Sultan Qaboos University Hospital Research Articles

Workplace Violence Against Nurses in Psychiatric Hospitals in Oman

Objective: This study aimed to assess workplace violence prevalence against nurses in Oman's psychiatric hospitals and explore associated factors. Methods: A cross-sectional study design was utilized and data was collected from all tertiary mental healthcare hospitals (Al Masarra Hospital and Sultan Qaboos University Hospital) between October and December 2021. Participants completed a sociodemographic survey and the Workplace Violence in the Health Sector questionnaire. Categorical variables were compared using the chi-square test (p < 0.05). 106 participants took part in the study (80% response rate). Most were female (52.8%) and Omani (72.6%), aged 30-39 years. Results: Workplace violence prevalence was high (90.6%), with verbal violence (86.8%) and physical violence (57.5%) being the most common types. Incidents were more frequent on weekdays (26.4%) and during morning shifts (34%), while 81.1% of nurses worked in shifts and had direct physical contact with patients (83.0%). The majority (92.5%) were aware of standardized workplace violence reporting procedures, and 89.7% confirmed their presence in hospitals. WPV was more prevalent among nurses in inpatient wards (P = 0.047). Conclusion: Workplace violence against nurses in Omani psychiatric hospitals is alarmingly high. Future research should investigate contributing factors among healthcare providers and emphasize violence prevention by providing staff nurses with effective training to handle violent incidents involving psychiatric patients. Keywords: Workplace, Workplace Violence, Occupational stress, Working conditions, Nurses, Psychiatry, Oman.

A Machine Learning-Based Mortality Prediction Model for Patients with Chronic Hepatitis C Infection: An Exploratory Study.

Background: Chronic hepatitis C (HCV) infection presents global health challenges with significant morbidity and mortality implications. Successfully treating patients with cirrhosis may lead to mortality rates comparable to the general population. This study aims to utilize machine learning techniques to create predictive mortality models for individuals with chronic HCV infections. Methods: Data from chronic HCV patients at Sultan Qaboos University Hospital (2009-2017) underwent analysis. Data pre-processing handled missing values and scaled features using Python via Anaconda. Model training involved SelectKBest feature selection and algorithms such as logistic regression, random forest, gradient boosting, and SVM. The evaluation included diverse metrics, with 5-fold cross-validation, ensuring consistent performance assessment. Results: A cohort of 702 patients meeting the eligibility criteria, predominantly male, with a median age of 47, was analyzed across a follow-up period of 97.4 months. Survival probabilities at 12, 36, and 120 months were 90.0%, 84.0%, and 73.0%, respectively. Ten key features selected for mortality prediction included hemoglobin levels, alanine aminotransferase, comorbidities, HCV genotype, coinfections, follow-up duration, and treatment response. Machine learning models, including the logistic regression, random forest, gradient boosting, and support vector machine models, showed high discriminatory power, with logistic regression consistently achieving an AUC value of 0.929. Factors associated with increased mortality risk included cardiovascular diseases, coinfections, and failure to achieve a SVR, while lower ALT levels and specific HCV genotypes were linked to better survival outcomes. Conclusions: This study presents the use of machine learning models to predict mortality in chronic HCV patients, providing crucial insights for risk assessment and tailored treatments. Further validation and refinement of these models are essential to enhance their clinical utility, optimize patient care, and improve outcomes for individuals with chronic HCV infections.

Prevalence of Dysmagnesemia among Patients with Diabetes Mellitus and the Associated Health Outcomes: A Cross-Sectional Study.

