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Virtual social network platforms have rapidly become settings for cultivating various types of bonding, bridging, and building social capital. This promotes professional and personal relationships and has implications for our psychological wellness. Our qualitative study, which has taken place in the United Arab Emirates (UAE) and Oman, explored the perspectives of science teachers in training regarding the utilization of social networks for professional development (PD). We conducted 26 semi-structured interviews across both countries. Our results unveiled nuanced insights into the influence of social networks on the professional development of prospective science teachers, the challenges they face while using these means for networking, and how cultural norms and institutional factors impact learning, collaboration, and adoption of such virtual social systems. The findings suggest that social networks can serve as valuable tools for the professional development of prospective science teachers. Notably, there was a subtle divergence between the two groups. The UAE participants have emphasized global perspectives and valued insights into worldwide educational trends, whereas the Omani participants have appreciated the global perspective and prioritized local connections. Additionally, remarkable differences in technology access and infrastructure challenges between UAE and Oman teachers in training highlight the need for more equitable professional development opportunities. Emirati and Omani participants differ in their access to international educational trends and technology because of economic disparities. This could be translated into more resources for education and technological infrastructure, as the geographical location of the UAE as a global hub makes it easier to access global networks and trends. The implications of these findings point to the critical need for the effective use of social networks in the professional development of science teachers. Doi: 10.28991/ESJ-2024-08-01-014 Full Text: PDF

Background: Anxiety disorders are common mental health illnesses in primary care. Undiagnosed and thus untreated mental disorders can interfere with the patient’s quality of life, ultimately resulting in poor daily functioning, a greater number of doctor consultations, and increased disability. Objective: The objective of this study was to determine the prevalence of generalised anxiety disorder (GAD) among an urban adult Omani population as well as associated sociodemographic and clinical variables. Methodology: This study utilised a cross-sectional design and was performed between December 2019 and January 2020. A total of 250 Omani patients were recruited from eight randomised government-funded primary care centres in Muscat, Oman. The prevalence of GAD among the participants was determined by utilising an Arabic version of the validated 7-item General Anxiety Disorder tool delivered during face-to-face interviews. Results: Total 250 patients were enorlled into the study with mean age of 34.3 ± 10.1 years. There was equal number of male and female participants. Overall, a total of 33 patients had GAD (13.2%). According to the univariate analysis, a personal history of anxiety (P = 0.001), chronic medical illnesses (P = 0.025), low monthly income (P = 0.018), divorced individuals (P = 0.015), and housewives with extra part-time employment (P = 0.032) were significantly associated with GAD. However, only the absence of a personal history of anxiety (P = 0.001), and high monthly income (P = 0.002) remained a statistically significant protective factor against GAD in the multivariate analysis. Conclusion: We found a high prevalence of GAD among an adult urban Omani population. Moreover, certain clinical and sociodemographic variables were found to be significantly associated with the disorder, including a personal history of anxiety and low monthly income. The quality of life of Omani GAD patients may be improved via rapid screening of the general population.

Objectives: We sought to identify subgroups of psychiatric patients in a sample of patients admitted at a tertiary care hospital in Oman who received electroconvulsive therapy (ECT) based on their demographic and clinical outcomes. Methods: We retrospectively collected data from patients who received ECT at Al Massarah Hospital, Muscat, Oman, between January 2015 and December 2019. Sociodemographic characteristics, clinical profiles, and psychiatric comorbidities were examined. Results: A total of 179 psychiatric patients received ECT; 96 (53.6%) were females. The average age at diagnosis was 42.5 years. Two-step cluster analysis showed 70 (39.1%) patients in cluster one and 109 (60.9%) patients in cluster two. Patients in cluster one included more (61.4%) females, were older (mean = 55.2 years), married (95.7%), and unemployed (88.6%). They reported they had comorbidities (55.7%) and less frequent ECT use (mean = 8.7) than patients in cluster two. Clusters differences were found on gender (p = 0.001), age (p < 0.001), marital status (p < 0.001), and occupation (p = 0.001). Significant differences were found for diagnosis (p < 0.001), comorbid medical conditions (p < 0.001), and use of ECT sessions (p = 0.006). Conclusions: Psychiatric patients receiving ECT are heterogeneous, with different demographic and clinical outcomes. Our study has shown that patients in cluster one are older females, unemployed, with more comorbidities, and depressive disorders, but received fewer ECT sessions. This study provides important information for clinicians to identify strategies to promote the use of ECT on its effectiveness and safety issues for each group. [ABSTRACT FROM AUTHOR]

Objectives: Peripheral intravenous (IV) access is a standard procedure in clinical settings. Nevertheless, previous studies have indicated that difficult peripheral IV access is prevalent in children. This study aimed to determine the prevalence and factors contributing to difficult peripheral IV cannulation in children admitted to a tertiary care hospital in Oman. Methods: This cross-sectional study was conducted from September to December 2015 at Sultan Qaboos University Hospital in Muscat, Oman. Nurses collected data concerning factors contributing to difficult IV access in children. Results: A total of 511 children undergoing cannulation during the study period were included in the analysis. Overall, 23.3% of the children experienced two or more cannulation attempts. The study identified three variables associated with successful cannulation in cases of difficult IV access. Visible veins were 2.72-times (95% CI: 1.58--4.68) more likely to be associated with success (p < 0.001), while palpable veins were 2.22-times (95% CI: 1.29--3.83) more likely to be associated with success (p = 0.004). However, scarring from previous IV access attempts was half (95% CI: 0.31--0.77) as likely to be associated with successful cannulation (p = 0.002). Conclusions: We identified statistically significant variables related to difficult IV cannulation in children, which we used to develop a prediction tool to assess the likelihood of difficult IV access in pediatric patients. Further research is necessary to validate the use of the difficult IV access prediction tool in this population. [ABSTRACT FROM AUTHOR]

