Mycotic aortic aneurysm treated by endovascular aneurysmal repair [EVAR] [first case report from Oman]

Mycotic aortic aneurysm is rare but life threatening disease. Endovascular aneurysm repair [EVAR] has become an established procedure for the treatment of many infrarenal aortic aneurysms

Although EVAR is obviously less invasive than open surgical repair but it is not without complications. Lower extremity ischemia is a known complication of endovascular abdominal aortic aneurysm repair [EVAR]. Limb occlusion, embolism or access related problems are the main causes. We hereby describe the first case of EVAR of infra renalmycotic aortic aneurysm in the history of Sultan Qaboos University Hospital Oman. A 67 years old lady known to have diabetes mellitus and hypertension admitted with fever and abdominal pain. On further evaluation found to have 4 cms infra-renal mycotic abdominal aortic aneurysm treated by EVAR but procedure was complicated by lower limb ischemia due to thrombosis at the puncture site which was successfully treated by aspirating thrombus and ischemia was relieved

Tumour lysis syndrome in haematological malignancies

Objectives: this study was conducted to determine the frequency of tumor lysis syndrome [TLS] in hematological malignancies

Materials and methods: this descriptive study was conducted at Liquate National Postgraduate Medical Centre from October 2005 to April 2006 over a period of six months. Total 50 patients with diagnosed hematological malignancies were included in the study and data were collected by non-probability convenient sampling. Patients pretreated for their malignancy were excluded from the study. Venous samples for serum uric acid, LDH, phosphorus, calcium, potassium and creatinine were collected on admission, before starting chemotherapy and then for four days after starting the chemotherapy. All patients received adequate hydration, allopurinol and induction chemotherapy. Data were analyzed by statistical package for social sciences [SPSS] version16.0

Results: out of 50 patients 10 fulfilled the criteria for TLS. Six patients developed laboratory tumor lysis syndrome [LTLS], whereas 4 developed clinical tumourlysis syndrome. Acute renal failure was observed in 4 out of 10 patients. Overall 3 patients died because of TLS. Hyperuricemia and lactate dehydrogenase above 2000 IU were the most prominent findings in patients with TLS

Conclusion: it is concluded that 20% of the patients developed TLS [including both laboratory and clinical TLS and despite all measures of prevention it can occur and result in devastating clinical effects

Comparison between helicobacter pylori fecal antigen detection and endoscopic gastric biopsy in diagnosis of H. Pylori infection in 50 adult cases

Objective: To compare the effectiveness of fecal antigen detection test with gastric biopsy via upper GI endoscopy for H pylori

Design: Comparative, observational, non- randomized

Place and Duration of Study: Sultan Qaboos University Hospital, Oman. February 2005 - February 2006

Patients and Methods: Fifty patients with epigastric pain and heart burn were subjected to upper GI endoscopy and gastric biopsy for H. pylori and at the same time stool was sent for fecal antigen detection for H. pylori

Results: Out of 30 females, 12 had biopsy proven H. pylori while 5 had positive fecal antigen test. In 20 male patients, 15 had positive biopsy while 12 had fecal antigen proven H. pylori

Conclusion: This study doesn't prove the effectiveness of fecal antigen detection test in comparison with upper GI endoscopy and biopsy, which is the gold standard test for H. pylori. Hence we cannot recommend the test to replace upper GI endoscopy and biopsy despite of the low cost and less trouble to the patient

Use of intravenous vs. intramuscular hepatitis B immunoglobulin in prevention of relapse of hepatitis B in post liver transplant patients

Object: To see the response of HBIg in post liver transplant patients in prevention of hepatitis B relapse by using two different routes of administration

Study Design: prospective comparative study

Place and Duration of Study: Sultan Qaboos University Hospital, Oman. From December 2001 - December 2007

