Proprotein convertase subtilisin/kexin type (PCSK9) is a crucial protein in LDL cholesterol (LDL-C) metabolism by virtue of its pivotal role in the degradation of the LDL receptor. Mutations in the PCSK9 gene have previously been found to segregate with autosomal dominant familial hypercholesterolemia (ADFH). In this study, DNA sequencing of the 12 exons of the PCSK9 gene has been performed for two patients with a clinical diagnosis of familial hypercholesterolemia where mutation in the LDL-receptor gene hasn't been excluded. One missense mutation was detected in the exon 9 PCSK9 gene in the two ADFH patients. The patients were found to be heterozygote for Ile474Val (SNP rs562556). Using an array of in silico tools, we have investigated the effect of the above mutation on different structural levels of the PCSK9 protein. Although, the mutation has already been reported in the literature for other populations, to the best of our knowledge this is the first report of a mutation in the PCSK9 gene from the Arab population, including the Omani population.
Mutation; Autosomal dominant hypercholesterolemia; PCSK9 protien
Little is known about thrombolytic therapy patterns in patients with ST-elevation myocardial infarction (STEMI) in the Middle East. The objective of this study was to evaluate the clinical profile and mortality of STEMI patients who arrived in hospital within 12 hours from pain onset and received thrombolytic therapy.
Patients and Methods:
This was a prospective, multinational, multi-centre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in six Middle Eastern countries during the period between October 2008 and June 2009, as part of Gulf RACE-II (Registry of Acute Coronary Events). Analyses were performed using univariate statistics.
Out of 2,465 STEMI patients, 66% (n = 1,586) were thrombolysed with namely: streptokinase (43%), reteplase (44%), tenecteplase (10%), and alteplase (3%). 22.7% received no reperfusion. Median age of the study cohort was 50 (45-59) years with majority being males (91%). The overall median symptom onset-to-presentation and door-to-needle times were 165 (95- 272) minutes and 38 (24-60) minutes, respectively. Generally, patients presenting with higher GRACE risk scores were treated with newer thrombolytic agents (reteplase and tenecteplase) (P < 0.001). The use of newer thrombolytic agents was associated with a significantly lower mortality at both 1-month (0.8% vs. 1.7% vs. 4.2%; P = 0.014) and 1-year (0% vs. 1.7% vs. 3.4%; P = 0.044) compared to streptokinase use.
Majority of STEMI patients from the Middle East were thrombolysed with streptokinase and reteplase in equal numbers. Nearly one-fifth of patients did not receive any reperfusion therapy. There was inappropriately long symptom-onset to hospital presentation as well as door-to-needle times. Use of newer thrombolytic agents in high risk patients was appropriate. Newer thrombolytic agents were associated with significantly lower mortality at 1-month and 1-year compared to the older agent, streptokinase.
Acute coronary syndrome; GRACE score; Middle East; mortality; reteplase; STEMI; streptokinase; tenecteplase; thrombolytic therapy
The aim of this study was to investigate the frequency of pulmonary function abnormalities in clinically asymptomatic children with Systemic Lupus Erythematosus and to determine the relationship of these abnormalities to clinical, laboratory, and immunological parameters as well as to disease activity.
Forty-two children with childhood onset Systemic Lupus Erythematosus were included in this study. Demographic, clinical, laboratory and immunological parameters, as well as disease activity were assessed. Pulmonary function tests (PFT) were performed routinely to screen for subclinical lung disease.
Out of the 42 children, 19% (n=8) had clinical evidence of pulmonary involvement. The patients with no clinical evidence of pulmonary involvement (n=34) represent the study cohort. From our cohort of patients with no clinical evidence of pulmonary involvement 79% (n=27) had PFT abnormality; including 62% (n=21) had reduced FVC, 71% (n=24) had reduced FEV1, and 67% (n=12) had reduced DLCO. Similarly, 56% (n=15) had a restrictive PFT pattern, and 2.6% (n=2) had an obstructive PFT pattern, while 33% (n=7) had an isolated impairment of diffusion capacity. Due to small sample size; it was not possible to find a statistically significant difference between the cohort of asymptomatic SLE patients with abnormal PFT findings (n=27) and those with normal PFT findings (n=7) in terms of clinical, laboratory, immunological or disease activity index score.
Subclinical lung disease, as demonstrated by abnormal PFT in patients with normal radiographs, may be common but should be interpreted with caution as an early sign of lung disease. Although PFT studies do not correlate well with pulmonary symptoms in patients with childhood onset SLE, they nevertheless provide objective quantification of the type and severity of the functional lesions.
