Sultan Qaboos University Medical Journal

Sultan Qaboos University Medical Journal

Basic info

  • Publisher: Sultan Qaboos University
  • Country of publisher: oman
  • Date added to EuroPub: 2017/Sep/12

Subject and more

  • LCC Subject Category: Biochemistry, Biomedicine, Medicine
  • Publisher's keywords: Medicine, Biomedicine, Community Health, Family Medicine, Health Sciences, Biochemistry
  • Language of fulltext: english
  • Full-text formats available: PDF

Publication charges

  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

Editorial information

Open access & licensing

  • Type of License: CC BY
  • License terms
  • Open Access Statement: Yes
  • Year open access content began: 1999
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

Best practice polices

  • Permanent article identifier: DOI
  • Content digitally archived in: LOCKSS
  • Deposit policy registered in: None

This journal has '1136' articles

Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy Case report

Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy Case report

Authors: Mohamad Iqhbal, Julina M. Noor, Nur A. Karim, Izzat Ismail, Halim Sanib, Mohd A. Mokhtar, Safreeda S. F. Salim
( 18 downloads)
Abstract

Te use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. Te patient was therefore referred for an emergency tracheostomy. Tis case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. Tis imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.

Keywords: Emergency Medicine; Stridor; Ultrasonography; Airway Management; Tracheostomy; Case Report; Malaysia
Rituximab Treatment in Myasthaenia Gravis Report of two paediatric cases

Rituximab Treatment in Myasthaenia Gravis Report of two paediatric cases

Authors: Roshan Koul, Amna Al-Futaisi, Rana Abdelrahim, Renjith Mani, Reem Abdwani, Abdullah Al-Asmi
( 16 downloads)
Abstract

Myasthaenia gravis (MG) is an autoimmune disease involving the postsynaptic receptors in the neuromuscular junction. Te condition is characterised by fatigable weakness of the skeletal muscles and is uncommon in children. Acetylcholinesterase inhibitors and immune-modifying medications are usually considered the mainstay of treatment. However, these medications have to be given on a lifelong basis so that patients remain in remission; furthermore, drug-related side-effects can have a major impact on quality of life. We report two paediatric cases who were treated for MG at the Sultan Qaboos University Hospital, Muscat, Oman, in 2007 and 2008, respectively. Rituximab was eventually administered to each patient after their condition failed to improve despite several years of standard treatment with acetylcholinesterase inhibitors and immune-modifying medications. Overall, rituximab resulted in complete remission in one case and signifcant clinical improvement in the other case.

Keywords: Myasthenia Gravis; Rituximab; Children; Cholinergic Receptors; Case Report; Oman
Recurrent Dermatofbrosarcoma Protuberans with Pigmentation and Myoid Differentiation

Recurrent Dermatofbrosarcoma Protuberans with Pigmentation and Myoid Differentiation

Authors: Surekha Yadav, Nidhi Verma, Nita Khurana, Sushant Neogi
( 17 downloads)
Abstract

Dermatofbrosarcomas protuberans (DFSP) are rare low-grade tumours with various subtypes and usually occur among middle-aged adults. However, myoid differentiation is very rare. We report a 44-year-old woman who presented to the Lok Nayak Jai Prakash Hospital, New Delhi, India, in 2017 with a recurrent pigmented DFSP presenting as an arm swelling. Upon histological and immunohistochemical analysis, myoid differentiation was confrmed. A literature review of the clinical and histopathological features of this rare entity is presented.

Keywords: Dermatofbrosarcoma Protuberans; Melanocytes; Pigmentation; Cell Differentiation; Case Report; India
Pulmonary Glue Embolism An unusual complication following endoscopic sclerotherapy for gastric varices

Pulmonary Glue Embolism An unusual complication following endoscopic sclerotherapy for gastric varices

Authors: Philips G. Michael, Georgios Antoniades, Anca Staicu, Shahid Seedat
( 21 downloads)
Abstract

A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butylcyanoacrylate and lipiodol). Tis condition may be associated with a delayed onset of respiratory compromise. Terefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infrmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. Te aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.

Keywords: Gastric Varices; Pulmonary Embolism; Sclerotherapy; N-butyl-cyanoacrylate; Lipiodol; Case Report; United Kingdom
Pulmonary Alveolar Microlithiasis A commonly misdiagnosed rare entity

Pulmonary Alveolar Microlithiasis A commonly misdiagnosed rare entity

Authors: Alkesh Khurana, Rajesh Malik, Jitendra Sharma, Ujjawal Khurana, Abhishek Goyal
( 13 downloads)
Abstract

Pulmonary alveolar microlithiasis (PAM) is an uncommon entity which can pose a diagnostic challenge. We report a 45-year-old female who was referred to the All India Institute of Medical Sciences, Bhopal, India, in 2017 with a two-year history of progressively worsening dyspnoea and dry coughing. She had been previously diagnosed with pulmonary tuberculosis elsewhere and prescribed antitubercular therapy; however, there was little improvement in her symptoms. Following referral, the patient was diagnosed with PAM based on high-resolution computed tomography fndings and the abundance of lamellar microliths in a bronchoalveolar lavage sample. She was subsequently managed symptomatically and enrolled in a rehabilitation programme.

