bluuebunny/crossref_metadata_2025 huggingface dataset:
Professional Report Generation Using Lexeme Theories and Openai's Generative Pretrained Transformer, GPT-4: A Comparison
Authors: Macfarlane Donald
Published: December 2023

The public release of OpenIA's GPT-4 has caused an explosion of interest in the ability of large language models to generate text documents in response to a simple text prompt. These documents can appear to be genuine professional reports, such as medical case notes. Expert-written templates guided by lexeme theories (TGLT) is a system under development which creates professional notes exploiting a set of theories and a lexicon which converts a clinician's ideas into text. We explored the differences between the two systems to determine if they can be used in clinical practice. Every element in a document created by TGLT is triggered by the user, whereas GPT-4 created documents may include invented text. LGLT can generate complex clinical notes that are more complete, more orderly, and less error-prone than conventionally written notes. The lexicon constructed for TGLT can be updated or corrected rapidly by end-users, whereas GPT-4 uses a huge library that may take many months to update. TGLT notes are concise, complete, and organized in a defined order, whereas GPT-4 may be incomplete and poorly ordered. TGLT can alert the user to recent best practice advisories. TGLT issues computer codes for every text element in the document and does not include confidential identity information, enabling the facile aggregation of the content of notes for down-stream analysis. GPT-4 does not issue computer codes, and generates text that may include patient identifiers. TGLT costs vastly less than GPT-4. We conclude that TGLT has none of the manifold disadvantages that GPT-4 has for creating professional reports.
Assessment of asthma control in adult patients by Fractional Exhaled Nitric oxide and Asthma Control Test
Authors: AYOOB MUHAMMED , Ismail Soumya
Published: December 2023

Background: The most crucial step in achieving and keeping asthma under control is to lessen the inflammation in the airways. Nitric oxide fractional exhaled (FeNO) levels have been utilised as an indicator of airway inflammation. Uncertainty regarding the potential function and properties of exhaled fractional nitric oxide in asthma management. Objective: To determine whether FeNO and Asthma Control Test (ACT) can objectively assess asthma control in adult patients and identify any potential relationships between FeNO and both the ACT score and the spirometry data of patients. Also determine their use in reducing the dose of inhaled steroids. Methods: The design of the study was a systematic review. A qualitative research methodology based on an analysis of previously published materials. Results: This study thoroughly examined the literature on the Asthma Control Test and Fractional Exhaled Nitric Oxide assessment of asthma control in adult patients. Finally, 16 scientific studies were analysed. The highest variations in FeNO values during diagnosis were significantly linked with FeNO levels at diagnosis during conventional asthma treatment. Evaluating adherence and FeNO response to monitored inhaled corticosteroid treatment may prevent the needless progression to biologic therapy in asthmatic patients with high Type-2 biomarker levels. There is a close connection between the ACT score and the treatment modifications as well as the measurements of lung function. FeNO may be able to detect poor asthma control; however, it cannot substitute for clinical judgment and may only be beneficial in a subset of asthmatics. The average and percentage variation of standards following asthma treatment did not show any significant relationship between FeNO levels and various other factors are related (expiratory volume in one second (FEV1) or ACT scoring), however, there were strong positive correlations between ACT scores and FEV1. Conclusion: Research revealed a highly significant link between the level of FeNO at diagnosis and the biggest variations in FeNO readings after diagnosis. Using FeNO as a supplementary non-invasive method for assessing asthma control may be effective in both steroid-naive asthmatics and those who are being treated with steroids.
In-vitro Antioxidant and Radical Scavenging Properties of Acacia Ferruginea Plant Stem: A Phytochemical Study
Authors: Ramya Nagesh , Balasubramanian Kiruthika , Harish Harish
Published: December 2023

Introduction: The study of free radical chemistry has received considerable attention in recent years. Our bodies produce free radicals through a variety of endogenous systems, exposed to various physiochemical or pathological conditions. Objective: The study aimed to assess the in-vitro antioxidant properties of Acacia ferruginea plant stem and to screen for their phytochemical components. Methodology: The stem was examined for enzymatic and non-enzymatic antioxidants, radical scavenging activity in three solvents with varying polarities, and phytochemical analyses. Result: The stem of Acacia ferruginea possessed considerable levels of enzymatic and non-enzymatic antioxidants. Conclusion: Although the three extracts had high scavenging properties, in-vitro assays did not show any significant DNA preventive properties. Phytochemical screening indicated the presence of alkaloids, flavonoids and phenols.
ATYPICAL PLASMA CELL GINGIVOSTOMATITIS: A RARE CASE REPORT
Authors: GHODKE PRERNA , DHANDE SHARAYU , HEGDE RASHMI , KOSHY AJIT , SHAH AMISHA , BALDAWA PRACHI
Published: December 2023

