Publications by authors named "Faisal Al Azri"

29 Publications

  • Page 1 of 1

"Virtual Interdisciplinary COVID-19 Team": A Hospital Pandemic Preparedness Approach.

Oman Med J 2020 Nov 20;35(6):e190. Epub 2020 Oct 20.

Department of Infection Prevention and Control, Sultan Qaboos University Hospital, Muscat, Oman.

The COVID-19 pandemic continues to move at record speed. Health systems and hospitals worldwide face unprecedented challenges to effectively prepare and respond to this extraordinary health crisis and anticipated surge. Hospitals should confront these unparalleled challenges with a comprehensive, multidisciplinary, coordinated, and organized strategy. We report our experience with the systematic application of the "4S" principle to guide our institutional preparedness plan for COVID-19. We used an innovative "virtual interdisciplinary COVID-19 team" approach to consolidate our hospital readiness.
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http://dx.doi.org/10.5001/omj.2020.131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578538PMC
November 2020

Maxillary Artery Pseudoaneurysm as a Complication of Maxillofacial Injuries: Report of three cases and literature review.

Sultan Qaboos Univ Med J 2019 Nov 22;19(4):e364-e368. Epub 2019 Dec 22.

Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman.

Traumatic maxillary artery pseudoaneurysm is an uncommonly reported complication in the field of oral and maxillofacial surgery. It is usually discovered incidentally, either early after trauma or weeks-to-months later. Quick recognition and prompt management are essential to avoid devastating consequences. In this paper, we report three uncommon cases of maxillary artery pseudoaneurysm recognised during the surgical management of maxillofacial injuries in Muscat, Oman. All cases presented as sudden brisk bleeding during the intraoperative surgical repair and were subsequently diagnosed and successfully managed by endovascular embolisation with platinum coils. This case report highlights the clinical presentation, diagnosis and management of maxillary artery pseudoaneurysm, in addition to a brief review of the literature.
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http://dx.doi.org/10.18295/squmj.2019.19.04.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930039PMC
November 2019

Loss of UGP2 in brain leads to a severe epileptic encephalopathy, emphasizing that bi-allelic isoform-specific start-loss mutations of essential genes can cause genetic diseases.

Acta Neuropathol 2020 03 9;139(3):415-442. Epub 2019 Dec 9.

Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Developmental and/or epileptic encephalopathies (DEEs) are a group of devastating genetic disorders, resulting in early-onset, therapy-resistant seizures and developmental delay. Here we report on 22 individuals from 15 families presenting with a severe form of intractable epilepsy, severe developmental delay, progressive microcephaly, visual disturbance and similar minor dysmorphisms. Whole exome sequencing identified a recurrent, homozygous variant (chr2:64083454A > G) in the essential UDP-glucose pyrophosphorylase (UGP2) gene in all probands. This rare variant results in a tolerable Met12Val missense change of the longer UGP2 protein isoform but causes a disruption of the start codon of the shorter isoform, which is predominant in brain. We show that the absence of the shorter isoform leads to a reduction of functional UGP2 enzyme in neural stem cells, leading to altered glycogen metabolism, upregulated unfolded protein response and premature neuronal differentiation, as modeled during pluripotent stem cell differentiation in vitro. In contrast, the complete lack of all UGP2 isoforms leads to differentiation defects in multiple lineages in human cells. Reduced expression of Ugp2a/Ugp2b in vivo in zebrafish mimics visual disturbance and mutant animals show a behavioral phenotype. Our study identifies a recurrent start codon mutation in UGP2 as a cause of a novel autosomal recessive DEE syndrome. Importantly, it also shows that isoform-specific start-loss mutations causing expression loss of a tissue-relevant isoform of an essential protein can cause a genetic disease, even when an organism-wide protein absence is incompatible with life. We provide additional examples where a similar disease mechanism applies.
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http://dx.doi.org/10.1007/s00401-019-02109-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035241PMC
March 2020

Dissecting Aneurysm of the Internal Carotid Artery as a Complication of Facial Bone Trauma.

Oman Med J 2019 Jan;34(1):70-73

Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

The involvement of the internal carotid artery in dissecting aneurysm is rarely reported in the literature and may occur as a complication of trauma, surgery, and other medical conditions. We report a case of a 22-year-old male who was involved in a motor vehicle accident with associated multiple orthopedic and maxillofacial fractures. During surgical management, the patient was incidentally diagnosed with a dissecting aneurysm involving the right internal carotid artery.
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http://dx.doi.org/10.5001/omj.2019.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330184PMC
January 2019

It is Always Darkest Before Dawn.

