Objectives: Inactive hepatitis B carriers constitute a considerable proportion of chronic hepatitis B virus (HBV)-infected patients. Understanding the clinical features of this often overlooked population is essential to inform patient management strategies. Our study aimed to describe the sociodemographic and clinical features of inactive HBV carriers presenting to a tertiary center in Muscat, Oman. Methods: We conducted a retrospective, descriptive study among 375 adult Omani patients with inactive HBV infections presenting to the Sultan Qaboos University Hospital between January 2017 and December 2018. Relevant data were collected from electronic patient records. Liver fibrosis status was determined using two-dimensional shear-wave elastography. Results: A total of 200 patients met the study inclusion criteria and were included in the analysis. Of these, 53.0% were male, and the mean age was 45.0 ± 9.3 years. Most (77.5%) were aged 32–50 years and were therefore born before 1990, the year of initiation of the national HBV vaccination program. A family history of HBV infection was reported in 29.0%, while 25.0% were obese. Severe fibrosis and cirrhosis were observed in 16.0% and 3.0% of the cohort, respectively. Conclusions: A large number of inactive Omani HBV carriers were born before the implementation of the national HBV vaccination program in Oman, and just under one-third had a family history of HBV infection. Notably, despite being considered inactive carriers, 19.0% displayed radiological features of severe fibrosis or cirrhosis. Screening for high-risk inactive HBV infection is essential to ensure early management and improved patient outcomes.

Keywords:Hepatitis B virus; Obesity; Elasticity Imaging Techniques; Liver Fibrosis; Oman.

Objectives: Antibiotic resistance in clinical isolates is often correlated to poor disease management or prolonged hospitalization. The study aimed to determine the prevalence of multidrug-resistant (MDR) Salmonella isolates in clinical samples collected from Dhaka, Bangladesh. Methods: We investigated 150 clinical samples for the presence of Salmonella. The Salmonella isolates were tested against 12 antibiotics categorizable into three groups based on action mechanism and nine classes based on chemical structure. The susceptibility patterns were analyzed using the Kirby-Bauer disk diffusion method on Mueller Hinton agar. The isolates were classified as MDR and extensively drug-resistant based on their resistance patterns against different antibiotics. Results: We used 100 Salmonella isolates for this study. The highest prevalence of resistance was observed against penicillin G (96.0%), cefuroxime (75.0%), and clindamycin (71.0%). The isolates exhibited 33.0% and 43.0% resistance against imipenem and meropenem, respectively. Almost all (98.0%) isolates showed MDR. A quarter of the isolates (23.0%) were resistant to five classes of antibiotics and 18.0% to six classes of antibiotics. Moreover, 20.0% of isolates exhibited extensive drug resistance. Among the cell wall synthesis inhibitors, the highest resistance was observed against penicillin G (31.0%). Resistance rates were in the range 20–30% against protein synthesis inhibitors, clindamycin (29.0%), tetracycline (21.0%), and chloramphenicol (21.0%). Among the Salmonella isolates, 90.0% showed multiple antibiotic resistance index scores of ≥ 0.3, while 65.0% scored ≥ 0.5. The carbapenem group accounted for the maximum sensitivity (62.0%), followed by 60.0% each for gentamicin and norfloxacin. Conclusions: The high prevalence of MDR Salmonella isolates in clinical samples from Bangladesh indicates a serious threat to public health. Our findings emphasize the urgent need to control MDR through promoting responsible use of suitable antibiotics and public awareness of the dangers of antibiotic misuse, increasing testing facilities, and promoting genetic research.

Keywords:Multiple Antibiotic Resistance Salmonella; Extensive Drug Resistance; Bangladesh.

Objectives: The management for chronic suppurative otitis media is tympanoplasty. The aim of the surgery is to prevent recurrent ear discharge and improve hearing. Several influencing factors are presumed to affect the outcome of tympanoplasty; however, their effect is considered controversial. No study in Oman evaluates the success rate of this surgery. Therefore, this study aimed to evaluate the anatomical and functional outcome of type 1 tympanoplasty in Al Nahdha Hospital, Oman, from 2010 to 2020. In addition, we sought to assess various factors that might have influenced the outcome and add our experience to the literature. Methods: We conducted a retrospective study that included all patients who had undergone type 1 tympanoplasty in Al Nahdha Hospital. The demographic data for patients were collected, in addition to the preoperative findings, pre- and postoperative air-bone gap (ABG) in a pure tone audiometry, the surgical approaches, and the type of grafts used. The success rate was defined as intact tympanic membrane six months after the surgery, and hearing improvement success was assessed by closure of ABG closure of 10 dB or more. Results: The total number of patients was 345, 40.6% were male, and 59.4% were female. The graft success rate was 84.3%. The average preoperative ABG was 26.1 ± 9.5, and the average postoperative ABG was 14.4 ± 9.3 with a gain of 11.7. This was statistically significant with a p-value of < 0.001. Hearing improvement (≥ 10 dB gain in ABG) was seen in 201 (67.0%) patients. There was no statistically significant difference in the hearing improvement and graft success rate when compared with influencing factors, including age, gender, perforation size, and surgical approach. However, there was a statistically significant difference between the types of graft used, where cartilage graft showed better hearing improvement than temporalis fascia graft. Conclusions: The graft success rate of type 1 tympanoplasty in Al Nahdha Hospital was 84.3%, and closure of ABG was 11.7. The percentage of patients who had improvement in ABG closure of ≥ 10 dB was 67.0%. These results are comparable with the results of other published studies. Factors that are presumed to influence the outcome of type 1 tympanoplasty were not statistically significant, which is consistent with other studies. Cartilage graft was found to give a better closure of ABG, which was statistically significant. We recommend that further studies be conducted within a more extended follow-up period and address more factors to achieve a better insight pertaining to the outcome of type 1 tympanoplasty.

