Sultan Qaboos University Medical Journal

Congenital Blood Cyst of a Child

Rachid Kaddoura — 2024-05-27

Blood-filled cysts of the heart valves are frequently reported at postpartum autopsies of infants. They are seen as round nodules mostly in the paediatric age group in infants less than 2 months of age and disappear spontaneously within 6 months of life. We report a unique case of an 11-month-old girl who presented at a tertiary healthcare hospital in 2022 with a blood-filled cyst on the posterior leaflet of the pulmonary valve that was successfully treated. This case report highlights the characteristics and course of a paediatric patient with blood-filled cysts. Further studies are yet needed to better understand the diagnostic approaches to blood-filled cysts as well as treatment modalities to fill the gap in clinical settings.

Keywords: Cyst Fluid; Pulmonary Valve; Pulmonary Artery; Paediatrics; Cardiac Tumors; Cardiology.

Peri-ictal Water Drinking in an Omani Patient with Bilateral Mesial Temporal Sclerosis

Younis Al-Mufargi — 2024-05-27

Peri-ictal water drinking (PIWD) is a rare vegetative manifestation of temporal lobe epilepsy without a definite lateralisation value. We report a case of PIWD in a 22-year-old Omani male patient with post-concussion syndrome and epilepsy presented to a tertiary care hospital in Muscat, Oman, in 2021 for evaluation of paroxysmal events. His behaviour of PIWD was misinterpreted by his family until characterised in the epilepsy-monitoring unit as a manifestation of epilepsy that was treated medically. To the best of the authors’ knowledge, this is the second reported case in the region.

Keywords: Peri-Ictal Water Drinking; Ictal Spitting; Epilepsy; Autonomic.

Paediatric Restrictive Cardiomyopathy - Diagnosis and Challenges

Dalal S Husain — 2024-05-27

Restrictive cardiomyopathy is one of the rarest forms of cardiomyopathies in paediatric patients characterised by impaired myocardial relaxation or compliance with restricted ventricular filling, leading to a reduced diastolic volume with a preserved systolic function. We report 2 cases—a 5-year-old boy who presented with abdominal distension and palpitation with family history of similar complaints but no definite genetic diagnosis as yet and a 5-year-old girl who presented with chronic cough and shortness of breath. Both cases were diagnosed in a tertiary care hospital in Muscat, Oman, in 2019 and are managed supportively with regular outpatient follow-up. This is the first series of reported cases of paediatric restrictive cardiomyopathy from Oman.

Keywords: Cardiomyopathy; Restrictive Cardiomyopathy; Congestive Heart Failure.

Tension Subdural Hygroma Following Resection of Posterior Fossa Tumour in a Child

Mahesh K Pillai — 2024-05-27

Persistent hydrocephalus is common in children after resection of posterior fossa tumours. However, occurrence of subdural hygroma is very rare. We report the case of a 14-month-old child who presented at a paediatric neurology clinic in Muscat, Oman in 2021 who developed a tense subdural hygroma with stable hydrocephalus, in the early postoperative period, following posterior fossa tumour resection. We describe the distinctive clinical, radiological and pathological features associated with the development of a tense subdural hygroma. We also discuss the management by cerebrospinal fluid diversion, which includes either a ventriculoperitoneal or subduroperitoneal shunt. This unique condition is distinguished from external hydrocephalus by features that are critical to the management strategy.

Keywords: Child; Posterior Fossa Tumour; Postoperative Period; Hydrocephalus; Subdural Hygroma.

Managing the Adverse Events Associated with Pembrolizumab and Lenvatinib Therapy in Endometrial Cancer

Aref Zribi — 2024-05-27

Endometrial cancer (EC) is the most common gynaecological cancer. The combination of lenvatinib and pembrolizumab has exhibited efficacy as the second line treatment for advanced EC, with a significant benefit in terms of progression free survival (PFS) and overall survival, but the adverse events (AE) profile is complex. AEs associated with the treatment may represent a limitation to this combination. Here, we report the case of a 38-year-old female patient diagnosed with stage IV EC elsewhere, whose disease progressed after the first line of treatment and was referred to a specialised cacncer centre in Muscat, Oman, in 2021. We treated her with the combination of lenvatinib and pembrolizumab. During the course of the treatment, she developed hand-foot syndrome grade III and hypothyroidism grade II. The AEs were managed with supportive medications, dose interruptions, dose reductions and multidisciplinary care, which allowed the continuation of the treatment. The patient achieved a good partial response and an ongoing PFS of more than 12 months.

