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Background: Percutaneous coronary intervention (PCI) is a well-established method for treating coronary artery disease. However, stent implantation necessitates the use of antiplatelet agents, which increases the risk of gastrointestinal bleeding (GIB). This study aims to assess the incidence, etiology, and outcomes of GIB within one year post-PCI at Sultan Qaboos University Hospital (SQUH), Muscat, Oman., Methods: This retrospective analysis included 435 patients who underwent PCI at SQUH between January and December 2017, excluding those with multiple PCI procedures and incomplete data. GIB was defined using the thrombolysis in myocardial infarction (timi) bleeding score. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, NY) with binary logistic regression employed to identify significant risk factors for GIB. A p-value < 0.05 was considered statistically significant., Results: GIB was identified in 15 patients (age 67.8 ± 8.8 years; 60% male), resulting in an incidence within one year post-PCI of 3.4%. Melena (53.3%) and hematemesis (20.0%) were the most frequent clinical presentations, with peptic ulcer disease being the predominant underlying etiology (40%). Significant risk factors included advanced age, chronic kidney disease, pre-existing peptic ulcer disease, and the use of non-steroidal anti-inflammatory drugs., Conclusions: The incidence of GIB observed in this study aligns with previously reported rates. These findings highlight the importance of pre-PCI risk stratification for bleeding, especially in high-risk patients. Prophylactic measures, such as the use of gastric protective agents, should be considered to mitigate the risk of GIB in patients undergoing PCI., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Medical Research Ethics Committee, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat issued approval 1089, dated May 4, 2015. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Hatmi et al.)

First popularized almost a century ago in epidemiologic research by Ronald Fisher and Jerzy Neyman, the P-value has become perhaps the most misunderstood and even misused statistical value or descriptor. Indeed, modern clinical research has now come to be centered around and guided by an arbitrary P-value of <0.05 as a magical threshold for significance, so much so that experimental design, reporting of experimental findings, and interpretation and adoption of such findings have become largely dependent on this "significant" P-value. This has given rise to multiple biases in the overall body of biomedical literature that threatens the very validity of clinical research. Ultimately, a drive toward reporting a "significant" P-value (by various statistical manipulations) risks creating a falsely positive body of science, leading to (i) wasted resources in pursuing fruitless research and (ii) futile or even harmful policies/therapeutic recommendations. This article reviews the history of the P-value, the conceptual basis of P-value in the context of hypothesis testing and challenges in critically appraising clinical evidence vis-à-vis the P-value. This review is aimed at raising awareness of the pitfalls of this rigid observation of the threshold of statistical significance when evaluating clinical trials and to generate discussion regarding whether the scientific body needs a rethink about how we decide clinical significance., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: This study aimed to evaluate the level of adherence to medication among patients with ischaemic heart disease (IHD) in Oman and assess the related factors., Methods: This cross-sectional questionnaire-based study among patients with IHD attending the outpatient clinic at Sultan Qaboos University Hospital, Muscat, Oman, was performed between January and December 2021., Results: A total of 105 patients (mean age = 49.9 ± 11.1 years, 78.1% male) were recruited. Most of the patients (80%) reported taking the medications by themselves; 77 (73.3%) patients said that over the preceding 2 weeks, they had missed at least 3 doses of their medication. The reasons for missing the medications included forgetting (100%), having to take too many tablets (57%), feeling that the tablets are not effective (48%) and having to take the tablets too often each day (23%). The factors responsible for patients failing to take medications could not be identified., Conclusion: Medication adherence was low among patients with IHD in Oman, with high pill burden being the most common reason for non-adherence. Physicians must bear this in mind when reviewing patients., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflicts of interest., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: This study aimed to identify angiographic features that would predict myocardial viability after coronary intervention for ST elevation myocardial infarction (STEMI)., Methods: This retrospective study included patients who attended Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 with a STEMI., Results: A total of 72 patients (61 male; mean age = 54.9 ± 12.7 years) were included in the study; 11 patients had evidence of non-viability on echocardiography. There were 13 patients with viable myocardium and 3 with non-viable myocardium who had a myocardial blush grade (MBG) of 2 or lower. Similarly, 10 patients with viability and 1 with non-viable myocardium had thrombolysis in myocardial infarction (TIMI) flow of 2 or lower in the infarct related artery (IRA). However, none of these were statistically significant. The TIMI flow in the IRA at the end of the procedure correlated with the MBG., Conclusion: There were no clear angiographic features during primary angioplasty that could predict myocardial viability., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interests., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Background and Objectives: Cardiovascular diseases (CVD) are associated with substantial psychological effects that can adversely influence long term prognosis. The aim of this study was to determine the psychological effect of the first hospital admission for acute coronary syndrome (ACS) or congestive heart failure (CHF) in an adult Omani population., Methods: This cross-sectional questionnaire based study used the Hospital Anxiety and Depression Scale. Patients were recruited from the in-patient cardiology and medical wards of our institution. Patients with a prior hospital admission for CHF and ACS were excluded. The questionnaire was administered between days 3 and 7 after admission once patients were clinically stable., Results: The study included 116 patients (mean age 60.3 + 13.8 years; 78 (67.8%) men), comprising 52 patients with ACS and 64 patients with CHF. Based on the scores, a total of 45 (38.8%) patients had moderate to severe anxiety, and 32 (27.6%) had moderate to severe depression. Patients with severe anxiety tended to be younger, and no other factors predicted anxiety or depression. The proportion of patients with severe depression was higher among patients with CHF (31.4%), and no other differences were observed between patients with ACS or CHF., Conclusion: A substantial proportion of patients admitted to our institution in Oman with CVD had severe anxiety and depression. Treating physicians and caregivers should be more open to identifying these patients, and steps should be taken to address their psychological wellbeing along with the medical management of their illness., (© 2023 The Authors.)

