Paediatric Restrictive Cardiomyopathy - Diagnosis and Challenges: A report of two cases

Restrictive cardiomyopathy is one of the rarest forms of cardiomyopathies in pediatric patients characterized by impaired myocardial relaxation or compliance with restricted ventricular filling, leading to a reduced diastolic volume with a preserved systolic function. We report two cases – a 5-year-old boy who presented with abdominal distension and palpitation with family history of similar complaints but no definite genetic diagnosis as yet, and a 5-year-old girl who presented with chronic cough and shortness of breath. Both cases were diagnosed in Sultan Qaboos University Hospital in 2019 and are managed supportively with regular outpatient follow-up. This is the first series of reported cases of pediatric restrictive cardiomyopathy from Oman. Keywords: restrictive cardiomyopathy, cardiomyopathy in children, heart failure in children

Awareness of the Dangers of High Salt Intake among the Urban Omani Population

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.Keywords: Cross-Sectional Survey; Sodium; Low Salt Diet; Oman

First Implementation of Transfusion Consent Policy in Oman : Audit of compliance from a tertiary care university hospital

Objectives: Transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH. Methods: The medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information. Results: In total, the records of 446 transfused patients (299 adult and 147 paediatric patients) were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists (95% and 97%, respectively). Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details (20–25%). Conclusion: In most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended

Impact of Blood Transfusion on Troponin I Levels and Outcomes after Cardiac Surgery: A Cohort Study

Objectives: Increased cardiac troponin I (TI) has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries. Methods: We conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours (TI24) (> 6.5 µg/L vs. ≤ 6.5 µg/L). The impact of transfusion on TI levels was estimated using logistic regression and adjusted for using a multivariable model that included aortic cross-clamp time and preoperative ejection fraction. The effect of TI on the clinical outcomes was examined. Results: Red blood cell (RBC) transfusion was found to be associated with high TI levels (odds ratio (OR) = 2.33, p = 0.007, 95% confidence interval (CI): 1.30–4.30). A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for (OR = 2.06, p = 0.080, 95% CI: 0.90–4.70). An association was found between aortic cross-clamp time and high TI levels in the multivariable model (OR = 1.01, p = 0.028, 95% CI: 1.00–1.02). Elevated TI levels was associated with higher mortality (OR = 4.15, p = 0.017, 95% CI: 1.29–13.08), renal failure (OR = 2.99, p = 0.004, 95% CI: 1.41–6.32), and increased length of stay in-hospital (OR = 4.50, p = 0.020, 95% CI: 0.69–8.30). Conclusions: RBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings

Prevalence and age-of-onset distributions of DSM IV mental disorders and their severity among school going Omani adolescents and youths: WMH-CIDI findings

