Objectives: Hip osteoarthritis is a growing global health burden with an increasing demand for total hip arthroplasty (THA), particularly among older populations. Robotic-assisted THA (RATHA) has emerged as a technological advancement that may improve precision, implant alignment, and potentially patient outcomes compared with conventional THA (COTHA). This systematic review aimed to compare the clinical and radiological outcomes of RATHA and COTHA. Methods: A systematic search was conducted from PubMed, Scopus, and Cochrane Library inception until 31 August 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were randomized controlled trials, retrospective studies, prospective studies, and cohort studies that compared RATHA with COTHA. Exclusion criteria were case reports, case series, abstracts, review articles, systematic reviews, meta-analyses, biomechanical or cadaveric studies, studies on revision THA or high-grade hip dysplasia, and non-English publications. Data were extracted and assessed using the Covidence systematic review software and the Cochrane Risk of Bias Tool. The primary outcomes were clinical outcomes measured by patient-reported outcome measures. The secondary outcomes were operative outcomes, complications, and radiological assessment. Results: Nine studies met the inclusion criteria, representing populations from Asia, the USA, the UK, and Italy. A total of 933 patients were assessed, 467 of whom underwent RATHA. No significant differences observed in patient-reported outcome measures. COTHA had shorter operative times, whereas RATHA showed potential in reducing hospital stays. RATHA demonstrated improved radiological outcomes, particularly in implant alignment; however, no significant differences were observed in complication rates. Conclusions: RATHA offers advantages in radiological precision but provides clinical outcomes similar to those of COTHA in terms of patient satisfaction and complications. Further high-quality trials are required to assess the long-term benefits of RATHA.

Keywords:Arthroplasty, Replacement, Hip; Osteoarthritis, Hip.

Objectives: To investigate the clinical presentation and treatment outcomes in Omani adults diagnosed with attention-deficit hyperactivity disorder (ADHD), with a focus on the efficacy of atomoxetine and methylphenidate in reducing symptoms, and identify clinical predictors of treatment response. Methods: This prospective study enrolled Omani adults with ADHD receiving treatment at Sultan Qaboos University Hospital, Oman. Data on sociodemographic and clinical history were collected. Treatment response was quantified using the Clinical Global Impressions-Improvement (CGI-I) scale, after three months of initiating treatment. Statistical analysis used independent chi-square tests and t-tests, with a significance threshold set at p < 0.05. Results: Among 171 participants, 60.8% were male. The majority (80.7%) received methylphenidate, while the others (19.3%) received atomoxetine. Inattentive subtype of ADHD (66.1%) was the most common, followed by combined hyperactivity and inattention (24.0%). Most (72.5%) patients had at least one comorbidity. After three months, 83.6% of the patients showed significant improvement on the Clinical Global Impressions-Improvement scale. Response rate for methylphenidate (84.8%) was higher than for atomoxetine (78.8%). Significant predictors of treatment response were male sex (odds ratio = 2.42, 95% CI: 1.00–5.71; p = 0.044) and absence of a family history of ADHD (odds ratio = 2.93, 95% CI: 1.18–7.28; p = 0.020). Conclusions: Both atomoxetine and methylphenidate were effective in treating adult ADHD, but methylphenidate showed a higher response rate. Male sex and the absence of a family history of ADHD were associated with greater response to treatment. These factors may serve as clinical indicators for tailoring pharmacological treatment decisions for individual adult ADHD patients in Oman.

Keywords:Attention Deficit Hyperactivity Disorder; Adult; Treatment Outcome; Atomoxetine; Methylphenidate; Outcome Assessment; Oman.

Objectives: Obstructive sleep apnea (OSA) and secondary polycythemia occasionally occur together, but their relationship remains unclear. This study aimed to explore the prevalence of OSA among patients with secondary polycythemia in our local population. Methods: In this retrospective cross-sectional study, we screened 524 adult patients with polycythemia who attended the hematology clinic at a major tertiary hospital in Muscat during 2013–2023. Our goal was to identify patients with OSA and secondary polycythemia who also underwent sleep studies and analyzed their data. Results: Out of 524 polycythemia patients, we identified N = 44 patients (8.4%) who had both OSA and secondary polycythemia. The vast majority were male (42/44; 95.5%). Participants’ mean age was 40.7 years, with a body mass index of 31.7 kg/m2, hemoglobin level of 16.5 g/dL, and hematocrit level of 0.5 L/L. The mean apnea/hypopnea index was 33.3, and the mean desaturation index was 20.3. More than half of the patients (23; 52.3%) had severe OSA (apnea/hypopnea index > 30). Conclusions: The majority of patients with secondary polycythemia had severe OSA. It is likely that OSA may contribute to secondary polycythemia, warranting further investigation.

