The World Health Organization has recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. Developing recommendations make little sense if they are not used. Thus, effective strategies to promote the appropriate use of recommendations by decision-makers are important.1 Discussions internationally have also been focusing on how to develop mechanisms to support the use of research evidence in developing clinical practice guidelines, health technology assessments, and health policy

health --- research

Objectives: This study was undertaken to determine the effect of subacute exposure of peracetic acid on lipid peroxidation and hepatic enzymes in Wistar rats.Methods: 48 male animals in Treatment Group I, II and III received 0.2%, 2% and 20% peracetic acid daily for 2 and 4 weeks.Results: Serum malondialdehyde increased and Alanine Transaminase and Aspartate Transaminase decreased significantly in groups 2 and 3, compared to the control group. The malondialdehyde, Alanine Transaminase and Aspartate Transaminase with 0.2% and 2% doses of peracetic acid for 2 weeks do not lead to the alteration of malondialdehyde and enzyme activities.Conclusion: This study demonstrated that the enhancement of malondialdehyde could provide an oxidative damage induced by disinfectant peroxidation at 20% and 2% doses at 2 and 4 weeks. The consumption of peroxidation with 20% for 2 weeks and 2% for 4 weeks can cause the increase of malondialdehyde and the decrease of enzyme activities, respectively.

peri acetic acid --- wistar rats

Objectives: Despite the scientific evidence of reducing cardiac events with HMG Co-A reductase inhibitors (statins) therapy in both primary and secondary preventions, these therapies continue to be underutilized in patients receiving convictional care. Simvastatin, a HMG Co-A inhibitor agent, is the most commonly used statin in Sultan Qaboos University Hospital. The aim of this study is to review the safety and the effectiveness of achieving LDL-C targets with Simvastatin according to the NCEP-ATP3 guidelines in patients with different cardiovascular risk categories at Sultan Qaboos University Hospital.Methods: A retrospective chart review was conducted for 160 patients. Patients were identified by outpatient prescriptions provided by pharmacy department from April 2008 to May 2008.Results: 98% of the patients were prescribed simvastatin 20 mg and only 2% received 40 mg. The mean age of patients was 57 years +/- 12. While 49% of the patients were male and 45% had diabetes mellitus, 50% had cardiovascular disease, 2.5% were smokers, 67% were hypertensive, and 3% had positive family history of coronary artery disease. 75% of patients were classified as high risk, 7% moderate risk and 18% low risk for coronary artery disease. Among all lipid profiles, only LDL-C was changed from baseline with simvastatin treatment in all patients (3.60±1.03 to 3.25±1.34 mmol/L). LDL-C level at baseline was higher in the high risk group (4.11±1.06 mmol/L) compared to low and moderate risk groups (3.68±0.89, 3.42±1.15) respectively. Achievement of LDL-C goals was achieved in only 43% for high risk, 50% in moderate risk, and 90% in low risk patients. There was no significant increase in liver enzymes and creatinine kinase.Conclusion: This study identified that more than half of the high risk patients were not at the target LDL-C goals which place them at a continuous risk of coronary heart disease. More appropriate lipid lowering therapy using more potent statins or combination therapy should be optimized to improve achievement of LDL-C goals according to ATP-III guidelines.

simvastatin --- cholesterol

Objectives: Urinary tract infection is the second most common clinical indication for empirical antibiotic treatment in primary and secondary health care settings. The incidence of diabetes mellitus throughout the world is increasing strikingly and in the long run, it has some major effects on the genitourinary system which makes diabetic patients more liable to urinary tract infection. This study is designed to reveal the distribution of uropathogens in diabetic patients according to age and sex, and corresponding resistance patterns.Methods: A six-month retrospective review of urine culture assay data from August 2009 to January 2010 from randomly selected 85 patients who suffered from both urinary tract infection and diabetes was conducted. Relevant information was retrieved and analyzed statistically using Microsoft® Excel 2002 software.Results: The study showed that females are more vulnerable to pathogenic attack than males throughout a wide age distribution. In terms of pathogenic distribution, Escherichia coli was the highest followed by Streptococcus sp., Acinetobacter, Klebsiella pneumoniae and few others. Though Meropenem showed no resistance with E. coli, Acinetobacter and Klebsiella pneumoniae, in the case of Streptococcus sp. it exhibited resistance of 25%. Amikacin exhibited only 3% resistance with E. coli, whereas no resistance with Acinetobacter and Klebsiella pneumoniae, and most interestingly showed 75% resistance with Streptococcus sp. Gentamicin exhibited no resistance with Acinetobacter while 26.9%, 50% and 87.5% resistance with E. coli, Klebsiella pneumoniae and Streptococcus sp. respectively. Hence, Nitrofurantoin exhibited less resistance 11.9% compared to 12.5% resistance with E. coli and Streptococcus sp. Nitrofurantoin was highly prone to resistance with Acinetobacter and Klebsiella pneumoniae (100%, 50% respectively). Cephalosporins (cephradine, cefixime, ceftriaxone, cefepime etc.) showed moderate resistance (avg. 50%), whereas amoxicillin and ciprofloxacin showed the highest resistance in all these cases.Conclusion: Pathogens are mostly resistant to antibiotics including amoxicillin, ciprofloxacin, cephalosporins and nitrofurantoin, with few exceptions including gentamicin, amikacin and meropenem.

