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July 2008 - Vol. 8, No. 2
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Physicians, Climate Change and Human Health Lamk Al-Lamki July 2008 - Vol. 8, No. 2, p.125-127
Genetic Services in the Sultanate of Oman and other Gulf Countries : Progress is needed now! Sandy Raeburn July 2008 - Vol. 8, No. 2, p.129-135
Major Advances in the Treatment of Cancer : What does a Non-Oncologist need to know? Ikram A Burney and Mansour S Al-Moundhri July 2008 - Vol. 8, No. 2, p.137-148
The last few years have seen major advances in the management of cancers. Since it is not possible for the non-oncologist to keep abreast with the latest developments in the field of oncology, this review summarises the most significant advances in the area of treatment of various cancers over the past four years. In some areas, a paradigm shift has occurred setting new standards of care, for example, the use of targeted therapy (trastuzumab) in adjuvant treatment of breast cancer; the use of monoclonal antibodies(rituximab), with or without chemotherapy, in the treatment and maintenance of indolent lymphoma; the use of the tyrosine kinaseinhibitor, imatinib, in the adjuvant setting in resected gastrointestinal stromal tumours. In other areas, new treatments have emerged,such as, the use of targeted therapies in hepatocellular carcinoma (sorafenib) and renal cell carcinoma (sunitinib, sorafenib, temsirolimus, bevacizumab). In some other cancers, the addition of targeted therapies has improved survival rates, for example, in colon cancer (bevacizumab, cetuximb, panitumumab), head and neck cancers (cetuximab), and pancreatic adenocarcinoma (erlotinib). In yet another group, new targeted therapies have emerged where resistance was previously observed with the existing targeted therapies, for example, breast cancer (lapatinib), chronic myeloid leukemia (dasatinib). Finally, the addition of chemotherapeutic agents has improved survival in some forms of cancer, for example, oxaliplatin in adjuvant treatment of colon cancer, temozolamide in glioblastoma multiforme, and adjuvant chemotherapy in non-small cell lung cancer. The information summarized here may provide useful for the busy physician needing an update in the field of oncology.
Keywords: Medical Oncology; Trastuzumab; Rituximab; Imatinib; Sorafenib; Sunitinib; Bevacizumab.Medical Education Units : History, Functions, and Organisation Nadia M Al-Wardy July 2008 - Vol. 8, No. 2, p.149-156
Most medical schools have established a medical education unit (MEU) or similar bodies in response to various reforms in medical education. Such units have a variety of titles and operate either independently or under the office of the dean. Their activities include conducting educational research, teaching and providing service and career development of academic staff. The scope of their activities ranges from serving medical faculty only to all other health professionals at either the undergraduate or postgraduate levels. Several factors contribute to the success of MEUs and their establishment is seen to have a positive effect on their medical school.
Keywords: Education, Medical. Organisation and administration; Oman.Regional Variation in the Prevalence of Asthma Symptoms among Omani School Children : Comparisons from Two Nationwide Cross-sectional Surveys Six Years Apart Omar A Al-Rawas, Bazdawi M Al-Riyami, Hussein Al-Kindy, Abdullah A Al-Maniri and Asya A Al-Riyami July 2008 - Vol. 8, No. 2, p.157-164
Objectives:The International Study of Asthma and Allergies in Children (ISAAC) highlighted the presence of wide variations in asthma prevalence between and within countries. The aim of this study was to determine the changes in the prevalence of asthma and its symptoms across the different regions of Oman. Methods: Two cross-sectional surveys were conducted as part of ISAAC phases I (1995) and III (2001) in two age groups (6-7 and 13-14 years) from nation-wide samples of Omani school children, with 7,067 participants in 1995 (3,893 young and 3,174 older group) and 7,879 participants in 2001 (4,126 young and 3,753 older group). Results: Over the period of six years, the Sharqiya (Eastern) region continued to have the highest prevalence of self-reported asthma diagnosis and all asthma symptoms in both age groups, with a significant increase in the prevalence of wheeze in the past 12 months (from 8.7% to 13.8%; p=0.002) and asthma diagnosis (from 13.8% to 17.8 %; p=0.046) in the young group, and a significant increase in night cough (from 21.6% to 27.8%; p=0.039) in the older group. All other regions had lower prevalence rates in 1995 in both age groups, and showed either no significant change or a decline in one or two of the self-reported asthma symptoms. The prevalence of asthma diagnosis among wheezy children remained unchanged across all regions. In addition, asthma under-diagnosis remains a problem with only 60% of children with severe wheeze reporting asthma diagnosis in both surveys. Conclusion: The geographic variation in the prevalence of self-reported of asthma symptoms among Omani school children persists with further increase in the Sharqiya region. The findings also suggest under-diagnosis and/or poor recognition of asthma which had not improved over time.Key words: Asthma, prevalence; Children; Adolescents; Oman.
