Objective Structured Clinical Examination: The Assessment of Choice

Marliyya Zayyan

Abstract

The Objective Structured Clinical Examination is a versatile multipurpose evaluative tool that can be utilized to assess health care professionals in a clinical setting. It assesses competency, based on objective testing through direct observation. It is precise, objective, and reproducible allowing uniform testing of students for a wide range of clinical skills. Unlike the traditional clinical exam, the OSCE could evaluate areas most critical to performance of health care professionals such as communication skills and ability to handle unpredictable patient behavior.

Tropical Cyclone Gonu: Number of Patients and Pattern of Illnesses in the Primary Health Centers in A’Seeb Area, Muscat, Sultanate of Oman

Mustafa Y. Alhinai

Abstract

Objectives: On June 6^th 2007, a tropical Cyclone Gonu striked the coastline of Oman. The purpose of this study is to compare number of patients and pattern of illnesses between disaster (June 2007) and peace times (June 2006/2008).

Methods: Descriptive comparative analysis of all patients who visited primary health centers in Wilayat A’Seeb during the index days. Electronic database collected from the Health Centers (HC) were grouped into four groups; infection-related, trauma-related, acute non trauma-related, and miscellaneous group. Data were analyzed to find difference of patient influx and disease patterns between disaster and peace times.

Results: HC visits during the index days decreased from 9006 in 2006 to 8687 in 2007 then increased to 8786 in 2008. Neither between years variation nor between disaster and peace times difference was found to be statistically significant. The proportion of patient visited the HC due to infection-related illnesses changed from 30% in 2006, 31% in 2007, and 24% in 2008 (p<0.0001). The proportion of patients visited the HC due to trauma-related illnesses had changed from 4% in 2006, to 6.7% in 2007, and to 4.4% in 2008. (p<0.0001). Proportions for acute non trauma-related visits were 27% in 2006, 24% in 2007, and 23% in 2008 (p<0.0001). Miscellaneous group accounted for 38% in 2006, 37% in 2007, and 47% in 2008 (p<0.0001).

Conclusion: Tropical Cyclone Gonu caused statistically significant increase in percentages of infectious and trauma-related visits. The overall ratios of total visits did not differ from peace times.

Keywords: Natural disasters; Tropical cyclone; Oman; A’Seeb; Gonu; Pattern of illnesses.

Immunohistochemical Expression of ki-67 and p53 in Colorectal Adenomas: A Clinicopathological Study

Faris Lutfi Nussrat¹, Hussam Hasson Ali¹, Haider Ghazi Hussein^2*, Raghad Jawad Al-Ukashi³

Abstract

Objectives: To evaluate the significance of P53 and Ki-67 expression as immunohistochemical markers in early detection of premalignant changes in different types of colorectal adenomas. Also, to correlate immunohistochemical expression of the two markers with different clinicopathological parameters including; age, and sex of the patient, type, site, size and grade of dysplasia of colorectal adenomas.

Methods: Forty-seven polypectomy specimens of colorectal adenomas were retrieved from the archival materials of the Gastrointestinal and Hepatic Diseases Teaching Hospital in Baghdad from 2009 - 2010. Four µm section specimens were stained by immunohistochemical technique with Ki-67 and P53 tumor markers. P-values <0.05 were considered statistically significant.

Results: Immunohistochemical expressions of Ki-67 and P53 had a significant correlation with the size and grade of dysplasia in colorectal adenomas. However, there was no significant correlation among the immunohistochemical expression of Ki-67 and P53 with the age and gender of the patient, and the type and site of colorectal adenomas. There was no significant correlation between Ki-67 and P53 expressions in colorectal adenomas. Villous adenomas of colorectum showed a significant correlation with the grade of dysplasia, while there was no significant correlation between size and site of colorectal adenoma with the grade of dysplasia.

Conclusion: High grade dysplasia with significant positive immunohistochemical markers of Ki-67 and P53 could be valuable parameters for selecting from the total colorectal adenoma population, those most deserving of close surveillance in follow-up cancer prevention programs. It is closely linked with increasing age particularly in patients with a large size adenoma of villous component in their histology.

Keywords: Colorectal adenomas; Dysplasia; p53; ki-67 expression; Immunohistochemical expression.

Prevalence of Depressive Symptoms among University Students in Oman

Zakiya Al-Busaidi^1*, Kamlesh Bhargava¹, Aida Al-Ismaily², Hadia Al-Lawati², Rahma Al-Kindi¹, Mohammad Al-Shafaee¹, Abdullah Al-Maniri¹

Abstract

Objectives: To study the prevalence of depressive symptoms and its association with gender, academic year, and college among university students in Oman.

