Ischial pressure ulcer reconstruction requires durable coverage while preserving local donor options for possible recurrence. The inferior gluteal artery perforator (IGAP) flap is a muscle-sparing option, but superthin elevation requires precise knowledge of the superficial fascial plane and the subcutaneous course of the selected perforator. This technical note describes colour Doppler ultrasonography-guided superficial fascial plane mapping before superthin IGAP flap elevation in a 27-year-old paraplegic patient with a chronic left ischial pressure ulcer who presented in 2025 to a tertiary care university hospital in Muǧla, Turkey. Preoperative high-frequency colour Doppler ultrasonography identified the dominant perforator, measured the relevant fascial intervals and guided a controlled dissection above the superficial fascia. The technique allowed elevation of a thin, pliable flap while preserving deeper gluteal structures and perforator integrity. Colour Doppler-guided fascial mapping may support safer superthin perforator flap elevation in selected pressure ulcer reconstructions.
Objectives:The bidirectional Glenn (BDG) procedure, a key palliative intervention for single-ventricle physiology, is conventionally performed using cardiopulmonary bypass (CPB) despite its associated complications and costs. However, the comparative impact of CPB versus off-pump techniques on perioperative safety, neurological risk and long-term outcomes remains controversial. Therefore, this meta-analysis aimed to determine whether performing the BDG procedure without CPB improves perioperative outcomes (including morbidity, mortality, and neurological events), resource utilisation, and long-term survival compared to the conventional on-pump approach. Methods:This review systematically searched PubMed, EMBASE and Cochrane Central from inception until January 2025 for comparative randomised and observational studies reporting outcomes in patients undergoing the BDG procedure with versus without CPB. The primary outcome was perioperative mortality (≤30 days or discharge); secondary outcomes included operative duration, recovery parameters (ventilation time, vasoactive support, intensive care unit (ICU)/hospital stay) and postoperative complications (infection, bleeding, neurological events, arrhythmias). Results:A total of 5 studies (2 randomised controlled trials, 3 observational studies; N = 339, 55% with CPB, 45% without CPB) were included. Patients had a mean age range of 6-66 months and mean weight of 6-16 kg. Common anomalies included double-outlet right ventricle and tricuspid atresia. Perioperative mortality did not differ significantly between groups (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 0.31-4.20; P = 0.83). Significant benefits favouring the off-pump approach were observed for operation duration (mean difference [MD] = 31.98 min, 95% CI = 14.97-48.99; P = 0.0002), duration of inotropic support (MD = 7.05 hours, 95% CI = 5.48-8.63; P <0.00001), duration of mechanical ventilation (MD = 4.09 hours, 95% CI = 3.26-4.92; P <0.00001) and ICU length-of-stay (MD = 0.73 days, 95% CI = 0.55-0.91; P <0.00001). No significant differences were found for hospital length-of-stay, postoperative bleeding, neurological complications, oxygen saturation, superior vena cava pressure, infection or arrhythmias. Risk of bias was assessed via the ROBINS-I and ROB2 assessment tools for non-randomised and randomised trials, respectively; a funnel plot was constructed to assess for publication bias. Conclusion:The findings suggest that, although off-pump BDG procedure is associated with shorter operative and recovery AU: Please provide the accepted date. times than the on-pump approach, it does not demonstrate superior perioperative mortality or hospital discharge outcomes. Given the risk of conversion and lack of extended follow-up in reporting studies, further randomised multicentre studies with standardised outcomes are warranted before off-pump is deemed a superior option.
