OBJECTIVES: There is a dearth of research in Oman regarding public knowledge and attitudes regarding the triage protocols for prioritizing patients for emergency care. This study aimed to investigate this at the emergenc...OBJECTIVES: There is a dearth of research in Oman regarding public knowledge and attitudes regarding the triage protocols for prioritizing patients for emergency care. This study aimed to investigate this at the emergency department (ED) of a tertiary referral hospital in Muscat, Oman. METHODS: This cross-sectional study was conducted from September to November 2019. Adult Omanis visiting the hospital's outpatient clinics or the ED during this period were selected using a consecutive convenience sampling strategy. A self-administered questionnaire was designed and used to assess the participants' knowledge and attitudes regarding the triage process used in the ED. RESULTS: A total of 572 Omani adults participated in the survey (response rate: 77.3%). The majority were female (56.8%). Most participants were educated to high school or bachelor's degree level (74.7%). Overall, less than half of the sample (41.8%) demonstrated adequate knowledge of proper ED utilization, with male participants ( 0.005) and those with a history of previous ED visits ( 0.001) demonstrating significantly better knowledge than their respective counterparts. Knowledge of the factors used to make triaging decisions ranged from 28.5% (patient's medical history) to 67.3% (vital signs). Most participants agreed that the triage system helped to prioritize emergency cases (84.8%), improved the quality of ED care (80.9%), and reduced overcrowding (76.2%). Although 59.1% still preferred to visit the ED for non-emergent indications to receive same-day care, 48.4% stated they would accept redirection to a primary health center if requested. CONCLUSIONS: This study's findings revealed the necessity of increasing awareness of appropriate indications for ED visits in Oman, as well as specific factors used in the ED triage process. This would help to ensure appropriate health resource utilization, avoid ED overcrowding and lengthy wait times, and increase overall levels of patient satisfaction and confidence in the healthcare system.
OBJECTIVES: We sought to estimate the impact of central precocious puberty (CPP) on psychosocial aspects in the cohort of children and to assess whether these aspects changed after treatment with gonadotropin-releasing h...OBJECTIVES: We sought to estimate the impact of central precocious puberty (CPP) on psychosocial aspects in the cohort of children and to assess whether these aspects changed after treatment with gonadotropin-releasing hormone (GnRH) analogues. METHODS: A case-control study enrolled 30 CPP children and 30 normal controls. The CPP group was assessed with emphasis on anthropometric measurements (Tanner staging for pubertal changes). The hormonal profile included gonadotropins, estradiol or testosterone, and GnRH stimulation test. The instruments used for neuropsychological assessment included the Arabic version of the pediatric quality of life inventory TM 4.0, the Child Behavior Checklist (CBCL), and IQ testing. RESULTS: The mean study group age was 5.1 ± 2.3 years compared to 5.2 ± 2.2 years in the control group; 29 patients and 29 controls (96.7%) were females. CPP children had significantly lower scores than controls in health-related quality of life (QoL) domains except school functioning without significant changes in CBCL scores and cognitive function. There was a statistically significant improvement in these scores after they were treated with GnRH analogues for a year. CONCLUSIONS: There are significant aberrations in CPP children's QoL with no effect on behavior or cognition. After treatment with GnRH analogues for a year, QoL and CBCL T-scores showed a significant improvement.
Brown-Séquard Syndrome (BSS) in children is a rare but serious neurological condition that can develop following damage to one-half of the spinal cord due to odontoid synchondrosis fracture. We report a case of a two-yea...Brown-Séquard Syndrome (BSS) in children is a rare but serious neurological condition that can develop following damage to one-half of the spinal cord due to odontoid synchondrosis fracture. We report a case of a two-year-old girl who presented with difficulty moving her neck, gait abnormalities, and right-side weakness. She had a history of a fall from bed three months earlier. Computed tomography scan and magnetic resonance imaging revealed an incomplete fracture of C2 vertebra, resulting in focal kyphosis and posterior impingement over the craniocervical junction along with significant cord thinning. Considering the patient's age and the incomplete nature of the fracture, a conservative approach was taken, and the patient underwent immobilization in a cervical collar for an extended period, followed by physiotherapy.