Systemic lupus erythematosus; Pulmonary; Prevalence; Oman
We used prospective cohort data of patients with acute coronary syndrome (ACS) to compare their management on weekdays/mornings with weekends/nights, and the possible impact of this on 1-month and 1-year mortality. Analyses were evaluated using univariate and multivariate statistics. Of the 4,616 patients admitted to hospitals with ACS, 76% were on weekdays. There were no significant differences in 1-month (odds ratio (OR), 0.88; 95% CI: 0.68-1.14) and 1-year mortality (OR, 0.88; 95% CI: 0.70-1.10), respectively, between weekday and weekend admissions. Similarly, there were no significant differences in 1-month (OR, 0.92; 95% CI: 0.73-1.15) and 1-year mortality (OR, 0.98; 95% CI: 0.80-1.20), respectively, between nights and day admissions. In conclusion, apart from lower utilization of angiography (P < .001) at weekends, there were largely no significant discrepancies in the management and care of patients admitted with ACS on weekdays and during morning hours compared with patients admitted on weekends and night hours, and the overall 30-day and 1-year mortality was similar between both the cohorts.
Acute coronary syndrome; Weekend; Weekday; Mortality; Admission.
Despite the high burden of type 2 diabetes mellitus (T2DM) in Oman, there are scarce data from a nationally representative sample on the level of glycaemia and other cardiovascular (CVD) risk factor control.
To estimate the proportion of patients with T2DM at goal for glycaemia and CVD risk factors using the National Diabetes Guidelines (NDG) and the American Diabetes Association (ADA) clinical care guidelines; and to assess the quality of selected services provided to patients with T2DM.
A sample of 2,551 patients (47% men) aged ≥20 years with T2DM treated at primary health care centers was selected. Patient characteristics, medical history and treatment were collected from case notes, Diabetes Registers and computer frameworks including the use of the last 3 laboratory investigations results and blood pressure (BP) readings recorded in 2007.
The overall mean age of the cohort was 54±13 years with an average median duration of diabetes of 4 (range 2 to 6) years. Over 80% of patients were overweight or obese (body mass index (BMI) of ≥25 Kg/m2). Sixty-nine percent were on oral anti-diabetic medication, 52% on anti-hypertensives and 40% on lipid lowering drugs. Thirty percent of patients were at goal for glycosylated haemoglobin level (<7%), 26% for BP (systolic/diastolic <130/80 mmHg), 55% for total cholesterol (<5.2 mmol/l), 4.5% for low-density lipoprotein cholesterol (<1.8 mmol/l), 52% for high-density lipoprotein cholesterol (>1 mmol/l for men, >1.3 mmol/l for women), and 61% for triglycerides (<1.7 mmol/l). Over 37% had micro-albuminuria and 5% had diabetic nephropathy.
Control of hyperglycaemia and other CVD risk factor appears to be suboptimal in Omani patients with T2DM and need to be addressed in the triad of patient, physician and health system.
Diabetes mellitus; glycosylated hemoglobin Alc; blood pressure; low-density lipoprotein cholesterol; high-density lipoprotein cholesterol; triglycerides; Oman.
This study aimed to assess the impact of diabetes mellitus and hypertension as well as other demographic and clinical characteristics on perceived health status in primary health centers in Oman.
In a cross-sectional retrospective study, 450 patients (aged ≥ 18 years) seen at six primary health centers in Wilayat A’ Seeb in the Muscat region, Oman, were selected. Perceived health status of the physical (PSCC) and mental (MSCC) components of quality-of-life were assessed using the 12-item short form health survey (SF-12). The analyses were performed using univariate statistical techniques.
The mean age of the participants was 54 ± 12 years and they were mostly female (62%). The presence of both diabetes mellitus and hypertension was associated with lower physical scores compared to those with diabetes alone (p = 0.001) but only marginally lower than those with hypertension alone (p = 0.066). No significant differences were found across the disease groups in mental scores (P = 0.578). Age was negatively correlated (p < 0.001) but male gender (P < 0.001), married (p < 0.001), literate (p < 0.001) and higher income (p = 0.002) were all associated with higher physical scores. Moreover, longer disease duration was associated with lower physical scores (p < 0.001). With regards to the mental status, male (p = 0.005), marriage (P = 0.017) and higher income (p < 0.001) were associated with higher mental scores. Polypharmacy was associated with lower physical (p < 0.001) and mental (p = 0.005) scores.
