Khoula Hospital Research Articles

Cranioplasty in Oman: Retrospective review of cases from the National Craniofacial Center 2012-2022.

Cranioplasty is a complex craniofacial and neurosurgical procedure that aims to reinstate the architecture of the cranial vault and elevate both its aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. This study aimed to evaluate different material used for cranial reconstruction in Oman. This retrospective study included all patients who had had cranioplasty procedures performed at Khoula Hospital, Muscat, Oman, from 2012 to 2022. Demographic information, the characteristics of the cranial defect and any complications that occurred post-operatively were analysed. A total of 47 patients were included in this study. The most common cause of cranial defects was craniectomy following traumatic head injury (70.2%) along with excision of fibrous dysplasia (10.6%). The most frequently utilised material for cranial repair was autologous bone grafts (n = 28), followed by polyetheretherketone (PEEK; n = 14). Interestingly, the replacement of bone grafts from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group. Patient-specific alloplastic implants such as PEEK have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone grafts remain the gold standard for small to medium-sized cranial defects.

Analysis of Blood Cultures from Major Burns Patients in a Tertiary Care Burn Unit in Oman.

This study aimed to review the blood stream infections of major burn patients in a tertiary care burn unit to determine the most prevalent infecting organisms in order to have a better empirical therapy protocol. This retrospective study analysed the blood stream infection of 155 major burn (>20% Total Body Surface Area [TBSA]) patients in Khoula Hospital, Muscat, Oman between January 2014 to December 2019. The median age was 33 years and 57.42% of patients were male. The median TBSA was 38%, mortality was 25.16% and 50.9% of patients had positive blood cultures. The expired patients had higher TBSAs, Abbreviated Burns Severity Index scores and earlier first positive blood cultures. Candida was commonly grown in all the blood cultures, but the most prevalent organisms were Acinetobacter, Staphylococci, Klebsiella, Enterococcus and Pseudomonas. All Acinetobacter species are multidrug resistant. Of the 17 patients who had Kelbsiella grown in the blood culture, 8 grew multidrug-resistant Klebsiella. Only 4 patients' blood cultures grew methicillin-resistant Staphylococcus aureus. The number of blood culture samples taken ranged between 1-28 (median = 6). The first positive blood culture showed that Staphylococcus epidermidis and Acinetobacter were the most common infecting organisms. Multidrug-resistant Acinetobacter was the most predominant microorganism grown from the blood cultures of major burn patients in a tertiary care burn unit. Empirical therapy should include antibiotics that are effective against this organism to reduce the mortality.

Predictors of Quality of Life Among Omani Family Caregivers of Patients With Traumatic Brain Injury.

This study aimed to explore the quality of life (QoL) of Omani family caregivers (FCs) of patients with traumatic brain injury (TBI). After acute care, the burden of caring for patients with TBI is mainly shouldered by FCs. This cross-sectional study was conducted at Khoula Hospital, Muscat, Oman. Patient data were collected at the time of discharge and 8 weeks post-discharge between April 2019 and December 2021. The SF-12 General Health Survey and Preparedness for Caregiving scale were used to measure the caregivers' QoL and preparedness, respectively. The Disability Rating and TBI Symptom scales were used to measure the patients' disability and symptoms, respectively. A total of 36 FCs and patients with TBI were recruited. Most caregivers were the parent (41.7%) or child (27.8%) of the patient with TBI. Overall, the caregivers had good physical QoL (PQoL) and mental health QoL (MHQoL) but low caregiving preparedness at the time of discharge. At 8 weeks post-discharge, there were significant improvements in caregiving preparedness (P <0.01) and patient disability (P <0.05) but a depreciation in caregivers' MHQoL (P <0.05), with no change in their PQoL. The caregiver's employment status and the severity of the patient's sleep and mood problems were modifiable predictors of the caregivers' PQoL. Caregiver's preparedness, the patient's inability to live independently, and the severity of the patient's mood and behavioural problems were predictors of caregivers' MHQoL. Caring for patients with TBI negatively impacts the QoL of Omani FCs; this correlates with the physical, emotional, and mental health symptoms of the patient.

