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Showing papers in "Sultan Qaboos University Medical Journal in 2018"


Journal ArticleDOI
TL;DR: This review article summarises current knowledge regarding the various sources, characteristics and therapeutic applications of MSCs.
Abstract: First discovered by Friedenstein in 1976, mesenchymal stem cells (MSCs) are adult stem cells found throughout the body that share a fixed set of characteristics. Discovered initially in the bone marrow, this cell source is considered the gold standard for clinical research, although various other sources-including adipose tissue, dental pulp, mobilised peripheral blood and birth-derived tissues-have since been identified. Although similar, MSCs derived from different sources possess distinct characteristics, advantages and disadvantages, including their differentiation potential and proliferation capacity, which influence their applicability. Hence, they may be used for specific clinical applications in the fields of regenerative medicine and tissue engineering. This review article summarises current knowledge regarding the various sources, characteristics and therapeutic applications of MSCs.

229 citations


Journal ArticleDOI
TL;DR: Using three or four rather than five options in MCQs is recommended to reduce the number of NFDs and improve the overall quality of the examination.
Abstract: Objectives: The current study aimed to carry out a post-validation item analysis of multiple choice questions (MCQs) in medical examinations in order to evaluate correlations between item difficulty, item discrimination and distraction effectiveness so as to determine whether questions should be included, modified or discarded. In addition, the optimal number of options per MCQ was analysed. Methods: This cross-sectional study was performed in the Department of Paediatrics, Arabian Gulf University, Manama, Bahrain. A total of 800 MCQs and 4,000 distractors were analysed between November 2013 and June 2016. Results: The mean difficulty index ranged from 36.70–73.14%. The mean discrimination index ranged from 0.20–0.34. The mean distractor efficiency ranged from 66.50–90.00%. Of the items, 48.4%, 35.3%, 11.4%, 3.9% and 1.1% had zero, one, two, three and four nonfunctional distractors (NFDs), respectively. Using three or four rather than five options in each MCQ resulted in 95% or 83.6% of items having zero NFDs, respectively. The distractor efficiency was 91.87%, 85.83% and 64.13% for difficult, acceptable and easy items, respectively ( P <0.005). Distractor efficiency was 83.33%, 83.24% and 77.56% for items with excellent, acceptable and poor discrimination, respectively ( P <0.005). The average Kuder-Richardson formula 20 reliability coefficient was 0.76. Conclusion: A considerable number of the MCQ items were within acceptable ranges. However, some items needed to be discarded or revised. Using three or four rather than five options in MCQs is recommended to reduce the number of NFDs and improve the overall quality of the examination.

34 citations


Journal ArticleDOI
TL;DR: Peer, video and combined peer-and-video education were equally effective in reducing angiography-related patient anxiety in hospitals in Iran.
Abstract: Objectives: Coronary angiography can be stressful for patients and anxiety-caused physiological responses during the procedure increase the risk of dysrhythmia, coronary artery spasms and rupture. This study therefore aimed to investigate the effects of peer, video and combined peer-and-video training on anxiety among patients undergoing coronary angiography. Methods: This single-blinded randomised controlled clinical trial was conducted at two large educational hospitals in Iran between April and July 2016. A total of 120 adult patients undergoing coronary angiography were recruited. Using a block randomisation method, participants were assigned to one of four groups, with those in the control group receiving no training and those in the three intervention groups receiving either peer-facilitated training, video-based training or a combination of both. A Persian-language validated version of the State-Trait Anxiety Inventory was used to measure pre- and post-intervention anxiety. Results: There were no statistically significant differences in mean pre-intervention anxiety scores between the four groups (F = 0.31; P = 0.81). In contrast, there was a significant reduction in post-intervention anxiety among all three intervention groups compared to the control group (F = 27.71; P <0.01); however, there was no significant difference in anxiety level in terms of the type of intervention used. Conclusion: Peer, video and combined peer-and-video education were equally effective in reducing angiography-related patient anxiety. Such techniques are recommended to reduce anxiety amongst patients undergoing coronary angiography in hospitals in Iran.

29 citations


Journal ArticleDOI
TL;DR: There was a lack of understanding of plagiarism and its legal ramifications among undergraduate medical and nursing students in Erbil, Iraq, and the findings indicate that there is an urgent need to increase students' understanding and its consequences so as to reduce the incidence of this type of academic misconduct.
Abstract: Objectives: The rapidly rising incidence of plagiarism among students at universities throughout the world requires attention. This study aimed to determine the extent to which medical and nursing students in Erbil, Iraq, plagiarise, their knowledge, understanding and perceptions of plagiarism and the underlying factors that may lead them to plagiarise. Methods: This cross-sectional study was carried out between January and June 2017 among a sample of 400 undergraduate medical and nursing students at Hawler Medical University in Erbil. Plagiarism-related data were collected through a specially designed self-administered questionnaire. Results: In total, 280 (70%) medical students and 120 (30%) nursing students were included in the study. The reported prevalence of plagiarism was 54.3%, with a slightly higher prevalence among male students compared to female students (54.9% versus 53.8%; P = 0.820) and medical students compared to nursing students (58.9% versus 43.3%; ( P = 0.004). Alarmingly, 34.8% of the students did not know what plagiarism was, and only 28% were aware of the legal consequences of plagiarism. Reported reasons for plagiarising included laziness and the ease with which others’ work could be plagiarised, confusion, cultural reasons and pressure to meet deadlines. Conclusion: There was a lack of understanding of plagiarism and its legal ramifications among undergraduate medical and nursing students in Erbil. The findings of this study indicate that there is an urgent need to increase students’ understanding of plagiarism and its consequences so as to reduce the incidence of this type of academic misconduct. Keywords: Undergraduate Medical Education; Plagiarism; Medical Students; Nursing Students; Perceptions; Iraq.

