bluuebunny/crossref_metadata_2025 huggingface dataset:
Women’s Knowledge of Cervical Cancer
Authors: Al-Saadi Aisha N , Al-Muqbali Aisha H , Dawi Eihab
Published: April 2021

Objectives: This study aimed to assess knowledge of cervical cancer and its prevention among Omani women aged 20 to 65 years. Method: This analytic cross-sectional study took place at primary healthcare institutions, in the Al Buraimi governorate, Oman, between November 2018 I believe that in response to comment #5 too much information may have been removed from the Results section, therefore we return the first two paragraphs that were removed to the Results section and make them more concise during the copy editing stage.  and February 2019. The study was carried out on the basis of a predesigned, validated, and self-administered 55 question questionnaire. Results: Data from seven hundred and ninety-one completed questionnaires were included in the final analysis, which represents a response rate of 79.1% of the total. The results of the study indicated that 86.7 percent of surveyed women had previously heard of cervical cancer, and 13.0 per cent assumed the possibility of this disease to affect them in the future. The results showed that women had low awareness of the association between Human Papilloma Virus (HPV) and cervical cancer (24.7%). Participants considered HPV infection and initiation of sexual intercourse at an age younger than 17 years as the lowest risks associated with cervical cancer. The results also indicated that 63.8% of women were unaware of a vaccination 'against HPV related cervical cancer' and many of respondents were unaware of Pap test. Women aged over 30 years, those married, and those with a high level of education were more likely to be aware of cervical cancer. Conclusion: General knowledge of cervical cancer among women aged 20 to 65 years is insufficient. Young women aged 20-30 are largely unaware. Thus, concerted efforts are needed to promote awareness among women in Oman.

Keywords: Cervical cancer, risk factor, Human Papilloma Virus, vaccine, Pap test.
Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia
Authors: Alqahtani Youssef A , Almutairi Khalid H , Alqahtani Yahya M , Almutlaq Ahmed H , Asiri Anas A
Published: April 2021

Objectives: Vaccination is the provision of a vaccine to initiate immunity trough stimulating immune system to develop protection from a certain disease. When a sufficiently large proportion of a population has been vaccinated, herd immunity initiated. The effectiveness of vaccination has been widely studied and verified. Although the harsh vaccine safety systems, some parents remain minded regarding the safety of the childhood vaccines and immunization schedule. These hesitations pushed some parents to not allow their children to receive some or all the scheduled vaccines.  The aim of the study is to assess the general population awareness regarding vaccines and to detect prevalence of vaccine hesitancy in Aseer region, southern of Saudi Arabia. Methods: A descriptive cross-sectional approach was used targeting all parents in Aseer region. Data were collected using structured questionnaire which developed by the researchers after intensive literature review and expert’s consultation. The questionnaire data included parents’ socio-demographic data, parents’ awareness regarding child vaccines safety and efficacy, parents’ attitude and adherence to children vaccination and hesitancy towards vaccines. Results: The survey included 796 participants whose ages ranged from 18 to 55 years old. Two thirds (63.4%) of the participants were females. Regarding vaccination adherence and hesitancy among participants, more than three quarters were completely adherent to the child vaccination schedule and only 3.9% were non adherent. As for participants awareness regarding child vaccination safety and efficacy, 89.3% of the respondents agreed on that vaccination keep child healthy, 84.2% reported that child vaccine is safe and effective, 83.4% said that all Saudi scheduled vaccines are effective. Conclusion: In conclusion, the study revealed that vaccine hesitancy among participants was not low and should be considered irrespective of their high awareness level. The recorded antivaccine action was mostly related to vaccines safety not efficacy.

Keywords: Vaccine hesitancy, antivaccine movement, parents, awareness, adherence
Parental Age and the Risk of Autism Spectrum Disorder in Oman
Authors: Al-Mamari Watfa , Idris Ahmed B , Al-Zadjali Aala' A , Jalees Saquib , Murthi Sathiya , Al-Jabri Muna , Gabr Ahlam , Fombonne Eric
Published: April 2021

Objective: This study aimed at evaluating advanced parental age as a risk factor for Autism Spectrum Disorder (ASD) in an Omani cohort. Methods: Case-control study of 278 ASD cases compared with 722 sex-matched controls retrieved from the electronic records of the Developmental Paediatric Clinic, Sultan Qaboos University Hospital (SQUH) between January 2015 and June 2016. Results: ASD cases (76.6% male) were mostly diagnosed between 3-4 years of age, with more than 50% of them originating from Muscat and Batinah governorates. Compared to controls, mothers from the case group had significantly higher educational level (post-secondary education versus high school/no formal education (odds-ratio (OR)=1.62; 95% C.I. 1.20-2.19). In a multivariate logistic regression, the odds ratio of maternal age as a risk for ASD increased dramatically with advancing age category (using age<25 as a reference, OR was 3.39, 6.12, 7.86 and 13.13 for age categories 25-29, 30-34, 35-39, and ≥40 years, respectively). The ORs of advancing paternal age as a risk for ASD were also statistically significant (using age<30 as referent, OR was 2.20, 2.36, and 3.12 for age categories 30-34, 35-39 and 40-44 years); however, there was a drop in the effect with paternal age ≥ 45 years (OR=1.42; 95% C.I .64-3.15). Conclusion: Both maternal and paternal increased age were associated with a higher risk of ASD; however, the association was more pronounced and more consistent with advanced maternal age compared to paternal age.

