Oman Medical Journal最新文献

Objectives: Obstructive sleep apnea (OSA) and secondary polycythemia occasionally occur together, but their relationship remains unclear. This study aimed to explore the prevalence of OSA among patients with secondary polycythemia in our local population.

Methods: In this retrospective cross-sectional study, we screened 524 adult patients with polycythemia who attended the hematology clinic at a major tertiary hospital in Muscat during 2013-2023. Our goal was to identify patients with OSA and secondary polycythemia who also underwent sleep studies and analyzed their data.

Results: Out of 524 polycythemia patients, we identified N = 44 patients (8.4%) who had both OSA and secondary polycythemia. The vast majority were male (42/44; 95.5%). Participants' mean age was 40.7 years, with a body mass index of 31.7 kg/m², hemoglobin level of 16.5 g/dL, and hematocrit level of 0.5 L/L. The mean apnea/hypopnea index was 33.3, and the mean desaturation index was 20.3. More than half of the patients (23; 52.3%) had severe OSA (apnea/hypopnea index > 30).

Conclusions: The majority of patients with secondary polycythemia had severe OSA. It is likely that OSA may contribute to secondary polycythemia, warranting further investigation.

Objectives: Setting research priorities is essential for optimizing healthcare resource allocation and addressing critical health challenges. We sought to identify data-driven clinical and health service research priorities for the Royal Hospital, Muscat, Oman.

Methods: We used a multi-step approach combined with retrospective electronic health record (EHR) analysis with structured and unstructured stakeholder consultations. Findings were validated using the Delphi method through online surveys and face-to-face discussions with 10 key hospital decision-makers.

Results: Analysis of EHR data from 652?%567 inpatient admissions over 14 years identified pregnancy-related conditions (25.0%) as the leading cause of hospitalization, followed by circulatory system disease (10.4%) and cancers (8.6%), with breast and colon cancers being the most prevalent. Septicemia, pneumonia, and myocardial infarction were the leading causes of death. Stakeholder consultations emphasized patient-centered care, telemedicine, operational efficiency, and artificial intelligence-driven diagnostics as key health service research priorities. Delphi validation confirmed high relevance (scoring 4?"5 on a 5-point scale), although feasibility concerns were noted, particularly regarding resource allocation and information technology infrastructure.

Conclusions: Our study established research priorities for the Royal Hospital by integrating clinical data analysis with stakeholder engagement to align research efforts with Oman?(tm)s Health Vision 2050. Effective implementation will require a hospital-wide research steering committee to oversee execution, integrate research themes into funding strategies, and enhance data-driven decision-making through artificial intelligence and EHR dashboards. Sustaining momentum necessitates annual reviews with leadership, cross-department collaboration, and capacity-building programs. For long-term sustainability, dedicated hospital funding and public-private partnerships should be explored.

Objectives: Hip osteoarthritis is a growing global health burden with an increasing demand for total hip arthroplasty (THA), particularly among older populations. Robotic-assisted THA (RATHA) has emerged as a technological advancement that may improve precision, implant alignment, and potentially patient outcomes compared with conventional THA (COTHA). This systematic review aimed to compare the clinical and radiological outcomes of RATHA and COTHA.

Methods: A systematic search was conducted from PubMed, Scopus, and Cochrane Library inception until 31 August 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were randomized controlled trials, retrospective studies, prospective studies, and cohort studies that compared RATHA with COTHA. Exclusion criteria were case reports, case series, abstracts, review articles, systematic reviews, meta-analyses, biomechanical or cadaveric studies, studies on revision THA or high-grade hip dysplasia, and non-English publications. Data were extracted and assessed using the Covidence systematic review software and the Cochrane Risk of Bias Tool. The primary outcomes were clinical outcomes measured by patient-reported outcome measures. The secondary outcomes were operative outcomes, complications, and radiological assessment.