The presence of both diseases was associated with lower physical scores of perceived health status. Health status was also affected by various demographic and clinical characteristics. However, the results should be interpreted in light of the study's limitations.
Perceived health status; Hypertension; Diabetes mellitus; Primary health centers; Oman
Acute coronary syndrome (ACS) is the most common cause of cardiovascular mortality and morbidity in Western countries. International guidelines for diagnosis and treatment have been developed based on randomised clinical trials. However, data from international registries report a lack of association between guideline recommendations and actual clinical practice. Similarly, the Gulf Heart Association initiated a registry called Gulf Registry of Acute Coronary Events (Gulf RACE). This registry was developed to determine the characteristics and management of ACS in the Gulf countries including Oman. Here, we report on the results of the various Gulf RACE registry studies from Oman and compare our results with the main Gulf RACE data as well as other international registries.
Acute coronary syndrome; Oman
Fine-needle aspiration (FNA) is a useful method for evaluating multinodular goiter; however, its role is still controversial. The aim of this study was to assess the utility of ultrasound-guided thyroid FNA in detecting malignancy in patients with multinodular goiter in Oman.
Materials and Methods:
This was a retrospective study where all patients with multinodular goiter seen at the Sultan Qaboos University Hospital endocrinology clinic in Oman in 2005 were evaluated. The thyroid FNA results were grouped into either malignancy (positive result) or others (negative result). They were compared to those of final histopathological examination in order to calculate the value of the test in diagnosing malignancy. Analyses were evaluated using descriptive statistics.
A total of 272 patients were included in the study. The mean age was 3913 years with an age range from 5 to 85 years. The majority of the patients were females (n=236; 87%). The results of thyroid FNA revealed that 6% (n=15) of the patients had malignancies while histopathological results showed that the proportion of subjects with malignancies was 18% (n=49). Out of the 15 cases identified to have malignances by thyroid FNA, only 53% (n=8) of the subjects were confirmed to have malignancy by biopsy. Overall, the results of the tests were poor, revealing a sensitivity of 16%, specificity of 97% and a diagnostic accuracy of 82%, with a positive predictive value of 53% and a negative predictive value of 84%.
Thyroid FNA is not a useful test in differentiating multinodular goiter from malignancy, as more than 80% of the malignancies go unnoticed.
Fine-needle aspiration; malignancy; multinodular goiter
The use of complementary and alternative medicine (CAM) for diabetes mellitus is becoming increasingly popular; however, little is known about the prevalence of CAM use in patients with diabetes mellitus in Oman. The objectives of this study were to estimate the prevalence of use of CAM among diabetic patients in Muscat region, Oman, and to determine the types of CAM used as well as to identify the demographic features influencing the use of CAM.
The study was performed from May to August 2009 on diabetic patients from 4 health centres in Muscat region. A total of 146 patients were interviewed. Information was obtained on demographics, and the prevalence and pattern of use of CAM.
Sixty two (42%) of the participants used CAM for the treatment of diabetes. Thirty (48%) were satisfied about its use and 27 (43%) intend to use it again. The only types of CAM used by participants in this study were herbs (n = 49, 79%), and/or food supplements (n = 7, 11%). Family and friends (n = 47/62, 76%) and/or traditional healers (n = 19, 31%) were the main source of information on CAM in the treatment of diabetes. There was no significant correlation between demographic characteristics and the use of CAM for diabetes.
CAM is used widely for diabetes in Muscat region, Oman. Patients have strong faith in CAM in terms of effectiveness. Doctors should recognise this and be prepared to talk more freely with patients about its use and potential side effects.
Complementary medicine; Alternative medicine; Complementary and alternative medicine (CAM); Diabetes mellitus (DM); Oman
Background and Objectives:
Hyperglycemia in patients admitted for acute coronary syndrome (ACS) is associated with increased in-hospital mortality. We evaluated the relationship between admitting (nonfasting) blood glucose and in-hospital mortality in patients with and without diabetes mellitus (DM) presenting with ACS in Oman.
Patients and Methods:
Data were analyzed from 1551 consecutive patients admitted to 15 hospitals throughout Oman, with the final diagnosis of ACS during May 8, 2006 to June 6, 2006 and January 29, 2007 to June 29, 2007, as part of Gulf Registry of Acute Coronary Events. Admitting blood glucose was divided into four groups, namely, euglycemia (≤7 mmol/l), mild hyperglycemia (>7-<9 mmol/l), moderate hyperglycemia (≥9-<11 - mmol/l), and severe hyperglycemia (≥11 mmol/l).
