Search

n/a

ABSTRACT: Objectives: This study aimed to determine the effects of propolis on immune mediators and tissue histopathology in rats with L-arginine-induced acute pancreatitis (AP). Methods: This study was conducted at Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia between September and November 2017. A total of 24 male albino Wistar rats were divided into three equal groups. Group one was the negative control, group two was the positive control (L-arginine-induced AP) and group three received treatment (L-arginineinduced AP and propolis). The rats in group three were treated with 100 mg/kg propolis for seven days after AP induction. Pancreatic tissue was evaluated histologically and levels of interleukin (IL)-6, IL-22 and IL-1β and tumour necrosis factor-alpha (TNF-α) were measured. Results: Propolis reduced the quanitity of proinflammatory molecules (TNF-α, IL-1β and IL-6) in group three compared to group two, significantly increased the overall anti-inflammatory effect of IL-22 (P

Objectives: This study aimed to determine the prevalence of depression, anxiety and stress among Saudi Arabian dermatology patients and to assess associations with sociodemographic and clinical characteristics. Methods: This cross-sectional study was conducted among 300 consecutive dermatology patients visiting King Abdulaziz Medical City in Riyadh, Saudi Arabia, in August 2015. The Arabic version of the Depression, Anxiety and Stress Scale was used to screen for symptoms of depression, anxiety and stress. Quality of life (QOL) was assessed using the Dermatology Life Quality Index. Results: A total of 254 dermatology patients participated in the study (response rate: 84.7%). The prevalence of depression, anxiety and stress was 12.6%, 22.1% and 7.5%, respectively. The presence of at least one of these negative emotional states was noted among 24.4% of the cohort (95% confidence interval: 19.3–30.2%). Depression was significantly higher among subjects who lacked family support (26.5% versus 10.7%; P = 0.006) while anxiety was less common among patients who engaged in physical exercise (14.5% versus 29.4%; P = 0.005). According to the multivariate logistic regression analysis, poor QOL and a lack of family support were significant predictors of a negative emotional state. Conclusion: Almost a quarter of the studied Saudi Arabian dermatology patients were found to suffer from at least one negative emotional state. A lack of family support and poor QOL were the primary factors associated with a negative emotional state. Interventional studies are needed to examine the effects of social and family support on psychological conditions among Saudi Arabian dermatology patients.

Objective: To describe the angiotensin converting enzyme (ACE) genotype frequencies among Omani Arabs. Method: A polymerase chain reaction (PCR) test, based on separation of different size DNA fragments, was developed to test the presence or absence (polymorphism) of a small DNA deletion in the ACE gene. The subjects were 124 Omani Arab students of Sultan Qaboos University, Muscat. Results: The frequency of the I allele was 0.29, while that of the D allele was 0.71. The gene frequency distribution did not deviate from Hardy-Weinberg equilibrium. Conclusions: The frequency of D allele among Omanis is similar to that among other Arabs and Africans, but differs significantly from that among the Japanese and Chinese.

