Gastric carcinoma in the Sultanate of Oman: Incidence and distribution.

Gastric carcinoma has always been considered a major problem in the Sultanate of Oman. This study was conducted to document the cases in Oman over a two-year period, in order to determine incidence, age, sex and geographical distribution of the condition. All cases of gastric carcinoma in Omani nationals presenting to the medical facilities throughout Oman from November 1987 to November 1989 were reviewed from pathology records, surgical database records and by personal communication with surgeons at regional hospitals. Specimens taken at surgery or endoscopic biopsy were examined and classified according to Lauren's criteria. Over the two-year period, 104 cases of gastric carcinoma were observed. This represented an annual incidence of 4.2/100,000 population, but when adjusted to the standard European population age distribution (in the Oman population, 51% are under 15 years of age), the incidence was 8.6/100,000. The male:female ratio was 1.6:1 and the peak age group was 60-69. All tumors were advanced and most were located in the antral part of the stomach. There were more intestinal types of tumors than diffuse and a preponderance of intestinal metaplasia. This first survey of stomach carcinoma in Oman will provide a reference for future studies and indicates the need for earlier detection.

High prevalence of diabetes mellitus and impaired glucose tolerance in the Sultanate of Oman: results of the 1991 national survey.

A national survey of glucose intolerance and cardiovascular disease risk factors in Oman has demonstrated a high prevalence of diabetes (10%) and impaired glucose tolerance (IGT, 13% in females and 8% in males). Prevalence of diabetes rose with age to a maximum of over 30% in both sexes. Prevalence of total glucose intolerance (diabetes and IGT combined) exceeded 50% in the seventh (females) and eighth (males) decade of life.

Oral health care of Saudi leukemic patients.

There is a growing demand in Saudi Arabia for better oral health care; however, the need varies from one group to another. Patients with leukemia require more dental care than do healthy subjects because of associated serious oral complications and physical disabilities in maintaining plaque-free teeth. Because of a dental manpower shortage, leukemic patients in Saudi Arabia are likely to be receiving less specialist dental care than they require. A pilot study of 30 leukemic patients from four major hospitals in Riyadh showed high indices of plaque, calculus, and gingival bleeding. While hopitalized, 54% of the patients had a plaque index of greater than 80%, whereas 31% of the patients had a bleeding index of greater than 80%. All leukemic patients examined had either oral ulcerations, fungal infection, gingival enlargement, or gingival bleeding that necessitated further medical attention. This study indicated that Saudi leukemic patients desperately require better oral health care. Additional specialist dental centers staffed by appropriately trained dental personnel are urgently needed to provide oral health care for these patients.

Tuberculin survey in the Eastern Province of Saudi Arabia.

We present the results of the Mantoux test (5 units tuberculin) survey in the Eastern Province of Saudi Arabia, which was conducted as part of a nationwide epidemiological survey of tuberculosis. A total of 1105 subjects were screened out of whom 630 gave a history of BCG vaccination in the past and 363 were BCG-negative. Among BCG-negative children aged 5-14 years, only 5% had a positive Mantoux, a rate lower than most Third World countries but higher than developed countries were under 2% of children are tuberculin reactors. This calls for continuation of free treatment of active cases and increased efforts towards screening of contacts. The results also vindicate the current policy of giving BCG vaccine at birth and probably indicates the need to revaccinate at school leaving age, in accordance with WHO recommendations. Tuberculin reactivity rose steeply with age (32% at age 15-24 and 72% at age 45-64 years) indicating the presence of a large pool of subjects at risk of breaking into active disease. Finally, 71% (201/283) of children aged 5-14 years who had received BCG vaccine at birth, reacted negatively to the Mantoux test. This supports the findings of previous studies that in the majority of subjects, BCG-induced tuberculin sensitivity fades a few years after vaccination.

Meswak chewing stick versus conventional toothbrush as an oral hygiene aid.

This study consisted of two trials. Trial 1 compared the meswak with the toothbrush when used twice and five times a day. Trial 2 compared habitual meswak users with toothbrush users. Under experimental conditions, a significant reduction in gingivitis was found both buccally (p less than 0.01) and lingually (p less than 0.05) after using a meswak five times a day compared with a conventional toothbrush. Twice a day brushing with a meswak produced a significant reduction in gingivitis buccally (p less than 0.005) compared with toothbrushing, but lingually the difference was insignificant. There were no significant differences in plaque scores between a meswak and a conventional toothbrush when brushing was continued five times a day. Plaque scores became significantly higher when a meswak was used only twice a day compared with toothbrushing, specifically on the lingual surfaces of the teeth (p less than 0.01). Habitual meswak users showed a significant reduction in gingival bleeding (p less than 0.05) and interproximal bone height (p less than 0.02) compared with toothbrush users. The differences in plaque scores and pocket depth measurements between the two groups were insignificant. The results imply that a meswak, used five times a day, may offer a suitable alternative to a toothbrush for reducing plaque and gingivitis. However, meswak may not be sufficient for maintaining interproximal dental health when used without the support of other oral hygiene aids.

