Annual Report 2013 College of Medicine & Health Sciences & Sultan Qaboos University Hospital

Contents Dean’s Message 2 Executive Summary 3 Overview College of Medicine & Health Sciences 5

Sultan Qaboos University Hospital 10

Academic & patient care departments Anaesthesia, ICU & Pain Management Overview 15 Staff 16 Highlights of the Year 2013 16 Teaching Programmes 17 Training Courses & CME Activities 17 Clinical & Diagnostic Services 18 Research 18 Behavioural Medicine Overview 21 Staff 22 Highlights of the Year 2013 22 Teaching Programmes 23 Training Courses & CME Activities 25 Clinical & Diagnostic Services 25 Research 26 Biochemistry Overview 33 Staff 34 Highlights of the Years 2013 34 Teaching Programmes 34 Clinical & Diagnostic Services 36 Research 36 Child Health Overview 43 Staff 44 Highlights of the Year 2013 45 Teaching Programmes 47 Training Courses & CME Activities 48 Clinical & Diagnostic Services 48 Research 50 Emergency Medicine Overview 57 Staff 58 Highlights of the Year 2013 59 Teaching Programmes 60 Training Courses & CME Activities 61 Clinical & Diagnostic Services 62 Research 64 Family Medicine & Public Health Overview 65 Staff 66 Highlights of the Year 2013 66 Teaching Programmes 66 Training Courses & CME Activities 68 Clinical & Diagnostic Services 68 Research 69 Genetics Overview 77 Staff 78 Highlights of the Year 2013 78 Teaching Programmes 78 Training Courses & CME Activities 79 Clinical & Diagnostic Services 80 Research 82 Haematology Overview 87 Staff 88 Highlights of the Year 2013 89 Teaching Programmes 89 Training Courses & CME Activities 90 Clinical & Diagnostic Services 90 Research 93 Human & Clinical Anatomy Overview 103 Staff 104 Highlights of the Year 2013 104 Teaching Programmes 104 Research 105 Medicine Overview 107 Staff 108 Highlights of the Year 2013 109 Teaching Programmes Training Courses & CME Activities 110 Clinical & Diagnostic Services 112 Research 116 Microbiology & Immunology Overview 123 Staff 124 Highlights of the Year 2013 125 Teaching Programmes 125 Clinical & Diagnostic Services 126 Research 126 Nursing Services Directorate Overview 133 Staff 134 Highlights of the Year 2013 135 Teaching Programmes 139 Training Courses & CNE Activities 139 Research 141 Nutrition & Dietetics Overview 143 Staff 144 Highlights of the Year 2013 144 Teaching Programmes 145 Training Courses & CME Activities 145 Research 145 Obstetrics & Gynaecology Overview 147 Staff 148 Highlights of the Year 2013 148 Teaching Programmes 149 Training Courses & CME Activities 150 Clinical & Diagnostic Services 151 Research 152 Ophthalmology Overview 161 Staff 162 Highlights of the Year 2013 163 Teaching Programmes 163 Training Courses & CME Activities 164 Clinical & Diagnostic Services 165 Research 166 Oral Health Overview 169 Staff 170 Highlights of the Year 2013 170 Teaching Programmes 171 Clinical & Diagnostic Services 171 Research 172 Pathology Overview 173 Staff 174 Highlights of the Year 2013 175 Teaching Programmes 176 Training Courses & CME Activities 177 Clinical & Diagnostic Services 178 Research 179 Pharmacology & Clinical Pharmacy Overview 187 Staff 188 Highlights of the Year 2013 188 Teaching Programmes 188 Research 190 Pharmacy Overview 197 Staff 198 Highlights of the Year 2013 199 Teaching Programmes 199 Training Courses & CME Activities 199 Clinical & Diagnostic Services 200 Research 204 Physiology Overview 209 Staff 210 Highlights of the Year 2013 210 Teaching Programmes 210 Training Courses & CME Activities 211 Clinical & Diagnostic Services 212 Research 214 Physiotherapy & Rehabilitation Overview 217 Staff 218 Highlights of the Year 2013 219 Teaching Programmes 220 Training Courses & CME Activities 221 Clinical & Diagnostic Services 222 Research 222 Radiology & Molecular Imaging Overview 223 Staff 228 Highlights of the Year 2013 229 Teaching Programmes 230 Clinical & Diagnostic Services 231 Research 232 Surgery Overview 235 Staff 236 Highlights of the Year 2013 237 Teaching Programmes 237 Training Courses & CME Activities 238 Research 238 Support Departments College Medical Library 240 Medical Education & Informatics Unit 244 Sultan Qaboos University Medical Journal 248 Hospital Directorate of Development & Quality 251 Directorate of Information System 255 Department of Procurement 258 Directorate of Patient Services 260 Directorate of Public Relations & Information 262 Directorate of Technical Affairs 264 Directorate of Training & Continuing Professional Development 274 Department of Finance 277 Department of Housing 279 Department of Medical Records 281 Department of Transport 283 Appendices Appendix I Clinico-Pathologic Conferences: SCRAPS 2012–2013 284 Appendix II Curriculum Information 285

Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Dean's Message

t is my pleasure to present to you the report of the College of Medicine & Health Sciences and the Sultan Qaboos University Hospital for the year 2013. IThe College of Medicine was founded in 1986 and became the College of Medicine & Health Sciences (COMHS) in 2002 when the Nursing Program was added. From the beginning, the COMHS and Sultan Qa- boos University Hospital (SQUH) have recognised teaching, research, training and clinical and community services as their core responsibilities. They aim for the highest standards of achievement in the quality of their medical and health education and services, in research and in their contribution to Omani society. They also aspire to become a role model for other medical and health science colleges and health care institutions in Oman and abroad.

In 2013, the College had a total of 86 faculty members including 17 Professors, 22 Associate Professors and 28 Assistant Professors. The COMHS has grown and diversified, with well-established programmes in the preclinical and clinical departments. The new curriculum, developed since 2008, is now in its second year of implementation. Student intake is around 125 per year and the total student numbers are around 1,100. The College runs an M.Sc. programme in Biomedical Sciences and Ph.D. programmes are now approved in eight study areas.

In 2013 the SQUH had 84 senior consultants and 72 consultants. It has had ISO 9001/2000 certification since 2005 and has introduced an electronic patient records system. SQUH and the COMHS have state of the art laboratories and equipment.

In 2013, the MD Programme was fully accredited for a ten-year period by the Association for Medical Edu- cation in the Eastern Mediterranean Region in association with and in accordance with the standards of the World Federation for Medical Education. The accreditation decision was made on basis that the M.D. Programme complies with the WFME’s “Basic and Quality Development Standards”. It is notable that COMHS’ “Quality Development Standards” are considered by the WFME as “Best Practice” thus conferring distinguished status on the COMHS’ M.D. Programme.

Prof. Omar Al-Rawas

Dean College of Medicine & Health Sciences Sultan Qaboos University

Chair Hospital Board Sultan Qaboos University Hospital 2 Executive Summary

he College of Medicine & Health Sciences (COM&HS) and the University Hospital (SQUH) continue to expand and develop their educational and clinical mission. This report documents their activities Tand achievements during 2013. Education In 2013, the COM&HS admitted into the M.D. programme a total of 130 students. Following successful completion of the Phase II of the M.D. programme, 99 students joined the clinical Phase III of the M.D. programme in September 2013. The training of B.Sc. Biomedical Sciences students is also among the responsibilities of the COM&HS and SQUH, of whom 18 graduated in 2013, all of them female.

The College of Medicine and the University Hospital graduated a total of 83 medical doctors in 2013. A total of 70 students have now graduated from the College’s Master’s programme in Biomedical Sciences, 12 of them in 2013. There are currently 18 Ph.D. students, 2 of them graduated in 2013. The number of SQU trained medical doctors joining the Oman Medical Specialty Board (OMSB) for postgraduate training, under the academic supervision of the COM&HS and SQUH, was 143 in 2013. These postgraduates joined 18 training programmes in different specialties. In this year the University also sponsored full scholarships for 4 Ph.D. students, and 8 Master’s students for between 1–5 years of training abroad (locations Canada, the UK, seen and Australia). The number of M.D. graduates who went abroad for residency and fellowship training in 2013 was 19 and 8 returned from training in this year. The locations were Canada, the UK, Australia, Ireland, Sweden and the Netherlands.

The College has continued to expand its e-learning system, with many departments making their teaching and course materials available on-line. Executive Summary

Research In 2013, the College saw a major increase in research activity. It undertook 180 research projects (compared to 179 in 2010–11) to a total value of OMR 1,615,730. In 2013, staff of the College published a total of 328 research articles and 3 book chapters. In the same period, College staff made a total of 284 conference and seminar presentations. Of these, 33 were international oral presentations and 97 were international poster presentations. Also 44 Ph.D. and Master’s theses were supervised. The COMHS and SQUH organised 6 major conferences and 10 seminars or workshops in 2013.

3 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Clinical Activity By the end of 2013, the Hospital was opened at full capacity after the following developments:

• Significant development and increase in the different clinical specialties and services. • Eight highly specialised doctors had returned from abroad while 19 scholars proceeded abroad for their studies in 2013. • Continuous professional development policy established for doctors in fellowship and training. • Purchase, commissioning, and installation of different types of new equipment. The Hospital has continued to maintain ISO by bi-annual external review. The hospital decided to go ahead for accreditation by inviting Canadian Accreditation International to assess and implement the Canadian accreditation system.

By the end of 2013, the Hospital staff had increased to 2,804 employees including 439 doctors, 1,208 nurses and 521 technicians and 636 administrative/support staff.

Clinical activity at SQUH expanded in all areas. Outpatient visits were 124,206 compared to 121,482 in 2012 and inpatient admissions were 32,525 compared to 32,044 in 2012. The average length of stay stayed at 5 days. The number of day care patients was 14,566 compared to 12,969 in the preceding year. Finally, newborn live deliveries showed a 3.1% increase from 3,697 in 2011 to 3,812 in 2013.

Meriel Carboni Annual Report Editor, Editorial Office, College of Medicine & Health Sciences

Thanks are due for the preparation of this report to the following staff of theE ditorial Office in the College of Medicine & Health Sciences:

Joy Biruar, Design and Layout Alaister Denoyo, Photographs Natasha Smith, English Copy Editing

4 College of Medicine & Health Sciences - Overview

College Administration The College Administration is the focal point of activities between the various Departments and the main University Administration. It consists of the Office of the Dean, the Director of Administration, four Assistant Deans (Preclinical, Clinical, Postgraduates Studies & Research, and Training & Community Service) and administrative staff.

The College Board met 11 times (9 regular meetings & 2 extraordinary meetings) between during January and December 2013. The following key matters were discussed:

[1] Accreditation of the MD Programme of the College of Medicine & Health Sciences (COMHS). [2] Report of the Committee on strengthening bonds between the COMHS and Sultan Qaboos University Hospital (SQUH) at Sultan Qaboos University. [3] Awarding Clinical Academic Titles to SQUH Medical Staff and ClinicalT itles/Privileges to COM- HS Faculty providing Clinical Service in SQUH. [4] SQU Academic Health Science Centre (SQU-AHSC). [5] Proposal for additional buildings for College of Medicine & Health Sciences. Overview [6] Proposal for a Medical Research Centre. [7] Byelaws on practising human medicine, dentistry and allied health. [8] Non-practising MD academics’ and doctors’ salary scale. [9] Promotion pathway for Clinical Lecturers. [10] Khoula Hospital Department of Surgery for training COMHS Interns. [11] Changing the name of BSc Medical Laboratory Sciences (MLS) degree to “BSc Biomedical Sciences (BMS)”. [12] Quantification of teaching and protected time for Undergraduate teaching. [13] Academic Regulations for Phase I & II of MD Program. [14] Registration Criteria for Summer Courses. [15] Curriculum Retreat held on 14 March 2013.

5 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

[16] Proposal on Master’s Program in Mental Health in collaboration with the World Health Organization. [17] Revision of transfer criteria from MD to BSc MLS Programme of COMHS. [18] Proposal to minimise Master’s programmes to 3 semesters. [19] Appointment of Dr. Muhammad Athar Sadiq as Assistant Professor in Cardiology Unit, Depart- ment of Medicine, COMHS. [20] Proposal for construction of Outpatient Department and National Positron Emission Tomogra- phy/ Computed Tomography (PET/CT) and Cyclotron Center Project at SQU Hospital. [21] Installation of CCTV cameras in the COMHS.

Staff

Dean Professor Omar Al-Rawas Assistant Deans Dr. Ibrahim Inuwa, Preclinical Affairs Dr. Arunodaya Gujjar, Clinical Affairs Dr. Khalid Al-Balushi, Research & Postgraduate Studies Dr. Yahya Al-Farsi, Training & Community Service COLLEGE ADMINISTRATION Dean’s Office Sagar Hussain, Executive Assistant to the Dean Amal Al-Jassasi, Clerk Qassim Al-Salhi, Clerk Administration Office Mohamed Al-Bulushi, Director of Administration Mahmoud Al-Abri, Deputy Director Safaa Al-Harasy, Administrative Assistant Zakiya Al-Omairi, Follow-up & Communications Officer Salim Al-Khaldi, Clerk Bakar Al-Hinai, Storekeeper Salim Al-Farai, Storekeeper

6 Examinations Office Alphonsus Okoro, Examinations Officer Nasser Al-Mufarji, Coordinator (study leave) Preclinical Affairs Zulfa Al-Busaidi, Student Affairs Officer Shabbir Patel, Coordinator Turkiya Al-Amri, Clerk Clinical Affairs Glorio Almeida, Coordinator, Clinical Affairs Muna Al-Alawi, Clerk Aisha Al-Wardi, Administrator, Clinical Electives Office Madiha Al-Abri, Coordinator for Affiliated Hospitals Training & Community Affairs Aisha Al-Senaidi, Administrator, Medical Internship Programme Office Research & Postgraduate Studies Asma Al-Siyabi, Coordinator Fauzia Al-Abrawi, Staff Support Staff Salem Al-Salhi, Photocopy Technician Overview Khalid Al-Hinai, Messenger Haitham Al-Hinai, Messenger Education Programmes PRECLINICAL PROGRAMME – B.SC. HEALTH SCIENCES The preclinical programme is part of the M.D. curriculum and consist of a foundational phase (Phase I) and an integrated systems-based phase (Phase II). These phases cover a period of 3-4 years (6-8 semesters) depending on the level of the student. Phase I consists of 34 credit-hour courses whilst Phase II consists of 69 credit-hour courses.

Students who successfully completed phases I and II and achieve a high cumulative grade point average (cGPA ≥ 2.5) have the option of spending an extra year (Intercalated Phase) to obtain a B.Sc. degree before re-joining the next phase (Phase III) of the M.D. programme. The B.Sc. Health Sciences degree is awarded to students after successful completion of 120 credit hours. The student intake is around 120 per year. See http:// www.squ.edu.om/medicine-health/tabid/2455/language/en- US/Default.aspx for details of the curriculum.

7 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

CLINICAL PROGRAMME This is a three-year clinical programme during which the knowledge acquired during the Pre-Clinical phases (I and II) is applied to the clinical practice of medicine (Phase III). An M.D. degree is awarded upon completion of this programme. See www.squ.edu.om/medicine-health/tabid/8421/language/en-US/Default.aspx for an overview of the M.D. programme.

CLINICAL ELECTIVE PROGRAMME An 8-week Elective Placement Programme is part of the second year of the Clinical Programme and is an essential requirement to qualify for the M.D. degree. Students experience the working pattern and culture at prestigious medical universities abroad during this rotation. The programme provides students with an opportunity to gain further experience and skills, as well as widen their horizons by exposure to different cultures and environments. This programme is sponsored by the University.

INTERNSHIP TRAINING PROGRAMME This consists of 3 rotations of 4 months each in General Medicine, Surgery and either Child Health or Ob- stetrics/Gynaecology in hospitals across Oman which have been approved for this purpose by the College of Medicine & Health Sciences. The programme involves not only SQU graduates but those of other medical programmes in Oman and also Omani medical graduates trained in institutions abroad. Approximately 230 graduates take part in this programme each year.

POSTGRADUATE STUDIES The College introduced a two-year Masters Programme in Biomedical Sciences in 2001. It has the following eight specialisations: Biochemistry & Molecular Biology; Clinical Biochemistry; Clinical Pharmacy; Medical Microbiology; Epidemiology & Medical Statistics; Physiology; Medical Physics, and Human & Clinical Anat- omy.

The College now offers the following 8 Ph.D. programmes: Biochemistry; Microbiology & Immunology; Epi- demiology & Public Health; Genetics; Clinical Pharmacy; Physiology; Human & Clinical Anatomy, and Radiol- ogy & Molecular Imaging.

The Oman Medical Specialty Board (OMSB) was established in June 1994 and became an independent entity in November 2006. Its role is to train high calibre and internationally recognised Omani medical specialists in diverse disciplines. These specialists provide leadership in clinical, research and healthcar service and boost the manpower resources of Oman thus making an important contribution towards translating national health policies into reality.

The OMSB has representatives from the University, the Ministry of Health and the medical services of the Sultan’s Armed Forces and the Royal Omani Police. It supervises and coordinates postgraduate training programmes as well as providing guidelines to ensure that the training meets international standards. Special-

8 ty committees staffed by highly experienced professionals run these programmes on a day-to-day basis.

The OMSB Office sources overseas postgraduate residency placements, particularly in North American universities, Australia and the UK. Residents who have received residency and postgraduate training abroad are required to return to Oman to strengthen the country’s manpower development efforts by focusing on the training of junior colleagues and students. Overview

9 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Sultan Qaboos University Hospital - Overview

Sultan Qaboos University Hospital (SQUH), with a total of 680 beds is the only teaching hospital in Oman. It currently has 679 of its beds in use, with 89 beds in ambulatory areas such as day care and Emergency. The goals of SQUH are to provide teaching, research and high-quality patient-centred care in an environment that supports continuous improvement.

During the year 2013, a number of developmental activities took place in SQUH. It is worthy of note that the renal transplantation service continued to provide patients with quality service. One kidney transplant was done in 2013. A total of 27 bone marrow trasplants were also done. A total of 124,206 outpatients and 32,525 inpatients were seen in the course of 2013. The staff strength as of December 2013 stood at 2,804 employees, comprising 439 doctors, 1,208 nurses, 521 technical staff and 636 administrative/support staff.

HOSPITAL MANAGEMENT The Hospital Management embraces the senior leadership of all the units in the hospital administration. The Hospital Director-General, Deputy Director-General (Clinical Affairs) and Deputy Director-General (Nursing Affairs) together with the Heads of Clinical Departments hold a monthly MedicalA dvisory Committee (MAC) meeting. The MAC, with representatives from all clinical departments, serves as a focal point for continued improvement of care, and makes a report of every meeting to the Hospital Board.

Similarly, the Hospital Board, comprising the top management team of the Hospital and representatives of academic staff, clinical staff and diagnostic staff, chaired by the Dean, College of Medicine & Health Sciences, meets monthly during the academic year. Through the recurrent agenda items from the Hospital Direc- tor-General’s office, the members are kept informed about important matters in hospital management and developments in patient-related activities.

During 2013, much discussion was devoted to accommodating the significant increase in patient flow and maintenance of standards of research, teaching and service in the face of continued budget constraints.

Staff Dr. Abdullah Al-Asmi, Hospital Director-General Dr. Abdullah Al-Harthy, Deputy Director-General (Clinical Affairs) Mr. Ahmed Al-Kindi, Deputy Director-General (Admin. & Finance) Ms. Shinoona Al-Harthy, Acting Deputy Director (Nursing Affairs)

10 Administrative Staff Yousuf Al-Balushi, Head of Coordination & Follow-Up Solomon Ola, Coordinator/Rapporteur of Hospital Board Moosa Abdubaqi, Coordinator John Faloye, Coordinator Maria Al-Omairi, Clerk Ahmed Al-Rusheidi, Chief Messenger Supervisor Fahdil Al-Farsi, Messenger DEVELOPMENTAL ACTIVITIES SQUH is continuing the process of development and growth in order to fulfill its main aims which are health education, research and clinical services. Furthermore, the Hospital plays a significant role in the community and the Hospital Management is committed to providing high-quality care services in collaboration with the College of Medicine & Health Sciences with the continued support of the University Administration.

PIONEER IN HEALTH CARE SERVICES By the end of 2013, the Hospital was opened at full capacity after the following developments:

• Significant development and increase in different clinical specialties and services • Eight highly-specialised doctors returned from abroad while 19 scholars proceeded abroad for their studies in 2013. • Continuous professional development policy for doctors in fellowship and training.

• Purchase, commissioning and installation of different types of new equipment such as: Overview - thrombectomy Generator System for Arteries and Veins - immunohistochemistry Autostainer - portable Ultrasound System - echocardiogram Unit - echocardiography System - pulmonary Function Laboratory - MRI Patient Monitoring System - auditory Otoacoustic Emission System - Operating Microscope - endoscopic Ultrasound Machine - gastrointestinal Videoscope - intravascular Ultrasound (IVUS) - Digital Laparoscopic System

11 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

- Flexible Fiberscope - DNA Sequencer - Ophthalmic Coherence Tomography - Long Term EEG Machine - DNA and RNA Extractor - pulse Oximeter - eeg Recorder - surgical Drill.

QUALIFIED HUMAN RESOURCES The Hospital Management believes in the training of Omani professionals abroad in order to achieve the goals of SQUH. Therefore, a total of 5–10 physicians are sent abroad yearly for higher education and fellowship training, with a total of over 100 doctors sent to Canada, USA, Australia and UK. Nine of these returned in 2012 and 8 in 2013. Also, we have established and completed the CPD system for continuous professional development.

A total of 151 members of staff from different departments attended external courses conducted by the Direc- torate of Training & CPD in 2013. A total of 589 members of staff (467 Omanis and 122 non-Omanis) attended 21 unscheduled in-house courses. A total of 3,017 participants attended 224 scheduled in-house courses conducted in 2013.

RECOGNITION The Hospital continued to be recognised as a centre of excellence by visiting experts and through receiving invitations from other health organisations in the community to conduct symposia and lectures in order to enhance the level of education services in other institutions. The Hospital has continued to maintain ISO accreditation by bi-annual external review. Striving for better quality, the hospital decided to go ahead for accreditation by inviting Canadian Accreditation International to assess and implement the Canadian accreditation system.

WORK IN PROGRESS Based on the Hospital’s aims and vision, the Hospital Development Committee plans to develop/update the current services through the following projects already approved by the Hospital Board:

• Theatres/Radiology Extension (almost completed) • A 6-floor Haematology Centre (project in progress) • Emergency Department Extension

12 • Administration Building • Extensions to the Intensive Care Unit (ICU) and Cardiac and Paediatric ICUs (20–40 beds) • Extension to the Central Sterile Supplies Department • Renal Dialysis Unit • Outpatient Department Building plus Day Care Unit.

FUTURE DEVELOPMENT - Laboratory Building Extension - postgraduate Centre - seminar Rooms, Offices and On-call Rooms-Complex - staff Residential Building - Multi-Storey Car Park.

CLINICAL ACTIVITIES The increase in patient activities over the years has relied on strong commitment by all the medical, nursing, technical and administrative staff.T he Hospital Management would like to acknowledge all their efforts towards continuous improvement. Such developments are unattainable without proper in-house and external training which has witnessed yet further improvement during the year 2013.

The role of SQUH as a major Omani health service provider continued in this period with a total of 124,206 outpatients and over 32,525 inpatients seen during the year. A total of 27 bone marrow transplants were done in 2013. Overview

The number of day care patients in 2013 was 14,566 compared to 12,969 recorded in the preceding year. The use of day care reflects a healthy trend as the encouragement of ambulatory care results in considerable savings in the cost of delivery as well as improved quality.

Inpatient admissions increased still further in 2013 to 32,525 surpassing the previous year’s figure of 32,044 (increase of 1.5%). The average length of stay for the year 2013 was 5.0 days, which was the same as recorded in the previous year.

Finally, newborn live deliveries stood at 3,812, comprising of 1,864 males and 1,982 females. This was an increase of 3.1% over the 2012 figure of 3,697 total deliveries.

13 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

14 departments

care

Anaesthesia, ICU & Pain Management patient

and

he Department of Anaesthesia, Intensive Care & Pain Management is a dynamic and very productive department of Sultan Qaboos University Hospital (SQUH). Our key roles are in the operating theatre, anaesthetising patients for all surgical specialties and subspecialties and in the Intensive Care Unit (ICU), managing critically ill patients. The Depart- mentT provides 24-hour elective and emergency anaesthesia services to the entire hospital, including referrals from other health academic institutions. We manage a 25-bed ICU. We are also involved in inserting venous access devices, both implantable and percutaneous, to patients from various clinical departments. Pain management is also part of our departmental functions with acute and chronic pain management services. Cardiopulmonary resuscitation is a significant function of the Department and now Anaesthesia, ICU & Pain Management cardiothoracic anaesthesia has also been added. The Department forms a solid part of the SQUH Trauma and Disaster management services.

The Pre-anaesthesia Assessment Clinic (PAC) has been fully functional since March 2009 and is open five days a week.P atients who have to undergo surgery are assessed here for surgical fitness at the outpatient department (OPD) level. This was initiated with the main aim of reducing inpatient cancellations—a key factor in improving hospital efficiency.

15 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Darshana Rathod, Specialist Zahra G. Ahmed, Specialist Acting Head of Department Ziad Waadallah, Specialist Amarnath Shetty, Consultant Shaikh K. Shakeer, Specialist Deputy Head of Department Nigel Kuriakose, Acting Specialist Mohammed Al-Ismaili, Consultant Support Staff Faculty Leena Chacko, Coordinator Ibrahim Al-Farsi, Coordinator Karin Nollain, Senior Consultant Suresh Chengode, Senior Consultant Technicians Ram N. Rao, Consultant Mohammed Al-Badi, Anaesthesia Technician Sinnakirouchenan, Senior Consultant Maheswariamma, Anaesthesia Technician Rajini Kausalya, Senior Consultant Bipin Aravind, Respiratory Therapist Ali Al-Abady, Consultant Kingsly Prabhkaran, Respiratory Therapist Nasser Al-Kemyani, Consultant Sathyanarayan P. Bai, Respiratory Therapist Intisar Al-Macki, Consultant Anil Kalarickal, Respiratory Therapist Jaswinder Sharma, Consultant Jayachandiran, Respiratory Therapist Binoy Zachariah, Senior Specialist Praisemabel, Respiratory Therapist Rahul Shabadi, Senior Speciailist Midhun Mohan, Respiratory Therapist Pardeep K. Sharma, Senior Specialist Carlos Gatdula, Respiratory Therapist Jyoti Burad, Senior Specialist Deepthi Alias, Respiratory Therapist Devaraj N. Dyamanna, Senior Specialist Aravind Narayanan, Senior Specialist Highlights of the Year 2013 Hatem A. El Ghany, Senior Specialist Sanath Kumar, Senior Specialist Training provided Rohit Date, Senior Specialist The Department conducted a workshop on Ultra- Chander Lal, Specialist sound-Guided Peripheral Nerve Blocks in Decem- Nisha John, Specialist ber 2013. It was facilitated entirely by the Anaes- Babji Kalapati, Specialist thesia faculty of SQUH. The response was positive Ajai K. Arora, Specialist and the workshop very successful. Pradeep Kumar, Specialist Sonali Deoskar, Specialist New Services Abdur R. Abid, Specialist The service of ultrasound-guided peripheral nerve Wael Riad, Specialist blocks is functioning very well and we are perform- Mohammed Hatab, Specialist ing more than 500 blocks per year. This has revo- Sheebu P. A., Specialist lutionised the practise of regional anaesthesia. The

16 Department is proud to have introduced this new service and also vascular access under ultrasound guidance.

New Sub-specialty The sub-specialties of Neuroanaesthesia and Paediatric Anaesthesia are functioning well. In Paediatric An- aesthesia, we are doing several procedures even on extremely preterm babies and some of them are being done for the first time in Oman.