Familial Mineralocorticoid Induced Hypertension in the Sultanate of Oman Nicholas JY Woodhouse, Omayma T Elshafie, Fatma Ben Abid, and Suhail A Doi July 2008 - Vol. 8, No. 2, p.165-169
Objectives: In Oman, many hypertensive patients with a family history of the disease respond to treatment with spironolactone, a mineralocorticoid receptor (MC-R) blocking agent thus suggesting a high prevalence of mineralocorticoid (MC) induced disease. The aim of this study was to document the prevalence of MC induced disease in patients with a positive family history of hypertension (HTN). Methods: Serum calcium, potassium, creatinine, aldosterone and renin levels were measured under standard conditions in all patients together with an abdominal ultrasound scan and an adrenal computed tomography (CT) scan in four patients. Results: In this small study, we show that 18 of the 27 patients (66%) had undetectable (suppressed) renin levels with usually normal aldosterone values (14 patients) and respond to treatment with spironoactone. Conclusion: We suggest that MC induced hypertension is likely to be common in the Middle East. In evolutionary terms, this makes sense as the ability to conserve salt in hot climates might be expected to confer a definite survival advantage.
Key words: Hypertension, familial; Mineralocorticoids; High prevalence; OmanExtended-spectrum β-lactamase (ESBL) in Omani Children : Study of prevalence, risk factors and clinical outcomes at Sultan Qaboos University Hospital, Sultan Zakariya Al Muharrmi, Akbar M Rafay, Abdullah Balkhair, Salem Al-Tamemi and Ali Al Mawali July 2008 - Vol. 8, No. 2, p.171-177
Objectives: Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum β-lactamase (ESBL) isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital (SQUH), Oman. Methods: During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed. Results: 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine (46.2%) and blood (42.6%). The main risk factors for ESBL in these children were previous exposure to antimicrobials (100%), prolonged hospital stay, severe illness (92.3%) and female gender (84.6%). Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin. Conclusion: ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives.Keywords: Extended-spectrum β-lactamase; Escherichia coli; Klebsiella pneumonia; Anti-infective agents; Risk factors; Oman.
Control and Management of Hypertension at a University Health Centre in Oman Abdulaziz Almahrezi, Ibrahim Al-Zakwani, Ayman Al-Aamri, Samia Al-Khaldi, Nisrin Al-Zadjali, Mohammed Al-Hatali and Abdullah Al-Shukeili July 2008 - Vol. 8, No. 2, p.179-184
Objectives: To evaluate the prevalence of hypertension, its control and management at Sultan Qaboos University (SQU) Health Centre, Oman. Methods: This was a retrospective cross-sectional study, in which were enrolled all the subjects (≥18 years), with the diagnosis of essential hypertension, who attended the SQU Health Centre between 1998 and 2002. The systolic and diastolic blood pressure (BP) values of the last three visits were used for analysis. BP control was defined using the Joint National Committee (JNC-7) criteria, <140 mmHg and <90 mmHg for systolic and diastolic BPs, respectively. Analyses were performed using univariate statistics. Results: Among the 7,702 medical records reviewed, the prevalence of hypertension was 2.4% (n = 187). The overall mean age of the cohort was 55±11 years, 54% (n = 101) were females, and majority of the subjects were Omanis (n = 123; 66%). The proportion of subjects who had their BP controlled was 41% (n = 77) with Omanis significantly less likely to have their BP controlled compared to non-Omanis (53% versus 35%; p = 0.017). The majority of the subjects were on mono (n = 131; 70%) followed by dual (n = 50; 27%) anti-hypertensive therapies. The most frequent mono anti-hypertensive therapies were B-blockers (n = 64; 34%) and angiotensin-converting enzyme (ACE) inhibitors (n = 47; 25%). Among the dual combination therapies, the most common prescribed regimens were ACE inhibitor plus B-blocker (n = 14; 28%) and B-blocker plus diuretic (n = 12; 24%). Conclusion: The prevalence of hypertension in this patient population was low compared to the national average. This study shows that control of hypertension is not optimal, but higher than those reported elsewhere.Key words: Hypertension; Prevention and control; Disease management; Oman.
