Masoud Al-Maskari

Psychosocial Aspects of Epilepsy in Oman: Attitude of Health Personnel

Summary:  Purpose: To assess with a questionnaire the awareness and attitudes of the doctors in Oman toward epilepsy. Attitudes of society toward epilepsy have a wide‐ranging influence, affecting issues as diverse as compliance with treatment and doctor–patient communication. Recent studies in both developing and developed countries suggest that within the medical profession, there is a lack of knowledge and negative attitudes toward people with epilepsy (PWE). There are no equivalent studies for Oman or the Arab world.

Folate and vitamin B12 deficiency and hyperhomocysteinemia promote oxidative stress in adult type 2 diabetes

OBJECTIVE The purpose of this study was to examine the status of folate and vitamin B12 (B12) in relation to serum homocysteine (HCY) and oxidative stress indices in patients with type 2 diabetes (T2DM). METHODS This case-control study involved 100 Omani adults (50 patients newly diagnosed with T2DM and 50 age- and gender-matched healthy controls). Several parameters were investigated, including dietary intake and biochemical assessments of folate, B12, HCY, oxidative stress markers (glutathione and total antioxidant status), and antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase). RESULTS Low serum levels of folate, B12, and hyperhomocysteinemia were prevalent in patients with T2DM compared with controls. Oxidative stress was evident in patients with T2DM as indicated by low serum levels of glutathione, total antioxidant status, and impaired antioxidant enzymatic activities (superoxide dismutase, glutathione peroxidase, and catalase). CONCLUSION The low intake of folate and B12 is associated with low serum levels of these two nutrients and hyperhomocysteinemia in Omani adults with T2DM.

Analysis of Inflammatory Mediators in Type 2 Diabetes Patients

The main aim of this study is to assess the inflammatory markers in type 2 diabetes mellitus (T2DM) by measuring some cytokines concentrations and lymphocytes subset and correlate them with other laboratory investigations. Fifty-seven patients with type-2 diabetes and 30 healthy volunteers were enrolled in this study. Data for the C-reactive protein (CRP), haemoglobin, HbA1c, and autoantibody levels were obtained from the patients files. The cytokine concentrations were measured in patients serum using commercially available ELISA assays. Lymphocytes subsets were measured by flow cytometric methods. The levels of IL-1β, IL-6, IL-15, and TNF-α were found to be decreased in T2DM patients, whereas the levels of IL-10, IFN-γ, and caspase-1 were increased, compared to normal controls. T2DM patients with hypertension show significantly decreased levels of IL-1β and caspase-1 compared to patients without hypertension. No significant differences in lymphocytes subset between cases and normal control were observed. Significant correlations were found between HbA1c and IL-6; body mass index (BMI) was significantly correlated with CRP, TNF-α, and phosphate; the weight (Wt) was associated with CRP and IFN-γ. In conclusion, an alteration in the function of the immune system was observed in T2DM patient.

HbA1c Levels among Primary Healthcare Patients with Type 2 Diabetes Mellitus in Oman.

OBJECTIVES To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c (HbA1c) levels compared to older patients, and to determine the factors associated with higher HbA1c levels. METHODS Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios (OR), and 95% confidence intervals (CI) from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate (eGFR), tobacco use, and healthcare index as predictors of good (HbA1c <7%) vs. poor (≥7%) glycemic control. RESULTS Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old (OR=1.7; 95% CI 1.1 to 2.6) and 60+ year (OR=2.5; 95% CI 1.6 to 4.0), female gender (OR=1.5; 95% CI 1.2 to 2.0) and in patients with eGFR ≥60 mL/min/1.73 m(2) (OR=1.9; 95% CI 1.1 to 3.3). Longer duration of diabetes (≥5 years) and treatment with oral agents or insulin were inversely related to good glycemic control. CONCLUSION Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams.

Cardiovascular Risk Assessment in Diabetes Mellitus: Comparison of the General Framingham Risk Profile Versus the World Health Organization/ International Society of Hypertension Risk Prediction Charts in Arabs—Clinical Implications

We estimated the prevalence of cardiovascular disease (CVD) risk and its clinical implications among 1 110 Omani patients with type 2 diabetes mellitus (DM) using 2 different CVD risk tools: the general Framingham risk profile (GFRP) and the joint World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts. The GFRP tool identified higher proportion of patients compared with joint WHO/ISH tool at 10-year CVD risk 10% to <20% and at 20% to <30%. At CVD risk ≥30%, both assessment tools identified similar proportions of patients (22% vs 24%; P=.120). Compared with WHO/ISH charts, the GFRP identified almost double the number of men eligible for aspirin treatment at CVD risk thresholds of ≥10% (86% vs 43%). In women, the proportions were, 66% and 45%, respectively. For statins, the figures were, 60% and 37%, for men and 28% and 36%, for women. In conclusion, the GFRP overestimates the number of patients eligible for primary prevention of CVD compared with the joint WHO/ISH method.

Control of risk factors for cardiovascular disease among adults with previously diagnosed type 2 diabetes mellitus: a descriptive study from a middle eastern arab population.