Keywords: Calcinosis; Pulmonary Alveolar Microlithiasis; Pulmonary Tuberculosis; Misdiagnosis; Case Report; India
Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion Despite Treatment with Appropriate Antimicrobials Case report

Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion Despite Treatment with Appropriate Antimicrobials Case report

Authors: Kowthar S. Hassan, Ghalib Al-Khadouri
( 11 downloads)
Abstract

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. Te pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.

Keywords: Mycoplasma pneumoniae; Bacterial Pneumonia; Pleural Effusion; Antimicrobial Agents; Drainage; Case Report; Oman
Uremic Leontiasis Ossea

Uremic Leontiasis Ossea

Authors: Uremic Leontiasis Ossea
( 13 downloads)
Abstract

Tree-dimensional reconstructions of the (A) facial features and (B) bones of a 23-year-old female with uremic leontiasis ossea based on non-contrast sinus computed tomography of the (C) mandible and (D) maxilla.

Keywords: Uremic, Leontiasis, Ossea
Thoracic Endometriosis Presenting with Bilateral Hydropneumothorax

Thoracic Endometriosis Presenting with Bilateral Hydropneumothorax

Authors: Varsha Viswanath, Alkesh Khurana, Abhishek Goyal, Yogesh Niwariya, Mahendra P. Singh, Hemlata Panwar, Garima Goel
( 10 downloads)
Abstract

Chest X-ray of a 36-year-old woman with menstruation-associated coughing and breathlessness showing right-sided hydropneumothorax (arrow) and left pleural effusion (arrowhead). B: Chest computed tomography showing right-sided hydropneumothorax treated with an intercostal drain in situ (arrow) and left pleural effusion with a small air pocket (arrowhead)

Keywords: Thoracic Endometriosis, Presenting, Bilateral Hydropneumothorax
‘Spoon-Fed’ Versus Self-Directed Learning in an Arab Context

‘Spoon-Fed’ Versus Self-Directed Learning in an Arab Context

Authors: Abdul S. Khan
( 9 downloads)
Abstract

During my many years of teaching, planning and research at both undergraduate and postgraduate medical education institutions in Saudi Arabia, I have witnessed the establishment of new learning environments following the adaptation of different curricula and application of new teaching and learning strategies, such as problem-based learning (PBL).1 However, it is debatable whether such environments are conducive for learning in Saudi Arabia and whether they will produce independent self-directed and lifelong learners. While people in various parts of the world have different lifestyles, they also think in distinctly different ways.2 Countries with predominantly Arab cultures, especially in the Middle East, have their own traditions that reflect varying elements of achievement, hierarchy and uncertainty. Tis may therefore complicate attempts to simply transfer existing skill-based systems from Western to Arab countries.2 In secondary schools with teacher-centred educational systems, students are generally less independent within the learning process; one might claim that such students are ‘spoon-fed’ the requisite knowledge by their teachers.3,4 Furthermore, the examination process encourages students to focus solely on their grades, inhibiting them from learning information outside of the set curricula. Unfortunately, the expectation of being ‘spoon-fed’ is often carried on from secondary school to medical school. Tis deters self-directed learning (SDL), which incorporates highly useful skills, particularly when subsequently entering a demanding and challenging learning environment such as a medical school.5 Graduating from a secondary school to a medical school presents a transitional challenge for many students due to the lack of academic rigour, self-motivation and dedication to lifelong learning necessary to become a competent physician. In general, many students favour a ‘spoon-feeding’ learning approach because it provides easy access to the right answers. However, such methods give students the incorrect impression that such knowledge is known to or accessible only via their teachers.3 As a result, it is common for students who have been ‘spoon-fed’ to only be capable of regurgitating information they have been told.6 In situations wherein students lack SDL skills, exposing frst-year medical students to an independent learning environment without guidance may cause difculties. Consequently, students may feel forced to turn to tutors, follow predetermined learning objectives or partake in rote learning in order to maintain their grade point average.6,7 Tis results in students who either attempt to apply rote learning during examinations or are not able to answer examination questions at all. Overall, PBL involves a constructivist approach whereby students build new knowledge upon prior knowledge.1 However, the acquirement of new knowledge requires time. Terefore, instead of expecting Arab students to take part in a fully independent SDL approach, such students should be guided towards directed self-learning.8,9 Tis approach provides initial guidance and a support system for students, thereby offering more time to acquire new knowledge and develop SDL skills. In addition, medical educators should create a grassroots strategy for the development of self-regulation skills in order to enable these future physicians to become selfdirected lifelong learners.10

