A Cerebellar High-Grade Neuroepithelial Tumour with BCOR Alteration in a five-year-old Child: A case report.

New groups of high-grade neuroepithelial tumours (HGNET) have emerged from the reclassification of central nervous system (CNS) embryonal tumours that have recognised CNS HGNET with BCOR alteration (CNS HGNET-BCOR). We report a two-year, nine-month-old Omani boy who presented to the Royal Hospital, Muscat, Oman, in 2015 with subacute head tilting and neck pain. A well-defined cerebellar lesion was found and he was treated with standard chemoradiotherapy. After a relapse at the age of five years, molecular testing revealed a BCOR alteration. He was treated with further surgery and high-dose chemotherapy; unfortunately, he relapsed and died three years after he was diagnosed

Asthma Clinics in Primary Healthcare Centres in Oman: Do they make a difference?

Objectives: This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods: This retrospective crosssectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results: A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6–95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P <0.001), trigger factors (79% versus 16%; P <0.001) and a history of atopy (81% versus 17%; P <0.001), smoking (61% versus 7%; P <0.001), asthma exacerbations (73% versus 10%; P <0.001) or previous admissions (63% versus 10%; P <0.001). Furthermore, prescription rates of inhaled corticosteroids (72% versus 61%; P = 0.021) and short-acting β-agonists (93% versus 82%; P = 0.001) were significantly higher at ACs compared to GCs. Conclusion: Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs.Keywords: Asthma; Disease Management; Patient Compliance; Medical History Taking; Medical Records; Documentation; Oman

Atherosclerotic Carotid Artery Disease: Where to from the Emergency Room? A University Hospital Experience

Objective: Stroke is the second leading cause of death worldwide, with 5.5 million deaths attributed to this cause in 2016. Vascular intervention, including carotid endarterectomy and carotid artery stenting, play a major role in stroke prevention, especially if intervention is performed early after onset of symptoms. The aim of the paper was to define the role of vascular surgeons in ischemic stroke and hence improve referral patterns by drawing an algorithm for the referral process which could reduce time to intervention and optimize patient benefit from intervention. Methods: This retrospective study reviewed the symptomatic and asymptomatic patients with atherosclerotic disease of the carotid artery referred to the vascular surgery unit of our institution from April 2018 to March 2020, to examine factors influencing recognition of suitable candidates for intervention. Results: A total of 38 patients with ischemic stroke were recognized as having carotid artery stenosis and were referred to the vascular surgery service during the study period. Only 6 met the criteria for carotid endarterectomy; 4 underwent the procedure. Conclusions: Choice of patients for carotid endarterectomy involves multiple steps, with potential for missed opportunities. By involving a multidisciplinary team approach, the recommended protocol aims to lead to early and appropriate referral to a vascular surgeon or interventional radiologist resulting in increased and optimised intervention in stroke prevention. Keywords: Stroke, TIA, carotid, symptomatic, asymptomatic, referral, vascular, surgery, endarterectomy, stenting, referral

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Determination of an Aspergillus fumigatus-Specific Immunoglobulin G Reference Range in an Adult Omani Population

Objectives: The presence of abnormally high levels of Aspergillus fumigatus-specific immunoglobulin (Ig) G antibodies can serve as a diagnostic criterion for severe conditions like allergic bronchopulmonary and chronic pulmonary aspergillosis. This study aimed to determine a reference range of A. fumigatus-specific IgG levels within a healthy adult Omani population. Methods: This study took place during November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The sera of 125 healthy Omani blood donors were tested for A. fumigatus-specific IgG levels using an automated fluorescence enzyme immunoassay. Results: Initially, the data were not normally distributed; however, log transformation and the exclusion of four outliers resulted in an acceptable Gaussian distribution. The reference range was 2.0–68.7 mgA/L at the 2.5th and 97.5th percentiles, respectively, with 90% confidence intervals of 2.0–3.0 mgA/L and 48.0–76.0 mgA/L, respectively. Conclusion: The A. fumigatus-specific IgG reference range within a healthy adult Omani population was comparable to those reported in other populations

Determination of an Aspergillus fumigatus-Specific Immunoglobulin G Reference Range in an Adult Omani Population

