Sultan Qaboos University Medical Journal

Development of Organoids from Malignant Ascites for Cancer Research in Oman

Fazal Khan — 2024-08-29

NONE

18th Asian Federation of Sports Medicine Congress cum 8th ISN international Sports Medicine & Sports Science Conference

Asian Federation of Sports Medicine — 2024-08-29

NONE

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

Hunain Raza — 2024-08-29

NONE

Septum Pellucidum Cavernous Malformation

Asma AlHatmi — 2024-08-29

NONE

Blastic Plasmacytoid Dendritic Cell Neoplasm

Dmitry V Kravchenko — 2024-08-29

NONE

Association between Internet Addiction and Dietary Habits among Omani Junior College Students

Mickael A Joseph — 2024-08-29

Objectives: To investigate the association between internet addiction and dietary habits among Omani junior college students. Methods: In this cross-sectional study at Sultan Qaboos University, 377 junior college students were surveyed in November 2020 using demographic data, the Compulsive Internet Use Scale, and a dietary habits questionnaire. Chi-square cross-tabulation analyses explored the relationship between internet addiction and dietary habits. Results: Overall, 59.9% of junior college students were identified as having an internet addiction. Within this group, 62.8% reported reduced meal sizes and 54.4% reported a decrease in appetite. There was a statistically significant difference in both meal size (X²=30.528, p<0.001) and appetite changes (X²=28.731, p<0.001) among student with different levels of internet addiction. These results suggest a possible link between internet addiction and altered dietary habits among this population. Conclusion: This study highlights the need for strategies that encourage healthy living behaviors and raise awareness about the adverse effects of internet addiction.

Keywords: Internet addiction disorder; diet; Students; appetite; Oman

Case Series of Midazolam-Induced Seizures-Like Activity in Five Neonates

Heba Shaker — 2024-08-29

An intravenous administration of midazolam may result in seizure-like activity or movement. This report describes five neonates who developed seizure-like movements after intravenous midazolam injection. The patients presented between 2019 and 2022. The abnormal movements occurred shortly after intravenous bolus administration of midazolam. None of our patients experienced seizure-like movements after receiving midazolam infusions. The seizure-like movements were aborted either spontaneously or by antiseizure medications. Also, we did not observe any seizure recurrence in any of the infants during the later stages of their treatment. Since this adverse effect might be related to the speed of the bolus administration, intravenous midazolam must be given as a slow bolus over 2-3 minutes followed by a slow flush of normal saline. To prevent midazolam's potential adverse effect on newborns, neonatal caregivers must be aware of it.

Keywords: Midazolam; Injection, intravenous, Seizures; Infant, Newborn; Hypnotics and Sedatives.

Health-Related Quality of Life of Omani Adult Patients with Sickle Cell Disease at the Sultan Qaboos University Hospital

Sara Al-Hinai — 2024-08-29

Objectives: This study aimed to determine the health-related quality of life (HRQoL) of adult Omani patients with sickle cell disease (SCD). The quality of life of these patients in Oman is unknown. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from June to October 2022 and included patients with SCD. A validated Arabic version of the 36-Item Short-Form Health Survey (SF-36) was used to assess HRQoL in 8 domains. Results: A total of 235 patients with SCD were included in this study, the majority of whom were female (74.9%) and between 18 and 35 years of age (64.6%). The lowest HRQoL was reported for the domain of role limitations due to physical health (median score = 25.0, interquartile range [IQR] = 35.0), while the highest was seen for role limitations due to emotional problems (median score = 66.7, IQR = 100.0). Frequent SCD-related emergency department visits/hospital admissions and the adverse effect of SCD on patients’ social lives had a significant negative impact on SF-36 scores for all 8 HRQoL domains (P ≤0.05). Additionally, SCD’s impact on academic performance and a history of having been bullied due to SCD had a significant negative impact on SF-36 scores for 7 domains (P ≤0.05). Conclusion: Omani adult patients with SCD reported relatively poor HRQoL in several domains, with various factors found to be significantly associated with this. Healthcare providers and policy makers should consider offering additional clinical, educational and financial support to these patients to enhance their HRQoL.