Objectives:Fasting hyperglycaemia (FHG) in insulin resistance is due to oxidative stress wherein gamma-glutamyl transferase (GGT) and uric acid (UA) are known to impair insulin secretion from pancreatic beta cells due to their pro-oxidant action and their role in metabolism of antioxidant glutathione. This study aims to determine the association of GGT and UA with FHG and its role in predicting the onset of prediabetes. Methods:This cross-sectional study was conducted in Government Villupuram Medical College, Villupuram, India, from July to December 2023. Individuals in the age range of 25-65 years attending the master health check-up clinic were included. The subjects were classified as normoglycaemic (FBG <100 mg/dL) or hyperglycaemic (FBG ≥100 mg/dL). GGT, UA, glucose (Glu):GGT ratio, Glu:UA ratio, lipid profile and GGT: high-density lipoprotein (HDL) were compared between the two groups using Student's t test. The parameters were compared between the quintiles of glucose using ANOVA. Pearson's correlation was used to analyse the correlation between the study parameters. Results:A total of 500 adults were included in this study. Triglyceride (TG), TG:HDL ratio, GGT, UA and Glu:GGT, Glu:UA and GGT:HDL ratios were significantly high in fifth quintile compared to other glucose quintiles. Glu:UA and Glu:GGT ratios showed significant positive correlation with glucose levels. Receiver operating characteristic analysis showed that Glu:UA ratio was a good predictor of FHG (AUC = 0.808; P <0.0001) with a sensitivity of 70.1% and specificity of 79.8% at a cut-off value of 26.5 to diagnose insulin resistance. Conclusion:Glu:UA and Glu:GGT ratios are surrogate markers of underlying oxidative stress and insulin resistance and good predictors of fasting hyperglycaemia.
NRXN1 (2p16.3) is essential for synaptic function and has been implicated in autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, the phenotypic features associated with NRXN1 copy number variants remains incompletely characterised, which complicates risk assessment in genetic counselling. This case series describes five children, who were evaluated at the Genetics and Developmental Pediatrics Clinic of a tertiary care hospital in Muscat, Oman, from 2011 to 2023, with rare NRXN1 deletions (57-150 kb). All met DSM-5 criteria for ASD and had speech and language delays with cognitive impairment. Consanguinity was reported in three of the families and two had a family history of ASD. Microcephaly was present in four children and one showed facial dysmorphism. Generalised tonic-clonic seizures were present in one child and one child had comorbid attention deficit hyperactivity disorder. These findings illustrate clinical heterogeneity among children with NRXN1 deletions and supports the need for larger studies to better define genotype-phenotype relationships.
Objective:Substance use disorder (SUD)-related emergencies are increasing globally, with cardiotoxicity contributing substantially to morbidity and mortality. This study evaluated cardiotoxicity patterns and factors associated with in-hospital mortality among adults with SUD presenting to the emergency department (ED). Methods:This retrospective observational study was conducted from January 2014 to December 2024 at Sultan Qaboos University Hospital, University Medical City, Muscat, Oman. Adults aged ≥18 years with SUD and positive urine drug screening (UDS) were included if they had elevated troponin (>14 ng/L), electrocardiographic abnormalities or echocardiographic structural dysfunction. Clinical, laboratory, imaging, management and outcome data were analysed. Results:A total of 4,400 ED medical records were reviewed; 478 patients had SUD and 78 (16.3%) met the inclusion criteria (mean age = 40.8 ± 12.3 years, 92.3% male). Opiate-class positivity on UDS was the most frequent finding (62.8%), followed by methamphetamine (29.5%). Sinus tachycardia (41.0%) and ST-T changes (15.4%) were the most common electrocardiographic abnormalities. Elevated troponin was present in 87.2%. Overall, in-hospital mortality was 15.4%. Hypokinesia (odds ratio [OR] = 5.12, 95% confidence interval [CI]: 1.08-24.22; P = 0.040) and left ventricular impairment (OR = 6.14, 95% CI: 0.95-39.88; P = 0.057) showed the strongest mortality associations. Conclusion:Among ED patients with SUD, positive UDS and cardiotoxicity, structural cardiac dysfunction was associated with higher in-hospital mortality. These findings support early cardiovascular assessment, including electrocardiography, troponin testing and selective echocardiography, in high-risk patients with substance-related toxicity.
