Objectives: To evaluate the performance of measurement of glomerular filtration rate (GFR) using Modification of Diet in Renal Disease equations (MDRD186, MDRD175) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, in comparison with technetium-99m diethylenetriaminepentaacetic acid (99Tc-DTPA) renogram method, the gold standard. A related aim was to correlate the three equations to estimate GFR and their impact on reclassifying the stages of CKD in adult Omani patients. Methods: This cross-sectional study recruited two groups of patients diagnosed with CKD during a 10-month period from January to October 2021. The first group comprised 48 patients who underwent a 99Tc-DTPA renogram procedure for GFR measurement, and the second group comprised 30 348 adult patients who did not undergo the same procedure; estimated GFR was calculated using the three equations. Results: The median of the reference GFR was 106.0 mL/min/1.73 m2, whereas the median estimated GFR for the MDRD175, MDRD186, and CKD-EPI equations were 92.5, 98.3, and 102.1, respectively. All three equations correlated moderately with the reference GFR (0.428, 0.428, 0.523, respectively; p < 0.010). The CKD-EPI showed lesser bias (3.7 vs. 12.9 and 7.5 for MDRD175 and MDRD186, respectively) and more accuracy (95.8% vs. 91.7% and 93.8%); however, it was the least precise (25.1 vs. 22.3 and 23.8). The MDRD186 performed similarly to the CKD-EPI equation at CKD stages 3a–5 and differed significantly at stages 1–2. Whereas the MDRD175 differed significantly with both equations at stages 1–3b and was similar to them at stages 4–5. Conclusions: The CKD-EPI equation had the highest accuracy and the least bias and precision in the general population. The MDRD186 CKD classification differed significantly from the CKD-EPI equation at CKD-stages 1–2 only. The CKD-EPI equation is preferred to MDRD for the detection and classification of early CKD stages.

Keywords:Creatinine, Glomerular Filtration Rate; Kidney Failure, Chronic; Oman.

Objectives: Ameloblastoma, comprising approximately 11% of all odontogenic tumors, is a locally aggressive tumor with a high recurrence rate. This study aimed to assess the immunohistochemical expression of Ki-67 and p53 and their association with clinical and pathological factors among patients with ameloblastoma. Methods: Retrospective follow-up data of patients histologically confirmed with ameloblastoma at Makerere College of Health Sciences in Kampala, Uganda from January 2012 to December 2018 were retrieved. Factors associated with Ki-67 and p53 immunohistochemical expression were determined using one-way one-way analysis of variance. Chi-square and Fisher’s exact statistical tests were used to assess factors associated with recurrence. A two-tailed p < 0.05 was considered statistically significant. Results: A total of 40 patients confirmed histologically with ameloblastoma were included in the analysis. The majority (62.5%) of cases were of the conventional type of ameloblastoma. The expressions of Ki-67 and p53 were 52.5% and 85.0%, respectively. Recurrence was found in 47.5% of patients and it was associated with conventional histological type (p = 0.042), segmental resection (p < 0.001), tumor size (p < 0.001), and high p53 expression (p = 0.041). Conclusions: Almost half the cases in this study had recurrence. The immunohistochemical expression of p53 was significantly higher than that of Ki-67.

Keywords:Ameloblastoma; Ki-67 Antigen; Tumor Suppressor Protein p53.

Objectives: Meningiomas are slow-growing brain neoplasms classified into three grades based on morphological criteria. While these grades are simple, they do not always correlate with patient outcomes. This study aimed to evaluate the status of estrogen receptor (ER), progesterone receptor (PR), and proliferation marker Ki-67/molecular immunology borstel-1 (MIB-1) in the three grades of meningioma. Methods: We evaluated the data of meningioma patients who were seen in our tertiary center over 10 years—8.5 years retrospectively and 1.5 years prospectively. Their archival hematoxylin and eosin stained slides were reviewed and re-graded according to the World Health Organization 2021 criteria. Immunohistochemical analysis for ER, PR, and Ki-67 was performed on all grade 2 and grade 3 meningiomas and 30 cases of grade 1 formalin-fixed, paraffin-embedded samples. Results: Of the 276 cases included in the study, there were 231 (83.7%) cases of grade 1 meningioma, 34 (12.3%) cases of grade 2, and 11 (4.0%) cases of grade 3. ER was positive in 26.0% of grade 1 tumors, 5.8% of grade 2, and 0.0% of grade 3. PR was positive in 70.0% of grade 1 tumors, 20.0% of grade 2, and 18.0% of grade 3. The Ki-67/MIB-1 labeling index (LI) was 2.1 in grade 1, 6.3 in grade 2, and 13.4 in grade 3 tumors. For both PR and Ki-67, the differences between grades 1, 2, and 3 tumors were significant (p < 0.001). There was a significant inverse relationship between mean Ki-67 LI and PR status, with increasing grade of tumor. Conclusions: Ki-67/MIB-1 LI has significant positive correlations with meningioma grade and its recurrence, which makes it a useful auxiliary method for the routine assessment of meningiomas, especially in patients with borderline atypia. The expression of PR, on the other hand, is a positive prognostic indicator and has a substantial correlation with histological grade. In cases of subtotal resection, high proliferative/recurrence rates, and borderline histopathology, the PR status in combination with the MIB-1 LI can offer insights into the behavior and the recurrence probability of a meningioma.