The purpose of the study is to investigate the entrepreneurial intentions among students of Sultan Qaboos University. Then, to determine if entrepreneurial intentions differ according to students’ demographics variables. The study used a questionnaire to collect data as a quantitative methodology. The sample of study included 328 students’ that randomly selected. The results of study revealed that entrepreneurial intentions among students at SQU in general with level of moderate, entrepreneurial intentions of male students higher than female, the entrepreneurial intentions among senior higher than junior, sophomore and freshman. In time of joblessness all institutions of learning from primary to university should involve entrepreneurial education in their curriculum. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the intelligence quotient (IQ) profile among children with autism spectrum disorder (ASD) and identify the most important subscales that predict the IQ. The analysis of an intellectual profile with age and gender differentials and the identification of a battery of subscales of intelligence are important for clinical management of ASD among children and for facilitating placement for remedial and educational services. Methods: Data were collected through an exploratory study of 100 children aged between three and 13 years, who were referred to the department of child health and development in Sultan Qaboos University Hospital, a tertiary hospital, in Oman between June 2016 and June 2019. Results: Among the 100 participants of this study, 79% were male, resulting in a male–female ratio of 4:1. The mean of full-scale IQ was found to be 68.6 ± 18.1. Furthermore, the mean of nonverbal IQ (73.5 ± 17.5) was significantly higher than that of verbal IQ (65.5 ± 17.6). Finally, more than half (61%) of the children were observed to have had mild to moderate impairment in their IQ levels. Conclusions: Age and gender showed no significant association with IQ level. The regression analysis identified nonverbal fluid reasoning, nonverbal visual-spatial processing, nonverbal working memory and verbal knowledge as the significant predictors of total IQ. The crucial dimensions of verbal and nonverbal IQ identified in this study can be used to evaluate complicated cases. [ABSTRACT FROM AUTHOR]

Unilateral proptosis is a rare initial presenting sign of acute myeloid leukemia (AML). We report a case of unilateral proptosis in a six-year-old girl as the initial manifestation of AML. The cancer link was initially missed and the case was investigated as one of hyperthyroidism. Peripheral blood smear and bone marrow aspirate evaluation showed signs diagnostic of AML. Computed tomography scan of orbits showed infiltrative process in the right orbit, right maxillary, and right ethmoidal sinuses. Unilateral proptosis as an extramedullary first presenting feature of AML is very rare; however, it should always be considered in the differential diagnosis of proptosis in pediatric age group. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to determine the demographic, clinical and immunological manifestations of SLE among the Omani population and to compare the results with a previous study in 2003and global data. METHODOLOGY: This retrospective study included patients aged >12 years old with SLE who complied with the 2012 Systemic Lupus International Collaborating Clinics SLE criteria and presented to the Sultan Qaboos University Hospital, Muscat, Oman between January- December 2016. The cumulative frequency of disease manifestations and auto antibodies was determined. Published studies evaluating SLE manifestations in other countries (Gulf countries, India, UK, Italy and Australia) were collected for comparison. RESULTS: A total of 285 patients were included in this study, 256 (89.5%) were female and 29 (10.5%) were male with a female: male ratio of 9:1. The median age was 33 years (age range: 14-69). The 10 year survival rate was found to be 99% with 6.8% of patients lost to follow up. More than 60% of the patients were from two highly populated regions: Al Batinah (37%) and Muscat (24%) governorate. The cumulative frequency of the clinical manifestations was as follows: haematological manifestations (63%), arthritis (62%), renal manifestations (44%), serositis (12.3%), alopecia (26.3%), rash (31%), oral ulcers (11.9%) and neurological disorders (15%). The cumulative frequency of the detected auto-antibodies was as follows: anti-nuclear antibodies(98%), anti-double stranded DNA (81%), extractable nuclear antigens (89%), anti-histone (37%), anti-smith (25%), anti-Sjögren's syndrome A (36%), anti-Sjögren's syndrome B(10.6%), anti-nucleosome (35%) and anti-Ribosomal antibodies (23%). CONCLUSION: Comparing the above results to other studies, clinical and immunological manifestations of SLE in Oman are similar to other Gulf countries. There is an increased frequency of visceral (renal and neurological) involvement in the Gulf region compared to other geographic areas around the world.

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

Due to the high rate of consanguineous marriages in Oman, there is a correspondingly high prevalence of hereditary blood disorders, particularly sickle cell disease and β-thalassaemia. This article proposes the possibility of implementing mandatory premarital carrier screening for blood disorders in Oman, while giving due consideration to potential social and cultural obstacles. Although the implementation of such legislation would require collaboration between different sectors and may negatively affect the autonomy of certain individuals, mandatory premarital screening would help to alleviate the burden of hereditary blood disorders on the national healthcare system, as well as reduce avoidable suffering among carriers and their families.