Results: Nine studies met the inclusion criteria, representing populations from Asia, the USA, the UK, and Italy. A total of 933 patients were assessed, 467 of whom underwent RATHA. No significant differences observed in patient-reported outcome measures. COTHA had shorter operative times, whereas RATHA showed potential in reducing hospital stays. RATHA demonstrated improved radiological outcomes, particularly in implant alignment; however, no significant differences were observed in complication rates.

Conclusions: RATHA offers advantages in radiological precision but provides clinical outcomes similar to those of COTHA in terms of patient satisfaction and complications. Further high-quality trials are required to assess the long-term benefits of RATHA.

Carnitine-acylcarnitine translocase deficiency with SLC25A20 c.199-10T>G variation is a rare condition, typically associated with severe neonatal outcomes. Recently, preimplantation genetic testing (PGT) has emerged as a screening test applicable to embryos produced through in vitro fertilization for genetic analysis before transfer. Thus, PGT allows for the identification and elimination of embryos carrying inherited genetic diseases. This case report aims to present data from PGT on intervention in the management of SLC25A20 c.199-10T>G variation, particularly in middle-income countries. A 26-year-old woman with a high-risk term pregnancy and a history of two sudden neonatal deaths underwent parental carrier testing, revealing heterozygous SLC25A20 c.199-10T>G variation in both parents. The subsequent pregnancy, identified as a homozygous for SLC25A20 c.199-10T>G mutation, was terminated at 20 weeks. The current pregnancy was successfully managed by in vitro fertilization-selective embryo transfer. Carnitine-acylcarnitine translocase deficiency owing to SLC25A20 c.199-10T>G variation can result in sudden neonatal collapse. Obstetricians should maintain a high index of suspicion in recurrent cases of unexplained early neonatal death. Parental carrier testing is crucial for prenatal management, and selective embryo transfer is a core treatment for heterozygous SLC25A20 gene carriers in this highly lethal disorder.

Objectives: Computed tomography (CT) scans are commonly used to evaluate the brain in geriatric patients presenting to emergency department (ED). Our study retrospectively aimed to evaluate the effectiveness of CT scans in diagnosing generalized weakness in elderly patients.

Methods: Elderly patients (age ≥ 65 years) presenting to the ED with generalized weakness and either fatigue, dizziness, vertigo, fever, nausea, or vomiting between 1 January and 31 December 2022 were included from two prominent EDs in Muscat. Multiple variables were coded and systematically analyzed.

Results: Out of 12 608 847 patients, 6.7% presented with generalized weakness and underwent a CT scan of the brain as part of their evaluation. The mean age was 76.0 ± 7.7 years, with males comprising 47.5% of the group. Presenting complaints to the ED were fever (57.0%), drowsiness (46.9%), and dizziness (30.0%). CT brain findings included acute ischemic changes (3.3%), subacute ischemic changes (7.8%), acute-on-chronic subdural hematoma or intracranial hematoma (3.4%), and new space-occupying lesions or abscesses (4.4%). Receiver operating characteristic curves assessed the diagnostic performance of CT imaging for various conditions: acute/subacute ischemic cerebrovascular accident (area under the curve (AUC) = 0.47, optimal threshold: 0.188), acute/acute on chronic subdural hematoma or intracranial hemorrhage (AUC = 0.41, optimal threshold: 0.122), significant new and/or acute CT findings overall (AUC = 0.45, optimal threshold: 0.026), and newly detected space occupying lesions (AUC = 0.43, optimal threshold: 0.144).

Conclusions: A CT scan is limited as a diagnostic tool for patients presenting with generalized weakness, particularly in diagnosing new or acute/subacute medical or surgical conditions of the brain.

Objectives: To investigate the clinical presentation and treatment outcomes in Omani adults diagnosed with attention-deficit hyperactivity disorder (ADHD), with a focus on the efficacy of atomoxetine and methylphenidate in reducing symptoms, and identify clinical predictors of treatment response.

Methods: This prospective study enrolled Omani adults with ADHD receiving treatment at Sultan Qaboos University Hospital, Oman. Data on sociodemographic and clinical history were collected. Treatment response was quantified using the Clinical Global Impressions-Improvement (CGI-I) scale, after three months of initiating treatment. Statistical analysis used independent chi-square tests and t-tests, with a significance threshold set at p < 0.05.

