Alanine aminotransferase (ALT) is a key biomarker used in primary care to detect chronic liver diseases, particularly in high-risk populations such as those with metabolic syndrome and obesity. This review explores the role ALTs play in screening for asymptomatic liver diseases and its ability to predict all-cause and liver-related mortality. While ALT remains valuable for screening in high-risk groups, its utility in the general population is limited due to a lack of cost-effective studies. Recent research suggests that lower ALT thresholds may improve early detection of liver disease, especially in individuals with non-alcoholic fatty liver disease. However, ALT alone may not be sufficient, as it has limitations regarding specificity and sensitivity. Combining ALT with other diagnostic tools, such as imaging techniques and additional liver enzyme markers, could enhance screening accuracy and early detection in primary care settings. Regular monitoring and adapting ALT cutoff values for specific populations are recommended to optimize liver disease management. This approach could lead to improved clinical outcomes, reduced progression to severe liver conditions, and better healthcare resource utilization.

Keywords:Alanine Transaminase; Non-alcoholic Fatty Liver Disease; Primary Healthcare.

Objectives: We aimed to investigate the expression levels and interaction between E2F-1 and Akt1 in triple-negative breast cancer (TNBC) cells, and whether cis-diamminedichloroplatinum(II) (cisplatin) could influence such an interaction.Methods: A batch of MDA-MB-321 breast cancer cells were treated with increasing concentrations of cisplatin (2.5–40 μM) for 24 hours. Additional cells from the same source were used for control experiments. Cisplatin-induced apoptosis was confirmed biochemically using cleaved polymerase and flow cytometry analysis, and morphologically using hematoxylin and eosin staining, Hoechst staining, and scanning electron microscopy. Caspase-3 cleavage, an indicator of apoptotic induction, was measured by immunofluorescence. A western blot test was used to investigate the effects of cisplatin on E2F-1 and Akt1 expressions, while their co-localization and interaction were detected using immunofluorescence and immunoprecipitation, respectively. Results: A western blot analysis revealed an increase in E2F-1 and a decrease in Akt1 expression with increasing concentration of cisplatin, compared to untreated cells. Merged E2F-1 and Akt1 immunosignals observed by immunofluorescence demonstrated that cisplatin-treated cells exhibited co-localization of immunosignals in clusters and with increased intensity in the cytoplasm. Immunoprecipitation and western blot analysis results further confirmed the association between E2F-1 and Akt1, indicating a potential interaction between the two proteins in MDA-MB-231 cells. Conclusions: Our findings suggest a potential interaction between E2F-1 and Akt1, which in turn could be the precursor for the cisplatin-induced apoptosis in TNBC cells. Further studies are needed to determine whether this interaction occurs directly or via an intermediate protein.

Keywords:E2F-1; Akt1; Cisplatin; Triple Negative Breast Neoplasms; Protien Binding.

Objectives: This study aimed to estimate the incidence and trends of hypoglycemia cases admitted to the emergency department of a tertiary hospital in Oman before the COVID-19 pandemic. Methods: We retrospectively reviewed the hospital records of all patients aged ≥ 15 years admitted to the emergency department with hypoglycemia (random blood glucose level ≤ 3.9 mmol/L) between January 2010 and January 2017. Results: A total of 242 patients were admitted with hypoglycemia, with an incidence increasing from 3.31 to 5.25 per 10 000 individuals during the study period. Non-diabetic patients exhibited significantly higher rates of abnormal heart rates compared to those with diabetes (p = 0.010). Non-diabetics were more likely to have liver disease, liver cirrhosis, malignancies, exposure to drugs/toxins, and infections (p < 0.050), while diabetic patients had significantly higher rates of cerebrovascular diseases (p < 0.050). To manage hypoglycemia, intravenous dextrose was administered significantly more for patients with diabetes compared to non-diabetics (p = 0.015). In the study cohort, glucagon was administered to only one patient. Conclusions: The incidence of hypoglycemia presentations increased during the study period. Intravenous dextrose was the primary management approach for diabetic patients, and glucagon use was minimal. Further investigation is required to decipher the hypoglycemia trends in the post-pandemic period.