Keywords: Estrogen Receptor; Meningioma; Ki-67 Antigen; MIB-1 Monoclonal Antibody; Progesterone Receptor; India.

Objectives: To understand the pattern of hysterosalpingographic (HSG) findings and annual trends among Ghanaian women with infertility over a five-year period. Methods: We retrospectively evaluated the hospital medical records of women with infertility who underwent HSG at a major tertiary center in Ghana between January 2018 and December 2022. The data was statistically analyzed. Results: The subjects comprised of 2324 Ghanaian women diagnosed with clinical infertility. HSG identified 1685 (72.5%) with primary infertility and they were also younger women with a mean age of 32.2±4.5 years. The remaining 639 (27.5%) women had secondary infertility and were older (34.2±5.3 years; p < 0.001). Primary infertility rate decreased with increasing age (p < 0.001). Bilateral tubal blockage was seen in 701 (41.6%) women with primary infertility and 365 (57.1%) women with secondary infertility. Hydrosalpinx was present in 236 (10.2%) women, fimbrial adhesions in 444 (19.1%), Asherman’s syndrome in four (0.2%), and bilateral beaded tubes/tubercular salpingitis in five (0.2%). HSG was unable to detect infertility-related abnormalities in 513 (22.1%) women despite their clinical infertility. The majority of patients (1502; 64.6%) had tubal blockage: bilateral in 1066 (45.9%) and unilateral in 436 (18.8%). Conclusions: Infertility rates among Ghanaian women increased at an accelerating rate over the years. Primary infertility was significantly more prevalent among younger women. Tubal and cervical abnormalities were the most prevalent HSG findings.

Keywords: Hysterosalpingography; Female Infertility; Prevalence; Ghana.

Objectives: Our research aimed to study the microbiology and antimicrobial resistance in asymptomatic bacteriuria (ASB) among Omani pregnant women. Methods: We conducted a retrospective study that included data from 196 Omani pregnant women with ASB who received care at Sultan Qaboos University Hospital from 2010–2019. Data were obtained from the patients’ electronic medical records including demographics, clinical details, isolated organisms, antimicrobial susceptibility results, and prescribed antibiotics. Results: ASB was detected in 56.1% of cases during the third trimester. Klebsiella pneumoniae (32.1%) was the most frequently isolated organism, followed by Escherichia coli (29.6%). Twenty-one (10.7%) isolates were extended-spectrum beta-lactamase (ESBL)-producing organisms. The overall microbiological susceptibility pattern showed that organisms have a high susceptibility rate to nitrofurantoin reaching 82.8%, followed to a lesser extent by cefuroxime and augmentin. The susceptibility of E. coli and K. pneumoniae to cefuroxime was 74.1% and 71.4%, respectively. Only 52.4% of all isolated ESBL-producing organisms were susceptible to nitrofurantoin. Conclusions: K. pneumoniae and E. coli were the most frequently isolated bacteria in ASB, representing 60.7% of total isolates. A high prevalence of ESBL-producing organisms, 10.7% of the total isolates, was observed. Cefuroxime is an appropriate empirical antibacterial therapy for ASB and urinary tract infection in pregnant women. Nitrofurantoin should be considered for empirical antibiotic therapy in settings of high prevalence of ESBL-producing organisms.

Keywords:Asymptomatic Bacteriuria; Bacteria, empirical antibiotics; Pregnancy.

Objectives: Specialized pediatric cardiology clinics conducted in local hospitals are an important part of delivering specialized care to patients close to their homes. This study aimed to review our experience with a specialized pediatric cardiology outreach clinic at Jaalan Bani Bu Ali Hospital, South A'Sharqiyah, Oman. Methods: Patient records for each individual, seen in the outreach clinic between March 2018 and June 2022, were reviewed to determine demographic information, reason for referral, underlying diagnosis, and clinic visit outcomes. Results: Over the study period, 29 clinics were conducted, with 360 patients seen. Of these, 200 (55.6%) were male with a median age of 13 months. The majority of patients (n = 271; 75.3%) were referred due to a cardiac murmur. Most patients had a normal cardiac evaluation (n = 177; 49.2%). The most common congenital heart diseases detected were mild pulmonary valve stenosis (14.8%) and moderate to large secundum atrial septal defects (13.7%). Significant cardiac lesions detected included severe pulmonary hypertension (2.2%), tetralogy of Fallot (1.6%), and cor triatriatum sinistrum (0.5%). Overall, 70 (19.4%) patients were referred to tertiary care hospitals, and 179 (49.7%) were reassured and discharged. Conclusions: Conducting specialized pediatric cardiology outreach clinics in overpopulated areas is effective and well-received by families. It reassures many families and reduces the need for unnecessary travel to specialized centers. These clinics also play a crucial role in detecting patients with significant cardiac defects requiring urgent care. Implementing specialized clinics in primary and secondary health centers could be beneficial for other subspecialties in reducing long waiting lists.

