A Comparison of Two Scales to Determine Prevalence of Mood Disorders in Omani Patients Recently Diagnosed with Cancer.

OBJECTIVES: Studies on the prevalence rate of mood disorders in patients recently diagnosed with cancer from Middle East are scare in the literature. Therefore, this study assesses the prevalence rates of anxiety and depression, and their associations with socio-demographic factors, in recently diagnosed patients with cancer living in the Sultanate of Oman. METHODS: In this prospective study, adult patients were interviewed within the first three months of diagnosis of cancer using the Hospital Anxiety and Depression Scale (HADS), and the Centre for Epidemiological Studies Depression (CES-D) Scale. Associations were studied among symptoms of anxiety and depression, and the socio-demographic factors, along with levels of agreement between the two scales. RESULTS: Eighty-nine patients were interviewed, and 65% were females. Using the HADS tool, 41.6% of patients had anxiety, 28% had depression, whereas 5.6% displayed severe depression. Using the CES-D tool, 41.6% of patients had depression, and 11.2% had severe depression. A fair correlation between the CES-D and HADS tools was evidenced with a Cohen's Kappa coefficient value of 0.37 (P<0.001). The socio-demographic factors were not significantly associated with the presence of anxiety and depression (P >0.05). CONCLUSION: Collectively, these findings indicate high prevalence rates of anxiety and depression in Omani patients recently diagnosed with cancer along with a significant correlation between the two scales. These results support the implementation of screening tools early in the trajectory of cancer illness to improve the overall healthcare of these patients.

Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman.

Objectives: This study aimed to determine extubation failure (EF) rate among intubated preterm infants (<37 weeks gestational age [GA]) admitted to a tertiary care neonatal intensive care unit (NICU) in Oman and identify the risk factors associated with EF. Methods: This retrospective study included all intubated preterm infants (<37 weeks GA) admitted to the NICU at Sultan Qaboos University Hospital (SQUH) from January 2013 to December 2017. EF was defined as reintubation within seven days of planned extubation. Demographics, ventilation parameters, blood gas values and other possible risk factors of EF were collected. Statistical analysis included comparisons between EF and extubation success (ES) groups and a binary logistic regression analysis. Results: A total of 190 preterm infants were intubated during the study period with 140 eligible for analysis. A total of 106 infants (75.7%) were successfully extubated while 34 (24.3%) failed extubation. GA <28 weeks (P = 0.029), lower 1-minute Apgar score (P = 0.023) and patent ductus arteriosus diagnosis (P = 0.018) were significantly associated with EF. After the multivariate analysis, only GA <28 weeks predicted EF with an adjusted odds ratio of 2.621 (95% confidence interval: 1.118 - 6.146). Conclusion: EF rate in preterm infants admitted at the NICU of SQUH was within international rates. GA <28 weeks was the only predictor of the identified extubation failure. Neonatal practitioners need to seriously consider extreme prematurity in the extubation process and consider implementing strategies to decrease extubation failure in this group of fragile infants.

Reliability of carbapenem inactivation method (CIM) and modified carbapenem inactivation method (mCIM) for detection of OXA-48-like and NDM-1.

PURPOSE: Carbapenem inactivation method (CIM) and modified carbapenem inactivation method (mCIM) were recently developed for rapid detection of carbapenemase producing Gram negative bacilli (CP-GNB). In this study we compared the ability of modified Hodge test (MHT), CIM and mCIM to identify CP-GNB in Oman and India. METHODS: Fifty fully characterized and genotyped CP-GNB (26 OXA-48-like, 2 NDM-1 from Oman and 22 NDM-1 from India) and 8 AmpC as controls in India were subjected to MHT, CIM, mCIM and mCIM with in-house modifications. Wilcoxon paired test and receiver operating characteristics (ROC) were utilised for statistical analysis. RESULTS: Isolates were predominantly OXA-48-like genes producing Klebsiella pneumoniae from Oman and NDM-1 producing Escherichia coli from India. MHT was positive in all except one OXA-48-like producers and in 70.8 â€‹% of the NDM-1 isolates. The sensitivity of CIM in detecting 0XA-48 like and NDM-1 carbapenemases were 39.2% and 87.5% respectively. mCIM at 4 â€‹h detected 92.3 â€‹% and 79.1% of 0XA-48 and NDM-1 respectively. Using receiver operative characteristics (ROC), highest sensitivity and specificity for detection of OXA-48-like was obtained by mCIM at 4 â€‹h at cut off 17 â€‹mm while for NDM-1 CIM was the test of choice at 16 â€‹mm. CONCLUSION: CIM and mCIM are simple, cheap and easy tests to perform. CIM gave excellent results with NDM1 strains while it was quite poor in predicting OXA-48-like. We recommend CIM and eCIM for rapid identification of NDM-1 producers and mCIM at 4 â€‹h and MHT for detection of OXA-48-like. No one method can correctly detect both genotypes. As determined by ROC curves a zone of inhibition of 17 â€‹mm was considered adequate for detection of OXA-48-like and 16 â€‹mm of NDM-1 by mCIM at 4 â€‹h and CIM respectively.

