Paediatric blunt torso trauma: injury mechanisms, patterns and outcomes among children requiring hospitalisation at the sultan Qaboos university hospital, Oman

Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman

Methods: This retrospective single-centre study involved all children

Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 [55.7%] male patients. The mean age was 5.19 +/- 2.66 years. Of the cohort, 35 children [50.0%] received their injuries after having been hit by cars as pedestrians, while 19 [27.1%] were injured by falls, 12 [17.1%] during car accidents as passengers and four [5.7%] by falling heavy objects. According to computed tomography scans, thoracic injuries were most common [65.7%], followed by abdominal injuries [42.9%]. The most commonly involved solid organs were the liver [15.7%] and spleen [11.4%]. The majority of the patients were managed conservatively [92.9%] with a good outcome [74.3%]. The mortality rate was 7.1%. Most deaths were due to multisystem involvement

Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach

Pattern of childhood neuronal migrational disorders in Oman

To record the pattern of different neuronal migrational disorders [NMD] and their associated neurological conditions. The data were collected at the Child Neurology Services of Sultan Qaboos University Hospital, Oman, from January 1993 to September 2006 from all children with psychomotor delay and epilepsy, who underwent brain imaging [mostly MRI]. The MR imaging was used for the diagnosis of a neuronal migration anomaly. There were 86 cases of NMD. Corpus callosum agenesis and lissencephaly/pachygyria formed the major group. There were 48 cases of corpus callosum agenesis, and 16 cases of lissencephaly/pachygyria. Other disorders were 10 cases of heterotopias, 5 schizencephaly, 3 holoprosencephaly, 2 polymicrogyria, and one each of hemimegalencephaly, and hydranencephaly. Developmental delay was the most common associated finding noted in 80 [93%] cases. Sixty-seven [77.9%] cases had motor deficit. Forty out of 86 [46.5%] cases had epilepsy. Partial/partial complex seizures were the most common at 13 out of 40 [32.5%]. Syndromic seizures were seen in 11 out of 40 [27.5%] cases. The seizures were controlled in only 3/40 [7.5%] cases. The NMD constitute a significant number of child neurology patients with psychomotor delay and intractable epilepsy. Exogenic and genetic factors affecting the early embryonic and fetal development from sixth to twenty-sixth weeks of gestation result in NMD. Recent genetic studies are defining the underlying mechanism and these studies will help in early diagnosis and possible prevention of NMD

Corpus callosum agenesis

The objectives are to analyse corpus callosum agenesis in children with various neurological problems in a hospital set-up, and to study the neurological and systemic abnormalities associated with this condition. The children with various neurological problems who underwent computerized tomography brain from January 1993 to December 1997, and were found to have corpus callosum agenesis, formed the subjects of this study. These children were examined for any syndromic association, congenital infections or metabolic defects. Out of 2164 children who underwent computerized tomography brain, 22 had corpus callosum agenesis [1%]. Most cases were not syndromic and 64% were males. Epileptic disorders were noted in about one third of cases. Corpus callosum agenesis is an important anomaly in children with neurodevelopment handicaps, usually detected by neuroradiology

Are scintigraphy and ultrasonography necessary before fine-needle aspiration cytology for thyroid nodules?

To evaluate the effi cacy of scintigraphy, ultrasound and fi ne-needle aspiration in thyroid nodules and to establish the best diagnostic pathway in detecting thyroid cancer. Two hundred and sixteen patients with thyroid nodules were examined using high-resolution ultrasonography, 99mTc thyroid scintigraphy and ultrasound-guided fi ne-needle aspiration. Of these, 113 patients subsequently underwent thyroidectomy. The remaining 103 were followed up for two years without any evidence of malignancy. Cytopathology classifi ed 71% of the aspirate as benign, 3% as positive for malignancy, 21% as suspected neoplasia and 5% as unsatisfactory. Fine- needle aspiration cytology had a sensitivity of 87.5% and specifi city of 80%. On ultrasound 33% of malignant nodules were hypo-echoic and on scintigraphy 16% of solitary cold nodules were malignant. Neither test could reliably diagnose thyroid cancer. Ultrasound-guided fi ne-needle aspiration cytology should be the fi rst test performed in euthyroid patients with a thyroid nodule. Scintigraphy and ultrasound imaging should be reserved for follow-up studies and patients who have suppressed levels of thyroid stimulating hormone

Dense thalami - an important diagnostic feature of tay sack disease

Two cases of Tay Sachs disease which were diagnosed on clinico-radiological basis in Oman are presented