Anatomical variations of Koerner's septum: a computed tomography-based, single-centered study.

BACKGROUND: Koerner's septum (KS) is a bony plate located at the junction of the petrous and squamous parts of the temporal bone. The reported prevalence of KS varied between studies. KS variations are associated with various pathologies and pose difficulties during surgeries. The study aims to determine the KS frequency in Omani patients and analyze its association with sex and side. METHODS: The present study investigated the KS topography in 344 computed tomography (CT) scans of normal temporal bones of adult Omani patients at Sultan Qaboos University Hospital. The presence of KS and its parts (complete or incomplete), as well as its thickness at three anatomical landmarks were recorded. Additionally, sex and laterality differences in KS parameters were analyzed using a Chi-square test. RESULTS: The overall frequency of KS among Omani subjects was 39.5%. The complete KS was observed only in 14% of cases. The thickness of KS was 0.78 ± 0.21 mm, 0.93 ± 0.28 mm and 0.78 ± 0.21 mm at the head of the malleus (HM), the superior semicircular canal (SSC) and the tympanic sinus (TS), respectively (p < 0.01). KS was present most constantly at the level of HM (64.7%), followed by SSC (57.4%), and less constantly at the level of TS (49.3%). KS frequency was similar in both males than females (41.9% vs 37.3%), with statistically insignificant difference (p = 0.38). No side differences were observed concerning KS frequency (p = 0.955). CONCLUSION: The KS frequency in Omani subjects within the range of previously reported studies. It is incomplete in most of the cases and constantly present at the level of HM. Its thickness is more at the level of SSC.

Prevalence of cervical ribs and elongated transverse processes in Omani population: a computed tomography-based study.

INTRODUCTION: Cervical ribs are the supernumerary ribs that usually arise from the seventh cervical vertebra. Ethnic and geographical variations in cervical ribs and elongated transverse processes have been reported. Therefore, we aimed to study the prevalence of cervical ribs and elongated transverse processes and morphometry of cervical ribs in Omani subjects using computed tomography (CT). METHODS: A total of 1165 consecutive patients' CT scans of the cervical spine who had visited the tertiary care hospital from January 2016 to December 2020 were included in the study. The CT scans were screened for cervical ribs and elongated C7 transverse processes. Fisher's exact test was used to determine the gender influence. RESULTS: Cervical ribs were identified in 0.94% of patients with a male-to-female ratio of 0.37:1. Most cervical ribs were unilateral (54%). The elongated C7 transverse process was identified in 18.45% of patients, with a male-to-female ratio of 1.36:1. Female patients are more likely to have cervical ribs (effect size = 5.98, 95% CI = 1.58-22.6, p = 0.005) than male patients. In contrast, the elongated C7 transverse process is more frequent in males (effect size = 1.82, 95% CI = 1.34-2.47, p < 0.001). The length and width of the cervical ribs are presented. CONCLUSION: The prevalence of cervical ribs in Omani subjects is close to that of accepted prevalence worldwide. However, the elongated C7 transverse process prevalence is comparatively high and close to the Saudi population.

Personality Traits and Potential Career Choices Among Medical Students at Sultan Qaboos University: A Cross-Sectional Study.

Background Personality plays a vital role in choosing a medical specialty. Despite this, research is scarce on this subject, especially in Oman. This study aimed to investigate the correlation between the personality traits of medical students at Sultan Qaboos University (SQU), Muscat, Oman, and the specialty they wished to undertake after graduation. Methods This was a cross-sectional study. Two hundred and thirty-four medical students completed the Big Five personality questionnaire and were asked what specialty they would like to choose. The specialties were divided into three namely, surgical-oriented, medicine-oriented, and basic medicine. An ANOVA test was used to find any statistically significant correlation between personality traits and the desired specialty. Results The students who chose surgery-oriented specialties had significantly higher scores in the extraversion and openness means (P<0.05) than the students who opted for medicine-oriented specialties and basic medicine. The students who chose basic medicine had significantly higher scores in the neuroticism means (P<0.05) than the other groups. Conclusion The students who chose surgery-oriented specialties were more likely to be highly extraverted and open, while the medical students who chose basic medicine were more likely to have higher neuroticism levels when compared with the other groups. This study indicates that there is a correlation between personality traits and desired specialty. Further studies should be done to investigate if these personality traits remained similar after graduation.

Alendronate for Effective Treatment of Male Osteoporosis : An Insight.

Osteoporosis is a major global health problem. The increase in the incidence of osteoporosis in the elderly poses a challenge to treat and also results in an economic burden for the nation. Osteoporosis has been given more importance in females, and there is an urgent need to address this disease in males. Various drugs, such as nitrogen-containing phosphonates, RANK ligand inhibitors, parathormones, and alendronate, have been used for effective treatment of osteoporosis. Alendronate (alendronic acid), a nitrogen-containing bisphosphonate that inhibits bone resorption by osteoclasts, was synthesized during the 1970s. In the present review, we discuss the pharmacokinetics, mechanism of action, adverse effects, contraindications, and toxicity monitoring of alendronate. The drug may be effectively used for the treatment of male osteoporosis in order to increase bone mineral density and prevent fractures.

