Sultan Qaboos University Medical Journal is a refereed multidisciplinary journal, published quarterly print and online with free public access to full text articles. It aims to:
1) Be a leading regional medium of biomedical and allied scientific communication that is internationally recognized.
2) Encourage and stimulate medical research and scientific publication within Oman and the Gulf area, while attracting contributions from further a field.
3) Create awareness of developments in medicine and allied fields among health professionals in and outside Oman. SQUMJ is listed in PubMed and indexed in both SCOPUS and the WHO Index Medicus for the Eastern Mediterranean Region.
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.
Sexual Health for Older Women
Implications for nurses and other healthcare providers(Review) Joshua K. Muliira and Rhoda S. Muliira
ABSTRACT: This article presents findings from a review of the evidence regarding sexual health for older women from MEDLINE, SCOPUS and the Cumulative Index to Nursing and Allied Health (CINHAL) databases. A total of 10 articles based on primary studies, reporting about the sexuality or sexual health of older women (and older people), and published between 2002–2012, were deemed suitable. The major themes that emerged from the available literature suggest that the sexual health of older people is affected by factors such as physical changes, mental health, changes to their relationship with their husband, chronic ill health and other psychosocial situations. It is concluded that nurses and other healthcare providers have a range of interventions that can be adopted to promote sexual health among older women. These interventions may focus on improving the older woman’s sexual health assessment; increasing awareness and knowledge about sexuality in later life; pharmacological and psychotherapeutic therapies; using alternative techniques to achieve better sexual functioning; addressing partner and relationship issues, and advocating the importance of sexual health through media and policy development.
Keywords: Female; Aged; Sexual Behaviour; Nursing Care.
Management of Infants and Children who are Contacts of Contagious Tuberculous Patients
(Special Contribution) George Paul, Amal S. Al-Maani, Padmamohan J. Kurup
ABSTRACT: Contact investigation and management form the key for tuberculosis (TB) control in countries with a low tuberculosis incidence. Oman, with a low TB incidence, has implemented contact investigation and management as one important strategy to control TB. However there is a lack of clear guidelines for the investigation and treatment of contacts, especially with regard to children who are contacts of TB cases. The failure to manage children in contact with infectious TB cases indicates a missed opportunity to prevent TB disease in a population which is prone to progress rapidly to severe and complicated illness. This article attempts to provide a concise and practical approach for managing infants and children who are in contact with TB patients. Essential steps in a variety of possible scenarios are briefly discussed.
The Medical Case for a Positron Emission Tomography and X-ray Computed Tomography Combined Service in Oman
(Sounding Board) Naima K. Al-Bulushi, Dale Bailey, Giuliano Mariani
ABSTRACT: The value of a positron emission tomography and X-ray computed tomography (PET/CT) combined service in terms of diagnostic accuracy, cost-effectiveness and impact on clinical decision-making is welldocumented in the literature. Its role in the management of patients presenting with cancer is shifting from early staging and restaging to the early assessment of the treatment response. Currently, the application of PET/CT has extended to non-oncological specialties—mainly neurology, cardiology and rheumatology. A further emerging application for PET/CT is the imaging of infection/inflammation. This article illustrates some of the PET/CT applications in both oncological and non-oncological disorders. In view of the absence of this modality in Oman, this article aims to increase the awareness of the importance of these imaging modalities and their significant impact on diagnosis and management in both oncological and non-oncological specialties for patients of all age groups as well as the decision-makers.
Keywords: Positron Emission Tomography; X-Ray Computed Tomography; Medical Oncology; Oman.
