bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomical assessment of chest radiographs
Authors: Özşahin Esin , Boyan Neslihan , Kızılkanat Emine , Demir Şenay , Pelin Can , Soames Roger W. , Oğuz Özkan
Published: September 2018

Purpose: The aim of this study was to determine the frequency of anatomical parameters and their measurement as seen on normal posteroanterior (PA) chest radiographs in a Turkish population. Materials and Methods: We evaluated fifty normal PA chest radiographs of Turkish population adults. The frequency of anatomical parameters and their measurement with respect to the diaphragm was evaluated. Results: The frequency of anatomical parameters and their measurement with respect to the diaphragm is as follows:  level (right side higher in 98%, left and right sides same level 2%), lobulation (88% absent, 12% present), eventration (98% absent, 2% present)  and contour (90% smooth, 10% not smooth); level of hilum (right and left sides same level 52%, left side higher 36%, right side higher 12%); number of pairs of ribs (twelve 96%, unable to determine 4%); number of ribs superposing the lung parenchyma (seven 2%, eight 4%, nine 24%, ten 70%); distance from the lateral margin of the vertebral body to the aorta (16.44 ± 4.35 mm); angle between the vertebral body and the aorticopulmonary line (16.04 ± 3.110); the carina angle (58.46 ± 11.130) and the cardiothoracic ratio (38.75 ± 4.27).Conclusion: The data presented in this study may be useful in understanding normal thoracic structures. A knowledge of the normal anatomy as well as variations are significant for physicians in the assessment of chest radiographs.
Surgical approach to pediatric traumatic cataract
Authors: Çiloğlu Emine , Ünal Fikret
Published: September 2018

Purpose: The aim of this study was o evaluate our surgical approach in children who were operated due to traumatic cataract in our clinic.Material and Methods: By using anterior vitrector, lensectomy was performed in pediatric patients who have traumatic cataract. The patients who have capsular support, the intraocular lens (IOL) was implanted in the capsular bag or in the sulcus and who do not have capsule support the IOL was implanted with sutureless intrascleral fixation method.Results: 21 eyes of 21 patients were included in the study. The mean age of the cases was 8.7 ±3.5 years. All of the cases had penetran injuries, and performed corneal suturation before due to the corneal perforation. Lensectomy was performed by using anterior vitrectomy probe in all patients. ln two patients, monoblock foldable  IOL were implanted in the capsular bag, in 12 patients three-piece foldable IOL were implanted in the sulcus and in 4 patients three-piece foldable lens were implanted with intrascleral fixation. The combination of pars plana vitrectomy-lensectomy and three-piece foldable IOL implantation with intrascleral fixation were done in three patients because of retinal problem. Scleral tunnel was preferred to corneal tunnel for implantation of IOL.Conclusion: Lens capsule integrity was usually impaired in traumatic cataract cases. It may be not possible to do capsulorrhexis in these cases. Vitreous and fibrotic membrane are usually found in anterior chamber in these cases. It is considered that it is more appropriate to do lensectomy by using anterior vitrectomy probe instead of standard cataract surgery.
Çocukluk çağı akut myeloid lösemilerinde lamin protein gen ekspresyonu
Authors: Özkan Ayşe , Bayram İbrahim , Sezgin Gülay , Acıpayam Can , Küpeli Serhan , Tanyeli Atila
Published: September 2018

Amaç: Bu çalışmanın amacı çocukluk çağı akut myeloid lösemilerinde (AML) hücre çoğalması ve apoptozis ile ilgili yollarla bağlantılı olduğu düşünülen lamin A/C, lamin B1 ve lamin B2 proteinlerinin gen ekspresyon durumunun saptanması ve prognoz ile olan ilişkilerinin değerlendirilmesidir.Gereç ve Yöntem: AML tanısı alan 25 olgu ve 35 kontrol olgu çalışmaya alındı. Tanı anında ve indüksiyon tedavisi bitiminde lamin A/C, lamin B1 ve lamin B2 protein gen ekspresyonları Real Time-Polimeraz Zincir Reaksiyonu (RT-PCR) yöntemi ile çalışıldı. Bulgular: AML hastalarında, tanı anında bakılan lamin B1 protein gen ekspresyonu kontrol grubuna göre belirgin olarak düşük bulundu. İndüksiyon tedavisi sonrası bakılan lamin A/C ve B2 protein gen ekspresyonu, tanı anına göre anlamlı olarak düşük saptandı. Lamin B1’de istatistiksel olarak anlamlı değişiklik saptanmadı. Hepatomegalisi olan AML hastalarında, hepatomegalisi olmayanlara göre lamin A/C, splenomegalisi olan AML hastalarında, splenomegalisi olmayanlara göre hem lamin A/C, hem de lamin B2 protein gen ekspresyonu artmış bulundu. Sonuç: Çocukluk çağı akut myeloid lösemilerinde, lamin B1 protein gen ekspresyonu, tanısal bir belirteç olarak, indüksiyon tedavisi sonrasında lamin A/C ve B2’nin azalması ise tedaviye alınan yanıtın bir göstergesi olarak kullanılabilir.
Sağlık Bilimleri Fakültesi öğrencilerinin doğum şekli tercihleri ve etkileyen faktörler
Authors: TEKTAŞ Eliz , BOZKURT Gülçin , ERGİN Ezgi , SEZGİN Selma
Published: September 2018