Objectives: Haemolytic disease of the fetus and newborn (HDFN) causes hydrops fetalis. The successful treatment of HDFN has been reported with intrauterine blood transfusion (IUT). This study aimed to describe the initial experience with IUT procedures in Oman. Methods: This retrospective observational study took place at the Royal Hospital and Sultan Qaboos University Hospital Blood Bank, Muscat, Oman, and included all women who underwent IUT procedures in Oman between March 2012 and March 2016. Gestational and neonatal outcomes were assessed, including complications, morbidity, neurodevelopmental sequelae and mortality. Results: A total of 28 IUT procedures for 13 fetuses carried by 11 women were performed. Gestational age at the time of referral ranged from 13–30 weeks, while the median gestational age at first IUT procedure was 26 weeks (range: 19–30 weeks). Indications for the procedure included HDFN caused by anti-D (n = 6), a combination of anti-D and anti-C (n = 4), anti-K (n = 1) and anti-Jsb (n = 1) antibodies and nonimmune hydrops fetalis due to a congenital parvovirus infection (n = 1). Median fetal haemoglobin levels at the beginning and end of the procedure were 4.6 g/dL and 12.8 g/dL, respectively. Most procedures were transplacental intravascular transfusions through the placental umbilical cord root (71.4%), followed by transamniotic intravascular transfusions (14.3%). The overall survival rate was 61.5%, with five deaths; of these, four were intrauterine and one was an early neonatal death due to non-resolved hydrops and severe cardiac dysfunction. Conclusion: As a relatively novel obstetric procedure in Oman, IUT seems to result in a favourable outcome for hydropic fetuses.

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

Objectives: This study aimed to determine the prevalence of early pregnancy obesity among Omani women and to review maternal antenatal complications, intrapartum and postpartum events and neonatal complications among such women in comparison to women of normal weight. Methods: This retrospective cohort study included 2,652 pregnant Omani women who delivered at the Royal Hospital, Muscat, Oman, between November 2011 and April 2012. The patients’ electronic medical records were reviewed for antenatal, intrapartum and postpartum data. Body mass index was measured during the first trimester (≤12 gestational weeks) and classified according to the World Health Organization categories. Maternal and neonatal complications were compared between obese women and those of normal weight. Obstetric outcomes in uncomplicated pregnancies were also compared. Results: In the study cohort, there were 901 (34%) obese women and 912 (34.4%) women of normal weight; of these, 440 (48.8%) and 672 (73.7%) had uncomplicated pregnancies, respectively. Obese women had a significantly increased incidence of gestational diabetes (relative risk [RR]: 2.23; 95% confidence interval [CI]: 1.70–2.92; P

Objectives: The presence of abnormally high levels of Aspergillus fumigatus-specific immunoglobulin (Ig) G antibodies can serve as a diagnostic criterion for severe conditions like allergic bronchopulmonary and chronic pulmonary aspergillosis. This study aimed to determine a reference range of A. fumigatus-specific IgG levels within a healthy adult Omani population. Methods: This study took place during November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The sera of 125 healthy Omani blood donors were tested for A. fumigatus-specific IgG levels using an automated fluorescence enzyme immunoassay. Results: Initially, the data were not normally distributed; however, log transformation and the exclusion of four outliers resulted in an acceptable Gaussian distribution. The reference range was 2.0–68.7 mgA/L at the 2.5th and 97.5th percentiles, respectively, with 90% confidence intervals of 2.0–3.0 mgA/L and 48.0–76.0 mgA/L, respectively. Conclusion: The A. fumigatus-specific IgG reference range within a healthy adult Omani population was comparable to those reported in other populations.

Memorising human anatomy structures remains a challenge for nursing students. Educators endeavour to make human anatomy interesting and easy to memorise. Various instructional approaches can be used to help students enhance their memory. Mnemonics, for example, are well-established educational strategies that have proven useful in the encoding, retention and retrieval of anatomical terms. The carpal and tarsal bones are some of the anatomical structures that prove challenging to nursing students' study of anatomy. Although available online to students, most of the accessible mnemonics are in English and non-native English-speaking students (students who are native Arabic-speakers) might find them difficult to understand. Therefore, we have created two simple Arabic mnemonics that can simplify the memorisation of the carpal and tarsal bones. We believe that Arabic mnemonics effectively enhance memorisation by linking the new learning material to familiar information. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess knowledge of breast cancer (BC) risk factors, warning signs and symptoms and breast self-examination (BSE) practice among Omani female teachers in Al-Dhahira Governorate. Methods: A cross-sectional sample of female teachers aged 20–50 years was collected from January to December 2018 from three wilayats (provinces) in Al-Dhahira—Ibri, Dhank and Yunqal. A questionnaire that included the Breast Cancer Awareness Scale and demographic characteristics was administered. Data were analysed using descriptive statistics, regression analysis and Pearson's Chi-square test. Results: A total of 478 female teachers were included in the study (response rate: 72.4%). The majority of participants (60.5%) had good overall knowledge about BC while 19.9% of participants had excellent overall knowledge. Only 9% of participants demonstrating excellent knowledge of BC risk factors. More than half of the participants (56.1%) reported excellent knowledge in screening methods. Unfortunately, only 57% of the female teachers indicated practising BSE. Knowledge of BC symptoms was closely divided between excellent and good levels (45.8 and 42.5%, respectively). BSE practice was significantly (P <0.05) correlated with overall knowledge of BC and its symptoms and screening methods, but not with knowledge of BC risk factors. Conclusion: This study revealed unsatisfactory overall knowledge of BC risk factors, symptoms, screening methods and BSE practice among female Omani teachers in Al-Dhahira Governorate. These findings constitute a challenge to healthcare providers to continue developing awareness of BC and providing health information to the public. [ABSTRACT FROM AUTHOR]