The Identification of Pompe Disease Mutations in Archival Tissues and Development of a Rapid Molecular-based Test
(Original Study) Aliya Alansari, Samira Al-Rawahi, Taher Ba-Omar, Mariam Al-Nabhani, Anand Date
ABSTRACT:Objectives: Pompe disease (glycogen storage disease type II) is a rare autosomal recessive lysosomal storage disease that is caused by acid alpha-glucosidase deficiency. Early enzyme replacement therapy can benefit infants with the disease but the diagnosis is complicated by the rarity of the disease and the heterogeneity of the clinical manifestations. In this study, DNA extracted from archival postmortem formalin-fixed paraffin-embedded tissues was used to identify Pompe disease mutations in Oman and develop a rapid molecular-based test. Methods: Intronic primers were designed to amplify short fragments (193–454 base pairs [bp]) from coding exons (2–20) and screen for mutations using direct sequencing (DS). Results: Two mutations known to cause severe disease were identified in two infants. One was a coding mutation, c.2560C>T (p.Arg854X), and the second was found at a splice acceptor site, c.1327-2A>G. Polymerase chain reaction- and restriction fragment length polymorphism-based tests were designed for the rapid genotyping of the identified mutations. Conclusion: These tests can facilitate prenatal diagnosis and help in identifying carriers in families with the identified mutations.
Diet, physical activity and sleep duration among Omani adolescents(Original Study) Hashem Kilani, Hazzaa Al-Hazzaa, Mostafa I. Waly, Abdulrahman Musaiger
ABSTRACT:Objectives: This study aimed to investigate the lifestyle habits—physical activity (PA), eating habits (EH), and sleep duration (SD)—of Omani adolescents, and to examine gender differences in such variables. Methods: 802 Omani adolescents (442 females and 360 males), aged 15‒18 years were randomly recruited. Anthropometric
indices, PA level, and EH and SD were evaluated by the Arab Teenage Lifestyle questionnaire. A semi-quantitative food frequency questionnaire for dietary assessment was also administered. Results: The results showed that although the study subjects had a sedentary lifestyle (lack of PA, average of 6.7 hours sleep, and consumption of high calorie foods), they maintained a normal body mass (less than 25 Kg/m2). Males were more than twice as active as females. With respect to EH, there were few gender differences, except in dairy and meat consumption where 62.5% and 55.5% of males consumed more than 3 servings, respectively, compared to 18.78 % and 3.76% of females, respectively. In addition, waist/height ratio, height, reasons for being active, energy drinks, potato consumption, eating sweets, vigorous PA and breakfast EHs were statistically significant independent predictors for BMI, P <0.05
for both males and females. Conclusion: This study revealed a high prevalence of sedentary behaviors and a low level of physical activity, especially among females. Unhealthy dietary habits were also widely found among both genders. There is an urgent need for more research as well as a national policy promoting active living and healthy eating and discouraging sedentary behaviour among Omani adolescents.
Clinical Audit of Diabetes Care in the Bahrain Defence Forces Hospital
(Original Study) Marwa M. Al-Baharna and David L. Whitford
ABSTRACT:Objectives: Primary care audits in Bahrain have consistently revealed a failure to meet recognised standards of delivery of process and outcome measures to patients with diabetes. This study aimed to establish for the first time the quality of diabetes care in a Bahraini hospital setting. Methods: A retrospective clinical audit was
conducted of a random sample of patients attending the Diabetes and Endocrine Center at the Bahrain Defence Forces Hospital over a 15-month period which ended in June 2010. The medical records of 287 patients with diabetes were reviewed electronically and manually for process and outcome measures, and a statistical analysis was performed. Results: Of the patients, 47% were male, with a median age of 54 years, and 5% had type 1 diabetes. Measured processes, including haemoglobin A1c, blood pressure, lipids, creatinine and weight, were recorded in over 90% of the patients. Smoking (8%) and the patient’s body mass index (19%) were less frequently recorded. Screening for complications was low, with retinal screening in 42%, foot inspection in 22% and microalbuminuria in 23% of patients. Conclusion: This study shows that the implementation of recognised evidence-based practice continues to pose challenges in routine clinical care. Screening levels for the complications of diabetes were low in this hospital diabetes clinic. It is important to implement a systematic approach to diabetes care to improve the quality of care of patients with diabetes which could lead to a lowering of cardiovascular risk and a reduction in healthcare costs in the long term.
