J. Oman Med. Assoc., Volume 1, Issue 1 (December 2024) – 10 articles

Cytologic diagnosis of extra-adrenal paraganglioma presenting as a peripancreatic mass is challenging, with a high rate of diagnostic error. We present a case of a peripancreatic mass identified by radiology as a gastrointestinal stromal tumor. Endoscopic ultrasound-guided fine-needle aspiration (FNA) of the mass showed a moderately cellular tumor composed of small-to-medium-sized neoplastic cells with round-to-oval nuclei arranged singly and in loose clusters. The cells were positive for neuroendocrine markers (synaptophysin and chromogranin) and negative for CD117. A diagnosis of neoplasm with a neuroendocrine tumor (NET) was made based on FNA cytology. The subsequent surgical resection of the tumor revealed peripancreatic paraganglioma with immunohistochemistry positive for synaptophysin, chromogranin, and S100. The latter delineated the sustentacular cells. Although paraganglioma is a well-recognized tumor, a detailed comparison of peripancreatic paraganglioma versus pancreatic/gastrointestinal NET is still lacking. Full article

Carbon monoxide (CO) poisoning is a leading cause of poisoning-related deaths, particularly affecting organs with high oxygen demands such as the heart and brain. Cardiac complications, including non-ST elevation myocardial infarction (NSTEMI), can occur due to CO poisoning but are not frequently reported in the elderly. We present the case of an 82-year-old female with a medical history of diabetes, hypertension, dyslipidemia, and previous ischemic heart disease. She was brought to the emergency department after being found drowsy in a closed room with a burning charcoal heater. The initial assessment revealed a carboxyhemoglobin level of 33.5%, which decreased to 9.3% after high-flow oxygen therapy and hyperbaric oxygen therapy (HBOT). Laboratory tests indicated elevated troponin levels, and an ECG showed asymmetrical T-wave inversion and ST depression. Despite the improvement in carboxyhemoglobin, the patient experienced persistent chest pain and rising troponin levels. She was treated with dual antiplatelet therapy and low molecular weight heparin as per acute coronary syndrome protocol, leading to a gradual improvement and a subsequent discharge in a stable condition. This case highlights the potential for CO poisoning to induce NSTEMI in elderly patients. A prompt diagnosis and appropriate management, including the use of HBOT, were crucial for the patient’s recovery. Full article

Introduction: Hormone replacement therapy (HRT) prevents muscle loss associated with menopause; however, the relative role of the neuromuscular junction (NMJ) in post-menopausal women taking HRT is poorly known. We investigate the effects of HRT on plasma C-terminal agrin-fragment-22 (CAF22) in post-menopausal women taking HRT. Methods: We recruited three groups of women, including pre-menopausal (age = 45.3 ± 3.1 years, n = 48) post-menopausal HRT-users (age = 56.7 ± 4.1 years, n = 42) and non-users (age = 55.4 ± 3.9 years, n = 47) for measurements of handgrip strength (HGS), skeletal muscle mass index (SMI), short physical performance battery (SPPB; marker of physical capacity), and plasma CAF22 levels. Results: Post-menopausal non-users of HRT had lower HGS, SMI, gait speed, and SPPB scores and higher plasma CAF22 levels than pre-menopausal women (all p < 0.05). Conversely, HRT users had higher HGS and gait speed and lower plasma CAF22 than non-users among post-menopausal women. HRT users also exhibited SPPB scores similar to those of pre-menopausal women. We observed significant correlations of plasma CAF22 with HGS, gait speed, and total SPPB scores in pre-menopausal and post-menopausal women with HRT (ALL p < 0.05). Lastly, HRT users had lower markers of inflammation and oxidative stress than non-users among post-menopausal women (both p < 0.05). Conclusion: Altogether, menopause was associated with elevated markers of NMJ degradation along with reduced muscle strength and physical capacity. HRT partly reduced NMJ degradation and restored muscle strength and physical capacity in post-menopausal women. Full article

The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) stratifies patients with thyroid nodules for further evaluation. We evaluated the accuracy of this risk stratification and compared it with that of fine-needle aspiration cytology (FNAC) and final pathology. The nodules (n = 381) of 329 patients (mean age, 45.5 y; 251 female) who underwent thyroid surgery from January 2021 to September 2023 were retrospectively analyzed for the ACR TI-RADS, FNAC, and final pathology results. The nodules were categorized according to risk of malignancy as 75.9% ACR TI-RADS 5, 72.6% ACR TI-RADS 4, 38.9% ACR TI-RADS 3, and 33.3% ACR TI-RADS 2. Considering ACR TI-RADS 5 and 4 as high-risk categories, the sensitivity, specificity, positive-predictive value, and negative-predictive value of the ACR TI-RADS categories were 77.9%, 57.3%, 73.8%, and 62.8%, respectively. With both ACR TI-RADS and FNAC high-risk categories combined, the sensitivity and specificity improved to 82.4% and 58.6%, respectively. The ACR TI-RADS score effectively predicts malignancy in higher-risk categories; however, some malignant cases were found within lower-risk categories, implying the need for careful utilization of this system. Combining high-risk ACR TI-RADS and FNAC results improves the diagnostic accuracy of thyroid nodules. Confirmation from further prospective studies is required. Full article