Tebentafusp as a Promising Drug for the Treatment of Uveal Melanoma.

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults and commonly occurs in the Caucasian population. The malignancy involves the uvea of the eye, which includes the iris, ciliary body, and choroid. The etiology of UM is still not well understood, but age is a risk factor. Symptoms include blurred vision, redness of the eye, floaters, dark spots, a change in the size of the pupil, and loss of vision. The location, shape, and size of the tumor are important for therapeutic purposes. Treating metastasis is always a challenge in UM cases. In cases of lung metastasis, the survival rate decreases. Treatment includes surgery, laser therapy, immunotherapy, hormone therapy, and chemotherapy. Recently, in 2022, the United States Food and Drug Administration (FDA) approved the drug tebentafusp. Tebentafusp was developed to target the most common HLA complex in humans. The present review discusses the indications for the use of a new drug tebentafusp, its mechanism of action, dose, pharmacokinetics, results of clinical trials conducted, and adverse effects like cytokine release syndrome. Hence, tebentafusp is the first T cell receptor (TCR) therapeutic drug that could be considered for the treatment of UM.

Gut Microbiota and Insulin Resistance: Understanding the Mechanism of Better Treatment of Type 2 Diabetes Mellitus.

Gut microbiota refers to the population of trillions of microorganisms present in the human intestine. The gut microbiota in the gastrointestinal system is important for an individual's good health and well-being. The possibility of an intrauterine colonization of the placenta further suggests that the fetal environment before birth may also affect early microbiome development. Various factors influence the gut microbiota. Dysbiosis of microbiota may be associated with various diseases. Insulin regulates blood glucose levels, and disruption of the insulin signaling pathway results in insulin resistance. Insulin resistance or hyperinsulinemia is a pathological state in which the insulin-responsive cells have a diminished response to the hormone compared to normal physiological responses, resulting in reduced glucose uptake by the tissue cells. Insulin resistance is an important cause of type 2 diabetes mellitus. While there are various factors responsible for the etiology of insulin resistance, dysbiosis of gut microbiota may be an important contributing cause for metabolic disturbances. We discuss the mechanisms in skeletal muscles, adipose tissue, liver, and intestine by which insulin resistance can occur due to gut microbiota's metabolites. A better understanding of gut microbiota may help in the effective treatment of type 2 diabetes mellitus and metabolic syndrome.

Deleterious Biological Effects of Endocrine Disruptors: An Insight into Human Health Risks.

Endocrine-disrupting chemicals (EDCs) are environmental pollutants. Since EDCs are present in various consumer products, contamination of human beings is very common. EDCs have deleterious effects on various systems of the body, especially the endocrine and reproductive systems. EDCs interfere with the synthesis, metabolism, binding, or cellular responses of natural estrogens and alter various pathways. Biological samples such as blood, saliva, milk, placental tissue, and hair are frequently used for biomonitoring and the detection of EDCs. Early detection and intervention may help in preventing congenital anomalies and birth defects. The common methods for determining the presence of EDCs in body fluids include gas chromatography, high-performance liquid chromatography, and mass spectrometry. Understanding the health effects and dangers of EDC is important, given their widespread use. This mini-review aims to summarize the adverse biological effects of several important classes of EDCs and highlights future perspectives for appropriate control.

Unusual Presentation of Aggressive Atypical Hemolytic Uremic Syndrome With Brugada Syndrome.

Hemolytic uremic syndrome (HUS) is part of a spectrum of disorders known as thrombotic microangiopathies. These disorders are characterized by giving rise to platelet microthrombi, which subsequently develop hemolytic anemia and thrombocytopenia. In HUS, the kidneys are destroyed, mainly due to damage to the renal blood vessels. HUS can be typical or atypical, depending on the cause, and can lead to significant mortality rates. We herein report an unusual case of atypical HUS in a 15-year-old female who presented with fatigue, abdominal pain with nausea and vomiting, loss of appetite, and urine discoloration. Further tests showed low platelets with significant anemia. She was diagnosed with atypical HUS after discovering that she had no previous bloody diarrhea episode with a negative E. coli strain, O157:H7, alongside valid ADAMTS13 activity. The diagnosis was confirmed by genetic testing, and a variant of uncertain significance was found in the CFH gene. The patient, therefore, was started on eculizumab, and a follow-up was done once or twice a month through blood testing. She showed significant improvement. Due to non-compliance with the eculizumab treatment, the patient showed deterioration numerous times. A kidney biopsy was subsequently done, showing signs of acute to chronic thrombotic microangiopathy with moderate tubular atrophy and interstitial fibrosis. After many hemodialysis and plasma exchange sessions and being put on several treatments, such as prednisolone and rituximab, the patient faced death after one year.

