Diabesity (diabetes associated with obesity) is a major global and local public health concern, which has almost reached an epidemic order of magnitude in the countries of the Arabian Gulf and worldwide. We sought to review the lifestyle trends in this region and to highlight the challenges and opportunities that health care professionals face and attempt to address and correct them. In this regard, we aimed to review the regional data and widely held expert opinions in the Arabian Gulf and provide a thematic review of the size of the problem of diabesity and its risk factors, challenges, and opportunities. We also wished to delineate the barriers to health promotion, disease prevention, and identify social customs contributing to these challenges. Lastly, we wished to address specific problems with particular relevance to the region such as minimal exercise and unhealthy nutrition, concerns during pregnancy, the subject of childhood obesity, the impact of Ramadan fasting, and the expanding role of bariatric surgery. Finally, general recommendations for prevention, evidence-based, and culturally competent management strategies are presented to be considered at the levels of the individual, community, and policymakers.

Objectives: Influenza is a vaccine-preventable acute respiratory viral infection that causes epidemics annually around the globe. A regional influenza stakeholder network (MENA-ISN) comprised of experts assessed the status of influenza prevention and control using a structured survey. Methods: A survey questionnaire was used to obtain information from each participating country on surveillance system, the burden of disease, influenza vaccination programs, recommendations, funding and access for vaccine and vaccination, target rate, coverage rate monitoring, and drivers and barriers to influenza vaccination. Results: Out of the 10 countries that participated, nine had an influenza surveillance system and vaccination policy, and seven had World Health Organization (WHO) accredited reference laboratory. Three countries had burden of disease data available and eight had a reimbursement vaccine policy. Influenza vaccine was available in five countries through the Ministry of Health whereas in others, pharmacies also dispensed for the private sector. In all countries, prescribers were physicians, and vaccinators, which could be physicians, nurses, and pharmacists. Eight countries had a set vaccination target rate and only three monitored the influenza coverage rates. Drivers and barriers of vaccination were similar in all countries. Conclusions: Despite existing policies, influenza vaccination coverage remains far below the WHO recommendations. Increased awareness and effective implementation of policies with collaboration of stakeholders can help increase the rates to reach WHO targets.

Objectives: In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates. Methods: We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization (WHO) staging, laboratory analyses, and treatment outcomes. Results: The overall mean age of the cohort was 36.0±15.0 years, and 60.4% (n = 197) were males. The majority of patients acquired HIV through heterosexual transmission (58.9%; n = 192). At the time of the first clinic visit, 26.1% (n = 85) of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was < 200 cells/mm3 in 38.0% (n = 124) of patients, 201–500 cells/mm3 in 30.1% (n = 99) of patients, and > 500 cells/mm3 in 27.0% (n = 88) of patients. The baseline HIV RNA titer was greater than 1000 copies/mL3 in 74.5% (n = 243) of the cohort. A total of 96.3% (n = 314) of patients received antiretroviral therapy, most commonly non-nucleoside reverse transcriptase inhibitor-based regimens. HIV genotype resistance testing was performed in 165 patients (50.6%) either at baseline in treatment naïve patients or following treatment failure. Among the 326 patients included, 22 patients (6.7%) died, and 29 patients (8.9%) were lost to follow-up. Conclusions: Regarding the UNAIDs 90-90-90 target, over a quarter of the patients presented late with WHO stage 4 HIV disease, 96.3% of cohort patients received antiretroviral treatment, and 71.5% achieved virological suppression.

Objectives: Our study aimed to report the epidemiology, clinical presentations, diagnostic and therapeutic approaches, and outcomes of Crohn’s disease (CD) in pediatric patients in Bahrain. Methods: We conducted a retrospective review of the medical records of patients with CD diagnosed in the pediatric department, Salmaniya Medical Complex, Bahrain, between 1984 and 2017. We used the data to calculate the annual incidence and cumulative prevalence. Data about gender, nationality, clinical presentation, age at presentation and diagnosis, duration of illness, consanguinity, family history, contact with smokers, and comorbidities were gathered. Results of hematological, biochemical, and serological tests were also collected. All radiological, endoscopic, and histopathological findings were reviewed. Data about medical therapy, relapse episodes, hospital admissions, complications, and outcomes were collected. Results: Of 108 pediatric patients diagnosed with inflammatory bowel disease (IBD), 51 (47.2%) patients had CD. The annual incidence was 1 in 100 000 per year (range = 0–5 patients/year) with significant rise on comparing the three decades (p = 0.0001). Prevalence was 9.32 patients per 100 000 pediatric populations. Thirty-four patients (66.7%) were males, and the median age was 18.5 years (range = 6.4–35.0). Common clinical presentations were recurrent abdominal pain and weight loss. Family history of IBD was found in 10 patients. One patient had positive antineutrophil cytoplasmic antibody. The terminal ileum was involved in 68.1%, colon in 63.8%, and perianal area in 17.0% patients. Biological therapy was used in five patients. Surgical intervention was required in six patients. The mean follow-up period was 9.2±5.6 years. Conclusions: The clinical characteristics of our population are comparable to that reported in neighboring countries and worldwide.