Complications of Open Reduction and Internal Fixation of Mandibular Condyle Fractures in Oman

Khamis M Al Hasani — 2024-08-29

Objectives: This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. Methods: This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. Results: A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients’ clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications.

Keywords: Mandibular Fracture; Mandibular Condyle; Open Fracture Reduction; Complications; Facial Nerve Injuries; Oman.

Sharing Unpleasant Health Information with Patients

Rahma Al Kindi — 2024-08-29

Objectives: This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments. Results: A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information (‘bad news’), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients’ family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6–85.4%, 12.4–34.8% and 1.1–11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts. Conclusion: Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.

Assessment of Albumin Usage Patterns and Appropriateness in a Comprehensive Cancer Centre

Asma'a A Al-Kharabsheh — 2024-08-29

Objectives: Albumin is commonly used for various indications; however, there is conflicting data regarding its appropriate use in different clinical cases. This study aimed to determine the pattern and appropriateness of albumin use among cancer patients at the King Hussein Cancer Center in Jordan. Methods: A retrospective analysis was conducted on adult cancer patients who were prescribed albumin between January 2019 and July 2020 in both outpatient and inpatient settings. Data collected included demographics, prescribing services, indications and dosing regimens. A literature review was performed using PubMed to assess the appropriateness of albumin indications and dosing regimens against current guidelines, drug information resources and the package insert. Results: Albumin was prescribed to 1,361 patients during the study period. Each patient received an average of 74.4 ± 89 g of albumin for an average of 2.6 ± 1.8 days. Albumin use was deemed appropriate in 69% of the patients. The critical care service accounted for the highest albumin consumption, with 37% of prescriptions for septic shock. Inappropriate use of albumin was most prevalent in the medical solid tumour services (40.8% of prescriptions), primarily for edema (28%). Conclusion: To the best of the author’s knowledge, this study is the first to evaluate albumin use in a large cohort of oncology patients. Approximately one-third of the albumin prescriptions were considered inappropriate. Continuous education on appropriate usage and regular evaluations of guideline adherence are essential to ensure proper utilisation of albumin in cancer care.

Evaluation of Clinical Efficacy of Biodegradable Chip Containing Salvadora persica Extract in Chitosan Base as an Adjunct to Scaling and Root Planning in the Management of Periodontitis

Fouad H Al-Bayaty — 2024-08-29

Objective: The objectives of this study were to develop two biodegradable periodontal chips containing Salvadora persica or Benzyl isothiocyanate (BITC) extract and evaluate its clinical effectiveness in managing periodontitis. Methods: Chips were formulated from Salvadora persica, Benzyl isothiocyanate (BITC) and chitosan; twelve patients with periodontal pockets measuring ≥5 mm participated in this study. Overall, 240 periodontal pockets were evaluated. All patients were treated with full mouth scaling and root planning (SRP) at baseline. Periodontal pockets were divided into four groups. One of which is the control group, while group two received plain chitosan chip. Group three received chips containing Salvadora persica extract, and group four received chips containing BITC. Plaque index (PI), bleeding on probing (BOP), periodontal probing pocket (PPD) depth, and clinical attachment levels (CAL) using acrylic stents were recorded at days 0 and 60 only. Results: Data were statistically analysed; Chi-square t-test and an ANOVA were used. Results showed significant improvement in plaque index, bleeding on probing, and reduction in periodontal pocket depth in all four groups (p<0.05). The gain in clinical attachment level was significantly higher (p<0.005) among the group receiving Salvadora persica chips compared to the control and other chip-treated groups. Conclusion: Periodontal chips containing S. persica can be used as adjuncts to treat patients with periodontitis.

