OBJECTIVES: To assess the knowledge levels, attitudes, practices, and associated factors regarding herpes zoster (HZ) vaccination among primary healthcare physicians in Jazan, Saudi Arabia. METHODS: A cross-sectional stu...OBJECTIVES: To assess the knowledge levels, attitudes, practices, and associated factors regarding herpes zoster (HZ) vaccination among primary healthcare physicians in Jazan, Saudi Arabia. METHODS: A cross-sectional study was conducted in 2023, among 281 primary healthcare physicians in Jazan, Saudi Arabia. Data were collected using a self-administered questionnaire, which included a 15-point knowledge assessment scale and a Likert-type scale for attitudes and practices. Knowledge was deemed sufficient if the median score was achieved. Multivariate logistic regression analysis identified predictors of knowledge sufficiency. RESULTS: Of the 288 physicians invited, 281 participated with a response rate of 97.6%. The mean age was 35.2 ± 8.4 years, with a male majority (n = 164; 58.4%). Adequate knowledge of HZ vaccination was observed in 176 (62.6%) participants. Knowledge was associated with a professional level ( 0.027); years of experience ( 0.020)-especially those with ≥ 5 years of experience ( 0.038)-were significant predictors of adequate knowledge. Most physicians (71.5%) perceived the vaccine as safe, and 65.8% considered it a clinical priority; however, 47.3% cited time constraints as a barrier to recommending it to patients. CONCLUSIONS: While knowledge levels among primary healthcare physicians in Jazan are acceptable overall, gaps in vaccination practices persist. Experience was a significant determinant of knowledge sufficiency, whereas time constraints were the primary barrier to vaccine recommendation. Targeted educational interventions and systemic adjustments were recommended to address time management challenges.
Hyperthyroidism-related liver disease is an uncommon cause of jaundice in children. There is scarce data on its clinical and histological features and management. We report the case of a five-year-old girl with thyrotoxi...Hyperthyroidism-related liver disease is an uncommon cause of jaundice in children. There is scarce data on its clinical and histological features and management. We report the case of a five-year-old girl with thyrotoxicosis associated with hepatitis, which was managed solely and successfully with carbimazole and propranolol.
OBJECTIVES: Cystic fibrosis (CF) is a multisystemic genetic disease. Progressive decline in lung function is the major cause of morbidity and mortality in this population, primarily related to chronic airway infection an...OBJECTIVES: Cystic fibrosis (CF) is a multisystemic genetic disease. Progressive decline in lung function is the major cause of morbidity and mortality in this population, primarily related to chronic airway infection and recurrent pulmonary exacerbations. We sought to assess the pattern of airway bacterial growth among patients with CF in Oman and identify possible risk factors for the hypothesized early acquisition among this population. METHODS: We conducted a retrospective single-center cross-sectional study that included all patients who attended the CF clinic at Royal Hospital, Oman between 2004 and 2020. Collected data included age, sex, geographic region, date of CF diagnosis, CF genotype, number of siblings with CF, and the date and results of all positive respiratory cultures. Early acquisition was defined by a positive respiratory culture for before the age of two years. Multi-drug resistant was defined as not susceptible to ≥ 1 agent in ≥ 3 classes of antimicrobials. The above factors were compared between the early and late acquisition groups. RESULTS: A total of 114 patients were included, and 2393 positive bacterial cultures were analyzed. Eighty-four (73.7%) patients were identified to have a positive culture for , including 40 (47.6%) who acquired it before the age of two years. remained the most common organism across all age groups. Twenty-six (22.8%) patients were positive for on their first respiratory culture, while 56 (49.1%) patients had three or more positive respiratory cultures for Methicillin-resistant accounted for 7.2% of all positive cultures under the age of one year and peaked at 14.8% between the ages of four and five years. A significant association were found between early acquisition and male sex. No significant association was observed between CF genotype, geographic region, age at diagnosis, or the presence of a sibling with CF and early acquisition. CONCLUSIONS: Our study demonstrated earlier acquisition of and its predominance among children with CF in Oman. Male sex was associated with a higher risk for early acquisition. Further prospective studies are needed to confirm this association and identify other possible risk factors. These findings will impact the clinical practice of CF physicians in Oman.