Objectives: After completing the pre-clinical phase of a Doctor of Medicine (MD) curriculum, undergraduate medical students may choose to add a Bachelor of Science (BSc) degree in health sciences to their MD degree. Limited data exists on the motives behind students' decisions to undertake such intercalated degrees. Hence, this study aimed to identify the factors that influence students in making this choice. Methods: Undergraduate students who chose the research-based academic track of the intercalated phase of the BSc programme at the College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, between 2014–2018 were enrolled. A standardised and validated self-explanatory questionnaire examining motivations to join the intercalated phase was administered to all students in the first week of enrolment. Results: Over a five-year period, out of 557 eligible students, 18 (3%) were enrolled in the intercalated phase and all completed the questionnaire. The mean age was 22 } 1.5 years and the majority (83%) were female. Out of the 18 students, 10 (55%) had taken the university's foundation programme. A total of 45% of students chose to intercalate out of their own interest, regardless of career ambitions. The main reasons to intercalate were an opportunity to enhance research experience, alignment with long-term career goals and a chance to publish in indexed journals. Conclusion: Despite the benefits of obtaining an additional degree, a relatively small proportion of MD students were attracted to the intercalated phase. A better presentation of the BSc degree is needed to help students make a more informed decision. [ABSTRACT FROM AUTHOR]

A national cross-sectional survey was conducted to estimate the prevalence of anaemia, micronutrient deficiencies, haemoglobin disorders and over- and undernutrition in children and women of reproductive age in Oman. Wasting and stunting were found in 9.3% and 11.4% of children aged 0–59 months, respectively, while 4.2% were overweight or obese. In addition, 23.8% were anaemic and 10.2%, 9.5% and 10.6% had iron, vitamin A and vitamin D deficiencies, respectively. Sickle cell and β-thalassaemia genetic traits were present in 5.3% and 4.2% of children and 4.7% and 2.8% of women, respectively. Overall, 9.1% of Omani women were underweight and 59.2% were overweight or obese. The prevalence of anaemia was 27.8%, while iron, folate, vitamin B12 and vitamin D deficiencies affected 24.8%, 11.6%, 8.9% and 16.2%, respectively. Anaemia among both children and women and the prevalence of overweight and obesity in women are the most concerning nutritional problems in Oman. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare reference anthropometric measures of Omani neonates with the international standard growth charts of the World Health Organization (WHO) in order to determine the appropriateness of these growth charts to assess the growth of Omani neonates. Methods: This cross-sectional study included all healthy full-term Omani neonates born between November 2014 and November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. Birth weight, length and head circumference measurements were identified and compared to those of the 2006 WHO growth charts. Results: A total of 2,766 full-term neonates were included in the study, of which 1,401 (50.7%) were male and 1,365 (49.3%) were female. Mean birth weights for Omani males and females were 3.16 ± 0.39 kg and 3.06 ± 0.38 kg, respectively; these were significantly lower than the WHO standard measurements (P

Objectives: The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay (LOS). Methods: This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction were excluded. Results: A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results (81.3%). Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests (mean: three versus one day; P = 0.001). In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome (ACS), atrial fibrillation or other types of arrhythmia. Conclusion: A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected.

Objectives: Chronic hepatitis C (CHC) is a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC) worldwide. However, there is a lack of data regarding the epidemiology of CHC in Oman. This study aimed to describe the clinicopathological characteristics and outcomes of CHC-infected patients at a tertiary care hospital in Oman. Methods: This retrospective descriptive hospital-based study included all CHC-infected patients who presented to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, between January 2010 and December 2015. The baseline demographic, clinical, laboratory and radiological data of the patients were analysed. Results: A total of 603 CHC-infected patients were identified during the study period; of these, 65.8% were male and the mean age was 44.8 ± 16.5 years. The main risk factors associated with CHC infection were intravenous drug abuse (23.9%) and a history of blood transfusions (20.7%). The most prevalent virus genotypes were 1 and 3 (44.0% and 35.1%, respectively). Upon initial presentation, 33.0% of the cohort had liver cirrhosis; of these, 48.7% had decompensated cirrhosis and 23.1% had HCCs. Liver transplantation was only performed for 7.5% of the cirrhosis patients, mostly as a curative treatment for HCC. Conclusion: The implementation of national policies to prevent hepatitis C transmission and encourage the early screening of at-risk patients is recommended to reduce the burden and consequences of this disease in Oman.

This paper investigates the possibility of constructing multi-microgrids by interlinking the rural area systems in the Al Wusta governorate of the Sultanate of Oman, which are currently being supplied by diesel generators. It is proposed to enhance the rural system under study by switching off small diesel stations and replacing them with wind turbines. The microgrids formed in this way are then interlinked together to create multi-microgrids. The paper studies the interlinked multi-microgrids under different scenarios; in terms of voltage profiles and power flow using the ETAP software package. This study contributes to the feasibility study of retiring some diesel power plants and using renewable energy resources in rural Oman.

