Entrapment neuropathy is the result of pressure on a peripheral nerve as it passes through a narrow canal that is bounded by stiff tissues. In spite of their ubiquitous nature, they are underdiagnosed, underreported, and sometimes not properly managed, especially in developing countries. Entrapment neuropathies are of various types, but the most common type is carpal tunnel syndrome. Mechanisms involved in the pathophysiology of entrapment neuropathies include mechanical compression and nerve ischemia. A clear understanding of the various types and the underlying mechanisms of entrapment neuropathies are invaluable in the decision-making process involved in the management of every patient with the condition.

Objectives: We sought to determine the characteristics of women eligible for a high-yield screening mammography program in Oman. Methods: We conducted a retrospective review of women who underwent breast cancer screening at the Oman Cancer Association from 22 December 2009 to 6 February 2011. Women with a Breast Imaging Reporting and Data System (BI-RADS) score of 4–5 were compared with those with a score of 1–3 based on well-known breast cancer risk factors using the case-control approach analysis. Results: A BI-RADS score of 4–5 was found in 16.2% of women screened for breast cancer. A higher likelihood of a BI-RADS score of 4 or 5 was observed among women who did not breastfeed (odds ratio (OR) = 2.564; 95% confidence interval (CI): 1.690, 3.890), had their first pregnancy at an older age (OR = 1.062; 95% CI: 1.041, 1.083), used oral contraceptives (OR = 1.397; 95% CI: 1.008, 1.938), and those who reported a positive family history of malignancies (OR = 1.633; 95% CI: 1.285, 2.076). A BI-RADS score of 4 or 5 was significantly less likely in women with a higher number of full-term pregnancies (OR = 0.919; 95% CI: 0.890, 0.948). BI-RADS 4–5 were independently predicted in women with a lower number of full-term pregnancies, did not breastfeed, used oral contraceptives, and who had a positive family history of malignancies. These variables explained 84.0% of the variation in mammogram results. Conclusions: In the absence of a national screening program for breast cancer, the high-risk approach for screening should be considered. Women with the above characteristics should be identified and motivated to seek mammogram regularly to warrant a better outcome.

Objectives: To determine the characteristics of patients presenting with chronic pain in a primary health care setting in Oman. Methods: A retrospective cross-sectional study was carried out including all patients aged ≥ 18 years who attended Sultan Qaboos University Health Center during 2010. Patients were identified to have chronic pain if they were prescribed an analgesic medication for at least three months. Patients were compared to a control group which consisted of age- and gender-matched patients with no chronic pain. Results: Out of 6 609 patients, 241 (3.6%) were found to have chronic pain. The mean age of patients with chronic pain was 54.0±13.0 years. The majority of patients were female (n = 174; 72.1%), and most were Omani (n = 201; 83.4%). The prevalence of chronic pain was found to be significantly higher among females compared to males (4.5% vs. 2.5%; p < 0.001) and also among Omani nationals to non-nationals (83.4% vs. 70.1%; p < 0.001). Chronic pain was significantly associated with the following comorbidities; diabetes (33.1% vs. 20.7%; p < 0.001), obesity (35.2% vs. 26.5%; p = 0.001), and hypertension (51.0% vs. 38.5%; p = 0.002). Osteoarthritis was the most common pain condition (n = 104; 43.1%). Diclofenac was the most commonly prescribed drug (n = 168; 69.7%). Conclusions: The findings of our study point towards a higher prevalence of chronic pain in Omani females. These patients were also found to have a higher prevalence of other common comorbid conditions.

Objectives: The use of growth hormone (GH) in idiopathic short stature (ISS) has been a subject of debate for the past two decades. We sought to assess the effect of GH on final height (FH) in patients with ISS in our region, which has a high consanguinity rate, and compare it to the effect observed in GH deficient (GHD) patients. Methods: We conducted a retrospective chart review from 1 January 2005 to 31 December 2013 for patients with ISS or GHD from the local United Arab Emirates population who received GH treatment and were followed-up regularly in our clinic. The change in height Z-score at 12 months and FH were assessed within each group and between the two groups. Results: Twenty-one patients with ISS and 29 patients with GHD were studied. There was a significant change in height Z-score at 12 months and FH in both groups (p < 0.001). The improvement in the ISS group was comparable to the response seen in GHD patients at 12 months (0.5±0.3 standard deviation score (SDS), and 0.5±0.4 SDS, respectively; p = 0.540). The effect on FH was better in ISS group than the GHD group of all etiologies (1.3±0.6 SDS vs. 0.9±0.7 SDS, respectively; p = 0.050), there was no difference between the ISS and the subgroup of idiopathic GHD (1.3±0.5 SDS and 1.2±0.8 SDS, respectively). Conclusions: In our local population, GH has a positive effect on the short-term growth and FH of children with ISS to the same extent that has been observed in children with idiopathic GH deficiency.

