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.
Statin-Associated Muscle Adverse Events
Update for clinicians(Review) Maha A. Al-Mohaissen, Martha J. Ignaszewski, Jiri Frohlich and Andrew P. Ignaszewski
ABSTRACT: Statins are potent medications which reduce low-density lipoprotein cholesterol (LDL-C) levels. Their efficacy in cardiovascular risk reduction is well established and indications for their use are expanding. While statins are generally well tolerated and safe, adverse events are relatively common, particularly statinassociated muscle adverse events (SaMAEs), which are the most frequently encountered type of adverse event. Recent guidelines and guideline updates on SaMAEs and statin intolerance have included revised definitions of SaMAEs, incorporating new evidence on their pathogenesis and management. As SaMAEs emerge as a therapeutic challenge, it is important for physicians to be aware of updates on management strategies to ensure better patient outcomes. The majority of patients who are considered statin-intolerant can nevertheless tolerate some forms of statin therapy and successfully achieve optimal LDL-C levels. This review article discusses the recent classification of SaMAEs with emphasis on pathogenesis and management strategies.
Decoding the malignant truth(Review) Norman O. Machado
ABSTRACT: Gallbladder calcification, also referred to as porcelain gallbladder, has received significant attention in the medical literature due to its perceived role in increasing the risk of developing a gallbladder carcinoma. However, recent reports raise questions challenging this purported high risk. While previous studies reported a concomitant incidence of gallbladder cancer in porcelain gallbladder ranging from 7–60%, more recent analyses indicate the incidence to be much lower (6%). Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients. However, it is important to note that a nonoperative approach may require prolonged follow-up. A laparoscopic cholecystectomy is a feasible therapeutic option for patients with porcelain gallbladder, although some researchers have indicated a higher incidence of complications and conversion due to technical difficulties.
Histological Evaluation of Hydroxyapatite Granules with and without Platelet-Rich Plasma versus an Autologous Bone Graft
Comparative study of biomaterials used for spinal fusion in a New Zealand white rabbit model(Original Study) Zamzuri Zakaria, Che N. Z. C. Seman, Zunariah Buyong, Mohd A. Sharifudin, Ahmad H. Zulkifly and Kamarul A. Khalid
ABSTRACT:Objectives: Hydroxyapatite (HA) has osteoconductive properties and is widely used as a bone graft substitute. Platelet-rich plasma (PRP) is an autologous product with osteoinductive effects. Hypothetically, a combination of both would augment the bone formation effect of HA and widen its application in spinal fusion surgeries. This study aimed to compare new bone formation with HA granules alone and in combination with PRP versus an autologous bone graft during a lumbar intertransverse process spinal fusion. Methods: A total of 16 adult New Zealand white rabbits underwent single-level bilateral intertransverse process fusion at the L5–L6 vertebrae. One side of the spine received either HA granules alone or a combination of HA granules and PRP, while the contralateral side received an autologous bone graft. Four animals each from the HA group and the HA plus PRP group versus the autograft group were assessed either at six or 16 weeks by undecalcified histology and histomorphometry. The mean percentage of new bone areas over the corresponding fusion masses were compared between groups. Results: No significant difference in new bone formation was observed between the HA and HA plus PRP groups at six or 16 weeks. The autograft group had significantly more new bone formation at six and 16 weeks (P = 0.004 and <0.001, respectively). Conclusion: An autologous bone graft remains superior to HA granules, with or without PRP. HA granules demonstrated an excellent osteoconductive scaffold but had poor biodegradability. While PRP enhances the properties of HA granules, these biomaterials do not have a synergistic effect.
