Objectives: Giant perforation (size > 2 cm) is a catastrophic complication of peptic ulcer disease, which is difficult to repair and leads to postoperative leakage and 60% morbidity and 48.2% mortality rates. The objective of this meta-analysis was to compare the postoperative outcomes of omental plugging and omentopexy in the treatment of giant ulcer perforation. Methods: The dataset was defined by searching for articles published until December 2020 from PubMed, Embase, Google Scholar, and the Cochrane database. The search terms included were giant peptic ulcer, peptic ulcer perforation, omentopexy, and omental plug. The data analysis included a study published in English that evaluated the surgical outcomes of omental plugging and omentopexy in the management of giant peptic ulcer perforation patients. Meta-analysis was performed using Review Manager software version 5.4.1. Results: A total of 175 articles were identified during the initial search. After review, eight articles were suitable for inclusion in the meta-analysis. A total of 367 patients were included in the final analysis. The findings demonstrate that when compared to the omentopexy group, the omental plugging technique significantly reduced overall postoperative complications (odds ratio (OR) = 0.29, 95% CI: 0.18–0.47, p = 0.0001) and bile leakage rate (OR = 0.18, 95% CI: 0.07–0.46, p = 0.0003), resulting in a significantly lower postoperative mortality rate (OR = 0.35, 95% CI: 0.17–0.69, p = 0.003). However, there was no significant difference in intraabdominal collection, respiratory tract, and wound infection rates between each surgical treatment group. Conclusions: Omental plugging is a simple surgical procedure associated with fewer postoperative complications and mortality than omentopexy. This technique is a safe surgical treatment option for peptic ulcer perforations > 2 cm.

Keywords: Peptic Ulcer Perforation; Omentum; Emergency Treatment; Postoperative Complications; Mortality.

Objectives: To investigate the association between the consumption of antipsychotic drugs and breast cancer. Methods: In this systematic review and meta-analysis study, relevant studies were extracted from different databases including PubMed, ScienceDirect, Cochrane, Medline, and additional sources. The selected studies were statistically analyzed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Of a total of 11 studies selected, five were case-control type and six were cohort type. The overall study quality was 6.7. Meta-analysis of the five case-control studies (which together had 81 766 breast cancer patients and 1 150 316 control participants) showed no significant association between the overall use of antipsychotic drugs and the incidence of breast cancer (odds ratio = 1.06; 95% CI: 0.94–1.19; p = 0.36). Q-test results showed evidence of heterogeneity (p < 0.10) in the overall analysis. The I2 statistical assessment also show evidence of heterogeneity (I2 > 75%). Conclusions: The use of antipsychotic drugs does not significantly increase the risk of breast cancer.

Keywords:Antipsychotics; Breast Cancer; Risk; Systematic Review; Meta-Analysis; Indonesia.

Objectives: Our study sought to determine the effect of age, parity, body mass index (BMI), and previous oral contraceptive use on gallbladder volume and ejection fraction in pregnancy to enable obstetricians to identify patients at risk of gallbladder disease in pregnancy. Methods: We conducted a prospective cross-sectional study involving 190 pregnant women who were evaluated within 32 and 40 weeks gestation at the Fetal Assessment Unit of the Department of Radiology, University of Ilorin Teaching Hospital, Nigeria. Patients were scanned with a commercially available Siemens Ultrasound scanner using a curvilinear probe and a transducer frequency of 3.5 MHz. The fasting gallbladder volume (FGBV) and 30 minutes postprandial gallbladder volume (PGBV) were calculated using the prolate ellipsoid method. Gallbladder ejection fraction was determined using FGBV and PGBV. Each patient’s biodata, medical history, and somatometric parameters were documented. Results: A total of 190 volunteers were included in the study. BMI showed statistically significant positive, though weak correlations with FGBV (r = 0.179, p = 0.015) and PGBV (r = 0.216, p = 0.003). Maternal age, parity, and previous oral contraceptive use did not show any statistically significant correlation with gallbladder parameters. Conclusions: BMI showed a statistically significant but weakly positive correlation with FGBV and PGBV in pregnancy. Our study demonstrated that gallbladder volume in pregnancy might be dependent on BMI. Thus, high BMI may predispose to large gallbladder volume, increasing the risk of biliary stasis and gallstone formation in pregnancy. This is relevant for early detection and prevention of gallbladder disease and follow-up, including expectant management of subjects that may develop gallbladder disease in pregnancy.