OBJECTIVES: Antibiotic resistance in clinical isolates is often correlated to poor disease management or prolonged hospitalization. The study aimed to determine the prevalence of multidrug-resistant (MDR) isolates in cl...OBJECTIVES: Antibiotic resistance in clinical isolates is often correlated to poor disease management or prolonged hospitalization. The study aimed to determine the prevalence of multidrug-resistant (MDR) isolates in clinical samples collected from Dhaka, Bangladesh. METHODS: We investigated 150 clinical samples for the presence of . The isolates were tested against 12 antibiotics categorizable into three groups based on action mechanism and nine classes based on chemical structure. The susceptibility patterns were analyzed using the Kirby-Bauer disk diffusion method on Mueller Hinton agar. The isolates were classified as MDR and extensively drug-resistant based on their resistance patterns against different antibiotics. RESULTS: We used 100 isolates for this study. The highest prevalence of resistance was observed against penicillin G (96.0%), cefuroxime (75.0%), and clindamycin (71.0%). The isolates exhibited 33.0% and 43.0% resistance against imipenem and meropenem, respectively. Almost all (98.0%) isolates showed MDR. A quarter of the isolates (23.0%) were resistant to five classes of antibiotics and 18.0% to six classes of antibiotics. Moreover, 20.0% of isolates exhibited extensive drug resistance. Among the cell wall synthesis inhibitors, the highest resistance was observed against penicillin G (31.0%). Resistance rates were in the range 20-30% against protein synthesis inhibitors, clindamycin (29.0%), tetracycline (21.0%), and chloramphenicol (21.0%). Among the isolates, 90.0% showed multiple antibiotic resistance index scores of ≥ 0.3, while 65.0% scored ≥ 0.5. The carbapenem group accounted for the maximum sensitivity (62.0%), followed by 60.0% each for gentamicin and norfloxacin. CONCLUSIONS: The high prevalence of MDR isolates in clinical samples from Bangladesh indicates a serious threat to public health. Our findings emphasize the urgent need to control MDR through promoting responsible use of suitable antibiotics and public awareness of the dangers of antibiotic misuse, increasing testing facilities, and promoting genetic research.
OBJECTIVES: Hemoglobin Constant Spring (Hb CS) is one of the most common non-deletion types of alpha (α) thalassemia in Southeast Asia. The nature of this abnormal globin gene is unstable, labile, and present in minute a...OBJECTIVES: Hemoglobin Constant Spring (Hb CS) is one of the most common non-deletion types of alpha (α) thalassemia in Southeast Asia. The nature of this abnormal globin gene is unstable, labile, and present in minute amounts in the peripheral blood, leading to underdiagnosis. This study aimed to determine the prevalence of Hb CS among the Kelantan population in Malaysia, compare the levels of Hb CS detected by capillary electrophoresis (CE) among three groups of Hb CS (heterozygous, homozygous, and compound heterozygous), and evaluate the efficacy of CE and high-performance liquid chromatography (HPLC) in detecting Hb CS. METHODS: A cross-sectional study was conducted using data collected from secondary school students in Kelantan from 2017 to 2018 who participated in a thalassemia screening program conducted by the Ministry of Health, Malaysia. Hb analysis was performed using an automated CE system (CAPILLARYS 2 Flex-Piercing System Sebia) and HPLC (VARIANT II, Bio-rad Laboratories). DNA analysis was used multiplex polymerase chain reaction and multiplex amplification refractory mutation system to detect deletion and non-deletion α-thalassemia. RESULTS: Termination codon CS mutation was confirmed among 376 (99.5%) samples with a peak value in zone 2 of CE. Heterozygous Hb CS was the most common type, detected in 344 samples (91.5%), followed by compound heterozygous Hb CS in 31 samples (8.2%) and one sample (0.3%) of homozygous Hb CS. CONCLUSIONS: The diagnosis of Hb CS is most accurately achieved by combining CE and HPLC methods, with confirmation by DNA molecular study, although the latter is more expensive.
