Don’t Miss the Target

NON

A CVC Line Misadventure: “Doctor why do I have a humming sound in my ear?”

We report a 32-year-old female patient who was referred to a tertiary care hospital in Muscat, Oman, in 2021 with an iatrogenic arteriovenous fistula (AVF) that presented as a neck swelling which developed few weeks after an attempt of central venous catheterization through the right internal jugular vein (IJV). The fistula was corrected surgically at our institute with a successful outcome. AVF is an abnormal communication between an artery and vein which can occur as a congenital anomaly, after trauma or iatrogenic following central venous catheter (CVC) or endovenous thermal ablation. Keywords: Arteriovenous fistula, Iatrogenic, central venous catheter, critically ill, IC

Seismic Upgradation of RC Beams Strengthened with Externally Bonded Spent Catalyst Based Ferrocement Laminates

Globally, since there are more systems of civil infrastructure, there are also more degraded buildings and structures. If upgrading or strengthening is a practical option, complete replacement is likely to be an escalating financial burden and may be a waste of natural resources. It is necessary to repair or strengthen a number of reinforced concrete buildings and structures in order to boost their load-bearing capabilities or improve their ductility under seismic stress. Additionally, due to changes in service circumstances, a structure might need to be modified to reduce deflections or manage cracking. Strengthening may be preferable to limiting usage, capping applied loads, and regularly inspecting the structure rather than removing the existing structure or part and building a new one. This study aims to examine the flexural, shear, and combined effect of flexural and shear behavior of reinforced concrete (RC) beams strengthened with externally bonded spent catalyst-based ferrocement laminates and compare them to the control beams (unstrengthened) under two-point loading conditions. This study involves researching laminates with various spent catalyst doses, such as 3, 6, 9, and 12%, in an effort to determine the best amounts that will improve the structural performance of ferrocement laminates. Twelve spent catalyst-based ferrocement laminates measuring 500(L) × 125(B) × 20 mm (thickness) with 3% volume fraction of meshes each were cast and tested in the lab as part of the preliminary investigation. For repeatability, three laminates per case were employed. Eight numbers of under-reinforced RC beams measuring 75(L) × 100(B) × 150(D) mm were cast for the main study; six numbers were strengthened with optimized spent catalyst-based ferrocement laminates bonded with flexible epoxy systems at the tension zone, shear zone, and combination of tension and shear zone. Two of the beams were cast as control specimens. The beams were then evaluated using a Universal Testing Machine (UTM) with a 1000 kN capacity under two-point loading conditions. As a result, the strength, yield load, ultimate load, stiffness, ductility, and related failure modes of all tested beams' flexural and shear performances were examined. According to a preliminary analysis of laminates made of spent catalyst, the dosage of 9% provides good flexural strength in comparison to other doses. In comparison to the strengthened beam, the control beam's initial cracks appeared earlier. In comparison to the control beam, the strengthened beam has an increase in load-carrying capacity of 18% for flexure, 16% for shear, and 30% for the combined impact of flexure and shear. In comparison to the control beam, the deflection of the strengthened beam was decreased by close to 20 to 40% for flexure, 10 to 30% for shear, and 15 to 20% for the combined effects of flexure and shear at the same load level. In relation to control beams, the ductility also improved up to 30% for flexure, 25% for shear, and 25% for the combined impact of flexure and shear. Similar to this, the retrofitted beam is stiffer than the control beam by approximately 40% for flexure, 48% for shear, and 30% for the combined effect of flexure and shear. Theoretical formulation by section analysis is also derived and it gives close agreement with control and strengthened beams. The flexural and shear strengthening of the RC beam retrofitting system is effectively increased by using spent catalyst-based ferrocement laminates. No beam showed signs of premature and brittle failure. According to the test findings, it can be said that spent catalyst-based ferrocement reinforced beams perform better in every way than control beams. Doi: 10.28991/HIJ-2023-04-01-013 Full Text: PD

Evaluation of prescribing adherence to guideline-directed medical therapy in patients with chronic heart failure: a retrospective study at the National Heart Centre in Oman.

Guideline-directed medical therapy (GDMT) improves survival and quality of life in patients with heart failure with reduced ejection fraction (HFrEF). However, real-world adherence to these guidelines remains suboptimal. This study aimed to evaluate prescribing adherence to GDMT in HFrEF patients using a global guideline adherence scoring tool. This retrospective study included adult patients with HFrEF (left ventricular ejection fraction ≤ 40%) attending the Heart Failure Clinic at the National Heart Centre in Oman between January and June 2022. GDMT adherence was assessed based on 2021 European Society of Cardiology guidelines. Adherence levels were categorized as good (all indicated GDMT at ≥ 50% of target dose), moderate (more than half at ≥ 50%), or poor (less than half or < 50%). Descriptive statistics and chi-square tests were used to identify associations. Of the 259 patients included (mean age 57 ± 13.6 years, 70% male), 71% had good adherence, 22% moderate, and 7% poor. Target dose attainment varied by drug class: 78% for beta-blockers, 63% for ACEI/ARB/ARNI, 96% for MRAs, and 100% for ivabradine. Suboptimal GDMT (< 50% target dose) was significantly associated with hypertension (P = 0.004), dilated cardiomyopathy (P = 0.015), chronic kidney disease (P = 0.001), and older age (P = 0.004). Prescribing adherence to GDMT in Oman is consistent with international data. Suboptimal titration was significantly linked to older age and comorbidities, suggesting that perceived frailty and clinical complexity may influence physician prescribing patterns. Efforts to improve individualized, patient-centered GDMT titration are warranted

