Abstract

Objective: Malignant skin tumors rank amongst the most common forms of cancer worldwide and constitute a major challenge in dermatopathology and oncology research. This study aims to determine the frequency and patterns of malignant skin tumors at the University of Benin Teaching Hospital, Benin City, Nigeria.

Methods: A 25-year (1982-2007) retrospective study of surgical day books and slides of all patients presenting with skin lesions was conducted at the Surgical and Pathology Departments of University of Benin Teaching Hospital.

Results: A total of 694 skin biopsies were seen at the department during the study period; of these, 187 cases were malignant constituting 27% of all skin lesions. The majority of the malignant skin tumors (48%) occurred between the third and fifth decades with a male to female ratio of 1.4:1 and a mean age of 47 ± 29 years. Malignant melanoma was the most common skin malignancy, accounting for (n=61; 33%). Kaposi sarcoma constituted the second majority of the cases (n=56; 30%), with a markedly increased incidence between 2000 and 2008. This was consecutively followed by squamous cell carcinoma (n=45; 24%), basal cell carcinoma (n=18; 10%) and dermatofibrosarcoma protuberans (n=7; 4%). The leg and foot were the most common sites for malignant skin tumors.

Conclusion: Malignant melanoma was the most common skin malignancy in this study. However, an increasing incidence of all malignant skin tumors was observed. This was particularly noticeable with Kaposi sarcoma, which may be attributed to the increasing prevalence of HIV/AIDS in Nigeria.

Abstract

Objectives: To estimate the prevalence of pre-hypertension and its association with some selected cardiovascular risk factors among the Omani adult population in the primary healthcare setting.

Method: A cross-sectional study involving a sample taken from a National Screening Program of chronic non-communicable diseases in primary healthcare institutions, Sohar city, Sultanate of Oman (July 2006 - December 2007). Inclusion criteria included Omanis aged 40 years or above residents of Sohar city attending primary healthcare institutions not previously diagnosed with diabetes mellitus, hypertension, or chronic kidney diseases. Descriptive statistics were used to describe the demographic, physical and metabolic characteristics. Univariate analysis was used to identify the significant association between the characteristics and normal blood pressure, pre-hypertension and hypertension. Chi-squared test was used for categorical variables analysis and independent t-test was used for continuous variables analysis. In order to examine the strength of significant associations, the multinomial logistic regression analysis was used.

Results: There were 1498 participants, 41% were males and 59% were females. Overall, pre-hypertension was observed in 45% of the total study population (95% CI: 0.422 - 0.473). There were more males affected than females (46% versus 44%). About 34% of the total study population was hypertensive. The multinomial logistic regression analysis revealed that an increase of one unit of age, body mass index, fasting blood glucose and total blood cholesterol, were significantly associated with higher risk in both pre-hypertension and hypertension. High odds ratio of pre-hypertension and hypertension was found with the total blood cholesterol.

Conclusion: The prevalence of pre-hypertension was high among the Omani adult population. The determinants of pre-hypertension in this research age, body mass index, fasting blood glucose and total blood cholesterol. A cost-effectiveness study about the management of pre-hypertension within primary healthcare is significant in the future health system service strategies.

Keywords: Pre-hypertension; Diabetes; Hypertension; cardiovascular diseases.

Abstract

Objective: This study was aimed to assess public knowledge, belief and behavior towards antibiotics use in a general population in the Sultanate of Oman.

Methods: A 12-item self-administered questionnaire was distributed to 850 prospective participants by researchers using quota sampling in two governorates of Oman. The data obtained were evaluated to assess the responses to individual questions related to knowledge, belief and behavior of antibiotic use. Median score of the respondents was correlated with participant demographics and status on use of antibiotics.

Results: A total of 718 completed questionnaires were obtained giving a response rate of 85%. The median total score of the participants was 16 (Interquartile range: 6) out of a possible maximum score of 24. A moderate knowledge and behavior score was observed, while the belief score of the participants was low. A significant difference was observed in the median total score based on age group, educational qualification and employment status.

