Defining a mutational panel and predicting the prevalence of cystic fibrosis in Oman

Cystic fibrosis transmembrane conductance regulator [CFTR] mutations form distinct mutational panels in different populations and subgroups. The frequency of cystic fibrosis [CF] mutations and prevalence are unknown in Oman. This study aimed to elucidate the mutational panel and prevalence of CF for the North Al Batinah [NAB] region in Oman and to estimate the national prevalence of CF based on the carrier screening of unrelated volunteers. The study included retrospective and prospective analysies of CF cases in the NAB region for 1998-2012. Genetic analysis of disease-causing mutations was conducted by screening of the entire coding sequence and exon-intron borders. The obtained mutational panel was used for the carrier screening of 408 alleles of unrelated and unaffected Omani individuals. S549R and F508del were the major mutations, accounting for 89% of mutations in the patient population. Two private mutations, c.1733-1734delTA and c.1175T>G, were identified in the patient cohort. Two carriers, one for F508del and another for S549R, were identified by screening of the volunteer cohort, resulting in a predicted prevalence for Oman of 1 in 8,264. The estimated carrier frequency of CF in Oman was 1 in 94. The carrier frequency in the NAB region was 3.9 times higher. The mutational panel for the NAB region and the high proportion of S549R mutations emphasises the need for specific screening for CF in Oman. The different distribution of allele frequencies suggests a spatial clustering of CF in the NAB region

