Sultan Qaboos University Medical Journal

Bloodstream Infection in Children Managed at a Tertiary Hospital in Oman

Nadiya Al Saeghi — 2024-11-27

Objectives: This study aimed to assess the local epidemiology and outcome of bloodstream infection (BSI) among Omani children. Methods: This retrospective study was conducted at Sultan Qaboos University Hospital, Muscat, Oman, over 5 years (2014–2018) and included laboratory-confirmed BSI among children aged 0–12 years old. Patients’ demographic, clinical and laboratory data were extracted from the hospital’s electronic records and used to assess BSI rates and outcomes. Results: A total of 1,253 positive blood cultures were identified, of which 592 (47.2%) were regarded as contaminants. Overall, 404 (32.2%) significant episodes of BSI were identified in 272 patients; 346 (85.6%) significant episodes were in children aged ≤5 years and 366 (90.6%) had comorbidities. The 5-year incidence of BSI was 13 per 1,000 admissions. Furthermore, 333 (82.4%) episodes were healthcare-related infections. Enterobacterales (n = 152; 37.6%) were the most common organisms identified followed by coagulase-negative staphylococci (n = 63; 15.6%). Approximately 40% of Gram-negative organisms were resistant to third-generation cephalosporins. The crude mortality rate at 30 days was 9.2%. Paediatric intensive care unit admission (crude odds ratio [COR] = 2.24, 95% confidence interval [CI]: 0.98–4.78) and the presence of graft-versus-host disease (COR = 7.99, 95% CI: 1.52–37.76) were associated with increased death within 30 days. The multivariate logistic regression analysis showed that Pseudomonas aeruginosa (adjusted odds ratio = 18.46, 95% CI: 3.96–97.84) was the only independent predictor of increasing 30-day mortality in this cohort. Conclusion: A high rate of hospital-related BSI was found in children in Oman, highlighting the need to optimise infection control strategies and the care of central vein access devices.

Immuno-Informatics Insight into the Relationship Between Cholesterol and Cytokines in Cutaneous Leishmaniasis

Evan H Sulaiman — 2024-11-27

Objectives: The role of serum cholesterol and its interactions with cytokines in human cutaneous leishmaniasis (CL) pathophysiology is unknown. This study aimed to evaluate the correlation among serum total cholesterol (TC), very-low-density lipoprotein cholesterol (VLDL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and cytokines (including interleukin [IL] 10), IL-12 and tumour necrosis factor-alpha [TNF-α]) in CL. The cholesterol–cytokine network was analysed to illuminate the pathogenesis of CL. Methods: This case-control study was conducted from December 2022 to March 2023 in hospitals within Baghdad and Wasit provinces, Iraq, and included CL and CL-free subjects ranging between 20–30 years of age. The serum samples were analysed via commercial kits to detect TC, IL-10, IL-12, TNF-α, VLDL-C, LDL-C, HDL-C and TG levels. Computational efforts to dissect cholesterol-protein interaction networks were employed using STITCH. Results: A total of 50 CL and 25 control subjects were included. The TC, HDL-C and LDL-C levels in CL patients were markedly lower (P = 0.0001) than in control subjects, whereas the IL-10, IL-12, TNF-α, VLDL-C and TG levels were higher in CL patients. Serum cholesterol showed no correlation with cytokines; however, a significant correlation (r = 0.57; P = 0.026) was observed between IL-12 and TNF-α. Within the cholesterol-protein network, cholesterol potentially interacted with IL-10, connecting cholesterol to modules with immunological significance, including TRAF1, TRAF2 and TNF receptor superfamily member 1B, as well as IL-10, IL-10RA and IL-12RB1. Conclusion: This study showed the alteration of lipid and lipoprotein in CL and introduced 2 immunological modules in CL, highlighting the importance of the altered cholesterol-cytokine interaction network in CL.

