Sultan Qaboos University Medical Journal, an internationally peer-reviewed multidisciplinary journal, is published quarterly in print and online with free access to full text articles. Its aims are: to be an internationally recognised regional medium of biomedical communication; to encourage medical research and publication in Oman, the Gulf and further afield, and to create awareness of new developments among health professionals in Oman and beyond. SQUMJ is listed in PubMed and indexed in SCOPUS, the Directory of Open Access Journals, the Al Manhal database of Arab journals and the WHO Index Medicus for the Eastern Mediterranean Region. SQUMJ DOES NOT CHARGE AUTHORS FOR SUBMISSION OR PUBLICATION.
SQUMJ is an Open Access Journal. This means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author. This is in accordance with the Budapest Open Access Initiative (BOAI) definition of open access.
Care of Patients with Diabetic Foot Disease in Oman
(Review) Ibrahim S. Al-Busaidi, Nadia N. Abdulhadi and Kirsten J. Coppell
ABSTRACT: Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman.
Currently Available Tools and Teaching Strategies for the Interprofessional Education of Students in Health Professions
Literature review(Review) Nelofar S. Khan, Syed I. Shahnaz and Kadayam G. Gomathi
ABSTRACT: Interprofessional education (IPE) is designed to provide students from different health sectors with opportunities to work together to enhance future collaboration. The implementation of IPE activities is a current trend in various countries. This review exclusively targets IPE issues involving undergraduate health profession students and highlights various approaches in different regions. A total of 28 articles published in peer-reviewed journals between January 2012 and July 2015 were assessed to determine recent trends in IPE implementation. Nine main strategies were identified: simulation-based education programmes; rotations in rural and community settings; interprofessional training wards; patient-centred case studies; theme-centred workshops; student seminars; student-delivered lectures; health promotion activities; and interactive lectures in a common setting. Many of these institutions had not restricted themselves to a single strategy and supplemented these activities with additional teaching or learning methods. Recommendations gathered from these diverse approaches may assist the development of sustainable strategies for implementing IPE in undergraduate medical curricula.
Keywords: Interprofessional Relations; Interdisciplinary Communication; Undergraduate Medical Education; Health Professions.
Health Education in Saudi Arabia
Historical overview(Review) Anwar Al-Hashem
ABSTRACT: This article provides a historical overview of the evolution of health education in Saudi Arabia. It outlines milestones in the development of the health education profession and traces the roles of various health sectors and their achievements in the health education field. Additionally, this review seeks to describe the status of health education professionals in Saudi Arabia.
Keywords: History; Health Educators; Healthcare Sector; Health Promotion; Public Health; Government Agencies; Saudi Arabia.
First Implementation of Transfusion Consent Policy in Oman
Audit of compliance from a tertiary care university hospital(Original Study) Arwa Z. Al-Riyami, Naif Al-Ghafri, Fehmida Zia, Mohammed Al-Huneini, Abdul-Hakeem Al-Rawas, Salam Al-Kindi, Sachin Jose, Murtadha Al-Khabori, Hilal Al-Sabti and Shahina Daar
ABSTRACT:Objectives: Transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH. Methods: The medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information. Results: In total, the records of 446 transfused patients (299 adult and 147 paediatric patients) were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists (95% and 97%, respectively). Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details (20–25%). Conclusion: In most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended.
The Burden of Surgical Cancellations and No-Shows
Quality management study from a large regional hospital in Oman(Original Study) Sivasubramanian T. Appavu, Salim M. Al-Shekaili, Ahmed M. Al-Sharif and Mohamed M. Elawdy
ABSTRACT:Objectives: The operating theatre (OT) is a vital facility that utilises a considerable portion of the hospital’s budget; thus proper OT utilisation is essential. Surgical cancellation is a leading cause of OT underutilisation. This study aimed to report the rate and reasons for surgical cancellations and no-shows in a large regional hospital in Oman. Methods: This study took place as part of a retrospective quality management project at the Ibri Regional Hospital, Ibri, Oman. All elective surgical procedures scheduled between January and December 2014 were included. Cancelled procedures were reviewed to determine the reasons for cancellation. Results: A total of 4,814 elective procedures were scheduled during the study period; of these, 1,235 (26%) were cancelled. Patient no-shows were the most prevalent reason for surgical cancellation (63%), followed by surgical reasons (17%); in contrast, OT-associated reasons were responsible for only 2% of cancellations. According to speciality, general surgery had the highest percentage of total cancellations (65%), while ear, nose and throat had the highest rate of surgical cancellations among their scheduled cases (42%). Conclusion: Ibri Regional Hospital had a higher surgical cancellation rate due to no-shows than those reported in the literature. Regular audits, quality management projects and the appointment of a dedicated procedure booking coordinator may enhance proper utilisation of the OT, potentially saving funds, conserving resources and alleviating the burden of cancellations.
