results: A total of 140 women and their newborns were included in this study. There was a significantly lower maternal haemoglobin (10.6 ± 1.4 g/dL) and serum iron (93.5 ± 44.8 μg/dL) levels compared to newborn levels (13.3 ± 1.8 g/dL and 135.0 ± 76.5 μg/dL, respectively; P <0.001). A significant negative correlation between maternal haemoglobin and cord BLLs (R2 = 0.12; P < 0.001) and a significant positive correlation between maternal and cord iron (B = 0.41; P < 0.05) levels and maternal BLLs with both cord iron (B = 4.78; P <0.05) and cord BLLs (R2 = 0.29; P <0.001) were reported. Furthermore, the Pearson correlation revealed a significant negative correlation between cord BLLs and infant birth weight (R2 = 0.06; P = 0.01).

Conclusions: This study found that maternal BLLs were positively associated with both cord iron and cord BLLs. The cord BLL was negatively associated with maternal haemoglobin levels and infant birth weight. Preventive measures to reduce human lead exposure and monitor lead levels in pregnant women are important.

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.

Cutaneous leishmaniasis (CL) is the most common protozoal skin infection worldwide. Multiple treatments for CL have been developed to address issues related to resistance, availability, and safety. Topical treatments have shown promise by reducing unnecessary systemic exposure and providing a viable local therapeutic option. A systematic review and meta-analysis were conducted of all literature published before 28 February 2025 through PubMed/MEDLINE, the Cochrane Library, and EBSCO, comparing topical paromomycin-gentamicin (PG) with topical paromomycin alone (PR). Two studies involving a total of 774 patients were included. Relative risks (RRs) from both studies were pooled using a fixed-effect meta-analysis. The meta-analysis showed no significant difference in the final clinical cure of the index lesion between PG and PR (RR = 1.030; 95% confidence interval [CI]: 0.950-1.117), nor in the rate of cure of all lesions (RR = 0.987; 95% CI: 0.909-1.072). No serious adverse events were reported. When treating CL topically, the addition of gentamicin to paromomycin does not confer additional benefit.

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.