Keywords: Autism; parental age; case-control study
Transmesenteric Internal Abdominal Hernia
Authors: Mohakud Sudipta , Naik Suprava , Deep Nerbadyswari , Singh Arshdeep , Mishra Tushar Subhadarshan , Sinha Mithilesh
Published: April 2021

NONE
Acute Gastric Dilatation Leading to Ischemic Necrosis
Authors: Gurushankari Balakrishnan , Sureshkumar Sathasivam , Anandhi Amaranathan , Rajesh B. S. , Naik Debasis , Saurabh Kumar , Kate Vikram
Published: April 2021

NONE
Erythema Multiforme
Authors: Alamon-Reig Francesc , Castrejón Natalia , Bosch-Amate Xavier
Published: April 2021

NONE
Knowledge, Attitudes and Practices Related to Dietary Supplements among a Group of Palestinian Pharmacists
Authors: Altamimi Mohammad , Hamdan May , Badrasawi Manal , Allahham Saad
Published: April 2021

Objectives: The use of dietary supplements (DS) has increased, but due to a lack of related regulations, the prescription of DS depends on pharmacists’ knowledge. Hence, this study aimed to evaluate the knowledge, attitudes and practices (KAP) related to DS among community-based pharmacists. Methods: This study followed a cross-sectional design targeting community pharmacists in West Bank, Palestine between September and December 2019. Selected participants filled a self-administered questionnaire regarding their KAP related to DS. The questionnaire contained 15 items: five questions on knowledge, seven on practices and three on attitudes. Results: At a 90% response rate, 56.2% of the representative sample was female. The participants’ experience was distributed almost equally across the categories of 0–5, 5–10 and over 10 years. Additionally, a majority of the participants were the responsible pharmacist and/or the pharmacy owner. Overall, the participants showed a moderate level of knowledge about DS with a mean score of 3.68 ± 1.1 out of 5; the correct answers ranged from 3.6% to 75.3% of the surveyed participants. The practices with the highest frequencies were as follows: taking DS sometimes (79.9%), taking supplements from well-known brands (56.2%), giving supplements to any patient (55.7%), selling supplements according to the participants’ knowledge (74.2%) and providing advice about supplements (73.2%). The questions about the pharmacists’ attitudes towards DS market regulation revealed that more than half (52%) of the participants believed that it was suitable. The association between knowledge score and practices was highly significant (P <0.001). Conclusion: The study revealed that participants had moderate knowledge about DS. Additionally, knowledge and practices were highly connected.
Keywords: Dietary Supplements; Pharmacists; Knowledge; Attitude; General Practice; Curriculum.
Estimate of the HOMA-IR Cut-off Value Identifying Subjects at Risk of Insulin Resistance Using a Machine Learning Approach
Authors: Abdesselam Abdelhamid , Zidoum Hamza , Zadjali Fahd , Hedjam Rachid , Al-Ansari Aliya , Bayoumi Riad , Al-Yahyaee Said , Hassan Mohammed , Albarwani Sulayma
Published: April 2021

Objectives: This study describes an unsupervised machine learning approach used to estimate the homeostatic model assessment-insulin resistance (HOMA-IR) cut-off for identifying subjects at risk of IR in a given ethnic group based on the clinical data of a representative sample. Methods: The approach was applied to analyse the clinical data of individuals with Arab ancestors, which was obtained from a family study conducted in Nizwa, Oman, between January 2000 and December 2004. First, HOMA-IR-correlated variables were identified to which a clustering algorithm was applied. Two clusters having the smallest overlap in their HOMA-IR values were retrieved. These clusters represented the samples of two populations, which are insulin-sensitive subjects and individuals at risk of IR. The cut-off value was estimated from intersections of the Gaussian functions, thereby modelling the HOMA-IR distributions of these populations. Results: A HOMA-IR cut-off value of 1.62 ± 0.06 was identified. The validity of this cut-off was demonstrated by showing the following: 1) that the clinical characteristics of the identified groups matched the published research findings regarding IR; 2) that a strong relationship exists between the segmentations resulting from the proposed cut-off and those resulting from the two-hour glucose cut-off recommended by the World Health Organization for detecting prediabetes. Finally, the method was also able to identify the cut-off values for similar problems (e.g. fasting sugar cut-off for prediabetes). Conclusion: The proposed method defines a HOMA-IR cut-off value for detecting individuals at risk of IR. Such methods can identify high-risk individuals at an early stage, which may prevent or delay the onset of chronic diseases such as type 2 diabetes.
Keywords: Unsupervised Machine Learning; Cluster Analysis; Insulin Resistance; Diabetes Mellitus, Type II.
The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression
Authors: Jannati Nazanin , Farokhzadian Jamileh , Ahmadian Leila
Published: April 2021