Lumbar Kinematics, Functional Disability and Fear Avoidance Beliefs Among Adults with Nonspecific Chronic Low Back Pain
(Original Study) Nancy G. Jette, Yi L. Lim, Hui L. Lim, Sabarul A. Mokhtar, Kok B. Gan and Devinder K. A. Singh
ABSTRACT:Objectives: This study aimed to examine correlations between lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain (LBP). Methods: This crosssectional study was conducted between March and December 2014. A total of 32 adults diagnosed with nonspecific chronic LBP were recruited from outpatients attending either an orthopaedic clinic at a university hospital or a private physiotherapy clinic in Malaysia. Lumbar kinematics were measured using sensors attached at the first lumbar (L1) and second sacral (S2) vertebrae levels. The Oswestry Disability Index (ODI) and Fear-Avoidance Beliefs Questionnaire (FABQ) were used to assess degree of functional disability and fear avoidance beliefs, respectively. Results: For maximum range of motion, positive correlations were observed between ODI scores and right lateral flexion and right rotation (P = 0.01 each), although there was a negative correlation with left rotation (P = 0.03). With maximum angular velocity, ODI scores were positively correlated with right and left lateral flexion L1 (P = 0.01 and <0.01, respectively) but negatively correlated with left lateral flexion L2 (P = 0.04). Regarding minimum angular velocity, ODI scores were positively correlated with left lateral flexion S2 (P <0.01) but negatively correlated with right and left lateral flexion L1 (P = 0.02 each), right rotation L1 (P = 0.02) and left rotation S2 (P = 0.01). No significant correlations were found between lumbar kinematics and FABQ scores. Conclusion: These findings suggest that certain lumbar kinematic parameters are correlated with functional disability, but not with fear avoidance beliefs.
Keywords: Low Back Pain; Lumbar Vertebrae; Kinematics; Disability Evaluation; Fear.
Knowledge and Health Beliefs Regarding Sickle Cell Disease Among Omanis in a Primary Healthcare Setting
Cross-sectional study(Original Study) Mohammed H. Al-Azri, Rajaa Al-Belushi, Muna Al-Mamari, Robin Davidson and Anil C. Mathew
ABSTRACT:Objectives: Sickle cell disease (SCD) is a global health concern associated with high childhood morbidity and mortality; in Oman, the prevalence of SCD is 0.2%. Public awareness of SCD and the need for premarital screening (PMS) are essential to reduce the incidence of this disease. This study aimed to assess awareness of and beliefs regarding SCD and PMS among Omanis in a primary healthcare setting. Methods: This cross-sectional study took place in five health centres located in Al-Seeb Province, Muscat, Oman, between June and August 2015. A total of 500 Omanis aged ≥18 years old attending the clinics were invited to participate in the study. A previously described questionnaire by Gustafson et al. was used to measure awareness of and beliefs regarding SCD and PMS. Results: A total of 450 Omani adults completed the questionnaire (response rate: 90.0%). The majority (67.8%) were aware that SCD is genetically inherited and 85.1% believed in the value of PMS; however, only 24.4% reported having undergone PMS previously. Few participants were aware that SCD can be very painful (20.2%) and can cause strokes, infections and organ damage (20.0%). More than half (56.7%) reported that the availability of educational material on SCD or PMS in Oman was inadequate. Participants’ education levels were positively associated with accurate SCD knowledge (P <0.05). Conclusion: Despite the free availability of PMS services in local health centres, few Omanis reported having undergone PMS previously. Health promotion and education programmes are therefore needed in Oman in order to increase public awareness of SCD and the value of PMS.
Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section
Experience of a single tertiary centre in Oman(Original Study) Hazel Gonsalves, Nihal Al-Riyami, Tamima Al-Dughaishi, Vaidayanathan Gowri, Mohammed Al-Azri and Ayesha Salahuddin
ABSTRACT:Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Results: Most women were 25–35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%). Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.
Arterial Resistance in Late First Trimester as a Predictor of Subsequent Pregnancy-Related Hypertension
(Original Study) Pralhad Kushtagi and Anoosha Emani
ABSTRACT:Objectives: This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension. Methods: This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11–14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension. Results: Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP; P = 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN; P = 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI; P = 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P = 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%). Conclusion: Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension. Keywords: Vascular Resistance; Pulse Pressure; Uterine Artery; Doppler Ultrasonography; Pregnancy-Induced Hypertension; India.
Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries
(Original Study) Akram H. Guirgis, Venugopal K. Menon, Neelam Suri, Nilay Chatterjee, Emil Attallah, Maged Y. Saad and Shereen Elshaer
ABSTRACT:Objectives: This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). Methods: This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1–C2 vertebrae) and low (C3–C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Results: Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. Conclusion: An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.
Keywords: Spinal Cord Injuries; Tracheostomy; Treatment Outcome; Mechanical Ventilation; Intensive Care Unit.
Comparison of Postoperative Drain Insertion versus No Drain Insertion in Thyroidectomies
Retrospective case-control study from the Sultan Qaboos University Hospital, Muscat, Oman(Original Study) Asma S. Al-Habsi, Al-Anood K. Al-Sulaimani, Kadhim M. Taqi and Hani A. Al-Qadhi
ABSTRACT:Objectives: A thyroidectomy is a frequently performed surgical procedure which can result in lifethreatening complications. The insertion of a drain after a thyroidectomy has been suggested to prevent such complications. This study aimed to evaluate the use of surgical drains following thyroidectomies in relation to postoperative complications and mass sizes. Methods: This retrospective case-control study included all thyroidectomies conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2011 to December 2013. Length of hospital stay, readmission, postoperative complications and mass size were evaluated. Results: During the study period, 250 surgeries were carried out on 241 patients. The majority of patients were female (87.2%). Drains were inserted postoperatively after 202 surgeries (80.8%) compared to 48 surgeries (19.2%) without drains. A total of 32 surgeries (12.8%) were conducted on patients with thyroid masses <1 cm, 138 (55.2%) on those with masses between 1–4 cm and 80 (32.0%) on those with masses >4 cm. The association between drain use and mass size was not significant (P = 0.439). Although postoperative complications were more prevalent in patients with drains, the relationship between these factors was not significant (P >0.050). Length of hospital stay was significantly longer among patients with postoperative drains (P <0.010). Conclusion: The routine insertion of drains after thyroid surgeries was found to result in longer hospital stays and did not reduce rates of postthyroidectomy complications. Thyroid mass size should not be used as an indicator for the insertion of a drain after thyroidectomy.
Keywords: Thyroidectomy; Drainage; Length of Stay; Postoperative Complications; Oman.
A Hypothetical Model to Predict Nursing Students’ Perceptions of the Usefulness of Pre-Service Integrated Management of Childhood Illness Training
(Original Study) Fannah A. Al-Araimi and Sitwat U. Langrial
ABSTRACT:Objectives: This study aimed to test a hypothetical model to predict nursing students’ perceptions of the usefulness of pre-service Integrated Management of Childhood Illness (IMCI) training and their intention to apply this training in clinical practice. Methods: This study was carried out at the Sur Nursing Institute, Sur, Oman, in May 2015. Using six predefined constructs, a hypothetical structural model was created. The constructs were used as latent variables to highlight their probable impact on intention to apply IMCI-related knowledge and skills in practice. A structured validated questionnaire was subsequently developed to assess the perceptions of nursing students. Factor loadings and calculated variances were examined to ensure convergent validity. Cronbach’s alpha was used to calculate internal consistency reliability. Results: Factor loadings for each item in the model were above 0.70. All of the constructs had Cronbach’s alpha values over 0.700, except for enhanced assessment skills (Cronbach’s alpha: 0.694). The variance extracted value was 0.815 for perceived usefulness, 0.800 for enhanced assessment skills, 0.687 for enhanced knowledge, attitudes and skills, 0.697 for enhanced confidence, 0.674 for enhanced counselling skills and 0.805 for future intention to use IMCI in a clinical setting. Conclusion: Overall, the results support the hypothetical model and indicate that nursing students perceive IMCI training to be beneficial and intend to apply IMCI-related knowledge and skills in clinical practice.