Epidemiology of developmental dysplasia of the hip at a tertiary hospital in Oman

Objectives: Developmental dysplasia of the hip (DDH) is common in Oman in clinical practice, but the incidence in Oman is still unknown. This study aimed to evaluate the incidence and characteristic features of DDH in the Omani population managed at Khoula Hospital (KH). Methods: This is a retrospective study conducted at KH, targeting all Omani pediatric patients who have been officially diagnosed with DDH between the periods from January 2009 to December 2019. The data were collected from the medical record system at the hospital and phone interviews with the patient’s family to fill out the missed information. Results: The study included 795 DDH-diagnosed patients, out of which 652 (82.0%) were female and 143 (18.0%) were male, giving a ratio of 4.5:1. Bilateral DDH was diagnosed in 300 (37.7%) patients, left-sided DDH in 307 (38.6%), and right DDH in 188 (23.6%) patients. At least half of the DDH cases were 6 months old or younger at the first presentation to the hospital and 16.6% were diagnosed after the age of 18 months. Remarkably, at least one risk factor was present for 581 (73.1%) patients. The remaining patients had no risk factors for DDH at all. The prevalence of the first child in the family was 33.0% and oligohydramnios 10.9%. The estimated DDH incidence in this study is 1.05/1000 live births/year. Conclusion: Based on the national live births annual records from Oman National Center for Statistics and Information, this study estimated the DDH incidence to be 1.05/1000 live births. These findings cannot be generalized nationally as they are from a single center. We recommend conducting a multicenter prospective study to identify DDH incidence in Oman accurately. National guidelines and screening programs must be developed and executed for early detection and management.

Understanding air leak in COVID-19 patients: case series

Around one fifth of COVID-19 patients progress to develop acute respiratory distress syndrome. This cohort carries the highest morbidity and mortality, and the greatest treatment challenges. They are more likely to require mechanical ventilation. Thoracic air leak has been noted to be more prevalent in this group of patients. This study aims to explore the relationship between ventilator settings and the development of air leak as possible triggers, and the basic pathophysiological concepts behind its development, as well as preventive strategies. In this case series the data of all patients admitted with COVID-19 pneumonia to Khoula hospital intensive care unit (ICU) during the period from March 1st, 2020 to July 31st, 2021 were collected retrospectively and analyzed. Fourteen patients representing 7.1% out of the 196 ICU admissions had demonstrated one or more air leak manifestation. Male to female incidence was 3:1 and the mean age was 53 years. The 71.4% of these patients had received mechanical ventilation, 14.3% of them received continuous positive airway pressure (CPAP), and 14.3% just received oxygen supplementation via plain face mask. The average ventilation to air leak development time is around 7.6 days (95% CI: 1.9-13.4%). In conclusion, although the majority of the patients who had air leak were mechanically ventilated, the condition can develop in non-ventilated and even spontaneously breathing COVID-19 patients, and no specific ventilator measure could be blamed for its development. Lung-protective ventilation strategies and accurate timing for escalation of respiratory support are the mainstay for prevention.

Histopathological changes in the placentas of mothers with a history of coronavirus disease 2019 infection in pregnancy- A comparative cross-sectional study

This study aimed to evaluate histopathological changes in the placentas of mothers who had contracted COVID-19 during pregnancy. This prospective study involved the histopathological assessment of two groups of placentas submitted for evaluation to the Department of Histopathology at Khoula Hospital, Oman. The first group consisted of 48 placentas derived from COVID-19-positive pregnant women delivered at the centre between March 2020 and March 2021. The control group consisted of an additional 48 placentas derived from asymptomatic mothers who were not tested for COVID-19 but were assumed to be negative. All placentas underwent gross and microscopic histopathologic examination. Placental lesions were classified according to the Amsterdam system. There was a significantly higher frequency of fibrin thrombi at the terminal villi in placentas derived from the COVID-19-positive group compared to the control group (72.9% versus 0%; p-value = 0.001). Also, villous hypoperfusion was significantly more common in COVID-19-positive placentas than in controls (16.7% versus 0%; p-value = 0.006). However, no significant differences between the two groups were noted with regards to the frequency of other histopathologic features, including decidual vasculopathy, chorioamnionitis, funisitis, intervillositis, perivillous fibrin deposition, and infarction.

