Original Articles
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Influential Factors in the Selection of Subspecialty Fellowship Training Among Surgical Trainees in Oman
Ghassan Al Habsi, Ahmed Al Ghaithi, Yousef Al Weshahi, Ahmed Jahwari
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.
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Readiness of Omani Families to Prevent Accidental Injuries at Home in Children Younger than Six Years Old
Miada Alabdulsalam, Muna Al Saadoon
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.
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Complementary and Alternative Medicine for People with Epilepsy: Opinions of Physicians in Oman
Abdullah Al-Asmi, Fatema Al Sabahi, Samir Al-Adawi, Intisar Al-Yaqoubi, Sanjay Jaju, Moon Fai Chan, Haifa Al-Abri, Zahir Al-Anqoodi, Ali A. Asadi-Pooya
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.
Case Reports
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A Rare Case of Familial Methemoglobinemia with Congenital Heart Disease
Jhasaketan Nayak, Karthik Kumar, Sashi Kant Singh, Gaurav Dhingra, Uttam Kumar Nath
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.
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Idiopathic Capillary Leak Syndrome (Clarkson’s Disease): First Reported Case in Oman
Fatma Al-Zaabi, Hatem Al-Farhan, Ali Al-Lawati, Mujahid Al-Busaidi
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.
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Simultaneous Pancreatic and Kidney Transplant in Adult with Autosomal Dominant Polycystic Kidney Disease and Type I Diabetes Mellitus: Post Surgical Events and Genetic Review
Intisar Al Alawi, Ehab Mohammed, Fatma Al Rahbi, AbdelMasieh Metry, Suad Hannawi, Issa Al Salmi
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.
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Meckel's Diverticulum Fistulating into the Rectum: An Extremely Uncommon Presentation
Raghav Narang, Shishir Kumar, Aravindh Radhakrishnan, Prakriti Giri , Yogesh Kumar Sarin
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.
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A Common Disease, an Uncommon Location: Left Ventricle Papillary Fibroelastoma
Rashid Saif Al Umairi, Khadija Al Adawi, Ahmed Al Kindi, Nasser Al Rahbi
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.
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Kikuchi Disease “A Lupus Mimicker”: A Case Report
Aliya Juma Alsaadi, Saud Al Hashmi, Nabila Al-Julandani
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.
Brief Communication
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Evaluating the Impact of Pulmonary Arterial Hypertension Therapies on Pericardial Effusion and Patient Survival
Arif Albulush, Shabib Al-Asmi, Moosa Al-Abri, Hatem Al-Farhan
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.
Clinical Notes
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Anterolateral Ligament Pathological Anatomy and its Associated Injuries: An Infographic
Angelo V. Vasiliadis, Dimitrios Chytas, Vasileios Giovanoulis, Theodore Troupis, George Noussios
Clinical Quiz
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Psoriasiform Skin Lesions and Dental Abnormalities
Huda Al Maqbali, Ghada Otaify, Ali Al-Mullahi, Buthaina Al Musalhi
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A Six-year-old Girl with Bloody Diarrhea due to a Rare Cause
Yusriya Al Rawahi, Hajar Al Maamari, Hatem Al Rawahi, Laila S. Al Yazidi
Letter to the Editor
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Translated Perinatal Grief Scale-Persian Version Requires Modified Analysis
Elham Khoori, Tayebe Ziaei, Judith N. Lasker