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.
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Reflections on the Academic Accreditation of the MD Programme of the College of Medicine & Health Sciences, Sultan Qaboos University, Oman
(Editorial) Sulayma Albarwani, Muna Al-Saadoon, Omar Al-Rawas, Saif Al-Yaarubi, Rashid Al-Abri, Lamk Al-Lamki, Musbah O. Tanira
Obituary of Professor Christopher Sapara Grant MB.ChB, FRCS, FACS 1942–2013
The Epitome of Humility and Hard Work(Announcements) SQUMJ/SQU Horizon Magazine
ABSTRACT: Professor Grant, Head of the Department of Surgery at Sultan Qaboos University (SQU) for 15 years, died in SQU Hospital on Friday 4th October aged 71. Prof. Grant, who joined the College of Medicine & Health Sciences just four years after SQU opened in 1986, was one of the pioneers who made immense contributions to both medical education and the healthcare sector in Oman. Many of his former students now occupy senior positions in the Ministry of Health and the medical colleges in the country.
The Significance of Matrix Metalloproteinases in the Immunopathogenesis and Treatment of Multiple Sclerosis
(Review) Abbas Mirshafiey, Babak Asghari, Ghasem Ghalamfarsa, Farhad Jadidi-Niaragh, Gholamreza Azizi
ABSTRACT: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS). The major pathological outcomes of the disease are the loss of blood-brain barrier (BBB) integrity and the development of reactive astrogliosis and MS plaque. For the disease to occur, the non-resident cells must enter into the immune-privileged CNS through a breach in the relatively impermeable BBB. It has been demonstrated that matrix metalloproteinases (MMPs) play an important role in the immunopathogenesis of MS, in part through the disruption of the BBB and the recruitment of inflammatory cells into the CNS. Moreover, MMPs can also enhance the cleavage of myelin basic protein (MBP) and the demyelination process. Regarding the growing data on the roles of MMPs and their tissue inhibitors (TIMPs) in the pathogenesis of MS, this review discusses the role of different types of MMPs, including MMP-2, -3, -7, -9, -12 and -25, in the immunopathogenesis and treatment of MS.
Thrombophilia and Recurrent Pregnancy Loss
Is heparin still the drug of choice?(Review) Adel Abu-Heija
ABSTRACT: The association between thrombophilia and recurrent pregnancy loss (RPL) has become an undisputed fact. Thorombophilia creates a hypercoaguable state which leads to arterial and/or venous thrombosis at the site of implantation or in the placental blood vessels. Anticoagulants are an effective treatment against RPL in women with acquired thrombophilia due to antiphospholipid syndrome. The results of the use of anticoagulants for treating RPL in women with inherited thrombophilia (IT) are encouraging, but recently four major multicentre studies have shown that fetal outcomes (determined by live birth rates) may not be as favourable as previously suggested. Although the reported side-effects for anticoagulants are rare and usually reversible, the current recommendation is not to use anticoagulants in women with RPL and IT, or for those with unexplained losses. This review examines the strength of the association between thrombophilia and RPL and whether the use of anticoagulants can improve fetal outcomes.
Mutation Spectrum and Birth Prevalence of Inborn Errors of Metabolism among Emiratis
A study from Tawam Hospital Metabolic Center, United Arab Emirates(Original Study) Aisha Al-Shamsi, Jozef L. Hertecant, Sania Al-Hamad, Abdul-Kader Souid, Fatma Al-Jasmi
ABSTRACT:Objectives: This study aimed to determine the mutation spectrum and prevalence of inborn errors of metabolism (IEM) among Emiratis. Methods: The reported mutation spectrum included all patients who were diagnosed with IEM (excluding those with lysosomal storage diseases [LSD]) at Tawam Hospital Metabolic Center in Abu Dhabi, United Arab Emirates, between January 1995 and May 2013. Disease prevalence (per 100,000 live births) was estimated from data available for 1995–2011. Results: In 189 patients, 57 distinct IEM were diagnosed, of which 20 (35%) entities were previously reported LSD (65 patients with 39 mutations), with a birth prevalence of 26.87/100,000. This study investigated the remaining 37 (65%) patients with other IEM (124 patients with 62 mutations). Mutation analysis was performed on 108 (87%) of the 124 patients. Five patients with biotinidase deficiency had compound heterozygous mutations, and two siblings with lysinuric protein intolerance had two homozygous mutations. The remaining 103 (95%) patients had homozygous mutations. As of this study, 29 (47%) of the mutations have been reported only in Emiratis. Two mutations were found in three tribes (biotinidase deficiency [BTD, c.1330G>C] and phenylketonuria [PAH, c.168+5G>C]). Two mutations were found in two tribes (isovaleric aciduria [IVD, c.1184G>A] and propionic aciduria [PCCB, c.990dupT]). The remaining 58 (94%) mutations were each found in individual tribes. The prevalence was 48.37/100,000. The most prevalent diseases (2.2–4.9/100,000) were biotinidase deficiency; tyrosinemia type 1; phenylketonuria; propionic aciduria; glutaric aciduria type 1; glycogen storage disease type Ia, and mitochondrial deoxyribonucleic acid depletion. Conclusion: The IEM birth prevalence (LSD and non-LSD) was 75.24/100,000. These results justify implementing prevention programmes that incorporate genetic counselling and screening. Keywords: Metabolism, Inborn Errors; Mutations; Prevalence; Founder Effect; United Arab Emirates.
