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 DOAJ. It is indexed in both SCOPUS and the WHO Index Medicus for the Eastern Mediterranean Region.
Customised, Individualised Treatment of Metastatic Non-Small-Cell Lung Carcinoma (NSCLC)
(Review) Muhammad Furrukh, Mansour Al-Moundhri, Khawaja F. Zahid, Shiyam Kumar, Ikram Burney
A series of phase II and randomised phase III trials in Asia and Europe have confirmed recently that advanced stage non-small-cell lung carcinoma patients with adenocarcinoma subtypes harbouring specific mutations when subjected to targeted therapy experience equivalent survival outcomes as those treated with chemotherapy and are spared from its side effects. The concept of chemotherapy for all is fading, and therapy optimisation has emerged as a paradigm shift in treatment. This article briefly describes cellular mechanisms involved in lung carcinogenesis which provide a molecular basis for targeted therapy. Advances in molecular biology have improved our understanding of mechanisms involved in primary or secondary drug resistance. Evolving biomarkers of prognostic and predictive importance, and the impact of translational research on outcomes are also covered. A marker is considered prognostic if it predicts the outcome, regardless of the treatment, and predictive if it predicts the outcome of a specific therapy.
The Asthma Cost in Oman
(Original Study) Nasser H. Al-Busaidi, Zulfikar Habibullah, Joan B. Soriano
Objectives: This study evaluates the direct costs of treating asthma in Oman. Methods: Asthma prevalence and unit cost estimates were based on results from a panel using the Delphi technique, and were applied to the total Omani population aged 5 and older to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise were multiplied by the percentage of patients using government facilities to estimate the number of asthma patients managed in Oman. Treatment costs were also calculated using data from the Delphi exercise and the Asthma Insights and Reality for the Gulf and Near East study (reported in Omani riyals [OMR] and US dollars [USD]). Results: The prevalence of asthma was estimated to be 7.3% of adults (n = 96,470) and 12.7% of children (n = 58,344). Of these, 95% of both adults and children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest proportion of total direct costs (55%), followed by emergency room and outpatient visits (25% and 20%, respectively) and medications (<0.2%). The annual cost of treatment excluding medications, was OMR 34,273,696 (USD 89,111,609) for adults and OMR 27,014,735 (USD 70,238,311) for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over OMR 61,500,294 (USD 159,900,761). Conclusion: Given the high medical expenditures associated with facility visits relative to the lower medication costs, the focus of Oman’s asthma cost savings should be on improving asthma control rather than reducing medication costs.
Keywords: Asthma; Cost of asthma; Asthma medications; Economy; Health service utilization; Oman.
Vitamin D Status and Anthropometric Indices of an Omani Study Population
(Original Study) Clifford Abiaka, Marit Delghandi, Meenu Kaur, Mohsin Al-Saleh
Objectives: Serum 25-hydroxyvitamin D [25(OH)D] concentrations reflect vitamin D status, with deficiency implicated as causative of many diseases. This study assessed vitamin D status and anthropometric indices in a sample of healthy Omanis. Methods: Serum 25(OH)D concentrations were measured by high performance liquid chromatography in 206 healthy Omanis, aged 18–55 years (mean age: men 31.1, women 26.8) in Muscat, Oman. Of this number, 95% indicated that they had never taken vitamin D supplements. Findings were compared with published values for populations domiciled in more northerly latitudes. Classical procedures were used to determine global obesity (body mass index [BMI]), and central obesity determined by waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio. Results: Women, as compared to men, had markedly lower concentrations of 25(OH)D. Applying the cut-off point of serum 25(OH)D levels at 50 nmol/L, the prevalence of vitamin D deficiency in the study population was 87.5%; this was higher than the rates reported for the British, and European-, Hispanic-, and African-Americans. At a BMI cut-point of ≥30 kg/m2, the prevalence of obesity was 14.6%; this was lower than the rates reported for European-, Hispanic-, and African-Americans. Levels of 25(OH) D increased relative to age and obesity. WHR was the main predictor of 25(OH)D levels. Conclusion: The striking vitamin D deficiency seen in the study population, relative to more northerly populations, may be linked to sun avoidance, inadequate dietary vitamin D, and virtual non-intake of supplemental vitamin D. Age and male-gender determined the status of vitamin D and of obesity.