Objectives: The presence of abnormally high levels of Aspergillus fumigatus-specific immunoglobulin (Ig) G antibodies can serve as a diagnostic criterion for severe conditions like allergic bronchopulmonary and chronic pulmonary aspergillosis. This study aimed to determine a reference range of A. fumigatus-specific IgG levels within a healthy adult Omani population. Methods: This study took place during November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The sera of 125 healthy Omani blood donors were tested for A. fumigatus-specific IgG levels using an automated fluorescence enzyme immunoassay. Results: Initially, the data were not normally distributed; however, log transformation and the exclusion of four outliers resulted in an acceptable Gaussian distribution. The reference range was 2.0–68.7 mgA/L at the 2.5th and 97.5th percentiles, respectively, with 90% confidence intervals of 2.0–3.0 mgA/L and 48.0–76.0 mgA/L, respectively. Conclusion: The A. fumigatus-specific IgG reference range within a healthy adult Omani population was comparable to those reported in other populations

The p53 Mutation/Deletion Profile in a Small Cohort of the Omani Population with Diffuse Large B-Cell Lymphoma

Objectives: Mutations/deletions affecting the TP53 gene are considered an independent marker predicting a poor prognosis for patients with diffuse large B-cell lymphoma (DLBCL). A cohort within a genetically isolated population was investigated for p53 mutation/deletion status. Methods:Deoxyribonucleic acid (DNA) samples were extracted from 23 paraffin-embedded blocks obtained from DLBCL patients, and subjected to polymerase chain reaction (PCR) amplification and sequencing of exons 4–9 of the p53 gene. Results: While 35% of patients analysed displayed allelic deletions (P&lt;0.01), immunohistochemical analysis revealed a mutation rate of 69.5%. It is noteworthy that the rate of p53 mutations/deletions in this small cohort was found to be higher than that previously reported in the literature. Interestingly, patients with p53 mutations displayed a better overall survival when compared to those without. The survival of patients treated with rituximab-containing combination chemotherapy was significantly better than those who did not receive rituximab (P &lt;0.05). Furthermore, a modelling analysis of the deleted form of p53 revealed a huge structural change affecting the DNA-binding domain. Conclusion: The TP53 mutation/deletion status plays a role in mechanism(s) ruling the pathogenesis of DLBCL and may be useful for stratifying patients into distinct prognostic subsets

Complementary and Alternative Medicine Use among Adults with Diabetes in Muscat Region, Oman

Objectives: The use of complementary and alternative medicine (CAM) for diabetes mellitus is becoming increasingly popular; however, little is known about the prevalence of CAM use in patients with diabetes mellitus in Oman. The objectives of this study were to estimate the prevalence of use of CAM among diabetic patients in Muscat region, Oman, and to determine the types of CAM used as well as to identify the demographic features influencing the use of CAM. Methods: The study was performed from May to August 2009 on diabetic patients from 4 health centres in Muscat region. A total of 146 patients were interviewed. Information was obtained on demographics, and the prevalence and pattern of use of CAM. Results: Sixty two (42%) of the participants used CAM for the treatment of diabetes. Thirty (48%) were satisfied about its use and 27 (43%) intend to use it again. The only types of CAM used by participants in this study were herbs (n = 49, 79%), and/or food supplements (n = 7, 11%). Family and friends (n = 47/62, 76%) and/or traditional healers (n = 19, 31%) were the main source of information on CAM in the treatment of diabetes. There was no significant correlation between demographic characteristics and the use of CAM for diabetes. Conclusion: CAM is used widely for diabetes in Muscat region, Oman. Patients have strong faith in CAM in terms of effectiveness. Doctors should recognise this and be prepared to talk more freely with patients about its use and potential side effects

A Cerebellar High-Grade Neuroepithelial Tumour with BCOR Alteration in a five-year-old Child: A case report.

New groups of high-grade neuroepithelial tumours (HGNET) have emerged from the reclassification of central nervous system (CNS) embryonal tumours that have recognised CNS HGNET with BCOR alteration (CNS HGNET-BCOR). We report a two-year, nine-month-old Omani boy who presented to the Royal Hospital, Muscat, Oman, in 2015 with subacute head tilting and neck pain. A well-defined cerebellar lesion was found and he was treated with standard chemoradiotherapy. After a relapse at the age of five years, molecular testing revealed a BCOR alteration. He was treated with further surgery and high-dose chemotherapy; unfortunately, he relapsed and died three years after he was diagnosed