Exploring Work-Related Stress and Coping Strategies among Omani Nurses Working in Tertiary Governmental Hospitals at Muscat: A Cross-Sectional Study

Introduction: Work-related stress has become a global issue in the nursing workplace, with about 9.20% - 68.0% of nurses globally experiencing stress. Conversely, work-related stress ranges between 20% and 40% in nursing. Other researchers noted that 35.1% of nurses globally experienced elevated stress levels. Stress can damage well-being and lead to coping, which can, directly and indirectly, improve well-being through a perceived state. Nurses need coping mechanisms to manage their stress levels and maintain stability. Coping mechanisms can vary greatly depending on a nurse’s culture and background. Numerous findings indicate that managing stress is more critical than the cause of stress and that the more successful a stress-management approach, the less damage stress brings. Objective: In response to this, it is necessary to explore Omani nurses’ stress level and their coping strategies working in tertiary governmental hospitals in Muscat. Methods: The sample size for this study was 383 Omani nurses, with a 100% response rate. This study used a descriptive cross-sectional design from 15 October 2020 to 30 November 2020. Samples were selected through proportionate population sampling (PPS) from the five selected tertiary hospitals. Data were collected by self-administered questionnaires using a perceived stress scale and Ways of Coping. A simple random sample within a stratum (each hospital admitting ward) was done to identify the study participants. The sample size for this study was 383 Omani nurses, with a 100% response rate. Results: About 83.3% of participants had a moderate perceived level of stress with an overall mean perceived stress level of 18.46 ± 4.52. The most common sources of perceived stress are feeling nervous and “stressed” in the last month (2.30 ± 0.95). According to the ways of coping strategies, nurses seemed to be resorting to more “planful problem” (mean = 11.04) and least was seeking social support (mean = 9.67). Conclusion: This study highlighted the work-related stress level of staff nurses, explored their ways of coping and determined the relationship between work-related stress levels and methods of coping. The key finding of this study was that the frequency of stress reported by nurses was high enough to suggest that their stress levels were significant, given the demanding nature of their profession that requires maximum attention. Additionally, nurses seemed to resort to more planful problem-solving mechanisms to deal with their stressful situations than other coping strategies.

Assessment of Appropriateness of Diagnostic Lymph Node Tissue Collection from the Operating Theater and by Interventional Radiologist. A Clinical Audit

Background: Appropriate sample requesting, collecting and timely dispatch to the appropriate laboratory is essential in establishing diagnosis of pathologies with lesions. Much time and effort may be wasted if this is not done according to certain standards. We conducted this study to assess the route of lymph node samples from requests to reaching the laboratories. Methods: We conducted an audit over a period from 4th June until 10th Aug 2023. Data for all the procedures performed over this period on lymph node samples (was entered into and analysed using Excel. Results: A total of eighteen samples for sixteen patients were obtained during this period. Median age of the patients was 34 years (19 - 73) with a M:F ratio of 5:11. Among the IR samples, nine samples were from the neck, three from inguinal area and one from axilla. Seven samples (53.8%) were tru-cut biopsies, six samples (46.15%) were FNA. All samples were sent to the pathology laboratory fixed in formalin. Samples for TB were sent only for five cases (31.25%) and for only two cases (12.5%) were samples sent for bacterial culture. For the OR samples, none were sent for either bacterial culture or TB. Overall, eight patients (50%) were not investigated for any infectious etiologies like brucella, toxoplasmosis, CMV, EBV plus other possible causes. Repeat sampling was required for 25% of patients (within and out of the audit period). Conclusions: to avoid delays in making diagnoses, it is paramount to consider infectious etiologies as possible diagnosis for lymphadenopathy and request appropriate investigations. This requires liaising with infectious diseases/clinical microbiology experts to guide regarding types of samples, types of media and timely dispatch to the correct laboratory.

