Targeted study to evaluate the cardiovascular risk factor status among patients and efficacy of statins in attaining goal lipid levels in a regional hospital in Sultanate of Oman

Background and objective: Elevated LDL (Low Density Lipoprotein) cholesterol is a major cause of Coronary Heart Disease (CHD) and LDL lowering therapy reduces the risk for CHD. The study was conducted with the aim of assessing the prescribing pattern of statins based on cardiovascular risk factor category, pattern of lipid monitoring followed among the patients and extent of attainment of goal Low Density Lipoprotein (LDL-C) observed among the patients. Methods: A group of patient files (among those on statin agent during the year 2011) from the Department of Medicine in Nizwa Hospital were selected for targeted evaluation on the risk factor status of patients and efficacy of statins in attaining goal lipid levels. Goal LDL-C levels were estimated for each patient depending on their risk factor status. Subsequent follow ups of the patients were reviewed from the patient files and accordingly the attainment and maintenance of goal-LDL-C in the patients were evaluated. Results: A total of 183 patients were identified. Mean age of the evaluated patients was 63.6 ± 11.58 years. Evaluating the status of patients on the presence of risk factors, majority (63.9%) of them had presence of CHD. Simvastatin was the most commonly used agent and titration of dose was done in only 3.3% of patients. Mean LDL-C level of the patient before initiation of treatment was 3.74 ± 1.9 mmol/L. Only in 59 (32.2 %) of the total evaluated 183 patients, there was evidence of attaining goal-LDL-C levels. Among them, there was evidence of maintenance of goal LDL-C in 16 (27.1%) of the patients. Conclusion: Statins were used less frequently for primary prevention of CHD. Absence of lipid monitoring; base line and follow up in a good number of patients as well as lack of dose titration among the patients were observed. Importance of adequate lipid monitoring and follow up to ensure attainment of goal LDL-C needs to be stressed to serve the objective of use of statins; primary and secondary prevention of CHD.     

Consumption of fig fruits grown in Oman can improve memory,anxiety, and learning skills in a transgenic mice model of Alzheimer's disease

Alzheimer disease (AD) is one of the most common forms of dementia in the elderly. Several reports have suggested neurotoxic effects of amyloid beta protein (Aβ) and role of oxidative stress in AD. Figs are rich in fiber, copper, iron, manganese, magnesium, potassium, calcium, vitamin K, and are a good source of proanthocyanidins and quercetin which demonstrate potent antioxidant properties. We studied the effect of dietary supplementation with 4% figs grown in Oman on the memory, anxiety, and learning skills in APPsw/Tg2576 (Tg mice) mice model for AD. We assessed spatial memory and learning ability, psychomotor coordination, and anxiety-related behavior in Tg and wild-type mice at the age of 4 months and after 15 months using the Morris water maze test, rota-rod test, elevated plus maze test, and open-field test. Tg mice that were fed a control diet without figs showed significant memory deficits, increased anxiety-related behavior, and severe impairment in spatial, position discrimination learning ability, and motor coordination compared to the wild-type control mice on the same diet, and Tg mice fed on 4% fig diet supplementation for 15 months. Our results suggest that dietary supplementation of figs may be useful for the improvement of cognitive and behavioral deficits in AD.     

Relapsed Acute Leukemia in Children: Oman Experience

Acute leukemia (AL) is the most common malignancy in children in Oman. It accounts for over one-third of all childhood cancers, most of which (～75%) are acute lymphoblastic leukemia (ALL). Over a decade, a total of 128 cases of childhood acute leukemia have been diagnosed and managed at Paediatric Haematology/Oncology Unit, Sultan Qaboos University Hospital, which is the national referral center of pediatric leukemia cases. A retrospective review of case notes was used to study all children with a diagnosis of acute leukemia from January 1993 to January 2003. All the cases were diagnosed using a bone marrow aspirate with morphological and immunophenotypic classification. Over this period, 24 cases relapsed. They were classified as per BFM group as “very early,” “early,” and “late” according to the time from diagnosis to first relapse and were divided into isolated bone marrow (BM), extramedullary site, and combined relapse. Sixteen percent of ALL cases and 58.6% of acute myeloid leukemia (AML) cases so far relapsed. Most of the AML cases relapsed very early on in treatment. Eleven patients had combined relapse in BM and extramedullary site (9 in the central nervous system, 1 in the testicles, and 1 in the eye). The overall outcome of these patients is very poor, and only 6 patients out of 24 are still alive. In conclusion, the relapse rates of childhood AL are more or less similar to those of other reports but the overall outcome is very poor. A large majority of the patients in this study are either very early or early relapsers. Future studies including genetic and molecular analysis may be able to explain the difference in clinical outcome of these relapsed AL cases.     

