Transfusion knowledge of medical and surgical specialty board residents: a cohort study.

OBJECTIVES: This study was conducted to assess transfusion knowledge between different specialty board residents and to identify areas of need for further education. BACKGROUND: Physicians' knowledge of transfusion medicine (TM) is critical for patients' safety. Many clinicians who are involved in day-to-day transfusion practice have little or no formal training in TM. There are no studies to assess physician's TM knowledge locally. METHODS: A comprehensive anonymous survey was developed to assess baseline TM knowledge of all the residents. The survey is composed of different sections, including a questionnaire on resident's demographics, resident's self-reflection on their TM knowledge and 30 multiple choice questions addressing basic and clinical TM knowledge in two major domains: component selection and transfusion practice and transfusion safety and transfusion reactions. Finally, the residents' opinion on educational needs was assessed. RESULTS: A total of 130 residents were surveyed. The lowest score obtained among the two major domains assessed was in the transfusion safety and transfusion reaction domain, with a mean score of 4·34 of 15 (SD ± 3·27). The mean score obtained on component selection and transfusion practice was 7·1 of 15 (SD ± 3·74). A substantial proportion of the residents (74·7%) admitted minimal baseline knowledge in the field of TM. Finally, 94·5% of the residents admitted the need for more education during residency, whereas 49·5% thought additional education is required during the first year of practice. CONCLUSION: This survey shows serious TM knowledge deficiency and indicates the need for additional education among all physicians during training.

Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study.

BACKGROUND AND OBJECTIVES: The cell saver (CS) has been widely utilized in cardiac surgery to reduce red blood cell (RBC) transfusion. We aim at examining its effect on the rate of allogeneic transfusion, morbidity and mortality in our population. MATERIALS AND METHODS: Retrospective review of all patients operated at the Sultan Qaboos University Hospital between 2008 and 2013 was performed. Patients' demographics, comorbidities and surgical details were retrieved. Study end-points included blood transfusion, infection, renal failure and mortality. Baseline characteristics of both groups were compared and differences were adjusted for in the multivariable logistic regression. RESULTS: A total of 673 patients were included (CS = 395, non-CS = 278). Baseline characteristics were similar except for systemic hypertension, congestive heart failure and use of cardiopulmonary bypass. The CS group had higher transfusion rates of platelets (CS 36% vs. non-CS 18%; P < 0·001) and plasma (CS 31% vs. non-CS 19%; P < 0·001). After adjusting for baseline differences, CS use increased the odds of receiving platelet transfusion (odds ratio (OR) 3·2; P < 0·001) but not of plasma transfusion (OR 1·6; P = 0·087). There was no difference in the rate of RBC transfusion (CS 45% vs. non-CS 40%; P = 0·212), renal failure (CS 11% vs. non-CS 6%; P = 0·139), infection (CS 16% vs. non-CS 13%; P = 0·434) and mortality (CS 5% vs. non-CS 2%; P = 0·146). CONCLUSION: The CS use increases platelet requirements and has no impact on the rate of RBC transfusion in our population. These findings warrant caution with generalized use and require larger studies to confirm its results.

Transfusion indication predictive score: a proposed risk stratification score for perioperative red blood cell transfusion in cardiac surgery.

BACKGROUND AND OBJECTIVES: Red blood cell transfusion is known to be associated with increased morbidity and mortality in cardiac surgery. This study was performed to derive a score to predict that risk in our patients. MATERIALS AND METHODS: Clinical details of patients who underwent cardiac surgery at the Sultan Qaboos University Hospital over 5 years were reviewed. We used univariable and multivariable logistic regression to develop the score, the Hosmer-Lemeshow test for calibration, the receiver operator curve for discrimination and the bootstrap procedure for internal validation. RESULTS: The sample included 413 patients. The following were found to be statistically significant transfusion predictors (score given): cerebrovascular disease (4), use of aspirin or clopidogril within 7 days of surgery (3), non-elective surgery (2), haematocrit <35% (2), glucose-6-phosphate dehydrogenase (G6PD) deficiency (2), use of cardiopulmonary bypass (2), age > 60 years (1), diabetes mellitus (1) and male gender (-2). We classified the observations into three groups: group 1 with total score of <2, group 2 with total score of 2-5 and group 3 with total score of >5. The calculated probabilities of receiving transfusion were 42%, 63% and 91% for groups 1, 2 and 3 respectively. CONCLUSION: We derived a simple score that can be utilized to assess the need of blood transfusion in patients undergoing cardiac surgery. We are the first to report G6PD deficiency and history of cerebrovascular disease as predictors. We recommend prospective external validation of the proposed score on a larger cohort of patients.