22 citations


Journal ArticleDOI
TL;DR: Prematurity, premature rupture of the membranes, a previous stay in another hospital, prolonged NICU stay, the presence of invasive devices, previous exposure to carbapenems or aminoglycosides and prolonged antibiotic therapy before infection were significantly associated with CRAB-caused HAIs.
Abstract: Objectives: Acinetobacter baumannii is a causative pathogen of various healthcare-associated infections (HAIs) and is particularly prevalent in high-risk hospital settings. This study aimed to determine risk factors associated with HAIs caused by carbapenem-resistant A. baumannii (CRAB) in a neonatal intensive care unit (NICU). Methods: This prospective study was performed between January 2013 and June 2014 among NICU patients at the Mansoura University Children’s Hospital, Mansoura, Egypt. Neonates who developed HAIs due to CRAB were assigned to a case group, while those infected with carbapenem-sensitive A. baumannii (CSAB) were assigned to a control group. Results: Among the 124 neonates who developed A. baumannii -caused HAIs during the study period, 91 (73.4%) were caused by CRAB and 33 (26.6%) were caused by CSAB. Prematurity, premature rupture of the membranes (PROM), a previous stay in another hospital, prolonged NICU stay, the presence of invasive devices, previous exposure to carbapenems or aminoglycosides and prolonged antibiotic therapy before infection were significantly associated with CRAB-caused HAIs. A multivariate logistic regression analysis identified prematurity (adjusted odds ratio [aOR] = 25.3; P <0.01), mechanical ventilation (aOR = 18.9; P <0.01) and the previous use of carbapenems (aOR = 124.7; P <0.01) or aminoglycosides (aOR = 22.6; P = 0.04) to be independent risk factors for CRAB infections. Conclusion: Various risk factors were significantly associated with CRAB-caused HAIs among the studied NICU patients.

17 citations


Journal ArticleDOI
TL;DR: The findings of this study indicate that NAC supplementation may potentially overcome the therapeutic limitations of ex vivo-maintained HSPCs.
Abstract: Objectives: The ex vivo maintenance of haematopoietic stem/progenitor cells (HSPCs) is crucial to ensure a sufficient supply of functional cells for research or therapeutic applications. However, when exposed to reactive oxygen species (ROS) in a normoxic microenvironment, HSPCs exhibit genomic instability which may diminish their quantity and quality. This study aimed to investigate the role of N-acetylcysteine (NAC) supplementation on the oxidative stress levels, genotoxicity and lineage commitment potential of murine haematopoietic stem/progenitor cells (HSPCs). Methods: This study was carried out at the Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, between June 2016 and July 2017. Bone marrow cells were isolated from nine mice and cultured in a growth medium. Various concentrations of NAC between 0.125–2 μM were added to the culture for 48 hours; these cells were then compared to non-supplemented cells harvested from the remaining three mice as the control group. A trypan blue exclusion test was performed to determine cell viability, while intracellular ROS levels and genotoxicity were determined by hydroethidine staining and comet assay, respectively. The lineage commitment potential of erythroid, myeloid and pre-B-lymphoid progenitor cells was evaluated via colony-forming cell assay. Results: NAC supplementation at 0.25, 0.5 and 2 μM significantly increased cell viability ( P 0.050). Conclusion: The findings of this study indicate that NAC supplementation may potentially overcome the therapeutic limitations of ex vivo-maintained HSPCs. Keywords: Hematopoietic Stem Cells; N-acetylcysteine; Reactive Oxygen Species; DNA Damage; Cell Lineage.

16 citations


Journal ArticleDOI
TL;DR: Inappropriate doses of antibiotics, a diagnosis of septic shock and the presence of at least two comorbidities were found to significantly increase the mortality rate of sepsis patients admitted to an ICU in Indonesia.
Abstract: Objectives: This study aimed to evaluate the appropriateness of antibiotic use and factors associated with outcomes among sepsis patients in an ntensive care unit (ICU). Methods: This cross-sectional study was carried out from February to May 2017 and included all adult patients with sepsis or septic shock admitted to the ICU of Dharmais Cancer Hospital, Jakarta, Indonesia. Data were collected from the patients’ medical records. Results: A total of 60 patients with sepsis or septic shock were admitted to the ICU during the study period. The most common source of infection was hospital-acquired pneumonia (61.7%) and the majority had two or more comorbidities (93.3%). There were 115 antibiotic regimens prescribed. Overall, 33.3% of patients were prescribed inappropriate types of antibiotics and 51.7% were given an inappropriate dosage. The mortality rate was 68.3%. There was a statistically significant association between patient outcome and inappropriate doses of antibiotics ( P = 0.034), although not inappropriate types of antibiotics ( P = 0.050). A multivariate analysis indicated that the main factors influencing patient outcome were septic shock and the presence of at least two comorbidities (P <0.050 each). Conclusion: Inappropriate doses of antibiotics, a diagnosis of septic shock and the presence of at least two comorbidities were found to significantly increase the mortality rate of sepsis patients admitted to an ICU in Indonesia. Keywords: Drug Prescription, trends; Antibiotics; Sepsis; Septic Shock; Intensive Care Units; Indonesia.

