Pediatric Basic and Advanced Life Support: An Update on Practice and Education

Mohamed Al-Shamsi,¹ Waleed Al-Qurashi,² Allan de Caen,³ Farhan Bhanji⁴

Abstract

This review aims to summarize the major changes in the2010 Heart and Stroke foundation of Canada (HSFC) andthe American Heart Association (AHA) Pediatric Basic andAdvanced Life Support Guidelines. The Guidelines were based onthe International Liaison Committee on Resuscitation’s (ILCOR)comprehensive, evidence-based review of the resuscitationliterature. The key recommendations from the Guidelines include:the removal of “look, listen and feel” and a de-emphasis on theuse of the pulse check by healthcare providers to diagnose cardiacarrest; a change in the sequence of resuscitation for patientsin cardiac arrest from the previously well-known “A-B-C” i.e.Airway, Breathing, and Chest Compressions to “C-A-B” i.e.Chest Compressions first; modification to the appropriate depthof compression (at least 1/3 of the anterior-posterior depth of thechest wall or about 4 cm in infants and 5 cm in children); end-tidalCO2 monitoring (in intubated patients) to assess the quality ofchest compressions and optimize cardiopulmonary resuscitation(CPR); and titrating Fi0O2 once “Return of SpontaneousCirculation” (ROSC) is achieved to maintain an oxygen saturationbetween 94-99%. Overall, pediatricians, family and communityphysicians who may care for acutely ill children should be aware ofthese updated guidelines in order to provide the best possible careto their patients.

Health-related Quality of Life Assessment on 100 Tunisian Patients with Ankylosing Spondylitis using the SF-36 Survey

Wafa Hamdi,¹ Dhouha Azzouz,¹ Mohamed Mehdi Ghannouchi,¹ Manel Haouel,¹ Samir Kochbati,¹Kaouthar Saadellaoui,¹ Abdelmajid Ben Hmida,² Béchir Zouari,² Mohamed Montacer Kchir¹

Abstract

Objectives: The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS.

Methods: A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire.

Results: This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI.

Conclusion: Impairment in the quality of life can be significantwhen suffering from AS, affecting mental health more than physicalhealth. Among disease parameters, functional impairment,disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.

Incidence of Cleft Lip and Palate in Gorgan - Northern Iran: An Epidemiological Study

Arezou Mirfazeli, Nafiseh Kaviany, Kaniz Reza Hosseinpour, Mohammad Jafar Golalipour

Abstract

Objective: Cleft lip with or without cleft palate is the most common orofacial congenital anomaly among live births. This study was carried out to determine the incidence rate of oral clefting in Gorgan, North of Iran during 2004-2009.

Methods: This descriptive hospital-based study was performed on 35,009 live newborns in Dezyani Hospital in Gorgan, Northern Iran during 2004-2009. All newborns were screened for oral clefts. Data including birth date, gender, type of oral clefts, parents' consanguinity, parental ethnicity and presence of other congenital anomalies were recorded for analysis.

Result: The overall incidence rate of oral clefts during this 6-year period was 1.05 per 1000, or 1 per 946 live births. The incidence of cleft lip and isolated cleft palate was 0.08 and 0.37 per 1,000 live births, respectively. The ratio for different cleft types was 1:7:4 (CL: CLP: CP).

The incidence of oral clefting was 1.2 per 1,000 male births and 0.86 per 1,000 female births (RR=1.40, 95%, CI: 0.73-2.71). According to parental ethnicity, the incidence of oral clefting was 0.7, 1.7 and 1.26 per 1,000 in Native Fars, Turkman and Sistani, respectively. The relative risk for oral clefting in Turkman to native Fars group was 2.56 (p<0.02). In this study, 56.7% of clefts were CL+P, 8.1% were CL and 35.1% of cases were CP. CP was more common for girls (54%) than for boys (46%) but CL was more common for boys.

Conclusion: The result showed that the incidence of oral clefts in the study population as being at 1.05 per 1,000 live births, which is increased compared to an earlier study in this area with 0.97 per 1,000 live births.

Keywords: Cleft lip; Cleft palate; Gender; Ethnicity; Iran.

