Showing papers in "Sultan Qaboos University Medical Journal in 2013"

Recurrent Urinary Tract Infections Management in Women: A review.

Abstract: Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50-60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics.

Lifestyle Habits: Diet, physical activity and sleep duration among Omani adolescents.

Abstract: Objectives : This study aimed to investigate the lifestyle habits—physical activity (PA), eating habits (EH), and sleep duration (SD)—of Omani adolescents, and to examine gender differences in such variables. Methods : 802 Omani adolescents (442 females and 360 males), aged 15‒18 years were randomly recruited. Anthropometric indices, PA level, and EH and SD were evaluated by the Arab Teenage Lifestyle questionnaire. A semi-quantitative food frequency questionnaire for dietary assessment was also administered. Results : The results showed that although the study subjects had a sedentary lifestyle (lack of PA, average of 6.7 hours sleep, and consumption of high calorie foods), they maintained a normal body mass (less than 25 Kg/m2). Males were more than twice as active as females. With respect to EH, there were few gender differences, except in dairy and meat consumption where 62.5% and 55.5% of males consumed more than 3 servings, respectively, compared to 18.78 % and 3.76% of females, respectively. In addition, waist/height ratio, height, reasons for being active, energy drinks, potato consumption, eating sweets, vigorous PA and breakfast EHs were statistically significant independent predictors for BMI, P <0.05 for both males and females. Conclusion : This study revealed a high prevalence of sedentary behaviors and a low level of physical activity, especially among females. Unhealthy dietary habits were also widely found among both genders. There is an urgent need for more research as well as a national policy promoting active living and healthy eating and discouraging sedentary behaviour among Omani adolescents.

Tobacco Smoking and Lung Cancer: Perception-changing facts.

Abstract: Tobacco smoking remains the most established cause of lung carcinogenesis and other disease processes Over the last 50 years, tobacco refinement and the introduction of filters have brought a change in histology, and now adenocarcinoma has become the most prevalent subtype Over the last decade, smoking also has emerged as a strong prognostic and predictive patient characteristic along with other variables This article briefly reviews scientific facts about tobacco, and the process and molecular pathways involved in lung carcinogenesis in smokers and never-smokers The evidence from randomised trials about tobacco smoking’s impact on lung cancer outcomes is also reviewed

A Study of Stress among Students of Professional Colleges from an Urban area in India.

Abstract: Objectives: Various studies across the globe have emphasised that students undertaking professional courses, such as medical and dental studies, are subjected to higher stress. Excessive stress could lead to psychological problems like depression and anxiety. The objective of the current study was to assess stress among students of various professional colleges and its association with various academic, social and health-related factors. Methods: This cross-sectional study was conducted from September 2011 to February 2012 among students of medical, dental and engineering colleges from the urban area of Sangli district, Maharashtra, India, using a convenience sampling technique. The calculated total sample size was 1,200. A pretested self-administered questionnaire was used for the data collection. Analysis was done using percentage, the chi-square test, binary logistic regression and multinomial logistic regression. Results: Out of the 1,224 respondents, 299 (24.4%) experienced stress. Among them 115 (38.5%), 102 (34.1%) and 82 (27.4%) were dental, medical and engineering students, respectively. There was a statistically significant association between stress and the field of education. Stress was observed in 187 (27.7%) females and 112 (20.4%) males; the association with gender was statistically significant. By applying binary logistic regression, medical studies, health and lifestyle factors, and academic factors were the significant predictors for stress. Conclusion: Students from all the three fields studied were exposed to stress. Academic factors were one of the most important stressors. The introduction of stress management education into the curriculum could prove useful in combatting this problem.

The history of diabetes mellitus.

Abstract: A disease characterised by the ‘too great emptying of urine’ finds its place in antiquity through Egyptian manuscripts dating back to 1500 B.C.1 Indian physicians called it madhumeha (‘honey urine’) because it attracted ants. The ancient Indian physician, Sushruta, and the surgeon Charaka (400–500 A.D.) were able to identify the two types, later to be named Type I and Type II diabetes.2,3 Recognised for the last three millennia, recorded history attributes the first complete descriptions in the first century A.D. to Aretaeus the Cappadocian, who coined the word diabetes (Greek, ‘siphon’) and dramatically stated “... no essential part of the drink is absorbed by the body while great masses of the flesh are liquefied into urine,,.4–6 Avicenna (980–1037 A.D.), the great Persian physician, in The Canon of Medicine not only referred to abnormal appetite and observed diabetic gangrene but also concocted a mixture of seeds (lupin, fenugreek, zedoary) as a panacea.7 The term mellitus (Latin, ‘sweet like honey’) was coined by the British Surgeon-General, John Rollo in 1798, to distinguish this diabetes from the other diabetes (insipidus) in which the urine was tasteless.1

