Publications by authors named "Ranjan William"

10 Publications

  • Page 1 of 1

Transcranial Doppler ultrasonography in sickle cell disease: a study in Omani patients.

J Pediatr Hematol Oncol 2013 Jan;35(1):18-23

Department of Medicine (Neurology), College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.

Changes on Transcranial Doppler (TCD) ultrasonography have been proposed as significant predictors of cerebrovascular complications in sickle cell disease (SCD). However, consensus with regards to the TCD criteria to recognize abnormalities in cerebral vasculature is lacking. We studied the TCD characteristics of cerebral arteries among Omani patients with SCD and correlated them with cerebrovascular events. TCD was performed through the temporal and suboccipital windows using a 2 MHz probe (DWL). Thirty-three of 59 patients (56%) with SCD had neurological symptoms including stroke--12 (20%) and epilepsy--7. Fifteen patients (25%) had significant TCD abnormalities including: markedly increased velocities--11 (3 with stroke); turbulent flow--2; and reversal of flow--2. No patient had a time averaged maximum mean velocity of >200 cm/s in anterior circulation. On applying a modified definition of "abnormal TCD" to anterior and posterior circulation studies, increased TCD velocities in posterior circulation correlated with history of stroke (P < 0.05). TCD velocities in the 18 adult patients ( older than 15 y) were significantly lower than in children. Logistic regression analysis revealed abnormal TCD in the left posterior cerebral artery to be an independent predictor of stroke in this cohort (P = 0.035).
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http://dx.doi.org/10.1097/MPH.0b013e31827f0addDOI Listing
January 2013

Transcranial Doppler ultrasonography in acute ischemic stroke predicts stroke subtype and clinical outcome: a study in Omani population.

J Clin Monit Comput 2011 Apr 29;25(2):121-8. Epub 2011 Jun 29.

Department of Medicine (Neurology), College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, PC 123 Muscat, Oman.

Background: Transcranial Doppler ultrasonography (TCD) is being increasingly used for its ability to provide cerebral hemodynamic information in stroke. Few studies have explored its association with cerebral arteriographic changes and stroke subtype. This study explored the relation of TCD changes in acute stroke with stroke subtypes, MR cerebral arteriography and clinical outcome in Omani population.

Methods: Adult patients presenting with acute ischemic stroke within 4 days of stroke onset were subjected to TCD through the temporal and suboccipital windows using a 2 MHz probe; flow velocities, pulsatility and direction of flow were recorded from arteries at the skull base. MR arteriographic (MRA) changes on corresponding arteries were graded on a scale of 1-4. ANOVA, student's t test and ROC analysis were used to evaluate TCD in relation to stroke type, outcome and stenosis on MRA.

Results: Of 60 patients recruited, 52 (M:F::36:16; mean age: 60 + 13 years) had adequate bone window for TCD study. Large artery stroke occurred in 30 (58%) patients; lacunar stroke-11 (21%); cardioembolic and mixed groups 9 (17%), other specificed causes-2 (4%). 86.5% had evidence of intracranial disease. 10/52 patients (19%) died while 33 (63%) had good outcome (modified Rankin Score 0-3). Of the 186 arteries studied by the two methods, 52 had TCD evidence of stenosis while 42 were abnormal on MRA, giving a sensitivity of 60%, specificity: 81.25%; positive likelihood ratio: 3.18 and negative likelihood ratio: 0.5. 29/52 (56%) of patients had TCD changes in the arteries corresponding to stroke location. Abnormal TCD was associated with large artery strokes (p = 0.007), poor outcome (p = 0.038) and mortality (p = 0.01).

Conclusion: This study of TCD in acute stroke in Omani population demonstrates a relatively higher burden of intracranial arterial disease. TCD changes are associated with type of stroke and outcome in this population. TCD is a simple and fairly useful method of evaluation in patients with acute stroke. Adopting TCD in evaluation of stroke patients may provide useful information regarding the pathophysiology which could enhance patient management.
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http://dx.doi.org/10.1007/s10877-011-9288-yDOI Listing
April 2011

Lower cranial nerve palsies.

Oman Med J 2010 Jul;25(3):240-1

Department of Internal Medicine, Sultan Qaboos University Hospital, Al Khod, Muscat, Sultanate of Oman.

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http://dx.doi.org/10.5001/omj.2010.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191640PMC
July 2010

Absence of Left Pulmonary Artery: Case report.

Sultan Qaboos Univ Med J 2009 Aug 30;9(2):180-3. Epub 2009 Jun 30.

Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.

Agenesis and hypoplasia of left-sided pulmonary artery anomalies have been infrequently reported. The majority of cases are diagnosed in childhood, but occasionally some asymptomatic cases are first recognised in adulthood when detected by an abnormal chest radiograph. We report a twenty-one year old female patient with left pulmonary artery agenesis who was asymptomatic till adulthood, but presented with mild respiratory symptoms and an abnormal chest X-ray. A contrast enhanced computerised tomography (CECT) scan helped to establish the diagnosis. Early diagnosis of this condition is essential to avert potentially lethal complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074774PMC
August 2009

Pattern of childhood neuronal migrational disorders in Oman.