Of all, 38% (n = 584) and 62% (n = 967) of the patients were documented with and without a history of DM, respectively. Nondiabetic patients with severe hyperglycemia were associated with significantly higher in-hospital mortality compared with those with euglycemia (13.1 vs 1.52%; P<0.001), mild hyperglycemia (13.1 vs 3.62%; P = 0.003), and even moderate hyperglycemia (13.1 vs 4.17%; P = 0.034). Even after multivariate adjustment, severe hyperglycemia was still associated with higher in-hospital mortality when compared with both euglycemia (odds ratio [OR], 6.3; P<0.001) and mild hyperglycemia (OR, 3.43; P = 0.011). No significant relationship was noted between admitting blood glucose and in-hospital mortality among diabetic ACS patients even after multivariable adjustment (all P values >0.05).
Admission hyperglycemia is common in ACS patients from Oman and is associated with higher in-hospital mortality among those patients with previously unreported DM.
Acute coronary syndrome; admission hyperglycemia; diabetes mellitus; hyperglycemia; in-hospital mortality
To estimate the prevalence, predictors, and impact of low high-density lipoprotein cholesterol (HDL-C) on in-hospital outcomes among acute coronary syndrome (ACS) patients in the Middle East.
Data were collected prospectively from 6,266 consecutive patients admitted with a diagnosis of ACS and enrolled in the Gulf Registry of Acute Coronary Events (Gulf RACE). A low HDL-C was defined as a level <40 mg/Dl (1.0 mmol/L) for males and <50 mg/dL (1.3 mmol/L) for females. Analyses were performed using univariate and multivariate statistical techniques.
The overall mean age of the cohort was 56±12 years and majority were males (77%). The overall prevalence of low HDL-C was 62%. During in-hospital stay and at discharge, the majority were on statin therapy (83%) while 10% were on other cholesterol lowering agents. After adjustment of demographic and clinical characteristics, the predictors for low HDL-C were higher body mass index (BMI), prior myocardial infarction (MI), diabetes mellitus, smoking and impaired renal function. Multivariable adjustment revealed that low HDL-C was associated with higher in-hospital mortality (odds ratio (OR), 1.54; 95% CI: 1.06-2.24; p=0.022) and cardiogenic shock (OR, 1.61; 95% CI: 1.20-2.14; p=0.001).
ACS patients in the Middle East have a high prevalence of low HDL-C. Higher BMI, prior MI, diabetes mellitus, smoking, and impaired renal function were predictors of low HDL-C. Significantly higher in-hospital mortality and cardiogenic shock were associated with low HDL-C in men but not in women.
High density lipoprotein cholesterol; low density lipoprotein cholesterol; triglycerides; acute coronary syndrome; myocardial infarction; gender; Middle East.
The objectives of this study were to compare the demographics, semen parameters and hormone profiles in men with primary and secondary infertility.
The study was designed as a retrospective analysis of data collected from men attending a combined infertility clinic (seen together by urologist and gynaecologist) from January 2005 to December 2008 at Sultan Qaboos University Hospital, a tertiary care hospital in Oman. Ninety-eight consecutive male patients with one or more abnormalities in semen analysis were referred to the combined infertility clinic. A complete physical examination was carried out by a urologist followed by hormone evaluation of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and prolactin (PRL).
The semen parameters and the sex hormone evaluation were not significantly different between the men with primary and secondary infertility. The men with primary infertility were younger than the men with secondary infertility. A total of 24% of the men in the primary group and 16% in the secondary group were azoospermic with normal gonadotropin values in 9 men and 1 man in the primary and secondary group respectively.
Azoospermia was more common in the primary infertile group and, based on gonadotropin levels, obstructive causes seemed more prevalent in the primary group compared to secondary group.
Male infertility; Primary infertility; Secondary infertility; Varicocele; Sex Hormones; Semen parameters; Oman
To assess the prevalence, risk factors, presenting features, and in-hospital outcomes of acute coronary syndrome (ACS) patients ≤40 years of age from Oman.
Data were analyzed from 1579 consecutive ACS patients from Oman during May, 2006 to June, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). ACS patients ≤40 years of age were compared with patients >40 years of age.