Assessment of the Relationship of Hepatic Enzymes with Obesity and Insulin Resistance in Adults in Saudi Arabia Ali Ibrahim Al-Sultan July 2008 - Vol. 8, No. 2, p.185-192
Objectives: This study was conducted to assess the relationship of hepatic enzymes and serum albumin to obesity and insulin resistance in adults in Saudi Arabia. Methods: A comparative study of 136 Saudi adults, comprising of 68 obese and 68 non-obese was conducted. Anthropometric measurements, hepatic enzymes, serum albumin, blood glucose, serum insulin, lipid profile, and homeostasis model assessment of insulin resistance (HOMA IR) were measured. Results: The study showed significantly higher levels of gamma glutamyl transpeptidase (GGT), alkaline phosphatase, fasting glucose, serum insulin, and HOMA IR p < 0.001, <0.004 < 0.005, <0.0001, <0.0001, among obese subjects. Hepatic enzymes correlated with both anthropometric measures (body mass index (BMI), and waist to hip ratio) and markers of insulin resistance (HOMA IR, insulin, and fasting glucose). However, the study found that GGT had the strongest associations. Significant inverse correlation was found between serum albumin and BMI, HOMA IR, and serum insulin, p< 0.01, <0.05, <0.01, respectively. Conclusion: Deranged liver functions, especially GGT, had the strongest correlations with obesity and HOMA IR. GGT might be a better marker of hepatic pathology associated with obesity and insulin resistance in Saudi adults with restricted alcohol intake. The results also propose that albumin metabolism might be altered in obesity.Keywords: Obesity; Insulin resistance; Transaminases; Serum albumin; Saudi Arabia.
Varied Presentations of Acute Glomerulonephritis in Children : Single centre experience from a developing country Kalpana Malla, Moinak S Sarma, Tejesh Malla and Anna Thaplial July 2008 - Vol. 8, No. 2, p.193-199
Objectives: The objective of this prospective study, carried out at Manipal Teaching Hospital, Pokhara, was to document the various clinical presentations of children with acute glomerulonephritis and compare them with the available biological parameters in Western Nepal. Methods: Clinical and laboratory parameters of children with oedema and microscopic/macroscopic haematuria. Results: For seven years (2000-2007), 92 cases of children were clinically diagnosed with acute glomerulonephritis (AGN). Other clinical and laboratory anaylses were also eventful. Conclusion: The present study highlights the varied presentations of AGN, atypical presentations or complications of glomerulonephritis being more common than the classical presentation in the Western Region of Nepal.Keywords: Renal disease; Glomerulonephritis, acute; Urinary tract infection; Nepal.
Hydrogen Peroxide 3%: Is it Beneficial in Tonsillectomy? Ahmed M Al-Abbasi and Zahra K Saeed July 2008 - Vol. 8, No. 2, p.201-204
Objectives: The world over, tonsillectomy is one of the operations most frequently performed by otolaryngologists, who are in search of a technique of tonsillectomy where the operation time and operative blood loss is reduced. This study was carried out to evaluate the effect of hydrogen peroxide 3% on tonsillectomy times, blood loss during the surgery and on the number of ties used. Methods: A pilot study of 30 patients was carried out in the Department of Otolaryngology of Basrah General Hospital, Iraq, in the period from February to July 2006. Tonsillectomy was performed using hydrogen peroxide 3% as a haemostatic agent in Group A (n = 15), while in Group B (n = 15) no agent was used with the gauze pack. Results: The application of hydrogen peroxide 3% in the tonsillar fossae reduced the operation time by 31%, the operative blood loss by 32.9% and also reduced the number of ties used by 50% in Group A. All these results are statistically significant. Conclusion: The local application of 3% hydrogen peroxide on the tonsillar bed after tonsillectomy is beneficial in regard to decreasing the procedure time, the volume of blood loss, and the number of ties used.Keywords: Tonsillectomy; Hydrogen peroxide; Haemostasis.
Intravenous Lidocaine for Refractory Chronic Orofacial Pain : Two case reports and a literature review Abdulaziz Almahrezi, Louise Lamb, Mark A Ware, Yoram Shir and Ibrahim Al‑Zakwani July 2008 - Vol. 8, No. 2, p.205-209
This report presents the results of treatment of two adults, at the Pain Center of Montreal General Hospital, Canada, with intravenous lidocaine for intractable orofacial pain. Repeated lidocaine infusions (1mg/kg in a bolus, followed by 4mg/kg infused over 1 hour) resulted in satisfactory pain relief in both patients, and the drug was well tolerated. Intravenous lidocaine therapy may be considered for intractable orofacial pain; further research is warranted.Keywords: Facial pain; Lidocaine; Therapeutics; Humans; Review; Literature; Case reports; Canada
Cushing’s Disease : Pituitary Surgery versus Adrenalectomy Omayma El-Shafie, Fatma B Abid, Nayal Al-Kindy, Dilip Sankhla and Nicholas J Woodhouse July 2008 - Vol. 8, No. 2, p.211-214
We describe two patients of the Department of Medicine at Sultan Qaboos University Hospital, Muscat, Oman, with Cushing’s disease. Their magnetic resonance imaging scans of the pituitary were negative. One patient was treated by transsphenoidal surgery and the other by bilateral endoscopic adrenalectomy. Both procedures were successful and the patients cured. The advantages and disadvantages of these two approaches are discussed.Key words: Cushing’s disease; Surgery, pituitary; Endoscopy; Adrenalectomy; Case report; Oman.