Job Stress and Burnout among Academic Career Anaesthesiologists at an Egyptian University Hospital

Abstract: Objectives: There is compelling evidence that anaesthesiology is a stressful occupation and, when this stressful occupation is associated with an academic career, the burnout level is high. This study aimed to assess the predictors and prevalence of stress and burnout, associated sociodemographic characteristics, and job-related features. Methods: A cross-sectional survey study was carried out at Mansoura University Hospital in Egypt among 98 anaesthesiologists who had academic careers. The English version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale and the Workplace Stress Scale of the American Institute of Stress were used to measure job stress and burnout. Data were analysed according to the guidelines for data processing and an analysis of the scales used. Results: The participation rate of this study was 73.1%, where 69.4% were encountering job stress, while 62.2% experienced emotional exhaustion, 56.1% depersonalisation, and 58.2% reduced personal capacity. There was a significant positive correlation between job stress and MBI-HSS subscales. Residents and assistant lecturers were the most affected group. The strongest significant single predictor of all burnout dimensions was a lack of job support. Conclusion: Stress and burnout among academic anaesthesiologists were caused by the lack of job support; this was especially true among residents and assistant lecturers. We can conclude that a well-organised institutional strategy to mitigate the heavy professional demands of academic anaesthesiologists’ will relieve their stress and burnout.

Sexual Health for Older Women: Implications for nurses and other healthcare providers.

Abstract: This article presents findings from a review of the evidence regarding sexual health for older women from MEDLINE, SCOPUS and the Cumulative Index to Nursing and Allied Health (CINHAL) databases. A total of 10 articles based on primary studies, reporting about the sexuality or sexual health of older women (and older people), and published between 2002-2012, were deemed suitable. The major themes that emerged from the available literature suggest that the sexual health of older people is affected by factors such as physical changes, mental health, changes to their relationship with their husband, chronic ill health and other psychosocial situations. It is concluded that nurses and other healthcare providers have a range of interventions that can be adopted to promote sexual health among older women. These interventions may focus on improving the older woman's sexual health assessment; increasing awareness and knowledge about sexuality in later life; pharmacological and psychotherapeutic therapies; using alternative techniques to achieve better sexual functioning; addressing partner and relationship issues, and advocating the importance of sexual health through media and policy development.

Associations of Pass-Fail Outcomes with Psychological Health of First-Year Medical Students in a Malaysian Medical School

Abstract: Objectives : The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level. These consequences can include poor academic performance and impaired cognitive ability. This study was designed to explore associations between pass-fail outcome and psychological health parameters (i.e. stress, anxiety, and depression symptoms). Methods : A cross-sectional study was conducted on a cohort of first-year medical students in a Malaysian medical school. The depression anxiety stress scale 21-item assessment (DASS-21) was administered to them right after the final paper of the first-year final examination. Their final examination outcomes (i.e. pass or fail) were traced by using their student identity code (ID) through the Universiti Sains Malaysia academic office. Results : A total of 194 (98.0%) of medical students responded to the DASS-21. An independent t-test showed that students who passed had significantly lower stress, anxiety, and depression symptoms than those who failed the first-year final examination (P <0.05). Those who experienced moderate to high stress were at 2.43 times higher risk for failing the examination than those who experienced normal to mild stress. Conclusion : Medical students who failed in the final examination had higher psychological distress than those who passed the examination. Those who experienced high stress levels were more likely to fail than those who did not. Reducing the psychological distress of medical students prior to examination may help them to perform better in the examination.

Causes of stress and coping strategies adopted by undergraduate health professions students in a university in the United arab emirates.

