The effect of low-carbohydrate ketogenic diet in the management of obesity compared with low caloric, low-fat diet.

BACKGROUND & AIMS: Previous studies comparing low-carbohydrate ketogenic diet (LCKD) and low caloric fat low diets (LCLF) in obesity management are still controversial. This study evaluated the effect of LCKD in weight reduction compared to the LCLF diet among Omani obese adults. METHODS: This prospective cohort study was conducted at the National Diabetes and Endocrine Centre (NDEC), Royal Hospital, Muscat, Oman, between 2015 and 2017. We included 200 (100 in each group) obese patient with Body Mass Index (BMI) more than 30kg/m2, who attended the outpatient department and met the inclusion criteria were enrolled in the study for six months follow-up. Anthropometric, biochemical and clinical data was gathered before starting the diet. Follow-up outcomes included reduction in weight, fat mass and visceral fat, lipid profile and HbA1c. Data were analysed using SPSS-24. RESULTS: The LCKD group showed a significant reduction of 13.0 kg (95% CI: 11.0-15.1) in body weight compared to 4.7 kg (95% CI: 3.4-5.9) in the LCLF group with p-value<0.001. LCKD group showed a significant reduction of 4.0% (95% CI: 3.3-4.7) in fat mass, compared to 1.4% (95% CI: 0.83-1.9) in the LCLF group with p-value<0.001. In addition, LCKD group showed a significant reduction of 2.5L (95% CI: 2.0-2.9, P < 0.001) in visceral fat compared to 1.2L (95% CI: 0.86-1.56) P < 0.001) in the LCLF group with p-value<0.001. Combined with significant reduction in HbA1c with 0.69% (95% CI: 0.5-0.89, P < 0.001) in LCKD and a reduction of 0.74% (95% CI: 0.47-1.2, P < 0.001) in LCLF. Furthermore, this diet has not increased lipid profile with a mean reduction of 0.19 mmol/L (95% CI: 0.003-0.37, P < 0.001) in total cholesterol and mean change of 0.04 mmol/L (95% CI: 0.12-0.21) in LDL level. In addition, it has not increased uric acid with a mean reduction of 20.8 umol/L (95% CI: 4.8-36.7), (P = 0.01). CONCLUSION: LCKD seems superior to LCLF in weight, fat mass and visceral fat reduction. In addition, this diet does not increase serum cholesterol and uric acid, which encourage the use of this diet in obesity management.

Evaluation of Risk Factors of Snake Envenomation and Associated Complications Presenting to Two Emergency Departments in Oman.

Objectives: To assess the risk factors of snake envenomation and the associated complications that patients present with, using data from two different emergency departments in Oman. The secondary aim was to describe the common characteristics of the presenting patients. Methods: This multicenter retrospective observational study reviewed all cases presenting with symptoms of snakebite to the emergency departments of Sultan Qaboos University Hospital (tertiary) from March 2016 until August 2017 and Rustaq Hospital (secondary) from August 2015 to August 2017. Results: A total of 212 cases met the inclusion criteria. Coagulopathy was observed in 82 (38.7%) patients, while 14 (6.6%) had acute kidney injury (AKI) and 5 (2.4%) had external bleeding. Of the patients who developed AKI, 85.7% (p < 0.001) had encountered the snake in a valley and initially had bleeding from the site of the bite (p < 0.001) and vomiting (p < 0.007). The delay in receiving the anti-snake venom (ASV) increased the risk of AKI (p < 0.016). Of the patients who developed coagulopathy, 47.6% (p < 0.001) had encountered the snake on a farm and 72.0% (p < 0.002) received the bite to a lower limb. Increased time from bite to ASV was associated with development of coagulopathy (p < 0.001). No patient death was recorded. Conclusions: The location (terrain) where the snake was encountered was associated with the patient's risk for either AKI or coagulopathy, which suggests the preference of different snake species to different types of habitat. The time elapsed between the bite and the ASV administration was associated with higher risk of development of AKI or coagulopathy.

Cutaneous Manifestations of COVID-19: An Experience From Oman.

OBJECTIVES: To identify the cutaneous manifestations in COVID-19 disease in Oman. METHODS: The study was conducted in two phases with initial cross-sectional data collection with subsequent telemedical investigations of late skin manifestations including confirmed COVID-19 patients evaluated at Al-Nahdha Hospital and local health centers in Muscat from March 22 to June 2, 2020. RESULTS: The total number of patients included in the study was 374. Cutaneous manifestations were observed in 1.87% (n=7) of patients at presentation with an additional 1.6% (n=5) on follow-up. The types of skin reactions included maculopapular rash (n=6), urticaria (n=2), transient pruritic erythema (n=1), pruritic palmoplantar erythema (n=1), pustular eruption (n=1) and flare-up of atopic dermatitis (n=1). CONCLUSIONS: The low percentage of skin lesions is not contradicting previous data and it might just reflect under-reporting of skin rash in the context of the presence of more severe symptoms in our sample population. Skin lesions can still be utilized to treat patients as suspected cases until proven otherwise as it can be a silent clue in asymptomatic patients.