Amaç: Bu çalışmada Sağlık Bilimleri Fakültesi öğrencilerinin doğum şekline yönelik tercihlerini ve etkileyen faktörleri incelenmesi amaçlanmıştır.Gereç ve Yöntem: Tanımlayıcı ve kesitsel özellikteki araştırma verileri 16 Şubat-10 Mart 2018 tarihleri arasında elde edildi. Araştırmanın örneklemini İstanbul Üniversitesi Sağlık Bilimleri Fakültesinde, 2017-2018 eğitim öğretim döneminde okuyan 469 öğrenci oluşturdu. Verilerin toplanmasında araştırmacılar tarafından hazırlanan anket formu kullanıldı. Bulgular: Araştırmaya katılan öğrencilerin yaş ortalaması 20.07±1,56 yıl, %81.7’si kadın ve %38.2’si ebelik bölümünde okumakta idi. Öğrencilerin %82.5’sinin normal doğumla doğduğu, %87.8’inin normal doğumu tercih ettiği saptandı. İsteğe bağlı sezaryen yapılması gerektiğini belirtenlerin (%53.9) sezaryen doğumu daha fazla tercih ettiği belirlendi. Doğuma yönelik bilgisi olan (%87.2) öğrencilerin daha çok normal doğumu tercih ettiği  saptandı. Sonuç: Öğrencilerinin çoğunluğu normal doğumu tercih etmektedir. İsteğe bağlı sezaryen önerenler, sezaryen doğumu daha fazla tercih etmektedir. Sağlık Bilimleri Fakültelerinde okuyan öğrencilere gebelik ve doğuma yönelik eğitimler verilmesi, müfredat programlarının buna göre düzenlenmesi önerilebilir.
Serebral palsili çocuklarda spastisitenin myotonometri ile değerlendirilmesi ve spastisitede elektrik stimulasyonun etkinliği
Authors: HAVUÇ Safine , AYDENİZ Ali , BAŞARAN Sibel
Published: September 2018

Amaç: Bu çalışmanın amacı spastik serebral palsili çocuklarda myotonometre ile gastrokinemius kasının biyomekanik özelliklerini (tonus, elastisite, sertlik) değerlendirmek ve elektrik stimulasyonun kas tonusu, elastisite ve sertlik üzerine etkinliğini göstermektir. Gereç ve Yöntem: Spastik serebral palsili 40 hasta (11 diplejik, 16 quadriplejik, 13 hemiplejik) ve yaş, cinsiyet, vücut kitle indeksi eşleşen 20 sağlıklı kontrol değerlendirildi. Diplejik/quadriplejik hastaların ve sağlıklı kontrollerin bilateral, hemiplejik hastaların ise paralitik taraflarının medial ve lateral gastrokinemius kasının tonusu, elastisitesi ve sertliği MyotonPro cihazı ile ölçüldü. Spastisite Ashworth skalası ile, fonksiyonel seviyeleri Kaba Motor Fonksiyon Sınıflama Sistemi ile değerlendirildi. Serebral palsili hasta grubunun 66 ekstremitesinden elde edilen ölçümler, sağlıklı grubun 40 ekstremitesinden elde edilen ölçümlerle karşılaştırıldı. Bulgular: Serebral palsili hasta grubundan 18 hastanın (31 ekstremite) gastrokinemius kasına 5 gün elektrik stimulasyon tedavisi uygulandı. Tedavi öncesi ve sonrası ölçümler tekrarlandı. Elektrik stımulasyonu sonrası medial ve lateral gastrokinemius kasında tonus ve sertlikte anlamlı azalma, elastisitede ise anlamlı artış görüldü. Ashworth skoru da anlamlı olarak azalmakla birlikte Ashworth skoru ile myotonometrik değerler arasında korelasyon yoktu. Sonuç: Çalışmamızın sonucunda, elektrik stimulasyonu uygulaması ile kas tonusu, elastisite ve sertlik değerlerinde iyileşme sağlandı. MyotonPro’nun serebral palsili çocuklarda spastisitenin değerlendirilmesinde ve tedavi etkinliğinin ölçülmesinde kullanılabileceği sonucuna varıldı.
Hyperosmolar dextrose injections for treatment of Achilles tendinopathy
Authors: TAMAM Cüneyt
Published: September 2018

Purpose: Achilles tendinopathy is a degenerative, not an inflammatory, condition. It is one of the most frequently injured tendons in the human body despite its strength, due to repetitive strain acting on the tendon. Hyperosmolar dextrose injections also called prolotherapy,  is a regenerative injection technique using  stimulation of regenerative processes for treatment of chronic musculoskeletal conditions . The aim of study was to investigate the effect of prolotherapy in patients with non-insertional Achilles tendinopathy in terms of pain.Materials and Methods: This retrospective study is comprised of 18 consecutive patients above 18 years of age, who were diagnosed as Achilles tendinopathy.   Visual analogue scale (VAS) was used to assess pain intensity in the last 24 h.  Injections were applied to tender points in the subcutaneous tissues adjacent to the affected tendon. All evaluations were done before treatment, at 4weeks and 12 weeks after treatment.   Results: The study sample consisted of 18 adults (12 female and 6 male). Subjects’ ages ranged from 18 to 52 years, with a mean age of 34.89 ± SD 12.04 years. A statistically significant improvement in the VAS scale was demonstrated. Conclusion: Hyperosomolar dextrose injections, irrespective of dextrose concentration is an efficient   alternative regenerative treatment modality for achilles tendinopathy. Thus, it should be considered as a treatment option for chronic musculoskeletal conditions, particularly tendinopaties.
Sleepy Drivers: High time for action
Authors: Al-Lawati Nabil M.
Published: September 2018

