Sultan Qaboos University Medical Journal

Sultan Qaboos University Medical Journal

Basic info

  • Publisher: Sultan Qaboos University
  • Country of publisher: oman
  • Date added to EuroPub: 2017/Sep/12

Subject and more

  • LCC Subject Category: Biochemistry, Biomedicine, Medicine
  • Publisher's keywords: Medicine, Biomedicine, Community Health, Family Medicine, Health Sciences, Biochemistry
  • Language of fulltext: english
  • Full-text formats available: PDF

Publication charges

  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

Editorial information

Open access & licensing

  • Type of License: CC BY
  • License terms
  • Open Access Statement: Yes
  • Year open access content began: 1999
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

Best practice polices

  • Permanent article identifier: DOI
  • Content digitally archived in: LOCKSS
  • Deposit policy registered in: None

This journal has '1206' articles

Visceral leishmaniasis and haemophagocytic syndrome in an Omani child

Visceral leishmaniasis and haemophagocytic syndrome in an Omani child

Authors: Khalfan Al Sineidi| Department of Child Health (Haematology/Oncology Unit), College of Medicine & Health Sciences, Sultan Qaboos University, P.O.Box:...
( 17 downloads)
Abstract

The paper reports the case of a previously healthy 4-year-old-girl who presented with pallor, fever and hepatosplenomegaly. Laboratory findings included pancytopenia, hypertriglyceridemia and hyperferritinemia. Initial diagnosis of kala-azar could not be confirmed because of the absence of clinical evidence, negativity of bone marrow aspiration or specific serology for visceral leishmaniasis. Repeated marrow aspiration, performed due lack of clinical response, revealed histiocytes showing haemophagocytosis consistent with haemophagocytic lymphohistocytosis (HLH) and appropriate treatment was started. She continued to have high-grade fever, and a third bone marrow aspiration ultimately revealed presence of Leishmania amastigotes with evidence of active haemophagocytosis. The girl was treated with liposomal amphotericin (AmBisome) for 5 days, following which she recovered rapidly with definitive remission.

Keywords: haemophagocytic syndrome, visceral leishmaniasis, Oman
A Case of Recurrent Abdominal Pain

A Case of Recurrent Abdominal Pain

Authors: Faisal A. Al Temimi| Nizwa Hospital, P.0. Box 1222, RC. 611, Nizwa, Sultanate of Oman, Prasad George| Nizwa Hospital, P.0. Box 1222, RC. 611, Nizwa, S...
( 19 downloads)
Abstract

The paper decribes the case of a forty-year-old male patient who was admitted with recurrent abdominal pain. Investigations revealed high levels of blood lead; symptoms responded promptly to treatment. The paper also reviews lead poisoning and its treatment.

Keywords: Lead poisoning, plumbism, sodium calcium edetate, case report, Nizwa, Oman
Epidemic infections and their relevance to the Gulf and other Arabian Peninsula countries

Epidemic infections and their relevance to the Gulf and other Arabian Peninsula countries

Authors: Euan M. Scrimgeour| Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, Al-Khod-123, Sultanate of Om...
( 16 downloads)
Abstract