The p53 Mutation/Deletion Profile in a Small Cohort of the Omani Population with Diffuse Large B-Cell Lymphoma
(Original Study) Yahya Tamimi, Sheikha Al-Harthy, Ibrahim Al-Haddabi, Mohammed Al-Kindi, Hamza Babiker, Mansour Al-Moundhri, Ikram Burney
ABSTRACT:Objectives: Mutations/deletions affecting the TP53 gene are considered an independent marker predicting a poor prognosis for patients with diffuse large B-cell lymphoma (DLBCL). A cohort within a genetically isolated population was investigated for p53 mutation/deletion status. Methods: Deoxyribonucleic acid (DNA) samples were extracted from 23 paraffin-embedded blocks obtained from DLBCL patients, and subjected to polymerase chain reaction (PCR) amplification and sequencing of exons 4–9 of the p53 gene. Results: While 35% of patients analysed displayed allelic deletions (P <0.01), immunohistochemical analysis revealed a mutation rate of 69.5%. It is noteworthy that the rate of p53 mutations/deletions in this small cohort was found to be higher than that previously reported in the literature. Interestingly, patients with p53 mutations displayed a better overall survival when compared to those without. The survival of patients treated with rituximab-containing combination chemotherapy was significantly better than those who did not receive rituximab (P <0.05). Furthermore, a modelling analysis of the deleted form of p53 revealed a huge structural change affecting the DNA-binding domain. Conclusion: The TP53 mutation/deletion status plays a role in mechanism(s) ruling the pathogenesis of DLBCL and may be useful for stratifying patients into distinct prognostic subsets. Keywords: Mutations; Gene Deletion; Lymphoma, B-Cell; Paraffin Embedding; Immunohistochemistry; Oman.
Nasal Allergy and Otitis Media
A real correlation?(Original Study) Desiderio Passali, Giulio C. Passali, Maria Lauriello, Antonio Romano, Luisa Bellussi, Francesco M. Passali
ABSTRACT:Objectives: The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children. Methods: The study included 100 atopic children (52 boys, 48 girls) aged 5‒9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed. Results: The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 to Parietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference (P <0.01). Mean eosinophil cationic protein (ECP) values in the middle ear effusions of children who had undergone myringotomy were 251 ± 175.2 μg/L, and mean ECP blood values were 25.5 ± 16.3 μg/L, with significant differences (P < 0.001). Conclusion: There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms. Keywords: Otitis Media; Nasal Allergy; Children; Genetic Predisposition; Eustachian Tubes; Italy.
The Cytotoxicity of Aflatoxin B1 in Human Lymphocytes
(Original Study) Suleiman Al-Hammadi, Farida Marzouqi, Aysha Al-Mansouri, Allen Shahin, Mariam Al-Shamsi, Eric Mensah-Brown, Abdul-Kader Souid
ABSTRACT:Objectives: Aflatoxin B1 (AFB1) is a naturally occurring carcinogenic and immunosuppressive compound. This study was designed to measure its toxic effects on human peripheral blood mononuclear cells (PBMC). Methods: The study recruited 7 healthy volunteers. PBMC were isolated and cellular respiration was monitored using a phosphorescence oxygen analyser. The intracellular caspase activity was measured by the caspase-3 substrate N-acetyl-asp-glu-val-asp-7-amino-4-methylcoumarin. Phosphatidylserine exposure and membrane permeability to propidium iodide (PI) were measured by flow cytometry. Results: Cellular oxygen consumption was inhibited by 2.5 μM and 25 μM of AFB1. Intracellular caspase activity was noted after two hours of incubation with 100 μM of AFB1. The number of Annexin V-positive cells increased as a function of AFB1 concentration and incubation time. At 50 μM, a significant number of cells became necrotic after 24 hours (Annexin V-positive and PI-positive). Conclusion: The results show AFB1 is toxic to human lymphocytes and that its cytotoxicity is mediated by apoptosis and necrosis. Keywords: Aflatoxin B1; Oxygen Analyzer; Cellular Respiration; Mitochondria; Caspases; Leukocytes, Mononuclear.