Editorial
The Role of N-Acetylcysteine Supplementation on the Oxidative Stress Levels, Genotoxicity and Lineage Commitment Potential of Ex Vivo Murine Haematopoietic Stem/Progenitor Cells
Authors: Hamid Zariyantey A. , Tan Hui Y. , Chow Paik W. , Harto Khairul A. W. , Chan Chin Y. , Mohamed Jamaludin
Published: September 2018

Objectives: The ex vivo maintenance of haematopoietic stem/progenitor cells (HSPCs) is crucial to ensure a sufficient supply of functional cells for research or therapeutic applications. However, when exposed to reactive oxygen species (ROS) in a normoxic microenvironment, HSPCs exhibit genomic instability which may diminish their quantity and quality. This study aimed to investigate the role of N-acetylcysteine (NAC) supplementation on the oxidative stress levels, genotoxicity and lineage commitment potential of murine haematopoietic stem/progenitor cells (HSPCs). Methods: This study was carried out at the Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, between June 2016 and July 2017. Bone marrow cells were isolated from nine mice and cultured in a growth medium. Various concentrations of NAC between 0.125–2 μM were added to the culture for 48 hours; these cells were then compared to non-supplemented cells harvested from the remaining three mice as the control group. A trypan blue exclusion test was performed to determine cell viability, while intracellular ROS levels and genotoxicity were determined by hydroethidine staining and comet assay, respectively. The lineage commitment potential of erythroid, myeloid and pre-B-lymphoid progenitor cells was evaluated via colony-forming cell assay. Results: NAC supplementation at 0.25, 0.5 and 2 μM significantly increased cell viability (P <0.050), while intracellular ROS levels significantly decreased at 0.25 and 0.5 μM (P <0.050). Moreover, DNA damage was significantly reduced at all NAC concentrations (P <0.050). Finally, the potential lineage commitment of the cells was not significantly affected by NAC supplementation (P >0.050). Conclusion: The findings of this study indicate that NAC supplementation may potentially overcome the therapeutic limitations of ex vivo-maintained HSPCs.Keywords: Hematopoietic Stem Cells; N-acetylcysteine; Reactive Oxygen Species; DNA Damage; Cell Lineage.
Asthma Clinics in Primary Healthcare Centres in Oman: Do they make a difference?
Authors: Al-Mahrezi Abdulaziz , Baddar Sawsan , Al-Siyabi Sheikha , Al-Kindi Safaa , Al-Zakwani Ibrahim , Al-Rawas Omar
Published: September 2018

Objectives: This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods: This retrospective crosssectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results: A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6–95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P <0.001), trigger factors (79% versus 16%; P <0.001) and a history of atopy (81% versus 17%; P <0.001), smoking (61% versus 7%; P <0.001), asthma exacerbations (73% versus 10%; P <0.001) or previous admissions (63% versus 10%; P <0.001). Furthermore, prescription rates of inhaled corticosteroids (72% versus 61%; P = 0.021) and short-acting β-agonists (93% versus 82%; P = 0.001) were significantly higher at ACs compared to GCs. Conclusion: Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs.Keywords: Asthma; Disease Management; Patient Compliance; Medical History Taking; Medical Records; Documentation; Oman.
Daytime Sleepiness Among Young Adult Omani Car Drivers
Authors: Al-Abri Mohammed A. , Al-Adawi Samir , Al-Abri Ibrahim , Al-Abri Faisal , Dorvlo Atsu , Wesonga Ronald , Jaju Sanjay
Published: September 2018

Objectives: Sleepiness and fatigue play significant roles in exacerbating the occurrence of car crashes. However, there is a dearth of studies examining the prevalence of sleepiness while driving among Omanis. This study aimedto determine the proportion of young Omani adults who confess to daytime sleepiness while driving and to investigate associations between gender, daytime sleepiness and risk of obstructive sleep apnoea syndrome (OSAS). Methods: This cross-sectional study took place at the Sultan Qaboos University Hospital, Muscat, Oman, between May and July 2014 and included 600 young adult Omani non-commercial drivers. The Berlin Questionnaire and Epworth Sleepiness Scale (ESS) were distributed among the participants, along with additional questions about their sleeping habits. Associations between daytime sleepiness while driving and nocturnal sleep duration, risk of OSAS and gender were determined. Results: A total of 492 private vehicle drivers took part in the study (response rate: 82%), of which 50.4% were male. Overall, 124 Omanis (25.2%) reported experiencing daytime sleepiness while driving at least once per month. There was a significant association between nocturnal sleep duration of <6 hours and sleepiness while driving (P = 0.042). Female participants were significantly more likely to score >10 on the ESS, indicating a greater propensity for daytime sleepiness (P = 0.006). However, male drivers were significantly more likely to report sleepiness while driving (P = 0.001). Conclusion: Sleepiness while driving was common among young male drivers in Oman and might be due to nocturnal sleep deprivation. Further studies are needed so that preventative measures can be developed.Keywords: Motor Vehicles; Traffic Accidents; Sleep; Fatigue; Obstructive Sleep Apnea Syndrome; Oman.
Evaluation of Mitotic Figures and Cellular and Nuclear Morphometry of Various Histopathological Grades of Oral Squamous Cell Carcinoma: Comparative study using crystal violet and Feulgen stains
Authors: Kesarkar Kashmira , Tamgadge Avinash , Peirera Treville , Tamgadge Sandhya , Gotmare Swati , Kamat Pooja
Published: September 2018