Evaluating pediatric ureteropelvic junction obstruction:Dynamic magnetic resonance urography vs renal scintigraphy 99mtechnetium mercaptoacetyltriglycine

BACKGROUND Ureteropelvic junction obstruction(UPJO)is a common congenital urinary tract disorder in children.It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence.AIM To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography(dMRU)and scintigraphy 99m-technetium mercaptoacetyltriglycine(MAG-3)for the functional evaluation of UPJO.METHODS Between 2016 and 2020,126 patients with UPJO underwent surgery at Robert DebréHospital.Of these,83 received a prenatal diagnosis,and 43 were diagnosed during childhood.Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation.Split renal function was evaluated preoperatively using scintigraphy MAG-3(n=28),dMRU(n=53),or both(n=40).In this study,we included patients who underwent surgery for UPJO and scintigraphy MAG-3+dMRU but excluded those who underwent only scintigraphy MAG-3 or dMRU.The patients were divided into groups A(<10%discrepancy)and B(>10%discrepancy).We examined the discrepancy in split renal function between the two modalities and investigated the possible risk factors.RESULTS The split renal function between the two kidneys was compared in 40 patients(28 boys and 12 girls)using scintigraphy MAG-3 and dMRU.Differential renal function,as determined using both modalities,showed a difference of<10%in 31 children and>10%in 9 children.Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys.CONCLUSION Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.

Profile of Inpatient Child and Adolescent Psychiatry in Sultanate of Oman

Backgrounds: Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to answer the question what are the problems that are likely to bring a child or an adolescent for the admission in the child and adolescent psychiatry Unit. Methods: The case records of all inpatient children and adolescents younger than 18 years, who were admitted to the child psychiatric unit at SQUH, Muscat, Sultanate of Oman over a period of 10 years between Jan 2007 and Dec 2017, were retrospectively reviewed in regard to sociodemographic data, referring specialties and reason for referral. Result: A total of 255 cases were admitted in child psychiatry unit in a period of 10 yrs, the average age was 14.15 years, 95% patients were Omani nationals, 47.5% were male, 52.5 were females, 17.65% Acute and transient psychotic disorder, 13.7% bipolar affective disorder, current episode manic without psychotic symptoms, 12.94% Intentional self-harm by other specified means and 12.55% schizophrenia, were the most common diagnoses observed in this population who needed inpatient care;the average length of stay in the majority of cases was less than 3 weeks. Conclusion: The child and adolescent inpatient unit of SQUH from where the data was collected happens to be the only child psychiatric admitting unit in Oman till the end of 2017 and can be considered as representative;the children and adolescence in-patient unit exemplifies a short-term care set-up.

Octreotide in Hennekam syndrome-associated intestinal lymphangiectasia

A number of disorders have been described to cause protein losing enteropathy (PLE) in children. Primary intestinal lymphangiectasia (PIL) is one mechanism leading to PLE. Few syndromes are associated with PIL; Hennekam syndrome (HS) is one of them. The principal treatment for PIL is a high protein, low fat diet with medium chain triglycerides supplementation. Supportive therapy includes albumin infusion. Few publications have supported the use of octreotide to diminish protein loss and minimize hypoalbuminemia seen in PIL. There are no publications on the treatment of PIL with octreotide in patients with HS. We report two children with HS and PLE in which we used octreotide to decrease intestinal protein loss. In one patient, octreotide increased serum albumin to an acceptable level without further need for albumin infusions. The other patient responded more dramatically with near normal serum albumin levels and cessation of albumin infusions. In achieving a good response to octreotide in both patients, we add to the publications supporting the use of octreotide in PIL and suggest that octreotide should be tried in patients with PIL secondary to HS. To the best of our knowledge, this is the first case report on the use of octreotide in HS-associated PIL.

Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome

AIM: To study the etiopathogenesis, management and outcome of duodenal injury post laparoscopic cholecystectomy(LC).METHODS: A Medline search was carried out for all articles in English, on duodenal injury post LC, using the search word duodenal injury and LC. The cross references in these articles were further searched, for potential articles on duodenal injury, which when found was studied. Inclusion criteria included, case reports, case series, and reviews. Articles even with lack of details with some of the parameters studied, were also analyzed. The study period included all the cases published till January 2015. The data extracted were demographic details, the nature and day of presentation, potential cause for duodenal injury, site of duodenal injury, investigations, management and outcome. The model(fixed or random effect) for meta analyses was selected, based on Q and I2 statistics. STATA software was used to draw the forest plot and to compute the overall estimate and the 95%CI for the time of detection of injury and its outcome on mortality. The association between time of detection of injury and mortality was estimated using χ2 test with Yate's correction. Based on Kaplan Meier survival curve concept, the cumulative survival probabilities at various days of injury was estimated. RESULTS: Literature review detected 74 cases of duodenal injury, post LC. The mean age of the patients was 58 years(23-80 years) with 46% of them being males. The cause of injury was due to cautery(46%), dissection(39%) and due to retraction(14%). The injury was noted on table in 46% of the cases. The common site of injury was to the 2nd part of the duodenum with 46% above the papilla and 15% below papilla and in 31% to the 1st part of duodenum. Duodenorapphy(primary closure) was the predominant surgical intervention in 63% with 21% of these being carried out laparoscopically. Other procedures included, percutaneous drainage, tube duodenostomy, gastric resection, Whipple resection and pyloric exclusion. The day of detection among those who survived was a mean of 1.6 d(including those detected on table), compared to 4.25 d in those who died. Based on the random effect model, the overall mean duration of detection of injury was 1.6(1.0-2.2) d(95%CI). Based on the fixed effect model, the overall mortality rate from these studies was 10%(0%-25%). On application of the Kaplan Meier survival probabilities, the cumulative probability of survival was 94%, if the injury was detected on day 1 and 80% if detected on day 2. In those that were detected later, the survival probabilities dropped steeply.CONCLUSION: Duodenal injuries are caused by thermal burns or by dissection during LC and require prompt treatment. Delay in repair could negatively influence the outcome.

Klippel-Feil syndrome

男性患者,33岁。主因交通事故后右肩、左前臂疼痛伴颈后触痛入院。颈椎X线检查可见C4~5椎体融合及其椎弓根融合。临床诊断:Klippel Feil综合征。未予治疗,建议患者避免颈部损伤,如出现上肢感觉异常或感觉缺失,立即复诊。

Medical research during the COVID-19 pandemic

The current pandemic of coronavirus disease 2019(COVID-19)which was first detected in Wuhan,China in December 2019 is caused by the novel coronavirus named severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).The virus has quickly spread to a large number of countries leading to a great number of deaths.Unfortunately,till today there is no specific treatment or vaccination for SARS-CoV-2.Most of the suggested treatment medications are based on in vitro laboratory investigations,experimental animal models,or previous clinical experience in treating similar viruses such as SARS-CoV-1 or other retroviral infections.The running of any clinical trial during a pandemic is affected at multiple levels.Reasons for this include patient hesitancy or inability to continue investigative treatments due to self-isolation/quarantine,or limited access to public places(including hospitals).Additional barriers relate to health care professionals being committed to other critical tasks or quarantining themselves due to contact with COVID-19 positive patients.The best research approaches are those that adapt to such external unplanned obstacles.Ongoing clinical trials before COVID-19 pandemic have the potential for identifying important therapies in the long-term if they can be completed as planned.However,these clinical trials may require modifications due a pandemic such as this one to ensure the rights,safety,and wellbeing of participants as well as medical staff involved in the conduction of clinical trials.Clinical trials initiated during the pandemic must be time-efficient and flexible due to high contagiousness of severe acute respiratory syndrome coronavirus 2,the significant number of reported deaths,and time constraints needed to perform high quality clinical trials,enrolling adequate sample sizes.Collaboration between different countries as well as implementation of innovative clinical trial designs are essential to successfully complete such initiatives during the current pandemic.Studies looking at the long term sequalae of COVID-19 are also of importance as recent publications describe multi-organ involvement.Long term follow-up of COVID-19 survivors is thus also important to identify possible physical and mental health sequellae.