private - public partnership in the Gulf: the Oman medical college

This article describes the origin, structure, and evolution of the new Oman Medical College, and examines the organizational and operational features of this unique private-public medical education partnership. OMC is a community-based medical school with formal academic relationships with the Robert C. Byrd Health Sciences Center of West Virginia University in the United States, and with the Ministries of Health and Education in Oman. Essential elements of this private sector-public educational partnership include shared curriculum development and administrative and faculty leadership, joint problem-oriented long-term planning, and governmental financial support for students. The OMC experience shows that private-public partnerships can provide new avenues for medical education that cross national and international boundaries. Medical institutions, like cities and people, have their own unique histories and distinct personalities that characterize them. The histories may extend back years or decades, or even centuries, and a medical institution's past continually impacts on its present and future. Yet every school of medicine, no matter how established or esteemed, had its origin at some point in time. Every medical institution has a beginning. In Oman, the Oman Medical College [OMC] is living its beginning. In response to its realization, almost a decade ago, that the country will have a shortage of well-trained Omani doctors in the decades ahead, the government of Oman began considering the creation of a center for physician training apart from the one governmental school of medicine in Muscat. As of 2002, only 22% of Oman's physicians were of Omani origin, the remaining being expatriates. According to the vision and directives of His Majesty Sultan Qaboos bin Said, and with the financial backing of a large corporate benefactor, OMC was founded in 2001 as a private, co-educational institution with a first-year class of 69 students enrolled in its pre-medical education programme. In reality, however, OMC is in joint private sector-public partnership with the national Ministries of Health and Education of Oman. The College offers a 7-year programme of study leading to the M.D. [Doctor of Medicine] degree, as well as a 4-year programme of study conferring the B. Pharm [Bachelor of Pharmacy] degree. The first three years of pre-medical studies are conducted on the Bowsher Campus in Muscat, and four years of medical training take place on the Sohar Campus. OMC is totally committed to providing outst and ing educational opportunities, ensuring that medical doctors and pharmacists of high caliber graduate from the institution ready to fulfill the healthcare needs of the people of the Sultanate of Oman and the international community. The Government of Oman has extended unqualified support to the project by sponsoring a large number [about 40%] of Omani students, donating free l and, and above all, by dedicating the adjacent 406-bed Sohar Regional Hospital as the main academic teaching hospital for OMC. In addition, a joint board comprised of health and education ministers, hospital superintendents and departmental heads, and OMC administrators convenes regularly to draft and implement specific details of the transition of Sohar Regional Hospital from a purely service-oriented hospital to a teaching institution. OMC is in formal academic partnership with another public institution, West Virginia University [WVU] in the United States. This relationship is founded on a common desire to train young Omani nationals to become outst and ing medical doctors and pharmacists. The WVU School of Medicine, founded in 1902, is the academic cornerstone of the Robert C. Byrd Health Sciences Center, which also includes schools of Dentistry, Nursing, Pharmacy and programs in a wide variety of Allied Health disciplines. The Center is authorized to award 24 distinct academic degrees at all levels from baccalaureate through doctoral. Clinical education and training is conducted at the Center's four modern and well-equipped teaching hospitals, and also utilizes an extensive network of rural health centers. The Center is recognized as a distinguished medical research institution with particular emphasis on cancer, neurosciences, and medical imaging. According to the partnership agreement, WVU provides guidance, curriculum development, and leadership in order to give OMC students an opportunity to obtain a US-style medical or pharmacy degree entirely within Oman. The language of instruction is English. The College is open primarily to Omani secondary school graduates, but also accepts citizens of other Gulf Cooperation Council [GCC] countries and a limited number of students outside the GCC from countries such as Pakistan, India, Iran, Iraq, Sudan, Sri Lanka, and Tanzania. Even early in its nexus, questions have already been raised regarding the future of OMC as it pertains to institutional accreditation. In only its fifth year of existence, and entering into only the second year of medical studies, OMC does not currently have accreditation. In reality, with our students having not yet even begun their third-year clinical clerkships it is premature to seek accreditation now. Still, with the graduation of the first class in 2008, it will be appropriate for the College to pursue full professional accreditation at that point, and laying the groundwork for that process has already begun. Such early activities include developing broad-based and locally-relevant basic sciences and clinical curricula, recruiting a full cadre of well-trained, geographic full-time, academic faculty, exp and ing teaching facilities and capabilities, establishing documentation for a full range of administrative, educational, and clinical policies and procedures, and drafting written st and ard operating procedures for all aspects of college and teaching hospital activities. When accreditation is sought, it will likely begin with that endowed by the GCC. Actually, only a small number of countries have addressed the process of medical education and focused on the structure and function of medical schools, including educational procedures, duration of programs, facilities, number of staff available for instruction, and other resources necessary to provide educational experiences for students. Such process st and ards have been used for years by the United States Liaison Committee on Medical Education [LCME] for the accreditation of the medical schools in the US and Canada but have been adopted for use in few other nations[2,3] In 1999, the Institute for International Medical Education [IIME] drafted recommendations for global minimum essential requirements' of knowledge, skills, core competencies, and professional behavior and ethics that could eventually lead to international accreditation of medical schools [4]. An Advisory Committee of IIME is composed of presidents or senior representatives of 14 major international organizations including [among others] the World Federation for Medical Education [WFME], World Health Organization [WHO], Accreditation Council for Graduate Medical Education, American Association of Medical Colleges, Association for Medical Education in Europe, American Medical Association, Education Commission for Foreign Medical Graduates, National Board of Medical Examiners, and the Pan-American Federation of the Association of Medical Schools

influence of consent for lumbar puncture on the outcome of suspected meningitis

In Oman, consent for lumbar puncture [LP] is infrequently given by patients and /or parents, necessitating empiric treatment. We sought to determine if refusal for LP leads to a worse clinical outcome in patients with suspected meningitis. A case-control study and retrospective review of medical records of all patients seen or hospitalized at the Sohar Regional Hospital from January 2004 through October 2005 with a diagnosis of suspected meningitis. Clinical, treatment, and outcome features were compared between subjects consenting to [n = 7] and refusing [n = 12] LP. Patients refusing LP were more likely to be younger [6 yrs vs. 25 yrs; p < 0.001] and to be admitted to the pediatric service [10/12 vs. 2/7], to receive empiric antibiotics [12/12 [100%] vs 3/7 [43%]], to have an incomplete course of antibiotics [6.4 vs. 10 days], to have a shorter duration of hospital stay [6.5 vs. 10 days], and to leave the hospital against medical advice and /or be transferred to another facility. Patients undergoing LP were more likely to have clinical improvement and be discharged home. Two patients in the LP group had treatable CNS infections [tuberculous and cryptococcal meningitis] that would not have been adequately covered by empiric antimicrobial therapy. Diagnostic LP improves the management and prognosis for patients with suspected meningitis