Gestational Trophoblastic Disease at Sultan Qaboos University Hospital: Prevalence, Risk Factors, Histological Features, Sonographic Findings, and Outcomes

Objectives: We sought to assess the prevalence of gestational trophoblastic diseases (GTD) among pregnant women at Sultan Qaboos University Hospital (SQUH) and compare our results with the international studies. We also sought to determine the risk factors, histological features, sonographic findings, and outcomes in women with GTD. Methods: We conducted a retrospective cohort study of all women diagnosed with GTD and followed at SQUH between November 2007 and October 2015. We collected data on maternal demographics, risk factors, sonographic features, histological diagnosis, follow-up period, and chemotherapy treatment from the hospital information system. Results: Sixty-four women with GTD were included in the study with a mean age of 31.0±7.5 years, mean gravidity 4.0, and parity 2.0. The prevalence of GTD was 0.3% (one in 386 births), and the most common risk factors were increased maternal age and multiparity. A partial hydatidiform mole was diagnosed in 54.7%, complete hydatidiform mole in 43.8%, and invasive mole in 1.6% of women. Eleven percent of women required chemotherapy. Typical ultrasound features for partial molar pregnancy were present in 54.7% of our sample, while snowstorm appearance was seen in 89.3% of those with complete mole. Negative beta-human chorionic gonadotropin was achieved 70 days after diagnosis in 41 women. Conclusions: The awareness of the risks and complications of GTD among physicians with close follow-up is paramount. There is a need to establish a national registry of GTD cases in Oman

The Epidemics of Obesity and Cancer; No simple remedy

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Vitamin D Status in Pregnant Omanis: A disturbingly high proportion of patients with low vitamin D stores

Objectives: The objective of this study was to determine the vitamin D status of pregnant Omanis by measurement of their circulating 25 hydroxy vitamin D levels. Methods: Blood samples were obtained from a cohort of 103 consecutive healthy pregnant Omanis at the Armed Forces Hospital, Muscat, on their first antenatal visit. The study took place in May, June and July 2010. Results: Vitamin D deficiency was present in 34 (33%) of patients (25OHD3 <25 nmol/L), ‘at risk’ levels were found in 67 (65%) patients (25OHD3 25–50 nmol/L); two patients (1.9%) had values between 50 and 75 nmol/L, and no patients in the optimal range >75 nmol/L. Conclusion: If confirmed, these findings indicate the need for vitamin D replacement during pregnancy and lactation. Although not evidence based we recommend at least 1000 IU of cholecalciferol, (vitamin D3) daily

Ovarian Hernia: A rarity

Ovarian hernias are extremely rare. The prevalence of ovaries and fallopian tubes in operable inguinal hernias is only about 2.9%. We report here an unusual case of an ovary in a hernia sac in an adult female. She presented with symptoms and signs of an incarcerated left inguinal hernia. The left ovary contained a haemorrhagic cyst and, along with the left fallopian tube and broad ligament, these were found in the sac. She underwent a left ovarian cystectomy and the inguinal hernia was repaired with mesh

Effects of maternal age, parity and pre-pregnancy body mass index on the glucose challenge test and gestational diabetes mellitus

أهداف البحث: يهدف البحث لدراسة تأثير العمر، وعدد الولادات ومعامل كتلة الجسم على اختبار التحدي للجلوكوز ٥٠ غرام الإيجابي وسكري الحمل لدى السيدات الحوامل العمانيات السليمات. طرق البحث: اُستخدم ٥٠ غراما من الجلوكوز لإجراء اختبار التحدي للجلوكوز على ٣٠٧ سيدة عمانية حامل سليمة خلال الأسبوع ٢٤-٢٨ من الحمل. اُعتبر اختبار التحدي للجلوكوز إيجابيا إذا كان مستوى الجلوكوز في الدم< ٧.٨ ملمول⁄ ل، عند قياسه بعد ساعة واحدة. وتم تأكيد تشخيص السيدات بسكري الحمل باختبار تحمل الجلوكوز عن طريق الفم بعد ساعتين من استخدام ٧٥ غراما من الجلوكوز، عندما يكون أي من قيمة الاختبار عند الصوم أو بعد ساعتين من تناول ٧٥ غراما من الجلوكوز <٥.٥ ملمول⁄ ل و <٨ ملمول⁄ ل، على التوالي، تعتبر السيدات مصابات بسكري الحمل. النتائج: تم اختبار ٣٠٧ سيدة، وتحديد ٨٣ (٠٣¸٢٧٪) سيدة لديها اختبار إيجابي، و٢٣ (٥¸٧٪) حالة إيجابية لسكري الحمل. يزداد اختبار التحدي للجلوكوز الإيجابي وسكري الحمل بشكل كبير مع زيادة عمر الأم، من ٢٠٪ و ٢¸٢ ٪ على التوالي، لدى السيدات اللاتي أعمارهن ≤ ٢٥عاما إلى ٨¸٣٧٪ و٧¸١٤٪ على التوالي، عند السيدات اللاتي أعمارهن < ٣٥ عاما. كما يزداد اختبار التحدي للجلوكوز الإيجابي وسكري الحمل بشكل كبير مع زيادة معامل كتلة الجسم قبل الحمل من ٨¸١٩٪ و٨¸٣٪ على التوالي، لدى السيدات بمعدل كتلة الجسم ≤ ٢٥ كجم⁄ م٢ إلى ٨¸٣٧٪ و٩¸٩٪، على التوالي عند السيدات بمعدل كتلة الجسم < ٢٥ كجم⁄ م٢. الاستنتاجات: عمر الأمهات ومعامل كتلة الجسم قبل الحمل لهما تأثير كبير على اختبار التحدي للجلوكوز ٥٠ غرام الإيجابي وسكري الحمل

Fluctuation in the Levels of Immunoglobulin M and Immunoglobulin G Antibodies for Cardiolipin and β2-Glycoprotein among Healthy Pregnant Women

Objectives: Antiphospholipid antibodies fluctuate during a healthy normal pregnancy. This study aimed to investigate the levels of both immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies for cardiolipin and β2-glycoprotein (β2GP) among healthy pregnant women. Methods:This study was conducted between May 2010 and December 2012. A total of 75 healthy Omani pregnant women with no history of autoimmune disease were investigated during their pregnancy and 90 days after delivery at the Armed Forces Hospital in Muscat, Oman. A control group of 75 healthy Omani non-pregnant women were also investigated as a comparison. Levels of IgM and IgG antibodies for both anti-cardiolipin antibodies (ACAs) and β2GP were measured using a standard enzymelinked immunosorbent assay. Results: The ACA IgM levels were significantly higher in the control group compared to the pregnant women (P &lt;0.001). No significant differences were observed in the ACA IgM levels between the control group and the pregnant women after delivery. In contrast, ACA IgG levels were significantly higher during pregnancy and after delivery compared with those of the healthy control group (P = 0.007 and 0.002, respectively). The levels of β2GP IgG were significantly higher during pregnancy than after delivery and in the control group (P = 0.001 and &lt;0.001, respectively). Conclusion: In this study, ACA IgG levels increased during healthy pregnancies and after normal deliveries whereas β2GP IgG levels increased transiently during the pregnancies. Both phenomena were found to be significantly associated with a transient decline in the levels of IgM specific for these antigens. Therefore, the levels of these antibodies may be regulated during a healthy pregnancy

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population