Understanding physician burnout in Oman: current status, cultural influences and future directions.

Amidst the current global surge in physician burnout, a compelling need arises for precisely targeted research and interventions that cater to specific contexts, illuminating a path towards professional well-being. This brief communication analyses recent studies on physician burnout in Oman, critically evaluating the findings, cultural factors, methodological limitations and future growth opportunities. Distinct elements of Omani culture, encompassing attitudes towards mental illness, gender roles and patient expectations, can distinctly influence how burnout presents in this population. Advanced mixed-methods research integrating cultural insights, biomarkers and longitudinal tracking is needed to characterise burnout in Omani physicians. The findings can play a significant role in developing comprehensive interventions, at both a systemic and an individual level, that promote well-being of physicians while specifically aligning with the cultural values of Oman.

Telephone-based telepsychiatry consultations: a qualitative exploration of psychiatrists' experiences in Oman.

OBJECTIVES: The utilisation of tele-mental health services has the potential to address challenges in mental health services within the Eastern Mediterranean Region. However, the adoption of tele-mental health in Oman remains limited. Therefore, this study aimed to explore the experiences of psychiatrists with telephone consultations, offering valuable insights to advance the field of telepsychiatry. DESIGN: This is a qualitative exploratory study. The analysis of the data involved the application of manifest content analysis. SETTING: The semi-structured interviews were conducted with the psychiatrists at Al Masarra Hospital. PARTICIPANTS: A total of 10 semi-structured interviews were conducted. RESULTS: The study reveals that psychiatrists encounter communication challenges in telephone consultations, such as the absence of visual cues, confirming patient identity, conducting comprehensive assessments and effectively communicating with younger patients who may lack developed social skills or patients with specific health conditions. Infrastructure limitations, such as outdated medical records, lack of electronic prescriptions and limited availability of child/adolescent psychiatric medications, further restrict the effectiveness of telepsychiatry consultations. In contrast, telephone appointments offer convenience and flexibility for psychiatrists, allowing them to manage non-clinical responsibilities and provide focused consultations tailored to individual needs. In addition, it benefits patients by improving appointment adherence, diminishing stigma and financial savings compared with in-person consultations. CONCLUSIONS: Tele-mental health has emerged as a promising avenue for enhancing mental healthcare services in Oman. Addressing psychiatrists' challenges is crucial to further developing and strengthening these services.

Dexmedetomidine in the Treatment of Depression: An Up-to-date Narrative Review.

Depressive disorders (DD) are common, and their prevalence is expected to rise over the next decade. Depressive disorders are linked to significant morbidity and mortality. The clinical conundrum of depressive disorders lies in the heterogeneity of their phenomenology and etiology. Further, the currently available antidepressants have several limitations, including a delayed onset of action, limited efficacy, and an unfavorable side effect profile. In this review, Dexmedetomidine (DEX), a highly selective and potent α2-adrenergic receptor (α2-AR) agonist, is proposed as a potentially novel antidepressant with multiple mechanisms of action targeting various depression pathophysiological processes. These mechanisms include modulation of the noradrenergic system, regulation of neuroinflammation and oxidative stress, influence on the Brain-Derived Neurotrophic Factor (BDNF) levels, and modulation of neurotransmitter systems, such as glutamate. The review begins with an introduction before moving on to a discussion of DEX's pharmacological features. The pathophysiological and phenomenological targets of DD are also explored, along with the review of the existing preclinical and clinical evidence for DEX's putative anti-depressant effects. Finally, the review ends by presenting the pertinent conclusions and future directions.

The Seroprevalence of Hepatitis C Virus (HCV) in Hemodialysis Patients in Oman: A National Cross-Sectional Study.

