Alanine aminotransferase (ALT) is a key biomarker used in primary care to detect chronic liver diseases, particularly in high-risk populations such as those with metabolic syndrome and obesity. This review explores the r...Alanine aminotransferase (ALT) is a key biomarker used in primary care to detect chronic liver diseases, particularly in high-risk populations such as those with metabolic syndrome and obesity. This review explores the role ALTs play in screening for asymptomatic liver diseases and its ability to predict all-cause and liver-related mortality. While ALT remains valuable for screening in high-risk groups, its utility in the general population is limited due to a lack of cost-effective studies. Recent research suggests that lower ALT thresholds may improve early detection of liver disease, especially in individuals with non-alcoholic fatty liver disease. However, ALT alone may not be sufficient, as it has limitations regarding specificity and sensitivity. Combining ALT with other diagnostic tools, such as imaging techniques and additional liver enzyme markers, could enhance screening accuracy and early detection in primary care settings. Regular monitoring and adapting ALT cutoff values for specific populations are recommended to optimize liver disease management. This approach could lead to improved clinical outcomes, reduced progression to severe liver conditions, and better healthcare resource utilization.
OBJECTIVES: We aimed to investigate the expression levels and interaction between E2F-1 and Akt1 in triple-negative breast cancer (TNBC) cells, and whether cisdiamminedichloroplatinum (II) (cisplatin) could influence suc...OBJECTIVES: We aimed to investigate the expression levels and interaction between E2F-1 and Akt1 in triple-negative breast cancer (TNBC) cells, and whether cisdiamminedichloroplatinum (II) (cisplatin) could influence such an interaction. METHODS: A batch of MDA-MB-321 breast cancer cells were treated with increasing concentrations of cisplatin (2.5-40 μM) for 24 hours. Additional cells from the same source were used for control experiments. Cisplatin-induced apoptosis was confirmed biochemically using cleaved polymerase and flow cytometry analysis, and morphologically using hematoxylin and eosin staining, Hoechst staining, and scanning electron microscopy. Caspase-3 cleavage, an indicator of apoptotic induction, was measured by immunofluorescence. A western blot test was used to investigate the effects of cisplatin on E2F-1 and Akt1 expressions, while their co-localization and interaction were detected using immunofluorescence and immunoprecipitation, respectively. RESULTS: A western blot analysis revealed an increase in E2F-1 and a decrease in Akt1 expression with increasing concentration of cisplatin, compared to untreated cells. Merged E2F-1 and Akt1 immunosignals observed by immunofluorescence demonstrated that cisplatin-treated cells exhibited co-localization of immunosignals in clusters and with increased intensity in the cytoplasm. Immunoprecipitation and western blot analysis results further confirmed the association between E2F-1 and Akt1, indicating a potential interaction between the two proteins in MDA-MB-231 cells. CONCLUSIONS: Our findings suggest a potential interaction between E2F-1 and Akt1, which in turn could be the precursor for the cisplatin-induced apoptosis in TNBC cells. Further studies are needed to determine whether this interaction occurs directly or via an intermediate protein.
OBJECTIVES: To assess treatment initiatives in symptomatic and asymptomatic urinary tract infection (UTI) cases, identify effective antibiotics based on culture reports, and evaluate secondary factors such as symptoms, u...OBJECTIVES: To assess treatment initiatives in symptomatic and asymptomatic urinary tract infection (UTI) cases, identify effective antibiotics based on culture reports, and evaluate secondary factors such as symptoms, urine white blood cells, culture correlation, prevalent microbial flora, empirical antibiotic efficacy, and prevalence of multidrug resistance (MDR). METHODS: A retrospective analysis of urological cases with microbial growth on culture was conducted. Data on demographics, symptoms, urinalysis, culture analysis, antibiotic sensitivity, and MDR status were collected and statistically analyzed. RESULTS: Out of 223 cases included in the study, 191 were symptomatic and 32 were asymptomatic. was the most common pathogenic organism (55.6%). Nitrofurantoin exhibited high efficacy (75.4% in symptomatic and 78.1% in asymptomatic patients), with no significant difference between the two groups in MDR bacteria prevalence ( 0.377) or positive follow-up cultures ( 0.687). CONCLUSIONS: Nitrofurantoin was highly effective for UTIs; however, multidrug-resistant strains remain a concern. With limited access to minimum inhibitory concentration results and culture sensitivity tests during the initial patient visit, physicians prescribing first-line treatments for suspected cases of resistance must carefully evaluate clinical presentation, patient history, and local resistance patterns. Subsequent treatments should be based on culture sensitivity results and clinical guidelines. This study is particularly relevant in the Gulf Cooperation Council region due to its distinct epidemiological and clinical landscape.
OBJECTIVES: This study aimed to estimate the incidence and trends of hypoglycemia cases admitted to the emergency department of a tertiary hospital in Oman before the COVID-19 pandemic. METHODS: We retrospectively review...OBJECTIVES: This study aimed to estimate the incidence and trends of hypoglycemia cases admitted to the emergency department of a tertiary hospital in Oman before the COVID-19 pandemic. METHODS: We retrospectively reviewed the hospital records of all patients aged ≥ 15 years admitted to the emergency department with hypoglycemia (random blood glucose level ≤ 3.9 mmol/L) between January 2010 and January 2017. RESULTS: A total of 242 patients were admitted with hypoglycemia, with an incidence increasing from 3.31 to 5.25 per 10 000 individuals during the study period. Non-diabetic patients exhibited significantly higher rates of abnormal heart rates compared to those with diabetes (0.010). Non-diabetics were more likely to have liver disease, liver cirrhosis, malignancies, exposure to drugs/toxins, and infections ( < 0.050), while diabetic patients had significantly higher rates of cerebrovascular diseases ( < 0.050). To manage hypoglycemia, intravenous dextrose was administered significantly more for patients with diabetes compared to non-diabetics (0.015). In the study cohort, glucagon was administered to only one patient. CONCLUSIONS: The incidence of hypoglycemia presentations increased during the study period. Intravenous dextrose was the primary management approach for diabetic patients, and glucagon use was minimal. Further investigation is required to decipher the hypoglycemia trends in the post-pandemic period.
OBJECTIVES: Beckwith-Wiedemann syndrome (BWS) is a rare genetic and cancer-predisposing disorder characterized by variable clinical and molecular abnormalities. It is considered a spectrum ranging from classical BWS to i...OBJECTIVES: Beckwith-Wiedemann syndrome (BWS) is a rare genetic and cancer-predisposing disorder characterized by variable clinical and molecular abnormalities. It is considered a spectrum ranging from classical BWS to isolated hemihyperplasia (IHH). This study sought to characterize Omani patients with BWS and IHH clinically and molecularly, evaluate their surveillance results, and assess the tumor's prevalence in the cohort. METHODS: Nine patients with BWS were retrospectively recruited to the study by searching the medical records of Sultan Qaboos University Hospital between January 2012 and December 2022. Demographics, clinical features, molecular findings, and surveillance test results, including abdominal ultrasound and alpha-fetoprotein, were extracted from the hospital information system and systematically analyzed. RESULTS: Nine patients diagnosed with Beckwith-Wiedemann syndrome were studied, comprising four BWS cases and five IHH cases. Macroglossia was the predominant clinical feature among BWS patients, whereas lateralized overgrowth was consistently observed in IHH patients. All BWS patients tested positive for methylation anomalies: two exhibited loss of methylation at imprinting control 2 (22.2%), one had paternal uniparental disomy of chromosome 11 (11.1%), and another showed a gain of methylation at imprinting control 1 (11.1%). Throughout the surveillance period, none of the patients showed elevated alpha-fetoprotein levels or developed tumors. CONCLUSIONS: This is the first study to examine a cohort of patients with BW spectrum in Oman. It reveals comparable clinical and molecular characteristics to the previously reported BWS patients, yet no tumors were detected in this cohort.