Objectives: Immunization coverage in Nigeria remains low despite the protection it confers. Reminders via mobile phones may be deployed as a means of improving vaccination coverage but requires the participation and cooperation of the caregiver. Therefore, we evaluated the acceptability of reminders for immunization appointment by mothers in Ilorin, Nigeria. Methods: This descriptive cross-sectional study recruited 526 mothers from two public hospitals in Ilorin. Semi-structured questionnaires were used to collect information on ownership and access to phones, willingness to receive reminders, household, antenatal, and delivery characteristics. Results: The majority (92.7%) of mothers had a personal phone, and all willingly provided contact details. Over half (69.0%) of mothers were willing to receive reminders. Postsecondary education (odds ratio (OR) = 1.958; 95% confidence interval (CI): 1.232–3.111) and antenatal care attendance by mothers (OR = 8.381; 95% CI: 2.495–28.170) were significant determinants of mothers willingness to receive reminders. Mothers with less than or equal to four children had a three-fold increased odds of wanting reminders. Artisan mothers were less likely to want reminders compared with unemployed mothers (OR = 0.506; 95% CI: 0.291–0.847). Conclusions: Most mothers are willing to receive reminders on immunization appointments via their mobile phone. Determinants of maternal willingness to receive reminders include mothers with less than four children, postsecondary education, and antenatal care attendance. Program planners should consider utilizing reminders as a strategy to increase the immunization uptake with access to contact details making this feasible.

Objectives: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality around the world. Preliminary studies have evaluated the association between innate immunity including Toll-like receptors (TLRs) and airway samples of patients with COPD. The role of TLRs in peripheral blood neutrophils is poorly understood. Hence, this study aimed to investigate the role of TLR2 and TLR4 in peripheral blood neutrophils of COPD patients. Methods: A total of 101 COPD cases and an equal number of healthy controls participated in this case-control study. Peripheral blood neutrophils were isolated from all participants and cultured for 24 hours through lipopolysaccharide (LPS) stimulation. The gene expressions of TLR2 and TLR4 were assessed by real-time polymerase chain reaction. The protein levels of interleukin (IL)-8 and matrix metalloproteinase (MMP)-9 were measured in neutrophils cell culture supernatants using enzyme-linked immunosorbent assay (ELISA). Results: The levels of IL-8 and MMP-9 were significantly higher in patients with COPD compared to healthy controls. Similarly, the gene expression of TLR2 and TLR4 were increased in LPS stimulated peripheral blood neutrophils of patients with COPD. Smoke pack years was positively correlated with IL-8 levels and negatively correlated with forced expiratory volume in the first second % (r = -0.33; p = 0.023) and FEV1/forced vital capacity (FVC) (r = -0.27; p = 0.011). Conclusions: The increased expression of TLR2 and TLR4 suggests its role in disease pathogenesis of COPD. Smoke pack years was negatively associated with spirometric parameters in COPD patients. This may help to predict the smokers without COPD who risk developing the condition in the future.

Objectives: Toxoplasma gondii (T. gondii) is a serious public health issue, but limited data has been published to date on the seroprevalence of T. gondii infection in Saudi Arabia. Therefore, this study aimed to establish the seroprevalence and risk factors of T. gondii infection using a sample of females enrolled at a university in Northern Saudi Arabia. Methods: Using a cross-sectional research approach, we recruited a convenience sample of 180 healthy females studying at the University of Tabuk between February and June 2016. We used a questionnaire to gather sociodemographic data on the participants to establish the risk factors leading to exposure to toxoplasma. Blood samples were taken from the participants and analyzed to detect T. gondii antibodies (immunoglobulin M and immunoglobulin G) via the enzyme-linked immunosorbent assay technique. Multivariate logistic regression modeling was employed to establish the potential predictor variables for T. gondii infection. Results: Of the 180 participants, 17 (9.4%) were seropositive for T. gondii IgG. None tested positive for IgM antibodies exclusively. The sole variable positively associated with seropositive T. gondii IgG was the participants’ consumption of raw, unwashed fruit or vegetables (odds ratio = 3.36, 95% confidence interval: 1.11–10.22). Conclusions: Our findings emphasize the need for higher awareness of toxoplasmosis in Saudi Arabia, specifically knowledge of the way toxoplasma infection occurs so that women can more easily avoid it. Large-scale research is therefore required to inform the design of future public health interventions.