Keywords: Cancer; Endometrial Cancer; Lenvatinib; Pembrolizumab; Adverse Drug Events; Hand-Foot Syndrome; Hypothyroidism; Oman.

Efficacy of Ropivacaine for Sub-Arachnoid Block in Patients with Recent History of Scorpion Sting

Saurabh Trivedi — 2024-05-27

Failure of sub-arachnoid block (SAB), due to resistance to bupivacaine after a recent scorpion sting can lead to multiple block attempts and subsequent conversion to general anaesthesia. We report this case series of 10 patients with successful SAB with newly launched 0.75% hyperbaric ropivacaine, in patients with recent scorpion sting. Thus, intrathecal hyperbaric ropivacaine may be considered as the local anaesthetic agent of choice in patients with scorpion sting to prevent failure of SAB.

Keywords: Bupivacaine; Ropivacaine; Scorpion Stings; Spinal Anaesthesia.

Aortopulmonary Septal Defect

Suprava Naik — 2024-05-27

NONE

Unexpected Entrapment of Caravel Microcatheter in Percutaneous Chronic Total Coronary Intervention

Muhammad A Sadiq — 2024-05-27

NONE

The Use of a Simple Vaginal Speculum to Harvest Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction and Avoid Any Potential Pitfalls during Harvesting Procedure

Nikolaos E Koukoulias — 2024-05-27

This technical note aimed to present a straigthforward method for harvesting quadriceps tendon autografts with the use of a simple vaginal speculum and direct visualisation of a scope. Anterior cruciate ligament reconstruction with quadriceps tendon autografts has gained popularity in recent years, with many harvesting techniques that use different harvesting systems available on the market. These techniques vary from transverse to longitudinal skin incisions and from open to minimally invasive approaches and have a learning curve, as with the majority of surgical procedures. The technique proposed in this technical note is minimally invasive, can be easily reproduced by any surgeon irrespective of their experience, has a short learning curve, requires no additional cost or technical support during the procedure and creates a stable working space that allows for freedom of manipulation of surgical instruments and the arthroscope.

Keywords: Anterior Cruciate Ligament; Knee; Arthroscopic Surgery; Quadriceps Muscle; Autografting; Greece.

Correlation between Vascularity and Advancing Histological Grades of Oral Submucous Fibrosis with a Plausible Role in Malignisation

Deepak Pandiar — 2024-05-27

Objectives: This study aimed to quantify the vascularity in histological grades of oral submucous fibrosis (OSMF) and to determine if there is any connection between vasculogenesis and malignisation. Recent studies show no significant change in vascularity as the stage advances as opposed to the conventional concept. Methods: A comprehensive database search until December 2022 was conducted for published articles on vascularity in OSMF following preferred reporting items for systematic reviews and meta-analyses guidelines. Results: A total of 98 articles were screened of which 13 were included for systematic evaluation. The study included 607 cases, with a definite predilection for the male gender. Of the 13 studies, 11 evaluated mean vascular density. In more than half of the studies, the vascularity decreased as the stage advanced. Similar results were obtained for endothelial cells/μm², mean vascular area percentage and mean vascular area. Conclusion: The present review supports the prevailing concept that vascularity decreases with the advancement of the OSMF stage. This denies the systemic absorption of carcinogens into the circulation with resultant longer exposure of compromised epithelium and malignisation.

Keywords: Fibrosis; Oral Submucous Fibrosis; Vascularity.

The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South

Aishwarya Ganesh — 2024-05-27

This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post- TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.

Keywords: Traumatic Brain Injury; Neuropsychiatry; Systematic Review; Meta-analysis; Cognitive Impairment; Anxiety; Depression.

Inappropriate Polypharmacy and the Need for Comprehensive Medication Management Service

Juhaina S Al-Maqbali — 2024-05-27

NONE

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Munira A Al-Rumhi — 2024-05-27

Objectives: This study aimed to estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in Oman. Methods: A cross-sectional retrospective study was conducted on all patients who presented to the emergency department at Sultan Qaboos University Hospital and Royal Hospital, Muscat, Oman, and underwent primary percutaneous coronary interventions during 2018–2019. Results: The sample included 426 patients and the median DTB time was 142 minutes. The result of the bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were 3 times more likely to have a delayed DTB time, when compared to patients who presented with typical symptoms (odds ratio [OR] = 3.003, 95% confidence interval [CI]: 1.409–6.400; P = 0.004). In addition, patients who presented during off-hours were 2 times more likely to have a delayed DTB time, when compared to patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087; P = 0.005). Conclusion: To meet the DTB time recommendation, it is important to ensure adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.