Geriatric Neurosurgery in High-Income Developing Countries: A Sultanate of Oman Experience

This study aimed to investigate the prevalence and characteristics of geriatric neurosurgical conditions in the Neurosurgical Department at Khoula Hospital (KH), Muscat, Sultanate of Oman. The majority of various neurosurgical conditions is increasing in elderly patients, which leads to an increase in neurosurgical demand. The aging population has a direct effect on hospital decision-making in neurosurgery. However, limited data are available to assess geriatric neurosurgery in developing countries. A retrospective chart review of geriatric cases admitted to the Neurosurgery Department in KH served as our example of a neurosurgical center in a high-income developing country from January 2016 to 31st December 2019. Patients’ demographics, risk factors, diagnosis, Glasgow Coma Scale on arrival, treatment types, and length of stay were recorded. A total of 669 patients who were above the age of 65 years were recruited into our retrospective review. The mean age was 73.34 years in the overall cohort and the male-to-female ratio was (1.6:1). The most common diagnostic category was trauma, which accounted for 35.4% followed by oncology and vascular (16.3% each). Hydrocephalus accounted for 3.7% of the admissions. Most of the patients underwent surgical interventions (73.1%). The associations were significant between the treatment types (surgical vs. conservative), Length of Stay, and the GCS on arrival (p &lt; 0.05). In conclusion, the trend of geriatric neurosurgery is increasing in developing countries. The most common reason for admission to the neurosurgical ward was Traumatic Brain Injury. Special care must be taken when dealing with geriatric neurosurgical cases and a more holistic approach is needed.

Prevalence and Outcomes of Geriatric Traumatic Brain Injury in Developing Countries: A Retrospective Study

Abstract Introduction The world populace is aging and it is anticipated that 2 billion people will be older than 60 years by 2050. Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In the United States, 2.8 million people pursue medical attention yearly. TBI exemplifies a leading cause of mortality and morbidity among the geriatric age group worldwide. Methods A retrospective study of geriatric cases who were admitted to the Neurosurgery Department in Khoula Hospital from January 1, 2016, to December 31, 2019, was conducted. Patients' demographics, risk factors, neuro-vital sign, diagnosis, Glasgow coma scale (GCS) on arrival, treatment types, and length of stay (LOS) were recorded. Results Two hundred and thirty-four patients were admitted due to TBI in four years period. Seventy-five percent of the study cohort were more than 75 years old. Male to female ratio was 2.4:1. Subdural hematoma (SDH) was the most common TBI diagnosis based on computed tomography (77.4%). Most of the patients were having GCS scores of 14 to 15 (67.9%). Sixteen percent of the patients received antiepileptic medications. The majority of the patients underwent surgical intervention (70.5%). Eighty percent of the patients stayed in the hospital for less than 15 days. There was a significant difference between the LOS and type of surgery. Subarachnoid hemorrhage was found to have the highest mean age (79.7 years). Intracerebral hemorrhage patients had the longest LOS in the hospital with a mean of 44.2 days. There was no significant difference between the age of patients and type of surgery. Conclusion The number of TBI in the elderly population is increasing annually. The most common type of TBI in our cohort was SDH and most of the patients were treated with burr hole surgery.

