OBJECTIVES: To evaluate the levels of circulating erythrocyte-derived microparticles (EMPs) and platelet-derived microparticles (PMPs)in children with non-transfusion-dependent beta-thalassemia (NTDT), and explore their...OBJECTIVES: To evaluate the levels of circulating erythrocyte-derived microparticles (EMPs) and platelet-derived microparticles (PMPs)in children with non-transfusion-dependent beta-thalassemia (NTDT), and explore their contribution to hypercoagulability. METHODS: This case-control study included 50 children diagnosed with NTDT and 50 age- and sex-matched healthy controls. The children were recruited from the hematology/oncology unit of Alexandria University Children's Hospital, Egypt from November 2022 to May 2023. RESULTS: The percentage of EMPs and PMPs was significantly higher in NTDT patients compared with healthy controls. Serum B-type natriuretic peptide was higher in NTDT patients compared to controls; however, it didn't reach a statistical significance. CONCLUSIONS: The significantly higher levels of EMPs and PMPs in NTDT patients may contribute to the hypercoagulable state associated with the disease. Measurement of proB-type natriuretic peptide, though not statistically significant in this cohort, may hold potential as an early biomarker for pulmonary hypertension in NTDT patients, for which larger prospective studies are recommended.
Splenic infarction is an extremely rare complication of Epstein-Barr virus (EBV) infection. We report a case of a healthy young man who presented with fever and pharyngitis and was diagnosed with acute EBV infection. Dur...Splenic infarction is an extremely rare complication of Epstein-Barr virus (EBV) infection. We report a case of a healthy young man who presented with fever and pharyngitis and was diagnosed with acute EBV infection. During his hospital stay, he developed sudden left upper quadrant abdominal pain. Computed tomography scan of the abdomen demonstrated hepatosplenomegaly and multiple splenic hypodense lesions suggestive of infarcts. The patient was managed conservatively and discharged on prophylactic anticoagulation therapy. He is currently under close clinical follow up to minimize the risk of splenic rupture. We aim to highlight the importance of suspecting splenic infarction in patients presenting with fever, splenomegaly, and new onset abdominal pain, particularly in the setting of an ongoing or recent EBV infection.
An eight-year-old boy presented with a history of intermittent episodes of spastic abdominal pain accompanied by bilious vomiting. Imaging revealed an abnormal position of the large bowel loop, which was associated with...An eight-year-old boy presented with a history of intermittent episodes of spastic abdominal pain accompanied by bilious vomiting. Imaging revealed an abnormal position of the large bowel loop, which was associated with an abnormal vascular course. Additionally, a mesenteric cystic lesion was found in relation to the small bowel. A possibility of isolated hindgut malrotation with an enteric duplication cyst was suggested based on these findings. The surgical team confirmed this diagnosis during the procedure. Furthermore, they discovered an internal hernia intraoperatively, with a defect in the colonic mesentery through which the terminal ileum, ileocecal junction, cecum, and appendix herniated.
Kikuchi disease is a rare condition, typically characterized by cervical lymphadenopathy and fever. Although its association with systemic lupus erythematosus (SLE) is well established, the majority of SLE cases do not p...Kikuchi disease is a rare condition, typically characterized by cervical lymphadenopathy and fever. Although its association with systemic lupus erythematosus (SLE) is well established, the majority of SLE cases do not present with Kikuchi disease. We report a case of a young patient who presented with fever and cervical lymphadenopathies for two-weeks. This presents a broad differential, initially suggesting the possibility of infections or malignancies. However, after further clinical evaluation, including cervical node biopsy, direct histological examination revealed Kikuchi disease. Combining all clinical information and laboratory data, we concluded that the patient's condition was consistent with Kikuchi disease associated with SLE and probable autoimmune hepatitis. This case illustrates a young female patient with clinical presentations of SLE associated with Kikuchi disease as the first manifestation.
It has been hypothesized that increased intracranial pressure (ICP) may cause sick sinus syndrome (SSS) due to its effect on vagal discharge to the heart, resulting in disruption to the sinus cycle, despite age-related d...It has been hypothesized that increased intracranial pressure (ICP) may cause sick sinus syndrome (SSS) due to its effect on vagal discharge to the heart, resulting in disruption to the sinus cycle, despite age-related degeneration of the sinoatrial node being the most common intrinsic factor leading to sinus node dysfunction. In this case report, a 47-year-old man with unknown medical conditions presented to the emergency department at King Saud Medical City with a four-day history of headache, confusion, and chest pain. He also reported dizziness and lightheaded. Extensive cerebral venous thrombosis (CVT) and SSS were identified. We investigated the SSS etiology and its relation to CVT, concluding that SSS was caused by elevated ICP secondary to CVT.