Background: Plasma cell gingivostomatitis belongs to a group of uncommon benign inflammatory conditions characterised by macular lesions that are bright red, velvety, sharply circumscribed, flat to slightly elevated in nature. Intra-oral lesions can manifest as dense band-like gingival enlargements with plasma-cystic infiltrate seen in the histo-pathological sections. The present case report highlights findings of atypical plasma cell gingivostomatitis further managed through clinical, radiological, histopathology, immunohistochemistry, hematological analysis and treated with surgical periodontal therapy. Method: Intra-oral periodontal parameters were assessed followed by non-surgical periodontal therapy. In the later phase, internal bevel gingivectomy carried out and approximated with interrupted sutures. Furthermore, gingivoplasty with a 810nm diode laser, for better adaptation of gingival margins was performed. The patient was recalled for follow-up visits at regular intervals and results were maintained. Result: Intra-oral histopathological sections revealed plasma cell gingivitis whereas hematological reports were suggestive of anemia. Gradual follow up showed reduced gingival inflammation. Post-surgical wound healing was satisfactory. Disappearance of extraoral induration was highlighting feature in the post-operative phase.Further patient was recalled for follow-up visits at regular intervals and results were found to be maintained. Conclusion: The overall gingival condition was seen to be improving at the follow-up visits. The authors thus conclude that the case of plasma cell gingivitis treated by comprehensive periodontal therapy showed satisfactory results at 3 years follow-up and no recurrence in extra-oral findings was noted.
Using Intersectionality Theory to Explore the Impact of COVID-19 Pandemic on Black Canadian People's Health
Authors: Dixon Sandra , Batta Millie , Jidong Dung
Published: December 2023

There is a general reluctance to confront the pervasive reality of anti-Black racism that further produces false narratives of inequities in the healthcare system relative to Black communities, especially in Western countries, including Canada. Despite Canada’s orientation towards an anti-Black racist agenda that aims to acknowledge the social determinants of health (SDOH) disparities experienced by the Black community during the coronavirus disease 2019 (COVID-19) pandemic, a greater robust discussion is warranted to address this longstanding discourse. In this conceptual paper, we draw upon intersectionality theory to shed light on the social determinants and inequities in health for Black Canadians. Informed by the literature, the authors discuss the historical context of systemic barriers and social injustices Black people face that are uniquely rooted in systems of oppression and anti-Black racism. Additionally, the importance of collecting and analyzing race-based data to prioritize the health concerns of Black people is emphasized. The article also espoused the need for healthcare service providers to advocate for culturally responsive and appropriate interventions like the Africentric model to inform policies, practices, and programs that promote the wellness of Black populations in Canada and beyond. Implications for healthcare service providers are highlighted with emphasis placed on a commitment to cultural humility in the support delivered within this diverse community. The paper concludes with a higher level of consideration to be given to the structural challenges experienced by Black Canadians in the healthcare system as we move towards a collective understanding to better serve this racialized group.
A Proposal for the Cause of the Next Great Pandemic and Recommendations for Preparing to Survive It
Authors: Hearn James
Published: December 2023

May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency. COVID-19 resulted in the death of almost seven million people. After such an ordeal, it is normal to feel a sense of relief, the need to relax. Some are afforded this luxury but not so for those who must prepare us for the next pandemic. A pandemic of the same, or greater, magnitude is not statistically expected for some time. Yet, it is a fact that the next pandemic can occur at any time. Thus, we must be ever vigilant and in a state of constant preparation. The benefits of such preparation will be greatly enhanced if the most likely type and magnitude of the next pandemic can be anticipated. The author believes that there are signs pointing to this source. In pandemic preparation the worst-case scenario employed by many planners is based on the 1918 Spanish influenza. The highest mortality estimates indicate that the pandemic resulted in the death of between 50 and 100 million people. It is difficult to imagine a more intense pandemic. Yet we must. While the 1918 pandemic was the most intense we have experienced, it is certainly not the most intense that we can experience. “Disease X” is a placeholder name which represents a hypothetical pathogen that the World Health Organization lists as a priority disease on its R&D Blueprint which is a global strategy and preparedness plan. The author believes that it is both naïve and dangerous to employ the 1918 pandemic as a worst-case scenario. It is necessary to think beyond this level. Granted when one does so one is venturing into hypothetical territory. Yet, this must be done to even have a chance at adequately preparing for the next pandemic. This article proposes avian influenza as Disease X. The virus is known but is not currently transmissible between humans. If this becomes possible (and nature is working to make this a reality) the estimated death toll can be expected to exceed a world-changing 1.3 billion. While this article looks at avian influenza as Disease X it also recommends the preparations necessary to be made for the global society to even hope to survive it.
Jain Point : To avoid trocar injuries in multiple previous surgeries A retrospective analysis of 720 cases
Authors: Jain Nutan , Srivastava Sakshi , Sharma Suksham , Jain Vandana
Published: December 2023