Background: Despite the high burden of type 2 diabetes mellitus (T2DM) in Oman, there are scarce data from a nationally representative sample on the level of glycaemia and other cardiovascular (CVD) risk factor control. Objective: To estimate the proportion of patients with T2DM at goal for glycaemia and CVD risk factors using the National Diabetes Guidelines (NDG) and the American Diabetes Association (ADA) clinical care guidelines; and to assess the quality of selected services provided to patients with T2DM. Methods: A sample of 2,551 patients (47% men) aged ≥20 years with T2DM treated at primary health care centers was selected. Patient characteristics, medical history and treatment were collected from case notes, Diabetes Registers and computer frameworks including the use of the last 3 laboratory investigations results and blood pressure (BP) readings recorded in 2007. Results: The overall mean age of the cohort was 54±13 years with an average median duration of diabetes of 4 (range 2 to 6) years. Over 80% of patients were overweight or obese (body mass index (BMI) of ≥25 Kg/m2). Sixty-nine percent were on oral anti-diabetic medication, 52% on anti-hypertensives and 40% on lipid lowering drugs. Thirty percent of patients were at goal for glycosylated haemoglobin level (<7%), 26% for BP (systolic/diastolic <130/80 mmHg), 55% for total cholesterol (<5.2 mmol/l), 4.5% for low-density lipoprotein cholesterol (<1.8 mmol/l), 52% for high-density lipoprotein cholesterol (>1 mmol/l for men, >1.3 mmol/l for women), and 61% for triglycerides (<1.7 mmol/l). Over 37% had micro-albuminuria and 5% had diabetic nephropathy. Conclusion: Control of hyperglycaemia and other CVD risk factor appears to be suboptimal in Omani patients with T2DM and need to be addressed in the triad of patient, physician and health system.

Determination of the Levels of Anti-Thyroid- Stimulating Hormone Receptor Antibody with Thyroid Peroxidase Antibody in Omani Patients with Graves' Disease

Objective: To determine the levels of anti-thyroid-stimulating hormone receptor antibody (TRAb) and thyroid peroxidase antibodies (TPO) in Omani patients with Graves’ disease (GD). Subjects and Methods: ELISA was used to measure the levels of TRAb and TPO in sera of 111 patients with GD, 40 patients with systemic lupus erythematosus (SLE) and 50 healthy normal subjects. Seventy-eight GD patients received iodine-131 treatment while 33 newly diagnosed patients did not receive any treatment. Results: The levels of TRAb in the patients with GD, SLE and normal subjects were 7.24 9 ± 0.623, 1.04 ± 0.179 and 0.539 ± 0.070 units/liter, respectively. Elevated levels of TRAb were found in 75, 5 and 2% of patients with GD, SLE and normal subjects, respectively. For anti-TPO antibodies, the levels were 713.331 ± 97.905, 85.575 ± 34.936 and 22.96 ± 4.544 lU/ml, for patients with GD, SLE and normal subjects, respectively. The elevated level of anti-TPO antibodies were found in 72, 15 and 6% of patients with GD, SLE and normal subjects. Statistically significant differences in positive levels of TRAb and anti-TPO antibodies were found in patients with GD as compared to SLE and normal subjects (p < 0.001). The treated GD patients had lower levels of TRAb than untreated, but no difference was detected in the levels of anti-TPO antibodies between the treated and not treated. Conclusion: High levels of TRAb and TPO were detected in Omani patients with GD. TRAb may be helpful in the diagnosis and monitoring the efficacy of iodine-131 treatment in GD patients.

Mood dysfunction and health-related quality of life among type 2 diabetic patients in Oman: Preliminary study

Aim: A temporal relationship exists between the presence of affective disturbance, poor glycaemic control and complications in people with type-2 diabetes. The objective of this study is to compare the performance of patients diagnosed with type-2 diabetes and normoactive group on indices of mood functioning and indices of health-related quality of life. Materials and Methods: In 2006-2007, for a six-month period, diabetics from Oman were screened for the presence of propensity towards psychiatric distress using Self-Reporting Questionnaire during their routine consultation at the diabetic clinic at a tertiary care hospital in an urban area of Oman. Those who fulfilled presently operationalised criteria for subclinical propensity towards affective disorders were further screened for affective functioning (Hospital Anxiety and Depression Scale) and indices of general well-being or health-related quality of life (Nottingham Health Profile). The age- and sex-matched controls group (n=40) underwent the same procedure. Results: Both measurement scales used in the present study indicated that the diabetic group had significantly poorer quality of life and higher distress level than the non-diabetic group, with the exception of emotional reaction for which the non-diabetics showed poorer health than the diabetics. Additionally, no difference between groups was found when compared for social isolation. Conclusions: In agreement with previous studies from different populations, people with diabetes in Oman appear to have marked affective functioning and impairment based on the indices of quality of life. The present finding is discussed within a sociocultural context that has a direct bearing on the situation in Oman.

Chemical Report on Wild Growing Mentha arvensis and Citrullus colocynthus from Oman

Abstract Mentha arvensis and Citrullus colocynthus are important medicinal plants for Arab people as herbal remedy. The present study was designed to evaluate the components present in wild growing Mentha arvensis and Citrullus colocynthus using various advanced analytical techniques. After wet digestion plants samples were analyzed for metal contents using flame photometric and inductively coupled plasma (ICP) analyses. Volatile compounds present in essential oil of Mentha arvensis were determined using Gas chromatographic coupled with Mass spectrometry. Fatty acid composition of Citrullus colocynthus was determined using Gas chromatograph equipped with flame ionization detector (FID). Linoleic acid was found as a major component of Citrullus colocynthus seed oil. Phenolics and flavonoids present in Mentha arvensis and Citrullus colocynthus were detected using High performance liquid chromatography (HPLC). HPLC analysis of Citrullus colocynthus seed oil confirms the presence of anti-diabetic and cholesterol lowering compounds in it.