THE STRATEGIC LOCATION OF THE ARABIAN Peninsula between Africa, Asia and Europe, has since early historical times drawn travellers, seafarers, and merchants to this part of the Middle East. It is inevitable that importation of communicable diseases should be a feature of such population movements. In Saudi Arabia, this has been demonstrated repeatedly over past decades, with epidemics occurring during the annual Hajj, when over a million pilgrims from more than 80 countries congregate together with a similar number of local worshippers for a week in Mecca and Medina. Plague used to break out almost every year until 98,1 and other frequent outbreaks have included smallpox,2 cholera,3 and meningococcal infection.3,4 The latter has continued to pose a problem despite the use of bivalent (A,C) vaccination for intending pilgrims, and two recent meningococcal outbreaks in 2000 and 200 caused by new serogroups required planning to introduce quadrivalent (A,C,Y, W135) vaccination in the future.5 All Arabian Peninsula countries have been subject to outbreaks of introduced communicable diseases caused by various micro-organisms, although these have not always been so well documented as the Saudi epidemics. Parasitic infections have not posed a significant threat in recent decades except perhaps, falciparum malaria. It likely that malaria was introduced to the western region of Saudi Arabia and the United Arab Emirates in the very remote past since a large proportion of inhabitants of oases have one or more red cell markers which confer resistance, e.g., thalassaemia or the sickle cell trait.3 Suitable Anopheles mosquito vectors are present in all countries in the region. Although effective malaria-control programmes have been implemented in most countries in the region, the emergence of chloroquine-resistant falciparum malaria contracted overseas has created a new concern, and this has been noted in Saudi Arabia,3 Kuwait,6 Oman,7 and the United Arab Emirates.8 Leishmaniasis occurs widely in the Middle East. The cutaneous form causes minor morbidity in a relatively immune population, but the occasional complication of systemic infection, especially in the non-immune, became significant during Operation Desert Storm when eight American servicemen stationed in the Eastern Province of Saudi Arabia developed visceral leishmaniasis after Leishmania tropica infection.9 The usual species causing visceral leishmaniasis or kala azar in the Middle East is L. infantum. (This is the probable cause of kala azar in Oman.10) As a result of exposure of overseas troops to sandfly vectors of leishmaniasis during the recent war in Iraq, thousands of potential blood donors among the American troops were excluded as future donors. It is probable that schistosomiasis mansoni and haematobium which are widely prevalent in the Middle East, were introduced from the Nile Valley of Egypt in prehistoric times to Saudi Arabia, Yemen and probably Oman.11 Snail vector control programmes in most countries have limited transmission, but the need to implement vector control indefinitely was demonstrated recently in Dhofar province in Oman, when suspension of regular mollusciciding resulted in a new epidemic of schistosomiasis mansoni.12 Bacterial infections of potential epidemic significance to the Arabian Peninsula other than meningococcus infection, are few. Small outbreaks of typhoid fever are not infrequent, but do not pose a major community threat. Cholera has been introduced sporadically, e.g. by illegal immigrants from Pakistan and Afghanistan in Oman in 2000, and occasionally in other countries. In the Iraqi war, the breakdown in communicable disease control programmes led to epidemic cholera affecting 94 patients.13 There has been one documented outbreak of plague which spread from affected rodents on the Saudi Arabian-Yemen border in 969 with 0 deaths.14 Anthrax is rare in the region,3 but its use as a possible biological weapon has lately received notorious publicity. A second agent with potential as a biological weapon is the rickettsial infection Q fever, caused by Coxiella burnetii. This would have limited impact in the Middle East where it is widely endemic, and there is widespread immunity, such as in Saudi Arabia3 and in Oman.15 Viruses are currently the most likely source of significant epidemic infections in the Arabian Peninsula. The era of air travel has increased the opportunities for introduction of viral infections with short incubation periods from distant locations. Among these, viral haemorrhagic fevers (VHF) are regarded as one of the most serious risks. Many of these are arbovirus infections (spread by arthropod vectors). There is always the possibility of importing Ebola and Marburg disease (caused by Filoviridae viruses) from Africa, Lassa virus (an arenavirus) from West Africa, or Kyasanur Forest disease (caused by a flavivirus) from India, but fortunately, these have never been reported. Sources of infection of VHFs include rodent urine (Lassa fever), Hantaan virus disease (caused by a hantavirus, a genus of the Bunyaviridae which is widely prevalent in neighbouring regions), vector ticks (Kyasanur Forest disease and Crimean-Congo haemorrhagic fever (which is caused by a Nairovirus), possibly monkeys, (Ebola) or aerosol spread (Ebola, Marburg disease, Lassa fever, Crimean Congo haemorrhagic fever). Accordingly all major hospitals in the region should have an admission policy for suspected VHF.16 Crimean Congo haemorrhagic fever is widely prevalent in the Middle East wherever suitable vector idoxid (hard) ticks (especially Hyalomma spp.) are present. The disease can also be spread from contact with blood or meat from an infected animal, or by aerosol. It was almost certainly already indigenous to the Western Province of Saudi Arabia,17 when over a decade ago, there was evidence of new introduction through Jeddah seaport by imported small Sudanese ruminants.18 Similarly, because the vector ticks for CCHF were already indigenous to Oman,19 and no doubt also present in the United Arab Emirates, the first diagnoses of disease in a man in Buraimi, northern Oman, and at the same time in a patient in Muscat, merely confirmed that the disease was present.20 Luckily epidemiological studies elsewhere have shown that even when this zoonosis is prevalent in a country, human cases are infrequent and sporadic. Alkhurma virus (family Flaviviridae, genus Flavivirus) is another emerging VHF in the Middle East. It was reported to have caused haemorrhagic fever in Saudi patients in 1995,21 infection being contracted from viraemic vertebrates by tick bite, parenteral exposure to their blood, or drinking unpasteurised milk. Other VHFs include the arbovirus infections yellow fever and dengue fever which cannot be spread directly from person to person but require a mosquito vector. Arbovirus infections occupy a special category of communicable disease epidemiology. The majority are zoonoses which immediately poses a problem in control. When suitable vectors such as mosquitoes or ticks are already present in a region, there is always the risk of importation of a new virus infection. Although dengue fever (which is strictly anthroponotic) had never occurred in Saudi Arabia, the presence of indigenous Aedes aegypti mosquitoes in Jeddah allowed dengue type 2 to become