A 24-year-old primigravida at 12 weeks of gestation, with a history of hyperemesis gravidarum, presented on an early morning with mental confusion and weakness. She was diagnosed with Wernicke encephalopathy and successf...A 24-year-old primigravida at 12 weeks of gestation, with a history of hyperemesis gravidarum, presented on an early morning with mental confusion and weakness. She was diagnosed with Wernicke encephalopathy and successfully treated with thiamine. After a full-term pregnancy, she gave birth to a healthy baby.
Systemic lupus erythematosus (SLE) is a quintessential autoimmune disease once thought to be rare among Africans. Neuropsychiatric manifestations of SLE range from headaches, mood/behavioral disorders, to seizures. There...Systemic lupus erythematosus (SLE) is a quintessential autoimmune disease once thought to be rare among Africans. Neuropsychiatric manifestations of SLE range from headaches, mood/behavioral disorders, to seizures. There are documented reports of seizures accompanying the diagnosis of SLE, with varying prevalence according to specific regions. However, seizures rarely precede the diagnosis of SLE. We present a case report of a 19-year-old African woman with adult-onset seizures preceding an overt diagnosis of negative anti-dsDNA SLE. A preceding short course of anti-malarial and carbamazepine prompted early consideration of drug-induced lupus erythematosus. However, the clinical features of SLE progressed and persisted despite their discontinuation. Among high-risk groups, it is important to recognize SLE as a potential cause of adult-onset seizures. In the absence of clear offending agents, metabolic or structural disease, baseline antinuclear antibody may be imperative in the diagnostic workup of such patients.
OBJECTIVES: We sought to assess the prevalence of tobacco use among adolescent males in Oman and identify sociodemographic factors influencing usage and attitudes towards tobacco products. METHODS: A cross-sectional stud...OBJECTIVES: We sought to assess the prevalence of tobacco use among adolescent males in Oman and identify sociodemographic factors influencing usage and attitudes towards tobacco products. METHODS: A cross-sectional study was conducted between January and March 2024 among male adolescents in public schools (grades 9-12) in Sohar, Oman. A two-stage cluster sampling approach was employed: six schools were randomly selected proportional to enrollment size, followed by random selection of classrooms within each school. Data were collected using a validated Arabic version of the Global Youth Tobacco Survey, administered in-person. RESULTS: All participants completed the survey in classroom settings (100% response rate; n = 227). Forty participants (17.6%) reported having tried tobacco, with the age at initiation largely between 14 and 15 years. Current smoking prevalence was 7.5% (n = 17), and exposure to secondhand smoke (SHS) was reported by over 40% of participants, both in enclosed and open spaces. Awareness of the harmful effects of tobacco was high, with 61.7% (n = 140) acknowledging the health risks associated with tobacco use. However, misconceptions concerning tobacco use remained prevalent, notably regarding the risks of SHS, perceived prevalence of peer smoking, and social desirability associated with smoking. CONCLUSIONS: Despite relatively high awareness of harmful effects, tobacco use among adolescents in Sohar remains an important public health concern, particularly regarding SHS exposure and social influences. Appropriate intervention strategies should target persistent misconceptions and address social influences. Strengthening public health initiatives and enforcing smoking bans in public spaces are recommended to limit tobacco exposure among Omani youth.
A 39-year-old multiparous woman underwent emergency cesarean section after pathological findings in her cardiotocograph. A biopsy taken from the peritoneal mass confirmed the diagnosis of disseminated peritoneal leiomyom...A 39-year-old multiparous woman underwent emergency cesarean section after pathological findings in her cardiotocograph. A biopsy taken from the peritoneal mass confirmed the diagnosis of disseminated peritoneal leiomyomatosis. Postoperatively, the patient developed status epilepticus. Computed tomography image of the brain with angiography revealed a right frontal meningioma. With increasing ascites, excision of the tumor and total abdominal hysterectomy with bilateral salpingectomy were performed.
