The superior cornu of the thyroid cartilage is a versatile structure, and anatomical variations can lead to diverse clinical presentations. We describe a case of a patient with a medialized superior part of the thyroid c...The superior cornu of the thyroid cartilage is a versatile structure, and anatomical variations can lead to diverse clinical presentations. We describe a case of a patient with a medialized superior part of the thyroid cartilage caused by pressure from a large thyroid mass, detected during laryngoscopy before thyroidectomy. A neck computed tomography scan revealed an elongated and medially displaced superior cornu of the right thyroid cartilage, resulting from the push exerted by the right thyroid mass. As the patient remained asymptomatic and refused surgical intervention, no further consideration was given to surgically addressing the medialized superior thyroid cornu.
OBJECTIVES: We sought to report the frequency of non-typhoidal (SNT) and spp. diarrhea and the antibiotic sensitivity in children. METHODS: We conducted a retrospective study of children with bloody diarrhea seen at Ru...OBJECTIVES: We sought to report the frequency of non-typhoidal (SNT) and spp. diarrhea and the antibiotic sensitivity in children. METHODS: We conducted a retrospective study of children with bloody diarrhea seen at Rustaq Hospital between 1 June 2019 and 31 June 2023. We collected data related to demographic characteristics, symptoms, blood investigations, stool bacterial culture, and antimicrobial sensitivity. Stool samples were tested for and growth. RESULTS: Out of 1160 children with diarrhea, 153 (13.2%) had bloody diarrhea of which 129 (84.3%) were under five. Ninety-two (60.1%) children were positive for either or . Among the positive cultures, 58 (63.0%) children had SNT, while 34 (37.0%) had infection. Three children had bacteremia, all under one year old. SNT demonstrated high sensitivity primarily to ceftriaxone (n = 41; 70.7%), ampicillin (n = 53; 91.4%), and ciprofloxacin (n = 54; 93.1%). In contrast, showed high resistance to ceftriaxone and only 15 (46.9%) patients showed sensitivity. Additionally, 29 children had Entamoeba histolytica trophozoites co-infection with on stool microscopy. CONCLUSIONS: is more prevalent than in children under five years, while is more common in children over five. is sensitive to both ceftriaxone and ampicillin. demonstrates resistance to multiple antibiotics, including ciprofloxacin. It is recommended that children under the age of one be admitted and treated empirically with either ceftriaxone or ampicillin. In older children, antibiotic therapy should be guided by stool culture results. Ciprofloxacin is not a good empirical choice for in our population due to its high resistance and is contraindicated in patients with glucose-6-phosphate dehydrogenase.
Gigantomastia is a rare benign disorder characterized by excessive breast enlargement. Although a standard definition has yet to be established, it is generally known as an excess of approximately 1.5 kg tissue per breas...Gigantomastia is a rare benign disorder characterized by excessive breast enlargement. Although a standard definition has yet to be established, it is generally known as an excess of approximately 1.5 kg tissue per breast that requires reduction. We report a case of a 10-year-old girl who presented with enlarged breasts. The hormonal assay was normal. Breast ultrasound revealed increased fibroglandular breast tissue with an area of interstitial fluid, prominent vascularity, and dilated veins. There was no evidence of focal masses or collections, ductal ectasia, or axillary lymphadenopathy. Magnetic resonance imaging revealed extremely dense breasts with more than 75% fibroglandular tissue, consistent with juvenile breast hypertrophy. Bilateral reduction mammoplasty with nipple-areola complex graft was performed. The histopathological report confirmed benign gigantomastia.
OBJECTIVES: This study was performed to assess the accuracy of standard electrocardiographic criteria in diagnosing of right ventricular (RV) involvement in patients with inferior myocardial infarction (IMI). METHODS: Th...OBJECTIVES: This study was performed to assess the accuracy of standard electrocardiographic criteria in diagnosing of right ventricular (RV) involvement in patients with inferior myocardial infarction (IMI). METHODS: This was a retrospective analysis of patients admitted with an IMI. Proximal occlusion of the right coronary artery before the origin of the RV branch on angiography was considered diagnostic of RV involvement. RESULTS: The subjects were 129 patients (mean age = 55.8±13.1 years; 81.4% male) with inferior ST-elevation myocardial infarction. The most sensitive indicators of RV involvement were an ST elevation in V4R (72.9%) and a higher ST elevation in lead III than in lead II (80.4%). The most specific indicators were ST elevation in V1 (88.7%) and ST elevation in V1 with ST depression in V2 (97.1%). Combining all the criteria improved sensitivity to 85.7% but reduced specificity to 21.2%. CONCLUSIONS: No single electrocardiogram criterion was able to identify all cases of RV involvement in patients with IMI. Combining the different criteria helped pick up more cases at the cost of increasing false positives.