Objectives: Road traffic injuries (RTIs) are considered a major public health problem worldwide. In Oman, high numbers of RTIs and RTI-related deaths are frequently registered. This study aimed to evaluate the distribution of trauma care facilities in Oman with regards to their proximity to RTI-prevalent areas. Methods: This descriptive pilot study analysed RTI data recorded in the national Royal Oman Police registry from January to December 2014. The distribution of trauma care facilities was analysed by calculating distances between areas of peak RTI incidence and the closest trauma centre using Google Earth and Google Maps software (Google Inc., Googleplex, Mountain View, California, USA). Results: A total of 32 trauma care facilities were identified. Four facilities (12.5%) were categorised as class V trauma centres. Of the facilities in Muscat, 42.9% were ranked as class IV or V. There were no class IV or V facilities in Musandam, Al-Wusta or Al-Buraimi. General surgery, orthopaedic surgery and neurosurgery services were available in 68.8%, 59.3% and 12.5% of the centres, respectively. Emergency services were available in 75.0% of the facilities. Intensive care units were available in 11 facilities, with four located in Muscat. The mean distance between a RTI hotspot and the nearest trauma care facility was 34.7 km; however, the mean distance to the nearest class IV or V facility was 83.3 km. Conclusion: The distribution and quality of trauma care facilities in Oman needs modification. It is recommended that certain centres upgrade their levels of trauma care in order to reduce RTI-associated morbidity and mortality in Oman.

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

Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign condition involving the trachea. TPO is characterised by osteocartilaginous nodules developing within the submuscosa of the trachea, sparing the posterior wall. We present the first documented case of TPO in Oman in a 25 year-old Omani male who presented with a recurrent, productive cough from which he had suffered throughout the previous two years. Diagnosis was made by characteristic computed tomography scan, bronchoscopic findings, and a histopathological examination.

Objectives: The prevalence of hypertension (HTN) in Oman is alarmingly high and patient adherence to antihypertensive medications is inadequate. This study aimed to assess the relationship between medication adherence and health beliefs among Omani patients with HTN. Methods:This descriptive cross-sectional pilot study was conducted in December 2015 and included 45 patients with HTN recruited from four primary health centres in Al Dakhiliyah and Muscat governorates, Oman. Medication adherence and health beliefs were assessed using the Morisky Medication Adherence Scale (MMAS), Beliefs about Medicines Questionnaire, Brief Illness Perception Questionnaire and the revised Medication Adherence Self-Efficacy Scale. Results: The mean MMAS score was 5.3 ± 2.0, with 48.9% of patients reporting high adherence. Higher self-efficacy and stronger beliefs regarding medication necessity were significantly related to adherence (P = 0.012 and 0.028, respectively). Conclusion: The findings of this pilot study emphasise the role of health beliefs with regards to Omani patients’ adherence to antihypertensive medications.

To this day, tuberculosis (TB) continues to pose a significant global health burden. The World Health Organization’s Expanded Programme on Immunization (EPI) recommends the bacille Calmette-Guérin (BCG) vaccine for infants to protect against the haematogenous spread of primary TB and other more severe types of TB infection. We report an eight-month-old boy who presented to the Armed Forces Hospital, Muscat, Oman, in 2015 with a one-month history of intermittent fever associated with a limited range of motion in the right hip area. He was up-to-date with his EPI vaccinations and had no history of exposure to individuals with TB infections. He was initially treated for bacterial septic arthritis; however, a GeneXpert TB assay revealed the presence of Mycobacterium tuberculosis, BCG strain. To the best of the authors’ knowledge, this is the first documented case from Oman of a child with TB hip osteomyelitis due to a BCG vaccination.

Ritonavir is a powerful inhibitor of the cytochrome P450 3A4 (CYP3A4) isoenzyme. It is used as a pharmaceutical enhancer in the management of HIV-positive patients. However, when co-administered with other drugs that are metabolised via the CYP3A4 pathway, ritonavir can potentially cause serious drug-drug interactions. Inhaled fluticasone propionate, which is used to treat asthma and chronic obstructive airway disease, is particularly prone to such interactions due to its physiological attributes. We report a HIV-positive 48-year-old male patient who presented to Al Nahdha Hospital, Muscat, Oman, in 2012 with weight loss, generalised weakness and fatigue and diagnosed with secondary adrenal insufficiency as a result of concomitant ritonavir and inhaled fluticasone.

The transposition of the great arteries (TGA) is a complex congenital heart disease which usually presents as cyanosis in neonates with limited mixing between the systemic and pulmonary circulatory systems. A delayed diagnosis of TGA can lead to ventricular failure. We report a six-week-old infant who was admitted to the paediatric Intensive Care Unit of the Royal Hospital, Muscat, Oman, in 2016 for bronchiolitis. During admission, she was incidentally diagnosed with TGA and coarctation of the aorta. Postnatal screening, including the use of pulse oximetry, plays a significant role in avoiding a late diagnosis of TGA; however, this screening tool is not widely used in Oman. Moreover, the common practice of applying a pulse oximetry probe only to the foot may have been limited in the current case due to the reverse differential saturation between the upper and lower limbs caused by this particular combination of lesions.

