OBJECTIVES: Computed tomography (CT) scans are commonly used to evaluate the brain in geriatric patients presenting to emergency department (ED). Our study retrospectively aimed to evaluate the effectiveness of CT scans...OBJECTIVES: Computed tomography (CT) scans are commonly used to evaluate the brain in geriatric patients presenting to emergency department (ED). Our study retrospectively aimed to evaluate the effectiveness of CT scans in diagnosing generalized weakness in elderly patients. METHODS: Elderly patients (age ≥ 65 years) presenting to the ED with generalized weakness and either fatigue, dizziness, vertigo, fever, nausea, or vomiting between 1 January and 31 December 2022 were included from two prominent EDs in Muscat. Multiple variables were coded and systematically analyzed. RESULTS: Out of 12 608 847 patients, 6.7% presented with generalized weakness and underwent a CT scan of the brain as part of their evaluation. The mean age was 76.0 ± 7.7 years, with males comprising 47.5% of the group. Presenting complaints to the ED were fever (57.0%), drowsiness (46.9%), and dizziness (30.0%). CT brain findings included acute ischemic changes (3.3%), subacute ischemic changes (7.8%), acute-on-chronic subdural hematoma or intracranial hematoma (3.4%), and new space-occupying lesions or abscesses (4.4%). Receiver operating characteristic curves assessed the diagnostic performance of CT imaging for various conditions: acute/subacute ischemic cerebrovascular accident (area under the curve (AUC) = 0.47, optimal threshold: 0.188), acute/acute on chronic subdural hematoma or intracranial hemorrhage (AUC = 0.41, optimal threshold: 0.122), significant new and/or acute CT findings overall (AUC = 0.45, optimal threshold: 0.026), and newly detected space occupying lesions (AUC = 0.43, optimal threshold: 0.144). CONCLUSIONS: A CT scan is limited as a diagnostic tool for patients presenting with generalized weakness, particularly in diagnosing new or acute/subacute medical or surgical conditions of the brain.
OBJECTIVES: Obstructive sleep apnea (OSA) and secondary polycythemia occasionally occur together, but their relationship remains unclear. This study aimed to explore the prevalence of OSA among patients with secondary po...OBJECTIVES: Obstructive sleep apnea (OSA) and secondary polycythemia occasionally occur together, but their relationship remains unclear. This study aimed to explore the prevalence of OSA among patients with secondary polycythemia in our local population. METHODS: In this retrospective cross-sectional study, we screened 524 adult patients with polycythemia who attended the hematology clinic at a major tertiary hospital in Muscat during 2013-2023. Our goal was to identify patients with OSA and secondary polycythemia who also underwent sleep studies and analyzed their data. RESULTS: Out of 524 polycythemia patients, we identified N = 44 patients (8.4%) who had both OSA and secondary polycythemia. The vast majority were male (42/44; 95.5%). Participants' mean age was 40.7 years, with a body mass index of 31.7 kg/m, hemoglobin level of 16.5 g/dL, and hematocrit level of 0.5 L/L. The mean apnea/hypopnea index was 33.3, and the mean desaturation index was 20.3. More than half of the patients (23; 52.3%) had severe OSA (apnea/hypopnea index > 30). CONCLUSIONS: The majority of patients with secondary polycythemia had severe OSA. It is likely that OSA may contribute to secondary polycythemia, warranting further investigation.
Emphysematous pyelonephritis (EPN) is a rare necrotizing infection of the renal parenchyma and pelvicalyceal system caused by gas-forming organisms. We describe a novel case of an elderly woman with poorly controlled dia...Emphysematous pyelonephritis (EPN) is a rare necrotizing infection of the renal parenchyma and pelvicalyceal system caused by gas-forming organisms. We describe a novel case of an elderly woman with poorly controlled diabetes mellitus and end-stage renal failure on peritoneal dialysis, who developed polymicrobial EPN involving the and pathogens. She was successfully treated with culture-directed parenteral antibiotics and percutaneous drainage of renal collections. To our knowledge, is a previously unreported cause of EPN. This report highlights its potential in causing opportunistic infections in immunocompromised hosts in the appropriate clinical context.
Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in tropical regions, including the Indian subcontinent. It can affect several systems in the body and has high mortality and morbidity. N...Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in tropical regions, including the Indian subcontinent. It can affect several systems in the body and has high mortality and morbidity. Neuromelioidosis is a rare central nervous system manifestation of melioidosis. We report a case of a 37-year-old man who had disseminated melioidosis with severe central nervous system involvement, with radiological demonstration of spread along white matter tracts. Our report emphasizes the importance of prolonged intensive phase therapy in achieving clinical remission and preventing relapse.
