Sultan Qaboos University Medical Journal, an internationally peer-reviewed multidisciplinary journal, is published quarterly in print and online with free access to full text articles. Its aims are: to be an internationally recognised regional medium of biomedical communication; to encourage medical research and publication in Oman, the Gulf and further afield, and to create awareness of new developments among health professionals in Oman and beyond. SQUMJ is listed in PubMed and indexed in SCOPUS, the Directory of Open Access Journals, the Al Manhal database of Arab journals and the WHO Index Medicus for the Eastern Mediterranean Region. SQUMJ DOES NOT CHARGE AUTHORS FOR SUBMISSION OR PUBLICATION.
SQUMJ is an Open Access Journal. This means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author. This is in accordance with the Budapest Open Access Initiative (BOAI) definition of open access.
The Role of Vitamin E in Human Health and Some Diseases
(Review) Saliha Rizvi, Syed T. Raza, Faizal Ahmed, Absar Ahmad, Shania Abbas, Farzana Mahdi
ABSTRACT: Vitamin E is the major lipid-soluble component in the cell antioxidant defence system and is exclusively obtained from the diet. It has numerous important roles within the body because of its antioxidant activity. Oxidation has been linked to numerous possible conditions and diseases, including cancer, ageing, arthritis and cataracts; vitamin E has been shown to be effective against these. Platelet hyperaggregation, which can lead to atherosclerosis, may also be prevented by vitamin E; additionally, it also helps to reduce the production of prostaglandins such as thromboxane, which cause platelet clumping. The current literature review discusses the functions and roles of vitamin E in human health and some diseases as well as the consequences of vitamin E deficiency. The main focus of the review is on the tocopherol class of the vitamers.
A National Strategy for Promoting Physical Activity in Oman
A call for action(Sounding Board) Ruth Mabry, Neville Owen, Elizabeth Eakin
ABSTRACT: The increasing prevalence of chronic disease in Oman is a public health challenge. Available evidence in Oman on physical inactivity, the fourth leading risk factor for chronic disease, calls for urgent action to reduce physical inactivity as part of a key strategy to address chronic disease in Oman. The public health implications of this evidence for Oman are considered in light of recommendations outlined in the Toronto Charter for Physical Activity. The charter provides a systematic approach of physical activity and outlines an action plan that could be adapted to the Omani context. Urgent intersectoral action focusing on a shared goal and a more deliberate public health response addressing physical inactivity is required. Further research is needed on the determinants of physical inactivity and culturally appropriate interventions in order to guide future public health actions.
Keywords: Epidemiology; Public Health; Physical Activity; Health Policy; Oman.
Epidemiology of Breast Cancer among Bahraini Women
Data from the Bahrain Cancer Registry(Original Study) Randah R. Hamadeh, Najat M. Abulfatih, Majeda A. Fekri, Hala E. Al-Mehza
ABSTRACT:Objectives: The aim of this study was to describe the epidemiology of breast cancer among the Bahraini female population in the years 2000‒2010 and examine its health policy implications. Methods: All breast cancer cases in the Bahrain Cancer Registry from 1st January 2000 to 31st December 2010 were included. Results: There were 1,005 cases, 12.7% of which were detected by screening. The overall mean age at diagnosis was 50.9 years (95% confidence interval 50.1–51.6). The age-standardised incidence rate declined from 58.2 per 100,000 in 2000 to 44.4 per 100,000 in 2010. The majority of cases were infiltrating ductal carcinoma (76.9%). Of the registered cases, 44.1% and 48.1% had an unknown grade and stage, respectively. The five-year survival rate was 63 ± 2%. Conclusion: The low percentage of cases detected by screening merits further evaluation of Bahrain’s screening programme. More effort should be made to reduce the proportion of unknown stage and grade breast cancers. Future research has to be directed towards understanding the reasons for Bahrain having the highest incidence rate of breast cancer in the Gulf Cooperation Council countries. Keywords: Breast Cancer; Epidemiology; Incidence; Cancer Screening; Survival; Bahrain; Middle East.