Prevalence and Correlation of Human Papilloma Virus and its Types with Prognostic Markers in Patients with Invasive Ductal Carcinoma of the Breast in Kuwait
(Original Study) Issam M. Francis, Bushra Al-Ayadhy, Shafiqa Al-Awadhi, Kusum Kapila, Fahd Al-Mulla
ABSTRACT:Objectives: This study aimed to document the association of human papilloma virus (HPV) and its types in breast carcinoma tissues in Kuwaiti women, and correlate this with known prognostic markers. Methods: The clinicopathological data of archived tissue from 144 cases of invasive ductal breast carcinoma were studied (age, histological grade, size of tumour, lymph node metastases, oestrogen/progesterone receptors and
human epidermal growth factor receptor 2 status). HPV frequency was documented using immunohistochemistry (IHC) and chromogenic in-situ hybridisation (CISH). HPV types were documented by CISH using HPV probes. CISH and IHC techniques were compared and HPV correlated with prognostic parameters. Results: The HPV prevalence as determined by CISH and IHC was 51 (35.4%) and 24 (16.7%) cases, respectively. The sensitivity of HPV by IHC was 37.3% and specificity was 94.6%. The sensitivity and specificity of HPV-CISH compared to HPVIHC was statistically significant (P <0.001). HPV-CISH was seen in 51 cases. A combination of HPV 6 and 11, and 16 and 18 was seen in 2 (3.9%) cases, and a combination of HPV 6, 11, 31 and 33 was seen in 7 (13.7%) cases. All three HPV probes: 6 and 11, 16 and 18, as well as 31 and 33 were present in 2 (3.9%) cases. The prevalence of HPVCISH in the Kuwaiti and non-Kuwaiti populations was 27 (52.9%) and 19 (37.2%), respectively. No correlation was observed with the prognostic parameters. Conclusion: The frequency of HPV in breast carcinoma cases in Kuwait was 35.4% (CISH). Of those, 52.9% were Kuwaitis in whom both low- and high-risk HPV types were detected.
Keywords: Human Papillomavirus; Breast Neoplasm; Immunohistochemistry; In Situ Hybridization; Kuwait.
Discharge against Medical Advice among Children in Oman
A university hospital experience(Original Study) Muna Al-Sadoon and Khalid Al-Shamousi
ABSTRACT:Objectives: Discharge against medical advice (DAMA) is a major problem in healthcare delivery as it can complicate the health problems from which patients are suffering. The aim of this study was to understand DAMA among children in a tertiary teaching hospital in Oman and to evaluate the documentation of the events in the medical records. Methods: A retrospective survey of the medical records of patients discharged against medical advice over a two-year interval was performed (2004–2006). Results: Of the 11,802 admissions, there were 38 cases of DAMA, giving a prevalence rate of 0.32%. In 39.5% of the cases, the discharge happened within 24 hours of hospital admission. The majority of the cases were infants (n = 24; 63.25%). The diagnosis at discharge in some cases included life-threatening conditions. However, in 57.9% of the cases, the reasons for DAMA were neither reported nor documented in the patients’ medical records. Conclusion: Although the results of this study yielded a low prevalence rate compared to the rates reported in other studies, the occurrence of DAMA for children in a tertiary hospital is a distressing phenomenon. It was evident that the documentation of the DAMA process was poor. More studies should be conducted to understand the details of the problem. Policies should be established and implemented in order to attempt to reduce DAMA among child patients and to protect them from the consequences of such discharges.
Attitudes of Students at Sultan Qaboos University towards the Nursing Profession
(Original Study) Raghda K. Shukri, Bakkar S. Bakkar, Monther A. El-Damen, Samira M. Ahmed
ABSTRACT:Objectives: The aim of this study was to explore the attitudes of Sultan Qaboos University (SQU) students towards the nursing profession. Methods: A sample of 377 students (male = 130; female = 247) were selected from different colleges of SQU, including the College of Nursing. A questionnaire was constructed and validated to assess the attitudes of SQU students towards the nursing profession. Results: Findings revealed that both male and female students in all academic years and colleges had positive attitudes toward the nursing profession. The findings also revealed that gender and academic year created no significant differences (P <0.05) among the study participants, but that the students’ college affiliation did have a significant effect on their attitudes. In particular, nursing students had more positive attitudes than students of other colleges. Conclusion: Findings indicated that the attitudes of SQU students towards the nursing profession were positive, especially those of the nursing students. This means that serious efforts should be made to continue to promote the nursing profession and so ensure that it remains positively regarded by all concerned.