Knowledge and Attitude Towards the Elderly Among Doctors and Medical Students: A Questionnaire-Based Study.

INTRODUCTION:  There is a continuous rise in the total number and percentage of elders globally, and as such, they are expected to utilize healthcare services more often. Therefore, this study aimed to determine doctors' and students' current knowledge and attitudes toward elders and compare those findings with other studies worldwide. The specific objectives of this study were to determine and compare the differences in attitudes between medical students and doctors regarding geriatrics. This comparison will focus on the following four key domains: social values, resource distribution, compassion, and medical care. Another objective was to assess the knowledge of medical students and doctors regarding geriatric topics. This assessment will help determine the necessity for interventions such as educational programs and workshops on geriatrics. METHODS: This cross-sectional questionnaire-based study was conducted by disseminating a Google Forms survey to medical students and doctors. The survey included the University of California, Los Angeles (UCLA) Geriatrics Attitudes Scale and the UCLA Geriatrics Knowledge Test. Data was analyzed using SPSS version 29.0.2.0 (Armonk, NY: IBM Corp.). RESULTS:  A total number of 126 medical students and 72 doctors filled out the survey. Both medical students and doctors demonstrated moderate scores on the attitudes scale, with overall average scores of 2.92 out of 5 and 2.93 out of 5, respectively. As for knowledge, medical students achieved an average score of 41%, while doctors attained an average score of 43%. CONCLUSION:  This study provides significant insights regarding the knowledge and attitudes of students and doctors and attitudes towards geriatrics. The moderate attitudes score and poor knowledge score across both groups indicate the need for medical educators in Oman to further emphasize and teach about geriatrics in medical curricula.

Prescription Patterns of Analgesic Drugs in the Management of Pain Among Palliative Care Patients at a Tertiary Hospital in Oman: A Retrospective Observational Study.

Objectives Analgesic drugs are commonly used to alleviate the pain experienced by palliative care (PC) patients. Thus, we sought to determine the prescription patterns of analgesic drugs in the management of pain among haematology and oncology palliative care patients at Sultan Qaboos University Hospital (SQUH) and then see if they were following the World Health Organization (WHO) guidelines. Methods A retrospective observational cross-sectional study was conducted, and adult PC patients prescribed analgesics for pain relief between January 2018 and January 2021 at SQUH constituted the sample. Data were collected from patients' electronic medical records using the SQUH TrakCare system. The data was then presented descriptively using graphs and tables. Results Data from 200 PC patients were analyzed. Breast cancer was the most common malignancy, with 73 (36.5%) patients diagnosed with it. Severe pain was the most reported degree of pain, with exactly 100 (50.0%) patients experiencing it. More patients experienced mild pain than moderate pain. Opioids were the most prescribed analgesics, followed by analgesics and antipyretics, anticonvulsants, and finally non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol was the most prescribed analgesic for pain overall, with 127 (63.5%) patients utilizing it. For severe pain, morphine was the most prescribed analgesic, with 65.0% of patients using it. Fentanyl and pregabalin, the strongest two analgesics, increased in prescription for severe pain compared to mild and moderate pain, with both being prescribed to 23.0% of patients suffering from severe pain. The oral route of administration was the most prescribed, with 128 (64.0%) utilizing it. Conclusion This study showed the prescription patterns of analgesic drugs for palliative care patients at SQUH. The findings were similar to those of other studies, though there were some differences. The prescription patterns of analgesic drugs prescribed for the various pain levels among PC patients were found to be in accordance with the WHO guidelines.

Knowledge, Attitudes, and Perceptions of Artificial Intelligence in Healthcare Among Medical Students at Sultan Qaboos University.

Background Artificial intelligence (AI) is increasingly used in healthcare, but more data are needed about the knowledge, perceptions, attitudes, and preparedness of medical students in Oman towards this technology. This study aimed to investigate these aspects among clinical-year medical students at Sultan Qaboos University. Methodology A web-based validated exploratory questionnaire adapted from a study conducted at the University of Toronto was distributed to all clinical year (phase III) medical students at Sultan Qaboos University. The questionnaire collected demographic and background information, tested students' knowledge of AI, and assessed their perceptions and attitudes toward it. The data were analyzed using the Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY). Results A total of 221 out of 368 clinical-year medical students (60%) completed the survey. Most respondents were in their junior clerkship year (n = 94, 42.5%). Most students (n = 167, 75.4%) had no prior exposure to AI in healthcare, with a median knowledge score of 3.25 out of 5 in AI, and showed no improvement over the years. However, they overall had positive perceptions and attitudes towards AI. Students also had concerns about the impact of AI on employment prospects and ethical issues but were generally receptive to incorporating AI into medical school curricula, as 174 students (78.7%) believed every medical trainee should receive training on AI competencies. Conclusion This study provides valuable insights into the knowledge, perceptions, attitudes, and preparedness of medical students in Oman toward AI in healthcare. Medical educators in Oman should consider incorporating AI into medical school curricula to prepare future physicians for using this technology in healthcare.

