The endurance shuttle walk test (ESWT) is a simple, acceptable, field-based test first established in 1999 to measure endurance exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to examine the reliability and responsiveness of ESWT in COPD. Of the 791 articles identified through electronic databases, 17 were included in this review. Qualitative and quantitative analyses were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and as per Consensus-Based Standards for the Selection of Health Status Measurements Instruments, the quality of the studies was graded as low for reliability and moderate for responsiveness. Qualitative analysis indicated inadequate evidence for the reliability of the ESWT in patients with COPD. The meta-analysis found strong evidence that ESWT was responsive to change following pulmonary rehabilitation with an estimated mean difference (ESWT time, seconds) 303.19 s (95% CI: 175.63–430.75; p< 0.001), ambulatory oxygen with a mean difference (ESWT time, seconds) 129.04 s (95% CI: 47.98–210.09; p = 0.002), and (ESWT mean distance, meters) 80.71 m (95% CI: 38.66–122.76; p < 0.001). The ESWT was also responsive to bronchodilation with a mean difference of 168.62 m (95% CI: 117.03–220.21; p < 0.001). Our findings suggest the strong potential of ESWT as a responsive test in COPD, but to draw a definitive conclusion regarding the reliability of the ESWT, further research is needed in this population.

Keywords: Exercise Tolerance; Walk Test; Pulmonary Disease, Chronic Obstructive.

Objectives: From early 2020, Malaysia had to implement nationwide lockdowns, quarantines, and other social distancing practices to contain the spread of COVID-19 virus, leading to symptoms of psychosocial burnout among the people. The aim of the present research is to develop and validate a Malay language version of the COVID-19 Burnout Scale (M-COVID-19-BS). Methods: This three-phase study was conducted among Malaysian population. Phase 1 involved forward and backward translations of the Scale to Malay language by four professional bilingual translators. In Phase 2, the new M-COVID-19-BS instrument was piloted on 30 participants who suggested minor lexical modifications. Phase 3 consisted of online recruiting of Malaysian citizens to answer a composite questionnaire comprising the M-COVID-19-BS, Copenhagen Burnout Inventory (CBI), World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF), and Fear of COVID-19 Scale (FCV-19S). Data were statistically analyzed. Results: The composite four-part questionnaire in Malay was answered by N = 225 Malaysian citizens. The M-COVID-19-BS instrument demonstrated a good internal consistency (Cronbach’s alpha = 0.926) and had a unidimensional factor structure. M-COVID-19-BS scores positively correlated with the three CBI subscales, showing evidence of convergent validity. Negative correlation was reported between M-COVID-19-BS and WHOQOL-BREF, achieving discriminant validity. M-COVID-19-BS also exhibited moderate positive correlations with the FCV-19S, thus supporting its concurrent validity. Conclusions: Results demonstrate that M-COVID-19-BS is a valid and reliable instrument to assess burnout symptoms related to COVID-19 among Malay-speaking populations either collectively or as a self-care tool to detect burnout symptoms without needing to further burden the already overwhelmed Malaysian healthcare system.

Keywords:COVID-19; Burnout; Reliability; Validation; Psychometrics; Malaysia.

Objectives: Patient ‘no-shows’ (failure to keep or cancel appointments) is a global problem that impacts healthcare systems by delaying patient access to healthcare, reducing quality of care, and wasting resources. The no-show phenomenon has not yet been studied in Oman despite it having grown in importance ever since the appointments system was implemented in 2014. This study aimed to characterize the no-shows in primary healthcare facilities in Oman. Methods: We collected and analyzed administrative data during the period 2014–2017 from 14 primary healthcare institutions in Oman focusing on the ophthalmology, ear, nose, and throat, and dermatology clinics therein. Results: The overall no-show rates were > 50.0%. No-show probabilities were higher in males, younger adults, new appointments, early morning appointments, appointments during Ramadan, and appointments scheduled farther in advance. Patient experience with the appointment system reduced the no-show probability. Conclusions: Policymakers should consider these trends to optimize the number of appointments per day, and researchers should further investigate no-shows for other specialties and levels of care.