Objectives: This study aims to describe healthcare professionals' experience in providing mental health services to women with postpartum depression. Methods: In this qualitative study, data were collected through semi-structured interviews with five physicians, five midwives, and five psychologists from fourteen urban healthcare centers in Kerman, Iran, from April 2019 to September 2019. We used purposeful sampling to select the participants. Data were qualitatively analyzed using a content analysis approach. Results: Data analysis revealed the main theme of the study, "the long way ahead of comprehensive, integrated and responsive mental health services." This theme includes four categories: "postpartum depression challenges, "social and personal factors," "structural challenges," and "need to change in the mental health services." The participants described that the diagnosis of depression is difficult due to insufficient knowledge of healthcare providers and hidden signs of postpartum depression. The participants described how different factors might cause depression. These factors were economic, cultural factors in the society, personality traits, community lack of knowledge, negative attitude toward depression, and limited family support. Moreover, providing mental health services has some challenges, such as limited human resources, insufficient financial resources, and incomplete or inefficient policy makings. Conclusion: Although measures have been taken to provide mental health services, there are many challenges regarding providing mental health services to mothers. Therefore, there is a need to take serious measures to improve mental health services and re-define the existing measures. Informing the community, empowering the healthcare providers, and planning to change the community's attitude and belief can affect women's mental health care with depression.

Keywords: Postpartum Depression, Mental Health Services, Community Mental Health Services, Mental Disorders, Depressive Disorder.
Neuroblastoma Among Omani Children
Authors: Al-Battashi Abeer , Al-Rahbi Ameera , Al-Rawahi Adbulhakeem , Mamdouh Mohammed , Al-Ghaithi Ibrahim , Ramadhan Fatma A
Published: April 2021

Objectives: A limited number of publications from the Middle East have focused on neuroblastoma, a common childhood malignancy. This study describes the clinical characteristics and survival outcome of Omani children with neuroblastoma treated at the National Oncology Centre, Oman, between 2010 and 2017. Methods: From January 2010 to December 2017, data on Omani children aged less than 13 years with neuroblastoma were retrospectively collected. Survival data were statistically correlated with known prognostic factors, including age, stage of disease, MYCN profile and presence of metastasis. Results: A total of 56 Omani children were included. in this study. The male to female ratio was 1:1. The mean age at presentation was one year and 10 months. The two most common presenting complaints were body masses (48.2%) and constitutional symptoms (33.9%). Approximately, 54.5% were high risk, 35.7% were intermediate risk and 9.8% were low risk. High-risk neuroblastoma was mainly found in children older than one year (76.6%), with low risk mainly observed in children less than one year of age (80%). The overall survival of all groups combined was 74% (P <0.05); the event-free survival (EFS) was 67% (P <0.05). The overall survival rates over five years for the high-risk, intermediate-risk and low risk groups were 60%, 88% and 100%, respectively, and the EFS was 51%, 79% and 100%, respectively. Conclusion: Omani children with neuroblastoma mainly presented with masses or constitutional symptoms and had an advanced disease at presentation which was associated with inferior survival. The survival outcomes were reasonably similar to published international data.
Keywords: Neuroblastoma; Survival; Event-Free Survival; Oman.
Overview of Assault-Induced Trauma Presenting to a Trauma Centre in Oman
Authors: Al-Busaidi Mira , Al-Miskry Hilal , Al-Harbi Aisha , Al-Zadjali Ilyas , Al-Saidi Firas , Al-Qadhi Hani
Published: April 2021

Objectives: Assault-induced trauma (AIT) is a public health concern that must be addressed and acknowledged. This study aimed to characterise cases of AIT presenting to Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Methods: This retrospective descriptive study included patients presenting with AIT to the emergency department of SQUH from January 2007 to December 2018. The data obtained included incidence, patients’ demographics, mode of assault, triaging, management and hospital stay. The data were collected using the hospital’s information system and subsequently analysed. Results: A total of 268 cases of AIT were identified and 239 fulfilled the study criteria. The highest incidence recorded was in 2018, accounting for 72 cases. The mean incidence of AIT was 20 ± 19 per year. The sample was predominantly comprised of males (82.4%) and Omani citizens (65.3%). Most patients (66.9%) were between the ages of 20 and 39. The most common mode of assault was the use of bodily force (34.7%). Additionally, 18.4% were triaged as red cases. In terms of management, 84.5% of the cohort were treated non-surgically. No incidence of in-patient mortality was recorded. Conclusion: This study found that the rate of AIT averaged at 20 per year with most of the victims being young males. This was the first study that examined AIT in Oman and its results will aid future research and the estimation of the magnitude of this problem in the community.
Keywords: Trauma; Physical Violence; Demography; Oman.
Knowledge, Attitudes and Practices of Primary Care Physicians Regarding Tobacco Dependence Treatment in Muscat Governorate, Oman
Authors: Alsaidi Yaqoub , AlMaskari Buthaina , Chan Moon Fai , Al Sumri Sanaa , Alhamrashdi Hajer
Published: April 2021

