A retrospective descriptive study was conducted using the medical records of 907 patients (of 1005 identified) who underwent orthognathic surgery between 2008 and 2021 at the national referral centre for oral and maxillofacial surgery in Oman, to evaluate the rates and Clavien–Dindo severity grading of intraoperative and postoperative complications across variables including age, sex, surgical diagnosis, procedure, surgical protocol, and length of hospital stay. Based on the Clavien-Dindo classification, complications were recorded, evaluated, and graded. A total of 907 patient records were collected. Age ranges from 16 to 58 with a mean age of 25.32 ± 6.34 years were collected. Orthognathic complications, including neurosensory disturbance (10.6
Autosomal recessive hypophosphatemic rickets type 2 (ARHR2) caused by biallelic ENPP1 mutations is a rare disorder with a broad phenotypic spectrum. We describe 3 affected siblings from a consanguineous family who presented with markedly heterogeneous clinical features. The proband exhibited classical signs of rickets with progressive lower-limb deformities, short stature, and elevated alkaline phosphatase. Her older sister demonstrated limited elbow extension, conductive hearing loss, and vascular stenoses, while the youngest sibling developed early biochemical abnormalities before overt skeletal manifestations of rickets emerged. All affected children had hypophosphatemia, reduced tubular maximum phosphate reabsorption per glomerular filtration rate, and elevated or inappropriately normal fibroblast growth factor 23 (FGF23) concentrations, consistent with FGF23-mediated phosphate wasting. Notably, plasma inorganic pyrophosphate levels were markedly reduced in the affected children and mildly reduced in the carriers of monoallelic mutation. Genetic testing identified a homozygous ENPP1 variant, c.2559_2561del p.(Leu854del), which was essential for establishing the diagnosis and distinguishing ARHR2 from other hereditary forms of hypophosphatemic rickets. The father had low LS BMD. These cases highlight the clinical heterogeneity of ENPP1 deficiency and reinforce the essential role of genetic testing in establishing the correct diagnosis.
Depression is the most common psychiatric comorbidity among people living with HIV and is associated with an increased risk of disease progression. However, existing screening tools generally do not account for sociodemographic and psychosocial factors. Machine learning models offer a promising approach by capturing complex interactions in variables that traditional methods overlook. This cross-sectional, multicentre study included people living with HIV attending infectious disease clinics in four hospitals in Oman. Data were collected between January 2023 and February 2025. Adults aged 18 years and above with a diagnosis of HIV infection were included. Of the 289 recruited participants, 256 with complete data on all model variables were included in the final analysis. Depression severity was assessed using the PHQ-9 scale and sociodemographic and psychosocial variables were collected using validated questionnaires. A Random Forest regression model was implemented using the JASP Machine Learning module. The depression prevalence among people living with HIV was 26.3%. The model demonstrated moderate predictive accuracy, explaining approximately 35% of the variance in PHQ-9 scores. Self-efficacy and perceived social support were the strongest predictors of depression severity. Findings underscores the potential of machine learning- particularly Random Forest- in HIV and mental health care using routinely collected data.
Sweet syndrome (SS) is a rare, acute, febrile neutrophilic dermatosis marked by neutrophilic infiltration into the skin, blood, and various organ systems. It manifests as painful skin eruptions, which can range from violaceous papules and plaques to vesicles and ulcers, accompanied by peripheral blood neutrophilia and fever. Sweet syndrome has three subtypes: classical, drug-induced, and malignancy-associated. There are different clinical and pathological variants of SS. However, rare variants, such as necrotizing SS and histiocytoid SS, can complicate the clinical and pathological picture, particularly in the context of hematologic malignancies. We report a case of a female patient in her late 50s with acute myeloid leukemia (AML) who developed rapidly progressing, painful, necrotic skin lesions. Clinically, the presentation raised immediate suspicion for necrotizing fasciitis. However, histopathological examination revealed a dense dermal infiltrate of mononuclear cells resembling histiocytes. Immunohistochemical staining confirmed these cells were immature myeloid precursors (MPO+/CD68+), consistent with histiocytoid SS. Despite the clinical appearance of full-thickness necrosis, the patient responded dramatically to high-dose systemic corticosteroids, avoiding the need for extensive surgical debridement. This case highlights the rare overlap of necrotizing and histiocytoid variants of SS as a paraneoplastic phenomenon in AML. It underscores the importance of recognizing these atypical presentations to prevent misdiagnosis of infection and to ensure the timely initiation of immunosuppressive therapy. Clinicians should remain vigilant, as these variants may serve as a sentinel marker for underlying or relapsed leukemia.
BACKGROUND:The Gulf Cooperation Council (GCC) countries face an escalating epi-demic of diabetes, with prevalence rates substantially exceeding global averages and projections indicating a 96% increase by 2035. Diabetic Foot Disease (DFD) represents one of the most serious and costly complications of diabetes, yet regionally adapted clinical guidance is absent across all six GCC nations. METHODS:A modified Delphi study incorporating elements of the RAND/UCLA Appropriateness Method was conducted with an expert panel of 18 multidisciplinary clinicians from all six GCC countries (United Arab Emirates, Kingdom of Saudi Arabia, Qatar, Bahrain, Kuwait, and Oman). Panelists rated consensus statements using a 5-point Likert scale over two anonymous voting rounds, with an 80% agreement threshold defining consensus. Statements not achieving consensus were revised following structured group discussion. RESULTS:The panel generated consensus recommendations across seven domains: prevention and screening, risk assessment and classification, vascular assessment and management, wound management, infection and osteomyelitis, Charcot neuroarthropathy, and follow-up and recurrence prevention. Recommendations encompass GCC-specific adaptations addressing cultural practices, regional microbiology, climatic factors, healthcare system organization, and resource constraints. CONCLUSIONS:This consensus provides the first evidence-informed, regionally adapted framework for DFD management in the GCC. Implementation requires coordinated investment in multidisciplinary care models, workforce development, patient education programmes tailored to regional contexts, and robust data systems to monitor outcomes and guide continuous quality improvement.