Oman Med J 2017 Sep;32(5):440-441

Ear, Nose, and Throat Unit, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

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http://dx.doi.org/10.5001/omj.2017.83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632689PMC
September 2017

Longitudinal extensive transverse myelitis (LETM) in children: A twenty-year study from Oman.

Neurosciences (Riyadh) 2017 04;22(2):127-130

Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman. E-mail:

Objective: The data on children with diagnosis of idiopathic transverse myelitis (ITM) was searched to find the pattern of myelitis in Oman.

Methods: A retrospective study was carried out from January1995 to December 2014. Electronic medical records and patient medical files were seen to get the complete data of the children with ITM. This work was carried out at Sultan Qaboos University hospital, Muscat, Oman. The ethical committee of the hospital had approved the study. The diagnosis was based on the established criteria. Other causes of myelopathy were excluded.

Results: 19 children with idiopathic transverse myelitis were found. There were 18 out of 19 (94.6%) children with longitudinal extensive transverse myelitis (LETM).

Conclusion: Longitudinal transverse extensive myelitis is the most common form of ITM in Oman.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726818PMC
http://dx.doi.org/10.17712/nsj.2017.2.20160352DOI Listing
April 2017

A mutation of EPT1 (SELENOI) underlies a new disorder of Kennedy pathway phospholipid biosynthesis.

Brain 2017 03;140(3):547-554

Medical Research (Level 4), University of Exeter Medical School, RILD Wellcome Wolfson Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.

Mutations in genes involved in lipid metabolism have increasingly been associated with various subtypes of hereditary spastic paraplegia, a highly heterogeneous group of neurodegenerative motor neuron disorders characterized by spastic paraparesis. Here, we report an unusual autosomal recessive neurodegenerative condition, best classified as a complicated form of hereditary spastic paraplegia, associated with mutation in the ethanolaminephosphotransferase 1 (EPT1) gene (now known as SELENOI), responsible for the final step in Kennedy pathway forming phosphatidylethanolamine from CDP-ethanolamine. Phosphatidylethanolamine is a glycerophospholipid that, together with phosphatidylcholine, constitutes more than half of the total phospholipids in eukaryotic cell membranes. We determined that the mutation defined dramatically reduces the enzymatic activity of EPT1, thereby hindering the final step in phosphatidylethanolamine synthesis. Additionally, due to central nervous system inaccessibility we undertook quantification of phosphatidylethanolamine levels and species in patient and control blood samples as an indication of liver phosphatidylethanolamine biosynthesis. Although this revealed alteration to levels of specific phosphatidylethanolamine fatty acyl species in patients, overall phosphatidylethanolamine levels were broadly unaffected indicating that in blood EPT1 inactivity may be compensated for, in part, via alternate biochemical pathways. These studies define the first human disorder arising due to defective CDP-ethanolamine biosynthesis and provide new insight into the role of Kennedy pathway components in human neurological function.
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http://dx.doi.org/10.1093/brain/aww318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382949PMC
March 2017

Relapse of Multiple Myeloma Presenting as Lower Lip Numbness.

Sultan Qaboos Univ Med J 2016 Nov 30;16(4):e500-e503. Epub 2016 Nov 30.

Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman.

Multiple myeloma (MM) is an uncommon malignancy characterised by the proliferation of clonal plasma cells. There are few published reports describing the extramedullary presentation of MM manifesting primarily in the head and neck region. In addition, the occurrence of an isolated relapse of MM in these sites is exceedingly rare. We report a 56-year-old female who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2010 with sudden-onset numbness of the lower lip. She had a history of MM in remission following chemotherapy and a bone marrow transplant. Clinical and radiographic examinations were indicative of a possible relapse of MM, which was subsequently confirmed by bone marrow aspiration and histopathological evaluation. This unique case highlights the unusual site of relapse of a haematolymphoid malignancy.
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http://dx.doi.org/10.18295/squmj.2016.16.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135465PMC
November 2016

A regional consensus recommendation on brain atrophy as an outcome measure in multiple sclerosis.

BMC Neurol 2016 Nov 24;16(1):240. Epub 2016 Nov 24.

Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory and neurodegenerative processes leading to irreversible neurological impairment. Brain atrophy occurs early in the course of the disease at a rate greater than the general population. Brain volume loss (BVL) is associated with disability progression and cognitive impairment in patients with MS; hence its value as a potential target in monitoring and treating MS is discussed.

Methods: A group of MS neurologists and neuro-radiologists reviewed the current literature on brain atrophy and discussed the challenges in assessing and implementing brain atrophy measurements in clinical practice. The panel used a voting system to reach a consensus and the votes were counted for the proposed set of questions for cognitive and brain atrophy assessments.

Results: The panel of experts was able to identify recent studies, which demonstrated the correlation between BVL and future worsening of disability and cognition. The current evidence revealed that reduction of BVL could be achieved with different disease-modifying therapies (DMTs). BVL provided a better treatment and monitoring strategy when it is combined to the composite measures of "no evidence of disease activity" (NEDA). The panel recommended a set of cognitive assessment tools and MRI methods and software applications that may help in capturing and measuring the underlying MS pathology with high degree of specificity.

Conclusion: BVL was considered to be a useful measurement to longitudinally assess disease progression and cognitive function in patients with MS. Brain atrophy measurement was recommended to be incorporated into the concept of NEDA. Consequently, a consensus recommendation was reached in anticipation for implementation of the use of cognitive assessment and brain atrophy measurements on a regional level.
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http://dx.doi.org/10.1186/s12883-016-0762-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121973PMC
November 2016

Thoracolumbar Spine Injury at CT: Trauma/Emergency Radiology.

Radiographics 2016 Nov-Dec;36(7):2234-2235

From the Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, PO Box 38, PC 123, Al Khoud, Muscat, Sultanate of Oman (S.B.R., F.H.A.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (M.R.S.); Department of Radiology, Manchester Royal Infirmary, Manchester, England (A.K.); Department of Spine Surgery, Khoula Hospital, Muscat, Oman (V.K.M.); and Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, England (S.B.).

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http://dx.doi.org/10.1148/rg.2016160058DOI Listing
September 2017

'Papaya Seed' Appearance of Subependymal Nodules on Magnetic Resonance Imaging in a Patient with Tuberous Sclerosis.

Sultan Qaboos Univ Med J 2016 Aug 19;16(3):e385-6. Epub 2016 Aug 19.

Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman.

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http://dx.doi.org/10.18295/squmj.2016.16.03.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996310PMC
August 2016

Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a Child.

Case Rep Emerg Med 2016 18;2016:6964713. Epub 2016 Feb 18.

Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman.

Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushing's reflex and papilledema of left eye. MRI (magnetic resonance imaging) of the brain showed left temporal extra-axial cystic lesion of 5.40 × 4.10 cm in size, representing arachnoid cyst, with bilateral frontoparietal subdural hygromas. Cyst was partially drained through left temporal craniectomy and subdural hygromas were drained through bilateral frontal burr holes. Postoperatively the child recovered uneventfully and was discharged on the seventh postoperative day. Histopathology proves it to be arachnoid cyst of the brain with subdural CSF (cerebrospinal fluid) collection or hygroma.
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http://dx.doi.org/10.1155/2016/6964713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775777PMC
March 2016

Varicella zoster virus pneumonitis and brainstem encephalitis without skin rash in an immunocompetent adult.

Open Forum Infect Dis 2014 Sep 6;1(2):ofu064. Epub 2014 Aug 6.

Departments of Neurology ; Microbiology , University of Colorado School of Medicine , Aurora.

Varicella zoster virus (VZV) pneumonitis and brainstem encephalitis developed in an immunocompetent adult without rash. Chest computed tomography exhibited nodularity; lung biopsy revealed multinucleated giant cells, Cowdry A inclusions, VZV antigen, and DNA. Varicella zoster virus central nervous system disease was verified by cerebrospinal fluid (CSF) anti-VZV IgG antibody with reduced serum/CSF ratios.
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http://dx.doi.org/10.1093/ofid/ofu064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281813PMC
September 2014

Cognitive profiles in patients with multi-infarct dementia: an omani study.

Dement Geriatr Cogn Dis Extra 2014 May 18;4(2):271-82. Epub 2014 Jul 18.

Khoula Hospital, Muscat, Oman.

Background: Studies on neurocognitive impairment among patients presenting with multi-infarct dementia (MID) have received little attention from non-Western societies, and the Arab world is no exception. To our knowledge, this is the first study to characterize neurocognitive, affective and vegetative functioning in patients with MID in Oman.