Impaired Fasting Glucose in Omani Adults with no Family History of Type 2 Diabetes
(Original Study) Sawsan Al-Sinani, Mohammed Al-Shafaee, Ali Al-Mamari, Nicolas Woodhouse, Omayma El-Shafie, Mohammed O. Hassan, Said Al-Yahyaee, Sulayma Albarwani, Deepali Jaju, Khamis Al-Hashmi, Mohammed Al-Abri, Syed Rizvi, Riad Bayoumi
ABSTRACT:Objectives: The aim of this study was to estimate the prevalence of impaired fasting glucose (IFG) among Omani adults with no family history (FH) of diabetes and to investigate the factors behind the risk of developing type 2 diabetes (T2D), while excluding a FH of diabetes. Methods: A total of 1,182 Omani adults, aged ≥40 years, visited the Family Medicine & Community Health Clinic at Sultan Qaboos University Hospital, Oman, on days other than the Diabetes Clinic days, from July 2010 to July 2011. The subjects were interviewed and asked if they had T2D or a FH of T2D. Results: Only 191 (16%) reported no personal history of T2D or FH of the disease. Of these, anthropometric and biochemical data was complete in 159 subjects. Of these a total of 42 (26%) had IFG according to the American Diabetes Association criteria. Body mass index, fasting insulin, haemoglobin A1C and blood pressure (BP), were significantly higher among individuals with IFG (P <0.01, P <0.05, P <0.01 and P <0.01, respectively). In addition, fasting insulin, BP and serum lipid profile were correlated with obesity indices (P <0.05). Obesity indices were strongly associated with the risk of IFG among Omanis, with waist circumference being the strongest predictor. Conclusion: Despite claiming no FH of diabetes, a large number of Omani adults in this study had a high risk of developing diabetes. This is possibly due to environmental factors and endogamy. The high prevalence of obesity combined with genetically susceptible individuals is a warning that diabetes could be a future epidemic in Oman.
Keywords: Prediabetic State; Diabetes Mellitus, Type 2; Obesity; Prevalence; Oman.
Haemostatic Parameters in Patients with Behçet’s Disease
(Original Study) Juma K. Alkaabi, David Gravell, Hamood Al-Haddabi, Anil Pathare
ABSTRACT:Objectives: This study aimed to evaluate the cause of thrombosis in Behçet’s disease (BD) patients, since abnormalities in coagulation and fibrinolytic parameters have shown contradictory results. Methods: Haemostatic parameters were retrospectively evaluated in BD patients treated between January 2007 and January 2011 at Sultan Qaboos University Hospital, Oman. The blood samples of 35 Omani BD patients and 30 healthy controls were analysed for factor VIII:C levels, activated protein C resistance (APCR), von Willebrand factor (vWF) antigens (Ag), collagen binding and ristocetin co-factor activity (RiCoF), antithrombin (AT), protein C (chromogenic and clotting), protein S, homocysteine, tissue plasminogen activator, plasminogen activator inhibitor, plasminogen, alpha 2-antiplasmin, lupus anticoagulant and anticardiolipin and beta2-glycoprotein-1 antibodies. Results: The mean values of factor VIII:C, vWF Ag, AT and protein S were significantly higher in the patient group (P = 0.01, 0.006, 0.04 and 0.01, respectively). There was no deficiency in protein C. Screening for APCR, anticardiolipin antibodies, anti-beta2-glycoprotein-1 antibodies and lupus anticoagulant was negative and there were no differences in homocysteine levels, nor were there differences between patients with and without thrombosis. Six patients had elevated factor VIII:C levels (>150 IU/dL, P <0.02) which normalised on repeat measurements after three months. Conclusion: The elevation of factors VIII:C, vWF Ag and AT most likely represent an acute phase phenomenon. In this study, thrombophilic factors did not seem to explain thrombotic tendency. Therefore, further mechanistic studies in a larger group of patients are needed to elucidate the basis for thrombosis in BD. We hypothesise that active BD causes vasculitic endothelial perturbation with dysfunction, leading to the observed increased propensity for thrombosis.