Clonal cytogenetic abnormalities have been reported among 30–80% of patients with myelodysplastic syndromes (MDS); however, 20–70% of patients with MDS show a normal karyotype that may nevertheless harbour a cryptic genetic alteration. Earlier reports have suggested that the distribution of specific chromosomal aberrations varies among Western and Asian countries, with geographical and ethnic differences in the frequency of specific chromosomal aberrations. This article compared the cytogenetic data of 36 adult Omani patients with MDS to previously reported data from other populations. Differences were noted between the percentages of clonal aberrations and the median age of Omani subjects at presentation in comparison to individuals of different ethnicities and from various geographical locations. To the best of the authors’ knowledge, this is the first report to describe the cytogenetic data of patients with MDS from Oman.

Objectives: The incidence of lung cancer in Oman has shown a gradual but definitive increase since 2002. This study aimed to evaluate the demographic and epidemiological characteristics and survival outcomes of patients with non-small-cell lung cancer (NSCLC) at a university hospital in Oman. Methods: This study was conducted from January to June 2016. A retrospective analysis was performed of consecutive patients diagnosed with NSCLC presenting to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, between March 2000 and December 2015. Clinical features at presentation and prognostic and predictive markers were reviewed. Kaplan-Meir estimates were used to determine relapse-free survival, progression-free survival (PFS) and overall survival (OS). Results: A total of 104 patients presented to SQUH during the study period. The median age at diagnosis was 64 years. Overall, 62 patients (59.6%) had adenocarcinomas. Only 12 patients (11.5%) presented in the early stages (I or II) of the disease and the majority of patients had an Eastern Cooperative Oncology Group performance status of 1 (27.9%) or 2 (26.0%). The prevalence of epidermal growth factor receptor mutations was 27.9%. The median PFS for patients with advanced disease (stages III or IV) was five months and the median OS for all patients was seven months. After five years, 50.0%, 60.0%, 10.0% and 8.0% of patients with disease stages I, II, III and IV, respectively, were alive. Conclusion: Patients with NSCLC in Oman were found to present at an advanced stage. However, patient outcomes were similar to those reported in the USA.

Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function. We report a 45-yearold female patient with mild mitral stenosis and moderate-to-severe mitral regurgitation who presented to the Khoula Hospital, Muscat, Oman, in 2016 following a ruptured anterior communicating artery aneurysm requiring urgent surgical intervention. As highlighted in this case, the VolumeView EV1000™ (Edwards Lifesciences, Irvine, California, USA) system is a minimially invasive haemodynamic monitor that can help immensely in the perioperative management of such patients.

Objectives: Pre-analytic errors during diagnostic laboratory investigations can lead to increased patient morbidity and mortality. This study aimed to ascertain the effect of educational nursing activities on the incidence of pre-analytical errors resulting in non-conforming blood samples. Methods: This study was conducted between January 2008 and December 2015. All specimens received at the Haematology Laboratory of the Sultan Qaboos University Hospital, Muscat, Oman, during this period were prospectively collected and analysed. Similar data from 2007 were collected retrospectively and used as a baseline for comparison. Non-conforming samples were defined as either clotted samples, haemolysed samples, use of the wrong anticoagulant, insufficient quantities of blood collected, incorrect/lack of labelling on a sample or lack of delivery of a sample in spite of a sample request. From 2008 onwards, multiple educational training activities directed at the hospital nursing staff and nursing students primarily responsible for blood collection were implemented on a regular basis. Results: After initiating corrective measures in 2008, a progressive reduction in the percentage of non-conforming samples was observed from 2009 onwards. Despite a 127.84% increase in the total number of specimens received, there was a significant reduction in non-conforming samples from 0.29% in 2007 to 0.07% in 2015, resulting in an improvement of 75.86% (P

Bilateral diaphragmatic paralysis (BDP) is a rare complication of paediatric cardiac surgery. We report four children who developed BDP following cardiac surgery who were managed at the Royal Hospital, Muscat, Oman, between 2009 and 2014. All four children suffered severe respiratory distress soon after extubation and required re-intubation within two hours. In addition, all of the children underwent a tracheostomy as an interim method for ventilation. The four children were successfully weaned from positive pressure ventilation following the functional recovery of at least one side of the diaphragm.

Objectives: Trauma surgeons are essential in hospital-based trauma care systems. However, there are limited data regarding the impact of their presence on the outcome of multi-trauma patients. This study aimed to assess the outcomes of multi-trauma road traffic crash (RTC) cases attended by trauma surgeons versus those attended by non-trauma surgeons at a tertiary hospital in Oman. Methods: This retrospective study was conducted in December 2015. A previously published cohort of 821 multi-trauma RTC patients admitted between January and December 2011 to the Sultan Qaboos University Hospital, Muscat, Oman, were reviewed for demographic, injury and hospitalisation data. In-hospital mortality constituted the main outcome, with admission to the intensive care unit, operative management, intubation and length of stay constituting secondary outcomes. Results: A total of 821 multi-trauma RTC cases were identified; of these, 60 (7.3%) were attended by trauma surgeons. There was no significant difference in mortality between the two groups (P = 0.35). However, patients attended by trauma surgeons were significantly more likely to be intubated, admitted to the ICU and undergo operative interventions (P