<p>Abstract</p> <p>Background</p> <p>There is a dearth of studies exploring the magnitude of mental disorders amongst adolescents and youths in the Arab world. To our knowledge, this phase 2 survey in Oman is the first nationally representative school-based study to determine the prevalence of DSM-IV mental disorders (lifetime and over the preceding 12 months), their age-of-onset distributions and determine their severity over the past 12 months using the World Mental Health-Composite International Diagnostic Interview, the WMH-CIDI, used for international comparison.</p> <p>Methods</p> <p>A total of 1,682 (91.61%) students out of 1836 students who formed the phase 2 random sub-sample of a multi-stage, stratified, random sampling design (phase 1), participated in the face-to-face structured interview using the Arabic-version of WMH-CIDI 3.0.</p> <p>Results</p> <p>The phase 1 results using the General Health Questionnaire (GHQ-12) and Child Depression Inventory (CDI) showed depressive symptoms to be 17% prevalent in the larger sample of 5409 adolescents and youths. Amongst the phase 2 respondents from this sample, 13.9% had at least one DSM IV diagnostic label. The lifetime prevalence of Major Depressive Disorder (MDD) was 3.0%; Bipolar Mood Disorder (BMD) was 1%, Specific phobia 5.8% and Social phobia 1.6%. The female gender was a strong predictor of a lifetime risk of MDD (OR 3.3, 95% CI 1.7-6.3, <it>p </it>= 0.000); Any Mood Disorders (OR 2.5, 95% CI 1.4-4.3, p = 0.002) and Specific Phobia (OR 1.5, 95% CI 1.0-2.4, p = 0.047). The severity of illness for cases diagnosed with 12 month DSM IV disorders was found to be 80% lower in females (OR 0.2, 95%CI 0.0-0.8). The estimates over the previous 12 month period when compared with the lifetime prevalence showed a 25% to 40% lower prevalence for MDD, Specific phobia, Social phobia, Any Anxiety Disorders (AAD) and Any Mood disorders (AMD) while the rate was 80% lower for Separation Anxiety Disorder/Adult Separation Anxiety (SAD/ASA). Mood disorders were significantly lower in the 14-16 age groups (70% lower) in comparison to the older age groups and AMD showed a linear increase in prevalence across increasing age groups (<it>p </it>= 0.035).</p> <p>Conclusion</p> <p>The implications of the present findings are not clear cut, however this study endorses the adult CIDI studies findings that mental disorders do begin earlier in life. The relatively lower prevalence of DSM IV depressive disorders cautions against any conclusive interpretation of the inflated results based on the exclusive study of the depressive symptoms alone in the same sample in the same time period. The female gender proved to be a strong predictor of lifetime risk of MDD, any mood disorder and specific phobia. Under-reporting by males or some other gender-specific factors may have contributed to such a discrepancy. The odds of the severity of illness for cases with 12 month DSM IV disorders were significantly lower in females.</p

Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman

Objectives: To determine extubation failure (EF) rate among intubated preterm infants (&lt;37 weeks gestational age [GA]) admitted to a tertiary care neonatal intensive care unit (NICU) in Oman and identify the risk factors associated with EF. Methods: Charts of all intubated preterm infants (&lt;37 weeks GA) from January 2013 to December 2017 were retrospectively reviewed. EF was defined as reintubation within 7 days of planned extubation. Demographics, ventilation parameters, blood gas values and other possible risk factors of EF were collected. Statistical analysis included comparisons between EF and extubation success (ES) groups, and binary logistic regression analysis. Results: A total of 190 preterm infants were intubated during the study period, with 140 eligible for analysis. N=106 were successfully extubated; 34 (24.3%) failed extubation. GA &lt;28 weeks (p=0.029), lower 1-minute APGAR score (p=0.023) and patent ductus arteriosus diagnosis (PDA) (p=0.018) were significantly associated with EF. After the multivariate analysis, only GA &lt;28 weeks predicted EF with adjusted odds ratio (95% confidence interval) of 2.62 (1.17 – 6.15). Conclusions: EF rate in preterm infants admitted at our NICU in Oman, was within international rates. GA &lt;28 weeks was the only predictor of extubation failure identified. Neonatal practitioners need to seriously consider extreme prematurity in extubation process and consider implementing strategies to decrease extubation failure in this group of fragile infants. Keywords: Premature Infants; Neonate; Airway Extubation; Extubation Failure, Risk Factors

Health services utilization by school going Omani adolescents and youths with DSM IV mental disorders and barriers to service use