Keywords: Chitosan; Periodontal chip; Miswak extract; Benzyl isothiocyanate; Periodontitis.

Aetiology and Outcome of Childhood Convulsive Status Epilepticus

Areeba Wasim — 2024-08-29

Objective: This study aimed to evaluate the etiology, management, and outcomes of convulsive status epilepticus (CSE) in children highlighting the factors that affect patient outcome. Methods: In a retrospective study spanning 2020 to 2023, 93 children with convulsive status epilepticus (CSE) treated at Sultan Qaboos University Hospital's emergency department (ED), High Dependency (HD), and intensive care unit (ICU) were analyzed. The Modified Rankin Scale at discharge determined CSE outcome. Results: Study of 93 children (mean age 4.84 years ± 3.64), predominantly Omani (92.47%). Acute 14 symptomatic (37.7%) and febrile tatus (31.2%) were primary causes. Diazepam used in 67.44% 15 cases as first-line treatment, with median seizure duration of 45 minutes. Successful control achieved in 16 76.34% within 60 minutes. Return to baseline in 55.9%, 5.38% mortality, and 38.7% disability. Etiology and 17 duration significantly impacted outcomes (p < 0.05). Conclusion: Acute symptomatic is the most common etiology of CSE, and a longer duration is associated with higher mortality and neurological disability. Therefore, managing CSE promptly and appropriately is crucial. Furthermore, identifying and treating the underlying cause is essential to reduce the duration of CSE and improve the outcome.

Keywords: Etiology, Outcome, Convulsive Status Epilepticus, Modified Rankin Scale

Prevalence, Clinico-Laboratory Features and Outcomes of Paediatric Scrub Typhus Cases in a Tertiary Care Centre in Eastern India

Raghunath Murmu — 2024-08-29

Objectives: Scrub typhus is the most common rickettsial disease in India, caused by Orientia tsutsugamushi and transmitted by chigger mites. Previously prevalent in South India, a resurgence of scrub typhus cases has recently affected Eastern India. This study aimed to estimate the prevalence and describe the clinico-laboratory profile of scrub typhus in paediatric patients (1–12 years old) living in Eastern India. Methods: This prospective observational study was conducted from January to December 2019 at the Dr B C Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India. All acute undifferentiated cases of febrile illness, in patients aged between 1–12 years, were tested using scrub typhus serology by ELISA. Demographic details, clinical features, laboratory findings, complications and treatment outcomes of these scrub typhus patients were extracted and analysed. Results: Out of 1,473 patients with acute febrile illness, 67 (4.5%) children were diagnosed with scrub typhus. The mean age of the selected patients was 5.22 ± 3.05 years, and the majority (64.2%) had been running a fever since the preceding 7–14 days. Gastrointestinal symptoms such as vomiting (43.3%) and abdominal pain (32.8%) were most frequently observed. Major clinical signs of scrub typhus were hepatomegaly (41.8%) and splenomegaly (31.3%). Complications were observed in 74.6% of patients, with thrombocytopenia (40.3%) and meningoencephalitis (29.9%) occurring more frequently. The case fatality rate of the study sample was 1.5%. Conclusion: Classical eschar was absent in three-fourth of the studied patients. Hence, this study advocates laboratory scrub typhus tests for all suspected cases in the endemic region (Eastern India). Prompt treatment with doxycycline and/or azithromycin could prevent complications such as thrombocytopenia/meningoencephalitis and reduce mortality.

