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Background: Ginseng has been used as a traditional medicinal herb for thousands of years. It is used for the treatment of various ailments, including gastrointestinal disturbances, metabolic disorders like diabetes mellitus, and even cancer. However, indiscriminate use can lead to serious cardiac emergencies, as observed in a case of life-threatening ventricular tachycardia that developed after consuming ginseng for several days.

Case Presentation: A 38-year-old woman was admitted to the emergency department (ED) with sudden-onset palpitations and recurrent episodes of syncope. On arrival, her ECG indicated an irregular rhythm marked by premature ventricular complexes that escalated into pulseless ventricular tachycardia (VT), necessitating defibrillation. Subsequent electrocardiogram (ECG) revealed a significantly prolonged QT interval. Treatment was initiated with intravenous magnesium and potassium (serum potassium 3 mmol/L), along with an oral beta-blocker (Metoprolol succinate 25 mg once daily). These interventions successfully prevented further VT episodes. It was later revealed that she had been taking ginseng regularly for the treatment of haemorrhoids. 

Conclusion: The consumption of ginseng can have potentially life-threatening consequences. Raising awareness about the potential adverse effects of indiscriminate use is crucial. Medical professionals should enquire about the use of herbal supplements in patients presenting with unexplained cardiac arrhythmias.

Background: Parathyroid carcinoma is an exceptionally rare endocrine malignancy with poorly understood pathogenesis due to limited global data. It is often associated with unfavorable outcomes, largely attributable to delayed diagnosis and severe hypercalcemia.
Aims and Objectives: To present the clinical, biochemical, radiological, and pathological features of parathyroid carcinoma.
Settings: This study was a retrospective chart review conducted at the Endocrine Surgery Unit of the Royal Hospital, Muscat, Oman.
Methods: The medical records of all patients with histopathologically confirmed parathyroid carcinoma between January 2012 and December 2023 were examined.
Results: Four patients (three males, one female) with a mean age of 49 years were identified. Three patients were presented with symptomatic hypercalcemia, and one was diagnosed incidentally. Preoperative parathyroid hormone (PTH) levels were elevated in all patients, with one exceeding 80 times the upper limit of normal. All patients underwent surgical resection. Postoperative outcomes were favorable with no disease recurrence observed over at least 2 years of follow-up.
Conclusion: Parathyroid carcinoma remains a diagnostic challenge due to its rarity and overlapping features with benign disease. A high index of clinical suspicion, supported by significantly elevated PTH and calcium levels, is essential. This report emphasized towards the importance of prompt diagnosis and complete surgical excision in optimizing patient outcomes in the Arab population.

Background: Adrenal malignancy is a rare entity of diseases that has a low incidence, vague symptoms, and variable prognosis. Due to its rarity, case series studies from around the world can contribute to a better understanding of the disease.
Aims and Objectives: To analyze the similarities and differences in this adrenal malignancy spectrum within the Middle East.
Settings: This retrospective case series was conducted at the Royal Hospital, Muscat, Oman.
Methods: The medical records of the patients diagnosed with primary adrenal malignancies were reviewed from January 2014 to December 2023.
Results: A total of 15 patients with a mean age of 52 years were included, with a male-to-female ratio of 1:2.7. The majority of patients (80%) had a personal medical history, and the most common condition was hypertension. Four patients (26.6%) presented with abdominal pain that required computed tomography imaging to determine the cause. Left-sided malignancy was predominant (60%); however, the majority of male patients had right-sided tumors (75%) (p-value = 0.235). The largest tumor measured 169 mm, with no statistically significant difference in tumor size between males and females: 87.3 ± 10.6 mm in males
versus 91.8 ± 47.4 mm in females (p-value = 0.77). Laboratory investigations revealed that 53% of the patients had elevated hormone levels, including aldosterone, cortisol, testosterone, and metanephrines.
Conclusion: With the rarity of this spectrum of diseases, more studies are needed for a better evaluation of its impact on the community. Hopefully, more advanced technology, especially at the molecular level, can allow a better understanding of its
behavior.

Patients with atrial fibrillation and ACS need triple antithrombotic therapy (double antiplatelet plus anticoagulant).

In cases of ACS where a high thrombus burden exists, even in the absence of atrial fibrillation, triple antithrombotic therapy (double antiplatelet plus anticoagulant) is essential.

Background: Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by structural and/or functional abnormalities of motile cilia. It typically presents with neonatal respiratory distress, recurrent respiratory infections and sometimes laterality defects, which define Kartagener syndrome. Diagnosis is often delayed due to nonspecific symptoms.

Case Presentation: A 10-year-old female was referred to pediatric allergy consultation for perennial nasal obstruction and impaired growth. Her history included neonatal respiratory distress, hydrocephalus, situs inversus totalis, recurrent otitis media with hearing impairment and chronic rhinosinusitis. Genetic testing by whole-exome sequencing revealed a previously undescribed heterozygous frameshift variant in FOXJ1 (c.929_932del p.Asp310Glyfs*22), a gene crucial for motile cilia function and associated with autosomal dominant PCD. Chest computed tomography showed extensive bronchiectasis. She started multidisciplinary treatment including airway clearance, additional immunizations and prophylactic azithromycin.

Conclusion: This case reinforces the importance of clinical suspicion for PCD when faced with characteristic symptoms to achieve early diagnosis and intervention. Identification of a novel FOXJ1 variant expands the genotypic spectrum of PCD, provides insight into genotype-phenotype correlations and has important implications for genetic counseling and family planning due to its autosomal dominant inheritance. Early diagnosis and comprehensive management are essential to prevent progression and improve quality of life.