HbA1c Levels among Primary Healthcare Patients with Type 2 Diabetes Mellitus in Oman

Jawad A Al-Lawati,¹ Mohammed N. Barakat,¹ Masoud Al-Maskari,² Medhat K. Elsayed,³ Alya M. Al-Lawati,⁴ Ali Jaffer Mohammed⁵

Abstract

Objectives: To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c (HbA1c) levels compared to older patients, and to determine the factors associated with higher HbA1c levels.

Methods: Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios (OR), and 95% confidence intervals (CI) from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate (eGFR), tobacco use, and healthcare index as predictors of good (HbA1c <7%) vs.poor (≥7%) glycemic control.

Results: Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old (OR=1.7; 95% CI 1.1 to 2.6) and 60+ year (OR=2.5; 95% CI 1.6 to 4.0), female gender (OR=1.5; 95% CI 1.2 to 2.0) and in patients with eGFR ≥60 mL/min/1.73 m² (OR=1.9; 95% CI 1.1 to 3.3). Longer duration of diabetes (≥5years) and treatment with oral agents or insulin were inversely related to good glycemic control.

Conclusion: Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams.

Keywords: Diabetes; Oman; HbA1c; Epidemiology.

Validity of Serum Testosterone, Free Androgen Index, and Calculated Free Testosterone in Women with Suspected Hyperandrogenism

Manal K. Al Kindi, Faiza S. Al Essry, Fatma S. Al Essry, Waad-Allah S. Mula-Abed

Abstract

Objectives: There are technical limitations for the currently available methods of measuring serum total and free testosteronein females. The study objectives were to evaluate the usefulness of serum total testosterone, sex hormone-binding globulin (SHBG), free androgen index (FAI), and calculated free testosterone (CFT) in the assessment of androgen status in women investigated for suspected hyperandrogenism.

Methods: This is a case control study that was conducted during the period from 1st May 2011 to 31st October 2011 on 122 patients aged (18-45 years) whom were referred to the Clinical Biochemistry Laboratory from the Endocrinology and Gynecology Clinics, Royal Hospital, Oman. Women with no clinical feature or laboratory data indicative of hormonal dysfunction and with midluteal progesterone >30 nmol/L were selected as controls (group 1; n=18). The patients were divided into subgroups based on the clinical/laboratory diagnosis of polycystic ovary syndrome (PCOS [group 2; n=19), hirsutism (group 3; n=18), menstrual disturbances (irregularities) or infertility (group 4; n=49), as well as combination of PCOS or hirsutism and menstrual disturbances or infertility (group 5;n=18). Serum total testosterone and SHBG were measured, FAI was calculated as percentage ratio of total testosterone to SHBG values, and CFT was calculated according to Vermeulen equation.

Results: There was a statistically significant difference in the mean levels of testosterone, FAI and CFT in each patient group compared with the control group. For diagnosing hyperandrogenism, each indicator was selected at the recommended cut-off: testosterone >3.0 nmol/L, SHBG <30 nmol/L, FAI >5%, and CFT >32 pmol/L. In group 2, 89.5% and 94.7% of the patients had increased FAI and CFT, respectively; compared with 36.4% for increased testosterone. In group 3, 88.9% and 88.9% of the patients had similarly increased FAI and CFT, respectively; compared with 66.7% for testosterone. In group 4, patients had 63.3% and 73.5% elevated FAI and CFT, respectively; compared with 53.1% for testosterone, while in group 5, patients had 83.3% and 88.9% elevated FAI and CFT, respectively, compared with 61.1% for testosterone.

Conclusion: The diagnosis of hyperandrogenism was most obvious when using CFT or FAI than testosterone alone. It is thus recommended to include these calculated parameters (CFT and/or FAI) in the routine investigation and assessment of women with disorders related to clinical or biochemical hyperandrogenism.

Keywords: Hyperandrogenism; Testosterone; SHBG; Freeandrogen index; Calculated free testosterone.

Transit Time Flowmetry in Coronary Artery Bypass Grafting-experience at Queen Alia Heart Institute, Jordan

Basel Harahsheh

Abstract

Objectives: To assess the results of transit time flowmetry (TTF) on a consecutive group of coronary artery bypass grafting (CABG) patients at Queen Alia Heart Institute.