OBJECTIVES: The management for chronic suppurative otitis media is tympanoplasty. The aim of the surgery is to prevent recurrent ear discharge and improve hearing. Several influencing factors are presumed to affect the o...OBJECTIVES: The management for chronic suppurative otitis media is tympanoplasty. The aim of the surgery is to prevent recurrent ear discharge and improve hearing. Several influencing factors are presumed to affect the outcome of tympanoplasty; however, their effect is considered controversial. No study in Oman evaluates the success rate of this surgery. Therefore, this study aimed to evaluate the anatomical and functional outcome of type 1 tympanoplasty in Al Nahdha Hospital, Oman, from 2010 to 2020. In addition, we sought to assess various factors that might have influenced the outcome and add our experience to the literature. METHODS: We conducted a retrospective study that included all patients who had undergone type 1 tympanoplasty in Al Nahdha Hospital. The demographic data for patients were collected, in addition to the preoperative findings, pre- and postoperative air-bone gap (ABG) in a pure tone audiometry, the surgical approaches, and the type of grafts used. The success rate was defined as intact tympanic membrane six months after the surgery, and hearing improvement success was assessed by closure of ABG closure of 10 dB or more. RESULTS: The total number of patients was 345, 40.6% were male, and 59.4% were female. The graft success rate was 84.3%. The average preoperative ABG was 26.1 ± 9.5, and the average postoperative ABG was 14.4 ± 9.3 with a gain of 11.7. This was statistically significant with a -value of < 0.001. Hearing improvement (≥ 10 dB gain in ABG) was seen in 201 (67.0%) patients. There was no statistically significant difference in the hearing improvement and graft success rate when compared with influencing factors, including age, gender, perforation size, and surgical approach. However, there was a statistically significant difference between the types of graft used, where cartilage graft showed better hearing improvement than temporalis fascia graft. CONCLUSIONS: The graft success rate of type 1 tympanoplasty in Al Nahdha Hospital was 84.3%, and closure of ABG was 11.7. The percentage of patients who had improvement in ABG closure of ≥ 10 dB was 67.0%. These results are comparable with the results of other published studies. Factors that are presumed to influence the outcome of type 1 tympanoplasty were not statistically significant, which is consistent with other studies. Cartilage graft was found to give a better closure of ABG, which was statistically significant. We recommend that further studies be conducted within a more extended follow-up period and address more factors to achieve a better insight pertaining to the outcome of type 1 tympanoplasty.
OBJECTIVES: Inactive hepatitis B carriers constitute a considerable proportion of chronic hepatitis B virus (HBV)-infected patients. Understanding the clinical features of this often overlooked population is essential to...OBJECTIVES: Inactive hepatitis B carriers constitute a considerable proportion of chronic hepatitis B virus (HBV)-infected patients. Understanding the clinical features of this often overlooked population is essential to inform patient management strategies. Our study aimed to describe the sociodemographic and clinical features of inactive HBV carriers presenting to a tertiary center in Muscat, Oman. METHODS: We conducted a retrospective, descriptive study among 375 adult Omani patients with inactive HBV infections presenting to the Sultan Qaboos University Hospital between January 2017 and December 2018. Relevant data were collected from electronic patient records. Liver fibrosis status was determined using two-dimensional shear-wave elastography. RESULTS: A total of 200 patients met the study inclusion criteria and were included in the analysis. Of these, 53.0% were male, and the mean age was 45.0 ± 9.3 years. Most (77.5%) were aged 32-50 years and were therefore born before 1990, the year of initiation of the national HBV vaccination program. A family history of HBV infection was reported in 29.0%, while 25.0% were obese. Severe fibrosis and cirrhosis were observed in 16.0% and 3.0% of the cohort, respectively. CONCLUSIONS: A large number of inactive Omani HBV carriers were born before the implementation of the national HBV vaccination program in Oman, and just under one-third had a family history of HBV infection. Notably, despite being considered inactive carriers, 19.0% displayed radiological features of severe fibrosis or cirrhosis. Screening for high-risk inactive HBV infection is essential to ensure early management and improved patient outcomes.
Myiasis is the term referring to an infestation of dipterous larvae in the living body tissue, where they feed on the tissue and cause infection. It is typically found in individuals living in unhygienic conditions, with...Myiasis is the term referring to an infestation of dipterous larvae in the living body tissue, where they feed on the tissue and cause infection. It is typically found in individuals living in unhygienic conditions, with foul-smelling odor emanating from neglected wounds or body discharge, which attract flies to lay their eggs in the affected area. Myiasis can cause life-threatening complications if maggots invade vital organs, resulting in sepsis, hemorrhage, and organ dysfunction. The mainstay of treatment includes mechanical removal of the maggots, wound debridement, daily wound dressing, and administration of antibiotics for concurrent bacterial infections. Recently, we encountered a patient who presented with bleeding and foul-smelling discharge from a tracheostomy wound, which was found to be infested with maggots.
Hypocalcemia, deafness, and renal syndrome, also known as Barakat syndrome, is an autosomal dominant genetic condition characterized by hypocalcemia, sensorineural hearing loss, and renal dysplasia. Papilledema, which re...Hypocalcemia, deafness, and renal syndrome, also known as Barakat syndrome, is an autosomal dominant genetic condition characterized by hypocalcemia, sensorineural hearing loss, and renal dysplasia. Papilledema, which refers to optic disc swelling due to increased intracranial pressure caused by hypocalcaemia, has been reported in the literature. However, optic disc edema secondary to hypocalcemia-induced optic neuropathy with normal intracranial pressure is rare. In this case report, we present a rare case of hypocalcemia, deafness, and renal syndrome, possibly the first diagnosed based on the presence of hypocalcemia-induced optic disc edema. We suggest that patients with optic disc edema referred for further neurological investigations should have their serum calcium levels analyzed, as early diagnosis and correction of hypocalcemia may improve the signs and symptoms of optic nerve disease.