Keywords: Cross-Sectional Studies; Maternal Age; Parity; Body Mass Index; Gallbladder; Pregnant Women; Nigeria.

Objectives: We sought to identify the impact of the COVID-19 pandemic on the Oman Dental College (ODC) students’ management of their educational and student life. Methods: We conducted a quantitative cross-sectional online survey study using SurveyMonkey. During the 2019–2020 academic year, 383 ODC students across six levels of education were invited to participate in the survey. Descriptive statistics were applied to the students’ demographic profiles, and other characteristics of the participants’ data were analyzed. Cronbach’s alpha was calculated for internal consistency. A univariate analysis was carried out to identify the differences between genders and between the Bachelor of Dental Surgery levels in relation to the questionnaire themes. A Pearson’s correlation test evaluated the association between students’ perception of risks due to the pandemic and the other relevant themes. Results: A 50.9% response rate revealed that five of the themes showed internal reliability ranging from excellent to acceptable, namely: performance of exercise, effect of the pandemic on their families, use of a facemask, college’s online services, and students’ mental health (0.51, 0.59, 0.70, 0.78, and 0.90, respectively). More than half of the participants felt encouraged to engage in self-directed learning using online resources. They felt some level of nervousness, worry, anxiety, or tension as well as stress during the pandemic. Statistical differences between levels of education were noted in the ODC’s-online teaching services (p < 0.001) and students’ mental health (p = 0.03). There was no difference between female and male students. The ODC’s online services theme positively related to the students’ mental health theme (r = 0.22, p < 0.001). Conclusions: ODC students experienced some mental health issues during the pandemic, including anxiety, stress, and sleeping issues. However, the majority of them were healthy. Most students were satisfied with the online teaching provided by ODC. It was also evident that faculty were always connected with the students. A positive relationship was noted between the management of online lectures and students’ mental health.

Keywords: Mental Health; Students; Perception; Academic Performance; COVID-19; Pandemics; Oman.

Objectives: To identify the biochemical, hematological, and immune biomarkers in COVID-19 patients on admission that are predictive of eventual admission to the intensive care unit (ICU). Methods: This retrospective cohort study was conducted on all confirmed COVID-19 cases hospitalized at Royal Hospital, Oman from 24 February to 30 July 2020. The demographic, clinical, and laboratory data were collected from the hospital information system. Patients were divided into two groups: non-ICU admitted group and ICU admitted group. Results: Out of 445 patients, 276 (62.0%) were male and 169 (38.0%) were female; 259 (58.2%) patients were admitted to COVID-19 general wards whereas 186 (41.8%) were admitted to ICU. Admission to ICU was more likely when patient had the following comorbidities: diabetes (OR = 1.8; 95% CI: 1.3–2.7), liver diseases (OR = 2.1; 95% CI: 1.1–4.3), and respiratory diseases (OR = 2.0; 95% CI: 1.1–3.7). Between ICU and non-ICU patients, there were significant differences in on-admission laboratory blood/serum parameters: total white blood cells (WBCs) count, lymphocytes count, C-reactive protein (CRP), ferritin, corrected calcium, interleukin 6 (IL-6), D-dimer, alanine transaminase (ALT), lactate dehydrogenase (LDH), albumin, and troponin. Conclusions: The current study identified the presence of the comorbidities (i.e., diabetes, liver diseases, and respiratory diseases) and on-admission laboratory blood and serum test results (i.e., WBC, lymphocytes, CRP, ferritin, corrected calcium, IL-6, D-dimer, ALT, LDH, albumin, and troponin) that are associated with ICU admission.

Keywords:COVID-19; Comorbidity; Intensive Care Unit; Biomarkers; Risk Factors; Oman.