Perceptions of the Use of Blueprinting in a Formative Theory Assessment in Pharmacology Education
(Original Study) Tejas Patel, Manoj K. Saurabh and Parvati Patel
ABSTRACT:Objectives: This study aimed to assess perceptions of the use of a blueprint in a pharmacology formative theory assessment. Methods: This study took place from October 2015 to February 2016 at a medical college in Gujurat, India. Faculty from the Department of Pharmacology used an internal syllabus to prepare an assessment blueprint. A total of 12 faculty members prepared learning objectives and categorised cognitive domain levels by consensus. Learning objectives were scored according to clinical importance and marks were distributed according to proportional weighting. A three-dimensional test specification table of syllabus content, assessment tools and cognitive domains was prepared. Based on this table, a theory paper was created and administered to 126 pharmacology students. Feedback was then collected from the faculty members and students using a 5-point Likert scale. Results: The majority of faculty members agreed that using a blueprint ensured proper weighting of marks for important topics (90.00%), aligned questions with learning objectives (80.00%), distributed questions according to clinical importance (100.00%) and minimised inter-examiner variations in selecting questions (90.00%). Few faculty members believed that use of the blueprint created too many easy questions (10.00%) or too many difficult questions (10.00%). Most students felt that the paper had a uniform distribution of questions from the syllabus (90.24%), that important topics were appropriately weighted (77.23%), was well organised (79.67%) and tested indepth subject knowledge (74.80%). Conclusion: These findings indicate that blueprinting should be an integral part of written assessments in pharmacology education.
Keywords: Medical Education; Educational Measurement; Perceptions; Students; Faculty; Reliability and Validity.
Laparoscopic Splenectomy Alone for Sickle Cell Disease
Account of 50 paediatric cases(Original Study) Zainab N. Al-Balushi, Khalid M. Bhatti, Muhammad T. Ehsan, Yousuf Al-Shaqsi, Nawal A. R. Al-Sharji, Hatem A. A. Mady and Mahmoud H. Sherif
ABSTRACT:Objectives: In Oman, the most frequent indication for a splenectomy in children is sickle cell disease (SCD), which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman. Methods: This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged ≤15 years old undergoing splenectomies during the study period were reviewed. Results: A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children (28 male and 22 female) underwent laparoscopic splenectomies alone for SCD. The children’s weight ranged between 11–43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis (92%). Surgically removed spleens weighed between 155–1,200 g and measured between 9–22 cm. Operative times ranged between 66–204 minutes and intraoperative blood loss ranged between 10–800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days. Conclusion: Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option.
Use of Prescription Drugs and Investigations by Doctors in Primary Care Settings in Oman and the UK
(Brief Communication) Robin Davidson
ABSTRACT:Objectives: This audit aimed to investigate the use of prescription drugs and investigations by trainee doctors in primary care settings in Oman and the UK. Methods: This audit took place between February and April 2015. The medical records of consecutive patients seen by five family medicine trainee doctors at a primary care setting in Oman were retrospectively reviewed. These data were compared to those gathered from two trainees at a general practice clinic in the UK as well as an experienced general practitioner (GP) who had practiced in both countries. Results: The average number of items prescribed per patient was 1.19, 0.43 and 0.24 and the rate of investigations was 20%, 21% and 11% for Omani trainees, UK trainees and the GP, respectively. Conclusion: This audit suggests that family medicine trainees in Oman prescribe almost three times as many drugs as trainees in the UK. The findings also point towards an over-investigation of the relatively young Omani patient population.
Keywords: Prescriptions; Health Resources; Primary Health Care; Oman; United Kingdom.