Background: Laparoscopic entry in previous surgery cases has several challenges but complexity rises further in patients with history of multiple previous surgeries leading to intra-abdominal adhesions, visceral, vascular, nerve injuries, dilemma in port placement, difficulty in establishing pnemoperitoneum, reduced visibility and all these leading to longer operative time. To address the above issues, we conducted this study to assess the safety and efficacy of Jain point in avoiding trocar injuries in patients with multiple previous surgeries. Methods: We present a retrospective analysis of 720 cases with two or more previous surgeries conducted at a tertiary care referral centre for advanced gynecological laparoscopic surgery from January 2011 to July 2023. We perform a detailed preoperative work up of the patient and delve into all details of the previous surgeries including indications and nature of surgery, open or laparoscopic. We then inspect all scar sites to assess possible intra-abdominal adhesions and feasibility of Jain point entry. Veress entry is made at Jain point, which lies at L4 level on left side of abdomen, 10-13 cm lateral to the umbilicus. This is followed by primary blind trocar entry at the Jain point, which becomes the main working port in due course of the surgery. We make a note of intraoperative adhesions and postoperative complications. Results: In total 720 cases with history of multiple previous surgeries, laparoscopic entry was safely made through Jain point port by consultants, senior residents and fellows, almost in equal number of cases. In this study group, no major bowel or vascular complications were noted. Conclusion: Jain point laparoscopic entry is safe for all types of previous scars, in all quadrants of abdomen, in all ranges of BMI, age, with varied indications and by surgeons of various subspecialties. It is feasible in low resource settings as in this study we utilized our routine reusable trocars. Jain point has the potential to minimize trocar injuries in hands of novice as well as experts, as its precise location avoids injury to vessels, viscera and bowel; thus posing as a safe and feasible laparoscopic entry port in multiple previous surgeries.
The Upcoming Drift of Organ-Chip in Pharmacological Trial Investigate
Authors: Ubaidulla U. , V Sandhiya , Prabhu T. Purushoth , Deepa N. , K C Arulprakasam , Balakrishnan Senthilkumar , Suresh Velayutham
Published: December 2023

The urgent need for a novel way to replicate human drug reactions in preclinical research has motivated the development of organ-on-a-chip (OoC) systems. These difficulties are not recognized during preclinical trials, owing to ineffective screening technologies that mimic the complexities of human tissues and provide quick, accurate screening readouts. Microfluidics and microfabrication are powerful methods for creating numerous systems with high spatiotemporal precision to simulate in vivo microenvironments for drug delivery, discovery, development, and screening. This method might be used to investigate cell responses to pharmacological and mechanical stimuli in a more physiologically effective way. In this paper, we examine current achievements in OoC with an emphasis on biomimicry, functionality, and characteristics, as well as multi-organ platforms that attempt to replicate the essential aspects of integrated human physiology. Finally, we explore future prospects and limits that must be addressed in order to get OoC systems closer to clinical translation.
The Current Successes (and Failures) in the Treatment of Cutaneous Metastatic Melanoma
Authors: JC Coelho , RP Pereira , EP Cassol , GT Andrade , AB Zanon , G Gatto , PER Liedke , SJ Azevedo
Published: December 2023

The contemporaneous treatment of cutaneous metastatic melanoma (CMM) has been revolutionized in a process started decades ago with the better understanding of cancer genetics, cancer biology and the functioning mechanisms of the immune system, which were more recently translated from basic and clinical research into efficacious and effective new drugs. At the turn of the 21st century, patients with CMM had very few treatment options and their survival was measured in few months. Traditional chemotherapy or cytotoxic drugs had very limited non curative potential, with OS in the ranging from 6 to 12 months, at best. Currently, the use of immune check point inhibitors (ICIs) and drugs directed at blocking mutated BRAF gene proteins as well as MEK inhibitors have transformed the landscape of CMM treatment, with immense positive impact on hard surrogates such as overall survival (OS) and disease-free survival (DFS) and on the quality of life (QoL) of such patients. Our objective here is to review the last ten years of data regarding this evolution, as well as acknowledging its pitfalls and limitations, while trying to look forward in the search for biomarkers that could better tail treatment choices while preventing unnecessary toxicities.
Technological and Manufacturing Innovation Drive Improved Access to Engineered T Cell Therapies
Authors: Xiong Ying , Xie Yanping , Zhu Zhongyu , Oparaocha Ibeawuchi , Sleesareva Oxana , Dropulić Boro , Orentas Rimas
Published: December 2023

The creation of autologous gene-modified cell products, such as CAR-T cells (chimeric antigen receptor T cells) has met with clinical success but has been severely restricted by cost, availability, and current commercial models of central manufacturing. Moreover, the inability to produce CAR-T cells at reasonable cost in all but the largest centers slow innovation. CAR-T cells are unique in that these ex vivo expanded effector T cell populations express activation receptors comprised of immunoglobulin-like binders, or other immune ligands, bypassing the restriction of expanding and appropriately activating effector cells that arise by recombination of V-D-J genetic elements. However, the use of a single binding moiety to recognize leukemia target cells has selected for the generation of escape mutants, or for cryptic clones to expand that were not initially detected upon diagnostic work-up. To meet this challenge, we have engineered both B cell malignancy-specific and HIV surface antigen-specific CAR-T cells that express multiple binding moieties, thereby reducing the chance of immune escape. The creation of a therapeutic CAR-T cell population also requires a complex set of procedures that includes procurement of a large number of patient T cells, most often by leukapheresis, activation of the T cell population using matrix-associated antibodies targeting the T cell receptor and an immune co-receptor, a gene vector to permanently transduce T cells, and a bioreactor that can accommodate the expansion of the engineered cell population to numbers suitable for infusion. This complex set of procedures, combined with the current central processing model, has led to a complex chain of custody and expensive temperature-controlled shipping requirements. We present here a model whereby production of CAR-T cells at the point of care, using simplified cell procurement, purification, and expansion, can reduce the time and expense of CAR-T cell generation, with the aim to expand the use of these therapies in both the majority world, and in managed care or publicly funded systems. The CAR-T populations produced in this point-of-care ready process are highly active, viable, and have preferred CAR-T phenotypic characteristics associated with clinical efficacy.
The Challenges to Advancing Induced Pluripotent Stem Cell-Dependent Cell Replacement Therapy
Authors: Moy Alan , Kamath Anant , Ternes Sara , Kamath Jay
Published: December 2023