Objectives: This study aimed to assess the knowledge, attitudes and practices (KAPs) of primary care physicians (PCPs) regarding tobacco dependence treatment (TDT) and to identify barriers to TDT practice in Muscat, Oman. Methods: This cross-sectional study was carried out from September 2019 to December 2019 at all 27 health centres in Muscat. All 313 PCPs working in these health centres were invited to participate. An adapted version of a previously validated 36-item questionnaire was used to assess KAPs regarding TDT services. Results: A total of 255 PCPs completed the survey (response rate: 81.5%) and they demonstrated poor knowledge (40%) but positive attitudes (60%) about TDT services. Of these, the majority were female (85.9%), had never smoked (99.2%) and were general practitioners (64.3%). The mean age was 34.3 ± 6.3 years. Only 28.2% had previously received TDT training and less than half displayed accurate TDT-related knowledge, with undergraduate medical school representing the main source of such knowledge (58.8%). While 96.9% of the PCPs agreed on the importance of TDT, only 28.6% reported feeling sufficiently confident to provide such services themselves. Lack of training (83.5%) and time (71.4%) were the main barriers to TDT practice. Conclusion: Overall, PCPs in Muscat demonstrated poor knowledge but positive attitudes with regard to TDT; however, further knowledge and training is required in order to ensure the effective and accurate provision of TDT services. These findings provide baseline data which may be of value for further research and in overcoming barriers to TDT practice in Oman; for instance, establishing cessation services as part of the package of care in primary health centres could address the time constraints barriers identified by the PCPs.
Keywords: Tobacco Dependence; Smoking Cessation; Primary Care Physicians; Health Knowledge, Attitudes, Practice; Oman.
Types of Primary Healthcare Emergencies in Muscat, Oman
Authors: Al Mahrouqi Amal , Al Maqbali Raya H , Al Fadhil Faiza , Al Salmani Asma A
Published: April 2021

Objectives: Emergencies can occur at any time and be life-threatening or cause permanent damage. Accordingly, the management of emergency cases is an integral part of primary healthcare (PHC). This study aimed to estimate the proportion and types of emergency cases presented to PHC centres in Muscat, Oman. Methods: This retrospective cross-sectional study was conducted from March to August 2016 at five PHC centres in the Muscat Governorate. A total of 800 emergency cases (i.e. those labelled in the health information system as an accident and emergency) of Omani patients aged ≥5 years presented during this period. Every second case, based on arrival to the registration desk, was selected for analysis. Electronic medical records were reviewed to collect data regarding demographic features, presenting complaints, time and season of presentation, management provided and method of transportation if referred to tertiary care. Results: The proportion of emergency cases was <2.5% (range: 1–2.5%). The most common type of emergency was musculoskeletal issues/trauma (34.3%) followed by gastroenterological (15.1%) and genitourinary (10.0%) emergencies. Most patients were either 21–39 or 5–12 years old (35.0% and 21.6%, respectively). The majority (59.6%) were treated directly at the health centre, while the remaining patients (40.4%) were referred to tertiary care. At referral, only 12.1% were transported by ambulance and the rest via private transport. Conclusion: Musculoskeletal issues/trauma was the most common type of emergency seen at the selected PHC centres in Muscat. Further research is needed to determine whether PHC centres have the capability and resources necessary to appropriately manage emergency cases.
Keywords: Emergencies; Primary Healthcare; Public Health; Emergency Medicine; Oman.
Transient Insulin Resistance in Propionic Acidaemia
Authors: El-Naggari Mohamed A , Rady Marwa , Althihli Khalid
Published: April 2021

Propionic acidaemia (PPA) is a disorder of amino acid and odd-chain fatty acid metabolism. Hypoglycaemia is a more commonly described finding rather than hyperglycaemia during metabolic decompensation of PPA. There is a high mortality rate in patients with organic acidaemias having severe insulin-resistant hyperglycaemia. We report a nine-month-old boy with PPA who was admitted to tertiary care hospital in Muscat, Oman, in 2018 with metabolic decompensation, persistent hyperglycaemia and transient insulin resistance. Hyperglycaemia did not respond to high insulin infusion. Plasma glucose only improved when glucose infusion rate (GIR) reached 7 mg/kg/min. The patient has full recovery and was discharged, with follow up plan. It is important to balance the GIR to achieve the targeted insulin level, beyond which the risks of hyperglycaemia start to outweigh the potential anabolic benefits of additional insulin secretion. Timely clinical attention should be given to achieve adequate caloric delivery through alternative sources other than high GIR to permit better glycaemic control, especially when insulin-resistant hyperglycaemia is present.
Keywords: Propionic Acidaemia; Insulin Resistance; Infant; Case Report; Oman.
Bridging the Gap in Online Learning Anxiety Among Different Generations in Health Professions Education
Authors: Elshami Wiam , Saravanan Coumaravelou , Taha Mohamed H , Abdalla Mohamed E , Abuzaid Mohamed , Al Kawas Sausan
Published: April 2021