Conclusion: Antibiotics are frequently used by the public. An inappropriate belief on antibiotic related aspects was observed and inappropriate behavior was noticed, which are reflections of insufficient knowledge and wrong beliefs. Interventions must be put in place to educate the public on appropriate antibiotic use.

Abstract

Objectives: Noise is known to be one of the environmental and occupational hazards listed in the Factory and Machinery Act 1967. Quarries with loud deafening sounds from trucks and machineries pose the risk of noise-induced hearing loss to workers. This study was designed to assess the knowledge, attitude and practice towards noise-induced hearing loss and to determine the prevalence of noise-induced hearing loss and its associated factors among quarry workers in a north-eastern state of Malaysia.

Methods: A cross-sectional study was conducted at six quarries in a north-eastern state of Malaysia, with 97 consented respondents who answered a validated version of a questionnaire and underwent pure tone audiogram. The respondents were male, aged between 18 to 50 years, working in the quarry area for at least 6-months duration with no family history of ear diseases.

Results: The mean percentage scores of knowledge, attitude and practice were 44 (11), 70 (10) and 28 (16) percent, respectively. The prevalence of noise-induced hearing loss was found to be 57 (95% CI: 47, 67) with 46 (84%) having mild and moderate noise-induced hearing loss, and 34 (62%) involved both ears. Multiple logistic regressions showed that age and practice score were the associated factors with odd ratios of 1.1 (95% CI: 1.1, 1.2; p<0.001) and 0.9 (95% CI: 0.8, 1.0; p=0.008), respectively.

Conclusion: The knowledge, attitude and practice scores of the respondents were poor and the high prevalence of noise-induced hearing loss was contributed by factors such as poor practice and old age.

Abstract

Objectives: The aims of this study are to highlight the clinicopathological features of urinary bladder cancer in Yemen, and to describe the histological grading of urothelial neoplasms according to the World Health Organization and International Society of Urologic pathology (WHO/ISUP 1998) classification.

Methods: This is a descriptive record-based study of 316 cases of bladder cancer diagnosed by two pathologists at the Department of pathology, Sana'a University from 1^st January 2005 to 30^th April 2009. The diagnoses were made on hematoxylin and eosin stained sections and categorized according to WHO/ISUP 1998 classification.

Results: Out of 316 urinary bladder cancers, 248 (78%) were urothelial neoplasms, 53 (17%) were squamous cell carcinoma, 7 (2%) were adenocarcinoma, and 3 (1%) were rhabdomyosarcoma. The remaining cases were metastatic carcinomas (n=3), small cell carcinoma (n=1), and non-Hodgkin's lymphoma (n=1). The urothelial neoplasms observed were carcinoma in situ 4 (2%), papilloma 7 (3%), papillary urothelial neoplasm of low malignant potential 26 (11%), papillary urothelial carcinoma of low grade 107 (43%), papillary urothelial carcinoma of high grade 18 (7%), and non-papillary urothelial carcinoma of high grade 85 (34%), with 60 years mean age for males and 58 years for females; along with a male to female ratio of 4:1. The peak incidence was observed in the 61-70 years age group.

Conclusion: This study documents a high frequency of urothelial neoplasms, mostly papillary urothelial carcinoma of low grade and non-papillary urothelial carcinoma of high grade with male preponderance and peak incidence in 6^th decade of age.

Abstract

Objective: To examine the correlation of lactase persistence phenotype with genotype in Omani adults.

Methods: Lactase persistence phenotype was tested by hydrogen breath test in 52 Omani Adults using the Micro H₂ analyzer. Results were checked against genotyping using direct DNA sequencing.

Results: Forty one individuals with C/C-13910 and T/T-13915 genotypes had positive breath tests (≥20 ppm); while eight of nine individuals with T/C-13910 or T/G-13915 genotypes had negative breath tests (<20 ppm) and two subjects were non-hydrogen producers. The agreement between phenotype and genotype using Kappa value was very good (0.93).

Conclusion: Genotyping both T/C-13910 and T/G-13915 alleles can be used to assist diagnosis and predict lactose intolerance in the Omani population.