Methods: Intraoperative flow measurements of a consecutive group of 436 CABG patients. The flow pattern for each coronary artery system was assessed including mean flows, pulsatility index (PI) and the need for revision.

Results: A total of 1394 grafts in 436 patients were assessed (3.2 grafts per patient), wherein 100 grafts showed inadequate flowmetry results (7.2%); most of which were in the circumflex and right coronary artery systems with a percentage of 9.4% and the least in the LAD system with a percentage of 4.4%. The mean flow of grafts to the LAD system was 33.4±5.3 mL/min with a PI of 2.4±0.4; while the mean for grafts to the circumflex artery systemwas 35.1±7.2 mL/min with a PI of 3.5±0.7. The mean for theright coronary artery was 38.4±5.9 mL/min with a PI of 2.6±0.6. Revisions occurred in five patients (1.1%). Suboptimal grafts to the LAD system exhibited a flow of 14.1±7.4 mL/min with a PI of 6.9±1.7. While for the circumflex system a flow of 5.5±3.6 mL/min was reported with a PI of 10.4±7.8; and for the right coronary system a flow of 7.2±5.3 mL/min with a PI of 9.1±5.7 was reported.

Conclusion: Grafts to the LAD system showed the best flowmetry results compared to grafts to the circumflex and right coronary systems. A proportion of poor grafts were revised.

Keywords: Transit Time Flowmetry; CABG; Outcomes.

Obstetric and Non-Obstetric Risk Factors for Cesarean Section in Oman

Ibrahim Al Busaidi,¹ Yahya Al-Farsi,² Shyam Ganguly,² Vaidyanathan Gowri³

Abstract

Objectives: This study aims to explore the risk factors, profiles and neonatal outcomes of Cesarean sections among selected women in Oman.

Methods: In this hospital-based case-control study, a total of 500 participants (250 cases who had cesarean section and 250 controls who had spontaneous vaginal delivery), were randomly selected from four hospitals. Cases and controls were matched according to timing and place of delivery.

Results: The following predictors were found to be significantly associated with increased risk of cesarean section: a) advancing age (above the age of 25 years, OR=1.42; p=0.03), b) prior cesarean section (previous cesarean section=1, OR=22.71; p=0.001), c) increased body mass index (obesity, OR=2.11; p=0.07), d) extremes of neonatal birth weight (neonates birth weight <2.5 kg, OR=5.2; neonates birth weight >4.0 kg, OR=7.3; p<0.001), and e) prepregnancy diabetes (OR=9.3; p=0.04). On the contrary, increased parity and history of the use of birth spacing methods (OR=0.38; p=0.03) were associated with decreased risk of cesarean section.

Conclusion: The study calls for increasing awareness about clinical and public health majors that would lead to prevention of risk factors associated with increased risk of cesarean section such as maintaining normal BMI and prevention of gestational and type 2 diabetes mellitus.

Keywords: Obstetrics; Non-obstetrics; Cesarean.

Detection of Inborn Errors of Metabolism using Tandem Mass Spectrometry among High-risk Omani Patients

Sulaiman Al Riyami,¹ Matar Al Maney,¹ Surendra Nath Joshi,² Riad Bayoumi³

Abstract

Objectives: This is a report on the types and patterns of inborn errors of metabolism (IEMs) of amino acids, organic acids and fatty acids oxidation detected by Tandem Mass Spectrometry for a period of 10 years (1998-2008) at Sultan Qaboos University Hospital (SQUH), the major centre for diagnosis and management of IEM in Oman.

Methods: Tandem mass spectrometry (MS/MS) was used in the initial screening and diagnosis of IEMs in high risk neonatal and pediatric populations.

Results: Out of 1100 patients investigated, 119 were detected positive for IEM by MS/MS spectrometry. Twenty six different metabolic diseases were detected. Patients were categorized into three major groups: a) 54 with amino acids and urea cycle disorders, b) 35 with organic acid disorders, and c) 30 with fatty acid oxidation disorders. The commonest conditions encountered were maple syrup urine disease (MSUD), phenylketonuria (PKU), propionic and isovaleric acidurias, as well as HMG-CoA lyase deficiency and glutaric aciduria type II (GA-II). Most of these IEMs were over representedin babies born to consanguineous parents, which is consistent with the recessive autosomal inheritance.

