Though hypocalcemia in pregnancy is not often reported in the literature, it occurs in cases of hypoparathyroidism and in mothers with severe dietary inadequacy. Hypocalcemia during pregnancy can pose numerous problems to the mother and fetus. It is associated with hypertensive disorders and can increase the risk of numerous problems such as preeclampsia and fetal growth disorders. In this review, we summarize the challenges physicians face diagnosing and managing hypocalcemia during pregnancy. A multidisciplinary team including endocrinologists and obstetricians is warranted to ensure appropriate treatment and optimal outcomes.

Objectives: We sought to describe the frequency of encounters and complications of foreign body (FB) ingestion in children seen at Royal Hospital, Oman. Methods: Medical records of all children (≤ 13 years) who presented to Royal Hospital between 1 January 2011 and 31 December 2014 diagnosed with FB ingestion were reviewed. Children with FBs in their mouth or airway, with esophageal food impaction, and caustic ingestion were excluded from the analysis. Parameters including age, sex, type of FB, anatomical location of the FB on X-ray, endoscopic findings, and all complications were reviewed. Results: Of the 585 children diagnosed with FB ingestion, 385 were included in the study; 58.4% were males and 41.6% were females giving a male to female ratio of 1.4:1.0. Half (50.9%) of the children were less than three years old. Coins were the most frequently ingested objects (41.3%) followed by disc batteries (12.2%). Sixty-three patients (16.3%) required urgent esophagogastroduodenoscopy (EGD). EGD was performed mainly for coins (44.4%) followed by disc batteries (14.3%) in the esophagus or stomach. The complication rate was 5.2% in total, and 3.6% for clinically significant complications. We had no mortality cases. Conclusions: FB ingestion is common in toddlers in Oman. Coins and disc batteries are most commonly ingested calling for strict family vigilance. Endoscopy is done in a small number of children and clinically significant complications, in general, are low. However, these findings should not lead to a false sense of security, and ingested FBs should always be taken seriously.

Objectives: We sought to describe the epidemiological and clinical features of typhoid fever in Qatar. Methods: We conducted a retrospective study of adult patients treated for typhoid fever at Hamad General Hospital and Alkhor Hospital between 2005 and 2012. Results: The mean age of the 354 patients enrolled in the study was 28.4±9.3 years; 296 (83.6%) were males. There were 42, 48, 39, 44, 46, 47, 52, and 36 cases of adults with typhoid fever in 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012, respectively. Overall, 343 (96.9%) patients had a history of travel to endemic areas. Among them, 93.0% acquired typhoid fever in the Indian subcontinent. Fever was observed in all cases, and the other predominant symptoms were abdominal pain (38.1%), diarrhea (35.6%), and headache (33.1%). Salmonella typhi, showed high resistance to ciprofloxacin (n = 163; 46.0%), and low resistance to ceftriaxone (n = 2; 0.6%). Four patients developed intestinal perforation, which was surgically repaired in two cases. Two patients (0.6%) died. Conclusions: Typhoid fever was frequent among immigrants to endemic areas. Travelers returning from endemic areas with suspected typhoid fever should be treated empirically with third-generation cephalosporin after obtaining appropriate cultures. Moreover, preventive measurements such as education on food and water hygiene, and effective vaccination of travelers should be practiced widely among travelers to endemic areas to reduce morbidity and mortality.

Objectives: We sought to evaluate the effects of omega-3 and vitamin E co-supplementation on carotid intima-media thickness (CIMT) and inflammatory factors in patients with polycystic ovary syndrome (PCOS). Methods: This randomized, double-blind, placebo-controlled trial was done among 60 women with PCOS. Participants were randomly assigned into two groups (n = 30 each group) and assigned to take either 1000 mg omega-3 plus 400 IU vitamin E supplements or a placebo for 12 weeks. Results: Compared with placebo, omega-3 and vitamin E co-supplementation led to significant decreases in maximum levels of left CIMT (-0.006±0.006 vs. +0.002±0.007 mm, p < 0.001), mean levels of left CIMT (-0.005±0.006 vs. +0.002±0.010 mm, p = 0.010), maximum levels of right CIMT (-0.006±0.010 vs. +0.006±0.010 mm, p = 0.010), and mean levels of right CIMT (-0.005±0.005 vs. +0.001±0.010 mm, p = 0.020). Change in high-sensitivity C-reactive protein (hs-CRP) (-390.6±942.9 vs. +237.0±754.3 ng/mL, p = 0.006) was significantly different between the supplemented patients and placebo group. We did not observe any significant effect in plasma nitric oxide (NO) values following supplementation with omega-3 plus vitamin E compared with the placebo. Conclusions: Co-supplementation with omega-3 and vitamin E for 12 weeks among patients with PCOS had beneficial effects on CIMT and serum hs-CRP values, but unchanged NO values.