Assessment of Glomerular Filtration Rates by Cockcroft-Gault and Modification of Diet in Renal Disease Equations in a Cohort of Omani Patients
(Original Study) Magdi E. Al-Osali, Salim S. Al-Qassabi, Saud M. Al-Harthi
ABSTRACT:Objectives: Glomerular filtration rate (GFR) is the best index of renal function and is frequently assessed by corrected creatinine clearance (CCLcr). The limitations of CCLcr have inspired researchers to derive easy formulas to estimate GFR, with Cockcroft-Gault (C-G) and the modification of diet in renal disease (MDRD) being the most widely used. This study aimed to evaluate the validity of these equations by finding the relation between CCLcr and estimated GFR (eGFR) by C-G, modified C-G and MDRD equations. Methods: From 2007 to 2011, 158 subjects were analysed for serum creatinine and CCLcr at Bowsher Polyclinic, Muscat, Oman. The C-G equation was used to obtain eGFRC-G which was adjusted to body surface area (BSA) to obtain eGFRmC-G, and the MDRD equation was used to obtain eGFRMDRD. The eGFRMDRD, eGFRmC-G and eGFRC-G were then compared to CCLcr. Results: The eGFRMDRD, eGFRmC-G and eGFRC-G significantly correlated with CCLcr, with a slightly stronger correlation with eGFRMDRD (r = 0.701, 0.658 and 0.605, respectively). A receiver operating characteristic curve analysis showed that the diagnostic accuracy of eGFRMDRD for diagnosing chronic kidney disease (CKD) was higher than that of eGFRmC-G, which in turn was higher than that of eGFRC-G (area under the curve was 0.846, 0.831, and 0.791; cut-off limits were 61.9, 58.3 and 59.5, respectively). Conclusion: C-G and MDRD equations can be an alternative to the CCLcr test for assessing GFR, thus avoiding the need for the cumbersome and expensive GFR test. The MDRD formula had greater validity than the C-G equation and the C-G equation validity was improved by an adjustment to BSA.
Clinical and Laboratory Manifestations of Yemeni Patients with Systemic Lupus Erythematosus
(Original Study) Hassan A. Al-Shamahy, Najla H. M. Dhaifallah, Yahya M. Al-Ezzy
ABSTRACT:Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterised by multi-systemic involvement. This is the first study undertaken to determine the relationships between serological marker positivity and age, gender, signs and symptoms, risk factors and the treatment of SLE in Yemen. Methods: We investigated the cases of 149 patients with SLE admitted to Al-Thawra Hospital in Sana’a city between November 2009 and November 2010. Of the 149 patients, females represented 75.2% and males, 24.8%. Results: The most frequent presenting signs and symptoms were fatigue (84.6%), fever (81.9%), arthropathy (81.2%), anaemia (64.4%), photosensitivity (54.4%), renal involvement (53%), malar rash (52.3%), and alopecia (49%). Antinuclear antibodies (ANA) were detected in 95.3% of the patients and were associated significantly with most clinical presentations, except weight loss, hypertension and serositis. Anti-ds deoxyribonucleic acid (anti-dsDNA) was detected in 59.7% of the patients, and was associated significantly with fever and fatigue. Anti-Smith (anti-Sm) antibodies were detected in 27.5% of the patients, but were not significantly associated with all clinical presentations. Social stress was the most important risk factor for inducing SLE, with an odds ratio (OR) of 6.0, followed by common exposure to sunlight (OR = 2.2). Conclusion: In this study, SLE was more prevalent among females and young adults. The clinical presentation was characterised by a high incidence of fatigue and fever, and a low incidence of oral ulcers and serositis. ANA was associated with most clinical presentations except weight loss, hypertension, and serositis. AntidsDNA antibodies were most frequently associated with fever, fatigue and hypertension. There was no significant association of the anti-Sm antibodies with any clinical presentations. Keywords: Systemic lupus erythematosus (SLE); Autoantibodies; Antinuclear antibodies (ANA); Anti-ds DNA; Anti-Smith Antibodies (Anti-Sm); Yemen.
