Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) Of the Second Proximal Phalanx Encasing the Flexor Tendon of the Foot: A Case Report.

Introduction: Bizarre Parosteal Osteochondromatous Proliferation (BPOP) is a rare benign lesion commonly referred to as Nora's lesion. It typically affects adults in their 20s-30s. Due to its aggressive local invasion, it can be confused with some malignant tumors, including chondrosarcoma. Nora's lesion can be diagnosed radiographically, and its diagnosis is confirmed with an excisional biopsy. Case Report: A 40-year-old Bahraini male complained of swelling over the metatarsal head of the second digit, increasing in size over a year. He also complained of a reduced range of motion of the second toe and a pins-and-needles sensation affecting the entire toe. Plain X-ray, computed tomography, and magnetic resonance imaging were done, showing findings suggestive of bizarre parosteal osteochondromatous. The lesion was encasing the flexor tendon of the second digit. He was treated with surgical excision, and histopathology confirmed the diagnosis of BPOP. Conclusion: We report on a rare presentation of BPOP in the second proximal phalanx of a male in his 40 s. The patient underwent a wide local excision, and the diagnosis was confirmed with histopathology.

Adherence to levothyroxine treatment among patients with hypothyroidism in Oman: a national cross-sectional study.

OBJECTIVE: Hormone replacement therapy with levothyroxine is considered the treatment of choice for hypothyroidism; however, non-adherence is a major contributor to poor treatment outcomes. This study aimed to evaluate levels of drug adherence (DA) to levothyroxine therapy among Omani adults with hypothyroidism and to explore related sociodemographic and clinical factors. METHODS: A national, multi-center, cross-sectional survey was carried out from August to December 2021 at 18 primary healthcare centers across all governorates of Oman. A total of 415 Omani adults were recruited. Data were collected using a pre-tested, Arabic-language questionnaire completed by trained researchers during face-to-face interviews with the participants. Level of DA was determined using the 8-item Morisky Medication Adherence Scale (MMAS-8). RESULTS: A total of 400 Omani adults participated in the study (response rate: 96.4%). The mean age was 41.9 ± 12.4 years old (range: 18-78 years) and 90.3% were female. According to their MMAS-8 scores, 157 (39.2%), 139 (34.8%), and 104 (26.0%) participants demonstrated low, medium, and high DA, respectively. No significant correlations were observed between level of DA and any sociodemographic or clinical characteristics, including age, gender, education, duration of treatment, and family history of thyroid disease (p > 0.050). CONCLUSIONS: Only a quarter of Omani patients with hypothyroidism reported high levels of adherence to levothyroxine treatment, likely as a result of lack of awareness of the disease and the importance of maintaining an euthyroid state. Further studies using more objective measures of DA are recommended to determine correlates of non-compliance to levothyroxine therapy among Omani patients.

Vertebral Osteomyelitis Secondary to a Retroperitoneal Abscess in an Adolescent Male: A Case Report.

Pyogenic vertebral osteomyelitis (PVO) is included in a spectrum of spine infections called spondylodiscitis. It is commonly caused by hematogenous seeding. The annual incidence of spondylodiscitis is 2.4 per 100,000 person-years and the incidence triples for people over seventy. We report a case of a previously healthy 14-year-old male with a rare presentation of vertebral osteomyelitis associated with a large retroperitoneal abscess of unknown origin, manifested with flank pain, back pain, and fever, and treated with antibiotics with good short-term outcomes. We concluded that vertebral osteomyelitis in adolescent patients could manifest with back or flank pain. Moreover, it can occur as an extraperitoneal manifestation of a retroperitoneal abscess.

Study of Breast Cancer Resistance Protein ABCG2 C421A Single Nucleotide Polymorphism RS2231142 in Multiple Myeloma.

Breast cancer resistance protein is an adenosine triphosphate-binding cassette (ABC) transporter that belongs to the G-superfamily. It acts as an efflux pump that is crucial for cell protection against toxic compounds and xenobiotics such as procarcinogens. An individual's risk of developing carcinoma depends on genetic variations like single nucleotide polymorphisms (SNPs) that may cause alteration in gene expression and/or reductions in their activities. These changes may influence blood cells' exposure to toxic compounds and increase the susceptibility to multiple myeloma (MM). Our study aimed at investigating polymorphisms at position C421A of the ABCG-2 gene in MM for the first time in Egyptian patients. Peripheral blood mononuclear cells were analyzed for ABCG-2-C421A gene polymorphisms using real-time quantitative polymerase chain reaction in 50 MM patients and 50 control subjects. There is a statistically significant correlation between SNP-C421A of the ABCG-2 gene and the risk for MM (p = 0.0218). Preliminary studies suggest that SNP-C421A of the ABCG-2 gene can be helpful in predicting the risk of developing MM. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-022-01523-3.