Teaching Programmes UNDERGRADUATE TEACHING – NEW CURRICULUM The Department is involved in the Integrated Module and teaching in the Pre-clerkship, Junior Clerkship and Senior Clerkship. For the Junior Clerkship, students come to us for the Anaesthesia Rotation and in Senior Clerkship we teach the ICU rotation. departments

Junior Clerkship Programme During the one-week Anaesthesia rotation of the Junior Clerkship, students participate in the Department’s care clinical activities and we teach topics relevant to basic anaesthetic management. The students are given ‘hands on’ experience, on both manikins as well as patients, under the close supervision of anaesthesiol- ogists. The tutorials are aimed at making the student understand the use of airway adjuncts, respiratory patient

equipment, central venous and arterial cannulation, regional blocks and drugs used in anaesthesia and cardiopulmonary resuscitation. and

POSTGRADUATE PROGRAMME Oman Medical Specialty Board (OMSB) A 4-year residency programme in anaesthesia was started in September 2007 under the OMSB. After suc- academic cessful completion, the residents will do a further year of specialised training. The Department is actively involved in teaching the residents in the Anaesthesia programme, evaluating and assessing them on a regular basis. Anaesthesia, ICU & Pain Management

Training Courses & CME Activities The Department is actively involved in the teaching of courses organised by the SQUH Directorate of Train- ing & CPD. These include the Advanced Cardiac Life Support (ACLS) provider course; the ACLS Recertification course; the Basic Life Support (BLS) provider course; the BLS Recertification course; the Pain Management

17 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Course, and the Central Venous Access Device course.

Every Monday there is a CME session in the Department covering topics of recent interest in anaesthesia and intensive care. Doctors of the Department present interesting topics for professional development and update the staff. Residents are encouraged to attend.

Members of the Department are also part of the Oman Society for Anaesthesia & Critical Care (OSAAC) which is involved in regular CME activities and scientific sessions.

Clinical & Diagnostic Services A total of 7,039 anaesthetic procedures were carried out in 2013 compared to 6,668 in 2012 and 5,591 in 2011. In 2013, a total of 4,599 elective cases were carried out as well as 2,440 emergency cases.

Figure 1: Anaesthesia statistics in 2013

Research RESEARCH PROJECTS Comparison of conventional and ultrasound guided techniques for radial artery cannulation to find out a better technique in terms of number of attempts, ease of insertion, time taken, in various sub-groups of patients with different hemodynamic status Code: MREC #644 Dates: 2012–2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Jyoti Burad, Dept. Anaesthesia & ICU, SQU.

18 Regional versus general anaesthesia for emergency caesarean section: Procedural impact on maternal and neonatal outcome. Single centre retrospective study at Sultan Qaboos University Hospital, Muscat, Oman Code: MREC #673 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Devaraj Dyamanna, Dept. Anaesthesia & ICU, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Bhakta P, Sharma PK, Date RR, Mohammed AK. Can low dose spinal anaesthesia combined with ultrasound guided bilateral ilioinguinal-iliohypogastric nerve blocks avoid use of additional epidural catheter in high risk obstetric cases. Acta Anaesth Belg 2013; 64:163–7.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations departments

International 1. Sharma PK. Difficult Airway Guidelines for Adult and Paediatric Patients. 23rd Annual National Conference Research Society of Anaesthesiology Clinical Pharmacology (RSACPCON), Srinagar, India, 25–27 Oct 2013. care

National 1. Sharma PK. Airway and Ventilatory Management in Trauma patient. Trauma Course for Nurses, SQUH, Muscat, Oman, 3 Jun 2013. patient

2. Kausalya R. Patient Safety: Ask – Listen – Talk. 2nd GCC International Conference on Patient Safety, Directorate of Development & Quality, SQUH, Muscat, Oman, Jan 2013. and

3. Kausalya R. Patient safety in Anaesthesia. 6th Annual Scientific Session Oman Society for Anaesthesia & Critical Care, Muscat, Oman, Dec 2013. Poster Presentations International academic 1. Kuriakose N, Kausalya R. Regional anaesthesia experience in a traumatized infant. European Society of Regional Anaesthesia Congress, Glasgow, UK, 4–7 Sep 2013. Anaesthesia, ICU & Pain Management

19 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

20 departments

care

Behavioural Medicine patient

and

ehavioural medicine is an interdisciplinary field of medicine concerned with the integration of knowledge in the bio- Behavioural Medicine logical, behavioural, psychological and social sciences relevant to health and illness. Therefore, the Department of Be- havioural Medicine embraces expertise from diverse fields including psychological sciences, anthropology, sociology and Bclinical psychiatry. The service is one of the best in the country and was one of the very first to provide modern diagnosis academic and research on behavioural medicine. For its clinical services, the Department provides state-of-the-art treatment and care of psychiatric disorders, much of it based on the innovative research done by our faculty. The Department has fully functioning services that address mental healthcare needs for all developmental milestones from the ‘cradle to the grave’. Thus, the Depart- ment provides child and adolescence mental health services, general adult mental health services as well as geriatric psychiatry. The Department strives, as an academic and clinical department, for excellence in learning, teaching and research and to be the flagship department in its field in Oman and the region.T here is ample evidence to suggest that most illnesses, whether physical or psychiatric, are invariably influenced by biology, psychological and social factors and so a biopsychosocial approach is necessary. Therefore, in the approach to learning, teaching and research, efforts are made to determine how biopsychosocial- factors are central to the predisposition, onset, course and outcome of most disorders.

21 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Whilst communicable diseases continue to be a Ziad A. J. Zaidan, Associate Professor source of attrition in a country like Oman, there Marwan Al-Sharbati, Associate Professor is also the ‘silent epidemic’ of non-communicable Harith Al-Ghassany, Assistant Professor diseases, often precipitated and exacerbated by Rodger Martin, Senior Consultant an individual’s behaviour and lifestyle which can Ather S. Jafri, Senior Consultant result in serious distress and often fatal diseases. Amre El Guenedi, Consultant Research in the Department has specifically fo- Hamed Al-Sinawi, Consultant cused on the psychosocial determinants of health Ahmed S. B. Amer, Consultant and ill-health since biological sciences alone are Yousif A. Obeid, Senior Specialist not sufficient in the prevention of and interven- Ahmed Al-Harrasi, Senior Specialist tion in matters related to disease. This has led the Aziz Al-Naamani, Specialist Department’s researchers to consider cultural vari- Nonna Viernes, Specialist ations when establishing psychological services in Amaal Ambusaidi, Specialist Oman. Research coming from the Department indi- Amira Al-Hosni, Specialist cates that the incidence of psychological distress in Hassan Mirza, Specialist Oman is common, with some minor differences in Ibrahim Elzein, Senior House Officer the incidence of the types of reaction. Zena M. Al-Sharbati, Clinical Psychologist Samira Al-Hamdan, Psychologist We have come a long way since the time when the Salwa Al-Redha, Psychologist relevance of behavioural input in medical science Abdullah Al-Sulaimani, Social Worker was considered to be a ‘luxury’ only affordable in Ahmed Al-Salmi, Social Worker the industrialised world. Now the question is not Khamis Al-Balushi, Social Worker how relevant behavioural medicine is for Oman, Khoula Al-Wahaibi, Social Worker but how Oman is implementing behavioural med- Younis Al-Hashim, Social Worker icine in its healthcare infrastructure. Given the rising magnitude of non-communicable diseases, Support Staff there is immense relevance in a scientific approach Ravindran Kozhapatil, Coordinator to the study of human behaviour. Govindan Mundayadan, Coordinator Highlights of the Year 2013 Staff As in previous years, the year 2013 witnessed enor- mous growth and expansion in the Department. Head of Department The psychiatric residency programme had yet an- Samir Al-Adawi, Professor other year of substantial development. In line with Faculty changes in medical education, the Department has been instrumental in embracing the new curricu- Ala’Aldin Al-Hussaini, Professor

22 lum with its integrated approach to teaching. This approach has been shown to be in the vanguard for the much needed holistic approach to learning medical skills.

The Department has been active in local and international research collaborations and published a number of papers on various aspects of health trends in Oman. In this period, a number of articles have been published on issues pertinent to child and adolescent emotional, cognitive and behavioural functioning. These studies are timely as they form a much needed database on the mental welfare of ‘tomorrow’s people’ in Oman—as the bulk of the Omani population are either children or adolescents. Such a database is expected to provide enlightened views to safeguard their development. Road traffic safety is increasingly recognised as a health ‘enemy’ in Oman with many people either maimed or killed in road accidents. In response to this challenge, the Department has secured grants in collaboration with others to examine the biopsychosocial issues that contribute to this situation. Some preliminary data as well as a Ph.D. project have been completed in order to lay the groundwork for evidence-based good practice to mitigating road traffic crashes and their aftermath.

As testimony to its international stature, the Department has duly participated in the Classification of Men- departments tal and Behavioural Disorders in Arab Countries and the World Health Organization Expert Consultation Group on Feeding and Eating Disorders in order to shape the content of the forthcoming International Clas-

sification of Diseases, ICD-11. care

The Department has been active at the national level in the anti-stigma campaign, ‘All for One’, which aims to eradicate the social stigma associated with people with compromised cognitive and emotional functioning. patient As Oman has an increasing number of elderly people, the Department has been at forefront of promoting

the well-being of these people. The Aging and Dementia Research Group was formed in order to advance and research on Alzheimer’s and dementia as well as provide a venue to discuss care for those living with this disease and to establish a self-help group for caregivers. Behavioural Medicine There are a total of 24 members of nursing staff in the psychiatric unit: 22 staff on the ward and 2 staff in the outpatient department (OPD). An important feature of the Department’s clinical services is the essential role academic of nurses. Members of the nursing team won the awards for ‘Best Innovative Nurse’, ‘Best Documentation Nurse’ and ‘Best Nurse-Overall’, a major accomplishment.

Teaching Programmes The main thrust of the Department’s teaching approach is to equip future Omani doctors with the ability to prevent, diagnose and treat various mental illnesses in the community at large and to expose our students to the empirical evidence that distress, disease and treatment are experienced in the context of cultural and social processes, as well as to introduce the idea of integrating mental health services into primary care.

23 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 1: Statistics for the In- and Outpatients Clinic 2011–2013.

The academic component includes: a regular seminar on the therapeutic skills of teaching and consultation; teaching on current issues in psychiatry, developmental psychology, behavioural medicine, psychological assessments, personality, bereavement, cross-cultural psychiatry and eclectic approaches to psychological intervention; a clinical clerkship in psychiatry; teaching of psychiatry residents; teaching liaison psychiatry in hospital; clinical OPDs; ward rounds and ward work, and the new liaison psychiatry service. To keep abreast with the development of psychiatry elsewhere, a regular Journal Club is held. External speakers are also part and parcel of this endeavour.

Development of the New Medical Curriculum The Department has been active in developing its new curriculum for the new medical degree programme. Behavioural medicine lectures, tutorials and seminars are now fully integrated into the pre-clinical system modules of Phases 1 and 2 and the integrated modules. The Phase 3 clinical curriculum for behavioural medicine is being developed. Its primary focus is on the Pre-clerkship and Junior Clerkship training although it will be a contributing theme throughout the Senior Clerkship and Junior Internship phases. The Department will be contributing specific lectures, case studies and training in theP re-clerkship stage on the topics of clinical assessment (young people, working adults and older adults); vulnerability for mental health (genetic versus environmental influences); models of stress and coping, and health psychology and chronic illness management. In liaison with other College departments, teaching is provided on specific clinical communication skills (e.g. working with psychotic patients) and clinical ethics (e.g. confidentiality and suicide management). The Junior Clerkship stage will focus on the advanced training of medical students in the clinical application of the basic skills learned within the Pre-clerkship stage, giving them clinical exposure to a wide range of psychiatric conditions and their medical and psychotherapeutic treatment.

24 Postgraduate Programme The Department continued in this period to train Family Medicine & Community Health residents and contributed to revising the programmes for the examination for Membership of the Royal College of General Practitioners (MRCGP), the Arab Board of Psychiatry and the Oman Medical Specialty Board (OMSB) residency training programme (including writing the curriculum, preparing for examinations and writing their programmes).

Training Courses & CME Activities The Department conducted a number of workshops on various aspects of stress and coping; the psychology of chronic disease management; research methodology, and issues pertinent to social medicine.

Clinical & Diagnostic Services On the hospital side, the combination of referrals from all part of Oman and prompt service delivery put the Department in the vanguard of psychiatric services in the country. The Department is one of the few in departments Oman which provides for specialist tertiary referrals. It has a multidisciplinary team approach designed for the optimum treatment of patients and training of medical students. The Department has a support staff of care psychologists, nurses, social workers and other clinicians.

The Department strives to offer comprehensive liaison psychiatry with other branches of medicine as well as psychosocial intervention and various social work services with its fully-functioning team of psychiatrists, patient psychologists and social workers. The Department offers unique clinical and diagnostic services—including a wide range of assessments relevant for the diagnosis of cognitive disorders and personality testing. The and assessments provided by our staff employ specialised testing procedures to integrate medical, neurological and behavioural data with the findings in order to answer any of a number of referral questions. Referrals to our services typically consist of, but are not limited to, questions concerning: (a) differential diagnoses Behavioural Medicine between functional and organic syndromes (e.g. depression versus dementia); (b) the delineation of spared and impaired cognitive functions secondary to central nervous system dysfunction; (c) the establishment of academic behavioural baseline measures to monitor the recovery or progression of a central nervous system dysfunction; (d) the comparison of pre- and post-pharmacological states, surgical, and behavioural interventions; (e) the assessment of cognitive/behavioural functions for the formulation of rehabilitation, management strategies, and/or educational or employment placement, and (f) the evaluation of neurocognitive status for the purpose of tests for disability, compensation and liability determinations. One of the new developments in this regard was the establishment, from September 2010, of an Old Age Psychiatry service. It provides services for the increasing ageing population in Oman. A major undertaking is to develop cognitive testing for the elderly population in Oman as well as to liaise with nuclear medicine and radiology to obtain neuro-imaging data.

25 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Research RESEARCH PROJECTS Effect of dietary supplementation of fruits grown in Oman on cognitive decline in Alzheimer’s dementia, mild cognitive impairment, vascular cognitive impairment and traumatic brain injury Code: RC/AGR/FOOD/11/01 Dates: 2011–2014 Value: OR 201,000 Funder: The Research Council Oman Investigators: Dr. Mohamed Essa, Ms. Roopa Koshy, Dept. Food Science & Human Nutrition, SQU; Dr. Samir Al-Adawi, Dr. Hamed Al-Sinawi, Dept. Behavioural Medicine, SQU; Dr. Abdullah Al-Asmi, Dept. Medicine, SQU; Dr. Ragini Vaishnav, Dept. Pharmacology, SQU.

Internet addiction in a sample of secondary and university Omani Students Code: RC/ART/INFO/11/01 Dates: 2011–2014 Value: OR 82,000 Funder: The Research Council, Oman Investigators: Prof. Abdelmajid Bouazza, Dept. Information Studies, College of Arts, SQU; Dr. Marwan Al-Sharbati, Dept. Behavioural Medicine, SQU.

A study of the nutritional and metabolic factors contributing to the occurrence of autistic spectrum disorder among children in the Sultanate of Oman Code: IG/AGR/FOOD/10/01 Dates: 2010–2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Mostafa Waly, Dept. Food Science & Nutrition, College of Agriculture, SQU; Dr. Marwan Al-Sharbati, Dept. Behavioural Medicine, SQU.

Prevalence of depression among adults with sickle cell disease Code: MREC #718 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Hamad Al-Sinawi, Dept. Behavioral Medicine, SQU.

Adolescent-onset psychosis: Demographic variables and clinical characteristics of inpatient psychotic adolescents at the Department of Behavioural Medicine at SQUH Code: MREC #722 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Hassan Mirza, Dept. Behavioral Medicine, SQU.

Public knowledge of dementia in Oman Code: MREC #735 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Hamad Al-Sinawi, Dr. Ahmed Al-Harrasi, Dept. Behavioral Medicine, SQU.

26 Stress and burden of care among dementia carers in Omani Code: MREC #736 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr.Hamad Al-Sinawi, Dept. Behavioral Medicine, SQU.

Average length of stay of elderly people in SQUH Code: MREC #738 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Hamad Al-Sinawi, Dept. Behavioral Medicine, SQU.

Genetic basis of schizophrenia in Oman Code: MREC #759 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Hamad Al-Sinawi, Dr. Hassam Mirza, Dept. Behavioral Medicine, SQU.

Prevalence of depression among stroke patients and relation with demographic and stroke characteristics departments Code: MREC #760 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Nawal Al-Zadjali, Dept. Behavioral Medicine, SQU. care

Compassion fatigue among resident physicians in the Oman Medical Specialty Board Code: MREC #771 Dates: 2013 Value: Unfunded Project Approval: SQU patient Investigator: Ms. Zena Al-Sharbati, Dept. Behavioral Medicine, SQU. and Rates of nonadherence, discontinuation, relapse and readmission in patients with schizophrenia

Code: MREC #778 Dates: 2013 Value: Unfunded Project Approval: SQU Behavioural Medicine Investigator: Dr. Ahmed Al-Harrasi, Dept. Behavioral Medicine, SQU. academic Physical co-morbidities among patients with dementia seen at Sultan Qaboos University Hospital Code: MREC #803 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Azza Al-Hinai, Dept. Behavioral Medicine, SQU.

Effectiveness of contact-based education in changing negative perceptions and attitudes towards mental illness among medical students at Sultan Qaboos University Code: MREC #833 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Amaal Ambusaidi, Dept. Behavioral Medicine, SQU.

27 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Schizophrenia profile Code: MREC #834 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Amira Al-Hosni, Dept. Behavioral Medicine, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Braidy N, Selvaraju S, Essa MM, Vaishnav R, Al-Adawi S, Al-Asmi A, Al-Senawi H, et al. Neuroprotective effects of a variety of pomegranate juice extracts against mptp-induced cytotoxicity and oxidative stress in human primary neurons. Oxid Med Cell Longev 2013; 2013:685909. 2. essa MM, Subash S, Braidy N, Al-Adawi S, Lim CK, Manivasagam T, et al. Role of NAD(+), oxidative stress, and tryptophan metabolism in autism spectrum disorders. Int J Tryptophan Res 2013; 21:6:15–28. 3. al Asmi A, Al Maniri A, Al-Farsi YM, Burke DT, Al Asfoor FM, Al Busaidi I,…Al-Adawi S. Types and sociodemographic correlates of complementary and alternative medicine (CAM) use among people with epilepsy in Oman. Epilepsy Behav 2013; 29:361–6. 4. younis MS, Al-Noaimi AS, Zaidan ZA, Al-Rubayie AF, Al-Farsi Y, Al-Zakwani I, Al-Adawi S. Clinical and demographic profile of attendees at Baghdad’sW alk-in Psychiatric Clinic. Oman Med J 2013; 28:365–70. 5. al-Mandhari A, Al-Adawi S, Al-Zakwani I, Dorvlo A, Al-Shafaee M. Reasons for consultation among patients attending primary healthcare centres in Oman. Sultan Qaboos University Med J 2013; 13:248–55. 6. al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O,…Al-Adawi S, et al. Impact of nutrition on serum levels of docosahexaenoic acid among Omani children with autism. Nutrition 2013; 29:1142–6. 7. al Reesi H, Al Maniri A, Plankermann K, Al Hinai M, Al Adawi S, Davey J, et al. Risky driving behavior among university students and staff in the Sultanate of Oman. Accident Anal Prev 2013; 58:1–9. 8. al-Reesi H, Ganguly SS, Al-Adawi S, Laflamme L, Hasselberg M, Al-Maniri A. Economic growth, motorization, and road traffic injuries in the Sultanate of Oman, 1985-2009. Traffic Inj Prev 2013; 14:322–8. 9. al-Shafaee M, Al-Kaabi Y, Al-Farsi Y, White G, Al-Maniri A, Al-Sinawi H, Al-Adawi S. Pilot study on the prevalence of abuse and mistreatment during clinical internship: a cross-sectional study among first year residents in Oman. BMJ Open 2013; 3:e002076. 10. al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O,…Al-Adawi S, et al. Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism. Nutrition 2013; 29:537–41. 11. Burke DT, Tran D, Cui D, Burke DP, Al-Adawi S, Dorvlo ASS. Significant progression of load on the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using the Anatoly Gravitational System, in a 10-week training period. Open Access J Sports Med 2013; 4:211–19. 12. al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee MA, Al-Farsi OA, Al-Khaduri MM,…Al-Adawi S, et al. Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: a case-control study. Biol Trace Elem Res 2013; 151:181–6. 13. al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O, Al-Fahdi S,…Al-Adawi S. Variation in socio-economic burden for caring of children with autism spectrum disorder in oman: caregiver perspectives. J Autism Dev Disord 2013; 43:1214–21. 14. Al-Adawi S, Bax R, Bryant-Waugh R, Claudinod A, Haye P, Herscovicif CR, et al.. Revision of ICD – status update on feeding and eating disorders. Adv Eat Disord 2013; 1:1–10. 15. essa MM, Braidy N, Waly MI, Al-Farsi YM, Al-Sharbati M, Subash S, et al. Impaired antioxidant status and reduced energy metabolism in autistic children. Res Autism Spect Dis 2013; 7:557–65.

28 16. al-Farsi YM, Al-Khaduri M, Al-Sumri H, Al-Farsi O, Al-Sharbati M, Waly M. Association of gestational diabetes mellitus with occurrence of autism: A cohort study. FASEB J 2013 (Meeting Abstract Supplement); 27:lb111. 17. Al Harrasi A, Aravazhi MS, Sinawi H. Dementia with Lewy bodies: Enigmatic presentation. Int J Nutr Pharmacol Neurol Dis 2013; 3:156–9. 18. Mirza H, Al Sinawi H, Al Ruqaishi N. Eating disorders among Omani adolescents attending a tertiary care center. Int J Nutr Pharmacol Neurol Dis 2013; 3313–17. 19. al-Sabahi SM, Al Sinawi HM, Al Hinai SS, Youssef RH. Rates and determinants of functional limitation among the elderly population in Al Dakhlyia Region, Sultanate of Oman. Middle East J Age Ageing 2013; 10:3. Books & Book Chapters 1. Al-Sharbati Z, Al-Sharbati M, Gupta I. The Art of Psychotherapy in Oman: practice and limitations. In: Introduction to Clinical Methods in Neurological Disorders. iConcept Press Ltd, 2013.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International

1. Al-Sharbati M, Al-Farsi YM, Al-Shafaee MA, Waly MI, Al-Farsi O, Al-Khaduri MM, Al-Adawi S, et al. Misconceptions departments about autism among school teachers in Oman. International Iraqi Medical Association, 9th Conference, Sharjah, United Arab Emirates, 28–31 Mar 2013. care National 1. Al-Adawi S. Psychosocial sequelae of road traffic injuries: For whom the bell tolls. 1st International Mental Health Conference, Al-Masarra Hospital, Oman, 1–2 Dec 2013.

2. Al-Adawi S. Effective Communication. Communication Skills Part I Workshop for R1 Residents. Oman Medical Spe- patient cialty Board, Al-Khoudh, Oman, 18, 19 & 25 Nov 2013.

3. Al-Adawi S. Coping with disasters and mourning for the loss. Presentation to the Filipino Community following and Typhoon Haiyan in the Philippines, SQU, 24 Nov 2013. 4. al-Adawi S. Neuroscience of Mindfulness. Workshop for Sultan Qaboos University Students (SCOPE), 24 Nov 2013. Behavioural Medicine 5. al-Adawi S. Occupational Stress. Lecture to Oman Cables Industry (SAOG), Al Bustan Hotel, Muscat, Oman, 15 Sep 2013.

6. Al-Adawi S. Procrastination is the thief of time. Lecture given to Oman Cables Industry (SAOG), Al Bustan Hotel, academic Muscat, Oman, 16 Sep 2013. 7. Al-Adawi S. Mental Health Research in Oman. Al-Masarra Hospital, Ministry of Health, Oman, 19 Sep 2013. 8. Al-Adawi S. Think - Eat - Save. World Environment Day Lecture, United Nations Environment Program (UNEP), Cul- tural Centre, SQU, 5 June 2013. 9. Al-Adawi S. Psychosocial sequelae of road traffic injuries: For whom the bell tolls? Public Health Forum, Khoula Hos- pital, Muscat, Oman, 9 Apr 2013. 10. Al-Adawi S. Literature Review. Muscat Governorate, Ministry of Health, Darsait, Muscat, Oman, 7 Jan 2013. 11. Al-Sinawi H. Alzheimer’s and other neurocognitive disorders. Geriatric conference, Al-Massara Hospital, Muscat, Oman, 6 Oct 2013.

29 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

12. Al-Sinawi H. Profile of geriatric psychiatry in Oman. Oman Speciality Nursing Institute, Muscat, Oman, 14 Feb 2013. 13. Al-Harrasi. A multidispilinary approach to dementia care. 2nd Rehabilitation Psychiatry Conference, Al-Massara Hospital, Muscat, Oman, 3 Dec 2013. 14. Al-Sharbati Z. Evidence-based psychological interventions. 1st International Conference on Psychological Services in Oman, Muscat, Oman, 11–12 Dec 2013. Poster Presentations International 1. al-Farsi O, Al-Farsi YM, Waly M, Al-Sharbati M, Al-Shafaee M, Ouhtit A,…Al-Adawi S. Sleep patterns and quality among children with autism and their caregivers in Oman: a case control study. International Meeting for Autism Research (IMFAR), San Sebastián, Spain, 2–4 May 2013. 2. al-Kindi N, Al-Shafaee M, Waly M, Al-Sharbati M, Ouhtit A, Al-Khaduri M, Al-Adawi S, et al. Dietary patterns among children with autism in Oman: a study protocol. International Meeting for Autism Research (IMFAR), San Sebastián, Spain, 2–4 May 2013. 3. al-Khaduri M, Al-Sumri H, Al-Farsi O, Al-Sharbati M, Waly M, Ouhtit A, et al. Association of gestational diabetes mellitus with occurrence of autism: a cohort study. Federation of American Societies for Experimental Biology (FASEB), Boston, USA, 20–24 Apr 2013. 4. al-Said M, Al-Farsi M, Al-Khaduri M, Al-Sharbati M, Waly M, Al-Shafaee M,…Al-Adawi S. Challenges facing educators of children with autism in Oman from educators’ perspective: a qualitative study. International Meeting for Autism Research (IMFAR), San Sebastián, Spain, 2–4 May 2013. 5. Al Sinawi H, Al Harrasi A. Profile of patients attending Old Age Psychiatry Clinic at SQUH. Royal College of Psychia- trists International Congress, Edinburgh, UK, 2–5 Jul 2013. Seminar Presentations National 1. Al Sinawi H. How to care for person with dementia. Workshop for Friends of the Elderly Association, Muscat, Oman, 16 Oct 2013.