Objectives: HIV infection in pregnancy affects the mother, her placenta, and fetus resulting in perinatal/maternal morbidity and mortality. Studies show that HIV-positive mothers have several placental morphological changes. This study aimed to describe the histomorphometric parameters/lesions of placentas of HIV-positive mothers in Uyo, Akwa Ibom State, Nigeria. Methods: A prospective cross-sectional hospital-based analytical study was conducted at the departments of Obstetrics and Gynecology, and Histopathology, University of Uyo Teaching Hospital, Nigeria from December 2015 to May 2016. We studied 144 pregnant mothers (48 HIV-positive as the test group vs. 96 HIV-negative as controls). Their placentas (fetal membrane, umbilical cord, and placental disk) were collected post-delivery and evaluated (grossly/microscopically) to determine the range of histomorphometric placental parameters/lesions. Relevant obstetric data were obtained from their case notes. Results: The test group delivered more through cesarean section than the control group (52.1% vs. 31.3%), with mean birth weights of 2.8±0.7 and 3.1±0.6 kg (p = 0.004). The mean placental weights were 57±190.1 and 664.6±167.4 g (p = 0.003), with mean placenta-birth weight ratio of 20.1±4.8 and 20.5±4.57% (p = 0.33). The test groups placental fetal membranes, umbilical cords, and disks mainly displayed acute chorioamnionitis (47.9%), acute umbilical phlebitis (14.6%), and villous vasculopathy (33.3%). The test group had a higher stage/grade of placental inflammation than the control group. In the test group, two stage 4 HIV disease state cases presented with the most severe form of placental inflammatory lesions. Conclusions: The commonest placental histomorphometric parameters/lesions were acute chorioamnionitis, acute umbilical phlebitis, and acute intervillositis. There was no significant association between HIV/AIDS disease stage with the most severe forms of placental inflammatory lesions.

Keywords:Pregnancy; Chorioamnionitis; Placenta; HIV Infections; Acquired Immunodeficiency Syndrome; Nigeria.

Objectives: To evaluate the expression of programmed death-ligand 1 (PD-L1) in bladder cancer cases in Oman using immunohistochemistry, and to determine whether the level of PD-L1 expression is associated with tumor grade, stage, or outcome. An additional objective was to identify the clinicopathological features of bladder cancer among Omanis. Methods: This was a retrospective cohort study of patients where we subjected archived tissue samples to prospective analysis. All patients diagnosed and treated for bladder cancer in Sultan Qaboos University Hospital from January 2006 to December 2017 and followed up for at least one year were included. Clinical and demographical information of the patients was obtained from their medical records. PD-L1 testing using immunohistochemistry was performed on formalin-fixed paraffin-embedded tissue blocks. Scoring of PD-L1 expression by tumor cells was conducted independently by two pathologists. Positivity was defined using two different cut-off values (≥ 5% and ≥ 25%) of tumor cells showing membrane or cytoplasmic staining. The outcome was divided into two categories either no recurrence at the last follow-up, or recurrence/disease progression/death. Results: There were 68 cases of bladder cancer; 72.1% were male; the age range was 35–89 years (mean = 65.3 and median = 66). The largest number of patients were diagnosed with stage II cancer (38.8%) followed by stage I cancer (32.8%). Hematuria was the most common presentation (58.7%). High-grade tumors were seen in 83.8% (57/68) of patients. Invasive urothelial carcinoma appeared in 79.4% (54/68). PD-L1 tests were performed on 63 cases where tissue blocks were available. PD-L1 was positive in 44.4% of cases using a cut-off value of 5%; however, it dropped to 30.2% at a cut-off value of 25%. At the cut-off value of 5%, PD-L1 was significantly associated with tumor grade (p = 0.033), but the significance was lost when the cut-off value of 25% was applied (p = 0.250). No significant association was found between PD-L1 expression and outcome using both cut-off values and stage at diagnosis (p = 0.798 and p = 0.102, respectively).Conclusions: This study showed that at a cut-off value of ≥ 5%, 44.4% of cases of bladder cancer were PD-L1 positive. There was a significant association between PD-L1 expression in bladder cancer and tumor grade. No statistically significant association was found between tumor stage and outcome. The results indicated the potential benefit of anti-PD-L1 immunotherapy for patients with high tumor grades.