Objectives: Most children presenting with febrile illness require a blood culture to determine the causative organism as well as its sensitivity to antibiotics. However, false-positive results lead to unnecessary hospitalisations, prescriptions and tests. This study aimed to evaluate the impact of false-positive blood cultures among a paediatric population at a tertiary hospital in Oman. Methods: This retrospective study included all 225 children

Objectives: This study aimed to develop and validate a health education programme to encourage breast cancer awareness and early detection behaviours among Arab women. Methods: This study took place between December 2015 and March 2016. The Enabling Systems Raising Awareness model was used to develop a breast cancer health education programme which was subsequently implemented by trained health educators at three female-only fitness clubs in Muscat, Oman. Breast cancer knowledge among 53 women was assessed using the breast module of the Cancer Awareness Measure before and after each health education session. Overall pre- and post-session knowledge scores were then compared. Additionally, three focus group discussions were conducted with 10 participants from each location. Thematic analysis was used to analyse the transcribed discussions and collect feedback on the programme. Results: The health education sessions resulted in a statistically significant increase in overall mean knowledge scores (P

Objectives: This study aimed to evaluate the accuracy of the Broselow™ Pediatric Emergency Tape (BT) for estimating weight in an Omani paediatric population at a tertiary care hospital. Methods: This retrospective cross-sectional study was conducted during July 2015. The electronic medical records of Omani outpatients

Objectives: Secondary prevention of ischaemic heart disease (IHD) is very important. This study aimed to assess knowledge of necessary lifestyle changes among Omani patients diagnosed with IHD. Methods: This cross-sectional pilot study took place between October 2015 and February 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. A total of 30 random patients with IHD from the Cardiology Outpatient Clinic of SQUH were included. A 30-item survey was used to determine patients’ knowledge of necessary lifestyle practices following their IHD diagnosis, with scores of

Objectives: This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. Methods: This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. Results: A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). Conclusion: All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined.

Objectives: In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI) of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS) cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. Methods: This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of 60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P

Sickle cell anaemia (SCA) is a common haemoglobinopathy among people from the Middle East, the Afro-Caribbean region, the Mediterranean and East India. While osteomyelitis of the long bones is a welldocumented complication of SCA, there are few documented cases of SCA patients presenting with jaw osteomyelitis. We report three SCA patients with chronic jaw osteomyelitis who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, between 2009 and 2013. Two of the patients had osteomyelitis of the mandible and the third had osteomyelitis of the maxilla. In addition, a brief review of the literature is presented focusing on the clinical presentation, diagnosis and management of jaw osteomyelitis among patients with SCA.

Al Wusta is a desert area in the Sultanate of Oman which is famous due to the discovery of a number of Martian and Lunar meteorites since the start of the present millennium. According to the Meteoritical Bulletin database, 137 approved Martian meteorites have been found worldwide, including 17 from Oman (4 from Zufar, 13 from Al Wusta region). Interestingly 11 finds in the last 15 years have been of Sayh al Uhaymir (SaU) 005 and its pairings. These finds (estimated mass = 11.2 kg) are linked to 10 search expeditions carried out between November 26, 1999 and March 2, 2014 by the Swiss group from the University of Bern and several anonymous meteorite hunters. The bulk of these meteorites (~97%) is in the possession of anonymous collectors, negatively affecting Oman’s natural heritage and denying further research opportunities, given their associated scientific value. SaU 005 and its pairings belong to the shergottite group of the Shergotty-Nakhla-Chassigny (SNC) meteorites, originating from various depths within the Martian mantle. We discuss the recently published oxygen isotope data of bulk and mineral fractions of SaU 008 recovered during the very first expedition in 1999 in the context of other shergottites found in Oman. The bulk oxygen isotope data of SaU 008 and Dhofar 019, another Martian meteorite from Oman, show a narrow range in δ18O values. Their Δ17O values are remarkably close to identical and fall linearly on a Martian fractionation line above the terrestrial fractionation line (TFL) by + 0.32‰, suggesting that Mars’ mantle is homogeneous in oxygen isotopes. Petrographic and mineralogical data of SaU 005 and other pairings published in the Meteoritical Bulletin are compiled, and it is noted that all the meteorites are identical and are likely paired. The story behind these rare extra-terrestrial specimens demands a local meteorite museum and preliminary testing laboratory at Sultan Qaboos University (SQU) to protect this treasure trove of Omani heritage.

Sixty seven healthy growing goat kids of three Omani breeds, born and raised in Sultan Qaboos University Agricultural Experiment Station, were used to study the effects of age, breed and sex on haematological parameters. Blood samples were collected at several times from the first to 25 weeks to study the following parameters: Red Blood Cells (RBCs), White Blood Cells (WBCs), Packed Cell Volume (PCV), Haemoglobin (Hb), Mean Cell Volume (MCV), Mean Cell Haemoglobin Concentration (MCHC) and Mean Cell Haemoglobin (MCH). At birth, MCV and MCH levels were significantly higher in Batina (BAT) kids than both Jabal Akhdar (JA) and Dhofari (DOF), but there were no breed differences in the rest of the haematological values. There were significant breed differences in RBC, MCH, WBC, MCV at different ages, with Hb and PCV being highly significant at all ages. All blood parameters changed with time but showed different patterns in all breeds. There was no effect of sex on RBC, MCHC, PCV, Hb or WBC, but female kids had significantly higher MCH and MCV values at week 12. This study indicates that haematology parameters in Omani goat kids could be affected by age, breed and sex.