Hyperreactio luteinalis (HL) and ovarian hyperstimulation syndrome during pregnancy are both benign conditions where the ovaries are enlarged with presence of multiple thin-walled cysts. The differential diagnosis is ovarian malignancy. Hyperandrogenism with resultant maternal virilisation could be seen in some cases of HL as well as in androgen secreting tumours. We report a 41-year-old female patient who underwent ovulation induction due to secondary infertility at a high-risk pregnancy unit in Muscat, Oman, in 2022. She had recurrent hospital admission with abdominal pain and large multicystic enlargement of both ovaries. She developed virilisation features by 35 weeks of pregnancy. Lower segment caesarean section was done at 36 weeks gestation for breech presentation with intra-uterine growth restriction. Magnetic resonance imaging confirmed the benign nature of the cysts. Ovarian cysts and hyperandrogenism gradually resolved 3-months post-delivery. Awareness, judicious imaging and close monitoring in such cases can result in live birth and avoid oophorectomies., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to identify the impact of the COVID-19 pandemic on the frequency, clinical characteristics and outcomes of patients with acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL)., Methods: This retrospective cohort study included all patients treated at Sultan Qaboos University Hospital in Muscat, Oman with AML or ALL from January 2017 to December 2021. Data were obtained from the electronic medical record, and patients diagnosed before the start of the COVID-19 pandemic were compared with those diagnosed during the pandemic using appropriate statistical tests., Results: A total of 151 patients with ALL (n = 58) and AML (n = 93) were included, of whom 78 were diagnosed before the COVID-19 pandemic and 73 during the pandemic. The rate of acute leukaemia increased during the pandemic ( P = 0.039). The clinical characteristics and molecular profiles were similar between the 2 periods, except for platelet count which was higher during the pandemic compared to before the pandemic (median platelet count: 55 × 10 9 /L versus 47 × 10 9 /L; P = 0.02). No significant difference was found in the number of FLT3-positive AML; however, the number of NPM1-mutated AML cases was higher during the pandemic ( P = 0.02). The number of Philadelphia-positive ALL cases remained consistent between the 2 time periods. The complete remission ( P = 0.48) and the overall survival rates were similar ( P >0.05)., Conclusion: Except for an increased rate of acute leukaemia and a lower platelet count, the COVID-19 pandemic did not impact the presentation and outcomes of acute leukaemia., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interest., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to investigate the variables that influenced a sample of Omani mothers' support for mandatory COVID-19 vaccines for children. The vaccination against COVID-19 averted millions of fatalities during the COVID-19 pandemic. Nevertheless, a considerable number of parents and caregivers opposed mandating COVID-19 vaccines for children., Methods: This cross-sectional study was conducted at several healthcare facilities in Oman using a structured questionnaire between February and March 2022. Univariable and multivariable logistic regression models were used to analyse the data., Results: A total of 700 Omani mothers (response rate = 73.4%) who had children aged 5-11 years old were included. The median age of the mothers was 38 ± 5.19 years. The results of multivariable logistic regression were generally consistent with those of the univariable analysis except for age (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 0.58-1.93; P = 0.86) and income (OR = 1.09, 95% CI: 0.58-2.03; P = 0.79). Mothers who were vaccine hesitant (OR = 9.82, 95% CI: 5.27-18.28; P <0.001), tested positive for COVID-19 (OR = 3.25, 95% CI: 1.80-5.86; P <0.001) and had one or two doses of COVID-19 vaccines (OR = 5.41, 95% CI: 2.92-10.03; P <0.001) were more likely to refuse mandating COVID-19 vaccines for children 5-11 years old., Conclusion: Mothers who were vaccine hesitant, tested positive for COVID-19 and had one or two doses of COVID-19 vaccines were more likely to oppose mandatory COVID-19 vaccines for young children. The findings should aid public health authorities in designing future childhood vaccine literacy programmes with specific attention to some subgroups in Oman to help reduce opposition to vaccines in future pandemics among mothers., Competing Interests: CONFLICT OF INTEREST: The authors declare no conflict of interest., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to assess the prevalence of workplace violence (WPV) against nurses in Oman's psychiatric hospitals and explore associated factors., Methods: This cross-sectional study was conducted between October and December 2021 and included all tertiary mental healthcare hospitals in Oman (Al Masarra Hospital and Sultan Qaboos University Hospital, Muscat, Oman). The participants completed a sociodemographic survey and a questionnaire on WPV in the health sector., Results: A total of 106 participants (response rate = 80.3%) were included in this study. Most were female (52.8%) and Omani (72.6%) and aged 30-39 years. WPV prevalence was high (90.6%), with verbal (86.8%) and physical violence (57.5%) being the most common types. WPV incidents were more frequent on weekdays (26.4%) and during morning shifts (34%), while 81.1% of the nurses worked in shifts and had direct physical contact with patients (83.0%). The majority (92.5%) were aware of standardised WPV reporting procedures and 89.7% confirmed the presence of such procedures in hospitals. WPV was more prevalent among nurses in inpatient wards ( P = 0.047)., Conclusion: WPV against nurses in Omani psychiatric hospitals is alarmingly high. Future studies should investigate contributing factors among healthcare providers and emphasise violence prevention by providing staff nurses with effective training to handle violent incidents involving psychiatric patients., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interest., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: Cranioplasty is a complex craniofacial and neurosurgical procedure that aims to reinstate the architecture of the cranial vault and elevate both its aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. This study aimed to evaluate different material used for cranial reconstruction in Oman., Methods: This retrospective study included all patients who had had cranioplasty procedures