Harith Al-Aamri, Salim Al-Huseini, Moon Fai Chan, Alkhatib Al Saadi, Nasser Al-Sibani, Zainab Al-Dughaishi, Mohammed Al-Alawi

Objectives: Many studies suggest that depression is prevalent among patients suffering from inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Both depression and IBD have a significant disease burden. However, these studies have mostly been conducted among European and American populations and there is a paucity of studies from Arab countries. This study aimed to examine the prevalence and predictors of depressive symptoms among adult IBD patients attending a tertiary care hospital in Muscat, Oman. Methods: We conducted a cross-sectional study among a random sample of patients aged ≥ 18 years who attended the gastroenterology clinic at Sultan Qaboos University Hospital, Muscat, Oman, between June 2018 and January 2019. Participants were asked to complete the Patient Health Questionnaire-9, which is used to assess depression, and a sociodemographic survey. Logistic regression analysis was used to identify the independent predictors of depressive symptoms among the study sample. Adjusted odds ratios (aORs) were also reported. Results: This study included 201 participants, with an average age of 36 years. Just over half (51.2%) of participants were female. The mean duration of the patients’ IBD diagnosis was 1.9±0.3 years, the majority (n = 174, 86.6%) of the participants had UC, 80.1% (n = 161) of the participants had received steroids, and 5.5% of the sample had a history of a surgical stoma. The medical comorbidities among the participants were cerebrovascular accidents (24.9%), hypertension (24.5%), and diabetes mellitus (23.9%). The prevalence of depressive symptoms was 23.4%. The logistic regression analysis resulted in four independent predictors of depression: being female (OR = 2.090, p = 0.047), history of surgical stoma (OR = 5.737, p < 0.001), comorbid diagnosis of hypertension (OR = 2.846, p = 0.007), and history of a cerebrovascular accident (OR = 2.651, p = 0.011). Conclusions: Depressive symptoms are prevalent among Omani patients with IBD. Certain clinical factors appeared to increase the risk of depression among this population. The findings of this study fill a gap in the existing literature and call for further work aiming at screening and managing depression among IBD patients.

Keywords: Depression; Cross-Sectional Studies; Patient Health Questionnaire; Colitis, Ulcerative; Crohn Disease; Prevalence; Oman.

Salem Al Tamemi, Yusra Al Lamki, Shafiq Ur-Rehman Naseem, Nabila Al Siyabi, Bushra Al Siyabi, Ibrahim Al-Zakwani

Objectives: Anaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman. Methods: This retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records. Results: One hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0–16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1–0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25–8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0–972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p = 0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p = 0.010). Conclusions: Due to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

Shiyam Kumar, Ikram A. Burney, Joseph Kunju, Mohammed Salim Al-Marhoon, Khurrum Mutahir Siddiqui

Objectives: Prostate cancer (PCa) is the third most common cancer worldwide, with its incidence rising in the Middle East. There is a paucity of data about the clinicopathological features and outcomes of metastatic prostate cancer (mPCa) from the Middle East. We report the outcomes of mPCa from Oman. Methods: We recruited consecutive men diagnosed with mPCa and treated at Sultan Qaboos University Hospital in Oman between January 2006 and December 2017. Information about demographics, clinical, laboratory, pathological, and radiological features at presentation, treatment, and survival outcomes was collected. Data were gathered until April 2019 or until the patient’s death for progression-free survival (PFS) and overall survival (OS), whichever came first. Survival rates were estimated using the Kaplan-Meier method. Univariate and multivariate analysis and Cox regression analyses were performed to study factors affecting the PFS and the OS. Results: Of the 239 men diagnosed with PCa over the study period, 62 were diagnosed with mPCa. The median age was 71 (range = 57–92) years. The majority of patients (61.3%) had a Gleason score ≥ 8. Median prostate-specific antigen (PSA) level was 100.0. Bone was the most common site of metastatic disease (90.3%). The majority of patients with the hormone-sensitive disease were treated with testosterone suppression only, while abiraterone, enzalutamide, and docetaxel were added for treating metastatic castration-resistant mPCa (mCRPC). After a median follow-up of 34.5 months, the median PFS was 17 months, while the median OS was 43 months. Median survival post mCRPC was 17 months. Conclusions: Omani patients with mPCa present with high PSA and Gleason score and with widespread metastatic disease burden. Treatments offered are according to internationally accepted standards and have comparable PFS and OS as reported elsewhere.