<p>Abstract</p> <p>Background</p> <p>Recent corpus of research suggests that psychiatric disorders amongst adolescents and youths are an emerging global challenge, but there is paucity of studies exploring health services utilization by this age group in Arab region.</p> <p>Aim</p> <p>This study focus on the health services utilization and the barriers among school going adolescents and youths with DSM IV disorders in the country Oman, whose population is predominantly youthful.</p> <p>Methods</p> <p>Representative sample of secondary school Omani adolescents and youths were concurrently interviewed for the (i) presence of DSM IV mental disorders using the face-to-face interview, World Mental Health-Composite International Diagnostic Interview (WMH-CIDI), (ii) tendency for health care utilization and (iii) predictors of utilization with clinical and demographic background.</p> <p>Results</p> <p>The proportions of lifetime cases having ever made treatment contact are low, being 5.2% for any anxiety disorder and 13.2% for any mood disorder category. None of these anxiety cases made treatment contact in the year of onset of the disorder, and the median delay when they eventually made treatment contact is about 14 years. In any mood disorders category only 3.6% made contact within the 1st year of onset with the median delay in initial treatment contact is two years for the Bipolar disorder (broad), four years for Any Mood disorder and nine years for the Major Depressive Disorder group. Male gender is significantly associated with less likelihood of making treatment contact when suffering from Social phobia (p = 0.000), Major Depressive Disorder (p = 0.000) and Bipolar Disorder (p = 0.000). The younger cohorts of 14-16 years and 17-18 years of Social phobic made significantly less lifetime any treatment contact (p = 0.000). The 14-16 year olds were significantly less likely to make lifetime any treatment contact for Bipolar Mood disorder (p = 0.000), while the 17-18 group were 1.5 times more likely to do so. Over past 12 months only between 6 to 12% of those having some form of mental disorder avail of any treatment facility with utilization pattern nearly equal between the any healthcare and any non healthcare facilities. In the any healthcare services, more of those with anxiety disorders seek help from general medical doctors while those with Major Depressive Disorder and any Mood disorders are comparatively treated more by non allopathic services. Females were 13.5 times more likely to avail treatment(chi sq 7.1) as also those cases with increased severity of illness were 7 times more likely(chi sq 9.6). In the any treatment category for any 12 month disorder in general, the younger cohort of 14-16 years is 2.2 times more likely to receive any treatment over past 12 months (p = 0.042) while the situation shows marked reversal in the 17-18 age groups. Having any mood disorder is a significant predictor for the same (p = 0.040).</p> <p>Discussion</p> <p>Present findings confer with other studies from elsewhere suggesting under utilization of health care services for those with mental illness. Since cultural teaching and traditional coping with mental illness are contributing significantly in furnishing mental health need for many in Oman, the findings are discussed within social-cultural context that forms the basis of the complex health care utilization in Oman. This could foster policies that help bridge the gap between allopathic and non-allopathic care services.</p

Comparative study of phytochemical screening, antioxidant and antimicrobial capacities of fresh and dry leaves crude plant extracts of Datura metel L

The aim of this work is to investigate and compare the phytochemical screening, antioxidant and antimicrobial activities of different crude extracts from dry and fresh leaves of Datura metel L. Different organic solvents including methanol, chloroform, hexane, ethyl acetate and butanol were used to prepare the crude extracts from the fresh and dry leaves. Antioxidant and antimicrobial activities of different crude extracts from dry and fresh leaves of D. metel were determined by DPPH method and agar disc diffusion method with minor modification. In vitro phytochemical screening for all crude extracts from both dry and fresh leaves was tested and shown positive result for alkaloid, flavonoid, saponin and tannin compounds. However, all the crude extracts did not show positive results for steroids and triterpenoid compounds. The antioxidant activity results of both fresh and dry crude extracts showed that when gradually increasing the samples concentration there was an increase in the absorbance. Therefore the antioxidant activity of dry crude extracts as equivalent to DPPH (2, 2-diphenyl-1-picrylhydrazyl) was in the order of butanol > chloroform > ethyl acetate extract > methanol > hexane extract. However, the order of antioxidant activity for fresh organic crude extracts to DPPH was in order of methanol > hexane > chloroform > ethyl acetate extract > butanol. The methanol crude extract and its derived fractions from dry and fresh leaves showed small and moderate antibacterial potential with one gram positive (Staphylococcus aureus) and three gram negative(Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa) bacteria in the range of 0–17%. In conclusion, all organic crude extracts from both fresh and dry leaves could be used as potential sources of new antioxidant and antimicrobial agents

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population