Objectives: This study aimed to examine the effects of an individual’s generation group on anxiety related to online learning among students and online learning and teaching activities among faculty. Methods: This cross-sectional study was conducted at the University of Sharjah, Sharjah, United Arab Emirates, in April 2020 using the Online Course Anxiety Scale. The questionnaires were sent to 370 undergraduate students and 81 faculty members via email and the responses were stratified by generation. Descriptive statistics and an independent sample t-test was used to compare the mean scores of online learning anxiety with gender and previous experience among faculty and students. Results: A total of 358 students and 70 faculty members completed the questionnaire (response rate: 96.8% and 86.4%, respectively). Only 5.7% of the faculty (compared to 54.7% of the students) enjoyed browsing internet resources during online learning. Among the faculty, 75.7% experienced anxiety during online teaching compared to 37.7% of students. Of the faculty, 92.3% of baby boomers felt anxious compared to 70.5% and 76.9% of X and Y generations, respectively. Conclusion: While students of Generations Z and Y enjoyed browsing the internet during online learning, the Generation Z students were anxious during online discussions and concerned about the misinterpretation of their written communication. Anxiety among faculty members was related to confusion regarding the use of the internet and computers and misinterpretations of text-based messages.
Keywords: Anxiety; Online Learning; Generations; Work Engagement; Medical Education; United Arab Emirates.
Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman
Authors: Al Sekri Eman , Al Musalhi Asma , Al Abri Khadija , Al Kindi Hunaina , Al Salmani Asma A
Published: April 2021

Objectives: This study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women. Methods: A cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist. Results: A total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each). Conclusion: The prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections.
Keywords: Cervical Cancer; Screening; Pap Smear; Human Papillomavirus; Oman.
Expression Levels and Genetic Polymorphism of Scavenger Receptor Class B Type 1 as a Biomarker of Type 2 Diabetes Mellitus
Authors: Wamique Mohd , Himanshu D. , Ali Wahid
Published: April 2021

Objectives: This study aimed to determine whether the expression level and genetic polymorphism scavenger receptor class B type 1 (SCARB1) rs5888 may be used as biological markers in type 2 diabetes mellitus (T2DM). Methods: This case-control study was conducted at King George’s Medical University, Lucknow, India, from September 2018 to December 2019. Blood samples were collected from each individual with T2DM and each healthy individual. Total proteins were determined using western blot analysis. Additionally, restriction fragment length polymorphism analysis was achieved to detect the incidence of genetic polymorphisms. Results: A total of 600 individuals, including 300 individuals with T2DM and 300 healthy individuals, were enrolled in the study. Western blot analysis results revealed that the protein expression of SRB1 was significantly decreased in T2DM of SCARB1 CC variant when compared with controls (P = 0.007). The genotype distribution and the allelic frequencies for the SRB1 polymorphism were significantly different between T2DM and controls (P = 0.03). The CC genotype of the SCARB1 polymorphism showed a potential association with the incidence of T2DM (odds ratio = 1.19, 95% confidence interval = 0.63–2.25; P = 0.577). Conclusion: The expression levels and genetic polymorphisms of the SCARB1 CC variant may be potential biomarkers for the occurrence of T2DM.
Keywords: Genetic Polymorphism; Type 2 Diabetes Mellitus; Human SRB1 Protein; Biomarker; India.
Risk Factors for Ischaemic Stroke in an Omani Community
Authors: Ganguly Shyam S , Gujjar Arunodaya R. , Al Harthi Hasina , Al Hashmi Amal , Jaju Sanjay , Al-Mahrezi Abdulaziz , Al-Asmi Abdullah R
Published: April 2021

Objectives: Stroke is recognised as the third most common cause of mortality and it has an increasing incidence in developing countries. Recognition and control of risk factors are of prime importance in the prevention of stroke. This study aimed to examine the characteristics of ischaemic stroke (IS) patients in Oman and quantify its various risk factors using a case-control model. Methods: This case-control study was conducted from January 2012 to March 2013 at Sultan Qaboos University Hospital and Royal Hospital, Muscat. Adult Omani patients with IS who were admitted to either hospital were compared to age- and gender-matched controls. Demographic factors and frequency of various conventional risk factors were documented. Univariate and stepwise multivariate logistic regression analyses were performed to evaluate the risk factors associated with IS. Results: A total of 255 patients and age-and gender-matched controls were included in this study. The mean age was 62.2 ± 13.2 years and 63.14% were male. Most cases (89.02%) were above 45 years of age. Cardio-embolism (31.76%) was the commonest mechanism of IS. Stepwise multiple logistic regression model revealed that family history of stroke was the strongest independent risk factor, followed by hypertension and high-density lipoprotein levels (odds ratio: 10.10, 5.17 and 3.34, respectively; P <0.01 each). Conclusion: Cardio-embolism was the predominant mechanism of IS in this study. Family history of stroke, hypertension and reduced high-density lipoprotein were the leading independent risk factors. Strong emphasis on screening for risk factors, control of hypertension and lifestyle modification for those with a family history of stroke would be expected to emerge as the major stroke-preventive measures in Oman.
Keywords: Ischemic Stroke; Risk Factors; Case-Control Study; Oman.
A Novel SPINK5 Gene Mutation Associated with Netherton Syndrome in an Omani Patient
Authors: Hamza Nishath , Al Sukaiti Nashat , Ahmed Khwater AM , Romano Rosa , Gokhale Uday A , Hammarström Qiand-Pan
Published: April 2021