BACKGROUND: HCV infection in hemodialysis units is a significant cause of morbidity and mortality. The risk of HCV infection among dialysis patients is higher compared to the general population due to high potential blood exposures in hemodialysis settings. This study aims to assess the national HCV seroprevalence in selected dialysis units and to determine the risk factors for acquiring HCV infection. METHODS: This cross-sectional study was conducted from 1 January to 31 March 2021. A total of 734 patients from 11 hemodialysis centers in Oman were included. Samples were tested simultaneously for HCV antibodies and HCV RNA. HCV genotyping was determined in all viremic patients. Demographic and hemodialysis center related data were gathered and their association with the positive HCV serology were explored using univariate and multivariate logistic regression analysis. RESULTS: Out of 800 patients selected from 11 dialysis units for the study, 734 patients (91.8%) were included. The overall seroprevalence of HCV infection among hemodialysis patients was 5.6%. (41/734). HCV RNA was detected in 31.7% (13/41) of seropositive hemodialysis patients. The most common genotype was subtype 1a, followed by subtype 3. Variables associated with high HCV prevalence were family history of HCV and duration of dialysis. CONCLUSION: The prevalence of infection within hemodialysis patients in Oman has significantly decreased but remained higher than the general population. Continuous monitoring and follow-up, including periodic serosurvey and linkage to care and treatment are recommended. Additionally, practice audits are recommended for identifying gaps and ensuring sustainability of best practices and further improvement.

The differential mediating roles of resilience in the relationship between meaningful living and stress among college students during the COVID-19 pandemic.

The current literature, mostly Euro-American based, indicates that the presence of meaning in life (MIL) improves resilience and lowers stress. However, the differential mediating roles of resilience in the relationship between the search for and presence of MIL, and stress have not been explored. This study aimed to investigate the differential mediating roles of resilience in the relationship between the presence of and search for MIL, and stress among Omani college students amid the COVID-19 pandemic. This cross-sectional study consisted of the Brief Resilience Scale, Perceived Stress Scale 4, and Meaning in Life Questionnaire, as well as socio-demographic questions. A path analysis model was used to examine the hypothesis. A total of 970 Omani college students responded to the questionnaire. Findings indicate that searching for MIL was significantly associated with a high level of stress directly (ß = 0.023; p < 0.001) and indirectly, through a negative effect on resilience (ß = 0.006; p < 0.001). Conversely, the presence of MIL was significantly associated with a decreased level of stress directly (ß = - 0.045; p < 0.001) and indirectly via a positive effect on resilience (ß = - 0.151; p < 0.001). In keeping with the proposed hypothesis, this study contributes to the current knowledge, by extrapolating the effect of searching for MIL on resilience and stress, and culturally re-contextualizing MIL research. University counseling centers could adopt meaning-based strategies to mitigate stress by promoting meaningful living and resilience.

A promising future for tele-mental health in Oman: A qualitative exploration of clients and therapists' experiences.

Objectives: Tele-mental health services can play an important role in overcoming barriers in mental health services in the Eastern Mediterranean Region. However, despite its potential, tele-mental health has not been widely adopted in Oman. This study is an exploratory investigation into the experiences of therapists and their clients in utilizing video-based tele-mental health care during the COVID-19 pandemic. Methods: A total of 19 semistructured qualitative interviews were individually conducted, it included 13 adult clients with mental health conditions who received video-based tele-mental health care and six clinical psychologists who provided video-based tele-mental health care during the COVID-19 pandemic. Results: The clients reported favorable experiences using tele-mental health, with the primary benefits being convenience, easy accessibility to subspecialized care, reduced absenteeism from work with commuting costs, and alleviated mental health stigma. The therapists also expressed experiencing benefits from tele-mental health, such as reduced risk of intrahospital infection, reduced healthcare costs, and the achievement of work-life balance. Primary concerns were related to the lack of public tele-mental health services, lack of specified tele-mental health guidelines, shortage of trained therapists, limited access to high-speed Internet, electronic devices, privacy, and concerns toward the security of telehealth systems in general. Conclusion: Clients and therapists report that tele-mental health offers new opportunities to improve the quality of mental healthcare services in Oman, and that the challenges could be resolved by establishing governmental tele-mental health services along with developing tele-mental health guidelines and implementing local postgraduate clinical psychology programs in universities in Oman.

Clinical Predictors of Depression among Patients with Inflammatory Bowel Diseases: A Cross-sectional Analytical Study from Oman.