Factors Associated with Coping Strategies Due to COVID-19 Pandemic-related Stressors among Omani Adults.

Objectives: We sought to examine stressors and coping strategies adopted by Omani adults during the COVID-19 pandemic and explore the relationships between coping strategies (avoidant and approach coping) and sociodemographic characteristics. Methods: This national cross-sectional survey was conducted throughout Oman between September and December 2020. An online questionnaire was distributed to collect information concerning sociodemographic characteristics, potential stressors experienced during the pandemic, and coping strategies. Results: A total of 790 Omani adults submitted completed questionnaires (response rate 88.4%). High, moderate, and low stress were reported by 492 (62.3%), 139 (17.6%), and 159 (20.1%) participants, respectively. Approach coping mechanisms received a higher mean score than avoidant mechanisms (22.01±6.55 vs. 8.88±4.80). Regarding specific coping strategies, planning had the highest mean score (5.15±1.31), followed by acceptance (4.95±1.34), religion (4.56±1.52), and positive reframing (4.28±1.89), while substance use (0.01±0.19) was the least reported followed by humor (0.86±1.43), denial (0.97±1.56), and behavioral disengagement (1.02±1.60). Associations were observed between the different coping strategies and participants' gender, age, marital status, exercise level, and stress level (p ≤ 0.05). Conclusions: During a large-scale pandemic, the psychological impact on the general population is significant, even among individuals not infected with the disease. These results underscore the need for a mental health support system in Oman that can address the general population's needs. Public education on coping strategies and stress management may be helpful.

Hemoglobin Drop and the Need for Transfusion in Primary Knee Arthroplasty.

Background Blood loss is still a serious adverse effect of total knee replacement (TKR), resulting in Hemoglobin drop and a higher need for blood transfusions. Multiple modalities are used to reduce intra-operative blood loss and hemoglobin drop for this procedure, such as placing a drain intraoperatively and Tranexamic acid (TXA) administration. This study aimed to investigate factors associated with hemoglobin loss and blood transfusion increased demand. Patients and methods We retrospectively looked at 223 patients who underwent primary unilateral or staged bilateral knee arthroplasty by a single surgeon from January 2013 until April 2018 in Salmaniya Medical Complex (SMC), Bahrain. We looked into patients' demographics such as age, gender, preoperative hemoglobin and hematocrit, postoperative hemoglobin and hematocrit, drain insertion intra-operatively, and the administration of Intravenous tranexamic acid intra-operatively. Eighty-three patients had a drain inserted intra-operatively, and sixty-nine patients received intra-venous Tranexamic acid during the procedure. Results Out of 223 patients, 152 patients were included after applying exclusion criteria. The mean hemoglobin (Hb) loss in patients who had a drain inserted was 2.186 g/dL, while patients who received tranexamic acid had a mean of 1.609 g/dL. Multivariable regression analysis revealed that increased blood transfusion requirements postoperatively were significantly associated with reduced pre-operative Hemoglobin levels (p-value .004). Univariable analysis of the hemoglobin drop showed that the use of TXA would reduce Hb loss while a drain would increase Hb drop (p-value .003 and .002, respectively). Moreover, univariable analysis of blood transfusion requirements showed reduced pre-operative Hb, and placing a drain would increase blood transfusion demand (p-value <.001, .044 respectively), while administration of tranexamic acid would reduce blood transfusion demand (p-value 0.05). Conclusion Reducing the need for blood transfusion following primary total knee arthroplasty can be achieved by maintaining preoperative hemoglobin levels, administering tranexamic acid intra-operatively, and avoiding placing an intra-articular drain.

The Role of Serum Procalcitonin Level as an Early Marker of Ascitic Fluid Infection in Post Hepatitic Cirrhotic Patients.

