Omar A. Al-Rawas

A relatively high prevalence and severity of asthma, allergic rhinitis and atopic eczema in schoolchildren in the Sultanate of Oman.

Objectives:  Although asthma, allergic rhinitis and eczema are among the most common chronic diseases in children worldwide, there is very limited information about the burden of these conditions in Oman. The aim of this study was to determine the prevalence and severity of symptoms of asthma, allergic rhinitis and eczema in Omani schoolchildren using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I questionnaire.

Asthma control: importance of compliance and inhaler technique assessments

Abstract Objectives: The available assessment tools to determine asthma control do not include components assessing factors that may directly affect control. Our aim was to evaluate the relationship between patient compliance, inhaler technique and the level of asthma control. Methods: Scores from the Asthma Control Test, individual inhaler device checklists and a novel questionnaire on the patient’s medication regimen were used to measure control, inhaler technique and compliance, respectively, in patients with asthma attending Sultan Qaboos University Hospital, Muscat, Oman during a 3-month period. Results: All of the 218 patients were receiving inhaled steroids, either in combination with long-acting beta agonists (86.2%) or alone. Asthma control was good in 92 (42.2%) patients; with 38 males (50%) and 54 females (38%), respectively (p = 0.059). Compliance and inhaler technique were poor in 40.8% (89) and 18.3% (40) of the patients. 60% (36) of the patients with good and 59.4% (41) with partial compliance had good control while 83.1% (74) with poor compliance had poor control (p < 0.001). Of the 92 patients with good control, 86 (93.5%) exhibited good inhaler techniques. In contrast, 85% (34) of the patients with poor inhaler techniques demonstrated poor control (odds ratio [OR] = 5.3; 95% confidence interval [CI]: 2.05–14.8; p < 0.001). A total of 93.3% (56) with good and 89.9% (62) with partial compliance demonstrated good inhaler techniques (p < 0.001). In patients with good control, 35 (38%) exhibited both good inhaler techniques and compliance and 38 (41.3%) had a good technique and partial compliance. Conclusion: Patients with good inhaler techniques and compliance have better control of their asthma. Asthma control will remain suboptimal unless the reasons for this lack of control are identified, assessed and eliminated. We recommend that inhaler technique assessment and measurements of patient compliance with their prescribed treatments should be considered for inclusion in the current assessment tools.

Tuberculosis suspicion and knowledge among private and public general practitioners: Questionnaire Based Study in Oman

BackgroundEarly detection of smear positive TB cases by smear microscopy requires high level of suspicion of TB among primary care physicians. The objective of this study is to measure TB suspicion and knowledge among private and public sector general practitioners using clinical vignette-based survey and structured questionnaire.MethodsTwo questionnaires were distributed to both private and public GPs in Muscat Governorate. One questionnaire assessed demographic information of the respondent and had 10 short clinical vignettes of TB and non-TB cases. The second questionnaire had questions on knowledge of TB, its diagnosis, treatment, follow up and contact screening based on Ministry of Health policy. TB suspicion score and TB Knowledge score were computed and analyzed.ResultsA total of 257 GPs participated in the study of which 154 were private GPs. There was a significant difference between private and public GPs in terms of age, sex, duration of practice and nationality. Among all GPs, 37.7% considered TB as one of the three most likely diagnoses in all 5 TB clinical vignettes. Private GPs had statistically significantly lower TB suspicion and TB knowledge scores than public GPs.ConclusionIn Oman, GPs appear to have low suspicion and poor knowledge of TB, particularly private GPs. To strengthen TB control program, there is a need to train GPs on TB identification and adopt a Private Public Mix (PPM) strategy for TB control.

Normal spirometric reference values for Omani children and adolescents

Objectives:  Normal lung function has been shown to be population specific. The aim of this study was to derive normal reference spirometric values for Omani children and adolescents.

Immigrants and health system challenges to TB control in Oman.

