Objectives: To present the magnitude and determinants of awareness about refractive surgery among the adult Saudi population and recommend improving their knowledge. Methods: This used a web-based cross-sectional survey of the adult Saudi population held in 2020–2021. Eleven close-ended questions related to indication, contraindication, preparation, and surgery procedures were asked. The awareness score was grouped as 6 or more for good and 5 or less for poor. Demographic and ocular parameters were associated with the outcomes. Results: Among the 6,746 participants, 6,580 (97.5%) completed the survey. The participation of younger women and older man was more than their proportions in the population, and older women participated less than their proportion in the population. Good awareness about refractive surgery was noted in 1,165 (17.7%; 95% confidence interval 16.2; 18.0) adult Saudi participants. Women (P<0.001), 15–29 ages group (P<0.001), residents in the central region (P <0.001), health professionals (P <0.001), health sector students (P = 0.0004), people with myopia (P <0.001), and history of refractive surgery (P <0.001) were associated with good awareness. Women (Adjusted Odd’s Ratio = 1.5, P <0.001), health sector students (Adj OR 1.57, P <0.001), and residents in the central region (Adj OR = 1.27, P <0.001) were independent predictors of awareness. Information about contraindications for surgery was good in more than one-third of participants. Of the 535 participants who underwent operation in the past, 452 (84.5%) were satisfied with the refractive surgery. Conclusions: Awareness of refractive surgeries was low in the adult Saudi population. Targeted counseling is recommended to improve the knowledge and acceptance of refractive surgery.
KEYWORDS: Refractive surgeries, Awareness, web-based survey, LASIK, Refractive errors
目的:介绍沙特成人屈光手术认知的大小和决定因素，并建议提高他们的知识。方法:该研究采用了2020-2021年对沙特成年人口进行的基于网络的横断面调查。涉及适应症、禁忌症、术前准备和手术程序等11个封闭式问题。意识得分分为6分或以上为好，5分或以下为差。人口学和眼部参数与结果相关。结果:6746名参与者中，6580人(97.5%)完成了调查。年轻妇女和老年男子的参与率高于其在人口中的比例，老年妇女的参与率低于其在人口中的比例。1165例(17.7%;95%置信区间16.2;18.0)沙特成年参与者。女性(P<0.001)、15-29岁年龄组(P<0.001)、中部地区居民(P<0.001)、卫生专业人员(P<0.001)、卫生部门学生(P = 0.0004)、近视患者(P<0.001)和屈光手术史(P<0.001)与良好的认知相关。女性(调整奇数比= 1.5,P <0.001)、卫生部门学生(Adj OR = 1.57, P <0.001)和中部地区居民(Adj OR = 1.27, P <0.001)是意识的独立预测因子。超过三分之一的参与者关于手术禁忌症的信息是好的。在535名过去接受过手术的参与者中，452名(84.5%)对屈光手术感到满意。结论:沙特成年人对屈光手术的认知度较低。建议进行有针对性的咨询，以提高对屈光手术的认识和接受程度。
关键词:屈光手术，意识，网络调查，LASIK，屈光不正
{"title":"Magnitude and Determinants of Awareness and Practice Regarding Refractive Surgeries Including Laser Procedures among Saudi Adults","authors":"Reem AlHuthail, Dalal AlEssa, Amani Abualnaja, Shuruq AlKhalaf, Nadeef AlQahtani, Yara AlDosari, Jood AlNojaidi, Dalal AlDosari, Shahad AlRuwaili","doi":"10.18295/squmj.10.2023.060","DOIUrl":"https://doi.org/10.18295/squmj.10.2023.060","url":null,"abstract":"Objectives: To present the magnitude and determinants of awareness about refractive surgery among the adult Saudi population and recommend improving their knowledge. Methods: This used a web-based cross-sectional survey of the adult Saudi population held in 2020–2021. Eleven close-ended questions related to indication, contraindication, preparation, and surgery procedures were asked. The awareness score was grouped as 6 or more for good and 5 or less for poor. Demographic and ocular parameters were associated with the outcomes. Results: Among the 6,746 participants, 6,580 (97.5%) completed the survey. The participation of younger women and older man was more than their proportions in the population, and older women participated less than their proportion in the population. Good awareness about refractive surgery was noted in 1,165 (17.7%; 95% confidence interval 16.2; 18.0) adult Saudi participants. Women (P<0.001), 15–29 ages group (P<0.001), residents in the central region (P <0.001), health professionals (P <0.001), health sector students (P = 0.0004), people with myopia (P <0.001), and history of refractive surgery (P <0.001) were associated with good awareness. Women (Adjusted Odd’s Ratio = 1.5, P <0.001), health sector students (Adj OR 1.57, P <0.001), and residents in the central region (Adj OR = 1.27, P <0.001) were independent predictors of awareness. Information about contraindications for surgery was good in more than one-third of participants. Of the 535 participants who underwent operation in the past, 452 (84.5%) were satisfied with the refractive surgery. Conclusions: Awareness of refractive surgeries was low in the adult Saudi population. Targeted counseling is recommended to improve the knowledge and acceptance of refractive surgery.