Keywords:Cardiology; Echocardiography; Heart Defects, Congenital.

Objectives: To determine the irregularity in the sleep schedule among university students in the UAE and determine its correlation with poor sleep quality, daytime sleepiness, and fatigue. Methods: This observational cross-sectional survey was electronically conducted among undergraduate students of Ajman University during the academic year 2022–2023. The participants were selected using a simple random sampling method. The instruments for data collection comprised of sleep schedule questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale. Data was subjected to chi-square analysis, Mann-Whitney U test, Wilcoxon rank-sum test, and Spearman’s correlation. Results: Of the 537 participants, 353 (65.7%) were female. The majority (57.2%) kept highly irregular bedtimes. The cohort’s mean global PSQI score was 8.9±3.0 indicating poor sleep quality. There was a positive correlation between the irregular bedtime frequency and the global PSQI score (r = 0.311; p < 0.010). Most (70.8%) participants had a total high Fatigue Severity Scale score of ≥ 36. The scores of women (41.0±10.5) were significantly higher than those of men (38.5±11.0) (p = 0.006). Around 53.0% of the participants had high ESS scores indicating excessive daytime sleepiness. There was also a significant correlation between ESS score and irregular bedtime frequency (r = 0.113; p = 0.009). Conclusions: The students at Ajman University had a high prevalence of irregular bedtime and inadequate sleeping hours. This was affecting their sleep quality and causing excessive daytime sleepiness. The students, especially women, were suffering from fatigue, potentially affecting their normal functionality. It is crucial to encourage students to establish regular sleep patterns and improve sleep habits to promote their productivity and general well-being.

Keywords:Fatigue; Sleep Quality; Daytime Sleepiness; Sleep Disorders; United Arab Emirates.

Objectives: The impact of beta-thalassemia major (β-TM) on health-related quality of life (HRQoL) in Oman is not yet known. Affected individuals suffer from a wide range of physical, mental, and social consequences due to the need for regular hospital visits for blood transfusions and complications related to iron overload. This study aimed to assess the HRQoL of adult patients with β-TM attending a single tertiary care center in Muscat, Oman, to identify factors influencing Omani patients’ QoL for improved management and counseling. Methods: A cross-sectional study was conducted among adult patients (≥ 18 years) with β-TM at Sultan Qaboos University Hospital between September and November 2022. A validated Arabic version of the self-reported 36-item short-form health survey was used to determine HRQoL. Results: A total of 78 patients with β-TM were enrolled in the study; 53.8% were male and the mean age was 26.0±0.8 years, ranging from 21–53 years. Most patients were from Al Batinah North governorate (n = 21; 26.9%) and Muscat (n = 20; 25.6%), unmarried (n = 44; 56.4%), did not have university-level education (n = 45; 57.7%), and were unemployed (n = 44; 56.4%). The HRQoL domain with the highest score was role limitations due to emotional problems (median score = 100), while general health and vitality received the lowest scores (mean scores were 60.2±15.9 and 59.1±20.5, respectively). Several variables were associated with better HRQoL in certain domains, including being married, having a high level of education, being employed, exercising regularly, and receiving family support (p < 0.05). However, iron overload and having ≥ 3 β-TM-related disease complications were associated with poorer general health scores (p = 0.031 and 0.038, respectively), while a history of mental issues was associated with poorer scores in six out of eight HRQoL domains (p < 0.05). Moreover, negative perceptions regarding the social impact of the disease including delayed marriage, workplace difficulties, and reduced academic achievement were associated with poorer HRQoL in various domains (p < 0.05). Conclusions: Although the studied sample reported generally good QoL, several factors were found to affect HRQoL in various domains. Healthcare providers should prioritize maintaining acceptable iron overload levels in Omani patients with β-TM to help avoid the development of disease-related complications, thereby ensuring better control of their clinical conditions and consequently improving their HRQoL.

Keywords:beta-Thalassemia; Health-Related Quality of Life; Adults; Oman.