Objectives: Many studies suggest that depression is prevalent among patients suffering from inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Both depression and IBD have a significant disease burden. However, these studies have mostly been conducted among European and American populations and there is a paucity of studies from Arab countries. This study aimed to examine the prevalence and predictors of depressive symptoms among adult IBD patients attending a tertiary care hospital in Muscat, Oman. Methods: We conducted a cross-sectional study among a random sample of patients aged ≥ 18 years who attended the gastroenterology clinic at Sultan Qaboos University Hospital, Muscat, Oman, between June 2018 and January 2019. Participants were asked to complete the Patient Health Questionnaire-9, which is used to assess depression, and a sociodemographic survey. Logistic regression analysis was used to identify the independent predictors of depressive symptoms among the study sample. Adjusted odds ratios (aORs) were also reported. Results: This study included 201 participants, with an average age of 36 years. Just over half (51.2%) of participants were female. The mean duration of the patients' IBD diagnosis was 1.9±0.3 years, the majority (n = 174, 86.6%) of the participants had UC, 80.1% (n = 161) of the participants had received steroids, and 5.5% of the sample had a history of a surgical stoma. The medical comorbidities among the participants were cerebrovascular accidents (24.9%), hypertension (24.5%), and diabetes mellitus (23.9%). The prevalence of depressive symptoms was 23.4%. The logistic regression analysis resulted in four independent predictors of depression: being female (OR = 2.090, p = 0.047), history of surgical stoma (OR = 5.737, p < 0.001), comorbid diagnosis of hypertension (OR = 2.846, p = 0.007), and history of a cerebrovascular accident (OR = 2.651, p = 0.011). Conclusions: Depressive symptoms are prevalent among Omani patients with IBD. Certain clinical factors appeared to increase the risk of depression among this population. The findings of this study fill a gap in the existing literature and call for further work aiming at screening and managing depression among IBD patients.

Exploring Factors Associated With Depressive Symptoms Among Patients With Chronic Pain: A Cross-Sectional Multicenter Study.

ABSTRACT: This cross-sectional study examined the factors associated with depression among people with chronic pain (PwCP) attending specialized pain clinics in Muscat, Oman. Two-hundred eighty-seven participants were recruited for the study, and univariate analyses were used to investigate the difference between individuals who scored above/below the cutoff points for depressive symptoms. A multiple regression analysis was used to detect the independent predictors. Twenty-six percent of participants scored above the cutoff point. Further analysis indicated that unstable family relationships pre-existing depressive symptoms (odds ratio [OR], 2.86; p = 0.044), a family history of depression (OR, 4.75; p = 0.019), severe pain (OR, 4.21; p < 0.006), having fibromyalgia (OR, 28.29; p = 0.005), and lumbago/truck (OR, 2.41; p = 0.039) were independent predictors of depressive symptoms. This study indicates that one in four patients with chronic pain also presents with depressive symptoms. However, the role of culture needs to be taken into consideration when interpreting these findings and when building on these data.

Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman.

BACKGROUND: A different ethos with respect to the perception of medical ethics prevails in societies in transition such as those in the Arabian Peninsula, which makes it difficult to apply international principles of bioethics in medical practice. This study aimed to develop and psychometrically test an instrument that measures physicians' awareness of bioethics and medical law and their attitudes towards the practice of medical ethics. Additionally, it examined physician correlates influencing the awareness of bioethics. METHODS: Following a rigorous review of relevant literature by a panel of experts, a 13-item instrument, the Omani physicians' bioethics and medical law awareness (OBMLA) questionnaire was developed with the aim of assessing physicians' awareness of bioethics and medical law. The study tool's construct validity and internal consistency reliability were examined by exploratory factor analysis (EFA) and Cronbach's alpha. In a cross-sectional study, the questionnaire was distributed among a random sample of 200 physicians at a tertiary hospital in Muscat, Oman. Participant characteristics that may influence awareness of bioethics and medical law were explored. RESULTS: The EFA of the OBMLA questionnaire resulted in three well-loading factors: (1) Physicians' bioethics practice subscale (2) incentive related bioethics subscale and (3) medical law awareness subscale. Internal consistency reliability ranged between Cronbach's α: 0.73-0.8. Of the total 200 participants, 52% reported that teaching medical ethics during medical school was inadequate. The overall mean (standard deviation, SD) of the bioethics awareness score and Omani medical law awareness were 27.6 (3.5) and 10.1 (2.1) respectively. The majority of physicians (73%) reported that they frequently encountered ethical dilemmas in their practice and 24.5% endorsed the view that unethical decisions tended to occur in their practice. CONCLUSION: The study provides an insight into the practice of bioethics, and the awareness of bioethics and medical law among physicians in a teaching hospital in Oman. The OBMLA questionnaire appears to be a valid and reliable tool to assess a physician's awareness of bioethics and medical law. In this preliminary study, it appears that participants have suboptimal scores on the indices which measure practice and awareness of bioethics and medical law.

Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19-Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial.

BACKGROUND: The COVID-19 pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions that aim to improve the elevated levels of psychological distress due to the COVID-19 pandemic. OBJECTIVE: This study aimed to comparatively assess the efficacy of therapist-guided online therapy with that of self-help, internet-based therapy focusing on COVID-19-induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. METHODS: This was a 6-week-long pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety or depression among the Omani public amid the COVID-19 pandemic. Participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman; these sessions were conducted in Arabic or English. The psychotherapists utilized cognitive behavioral therapy and acceptance and commitment therapy interventions. Participants in the control group received an automatic weekly newsletter via email containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of cognitive behavioral therapy and acceptance and commitment therapy. The primary outcome was measured by comparing the change in the mean scores of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scale from the baseline to the end of the study (ie, after 6 sessions) between the two groups. The secondary outcome was to compare the proportions of participants with depression and anxiety between the two groups. RESULTS: Data from 46 participants were analyzed (intervention group n=22, control group n=24). There was no statistical difference in the baseline characteristics between both groups. Analysis of covariance indicated a significant reduction in the GAD-7 scores (F1,43=7.307; P=.01) between the two groups after adjusting for baseline scores. GAD-7 scores of participants in the intervention group were considerably more reduced than those of participants in the control group (ß=-3.27; P=.01). Moreover, a greater reduction in mean PHQ-9 scores was observed among participants in the intervention group (F1,43=8.298; P=.006) than those in the control group (ß=-4.311; P=.006). Although the levels of anxiety and depression reduced in both study groups, the reduction was higher in the intervention group (P=.049) than in the control group (P=.02). CONCLUSIONS: This study provides preliminary evidence to support the efficacy of online therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist-guided online therapy was found to be superior to self-help, internet-based therapy; however, both therapies could be considered as viable options. TRIAL REGISTRATION: ClinicalTrials.gov NCT04378257; https://clinicaltrials.gov/ct2/show/NCT04378257.

Predictors of psychological distress among the public in Oman amid coronavirus disease 2019 pandemic: a cross-sectional analytical study.

Coronavirus disease 2019 (COVID-19) is a global, virulent pandemic disease that emerged in December 2019, with both short- and long-term psychological repercussions being inevitable. This study aimed to investigate the prevalence and predictors of psychological distress, defined by the presence of either depression or anxiety, among the public in Oman during the COVID-19 pandemic. This was a web-based, cross-sectional study conducted using governmental and private institutional e-mail systems and social media platforms. Anxiety and depression were assessed using both the Generalized Anxiety Disorder-7 Scale and the Patient Health Questionnaire-9. Logistic regression analysis was used to assess the independent predictors. There were a total of 1538 participants in this study (75% female). The prevalence of psychological distress was 30%. Being female, having financial instability, being treated for mental illness and self-medication for coping with stress were independent predictors of psychological distress among the study sample (Odds ratio [OR] = 1.69, confidence interval [CI] = 1.24-2.29; OR = 2.05, CI = 1.54-2.74; OR = 5.35, CI = 3.50-8.18; OR = 7.23, CI = 3.06-17.09, respectively). The results from this study will help public health officials in Oman to plan for and mitigate psychological repercussions of the current and future pandemics.

The potential anti-depressant properties of dexmedetomidine infusion: a review of mechanistic, preclinical, and clinical evidence.