BackgroundDuring the past three decades, Oman has made significant progress in controlling TB within its borders. However, the national TB control program elimination target has yet to be reached. This study aims to explore the perceived roles played by the immigrant population and the private health sector in relation to TB control in Oman.MethodsWe conducted seventeen interviews with different health care providers. The verbatim transcripts were processed using content analysis.ResultsThree main themes emerged. Firstly the threat of repatriation faced by underprivileged expatriates, secondly the criticized and forgotten private health sector as a key player and thirdly the user and provider barriers faced by Omani patients in the Omani public health system.ConclusionsThe study has identified some of the challenges and barriers to TB control in Oman. These challenges are mainly related to unintended negative consequences arising from the current repatriation policy of immigrants and to and the lack of involvement of the private sector in TB control. TB control strategies designed to address these challenges are needed, for Oman to reach its TB elimination targets.

Trends in asthma prevalence and severity in Omani schoolchildren: comparison between ISAAC phases I and III.

Background and objective:  This study evaluated changes in the prevalence of asthma symptoms and asthma severity in Omani school children over time.

Severe Pulmonary Involvement in Leptospirosis : Alternate antibiotics and systemic steroids

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem (1 g every 8 hours), moxifloxacin (400 mg once daily), and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions.

Reflections on the academic accreditation of the MD programme of the college of medicine & health sciences, sultan qaboos university, oman.

In November 2013, The College of Medicine and Health Sciences (COMHS) at Sultan Qaboos University (SQU) was “fully accredited” for a ten-year period (on its first attempt) by the Association for Medical Education in the Eastern Mediterranean Region (AMEEMR) in association with and in accordance with the standards of the World Federation for Medical Education (WFME).The accreditation decision was made on the basis that the MD Programme complies with the WFME’s “Basic and Quality Development Standards”.1 It is notable that COMHS’ “Quality Development Standards” are considered by the WFME as “Best Practice” thus conferring distinguished status on the COMHS’ MD Programme. This article describes the actions taken by the COMHS which led to this success. The achievement of accreditation was neither a sudden nor an unsystematic accomplishment. It was the result of a lengthy and extensive process of continuous improvement of the COMHS’ abilities and capacities that started long before the accreditation endeavour per se began in 2008. The process began by the construction of the “new” curriculum—an exercise that was accompanied and followed by other complementary measures. Only after that was the accreditation process initiated. Before explaining the process in more detail, a description of SQU and the COMHS might be helpful.

Asthma Clinics in Primary Healthcare Centres in Oman: Do they make a difference?

Objectives This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods This retrospective cross-sectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6-95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P <0.001), trigger factors (79% versus 16%; P <0.001) and a history of atopy (81% versus 17%; P <0.001), smoking (61% versus 7%; P <0.001), asthma exacerbations (73% versus 10%; P <0.001) or previous admissions (63% versus 10%; P <0.001). Furthermore, prescription rates of inhaled corticosteroids (72% versus 61%; P = 0.021) and short-acting β-agonists (93% versus 82%; P = 0.001) were significantly higher at ACs compared to GCs. Conclusion Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs.

Peripheral Rim Enhancement in Tuberculous Mediastinal Lymph Nodes

A 50-year-old Arab woman presented with a 3-month history of fever, weight loss, and tiredness. She noticed mild shortness of breath on exertion a month before presentation. She looked fairly healthy, a few cervical lymph nodes were palpable, and the chest examination showed features of a right-sided pleural effusion. A chest radiograph showed a right pleural effusion and mediastinal widening. Computed tomography (CT) confirmed massive mediastinal lymphadenopathy ( Figures 1 and 2 ). The largest lymph node was seen in the right para tracheal area measuring 5 × 3.5 cm. Bilateral pleural effusions were also seen. As seen in the figures, all the lymph nodes showed characteristic central low attenuation with a peripheral rim of enhancement (arrows). A cervical lymph node biopsy showed caseating necrosis and a few acid-fast bacilli, confirming the diagnosis of tuberculosis. HIV serology was negative. CT accurately defines the extent and placement of the lymph nodes. The low attenuation necrotic lymph nodes with rim enhancement after contrast infusion strongly suggest a diagnosis of mycobacterial infection. 1 A similar appearance may be seen in patients with fungal infection, especially Cryptococosis or Histoplasmosis . This appearance is usually not observed in other causes of mediastinal lyphadenopathy such as metastatic carcinoma, lymphoma, sarcoidosis, or leukemia. Low attenuation areas within the nodes represent areas of caseation necrosis and may be a reliable indicator of disease activity. 2,3