Netherton syndrome (NS) is an autosomal recessive primary immunodeficiency. It is characterised by substantial skin barrier defects and is often misdiagnosed as severe atopic dermatitis or hyper-immunoglobulin E syndrome. Although more than 80 NS-associated pathogenic mutations in the serine peptidase inhibitor kazal type 5 (SPINK5) gene have been reported worldwide, only one has been reported in the Arab population to date. We report the case of a novel association between the c.1887+1G>A mutation in the SPINK5 gene and NS in an Omani-Arab patient born in 2014 who was managed at a paediatric immunology clinic in Muscat, Oman. Accurate genetic diagnosis facilitated tailored clinical management of the index patient and enabled the provision of genetic counselling and offering of future reproductive options to the individuals related to the index patient.
Keywords: Netherton Syndrome; Primary Immunodeficiency Disease; Serine Peptidase Inhibitor Kazal Type 5; Congenital Ichthyosiform Erythroderma; Genetics; Case report; Oman.
Hymenialdisine is Cytotoxic Against Cisplatin-Sensitive but not Against Cisplatin-Resistant Cell Lines
Authors: Abdullah Nada , Al Balushi Najwa , Hasan Syed I , Al Bahlani Shadia , Dobretsov Sergey , Tamimi Yahya , Burney Ikram A
Published: April 2021

Objectives: New compounds are needed to overcome the resistance to commonly used cytotoxic chemotherapy for epithelial ovarian cancer. Marine sponges are a rich source of diverse chemical compounds and hymenialdisine has been found to have antiproliferative effects. This study aimed to investigate the cytotoxic effect of hymenialdisine in cisplatin-sensitive and cisplatin resistant ovarian cancer cell lines. Methods: This study took place at Sultan Qaboos University, Muscat, Oman between August and November, 2019. The anti-cancer effects of hymenialdisine or cisplatin were assessed using treating cells with different concentrations of hymenialdisine and cisplatin. Cell viability was determined using the AlamarBlue® Assay. Results: The half-maximal inhibitory concentration (IC50) of cisplatin was estimated at 31.4 μM for A2780S and 76.9 μM for A2780CP, whereas the IC50 of hymenialdisine was evaluated at 146.8 μM for A2780S cells. Despite the higher concentrations of hymenialdisine (up to 300 μM), IC50 could not be determined for the A2780CP cell line. Conclusion: When compared to cisplatin, hymenialdisine was less toxic against both A2780S and A2780CP ovarian cancer cell lines.
Keywords: Gynecologic Neoplasm; Ovarian Cancer; Cisplatin; Hymenialdisine; Oman.
A Rare Type of Uterine Rupture Following Over-the-Counter Use of Misoprostol in Second Trimester Abortion
Authors: Jha Nivedita , Sagili Haritha , Sharma Jyotsna , Jha Ajay K
Published: April 2021

The use of misoprostol in the second trimester by a woman with a uterine scar may lead to severe contractions and uterine rupture. We report a 24-year-old pregnant female patient who presented at the Emergency Department at a tertiary care hospital in Puducherry, India, in 2020 with haemorrhagic shock. She was at 16 weeks of gestation and had taken over the counter misoprostol for inducing an abortion. A quick initial resuscitation and urgent laparotomy were performed. An irreparable circumferentially avulsed uterus suspended only by round ligaments was noted. Haemostasis required internal artery ligation and immediate total hysterectomy. The patient was doing well upon follow-up six months after the surgery. Proper and supervised use of misoprostol in the appropriate dosage can avoid life-threatening consequences of uterine rupture.
Keywords: Uterine Rupture; Misoprostol; Induced Abortion; Hysterectomy; Case Report; India.
Follicular Lymphoma Rich in Warthin-Finkeldey Cells
Authors: Aladily Tariq , Bustami Nadwa
Published: April 2021

NONE
Action plan to increase physical activity during COVID-19 pandemic
Authors: Memari Amir-Hossein , Selk-Ghaffari Maryam , Khosravi Afifeh , Kordi Ramin
Published: April 2021

NONE
Evaluation of Diagnostic Value of SPECT/CT Imaging in Post-radioiodine Therapy in Thyroid Cancer
Authors: Al Hatmi Asma , Jain Anjali , Mittal Alok Kumar , Hussain Samir
Published: April 2021