Predictors of Human Immunodeficiency Virus Knowledge among Jordanian Youths
(Original Study) Esra M. Al-Khasawneh, Leyla Ismayilova, Vidya Seshan, Olimat Hmoud, Nabila El-Bassel
Objectives: Understanding factors associated with the level of human immunodeficiency virus (HIV) knowledge acquisition is crucial to inform preventative programmes for young people. This study examines predictors of HIV knowledge among Jordanian youths. Methods: A cross-sectional survey was conducted among 8,129 youths aged between 14 and 25 years randomly selected from schools representing each of the 12 governorates of Jordan. A total of 50% of respondents were female and, on average, 17 years old. Participants completed a self-administered questionnaire covering sociodemographic characteristics, HIV knowledge, gender awareness, exposure to and favourable attitudes toward risky behaviours. Results: On a 13-item HIV knowledge test, participants answered an average of 7 questions correctly (mean = 7.21; standard deviation = 2.63). Female respondents from rural areas demonstrated significantly lower levels of HIV knowledge, while college and university students demonstrated higher levels. HIV knowledge differed significantly by sources of information, with peeracquired information associated with more accuracy, while HIV information from parents or health centres was associated with a lower score. Youths with more egalitarian gender views also demonstrated higher knowledge levels, whereas youths approving of drug use showed lower levels of HIV knowledge. Conclusion: HIV education programmes in Jordan should focus on females and youths living in rural areas. Educational institutions have been shown to be effective in providing accurate information to students, while parents and health professionals should also be included in HIV prevention programmes in order to reduce misconceptions and raise the level of HIV knowledge among Jordanian youths.
Keywords: HIV knowledge; Youth; Jordan; Middle East.
Idiopathic Granulomatous Mastitis
Diagnostic strategy and therapeutic implications in Omani patients(Original Study) Adil Al-Jarrah, Varna Taranikanti, Ritu Lakhtakia, Asma Al-Jabri, Sukhpal Sawhney
Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. Methods: From 2009–2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. Results: The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11–33 months). All patients had complete remission with no further recurrence. Conclusion: This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM’s excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat.
Reasons for Consultation among Patients attending Primary Healthcare Centres in Oman
(Original Study) Ahmed Al-Mandhari, Samir Al-Adawi, Ibrahim Al-Zakwani, Atsu Dorvlo, Mohammed Al-Shafaee
Objectives: Pathways to care or care-seeking, which translate into healthcare utilisation, have been investigated in many parts of the world, but there is a dearth of studies in the Arabian Gulf. The aim of this study was to examine the characteristics of attendees at primary healthcare centres in northern Oman and their reasons for visiting. Methods: Face-to-face interviews were conducted with 676 participants attending 12 primary healthcare centres between June and July 2006. The catchment area was selected to represent the population structure in Oman. The 12-item questionnaire was read to every fifth eligible patient entering each healthcare centre for a routine appointment. Analyses were conducted using univariate statistics. Results: About a third (n = 200; 29.6%) of the participants had a history of chronic illness; 231 (34%) were on regular medications; 211 (31%) were taking part in health education programmes; 130 (19%) were open to complementary medicine. The majority of the participants mentioned physician's advice (n = 570; 84%) as the strongest reason for seeking consultation. Conversely, physician's advice was strongly related to particular demographic factors. Conclusion: This observational study identified some characteristics and reasons for visiting healthcare facilities in northern Oman. These are discussed within the context of prevailing sociocultural factors. The implications for the prevention and detection of ill health in Oman are also discussed.
Keywords: Patient Acceptance of Healthcare; Attitude to Health; Community Health Centers; Physician-Patient Relations; Oman.
Does Haloperidol Prophylaxis Reduce Ketamine-Induced Emergence Delirium in Children?