Short-Term Weight Loss Outcomes of 104 Mini-Gastric Bypass or One-Anastomosis Gastric Bypass Operations

Nabaz H Ismael — 2024-11-27

Objectives: This study aimed to examine the short-term effects of mini-gastric bypass (MGB) or one-anastomosis gastric bypass (OAGB) procedures on weight loss in individuals with obesity. Methods: This retrospective study was conducted in Medicano Hospital, Erbil, Iraq, from January 2019 to May 2020. Preoperative body mass index (BMI), age, height and preoperative weight were recorded as baseline measures. Weight-related changes were evaluated during a follow-up phase of 48 weeks. Results: A total of 104 patients with obesity underwent MGB or OAGB surgery. The mean baseline parameters of the subjects before surgery included 1.64 m for height, 122.9 kg for weight and 45.6 kg/m²for BMI. During the 48-week follow-up period, there was a substantial reduction in mean weight, which dropped from 122.9 kg at baseline to 75.5 kg at week 48. The weight change (in percentage) gradually increased from −11.8% at week 12 to −37.9% at week 48, without statistically significant association with demographic factors or chronic diseases. From week 12 to week 48, the percentage of excess weight loss (%EWL) increased substantially from 26.8% to 86.1%. The results of the subgroup analysis indicated that the %EWL was considerably higher among those aged 30 or older at week 36 and singles at week 48. Conclusion: This study’s results illustrate the efficacy of MGB or OAGB procedures in significantly reducing weight in the short term. The %EWL increased with the follow-up time and was significantly associated with age and marital status.

Profile of Perinatal Infections Among Abandoned Neonates Admitted in a Tertiary Hospital in Oman

Laila Al Yazidi — 2024-11-27

Objectives: Little is known about the profile of perinatal infections among abandoned neonates, and there are no specific evidence-based guidelines on how to screen and manage these neonates. This study aimed to report the rate of perinatal infections among abandoned babies managed at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, over 15 years (2006–2021). Methods: This retrospective cohort study included all abandoned babies admitted at SQUH from January 2006 to December 2021. Demographic data, the area where they were found, anthropometric parameters, symptoms, investigations and management were included in the study. Results: Of the 20 neonates included in this study, 11 (55%) were male and 9 (45%) were female; only 1 baby looked preterm. The estimated median age at admission was 1 day, while the median length of hospitalisation was 30 days. Infectious disease screening was not optimal for syphilis. Among the babies who were tested for perinatal infections such as HIV (n = 20), syphilis (n = 7), hepatitis B (n = 20) and hepatitis C (n = 19), none tested positive and all babies received the hepatitis B vaccine. Overall, 13 out of 20 babies received antibiotics for presumed sepsis. Zidovudine was given prophylactically to 3 neonates until the HIV test result was received. A total of 2 neonates were managed for gastroenteritis, 2 for sepsis and 1 for pneumonia; no death was recorded. Conclusion: A national protocol on what should be included in the screening and how to manage these babies is urgently needed to avoid adverse outcomes in this disadvantaged population.

A Prospective Cohort Study on the Effect of Antiseizure Medications on Thyroid Function in Children Aged 6 Months to 12 Years with Epilepsy

Shivaprasad Mohankumar — 2024-11-27

Objectives: This study aimed to explore the effect of antiseizure medications (ASM) on thyroid function in children with epilepsy. Methods: A prospective study involving children between 6 months and 12 years of age with new-onset seizures who took ASM within 2 months was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, between August 2019 to March 2022. Thyroid function tests—free T3, free T4 and thyroid stimulating hormone (TSH)—were done at baseline and after completing 3 months by competitive immunoassay using direct chemiluminescent technology. The primary outcome was the proportion of patients diagnosed with thyroid dysfunction (subclinical or overt hypothyroidism). Results: In total, 126 patients were enrolled. Median (interquartile range [IQR]) age and follow-up months were 10 years (7–12) and 6 months (4–8), respectively. Most patients (n = 103, 81.7%) had generalised seizures, while the remaining (n = 23, 18.3%) had focal seizures. There was a significant difference noted in median (IQR) TSH (micro- IU/mL) at baseline (2.08 [1.41–3.31]) and follow-up (2.56 [1.65–4.14]; P ≤0.001). Thyroid dysfunction (subclinical hypothyroidism) was noted in 7 patients. Among the 7 children with subclinical hypothyroidism, 6 (4.8%) were on sodium valproate either as monotherapy (n = 3, 2.4%) or polytherapy (n = 3, 2.4%), while the remaining child was on phenytoin. No difference was noted between the monotherapy and polytherapy groups (4% versus 11.5%; P = 0.15). Conclusion: The incidence of thyroid dysfunction (subclinical hypothyroidism) was 5.6% in children taking ASM with a median follow-up period of 6 months. A longer follow-up period and larger sample size study is warranted in the future.

