Publications by authors named "Nabil Al-Lawati"

15 Publications

  • Page 1 of 1

Pulmonary Alveolar Microlithiasis: A Case Report.

Oman Med J 2020 Mar 20;35(2):e115. Epub 2020 Apr 20.

Department of Medicine, Royal Hospital, Muscat, Oman.

Pulmonary alveolar microlithiasis (PAM) is a rare disease caused by a mutation in the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells. This results in the formation and accumulation of calcium phosphates crystals in the alveoli. Early in the disease, most patients are asymptomatic or might experience mild symptoms. However, in some patients, PAM can progress resulting in pulmonary fibrosis, cor pulmonale, and respiratory failure. We report the case of a 33-year-old Omani male who was referred to our institute with a history of fever and shortness of breath. A chest radiograph revealed bilateral dense consolidation. Chest computed tomography showed bilateral dense interlobular thickening and extensive consolidations with a lower lung predominance. Our findings were highly suggestive of PAM. The diagnosis was confirmed by bronchoalveolar lavage.
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http://dx.doi.org/10.5001/omj.2020.33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171818PMC
March 2020

Pulmonary Hyalinising Granuloma: A report of two cases.

Sultan Qaboos Univ Med J 2019 May 8;19(2):e157-e160. Epub 2019 Sep 8.

Department of Radiology, Royal Hospital, Muscat, Oman.

Pulmonary hyalinising granuloma (PHG) is a rare fibrosclerosing inflammatory lung condition of unknown aetiology. It is characterised by solitary or multiple pulmonary nodules that are usually found incidentally while imaging the chest for other reasons. We report two cases of histologically proven PHG diagnosed at the Royal Hospital, Muscat, Oman. The first case was a 71-year-old male patient who presented in 2010 with a dry cough, weight loss and bilateral pulmonary nodules. The second case was a 58-year-old male patient who presented in 2012 and was found to have incidental bilateral pulmonary nodules on chest X-ray. Both patients were started on prednisolone and on follow-up the PHG nodules remained stable. Although there is no definitive treatment, PHG generally has an excellent prognosis.
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http://dx.doi.org/10.18295/squmj.2019.19.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736260PMC
May 2019

Sleepy Drivers: High time for action.

Sultan Qaboos Univ Med J 2018 05 9;18(2):e127-e129. Epub 2018 Sep 9.

Department of Medicine, Royal Hospital, Muscat, Oman.

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http://dx.doi.org/10.18295/squmj.2018.18.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132518PMC
May 2018

The dialysis outcomes and practice patterns study phase 5 in the Gulf Cooperation Council countries: Design and study methods.

Saudi J Kidney Dis Transpl 2016 11;27(6 Suppl 1):S1-11

List of Study Group in Acknowledgment.

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort study of the relationships between hemodialysis (HD) care practices and HD patient outcomes. The DOPPS began in 1996, in the United States, and has since expanded to 21 countries, collecting detailed data from >75,000 HD patients, with >200 scientific publications, focused on describing HD practices associated with improved HD patient outcomes. The goal of DOPPS is to help HD patients "live better and live longer." Starting in 2012, the DOPPS was able to expand to all six of the Gulf Cooperation Council (GCC) countries, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The DOPPS study design consists of selecting HD facilities for study participation in each country to represent the different types of HD facilities and geographic regions within each GCC country. Within each study site, HD patients were randomly selected for detailed data collection to represent the HD practices within each participating HD facility. Altogether, 41 HD facilities have participated in the GCC-DOPPS Phase 5 study including 20 facilities from Saudi Arabia, nine from the United Arab Emirates, four each from Kuwait and Oman, two from Qatar, and one from Bahrain. Herein, we provide a detailed description of the study design and methods, data collection, study management, scientific investigator oversight and guidance, and study governance and support for the GCCDOPPS Phase 5 study.
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http://dx.doi.org/10.4103/1319-2442.194878DOI Listing
November 2016

The World's Youngest Cadaveric Kidney Transplant: Medical, Surgical and Ethical Issues.

Transplant Direct 2016 Dec 16;2(12):e117. Epub 2016 Nov 16.

Department of Medicine, Sultan Qaboos University, Muscat, Oman, Al Khoudh, Muscat, Sultanate of Oman.