AIMS & BACKGROUND: The early diagnosis of spontaneous bacterial peritonitis (SBP) has been considered important in the overall patient's survival. Ascitic fluid culture examination performance, in the emergency setting, is time-consuming and not always available, so there is a need for easy to apply, rapid and reliable markers for diagnosis of patients with ascites. The present prospective study aimed to determine the early diagnostic value of serum procalcitonin (PCT) levels in decompensated cirrhotic patients (DCPs) with SBP. METHODS: 47 HCV cirrhotic patients with ascites were enrolled for this prospective study. The severity of cirrhosis was classified based on the Child-Pugh criteria. All patients were subjected to paracentesis and ascitic fluid (AF) culture. Serum PCT levels were measured using enzyme-linked fluorescence analysis (ELFA). RESULTS: The diagnostic value of serum PCT levels and WBC/PLT ratios for detecting infections were serum PCT levels (3.63 ± 3.47 ng/mL) in DCPs with infections which were significantly higher than in DCPs without infections (0.505 ± 0.230 ng/mL); p < 0.05. The cut-off value for serum PCT levels was 0.7 ng/mL for the diagnosis of infections in DCPs, for which the sensitivity and specificity were 93.1% and 73.2%, respectively. The AUC was 0.91 (95% CI: 0.83-0.99). CONCLUSION: Serum procalcitonin seems to provide satisfactory diagnostic biomarkers in SBP.

Impact of interleukin IL-6 rs-1474347 and IL-10 rs-1800896 genetic polymorphisms on the susceptibility of HCV-infected Egyptian patients to hepatocellular carcinoma.

Hepatitis C virus (HCV) is considered leading cause of cirrhosis and hepatocellular carcinoma (HCC). We aimed to examine the association of IL-6 and IL-10 single-nucleotide polymorphisms with the progression of chronic HCV (CHC) infection to cirrhosis and HCC. For comparative purposes, four groups were enrolled; chronic HCV group (CHC, n = 22), HCV-related liver cirrhosis group (HCV-LC, n = 22), HCV-related HCC group (HCV-HCC, n = 54), and an apparently healthy control group (controls, n = 48). HCC diagnosis and staging were in concordance to Barcelona Clinic Liver Cancer (BCLC) staging system. IL-6 rs-1474347 and IL-10 rs-1800896 genotyping was performed by allelic (VIC- and FAM-labeled) discrimination method using assay-on-demand TaqMan real-time PCR assays. For IL-6 rs1474347, the AA genotype was more frequent in CHC, HCV-LC, and HCV-HCC compared to controls. Also, the IL-6 rs1474347 AC genotype was favorable for the progression of HCV chronic infection to cirrhosis and HCC. On the other hand, the IL-10 rs1800896 TT genotype was found to be prominent in the HCC group. Additionally, the IL-10 rs180096 TT genotype was favorable for the progression of chronic HCV infection to cirrhosis and HCC. Furthermore, higher levels of AFP were observed in HCC patients with IL-6 rs1474347 AA genotype and HCC patients with IL-10 rs1800896 CC and TT genotypes. Screening for IL-6 rs 1474347 AC genotype and IL-10 rs180096 TT genotype as well as the determination of AFP level showed to be good markers for examining the susceptibility of HCV Egyptian patients to develop cirrhosis and HCC.

Prevalence and sociodemographic determinants of contraceptive use among women in Oman.

BACKGROUND: The fertility rate in Oman is high, as found elsewhere in Arab countries. The government of Oman has made considerable improvements in providing contraceptive methods in response to growing demand. AIMS: This study aimed to find out the prevalence of contraceptive usage and determine the sociodemographic determinants of its use among married Omani women. METHODS: A cross-sectional survey was carried out in 12 health centres which were randomly selected from each county (Wilayat) in Muscat region. A total of 400 women aged 18-49 years old who had not reached menopause were subjected to a face-to-face interview. Information was obtained on sociodemographic characteristics and family planning practice. RESULTS: Majority of women (n=397; 99.2%) had heard about family planning. More than half (n=225; 56.3%) knew about family planning and only three (0.8%) did not know its meaning. The contraceptive pill was the most common known method (n=383; 95.8%), while vaginal cream was the least recognized method (n=67; 16.8%). Most of the participants (n=307; 76.8%) reported previous use of these methods and 54% (n=214) were current users. Withdrawal was the most frequently used method (n=70; 32.7%) and breast-feeding was the least used method (n=3; 1.4%). Contraception use increased significantly with age (P < 0.005), duration of marriage (P < 0.005) and high monthly income (P < 0.005). CONCLUSIONS: Health care providers play a key role in providing information and education about family planning. Efforts are recommended in educating couples and promoting the use of the different family planning methods.