(Original Study) Mostafa A. M. Amr, Tarek Shams, Hamid Al-Wadani
Objectives: Ketamine is a non-barbiturate agent with rapid action onset that induces profound sedation; however, some emergency physicians tend not to use ketamine because of the risk of emergence delirium (ED). This study aimed to evaluate the effectiveness of haloperidol prophylaxis in postoperative ketamine delirium in children. Methods: Prospective data relating to any emergence dreams, delirium, hallucinations, agitation, crying, altered perceptions, and necessary interventions were recorded in consecutive cases of ketamine delirium in patients attending Mansoura University Hospital, Egypt, from June 2010 to May 2011. Results: A total of 537 records were available for analysis. Of those, 267 received prophylactic haloperidol (49.7%). There were significant differences between the two groups regarding post-anaesthetic care unit behaviour. The ketamine-haloperidol groups included more patients who were sleepy, calm (P ≤0.01) and less irritable (P ≤0.01), with a lower incidence of crying (P ≤0.01) and disorientation (P ≤0.01). Conclusion: We found that preoperative administration of haloperidol decreases the incidence of postoperative delirium in a sample of Egyptian children undergoing minor surgery. This is congruent with earlier work conducted in adults. This work carries great hope to decrease and even prevent ED in hospitalised, non-surgical patients. Keywords: Ketamine; Anesthesia; Children; Delirium; Haloperidol; Egypt.
A Study of Adiponectin in Children with Diabetes Mellitus
(Original Study) Basma A. Ali, Doaa M. Mahrous, Ahlam M. Abdallah, Mina Fikri
Objectives: Adiponectin is a hormone produced by adipose tissue. It is secreted exclusively by adipocytes and appears to play a role in the pathophysiology of obesity, diabetes mellitus (DM), and its comorbidities. The aim of this study was to assess adiponectin levels in diabetic children with type 1 DM (T1DM) and type 2 DM (T2DM), and to detect its prognostic role in them. Methods: This study was undertaken from April to July 2011 at Minia University Children’s Hospital, Egypt, and included 314 children aged 2–18 years divided into two patient groups. Group I consisted of 164 pre-diagnosed diabetic patients, further subdivided into Group Ia which included 142 patients with T1DM and Group Ib, 22 patients with T2DM; Group 2 included 150 apparently healthy children as a controls; they were age- and sex-matched to the diseased group. Patients were subjected to a thorough history taking, clinical examination, and laboratory investigations including assessment of HbA1c percentages, fasting C-peptide levels, lipid profiles and fasting serum adiponectin levels. Results: Adiponectin levels did not differ significantly between patients with T1DM and T2DM, but it was significantly higher in diabetic patients than in the controls. In T1DM, adiponectin had positive significant correlations with the duration of the disease and waist circumference, while in T2DM, it had a positive significant correlation with the dose of insulin given and negative significant associations with diastolic blood pressure, cholesterol, and C-peptide levels. Conclusion: The results of the study suggest that adiponectin can play a protective role against the metabolic complications of DM. Keywords: Diabetes mellitus; Adiponectin; Insulin resistance; Egypt.
Prevalence of Urinary Incontinence and Probable Risk Factors in a Sample of Kurdish Women
(Original Study) Hamdia M. Ahmed, Vian A. Osman, Shahla K. Al-Alaf, Namir G. Al-Tawil
Objectives: The most common manifestation of pelvic floor dysfunction is urinary incontinence (UI) which affects 15–50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. Methods: A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. Results: The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus (DM), chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. Conclusion: A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM.