Immunoglobulin A vasculitis, formerly known as Henoch-Schoenlein purpura, is a rare acute auto-immune condition often associated with infections. We describe an adolescent girl who had recently recovered from COVID-19 in...Immunoglobulin A vasculitis, formerly known as Henoch-Schoenlein purpura, is a rare acute auto-immune condition often associated with infections. We describe an adolescent girl who had recently recovered from COVID-19 infection. She presented with painless hematuria, high blood pressure, purpuric skin rash, bilateral ankle pain and swelling, abdominal pain, and inability to walk. She was admitted and clinically diagnosed with immunoglobulin A vasculitis and started on steroid treatment, to which there was a dramatic response, only to relapse as the steroid was being tapered off. Treatment with azathioprine as a steroid-sparing agent led to complete remission without recurrence. This case also suggests that SARS-CoV-2 infection may trigger the development of autoimmune diseases.
A previously healthy five-year-old boy was seen in the rheumatology clinic with a five-month history of migrating joint discomfort, followed by right knee and left ankle arthritis. He showed no signs of lymphadenopathy,...A previously healthy five-year-old boy was seen in the rheumatology clinic with a five-month history of migrating joint discomfort, followed by right knee and left ankle arthritis. He showed no signs of lymphadenopathy, organomegaly, rashes, or fever. He could not bear weight and had nocturnal pain that was out of proportion to juvenile idiopathic arthritis. Blood tests revealed no pancytopenia. Whole-body magnetic resonance imaging showed extensive enhancement in nearly all bones, suggestive of chronic recurrent multifocal osteomyelitis. However, bone biopsy followed by marrow aspiration confirmed a diagnosis of pre-B-cell leukemia. This case highlights the importance of considering the possibility of childhood malignancies mimicking juvenile idiopathic arthritis and chronic recurrent multifocal osteomyelitis, even in the absence of typical neoplasm symptoms.
Empyema caused by in e-cigarette or vaping product use-associated lung injury (EVALI) can result in fatal outcomes. Empyema as a presentation of EVALI is rarely reported. is a known causative pathogen in empyema, typic...Empyema caused by in e-cigarette or vaping product use-associated lung injury (EVALI) can result in fatal outcomes. Empyema as a presentation of EVALI is rarely reported. is a known causative pathogen in empyema, typically associated with the elderly and immunocompromised states. We report the case of a 13-year-old male with a history of active e-cigarette use who presented to our center with right lung empyema, complicated by a suspected bronchopleural fistula. Despite chest drainage, antibiotic therapy, inotropic support, and mechanical ventilation, the patient ultimately succumbed to his illness. This case highlights a rarely reported severe complication of EVALI. Clinicians should be vigilant about obtaining a history of e-cigarette use in patients presenting with unexplained empyema.
OBJECTIVES: To examine the prevalence, characteristics, causes, and contributing factors of depression among university students to aid in the management of this condition through the identification of root causes and in...OBJECTIVES: To examine the prevalence, characteristics, causes, and contributing factors of depression among university students to aid in the management of this condition through the identification of root causes and influencing factors. METHODS: This cross-sectional study surveyed students enrolled in various colleges of Sultan Qaboos University, Muscat, between 1 September and 20 November 2023. Depressive symptoms were assessed using the self-report Patient Health Questionnaire-9. RESULTS: Out of a total of 1036 participants, 349 had depression, revealing a prevalence rate of 33.7%. Most depressed students were female (n = 261, 74.8%) and lived on campus (n = 210, 60.2%). Depression was significantly more prevalent among female students ( < 0.001) and among those residing on campus ( 0.028). The highest rate of depression was observed among students in the Colleges of Science (39.9%), Engineering (38.5%), and Agriculture and Marine Sciences (36.8%). There was no significant association between academic grade point average and depressive symptoms (p = 0.462). CONCLUSIONS: Over one-third of Sultan Qaboos University students had depressive symptoms, which was more prevalent among female students and those residing on campus, though an over representation of women in university housing confounds the latter association. Further research, especially in collaboration with other educational institutions, is recommended to assess the nationwide prevalence, identify vulnerable groups, and develop effective treatment strategies.