Dynamic Facial Reanimation for Facial Palsy

Sony P Varghese — 2024-11-27

Objectives: The goal of facial reanimation for facial palsy is to restore resting facial symmetry and dynamic facial motion that mirrors the opposite side as closely as possible. This study aimed to evaluate the restoration of oral commissure symmetry at rest and during excursion among patients with facial paralysis treated with free gracilis muscle transfer. Methods: This study included 9 patients who underwent facial reanimation with free gracilis muscle transfer at Khoula Hospital, Muscat, Oman, from 2019 to 2022. Children under 14 underwent a 2-stage surgery, while those above 14 underwent single-stage reconstruction. Results: The average age among the cohorts was 24 years. Overall, 5 cases underwent a 2-stage facial animation, 4 underwent single-stage reconstruction and 1 patient had free flap loss following the free gracilis muscle transfer. The mean time for noticing recovery was 3 months postoperatively. Early recovery was noted in patients who underwent single-stage free gracilis muscle transfer with motor innervation from the ipsilateral nerve to the masseter compared to the cross-facial nerve transfer. Good patient satisfaction (88.9%) was observed following the procedure. Conclusion: This study observed earlier recovery in patients who had undergone single-stage free gracilis muscle transfer with motor innervation from the ipsilateral nerve to the masseter compared to the cross-facial nerve transfer. The oral commissure symmetry at rest and during excursion among patients with facial paralysis treated with free gracilis muscle transfer in Oman was found to be near normal.

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot

Mohammed H Al Ghafri — 2024-11-27

Objectives: This study primarily aimed to compare the mechanical ventilation durations between pulmonary valve-sparing and transannular patch repair techniques in the surgical correction of Tetralogy of Fallot. Secondary objectives included comparison of demographic characteristics, cardiopulmonary bypass parameters, postoperative vasoactive inotrope requirements, incidence of cardiac conduction abnormalities, echocardiographic findings, intensive care unit and hospitalisation durations, reoperations rates, morbidity and mortality between the 2 approaches. Methods: This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, between January 2016 and December 2019. This study included 102 paediatric patients who underwent complete surgical correction of Tetralogy of Fallot over 3 years, either by a pulmonary valve-sparing technique (Group 1, n = 43) or by transannular patch repair (Group 2, n = 59). Data for both primary and secondary outcomes were extracted from hospital records. Results: Mechanical ventilation duration was significantly shorter in Group 1 (P = 0.039). Patients in Group 1 were generally older, with shorter cardiopulmonary bypass and aortic clamp times, lower inotrope scores, and shorter chest tube retention, intensive care unit and hospitalisation periods. Junctional ectopic tachycardia and severe pulmonary regurgitation were significantly more common in Group 2, while right ventricular outflow tract peak pressure gradients were higher in Group 1. Multivariate analysis identified patient weight as the only independent predictor of mechanical ventilation duration. Conclusion: Pulmonary valve preservation was associated with better early outcomes, including reduced mechanical ventilation duration, lower vasoactive inotrope scores, decreased postoperative arrhythmias and shorter hospital stay.

Influence of Drinking Context and Age of Onset on Alcohol Consumption Patterns and Motivations Among Uruguayan Adults

Paul Ruiz — 2024-11-27

Objectives: An early age of drinking onset is linked to a greater likelihood of alcohol-related problems. Alcohol use occurs in places featuring characteristic social groups, and different drinking contexts are associated with different levels of alcohol-related outcomes. Drinking context may affect drinking motives, expectations or alcohol-related outcomes in concert with individual-level variables. The study aimed to examine how the preferred drinking context and age of the first drink affects the occurrence and volume of alcohol use, drinking motives and alcohol-related expectations. Methods: This cross-sectional study was conducted at Faculty of Veterinary Medicine, University of the Republic, Montevideo, Uruguay, from September 2020 to January 2021. Uruguayan citizens ≥18 years old were asked about their preferred drinking context, the age of first alcohol use and alcohol consumption frequency. In addition, the Drinking Motives Questionnaire and Alcohol Outcome Expectancies Questionnaire were used. Results: A total of 752 Uruguayan citizens were included. The distribution of alcohol consumption across social contexts was not influenced by the age of first alcohol use. Those who began drinking early and endorsed solitary drinking reported higher frequency of drinking (P <0.05) and coping motives (P <0.05) than any other group. Those who drank at parties reported more conformity motives than most of the groups (P <0.01). An early age of drinking onset was associated with greater enhancement and social motives (P <0.05) and higher alcohol expectancies for stress reduction and social facilitation (P <0.005). Conclusion: Solitary drinking as a high-risk drinking context is likely to interact with the age of first alcohol use, suggesting that drinking in specific contexts is associated with specific drinking motivations and expectancies. This study represents progress towards exploring factors that influence alcohol consumption among a broader range of socio-cultural populations.