Methods: A cross-sectional study was conducted among Omani students attending the students’ clinic of the Sultan Qaboos University (SQU). A systematic sampling of students, males and females, from different colleges, who visited the clinic during the study period, was carried out. The self-administered Patient Health Questionnaire (PHQ-9) was used to screen for propensity to depression.

Results: A total of 481 students participated in the study (243 males and 238 females). Overall, 133 (27.7%) of the participants (66 males and 67 females) had depression of various grades based on the PHQ-9 diagnostic criteria using a cut point of more than 11. Depression score at the cut point of 11 was not statistically associated with gender, college and the academic year.

Conclusion: Tendency for depression might be a common health problem among college students in Oman attending primary health care facilities. Further research on socio-demographic characteristics and the effect of depression on the academic performance is needed.

Keywords: Prevalence; Affective disorders; Depression; PHQ-9; University Students; SQU; Oman.

Bloodstream Bacterial Pathogens and their Antibiotic Resistance Pattern in Dhahira Region, Oman

Prakash KP¹, Vinod Arora², Geethanjali PP³

Abstract

Objectives: To describe the epidemiological, clinical, microbiological characteristics and antimicrobial resistance pattern of Bloodstream infections in Dhahira region, Oman.

Methods: Clinical data was collected from all patients with positive blood cultures for two years period. Standard laboratory methods were used for blood culture. Antibiotic sensitivity was tested using Kirby-Bauer disc diffusion method.

Results: Of the 360 bacterial pathogens isolated from 348 patients, 57.8% were gram-positive and 42.2% were gram-negative. The common isolates were: Streptococcus species 76 (21.1%), coagulase-negative Staphylococci 75 (20.8%), Escherichia coli 43 (11.9%), Staphylococcus aureus 41 (11.4%). Overall, mortality was 21.3% (74/348). Staphylococcus species (Staphylococcus aureus and CoNS) were more commonly resistant to Trimethoprim/ Sulphamethoxazole (35.3%) and Penicillin (25.9%). Streptococcus species were resistant to Trimethoprim/Sulphamethoxazole (39.1%) and Erythromycin (19.6%).

Conclusion: Bloodstream infections are important causes of morbidity and mortality in our patients, especially among chronically ill elderly adult males. Prescription of proven resistant antibiotics to suspected bacteremic patients needs attention in Dhahira region.

Keywords: Bloodstream infections; Antibiotic resistance; Bacterial pathogen; Epidemiology; Oman

An Audit of Hypertension at University Health Center in Oman

Thuraya Ahmed Al-Shidhani¹, Kamlesh Bhargava², Syed Rizvi³

Abstract

Objectives: To audit the documentation of medical care provided to hypertensive patients and to evaluate the management of hypertension in a primary healthcare center, Family Medicine Staff Clinic, Sultan Qaboos University (SQU) in Oman.

Methods: An audit of electronic medical records (EMR) was carried out during 2007and 2008 on a representative sample of 150 patients, selected randomly using a simple randomization method. The mean age of the patients was 54.8 +/- 9.9 years. The majority were Omanis; 53.3% were female, 46.7% were male. All patients’ records were reviewed for proper recording in a pre designed structured form. Re-auditing was done in 2008. McNemar’s test was used to compare data in 2007 with data in 2008.

Results: Age, gender, blood pressure recording, renal function tests, and lipid levels were sufficiently recorded (>75%) in the computer system. Histories of pertinent symptoms and smoking history were poorly recorded (<1%). Fifty-five percent of the hypertensive patients were sufficiently controlled (BP<140/90). There were significant differences between 2007 and 2008 with respect to documentation and recording of pertinent symptoms (p<0.001) and renal function tests (p=0.026).

Conclusion: Conducting an audit of EMR is essential to evaluate clinical performance and to determine what changes should be made to improve quality of care. There was significant improvement in documentation of pertinent symptoms in the second audit.

Keywords: Hypertension; Medical audit; Primary Health Care; Cardiovascular diseases; Blood Pressure; Humans; Clinical audit; Oman.

Effect of Mothers Nutritional Knowledge and Attitudes on Omani Children’s Dietary Intake

Ali Al-Shookri¹, Layla Al-Shukaily¹, Fouad Hassan², Sadeq Al-Sheraji³, Saif Al-Tobi⁴

Abstract

Objectives: The study investigates the dietary intakes of Omani preschoolers and associations with both socio-demographic characteristics and the mother’s nutritional knowledge and attitudes.

Methods: A sample of 154 parents of preschoolers completed a questionnaire including socio-demographic characteristics, a food-frequency questionnaire to assess children’s food intake, nutritional knowledge and attitudes towards healthy eating.