Abstract: Objectives : This study aimed to compare causes of stress and coping strategies adopted by a sample of undergraduate health-profession students at the Gulf Medical University, United Arab Emirates. Methods : An anonymous voluntary questionnaire-based survey was conducted, from January to July 2011, among first- and second-year medicine, dentistry, pharmacy and physiotherapy students (N = 212) to identify causes of stress. Coping strategies were studied using the Brief COPE Inventory. Results : Worries regarding the future (54.2%) and parental expectations (40.1%) were the major stressors. Poor diet (36.8%) and a lack of exercise (36.3%) were also reported to cause stress. Students used multiple strategies, mainly religion/praying (74.5%), planning (70.5%) and taking action (70.5%) to cope with stress. There were no significant differences observed in the stressors or coping strategies between genders or programmes. First-year students (62.5%) relied on emotional support significantly more ( P <0.05) than second-year students (48.5%). Conclusion : The main causes of stress were worries regarding future and parental expectations. The majority of the students used positive coping strategies, with religion/praying found to be the most frequently used strategy.

Disease Patterns and Outcomes of Neonatal Admissions at a Secondary Care Hospital in Pakistan

Abstract: Objectives : This study aimed to determine the disease patterns and outcome of patients admitted to the neonatal unit of a secondary care hospital in Pakistan from January to December 2009. Methods : Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analysed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome. Trends were examined to identify the indicators of inpatient neonatal deaths. Results : The total number of neonates admitted during the study period was 1,554; 979 were male (63%), and 575 were female (37%). A total of 891 patients (57.3%) were born in the hospital while 663 (42.7%) were born elsewhere. The majority were admitted during the first 24 hours of life (51.3%). A total of 13 patients (0.8%) weighed <1 Kg; 85 (5.4%) weighed 1–1.49 Kg, and 587 (37.7%) between 1.5–2.5 Kg. Prematurity and infection were the main reasons for admission (27.9% and 20.33%, respectively), followed by birth asphyxia (13%) and neonatal jaundice (11.3%). A total of 1,287 patients (82.8%) were discharged, 41 left against medical advice (2.6%), 59 were referred to tertiary care hospitals (3.79%) and 106 (6.8%) died. Conclusion : Prematurity, low birth weight, birth asphyxia and neonatal jaundice were the major causes of neonatal admissions. This could be reduced by appropriate antenatal care, timely intervention, and in-time referral to tertiary care centres for the deliveries of all high-risk pregnancies. The major cause of neonatal mortality was prematurity.

The Impact of Small Group Case-based Learning on Traditional Pharmacology Teaching.

Abstract: Objectives : This study aimed to measure medical students’ perceptions of incorporating small group case-based learning (CBL) in traditional pharmacology lectures Methods : Data were collected from third-year students (N = 68; 57% males, 43% females) at Al Quds University Medical School, Palestine The students were offered a CBL-incorporated Pharmacology-2 course after they had been taught Pharmacology-1 in the traditional format during the preceding semester Student attitudes towards the restructured course were examined by a self-administered structured questionnaire Results : The majority of students thought that CBL was an effective learning tool for them (82%) and that it improved their learning skills (83%), independent learning skills (74%), analytical skills (70%), and their level of preparation for exams (75%) Most students reported that team discussions addressed lecture objectives (84%) Regarding cases discussed, most responders said that the cases were appropriate to the lecture topics (96%) and that the time allocated for case discussion was sufficient (86%) A large proportion of students thought that CBL improved their communication and collaborative skills (68% and 80%, respectively) and ability to work within a team (79%) Conclusion : Pharmacology-2 course restructuring led to a significant improvement of self-reported student satisfaction, motivation, and engagement

Vitamin D Status and Anthropometric Indices of an Omani Study Population

Abstract: Objectives : Serum 25-hydroxyvitamin D [25(OH)D] concentrations reflect vitamin D status, with deficiency implicated as causative of many diseases. This study assessed vitamin D status and anthropometric indices in a sample of healthy Omanis. Methods : Serum 25(OH)D concentrations were measured by high performance liquid chromatography in 206 healthy Omanis, aged 18–55 years (mean age: men 31.1, women 26.8) in Muscat, Oman. Of this number, 95% indicated that they had never taken vitamin D supplements. Findings were compared with published values for populations domiciled in more northerly latitudes. Classical procedures were used to determine global obesity (body mass index [BMI]), and central obesity determined by waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio. Results : Women, as compared to men, had markedly lower concentrations of 25(OH)D. Applying the cut-off point of serum 25(OH)D levels at 50 nmol/L, the prevalence of vitamin D deficiency in the study population was 87.5%; this was higher than the rates reported for the British, and European-, Hispanic-, and African-Americans. At a BMI cut-point of ≥30 kg/m2, the prevalence of obesity was 14.6%; this was lower than the rates reported for European-, Hispanic-, and African-Americans. Levels of 25(OH) D increased relative to age and obesity. WHR was the main predictor of 25(OH)D levels. Conclusion : The striking vitamin D deficiency seen in the study population, relative to more northerly populations, may be linked to sun avoidance, inadequate dietary vitamin D, and virtual non-intake of supplemental vitamin D. Age and male-gender determined the status of vitamin D and of obesity.

