Postprocedural Endophthalmitis or Postprocedural Intraocular Inflammation: A Diagnostic Conundrum

We experienced an atypical endophthalmitis occurring post consecutively performed in-office procedures; an intravitreal injection (IVI) of ranibizumab followed by an anterior chamber (AC) paracentesis performed twice in an eye with neovascular glaucoma (NVG). A 52-year-old diabetic male who was asymptomatic developed signs of endophthalmitis and decreased vision without pain in his left eye a few days post-IVI and AC paracentesis. The condition worsened after an initial vitreous tap and injection of antibiotics. Cultures of vitreous and aqueous samples were negative. Complete resolution occurred after a pars plana vitrectomy with IVI of antibiotics and steroid with removal of a dense “yellowish-brown” fibrinous plaque. The absence of pain, presence of a peculiar colored fibrin, mild-to-moderate vitritis without retinitis, negative cultures, and complete recovery despite the fulminant presentation; favor a diagnosis of inflammation over infection. We hypothesize that a micro-leak from a 26-gauge AC tap tract might have served as an entry port for 5% povidone-iodine from the ocular surface thus inciting inflammation. However, an exuberant inflammatory response that can be typically seen in NVG eyes after intraocular procedures cannot be excluded. Various causes of inflammation post-procedures, both toxic and nontoxic should be considered in atypical culture-negative fulminant endophthalmitis cases with good outcome posttreatment. Any minor ocular procedure may carry a risk of such complication. Patient counseling and care must be exercised in performing these procedures

Bilateral Ocular Ischaemic Syndrome—Rare Complication of Rhinocerebral Mucormycosis in an Omani Patient : Case report and literature review

Ocular ischaemic syndrome (OIS) is a relatively uncommon condition. Simultaneous bilateral involvement is even less common and has been reported in only 22% of all cases of OIS. It has variable clinical presentations, of which visual loss and ocular pain are the most common. It is believed to occur when there is a 90% or greater carotid artery obstruction. This syndrome is often associated with a number of systemic diseases including diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease. Only occasionally has it been described as a complication of rhinocerebral mucormycosis. We report an unusual case of bilateral OIS secondary to bilateral internal carotid artery thrombosis as a complication of invasive rhinocerebral mucormycosis. In addition, a review of clinical presentation, diagnostic work-up and treatment options for OIS is provided

Medical Tourism Abroad : A new challenge to Oman’s health system - Al Dakhilya region experience

Objectives: This study aimed to understand why people seek medical advice abroad given the trouble and expense this entails. The types of medical problems for which treatment abroad was sought, preferred destinations and satisfaction with the treatment were explored. A secondary aim was to give feedback to stakeholders in the health care system on how to handle this issue and meet the needs of the community. Methods: 45 patients who had recently travelled abroad for treatment were asked to complete a questionnaire or were interviewed by telephone. Results: 40 questionnaires were received. 68% of the respondents were male. Orthopaedic diseases were the most common conditions leading patients to seek treatment abroad. Thailand was the most popular destination followed by India (50% and 30% respectively). 85% of respondents went abroad for treatment only, 10% for treatment and tourism and 2.5% were healthy, but travelled abroad for a checkup. Interestingly, 15% of the participants went abroad without first seeking medical care locally. Out of those initially treated in Oman, 38.2% had no specific diagnosis and 38.2% had received treatment, but it was not effective. 73% of respondents obtained information on treatment abroad from a friend. The Internet and medical tourism offices were the least used sources of information. 15% of the patients experienced complications after their treatment abroad. Conclusion: Various facts about medical treatment abroad need to be disseminated to the public. This will necessitate greater effort in public health promotion and education. 

Use of Prophylactic Inferior Vena Cava Filters in Trauma

Venous thromboembolisms, specifically pulmonary embolisms (PEs), represent a significant burden on healthcare systems worldwide, particularly within the setting of trauma. According to the literature, PEs are the most common cause of in-hospital death; however, this condition can be prevented with a variety of prophylactic and therapeutic measures. This article aimed to examine current evidence on the use, indications for prophylaxis, outcomes and complications of prophylactic inferior vena cava filters in trauma patients

Infectious Endophthalmitis: Ongoing Challenges and New Prospectives

Endophthalmitis is a rare but potentially sight and organ-threatening ocular emergency characterized by marked intraocular inflammation. It can be categorized into two broad categories of exogenous and endogenous types. Exogenous endophthalmitis is caused by inoculation of the globe by either bacterial or fungal microorganisms from an external environment and most commonly occurs as a complication of intraocular surgeries or procedures and open globe injuries. Blurred vision and pain are the main symptoms, and gram-positive coagulase-negative organisms are the main etiology of exogenous endophthalmitis. Endogenous endophthalmitis is caused by the hematogenous spread of microorganisms from distant sites of the body into the globe. Both categories lead to subsequent intraocular inflammation and potentially severe visual and anatomical devastating consequences. In addition, they have different risk factors and causative microorganisms, and thus, require somehow different diagnostic and treatment approaches. In this review chapter, further review of infectious endophthalmitis in terms of risk factors, causative pathogens, clinical presentations, prognosis, prevention, and the latest therapeutic recommendations are discussed