Induced pluripotent stem cells (iPSC) represent a potentially exciting regenerative-medicine cell therapy for several chronic conditions such as macular degeneration, soft tissue and orthopedic conditions, cardiopulmonary disease, cancer, neurodegenerative disorders and metabolic disorders. The field of iPSC therapeutics currently exists at an early stage of development. There are several important stakeholders that include academia, industry, regulatory agencies, financial institutions and patients who are committed to advance the field. Yet, unlike more established therapeutic modalities like small and large molecules, iPSC therapies pose significant unique challenges with respect to safety, potency, genetic stability, immunogenicity, tumorgenicity, cell reproducibility, scalability and engraftment. The aim of this review article is to highlight the unique technical challenges that need to be addressed before iPSC technology can be fully realized as a cell replacement therapy. Additionally, this manuscript offers some potential solutions and identifies areas of focus that should be considered in order for the iPSC field to achieve its promise. The scope of this article covers the following areas: (1) the impact of different iPSC reprogramming methods on immunogenicity and tumorigenicity; (2) the effect of genetic instability on cell reproducibility and differentiation; (3) the role of growth factors and post-translational modification on differentiation and cell scalability; (4) the potential use of gene editing in improving iPSC differentiation; (5) the advantages and disadvantages between autologous and allogeneic cell therapy; (6) the regulatory considerations in developing a viable and reproducible cell product; and (7) the impact of local tissue inflammation on cell engraftment and cell viability.
Implication of C-MYC Mutations in the Tumorogenesis of Breast Cancer in Senegalese Females
Authors: MBAYE Fatimata , AGENDEY Nada , SEMBENE Mbacké
Published: December 2023

Breast tumors are a frequent cause of medical consultations. Although these tumors are mainly benign, they can become malignant or cancerous. This study aimed to elucidate the involvement of genetic alterations in the C-MYC oncogene in breast tumorigenesis in Senegalese females. After PCR, the epidemiological and molecular profiles of 45 samples, including 19 controls (C) from healthy individuals and 11 benign (BT) and 15 cancerous (MT) samples from patients with tumors, were determined. Mutations were determined using Mutation Surveyor software, and their pathogenicity was assessed using SIFT, Polyphen-2, Mutpred2, SNAP2, PANTER-PSEP, PROVEAN, PhD-SNP, SNP&GO, MUpro, and I-mutant prediction tools. At the epidemiological level, the average ages of the BT and MT groups were 21 and 49.76 years, respectively, and the average ages at menarche were 14.14 and 14.58 years, respectively, with a high frequency of adenofibromas (53.85%) in the BT group and only infiltrating ductal carcinomas (100%) found in the MT group. The stages (III and IV) and grade of SBR were specific to the MT group 76.47% and 58.82%, respectively. At the molecular level, four mutations were identified, all of which were heterozygous and novel, and three of which were non-synonymous. One of the mutations (c.115 T > TC; p.Tyr39His) was recurrent (frequency = 26.67%, 4/15 in the MT group; and 10.53%, 2/19 in the C group) and the other two (c.113 T > TC; p.Phe38Ser and c.117 C > CT) were exclusive to the C group, with the same frequency of 5.26% (1/19). No mutations were found in the BT group. The p.Phe38Ser and p.Tyr39His mutations were described as deleterious and can cause cancer according to the prediction tools. Overall, these mutations can be considered as variants of interest and are the subject of PCR screening for breast cancer prevention.
Comparison between Free and Encapsulated Form of Epicatechin in Liposomes and In Polymeric Nanoparticles Against the Paraquat-Induced Toxicity of NRK-52E Cells
Authors: Layas Kauther , Pannala Ananth , Chatterjee Prabal
Published: December 2023