Keywords: Hydrogen Breath Test; Lactose Intolerance; Lactase Persistence; Oman; T/C-13910; T/G-13915.

Abstract

Objective: This study was conducted to determine the impact of an 8-week intradialytic exercise program (consisting of 15 minutes low-intensity exercise during the first 2 hours of dialysis) on dialysis efficacy.

Methods: In an open randomized controlled trial, a total of 50 clinically stable hemodialysis patients were enrolled into the study and randomly allocated into two groups: the aerobic exercise group (n=25) and the control group (n=25). Aerobic exercises were done in the intervention group for 15 min/day, three times a week for 2 months. The dialysis efficacy was assessed prior to and at the end of each month of the program.

Results: The efficacy of dialysis increased at the end of the first month and remained elevated for the duration of the program in the exercise group (p<0.05).

Conclusion: A simplified aerobic exercise program has increased the efficacy of dialysis and may be considered as a safe, complementary and effective modality for hemodialysis patients.

Keywords: Exercise; Dialysis; Kidney Failure; Chronic.

Abstract

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Keywords: Mucinous breast cancer; Solitary humeral bone metastases; Neoadjuvant chemotherapy-radiotherapy.

Abstract

Very long-chain acyl-CoA dehydrogenase deficiency (MIM 201475) is a severe defect of mitochondrial energy production from oxidation of very long-chain fatty acids. This inherited metabolic disorder often presents in early neonatal period with episodes of symptomatic hypoglycemia usually responding well to intravenous glucose infusion. These babies are often discharged without establishment of diagnosis but return by 2-5 months of age with severe and progressive cardiac failure due to hypertrophic cardiomyopathy with or without hepatic failure and steatosis. An early diagnosis and treatment with high concentration medium chain triglycerides based feeding formula can be life saving in such patients. Here, we report the first diagnosed and treated case of Very long-chain acyl-CoA dehydrogenase deficiency in Oman. This infant developed heart failure with left ventricular dilation, hypertrophy and pericardial effusion at the age of 7 weeks. Prompt diagnosis and subsequent intervention with medium chain triglycerides-based formula resulted in a reversal of severe clinical symptoms with significant improvement of cardiac status. This treatment also ensured normal growth and neurodevelopment. It is stressed that the disease must be recognized by the pediatricians and cardiologists since the disease can be identified by Tandem Mass Spectrometry; therefore, it should be considered to be included in expanded newborn screening program, allowing early diagnosis and intervention in order to ensure better outcome and prevent complications.

Keywords: Fatty acid oxidation defect; Very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency; Cardiomyopathy; Medium Chain Triglycerides (MCT) based formula.

Abstract

This is a rare case of adult primary obstructive megaureter complicated by combined uric acid-oxalate lithiasis of the ureter and renal stones. A 24-year-old male patient presented with frank hematuria on exercise of 4 years duration. The patient had an open surgery in the form of excision of stenotic segment of ureter and left ureteric re-implantation with removal of ureteric and renal stones. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.

Abstract

Catatonia is a potentially treatable neuropsychiatric syndrome less commonly encountered in developed countries these days. This review presents a case of a 19-year-old male with catatonic signs and symptoms compounded within a spectrum of a mood disorder, as well as literature review of the current treatment guidelines for this condition. There was no structural brain lesion or abnormality on cranial magnetic resonance imaging. The patient demonstrated favorable therapeutic response to benzodiazepine. This report discusses the management approach for catatonia through the case illustration, in an attempt to improve awareness and prompt recognition of this important disorder among physicians in Oman.

Abstract

Segmental gut gangrene is a very rare presentation in pregnancy. Gut obstruction (bands and adhesions) and vascular diseases (embolism, thrombosis, vasculitis and thrombophilia) are the usual causes of gut gangrene. In this report, we present a rare case where lower uterine cesarean section was done for fetal distress in an elderly primigravida with term size pregnancy and idiopathic segmental small gut gangrene was identified.