Efficacy of 6% Hydroxyethyl Starch and 2% Lidocaine in Reducing the Pain of Propofol Injection

Tapan K Sahoo — 2024-11-27

Objectives: Propofol administration is associated with pain, mediated by the activation of vascular endothelium. Hydroxyethyl starch (HES) inhibits endothelial membrane activation by various nociceptive substances. Thus, this study hypothesised that pre-administration of HES can reduce pain on propofol administration. This study aimed to compare the proportion of patients with no pain on propofol administration and to compare the severity of pain and any change in pre- and post-induction haemodynamic variables. Methods: This prospective, randomised, placebo-controlled clinical trial was conducted at Chirayu Medical College & Hospital, Bhopal, India, between August 2023 and December 2023 and included patients undergoing elective surgery under general anaesthesia. Patients were randomly assigned to 3 groups to receive either 100 mL of 6% HES followed by propofol (Group HES), 100 mL normal saline (NS) followed by propofol premixed with 2% lidocaine (Group L) or 100 mL NS followed by propofol induction (Group P). Results: A total of 339 patients were included. The proportion of patients with no pain on propofol injection was significantly higher in the HES group (n = 75) than in the lignocaine (n = 33) and placebo (n = 13) groups (P <0.0001 each). The median pain scores were 0 (interquartile range [IQR]: 0–1), 1 (IQR: 0–1) and 2 (IQR: 2–3) in the HES, lignocaine and placebo groups, respectively. The proportion of patients with moderate (n = 44) and severe (n = 48) pain scores was significantly higher in the placebo group than in the HES and lignocaine groups (P <0.0001 each). Conclusion: The proportion of patients experiencing pain on propofol injection was found to be significantly less with the pre-administration of 100 mL 6% HES compared to the pre-administration of lidocaine.

Reconsidering the Need for Intraoperative Frozen Section in Sentinel Lymph Node Biopsy for Early Breast Cancer in Bahrain

Ahmed Z Salman — 2024-11-27

Objectives: Frozen section is performed in sentinel lymph node biopsy (SLNB) for early breast cancer to prevent a second surgery, but it has certain disadvantages. Several trials have demonstrated the oncological safety of avoiding axillary dissection in patients with 1–2 positive nodes. This study aimed to assess the need for frozen section during SLNB in early breast cancer. Methods: This retrospective study included patients with early-stage clinically node-negative breast cancer who underwent SLNB with frozen section at Salmaniya Medical Complex, Manama, Bahrain, between October 2021 and September 2023. Patients who had neoadjuvant chemotherapy, cT3-4 tumours, ductal carcinoma in situ, occult breast cancer and previous breast cancer were excluded. Results: A total of 147 patients underwent breast cancer surgery with SLNB using frozen section. The sensitivity of frozen section was 84.6%, and the false-negative rate was 15.4%. Furthermore, 4.8% underwent immediate axillary dissection. In the remaining cases, there were only 1–2 positive sentinel nodes, and axillary dissection was omitted. Multifocal or multicentric disease was significantly associated with <3 positive sentinel nodes (71.4% versus 15.0%; P = 0.005). Patients with an indication for axillary dissection were also more likely to have tumours with lymphovascular invasion compared to patients with ≥3 positive sentinel nodes (85.7% versus 17.1%; P = 0.001). Conclusion: There was no indication for frozen section is needed in most patients with early breast cancer. Routine frozen section is unnecessary during SLNB, and permanent section alone may be sufficient without compromising overall standard of care.

