Cost Comparison between Laparoscopic and Open Appendectomies in Children

Objectives: Laparoscopic appendectomy (LA) for children has become very popular and is routinely performed in most health care centres around the world. The cost of surgical procedures is always a concern for patients and health care providers. This study compares, the total cost of open appendectomy (OA) with LA in children who required an appendectomy for acute appendicitis. Suitable and safe cost-effective techniques were also explored to reduce the cost of these procedures. Methods: The medical records of all the children (ranging between 0 and 12 years) at Sultan Qaboos University Hospital in Oman, who required OA or LA from June 2009 to July 2011, were reviewed. Results: LA were performed in 75 patients while OA were done in 34. Patients from the OA and LA groups were age- and gender-matched. The average operative time was 76 minutes for LA and 49 minutes for OA (P <0.001) while the average hospital stay was 3.14 days for LA and 2.15 days for OA (P = 0.08). The average cost of the two procedures was Omani riyals (OMR) 534 for LA and OMR 343 for OA (P = 0.00). The complication rate following procedures was lower in the case of LA, however this was not statistically significant (LA = 8% versus OA = 11.7 %, P = 0.32). Conclusion: LA are costlier procedures than OA, however they are as safe as OA, and do not increase morbidity or the duration of hospital stay

Laparoscopic Splenectomy Alone for Sickle Cell Disease : Account of 50 paediatric cases

Objectives: In Oman, the most frequent indication for a splenectomy in children is sickle cell disease (SCD), which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman. Methods: This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged ≤15 years old undergoing splenectomies during the study period were reviewed. Results: A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children (28 male and 22 female) underwent laparoscopic splenectomies alone for SCD. The children’s weight ranged between 11–43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis (92%). Surgically removed spleens weighed between 155–1,200 g and measured between 9–22 cm. Operative times ranged between 66–204 minutes and intraoperative blood loss ranged between 10–800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days. Conclusion: Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option

A Triad of Temporomandibular Joint Ankylosis, Mandibular Retrognathia and Severe Obstructive Sleep Apnoea: Case report

The surgical management of paediatric patients with temporomandibular joint (TMJ) ankylosis, mandibular retrognathia and obstructive sleep apnoea (OSA) is challenging. We report a nine-year-old boy who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with complaints of limited mouth opening, loud snoring and excessive daytime sleepiness. He was diagnosed with TMJ ankylosis, mandibular retrognathia and severe OSA. The patient initially underwent mandibular distraction and, subsequently, release of the TMJ ankylosis and rib graft reconstruction. The overall patient outcome was successful, with improvement in OSA-related symptoms, good facial symmetry and adequate mouth opening. Keywords: Temporomandibular Joint Disorders; Temporomandibular Ankylosis; Retrognathia; Obstructive Sleep Apnea; Case Report; Oman

A national survey to estimate sodium and potassium intake, and knowledge attitudes and behaviours towards salt consumption of adults in the Sultanate of Oman

Objectives. To estimate population sodium and potassium intakes, and explore knowledge, attitudes and behaviour (KAB) towards the use of salt in adults in the Sultanate of Oman. Design. National cross-sectional population-based survey. Setting. Proportional random samples, representative of Omani adults (18 years or older), were obtained from all Governorates of the Sultanate of Oman. Participants. Five hundred and sixty-nine (193 men, 376 women; 18 years or older) were included in the analysis (response rate 57%). Mean age was 39.4 years (SD 13.1). Participants attended a screening including demographic, anthropometric and physical measurements. Primary and secondary outcome measures. We assessed dietary sodium, potassium and creatinine by 24h urinary sodium (UNa), potassium (UK) and creatinine (UCr) excretions. We collected KAB by a questionnaire on an electronic tablet. Results. Mean UNa was 144.3 (78.8) mmoL/day, equivalent to 9.0 g of salt/day and potassium excretion 52.6 (32.6) mmoL/day, equivalent to 2.36 g/day, after adjusting for non-urinary losses. Men ate significantly more sodium and potassium than women. Only 22% of the sample had a salt intake below the World Health Organization (WHO) recommended target of 5 g/day and less than 10% met WHO targets for potassium excretion (>90 mmoL/day). Whilst 89.1% of those interviewed knew that consuming too much salt could cause serious health problems and only 6.9% felt they were using too much added salt, 1 in 2 participants used always or often salt, salty seasonings or salty sauces in cooking or when preparing food at home. Conclusions. In the Sultanate of Oman, salt consumption is higher, and potassium consumption lower, than recommended by WHO, both in men and in women. The present data provides, for the first time, evidence to support a national programme of population salt reduction to prevent the increasing burden of CVD in the area