Abstract

Several occupational hazards especially exposure to silica have been implicated as causal factors for the development of scleroderma-like disorders. Many case reports have documented the co-existence of silicosis and progressive systemic sclerosis in the same patient, mostly from European countries and also from Japan and the United States. We report a case of a 26-year-old male involved in stone masonry who developed silicosis-induced diffuse parenchymal lung disease and systemic sclerosis after exposure to silica dust. To our knowledge, it is the second case to be reported from India.

Abstract

Hemifacial hyperplasia is a rare developmental anomaly exhibiting asymmetric growth of one or more body parts. It is characterized by hyperplasia of tissues rather than a hypertrophy, so it is better to call it hyperplasia rather than hypertrophy. Hemifacial hyperplasia may be associated with deformities of the skeletal system, including macrodactyly, polydactyly, syndactyly, scoliosis, tilting of the pelvis, and clubfoot. Though the etiology is unknown, various factors have been described. To date, very few cases have been reported thus far, according to the data we have collected. Through literature search, hemifacial hyperplasia was often implicated on the right side compared to the left. In contrast, we describe a case of hemifacial hyperplasia on the left side of the face in this report. This is a rare presentation for the condition which is detailed in this case report of hemifacial hyperplasia in a 50-year-old female who presented with unilateral facial enlargement since birth.

Abstract

Objective: Adequate dietary intake is crucial for optimum training and performance of athletes. There is almost no available information related to dietary practices among Omani athletes, especially during the competition. This study aimed to assess the nutritional practices (nutritional knowledge, eating habits and daily nutrients intake) among Omani male handball athletes in Muscat city, Oman.

Methods: This is a cross sectional study including 35 male handball athletes involved in serious training for no less than three years. Data collection was done through personal interviews using a study questionnaire which enlisted questions relating to socio-demographic information, anthropometric measurements and nutritional practices. All the study participants declared no intake of anabolic steroids.

Results: The mean age of the study participants was 27 ± 3 years. Their anthropometric assessment revealed that their mean height was 166 ± 12 cm, mean weight was 75 ± 10 kg, and body mass index was 27 ± 3. Nutritional knowledge analysis revealed that 80% had no nutritional supervision by a nutritionist/dietitian. Their knowledge of nutritional requirements was only 23% correct for total energy intake, 63% for protein intake, 46% for carbohydrate intake, 11% for fat intake and 83% for water intake. Eating habits indicated that 55% had <3 meals/day, 51% had lunch as the principal meal, 51% always added extra salt to their food, 28% took protein supplements on a daily basis, and 51% used pre-competition glycogen load diet. However, none consumed vitamins or mineral supplements. The mean daily caloric intake was 3674 ± 265 kcal/day, which was roughly comprised of 596 ± 66 g carbohydrates, 147 ± 28 g of protein and 78 ± 20 g of total fat.

Conclusion: Professional nutritional supervision is needed in order to improve the nutritional knowledge and eating habits of Omani athletes, and therefore improve their athletic performance.

Abstract

Objective: Few studies have examined clinical and demographic profile of attendees of a walk-in psychiatric clinic in countries ravaged by wars. The aim of this study is to quantify the characteristics of attendees of an open walk-in psychiatric clinic in a general hospital in Baghdad and the suburb towns of Iraq in the year 2010.

Methods: As part of a retrospective survey, information on specific variables (socio-demographic background, clinical characteristics and attendance rate) were sought from medical records in the year 2010 (January to December).

Results: Despite the shortcomings expected from a country coming out of the ravage of war, the survey included 2,979 attendees (1,864 [63%] males and 1,115 [37%] females) of a walk-in psychiatric clinic who fulfilled the inclusion criteria. The profile of attendees indicated that a majority of the cohort was self-referred with a predominance of employed males, aged 19 to 49 years, residing in Baghdad City. Depression and psychosis were the most common diagnosis given.

Conclusion: The observed patterns are discussed within the available literature relevant to consultation liaison psychiatry, and specific to situations in Iraq and Arab/Islamic cultural patterning.