Both liposomes and polymeric nanoparticles have lately been utilized as carriers of conventionally prescribed medications with the aim of improving their activity in various ways. Epicatechin is a flavonoid with a limited bioavailability that can be found in natural sources. It is somewhat water soluble. However, because of its poor absorption and quick metabolism, it cannot function as it is expected. This work sought to enhance the pharmacokinetic features of epicatechin by encapsulating it in polylactic acid nanoparticles and liposomes. Liposomes were formed by the hydration of a lipid film to prepare large multilamellar vesicles, followed by membrane extrusion to formulate smaller unilamellar vesicles. On the other hand, polymeric nanoparticles were produced by double emulsification solvent diffusion method using polylactic acid as the polymer. Both products were then characterized for their particle size, zeta potential, drug loading, antioxidant activity, toxicity on cell lines (NRK-52E cells) and protection against paraquat oxidation. The mean particle size of liposomes was 183.8 ± 80.1 nm and for polylactic acid nanoparticles it was 350.9 ± 87.4 nm. Their surface zeta-potentials were -11.3 ± 3.93 and -32.9 ± 7.54 mV; respectively. The encapsulation of epicatechin in liposomes was 10.23 ± 1.54% and in polylactic acid nanoparticles 5.35 ± 3.35% (%encapsulation efficiency = 18.09 ± 1.95%). Microscopic images presented both sorts of nanoparticles to be sphere-shaped. Encapsulation of epicatechin into both liposomes and polylactic acid nanoparticles enhanced the % internalisation remarkably from 4.18 ± 0.03% to 27.05 ± 1.07% and 36.29 ± 0.09%; respectively. The toxicity test found all three forms not to be harmful to the NRK-52E cells within the concentration ranges tested. Examining the in vitro activity results showed that the same concentration of epicatechin in the liposomal form showed more protection against paraquat than epicatechin in its free form. Moreover, a lower epicatechin concentration was used in the polylactic acid nanoparticle form and still found to be more protective. From these results it can be concluded that epicatechin-loaded liposomes and polylactic nanoparticles offer protection to NRK-52E cells against paraquat induced toxicity.
Acute Kidney Injury: Current and Future Therapies Involving Antioxidants and Antioxidant Formulations
Authors: Layas Kauther , Chatterjee Prabal , Pannala Ananth
Published: December 2023

Acute kidney injury is characterised by abrupt failure of kidney function, sometimes leading to chronic kidney disease, and is associated with significant morbidity and mortality. However, there is no clear effective therapeutic solution and treatment is mainly based on either alleviation or removal of the possible cause and/or renal replacement therapy. Oxidative stress has been indicated as one of the main pathophysiological pathways in the development of acute kidney injury. Various treatments including antioxidants, inflammatory mediators and genetic modifiers have been proposed to for the treatment of this condition. Epidemiological studies show lower incidence of kidney failure with higher consumption of antioxidants. However, the data is inconclusive due to their physicochemical properties, bioavailability or toxicity. Novel drug delivery systems such as liposomes and nanoparticles have been proposed to overcome the pharmacodynamic and pharmacokinetic barriers. This review provides a brief introduction to acute kidney injury and the different factors involved in its pathology, focusing on oxidative stress. It also covers details of antioxidant use as preventive and/or treatment option. It will summarise their limitations as free drugs and the possible improvement in their bioavailability by two main novel drug delivery systems: liposomes and polymeric nanoparticles. Other therapies such as inflammatory mediators and genetic modifiers are also discussed briefly.
A Newly Detected Left Ventricular Mass Following A Complex Intracardiac Repair
Authors: Maddali Madan M , Chauhan Avinash , Kandachar Pranav S , Al-Farqani Abdulla , Al Kindi Hamood N
Published: December 2023

Appearance of unexpected masses in the chambers of the heart during cardiac surgery can be intriguing. We report the case of a mass in the left ventricle that appeared at the time of separation from cardiopulmonary bypass in a child after a complex intracardiac repair. The child presented for surgery to a tertiary care hospital in Muscat, Oman, in 2022. Prior to the surgical repair the mass was not appreciated by echocardiography. An intraventricular baffle was used to divert left ventricular blood flow towards the outflow tract, after which an intraventricular “mass” was observed. Intraoperative transoesophageal echocardiography identified the mass as a portion of the interventricular septum that was located between the inlet and outlet ventricular septal defects.

Keywords: Echocardiography; Heart Septal Defects; Heart Ventricles; Diagnostic Imaging.
Device Closure of Superior Sinus Venosus Atrial Septal Defects
Authors: Al Maskari Salim N , Maddali Madan M , Al Alawi Khalid , Raju Sowmiya , Al-Farqani Abdulla
Published: December 2023

Sinus venosus atrial septal defects present a wide variety of anatomical features and are frequently associated with partial anomalous pulmonary venous drainage of one or more right pulmonary veins. Surgical correction used to be the standard treatment. In recent times, transcatheter correction of superior sinus venosus atrial septal defects has come into vogue. The transcatheter closure of these defects with covered stents at a tertiary care centre in Oman between 2018 and 2023 is reported.

