Background:Fine-needle aspiration (FNA) is a useful method for evaluating multinodular goiter; however, its role is still controversial. The aim of this study was to assess the utility of ultrasound-guided thyroid FNA in detecting malignancy in patients with multinodular goiter in Oman.Materials and Methods:This was a retrospective study where all patients with multinodular goiter seen at the Sultan Qaboos University Hospital endocrinology clinic in Oman in 2005 were evaluated. The thyroid FNA results were grouped into either malignancy (positive result) or others (negative result). They were compared to those of final histopathological examination in order to calculate the value of the test in diagnosing malignancy. Analyses were evaluated using descriptive statistics.Results:A total of 272 patients were included in the study. The mean age was 3913 years with an age range from 5 to 85 years. The majority of the patients were females (n=236; 87%). The results of thyroid FNA revealed that 6% (n=15) of the patients had malignancies while histopathological results showed that the proportion of subjects with malignancies was 18% (n=49). Out of the 15 cases identified to have malignances by thyroid FNA, only 53% (n=8) of the subjects were confirmed to have malignancy by biopsy. Overall, the results of the tests were poor, revealing a sensitivity of 16%, specificity of 97% and a diagnostic accuracy of 82%, with a positive predictive value of 53% and a negative predictive value of 84%.Conclusion:Thyroid FNA is not a useful test in differentiating multinodular goiter from malignancy, as more than 80% of the malignancies go unnoticed.
Objectives: This study aimed to identify the main barriers which prevent patients with diabetes mellitus from accepting insulin therapy. Methods: This cross-sectional study was conducted from May to December, 2019. Convenience sampling was used to recruit participants from three Diabetes Clinics in Muscat. Eligible participants were interviewed in person based on a pre-prepared questionnaire. The questionnaire, which was administered in Arabic, includes demographic data, and 19 specific items on barriers to insulin therapy. Results: A total of 201 participants (response rate 93 %) were enrolled in the study. The commonest barriers were as follows: concern of frequent blood glucose checking (36.3%), long- term injections (33.8%), side-effects of insulin (29.9%), and weight gain (29.4%). Needle phobia was considered as a barrier by only 9% of the participants. Overall, 125 (62.2%) of the participants were willing to initiate insulin therapy despite of the presence of these barriers and only 20 (10%) of the participants were influenced by these barriers to the degree that they would reject insulin therapy. Conclusion: The majority of our participants had no identifiable reasons which would stop them from accepting insulin therapy. Effective strategies should be developed to address each of the main barriers to improve acceptance and adherence to insulin therapy. Keywords: Diabetes; Insulin; Barrier; Needle phobia; Hypoglycemia; Weight gain.
abstract:Objectives: Glomerular filtration rate (GFR) is the best index of renal function and is frequently assessed by corrected creatinine clearance (CCL cr ). The limitations of CCL cr have inspired researchers to derive easy formulas to estimate GFR, with Cockcroft-Gault (C-G) and the modification of diet in renal disease (MDRD) being the most widely used. This study aimed to evaluate the validity of these equations by finding the relation between CCL cr and estimated GFR (eGFR) by C-G, modified C-G and MDRD equations. Methods: From 2007 to 2011, 158 subjects were analysed for serum creatinine and CCL cr at Bowsher Polyclinic, Muscat, Oman. The C-G equation was used to obtain eGFR C-G which was adjusted to body surface area (BSA) to obtain eGFR mC-G , and the MDRD equation was used to obtain eGFR MDRD . The eGFR MDRD , eGFR mC-G and eGFR C-G were then compared to CCL cr . Results: The eGFR MDRD , eGFR mC-G and eGFR C-G significantly correlated with CCL cr , with a slightly stronger correlation with eGFR MDRD (r = 0.701, 0.658 and 0.605, respectively). A receiver operating characteristic curve analysis showed that the diagnostic accuracy of eGFR MDRD for diagnosing chronic kidney disease (CKD) was higher than that of eGFR mC-G , which in turn was higher than that of eGFR C-G (area under the curve was 0.846, 0.831, and 0.791; cut-off limits were 61.9, 58.3 and 59.5, respectively). Conclusion: C-G and MDRD equations can be an alternative to the CCL cr test for assessing GFR, thus avoiding the need for the cumbersome and expensive GFR test. The MDRD formula had greater validity than the C-G equation and the C-G equation validity was improved by an adjustment to BSA.
Ritonavir is a powerful inhibitor of the cytochrome P450 3A4 (CYP3A4) isoenzyme. It is used as a pharmaceutical enhancer in the management of HIV-positive patients. However, when co-administered with other drugs that are metabolised via the CYP3A4 pathway, ritonavir can potentially cause serious drug-drug interactions. Inhaled fluticasone propionate, which is used to treat asthma and chronic obstructive airway disease, is particularly prone to such interactions due to its physiological attributes. We report a HIV-positive 48-year-old male patient who presented to Al Nahdha Hospital, Muscat, Oman, in 2012 with weight loss, generalised weakness and fatigue and diagnosed with secondary adrenal insufficiency as a result of concomitant ritonavir and inhaled fluticasone.
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