Keywords:Diabetes Mellitus; Type 2 Diabetes; Hypoglycemia; Emergency Department; Glucagon; Oman.

Objectives: The aim of the study was to assess morbidity and mortality outcomes using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) scores in patients undergoing emergency gastrointestinal surgeries, and to compare the capabilities of POSSUM and P-POSSUM models in predicting mortality and morbidity. Methods: In this prospective observational study, participants were selected from patients undergoing emergency gastrointestinal surgery at our hospital. The physiological component of POSSUM and P-POSSUM scores was calculated preoperatively, while the operative component was determined intraoperatively. Results: A total of 45 patients were included in the study, with a mean age of 37.9 ± 15.7 years. The male-female ratio was 1.5:1.0. Intestinal perforation was the most common diagnosis (15; 33.3%) that necessitated exploratory laparotomy. The cutoff of POSSUM morbidity score of 87.5% had a sensitivity of 83.3% and a specificity of 92.6%, while the cutoff P-POSSUM morbidity score of 88.6% yielded a sensitivity of 88.9% and a specificity of 96.3%. Regarding mortality prediction, the cutoff POSSUM mortality score of 56.7% had a sensitivity of 87.5% and a specificity of 94.6%, while a P-POSSUM mortality cutoff score of 22.7% had a sensitivity of 100% and a specificity of 81.1%. Conclusions: Both POSSUM and P-POSSUM scores demonstrated significant sensitivity and specificity in predicting morbidity and mortality in patients undergoing emergency gastrointestinal surgeries. They can be effectively utilized for risk assessment in clinical practice.

Keywords:Severity of Illness Index; Risk Assessment; Surgical Procedures, Operative; Gastrointestinal Tract; Outcome; Prediction; Score; India.

Objectives: Beckwith-Wiedemann syndrome (BWS) is a rare genetic and cancer-predisposing disorder characterized by variable clinical and molecular abnormalities. It is considered a spectrum ranging from classical BWS to isolated hemihyperplasia (IHH). This study sought to characterize Omani patients with BWS and IHH clinically and molecularly, evaluate their surveillance results, and assess the tumor's prevalence in the cohort. Methods: Nine patients with BWS were retrospectively recruited to the study by searching the medical records of Sultan Qaboos University Hospital between January 2012 and December 2022. Demographics, clinical features, molecular findings, and surveillance test results, including abdominal ultrasound and alpha-fetoprotein, were extracted from the hospital information system and systematically analyzed. Results: Nine patients diagnosed with Beckwith-Wiedemann syndrome were studied, comprising four BWS cases and five IHH cases. Macroglossia was the predominant clinical feature among BWS patients, whereas lateralized overgrowth was consistently observed in IHH patients. All BWS patients tested positive for methylation anomalies: two exhibited loss of methylation at imprinting control 2 (22.2%), one had paternal uniparental disomy of chromosome 11 (11.1%), and another showed a gain of methylation at imprinting control 1 (11.1%). Throughout the surveillance period, none of the patients showed elevated alpha-fetoprotein levels or developed tumors. Conclusions: This is the first study to examine a cohort of patients with BW spectrum in Oman. It reveals comparable clinical and molecular characteristics to the previously reported BWS patients, yet no tumors were detected in this cohort.

Keywords:Beckwith-Wiedemann Syndrome; Hemihyperplasia, Isolated; Methylation; Alpha-Fetoproteins.