Surgical Management of Renal Cell Carcinoma

Noor N Junejo — 2024-08-29

Objectives: Renal Cell Carcinoma (RCC) is one of the foremost urological malignancies. In Oman, an age-standardized incidence rate of 2.5 per 100,000 per year is reported. There is a trend towards early detection and use of minimally invasive technology for the treatment of RCC. Aim of our study was to report the changing trend in clinical presentation and RCC management, including to compare the outcomes of laparoscopic versus open nephrectomy in Oman. Methods: After ethical committee’s approval, the bio-data for adult patients and peri-operative details were collected, who were diagnosed with RCC between 2011 and 2022. We analyze the variables, both continuous and categorical by Chi-square analysis. The p-value <0.05 was set as a level of significance. Results: Fifty-six patients underwent surgical treatment of RCC. Among them, 34 patients underwent laparoscopic nephrectomy (LN) and 22 open nephrectomy (ON). The mean age in the LN group was 53.82 years ± 13.44, and 56.2 years ± 15 (p-value 0.535) in ON group. Forty-seven patients were of Omani descent and 9 patients were expatiates. The mean tumor size was 6.25 ± 3.16 and 9.2 ± 5.20 cm for the LN and ON groups, respectively. More than 55% cases were incidentally diagnosed. Over the years there has been a trend towards LN. Conclusion: In our study, we found a trend towards early diagnosis with majority of cancers discovered incidentally. We also recognized that laparoscopic approach is more commonly employed in the surgical management with acceptable morbidity. These trends are in congruence with the global literature.

Keywords: nephrectomy, laparoscopic, open, renal cell carcinoma

Coexistence of Pulmonary Thromboembolism, Pulmonary Tuberculosis and Granulomatosis with Polyangiitis

Sai T Pavirala — 2024-08-29

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease with multi‐system involvement. It involves the upper respiratory tract, lungs and kidneys. A 36-year-old female patient presented with complaints of low-grade fever, dry cough and loss of appetite initially followed by dyspnea, purpuric skin lesions, right lower limb swelling with pain and redness. Her chest radiograph revealed right upper lobe cavitary lesion with consolidation in right lower lobe. Mycobacterium tuberculosis was detected in sputum and Broncho alveolar lavage (BAL) via Cartridge based nucleic acid amplification assay (CB-NAAT). Later, Computed Tomography Pulmonary Angiography (CTPA) revealed bilateral pulmonary artery thromboembolism. Furthermore, her C-ANCA was positive, serum creatinine was rising, urine microscopy had red cell casts and lower limb venous doppler revealed DVT. Histopathological examination of the skin lesion revealed vasculitis. Based on the above findings, diagnosis of GPA was comfortably made. Patient improved with pulse steroids, cyclophosphamide, anticoagulants and anti-tuberculous therapy (ATT).

Keywords: Granulomatosis with polyangiitis (GPA), Pulmonary Tuberculosis, Pulmonary thrombo-embolism, deep venous thrombosis, vasculitis, c-ANCA.

Erdheim-Chester Disease Presenting as Bilateral Facial Masses

Asim Qureshi — 2024-08-29

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis with unknown etiology. It is recently recognized to be neoplastic with genetic mutations affecting the mitogen-activating protein kinase (MAPK) pathway. We here present a case of a 49-year-old female who initially presented in 2012 with bilateral facial masses to a tertiary care center. These were removed but later recurred over a period of ten years. She then presented with xanthelasmas, bone lesions, secondary infertility due to hypothalamic hypogonadism, diabetes insipidus, and Hashimoto’s hypothyroidism. The facial masses were biopsied, and they showed classic morphological features in the form of diffuse infiltration by foamy histiocytes, with scattered Touton type of giant cells, patchy lymphocytic infiltrates, and dense fibrosis. The presented ECD case is particularly interesting due to the recurrent bilateral facial masses. To the best of our knowledge, this is the first documented case in Oman. The patient is stable and is being followed up in the clinic.

Keywords: Erdheim-Chester disease, Langerhans cell histiocytosis.

Successful Treatment of Angiolymphoid Hyperplasia with Eosinophilia Associated with Scalp Demodicosis Using Cryotherapy and Topical Metronidazole

Salma T Al Kharusi — 2024-08-29

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign, vasoproliferative tumour. We report a 25-year-old female patient who reported in 2021 to the dermatology clinic, with multiple, grouped, erythematous dome-shaped papules and nodules of 6 months duration on the left temporo-occipital region. Biopsy findings were consistent with a diagnosis of ALHE with evidence of Demodex mite infestation in the sebaceous ducts. The patient demonstrated significant improvement following 7 weeks of treatment with multiple cryotherapy sessions and topical application of metronidazole gel. This case suggests that scalp demodicosis may represent a novel trigger for the development of ALHE.