Frequency of Glomerular Dysfunction in Children with Beta Thalassaemia Major
(Original Study) Basma A. Ali and Ahmed M. Mahmoud
ABSTRACT:Objectives: This study investigated the frequency of glomerular dysfunction in children with beta thalassaemia major (β-TM) by using different markers and correlating them with serum ferritin and iron chelation therapy. Methods: The study, carried out between August 2011 and May 2012, included 100 patients with β-TM, in two groups. Group Ia (n = 62) received chelation therapy (deferoxamine). Group Ib (n = 38) received followup care at the Pediatric Hematology Outpatient Clinic, Minia University Children’s Hospital, Egypt. Group II included 50 apparently healthy controls, age- and sex-matched to Group I. All patients underwent a thorough history-taking, clinical examination and laboratory investigations. Results: Compared to Group II, Groups Ia and Ib had significantly higher levels of cystatin C, serum creatinine and serum ferritin, and a higher albumin/ creatinine ratio in their urine, and a significantly lower estimated glomerular filtration rate (eGFR) and creatinine clearance (P <0.05). Moreover, Group Ιa had a significantly lower eGFR and creatinine clearance than Group Ib. Cystatin C had a highly significant strong negative correlation with eGFR and creatinine clearance and a significantly strong positive correlation with serum ferritin, and a higher sensitivity and specificity than serum creatinine and creatinine clearance for small changes in GFR. Conclusion: β-TM patients had a high frequency of glomerular dysfunction—possibly attributable to chronic anaemia, iron overload or chelation therapy. Periodic renal assessment is mandatory to detect renal complications. Cystatin C is a promising marker to monitor glomerular dysfunction, having a higher sensitivity and specificity than serum creatinine and creatinine clearance for small changes in GFR. Keywords: Abnormalities, glomerular; beta-Thalassemia; Cystatin C; Chelation Therapy; Egypt.
Tocotrienol-Rich Fraction from Palm Oil Prevents Oxidative Damage in Diabetic Rats
(Original Study) Fatmah A. Matough, Siti B. Budin, Zariyantey A. Hamid, Mariati Abdul-Rahman, Nasar Al-Wahaibi, Jamaludine Mohammed
ABSTRACT:Objectives: This study was carried out to determine the effects of tocotrienol-rich fraction (TRF) (200 mg/Kg) on biomarkers of oxidative stress on erythrocyte membranes and leukocyte deoxyribonucleic acid (DNA) damage in streptozotocin (STZ)-induced diabetic rats. Methods: Male rats (n = 40) were divided randomly into four groups of 10: a normal group; a normal group with TRF; a diabetic group, and a diabetic group with TRF. Following four weeks of treatment, fasting blood glucose (FBG) levels, oxidative stress markers and the antioxidant status of the erythrocytes were measured. Results: FBG levels for the STZ-induced diabetic rats were significantly increased (P <0.001) when compared to the normal group and erythrocyte malondialdehyde levels were also significantly higher (P <0.0001) in this group. Decreased levels of reduced glutathione and increased levels of oxidised glutathione (P <0.001) were observed in STZ-induced diabetic rats when compared to the control group and diabetic group with TRF. The results of the superoxide dismutase and glutathione peroxidase activities were significantly lower in the STZ-induced diabetic rats than in the normal group (P <0.001). The levels of DNA damage, measured by the tail length and tail moment of the leukocyte, were significantly higher in STZ-induced diabetic (P <0.0001). TRF supplementation managed to normalise the level of DNA damage in diabetic rats treated with TRF. Conclusion: Daily supplementation with 200 mg/Kg of TRF for four weeks was found to reduce levels of oxidative stress markers by inhibiting lipid peroxidation and increasing the levels of antioxidant status in a prevention trial for STZ-induced diabetic rats. Keywords: Antioxidants; Diabetes Mellitus; Oxidative Stress; Tocotrienols.