Cost Comparison between Laparoscopic and Open Appendectomies in Children
(Original Study) Shahzad Y. Khan, Zainab N. Al-Balushi, Khalid M. Bhatti, Toufique Ehsan, Prakash Mandhan
Objectives: Laparoscopic appendectomy (LA) for children has become very popular and is routinely performed in most health care centres around the world. The cost of surgical procedures is always a concern for patients and health care providers. This study compares, the total cost of open appendectomy (OA) with LA in children who required an appendectomy for acute appendicitis. Suitable and safe cost-effective techniques were also explored to reduce the cost of these procedures. Methods: The medical records of all the children (ranging between 0 and 12 years) at Sultan Qaboos University Hospital in Oman, who required OA or LA from June 2009 to July 2011, were reviewed. Results: LA were performed in 75 patients while OA were done in 34. Patients from the OA and LA groups were age- and gender-matched. The average operative time was 76 minutes for LA and 49 minutes for OA (P <0.001) while the average hospital stay was 3.14 days for LA and 2.15 days for OA (P = 0.08). The average cost of the two procedures was Omani riyals (OMR) 534 for LA and OMR 343 for OA (P = 0.00). The complication rate following procedures was lower in the case of LA, however this was not statistically significant (LA = 8% versus OA = 11.7 %, P = 0.32). Conclusion: LA are costlier procedures than OA, however they are as safe as OA, and do not increase morbidity or the duration of hospital stay.
Keywords: Appendicitis; Appendectomy; Costs and Cost Analysis; Oman.
The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears
Experience at King Hussein Medical Center, Jordan(Original Study) Asem A. Al-Hiari
Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. Methods: The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA) and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93%) and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39), and specificity was 80% (16/20). The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34). Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.
Keywords: Triangular fibrocartilage complex; Wrist; Magnetic resonance imaging; Arthrography.
Job Stress and Burnout among Academic Career Anaesthesiologists at an Egyptian University Hospital
(Original Study) Tarek Shams and Ragaa El-Masry
Objectives: There is compelling evidence that anaesthesiology is a stressful occupation and, when this stressful occupation is associated with an academic career, the burnout level is high. This study aimed to assess the predictors and prevalence of stress and burnout, associated sociodemographic characteristics, and job-related features. Methods: A cross-sectional survey study was carried out at Mansoura University Hospital in Egypt among 98 anaesthesiologists who had academic careers. The English version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale and the Workplace Stress Scale of the American Institute of Stress were used to measure job stress and burnout. Data were analysed according to the guidelines for data processing and an analysis of the scales used. Results: The participation rate of this study was 73.1%, where 69.4% were encountering job stress, while 62.2% experienced emotional exhaustion, 56.1% depersonalisation, and 58.2% reduced personal capacity. There was a significant positive correlation between job stress and MBI-HSS subscales. Residents and assistant lecturers were the most affected group. The strongest significant single predictor of all burnout dimensions was a lack of job support. Conclusion: Stress and burnout among academic anaesthesiologists were caused by the lack of job support; this was especially true among residents and assistant lecturers. We can conclude that a well-organised institutional strategy to mitigate the heavy professional demands of academic anaesthesiologists’ will relieve their stress and burnout.
Keywords: Job stress; Burnout; University career anesthesiologists; Egypt.
Measurement of Impairment among Children with Attention Deficit Hyperactivity Disorder as Part of Evaluating Treatment Outcome
(Brief Communication) Ahmed M. Al-Ansari
ABSTRACT:Objectives: This study assesses the impairment and treatment outcome of children with attention deficit hyperactivity disorder (ADHD) in an outpatient child psychiatry clinic, using multiple sources, including the Children Global Assessment Scale (C-GAS). Methods: A total of 20 children, aged 4 to 16 years, were recruited serially in 2010 from the Child Psychiatric Unit of the Psychiatric Hospital, Manama, Bahrain. The children received a diagnosis of ADHD using the Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR). The children were assessed with the C-GAS by a blinded investigator, initially at the beginning of the treatment and then one year later. Results: The parents of the patients reported improvement in all cases; the improvement in impairment after one year, assessed using the C-GAS, was significant for all of the cases (P = 0.001) and low for those with comorbidity (P = 0.07). Conclusion: Measurement of improvement using the C-GAS was a suitable method of collecting data, and hence should be included in routine clinical practice for both ADHD diagnosis and outcome measurement.