Objectives: The objectives of this study were to quantitatively estimate the number of mitotic figures (MFs) and evaluate the cellular and nuclear features of various histological grades of oral squamous cell carcinoma (OSCC) using Feulgen and 1% crystal violet stains. Methods: This case-control study took place at the Dr D. Y. Patil Dental College & Hospital in Mumbai, Maharashtra, India, between June and December 2016. A total of 51 samples were retrieved from the hospital archives. Of these, 15 well-differentiated, 15 moderately-differentiated and six poorly-differentiated OSCC samples formed the case group while 15 samples of normal gingival mucosa constituted the control group. Each sample was dyed using Feulgen and 1% crystal violet stains and the mitotic count, nuclear area (NA), cellular area (CA), nuclear perimeter (NP), cellular perimeter (CP) and nuclear-to-cytoplasmic (N/C) ratio was calculated using computeraided morphometry techniques. Results: The number of MFs visible per field was significantly higher in Feulgen-stained sections as compared to those stained with crystal violet (P = 0.050). In addition, the NA, NP, CA and CP values and N/C ratios of samples in the experimental group increased significantly in accordance with an increase in OSCC grade (P <0.001). Conclusion: The Feulgen stain is more reliable than 1% crystal violet in terms of the selective staining of MFs. Moreover, the findings of this study indicate that computer-based morphometric analysis is an effective tool for differentiating between various grades of OSCC.Keywords: Crystal Violet; Feulgen Stain; Mitotic Index; Image Cytometry; Squamous Cell Carcinoma; Oral Cancers.
Epidemiology, Outcomes and Coronary Angiography Findings of Patients Following Out-of-Hospital Cardiac Arrest: A single-centre experience from Oman
Authors: Nadar Sunil K. , Mujtaba Mohammed , Al-Hadi Hafidh , Sadiq Muhammed , Al-Riyami Adil , Ali Mehar , Al-Lawati Hatim
Published: September 2018

Objectives: Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records. Results: A total of 216 patients were included in the study. The majority (63.9%) presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm (62.5%), with only 10% having ventricular tachycardia/fibrillation. Very few patients (1.4%) had received cardiopulmonary resuscitation (CPR) prior to presentation. In total, 85 patients (39.4%) returned to spontaneous circulation (RSC); of these, post-RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage. Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman.Keywords: Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Patient Outcome Assessment; Survival Rate; Coronary Angiography; Oman.
Arabic Translation, Validation and Cultural Adaptation of the 7-Item Hamilton Depression Rating Scale in Two Community Samples
Authors: Alhadi Ahmad N. , Alarabi Mohammed A. , Alshomrani Abdulaziz T. , Shuqdar Raafat M. , Alsuwaidan Mohammad T. , McIntyre Roger S.
Published: September 2018

Objectives: Depression is a common mental disorder, the severity of which is frequently assessed via interview-based clinical scales such as the 7-item Hamilton Depression Rating Scale (HAMD-7). The current study aimed to translate and examine the validity of an Arabic version of the HAMD-7 scale. Methods: This study took place between February and March 2016 in the Psychiatry Department of King Saud University, Riyadh, Saudi Arabia. The HAMD-7 scale was translated into Arabic using forward and backward translation methods. A total of 153 Arabic speakers were recruited to test the translated scale, including 57 medical students and 96 members of the general public. The Arabic version of the HAMD-7 scale was completed by trained investigators during face-toface interviews with the participants. In order to assess convergent validity, participants also completed an Arabicversion of the self-assessed Patient Health Questionnaire-9 (PHQ-9) scale. Subsequently, the test-retest reliability of the translated HAMD-7 scale was evaluated two weeks later during a second interview. Results: Overall, HAMD-7 scores were positively correlated with PHQ-9 scores (r = 0.633–0.749). Moreover, the translated HAMD-7 scale proved to be reliable in terms of test-retest reliability (intra-class correlation coefficient: 0.807; P <0.001). With regards to internal consistency, the Cronbach’s α values ranged between 0.607–0.756. Conclusion: The Arabic HAMD-7 scale was found to be reliable and valid among two samples of Arabic speakers in Saudi Arabia. However, further research among Arab-speaking patients diagnosed with depression is needed in order to establish its usefulness in assessing the severity of depressive symptoms.Keywords: Psychiatry; Depression; Psychometrics; Validity and Reliability; Translation; Questionnaire Design; Saudi Arabia.
The Dundee Ready Education Environment Measure: A prospective comparative study of undergraduate medical students’ and interns’ perceptions in Oman
Authors: Prashanth Gowda P. , Ismail Salim K.
Published: September 2018

