In Memory of Professor Bazdawi Al-Riyami, MD

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Inflammatory Markers as a Predictor of Postmenopausal Osteoporosis

Objectives: Postmenopausal osteoporosis is a progressive metabolic bone disease resulting from estrogen deficiency. However, due to the silent nature of the disease, there is an urgent need for a simple, early predictive marker. This study, conducted between January 2017 to December 2019, aimed to assess the potential of three factors—specifically, the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR)—as inflammatory markers of bone mineral density (BMD) loss. Methods: A retrospective cross-sectional study was conducted among 450 postmenopausal Omani women undergoing dual-energy X-ray absorptiometry at the Sultan Qaboos University Hospital, Muscat, Oman. Participants were allocated into groups based on lumbar spine BMD t-score values. A receiver-operating characteristic curve was used to find the area under the curve (AUC). Multivariate logistic regression was performed to identify independent predictors of low BMD. Results: A total of 65 (14.4%), 164 (36.4%), and 221 (49.1%) women were allocated to the control, osteopenia, and osteoporosis groups, respectively. No significant differences in PLR, MLR, and NLR values were observed based on group allocation. BMD t-score values were reversely correlated with age (P = 0.007) and PLR (P = 0.004), and positively correlated with body mass index (BMI) (P <0.001). The AUC was 0.59. However, the only independent predictors of low BMD were age (>65 years) and BMI (<25 kg/m2). Conclusion: None of the three inflammatory biomarkers studied were found to be useful prognostic indicators of bone loss. Further research is recommended to reject or support theories regarding the role of inflammatory status in the pathogenesis. Keywords: inflammatory markers, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Bone mineral density, osteoporosis

Productivity of Clinical Trials Conducted at the Gulf Cooperative Council

Objectives: Clinical trial productivity has not been investigated in the Gulf Cooperation Council (GCC) region, including Oman, Saudi Arabia, United Arab Emirates (UAE), Qatar, Bahrain, and Kuwait. We aim to assess the productivity of clinical trials conducted in the GCC region. Specifically, we aim to estimate the number of clinical trials conducted and estimate the proportion of clinical trials conducted in the GCC countries published in peer-reviewed journals. Methods: The clinical trials registry of the U.S. National Library of Medicine (NLM) was searched for clinical trials conducted from January 2000 to October 2019. The productivity was assessed by the publication status of the trials in the registry and through the search in Medline indexed journals. Results: A total of 682 trials were found from the GCC region, with an overall trend of 4.1 trials each year. However, the clinical trial productivity from our area contributes to only 0.37% of the trials globally. When comparing the raw data, Saudi Arabia shows the highest proportion by contributing 66.6% of the clinical trials from the region (p < 0.001). Oman contributed 3.5 %. After normalization to population, Qatar shows to be the highest with 42.78 trials per million. A total of 238 trials were conducted before 2016, of which 46.6% were published. Conclusion: Saudi Arabia is the leading country in clinical trial productivity in the GCC region. Countries should utilize the triple helix model to a partnership with industry and improve their contribution to science. Keywords: Productivity; Clinical Trials; Publication; Oman; Gulf Cooperative Council.

Parents’ Awareness of and Perspectives on Childhood Refractive Error and Spectacle Wear in Saudi Arabia

Objectives: This study aimed to assess parents’ awareness of and perspectives on childhood refractive error in Saudi Arabia. Methods: This cross-sectional study included parents from different regions of Saudi Arabia was conducted between October and November 2020 and included 358 parents. Data were collected using an online questionnaire that involved questions to assess parents’ knowledge and perceptions of childhood refractive error and spectacle wear. Results: A total of 358 completed questionnaires were obtained in this study with a response rate of 85%. Almost 38.3% of parents reported that they had never heard of refractive error. One-third (33.7%) mentioned that uncorrected refractive error did not lead to visual impairment. The majority (74.0%) cited using eyeglasses as an effective way to manage childhood refractive error. Two-thirds (63.7%) stated that they did not receive any information about paediatric eye care. Better knowledge was associated with having a higher educational level, being female, and having an older age (p˂0.001, p=0.008, and p=0.024 respectively). Regarding parents' perspective on spectacle wear, almost 13.7% felt that using eyeglasses affected their children's chances of learning. However, 82.7% supposed that eyeglasses did not affect their children's employment opportunities. Approximately 22.1% thought that using eyeglasses would decrease the eyes power resulting in childhood visual impairment. Conclusion: The level of awareness and perceptions of childhood refractive error and spectacle wear was low among parents. Therefore, a policy is needed to improve the awareness and perception of key stakeholders such as parents and teachers. In turn such an improvement could play a crucial role in addressing the poor knowledge and bad perception of treatment for childhood refractive error. Keywords: Childhood visual impairment; spectacle wear; parental attitudes; refractive error; paediatric eye care; psychological effect; vision care; Spectacle compliance.