Carcinoid tumors are slow-growing tumors that typically occur in the gastrointestinal (GI) tract, lungs, and other endocrine glands. They are commonly discovered incidentally and usually cause no symptoms. When symptomat...Carcinoid tumors are slow-growing tumors that typically occur in the gastrointestinal (GI) tract, lungs, and other endocrine glands. They are commonly discovered incidentally and usually cause no symptoms. When symptomatic, they tend to present with vague abdominal pain and may lead to carcinoid syndrome after metastasis to the liver. Such tumors rarely present with GI bleeding and thus rarely lead to iron deficiency anemia. In this report, we present an uncommon case of a 71-year-old male who presented with fatigue, weakness, intermittent rectal bleeding, and black stools. He was vitally stable but cachectic. Laboratory studies revealed iron deficiency anemia of unknown origin. Initially, a colonoscopy was performed, which only revealed internal hemorrhoids, so an upper endoscopy was scheduled. Upper GI endoscopy revealed a bleeding duodenal nodule in the upper half of the duodenum that was biopsied. Immunohistochemistry revealed a duodenal carcinoid tumor. The lesion was resected endoscopically as the patient was unfit for surgery due to concurrent comorbidities. Abdominal imaging showed no signs of liver metastasis. The patient was followed periodically by the gastroenterology clinic to ensure no recurrence or metastasis, but he eventually succumbed to other comorbidities. This case highlights the challenges in diagnosing and managing this rare presentation in a significantly ill patient with multiple comorbidities. Upon reviewing the literature, we found that it was uncommon for carcinoid tumors of the GI tract to present with bleeding or anemia. Of those reported in the literature to have caused bleeding, the majority were in the stomach or ileum. To the best of our knowledge, this is the first reported case of a duodenal carcinoid tumor presenting with iron deficiency anemia.
Hemangiolymphangioma is a rare malformation of the vascular and lymphatic system affecting different parts of the human body. Hemangiolymphangioma of the small bowel mesentery is extremely rare. We report the case of a 2...Hemangiolymphangioma is a rare malformation of the vascular and lymphatic system affecting different parts of the human body. Hemangiolymphangioma of the small bowel mesentery is extremely rare. We report the case of a 23-year-old woman who presented with generalized colicky abdominal pain. Computed tomography findings were initially thought to represent possible secondary mesenteric and peritoneal metastatic deposits. However, no primary tumor was identified. A pelvic magnetic resonance imaging was then performed, which favored the diagnosis of extensive mesenteric lymphangiomatosis. The diagnosis was confirmed histopathologically as hemangiolymphangioma of the small bowel mesentery.
The artery of Percheron is a rare anatomical variant artery that supplies the bilateral thalami and midbrain. An acute occlusion of the vessel will lead to the presentation of a bilateral thalamic stroke syndrome. The cl...The artery of Percheron is a rare anatomical variant artery that supplies the bilateral thalami and midbrain. An acute occlusion of the vessel will lead to the presentation of a bilateral thalamic stroke syndrome. The classical presentation includes somnolence and a reduced level of consciousness. Therefore, this clinical entity often goes unrecognized and diagnoses are usually delayed due to the ambiguity of presenting symptoms. We report a case of a man presenting with an acute onset of drowsiness, later diagnosed with a bilateral thalamic infarct only days later due to the vague clinical symptoms. We also highlighted several key learning points from this case and emphasized the importance of recognizing this syndrome.
Cases of small bowel obstruction in the virgin abdomen are rare and can pose diagnostic challenges, especially when associated with endocrinopathy. We present a young woman with uncontrolled Graves' disease who was admit...Cases of small bowel obstruction in the virgin abdomen are rare and can pose diagnostic challenges, especially when associated with endocrinopathy. We present a young woman with uncontrolled Graves' disease who was admitted with a small bowel obstruction in a virgin abdomen a few weeks after developing a thyroid storm.