Objectives: Strokes are a major cause of morbidity and mortality. This study aimed to evaluate the effectiveness of routine cardiac investigations in identifying a cardioembolic aetiology for ischaemic strokes., Methods: This retrospective study involved patients who presented with a stroke to the Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019., Results: A total of 183 patients (mean age = 66.2 ± 13.5 years), the majority of which were male (n = 109, 59.6%), were included. The common risk factors included hypertension (74.9%), diabetes (61.7%) and hyperlipidaemia (54.6%). The middle cerebral artery was the most common artery affected, in 44 patients (24.0%). On admission, 14 (7.6%) patients were in atrial fibrillation (AF), while the rest were in sinus rhythm. The 24-hour electrocardiogram (ECG) Holter monitoring revealed no abnormalities in 135 patients. AF was observed in 15 (8.1%) patients (inclusive of the 14 who had AF on resting ECG). Furthermore, 32 (17.4%) patients had evidence of non-sustained atrial arrhythmia, and nine (4.9%) had non-sustained ventricular tachycardia. Frequent supraventricular ectopics (>30/hour) was noted on 30 patients (16.3%), while five (2.7%) patients had a high ventricular ectopic burden (>10% burden). No significant abnormalities were noted in the echocardiograms of the patients; however, 10 out of 132 (7.5%) patients presented a positive bubble echo. Enlarged left atria were found in 24 (13.1%) patients., Conclusion: The overall diagnostic yield of the abnormalities from routine cardiac testing for patients with stroke appears to be low. Targeted screening of patients with cryptogenic stroke, as suggested by newer guidelines, is recommended., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Abstract: Angina pectoris remains a significant burden despite advances in medical therapy and coronary revascularization. Many patients (up to 30%) with angina have normal coronary arteries, with coronary microvascular disease and/or coronary artery vasospasm being major drivers of the myocardial demand-supply mismatch. Even among patients revascularized for symptomatic epicardial coronary stenosis, recurrent angina remains highly prevalent. Medical therapy for angina currently centers around 2 disparate goals, viz secondary prevention of hard clinical outcomes and symptom control. Vasodilators, such as nitrates, have been first-line antianginal agents for decades, along with beta-blockers and calcium channel blockers. However, efficacy in symptoms control is heterogenous, depending on underlying mechanism(s) of angina in an individual patient, often necessitating multiple agents. Nicorandil (NCO) is an antianginal agent first discovered in the late 1970s with a uniquely dual mechanism of action. Like a typical nitrate, it mediates medium-large vessel vasodilation through nitric oxide. In addition, NCO has adenosine triphosphate (ATP)-dependent potassium channel agonist activity (K ATP ), mediating microvascular dilatation. Hence, it has proven effective in both coronary artery vasospasm and coronary microvascular disease, typically challenging patient populations. Moreover, emerging evidence suggests that cardiomyocyte protection against ischemia through ischemic preconditioning may be mediated through K ATP agonism. Finally, there is now fairly firm evidence in favor of NCO in terms of hard event reduction among patients with stable coronary artery disease, following myocardial infarction, and perhaps even among patients with congestive heart failure. This review aims to summarize the mechanism of action of NCO, its efficacy as an antianginal, and current evidence behind its impact on hard outcomes. Finally, we review other cardiac and emerging noncardiac indications for NCO use., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study aimed to assess the knowledge, attitudes and practices regarding traditional medicine (TM) in Oman and examine the factors that necessitate its use., Methods: This cross-sectional, questionnaire-based study was conducted among the general population from November 2019 and March 2020. All Omani nationals above the age of 18 were eligible to be enrolled. The questionnaire consisted of questions on the knowledge, attitudes and use regarding traditional medicine in Oman., Results: A total of 598 responses to the questionnaire were received (response rate: 85.4%), of which 552 were deemed complete. Most responses were received from males (62.5%) and the sample had a mean age of 33.6 ± 7.7 years. A majority of the respondents (90%) were aware of the different types of TM in Oman; a high percentage (81.5%) felt that it was effective. Most (67.8%) had tried at least one method of TM use. Individuals who were older had tried TM compared to those who had not (34.5 ± 7.8 years versus 31.8 ± 7.2 years; P <0.001); in addition, more males than females (72.2% versus 27.8%; P <0.001) and those with full-time employment than those without had tried TM (84.2% versus 14.2%; P <0.001). Herbal medications (65.8%) and traditional massage (60.4%) were the most common forms of TM practice. Among females, herbal medications (69.2%) and massage (63.5%) are most often used; among males, cupping (65.2%) followed by herbal medications (64.4%) and massage (59.3%) were used more often. Notably, back pain (74.3%) was the most common condition for which TM was reportedly used, with only a small percentage (8.3%) reporting any concomitant side-effects., Conclusion: There is widespread use of TM among Oman's urban population. An improved understanding of their benefits will facilitate their incorporation into modern health care services., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Environmental temperature is now well known to have a U-shaped relationship with cardiovascular (CV) and all-cause mortality. Both heat and cold above and below an optimum temperature, respectively, are associated with adverse outcomes. However, cold in general and moderate cold specifically is predominantly responsible for much of temperature-attributable adversity. Importantly, hypertension-the most important CV risk factor-has seasonal variation such that BP is significantly higher in winter. Besides worsening BP control in established hypertensives, cold-induced BP increase also contributes to long-term BP variability among normotensive and pre-hypertensive patients, also a known CV risk factor. Disappointingly, despite the now well-stablished impact of temperature on BP and on CV mortality separately, direct linkage between seasonal BP change and CV outcomes remains preliminary. Proving or disproving this link is of immense clinical and public health importance because if seasonal BP variation contributes to seasonal adversity, this should be a modifiable risk. Mechanistically, existing evidence strongly suggests a central role of the sympathetic nervous system (SNS), and secondarily, the renin-angiotensin-aldosterone axis (RAAS) in mediating cold-induced BP increase. Though numerous other inflammatory, metabolic, and vascular perturbations likely also contribute, these may also well be secondary to cold-induced SNS/RAAS activation. This review aims to summarize the current evidence linking temperature, BP and CV outcomes. We also examine underlying mechanisms especially in regard to the SNS/RAAS axis, and highlight possible mitigation measures for clinicians., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Objectives: High salt consumption is a major risk factor for hypertension. Studies have shown dietary salt intake to be high in many parts of the world. This study aimed to assess the daily salt consumption of the Omani urban population and their knowledge and attitudes regarding dietary salt., Methods: This cross-sectional questionnaire-based study was conducted in Muscat between September and December 2017. Participants were recruited from malls, university students and staff, hospital staff and their relatives and relatives of patients. A previously validated questionnaires were used to assess the participants' salt intake and their knowledge and attitudes regarding salt intake., Results: A total of 345 participants were included in this study (response rate: 69%), of which 300 responses (mean age: 27.88 ± 7.9 years, 54.3% male) were included for analysis. Overall, 94.3% of the participants agreed that lowering salt in diet is important, and nearly half the participants said that they were taking measures to reduce salt intake. However, the median salt intake was high at 10.5 g/day (interquartile range: 7.3-15.1 g/day), with 90% of the respondents consuming more than the maximum recommended amount of salt per day. Salt intake was significantly higher in women and the older age group (>40 years). There did not appear to be any correlation between awareness of the dangers of salt intake and the amount consumed., Conclusion: The salt intake in the sampled population in Oman was high and did not depend on knowledge. Strategies should be designed to reduce salt intake among the urban population, including health education to increase knowledge about the complications of high salt intake., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Objectives: To assess the causes of delay for presentation with ST elevation myocardial infarction (STEMI)., Methods: Patients who presented with STEMI to the Emergency Department at the Sultan Qaboos University Hospital, Muscat, Oman between January 2017 and December 2019 and were admitted for primary angioplasty were included in this study., Results: A total of 101 patients were included with a mean age of 54.8 + 10.8 years and the majority were male patients (n = 80; 79.2%). The median (interquartile range) pain-to-door time was 60 min (30-120 min). There were 66 (65.4%) patients who arrived within 90 minutes. All except one arrived by privately arranged transport. Feeling that the pain was not important (61.0%) or not cardiac (22.8%) were the main reasons for delay. Being diabetic was the only patient factor that predicted delay., Conclusion: A high proportion of patients presenting to our institution with a STEMI arrived within recommended times. However more public education is required to improve awareness about the importance of early evaluation of chest pain., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