14 citations


Journal ArticleDOI
TL;DR: Coronary computed tomography angiography revealed a dual LAD artery anomaly in which the short and long LAD arteries shared a common ostium with theright coronary artery from the right coronary sinus, which has not been previously reported in the literature.
Abstract: A dual left anterior descending (LAD) artery is a rare congenital anomaly which is classified into different types based on the origin, course and termination of the short and long LAD arteries. To date, 10 variants of dual LAD artery anomalies have been described. We report a 44-year-old woman who was referred to the Department of Radiology, Royal Hospital, Muscat, Oman, in 2017. Coronary computed tomography angiography revealed a dual LAD artery anomaly in which the short and long LAD arteries shared a common ostium with the right coronary artery from the right coronary sinus. To the best of the authors’ knowledge, this type of variant has not been previously reported in the literature. Keywords: Coronary Angiography; Congenital Abnormality; Coronary Vessel Anomalies; Case Report; Oman.

14 citations


Journal ArticleDOI
TL;DR: Omani nurses had positive attitudes towards EBP as well as similar perceptions of barriers and facilitators to EBP implementation, which may help to inform recommendations for the integration of EBP in educational programmes and clinical settings in Oman.
Abstract: Objectives: This study aimed to explore the attitudes of Omani nurses towards evidence-based practice (EBP) and their perceptions of the barriers to and facilitators of EBP implementation in Oman. In addition, the attitudes and perceptions of nurse leaders and staff nurses were compared. Methods: This descriptive cross-sectional study was conducted between August and October 2016 in three suburban governmental hospitals in Northern Oman. A demographic questionnaire and two EBP instruments were used to collect data from 282 registered Omani nurses, including the Evidence-Based Nursing Attitude Questionnaire and the Developing Evidence-Based Practice Questionnaire. Results: A total of 260 Omani nurses took part in the study (response rate: 92.2%). On the whole, the nurses had positive attitudes towards EBP, with no significant difference in mean attitude scores per item between staff nurses and nurse leaders (3.98 ± 0.46 versus 4.03 ± 0.50; P = 0.431). However, in comparison to staff nurses, nurse leaders had higher scores per item for the barriers to changing practice and finding and reviewing evidence subsections, with lower scores for the facilitators to changing practice section. Conclusion: In accordance with the international literature, Omani nurses had positive attitudes towards EBP as well as similar perceptions of barriers and facilitators to EBP implementation. These findings may help to inform recommendations for the integration of EBP in educational programmes and clinical settings in Oman, as well as to facilitate necessary changes in nursing practice. Keywords: Evidence-Based Practice; Nurses; Attitudes; Perceptions; Oman.

12 citations


Journal ArticleDOI
TL;DR: A 65-year-old man who was admitted to the Hull Royal Infirmary in 2017 with haematemesis and melaena developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices, and underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding.
Abstract: A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butyl-cyanoacrylate and lipiodol). This condition may be associated with a delayed onset of respiratory compromise. Therefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infirmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. The aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.

12 citations


Journal ArticleDOI
TL;DR: The overall survival rate of patients who had experienced an OHCA was low, although three survivors suffered permanent hypoxic brain damage, and education programmes should focus on the benefits of immediate CPR for individuals experiencing anOHCA.
Abstract: Objectives: Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records. Results: A total of 216 patients were included in the study. The majority (63.9%) presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm (62.5%), with only 10% having ventricular tachycardia/fibrillation. Very few patients (1.4%) had received cardiopulmonary resuscitation (CPR) prior to presentation. In total, 85 patients (39.4%) returned to spontaneous circulation (RSC); of these, post-RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage. Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman. Keywords: Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Patient Outcome Assessment; Survival Rate; Coronary Angiography; Oman.