Objectives: This study aimed to assess perceptions of the educational environment in Oman among medical undergraduate students and interns using the Dundee Ready Education Environment Measure (DREEM) tool. Methods: This cross-sectional study was conducted between October 2016 and April 2017 at the Oman Medical College (OMC), Sohar, Oman. A total of 737 medical undergraduate students and interns from the OMC and College of Medicine & Health Sciences of Sultan Qaboos University in Muscat, Oman, were invited to complete the DREEM questionnaire in the form of an online survey. Mean overall scores, subscale scores and individual item scores were subsequently compared between undergraduate students and interns. Results: A total of 418 undergraduate students and interns completed the survey (response rate: 56.7%). The mean overall DREEM score was 130.75 ± 12.69. While interns had higher mean DREEM scores than undergraduate students, this difference was not significant (133.00 ± 17.64 versus 128.50 ± 15.53; P = 0.326). The mean score percentages for the perceptions of learning (66.7% versus 58.3%; P = 0.028) and perceptions of teachers (75% versus 68.2%; P = 0.038) subscales were significantly higher among OMC interns compared to undergraduate students from the same college. The perceptions of the environment subscale received the lowest mean score percentages among undergraduate students and interns from both colleges. Conclusion: Overall, medical undergraduate students and interns viewed the educational environment in Oman in a positive light. It is possible that undergraduate students’ perceptions of the educational environment may become more favourable as they progress with their medical career and become interns.Keywords: Medical Education; Undergraduate Medical Students; Internships; Perceptions; Oman.
Cephalometric Norms in an Omani Adult Population of Arab Descent
Authors: Govinakovi Prashantha S. , Al-Busaidi Ibrahim , Senguttuvan Viswapurna
Published: September 2018

Objectives: This study aimed to establish cephalometric norms for an Omani population of Arab descent and to compare these with established cephalometric values for Caucasians. Methods: This cross-sectional studywas conducted at the Military Dental Centre and Oman Dental College in Muscat, Oman, between May 2014 and October 2016. A total of 150 Omani patients between 20–29 years old seeking orthodontic treatment were included. All participants had a symmetrical face, class I molar and canine relationships, proper intercuspation, a normal overjet/overbite (<3 mm) and mild spacing/crowding of the teeth (≤3 mm). Lateral cephalography was performed in centric occlusion with the lips relaxed and the head in a natural position. Cephalometric measurements were then compared with Eastman Standard norms. Results: The Omani subjects were found to have a slightly retrusive maxilla, an increased angle between the maxillary and mandibular planes and shorter facial heights in comparison to the Eastman Standard norms. Furthermore, incisor relations were edge-to-edge in nature and the interincisal angle was reduced, suggesting that the Omani subjects had more proclined incisors. In addition, the lips were more protrusive and the nasolabial angle was more obtuse. Conclusion: In the Omani sample, increased proclination of the incisors was observed in comparison to Eastman Standard norms. As such, slightly more proclined incisors should be considered acceptable and natural among Omani patients of Arab descent. The cephalometric findings of this study may be helpful in the diagnosis and treatment planning of orthodontic problems among Omanis of Arab descent.Keywords: Cephalometry, standards; Population Characteristics; Ethnic Groups; Arabs; Orthodontics; Oman.
Characteristics of Critically-Ill Patients at Two Tertiary Care Hospitals in Sudan
Authors: Sulieman Hagir , El-Mahdi Wael , Awadelkareem Mohannad , Nazer Lama
Published: September 2018

Objectives: Knowledge of intensive care unit (ICU) admission patterns and characteristics is necessary for the development of critical care services, particularly in low-resource settings. This study aimed to describe the characteristics of critically-ill patients admitted to ICUs in Sudan. Methods: This prospective observational study was conducted between February and May 2017 in the ICUs of two government tertiary care hospitals inKhartoum, Sudan. A total of 100 consecutive adult patients admitted to the ICUs were included in the study. The patients’ demographic and clinical characteristics and Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) scores upon admission were recorded, as well as the reason for admission, presence of any underlying comorbidities, interventional requirements like mechanical ventilation or haemodialysis, length of stay in the ICU and patient outcome. Results: Of the sample, 58% were female and 42% were male. The mean age was 47.4 ± 18.3 years old. Upon admission, the mean APACHE II score was 14.2 ± 9.6. In total, 54% of the patients had no known underlying comorbidities. The most common reasons for ICU admission were neurological diseases (27%), sepsis or infectious diseases (19%) and postoperative management (12%). Mechanical ventilation and haemodialysis were required by 35% and 11% of the patients, respectively. The average length of stay was 10.0 ± 7.2 days and the mortality rate was 24%. Conclusion: Most of the patients admitted to the ICUs were middle-aged females with no known underlying comorbidities. Larger studies are necessary to provide a comprehensive understanding of the critical care needs of Sudanese hospitals.Keywords: Intensive Care Units; Patient Admission, trends; Critical Care Outcomes; Developing Countries; Sudan.
Perceptions of Plagiarism Among Medical and Nursing Students in Erbil, Iraq
Authors: Ismail Kameran H.
Published: September 2018