Keywords:Polycythemia; Sleep Apnea, Obstructive; Hematocrit; Hypoxia; Oman.

Objectives: Computed tomography (CT) scans are commonly used to evaluate the brain in geriatric patients presenting to emergency department (ED). Our study retrospectively aimed to evaluate the effectiveness of CT scans in diagnosing generalized weakness in elderly patients. Methods: Elderly patients (age ≥ 65 years) presenting to the ED with generalized weakness and either fatigue, dizziness, vertigo, fever, nausea, or vomiting between 1 January and 31 December 2022 were included from two prominent EDs in Muscat. Multiple variables were coded and systematically analyzed. Results: Out of 12 608 847 patients, 6.7% presented with generalized weakness and underwent a CT scan of the brain as part of their evaluation. The mean age was 76.0 ± 7.7 years, with males comprising 47.5% of the group. Presenting complaints to the ED were fever (57.0%), drowsiness (46.9%), and dizziness (30.0%). CT brain findings included acute ischemic changes (3.3%), subacute ischemic changes (7.8%), acute-on-chronic subdural hematoma or intracranial hematoma (3.4%), and new space-occupying lesions or abscesses (4.4%). Receiver operating characteristic curves assessed the diagnostic performance of CT imaging for various conditions: acute/subacute ischemic cerebrovascular accident (area under the curve (AUC) = 0.47, optimal threshold: 0.188), acute/acute on chronic subdural hematoma or intracranial hemorrhage (AUC = 0.41, optimal threshold: 0.122), significant new and/or acute CT findings overall (AUC = 0.45, optimal threshold: 0.026), and newly detected space occupying lesions (AUC = 0.43, optimal threshold: 0.144). Conclusions: A CT scan is limited as a diagnostic tool for patients presenting with generalized weakness, particularly in diagnosing new or acute/subacute medical or surgical conditions of the brain.

Keywords:Geriatric Diseases; Brain; Computed Tomography; Elderly.

Objectives: In Arab cultures, significant social stigma impedes the disclosure of mental illness and seeking professional help. To date, no validated Arabic tool exists to assess these perceived barriers. Therefore, we aimed to translate the Coming Out with Mental Illness Scale (COMIS) into Arabic and validate it for Arabic-speaking populations.
Methods: We generated an Arabic translation of COMIS (COMIS-Ar) using standard forward–backward translation procedures. The instrument was tested via a cross-sectional online survey among Arabic-speaking participants. Internal consistency, confirmatory factor analysis (CFA), and model fit indices were assessed. Results: A total of 420 Arabic-speaking adults of median age of 23 years (range 18–60) completed the survey; 73.3% were female. The COMIS-Ar showed overall good internal reliability; Cronbach’s alpha (α) = 0.89; McDonald’s omega (ω) = 0.90. Factor 1 on ‘Benefits of being out’ showed good reliability (α = 0.88; ω = 0.88), while Factor 2 on ‘Benefits of remaining in’ achieved ‘excellent’ reliability (α = 0.94; ω = 0.94). The overall CFA indicated a structural validity of comparative fit index = 0.83 with a root mean square error of approximation of 0.11, suggesting scope for further refinement. Conclusions: The COMIS-Ar is a reliable and potentially valid instrument, albeit with limitations, to assess mental health disclosure-related barriers among Arabic speakers. As a preliminary model with limited testing, its cautious use may aid clinicians to identify the obstacles, including self-stigma in this population and plan targeted interventions, in addition to enhancing public awareness of mental health stigma. Additional psychometric studies are required to enhance the scale.

Keywords:Mental Health; Disclosure; Psychometrics; Personal Autonomy; Surveys.

Objectives: Setting research priorities is essential for optimizing healthcare resource allocation and addressing critical health challenges. We sought to identify data-driven clinical and health service research priorities for the Royal Hospital, Muscat, Oman. Methods: We used a multi-step approach combined with retrospective electronic health record (EHR) analysis with structured and unstructured stakeholder consultations. Findings were validated using the Delphi method through online surveys and face-to-face discussions with 10 key hospital decision-makers. Results: Analysis of EHR data from 652 567 inpatient admissions over 14 years identified pregnancy-related conditions (25.0%) as the leading cause of hospitalization, followed by circulatory system disease (10.4%) and cancers (8.6%), with breast and colon cancers being the most prevalent. Septicemia, pneumonia, and myocardial infarction were the leading causes of death. Stakeholder consultations emphasized patient-centered care, telemedicine, operational efficiency, and artificial intelligence-driven diagnostics as key health service research priorities. Delphi validation confirmed high relevance (scoring 4–5 on a 5-point scale), although feasibility concerns were noted, particularly regarding resource allocation and information technology infrastructure. Conclusions: Our study established research priorities for the Royal Hospital by integrating clinical data analysis with stakeholder engagement to align research efforts with Oman’s Health Vision 2050. Effective implementation will require a hospital-wide research steering committee to oversee execution, integrate research themes into funding strategies, and enhance data-driven decision-making through artificial intelligence and EHR dashboards. Sustaining momentum necessitates annual reviews with leadership, cross-department collaboration, and capacity-building programs. For long-term sustainability, dedicated hospital funding and public-private partnerships should be explored.