established in 994. (The first patient, a Saudi, who died from dengue haemorrhagic fever, was under the care of the author). It was suspected that a viraemic Indonesian visitor to Jeddah had infected local mosquitoes which then infected the Saudi population. It proved to be impossible to eliminate the vector mosquitoes, and surveillance thereafter showed that two other serotypes,  and 3 had become established in the community.22 Fortunately, Oman has so far escaped an epidemic of dengue fever despite its diagnosis in several patients who had visited India, possibly because the Aedes spp. in northern Oman is not a suitable vector. It is only in Dhofar that A. aegypti is present (D. Roberts, personal communication). Rift Valley fever, another arbovirus infection, has become of concern to the Arabian Peninsula. The responsible virus is a member of the Phlebovirus genus, one of the five genera of Bunyaviridae. Its first detection on the Arabian Peninsula was southern Saudi Arabia and Yemen in September, 2000. Genetic analysis supported the belief that this zoonosis originated in East Africa and was probably imported to Saudi Arabia and/or Yemen in livestock.23 The natural hosts include birds and animals including cattle, sheep, goats and camels, and the vectors include A. aegypti and other mosquitoes including Anopheles and Culex, as well as ticks. Transovarian virus infection results in the new generation of infected arthopods, perpetuating infection in the community. Infected mosquito eggs may survive several years in dry conditions. The disease causes haemorrhagic fever and necrotising retinitis with blindness, in a small percentage of patients. In livestock, it causes abortions and mortality among young animals. In Saudi Arabia, a total of 884 hospitalized cases occurred with 24 deaths, whereas in Yemen, it was estimated that ,087 cases occurred with 2 deaths.23 A major control programme in Saudi Arabia and Yemen, was implemented with advice from international experts from WHO, the United States Naval Medical Research Unit (NAMRU-2) based in Egypt, experts form Oman, and the Food and Agriculture Organisation. Measures included limiting population movements in affected areas, wholesale slaughtering of potentially infected livestock, and control of arthropod vectors, and a limited vaccination programme. (An animal vaccine is routinely used to protect susceptible livestock, but supplies of an experimental inactivated vaccine for man are not commercially available.) Themeasures.appear to have been successful in localising the infection and preventing its spread elsewhere in the Peninsula. At the time of writing (October 2003), cases have not been reported in Oman.West Nile virus a Flavivirus spread from birds by Culex mosquitoes to man, horses, and other mammals, occurs in the Nile Valley and around the Mediterranean basin. It may well have been indigenous to the Arabian Peninsula as well, although it had never been detected here The virus has shown an ability to spread and become established wherever suitable mosquito vectors are present e.g. it became widespread in the USA following its accidental introduction to New York in 999. It was first reported in Israel several years ago, and appeared to have been spread from geese and migrating storks.24 It has also been of concern in Lebanon and Jordan25,26 and poses a definite risk to Gulf countries including Oman. The virus has become more neuropathic in recent years with a higher rate of encephalitis.Viruses other than arboviruses pose a threat of epidemic infection in the Arabian Peninsula. Outbreaks of human-strain influenza A in Jeddah regularly follow the Hajj, presumably having been introduced by pilgrims.3 Avian influenza is an important source of epidemic influenza in man. It is believed that the 98 pandemic of Spanish influenza,27 and certain that the last three pandemic strains of influenza A virus-Asian/57, Hong Kong/68, and Russian/77, which originated in China, arose from interspecies transmission of viruses, from avian and other sources.28 Reassortment of human and avian virus genes in a permissive host e.g. the pig has been proposed as an amplifying source of virus.29 Genetic analysis of avian influenza viruses allows tracking of subtypes which may be associated with human infection. Severe acute respiratory syndrome (SARS), a newly identified epidemic disease, appeared for the first time in February, 2003 in Hanoi, Vietnam. The causal virus was later identified as a previously unrecognized species from the coronavirus family.30 (Coronaviruses cause about one third of common colds.) The new virus spread locally and cases were confirmed in Canada, China, Hong Kong, Singapore and Taiwan. The source of the virus was unknown, but later, it was reported to be similar to a coronavirus in civet cats (popular as food in South China). It became apparent that person-to-person spread was responsible for its rapid dissemination and a number of health workers contracted the disease, with fatalities in some cases. In Oman, as in other Arabian Peninsula countries, the Ministry of Health implemented a comprehensive, extensive (and expensive) public health project to prevent introduction of SARS. Similar preventative measures were in force in other Gulf countries. A large team of health personnel was at hand with 24 hour airport surveillance of visitors who may have been in contact with the infection, to evaluate and treat suspected cases. After many weeks of surveillance, the epidemic waned in the Far East, and as no cases were encountered in Oman, the project was concluded.There are other conditions apart from those mentioned, which could cause epidemic disease in the Arabian Peninsula. The bovine spongiform encephalopathy (BSE) epidemic in the United Kingdom, caused by a variant prion (an infectious amyloid protein) derived from the scrapie prion (which causes spongiform encephalopathy in sheep), and its passage into the food chain, resulted in the emergence of variant Creutzfeldt-Jakob disease (v-CJD). In 990s BSE was identified in Oman in two cattle imported from the UK.31 The report that sporadic, endemic CJD occurred in Oman32 gave further impetus to the decision to ban the importation of British beef into Oman. Similar bans were imposed in other Gulf counries. Surveillance for possible cases of v-CJD in Omanis continues, but until now, no case has been diagnosed. Nevertheless, prior to the ban, beef imports both fresh, frozen, and canned, may have been infected in some cases, and v-CJD may yet appear in Oman and perhaps other Gulf countries. This disease has an incubation period of several years, possibly decades. The evidence to date indicates that a major epidemic is unlikely, but the median incubation period has not yet been ascertained. The evidence suggests all countries of the Arabian Peninsula will have to remain constantly vigilant to the importation of recognised as well as new epidemic infectious diseases in the future. Most of these countries have a well-established public health programme of surveillance of diseases, and an effective system of preventing introduction of infections. The ministries of health and veterinary services within the Gulf and neighbouring countries can collaborate to mutual advantage, sharing expertise in this field where many infections are zoonotic.