Objectives—This study aimed to investigate the factors contributing to increased absenteeism among nurses in primary healthcare institutions in Oman. Methods—A quantitative descriptive cross-sectional design included a structured written questionnaire that uses a quantitative self-repot technique was used. The study was conducted between January 2022 to November 2022 on a random selection of 300 nurses working in the primary and secondary healthcare institutions and regional hospitals in the Muscat governorate. Results—A total of 229 questionnaire were returned with a response rate of 76%. Almost 97% (222) participants were females, and 7 (3.1%) were males. Almost 51% of nurses were 25–34 years old. The respondents considered minor physical alignments, chronic medical conditions, and stress-related factors to be the predominant factors contributing to absenteeism among nurses. In addition, the coercive attitude of the leader, nurses whose performance was always criticized by the leader, and the nurse leader having inadequate support and guidance in performing patient care were considered important factors contributing to absenteeism. Conclusions—Nurses’ absenteeism is considered a threat to the quality of services provided for society at the primary healthcare level. The most common factors leading to increased absenteeism among nurses were found to be linked with demographic, leadership, and work characteristics. The most significant factors were considered to be within work characteristics, specifically the shortage of staff leading to workload, shift duties with limited flexibility, extra tasks, and absence of supportive policies. Additionally, leadership factors such as involvement, regular feedback, respect, and active listening to concerns were among the contributing factors to increased nursing absenteeism. Full article

Whole genome sequencing (WGS) has the potential to greatly enhance AMR (Anti-microbial Resistance) surveillance. To characterize the prevalent pathogens and dissemination of various AMR-genes, 73 clinical isolates were obtained from blood and respiratory tract specimens, were characterized phenotypically by VITEK-2 (bioMerieux), and 23 selected isolates were genotypically characterized by WGS (Illumina). AST revealed high levels of resistance with 50.7% XDR, 32.9% MDR, and 16.4% non-MDR phenotype. A total of 11 K. pneumoniae revealed six sequence types, six K-locus, and four O-locus types, with ST437, KL36, and O4 being predominant types, respectively. They carried ESBL genes CTX-M-15 (90.9%), TEM-1D (72.7%), SHV-11 (54.5%), SHV-1, SHV-28, OXA-1, FONA-5, and SFO-1; NDM-5 (72.7%) and 63.6%OXA48-like carbapenamases; 90.9%OMP mutation; dfrA12, sul-1, ermB, mphA, qnrB1, gyrA831, and pmrB1 for other groups. Virulence gene found were Yerisiniabactin (90.9%), aerobactin, RmpADC, and rmpA2. Predominant plasmid replicons were Col(pHAD28), IncFII, IncFIB(pQil), and Col440. A total of seven XDR A. baumannii showed single MLST type(2) and single O-locus type(OCL-1); with multiple AMR-genes: blaADC-73, blaOXA-66, blaOXA-23, blaNDM-1, gyrA, mphE, msrE, and tetB. Both S. aureus tested were found to be ST22, SCCmec IVa(2B), and spa type t309; multiple AMR-genes: blaZ, mecA, dfrC, ermC, and aacA-aphD. Non-MDR Enterococcus faecalis sequenced was ST 946, with multiple virulence genes. This study documents for the first-time prevalent virulence genes and MLST types, along with resistance genes circulating in our center. Full article

Background: Primary breast lymphoma is a rare entity in that it accounts for less than 1% of breast cancer and 2.2% of extranodal lymphoma. The most common histological type is diffuse B-cell lymphoma. Early stages of the disease have relatively good prognosis. Case Presentation: In this case, we are reporting on a forty-four-year-old lady presenting a large fungating right breast mass that turned out to be a primary breast lymphoma and whose outcome was unfortunate due to late presentation. Conclusions: Despite significant evolvement on treatment of lymphoma, negligence and social stigmatization still have a role in patients’ demise. Efforts toward awareness and anti-stigmatization are of paramount importance. Full article

Background: Gestational anemia is one of the most confronted problems during gestation. Nevertheless, the number of pregnant women with gestational anemia is growing in Oman. This study aimed to explore the perception of pregnant women regarding gestational anemia and iron supplements. This study would help us to comprehend pregnant women’s perceptions, attitudes, and factors regarding gestational anemia and iron supplements, as well as to understand the factors behind iron-deficiency anemia among pregnant women. Method: This study utilized a qualitative method directed by a grounded theory (constructivist) approach. The researchers conducted semi-structured (in-depth) interviews with 36 pregnant women with gestational anemia in the North Batinah Governorate in Oman. The researchers selected three primary healthcare institutions and one secondary healthcare institution, intending to reach pregnant women with gestational anemia. Both purposive sampling and theoretical sampling were used in this study. Results: From constant comparative analysis, four categories were developed: “Knowing the Problem”, “Believing in Treatment”, “Influencing Factors”, and “Trying To Manage”. Conclusion: Understanding pregnant women’s perception of gestational anemia and iron supplements could assist the Ministry of Health in developing ways to provide proper education and service for expectant mothers in Oman. Full article

Echocardiography is fundamental to diagnostic medicine, yet medical students seldom learn it. Simulation-based training to improve echocardiography learning is promising. This study examined how simulation-based echocardiography training affects final-year medical students’ knowledge and abilities. The study involved 16 medical students. Prior ultrasound experience and self-assessed competence were assessed using a pre-test that also had six multiple-choice questions on cardiac anatomy and physiology. The students went through an echocardiography teaching session using a simulator and a post-test with similar questions as the pre-test was administered thereafter. We compared both tests, and data analysis was performed using Microsoft Excel. Most students had little echocardiography experience before the class. After the teaching, scores averaged 5.07, up from 4.13 in the pre-test. Differences in pre-test and post-test scores were statistically significant (p = 0.007). The responses represented an improvement in self-assessed competence after the session. Simulation-based echocardiography improved medical students’ knowledge and skills. This study emphasizes the need for simulation-based training research to determine its long-term effects on clinical practice. Full article