Clinical Significance of an Unusual Variation
Anomalous additional belly of the sternothyroid muscle(Case Report) Senthil Murugan M., Sudha R. and Rajesh Bhargavan
ABSTRACT: The infrahyoid muscles are involved in vocalisation and swallowing; among these, the sternothyroid muscle is derived from the common primitive sheet. The improper differentiation of this muscle may therefore result in morphological variations. We report an unusual variation found during the dissection of a 65-year-old male cadaver at the Sri Manakula Vinayagar Medical College, Madagadipet, Pondicherry, India, in 2015. An anomalous belly of the right sternothyroid muscle was observed between the internal jugular (IJ) vein and the internal carotid artery with an additional insertion into the tympanic plate and petrous part of the temporal bone and the presence of a levator glandulae thyroideae muscle. The anomalous muscle may compress the IJ vein if it is related to the neurovascular structures of neck; hence, knowledge of variations of the infrahyoid muscles can aid in the evaluation of IJ vein compression among patients with idiopathic symptoms resulting from venous congestion.
Keywords: Neck Muscles; Thyroid Gland; Cervical Plexus; Jugular Veins; Case Report; India.
Dental and Anaesthetic Challenges in a Patient with Dystrophic Epidermolysis Bullosa
(Case Report) Ali Al-Abadi, Salah A. Al-Azri, Abdulaziz Bakathir and Yusra Al-Riyami
ABSTRACT: Epidermolysis bullosa is a group of rare genetic disorders characterised by skin and mucous membrane fragility and systemic manifestations of variable severity. We report a case of dystrophic epidermolysis bullosa in an 18-year-old male patient who presented to the Department of Oral Health at Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with recurrent dental pain and infections. Due to the poor dental status of the patient and anticipated operative difficulties due to microstomia and limited mouth opening, the patient underwent full dental clearance under general anaesthesia. This article discusses the dental and anaesthetic challenges encountered during the management of this patient and provides a brief literature review.
Keywords: Dystrophic Epidermolysis Bullosa; Dentistry; Disease Management; General Anesthesia; Case Report; Oman.
Relapse of Multiple Myeloma Presenting as Lower Lip Numbness
(Case Report) Yusra M. Al-Riyami, Abdulaziz Bakathir, Khalil Al-Farsi and Faisal Al-Azri
ABSTRACT: Multiple myeloma (MM) is an uncommon malignancy characterised by the proliferation of clonal plasma cells. There are few published reports describing the extramedullary presentation of MM manifesting primarily in the head and neck region. In addition, the occurrence of an isolated relapse of MM in these sites is exceedingly rare. We report a 56-year-old female who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2010 with sudden-onset numbness of the lower lip. She had a history of MM in remission following chemotherapy and a bone marrow transplant. Clinical and radiographic examinations were indicative of a possible relapse of MM, which was subsequently confirmed by bone marrow aspiration and histopathological evaluation. This unique case highlights the unusual site of relapse of a haematolymphoid malignancy.
Keywords: Multiple Myeloma; Relapse; Head and Neck Neoplasms; Plasmacytoma; Case Report; Oman.
Bilateral Anterior Ischaemic Optic Neuropathy in a Child on Continuous Peritoneal Dialysis
Case report and literature review(Case Report) Abdullah Al-Kaabi, Agha S. Haider, Mohammed O. Shafeeq, Mohammed A. El-Naggari, Ibtisam El-Nour and Anuradha Ganesh
ABSTRACT: Non-arteritic anterior ischaemic optic neuropathy (NAION) is a serious complication of continuous peritoneal dialysis (CPD) which can lead to poor vision and blindness. We report a five-year-old girl who had undergone a bilateral nephrectomy at the age of one year and was on home CPD. She was referred to the Paediatric Ophthalmology Unit of Sultan Qaboos University Hospital, Muscat, Oman, in 2013 with acute bilateral vision loss, preceded by a three-day history of poor oral intake. At presentation, the patient had severe systemic hypotension. An ophthalmological examination revealed severe bilateral visual impairment and NAION. She was treated with intravenous methylprednisolone and normal saline boluses. At a five-month follow-up, the visual acuity of the right eye had improved but vision in the left eye remained the same. Acute bilateral blindness due to NAION while on CPD is a rare condition in childhood. Paediatricians should be aware of this complication in order to ensure prompt management.