Impact of COVID-19 on the Clinical Characteristics and Outcomes of Patients with Acute Leukaemia

Al-Yaqadhan Al-Kindi — 2024-11-27

Objectives: This study aimed to identify the impact of the COVID-19 pandemic on the frequency, clinical characteristics and outcomes of patients with acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL). Methods: This retrospective cohort study included all patients treated at Sultan Qaboos University Hospital in Muscat, Oman with AML or ALL from January 2017 to December 2021. Data were obtained from the electronic medical record, and patients diagnosed before the start of the COVID-19 pandemic were compared with those diagnosed during the pandemic using appropriate statistical tests. Results: A total of 151 patients with ALL (n = 58) and AML (n = 93) were included, of whom 78 were diagnosed before the COVID-19 pandemic and 73 during the pandemic. The rate of acute leukaemia increased during the pandemic (P = 0.039). The clinical characteristics and molecular profiles were similar between the 2 periods, except for platelet count which was higher during the pandemic compared to before the pandemic (median platelet count: 55 × 109/L versus 47 × 109/L; P = 0.02). No significant difference was found in the number of FLT3-positive AML; however, the number of NPM1-mutated AML cases was higher during the pandemic (P = 0.02). The number of Philadelphia-positive ALL cases remained consistent between the 2 time periods. The complete remission (P = 0.48) and the overall survival rates were similar (P >0.05). Conclusion: Except for an increased rate of acute leukaemia and a lower platelet count, the COVID-19 pandemic did not impact the presentation and outcomes of acute leukaemia.

Duodenal Diverticulum Causing Lemmel Syndrome

Carutia A Soares — 2024-11-27

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Unbridled Advertising of Female Cosmetic Genitoplasty Procedures in the Absence of Health Policy-making in the World

Elham Azmoude — 2024-11-27

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The Impact of the Fruit and Seed of Date on Childbirth Stages and Pregnancy Complications

Fatemeh A Rahnemaei — 2024-11-27

This review aimed to investigate the effects of date fruit products on childbirth and pregnancy-related complications. MeSH keywords were systematically searched in scientific databases, and 16 articles were reviewed. It was found that consuming 7 date fruits (average of 80 g) per day for 2–4 weeks before the estimated date of delivery leads to a better cervical dilatation at admission or improvement of Bishop score, a decrease in the need for induction or stimulation of labour and an increase in effective uterine contractions, which, in turn, decreases the duration of pregnancy and the different stages of labour. Additionally, date fruit products can improve blood pressure parameters in pregnant women at risk of preeclampsia and accelerate episiotomy healing.

Diagnostic Test Accuracy of the YEARS Algorithm for Pulmonary Embolism

Sean R Te Haara — 2024-11-27

This systematic review and meta-analysis aimed to assess the diagnostic accuracy of the YEARS algorithm in excluding pulmonary embolism, as well as to compare the utilisation of advanced imaging modalities between the YEARS approach and standard clinical practice. Eligible studies were identified from multiple databases spanning July 2017 to September 2022, following the Joanna Briggs Institute methodology for diagnostic accuracy reviews. A total of 10 studies, involving approximately 14,000 participants, were included in the analysis. The YEARS algorithm demonstrated a sensitivity of 96% (95% confidence interval [CI]: 93–98%) and a specificity of 50% (95% CI: 33–67%). Additonally, the risk ratio for advanced imaging utilisation was 0.78 (95% CI: 67–90), indicating a significant reduction in imaging use. These findings suggest that the YEARS is an effective and safe strategy for managing patients with suspected pulmonary embolism.

Palato-Antral Involvement of a Primary Extracranial Sinonasal Meningioma

Vasantha Dhara — 2024-11-27

Primary extracranial sinonasal meningiomas are one of the rarest tumours involving the head and neck region. Very few reports exist with additional involvement of the palato-antral region. A 45-year-old male presented with frequent episodes of epistaxis, complaints of nasal blockage and nasal regurgitation for 8 months in 2021 at our tertiary care government hospital in East Godavari district, India. The patient was diagnosed with a primary extracranial sinonasal meningioma with palatal involvement and surgical excision via intra-oral and endoscopic approaches were performed. Postoperative healing was uneventful with no recurrence noted over 2 years. A palatal obturator was used for rehabilitation. The diagnosis of this pathology requires additional immunohistochemistry testing for confirmation and treatment entails complete surgical excision which assures no recurrence or delayed presentation of residual disease in follow-up.

Unusual Presentation of Crohn’s Disease

Abdulrahman Aljuraisi — 2024-11-27

Crohn’s disease is an inflammatory chronic disease affecting the gastrointestinal tract, mostly the colon and terminal ileum. A 42-year-old female patient presented to a tertiary care centre in Riyadh, Saudi Arabia, in 2021 with chronic abdominal pain. The computed tomography findings showed a transverse colon mass invading the stomach. The biopsy report indicated reactive colonic mucosa with focal inflammatory exudate. She underwent a laparoscopic extended left hemicolectomy with en-bloc resection of the greater curvature of the stomach and primary anastomosis. The patient was subsequently diagnosed with Crohn’s disease based on the final pathology report. The patient had an uncomplicated postoperative course and is being follow-up.