 KEYWORDS: Refractive surgeries, Awareness, web-based survey, LASIK, Refractive errors","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.18295/squmj.10.2023.061
Blnd Ibrahim Mohammed, Bushra K Amin
Objectives: Inflammatory bowel disease, generally comprising Crohn's disease (CD) and ulcerative colitis (UC), has become a significant global public health concern in the last decade. The present study aimed to determine the alterations of the whole genomic expression profile among patients with inflammatory bowel disease. This study was conducted to provide the expression profile of IBD patients for the first time in this geographic location, as there are very few articles in the literature addressing this specific aspect. Methods: A study conducted in Erbil province, Kurdistan region of Iraq, from July 2021 to July 2022 compared the genome expression profiles of 10 patients with inflammatory bowel diseases to their matched controls. The sequences used in the design of this array were selected from GenBank®, dbEST, and RefSeq, Whole blood RNA extracted and hybridization on GeneChip® human genome U133A 2.0. The Scanner 3000 was used for the scanning high-resolution image and operating software (GCOS) was used for reading the results. Results: Shared upregulated genes between ulcerative colitis (UC) and Crohn's disease (CD) were (RIT2, BCL2L1, MDM2, and FKBP8) while shared downregulated genes were (NFKBIB, DDX24, and RASA3). Conclusions: Upregulated and downregulated gene expression patterns are detected in individuals with inflammatory bowel disease, offering diagnostic potential and opportunities for treatment by targeting the associated pathways. Keywords: Crohn’s disease, Expression, Erbil, Gene, Ulcerative colitis.
{"title":"Differential Gene Expression Profiles in Inflammatory Bowel Disease Patients from Kurdistan, Iraq","authors":"Blnd Ibrahim Mohammed, Bushra K Amin","doi":"10.18295/squmj.10.2023.061","DOIUrl":"https://doi.org/10.18295/squmj.10.2023.061","url":null,"abstract":"Objectives: Inflammatory bowel disease, generally comprising Crohn's disease (CD) and ulcerative colitis (UC), has become a significant global public health concern in the last decade. The present study aimed to determine the alterations of the whole genomic expression profile among patients with inflammatory bowel disease. This study was conducted to provide the expression profile of IBD patients for the first time in this geographic location, as there are very few articles in the literature addressing this specific aspect. Methods: A study conducted in Erbil province, Kurdistan region of Iraq, from July 2021 to July 2022 compared the genome expression profiles of 10 patients with inflammatory bowel diseases to their matched controls. The sequences used in the design of this array were selected from GenBank®, dbEST, and RefSeq, Whole blood RNA extracted and hybridization on GeneChip® human genome U133A 2.0. The Scanner 3000 was used for the scanning high-resolution image and operating software (GCOS) was used for reading the results. Results: Shared upregulated genes between ulcerative colitis (UC) and Crohn's disease (CD) were (RIT2, BCL2L1, MDM2, and FKBP8) while shared downregulated genes were (NFKBIB, DDX24, and RASA3). Conclusions: Upregulated and downregulated gene expression patterns are detected in individuals with inflammatory bowel disease, offering diagnostic potential and opportunities for treatment by targeting the associated pathways. \u0000Keywords: Crohn’s disease, Expression, Erbil, Gene, Ulcerative colitis.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.18295/squmj.10.2023.062
Deepak Pandiar, Suvarna K Nair, Ronell Bologna-Molina, Reshma P Krishnan, Naina Sivakumar, Rahul Anand, Sahil Chaudhari, Pooja Sharma
Objectives: Recent studies showed that as the stage advances there is no significant change in the vascularity as opposed to the conventional concept, thus, the present was designed to quantify the vascularity in histological grades of OSMF and to assess if there is any connection between vasculogenesis and malignisation. Methods: A comprehensive database search was done for published articles on vascularity in oral submucous fibrosis following PRISMA guidelines without date constrains; the search was done till December 2022. The review was registered in Prospero. After screening 607 articles, a total of 13 studies were finally included for systematic evaluation. Results: A total of 607 cases were included, with a definite predilection for the male gender. 11/13 studies evaluated mean vascular density; in more than half, the vascularity decreased as the stage advanced. Similar results were obtained for endothelial cells /square μm, mean vascular area percentage & mean vascular area. Conclusion: The present review supports the prevailing concept that vascularity decreases with advancement of the stage of OSMF, denying systemic absorption of carcinogens into the circulation with resultant longer exposure of compromised epithelium and malignisation.