Proteinuria selectivity index in Saudi children with nephrotic syndrome.

Proteinuria selectivity index (PSI) was determined in 54 Saudi children with nephrotic syndrome whose renal biopsy showed minimal change in 13 and non-minimal histologic changes in 41 patients. The selectivity was determined with two pairs of proteins, IgG/transferrin and IgG/albumin. There was considerable overlap in the values of PSI in patients with minimal and non-minimal histological changes. The clinical utility of PSI in differentiating minimal change nephrotic syndrome and non-minimal change nephrotic syndrome is low.

The oculo-emetic reflex. A rationalisation of postophthalmic anaesthesia vomiting.

Data related to the incidence of postoperative vomiting were collected during prospective studies on 607 ophthalmic surgical patients of all ages who underwent halothane anaesthesia with spontaneous ventilation. Analysis of data in respect of age, sex and surgical site variables, and time of onset of vomiting, identified a female sex-related vomiting incidence of about 13% and a squint-related vomiting incidence of about 41%; no relationship between age and vomiting was identified. The analyses showed that squint surgery predisposed particularly to emesis, and was associated with a high incidence of both early and delayed vomiting. It is suggested that the apparent absence of an age-vomiting relationship in ocular, and especially squint, surgery, and the high incidence of vomiting, particularly the early vomiting associated only with squint surgery, provide clinical evidence for the existence of an oculo-emetic reflex. Our observations show that intra- and postoperative surgical stimulation of this oculo-emetic reflex is reflected in the incidences of vomiting after ocular surgery.

Epidemiologic study of gestational trophoblastic diseases in Saudi Arabia.

The role of cultural and socioeconomic diversities (that is, marriage, conceptions at the extremes of reproductive life, consanguinity, economic affluence and such) were analyzed for significance in the epidemiologic study of gestational trophoblastic disease (GTD) in Saudi Arabia. For the study period, the incidence of hydatidiform mole remained unchanged at a mean of one in 448 pregnancies and one in 6,130 for its malignant counterpart. In the instance of molar pregnancies, the youngest (less than 20 years of age) and the oldest (more than 40 years of age) had significantly higher than expected incidence; in contrast, in malignant GTD, the trend was for a higher than expected frequency for the older age group only (more than 40 years of age). Consanguinity showed no significant epidemiologic role.

Dose-response aggregometry in maternal/neonatal platelets.

The aggregation of platelets collected from maternal/neonatal pairs (n = 240) at the time of childbirth, was studied in response to multiple doses of ADP, collagen, arachidonic acid and ristocetin. Similar responses were obtained from healthy nonpregnant adult controls for comparison. The lag phase, slope of the aggregation curves as well as maximum aggregation (MA%) were recorded and analysed. Neonatal and adult platelets exhibited more enhanced responses to decreasing doses of ADP, arachidonic acid and ristocetin, than maternal platelets. These enhanced responses were exhibited more consistently in the slopes of the aggregation curves than in MA%. Although neonatal platelets have shown longer lag phase in their responses to collagen, the rate of the aggregation reaction was significantly faster than maternal platelets, with no differences in MA%. These results contradict many previous reports suggesting impaired aggregation responses of neonatal platelets to these agonist. The possible reasons for these contradictions were discussed.

Cerebral infarction and left ventricular mass: a clinical and echocardiographic study.

One hundred and two stroke patients were studied. Thirty-three (32 per cent) were hypertensive by the WHO criteria. Eighty-three (83 per cent) had cerebral infarction and three patients suffered from spontaneous intracerebral haemorrhage. The mean left ventricular mass was calculated from echocardiographic measurements and compared with that of controls. Neither cases nor controls had valvular or congenital heart disease, or disease processes that may be associated with myocardial infiltration. Mean left ventricular mass of all cases was significantly greater than that of controls (p less than 0.025) and that of the cases over the age of 50 years was also significantly greater than that of controls of the same age (p less than 0.02). The clinically normotensive cases had greater left ventricular mass than the normotensive controls (p less than 0.02). Meanwhile left ventricular mass in patients aged 50 and under was not significantly different from the appropriate control group (p greater than 0.2). These data indicate that the frequency of arterial hypertension among victims of cerebral infarction is greater than may be ascertained clinically particularly in those over 50.

Vaginal birth after cesarean section: management debate.

Obstetric performance of 1847 women with previous cesarean section (CS) during the years 1983 and 1984 were studied. Vaginal birth after cesarean section (VBAC) was attempted in 94% of females with one previous CS, 4% in those with two previous CS, and one among the 70 patients with three or more previous CS. VBAC was achieved in 51% of those with one previous CS. It was successful in 60% of parturients with CS for non-recurrent causes, 36% of CS for cephalopelvic disproportion (CPD) and in 64% of those with a prior vaginal delivery. Uterine scar dehiscence was found in 0.9% of all patients with a previous CS. A failed attempt with Ventouse to achieve VBAC caused maximum maternal and perinatal morbidity.

