Profile of Mental and Behavioral Disorders Among Preschoolers in a Tertiary Care Hospital in Oman: A Retrospective Study

Objectives Early diagnosis and prompt treatment of mental and behavioral disorders in preschoolers is critical for a better prognosis, ultimately leading to improved quality of life for both the child and the family. Our study investigated the clinical profile of mental and behavioral disorders in children < 7 years of age, seeking consultation at Sultan Qaboos University Hospital, Muscat, Oman, between 1 June 2006 and 31 December 2010. The objective was to explore demographic variables, intervention types, and annual trends. Methods This retrospective, descriptive study was conducted by reviewing the electronic records of preschoolers seeking consultation on mental and behavioral disorders at the Department of Behavioral Medicine. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Results The total number of cases was 466, the majority (77.9%) being boys. The cumulative frequencies and annual hospital-based prevalence rates were estimated for each category of mental and behavioral disorders. Our findings showed increased service utilization among preschoolers, as reflected in the annual trend and case-specific prevalence rates. While comorbidity was common, the most frequent disorders encountered were attention deficit hyperactivity disorder (70.8%), developmental language disorder (23.6%), autism spectrum disorders (20.2%), and disruptive behavior disorders (11.6%). The most commonly prescribed drugs/supplementation were risperidone (18.7%), atomoxetine (9.7%), omega-3 (8.8%), and methylphenidate (6.2%). Conclusions Consultations for mental and behavioral disorders are being sought for Omani preschoolers. Beside pharmacotherapy, other interventions, which are an integral part of a much desired multidisciplinary approach should be introduced. Readdressing the missing needs is essential for a comprehensive approach to managing mental and behavioral disorders.H.M. Sultan Qaboos Gran

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

A strange type of Pica

Pica, where the patient eats non-food items such as mud, clay, varnish etc., is a common behavioural problem seen in children, pregnant women and the mentally retarded. However sponge pica is a very rare variation. We report a case of a 5-year-old Omani girl, who presented with sponge pica since the age of two years, with recent abdominal pain. Investigations showed anaemia, elevated liver enzymes and normal intelligence. There was no evidence of obsessive-compulsive disorder. Both clinical and laboratory findings showed complete recovery after a few weeks of oral iron therapy. Her appetite improved, and she started to gain weight. No recurrence was observed when followed up after two years. Awareness is necessary to detect and treat pica as early as possible to prevent its complications.

Urbanization, Culture & Hyperactivity: An Exploratory Study of Omani Schoolgirls

Although formulated for Western populations, the study of variation in human behaviors within the advocated diagnostic categories of the Western psychiatric nosology has been found to be universally applicable. This paper attempts to tease out whether gender differences are shaped by socio-cultural or ecological factors by examining the prevalence of attention deficit hyperactivity disorder (ADHD) in a sample of 708 Omani schoolgirls residing in Muscat, the capital of Oman. Academic performance, and some intellectual and social correlates were also explored. The findings reveal that academic, intellectual and social correlates fluctuate in complex ways. The prevalence of ADHD amongst Omani students was 5%, a rate that is lower than what is observed in many Western samples. The authors discuss the importance of socio-cultural versus ecological factors that might play a role in the expression of hyperactivity and speculate about the gender related issues concerning ADHD in an Arab/Islamic country

Growth Pattern of Primary School Children in Benghazi, Libya

Objective: To fi nd the growth trends in a sample of schoolchildren in Benghazi (Libya), and to compare it with international and other local growth charts, as a step for setting the national curves. Method: From 25th February to 31st October 1993, a sample of 2,022 pupils (1,160 boys and 862 girls) were randomly selected from three public primary schools in three different socio-economic areas in Benghazi. A questionnaire consisting of social and scholastic items was distributed to teachers a few days before the examination. The height and weight of all the pupils were measured according to the standards of Jellife, Gorstein, WHO, and de Onis. Data were analyzed and compared with both the reference standard of the United States National Center for Health Statistics (NCHS-USA), and the local standards of Tripoli-1986. Results: The boys and girls in the lowest age-group had a pattern similar to that of the reference population for both height/age and weight/age, but it dropped sharply from mid-school years. The Benghazi curves were consistently higher than those of Tripoli, particularly for height/age. Conclusion: The nutritional status of these children, which was good before the beginning of schooling, was negatively affected during the school years. This could be attributed either to births in the family and consequent neglect, or to the school’s negative effects on the child, such as lack of appetite created by anxiety or other factors. Further studies from dif ferent regions of the country are needed to set national growth curves.