Keywords: Acute Myocardial Infarction; Coronary Balloon Angioplasty; Patient Care Management; Emergency Care Systems; Staffing and Scheduling; Oman.

Outcomes from Early Experience with Laparoscopic Inguinal Hernia Repair Versus Open Technique

MA Raajeshwaren — 2024-05-27

Objectives: This study aimed to evaluate the outcomes of laparoscopic inguinal hernia repair (LIHR) regarding postoperative pain, recurrence rates, duration of hospital stay and other postoperative outcomes within the context of a tertiary care teaching hospital in South India, and the initial experience of laparoscopic repairs. The current consensus in the literature often suggests LIHR as superior to open inguinal hernia repair (OIHR). Methods: This single-centre, retrospective, observational study was conducted at the Jawaharlal Institute of Postgraduate Education and Research, Puducherry, India, from January 2011 to September 2020. All patients who underwent elective OIHR and LIHR were included. Data on the patients demographics, comorbidities, hernia type, mesh characteristics, surgery duration, hospital stay and immediate postoperative complications were collected and analysed. Results: A total of 2,690 OIHR and 158 LIHR cases were identified. The demographic profiles, hospital stay and complication rates were similar in both groups. However, surgical site infection was present exclusively in the OIHR group (3.55% versus 0.0%; P <0.05). The timeline for returning to normal activities was statistically shorter for the LIHR group (6 versus 8 days; P <0.05). The most frequent immediate complication in the LIHR group was subcutaneous emphysema (6.54% versus 0.0%; P <0.05). Recurrence (9.23% versus 3.61%; P = 0.09) and chronic pain (41.53% versus 13.55%; P <0.05) were higher in the LIHR group. Conclusion: Lower recurrence and chronic pain rates were observed with OIHR in the initial experience with LIHR in the hospital. However, LIHR had significant advantages concerning faster patient recovery and lower rates of surgical site infections. While the results contribute an interesting deviation from the standard narrative, they should be interpreted within the context of a learning curve associated with the early experience of the research team with LIHR.

Keywords: Hernia; Inguinal Hernia; Laparoscopy; India.

Workplace Violence Against Nurses in Psychiatric Hospitals in Oman

Maryam Al-Kalbani — 2024-05-27

Objective: This study aimed to assess workplace violence prevalence against nurses in Oman's psychiatric hospitals and explore associated factors. Methods: A cross-sectional study design was utilized and data was collected from all tertiary mental healthcare hospitals (Al Masarra Hospital and Sultan Qaboos University Hospital) between October and December 2021. Participants completed a sociodemographic survey and the Workplace Violence in the Health Sector questionnaire. Categorical variables were compared using the chi-square test (p < 0.05). 106 participants took part in the study (80% response rate). Most were female (52.8%) and Omani (72.6%), aged 30-39 years. Results: Workplace violence prevalence was high (90.6%), with verbal violence (86.8%) and physical violence (57.5%) being the most common types. Incidents were more frequent on weekdays (26.4%) and during morning shifts (34%), while 81.1% of nurses worked in shifts and had direct physical contact with patients (83.0%). The majority (92.5%) were aware of standardized workplace violence reporting procedures, and 89.7% confirmed their presence in hospitals. WPV was more prevalent among nurses in inpatient wards (P = 0.047). Conclusion: Workplace violence against nurses in Omani psychiatric hospitals is alarmingly high. Future research should investigate contributing factors among healthcare providers and emphasize violence prevention by providing staff nurses with effective training to handle violent incidents involving psychiatric patients.

Keywords: Workplace, Workplace Violence, Occupational stress, Working conditions, Nurses, Psychiatry, Oman.