Keywords: null
Screening for gestational diabetes by measuring fasting plasma glucose levels

Screening for gestational diabetes by measuring fasting plasma glucose levels

Authors: Khalil E. Rajab| Department of Obstetrics and Gynaecology, Department of Anaesthesia and Intensive Care, Arabian Gulf University, College of Medicine...
( 17 downloads)
Abstract

Objectives: (a) To test the sensitivity and specificity of measuring fasting plasma glucose levels (FPG) as a screening test for gestational diabetes mellitus (GDM). (b) To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test (GCT) for predicting GDM. Methods: One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26–32 weeks gestation, giving a 13.5% incidence of GDM (using the Third International Workshop cutoff values of 7.8 mmol /l). All patients also had an FPG estimation followed by the threehour oral glucose tolerance test (oGTT). Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves (ROC) were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. Results: FPG levels of 5.6 mmol /l and 5.4 mmol /l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. Conclusion: Using FPG levels at a cutoff value of ≥ 5.5 mmol /l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT.

Keywords: gestational diabetes, pregnancy, screening, fasting plasma glucose levels
Distribution of arylamine N-acetyltransferase 2 (NAT2) genotypes among Omanis

Distribution of arylamine N-acetyltransferase 2 (NAT2) genotypes among Omanis

Authors: Musbah O. M. Tanira| Departments of Pharmacology, College of Medicine & Health Sciences, Sultan Qaboos University, P O Box 35, Al Khod 123, Sultanate...
( 16 downloads)
Abstract

Objective: to determine the genotypes of arylamine N-acetyltransferase (NAT2) among 127 unrelated apparently healthy Omanis. Method: Identify the most common known polymorphisms of NAT*2 gene namely, G191A, C282T, C341T, C481T, G590A, A803G and G857A using PCR-RFLP analysis. Results: Eleven allele variants (3 alternative) and 30 different genotypes were determined. The commonest alleles were found to be NAT*5B, NAT2*6A and NAT*4 with corresponding frequencies of 0.362, 0.248 and 0.189 respectively. The overall frequency of rapid acetylator alleles was 0.25. Conclusion: A new allele variant containing G590A, C282T and T341C polymorphisms was found in one subject (was named NAT2*5J). The commonest genotypes were found to be 5B/5B, 5B/6A, 4/5B, 4/6A with frequencies 0.165, 0.157, 0.118, 0.110 and 0.079 respectively.