Keywords: Malignisation; Mean Vascular Density; Oral Submucous Fibrosis; OSMF; Vascularity.
{"title":"Correlation between Vascularity and Advancing Histological Grades of Oral Submucous Fibrosis with a Plausible Role in Malignisation","authors":"Deepak Pandiar, Suvarna K Nair, Ronell Bologna-Molina, Reshma P Krishnan, Naina Sivakumar, Rahul Anand, Sahil Chaudhari, Pooja Sharma","doi":"10.18295/squmj.10.2023.062","DOIUrl":"https://doi.org/10.18295/squmj.10.2023.062","url":null,"abstract":"Objectives: Recent studies showed that as the stage advances there is no significant change in the vascularity as opposed to the conventional concept, thus, the present was designed to quantify the vascularity in histological grades of OSMF and to assess if there is any connection between vasculogenesis and malignisation. Methods: A comprehensive database search was done for published articles on vascularity in oral submucous fibrosis following PRISMA guidelines without date constrains; the search was done till December 2022. The review was registered in Prospero. After screening 607 articles, a total of 13 studies were finally included for systematic evaluation. Results: A total of 607 cases were included, with a definite predilection for the male gender. 11/13 studies evaluated mean vascular density; in more than half, the vascularity decreased as the stage advanced. Similar results were obtained for endothelial cells /square μm, mean vascular area percentage & mean vascular area. Conclusion: The present review supports the prevailing concept that vascularity decreases with advancement of the stage of OSMF, denying systemic absorption of carcinogens into the circulation with resultant longer exposure of compromised epithelium and malignisation.
 Keywords: Malignisation; Mean Vascular Density; Oral Submucous Fibrosis; OSMF; Vascularity.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135732548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.18295/squmj.10.2023.064
Woi H Boo, Muhamad R Zakaria, Hidayatul F Sulaiman, Hasmaizal Hassim
Mushroom poisoning is an important yet underreported public health issue. We present a case report of acute Chlorophyllum palaeotropicum mushroom poisoning in a family of five, involving both adult and paediatric subjects. They exhibited mainly gastrointestinal symptoms with varying severity. Two of the patients sustained acute renal injury from profuse vomiting and diarrhoea whilst the rest had mild dehydration and required outpatient treatment alone. There was no fatality with all of the patients recovered without any complications after receiving timely supportive treatment. This report highlights the challenges in managing mushroom poisoning in a low-resource setting where mycological and toxin identification facilities are not readily available.
Keywords: chlorophyllum; palaeotropicum; mushroom; poisoning; Malaysia
{"title":"A Case Report of Chlorophyllum palaeotropicum Mushroom Poisoning","authors":"Woi H Boo, Muhamad R Zakaria, Hidayatul F Sulaiman, Hasmaizal Hassim","doi":"10.18295/squmj.10.2023.064","DOIUrl":"https://doi.org/10.18295/squmj.10.2023.064","url":null,"abstract":"Mushroom poisoning is an important yet underreported public health issue. We present a case report of acute Chlorophyllum palaeotropicum mushroom poisoning in a family of five, involving both adult and paediatric subjects. They exhibited mainly gastrointestinal symptoms with varying severity. Two of the patients sustained acute renal injury from profuse vomiting and diarrhoea whilst the rest had mild dehydration and required outpatient treatment alone. There was no fatality with all of the patients recovered without any complications after receiving timely supportive treatment. This report highlights the challenges in managing mushroom poisoning in a low-resource setting where mycological and toxin identification facilities are not readily available.