Conclusion: This study shows that various types of IEMs, reported elsewhere, were also prevalent in Oman, but the pattern of prevalence and distribution is different. The situation, therefore, warrants the development of a nationwide screening and prevention program.

Keywords: Oman; Mass spectrometry; Inborn errors.

Injuries Presented at a Primary Care Setting in Oman

Hassan Al-Balushi,¹ Ahmed Al-Kalbani,¹ Talal Al-Khwaldi,¹ Salim Al-Suqri,¹ Abdullah Al-Maniri,² Mohamed Alazri,² Mustafa Al-Hinai²

Abstract

Objective: This study aims to measure the rate, types, and causes of injuries presented at a primary care setting in the Muscat governorate.

Methods: A cross-sectional study was carried out where all patients who attended the Al Moabelah Health Center from the period of 1st January 2010 to the 31st December 2010 were identified from the electronic medical records. Patients identified with any type of injury were then selected for further data collection with their age and gender recorded. Details such as the type, cause and nature of the injury at the clinic were gathered from the clinical notes.

Results: A total number of 86,554 visits were recorded for the year 2010. The rate of injury visits was 24 per 1000 visits. In this study, the rate of injury visits was found to be four times more common in males (44.4 per 1000) than in females (11.5 per 1000), p≤0.001.While children aged under 12 years accounted for 41.4%, and elderly patients aged over 60 years accounted for 3.5% of the total visits emanating from injuries. The results show that home was the most common place where the majority of injuries occurred (42%), followed by playgrounds (10.2%). The most common causes of injury visits were falls, followed by cutting/piercing by sharp objects and sports injuries, which accounted for 40%, 13.4%, and 12%,respectively.

Conclusion: Injuries in a primary care setting with close proximity to emergency departments of secondary and tertiary hospitals may only account to less than 3% of the total visits.

Keywords: Injuries; Primary care; Oman; falls.

Anti-platelet and Anti-thrombotic Effects of a Poly-ingredient formulation: In vitro and in vivo experimental evidences

Viswanatha GL, Mohamed Rafiq, Rajesh S, Sandeep Rao KS, Mohammed Azeemuddin, Anturlikar SD, Rangesh P, Patki PS

Abstract

Objective: The present study was conducted to evaluate the efficacy of Abana^® (a poly-ingredient formulation with natural constituents) on in vitro platelet aggregation and occlusion-induced deep venous thrombosis in rats.

Methods: Anti-platelet property of Abana^® was evaluated using ADP (Adenosin 5′-diphosphate) and adrenaline-induced platelet aggregation models, and anti-thrombotic activity was evaluated against occlusion-induced deep venous thrombosis model in wistar rats.

Results: Under the in vitro conditions, Abana® (250, 500 and 1000 µg/ml) alleviated ADP and adrenaline-induced platelet aggregation in a dose-dependent manner. Abana® (1000 µg/ml) inhibited ADP and adrenaline-induced platelet aggregation by as much as 50.69% and 64.83% respectively. Furthermore, 6 days pre-treatment with Abana® (250 and 500 mg/kg, p.o.) in an in vivo study showed significant and dose-dependent protection against occlusion-induced deep venous thrombosis in rats.

Conclusion: These findings suggest that Abana^®, a polyherbal formulation possesses anti-platelet and anti-thrombotic activities in the experimental models of in vitro platelet aggregation and in vivo deep venous thrombosis in rats.

Signet Ring Cell Lymphoma of the Small Bowel: A case report

Norwani Basir,¹ Ian C. Bickle,² Pemasari Upali Telisinghe,³ Muhd Syafiq Abdullah,¹ Vui Heng Chong¹

Abstract

Gastrointestinal lymphoma of the bowel is uncommon compared to adenocarcinoma. Signet ring cell lymphoma (SRCL) is a rare variant of non-Hodgkin’s lymphoma that is characterized by clear cytoplasm with displaced nuclei to the periphery giving a signet ring appearance. Small bowel involvement has not been previously reported. We report the rare case of a 78-year-old female who presented with short history of fever, loss of appetite, nausea,vomiting, mild weight loss with abdominal discomfort and was later diagnosed to have SRCL of the ileum.