Keywords: Omani, N-acetyltransferase (NAT2), genotyping
Laboratory diagnosis of viral hepatitis C The Sultan Qaboos University Hospital experience

Laboratory diagnosis of viral hepatitis C The Sultan Qaboos University Hospital experience

Authors: Said H S Al Dhahry| Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, P O Box 35, Al Khod,...
( 16 downloads)
Abstract

Objectives: A retrospective study was carried out to assess the performance of hepatitis C diagnostic assays in our laboratory, and to determine the prevalence of hepatitis C among blood donors at the Sultan Qaboos University Hospital. Methods: From 1991 to 2001, approximately 55,000 serum samples collected from blood donors and patients were submitted to our laboratory for testing. All sera were screened for antibodies to hepatitis C virus (HCV) by three successive generations of the enzyme-linked immunosorbent assay (ELISA). Anti-HCV positive sera were further tested by recombinant immunoblot assay (RIBA). Reverse-transcriptase polymerase chain reaction (RTPCR) for HCV RNA was carried out on a limited number (241) of ELISA positive samples. Results: Out of 30012 samples from blood donors that were screened for anti-HCV, 272 (0.91%) were positive. Of these, 46.5% were confirmed positive by RIBA. The proportion of patient sera that were confirmed positive varied from 95% among intravenous drug users to 81% in patients with hepatitis to 70% in those with haemoglobinopathies. HCV RNA was detected in 67%, 6%, and 0% of the RIBA positive, indeterminate and negative samples respectively. Conclusions: Based on RIBA, the prevalence of anti-HCV among blood donors in Oman is close to 0.5%. In our experience, RIBA-positivity is predictive of HCV infection in two thirds of subjects, and HCV infection is highly unlikely in those who are RIBA-negative. The experience at SQUH with three types of HCV assays has enabled the laboratory to develop a test algorithm, starting with screening anti-HCV ELISA.

Keywords: hepatitis C virus, ELISA, RIBA, polymerase chain reaction
Magnitude and determinants of exodontia in South Batinah region of Oman A cross sectional study

Magnitude and determinants of exodontia in South Batinah region of Oman A cross sectional study

Authors: Rajiv Khandekar| Specific Diseases Control Programme, DSDC, DGHA, Ministry of Health, P.O.Box 393, Muscat-113, Sultanate of Oman, Zina Fouad| Dental D...
( 17 downloads)
Abstract

Objectives: To estimate the magnitude, determinants and causes of exodontia presented at all the three dental units of South Batinah region of Oman. Methods: This is a cross sectional study of 8,963 samples representing dental cases reported at the three dental units for 12 weeks in year 2000. The information on patients undergoing exodontia and its indications were collected from their case files. Standard definitions were used to categorise causes of exodontia. Mid 2000 population was used as reference for calculating rates. Age-sex standardisation and 95% confidence interval of the exodontia rates were calculated for statistical validation. Results: The annual exodontia rate was 16.67 per 1,000 population (CI95% 16.52, 16.82). The rate in males was 11.56 (CI95% 11.40, 11.73) and and in females, 40.04 (CI95% 39.73, 40.34). The rate in the 12+ age group was significantly higher than that in the 0–12 age group. The rates showed geographic differences. Conclusions: The exodontia rates were high in the study area. Exodontia rates were significantly higher in females, persons older than 12 years, and those living in the coastal areas of South Batinah. Based on the exodontia rates, the impact on the oral health services was reviewed and recommendations for improving the dental care were proposed.

Keywords: exodontia, dental caries, oral health programmme, Oman
Radiology resident selection Objective Restructured Interview to assess five essential attributes

Radiology resident selection Objective Restructured Interview to assess five essential attributes

Authors: Neela Lamki| Dept of Radiology, Baylor College Of Medicine, 1 Baylor Plaza, Houston, Texas 77030, USA, Alfred B. Watson| Dept of Radiology, Baylor Col...
( 17 downloads)
Abstract

Like in other medical fields, candidates seeking a career in Radiology requires special skills and aptitudes. Selecting candidates for radiology residency is made difficult by the fact that many of the essential qualities predictive of a good radiology consultant, such as interpersonal skills, recognition of limits, curiosity, conscientiousness, and confidence level, are “non-cognitive”, and thus difficult to assess. This paper describes the selection procedure developed by the Department of Radiology of Baylor College of Medicine to measure, as objectively as possible, both the cognitive and non-cognitive qualities of candidates, based on a combination of traditional screening and Objective Structured Interviews. This paper highlights efficacy of this selection procedure that includes both cognitive and non-cognitive factors, that is relevant also to other medical specialities.

