Systemic Lupus Erythematosus with Severe Nephritis That Mimicked Henoch-Schoenlein Purpura

Introduction: Systemic lupus erythematosus (SLE) belongs to a family of related autoimmune rheumatic disorders that are capable of affecting multiple organs, and they are all associated with a variety of autoantibodies. Henoch Schoenlein purpura (HSP) is a sort of systemic vasculitis that is not associated with auto-antibodies and can affect different organs including the kidneys. Case report: A 12 year-old girl presented with abdominal pain, low grade fever, swollen and tender feet and left hand, skin rash on the lower extremities, and high blood pressure. Initial laboratory tests revealed severe proteinuria, microscopic hematuria and low C3 level. Renal biopsy showed diffuse proliferative glomerulonephritis with IgA, fibrinogen and C3 deposits. The case was accordingly diagnosed as HSP with severe IgA nephropathy. Treatment was started with mycophenolate mofetil (MMF) and pulse methylprednisolone followed by prednisolone. The patient improved and treatment was discontinued after 5.5 months. One month after withdrawal of her medications, the patient presented again with serositis and recurrent proteinuria. Both antinuclear antibodies (ANA) and anti dsDNA were positive. At this point she was diagnosed to have SLE disease and immunosuppressive treatment was restarted. Following this, symptoms disappeared, proteinuria regressed and anti-dsDNA titer dropped. Conclusion: This case presented with features of HSP and was later-on diagnosed to have SLE. This kind of clinical overlapping has not been reported in the literature to the best of our knowledge.Keywords: Henoch-Schoenlein Purpura; Nephritis; Systemic Lupus Erythematosu

Jurisprudential and Legal Perspectives on the Protection of Rights and Freedoms in the 2021 Basic Statute of the Sultanate of Oman

In this paper, we examine the constitutional protection of economic rights and freedoms in the Basic Statute of the Sultanate of Oman. Through descriptive, analytical, and historical approaches, the study identifies the protection and mechanisms for attaining social justice according to the Basic Statute to achieve Omans 2040 vision. The study concludes that courts must refrain from applying laws that violate the Basic Statute, and that weak guarantees of economic and social rights and freedoms hinder their protection and prevent the achievement of Oman Vision 2040. The study recommends spreading a culture of human rights and education on economic, social, and cultural rights, as well as adhering to international human rights conventions and covenants ratified by Oman

Dental and Anaesthetic Challenges in a Patient with Dystrophic Epidermolysis Bullosa

Epidermolysis bullosa is a group of rare genetic disorders characterised by skin and mucous membrane fragility and systemic manifestations of variable severity. We report a case of dystrophic epidermolysis bullosa in an 18-year-old male patient who presented to the Department of Oral Health at Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with recurrent dental pain and infections. Due to the poor dental status of the patient and anticipated operative difficulties due to microstomia and limited mouth opening, the patient underwent full dental clearance under general anaesthesia. This article discusses the dental and anaesthetic challenges encountered during the management of this patient and provides a brief literature review

Protective effect of small molecule analogues of the Acanthocheilonema viteae secreted product ES-62 on oxazolone-induced ear inflammation

ES-62 is the major secreted protein of the rodent filarial nematode Acanthocheilonema viteae. The molecule contains covalently attached phosphorylcholine (PC) residues, which confer anti-inflammatory properties on ES-62, underpinning the idea that drugs based on this active moiety may have therapeutic potential in human diseases associated with aberrant inflammation. Here we demonstrate that two synthetic small molecule analogues (SMAs) of ES-62 termed SMA 11a and SMA 12b are protective in the oxazolone-induced acute allergic contact dermatitis mouse model of skin inflammation, as measured by a significant reduction in ear inflammation following their administration before oxazolone sensitisation and before oxazolone challenge. Furthermore, it was found that when tested, 12b was effective at reducing ear swelling even when first administered before challenge. Histological analysis of the ears showed elevated cellular infiltration and collagen deposition in oxazolone-treated mice both of which were reduced by treatment with the two SMAs. Likewise, the oxazolone-induced increase in IFNγ mRNA in the ears was reduced but no effect on other cytokines investigated was observed. Finally, no influence on the mast cell populations in the ear was observed

Comparative analysis of maternal and neonatal outcomes between elective and emergency caesarean section at a single tertiary hospital: a retrospective COHORT study