Comparison between Three Different Equations for the Estimation of Glomerular Filtration Rate in Omani Patients with Type 2 Diabetes Mellitus
(Original Study) Salima R. S. Al-Maqbali and Waad-Allah S. Mula-Abed
ABSTRACT:Objectives: Estimated glomerular filtration rate (eGFR) is an important component of a patient’s renal function profile. The Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease- Epidemiology Collaboration (CKD-EPI) equation are both commonly used. The aim of this study was to compare the performance of the original MDRD186, revised MDRD175 and CKD-EPI equations in calculating eGFR in type 2 diabetes mellitus (T2DM) patients in Oman. Methods: The study included 607 T2DM patients (275 males and 332 females, mean age ± standard deviation 56 ± 12 years) who visited primary health centres in Muscat, Oman, during 2011 and whose renal function was assessed based on serum creatinine measurements. The eGFR was calculated using the three equations and the patients were classified based on chronic kidney disease (CKD) stages according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. A performance comparison was undertaken using the weighted kappa test. Results: The median eGFR (mL/min/1.73 m2) was 92.9 for MDRD186, 87.4 for MDRD175 and 93.7 for CKD-EPI. The prevalence of CKD stage 1 was 55.4%, 44.7% and 57% while for stages 2 and 3 it was 43.2%, 54% and 41.8%, based on MDRD186, MDRD175 and CKD-EPI, respectively. The agreement between MDRD186 and CKD-EPI (к 0.868) was stronger than MDRD186 and MDRD175 (к 0.753) and MDRD175 and CKD-EPI (к 0.730). Conclusion: The performances of MDRD186 and CKD-EPI were comparable. Considering that CKD-EPI-based eGFR is known to be close to isotopically measured GFR, the use of MDRD186 rather than MDRD175 may be recommended. Keywords: Diet Modification; Chronic Renal Insufficiency; Epidemiology; Collaboration; Glomerular Filtration Rates; Type 2 Diabetes Mellitus; Oman.
Maternal and Fetal Outcomes of Triplet Gestation in a Tertiary Hospital in Oman
(Original Study) Maryam Al-Shukri, Durdana Khan, Atka Al-Hadrami, Nihal Al-Riyami, Vaidyanathan Gowri, Rahma Haddabi, Mohammed Abdellatif, Tamima Al-Dughaishi
ABSTRACT:Objectives: The aim of this study was to describe the fetal and maternal outcomes of triplet gestation and to report on the maternal characteristics of those pregnancies in a tertiary care centre in Oman. Methods: A retrospective study was undertaken of all triplet pregnancies delivered at Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2011. Results: Over the three-year study period, there were 9,140 deliveries. Of these, there were 18 triplet pregnancies, giving a frequency of 0.2%. The mean gestational age at delivery was 31.0 ± 3.0 weeks, and the mean birth weight was 1,594 ± 460 g. The most common maternal complications were preterm labour in 13 pregnancies (72.2%), gestational diabetes in 7 (39%) and gestational hypertension in 5 (28%). Of the total deliveries, there were 54 neonates. Neonatal complications among these included hyaline membrane disease in 25 neonates (46%), hyperbilirubinaemia in 24 (43%), sepsis in 18 (33%) and anaemia in 8 (15%). The perinatal mortality rate was 55 per 1,000 births. Conclusion: The maternal and neonatal outcomes of triplet pregnancies were similar to those reported in other studies. Keywords: Triplet Pregnancies; Morbidity; Perinatal Mortality; Fetus, complications; Preterm Births; Fertility; Oman.
A Study of Post-Caesarean Section Wound Infections in a Regional Referral Hospital, Oman
(Original Study) Hansa Dhar, Ibrahim Al-Busaidi, Bhawna Rathi, Eman A. Nimre, Vibha Sachdeva, Ilham Hamdi
ABSTRACT:Objectives: The aim of this study was to determine the incidence of surgical site infections (SSI) in patients undergoing a Caesarean section (CS) and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patient’s quality of life by increasing morbidity and extending hospital stays. Methods: A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS) SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI. Controls (220) were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. Results: The total number of PCS wound infections was 211 (2.66%). There was a four-fold higher incidence of premature rupture of the membranes (37, 17.53%) and a three-fold higher incidence of diabetes (32, 15.16%) in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus (66, 31.27%) and the Gram-negative Escherichia coli group (40, 18.95%). The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 (19.90%), while 47 (22.27%) yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Conclusion: Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques. Keywords: Caesarean Section; Surgical Wound Infections; Wounds and Injuries; Antibiotics; Risk Factors; Nosocomial Infections; Oman.