The relationship of variations in children's growth rates to seasonal climatic variations

The growth rates in stature of 300 children in the Orkney Islands, measured at monthly intervals over 2 years, were negatively correlated with various measures of light and temperature. All correlations were small but statistically significant, the highest being with the mean of the maximal daily temperatures (?0·32) for the boys and with hours of bright sunshine (?0·29) for the girls.

The children's mean growth rates reached maxima at midwinter and minima at midsummer but the maximum in the winter 1971–72 was much lower than those at the beginning of 1971 and at the end of 1972. The climatic variables were not appreciably different in the two years.

Only about 35 per cent of children showed cycles of growth rates which could be regarded as seasonal in that they rose to peak values at approximately the same time in the two successive years.

The difference between the maximal and minimal rates exhibited by Orkney children (5·26±0·12 cm/yr for boys; 5·46±0·14 cm/yr for girls) was almost identical to that in London children. The synchronization of the maximal growth rates was no more precise in Orkney than in London.

It is concluded that seasonal variations in light and temperature exert at most only a small effect on growth rate and perhaps none at all. The influence of other factors, as yet unidentified, is greater.     

A cross sectional pilot study on assessing the knowledge,attitude and behavior of community pharmacists to adverse drug reaction related aspects in the Sultanate of Oman

Background and objectives

Adverse drug reaction (ADR) monitoring and reporting requires a multidisciplinary approach and pharmacists have a major role to play in it. The present pilot study was conducted to assess the knowledge, attitude and behavior of community pharmacists to ADR related aspects in the Sultanate of Oman.

Methods

A self-administered questionnaire comprising of 21 questions were distributed to a random sample of pharmacists in two Governorates in the Sultanate of Oman. It assessed the knowledge of pharmacists on some of the selected basic aspects of drug safety. Further, the knowledge and attitude of community pharmacists toward ADR reporting and their behavior on ADR related aspects were assessed. A scoring scheme was used to estimate the median total score of participants for various parameters. Obtained scores were correlated with the demographics of the respondents.

Results

A total of 107 community pharmacists participated in the survey giving a response rate of 72.3%. The responses of the pharmacists to the questions on the drug safety of individual drugs were incorrect for some important and practical questions. Consequently, total median score corresponding to these questions was 5 (Inter Quartile Range, IQR 2) out of a possible maximum score of 9, which was below the acceptable score. Total median score based on knowledge, attitude and behavior was 38 (IQR 8) out of a possible maximum of 50 which shows a moderate score. Lack of awareness on how to report an ADR and concern that the report may be wrong were the most common factors discouraging pharmacists from reporting ADRs. Qualification as well as years of experience were the only demographic parameters which had an influence on the score obtained by the pharmacists.

Conclusions

Even though the pharmacists had an acceptable knowledge, attitude and behavior on ADR reporting and related aspects, a good number of them had below than acceptable knowledge on drug safety related aspects of specific drugs. Educational programs have to be continued to generate awareness on how to report ADR and stimulate pharmacists’ more active participation in the pharmacovigilance program. There is a genuine need to have training programs to improve the knowledge of pharmacists on ADR related aspects which are of benefit on a daily basis which could greatly have an impact on patient safety.     

Occupational therapy in oman: the impact of cultural dissonance

Occupational therapy theory and philosophy are broadly considered to be based on Western cultural values. In contrast, the application of theory and practice in the Sultanate of Oman, historically based on traditional Middle Eastern and Islamic cultural values, provides a case exemplar, which highlights both paradigmatic differences and cultural dissonance. Drawing on the experiences of occupational therapists working in Oman, this study found that the application of therapeutic goals aimed at patient independence and autonomy were difficult to achieve in an environment where family duty and responsibility for care were highly prized. Dressing and cooking assessments were challenging, and issues related to gender proved problematic. Therapists found the need to adapt practice to acknowledge these differences, and to adopt pragmatic problem‐solving strategies, without resolving the underpinning philosophical contradictions. Occupational therapy in Oman is under‐researched; further work is needed to confirm the cross‐cultural validity of specific assessments and practice models. Copyright © 2012 John Wiley & Sons, Ltd.     