Keywords:Bladder Cancer; Programmed Death Ligand 1; PD-L1 Inhibitors; Oman.

Objectives: This study sought to analyze the outpatient parenteral antimicrobial therapy (OPAT) services provided by a tertiary hospital, in terms of types and duration of antimicrobials administered, and assess whether these services were in line with current good practice recommendations. Methods: The electronic healthcare records of all stable patients with infectious diseases, aged ≥ 18 years, who received OPAT services between January 2019 and March 2021, were analyzed. For statistical analysis, the patients were divided into younger (< 65 years) and older (≥ 65 years) adults and the difference between them, in terms of healthcare resources utilization, was assessed. Results: Over 27 months, 199 patients received OPAT services, resulting in saving of 7514 bed-days. Bone and joint infections (38.7%) were the predominant diagnoses. The median actual OPAT duration was significantly greater than the planned duration for the total study population, younger adults, and older adults (p < 0.050). Of 28 (14.1%) patients with adverse events, 25 were related to antimicrobials while the remaining three were associated with catheters. There were no significant differences between younger and older adults in the characteristics evaluated, except for the higher incidence of Staphylococcus aureus (p < 0.001) and Escherichia coli, Staphylococcal spp., Streptococcal spp., and Pseudomonas spp. (p = 0.003) infection in older adults. Conclusions: The actual median duration of OPAT therapy was significantly longer than planned, with suboptimal adherence to the principles of antimicrobial stewardship. OPAT has been shown to be safe for both younger and older adults.

Keywords:Antimicrobial Stewardship; Infection Control; Safety; United Kingdom.

Objectives: Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19. Methods: A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI). Results: The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p = 0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI. Conclusions: Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI.

Keywords:COVID-19; Treatment Outcome; Liver Injury, Drug-Induced; Aspartate Aminotransferase; Alanine Aminotransferase; Acute Kidney Injury; Russia.

Objectives: To describe the demographic distribution of cystic fibrosis (CF) in Omani children, estimate the national prevalence, and provide updated mutational panels of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Methods: We conducted a retrospective cross-sectional study of all CF patients who had been diagnosed and followed-up at Sultan Qaboos University Hospital and Royal Hospital in Oman between 2006 and 2020. Data were collected from electronic hospital records and telephone interviews. Results: A total of 227 patients with CF were included in the study. Geographical clusters of the disease were identified in the governorates of Al-Batinah, A’Dhahirah, and A’Dakhiliyah. Parental consanguinity and family history of CF were present in 68.3% and 69.6% of the patients , respectively. The most common CFTR mutation was p.Ser549Arg (52.0%), followed by p.Phe508del (12.3%), and c.2988+1G>A (4.4%). Three novel CFTR mutations were identified, viz., Leu88TyrFs*, p.Asp192Val, and c.4242+1G>C. Conclusions: The estimated prevalence of CF in Oman is 10.3 per 100 000 individuals. Premarital genetic counseling and preimplantation genetic testing are recommended in CF-prevalent regions.

Keywords: Congenital Disorders; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Mutation; Prevalence; Genetic Testing; Oman.

Objectives: Dengue fever (DF) is the most common arthropod-borne viral illness with significant public health implications that can cause severe clinical symptoms and possibly death. We sought to determine the epidemiological and clinical characteristics of patients presented with DF to the Royal Hospital in a recent outbreak in Oman. Methods: We conducted a retrospective cohort study between 1 January and 18 April 2022, at the Royal Hospital, Oman, including all patients who presented with febrile illness and laboratory-confirmed DF. Descriptive statistics were used to summarize the results. Results: The cohort included 58 patients with laboratory-confirmed DF, of whom 39 (67.2%) required admission. The overall mean age was 41.0±20.0 years. Over half (55.2%) were females and the majority (86.2%) were Omani citizens. Eighty-one percent of the patients were residents of Bawshar in Muscat governorate. Dengue virus 2 was the isolated serotype. Fever (98.3%), muscular aches and pains (55.2%), and headache (53.4%) were the most common symptoms on presentation. All patients except two had no travel history. The most common comorbidities were hypertension (29.3%) and diabetes mellitus (17.2%). Upon admission, the most prominent hematological and biochemical abnormalities were severe thrombocytopenia (31.0%) with platelet counts of < 50 000/mm3 and hepatic impairment (15.5%). Antibiotics were prescribed to 27.6% of the patients. All patients improved clinically, and no deaths were reported during the study period. Conclusions: Fever and thrombocytopenia were the commonest presentations of DF. Identification of factors linked to increased risk of hospitalization in patients with DF can assist in recognizing individuals who need close monitoring and intensive support.