Objectives: Sickle cell disease (SCD) is a global health concern associated with high childhood morbidity and mortality; in Oman, the prevalence of SCD is 0.2%. Public awareness of SCD and the need for premarital screening (PMS) are essential to reduce the incidence of this disease. This study aimed to assess awareness of and beliefs regarding SCD and PMS among Omanis in a primary healthcare setting. Methods: This cross-sectional study took place in five health centres located in Al-Seeb Province, Muscat, Oman, between June and August 2015. A total of 500 Omanis aged ≥18 years old attending the clinics were invited to participate in the study. A previously described questionnaire by Gustafson et al. was used to measure awareness of and beliefs regarding SCD and PMS. Results: A total of 450 Omani adults completed the questionnaire (response rate: 90.0%). The majority (67.8%) were aware that SCD is genetically inherited and 85.1% believed in the value of PMS; however, only 24.4% reported having undergone PMS previously. Few participants were aware that SCD can be very painful (20.2%) and can cause strokes, infections and organ damage (20.0%). More than half (56.7%) reported that the availability of educational material on SCD or PMS in Oman was inadequate. Participants’ education levels were positively associated with accurate SCD knowledge (P

Objectives: A thyroidectomy is a frequently performed surgical procedure which can result in lifethreatening complications. The insertion of a drain after a thyroidectomy has been suggested to prevent such complications. This study aimed to evaluate the use of surgical drains following thyroidectomies in relation to postoperative complications and mass sizes. Methods: This retrospective case-control study included all thyroidectomies conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2011 to December 2013. Length of hospital stay, readmission, postoperative complications and mass size were evaluated. Results: During the study period, 250 surgeries were carried out on 241 patients. The majority of patients were female (87.2%). Drains were inserted postoperatively after 202 surgeries (80.8%) compared to 48 surgeries (19.2%) without drains. A total of 32 surgeries (12.8%) were conducted on patients with thyroid masses 4 cm. The association between drain use and mass size was not significant (P = 0.439). Although postoperative complications were more prevalent in patients with drains, the relationship between these factors was not significant (P >0.050). Length of hospital stay was significantly longer among patients with postoperative drains (P

Non-arteritic anterior ischaemic optic neuropathy (NAION) is a serious complication of continuous peritoneal dialysis (CPD) which can lead to poor vision and blindness. We report a five-year-old girl who had undergone a bilateral nephrectomy at the age of one year and was on home CPD. She was referred to the Paediatric Ophthalmology Unit of Sultan Qaboos University Hospital, Muscat, Oman, in 2013 with acute bilateral vision loss, preceded by a three-day history of poor oral intake. At presentation, the patient had severe systemic hypotension. An ophthalmological examination revealed severe bilateral visual impairment and NAION. She was treated with intravenous methylprednisolone and normal saline boluses. At a five-month follow-up, the visual acuity of the right eye had improved but vision in the left eye remained the same. Acute bilateral blindness due to NAION while on CPD is a rare condition in childhood. Paediatricians should be aware of this complication in order to ensure prompt management. Keywords:

Multiple myeloma (MM) is an uncommon malignancy characterised by the proliferation of clonal plasma cells. There are few published reports describing the extramedullary presentation of MM manifesting primarily in the head and neck region. In addition, the occurrence of an isolated relapse of MM in these sites is exceedingly rare. We report a 56-year-old female who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2010 with sudden-onset numbness of the lower lip. She had a history of MM in remission following chemotherapy and a bone marrow transplant. Clinical and radiographic examinations were indicative of a possible relapse of MM, which was subsequently confirmed by bone marrow aspiration and histopathological evaluation. This unique case highlights the unusual site of relapse of a haematolymphoid malignancy.

Objectives: In Oman, the most frequent indication for a splenectomy in children is sickle cell disease (SCD), which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman. Methods: This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged ≤15 years old undergoing splenectomies during the study period were reviewed. Results: A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children (28 male and 22 female) underwent laparoscopic splenectomies alone for SCD. The children’s weight ranged between 11–43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis (92%). Surgically removed spleens weighed between 155–1,200 g and measured between 9–22 cm. Operative times ranged between 66–204 minutes and intraoperative blood loss ranged between 10–800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days. Conclusion: Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option.

A ruptured sinus of Valsalva aneurysm (RSVA) is a rare cardiac anomaly. Traditionally, RSVAs were repaired surgically; however, percutaneous transcatheter closure is the current treatment of choice. We report two cases of RSVA which were closed using this approach. The first case was a 45-year-old female who presented to the Royal Hospital, Muscat, Oman, in 2014 with a RSVA in the right ventricle. The second case was a 39-year-old male who was admitted to the Sultan Qaboos University Hospital, Muscat, in 2015 with a large multifenestrated RSVA extending into the right ventricle outflow tract. Each patient underwent transcutaneous cardiac catheterisation using three-dimensional echocardiography. Both interventions were technically successful; however, the second patient required a subsequent surgery due to the continuing presence of a significant shunt. Transcatheter closure of RSVAs is an effective alternative to surgical repair, although large multifenestrated RSVAs should be repaired surgically to ensure complete closure.