Objectives: This study aimed to investigate the value of single photon emission computed tomography/ computed tomography (SPECT/CT) imaging in well-differentiated thyroid cancer (DTC) after radioiodine (I-131) ablation/therapy for clinical staging and risk stratification. It also aimed to determine whether SPECT/CT would change the management plan or predict the clinical outcomes of DTC patients. Methods: A total of 78 DTC patients underwent first post radioiodine therapy “Whole body iodine-131 scintigraphy (WBS) along with SPECT/CT” at the Department of Radiology and Molecular imaging, Sultan Qaboos University Hospital, Muscat, Oman, between January 2014 and August 2017. Differences between WBS and SPECT/CT, change in clinical staging, risk stratification and management were recorded. The clinical outcome at 6–12 months was recorded. A generalised McNemar test was used to assess disagreement between WBS and SPECT/CT. Results: According to the American Thyroid Association (ATA) risk stratification, the sample showed low (35.8%), intermediate (53.8%) and high-risk groups (10.2%) on WBS, which changed to 44.8%, 38.4% and 16.6%, respectively, on SPECT/CT imaging. Overall change in risk stratification was noted in 16.7% and TNM stage in 11.5% of patients after SPECT/CT imaging. SPECT/CT changed the therapeutic plan and clinical outcome in 19.2% of patients. Conclusion: SPECT/CT allows better detection and characterisation of metastatic lymph nodes and distant metastasis in DTC patients compared to WBS imaging alone. It alters TNM staging, ATA risk classification and management in a significant number of patients. It is recommended that SPECT/ CT should be done routinely along with WBS in well-differentiated thyroid carcinoma.
Keywords: Thyroid Cancer; Iodine; Ablation Techniques; SPECT/CT; Oman.
Exploring Frequency of Event Reporting as Perceived by Intensive Care Units’ Nurses in Sultanate of Oman
Authors: Al Ma'mari Qasim , Al Omari Omar , Abu Sharour Loai
Published: April 2021

Objectives: Little is known about the factors that affect the perceived frequency of event reporting among healthcare workers especially registered nurses working in Oman. This study aimed to find out whether fatigue, workload, burnout, and work environment as independent variables have a relationship with frequency of event reporting as dependent variable and to what extent the aforementioned independent variables predict the frequency of event reporting between nurses working in different intensive care units in selected hospitals in Oman. Methods: This study used a cross-sectional research design. Also this study used standardized questionnaires which are hospital survey on patient safety culture, fatigue assessment scale, maslach burnout inventory-human services survey, NASA task load index, and practice environment scale of the nursing work index. Registered nurses working in intensive care units participated in this study from two referral hospitals in Oman during the period between June and September 2018. Results: A total of 270 nurses were included in this study (response rate: 90%). There was a statistically significant positive relationship between personal accomplishment and the frequency of event reporting (r = 0.132, p < 0.05). Regression analysis showed that nurses’ feedback and communication about errors predicted the frequency of events reporting between intensive care units’ nurses in Oman (R2 = 0.214, adjusted R2 = 0.046; F = 12.82, p < 0.01). Conclusion: Personal accomplishment and feedback and communication about error of intensive care units’ nurses had positive impact on perceived frequency of event reporting whereas no relationship found between fatigue, workload, work environment and frequency of event. Strategies need to be in place in health organizations to encourage nurses to report errors.

Keywords: Burnout; Intensive care units’ nurses; Fatigue; frequency of event reporting; Work environment.
Knowledge and Attitude Towards Corneal Donation
Authors: Aloudah Khalid M , Ataweel Abdulaziz A , Agha Sajida , Shah Syed Waqas H
Published: April 2021

Objectives: To attain more local corneal donations, awareness of corneal donations must be raised among doctors and medical students. This study aimed to evaluate the knowledge and attitude of medical students regarding corneal donations. Methods: This cross-sectional study was conducted among male fifth- and final-year medical students at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia, between August and October 2019. Non-probability convenience sampling was used and an English-language self-administered questionnaire was administered to evaluate different aspects of the participants’ knowledge regarding and attitudes towards corneal donation. Data were analysed using descriptive statistics, analysis of variance, and independent samples t-test. Results: A total of 141 students participated in this study (response rate: 53%). A mean score of 3.24 ± 1.86 was achieved by the participants on the knowledge test. Approximately 47% of the sample correctly recognised that people who die of AIDS cannot donate an eye. The most common reason for eye donations was to provide vision to a blind person (47%), while a lack of understanding of benefits to others (55%) and religious beliefs (44%) were seen barriers. The internet was identified by 56% as the most common source of information. There was no significant difference in the knowledge of fifth-year and final-year medical students (3.31 ± 1.84 versus 3.17 ± 1.89; P = 0.65). Conclusion: This study showed a low level of knowledge of corneal donations among the participants. Raising awareness among medical students is important to increase donation rates. However, media and the internet are not enough to achieve this. Basic knowledge of corneal donations to students by organising awareness-raising activities and motivating them for voluntary participation is important to fill this knowledge gap.
Keywords: Knowledge; Attitude; Cornea; Medical Students; Saudi Arabia.
Evaluating Trauma Care Capabilities using the Essential Trauma Care Guidelines of the World Health Organization
Authors: Al Balushi Aisha , Al Balushi Zaleikha , Al Salmani Asma Ali
Published: April 2021