Experience of intravitreal triamcinolone acetonide for treatment of diabetic macular edema among Omani population.

PURPOSE: The purpose of this study was to evaluate the outcome of intravitreal (IVT) triamcinolone in diabetic macular edema (DME). MATERIALS AND METHODS: A retrospective study of 42 eyes diagnosed clinically and supported with optical coherence tomography (OCT), with DME of more than 300 µm in thickness. All eyes were injected with a single IVT injection of preservative free triamcinolone acetonide (TA) with dose of 4 mg. Patients were subjected to visual acuity (VA) and OCT on each follow-up visit which was continued for 6 months. The total number of IVT injections given was 48. Six eyes had a repeat injection. None of the eyes had any other IVT injection within 6 weeks of TA. Twenty-one eyes were pseudophakic. RESULTS: Mean age of the patients was 58.8 years. The mean central subfield thickness (CST) at baseline was 504.6 µm. At 6 weeks, the mean CST dropped by 183.6 µm (P < 0.00001). At 6-month follow-up, the mean CST had increased by 74.6 µm from 6 weeks level; however, the 6-month mean CST was 109 µ less than mean baseline thickness (P < 0.0005). The mean baseline VA was 0.80 LogMAR units. At 6 weeks, the mean VA dropped by 0.01 LogMAR. At 6 months, VA improved by 0.02 LogMAR units from baseline. Overall, VA improved in 47% eyes, dropped from baseline in 35% eyes, and remained unchanged in 18% eyes. CONCLUSION: Triamcinolone acetonide is a safe, effective, and promising therapy in DME.

Laparoscopic Adrenalectomy for Large Adrenocortical Carcinoma.

BACKGROUND: Adrenocortical cancer (ACC) is a rare disease that is difficult to treat. Laparoscopic adrenalectomy (LA) is performed, even for large adrenocortical carcinomas. However, the oncological effectiveness of LA remains unclear. This review presents the current knowledge of the feasibility and oncological effectiveness of laparoscopic surgery for ACC, with an analysis of data for outcomes and other parameters. DATABASE: A systematic review of the literature was performed by searching the PubMed and Medline databases for all relevant articles in English, published between January 1992 and August 2014 on LA for adrenocortical carcinoma. DISCUSSION: The search resulted in retrieval of 29 studies, of which 10 addressed the outcome of LA versus open adrenalectomy (OA) and included 844 patients eligible for this review. Among these, 206 patients had undergone LA approaches, and 638 patients had undergone OA. Among the 10 studies that compared the outcomes obtained with LA and OA for ACC, 5 noted no statistically significant difference between the 2 groups in the oncological outcomes of recurrence and disease-free survival, whereas the remaining 5 reported inferior outcomes in the LA group. Using a paired t test for statistical analysis, except for tumor size, we found no significant difference in local recurrence, peritoneal carcinomatosis, positive resection margin, and time to recurrence between the LA and OA groups. The overall mean tumor size in patients undergoing LA and OA was 7.1 and 11.2 cm, respectively (P = .0003), and the mean overall recurrence was 61.5 and 57.9%, respectively. The outcome of LA is believed to depend to a large extent on the size and stage of the lesion (I and II being favorable) and the surgical expertise in the center where the patient undergoes the operation. However, the present review shows no difference in the outcome between the 2 approaches across all stages. A poor outcome is likely to result from inadequate surgery, irrespective of whether the approach is open or laparoscopic.