performed at Khoula Hospital, Muscat, Oman, from 2012 to 2022. Demographic information, the characteristics of the cranial defect and any complications that occurred post-operatively were analysed., Results: A total of 47 patients were included in this study. The most common cause of cranial defects was craniectomy following traumatic head injury (70.2%) along with excision of fibrous dysplasia (10.6%). The most frequently utilised material for cranial repair was autologous bone grafts (n = 28), followed by polyetheretherketone (PEEK; n = 14). Interestingly, the replacement of bone grafts from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group., Conclusion: Patient-specific alloplastic implants such as PEEK have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone grafts remain the gold standard for small to medium-sized cranial defects., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interest., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: The size of the pulmonary valve annulus often determines the feasibility of pulmonary valve preservation at the time of intracardiac repair of Tetralogy of Fallot. Currently, there is limited available data regarding the growth pattern and the determining factors that contribute towards pulmonary valve annulus growth., Methods: This retrospective study included patients who underwent surgical repair of Tetralogy of Fallot with or without prior palliation. These patients had an echocardiogram at the time of initial diagnosis and a second echocardiogram prior to intracardiac repair. The sizes of the pulmonary annulus, the right and left pulmonary arteries with z-scores were recorded. Patients with improvement in the pulmonary annulus z-scores between the 2 echocardiographic examinations were allocated in Group I (n = 46) and Group II (n = 68) were those with no improvement., Results: A total of 114 patients were included in the study. The right and left pulmonary arteries size and z scores improved significantly between the 2 echocardiograms. Although the median size of the pulmonary annulus increased between the 2 echocardiograms (6 and 7.9 mm; P <0.001), there was no significant change in the z-score (-2.2, -2.34; P = 0.185). Multivariate logistic regression analysis showed that gender, blood group, presence of collaterals, and palliation with Blalock-Taussig shunt had no impact on the improvement in pulmonary annulus z-score., Conclusion: In Tetralogy of Fallot, the pulmonary valve annulus z-score may not change significantly prior to the intracardiac repair. Although in certain subgroups there may be an improvement, there was no specific factor that could be identified and had an influence on this improvement., Competing Interests: CONFLICT OF INTEREST: The authors declare no conflict of interest., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to investigate parental attitude towards psychotropic drugs' use for children's mental disorders., Methods: This cross-sectional study was conducted from December 2020 to March 2021 at the Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman. A questionnaire was used to determine parents' opinions and attitudes about use of psychotropic medications on their children and, in a small proportion, other caregivers if the child attended with them. Risk factors associated with parents who preferred to consult a folk healer (FH) for children with mental disorders were identified by the logistic regression model., Results: A total of 299 parents participating in the study (response rate: 95.2%). Most (n = 244, 81.6%) agreed to give their child psychotropic medications if necessary, but 25.4% (n = 76) would consult an FH before a psychiatrist. Married parents were 14.5 times ( P = 0.011) more likely than separated or divorced parents to consult an FH. Caregivers with a monthly income below 500 OMR and between 500 and 1,000 OMR were 2.5 ( P = 0.016) and 3.2 times ( P <0.001), respectively, more likely than those with more than 1,000 OMR to consult an FH. Parents who disagreed with giving their children psychotropic medications were 3.8 times ( P <0.001) more likely to consult an FH than parents who agreed to give them if necessary., Conclusion: Most parents agreed to give their children psychotropic medications if necessary. However, a proportion of parents and caregivers preferred to consult an FH before accessing mental health services., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflict of interests., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to assess the knowledge of and attitude toward cervical cancer and human papillomavirus (HPV) among Omani women aged 18 years and older., Methods: This cross-sectional survey was conducted between September 2019 and February 2020 in primary healthcare facilities throughout Oman. A self-administered questionnaire was distributed to assess women's knowledge and attitude regarding cervical cancer and HPV., Results: A total of 805 women participated in the study (response rate: 89%). Two-thirds of the participants had heard about cervical cancer (67.5%) while fewer were aware of HPV (15.8%). Approximately one-third of the women identified HPV as a risk factor for developing cervical cancer (38.9%). Very few participants knew of HPV vaccines (10.1%). A major source of information regarding both cervical cancer and HPV was social media (33.0%), as compared to healthcare providers (16.9%). Despite the poor knowledge, almost half of the participants were open to having their daughters (47.0%) and other schoolgirls (41.2%) vaccinated., Conclusion: Most participants had poor knowledge of cervical cancer and HPV, even those with a personal or family history of cervical cancer. The main source of knowledge was social media. Most participants were open to the idea of offering the HPV vaccine to their daughters and middle school-aged girls. Incorporating information about cervical cancer and HPV into school curricula and improving access to trusted medical knowledge through social media may help in enriching the public's knowledge and, possibly, correcting misinformation and related myths., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to explore undergraduate nursing students' perception and attitude towards the Objective Structured Clinical Examination (OSCE)., Methods: This cross-sectional descriptive study was conducted between April-May 2020 among undergraduate nursing students at the College of Nursing at Sultan Qaboos University, Muscat, Oman. Two self-administered questionnaires were utilised to obtain data on students' perception and attitude towards OSCE. Students' feedback on OSCE