Keywords: ‘Spoon-Fed’, Versus, Self-Directed, Learning
Re: Controversies in Odontogenic Tumours Review

Re: Controversies in Odontogenic Tumours Review

Authors: Divya Gopinath, Rohit K. Menon
( 9 downloads)
Abstract

We read with great interest the recent review article by Siwach et al. published in the August 2017 issue of SQUMJ.1 We congratulate the authors on their elaborative narrative review of the controversies regarding various tumours of odontogenic origin. We would like to further contribute by adding an interesting odontogenic tumour to the debate—adenoid ameloblastomas with dentinoid. First reported by Slabbert et al., this tumour shows histopathological features of both an ameloblastoma and an adenomatoid odontogenic tumour (AOT), along with hard tissue formation (i.e. dentin or dentinoid-like material).2 While ameloblastic elements such as epithelial whorls, duct-like structures and occasional signs of induction cover a major portion of the tumour, AOT-like areas are also visually evident, indicating a composite odontogenic tumour.2 Initially known as dentinoameloblastomas, the suggestion that these tumours were the result of the hybridisation of an ameloblastoma and AOT with fbrous separation resulted in signifcant controversy, as numerous cases revealed duct-like structures with bordering cells displaying subnuclear vacuoles.2,3 Subsequently, Loyola et al. described a similar neoplasm with the potential for recurrence and suggested the term ‘adenoid ameloblastoma with dentinoid’ for such lesions.3 To date, adenoid ameloblastomas have not yet been included by the World Health Organization (WHO) in the histological classifcation of odontogenic tumours.4 Te exclusion of this entity is interesting as other tumours with comparatively fewer documented cases, such as sclerosing odontogenic carcinomas, have nevertheless been incorporated in the latest WHO classifcation of odontogenic tumours.4 While the nature of the hard tissue in these tumours is unknown, ectomesenchymal cells showing odontoblastic differentiation can be completely absent.5 According to Sonone et al., the formation of dysplastic dentin in these tumours may be the result of a metaplastic process rather than the currently accepted theory of epithelial-ectomesenchymal interaction.5 Tis new hypothesis is further supported by the expression of certain genes by ameloblastic epithelial cells usually present in ectomesenchymal cells, thereby resulting in the conversion and co-expression of a mesenchymal phenotype.6 Further studies with more detailed molecular profling are needed to determine whether the hard tissue in adenoid ameloblastoma is the result of a metaplastic process or a true inductive phenomenon. Te co-occurrence of multiple phenotypes of ameloblastoma within the same lesion is not uncommon.4 In general, the diverse histological hybridisation of subtypes of solid and multicystic ameloblastoma does not impact the clinical behaviour of the lesion. However, substantial evidence indicates that adenoid ameloblastomas are locally aggressive.3 Adenoid ameloblastomas can present with hypercellularity and atypia, thus posing a challenge in distinguishing these lesions from ameloblastic carcinomas. Nevertheless, features of loss of ameloblastic differentiation, basilar hyperplasia, necrosis and vascular/perineural invasion can assist in differentiating a true ameloblastic carcinoma from an adenoid ameloblastoma.

Keywords: Controversies, Odontogenic Tumours
Re: Small-Cell Neuroendocrine Carcinoma of the Cervix Masquerading as a Cervical Fibroid Report of a rare entity

Re: Small-Cell Neuroendocrine Carcinoma of the Cervix Masquerading as a Cervical Fibroid Report of a rare entity

Authors: Mahmood D. Al-Mendalawi
( 13 downloads)
Abstract

I read with interest the recent case report by Pujani et al. published in the February 2018 issue of SQUMJ in which the authors describe a case of small-cell neuroendocrine carcinoma (SNEC) of the cervix in a 44-year-old Indian woman.1 I presume, given the rarity of this condition and the highly aggressive nature of the tumour, the authors have considered that the reported patient may have had an altered immune status.1 In India, HIV infection is a sizable health problem, with available data indicating a heightened seroprevalence of 0.26% compared to the global average of 0.2%.2 Among those with altered immune states, HIV status is of the utmost importance. My presumption is based on the fact that HIV-infected patients are more vulnerable to various types of tumours compared to immunocompetent individuals. Tis increased vulnerability has been attributed to various factors, including suppressed immunity, associated infection with oncogenic viruses and prolonged life expectancy due to antiretroviral treatment.3 High rates of cervical cancer have been reported among HIV-infected patients.4 Furthermore, genital cancers are found to occur in a substantial proportion of HIV-infected women in India.5 Hence, a diagnostic blood workup, cluster of differentiation (CD)4 count and viral overload measurements should have been conducted in order to determine the HIV status of the reported patient.1 If the patient was subsequently found to have an HIV infection, the case in question would surely be considered novel as, to the best of my knowledge, HIV-associated SNEC of the cervix has not been reported in the literature to date.

Keywords: Small-Cell, Neuroendocrine, Carcinoma

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