Perinatal Mortality Rate as a Quality Indicator of Healthcare in Al-Dakhiliyah Region, Oman
(Original Study) Asha Santosh, Geeta Zunjarwad, Ilham Hamdi, Jamila A. Al-Nabhani, Bahaa E. Sherkawy, Ibrahim H. Al-Busaidi
ABSTRACT:Objectives: This study aimed to provide insight into the causes of stillbirths and early neonatal deaths and identify better intervention strategies. Methods: This was a retrospective study during a 7-year period (January 2003 to December 2009) of all stillbirths and early neonatal deaths at the Nizwa regional referral hospital in Al-Dakhiliyah region, Oman. Results: Of a total 27,668 births, there were 244 stillbirths and 157 early neonatal deaths. The perinatal mortality rate (PMR) was 14.49/1,000 births. The period-specific rates were 17.23/1,000 in 2003, 18.33/1,000 in 2004, 15.20/1,000 in 2005, 12.20/1,000 in 2006, 12.46/1,000 in 2007 and 12.09/1000 in 2008. This decline in the death rate was significant (P = <0.005). The rate rose in 2009 to 15.63/1,000, mostly from an increase in early neonatal deaths (congenital anomalies). The most common identifiable cause of stillbirth was congenital anomalies (18.82%), in which central nervous system anomalies were most common. Other causes include abruptio placentae (13%), cord accidents (12%), and intrauterine growth restriction (IUGR), while the cause remained unknown in 22.59%. Congenital anomalies accounted for 53.50% of early neonatal deaths followed by prematurity (23.56%) and birth asphyxia (5.73%). Extremes of maternal age were related to higher PMRs. Conclusion: An overall improvement in the stillbirths and neonatal death rates was witnessed; however, further improvement is warranted for common avoidable fetal and maternal risk factors. Extra care needs to be provided for women who are at risk of developing complications such as gestational diabetes, pregnancy-induced hypertension, IUGR, etc.
Systolic Function and Intraventricular Mechanical Dyssynchrony Assessed by Advanced Speckle Tracking Imaging with N-terminal Prohormone of Brain Natriuretic Peptide for Outcome Prediction in CHF Pts.
(Original Study) Faida A. Obaid, Oteh Maskon, Fadillah Abdolwahid
ABSTRACT:Objectives: The aim of this study was to assess longitudinal systolic function and mechanical synchrony parameters derived from advanced speckle tracking echocardiography (STE) and to determine their correlation with N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Their influence on heart failure (HF) outcomes at a one-year follow-up, not clarified in previous studies, was also examined. Methods: Advanced STE was performed from August 2009 to January 2012 in 103 chronic HF patients at the University Kebangsaan Malaysia Medical Center to assess their longitudinal systolic function and synchrony parameters; NT-proBNP blood measurement was taken at the same time. Results: Longitudinal cardiac velocity; strain; strain rate; displacement; intraventricular mechanical dyssynchrony based on the standard deviation (SD) of time to peak systolic strain rate (Tsr-SD); displacement, and antero-septal to posterior (AS-P) delay were associated with cardiac events. In multivariate analysis, NT-proBNP and AS-P delay were identified as independent predictors for cardiac events. Significant correlations were found between NT-proBNP and longitudinal velocity; displacement; strain; strain rate, and ejection fraction. Log NT-proBNP levels correlated moderately with the SD of time to peak displacement and to peak strain, and there was a small correlation with maximal differences and SD of time to peak velocity. A multiple linear analysis revealed that NT-proBNP levels significantly correlated to age, ejection fraction and velocity. Conclusion: Advanced STE is a promising technique which accelerates the clinical application of the quantification of myocardial function and synchrony. STE parameters and NT-proBNP have the ability to identify patients at higher risk of death and hospitalisation.
Keywords: Heart Failure; Echocardiography; Left Ventricular Dysfunction; N-terminal pro-BNP.