Keywords: Heart Septal Defects, Atrial; Vena Cava, Superior; Endovascular Procedures; Stents; Cardiac Catheterization; Echocardiography, Transesophageal; Oman.
Mogul in a Baby
Authors: Kandachar Pranav S , Varughese Nithil A , Kaur Charanjit , Al Farqani Abdulla MS , Al Lawati Ala
Published: December 2023

NONE
The Evolution of Paediatric Cardiology Service in Oman
Authors: Al Maskari Salim N
Published: December 2023

NONE
Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation
Authors: Al Kindi Hamood , Al Harthi Hasina , Al Balushi Asim , Atiq Ahlam , Shaikh Samiuddin , Al Alawi Khalid , Al-Farqani Abdullah
Published: December 2023

Objectives: There is limited data published from outside North America and Europe comparing the outcomes of a modified Blalock-Taussig shunt (MBTS) and ductal stenting as the first palliative procedure for infants with duct-dependent pulmonary circulation. This study reports the National Heart Center’s, in Muscat, Oman, experience in comparing the outcomes of these 2 interventions. Methods: This retrospective study included all infants with duct-dependent pulmonary circulation who received either a MBTS or ductal stenting from 2016–2019. The primary outcomes were death or re-interventions. Secondary outcomes included death, subsequent re-interventions, survival to subsequent surgical intervention, survival to hospital discharge, post-procedural mechanical ventilation and duration of intensive care unit stay. Results: A total of 71 patients were included in the study, 33 (46%) of whom received ductal stenting. The prevalence of the primary outcome (death or re-intervention) in the patent ductus arteriosus (PDA) stent group was 54.5% versus 31.6% in the MBTS group but this was not statistically significant (P = 0.06). There was no difference between the 2 groups in terms of time to next surgical intervention (P = 0.233). The PDA stent group had shorter post-procedural, mechanical ventilation and intensive care unit stay durations (P <0.05). Syndromic patients were at higher risk of mortality compared to non-syndromic patients. Conclusion: MBTS and ductal stenting are both acceptable modalities as a palliative intervention for infants with duct-dependant pulmonary circulation. Syndromic patients are at higher risk of mortality. This can be considered an important factor for patient selection.

Keywords: Blalock-Taussig Procedure; Patent Ductus Arteriosus; Pulmonary Atresia; Oman.
Rupture of Renal Angiomyolipoma Post Fibrinolysis
Authors: Al-Kindi Saba , Al-Hajriy Mahmood , Al-Jabri Adil
Published: December 2023

Angiomyolipoma is a common benign solid tumour that accounts for up to 3% of all renal tumours; most of the cases are sporadic. However, it can be part of other diseases. Angiomyolipomas are usually found incidentally through unrelated clinically indicated images but also, they can be diagnosed after complications have occurred. We report the case of retroperitoneal haemorrhage following the rupture of renal angiomyolipoma post-fibrinolysis, we are highlighting such a rare condition, the management options and the follow-up plan. The management of angiomyolipomas ranges from conservative treatment to surgical intervention depending on the patient’s condition and the tumour’s radiological features. Following-up on patients with angiomyolipomas depends on the symptoms and the tumour size. Till date, there is no reported cases of renal angiomyolipoma rupture post-fibrinolysis therapy as a treatment for myocardial infarction in non-percutaneous intervention capable facility.

Keywords: Angiomyolipoma; Myocardial Infarction; Fibrinolysis, Retroperitoneal; Hemorrhage; Artery Embolization; Percutaneous Intervention.
The Sinus Venosus Veno-Venous Bridge
Authors: Maddali Madan M , Anderson Robert H , Al Maskari Salim N , Al Kindi Faiza , Al Kindi Hamood N
Published: December 2023

This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.

Keywords: Heart Septal Defects, Atrial; Diagnostic Imaging; Sinoatrial Node; Vena Cava, Superior.
Post-Infarction Ventricular Septal Defect
Authors: Al-Bulushi Ahmed , Al Salmi Issa , Ahmed Ahmed R , Al Rahbi Fatma
Published: December 2023

Objectives: Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD. Methods: This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman. Results: Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis. Conclusion: Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

Keywords: Post Infarction Heart Rupture; Ventricular Septal Rupture; Coronary Artery Bypass Grafting; Mortality; Oman.
Angiographic Predictors of Viability During Intervention for a ST Elevation Myocardial Infarction
Authors: Al-Maashari Suhaib , Al-Malki Yasir , Al Lawati Hatim , Al-Riyami Adil , Nadar Sunil K
Published: December 2023

Objectives: This study aimed to identify angiographic features that would predict myocardial viability after coronary intervention for ST elevation myocardial infarction (STEMI). Methods: This retrospective study included patients who attended Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 with a STEMI. Results: A total of 72 patients (61 male; mean age = 54.9 ± 12.7 years) were included in the study; 11 patients had evidence of non-viability on echocardiography. There were 13 patients with viable myocardium and 3 with non-viable myocardium who had a myocardial blush grade (MBG) of 2 or lower. Similarly, 10 patients with viability and 1 with non-viable myocardium had thrombolysis in myocardial infarction (TIMI) flow of 2 or lower in the infarct related artery (IRA). However, none of these were statistically significant. The TIMI flow in the IRA at the end of the procedure correlated with the MBG. Conclusion: There were no clear angiographic features during primary angioplasty that could predict myocardial viability.