Background: We report here the first successful transplant from a preterm cadaveric donor. This was performed in November 1994. The donor, who had been born at about 33 weeks of gestation, was diagnosed as having agenesis of the corpus callosum. The transplant was carried out 10 days after the donor's birth. The recipient was a 17-month-old boy with a diagnosis of Denys-Drash syndrome (WT1 mutation).

Method: We describe and analyze the ethical, social, cultural, medical and surgical issues encountered and how these were addressed. The major issue of determining death in a beating heart, very young donor was dealt with in the absence of worldwide experience and guidelines.

Results: The transplanted recipient has lived with the grafted pair of kidneys for more then 22 years. He has led a relatively normal life.

Conclusions: It is possible for immature preterm deceased donor kidneys to be transplanted into a 17-month-old recipient and for the grafted kidneys to grow with the recipient and function for 22 years. There were challenges in ethically determining the death of the donor, in surgical techniques to obviate potential surgical complications, and in postoperative care of the recipient, but these were managed successfully.
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http://dx.doi.org/10.1097/TXD.0000000000000631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142357PMC
December 2016

Clinical features of Sarcoidosis in Oman: A report from the Middle East region.

Sarcoidosis Vasc Diffuse Lung Dis 2016 Oct 7;33(3):201-208. Epub 2016 Oct 7.

Sultan Qaboos University.

Background: Though clinical features of sarcoidosis follow a similar pattern, some heterogeneity is seen in different ethnic and racial groups.

Objectives: To describe for the first time the clinical characteristics of sarcoidosis patients in the Sultanate of Oman.

Methods: The data on all cases of sarcoidosis followed up in the two tertiary hospitals in Oman were retrieved retrospectively.

Results: Of the 92 patients, for representing the ethnic data only Omani patients (n=83) were included. The mean age was 52.90±12.35 years. Majority were females (72.3%, n=60). Cough (n=44, 53.0%), dyspnea (n=39, 47%), arthralgia (n=26, 31.3%) and fatigue (30.1%) were the major symptoms. Arthralgia was reported by 41.7% of the females and 4.3% of the males (p= 0.001). Uveitis was present in 16 (19.3%), erythema nodosum in 8 (9.6%) and hypercalcemia in 13 (15.7%). The radiological stage at presentation was stage 0, 18.7%; I, 28%; II, 17.3%; III, 24% and IV, 12%. Majority (61.4%) of the patients had tissue diagnosis; intra-thoracic site 70.6%. Pulmonary function showed abnormal diffusion in 75%. Sixty eight received treatment, 81.9% took prednisolone. Based on radiograph good outcome (Resolving) was noted in 20.9%, intermediate (Stable) in 73.1% and poor (Progressive) in 6%. Lung function wise, resolving, stable and progressive disease was seen in 31.4%, 40.0% and 28.6% respectively.

Conclusion: The clinical picture of the patients with sarcoidosis from Oman was similar to that reported from the rest of the world. Region wise, our patients were older and arthralgia and hypercalcemia were more common. The management of sarcoidosis needs a more organized approach in the country with clear guidelines on monitoring and treatment.
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October 2016

Successful Salvage Treatment of Resistant Acute Antibody-Mediated Kidney Transplant Rejection with Eculizumab.

Sultan Qaboos Univ Med J 2016 Aug 19;16(3):e371-4. Epub 2016 Aug 19.

Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.

Antibody-mediated rejection (ABMR) jeopardises short- and long-term transplant survival and remains a challenge in the field of organ transplantation. We report the first use of the anticomplement agent eculizumab in Oman in the treatment of a 61-year-old female patient with ABMR following a living unrelated kidney transplant. The patient was admitted to the Sultan Qaboos University Hospital in Muscat, Oman, in 2013 on the eighth day post-transplantation with serum creatinine (Cr) levels of 400 µmol/L which continued to rise, necessitating haemodialysis. A biopsy indicated ABMR with acute cellular rejection. No improvement was observed following standard ABMR treatment and she continued to require dialysis. Five doses of eculizumab were administered over six weeks with a subsequent dramatic improvement in renal function. The patient became dialysis-free with serum Cr levels of 119 µmol/L within four months. This case report indicates that eculizumab is a promising agent in the treatment of ABMR.
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http://dx.doi.org/10.18295/squmj.2016.16.03.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996305PMC
August 2016

The Burden of Asthma in Oman.