OBJECTIVES: Hydroxyurea is been recommended for patients with sickle cell disease (SCD) as it reduces the complications from the disease by increasing the production of fetal hemoglobin. In Oman, hydroxyurea is not consi...OBJECTIVES: Hydroxyurea is been recommended for patients with sickle cell disease (SCD) as it reduces the complications from the disease by increasing the production of fetal hemoglobin. In Oman, hydroxyurea is not consistently prescribed to children with SCD, and limited research has compared the health-related quality of life (HRQOL) among children prescribed hydroxyurea. Thus, this study evaluated HRQOL differences between children with SCD who received hydroxyurea and those who did not. METHODS: A cross-sectional study was conducted on children from a hematology clinic at a tertiary hospital in Oman. We collected the data using two questionnaires: HRQOL-SCD and HRQOL-Generic. A one-way analysis of variance was used for statistical analysis. RESULTS: A total of 74 children (47.3% male and 52.7% female) completed the questionnaire; 33 children were on hydroxyurea and 41 were not. A significant difference in HRQOL scores was found between children receiving hydroxyurea and those not taking the drug [F (1,68) = 419.4; p-value = 0.001]. Regression analysis revealed that hydroxyurea was a significant predictor of improved HRQOL among children with SCD. An R2 of 0.87 indicated that 87.0% of the variability in the child-reported HRQOL-Generic was explained by parental familiarity, self-efficacy, child age, sex, and receiving hydroxyurea [R2 = 0.87, F (8,69) = 52.4; p-value < 0.001]. CONCLUSIONS: Hydroxyurea improved the children's HRQOL compared to those who did not receive the drug. These findings support the use of hydroxyurea in children to improve HRQOL and reduce vaso-occlusive episodes. We recommend increasing parents' understanding of hydroxyurea's significance and devising strategies to promote children's medication adherence. It is essential to modify the SCD management protocol to optimize the HRQOL among children with SCD.
OBJECTIVES: Our study sought to investigate the relationship between sleep quality, sleep patterns, and 10-year cardiovascular disease (CVD) risk among Omani adults attending primary healthcare centers in Muscat. METHODS...OBJECTIVES: Our study sought to investigate the relationship between sleep quality, sleep patterns, and 10-year cardiovascular disease (CVD) risk among Omani adults attending primary healthcare centers in Muscat. METHODS: We used a cross-sectional design to collect patient data obtained between September 2023 and September 2024. Participants who were Omani and aged 30-75 years were included in the study using convenience sampling; however, those with established cardiovascular disease or showing signs of obstructive sleep apnea were excluded. The 10-year CVD risk was calculated using the Framingham Risk Score, and sleep quality was assessed using the Pittsburgh Sleep Quality Index. The research explored the impact of various sleep patterns (monophasic, biphasic, polyphasic), work timings, sociodemographic factors, and body mass index on sleep quality and CVD risk. RESULTS: A total of 400 participants were included in this study, with the majority (60.0%) being female. We observed a significant association between poor sleep quality and an increased risk of developing CVD over 10 years (odds ratio = 1.734; p = 0.032). Flexible work timings showed a protective effect against CVD (odds ratio = 0.514; p = 0.010). We found no significant difference between sleep patterns and CVD risk. CONCLUSIONS: Our findings emphasize the importance of sleep quality and work flexibility in reducing cardiovascular risk, with potential implications for public health interventions.
OBJECTIVES: To evaluate the maternal and perinatal outcomes of preeclampsia in accordance with the World Health Organization prematurity criteria, in a low-resource setting. METHODS: This cross-sectional study was conduc...OBJECTIVES: To evaluate the maternal and perinatal outcomes of preeclampsia in accordance with the World Health Organization prematurity criteria, in a low-resource setting. METHODS: This cross-sectional study was conducted from January 2017 to December 2019 at Aga Khan University Hospital, Karachi. All women with preterm preeclampsia were included in the study. Cases with fetal anomalies or incomplete medical records were excluded. Participants were grouped according to gestational age at delivery, following the World Health Organization prematurity classification: (I) extremely preterm birth (EPB): 24-27 weeks, (II) very preterm birth (VPB): 28-31 weeks, and (III) moderate to late preterm birth (MLPB): 32-36 weeks. Data was statistically analyzed. RESULTS: The study included 324 women who delivered at the following gestation terms: EPB = 89 (27.5%), VPB = 35 (10.8%), and MLPB = 200 (61.7%), resulting in 331 neonates. Serious maternal complications developed in 45 (13.9%) women. Intrauterine death occurred in 18 (5.6%) cases. The median birth weights were significantly lower in the EPB and VPB groups. Of the 331 neonates, 21 (6.3%) died (20 in the EPB group and one in the MLPB group). Neonatal ICU admission, ventilator support, and low Apgar scores were also significantly more frequent in the EPB group. CONCLUSIONS: Neonatal mortality rises significantly when delivery occurs before 28 weeks of gestation. Complications rise with preeclampsia before 32 weeks. Vigilant monitoring and timely referral improve outcomes, but in resource-limited settings like Pakistan, restricted access to specialized care indicate the need for targeted healthcare investment.