was collected using open-ended questions about OSCE strengths, weaknesses and recommendations for improvement. Survey responses were based on a five-point ordinal scale, ranging from strongly disagree to strongly agree. Students' feedback on OSCE was analysed as descriptive data by identifying the common themes and categorising them in groups., Results: A total of 160 students completed the study questionnaires. Most did not find the atmosphere of OSCE to be pleasant (66.3%) and preferred more modes of practical examination (40.6%). Moreover, 64.4% believed the time limitation to be inadequate. The data depict that 33.1% of the examinees deemed the OSCE more stressful than the full practical examination. In addition, a few students confirmed that the OSCE improved their communication skills and confidence in nursing skills., Conclusion: The findings of this study appear alarming in regard to students' perception regarding the overall process and validity of OSCE as an assessment method. Nursing educators must consider further evaluation and improvement of the OSCE in order to improve students' acceptance and appreciation of OSCE as an important form of clinical learning and assessment., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to identify the prevalence of clinically significant depression among adult Omani patients with type 2 diabetes mellitus (T2DM) and explore potential associations with sociodemographic and clinical variables in this population., Methods: This descriptive cross-sectional study was conducted between August 2018 and September 2019 and included 427 Omani T2DM patients from 12 randomly selected government health centres in Muscat, Oman. An Arabic version of the validated Patient Health Questionnaire-9 was administered to the participants via face-to-face interviews to determine the prevalence of depression., Results: A total of 111 T2DM patients (response rate: 100%) had depression (26%). The presence of a personal history of depression was the only variable significantly associated with depression ( P <0.001). Other sociodemographic and clinical factors including age, gender, duration of diabetes, glycated haemoglobin level, mode of diabetes treatment or the presence of diabetes-related complications such as cardiac complications, renal impairment, retinopathy, neuropathy and erectile dysfunction, were not associated with depression, ( P >0.050 each)., Conclusion: This study revealed a high prevalence of depression among urban Omani adults with T2DM and a personal history of depression, which was found to be significantly associated with depression. Therefore, early screening for depressive symptoms is necessary to improve the quality of life of diabetic patients in this region., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study was conducted to assess pregnancy outcomes in women with systemic lupus erythematosus (SLE) in Oman., Methods: A retrospective cohort study of 149 pregnancies in 98 women with SLE was conducted over 10 years to evaluate the impact of clinical and laboratory parameters in predicting adverse pregnancy outcomes., Results: Mean maternal age was 30.6 ± 5 years ranging from 20-44 years, and the mean disease duration was 10 ± 5 years, ranging from 2-27 years. The most common maternal manifestations were joint pain in 36 (24.2%), lupus nephritis (LN) in 18 (12.08%), preeclampsia in 11 (7.4%), eclampsia in three (2%) and lupus flare in one pregnancy. The live birth rate was 139 (93.3%) with a mean gestational age of 36 ± 2 weeks ranging from 26-40 weeks. In total, 55 (39.6%) were preterm deliveries, six (4%) pregnancies ended in miscarriage, and four (2.7%) resulted in intrauterine fetal death. Intrauterine growth restriction was observed in 49 babies (35%). A significant association was found between hypertension (HTN) and miscarriage ( P = 0.024) and preterm birth ( P = 0.019). In addition, HTN was positively associated with preeclampsia ( P = 0.004) and LN ( P = 0.048). Antiphospholipid syndrome impacted preterm birth ( P = 0.013) and postpartem haemorrhage (PPH) ( P = 0.027) and was found to be a significant predictor for women developing deep vein thrombosis and pulmonary embolism ( P <0.001 for both)., Conclusion: Despite potential complications, most pregnancies complicated by SLE in Oman result in good outcomes. Adverse pregnancy outcomes, however, may still occur in women with SLE. In women with SLE, pregnancy planning, careful antenatal monitoring and efficient SLE treatment need to be undertaken for successful pregnancy outcomes., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2021, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: Obstetrics and gynaecology (OBGYN) is a major speciality in the medical field that is often demanding yet rewarding; however, OBGYN receives the least number of applicants in Oman. This study aimed to determine the factors that influence graduates in choosing OBGYN as their speciality., Methods: This cross-sectional questionnaire-based study was conducted from February to March 2017 at Sultan Qaboos University Hospital, Royal Hospital, Khoula Hospital and Al Nahdha Hospital, Muscat, Oman. The questionnaire was distributed to 150 Omani medical graduates (interns and post-intern doctors)., Results: A total of 145 Omani graduates took part in the study (response rate: 96.7%) and the participants' average age was 26 years. Family medicine ranked as the first choice followed by paediatrics and emergency medicine. OBGYN was the first choice for eight female graduates. The top factors attracting male graduates to the OBGYN speciality were its surgical opportunities (80.6%), intellectual content (77.4%), faculty interactions and the opportunity to care for a healthy population (54.8% each); however, the top factors attracting females were the intellectual content (88.6%), patients' desire for female physicians (85.1%), the opportunity to care for a healthy population (76.3%) and cultural expectations (69.5%). The most discouraging factors for male graduates were cultural expectations (100%), the patients' desire for a female physician (93.5%) and the level of stress (71%), while the discouraging factors for female graduates were the level of stress (82.5%), time demands (78.1%), night duties and the length of the residency (71.9% each)., Conclusion: Most of the factors that discourage female graduates from choosing OBGYN are to some extent modifiable. These changes should be considered to encourage the selection of OBGYN as a career by medical students., Competing Interests: Conflict of Interest The authors declare no conflicts of interest.