Primary School Managers’ Knowledge of and Attitude towards Epilepsy among Children in Erbil City, Iraq
(Original Study) Salih A. Abdulla
ABSTRACT:Objectives: This study aimed to determine the knowledge and attitudes of primary school managers regarding epilepsy among school children in Erbil City, Iraq. Methods: A cross-sectional study was conducted in primary schools between 18 June and 18 August 2013. A total of 80 primary school managers were selected to answer a questionnaire covering three domains: socio-demographical characteristics, knowledge of epilepsy and attitudes towards epilepsy. Results: More than half of the participants (55%) had spent less than 10 years in school administration. More than one-third (37.5%) of the participants believed that epilepsy was an infectious disease, and over half of the respondents (53.75%) stated that epilepsy cannot be treated or prevented. Conclusion: Although the respondents’ attitudes towards pupils with epilepsy were generally positive, their knowledge of epilepsy was imperfect; thus, an epilepsy education campaign is required. This should focus on the causes of epilepsy and its management. Keywords: Epilepsy; Health Knowledge; Attitudes; Practice; Iraq.
Knowledge and Use of Evidence-based Dentistry among Iranian Dentists
(Original Study) Nader Navabi, Arash Shahravan, Sepideh Pourmonajem, Maryam A. Hashemipour
ABSTRACT:Objectives: The objective of this study was to assess the knowledge and use of evidence-based dentistry (EBD) among Iranian dentists. Methods: A cross-sectional survey was conducted by means of a questionnaire among dentists attending the 52nd National Annual Congress of the Iranian Dental Association in Tehran in April 2012. The questions covered the participants’ level of knowledge and use of EBD. Results: The mean knowledge score of the 310 respondents was 3.66 ± 1.19 out of a maximum of 5. The majority of the dentists had little (56.1%) or no (20.7%) knowledge of EBD. The main reported barrier to the use of EBD was lack of time (44.1% of respondents) with 42.8% of dentists using the Internet less than one hour per week. Conclusion: EBD was not a familiar concept to these Iranian dentists; the majority of them preferred consultation with colleagues over seeking evidence from electronic databases. Keywords: Evidence-Based Dentistry, trends; Knowledge; Iran.
Adherence to Medications among Type 2 Diabetes Mellitus Patients in Three Districts of Al Dakhliyah Governorate, Oman
A cross-sectional pilot study(Brief Communication) Beena Jimmy, Jimmy Jose, Zainab A. Al-Hinai, Intisar K. Wadair, Ghalia H. Al-Amri
ABSTRACT:Objectives: This pilot study aimed to assess the medication adherence of type 2 diabetes mellitus (T2DM) patients in three wilayats (districts) of the Al Dakhliyah governorate, Oman, and to identify the probable reasons for medication non-adherence. Methods: A cross-sectional questionnaire-based pilot survey was conducted among T2DM Omani patients between February and June 2012 to assess their medication adherence and the relationship between their socio-demographic characteristics and adherence levels. Results: A total of 158 patients participated in the survey. The majority of the participants were unemployed or were housewives (66.5%). Forgetfulness was the most frequent reason for medication non-adherence (36.4%). Participants demonstrated an excellent level of adherence to their medicines (median total score = 3). No significant difference in median total adherence scores was observed based on the evaluated parameters. Conclusion: The medication adherence of T2DM patients in the area under study was good. A larger study in a wider population is warranted to obtain a more representative picture of this important factor which contributes to public health. Keywords: Diabetes Mellitus, Type 2; Medication Adherence; Cross-Sectional Study; Oman.
Successful Management of Phaeochromocytoma using Preoperative Oral Labetalol and Intraoperative Magnesium Sulphate
Report of four cases(Case Report) Sanath Kumar B. S., Rohit Date, Nicholas Woodhouse, Omayma El-Shafie, Karin Nollain
ABSTRACT: Phaeochromocytoma is a rare neuroendocrine catecholamine-secreting tumour. This type of tumour poses multidimensional anaesthetic challenges as it has an unpredictable clinical course during surgical resection. The alpha-blocking agent phenoxybenzamine remained the mainstay in preoperative preparation before the introduction of beta-blocking agents. We report four cases operated between 2009–2012 at Sultan Qaboos University Hospital, Muscat, Oman. The cases were prepared with oral labetalol, as the alpha-blocking drug phenoxybenzamine was not immediately available. Responses to simulated stress were tested in the theatre before surgery. Anaesthesia was induced under invasive arterial pressure monitoring and magnesium sulphate infusion. Rare intraoperative surges in blood pressure during tumour manipulation were treated with sodium nitroprusside infusions and phentolamine boluses. All of the patients had an uneventful postoperative recovery. Preoperative treatment with labetalol has rarely been reported and can be considered as a potential therapeutic option with optimal patient monitoring if phenoxybenzamine is unavailable.