The Effect of Residing Altitude on Levels of High-Density Lipoprotein Cholesterol: A Pilot Study From the Omani Arab Population.

Lower mortality rates from coronary heart disease and higher levels of serum high-density lipoprotein cholesterol (HDL-C) have been observed in populations residing at high altitude. However, this effect has not been investigated in Arab populations, which exhibit considerable genetic homogeneity. We assessed the relationship between residing altitude and HDL-C in 2 genetically similar Omani Arab populations residing at different altitudes. The association between the levels of HDL-C and other metabolic parameters was also investigated. The levels of HDL-C were significantly higher in the high-altitude group compared with the low-altitude group. Stepwise regression analysis showed that altitude was the most significant factor affecting HDL-C, followed by gender, serum triglycerides, and finally the 2-hour postprandial plasma glucose. This finding is consistent with previously published studies from other populations and should be taken into consideration when comparing cardiovascular risk factors in populations residing at different altitudes.

Heritability of ambulatory and beat-to-beat office blood pressure in large multigenerational Arab pedigrees: the 'Oman Family study'.

OBJECTIVE: To estimate the heritability of ambulatory blood pressure (BP), heart rate (HR), and beat-to-beat office BP and HR in an isolated, environmentally and genetically homogeneous Omani Arab population. METHODS: Ambulatory BP measurements were recorded in 1,124 subjects with a mean age of 33.8 ± 16.2 years, using the auscultatory mode of the validated Schiller ambulatory BP Monitor. Beat-to-beat BP and HR were recorded by the Task Force Monitor. Heritability was estimated using quantitative genetic analysis. This was achieved by applying the maximum-likelihood-based variance decomposition method implemented in SOLAR software. RESULTS: We detected statistically significant heritability estimates for office beat-to-beat, 24-hour, daytime, and sleep HR of 0.31, 0.21, 0.20, and 0.07, respectively. Heritability estimates in the above mentioned conditions for systolic BP (SBP)/diastolic BP (DBP)/mean BP (MBP)were all significant and estimated at 0.19/0.19/0.19, 0.30/0.44/0.41, 0.28/0.38/0.39, and 0.21/0.18/0.20,respectively. Heritability estimates for 24-hour and daytime ambulatory SBP, DBP, and MBP ranged from 0.28 to 0.44, and were higher than the heritability estimates for beat-to-beat recordings and sleep periods,which were estimated within a narrow range of 0.18-0.21. CONCLUSION: In this cohort, because shared environments are common to all, the environmental influence that occurs is primarily due to the variation in non-shared environment that is unique to the individual. We demonstrated significant heritability estimates for both beat-to-beat office and ambulatory BP and HR recordings, but 24-hour and daytime ambulatory heritabilities are higher than those from beat-to-beat resting levels and ambulatory night-time recordings.

Is performance in pre-clinical assessment a good predictor of the final Doctor of Medicine grade?

OBJECTIVE: To investigate if any correlation exists between students' grades on their final doctor of Medicine (MD) assessment and their overall preclinical grade point average (GPA) and its component parts. METHODS: Student data available from the Deanship of Admissions and Registration were analyzed. Pearson correlation coefficient was obtained to assess the degree of linear relationship between performance in the preclinical and the MD assessment of 529 students who graduated from the College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khoud, Oman from June 1998 to June 2005. Simple and multiple regression analyses were performed to evaluate individual and combined impact of the preclinical courses' grades on MD grades. RESULTS: Preclinical GPA correlated highly with MD GPA (r=0.641). The science component taught early in the preclinical phase correlated more strongly (r=0.457) than student electives (r=0.246). This correlation was better in the good English group. Students' performance, however, was best in electives, but worst in English. Most students who had low MD GPA (<2.0) had also preclinical and science GPA of <2.5. The students with low GPA were found to spend longer in the medical program. CONCLUSION: Restricting progression to the clinical phase to those students whose preclinical GPA is >2.5, and limiting the credit hour requirement of electives by the College seems to be justified.

In vivo morphometry of corneal endothelial cells in pseudoexfoliation keratopathy with glaucoma and cataract.