Self-reported sleep quality and depression in post myocardial infarction patients attending cardiology outpatient clinics in Oman

Objective: This study aimed to examine the sleep quality and prevalence of depression in post myocardial infarction patients attending cardiology outpatient clinics of selected hospitals in Oman.Methods: A descriptive cross-sectional design was used to collect data from patients (n 180) who were at least 4 weeks post myocardial infarction diagnosis and receiving follow-up care in the outpatient clinic.The Arabic version of the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 were used to assess sleep quality and depressive symptoms,respectively.Results: The sample mean age was 62.0 ± 11.3 years.Poor sleep quality affected 61.1% of the participants.The significant predictors of poor sleep quality were gender (P ≤ 0.05),body mass index (P ≤ 0.05),and self-reported regular exercise (P ≤ 0.01).The most impacted domains of sleep quality were sleep latency,sleep duration,and sleep disturbances.The prevalence of major depression was low (5%) and the rate of re-infarction was 27.2%.The prevalence of minimal to mild major depression with a potential of transitioning into major depression overtime was very high.Self-reported regular exercise (P ≤ 0.01) was the only significant predictor of depressive symptoms.Conclusion: The sleep quality of post myocardial infarction patients was poor and the prevalence of depression was low.There was no significant relationship between sleep quality or depression with reinfarction.

Proteomics:Concepts and applications in human medicine

Proteomics is the complete evaluation of the function and structure of proteins to understand an organism’s nature.Mass spectrometry is an essential tool that is used for profiling proteins in the cell.However,biomarker discovery remains the major challenge of proteomics because of their complexity and dynamicity.Therefore,combining the proteomics approach with genomics and bioinformatics will provide an understanding of the information of biological systems and their disease alteration.However,most studies have investigated a small part of the proteins in the blood.This review highlights the types of proteomics,the available proteomic techniques,and their applica-tions in different research fields.

A huge brain cyst in left temporal fossa

男性患者,27岁。主因头痛、恶心、呕吐入院。患者幼时即左侧颞叶突起。MRI检查显示左侧颞窝囊性病变,约为6.00 cm×7.00 cm×8.00 cm大小。临床诊断为表皮样囊肿,予手术切除。表皮样囊肿生长缓慢,由富含胆固醇的表皮样细胞碎片组成,发生后应施行预防性切除。

A qualitative study of the Omani physicians’ lived experience with truth disclosure to cancer patient

Objectives: The purpose of this phenomenological Qualitative Study is to gain an in depth understanding of the nature and meaning of the experiences of physicians in relation to truth disclosure and ethics of veracity when diagnosing cancer. Methods: A qualitative phenomenological study using semi-structured interviews was conducted at Sultan Qaboos university hospital (SQUH), l to explore the Omani Physicians’ lived experiences with truth disclosure in patients who were diagnosed with cancer. The target population for this study is Omani physicians working in SQUH. The total of four participants was involved in this study. Results: Three essential themes were generated through the analysis of the participants’ descriptions of their perceptions and lived experiences as the following with their subthemes: the first theme is the clinical aspect of the experiences with three subthemes: 1) The ethical aspect and the physician’s attitude;2) The strategy of breaking bad news;3) Training and breaking bad news. The second theme is Cultural diversity with three subthemes: 1) Relatives preference;2) The patient education;3) The hospital setting. The third theme is the emotional aspect of the experiences with five subthemes: 1) Emotional sadness;2) Personal grief;3) Other emotions;4) The positive emotions;5) Control of the emotions. Conclusion: This study recommends: to build up appropriate measures and guidelines on the subject of truth telling and medical ethics, and to provide more training for the health care providers in the context of breaking bad news. In addition to add to the curriculum of medical colleges the basic ethical principles relevant to medical practice. Finally, to establish medical social work departments in SQUH, and other healthcare institutions in Oman.

Late Presentation of a Congenital Intrinsic Duodenal Obstruction in a Patient with Anorectal Malformation

Anorectal Malformations are known to be associated with various other congenital anomalies including duodenal atresia. An association of congenital intrinsic duodenal obstruction causing partial duodenal obstruction in a patient with anorectal malformation is not described in literature. We describe a case of delayed presentation of congenital intrinsic duodenal obstruction in a child with high-type anorectal malformations causing diagnostic dilemma.