Objectives:The Thoracic Trauma Severity Score (TTSS) is a composite scoring system developed to assess injury severity and predict outcomes in thoracic trauma. This study aimed to evaluate the performance of TTSS in predicting clinical outcomes in patients with isolated thoracic trauma in Oman. Methods:This retrospective observational study was conducted at two tertiary academic hospitals in Muscat, Oman, between January 2014 and December 2024 and included adult patients with isolated thoracic trauma. TTSS was calculated from demographic, radiological and clinical data. Its predictive performance was assessed using receiver operating characteristic analysis for mortality, intensive care unit (ICU) admission, and surgical intervention, and correlation analysis for ICU length of stay and duration of mechanical ventilation. Results:A total of 100 patients were included, of which most were male (77.0%), the mean age was 42.6 ± 17.3 years and the mean TTSS was 4.28 ± 3.35. TTSS showed significant discrimination for ICU admission (area under the curve [AUC] = 0.788, 95% confidence interval [CI]: 0.696-0.879; P <0.001) and was positively correlated with ICU length of stay and duration of mechanical ventilation. In contrast, TTSS showed poor discrimination for mortality (AUC = 0.643, 95% CI: 0.382-0.903; P = 0.402) and no discriminatory value for surgical intervention (AUC = 0.503, 95% CI: 0.382-0.625; P = 0.956), neither were statistically significant. Conclusion:TTSS was most useful for predicting ICU-related outcomes in isolated thoracic trauma, particularly ICU admission and respiratory support requirements. Its value for mortality and surgical intervention was limited in the current cohort, likely reflecting the very low number of deaths and the lesion-specific nature of operative decision-making.
Objectives:Temporary blood donor deferral can be a challenge in retaining donors and to maintain a stable blood supply. This study aimed to analyse the pattern of temporary donor deferral and its impact on their future return for donation. Methods:This retrospective study included deferred blood donors from the Blood Bank department of King Khaled University Hospital, Riyadh, Saudi Arabia, and included data from January 2021 till December 2023 with subsequent donors follow up till August 2025 were recorded. Effect of demographics, causes of temporary deferrals and gender wise distribution were compared between new and regular blood donors and their return for future re-donations. Results:A total of 47,522 whole blood donors were included in this study; 5,182 donors were deferred, of whom 97.3% experienced temporary deferral. Among these, 46.8% were new and 53.1% were regular donors. The leading causes of deferral were low haemoglobin/haematocrit (Hb/Hct; 45.9%), recent medication use (9.3%) and low blood pressure (8.8%). Donors deferred due to low Hb/Hct demonstrated lower return rates compared to those deferred for low blood pressure or medication use. Return rates among new donors ranged from 0-40%, whereas among regular donors it ranged from 37.5-100%, depending on the deferral category. Overall, the return rate was significantly lower in new donors and female donors (P <0.001 each). Conclusion:Temporary donor deferral has an effect on the future donations of the donor. This study highlights the need for stronger interventions, particularly donor education, reminder messages and follow-up to encourage the deferred donors to return, thereby supporting a consistent supply of safe blood for patients.
Objectives:This study aimed to assess the incidence and contributing factors of renal dysfunction among patients receiving intravenous (IV) acyclovir at Khoula Hospital, Muscat, Oman. Specifically, this study aimed to evaluate the incidence of acute kidney injury (AKI) following IV acyclovir administration, associated risk factors and potential preventive strategies to reduce nephrotoxicity. Methods:This retrospective cohort study was conducted at Khoula Hospital and included patients aged 12-80 years who received IV acyclovir between January 2019 and December 2023. Patients with pre-existing renal disease or increased baseline serum creatinine were excluded. The sample size was computed using Daniel's formula, resulting in a minimum sample size of 92 patients. Results:A total of 99 patients were included; 64.6% were males and 35.4% females. The incidence of AKI was 34.3% (n = 34, 95% confidence interval [CI]: 24.9-43.7). Dose reduction was required in 29.3% of AKI cases, and hydration with slow infusion was applied to all patients. Significant associations were observed with nationality, where non-Omani patients had a higher incidence of AKI compared to Omanis (66.7% versus 27.2%, odds ratio = 5.46, 95% CI: 1.79-16.04; P = 0.001). AKI incidence increased with the number of concomitant nephrotoxic medications (P = 0.004). Conclusion:Nationality and concomitant nephrotoxic medications were significantly associated with AKI risk in patients receiving IV acyclovir. Non-Omani patients on multiple nephrotoxic agents demonstrated higher susceptibility to AKI.