The May Measurement Month (MMM) programme is a global cross-sectional blood pressure (BP) screening programme. Here we present the combined data for the years 2017-2019 from Oman. BP was measured at various screening sites, according to standard protocol and hypertension was diagnosed if the BP was ≥140/90 mmHg or if the individual was already on antihypertensive medication. A total of 15,679 individuals (mean age 41.1 ± 12.6 years range 18-89 years; 71% male) were screened over the 3-year period. 7702 individuals (mean age 41.8 ± 13.9 years; 71.5% male) had three BP readings. The mean of the last two BP readings was 127.3 ± 17.1 mmHg. 1573 readings were in the hypertensive range (1004 newly diagnosed hypertension). A further 749 individuals were on antihypertensive medications with normal BP readings giving a proportion of 30.1% of the entire cohort being hypertensive. BP was high in 43% of patients on antihypertensive medications, 28.1% of those with previous myocardial infarction, 33.9% of those with previous stroke and 37.6% of the diabetic patients. BP strongly correlated with body mass index (BMI) and age (both p < 0.001), with a large proportion (68.5%) of individuals having high BMI(>25 kg/m 2 ). Arab and South Asian ethnicity was associated with higher BMI and BP (both p < 0.001).Community screening programmes help identify previously undiagnosed hypertension and hypertensives with high BP. They also help to identify those at high cardiovascular risk. More emphasis should be given to monitoring those in high cardiovascular risk categories and high-risk ethnic groups., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Objectives: We sought to identify the most commonly used antihypertensive medications in pregnant women and to determine the impact of these medications on perinatal (maternal and fetal) outcomes., Methods: The medical records of 484 hypertensive pregnant women who attended a tertiary university hospital during the study period were retrospectively evaluated for eligibility. Singleton pregnancies of women on antihypertensive medications and who delivered in the hospital were included in the study., Results: A total of 210 women (mean age of 32.4±5.6 years and mean body mass index of 34.0±8.1 kg/m 2 ) were eligible for inclusion in the study. The most prevalent subtype of hypertension was preeclampsia (41.4%). Low birth weight (LBW), preterm delivery (PTD), intrauterine growth restriction (IUGR), small for gestational age (SGA), respiratory distress syndrome, and neonatal care unit admissions were significantly higher in women with preeclampsia than in the women with other types of hypertension. Labetalol was the most commonly prescribed antihypertensive drug. There were 101 (48.1%) women on combined therapy. LBW, PTD, IUGR, SGA, respiratory distress syndrome, absent end diastolic flow, neonatal care unit admission, preeclampsia, and high dependency unit admissions of mothers were significantly higher in the women who received combined therapy., Conclusions: Labetalol was the most commonly prescribed antihypertensive drug in this cohort, and women on combined antihypertensive medications had significantly higher maternal and fetal complications. A larger prospective study including hypertensive women with or without antihypertensive medications in more than one center is needed to evaluate the effect of these drugs on perinatal outcomes., (The OMJ is Published Bimonthly and Copyrighted 2022 by the OMSB.)