Bacterial, parasitic and viral enteropathogens associated with diarrhoea in Saudi children.

In a 2-year study of stools from Saudi children with gastro-enteritis and from controls, rotavirus was the pathogen most frequently detected, either alone (44.3%) or in combination with other enteropathogens (7%). There were two peaks for rotavirus isolates, one during the cold months and the other during the dry, hot season. Salmonella spp. and Campylobacter jejuni were the second and third most frequently isolated enteropathogens. Enteropathogenic Escherichia coli did not contribute significantly to diarrhoea. Detection of enterotoxigenic E. coli was not attempted and its role in diarrhoea remains obscure. Giardia lamblia was detected more frequently in controls than in cases of diarrhoea. Neither Entamoeba histolytica nor Schistosoma mansoni was detected in any of the children studied.

Relationship between posttetanic count and response to carinal stimulation during vecuronium-induced neuromuscular blockade.

The correlation between degree of peripheral neuromuscular blockade and response to carinal stimulation was evaluated in two groups of 25 patients: one group was anaesthetized with thiopental, N2O and halothane, and the other group received thiopental, N2O and fentanyl. The degree of peripheral blockade was evaluated using train-of-four (TOF) and posttetanic twitch (PTC) stimulation of the ulnar nerve. The degree of diaphragmatic paralysis was evaluated indirectly by stimulating the carina and observing the corresponding muscular response, which was graded as severe, mild or absent. During halothane anaesthesia a PTC of 0 always indicated that no response to carinal stimulation could be elicited. On the appearance of the first response to posttetanic twitch stimulation (PTC = 1), 2% of the patients showed a mild response to carinal stimulation. At the first response to TOF stimulation, 48% of the patients reacted with a mild response. During thiopental, N2O, fentanyl anaesthesia one of 25 patients showed a mild response to carinal stimulation at a PTC of 0. When PTC was 1, 20% of the patients reacted mildly to the stimulation. At the first response to TOF stimulation, 92% showed a response to carinal stimulation; 24% of these responses were severe, necessitating intervention. It is concluded that the TOF response elicited peripherally is a late sign of neuromuscular recovery of the diaphragm, and that the method of counting posttetanic twitches is superior to the TOF response in evaluating early recovery of this muscle. Further, to ensure total diaphragmatic paralysis, the neuromuscular blockade of the peripheral muscles should be so intense that no response to posttetanic twitch stimulation (PTC = 0) can be elicited.

Cesarean section; changing patterns in Saudi Arabia.

Analysis of 8000 cesarean births in the Maternity and Children's Hospital, Riyadh, Saudi Arabia documents an increase in the cesarean section (CS) rate from 3.9% in 1979 to 9.9% in 1984. This increase is mainly attributed to indications such as repeat section (37.2%) and fetal distress (28.5%). Increase in the diagnosis of fetal distress was related to the introduction of electronic fetal monitoring and this diagnosis was not substantiated by Apgar score of the neonate. Because of the social preference for large families in Saudi Arabia, over-use of cesarean section should be avoided. For this reason, critical analysis of fetal distress and adequate trial of labor for patients with previous cesarean section is mandatory.

Relationship of post-tetanic count and train-of-four response during intense neuromuscular blockade caused by atracurium.

Atracurium-induced intense neuromuscular blockade was evaluated in 60 randomly selected patients using the post-tetanic count (PTC) and train-of-four (TOF) methods. Thirty patients were anaesthetized with thiopentone, nitrous oxide and halothane, and 30 patients received thiopentone, nitrous oxide and fentanyl. In all patients, the response to post-tetanic single twitch stimulation appeared before the response to TOF stimulation, and a close correlation was found between the number of post-tetanic twitches (PTC) and the time interval between the PTC and the first detectable TOF response. A PTC of zero indicated that the time to first response to TOF stimulation was always more than 8 min. A PTC of 1 meant that the TOF response would appear in, on average, 9 min (95% confidence limits: 4-14 min). Halothane significantly prolonged the time from injection of atracurium to the first response to post-tetanic single twitch stimulation. It is concluded that the relationship between PTC and the time to first response to TOF nerve stimulation makes the PTC method a valuable supplement to TOF nerve stimulation for neuromuscular monitoring during clinical anaesthesia involving atracurium.

Performance of men and women medical students at King Saud University, Riyadh: a 10-year retrospective study.

This study was carried out using the results of medical students at the College of Medicine at King Saud University, Riyadh between 1975 and 1985. The purpose of the study was to ascertain whether any correlation existed between school performance and college performance, whether results from males were different from results from females, and whether the semester system, in operation since 1981, produced different results from the annual system. Significant correlations were found between school Grade Point Average (GPA) results and college results, being highest for premedical courses and lowest for clinical courses. However, these correlations were too small to be of practical use. Men students were found to perform better at preclinical subjects whereas women had better results at clinical subjects. The overall performance on the semester system was significantly higher than that on the annual system.