Thesis supervision Student Name: Omar Al-Farsi Qualification: Ph.D. Title: Stress and the quality of life of families having children with autism spectrum disorder. Supervisor: Dr. Marwan Al-Sharbati Date of completion: On-going

30 Student Name: Dr. Aziz Al-Naamani Qualification: Ph.D. Title: Neuropsychiatric syndrome in Oman among the victims of acquired brain injuries Supervisor: Prof. Samir Al-Adawi Date of completion: On-going

Student Name: tayyiba Almarri Qualification: Ph.D. Title: Investigating alcohol consumption patterns, associated cognitions and behaviors of Arab nationals living in the Arabian Gulf countries Supervisor: Prof. Samir Al-Adawi Date of completion: On-going departments

care

patient

and

Behavioural Medicine academic

31 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

32 departments

care

Biochemistry patient

Biochemistry and

he mission of the Biochemistry Department is to maintain excellence in service, teaching and research. The Department is involved in both pre-clinical and clinical teaching. In the pre-clinical years, teaching concentrates mainly on basic principles of biochemistry and metabolism. Teaching in the clinical years is devoted to clinical chemistry, including Tinterpretation of biochemical data on patients. The Department is also engaged in teaching biochemistry to medical laborato- academic ry science undergraduates and to nursing students. It also offers a graduate programme leading to M.Sc. and Ph.D. degrees in biochemistry. The Department also actively participates in the postgraduate training of doctors under the auspices of the Oman Medical Specialty Board.

The Department’s research interests cover diverse aspects of biochemistry, as well as structural and molecular biology. Research focuses around the development of biochemical tests for detecting mutations and mapping various monogenic and polygenic disorders including hypertension, diabetes, deafness and hyperlipidaemias.

The Department also provides a clinical biochemistry service to Sultan Qaboos University Hospital (SQUH) on a 24-hour basis and serves as a referral laboratory for hospitals all over the Sultanate. A total of 21 biomedical scientists serve the Department at SQUH.

33 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Abdulrahim Al-Abri, Biomedical Scientist (College) Sana Hasari, Biomedical Scientist (College) Head of Department Khalsa Al-Lamki, College Khalid Al-Rasadi, Senior Consultant Zainab Al-Hashami, College Faculty Hala Al-Baadi, College Zeyana Al-Dahmani, College Riad Bayoumi, Professor Manal Al-Khanbashi, College Nadia Al-Wardy, Associate Professor Taruna Dutt, Coordinator (College) Jumana Saleh, Associate Professor Marina Bendecio, Coordinator (Clinical) Hamza Babiker, Associate Professor Clifford Abiaka, Assistant Professor Marit Delghandi, Assistant Professor Highlights of the Year 2013 In the year 2013, Dr. Khalid Al-Rasadi was appointed Yahya Tamimi, Assistant Professor as Head of the Department. Ms. Arwa Al-Kindi re- Yajnavalka Banerjee, Assistant Professor turned and joined the Department as a lecturer after Fahad Al-Zadjali, Assistant Professor completing her master’s degree from Sussex Univer- Nafila Al-Riyami, Consultant sity, UK. Mr. Abdulrahim Al-Abri was awarded a His Khalid Al-Waili, Consultant Majesty’s Scholarship to study for a Ph.D. New tech- Arwa Al-Kindi, Lecturer nical staff, Ms. Zeyana Al-Dahmani and Ms. Manal Support Staff Al-Khanbashi, joined the Department. Mohammed Al-Kindi, Superintendent (College) Halima Aidid, Superintendent (Clinical) Mater Al-Maney, Chief Biomedical Scientist (Clinical) Teaching Programmes Adil Al-Wahaibi, Chief Biomedical Scientist (Clinical) UNDERGRADUATE MEDICAL PRO- Younis Al-Musafir, Chief Biomedical Scientist (Clinical) GRAMME Sameera Al-Harrasy, Chief Biomedical Scientist The Department teaches biochemistry in the new (Clinical) M.D. curriculum on the following courses: Molecular Zakiya Al-Zakwani, Chief Biomedical Scientist Biology & Introductory Genetics and Enzymology (Clinical) & Metabolism. The Department also participates in Laila Al-Hinai, Chief Biomedical Scientist (Clinical) various system courses like the Hematopoietic Sys- Romulo Cipriano, Senior Biomedical Scientist tem, Endocrine System, Respiratory System, Tissues, (Clinical) Urinary System, 7th year clinical rotations, the Inte- Suleiman Al-Riyami, Senior Biomedical Scientist grated Lecture Series and the student Research Proj- (Clinical) ect. Hamed Al-Riyami, Senior Biomedical Scientist (Clinical) B.Sc. Biomedical SCIENCES Hameeda Al-Barwani, Senior Biomedical Scientist (BMS) (College) The Department is teaching four courses in the BMS

34 degree in semesters 6 through 10. They are: Molecular Diagnostics; Systems Pathophysiology; Investigations of Endocrine Diseases; Advanced Clinical Chemistry, and Laboratory Operations.

NURSING DEGREE The Department of Biochemistry offers one course in Biochemistry for Nursing students.

POSTGRADUATE PROGRAMMES In the postgraduate programme, the Department offers the following four courses: Biochemical Basis of Disease; Instrumentation and Biochemical Techniques; Molecular Biology, and Methodology in Clinical Bio- chemistry. During 2012/2013, the Department had 14 students registered for an M.Sc. degree and 8 students studying for their Ph.D.

Clinical & Diagnostic Services

Service Provision departments

The Department of Clinical Biochemistry provides a wide range of routine and specialised investigations. Some of the specialised tests such as neonatal screening for inborn errors of metabolism are unique in Oman care and hence the Department offers a referral laboratory service for such investigations. Service is provided to SQU hospital on 24-hour basis. The number of tests performed from January to December 2013 was 1,571,293 (13.3% increase compared to 2012). patient

Biochemistry and

academic

Figure 1: Diagnostic services in 2005–2013

35 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

The Clinical Biochemistry Department also manages the Commercial Laboratory Services offered to selected hospitals within the private sector, e.g. Muscat Private Hospital, Badar Al-Samaa Polyclinic and Hatat Poly- clinic.

New Tests Plasma intraoperative parathyroid hormone, plasma amino acids, urine amino acids and cerebrospinal fluid amino acids analysis have been introduced in the laboratory.

Point-of-Care Testing The Department maintains the quality assurance of the blood gas analysers outside the laboratory, i.e. in the Emergency Medicine Department, the operating theatre, and the Intensive Care and Neonatal units.

Research RESEARCH PROJECTS The clinical and genetic characterization of type-2 diabetes mellitus in Omanis Code: RC/MED/BIOC/10/01 Dates: 2010–2013 Value: OR 87,300 Funder: The Research Council, Oman Investigators: Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Prof. Mohammed Hassan, Dr. Sulayma Al-Bar- wani, Dept. Physiology, SQU; Prof. Nicolas Woodhouse, Dr. Omayma El-Shafie, Dept. Medicine, SQU; Dr. Mo- hammed Al-Shafaee, Dept. Family Medicine & Public Health, SQU.

Identification of novel therapeutics targets for inflammatory-associated human disorders Code: SR/MED/BIOC/13/01 Dates: 2013–2015 Value: OR 94,200 Funder: His Majesty’s Strategic Research Fund Investigators: Dr. Fahad Al-Zadjali, Dept. Biochemistry, SQU; Dr. Sulaiman Al-Hashmi, Dept. Genetics, SQU; Dr. Mohammed Boulassel, Dept. Haematology, SQU.

Analysis of gene expression in ulcerative colitis Code: FURAP 2013 #1 Dates: 2013–2014 Value: OR 2,300 Funder: The Research Council, Oman - Faculty Men- tored Undergraduate Research Award Program Investigators: Dr. Fahad Al-Zadjali, Dept. Biochemistry, SQU.

Family based associations of variants of SOCS2 gene and traits of type 2 diabetes Code: FURAP 2013 #2 Dates: 2013–2014 Value: OR 2,300 Funder: The Research Council, Oman - Faculty Men- tored Undergraduate Research Award Program Investigators: Dr. Fahad Al-Zadjali, Dept. Biochemistry, SQU.

36 Analysis of molecular epigenetic programming of diabetes mellitus Code: CL/UAE/MED/BIOC/13/01 Dates: 2013–2015 Value: OR 20,000 Funder: SQU-UAE Collaborative Fund Investigators: Dr. Fahad Al-Zadjali, Dept. Biochemistry, SQU; Dr. Khalid Al-Balushi, Dept. Pharmacology, SQU; Dr. Starling Emerald, Dept. Anatomy, UAE University.

Population genetics of malaria parasites in relation to geographical, transmission intensities Code: N/A Dates: 2010–2013 Value: SEK 1,500,000 Funder: Swedish International Development Cooperation Agency Investigators: Dr. Göte Swedberg, Dept. Medical Biochemistry & Microbiology, Uppsala University, Sweden; Dr. Hamza Babiker, Dept. Biochemistry, SQU.

Asian regional capacity development for research and social determinant of health Code: IG/MED/FAMH/11/01 Dates: 2011–2015 Value: OR 43,000 Funder: European Union Investigators: Dr. Fahad Al-Zadjali, Dept. Biochemistry, SQU; Dr. Abdullah Al-Muniri, The Research Council, departments

Oman.

A study of the effects of pregnancy-related thyroid autoimmunity and oxidative stress in Omani women care from conception to parturition Code: IG/MED/BIOC/10/04 Dates: 2010–2013 Value: OR 7,000 Funder: SQU

Investigators: Dr. CliffordA biaka, Dept. Biochemistry, SQU; Dr. Lovina Machado, Dept. Obstetrics & Gynae- patient cology, SQU. Biochemistry and Lipids of minor physiological abundance as modulators of thrombin generation. Code: IG/MED/BIOC/11/01 Dates: 2011–2013 Value: OR 10,000 Funder: SQU Investigators: Dr. Yajnavalka Banerjee, Prof. Riad Bayoumi, Dr. Jumana Saleh, Dr. Khalid Al-Rasadi, Dept.

Biochemistry, SQU. academic

Identification and characterization of novel pharmacologically active proteins from the venoms of snakes native to the Sultanate of Oman Code: IG/MED/BIOC/12/01 Dates: 2012–2014 Value: OR 13,600 Funder: SQU Investigators: Dr. Yajnavalka Banerjee, Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Dr Khalil Al-Farsi, Dept. Haematology, SQU; Mr. Sayed Farooq, Small Animal House, SQU.

The analysis of SCN5A as a candidate gene for heart pacemaker control in Oman Family Study Code: IG/MED/BIOC/12/02 Dates: 2012–2013 Value: OR 4,736 Funder: SQU Investigators: Dr. Marit P. Delghandi, Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Dr. Sulayma Al-Barwani, Prof. Mohammed O. Hassan, Dept. Physiology, SQU. 37 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

The suppressor of cytokine signalling 2 (SOCS2): role in the development of inflammatory bowel disease Code: IG/MED/BIOC/13/01 Dates: 2013–2015 Value: OR 15,800 Funder: SQU Investigators: Dr. Fahad Al-Zadjali, Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Dr. Ibrahim Al-Haddabi, Dept. Pathology, SQU; Dr. Amira Al-Kharusi, Dept. Physiology, SQU; Prof. Gunnar Norstedt, Karolinska Institu- tet, Sweden.

Rapamycin derivatives differential inhibition of the Tm OR signaling pathway in colorectal cancer Code: IG/MED/DEAN/13/02 Dates: 2013–14 Value: OR 9,000 Funder: SQU Investigators: Dr. Yahya Tamimi, Dept. Biochemistry, SQU; Prof Mansour Al-Moundhri, Dept. Medicine, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Abiaka C, Delghandi MP, Al-Saleh M. Vitamin D status and anthropometric indices of an Omani study population. Sultan Qaboos Univ Med J 2013; 13:224–31. 2. Al-Abri A, Bayoumi R. The phenotype/genotype correlation of lactase persistence among Omani adults. Oman Med J 2013; 28:341–4. 3. al-Sabti HA, Al Kindi A, Al-Rasadi K, Banerjee Y, Al-Hashmi K, Al-Hinai A. Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft. Review. J Saudi Heart Assoc 2013; 25:247–54. 4. Banerjee Y. Is prolong use of statins associated with increase in the risk of diabetes? J Am Coll Cardiol 2013; 61:989. 5. al-Waili K, Al-Zidi WA, Al-Abri AR, Al-Rasadi K, Al-Sabti HA, Shah K,…Banerjee Y. Mutation in the PCSK9 gene in Omani Arab Subjects with autosomal dominant hypercholesterolemia and its effect onP CSK9 protein structure. Oman Med J 2013; 28:48–52. 6. al-Hinai AT, Al-Abri A, Al-Dhuhli H, Al-Waili K, Al-Sabti H, Al-Yaarubi S,…Banerjee Y,…Al-Rasadi K. First case report of familial hypercholesterolemia in an Omani family due to novel mutation in the low-density lipoprotein receptor gene. Angiology 2013; 64:287–92. 7. al-Hamidhi S, Mahdy MA, Al-Hashami Z, Al-Farsi H, Al-Mekhlafi AM, Idris MA,...Babiker HA. Genetic diversity of Plasmodium falciparum and distribution of drug resistance haplotypes in Yemen. Malar J 2013; 12:244. 8. Babiker HA, Gadalla AA, Ranford-Cartwright LC. The role of asymptomatic P. Falciparum parasitaemia in the evolution of antimalarial drug resistance in areas of seasonal transmission. Drug Resist Updat 2013; 16:1–9. 9. al-Kharusi N, Babiker HA, Al-Salam S, Waly MI, Nemmar A, Al-Lawati I, et al. Ellagic acid protects against cisplatin-induced nephrotoxicity in rats: a dose-dependent study. Eur Rev Med Pharmacol Sci 2013; 17:299–310. 10. Mahgoub O, Babiker HA, Kadim IT, Al-Kindi M, Hassan S, Al-Marzooqi W, et al. Disclosing the origin and diversity of Omani cattle. Anim Genet 2013; 44:336–9. 11. Zadjali F, Al-Yahyaee S, Hassan MO, Albarwani S, Bayoumi RA. Association of adiponectin promoter variants with traits and clusters of metabolic syndrome in Arabs: Family-based study. Gene 2013; 527:663–9. 12. shah K, Bayoumi R, Banerjee Y. Protein anticoagulants targeting factor VIIa-tissue factor complex: a comprehensive review. Hematology 2013; 18:1–7. 13. saleh J, Farhan H, Al-Saqri I, Al-Riyami B, Cianflone K. Plasma gamma-glutamyltransferase is strongly determined by acylation stimulating protein levels independent of insulin resistance in patients with acute coronary syndrome. Dis Markers 2013; 35:155–61.

38 14. Saleh J, Machado L, Razvi Z. 2-Hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in “appropriate for gestational age” neonates in healthy nondiabetic pregnancies. Biomed Res Int 2013; 2013:757459. 15. saleh J, Wahab R, Farhan H, Al-Amri I, Cianflone K. Plasma levels of acylation-stimulating protein are strongly pre- dicted by waist/hip ratio and correlate with decreased LDL size in men. ISRN Obesity 2013; 2013:342802.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Saleh J, Farhan H, Al-Saqri I, Al-Riyami B, Cianflone K. Acylation stimulating protein is a major determinate of gamma-glutamyltransferase levels in patients with acute coronary syndrome independent of insulin resistance. Inter- national Cardiology Symposium - A Global Agenda (ICS-13), Dubai, UAE, 16–18 May, 2013.

THESIS SUPERVISION Student Name: sawsan Al-Sinani Qualification: Ph.D. departments

Title: The clinical and genetic characterization of type 2 diabetes mellitus in Omanis care

Supervisor: Prof. Riad Bayoumi Date of completion: On-going patient Student Name: Bashair Al-Riyami Biochemistry and

Qualification: Ph.D. Title: Hormonal regulation of acylation-stimulating protein production and receptor expression in rodent regional adipose tissue Supervisor: Dr. Jumana Saleh academic Date of completion: On-going

Student Name: amal Gadalla Qualification: Ph.D. Title: Factors influencing malaria parasitesP lasmodium falciparum transmission strategies Supervisor: Dr. Hamza Babiker Date of completion: On-going

39 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Student Name: amani Ahmed Qualification: Ph.D. Title: Genetic mapping of drug resistant Plasmodium falciparum in Sudan Supervisor: Dr. Hamza Babiker Date of completion: On-going

Student Name: najma Al-Kharusi Qualification: Ph.D. Title: Genetic susceptibility to CVD and related metabolic disorders. Supervisor: Prof. Riad Bayoumi Date of completion: On-going

Student Name: ibtisam Al-Lawatia Qualification: Ph.D. Title: Sleep deprivation and association with metabolic syndrome Supervisors: Dr. Mohammed Al Abri, Dr. Fahad Al- Zadjali Date of completion: On-going

Student Name: amira Al-Kharusi Qualification: Ph.D. Title: Mechanisms in control of prolactin and growth hormone sensitivity Supervisor: Prof. Gunnar Norstedt, Dr. Fahad Al-Zadjali Date of completion: On-going

Student Name: amna Al-Araimi Qualification: Ph.D. Title: Molecular study of inflammatory processes and role of growth hormone Supervisor: Dr. Fahad Al-Zadjali Date of completion: On-going

40 Student Name: Khawla Al-Masoudi Qualification: M.Sc. Title: The association of bilirubin with basal oxidation status in Omani cardiovascular patients, and the effect of bilirubin on serum oxidation in vitro Supervisor: Dr. Jumana Saleh Date of completion: Aug 2013

Student Name: abdulHakeem Al-Hinai Qualification: M.Sc. Title: Composition of urinary stones in Oman Supervisor: Prof. Riad Bayoumi Date of completion: Sep 2013 departments

Student Name: Mohsin Al-Taqi Qualification: M.Sc. care Title: The prevalence of vitamin D deficiency in type 1 diabetes mellitus children in Oman and the correlation between vitamin D deficiency and glycemic control patient Supervisor: Dr. Khalid Al-Rassadi Biochemistry

Date of completion: Sep 2013 and

Student Name: Basma H. Al-Jabri Qualification: M.Sc.

Title: Evaluation of vitamin D and bone analyte status in term pregnancy and academic spontaneous abortion Supervisor: Dr. Clifford Abiaka Date of completion: On-going

Student Name: ward Al-Muna Al-Zidi Qualification: M.Sc. Title: Identification and characterization of mutations in genes implicated in familial hypercholesterolemia in Omani families Supervisor: Dr. Yajnavalka Banerjee Date of completion: Aug 2013 41 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Student Name: elango Abbhirami Qualification: M.Sc. Title: Association of human taste variation with heath status Supervisor: Prof. Riad Bayoumi Date of completion: On-going

Student Name: afraa Al-Abri Qualification: M.Sc Title: Mutation status of EGFR, Kras and Braf Genes in an Omani gastric cancer cohort Supervisor: Dr. Yahya Tamimi Date of completion: On-going

Student Name: raja Al-Sidairi Qualification: M.Sc. Title: The PNPLA3 I148M mutation and risk of developing non-alcoholic fatty liver disease Supervisor: Dr. Fahad Al-Zadjali Date of completion: On-going

Student Name: ishraq Al-Kindi Qualification: M.Sc. Title: Gum Arabic use in the management of ulcerative colitis Supervisor: Dr. Fahad Al-Zadjali Date of completion: On-going

42 departments

care

Child Health patient

Child Health and

he Department of Child Health is one of the pioneer Departments in the College of Medicine & Health Sciences (COMHS) and Sultan Qaboos University Hospital (SQUH). The Department accounts for more than a third of total SQUH admissions and provides the best of patient care from birth to adolescence, encompassing all subspecialties. T academic The Department has well-developed undergraduate teaching and training programmes collaborating with other sister institutions locally and internationally. Department members are actively involved in almost all of the COMHS educational activities and committees including the Curriculum and Examination committees. Department members have contributed significantly towards the development and implementation of the new curriculum. The Department trains many foreign undergraduate medical students during their elective rotations.

The Department also has a highly integrated postgraduate training programme and is equipped with excellent Clinical Teach- ing Units (CTUs) run by experienced teachers. Our Department started the first CTU in Oman and has been complimented on the initiative by a number of international medical educationalists and accreditation agencies. Various other departments have since followed our example. The Department teaches and trains junior doctors, preparing them for various examinations affiliated to the Royal College of Paediatrics & Child Health (UK), Royal College of Physicians & Surgeons of Glasgow and the

43 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Arab Board. The Department is the only centre in gic plan, we feel that the time is now right to de- Oman offering subspecialty training of paediatric velop an Institute of Child Health and a Children’s residents in metabolic diseases, neurology, immu- Hospital. nology and haemato-oncology. It also serves as the national referral centre for polio surveillance, various benign haematological conditions and leukae- Staff mia. The Genetic-Metabolic Unit has expanded and Head of Department moved to a dedicated building, in order to cater to Yasser Wali, the overwhelming numbers and this is well sup- Professor ported by the Development Progress Clinic, started Faculty by Dr. Watfa Al-Mamari. The cardiology services Zakia Al-Lamki, Professor have expanded over the last year and are exploring Muna Al-Saadoon, Assistant Professor the possibility of starting paediatric interventional Zahraa A. H. Al-Lawati, Clinical Lecturer cardiology services; currently, there is a twinning Nawal Al-Shamli, Clinical Lecturer programme with the Royal Hospital. The long-term follow-up clinics including the Post Bone Marrow Hospital Staff Transplant Clinic and the Cancer Survival Clinic are Hussein Al-Kindy, Senior Consultant in full swing, along with the Chemotherapy Clinic. Amna Al-Futaisi, Senior Consultant Multi-disciplinary clinics for Haemophilia Compre- Saif Al-Yaarubi, Senior Consultant hensive Care and the Haemostasis have also been Ibtisam B. Elnour, Senior Consultant started. Salem Al-Tamemi, Senior Consultant Roshan L. Koul, Senior Consultant The Department conducts high-quality research P. C. Alexander, Senior Consultant with state-of-the-art support from the SQU genetic Siham Al-Sinani, Senior Consultant laboratories, leading to publications in high-impact Reem Abdwani, Senior Consultant peer-reviewed indexed journals. Collaboration with Matthew Zachariah, Senior Consultant international centres of excellence in paediatrics Abdulhakim Al-Rawas, Consultant has benefited a large number of sick children, espe- Khalfan Al-Senadi, Consultant cially those with haematological diseases. Mohamed Abdellatif, Consultant Anas-Alwogud Abdelmogheth, Consultant To sum up, the Department strives to achieve ex- Hashim Javad, Consultant cellence in the region in undergraduate and post- Watfa Al-Mamari, Consultant graduate education, research and patient-centered Asad U. Rahman, Consultant care. It also plays a major role in the achievement of Azza Al-Shadhani, Senior Specialist excellence in all aspects of child healthcare in the Irfan Ullah, Senior Specialist country and the community. As a visionary strate- Masood Ahmed, Senior Specialist Mohamed Elshinawy, Senior Specialist

44 Wafa Bashir, Senior Specialist Amna Al-Alawi, Play Therapist Mathew Kripail, Senior Specialist Kawther Al-Khusaibi, Play Therapist Zenaida Reyes, Senior Specialist Fathiya Al-Huseini, Play Therapist Surekha Tony, Senior Specialist Ismail Elbeshlawi, Senior Specialist Highlights of the Year 2013 Mohammed A. El-Naggari, Senior Specialist Mohammed Fazalullah, Senior Specialist Scholarly and Academic Ac- Hanan Fawzy, Senior Specialist tivities Akram Zakria, Senior Specialist The Paediatric Pulmonology team organised the 1st Eiman Abdalla, Specialist Cystic Fibrosis Family Day at SQUH and the Oman Aamir Qais M. H., Specialist Thoracic Day at SQU was headed by Dr. Hussein Maria F. Bataclan, Specialist Al-Kindy. The Paediatric Gastroenterology Unit, led Cheryl Montemayor, Specialist by Dr. Siham Al-Sinani with the collaboration of the Naga R. Dhande, Specialist Paediatric Surgery Unit, arranged the visits of two dis- Raghad Abdwani, Specialist tinguished specialists in hepatology, gastroenterology

Yusriya Al-Rawahi, Specialist and nutrition from Kings’ College Hospital, London, departments

Laila Al-Yazidi, Specialist and the Global Hospital, Chennai, India. They facili- Renjit Mani, Specialist tated a symposium in SQUH called 'Current Update in care Rana Abelrahim, Specialist Pediatric Liver Diseases'. The Haematology/Oncology Shafiq U. Rehman, Specialist Team, under the headship of Prof. Yasser Wali with Fatma E. Amer, Specialist the assistance of COMHS and SQU Administration, patient

Mazen A. M. Abuanza, Specialist co-organised and hosted the 1st Pediatric Oncology

Alddai M. Ahmed, Specialist East Mediterranean Group (POEM) Business Meeting, Child Health and

Sharef W. Sharef, Specialist which attracted a number of international speakers Marwa Fawzy, Specialist and guests from the USA, UK, Egypt, Lebanon and Ashfaq Khan, Senior Medical Officer prominent Arabian Gulf countries as well as many Ashraf A. Saad, Senior Medical Officer participants from Oman.

Hilal N. B. Al-Riyami, Senior Medical Officer academic Prof. Yasser Wali, Asst. Prof. Muna Al-Saadoon and Mohammed Al-Nuaimi, Senior Medical Officer Prof. Zakia Al-Lamki served in this period on the Edi- Ahmed B. Idris, Senior Medical Officer torial Board of the SQU Medical Journal (SQUMJ). Dr. Hatem M. M. Al-Rawahi, Senior Medical Officer Amna Al-Futaisi, Dr. Saif Al-Yaarubi and Dr. Reem Ab- Anwar H. Al-Omairi, Senior Medical Officer dwani served in this period on the Editorial Board of Fatma J. M. Al-Amrani, Senior Medical Officer the Oman Medical Journal (OMJ). Both of these jour- Support Staff nals are indexed in Scopus with full text articles avail- Aisha Al-Maskary, Coordinator (College) able in PubMed. Dr. Roshan Koul was a member of the Jolina Balasta-Pogoy, Coordinator (Hospital) International Advisory Board to the Journal of Pediat- Aisha Al-Rawahi, Social Worker ric Neurology. Fatma Al-Farsi, Play Therapist

45 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Prof. Yasser Wali was a reviewer for the Journal of Pediatric Hematology/Oncology, the Postgraduate Medical Journal, SQUMJ, OMJ and the Alexandria Journal of Pediatrics. Dr. Roshan Koul was a reviewer for SQUMJ, OMJ, the Saudi Medical Journal, Neurosciences, Neurology India and the Journal of Pediatric Neurology.

National and Regional Committees The Department members continuously contributed to various external and internal committees including: Dr. Siham Al-Sinani, Executive Board Member of the Oman Pediatric Society; Dr. Hashim Javad, Chairman of the Quality Development Committee dealing with the Accreditation Canada International (ACI) process, a continuous commitment to assure the quality improvement of SQUH, together with his deputies, Dr. Wafa Bashir, Dr. Alexander P. C. and Dr. Sharef Sharef; Dr. Salem Al-Tamemi, Member of the Immunization Com- mittee, Ministry of Health; Dr. Amna Al-Futaisi, Member of the Medical Promotion Committee, Ministry of Diwan; Prof. Yasser Wali and Dr. Abdulhakim Al-Rawas, Members of the New Muscat Pediatric Hospital Com- mittee; Prof. Yasser Wali and Prof. Zakiya Al-Lamki, Technical Experts and Members of the Higher Medical Committee (HMC) for haematology and oncology cases, Dr. Ibtisam El Nour for nephrology cases, Dr. Mo- hammed Abdellatif for neonatology cases, Dr. Amna Al-Futaisi and Dr. Roshan Koul for neurology cases. Dr. Roshan was also a member of the National Polio Surveillance Committee; Prof. Zakiya Al-Lamki, Member of the Research and Ethical Review Committee, Ministry of Health, and Asst. Prof. Muna Al-Saadoon, Member of the National Bioethics Committee, the National Maternal & Child Health Committee and the National Early School Improvement Task Force.