Primary squamous cell carcinoma (SCC) of the renal parenchyma without a history of urolithiasis is a rare entity. Renal SCC is usually associated with other conditions like renal stone disease, chronic inflammation, and...Primary squamous cell carcinoma (SCC) of the renal parenchyma without a history of urolithiasis is a rare entity. Renal SCC is usually associated with other conditions like renal stone disease, chronic inflammation, and infection. We report three cases of primary SCC with no history of renal stone disease or identifiable risk factors. We also present a current review of the literature and a detailed description of the morphological features.
OBJECTIVES: Obesity poses a significant challenge worldwide, increasing the risk of various metabolic diseases, including type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia. Bariatric surgery, specific...OBJECTIVES: Obesity poses a significant challenge worldwide, increasing the risk of various metabolic diseases, including type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia. Bariatric surgery, specifically a laparoscopic sleeve gastrectomy (LSG), is effective in inducing weight loss, thereby improving the rate of obesity-related metabolic diseases. This study aimed to assess the short-term effectiveness and metabolic effects of LSG procedures among patients in Oman. METHODS: This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, and included patients who underwent LSG between 1 January 2017 and 31 December 2018. Demographic, clinical, and anthropometric data were collected from the hospital's computerized records preoperatively and one year postoperatively. RESULTS: A total of 168 patients were included in the study, of whom most were female (66.1%). Before surgery, the mean age was 36.1 years, and the mean body mass index (BMI) was 50.8 kg/m. In terms of comorbidities, 28.6% had T2DM, 28.6% had HTN, and 20.8% had dyslipidemia. Postoperatively, more than two-thirds of the cohort (n = 132; 78.6%) achieved a target percent excess weight loss (EWL) of > 50%, including 89.5% and 73.0% of male and female patients, respectively ( 0.014). The percent EWL was positively correlated to preoperative BMI ( < 0.001); however, no significant associations were observed with various comorbidities, including HTN, T2DM, dyslipidemia, and obstructive sleep apnea ( > 0.050). CONCLUSIONS: The results of this study indicate that LSG is effective for the short-term achievement of percent EWL among Omani patients with morbid obesity. However, further studies are needed to assess the long-term effectiveness of LSG on percent EWL and its effect on obesity-related metabolic diseases.
OBJECTIVES: We sought to compare the epidemiological and clinical features of variant leiomyoma, smooth muscle tumors of uncertain malignant potential (STUMP), and sarcoma to classical leiomyoma and assess the radio-hist...OBJECTIVES: We sought to compare the epidemiological and clinical features of variant leiomyoma, smooth muscle tumors of uncertain malignant potential (STUMP), and sarcoma to classical leiomyoma and assess the radio-histological correlation. METHODS: This retrospective, observational study was conducted in Royal Hospital, Muscat, Oman. We included all patients who underwent surgical treatment for uterine fibroids from 1 January 2011 to 31 December 2016. Data was retrospectively collected from electronic patient records, pictures archiving system, and histopathology reports, and analyzed using SPSS version 29 and MedCalc Statistical Software. RESULTS: Out of the 14269 patients who attended the gynecology outpatient department, 19.5% were clinically diagnosed with uterine fibroids. Surgical procedures were performed in 545 (19.6%) women. Diagnosis from histopathology reports was classical leiomyoma in 508 (93.2%) cases, variant leiomyoma in 35 (6.4%), and sarcomas in two (0.4%); there were no cases of STUMP. Magnetic resonance imaging (MRI) correctly identified 125 (89.9%) cases of classical leiomyoma and 2/11 (18.2%) cases of variants. The sensitivity and specificity of MRI to predict non-classical varieties was 22.22% and 88.65%, respectively. MRI had a strong negative predictive value (94.7%) for leiomyoma variants. The area under the curve for classical and variant leiomyoma was 0.63 (0.55-0.71) and 0.55 (0.47-0.64). The accuracy of MRI in predicting classical leiomyoma was 86.00 (79.40-91.12) and 84.67 (77.87-90.03) the non-classical varieties. CONCLUSIONS: Epidemiological and clinical features were not helpful in distinguishing between classical leiomyoma and non-classical varieties. MRI had weak discriminatory power to distinguish between classical and non-classical varieties.