Objectives:Fibreoptic bronchoscopy has become a key procedure in critical care, transitioning from pulmonologists to intensivists. This study aimed to evaluate the effectiveness of a one-day simulation-based training programme in acquiring basic bronchoscopy skills. Methods:A one-day workshop was conducted at Sultan Qaboos Comprehensive Cancer Care and Research Centre, University Medical City, Muscat, Oman, in October 2024 with didactic lectures, small group skill stations, virtual bronchoscopy simulations and hands-on training using manikins and a novel, cost-effective, 3D-printed airway model. The pre-course knowledge of the attendees and their gain in skill were assessed with a 50-question survey tool. Results:A total of 61 participants attended the workshop; 53 attendants completed the pre- and post-training survey of which 38 were medical doctors (MDs) and 15 were non-MDs (respiratory therapists and nurses) whose average ages were 41.3 ± 8.6 years and 34.3 ± 5.5 years, respectively. Prior experience with bronchoscopy was indicated by 65.8% of the MDs and 60% of the non-MDs. Among the MDs, the pre-test post-test average correct response improved from 53.5% to 85.4% (gain of 31.9 percentage points; P <0.001). Non-MDs improved in a similar way from 54.2% to 86.2% (32 percentage point increase; P <0.001). The maximum gains were in sampling (MDs = 46.5%, non-MDs = 48.9%) and critical care practices (MDs = 36.2%, non-MDs = 38.3%). The participants were highly satisfied with scores ranging from 89.5-100%. Conclusion:The one-day simulation-based bronchoscopy workshop significantly enhanced intensivists' knowledge and practical skills. The manikin and the custom designed 3D-model were valuable tools in teaching bronchoscopy and furthering clinician confidence and competency. These results indicate the potential of brief, focused training in bronchoscopy in critical care, particularly utilising cost-effective, portable training tools in resource-limited areas.
Objectives:Antimicrobial resistance (AMR) is driven by inappropriate antibiotic use. This study aimed to assess the knowledge, attitudes and dispensing practices (KAP) regarding AMR and antimicrobial stewardship (AMS) among primary healthcare (PHC) pharmacists and assistant pharmacists in Oman. Furthermore, the study sought to compare these parameters across facilities with historically high versus standard antibiotic consumption to identify structural determinants of AMS. Methods:This national cross-sectional study was conducted among PHC pharmacy staff in February 2025. KAP were assessed via a structured electronic questionnaire. Data were analysed using generalized estimating equation models to identify KAP predictors while accounting for facility-level clustering. Results:A total of 333 PHC pharmacy staff were included in this study. Overall, 72.1% of participants had adequate knowledge and 78.7% showed favourable attitudes; however, only 56.2% demonstrated good practice. Knowledge was adequate in only 20.8% of staff at high-consumption centres compared to 76.1% at standard centres (P <0.001). Multivariable analysis confirmed that working in a high-consumption centre was strongly associated with reduced odds of adequate knowledge (adjusted odds ratio [aOR] = 0.08, 95% confidence interval: 0.05-0.14). While prior AMR training improved the odds of good practice (aOR = 2.04), this benefit was significantly diminished in high-consumption settings (interaction P = 0.030). Conclusion:Although Omani PHC pharmacy staff exhibit positive attitudes, significant knowledge gaps and practical barriers exist, particularly in high-consumption facilities. Interventions must move beyond generic training to include system-level strategies, such as integrating AMS tools within electronic health records, to address structural challenges in high-risk settings.