Community Service We take great pride in continuing to serve the community, raising funds to serve children with all kinds of special needs in various ways. The School Health Education Programme has been an innovative initiative from the Department, addressing issues of healthy lifestyle, alcohol and drug abuse, obesity/healthy diet for children studying in various schools. We provide consultancies in national hospitals and in India for haematology cases. We offer parents counselling and education for home ventilation.T he Department participates in medical missions at the Philippine Embassy for neonatal clinical services and takes part in radio and TV campaigns to raise awareness about paediatric hematology/oncology diseases; autism, asthma and immunological diseases. The Department also helps in awareness campaigns about genetic blood disorders and juvenile diabetes. We provide free paediatric services to sick children in orphanages in Oman.

46 Teaching Programmes The Department is actively involved in undergraduate and postgraduate teaching.

UNDERGRADUATE PRECLINICAL PROGRAMME The Department is committed to the process of delivering to undergraduate students the main concepts and principles of child health that will help them to undertake their internship duties safely and also decide on their future postgraduate studies.

The Department has structured teaching activities for students under the responsibility of the clinical year coordinators and the Education Committee of the Department. The students have different components of assessment during the rotations and at the end of the rotation, organised by the clinical coordinators and monitored by the Department’s Examination Committee.

Members of the Department are involved in the following courses in the preclinical studies of the COMHS: the Clinical Communication and Clinical Skills courses. departments

UNDERGRADUATE CLINICAL PROGRAMME

Phase III of the new curriculum has been successfully implemented, starting with the Pre-clerkship, followed care by Junior Clerkship and Senior Clerkship thereafter. The Department also participates in Integrated Modules I to II which takes around 36 students every spring and fall semester. patient POSTGRADUATE TEACHING Child Health

The morning meetings provide an hour of clinical teaching every day in the form of clinical meetings, case and presentations, grand rounds, histopathology meetings and clinical radiological meetings. In addition to this, there are weekly presentations for interns, monthly journal clubs and mortality meetings.

The Department has around 10–14 interns at any one time. The Department is involved in teaching Oman

Medical Specialty Board (OMSB) residents. At any time of the year, the Department will have 3–4 OMSB child academic health residents for training. Each year, three members of staff are invited to give presentations to Family Medicine & Public Health residents on common childhood diseases. One members of staff is invited yearly to deliver a clinical presentation to the Emergency Department residents.

Prof. Yasser Wali was the convener of the Clinical Ph.D. Programme, a new degree programme of the COMHS.

The Department conducts the examination leading to Membership of the Royal College of Paediatrics & Child Health (MRCPCH). In collaboration with the concerned international bodies, it is also the centre for the yearly Diploma of Child Health (DCH) examination.

47 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Training Courses & CME Activities The Department runs the following training courses: Neonatal Advance Resuscitation Course (three times a year); Paediatric Advance Life Support (twice a year), the MRCPCH Course (once a year) and contributes towards other courses offered by SQUH such as Basic Life Support (BLS) and Pain Management.

Clinical & Diagnostic Services Clinical Services Under the headship of Dr. Reem Abdwani as Chairperson of the Outpatient Department (OPD) Committee, the Department, together with the SQUH Paediatric Outpatient Clinic and the Daycare Unit, succeeded in creating 15 OPD rooms and 11 beds in the new Paediatric Daycare Unit. The development of the OPD aims to follow-up children with chronic diseases and disabilities including patients with haematological malignancies. The Pediatric Haematology Clinic receives over 1,500 children and families for routine clinic visits annually, in addition to treatments such as regular blood transfusions, chemotherapy and invasive procedures such as bone marrow aspiration. Currently, we have expanded and all the paediatric subspecialties have their own days and allocated rooms for clinical services (see table below).

Table 1: Paediatric Outpatient Department Sunday Monday Tuesday Wednesday Thursday Haematology Cardiology Nephrology Neurology Neonatal Neonatal Neurology Child Protection Develop. Behaviour Develop.

Behaviour Paediatric Surgery Immunology General Paediatrics Pulmonology Haematology Nephrology Endocrinology Rheumatology Endocrinology

Gastroenterology Hepatology (1st and Neonatal General Paediatrics Cardiology 3rd week) Genetics (3rd week) Surgery

Table 2: Paediatric inpatients Year Admissions % Average bed occupancy Average length of stay in days 2013 4,430 72 3.9

48 Table 3: Paediatric Daycare Unit Year Admissions Discharges Average duration of stay in hours 2013 5,003 5,003 5

Table 4: Paediatric outpatients Year Booked Total seen Admitted Discharged 2013 13,593 11,671 275 1, 258

Table 5: Neonatal Intensive Care Unit Year Admissions % Average bed occupancy Average length of stay in days 2013 493 93 15 departments

Table 6: Postnatal Ward care Year Admissions % Average bed occupancy Average length of stay in days 2013 3,309 85 2 patient

Table 7: Paediatric Intensive Care Unit Child Health and Year Admissions % Average bed occupancy Average length of stay in days 2013 241 82 7.2 academic Table 8: Child Health Developmental & Autism Clinic Year Booked Total seen Admitted Discharged 2013 463 721 1 0

Table 9: Genetic services Year Services Booked Total seen Admitted Discharged 2013 Clinical Biochemical Genetics 828 1,508 5 4 Clinical Genetics 464 662 0 2 Cancer Genetics 59 48 0 0 49 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Services to Emergency Medicine An average of 350 children are seen every month in the Emergency Department and half of them are provided with a paediatric consultation by the on-call team.

The following specialised procedures are offered by the Department:

• Neurology: electroencephalogram (EEG), electromyography, nerve conduction velocity, brainstem auditory evoked response, somatosensory evoked potential, visual evoked potential and 24-hour video EEG • Gastroenterology: endoscopy and colonoscopy • Pulmonology: bronchoscopy and sleep studies • Immunology: skin test • Nephrology: peritoneal dialysis • Haematology: exchange transfusions, plasmapheresis and portacath access.

Research RESEARCH PROJECTS Clinical and genetic characteristics of HBS in Oman: A severe unrevealed form of sickle cell disease Code: RC/MED/CHLD/13/01 Date: 2013 Value: OR 35,700 Funder: The Research Council, Oman Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

Towards understanding the genetics of familial Bronchiectasis Code: IG/MED/CHLD/12/01 Dates: 2012–2013 Value: OR 12,541 Funder: SQU Investigators: Dr. Hussein Al-Kindy, Dept. Child Health, SQU; Dr. Allal Ouhtit, Dept. Genetics, SQU; Prof. Omar Al-Rawas, Dept. Medicine, SQU; Dr. Qasem Al-Salmi, Dept. Pediatric Pulmonolgy, Royal Hospital, Oman; Dr. Erik-Jan Kamsteeg, Dept. Human Genetics, University Medical Centre St Radboud, Netherlands.

Enuresis in children: Biochemical and psychosocial factors Code: IG/MED/CHLD/12/03 Dates: 2012–2013 Value: OR 5,000 Funder: SQU Investigators: Dr. Muna Al-Saadoon, Dr. Ibtisam Elnour, Dept. Child Health, SQU; Ms Sana Hasari, Dept. Biochemistry, SQU; Ms Basma Al-Said, Dept. Behavioural Medicine, SQU; Ms Salima Al-Badri, BMS student, SQU; Ms Buthaina Al-Dhali, BMS student, SQU.

Genetics of systemic lupus erythematosus Code: IG/MED/CHLD/12/04 Dates: 2013–2014 Value: OR 5,021 Funder: SQU Investigators: Dr Reem Al Abdawani, Dr. Fathiya Al-Murshidi, Dept. Child Health, SQU.

50 Genetic causes of primary immunodeficiency disorders in Omani patients Code: IG/MED/CHLD/13/01 Value: OR 14,500 Funder: SQU Investigators: Dr. Salem Al-Tamemi, Dept.Child Health, SQU; Dr. David Dennison, Dept. Haematology, SQU; Dr Mostafa Wali, Dept. Food Sciences & Nutrition, College of Agricultural, SQU; Mr. Isehaq Al-Husseini, Dept. Physiology, SQU.

Assessment of systolic and diastolic in children with propionic academia using conventional and newer echocardiographic techniques Code: MREC #671 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Khalfan Al-Senaidi, Dept. Child Health, SQU.

Cardiac assessment of children with osteogenesis imperfect using conventional, tissue Doppler, strain and strain rate echocardiographic techniques Code: MREC #672 Dates: 2013 Value: Unfunded Project Approval: SQU departments

Investigator: Dr. Khalfan Al-Senaidi, Dept. Child Health, SQU.

Rigid spine muscular dystrophy and rigid spine syndrome: Report of seven children care

Code: MREC #675 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Roshan Koul, Dept. Child Health, SQU. patient Assessment of systolic, diastolic function and development of pulmonary hypertension in children with Child Health

beta-thalassemia intermedia using conventional and tissue Doppler echocardiography and

Code: MREC #685 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

Assessment of systolic, diastolic function and development for pulmonary hypertension in children academic with B-thalassemia and sickle cell disease (SCD) using conventional and tissue Doppler echocardiology Code: MREC #689 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

General quality of life in children and adolescents with type 1 diabetes mellitus in SQUH Code: MREC #692 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Saif Al-Yaarubi, Dept. Child Health, SQU.

51 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Characteristics of children with type 1 diabetes mellitus: Sultan Qaboos University Hospital experience Code: MREC #693 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Saif Al-Yaarubi, Dept. Child Health, SQU.

Epidemiological tends of retinopathy of prematurity in neonates with gestational age 32 weeks in a single tertiary center in Oman Code: MREC #697 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Zenaida S. Reyes, Dept. Child Health, SQU.

Evolution of epileptic encephalopathy in an infant with non-accidental head injury Code: MREC #724 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Roshan Koul, Dept. Child Health, SQU.

Time-based emergency department performance measures, involving children in a university hospital Code: MREC #746 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Alexander P. C., Dept. Child Health, SQU.

Genetic studies of intellectual developmental disabilites (IDD) in affected Omani families Code: MREC #751 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Watfa Al-Mamari, Dept. Child Health, SQU.

Evaluation of the clinical features of children with an autism spectrum disorder at the first developmental paediatrics clinic in Oman Code: MREC #752 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Watfa Al-Mamari, Dept. Child Health, SQU.

Phenotypic and genotypic characterization of childhood hereditary spastic paraplegia in Oman Code: MREC #753 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Amna Al-Futaisi, Dept. Child Health, SQU.

Celiac disease prevalence in Omanis with type 1 diabetes mellitus Code: MREC #754 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Siham Al-Sinani, Dept. Child Health, SQU.

52 Descriptive study of sickle cell disease risk factors and magnitude in the Gulf Region based on TCD values Code: MREC #755 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

Impact of RSV prophlaxis on respiratory illness and hospitalization of preterm neonates in SQUH Code: MREC #761 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Asad Ur Rahman, Dept. Child Health, SQU.

Discharge against medical advice (DAMA) among Omani children attending tertiary hospital: Reasons and outcome Code: MREC #763 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Muna Al-Saadoon, Dept. Child Health, SQU. departments

KAAPA: Key aspects of medical practice in patients with haemophilia A Code: MREC #766 Dates: 2013 Value: Unfunded Project Approval: SQU care Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

An open-label study to evaluate prophylaxis treatment, and to characterize the efficacy, safety, and

pharmacokinetics of b-domain deleted recombinant factor VIII albumin free (moroctocog alfa [AF-CC]) patient in children with hemophilia A Child Health and

Code: MREC #767 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

Long-term glycemic control between insulin glargine and NPH in children and adolescents with type 1

diabetes: Single centre experience academic Code: MREC #769 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Saif Al-Yaarubi, Dept. Child Health, SQU.

Clinical presentation, cerebrospinal fluid analysis and pattern of antibiotic sensitivity among children with bacterial meningitis Code: MREC #777 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Ahmed B. Idris, Dept. Child Health, SQU.

53 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Assessment process in COMHS: Students’ perception Code: MREC #784 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Muna Al-Saadoon, Dept. Child Health, SQU.

The impact of bronchial asthma on school attendance among Omani children aged 6–16 years in Mus- cat Governorate in 2013 Code: MREC #788 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Muna Al-Saadoon, Dept. Child Health, SQU.

Rates and correlates of bullying and aggressive behavior among Omani youth in Muscat Governorate, Sultanate of Oman Code: MREC #796 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Muna Al-Saadoon, Dept. Child Health, SQU.

Evaluation of sampling time and indications for therapeutic drug monitoring requests at Sultan Qaboos University Hospital Code: MREC #798 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Sharef Waadallah Sharef, Dept. Child Health, SQU.

Evaluation of purified poloxamer 188 in children in crisis (EPIC): A phase 3 randomized, double-blind, placebo-controlled, multicenter clinical trial of MST-188 (purified poloxamer 188) injection in children with sickle cell disease experiencing vaso-occlusive crisis Code: MREC #813 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

Wrist drop in muscular atrophy (Werdnig-Hoffman disease) Code: MREC #817 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Roshan Koul, Dept. Child Health, SQU.

The incidence, risk factors, clinical course and outcomes of hypoxic ischemic encephalopathy in Neonatal Intensive care Unit (NICU) in SQUH Code: MREC #819 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Asad Ur Rahman, Dept. Child Health, SQU.

54 The pattern and causes of neonatal mortality at a tertiary hospital in Oman Code: MREC #824 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohammed Abdellatif, Dept. Child Health, SQU.

Clinical and laboratory correlations of anti-streptolysin O antibodies: Rheumatological prospect Code: MREC #835 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Reem Abdwani, Dept. Child Health, SQU.

A prospective, single arm study to assess the efficacy and safety of deferasirox 20 mg/kg BID in transfusion dependent beta<35 mg/kg OD Code: MREC #838 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Yasser Wali, Dept. Child Health, SQU.

RESEARCH PUBLICATIONS & BOOKS departments

Journal Publications 1. Abdellatif M, Alsinani S, Al-Balushi Z, Al-Dughaishi T, Abuanza M, Al-Riyami N, Spontaneous resolution of fetal and care neonatal ascites after birth. Sultan Qaboos Univ Med J 2013; 13:175–8. 2. Koul R, Al-Mursheidi F, Al-Azri F, Mani R, Abdelrahim RA, Koul V, Al-Futaisi A. Clinical spectrum of hereditary spastic paraplegia in children. Sultan Qaboos Univ Med J 2013; 13:371–9.

3. Javad H, Al-Yarubi S, Chacko AP, Sankhla D, Al-Futasi A, Abdelmogheth A, El-Naggari M. Semilobar holoprosen- patient cephaly with neurogenic hypernatraemia: Two new cases. Sultan Qaboos Univ Med J 2013; 13:E463–6. Child Health

4. gujjar AR, Zacharia M, Al-Kindi S, William R, Al Lamki Z, Wali Y, et al. Transcranial Doppler ultrasonography in sickle and cell disease: a study in Omani patients. J Pediatr Hematol Oncol 2013; 35:18–23. 5. Zachariah M, Tony S, Bashir W, Al Rawas A, Wali Y, Pathare A. Comparative assessment of deferiprone and deferasirox in thalassemia major patients in the first two decades-single centre experience. Pediatr Hematol Oncol 2013; 30:104–12.

6. Sharef SW,...Elshinawy M, Zachariah M,...Bashir W, Rawas A,...Al-Lamki Z, Wali Y. Optimizing hydroxyurea use in academic children with sickle cell disease: low dose regimen is effective. Eur J Haematol 2013; 90:519–24. 7. alkindi SS, Alzadjali S, Daar S, Sindhuvi E, Wali Y, Pathare AV, et al. A stepwise β-thalassemia screening strategy in high-prevalence areas. Eur J Haematol 2013; 91:164–9. 8. al Zadjali S, Bashir W, Gravell D, Al Riyami AZ, Wali Y, Daar S. First reported case of compound heterozygosity for HbA2-Yialousa (HBD: c.82 G>C) and HbA 2-Wrens (HBD: c.295 G>A) in Oman. Int J Hematol 2013; 98:24–2. 9. rathod KJ, Khan AA, Kripail M, Fazallulah M, Al Balushi Z, Abdellatif M. Management of Necrotising Enterocolitis Experience at a tertiary care hospital in Oman. Ann Pediatr Surg 2013; 9:65–8.

55 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Kripail M. Primum non nocere - Iatrogenic disorders in NICU. 19th Annual State Conference of National Neonatolo- gy Forum, Kerala, India, 16–17 Feb 2013.

National 1. Al-Tamemi S. The impact of risk management on patient safety. 2nd GCC International Conference on Patient Safe- ty - Promoting Excellence in Patient Safety, Mutual Accountability Winning Ways, Muscat, Oman, Jan 2013. Poster Presentations International 1. Wali Y, Al-Rawas A, Al-Zadjali S, Al-Khabori MK, Bashir W, Zachariah M, Tony S, et al. Outcome of early introduction of hypertransfusion/chelation program in children with thalassemia intermedia. Poster No.3260. American Society of Pediatric Hematology/Oncology (ASPHO) 26th Annual Meeting, Miami, Florida, 24–27 Apr 2013. 2. El Naggari M, Elnour IB. Nocardia asteroides peritoneal dialysis-related peritonitis - First case in pediatrics, treated with protracted linizolid: Case report and literature review. European Society for Paediatric Infectious Diseases (ES- PID) 31st Annual Meeting, Milan, Italy, 28 May – 31 Jun 2013. Seminar Presentations International 1. Kripail M. Basic Neonatal Ventilation Workshop. Conference of National Neonatology Forum, Kerala, India, 16 Feb 2013.

National 1. Al-Tamemi S. Initiatives on patient safety. Quality Awareness Day, Royal Hospital, Oman, Mar 2013.

56 departments

care

Emergency Medicine patient

and

ver since its establishment in 1986, the Department has been the leader in emergency medicine in Oman. Our high stan- Emergency Medicine dards of care have inspired other hospitals in the country. The Department is one of the major tertiary care facilities in the governorate of Muscat having its own helipad used by different national agencies in the event of a disaster or other Eemergency situations. We treat approximately 65,000 patients annually and receive patients from every corner of the country. academic Acting as the first point of entry for the majority of the patients coming toS ultan Qaboos University Hospital (SQUH) and serving as the main hub for patients being admitted into various SQUH departments, it is no wonder that the Department is the busiest place in the whole hospital. Triage is a key focus and concern of the Department and continuous other improvments are made to keep pace with the ever increasing number of patients.

Most of the trauma patients are brought to the Department by the Oman Emergency Medical Services (EMS). Based on the Anglo-American system of EMS, the main catchment area of our hospital is the densely populated Seeb wilayat (district). Upon arrival in the hospital, EMS staff hand over patients to the trauma team which is geared up for major trauma cases.T he trauma team comprises emergency physicians, surgeons, anaesthetists and orthopaedic surgeons. After initial management all

57 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

patients requiring surgery are transferred immedi- Staff ately to the operating theatre. The Department has very good patient survival rates. Acting Head of Department Khalfan Al-Amrani, Consultant At present, the Department has 29 beds with a Medical Staff fully equipped triage desk with one doctor and two Nabil Al-Zadjali, nurses to ensure prompt medical attention for all Senior Consultant Abdullah Al-Reesi, patients. The Department has the most modern Senior Consultant Marwan Al-Raisi, equipment, including different types of ventilators, Consultant (Paediatric) Hilal Al-Barwani, conventional and non-invasive, sonographic ma- Consultant (Paediatric) Niranjan Lal, chines and an arterial blood gas machine. Registrar (Paediatric) Yousef Al-Weshahi, Senior Registrar In order to fulfill the vision of the Department to Remanand Sudhir, Senior Registrar be a national model for the development of emer- Asma Al-Balushi, Senior Registrar gency medicine of international standing, various Awatif Al-Alawi, Senior Registrar training and learning activities are organised for Amal Al-Shibli, Senior Registrar the departmental healthcare personnel. In turn, Sabah Awad, Senior Registrar a wide range of healthcare professionals receive Ashraf Ali, Registrar training in the Department, including under- Mohammed F. Khilji, Registrar graduate and postgraduate medical and nursing Mohammed O. Mubashir, Registrar students from Sultan Qaboos University’s (SQU) Rafael Hashmi, Registrar Colleges of Medicine & Health Sciences and Nurs- Umar Shahzad, Registrar ing; other SQUH staff; students of the Oman Med- Qazi Ziaullah, Registrar ical Specialty Board (OMSB); medical staff of the Vinod Abraham, Senior House Officer Royal Court and Royal Affairs, the Ministry of Mohammed Awais, Senior House Officer Health, the Health Institute and the Royal Oman Nowfal Sabri, Senior House Officer Police, and also interns of the Oman Medical Col- Mohammad S. Khan, Senior House Officer lege in Sohar. Bader Al-Amri, Senior House Officer Quratulain, Senior House Officer The Department actively participates in different Mohammed R. Kabir, Senior House Officer national and international research projects. The Aisha Al-Khamisi, Senior House Officer (in training Department also regularly participates in various abroad) disaster drills organised by the concerned govern- Suad Al-Abri, Senior Registrar (in training abroad) ment agencies. These drills aim to familiarise par- Amal Al-Mandhari, Senior House Officer (in ticipants with the procedures needed for real-time training abroad) disasters and to eradicate any weaknesses in the Aisha Al-Buraiki, Senior House Officer (OMSB national disaster plan. Resident)

58 Nursing Staff Chief Nurse Level 1 (2) Chief Nurse Level 2 (1) Chief Nurse Level 3 (3) Staff Nurse Level 1 (10) Staff Nurse Level 2 (53) Support Staff Ayida Al-Hadhrami, Coordinator Abdullah Al-Rawahi, Coordinator (ED clinical area) Sabeel Al-Zadjali, Ambulance Attendant Florenda Sicat, Emergency Medical Technician (Ambulance) Ahmad Al-Shaqsi, Emergency Medical Technician Fahad Al-Abri, Emergency Medical Technician Medical Record Clerks (2 per shift) Medical Orderlies (12) departments

Highlights of the Year 2013 care Trauma course and Conference workshops In 2013, the Department again organised a three-day Trauma Course for nurses with the goal of enhancing staff knowledge and refining trauma management skills, thus improving patient outcomes. Department patient doctors participated in teaching courses during the 2013 Gulf Cooperation Council Conference for Medical Students. and

Emergency Medicine International Day Emergency Medicine The Department celebrated the Emergency Medicine International day in October 2013. A stand was prepared to deliver a case presentation to visitors on non-invasive ventilation. academic

International Visitors During the year, the Department received various visiting consultants from different parts of the world and interacted with them to gain from their experiences. Many of them delivered lectures to our staff on state- of-the-art developments in emergency medicine.

Expansion of Emergency Department Facilities The SQUH management approved the Department’s expansion plan. The official formalities were started prior to the commencement of the construction work.

59 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Professional examinations Many of our doctors presented themselves for international professional examinations. In 2013, one of our doctors gained Membership of the Royal Colleges of Physicians (MRCP) UK. Different parts of the Member- ship examinations of the College of Emergency Medicine (MCEM), UK, were passed by many of our staff. Most of the doctors updated their ACLS (Advanced Cardiac Life Support), PALS (Paediatric Life Support) and Advanced Trauma Life Support (ATLS) certificates.

Promotions and Farewells Some of our doctors and nurses were promoted to a higher grade in recognition of their performance. In 2013, we also said goodbye to Dr. Daniel O. Ogunjumo, Senior Consultant, Dr. Asim Bilal, Senior House Officer and Ms. Mercy Neskumar, departmental Coordinator.

Teaching Programmes Undergraduate Clinical Programme Emergency Medicine for 6th year Medical Students: Old curriculum The Department actively participated in the training and teaching of 6th year medical students in the old curriculum. We received 8 batches of students every year on a monthly rotation from August to May. Each batch was divided into 4 groups. Teaching sessions were held by consultants and included lectures along with bedside teaching. The teaching topics included basic life support, wound care, recognition and treatment of dynamic arrhythmias, and the use of defibrillators. In addition to these sessions, problem-based tutorials were also held regularly by consultants on important clinical emergencies like chest pain, shortness of breath, polytrauma, poisoning, etc. The student’s performance was assessed at the end of the rotation by a one-hour multiple-choice question examination based on the contents of the core curriculum. The Depart- ment received the last group of students in the old curriculum in April 2013.

New Curriculum The Department started to prepare the ground for receiving the new curriculum students, taking into con- sideration the goal of the new curriculum to produce undifferentiated physicians ready to go and work in this field.T o this end, the Department held several meetings both within the Department and with members of the College of Medicine & Health Sciences’ (COMHS) curriculum committee.

60 POSTGRADUATE PROGRAMME Teaching and Training of Interns Interns rotate through the Department on a one-month elective rotation during their General Surgery posting. Interns are given handouts and a one-day tour of the Department at the start of their rotation. During their rotation, the interns are exposed to real emergency cases like chest pain, polytrauma, poisoning, etc. They are taught procedures such as different types of suturing, foreign body removal, arterial blood gas testing, and the basic know-how of intubations and central lines placement, etc. Bedside teaching and regular CMEs are also provided. The shift supervisor assesses all interns at the end of every call and the final assessment is made on the basis of the performance in all the shifts. Apart from assessing knowledge, the following are also taken into account: punctuality, overall behaviour as part of a team, and performance under pressure during busy shifts.

Teaching and Training of Residents The residents participating in the OMSB (Oman Medical Specialty Board) programmes of Emergency Medi- cine, Family & Community Medicine and Surgery rotate through the Department at various stages of their departments training. They are exposed to real emergencies and given a full chance to handle patients independently as an active member of the team under the supervision of the shift supervisor. They are also given the chance care to practise and improve recently learned skills such as suturing and other simple procedures; they are also taught new skills like intubations, central line placement, basic bedside ultrasound, etc. Senior residents handle more critical patients in the bay area under supervision of the doctor in charge of the shift. Apart from

the clinical activities, academic activities for a minimum 4 hours per week are mandatory. These activities patient include case or topic presentations, Journal Clubs, workshops, etc. and

Clinical Electives & Attachments

The Department welcomes international medical students doing electives. This year we received several stu- Emergency Medicine dents from different countries for electives.T he Department also regularly receives foreign medical gradu-

ates for clinical attachments. This year several graduates from different countries joined us for their clinical academic attachment.

Training Courses & CME Activities In 2013, the Department again organised a three-day Trauma Course for nurses. This course is now gaining in popularity and was attended by more than 50 participants from different hospitals including Khoula Hospi- tal and the Armed Forces Hospitals.

61 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

The Department is an integral part of teaching staff of theS QUH’s Directorate of Training & Continuing Pro- fessional Development and is involved in carrying out the BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Life Support) courses. All these courses are now American Hospital Associ- ation (AHA) certified.

The Department’s in-house CME activities include the long-held tradition of its popular fortnightly CME activity. Activities include interesting presentations, a Journal Club, quizzes etc. Sometimes the hands-on practice of different skills is also provided during CME activity in order to refresh the skills of the staff.

Clinical & Diagnostic Services In 2013, the Department received 62,525 patients compared to 66,777 in 2012. The details of these patients are shown in the table below.