Methods: In this study, we recruited 20 Omani patients presenting with MID and age- and gender-matched controls at the outpatient clinic of the Department of Behavioral Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman. In addition to the collection of clinical and demographic information, various cognitive batteries were administered to the consenting participants, including those indexing nonverbal reasoning abilities, working memory (attention, concentration and recall) and executive functioning. Questionnaires that elicit the affective range and the quality of sleep were also administered.

Results: Compared with the matched healthy subjects, the patients diagnosed with MID significantly differed in the presently operationalized indices of visuospatial function, semantic memory and affective and vegetative functioning. In contrast, episodic memory and some attentional capacities were not significantly different compared with the control subjects.

Conclusions: The present study was explorative and clinically designed to describe neurocognitive functioning in patients with MID seeking consultation at a tertiary care center in Oman. Our data are necessary for planning and setting up community services and health care programs for demented patients in a society where dementia is a growing silent epidemic.
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http://dx.doi.org/10.1159/000363621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154192PMC
May 2014

Severe acute disseminated encephalomyelitis mimicking leukodystrophy in a child.

Sultan Qaboos Univ Med J 2014 Aug 24;14(3):e409-11. Epub 2014 Jul 24.

Departments of Child Health, Sultan Qaboos University Hospital, Muscat, Oman.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117671PMC
August 2014

Septo-optic dysplasia complex: Clinical and radiological manifestations in Omani children.

Oman J Ophthalmol 2013 Sep;6(3):193-8

Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.

Background: Septo-optic dysplasia (SOD), also known as de-Morsier's syndrome, is a rare disorder characterized by any combination of optic nerve hypoplasia (ONH), pituitary gland hypoplasia, and midline abnormalities of the brain including absence of septum pellucidum and corpus callosum dysgenesis. It is typically diagnosed in infancy and has a variable presentation that includes visual, neurologic, and/or hypothalamic-pituitary endocrine deficits.

Purpose: To demonstrate the ophthalmic, endocrine, and neurologic spectrum of SOD in five Omani children and address the crucial role of high-resolution neuroimaging for its early and accurate diagnosis.

Materials And Methods: A retrospective chart review was performed in 2010 of all children in the pediatric ophthalmology database of Sultan Qaboos University Hospital (SQUH) who were diagnosed to have ONH. All relevantdemographic, ophthalmic, neurologic, endocrine, and neuro-radiological manifestations were recorded in a data collection form. All previous neuroimaging results were reviewed by a neuro-radiologist.

Results: Five patients (four males, one female) with the diagnosis of ONH were included in the study. They presented during the period 1998-2008. All patients were born at term, with normal birth weights to healthy mothers with insignificant antenatal history. Age at presentation ranged from three months to one year. Manifestations at presentation included severe visual impairment (5/5), neonatal hypoglycemia (3/5), seizure disorder (2/5), and failure to thrive (4/5). ONH was bilateral in 3/5 patients and unilateral in (2/5). Brain and orbit imaging revealed varying anomalies in all patients. These included absent septum pellucidum (3/5), severe corpus callosum agenesis (1/5), ectopic pituitary (5/5), falx cerebri deficiency (1/5), optic nerve hypoplasia (5/5), optic chiasmal hypoplasia (5/5), and olfactory tract hypoplasia (1/5). Endocrine deficits were detected in 4/5 patients (3 with panhypopituitarism, and 1 with growth hormone deficiency) and necessitated replacement therapy.

Conclusion: SOD is a clinically heterogeneous disorder with a wide spectrum of ophthalmic, endocrine, and neurologic manifestations. All features might not be present in a single patient. A high consanguinity rate and lack of history of alcohol and drug use were observed in our cohort. Most affected children present first to the pediatrician with failure to thrive. Radiological confirmation of ONH necessitates high-resolution imaging and interpretation by an experienced neuro-radiologist. In our cohort, all patients with ONH had associated optic chiasmal hypoplasia. Early detection and treatment reduces disease-related morbidity, and can be life saving.
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http://dx.doi.org/10.4103/0974-620X.122277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872571PMC
September 2013

Megalencephalic leukoencephalopathy with subcortical cysts.

Sultan Qaboos Univ Med J 2013 Nov 8;13(4):585-6. Epub 2013 Nov 8.