Atherosclerotic Carotid Artery Disease: Where to from the Emergency Room? A University Hospital Experience

Objective: Stroke is the second leading cause of death worldwide, with 5.5 million deaths attributed to this cause in 2016. Vascular intervention, including carotid endarterectomy and carotid artery stenting, play a major role in stroke prevention, especially if intervention is performed early after onset of symptoms. The aim of the paper was to define the role of vascular surgeons in ischemic stroke and hence improve referral patterns by drawing an algorithm for the referral process which could reduce time to intervention and optimize patient benefit from intervention. Methods: This retrospective study reviewed the symptomatic and asymptomatic patients with atherosclerotic disease of the carotid artery referred to the vascular surgery unit of our institution from April 2018 to March 2020, to examine factors influencing recognition of suitable candidates for intervention. Results:&nbsp;A total of 38 patients with ischemic stroke were recognized as having carotid artery stenosis and were referred to the vascular surgery service during the study period. Only 6 met the criteria for carotid endarterectomy; 4 underwent the procedure. Conclusions: Choice of patients for carotid endarterectomy involves multiple steps, with potential for missed opportunities. By involving a multidisciplinary team approach, the recommended protocol aims to lead to early and appropriate referral to a vascular surgeon or interventional radiologist resulting in increased and optimised intervention in stroke prevention. Keywords: Stroke, TIA, carotid, symptomatic, asymptomatic, referral, vascular, surgery, endarterectomy, stenting, referral

Business strategy and earnings management: financial versus non-financial firms

This study investigates the impact of business strategy on earnings management practices for financial and non-financial firms in Oman. To assess the research objective, 430 firm-year observations from 2015 to 2019 were employed in the study. Using regression analysis, the findings suggest that differentiation strategy positively affects earnings management in financial sector firms. In addition, cost leadership strategy positively affects earnings management in non-financial sector firms. This indicates that business strategy is associated with company leaders managing their earnings while they are trying to survive through competition. These findings are useful for regulators, as they can introduce mechanisms to curb earnings management practices and instil more faith in investors

Cotton, cowpea and sesame are alternative crops to cucurbits in soils naturally infested with Monosporascus cannonballus

[EN] Monosporascus cannonballus is an important cucurbit root pathogen, which has been reported in the main production areas of melon and watermelon in Brazil and worldwide and potentially capable to colonize roots of different species. Crop rotation is considered an effective management strategy to prevent this disease. The aim of this study was to evaluate the response of different crops, pumpkin, cotton, cowpea, sesame, watermelon, melon, corn, cucumber, sorghum and tomato, to the infection of this pathogen. Seedlings were transplanted into plastic containers with an inoculum concentration of 20 colony-forming units (CFU) g(-1) of M.cannonballus. Fifty days after transplanting, the variables analysed were the degree of disease severity on the root system and the frequency of reisolation. On cucurbits, the results demonstrated different degrees of susceptibility among crops and cultivars, being melon and watermelon the most sensitive species. In contrast, Cucurbita cultivars were the most tolerant. Regarding non-cucurbit crops, maize, sorghum and tomato presented root discoloration and M.cannonballus was reisolated from roots. Cotton, cowpea and sesame cultivars were not affected by the pathogen, so they can be considered as alternative crops to be cultivated, or in rotation with cucurbits, in M.cannonballus infested soils.We are thankful to Conselho Nacional de Desenvolvimento Cientifico e Tecnologico-CNPq for the research fellowships granted to Rui Sales Junior e Erika Valente de Medeiros.Sales, R.; Días Balbino, DA.; Mitsa Paiva Negreiros, A.; Da Silva Barboza, H.; Valente De Medeiros, E.; Armengol Fortí, J. (2018). Cotton, cowpea and sesame are alternative crops to cucurbits in soils naturally infested with Monosporascus cannonballus. Journal of Phytopathology. 166(6):396-402. https://doi.org/10.1111/jph.12698S396402166

Effect of rootstock on muskmelon cultivar reaction to vine decline disease and yield under arid conditions