OBJECTIVES: Research indicates that active smokers are at risk of cognitive impairment. However, the correlation between chronic passive smoking and the risk of cognitive impairment remains underexplored. This study aime...OBJECTIVES: Research indicates that active smokers are at risk of cognitive impairment. However, the correlation between chronic passive smoking and the risk of cognitive impairment remains underexplored. This study aimed to determine the association between smoking, passive smoking, and cognitive impairment and examined the dose-response effect. METHODS: This population-based two-year survey was conducted in four rural public health centers from 2021 to 2023 in Central Java, Indonesia, each center caters to approximately 30 000 people. The participants were selected using simple random sampling from the health center visitors aged 30-60 years. Smoking and passive smoking were determined by self-assessment. Mini-Mental State Examination was used to evaluate cognitive impairment. The potential impact of confounding variables such as lifestyle, sociodemographic factors, and chronic diseases were considered and excluded during statistical analysis. RESULTS: The participants were 409 individuals aged 30-60 years. The majority were men (264; 64.5%). Among them, 308 (75.3%) were active smokers, 271 (66.3%) were passive smokers, and 138 (33.7%) were not exposed to tobacco smoke. There was a significant relationship between cognitive impairment and increasing pack years of active smoking. The highest and most significant risk was observed in those who smoked ≥ 20 pack-years with an adjusted odds ratio (aOR) of 1.61 and 95% CI: 0.98-2.31. Passive smokers had a slightly lower risk of cognitive impairment than those who did not smoke and never smoked (aOR = 2.01; 95% CI: 1.37-2.70). They were comparable with OR of 10-19 pack-years total exposure to active smoking (aOR = 1.86; 95% CI: 1.24-2.42). CONCLUSIONS: There was a dose-response relationship between smoking and cognitive impairment with a significant effect on ≥ 20 pack-years of exposure. Passive smoking also indicated a significant risk of cognitive impairment equivalent to an estimated 10-19 pack-years of active smoking.
Acute myeloid leukemia (AML) is rarely associated with central diabetes insipidus (CDI) with unclear underlying pathophysiological mechanisms. The most commonly reported cytogenetic abnormality in cases of AML-associated...Acute myeloid leukemia (AML) is rarely associated with central diabetes insipidus (CDI) with unclear underlying pathophysiological mechanisms. The most commonly reported cytogenetic abnormality in cases of AML-associated CDI is monosomy 7, followed by chromosome 3 abnormalities. We report a case of a woman with newly diagnosed AML with 9q34 deletion ( gene region), who developed symptoms of polyuria and polydipsia with an investigation confirming CDI. This is the first reported case of cytogenetic abnormality of 9q34 deletion ( gene region) in AML with CDI.
Polyangiitis overlap syndrome (POS) is a systemic vasculitis characterized by overlapping features of more than one well-defined vasculitic syndrome. We present the case of a 38-year-old Malay man with progressive dyspne...Polyangiitis overlap syndrome (POS) is a systemic vasculitis characterized by overlapping features of more than one well-defined vasculitic syndrome. We present the case of a 38-year-old Malay man with progressive dyspnea and palpable purpura in his lower limbs. The diagnostic evaluation revealed right-sided segmental pulmonary consolidation with pleural effusion, systolic cardiac dysfunction with the presence of an intracardiac thrombus, and left vocal cord palsy secondary to laryngeal mononeuropathy. Anti-neutrophil cytoplasmic antibodies testing yielded negative results, and skin biopsy revealed leukocytoclastic vasculitis (LCV) with negative immunofluorescence studies. The patient fulfilled the American College of Rheumatology diagnostic criteria for polyarteritis nodosa and idiopathic LCV. Only three case reports of POS with a combination of polyarteritis nodosa overlapping with idiopathic LCV have been reported in the medical literature. To the best of our knowledge, this is the first report of POS with cardiopulmonary involvement and laryngeal mononeuropathy. This patient had an excellent response to remission induction therapy using high-dose corticosteroids and mycophenolate mofetil and remains in remission while undergoing a steroid taper. Timely initiation of treatment is essential to prevent vasculitic complications and irreversible organ dysfunction. Mycophenolate mofetil may serve as an acceptable alternative to cyclophosphamide as a remission induction agent in this condition.