Table 1: Emergency Department statistics in 2013 Category Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total B 12 9 22 17 15 18 10 12 17 15 15 11 173 R 75 81 178 143 136 117 137 126 112 106 109 124 1444 Y 2555 2404 2451 2492 2372 2449 2395 2409 2398 2531 2512 2557 29525 G 860 831 1056 852 870 817 944 773 913 977 891 1008 10792 W 1334 1372 1621 1616 1527 1281 1338 1409 1323 1515 1520 1668 17524 F/U 221 247 251 248 262 267 248 265 265 267 256 270 3067 Total 5057 4944 5579 5368 5182 4949 5072 4994 5028 5411 5303 5638 62525 SSU 161 166 187 188 141 133 101 125 183 143 146 166 1840 DEF 1064 983 1221 1237 1089 874 1040 946 942 1069 1003 1123 12591 LWBS 59 87 104 100 87 72 81 72 95 118 102 162 1139 ADM 637 609 625 646 623 623 625 693 669 653 655 646 7704 TRANS 37 16 18 23 17 11 24 15 7 20 12 20 220 DOA 11 6 13 16 11 6 9 10 15 24 8 3 132 DAA 0 0 0 0 0 0 0 2 1 0 0 16 19 SCD 487 440 476 467 435 461 512 479 418 400 409 458 5442

62 RTA 147 137 151 156 119 125 146 169 148 187 193 137 1815 Adults 3664 3513 3965 3865 3709 3802 3859 3762 3732 4000 3794 4085 45753 Paediatric 1407 1435 1614 1500 1388 715 760 787 891 965 985 24 12471 4-hour stay 374 328 298 300 332 283 231 214 351 282 301 339 3633 2-hour ADM 100 94 298 27 92 95 52 60 108 61 56 123 1166 Ambulance activities Ward 28 23 34 30 34 23 24 15 28 7 15 13 274 ED 32 15 14 25 15 11 11 10 7 11 12 8 174 Home 2 2 2 2 6 5 7 2 3 1 2 6 40 Airport 6 9 6 7 6 3 6 5 2 2 9 7 68 Campus 5 5 10 9 7 3 4 1 2 11 8 15 80 departments

Total 73 54 69 73 68 45 52 33 42 32 46 49 636 care

Total patients in 2013 = 62,525 (total patients in 2012 = 66,777)

B = blue category patients (unlikely to survive or those who need extensive care within minutes); R = red category patients (critical, may survive if simple lifesaving measures are applied; Y = yellow category patients (likely to survive if simple care is given within hours); G = green category

patients (minor trauma, care may be delayed while other patients receive care); W = white category patient; F/U = follow-up patients; SSU = patient

short stay unit; DEF = deferred cases; LWBS = left without being seen; ADM = admission cases; TRANS = transferred to other wards/hospitals; DOA = dead on arrival; DAA = died after arrival; SCD = sickle cell disease cases; RTA = road traffic accident cases; ED = Emergency Department. and

Emergency Medicine academic

Figure 1: Adult versus paediatric patients.

63 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 2: Duration of stay in Emergency Department.

Research Research Projects Different consultants supervised the research projects of the OMSB residents.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al-Reesi A, Ashour M. Foreign body (pen) in the stomach and lower oesophagus. J Emerg Med 2013; 44:173–4.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Al-Reesi A. How to start and monitor a research project. 3rd International Committee of Military Medicine (ICMM) Pan Arab Regional Working Group Conference on Military Medicine, Abu Dhabi, UAE, 9–12 Dec 2012.

64 departments

care

Family Medicine & Public Health patient

and

stablished in 1986, the Department of Family Medicine & Public Health is one of the major clinical departments in the College of Medicine & Health Sciences (COMHS) and Sultan Qaboos University Hospital (SQUH). The clinical services are provided through the University Health Centre and the Student Clinic. The Department is extensively involved in

teaching medical students at different levels.T he postgraduate programmes include the Masters in Epidemiology & Medical academic

E Family Medicine & Public Health Statistics, the Ph.D. in Epidemiology & Public Health and the Family Medicine Residency Programme. The Department conducts the Membership of the Royal College of General Practitioners - International (MRCGP - INT) examination. The Department is also actively involved in research both independently and also in collaboration with other departments and external bodies.

65 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Highlights of the Year 2013 The Department offered the 12th MRCGP-INT ex- Head of Department amination in September 2013. The examination Mohammed Al-Shafaee, Associate Professor was taken by 8 doctors. The Royal College of Gen- Faculty eral Practitioners has appreciated and recognised Abdulaziz Al-Mahrezi, Senior Consultant, Deputy the progress made in the development of this ex- Head (Clinical Services) amination. Yahya Al-Farsi, Assistant Professor, Assistant Dean (Training & Community Service) Shyam S. Ganguly, Associate Professor Teaching Programmes Randa Youssef, Associate Professor UNDERGRADUATE PROGRAMMES Syed Rizvi, Assistant Professor The Department offered courses in: Epidemiology Kamlesh Bhargava, Senior Consultant & Medical Statistics; Data Analysis using SPSS (uni- Thord Theodorsson, Senior Consultant versity elective); Epidemiology & Medical Statistics Ahmed Al-Mandhari, Senior Consultant for B.Sc. Medical Laboratory Sciences; Biostatistics Mohammed Al-Azri, Senior Consultant for the College of Nursing; Principles of Epidemiol- Zakiya Al-Busaidi, Senior Consultant ogy; Special Epidemiology & Health Management Ahmed Al-Waily, Senior Consultant/Dermatologist for health statistics students from the College of Hamdan Al-Habsi, Consultant Science; Nutrition & Health Education for the Col- Mustafa Al Hinai, Consultant lege of Agriculture; the Hospital & Community At- Kawther El-Shafie, Consultant tachment course for M.D. students in the new cur- Ana Maria Anido, Senior Registrar/Dermatologist riculum; the Research Methodology course and the Rahma Al-Kindi, Consultant Student Project for M.D. students in Phase II of the Laila A. Ramadhan, Registrar curriculum. Aisha Al-Hinai, Registrar Vrunda Pimpalkhute, Registrar Nafisa Samir, Registrar New Curriculum Imran Saad, Registrar The Department is involved in Phase II and Phase III Teodorico Diputado, Registrar of the new curriculum. In addition, the Department Hanaa Al-Sumri, Senior House Officer is involved in teaching of students from the inter- Wahida Al-Maskeri, Senior Chief Dietician calated phase. Support Staff Pre-Clerkship Programme Perpetua Gabor, Coordinator The Department participated in the Pre-clerkship Zulfa Al-Tobi, Coordinator programme for the second time in 2013 by conduct- Bahiya Al-Siyabi, Coordinator ing 9 general assessment weeks and also participated in the final examination.T he objectives of

66 the General Assessment week had been updated. The clinical teaching is done in staff and student clinics. About 120 students, 15 students per group, get the chance to take a focused history and conduct a focused physical examination on real or simulated patients. The aim of this course is to prepare the students for their clinical years.

Junior Clerkship Programme About 122 students, in groups of 20, have a 5-week clinical rotation in the SQU Health Centre and in 5 of the accredited Ministry of Health (MOH) Health Centres. The aim of the rotation is for the students to practise focused history-taking and physical examinations, as well as making differential diagnoses and defining management plans. The emphasis is on the acquisition of knowledge that is required to manage a wide variety of health conditions (physical, social and psychological) in the context of family, culture, work and community. The rotation explores further the principles of patient-centred care; the holistic approach; taking account of the patient’s ideas, concerns and expectations; non-pharmacological and pharmacological treatments; recognition of risk factors; continuity of care; community medicine; health promotion, and preventive measures. The students also observe/perform common procedures typically conducted in family practice departments settings and participate in the different health services provided at the primary care level including: vacci- nation; antenatal care; the integrated management of childhood illness; school and community health, etc. care

Senior Clerkship The Senior Clerkship students have an 8-week rotation in family medicine. During the rotation, they attend family medicine clinics for three weeks. The Senior Clerkship in Family Medicine explores further the princi- patient ples and practice of patient-centred care which was introduced in the Junior Clerkship. The Senior Clerkship

course takes place in an out-of-hospital setting either in the FAMCO clinic or in one of the nearby MOH clin- and ics. The student learns how to deal with undifferentiated health problems presented to the family doctor as well as how to manage chronic illness among the members of the community. During the rotation, students have various assessments in the form of a mini-clinical evaluation exercise, a case-based discussion and case-based learning; each form of assessment is followed by feedback. In addition students, are encouraged to work on their portfolio which includes case summaries and procedures performed or observed during the academic rotation. Family Medicine & Public Health

POSTGRADUATE PROGRAMME Family Medicine Residency training programme The Department, along with the Oman Medical Speciality Board (OMSB), is actively involved in the teaching, training and examination of the family medicine residents. There were 77 Residents in the programme in 2013 at various levels of training. The exit examination, MRCGP-INT, is accredited by the Royal College of General Practitioners, UK.

67 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

M.Sc. Programme The following postgraduate courses were conducted by the Epidemiology & Medical Statistics Unit for the Master’s Programme: Statistics & Computers; Advanced Principles of Epidemiology; Advanced Statis- tical Methods; Categorical Data Analysis; Applied Epidemiology; Statistical Methods in Quality Control. A Research Methodology course was also offered as well as supervision of master’s thesis research projects. During 2012–2013, the Department had 5 students in the Master’s degree programme.

Ph.D. Programme During 2012–2013, the Department had 3 candidates who joined the Ph.D. programme in Epidemiology & Public Health.

Training Courses & CME Activities In 2013, the Department continued to arranged CME activities through journal clubs and seminars. These activities are open to doctors, nurses and paramedics from the Department, the MOH and also to other SQUH personnel. The CME sessions are usually conducted by speakers from the Department or external speakers from other departments. The main focus is on improving the quality of the service by updating medical staff in clinical knowledge and recent guidelines and protocols. Other topics were quality sessions and audit projects, as well as updates of SQUH mandatory courses (Basic Lifesaving Skills and Fire Safety).

Clinical & Diagnostic Services The SQU Health Centre is a pioneer primary care institution in Oman. It is the first health centre in the country to have received international accreditation as a “model health centre” by the Arab Board of Medical Spe- cializations and by the Royal College of General Practitioners (RCGP), UK, for clinical services and the teaching of family medicine. Our Health Centre is the leading star in primary healthcare (PHC) in Oman as regards PHC ideology, quality, comprehensiveness of care and prevention.

Patient services are provided at the SQU Health Centre and the Student Clinic. A total of 39,904 patients were seen at the Health Centre in 2013. The Department has separate diabetes, antenatal and postnatal clinics besides the birth spacing and MOH infertility programmes and the extended programme of immunisation for mother and child health. The Dermatology Clinic gets referrals from all departments in SQUH and different parts of the country for various procedures including laser treatment. The Student Clinic serves the Universi- ty students for all of their primary health needs. It offers the following clinics: General Appointments; Walk- in; Diabetes; Antenatal & Postnatal; Immunisation/well baby; Birth spacing; Dermatology, and Counselling.

68 Table 1: Clinical workload in 2013 for the Family Medicine & Community Health Centre Type of patient/clinic 2011 2012 2013 Patients with appointments 18,393 15,711 15,119 Walk-in patients 16,552 24,998 16,856 Vaccinations 8,744 10,739 10,193 Antenatal/Prenatal/Birth Spacing Clinics 1,336 1,599 1,305 Dermatology 5,414 4,673 3,251 Diabetes Clinic 301 322 318 Respiratory therapist 129 136 119 Dietician 233 341 430 Treatment room services 1,885 1953 2,022 departments Total patients seen 42,077 40,709 39,904 care

Table 2: Student Clinic 2011 2012 2013 patient

Total patients seen 14,885 15,199 14,326 and

Research Research Projects An assessment of the application of LEAN thinking in the Omani health care sector academic Family Medicine & Public Health Code: SR/CCE/OMBS/12/01 Dates: 2012–2015 Value: OR 58,000 Funder: His Majesty’s Strategic Research Fund Investigators: Dr. S. Al-Balushi, Dr. A. Al-Hajri, Dept. Operations Management & Business Statistics, SQU; Dr. P. Sohal, Dept. Management, University of Monash, Australia; Dr. A. Kumar, University of Melbourne, Australia; Dr. Yahya Al-Farsi, Dept. Family Medicine & Public Health, SQU.

69 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Evaluation of risk factors for stroke in an Omani community Code: IG/MED/FAMCO/13/01 Dates: 2013–2014 Value: OR 5,100 Funder: SQU Investigators: Dr. Shyam Ganguly, Dr. Mohammed Al-Shafaee, Dept. Family Medicine & Public Health, SQU; Dr. Arunodaya R. Gujjar, Dr. Abdullah R. Al-Asmi, Dept. Medicine, SQU; Dr. Santosh Kumar B., Dept. Neu- rology, Royal Hospital.

Transmission dynamics and spread of drug resistance of Mycobacterium tuberculosis in Oman Code: IG/MED/FMCO/13/02 Dates: 2013–2014 Value: OR 14,636 Funder: SQU Investigators: Dr. Abdullah Al-Maniri, Dept. Family Medicine & Public Health, SQU; Dr Hamza Babiker, Dept. Biochemistry, SQU; Dr. Saleh Al-Azri, Ms. Sara Al-Mahruqi, Ms. Laila Al-Bulushi, Public Health Laborato- ries, Ministry of Health, Oman.

Knowledge and health beliefs toward sickle cell disease among Sultan Qaboos University students Code: MREC #682 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohammed Al-Azri, Dept. Family Medicine & Public Health, SQU.

Comprehensive health assessment of elderly people in Al Dakhliyah Governorate Code: MREC #694 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Randa Youssef, Dept. Family Medicine & Public Health, SQU.

Barriers in initiating insulin treatment in type 2 DM among physicians in wilayat Bowsher Code: MREC #706 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Thord Theodorsson, Dept. Family Medicine & Public Health, SQU.

Evaluating trauma care capabilities of primary care level in Oman Code: MREC #731 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Kamlesh Bhargava, Dept. Family Medicine & Public Health, SQU.

A comprehensive investigation of the risky behavior of young drivers (17–25) in Oman Code: MREC #733 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Abdullah Al-Maniri, Dept. Family Medicine & Public Health, SQU.

70 Identification of a mutation A( 268G) in the THRB gene in a patient with thyroid hormone resistance in Oman Code: MREC #734 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Kawther El-Shafie, Dept. Family Medicine & Public Health, SQU.

Quality of life among parents of children with autism spectrum disorder in Oman Code: MREC #785 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Yahya Al-Farsi, Dept. Family Medicine & Public Health, SQU.

Public awareness of cancer among Omani population Code: MREC #793 Dates: 2013 Value: OR 800 Funder: SQU Investigator: Dr. Mohammed Al-Azri, Dept. Family Medicine & Public Health, SQU.

Point of care devices (P.O.C) awareness, usage and training: Targeting residents and trainers in Oman departments

Code: MREC #816 Dates: 2013 Value: Unfunded Project Approval: SQU care

Investigator: Dr. Mohammed Al-Shafaee, Dept. Family Medicine & Public Health, SQU.

Dysbiosis of gut microbiota (DOMA) and risk factors of polycystic ovarian syndrome in the Sultanate of Oman patient Code: MREC #826 Dates: 2013 Value: Unfunded Project Approval: SQU and

Investigator: Dr. Yahya Al-Farsi, Dept. Family Medicine & Public Health, SQU.

The prevalence of bullying among school students and its effect on mental health Code: MREC #842 Dates: 2013 Value: Unfunded Project Approval: SQU

Investigator: Dr. Mohammed Al-Shafaee, Dept. Family Medicine & Public Health, SQU. academic Family Medicine & Public Health Research Publications & Books Research Publications 1. Al-Mandhari A, Al-Adawi S, Al-Zakwani I, Dorvlo A, Al-Shafaee M. Reasons for consultation among patients attending primary healthcare centres in Oman. Sultan Qaboos Univ Med J 2013; 13:248–55. 2. elliott JA, Abdulhadi NN, Al-Maniri AA, Al-Shafaee MA, Wahlström R. Diabetes self-management and education of people living with diabetes: A survey in primary health care in Muscat Oman. PLoS One 2013; 8:e57400. 3. Al-Shafaee M, Al-Kaabi Y, Al-Farsi Y, White G, Al-Maniri A, Al-Sinawi H, et al. Pilot study on the prevalence of abuse and mistreatment during clinical internship: A cross-sectional study among first year residents in Oman. BMJ Open 2013; 3:e002076.

71 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

4. noor Abdulhadi NM, Al-Shafaee MA, Wahlström R, Hjelm K. Doctors' and nurses' views on patient care for type 2 diabetes: An interview study in primary health care in Oman. Prim Health Care Res Dev 2013; 14:258–69. 5. Ouhtit A, Ismail MF, Othman A, Fernando A, Abdraboh ME,…Al-Farsi YM, et al. Chemoprevention of rat mammary carcinogenesis by spirulina. Am J Pathol 2013; 184:296–303. 6. al Asmi A, Al Maniri A, Al-Farsi YM, Burke DT, Al Asfoor FM, Al Busaidi I, et al. Types and sociodemographic correlates of complementary and alternative medicine (CAM) use among people with epilepsy in Oman. Epilepsy Behav 2013; 29:361–6. 7. younis MS, Al-Noaimi AS, Zaidan ZA, Al-Rubayie AF, Al-Farsi Y, Al-Zakwani I, et al. Clinical and demographic profile of attendees at Baghdad's walk-in psychiatric clinic. Oman Med J 2013; 28:365–70. 8. Ouhtit A, Madani S, Gupta I, Shanmuganathan S, Abdraboh ME,…Al-Farsi YM, et al. TGF-α2: A novel target of CD44-promoted breast cancer invasion. J Cancer 2013; 4:566–72. 9. Al-Farsi YM. Response to comment on: Low folate and vitamin B12 nourishment is common among Omani children newly diagnosed with autism. Nutrition 2013; 29:1170–1. 10. waly MI, Ali A, Al-Farsi YM, Bhatt N, Al-Kilani H, Ouhtit A, et al. Leptinemia among obese Omani adults newly diagnosed with type 2 diabetes mellitus: A case-control study. J Med Sci 2013; 13:208–4. 11. essa MM, Braidy N, Waly MI, Al-Farsi YM, Al-Sharbati M,…Al- Shaffaee AM , et al. Impaired antioxidant status and reduced energy metabolism in autistic children. Res Autism Spectr Disord 2013; 7:557–65. 12. Al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O, et al. Impact of nutrition on serum levels of docosahexaenoic acid among Omani children with autism. Nutrition 2013; 29:1142–6. 13. Al-Farsi YM, Waly MI, Al-Sharbati MW, Al-Shafaee M, Al-Farsi OA, Al-Khaduri MM, et al. Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: A case-control study. Biol Trace Elem Res 2013; 151:181–186. 14. Al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee M, Al-Farsi OA, et al. Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism. Nutrition 2013; 29:537–41. 15. Al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O, Al-Fahdi S, et al. Variation in socio-economic burden for caring of children with autism spectrum disorder in Oman: Caregiver perspectives. J Autism Dev Disord 2013; 43:1214–21. 16. waly MI, Ali A, Al-Farsi YM, Ouhtit A, Al-Nassri A, Arafa M. Assessment of folate, vitamin B6 and vitamin B12 status among newly diagnosed Omani cardiac patients. FASEB J 2013; 27:1078.4. 17. Al-Farsi YM, Al-Khaduri M, Al-Sumri H, Al-Farsi O, Al-Sharbati M,…Al-Shafaee M, et al. Association of gestational diabetes mellitus with occurrence of autism: A cohort study. FASEB J 2013; 27:lb111. 18. gujjar AR, Jacob PC, Nandhagopal R, Ganguly SS, Obaidy A, Al-Asmi AR. Full outline of unresponsiveness score and Glasgow coma scale in medical patients with altered sensorium: Inter-rater reliability and relation to outcome. J Critical Care 2013; 28:316. 19. al-Reesi H, Ganguly SS, Al-Adawi S, Laflamme L, Hasselberg M, Al-Maniri A. Economic growth, motorization and road traffic injures in the Sultanate of Oman, 1985-2009. Traffic Inj Prev 2013; 14:322–8. 20. Elshafie KIT, Al-Hinai MM, Al-Habsi HA, Al-Hattali MS, Hassan O, Al-Sukaiti R. A massive tuberculosis abscess at the erector spinae muscles and subcutaneous tissues in a young man. Sultan Qaboos Univ Med J 2013; 13:601–5. 21. el-Shafie KT. Palpitations caused by a seizure with autonomic features. Sultan Qaboos Univ Med J 2013; 13:e339–41. 22. Youssef RM, Al Shafie K, Al-Mukhaini M, Al-Balushi H. Physical activity and perceived barriers among high school students in Muscat, Sultanate of Oman. East Mediterr Health J 2013; 19:759–68.

72 23. Al-Hinai M, Al-Muqbali M, Al-Moqbali A, Gowri V, Al-Maniri A. Effects of pre-pregnancy body mass index and gestational weight gain on low birth weight in Omani infants: A case-control study. Sultan Qaboos Univ Med J 2013; 13:386–91. 24. al Reesi H, Al Maniri A, Plankermann K, Al Hinai M, Al Adawi S, Davey J, et al. Risky driving behavior among university students and staff in the Sultanate of Oman. Accid Anal Prev 2013; 58:1–9. 25. al-Balushi H, Al-Kalbani A, Al-Khwaldi T, Al-Suqri S,…Alazri M, Al-Hinai M, et al. Injuries presented at a primary care setting in Oman. Oman Med J 2012; 27:486–90.

Conference & Seminar Presentations Oral Presentations International 1. Ganguly SS, Bhargava K, Al Shafaee MA. Screening of dysglycemia based on anthropometric indices among Arab Omani adult population. 5th International Congress on Prediabetes and Metabolic Syndrome. Vienna, Austria, 18– 20 Apr 2013. 3. Al-Farsi YM. Lean Thinking: Can Toyota improve patient safety in hospitals in Oman? Second Gulf Cooperation Council (GCC) Conference on Patient Safety, Muscat, Oman, 20–23 Jan 2013. departments

National 1. Al-Farsi YM. Public Health in Oman: Past, Present, and Future. The First National Public Health Symposium - Public Health in Oman: Evidence, Policy and Action, Oman Public Health Society, Muscat, Oman, 15 Apr 2013. care

Poster Presentations International patient

1. al-Khaduri M, Al-Farsi YM. Assessment of risk factors of polycystic ovarian syndrome among Omani females in reproductive age. The Ovarian Club III, Paris, France, 14–16 Nov 2013.

2. al-Balushi S, Al-Farsi YM, Sohal P, Prakash A, Al-Hajri A. Readiness factors for applying Lean Thinking in healthcare and system in Oman. 12th International Decision Sciences Institute (DSI) Conference with 18th Asia Pacific DSI Confer- ence Bali, Indonesia, 9–13 July 2013. 3. al-Said MF, Al-Farsi YM, Al-Khaduri MM, Al-Sharbati MM, Waly MI, Al-Shafaee MA, et al. Challenges facing educators of children with autism in Oman from educators’ perspective: a qualitative study. 13th International Meeting for Autism Research, San Sebastian, Spain, 2–4 May 2013. academic 4. al-Kindi NM, Al-Shafaee MA, Waly MI, Al-Sharbati MM, Ouhtit A,...Al-Farsi YM. Dietary patterns among children with autism in Oman: a study protocol. 13th International Meeting for Autism Research, San Sebastian, Spain, 2–4 Family Medicine & Public Health May 2013. 5. al-Khaduri MM, Al-Tobi I, Al-Farsi YM. Assessment of risk factors of polycystic ovarian syndrome among Omani females in reproductive age. 1st Annual Middle East Society for Gynecological Endoscopy (MESGE) Congress with Turkish Society of Gynecological Endoscopy, Antalya, Turkey, 24–28 April 2013. 6. Al-Farsi YM, Al-Khaduri M, Al-Sumri H, Al-Farsi O, Al-Sharbati M,...Al-Shafaee M. Association of gestational diabetes mellitus with occurrence of autism: A cohort study. Conference of Federation of American Societies for Experimen- tal Biology (FASEB), Boston, Massachusetts, USA, 20–24, Apr 2013. 7. al-Farsi OA, Al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee MA, Ouhtit A, et al. Sleep patterns and quality among children with autism and their caregivers in Oman: a case control study. 13th International Meeting for Autism Re- search, San Sebastian, Spain, 2–4 May 2013.

73 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

8. Ouhtit A, Abdraboh ME, Gupta P, Hollenbach A, Al-Farsi YM, Gupta I, et al. CD146 is a novel target of CD44-signaling mediating breast tumor invasion. Tumor Invasion and Metastasis – American Association for Cancer Research Spe- cial Conference, San Diego, California, USA, 20–23 Jan 2013. 9. Al-Hinai M. Leptin is an independent risk factor for prediabetes in lean, non-diabetic subjects, 5th International Congress on Prediabetes and the Metabolic Syndrome, Vienna, Austria, 18–20 Apr 2013.

National 1. sabt FY, Al-Khaduri MM, Al-Fazari M, Al-Farsi YM. Clinical profile of women diagnosed with polycystic ovarian syndrome in a tertiary hospital in Oman: a case controlled study. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 2. al-Khaduri MM, Al-Farsi YM. Evaluation of diagnostic ability of novel techniques in endometrial biopsy. 1st Interna- tional Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 3. al-Khaduri MM, Al-Hajri H, Al-Farsi YM. Assessment of awareness about polycystic ovary syndrome among female university students. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. Seminar Presentations National 1. Al-Farsi YM. Use of Lean Thinking in critical care. Mysteries in Critical Care Symposium, Rustaq Hospital, Oman, 17 Dec 2013. 2. Al-Farsi YM. Evaluation of professionalism among medical interns: experience at Sultan Qaboos University. First National Confenrece on New Horizon in Higher Education, Sur, Sharqiya Governorate, Oman, 4–5 Dec 2013. 3. al-Asfoor DH, Al-Farsi YM. Health financing in Oman. FirstR ound Table Discussion, Organized by Oman Public Health Society, Muscat, Oman, 8 Apr 2013. 4. Al-Farsi YM. Being a doctor: Ethics and professionalism. White coat ceremony, Oman Medical College, Sohar, Oman, 15 Jan 2013.

THESIS SUPERVISION Student Name: Hasina A. S. Al-Harthi Qualification: M. Sc. Biomedical Sciences, Major in Epidemiology & Medical Statistics Title: Risk factors of stroke among Omani adult population: A hospital based case-control study Supervisor: Dr. Shyam S. Ganguly Date of completion: October 2013

74 Student Name: najma Al-Kindi Qualification: Ph.D. Title: The impact of postnatal nutrition and oxidative stress in the etiology of autism spectrum in Oman Supervisor: Dr. Mohammed Al-Shafaee Date of completion: On-going

Student Name: Omar Al-Farsi Qualification: M. Sc. Title: Effect of antenatal and perinatal adverse events on occurrence of ASD in Oman Supervisor: Dr. Yahya Al-Farsi Date of completion: On-going departments

Student Name: Hamad Al Reesi care

Qualification: M. Sc. Title: A comprehensive investigation of risky driving behaviors among young drivers in Oman patient Supervisor: Dr. Abdulla Al-Maniri

Date of completion: On-going and

academic Family Medicine & Public Health

75 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

76 departments

care

Genetics patient Genetics

and

enetics is a department with ample resources and potential, providing scientists and clinicians with unprecedented opportunities to make a difference to society.T he mission of the Department is to provide state-of-the-art diagnostic services for patient care, education, research as well as raising public awareness in the field of genetics.W hile serving asG a focal point for routine clinical services, the Department is committed to updating the on-going routine diagnostic tests in academic cytogenetics and immunogenetics and, in addition, to developing new molecular diagnostic tests for various genetic diseases, including cancer, cardiovascular and neurological diseases.