Objectives: Transcription factor 7-like 2 (TCF7L2) has emerged as a promising candidate gene associated with type 2 diabetes mellitus (T2DM), and the intronic variant rs12255372 of the TCF7L2 gene has demonstrated a robust association with T2DM across various ethnic groups. We sought to determine the frequency of rs12255372 polymorphism in the Bangladeshi adult population, both with and without T2DM. Methods: This cross-sectional study was conducted in the Endocrinology Department of Bangabandhu Sheikh Mujib Medical University. Eighty patients with T2DM and 80 normoglycemic controls were included in the study. The rs12255372 polymorphism was genotyped using the polymerase chain reaction-restriction fragment length polymorphism technique. Results: An allelic odds ratio (OR) of 3.29 (95% CI: 1.78–6.05; p < 0.001) was found for the minor T allele of rs12255372, significantly increasing the T2DM risk. A significant difference in TT and GT genotypes was noted between participants with T2DM (OR = 5.26, 95% CI: 1.39–19.9; p = 0.008) and normoglycemic controls (OR = 3.00, 95% CI: 1.33–6.75; p = 0.007), respectively. The dominant model appears to be the most suitable for representing the susceptibility gene effect. Conclusions: The frequency of the minor T allele of rs12255372 was about one-fourth and one-tenth among patients with T2DM and normoglycemic controls, respectively, indicating that this polymorphism may be associated with the risk of developing T2D in the studied population.

Keywords:Diabetes Mellitus; Mutation; TCF7L2.

Objectives: To assess treatment initiatives in symptomatic and asymptomatic urinary tract infection (UTI) cases, identify effective antibiotics based on culture reports, and evaluate secondary factors such as symptoms, urine white blood cells, culture correlation, prevalent microbial flora, empirical antibiotic efficacy, and prevalence of multidrug resistance (MDR). Methods: A retrospective analysis of urological cases with microbial growth on culture was conducted. Data on demographics, symptoms, urinalysis, culture analysis, antibiotic sensitivity, and MDR status were collected and statistically analyzed. Results: Out of 223 cases included in the study, 191 were symptomatic and 32 were asymptomatic. Escherichia coli was the most common pathogenic organism (55.6%). Nitrofurantoin exhibited high efficacy (75.4% in symptomatic and 78.1% in asymptomatic patients), with no significant difference between the two groups in MDR bacteria prevalence (p = 0.377) or positive follow-up cultures (p = 0.687). Conclusions: Nitrofurantoin was highly effective for UTIs; however, multidrug-resistant strains remain a concern. With limited access to minimum inhibitory concentration results and culture sensitivity tests during the initial patient visit, physicians prescribing first-line treatments for suspected cases of resistance must carefully evaluate clinical presentation, patient history, and local resistance patterns. Subsequent treatments should be based on culture sensitivity results and clinical guidelines. This study is particularly relevant in the Gulf Cooperation Council region due to its distinct epidemiological and clinical landscape.

Keywords:Urinary Tract Infection; Antimicrobial Resistance; Culture Sensitivity; Multidrug-Resistant; Antibiotic Stewardship; Oman.

Objectives: We sought to compare the epidemiological and clinical features of variant leiomyoma, smooth muscle tumors of uncertain malignant potential (STUMP), and sarcoma to classical leiomyoma and assess the radio-histological correlation.Methods: This retrospective, observational study was conducted in Royal Hospital, Muscat, Oman. We included all patients who underwent surgical treatment for uterine fibroids from 1 January 2011 to 31 December 2016. Data was retrospectively collected from electronic patient records, pictures archiving system, and histopathology reports, and analyzed using SPSS version 29 and MedCalc Statistical Software. Results: Out of the 14269 patients who attended the gynecology outpatient department, 19.5% were clinically diagnosed with uterine fibroids. Surgical procedures were performed in 545 (19.6%) women. Diagnosis from histopathology reports was classical leiomyoma in 508 (93.2%) cases, variant leiomyoma in 35 (6.4%), and sarcomas in two (0.4%); there were no cases of STUMP. Magnetic resonance imaging (MRI) correctly identified 125 (89.9%) cases of classical leiomyoma and 2/11 (18.2%) cases of variants. The sensitivity and specificity of MRI to predict non-classical varieties was 22.22% and 88.65%, respectively. MRI had a strong negative predictive value (94.7%) for leiomyoma variants. The area under the curve for classical and variant leiomyoma was 0.63 (0.55–0.71) and 0.55 (0.47–0.64). The accuracy of MRI in predicting classical leiomyoma was 86.00 (79.40–91.12) and 84.67 (77.87–90.03) the non-classical varieties. Conclusions: Epidemiological and clinical features were not helpful in distinguishing between classical leiomyoma and non-classical varieties. MRI had weak discriminatory power to distinguish between classical and non-classical varieties.