OBJECTIVES: In Arab cultures, significant social stigma impedes the disclosure of mental illness and seeking professional help. To date, no validated Arabic tool exists to assess these perceived barriers. Therefore, we a...OBJECTIVES: In Arab cultures, significant social stigma impedes the disclosure of mental illness and seeking professional help. To date, no validated Arabic tool exists to assess these perceived barriers. Therefore, we aimed to translate the Coming Out with Mental Illness Scale (COMIS) into Arabic and validate it for Arabic-speaking populations. METHODS: We generated an Arabic translation of COMIS (COMIS-Ar) using standard forward-backward translation procedures. The instrument was tested via a cross-sectional online survey among Arabic-speaking participants. Internal consistency, confirmatory factor analysis (CFA), and model fit indices were assessed. RESULTS: A total of 420 Arabic-speaking adults of median age of 23 years (range 18-60) completed the survey; 73.3% were female. The COMIS-Ar showed overall good internal reliability; Cronbach's alpha (α) = 0.89; McDonald's omega (ω) = 0.90. Factor 1 on 'Benefits of being out' showed good reliability (α = 0.88; ω = 0.88), while Factor 2 on 'Benefits of remaining in' achieved 'excellent' reliability (α = 0.94; ω = 0.94). The overall CFA indicated a structural validity of comparative fit index = 0.83 with a root mean square error of approximation of 0.11, suggesting scope for further refinement. CONCLUSIONS: The COMIS-Ar is a reliable and potentially valid instrument, albeit with limitations, to assess mental health disclosure-related barriers among Arabic speakers. As a preliminary model with limited testing, its cautious use may aid clinicians to identify the obstacles, including self-stigma in this population and plan targeted interventions, in addition to enhancing public awareness of mental health stigma. Additional psychometric studies are required to enhance the scale.
Isolated tubal torsion is a rare diagnosis that can be easily missed due to nonspecific clinical and imaging features. To diagnose preoperatively, a high level of suspicion is required for this condition. We present a ca...Isolated tubal torsion is a rare diagnosis that can be easily missed due to nonspecific clinical and imaging features. To diagnose preoperatively, a high level of suspicion is required for this condition. We present a case where ultrasonography initially indicated salpingitis, but intraoperatively revealed tubal torsion with an interesting etiology.
Carnitine-acylcarnitine translocase deficiency with SLC25A20 c.199-10T>G variation is a rare condition, typically associated with severe neonatal outcomes. Recently, preimplantation genetic testing (PGT) has emerged as a...Carnitine-acylcarnitine translocase deficiency with SLC25A20 c.199-10T>G variation is a rare condition, typically associated with severe neonatal outcomes. Recently, preimplantation genetic testing (PGT) has emerged as a screening test applicable to embryos produced through in vitro fertilization for genetic analysis before transfer. Thus, PGT allows for the identification and elimination of embryos carrying inherited genetic diseases. This case report aims to present data from PGT on intervention in the management of SLC25A20 c.199-10T>G variation, particularly in middle-income countries. A 26-year-old woman with a high-risk term pregnancy and a history of two sudden neonatal deaths underwent parental carrier testing, revealing heterozygous SLC25A20 c.199-10T>G variation in both parents. The subsequent pregnancy, identified as a homozygous for SLC25A20 c.199-10T>G mutation, was terminated at 20 weeks. The current pregnancy was successfully managed by in vitro fertilization-selective embryo transfer. Carnitine-acylcarnitine translocase deficiency owing to SLC25A20 c.199-10T>G variation can result in sudden neonatal collapse. Obstetricians should maintain a high index of suspicion in recurrent cases of unexplained early neonatal death. Parental carrier testing is crucial for prenatal management, and selective embryo transfer is a core treatment for heterozygous gene carriers in this highly lethal disorder.
Mucormycosis is a rare and opportunistic fungal infection caused by the order Mucorales. The emergence of COVID-19 has led to a resurgence of this opportunistic infection. COVID-19 and its management protocols have been...Mucormycosis is a rare and opportunistic fungal infection caused by the order Mucorales. The emergence of COVID-19 has led to a resurgence of this opportunistic infection. COVID-19 and its management protocols have been implicated in causing this surge due to sequential impaired immunity in affected patients. A high index of suspicion, along with prompt evaluation and management, is advisable for the best clinical outcome.