OBJECTIVES: Placenta accreta spectrum (PAS) is commonly associated with adverse pregnancy outcomes. While ultrasound (US) is the primary imaging tool, magnetic resonance imaging (MRI) plays a crucial complementary role i...OBJECTIVES: Placenta accreta spectrum (PAS) is commonly associated with adverse pregnancy outcomes. While ultrasound (US) is the primary imaging tool, magnetic resonance imaging (MRI) plays a crucial complementary role in assessing PAS disorders. This study aimed to evaluate the MRI features in PAS diagnosis and enhance the role of MRI in conjunction with US for better management. Additionally, the study examined the association between imaging findings and clinical outcomes. METHODS: This retrospective cross-sectional study was conducted between January 2017 and June 2022 at Tu Du Hospital, Vietnam. A total of 87 cases were eligible for inclusion. Antenatal MRI and US findings were compared to intraoperative diagnoses and/or histopathological confirmation, which is considered the gold standard. The diagnostic value of each MRI feature was calculated, and the association between MRI/US findings, estimated blood loss, and surgical methods was analyzed. Statistical significance was determined with a -value < 0.05. RESULTS: Among the 87 women suspected of PAS on US, 83 were confirmed to have PAS through intraoperative diagnosis and/or histology. The mean maternal age was 35.9 5.7 years and the mean gestational age at cesarean section was 31.1 7.1 weeks. MRI sensitivity (Se) in detecting PAS ranged from 10.8-94.0%, while the specificity (Sp) ranged from 25.0-100%. Loss of retroplacental T2 dark zone demonstrated the highest diagnostic value. When combining three to six MRI signs, Se increased from 53.0-100%, and Sp from 25.0-100%. The highest Youden?(tm)s index (0.759) was observed with five MRI signs (Se = 75.9%, Sp = 100%). PAS diagnosed via MRI/US was associated with more significant blood loss during cesarean section (1000 (600-2000) mL vs. 500 (250-850) mL and 1000 (600-2000) mL vs. 300 (300-500) mL, respectively). Furthermore, the percreta type of PAS identified on MRI/US was linked to significantly higher rates of cesarean hysterectomy compared to conservative surgery (56.4% vs. 43.6% and 63.5% vs. 36.5%, respectively). CONCLUSIONS: MRI provides a reliable diagnostic value for PAS, particularly following uncertain US findings. Depending on resource availability, a stepwise approach utilizing both imaging modalities should be considered. MRI can guide strict interdisciplinary management in cases of suspected PAS, especially percreta type. Further studies are needed to solidify the role of MRI in severe PAS cases.