One in Three: Congenital Bent Bone Disease and Intermittent Hyperthermia in Three Siblings with Stuve-Wiedemann Syndrome
(Case Report) Roshan Koul, Adila Al-Kindy, Renjith Mani, Dilip Sankhla, Amna Al-Futaisi
Stuve-Wiedemann syndrome (STWS) is a rare disorder characterised by congenital bowing of the long bones, contractures of the joints, neonatal onset of respiratory distress, sucking and swallowing difficulties, dysautonomia presenting as episodic hyperthermia, and usually an early death. Three siblings from a consanguineous marriage presented with similar clinical features over 16 years. STWS was established with their last child at the beginning of 2012. All the children exhibited the onset of STWS in the neonatal period with fever and generalised hypotonia. Examinations of all the infants revealed camptodactyly, micrognathia, bent long bones with wide metaphyses, and hypotonia. Only the second affected child had myotonia, demonstrated by electromyography. Unusual pyrexia as a presenting feature in this syndrome needs early recognition so that extensive and elaborate investigations can be avoided. The disorder is usually caused by a mutation in the leukaemia inhibitory factor receptor gene.
Keywords: Stuve-Weidemann syndrome; Schwartz-Jampel syndrome; Myotonia; Pyrexia; Case report; Oman.
Implications of a Chr7q21.11 Microdeletion and the Role of the PCLO Gene in Developmental Delay
(Case Report) Roberto L. Mazzaschi, Fern Ashton, Salim Aftimos, Alice M. George, Donald R. Love
We report here a 4-year-old boy with global developmental delay who was referred for karyotyping and fragile X studies. A small interstitial deletion on chromosome 7 at band 7q21 was detected in all cells examined. Subsequent molecular karyotype analysis gave the more detailed result of a 6.3 Mb heterozygous deletion involving the interstitial chromosome region 7q21.11. In this relatively gene-poor region, the presynaptic cytomatrix protein, Piccolo (PCLO) gene appears to be the most likely candidate for copy number loss leading to a clinical phenotype. G-banded chromosome analysis of the parents showed this deletion was inherited from the father. Molecular karyotype analysis of the father’s genome confirmed that it was the same deletion as that seen in the son; however, the father did not share the severity of his son’s phenotype. This cytogenetically-visible deletion may represent another example of a chromosomal rearrangement conferring a variable phenotype on different family members.
Keywords: PCLO protein, human; Haploinsufficiency; Chromosome7, trisomy 7q; Case report; New Zealand.
Clinical Outcomes and Counselling Issues regarding Partial Trisomy of Terminal Xp in a Child with Developmental Delay
(Case Report) Karen L. Sheath, Roberto L. Mazzaschi, Salim Aftimos, Nerine E. Gregersen, Alice M. George, Donald R. Love
Female carriers of balanced translocations involving an X chromosome and an autosome offer genetic counselling challenges. This is in view of the number of possible meiotic outcomes, but also due to the impact of X chromosome-localised genes that are no longer subject to gene silencing through the X chromosome inactivation centre. We present a case where delineation of the extent of X chromosome-localised genes on the derivative autosome using molecular karyotyping offers critical information in the context of genetic counselling.
Keywords: Trisomy; X chromosome, monosomy Xp22 pter; X chromosome inactivation; Receptors, gastrinreleasing peptide; KAL-1 protein; Case report; New Zealand.
Severe Pulmonary Involvement in Leptospirosis
Alternate antibiotics and systemic steroids(Case Report) Jayakrishnan B, Fatma Ben Abid, Abdullah Balkhair, Juma K. Alkaabi, Omar A. Al-Rawas, Jojy George, Khalfan Al-Zeedy
Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem (1 g every 8 hours), moxifloxacin (400 mg once daily), and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions.
Keywords: Leptospirosis; Human ARDS; Steroids; Case report; Oman.
Asymptomatic Ileal Schwannoma presenting as a Mesenteric Tumour
Case report and review of literature(Case Report) Shahzad Y. Khan, Khalid M. Bhatti, Sreedharan V. Koliyadan, Marwa Al Riyami
A schwannoma is a benign tumour which arises from the schwann cells of the central or peripheral nervous system. Common sites include the head and limbs; it is rare that this tumour arises from the gastrointestinal tract’s neural plexus. It is even rarer to find the ileum as the site of origin. We report a patient who presented with a central abdominal mass which was preoperatively diagnosed as a mesenteric tumour. However, immunohistochemistry of the surgically-removed specimen proved it to be a benign ileal schwannoma.