Introduction: Magnesium is a vital intracellular cation crucial for over 320 enzymatic reactions related to energy metabolism, musculoskeletal function, and nucleic acid synthesis and plays a pivotal role in human physiology. This study aimed to explore the prevalence of dysmagnesemia in patients with diabetes mellitus and evaluate its correlations with glycemic control, medication use, and diabetic complications. Methods: A cross-sectional study was conducted at Sultan Qaboos University Hospital, including 316 patients aged 18 years or older with diabetes mellitus. Data included demographics, medical history, medications, and biochemical parameters. Serum total magnesium concentrations were measured, and dysmagnesemia was defined as magnesium ≤ 0.69 mmol/L for hypomagnesemia and ≥1.01 mmol/L for hypermagnesemia. Results: The prevalence of hypomagnesemia in patients with diabetes was 17.1% (95% CI: 13.3-21.7%), and hypermagnesemia was 4.1% (95% CI: 2.4-7.0%). Females were significantly overrepresented in the hypomagnesemia group, while the hypermagnesemia group showed a higher prevalence of hypertension, retinopathy, an increased albumin/creatinine ratio, chronic kidney disease (CKD), elevated creatinine levels, and a lower adjusted calcium concentration. The multinominal logistic regression exhibited that the female sex and higher serum-adjusted calcium were independent risk factors of hypomagnesemia. In contrast, the presence of hypertension, higher levels of albumin/creatinine ratio, and stage 5 CKD were independent risk factors of hypermagnesemia. Conclusions: Hypomagnesemia was common among patients with diabetes mellitus; however, hypermagnesemia was associated with microvascular complications.

Anatomical variations of Koerner's septum: a computed tomography-based, single-centered study.

Koerner's septum (KS) is a bony plate located at the junction of the petrous and squamous parts of the temporal bone. The reported prevalence of KS varied between studies. KS variations are associated with various pathologies and pose difficulties during surgeries. The study aims to determine the KS frequency in Omani patients and analyze its association with sex and side. The present study investigated the KS topography in 344 computed tomography (CT) scans of normal temporal bones of adult Omani patients at Sultan Qaboos University Hospital. The presence of KS and its parts (complete or incomplete), as well as its thickness at three anatomical landmarks were recorded. Additionally, sex and laterality differences in KS parameters were analyzed using a Chi-square test. The overall frequency of KS among Omani subjects was 39.5%. The complete KS was observed only in 14% of cases. The thickness of KS was 0.78 ± 0.21 mm, 0.93 ± 0.28 mm and 0.78 ± 0.21 mm at the head of the malleus (HM), the superior semicircular canal (SSC) and the tympanic sinus (TS), respectively (p<0.01). KS was present most constantly at the level of HM (64.7%), followed by SSC (57.4%), and less constantly at the level of TS (49.3%). KS frequency was similar in both males than females (41.9% vs 37.3%), with statistically insignificant difference (p = 0.38). No side differences were observed concerning KS frequency (p = 0.955). The KS frequency in Omani subjects within the range of previously reported studies. It is incomplete in most of the cases and constantly present at the level of HM. Its thickness is more at the level of SSC.

Evaluation of Hospital Wastewater Treatment Using Sewage Treatment Plant for Heavy Metals, Radionuclides, and Some Pharmaceuticals: A Case Study

This is the first study in Oman to evaluate the efficiency of a sewage treatment plant (STP) for hospital wastewater (HWW) treatment for heavy metals, radionuclides, and some selected pharmaceuticals. A sewage treatment plant (STP) at Sultan Qaboos University (SQU) receives HWW, from Sultan Qaboos University Hospital (SQUH), and municipal wastewater from non-medical facilities at SQU. Representative samples of HWW (before mixing with municipal wastewater at STP), STP-treated wastewater (TWW), and STP mixing sludge, were collected and analyzed. A method for analyzing pharmaceuticals including metformin, atenolol, chlorpheniramine, triprolidine, diphenhydramine, and citalopram was developed and validated using LC-MS-MS. HWW and TWW show low concentrations of heavy metals. Radionuclides found in HWW include Cs137, K40, Ra226, Th234, I131, Tl208, Zn65 Ac228, Sb125, Bi124 and Be7. Diphenhydramine (2.24 mg/L), chlorpheniramine (0.293 mg/L) and atenolol (0.0260 mg/L) were found in HWW. Heavy metals, radionuclides, and pharmaceuticals were found less in TWW than in HWW. STP sewage sludge showed higher levels of these pollutants than HWW or TWW. Concentrations of diphenhydramine, chlorpheniramine, and citalopram were 137, 0.950, and 169 mg/kg, respectively in dried sewage sludge. The study confirms the ineffectiveness of STP treatment to completely remediate HWW. HWW should be considered hazardous and requires physico-chemical treatment before mixing with municipal wastewater. Keywords: Hospital, pharmaceuticals, radionuclides, heavy metals, wastewater.

Health-Related Quality of Life of Omani Adult Patients with Sickle Cell Disease at the Sultan Qaboos University Hospital

Objectives: The quality of life of Omani adults with sickle cell disease (SCD) is not yet known. This study aimed to determine the health-related quality of life (HRQoL) of adult Omani patients with SCD attending a single tertiary center. Methods: A cross-sectional study was conducted among patients with SCD from June to October 2022 at the Sultan Qaboos University Hospital. A validated Arabic version of the 36-Item Short-Form Health Survey (SF-36) was used to assess HRQoL over eight domains. Results: A total of 235 patients with SCD participated in the study, of which the majority were female (74.9%) and 18–35 years of age (64.6%). The lowest HRQoL was reported for the domain of role limitations due to physical health (median score: 25.0; interquartile range [IQR]: 35.0), while the highest was seen for role limitations due to emotional problems (median score: 66.7, IQR: 100.0). Frequent SCD-related emergency department visits/hospital admissions and the adverse effect of SCD on patients’ social lives had a significant negative impact on SF-36 scores for all eight HRQoL domains (p ≤0.05). In addition, the impact of SCD on academic performance and a history of having been bullied due to SCD had a significant negative impact on SF-36 scores for several domains (p ≤0.05). Conclusion: Omani adult patients with SCD reported relatively poor HRQoL in several domains, with various factors found to have significant associations with poorer HRQoL. Healthcare providers and policy-makers should consider offering additional clinical, educational, and financial support to patients to enhance their HRQoL.&#x0D; Keywords: Sickle Cell Disease; Health-Related Quality of Life; Adults; Oman

Sharing Unpleasant Health Updates with Patients

Objectives: This study aimed to investigate knowledge, attitudes, and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital (SQUH) from August to October 2022. An electronic, self-administered questionnaire was used to gather data from 400 physicians across various SQUH departments. Results: A total of 89 physicians completed the questionnaire (response rate: 22.3%). Most (96.6%) recognised the need for additional training in the delivery of unpleasant health updates, with 78.7% expressing their willingness to undertake such training. However, 32.6% reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing unpleasant updates to the patient’s family without their consent. The majority (86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6–85.4%, 12.4–34.8%, and 1.1–11.2% of physicians reported usually, sometimes, and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables to correlate with adherence level, with married physicians and those with board or fellowship certificates reporting significantly better adherence compared to their counterparts. Conclusion: Physicians in Oman encountered challenges in delivering unpleasant health updates, underscoring the interplay of cultural influences, training, and adherence to protocols. To address these challenges, targeted and frequent training programs are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.&#x0D; Keywords: Physician-Patient Relations; Truth Disclosure; Clinical Protocols; Communication; Empathy; Oman.

Complications of Open Reduction and Internal Fixation of Mandibular Condyle Fractures in Oman

Objectives: The management of mandibular condyle fractures by Open Reduction and Internal Fixation (ORIF) is gaining popularity worldwide. The aim of this study is to report the complication rate associated with ORIF of mandibular condyle fractures in Oman. Methods: A retrospective cohort study was conducted among all patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and Sultan Qaboos University Hospital, Muscat, Oman, from January 2008 to December 2020. Data collected included; patient demographics, fracture aetiology, fracture side and type, surgical approach, and recorded complications and outcome. Results: A total of 68 patients (59 males and 9 females, mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fracture was the commonest type accounting for 62.7% and bilateral fractures occurred in 21 (30.8%) patients. The most common surgical approach was retromandibular accounting for 42.2%. The overall rate of recorded complications was 42.6% and the commonest reported complications were transient facial nerve palsy (18.1%), followed by malocclusion and restricted mouth opening accounting for 14.7% and 10.3%, respectively. Subsequent surgical intervention to correct malocclusion was performed in six cases. There was no statistically significant difference in overall complications and the patient’s clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures offers a favourable outcome, it carries a small risk of developing a few complications.&#x0D; Keywords: Mandibular Fracture; Mandibular Condyle; Open Fracture Reduction; Complications; Facial Nerve Injuries; Oman.

Factors Affecting the Early Maturation of Arteriovenous Fistulae Created at a Tertiary Centre in Oman.