Factors Responsible for the Prolonged Stay of Surgical Neonates in Intensive Care Units

Objectives: The length of hospital stay (HS) for patients is a major concern due to its social, economic and administrative implications; this is particularly important for neonates admitted to intensive care units (ICUs). This study aimed to determine the factors responsible for prolonged HS in surgical neonates. Methods: This retrospective study was conducted at Sultan Qaboos University Hospital, in Muscat, Oman. The medical records of 95 neonates admitted to the neonatal ICU who underwent general surgical procedures between July 2009 and June 2013 were reviewed. Mann-Whitney U and Pearson’s Chi-squared tests were used for non-parametric numerical and categorical variables, respectively. A multiple regression analysis was performed to find a relationship between the variables and to detect the most important factor responsible for prolonged HS. A P value of <0.05 was considered statistically significant. Results: Gestational age, birth weight, number of days on a ventilator and postoperative morbidity were associated with prolonged HS. Furthermore, the age of neonates at first full enteral feed was associated with increased HS using both independent and multiple regression analyses. Conclusion: Prolonged HS can occur as a result of many factors. In this study, a number of factors were identified, including low gestational age, low birth weight, increased number of days on a ventilator and postoperative morbidity. Additionally, neonate age at first full enteral feeds also correlated with increased HS. Further research on this topic is suggested to explore this correlation in more detail and to inform future practices

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

The effects of mutual dependence and inter-firm dynamic capabilities in buyer-supplier relationship on supply performance: an empirical study from the Arabian Gulf countries

© 2012 Dr. Zainab Ali Abdullah Al-BalushiIn a supply chain management context, the link between exchange partners is critical. Procurement is charged with the responsibility of ensuring that resource exchange is accomplished in an efficient and effective way. Yet, contemporary strategies such as outsourcing, just in time and supply base consolidation have increased interdependence between exchange partners. This creates a need for inter-firm dynamic capabilities facilitating mutual benefit. Based on this premise, this study provides a conceptual integration and focused synthesis of the literature on interdependence (i.e. mutual dependence and power asymmetry), and dynamic capabilities (i.e. boundary spanning and inter-firm absorptive capacity) in the context of supply performance. A primary objective of this thesis is to investigate the concept of interdependence in buyer-supplier relationships through an integrated lens of Resource Dependence Theory and the Dynamic Capability View, hence addressing the following research questions from a buying firm perspective: To what extent do mutual dependence in buyer-supplier relationships and inter-firm dynamic capabilities affect supply performance? How does power asymmetry moderate these relationships? A mixed methods research approach was utilized. Data was collected from organizations in the Arab Gulf Countries, including: Oman, UAE, Kuwait, Qatar, Saudi Arabia and Bahrain. In the first phase, 400 survey responses were gathered to test the hypothesized relationships using structural equation modelling. This was followed by a case study with an airline company to better understand the dynamics of interdependency and dynamic capability between exchange-partners. The study contributes to the body of knowledge by providing empirical evidence to support the conceptual statements in the literature regarding the impact of interdependency and dynamic capabilities on supply performance. The current thesis is valuable as it contends that mutual dependence would typically foster supply performance. Yet, mutual dependence is not always synonymous with good relationships, especially under conditions of high power asymmetry. Further, this study identifies from a buying firms perspective strategies that would typically foster supply performance under asymmetric power distribution. For example, under high power asymmetry the mediating effects of demand-side boundary spanning do not hold, whereas under low power asymmetry the mediating effects of supply side boundary spanning do not hold. On the other hand power asymmetry is not shown in this study to moderate the effects of inter-firm absorptive capacity. The motivation for this thesis is found in the following areas of contribution. First, integrating resource dependence theory and the dynamic capability view enhances the theoretical explanations of the examined phenomena. Second, following recent debate in the literature, this study distinguishes between mutual dependence and power asymmetry, which are assumed to be two faces of interdependence. Third, this research extends the concept of absorptive capacity to an inter-firm perspective and adds “boundary spanning” as a means of value recognition. Fourth, studies related to supply chain are mostly conducted in western economies. This study was conducted in the Arabian Gulf Countries providing the opportunity to view these relationships in an Arab cultural context. By examining well established theoretical perspectives (e.g. resource dependence and dynamic capability) in diffident economic, political and cultural settings provides interesting theoretical and empirical implications. In regard to practical contribution, this study should be of interest to managers who are considering developing realistic survival strategies to improve supply performance in their upstream supply chains