Elevated plasma leptin levels in autistic children of Sultanate of Oman

Autistic spectrum disorders (ASD) are mysterious, complex, childhood pervasive developmental disorders characterized by impairments in social interaction, deficits in verbal and non-verbal communication, and restricted repetitive and stereotyped patterns of behavior and interests. The etiology of this disorder is poorly understood and no biomarkers have yet been identified as characteristic of ASD. Leptin, a peptide hormone mainly secreted by adipose tissue, is involved in the regulation of body weight and energy expenditure. Leptin also play a role in regulation of neuroendocrine functions, immune system and inflammatory response and development. Recent evidences suggest that leptin might be implicated in the pathophysiology of autism. Availability of biochemical data related with leptin for Omani autistic children is scarce. So, the current study was aimed to compare the levels of leptin in the plasma of ASD children in Sultanate of Oman. Significant higher levels of leptin were found in Omani autistic children as compared with controls. Our results corroborate with the previous findings and also suggest that there might be some relationship between leptin and the pathophysiology of autism. The exact mechanism is still unknown and further extensive research needed.3 page(s

Impaired antioxidant status and reduced energy metabolism in autistic children

Accumulating evidence suggests that oxidative stress induced mechanisms are believed to be associated with the pathophysiology of autism. In this study, we recruited 19 Omani autistic children with age-matched controls to analyze their plasma and serum redox status and the levels of ATP, NAD⁺ and NADH using well established spectrophotometric assays. A significant decrease was observed in the levels of plasma total antioxidants (TA), reduced glutathione (GSH), superoxide and catalase activity in Omani autistic children as compared to their age-matched controls. In contrary, the level of plasma glutathione peroxidase (GSH-Px) was significantly increased in autistic children. Reduced serum NAD⁺ and ATP levels and lower NAD⁺:NADH ratio were observedin patients with autism compared to controls. Finally, a significant inverse correlation was observed between plasma GSH, SOD, catalase activity, and serum NAD⁺ and ATP levels, and autism severity using Childhood Autism Rating Scale (CARS) scores. The levels of plasma GSH-Px and serum NADH correlated strongly with autism severity whilst no significant correlation was observed for plasma TA. Our data suggests that increased vulnerability to oxidative stress in autism may occur as a consequence of alterations in antioxidant enzymes leading to mitochondrial dysfunction.9 page(s

Increased markers of oxidative stress in autistic children of the Sultanate of Oman

Autism spectrum disorder (ASD) is a neurodevelopmental disorder of early childhood, and an enumeration about its etiology and consequences is still limited. Oxidative stress-induced mechanisms are believed to be the major cause for ASD. In this study 19 autistic and 19 age-matched normal Omani children were recruited to analyze their degree of redox status and a prewritten consent was obtained. Blood was withdrawn from subjects in heparin-coated tube, and plasma was separated. Plasma oxidative stress indicators such as nitric oxide (NO), malondialdehyde (MDA), protein carbonyl, and lactate to pyruvate ratio were quantified using commercially available kits. A significant elevation was observed in the levels of NO, MDA, protein carbonyl, and lactate to pyruvate ratio in the plasma of Omani autistic children as compared to their age-matched controls. These oxidative stress markers are strongly associated with major cellular injury and manifest severe mitochondrial dysfunction in autistic pathology. Our results also suggest that oxidative stress might be involved in the pathogenesis of ASD, and these parameters could be considered as diagnostic markers to ensure the prevalence of ASD in Omani children. However, the oxidative stress-induced molecular mechanisms in ASD should be studied in detail.3 page(s