Objectives: Critically ill patients have raised troponins. This study aimed to assess the incidence of myocardial injury in the intensive care unit (ICU) at a tertiary care hospital and assess the management and prognosis., Methods: This retrospective study included adult patients who were admitted to the ICU of Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 and had undergone a high-sensitive cardiac troponin (hs-cTn) assay. Patients admitted with a primary diagnosis of myocardial infarction were excluded., Results: A total of 264 patients had their hs-cTn measured during the study period. Of these, 128 (64.3 ± 17.1 years; 58.6% male) had elevated levels, giving an incidence rate of approximately 48.5%. Those with raised troponin were older and had more co-morbidities. These patients were also more critically ill with lower blood pressure, higher heart rates and increased hypotensive episodes. Of these, 47 were treated for acute coronary syndrome, 32 underwent coronary angiography and only three required stenting. Patients with raised troponin had a poor outcome with only 45 (35.2%) surviving to discharge compared to 101 (74.3%) with normal troponin. Patients with raised troponin had shorter hospital stays than those with normal troponin (16 versus 19 days; P = 0.017)., Conclusion: A high proportion of critically ill patients showed evidence of myocardial injury without significant coronary artery disease, which is associated with a poor prognosis. Further prospective studies are required to ascertain the best course of treatment for these patients., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest., (© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Cardiac complications are the major cause of mortality in patients with Thalassemia major (TM). Cardiac T2* MRI is currently the gold standard for assessing myocardial iron concentration. The aim of our study was to assess whether any echocardiographic parameter would correlate with these findings in patients well established on chelation therapy. This was a prospective study on patients with TM who are regularly followed in our clinic. Patients had a cardiac MRI and echocardiogram within 2 months of each other. Echo parameters included global longitudinal strain and diastolic function. We also compared these findings with those from a cohort of thalassemia intermedia (TI) and normal controls. A total of 84 patients (mean age 26.3 ± 6.1 years, 42.8% male) with TM were enrolled. All had normal left ventricular ejection fraction and only 8 patients had MRI T2* < 10. As compared to 17 patients with TI and 53 controls, these patients had significantly higher E/E' and lower pulmonary vein s/dd ratio suggesting early diastolic dysfunction. 28 patients fulfilled criteria for diastolic dysfunction even in the presence of normal MRI T2*. Global longitudinal strain (GLS) was significantly lower in the TM group as compared to the TI and controls. We found no correlation between any of the echo findings and the MRI T2*in TM patients. In patients with thalassemia and MRI T2* > 20 ms features of diastolic dysfunction persist even in the presence of normal LV function and normal GLS. This suggests that diastolic function remains abnormal even when myocardial iron concentrations are normal and follow up therefore is essential.