OBJECTIVES: This study aimed to evaluate the screening rate and the prevalence of obstructive sleep apnea syndrome (OSAS) in patients with apparent resistant hypertension (ARH) attending Sultan Qaboos University Hospital...OBJECTIVES: This study aimed to evaluate the screening rate and the prevalence of obstructive sleep apnea syndrome (OSAS) in patients with apparent resistant hypertension (ARH) attending Sultan Qaboos University Hospital, and to assess sex differences. METHODS: A cross-sectional retrospective study was conducted using the data from 500 patients with ARH between January 2018 and January 2023. The cohort included 270 women and 230 men. Data extracted from hospital records included demographic and clinical characteristics, antihypertensive medications, results of OSA screening tools (e.g., Epworth Sleepiness Scale and STOP-Bang questionnaire), and polysomnography outcomes. RESULTS: Of the 500 patients with ARH, 54 (10.8%) were diagnosed with OSAS. Only 6.6% (n = 33) were screened for OSA using the Epworth Sleepiness Scale or STOP-Bang questionnaire, while the majority (93.4%, n = 467) were not screened. Women constituted 54.0% of the cohort and had a higher mean body mass index than men (32.7 kg/m vs. 30.2 kg/m, < 0.001). OSAS prevalence was significantly higher in women than men (14.1% vs. 7.0%, 0.013). CONCLUSIONS: There was a low rate of screening for OSAS among patients with ARH at Sultan Qaboos University Hospital, which may explain the lower-than-expected prevalence observed. Contrary to published literature, OSAS was more frequently diagnosed in women, who were screened more often, suggesting that OSA may be underdiagnosed in men.
Kianpour P, Mourtami R, Sahab-Negah S
… +10 more, Panahi Y, Bayatani B, Qazivini A, Izadi M, Mojtahedzadeh M, Shahrami B, Hadadi A, Montazeri M, Bagher N, Najmeddin F
OBJECTIVES: To evaluate the efficacy and safety of umifenovir as a potential antiviral therapy for COVID-19; specifically, to determine whether umifenovir improves clinical outcomes, reduces hospitalization duration, and...OBJECTIVES: To evaluate the efficacy and safety of umifenovir as a potential antiviral therapy for COVID-19; specifically, to determine whether umifenovir improves clinical outcomes, reduces hospitalization duration, and enhances recovery rates in patients diagnosed with COVID-19 compared to standard care. METHODS: In this multicenter, open-label, randomized controlled trial, 260 patients diagnosed with COVID-19 were randomly assigned to receive either umifenovir (200 mg every six hours for seven days) or standard care. The primary outcome was clinical improvement, assessed via the National Early Warning Score 2 system, while secondary outcomes included changes in computed tomography scan scores, length of hospital stay, intensive care unit admission rates, and mortality. RESULTS: Of the 260 patients enrolled, 193 completed the study. Both groups showed significant reductions in clinical symptoms, although myalgia was more prevalent in the umifenovir group. The intervention group demonstrated a significant decrease in computed tomography scan scores; however, no significant differences were observed between groups regarding in hospital stay duration, intensive care unit admissions, or mortality rates. CONCLUSIONS: While umifenovir exhibited some immunological benefits in COVID-19 patients, it did not significantly improve broader patient-important outcomes compared to standard care. Therefore, its routine use in clinical practice for COVID-19 treatment is currently not justified, highlighting the need for further research to explore alternative therapeutic strategies.