Major depressive disorder (MDD) is a highly prevalent and disabling condition for which the currently available treatments are not fully effective. Existing unmet needs include rapid onset of action and optimal management of concurrent agitation. Dexmedetomidine (DEX) is a selective and potent α2-adrenergic receptor (α2-AR) agonist, with unique pharmacokinetic and pharmacodynamic properties. In this review, we discuss pre-clinical and clinical studies which focused on DEX in the context of its putative antidepressant effects for the management of MDD. Preliminary data support DEX as an antidepressant with fast onset of action, which would be especially helpful for patients experiencing treatment resistant depression, and agitation. We further explore the mechanistic and clinical implications of considering DEX as a putative antidepressant agent, and the next steps to explore the efficacy of low dose DEX infusion among patients with treatment resistant depression.

Trait Emotional Intelligence and Its Correlates in Oman Medical Specialty Board Residents.

BACKGROUND: As part of the globalization of medical education, residency programs in Oman have adopted competency-based standards by the Accreditation Council for Graduate Medical Education International (ACGME-I). Correctly perceiving the emotions of others and managing one's own emotions are essential to high-quality patient care. OBJECTIVE: We tested the reliability and construct validity of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and assessed trait Emotional Intelligence (EI) in Oman Medical Specialty Board (OMSB) residents in multiple specialties. We explored for correlations with trainees' sociodemographic background data. METHODS: We conducted a cross-sectional, observational study between February and August 2017. Participants were OMSB residents. We administered the TEIQue-SF and collected sociodemographic data from participants. Multiple linear regression analysis was conducted to identify independent predictors of trait EI. RESULTS: The present cohort scored high in the trait EI subscale of Well-being, followed by Sociability, Self-control, and Emotionality. Among sociodemographic factors, female gender and high income were significant predictors of TEIQue-SF's Well-being subscale and high income and living in a rented home were significant predictors of the Sociability subscale. CONCLUSIONS: This is the first study conducted among medical residents in Oman regarding trait EI and its correlates. Our findings of overall high EI and several socioeconomic predictors echo the literature on the assessment of EI in trainees. The findings add to the evidence of cross-cultural applicability of instruments to measure trait EI, and use assessments of EI in resident selection and education.

Burnout Syndrome Among Primary Care Physicians in Oman.

OBJECTIVES: Medical professionals are exposed to many job stressors everyday, which can lead to psychological disturbances as well as burnout syndrome. We sought to assess the level of burnout among primary care physicians (PCPs) in Oman and explore risk factors for its development. METHODS: We conducted a cross-sectional, analytical study among a random cluster sample of 190 PCP working in Muscat, Oman. Indices of burnout (emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA)) were noted using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). We also used a questionnaire to obtain sociodemographic and job characteristics data. We used a binary logistic regression model and both unadjusted and adjusted odds ratios for statistical analysis. RESULTS: The prevalence of burnout in all three dimensions was 6.3%. High levels of MBI-HSS subscales were reported on EE, DP and PA with 17.8%, 38.2%, and 21.5%, respectively. Logistic regression analysis revealed that working over 40 hours per week was the most important risk factor for burnout among PCPs. CONCLUSIONS: A total of 6.3% of PCPs working in urban areas in Oman suffered burnout. Long working hours was strongly associated with high occupational burnout. Solutions to eliminate or decrease the rate of burnout involve institutional changes, primarily respecting weekly working hours, and in more severe cases psychotherapy help is very important.

Prevalence and determinants of burnout Syndrome and Depression among medical students at Sultan Qaboos University: A cross-sectional analytical study from Oman.

This study investigated the prevalence and determinants of Burnout Syndrome and Depressive Symptoms among medical students in Oman. Then, it explored whether the three-dimensional aspects of Burnout Syndrome (High Emotional Exhaustion, High Cynicism and Low Academic Efficacy) would predict the presence of Depressive Symptoms in a logistic regression model. A cross-sectional study was conducted among a random sample of medical students of Sultan Qaboos University. 662 students participated in the study with a response rate of 98%. The prevalence of Burnout Syndrome and Depressive Symptoms were; 7.4% and 24.5% respectively. Preclinical students reported high levels of both Burnout Syndrome (Odds Ratio-OR 2.83, 95% Confidence Interval CI 1.45-5.54) and Depressive Symptoms (OR 2. 72, 95% CI 1.07-6.89). The three-dimensional aspects of Burnout Syndrome(High Emotional Exhaustion, High Cynicism, low Professional efficacy) were statistically significant predictors of the presence of Depressive Symptoms; OR 3.52 (95% CI: 2.21-5.60), OR 3.33 (95% CI:2.10-5.28) and OR 2.07(95%CI:1.32-3.24) respectively. This study indicates that Burnout Syndrome and Depressive Symptoms are common among medical students, particularly in preclinical grade. Furthermore, the presence of high occupational burnout elevates the risk of depression.