Predicting Patients at Risk for Prolonged Hospital Stays Following Pediatrics Traumatic Head Injuries in High-Income Developing Country: A Retrospective Cohort Study

Traumatic brain injuries (TBIs) in pediatrics are the most common cause of long-term morbidity and mortality, generating a considerable burden on the health care system. In the current retrospective study, we aimed to identify the predictors that contribute to prolonged hospital stays in pediatric TBI. A retrospective cohort study including all pediatric cases (age younger than 14) who presented to Khoula Hospital with TBI and were seen from January 2015 to December 2019. The multivariate binary logistic regression analysis has been used to determine the independent predictors of prolonged hospital stay. Prolonged hospitalization was defined as mean ± 2 standard deviation days. A total of 866 cases of pediatric TBI were documented. The mean age was 4.33 years. The length of hospital stay ranged from <1 day to 90 days (mean= 3.65, standard deviation= 6.84). Prolonged hospitalization was calculated to be >17 days. Thirty-one patients had prolonged hospital stay out of the studied cohort, with an incidence proportion of prolonged stay= 3.6% (95% CI= 2.4%-5.0%). Prolonged hospitalizations were associated with motor vehicle collision injuries (odds ratio [OR]: 27.028, 95% confidence interval [CI]= 2.744-266.194, P= 0.005); pedestrian injuries (OR= 11.667, 95% CI= 1.017-133.805, P= 0.048), and Glasgow Coma Scale score onarrival of <9 (OR= 8.149, 95% CI= 1.167-56.921, P= 0.034). The current study identified motor vehicle collision and pedestrian injuries, as well as initial Glasgow Coma Scale score of <9 as independent predictors of prolonged hospitalization in pediatrics TBI.

Anti-Epileptic Drugs in Geriatric Neurosurgery: A Review of 669 Neurosurgical Cases

Background and PurposePatients over the age of 75 are more likely to develop epilepsy than children under the age of 10. Patients of all ages are prescribed anti-epileptic drugs; however, those over the age of 65 are the most typically prescribed group.MethodsThis is a retrospective study of geriatric cases admitted to the Neurosurgery Department in Khoula Hospital from January 1, 2016 to December 31, 2019. A medical records of 669 patients were identified. Patients’ demographics, risk factors, usage of anti-epileptic drug (AED), type of tumor, tumor location, neuro-vital signs diagnosis, Glasgow coma scale on arrival, treatment types, and length of stay (LOS) were recorded.ResultsThe prevalence of AEDs use was 19%. Patients with traumatic brain injury (TBI) were found to have a higher rate of using AEDs (32.1%) followed by patients with oncological and vascular pathologies, respectively (30.1% and 21.6%). There was a significant relationship between the utilization of AEDs among different neurological diseases investigated (p<0.05). Patients who received surgical interventions were using AEDs much more than patients with conservative management (p=0.001). There was a significant difference in the LOS and the usage of AEDs. Added to that, the results signify a relationship between the intensive care unit (ICU) admission and the utilization of AEDs in which the majority of the patients who were not on AEDs were not admitted to the ICU (p<0.05). Phenytoin was the most commonly used AED among different neurosurgical pathologies in the present study (n=110).ConclusionsAEDs are used as prophylaxis to prevent seizures before most neurosurgical procedures and were commonly prescribed in TBI patients. Phenytoin was found to be the commonest AEDs utilized among the different neurosurgical categories followed by levetiracetam.

Ileosigmoid knotting: Case report and literature review

Objective: Ileosigmoid knotting (ISK) is the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. ISK is a rare cause of bowel obstruction in general and rare during pregnancy. Case: We present a case of ISK, a Pregnant lady 29th weeks gestation, which was treated successfully in our institution – Khoula Hospital – Muscat - Sultanate of Oman.

