Obstructive sleep apnea in patients with severe asthma: Prevalence and association between severity and asthma control.

INTRODUCTION: Asthma and obstructive sleep apnea (OSA) are common respiratory disorders that can coexist and cause sleep disturbances. The strength of this association and the impact of OSA on asthma severity and control remain unclear. The study aims to estimate the prevalence of OSA in patients with severe asthma in Oman and to examine whether the severity of OSA contributed to the level of asthma control. METHODS: Adult patients with confirmed diagnosis of severe asthma who attended the respiratory clinic in a tertiary hospital in Oman over a period of 19 months were enrolled in the study. Eligible participants were screened by asthma control test (ACT) and Berlin questionnaire (BQ). Patients with high risk for OSA were subjected further to level 3 sleep study. The prevalence of OSA in patients with severe asthma and the associations between the severity of OSA and asthma control were calculated. RESULTS: We identified 312 adult asthma patients on Global Initiative for Asthma step 4 or 5 management out of 550 who were screened. The mean age of the study population was 56.59 ± 12.40 years and the mean body mass index (BMI) 40.30 ± 12.24 kg/m2. The prevalence of OSA in asthma patients with severe asthma was found to be 32.4%. Out of the 138 well-controlled asthma patients (ACT ≥20), 35 had high risk of OSA based on BQ, and 32 were confirmed to have OSA (23%). Of the 174 uncontrolled patients, 80 patients had high risk of OSA and 69 patients were confirmed to have OSA (39.65%). Severe OSA was seen in 63.8% and 9.4% in uncontrolled and controlled asthma patients, respectively (P = 0.002). The median respiratory event index in the uncontrolled group was 43, and it was significantly higher than 12.5 in the controlled group (P < 0.001). CONCLUSIONS: The prevalence of OSA was high (32.37%) in patients with severe asthma. Uncontrolled severe asthma was significantly associated with severe OSA.

Prevalence of restless legs syndrome in pregnant women in Oman and its effect on pregnancy and neonatal outcomes.

BACKGROUND: Restless legs syndrome (RLS) is a common sensorimotor disorder during pregnancy. The purpose of this study was to assess the prevalence of RLS and explore the associated risk factors and outcomes in Omani women in the first and third trimester and at 2-week postpartum. MATERIALS AND METHODS: This cross-sectional study included 305 pregnant women visiting four health centers in Muscat between May 2018 and October 2020. A structured questionnaire was used and data were collected through review of electronic records and face-to-face interviews. The International RLS Study Group criteria were used to diagnose RLS. Participants were interviewed during their first trimester, their third trimester, and at their 2-week postpartum visit. Results were presented as means and standard deviations or percentages, as appropriate. To assess the association between RLS and various variables, unpaired t-test or McNemar's test were used, as appropriate. RESULTS: The mean age at baseline was 29.8 ± 5.28 years. The prevalence of RLS was significantly higher in the third trimester (41.0%) than in the first trimester (15.7%) and postpartum period (15.1%) (P < 0.001), although there was no significant difference in severity. Family history and personal history of RLS were the only independent correlates of RLS (P < 0.001 and 0.002, respectively). No associations were noted with pregnancy and neonatal outcomes or other comorbidities, including anemia. However, there was a significant relationship between the development of RLS and weight gain during pregnancy (P = 0.023). CONCLUSION: One in six pregnant Omani women may be at risk of RLS during the first trimester, while one in 2-3 may be at risk in the third trimester, particularly those with a personal or family history of RLS and those who gain >12 kg during pregnancy.

Expression of Toll-like Receptor 2 and 4 in Peripheral Blood Neutrophil Cells from Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality around the world. Preliminary studies have evaluated the association between innate immunity including Toll-like receptors (TLRs) and airway samples of patients with COPD. The role of TLRs in peripheral blood neutrophils is poorly understood. Hence, this study aimed to investigate the role of TLR2 and TLR4 in peripheral blood neutrophils of COPD patients. METHODS: A total of 101 COPD cases and an equal number of healthy controls participated in this case-control study. Peripheral blood neutrophils were isolated from all participants and cultured for 24 hours through lipopolysaccharide (LPS) stimulation. The gene expressions of TLR2 and TLR4 were assessed by real-time polymerase chain reaction. The protein levels of interleukin (IL)-8 and matrix metalloproteinase (MMP)-9 were measured in neutrophils cell culture supernatants using enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of IL-8 and MMP-9 were significantly higher in patients with COPD compared to healthy controls. Similarly, the gene expression of TLR2 and TLR4 were increased in LPS stimulated peripheral blood neutrophils of patients with COPD. Smoke pack years was positively correlated with IL-8 levels and negatively correlated with forced expiratory volume in the first second % (r = -0.33; p = 0.023) and FEV1/forced vital capacity (FVC) (r = -0.27; p = 0.011). CONCLUSIONS: The increased expression of TLR2 and TLR4 suggests its role in disease pathogenesis of COPD. Smoke pack years was negatively associated with spirometric parameters in COPD patients. This may help to predict the smokers without COPD who risk developing the condition in the future.

Comprehensive Analysis of the Chemical Composition and In Vitro Cytotoxic Mechanisms of Pallines Spinosa Flower and Leaf Essential Oils Against Breast Cancer Cells.

BACKGROUND/AIMS: In our quest for new natural anticancer agents, we studied the cytotoxicity of the essential oils extracted from flowers and leaves of Pallines spinosa. METHODS: The essential oils were extracted by hydrodistillation and solid phase microextraction (SPME) from flowers and leaves of the plant and their composition was determined by GC/GC-MS. The cytotoxicity of the oils was evaluated against MCF-7 and MDA-MB-231 breast adenocarcinomas, and the non-cancerous MCF-10-2A cells, using a flow cytometry-based assay Apoptosis was evaluated by flow cytometry, nuclear staining, caspases activation, and Western blotting techniques, and cell cycle by measuring DNA contents. RESULTS: The hydrodistilled flower oil contained mainly sesquiterpenes (96.39%), while the leaf sample was dominated by oxygenated-sesquiterpenes (51.60%) and sesquiterpene-hydrocarbons (34.06%). In contrast, the SPME oil contained mainly monoterpene-hydrocarbons (44.09%) and sesquiterpene-hydrocarbons (34.15%) in the flower and leaf samples, respectively. The cytotoxicity of the flower oil against MCF-7 (IC50 0.25 ± 0.03 µg/mL) and MDA-MB-231 (IC50 0.21 ± 0.03 µg/mL) was much stronger than the leaf oil (IC50 2.4 ± 0.5 µg/mL and 1.5 ± 0.1 µg/mL, respectively). The toxicity of the flower oil was ∼5 to 8-times less in normal MCF-10-2A (IC50 1.3 ± 0.2 µg/mL) and blood mononuclear cells (2.80 ± 0.45 µg/mL) as compared to breast and hematological cancer cells, respectively. Both oils induced a caspase-dependent and -independent apoptosis in MCF-7 and MDA-MB-231 cells, and altered the levels of Bcl-2 and Bax proteins. In addition, the oils arrested cell cycle in both cancer cell lines at G0/G1 phase by modulating the expression of cyclin D1, CDK4 and p21 proteins. CONCLUSION: The cytotoxicity of P. spinosa oils were mediated by apoptosis and cell cycle arrest, suggesting the potential use of their bioactive compounds as natural anticancer compounds.

Risk factors profile of shoulder dystocia in oman: a case control study.

OBJECTIVE: This study aimed to assess the risk factor profile of shoulder dystocia and associated neonatal complications in Oman, a developing Arab country. METHODS: A retrospective case-control study was conducted among 111 cases with dystocia and 111 controls, identified during 1994-2006 period in a tertiary care hospital in Oman. Controls were randomly selected among women who did not have dystocia, and were matched to cases on the day of delivery. Data related to potential risk factors, delivery, and obstetric complications were collected. RESULTS: Dystocia was significantly associated with older maternal age, higher parity, larger BMI, diabetes, and previous record of dystocia. In addition, dystocia was associated more with vacuum and forceps deliveries. Routine traction (51%) was the most used manoeuvre. Among dystocia cases, 13% were associated with fetal complications of which Erb's Palsy was the most prevalent (79%). CONCLUSION: Our finding of significant associations with risk factors lays out the ground to develop a predictability index for shoulder dystocia, which would help in making it preventable. Further p rospective studies are required to confirm the obtained results.

A study on the effects of human age, type of computer and noise on operators' performance of a data entry task.

The effects of human age, type of computer, and noise on computer operators' performance of a data entry task were investigated. Twenty male subjects aged 10-55 were assigned into 4 age groups each consisting of 5 persons. They performed the task for 15 min on desktop and laptop computers in a sitting posture under varying levels of noise. The mean number of characters entered per minute (MNCEPM) was statistically analyzed. Operators in the 16-25 age group achieved the highest rate of data entry at each level of noise investigated. Operators performed better on desktop than on laptop computers. Their performance decreased when noise level increased from 82 to 92 dB(A), but it improved at 102 dB(A). The effects of age and noise were statistically significant. However, the effects of the type of computer, the interactions between age and type of computer, age and noise level, and type of computer and noise were not found to be statistically significant.

Control of Hypertension among Type II Diabetics.

OBJECTIVES: Numerous studies have confirmed the high prevalence of hypertension among type 2 diabetics, and that intensive hypertensive treatment is more beneficial to diabetics than non diabetics. The aim of this study is to assess blood pressure control in patients with type 2 diabetes mellitus and to study the types of antihypertensives used. METHODS: A retrospective study was conducted on hypertensive diabetics followed at a health center in Oman within a year. Patients' age, sex, duration of diabetes, hypertension and the type of antihypertensive used were noted. Patients were classified according to the degree of systolic and diastolic BP control into 4 groups. RESULTS: 210 patients with a mean age of 53.7±9.1 years were included with a 2:5 male to female ratio. The mean duration of diabetes was found to be 9 years and 7 years for hypertension. 10% of the subjects were in the systolic group I, 23% in group II, 23% in group III and 41% in group IV. While 56% were in diastolic group I, 19% in group II, 16% in group III, and 7% in group IV. Angiotensin converting enzyme-inhibitors (ACE) were used in 50% of the subjects followed by a combination of angiotensin receptor blockers (ARB) with diuretics in 40%. B blockers were used in 38% of the patients. Calcium channel blockers were used in 18%, while diuretics were used in 16% of the patients. CONCLUSION: Only 30% of the BP of the hypertensive diabetics met the recommended BP for diabetes. More effort should be dedicated to control the BP in diabetics. Physicians should be careful in the selection of hypertensive medications, because in some combinations, they are not useful.

A study on the effect of human laterality, type of computer and noise on operators' performance of a data entry task.

Effects of human laterality, type of computer and noise on computer operators' performance of a data entry task were investigated. Seven right- and 7 left-motorsided male subjects performed the task on desktop and laptop computers in a sitting posture under varying noise levels. The mean number of characters entered per minute was statistically analysed. The right-motorsided operators entered more data than left-motorsided ones at each noise level. Operators performed better on desktop computers. Operators' performance decreased when noise level increased from 82 to 92 dB(A) but it improved at 102 dB(A). Effects of laterality, type of computer and noise, and the interaction between laterality and noise were statistically significant. The interactions between laterality and type of computer, and type of computer and noise were statistically insignificant. Laterality was statistically significant at all noise levels and noise was statistically significant for right motor-sided operators only.