This systematic review explores the effectiveness and safety of a short-term regimen (STR) in treating multidrug-resistant tuberculosis (MDR-TB). We use several cohort studies which were searched using standardized Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The keywords were used based on problem, intervention, comparison, and outcome consisted of MDR-TB and STR. Seven cohort studies were selected from 314 studies. The result showed that STR has better therapeutic efficacy and shorter duration than the 2011 World Health Organization regimen for MDR-TB with success rates above 50% in respective studies. The most effective regimen was kanamycin-high-dose isoniazid-clofazimine-ethambutol-prothionamide-pyrazinamide-gatifloxacin in the intensive phase for four months and clofazimine-ethambutol-pyrazinamide-gatifloxacin-prothionamide in the continuation phase for eight months. Gastrointestinal problems, ototoxicity, dysglycemia, and liver problems were the most reported side effects. STR provides good effectiveness in MDR-TB treatment in terms of treatment success rate and short therapy duration.

COVID-19 pandemic has been associated with high short-term morbidity and mortality. Lungs are the main organs affected by SARS-CoV-2 infection. In the long-term, the pulmonary sequelae related to COVID-19 are expected to rise significantly leading to an extended impact on community health and health care facilities. A wide variety of long-term respiratory complications secondary to COVID-19 have been described ranging from persistent symptoms and radiologically observable changes to impaired respiratory physiology, vascular complications, and pulmonary fibrosis. Even after two-years, respiratory sequalae related to post-acute SARS-CoV-2 infection have not been fully explored and understood. The main treatment for most COVID-19 respiratory complications is still symptomatic and supportive-care oriented. In this review article, we shed light on current knowledge of the post-COVID-19 complications, focusing on pulmonary fibrosis, treatment directions, and recommendations to physicians.

Keywords: COVID-19; Pulmonary Fibrosis.

Objectives: Anaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman. Methods: This retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records. Results: One hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0–16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1–0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25–8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0–972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p = 0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p = 0.010). Conclusions: Due to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

Objectives: Prostate cancer (PCa) is the third most common cancer worldwide, with its incidence rising in the Middle East. There is a paucity of data about the clinicopathological features and outcomes of metastatic prostate cancer (mPCa) from the Middle East. We report the outcomes of mPCa from Oman. Methods: We recruited consecutive men diagnosed with mPCa and treated at Sultan Qaboos University Hospital in Oman between January 2006 and December 2017. Information about demographics, clinical, laboratory, pathological, and radiological features at presentation, treatment, and survival outcomes was collected. Data were gathered until April 2019 or until the patient’s death for progression-free survival (PFS) and overall survival (OS), whichever came first. Survival rates were estimated using the Kaplan-Meier method. Univariate and multivariate analysis and Cox regression analyses were performed to study factors affecting the PFS and the OS. Results: Of the 239 men diagnosed with PCa over the study period, 62 were diagnosed with mPCa. The median age was 71 (range = 57–92) years. The majority of patients (61.3%) had a Gleason score ≥ 8. Median prostate-specific antigen (PSA) level was 100.0. Bone was the most common site of metastatic disease (90.3%). The majority of patients with the hormone-sensitive disease were treated with testosterone suppression only, while abiraterone, enzalutamide, and docetaxel were added for treating metastatic castration-resistant mPCa (mCRPC). After a median follow-up of 34.5 months, the median PFS was 17 months, while the median OS was 43 months. Median survival post mCRPC was 17 months. Conclusions: Omani patients with mPCa present with high PSA and Gleason score and with widespread metastatic disease burden. Treatments offered are according to internationally accepted standards and have comparable PFS and OS as reported elsewhere.

