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

Protein fermentation, gut microbiota and colorectal cancer

The purpose of this project was to determine the interaction between dietary protein and the gut microbiome in the production of genotoxic metabolites, with a particular focus on the poorly characterised metabolite 4-cresol. The thesis describes, in the first instance, data from a large human observation study (n=205 healthy Omani adults). In which dietary records and urinary nitrogen excretion were used to estimate protein consumption in relation to urinary 4-cresol excretion. The study observed positive correlations between excreted 4 cresol and protein intake and then sought to explain the inter-individual variance in this by evaluating the influence of the colonic microbiota. Then the study focused on predicting 4-cresol exposures in the colon using in vitro gut fermentation models. The microbiota composition and metabolic profiles from these models are evaluated against different substrates, including comparisons of animal and plant proteins. We show that the total production of 4-cresol is dependent both on the host microbiota and also upon the dietary nitrogen source. The metabolite profiles of these fermentations may be used to predict DNA damage, with 4-cresol emerging as the greatest correlate of fermentation supernatant mediated genotoxicity. Finally, the study explored whether specific tumour isolates of F. nucleatum produce 4-cresol, or other genotoxins, that could drive intestinal carcinogenesis. At this stage the study is unable to conclude whether or not these isolates are passengers or drivers of intestinal disease. This work suggests the need for better models of the effects of the tumour environment on microbial growth. The most significant aspect of this thesis is that it evidences both the potential genotoxic contribution of 4-cresol in the colonic milieu, but also that urinary 4-cresol sulfate may be used as a biomarker of genotoxic colonic fermentation and thus, may be of use as a cancer risk endpoint in future dietary intervention study

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

Hepatoblastomas in Oman : Unveiling success

Objectives: Primary malignant liver tumours account for more than 1% of all paediatric malignancies, with the most common form being hepatoblastomas (HB). Such malignancies among Arab populations have rarely been addressed in the literature. Using data from Oman’s sole national referral centre for childhood solid malignancies, this study aimed to present the nationwide Omani experience with HB over the past 21 years. Methods:This retrospective study reviewed the medical records of all children with HB who were managed in the Royal Hospital, Muscat, Oman, between January 1991 and April 2012. Clinical, radiological and laboratory characteristics were examined as well as treatments and outcomes. Results: During the study period, 15 patients with HB were treated. Of these, 10 have survived to date. Nine of the survivors were no longer receiving treatment and one patient still had the disease but was in a stable condition. Of the remaining five patients, three did not survive and two were lost to follow-up. The survival rate among patients who completed therapy was 91%. Conclusion: HB has an excellent prognosis in Oman. The main obstacle to improving outcomes among Omani patients is non-compliance with therapy

Clinical Pathways for Non-ST Elevation Acute Coronary Syndrome in Oman: An Oman Heart Association Protocol for Hospital Quality Improvement Initiative

In 2012, Oman Heart Association (OHA) published its own guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction, the aim was not to be comprehensive but rather simplified and practical in order to reduce the gap between the long comprehensive guidelines and our actual practice. However, we still feel that the busy registrars and residents need simpler and direct clinical pathways or protocol to be used in the emergency departments, coronary care units and in the wards. Clinical pathways are now one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes in acute care

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity