The patterns and causes of neonatal mortality at a tertiary hospital in oman.

OBJECTIVE: To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. METHODS: This is a retrospective cohort study where four years data (January 2006 - December 2009) of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification. RESULTS: The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths (neonatal and post neonatal) at the neonatal intensive care unit was 73 (63 inborn and 10 out born). Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths (n=58), 34 (59%) were males and 24 (41%) were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% (n=30). Lethal congenital malformations lead to 17 (29%) newborn deaths, specific diagnosis in 7 newborns (12%), and birth asphyxia in four (7%) of cases. CONCLUSION: There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Cytogenetic profile of childhood acute lymphoblastic leukemia in Oman.

BACKGROUND: Chromosomal abnormalities have important diagnostic and prognostic significance in acute lymphoblastic leukemia (ALL). The purpose of this study was to define and classify the frequency and type of chromosomal abnormalities among newly diagnosed children with ALL and compare the results with those reported from other geographical regions of the world. METHODS: Bone marrow chromosomal studies with GTG banding were performed in untreated ALL pediatric patients aged from 7 days to 14 years. RESULTS: Among Omani children examined with ALL, 47 (81%) patients yielded results, with 26 (55.3%) showing an abnormal karyotype [10 (21.3%) pseudodiploid, 2 (4.3%) hypodiploid and 14 (29.7%) hyperdiploidy] and 21 (44.6%) had normal diploidy. Structural abnormalities were observed in 16 (34%), of which 11 (23.4%) cases were translocations, the most frequent being t(9;22) observed in three (6.4%) of our patients. Uncommon translocations such as t(9;15)(p11;q10), t(3;6)(p12;q11), t(1;6)(?31;?q23), t(1;19)(q12;q12), der(18)t(12;18)(q11;p11), and other structural aberrations add(2)(q22), add(6)(q16), add(18)(q22), add(14)(q32) along with deletions del(10)(q22), del(12)(p11), del(12)(p12), del(18)(q11) were also observed. CONCLUSIONS: The study showed a good correlation and concordance between the ploidy distribution by cytogenetics and flow cytometry. The patterns of chromosomal anomalies in our patients showed some variations in the frequency of aberrations reported. It is therefore necessary that newer techniques like fluorescence in situ hybridization (FISH) along with reverse transcriptase polymerase chain reaction (RT-PCR) and spectral karyotyping will help us identify chromosomal aberrations not detected by conventional cytogenetic methods in the near future. To our knowledge, this is the first report from the Middle East of a cytogenetic study on childhood ALL.

Comparison of plain potassium hydroxide mounts, fungal cultures and nail plate biopsies in the diagnosis of onychomycosis.

OBJECTIVE: To compare the relative sensitivity of direct microscopy, fungal culture and nail plate biopsy in the diagnosis of onychomycosis. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Skin Department, Military Hospital, Rawalpindi from February 1998 to February 1999. PATIENTS AND METHODS: A total of 50 patients who were suffering from different clinical variants of onychomycosis, irrespective of their age, gender, with or without simultaneous presence of systemic diseases, were subjected to laboratory investigations including direct microscopy with 20% potassium hydroxide (KOH) for fungal hyphae, fungal cultures and nail plate biopsies. These patients were later categorized into two groups based upon the results of nail plate biopsies. RESULTS: Of 50 patients, 15 (30%) were positive for fungal elements in direct microscopy, 8 (16%) were positive for fungal culture and 16 (32%) revealed positive results in nail plate biopsies. Amongst nail plate biopsy positive cases, 10 (63%) were positive for direct microscopy and 6 (37.5%) were positive for fungal cultures. In biopsy negative cases, positive results for direct microscopy were seen in 5 (14.7%) patients and positive fungal culture was found in 2 (5.88%) patients. CONCLUSION: The clinical impression of onychomycosis is not true in all the cases. Nail scraping for direct microscopy with 20% KOH should be the first line screening test for all patients which should then be supplemented with fungal culture and/ or nail plate biopsy.