Sultan Qaboos Univ Med J 2015 May 28;15(2):e184-90. Epub 2015 May 28.

Department of Medicine, Respiratory Unit and, Royal Hospital, Muscat, Oman.

Asthma is a common lung disease worldwide, although its prevalence varies from country to country. Oman is ranked in the intermediate range based on results from the International Study of Asthma and Allergies in Childhood. A 2009 study revealed that the majority of asthmatic patients in Oman reported both daytime and nocturnal symptoms, while 30% of adults and 52% of children reported absences from work or school due to their symptoms. Despite these findings, there is little data available on the economic burden of asthma in Oman. The only accessible information is from a 2013 study which concluded that Oman's highest asthma-related costs were attributable to inpatient (55%) and emergency room (25%) visits, while asthma medications contributed to less than 1% of the financial toll. These results indicate a low level of asthma control in Oman, placing a large economic burden on healthcare providers. Therefore, educating asthmatic patients and their families should be prioritised in order to improve the management and related costs of this disease within Oman.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450780PMC
May 2015

Carcinoma of unknown primary presenting as large right atrial and ventricular mass secondary to disseminated tumor thrombosis.

Heart Views 2014 Apr;15(2):54-6

Department of Radiology, Royal Hospital, Muscat, Sultanate of Oman.

We report a 65-year-old male patient who presented with right heart failure and a large mobile right atrial and ventricular mass on echocardiography. His computed tomography demonstrated bilateral supraclavicular/mediastinal lymphadenopathy, right atrial and ventricular mass with right pulmonary artery segmental embolism, and multiple liver hypodense lesions. His tumor markers were negative. However, fine-needle aspiration cytology of supraclavicular lymph node revealed metastatic carcinoma suggestive of squamous cell carcinoma. He was suspected to have carcinoma of unknown primary origin. This case illustrates a rare presentation of carcinoma of unknown primary origin with disseminated tumor thrombosis primarily manifesting in heart and other sites.
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http://dx.doi.org/10.4103/1995-705X.137506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124668PMC
April 2014

Residual sleep apnea on polysomnography after 3 months of CPAP therapy: clinical implications, predictors and patterns.

Sleep Med 2010 Feb 18;11(2):119-25. Epub 2010 Jan 18.

Department of Medicine, Bon Secours Hospital, Tralee, Co. Kerry, Ireland.

Objective: We sought to determine the clinical implications, predictors and patterns of residual sleep apnea on continuous positive airway pressure (CPAP) treatment in patients with moderate-to-severe obstructive sleep apnea (OSA).

Methods: We performed a post hoc secondary analysis of data from a previously reported randomized trial. Sleepy patients with a high risk of moderate-to-severe OSA identified by a diagnostic algorithm were randomly assigned to standard CPAP titration during polysomnography (PSG) or ambulatory titration using auto-CPAP and home sleep testing. We observed them for 3 months and measured apnea-hypopnea index (AHI) on CPAP, Epworth sleepiness scale (ESS), sleep apnea quality of life index (SAQLI), CPAP pressure and objective CPAP compliance.

Results: Sixty-one patients were randomized, 30 to the PSG group and 31 to the ambulatory group. Fifteen patients (25%) had residual sleep apnea (AHI > 10/h on CPAP) with similar proportions in the PSG (7/30) and ambulatory (8/31) groups. Baseline variables including age, body mass index (BMI), ESS, SAQLI, respiratory disturbance index (RDI) and CPAP pressure did not differ between the groups. Outcomes including compliance were worse in patients with residual sleep apnea. Periodic breathing was prevalent among patients with residual sleep apnea.

Conclusions: Residual sleep apnea is common in patients with moderate-to-severe OSA, despite careful CPAP titration, and is associated with worse outcomes.
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http://dx.doi.org/10.1016/j.sleep.2009.05.017DOI Listing
February 2010

Pro-atherogenic cytokine profile of patients with suspected obstructive sleep apnea.

Sleep Breath 2009 Nov 5;13(4):391-5. Epub 2009 May 5.

University of British Columbia, Vancouver, Canada.

Purpose: Systemic inflammation is important in the pathogenesis of cardiovascular disease (CVD). We sought to characterize the systemic inflammatory profile associated with obstructive sleep apnea (OSA).