uropathogens --- diabetes

Objectives: Polycystic ovary syndrome is associated with insulin resistance and obesity. Previous studies suggest that metformin by reducing hyperinsulinemia is clinically useful in the treatment of polycystic ovary syndrome. This study’s Objective is to observe the role of metformin in omentin1, ghrelin, and other biochemical, clinical features within three months in hyperinsulinemic women with polycystic ovary syndrome. Another aim is to assess the decrease in hyperinsulinemia and body weight by metformin in the population.Methods: This study was carried out at the Kamal AL-Samarai Hospital between June 2007 and March 2008. 60 women fulfilling the clinical and biochemical criteria for polycystic ovary syndrome and hyperinsulinemia were enrolled. Metformin was started at an oral dose of 850 mg/day for 3 months. Besides Body Mass Index (BMI), Waist Hip Ratio (WHR), serum omentin1, ghrelin, fasting insulin, fasting blood sugar and lipid profile levels were performed. After three months, all these parameters were assessed. Omentin1, ghrelin and insulin were measured by enzyme-linked immunosorbent assay, fasting blood glucose and lipid profile were measured by colorimetric methods.Results: Mean Body Mass Index and Waist Hip Ratio had significantly decreased in the 60 polycystic ovary syndrome patients after three months of Metformin therapy. Serum levels of omentin1, ghrelin and HDL-cholesterol were increased while the total cholesterol/HDL cholesterol ratio was decreased significantly. Serum concentrations of insulin, Homeostatic Model Assessment (HOMA) and HOMA ß-cell % were also decreased significantly, the present study showed a significant increase in omentin1: insulin ratio, omentin1: HOMA ratio and omentin1: HOMA ß-cell% ratio.Conclusion: There was a significant an increase in omentin1: insulin ratio, omentin1: HOMA ratio and omentin1: HOMA ß-cell% ratio. These results in the present study are shown the first time, these factors may be useful in following improvements in insulin sensitivity in subjects with polycystic ovary syndrome or obesity treated with insulin sensitizers. Further studies are needed to certify these factors in other populations with these treatment or with other insulin sensitizers or when treated with diet and exercise.

metformin --- ghrelin

Post-partum ovarian vein thrombosis is an uncommon clinical presentation. 90% of cases present as right loin and right iliac fossa pain, within 10 days of the puerperal period. Two such cases that were referred to the Imaging department as suspected appendicitis/ureteric colic are reported. The findings seen on imaging illustrate the difficulty in the clinical and radiological diagnosis of post-partum ovarian vein thrombosis and highlight the need to include it as a differential diagnosis in cases of post partum acute abdomen. Post-partum ovarian vein thrombosis can be accurately diagnosed by appropriate non-invasive investigations to enable early therapy with anti-coagulants and intravenous antibiotics which are the mainstay of treatment. Surgery can be avoided if diagnosis is made early.

ovarian vein --- thrombosis

This is a case report of a 59 years old male who had a commercial non-related living renal transplantation for his end stage renal insufficiency secondary to adult polycystic kidney disease. He suffered an immediate and early post-operative bleeding, which was managed conservatively. He was presented at Sultan Qaboos University Hospital four months after his transplant with abdominal pain, nausea, loss of appetite and a rise in serum creatinine levels. Ultrasonography and angiography have shown a 4 cm false aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. Surgical exploration with resection of the false aneurysm and reanastomosis of the donor renal artery to the external iliac artery was carried out successfully with preservation of the renal allograft. This is a rare case of an extra-renal false aneurysm at the anastomotic site of the transplant renal artery to the external iliac artery four months after renal allotransplantation. Literature review on the management and outcome of false aneurysms after renal transplant was carried out.

transplant --- aneurysm

A thyroid mass, most often a non toxic colloid goiter or occasionally an adenoma, is not an unusual finding below the level of the thoracic inlet.1 In 1992 Creswell and Wells estimated that these tumors comprise 5.8% of all mediastinal lesions.1 There is no standard definition for thyroid glands extending below the thoracic inlet, but such masses descend from their original cervical location for more than 2 or 3 cm below the thoracic inlet, and are not truly primary tumors of the mediastinum. They preserve the connection between the thoracic and cervical portion and receive their blood supply from the neck.2,3 In 1940, the seminal report of Wakeley and Mulvany divided intrathoracic thyroid masses into 3 types; (1)”Small substernal extension” of a mainly cervical mass, (2) “Partial” intrathoracic, in which the major portion of the mass is situated within the thorax, and (3)”Complete” in which all of the mass lies within the thoracic cavity.

thyroid

An Emergency Medical Service (EMS) can be defined as “a comprehensive system which provides the arrangements of personnel, facilities and equipment for the effective, coordinated and timely delivery of health and safety services to victims of sudden illness or injury.”1 The aim of EMS focuses on providing timely care to victims of sudden and life-threatening injuries or emergencies in order to prevent needless mortality or long-term morbidity. The function of EMS can be simplified into four main components; accessing emergency care, care in the community, care en route, and care upon arrival to receiving care at the health care facility.2

EMS