Occlusion of Upper Genital Tract Following Lower Segment Caesarean Section for Placenta Praevia Mini B Poothavelil, Ilham Hamdi andGeeta Zunjurwad July 2008 - Vol. 8, No. 2, p.215-218
Uterine cavity occlusion following caesarean section for central placenta praevia culminating in haematometra and thereby amenorrhoea is one of the rarest long term complications of lower segment caesarean section. We report a case of 28 year old primigravida with Grade 4 placenta praevia who underwent elective caesarean section at 35 weeks gestation. She presented at Nizwa Hospital, Sultanate of Oman, after 7 months with cyclical lower abdominal pain and amenorrhoea. She was treated by hysteroscopic adhesiolysis and an in utero Foley’s catheter. She had complete resolution of her condition within 2 months and resumption of menstrual cycles. Multiple haemostatic sutures at caesarean section for placenta praevia can be an causative factor for such a complication along with other risk factors like multiple caesarean sections, chorioamniotis etc. Recognition of these factors, meticulous surgical technique and appropriate post operative care can effectively prevent it. Keywords:
Placenta previa; Adhesions, intrauterine; Occlusion; Genital tract; Case report, Oman.Traumatic Rupture of the Right Hemidiaphragm:Diagnosis aided by Computerized Tomography and Image Reformation : A Case Report Ranjan R William, Dilip Sankhla, Badriya Al-Qassabi and Khalsa Al Ramadani July 2008 - Vol. 8, No. 2, p.219-222
Traumatic rupture of the diaphragm (TRD) poses a challenge to both radiologists and surgeons. They are uncommon and occur following blunt abdominal or lower thoracic trauma. The right side involvement is less common than the left side and is easily missed. Spiral computed tomography (Spiral CT) with image reformation is very useful in the diagnosis of TRD and in identifying associated injuries. Early diagnosis and repair reduces mortality and morbidity. We present the case of a 16 year old boy who was involved in a high speed traffic accident with blunt injury to his thorax and abdomen. He was referred from a peripheral hospital in Oman for further management at Sultan Qaboos University Hospital. A spiral CT scan of thorax and abdomen with image reformation helped in the early diagnosis and management of the traumatic rupture of his right hemidiaphragm.
Key words: Right hemidiaphragm; Rupture; Computerized tomography; Case report; Oman.Fracture of Supracondylar Process of the Humerus S S Suresh July 2008 - Vol. 8, No. 2, p.223-225
The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.Keywords: Humeral fractures; Median nerve; Entrapment neuropathies; Osteochondroma; Case Report; Oman.
Unilateral Anomalous Arterial Pattern of Human Upper Limb : Anatomical Description and Clinical Implications Vandana Mehta, Jyoti Arora, R K Suri and Gayatri Rath July 2008 - Vol. 8, No. 2, p.227-230
A unilateral case of variations in the brachial and antebrachial arterial branching pattern of a human upper limb is reported. A high bifurcation of brachial artery along with superficial course of ulnar artery was observed. Additionally, the profunda brachii and common interosseous artery originated from the radial artery instead of brachial and ulnar arteries respectively. An atypical branching pattern of arteries in an upper limb could pose a challenging problem to vascular surgeons while performing reconstructive procedures.
Key words: Brachial artery; Anomalies; Case Report; India.Tracheal Bronchus Anupam K Kakaria, Sukhpal Sawhney andRajeev Jain July 2008 - Vol. 8, No. 2, p.231-232
Caring for Arab Patients : A Biopsychosocial Approach Laeth S Nasir and Arwa K Abdul-Haq July 2008 - Vol. 8, No. 2, p.233-234
Wounded by Reality Ghislaine Boulanger July 2008 - Vol. 8, No. 2, p.235-236
Molecular Anatomic Imaging: Pet-CT and SPECT-CT Integrated Modality Imaging : 2nd Edition, 2007 Gustav K. Von Schulthess (and over 70 contributors) July 2008 - Vol. 8, No. 2, p.237-239
Re: Continuity of Care - Literature Review and Implications George Carruthers and Hussain Saadi July 2008 - Vol. 8, No. 2, p.241-242
Re: Prevalence and determinants of waterpipe (‘sheesha’) tobacco use among adolescents in Oman Ragini Vaishnav, Talal Al Aghbari, Thuraiya Al Masoudi and Maha Al Jabri July 2008 - Vol. 8, No. 2, p.243
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