Sultan Qaboos University

Diabetes is considered to be one of the most common chronic diseases worldwide. There is a growing scientific and public interest in connecting oxidative stress with a variety of pathological conditions including diabetes mellitus (DM) as well as other human diseases. Previous experimental and clinical studies report that oxidative stress plays a major role in the pathogenesis and development of complications of both types of DM. However, the exact mechanism by which oxidative stress could contribute to and accelerate the development of complications in diabetic mellitus is only partly known and remains to be clarified. On the one hand, hyperglycemia induces free radicals; on the other hand, it impairs the endogenous antioxidant defense system in patients with diabetes. Endogenous antioxidant defense mechanisms include both enzymatic and non-enzymatic pathways. Their functions in human cells are to counterbalance toxic reactive oxygen species (ROS). Common antioxidants include the vitamins A, C, and E, glutathione (GSH), and the enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GRx). This review describes the importance of endogenous antioxidant defense systems, their relationship to several pathophysiological processes and their possible therapeutic implications in vivo.

Vitamin E is the major lipid-soluble component in the cell antioxidant defence system and is exclusively obtained from the diet. It has numerous important roles within the body because of its antioxidant activity. Oxidation has been linked to numerous possible conditions and diseases, including cancer, ageing, arthritis and cataracts; vitamin E has been shown to be effective against these. Platelet hyperaggregation, which can lead to atherosclerosis, may also be prevented by vitamin E; additionally, it also helps to reduce the production of prostaglandins such as thromboxane, which cause platelet clumping. The current literature review discusses the functions and roles of vitamin E in human health and some diseases as well as the consequences of vitamin E deficiency. The main focus of the review is on the tocopherol class of the vitamers.

Diabetes mellitus is a non-communicable disease that occurs in both developed and developing countries. This metabolic disease affects all systems in the body, including the liver. Hyperglycaemia, mainly caused by insulin resistance, affects the metabolism of lipids, carbohydrates and proteins and can lead to non-alcoholic fatty liver disease, which can further progress to non-alcoholic steatohepatitis, cirrhosis and, finally, hepatocellular carcinomas. The underlying mechanism of diabetes that contributes to liver damage is the combination of increased oxidative stress and an aberrant inflammatory response; this activates the transcription of pro-apoptotic genes and damages hepatocytes. Significant involvement of pro-inflammatory cytokines-including interleukin (IL)-1β, IL-6 and tumour necrosis factor-α-exacerbates the accumulation of oxidative damage products in the liver, such as malondialdehyde, fluorescent pigments and conjugated dienes. This review summarises the biochemical, histological and macromolecular changes that contribute to oxidative liver damage among diabetic individuals.

First discovered by Friedenstein in 1976, mesenchymal stem cells (MSCs) are adult stem cells found throughout the body that share a fixed set of characteristics. Discovered initially in the bone marrow, this cell source is considered the gold standard for clinical research, although various other sources-including adipose tissue, dental pulp, mobilised peripheral blood and birth-derived tissues-have since been identified. Although similar, MSCs derived from different sources possess distinct characteristics, advantages and disadvantages, including their differentiation potential and proliferation capacity, which influence their applicability. Hence, they may be used for specific clinical applications in the fields of regenerative medicine and tissue engineering. This review article summarises current knowledge regarding the various sources, characteristics and therapeutic applications of MSCs.

Although relatively uncommon in health care research, qualitative research is now receiving recognition and is increasingly used in health care research with social and cultural dimensions. Unlike quantitative research, which is deductive and tends to analyze phenomena in terms of trends and frequencies, qualitative research seeks to determine the meaning of a phenomenon through description. It aims to develop concepts that aid in the understanding of natural phenomena with emphasis on the meaning, experiences and views of the participants. Differences among qualitative researchers exist on matters of ontology, epistemology, data collection methods and methods of evaluation. The aim of this article is not to act as a practical guide on how to conduct qualitative research, but is an attempt to give an introduction to qualitative research methods and their use in health-related research.

Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50-60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics.