Ischemic priapism is a male urologic emergency. Most cases have been linked to genetic conditions such as sickle cell disease and (much more rarely) glucose-6-phosphate dehydrogenase deficiency, and the use of certain dr...Ischemic priapism is a male urologic emergency. Most cases have been linked to genetic conditions such as sickle cell disease and (much more rarely) glucose-6-phosphate dehydrogenase deficiency, and the use of certain drugs. Here, we report the case of a 34-year-old male who was a known case of the recurrent ischemic type of priapism, which was relieved by penile aspiration. Genetic investigation revealed that the patient had glucose-6-phosphate dehydrogenase.
Biotin is sometimes administered in mega doses to children to treat certain inborn errors of metabolism. We report the case of a one-week-old newborn who was started on a 'mitochondrial cocktail' that contained a high do...Biotin is sometimes administered in mega doses to children to treat certain inborn errors of metabolism. We report the case of a one-week-old newborn who was started on a 'mitochondrial cocktail' that contained a high dose of biotin. On day seven of life, his thyroid function test showed a biochemical picture of primary hyperthyroidism, which was not clinically evident. The suspicion of immunoassay interference with thyroid function test was confirmed when another lab, using a different immunoassay, gave normal results. If the biochemical profile does not match the clinical picture, it is reasonable to doubt the test result and think of assay interference.
OBJECTIVES: Vitamin D deficiency can harm both the infant and the mother, potentially altering the trajectory of the child's life. This study aimed to delve into the potentially life-changing impact of vitamin D intake a...OBJECTIVES: Vitamin D deficiency can harm both the infant and the mother, potentially altering the trajectory of the child's life. This study aimed to delve into the potentially life-changing impact of vitamin D intake at birth on the prognosis of premature newborns. METHODS: We conducted a double-blind, randomized clinical trial study, between 2021-2022, including 100 infants admitted to the neonatal intensive care unit of Ghaem Hospital in Mashhad, Iran. Premature infants with a gestational age of < 34 weeks and requiring the neonatal intensive care unit admission were randomly allocated into two groups. The intervention group consisted of infants who received 10 000 units of vitamin D, while the control group comprised infants who did not receive any vitamin D at birth. The infants were evaluated based on clinical symptoms, the requirement and duration of oxygen therapy, the necessity and length of mechanical ventilation, the method of oxygen therapy administered, and the length of their hospital stay. RESULTS: This study included 56 (56.0%) boys and 44 (44.0%) girls. A significant difference was observed between the intervention and control groups regarding maternal age frequency ( 0.013). Additionally, the frequency of mechanical ventilation ( 0.030), surfactant administration ( 0.009), and the number of times surfactant was administered ( 0.020) also showed significant differences between both groups. CONCLUSIONS: Vitamin D intake at birth could potentially revolutionize the management of respiratory complications in premature infants, a crucial discovery for healthcare practitioners and researchers.
OBJECTIVES: The quality of asthma management in tertiary hospitals' emergency departments (EDs) is key to sustained asthma control. We assessed the quality of asthma care and adherence to guidelines at the Royal Hospital...OBJECTIVES: The quality of asthma management in tertiary hospitals' emergency departments (EDs) is key to sustained asthma control. We assessed the quality of asthma care and adherence to guidelines at the Royal Hospital in Oman. METHODS: We conducted a retrospective, observational study examining the medical records of asthma patients who presented to the ED between 1 June 2014 and 1 June 2016. RESULTS: A total of 217 patients were included in the study. Lack of proper documentation was observed throughout the study. Only 80 patients (59.7% of 134 available records) were on controller therapy and 51 were reported to be compliant. No asthma severity assessment was conducted, and 57 (32.9%) patients experienced respiratory distress. Peak expiratory flow rate measurements were not performed for all patients; chest X-ray was performed for 145 (66.8%) patients, and blood gas analysis for 83 (38.2%). The mean±SD time from the initial assessment to the treatment initiation was 12.0±11.0 minutes. Systemic steroids and nebulizers were used for initial management in 70.5% (n = 153) and 96.3% (n = 209) of patients, respectively. Reassessments at one and two hours following initial assessment were not done for all patients; reassessment records were missing for 50 (54.9%) patients after the first hour, and 50 patients after the second hour. Out of the total sample, 45 (20.7%) patients required hospital admission, with the majority (93.3%) admitted to the medical ward. Post-discharge procedures recommended by guidelines were rarely employed. CONCLUSIONS: There is a serious lack of adherence to asthma management guidelines in the ED. The 2009 Omani Ministry of Health guidelines should be updated, considering the recent updates of Global Initiative for Asthma strategies, adopted as the standard of care, and disseminated with regular monitoring to ensure compliance.