Predictors of Burden of Care Among Caregivers of Drug-Naive Children and Adolescents With ADHD: A Cross-Sectional Correlative Study From Muscat, Oman.

OBJECTIVE: the study assessed the prevalence of burden of care among caregivers of children with ADHD in Oman. A related aim is to explore the predictors of the burden of care, subtypes of ADHD, and socio-demographic factors. METHOD: Arabic version of the Zarit Burden Interview (ZBI) was administered to 117 caregivers of drug-naive children with ADHD. Sociodemographic background and clinical data were gathered from medical records and from the attending caregivers themselves. The ADHD symptoms were grouped under three categories : hyperactive, inattentive, or mixed. RESULTS: the prevalence of the burden of care was estimated to be 34%. Income levels and the child's ADHD diagnosis being of "mixed" type have significant impact on the burden of care. CONCLUSION: the results of this study indicate that the prevalence of the burden of care among the caregivers of ADHD children in Oman is comparable with that in the other regions of the world.

Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman.

BACKGROUND: Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations. OBJECTIVES: The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical-demographic factors associated with depressive symptoms. METHODS: A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs). RESULTS: A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27-39.05, P = 0.002; OR = 2.0, 95% CI: 1.2-3.21, P = 0.05; OR = 2.28, 95% CI: 1.09-4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08-7.19, P = 0.035, respectively). CONCLUSION: This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.

In the Realm of Psychoneuroimmunology: The Role of Celecoxib as an Add-On Treatment for Bipolar Mania.

Bipolar affective disorder (BPAD) is a chronic debilitating psychiatric illness seriously affecting the quality of patients' life. The available treatment is effective in about half of those suffering from the illness. The neurobiological basis of the disorder is not fully unraveled. With such lacunae, attempts have been made to decipher the underlying neuroimmunological process of the illness as is the case with other mental disorders. As a result, some inflammatory processes have been implicated in the etiology of BPAD, as described in this communication. Subsequently, the role of anti-inflammatory agents such as celecoxib was investigated by treating different phases of BPAD. Given the promising outcomes of several trials and reviews, celecoxib has gained momentum and has been recommended as an adjunctive treatment by some guidelines for treating resistant BPAD cases. This brief communication highlights some of the caveats in the randomized trials using celecoxib as an add-on treatment in bipolar mania specifically, which need to be addressed in future work.

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study.

OBJECTIVES: This study aimed to evaluate cognitive and behavioural changes among 9-14-year-old Omani children with obstructive sleep apnoea (OSA) after an adenotonsillectomy (AT). METHODS: This naturalistic observational study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2012 and December 2014. Omani children with adenotonsillar hypertrophy (ATH) underwent overnight polysomnography and those with confirmed OSA were scheduled for an AT. Cognitive and behavioural evaluations were performed using standardised instruments at baseline prior to the procedure and three months afterwards. RESULTS: A total of 37 children were included in the study, of which 24 (65%) were male and 13 (35%) were female. The mean age of the males was 11.4 ± 1.9 years, while that of the females was 11.1 ± 1.5 years. Following the AT, there was a significant reduction of 56% in mean apnoea-hypopnoea index (AHI) score (2.36 ± 4.88 versus 5.37 ± 7.17; P <0.01). There was also a significant positive reduction in OSA indices, including oxygen desaturation index (78%), number of desaturations (68%) and number of obstructive apnoea incidents (74%; P <0.01 each). Significant improvements were noted in neurocognitive function, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%) and general intellectual ability (33%; P <0.01 each). There was a significant decrease of 21% in both mean inattention and hyperactivity scores (P <0.01 each). CONCLUSION: These results demonstrate the effectiveness of an AT in improving cognitive function and attention deficit hyperactivity disorder-like symptoms among children with ATH-caused OSA. Such changes can be observed as early as three months after the procedure.