Idiopathic Granulomatous Mastitis: Diagnostic strategy and therapeutic implications in Omani patients.

Abstract: Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature.

Self-Reported Knowledge of Diabetes among High School Students in Al-Amerat and Quriyat, Muscat Governate, Oman

Abstract: Objectives : Type 2 diabetes mellitus (T2DM) is emerging as one of the world’s greatest health problems, and its incidence and prevalence are increasing at an alarming rate and globally reaching epidemic proportions. With this increasing incidence, emphasis is now being placed on implementing primary prevention, early detection, and educational prevention programmes. This study was undertaken to estimate the level of knowledge of T2DM among high school students and to explore the factors influencing the knowledge of T2DM. Methods : A cross-sectional study was conducted in four secondary schools in two wilayats (districts) of Muscat governate, Oman, namely Al-Amerat and Quriyat. The study was conducted using a validated English questionnaire covering all aspects of T2DM in one-to-one interviews. A scoring system was used to assess the students’ knowledge. Results : Of the 541 students enrolled in the study (45% male and 55% female), only 24% achieved a score of over 10 out of 20. The key areas of poor knowledge were wrong perceptions about diabetic meals (73%), and the possibility of a cure for diabetes (63%). Conclusion : Overall poor knowledge levels about T2DM were found among school students. National efforts and school health-based interventions are highly recommended to increase awareness about diabetes among this age group.

The pattern of female nuptiality in oman.

Abstract: The purpose of this study was to examine Omani patterns of female nuptiality, including the timing of marriage and determinants of age at a woman’s first marriage. Methods : The study utilised data from the 2000 Oman National Health Survey. Univariate, bivariate, and multivariate statistical methods, including logistic regression analysis, were used for data analysis. Results : One of the most important aspects of the marriage pattern in Oman is the high prevalence of consanguineous marriages, as more than half (52%) of the total marriages in Oman are consanguineous. First cousin unions are the most common type of consanguineous unions, constituting 39% of all marriages and 75% of all consanguineous marriages. About 11% of the marriages are polygynous. Early and universal marriage is still highly prevalent in Oman. Three-quarters (75%) of married women respondents aged 20–44 years were married by age 20, with their median age at their first wedding being 16 years. However, women’s average age upon marriage is gradually increasing. The change is especially apparent in more recent marriages or among younger cohorts of women, and for certain socio-cultural groups. Multivariate analysis identified female education, age cohort, residential status, region of residence, types of marriage, and employment as strong predictors of Omani women’s age at marriage. Conclusion : The growing number of young adults, accompanied by their tendency to delay marriage, may have serious demographic, social, economic, and political ramifications for Oman, highlighting the need to understand the new situation of youth, their unique characteristics, and their interests and demands. Culturally appropriate policies need to be implemented to address the issues and challenges of unmarried young adults.

Perinatal Outcome in Pregnancies with Extreme Preterm Premature Rupture of Membranes (Mid-Trimester PROM)

Abstract: Objectives: Preterm premature rupture of membranes (PPROM) is defined as the rupture of fetal membranes before 37 weeks Extreme PPROM occurs before 26 weeks’ gestation and can result in perinatal morbidity and mortality The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM

Improving vaginal examinations performed by midwives.

Abstract: A vaginal examination (VE) is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant, embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE) using the following search terms: “VEs in labour”, “midwives and use of VEs” and “women experiences of VEs in labour”. The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management of pain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE.

Divergent views on abortion and the period of ensoulment.

Abstract: A Muslim woman in her sixteenth week of pregnancy was informed that her ultrasound scan showed spina bifida, and laboratory results confirmed the diagnosis. The child would have various complications and, most probably, would need medical care for life. With the consent of her husband she decided to terminate the pregnancy. Her decision sparked controversy among Muslim clerics in her community, sparking debate between those who would allow abortion for medical reasons and those who oppose abortion for any reason. This paper will review the philosophical and theological arguments of the pro-life and pro-choice groups as well as the Islamic perspective concerning a woman’s autonomy over her reproductive system, the sanctity of the fetus and the embryo, therapeutic abortion, and ensoulment.