Objectives: This study aimed to evaluate trauma care capabilities at the primary care level in Muscat, Oman, using World Health Organization guidelines. Methods: This descriptive cross-sectional study was conducted between January and March 2015 at eight primary health centres in Seeb. An English-language questionnaire was distributed to the medical officer or nurse in-charge at each centre to determine the number of staff, total population being served, number of emergency trauma cases and availability of ambulances. Subsequently, 10 doctors from each health centre were randomly selected to assess the availability of physical resources as well as their trauma skills and knowledge. Results: There were limited physical and human resources for the management of trauma and a complete absence of trauma administrative functions, such as local trauma registries or quality improvement activities. Conclusion: This study highlighted the need to introduce national guidelines and improve the delivery of trauma services in Oman.
Keywords: Primary Healthcare; Trauma; Emergency Medicine; Capacity Building; Health Resources; Delivery of Health Care; Oman.
Emphysematous Pyelonephritis
Authors: Al-Saraf Mohammed , Al-Busaidy Salim , George Kurian , Elawdy Mohamed , Al Hajriy Mahmood NM , Al-Salmi Issa
Published: April 2021

Objectives: The recent drop in the mortality rates of emphysematous pyelonephritis, a serious medical condition, is attributable to renal percutaneous drainage (PCD) techniques that have also reduced the necessity for surgery. Since the difference in the objectives of the two specific techniques, i.e. PCD and percutaneous nephrostomy (PCN), is often overlooked, this study aimed to highlight the inconsistencies in the use of these two techniques. Methods: A retrospective study of 17 patients was conducted over a 10-year period from January 2008 to December 2017 at The Royal Hospital, Muscat, Oman. All patients had undergone abdominal computerised tomography. The obtained images were reviewed and categorised based on Huang and Tseng’s classification. Results: From the sample, 13 patients (76%) were categorised as class I and II, three (17%) as class IIIA and one (6%) as class IIIB. Five patients from the class I and II categories underwent drainage of the pelvicalyceal system, four by PCN and one by a double-J stent insertion. PCN was performed on all the class IIIA and IIIB patients. One class IIIB patient required PCD for localised gas and fluid collection but later underwent emergency nephrectomy. There were no mortalities. Conclusion: The favourable outcome of this study was in keeping with those of the more recent studies. However, despite the present classifications and guidelines, wide variations were reported in the use of percutaneous drains with PCD, ranging from 2.5–91%. The lack of precise guidelines may be a cause of these disparities in clinical management.
Keywords: Renal Infection; Pyelonephritis; Drainage; Percutaneous Nephrostomy; Oman.
Mid-Term Radiological and Functional Outcomes of Bicondylar Tibial Plateau Fractures Managed with Open Reduction and Internal Fixation Using Dual Plates
Authors: Vasiliadis Angelo V. , Poutoglidou Frideriki , Metaxiotis Dimitrios , Mpeletsiotis Anastasios
Published: April 2021

Objectives: This study aimed to evaluate the mid-term radiological and functional outcome of tibial plateau fractures treated by plating. Methods: This study was conducted at the General Hospital of Thessaloniki ‘Papageorgiou’, Thessaloniki, Greece. Patients with Schatzker type V and VI tibial plateau fractures who were managed with open reduction and internal fixation using dual plates between January 2011 and December 2018 were included in this retrospective study. The functional evaluation of the patients was carried out with the visual analogue scale (VAS), the health-related quality of life status was measured using the Short Form-36 and the dimensions of pain, stiffness and function were assessed using the Western Ontario and McMaster Universities Arthritis Index. For the radiological outcome evaluation, the modified Rasmussen criteria were used. Results: Fifty-seven patients (30 male and 27 female) were included in the study with a mean follow-up of 50.88 months. There were 23 Schatzker type V and 34 type VI fractures. The majority of patients (86%) had a good to excellent radiological outcome. The mean VAS score was 1.65 for all the patients. The functional outcome was excellent in the majority of the patients. Among them, 5.3% (n = 3) suffered wound infection and all wounds healed after different treatments. All patients returned to their pre-injury activities of daily living and employment status, while 53% of the patients returned to sporting activities. Conclusion: The findings support previous literature which has demonstrated that bicondylar tibial plateau fractures can provide good-to-excellent radiological and functional outcomes if they are treated with open reduction and internal fixation with dual plating.
Keywords: Tibial; Fracture; Classification; Surgical Procedure; Plating.
Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit
Authors: Nadar Sunil K. , Shaikh Muhammad M. , Khatri Muhammad A. , Abdelmottaleb Wael A. , Ahmed Sheeraz , Alhashim Abdulhakeem , Albusaidi Mujahid , Alkindi Fahad
Published: April 2021

Objectives: Critically ill patients have been shown to have raised troponins.  The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients.

Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.