Clinicopathological Features and Outcomes of Endometrial Cancer

Ikram A Burney — 2024-05-27

Objectives: This study aimed to report the demographic features, clinical presentation, pathological types and long-term outcomes of patients diagnosed with endometrial cancer (EC) in Oman. EC is the sixth most common cancer in women worldwide and the fifth most common cancer in women in Oman. Survival outcomes of EC have not been reported previously from Oman. Methods: This retrospective study was carried out on consecutive patients treated at the Sultan Qaboos University Hospital, Muscat, Oman, between 2008 and 2020. Survival was estimated using the Kaplan and Meier method. Results: A total of 50 patients with EC were included. The median age was 61 years (range: 31–86 years), and 72% of the patients had type I histology. Most patients were diagnosed with stage IA and IB EC (49% and 20%, respectively), and the majority had grade 1 or 2 tumours (40% and 34%, respectively). Overall, the 5-year survival and 10-year survival rates were estimated to be 70% and 56%, respectively. Weight (>75 kg) and body mass index (>30 kg/m2) were significantly associated with better survival. Tumour histology (type I versus type II or carcinosarcoma), grade (1 versus 2 versus 3) and stage (IA or IB versus II–IV) were associated with better overall survival (P = 0.007, P <0.0001 and P <0.0003, respectively). Patients diagnosed with EC with co-morbidities, other than obesity, had inferior survival compared to those without co-morbidities. Conclusion: Median age at presentation, histological sub-type, clinical stage and outcomes are comparable to the published literature. Almost two-thirds of the patients were obese. These data could be used as a benchmark for outcomes of EC in the region.

Keywords: Endometrial Cancer; Obesity; Cancer; Survival; Oman.

Comparison of the Effect of Cumin Cyminum and Nettle Oral Drops on the Breast Milk Sufficiency Indicators in New Mothers

Fatemeh Farshad — 2024-05-27

Objectives: This study aimed to compare the effects of green cumin (Cuminum cyminum) and nettle (Urtica dioica L.) oral drops on the indicators of breast milk adequacy in lactating mothers. Due to the presence of phytoestrogens in the combinations of cumin and nettle, it is stipulated that they may have milk-increasing properties. Methods: A triple-blind, randomised, controlled clinical trial was conducted on 117 lactating mothers who had given birth to healthy infants aged 10–15 days and who received cumin oral drops (n = 39), nettle oral drops (n = 39) or placebo (n = 39) from August 2020 to March 2021. The participants were recruited from a regional public health care centre affiliated with Iran University of Medical Sciences of Tehran, Tehran, Iran. The 3 study groups received 15 drops thrice a day for 4 weeks. Infant weight, breastfeeding frequency, number of wet diapers, diaper weight and frequency of infant defecation were evaluated before and after the intervention. Results: At the beginning of the trial, no statistically significant differences were observed between the 3 groups for infant weight (P = 0.891), breastfeeding frequency (P = 0.921), number of wet diapers (P = 0.783), diaper weight (P = 0.841) and frequency of infant defecation (P = 0.898). However, following the intervention, the mean scores of all indicators were significantly higher in the experimental groups than in the placebo group (P <0.001). In addition, all the indicators in the cumin group increased significantly compared to those in the nettle group (P <0.001). Conclusion: Considering the effectiveness of cumin and nettle drops in increasing milk and the availability of these native plants in Iran, it is suggested that they, especially cumin, be used postpartum to increase breast milk production.

Keywords: Cumin; Nettle; Breastfeeding; Iran.

Analysis of COVID-19 Vaccine Adverse Drug Reactions Reported Among Sultan Qaboos University Hospital Staff

Bushra H Al Busaidi — 2024-05-27

Objectives: This study aimed to report any suspected adverse drug reactions (ADRs) experienced by all vaccinated staff and students in a tertiary teaching hospital following COVID-19 vaccination. Methods: This retrospective study was conducted during the COVID-19 vaccination campaign at Sultan Qaboos University and Hospital in Muscat, Oman, from August to September 2021. An online survey was generated and sent to all staff and students via email and text messages. An announcement was made on the hospital website with a link to the survey. Results: A total of 8,421 individuals reported being vaccinated at least once with a total of 11,468 doses administered from January to July 2021; 8,014 staff and students received the Pfizer-Biotech vaccine while 3,454 staff and students received the Oxford-AstraZeneca vaccine. The survey received a total of 3,275 responses (response rate = 38.8%). Of these, 741 individuals (22.6%) experienced an ADR after vaccination and 67.2% (n = 498) were females (P <0.001). The majority of the ADRs reported were fever and chills (19.7%) followed by localised pain and swelling at the injection site (18.8%). Other ADRs such as hair loss (0.5%) were reported, and one staff/student reported a clot in the right leg. Among the responders, 27.0% considered their ADRs as mild while 25.0% considered them as severe. Conclusions: In the study cohort, mild symptoms of COVID-19 vaccines were reported. Females experienced more ADRs compared to males. Long-term observation of ADRs to the vaccines and follow-up monitoring should be done on subjects to preclude any unwanted effects.