OBJECTIVES: The demand for procedural sedation is increasing, with propofol remaining a popular choice due to its safety and rapid recovery profile. Remimazolam presents a promising alternative, offering a rapid onset an...OBJECTIVES: The demand for procedural sedation is increasing, with propofol remaining a popular choice due to its safety and rapid recovery profile. Remimazolam presents a promising alternative, offering a rapid onset and short duration of action. Its favorable safety profile and suitability for continuous infusion make it particularly advantageous. This study aimed to evaluate recovery times following continuous infusion of remimazolam compared to propofol sedation. METHODS: A single-center, prospective, observational study was conducted from February to June 2023 and was approved by the Sestre Milosrdnice University Hospital Center Ethics Committee. Ninety American Society of Anesthesiologists II or III patients undergoing infraumbilical orthopedic, vascular, or inguinal hernia repair surgeries under spinal anesthesia were assigned to receive either remimazolam or propofol sedation. Sedation depth was assessed using bispectral index (BIS), Modified Observer's Assessment of Awareness/Sedation Scale, and Richmond Agitation-Sedation Scale. Sedation onset, duration, and recovery times were recorded, alongside dosage adjustments based on target BIS values of 60-80. Propensity score matching was employed to address confounding variables. RESULTS: Remimazolam exhibited significantly faster recovery times, with a median time to achieve BIS > 80 of 3.0 min (IQR = 2.5), compared to 6.0 min (IQR = 3.0) for propofol, p < 0.001. Remimazolam achieved satisfactory sedative and amnestic effects at a median continuous dose of 0.2 (0.1) mg/kg/h, with comparable sedation durations. Significant differences were observed in intraoperative memory retention: 40.0% of patients in the propofol group vs. 10.0% in the remimazolam group reported memory of the event, p = 0.017. CONCLUSIONS: Remimazolam demonstrates superior recovery time and amnestic properties compared to propofol after continuous infusion sedation. Additionally, remimazolam matches or exceeds propofol in efficacy and safety for intraoperative sedation in non-healthy patients undergoing spinal anesthesia.
OBJECTIVES: To investigate the clinical presentation and treatment outcomes in Omani adults diagnosed with attention-deficit hyperactivity disorder (ADHD), with a focus on the efficacy of atomoxetine and methylphenidate...OBJECTIVES: To investigate the clinical presentation and treatment outcomes in Omani adults diagnosed with attention-deficit hyperactivity disorder (ADHD), with a focus on the efficacy of atomoxetine and methylphenidate in reducing symptoms, and identify clinical predictors of treatment response. METHODS: This prospective study enrolled Omani adults with ADHD receiving treatment at Sultan Qaboos University Hospital, Oman. Data on sociodemographic and clinical history were collected. Treatment response was quantified using the Clinical Global Impressions-Improvement (CGI-I) scale, after three months of initiating treatment. Statistical analysis used independent chi-square tests and t-tests, with a significance threshold set at p < 0.05. RESULTS: Among 171 participants, 60.8% were male. The majority (80.7%) received methylphenidate, while the others (19.3%) received atomoxetine. Inattentive subtype of ADHD (66.1%) was the most common, followed by combined hyperactivity and inattention (24.0%). Most (72.5%) patients had at least one comorbidity. After three months, 83.6% of the patients showed significant improvement on the Clinical Global Impressions-Improvement scale. Response rate for methylphenidate (84.8%) was higher than for atomoxetine (78.8%). Significant predictors of treatment response were male sex (odds ratio = 2.42, 95% CI: 1.00-5.71; p = 0.044) and absence of a family history of ADHD (odds ratio = 2.93, 95% CI: 1.18-7.28; p = 0.020). CONCLUSIONS: Both atomoxetine and methylphenidate were effective in treating adult ADHD, but methylphenidate showed a higher response rate. Male sex and the absence of a family history of ADHD were associated with greater response to treatment. These factors may serve as clinical indicators for tailoring pharmacological treatment decisions for individual adult ADHD patients in Oman.