Objectives: To evaluate the prevalence of risk for venous thromboembolism (VTE) and the proportion of at-risk patients who receive appropriate thromboprophylaxis among inpatients in acute hospital care settings in Oman. A related objective was to evaluate the type and time of initiation of VTE prophylaxis. Methods: This multicenter, cross-sectional study was conducted in three tertiary hospitals in Oman. The study included acutely ill medical and surgical inpatients admitted from August to September 2022. VTE risk assessment and prophylaxis were assessed based on the 2012 recommendations of the American College of Chest Physicians (ACCP). Results: A total of 384 patients were enrolled, 240 were medical patients and 144 were surgical patients. As per the ACCP criteria, 179 (74.6%) of medical and 92 (63.9%) of surgical patients were at risk for VTE and required prophylaxis. Appropriate prophylaxis was received by 142 (79.3%) at-risk medical and 70 (76.1%) at-risk surgical patients. In cases where pharmacological prophylaxis was contraindicated, mechanical prophylaxis was markedly underused. For medical patients, the median day of initiating VTE prophylaxis was day one of admission. For surgical patients, the median day of initiating VTE prophylaxis was postoperative day one. Conclusions: The majority of hospitalized patients in Oman are at risk of VTE. However, a significant minority of patients do not receive the required pharmacological or mechanical prophylaxis. We recommend the development of a national VTE risk assessment and guiding tool with a facility for monitoring compliance.

Keywords: Venous Thromboembolism; Risk; Prophylaxis; Inpatients; Oman.

Aortic dissection is rare and often presents with atypical symptoms. We describe a case of a patient with acute aortic dissection involving the coronary arteries, complicated by pericardial tamponade, and discuss findings using point-of-care ultrasound, diagnostics, and treatment of this condition.

Keywords:Aortic Dissection; Ischemia; Coronary Disease; Pericardial Tamponade; Lebanon.

Performing classical vaginal hysterectomy on patients with pelvic organ prolapse and cervical elongation can be challenging. Despite the difficulties and risks, it remains the safest and the best available option. We present an illustrated case of step-by-step vaginal hysterectomy management of pelvic organ prolapse with cervical elongation in a 42-year-old woman.

Keywords:Cervical Elongation; Pelvic Organ Prolapse; Vaginal Hysterectomy; Indonesia.

Enterovirus is not a common cause of myositis and rhabdomyolysis in children. We report a case of a two-year-old boy with acute lymphoblastic leukemia with disseminated enterovirus infection complicated by hepatitis, myositis, and rhabdomyolysis. The case was managed successfully with supportive care and high-dose intravenous immunoglobulins.

Keywords:Enterovirus; Rhabdomyolysis; Pediatrics; Acute Lymphoblastic Leukemia; Egypt.

Placenta accreta, one of the morbidly adherent placenta components and currently known as placenta accreta spectrum (PAS), is a condition characterized by abnormal adherence of the placenta to the uterine wall. This can lead to significant blood loss and may lead to high morbidity and mortality rates for the mother. It is a failure of placenta separation during the third stage of labor, which is thought to be high prevalence in those with previous cesarean delivery, especially with the presence of placenta previa. However, PAS is possible in cases of a normally-situated placenta without previous cesarean delivery. We reported an interesting case of a 41-year-old woman, gravida 8 para 7, admitted to the labor room for augmentation of labor, who needed emergency lower segment cesarean section. The incidental finding of PAS was made intraoperatively and was complicated with a hysterectomy. PAS in a normally situated placenta (upper segment) in a virgin abdomen that has been discovered during emergency lower segment cesarean section could cause a nightmare to the obstetrician as it leads to massive postpartum hemorrhage, ureteric injury, and high maternal morbidity and mortality.

Keywords:Placenta Accreta; Placenta Previa; Placenta.

A 32-year-old woman at 26 weeks gestation presented with severe unexplained thrombocytopenia with signs and symptoms of severe pregnancy-induced hypertension and what appeared to be hemolysis, elevated liver enzymes, and low platelet count syndrome, leading to a severe diagnostic challenge. The multidisciplinary team identified her condition as thrombotic thrombocytopenic purpura. Timely management decisions and multidisciplinary care ensured a safe delivery.

Keywords:Obstetrics; Gynecology; Thrombotic Thrombocytopenic Purpura; Preeclampsia; United Arab Emirates.

Isolated elephantiasis of the vulva refers to a gigantic swelling of the vulva without concomitant swelling of the lower limbs. It is a rarely reported entity and its occurrence during pregnancy has been reported only once. We report a case of an isolated vulval elephantiasis during pregnancy and we discuss the possible etiologies and management issues. Our patient had a successful vaginal delivery followed by a satisfactory genital reconstruction at eight months postpartum and no recurrence thereafter.

Keywords: Elephantiasis; Plastic Surgery; Genitalia, Female; India.