The date palm, Phoenix doctylifera L., is the most important fruit crop in the Middle East, cultivated since prehistoric times. Since mid-eighties the dreaded pest of palms viz. the red palm weevil. Rhynchophorus ferrugineus Oliv. has been reported to cause serious damage to date palm in certain pockets of the Gulf region. The pest subsequently spread to most of the date growing centers in the region and attained a key pest status. The unique agroclimatic conditions prevailing in the Middle East and the nature of the crop, coupled with transportation of planting material have helped in the rapid development and spread of the pest in a short period of about a decade Feeding of the soft tissues by this concealed borer often leads to the death of the palm. if timely curative measures are not adopted. However, taking up curative measures in the early stage of attack is often not possible as detection in infestation in the early stage is difficult. Moreover, the presence of neglected date gardens, beheaded palms, retention of unwanted off shoots etc. make the problem intricate. To tackle this problem from various angles and successfully combat the pest, the following Integrated Pest Management (IPM) programme is suggested. The major components of the IPM strategy are surveillance, trapping the weevil using pheromones lures, detection of infestation by examining palms. Eliminating hidden breeding sites, clearing abandoned gardens, maintaining crop and field sanitation, preventive chemical treatments, curative chemical control implementing quarantine measures and training and education.

This article is the second part of a review that addresses the role of damage-associated molecular patterns (DAMPs) in human diseases by presenting examples of traumatic (systemic inflammatory response syndrome), cardiovascular (myocardial infarction), metabolic (type 2 diabetes mellitus), neurodegenerative (Alzheimer's disease), malignant and infectious diseases. Various DAMPs are involved in the pathogenesis of all these diseases as they activate innate immune machineries including the unfolded protein response and inflammasomes. These subsequently promote sterile autoinflammation accompanied, at least in part, by subsequent adaptive autoimmune processes. This review article discusses the future role of DAMPs in routine practical medicine by highlighting the possibility of harnessing and deploying DAMPs either as biomarkers for the appropriate diagnosis and prognosis of diseases, as therapeutics in the treatment of tumours or as vaccine adjuncts for the prophylaxis of infections. In addition, this article examines the potential for developing strategies aimed at mitigating DAMPs-mediated hyperinflammatory responses, such as those seen in systemic inflammatory response syndrome associated with multiple organ failure.

Objectives: Quality of sleep is an important indicator of health. Sleep disturbance and daytime fatigue is one of the most common problems in the postpartum period. Early postpartum (first 4 weeks) is when sleep is most disturbed. The gut microbiota may affect sleep quality and affect host health through the production of metabolites and compounds. This study aimed to determine the effect of oral probiotic capsule on the quality of sleep after delivery in primiparous women. Method: This triple-blind randomised controlled trial study was conducted in August to November 2023 with eligible primiparous women who gave birth at Health Centers No. 2 and 3, Mashhad, Iran. The participants were randomly and equally divided into two groups: (1) the probiotic group, which received probiotic capsules (containing Lactobacillus acidophilus, Bifidobacterium bifidum, B. lactis and B. longum) and (2) the placebo group, which received placebo capsules. All participants received one capsule daily from the third day after delivery for 30 days. The Pittsburgh Sleep Quality Index questionnaire was completed before and after the study. Kolmogorov-Smirnov and Shapiro-Wilk tests, T-test and Mann-Whitney test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant. Results: A total of 60 women were included in this study (n = 30 for each group). The two groups were homogeneous in terms of demographic and obstetric characteristics except for body mass index. Before the intervention, the overall score of postpartum quality of sleep in the probiotic and placebo groups was 9.66 ± 6.21 and 11.70 ± 6.68, respectively; after the intervention, the probiotic group had a score of 6.16 ± 2.75 with the score difference of -3.50 ± 5.53 and the placebo group a score of 6.60 ± 2.66 with the score difference of -5.10 ± 6.31 with a statistically significant difference in the intervention group compared to the placebo (P = 0.003). Conclusion: Consumption of probiotic capsules improves the quality of sleep and maternal health in the postpartum period.