Monosporascus cannonballus, Rhizoctonia solani and Pythium aphanidermatum are the main causal agents of muskmelon vine decline disease in Oman. This study was conducted to examine the response of six cucurbit rootstocks grafted on four muskmelon scions to the causal agents and fruit quality and quantity. The response of 10 day old Palmira seedlings to artificial inoculation with R. solani pathogen alone revealed more damage to muskmelon seedling whereas P. aphanidermatum and M. cannonballus caused less damage when inoculated singly but more disease severity index when combined with R. solani. Artificial inoculation of different rootstocks produced significantly no damping-off and very low vine decline disease severity index on Mubyeongjangsoo, Titan, Tetsukabuto, Rsscih7458, Ezra and Strong Tosa rootstocks. All rootstocks produced high grafting success and low graft failure with the four selected muskmelon cultivars. Rootstocks enhanced early harvesting of grafted Tamara but had no effect on other scions. Fruit shape was almost not significantly affected by grafting except Samit grafted on Strong Tosa and Caramel grafted on Mubyeongjangsoo produced significantly different fruit shapes compared to ungrafted controls in the spring 2013 trial. Fruits from both grafted Shahd and Tamara showed no significant differences in rind brightness, redness and yellowness from the control. An various effect of rootstock was found on harvesting, fruit number and weight, chlorophyll content, and stem diameter of the scion. Rootstocks enhanced early harvesting and increased fruit number and fruit weight in grafted Tamara scions. There was no significant effect of grafting on fruit TSS. The study shows positive effects of grafting on tolerance to vine decline and on fruit quality and yield

Effect of rootstock on muskmelon cultivar reaction to vine decline disease and yield under arid conditions

Monosporascus cannonballus, Rhizoctonia solani and Pythium aphanidermatum are the main causal agents of muskmelon vine decline disease in Oman. This study was conducted to examine the response of six cucurbit rootstocks grafted on four muskmelon scions to the causal agents and fruit quality and quantity. The response of 10 day old Palmira seedlings to artificial inoculation with R. solani pathogen alone revealed more damage to muskmelon seedling whereas P. aphanidermatum and M. cannonballus caused less damage when inoculated singly but more disease severity index when combined with R. solani. Artificial inoculation of different rootstocks produced significantly no damping-off and very low vine decline disease severity index on Mubyeongjangsoo, Titan, Tetsukabuto, Rsscih7458, Ezra and Strong Tosa rootstocks. All rootstocks produced high grafting success and low graft failure with the four selected muskmelon cultivars. Rootstocks enhanced early harvesting of grafted Tamara but had no effect on other scions. Fruit shape was almost not significantly affected by grafting except Samit grafted on Strong Tosa and Caramel grafted on Mubyeongjangsoo produced significantly different fruit shapes compared to ungrafted controls in the spring 2013 trial. Fruits from both grafted Shahd and Tamara showed no significant differences in rind brightness, redness and yellowness from the control. An various effect of rootstock was found on harvesting, fruit number and weight, chlorophyll content, and stem diameter of the scion. Rootstocks enhanced early harvesting and increased fruit number and fruit weight in grafted Tamara scions. There was no significant effect of grafting on fruit TSS. The study shows positive effects of grafting on tolerance to vine decline and on fruit quality and yield.

Effect of rootstock on muskmelon cultivar reaction to vine decline disease and yield under arid conditions

Monosporascus cannonballus, Rhizoctonia solani and Pythium aphanidermatum are the main causal agents of muskmelon vine decline disease in Oman. This study was conducted to examine the response of six cucurbit rootstocks grafted on four muskmelon scions to the causal agents and fruit quality and quantity. The response of 10 day old Palmira seedlings to artificial inoculation with R. solani pathogen alone revealed more damage to muskmelon seedling whereas P. aphanidermatum and M. cannonballus caused less damage when inoculated singly but more disease severity index when combined with R. solani. Artificial inoculation of different rootstocks produced significantly no damping-off and very low vine decline disease severity index on Mubyeongjangsoo, Titan, Tetsukabuto, Rsscih7458, Ezra and Strong Tosa rootstocks. All rootstocks produced high grafting success and low graft failure with the four selected muskmelon cultivars. Rootstocks enhanced early harvesting of grafted Tamara but had no effect on other scions. Fruit shape was almost not significantly affected by grafting except Samit grafted on Strong Tosa and Caramel grafted on Mubyeongjangsoo produced significantly different fruit shapes compared to ungrafted controls in the spring 2013 trial. Fruits from both grafted Shahd and Tamara showed no significant differences in rind brightness, redness and yellowness from the control. An various effect of rootstock was found on harvesting, fruit number and weight, chlorophyll content, and stem diameter of the scion. Rootstocks enhanced early harvesting and increased fruit number and fruit weight in grafted Tamara scions. There was no significant effect of grafting on fruit TSS. The study shows positive effects of grafting on tolerance to vine decline and on fruit quality and yield