The Epidemiology of Acute Coronary Syndrome in Oman: Results from the Oman-RACE study.

Abstract: Objectives This study aimed to evaluate the epidemiology and coronary risk factors of acute coronary syndrome (ACS) in Oman. Methods Data were collected through a prospective, multinational, multicentre survey of consecutive patients, hospitalised over a 5-month period in 2007 with a diagnosis of ACS, in Yemen and five Arabian Gulf countries (Oman, Bahrain, Kuwait, Qatar, United Arab Emirates). Here we present data of Omani patients aged ≥20 years who received a provisional diagnosis of ACS and were consequently admitted to 14 different hospitals. Results There where 1,340 confirmed ACS episodes in 748 men and 592 women (median age 61 years). The overall crude incidence rate of ACS was 338.9 per 100,000 person-years (P-Y). The age-standardised rate (ASR) of ACS was 779 and 674 per 100,000 P-Y for men and women, respectively. The ASR male-to-female rate ratio was highest in the ST-elevation myocardial infarction (STEMI) group (2.26, 95% confidence interval ([CI], 1.63 to 3.15) followed by the non-STEMI (NSTEMI) group (1.68, 95% CI 1.28 to 2.21) and unstable angina (0.79, 95% CI 0.66 to 0.99). Unstable angina accounted for 55%, STEMI for 26% and NSTEMI for 19% of ACS cases. Among the coronary risk factors, there was a high prevalence of hypertension (68%), diabetes mellitus (DM) (36%), hyperlipidaemia (63%), and overweight/obesity (65%), with a relatively low rate of current tobacco use (11%). Conclusion Our study confirms a high incidence of ACS in Omanis and supports the notion that the cardiovascular disease epidemic is also sweeping developing countries.

Prevalence of urinary incontinence and probable risk factors in a sample of kurdish women.

Abstract: Objectives : The most common manifestation of pelvic floor dysfunction is urinary incontinence (UI) which affects 15–50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. Methods : A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. Results : The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus (DM), chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. Conclusion : A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM.

Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Low Birth Weight in Omani Infants: A case-control study

Abstract: Objectives : This study aimed to investigate the association between pre-pregnancy maternal body mass index (BMI), gestational weight gain and low birth weight (LBW) in babies born to a sample population of Omani women. Methods : A case-control study was carried out among deliveries registered between 1st May 2010 and 30th April 2011 at Sultan Qaboos University Hospital, Muscat, Oman. A case was defined as a woman who delivered a low birth weight baby (<2,500 g); a control was a woman delivering a baby weighing between 2,500 and 4,000 g. A random selection of 150 cases and 300 controls was carried out using the hospital information system. Maternal, pre-natal, and delivery data were extracted from the mothers’ follow-up cards. Bivariate and multivariate logistic regression analyses were executed to examine the association between pre-pregnancy maternal BMI and LBW. Results : The percentage of underweight mothers (BMI <18.5) was higher among the cases compared to the controls (17.3% versus 6%; P <0.001). The proportion of mothers with less-than-recommended weight gain was also higher among the cases compared to the controls (57.7% versus 33%; P <0.001). After adjustment for potential confounders, infants of underweight mothers had more than twice the risk of LBW compared to those of mothers with normal weight (odds ratio = 2.27; 95% confidence interval 1.09–4.71). Conclusion : Underweight Omani women as well as women with less-than-recommended gestational weight gain were at higher risk of delivering LBW babies. Maternal health promotion programmes should be directed towards improving mothers’ nutrition before and during pregnancies.

Severe Pulmonary Involvement in Leptospirosis: Alternate antibiotics and systemic steroids

Abstract: Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem (1 g every 8 hours), moxifloxacin (400 mg once daily), and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions.

Discharge against Medical Advice among Children in Oman: A university hospital experience

Abstract: Objectives: Discharge against medical advice (DAMA) is a major problem in healthcare delivery as it can complicate the health problems from which patients are suffering The aim of this study was to understand DAMA among children in a tertiary teaching hospital in Oman and to evaluate the documentation of the events in the medical records Methods: A retrospective survey of the medical records of patients discharged against medical advice over a two-year interval was performed (2004–2006) Results: Of the 11,802 admissions, there were 38 cases of DAMA, giving a prevalence rate of 032% In 395% of the cases, the discharge happened within 24 hours of hospital admission The majority of the cases were infants (n = 24; 6325%) The diagnosis at discharge in some cases included life-threatening conditions However, in 579% of the cases, the reasons for DAMA were neither reported nor documented in the patients’ medical records Conclusion: Although the results of this study yielded a low prevalence rate compared to the rates reported in other studies, the occurrence of DAMA for children in a tertiary hospital is a distressing phenomenon It was evident that the documentation of the DAMA process was poor More studies should be conducted to understand the details of the problem Policies should be established and implemented in order to attempt to reduce DAMA among child patients and to protect them from the consequences of such discharges

Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla: Report of five cases

Abstract: Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech.