Keywords: Non-Hodgkin’s lymphoma, B-cell lymphoma, small bowel, malignancy.

Pyopneumothorax Secondary to Aspergillus Infection: A Case Report

Surya Kant,¹ S Saheer,² Abhijjeet Singh,² Ghulam Hassan³

Abstract

A 32 -year- old male presented with complaints of fever, dry cough, breathlessness and right sided chest pain of two months duration. Chest radiograph showed right sided hydropneumothorax which revealed frank pus on diagnostic thoracocentesis, for which tube thoracostomy was done. Despite vigorous broad spectrum antibiotic coverage, postural drainage and chest physiotherapy, there was no clinical improvement. Further work up included serology, pleural fluid culture, closed as well as thoracoscopic guided pleural biopsy revealed growth of Aspergillus fumigatus. Patient was prescribed antifungal medication (Voriconazole) and subsequent thoracotomy with right sided pneumonectomy showed good clinical recovery.

Keywords: Aspergillosis; Aspergillus fumigatus; Aspergillus pyopneumothorax.

Diagnosis of Microvillous Inclusion Disease: A Case Report and Literature Review with Significance for Oman

Siham Al-Sinani,¹ Sharef Waadallah Sharef,² Ritu Lakhtakia,³ Mohamed Abdellatif²

Abstract

Microvillous Inclusion Disease (MVID) is one of the congenital diarrheal disorders (CDD) caused by genetic defects in enterocyte differentiation and polarization. Its prevalence is higher in countries with a high degree of consanguinity. It causes severe, intractable secretory diarrhea leading to permanent and definitive intestinal failure with resultant dependency on parenteral nutrition (PN). Small bowel transplantation is the only curative treatment. The gold standard for diagnosis are the typical morphological abnormalities in small bowel biopsies on light and electron microscopy (EM). In recent times, histochemistry and immunohistochemistry haves hown sufficient diagnostic accuracy replacing EM if the facility is unavailable or EM findings are inconclusive. We describe a neonate with CDD who was diagnosed to have MVID on the duodenal biopsy by morphohistochemical and immunophenotypic methods used for the first time in Oman. By utilizing such easy and accessible diagnostic methods, a rare genetic disorder could be diagnosed with certainty and the family could be counseled accordingly. With a high degree of consanguinity in the region, the prevalence of MVID in Oman needs to be identified once these patients are diagnosed by utilizing appropriate investigations. Care of such patients necessitates improving current parenteral nutrition services and addressing the future need for small bowel transplantation (SBTx), in Oman.

Keywords: Congenital diarrheal disorder; Microvillous Inclusion Disease; Small intestine biopsy; Intestinal transplantation.

Prepubertal Hypertransfusion in Thalassemia Intermedia: Sustained Positive Effects on Growth, Splenic Function and Endocrine Parameters

Surekha Tony,¹ Shahina Daar,² Mathew Zachariah,¹ Yasser Wali¹

Abstract

We report a known case of thalassemia intermedia (Hb Dhofar) who in spite of mild thalassemic facies, attained his normal genetic height, pubertal maturity and improved self-image with minimal splenomegaly through a hypertransfusion/chelation regimen that was started just before puberty and maintained for 5 years. As there are no clear guidelines in the management of patients with thalassemia intermedia, the option of hypertransfusion/chelation during the pubertal growth spurt may alleviate some of the complications associated with thalassemia intermedia.

Keywords: Thalassemia Intermedia; prepuberty;hypertransfusion.

Fibromatosis Colli: A Case Report

Saifullah Khalid,¹ Samreen Zaheer,¹ Shagufta Wahab,² M Azfar Siddiqui,³ Navneet Redhu,¹ Faraz Yusuf⁴

Abstract

Fibromatosis colli or sternocleidomastoid tumor of infancy is a condition of benign proliferation of fibrous tissue within the sternocleidomastoid muscle leading to focal or diffuse enlargement of the sternocleidomastoid muscle and is often clinically associated with torticollis. Radiological imaging especially ultrasound, if performed by an expert radiologist plays an important role in differentiating this benign condition from other causes of neck masses in this age group, thereby preventing unnecessary investigations in a neonate and decreasing parent`s anxiety. We hereby, present a case report of a sternomastoid tumor in a two week old neonate diagnosed using high frequency ultrasound, signifying that every physician should be aware of this clinical entity in a neonate and refer them immediately for ultrasound.