 Keywords: chlorophyllum; palaeotropicum; mushroom; poisoning; Malaysia","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135732844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.18295/squmj.9.2023.057
Aref Zribi, Khulood Al Riyami, Hajar S Al Zahibi, Ikram A Burney
Endometrial cancer (EC) is the most common gynecological cancer. The combination of lenvatinib plus pembrolizumab has exhibited efficacy as the second line treatment for advanced EC, with a significant benefit in terms of progression free survival (PFS) and overall survival (OS), but the adverse effects (AE) profile is complex. AEs associated with the treatment may represent a limitation to this combination. Here, we report the case of a 38-year-old lady diagnosed with stage IV EC elsewhere, whose disease progressed after the first line of treatment, and was referred to our center in 2021. We treated her with the combination of lenvatinib and pembrolizumab. During the course of the treatment. she developed hand- foot syndrome (HFS) grade III, and hypothyroidism grade II. The AEs were managed with supportive medications, dose interruptions, dose reductions, and multidisciplinary care, which allowed us to continue the treatment. The patient achieved a good partial response, and an ongoing PFS of more than 12 months.
Keywords: cancer, endometrial, lenvatinib, pembrolizumab, adverse drug events, hand foot syndrome, hypothyroidism, Oman.
{"title":"Managing the Adverse Events Associated with the Combination Pembrolizumab and Lenvatinib Therapy in Endometrial Cancer","authors":"Aref Zribi, Khulood Al Riyami, Hajar S Al Zahibi, Ikram A Burney","doi":"10.18295/squmj.9.2023.057","DOIUrl":"https://doi.org/10.18295/squmj.9.2023.057","url":null,"abstract":"Endometrial cancer (EC) is the most common gynecological cancer. The combination of lenvatinib plus pembrolizumab has exhibited efficacy as the second line treatment for advanced EC, with a significant benefit in terms of progression free survival (PFS) and overall survival (OS), but the adverse effects (AE) profile is complex. AEs associated with the treatment may represent a limitation to this combination. Here, we report the case of a 38-year-old lady diagnosed with stage IV EC elsewhere, whose disease progressed after the first line of treatment, and was referred to our center in 2021. We treated her with the combination of lenvatinib and pembrolizumab. During the course of the treatment. she developed hand- foot syndrome (HFS) grade III, and hypothyroidism grade II. The AEs were managed with supportive medications, dose interruptions, dose reductions, and multidisciplinary care, which allowed us to continue the treatment. The patient achieved a good partial response, and an ongoing PFS of more than 12 months.
 Keywords: cancer, endometrial, lenvatinib, pembrolizumab, adverse drug events, hand foot syndrome, hypothyroidism, Oman.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.18295/squmj.9.2023.054
Ioannis E Kougioumtzis, George D Chloros, Peyman Bakhshayesh
The combination of plate and intramedullary nailing has been established as the treatment of proximal tibial fractures. Nevertheless, at the distal end of the tibia, the application of the plate-assisted intramedullary nailing is rarely applied as a therapeutic technique. The authors provide a technical note on the use of the reduction plating technique for nail insertion as the management of distal tibia fractures.
Keywords: Distal tibia fracture; open reduction internal fixation; percutaneous plating; plate-assisted reduction; intramedullary nail; nail plate combination.
{"title":"Plate-Assisted Intramedullary Nailing of Distal Tibia Fractures","authors":"Ioannis E Kougioumtzis, George D Chloros, Peyman Bakhshayesh","doi":"10.18295/squmj.9.2023.054","DOIUrl":"https://doi.org/10.18295/squmj.9.2023.054","url":null,"abstract":"The combination of plate and intramedullary nailing has been established as the treatment of proximal tibial fractures. Nevertheless, at the distal end of the tibia, the application of the plate-assisted intramedullary nailing is rarely applied as a therapeutic technique. The authors provide a technical note on the use of the reduction plating technique for nail insertion as the management of distal tibia fractures.