Background: Caesarean section rates have been increasing worldwide despite it’s known complications. The aim of this study was to determine maternal and neonatal complications related to caesarean section at Sultan Qaboos University Hospital (SQUH) and to compare the outcomes between emergency and elective caesarean sections. Methods: This retrospective cohort study was conducted in the department of obstetrics and gynecology at SQUH from 1st January 2016 to 31st December 2016. This comparative study involved 300 women who underwent caesarean section, 150 in elective caesarean section group and 150 in emergency caesarean section group. Results: The mean maternal age was 29.66 (±4.96) and 33.22 (±4.63) years in the elective and emergency caesarean section groups respectively (p=001). The main risk factor for both the groups was maternal diabetes and the most common indication was previous caesarean section. Hypotension related anesthetic complication was noted more in elective caesarean section (15.3%) than in emergency caesarean section group (4.0%) with p value=0.002. Post-partum fever was seen in 12.0% of women in emergency group as compared to 4% in elective group (p=0.019). Anemia was observed in 79.2% and 65.3% in emergency and elective groups respectively (p=0.011). Respiratory distress syndrome and transient tachypnea of the newborn were the main neonatal complications in both groups. Conclusions: There was no significant difference between emergency and elective caesarean section related maternal and neonatal complications except for transient intraoperative hypotension, maternal postoperative febrile morbidity and anemia. Future prospective studies including larger sample size and multiple centers is recommended.

Giant Mediastinal Myxoid Pleomorphic Liposarcoma

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Managing the Adverse Events Associated with the Combination Pembrolizumab and Lenvatinib Therapy in Endometrial Cancer

Endometrial cancer (EC) is the most common gynecological cancer. The combination of lenvatinib plus pembrolizumab has exhibited efficacy as the second line treatment for advanced EC, with a significant benefit in terms of progression free survival (PFS) and overall survival (OS), but the adverse effects (AE) profile is complex. AEs associated with the treatment may represent a limitation to this combination. Here, we report the case of a 38-year-old lady diagnosed with stage IV EC elsewhere, whose disease progressed after the first line of treatment, and was referred to our center in 2021. We treated her with the combination of lenvatinib and pembrolizumab. During the course of the treatment. she developed hand- foot syndrome (HFS) grade III, and hypothyroidism grade II. The AEs were managed with supportive medications, dose interruptions, dose reductions, and multidisciplinary care, which allowed us to continue the treatment. The patient achieved a good partial response, and an ongoing PFS of more than 12 months. Keywords: cancer, endometrial, lenvatinib, pembrolizumab, adverse drug events, hand foot syndrome, hypothyroidism, Oman

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Objective: To estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in the Sultanate of Oman. Methods: A cross-sectional retrospective study was conducted. All patients who presented to the emergency department at two public hospitals and underwent primary percutaneous interventions during the period of two years were included. Results: The sample included 426 patients. The median door-to-balloon time was 142 minutes. The result of bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were three times more likely to have a delayed DTB time compared with patients presenting with typical symptoms (OR = 3.003, 95% CI: 1.409–6.400, p = .004). In addition, patients who presented during off-hours were two times more likely to have a delayed DTB time compared with patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087, p = .005). Conclusion: To meet the door-to-balloon time recommendation, it is important to ensure that there is adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care. Keywords: Acute Myocardial Infarction; Clinical Management; Door-to-balloon Time; Emergency Care Systems; Staffing and Scheduling; Oman

Telenomus nizwaensis (Hymenoptera : Scelionidae), an important egg parasitoid of the pomegranate butterfly Deudorix livia Klug (Lepidoptera: Lycaenidae) in Oman

The pomegranate butterfly Deudorix (= Virachola) livia is the major pest of pomegranate, a crop of economic importance, in Oman. A species of parasitoid wasp in the hymenopteran family Scelionidae is responsible for high levels of mortality of its eggs. This wasp is described herein as Telenomus nizwaensis Polaszek sp. n., based on morphology and DNA sequence data. T. nizwaensis is currently known only from D. livia, which is also a pest of economic importance on other crops in North Africa, the Arabian Peninsula, and the Mediterranean. We summarise current knowledge of T. nizwaensis life-history and its potential to provide biological pest control.Peer reviewe