Corrigendum to: Al Abdulsalam R, Al Shaaibi H, Al Sanaa Al Zeedi M, Al Hadhrami R. Predictors of Caregiver Burden Among the Caregivers of Bedridden Patients in Muscat, Oman. Sultan Qaboos Univ Med J 2025; 26:20–8. https://doi.org/10.18295/2075-0528.2946
Type IV sacrococcygeal teratomas (SCTs) are the rarest subtype of SCTs. We report a 2-week-old female who presented to a tertiary care centre in Muscat, Oman, in 2024 with abdominal distension and feeding intolerance. Imaging revealed a purely cystic presacral lesion, managed with successful laparoscopic-assisted cyst excision and coccygectomy. Histopathology confirmed a mature cystic SCT and the patient was diagnosed with a purely cystic Altman type IV SCT. The postoperative course was uneventful apart from minor wound dehiscence, which resolved with conservative management. Follow-up showed complete wound healing and no recurrence. Purely cystic Type IV SCTs are extremely rare and challenging to diagnose due to their benign radiological appearance and lack of external manifestations. Complete surgical excision with coccygectomy remains the cornerstone of treatment; laparoscopic-assisted excision in neonates is feasible and safe.
Objectives:Despite Oman having a low HIV prevalence, stigma and lack of knowledge among young people may hinder prevention efforts. This study aimed to assess HIV/AIDS-related knowledge and misconceptions among Grade 10 students in Muttrah wilayat in Oman. Methods:This cross-sectional study was conducted in February 2025 and included Grade 10 students from 4 governmental schools in Muttrah selected via proportional stratified sampling. The sample size was calculated depending on the number of students in Grade 10. Data collection was performed during face-to-face interviews using a validated Arabic-language questionnaire. Results:A total of 271 Grade 10 students were included in this study. Only 11.8% of students showed good knowledge of HIV/AIDS (≥70% correct responses), while 48.7% showed poor knowledge (<50%). Male students were more likely to show poor knowledge than female students (59.7% versus 24.7%; P <0.001). Similarly, female students held low levels of misconceptions, defined as answering <50% of misconception items incorrectly compared to male students (82.4% versus 37.6%; P <0.001). Age was not associated with knowledge (P = 0.198); however, 14-15-year-olds held fewer misconceptions compared to 16-17-year-olds (P = 0.016). Common misconceptions included the possibility of transmission through mosquito bites or casual contact and existence of a vaccine or cure. Conclusion:The students showed inconsistencies in knowledge and persistent misconceptions. This suggests that structured HIV/AIDS education interventions in Omani schools might be beneficial, especially to target gender differences and myths. Further research is suggested to explore other elements linked to behavioural change, such as perceived susceptibility to contracting infection, attitudes and intentions to adopt preventive behaviours.
Objectives:This study aimed to determine whether it would be possible to reclassify the severity of secondary mitral regurgitation (MR) using an integrated mitral regurgitant volume (RVol) derived from computed tomography (CT) and echocardiography data. Methods:This cross-sectional study was conducted at Ibn al-Bitar Specialized Center for Cardiac Surgery, Baghdad, Iraq. Systolic CT data of patients with isolated secondary MR were evaluated from June 2023 to December 2025. The image with the highest regurgitant orifice area (ROA) and the smallest left ventricular volume was chosen from the CT systolic phase. To calculate the integrated RVol (iRVol), the velocity time integral obtained by echocardiography was multiplied by the mitral anatomic ROA (AROA) that was obtained using planimetry. Results:A total of 113 patients were included in this study. While the mean AROA and iRVol measured by CT were 0.143 ± 0.090 cm2 and 26.47 ± 10.61 mL, respectively, the mean effective ROA and RVol of MR measured by echocardiography were 0.175 ± 0.095 cm2 and 27.57 ± 8.82 mL, respectively. A total of 62% of patients were reclassified from severe to non-severe MR and 21% from non-severe to severe MR when iRVol grading was used instead of only echocardiography. Conclusion:By integrating the real cross-sectional mitral ROA measured by CT with Doppler mitral haemodynamics, a quantitative metric for MR severity (called mitral iRVol) was developed, leading to a clinically important reclassification of secondary MR grade.