Keywords:Leiomyoma; Magnetic Resonance Imaging; Oman.

Objectives: To evaluate the efficacy and safety of umifenovir as a potential antiviral therapy for COVID-19; specifically, to determine whether umifenovir improves clinical outcomes, reduces hospitalization duration, and enhances recovery rates in patients diagnosed with COVID-19 compared to standard care. Methods: In this multicenter, open-label, randomized controlled trial, 260 patients diagnosed with COVID-19 were randomly assigned to receive either umifenovir (200 mg every six hours for seven days) or standard care. The primary outcome was clinical improvement, assessed via the National Early Warning Score 2 system, while secondary outcomes included changes in computed tomography scan scores, length of hospital stay, intensive care unit admission rates, and mortality. Results: Of the 260 patients enrolled, 193 completed the study. Both groups showed significant reductions in clinical symptoms, although myalgia was more prevalent in the umifenovir group. The intervention group demonstrated a significant decrease in computed tomography scan scores; however, no significant differences were observed between groups regarding in hospital stay duration, intensive care unit admissions, or mortality rates. Conclusions: While umifenovir exhibited some immunological benefits in COVID-19 patients, it did not significantly improve broader patient-important outcomes compared to standard care. Therefore, its routine use in clinical practice for COVID-19 treatment is currently not justified, highlighting the need for further research to explore alternative therapeutic strategies.

Keywords:COVID-19; Antiviral Therapy; Umifenovir; Randomized Controlled Trial; Clinical Outcomes; Iran.

Objectives: Obesity poses a significant challenge worldwide, increasing the risk of various metabolic diseases, including type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia. Bariatric surgery, specifically a laparoscopic sleeve gastrectomy (LSG), is effective in inducing weight loss, thereby improving the rate of obesity-related metabolic diseases. This study aimed to assess the short-term effectiveness and metabolic effects of LSG procedures among patients in Oman. Methods: This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, and included patients who underwent LSG between 1 January 2017 and 31 December 2018. Demographic, clinical, and anthropometric data were collected from the hospital’s computerized records preoperatively and one year postoperatively. Results: A total of 168 patients were included in the study, of whom most were female (66.1%). Before surgery, the mean age was 36.1 years, and the mean body mass index (BMI) was 50.8 kg/m2. In terms of comorbidities, 28.6% had T2DM, 28.6% had HTN, and 20.8% had dyslipidemia. Postoperatively, more than two-thirds of the cohort (n = 132; 78.6%) achieved a target percent excess weight loss (EWL) of > 50%, including 89.5% and 73.0% of male and female patients, respectively (p = 0.014). The percent EWL was positively correlated to preoperative BMI (p < 0.001); however, no significant associations were observed with various comorbidities, including HTN, T2DM, dyslipidemia, and obstructive sleep apnea (p > 0.050). Conclusions: The results of this study indicate that LSG is effective for the short-term achievement of percent EWL among Omani patients with morbid obesity. However, further studies are needed to assess the long-term effectiveness of LSG on percent EWL and its effect on obesity-related metabolic diseases.

Keywords:Obesity, Morbid; Body Mass Index; Diabetes Mellitus, Type 2; Retrospective Studies; Bariatric Surgery; Treatment Outcome; Hypertension; Dyslipidemias; Weight Loss; Oman.

Cases of small bowel obstruction in the virgin abdomen are rare and can pose diagnostic challenges, especially when associated with endocrinopathy. We present a young woman with uncontrolled Graves’ disease who was admitted with a small bowel obstruction in a virgin abdomen a few weeks after developing a thyroid storm.

Keywords:Hyperthyroidism; Thyroid disease; Pseudointestinal Obstruction Syndrome; Oman.