BACKGROUND: This study was designed to define correlations between in vivo morphometric and demographic data of pseudoexfoliation (PEX) keratopathy patients from Omani Arab origin with cataract and glaucoma. METHODS: In a non-randomized controlled comparative case series, 69 adult patients (43 males and 26 females) with 78 cataract and 48 glaucoma eyes with corneal PEX material were assessed by confocal biomicroscopy (Confoscan 2, Nidek) and values compared to normative US and Omani Arab population values. Descriptive statistics. RESULTS: The mean age of glaucoma patients was 60.81 +/- 8.33 years, of cataract patients 64.65 +/- 6.67 years; 109/126 eyes (74%) were from patients >60 years old (14 glaucoma and 95 cataract eyes). Age-adjusted endothelial cell counts were similar to normative values in 108/126 eyes (85.7%). Polymegathism and pleomorphism were abnormal in 124/126 (98.4%) and 122/126 eyes (96.8%), respectively. The correlation of pleomorphism and polymegathism with males (R(2) = 0.6378, p = 0.05) was stronger than with females (R(2) = 0.6024, p = 0.06), and stronger for patients <60 years (R(2) = 0.7268, p = 0.01) than >60 years old (R(2) = 0.5805, p = 0.01). Cataracts: Endothelial cell counts were normal (mean 2,483 +/- 511.2). Pleomorphism was 33.12 +/- 11.44% and different from Omani Arab controls (p < 0.01), polymegathism 58.14 +/- 16.58% (p <0.01). Glaucomas: Endothelial cell counts were normal (mean: 2,438 +/- 503). Pleomorphism and polymegathism were 37.09 +/- 12.43% (p < 0.01) and 59.69 +/- 16.79% (p < 0.01), respectively. Pleomorphism and polymegathism were more associated with glaucomas (R(2) = 0.7652, p = 0.02) than with cataracts (R(2) = 0.6041, p = 0.06). CONCLUSIONS: Endothelial cell polymegathism and pleomorphism in PEX keratopathy with glaucoma is more frequently associated with age <60 years and male gender than with cataract.

Acylation-stimulating protein increases and correlates with increased progesterone levels during the luteal phase of the menstrual cycle.

OBJECTIVE: The menstrual cycle represents a continuous state of change in terms of female sex steroid environment. Progesterone is linked to increased fat storage while estrogen exerts anti-lipogenic effects. This study investigated variations in the potent lipogenic factor acylation-stimulating protein (ASP), and examined its association with hormonal and lipid profile alterations across the menstrual cycle. METHODS AND DESIGN: Nineteen non-obese women with regular menstrual cycles were investigated in a longitudinal study during the follicular, ovulatory, and mid-luteal phases (ML) of the cycle. Fasting ASP, LH, FSH, progesterone, estradiol, insulin, lipid profile, and apoproteins were evaluated during different phases of the cycle. RESULTS: ASP levels changed significantly throughout the menstrual cycle (K-related Friedman test: P=0.013). Interestingly, these changes coincide with variations in progesterone levels across the cycle as no significant change in the ASP levels was seen across the follicular phases of the cycle, followed by a significant increase in the ovulatory phase, which continued to elevate toward the ML. The ASP levels correlated positively with the progesterone levels normally elevated in the ML. No significant correlation was seen between ASP and estrogen or any other measured female hormone. Multiple regression analysis including all measured parameters and body mass index showed that progesterone was the only significant predictor of the ASP levels. CONCLUSION: Our findings suggest that during the menstrual cycle of normal women, the ASP levels coincidentally fluctuate with the progesterone levels, possibly reflecting cooperation between them in fat storage enhancement.

Subjective and quantitative measurement of wavefront aberrations in nuclear cataracts - a retrospective case controlled study.