Objectives: We sought to determine the prevalence of renal osteodystrophy (ROD) and its related factors in a group consisting of end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis. Methods: A total of 128 ESRD patients (52 men and 76 women) with a mean age of 59.3 years undergoing maintenance hemodialysis at Imam Reza Referral Hospital, Iran were included in this cross-sectional study. We measured serum parathyroid hormone (PTH) levels and determined 150 to 300 pg/mL as the desirable range for the values. Values lower or higher than this range were used to determine ROD. Furthermore, this study investigated the association of ROD with clinical and laboratory variables (age at the onset of renal failure, hemodialysis sessions per week, clinical symptoms associated with ROD, and serum calcium and phosphate levels). Results: ROD was diagnosed in 93 (72.7%) out of 128 patients studied. Of them, 53 (41.4%) patients had PTH levels above 300 pg/mL (high bone turnover, HTO group) and 40 patients (31.3%) had PTH levels below 150 pg/mL (low bone turnover, LTO group). No statistically significant difference was detected in terms of ROD-related clinical findings (p = 0.110), age at the time of ESRD diagnosis (p = 0.200), and the number of hemodialysis sessions per week (p = 0.200). Hyperphosphatemia was more prevalent in the ROD group (n = 52, 57.1%) compared with 11 patients (31.4%) included in the group without ROD (p = 0.004). Conclusions: The prevalence rate of ROD in this study was significant, and it was largely consistent with the rate reported in some Asian countries. Hyperphosphatemia were laboratory variables closely related to ROD.

Objectives: We sought to translate the parallel forms (parent and child versions) of English versions of the Loneliness and Dissatisfaction Questionnaire (LSDQ-C), Parent Child Relationship (PCRQ-C), and Conflict Behavior Questionnaire (CBQ-C) into Hindi and evaluate their psychometric properties. Methods: Hindi translation and cross-language adaptation of LSDQ-C, PCRQ-C, and CBQ-C were done following WHO guidelines. Children aged 10–18 years old studying in either government or private schools of Chandigarh were enrolled through snowball convenient random sampling technique. Psychometric properties were assessed using intraclass correlation (ICC), Chronbach’s alpha, test-retest reliability, paired t-test, and split-half reliability. Results: Item wise test-retest reliability of the Hindi version of all scales was assessed, and for most items, the ICC value was > 0.80, indicting good to excellent reliability. ICC value was in the acceptable range for a few items for the child version of the scales (0.70). Split half reliability was > 0.80. Our findings suggest good to excellent agreement between the English and Hindi version of all the scales. Conclusions: The internal consistency, split-half reliability, and test-retest reliability are good to excellent. Thus, the Hindi version of parallel forms (parent and child versions) LSDQ, PCR, and CBQ as translated in this study is a valid instrument.

Keywords: Parent-Child Relations; Surveys and Questionnaires;  Loneliness; Cross-Cultural Comparison; India.

Objectives: In the last decade, bulk-fill materials were introduced to allow resin-based composites (RBC) in one layer (up to 4-5 mm thick) with optimum polymerization. We sought to evaluate the adaptation ability of different bulk-fill composites resin (CRs)and restoration marginal integrity. Methods: A total of 28 caries-free and crack-free human molars underwent mesio-occlusal-distal cavity preparation. Each sample prepared the mesial margins on enamel, and the distal margins were extended into dentin. Teeth were then randomly distributed into four groups (n = 7 per group) according to the CR used to restore the cavity. Three bulk-fill CRs—Smart Dentin Replacement Flow+, 3M™ Filtek™ One Bulk Fill (FBF), and Tetric® N-Ceram Bulk Fill (TBF)—and one conventional CR (CC)—Filtek™ Z350—were used. The teeth were then subjected to aging via thermocycling, followed by cyclic loading. Finally, the volumetric width of the interfacial gap at the tooth-restoration interface was measured using a microcomputed tomography (µ-CT) analysis. Results: SDR demonstrated the smallest gap volume among all tested CRs, followed by CC in enamel and TBF in dentin after aging. FBF showed the highest gap volume. There was no statistically significant three-way interaction between surface, aging, and material (p > 0.050). Conclusions: It is safe to suggest using bulk-fill RBC in deep class II cavities instead of conventional layered RBC when dealing with dentin margins. However, further clinical investigation is required.