Aim: The aim of this study was to evaluate the progression of tricuspid regurgitation (TR) in patients with pacemaker leads across the tricuspid valve and assess the clinical effect on right ventricular (RV) function., Methods: Patients who had undergone permanent pacemaker implantation at our institution over an 8-year period were identified. Those who had an echo (for any indication) pre- and postdevice implantation were included in this study, and their data assessed. Clinical information was obtained from their medical records. A total of 65 patients (mean age 70 ± 13 years, 31 (48%) males, and 34 (52%) females) were enrolled in the study., Results: The median interval of echo after implantation was 12 (12 to 24) months. Before implantation, 29 patients had TR, which increased to 51 (78%) during follow up, indicating that 22 patients developed new TR. Of those with preexisting TR, the grade of TR had worsened by at least one grade in 17 patients. RV function as measured by tricuspid annular plane systolic excursion (TAPSE) had decreased from 1.87 ± 0.44 to 1.68 ± 0.42 ( p  = 0.002). Eighteen patients had developed signs of right heart failure (either breathlessness with raised jugular venous pressure or pedal edema or both), of which 13 had only new pedal edema., Conclusion: There is a definite progression of TR in patients with a pacing lead across the tricuspid valve (TV) associated with an increase in the incidence of right heart failure. Patients with a pacing lead across the TV should be followed closely for signs of right heart failure., (© 2020 Nadar, Shaikh, Jabri, Rawahi, licensee HBKU Press.)