Missed Gastric Injuries in Blunt Abdominal Trauma
Case report with review of literature(Case Report) Ahmed A. Naiem, Kadhim M. Taqi, Badriya H. Al-Kendi and Hani Al-Qadhi
ABSTRACT: Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate.
Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm
Report of two cases(Case Report) Khalfan S. Al-Senaidi, Abdullah Al-Farqani, Madan Maddali and Salim Al-Maskary
ABSTRACT: A ruptured sinus of Valsalva aneurysm (RSVA) is a rare cardiac anomaly. Traditionally, RSVAs were repaired surgically; however, percutaneous transcatheter closure is the current treatment of choice. We report two cases of RSVA which were closed using this approach. The first case was a 45-year-old female who presented to the
Royal Hospital, Muscat, Oman, in 2014 with a RSVA in the right ventricle. The second case was a 39-year-old male who was admitted to the Sultan Qaboos University Hospital, Muscat, in 2015 with a large multifenestrated RSVA extending into the right ventricle outflow tract. Each patient underwent transcutaneous cardiac catheterisation
using three-dimensional echocardiography. Both interventions were technically successful; however, the second patient required a subsequent surgery due to the continuing presence of a significant shunt. Transcatheter closure of RSVAs is an effective alternative to surgical repair, although large multifenestrated RSVAs should be repaired surgically to ensure complete closure.
Keywords: Sinus of Valsalva; Ruptured Aneurysm; Cardiac Catheterization; Three-Dimensional Echocardiography;
Case Report; Oman.
A Case of Deep Vein Thrombosis and Intracranial Sinus Thrombosis
Possible rare complications of childhood abdominal tuberculosis(Case Report) Geeta Gathwala, Poonam Dalal, Virender Gehlawat, Jasbir Singh and Vandana Arya
ABSTRACT: Severe pulmonary tuberculosis (TB) complicated by deep vein thrombosis (DVT) in adults has been reported previously in the medical literature; however, childhood extrapulmonary TB complicated by DVT is rare. We report a 13-year-old girl who presented to the Department of Pediatrics at the Postgraduate Institute of Medical Sciences in Rohtak, India, in 2012 with abdominal TB complicated by DVT and intracranial sinus thrombosis. She was treated with a course of four antitubercular drugs and short-term anticoagulation therapy with a positive outcome over the next six months. To the best of the authors’ knowledge, no previous reports have yet suggested a possible association between childhood TB and intracranial sinus thrombosis.
Keywords: Deep Vein Thrombosis; Intracranial Sinus Thrombosis; Gastrointestinal Tuberculosis; Case Report; India.
Coexistence of Autism Spectrum Disorders Among Three Children with Tuberous Sclerosis Complex
Case reports and review of literature(Case Report) Amna Al-Futaisi, Ahmed Idris, Abeer Al-Sayegh and Watfa S. Al-Mamari
ABSTRACT: Tuberous sclerosis complex (TSC) is a multisystem neurocutaneous disorder inherited in an autosomal dominant manner and characterised by benign tumours in the brain and other vital organs such as the heart, eyes, kidneys, skin and lungs. Links between autism spectrum disorder (ASD) and TSC have been postulated for many decades, with TSC considered to be one of the main syndromic causes of ASD; however, precise confirmation of a relationship between these two disorders required validated diagnostic tools. Fortunately, accurate evaluation of this relationship is now possible with standardised criteria for ASD diagnosis. We report three children who presented to the Sultan Qaboos University Hospital, Muscat, Oman, between 2014 and 2015 with ASD and TSC. These cases demonstrate the spectrum of neuropsychiatric involvement in TSC and highlight the importance of screening children with TSC for ASD features in order to encourage the early enrolment of these children in educational and rehabilitation programmes.
Keywords: Autism Spectrum Disorder; Tuberous Sclerosis; Case Report; Oman.
Erratum Notice of Author Name Correction: Currently Available Tools and Teaching Strategies for the Interprofessional Education of Students in Health Professions
Literature review(Announcements) No Authors Listed