Keywords: Angiolymphoid Hyperplasia with Eosinophilia; Mite; Infestation; Scalp; Kimura disease; Cryosurgery; Metronidazole; Case Report.

Adrenocorticotropic Hormone-Secreting Pituitary Microadenoma Presenting with Acute Psychosis, Delirium and Paroxysmal Sympathetic Hyperactivity

Neeraja Rajeev — 2024-08-29

Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are known to be associated with behavioural changes but acute presentation including psychosis and delirium are less common. We report the case of a 42-year-old female patient with a known medical history of hypertension and diabetes mellitus, presenting with acute onset behavioural changes suggestive of psychosis to a tertiary care centre in Muscat, Oman in 2022. Further evaluation revealed an ACTH dependent Cushing’s disease with a pituitary microadenoma. The patient was admitted for endoscopic resection of the adenoma. During the peri-operative period, she experienced worsening of psychosis in addition to delirium. She also developed episodes of unresponsiveness, posturing, severe diaphoresis and dyspnoea accompanied by tachycardia and hypertension which were managed with midazolam and levetiracetam. A seizure work-up and computed tomography brain scan were unremarkable. At follow-up, she showed full resolution of symptoms with good blood pressure and glycaemic control.

Breastfeeding Needs in Adolescent Mothers

Atefeh Yas — 2024-08-29

Adolescent mothers face numerous challenges while breastfeeding. This study aimed to assess the breastfeeding needs of adolescent mothers. For this systematic review, Web of Science, PubMed, Scopus, Cochrane Library, SID and Magiran databases were searched. The initial search yielded 2,290 studies, of which 41 were included in this review. Adolescent mothers’ breastfeeding requirements were grouped into 8 categories: (1) social support from healthcare providers, partners and families; (2) school support for breastfeeding mothers; (3) breastfeeding counselling based on cultural sensitivities; (4) educational assistance from health providers for adolescent mothers' families; (5) changing harmful cultural values and judgments about adolescent mothers' breastfeeding; (6) additional home or outpatient visits in the days following hospital discharge; (7) peer support and counselling; and (8) economic needs. To promote breastfeeding, policymakers and healthcare providers should devise specifically tailored programmes and interventions to cater to the specific requirements of adolescent mothers.

Impact of Dapagliflozin Adjunctive Therapy on Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes and CKD Stage 2–5

Kanimozhi M — 2024-08-29

This meta-analysis was conducted by searching PubMed, Scopus, Cochrane, Ovid till November 2022 for randomized controlled trials (RCTs) that utilized dapagliflozin 10 mg as adjunctive therapy in patients with T2DM and CKD stage 2-5 and reported its renal efficacy in terms of mean change in estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (UACR) from baseline. From 1682 identified records, nine studies representing 13,057 patients were selected for this study. Pooled estimate of five studies showed that dapagliflozin did not affect eGFR but caused significantly less chronic eGFR decline than placebo in two studies [Mean difference (MD) +2.74 (95% CI: 1.55, 3.92; p < 0.00001)]. Pooled estimate of four studies showed that dapagliflozin significantly reduced UACR[-23.99 % MD (95% CI - 34.82, -13.15, p-value < 0.0001; = 0%)]. This confirms that long-term dapagliflozin use significantly attenuates eGFR decline and reduces albuminuria in T2DM and CKD stages 2-5 patients.

Keywords: Chronic kidney disease, Dapagliflozin, Estimated GFR, eGFR, SGLT2 inhibitors, Type 2 diabetes mellitus, Urine albumin to creatinine ratio, UACR.