Cardiac troponins (cTn) are currently the standard of care for the diagnosis of acute coronary syndromes (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). However, their plasma kinetics necessitate a prolonged ED stay or overnight hospital admission, especially in those presenting early after CP onset. Moreover, ruling out ACS in low-risk patients requires prolonged ED observation or overnight hospital admission to allow serial measurements of c-Tn, adding cost. Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury with putative advantages over cTn. Being present in abundance in the myocellular cytoplasm, it is released rapidly (<1 h) after the onset of myocardial injury and could potentially play an important role in both earlier diagnosis of high-risk patients presenting early after CP onset, as well as in risk-stratifying low-risk patients rapidly. Like cTn, H-FABP also has a potential role as a prognostic marker in other conditions where the myocardial injury occurs, such as acute congestive heart failure (CHF) and acute pulmonary embolism (PE). This review provides an overview of the evidence examining the role of H-FABP in early diagnosis and risk stratification of patients with CP and in non-ACS conditions associated with myocardial injury. Key messages Heart-type fatty acid-binding protein is a biomarker that is elevated early in myocardial injury The routine use in the emergency department complements the use of troponins in ruling out acute coronary syndromes in patients presenting early with chest pain It also is useful in risk stratifying patients with other conditions such as heart failure and acute pulmonary embolism.