Chemical Reaction between Boric Acid and Phosphine Indicates Boric Acid as an Antidote for Aluminium Phosphide Poisoning
(Original Study) Motahareh Soltani, Seyed F. Shetab-Boushehri and Seyed V. Shetab-Boushehri
ABSTRACT:Objectives: Aluminium phosphide (AlP) is a fumigant pesticide which protects stored grains from insects and rodents. When it comes into contact with moisture, AlP releases phosphine (PH3), a highly toxic gas. No efficient antidote has been found for AlP poisoning so far and most people who are poisoned do not survive. Boric acid is a Lewis acid with an empty p orbital which accepts electrons. This study aimed to investigate the neutralisation of PH3 gas with boric acid. Methods: This study was carried out at the Baharlou Hospital, Tehran University of Medical Sciences, Tehran, Iran, between December 2013 and February 2014. The volume of released gas, rate of gas evolution and changes in pH were measured during reactions of AlP tablets with water, acidified water, saturated boric acid solution, acidified saturated boric acid solution, activated charcoal and acidified activated charcoal. Infrared spectroscopy was used to study the resulting probable adduct between PH3 and boric acid. Results: Activated charcoal significantly reduced the volume of released gas (P <0.01). Although boric acid did not significantly reduce the volume of released gas, it significantly reduced the rate of gas evolution (P <0.01). A gaseous adduct was formed in the reaction between pure AlP and boric acid. Conclusion: These findings indicate that boric acid may be an efficient and non-toxic antidote for PH3 poisoning.
Impact of Body Mass Index on Vascular Calcification and Pericardial Fat Volume Among Patients with Suspected Coronary Artery Disease
(Original Study) Hussein Nafakhi, Abdulameer Al-Mosawi, Hayder Elwali, Hasan Al-Nafakh, Raad Tawfeq and Ahmed Nafakhi
ABSTRACT:Objectives: This study aimed to assess the effect of body mass index (BMI) on the relationship between pericardial fat volume (PFV), aortic root calcification (ARC) and coronary artery calcification (CAC) among patients with suspected coronary artery disease (CAD). Methods: This cross-sectional study took place between January and December 2014 at the Kufa University Teaching Hospital, Najaf, Iraq. A total of 130 consecutive patients with an intermediate pretest probability of ischaemic heart disease who underwent 64-slice multidetector computed tomography (CT) angiography during the study period were recruited. Of these, 111 were included in the study and divided into groups according to BMI. Imaging markers were measured on CT angiography. Results: A total of 28 patients were obese, while 42 and 41 were overweight and normal weight, respectively. The median PFV, CAC and ARC was 109 cm3 (interquartile range [IQR]: 52–176 cm3), 0 Agatston score (IQR: 0–52 Agatston score) and 0 Agatston score (IQR: 0–15 Agatston score), respectively, in the normal weight group in comparison to 79 cm3 (IQR: 43–138 cm3), 0 Agatston score (IQR: 0–54 Agatston score) and 0 Agatston score (IQR: 0–0 Agatston score), respectively, in the obese group. Significant correlations were observed between PFV and CAC (r2 = 0.22; P = 0.002) and ARC and CAC (r2 = 0.37; P <0.001) in the normal weight group. However, no significant correlations were observed for obese and overweight patients. Conclusion: These findings indicate that BMI may not be an accurate tool for measuring adiposity or assessing subclinical coronary atherosclerosis in patients with suspected CAD. Keywords: Body Mass Index; Obesity; Pericardium; Coronary Vessels; Vascular Calcification; Atherosclerosis; Coronary Angiography.