OBJECTIVES: This meta-analysis aimed to identify the risk factors associated with nonsteroidal anti-inflammatory drug -exacerbated respiratory disease (NERD), a chronic eosinophilic, inflammatory respiratory disorder cha...OBJECTIVES: This meta-analysis aimed to identify the risk factors associated with nonsteroidal anti-inflammatory drug -exacerbated respiratory disease (NERD), a chronic eosinophilic, inflammatory respiratory disorder characterized by hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs in patients with asthma and chronic rhinosinusitis with nasal polyps. METHODS: We systematically reviewed 19 eligible studies and assessed their quality using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Descriptive statistics and meta-analyses were conducted to estimate the pooled odds ratio and identify the risk factors associated with NERD. The analysis considered factors such as age, gender, body mass index, family history, smoking, and atopy. RESULTS: Being female, having atopy, a history of smoking, and a family history of asthma were significant risk factors for NERD. Female gender was associated with hormonal differences and the effects of progesterone and estrogen on inflammation and bronchial hyperresponsiveness. Atopy increased the risk through heightened airway sensitivity, persistent inflammation, and increased mast cell activation. Smoking contributes to NERD by causing chronic airway inflammation, excess mucus production, airway remodeling, and decreased lung function. A family history of asthma indicated a genetic predisposition to bronchial hyperresponsiveness. CONCLUSIONS: The meta-analysis identified several risk factors associated with NERD, including being female, having atopy, a history of smoking, and a family history of asthma. These factors contribute to increased susceptibility and inflammation in patients with NERD.
Encysted hydroceles are often considered rare. We report three cases of Ghanaian boys who presented with left scrotal swellings at a primary care center. This paper emphasizes the importance of primary care practitioners...Encysted hydroceles are often considered rare. We report three cases of Ghanaian boys who presented with left scrotal swellings at a primary care center. This paper emphasizes the importance of primary care practitioners considering a possible clinical diagnosis of encysted spermatic cord hydroceles in new-onset scrotal swellings in children and adolescents, as such cases may not be as rare as previously thought.
OBJECTIVES: This study aimed to analyze pediatric trauma cases treated at Sultan Qaboos University Hospital in Oman, focusing on injury patterns, mechanisms, and outcomes. METHODS: We conducted a retrospective chart revi...OBJECTIVES: This study aimed to analyze pediatric trauma cases treated at Sultan Qaboos University Hospital in Oman, focusing on injury patterns, mechanisms, and outcomes. METHODS: We conducted a retrospective chart review of pediatric patients aged 15 years and younger who presented to the emergency department over 12 months, from January to December 2022. Data were collected on demographics, injury characteristics, clinical management, and outcomes, including pediatric intensive care unit admissions and length of stay. RESULTS: A total of 1643 pediatric trauma cases were included in the study. Most injuries occurred in males (64.8%) and children aged 0-5 years (51.4%). The leading cause of injury was falls from height (50.8%), followed by collisions with fixed objects (12.2%) and sports injuries (8.2%). Injuries predominantly occurred at home (72.7%) and were most frequent during the evening and nighttime (71.5%). Lacerations (32.3%) and soft tissue injuries (19.3%) were the most common types of injuries, with the face (33.0%) and upper extremities (25.3%) being the most frequently affected anatomical sites. Adolescents (11-15 years) were more prone to road traffic accidents and sports-related injuries, while younger children were more vulnerable to falls. Sex differences showed males were more susceptible to lacerations and fractures, while females experienced higher rates of crush injuries and contusions. Most patients (89.3%) were treated and discharged from the emergency department, while 6.7% were admitted to the hospital, and 2.0% had significant clinical outcomes. Patients admitted to the pediatric intensive care unit had higher rates of motor vehicle collisions and polytrauma and required more intensive interventions. CONCLUSIONS: Falls from height were the most common mechanism of injury in our study, particularly among younger children. Males were more frequently affected, with lacerations and soft tissue injuries being the most common injury types. Adolescents were more prone to road traffic and sports-related injuries. The results emphasize the need for targeted preventive measures, especially at home, roadside, and during recreational activities, to reduce pediatric trauma.
OBJECTIVES: This study aimed to assess the knowledge, attitudes, and experiences of physicians in delivering bad news and their adherence to the SPIKES protocol within the Directorate General of Health Services (DGHS) in...OBJECTIVES: This study aimed to assess the knowledge, attitudes, and experiences of physicians in delivering bad news and their adherence to the SPIKES protocol within the Directorate General of Health Services (DGHS) in Muscat, Oman. METHODS: A cross-sectional study was conducted from December 2023 to June 2024 at primary healthcare centers in Muscat. Data were collected through an online self-administered questionnaire completed by physicians at these centers. RESULTS: A total of 140 physicians completed the questionnaire (response rate = 100%). The vast majority of participants (n = 133, 95.0%) recognized the importance of training in breaking bad news and expressed a willingness to attend future training sessions. Nearly half of the participants (n = 67, 47.9%) reported negative experiences due to improper delivery of bad news. Overall, adherence to the SPIKES protocol was categorized as low (n = 2, 1.4%), medium (n = 25, 17.9%), and high (n = 113, 80.7%). No significant associations were found between adherence levels and any sociodemographic or clinical characteristics. CONCLUSIONS: Physicians in primary care face challenges in delivering bad news, which are influenced by cultural factors, training, and adherence to protocol. These challenges can be mitigated through regular, targeted training programs, beginning at the undergraduate level and continuing throughout a physicians' careers.
