Case Series on Barotrauma in COVID-19 Infection Patients.

As COVID-19 emerged in the world, there was a high prevalence of intubation and intensive care admissions. Many cases of barotrauma were reported in those patients. This condition is caused by alveoli rupture, which causes the air to enter the surrounding extra-alveolar spaces. It mainly happens in intubated patients. Here, we report 14 cases of barotrauma in COVID-19 patients, which appeared either spontaneously or after receiving non-invasive ventilation, some of the patients presented initially with mild-moderate forms of the disease in terms of severity. Developing barotrauma causes a management challenge in COVID-19 patients, where the patients might require invasive mechanical ventilation afterwards, which is a difficult situation. Lung protective measures should be used to reduce the risk of barotrauma in all patients as it is associated with increased mortality.

Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Disease): The role of cardiovascular magnetic resonance.

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss disease, is a rare vasculitis that affects small- to medium-sized vessels and has a propensity to involve the heart. Patients with cardiac involvement have a poor prognosis and usually require immunosuppressive treatment along with corticosteroids. Cardiovascular magnetic resonance (CMR) is a non-invasive diagnostic tool for detecting cardiac involvement and guiding the management plan. We report a 39-year-old male patient with a known history of bronchial asthma who was referred to the chest clinic at a tertiary hospital in 2019 for further assessment of persistent lung parenchymal changes on chest computed tomography. Given the clinical context of the patient and the radiological findings, EGPA was suspected and confirmed with a lung biopsy. CMR was performed for further assessment, which confirmed cardiac involvement. The patient was started on prednisolone and azathioprine and showed significant radiological and clinical improvement.

Evaluation Of Intraoperative Touch Imprint Cytology Of Axillary Sentinel Lymph Node Accuracy In Comparison To The Permanent Histology Diagnosis. A prospective study Of 25 Invasive Breast Cancers.

BACKGROUND: Intraoperative evaluation of axillary sentinel lymph node (SLN) in patients with breast carcinoma reduces the need of re-operations for axillary lymph node dissection. Various methods such as touch imprintcytology (TIC) and frozen section histology (FS) have been used to determine the SLN status intra-operatively. The sensitivity of intraoperative TIC examination on SLN is not consistent and varies in different studies. The aim of this study was to determine the specificity and sensitivity of TIC, and its feasibility in clinical use. METHODS: A prospective study was conducted on 24 female and 1 male patients with histologically proven breast carcinoma and an at most clinical stage of cT2N0, between March 2017 and 2020. Axillary lymph nodes were not detected/palpable on physical examination. The patient underwent breast-conserving surgery i.e. quadrantectomy with sentinel lymph node biopsy. The intact lymph nodes were sent to histopathology laboratory for intraoperative TIC. The nodes were bisected, touch smears made and stained using the H&E and may Grunwald - Giemsa methods. The remaining tissue was processed in formalin fixed paraffin-embedded blocks and the slides were stained with H&E. RESULTS: In the three- year period (2017-2020), sentinel lymph node intraoperative touch imprint cytology was performed on 25 patients' lymph nodes with primary breast cancer and clinically negative axillary lymph nodes in Muscat Private Hospital, Muscat, Oman. The average age of the patients was 54.69 year. SLN- TIC revealed 88.9% sensitivity, 93.75% specificity, 11.1% false negative rate and 6.25% false positive with an overall accuracy 92%. CONCLUSION: Touch imprint cytology has high sensitivity and specificity with an accepted accuracy. Intraoperative TIC is practical, time-efficient, and cost-effective procedure requiring minimal tissue preparation for SLN evaluation especially in clinical practice where FS is unavailable. Intraoperative touch imprint cytology can detect macrometastasis and micrometastasis to a lesser extent. Key words: breast carcinoma, sentinel node biopsy, intraoperative diagnosis, touch imprint cytology, micrometastasis.

Renal Epithelioid Angiomyolipoma: A Case Report and Review of Literature.

Epithelioid angiomyolipoma (EAML) is an uncommon renal neoplasm with malignant potential. It is classified under the group of perivascular epithelioid cell tumors and can be sporadic or as part of the tuberous sclerosis complex. On imaging, unlike classical AML that contains fat, EAML has a very low percentage of fat which can mimic the imaging findings of renal cell carcinoma. We reported a 31-year-old female who had a history of renal failure and bilateral renal masses. Magnetic resonance imaging of the abdomen revealed bilateral large renal masses replacing renal parenchyma with features suggestive of bilateral renal AML. The patient underwent left nephrectomy, and histopathology examination findings were consistent with the diagnosis of EAML.