A total of 121 (7.6%) patients were ≤40 years of age with mean age of 36 ± 4 vs. 61 ± 11 years in young and old adults, respectively (P<0.001). More men were seen in the younger age group (81 vs. 60%; P<0.001). Among all the coronary risk factors, young patients had more history of smoking (47 vs. 15%; P<0.001), obesity (72 vs. 58%; P = 0.009), and family history of coronary artery disease (CAD) (16 vs. 7%; P = 0.001). Both groups received aspirin, statins, thrombolytic therapy, and anticoagulants equally; however, younger patients received clopidogrel, glycoprotein IIb/IIIa inhibitors, β-blockers, and in-hospital coronary angiogram more. Younger patients experienced less heart failure (6 vs. 27%; P<0.001) and in-hospital mortality, especially among STEMI patients (0 vs. 10%; P = 0.037).
Young ACS patients from Oman have different risk profile. They were treated more aggressively and their outcome was better, which is similar to other populations. However, smoking, along with obesity and family history of CAD were strong risk factors in the young Omani ACS patients. There is a need for prevention programmes to control smoking and obesity epidemic by targeting young adults in the population.
Acute coronary syndrome; Oman; smoking; young adults
Despite the scientific evidence of reducing cardiac events with HMG Co-A reductase inhibitors (statins) therapy in both primary and secondary preventions, these therapies continue to be underutilized in patients receiving convictional care. Simvastatin, a HMG Co-A inhibitor agent, is the most commonly used statin in Sultan Qaboos University Hospital. The aim of this study is to review the safety and the effectiveness of achieving LDL-C targets with Simvastatin according to the NCEP-ATP3 guidelines in patients with different cardiovascular risk categories at Sultan Qaboos University Hospital.
A retrospective chart review was conducted for 160 patients. Patients were identified by outpatient prescriptions provided by pharmacy department from April 2008 to May 2008.
98% of the patients were prescribed simvastatin 20 mg and only 2% received 40 mg. The mean age of patients was 57 years +/- 12. While 49% of the patients were male and 45% had diabetes mellitus, 50% had cardiovascular disease, 2.5% were smokers, 67% were hypertensive, and 3% had positive family history of coronary artery disease. 75% of patients were classified as high risk, 7% moderate risk and 18% low risk for coronary artery disease. Among all lipid profiles, only LDL-C was changed from baseline with simvastatin treatment in all patients (3.60±1.03 to 3.25±1.34 mmol/L). LDL-C level at baseline was higher in the high risk group (4.11±1.06 mmol/L) compared to low and moderate risk groups (3.68±0.89, 3.42±1.15) respectively. Achievement of LDL-C goals was achieved in only 43% for high risk, 50% in moderate risk, and 90% in low risk patients. There was no significant increase in liver enzymes and creatinine kinase.
This study identified that more than half of the high risk patients were not at the target LDL-C goals which place them at a continuous risk of coronary heart disease. More appropriate lipid lowering therapy using more potent statins or combination therapy should be optimized to improve achievement of LDL-C goals according to ATP-III guidelines.
The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease (CAD) remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina.
Electrocardiograms (ECGs) of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded (66 patients). The remaining 191 patients constituted the study population. Detailed ECG interpretation and coronary angiographic findings were conducted by experienced cardiologists.
T wave inversion in aVL was identified in 89 ECGs (46.8%) with definite ischemic Q-ST-T changes in different leads in 97 ECGs (50.8%). Stand alone aVL T wave inversion was found in 27 ECGs (14.1%) while ischemic changes in other leads with normal aVL were identified in 36 ECGs (18.8%). The incidence of CAD was 86.3%. Single, two- and multi-vessel CAD were found in 38.8%, 28.5% and 32.7% of cases respectively. The prevalence of left main, left anterior descending, left circumflex and right coronary arteries were 4.7%, 61.2%, 29.3% and 44.5%, respectively. T wave inversion in aVL was found to be the only ECG variable significantly predicting mid segment left anterior descending artery (LAD) lesions (Odds Ratio 2.93, 95% Confidence Interval 1.59-5.37, p=0.001).
This study provides new information relating to T wave inversion in lead aVL to mid segment LAD lesions. Implication of this simple finding may help in bedside diagnosis of CAD typically mid LAD lesions. However, further studies are needed to corroborate this finding.
It has been well established that pathways to care are considerably modified by local, social and psychological characteristics as well as the doctor-patient relationship. Scant attention has been paid to the role of family advice in care-seeking. In Omani society, traditional family values and a collective mindset are the norm rather than the exception. This paper examines how family advice affects the trajectory of care seeking.