Patients and Methods: Total 32 patients who underwent cadavaric liver-transplantation due to hepatitis B related end-stage liver disease were included in this study. Patients were divided into two groups by simple random technique. HBIg was administered through intravenous route to subjects of Group 1, whereas to subjects of Group II it was administered through intramuscular route. All patients received full recommended dose of HBIg with oral lamirudine for the prevention of relapse. Subjects were followed up for 30-months to record any event of relapse in both groups

Results: There were 24 [75%] males and 8 [25%] females, with median age of 37 years. Pretreatment HBV - DNA was detected in 28 [87.5%] and anti-HBS levels were <10-IU in all patients. During the course of treatment HBV-DNA found to be un-detectable and anti-HBS levels were maintained >100 in all patients. None of the study subjects in both groups had relapse of Hepatitis B

Conclusion: Intramuscular route of administrating HBIg in post liver transplant cases secondary to hepatitis B was found to be as effective as intra venous route

Preferred antipsychotic by mental health professionals of Sindh and Balauchistan

Objective: To determine the preferred antipsychotic drug of mental health professionals

Material and Methods: This cross-sectional survey was conducted among mental healthcare professionals of 25 public/private healthcare facilities of Sindh and Blochistan provinces form April 2007 to March 2008. After approval from ethical committee of Dow University of Health Sciences mental health professionals [trainees, consultants with experience only and consultant with postgraduate qualification] present on the day of visit to a facility were approached and asked to fill a semi-structured questionnaire to determine the preferred antipsychotic for patient as well as for themselves if they got ill and the factors they consider while choosing that antipsychotic. Descriptive analysis of the data was performed by SPSS v. 14

Results: One-hundred five mental health professionals were divided in 3 groups i.e. trainees [29], experienced doctors [24] and consultants psychiatrists [52]. They have almost equal experience of using typical [48%] and atypical [49%] antipsychotic, but when asked to chose antipsychotic for themselves, atypical [81%] were preferred over typical [14%] antipsychotic with Risperidone as the most common choice [55%] followed by quetiapine, olanzapine and clozapine. Regarding the factors influencing prescription, efficacy and safety were most considered factor while choosing antipsychotic for themselves as compare to efficacy and cost while experiencing prescription for patients

Conclusion: Clinical approach varies while prescribing anti-psychotic drug for the patients and for themselves between typical and atypical. Efficacy and safety were considered while choosing for themselves, whereas efficacy and cost while prescribing for patients

Extra-intestinal manifestations of ulcerative colitis in Omani population: a study of 100 cases

Object: to identify the extra intestinal manifestations of Ulcerative Colitis in Omani population

Study design: observational study

Place and duration of study: Sultan Qaboos University Hospital, Oman from January, 2002 to January, 2006

Patients and Methods: inclusion Criteria: All patients seen in Gastroenterology out patient's clinic with bleeding per rectum and diagnosis of ulcerative colitis by colonoscopy and subsequent confirmation by biopsy. Exclusion Criteria: All patients with other systemic illness

Results: total 100 Patients were included in the study, among them 61 were males. Extra intestinal manifestations were observed in 6 males and 5 females. Among 6 male patients 2 had more than one complication while 4 had only one complication. Among 5 female patients 2 had more than one, while 3 had only one complication

Conclusion: it is thus concluded that incidences and severity of extra intestinal manifestation is much less in the Omani population as compared to the Western population

Birth order and depressive disorder

Objective: to determine any relationship of birth order with depressive disorder

Method: this is a retrospective study from record of twelve hundred and eight patients who attended psychiatric department in OPD and wards of Isra University Hospital Hyderabad between January 2002 and February 2004 out of which 626 were diagnosed as cases of Depressive Disorder who were compared with the rest of the population. These were also studied with reference to gender, catchment area, and family type. Data were analyzed on 13th version of SPSS

Results: cases with depressive disorder were clustered in birth order-two; 36.42% of depression patients were found out to be birth order-two. The pattern remains almost the same irrespective of gender, catchment area, and family type