Keywords: Tympanoplasty; Otitis Media, Suppurative; Hearing Loss, Conductive; Oman.

Hyperthyroidism-related liver disease is an uncommon cause of jaundice in children. There is scarce data on its clinical and histological features and management. We report the case of a five-year-old girl with thyrotoxicosis associated with hepatitis, which was managed solely and successfully with carbimazole and propranolol.

Keywords:Hyperthyroidism; Jaundice; Pediatrics; Autoimmune Hepatitis; Carbimazole; Oman.

Brown-Séquard Syndrome (BSS) in children is a rare but serious neurological condition that can develop following damage to one-half of the spinal cord due to odontoid synchondrosis fracture. We report a case of a two-year-old girl who presented with difficulty moving her neck, gait abnormalities, and right-side weakness. She had a history of a fall from bed three months earlier. Computed tomography scan and magnetic resonance imaging revealed an incomplete fracture of C2 vertebra, resulting in focal kyphosis and posterior impingement over the craniocervical junction along with significant cord thinning. Considering the patient’s age and the incomplete nature of the fracture, a conservative approach was taken, and the patient underwent immobilization in a cervical collar for an extended period, followed by physiotherapy.

Keywords:Odontoid fracture; Synchondrosis; Brown-Sequard Syndrome; Pediatrics; Pakistan.

Biotin is sometimes administered in mega doses to children to treat certain inborn errors of metabolism. We report the case of a one-week-old newborn who was started on a ‘mitochondrial cocktail’ that contained a high dose of biotin. On day seven of life, his thyroid function test showed a biochemical picture of primary hyperthyroidism, which was not clinically evident. The suspicion of immunoassay interference with thyroid function test was confirmed when another lab, using a different immunoassay, gave normal results. If the biochemical profile does not match the clinical picture, it is reasonable to doubt the test result and think of assay interference.

Keywords:Biotin; Hyperthyroidism, Immunoassay; Newborns; Thyroid Function Tests; Oman.

Ischemic priapism is a male urologic emergency. Most cases have been linked to genetic conditions such as sickle cell disease and (much more rarely) glucose-6-phosphate dehydrogenase deficiency, and the use of certain drugs. Here, we report the case of a 34-year-old male who was a known case of the recurrent ischemic type of priapism, which was relieved by penile aspiration. Genetic investigation revealed that the patient had glucose-6-phosphate dehydrogenase.

Keywords: Priapism; Glucose-6-Phosphate Dehydrogenase Deficiency; Ischemic; Oman.

Myiasis is the term referring to an infestation of dipterous larvae in the living body tissue, where they feed on the tissue and cause infection. It is typically found in individuals living in unhygienic conditions, with foul-smelling odor emanating from neglected wounds or body discharge, which attract flies to lay their eggs in the affected area. Myiasis can cause life-threatening complications if maggots invade vital organs, resulting in sepsis, hemorrhage, and organ dysfunction. The mainstay of treatment includes mechanical removal of the maggots, wound debridement, daily wound dressing, and administration of antibiotics for concurrent bacterial infections. Recently, we encountered a patient who presented with bleeding and foul-smelling discharge from a tracheostomy wound, which was found to be infested with maggots.

Keywords:Maggot Infestations; Tracheostomy; Wound Infection.

Hypocalcemia, deafness, and renal syndrome, also known as Barakat syndrome, is an autosomal dominant genetic condition characterized by hypocalcemia, sensorineural hearing loss, and renal dysplasia. Papilledema, which refers to optic disc swelling due to increased intracranial pressure caused by hypocalcaemia, has been reported in the literature. However, optic disc edema secondary to hypocalcemia-induced optic neuropathy with normal intracranial pressure is rare. In this case report, we present a rare case of hypocalcemia, deafness, and renal syndrome, possibly the first diagnosed based on the presence of hypocalcemia-induced optic disc edema. We suggest that patients with optic disc edema referred for further neurological investigations should have their serum calcium levels analyzed, as early diagnosis and correction of hypocalcemia may improve the signs and symptoms of optic nerve disease.

Keywords:Optic Nerve Diseases; Hypoparathyroidism; Hypocalcaemia; Barakat syndrome.