The Department has four specialised sections: Clinical Genetics, Cytogenetics, Molecular Genetics and Immunogenetics. The research in the Department is currently focused on inborn errors of metabolism, rare genetic diseases, cystic fibrosis and cancer.

77 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Suriyan Mani, Biomedical Scientist Iman H. Al-Hadhili, Biomedical Scientist Acting Head of Department Support staff Khalid Al-Thihli, Consultant Ghadeer Al-Zadjali, Coordinator (College) Faculty Soad S. Al-Muqaimi, Coordinator (Clinic) Allal Ouhtit, Associate Professor A. M. Udayakumar, Associate Professor Highlights of the Year 2013 Clinical Genetics The Genetics Department continued to evolve rapidly in 2013 as is expected of a relatively young de- Adila Al-Kindy, Senior Consultant partment in such a multidisciplinary field.T he year Fathiya Al-Murshedi, Consultant 2013 saw the development of the Molecular Ge- Zandre Bruwer, Genetic Counselor netics and Genomic Laboratory which is expected Maha Al-Awadi, Registrar to flourish in 2014.T he Genetic & Developmental Sara S. Al-Alawi, Social Worker Medicine Clinic witnessed a significantly increased Khalsa Al-Kharousi, Biomedical Scientist number of referrals and consultations. This high- Molecular Genetics lights the national significance and public aware- Patrick Scott, In charge, Molecular Laboratory ness of this clinic. The sustained and augmented Mariam Al-Nabhani, Biomedical Scientist research productivity in 2013 emphasises the role Aisha Al-Naamani, Biomedical Scientist the Department plays as one of the leading re- Feisal Al-Mahrizi, Biomedical Scientist search departments in the College of Medicine & Samia Al-Rashdi, Biomedical Scientist Health Sciences (COMHS). Farida Al-Mamaari, Biomedical Scientist Lina Al-Mashhadani, Biomedical Scientist Teaching Programmes Cytogenetics The Department of Genetics participates in teach- Robert Sigmani, Biomedical Scientist ing and training clinicians and medical science stu- Shoma S. Raj, Biomedical Scientist dents. Sami Al-Kalbani, Biomedical Scientist Balaji Krishnan, Biomedical Scientist UNDERGRADUATE PRECLINICAL Sultan S. Al-Salhi, Biomedical Scientist PROGRAMME Immunogenetics The Department is involved in a significant amount Hamad Al-Riyami, Chief Biomedical Scientist, of teaching and training in the College of Medicine Superintendent & Health Sciences. It coordinates the new Cell Biol- Varghese CM, Senior Biomedical Scientist ogy course. It contributes to the Molecular Biology Faiza Al-Yahyai, Senior Biomedical Scientist (on and the Principles of Genetics undergraduate pre- study leave)

78 clinical courses with lectures and tutorials on molecular genetics and cytogenetics. It also participates in the annual teaching rotations and training of doctors and students proceeding to the 2nd or 3rd year of their degree. This is achieved through laboratory-based workshops as follows: (1) a bi-annual workshop in standard molecular genetic laboratory techniques and (2) the rotation of students and doctors in the Cytogenetics, Immunogenetics, and Molecular Genetics diagnostic laboratories. This includes training and an observation course on genetic techniques organised in January and June each year.

UNDERGRADUATE CLINICAL PROGRAMME The Department is involved in the following clinical teaching activities: (1) Clinical (bedside and outpatient) teaching for residents, senior house officers and registrars; (2) the Junior Clerkship Clinical Genetics and Counselling rotation, an intense course-format structured rotation that takes place every 6 weeks; (3) Two seminars on the approach to metabolic diseases for final year M.D. students; (4) A two-hour clinical lecture for nursing students from the Ministry of Health, and (5) a genetics lecture for 7th year medical Obstetrics & Gynecology rotation students; this is repeated every 6 weeks with 25–28 students in each batch.

The Department participates in the teaching of the Molecular Diagnosis and Biology of Disease courses in departments the Biomedical Sciences (BMS) bachelor’s degree programme. It also provides lectures on cancer genetics and genetics. care

Finally, the Department contributes to the teaching in the Sultan Qaboos University (SQU) Colleges of Agriculture & Marine Sciences and Nursing with lectures on genetics and nutrigenomics. patient Genetics

POSTGRADUATE PROGRAMME and

The Department has its own Ph.D. programme in Genetics and Genomics and currently has four Ph.D. students. The Department takes part in the Master’s programme in Biochemistry, the senior house officer in-house training, and the Oman Medical Specialty Board (OMSB) residents training programme in Hae- matology and Biochemistry with lectures on cytogenetics, molecular genetics and immunogenetics. The De-

partment is actively involved in training residents on rotation in the field of medical genetics and biochem- academic ical genetics (inborn errors of metabolism). Clinicians from the Department of Genetics are OMSB trainers associated with the Paediatrics Residency Training Programme.

Training Courses & CME Activities The Omani staff members of the Department are sent abroad for regular training in genetics (residency training, Ph.Ds. and short training courses in genetics). There are regular in-house training activities in genetics for the staff and for Omani graduates from SQU and abroad. Senior staff members are encouraged to participate in international meetings to ensure adequate CME credits are obtained for the maintenance of their certifications.

79 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Clinical & Diagnostic Services Clinical Genetics The main objectives of the Clinical Genetics section, in addition to its teaching and research activities, is to provide a standard-of-care service for patients and families with genetic disorders including diagnosis, genetic counselling, management and social support. In 2013, the Clinical Genetics team of four clinical genet- icists saw a total of more than 1,400 patients/families for outpatient consultations; the number of inpatient consultations was of a similar order.

The Clinical Genetics team also contributed to the care of metabolic patients and in teaching M.D. and postgraduate students. Although no active grant proposals are linked to the Clinical Genetics section at present, the potential is being explored and self-funded clinical projects are presently underway. The clinical unit is actively involved in liaison with other clinical services in designing, arranging and facilitating clinical research that may have direct or indirect genetic implications. Clinical genetic services naturally imply dealing with rare disorders. These are typically associated with ongoing research questions that are being explored on a family or individual basis as indicated by the clinical needs. So far, there are several families that have been involved in clinical research or are currently considering such an involvement.

Cytogenetics Laboratory Table 1: 2013 statistics for conventional cytogenetics - Karyotyping Month Haematological Non-haematological No. Bone marrow Blood Blood Amniotic fluid FNA January 16 - 37 1 - 54 February 17 1 44 1 1 64 March 25 3 31 1 - 60 April 23 - 21 - - 44 May 24 - 30 - - 54 June 22 2 14 - - 38 July 24 1 28 1 - 54 August 16 2 11 - - 29 September 24 - 14 - - 38 October 21 1 19 1 - 42

80 November 12 1 9 2 - 24 December 21 1 25 - 1 48 Total 245 12 283 7 2 549

FNA = fine needle aspiration cytology.

Table 2: Types of patients karyotyped in 2013 Referring Department No. Haematology (adult ) 212 Haematology (paediatrics) 49 Obstetrics & Gynaecology 129 Child Health 48 departments

Neonatology 17 Genetics 67 care Medicine 7 Paediatric Neurology 5 patient Genetics Paediatric Endocrinology - Urology 7 and

Family Medicine & Public Health 1 Paediatric Intensive Care Unit 1 Neurology 1 academic Pediatric Surgery 1 Pathology 1 Neonatal Intensive Care Unit 3 Total 549

81 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 1: Patient samples from 2002–2013.

In 2013, a total of 7 patients underwent prenatal diagnosis by amniocyte cultures.

Molecular Genetics and Genomics Laboratory This laboratory section is involved with the molecular study of disorders with a genetic basis. In 2013, the laboratory completed a major reorganisation of the available space to meet the particular workflow requirements in addition to the modernisation of essential equipment. This will allow the laboratory to satisfy the needs of clinicians and patients. The aim is for the laboratory to provide comprehensive and specialised molecular diagnostic services, including teaching and research. It is anticipated that by the end of 2014, a basic menu of specific clinical tests will be available in support of the Genetic and Developmental Clinic and other specialty clinics within SQUH and beyond. The number of specimens for nucleic acid extraction grew to 1,229 in 2013 compared to only 330 in 2011.

Research RESEARCH PROJECTS From gene expression analysis of Omani breast tumours to biomarkers/candidate gene discovery Code: SR/MED/GENT/10/01 Dates: 2010–2014 Value: OR 207,850 Funder: His Majesty’s Strategic Research Fund Investigators: Dr. Allal Ouhtit, Dr. Said Al-Yahyaee, Dept. Genetics, SQU; Dr. Yahya Al-Tamimi, Dept. Bio- chemistry, SQU; Dr. Mansour Al-Moundhri, Dept. Medicine, SQU; Prof. Madhwa H. G. Raj, LSU Health Sciences Center, New Orleans, USA; Prof. Herlyn Meenhard, Dept. Dermatology, Wistar Institute, Pennsylvania, USA.

82 From chemoprevention to biomarkers and target development for breast cancer Project Code: IG/MED/GENT/12/01 Dates: 2012–2014 Value: OR 10,657 Funder: SQU Investigators: Dr. Allal Ouhtit, Dr. Hamad Al-Riyami, Dept. Genetics, SQU.

Cytogentic and molecular screening for subtelomeric chromosomal imbalance in Omani patients with idiopathic mental retardation Code: IG/MED/GENT/12/02 Dates: 2012–2013 Value: OR 13,970 Funder: SQU Investigators: Dr. A. M. Udayakumar, Ms. Aisha Al-Namani, Ms. Shoma Raj, Dept. Genetics, SQU; Prof. Samir Al-Adawi, Dr. Marwan Al-Sharbati, Dept. Behavioural Medicine, SQU.

Nature and frequency of Y chromosome microdeletions in infertile male Omanis Code: IG/MED/DEAN/1461 Dates: Jan – Oct 2013 Value: 1,000 OMR Funder: SQU-MRC Investigators: Dr. Patrick Scott, Dr. Udayakumar Achandira, Dept. Genetics, SQU. departments RESEARCH PUBLICATIONS & BOOKS Journal Publications care

1. Ouhtit A, Madani S, Gupta I, Shanmuganathan S, Abdraboh ME, Al-Riyami H, et al. TGF-β2: A novel target of CD44-promoted breast cancer invasion. J Cancer 2013; 4:566–72. 2. al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee M,…Ouhtit A, et al. Impact of nutrition on serum levels of docosahexaenoic acid among Omani children with autism. Nutrition 2013; 29:1142 6. – patient Genetics

3. al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee M,…Ouhtit A. Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism. Nutrition 2013; 29:537 41.

– and 4. al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee MA, Al-Farsi OA,…Ouhtit A, et al. Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: A case-control study. Biol Trace Elem Res 2013; 151:181–6. 5. al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O,…Ouhtit A, et al. Variation in socio-economic burden for caring of children with autism spectrum disorder in Oman: Caregiver perspectives. J Autism Dev Disord 2013; academic 43:1214–21. 6. Ouhtit A, Ismail MF, Othman A, Fernando A, Abdraboh ME, El-Kott AF, et al. Chemoprevention of rat mammary carcinogenesis by spirulina. Am J Pathol 2014; 184:296–303. 7. Ouhtit A, Gaur RL, Abdraboh M, Ireland SK, Rao PN, Raj SG, et al. Simultaneous inhibition of cell cycle, proliferation, survival, metastatic pathways and induction of apoptosis in breast cancer cells by a phytochemical super-cocktail: Genes that underpin its mode of action. J Cancer 2013; 4:703–715. 8. waly MI, Ali A, Bhatt N, Al-Farsi YM, Al-Kilani H, Ouhtit A, et al. Leptinemia among obese Omani adults newly diagnosed with type 2 diabetes mellitus: A case-control study. J Med Sci 2013; 13:208–214. 9. Bruwer Z, Futter M, Ramesar R. A mobile colonoscopic unit for Lynch syndrome: Trends in surveillance uptake and patient experiences of screening in a developing country. J Genet Couns 2013; 22:125–37.

83 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

10. Bruwer Z, Futter M, Ramesar R. Communicating cancer risk within an African context: Experiences, disclosure patterns and uptake rates following genetic testing for Lynch syndrome. Patient Edu Couns 2013; 92:53–60. 11. Bruwer Z, Ursula Algar, Alvera Vorster, Karen Fieggen, Alan Davidson, Paul Goldberg, et al. Predictive genetic testing in children: Constitutional mismatch repair deficiency cancer predisposing syndrome. J Genet Couns 2014; 23:147– 55. 12. ganesh A, Bruwer Z, Al-Thihli K. An update on ocular involvement in mucopolysaccharidoses. Curr Opin Ophthal- mol 2013; 24:379–88. 13. pfisterT , Sekhon R, White M, Scott P, Munro S, Johnston M, et al. Familial amyotrophic lateral sclerosis in Alberta, Canada. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:273–7. 14. Al-Thihli K, Sinclair G, Sirrs S, Mezei M, Nelson J, Vallance H. Performance of serum and dried blood spot acylcarni- tine profiles for detection of fatty acidβ -oxidation disorders in adult patients with rhabdomyolysis. J Inherit Metab Dis 2014; 37:207–13. 15. alfadhel M, Al-Thihli K, Moubayed H, Eyaid W, Al-Jeraisy M. Drug treatment of inborn errors of metabolism: A systematic review. Arch Dis Child 2013; 98:454–61. 16. UdayaKumar AM, Al-Kindy A. A rare case of de novo mosaicism: Deletion 18p and isochromosome 18q syndrome. J Paed Genet 2013; 2:141–146. 17. abdraboh MEE, Gaur R, Ouhtit A, Hollenbach A, El-hadidy A, Raj M. Synergistic effects of combined phytochemicals in diminishing breast cancer cell growth and metastasis. Clin Nutr 32:S56. Books & Book Chapters 1. Bruwer Z, Ramesar R. Lynch Syndrome: Genetic Counselling of At-Risk Individuals and Families. In: Vogelsang M, Ed. DNA alterations in Lynch syndrome: Advances in molecular diagnosis and genetic counselling. Berlin: Springer Publishing Company, 2013. ISBN: 978-94-007-6596-2.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Ouhtit A, Shanmuganathan S, Gupta I, Al-Riyami H. From phyto-chemoprevention to discovery of novel markers and targets for therapy of breast cancer. Pharma-Nutrition 2013, Singapore, 15–17 Apr 2013. 2. Udayakumar AM. A rare case of de novo mosaic-deletion 18p and isochromosome 18q syndrome. Qatar Foundation Annual Research Conference, Doha, Qatar, 24–25 Nov 2013. Poster Presentations International 1. al-Farsi O, Al-Farsi YM, Waly MI, Al-Sharbati M, Al-Shafaee M, Ouhtit A, et al. Sleep patterns and quality among children with autism and their caregivers in Oman: A case control study. International Meeting for Autism Research (IMFAR), San Sebastian, Spain, 2–4 May 2013. 2. al Farsi YM, Waly MI, Al-Sharbati M, Al-Shafaee M, Al-Farsi O, Ouhtit A, et al. Levels of heavy metals and essential minerals in hair samples of children with autism in Oman: A case-control study. International Meeting for Autism Research (IMFAR), San Sebastian, Spain, 2–4 May 2013. 3. Ouhtit A, Al-Riyami H, Varghese CM, Gupta I, Shanmuganathan S, Al-Farsi YM, et al. Novel potential HLA-biomarkers for autism among Omani children. International Meeting for Autism Research (IMFAR), San Sebastian, Spain, 2–4 May 2013.

84 4. al-Said MF, Al-Farsi YM, Al-Khaduri MM, Al-Sharbati MM, Waly MI,...Ouhtit A, et al. Challenges facing educators of children with autism in Oman from educators’ perspective: a qualitative study. International Meeting for Autism Research (IMFAR), San Sebastian, Spain, 2–4 May 2013. 5. al-Khaduri MM, Al-Sumri H, Al-Farsi O, Al-Sharbati MM, Waly MI, Ouhtit A, et al. Association of gestational diabetes mellitus with occurrence of autism: A Cohort Study. International Meeting for Autism Research (IMFAR), San Sebas- tian, Spain, 2–4 May 2013. 6. al-Kindi NM, Al-Shafaee M, Waly MI, Al-Sharbati M, Ouhtit A, Al-Khaduri MM, et al. Dietary patterns among children with autism in Oman: A study protocol. International Meeting for Autism Research (IMFAR), San Sebastian, Spain, 2–4 May 2013. 7. al-Sharbati M, Al-Farsi YM, Al-Shafaee MA, Al-Khaduri MM, Al-Adawi S, Ouhtit A, et al. Autism awareness workshops for medical students can raise their interest. International Meeting for Autism Research (IMFAR), San Sebas- tian, Spain, 2–4 May 2013. 8. al-Sharbati M, Al-Farsi YM, Al-Shafaee MA, Waly MI, Al-Farsi O,...Ouhtit A, et al. Knowledge and attitude towards autism among school teachers in Oman. International Meeting for Autism Research (IMFAR), San Sebastian, Spain, 2–4 May 2013. 9. Ouhtit A, Abdraboh M, Ishita Gupta, Hollenbach A, Raj M. CD146 is a novel target of CD44-signaling mediating breast tumor invasion. American Association for Cancer Research (AACR) Special Conference Tumor Invasion and Metastasis, San Diego, California, USA, 20–23 Jan 2013.

10. Ouhtit A, Madani S, Gupta I, Shanmuganathan S, Al-Riyami H, Al-Farsi YM. TGF- 2 underpins CD44-promoted breast departments

β tumor cell invasion. American Association for Cancer Research (AACR) Special Conference Tumor Invasion and Me- tastasis, San Diego, California, USA, 20–23 Jan 2013.

11. Fernando A, Abdel Mageed Z, Gupta I, Al-Riyami H, Ouhtit A. In vivo evidence of TIMPv as a potential target of care CD146-signaling inhibiting breast tumor invasion. American Association for Cancer Research (AACR) Special Con- ference Tumor Invasion and Metastasis, San Diego, California, USA, 20–23 Jan 2013. 12. Ouhtit A, Madani S, Gupta I, Shanmuganathan S, Al-Farsi YM. TGF-β2 underpins CD44-promoted breast tumor cell

invasion. Ninth AACR-Japanese Cancer Association Joint Conference: Breakthroughs in Basic and Translational Can- patient Genetics cer Research, Maui, Hawaii, USA, 21–25 Feb, 2013. 13. Ouhtit A, Gaur RL, Welsh DA. Deregulation of mesenchymal stem cell CD44-signaling in response to cigarette smoke. and Ninth AACR-Japanese Cancer Association Joint Conference: Breakthroughs in Basic and Translational Cancer Re- search, Maui, Hawaii, USA, 21–25 Feb, 2013. 14. Ouhtit A, Madani S, Gupta I, Shanmuganathan S, Al-Riyami H, Al-Farsi YM. Deregulation of cell cycle and apoptotic mechanisms in UVB-irradiated p16-mutant melanoma cell lines. Ninth AACR-Japanese Cancer Association Joint Conference: Breakthroughs in Basic and Translational Cancer Research, Maui, Hawaii, USA, 21–25 Feb, 2013. 15. Ouhtit A, Shanmuganathan S, Gupta I, Al-Kindy I, Al-Riyami H. Molecular mechanisms underpinning the effective- academic ness of the combination of camel milk and urine in the clearance of breast cancer cells. 2nd Middle East Congress American Society for Nutrition (ASN) Nutrition in Health and Disease, Dubai, UAE, 20–22 Feb 2013. 16. gupta I, Ouhtit A, Shanmuganathan S, Al-Kindy I, Al-Riyami H. Molecular mechanisms underpinning the effectiveness of the combination of camel milk and urine in the breast cancer. Pharma-Nutrition 2013, Singapore, 15–17 Apr 2013. 17. Ouhtit A, Fernando A, Gaur R, Gupta I, Shanmuganathan S, Al-Riyami H. Discovery of CD146/Latexin as a novel pathway suppressing breast tumor invasion. American Association of Cancer Research Annual Meeting, Washington, 6–10 Apr 2013. 18. Ouhtit A, Gupta I, Abdraboh ME, Gupta P, Hollenbach A, Al-Riyami H, et al. CD146, a suppressor of breast cancer, is a novel target of CD44-signalling. American Association of Cancer Research Annual Meeting, Washington, USA, 6–10 Apr 2013.

85 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

19. al-Marhoon M, Ouhtit A, Venkiteswaran K, Al-Busaidi Q, Mathew J, Al-Haddabi I, et al. The Relationship of Helico- bacter Pylori Infection to Prostate Cancer and Benign Prostatic Hyperplasia: Is It Real? 33rd Congress of the Société Internationale d’Urologie, Vancouver, British Columbia, Canada, 8–12 Sep 2013. 20. Bruwer Z. Regular colonoscopic surveillance reduces risk of colon cancer by fifty percent in Lynch syndrome:W hy patients do not heed this advice. Joint International Conference African & South African Society of Human Genetics, Sandton, South Africa, 6–9 Oct 2013. 21. Bruwer Z. Non-adherence to life-saving screening in Lynch syndrome. Joint International Conference African & South African Society of Human Genetics, Sandton, South Africa, 6–9 Oct 2013. 22. Scott P, Almurshedi F. Occurrence of recurrent optic neuritis and cervical cord schwannoma with recessive Char- cot-Marie-Tooth disease: A case report. 2013 American Society of Human Genetics (ASHG) Annual Meeting, Boston, USA, 22–26 Oct 2013. 23. Harikrishna B, Al-Thihli K, Al-Zuhaibi S, Al-Kharousi N, Qureishi A, Al-Badawi K, et al. Clinical and Molecular Char- acterization of Mucolipidosis-IV in Oman. The Royal College of Ophthalmologists Annual Congress, Liverpool, UK, 21–23 May 2013. 24. Al-Thihli K, Abdwani R, Al-Abrawi S. Homozygous R92Q variants in the TNFRSF1a gene in two sisters with tumor necrosis factor receptor–associated periodic syndrome. Joint Conference of the HGM 2013 and 21st International Congress of Genetics, Singapore, 13–18 Apr 2013. 25. Al-Thihli K, Al Habsi A, Panteix G, Koul R, Al Mammary W. L2-hydroxyglutaric aciduria in three Omani siblings with a novel homozygous mutation of the L2HGDH gene. 12th International Congress of Inborn Errors of Metabolism, Barcelona, 3–6 Sep 2013. J Inherit Metab Dis 2013; S36:55–90. 26. r Salvarinova, Al-Thihli K, Dionne J, Kollman TR, Waters P, Langley T, et al. A novel heteroplasmic frame shift mutation in the COX2 gene leading to severe recurrent rhabdomyolysis in association with viral illness. 12th International Congress of Inborn Errors of Metabolism, Barcelona, Spain, 3–6 Sep 2013. J Inherit Metab Dis 2013; S36:55–90. 27. al Belushi S, Al Habsi A, Al-Murshedi F, AlShekaili S, Al-Thihli K. The practice of dietary emergency regimen application among care givers of patients with inborn errors of small molecules metabolism: a survey and a retrospective study. 12th International Congress of Inborn Errors of Metabolism, Barcelona, Spain, 3–6 Sep 2013. J Inherit Metab Dis 2013; S36:55–90. 28. al-Riyami S, Al-Maney M, Bayoumi R, Krishnan L,...Al-Murshedi F, Al-Thihli K. Newborn screening for inborn errors of metabolism at Sultan Qaboos University Hospital (Oman): a pilot study. 12th International Congress of Inborn Errors of Metabolism, Barcelona, Spain, 3–6 Sep 2013. J Inherit Metab Dis 2013; S36:55–90. 29. alfadhel M, Al-Thihli K, Moubayed H, Eyaid W, Al-Jeraisy M. Drug treatment of inborn errors of metabolism: a systematic review. 12th International Congress of Inborn Errors of Metabolism, Barcelona, 3–6 Sep 2013. J Inherit Metab Dis 2013; S36:55–90. 30. Bruwer Z, Al-Kharusi A, Achandira U, Al-Kindy A. Difficulties in genetic counselling and prenatal diagnosis: An Omani consanguineous couple at risk for two distinct genetic syndromes. ESHG European Society of Human Genet- ics, Paris, France, 8–11 Jun 2013. 31. Al-Kharusi K, Bruwer Z, Al-Kindy A, Al-Murshedi F. Three new Omani cases of Warburg micro syndrome with two different RAB3GAP1 novel mutations. European Society of Human Genetics, Paris, France, 8–11 Jun 2013. 32. Al-Kindy A, Al-Murshedi F, Bruwer Z. Split hand/split foot malformation type 6 in multiple consanguineous Omani family with a novel homozygous mutation in WNT10B gene providing further evidence of recessive inheritance in SHFM. ESHG European Society of Human Genetics, Paris, France, 8–11 Jun 2013.

86 departments

care

Haematology patient

Haematology and

he Department of Haematology is unique as it functions both as a major clinical and laboratory medicine department. It plays a central role in the teaching of haematology to undergraduate medical students (M.D.), postgraduate students of medicine who have opted to specialise in medicine, and haematology residents of the Oman Medical Specialty Board T(OMSB), as well as medical laboratory technicians in the B.Sc. Medical Laboratory Sciences courses. The Department’s labora- academic tories provide state-of-the-art haematology testing for the University Hospital (SQUH) and referral services to several other hospitals like the Muscat Private Hospital. The Department is also the national centre for highly specialised testing such as flowcytometric and molecular haematological analysis for the diagnosis of haematological conditions.