A Logarithmic Formula to Describe the Relationship between the Increased Radiosensitivity at Low Doses and the Survival at 2 Gray
(Original Study) Faika A. Azooz and Suzan K. Hash
ABSTRACT:Objectives: Intrinsic radiosensitivity at doses used in radiotherapy is linked to hypersensitivity (HRS) and increased radio resistance (IRR) at low doses. The aim of this study was to explore this relationship. Methods: Survival curves for 18 human tumour cell lines were analysed, using two models to fit the data points in order to extract the necessary parameters relevant for this study. Results: The IRR ratio αs/αr versus the survival at 2 gray (Gy) can be described by a logarithmic relation which leads to a series of straight lines. Conclusion: The relationship obtained implies that there is a direct link between HRS/IRR and survival at clinically relevant doses of 2 Gy.
Non-Steroidal Anti-Inflammatory Drugs and Antibiotics Prescription Trends at a Central West Bank Hospital
(Original Study) Yasin I. Tayem, Marwan M. Qubaja, Riyad K. Shraim, Omar B. Taha, Imadeddin A. Abu Shkheidem, Murad A. Ibrahim
ABSTRACT:Objectives: We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine.Methods: This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Results: Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. Conclusion: These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians’ knowledge of the rational prescription of these agents.
Risk Factors Associated with Denture Stomatitis in Healthy Subjects Attending a Dental School in Southeast Iran
(Original Study) Nader Navabi, Ahmad Gholamhoseinian, Badri Baghaei, Maryam A. Hashemipour
ABSTRACT:Objectives: There is scant information regarding the multifactorial aetiology of denture stomatitis (DS) in the world and, despite its frequency, associated factors are not completely understood. The aim of this study was to investigate the risk factors that may be associated with this lesion. Methods: A total of 70 edentulous patients, all wearing removable dentures, were divided into two groups. The test group comprised 43 patients with DS and the control group comprised 27 subjects with clinically healthy palatal mucosa. A thorough history-taking and physical examination were carried out; the subjects also answered a questionnaire. The serum level of vitamin A for each subject was assayed from a blood sample taken after the examination. Results: This study showed a significant relationship between the incidence of DS and three major factors: denture age (in terms of years), the practitioner manufacturing the dentures (general dental practitioner versus dental hygienist), and the nightlong wearing of dentures. Also, the vitamin A serum level was low in 94.29% of all subjects (cases and controls). Conclusion: Although many predisposing conditions were related to this situation, the most important risk factor was the continuous use of the dentures.
Impact of Valvular Prosthesis Type on Cardiovascular Outcomes in Patients on Chronic Dialysis
(Techinical Note) Jamil Hajj-Chahine, Ziad S. Dahdouh, Tony Abdel-Massih
ABSTRACT: There is conflicting evidence guiding valve prosthesis selection in patients with end-stage renal disease on dialysis. We sought to determine, after reviewing the relevant literature, the best valve substitute in patients on chronic dialysis. A total of 9 retrospective studies compared the outcomes of two valves, showing similar results and highlighting the safety of implanting bioprostheses in patients on chronic dialysis. Standards of valve selection have changed over time; it has long been believed that tissue valves undergo premature degeneration due to calcium metabolism derangements in patients with end-stage renal disease. Bleeding was the most common valve-related complication and represented a major drawback of mechanical valves. Two studies demonstrated a survival advantage in favour of mechanical prostheses. It can be concluded that surgeons should not hesitate to implant bioprostheses because singular valve decomposition would be uncommon in this patient population. Prosthesis selection should be based on the same criteria as those used for non-dialysis patients.
Multiple Enteric Duplication Cysts in a Twin Fetus
Diagnosis and management(Case Report) Shahila Sheik,1 Mariam Mathew,1 Mohamed Abdellatif,2 Asim Qureshi,3 Prakash Mandhan4
ABSTRACT: Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract. These can be suspected if cystic lesions are noted in the fetal abdomen during an antenatal ultrasonogram. The differential diagnoses of fetal intra-abdominal cystic lesions include fetal omental cysts, fetal mesenteric cysts, meconium pseudocysts and fetal ovarian cysts. We report an antenatally diagnosed enteric duplication cyst in one of a set of twin fetuses which was managed successfully. Keywords: Congenital Abnormalities; Cysts; Twin Pregnancy; Ultrasonography; Prenatal Diagnosis; Peritoneal Neoplasm; Intestinal Malrotation, Familial; Case report; Oman.