Sarcoidosis often manifests with pulmonary involvement, making isolated extrapulmonary presentations rare and diagnostically challenging. We present the case of a 43-year-old woman who presented with prolonged fever, dee...Sarcoidosis often manifests with pulmonary involvement, making isolated extrapulmonary presentations rare and diagnostically challenging. We present the case of a 43-year-old woman who presented with prolonged fever, deep lymphadenopathy, massive splenomegaly, hepatomegaly, and severe hypercalcemia, mimicking malignancy. The diagnosis of sarcoidosis was established after the failure of anti-tubercular therapy, exclusion of differential diagnosis, and the subsequent development of cutaneous sarcoids. This case highlights the importance of recognizing isolated extrapulmonary pseudo-tumoral presentations of sarcoidosis, which can lead to delayed diagnosis.
Zoledronic acid is commonly used to treat osteoporosis and it is generally well tolerated. We describe the case of a woman with osteoporosis, who developed a flare-up of osteoarthritis hours after receiving a single dose...Zoledronic acid is commonly used to treat osteoporosis and it is generally well tolerated. We describe the case of a woman with osteoporosis, who developed a flare-up of osteoarthritis hours after receiving a single dose of zoledronic acid. She developed fever with chills, generalized body aches, and severe low back pain. This was followed by severe bilateral knee pain, wrist pain, and minor joint pain in the hands. Radiography revealed signs of osteoarthritis in the following joints: proximal and distal interphalangeal joints of the hands, trapeziometacarpal joint, patellofemoral, and medial tibiofemoral joint on both sides. Investigations excluded septic arthritis, gout arthritis, and systemic infection. A diagnosis of a flare-up of osteoarthritis secondary to zoledronic acid infusion was made. Symptomatic treatment and supportive care led to the patient's recovery. Treating physicians need to be aware of the possibility of such rare symptom flare-ups following zoledronic acid infusion.
OBJECTIVES: Selective immunoglobulin A deficiency (SIgAD) is characterized by an isolated deficiency of serum IgA while immunoglobulin G (IgG) and immunoglobulin M (IgM) levels remain normal. Symptoms range from asymptom...OBJECTIVES: Selective immunoglobulin A deficiency (SIgAD) is characterized by an isolated deficiency of serum IgA while immunoglobulin G (IgG) and immunoglobulin M (IgM) levels remain normal. Symptoms range from asymptomatic to recurrent infections. We aimed to determine the prevalence of IgAD and SIgAD among Omani patients undergoing screening for celiac disease. METHODS: This cross-sectional study included Omani nationals aged above one year, who were screened for celiac disease with anti-tissue transglutaminase (anti-tTG) IgA at Royal Hospital, Muscat, from January 2005 to December 2023. IgAD was defined as a total serum IgA level below the age-dependent reference range. SIgAD was diagnosed when both IgG and IgM values were within their respective reference limits. The prevalence of IgAD and SIgAD was statistically reviewed. RESULTS: Of the 9615 individuals who underwent screening for celiac disease, 114 had low IgA levels. The prevalence of IgAD was 1.2%, and among these, 0.4% were confirmed to have SIgAD. The majority were > 14 years. Patients aged 6-14 years and > 14 years were more likely to have IgAD compared to 1-2 years old. Only 39 (34.2%) patients underwent further testing to confirm SIgAD, while the remaining 75 (65.8%) did not undergo follow-up IgG and IgM testing. Among the patients with confirmed SIgAD, 11 (28.2%) underwent further testing with anti-tTG IgG antibody, with only one (9.1%) testing positive for celiac disease as confirmed by esophagogastroduodenoscopy (EGD) and histopathology. Patients with anti-tTG IgG and EGD exhibited a significantly increased risk of low IgA levels. The remaining 28 (71.8%) patients did not undergo further celiac disease workup (anti-tTG IgG antibody, EGD, or genetic testing). CONCLUSIONS: IgAD was present in 1.2% of Omani patients evaluated for celiac disease, and 0.4% had confirmed SIgAD. Referral to an immunologist is recommended when IgG/IgM levels are low or infections are recurrent.