During 2006–2007, data was collected through face-to-face interviews among a randomised sample of patients seeking medical consultation in various primary health care centres in the northern region of Oman. This study enrolled a total of 493 patients. The association between the advice of family members as a reason to seek health care and other predictors was analysed using multivariable logistic regression.
The data suggest that the advice of family members in care-seeking is strongly associated with gender, education, history of chronic illness, previous exposure to traditional medicine, and health education, as well as the history of immunisation.
These findings suggest that the advice of family members remains a strong catalyst for care-seeking in Oman. The psychosocial factors affecting care-seeking leading to underutilisation of services or otherwise are discussed.
Care-seeking behavior; Relatives’ advice; Clinical population; Oman; Arab/Islamic
The objective of this study was to evaluate the quality of diabetes care in Oman.
This was a cross-sectional observational study. Fifty percent of all those attending six general health centres in June 2005 were systematically selected for the study. Descriptive statistics were used to describe the data.
A total of 430 diabetic subjects were included. Just over 61% percent of the subjects were female (n = 263). The overall mean age of the cohort was 52 ± 12 years ranging from 6 to 84 years. Only 40% (n = 171) and 39% (n = 169) of the diabetics had their random blood sugar (RBS) and fasting blood sugar (FBS) documented, respectively. However, 79% (n = 339) had either RBS or FBS done according to the records. Documentation for the other measurements ranged from 74% (n = 317) for HbA1c and LDL (low density lipoproteins)-cholesterol to 95% (n = 409) for systolic and diastolic blood pressure (SBP/DBP) readings. A total of 58% (n = 249) of patients had non-missing values of HbA1c, SBP/DBP, total cholesterol, LDL-cholesterol, HDL (high density lipoproteins)-cholesterol, and triglycerides. Only 2.4% (6 out of 249 diabetics) were simultaneously within goal for HbA1c (<7%), SBP/DBP (<=130/80mmHg), total cholesterol (<5.2mmol/L), LDL-cholesterol (<3.3mmol/L), HDL-cholesterol (>1.1 – <1.68mmol/L), and triglycerides (<1.8mmol/L).
There was good documentation of values for the indicators used in the assessment of quality. However, the proportion (2.4%) of those meeting internationally recognised goals for the three diabetes-related factors was extremely low.
Quality; Diabetes; Indicators; Oman
To determine predictors associated with positive chest x-ray finding in patients presenting with non-traumatic chest pain in the Emergency Department (ED).
Health records, including the final radiology reports of all patients who presented with non-traumatic chest pain and had a chest x-ray performed in an urban Canadian tertiary care ED over four consecutive months were reviewed. Demographic and clinical variables were also extracted. Chest x-ray findings were categorized as normal (either normal or no significant change from previous x-rays) or abnormal. Descriptive statistics were used to describe the data. Multivariable logistic regression was used to determine the association between various predictors and chest x-ray finding (positive/negative).
The 330 study patients had the following characteristics: mean age 58±20 years; female 41% (n=134). Patients’ chief complaints were only chest pain 75% (n=248), chest pain with shortness of breath 12% (n=41), chest pain with palpitation 4% (n=14), chest pain with other complaints 9% (n=28). Chest x-rays were reported as normal or no acute changes in 81% (n=266) of patients, and abnormal in 19% (n=64) of patients. The most common abnormal chest x-ray diagnoses were congestive heart failure (n=28; 8%) and pneumonia (n=17; 5%). Those with abnormal chest x-ray findings were significantly older (71 versus 55 years; p<0.001), had chest pain with shortness of breath (36% versus 11%; p<0.001), had significant past medical history (39% versus 14%; p<0.001), and were also tachypnoic (31% versus 12%; p<0.001).
This study found that patients with non-traumatic chest pain are likely to have a normal chest x-ray if they were young, not tachypnoeic or short of breath, and had no significant past medical history. A larger study is required to confirm these findings.
Despite its impact on health policy, the relationship between geographical proximity and health care seeking has received scant attention in the medical literature. This paper aims to evaluate the relationship between geographic proximity and health care usage behaviour among patients seeking medical consultation in the northern region of Oman.
During 2006–2007, data was collected via face-to-face interviews among 428 randomized patients seeking medical consultation in various primary health care centres in the northern region of Oman. The association between geographical proximity as a reason to seek health care and other predictors was also analysed using multivariable logistic regression.