87 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Heidi M. Davis, Chief Biomedical Scientist, Ali Al-Marhoobi, Chief Biomedical Scientist Head of Department Shakila Ashraf, Senior Biomedical Scientist Salam Alkindi, Associate Professor & Senior Hamood Al-Haddabi, Senior Biomedical Scientist Consultant Rodrigo Villacrusis, Senior Biomedical Scientist Faculty Maria Cicillia, Senior Biomedical Scientist Abdulrehman N. Rashid, Senior Biomedical Scientist Shahina Daar, Associate Professor Bushra Al-Said, Senior Biomedical Scientist Mohammed R. Boulassel, Associate Professor Sahima Al-Mamari, Senior Biomedical Scientist Mariyam Al-Bakri, Clinical Lecturer Karima Al-Falahi, Senior Biomedical Scientist Muna Al-Maskari, Lecturer Deuel M. Labrador, Senior Biomedical Scientist David Dennison, Senior Consultant Enrique O. Pedojan, Senior Biomedical Scientist Naglaa Fawaz, Senior Consultant Hamed Al-Gheithi, Senior Biomedical Scientist Anil Pathare, Senior Consultant Sabah Al-Mahrooqi, Senior Biomedical Scientist Mohammad Huneini, Senior Consultant Sumaya Al-Hinani, Senior Biomedical Scientist Khalil Al-Farsi, Senior Consultant Qamariya Al-Abri, Senior Biomedical Scientist Murtadha Al-Kabori, Senior Consultant Shoaib Al-Zadjali, Senior Biomedical Scientist Arwa Al-Riyami, Consultant Mariyam Al-Brashdi, Senior Biomedical Scientist Bader Al-Rawahi, Senior Registrar (on study leave) Julian Neson, Senior Biomedical Scientist Zeba Zabeen, Senior Registrar Asma A. Musleh, Senior Biomedical Scientist Hammad Khan, Senior Registrar Badriya Al-Belushi, Biomedical Scientist Fehmida Zia, Senior Registrar Saif Al-Hosni, Biomedical Scientist Fauzia Wasim, Senior Registrar Mohammed Al-Rawahi, Biomedical Scientist Nausheeen Kamran, Registrar Ishaq Al-Salmi, Biomedical Scientist Mohamed Nadeem, Registrar Jamal Al-Qasabi, Biomedical Scientist Rabia Jadoon, Registrar Eufrosina Alverez, Biomedical Scientist Rizwan Querishi, Registrar Mohan Doraiswamy, Biomedical Scientist Vinodh Panjwani, Registrar Nestor Naniong, Biomedical Scientist Najwa Abdulhameed, Registrar Rene Gabucay, Biomedical Scientist Mohamed Rehan, Senior House Officer Allan S. Aurelio, Biomedical Scientist Moez H.A. Rhim, Senior House Officer Adela Angeles, Biomedical Scientist Abubakar Ibrouf, Senior House Officer Melani Tauro, Biomedical Scientist Niveen Al-Ansari, Senior House Officer Malvin J. W. Li, Biomedical Scientist Support Staff Vardarajan Nelvoy, Biomedical Scientist Stuart Donaldson, Superintendent Lancy Henry, Biomedical Scientist David Gravell, Chief Biomedical Scientist Jerry Macni, Biomedical Scientist

88 Rhea Misquith, Biomedical Scientist Teaching Programmes Fatma Al-Hasmi, Biomedical Scientist Isehaq Al-Omairi, Biomedical Scientist UNDERGRADUATE PROGRAMME Zainab Al-Douhori, Biomedical Scientist Old Curriculum Alshima M. Taqi, Biomedical Scientist The Department participates in teaching the Hae- Rahma Ambusaidi, Biomedical Scientist mato-Lymph-Vascular course to 3rd year students. It Raya H. Al-Farsi, Biomedical Scientist runs a 5-week course on case-based learning in hae- Binny Sam, Head Staff Nurse -1 matology for the 5th year students in the Integrat- Rose Saly, Staff Nurse -2 ed Lecture Series. It participates in bedside clinical Mary Kurian, Staff Nurse - ICH3 teaching for 7th year students and runs a one-week Victoria G. Menezes, Staff Nurse 2 laboratory rotation for 6 groups of 7th year students. Shiney Thomas, Staff Nurse 2 It provides seminars on Anaemia & Haemostasis in Silva Kumari, Staff Nurse 2 Pregnancy for 7th year Obstetrics & Gynaecology Bindu Shiby, Staff Nurse 2 students. Finally, the Department runs a course in Shobha Sujith, Staff Nurse 2 the B.Sc Medical Laboratory Sciences.

Nuha Al-Kiyumi, Staff Nurse 2 departments

Helen Carteza, Staff Nurse 2 Mhey Agilano, Staff Nurse 2 New Curriculum care Eman Al-Homaidi, Coordinator The Department developed and taught a new mod- Tomichan Varghese, Coordinator ule on Hemato-lymphatic-Immunology in Phase II of Dalal Y. Al-Khusaibi, Clerk the new undergraduate curriculum. It also partici-

pated and coordinated the various courses in Phase II patient

Anisa Al-Belushi, Social Worker Ali Al-Kiyari, Medical Orderly in the new curriculum, in particular integrated mod- Haematology

ules I, II and III. It provided lectures on Introduction to and

Highlights of the Year 2013 Human Physiology in Phase I. Further it participated In 2013, the Haematology Clinical Unit treated pain and coordinated the Junior Clerkship Respiratory tients with a vast range of haematological disorders, course and participated in the Junior Clerkship training with seminars on Complete Blood Count, Sickle both as inpatients and outpatients. In addition, the academic Department runs a Thalassaemia Day Care Unit. Cell Vaso-Occlusive Crisis, Systolic Murmur Examina- In 2013, it offered comprehensive care for about 150 tion, Haemostasis, Bone Marrow Aspirate/Trephine patients with transfusion-dependent thalassaemia. and Hepatosplenomegaly. Of national interest is the successful bone marrow In Intercalated Medicine, it provided the Haema- transplant programme, run by this Department. By tology Laboratory Rotation. The Department also the end of December 2013, a total of 271 bone marrow developed and conducted Senior Clerkship Phase III transplants on 260 patients had been performed in teaching in collaboration with the Child Health de- this centre, with results as good as those from the partment, as well as developing and conducting lab- best centres around the world. oratory rotations for these students. Finally, departmental staff taught in Research Modules I, II and III.

89 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

POSTGRADUATE PROGRAMME The Department has developed and taught the Haematopathology course along with the Ministry of Health’s (MOH) Royal Hospital which is affiliated with the Oman Medical Specialty Board. There are 6 residents at various stages of training in the programme.

Training Courses & CME Activities The Department also gave lectures to OMSB residents in Haematology, Pediatrics, Internal Medicine and Ob- stetrics & Gynecology. Finally, it participated in the Communications Skills workshop for OMSB and delivered multiple lectures in various parts of the country as part of its CME activity.

Clinical & Diagnostic Services Clinical services are provided in the following major areas; adult outpatients (one specialised and three general clinics); adult inpatients; bone marrow transplantation (4 beds in the Bone Marrow Transplantation [BMT] Unit), and the sickle cell anaemia programme (in- and outpatients—both diagnostic and research activities).

The Department provides state-of-the-art diagnosis and therapy (including BMT) in the leukaemia, lymphoma and myeloma programmes, and in the thalassaemia day care programme.

The laboratory services cover specialised areas including: haemostasis; flowcytometry; haemoglobinopathy; molecular diagnostics; stem cell processing laboratory and general laboratory haematology. The blood transfusion service includes blood donation and storage; irradiation; plasmapheresis and exchange, and apheresis facilities (including stem cells) as well as the blood grouping and cross-matching laboratory.

Bone Marrow Transplantation Programme The bone marrow transplant programme, established in the Department in 1995, serves the whole of Oman and continues to provide curative treatment for patients with haematological malignancy, bone marrow failure and potentially fatal genetic diseases. In 2013, 27 transplants were performed on 26 patients (22 al- logeneic, 5 haplo-identical, 8 with bone marrow, 9 peripheral blood stem cell [PBSC] transplantation and 5 autologous). This makes a total of 271 transplants for 260 patients since 1995. The results of this transplant centre are comparable with those of the best centres worldwide. Importantly, the cost per transplant is a fraction of what is charged in other countries. Additionally, we have also collected 7 PBSCs from 6 patients (three T-cell depleted) and 6 bone marrow harvests and cryopreserved them in our liquid nitrogen storage facility for future use. Furthermore, we have also cryopreserved 177 cord blood units (siblings = 110; unrelated = 67).

90 Sickle Cell Programme The Department looks after a large number of patients with sickle cell disease (SCD) providing acute medical care, as well as genetic counselling and preventive programmes (vis-à-vis cord blood testing), and organising and guiding the patients and the medical community in the care of SCD. Recently, the role of the Department has been highlighted through our community outreach programs via the Hereditary Blood Disorders Soci- ety. Furthermore, several patients with severe SCD have now benefited from the Department’s active role in transplants for these patients from sibling donors with good success.

Leukemia Lymphoma and Myeloma Programme The Department is now an important tertiary care centre for most referrals for adult haematological malignancies particularly leukaemias, lymphomas and myelomas. The patients are able to receive state-of-the-art care in terms of both diagnostic and therapeutic modalities, including BMT and the advanced molecular diagnostics needed for proper workup and follow-up.

Thalassaemia Programme departments The Department has been looking after about 150 patients with thalassaemia, delivering comprehensive care including blood transfusions, chelation therapy and regular meticulous monitoring for the side-effects care and complications of the disease and its treatment. The unit is a centre of excellence in the region with extensive involvement in care and research including participation in an international drug trial (Exjade). The availability of the latest state-of-the-art MRI T2* equipment at the Radiology Department has improved the

monitoring of the cardiac and liver iron overload status of these patients. patient

Haematology and

Haematology Clinics at Sohar Hospital The Department conducts a monthly haematology clinic at the new Sohar Hospital. The clinic is run on rotation basis by one of the Department’s haematology consultants. They are assisted locally by Dr. Ali Al-Mad- hani from the Department of Medicine at Sohar Hospital. academic Outreach Clinics in Nizwa and salalah The Department conducts a monthly haematology clinic at Nizwa Hospital as part of the Outreach Clinics programme. This has really benefitted the SCD patients living in and around the catchment area of Nizwa Hospital as this means that these patients do not have to travel all the way to SQUH for routine medications and consultations. Every two months, the Department also conducts a Haematology Clinic at the Sultan Qaboos Hospital in Salalah.

91 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

General Laboratory Services The Haematology Laboratory caters for the entire hospital and additionally receives referral samples from all over Oman for routine and advanced haematology laboratory testing. The laboratory is subdivided into various sections including general haematology, haemoglobinopathy, haemostasis and special haematology, blood banking and donor room services, and the molecular division.

Molecular Research and Diagnostic Laboratory The Department now offers DNA diagnostic facilities for several thrombophilic disorders; haemoglobin disorders, immune deficiency syndromes and malignant haematology, especially for acute and chronic leukaemia. The section is also involved in the monitoring of the transplant progress by chimerism studies in post-transplant patients. Finally it provides diagnosis of chronic myeloproliferative disorders.

Cord Blood Bank The Department, in collaboration with the Obstetrics & Gynaecology department, has now set up a Cord Blood Bank. We have standardised the collection and storage of cord blood samples. Collection of cord blood is currently done under two programmes: (a) sibling cord blood (SCB) and (b) unrelated cord blood (UCB). Up to December 2013, we had collected a total of 110 SCB units and 6 UCB units. We have so far used 3 SCB units for sibling cord blood transplantation.

Apheresis Unit of the Blood Bank The Department has now installed the Baxter Amicus, Optia and Cobe Spectra apheresis systems and our apheresis nurses and technicians are trained in their use. All these systems are now in routine use for harvesting stem cells from donors in the Department’s BMT programme; plasma exchange; platelet apheresis, and leucocyte collection. We have performed bone marrow harvesting for the autologous backup of patients undergoing transplantation in 9 cases. Additionally, in 18 cases, we have done peripheral blood stem cell cryopreservation for patients undergoing autologous transplantations. Furthermore, apheresis services are now made available, in consultation with the attending haematologist, to the SQUH wards and intensive care units whenever the need for plasmapheresis or plasma exchange arises.

Busulphan Pharmakokinetics Optimisation of busulphan dosage in patients undergoing bone marrow transplantation is recommended in order to reduce the toxic effects associated with high drug levels.T he API 150 EX LCMS system which has been installed for the research project on intravenous versus oral busulphan in BMT for thalassaemia is now fully operational. The section looks after the busulphan pharmakokinetics in patients undergoing BMT to assess the blood levels of the drug in order to optimise the treatment protocols. We have thus far performed pharmacokinetic studies on 9 patients for this purpose. A new API 3200 LCMSMS was installed in the Depart- ment in December 2013.

92 Table 1: Haematology laboratory activities Year Patients % Change on previous year Tests and procedures % Change on previous year 2008 14,779 +25.6 59,830 +23.3 2009 17,756 +20.1 71,252 +19.1 2010 19,810 +11.6 77,866 +9.3 2011 21,340 +7.7 84,030 +7.9 2012 20,770 -2.7 82,409 -1.9 2013 21,138 +1.8 81,113 -1.6

Table 2: Clinical workload Year Haematology % Change on Haematology % Change on Haematology % Change on inpatients previous year day care previous year outpatients previous year departments 2008 1,409 -0.5 3,035 -1.4 3,428 +21.3

2009 1,887 +33.9 3,127 +3.0 4,181 +22.0 care

2010 1,869 -1.0 3,271 +4.6 4,407 +5.4 2011 1,630 -12.8 3,773 +15.3 5,336 +21.1 patient 2012 1,545 -5.2 3,769 -0.1 6,069 +13.7 Haematology and

2013 1,343 -13.1 3,885 +3.1 5,406 -10.9

Research academic Research Projects Establishment of a national facility in stem cell translation research for novel cellular-based therapies and tissue repair Code: SR/MED/HAEM/09/01 Dates: 2009–2013 (extended) Value: OR 165,000 Funder: His Majesty’s Strate- gic Fund, Oman Investigators: Dr. David Dennison, Dr. Anil Pathare, Dr. Salam Al-Kindi, Dr. Khalil Al-Farsi, Dr. Moham- med Hunieni, Dr. Naglaa Fawaz, Ms. Qamariya Al-Abri, Ms. Sahima Al-Maamaari, Ms. Sabah Al-Mah- rooqi, Mr. Ali Al-Marhoobi, Mr. Hamed Al-Gheithi, Mr. Shoaib Al-Zadjali, Ms. Melanie Tauro, Dept. Hae- matology, SQU; Dr. Yasser Wali, Dr. Abdulhakeem Rawas, Dept. Child Health, SQU; Dr. Muhanna Al-Muslahi, Dept. Haematology, Royal Hospital, Oman; Dr. Hamoud Al-Dhuli, Dr. Rashid Al-Sukaiti, Dept. Radiology & Molecular Imaging, SQU; Dr. Shyam Ganguly, Dept. Family Medicine & Public Health, SQU; Dr. Helmut Schus- ter, Dept. Microbiology & Immunology, SQU; Dr. Adeeb Al-Zoubi, Jordan University, Jordan. 93 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Molecular genetics of alpha globin gene expression in native Omani population: Towards understanding the molecular basis of alpha thalassaemia and impact on clinical expression of beta thalassaemia and sickle cell disease Code: RC/MED/HAEM/10/01 Dates: 2010–2013 (extended) Value: OR 68,300 Funder: The Research Council, Oman Investigators: Dr. Salam Al-Kindi, Dr. Mohammad Huneini, Dr. Khalil Al-Farsi, Dr. Anil Pathare, Dr. Na- gla Fawaaz, Dr. Shoaib Al-Zadjali, Mr. Hamood Al-Haddabi, Dept. Haematology, SQU; Dr. R. Krishnamoor- thy, INSERM U 763, Paris, France.

Rhesus [RH] and Kell [KEL] alleles in sickle cell patients with alloimmunization Code: IG/MED/HAEM/11/01 Dates: 2011–2013 Value: OR 13,000 Funder: SQU Investigators: Dr. Anil Pathare, Dr. Salam Al-Kindi, Dr. Nagalaa Fawaz, Mr. Shoaib Al-Zadjali, Mr. Ali Al-Marhoobi, Ms. Saba Mahrooqi, Dept. Haematology, SQU.

Towards understanding the environmental and inherited basis of iron deficiency and iron deficiency anemia in the native Omani population: Molecular genetics of iron metabolism Code: IG/MED/HAEM/11/02 Dates: 2011–2013 Value: OR 16,700 Funder: SQU Investigators: Dr. Nagala Fawaz, Dr. Anil Pathare, Dr. Salam Al-Kindi, Dr. Vinodh Panjwani, Mr. Shoaib Al-Zadjali, Dept. Haematology, SQU; Dr. R. Krishnamoorthy, INSERM U 763, Paris, France.

Evaluation of a multiparameter flow cytometry panel to detect minimal residual disease (MRD) in B-precursor ALL Code: MREC #667 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Anil Pathare, Dept. Haematology, SQU.

Establishing a maximum surgical blood ordering schedule for elective surgeries in Sultan Qaboos Uni- versity Hospital Code: MREC #669 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Arwa Al-Riyami, Dept. Haematology, SQU.

Impact of myeloid antigen expression on treatment and outcome of adult patients with T-cell acute lymphoblastic leukemia Code: MREC #678 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Murtadha Al-Khabori, Dept. Haematology, SQU.

94 Assessment of platelet counts using cell Dyn Sapphire in patients with low platelets Code: MREC #680 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Salam Al-Kindi, Dept. Haematology, SQU.

Prospective, open-label, multi-center, Phase III clinical study to investigate the efficacy and safety of human factor VWF/VIII concentrate (Wilate) in subjects with inherited type 3 von Willebrand disease (VWD) who undergo major surgical procedures Code: MREC #686 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Salam Al-Kindi, Dept. Haematology, SQU.

The effect of temperature and duration of sample storage on the measurement of lymphocyte sub populations for HIV positive and control subjects Code: MREC #687 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Salam Al-Kindi, Dept. Haematology, SQU. departments

Incidence of Factor VIII inhibitors in haemophilia a patients following a product switch care

Code: MREC #695 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Anil Pathare, Dept. Haematology, SQU.

Manifestations of B12 deficiency at SQUH patient

Code: MREC #696 Dates: 2013 Value: Unfunded Project Approval: SQU Haematology and Investigator: Dr. Khalil Al-Farsi, Dept. Haematology, SQU.

Can the new SIEMENS INNOVANCE VWF AC test kit replace the ristocetin co-factor assay in the investigation of von Willebrands disease? A preliminary assessment

Code: MREC #699 Dates: 2013 Value: Unfunded Project Approval: SQU academic Investigator: Dr. Anil Pathare, Dept. Haematology, SQU.

Incidence of Du phenotype and Bombay blood group in Omani population Code: MREC #702 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Shakila Ashraf, Dept. Haematology, SQU.

95 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Comparative analysis of the sysmex XE-5000 and Cell DYN Saphire Code: MREC #703 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Shakila Ashraf, Dept. Haematology, SQU.

Clinical and molecular characterization of von Willebrand disease patients in Oman Code: MREC #714 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Anil Pathare, Dept. Haematology, SQU.

Pneumatic tube delivery system for transporting patient samples at SQUH, a quality study Code: MREC #726 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Arwa Al-Riyami, Dept. Haematology, SQU.

Exploring the role of circulating invariant natural killer T cells in sickle cell disease Code: MREC #727 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohamed-Rachid Boulassel, Dept. Haematology, SQU.

Understanding the cross-talk among regulatory immune cells in lymphomas: A link to improve the efficacy of immunotherapeutic Code: MREC #741 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohamed-Rachid Boulassel, Dept. Haematology, SQU.

A phase 3, double-blind, randomized, efficacy and safety comparison of prasugrel and placebo in patients with sickle cell disease Code: MREC #756/780 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Salam Al-Kindi, Dept. Haematology, SQU.

Safety of peripheral stem cell mobilization in donors with sickle cell trait Code: MREC #758 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Murtadha Al-Khabori, Dept. Haematology, SQU.

Reproducibility of manual platelet estimation Code: MREC #786 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Murtadha Al-Khabori, Dept. Haematology, SQU.

96 Characterization of circulating microparticles in Omani sickle cell anemia patients: Comparison in steady state and painful crisis Code: MREC #792 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Anil Pathare, Dept. Haematology, SQU.

Malaria-related deferral of blood donors at SQU blood bank Code: MREC #805 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Arwa Al-Riyami, Dept. Haematology, SQU.

Evaluation of purified poloxamer 188 in children in crisis (EPIC): A phase 3 randomized, double-blind, placebo-controlled, multi-center clinical trial of MST-188 (purified poloxamer 188) injection in children with sickle cell disease experiencing vaso-occlusive crisis Code: MREC #814 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Murtadha Al-Khabori, Dept. Haematology, SQU. departments

Validation of liver MRI T2*- comparison with liver iron load by R2 MRI (FERRISCAN) care

Code: MREC #815 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Shahina Daar, Dept. Haematology, SQU.

Obstacles of conducting clinical and basic science research faced by the staff of College of Medicine and patient Sultan Qaboos University Hospital Haematology and

Code: MREC #832 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Murtadha Al-Khabori, Dept. Haematology, SQU.

Genetic basis of variable phenotypic expression in sickle cell disease: The Sickle cell Sibling Study

Code: MREC #837 Dates: 2013 Value: Unfunded Project Approval: SQU academic Investigator: Dr. Salam Al-Kindi, Dept. Haematology, SQU.

Disclosure of medical errors among patients at Sultan Qaboos University Hospital Code: MREC #839 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Murtadha Al-Khabori, Dept. Haematology, SQU.

97 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. alkindi SS, Alzadjali S, Daar S, Sindhuvi E, Wali Y, Pathare AV, et al. A stepwise β-thalassemia screening strategy in high-prevalence areas. Eur J Haematol 2013; 91:164–9. 2. Zachariah M, Tony S, Bashir W, Al Rawas A, Wali Y, Pathare A. Comparative assessment of deferiprone and deferasirox in thalassemia major patients in the first two decades-single centre experience. Pediatr Hematol Oncol 2013; 30:104–12. 3. Joshi SR, Pathare A, Al-Marhoubi A, Al-Muhaidry R, Ashraf T. A profile of rare bloods in Oman. Asian J Transfus Sci 2013; 7:162. 4. gujjar AR, Zacharia M, Al-Kindi S, William R, Al Lamki Z,…Pathare A, et al. Transcranial Doppler ultrasonography in sickle cell disease: A study in Omani patients. J Pediatr Hematol Oncol 2013; 35:18–23. 5. abou Saleh M, Mafiana RN, Al Za’abi M, Vaishnav R, Al Kindi S, Al-Zakwani I. Epidemiology of chemotherapy-induced neutropenia at a tertiary university hospital in Oman. Int J Clin Pharm 2013; 35:1036–9. 6. Al Huneini M, Wasim F, Al Farsi K, Al-Khabori M, Al Kindi S. Genital ulcer development in patients with acute promyelocytic leukaemia treated with all-trans retinoic Acid: A case series. Oman Med J 2013; 28:207–9. 7. Knox-Macaulay HH, Rehman JU, Al Zadjali S, Fawaz NA, Al Kindi S. Idiopathic thrombocytopenic purpura and hypo- kalaemic dRTA with compensated haemolysis and striking acanthocytosis in a band 3 (SLC4A1/AE1) A858D homozy- gote. Ann Hematol 2013; 92:553–4. 8. Al Zadjali S, Bashir W, Gravell D, Al Riyami AZ, Wali Y, Daar S. First reported case of compound heterozygosity for HbA2-Yialousa (HBD: c.82 G>C) and HbA2-Wrens (HBD: c.295 G>A) in Oman. Int J Hematol 2013; 98:240–2. 9. al-Tamemi S, Al-Zadjali S, Al-Ghafri F, Dennison D. Chediak-Higashi syndrome: Novel mutation of the CHS1/LYST gene in 3 Omani patients. J Pediatr Hematol Oncol 2014; 36: e248–50. 10. al-Khabori M, Al-Riyami AZ, Al-Farsi K, Al-Huneini M, Al-Hashim A,…Daar S, et al. Validation of a non-invasive pulse CO-oximetry based hemoglobin estimation in normal blood donors. Transfus Apher Sci 2014; 50:95–8. 11. Al-Riyami AZ, Al-Khabori M. Concomitant microfilaria and malaria infection. Blood 2013; 121:4437. 12. Al-Riyami AZ, Hudoba M, Young S, Forrest D. Sorafenib is effective for imatinib-resistant FIP1L1/PDGFRA T674I mutation-positive acute myeloid leukemia with eosinophilia. Leuk Lymphoma 2013; 54:1788–90. 13. al Riyami N, Al-Rusheidi A, Al-Khabori M. Perinatal outcome of monochorionic in comparison to dichorionic–twin pregnancies. Oman Med J 2013; 28:173–7. 14. Al-Khabori M, Bhandari S, Al-Huneini M, Al-Farsi K, Panjwani V, Daar S. Side effects of deferasirox iron chelation in patients with beta thalassemia major or intermedia. Oman Med J 2013; 28:121–4. 15. al Riyami N, Al-Ruheili I, Al-Shezaw F, Al-Khabori M. Extreme preterm premature rupture of membranes: Risk factors and feto maternal outcomes. Oman Med J 2013; 28:108–11. 16. al-Farsi SH, Al-Riyami NM, Al-Khabori MK, Al-Hunaini MN. Maternal complications and the association with baseline variables in pregnant women with sickle cell disease. Hemoglobin 2013; 37:219–26. 17. al-Riyami N, Al-Shezawi F, Al-Ruheili I, Al-Dughaishi T, Al-Khabori M. Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes (mid-trimester PROM). Sultan Qaboos Univ Med J 2013; 13:51–6. 18. Al-Khabori M,…Jabeen Z, Al-Farsi K, Al-Huneini M, Al-Riyami A,…Daar S, et al. Validation of a noninvasive pulse CO-oximetry-based hemoglobin estimation in patients with sickle cell disease. Int J Lab Hematol 2013; 35:e21–3. 19. Al-Farsi K, Siddiqui AA, Sharef YW, Al-Belushi AK, Al-Hashim H, Al-Ghailani M, et al. Hemorrhagic cardioembolic stroke secondary to a left ventricular thrombus: A therapeutic dilemma. Oman Med J 2013; 28:56–9.

98 20. Al-Farsi K. Multiple myeloma: An update. Oman Med J 2013; 28:3–11. 21. puig N, Wang L, Seshadri T, Al-Farsi K, Keating A, Crump M, et al. Treatment response and overall outcome of patients with relapsed and refractory peripheral T-cell lymphoma compared to diffuse large B-cell lymphoma. Leuk Lympho- ma 2013; 54:507–13. 22. rasheed W, Ghavamzadeh A, Hamladji R, Ben Othman T, Alseraihy A,…Dennison D, et al. Hematopoietic stem cell transplantation practice variation among centers in the eastern Mediterranean region (EMRO): Eastern Mediterra- nean bone marrow transplantation (EMBMT) group survey. Hematol Oncol Stem Cell Ther 2013; 6:14–9. 23. Breton G, Chomont N, Takata H, Fromentin R, Ahlers J,…Boulassel MR, et al. Programmed death-1 is a marker for ab- normal distribution of naive/memory T cell subsets in HIV-1 infection. J Immunol 2013; 191:2194–204. 24. pezeshki AM, Azar GA, Mourad W, Routy JP, Boulassel MR, Denzin LK, et al. HLA-DO increases bacterial superantigen binding to human MHC molecules by inhibiting dissociation of class II-associated invariant chain peptides. Hum Immunol 2013; 74:1280–7. 25. routy B, Boulassel MR, Spurll GM, Warner MN, Routy JP. Multiple cycles of rituximab therapy in chronic refractory immune thrombocytopenia: A case report with a 10-year follow-up. Am J Ther 2013; 20:219–22. CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations departments International 1. Alkindi S. An overview of sickle cell disease in Oman. International Conference on Sickle Cell Disease Management

& Prevention, Bahrain, 5–7 Feb 2013. care

2. Alkindi S. Management of acute chest syndrome. International Conference on Sickle Cell Disease Management & Prevention, Bahrain, 5–7 Feb 2013. 3. Alkindi S. Correlation of Acute Chest Syndrome with e-NOS, ARG1 and GSNOR gene polymorphisms in Omani Sickle patient

cell patients. Thalassemia International Federation (TIF) World Congress on Thalassemia & Hemoglobinopathies, Abu Dhabi, UAE, 20–23 Oct 2013. Haematology and

4. Alkindi S. Pulmonary hypertension in sickle cell disease: Correlation with serum brain natriuretic peptide concentrations. Thalassemia International Federation (TIF) World Congress on Thalassemia & Hemoglobinopathies, Abu Dhabi, UAE, 20–23 Oct 2013. 5. Alkindi S. First report of the spectrum of δ-globin gene mutations in Omani subjects. Thalassemia International Federation (TIF) World Congress on Thalassemia & Hemoglobinopathies, Abu Dhabi, UAE, 20–23 Oct 2013. academic Poster presentations International 1. Al-Riyami AZ, Al-Khabori M,...Davis H, Al-Farsi K, Al-Huneini M, Alkindi S, Daar S. The pneumatic tube system does not affect normal complete blood count results: A validation study. Poster #P800. ISLH 2013, the XXVIth Inter- national Symposium on Technological Innovations in Laboratory Hematology, Toronto, Canada, 10–12 May 2013. 2. Al-Riyami AZ, Al-Khabori M,...Davis H, Al-Farsi K, Al-Huneini M, Alkindi S, Daar S. The pneumatic tube system improves sample turnaround time without affecting complete blood count results: A validation study at a tertiary care hospital. Poster #P801. ISLH 2013, XXVIth International Symposium on Technological Innovations in Laboratory Hematology, Toronto, Canada, 10–12 May 2013. 3. Al-Riyami AZ, Al-Farsi K, Al-Mammari S, Al-Gaithi H,...Al-Khabori M, Al-Huneini M, et al. Unusual presentations of NK Related lymphoproliferative disorders: Report of two Omani patients. Poster #P500. ISLH 2013, XXVIth Interna- tional Symposium on Technological Innovations in Laboratory Hematology, Toronto, Canada, 10–12 May 2013.

