diagnostic yield of thyroid function tests and their cost-effectiveness in the student clinic at Sultan Qaboos University: retrospective chart review

To assess the significance of requesting thyroid function tests [TFT] and their cost effectiveness for specific and non-specific symptoms of thyroid disease in a specific population in Oman. A retrospective chart review study was conducted in the student clinic at Sultan Qaboos University in Oman in the year 2007-2008. It included all patients [N=319] of both sexes for whom TFTs were requested. The patients' main complaints and the final diagnoses were collected from their medical records. The most common presentations for which TFTs were requested were irregular periods [n=82]; fatiguability [n=49], palpitations [n=39]; weight changes [n=22]; hair changes [n=20]; sensation of heat and cold [n=18]; diarrhoea and constipation [n=13], and neck swelling [n=13].The most common diagnoses reached in relation to these complaints were polycystic ovarian syndrome [n=51]; iron deficiency anaemia [n=42]; anxiety and depression [n=11]; thyroid disease [n=18], and no specific diagnosis [n=193]. The percentage of thyroid diseases among females [7.1%] compared to males [1.2%] was statistically significant [P <0.05]. Thyroid disease accounted for 61.5% of those patient with neck swelling, 7.7% of those with palpitations, 4.1% of those with fatigue, 3% of those with other complaints, and 1.2% of those with irregular periods. The cost of the tests was around 20,000 US dollars. TFT is necessary for those presenting with neck swelling, but restraint should be used in administering the test for those complaining of palpitations or fatigue. Additionally, irregular periods have little link with TFT abnormality

importance of HIV antenatal screening programs for pregnant women

To investigate retrospectively the prevalence of human immunodeficiency virus [HIV]-1 and among pregnant women during a 10-year period. The total number of pregnant women attending the Sultan Qaboos University Hospital [SQUH]. Muscat, Oman between January 1995 and December 2005 was 11553 women. Their age range was 16-45 years [average of 28.6 +/- 7.6 years]. The women were tested for HIV- 1 and 2 using the standard enzyme-linked immunosorbent assay [ELISA]. Positive samples were further tested by Western Blot. The data were statistically analyzed using the Statistical Package for Social Sciences Version 10.0. By ELISA testing, 21 women were positive for HIV-1 [prevalence rate: 0.2%] and 3 women were weakly positive for HIV-1 [24 women; 0.2% prevalence rate]. However, 15 women were confirmed HIV- 1 positive using the Western Blot method [prevalence rate: 0.13%] with an average of 1.5 positive women per year. None of the women were found positive for HIV-2. This relatively high prevalence of HIV-1 among pregnant women attending SQUH, highlights the need for screening all pregnant women attending different hospitals and antenatal clinics in Oman. This is essential for preventing the transmission of HIV-1 and 2 to the infants and to the community, and for the appropriate medical treatment and counseling of affected women

Patients' views of interpersonal continuity of care in four primary health care centres of Urban Oman

Interpersonal continuity of care [consulting the same physician] is widely regarded as a core value of primary care and a crucial component of quality of care. Nonetheless, interpersonal continuity as experienced by patients remains a neglected topic in Arab countries including Oman. The aim of this study was to explore how patients view interpersonal continuity of care in the primary care setting in Oman. Four primary health centres [PHCs] were selected from two urban cities in Oman. In the period June to August 2008, adult patients were surveyed by questionnaire at their PHC while waiting to see their primary care physicians [PCPs]. Results: We interviewed 319 [71%] of enrolled participants. Their ages ranged from 18-70 years. The majority of patients [223 - 70%] thought interpersonal continuity was very important for them; 232 [73%] patients felt that they obtained better care with interpersonal continuity. 225 [71%] patients preferred interpersonal continuity if they had personal, family or social problems. Nonetheless, compared to male patients, female patients had less chance to maintain interpersonal continuity [p=0.018]. Interpersonal continuity increased as the number of consultations increased [p=0.030]. Preference for interpersonal continuity was associated with increasing age [p=0.020] and with the presence of chronic illnesses [p=0.001]. Patients with chronic illnesses, who reported more preference for interpersonal continuity, were also found to be more compliant with medications and committed to carrying out recommended advice compared to patients without such illnesses [p=0.027]. Omani patients perceived interpersonal continuity as an important aspect of primary care. Health planners should note patients' preference for interpersonal continuity and take visible measures to support it. A larger study is needed to survey more of the PHCs of Oman