Objectives: Contralateral inguinal exploration in pediatric unilateral inguinal hernia has been an issue of debate. Controversy still exists on whether contralateral patent processus vaginalis (CPPV) is justifiable for herniotomy. This study was conducted to investigate the hypothesis that CPPV always necessitates herniotomy. Methods: This prospective study was conducted on 200 pediatric patients aged 2–120 months old. All patients clinically diagnosed with a unilateral inguinal hernia underwent a clinical examination of both inguinoscrotal regions followed by ultrasonography to elucidate CPPV in both sides. Herniotomy was then performed on the hernia site with laparoscopic evaluation of CPPV. Contralateral herniotomy was performed in 44 patients with Chin’s type III CPPV while the rest were followed-up for three years to detect the appearance of any contralateral inguinal hernia. Results: The current study included 158 boys and 42 girls (ratio of 3.8:1.0). Hernia was more common on the right side (n = 136) than the left side (n = 64). Bilateral herniotomy was performed on 44 patients with Chin’s type III CPPV, while the remaining 156 patients underwent unilateral herniotomy. During the follow-up period, contralateral hernia appeared in 58 patients; the remaining 98 patients, proved to have CPPV did not complain of a clinical hernia during that period. Conclusions: Inguinal herniotomy for CPPV seems not to be necessary in all cases. This would decrease the use of anesthesia and surgical morbidity in young infants and save hospital resources through avoidance of unnecessary operations.

Objectives: This study aimed to develop the required interprofessional competencies for health service managers in Oman. Methods: Experts (n = 20) were selected based on their years’ experience, position, fluency in English (both verbal and written), and who had completed higher education at either masters or doctorate levels in the relevant field. The data collection consisted of three rounds. Responses were collected and extracted from a web-based designed survey and subsequently analyzed. Results: Experts agreed on the nine interprofessional domains and 41 competencies based on the inclusion of means (M) ≥ 4.4, an interquartile distribution (IQD) ≤ 1.25, and > 80.0% agreement. Findings revealed that there were levels of agreement (90.0% to 95.0%) among the experts in the nine interprofessional competency domains namely: resilience (M = 4.7, IQD = 0.40), research leverage (M = 4.7, IQD = 0.60), interprofessional ethics (M = 4.7, IQD = 0.80), quality improvement (M = 4.7, IQD = 0.80), information technology (M = 4.6, IQD = 0.80), leadership (M = 4.5, IQD = 1.00), management skills (M = 4.5, IQD = 0.80), communication (M = 4.5, IQD = 1.00), and team dynamics (M = 4.5, IQD = 1.00). Conclusions: The development of interprofessional competencies for health service managers is an impetus to strengthen the human resources capabilities, sustain a high level of quality patient outcomes, and to achieve the Ministry of Health’s Health Vision 2050.

Objectives: Fear of childbirth is common during pregnancy and may contribute to several adverse outcomes. We aimed to investigate childbirth fear and associated factors in a sample of pregnant Iranian women. Methods: This cross-sectional study was conducted on 525 pregnant women in Sabzevar, Iran from December 2016 to March 2017. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) was used to investigate fear of childbirth. Results: The mean W-DEQ score was 67.6±23.5. Of 525 women, 19.6% and 6.1% experienced moderate (mean W-DEQ score ≥ 85) and severe (mean W-DEQ score ≥ 100) fear of childbirth, respectively. W-DEQ scores were not different in the categories of gestational age, parity, maternal age, educational level, body mass index, and employment status (p > 0.050). The mean score of childbirth fear was significantly higher in multiparas who preferred cesarean in comparison to those who preferred vaginal delivery (p < 0.032). The mean score of childbirth fear was significantly higher in nulliparas with a lower family income compared to those with a higher family income (p < 0.011). In nulliparas, predictors of moderate and severe childbirth fear were women’s description of their present pregnancy (odds ratio (OR) = 2.600; 95% confidence interval (CI): 1.323–5.112), and receiving a low level of emotional support from their husband (OR = 4.450; 95% CI: 1.349–14.674), respectively. In multiparas, predictors of childbirth fear were unwanted pregnancy (OR = 2.930; 95% CI: 1.549–3.541), experiencing moderate to severe dyspareunia in the first intercourse (OR = 2.829; 95% CI: 1.479–5.414), having a low level of physical activity (OR = 1.942; 95% CI: 1.014–3.716), and perceived a low level of health (OR = 3.415; 95% CI: 1.172–9.950). Conclusions: We observed a relatively high prevalence of childbirth fear in pregnant women in Iran. Interventions should be implemented in high-risk women considering psychological variables.