Departments of Child Health, Sultan Qaboos University, Muscat, Oman.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836650PMC
November 2013

Clinical Spectrum of Hereditary Spastic Paraplegia in Children: A study of 74 cases.

Sultan Qaboos Univ Med J 2013 Aug 25;13(3):371-9. Epub 2013 Jun 25.

Departments of Child Health, Sultan Qaboos University Hospital;

Objectives: The aim of the study was to explore the spectrum of hereditary spastic paraplegia (HSP) in children in Oman.

Methods: This retrospective study was carried out between January 1994 and August 2011 on children with delayed development, gait disorders and motor handicaps, with signs of symmetrical pyramidal tract involvement. A detailed perinatal and family history, including the age of onset of symptoms, was recorded. The children were labelled as having either the pure or complicated form of HSP based on the established diagnostic criteria. In families with more than one affected child, parents and all other siblings were also examined.

Results: Within the study, 74 children from 31 families were diagnosed with HSP. Parental consanguinity was seen in 91% of cases, with 44 children (59.4%) experiencing onset of the disease under one year of age. Complicated HSP was the most common type, seen in 81.1%. Speech involvement, mental retardation, and epilepsy were the most common associated abnormalities. Nonspecific white matter changes and corpus callosum abnormalities were noted in 24.3% of cases on magnetic resonance imaging.

Conclusion: The study described clinical features of 74 children with HSP. Autosomal recessive complicated HSP was seen in 81.1% of cases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749020PMC
http://dx.doi.org/10.12816/0003258DOI Listing
August 2013

Evolution of epileptic encephalopathy in an infant with non-accidental head injury.

Neurosciences (Riyadh) 2013 Jul;18(3):264-8

Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman.

A 5-month-old child, previously healthy, was hospitalized with frequent episodes of tonic seizures. The seizures were controlled with antiepileptic medication. However, the parents did not continue medications after discharge from the hospital. The child was admitted several times with breakthrough seizures. Over time the seizures became refractory to treatment. Neurometabolic work up and imaging studies for uncontrolled seizures revealed non-accidental head injury (shaken baby syndrome) as the underlying cause. His first EEG was normal and changed from normal to an epileptic encephalopathy pattern during his several admissions for uncontrolled seizures. From a normal child at the first admission, the child was severely regressed at the last admission. The present paper highlights the evolution of EEG changes in a child with non-accidental head injuries. This report also highlights considering non-accidental head injury as the underlying cause in younger children presenting with unexplained epileptic encephalopathy.
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July 2013

Bilateral Ocular Ischaemic Syndrome-Rare Complication of Rhinocerebral Mucormycosis in an Omani Patient: Case report and literature review.

Sultan Qaboos Univ Med J 2013 Feb 27;13(1):137-42. Epub 2013 Feb 27.

Departments of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman.

Ocular ischaemic syndrome (OIS) is a relatively uncommon condition. Simultaneous bilateral involvement is even less common and has been reported in only 22% of all cases of OIS. It has variable clinical presentations, of which visual loss and ocular pain are the most common. It is believed to occur when there is a 90% or greater carotid artery obstruction. This syndrome is often associated with a number of systemic diseases including diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease. Only occasionally has it been described as a complication of rhinocerebral mucormycosis. We report an unusual case of bilateral OIS secondary to bilateral internal carotid artery thrombosis as a complication of invasive rhinocerebral mucormycosis. In addition, a review of clinical presentation, diagnostic work-up and treatment options for OIS is provided.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616780PMC
http://dx.doi.org/10.12816/0003208DOI Listing
February 2013

Oral propranolol for the treatment of periorbital infantile hemangioma: a preliminary report from oman.

Middle East Afr J Ophthalmol 2011 Oct;18(4):298-303

Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman.

Purpose: To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects.

Materials And Methods: Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated.

Results: Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy.

Conclusions: Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy.
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http://dx.doi.org/10.4103/0974-9233.90131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249815PMC
October 2011

Syncopal attacks and severe abdominal pain.

Oman Med J 2010 Oct;25(4):318-9

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http://dx.doi.org/10.5001/omj.2010.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191654PMC
October 2010

Recurrent episodes of hemiparesis and aphasia.

BMJ 2010 Oct 20;341:c4674. Epub 2010 Oct 20.

Department of Medicine, College of Medicine and Health Sciences, Al-Khod, Muscat, Oman.