This study aimed to determine the risk factors associated with the failure of arteriovenous fistulae (AVF) maturation. This retrospective cohort study was conducted from January 2014 to December 2018 in Sultan Qaboos University Hospital, Muscat, Oman. Patients were followed-up 3 months after surgery, and their electronic medical records were accessed for demographic and clinical data. Univariate analysis was used to determine the risk factors associated with early AVF maturation and multivariant analysis was used to determine the predictive factors for AVF failure. A total of 269 patients were included. Female gender was a significant factor affecting AVF maturity (P = 0.049), while age (P = 0.626), diabetes (P = 0.954), hypertension (P = 0.378), dyslipidaemia (P = 0.907), coronary artery disease (P = 0.576), cerebrovascular accident (P = 0.864), congestive heart failure (P = 0.685), previous central venous catheterisation (P = 0.05), fistula type (P = 0.863) and fistula site (P = 0.861) did not affect AVF maturation. Binary logistic regression showed that all the risk factors were insignificant. Failure of early AVF maturation affected 11.5% in the cohort. This study found that the proportion of early AVF maturation at our hospital is at par with that in the international literature. Failure of AVF maturation was significantly associated with the female gender. These findings can help nephrologists and vascular surgeons prognosticate AVF maturation rates. However, a larger study is needed for definitive conclusions.

Adherence to Medications in Patients with Ischaemic Heart Disease in Oman.

This study aimed to evaluate the level of adherence to medication among patients with ischaemic heart disease (IHD) in Oman and assess the related factors. This cross-sectional questionnaire-based study among patients with IHD attending the outpatient clinic at Sultan Qaboos University Hospital, Muscat, Oman, was performed between January and December 2021. A total of 105 patients (mean age = 49.9 ± 11.1 years, 78.1% male) were recruited. Most of the patients (80%) reported taking the medications by themselves; 77 (73.3%) patients said that over the preceding 2 weeks, they had missed at least 3 doses of their medication. The reasons for missing the medications included forgetting (100%), having to take too many tablets (57%), feeling that the tablets are not effective (48%) and having to take the tablets too often each day (23%). The factors responsible for patients failing to take medications could not be identified. Medication adherence was low among patients with IHD in Oman, with high pill burden being the most common reason for non-adherence. Physicians must bear this in mind when reviewing patients.

Pituitary Adenoma Prevalence and Characteristics of Omani Patients: A Single Center Experience.

To estimate the incidence of pituitary adenomas (PA) in adult Omani patients and describe its epidemiological, clinical, and radiological characteristics. In this longitudinal, descriptive study, we reviewed the records of all PA patients from January 2015 to January 2020 who presented at the endocrinology facilities at Sultan Qaboos University Hospital, Muscat. The participants comprised of 112 Omani patients with PA. The incidence of PA among all adult patients at Sultan Qaboos University Hospital (inpatient and outpatient) over five years (2015-2020) was 0.23%. The cohort had a mean age of 41.0±15.0 years. Of the 112 patients included in this study, 79 (70.5%) were women. Nearly half (51; 45.5%) of adenomas were prolactinomas while 46 (41.1%) were non-functioning adenomas, and seven (6.3%) were growth hormone-secreting adenomas while six (5.4%) were adrenocorticotropic hormone secreting adenomas. Headache was present in 67 (59.8%) patients, followed by visual field defects (40; 35.7%), galactorrhea (26; 23.2%), and fatigue (19; 17.0%). The majority of women (45/79; 57.0%) presented with menstrual cycle abnormalities. Radiological appearances were nearly equally distributed between micro- and macroadenomas. Most cases (58/112; 52.0%) of PA were treated medically by cabergoline, octreotide, and replacement therapies such as hydrocortisone and thyroxin, 38 (33.9%) were treated surgically (mainly by trans-sphenoidal pituitary resection), and the remaining 10 (8.9%) cases were subjected to radiotherapy. Medical treatment combined with surgery was employed for 15 (13.4%) patients. In our investigation, PA was primarily prevalent among Omani female patients, and the most common subtype of pituitary tumors was prolactinomas. The most common presentation symptom was headaches; most female patients had menstrual irregularities. Medical treatment was the primary approach for the applicable types of PAs, while surgery and radiotherapy were found to be secondary and tertiary treatment options, respectively.

Seroprevalence of Human T-cell Lymphotropic Virus Types I/II Among Blood Donors in a Tertiary Hospital in Oman.