Results: Among 171 participants, 60.8% were male. The majority (80.7%) received methylphenidate, while the others (19.3%) received atomoxetine. Inattentive subtype of ADHD (66.1%) was the most common, followed by combined hyperactivity and inattention (24.0%). Most (72.5%) patients had at least one comorbidity. After three months, 83.6% of the patients showed significant improvement on the Clinical Global Impressions-Improvement scale. Response rate for methylphenidate (84.8%) was higher than for atomoxetine (78.8%). Significant predictors of treatment response were male sex (odds ratio = 2.42, 95% CI: 1.00-5.71; p = 0.044) and absence of a family history of ADHD (odds ratio = 2.93, 95% CI: 1.18-7.28; p = 0.020).

Conclusions: Both atomoxetine and methylphenidate were effective in treating adult ADHD, but methylphenidate showed a higher response rate. Male sex and the absence of a family history of ADHD were associated with greater response to treatment. These factors may serve as clinical indicators for tailoring pharmacological treatment decisions for individual adult ADHD patients in Oman.

Objectives: Hydroxyurea is been recommended for patients with sickle cell disease (SCD) as it reduces the complications from the disease by increasing the production of fetal hemoglobin. In Oman, hydroxyurea is not consistently prescribed to children with SCD, and limited research has compared the health-related quality of life (HRQOL) among children prescribed hydroxyurea. Thus, this study evaluated HRQOL differences between children with SCD who received hydroxyurea and those who did not.

Methods: A cross-sectional study was conducted on children from a hematology clinic at a tertiary hospital in Oman. We collected the data using two questionnaires: HRQOL-SCD and HRQOL-Generic. A one-way analysis of variance was used for statistical analysis.

Results: A total of 74 children (47.3% male and 52.7% female) completed the questionnaire; 33 children were on hydroxyurea and 41 were not. A significant difference in HRQOL scores was found between children receiving hydroxyurea and those not taking the drug [F (1,68) = 419.4; p-value = 0.001]. Regression analysis revealed that hydroxyurea was a significant predictor of improved HRQOL among children with SCD. An R2 of 0.87 indicated that 87.0% of the variability in the child-reported HRQOL-Generic was explained by parental familiarity, self-efficacy, child age, sex, and receiving hydroxyurea [R2 = 0.87, F (8,69) = 52.4; p-value < 0.001].

Conclusions: Hydroxyurea improved the children's HRQOL compared to those who did not receive the drug. These findings support the use of hydroxyurea in children to improve HRQOL and reduce vaso-occlusive episodes. We recommend increasing parents' understanding of hydroxyurea's significance and devising strategies to promote children's medication adherence. It is essential to modify the SCD management protocol to optimize the HRQOL among children with SCD.

Objectives: Our study sought to investigate the relationship between sleep quality, sleep patterns, and 10-year cardiovascular disease (CVD) risk among Omani adults attending primary healthcare centers in Muscat.

Methods: We used a cross-sectional design to collect patient data obtained between September 2023 and September 2024. Participants who were Omani and aged 30-75 years were included in the study using convenience sampling; however, those with established cardiovascular disease or showing signs of obstructive sleep apnea were excluded. The 10-year CVD risk was calculated using the Framingham Risk Score, and sleep quality was assessed using the Pittsburgh Sleep Quality Index. The research explored the impact of various sleep patterns (monophasic, biphasic, polyphasic), work timings, sociodemographic factors, and body mass index on sleep quality and CVD risk.

Results: A total of 400 participants were included in this study, with the majority (60.0%) being female. We observed a significant association between poor sleep quality and an increased risk of developing CVD over 10 years (odds ratio = 1.734; p = 0.032). Flexible work timings showed a protective effect against CVD (odds ratio = 0.514; p = 0.010). We found no significant difference between sleep patterns and CVD risk.

Conclusions: Our findings emphasize the importance of sleep quality and work flexibility in reducing cardiovascular risk, with potential implications for public health interventions.