Keywords: Myocardial infarction; Coronary Angiography; Viability; Oman.
Propofol and Kearns-Sayre Syndrome
Authors: Maddali Madan M , Munasinghe Thushara D , Al Aamri Is'haq , Al-Abri Ismail A , Al-Adawi Samir
Published: December 2023

With the focus on an idiographic approach whereby the observations incorporated the various dimensions of individual functioning ‘top-down’ to ‘bottom-up’, this case report describes the successful management of a 14-year-old girl with Kearns-Sayre syndrome and Dyggve-Melchior-Clausen disease requiring a transvenous permanent pacemaker implantation for complete heart block. The patient presented to a tertiary care centre in Muscat, Oman, in 2023 seeking consultation. The current idiographic approach appears to have a heuristic value for 2 interrelated reasons. Firstly, it is unlikely that even tertiary care units can accrue such rare presentations and scrutinise them under nomothetic approach. Secondly, by employing the idiographic approach that is capable of examining each case in-depth, the aspiration for good health and well-being may come to the forefront. To the best of the authors’ knowledge this is the first published idiographic report in anaesthesia care.

Keywords: Intravenous Anaesthetics; Artificial Pacemaker; Kearns-Sayre Syndrome; Propofol; Idiographic Approach; Case Report; Oman.
A Rare Pathology Masquerading as Myocardial Infarction
Authors: Maddali Madan M , Chauhan Avinash , Kandachar Pranav S , Al-Mukhaini Mohammed
Published: December 2023

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Sudden Cardiac Death in Patients Under 49 Years Including Adolescents
Authors: Maddali Madan M , Al Habsi Ahmed S , Al Dhamri Mariya J , Jayapal Sathish K , Al Kindi Hamood N
Published: December 2023

Objectives: This study aimed to identify the incidence of sudden cardiac death (SCD0 in adult patients under the age of 49 years, including adolescents with an out-of-hospital cardiac arrest that presented to the emergency department of a tertiary care hospital. Methods: This retrospective cross-sectional study was conducted at the Royal Hospital, Muscat, Oman, between January 2015 and December 2019. All patients with out-of-hospital cardiac arrest were enrolled. The incidence of SCD was evaluated. Information about the patient's demographic data, the site of cardiac arrest, the mode of arrival, the duration of pre-arrest symptoms and if cardiopulmonary resuscitation was performed was gathered. Survival data at 3-year follow-up was obtained. Results: A total of 117 out of 769 (15%) patients met the criteria for SCD. Male gender was predominant, with a median age of 33 years. In about 79.5% of the patients, cardiac arrest was witnessed. Only 43 patients (36.8%) received cardiopulmonary resuscitation at the arrest site; 21 patients (17.9%) had a shockable rhythm and 96 patients (82.1%) had a non-shockable rhythm. Spontaneous circulation was returned in 15 patients (12.8%). Nine patients (7.7%) were discharged from the hospital and 8 (6.8%) survived at least 36 months. Conclusion: The study findings indicate the prevalence of SCD among patients who experienced a cardiac arrest outside the hospital. Unfortunately, only a small number of patients were able to survive in the long term. By implementing preemptive screening for individuals and their families, it may be possible to prevent SCD and improve outcomes for those affected.

Keywords: Death, Sudden, Cardiac; Epidemiology; Etiology; Risk Factors; Incidence; Cardiopulmonary Resuscitation; Retrospective Studies; Oman.
Lipid disorders before and after successful liver transplantation
Authors: Gojowy Damian , Urbaniec-Stompór Joanna , Adamusik Joanna , Wójcik Gabriela , Karkoszka Henryk , Król Robert , Więcek Andrzej , Adamczak Marcin
Published: December 2023

Introduction: Liver transplantation (LTx) is the only successful treatment for end-stage liver disease. The results of liver transplantation depend not only on graft survival but may be also affected by superimposed cardiovascular morbidities. The aim of this retrospective study was to assess the prevalence of lipid disorders as one of the important cardiovascular risk factors in patients before and after successful LTx. Material and Methods: One hundred eleven patients who underwent liver transplantation because of liver cirrhosis and survived at least 2 years with functioning graft between November 2005 and May 2014 were included in this retrospective analysis. The mean age of the patients at the time of liver transplantation was 49.7±12.2 years. The prevalence of dyslipidemia was assessed before and two years after liver transplantation. This was analyzed in relation to the etiology of liver disease, including alcohol toxicity, viral or autoimmune diseases. Results: The prevalence of hypertriglyceridemia before and after LTx was 13.5% and 40.5%, respectively (P<0.001). Similarly, hypercholesterolemia was noted in 17.1% and 51.4% respectively (P<0.001). The annual incidence of hypertriglyceridemia and hypercholesterolemia during the first two years after LTx was 16.2% and 20.7%, respectively. The prevalence of hypertriglyceridemia (18.5% vs 66.7%, P<0.001) and hypercholesterolemia (29.6% vs 70.0%, P=0.002) was significantly lower in patients with the autoimmune cause of liver cirrhosis in comparison to patients with the alcoholic liver disease. Conclusions: The prevalence of dyslipidemia is increased after liver transplantation. The prevalence of dyslipidemia may be related to the cause of liver injury before LTx.
Relationship between chemical industrial environment and allergic skin diseases
Authors: Fu Shaohua , Gong Minli , Xing Guisheng
Published: December 2023