Journal ArticleDOI
TL;DR: The role of blood glucose level alterations in predicting patient outcomes in AlP poisoning cases remains inconclusive and further studies with larger sample sizes are required.
Abstract: Objectives: This study aimed to assess the prognostic significance of blood glucose levels and blood glucose alterations (i.e. hyper- or hypoglycaemia) among patients with aluminium phosphide (AlP) poisoning. Methods: This prospective observational study was conducted at the Postgraduate Institute of Medical Education & Research, Chandigarh, India, between January 2010 and June 2011. All patients presenting to the emergency department with a definitive history of AlP ingestion or symptoms compatible with AlP poisoning were included in the study. Blood glucose levels were recorded at presentation and every six hours thereafter. Alterations in blood glucose levels and other clinical and laboratory variables were subsequently compared between survivors and non-survivors. Results: A total of 116 patients with AlP poisoning were identified. Of these, 57 patients (49%) survived and 59 patients (51%) died. At presentation, the mean blood glucose levels of survivors and non-survivors were 119.9 ± 35.7 mg/dL and 159.7 ± 92.5 mg/dL, respectively ( P <0.001). In comparison to the survivors, non-survivors had significantly higher heart rates, total leukocyte counts, blood glucose level alterations and serum creatinine levels ( P <0.050). In addition, systolic blood pressure, Glasgow coma scale scores, arterial blood gas pH and bicarbonate values and duration of hospital stay was significantly lower compared to survivors ( P <0.001). However, neither blood glucose levels at admission nor blood glucose alterations correlated independently with mortality in a multivariate analysis. Conclusion: The role of blood glucose level alterations in predicting patient outcomes in AlP poisoning cases remains inconclusive. Further studies with larger sample sizes are required. Keywords: Aluminum Phosphide; Poisoning; Blood Glucose; Hyperglycemia; Hypoglycemia; Mortality; Prognostic Factors; India.

Journal ArticleDOI
TL;DR: Most of the patients admitted to the ICUs were middle-aged females with no known underlying comorbidities, and larger studies are necessary to provide a comprehensive understanding of the critical care needs of Sudanese hospitals.
Abstract: Objectives: Knowledge of intensive care unit (ICU) admission patterns and characteristics is necessary for the development of critical care services, particularly in low-resource settings. This study aimed to describe the characteristics of critically-ill patients admitted to ICUs in Sudan. Methods: This prospective observational study was conducted between February and May 2017 in the ICUs of two government tertiary care hospitals in Khartoum, Sudan. A total of 100 consecutive adult patients admitted to the ICUs were included in the study. The patients’ demographic and clinical characteristics and Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) scores upon admission were recorded, as well as the reason for admission, presence of any underlying comorbidities, interventional requirements like mechanical ventilation or haemodialysis, length of stay in the ICU and patient outcome. Results: Of the sample, 58% were female and 42% were male. The mean age was 47.4 ± 18.3 years old. Upon admission, the mean APACHE II score was 14.2 ± 9.6. In total, 54% of the patients had no known underlying comorbidities. The most common reasons for ICU admission were neurological diseases (27%), sepsis or infectious diseases (19%) and postoperative management (12%). Mechanical ventilation and haemodialysis were required by 35% and 11% of the patients, respectively. The average length of stay was 10.0 ± 7.2 days and the mortality rate was 24%. Conclusion: Most of the patients admitted to the ICUs were middle-aged females with no known underlying comorbidities. Larger studies are necessary to provide a comprehensive understanding of the critical care needs of Sudanese hospitals. Keywords: Intensive Care Units; Patient Admission, trends; Critical Care Outcomes; Developing Countries; Sudan.

Journal ArticleDOI
TL;DR: The number of publications authored by GCC researchers has risen in recent years, and increasing research funding and promoting collaboration between local and international researchers and institutes are recommended to bolster research regarding DFD prevention and management in GCC countries.
Abstract: Objectives: Countries in the Gulf Cooperation Council (GCC) have some of the highest prevalence rates of diabetes mellitus (DM) in the world; however, DM-related research activity in this region is limited. This study aimed to examine trends in published diabetic foot disease (DFD) research undertaken in GCC countries. Methods: This bibliometric study was conducted in December 2016. Standardised criteria were used to search the MEDLINE ® database (National Library of Medicine, Bethesda, Maryland, USA) for DFD-related publications authored by GCC researchers between January 1990 and December 2015. Various details such as the type of publication, journal impact factor and number of article citations were analysed. Results: A total of 96 research articles were identified. The number of publications per year significantly increased from nil prior to 1991 to 15 in 2015 ( P <0.01). Basic/clinical research articles accounted for 96.9% of publications, with three randomised controlled trials and no systematic reviews/meta-analyses. When adjusted for population size, Kuwait had the highest number of published papers per year, followed by Bahrain and Qatar. The number of authors per publication significantly increased during the study period ( P = 0.02). However, 16 articles (16.7%) had no citations. The median journal impact factor was 0.15 ± 1.19 (range: 0–6.04). Conclusion: The number of publications authored by GCC researchers has risen in recent years. Increasing research funding and promoting collaboration between local and international researchers and institutes are recommended to bolster research regarding DFD prevention and management in GCC countries. Keywords: Bibliometric Analysis; Diabetes Mellitus; Diabetic Foot; Research; Publications; Arab Countries; Gulf Cooperation Council.