Reference ranges for lymphocyte subsets in healthy adult male Omanis

To determine the reference ranges of lymphocyte subsets in serologically HIV-seronegative healthy male adults in Oman. A cohort, of 118 healthy male blood donors ranging in age from 18-51 years, was included in the study. The average age was 25 years. Blood samples collected into tubes containing ethylene-diamine-tetra acetic acid were investigated for lymphocyte subsets using flow cytometer. This study was conducted in the Immunology Laboratory of the Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman during the year 2006. For the 118 males investigated, the mean percentage and absolute values of the lymphocyte subsets were as follows: CD3: 68.53 +/- 7.5%, 1701 +/- 489 cells/microliter; CD4: 40.4 +/- 6.5%, 1006 +/- 319 cells/microliter; CD8: 25.8 +/- 5.9%, 638 +/- 225 cells/microliter; CD19: 13.7 +/- 4.7%, 349 +/- 158 cells/microliter, and CD56: 12.2 +/- 6.7%, 308 +/- 204 cells/microliter. The ratio of CD4/CD8 was 1.6. Immunophenotyping has been used to establish reference values of lymphocyte subsets in normal healthy adult males in Oman. The Omani male reference values obtained in this study show wide variations compared with kits values previously used as a reference

Outcome as a measure of quality of care in oncology: experience at Sultan Qaboos University Hospital, Oman

Measurement of outcomes is increasingly employed as an indicator of the quality of clinical care. The most commonly measured outcome in many clinical studies, especially in oncology, still remains the overall survival rate. Sultan Qaboos University Hospital [SQUH], Oman, is striving for excellence through quality management. In seeking continual improvement, quality measurement exercises have been initiated throughout the Hospital. We present the overall survival rate of four of the ten most common cancers diagnosed in Oman. The cancers included non-Hodgkin's lymphoma [NHL], Hodgkin's lymphoma [HL], breast cancer, and stomach cancer. The studies were all retrospective and had been conducted previously. For present purposes, only the overall survival was compared with studies both from the region, and with bench-mark studies. For NHL, with a median follow-up of 8 months, the 2-year overall survival rate was 64%; 90% for low risk, 55% for intermediate risk, and 15% for high risk groups. For HL, the 5-year overall survival rate was 64%; 76% for low risk and 42% for high risk. For breast cancer, the 5-year survival rate was 67%; percentages were 88%, 75% and 59% for Groups I, II, and III respectively. For gastric cancer, the 5-year survival rate was 16.5%; 24% for the non-metastatic group. The outcome of patients with early stages and fewer adverse prognostic factors is comparable to what has been reported in the international literature; however, the outcome is inferior for patients presenting withadvanced stage disease and several adverse prognostic factors

Some risk factors for coronary heart disease among Omani males: a matched case-control study

Evaluation of some of the leading risk factors for coronary heart disease [CHD] among males in Oman. We conducted a hospital-based pair-wise matched case-control study among Omani CHD patients admitted in the Sultan Qaboos University Hospital and the Royal Hospital located in Muscat, Oman. The cases were matched with an equal number of controls in respect of age and hospital. The information was collected from the cases and controls based on an interview and review of the medical records of the admitted CHD patients. The odds ratios [ORs] were estimated under univariate as well as multivariate situations using conditional multiple binary logistic regression model. The analysis revealed that 74 percent of the cases were of angina pectoris. The majority of the cases [96%] were above 40 years of age. The prevalence of sedentary life style was predominant [88.0%]. Hypertension, diabetes, family history of CHD and a sedentary occupation were the most significant risk factors for the development of the disease. The estimated values of the adjusted ORs were found to be 9.98, 2.74, 28.19 and 3.00 respectively [p<0.05]. Individuals with hypertension, diabetes mellitus, a family history of CHD and with sedentary occupations are to be considered at high risk of developing CHD. Such individuals should be provided with appropriate health education along with close monitoring for symptoms and signs of CHD

Reference ranges for serum immunoglobulin A, G and M in the adult population from the South of Oman

Data on the normal levels of serum immunoglobulins in the south of Oman is lacking. This region of Oman is unique in its climate and environment compared to all other regions of Oman and the Gulf countries. We have conducted this study to determine the reference levels of serum immunoglobulin G, M and A in an adult healthy group of individuals from the south of Oman. Serum samples were collected from 489 healthy Omani individuals, 389 males and 100 females, from the southern area of Oman [Dhofar]. The age range of the males and females were 18 to 54 and 19 to 48 years, with an average of 30 and 24 years, respectively. Serum lgG, IgM and IgA levels were measured using a rate nephelometer. The mean serum levels of lgG, IgM and IgA were 12.88 g/L, 1.01 g/L and 2.64g/L, respectively. The lower and upper limits for the normal serum levels of IgG, IgM and IgA were determined as 8.52-17.45g/L; 0.374-2.05g/L and 1.23-4.77g/L, respectively. No significant difference in the mean serum levels was observed between the two sexes for lgG. However, IgM and IgA levels were significantly higher in the female group [P<0.001]. Young individuals with age below 20 years have significantly low levels of IgA [P<0.01] as compared to those above this age. The normal levels of the serum immunoglobulin G, M, and A were established for this Omani group. Our results confirmed the significant difference in IgM concentration between adult male and female individuals, with females having higher levels than males. Further, the results showed the occurrence of low levels IgA in young Dhofari individuals [