Objectives: ATP-binding cassette transporter A1 (ABCA1) plays a pivotal role in reverse cholesterol transport from peripheral tissues back to the liver. Abnormalities in ABCA1 function may lead to dyslipidemia and coronary artery disease (CAD). We investigated the role of C-565T (rs2422493) promoter polymorphism of ABCA1 gene in the development and severity of CAD in an Iranian subpopulation. Methods: Our study population consisted of 110 angiographically-confirmed CAD patients and 110 matched controls. The severity of CAD was expressed based on the number of stenotic vessels. Genotyping of C-565T promoter polymorphism was performed using the polymerase chain reaction followed by restriction fragments length polymorphism analysis methods. Lipid profile was determined by routine colorimetric methods. Results: The distribution of ABCA1 C-565T genotypes (p = 0.035) and alleles (p = 0.017) was significantly different between the CAD and control groups. In univariate analysis (with genotype CC as reference), the TT genotype was significantly associated with an increased risk of CAD (odds ratio = 3.83; 95% confidence interval: 1.29–11.30, p = 0.014), but the CT genotype was not (p = 0.321). A multiple binary logistic regression analysis revealed that smoking, hypertension, triglyceride, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and ABCA1 C-565T dominant genotype were significant and independent risk factors for CAD development (p < 0.050). The ABCA1 C-565T polymorphism affected the severity of CAD in TT homozygote state (p = 0.028). However, no significant correlation was seen between this common polymorphism and lipid profile in the study population (p > 0.050). Conclusions: Our study indicated that ABCA1 C-565T polymorphism is a significant risk factor for development and severity of CAD in our population.

Objectives: Many medical conditions and medicines with therapeutic importance have been shown to impair driving skills, causing road traffic accidents, which leads to great human and economic suffering in Oman. The primary purpose of this study was to assess retrospectively the extent of medical conditions and medications influencing road traffic safety among drivers involved in road accidents. Methods: We conducted a retrospective study among 951 injured or non-injured drivers who reported to Khoula and Nizwa hospitals. We used the Al-Shifa database to find the drivers and contacted randomly selected patients over phone. Results: The majority of victims were male (72.0%), involving personal cars, and reported at Khoula Hospital. The results show that 7.6% of the victimized drivers had a history of medical conditions with diabetes and hypertension (36.1% each) the most common. About 4.0% of victims were on medications of which insulin was the most common (9.4%). Loss of control was contributed to 38.5% of cases followed by dizziness (25.6%), sleep amnesia (10.3%), and blurred vision (7.7%). Other effects blamed by victimized drivers include vertigo, phonophobia, photophobia, back pain, loss of sensation, and headache accounting for 17.9% of cases. Conclusion: Medical conditions and medications influence road traffic safety to some extent in Oman.

Objectives: We conducted this study to assess the risk factors of gestational anemia and evaluate the effectiveness of a culturally-tailored nutrition educational intervention on hemoglobin (Hb) status among pregnant Omani women. Newborn birthweight was used as a birth outcome. Methods: The study was conducted in two phases. The first phase investigated the risk factors associated with gestational anemia in 206 Omani women who were ≥ 20 years old and had at least completed 12 weeks of gestation. A suitable sample was recruited at a tertiary teaching hospital in Muscat, Oman. Hb status was recorded, and backward linear regression was used to analyze the demographic and obstetric variables associated with Hb levels. In the second phase, a specially designed culturally-tailored nutrition educational intervention was delivered to women in the study group by trained research assistants whereas women in the control group received routine care only. The Hb levels of the pregnant women and birth weight of newborns after the intervention were evaluated in the second phase of the study. Results: The prevalence of gestational anemia among 206 pregnant Omani women was 41.7%. A significant negative relationship was found between Hb and parity whereas a positive relationship was found between Hb and gestational age. The Hb level increased as the gestational age advanced (β = 0.31, p < 0.050) and decreased as the parity increased (β = -0.22, p < 0.050). The pre-post mean difference of Hb levels in the study group was 11.0 g/dL and in the control group was 10.7 g/dL. The difference between the pre- and post-test Hb levels for the study group was significant (t = 3.58, p = 0.001), indicating that the culturally-tailored nutrition education intervention was effective in improving the Hb level in pregnant Omani women. No significant difference was found between the study and control group with respect to birth outcomes. Conclusion: The prevalence of gestational anemia is high in pregnant Omani women. The use of a specially designed culturally-tailored nutrition education intervention for pregnant women supplemented with follow-up reminders can reduce the occurrence of gestational anemia. Such programs are ultimately necessary in light of the high prevalence of gestational anemia in developing countries.