Journal ArticleDOI
TL;DR: Overall, medical undergraduate students and interns viewed the educational environment in Oman in a positive light and it is possible that undergraduate students' perceptions of theeducational environment may become more favourable as they progress with their medical career and become interns.
Abstract: Objectives: This study aimed to assess perceptions of the educational environment in Oman among medical undergraduate students and interns using the Dundee Ready Education Environment Measure (DREEM) tool Methods: This cross-sectional study was conducted between October 2016 and April 2017 at the Oman Medical College (OMC), Sohar, Oman A total of 737 medical undergraduate students and interns from the OMC and College of Medicine & Health Sciences of Sultan Qaboos University in Muscat, Oman, were invited to complete the DREEM questionnaire in the form of an online survey Mean overall scores, subscale scores and individual item scores were subsequently compared between undergraduate students and interns Results: A total of 418 undergraduate students and interns completed the survey (response rate: 567%) The mean overall DREEM score was 13075 ± 1269 While interns had higher mean DREEM scores than undergraduate students, this difference was not significant (13300 ± 1764 versus 12850 ± 1553; P = 0326) The mean score percentages for the perceptions of learning (667% versus 583%; P = 0028) and perceptions of teachers (75% versus 682%; P = 0038) subscales were significantly higher among OMC interns compared to undergraduate students from the same college The perceptions of the environment subscale received the lowest mean score percentages among undergraduate students and interns from both colleges Conclusion: Overall, medical undergraduate students and interns viewed the educational environment in Oman in a positive light It is possible that undergraduate students’ perceptions of the educational environment may become more favourable as they progress with their medical career and become interns Keywords: Medical Education; Undergraduate Medical Students; Internships; Perceptions; Oman

Journal ArticleDOI
TL;DR: The quality of counselling services in governmental family planning centres in Jordan needs to be improved to ensure that women receive the highest possible level of care.
Abstract: Objectives: Counselling plays a key role in enhancing reproductive services, providing contraception-related information and supporting long-term family planning for women of childbearing age. This study aimed to evaluate family planning counselling sessions in selected governmental and private clinics in northern Jordan. Methods: This cross-sectional study was conducted between January and June 2016 in Irbid, Jordan. A total of 200 women attending two private clinics affiliated with the Jordanian Association for Family Planning and Protection (JAFPP) and six governmental clinics were invited to participate in the study. Counselling sessions were attended by an independent observer and evaluated with regards to their compliance with the standard Greet, Ask, Tell, Help, Explain, Return (GATHER) framework. Results: A total of 198 women participated in the study (response rate: 99.0%), including 80 women (40.4%) from JAFPP clinics and 118 (59.6%) from governmental clinics. In total, 42.9% of the counselling sessions were deemed adequate, with providers applying 80% or more of the GATHER framework, while 26.8% of the sessions were deemed semi-adequate and 30.3% were considered inadequate. Counselling services provided in the governmental clinics were significantly less adequate than those provided in JAFPP clinics ( P <0.001). Conclusion: The quality of counselling services in governmental family planning centres in Jordan needs to be improved to ensure that women receive the highest possible level of care. Healthcare policymakers should therefore focus on developing and supporting effective family planning counselling services in northern Jordan.

Journal ArticleDOI
TL;DR: The Arabic HAMD-7 scale was found to be reliable and valid among two samples of Arabic speakers in Saudi Arabia, however, further research among Arab-speaking patients diagnosed with depression is needed in order to establish its usefulness in assessing the severity of depressive symptoms.
Abstract: Objectives: Depression is a common mental disorder, the severity of which is frequently assessed via interview-based clinical scales such as the 7-item Hamilton Depression Rating Scale (HAMD-7). The current study aimed to translate and examine the validity of an Arabic version of the HAMD-7 scale. Methods: This study took place between February and March 2016 in the Psychiatry Department of King Saud University, Riyadh, Saudi Arabia. The HAMD-7 scale was translated into Arabic using forward and backward translation methods. A total of 153 Arabic speakers were recruited to test the translated scale, including 57 medical students and 96 members of the general public. The Arabic version of the HAMD-7 scale was completed by trained investigators during face-toface interviews with the participants. In order to assess convergent validity, participants also completed an Arabic version of the self-assessed Patient Health Questionnaire-9 (PHQ-9) scale. Subsequently, the test-retest reliability of the translated HAMD-7 scale was evaluated two weeks later during a second interview. Results: Overall, HAMD-7 scores were positively correlated with PHQ-9 scores (r = 0.633–0.749). Moreover, the translated HAMD-7 scale proved to be reliable in terms of test-retest reliability (intra-class correlation coefficient: 0.807; P <0.001). With regards to internal consistency, the Cronbach’s α values ranged between 0.607–0.756. Conclusion: The Arabic HAMD-7 scale was found to be reliable and valid among two samples of Arabic speakers in Saudi Arabia. However, further research among Arab-speaking patients diagnosed with depression is needed in order to establish its usefulness in assessing the severity of depressive symptoms. Keywords: Psychiatry; Depression; Psychometrics; Validity and Reliability; Translation; Questionnaire Design; Saudi Arabia.