OBJECTIVES: Q fever is a worldwide zoonosis, yet its prevalence may be underestimated due to the challenges in diagnosis. We present a series of cases where patients were treated for Q fever infection based primarily on...OBJECTIVES: Q fever is a worldwide zoonosis, yet its prevalence may be underestimated due to the challenges in diagnosis. We present a series of cases where patients were treated for Q fever infection based primarily on their clinical features and available laboratory tests, highlighting the difficulties in establishing the diagnosis. METHODS: This 15-year case series was observed from January 2009 to November 2023 at Sultan Qaboos University Hospital, Oman. Relevant patient information was obtained from the electronic hospital records under the ethical approval MREC # 3139. RESULTS: We treated 17 patients from a total of 1481 patients tested. The median age was 38 years, with a male-to-female ratio of 1.4:1. Fever was the most common symptom, and six patients experienced weight loss. Hepatobiliary, respiratory, neurological, and musculoskeletal symptoms occurred in 10, six, five, and four patients, respectively. Three patients developed rashes during their illness. Two patients had definite infective endocarditis, one had probable infective endocarditis, and two patients had pericardial effusion. CONCLUSIONS: Q fever should be considered in the differential diagnosis of a wide range of clinical presentations. However, it can be clinically challenging, and serological test interpretation can be difficult in areas of endemicity and with limited diagnostic tests. A combination of compatible clinical illnesses and appropriate diagnostic tests is necessary for accurate diagnosis.
OBJECTIVES: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening autoimmune disorder; limited information about this disease is available from the Middle East. This study aimed to provide a background da...OBJECTIVES: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening autoimmune disorder; limited information about this disease is available from the Middle East. This study aimed to provide a background data on TTP epidemiology in Oman, including its clinical characteristics, disease course, and outcomes. METHODS: The study used a longitudinal retrospective observational design, drawing on the electronic patient records of two major hospitals in Muscat from January 2006 to December 2019. Patients who met the diagnostic criteria for TTP were included in the analysis. RESULTS: Over 13 years, 54 patients were diagnosed with TTP, seven (13.0%) of whom experienced a relapse. The incidence of TTP in Oman was 1.8 cases per million population per year, mainly affecting women aged 30-50 years. ADAMTS-13 testing in 23 (42.6%) cases revealed enzyme deficiency in six patients and acquired autoantibodies in 10 patients. Treatments included steroids (94.4%), therapeutic plasma exchange (77.8%), rituximab (42.6%), and cyclosporin (18.5%). Among the TTP-induced morbidities, 46.3% of the participants developed deranged kidney function, 24.0% required hemodialysis. Neurological morbidities included seizures (25.4%), confusion (24.1%), stroke (18.5%), and coma (3.7%). Residual neurological deficits occurred in two (20.0%) of 10 patients with stroke. All patients with seizures recovered. The case fatality rate during the study period was seven (13.0%), with 30-day and 90-day mortality rates of 9.3% and 13.0%, respectively. CONCLUSIONS: Though TTP was found to be rare in Oman, the affected patients were at risk of developing serious renal and neurological complications. The unusually low prevalence suggests TTP may be underdiagnosed in Oman.
Respiratory syncytial virus (RSV) infection poses a significant health threat to infants and young children. Considering the substantial burden in Gulf Cooperation Council (GCC) countries, prevention of RSV remains a maj...Respiratory syncytial virus (RSV) infection poses a significant health threat to infants and young children. Considering the substantial burden in Gulf Cooperation Council (GCC) countries, prevention of RSV remains a major public health priority. Globally, palivizumab prophylaxis has proven effective in reducing hospitalization and preventing complications in high-risk infants. While several national-level recommendations have been developed for palivizumab prophylaxis, few countries follow external guidelines due to a lack of regional directives. For effective RSV management, recommendations should be based on regional evidence and local clinical practices. Hence, it is imperative to establish uniform recommendations for palivizumab prophylaxis for the GCC region. We reviewed the literature on RSV prevalence, palivizumab immunoprophylaxis's efficacy, and the optimal timing for initiating RSV immunoprophylaxis programs. Experts were invited to share their insights on disease burden, current immunoprophylaxis practices, barriers to compliance, and strategies to improve adherence to palivizumab prophylaxis. These recommendations are intended to bridge the existing gaps and serve as a unified reference guide for local physicians and those recruiting eligible patients in RSV immunoprophylaxis programs, thus allowing for effective RSV management. This collaborative initiative aims to reduce the overall burden of RSV-related illness in the GCC region by promoting alignment in recommendations and addressing obstacles to compliance.