OBJECTIVES: Transcription factor 7-like 2 (TCF7L2) has emerged as a promising candidate gene associated with type 2 diabetes mellitus (T2DM), and the intronic variant rs12255372 of the gene has demonstrated a robust ass...OBJECTIVES: Transcription factor 7-like 2 (TCF7L2) has emerged as a promising candidate gene associated with type 2 diabetes mellitus (T2DM), and the intronic variant rs12255372 of the gene has demonstrated a robust association with T2DM across various ethnic groups. We sought to determine the frequency of rs12255372 polymorphism in the Bangladeshi adult population, both with and without T2DM. METHODS: This cross-sectional study was conducted in the Endocrinology Department of Bangabandhu Sheikh Mujib Medical University. Eighty patients with T2DM and 80 normoglycemic controls were included in the study. The rs12255372 polymorphism was genotyped using the polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: An allelic odds ratio (OR) of 3.29 (95% CI: 1.78-6.05; < 0.001) was found for the minor T allele of rs12255372, significantly increasing the T2DM risk. A significant difference in TT and GT genotypes was noted between participants with T2DM (OR = 5.26, 95% CI: 1.39-19.9; 0.008) and normoglycemic controls (OR = 3.00, 95% CI: 1.33-6.75; 0.007), respectively. The dominant model appears to be the most suitable for representing the susceptibility gene effect. CONCLUSIONS: The frequency of the minor T allele of rs12255372 was about one-fourth and one-tenth among patients with T2DM and normoglycemic controls, respectively, indicating that this polymorphism may be associated with the risk of developing T2D in the studied population.
OBJECTIVES: The aim of the study was to assess morbidity and mortality outcomes using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM...OBJECTIVES: The aim of the study was to assess morbidity and mortality outcomes using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) scores in patients undergoing emergency gastrointestinal surgeries, and to compare the capabilities of POSSUM and P-POSSUM models in predicting mortality and morbidity. METHODS: In this prospective observational study, participants were selected from patients undergoing emergency gastrointestinal surgery at our hospital. The physiological component of POSSUM and P-POSSUM scores was calculated preoperatively, while the operative component was determined intraoperatively. RESULTS: A total of 45 patients were included in the study, with a mean age of 37.9 ± 15.7 years. The male-female ratio was 1.5:1.0. Intestinal perforation was the most common diagnosis (15; 33.3%) that necessitated exploratory laparotomy. The cutoff of POSSUM morbidity score of 87.5% had a sensitivity of 83.3% and a specificity of 92.6%, while the cutoff P-POSSUM morbidity score of 88.6% yielded a sensitivity of 88.9% and a specificity of 96.3%. Regarding mortality prediction, the cutoff POSSUM mortality score of 56.7% had a sensitivity of 87.5% and a specificity of 94.6%, while a P-POSSUM mortality cutoff score of 22.7% had a sensitivity of 100% and a specificity of 81.1%. CONCLUSIONS: Both POSSUM and P-POSSUM scores demonstrated significant sensitivity and specificity in predicting morbidity and mortality in patients undergoing emergency gastrointestinal surgeries. They can be effectively utilized for risk assessment in clinical practice.
Undifferentiated pleomorphic sarcoma of the laryngeal ventricle is extremely rare. We report a case of an elderly man with this condition, where a multidisciplinary team, involving an otorhinolaryngologist, pathologist,...Undifferentiated pleomorphic sarcoma of the laryngeal ventricle is extremely rare. We report a case of an elderly man with this condition, where a multidisciplinary team, involving an otorhinolaryngologist, pathologist, and oncologist developed a management plan, with a good outcome for the patient. We recommend a multidisciplinary team approach for diagnosing and treating undifferentiated pleomorphic sarcoma to achieve an optimal outcome.
