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Our objective is to develop national staffing norms to ensure adequate numbers, appropriate skills mix and equitable distribution of professionals working in PHC in Oman using the WISN method. This paper describes the process of formulating the national norms and presents the key findings and some of the limitations. Methods First, a joint team from the Directorate General of Planning and Studies and the Directorate General of Primary Health Care listed all types of primary health care services provided currently. This list comprises 42 services that encompass promotive, preventive, curative, and rehabilitative and support services. Next, the team categorized the services into three packages of services based on the location and catchment population served. These are: core services (basic), supplementary services, and complementary services (Table 1). Hence, each health facility will provide a defined package of primary health care ser

Single-site robotic cholecystectomy is safe in both elective and urgent conditions, and in patients with previous abdominal surgeries. It has a short learning curve.

We report the case of an 8-month-old female infant presenting with bilateral, diffusely enlarged kidneys. A diagnosis of bilateral, universal nephroblastomatosis was made on tissue biopsies from both kidneys after correlation with the radiological findings. As far as we know, this is the oldest patient reported with this diagnosis in the English literature (they are usually younger than 4 months). The patient was treated with chemotherapy with very good response and almost 1 year later she is showing no signs of recurrence of her disease.

SummaryThe left atrial appendage (LAA) represents one of the major sources of cardiac thrombi responsible for embolic stroke in patients with atrial fibrillation (AF). The aim of the present study was to evaluate LAA structure and functions by transesophageal echocardiography (TEE) in patients with AF to investigate the possible association between the different LAA morphologies and the patients' history of ischemic cerebral stroke. We included 50 patients with non-valvular AF (29 chronic, 21 paroxysmal), 24 patients (13 men) without stroke; and 26 patients (9 men) with a history of ischemic stroke. All patients underwent TEE evaluation of LAA morphology and functions. Compared to patients without stroke, patients with ischemic stroke had significantly higher CHADS2 scores (4.19 ± 0.89 versus 1.67 ± 1.13; P < 0.001) and C-reactive protein levels (8.3 ± 1.6 versus 7.6 ± 0.83 mg/L; P = 0.023), and lower peak filling (21.7 ± 11.3 versus 31.2 ± 9.5 cm/second; P = 0.033) and emptying (22.2 ± 9.7 versus 33.4 ± 13.4 cm/second, P = 0.030) velocities. Triangular LAA morphology had a higher prevalence in patients with stroke (36% versus 12% in non-stroke group); and in half of them an LAA thrombus was present. LAA thrombi were detected in 9 patients (18%) with stroke and in 5 patients (10%) Approximately 33% of arrhythmiarelated hospitalizations are for AF, which is also associated with a 5-fold increase in the risk of stroke and 2-fold increase in the risk of all cause mortality. 1) AF causes 15-20% of ischemic strokes, and the annual risk of stroke in patients with nonvalvular AF is as high as 5%.2)The left atrial appendage (LAA) has been described as a long, narrow, tubular, wavy, hooked structure with different lobes and a narrow junction and crenellated lumen. 3,4) As the LAA represents one of the major sources of cardiac thrombus formation responsible for stroke in patients with AF, 5,6) the imaging of the different structures and lobes is of utmost importance to diagnose the presence of thrombus, especially in patients with non-valvular AF. 7,8) Multidetector computed tomography 9) and contrast-enhanced magnetic resonance imaging 10) are able to image the LAA; however, it was concluded that magnetic resonance imaging lacks diagnostic accuracy for the detection of LAA thrombi.10) Transesophageal echocardiography (TEE) is the gold standard to detect LAA thrombus, 11) but false positive results still occur.12) In this study, we evaluated the LAA structure and functions by TEE in patients with non-valvular AF (both chronic and paroxysmal types) to study the possible association between the different LAA morphologies and functional changes with the patients' history of ischemic cerebral stroke. MethodsStudy design and participants: This study was conducted on 50 patients with non-valvular AF; including both chronic (29 patients, 58%) and paroxysmal (21 patients, 42%) cases. We included patients with documented paroxysmal AF because large, prospective studies have shown that the risk for thromboembolism does not differ ...