Pulmonary Alveolar Microlithiasis: A Case Report.

Pulmonary alveolar microlithiasis (PAM) is a rare disease caused by a mutation in the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells. This results in the formation and accumulation of calcium phosphates crystals in the alveoli. Early in the disease, most patients are asymptomatic or might experience mild symptoms. However, in some patients, PAM can progress resulting in pulmonary fibrosis, cor pulmonale, and respiratory failure. We report the case of a 33-year-old Omani male who was referred to our institute with a history of fever and shortness of breath. A chest radiograph revealed bilateral dense consolidation. Chest computed tomography showed bilateral dense interlobular thickening and extensive consolidations with a lower lung predominance. Our findings were highly suggestive of PAM. The diagnosis was confirmed by bronchoalveolar lavage.

Pulmonary Hyalinising Granuloma: A report of two cases.

Pulmonary hyalinising granuloma (PHG) is a rare fibrosclerosing inflammatory lung condition of unknown aetiology. It is characterised by solitary or multiple pulmonary nodules that are usually found incidentally while imaging the chest for other reasons. We report two cases of histologically proven PHG diagnosed at the Royal Hospital, Muscat, Oman. The first case was a 71-year-old male patient who presented in 2010 with a dry cough, weight loss and bilateral pulmonary nodules. The second case was a 58-year-old male patient who presented in 2012 and was found to have incidental bilateral pulmonary nodules on chest X-ray. Both patients were started on prednisolone and on follow-up the PHG nodules remained stable. Although there is no definitive treatment, PHG generally has an excellent prognosis.

Nodular Pulmonary Amyloidosis Mimicking Metastatic Pulmonary Nodules: A case report and review of the literature.

Amyloidosis is a disorder characterised by the extracellular deposition of amyloid, a fibrillary protein, in various organs such as the lungs. Pulmonary nodular amyloidosis can mimic other lung conditions that present with pulmonary nodules, such as metastasis, sarcoidosis and hyalinising granuloma. We report a 60-year-old man who presented to the Royal Hospital, Muscat, Oman, in 2017 with a history of shortness of breath upon exertion, orthopnoea and bilateral lower limb swelling. A chest X-ray showed bilateral nodular opacities. Enhanced chest computed tomography revealed bilateral pulmonary nodules with a predominantly perilymphatic and subpleural distribution, giving the impression of a neoplastic nodule. A histopathological examination of biopsied lung tissue confirmed a diagnosis of nodular pulmonary amyloidosis.

Repository of mutations from Oman: The entry point to a national mutation database.

The Sultanate of Oman is a rapidly developing Muslim country with well-organized government-funded health care services, and expanding medical genetic facilities. The preservation of tribal structures within the Omani population coupled with geographical isolation has produced unique patterns of rare mutations. In order to provide diagnosticians and researchers with access to an up-to-date resource that will assist them in their daily practice we collated and analyzed all of the Mendelian disease-associated mutations identified in the Omani population. By the 1 (st) of August 2015, the dataset contained 300 mutations detected in over 150 different genes. More than half of the data collected reflect novel genetic variations that were first described in the Omani population, and most disorders with known mutations are inherited in an autosomal recessive fashion. A number of novel Mendelian disease genes have been discovered in Omani nationals, and the corresponding mutations are included here. The current study provides a comprehensive resource of the mutations in the Omani population published in scientific literature or reported through service provision that will be useful for genetic care in Oman and will be a starting point for variation databases as next-generation sequencing technologies are introduced into genetic medicine in Oman.

Gastrointestinal Basidiobolomycosis: First case report from Oman and literature review.

Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with few reported cases worldwide. We report here the first case diagnosed in Oman in a previously healthy 5-year-old Omani female child who had been thought initially to have an abdominal malignancy. The case was referred to the Royal Hospital, Muscat, Oman, in July 2012. She was treated successfully with surgical resection and prolonged antifungal therapy (voriconazole). Physicians, including clinicians, radiologists and pathologists, should have a high index of suspicion for GIB when a patient presents with an abdominal mass and fever.