The role of patients' families in treatment decision-making among adult cancer patients in the Sultanate of Oman.

There are limited numbers of studies available in Middle Eastern Arabic countries regarding participation of family members in cancer treatment decision-making (TDM). The aim of this study was to evaluate the role of family members' in TDM among adult Omani cancer patients. A cross-sectional study was conducted in two main teaching hospitals. All adult Omani patients who were diagnosed with cancer and their nominated family members were invited to participate. A tool developed by Cancer Care Outcomes Research and Surveillance Consortium was used to identify the level of family involvement in TDM. A weighted kappa (k) was significant (p < .001) and showed almost full agreement between the patients' experiences and their preferences ( k = .98) and between family members' experiences and their preferences ( k = .96) of family involvement in TDM. Binary logistic regression showed significant family-controlled TDM if the patient communicated less with oncologists (OR = 9.89; 95% CI: 3.79-25.81); financial dependence of the patient on their families (OR = 6.21; 95% CI: 2.19-17.10 ); and advanced stages of cancer at the time of diagnosis (OR = 3.10; 95% CI: 1.37-7.03). Oncologists in Oman should be aware of the strong family involvement in TDM to allow a successful cancer treatment.

Patients' views of interpersonal continuity of care in four primary health care centres of urban oman.

OBJECTIVES: 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. METHODS: 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). CONCLUSION: 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.

First Report of Pythium splendens Associated with Severe Wilt of Muskmelon (Cucumis melo) in Oman.

Muskmelon (Cucumis melo L.) is one of the most important vegetable crops in Oman. In the fall of 2004, sudden wilt was observed in muskmelon grown in a field at Sultan Qaboos University, Muscat. The disease was characterized by rapid collapse of vines and muskmelon plants at the fruit production to maturation stage, associated with brown-to-dark brown rotted primary and secondary roots. The disease resulted in death of more than 85% of muskmelon plants in that field. On potato dextrose agar (PDA), with published methods (1), Pythium spp. were consistently isolated from crowns and roots of plants showing wilt symptoms. Further identification of five isolates of Pythium with sequences of the internal transcribed spacer (ITS) of the ribosomal DNA (1) using ITS1 and ITS4 primers produced a nucleotide sequence 806 bp long, which was identical among all isolates. Comparison with sequences deposited at the National Center for Biotechnology Information revealed 100% nucleotide similarity to a previously published sequence (Accession No. DQ381808) of isolate P091 of P. splendens from cucumber from Oman, for which identification has also been confirmed by morphological characteristics. The sequence of one isolate of P. splendens (P222) was assigned GenBank Accession No. EF546436 and deposited at CBS under Accession No. CBS121855. In pathogenicity tests conducted in a greenhouse, P. splendens induced damping-off symptoms on 7-day-old muskmelon seedlings and also reproduced the same wilt symptoms observed in the field when 2-month-old muskmelon plants were inoculated with 3-day-old P. splendens grown in PDA. To our knowledge, this is the first report of association of P. splendens with wilt of muskmelon in Oman. Reference: (1) A. M. Al-Sa'di et al. Plant Pathol. 56:140, 2007.

First Report of 16S rDNA II Group Phytoplasma on Polygala mascatense, a Weed in Oman.

Polygala mascatense Boiss. (family Polygalaceae) is a common weed found in neglected farms, under date palm trees, and in stony locations throughout the Sultanate of Oman (1). It is a perennial herb approximately 30 to 40 cm tall, has slender branches, is woody at the base, and has linear leaves with purple flowers. Recently (November 2004), in the interior region of Oman (210 km south of Muscat), some polygala plants were found stunted with small leaves, bushy growth, and the floral parts were showing phyllody symptoms. Total genomic DNA extracted from asymptomatic and symptomatic plants with modified cetyltrimethylammoniumbromide (CTAB) buffer method (4) was used as a template for direct polymerase chain reaction (PCR) amplification of phytoplasma 16S rDNA with P1/P7 primers. Direct PCR product was used as template DNA for nested PCR with primers R16F2n/R16R2. DNA from plants infected with alfalfa and lime witches'-broom phytoplasma was used as positive controls, and DNA from healthy plants and water was used as negative controls. Products from nested PCR (1.2 kb) were analyzed by using single endonuclease enzyme digestion (restriction fragment length polymorphism [RFLP]) with Tru9I, HaeIII, HhaI, TaqI, AluI, and RsaI (3). The results showed the presence of a 1.8-kb product amplified with direct PCR and a 1.2-kb product of the nested PCR from infected polygala and the positive controls, whereas no PCR products were observed in the negative controls. The PCR assay confirmed the presence of phytoplasma causing witches'-broom disease in polygala. The RFLP results showed the polygala phyto-plasma to be most similar to the alfalfa phytoplasma, a member of 16SrII group (2). Infected polygala weeds may serve as a reservoir for alfalfa witches'-broom phytoplasma that causes annual losses over $25 million to alfalfa cultivation in Oman (2). A detailed investigation needs to be carried out to establish transmission of phytoplasma from polygala to alfalfa. To our knowledge, this is the first report of phytoplasma infecting polygala weeds in Oman. References: (1) S. A. Ghazanfar. Pages 95-96 in: An Annotated Catalogue of the Vascular Plants in Oman. Scripta Botanica Belgica Meise, National Botanic Garden of Belgium, 1992. (2) A. J. Khan et al. Phytopathology 92:1038, 2002. (3) I. M. Lee et al. Int. J. Syst. Bacteriol. 1153, 1998. (4) M. A. Saghai-Maroof et al. Proc. Natl. Acad. Sci. USA 81:8014, 1984.

Kawasaki disease resistant to immunoglobulin G therapy.

We describe a 3-year-old boy with Kawasaki disease who, despite therapy with two doses of intravenous immunoglobulin G and high-dose aspirin, developed myocarditis in the 1st week of illness and coronary artery aneurysms in the 2nd week. He required a short course of systemic corticosteroids for remission of the illness. The myocarditis subsided and coronary aneurysms remained static and uncomplicated during 6 weeks of follow-up. The diagnosis and recent trends in management of this not uncommon vasculitic disorder are outlined.