The data suggest that preference for geographical proximity as a reason for seeking health care is strongly associated with marital status, previous exposure to traditional medicine and health education, as well as history of immunisation.
This finding supports the view from elsewhere that geographical proximity remains a strong catalyst for care seeking in Oman. The psychosocial factors affecting care seeking are discussed.
Geographic proximity; Health care utilization; Arab/Islamic; Clinical-based study; Oman
Errors have been the concern of providers and consumers of health care services. However, consumers' perception of medical errors in developing countries is rarely explored. The aim of this study is to assess community members' perceptions about medical errors and to analyse the factors affecting this perception in one Middle East country, Oman.
Face to face interviews were conducted with heads of 212 households in two villages in North Al-Batinah region of Oman selected because of close proximity to the Sultan Qaboos University (SQU), Muscat, Oman. Participants' perceived knowledge about medical errors was assessed. Responses were coded and categorised. Analyses were performed using Pearson's χ2, Fisher's exact tests, and multivariate logistic regression model wherever appropriate.
Seventy-eight percent (n = 165) of participants believed they knew what was meant by medical errors. Of these, 34% and 26.5% related medical errors to wrong medications or diagnoses, respectively. Understanding of medical errors was correlated inversely with age and positively with family income. Multivariate logistic regression revealed that a one-year increase in age was associated with a 4% reduction in perceived knowledge of medical errors (CI: 1% to 7%; p = 0.045). The study found that 49% of those who believed they knew the meaning of medical errors had experienced such errors. The most common consequence of the errors was severe pain (45%). Of the 165 informed participants, 49% felt that an uncaring health care professional was the main cause of medical errors. Younger participants were able to list more possible causes of medical errors than were older subjects (Incident Rate Ratio of 0.98; p < 0.001).
The majority of participants believed they knew the meaning of medical errors. Younger participants were more likely to be aware of such errors and could list one or more causes.
This report presents the results of treatment of two adults, at the Pain Center of Montreal General Hospital, Canada, with intravenous lidocaine for intractable orofacial pain. Repeated lidocaine infusions (1mg/kg in a bolus, followed by 4mg/kg infused over 1 hour) resulted in satisfactory pain relief in both patients, and the drug was well tolerated. Intravenous lidocaine therapy may be considered for intractable orofacial pain; further research is warranted.
Facial pain; Lidocaine; Therapeutics; Humans; Review; Literature; Case reports; Canada
To evaluate the prevalence of hypertension, its control and management at Sultan Qaboos University (SQU) Health Centre, Oman.
This was a retrospective cross-sectional study, in which were enrolled all the subjects (≥18 years), with the diagnosis of essential hypertension, who attended the SQU Health Centre between 1998 and 2002. The systolic and diastolic blood pressure (BP) values of the last three visits were used for analysis. BP control was defined using the Joint National Committee (JNC-7) criteria, <140 mmHg and <90 mmHg for systolic and diastolic BPs, respectively. Analyses were performed using univariate statistics.
Among the 7,702 medical records reviewed, the prevalence of hypertension was 2.4% (n = 187). The overall mean age of the cohort was 55±11 years, 54% (n = 101) were females, and majority of the subjects were Omanis (n = 123; 66%). The proportion of subjects who had their BP controlled was 41% (n = 77) with Omanis significantly less likely to have their BP controlled compared to non-Omanis (53% versus 35%; p = 0.017). The majority of the subjects were on mono (n = 131; 70%) followed by dual (n = 50; 27%) anti-hypertensive therapies. The most frequent mono anti-hypertensive therapies were B-blockers (n = 64; 34%) and angiotensin-converting enzyme (ACE) inhibitors (n = 47; 25%). Among the dual combination therapies, the most common prescribed regimens were ACE inhibitor plus B-blocker (n = 14; 28%) and B-blocker plus diuretic (n = 12; 24%).
The prevalence of hypertension in this patient population was low compared to the national average. This study shows that control of hypertension is not optimal, but higher than those reported elsewhere.
Hypertension; Prevention and control; Disease management; Oman
To evaluate the prevalence of hypoparathyroidism in adult transfusion-dependent patients with beta-thalassemia major in a teaching referral hospital in Oman.
All adult (>13 years) patients with beta-thalassemia major seen at Royal Hospital in Oman between 2004 and 2006 were studied. Demographic, pharmaceutical, clinical and biochemical data were collected for all the subjects. Analyses were performed using both descriptive and univariate statistics.