Journal ArticleDOI
TL;DR: The prevalence of early pregnancy obesity among Omani women and to review maternal antenatal complications, intrapartum and postpartum events and neonatal complications among such women in comparison to women of normal weight were determined.
Abstract: Objectives: This study aimed to determine the prevalence of early pregnancy obesity among Omani women and to review maternal antenatal complications, intrapartum and postpartum events and neonatal complications among such women in comparison to women of normal weight. Methods: This retrospective cohort study included 2,652 pregnant Omani women who delivered at the Royal Hospital, Muscat, Oman, between November 2011 and April 2012. The patients’ electronic medical records were reviewed for antenatal, intrapartum and postpartum data. Body mass index was measured during the first trimester (≤12 gestational weeks) and classified according to the World Health Organization categories. Maternal and neonatal complications were compared between obese women and those of normal weight. Obstetric outcomes in uncomplicated pregnancies were also compared. Results: In the study cohort, there were 901 (34%) obese women and 912 (34.4%) women of normal weight; of these, 440 (48.8%) and 672 (73.7%) had uncomplicated pregnancies, respectively. Obese women had a significantly increased incidence of gestational diabetes (relative risk [RR]: 2.23; 95% confidence interval [CI]: 1.70–2.92; P <0.01), gestational hypertension (RR: 3.04; 95% CI: 1.63–5.65; P <0.01), Caesarean delivery (RR: 1.48; 95% CI: 1.08–2.03; P <0.01), postpartum haemorrhage (RR: 2.10; 95% CI: 1.11–4.10; P = 0.01) and fetal macrosomia (RR: 2.71; 95% CI: 1.21–6.09; P <0.01). Conclusion: Approximately one-third of the studied Omani women were obese. These women had a significantly increased risk of various maternal antenatal complications, intrapartum and postpartum events and neonatal complications.

Journal ArticleDOI
TL;DR: Omanis had a low level of knowledge of clinical trials and a very low rate of previous participation in such trials, despite a moderate level of interest.
Abstract: Objectives: Clinical trials are prospective studies on human subjects designed to answer various clinical questions. However, only a limited number of clinical trials have been conducted in Oman. This study aimed to assess the knowledge and attitudes of Omani patients and their relatives towards participating in clinical trials. Methods: This cross-sectional study was conducted between October 2015 and March 2016 among 174 patients and relatives attending the Haematology and Oncology Outpatient Clinics and Day Care Unit of the Sultan Qaboos University Hospital, Muscat, Oman. A self-administered questionnaire was designed to elicit participants’ knowledge of and attitudes towards participation in clinical trials. Results: A total of 100 patients and relatives agreed to take part in the study (response rate: 57.5%). The male-to-female ratio was 1:1.2. Only 31.3% of the studied population knew what clinical trials were and only 6.5% had themselves previously participated in a clinical trial. The majority agreed or strongly agreed that they would participate in clinical trials related to their own condition (59.2%). Overall, 89.7% expected to be informed about potential clinical trials by their treating physicians. Conclusion: Omanis had a low level of knowledge of clinical trials and a very low rate of previous participation in such trials, despite a moderate level of interest. Patients should therefore be educated and informed of ongoing clinical trials in order to improve participation rates for clinical trials conducted in Oman.

Journal ArticleDOI
TL;DR: Researchers in the Asian Pacific region have concluded that there are meaningful segments of patients across very different cultures who prefer little or no family involvement in TDM and higher levels of shared and autonomous TDM.
Abstract: is the process by which physicians and patients make treatment decisions by sharing information, expressing preferences and agreeing to implement a proposed treatment.1 Among patients who are diagnosed with life-threatening diseases such as cancer, shared TDM has been associated with improved physical and psychological health outcomes, greater patient compliance with regards to oncological treatments, higher levels of patient satisfaction and reduced overall healthcare costs.2,3 Indeed, it has been observed that the majority of cancer patients prefer having a role in TDM along with their physicians; however, there is controversy regarding the appropriate level of involvement of patients’ families.4,5 In an online survey of 290 middle-aged urban residents, Alden et al. found that individuals who preferred to be more involved in TDM—either as shared or autonomous TDM—tended to prefer less family involvement for a variety of illnesses ranging in severity, particularly if the family member in question was young.5 Interestingly, this study included samples from many Eastern countries, including China, Thailand, South Korea, Malaysia and India; this finding also held in those countries, as well as in the USA and Australia.5 Another study found that poor South Korean patients preferred autonomous TDM for end-of-life decisions, as they were often concerned that younger relatives might more heavily weigh financial concerns versus the patient’s own preferences.6 Researchers in the Asian Pacific region have therefore concluded that there are meaningful segments of patients across very different cultures who prefer little or no family involvement in TDM and higher levels of shared and autonomous TDM.5,6 In another study of patient-caregiver dyads in Korea, most patients and caregivers valued and expected family involvement in TDM; however, there was little explicit agreement regarding which party in the dyad should take decisional leadership and which should play a supporting role.7 Several studies have shown that cancer patients and their family members prefer family participation in TDM to some extent.7–9 Among patients with advanced lung cancer in Belgium, Pardon et al. reported that patients’ family members regularly attended consultation and treatment appointments in order to provide emotional support, request further information and participate in the TDM process.10 A large, multiregional, prospective cohort study of newly diagnosed patients with lung and colorectal cancer undertaken in the USA found that most participants involved family members in treatment decisions.11 Nevertheless, the study concluded that further research is required to evaluate the impact such involvement might have on patient outcomes. The authors also noted that physicians should consider determining the patients’ preferences regarding family involvement at the outset of care.11 In Oman, many breast cancer patients were found to rely on their families for emotional, physical and financial support, the absence of which negatively affected the patient’s prognosis.12 It should be noted that the impact of a cancer diagnosis on family members is sometimes similar to that of the patient in terms of stress, depression, anxiety, financial constraints and interpersonal problems.13,14 In Eastern countries, patients are more likely to be guided by their families during the TDM process, which is often associated with high levels of positive emotional engagement, and are therefore less likely to make key medical decisions.15 Family members in such countries tend to believe that TDM should lie in the hands of the patient’s family members and that these individuals should be involved directly in the