A Study on the Prevalence of Alcohol Consumption, Tobacco Use and Sexual Behaviour among Adolescents in Urban Areas of the Udupi District, Karnataka, India
(Original Study) Padma Mohanan, Subhashisa Swain, Noore Sanah, Vikram Sharma, Deboporna Ghosh
ABSTRACT:Objectives: The aim of this study was to assess the prevalence of alcohol consumption, tobacco use and risky sexual behaviour among adolescents, and to evaluate the socioeconomic factors potentially influencing these behaviours. Methods: This cross-sectional study was conducted from January to April 2011 among 376 adolescents (15–19 years old) studying in different schools and colleges in Udupi, India. The Youth Risk Behavior Survey questionnaire and guidelines were followed for data collection. Participants’ alcohol consumption, smoking habits and sexual behaviour patterns were explored. Univariate analysis followed by multivariate logistic regression was done. Results: The prevalence of alcohol consumption, tobacco use and sexual activity was found to occur in 5.7%, 7.2% and 5.5% of participants, respectively. The mean age of the participants’ first sexual activity, consumption of alcohol and tobacco use was reported to be approximately 16.8 years. Multivariate analysis showed that males were more likely to have used alcohol and tobacco. Other factors, such as religion and tobacco use among family members, were found to be influential. Conclusion: The potential coexistence of multiple risk behaviours in a student demands an integrated approach. Emphasis should be placed on health education in schools and an increased awareness among parents in order to prevent adolescents’ behaviours from becoming a risk to their health.
Keywords: Adolescents; Risk Behaviors; Tobacco; Alcoholic Beverages; Sexual Behavior; India.
Attitudes of nursing students at Sultan Qaboos University(Original Study) Shreedevi Balachandran, Ramesh Venkatesaperumal, Jothi Clara, Raghda K. Shukri
ABSTRACT:Objectives: The objectives of this study were to assess the attitude of Omani nursing students towards writing-to-learn (WTL) and its relationship to demographic variables, self-efficacy and the writing process. Methods: A cross-sectional design was used to evaluate attitudes towards WTL by Sultan Qaboos University nursing students. A convenience sample of 106 students was used and data collected between October 2009 and March 2010. A modified version of the WTL attitude scale developed by Dobie and Poirrier was used to collect the data. Descriptive and inferential statistics were used for analysis. Results: Senior and junior students had more positive attitudes to WTL than mid-level students who tended to have negative attitudes towards writing. Although 52.8% students had negative attitudes towards the writing process, the median was higher for attitudes to the writing process compared to the median for self-efficacy. There was a positive correlation between self-efficacy and writing process scores. Conclusion: Overall, students had negative attitudes towards WTL. Attitudes are learnt or formed through previous experiences. The incorporation of WTL strategies into teaching can transform students’ negative attitudes towards writing into positive ones. Keywords: Attitude; Nursing; Students; Writing; Learning; Self Efficacy; Education; Oman.
Is a Team-based Learning Approach to Anatomy Teaching Superior to Didactic Lecturing?
(Original Study) Naghme Ghorbani, Saied Karbalay-Doust, Ali Noorafshan
ABSTRACT:Objectives: Team-based learning (TBL) is used in the medical field to implement interactive learning in small groups. The learning of anatomy and its subsequent application requires the students to recall a great deal of factual content. The aims of this study were to evaluate the students’ satisfaction, engagement and knowledge gain in anatomy through the medium of TBL in comparison to the traditional lecture method. Methods: This study, carried out from February to June 2012, included 30 physical therapy students of the Shiraz University of Medical Science, School of Rehabilitation Sciences. Classic TBL techniques were modified to cover lower limb anatomy topics in the first year of the physical therapy curriculum. Anatomy lectures were replaced with TBL, which required the preparation of assigned content, specific discussion topics, an individual self-assessment test (IRAT) and the analysis of discussion topics. The teams then subsequently retook the assessment test as a group (GRAT). The first eight weeks of the curriculum were taught using traditional didactic lecturing, while during the second eight weeks the modified TBL method was used. The students evaluated these sessions through a questionnaire. The impact of TBL on student engagement and educational achievement was determined using numerical data, including the IRAT, GRAT and final examination scores. Results: Students had a higher satisfaction rate with the TBL teaching according to the Likert scale. Additionally, higher scores were obtained in the TBL-based final examination in comparison to the lecture-based midterm exam. Conclusion: The students’ responses showed that the TBL technique could be used alone or in conjunction with traditional didactic lecturing in order to teach anatomy more effectively. Keywords: Learning; Anatomy; Physical Therapy Specialty; Education; Curriculum.