Conclusion: birth-order two is found to be more vulnerable to depressive disorder in our sample

Correlation of Urdu version of hospital anxiety depression scale and Hamilton depression rating scale in quantifying depression among post-myocardial infarction patients

Objective: to validate the use of Urdu Version of Hospital Anxiety Depression Scale as screening as well as quantifying tool for depression among non-psychiatric hospital population

Material and methods: this retrospective study was conducted at National Institute of Cardiovascular Disease [NICVD] Karachi and Civil Hospital Karachi [CHK] from 23rd October to 22nd November 1998. We searched the record of a previous study on the patients on myocardial infarction. A comparison of scores of Hospital Anxiety Depression Scale and Hamilton Depression Rating Scale, done on the patients with first myocardial infarction at an interval of about two weeks during hospitalization and after their discharge, was made

Results: correlation co-efficient between Hospital Anxiety Depression Scale scores and Hamilton Depression Rating Scale scores was found to be statistically significant [r =55; p<0.001]

Conclusion: results suggest that Hospital Anxiety Depression Scale can be used as an effective tool to screen and quantify depression

Spectrum of complications in post liver transplant patients: a study of 30 cases

Objective: To study the complications encountered in post liver transplant patients performed due to different etiologies leading to end stage liver disease. Study Design: Cohort and observational study. Place and Duration of Study: Sultan Qaboos University Hospital, Oman. From Dec 2001- July 2006

Patients and Methods: The study was conducted on all patients having cadavaric liver transplantation outside Oman. All patients were followed up for at least 18 months after enrolling in the study. They all had certain routine tests at the start of the study and were repeated according to the requirement of the individual patients. All patients had tacrolimus as an immunosuppressive agent. Patients with hepatitis B had hepatitis B immunoglobulin, alongwith lamivudine for relapse prophylaxis

Results: Complications of liver transplantation was observed in 21 patients, out of total 30 patients. Thirteen patients developed new onset diabetes mellitus, among them 7 had other complications as well. Eight patients had different hepatic complications and 7 had non hepatic problems. Total 5 patients expired during our follow up

Conclusion: The complications of liver transplantation can be controlled and managed if diagnosed promptly and treated early

Correlation of obsessive compulsive disorder with birth order - one

Objective: The study sought to explore, whether Obsessive Compulsive Disorder has any relation with birth order-one

Method: This a retrospective study from record of twelve hundred and eight patients who attended psychiatric department of Isra University Hospital Hyderabad, out of which 138 were OCD; who were compared with the rest of the population. These were also studied with reference to gender, catchment area and family type

Results: Cases with obsessive compulsive disorder were clustered in birth order-one. Total 44% of OCD patients were found out to be birth order-one as compared to 19.40% of the rest of the psychiatric population

Conclusion: Current study supports the hypothesis that in our sample birth order-one is correlated with Obsessive Compulsive Disorder

Socio-demographic correlates of stigma attached to mental illness

Objective: To identify socio-demographic correlates of stigma attached to psychiatric illnesses

Method: This is a retrospective study. Data of the patients who had attended psychiatry department; either as a referral or direct consultation; and as in-patient or outpatient; at Isra University Hospital at Hyderabad during the years 2001 to 2004, were reviewed and presence or absence of stigma feelings were compared to their socio-demographic backgrounds. Demographic characteristics of a total of 1208 patients with different psychiatric illnesses were recorded. Data obtained, was subjected to analysis using SPSS 13[th] version

Results: Feelings of stigma was present in forty seven percent of the studied population. Males had slightly more feelings of stigma. People from urban areas were also carrying more feelings of stigma but it was statistically insignificant. Apart from people with no formal education who had maximum stigma feelings; education level was found to increase such feelings, in the population studied

Conclusion: In our studied population, feeling of stigma seems to prevail in every demographic class; this is specially so among neurotics, male gender, urban patients. Level of education has interesting relation with the feeling of Stigma, which is found to increase with level of education