Neurosciences (Riyadh) 2009 Apr;14(2):158-62

Department of Child Health, Sultan Qaboos University Hospital, PO Box 38, BW-1, Muscat 123, Sultanate of Oman. Fax. +968 24413128. E-mail: /

Objective: To record the pattern of different neuronal migrational disorders (NMD) and their associated neurological conditions.

Methods: 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.

Results: 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.

Conclusion: 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.
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April 2009

Hydroxyurea or chronic exchange transfusions in patients with sickle cell disease: role of transcranial Doppler ultrasound in stroke prophylaxis.

J Pediatr Hematol Oncol 2009 Jan;31(1):42-4

Departments of Child Health, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.

Hydroxyurea is increasingly used in patients with sickle cell disease and acts by several underlying mechanisms. Its usage has been reported to eliminate transfusion needs in children with beta-thalassemia major. It has also been used in sickle cell disease patients on stroke prophylaxis with exchange transfusions who develop transfusional iron overload and is now being considered as a possible alternative to chronic transfusions for secondary stroke prophylaxis. Our case demonstrates a pitfall when using hydroxyurea without monitoring intracranial cerebral vessels for vasculopathic changes; presence of which can predict stroke risk and alert the need for chronic blood transfusions as primary stroke prophylaxis. Transcranial Doppler is a crucial investigation that can reveal elevated cerebral arterial flow velocities.
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http://dx.doi.org/10.1097/MPH.0b013e318190d707DOI Listing
January 2009

Orbital infarction in sickle cell disease.

Am J Ophthalmol 2008 Oct 26;146(4):595-601. Epub 2008 Jul 26.

Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman.

Purpose: To determine the role of hematological and genetic factors in the development of orbital infarction in sickle cell disease.

Design: Retrospective, noncomparative case series.

Methods: Fourteen sickle cell disease patients were diagnosed with orbital infarction during a vaso-occlusive crisis. Clinical and radiological findings were reviewed retrospectively. Sickle cell disease patients without orbital infarction were recruited as controls after matching for disease severity. Sickle haplotypes were determined for all patients. Differences between groups were evaluated statistically.

Results: Patients with orbital infarction in sickle cell disease presented with acute periorbital pain and swelling with or without proptosis, ophthalmoplegia, and visual impairment during a vaso-occlusive crisis. Radiological findings included orbital soft tissue swelling (100%), hematoma (orbital, 36%; intracranial, 21%), and abnormal bone marrow intensities. Severity of orbital involvement was unrelated to that of the systemic disease (Pearson correlation coefficient, -0.1567). Affected patients predominantly had the Benin haplotype (P < .00782).

Conclusions: Orbital infarction is a potential threat to vision in sickle cell disease patients. Magnetic resonance imaging is more specific than computed tomography or nuclear scintigraphy in the evaluation of orbital changes. The degree of severity of the orbital manifestations appears unrelated to the severity of sickle cell disease. Patients with the Benin haplotype are more likely to develop orbital infarction during vaso-occlusive crises.
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http://dx.doi.org/10.1016/j.ajo.2008.05.041DOI Listing
October 2008

Traumatic Rupture of the Right Hemidiaphragm: Diagnosis aided by Computerized Tomography and Image Reformation: A Case Report.

Sultan Qaboos Univ Med J 2008 Jul;8(2):219-22

Department of Radiology and Molecular Imaging, Sultan Qaboos University & Hospital, Muscat, Sultanate of Oman.

Traumatic rupture of the diaphragm (TRD) poses a challenge to both radiologists and surgeons. They are uncommon and occur following blunt abdominal or lower thoracic trauma. The right side involvement is less common than the left side and is easily missed. Spiral computed tomography (Spiral CT) with image reformation is very useful in the diagnosis of TRD and in identifying associated injuries. Early diagnosis and repair reduces mortality and morbidity. We present the case of a 16 year old boy who was involved in a high speed traffic accident with blunt injury to his thorax and abdomen. He was referred from a peripheral hospital in Oman for further management at Sultan Qaboos University Hospital. A spiral CT scan of thorax and abdomen with image reformation helped in the early diagnosis and management of the traumatic rupture of his right hemidiaphragm.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074810PMC
July 2008

Laparoscopic deroofing of large renal simple cysts causing gastric symptoms.

Sultan Qaboos Univ Med J 2007 Aug;7(2):139-44

Department of Surgery, Sultan Qaboos University Hospital, P. O. Box 38, Al-Khod 123, Muscat, Sultanate of Oman.

Widespread use of ultrasonography and computerized tomography of the abdomen result in the detection of a large number of renal mass lesions. Most of these are simple renal cysts, which do not need any further evaluation or follow up unless symptomatic. Simple renal cysts can be diagnosed with certainty if the treating physician or surgeon is aware of these features and can avoid unnecessary urology referral, patient anxiety, inconvenience and expense. Symptomatic cysts and complex renal cysts need further evaluation and intervention. We present the case of large symptomatic renal cysts persisting after aspiration sclerotherapy, which were managed by deroofing the cyst laparoscopically. Laparoscopic deroofing is rapidly becoming accepted as the surgical intervention of choice for symptomatic renal cysts persisting after aspiration sclerotherapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074858PMC
August 2007