Objective: This study is an exploration of the relationship between chemical industrial environment and allergic skin diseases. Methods: In this retrospective analysis, 200 patients with allergic skin diseases who worked or lived in a chemical industrial zone and were admitted in our hospital between January 2018 and January 2020 were enrolled as Group A. Besides, 500 patients with allergic skin disease who lived in Zhenhai New District, five kilometers away from the chemical radiation zone, were selected as Group B. The specific immunoglobulin E (IgE) levels were determined by Western blotting. The allergen positivity, as well as allergen positivity between different age, sex and body mass index (BMI) were compared between the two groups. The positive food-specific allergen IgE antibody (sIgE) and positive inhalational sIgE were compared between the two groups. Results: The positive rate of total IgE and inhalational sIgE in Group A was higher than that in Group B (P<0.05), while there was no significant difference in positive rate in food sIgE between the two groups (P>0.05). In Group A, the differences in positive rates of total IgE, food-induced sIgE and inhalational sIgE were not significant between patients with different ages, sexes and BMI (P>0.05). There was no significant difference between the two groups in sIgE positive rates of wheat, mango, soybean/peanut/cashew nut combination, limb/beef combination, crab/shrimp/fish combination, milk and egg white (P>0.05). The positive rates of inhalational sIgE in tree combination and dust mites/household dust mites combination in Group A were higher than those in Group B (P<0.05), but had no significant difference between the two groups in the positive rates of inhalational sIgE in Humulus japonicus, mold combination 1, cockroach, cat/dog hair combination, and ragweed/artemisia combination (P>0.05). Conclusion: Chemical industrial environment is closely associated with allergic dermatosis, and the positive rate of total IgE and inhalational sIgE increases significantly in patients living there.
Use of sertraline and agomelatine in hemodialysis patients: A case series report
Authors: Kubanek Alicja , Przybylak Mateusz , Paul Przemysław , Kowalska Anna Sylwia , Błaszczyk Michał , Macul-Sanewska Aleksandra , Renke Marcin , Rutkowski Przemysław , Bidzan Leszek , Grabowski Jakub
Published: December 2023

Objective: Major depressive disorder (MDD) is one of the most common psychiatric issues in hemodialysis population. However, the research on proper diagnostic tools and its treatment is still insufficient. The study was performed to investigate the safety and effectiveness of sertraline and agomelatine in a group of hemodialysis patients. Patients and Methods: 78 adult patients from one dialysis centre in Poland were included into the study. The Beck Depression Inventory II (BDI-II) was used to screen for depressive symptoms and was followed by the clinical interview with the psychiatrist. Nine patients diagnosed with major depressive disorder received antidepressant treatment with sertraline or agomelatine, according to the best clinical practice. The additional treatment with vortioxetine was used if the initial one was not effective. The time of observation was 24 weeks. The psychiatric follow up as well as the laboratory data were obtained during the course of observation. Results: All patients receiving sertraline achieved remission of depressive symptoms. In patients receiving agomelatine no remission was observed despite dose augmentation. The side effects of antidepressants were mild and did not result in treatment discontinuation. No abnormalities in liver enzymes levels were observed. In five cases the significant decrease of haemoglobin level was noticed, with no cases of bleeding reported. Conclusion: In patients receiving sertraline the antidepressant effect was satisfactory. No remission of depressive symptoms was observed in patients taking agomelatine. The side effects of antidepressants were mild and transient. Further research on depression treatment in hemodialysis patients is needed, including newer medications.
ISOLATION AND IDENTIFICATION OF BROAD-SPECTRUM ANTAGONIST BACTERIA AGAINST PATHOGENIC FUNGI OF MAIZE CROP
Authors: Dias Diniz Gisele de Fátima , Viana Cota Luciano , Fontes Figueiredo José Edson , De Paula Lana Ubiraci Gomes , Sousa Marins Mikaely , Campos Silva Felipe , Dos Santos Vera Lúcia , Abreu de Oliveira-Paiva Christiane
Published: December 2023

Fungal diseases may cause significant damage to crops worldwide, generating yield losses, poor grain quality, and health risks to humans and animals. Biological control using antagonistic bacteria offers innovative solutions for sustainable management aiming at plant protection. However, beneficial plant-microorganism interactions are particular, and few antagonists with broad-spectrum activity have been reported. In this work, two bacteria isolated from sorghum seeds were identified by partial sequencing of the 16S rRNA gene and tested in vitro for their capacity to control six important pathogenic fungi of maize: Fusarium verticillioides, Macrophomina phaseolina, Stenocarpella sp., Fusarium graminearum, Colletotrichum graminicola, and Bipolaris sp. The molecular identification revealed that the bacterial isolates belong to the genera Bacillus (strain LIS05) and Paenibacillus (strain LIS04). Both bacterial isolates inhibited the growth of all six phytopathogens by at least 49%. The isolate LIS05 showed the most significant antagonistic potential against the fungal pathogens tested, at an average of 73% inhibition. The highest antagonist activity (86.1% inhibition) was observed in the confrontation test between the isolate LIS05 and C. graminicola. In addition to the mycelial growth inhibition, the isolate LIS04 blocked the production of dark pigments by Bipolaris sp. This study showed that LIS05 and LIS04 are promising alternatives for developing integrated management strategies to control fungal diseases in maize and sorghum.