Keywords: Dengue; Epidemiological Study; Disease Outbreak; Communicable Disease; Oman.

Intimal sarcomas are rare malignant mesenchymal tumors that arise in the large arteries and rarely in the heart. Herein, we report the case of a 55-year-old man who was referred for further assessment of a right ventricular outflow tract mass. Assessment with cardiac magnetic resonance imaging revealed an enhancing mobile mass arising within the right ventricular outflow tract and extending into the main pulmonary artery. The initial diagnostic possibilities included thrombus and myxoma. The patient underwent surgical recession of the mass and the histopathology examination confirmed the diagnosis of cardiac intimal sarcoma.

Tracheobronchial leiomyoma is a rare tumor of the airway. They arise from the lower respiratory tract tissue of the bronchi, trachea, and lung. Symptomatology is based on the degree of endoluminal bronchial obstruction, and surgical resection is generally the mainstay of treatment. We present the case of a 33-year-old male who suffered from chronic cough and breathlessness for two years caused by large endobronchial leiomyoma diagnosed by preoperative biopsy. The tumor was surgically resected through bronchotomy and complete preservation of the lung parenchyma. We stress the importance of a definitive preoperative diagnosis of this rare tumor to employ lung preserving surgical techniques.

Keywords:Trachea; Leiomyoma; Bronchial Neoplasms; Lung; Diagnosis.

We report a 10-year-old girl who presented with acute arthritis of the left knee, which was confirmed as Lyme arthritis by serology and molecular assay. Careful history and examination were the keys to suspecting the diagnosis. The patient lived in the US for five years and her symptoms developed about a year after her return to Oman. To the best of our knowledge, this is the first case report of Lyme arthritis in Oman and the Arabian Gulf region. This case indicates the need to suspect Lyme disease in patients presenting with compatible symptoms and a history of recent travel to endemic regions.

Keywords:Lyme Disease; Lyme Arthritis; Travel; Ticks; Oman.

This paper reviews our institutional experience in the management of rhino-facial entomophthoromycosis, a rare subcutaneous fungal infection. We adopt a fixed two-phase protocol comprising an initial ‘intensive phase’ (two-drug regimen) followed by an ‘eradication phase’ (monotherapy). We present five patients treated between May 2013 and May 2020 in our institution who were subjected to the mentioned protocol. All five patients received six months of supersaturated potassium iodide solution and itraconazole, followed by four months of monotherapy with only supersaturated potassium iodide solution. All patients responded well to the treatment and were disease-free on follow-up of a minimum two years post-treatment. We recommend this procedure for all typical cases of entomophthoromycosis and suggest avoiding surgical intervention which may disseminate the fungus and delay response to treatment.

Keywords: Entomophthoromycosis; Skin; Zygomycosis; Basidiobolomycosis; Potassium Iodide; Azoles; India.

We describe here the first confirmed case in Oman of chronic osteomyelitis due to Coxiella burnetii, in a previously healthy four-year-old Omani girl. After laboratory confirmation of C. burnetii infection using molecular and qualitative and quantitative serological assays, the case was successfully managed with a combination of oral ciprofloxacin and cotrimoxazole and thereafter followed up for a long period without remission.

Keywords:Coxiella burnetii; Osteomyelitis; Ankle Joint; Q Fever; Zoonotic; Molecular Testing; Oman.