Is Cerebrospinal Fluid C-reactive Protein a Better Tool than Blood C-reactive Protein in Laboratory Diagnosis of Meningitis in Children?

Abstract: Objectives: This study aimed to test whether C-reactive protein (CRP) measurement could differentiate between different types of meningitis and become a routine test.

Disease Patterns and Outcomes of Neonatal Admissions at a Secondary Care Hospital in Pakistan = أنماط المرض و النتائج لحديثي الولادة المرقدين في مستشفى مرجعي ثانوي في باكستان

Abstract: OBJECTIVES This study aimed to determine the disease patterns and outcome of patients admitted to the neonatal unit of a secondary care hospital in Pakistan from January to December 2009. METHODS Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analysed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome. Trends were examined to identify the indicators of inpatient neonatal deaths. RESULTS The total number of neonates admitted during the study period was 1,554; 979 were male (63%), and 575 were female (37%). A total of 891 patients (57.3%) were born in the hospital while 663 (42.7%) were born elsewhere. The majority were admitted during the first 24 hours of life (51.3%). A total of 13 patients (0.8%) weighed <1 Kg; 85 (5.4%) weighed 1-1.49 Kg, and 587 (37.7%) between 1.5-2.5 Kg. Prematurity and infection were the main reasons for admission (27.9% and 20.33%, respectively), followed by birth asphyxia (13%) and neonatal jaundice (11.3%). A total of 1,287 patients (82.8%) were discharged, 41 left against medical advice (2.6%), 59 were referred to tertiary care hospitals (3.79%) and 106 (6.8%) died. CONCLUSION Prematurity, low birth weight, birth asphyxia and neonatal jaundice were the major causes of neonatal admissions. This could be reduced by appropriate antenatal care, timely intervention, and in-time referral to tertiary care centres for the deliveries of all high-risk pregnancies. The major cause of neonatal mortality was prematurity.

Risk factors associated with denture stomatitis in healthy subjects attending a dental school in southeast iran.

Abstract: Objectives: There is scant information regarding the multifactorial aetiology of denture stomatitis (DS) in the world and, despite its frequency, associated factors are not completely understood. The aim of this study was to investigate the risk factors that may be associated with this lesion. Methods: A total of 70 edentulous patients, all wearing removable dentures, were divided into two groups. The test group comprised 43 patients with DS and the control group comprised 27 subjects with clinically healthy palatal mucosa. A thorough history-taking and physical examination were carried out; the subjects also answered a questionnaire. The serum level of vitamin A for each subject was assayed from a blood sample taken after the examination. Results: This study showed a significant relationship between the incidence of DS and three major factors: denture age (in terms of years), the practitioner manufacturing the dentures (general dental practitioner versus dental hygienist), and the nightlong wearing of dentures. Also, the vitamin A serum level was low in 94.29% of all subjects (cases and controls). Conclusion: Although many predisposing conditions were related to this situation, the most important risk factor was the continuous use of the dentures.

Attitudes of Students at Sultan Qaboos University towards the Nursing Profession.

Abstract: Objectives: The aim of this study was to explore the attitudes of Sultan Qaboos University (SQU) students towards the nursing profession. Methods: A sample of 377 students (male = 130; female = 247) were selected from different colleges of SQU, including the College of Nursing. A questionnaire was constructed and validated to assess the attitudes of SQU students towards the nursing profession. Results: Findings revealed that both male and female students in all academic years and colleges had positive attitudes toward the nursing profession. The findings also revealed that gender and academic year created no significant differences (P <0.05) among the study participants, but that the students’ college affiliation did have a significant effect on their attitudes. In particular, nursing students had more positive attitudes than students of other colleges. Conclusion: Findings indicated that the attitudes of SQU students towards the nursing profession were positive, especially those of the nursing students. This means that serious efforts should be made to continue to promote the nursing profession and so ensure that it remains positively regarded by all concerned.