Comparison of Salivary pH, Buffering Capacity and Alkaline Phosphatase in Smokers and Healthy Non-Smokers
Retrospective cohort study(Original Study) Fatemeh Ahmadi-Motamayel, Parisa Falsafi, Mohammad T. Goodarzi and Jalal Poorolajal
ABSTRACT:Objectives: Saliva contains alkaline phosphatase (ALP)—a key intracellular enzyme related to destructive processes and cellular damage—and has buffering capacity (BC) against acids due to the presence of bicarbonate and phosphate ions. Smoking may have deleterious effects on the oral environment due to pH changes which can affect ALP activity. This study aimed to evaluate the salivary pH, BC and ALP activity of male smokers and healthy non-smokers. Methods: This retrospective cohort study took place between August 2012 and December 2013. A total of 251 healthy male non-smokers and 259 male smokers from Hamadan, Iran, were selected. Unstimulated whole saliva was collected from each participant and pH and BC were determined using a pH meter. Salivary enzymes were measured by spectrophotometric assay. Results: Mean salivary pH (7.42 ± 0.48 and 7.52 ± 0.43, respectively; P = 0.018) and BC (3.41 ± 0.54 and 4.17 ± 0.71; P = 0.001) was significantly lower in smokers compared to non-smokers. Mean ALP levels were 49.58 ± 23.33 IU/L among smokers and 55.11 ± 27.85 IU/L among non-smokers (P = 0.015). Conclusion: Significantly lower pH, BC and ALP levels were observed among smokers in comparison to a healthy control group. These salivary alterations could potentially be utilised as biochemical markers for the evaluation of oral tissue function and side-effects among smokers. Further longitudinal studies are recommended to evaluate the effects of smoking on salivary components.
Psychometric Examination of an Arabic Version of the State-Trait Anger Expression Inventory
(Original Study) Motohiro Nakajima, Ines Bouanene, Sana El-Mhamdi, Mohamed Soltani, Stephan Bongard and Mustafa al’Absi
ABSTRACT:Objectives: This study aimed to examine the psychometric properties of an Arabic version of the trait anger and anger expression scales of the State-Trait Anger Expression Inventory (STAXI). Methods: This study took place between April 2005 and August 2014. Adults in Yemen (n = 334) and Tunisia (n = 200) were recruited from university campuses and a smoking cessation clinic, respectively. The STAXI was translated into Arabic using backtranslation methods. An explanatory principal component analysis was conducted to explore the factor structure of the anger expression scale, utilising parallel analyses to determine the number of retained factors. Results: Good internal consistency of the trait anger scale was observed among the Yemeni (Cronbach’s alpha = 0.76) and Tunisian (Cronbach’s alpha = 0.86) samples. The parallel analysis suggested a three-factor solution for the anger expression scale (anger in, anger out and anger control), in accordance with the original STAXI. The internal consistency of anger in, anger out and anger control factors ranged between 0.51–0.79 in the Yemeni sample and 0.66–0.81 in the Tunisian sample. Overall, items loaded on the anger control factor included all items proposed by the original authors and this factor had higher reliability than the other two factors in both samples. Conclusion: The results of the current study provide initial support for the use of the trait anger and anger expression scales of the STAXI in Arabic-speaking countries. Keywords: Psychometrics; Anger; Reliability and Validity; Translations; Yemen; Tunisia.
Prevalence and Levels of Depression Among Parents of Children with Cancer in Basrah, Iraq
(Original Study) Shukrya K. Al-Maliki, Jasim Al-Asadi, Akeel Al-Waely and Sabah Agha
ABSTRACT:Objectives: Cancer in a family member can be a major source of psychological disorders, especially for the parents of children diagnosed with cancer. This study aimed to determine the prevalence and levels of depression among parents of children with cancer in Basrah, Iraq. Methods: This cross-sectional study was conducted between November 2014 and April 2015 at the Specialist Paediatric Hospital in Basrah City, Iraq. One parent each of 384 children with cancer admitted to the hospital for treatment or follow-up during the study period were invited to participate in the study. Age, gender, years of education, occupation, monthly income, place of residence and the overall number of children in a family were recorded. The Center for Epidemiologic Studies Depression Scale was used to identify depression and assess levels of depression. Results: A total of 336 parents participated in the study (response rate: 87.5%). Of these, 70.5% were depressed, 54.1% of which had major depression. Depression was significantly more common (77.2% versus 57.1%) and more severe (60.7% versus 41.1%) among mothers compared to fathers (P = 0.001). Parents with fewer years of education were more likely to be depressed; this association was significant for mothers but not fathers (P = 0.001 and 0.814, respectively). Depression was significantly inversely associated with monthly income (P = 0.001). Conclusion: The prevalence of depression among the parents of children with cancer was high. Depression was significantly more severe among mothers compared to fathers and among mothers who were less educated. Income also had a significant association with levels of depression among parents. Keywords: Cancer; Children; Parents; Depression; Prevalence; Iraq.