Syringocystadenoma Papilliferum of the Upper Lip

Syringocystadenoma papilliferum (SCAP) is a rare skin tumour believed to arise from the apocrine or eccrine sweat glands. It appears predominantly in childhood, usually at birth. It is exceedingly rare for it to appear on the upper lip. We report a case of SCAP in a 10-year-old Omani girl who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in February 2012 with a non-tender, non-pruritic, solitary verrucous papule of 4 x 5 mm on the left side of the upper lip. It had been present since birth and had slowly been increasing in size over the years. It was occasionally associated with recurrent ulceration and bleeding and had previously been misdiagnosed and mismanaged. An excisional biopsy was performed and the whole lesion was removed. The surgical site was then sutured and the patient was discharged on the same day

A Turning Point for Paediatric Developmental Services in Oman : Establishment of a national autism screening programme

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Clinical and Autoimmune Profiles of Omani Patients with True Versus False Positive Autoimmune Encephalitis Antibodies Panels

The incidence of autoimmune encephalitis (AE) is rising due to increased awareness of the condition and detection of new autoantibodies. Coinciding with this rise are false positive autoantibodies without clinical correlates. Objective: To explore the clinical profiles of Omani patients who are truly positive for AE autoantibodies and compare them with those with false-positive autoantibodies. Methods: We reviewed the medical records of all patients who tested positive for AE antibody from May 2016 to December 2022. Cases were verified by three neurologists based on the existing criteria for AE. Results: The participants comprised N = 67 patients, 19 (28%) of whom fulfilled the criteria for AE. True-positive AE patients were younger with mean age of 35.3 ± 4.7 years (p = 0.010). They were also more likely to present with subacute memory disturbances (6/19; 32%; p = 0.030), seizures (12; 63%; p = 0.028), abnormal electroencephalogram (EEG) findings (10; 65%; p = 0.040), and abnormal signals in limbic region on magnetic resonance imaging (MRI) (5; 26%; p = 0.010). Subacute memory disturbance was a significant predictor for true positivity (OR = 17.807, 95%CI = 1.608–197.202; p = 0.019). Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis was the most frequent type of AE (8; 42.1%), followed by anti-glutamic acid decarboxylase 65 (GAD65) (4; 21.1%). Conclusion: Of the 67 cases with positive AE autoantibody panel, 48 (72%) were false-positive. The presence of subacute memory impairment was a significant predictor of AE. Anti-NMDAR encephalitis was the most frequent AE encountered in our cohort

The historical approach to the "Ibn Soula" novel by Ali Al-Mamari = المقاربة التاريخية لرواية "بن سولع" للكاتب علي المعمري