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http://dx.doi.org/10.1136/bmj.c4674DOI Listing
October 2010

Necrotizing vacuolar myopathy presenting with recurrent myoglobinuria.

Int J Neurosci 2010 Dec 13;120(12):784-6. Epub 2010 Oct 13.

Departments of Medicine (Neurology Unit), College of Medicine and Health Sciences, Al-Khod, Muscat, Oman.

Myoglobinuria occurs in a variety of systemic and neurological disorders and can pose diagnostic challenges. We report on a 23-year-old man in whom recurrent myoglobinuria was observed due to necrotizing vacuolar myopathy confirmed on muscle biopsy. Histopathologically the intramuscular vacuoles lacked the typical findings reported in vacuolar myopathy due to disorders of glycogen and lipid metabolism. We discuss the management approach to recurrent myoglobinuria. Recurrent myoglobinuria in the absence of toxin or drug exposure and seizure is more often due to primary muscle disease. Recognizing the presence of myoglobinuria and the proximate cause is essential in preventing the development of renal dysfunction and the future recurrence of symptoms.
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http://dx.doi.org/10.3109/00207454.2010.518778DOI Listing
December 2010

Investigation of the cerebral blood flow of an Omani man with supposed 'spirit possession' associated with an altered mental state : a case report.

J Med Case Rep 2009 Dec 10;3:9325. Epub 2009 Dec 10.

Department of Behavioral Medicine, College of Medicine and Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.

Introduction: The view that spirits may possess humans is found in 90% of the world population, including Arab/Islamic societies. Despite the association between possessive states and various neurological and psychiatric disorders, the available literature has yet to correlate possessive states with functional brain imaging modalities such as single-photon-emission computed tomography.

Case Presentation: This paper describes the clinical case of a 22-year-old male Omani patient who presented to us with an altered state of consciousness that his caregiver attributed to possession. We examined whether the patient's mental state correlated with neuro-imaging data. The patient's distress was invariably associated with specific perfusion in the left temporal lobe and structural abnormality in the left basal ganglia.

Conclusion: We discuss the case in the context of possession as a culturally sanctioned idiom of distress, and highlight the importance of studying cross-cultural presentations of altered states of consciousness within biomedical models.
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http://dx.doi.org/10.1186/1752-1947-3-9325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803848PMC
December 2009

A Female Child with Skin Lesions and Seizures: Case report of Incontinentia Pigmenti.

Sultan Qaboos Univ Med J 2009 Aug 30;9(2):157-61. Epub 2009 Jun 30.

Departments of Ophthalmology.

Incontinentia Pigmenti (IP), (OMIM # 308300), is a rare X-linked dominant condition. It is a multisystemic disease with neuroectodermal findings involving the skin, eyes, hair, nails, teeth, and central nervous system. It is usually lethal in males; the disease has variable expression in an affected female. We report the case of a 6 month old girl who presented at Sultan Qaboos University Hospital, Oman, with neonatal seizures and hypopigemented/hyperpigmented skin lesions. She had multiple ophthalmic abnormalities and neurological manifestations which are discussed in this report.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074784PMC
August 2009

Orbital wall infarction versus infection in sickle cell disease.

Can J Ophthalmol 2009 Feb;44(1):101; author reply 102

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http://dx.doi.org/10.1139/i08-185DOI Listing
February 2009

State-of-the-art imaging of acute stroke.

Radiographics 2006 Oct;26 Suppl 1:S75-95

Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada.

Stroke is a leading cause of mortality and morbidity in the developed world. The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy. A comprehensive evaluation may be performed with a combination of computed tomography (CT) or magnetic resonance (MR) imaging techniques. Unenhanced CT can be performed quickly, can help identify early signs of stroke, and can help rule out hemorrhage. CT angiography and CT perfusion imaging, respectively, can depict intravascular thrombi and salvageable tissue indicated by a penumbra. These examinations are easy to perform on most helical CT scanners and are increasingly used in stroke imaging protocols to decide whether intervention is necessary. While acute infarcts may be seen early on conventional MR images, diffusion-weighted MR imaging is more sensitive for detection of hyperacute ischemia. Gradient-echo MR sequences can be helpful for detecting a hemorrhage. The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra. The information obtained by combining various imaging techniques may help differentiate patients who do not need intravenous or intraarterial therapy from those who do, and may alter clinical outcomes.
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http://dx.doi.org/10.1148/rg.26si065501DOI Listing
October 2006