Utilization of anticoagulant and antiplatelet medications among geriatric patients with neurosurgical diseases

Aim: To study the utilization patterns of anticoagulant and antiplatelet medications among geriatric patients with neurosurgical conditions in the neurosurgical department at Khoula Hospital, Muscat, Sultanate of Oman. Introduction: Anticoagulant and antiplatelet presumption is a worry in neurosurgical patients, that suggests a subtle balance between the risk of thromboembolism against the risk of peri- and postoperative haemorrhage. Patients taking those medications were found to have an increased risk of bleeding from traumatic and traumatic events. Materials and Methods: A retrospective study of geriatric cases admitted to the Neurosurgery Department in Khoula Hospital (KH) as an example of a neurosurgical center in Sultanate of Oman, from January 2016 to 31st December 2019. Patients demographics, diagnosis, length of hospital stay (LOS), Glasgow Coma Scale (GCS), length of ICU admission, and treatment proposed were recorded. Results: The most common diagnostic category was trauma (35.4%). 16.0 % of the patients were taking anticoagulant medications. Patients with traumatic brain injury (TBI) were found to have a higher rate of using anticoagulant medications (36.6%). There was a significant difference between the LOS, type of intervention, ICU admission, and the usage of anticoagulant and antiplatelet drugs (p&lt;0.05). Enoxaparin was the most commonly used anticoagulant agent. 19.6 % of the patients were taking antiplatelet medications. This study was showed that aspirin is the most commonly used antiplatelet agent among different neurosurgical pathologies. Conclusion: Patients with TBI were found to have a higher rate of using anticoagulant medications. Decisions regarding prescription and resumption of anticoagulants and antiplatelet medications should be taken on a case-by-case basis involves multidisciplinary and holistic approaches.

Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman.

ObjectivesStroke is a significant public health problem and one of the most important preventable non-communicable diseases. Preventive stroke programmes with a better focus on increasing awareness among those who are currently at risk are yet to be properly established in Oman. This study was conducted to describe the characteristics of stroke patients presenting to a tertiary care hospital in Oman.MethodsThis cross-sectional hospital-based study included 193 stroke cases which were prospectively recruited from the Emergency Department of Khoula Hospital, Muscat, Oman. Data were collected from November 2017 to April 2018.ResultsThe total number of patients was 193 with 82.9% of strokes being ischaemic strokes. Of this, 58% were male. The mean age of stroke patients was 61.05 years. Risk factors included hypertension (72.5%) and diabetes mellitus (54.4%). Dyslipidaemia, atrial fibrillation and ischaemic heart diseases were not particularly prevalent in the studied population and 24.4% of ischaemic strokes had large artery atherosclerosis while 21.9% had small vessel occlusion. Significantly more patients had lower Glasgow Coma Scale scores, required intensive care unit admission and experienced in-hospital deaths due to haemorrhagic stroke compared to ischaemic stroke.ConclusionThis study provides essential data regarding stroke characteristics specific to Oman’s population. Most of the information obtained appears to be in-line with what has been described internationally and, hence, preventive strategies similar to those indicated in extant literature can be implemented. This information can be utilised by health administrators in planning resource allocation. Further research is needed to explore rehabilitation aspects and long-term outcomes.

Health-related Quality of Life of People with Multiple Sclerosis in Oman.

ObjectivesMultiple sclerosis (MS) is a disabling neurological disorder with significant adverse effects on patients’ quality of life (QoL). Despite the increased prevalence of MS in Arabian Gulf countries in recent years, no study has assessed the impact of MS on the health-related QoL (HRQoL) of Omani patients. Therefore, the objective of this study was to determine the impact of MS on HRQoL of Omani patients using the validated disease-specific self-administered MS International QoL (MusiQoL) instrument.MethodsWe conducted a descriptive cross-sectional survey between April and December 2019 on 177 Omani patients with MS attending Sultan Qaboos University Hospital and Khoula Hospital in Oman using the MusiQoL instrument.ResultsThe majority (51.4%) of patients had poor HRQoL, and 48.6% had moderate HRQoL. We found that being > 30 years, female, married, separated, widowed, or divorced, and having visual and sleep problems resulted in poorer HRQoL scores. Among the different HRQoL components, relationships with the healthcare system and relationships with family and friends were the most affected by the disease process. Our results also showed that psychological wellbeing and coping domains of MusiQoL questionnaires are significantly reduced in females compared to males.ConclusionsUnderstanding the HRQoL of Omanis with MS provides valuable knowledge that could help optimize the management of this disease.

Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman.

ObjectivesThis study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women.MethodsA cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist.ResultsA total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each).ConclusionThe prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections.

Characteristic of Cleft Lip and Palate Cases Attended to Khoula Hospital Cleft Center

The data were collected from Plastic Surgery Department of Khaula Hospital Muscat, Oman, between years 2010 and 2019. Data was collected using a form that included demographic distribution of patients, gender, age, birth weight, region, age when first attended hospital, associated congenital anomalies and syndromes, type of delivery, mother consumption of Folic Acid, types of cleft lip/palate, and surgeries done. During 9 years period the total number of recorded patients having cleft Lip/Palate was 1899. 43.7% of cases had CLP, 36% had CP, 20.3% had complete fissuring of the lip. Sixty-eight percent of the children were between 0 and 3 months of age when they first attended Hospital. 6.2% of children had siblings with orofacial clefts. Congenital malformations associated with CL/P or syndromic cleft were seen in 31.1% of cases. 86.8% of children got operated at Hospital and most common types of surgeries were lip and palate repair. Twenty-three percent of patients had undergone orthodontic treatment, 49.3% of patients had speech therapy, 32.5% referred for ENT consultation, and 20.5% of patients got grommet inserted. Prevalence of CL/P in Oman is 2.6 in 1000 live births. Two main possible reasons contributing to the increase seen in this prevalence can be increase in the number of live births in Oman and parent's education toward cleft treatment that led more patients attending hospital for treatment.

Spinal conditions in geriatric patients in developing countries

Background: The spinal injury in an elderly patient is associated with higher mortality and an increased frequency of life-threatening complications and specifically spinal cord injuries. The aim of this study is to study the prevalence of geriatric spinal neurosurgical conditions in the Neurosurgical Department at Khoula Hospital, Muscat, Sultanate of Oman. Results: 171 patients were admitted due to spinal pathologies, which will be the main focus of the present study with an average age of 70.7 years. The male-to-female ratio was (1.5:1). Degenerative conditions were the most common spinal diagnosis (90.6%) followed by traumatic accidents (2.9%). Most of the patients underwent surgical intervention (78.9%). The majority of the patients (91.2%) of the patients stayed in the hospital for less than 15 days. There was a significant difference between the age of patients above and below 75 years the gender (p=0.003) and between the length of stay and type of intervention (P&lt;0.005). Conclusion: Spinal cord-related pathologies are a growing cause of mortality and morbidity worldwide, because of the increasing number of elderly people due to an increasingly rising life span worldwide. In the present study, degenerative conditions were the most common spinal diagnosis followed by traumatic accidents.

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Background: The aging of the healthy population without severe morbidity exposes them to cerebrovascular diseases and demand effective management. This study aimed to study the prevalence of geriatric cerebrovascular neurosurgical conditions in the Neurosurgical Department at Khoula Hospital, Muscat, Sultanate of Oman. Methods: A retrospective chart review of was done on geriatric cases admitted to the Neurosurgery Department in Khoula Hospital as an example of a neurosurgical center in a high-income developing country from January 2016 to 31st December 2019. Patients’ demographics, risk factors, diagnosis, Glasgow Coma Scale (GCS) on arrival, medications used, and length of stay were recorded. Results: 109 patients aged over 65 years were recruited in our retrospective review with a mean age of 74.12 years. Male-to-female ratio was (1.2:1). Intracerebral hemorrhage (ICH) was the most common vascular diagnosis (39.0%) followed by subarachnoid hemorrhage (SAH) (22.9%). Most patients (41.9%) had a GCS score of less than 8. About one-fifth of the patients received antiplatelet and anticoagulant medications. Most of the patients underwent surgical intervention (61.9%). 59% of the patients stayed in the hospital for less than 15 days. There were significant associations between the length of stay, treatment types (surgical vs. conservative), and age (P&lt;0.05). Conclusion: Cerebrovascular pathologies are a growing cause of mortality and morbidity worldwide including developing countries because of the increasing number of elderly people. Antiplatelet medication and anticoagulants should be used with caution in the elderly.