Objectives: The aim of this study was to determine the factors that affect the provision of bystander cardiopulmonary resuscitation (CPR) among the general public in Oman., Methods: This was a descriptive cross-sectional study performed over a two-month period from November to December 2018 using a questionnaire among the general public with no medical background., Results: A total of 1,080 individuals were included in the study. The median age of the participants was 27 (20-39) years old with 624 (57.8%) male participants. More than half of the participants (52.9%) were willing to perform CPR on a stranger. Lack of knowledge of CPR and a fear that they might cause more harm were the main reasons precluding people from performing CPR. Age, educational status and having attended a CPR course were predictors of willingness to perform CPR., Conclusion: There is a positive attitude towards bystander CPR in Oman among the general public. More education and training opportunities should be made available in workplaces and educational institutions., Competing Interests: CONFLICT OF INTEREST The author declares no conflicts of interest., (© Copyright 2020, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Background and Aim: The presence of grade 3 collaterals is known to be associated with viability in the presence of a chronic total occlusion (CTO). However, it is not clear whether this holds true even in patients who had ST-segment elevation myocardial infarction (STEMI). The aim of our study was to look at the viability of myocardium in patients with CTOs in both infarct-related and non-infarct related occluded vessels with grade 3 collaterals., Methods: We prospectively collected consecutive patients with CTOs who had good grade 3 collaterals and studied the viability of the myocardium in the segment perfused by these occluded arteries. Viability was assessed with a positron emission tomography (PET) scan with fluoro-deoxyglucose uptake., Results: A total of 75 patients (60 men and 15 women; age, 61 ± 9 years) were included in the study; of these, 25 patients had a previous MI with Q-waves on the electrocardiogram. All 25 patients (100%) with a previous MI had non-viable myocardium, while those without a history of previous MI had viable myocardium on the PET scan. The overall left ventricular function or regional wall-motion abnormality did not have an influence on the viability., Conclusion: In the presence of previous STEMI, if the infarct-related artery is a CTO, the myocardium supplied by that vessel is most likely non-viable even in the presence of grade 3 collaterals.

Objectives: This study aimed to assess the knowledge, attitudes and practices of the general public in Oman regarding the dangers of high salt intake., Methods: This cross-sectional questionnaire-based survey was conducted among the urban population in Oman. Individuals aged ≥18 were invited to join the study., Results: A total of 1,214 respondents (mean age 34 ± 10 years) answered the questionnaire. The majority were male (65.8%), employed (69.4%) and some were hypertensive (14.3%). Most (90.9%) were aware that excess salt can cause diseases such as hypertension and that it is either somewhat important (51.2%) or very important (42.9%) to reduce salt in the diet. However, only 42.2% said that they actively try to reduce salt in their diet., Conclusion: Although most people in urban areas of Oman appear to be aware of the dangers of high salt intake, only a few are actively trying to reduce it. More educational activities are required to improve awareness., (© Copyright 2020, Sultan Qaboos University Medical Journal, All Rights Reserved.)

As per WHO estimates, around 17% of the adult Omani population are hypertensive. However, people with hypertension are often unaware of the diagnosis, and so the May Measurement Month (MMM) programme was set up to raise awareness of the importance of blood pressure (BP) screening. A cross-sectional screening of BP of subjects aged 18 years or more was carried out in May 2018 at various sites in Muscat, Oman. Screening sites were set up at the reception areas of participating hospitals, and at a few public areas such as shopping malls and workplaces of the volunteers. Blood pressure was measured according to a standardized protocol, and hypertension was defined as per the 2018 European Society of Hypertension guidelines. The data were analysed centrally by the MMM project team. A total of 12 689 individuals (mean age 40.6 ± 12.5 years, 72% male) were screened. The crude mean BP of the second and third readings (where three readings were taken, n  = 4 738) was 127.1/79.2 mmHg. After multiple imputations, the average age and sex standardized BP was 127.3/80.2 mmHg. Of all participants, 29.8% had hypertension. There were 1 983 patients with a previous diagnosis of hypertension, of whom 1 810 were on antihypertensive medication. A further 1 973 subjects were newly diagnosed with hypertension. Of those on antihypertensive medication, 34.9% had uncontrolled BP readings. Screening programmes such as MMM are useful to identify persons with undiagnosed hypertension. However, more educational activities are required to increase the public awareness regarding the dangers of hypertension., (Published on behalf of the European Society of Cardiology. © The Author(s) 2020.)