Keywords: radiology, residency, cognitive, non-cognitive, Objective Structured Interview
How does HIV-1 infect a susceptible human cell? Current thinking

How does HIV-1 infect a susceptible human cell? Current thinking

Authors: Ali A. Al-Jabri| Department of Microbiology and Immunology, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khod-123,...
( 17 downloads)
Abstract

To insure its survival, the human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS), utilises more than one gate to enter a target cell. This strategy makes it more difficult for the immune system to defeat the virus. This has also made it difficult for scientists working in the HIV research to understand how exactly HIV infects a susceptible human cell. Such understanding will no doubt open many gates for scientists to vanquish the virus by designing agents that can block HIV entry into target cells, thus rendering the virus vulnerable to immune destruction. This will also help in understanding the replication of the virus and the pathogenesis of the disease. The present article briefly describes the past and current thinking of how HIV-1 infects a susceptible human cell, and the dilemma scientists are facing when studying the infectivity of this virus and applying current knowledge to design agents that can block HIVs entering target cells. In the context of our own experience with HIV infectivity in vitro, the present article will also address the behaviour of different HIV isolates, both laboratory-adopted and clinical (primary) isolates in culture and the difficulties in performing HIV infectivity testing. Moreover, our experience of peripheral blood mononuclear cells’ (PBMCs) susceptibility to HIVs infection in vitro is discussed.

Keywords: HIV, AIDS, infection, immune, virus, susceptible cell
The Smallest Miracle Baby that Survived in Oman

The Smallest Miracle Baby that Survived in Oman

Authors: Zakia Al Lamki| Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P 0 Box 35, Al Khod 123, Sultanate of Oma...
( 17 downloads)
Abstract

Extreme prematurity is a major cause of perinatal morbidity and mortality. Management of such babies is a big challenge to neonatologists. Here we report the smallest baby ever survived in Oman.

Keywords: Extremely low birth weight infant (ELBW), prematurity, intra-ventricular haemorrhage (IVH), retinopathy of prematurity (ROP), adrenal insufficiency of prematurity, bronchopulmonary dysplasia (BPD)
A strange type of Pica

A strange type of Pica

Authors: Marwan M. Al-Sharbati| Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, P O Box 35, Ziad A. J. Zai...
( 17 downloads)
Abstract

Pica, where the patient eats non-food items such as mud, clay, varnish etc., is a common behavioural problem seen in children, pregnant women and the mentally retarded. However sponge pica is a very rare variation. We report a case of a 5-year-old Omani girl, who presented with sponge pica since the age of two years, with recent abdominal pain. Investigations showed anaemia, elevated liver enzymes and normal intelligence. There was no evidence of obsessive-compulsive disorder. Both clinical and laboratory findings showed complete recovery after a few weeks of oral iron therapy. Her appetite improved, and she started to gain weight. No recurrence was observed when followed up after two years. Awareness is necessary to detect and treat pica as early as possible to prevent its complications.

Keywords: pica, anemia, sponge pica, abdominal pain, Oman
A swallowed fishbone penetrating the oesophagus into the sternomastoid muscle

A swallowed fishbone penetrating the oesophagus into the sternomastoid muscle

Authors: Sabah M Al-Shukry| Department of Surgery, Rustaq Hospital, PO box 2, Rustaq-239, Sultanate of Oman
( 17 downloads)
Abstract

A 40-year-old woman presented with the history of swallowing a fishbone one hour earlier. Since the patient was swallowing normally and the X-ray results were negative, she was reassured and sent home. Twenty days later, when the patient again presented with pain and tenderness in her neck, the fishbone was detected in the left sternomastoid muscle, and removed under local anaesthesia.

Keywords: null
Road Traffic Accidents - A Challenging Epidemic

Road Traffic Accidents - A Challenging Epidemic

Authors: Shirley McIlvenny| Callander Cottage, Lochgoilhead Argyll, PA 24 8AQ, Scotland, United Kingdom
( 16 downloads)
Abstract