Objectives: The rapidly rising incidence of plagiarism among students at universities throughout the world requires attention. This study aimed to determine the extent to which medical and nursing students in Erbil, Iraq,plagiarise, their knowledge, understanding and perceptions of plagiarism and the underlying factors that may lead them to plagiarise. Methods: This cross-sectional study was carried out between January and June 2017 among a sample of 400 undergraduate medical and nursing students at Hawler Medical University in Erbil. Plagiarism-related data were collected through a specially designed self-administered questionnaire. Results: In total, 280 (70%) medical students and 120 (30%) nursing students were included in the study. The reported prevalence of plagiarism was 54.3%, with a slightly higher prevalence among male students compared to female students (54.9% versus 53.8%; P = 0.820) and medical students compared to nursing students (58.9% versus 43.3%; (P = 0.004). Alarmingly, 34.8% of the students did not know what plagiarism was, and only 28% were aware of the legal consequences of plagiarism. Reported reasons for plagiarising included laziness and the ease with which others’ work could be plagiarised, confusion, cultural reasons and pressure to meet deadlines. Conclusion: There was a lack of understanding of plagiarism and its legal ramifications among undergraduate medical and nursing students in Erbil. The findings of this study indicate that there is an urgent need to increase students’ understanding of plagiarism and its consequences so as to reduce the incidence of this type of academic misconduct.Keywords: Undergraduate Medical Education; Plagiarism; Medical Students; Nursing Students; Perceptions; Iraq.
“Different Strokes”: A management dilemma
Authors: Gujjar Arunodaya R. , El-Tigani Mortada , Lal Darshan , Kakaria Anupam K. , Al-Asmi Abdullah R.
Published: September 2018

Stroke is a common medical emergency resulting from numerous pathophysiological mechanisms and with varied clinical manifestations; as such, the diagnosis of stroke requires diligent clinical assessment. When different stroke syndromes occur in the same patient, it may cause a dilemma in terms of diagnosis and management. This continuing medical education article describes an interesting patient with recurrent neurological events, highlighting the complex pathophysiological processes associated with cerebrovascular syndromes. It offers readers the opportunity to apply their own basic neuroscience knowledge and clinical skills to solve the challenges encountered during the course of diagnosing and treating this patient. Specifically, the article aims to familiarise readers with an approach to diagnosing brainstem strokes and the diverse manifestations of a common stroke syndrome.Keywords: Stroke; Lacunar Stroke; Cerebral Hemorrhage; Cerebral Small Vessel Disease; Continuing Medical Education.
Nasopharyngeal Salivary Gland Anlage Tumour: A rare cause of neonatal respiratory distress
Authors: Al-Sheibani Salma M. , Sawardekar Kiran P. , Habib Salwa J. , Al-Kindi Hunaina M.
Published: September 2018

A salivary gland anlage tumour (SGAT) is a very rare type of benign tumour that usually presents in early infancy with respiratory distress which is exacerbated upon feeding. We report a full-term male neonate who was referred to the Al Nahdha Hospital, Muscat, Oman, in 2015 with severe neonatal respiratory distress due to a nasopharyngeal obstruction immediately after birth. Computed tomography and magnetic resonance imaging revealed a well-circumscribed mass in the nasopharynx, without intracranial extension. Histopathological analysis of the lesion confirmed a diagnosis of SGAT. Following excision of the tumour, the postoperative period was uneventful. No recurrence was observed over the next two years. This case report highlights the importance of the early recognition of this extremely rare and potentially life-threatening, yet easily curable, condition.Keywords: Nasopharyngeal Neoplasms; Salivary Gland Neoplasms; Neonatal Respiratory Distress Syndrome; Case Report; Oman.
Inflammatory Reactions to Red Tattoo Inks: Three cases highlighting an emerging problem
Authors: Ruiz-Villaverde Ricardo , Fernandez-Crehuet Pablo , Aguayo-Carreras Paula , Hernandez-Centeno Jose L. , Cuenca-Barrales Carlos
Published: September 2018

In recent years, tattoos have become more commonplace. However, this can result in various inflammatory processes, the management of which can be challenging in daily clinical practice. Tattoo-related inflammatory reactions can comprise different patterns, including acute and immediate reactions, foreign body granulomas, sarcoid granulomas, isomorphic lesions, allergic contact dermatitis and photosensitivity. We report three cases who were referred to the Dermatology Outpatient Clinic of the Hospital Universitario San Cecilio, Granada, Spain, in 2017 with various skin reactions in the red-ink areas of their tattoos. Screening was performed for infectious diseases like atypical mycobacterial infections and systemic processes such as sarcoidosis. A good therapeutic response was achieved in all cases. An adequate differential diagnosis is essential for the therapeutic management of this emerging health problem.Keywords: Non-Therapeutic Body Modification; Tattooing, adverse effects; Inks; Foreign Body Reaction; Inflammation; Case Report; Spain.
Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case report
Authors: Iqhbal Mohamad , Noor Julina M. , Karim Nur A. , Ismail Izzat , Sanib Halim , Mokhtar Mohd A. , Salim Safreeda S. F.
Published: September 2018

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.Keywords: Emergency Medicine; Stridor; Ultrasonography; Airway Management; Tracheostomy; Case Report; Malaysia.
Rituximab Treatment in Myasthaenia Gravis: Report of two paediatric cases
Authors: Koul Roshan , Al-Futaisi Amna , Abdelrahim Rana , Mani Renjith , Abdwani Reem , Al-Asmi Abdullah
Published: September 2018