The symptoms of malignant pleural mesothelioma can be mimicked by some other malignancies, clinically and radiologically. We describe a case of a 57-year-old man whose clinical and radiological findings were consistent w...The symptoms of malignant pleural mesothelioma can be mimicked by some other malignancies, clinically and radiologically. We describe a case of a 57-year-old man whose clinical and radiological findings were consistent with malignant pleural mesothelioma; however, a pleural biopsy showed undifferentiated epithelioid malignant neoplasm.
OBJECTIVES: Systemic fungal infections (SFIs) account for 12% of all late-onset sepsis among very low birth weight (VLBW) infants and result in adverse long-term neurodevelopmental outcomes among survivors. This study co...OBJECTIVES: Systemic fungal infections (SFIs) account for 12% of all late-onset sepsis among very low birth weight (VLBW) infants and result in adverse long-term neurodevelopmental outcomes among survivors. This study compared the prophylactic efficacies of systemic fluconazole or oral nystatin prophylaxis to prevent SFI in VLBW infants. METHODS: In a randomized controlled clinical trial, 120 neonates with gestational age < 32 weeks and birth weight < 1500 g were randomly allocated in two groups. Patients in group A received fluconazole 3 mg/kg intravenously twice weekly from the first 72 hours of life. Patients in group B were administered oral nystatin 1 mL (100 000 units) every eight hours. The primary endpoint was SFI and its associated mortality rate during hospital stay. RESULTS: The mean gestational age of the enrolled infants was 28.2±1.4 weeks. Demographic characteristics were similar in both groups. SFI was detected in six (5.0%) infants with three cases from each group. Three (2.5%) patients died, two of whom were in group B. Four (6.7%) patients in group B and one (1.7%) in group A were treated for retinopathy of prematurity ( 0.040). Intraventricular hemorrhage was detected in brain ultrasound examination in three (5.0%) neonates in group B and seven (11.7%) in group A ( 0.020). CONCLUSIONS: The intravenous fluconazole and oral nystatin were similarly effective in preventing SFIs in VLBW infants. Future studies are recommended with a larger number of patients before routine administration of nystatin prophylaxis.
OBJECTIVES: We sought to explore the clinical characteristics of corneal ectasia and provide insights on related factors, including demography, ocular health, and the management trends in the Saudi population. METHODS: W...OBJECTIVES: We sought to explore the clinical characteristics of corneal ectasia and provide insights on related factors, including demography, ocular health, and the management trends in the Saudi population. METHODS: We conducted a retrospective hospital-based chart review of patients with corneal ectasia in multiple medical centers in Saudi Arabia between 1 January and 31 December 2018. Eye care professionals diagnosed these patients based on their medical history, physical examination, and the use of Pentacam. The severity of the condition was assessed using the k median index from the Pentacam map following the modified Krumeich grading system. RESULTS: We reviewed the medical records of 430 eyes of 215 patients with corneal ectasia. The majority (98.6%) of patients had bilateral corneal ectasia, with 202 (94.0%) having keratoconus and 13 (6.0%) having post-laser in situ keratomileusis ectasia. Males and age groups between 14 and 45 years were more affected. The mean age of onset was 7.1 years, ranging from 2-32 years, which was higher among patients from the western region. Regarding severity, 230 (53.5%) eyes presented in the initial stages, while 36 (8.4%) were in the severe stage with no significant difference between the regions studied. No significant differences were observed in mean central corneal thickness and power between patients from the central and western regions. Corneal rigid gas permeable contact lens was most used in treatment of 176 (40.9%) eyes followed by glasses in155 (36. 0%), while corneal cross-linking was the common surgical intervention (10.9%), followed by penetrating keratoplasty (3.0%). CONCLUSIONS: Most keratoconus patients had a bilateral mild stage of the disease and were in their third decade. This high rate of bilaterality of diseases during diagnosis may be due to misdiagnosis in the initial stages, which highlights the importance of community and eye care professionals' awareness of comprehensive eye examinations and regular follow-up, including corneal topography assessments of both eyes.