 Keywords: Distal tibia fracture; open reduction internal fixation; percutaneous plating; plate-assisted reduction; intramedullary nail; nail plate combination.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.18295/squmj.9.2023.052
Mahmood Alawainati, Fatima Habib, Eman Ateya, Eman Dakheel, Muneera Al-Buainain
Objectives: This study aims to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain. Methods: A cross-sectional study was conducted in the period between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as a patient aged 60 years or above. In addition, polypharmacy was defined as the concomitant use of 5 medications or more and excessive polypharmacy was defined as the concomitant use of 10 medications or more. Results: A total of 977 patients were included, more than half of them were females (n=533, 54.44%) and the mean age of the participants was 67.90 ±6.87 years. Essential hypertension, hyperlipidemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Of the cohort, 443 were on 5 or more medications i.e., polypharmacy (45.34%), and around 7% were on at least 10 medications (n=66, 6.76%). A multivariate analysis revealed that patients with diabetes (OR=5.836, CI 4.061-8.385, P<0.001), hypertension (OR=6.231, CI= 4.235-9.168, P<0.001), hyperlipidemia (OR 3.999, 95% CI 2.756-5.802, P<0.001), cardiovascular diseases (OR 3.589, 95 CI 1.787-7.205, P<0.001) and asthma (OR 3.148, 95% CI 1.646-6.019, P<0.001) were significantly more likely to suffer from polypharmacy. Conclusion: Polypharmacy was prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering elderly healthcare services, especially in patients with non-communicable diseases.
Keywords: Aged, Bahrain, Elderly, Polymorbidity, Polypharmacy.
目的:本研究旨在确定巴林老年患者多药的患病率、特点和决定因素。方法:在2022年3月至4月期间，在巴林所有初级卫生保健中心进行了横断面研究。得到一个简单的随机样本。老年患者定义为60岁或以上的患者。此外，多重用药定义为同时使用5种及以上药物，过度多重用药定义为同时使用10种及以上药物。结果:共纳入977例患者，其中女性占一半以上(n=533, 54.44%)，平均年龄67.90±6.87岁。原发性高血压、高脂血症和糖尿病是最常见的合并症(分别为61.51%、57.63%和53.22%)。在队列中，443名患者使用5种及以上药物，即多种药物(45.34%)，约7%的患者至少使用10种药物(n=66, 6.76%)。多因素分析显示，糖尿病(OR=5.836, CI 4.061-8.385, P<0.001)、高血压(OR=6.231, CI= 4.235-9.168, P<0.001)、高脂血症(OR 3.999, 95% CI 2.756-5.802, P<0.001)、心血管疾病(OR 3.589, 95 CI 1.787-7.205, P<0.001)和哮喘(OR 3.148, 95% CI 1.646-6.019, P<0.001)患者更容易出现多药。结论:巴林老年患者中，尤其是非传染性疾病患者，普遍存在多种用药现象。在提供老年人保健服务时应考虑综合用药，特别是对患有非传染性疾病的患者。关键词:老年;巴林;老年;
{"title":"Prevalence, Characteristics and Determinants of Polypharmacy Among Elderly Patients Attending Primary Health Care Centers in Bahrain","authors":"Mahmood Alawainati, Fatima Habib, Eman Ateya, Eman Dakheel, Muneera Al-Buainain","doi":"10.18295/squmj.9.2023.052","DOIUrl":"https://doi.org/10.18295/squmj.9.2023.052","url":null,"abstract":"Objectives: This study aims to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain. Methods: A cross-sectional study was conducted in the period between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as a patient aged 60 years or above. In addition, polypharmacy was defined as the concomitant use of 5 medications or more and excessive polypharmacy was defined as the concomitant use of 10 medications or more. Results: A total of 977 patients were included, more than half of them were females (n=533, 54.44%) and the mean age of the participants was 67.90 ±6.87 years. Essential hypertension, hyperlipidemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Of the cohort, 443 were on 5 or more medications i.e., polypharmacy (45.34%), and around 7% were on at least 10 medications (n=66, 6.76%). A multivariate analysis revealed that patients with diabetes (OR=5.836, CI 4.061-8.385, P<0.001), hypertension (OR=6.231, CI= 4.235-9.168, P<0.001), hyperlipidemia (OR 3.999, 95% CI 2.756-5.802, P<0.001), cardiovascular diseases (OR 3.589, 95 CI 1.787-7.205, P<0.001) and asthma (OR 3.148, 95% CI 1.646-6.019, P<0.001) were significantly more likely to suffer from polypharmacy. Conclusion: Polypharmacy was prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering elderly healthcare services, especially in patients with non-communicable diseases.