Primary ‘False’ Enterolith

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Emphysematous Gastritis on Computed Tomography

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Progressive Dilatation as a Successful Treatment for Y duplication of Urethra

Duplication of urethra is a rare congenital anomaly that has been reported in case reports and case series. A Y-shaped urethral duplication is the rarest variant as per the classification suggested and hence lacks a standardized treatment option. We report a case of Y-duplication of urethra diagnosed during neonatal age and presented to us at nine years of age. The patient had undegone a vesicostomy at seventh day of life for passing urine per anus and was lost to follow up thereafter. An attempt at disconnection of the duplicated urethral tract to anus after colostomy, at eight years of age had failed. The patient was managed successfully by progressive dilatation of the orthotopic urethra, which required multiple stages, followed by separation of the urethra from the rectum. At three years follow up the patient is continent and asymptomatic. Keywords: Y duplication of the urethra; PADUA technique; Rectourinary fistula; Urethral duplication.

Is There an Association between Variceal Bleed and Helicobacter pylori Infection in Cirrhotic Patients with Portal Hypertension?

Objectives: The objective of this study was to find the association of H. pylori in patients with variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension. Methods: This was a prospective cohort of patients with bleeding esophageal varices. The primary outcome was correlation between prevalence of H. pylori and the incidence of bleeding/ rebleeding from varices and with encephalopathy. The secondary outcome were correlation between the site of bleeding with H. pylori infection and the association of pepsinogen I & II and the ratio of pepsinogen I/II with bleeding. Results: A total of 190 patients were assessed for eligibility, out of which 159 patients were included in this study. 124 out of 159 patients (77.9%) had alcohol-related liver disease. 8 out of 159 patients had HBV-related liver disease. 7 patients with varices had neither bled at presentation nor did bleed in the follow-up period. A total of 78 out of 159 (49.05%) patients were H.pylori-infected. Patients with esophageal varices [Adjusted Risk (AR)=0.7] and H.pylori infection (AR=0.7) had a lower risk of variceal rebleeding. Among the patients negative for H.pylori, pepsinogen I was higher in patients with rebleeding (30.7 vs 14.4; p<0.001). Among H.pylori positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 vs 1.3; p=0.023). Conclusion: H.pylori infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of H.pylori infection, rebleeding was associated with more gastric acid output demonstrated by the level of pepsinogen. Keywords: Pepsinogen; hepatic encephalopathy; gastric acid output, Helicobacter pylori

The Impact of Traffic Law Enforcement Regulations on the Incidence and Severity of Maxillofacial Injuries

Objectives: Road traffic accidents (RTAs) are the main cause of facial injuries in Oman. This study aimed to assess the effectiveness of the new traffic law enforcement regulations (TLERs) on the incidence and severity of maxillofacial injuries in Oman. Methods: A retrospective longitudinal analytic study was conducted at three tertiary care hospitals in Muscat, Oman. All patients with RTA-related maxillofacial injuries for a five-year period from January 2005 to December 2009 (before the new TLERs) and the five-year period from January 2015 to December 2019 (after the new TLERs) were included in the study. Results: A total of 1127 patients were included in the study. Of these, 646 (57.3%) patients sustained RTA-related maxillofacial injuries before the implementation of the new TLERs compared to 481 (42.7%) after the introduction of TLERs. There was no significant difference in gender sustained injuries between the two study periods. The incidence of injury before the implementation of the TLERs was 22.7 per 100,000 population, which then reduced significantly to 11 per 100,000 after the new TLERs. Overall, there was a significant reduction in the mean facial injury severity score from 3.2 to 2.3 before and after the implementation of the new TLERs, respectively. Conclusion: The findings of this study indicate that the newly introduced TLERs have resulted in a reduction in the incidence and severity of RTA-related maxillofacial injuries. Continuous improvement and reinforcement of TLERs will further help to reduce the burden of these injuries to the society in general and health services in particular. Keywords: Law Enforcement; Traffic Accidents; Maxillofacial Injuries; Injury Severity Score; Oman.

The Unmet Supportive Care Needs of Omani Women Diagnosed with Breast Cancer

Objectives: This study aimed to assess the unmet supportive care needs of Omani women with breast cancer (BC). Methods: This cross-sectional study was conducted from November 2020 to February 2021 among 250 adult Omani women diagnosed with BC at a university teaching hospital in Muscat, Oman. An Arabic version of the 34-item Supportive Care Needs Survey-Short Form tool was used to determine perceived unmet supportive care needs across five domains. Results: A total of 181 women participated in the study (response rate: 72.4%). The domain with the highest mean score per item was health system and information (mean score: 3.33), with the greatest unmet need in this domain being informed about things that the patient could do to help themselves get well (40.9%). The domain with the second highest mean score per item was patient care and support (mean score: 3.04), with the greatest unmet need being for clinicians to be more sincere with the patient (36.5%). Higher total mean scores were reported by women who had visited the hospital four times or more over the past two months (P = 0.045), those with stage 3 or 4 cancer (P = 0.047) and those who had recently undergone radiotherapy or chemotherapy (P = 0.014). Conclusion: Most unmet supportive care needs fell under the health system and information domain. Healthcare providers in Oman should explore patient concerns and provide sufficient information at various stages of the care process in order to decrease the anxiety associated with living with cancer. Keywords: Breast Neoplasms; Needs Assessment; Supportive Care; Women; Oman.