Objectives:This study aimed to compare the efficacy of intralesional autologous platelet rich plasma (PRP) injection in post-traumatic and post-surgical scars to a control group managed with silicone-based products. In addition, this study aimed to determine the success rate via aesthetic result, symptom improvement and outcome in terms of complications using autologous PRP on scars caused by burns or trauma. Methods:This randomised controlled trial study was conducted from August 2022 and February 2024 at the Departments of Burns and Plastic Surgery, Surgical Gastroenterology and Obstetrics and Gynaecology, AIIMS, Bhubaneswar, India. Intralesional autologous PRP injections were administered to post-traumatic or post-surgical scars of 6 weeks to 1.5 years duration. The control group was managed with silicone-based products. Clinical outcome of the scars was assessed using the Patient and Observer Scar Assessment Scale (POSAS) to determine improvement in scar characteristics and aesthetics. The Likert scale was also employed to assess the aesthetic satisfaction. Results:A total of 34 patients were included in this study (17 in each group). The PRP group reflected a statistically significant result in terms of both patient and observer factors as a part of the POSAS score. The mean observer POSAS significantly decreased from 16.76 on day 7 to 12.47 at 5 months (P <0.001). Mean patient POSAS also significantly decreased from 26.41 on day 7 to 19.88 at 5 months (P <0.001). Statistically significant improvement in Likert scale in PRP group. Conclusion:Scars following trauma or surgery showcased a significantly more efficient and faster extent of aesthetic and symptomatic improvement when treated with autologous PRP compared to silicone products.
Objectives:This study aimed to evaluate the diagnostic yield and complications associated with computed tomography (CT)-guided transthoracic core-needle biopsy (CNB) of lung lesions and to identify factors influencing biopsy outcomes. Methods:This retrospective study included patients who underwent CT-guided CNB of lung lesions at Sultan Qaboos Comprehensive Cancer Care & Research Centre, University Medical City, Muscat, Oman, from November 2021 to December 2024. Patients were categorised as either having undiagnosed lung masses/nodules or suspected pulmonary metastases from known malignancies. Biopsies were performed using an 18-gauge coaxial needle, following standard protocols. Diagnostic yield, sample adequacy for molecular analysis and complications were analysed using descriptive statistics and Chi-squared or Fisher's exact tests. Results:A total of 105 patients were included. Diagnostic yield of CT-guided CNB was 81.9% (n = 86) with malignancy confirmed in 72.4% of cases. Diagnostic yield significantly correlated with lesion size with increasing accuracy for lesions >2.1 cm compared to those <1 cm (93.9% versus 55%; P = 0.003). Lesion morphology, localisation, positron emission tomography guidance and patient demographics had no significant effects statistically. Complications in 28.8% of patients were largely pneumothorax (21.2%), followed by haemoptysis (8.7%) and haemothorax (1.9%). Smaller lesions (<1 cm) and deeper locations (>5 cm) had higher rates of complications (P = 0.007 and P = 0.080, respectively). Conclusion:CT-guided lung biopsy demonstrated high diagnostic yield with acceptable rates of complications. Lesion depth and size had significant impacts on diagnostic success and occurrence of complications. These results support that CT-guided CNB is a safe and reliable diagnostic procedure for lung lesions, especially when lung lesions are superficially located and solid.