Objectives: We sought to determine the effects of the delayed start protocol with gonadotropin-releasing hormone (GnRH) antagonists in poor responders undergoing in vitro fertilization (IVF). Methods: This randomized clinical trial was conducted during a 15-month period from April 2014 to July 2015 in clinics in Shiraz, Iran. A total of 42 poor responders with primary infertility were randomly assigned to the controlled ovarian stimulation group utilizing the delayed start protocol (n = 21) or the traditional group (n = 21) using GnRH antagonist, Cetrotide. The primary endpoint was the number of patients undergoing oocyte pick-up, implantation, and the rate of pregnancy. Results: The baseline characteristics of the two study groups were comparable including age, infertility duration, and body mass index. The number of follicles measuring > 13 mm in diameter (p = 0.057), retrieved oocytes (p = 0.564), mature metaphase II oocytes (p = 0.366), embryos (p = 0.709), and transferred embryos (p = 0.060) were comparable between the two groups. The number of patients undergoing oocyte pick-up (p = 0.311), the rates of implantation (p = 0.407), and pregnancy (p = 0.596) were also comparable between the two groups. Conclusions: The delayed start protocol was not associated with better conception results or cycle outcomes in poor responders with primary infertility undergoing IVF cycles.

Objectives: We sought to evaluate the characteristics and correlates of psychiatric problems in the wives of men with substance-related disorders. Methods: Four-hundred and fifty women whose husbands had substance-related disorders were selected by purposive sampling for inclusion in the study. Results: The prevalence of psychiatric symptoms in our sample was 67.1% (n = 302). Depression was the most prevalent symptom (n = 63) and the least was psychosis (n = 5). The prevalence of psychiatric symptoms was highest (26.0%) among women with opiate-dependent spouses (n = 117), and those with hallucinogen-dependent spouses had the lowest prevalence (4.2%). We found a significant relationship between the prevalence of psychiatric disorders and demographic factors including age, women’s education, spouse’s education, women’s job, duration of marriage, number of children, monthly income, and history of psychiatric disorders with the exception of spouses’ jobs. Conclusions: There is a high prevalence of psychiatric symptoms among the wives of men with substance-related disorders and there is need to devise mechanism to reduce the high prevalence of psychiatric disorders.

Acquired cervical aerocele in adults is a rare condition and its delay development after tracheostomy decannulation is reported rarely. Our patient presented eight years after tracheostomy decannulation with a compressible anterior neck mass that only appeared when she coughed and could be deflated using manual compression. The mass was situated suprasternal at the previous tracheostomy scar. Computed tomography scan showed a paratracheal air sac without significant defect at the tracheal wall. Surgical intervention is the best treatment for symptomatic patients. As in this patient, we advise direct laryngoscopy and bronchoscopy for diagnostic and therapeutic purposes in such cases. However, our patient refused any surgical intervention.

Lemierre’s syndrome is a rare, life-threatening condition, which may be fatal if not properly treated. This disease refers to thrombophlebitis of the internal jugular vein, which is the result of bacterial sore throat infection (usually in the form of pharyngitis) that extends into the parapharyngeal space. However, it can result from other infective foci in the ear, nose, parotid glands, and paranasal sinuses. The bacteria typically responsible is Fusobacterium necrophorum. Here, we describe a case of Lemierre’s syndrome that occurred in a 20-year-old female who presented with neurological deficits following a two-week history of upper respiratory tract infection. Our case displayed typical findings of this rare condition with a review of the previous literature and also to emphasize the importance of high index of suspicion to reduce the mortality of this disease.

Choriocarcinoma of the ovary is a rare neoplasm and tends to metastasize early to involve the lungs, brain, and liver. Metastasis to the gastrointestinal tract is rare. We report the case of a young lady, who presented with life-threatening gastrointestinal bleeding, secondary to jejunal involvement. The site of bleeding was localized using a computed tomography angiogram following inconclusive upper and lower gastrointestinal endoscopies. The bleeding jejunal segment was resected and the metastatic disease responded to combination chemotherapy. Metastatic choriocarcinoma of the ovary should be considered a possible diagnosis in patients presenting with gastrointestinal bleeding.

Mitral valve regurgitation (MR) is a common problem in patients with cardiac issues especially those with dilated cardiomyopathy (DCM) due to mitral annular dilatation and malcoaptation of the mitral valve leaflets. Although DCM is associated with high mortality rates, there has been no global agreement about the best method of treatment. Treatment of MR in such cases can be done by surgery, which has many limitations due to high-risk concerns. MR may also be managed by other alternatives such as mitral-clip and transcoronary venous mitral annuloplasty using the Carillon® Mitral Contour System®. Combined therapy with a cardiac resynchronization therapy defibrillator (CRT-D) and mitral contour can be used in such cases with valuable improvement in general condition in many patients. In our case, we used the Carillon Mitral Contour System for treatment of severe MR in a 64-year-old patient with severely impaired systolic function after implantation of a CRT-D.