Routine blood donor screening of human T-cell lymphotropic virus (HTLV) has been practiced in Oman since 2017. Limited data exists on HTLV seroprevalence among Omanis. This study aims to determine the seroprevalence of HTLV-I/II among blood donors attending a hospital-based blood bank to assess the need for a universal versus targeted screening. We conducted a retrospective review of blood donors' results attending a hospital blood bank between January 2017 and February 2020. Blood samples were screened for HTLV-I/II antibodies using ARCHITECT i2000SR. Reactive samples underwent further testing by immunoblot assay (MP Diagnostics HTLV Blot 2.4). Age, gender, and nationality were assessed. All components manufactured at the blood bank undergo leukoreduction before storage. A total of 24 469 first-time blood donors were screened for HTLV antibodies. Most participants were male (n = 22 186, 90.7%), and the majority were Omani (n = 22 711, 92.8%). The age range was 18 to 64 years, with a median of 32 years. The seroreactivity rate was 0.2% (43; 95% CI: 0.12-0.23). Confirmatory testing by immunoblot revealed three indeterminate results (7.9%), of which two were Omani and one non-Omani donor, and the remaining 40 seroreactive donors tested negative. Our study revealed zero seroprevalence of confirmed HTLV among blood donors. The continuation of universal screening for first-time donors is a standard of care. With universal leukoreduction at Sultan Qaboos University Hospital and a very low risk of HTLV in Oman's population, the need for screening regular donors can be reconsidered if these findings are confirmed on a larger scale involving other blood banks in Oman.

The Rate of Epidural Analgesia in Labor with Maternal And Neonatal Outcome at Tertiary Hospital in Oman

Objectives: The primary objective is to determine the epidural analgesia rate and its effect on the mode of delivery. The secondary objectives are to assess patient satisfaction, duration of second stage of labour and incidence of maternal, fetal and neonatal outcomes. Methods: A retrospective cohort design utilized in this study, involving all pregnant women received epidural analgesia in labour at Sultan Qaboos University Hospital over 3 years period (March 2020 to March 2023). All data is collected from the delivery register at Delivery ward, SQUH track care system, and epidural record chart. Women’s information remained confidential. All entered data in the SPSS program is stored in a passwordprotected computer. Results: There was a total of 7076 deliveries, out of which 389 received epidural analgesia, with a rate of 5.0% (95% CI: 5.0 – 6.0). Out of 389 deliveries, around half were nulliparous and the other half were multiparous. The rate of spontaneous vaginal delivery constituted 60.7%. On the other hand, instrumental deliveries and LSCS constituted 14.9% and 24.4% respectively. The median and mean (±SD) period of 2nd stage were 24.0 and 38.3±40.1. Only 1% of all included patients had prolonged second stage of labor. The rate of oxytocin use was 54.5%, and around 52.4% of it was among nulliparous. 148 patients (52.5% ) reported full benefit from epidural analgesia use, compared to 6% who reported no benefit. In addition, 12.7% of CTG showed fetal distress and postpartum hemorrhage constituted 6.7% among delivered ladies. The study showed that 10.0% of included ladies suffered one or more of post-partum complications, including fever (n 13, 3.3%), headache (n 10, 2.6%), backache (n 3, 0.8%), hypotension (n 9, 2.3%), urine retention (n 3, 0.8%), pruritus (n 1, 0.3%), and nausea and vomiting (n 1, 0.3%). 6.2% was the rate of NICU admissions among the newborns. Conclusions: The study revealed that 5% was the rate of epidural analgesia usage and spontaneous vaginal delivery was the main mode of delivery. However, the indications for delivery by cesarean section or instruments were not related to epidural analgesia in labour. In addition, there was no significant adverse effect on maternal, fetal and neonatal outcome. Based on that, we need to elaborate more on epidural analgesia awareness and usage in order to be offered. Although some previous reviewed studies reported adverse effects of epidural analgesia on labour outcome. Future researches are recommended including prospective design study, bigger sample size, wider variation and multicenter studies.