Scapular Bronchogenic Cyst: A Case Report and Literature Review

Bronchogenic cysts originate from abnormal budding of the tracheal diverticula during the embryological period. Inaccuracy in the process of growing of the ventral foregut will give rise to bronchogenic cyst. Scapular bronchogenic cyst is an extremely rare form of this anomaly. A three years old boy suffered for 2 years with left sided suprascapular cystic lesion which was gradually increasing in size. The swelling was 4 × 3 cm in size and non tender. The cyst was evaluated by CT scan that showed complex cystic lesion over the left scapular spine. Total excision of the cyst was done and histopathology showed cutaneous bronchogenic cyst. The proposed mechanism for such cutaneous lesion is that the accessory buds from the tracheobronchial tree/primitive foregut migrated from the thorax in an aberrant manner to lie in periscapular positions. The definitive treatment of scapular lesions is total surgical excision. The final diagnosis is based on the histopathological findings in the majority of cases

Congenital mesenteric hernia in neonates: Still a dilemma

Congenital transmesenteric hernia in neonates is a rare cause of intestinal obstruction with devastating outcomes and still remains a challenge to diagnose pre-operatively. Patients are often managed with emergency surgical exploration and may need bowel resection. We present 2 neonates with small bowel obstruction secondary to strangulated transmesenteric hernia through a congenital defect in the small bowel mesentery, which were managed successfully. We have also reviewed the literature about congenital transmesenteric hernia in neonates

Critical indices and model of uncertainty perception for regional supply chains: insights from a Delphi-based study

Purpose: The dynamic nature of uncertainty sources in regional operations represents supply chain management (SCM) imperatives to review uncertainty management frameworks on an ongoing basis with a view to identifying and prioritising critical indices of uncertainty for effective SCM. The purpose of this study is to identify the critical indices of uncertainty for regional supply chains and analyse how SCM practitioners perceive uncertainty. Design/methodology/approach: This paper presents a Delphi-based study with a panel of 70 SCM experts from the Sultanate of Oman in the Gulf Cooperation Council (GCC) region. It applies three rounds of a Delphi exercise to identify, select and prioritise the critical indices of supply chain uncertainty perceived by panel experts. The thematic analysis also provides theorisations on the process for uncertainty perception and factors shaping perception. Findings: A total of 39 uncertainty indices were identified from demand, supply, manufacturing, control, technology, competitive, project, transport and geological sources. The Delphi selection round captured the top 12 indices of experts. The research found an accumulative–aggregative duality that explains uncertainty perception and a cost–conformance–connection triadic set of factors underlying the perceived critical indices. Project uncertainty produced the top-ranked index in the final Delphi round. Originality/value: This paper makes three main contributions. First, it offers a bottom-up based insight into supply chain uncertainty using the Delphi-based study and from a GCC perspective. Second, the research is unique in its focus on Oman and, third, it is of value for the international operations of GCC companies and for international firms with intentions of expanding, moving or outsourcing their operations to a GCC country such as Oman