Keywords: Pfizer-BioNTech (BNT162b2); Oxford-AstraZeneca (ChAdOx1 nCoV-19); COVID-19 vaccines; COVID-19; Adverse Drug Reactions; Oman.

Medical Students’ Clinical Knowledge of Integrated Management of Childhood Illness

Zamzam Al Abri — 2024-05-27

Objectives: This study aimed to investigate and compare the clinical knowledge implications of the integrated management of childhood illness (IMCI) preservice education between pre-clerkship and junior clerkship medical students. Methods: This observational comparative cross-sectional study was conducted between June and August 2022 at Sultan Qaboos University, Muscat, Oman. A self-administered questionnaire was utilised and included questions on sociodemographic data, duration of IMCI preservice training, knowledge of the participants concerning the IMCI objectives and information on a range of childhood conditions. Results: A total of 97 medical students were included in the study. The majority of students (42.3%) had received 2 lectures in IMCI preservice training. The role of the IMCI approach in reducing childhood morbidity and mortality was advocated by the majority of students (80.8% in the junior-clerkship [JCR] group and 73.3% in the pre-clerkship group). The awareness of the IMCI component of improving the health system was higher in JCR compared to pre-clerkship participants (P = 0.044). When compared to pre-clerkship students, the JCR participants demonstrated a slightly higher awareness of skin pinch (P = 0.038), chest indrawing (P = 0.008), anaemia assessment based on nail bed examination (P = 0.002), diagnostic assessment of malnutrition based on palm examination (P = 0.018), sucking capacity in breastfeeding (P = 0.025), and vaccines such as those for tuberculosis (P = 0.001), pneumococcal (P = 0.018) and rotavirus (P = 0.007). Conclusion: The majority of students displayed good IMCI knowledge and JCR students showed better knowledge compared to pre-clerkship candidates.

Keywords: Pediatrics; Disease Management; Students; Undergraduate Medical Education; Oman.

Support for Mandatory COVID-19 Vaccines for 5- to 11-Year-Old Children

Salah Al Awaidy — 2024-05-27

Objectives: This study aimed to investigate the variables that influenced a sample of Omani mothers’ support for mandatory COVID-19 vaccines for children. The vaccination against COVID-19 averted millions of fatalities during the COVID-19 pandemic. Nevertheless, a considerable number of parents and caregivers opposed mandating COVID-19 vaccines for children. Methods: This cross-sectional study was conducted at several healthcare facilities in Oman using a structured questionnaire between February and March 2022. Univariable and multivariable logistic regression models were used to analyse the data. Results: A total of 700 Omani mothers (response rate = 73.4%) who had children aged 5–11 years old were included. The median age of the mothers was 38 ± 5.19 years. The results of multivariable logistic regression were generally consistent with those of the univariable analysis except for age (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 0.58–1.93; P = 0.86) and income (OR = 1.09, 95% CI: 0.58–2.03; P = 0.79). Mothers who were vaccine hesitant (OR = 9.82, 95% CI: 5.27–18.28; P <0.001), tested positive for COVID-19 (OR = 3.25, 95% CI: 1.80–5.86; P <0.001) and had one or two doses of COVID-19 vaccines (OR = 5.41, 95% CI: 2.92–10.03; P <0.001) were more likely to refuse mandating COVID-19 vaccines for children 5–11 years old. Conclusion: Mothers who were vaccine hesitant, tested positive for COVID-19 and had one or two doses of COVID-19 vaccines were more likely to oppose mandatory COVID-19 vaccines for young children. The findings should aid public health authorities in designing future childhood vaccine literacy programmes with specific attention to some subgroups in Oman to help reduce opposition to vaccines in future pandemics among mothers.

Keywords: COVID-19; Mandatory Vaccine; Vaccine Hesitancy; Children; Oman.

Navigating the Factors Affecting Functional Impairment in Spondyloarthritis

Kaouther Maatallah — 2024-05-27

Objectives: This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI). Methods: This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI. Results: A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI. Conclusion: Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients.

Keywords: Spondyloarthritis; North Africa; Tunisia.

Efficacy and Safety of Vildagliptin and Remogliflozin as Add-on Therapy to Metformin in Patients of Type 2 Diabetes Mellitus

Vikram Sharma — 2024-05-27

Objectives: This study aimed to evaluate the safety and efficacy of remogliflozin compared to vildagliptin as an add-on drug to metformin in type 2 diabetes mellitus (T2DM) treatment. Metformin is considered a first-line drug in T2DM. However, as the disease progresses with heightened insulin resistance and declining β-cell function, the use of metformin alone is often inadequate to achieve optimum glucose levels. Methods: This prospective, randomised study was conducted at Maulana Azad Medical College and Associated Hospital in New Delhi, India, between February 2020 to January 2021. This study recruited 60 T2DM patients aged 35–70 years with glycated haemoglobin (HbA1c) >6.5% taking metformin at a daily dosage of 1,500–3,000 mg for ≥3 months. Patients were randomly assigned in a 1:1 ratio to receive either vildagliptin (50 mg) or remogliflozin (100 mg) twice daily for 90 days. The primary endpoint was a change in HbA1c levels from baseline to the end of 90 days whereas secondary endpoints were changes in lipid profile and weight. Results: The decrement in mean HbA1c levels was significantly higher in the remogliflozin group than in the vildagliptin group (−8.1% versus −2.4%; P <0.001). In addition, more significant weight loss was found in remogliflozin-treated patients (−5.2% versus −0.6%; P <0.01). Both treatments were well tolerated throughout the study. Conclusion: Compared to vildagliptin, remoglilflozin was significantly more effective in glycaemic control and weight loss in patients with T2DM and can therefore be considered as an add-on drug in T2DM not adequately controlled by metformin monotherapy.

Keywords: Remogliflozin; Vildagliptin; Metformin; Type 2 Diabetes Mellitus; Efficacy; Safety; Glycaemic Control; Weight Loss; India.

Cranioplasty in Oman

Khalifa Al Alawi — 2024-05-27

Objectives: Cranioplasty is a complex craniofacial and neurosurgical procedure that aims to reinstate the architecture of the cranial vault and elevate both its aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. This study aimed to evaluate different material used for cranial reconstruction in Oman. Methods: This retrospective study included all patients who had had cranioplasty procedures performed at Khoula Hospital, Muscat, Oman, from 2012 to 2022. Demographic information, the characteristics of the cranial defect and any complications that occurred post-operatively were analysed. Results: A total of 47 patients were included in this study. The most common cause of cranial defects was craniectomy following traumatic head injury (70.2%) along with excision of fibrous dysplasia (10.6%). The most frequently utilised material for cranial repair was autologous bone grafts (n = 28), followed by polyetheretherketone (PEEK; n = 14). Interestingly, the replacement of bone grafts from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group. Conclusion: Patient-specific alloplastic implants such as PEEK have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone grafts remain the gold standard for small to medium-sized cranial defects.

Keywords: Bone Grafting; PEEK; Oman.

Prevalence, Severity Patterns and Risk Factors of Bronchopulmonary Dysplasia in Preterm Infants Younger than 32 Weeks of Gestation in a Tertiary Centre in Oman

Hilal Al Mandhari — 2024-05-27

Objectives: This study aimed to determine the rate and severity patterns of bronchopulmonary dysplasia (BPD) and identify antenatal and postnatal factors associated with BPD in preterm infants <32 weeks of gestational age (GA). Methods: This retrospective observational study included preterm neonates <32 weeks of gestation admitted into the neonatal intensive care unit between January 2010 and December 2017 at Sultan Qaboos University Hospital, Muscat, Oman. A data set of antenatal and perinatal factors were collected. BPD was defined as the need for oxygen and/or respiratory support at 36 weeks post-menstrual age (PMA). Infants with and without BPD were compared in their antenatal and perinatal factors. Results: A total of 589 preterm infants <32 weeks were admitted. Among them, 505 (85.7%) survived to 36 weeks’ PMA and 90 (17.8%) had BPD. The combined BPD and mortality rate was 28.4%. Grades 1, 2 and 3 BPD constituted 77.8%, 7.8% and 14.4%, respectively. BPD was associated with lower GA, lower birth weight, need for intubation at resuscitation, lower Apgar scores, longer duration of ventilation, surfactant therapy and higher rates of neonatal morbidities. On binary logistic regression analysis, predictors of BPD were longer duration of ventilation, intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). Conclusion: In an Omani centre, 17.8% of preterm infants (<32 weeks GA) developed BPD. Various perinatal and neonatal factors were associated with BPD. However, longer duration of ventilation, IVH grades 1 and 2 and NEC stages II and III were significant predictors. Future multicentre research is necessary to provide the overall prevalence of BPD in Oman to help optimise the resources for BPD prevention and management in preterm infants.

Keywords: Infant; Premature Birth; Bronchopulmonary Dysplasia; Risk Factors; Oman.