Journal ArticleDOI
TL;DR: A significant association between RSI and VHI-10 scores suggests that there may be an association between LPR and voice disorders, although more detailed studies are needed to confirm this association using a larger sample size.
Abstract: Objectives: This study aimed to assess potential associations between self-reported symptoms of laryngopharyngeal reflux (LPR) and voice disorders among two undiagnosed cohorts in Saudi Arabia. Methods: This cross-sectional study was conducted from February to April 2017 in Khobar, Saudi Arabia. Validated Arabic versions of the Reflux Symptom Index (RSI) and 10-item Voice Handicap Index (VHI-10) were distributed to 400 teachers at 13 schools and 300 members of the general population attending an ear, nose and throat clinic in Khobar. Scores of >13 and >11 on the RSI and VHI-10 indicated a potential subjective diagnosis of LPR and voice disorders, respectively. Results: A total of 446 individuals took part in the study, including 260 members of the general population (response rate: 86.7%) and 186 teachers (response rate: 46.5%). The mean age was 32.5 years. In total, 62.2% complained of voice and/or reflux problems, with the remaining 37.8% not reporting/unaware of any problems in this regard. Among the teachers, 30.6% and 18.3% had positive RSI and VHI-10 scores, respectively, while 43.1% and 14.6% of the individuals from the general population had positive RSI and VHI-10 scores, respectively. Overall, VHI-10 scores were significantly associated with RSI scores ( P <0.001). Conclusion: A significant association between RSI and VHI-10 scores suggests that there may be an association between LPR and voice disorders. These tools would therefore be a valuable method of monitoring patients; however, they cannot be used to confirm a diagnosis. Thus, more detailed studies are needed to confirm this association using a larger sample size. Keywords: Voice Disorders; Laryngopharyngeal Reflux; Hoarseness; Diagnostic Self Evaluation; School Teachers; Saudi Arabia.

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TL;DR: Clinical pharmacist interventions were found to reduce subsequent DRPs and clinical problems among CHD patients with at least one previous DRP.
Abstract: Objectives: This study aimed to evaluate the role of a clinical pharmacist intervention in decreasing subsequent clinical and drug-related problems (DRPs) among coronary heart disease (CHD) inpatients with at least one previous DRP. Methods: This pre-experimental study with a pre-post design was carried out from January to April 2017 among inpatients with at least one previous DRP at a general hospital in Tangerang District, Banten, Indonesia. Clinical and DRPs were documented prospectively by a clinical pharmacist, with DRPs classified using Version 6.2 of the DRP classification scheme of the Pharmaceutical Care Network Europe Foundation. The intervention consisted of a discussion of identified DRPs with physicians, patients, pharmaceutical logistics clerks, nurses and nutritionists. Following this, any subsequent clinical and DRPs were re-identified and further interventions were conducted as necessary. Results: A total of 75 inpatients were included in the study. Pre-intervention, there were 443 DRPs and 202 clinical problems. The most frequent DRPs were adverse drug reactions (52.6%), followed by drug effects (41.8%). Most DRPs were of moderate severity and would have resulted in moderate consequences had the pharmacist not intervened. The interventions resulted in a significant reduction in the number of DRPs, type of DRPs and number of clinical problems ( P <0.05 each). Patients with complications were 26.047 times more likely to have no reduction or an increased number of clinical problems compared to patients without complications ( P <0.05). Conclusion: Clinical pharmacist interventions were found to reduce subsequent DRPs and clinical problems among CHD patients with at least one previous DRP.

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TL;DR: Five cases of benign head or neck masses occurring among patients who were managed at the Bahrain Defence Force Royal Medical Services Hospital, Ar-Rifaa, Bahrain between 2005-2014 are reported.
Abstract: Head and neck masses can present in different pathologies that usually vary according to the age of the patient. We report five cases of benign head or neck masses occurring among patients of different ages who were managed at the Bahrain Defence Force Royal Medical Services Hospital, Ar-Rifaa, Bahrain, between 2005-2014. All of the patients were treated using the sclerotherapeutic agent OK-432. Although surgical removal is usually considered optimal treatment in the management of such cases, OK-432 appears to be a promising alternative.

Journal ArticleDOI
TL;DR: Three cases who were referred to the Dermatology Outpatient Clinic of the Hospital Universitario San Cecilio, Granada, Spain, in 2017 with various skin reactions in the red-ink areas of their tattoos with an adequate differential diagnosis are reported.
Abstract: In recent years, tattoos have become more commonplace. However, this can result in various inflammatory processes, the management of which can be challenging in daily clinical practice. Tattoo-related inflammatory reactions can comprise different patterns, including acute and immediate reactions, foreign body granulomas, sarcoid granulomas, isomorphic lesions, allergic contact dermatitis and photosensitivity. We report three cases who were referred to the Dermatology Outpatient Clinic of the Hospital Universitario San Cecilio, Granada, Spain, in 2017 with various skin reactions in the red-ink areas of their tattoos. Screening was performed for infectious diseases like atypical mycobacterial infections and systemic processes such as sarcoidosis. A good therapeutic response was achieved in all cases. An adequate differential diagnosis is essential for the therapeutic management of this emerging health problem. Keywords: Non-Therapeutic Body Modification; Tattooing, adverse effects; Inks; Foreign Body Reaction; Inflammation; Case Report; Spain.