Complicated Subacute Bacterial Endocarditis in a Patient with Ventricular Septal Defect
(Case Report) Khalfan S. Al-Senaidi, Anas-Alwogud A. Abdelmogheth, Abdullah A. Balkhair
ABSTRACT: Infective endocarditis (IE) is an uncommon but life-threatening infection. Despite advances in management, it still causes high morbidity and mortality. We report the case of an 8-year-old girl who presented with a prolonged fever of 2.5 months duration and a history of a small perimembranous ventricular septal defect. She was diagnosed with subacute bacterial endocarditis secondary to Streptococcus mutans. The patient developed a septic pulmonary embolism; however, with the use of appropriate antimicrobial therapy, she made an uneventful recovery. Clinicians should have a high index of suspicion for IE as the possible cause of a prolonged fever, especially in the presence of congenital heart disease (CHD). Currently, IE prophylaxis is not indicated for unrepaired acyanotic CHD. Nevertheless, with the new changes in the guidelines, more prospective studies are needed to investigate the incidence of IE in such lesions, before long-term conclusions can be drawn. Keywords: Endocarditis, Subacute Bacterial; Streptococcus mutans; Pulmonary Embolism, Septic; Erythema Nodosum; Case Report; Oman.
Pregnancy in the Rudimentary Uterine Horn
Case report of an unusual presentation(Case Report) Qamariya Ambusaidi and Chitra Jha
ABSTRACT: A unicornuate uterus with a rudimentary horn is a uterine anomaly resulting from the incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side. Pregnancy in a rudimentary horn of the uterus is a rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. Usually the diagnosis is missed and may present as an emergency with haemoperitoneum. The standard treatment is the surgical excision of the horn. A gravida 2, para 1 patient presented at 23 weeks’ gestation with fetal demise. Repeated failed attempts at induction of labour raised the suspicion of an abnormally located pregnancy which was confirmed by magnetic resonance imaging. She underwent a laparotomy with right rudimentary horn excision. The final diagnosis of a non-communicating rudimentary horn pregnancy was made intraoperatively and was confirmed by histopathology. This case highlights the importance of an early ultrasound in detecting uterine anomalies and the need for high clinical suspicion. Keywords: Uterus, abnormalities; Pregnancy; Ultrasonography; Magnetic Resonance Imaging; Laparotomy; Case Report; Oman.
Accordion Phenomenon in the Radial Artery
Should we treat the radial as a coronary artery?(Case Report) Ziad S. Dahdouh, Tony Abdel-Massih, Antoine Sarkis, Gilles Grollier
ABSTRACT: The accordion phenomenon is a well-known finding mechanism in the field of interventional cardiology. It is a benign condition and has mainly been described in tortuous coronary arteries during percutaneous coronary interventions. It is believed to be induced by a stiff guidewire. However, this phenomenon has not been observed previously in the radial artery. We present a case of accordion phenomenon in the radial artery, which was successfully resolved after the catheters and the wire were retrieved, with the pseudolesions found to have completely disappeared in subsequent image findings.
Keywords: Radial Artery; Percutaneous Coronary Intervention; Complications; Case Report; France.
Urinary Bladder Stone Complicating Ventriculovesical Shunt
(Case Report) Ahmed K. Ibrahim
ABSTRACT: The standard treatment for hydrocephalus is either a ventriculoperitoneal or a ventriculo-atrial shunt. However, these conventional shunts may be associated with considerable complications and high revision rates which make these familiar shunts inappropriate for a certain subset of patients. A rare complication is reported associated with an unusual procedure in a 42-year-old woman who had had a ventriculovesical shunt for four years. She presented with recurrent urinary tract infections, haematuria and urge incontinence, and was discovered to have a large vesical stone over the vesical end of the shunt. She was treated with open suprapubic cystolithotomy and the redirection of the shunt to the peritoneal cavity. The patient was followed up for 12 months postoperatively and remained free of any urinary tract symptoms.
Solitary Periosteal Osteoma of the Mandible
A case report(Case Report) Reema Mehta, Archana Yadav, Shivani P. Bansal, Mohan D. Deshpande
ABSTRACT: Osteoma of the jaw bones is a rare entity with very few cases reported in the literature. Osteomas are benign, slow-growing osteogenic tumours of the bone commonly encountered in the craniofacial skeleton and characterised by the proliferation of compact or cancellous bone. They can be central, peripheral or extra-skeletal in their location. In the facial region, periosteal osteomas occur more frequently in the paranasal sinuses, but solitary periosteal osteomas of the jaw bones are quite rare. The mandible is more commonly affected than the maxilla, with the sites of predilection being the lingual aspect of the body, the angle and the inferior border. We report a case of a solitary periosteal osteoma on the buccal aspect of the mandible in a 42-year-old woman.
Keywords: Mandible; Osteoma; Periosteal; Case Report; India.