PURPOSE: To measure, quantify and compare Ocular Aberrations due to nuclear cataracts. SETTING: Department of ophthalmology and school for ophthalmic technicians, college of medicine and health sciences, Sultan Qaboos University, Muscat, Oman. DESIGN: Retrospective case controlled study. METHODS: 113 eyes of 77 patients with nuclear cataract (NC) were recruited from outpatient clinic of a major tertiary referral center for Ophthalmology. Patients having NC with no co-existing ocular pathologies were selected. All patients were subjected to wavefront aberrometry (make) using Hartmann-Shack (HS) aberrometer. Consents were taken from all patients. Higher order Aberrations (HOA) were calculated with Zernike polynomials up to the fourth order. For comparison 28 eyes of 15 subjects with no lenticular opacities (control group) were recruited and evaluated in an identical manner. No pupillary mydriasis was done in both groups. RESULTS: Total aberrations were almost six times higher in NC group compared to control (normal) subjects. The HOA were 21 times higher in NC group, and coma was significantly higher in NC eyes compared to normal (control) group. The pupillary diameter was significantly larger in control group (5.48mm +/- 1.0024, p<.001) compared to NC (3.05mm +/- 1.9145) subjects (probably due to younger control age group). Amongst Zernike coefficients up to fourth order, two polynomials, defocus (Z(2) (0)) and spherical aberration (Z(4) (2)) were found to be significantly greater amongst NC group, compared to normal control group. CONCLUSION: Nuclear cataracts predominantly produce increased defocus and spherical aberrations. This could explain visual symptoms like image deterioration in spite of normal Visual acuity.

Polyhydramnios. Risk factors and outcome.

OBJECTIVE: To determine the risk factors associated with polyhydramnios, and assess the maternal and perinatal outcome in these patients. METHODS: A prospective study of all deliveries complicated with polyhydramnios in Sultan Qaboos University Hospital, Sultanate of Oman between January 2005 and April 2006. Polyhydramnios was divided into mild and moderate to severe based on the amniotic fluid index values. The demographic data, antenatal complications, gestational age at delivery, mode of delivery, postpartum complications, and perinatal outcome were studied. RESULTS: A total of 2648 singleton deliveries occurred during the study period. Two hundred and eight (7.8%) women with polyhydramnios formed the study group, and 2440 women with normal amniotic fluid formed the control. Polyhydramnios was mild in 179 (86.1%) and moderate to severe in 29 (13.9%) cases. Sixty-eight (32.7%) of these pregnancies were complicated with diabetes as compared with 12.4% of the controls. Preterm delivery occurred in 16 (7.7%) cases. Cesarean delivery rate was 27.9% in the study group compared with 17.3% in the control. Major congenital anomalies were found in 2.8% of newborns compared with 1% among the controls. Eighteen babies were admitted to the special care baby unit. CONCLUSION: These data demonstrates a significant positive relation with maternal age, diabetes in pregnancy, and fetal macrosomia with polyhydramnios. Anemia during pregnancy, cesarean delivery rate, and congenital anomalies were significantly higher in the study group.

Quantitative and qualitative corneal endothelial morphology of omani patients with pseudoexfoliation syndrome.

OBJECTIVE: Pseudoexfoliation (PEX) syndrome is one of the leading causes of secondary open angle glaucoma and blindness. This study explored whether in PEX eyes, preoperative changes in corneal endothelial cell morphology might be a risk factor for postoperative corneal decompensation. METHODS: One hundred twenty six eyes of 69 preoperative cataract patients (43 males, 26 females) were enrolled in this cross-sectional study from the Ophthalmology Department at Sultan Qaboos University Hospital between 2003-2005. All patients were subjected to confocal biomicroscopy. RESULTS: The mean age of patients with PEX eyes was 63.2 years. One hundred and eight (85.7%) eyes with PEX had endothelial cell counts within the normal range (1650-3500/mm(2)). The qualitative morphology of the endothelium of PEX corneas was highly abnormal in term of polymegathism and pleomorphism. Twelve eyes had endothelial cell counts higher than normal for that age group. Only 6 eyes had endothelial cell counts lower than normal. The mean value for the pleomorphism was found to be significantly lower than normal and for polymegathism significantly more than normal. The relationship between pleomorphism and polymegathism was stronger for males than for females and stronger for patients under 60 years than patients over 60 years. The same relationship between pleomorphism and polymegathism showed a stronger relationship for the glaucoma group as compared to the non-glaucoma group. CONCLUSION: This study revealed that corneal decompensation in PEX eyes can occur in presence of abnormalities in polymegathism and pleomorphism, even when the endothelial cell counts may be normal.

Use of intravenous sulprostone for the termination of pregnancy with fetal death in second and early third trimester of pregnancy.