Keywords:Primary Health Care; Patient Appointments; No-Show Patients; Oman.

Objectives: Significant delays occur in referring cases for care of endometriosis, despite women suffering for years. This study was conducted to assess whether there is a specific symptom profile characteristic of endometriosis to alert physicians for earlier referrals. Methods: In this retrospective observational cohort study, patient data of the women who attended Sultan Qaboos University Hospital from January 2011 to December 2019 with a diagnosis of endometriosis was collected from the hospital’s electronic data archive and analyzed. Results: Cases of N = 262 endometriosis patients were studied. The diagnosis was surgical in 198 (75.6%) of patients and the remaining 64 (24.4%) were diagnosed by clinical assessment and imaging. The mean age at diagnosis was 30.7±6.8 years (range = 15–51). The presence of ovarian endometrioma on ultrasound served as an alert for earlier referral. The mean age at diagnosis for those who had an endometrioma was 30.3±6.7 years and 32.4±7.1 years for those without an endometrioma without a significant difference. The mean age at diagnosis for those who did not have pain was 31.2 years and those with pain was 30.0 years (p = 0.894; CI: -2.58–2.91). Among the 163 married women in the sample, 88 (54.0%) had primary infertility, and 31 (19.0%) had secondary infertility. There was no significant difference between the groups in the mean age at diagnosis (analysis of variance test; p = 0.056). Over the nine-year period, diagnosis was made at progressively younger ages (p = 0.047).
Conclusions: Based on this study, no specific symptom profile appears to predict an early diagnosis of endometriosis. However, over the years the diagnosis of endometriosis is made earlier likely due to increasing awareness of women and their physicians about
the disease.

Keywords: Endometriosis; Delayed Diagnosis; Quality of Life; Infertility, Female; Pelvic Pain; Oman.

Objectives: We sought to determine the clinical presentations and ultrasonographic features of uterine fibroids in adult Ghanaians. Methods: Between 1 January 2018 and 31 December 2021, 4279 ultrasound-confirmed cases of uterine fibroids were retrieved. The data obtained, which included age, clinical presentations, and sonographic features were analyzed. A chi-squared test was done to assess for possible associations between the clinical indications, age distribution, and ultrasonographic features of uterine fibroids. Results: The mean age of the patients diagnosed with uterine fibroids was 37.1±11.5 years (range = 16–69 years). Routine checkup (n = 1310, 28.1%), menorrhagia (n = 1104, 23.7%), and lower abdominal mass (n = 801, 17.2%) were the leading clinical indications. Dysmenorrhea, amenorrhea, menorrhagia, and routine checkup were significantly noted in the younger patients (p ≤ 0.001). The majority of the fibroid nodules had smooth regular outline (n = 4125, 96.4%) and were mostly heterogeneous (n = 3282, 76.7%). The echo pattern of the nodules was predominantly hypoechoic (n = 3358, 51.1%) followed by hyperechoic nodules (n = 2554, 38.9%). Degenerative changes accounted for less than one-third of the total fibroid nodules, with the least recorded degenerative change being nodules with cystic areas (n = 55, 5.4%) and the most observed degenerative feature being nodules with rim of calcification and areas of calcified degeneration (n = 965, 94.6%). Almost all the sonographic features were significantly seen in the 30–44 years age category. Conclusions: Sonographically, uterine fibroids were mostly hypoechoic heterogeneous nodules with a smooth regular outline with a predominant occurrence within women in the fourth to fifth decade of life.

Keywords:Leiomyoma; Ultrasonography; Ghana.

Objectives: Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran.
Methods: The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity. Results: 72.4% of the subjects were living alone, 92.9% required support in activities of daily living , and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach’s alpha, intra-cluster correlation coefficient, and McDonald’s omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance. Conclusions: The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.