Public Knowledge of Oral Cancer and Modelling of Demographic Background Factors Affecting this Knowledge in Khartoum State, Sudan
(Original Study) Hamdi A. Al-Hakimi, Abdulqaher E. Othman, Omima G. Mohamed, Abdulaal M. Saied and Waled A. Ahmed
ABSTRACT:Objectives: Knowledge of oral cancer affects early detection and diagnosis of this disease. This study aimed to assess the current level of public knowledge of oral cancer in Khartoum State, Sudan, and examine how demographic background factors affect this knowledge. Methods: This cross-sectional study involved 501 participants recruited by systematic random sampling from the outpatient records of three major hospitals in Khartoum State between November 2012 and February 2013. A pretested structured questionnaire was designed to measure knowledge levels. A logistic regression model was utilised with demographic background variables as independent variables and knowledge of oral cancer as the dependent variable. A path analysis was conducted to build a structural model. Results: Of the 501 participants, 42.5% had no knowledge of oral cancer, while 5.4%, 39.9% and 12.2% had low, moderate and high knowledge levels, respectively. Logistic regression modelling showed that age, place of residence and education levels were significantly associated with knowledge levels (P = 0.009, 0.017 and <0.001, respectively). According to the structural model, age and place of residence had a prominent direct effect on knowledge, while age and residence also had a prominent indirect effect mediated through education levels. Conclusion: Education levels had the most prominent positive effect on knowledge of oral cancer among outpatients at major hospitals in Khartoum State. Moreover, education levels were found to mediate the effect of other background variables. Keywords: Oral Cancer; Knowledge; Logistic Regression; Statistical Model; Patient-Specific Modeling; Sudan.
Occupational Stress and Coping Behaviours Among Dentists in Kerman, Iran
(Original Study) Shiva Pouradeli, Arash Shahravan, Ali Eskandarizdeh, Forozan Rafie and Maryam A. Hashemipour
ABSTRACT:Objectives: Recognising causes of stress can help prevent associated adverse effects. This study aimed to investigate causes of occupational stress and coping behaviours among general dentists in Iran. Methods: This cross-sectional study was carried out from April to December 2014. A modified version of the Occupational Stress Indicator questionnaire was used to assess causes of stress and coping behaviours among 142 general dentists in Kerman, Iran. Results: A total of 93 dentists participated in the study (response rate: 65.5%). Of these, 58.9% reported often being stressed. The mean general stress score was 63.33 ± 19.99. The most common causes of stress were maintaining high levels of concentration while working (65.6%), time pressures (64.5%), concern over their ability to deliver dental services in future (60.2%) and rising costs (59.1%). No significant relationships between stress and gender, age, workplace or working hours per week were noted (P >0.05). However, there was a significant correlation between general stress scores and years of job experience (P = 0.05) and number of patients treated daily (P = 0.03). The most common methods for coping with stress were resting (71.0%), sports (45.2%) and entertainment (43.0%). Most dentists felt that stress management courses could help to reduce stress (89.7%). Conclusion: General dentists in Kerman were subject to many sources of stress in their workplaces, with significant relationships between stress scores and years of work experience and number of patients treated daily. Dentists should be encouraged to participate in stress management courses to help alleviate stress. Keywords: Psychological Stress; Dentists; Coping Behavior; Iran.
