Sampling time and indications appropriateness for therapeutically monitored drugs at a teaching university hospital in Oman

AbstractObjective: To evaluate prospectively the appropriateness of indications, sampling time and outcome of TDM requests at a teaching university hospital in Oman. Methods: A prospective cross-sectional study was conducted over a four months period; October 2013–January 2014 at the Sultan Qaboos University Hospital (SQUH), an 855 bed university teaching hospital. Appropriateness criteria for indications and sampling time were defined a priori. The evaluated drug’s requests were for carbamazepine, phenytoin, phenobarbital, valproic acid, digoxin, gentamicin, amikacin, vancomycin, tobramycin, theophylline, lithium, and cyclosporine. Results: Of 733 evaluated TDM requisitions, the majority were for antibiotics (75.0%) followed by antiepileptics (10.5%) and cyclosporine (8.9%). Most of the requests had appropriate indication (78.2%), however, only 28.5% had appropriate sampling time. Results were applied by dosage adjustments in 65.8% of requests and some of the inappropriately sampled requests (15.3%) were used as a basis for modifying the dosage regimen. Of all the reported plasma concentrations 42.3%, 41.2%, and 16.5% were within, below and above the reference range, respectively. Conclusion: TDM service is much less than optimal in SQUH. A lot of effort needs to be carried out to improve TDM use in the developing countries as adjusting the doses on results that are based on wrong sampling time might expose patients to toxicity or therapeutic failure

PROPOLIS AND BEE VENOM IN DIABETIC WOUNDS; A POTENTIAL APPROACH THAT WARRANTS CLINICAL INVESTIGATION

Background: Wound healing in diabetes mellitus is a complex multi-stage process that requires the proper function of multiple systems. The mechanisms of impaired wound healing of diabetic wounds are still poorly understood. Therefore, various interventions are being used for wound management without great success. Bee products have various properties that make them an important addition to the diabetic wound management. Methods: This review summarized previous and recently published papers of the effects of two bee products, propolis and bee venom, on the wound healing. The main results were obtained from preclinical experimentation. Results: Diabetes mellitus compromises immune system, increases infections, impairs wound healing, and affects cells and factors involved in the wound healing. There is an increasing interest in natural products in modern medicine as part of disease management. Bee products are natural substances that others and we have explored some of their biological activities and applications in the treatment of various diseases. Some of these products are bee venom and propolis. These products have analgesic, antioxidant, antimicrobial, and anti-inflammatory properties. In addition, both propolis and bee venom contain considerable amounts of antioxidants that have a great role in accelerating wound healing. Conclusion: There is sound rationality and scientific data for using propolis and bee venom in diabetic wound healing. We believe that topical application of propolis in addition to bee venom might have a place in repairing damaged tissues and accelerating the healing of diabetic wounds

Patients’ Perceptions of Communication and Clinical Skills of Primary Healthcare Physicians in Oman

ABSTRACT: Objectives: As a large proportion of patients are seen in primary healthcare (PHC) centres, it is important to explore patients’ perceptions of communication and clinical skills of PHC physicians. In Oman, PHC is provided by both trained family physicians (FPs) and general practitioners (GPs). Methods: This crosssectional study was conducted at 12 PHC centres in Muscat Governorate, Oman between November 2014 and August 2015. Adult Omani patients’ perceptions of Omani and other Arabic-speaking doctors were examined using an Arabic translation of a validated self-administered questionnaire. Results: A total of 626 patients completed the questionnaire (response rate: 100%). The patients’ responses were significantly more positive towards FPs compared to GPs on whether the doctor provided reassurance (P = 0.03), took a complete medical history (P = 0.03) and gave the patient the opportunity of a follow-up with the same doctor (P = 0.01). Conclusion: Certain skills in communication and clinical aspects of FPs were favourably viewed by patients compared to GPs.Keywords: Patient Satisfaction; Physicians, Primary Health Care; Communication; Clinical Competence; Quality of Health Care; Oman

Medical Honey for Wound Care—Still the ‘Latest Resort’?

While the ancient Egyptians and Greeks used honey for wound care, and a broad spectrum of wounds are treated all over the world with natural unprocessed honeys from different sources, Medihoney™ has been one of the first medically certified honeys licensed as a medical product for professional wound care in Europe and Australia. Our experience with medical honey in wound care refers only to this product. In this review, we put our clinical experience into a broader perspective to comment on the use of medical honey in wound care. More prospective randomized studies on a wider range of types of wounds are needed to confirm the safety and efficacy of medical honey in wound care. Nonetheless, the current evidence confirming the antibacterial properties and additional beneficial effects of medical honey on wound healing should encourage other wound care professionals to use CE-certified honey dressings with standardized antibacterial activity, such as Medihoney™ products, as an alternative treatment approach in wounds of different natures

Group A Streptococcal Pericarditis in a Four-Month-Old Infant : Case report

Purulent pericarditis is uncommon among paediatric patients and cases caused by group A Streptococcus (GAS) are even rarer. We report a four-month-old female infant who was referred to the Royal Hospital, Muscat, Oman, in 2015 with pericardial effusion and cardiac tamponade. She had initially presented to a secondary hospital with a two-week history of fever, a runny nose and shortness of breath. Blood and pericardial fluid cultures confirmed GAS isolates. The infant was treated with a two-week course of antibiotics and made a complete recovery with no echocardiographical evidence of pericardial effusion at a two-month follow-up. To the best of the authors’ knowledge, this case constitutes the youngest infant to present with GAS pericarditis. As invasive GAS infections can present in infancy, early recognition and treatment is required

Antimicrobial activity of Dracaena cinnabari resin from Soqotra Island on multi drug resistant human pathogens

Background: Few studies showed that Dracaena cinnabari resin, collected from Soqotra Island,  Yemen,  has antimicrobial activity. This study is the first to investigate antimicrobial activity of the resin on both antibiotic multi-resistant human pathogens and on poly-microbial culture.Material and Methods: Antimicrobial activity of ethanolic extract of Dracaena cinnabari resin from  Soqotra Island on multidrug resistant Gram-positive and Gram-negative human ATCC standard pathogens  and Ascosphaera apis, the causal organism of chalkbrood disease of honeybee was studied using the agar disc diffusion method. The minimal inhibitory concentration of extracts was carried out by  the broth micro dilution method.Results: Ethanolic extract of Dracaena cinnabari resin showed a considerable antimicrobial activity  against all the pathogens tested. The zone of inhibition were between 4.9-11.5 mm. The most sensitive  microbe was Staphylococcus aureus and least sensitive was Aspergillus nidulans. The minimal inhibitory concentration of the extract against Escherichia. coli ATCC 10402, Klebsiella pneumonia ATCC 10031, and Staphylococcus aureus ATCC 29212 was 1.25 μg/mL (w/v) and for the other pathogens (Candida albicans ATCC 10231, Salmonella typhimurum ATCC 3311 and Pseudomonos aeruginosa ATCC 2785) was 2.5 μg/mL (w/v).Conclusion: Ethanolic extract of Dracaena cinnabari resin has a considerable antimicrobial activity  against Gram-positive and Gram-negative human pathogens and fungi. This extract might possess a role in the management of microbial infections in human and honeybee disease.Key words: Antimicrobial Activity, Dracaena cinnabari, Human pathogens, Minimum Inhibitory Concentratio

Localised Skin Hyperpigmentation as a Presenting Symptom of Vitamin B12 Deficiency Complicating Chronic Atrophic Gastritis

Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms. Dermatological manifestations associated with this deficiency include skin hyper- or hypopigmentation, angular stomatitis and hair changes. We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two months’ duration. Other symptoms included numbness of the hands, anorexia, weight loss, dizziness, fatigability and a sore mouth and tongue. There was no evidence of hypocortisolaemia and a literature search revealed a possible B12 deficiency. The patient had low serum B12 levels and megaloblastic anaemia. An intrinsic factor antibody test was negative. A gastric biopsy revealed chronic gastritis. After B12 supplementation, the patient’s symptoms resolved. Family physicians should familiarise themselves with atypical presentations of B12 deficiency. Many symptoms of this deficiency are reversible if detected and treated early