Telenomus nizwaensis (Hymenoptera: Scelionidae), an important egg parasitoid of the pomegranate butterfly Deudorix livia Klug (Lepidoptera: Lycaenidae) in Oman.

The pomegranate butterfly Deudorix (= Virachola) livia is the major pest of pomegranate, a crop of economic importance, in Oman. A species of parasitoid wasp in the hymenopteran family Scelionidae is responsible for high levels of mortality of its eggs. This wasp is described herein as Telenomus nizwaensis Polaszek sp. n., based on morphology and DNA sequence data. T. nizwaensis is currently known only from D. livia, which is also a pest of economic importance on other crops in North Africa, the Arabian Peninsula, and the Mediterranean. We summarise current knowledge of T. nizwaensis life-history and its potential to provide biological pest control.

The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spurred a global health crisis. The safety and supply of blood during this pandemic has been a concern of blood banks and transfusion services as it is expected to adversely affect blood system activities. We aim to assess the situation in the Eastern Mediterranean Region (EMR) during the first months of the pandemic. MATERIALS AND METHODS: A survey was designed to address blood supply, transfusion demand, and donor management during the coronavirus disease-19 (COVID-19) pandemic. Medical directors of different blood banks were invited to participate. RESULTS: A total of 16 centers participated with representation from 15/19 countries in the region. In total, 75% were from national blood banks. Most centres had a decrease in the blood supply, ranging from 26-50%. Representatives from 14 countries (93.3%) believed that public fear has contributed to a decrease in donations. Most centres (n=12, 75%) had a reduction in transfusion demand, while those who did not, reported heavy involvement in treating patients with underlying haemoglobinopathies and haematological malignancies. Half of the centres activated their contingency plans. Four centres had to alter the blood donor eligibility criteria to meet demands. All centres implemented donor deferral criteria in relation to SARS-CoV-2, but were variable in measures to mitigate the risk of donor and staff exposure. CONCLUSION: Blood services in the region faced variable degrees of blood shortages. We summarize lessons learnt during this pandemic for the blood banks to consider to plan, assess, and respond proportionately to future similar pandemics.

Nutrition knowledge, beliefs and dietary habits among elderly people in Nizwa, Oman: implications for policy.

The nutritional needs of the ageing population require special attention. We undertook a cross-sectional, community-based, household survey in Nizwa wilayat, Oman to study nutrition-related knowledge and beliefs and self-reported dietary habits among a sample of elderly people. The response rate for the household interview was 99.3% from a total sample of 2041. About 45% of the elderly were overweight or obese. Overall we found poor knowledge of nutrition plus some nutritional imbalances and low levels of physical activity. Significant sex differences existed in elderly peoples' nutritional knowledge, consumption of fluids, milk and sweets, use of dietary regimens and experience of appetite change. The findings warrant reorientation of the existing health promotion strategy for the elderly.

Correlation between flow cytometry and molecular findings in autosomal recessive chronic granulomatous disease: A cohort study from Oman.

BACKGROUND: Chronic granulomatous disease (CGD) is an X-linked (XL) or autosomal recessive (AR) primary immunodeficiency disease. Respiratory burst assessment by flow cytometry is a rapid test of granulocyte stimulation, and results predict the underlying genotype. This study aims to describe the immune-phenotypic profile of patients with CGD diagnosed in our center and correlate that with underlying genetic mutations. METHODS: Immuno-phenotypic and genetic data on all patients with CGD diagnosed at Sultan Qaboos University Hospital (SQUH) were reviewed. RESULTS: A total of 32 patients were diagnosed with CGD using molecular studies. Genetically confirmed individuals included 1 patient with XL-CGD (a large deletion involving the CYBB and XK genes resulting in a McLeod phenotype), 27 patients with AR-CGD with a c.579G>A (p.Trp193X) mutation at the NCF1 gene, and 4 patients with AR-CGD with a c.784G>A (p.Gly262Ser) mutation at the NCF1 gene. Flow cytometry and molecular results were available for comparison in 26 patients with AR-CGD. The patients with AR-CGD had a range of flow cytometry-generated fluorescent patterns as follows: reduced neutrophil stimulation with a sharp peak (12/26), reduced neutrophil stimulation with a broad peak (11/26), and a complete lack of neutrophil stimulation (3/26). No consistent flow cytometry-generated fluorescent pattern was observed in either of the 2 AR mutations identified in our patients. CONCLUSION: Flow cytometry is a robust test of CGD diagnosis. However, results should be interpreted with caution when predicting the underlying probable genotype, and results need to be complemented with definitive molecular studies.