Methods: Adult patients referred for suspected OSA at the University of British Columbia Hospital Sleep Disorders Program were recruited for our study. Patients using HMG CoA inhibitors or a history of CVD were excluded. Fasting serum samples were obtained the morning after their diagnostic polysomnograms. Samples were tested for the following circulating inflammatory mediators: interferon gamma; interleukins 1B, 6, and 8; intercellular and vascular cell adhesion molecules (sICAM-1 and sVCAM-1); and leptin using a multiplex Luminex System.

Results: There were 176 patients; 68% were male, mean age = 50 +/- (SD) 11 years, mean apnea/hyponea index (AHI) = 22.9 +/- 22/h, mean desaturation (i.e. % of sleep time spent below an oxyhemoglobin saturation of 90%) = 5.4% +/- 15, and mean body mass index (BMI) = 32.2 +/- 8 kg/m(2). In univariate analyses, only leptin, sVCAM-1, and sICAM-1 were significantly associated with indices of OSA severity (i.e. AHI and/or desaturation). In multivariate linear regression analyses that controlled for BMI, gender, age, and current smoking; desaturation persisted as a significant independent predictor for elevated sVCAM-1 and leptin.

Conclusions: We did not find significant associations between OSA and markers of activated innate immunity (IL-1B, 6, and 8). However, OSA severity was independently associated with serum levels of sVCAM-1 and leptin; these may represent mechanisms involved in the pathogenesis of OSA-related CVD.
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http://dx.doi.org/10.1007/s11325-009-0259-1DOI Listing
November 2009

Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration.

Prog Cardiovasc Dis 2009 Jan-Feb;51(4):285-93

Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

We will review the epidemiology, risk factors, and consequences of obstructive sleep apnea (OSA) and short/long sleep duration. Obstructive sleep apnea is a disease characterized by recurrent upper airway obstruction during sleep. Obstructive sleep apnea is common, with moderate to severe disease present in approximately 9% of middle aged men and 4% of women. The prevalence of OSA in certain patient populations (such as elderly patients, hypertensive patients, patients with coronary disease, and prebariatric surgery patients) is even greater. There are a number or risk factors for disease including obesity, male sex, and family history. Obstructive sleep apnea negatively impacts quality of life and is also associated with a number of adverse safety and health consequences including cardiovascular disease and motor vehicle crashes. Short habitual sleep duration can result in excessive daytime sleepiness and reduced neurocognitive function. Sleep loss may have long-term health consequences and may lead to premature death, cardiovascular disease, and the development of diabetes.
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http://dx.doi.org/10.1016/j.pcad.2008.08.001DOI Listing
January 2009

To sleep, perchance to dip: obstructive sleep apnea, blood pressure, and cardiovascular disease.

Sleep 2008 Jun;31(6):772-3

Respiratory Division, Department of Medicine, Sleep Disorders Program, University of British Columbia, Vancouver, Canada.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442410PMC
http://dx.doi.org/10.1093/sleep/31.6.772DOI Listing
June 2008

Hypercoagulability: another potential mechanism of obstructive sleep apnea-related cardiovascular disease?

Lung 2008 Jul-Aug;186(4):195-196. Epub 2008 Apr 22.

Sleep Disorders Program and Respiratory Division, University British Columbia, Vancouver, BC, Canada.

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http://dx.doi.org/10.1007/s00408-008-9090-xDOI Listing
December 2008

Paradoxical embolization in an adult cystic fibrosis patient.

Can Respir J 2007 Jul-Aug;14(5):293-4

University of British Columbia, Vancouver, Canada.

Cystic fibrosis patients with an implantable venous access device (IVAD) and a patent foramen ovale (PFO) are at an increased risk of developing paradoxical embolism. A 33-year-old patient who had a cerebrovascular accident in the above setting is described. She had been anticoagulated because she had thrombosis of the tip of the indwelling catheter, and her PFO was closed percutaneously followed by replacement of her IVAD. She made a full neurological recovery. Echocardiography and prophylactic closure of the PFO, when present, as primary prevention for paradoxical embolism may be warranted in cystic fibrosis patients before placement of an IVAD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676396PMC
http://dx.doi.org/10.1155/2007/492128DOI Listing
November 2007