Objectives: To compare the feasibility and efficacy of the mini-resectoscope with the conventional resectoscope in terms of the operative, menstrual, and reproductive outcome in hysteroscopic adhesiolysis in infertile women. Methods: We conducted a parallel prospective randomized study at All India Institute of Medical Sciences, New Delhi. A total of 60 patients underwent hysteroscopic adhesiolysis using either conventional resectoscope (n = 30) or mini-resectoscope (n = 30). The primary outcome measures were pregnancy-related indicators. Secondary outcome measures were the operative parameters (cervical dilatation time, operation time, postoperative pain scores, fluid deficit, and preoperative and postoperative sodium levels), second-look hysteroscopy findings, and improvement in the menstrual pattern after surgery. Results: Cervical dilatation time and pain score 30 minutes after the procedure were significantly lower in the mini-resectoscope group. Out of the total 21 cases with hypomenorrhea, 12 cases (57.1%) started having normal menstrual flow postsurgery. All amenorrheic patients resumed menstruation after surgery. However, nine cases continued to have hypomenorrhea. Over long-term follow-up, 16 patients out of 60 had conceived (seven in the conventional resectoscope group and nine in the mini-resectoscope group). There were three ongoing pregnancies, three abortions, one ectopic pregnancy, and nine term pregnancies. The difference between the two groups was not statistically significant. Conclusions: The use of mini-resectoscope for hysteroscopic adhesiolysis is associated with reduced operative morbidity. Use of the mini-resectoscope is an effective and safe alternative to the conventional system.

Objectives: We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran. Methods: This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lin’s self-management questionnaire was completed at baseline and three months post-intervention. Results: Statistical analysis, including the use of independent t-test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization (t =11.24, p < 0.001), self-adjustment (t = 7.53, p < 0.001), interaction with health experts (t = 7.31, p < 0.001), blood sugar self-monitoring (t = 6.42, p < 0.001), adherence to the proposed diet (t = 5.22, p < 0.001), and total self-management (t = 10.82, p < 0.001) in the intervention group. Conclusions: Sharing experiences through group discussions and receiving instructive feedback can improve the ability to self-manage diabetes.

A ten-year-old boy presented to the hospital with body ache and joint pains for two months and headache, vomiting, and skin rash for three days. He was drowsy and lethargic at admission. Physical examination revealed bilateral papilledema. There were no cranial nerve involvement, neuromotor deficit, or signs of meningeal irritation. Computed tomography and magnetic resonance imaging of the brain did not reveal any evidence of cerebral edema or space occupying lesion. In view of the high endemicity of brucellosis in the area, Brucella agglutination test (BAT) was done at the time of admission and was negative. However, on the eighth day of admission, blood culture showed growth of Brucella melitensis. A repeat BAT at this time was strongly positive with a titer of 1:1 280. The initial one was negative due to prozone phenomenon caused by very high antibody titers. A diagnosis of neurobrucellosis with pseudotumor cerebri was made. He was treated with gentamicin, rifampicin, and septrin along with acetazolamide for raised intracranial pressure. The boy responded well to therapy and made a complete clinical recovery with resolution of papilledema. In areas endemic for brucellosis, a high index of suspicion for neurobrucellosis should be entertained in any child presenting with diverse neurological signs.

Separation of pubic symphysis during delivery is a rare complication resulting in considerable and prolonged morbidity for parturient women. The usual presentation is that of something giving way in the region of the symphysis pubis sometimes with an audible crack at the time of delivery. Unbearable pain on moving from side-to-side and on performing any weight-bearing activity (such as walking or climbing stairs) precludes ambulation in the immediate postpartum period. This could be accompanied by disruption of the sacroiliac joint, hemorrhage, or urine incontinence in severe cases. Radiography, ultrasound, and magnetic resonance imaging are the diagnostic modalities that aid confirmation of diagnosis. The magnitude of separation does not correlate well with the severity of symptoms. Treatment modalities range from conservative management (including analgesics, pelvic binders, transcutaneous nerve stimulation) and chiropractic management to orthopedic interventions such as external fixation or open reduction and internal fixation. Since postpartum pain is frequently dismissed as attributable to labor and childbirth, the diagnosis of pubic symphysis diastasis is often delayed and sometimes missed altogether. Since there is no consensus in the scientific literature on the definition, etiopathogenesis, and management of this rare complication, we attempted to review the literature on the subject and present a series of two cases.