Keywords:Aging; Accidental Falls; Psychometrics; Activities of Daily Living; Fear; Iran.

Objectives: The purpose of this study was to assess the effects of habitual chewing of khat (Catha edulis) on blood pressure, body mass index, and physiological aspects of sexuality among residents of an Ethiopian town. Methods: A statistically determined and randomly selected sample of khat-chewing individuals in the town of Hosanna in Southern Ethiopia were included in the study. We used physical measurements and a self-administered questionnaire to collect the data, which was statistically analyzed. Results: The participants comprised a total of 420 with mean age = 28.7±5.7 years; 336 (80.0%) were male. Nearly half (201; 47.9%) were in the age-group 30–34 years. The adverse effects of khat use were assessed from the median score of each outcome, namely, physical problems, abuse potential, and social effects. Having a score above the median on each of the three target outcomes was equated with the presence of adverse effects. Adverse effects were reported among 341 of 420 (81.2%) participants, of whom 277 of 341 (81.2%) were male and 64 of 341 (18.8%) were female. The reported adverse effects were significantly higher among those who co-used tobacco, coffee, or tea with khat, with adjusted odds ratio = 4.8; CI: 2.86–8.22. Conclusions: Khat chewing was found to have a significant adverse effect on the health of individuals who indulged in it. This finding implies the need for urgent intervention from health authorities.

Keywords: Catha edulis; Khat; Mairungi; Miraa; Substance Abuse; Ethiopia.

Objectives: COVID-19 vaccines lower the risk of infection hospitalization, and death. Despite the safety and effectiveness of COVID-19 vaccines, some caregivers are hesitant to vaccinate their children against COVID-19. In this study, we explored the factors that influence Omani mothers’ intentions to vaccinate their 5–11 year-old children. Methods: Of the 954 mothers approached, 700 (73.4%) participated in a cross-sectional face-to-face interviewer-administered questionnaire in Muscat, Oman, between 20 February and 13 March 2022. Data on age, income, level of education, trust in doctors, vaccine hesitancy, and intention to vaccinate their children were collected. Logistic regression was used to assess determinants of mothers’ intention to vaccinate their children. Results: Most mothers had 1–2 children (n = 525, 75.0%), had a college degree or higher education (73.0%), and were employed (70.8%). More than half (n = 392, 56.0%) reported that they were likely or very likely to get their children vaccinated. The intention to get children vaccinated was associated with older age (odds ratio (OR) = 1.05, 95% CI: 1.02–1.08; p = 0.003), trust in their doctor (OR = 2.12, 95%, CI: 1.71–2.62; p < 0.001), and low vaccine hesitancy (OR = 25.91, 95% CI: 16.92–39.64;
p < 0.001). Conclusions: Understanding the factors that influence caregivers’ intentions to vaccinate their children against COVID-19 is important for the development of evidence-based vaccine campaigns. To increase and sustain high vaccination rates for COVID-19 vaccination in children, it is critical to address the factors that cause caregiver hesitation about vaccines.

Keywords:COVID-19; Vaccine Hesitancy; Intention; Children; Immunization; Oman.

Objectives: Congenital uterine anomalies (CUAs) occur because of malformation of the female genital tract at any stage of the Müllerian duct development process. This retrospective study investigated the prevalence of CUAs and tubal blockage in infertile Omani women who underwent a hysterosalpingogram procedure as part of the evaluation of infertility. Methods: The radiographic reports of patients aged 19–48 years who underwent hysterosalpingogram as part of infertility evaluation during the 2013–2018 period, were collected and analyzed for the presence and the type of CUAs. Results: The records of N = 912 patients were evaluated, 44.3% of whom had been investigated for primary infertility and 55.7% for secondary infertility. Patients with primary infertility were significantly younger than those with secondary infertility. Of the 27 (3.0%) patients who were found to have CUAs, 19 had arcuate uterus. No correlation was found between the type of infertility and the CUAs. Conclusions: CUAs were prevalent in 3.0% of the cohort, most of whom were diagnosed with arcuate uterus.