Wet-Cupping's Impact on Pancreatitis Induced by Hypertriglyceridemia

Waleed Al Saadi — 2024-11-27

Familial hypertriglyceridemia is a genetic disorder marked by excessive production of very low-density lipoproteins, resulting in elevated serum triglyceride levels. This can lead to various medical conditions including acute pancreatitis. In cases of recurrence, it may progress to chronic pancreatitis. Cupping therapy, a traditional treatment practiced in numerous cultures worldwide, is utilised to address various medical conditions. We report a 34-year-old male patient who presented to a tertiary hospital, Muscat, Oman, in 2022. He was diagnosed with familial hypertriglyceridemia and subsequently developing chronic pancreatitis. During his last presentation with acute-on-chronic pancreatitis, his lipid profile revealed a notable reduction in serum triglycerides. This reduction coincided with the introduction of cupping therapy into his treatment regimen. Remarkably, following the initiation of cupping therapy, his hospital admissions for acute pancreatitis notably decreased. This case report highlights the potential impact of cupping therapy on familial hypertriglyceridemia, potentially mitigating the risk of acute pancreatitis.

Unilateral Graves’ Orbitopathy in a Patient with Marine-Lenhart Syndrome

Abdulla Alfutaisi — 2024-11-27

Thyroid eye disease (TED) is the most common symptoms of Graves’ disease. This condition commonly manifests bilaterally and symmetrically. The most prominent symptoms are lid retraction, exophthalmos and diplopia. Rarely, individuals with Graves’ disease show asymmetrical or unilateral eye symptoms. Marine-Lenhart syndrome is a variant of Graves’ disease with occasional hyperactive nodules. A 36-year-old male patient presented to the endocrinology outpatient department at a tertiary care hospital in Muscat, Oman, in 2022 with unilateral eye proptosis and was subsequently found to have Graves’ disease. This case presents a rare Graves’ disease variant with unilateral goiter and orbitopathy.

Ovarian Hyperstimulation and Maternal Virilisation with Successful Pregnancy Outcome

Istaqlal SH Al Ghaithi — 2024-11-27

Hyperreactio luteinalis (HL) and ovarian hyperstimulation syndrome during pregnancy are both benign conditions where the ovaries are enlarged with presence of multiple thin-walled cysts. The differential diagnosis is ovarian malignancy. Hyperandrogenism with resultant maternal virilisation could be seen in some cases of HL as well as in androgen secreting tumours. We report a 41-year-old female patient who underwent ovulation induction due to secondary infertility at a high-risk pregnancy unit in Muscat, Oman, in 2022. She had recurrent hospital admission with abdominal pain and large multicystic enlargement of both ovaries. She developed virilisation features by 35 weeks of pregnancy. Lower segment caesarean section was done at 36 weeks gestation for breech presentation with intra-uterine growth restriction. Magnetic resonance imaging confirmed the benign nature of the cysts. Ovarian cysts and hyperandrogenism gradually resolved 3-months post-delivery. Awareness, judicious imaging and close monitoring in such cases can result in live birth and avoid oophorectomies.

Inclusion Body Myositis

Marwa Al Sharji — 2024-11-27

Inclusion body myositis (IBM) is a rare progressive myopathy affecting individuals older than 50 years. It is associated with significant morbidity by restricting the patient's mobility and it has a relatively low mortality risk with respiratory muscles involvement. Muscle biopsy is the gold standard method for diagnosis. We report a 72-year-old female patient who was admitted to a tertiary care hospital in Muscat, Oman, in 2023 with progressive weakness of lower limbs. Various diagnostic tests were performed and the patient was subsequently diagnosed with IBM. The patient was treated with methylprednisolone, immunoglobulins, rituximab and prednisolone; this resulted in moderate clinical improvement. This case highlights the intricate nature of the diagnostic journey, as diagnosing IBM remains a challenge in clinical practice, requiring a high degree of suspicion and precise application of available diagnostic tools with the guidance of a collaborative multidisciplinary approach in investigating and providing patient care. This case report contributes valuable insights to the understanding of this complex myopathy, facilitating more accurate diagnosis and enhancing patient care strategies.