Results: The results showed a lower dietary adequacy of children’s food intake in mothers with low educational levels, high-ranked occupation, and lower levels of both nutritional knowledge and food related health attitudes. The highest food intake and healthy eating attitude scores were found in children of mothers with high education level and mother without a job. The association of the dietary adequacy with socio-demographic background can help the Omani healthcare decision makers to develop better-tailored nutrition interventions which are more suitable for the Omani community.

Conclusion: The results from this study of mothers’ nutritional knowledge and attitudes support the inclusion of knowledge and attitudes in dietary interventions.

Keywords: Dietary Intake; Nutritional knowledge; Mothers Nutritional Attitudes.

Incidence of Stomach Cancer in Oman and the Other Gulf Cooperation Council Countries

Haitham Al-Mahrouqi , Lianne Parkin, Katrina Sharples

Abstract

Objectives: Stomach cancer is the most common cancer among males in Oman and the second most frequent among females from 1997 to 2007. Reports have suggested the rate is higher in Oman than in the other GCC countries. This study aims to describe the epidemiology of stomach cancer in Oman and to explore the apparent differences in the incidence of stomach cancer between Oman and the other Gulf Cooperation Council (GCC) countries.

Methods: Data were obtained from the Omani National Cancer Registry (1997 - 2007) and from Gulf Centre for Cancer Registration reports (1998 - 2004).

Results: The annual average age-adjusted incidence rates for stomach cancer in Oman were 10.1 per 100,000 for males and 5.6 per 100,000 for females between 1997 and 2007. The age-adjusted incidence varied by region within Oman, and the incidence rate was higher in Oman than in most other GCC countries between 1998 and 2004.

Conclusion: Further investigation of the completeness and accuracy of cancer registration is essential for exploration of variations in stomach cancer rates in the GCC countries.

Keywords: Oman; Stomach cancer; Epidemiology; Incidence; Gulf Cooperation Council.

The Association Between Body Mass Index, Lipid Profile and Serum Estradiol Levels in a Sample of Iraqi Diabetic Premenopausal Women

Zinah Abd Ulelah Abd Ali¹, Mahmood Shakir Al-Zaidi²

Abstract

Objectives: To evaluate the association between body mass index (BMI), serum lipid profile and estradiol level in a sample of Iraqi diabetic premenopausal women at their pre ovulatory period.

Methods: A total of 155 diabetic female patients aged between 20-45 years, were enrolled in this study, which was conducted in Al Khademiyia Teaching Hospital from July 2008 to January 2010. Venous blood samples were taken, each serum sample was analyzed for total cholesterol, triglycerides, high density lipoprotein - cholesterol (HDL-C), low density lipoprotein - cholesterol (LDL-C), fasting glucose, insulin and estradiol. Body weight and height were measured for all patients included to calculate their Body Mass Index.

Results: The age of diabetic patients was 29.7 ± 4.3 years and BMI was 28.3 ±5.84 kg/m². Fifty patients had normal BMI, while 50 patients were overweight and 55 were obese. The study revealed a positive association between obesity, triglycerides and LDL-C and a negative association between serum estradiol, obesity and LDL-C.

Conclusion: Iraqi diabetic pre menopausal women at their pre ovulatory period exhibit a pro-atherogenic risk profile because of their abnormal BMI, higher LDL-C, lower HDL-cholesterol and estradiol level.

Keywords: BMI; Lipid Profile; Serum Estradiol; DM; Premenopausal women.

Tuberculosis of the Tongue Clinically Masquerading as a Neoplasm: A Case Report and Literature Review

Ammar Cherkess Al-Rikabi¹, Maria Abdul Raheem Arafah²

Abstract

Tuberculosis of the tongue is a very rare event even in areas and countries in which tuberculosis is endemic. The disease can present itself in a variety of clinical appearances, most of which may mimic malignant lingual neoplasms clinically. In this case, we present a patient who initially complained of an ulcerated lingual swelling, which was suspected to be a squamous cell carcinoma on clinical examination. In addition, the diagnosis was missed on the first and initial biopsy as it was not representative of the lesion. The diagnosis of lingual tuberculosis was made by histopathology on a second biopsy. In this article, we described the clinicopathological features of tuberculous glossitis with a comparison between our case and other similar reported cases in addition to a literature review.

Native Valve Endocarditis Caused by Coagulase Negative Staphylococci; an Appeal to Start Outpatient Antimicrobial Therapy: An Unusual Case Report

Nada Al-Tamtami¹, Jalila Al-Lawati², Seif Al-Abri³

Abstract

Coagulase negative staphylococci (CNS) were a rare cause of native valve endocarditis. However, they are emerging as an important cause of native valve endocarditis (NVE) in both community and healthcare settings. We describe a 64 yrs. old male who developed mitral valve endocarditis caused by coagulase negative staphylococci. There were no predisposing conditions or underlying cardiac disease that could have been the risk factor for the development of native valve infection. The patient had good recovery after six weeks of treatment with anti-staphylococcal antibiotics.