OBJECTIVES: Surfactant therapy is an established treatment for neonatal respiratory distress syndrome (RDS). We sought to compare two administration techniques, intubation-surfactant administration-extubation (INSURE) an...OBJECTIVES: Surfactant therapy is an established treatment for neonatal respiratory distress syndrome (RDS). We sought to compare two administration techniques, intubation-surfactant administration-extubation (INSURE) and minimally invasive surfactant therapy (MIST), for efficacy and safety in premature neonates with RDS. METHODS: In this randomized clinical trial, premature neonates with RDS admitted to a neonatal intensive care unit in Iran from July to December 2020 were randomly assigned either to INSURE or MIST. In the MIST group, the surfactant was administered during spontaneous breathing via a thin vascular catheter without intubation. In the INSURE group, infants were intubated, surfactant administered, and then extubated. The key outcomes were the frequency of surfactant administration, duration of oxygen support, need for mechanical ventilation in the first 72 hours, and complications arising. RESULTS: The baseline characteristics of the studied premature neonates (N = 82) were similar between the INSURE (n = 44) and MIST (n = 38) groups. The surfactant treatment time was much shorter for the INSURE group (10.5 ± 17.0 minutes) than for the MIST group (42.0 ± 42.5 minutes; < 0.001). All infants received the first dose of surfactant, and requiring a second dose was obeserved in 17 (38.6%) in the INSURE group and 18 (47.4%) in the MIST group ( 0.400). There were no significant differences between the groups in the incidence of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax, pulmonary hemorrhage, or disseminated intravascular coagulation. The duration of nasal continuous positive airway pressure and the need for mechanical ventilation were also similar. CONCLUSIONS: Both INSURE and MIST techniques are effective and safe for administering surfactant therapy to premature infants with RDS, with no significant differences in outcomes or complications.
OBJECTIVES: To identify and evaluate the prescribing pattern of antibiotics among hospitalized patients with SARS-CoV-2, Omicron variant in Oman, focusing on the prevalence of antibiotic use, rates of simultaneous infect...OBJECTIVES: To identify and evaluate the prescribing pattern of antibiotics among hospitalized patients with SARS-CoV-2, Omicron variant in Oman, focusing on the prevalence of antibiotic use, rates of simultaneous infection, and potential overuse. METHODS: This retrospective study analyzed data from the electronic medical records of patients with COVID-19 caused by SARS-CoV-2 Omicron variant who were hospitalized at the Royal Hospital, Muscat, during December 2021-February 2022. Information on demographic and clinical details (including existing infections and comorbidities), hospital stays, and outcomes were collected. The prevalence and pattern of antibiotic use were examined, an association with their disease characteristics and simultaneous infection status were assessed. Statistical analysis was performed using R software. Associations between categorical variables were evaluated using chi-square test. RESULTS: The participants were 176 hospitalized COVID-19 patients (mean age 59.3 ± 18.6 years), of whom 69.9% had mild disease and 22.7% had severe disease. Simultaneous infection (coinfection or superinfection) was present in 11 (6.3%) patients, including 7 (4.0%) bacterial infections as revealed by culture tests. Despite the low rate of simultaneous infections, 104 (59.1%) patients received antibiotics, as follows: ceftriaxone (45.2%), piperacillin and tazobactam (45.2%), and vancomycin (21.2%). Half of the patients who received antibiotics used them for only one to three days with a median duration of four days (range = 1-16). Antibiotic use was significantly associated with patient sex ( 0.030), and the presence of simultaneous infection ( 0.029). The number and duration of antibiotic treatment also showed significant associations with various patient and disease characteristics. CONCLUSIONS: Despite low rates of confirmed bacterial infections, antibiotics were administered to majority of hospitalized patients with COVID-19 (Omicron variant). This finding emphasizes the need for strengthening antimicrobial stewardship to curb unnecessary antibiotic use and reduce the risk of antibiotic resistance during pandemics in Oman.