Keywords:Infertility; Hysterosalpingography; Uterine Anomalies; Uterus; Oman.

Objectives: This study aimed to determine the prevalence of different types of intimate partner violence (IPV) experienced by married Iranian women and their impact on the growth and development of their children. Methods: For this descriptive-analytical study, we recruited the mothers of one-year-old children attending primary health centers in Gonbad-e-Kavoos city, Iran. The data was collected using a questionnaire comprising the World Health Organization Domestic Violence, Ages and Stages Questionnaire-12; and queries related to the participants’ socio-economic, obstetrics, demographic, and anthropometric characteristics. The body mass index z (BMI z) scores of the children were divided into five categories based on the World Health Organization’s classification: severely underweight (z < -3), underweight (-3 ≤ z < -2), normal (-2 ≤ z < 1), overweight (1 ≤ z ≤ 2), and obese (z > 2). The data were subjected to descriptive analysis, chi-square test, and regression. Results: A total of 596 of mother-child dyads were included in this study. The prevalence of psychological, physical, and sexual IPV was 29.5%, 7.4%, and 2.4%, respectively. Most children (91.7%) had normal weight while the rest were overweight or obese. Developmental problems were reported in 1.7% of children. The education level of the father was significantly related to IPV
(p = 0.001) while the type of his occupation was related to delay in child growth (p = 0.020). There was no significant difference between BMI z-score and developmental disabilities in the children of women exposed and not exposed to any type of IPV. Conclusions: The prevalence of psychological IPV was high while those of physical and sexual IPV were low. The rates of poor child growth and development were also low. The father’s educational and socio-economic status influenced IPV and the children’s growth deficits.

Keywords:Child Development; Growth; Intimate Partner Violence; Women; Iran.

Objectives: This study sought to determine whether early prone positioning of patients with moderate to severe COVID-19-related acute respiratory distress syndrome (ARDS) lowers the mortality rate. Methods: We conducted a retrospective study using data from intensive care units of two tertiary centers in Oman. Adult patients with moderate to severe COVID-19-related ARDS with a PaO2/FiO2 ratio < 150 on FiO2 of 60% or more and a positive end-expiratory pressure of at least 8 cm H2O who were admitted between 1 May 2020 and 31 October 2020 were selected as participants. All patients were intubated and subjected to mechanical ventilation within 48 hours of admission and placed in either prone or supine position. Mortality was measured and compared between the patients from the two groups. Results: A total of 235 patients were included (120 in the prone group and 115 in the supine group). There were no significant differences in mortality (48.3% vs. 47.8%; p = 0.938) and discharge rates (50.8% vs. 51.3%; p = 0.942) between the prone and supine groups, respectively. Conclusions: Early prone positioning of patients with COVID-19-related ARDS does not result in a significant reduction in mortality.

Keywords: Respiratory Distress Syndrome; Positive-Pressure Respiration; Prone Position; Retrospective Studies; COVID-19; Oman.

A right atrial myxoma extending to the inferior vena cava with associated right-to-left shunting leading to systemic desaturation is an exceedingly rare clinical entity. The number of cases reported in the literature to date is not more than five. This case study presents a 45-year-old female who was referred to our center with symptoms of breathlessness, easy fatigability, generalized weakness, and central cyanosis. On routine blood investigation, polycythemia was detected. On preoperative 2D-transthoracic echocardiography, the diagnosis of right atrial mass was confirmed but the reason for cyanosis was not revealed. A tumor thrombus in a branch of the right lower pulmonary artery with a small locoregional pulmonary infarct along with right atrial myxoma was reported in computed tomography angiography of the heart and great vessels. On-table transesophageal echocardiography showed patent foramen ovale (PFO) with right-to-left shunting because of raised right atrial pressure and dynamic obstruction of the tricuspid valve by the mass. The myxoma was resected completely via right atrial approach along with primary closure of PFO. Postoperative period was uneventful, and the patient was discharged on day seven. At three-month follow-up, the patient was doing well.