A total of 31 patients were included into the study with an overall mean age of 19±3 years ranging from 14 to 30 years. Just over half of the subjects were males (n=16; 52%). All the patients were on hypertransfusion and combined chelation therapy with desferrioxamine 40–60 mg/kg 5 days per week and deferiprone 75 mg/kg/day. Three of the patients had low levels of parathyroid hormone (<1.6 pmol/l). A further three patients had normal levels of parathyroid hormone (1.6 – 9.3 pmol/l) in the presence of low serum calcium levels (<2.1 mmol/l). These patients (with normal hypoparathyroid hormone levels, but lower calcium levels) were also defined to have hypoparathyroidism bringing the total prevalence of hypoparathyroidism in this cohort of adult patients with Beta-thalassemia major to 19% (6 out of 31). The patients with hypoparathyroidism had statistically significantly lower levels of parathyroid hormone (2.7 versus 5.3 pmol/l; p=0.031) and serum calcium (1.7 versus 2.3 pmol/l; p=0.004) compared to those without hypoparathyroidism.
The prevalence of hypoparathyroidism in adult beta-thalassemia major patients at this referral center was significantly higher (19%) than those reported elsewhere (2.5 and 10.7%).
Hypoparathyroidism; Thalassemia major; Beta-thalassemia; Oman
The percentage of Omani physicians from total number of physicians working in the Sultanate tripled from 9% in 1999 to 27% in 2006 and is expected to increase to 50% by 2010. The study aimed to asses community attitudes towards Omani doctors and to investigate the different socio-demographic variables related to these attitudes.
It was done in two selected Primary Health Care (PHC) facilities by simple random technique in Batinah region. Face-to-face interview was made on 305 randomly selected samples of PHC customers by trained researchers from Sultan Qaboos University (SQU). Omani Doctors Acceptance Scale (ODAS) was adapted and used to assess participants acceptance of the communication skills of the Omani doctor, care to the patient, absence of language barrier, competence level, preference to be seen by doctor from the same sex, embarrassment from seeing an Omani doctor, qualification, experience, knowledge and skills of the Omani experience of the Omani doctor, and trust on the Omani doctor. Chi squared tests of significance was used in analysis.
Males reported more satisfaction about communication skills of the Omani doctors, whereas female respondents reported higher likelihood of being embarrassed from the latter. Elder age cohort, those reported ever treated by an Omani doctor, married respondents, and those of lower level of education were more likely to report higher level of acceptance than others. Those aged 26-40 and those above 40 years of age were 2.41 and 3.41 times higher than the youngest age cohort respectively. Similarly, older age cohort reported having more trust than the middle age respondents relatively to the youngest age group.
The current study showed an accepted level of acceptance to Omani doctors. Looking for crucial issues in patient-doctor relationships as acceptance, satisfaction, trust, gender preference especially for PHC doctors ensure the continuity of care.
From a recently instituted web-based pituitary tumour registry at Sultan Qaboos University Hospital, Oman, this study explores the results of comprehensive clinical evaluation, hormonal levels, radiological evidence of pituitary mass lesion using magnetic resonance (MRI) and the different treatment modalities.
All patients who were diagnosed with pituitary mass tumours in our tertiary care endocrinology clinic between January 1998 and February 2006 were registered in the Oman pituitary tumour registry. Two physicians performed hospital chart review and data entry.
A total of 160 entries were made into the pituitary tumour registry. The overall mean age of the cohort was 32 ±12 years (age range 8–73 years). The majority of registrations were female (n=114; 71%). There were 81 patients with non-functioning adenomas (50.6%), 59 with prolactinoma (36.9%) eight with acromegaly (5%), seven with craniopharyngioma (4.4%), four with Cushing’s disease (2.5%) and one with sarcoidosis (0.6%). Sub-group analyses were done only for the subjects with the 3 most prevalent pituitary tumours (non-functioning adenomas, prolactinomas, and acromegaly). The most prevalent symptoms are amenorrhea-galactorrhea (n=55; 37%), headache (n=31; 21%) and fatigue (n=23; 16%). The most common treatment modality was medical (n=58; 39%), followed by observation (n=56; 38%), surgery (n=31; 21%) and surgery plus medical (n=3; 2%). None of the patients in this registry are recorded to have died.
To our knowledge, this is the first pituitary tumour registry in the Arabian Gulf countries using a web-based programme. This tumour registry will enable us to characterize clinical and the epidemiological features of pituitary tumours in the Sultanate of Oman.
Pituitary adenomas; Registry; Oman; Clinical; Epidemiology