Investigating Impostorism Among Undergraduate Medical Students at Sultan Qaboos University: A Questionnaire-Based Study.

Background Imposter syndrome or phenomenon (IP) is a behavioral phenomenon observed in successful individuals where they fail to recognize and internalize their achievements. It is often accompanied by feelings of self-doubt, anxiety, depression, and worries of being exposed as frauds, with the impostors often attributing their achievements to external factors like good luck and timing. The presence of IP among medical students is gaining more attention, with studies reporting a strong association with burnout phenomenon, anxiety, and depression. Objectives This study sought to determine the prevalence of IP among Omani medical students and classify the levels of severity among the sample. Methodology This was a cross-sectional, observational study conducted at a public university in Muscat, Oman. The Clance Impostor Phenomenon Scale (CIPS), a validated publicly available questionnaire, was used to determine whether students exhibited impostorism. Students who scored 63 or higher in the CIPS were classified as impostors. In addition, students were also classified based on the severity of their impostorism. As per the CIPS, scores between 41 and 60 indicate mild impostorism, scores between 61 and 80 indicate moderate impostorism, and finally scores between 81 and 100 indicate severe impostorism. Results A total of 276 students participated (M 34%, F 66%), of which 144 (52.2%) were found to have IP with 12.7% exhibiting severe impostorism.  Conclusion The results show that IP is present in significant frequencies among medical students; further studies are needed to address this problem.

Incidental Diagnosis of Primary Pleural Liposarcoma in a COVID-19-Positive Patient.

A few cases of primary liposarcoma of pleura have been reported worldwide. We report a young gentleman who was admitted with what was initially thought as coronavirus disease 2019 (COVID-19)-related pulmonary symptoms. His chest CT showed a large pleural effusion causing a mediastinal shift and compressing vital structures. He did not respond to conservative drainage intervention and subsequently underwent a left thoracotomy for his worsening clinical picture. He was found to have a large left pleural mass that was incompletely resected. Histopathology examination showed low-grade soft tissue sarcoma with lipogenic differentiation suggestive of myxoid liposarcoma. He was subsequently given adjuvant chemotherapy but succumbed and died because of the progression of the disease.

Severe Gastric Ulcerations With Impending Necrosis in a Patient Who Had Gastric Balloon Insertion Following Previous Sleeve Gastrectomy.

In this report, we discuss the case of a 44-year-old obese female patient who had her recently installed intragastric balloon removed due to ulceration in the gastric mucosa, which would have led to necrosis as shown by oesophago-gastro-duodenoscopy (OGD). In addition, she had symptoms of nausea, vomiting, dysuria, fever, and experienced severe dehydration, which could have resulted in the formation of ureteric and renal stones. Thus, she was rehydrated and was started on antibiotics. She also underwent successful removal of the intragastric balloon aimed at preserving and healing of the remaining gastric mucosa. Post-op findings were unremarkable; however, a tight peptic stricture at the proximal stomach was formed four weeks after her balloon removal.

A Rare Case of a Left Ventricular Pseudoaneurysm With Lateral Wall Rupture.

In this report, we present a case of a 51-year-old male patient with a left ventricular (LV) pseudoaneurysm and a ruptured lateral wall due to a previous myocardial infarction. This patient was referred to the Coronary Care Unit with a past history of acute coronary syndrome of two months. He presented with palpitations and acute pulmonary edema upon admission. Color Doppler detected a ruptured lateral ventricular wall, and an echocardiogram confirmed the presence of a lateral ventricular wall pseudoaneurysm. Emergency LV aneurysmal rupture repair surgery was performed on this patient, and the postoperative findings were stable till discharge.

Posterior Detachment of the Anorectum Following Blunt Trauma to the Perineum.

To the best of our knowledge, there have been few reports in the literature about perineal injury without an associated pelvic fracture. In this report, we are going to discuss the mechanism, management, and outcome of two cases of perineal injury associated with car accidents. The two cases, one male and one female, presented with sustained isolated soft tissue injuries to the perineum. Both cases revealed a separated anorectum from the coccyx and sacrum without detectable damage to the lumen or surrounding sphincter. Pelvis fracture was not present in either case nor did the urinary bladder or urethra show signs of injury. A defunctioning (temporary) colostomy medical innervation was done to both and the perineal wound was left to heal. At last, both patients were satisfied with the final outcome.