 Keywords: Aged, Bahrain, Elderly, Polymorbidity, Polypharmacy.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.18295/squmj.9.2023.053
Zalkha Al Kharusi, Rahma Al Kalbani, Rahma Al-Hadhrami
Objectives: Annual influenza vaccinations are recommended for patients with asthma to prevent against seasonal influenza and influenza-triggered asthma exacerbations. However, there is conflicting data as to the benefit of the influenza vaccine on the frequency of asthma exacerbations. Therefore, this study aimed to assess the effectiveness of the influenza vaccine in terms of reducing the frequency of asthma-related exacerbations and upper respiratory tract infections among adult patients with asthma. Methods: This retrospective cohort study was performed from January to December 2018 in Muscat Governorate, Oman. A total of 466 patients attending nine randomly selected primary health centres in Muscat Governorate were enrolled in the study and followed-up for one year post-vaccination. Results: Most patients were female (70.6%) and had moderate-persistent asthma (42.9%). Overall, there were 203 patients (43.6%) in the vaccinated group and 263 (56.4%) in the non-vaccinated group. A proportion of patients in each group had allergic rhinitis (28.6% and 25.5%, respectively). The frequency of upper respiratory tract infections over the one-year follow-up period was significant lower in the vaccinated group compared to the non-vaccinated group (37.9% versus 73%; relative risk [RR]: 2.299, 95% confidence interval [CI]: 1.834–2.882; P <0.001); however, there was no significant difference in terms of the frequency of asthma exacerbations (41.9% versus 45.2%; RR: 0.925, 95% CI: 0.750–1.141; P >0.050). Conclusion: The influenza vaccine significantly reduces the frequency of upper respiratory tract infections over the following year. However, it did not significantly reduce the frequency of asthma exacerbations among adult Omanis with asthma. Further studies are recommended to support the protective effect of the vaccine in this regard.
Keywords: Influenza Vaccines; Immunization; Asthma; Upper Respiratory Tract Infections; Observational Study; Oman.
{"title":"Frequency of Asthma Exacerbations and Upper Respiratory Tract Infections Among Adult with Asthma According to Vaccination Status","authors":"Zalkha Al Kharusi, Rahma Al Kalbani, Rahma Al-Hadhrami","doi":"10.18295/squmj.9.2023.053","DOIUrl":"https://doi.org/10.18295/squmj.9.2023.053","url":null,"abstract":"Objectives: Annual influenza vaccinations are recommended for patients with asthma to prevent against seasonal influenza and influenza-triggered asthma exacerbations. However, there is conflicting data as to the benefit of the influenza vaccine on the frequency of asthma exacerbations. Therefore, this study aimed to assess the effectiveness of the influenza vaccine in terms of reducing the frequency of asthma-related exacerbations and upper respiratory tract infections among adult patients with asthma. Methods: This retrospective cohort study was performed from January to December 2018 in Muscat Governorate, Oman. A total of 466 patients attending nine randomly selected primary health centres in Muscat Governorate were enrolled in the study and followed-up for one year post-vaccination. Results: Most patients were female (70.6%) and had moderate-persistent asthma (42.9%). Overall, there were 203 patients (43.6%) in the vaccinated group and 263 (56.4%) in the non-vaccinated group. A proportion of patients in each group had allergic rhinitis (28.6% and 25.5%, respectively). The frequency of upper respiratory tract infections over the one-year follow-up period was significant lower in the vaccinated group compared to the non-vaccinated group (37.9% versus 73%; relative risk [RR]: 2.299, 95% confidence interval [CI]: 1.834–2.882; P <0.001); however, there was no significant difference in terms of the frequency of asthma exacerbations (41.9% versus 45.2%; RR: 0.925, 95% CI: 0.750–1.141; P >0.050). Conclusion: The influenza vaccine significantly reduces the frequency of upper respiratory tract infections over the following year. However, it did not significantly reduce the frequency of asthma exacerbations among adult Omanis with asthma. Further studies are recommended to support the protective effect of the vaccine in this regard.
 Keywords: Influenza Vaccines; Immunization; Asthma; Upper Respiratory Tract Infections; Observational Study; Oman.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136308430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.18295/squmj.9.2023.055
Dalal S Husain, Niranjan P Joshi, Khalfan S Al Senaidi, Hilal Al Riyami
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.
