Thyrotoxic neuropathy: a rare cause of acute flaccid paraplegia

Acute polyneuropathy is a rare manifestation of severe hyperthyroidism. We report a 22-year-old Omani male who presented to the Sohar Hospital, Sohar, Oman, in 2016 with acute-onset rapidly progressive flaccid areflexic paraplegia as the presenting manifestation of thyrotoxicosis. Nerve conduction studies revealed mixed axonal and demyelinating polyneuropathy in both the motor and sensory nerves. Treatment of the hyperthyroidism with beta-blockers and carbimazole along with physiotherapy resulted in the patient's full recovery and the alleviation of his symptoms. Besides highlighting this rare association, this report underscores the importance of including thyroid function tests in the evaluation of patients with acute polyneuropathy

Knowledge and attitudes of Oman medical specialty board residents towards evidence-based medicine

This study aims to evaluate the knowledge and attitudes of Oman Medical Specialty Board [OMSB] residents towards Evidence-Based Medicine [EBM]. This cross sectional study was conducted on all OMSB residents through a self-administered online questionnaire between October 2012 and March 2013. An electronic survey was designed to identify and determine residents' knowledge and attitudes toward the use of EBM. The survey was completed by 93 [21%] OMSB residents, 76 [82%] of whom took part in continuing education courses and 50 [54%] belonged to professional practice-oriented organizations. On average, the residents were reportedly involved in patient care for approximately 70% [Standard Deviation [SD] 17%] of their time, while 14% [SD 12%] participated in research activities. The results showed that 53 respondents [57%] were competent users of medical search engines compared to 23 residents [25%] who rated their skills as neutral. Sixteen percent of the respondents strongly agreed and 46% only agreed that the facility supports the use of current research in practice. Fourteen percent strongly agreed and fifty-three percent only agreed that the foundation of EBM is part of OMSB academic preparation. On the other hand, 17% of the respondents thought that insufficient time is always a barrier against EBM, while another 27% perceived insufficient time as a usual barrier. The lack of information resources was reported to always be a barrier in 11% of the respondents while 32% thought that it usually acts as a barrier. Time constraints and skills in EBM were found to be the two major obstacles. This study was, however, limited by the low response rate of the survey; thus larger studies with a previously validated questionnaire should be conducted in the future

Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience

Objectives: To assess the feasibility and safety of transulnar approach whenever transradial access fails

Background: Radial access for coronary procedures has gained sound recognition. However, the method is not always successful

Methods: Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention [PCI] was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients [6.2%] requiring crossover to either femoral [128 patients, 4.6%] or ulnar approach [45 patients, 1.6%]

Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement

We documented procedural characteristics and major adverse cardio-cerebrovascular events

Results: Radial artery spasm was the most common cause of crossover to the ulnar approach [64.4%] followed by failure to puncture the radial artery [33.4%]

Out of 45 patients [82.2%], 37 underwent successful ulnar approach

The eight failed cases [17.8%] were mainly due to absent or weak ulnar pulse [75%]. PCI was performed in 17 cases [37.8%], of which 8 patients underwent emergency interventions

Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5%, 13.3%, 2.2% and 2.2%, respectively

No major cardiac-cerebrovascular events or hand ischemia were noted

Conclusion: Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach

Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications