Objectives:To evaluate the prognostic value (total mortality + repeated hospitalization for heart failure (HF)) of ultrasound diagnostic methods in patients with acute decompensated HF (ADHF). Methods: The subjects were patients with chronic HF, who were hospitalized for ADHF. Using ultrasound methods—lung ultrasound, ultrasound assessment of hepatic venous congestion as per the venous excess ultrasound (VExUS) protocol, and indirect elastometry—we assessed the number of B-lines, hepatic venous congestion, and liver density of the patients. Clinical outcomes were assessed using a structured telephone survey method at 1, 3, 6, and 12 months after discharge. Combined overall mortality and readmission rates associated with HF were assessed. Threshold values for different methods for detecting congestion were set as follows: the number of B-lines in ultrasound data > 5; liver density > 6.2 kPa.
Results: The subjects were 207 patients (54.1% male; mean age = 70.7 ± 12.8 years). A total of 63 (30.4%) endpoints and 23 (11.1%) deaths were detected within 364 days (IQR = 197–365). Liver density > 6.2 kPa had a hazard ratio (HR) of 1.9 ( 95% CI: 1.0–3.3;
p = 0.029). Hepatic venous congestion (VExUS protocol) had HR of 2.8 (95% CI: 1.3–5.7;
p = 0.004). There was a significant increase in the risk of overall prognostic value in the presence of congestion, identified by liver fibroelastometry + lung ultrasound (HR = 10.5, 95% CI: 2.3–46.2; p = 0.002). The ultrasound assessment of hepatic venous congestion (VExUS + lung ultrasound protocol) yielded HR of 16.7 (95% CI: 3.9–70.7;
p < 0.001). For all three methods combined, the overall HR was 40.1 (95% CI: 6.6–243.1;
p < 0.001). Conclusions: A combination of ultrasound diagnostic methods that include the number of B-lines, presence of hepatic venous congestion according to the VExUS protocol, and liver density according to indirect elastometry at discharge may have an independent prognostic value for patients with ADHF.

Keywords:Heart Failure; Assessment, Patient Outcomes; Survival; Prognosis.

Objectives: Surgical training has evolved over the past few decades, with an increasing number of surgeons pursuing subspecialty training through fellowship programs across various surgical specialties. While published reports confirm this trend, few studies explored the factors that determine which fellowship training surgical residents would pursue. This cross-sectional study aims to investigate the factors influencing fellowship choices made by surgical trainees in Oman. Methods: An online questionnaire, developed based on previously validated instruments, included 14 factors considered crucial for choosing a future career. Statistical analysis was performed to determine item-level validity, scale-level validity, and reliability. The survey was distributed via email and closed after six weeks for data analysis. Results: The survey achieved a response rate of 60.9%. The analysis revealed that the most influential factor among surveyed surgeons in selecting a subspecialty was prestige, with an average score of 2.7. The least reported influential factors were variety of cases (average score of 1.8) and personal interest (average score of 1.4). Only 57.7% of respondents received career choice guidance. Conclusions: Factors influencing the choice of surgical subspecialties vary among the different groups. This information can be valuable in designing programs and structuring professional career guidance and counseling.

Keywords:Education; Specialization; Fellowships; Residency; Surgery.

Objectives: We sought to assess the attitude of Omani families toward accidental injuries among children (aged < 6 years) and evaluate the safety measures and available preventive measures to reduce child injuries at home. Methods: We conducted a cross-sectional survey examining the self-reported attitudes of Omani parents about accidental injuries (poisoning, falls, burns, and drowning) at home among children younger than six and house safety measures. A total of 220 parents of children aged < 6 years, admitted to a tertiary healthcare teaching hospital, were invited to participate over a period of six months (May to November 2018). Analysis of 178 participant data was performed using SPSS, as 44 of the answered questionnaires had missing data, or were related to children over the age of six. Results: Only 16.9% of the Omani families had a history of a child injury in the year before the study. Males were more injured (61.0%) and 66.0% were younger than three years at the time of injury. A door to control access to stairs was available for 53.8% of the families. In 42.5% and 16.0% of the houses, children could access electrical sockets and wires, respectively. Fire alarms and extinguishers were not available in 90.8% and 82.1% of houses, respectively. Those who did not store medications and chemicals in safe places out of reach of children accounted for 56.7% and 63.3% of families, respectively. Conclusions: Many of the studied families are not providing an adequate safe environment for children in their houses. Therefore, actions should be taken to increase awareness about accidental injuries prevention within homes and to implement actions so that a safe home environment can be enjoyed by children.