{"title":"Paediatric Restrictive Cardiomyopathy - Diagnosis and Challenges","authors":"Dalal S Husain, Niranjan P Joshi, Khalfan S Al Senaidi, Hilal Al Riyami","doi":"10.18295/squmj.9.2023.055","DOIUrl":"https://doi.org/10.18295/squmj.9.2023.055","url":null,"abstract":"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.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136308557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-20DOI: 10.18295/squmj.9.2023.049
Huda Anwar, Thuraiya Al Harthi, Najlaa Jaafar, Fathiya Al Shuraiqi, Nihal Afifi, Khadeeja Al Abri, Salha Al Rujaibi, Thamra Al Ghafri
Objectives: To evaluate the appropriateness of emergency referrals made by primary care clinicians and determine factors contributing to inappropriate referrals. Methods: A cross sectional study, based on referral notes review. Patients referred to Khawla Hospital emergency department by a primary care clinician in Muscat governorate were randomly selected. Referral notes were reviewed by five family physicians. Appropriateness of referrals were evaluated according to primary care referral protocol. Any referral document that deviated from the protocol was classified as inappropriate. The prevalence and characteristics of inappropriate referrals were identified. Factors contributing to inappropriate referral were determined using multivariable logistic regression. Results: A total of 591 referrals were reviewed. 354 (59.9%) were classified as inappropriate. The reason for inappropriate classification was due to inadequate medical notes 291 (82.2%), lack of provisional diagnosis 176 (49.7%), misdirected to a non-concerned emergency 30 (8.4%), misclassification of urgency in which 107 (30.2%) were urgent and 45 (12.7%) were routine. After adjusting for multiple variables, insufficient clinical notes, unavailability of referral guidelines, and lack of expertise were strong determinants of inappropriate referral with odds ratio 62.52 (95% CI: 32.04 - 121.96), 2.88 (95% CI: 1.40 – 5.92), and 9.37 (95% CI: 4.09 – 21.43), respectively. Conclusion: While most referrals made by primary care clinicians required emergency management, the majority were identified as inappropriate and that was mainly due to insufficient clinical documentation. Inadequate clinical notes, lack of national guidelines and expertise were found to be strong predictors for inappropriate emergency referrals.
Keywords: Referral and consultation, hospital referral; emergency; primary care; physicians; documentation; records; guidelines.
{"title":"Appropriateness of Emergency Referrals Made by Primary Care Clinicians","authors":"Huda Anwar, Thuraiya Al Harthi, Najlaa Jaafar, Fathiya Al Shuraiqi, Nihal Afifi, Khadeeja Al Abri, Salha Al Rujaibi, Thamra Al Ghafri","doi":"10.18295/squmj.9.2023.049","DOIUrl":"https://doi.org/10.18295/squmj.9.2023.049","url":null,"abstract":"Objectives: To evaluate the appropriateness of emergency referrals made by primary care clinicians and determine factors contributing to inappropriate referrals. Methods: A cross sectional study, based on referral notes review. Patients referred to Khawla Hospital emergency department by a primary care clinician in Muscat governorate were randomly selected. Referral notes were reviewed by five family physicians. Appropriateness of referrals were evaluated according to primary care referral protocol. Any referral document that deviated from the protocol was classified as inappropriate. The prevalence and characteristics of inappropriate referrals were identified. Factors contributing to inappropriate referral were determined using multivariable logistic regression. Results: A total of 591 referrals were reviewed. 354 (59.9%) were classified as inappropriate. The reason for inappropriate classification was due to inadequate medical notes 291 (82.2%), lack of provisional diagnosis 176 (49.7%), misdirected to a non-concerned emergency 30 (8.4%), misclassification of urgency in which 107 (30.2%) were urgent and 45 (12.7%) were routine. After adjusting for multiple variables, insufficient clinical notes, unavailability of referral guidelines, and lack of expertise were strong determinants of inappropriate referral with odds ratio 62.52 (95% CI: 32.04 - 121.96), 2.88 (95% CI: 1.40 – 5.92), and 9.37 (95% CI: 4.09 – 21.43), respectively. Conclusion: While most referrals made by primary care clinicians required emergency management, the majority were identified as inappropriate and that was mainly due to insufficient clinical documentation. Inadequate clinical notes, lack of national guidelines and expertise were found to be strong predictors for inappropriate emergency referrals.
 Keywords: Referral and consultation, hospital referral; emergency; primary care; physicians; documentation; records; guidelines.","PeriodicalId":22083,"journal":{"name":"Sultan Qaboos University Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136308047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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