Pericardial-pleural fistula (PPF) may complicate between 0.8–6% of echocardiography-guided pericardiocentesis procedures, but reports are sporadic. A 22-year-old male presented to the general medical ward with underlying end-stage renal disease complicated by secondary hyperparathyroidism with worsening left pleuritic chest pain and shortness of breath for one week. Ultrasonographic investigations revealed global pericardial effusion, with no pleural effusion initially. After echocardiographic-guided pericardiocentesis via the apical approach, the patient developed respiratory distress. Follow-up ultrasound revealed a new pleural effusion with resolved pericardial effusion. The patient recovered with drainage of the pleural effusion. Bacterial and tuberculous cultures were negative, and fluid cytology was benign. Hyperparathyroidism may have contributed to the increased risk of PPF due to pericardial calcification. Clinicians should be aware of the potential risk of PPF after pericardiocentesis in patients with hyperparathyroidism.

Keywords:Pericardial Effusion; Fistula; Hyperparathyroidism.

The artery of Percheron is a rare anatomical variant artery that supplies the bilateral thalami and midbrain. An acute occlusion of the vessel will lead to the presentation of a bilateral thalamic stroke syndrome. The classical presentation includes somnolence and a reduced level of consciousness. Therefore, this clinical entity often goes unrecognized and diagnoses are usually delayed due to the ambiguity of presenting symptoms. We report a case of a man presenting with an acute onset of drowsiness, later diagnosed with a bilateral thalamic infarct only days later due to the vague clinical symptoms. We also highlighted several key learning points from this case and emphasized the importance of recognizing this syndrome.

Keywords:Artery of Percheron; Bilateral Thalamic Stroke; Confusion; Magnetic Resonance Imaging.

Primary squamous cell carcinoma (SCC) of the renal parenchyma without a history of urolithiasis is a rare entity. Renal SCC is usually associated with other conditions like renal stone disease, chronic inflammation, and infection. We report three cases of primary SCC with no history of renal stone disease or identifiable risk factors. We also present a current review of the literature and a detailed description of the morphological features.

Keywords:Kidney; Carcinoma, Squamous Cell; Oman.

Carcinoid tumors are slow-growing tumors that typically occur in the gastrointestinal (GI) tract, lungs, and other endocrine glands. They are commonly discovered incidentally and usually cause no symptoms. When symptomatic, they tend to present with vague abdominal pain and may lead to carcinoid syndrome after metastasis to the liver. Such tumors rarely present with GI bleeding and thus rarely lead to iron deficiency anemia. In this report, we present an uncommon case of a 71-year-old male who presented with fatigue, weakness, intermittent rectal bleeding, and black stools. He was vitally stable but cachectic. Laboratory studies revealed iron deficiency anemia of unknown origin. Initially, a colonoscopy was performed, which only revealed internal hemorrhoids, so an upper endoscopy was scheduled. Upper GI endoscopy revealed a bleeding duodenal nodule in the upper half of the duodenum that was biopsied. Immunohistochemistry revealed a duodenal carcinoid tumor. The lesion was resected endoscopically as the patient was unfit for surgery due to concurrent comorbidities. Abdominal imaging showed no signs of liver metastasis. The patient was followed periodically by the gastroenterology clinic to ensure no recurrence or metastasis, but he eventually succumbed to other comorbidities. This case highlights the challenges in diagnosing and managing this rare presentation in a significantly ill patient with multiple comorbidities. Upon reviewing the literature, we found that it was uncommon for carcinoid tumors of the GI tract to present with bleeding or anemia. Of those reported in the literature to have caused bleeding, the majority were in the stomach or ileum. To the best of our knowledge, this is the first reported case of a duodenal carcinoid tumor presenting with iron deficiency anemia.

Keywords:Carcinoid Tumors; Gastrointestinal Tract; Endoscopy.

Hemangiolymphangioma is a rare malformation of the vascular and lymphatic system affecting different parts of the human body. Hemangiolymphangioma of the small bowel mesentery is extremely rare. We report the case of a 23-year-old woman who presented with generalized colicky abdominal pain. Computed tomography findings were initially thought to represent possible secondary mesenteric and peritoneal metastatic deposits. However, no primary tumor was identified. A pelvic magnetic resonance imaging was then performed, which favored the diagnosis of extensive mesenteric lymphangiomatosis. The diagnosis was confirmed histopathologically as hemangiolymphangioma of the small bowel mesentery.

Keywords:Lymphangioma; Mesentery; Mesenteric Cyst; Small Intestine; Oman.