Objectives: We sought to develop and validate a diabetic risk score model as a non-invasive and self-administered screening tool to be used in the general Omani population. Methods: The 2008 World Health Survey (WHS) data from Oman (n = 2720) was used to develop the risk score model. Multivariable logistic regression with the backward stepwise method was implemented to obtain risk factors regression coefficients for sex, age, educational attainment, marital status, place of residence, hypertension, body mass index (BMI), waist circumference, tobacco use, daily fruit and vegetable intake, and weekly physical activity. The model coefficients were multiplied by a factor of five to allocate each variable category a risk score. The total score was calculated as the sum of these individual scores. The score was validated using another Omani cohort (Sur Survey 2006 dataset, n = 1355) by calculating the area under the receiver-operating characteristic (ROC) curve (AUC), and optimal score sensitivity and specificity were determined. Results: A robust diabetes risk score model was produced composed of eight variables (age, sex, education level, marital status, place of residence, hypertension, smoking status, and BMI) with an optimal cutoff point of ≥ 15 to classify persons with possible prevalent type 2 diabetes mellitus (T2DM). At this cutoff point, the model had a sensitivity of 71.1%, specificity of 74.4%, and AUC of 0.80 (95% confidence interval (CI): 0.78–0.82), when internally validated (in the WHS 2008 cohort). When the model was externally validated (using the Sur 2006 cohort), the optimal cutoff point for the score was ≥ 13, with a lower sensitivity (54.0%), higher specificity (79.0%), and an AUC of 0.74 (95% CI: 0.70–0.78). In contrast, the test of the old Omani, Kuwaiti, Saudi, and Finnish diabetes risk scores in our study populations showed poor performance of these models among Omanis with poor sensitivity (29% to 63.5%) and reasonable specificity (70% to 80%). Conclusions: The developed diabetes risk score for screening prevalent T2DM, provides an easy-to-use self-administered tool to identify most individuals at risk of this condition in Oman. The score incorporates eight diabetes-associated risk factors that can also act as a tool to increase people’s awareness about the importance of diabetes-related risk factors and provide information for policymakers to establish diabetes prevention programs.

Objectives: Diabetic ketoacidosis (DKA) is a life-threatening complication and a leading cause of hospitalization in patients with type 1 diabetes mellitus (T1DM). We aimed to assess the risk factors of admissions of children with DKA in a specialized children’s hospital to reduce morbidity and inform appropriate prevention and intervention strategies. Methods: We conducted a retrospective review of all DKA admissions at King Abdullah Specialized Children’s Hospital, Riyadh (March 2015–December 2017). Data were gathered from newly diagnosed patients with T1DM and known patients ≤ 14 years old with DKA criteria. The main variables were frequency, precipitating factors, and other characteristics of DKA admissions in both groups. Results: A total of 116/562 patients with T1DM (mean age 8.9±3.0 years) had 146 DKA episodes, of which 42/116 (36.2%) were newly diagnosed. The frequency of DKA admissions were 146/562 (26.0%), of which 42/141 (29.8%) were newly diagnosed versus 104/421 (24.7%) known T1DM patients. The majority were 10–14 years old (p ≤ 0.001), and 77.8% were females. Missing insulin was the main cause of DKA (p = 0.001) among known patients with T1DM. Recurrent episodes (n = 30/146, 20.5%) occurred in 15/116 patients and were more common in children ≥ 10 years of age (p = 0.024). The mean length of stay was 2.6±2.0 days and increased with DKA severity (p = 0.008). Conclusions: Most DKA episodes were in patients with known T1DM and missing insulin was the leading cause of DKA. In addition to awareness campaigns to prevent DKA as an initial presentation, intervention strategies should also target high-risk groups of known patients of T1DM such as adolescents and patients with recurrent episodes.