Combination of Continuous Dexmedetomidine Infusion with Titrated Ultra-Low-Dose Propofol-Fentanyl for an Awake Craniotomy
Case report(Case Report) Samaresh Das, Ali Al-Mashani, Neelam Suri, Neeraj Salhotra and Nilay Chatterjee
ABSTRACT: An awake craniotomy is a continuously evolving technique used for the resection of brain tumours from the eloquent cortex. We report a 29-year-old male patient who presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions due to a space-occupying brain lesion in close proximity with the left motor cortex. An awake craniotomy was conducted using a scalp block, continuous dexmedetomidine infusion and a titrated ultra-low-dose of propofol-fentanyl. The patient remained comfortable throughout the procedure and the intraoperative neuropsychological tests, brain mapping and tumour resection were successful. This case report suggests that dexmedetomidine in combination with titrated ultra-low-dose propofolfentanyl are effective options during an awake craniotomy, ensuring optimum sedation, minimal disinhibition and a rapid recovery. To the best of the authors’ knowledge, this is the first awake craniotomy conducted successfully in Oman. Keywords: Anesthesia; Craniotomy; Dexmedetomidine; Propofol; Fentanyl; Case Report; Oman.
Treatment of Aluminium Phosphide Poisoning with a Combination of Intravenous Glucagon, Digoxin and Antioxidant Agents
(Case Report) Zohreh Oghabian and Omid Mehrpour
ABSTRACT: Aluminium phosphide (AlP) is used to protect stored grains from rodents. It produces phosphine gas (PH3), a mitochondrial poison thought to cause toxicity by blocking the cytochrome c oxidase enzyme and inhibiting oxidative phosphorylation, which results in cell death. AlP poisoning has a high mortality rate among humans due to the rapid onset of cardiogenic shock and metabolic acidosis, despite aggressive treatment. We report a 21-yearold male who was referred to the Afzalipour Hospital, Kerman, Iran, in 2015 after having intentionally ingested a 3 g AlP tablet. He was successfully treated with crystalloid fluids, vasopressors, sodium bicarbonate, digoxin, glucagon and antioxidant agents and was discharged from the hospital six days after admission in good clinical condition. For the treatment of AlP poisoning, the combination of glucagon and digoxin with antioxidant agents should be considered. However, evaluation of further cases is necessary to optimise treatment protocols.
Variation in the Obturator Vasculature During Routine Anatomy Dissection of a Cadaver
(Case Report) Vishwajit Deshmukh, Seema Singh, Neerja Sirohi and Divya Baruhee
ABSTRACT: The obturator artery normally originates from the internal iliac artery while the obturator vein drains into the internal iliac vein. During a routine gross anatomy dissection class for undergraduate students at the All India Institute of Medical Sciences, New Delhi, India, in 2016, a rare unilateral variation in the obturator vasculature was found in a female cadaver of approximately 55 years of age. In this case, the left obturator artery originated from the superior gluteal artery and the left obturator vein drained into the external iliac vein. Knowledge of such variations is necessary during hernia procedures, ligation of the internal iliac artery and muscle graft surgeries. Keywords: Iliac Artery; Anatomic Variation; Dissection; Case Report; India.
A Combination of Drug-Eluting Stents and Bioresorbable Vascular Scaffolds in the Treatment of Multivessel Coronary Artery Disease
(Case Report) Ahmed Al-Mamary, Filippo Zilio and Massimo Napodano
ABSTRACT: Optimal management of multivessel coronary artery disease can be complex. We report a 67-year-old male patient who was admitted to the Padua University Hospital, Padua, Italy, in 2014 with a non-ST-elevation myocardial infarction. Coronary angiography showed diffuse multiple sub-occlusive lesions of the proximal and distal left coronary vessels involving a long segment of the vessel. On intravascular ultrasonography (IVUS), the left main artery was moderately diseased with critically stenotic and calcified branch ostia. A successful percutaneous coronary intervention using the T-stenting and small protrusion technique with two drug-eluting stents (DES) was performed on the left main artery and its main branches. Two bioresorbable vascular scaffolds were also deployed in overlap at the mid to distal segments of the left anterior descending artery and overlapping a previous DES at the proximal segment. The full expansion and apposition of the struts and scaffolds to the vessel wall without residual stenosis was confirmed by IVUS.