NAXE encephalopathy, also known as early-onset progressive encephalopathy with brain oedema and/or leukoencephalopathy-1 (PEBEL-1), is a rare and often lethal autosomal recessive mitochondrial disorder. Typical presentation includes psychomotor regression, ataxia, respiratory insufficiency and seizures triggered by febrile illness. This report describes three siblings from a consanguineous family who presented to a tertiary care hospital in Muscat, Oman, in 2022 and were found to have a homozygous pathogenic variant in the NAXE: NM_144772.2:c.827del, p.(Pro276Hisfs*43). Beyond the classic neuroradiological and clinical features of PEBEL-1, these patients exhibited novel phenotypic manifestations, including axonal polyneuropathy, Bull's eye maculopathy and a late-onset presentation of skin lesions. The identification of these features expands the known clinical spectrum of NAXE mutations and highlights the importance of considering this diagnosis in patients presenting with unexplained multisystemic mitochondrial symptoms involving the peripheral nerves and retina.

Objectives: This study aimed to evaluate neonatal outcomes associated with birthweight discordance in twin pregnancies managed at a regional tertiary care centre in Oman. Methods: This five-year retrospective cohort study (2020-2024) was conducted at Nizwa Hospital, Nizwa, Oman, and included twin pregnancies of ≥24 weeks' gestation. Birthweight discordance was defined as ≥20%. Multivariable logistic regression analysis was performed, adjusting for gestational age at delivery, chorionicity, preeclampsia and gestational diabetes mellitus. Results: A total of 226 twin pregnancies were included, of which 45 (19.9%) had birthweight discordance ≥20%. Discordant pregnancies were delivered at an earlier gestational age than non-discordant pregnancies (34.2 ± 2.9 versus 35.3 ± 2.2 weeks; P = 0.017). NICU admission was more frequent in the discordant group (60.0% versus 31.5%; P <0.001), as was the composite adverse neonatal outcome (62.2% versus 33.1%; P <0.001). Birthweight discordance ≥20% remained independently associated with the composite adverse neonatal outcome (adjusted odds ratio [aOR] = 2.74, 95% CI: 1.21-6.25; P = 0.016), while increasing gestational age at delivery was protective (aOR = 0.47 per additional week, 95% CI: 0.37-0.59; P <0.001). Conclusion: Birthweight discordance ≥20% was associated with adverse neonatal outcomes in twin pregnancies, with this association largely mediated by prematurity.

Objectives: Congenital nephrotic syndrome (CNS) is a rare, severe disease presenting within the first three months of life, with limited prevalence data from Oman and the Gulf region. This study aimed to report 20 years' experience of congenital nephrotic syndrome (CNS) in a single centre in Oman. Methods: This retrospective study including children diagnosed with nephrotic syndrome in first 3 months of life, from January 2000 to December 2020 at Royal Hospital, Muscat, Oman. Results: A total of 26 patients were included in the study, with no gender predominance. Consanguinity was noted in 61.5% of patients and a family history of renal disease was found in 46.2% of patients. The median age at presentation was 19.9 days (range: birth–2 months). Genetic workup was performed in 19 patients of which 73.6% were positive for NPHS1 gene. The median follow-up was 6.3 years (range: 1 month–13 years). Dialysis was initiated in 23.1% of patients, and 15.4% underwent transplantation. The median age at death was 1.5 years (range: 1 month–7 years). Conclusion: Genetic factors remain the predominant cause of CNS in this study's cohort. Despite significant disease course, advances in supportive and specialised care continue to improve outcomes.

Objectives: Fear of childbirth is commonly reported among primigravida women and may negatively influence labour and birth outcomes. This study aimed to evaluate the effectiveness of a structured prenatal educational programme in reducing fear of childbirth among primigravida women. Methods: A quasi-experimental single-group pretest-post-test design was conducted from January to June 2025. The study included primigravida women attending antenatal clinics in selected health centres in Muscat Governorate, Oman. No control group was included. Participants completed the baseline assessment during the third trimester (28–40 weeks of gestation) prior to the intervention. Post-intervention assessment was conducted at two weeks postpartum using the Self-Evaluation Questionnaire. Results: A total of 79 primigravida women were included. Following the intervention, the mean fear-of-childbirth score decreased from 4.35 ± 0.63 at baseline to 1.79 ± 0.74 at 2-week postpartum follow-up, representing a mean reduction of 2.56 points (95% CI: 2.38–2.74; t = 27.8; P <0.001; Cohen's d = 3.12), indicating a statistically significant improvement after participation in the prenatal educational programme. Conclusion: The structured prenatal educational programme was associated with a reduction of fear of childbirth among primigravida women. Incorporating such programmes into routine antenatal care may enhance maternal psychological well-being in Oman and in similar maternal health settings.

Ischial pressure ulcer reconstruction requires durable coverage while preserving local donor options for possible recurrence. The inferior gluteal artery perforator (IGAP) flap is a muscle-sparing option, but superthin elevation requires precise knowledge of the superficial fascial plane and the subcutaneous course of the selected perforator. This technical note describes colour Doppler ultrasonography-guided superficial fascial plane mapping before superthin IGAP flap elevation in a 27-year-old paraplegic patient with a chronic left ischial pressure ulcer who presented in 2025 to a tertiary care university hospital in Muǧla, Turkey. Preoperative high-frequency colour Doppler ultrasonography identified the dominant perforator, measured the relevant fascial intervals and guided a controlled dissection above the superficial fascia. The technique allowed elevation of a thin, pliable flap while preserving deeper gluteal structures and perforator integrity. Colour Doppler-guided fascial mapping may support safer superthin perforator flap elevation in selected pressure ulcer reconstructions.

Poe’s story “The Cask of Amontillado” has been read as a story of a premeditated crime, of revenge and the protagonist’s ultimate pride in his well-executed crime. Readers are repulsed by the sheer evil of Montresor, the main character of the story. However, this paper argues that this reading barely scratches the surface of the depth and complexity of this story. It argues that the story is told in the form of a confession. The narrator, an elderly Montresor, is full of remorse, and in telling the story, he is seeking absolution. In its deeper meaning, “The Cask of Amontillado” is about death as the inescapable biological trap. This paper argues that the story is about death as the great antagonist of the text.

The study aimed to investigate the impact of implementing a proposed vocational rehabilitation training program on improving the quality of life of individuals with intellectual disabilities. The study targeted 21 female students enrolled in the intellectual integration program in Al-Dakhiliyah Governorate, Sultanate of Oman, drawn from seven schools implementing the intellectual integration program. The present study is a quasi-experimental study that adopted the experimental method by implementing a vocational rehabilitation training program with an experimental group of female students with intellectual disabilities. The researchers developed a quality-of-life scale consisting of 55 items distributed across four dimensions: health-related quality of life, psychological quality of life, social and family quality of life, and vocational quality of life and practical skills. The scale was administered to the study participants after its validity had been established. The findings revealed statistically significant differences across all sub-dimensions of the scale, in favor of the post-test measurement. The training program demonstrated a strong impact on all dimensions of the quality-of-life-scale for female students with intellectual disabilities, as well as on the overall scale, with the Eta squared coefficient (η²) ranging from 0.70 to 0.91. Furthermore, no statistically significant differences were found between the post-test and follow-up measurements, confirming the sustained effect of the program on the study sample. The study recommends placing greater emphasis on implementing similar vocational training programs, providing financial support for individuals with intellectual disabilities, and incorporating vocational and professional activities into the curriculum.

The study aimed to identify the role of the social workers in promoting tourism awareness among Saudi university students in light of the Kingdom’s Vision 2030, from the point of view of male and female students. The study employed a questionnaire as the research instrument and adopted the descriptive-analytical method. The study sample consisted of 300 students including 157 male students and 143 female students, drawn from two academic institutions in the city of Riyadh. The findings indicated that the overall level of the practices included in the questionnaire was moderate. The perceived obstacles facing the role of the social workers in developing tourism awareness ranked first among the questionnaire dimensions, followed by the cognitive role of the social worker, while the performance-related role of the social worker ranked last. All dimensions were related at a moderate degree. The results also showed that there were no statistically significant differences between the study participants attributable to gender with respect to the questionnaire and the study instrument.