Myasthaenia gravis (MG) is an autoimmune disease involving the postsynaptic receptors in the neuromuscular junction. The condition is characterised by fatigable weakness of the skeletal muscles and is uncommon in children. Acetylcholinesterase inhibitors and immune-modifying medications are usually considered the mainstay of treatment. However, these medications have to be given on a lifelong basis so that patients remain in remission; furthermore, drug-related side-effects can have a major impact on quality of life. We report two paediatric cases who were treated for MG at the Sultan Qaboos University Hospital, Muscat, Oman, in 2007 and 2008, respectively. Rituximab was eventually administered to each patient after their condition failed to improve despite several years of standard treatment with acetylcholinesterase inhibitors and immune-modifying medications. Overall, rituximab resulted in complete remission in one case and significant clinical improvement in the other case.Keywords: Myasthenia Gravis; Rituximab; Children; Cholinergic Receptors; Case Report; Oman.
Recurrent Dermatofibrosarcoma Protuberans with Pigmentation and Myoid Differentiation
Authors: Yadav Surekha , Verma Nidhi , Khurana Nita , Neogi Sushant
Published: September 2018

Dermatofibrosarcomas protuberans (DFSP) are rare low-grade tumours with various subtypes and usually occur among middle-aged adults. However, myoid differentiation is very rare. We report a 44-year-old woman who presented to the Lok Nayak Jai Prakash Hospital, New Delhi, India, in 2017 with a recurrent pigmented DFSP presenting as an arm swelling. Upon histological and immunohistochemical analysis, myoid differentiation was confirmed. A literature review of the clinical and histopathological features of this rare entity is presented.Keywords: Dermatofibrosarcoma Protuberans; Melanocytes; Pigmentation; Cell Differentiation; Case Report; India.
Pulmonary Glue Embolism: An unusual complication following endoscopic sclerotherapy for gastric varices
Authors: Michael Philips G. , Antoniades Georgios , Staicu Anca , Seedat Shahid
Published: September 2018

A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butylcyanoacrylate and lipiodol). This condition may be associated with a delayed onset of respiratory compromise. Therefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infirmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. The aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.Keywords: Gastric Varices; Pulmonary Embolism; Sclerotherapy; N-butyl-cyanoacrylate; Lipiodol; Case Report; United Kingdom.
Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion Despite Treatment with Appropriate Antimicrobials: Case report
Authors: Hassan Kowthar S. , Al-Khadouri Ghalib
Published: September 2018

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. The pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.Keywords: Mycoplasma pneumoniae; Bacterial Pneumonia; Pleural Effusion; Antimicrobial Agents; Drainage; Case Report; Oman.
Uremic Leontiasis Ossea
Authors: Shim Jien , Yu Run
Published: September 2018

Interesting Medical Image
Thoracic Endometriosis Presenting with Bilateral Hydropneumothorax
Authors: Viswanath Varsha , Khurana Alkesh , Goyal Abhishek , Niwariya Yogesh , Singh Mahendra P. , Panwar Hemlata , Goel Garima
Published: September 2018

Interesting Medical Image
‘Spoon-Fed’ Versus Self-Directed Learning in an Arab Context
Authors: Khan Abdul S.
Published: September 2018

Letter to the Editor
Re: Small-Cell Neuroendocrine Carcinoma of the Cervix Masquerading as a Cervical Fibroid: Report of a rare entity
Authors: Al-Mendalawi Mahmood D.
Published: September 2018

Letter to the Editor
Adrenal hemorrhage in the neonatal intensive care unit: a four-year experience
Authors: FEDAKAR Atiye
Published: September 2018

Objectives: Adrenal
hemorrhage is relatively uncommon and usually underestimated. This study aimed
to review the clinical, predisposing factors and ultrasonographic findings of adrenal hemorrhage newborns treated in hospital neonatal intensive care unit. Methods: The
medical records of 14 newborns with adrenal
hemorrhage who had
been admitted to our neonatal intensive care unit were retrospectively
reviewed. Results: During
the study period, 1979 patients were admitted to our neonatal intensive care
unit. Throughout the four-year follow-up of patients in the neonatal intensive
care unit, adrenal hemorrhage was diagnosed with ultrasonography
in 14 (0.70%) infants; thirteen of them were term babies, one of them was a
premature baby. Among these 14 patients, 10 (71.4%) were males, 4 (28.6%) were
females. The average birth weight was 3809.1 ± 358.5 g. Neonates
had risk factors such as: birth trauma in 5 (35.7%) newborns, perinatal
asphyxia in 4
(28.6%)
newborns, sepsis in
2 (14.3%) newborns, large
gestation age in 3 (21.4%) newborns. Resuscitation was performed in 7 (50%) infants in the delivery room. The most common clinical presentations
of the newborn with adrenal
hemorrhage
was hypotonia and lethargy (n = 5; 35.7%). Nine (64.3%) newborns had adrenal hemorrhage
on the right side, three (21.4%) of them had bilateral adrenal hemorrhage, and the last two (14.3%) had adrenal hemorrhage on left side. Resolution time of adrenal hemorrhage was a minimum of one month and
maximum of three months in ultrasonographic follow-up.