We report a rare case of a middle-aged Omani woman who was known to have primary antiphospholipid syndrome, glucose-6-phosphate dehydrogenase deficiency, and iron deficiency anaemia. Cannulation attempts caused bulla whi...We report a rare case of a middle-aged Omani woman who was known to have primary antiphospholipid syndrome, glucose-6-phosphate dehydrogenase deficiency, and iron deficiency anaemia. Cannulation attempts caused bulla which progressed to ulceration. A pathergy phenomenon with high suspicion of pyoderma gangrenosum was postulated. Management with corticosteroids, cyclosporin, and finally ustekinumab, a novel biologic agent, yielded a beneficial response.
Vaccination is one of the most successful public health initiatives in human history, significantly reducing the incidence and severity of infectious diseases. The success of any vaccination program depends on several fa...Vaccination is one of the most successful public health initiatives in human history, significantly reducing the incidence and severity of infectious diseases. The success of any vaccination program depends on several factors, including effective leadership, funding, distribution management, and addressing vaccine hesitancy. Vaccine hesitancy, the delay or refusal to be vaccinated despite the availability of immunization services, has always been prevalent in societies but has become more pronounced during the COVID-19 pandemic. During the pandemic, anti-vaccine activists persistently promoted and increased vaccine hesitancy by using social media to spread rumors, propaganda, and conspiracy theories. The rising vaccine hesitancy among the public became a major challenge to the success of the COVID-19 immunization program. There are also indications that this hesitancy may have generalized against more traditional vaccines. This literature review explores the structure and evolving dynamics of COVID-19 vaccine hesitancy and the resultant generalized skepticism towards other vaccinations. It also suggests future strategies to address and mitigate the phenomenon of vaccine hesitancy.
OBJECTIVES: To determine the prevalence of hypothermia among preterm infants born before 32 weeks of gestation and whether their temperature at admission is associated with neonatal and maternal risk factors and gestatio...OBJECTIVES: To determine the prevalence of hypothermia among preterm infants born before 32 weeks of gestation and whether their temperature at admission is associated with neonatal and maternal risk factors and gestational age. Furthermore, the study evaluates the association between admission temperature, neonatal morbidity, and in-hospital mortality. METHODS: This study involved an eight-year retrospective analysis of preterm neonates born < 32 weeks of gestation and admitted to the neonatal intensive care unit at a tertiary hospital in Oman, from 2010 to 2017. RESULTS: The study included 587 preterm infants with a mean gestational age of 28.4 weeks, a mean birth weight of 1154.2 g, and a mean admission temperature of 35.5 °C. Hypothermia (axillary temperature < 36.5 °C) was present in 509 (86.7%) infants. In univariate analysis, only birth weight and neonatal resuscitation were associated with admission temperature (< 36.5 °C). In the multivariate analysis, only intraventricular hemorrhage demonstrated a significant association with the incidence of hypothermia. CONCLUSIONS: Most preterm newborns had hypothermia upon admission to the neonatal intensive care unit, which is associated with essential morbidities. More aggressive interventions are warranted to reduce the incidence of hypothermia in preterm infants.
OBJECTIVES: Globally, the preparedness of frontline healthcare providers (HCPs) to deliver timely and appropriate medical care has emerged as a significant concern. The training of HCPs in containment measures is conside...OBJECTIVES: Globally, the preparedness of frontline healthcare providers (HCPs) to deliver timely and appropriate medical care has emerged as a significant concern. The training of HCPs in containment measures is considered pivotal in elevating the quality of care for COVID-19 patients while simultaneously mitigating the risk of viral transmission to both fellow patients and HCPs. This study investigates the impact of training on HCPs readiness to manage COVID-19 patients in a tertiary hospital in Oman. METHODS: Employing a mixed-method design, we extended invitations to HCPs at the Royal Hospital in Muscat using electronic forms. We collected data about HCPs demographics, their comprehension of the hospital's core objectives and protocols, and any knowledge acquired through official training or self-directed study. Our analytical approach encompassed descriptive and univariate statistical methods, complemented by thematic analysis for the qualitative component. RESULTS: Our survey acquired responses from a total of 241 individuals. Among the respondents, 67.6% were female nurses, and 49.8% were aged between 31-40 years old. Significant differences were observed concerning gender ( 0.018 and 0.001) and profession ( < 0.001 and < 0.001) with the total score in awareness and knowledge, respectively. Stress and fear of handling confirmed or potentially contagious patients negatively impacted nearly half of the HCPs, with doctors and nurses reporting this effect significantly. Remarkably, 61.0% of HCPs expressed that their confidence in managing COVID-19 cases was positively influenced by their faith in national pandemic plans. CONCLUSIONS: While the hospital's protocols and procedures were well comprehended, the lack of preparedness and skills training for managing highly contagious patients resulted in diminished confidence and heightened stress. To fortify their ability to respond to future outbreaks and work with resilience and confidence, HCPs require ongoing, comprehensive, and hands-on training.