Suprasellar Clear Cell Meningioma in an Infant
Case report(Case Report) Charles C. Anunobi, Olufemi Bankole, Nzechukwu Z. Ikeri and Nurudeen A. Adeleke
ABSTRACT: Clear cell meningiomas are an uncommon subtype of meningioma rarely seen in infancy. We report a case of clear cell meningioma in an 8-month-old male infant. He presented at the Lagos University Teaching Hospital, Lagos, Nigeria, in 2015 with persistent vomiting, poor feeding and failure to thrive over a four month period. Generalised hypertonia and hyperreflexia were noted on examination. Computed tomography of the brain revealed a huge largely isodense suprasellar mass with a hypodense core. The tumour, which measured 6 x 5 x 4 cm, enhanced non-uniformly with contrast injection and extended to occlude the third ventricle. The patient underwent a bifrontal craniotomy with subtotal tumour excision. Six hours postoperatively, he went into cardiac arrest and could not be resuscitated. A histological diagnosis of clear cell meningioma was made as the tumour cells were immunoreactive to epithelial membrane antigen, S100 protein and vimentin. This case of clear cell meningioma was unusual due to its early occurrence and supratentorial location. Keywords: Clear Cell Meningioma; Brain Tumor; Central Nervous System Tumors; Infant; Case Report; Nigeria.
Disease-Modifying Drug Possibly Linked to Placental Insufficiency
Severe placental complications in a pregnant woman with multiple sclerosis(Case Report) Sultan M. Salahudheen and Muzibunnisa A. Begam
ABSTRACT: Disease-modifying drugs (DMDs) such as interferon (IFN)-β and glatiramer acetate are often prescribed to slow disability progression in patients with multiple sclerosis (MS). However, adverse pregnancy outcomes have been reported with these medications. We report the rare occurrence of severe placental complications in a 30-yearold pregnant woman with MS who continued to take IFN-β during her first trimester. She presented at the Tawam Hospital, Al Ain, United Arab Emirates, in 2013 with early-onset fetal growth restriction. At 30 gestational weeks, she developed severe pre-eclampsia. The baby was delivered via emergency Caesarean section and was discharged at the age of two months. Continuation of IFN-β during pregnancy may have contributed to the development of placental insufficiency in this patient. Increased education regarding the risks of DMDs for pregnant patients with MS is very important to ensure successful pregnancy outcomes.
Keywords: Multiple Sclerosis; Interferon Beta; Pre-Eclampsia; Fetal Growth Retardation; Placental Insufficiency; Case Report; United Arab Emirates.
Successful Salvage Treatment of Resistant Acute Antibody-Mediated Kidney Transplant Rejection with Eculizumab
(Case Report) Saif A. Khan, Dawood Al-Riyami, Yasser W. Al-Mula Abed, Saja Mohammed, Marwa Al-Riyami and Nabil M. Al-Lawati
ABSTRACT: Antibody-mediated rejection (ABMR) jeopardises short- and long-term transplant survival and remains a challenge in the field of organ transplantation. We report the first use of the anticomplement agent eculizumab in Oman in the treatment of a 61-year-old female patient with ABMR following a living unrelated kidney transplant. The patient was admitted to the Sultan Qaboos University Hospital in Muscat, Oman, in 2013 on the eighth day post-transplantation with serum creatinine (Cr) levels of 400 μmol/L which continued to rise, necessitating haemodialysis. A biopsy indicated ABMR with acute cellular rejection. No improvement was observed following standard ABMR treatment and she continued to require dialysis. Five doses of eculizumab were administered over six weeks with a subsequent dramatic improvement in renal function. The patient became dialysis-free with serum Cr levels of 119 μmol/L within four months. This case report indicates that eculizumab is a promising agent in the treatment of ABMR.
Seizures as an Atypical Feature of Beal’s Syndrome
(Case Report) Nazreen B. K. Jaman and Abeer Al-Sayegh
ABSTRACT: Congenital contractural arachnodactyly, commonly known as Beal’s syndrome, is an extremely rare genetic disorder caused by mutations in the fibrillin-2 (FBN2) gene located on chromosome 5q23. It is an autosomal dominant inherited connective tissue disorder characterised by a Marfan-like body habitus, contractures, abnormally shaped ears and kyphoscoliosis. We report a seven-year-old Omani male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2014 with seizures. He was noted to have certain distinctive facial features and musculoskeletal manifestations; he was subsequently diagnosed with Beal’s syndrome. Sequencing of the FBN2 gene revealed that the patient had a novel mutation which was also present in his mother; however, she had only a few facial features indicative of Beal’s syndrome and no systemic involvement apart from a history of childhood seizures. To the best of the authors’ knowledge, this is the first report of Beal’s syndrome with seizure symptoms as a potential feature.