Keywords: Diabetic ketoacidosis; Diabetes Mellitus, Type 1; Risk Factors; Saudi Arabia.

Objectives: Despite guidelines recommending no need for coagulation testing before surgeries when a history of bleeding is negative, surgeons still overuse it in this part of the world. We aim to measure unbiased estimates of hemostatic outcomes in ear, nose, and throat (ENT) surgeries and assess the surgeons’ behavior of preoperative coagulation testing. Methods: We enrolled all patients who underwent ENT surgeries from July 2017 to January 2018. The primary outcome was postoperative bleeding. Surgeons were asked about their decision on history alone or doing coagulation testing and their reason. Results: We recruited 730 patients; 372 were interviewed for a challenging bleeding history alone (group 1), and 358 had preoperative coagulation testing (group 2). Coagulation testing was repeated twice or more in 55.0% of patients, and more than half had coagulation factor and Von Willebrand factor assays. Most surgeons performed coagulation testing because of habitual practice. Conclusions: Almost half of the local surgeons consider coagulation testing as standard to evaluate bleeding risk before surgical procedures. This resulted in unnecessary delays in surgeries, parent/patient anxiety, and additional total cost. We recommend awareness campaigns for surgeons and the involvement of surgical societies to adhere to guidelines of detailed hemostatic history.

Keywords: Risk Factors; Blood Loss, Surgical; Hemostatics; Surgeons; Blood Coagulation Tests.

Patients with heterozygous β-thalassemia are generally asymptomatic. However, the intermediate phenotype is uncommon, and patients require further investigation to confirm the diagnosis. We describe a 32-year-old woman (gravida 3, para 2) with heterozygous β-thalassemia who presented with symptomatic anemia and had a history of frequent blood transfusion in each pregnancy. Physical examination was unremarkable. Laboratory results at presentation showed hypochromic microcytic anemia with reticulocytosis. Molecular study revealed intermedia phenotypes resulting from coinheritance of heterozygous β-globin chain mutation (IVS1-5) and a rare heterozygous α-globin triplication (αααanti-3.7). In this case report, we discuss the laboratory diagnostic approaches and the challenges faced in investigating this case.

Diabetic striatopathy is a neurological condition in patients with diabetes characterized by hemichorea-hemiballismus due to vascular and metabolic derangements in basal ganglia. This is a known entity in type 2 diabetic adult patients; however, seen rarely in pediatric patients with type 1 diabetes. Diabetic striatopathy develops in patients with poor glycemic control in the absence of ketosis. The patient tolerates hyperglycemia for a long time, which results in metabolic injury.

Para-Bombay blood phenotype is a rare blood group with limited cases reported worldwide. This blood group is characterized by the absence of ABH antigen on red blood cells but presence of ABH secretor substances in the body secretion. This rare phenotype is usually misinterpreted as O and may endanger the patient if urgent blood transfusion is required. A mother who was labelled as group O Rh D positive during antenatal follow-up was found to have ABO discrepancy during delivery. The newborn was admitted for extremely premature delivery at 25 weeks. As the baby required transfusion, problem arose during cross matching with the mother’s sample. It was found that the mother was group O Rh D positive in forward grouping. However, the reverse grouping showed the presence of reaction (2+) in O cells. The baby was grouped as O Rh D positive. As transfusion was urgently needed due to baby’s unstable condition, group O Rh D positive packed cell was found compatible with baby’s serum, subsequently transfused. Bombay blood donor was contacted, and the donated blood was sent to the hospital for further management. Further investigations were performed, indicating that the mother is para-Bombay A. Due to recent transfusion to baby, we suggested to repeat baby’s blood group after the baby is one year old. Para-Bombay was usually mislabelled as O if the sample was not tested with O cell in reverse grouping. Additional tests may be needed during antenatal follow-up to prevent complications during delivery, which requires emergency blood transfusion.