First case report from Oman and literature review(Case Report) Amal S. Al-Maani, George Paul, Amina Jardani, Madhavan Nayar, Fatma Al-Lawati, Sheikha Al-Baluishi, Ibrahim B. Hussain
ABSTRACT: Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with few reported cases worldwide. We report here the first case diagnosed in Oman in a previously healthy 5-year-old Omani female child who had been thought initially to have an abdominal malignancy. The case was referred to the Royal Hospital, Muscat, Oman, in July 2012. She was treated successfully with surgical resection and prolonged antifungal therapy (voriconazole). Physicians, including clinicians, radiologists and pathologists, should have a high index of suspicion for GIB when a patient presents with an abdominal mass and fever.
Keywords: Mycoses; Zygomycosis; Entomophthorales; Gastrointestinal Diseases; Child; Case Report; Oman.
Successful Management of a Neglected Case of Nephropathic Cystinosis
(Case Report) Mohamed A. El-Naggari, Ibtisam Elnour, Hussein Al-Kindy, Aamir Al-Shahrabally, Anas A. Abdelmogheth
ABSTRACT: Cystinosis is a rare metabolic disorder characterised by lysosomal cystine accumulation leading to multi-organ damage; clinically, the kidneys are the first organ affected. Respiratory insufficiency caused by overall respiratory muscle myopathy is a life-threatening complication. Treatment with cysteamine should be initiated rapidly and continued lifelong to prolong renal function and protect the extra-renal organs. We report the case of a four-year-old Omani girl, diagnosed with infantile nephropathic cystinosis at 21 months. Cysteamine was prescribed but with no compliance to medications. She presented to the Child Health Department of Sultan Qaboos University Hospital, Oman, two years later with severe failure to thrive, electrolyte disturbance and respiratory failure. The hypoventilation and early respiratory dysfunction, due to intercostal and diaphragm myopathy, was treated by non-invasive positive-pressure ventilation. The patient was discharged after four months of intensive rehabilitation with no ventilator support. No standard treatment options have yet been established for respiratory dysfunction in cystinosis.
Keywords: Cystinosis; Cysteamine; Continuous Positive Airway Pressure; Positive-Pressure Ventilation; Failure to Thrive; Pediatric Intensive Care Units; Case Report; Oman.
Sclerosing Mucoepidermoid Carcinoma
A unique case(Case Report) Keshava Bhat, Bhavna Pandey, Pushparaja Shetty, Vidya Manohar, Shruthilaxmi M. K., Madhvika Patidar
ABSTRACT: Sclerosing mucoepidermoid carcinoma is an unusual type of mucoepidermoid carcinoma with special histological features which differ from those of the classic type of mucoepidermoid carcinoma. We report the case of a 32-year-old male, who reported to the Vydehi Institute of Dental Sciences, Bangalore, India, with an asymptomatic swelling over the right parotid region which had been present for the previous two and a half years. Histopathological sections of the tumour mass showed mucous and epidermoid cell nests in a dense, hyalinised, sclerotic stroma. A diagnosis of sclerosing mucoepidermoid carcinoma was made. A superficial parotidectomy was performed on the patient and he has remained disease free to date.
Keywords: Mucoepidermoid Carcinoma; Salivary Gland Neoplasms; Case Report; India.
Giant Prostatic Hyperplasia
Fourth largest prostate reported in medical literature(Original Study) Joseph Maliakal, Emad E. Mousa, Varna Menon
ABSTRACT: A giant prostatic hyperplasia (GPH) weighing more than 700 g is a rare entity. It is believed that only eight such cases have been previously reported in the medical literature. This case report concerns a patient with a GPH weighing 740 g which was successfully removed by suprapubic prostatectomy. To our knowledge, this is the fourth largest benign prostatic enlargement ever reported in the literature.
Keywords: Benign Prostatic Hyperplasia; Prostatectomy, Suprapubic; Case Report; Oman.