Haematological and clinical features of beta-thalassaemia associated with Hb Dhofar

Hb Dhofar is a variant haemoglobin (β^{29 (GGC–GGT) gly-gly}, β^{58 (CCT–CGT) pro-arg}) associated with a thalassaemic phenotype and unique to the Sultanate of Oman. We report clinical and haematological data on 54 subjects with Hb Dhofar (37 heterozygotes, 14 homozygotes and three compound heterozygotes with a different β-thalassaemia mutation). In heterozygotes, the level of Hb Dhofar ranged from 8.8% to 21.5%. All heterozygotes had Hb A₂ > 3.5%, consistent with β-thalassaemia trait. Hb Dhofar in homozygotes and compound heterozygotes ranged from 26% to 59.7%, with a peripheral film consistent with homozygous β-thalassaemia. Age at presentation in homozygotes ranged between 6 months and 8 yr, with a majority presenting before 5 yr of age. All had splenomegaly and six (43%) had undergone splenectomy. All had some degree of frontal bossing and in particular, two patients with infrequent transfusions had marked thalassaemic facies and stunting of growth. Hb Dhofar can be mistaken for Hb D as the electrophoretic mobility is similar, but differs from it by a variable and reduced quantity of variant Hb in both heterozygotes and homozygotes. Clinical and haematological data suggest that this mutation behaves like a moderately severe β⁺ thalassaemia allele resulting in a thalassaemia intermedia phenotype.     

Complete nucleotide sequence of watermelon chlorotic stunt virus originating from oman

Watermelon chlorotic stunt virus (WmCSV) is a bipartite begomovirus (genus Begomovirus, family Geminiviridae) that causes economic losses to cucurbits, particularly watermelon, across the Middle East and North Africa. Recently squash (Cucurbita moschata) grown in an experimental field in Oman was found to display symptoms such as leaf curling, yellowing and stunting, typical of a begomovirus infection. Sequence analysis of the virus isolated from squash showed 97.6-99.9% nucleotide sequence identity to previously described WmCSV isolates for the DNA A component and 93-98% identity for the DNA B component. Agrobacterium-mediated inoculation to Nicotiana benthamiana resulted in the development of symptoms fifteen days post inoculation. This is the first bipartite begomovirus identified in Oman. Overall the Oman isolate showed the highest levels of sequence identity to a WmCSV isolate originating from Iran, which was confirmed by phylogenetic analysis. This suggests that WmCSV present in Oman has been introduced from Iran. The significance of this finding is discussed.     

Genetic diversity and distribution of a distinct strain of Chili leaf curl virus and associated betasatellite infecting tomato and pepper in Oman

Tomato and pepper are widely grown in Oman for local consumption. A countrywide survey was conducted during 2010–2011 to collect samples and assess the diversity of begomoviruses associated with leaf curl disease of tomato and pepper. A virus previously only identified on the Indian subcontinent, chili leaf curl virus (ChLCV), was found associated with tomato and pepper diseases in all vegetable grown areas of Oman. Some of the infected plant samples were also found to contain a betasatellite. A total of 19 potentially full-length begomovirus and eight betasatellite clones were sequenced. The begomovirus clones showed >96% nucleotide sequence identity, showing them to represent a single species. Comparisons to sequences available in the databases showed the highest levels of nucleotide sequence identity (88.0–91.1%) to isolates of the “Pakistan” strain of ChLCV (ChLCV-PK), indicating the virus from Oman to be a distinct strain, for which the name Oman strain (ChLCV-OM) is proposed. An analysis for recombination showed ChLCV-OM likely to have originated by recombination between ChLCV-PK (the major parent), pepper leaf curl Lahore virus and a third strain of ChLCV. The betasatellite sequences obtained were shown to have high levels of identity to isolates of tomato leaf curl betasatellite (ToLCB) previous shown to be present in Oman. For the disease in tomato Koch's postulates were satisfied by Agrobacterium-mediated inoculation of virus and betasatellites clones. This showed the symptoms induced by the virus in the presence of the betasatellite to be enhanced, although viral DNA levels were not affected. ChLCV-OM is the fourth begomovirus identified in tomato in Oman and the first in Capsicum. The significance of these findings is discussed.