Journal ArticleDOI
TL;DR: A 60-year-old man with a history of shortness of breath upon exertion, orthopnoea and bilateral lower limb swelling and histopathological examination of biopsied lung tissue confirmed a diagnosis of nodular pulmonary amyloidosis.
Abstract: Amyloidosis is a disorder characterised by the extracellular deposition of amyloid, a fibrillary protein, in various organs such as the lungs. Pulmonary nodular amyloidosis can mimic other lung conditions that present with pulmonary nodules, such as metastasis, sarcoidosis and hyalinising granuloma. We report a 60-year-old man who presented to the Royal Hospital, Muscat, Oman, in 2017 with a history of shortness of breath upon exertion, orthopnoea and bilateral lower limb swelling. A chest X-ray showed bilateral nodular opacities. Enhanced chest computed tomography revealed bilateral pulmonary nodules with a predominantly perilymphatic and subpleural distribution, giving the impression of a neoplastic nodule. A histopathological examination of biopsied lung tissue confirmed a diagnosis of nodular pulmonary amyloidosis.


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TL;DR: A 22-year-old Omani male who presented to the Sohar Hospital in 2016 with acute-onset rapidly progressive flaccid areflexic paraplegia as the presenting manifestation of thyrotoxicosis is reported, highlighting the importance of including thyroid function tests in the evaluation of patients with acute polyneuropathy.
Abstract: Acute polyneuropathy is a rare manifestation of severe hyperthyroidism. We report a 22-year-old Omani male who presented to the Sohar Hospital, Sohar, Oman, in 2016 with acute-onset rapidly progressive flaccid areflexic paraplegia as the presenting manifestation of thyrotoxicosis. Nerve conduction studies revealed mixed axonal and demyelinating polyneuropathy in both the motor and sensory nerves. Treatment of the hyperthyroidism with β-blockers and carbimazole along with physiotherapy resulted in the patient's full recovery and the alleviation of his symptoms. Besides highlighting this rare association, this report underscores the importance of including thyroid function tests in the evaluation of patients with acute polyneuropathy.

Journal ArticleDOI
TL;DR: Existing transfusion guidelines forickle cell disease and homozygous β-thalassaemia are summarized and recommendations for blood banks and transfusion services in Oman are provided.
Abstract: Sickle cell disease and homozygous β-thalassaemia are common haemoglobinopathies in Oman, with many implications for local healthcare services. The transfusions of such patients take place in many hospitals throughout the country. Indications for blood transfusions require local recommendations and guidelines to ensure standardised levels of care. This article summarises existing transfusion guidelines for this group of patients and provides recommendations for blood banks and transfusion services in Oman. This information is especially pertinent to medical professionals and policy-makers developing required services for the standardised transfusion support of these patients.

Journal ArticleDOI
TL;DR: Current evidence on the use of ranolazine is examined in various cardiovascular conditions in order to determine whether it is a true pluripotent cardiovascular agent or, on the other hand, a "jack of all trades, master of none."
Abstract: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Although the majority of patients with CVD are treated with interventional procedures, a substantial number require medical therapy in terms of both prognosis and symptomatic relief. However, commonly used agents such as β-blockers and calcium channel blockers reduce blood pressure in patients whose resting pressures are often already low. Ranolazine is a promising agent that does not have significant effects on blood pressure or heart rate. Use of this drug has been documented in various cardiovascular conditions, including ischaemic heart disease, heart failure and arrhythmias. This review article aimed to examine current evidence on the use of ranolazine in various cardiovascular conditions in order to determine whether it is a true pluripotent cardiovascular agent or, on the other hand, a "jack of all trades, master of none."

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TL;DR: The application of LM principles helped to improve value in a radiation oncology department and improve workflow, reduce waste and enhance patient and staff satisfaction.
Abstract: Objectives: Lean management (LM) principles were first developed by a Japanese manufacturing company to maximise value and minimise waste in the automotive industry. However, these principles can also be applied in the healthcare sector. This study aimed to illustrate the process of implementing LM principles in a radiation oncology department to streamline workflow and identify and reduce waste. Methods: This study took place in the Department of Radiation Oncology, Royal Hospital, Muscat, Oman, in December 2016. A value stream map (VSM) was created for the chain of processes followed in the department. A waste analysis was conducted to determine which processes did not add value for the patient or healthcare provider. Results: Based on the VSM analysis, only six out of 13 steps were found to be of value. Necessary and unnecessary non-value-adding activities were identified. Sources of waste included parking and registration. In addition, variabilities in workload were noted. Conclusion: Overall, LM principles improve workflow, reduce waste and enhance patient and staff satisfaction. In the current study, the application of LM principles helped to improve value in a radiation oncology department. Keywords: Health Services Administration; Healthcare Quality Assurance; Total Quality Management; Organization and Administration; Efficiency; Oman.