Distal Renal Tubular Acidosis, Hypokalemic Paralysis, Nephrocalcinosis, Primary Hypothyroidism, Growth Retardation, Osteomalacia and Osteoporosis Leading to Pathological Fracture: A Case Report

Ramen C. Basak¹, Khairy Mostafa Sharkawi², Mohammad Mizanur Rahman², Mayada Mohammad Swar³

Renal tubular acidosis (RTA) is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. RTA often presents as renal stone disease with nephrocalcinosis, ricket/osteomalacia and growth retardation in children with ultimate short stature in adulthood. The case reported here has features of distal renal tubular acidosis (dRTA), hypokalemic paralysis, primary hypothyroidism, growth retardation, osteomalacia and osteopenia leading to stress fracture. All these features presenting in a single case (as in our case) is a rare occurrence, so far other cases of distal renal tubular acidosis (dRTA) have been reported.

Familial Ectrodactyly Syndrome in a Nigerian Child: A Case Report

Mathew Durowaye, Muhammed Adeboye, Sefiyah Yahaya-Kongoila, Adeline Adaje, Omotayo Adesiyun, Samuel Kolade Ernest, Olugbenga Ayodeji Mokuolu, Abdulrasheed Adegboye

Abstract

Ectrodactyly, also known as Split-Hand/Split-Foot Malformation (SHFM) is a rare genetic condition characterized by defects of the central elements of the autopod. It has a prevalence of 1:10,000-1:90,000 worldwide. The X-linked and autosomal dominant types have been described. It can occur as an isolated malformation or in combination with other anomalies, such as tibial aplasia, craniofacial defects, and genitourinary abnormalities. Ectrodactyly-ectodermal dysplasia-clefting syndrome (EEC) is an example of ectrodactyly syndrome accompanied by multiple organ defects. Ectrodactyly has been reported in Africa, especially in several families in remote areas of central Africa but there has not been any published work on ectrodactyly in Nigeria. A baby was born in Ilorin, North Central Zone of Nigeria, with an uneventful prenatal and delivery history but was noticed to have malformation of the two hands and the two lower limbs at birth which are replica of the father’s malformation. We present this case to highlight familial ectrodactyly in Nigeria and prepare us to improve upon simple prenatal diagnosis and management of the challenges associated with patients with congenital malformation in Nigeria and other developing countries.

Replantation of an Amputated Hand: A Rare Case Report and Acknowledgement of a Multidisciplinary Team Input

Vipul Nanda^1*, Joe Jacob¹, Taif Alsafy¹, Thomas Punnoose¹, Sudhakar VR², G Iyasere³

Abstract

An amputation of the hand is a devastating injury. It adversely affects the victim’s ability to earn a livelihood, support a family, and carry out daily activities. It has a great psychological impact. We report a middle aged male with an amputation at the level of the distal forearm who underwent replantation. The operative details of this case are described. Awareness of the possibility of salvage should be spread among healthcare personnel and the need for immediate attention by a multispeciality team is advocated. This report reviews the literature related to the operative technique, contraindications and long term results.

An Overlooked Complication of Vancomycin Induced Acute Flaccid Paralysis in a Child with Acute Leukemia: A Case Report

Khalid Al Alawi¹, Mohammed Al Shinawy¹, Aqeela Taqee², Yasser Wali¹

Abstract

Vancomycin is a glycopeptide antibiotic which is commonly used to treat methicillin-resistant staphylococcal infections. It is commonly used in pediatric oncology wards for children with febrile neutropenia. We report a very rare side effect of vancomycin induced myopathy in a child with acute lymphoblastic leukemia. To the best of our knowledge, this is the first case reported from Oman.

Spontaneous Rupture of Umbilical Hernia in Pregnancy: A Case Report

Adamu Ahmed, Garba Stephen, Yahaya Ukwenya

Abstract

A 28 year old woman presented with a spontaneous rupture of an umbilical hernia in her seventh month of pregnancy. She had four previous unsupervised normal deliveries. There was no history of trauma or application of herbal medicine on the hernia. The hernia sac ruptured at the inferior surface where it was attached to the ulcerated and damaged overlying skin. There was a gangrenous eviscerated small bowel. The patient was resuscitated and the gangrenous small bowel was resected and end to end anastomosis done. The hernia sac was excised and the 12 cm defect repaired. Six weeks later, she had spontaneous vaginal delivery of a live baby. We advocate that large umbilical hernias should be routinely repaired when seen in women of child bearing age.