Keywords:Information Technology; Artificial Intelligence; Tertiary Healthcare; Research Priorities; Resource Allocation; Stakeholder Participation.

Encysted hydroceles are often considered rare. We report three cases of Ghanaian boys who presented with left scrotal swellings at a primary care center. This paper emphasizes the importance of primary care practitioners considering a possible clinical diagnosis of encysted spermatic cord hydroceles in new-onset scrotal swellings in children and adolescents, as such cases may not be as rare as previously thought.

Keywords:Scrotal Hydrocelesg; Surgery; Primary Care; Ghana.

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in tropical regions, including the Indian subcontinent. It can affect several systems in the body and has high mortality and morbidity. Neuromelioidosis is a rare central nervous system manifestation of melioidosis. We report a case of a 37-year-old man who had disseminated melioidosis with severe central nervous system involvement, with radiological demonstration of spread along white matter tracts. Our report emphasizes the importance of prolonged intensive phase therapy in achieving clinical remission and preventing relapse.

Keywords:Melioidosis; Burkholderia pseudomallei; India.

Abstract

Isolated tubal torsion is a rare diagnosis that can be easily missed due to nonspecific clinical and imaging features. To diagnose preoperatively, a high level of suspicion is required for this condition. We present a case where ultrasonography initially indicated salpingitis, but intraoperatively revealed tubal torsion with an interesting etiology.

Keywords:Sterilization; Tubal; Ovarian Torsion; Adnexa Uteri.

Mucormycosis is a rare and opportunistic fungal infection caused by the order Mucorales. The emergence of COVID-19 has led to a resurgence of this opportunistic infection. COVID-19 and its management protocols have been implicated in causing this surge due to sequential impaired immunity in affected patients. A high index of suspicion, along with prompt evaluation and management, is advisable for the best clinical outcome.

Keywords:COVID-19; Mucormycosis, Gastrointestinal.

Carnitine-acylcarnitine translocase deficiency with SLC25A20 c.199-10T>G variation is a rare condition, typically associated with severe neonatal outcomes. Recently, preimplantation genetic testing (PGT) has emerged as a screening test applicable to embryos produced through in vitro fertilization for genetic analysis before transfer. Thus, PGT allows for the identification and elimination of embryos carrying inherited genetic diseases. This case report aims to present data from PGT on intervention in the management of SLC25A20 c.199-10T>G variation, particularly in middle-income countries. A 26-year-old woman with a high-risk term pregnancy and a history of two sudden neonatal deaths underwent parental carrier testing, revealing heterozygous SLC25A20 c.199-10T>G variation in both parents. The subsequent pregnancy, identified as a homozygous for SLC25A20 c.199-10T>G mutation, was terminated at 20 weeks. The current pregnancy was successfully managed by in vitro fertilization-selective embryo transfer. Carnitine-acylcarnitine translocase deficiency owing to SLC25A20 c.199-10T>G variation can result in sudden neonatal collapse. Obstetricians should maintain a high index of suspicion in recurrent cases of unexplained early neonatal death. Parental carrier testing is crucial for prenatal management, and selective embryo transfer is a core treatment for heterozygous SLC25A20 gene carriers in this highly lethal disorder.

Keywords:Carnitine-acylcarnitine translocase; Pregnancy, High-Risk; Perinatal Death; Preimplantation Diagnosis; SLC25A20 Protein, Human; Fertilization in Vitro.

Emphysematous pyelonephritis (EPN) is a rare necrotizing infection of the renal parenchyma and pelvicalyceal system caused by gas-forming organisms. We describe a novel case of an elderly woman with poorly controlled diabetes mellitus and end-stage renal failure on peritoneal dialysis, who developed polymicrobial EPN involving the Bifidobacterium breve and Klebsiella pneumoniae pathogens. She was successfully treated with culture-directed parenteral antibiotics and percutaneous drainage of renal collections. To our knowledge, B. breve is a previously unreported cause of EPN. This report highlights its potential in causing opportunistic infections in immunocompromised hosts in the appropriate clinical context.

Keywords:Emphysematous Pyelonephritis; Bifidobacterium breve; Diabetes Mellitus; Peritoneal Dialysis; Singapore.