Keywords:Child; Accidental Injuries; Home Environment; Oman.

Objectives: There is a dearth of research regarding the motivations and experiences of Omani nationals who travel abroad for medical treatment, especially for neurological diseases. The primary objective was to examine and draw comparisons between Omani adults and children with neurological disorders who pursued medical treatment abroad after being evaluated by local specialists. The study also aimed to gain insights into these patients’ motivations and experiences. A related objective was to explore the sociocultural factors and family dynamics that shape the attitudes towards illness and treatment seeking. Methods: In this cross-sectional study, Omani patients treated at a major tertiary hospital in Muscat for neurological disorders and subsequently traveled overseas for treatment were identified and administered a structured questionnaire. Results: The participants were 116 Omani nationals (62 children and 54 adults) with neurological disorders, diagnosed predominantly with epilepsy (71.6%) followed by developmental delay, muscular dystrophy, and encephalopathy. Only 19.8% of patients received government sponsorship. The majority (69.8%) followed the recommendations of family members. Most (63.8%) participants reported positive outcomes after treatment abroad, though 4.3% developed complications and 5.2% acquired nosocomial infections. Most (83.6%) participants opined that the treatment they received overseas was comparable to what they would have received in Oman. There were no significant differences between children and adults in most of these aspects. Conclusions: Public awareness should be increased regarding the pros and cons of medical tourism. Patients must be made aware of the advanced treatment facilities available locally. Efforts should be made to enhance patient outcomes and satisfaction by adopting more efficient and patient-friendly processes.

Keywords:Medical Tourism; Neurological Disorders; Family; Treatment Outcomes; Healthcare Systems; Oman.

Objectives:Several studies have explored the opinions of healthcare workers on the use of complementary and alternative medicine (CAM) in epilepsy treatment. We sought to survey the views of non-neurologist and non-psychiatrist physicians in Oman on the use of CAM for epilepsy. Methods: We used convenience sampling to recruit physicians (except neurologists and psychiatrists) from all 11 governorates of Oman. The online questionnaire was open to physicians from 5 January 2022 to 15 February 2023. This study collected anonymous data on their demographics, discipline, work settings, geographical area, and years of practice. Additionally, participants were asked to answer questions about their perception of CAM use and its effectiveness in treating epilepsy.
Results: A total of 190 physicians participated, of whom 69.5% were men. Respondents were mostly 36 to 45 years old (51.1%). The majority (52.1%) were general practitioners, 21.1% were internists, 17.9% were pediatricians, and 8.9% were family physicians. Most participants (n = 144; 75.8%) believed that CAM may help treat patients with epilepsy (PWE). The most common therapies that participants considered helpful were meditation (46.0%), prayers (44.7%), yoga (32.6%), and exercise (31.1%). Conclusions: While the evidence supporting the use of CAM for the treatment of epilepsy is scarce, this survey showed that most physicians (non-neurologists and non-psychiatrists), who manage PWE in Oman, believed that some CAM modalities would help treat epilepsy. Well-designed controlled trials are needed to provide reliable evidence on the usefulness of CAM options in PWE.

Keywords:Epilepsy; Complementary Therapies; Seizures; Oman.