OBJECTIVES: Dyslipidemia and atherosclerotic cardiovascular events are highly prevalent in Pakistan, which could be attributed to a lack of education, poverty, unhealthy dietary habits, and the absence of local guideline...OBJECTIVES: Dyslipidemia and atherosclerotic cardiovascular events are highly prevalent in Pakistan, which could be attributed to a lack of education, poverty, unhealthy dietary habits, and the absence of local guidelines. Our main goal was to develop a comprehensive comparison of the existing international dyslipidemia guidelines, highlighting the different nutritional recommendations proposed by each. A secondary objective was to establish local food sources beneficial for dyslipidemia coexistent with other morbidities. METHODS: We conducted a systematic review of three databases Pubmed, Scopus, and International Guidelines Library to acquire guidelines for the management of dyslipidemia. The guidelines fulfilling the criteria of the Clinical Practice Guidelines developed by the Institute of Medicine in 2011 were selected for data extraction and their quality was assessed by the Mini-Checklist (MiChe) tool. Using the Harvard Healthy Eating Plate, a modified MyPlate describing portion of each macronutrient was established. Dietary recommendations for dyslipidemia and other comorbidity conditions were developed based on the review of guidelines and data from randomized control trials. RESULTS: A total of 23 guidelines were selected based on our inclusion criteria. Final guidelines presented dietary patterns beneficial for the management of dyslipidemia, which differed due to the availability and cost-effectiveness of nutritional sources in Pakistan. After developing a modified MyPlate better suited to the dietary intakes of the population of Pakistan, nutritional recommendations for dyslipidemia with other comorbids were developed using local sources suggested by practicing dietitians. CONCLUSIONS: Dietary modification is the cornerstone of managing dyslipidemia. Due to Pakistan's unique dietary patterns and the economic condition, a multidisciplinary approach with physicians and dietitians is required to develop easily applicable dietary regimes for dyslipidemia.
OBJECTIVES: The objective of this study was to boost pharmacovigilance activity in our psychiatry referral hospital and highlight the pharmacist's role in preventing, detecting, and managing adverse drug reactions (ADRs)...OBJECTIVES: The objective of this study was to boost pharmacovigilance activity in our psychiatry referral hospital and highlight the pharmacist's role in preventing, detecting, and managing adverse drug reactions (ADRs). Our goal was to promote patient safety and compliance with psychotropic medication by identifying ADR patterns among hospitalized patients in our psychiatry hospital. We aimed to assess and evaluate the causality, severity, and management of documented ADRs along with establishing a hospital-based ADR reporting platform. METHODS: We enrolled adult patients (18-60 years) admitted to our psychiatric facility between 1 September 2020 and 30 September 2021 who received at least one psychotropic agent for at least two months. Patients with a history of substance abuse, pregnant females, and patients on clozapine were excluded. Medical records were examined for demographics, clinical details, and psychotropic-related ADRs. ADRs were analyzed for causality using Naranjo's algorithm, for severity using modified Hartwig and Siegel, and for preventability using modified Schumock and Thornton scales. RESULTS: Among 506 admitted patients, 327 suspected psychotropic-related ADRs corresponding to 217 (42.9%) patients, were recorded. Hormonal ADRs were five times higher in men, while the odds of neurological ADRs were significantly higher for women. Otherwise, other ADRs were not statistically affected by gender. Combined therapy was associated with high odds of ADRs, whereas cardiovascular and neurological ADRs were statistically related to monotherapy. Neurological (47.4%) ADRs predominated, followed by cardiovascular (18.7%), and hormonal (15.0%). ADRs were more prevalent among antipsychotics, followed by antidepressants, then mood stabilizers. According to the Naranjo algorithm, some (22.9%) of ADRs were definite, while the majority (74.3%) were probable. As per the Hartwig severity scale, the majority (74.0%) of ADRs were moderate, and the rest (26.0%) were mild. The Modified Schumock and Thornton assessment questionnaire revealed that 75.2% of ADRs were unpreventable, 19.3% were probably preventable, and 5.5% were preventable. In 46.8% of the cases, a new medication was required to manage the emerging ADRs; one-third of ADRs necessitate the replacement of the suspected medication. Close monitoring without any pharmacological intervention was sufficient in 23.2% of cases, while dose reduction was the solution in 7.6% of cases. CONCLUSIONS: ADR monitoring in the psychiatry setting by a multidisciplinary team helps recognize the initial signs of ADRs, contributing to better compliance. Hospital-based reporting programs or data-capturing tools will aid in the spontaneous and active assessment of ADRs by healthcare practitioners.