Sporadic Lateral Ventricular Hemangioblastoma presenting with Intraventricular and Subarachnoid Haemorrhage
(Case Report) Mahasen Al-Najar, Azmy Al-Hadidy, Alaa Saleh, Ahmad Al-Tamimi, Asaad Al-Darawish, Fatima Obeidat
ABSTRACT: Intraventricular hemangioblastoma (HB) is very rare; few cases of intraventricular HB have been reported in the literature, either sporadically or in association with von Hippel-Lindau disease. Furthermore, the incidence of ventricular haemorrhage from HB seems to be uncommon. We report a unique case of sporadic HB of the right lateral ventricle presenting with intratumoural and intraventricular haemorrhage in addition to multifocal intracranial superficial siderosis, indicating the presence of a subarachnoid haemorrhage (SAH) as well. Such a combination has not been reported before. In the future, the detection of an intraventricular mass in association with ventricular haemorrhage, with or without SAH, should include HB as a differential diagnosis, particularly when the imaging appearances are not typical of the more common intraventricular tumours.
Keywords: Hemangioblastoma; Lateral Ventricle; Subarachnoid Hemorrhage; von Hippel-Lindau Disease; Case Report; Jordan.
A Massive Tuberculosis Abscess at the Erector Spinae Muscles and Subcutaneous Tissues in a Young Man
(Case Report) Kawther T. Elshafie, Mustafa M. Al-Hinai, Hamdan A. Al-Habsi, Mohammed S. Al-Hattali, Osama Hassan, Rashid Al-Sukaiti
ABSTRACT: Tuberculosis (TB) is a chronic granulomatous infection which can present in an atypical form. Isolated muscle involvement is very rare. We report a 25-year-old man who presented with a massive cystic swelling on the right side of his back, extending from the lower thoracic to the gluteal region. He had a history of contact with a friend who was suspected of having TB. Magnetic resonance imaging (MRI) showed that the origin of the cyst was from the erector spinae muscles. The result of a fluid aspirate showed acid fast bacilli. The swelling disappeared after treatment with anti-tuberculous medications. Muscular involvement in TB is very rare. In our patient, the reports of an ultrasound and MRI confirmed isolated muscle and subcutaneous involvement without bony lesions. This case is reported to increase physician awareness regarding soft tissue TB. Although it is rare, similar cases may be seen in the future.
Keywords: Tuberculosis; Muscle; Abscess; Cyst; Case Report; Oman.
Migrating Ingested Foreign Body of the Upper Aerodigestive Tract with Resultant Septic Shock
Case report and literature review(Case Report) Keshav Pai, Suresh Pillai, Ajay Bhandarkar, Aishwarya Anand, Harshita Sabhahit
ABSTRACT: Complications due to foreign body ingestion are rare; however, if present, these can cause significant morbidity to the patient. An overlooked ingested foreign body could present as an emergency and may prove fatal. We present a case of an accidentally ingested foreign body with delayed presentation, which migrated to the neck and produced a cervical abscess presenting as septic shock. The patient required prompt stabilisation followed by surgical intervention. The patient’s vital signs returned to normal on the second post-operative day, and he was discharged the following day.
Keywords: Foreign-Body Migration; Septic Shock; Abscess; Case Report; India.
Spontaneous Intracranial Hypotension with Magnetic Resonance Localisation of Spinal Cerebrospinal Fluid Leak
(Case Report) Yahya H. Al-Brashdi, Sameer Raniga, Sharma R. Revati
ABSTRACT: To increase the awareness of spontaneous intracranial hypotension (SIH), we report in this paper a middle-aged woman who presented with an intractable headache that worsened in sitting and standing positions (a postural headache). Magnetic resonance imaging (MRI) of the spine demonstrated a cerebrospinal fluid (CSF) leak at the level of the cervical spine, in addition to typical features in a brain MRI, including symmetrical subdural collections, circumferential dural enhancement and features of midbrain sagging. The patient underwent a surgical repair of the cervical CSF leak which resulted in a dramatic symptomatic improvement that was confirmed by follow-up imaging.