Depressive symptoms among high school adolescents in Oman.

We used the self-reported 27-item Child Depression Inventory to investigate the rate and correlates of depressive symptoms among 5409 secondary school adolescents in Oman. Being female was a significant predictor of adolescent depression in bivariate analysis, but adjusting to other predictors in multivariate analysis, it was no longer a significant independent risk factor. History of mental illness, high score in negative health locus of control, low score in positive health locus of control, not taking breakfast, poor relationship with family members, friends and teachers and physical abuse during adolescence significantly predicted depressive symptoms in the logistic regression model. Having a hobby and never dropping a class were protective variables.

The oral health status of Omani 12-year-olds--a national survey.

This study reports the first ever national oral health survey of Omani 12-year-olds. Conducted in October 1993, of the 3,435 children examined, 1,438 (41.9%) were caries-free, although regional variations ranged from 24.8% to 61.9%. Overall, the national DMFT averaged 1.53, the majority of caries experienced being in the form of untreated decay, with occlusal surfaces of first permanent molars being the most commonly involved site. Oral hygiene was poor, only 11% of those examined being scored as plaque-free.

Prevalence of dental caries in Omani 6-year-old children.

OBJECTIVE: To determine the prevalence of dental caries in Omani 6-year-old children. DESIGN: Clinical caries cross-sectional survey, conducted by 16 trained and calibrated dentists. SETTING: Omani primary schools in December 1994. SUBJECTS: 3,114 subjects, randomly selected to achieve an overall 6.6 per cent sample of Omani 6-year-old children. OUTCOME MEASURES: Caries diagnosis based solely on clinical examination in accordance with criteria of British Association for the Study of Community Dentistry. RESULTS: Only 484 subjects (15.5 per cent) were caries-free; regional variations ranging from 4.4 per cent to 31 per cent. Overall, the national dmft averaged 4.61; the majority of caries experienced being in the form of untreated decay, with occlusal surfaces of first primary molars being the most commonly involved site. CONCLUSIONS: Compared with results from a survey of Omani 12-year-old children in 1993, a much smaller proportion of this 6-year-old sample were caries free, emphasising the need for continuance of existing, and the development of further, preventive programmes.

Distribution and correlates of total impaired fasting glucose in Oman.

To determine the distribution and correlates of total impaired fasting glucose in Oman, we conducted a cross-sectional survey of 1968 households with 7011 eligible residents in 2000. During face-to-face interviews, demographic data, blood pressure, fasting blood glucose, serum cholesterol, weight, height and waist and hip measurements were obtained. Of 5788 subjects tested for total impaired fasting glucose (response rate: 83%), crude prevalence was 17.3% and age-adjusted prevalence was 20.3%. Associated factors in bivariate analysis were older age, male gender, lower education, hypercholesterolaemia, being married, obesity, abnormal waist to hip ratio and hypertension. Total impaired fasting glucose is a significant public health problem in Oman. Increasing the awareness of health care providers and community through health education is crucial.

A community-based study of common hereditary blood disorders in Oman.

We assessed the prevalence of three common hereditary blood disorders (sickle-cell and beta-thalassaemia traits and glucose 6-phosphate dehydrogenase deficiency) among the Omani population. We interviewed a representative sample of 6103 Omani households and blood samples from 6342 children aged 0-5 years were collected. About 27% of Omani males had inherited glucose-6-phosphate dehydrogenase deficiency (compared with 11% of females) while countrywide prevalence rates for the sickle-cell and beta-thalassaemia traits were estimated to be 5.8% and 2.2% respectively and showed no significant gender differences. There was a significant association between all three disorders and region of the country.

Clustering of cardiovascular risk factors among Omani adults.