Analysis of COVID-19 Vaccine Adverse Drug Reactions Reported Among Sultan Qaboos University Hospital Staff

Objectives: The aim of this study was to report any suspected adverse drug reactions (ADRs) experienced by all vaccinated staff and students. Methods: This study conducted during COVID-19 vaccination campaign that took place in a tertiary teaching hospital in Muscat from 29/Aug/2021 to 12/Sep/2021. An online survey was generated, and sent to all staff and students via email and through their mobile phones. An announcement at the hospital website with a link to the survey was made. Data analysis with descriptive statistics was done via STATA software. Results: In this study, 8,421 individuals reported being vaccinated with a total of 11,468 doses administered. A total of 8,014 patients’ doses received the Pfizer-Biotech vaccine while 3,454 patients’ doses received the Oxford-AstraZeneca brand. There were a total of 3,275 (38.8%) responses to the survey distributed. A total of 741 individuals (22.6%) experienced an ADR after taking the vaccine and 67% (n = 498) were females (P&lt;0.001). Majority of the ADRs reported were fever and chills (19.7%) followed by localized pain at the injection site (18.8%). Other ADRs were reported such as hair loss (0.5%) and one patient reported a clot in the right leg. Most responders (27%) considered their ADRs as mild while 25% of the responders considered them as severe. Conclusion: In the study cohort, there were mild symptoms of COVID-19 vaccines, and females had more risk of ADRs compared to males. It is crucial to observe for long term ADRs to the vaccines and a follow-up monitoring should be done to subjects to preclude any unwanted effects.&#x0D; Keywords: Pfizer-BioNTech (BNT162b2), Oxford-AstraZeneca (ChAdOx1 nCoV-19), COVID-19 vaccines, COVID-19, Adverse Drug Reactions.

Computed-tomography evaluation of parietal foramen topography in adults: a retrospective analysis.

The parietal foramen (PF) of the skull is a variable anatomic feature with important implications for venous drainage, infection, and injury. Its topography is clinically relevant for neurosurgeons for intracranial navigation and preoperative planning. PF topography was investigated in a series of 440 head computed-tomography scans of Omani subjects at Sultan Qaboos University Hospital. The mean age of the patients was 52 ± 17years and there were 160 males and 280 females. The topography features of the PF, including frequency, diameter, patency, and relative position in relation to the superior sagittal sinus (SSS), were recorded. Additionally, sex and laterality differences in PF parameters were analyzed using a Chi-square test. The overall prevalence of PF was 72.3% (318/440). The bilateral presence of PF was identified in 34% of skulls. Unilateral right-side prevalence was 18.2%, while left prevalence was 13.2% (p = 0.62). The prevalence of unilateral accessory PF on the right side was 1.8%, while it was 1.1% on the left (p = 0.69). PF within the sagittal suture/or intra-sutural PF was observed in 6.8% of skulls, with a frequency of 9.4% in men and 5.4% in women (p = 0.29). The diameter of the PF was 1.45 ± 0.74 mm on the right side, and 1.54 ± 0.99 mm on the left side (p = 0.96). There were 2% of incomplete PF. The PF was located over the SSS in 70.3% on the right side and 53.8% on the left side. No significant differences were observed between the PF topography parameters and sex or laterality. The present study for the first time reports the baseline data of PF topography in a large sample of CT scans in the Arab population. The geography and race influence the PF topography differences. PF may be used as a reliable landmark of SSS. The morphological characteristics and distribution of PF reported in this study have clinical implications for imaging diagnosis, intracranial navigation of vascular disorders, and treatment.

Knowledge of cervical cancer screening among Omani women attending a university teaching hospital: a cross-sectional study

ObjectivesTo assess knowledge, attitudes, and practices regarding cervical cancer and Pap smear screening among Omani women attending a tertiary clinic in Muscat, Oman, and to establish correlations with selected sociodemographic factors.MethodsAn observational, cross-sectional study was carried out among Omani women aged 18–50 years old attending the outpatient clinic of the Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, from October 2019 to February 2020. A validated Arabic-language questionnaire was utilized to collect data regarding the participants’ sociodemographic characteristics, their knowledge of cervical cancer and related risk factors, and their knowledge, attitudes, and practices related to cervical cancer screening and Pap smear testing.ResultsOf the 380 respondents, 86 and 55% had previously heard of cervical cancer and Pap smear testing, respectively; however, only 26% were knowledgeable concerning these topics. Knowledge scores were significantly associated with various sociodemographic factors, including marital status and a previous awareness of cervical cancer (odds ratio: > 1, p < 0.05). Only 21% had themselves previously undergone Pap smear testing; however, 75% reported being willing to undergo such screening in future.ConclusionsKnowledge regarding cervical cancer-related risk factors and Pap smear screening was poor among a cohort of Omani women attending a tertiary clinic in Muscat, Oman. This may play a role in the increased frequency of cervical cancer cases observed in Oman over recent years. As such, a well-structured public education program is recommended to raise awareness of this issue.