The Ethics of Veracity and It Is Importance in the Medical Ethics

The goals of this overview is to discuss the ethics of telling the patient the truth, with some historical backgrounds and it is importance in medical practice, Justifying Less than Full Disclosure in some situations in which the truth may have a terrible impact on the occasional patient, and the influence of the culture on the health care professionals attitudes towards telling the patient the truth. Conclusion: The health care professionals need more awareness, and training in ethics of veracity and also in the communication skills especially in the context of breaking bad news in telling the patient the truth about diagnosis, treatment outcomes, and prognosis of any serious illness.

Understanding the Ethical Theories in Medical Practice

It is important to understand the basic of the ethical theories and how to utilize them to deal with the ethical dilemma in the medical practice. This article presents a brief review of three of famous philosophical theories of ethics, which may enrich our understanding and guide our behaviour in medical practice. Conclusion: There is no fully adequate moral theory which can singly explain all ethical or moral dilemmas and none of them also can singly explain all ethical or moral dilemmas.

Management of Internal Mammary Artery Spasm

The article is dedicated to the management of internal mammary artery spasm intra- and postoperatively based on the accumulated evidence in the literature. It provides a stepwise decision algorithm for safely resolving the spasm and prevention of relapse.

Recurrent Giant Phyllodes Tumour of the Breast Pathological Considerations and Management Approach for Recurrence and Metastasis

Phyllodes tumours are rare and account for 0.4% of all breast tumours. The majority of them tend to be less than 5 cms in size with giant tumours larger than 10 cms being about 20% of these cases. They display a broad range of clinical and pathological behavior and are regarded as falling within the spectrum of fibroepithelial neoplasms. Surgery has been the primary modality of treatment. However the extent of resection and the role of adjuvant radiotherapy and chemotherapy are still controversial. The risk of recurrence is (4.7% - 30%) for benign phyllodes tumour and (30% - 65%) for borderline and malignant phyllodes tumour. A case of giant phyllodes tumour measuring 36 × 30 cm and weighing 6.8 kg is presented, which had recurred following a previous resection 5 years back. The literature is reviewed with regards to pathology, the role of investigations, nature of resection and the risk factors for recurrence and

The Health Care Ethics: Overview of the Basics

In this overview we answers certain Questions in order to increase the awareness towards the basic of the health care ethics: what is ethics, what are the several fields of ethics connected to medical activities, what are the types of Ethical approaches in relation to the medical practice. Conclusion: Through understanding the basics of the ethics, the awareness of the medical ethics in the health care can be increased.

Combined effect of <i>CYP2C9</i>and <i>VKORC1</i>polymorphisms on warfarin maintenance dose in Omani patients

Excepting host genetic factors, other influences on the pharmacokinetic and pharmacodynamic behavior of warfarin are subject to variations during the treatment despite attempts to stabilize the INR. In 214 Omani patients on warfarin therapy, we evaluated the extent of influence of known genetic predictors of warfarin dose variability, namely CYP2C9, CYP4F2 and VKORC1 gene polymorphisms in a genetically heterogeneous patient population. When patients were stratified according to their daily warfarin maintenance dose (to maintain INR between 2 and 3) into “low dose” (sensitive), “medium dose” (intermediate) and “high dose” (resistance) groups, overall, seven patients with three or four mutant alleles fell in the sensitive group and consequently 25% (7 out of 28) of at risk patients for over anticoagulation can be recognized by prospective pharmacogenetic testing in this patient population. Pre-prescription genotyping of these loci prior to therapy initiation will therefore benefit a small fraction of this population.

Early diagnosis and management of Congenital diaphragmatic hernia

This case report describes the case of a full term girl baby with left congenital diaphragmatic hernia(CDH)born to a 36-year-old mother at 38 weeks of gestation.The baby at birth had an APGAR 8 and birth weight 2.930 kgs.Pre operatively,the baby was ventilated and was kept Nil per oral and continued with Total parenteral nutrition.Nasogastric tube continuous suction was done.The parents were counselled for the surgical repair of CDH.On the third day of life,exploratory laparotomy was performed.5 cm diaphragmatic defect was found.The stomach,pancreas,small bowel,large bowel,and spleen were successfully restored from the left thoracic cavity and the diaphragmatic defect was closed.Post operatively,the baby was breastfed well,thermo regulated,maintained saturation,passed urine and stool and was discharged.