Geriatric Neuro-Oncology in the Middle East: A Sultanate of Oman Experience

Brain tumors are primary or metastatic malignancies of the central nervous system (CNS) with significant morbidity and mortality. The overall prevalence of cancer including brain cancer has increased by more than 10% according to the National Institute of cancer statistics. The average percent increase in primary brain tumor incidence for ages 75–79, 80–84, and 85 and older were 7%, 20.4%, and 23.4%, respectively. This manuscript describes a retrospective study of geriatric cases admitted to the Neurosurgical Department in Khoula Hospital (KH) and diagnosed with brain cancer from 1 January 2016 to 31 December 2019. Of the study cohort, 58.5% were more than 75 years of age. The male-to-female ratio was (1:1.1). Meningiomas are found to be the commonest tumor (52.8%) followed by glioblastoma (GBM) (18.9%). Most of the patients had a Glasgow coma scale (GCS) score of 14–15 on admission (69.9%). Patients diagnosed with a non-meningioma tumor had lower GCS score on admission compared to meningioma patients with statistical significance (p = 0.04). Also, there was a significant difference between the length of stay (LOS) and the type of intervention (surgical vs. conservative), in which patients received a conservative type of management found to have a shorter length of stay (LOS) compared with the patients who underwent surgical intervention (p < 0.005). In Oman, the number of geriatric oncology cases remained stable over the 4 years. The incidence of geriatric neuro-oncology cases was higher in patients aged more than 75 years of age. Finally, the GCS score was affected by the type of tumor. The length of stay varies according to the treatment administered. Special care must be taken when dealing with geriatric neuro-oncological cases due to the high potential rate of mortality and morbidity among those group, and a more holistic approach is recommended as an essential need to evaluate the overall situation of those patients and manage them accordingly.

Retrospective Study of Bone-TB in Oman: 2002–2019

ObjectiveLittle information is available about the etiology, pathophysiology, risk factors, and epidemiologic features of Bone Tuberculosis (Bone-TB). In this work, we present the epidemiological data about the Bone-TB in the Sultanate of Oman.MethodsRetrospectively, we identified and assessed those patients who were diagnosed with Bone-TB between January 2002 and December 2019 at Khoula Hospital. The following data were collected: demographics, clinical presentation, anatomical location, diagnosis, and treatment of the Bone-TB.ResultsDuring the study period, 115 cases of Bone-TB were diagnosed. Males were affected more than females (57.4% and 42.6%, respectively). About 30% of Bone-TB cases were primary diagnosed in other organs particularly the lungs and then after disseminated to the bone. However, the Bone-TB was detected in hip, leg, hand, shoulder, and skull bones, the most detected Bone-TB was in spine (66% of cases). After vaccination the Bacillus Calmette–Guérin (BCG) strains were identified in the bones of eight babies. Tubercle bacilli were detected by Acid-Fast Stain (AFS) in 59% of cases, and the rest of cases were confirmed using polymerase chain reaction (PCR) tests. There are two used treatment regimens, with 12.4% relapse. The gastrointestinal tract (GIT) disturbances were the most related side effects. The resistance has been detected to pyrazinamide in six cases, rifampicin in three cases, and isoniazid, streptomycin and kanamycin were detected in one case.ConclusionThe most predominant Bone-TB cases were spine-TB that were mainly disseminated from the lungs. AFS failed to detect tubercle bacilli in 40% of cases. There is no statistical significance in relapse between the used two regimens. The death was predominant among skull-TB cases.