Adrenal Oncocytic Neoplasm with Uncertain Malignant Potential
(Case Report) Mooyad A. Ahmed, SureshKannan K. S., Zaid R. Raouf, Sreedharan V. Koliyadan, Christopher S. Grant, Ahmed H. Al-Habsi, P. A. M Saparamadu, Dhuha Al-Sajee
ABSTRACT: Adrenal oncocytic neoplasms (AONs) are a rare group of tumours with a somewhat uncertain natural history and clinical behaviour. Out of 46 cases of AON reported to date, 6 cases were histologically classified as neoplasms with uncertain malignant potential. We report the case of a 35-year-old male with an incidentally detected large AON with mostly benign morphology and some characteristics which would make its behaviour uncertain.
Keywords: Adrenal tumors; Oncocytoma; Adrenal incidentaloma; Case report; Oman.
Palpitations caused by a Seizure with Autonomic Features
(Case Report) Kawther T. El-Shafie
Palpitations are a common symptom of presentation in medical practice. They are usually caused by cardiac arrhythmias, psychiatric problems or other miscellaneous causes, such as anaemia or endocrine causes. They are rarely due to autonomic seizures. We report a 55-year-old woman who presented at Sultan Qaboos University Hospital, Oman, with recurrent episodes of palpitations. Her associated symptoms included breathlessness and excessive sweating, followed by a sensation of dizziness. During subsequent episodes, she experienced symptoms of rising abdominal pain followed by a loss of consciousness. Positive electroencephalogram findings, as well as the response of the symptoms to antiepileptic drugs, were strongly suggestive of temporal lobe epilepsy as the possible diagnosis. The fact that the cardiac investigations, performed during an interictal period, were unremarkable also supports the hypothesis that the palpitations were linked to seizures. Epilepsy should be considered as a differential diagnosis of palpitations, especially if the palpitations are episodic.
Keywords: Arrhythmias, Cardiac; Epilepsy, Temporal Lobe; Seizures; Case Report; Oman.
Large Complex Odontoma
A report of a rare entity(Case Report) Audrey M. D'Cruz, Sushmini Hegde, Urvashi A. Shetty
Odontomas are hamartomatous lesions composed of mature enamel, dentin, and pulp, and may be compound or complex depending on the extent of morphodifferentiation or on their resemblance to normal teeth. They are the most common benign odontogenic tumours, constituting 22% of all odontogenic tumours of the jaw. They are often non-aggressive and slow growing in nature, and are usually diagnosed on routine radiological examinations in the second decade of life. We report the case of an unusually large, painless, complex odontoma, which is a rare entity. It was located in the left posterior mandible and was associated with missing 1st and 2nd left mandibular molars. The diagnosis was confirmed following surgical excision and histopathological analysis of the lesion.
Keywords: Odontoma; Radiopacity; Odontogenic tumor; Cysts; Case report; India.
Maxillary First Molar with Two Root Canals
(Case Report) Saeed Rahimi and Negin Ghasemi
Knowledge regarding the anatomic morphology of maxillary molars is absolutely essential for the success of endodontic treatment. The morphology of the permanent maxillary first molar has been reviewed extensively; however, the presence of two canals in a two-rooted maxillary first molar has rarely been reported in studies describing tooth and root canal anatomies. This case report presents a patient with a maxillary first molar with two roots and two root canals, who was referred to the Department of Endodontics, Tabriz University of Medical Sciences, Iran.
Sonographic Detection of Pseudoaneurysm in Vascular Injury in Emergency Department
(Case Report) Li-Jen Chien, Yu-Jang Su, Chang-Chih Chen, Weide Tsai
A 31-year-old man suffered from a stab wound to the lower extremity. The patient had a hard sign of a vascular injury (a diminished distal pulse) and therefore probably should have undergone operative repair, but refused. One week later, he returned to our emergency department with a painful right thigh swelling. Bedside sonography was used to detect a pseudoaneurysm. Emergency sonography is a fast, non-invasive, and rapid decision-making approach in emergency practice.