WORLD HEALTH DAY IS CELEBRATED BY the World Health Organization each year on 7th April and the theme of this year was ‘Road Safety’. Road Safety is no accident - and coincides with the release of a World Bank and WHO report (World report on Road Traffic Injury Prevention).1 Road traffic injuries kill 1.2 million people each year and injure or disable as many as 50 million, which represents a 60% increase in the last five years.2 Road crashes are the second leading cause of death globally among young people and affect the most economically active members of the population. It has been reported that 86% of deaths from road traffic injuries occur in low and middle income countries even though these account for only 40% of all motor vehicles.3 In these countries, reasons cited for the high burden include the growth in motor vehicles, higher number of people killed per crash, poor public health structure and poor enforcement of traffic regulations. The Sultanate of Oman has seen very rapid development in the last thirty years and in 2000 WHO ranked number one in improving the level of health of its population. Oman has an extensive road building program with road calming measures in operation and road safety programs run by the Royal Oman Police (ROP). However, deaths from Road Traffic Accidents are (RTAs) a major concern. In 2001, there were an estimated 117 cars per thousand population in the country with 13,101 RTAs (5.45 per thousand population)4499 deaths and 9625 people were injured. Forty percent of fatalities were vehicle passengers and 44% of incidents was due to speeding as reported by the traffic authority. Generally, car crashes represent the conjunction of multiple factors involving road infrastructure, vehicles and people. Safe human behaviour is a major risk factor in accounting for Road Traffic Injuries (RTIs) especially in developing countries where it is estimated that 64% to 95% of casualties are due to improper human activity as either a driver, passenger or pedestrian. Safe behaviour includes pre-crash elements of road user activity (e.g. speeding, attitudes, behaviour and pedestrian habits), crash elements (e.g. use of restraints) and post-crash elements (e.g. first aid skills and access to medical treatment). Wearing a seat belt can be a good indicator of safe road behaviour especially when comparing rear and front seat passengers. Although wearing a seat belt in the front seat is compulsory in Oman and the ROP makes spot checks on vehicles, many drivers and passengers do not comply with the regulations. Furthermore, there are no regulations regarding wearing a seat belt in the rear and few people bother to ‘belt up’ in the back. A study carried out by Family and Community Health residents in the Oman Medical Specialty Board training program examined seat belt wearing in cars entering Sultan Qaboos University complex on a single day.5 The results indicated that 90.1% of drivers and 80.9% of front seat passengers wore their seat belt. Only 1.4% of rear seat passengers wore a seat belt. Surprisingly, front seat passengers were not as compliant as drivers despite the fact that police staff all the gates into the campus and spot checks on the highways often result in fines (seat belt fines constitute 9% of traffic offences nationwide). Researchers also reported that they could see front seat occupants putting on their seat belts as they approached the gates. Studies in other Middle East countries have shown that seat belt use is infrequent.6 However, it can increase with a general understanding of road safety rules.7 Bener et al have shown that there is awareness of the benefits of wearing seat belts in Middle East countries and strong support for its enforcement.8 Poor enforcement of traffic regulations is one reason why low income countries have such a high burden of death and disability from RTAs.9 Although there appears to be good compliance with the law, evidence suggests that compliance in front seat occupants would not be as good in areas where they are unlikely to be observed. Wearing a seat belt is not compulsory in the back and very few back seat passengers were strapped in. This indicates that complying with regulations is more important than wearing a seat belt for protection and there is probably little knowledge of the dangers to other passengers and the driver. However, legislation is only part of the answer. Since compulsory rear seat belt wearing was introduced in UK in 1989, recent research (1998) reveals that even now, only 48% of adult passengers wear seat belts in the back compared with 92% in the front.10 Back seat passengers who do not wear seat belts are three times more likely to suffer death or serious injury than those who do. Furthermore, the UK Department of Transport estimates that some 40 front seat passengers die each year in Britain because of un-belted back seat passengers crashing into them. There is evidence that safety education can improve knowledge and behaviour but that improvement declines with time so must be repeated at regular intervals.11 A further study by the residents has investigated attitudes and knowledge to seat belt wearing in the Omani population and also attitudes to safety education but the results are not yet available. Regarding children, only 3.7% of ‘under fives’ were in a child restraint and this was probably due to lack of knowledge of the parents. Jan et al also showed infrequent use of child restraints in Saudi Arabia (8% of families), where seat belt use in general was linked to higher income families.12 Even though child restraints may be employed, their use may be incorrect and this has been recognized in western countries.13 The fact that so many parents in the front were restrained, while the children in the back were not, also indicates a willingness to comply with local laws rather than an understanding of the risks. Perhaps more worrying is the fact that so many ‘under fives’ sat in the front seat (34.6%). There is a perception among the population that it is cruel to keep a child alone in the back of the car and there is probably little awareness of the dangers to children of sitting in the front seat. A frequent occurrence is a child sitting in the front on the mother’s knee, close to the windscreen. An education program needs to be instituted to increase knowledge and awareness and to ensure that parents understand the importance of using child restraint equipment properly. According to Haddons’ Matrix [Figure 1],14 most pre-crash prevention can be attributed to the vehicle driver in attitudes and actions, and in maintaining road worthiness of the vehicle. Since most injuries can be attributed to improper human behaviour, driver responsibility seems to be a good place to start. Ensuring all occupants are wearing a seat belt would be a simple activity, which would have an impact on mortality and morbidity from RTIs and put the responsibility onto the driver of the vehicle. Health education agencies, for example local community clinics, could be involved in increasing the awareness of the population and promoting new regulations. Other areas for development involving the health services include the provision of emergency services, especially at the roadside. It is an auspicious development that an ambulance service for RTAs has been introduced by the ROP this year. Many local Primary Health Care clinics are also involved in managing RTIs especially in remote areas. These facilities would benefit from first aid and emergency management training.Health care workers are very aware of the burden to the health service and the community of RTAs particularly in emergency care, rehabilitation and care following permanent injuries and the consequences of the loss of the bread winner or main carer in a family. Road traffic injuries are responsible for the majority of disability and occupation handicap from major traumatic injury.15 On top of that, road crashes absorb a huge amount of financial resources particularly in developing countries. This can be as much as 1% of the Gross National Product and represents more than the total development aid they receive. By 2020, road traffic injuries are forecast to become the second leading cause of Disability- Adjusted Life Years lost in developing countries and decreasing the burden of injuries is one of the main challenges for public health in the next century.16 The WHO recommends that raising the awareness of all interested parties is the first step in injury prevention. Partnerships with other interested agencies, for example police and town planners, would allow health agencies to be involved in developing safety strategies to reduce RTIs and deaths from RTAs. The new ambulance service is a good example of co-operation in action. Health workers could also show these groups the cost to the health service of accident black spots, for example by producing figures comparing the cost of road improvements versus the financial burden on health services and the community. WHO challenged nations to manage this epidemic of disability and financial burden in this year. Health care agencies can be involved at the forefront of the race to confront the challenge and control the latest man-made epidemic to spread across the globe.