Objectives: Frequent attenders (FAs) in general practice receive significant attention in primary care research due to the financial costs associated with the higher utilization of health care services. The main objective of this study was to determine the prevalence of FAs in Oman by studying the overall rates of adult patient visits to primary health care centers (PHCs) and identify the characteristics of this group of patients. Methods: We conducted a retrospective longitudinal study including all adults aged 18 years and above who visited general practitioner clinics at four selected PHCs in the A'Dakhiliyah governorate of Oman. Sociodemographic data and number of visits were extracted from the electronic medical records system. Results: A total number of 12 902 adult patients contributed to 42 425 patient visits, with the number of visits made by individual patients ranging from 1 to 62. FAs constituted 2.4% (n = 313) of the total subjects and made 5449 (12.8%) visits. The mean rate of visits per patient per year was 3.2, while the median was two visits. The overall rate of visits per day was more than two-times higher in females (79.6 per day) compared to males (36.6 per day) and was about five-times higher in female FA (12.3 vs. 2.6). Conclusions: FAs represent a small proportion of patients attending PHCs in Oman. The proportion of females was higher among FAs and they also contributed to a higher number of visits to PHCs.

Objectives: Kaposi sarcoma (KS) shows greater geographic variation in incidence than almost any other vascular tumor globally. KS is common in parts of Sub-Saharan Africa accounting for 9% of all diagnosed cancer cases in men in the early 1990’s in Uganda and Zaire. KS is classified by the World Health Organization as a borderline vascular tumor. We aimed to determine the trends and histopathological patterns of KS as seen in the University of Benin Teaching Hospital in Benin City, Nigeria, and to compare with similar work in other centers. Methods: We conducted a retrospective analysis of all histologically confirmed KS seen over a 20-year period at the Pathology Department of the University of Benin Teaching Hospital. Results: A total of 269 histologically diagnosed vascular tumors were analyzed. Of these, borderline tumors constituted 30.9% (n = 83). KS constituted 79 (95.2%) out of the 83 borderline vascular tumors. Out of the 79 cases of KS, 76 (96.2%) cases were confirmed in HIV/AIDS patients on highly active antiretroviral therapy. The male to female ratio of KS was 1.1:1.0 while the mean age was 39.2±3.6 years. There was a sharp rise in the trend of KS from 2005 to a peak in 2008. The leg and foot region was the most common site of occurrence. There were two cases seen in the cervical lymph node in the pediatric age group. Conclusions: KS was the most common borderline vascular tumor with almost all cases confirmed as HIV/AIDS patients. The mean age of presentation was in the fourth decade of life with a sharp rise in its incidence from 2005 with a peak incidence in 2008. This was followed by a slight decline from 2009 to 2013. Mixed and nodular KS were the most frequently encountered types and patterns, respectively.

Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.

Primary central nervous system lymphoma is a well-known entity. However, the hypothalamus is a rare location, especially in adults. Few cases of secondary lymphomas have been reported. We report a case of primary hypothalamic lymphoma in an adult male with normal pituitary functions. Lymphoma should be considered as one of the differential diagnosis of lesions involving the hypothalamic/third ventricular area.

Tubercular splenic abscess is extremely rare, but are reported commonly in HIV-positive and immunocompromised patients along with miliary or disseminated tuberculosis. Isolated tubercular splenic abscess in an immunocompetent individual is rarely reported. Here we present a case of a young, immunocompetent male with isolated splenic cold abscesses, who was diagnosed with splenic tuberculosis and managed successfully with percutaneous drainage and anti-tubercular therapy alone.

Toxic epidermal necrolysis (TEN), a severe form of Stevens-Johnson syndrome, is an acute life-threatening adverse drug reaction with a mortality rate of approximately 30%. Primary treatment of TEN is usually supportive. The use of intravenous immunoglobulin (IVIG) and corticosteroids are still uncertain, as there are only a limited number of studies comparing the usefulness of these treatments. We report a case of a Filipino male patient who developed TEN, most likely due to one of the medications he received during his course of illness. The patient was admitted to Sultan Qaboos Hospital, Salalah, with fever and diffuse painful maculopapular eruption, which became vesicular and bullous after few days, followed by shedding of large sheets of the epidermis. The patient was admitted initially under medical care, and a diagnosis of TEN was considered later. All unnecessary drugs were discontinued, and the patient was shifted to the burns unit. In addition to standard supportive treatment, a combination therapy of systemic steroid and a low-dose IVIG (1.2 g/kg) divided over three days was administered. This low-dose regimen of IVIG has a pharmacoeconomic benefit compared with the previous cumulative dose (3 g/kg), which is usually given by dermatologists in other institutions to patients with TEN. The outcome was excellent, and the condition recovered almost completely two weeks after starting the treatment without sequelae.