The role and effect of companions during childbirth in Oman

BackgroundThere is increasing evidence that a companionship is an important tool for improving the quality of care provided to pregnant women during the labour and delivery process. The literature review shows very limited studies assessing the role of companions during childbirth from the companion’s point of view. Many published papers studied the role and satisfaction of pregnant women but not their companions. Therefore, this study aimed to assess the role and effect of companions during childbirth in Oman.MethodsThis cross-sectional observational study was conducted at Sultan Qaboos University Hospital, Oman, between June 2022 and April 2023. Companions were interviewed face-to-face at a time convenient to them. A telephone interview was conducted with those who left the hospital early. The questionnaire comprised sociodemographic data and other sections, including the nature of the help provided by the supportive companion, their effects on the women who gave birth, and the timing of their presence during companionship.ResultsA total of 214 companions were included in this study with the mean age of 42.54 years. The most common relationship to the pregnant women was mothers (35.7%), followed by husbands (30.5%). The majority of companions provided support during admission (62.6%), in the immediate post-partum ward (56.5%) and during delivery (54.2%), while a minority helped from admission to discharge (22.4%). The most common type of support provided was encouraging words (89.7%) followed by transferring things (43.9%), massage (37.4%) and touch (33.6%). The majority of companions (96.7%) reported that their support helped very much, and the pregnant women felt better and calmer.ConclusionsLabouring women felt better and calmer because of the presence of companions. Companions preferred to be present in the postpartum and during labour and delivery. The majority of companions support their labouring women by encouraging wards. Companions love and encourage others to support their labouring women during their critical times.

Adverse pregnancy, fetal and neonatal outcomes in women with sickle cell disease in a Middle Eastern country.

Sickle cell disease in pregnancy is associated with high maternal and fetal mortality. However, studies reporting pregnancy, fetal, and neonatal outcomes in women with sickle cell disease are extremely limited. The objectives of the study are to determine whether women with sickle cell disease have a greater risk of adverse pregnancy, fetal, and neonatal outcomes than women without sickle cell disease and identify the predictors of adverse pregnancy, fetal, and neonatal outcomes in women with sickle cell disease. A retrospective pair-matched case-control study was conducted to compare 171 pregnant women with sickle cell disease to 171 pregnant women without sickle cell disease in Muscat, Sultanate of Oman. All pregnant Omani women with sickle cell disease who delivered between January 2015 and August 2021 at Sultan Qaboos University Hospital and Royal Hospital, who were either primipara or multipara and who had a gestational age of 24-42 weeks, were included as patients, whereas women who had no sickle cell disease or any comorbidity during pregnancy, who delivered within the same timeframe and at the same hospitals, were recruited as controls. The data were retrieved from electronic medical records and delivery registry books between January 2015 and August 2021. Women with sickle cell disease who had severe anemia had increased odds of (χ2 = 58.56, p < 0.001) having adverse pregnancy outcomes. Women with sickle cell disease had 21.97% higher odds of delivering a baby with intrauterine growth retardation (χ2 = 17.80, unadjusted odds ratio = 2.91-166.13, p < 0.001). Newborns born to women with sickle cell disease had 3.93% greater odds of being admitted to the neonatal intensive care unit (χ2 = 16.80, unadjusted odds ratio = 1.97-7.84, p < 0.001). In addition, the children born to women with sickle cell disease had 10.90% higher odds of being born with low birth weight (χ2 = 56.92, unadjusted odds ratio = 5.36-22.16, p < 0.001). Hemoglobin level (odds ratio = 0.17, p < 0.001, 95% confidence interval = 0.10-3.0), past medical history (odds ratio = 7.95, p < 0.001, 95% confidence interval = 2.39-26.43), past surgical history (odds ratio = 17.69, p < 0.001, 95% confidence interval = 3.41-91.76), and preterm delivery (odds ratio = 9.48, p = 0.005, 95% confidence interval = 1.95-46.23) were identified as predictors of adverse pregnancy, fetal, and neonatal outcomes in women with sickle cell disease. As pregnant women with sickle cell disease are at increased risk for pregnancy, fetal, and neonatal adverse outcomes; improved antenatal surveillance and management may improve the outcomes.