Conclusions: If there are
anamneses of strenuous and traumatic deliveries, and any clinical suspicion, ultrasonography should be performed to exclude adrenal hemorrhage,
since it is non-invasive, and also straightforward to apply. In babies with
hematomas that are increasing in size, adrenocorticotropic hormone and cortisol levels should be analyzed to prevent any
possible adrenal insufficiency, even if there is no clinical sign.
Üniversite Öğrencilerinin Üniversite Yaşamına Uyum ile Benlik Ayrımlaşması Arasındaki İlişkinin İncelenmesi
Authors: MERT Abdullah , ÇETİNER Pınar
Published: September 2018

Bu çalışmanın amacı, üniversite öğrencilerinde üniversite yaşamına uyum düzeyi ile benlik ayrımlaşma düzeyi arasındaki ilişkinin incelenmesidir. Araştırmanın örneklemini, Uşak Üniversitesi Eğitim Fakültesinin çeşitli bölümlerinde öğrenim gören ve araştırmaya gönüllü olarak katılmayı kabul eden %68 kadın (189 kız öğrenci) ve %32 erkek (87 erkek Öğrenci) olmak üzere toplam 276 üniversite öğrencisi oluşturmuştur. Bu çalışma, ilişkisel tarama yöntemine göre yapılmıştır. Araştırmada, katılımcıların benlik ayrımlaşma düzeyini belirlemek için “Benliğin Ayrımlaşması Ölçeği (BAÖ)” ve Üniversite yaşamına uyum düzeyini belirlemek için “Üniversite Yaşamına Uyum Ölçeği” (ÜYUÖ) kullanılmıştır. Analizler SPSS 23.0 paket programı aracılığıyla .05 ve .01 anlamlılık düzeyinde analizler yapılmıştır. Elde edilen veriler korelasyon ve doğrusal regresyon ile test edilmiştir. Araştırma bulgularında üniversite yaşamına uyum ve benlik ayrımlaşması değişkenlerinin cinsiyete göre anlamlı olarak farklılaşmadığı ortaya çıkmıştır. Üniversite yaşamına uyum ile benlik ayrımlaşması arasında orta düzeyde pozitif ve anlamlı düzeyde bir ilişki görülmüştür.  Buna göre üniversite öğrencilerinin benlik ayrımlaşma düzeyi arttıkça üniversite yaşamına uyum düzeylerinin arttığı söylenebilir.  Üniversite öğrencilerinde benlik ayrımlaşmasının üniversiteye yaşamına uyum düzeyinde pozitif yönlü yordayıcı rolünün olduğu tespit edilmiştir. Bu da öğrencilerin üniversiteye yaşamına uyum düzeylerinin benlik ayrımlaşması ile açıklandığı ifade edilebilir.
Protective hepatitis B surface antibody (Anti-HBs) levels among health care workers in Duhok city of Iraq
Authors: ALİ Sagvan Hasan , RASHEED Bakhtiyar Ahmed , AL-HADİTHİ Tariq Salman
Published: September 2018

Objective: This cross sectional study aimed to find the prevalence of protective hepatitis B surface antibodies (anti-HBs) and HBV infection among health care workers in Duhok city.  Method: In this cross sectional study, 504 health care workers from Duhok city were studied. The data requested included some demographics and risk factors of exposure. Blood samples were tested for HBsAg, anti-HBc and anti-HBs by enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of protective anti-HBs was higher among vaccinated participants (p<0.001) and was positively associated with the number of vaccine doses (p<0.001). Around 60.0% of participants had received at least one dose of vaccine and 38% were fully vaccinated. Prevalence of postvaccination anti-HBs testing among fully vaccinated participants was 26.7%. The rate of protective anti-HBs levels among fully vaccinated participants was 84.8 %. The rates of HBsAg and overall HBV infection were 1.8%, and 9.5% respectively. HBV infection was significantly associated with occupational exposure to blood (OR=2.38; 95% CI=1.26-4.50) and dental interventions (OR=2.36; 95% CI=1.25-4.46).  Conclusion: The rate of protective anti- HBs level among fully vaccinated HCWs is acceptable. Vaccination coverage and post-vaccination testing are still low and there is no post-exposure prophylaxis policy in Duhok health care facilities.
Yaşlılarda yaşam kalitesini etkileyen faktörler
Authors: ÖZERDOĞAN Özgür , YÜKSEL Buse , ÇELİK Merve , OYMAK Sibel , BAKAR Coşkun
Published: September 2018

Amaç: Bu çalışmanın amacı; Çanakkale il merkezinde yaşayan 65 yaş ve üzerindeki kişilerin yaşam kalitesini etkileyen faktörlerin incelenmesidir. Yöntem: Kesitsel tipteki çalışmadaörneklem büyüklüğü 961 kişi olarak belirlenmiştir. Araştırmada 1 001 kişiye ulaşılmıştır ve veriler yüz yüze görüşme tekniği ile anket formu kullanılarak elde edilmiştir. Bulgular: Tekdeğişkenli analiz sonuçlarına göre yapılan ileri analizde; geçmişe yönelik pişmanlık duymanın, geçmişteki amaçlara ulaşamamanın, gelecekten umutlu olmamanın, son altı ay içinde düşmenin, hekim tarafından tanısı konulmuş sürekli ilaç kullanmayı gerektiren en az bir kronik hastalık varlığının, gelir durumu azlığının ve günlük yaşam aktivitelerinde bağımlı olmanın Avrupa Sağlık Etki Ölçeği (EUROHIS) toplam puanını azalttığı bulunmuştur. Sonuç: Yaşlı nüfusun ihtiyaçlarının yerel ve ulusal düzeylerde yapılacak izlem çalışmalarıyla takip edilmesinin gerekli müdahalelerin yapılmasına katkı sunacağı düşünülmektedir. Bu amaçla Çanakkale ilindeki yaşlı nüfusun sosyal destek hizmeti aldığı Altın Yıllar Yaşam Merkezinde izlem çalışmasıbaşlatılmıştır.