Background: This study aimed to assess the level of knowledge regarding the basic life support (BLS) and attitudes related to BLS training and to identify the factors affecting these among medical students in Oman., Materials and Methods: This prospective cross-sectional questionnaire-based study was carried out during the period July 2017 to February 2018 at Medical College of Sultan Qaboos University, Muscat, Oman. Validated questionnaires in English were distributed among undergraduate medical students from 1st to 7th years., Results: A total of 304 medical students completed the questionnaire with a response rate of 82.7%. The mean knowledge score of the participants was slightly high (5.5 ± 2.1) and median score of 5. About 53.6% of the participants had insufficient knowledge level. The scores increased with increase in the year of training. More than half (64.5%) of the participants had no previous BLS training. Students who attended previous BLS training showed higher knowledge scores ( p < 0.001). Majority of the participants (97.4%) supported including of BLS in the undergraduate medical curriculum. Majority of the students (74%) were not reluctant to perform BLS on a stranger, although there was some reluctance among the female students., Conclusion: Our findings show that medical students in Oman had insufficient knowledge about BLS. However, they showed positive attitudes toward BLS training and were not reluctant to provide BLS to a stranger if required. These highlights the importance to provide sufficient BLS training for medical students early in their course., How to Cite This Article: Albadi S, Al-Hadi H, Nadar SK. Knowledge and Attitudes toward Basic Life Support among Medical Students in Oman. Indian J Crit Care Med 2020;24(7):599-600., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.)

Aim: Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction., Methods: All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale., Results: A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 ( n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 ( n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 ( p = 0.01)., Conclusion: A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations., Competing Interests: The authors declare no conflict of interest., (© 2020 Saudi Heart Association.)

Competing Interests: Disclosure: The authors have no conflicts of interest to declare.

Despite the advances in the management of thalassemia major, heart disease remains the leading cause of mortality in patients afflicted with this disorder. Cardiac involvement in thalassemia encompasses a spectrum of disorders including myocardial dysfunction, arrhythmias, pulmonary hypertension, and peripheral vascular disease. Although cardiac siderosis (accumulation of iron in cardiac myocytes) as a consequence of repeated blood transfusions is deemed to be the main etiologic factor for myocardial dysfunction in transfusion-dependent patients, the significance of other pathophysiologic mechanisms is being increasingly recognized especially in non-transfusion dependent patients. Management of cardiac complications in thalassemia major hinges on the treatment of the underlying pathophysiology, which often is unmitigated iron overload. The prevalence and predictors of cardiac complications in 'ex-thalassaemics' [thalassaemic patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) is unknown at present. In this review, we look at the pathogenesis of cardiac involvement in patients with beta-thalassemia major, the advances in the management of these patients and the future prospects.

Heart failure is a clinical condition with complex pathophysiology that involves many different processes. Diagnosis is often difficult in patients presenting for the first time with breathlessness. Many biomarkers have been identified that are elevated in heart failure and their role in assessing prognosis has also been investigated. However, at present the natriuretic peptides appear to be the gold standard biomarker against which the other biomarkers are compared. In this review we will examine the evidence behind the other biomarkers for use in heart failure patients and the current guidelines for their use., Competing Interests: Disclosure: The authors have no conflicts of interest to declare

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

Since the publication of European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure (HF) in 2016, a new class of HF has been defined, namely HF with mildly reduced ejection fraction (HFmrEF). Although the name was new, there had long been awareness of the existence of a grey area between the two established classes of HF: HF with reduced ejection fraction and HF with preserved ejection fraction. Patients between these two classes were previously either excluded from HF studies or were included in the other groups. With the definition of this new group of patients, a door has opened for researchers to further explore their characteristics, treatment and outcomes. In this article we aim to clarify the existing literature on the clinical characteristics and pathophysiology of this newly-defined group of patients., Competing Interests: Disclosure: The authors have no conflicts of interest to declare.