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Te Medical Educator Teaching Portfolio Its Compilation and Potential Utility

Te Medical Educator Teaching Portfolio Its Compilation and Potential Utility

Authors: Neela Lamki| Department of Radiology, College of Medicine and health Sciences, P.O Box 35, Al-Khod, Muscat 123, Sultanate of Oman, Mark Marchand| Form...
( 18 downloads)
Abstract

A revolution in thinking and redefinition of traditional scholarship by prioritising teaching skills and achievements has led to the birth of the Teaching Portfolio, designed to carry a comprehensive and dynamic record of the teaching activities of the faculty. A teaching portfolio documents the faculty’s teaching scholarship and effectiveness. It is a record of selected information on one’s teaching achievements, skills and strategies and dynamically represents the faculty’s growth, progress and teaching record. Te author suggests a template for the Teaching Portfolio of a Medical Educator, which consists of four parts: () evaluation, (2) personal professional development, (3) learning processes and (4) an appendix.

Keywords: null
Incidence and Outcome of Severe Hyponatremia in Children and Young Adults A Single Institution Experience

Incidence and Outcome of Severe Hyponatremia in Children and Young Adults A Single Institution Experience

Authors: Zakia Al-Lamki| Department of Child Health, Sultan Qaboos University, College of Medicine and Health Sciences, P.O.Box 35, Al-Khod, Muscat 123, Sultan...
( 17 downloads)
Abstract

Objective: Our two main objectives are to assess the incidence and the outcome of severe hyponatremia in young hospitalized patients. Method: We retrospectively reviewed the incidence and outcome of severe hyponatremiac (Na <25 mmol/l) inpatients less than 8 years of age, admitted as consecutive admissions during one calender year. Psuedohyponatremia and artifactual hyponatremia were excluded. Patients’ demographics, clinical features, laboratory, treatment and outcomes were recorded. Results: Of 356 admissions of patients less than 8 years of age, 20 developed severe hyponatremia. Nausea, vomiting, irritability, clouded sensorium and seizures were the most common symptoms and signs. Underlying central nervous system disease, pneumonia and malignancy were major co-morbid conditions. Te initial volume status was determined as hypervolemia (n=7), hypovolemia (n=7) and euvolemia (n=6). Iatrogenic (diuretics 5 and hypotonic fluids 7) hyponatremia accounted for 60% of all cases. Mortality was 20%. Conclusion: Patients receiving intravenous hypotonic fluids should be closely monitored for the development of hyponatremia. Te common etiology of hyponatremia in our studied cohort of patients is iatrogenic.

Keywords: Iatrogenic hyponatremia, high morbidity

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