OBJECTIVE: To study the efficacy of intravenous sulprostone (Nalador) for the termination of pregnancy with fetal death in second and early third trimester of pregnancy. METHODS: This is a retrospective collection and analysis of data from a cohort of 97 women with fetal death between 12-30 weeks gestation treated with intravenous infusion of a prostaglandin analogue, sulprostone, to achieve expulsion of the products of conception. It was conducted in the Department of Obstetrics and Gynaecology, Sultan Qaboos University Hospital, Oman. The data collected was from January 2000 to December 2005. Sulprostone was started as an intravenous infusion of 15µgm/hr and titrated to a maximum of 240µgm/hr to a total dose of 1500µgm/day, as per the departmental protocol. The patients' demographic data, gestational age, induction-expulsion interval, the need for evacuation, side effects and complications were studied. RESULTS: Out of the 97 women who received sulprostone, 90 aborted within 24 hours. The average induction-expulsion interval was 11.9 ± 8.0 hours. Sulprostone use was associated with few side effects and was well tolerated by patients. Although most of the patients required evacuation and curettage, the blood loss was minimal. Only six out of 97 women required blood transfusions and two patients needed hysterotomy. CONCLUSION: We found sulprostone an efficient drug for termination of pregnancy with fetal death in second and early third trimester of pregnancy.

Non-dipping blood pressure in the metabolic syndrome among Arabs of the Oman family study.

OBJECTIVE: The objective was to examine the circadian changes in blood pressure and their relation to the metabolic syndrome and its components in Omani Arabs. RESEARCH METHODS AND PROCEDURES: Ambulatory blood pressure (ABPM) was recorded in 1124 subjects from 5 large, extended, consanguineous, and young Arab pedigrees. According to the International Diabetes Federation's definition, 264 subjects had the metabolic syndrome, a prevalence of 23%. Subjects were defined as non-dippers when their nocturnal systolic blood pressure (SBP) fell by <10% from daytime SBP. RESULTS: Non-dippers with the metabolic syndrome were 131 of 264 (50%), compared with 265 of 860 (31%) without the metabolic syndrome. Of the non-dippers, 99 of 131 (76%) were females and 32 of 131 (24%) were males. Daytime and nighttime SBP and DBP and nighttime pulse pressure were significantly higher in non-dipper subjects with the metabolic syndrome. The important determinants of a non-dipping BP in this cohort were high BMI and high serum triglycerides. DISCUSSION: We hypothesize that obesity and nocturnal volume-dependent hypertension may be involved in the pathophysiology of non-dipping in the metabolic syndrome. This study showed that non-dipping BP was common in subjects with the metabolic syndrome. Higher 24-hour blood pressure load may add to the indices of the overall cardiovascular burden already associated with the metabolic syndrome.

Heritability of determinants of the metabolic syndrome among healthy Arabs of the Oman family study.

The metabolic syndrome, as defined by the International Diabetes Federation, was investigated in five large, extended, highly consanguineous, healthy Omani Arab families of a total of 1277 individuals. Heritability (h2) of the phenotypic abnormalities that make up the syndrome and other related traits was estimated by variance decomposition method using SOLAR software. The overall prevalence of the syndrome was 23%. The prevalence of abnormalities making the syndrome in a descending order were: obligatory waist circumference, hypertension, raised fasting blood glucose, low serum high-density lipoprotein (HDL), and raised serum triglycerides (TGs). Highly significant, but widely spread, h2 values were obtained for: height (0.68), weight (0.68), BMI (0.68), serum HDL (0.63), serum leptin (0.55), percentage body fat (0.53), total serum cholesterol (0.53), fasting serum insulin (0.51), homeostasis model assessment-insulin resistance index (0.48), serum TG (0.43), waist circumference (0.40), diastolic blood pressure (0.38), and 2-hour glucose level (0.17), whereas for the metabolic syndrome itself, h2 was 0.38. The wide spread of h2 results (0.07 to 0.68) indicates that some determinants, such as weight, BMI, and HDL level, are under significant genetic influence among the Omani Arabs. Other determinants such as insulin resistance, abdominal obesity, diastolic blood pressure, and TG levels seem to be more environmentally driven.