Objectives: The existing biomarkers used to promptly identify graft dysfunction after kidney transplantation lack consistency. Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker but its levels measured from serum and urine have demonstrated varying predictive values. Our study aimed to explore the potential of NGAL as a biomarker in predicting graft dysfunction in kidney transplant patients, including live and deceased donor recipients. Methods: A single-centered observational cohort study with live and deceased kidney recipients as participants was conducted between 2018 and 2022 at a tertiary care hospital in Southern India. Serum creatinine levels were monitored daily; creatinine reduction on day two and day seven were calculated. The recipients were categorized based on graft recovery into three groups: delayed graft function (DGF), slow graft function (SGF), or immediate graft function (IGF). Analysis of serum and urine NGAL was conducted two hours after the transplant and their predictive values were evaluated by the area under the curves (AUC) method. Results: Of the 40 participants, 34 (85.0%) received their transplant from live-related donors, while six (15.0%) received kidneys from deceased donors. DGF occurred in four (10.0%) patients, SGF in 12 (30.0%), and 24 (60.0%) patients achieved IGF. Serum NGAL demonstrated higher sensitivity compared to urine NGAL. At a cut-off value of 678 ng/mL (AUC = 0.77), serum NGAL showed 90.0% sensitivity and 53.0% specificity. Urine NGAL had 70.0% sensitivity and 74.0% specificity at a cut-off value of 489 ng/mL (AUC = 0.72). Conclusions: Kidney recipients in SGF and DGF categories had elevated levels of serum and urine NGAL compared to those without IGF. Although serum NGAL showed higher sensitivity than urine NGAL in predicting graft dysfunction, both markers lacked the specificity needed for accurate predictions.

Keywords:Biomarker; Delayed Graft Function; Kidney Transplantation; NGAL Protein; India.

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.

Keywords:>Antipsychotic Agents; Pharmacovigilance; Drug-Related Side Effects and Adverse Reactions; Prevalence.

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.

Liver cirrhosis; Death; Machine learning; Artificial intelligence; Logistic Regression; Oman.

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 (p > 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 (p > 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.

Keywords:Leukemia, Myeloid, Acute; STAT Transcription Factors; Janus Kinases.

Methemoglobinemia is a rare dyshemoglobin disorder which can either be congenital or acquired. Dyshemoglobin disorders can be asymptomatic or symptomatic. We narrate the case of a 12-year-old girl who presented with a fever, cough, and oxygen saturation of 85%. She was diagnosed with COVID-19, along with a large atrial septal defect and pulmonary arterial hypertension. Arterial blood gas analysis revealed normal partial pressure of oxygen and on 100% exposure to oxygen, blood color turned chocolate brown. After the resolution of COVID-19 in 10 days, the patient was treated with oral ascorbic acid and successful atrial septal defect repair. It is important to suspect dyshemoglobin disorder in a patient who presents with hypoxia/hypoxemia.

Keywords: Methemoglobinemia; Cyanosis; Pediatrics; Heart Disease; India.

Idiopathic capillary leak syndrome, also known as Clarkson’s Disease, is a rare cause of hypovolemic shock that physicians should be aware of. It is characterized by a state of hypovolemia with features of widespread fluid third spacing and poses diagnostic and therapeutic challenges. Here, we present a challenging case of a 36-year-old woman who experienced recurrent episodes of widespread edema and hypovolemic shock symptoms suggestive of capillary leak syndrome. The resuscitative and therapeutic measures employed in managing this disease are described in this case report.

Keywords: Capillary Leak Syndrome; Hypovolemia; Shock; Edema.

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited condition characterized by the growth of multiple bilateral cysts in the kidneys. We describe the case of a 35-year-old male with combined ADPKD and type 1 diabetes mellitus with a strong family history of both. At the age of 32, he developed end-stage kidney disease for which he underwent preemptive simultaneous pancreatic and kidney transplant, which in turn led to multiple perioperative complications. Evaluation of familial clustering of genetic disease is critical in genetic epidemiology and precision medicine as it enables estimation of lifetime disease risk and early assessment as well as detection of the disease among one’s siblings.

Keywords: Polycystic Kidney Disease; Type 1 Diabetes Mellitus; End-Stage Kidney Disease; Pancreatic Islets Transplantation; Kidney Transplantation; Genetic Diseases; Oman.