Christos Damaskos, Dimitrios Dimitroulis, Anna Garmpi, Vasiliki E. Georgakopoulou, Alexandros Patsouras, Athanasios Syllaios, Nikolaos Garmpis

Abolhassan Seyedzadeh, Mohamad Reza Tohidi, Sima Golmohamadi, Hamid Reza Omrani, Mohammad Saleh Seyedzadeh, Sara Amiri, Sara Hookari

Objectives: We sought to determine the prevalence of renal osteodystrophy (ROD) and its related factors in a group consisting of end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis. Methods: A total of 128 ESRD patients (52 men and 76 women) with a mean age of 59.3 years undergoing maintenance hemodialysis at Imam Reza Referral Hospital, Iran were included in this cross-sectional study. We measured serum parathyroid hormone (PTH) levels and determined 150 to 300 pg/mL as the desirable range for the values. Values lower or higher than this range were used to determine ROD. Furthermore, this study investigated the association of ROD with clinical and laboratory variables (age at the onset of renal failure, hemodialysis sessions per week, clinical symptoms associated with ROD, and serum calcium and phosphate levels). Results: ROD was diagnosed in 93 (72.7%) out of 128 patients studied. Of them, 53 (41.4%) patients had PTH levels above 300 pg/mL (high bone turnover, HTO group) and 40 patients (31.3%) had PTH levels below 150 pg/mL (low bone turnover, LTO group). No statistically significant difference was detected in terms of ROD-related clinical findings (p = 0.110), age at the time of ESRD diagnosis (p = 0.200), and the number of hemodialysis sessions per week (p = 0.200). Hyperphosphatemia was more prevalent in the ROD group (n = 52, 57.1%) compared with 11 patients (31.4%) included in the group without ROD (p = 0.004). Conclusions: The prevalence rate of ROD in this study was significant, and it was largely consistent with the rate reported in some Asian countries. Hyperphosphatemia were laboratory variables closely related to ROD.

Issa Al-Jahdhami, Khalid Al-naamani, Adhra Al-Mawali, Sami M. Bennji

COVID-19 pandemic has been associated with high short-term morbidity and mortality. Lungs are the main organs affected by SARS-CoV-2 infection. In the long-term, the pulmonary sequelae related to COVID-19 are expected to rise significantly leading to an extended impact on community health and health care facilities. A wide variety of long-term respiratory complications secondary to COVID-19 have been described ranging from persistent symptoms and radiologically observable changes to impaired respiratory physiology, vascular complications, and pulmonary fibrosis. Even after two-years, respiratory sequalae related to post-acute SARS-CoV-2 infection have not been fully explored and understood. The main treatment for most COVID-19 respiratory complications is still symptomatic and supportive-care oriented. In this review article, we shed light on current knowledge of the post-COVID-19 complications, focusing on pulmonary fibrosis, treatment directions, and recommendations to physicians.

Keywords: COVID-19; Pulmonary Fibrosis.

Seema Rai, Varun Kaul, Sulena Singh, Savneet Kaur, Palani Thenmurugan

Diabetic striatopathy is a neurological condition in patients with diabetes characterized by hemichorea-hemiballismus due to vascular and metabolic derangements in basal ganglia. This is a known entity in type 2 diabetic adult patients; however, seen rarely in pediatric patients with type 1 diabetes. Diabetic striatopathy develops in patients with poor glycemic control in the absence of ketosis. The patient tolerates hyperglycemia for a long time, which results in metabolic injury.

Nabilah Rameli, Marini Ramli, Zefarina Zulkafli, Mohd Nazri Hassan, Shafini Mohd Yusoff, Noor Haslina Mohd Noor, Suryati Hussin, Nor Khairina Mohamed Kamarudin, Yuslina Mat Yusoff, Rosnah Bahar

Patients with heterozygous β-thalassemia are generally asymptomatic. However, the intermediate phenotype is uncommon, and patients require further investigation to confirm the diagnosis. We describe a 32-year-old woman (gravida 3, para 2) with heterozygous β-thalassemia who presented with symptomatic anemia and had a history of frequent blood transfusion in each pregnancy. Physical examination was unremarkable. Laboratory results at presentation showed hypochromic microcytic anemia with reticulocytosis. Molecular study revealed intermedia phenotypes resulting from coinheritance of heterozygous β-globin chain mutation (IVS1-5) and a rare heterozygous α-globin triplication (αααanti-3.7). In this case report, we discuss the laboratory diagnostic approaches and the challenges faced in investigating this case.

OMSB