Stridor presenting soon after birth due to bilateral abductor vocal cord paralysis (VCP) is rare. We report a family with bilateral VCP affecting four male members in two generations and hence suggesting X-linked recessive inheritance. Severe stridor in the neonatal period requires meticulous airway evaluation, and tracheostomy in 35–70% cases. The current trend is towards conservative management and tracheostomy is avoided unless respiratory distress is severe or life-threatening. Neonatal VCP can be an isolated finding, or it can be familial with or without syndromic features. There are very few reports of non-syndromic familial cases. Unlike the cases reported previously, none of our patients required prolonged intubation or tracheostomy suggesting an excellent prognosis in such cases. This is the first case study of congenital familial non-syndromic VCP reported from the Middle East.

Subcutaneous fat necrosis of the newborn (SCFNN) is a rare benign inflammatory disorder of the adipose tissue but may be complicated by hypercalcemia or less frequently, hypocalcemia, resulting in morbidity and mortality. Here we report the case of a neonate with subcutaneous fat necrosis who surprisingly developed hypocalcemia instead of hypercalcemia. A full-term female neonate was delivered by emergency cesarean section for fetal distress and was subsequently admitted to the Special Care Baby Unit. The mother’s pregnancy was uncomplicated up to delivery. Her anthropometric measurements were birth weight 4.1 kg (95th percentile), length 50 cm (50th percentile), and head circumference 34.5 cm (50th percentile). The Apgar scores were 2, 3, and 8 at 1, 5, 10 minutes, respectively. There was no abnormal facies and she was fed with breast milk only. On the seventh day of life, the infant was found to have multiple nodules located in the neck, upper back, and right arm. The nodules were firm, well circumscribed with no evidence of tenderness. Her total serum calcium level was 1.55 mmol/L (normal range 2.2 to 2.7 mmol/L) and this was associated with hypotonia and poor sucking reflex. The packed cell volume was 40%. The serum albumin and blood glucose levels were normal. Her blood culture was sterile. A clinical diagnosis of hypocalcemia associated with SCFNN was made. The infant was treated for hypocalcemia (using calcium gluconate) and was carefully followed-up. The skin lesions resolved completely three months after their eruption. Repeat serum calcium measurements at three, six, and nine months of age were all within normal limits. Although SCFNN is a rare benign clinical condition, it may be complicated by hypocalcemia. Therefore, periodic measurements of the serum calcium levels is warranted in such a patient, beginning from the neonatal period up to the age of six months.

Objectives: We sought to study the occurrence of portal vein thrombosis (PVT) in adult Omani patients. Methods: We conducted a retrospective cross-sectional study in patients diagnosed with PVT, which was confirmed by radiological imaging, from two tertiary hospitals over a 10-year period. Results: Amongst the 39 patients enrolled in the study, 15 (38.4%) had cirrhosis of the liver, and 24 (61.5%) were non-cirrhotic. In the non-cirrhotic PVT patients, 15 (62.5%) had acute PVT, whereas nine (37.5%) had chronic PVT. PVT was more common in males than females, (25 (64.1%) vs. 14 (35.8%), respectively, p = 0.020). The three most common clinical symptoms were abdominal pain (n = 25, 64.1%) followed by nausea (n = 12, 30.7%) and fever (n = 8, 20.5%) patients. Causative risk factors included prothrombotic states (17.9–28.2%) and local factors (20.5%) such as cholecystitis, cholangitis, and liver abscess. Complications were found in 23.0% of patients with PVT, namely variceal bleeding in seven patients (17.9%) patients and bowel ischemia in two patients (5.1%). Management with sclerotherapy was performed in all patients with variceal bleeding. Thrombectomy was done for one patient complicated with intestinal ischemia, but as it failed, he was treated with warfarin anticoagulation. Conclusions: This is the first study reflecting a real-life practice in PVT with possibly underlying inherited and acquired prothrombotic conditions as well as complications due to local and malignant conditions from Oman. We studied the prevalence, clinical presentation, underlying possible etiological factors, treatment, and outcomes. Since causative factors were found in 36 patients (92.3%), etiological screening seems worthwhile in every case with PVT, but thrombophilia screening may not be cost-effective.