Small intestinal fungal overgrowth (SIFO) is defined by an abnormal proliferation of fungal organisms, most commonly Candida species, within the small intestine. Fungal infections, particularly candidiasis, are recognized causes of gastrointestinal (GI) symptoms, especially in patients with underlying conditions, such as malignancy or diabetes mellitus (DM), and in those exposed to immunosuppressive therapies, corticosteroids, or prolonged antibiotic use. SIFO is an underrecognized cause of GI symptoms, including bloating, diarrhea, and malabsorption. In rare cases, excessive fungal colonization can lead to mechanical bowel obstruction. This case report describes a patient with advanced retroviral infection who developed small bowel obstruction secondary to SIFO, underscoring the diagnostic challenges, therapeutic approaches, and the critical importance of early recognition and management.
BACKGROUND:Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure and after myocardial infarction (MI), but patients with cardiogenic shock (CS) have been excluded from major trials. We therefore evaluated the association between discharge SGLT2 inhibitor prescription and 1-year outcomes in survivors of acute myocardial infarction (AMI) complicated by CS. METHODS:This retrospective, multicenter cohort study included 826 patients who survived to hospital discharge after AMI-CS. The primary exposure was SGLT2 inhibitor prescription at discharge versus standard therapy. Time zero was defined at discharge to avoid immortal time bias. Inverse probability of treatment weighting (IPTW) using 34 baseline covariates was applied. Primary outcomes were 1-year cardiac death and heart failure (HF) events, analyzed using Fine-Gray competing risk models. RESULTS:Of 826 patients, 197 (23.8%) received SGLT2 inhibitors. These patients had higher diabetes prevalence, lower left ventricular ejection fraction, and more advanced SCAI shock stages. After IPTW, SGLT2 inhibitor use was associated with a non-significant reduction in 1-year cardiac death (sHR 0.749, 95% CI 0.462-1.215, p=0.241) and no difference in HF events (sHR 0.986, 95% CI 0.629-1.546, p=0.952). The composite endpoint showed a non-significant trend toward benefit (HR 0.806, p=0.217). In subgroup analysis, SGLT2 inhibitor use was associated with significantly lower cardiac mortality in NSTE-ACS patients. CONCLUSIONS:In AMI-CS survivors, SGLT2 inhibitor use at discharge could be safe and associated with favorable numerical trends, supporting the need for randomized trials.
The rising cost of new health technologies and limited healthcare budgets challenge health systems worldwide, including Oman. Local value judgments are crucial for informed decision-making. This study aims to establish a cost-effectiveness thresholds (CETs) framework for Oman, aligned with the country’s economic status and healthcare priorities. The key findings from a recent literature review on global CETs and their applications were shared and discussed during a multi-stakeholder workshop in March 2024. Presenting these findings has provided participants a broad understanding of global CET practices and highlighted the use of multiple thresholds across different settings. Afterwards, a survey was distributed, asking participants to anonymously vote on six key concepts: the basis for the threshold, the baseline threshold multiplier, the use of multiple thresholds, the criteria for multiple thresholds, the number of multipliers, and which criterion should receive the 3X multiplier. The results from this voting guided the design and final agreement on the threshold values. Twenty respondents supported adopting multiple CET values based on cost per quality-adjusted life-year (QALY), linked to Oman’s economic status. A baseline CET equal to 1x Gross Domestic Product (GDP) per capita was suggested. Participants recommended three different threshold multipliers to reflect policy priorities. A continuous multiplier (1–3x GDP), based on incremental QALY gains, was used to favor technologies with greater health gains. Additionally, a fixed multiplier of 2 was chosen for both orphan drugs and treatments for priority diseases. The resulting CET values reflect technical and expert consensus and do not include patient or public perspectives. In Oman, the incremental cost per QALY gained should not exceed 1x GDP per capita for new health technologies that offer minimal health gains in common diseases. However, thresholds might increase to 12x GDP per capita for curative treatments in rare priority disease areas. It is recommended that CET values be reviewed and updated within three years, based on initial implementation experiences.
Nasal continuous positive airway pressure (CPAP) is widely used in premature infants but may cause pressure-related nasal injury. Severe deformities involving structural loss can result in significant airway compromise. We report a preterm infant presenting at 3 months of age with progressive nasal deformity, near-complete unilateral nostril occlusion, and features of obstructive sleep apnea complicated by pulmonary hypertension. Early reconstruction was performed at 6 months using autologous conchal cartilage to restore the lateral crus and a helical root composite chondrocutaneous graft for columellar support. Postoperative nasal stenting was utilized. The patient demonstrated marked improvement in airway patency, respiratory function, and tolerance of respiratory support, with stable structural and aesthetic outcomes at 3 months. This case highlights that early airway-directed reconstruction in selected infants is feasible and may prevent progression of functional and cardiopulmonary sequelae.
Objectives The study aims to identify the microbiological characteristics, clinical features, and outcomes of adult patients with septic arthritis (SA) at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, over a 10-year period from 2011 to 2020. Methods The study is an observational retrospective study that was conducted by retrospectively reviewing culture-positive SA cases treated at SQUH from 2011 to 2020. The data were collected from the hospital medical record (InterSystems TrakCare®; InterSystems Corporation, Cambridge, MA, USA) for patients whose ages were ≥18 years at the time of admission. The study was approved by the Medical Research and Ethics Committee of the College of Medicine and Health Sciences at SQU. Results A total of 57 adult patients (41 males, 71.9%) were identified to have native joint SA. The median age was 50 years. Among these patients, 24 patients (42%) had pre-existing joint disease, most commonly osteoarthritis (13 cases, 22.8%). Diabetes (23 patients, 40.4%) and sickle cell disease (SCD) (11 patients, 19.3%) were the most common comorbid conditions. A single joint was involved in 49 cases (86.0%). The most involved joints were the knee (34 cases, 59.6%), the hip (seven cases, 12.3%), and the shoulder (five cases, 8.8%). The most common causative pathogens were Staphylococcus aureus in 17 cases (29.8%), followed by Pseudomonas aeruginosa in nine cases (15.8%). Most patients underwent surgical interventions, including arthroscopic washout in 39 cases (68.4%) and arthrotomy in five cases (8.8%). The median duration of intravenous antibiotics was 14 days, and the median duration of oral antibiotics was 14 days. Seven cases were treated with antibiotics only without any surgical intervention. The mortality rate was 7%. Conclusion In this study, SA was more commonly observed among elderly patients and those with comorbidities, particularly diabetes mellitus and SCD. S. aureus was the most common organism.