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., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest.

Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman., Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records., Results: Most women were 25-35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%)., Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications., Competing Interests: The authors declare no conflicts of interest.

Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management.

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.

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

Placental tumours include placental chorioangiomas, teratomas, haemangiomas, and haematomas. Placental chorioangiomas are benign vascular tumours and are the most common placental tumours, with a prevalence of 1%. Large placental chorioangiomas are rare and may lead to pregnancy complications and poor perinatal outcomes. These complications include fetal anaemia, hydrops fetalis, fetal growth restriction, polyhydramnios, and preterm delivery. We report a case of a large placental chorioangioma, the antenatal management and the maternal and fetal outcomes.

Fetal ascites is an uncommon abnormality usually reported in relation to non- immunological causes. The prospect for fetal and neonatal mortality is high, particularly when the ascites develops before 24 weeks of gestation. The diminution of severe fetal ascites without intrauterine management, especially with an uncomplicated neonatal outcome, is unusual. We report a case of isolated fetal ascites detected at 20 weeks' gestation. All investigations carried out were normal. Consecutive ultrasound examination showed ascites at 20 weeks' gestation. A follow-up ultrasound examination at 6 months of age revealed complete recovery from the ascites. Spontaneous resolution of fetal ascites, with a good prognosis, can occur in cases with an idiopathic aetiology.

Objectives: Preterm premature rupture of membranes (PPROM) is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM., Methods: A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study., Results: Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 (55%) survived, 7 (16%) died within 24 hours of birth, 9 (20%) were miscarried, and 4 (9%) were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 (46%), respiratory distress syndrome in 19 (79%), sepsis in 12 (50%), and low birth weight in 11 (46%). The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes., Conclusion: Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counselling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals.

The haematological and clinical findings of a three year old Omani girl, phenotypically compound heterozygote for Hb S and Hb S Oman, are presented, further substantiated by family studies. The necessity of reviewing cases with sickle cell haemoglobin in Oman is stressed.

Objective: Chronic pain is associated with increased incidence of hypertension. Sleep deprivation, common in patients with chronic pain, is associated with increased blood pressure and heart rate. This study was designed to determine whether sleep deprivation induces increased cardiovascular responses to pain. In addition; we examined the role of melatonin and endorphins in mediating these responses., Method: The study was conducted in Sprague-Dawely rats divided into a control group (n=8) and Rapid Eye Moment sleep deprived (REMSD) group (n=8). REM sleep deprivation was done for three days using the inverted flowerpot technique. Systolic BP and HR were recorded at baseline as well as 5, 10 and 30 minutes after intra-plantar formalin injection. In addition, serum melatonin and endorphin levels were determined., Results: Under basal conditions, BP and HR and following acute pain (1(st) phase of formalin injection) were comparable with non-sleep deprived (non-SD) state. In contrast, the REMSD rats showed significantly greater increases in HR and BP during the 2(nd) phase of formalin pain as compared to non-SD state. These changes were associated with significant reductions in serum melatonin and endorphin levels in REMSD rats., Conclusion: These data indicate that exaggerated blood pressure and HR responsiveness to pain in sleep deprivation could be mediated through reductions in melatonin and endorphin.