Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas.

STUDY OBJECTIVE: Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative. STUDY DESIGN: Prospective, randomized clinical trial (Canadian Task Force classification I). SETTING: University maternity hospital. PATIENTS: Women diagnosed with unilateral or bilateral ovarian endometriomas. INTERVENTIONS: Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing. MEASUREMENTS AND MAIN RESULTS: A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2. CONCLUSION: Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.

Rectal vs. sublingual misoprostol before cesarean section: double-blind, three-arm, randomized clinical trial.

PURPOSE: The commonest surgical procedure for women is cesarean delivery. Postpartum hemorrhage and intra-operative blood during cesarean delivery is a major concern to all obstetricians. This study was conducted to assess the efficacy of the adjuvant use of misoprostol and oxytocin in decreasing intra-operative blood loss in cesarean delivery. METHODS: This was a double-blinded randomized clinical trial including 636 term pregnant woman scheduled for cesarean section at Ain Shams University Maternity Hospital, Cairo, Egypt, between February 2013 and February 2014. Participants received either 400-µg misoprostol rectally or sublingually or placebo before cesarean section together with 5-IU oxytocin IV. The main outcome measure was intra-operative blood loss. Difference between the three groups was analyzed using one-way ANOVA test (for numeric variables) and Chi-square test (for categorical variables). P < 0.05 was considered statistically significant. RESULTS: Intra-operative blood loss was higher in patients who did not receive misoprostol (Placebo Group) (295-1075 ml, 641.7 ± 135.7) than those who received it, regardless the route of administration, rectal (135-830 ml, 457.5 ± 140.7; P < 0.001), and sublingual (135-680 ml, 357.8 ± 129.7; P < 0.001). In addition, sublingual route was associated with significantly lower estimated intra-operative blood loss compared to rectal administration (P < 0.001). CONCLUSIONS: Misoprostol with oxytocin is an effective drug-combination for decreasing intra-operative blood loss during cesarian section with clinical superiority to sublingual over rectal route.

Hypertension in the adult Omani population: predictors for unawareness and uncontrolled hypertension.

BACKGROUND: Hypertension is a significant predictor for cardiovascular diseases and is the most important preventable or modifiable cause of morbidity and mortality from these diseases. Undiagnosed cases of hypertension and poor control are important factors in controlling hypertension worldwide, including Oman. AIM OF THE STUDY: The aim of this study was to identify the important risk factors and predictors of the state of unawareness of the presence of hypertension, as well as the risk factors for poor control of blood pressure, among hypertensive patients. MATERIALS AND METHODS: Data from Oman World Health Survey (OWHS), 2008, were used in this study. The OWHS adopted a multistage stratified cluster sampling to select study participants. An interview questionnaire was used to collect data related to risk factors. Other parameters included blood pressure, anthropometric and biochemical measurements. RESULTS: The prevalence of hypertension in Oman was estimated to be 41.5%. Of those who were hypertensive, three-quarters of them (75.7%) were unaware of being hypertensive and 65.5% of them had inadequately controlled hypertension. Male sex, higher wealth, and paying fewer visits to health facilities were found associated with high proportions of unawareness and high proportion of uncontrolled hypertension. CONCLUSION AND RECOMMENDATIONS: The study highlights high levels of unawareness of being hypertensive and high proportion of uncontrolled hypertension in Oman that need to be considered when developing health policies and strategies. Intersectorial collaborative and innovative strategies that focus on improving awareness, detection, and control of hypertension should be considered, especially with attention to young adults and men.

Trends in the Risk for Cardiovascular Disease among Adults with Diabetes in Oman.

OBJECTIVES: This study aimed to investigate trends in the estimated 10-year risk for developing cardiovascular disease (CVD) among adults with diagnosed diabetes in Oman. In addition, the effect of hypothetical risk reductions in this population was examined. METHODS: Data from 1,077 Omani adults aged ≥40 years with diagnosed diabetes were collected and analysed from three national surveys conducted in 1991, 2000 and 2008 across all regions of Oman. The estimated 10-year CVD risk and hypothetical risk reductions were calculated using risk prediction algorithms from the Systematic COronary Risk Evaluation (SCORE), Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) and World Health Organization/International Society of Hypertension (WHO/ISH) risk tools. RESULTS: Between 1991 and 2008, the estimated 10-year risk of CVD increased significantly in the total sample and among both genders, regardless of the risk prediction algorithm that was used. Hypothetical risk reduction models for three scenarios (eliminating smoking, controlling systolic blood pressure and reducing total cholesterol) identified that reducing systolic blood pressure to ≤130 mmHg would lead to the largest reduction in the 10-year risk of CVD in subjects with diabetes. CONCLUSION: The estimated 10-year risk for CVD among adults with diabetes increased significantly between 1991 and 2008 in Oman. Focused public health initiatives, involving recognised interventions to address behavioural and biological risks, should be a national priority. Improvements in the quality of care for diabetic patients, both at the individual and the healthcare system level, are required.

Metabolic Syndrome and Its Components: Secondary analysis of the World Health Survey, Oman.

OBJECTIVES: The study aimed to describe the prevalence of metabolic syndrome (MS) and its components among Omani adults. METHODS: The 2008 Oman World Health Survey dataset was used to determine the national prevalence of MS. Logistic regression using all key sociodemographic, clinical and behavioural variables was used to identify the associations of independent variables with MS. RESULTS: The age-adjusted prevalence of MS was 23.6%. MS was significantly associated with age, marital and work status and wealth level. MS was more common for people aged 50 years and older compared to the youngest cohort (OR 3.6, CI: 2.4-5.3; P <0.001) and in people who were married or employed (OR 1.6, CI: 1.3-2.1; P <0.001 and OR 1.3, CI: 1.1-1.8; P = 0.043, respectively) compared to their unmarried and unemployed counterparts. MS was also more common in people in the second lowest wealth quintile (OR 1.6, CI: 1.2-2.2; P = 0.05) compared to the lowest quintile and in those who sat for more than six hours per day (OR 1.3, CI: 1.1-1.7; P = 0.035). CONCLUSION: One in four adults had MS in Oman. This may fuel the epidemic of non-communicable diseases (NCDs) in Oman, particularly given the increasingly elderly population. Urgent action is required to ensure quality patient care at all levels of the healthcare system. Further research on behavioural risk factors is needed. Developing and implementing a multisectoral strategy to prevent NCDs should be at the top of the current health agenda for Oman.