Keywords: Fibromatosis colli, Sternomastoid tumor of infancy, birth trauma, congenital torticollis, botulinum toxin type A.

Acute Drug Overdose: Clinical Profile, Etiologic Spectrum and Determinants of Duration of Intensive Medical Treatment

B Jayakrishnan, Abdullah Al Asmi, Ahmed Al Qassabi, R Nandhagopal, Irshad Mohammed

Abstract

Objectives: Acute drug overdosing is an important cause of organ dysfunction and metabolic derangements and the patients often require intensive care. This study aims to determine the clinical pattern of severe drug overdose as well as the factors influencing the duration of intensive care.

Methods: The clinical characteristics and course of consecutive adult patients admitted with a diagnosis of acute drug poisoning in the ICU of a tertiary hospital in Oman from January 2007 to December 2008 were reviewed retrospectively from the electronic case records.

Results: Acute drug poisoning (n=29) constituted 3.9% of admissions to the ICU. Mean age was 29.38±7.9 years. They were brought in by their relatives (72%) or the state services (24%). Accidental poisoning was noted in 21 patients (72%) and suicidal overdosing in 6 (21%). The commonest drug was an opioid (65.5%). Glasgow Coma Scale score of ≤8 was recorded in 18 (62.1%). Sixty two percent of patients required mechanical ventilation. The prominent complications were hypotension in 9 (31%), pulmonary in 19 (65.5%), hepatic in 18 (62.1%) and renal in 12 (41.4%) patients. The major electrolytes abnormalities were low bicarbonate in 11 (37.9%), hyponatremia in 5 (17.2%) and hypokalemia in 4 (13.8%). Patients stayed in the ICU for 1 to 20 days (median-2 days). Factors associated with a longer ICU stay included hypotension upon arrival (p=0.048) and the need for mechanical ventilation on the first (p=0.001) and second (p=0.001) days of hospitalization. There was no mortality.

Conclusion: Early and prompt intensive medical therapy in acute drug poisoning can favorably influence the outcome. In addition, the presence of hypotension and requirement of mechanical ventilation on the first two days of hospitalization were responsible for prolonged ICU stay.

Keywords: Drug overdose, intensive care, opiates, Oman.

Patient’s Knowledge and Perception Towards the use of Non-steroidal Anti-Inflammatory Drugs in Rheumatology Clinic Northern Malaysia

Wahinuddin Sulaiman, Ong Ping Seung, Rosli Ismail

Abstract

Objective: In Rheumatology, non-steroidal anti-inflammatory drugs (NSAIDs) has been widely prescribed and used. However, despite their clinical benefits in the management of inflammatory and degenerative joint disease, NSAIDs have considerable side effects, mostly affecting the upper gastrointestinal system, which therefore, limit their use. This study was conducted to determine the patients’ knowledge and perception regarding the used of NSAIDS.

Methods: A total of 120 patients who attended the rheumatology clinic Hospital, Raja Permaisuri Bainun, Malaysia, and received NSAIDs more than 3 months were interviewed irrespective of the irrheumatological conditions. Patient’s knowledge and perception on the side effects of NSAIDs were recorded.

Result: Fifty-four percent of the patients obtained information regarding the side effect of NSAIDs either from the rheumatologist, rheumatology staff nurse or other medical staffs (75.4%). The remaining 45.8% were naive of such knowledge. Fifteen percent obtained the information by surfing the internet and 9.2% from printed media. Twenty-four (24.2%) patients, experiencedin digestion and/or stomach discomfort attributed to NSAIDsused. Two patients (1.7%) had hematemesis and malena once.

Conclusion: This study shows that half of the patients who attended the rheumatology clinic were unaware of the side effect of NSAIDs. Available data showed that most of the knowledgeable patients are more conscience and self-educated. This study also reveals the important roles of clinicians, trained staff nurses as well as the pharmacist in providing the guidance and knowledge of any medication taken by patients.

Keywords: NSAIDs; Knowledge; Side effects; Rheumatology.