An 11-year-old girl presented with an extremely rare complication of Meckel's diverticulum. The patient presented with complaints of abdominal distension, abdominal pain, decreased appetite, and non-bilious vomiting for 20 days with a history of mass protruding per rectum. Examination revealed a distended abdomen and prolapsing bowel loops during rectal examination, resembling intussusception. Radiological findings indicated intestinal obstruction. Surgical exploration revealed Meckel's diverticulum invading the rectum, accompanied by dense inter-bowel adhesions. The patient underwent resection of Meckel’s diverticulum and repair of the rectal rent. This case highlights the rarity of Meckel's diverticulum fistulating into the rectum.

Keywords: Meckel Diverticulum; Intestinal Obstruction; Pediatric Surgery.

Cardiac papillary fibroelastoma (PFE) is a rare benign cardiac tumor, usually associated with cardiac valves. Cases of non-valvular, left ventricular (LV) cavity PFE are extremely rare. We report the case of a 75-year-old man with a history of exertional chest pain. He was referred to our tertiary-care hospital for evaluation. On the echocardiogram, the patient was found to have a LV lesion related to the papillary muscle. Cardiac magnetic resonance imaging revealed an enhancing mobile lesion related to the LV anterolateral papillary muscle which suggested a myxoma. The patient underwent surgical resection of the lesion, later histopathologically confirmed to be PFE.

Keywords: Cardiac Papillary Fibroelastoma; Cardiac Tumor; Oman.

Kikuchi disease, also called, Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis, is a rare self-limiting illness with an unknown etiology and pathogenesis. It is predominantly seen among young females. The cardinal clinical features include fever and cervical lymphadenopathy. Skin eruptions have also been reported. In Oman, two cases have been reported to date, in 2005 and 2020, with only one case exhibiting skin manifestations. There is a paucity of disease in our country and worldwide. In this case report, we discuss the diagnosis of Kikuchi disease in a previously healthy 17-year-old Omani female who presented with fever, cervical lymphadenopathy, and malar rash. The clinical picture in this case resembled that of systemic lupus erythematosus. Due to the rarity of Kikuchi disease, particularly in our region, it is crucial to consider it as a differential diagnosis when a patient exhibits the aforementioned symptoms to prevent misdiagnosis and inappropriate treatment, as it can easily be misdiagnosed as systemic lupus erythematosus.

Keywords: Histiocytic Necrotizing Lymphadenitis; Lymphadenopathy; Oman.

Objectives: To evaluate the impact of Pulmonary Arterial Hypertension (PAH) therapies on the incidence of pericardial effusion and its prognostic implications for patient survival. Methods: This retrospective cohort study included 60 patients diagnosed with PAH at a high-volume tertiary care center, treated with intravenous or subcutaneous prostanoids. Data were collected from 2015 to 2019, including echocardiographic assessments, right heart catheterization, World Health Organization functional class evaluations, six-minute walk distance tests, and biomarkers such as brain natriuretic peptide and N-terminal prohormone of brain natriuretic peptide. Follow-up was conducted at least 90 days post-treatment initiation. Results: Pericardial effusion was observed in 31.7% of patients before therapy. Patients with moderate to large effusions had a significantly higher mortality risk (HR = 1.92; 95% CI 1.1–44.78; p = 0.0044), while small effusions appeared protective (HR = 0.27; 95% CI 0.15–0.48; p = 0.006). Survival rates declined from 89% at one year to 71% at three years post-therapy, with effusion presence correlating with more severe PAH manifestations. Conclusions: Initial pericardial effusion severity is a critical predictor of mortality in PAH patients. Early assessment and stratified management of pericardial effusion are essential for optimizing therapeutic outcomes in PAH management. Future research should explore targeted interventions for managing pericardial effusion to improve patient prognosis.

Keywords: Pericardial Effusion; Hypertension, Pulmonary; Vasodilator Agents.