To determine the distribution and correlates of clustering of cardiovascular disease (CVD) risk factors, data from the Oman National Health Survey, 2000 were analysed. Based on demographic data (blood pressure, fasting blood glucose, serum cholesterol, weight, height, waist and hip measurements), 5660 subjects were grouped according to how many of four CVD risk factors (hypertension, high cholesterol, diabetes, overweight/obesity) they had. We found that 72% of subjects had less than one risk factor and 2% had all four. Older age exacerbated risk, while living in rural areas or being single was protective. Metabolic cardiovascular syndrome is a public health problem in Oman. Increasing awareness in healthcare providers and the wider population by comprehensive dissemination of the survey results is crucial.

Smoking in Oman: prevalence and characteristics of smokers.

We carried out a cross-sectional survey to study the prevalence and the characteristics of current and former smoking among Omani adults. Crude prevalence of current smoking was 7.0% (males 13.4%, females 0.5%); 2.3% were former smokers. The overall highest prevalence of current smoking (11.1%) was observed in those 40-49 years (18.7% of males, 0.9% of females). Older age (> or = 40 years), higher educational level and larger family size were protective against smoking. Mean age for starting smoking was 18.7 years for males and 24.3 years for females. Although smoking prevalence is low in Oman, prevention should be addressed in health education programmes, with the emphasis on heightening awareness in adolescents. Government action, e.g. tobacco taxation, clean air laws and bans on advertising, is also recommended.

Potential pitfalls in the diagnosis of Hb Handsworth in areas with high prevalence of HbS.

Hb Handsworth is a rare α-globin structural variant caused by a missense mutation either on the α2 or α1-globin gene (HBA2 or HBA1: c.55G>C, p.Gly18Arg). This variant might be erroneously diagnosed as HbS unless secondary confirmative tests are carried out. We encountered a child with a prominent peak eluting in the 'S' window on high-performance liquid chromatography (HPLC). Sickle solubility test, gel electrophoresis, and selective direct nucleotide sequencing of α1, α2, and ß globin genes were performed on the patient's sample. In addition, previous HPLC results on a cord blood sample were retrieved. Sickle solubility test was negative. Gel electrophoresis revealed a band migrating at the S region with an extra faint band seen on acid gel electrophoresis. Molecular analysis of α2 globin gene revealed heterozygous state of Hb Handsworth. Hb Handsworth is a rare variant that can mimic HbS on HPLC. Failure to recognize this rare variant in regions where HbS is highly prevalent may result in serious misdiagnosis and subsequent incorrect genetic counseling.

The pneumatic tube system does not affect complete blood count results; a validation study at a tertiary care hospital.

INTRODUCTION: Effect of the pneumatic tube system (PTS) on sample quality is controversial. Herein we aim at evaluating the impact of sample transportation via the PTS on complete blood count (CBC) results. METHODS: Duplicate CBC samples from normal donors and anemic patients were sent in parallel to the laboratory for testing through the PTS and the courier (CO). We used scatter plots, Bland-Altman plots, correlation coefficient (r), and coefficient of determination for the validation. RESULTS: A total of 115 samples (donors: 59, patients: 56) were tested. There was excellent correlation between both methods for red blood cell parameters (r range = 0.9213-0.9958) and platelet count. White blood cell (WBC) count and differential count showed similar results (r range = 0.8605-0.9821) for all, with exception of basophils which showed modest correlation (r = 0.4827 for patients and 0.5758 for normal donors). Most of the differences in measurement of all CBC parameters were within the 95% confidence interval of the mean difference on Bland-Altman plots. CONCLUSION: Modern PTS can be safely used for transporting CBC samples.

The construction of a monoclonal diagnostic system for the field detection of Vibrio cholerae.

An enzyme-based double monoclonal field diagnostic system detecting both serotypes of Vibrio cholerae has been developed. The system uses nitrocellulose as a solid support, 1.25% skimmed dried milk as blocking reagent, water as washing reagent, and alkaline phosphatase cross-linked to antibody by means of glutaraldehyde as detecting reagent. The sensitivity of the system was 10(5) vibrios/ml. The biotin-avidin system gave sensitivity an order of magnitude weaker. There were no cross-reactions with the range of other bacteria tested.

Oman Family Health Survey 1995.

Rapid improvements have been occurring in public health and in individual health status in the Sultanate of Oman as a result of the 5-year health development plans that have been implemented since 1976, and also because of accelerated socioeconomic progress. A nationwide health survey was conducted in 1995 as part of the Gulf Family Health Project of the Council of Health Ministers of GCC States. This paper describes the survey methodology used and the results. In the process of rapid epidemiologic transition currently occurring in the country the survey results provide a perspective of public health in the Sultanate of Oman.