OBJECTIVES: Setting research priorities is essential for optimizing healthcare resource allocation and addressing critical health challenges. We sought to identify data-driven clinical and health service research priorit...OBJECTIVES: Setting research priorities is essential for optimizing healthcare resource allocation and addressing critical health challenges. We sought to identify data-driven clinical and health service research priorities for the Royal Hospital, Muscat, Oman. METHODS: We used a multi-step approach combined with retrospective electronic health record (EHR) analysis with structured and unstructured stakeholder consultations. Findings were validated using the Delphi method through online surveys and face-to-face discussions with 10 key hospital decision-makers. RESULTS: Analysis of EHR data from 652?%567 inpatient admissions over 14 years identified pregnancy-related conditions (25.0%) as the leading cause of hospitalization, followed by circulatory system disease (10.4%) and cancers (8.6%), with breast and colon cancers being the most prevalent. Septicemia, pneumonia, and myocardial infarction were the leading causes of death. Stakeholder consultations emphasized patient-centered care, telemedicine, operational efficiency, and artificial intelligence-driven diagnostics as key health service research priorities. Delphi validation confirmed high relevance (scoring 4?"5 on a 5-point scale), although feasibility concerns were noted, particularly regarding resource allocation and information technology infrastructure. CONCLUSIONS: Our study established research priorities for the Royal Hospital by integrating clinical data analysis with stakeholder engagement to align research efforts with Oman?(tm)s Health Vision 2050. Effective implementation will require a hospital-wide research steering committee to oversee execution, integrate research themes into funding strategies, and enhance data-driven decision-making through artificial intelligence and EHR dashboards. Sustaining momentum necessitates annual reviews with leadership, cross-department collaboration, and capacity-building programs. For long-term sustainability, dedicated hospital funding and public-private partnerships should be explored.
Thyroglossal duct cysts are commonly seen in the midline of the neck, accounting for 7% of cases presenting with midline swelling. Carcinoma within a thyroglossal duct cyst is extremely rare, occurring in fewer than 1% o...Thyroglossal duct cysts are commonly seen in the midline of the neck, accounting for 7% of cases presenting with midline swelling. Carcinoma within a thyroglossal duct cyst is extremely rare, occurring in fewer than 1% of cases, and lateral occurrences are particularly uncommon. This case describes a 25-year-old female with papillary carcinoma identified in the left lateral thyroglossal duct cyst, along with de novo papillary carcinoma in the right thyroid lobe.
OBJECTIVES: Hip osteoarthritis is a growing global health burden with an increasing demand for total hip arthroplasty (THA), particularly among older populations. Robotic-assisted THA (RATHA) has emerged as a technologic...OBJECTIVES: Hip osteoarthritis is a growing global health burden with an increasing demand for total hip arthroplasty (THA), particularly among older populations. Robotic-assisted THA (RATHA) has emerged as a technological advancement that may improve precision, implant alignment, and potentially patient outcomes compared with conventional THA (COTHA). This systematic review aimed to compare the clinical and radiological outcomes of RATHA and COTHA. METHODS: A systematic search was conducted from PubMed, Scopus, and Cochrane Library inception until 31 August 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were randomized controlled trials, retrospective studies, prospective studies, and cohort studies that compared RATHA with COTHA. Exclusion criteria were case reports, case series, abstracts, review articles, systematic reviews, meta-analyses, biomechanical or cadaveric studies, studies on revision THA or high-grade hip dysplasia, and non-English publications. Data were extracted and assessed using the Covidence systematic review software and the Cochrane Risk of Bias Tool. The primary outcomes were clinical outcomes measured by patient-reported outcome measures. The secondary outcomes were operative outcomes, complications, and radiological assessment. RESULTS: Nine studies met the inclusion criteria, representing populations from Asia, the USA, the UK, and Italy. A total of 933 patients were assessed, 467 of whom underwent RATHA. No significant differences observed in patient-reported outcome measures. COTHA had shorter operative times, whereas RATHA showed potential in reducing hospital stays. RATHA demonstrated improved radiological outcomes, particularly in implant alignment; however, no significant differences were observed in complication rates. CONCLUSIONS: RATHA offers advantages in radiological precision but provides clinical outcomes similar to those of COTHA in terms of patient satisfaction and complications. Further high-quality trials are required to assess the long-term benefits of RATHA.