Characteristics of Patients Presenting with Deliberate Self-harm to the Sultan Qaboos University Hospital, Muscat, Oman

Background: Deliberate self-harm (DSH) is an increasingly prevalent public health concern, particularly in adolescents and young adults. There is a dearth of recent studies that focus on DSH in countries in the Arab-Islamic world, such as Oman, which is undergoing rapid urbanization and modernization. Objectives: This study aimed to investigate the demographic and clinical characteristics of patients presenting with DSH at a single tertiary center in Muscat, Oman. Patients and Methods: A retrospective, cross-sectional study was conducted among patients aged ≥ 10 years clinically diagnosed with non-suicidal DSH at the Sultan Qaboos University Hospital between January 2019 and December 2021. Patients' electronic medical records were used to collect information on patients' demographics (gender, age, employment, educational, and marital status) and clinical characteristics (psychological comorbidity, method, frequency, and triggers of DSH). Descriptive and univariate analyses using the Pearson chi-squared test were performed using the statistical package for social sciences (SPSS) software program. Results: A total of 98 patients were diagnosed with DSH during the study period, of whom 17 (17.3%) were male and 81 (82.7%) were female. Most patients were aged 10 - 25 years (61.2%), single (66.3%), and were students either in college (27.6%) or school (24.5%). The majority (62.2%) had mental health comorbidities, with psychotic disorders (27.6%) being the most common, followed by major depressive disorder (24.5%). The majority of DSH acts (88.9%) were impulsive in nature and not premeditated. Social stress was reported to be the most common trigger for DSH (41.8%), with the most common method being drug overdoses (58.2%). Overall, drug overdoses were slightly more common among patients aged &lt; 40 years (60.9%; P = 0.067) and female patients (63.0%; P = 0.067), while self-cutting more frequently occurred among patients aged &gt; 40 years (54.5%; P = 0.070) and male patients (47.1%; P = 0.080); however, these differences were not statistically significant. Conclusions: This study found that DSH was more frequent in young, single female students with comorbid mental disorders. Healthcare providers should be cognizant of the increased likelihood of DSH in this patient group and, therefore, screen and refer at-risk patients and those suspected of DSH for appropriate psychological support and counseling.

Feed-forward networks using logistic regression and support vector machine for whole-slide breast cancer histopathology image classification

The performance of an image classification depends on the efficiency of the feature learning process. This process is a challenging task that traditionally requires prior knowledge from domain experts. Recently, representation learning was introduced to extract features directly from the raw images without any prior knowledge. Deep learning using a Convolutional Neural Network (CNN) has gained massive attention for performing image classification, as it achieves remarkable accuracy that sometimes exceeds human performance. But this type of network learns features by using a back-propagation approach. This approach requires a huge amount of training data and suffers from the vanishing gradient problem that deteriorates the feature learning. The forward-propagation approach uses predefined filters or filters learned outside the model and applied in a feed-forward manner. This approach is proven to achieve good results with small size labeled datasets. In this work, we investigate the suitability of using two feed-forward methods such as Convolutional Logistic Regression Network (CLR), and Convolutional Support Vector Machine Network for Histopathology Images (CSVM-H). The experiments we have conducted on two small breast cancer datasets (Sultan Qaboos University Hospital (SQUH) and BreaKHis dataset) demonstrate the advantage of using feed-forward approaches over the traditional back-propagation ones. On those datasets, the proposed models CLR and CSVM-H were faster to train and achieved better classification performance than the traditional back-propagation methods (VggNet-16 and ResNet-50) on the SQUH dataset. Importantly, our proposed approach CLR and CSVM-H efficiently learn representations from small amounts of breast cancer whole-slide images and achieve an AUC of 0.83 and 0.84, respectively, on the SQUH dataset. Moreover, the proposed models reduce memory footprint in the classification of Whole-Slide histopathology images since their training time is significantly reduced compared to the traditional CNN on the SQUH and BreaKHis datasets.