Keywords: Atrial; Mass; Myxoma Cyanosis; Shunting; Patent Foramen Ovale.

COVID-19 is a severe respiratory disease with a spectrum of clinical presentations and complications. Warm autoimmune hemolytic anemia (WAIHA) is increasingly recognized in patients with COVID-19 either while infected or shortly after infection. We report a 36-year-old male with clinical and laboratory findings consistent with WAIHA. His medical history was significant for COVİD-19 infection three months before presentation. He was initially resistant to steroids but had substantial improvement following initiation of rituximab, with complete recovery thereafter. Therefore, serial assessment of complete blood cell count parameters and hemolysis markers post-COVID-19 infections is warranted for early detection and prompt treatment.

Keywords:Anemia, Hemolytic, Autoimmune; COVID-19; Rituximab; Cyanosis.

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm of low malignant potential often misdiagnosed clinically. It typically occurs in the superficial soft tissues of the extremities in children and young adults. It is characterized by recurrences and rarely metastases. Surgery remains the mainstay of management. Here, we present a rare case report of AFH in a 65-year-old male diagnosed using fine needle aspiration as spindle cell sarcoma. The patient underwent wide local excision. The patient is under follow-up. There is no evidence of metastases, and the patient is disease free three-years post-excision.

Keywords: Histiocytoma, Benign Fibrous; Soft Tissue Neoplasms; Recurrence.

Superior mediastinal syndrome is a life-threatening pediatric oncological emergency that requires high level of awareness and clinical suspicion to avoid misdiagnosis and devastating outcomes. Early diagnostic evaluation and management of underlying etiology are of utmost significance for optimal results. In children, it is most commonly caused by non-Hodgkin’s lymphoma and T-cell lymphoblastic leukemia. We report a case of a six-year-old boy with superior mediastinal syndrome secondary to T-cell acute lymphoblastic leukemia, initially misdiagnosed as foreign body aspiration and underwent a procedure with a life-threatening outcome.

Keywords:Chemotherapy; Lymphoblastic Leukemia; Vena Cava, Superior; T-cells.

A 29-year-old woman (gravida 3, para 2) presented at 28 weeks+2 days of gestation with a two-months history of dyspnea associated with orthopnea and occasional palpitations. On transthoracic echocardiography, she was diagnosed with a 3.2 × 2.7 cm left atrial myxoma. The patient underwent open surgical resection at 30 weeks of gestation. She had an uneventful postoperative recovery and was discharged on the ninth day. At 41 weeks of gestation, she gave birth by cesarean to a healthy baby of normal weight. Both the mother and the baby were discharged in stable condition.

Keywords:Atrial Myxoma, Familial; Pregnancy; Cardiac Tumors; Oman.

Soft tissue neoplasm is common among patients with neurofibromatosis type 1 (NF-1). We present a case of a middle-aged woman with NF-1 who presented with a painless, insidiously increasing perineal mass for the past eight months. She underwent colonoscopy, computed tomography staging, magnetic resonance imaging of the pelvis, core-needle biopsy, and later wide local excision of left perineum swelling. Histopathological examination showed a high-grade spindle cell sarcoma, which is a rare association among NF-1. Spindle cell sarcoma is a group of malignant soft tissue tumors with locally destructive growth with spindle-shaped neoplastic cells. The solitary spindle cell sarcoma of the perineum is rare, and wide local resection with a clear margin is the only treatment at present—the scarcely available evidence limiting the use of adjuvant chemotherapy, immunotherapy, and radiotherapy.

Keywords:Neurofibromatosis 1; Sarcoma; Soft Tissue Neoplasms; Perineum.