تناقش هذه الدراسة التحليلية رواية "بن سولع" للأديب العُماني علي المعمري، التي تبين حقيقة التاريخ الدفين الذي شهدته منطقة شبه الجزيرة العربية، الذي لم تذكره كتب المؤرخين من قبل، وصراع أبنائها فيما بينهم، وتكالب الأطماع الخارجية على خيراتها النفطية والاستراتيجية، وأثره على المجتمع الخليجي. وظف المعمري آلية التاريخ في روايته، حين يجنح إلى الخيال والعاطفة التي قلما نجدها في كتب التاريخ؛ لكي يقود إلى معرفة حقيقة الأوضاع التي عاشتها المنطقة، وكشف الغموض العالق في صراع الواحات العربية. تهدف الدراسة: التعريف بالكاتب وماهية الرواية، وعلاقة عنوان بمضمونها التاريخي العميق. وبيان أهمية الرواية التاريخية، ودور النص التاريخي في الأحداث التاريخية والوقائع. ومناقشة الأحداث التاريخية وتأثر الخليج بالشركات النفطية الغربية. اعتمد الباحث؛ المنهج التحليلي، والمنهج الاستقرائي الوصفي. بينتْ نتائج الدراسة: استطاع قلم المعمري أنْ يصهر العبث الجغرافي والشاهد التاريخي في واحات البريمي، حين تحرّى الدقة والأمانة في توظيفه التاريخ في الرواية. فاستطاع أن يوثق الأحداث والوقائع التاريخية، بطريقة عجز عنها المؤرخون ورواة التاريخ، بل أحجموا عنها خوفا من الطغيان أو مجاملة للشيخ أو للسلطان. تميز المعمري في سرد أحداث التاريخ، باتخاذ التاريخ مادة للسرد، وإعمال الخيال في تقديم المادة التاريخية، بهدف خلق المتعة والتشويق، وشد القارئ إلى متابعة الرواية. فاستطاع أن ينجو من أصعب مزالق "الرواية التاريخية" وهو الانسياق لا شعوريا إلى العواطف الجامحة التي تُمليها الوقائعُ التاريخية الحقيقية. كلمات مفتاحية: المعمري، الرواية التاريخية، بن سولع. *************************************************************************** This analytical study discusses the novel "bn Soula" by the Omani writer Ali Al-Maamari, which shows the truth of the hidden history witnessed in the Arabian Peninsula, which was not mentioned by the books of historians before, the struggle inside it, the demands of external ambitions over its oil and its impact on the Gulf society. Al-Maamari used the history in his novel, when he strives to the imagination and passion that we rarely find in the history books. In order to lead to know the reality of the conditions experienced by the region, and to reveal the mystery lingering in the struggle of Arab oases. The study aims to introduce the author and what the novel is, the relationship of a title to its deep historical content. Explaining the importance of the historical novel, and the role of the historical text in historical events and facts. And discuss the historical events and the Gulf's influence on Western oil companies. The researcher adopted; The analytical method, and the descriptive inductive approach. The findings revealed: Al-Maamari was able to melt the geographical absurdity and the historical witness in Al-Buraimi oases, when the history was employed in a careful and honest way in the novel. He was able to document historical events and facts, in a way that historians and narrators of history were unable to do, but rather refrained from them for fear of tyranny or courtesy of the Sheikh or the Sultan. Al-Maamari has distinguished himself in narrating the events of history, by taking history as a material for narration, and the realization of imagination in presenting historical material, with the aim of creating fun and suspense, and drawing the reader to follow the novel. He managed to escape the most difficult pitfalls of the "historical narration", which is subconsciously drifting into the wild passions dictated by the real historical facts. Key words: Al-Maamari, Historical Novel, Bin Sulaa

Utilize technical elements in the novel "Ibn Soula" by Ali Al-Mamari = توظيف العناصر الفنية في رواية "بن سولع" للكاتب علي المعمري

ناقشتْ هذه الدراسة التحليلية رواية "بن سولع" للأديب العُماني علي المعمري، التي بينت أسلوب المعمري في توظيف العناصر الفنية في الرواية. إذْ تعدُّ الرواية بناءً واحدًا لا يمكن فصل عناصرها؛ الشخصية، والزمانية، والحيّز المكاني، والأحداث، واللغة والأسلوب عندما تلتحم، عندئذٍ تحتاج إلى بحث إجرائي لاستخراج مكنوناته الكامنة في أعماقه، لتبيّن حقيقة التاريخ الدفين الذي شهدته تلك المنطقة. تهدف الدراسة: مناقشة توظيف العناصر الفنية في الرواية، وتوظيف الشخصية تاريخياً، والزمن في السرد الروائي، والحيّز، وتوظيف الوصف، وأخيراً توظيف اللغة والأسلوب. ومن خلال المنهج التحليلي، والمنهج الاستقرائي الوصفي؛ بينتْ نتائج الدراسة: اهتمام الكاتب في وصف الصراع، ومعاناة الشعوب في الإمارات، عمان، قطر، البحرين، السعودية، الكويت؛ سواء بسبب حكامها أم أطراف خارجية معادية. عرض الكاتب التاريخ العماني من جميع أبوابه؛ التاريخ السياسي والصراع الداخلي بين حكومة مسقط وعمان، والإمامة، والصراع حول "واحات البريمي" المتنازع عليها بين السعودية وعمان والأمارات. تجلت لنا شخصية الراوي في مخالفته للمعتقدات الخاطئة في المجتمع. ********************************************************** This analytical study discussed the novel "Bin Soula" by the Omani writer Ali Al-Maamari, which showed Al-Maamari's method of employing the artistic elements in the novel. As the novel is one building whose elements cannot be separated; Personality, temporality, spatial space, events, language and style when combined, then you need procedural research to extract its potentials deep within it, to show the truth of the hidden history that this region has witnessed. The study aims to: discuss the employment of artistic elements in the novel, the employment of personality historically, the time in narrative narration, space, the employment of description, and finally the language and style. Through the analytical method and the descriptive inductive approach; The results of the study showed: the writer's interest in describing the conflict and the suffering of peoples in the Emirates, Oman, Qatar, Bahrain, Saudi Arabia, Kuwait; Whether because of its rulers or hostile external parties. The author presented Omani history in all its chapters; Political history and internal conflict between the government of Muscat and Oman, the Imamate, and the struggle over the disputed Buraimi Oasis between Saudi Arabia, Oman, and the United Arab Emirates. The narrator's character was revealed to us in contradiction with wrong beliefs in society