OBJECTIVES: Chronic liver disease and cirrhosis are persistent global health threats, ranking among the top causes of death. Despite medical advancements, their mortality rates have remained stagnant for decades. Existin...OBJECTIVES: Chronic liver disease and cirrhosis are persistent global health threats, ranking among the top causes of death. Despite medical advancements, their mortality rates have remained stagnant for decades. Existing scoring systems such as Child-Turcotte-Pugh and Mayo End-Stage Liver Disease have limitations, prompting the exploration of more accurate predictive methods using artificial intelligence and machine learning (ML). METHODS: We retrospectively reviewed the data of all adult patients with acute decompensated liver cirrhosis admitted to a tertiary hospital during 2015-2021. The dataset underwent preprocessing to handle missing values and standardize continuous features. Traditional ML and deep learning algorithms were applied to build a 28-day mortality prediction model. RESULTS: The subjects were 173 cirrhosis patients, whose medical records were examined. We developed and evaluated multiple models for 28-day mortality prediction. Among traditional ML algorithms, logistic regression outperformed was achieving an accuracy of 82.9%, precision of 55.6%, recall of 71.4%, and an F1-score of 0.625. Naive Bayes and Random Forest models also performed well, both achieving the same accuracy (82.9%) and precision (54.5%). The deep learning models (multilayer artificial neural network, recurrent neural network, and Long Short-Term Memory) exhibited mixed results, with the multilayer artificial neural network achieving an accuracy of 74.3% but lower precision and recall. The feature importance analysis identified key predictability contributors, including admission in the intensive care unit (importance: 0.112), use of mechanical ventilation (importance: 0.095), and mean arterial pressure (importance: 0.073). CONCLUSIONS: Our study demonstrates the potential of ML in predicting 28-day mortality following hospitalization with acute decompensation of liver cirrhosis. Logistic Regression, Naive Bayes, and Random Forest models proved effective, while deep learning models exhibited variable performance. These models can serve as useful tools for risk stratification and timely intervention. Implementing these models in clinical practice has the potential to improve patient outcomes and resource allocation.
OBJECTIVES: Acute myeloid leukemia (AML), among other malignancies, has been linked to the deregulation of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signalling pathway, which is essenti...OBJECTIVES: Acute myeloid leukemia (AML), among other malignancies, has been linked to the deregulation of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signalling pathway, which is essential for cell growth, proliferation, and differentiation. This study aimed to investigate the expression of JAK/STAT proteins at diagnosis and remission and how it affects overall survival (OS). METHODS: This is a prospective study conducted in the College of Medicine, Sultan Qaboos University. Using the enzyme-linked immunosorbent assay assay, we estimated the expression levels of JAK/STAT pathway proteins, including pJAK2, pJAK1, JAK1, pSTAT3, pSTAT5, and STAT5, in peripheral blood and bone marrow samples at diagnosis and remission and normalized to the total protein content. Twenty-three adult AML patients (median age = 47) and seven healthy volunteers, who were used as controls, were included in the study. A total of 68 cell lysates were extracted from samples using peripheral blood mononuclear cells isolation assay. RESULTS: OS was estimated using the Kaplan-Meier curve, and groups were compared with the COX regression model. The overexpression percent was calculated using the chi-square test ( > 0.050). The study revealed that the expression of JAK1, pJAK1, pJAK2, pSTAT3, STAT5, and pSTAT5 in peripheral blood was lower during the diagnosis phase compared to the remission phase ( > 0.050). All these proteins were overexpressed at diagnosis. These proteins did not impact the OS of AML. CONCLUSIONS: The expression levels of these proteins at the time of diagnosis do not significantly influence the OS of patients with AML. The study is limited in sample size and needs to be confirmed in future studies with a larger sample size.