99 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

4. Dennison D, Al-Farsi K, Al-Huneini M, Al-Khabori M,…Al-Riyami AZ, Pathare A,…Alkindi S. Hematopoietic stem cell transplantation for sickle cell anemia with busulfan-based reduced intensity conditioning: Cure and fertility. Abstract. BMT Tandem Meetings, Salt Lake City, Utah, USA, 16 Feb 2013. Biol Blood Marrow Transplant 2013; 19:S285– 6. 5. pathare A, Alkindi S, Al Riyami A, AlMahrooqi S, Wasim F, Panjwani V, Zabeen Z, AlHinai S, Al Hosni S, AlMar- hoobi A, Dennison D. Alloimmunization with uncommon alloantibodies in Sickle Cell Disease Patients. (Abstract) American Association of Blood Banks (AABB) Annual Meeting & CTTXPO 2013, Denver, Colorado, USA, 12–15 Oct 2013. 6. Al Wahaibi A, Alkindi SS, Al Zadjali S, Pathare AV (Abstract-OP18). Correlation of acute chest syndrome with e-NOS, ARG1 and GSNOR gene polymorphisms in Omani sickle cell patients. 13th International Conference on Thalassaemia & Haemoglobinopathies and 15th Thalassaemia International Federation World Congress, Abu Dhabi, UAE, 20–23 Oct 2013. 7. alMahrooqi S, AlHinai S, Al Hosni S, Alkindi S, Pathare AV. Spectrum of alloimmunization in sickle cell disease patients from Oman. (Abstract-112). 13th International Conference on Thalassaemia & Haemoglobinopathies and 15th Thalassaemia International Federation World Congress, Abu Dhabi, UAE, 20–23 Oct 2013. 8. Alkindi SS, Daar S, Al Dhuhli H, Pathare AV. Correlation the iron overload with cardiac and liver iron estimation by noninvasive T2*MRI in Omani Sickle cell disease patients. (Abstract-113).13th International Conference on Thalas- saemia & Haemoglobinopathies and 15th Thalassaemia International Federation World Congress, Abu Dhabi, UAE, 20–23 Oct 2013. 9. AlZadjali S, Alkindi SS, Daar S, Krishnamoorthy R, Pathare AV. First report of the spectrum of δ-globin gene mutations in Omani subjects. (Abstract-OP8) 13th International Conference on Thalassaemia & Haemoglobinopathies and 15th Thalassaemia International Federation World Congress, Abu Dhabi, UAE, 20–23 Oct 2013. 10. Jabeen Z, Alkindi SS, Al Huneini M, Al Riyami A, Pathare AV. Pulmonary hypertension in sickle cell disease: correlation with serum brain natriuretic peptide concentrations. (Abstract-OP18).13th International Conference on Thalas- saemia & Haemoglobinopathies and 15th Thalassaemia International Federation World Congress, Abu Dhabi, UAE, 20–23 Oct 2013. Seminar Presentations International 1. Al-Khabori M. Hemoglobinopathies Clinic: Case presentation and discussion. Middle East 4th Hematology Oncolo- gy Summit, Novartis Oncology, Dubai, UAE, 13 Apr 2013. 2. Al-Khabori M. Non-invasive hemoglobin monitoring. Updates from 54th ASH Meeting, Saudi Scientific Society of Blood & Marrow Transplantation (SS-BMT), Dammam, Saudi Arabia, 14 Mar 2013. 3. Al-Khabori M. Use of heparin in pregnant patients with previous pregnancy loss. Updates from 54th ASH Meeting, Saudi Scientific Society of Blood & Marrow Transplantation (SS-BMT), Dammam, Saudi Arabia, 14 Mar 2013. 4. Daar S. Strategies for personalizing chelation therapy according to iron overload status. EGM Thalassaemia Net- work, Abu Dhabi, UAE, Oct 2013. 5. Daar S. Non-Transfusion Dependent Thalassaemia. Thalassaemia Awareness Symposium, Dubai, UAE, Sep 2013. 6. Daar S. Monitoring and managing iron burden in the endocrine system. EGM Summit, New Delhi, India, Sep 2013. 7. Daar S. Non-transfusion dependent thalassaemia. Epidemiology,Pathophysiology, Complication and Treatment, Zu- rich, Switzerland, Mar 2013. 8. Alkindi S. Chronic myeloid leukaemia landscape: Oman experience. Dubai, UAE, Sep 2013 .

100 Seminar Presentations National 1. alkindi S. Iron overload in sickle cell disease. Nizwa Hospital, Oman, May 2013. 2. alkindi S. Towards comprehensive care in sickle cell disease. Ibri Hospital, Oman, Mar 2013. 3. Alkindi S. Pain management in sickle cell disease. Ibri Hospital, Oman, Mar 2013. 4. Alkindi S. Management of acute leukaemia. Buraimi Hospital, Oman, Apr 2013. 5. Alkindi S. Comprehensive care for sickle cell disease. Ibra Hospital, Oman, Apr 2013. 6. Al-Khabori M. Logistic Regression. Hands-on Training Workshop, Statistical Analysis using SPSS. The Research Council, Muscat, Oman, 6 Jun 2013. 7. Al-Khabori M. Survival Analysis. Hands-on Training Workshop, Statistical Analysis using SPSS. The Research Coun- cil, Muscat, Oman, 6 Jun 2013. 8. Al-Khabori M. Statistical Analysis using SPSS. Hands-on Training Workshop, Statistical Analysis using SPSS. The Research Council, Muscat, Oman, 5 Jun 2013. 9. Al-Khabori M. Research Methodology workshop for Residents. Oman Medical Specialty Board Research Day, Mus- cat, Oman, 23–24 Jan 2013. departments

10. Al-Khabori M. Multiple Myeloma for the Internist. Sohar Hospital, Ministry of Health, Oman, 31 Mar 2013.

Thesis Supervison care

Student Name: amal Khalfan Qualification: B.Sc. BMS patient

Title: The effect of temperature and duration of sample storage on the measurement of lymphocyte sub populations for HIV positive and control subjects Haematology and Supervisors: Dr. Salam Alkindi, Mr. Hamed Al-Gheithi Date of completion: May 2013

Student Name: ala Mubarak academic Qualification: B.Sc. BMS Title: Comparative analysis of Sysmex XE-5000 and Cell-Dyn Saphire Supervisor: Dr. Salam Alkindi, Ms. Heidi Davis Date of completion: May 2013

101 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Student Name: raya Hilal Qualification: B.Sc. BMS Title: Assessment of platelet count on cell dyn sapphire using optical and imped- ance methodology and CD61 on low platelet counts Supervisors: Dr. Salam Alkindi, Ms. Heidi Davis Date of completion: May 2013

Student Name: amira Al-Ghafri Qualification: B.Sc. BMS Title: Can the new Siemens Innovance vWF Ac test kit replace the ristocetin co-factor assay in the investigation of von Willebrand disease? Supervisors: Dr. Anil Pathare, Ms. Qamariya Al-Abri Date of completion: May 2013

Student Name: sheikha Al-Mukhbali Qualifying Exam: B.Sc. BMS Title: Incidence of weak D phenotypes at SQUH Supervisors: Dr. Salam Alkindi, Ms. Sabah Al-Maruqhi Date of completion: May 2013

102 departments

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Human & Clinical Anatomy patient

and

he Department is concerned with the science of human anatomy, especially the relationship between structure and function, clinical applications and its use in interpreting images produced by modern radiographic techniques. The De-

partment’s main teaching load is in Phases I and II of the M.D. programme. This is shared with other basic medical Human & Clinical Anatomy Tsciences departments in the delivery of integrated system courses. However, it also teaches a few department-based courses academic and contributes to other programmes like the B.Sc. degrees in Biomedical Sciences and Nursing. The teaching focuses on gross anatomy, developmental anatomy and the study of the microstructure of tissues and cytogenetics. In addition to radiological anatomy, students study gross and topographical anatomy using prosections and anatomical models, histology and embryology. Living and surface anatomy is an important component of the course. Students taught include medical undergraduates and postgraduates preparing for higher examinations, e.g. Fellowship of the Royal Colleges (FRCS, MRCP-PATH, FRCP) as well as anticipated Master’s and Ph.D. students

In addition, the Department’s input includes teaching clinical and applied anatomy to Oman Medical Specialty Board candidates. Postgraduate teaching involves the teaching of advanced histology and embryology to candidates specialising in histopathology and obstetrics & gynaecology. Candidates preparing for their FRCS examinations enjoy the teaching facilities provided by the Department. The Department also provides services to other clinical departments and students of the Institute of Health Sciences in Muscat. 103 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Research continues to be pivotal to the academic Dr. Sujata Jog and Dr. Mirghani Osman were visit- activities of the Department. This embraces hyper- ing Consultants in the Department from Septem- tension; immune response to pregnancy; the bac- ber to December 2013. In September 2013, Dr. Hali- teriostatic effect of some medicinal plants; the use ma Al-Belushi, Clinical Lecturer, started a five-year of honey in histological sections and plastination; scholarship for Ph.D. studies at the Karolinska Insti- breast cancer markers; medical education; medical tutet, Sweden, while Dr. Ruqaiya Al-Jabri, Clinical informatics and curriculum development. Lecturer, started a four-year scholarship for Ph.D. studies at the University of Bath, UK. Staff Head of Department Teaching Programmes Ibrahim Inuwa, Associate Professor (to 30 Aug 2013) PRE-CLINICAL PROGRAMME Omar Habbal, Associate Professor (from 1 Sep 2013) The Department offered several courses in the M.D. Faculty programme and contributed to most system-based courses in the curriculum. Courses offered in the Varna Taranikanti, Assistant Professor new curriculum were: Introduction to Anatomy; Sadhana Roychoudhury, Assistant Professor Structure-Function Relationship; Growth & Devel- Halima Al-Balushi, Clinical Instructor opment; The Integrated Module I; Cardiovascular Ruqaya Al-Jabri, Clinical Instructor System; Respiratory System; Haemo, Lymph, Im- Mohamed Al-Mushaiqri, Lecturer mune Systems; The Integrated Module II; Alimen- Support Staff tary System; Uro-reproductive System; Integrated Sulaiman Al-Khiyari, Acting Superintendent Module III; Locomotor System; Nervous System & Abdulgaffar El-Hag, College Superintendent Special Senses; Endocrine System. Nasser Al-Hashmi, Biomedical Scientist Nawal Al-Mukheini, Biomedical Scientist B.Sc. NURSING PROGRAMME Talal Al-Hassani, Biomedical Scientist The Department offered Anatomy and Physiology Prem Tilaka, Biomedical Scientist courses in the B.Sc. Nursing programme in College Indrani Arambewela, Biomedical Scientist of Nursing. Alexander George, Coordinator CLINICAL PROGRAMME Highlights of the Year 2013 The Department contributes to the Pre-Clerkship Dr. Ibrahim Inuwa was promoted to Assistant Dean stage of Phase III of the M. D. curriculum. for Preclinical Affairs in September 2013. Dr. Omar Habbal became the Head of the Department on 1 September 2013 having previously been Assistant Dean for Preclinical Affairs.

104 POSTGRADUATE TEACHING The Department anticipates receiving Master’s students as the course is now on offer.

Research RESEARCH PROJECTS The effect of sleep-deprivation on the immune system: Role of cortisole in the effect of sleep deprivation on T-cells and neutrophil functions Code: IG/MED/ANAT/13/03 Dates: 2013–2014 Value: OR 14,000 Funder: SQU Investigators: Dr. Omar Habbal, Dept. Human & Clinical Anatomy, SQU; Prof. Ali Al-Jabri, Dept. Microbiology & Immunology, SQU; Dr. Elias Said, Dept. Microbiology & Immunology, SQU; Dr. Mohammed Al-Abri, Dept. Physiology, SQU.

A study of the role of lymphangiogenesis in breast cancer departments Code: IG/MED/ANAT12/01 Dates: 2012–2014 Value: OR 11,561 Funder: SQU Investigators: Dr. Varna Taranikanti, Dept. Human & Clinical Anatomy, SQU; Dr. Adil Al-Ajmi, Dept. Surgery, care

SQU; Dr. Ritu Lakhtakia, Dept. Pathology, SQU; Dr. Shyam Ganguly, Dept. Family Medicine & Public Health, SQU; Ms. Kawther Al-Adawi, Department of Pathology, SQU.

RESEARCH PUBLICATIONS & BOOKS patient

Journal Publications and 1 Inuwa I. “There are Doctors and there are ‘Doctors’”: Creating a dichotomy between physicians’ roles. Sultan Qaboos Univ Med J 2013; 13:183–4. 2. al-Jarrah A, Taranikanti V, Sawhney S, Furrukh M, Al-Hosni M, Saparamadu PAM, et al. Metastatic invasive lobular carcinoma of the breast masquerading as a primary renal malignancy. Sultan Qaboos University Med J

2013; 13:453–5. Human & Clinical Anatomy 3. Burute PP, Korade V, Belsare S, Roychoudhury S. Congenital diaphragmatic hernia with lung hypoplasia: A case of academic sudden death in a neonate. IOSR J Dent Med Sci 2013; 8:9–12. 4. al-Jarrah A, Taranikanti V, Lakhtakia R, Al Jabri A, Sawhney S. Granulomatous mastitis: Diagnostic and therapeutic implications in Omani patients. Sultan Qaboos University Med J 2013; 13:241–7. 5. Hasson SSA, Al-Balushi MS, Al-Harthy K, Al-Busaidi JZ, Aldaihani MS,...Habbal O, et al. Evaluation of anti-resistant activity of Auklandia (Saussurea lappa) root against some human pathogens. Asian Pac J Trop Biomed 2013; 3:557–62.

105 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

CONFERENCE & SEMINAR PRESENTATIONS Poster Presentations International 1. Roychoudhury S. “Map the journey, tag the lesson”- Excerpts from an interactive clinical neuroanatomy workshop in an integrated curriculum. 61st National Conference of Anatomical Society of India, Chandigarh, India, 22 Nov 2013. 2. Taranikanti V. Medical Education in an Integrated Curriculum. UK Anatomical Society Winter Meeting, Newcastle, UK, 16–18 Dec 2013.

106 departments

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Medicine patient Medicine

and

he Department of Medicine endeavours to create an environment conducive to achieving excellence in learning for undergraduate and postgraduate students, to provide opportunities to conduct clinical research relevant to the region, and to be a centre of excellence providing specialised, state-of-the-art clinical care in a tertiary care pattern. The ma- jorT research themes include asthma, breast cancer, gastric cancer, HIV, Hodgkin’s and non-Hodgkin’s lymphoma and cerebro- academic vascular disease. Research areas include epidemiology, molecular characterisation, study of genetic polymorphisms and the study of novel mechanisms of the aetiology of various diseases. Members of the Department are principal or co-investigators of numerous research projects. The Department provides clinical services through a specialty-based system and takes pride in providing continuous, comprehensive care to the patients in the area required. Consultants are on-call daily from ten different sub-specialties: cardiology, endocrinology, gastrointestinal and liver diseases, general internal medicine, infectious disease, nephrology, neurology, oncology, respiratory diseases and rheumatology. These subspecialties offer medical services to patients in the capital area and accept complicated referrals from all over the country

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Staff Hatim A. Al-Lawati, Consultant Issa S. Al-Qarshoubi, Consultant Head of Department Wasif Rasool, Consultant Ali Al-Mamari, Senior Consultant Said A. Al-Busafi, Consultant Faculty Mujahid Al-Busaidi, Consultant Zeid A. Gaifer, Consultant Omar Al-Rawas, Professor, Dean Shiyam Kumar, Consultant Bazdawi M. Al-Riyami, Professor Muhammad A. Khatri, Senior Specialist Nicholas Woodhouse, Professor Saif Khan, Senior Specialist Mansour Al-Moundhri, Professor Mohammed Misbah, Senior Specialist Arunodaya Gujjar, Professor Mohammed M. Shaikh, Senior Specialist Jamal Sallam, Assistant Professor Osama Tariq, Senior Specialist Batool Hassan, Assistant Professor Suneel Kumar, Senior Specialist Poovathor C. Jacob, Assistant Professor Abdulmanan Khaskheli, Senior Specialist Muhammad A. Sadiq, Assistant Professor Khalfan B. Al-Zeedy, Senior Specialist Abdullah Al-Asmi, Senior Consultant & Hospital Osama Hassan, Senior Specialist Director-General Ammar Abdulrahman, Senior Specialist William J. Johnston, Senior Consultant Darshan Lal, Senior Specialist Aftab A. Siddiqui, Senior Consultant Saja M. Mohamed, Senior Specialist Ali Al-Shirawi, Senior Consultant Ali M. Al-Shemmari, Senior Specialist Mehar Ali, Senior Consultant Khawaja F. Zahid, Senior Specialist Masoud Kashoob, Senior Consultant Dawar M. Rizavi, Senior Specialist Ikram Burney, Senior Consultant Saif Al-Mubaishi, Senior Specialist Muhammad Furrukh, Senior Consultant Babar Dildar, Senior Specialist Hafidh Al-Hadi, Senior Consultant Fatima Aamer, Specialist Mansour Sallam, Senior Consultant Nooralddin Mahmood, Specialist Abdullah Balkhair, Senior Consultant Farooq M. H. Rehman, Specialist Juma Al-Kaabi, Senior Consultant Leena Bella, Specialist Omayma Elshafie, Senior Consultant Kowthar Hassan, Specialist B. N. Jayakrishnan, Senior Consultant Tanwer Ahmed, Specialist Jojy George, Senior Consultant Nisreen Siddiq, Specialist Dawood Al-Riyami, Senior Consultant Abdullah Al-Alawi, Specialist Ramachandiran Nandhagopal, Senior Consultant Ahmed Al-Qassabi, Specialist Abdulhakim Al-Hashim, Senior Consultant Jamal N. Al-Agbhari, Specialist Adil B. Al-Riyami, Senior Consultant Hashim BaTaher, Specialist Hatem Farhan, Consultant Ahmed Al-Riyami, Specialist Mohammed Al-Ghailani, Consultant

108 Haifa Al-Abri, Specialist terology. Dr. Abdullah Al-Asmi was appointed the Mohammed Al-Rawahi, Specialist Director General of Sultan Qaboos University Hos- Ali Al-Lawati, Specialist pital (SQUH). Dr. Hatem Farhan won the Best Train- Khaled Al-Baimani, Specialist er Award from the Oman Medical Specialty Board Ibrahim Al-Busaidi, Specialist (OMSB). Zaheer Siddiq, Specialist The Department welcomed the following new staff: Taher Al-Mufti, Specialist Dr. Muhammad Sadiq as Assistant Professor in Car- Sara Aziz, Senior House Officer diology and Dr. Mohammed Shaikh as Senior Spe- Anjum H. Osman, Senior House Officer cialist in Cardiology. Dr. Mujahid Al-Busaidi (inten- Zeyana Al-Hadrami, Senior House Officer sive medicine), Dr. Hatim Al-Lawati (interventional Nasreen El-Fatih, Senior House Officer cardiology) and Dr. Saif Al-Mubaishi (pulmonology) Waiel M. Mekki, Senior House Officer returned from scholarship studies in Canada. Taha D. Al-Mufti, Senior House Officer Zamzam Al-Hashami, Clinical Lecturer & Senior Dr. Arunodaya Gujjar was promoted to Professor. House Officer The following doctors were promoted to Senior

Khalid R. Al-Shamousi, Clinical Lecturer & Senior departments Consultant: Dr. Jojy George, Dr. R. Nandhagopal, Dr. House Officer Abdulhakim Al-Hashim and Dr. Adil Al-Riyami. The

Technologists following doctors were promoted to Consultant: care

Saphiya A. Al-Ajmi, Podiatrist Dr. Mohammed Al-Ghailani, Dr. Shiyam Kumar, Dr. Sawsan Baddar, Respiratory Therapist Mujahid Al-Busaidi and Dr. Hatim Al-Lawati. The following doctors were promoted to Senior Specialist: patient Medicine Coordinators Dr. Osama Tariq, Dr. Abdulmanan Khaskheli and Dr. Roselyn Natividad Osama Hassan. The following doctors were promot- and Ghaniya Al-Siyabi ed to Specialist: Dr. Fatima Aamer, Dr. Nisreen Siddiq, Maryam Al-Baloushi Dr. Taha Al-Mufti, Dr. Zaheer Siddiq and Dr. Leena Bella. Highlights of the Year 2013 The final M.D. examinations in medicine, consisting In this period, a number of departmental staff re- academic ceived awards for their achievements. Dr. Ikram Bur- of a written theory examination, an Objective Struc- ney received the Certificate ofA cademic Excellence tured Clinical Examination and a Clinical Examina- on the occasion of the 13th University Day, in recog- tion, were held in June 2013. A total of 78 students nition of his outstanding teaching performance in passed in medicine, two of whom were awarded dis- the year 2012–13. Dr. Said Al-Busafi won the 2013 Dr. tinctions. The four students who failed passed the ABR Thomson - Dr. CN Williams Award for his pub- repeat examination in September. This examination lication of 'The utility of Xenon-133 liver scan in the was the last one for all the cohorts from the old cur- diagnosis and management of nonalcoholic fatty riculum. liver disease' in the Canadian Journal of Gastroen-

109 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

The Department organised two postgraduate examinations during 2013: Membership of the Royal College of Physician of the UK and of Ireland. The Department was complemented for its outstanding organisation and experience in handling all issues related to the examination process.

The Department continues to attract undergraduate and postgraduate students from Oman and abroad for electives. In 2013, we received more than 20 students from Oman and other countries. In addition, eight junior doctors undertook clinical attachments in the Department in preparation for postgraduate examinations and further training.

The staff of the department participated in many of courses and workshops organised by the Medical Edu- cation Unit (MEU) of the College of Medicine & Health Sciences (COMHS) in order to improve their teaching and assessment skills for undergraduate and postgraduate level courses. These included the Certificate in Health Professional Education (CHPE) and workshops on Appraisal Skills; Student Assessment; Continuous Assessment of Clinical Skills; Professional Behaviour, and Designing Integrated Questions.

The Department's Annual Research Retreat was held on 22 June 2013 at the Crowne Plaza Hotel, Muscat. It was attended by the Dean of the COMHS and the Director General of SQUH. An overview of the research productivity of the Department was given and discussions ensued on how to improve the departmental research output. Certificates of appreciations were also distributed to staff with distinguished performances during the academic year.

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Department continued its major role in teaching at all levels.

Integrated modules Members of the Department participated in all Phase II teaching modules including: Integrated module I, which covers the cardiovascular, pulmonology and locomotor systems; Integrated module II, which covers the gastrointestinal system in addition to the nutrition lectures; Integrated module III, which covers the nervous, endocrine and locomotor systems. The teaching took the form of formal lectures, tutorials and bedside teaching activities.

UNDERGRADUATE CLINICAL PROGRAMME Pre-Clerkship Programme This section of Phase III consists of nine weeks of rotations per year. The Department contributes heavily to three modules (Cardiovascular, Pulmonology and Neurology), in addition to the Musculoskeletal system with the Department of Surgery.

110 Pre-clerkship students, divided into 9 groups are posted for a week each in 9 different components of the programme. Three of these components (Cardiovascular, Central Nervous and Pulmonology systems) were undertaken in the Department of Medicine. Unlike other departments, 3 groups of students (a total of 42 students) were posted together in Medicine at all times during the year.

Once a week, three tutors taught the physical examination of their respective systems in the Skills Labora- tory. This was done with the aid of pre-recorded videos and a demonstration of history-taking and physical examination on a healthy volunteer. Following this the students were allowed to practice under supervision on this simulated patient. Three days a week, the students had two clinical sessions every day in each of these three specialties (separately for each group). They took histories from patients in the wards and later performed the physical examination under the guidance of a tutor. A list of nine symptoms given at the beginning of each week in each of these three systems formed the basis for a focused history and the clinical examination. On the last morning of the week these 42 students were assessed independently by a mini-Clinical Evaluation Exercise (mini-CEX). The Cardiothoracic and Neurosurgery units and the Depart- ment of Anaesthesia were involved in the teaching with Cardiology, Neurology and Pulmonology units, respectively. departments

In these nine weeks, all of the students acquired the basic skills, knowledge and attitudes to elicit a patient

history and perform physical examinations on patients with cardiovascular, neurological and respiratory care diseases.

Junior Clerkship patient Medicine This part of Phase III consists of eight-week rotations throughout the year for six groups: seven weeks of clinical rotations in Medicine and one week of Skills Laboratory Training (SLT). During this rotation, students and are expected and facilitated to achieve well-defined objectives of knowledge, skills and attitudes. During the seven weeks, the student groups are distributed amongst the acute medicine teams. In addition, the students attend two didactic teaching sessions per day. Moreover, as part of their continuous assessment, each student is examined by different members of the Department via a mini-CEX in weeks 3, 5 and 7 and a long case in weeks 4 and 6. Each afternoon during the SLT week all of the students are trained by members of the academic Department using the dummies on how to perform different procedures e.g. phlebotomy, arterial blood gas testing, lumbar punctures, etc. The Department contributes substantially to the preparation and organisation of the final examination which is conducted in December each year.

Senior Clerkship Similar to the junior clerkship, this part of Phase III, consists of eight-week rotations throughout the year for 6 groups: 7 weeks clinical rotation in Medicine and 1 week in the SLT. During the 7 weeks, groups of 8–10 students get distributed amongst the acute medicine teams. In addition, the students attend one didactic

111 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

teaching session per day where they are expected to do a presentation on one of the topics of essential knowledge of medicine expected of senior clerkship students. Moreover, each student will have a long case assessment at the end of the rotation. The preparation of the first final examination for the senior clerkship students, planned for February 2014, is on-going.

Pre-internship The main objectives and the rotations, including the three-week medicine rotation of this final section of Phase III, have been prepared and the first group is expected to start in March 2014.

POSTGRADUATE PROGRAMME OMSB Residency Programme The Department continuously receives OMSB residents for training in internal medicine. Undergraduates and postgraduates are involved in many educational activities including the morning case report (morning meeting), grand rounds, radiology meetings and journal clubs, as well as the monthly mortality review meeting.

Members of the Department actively participate in the postgraduate teaching of interns, house officers and the OMSB residents in internal medicine as well as residents from other subspecialties (such as Family Medicine & Public Health, Dermatology, Laboratory Sciences and Accident & Emergency) rotating through Medicine. Residents receive supervised training on ward rotations and during electives for the different subspecialties of Medicine. Members of the Department participate in organised teaching activities, such as lectures (twice weekly), radiology rounds (weekly) and grand rounds (weekly). In addition, they are invited to deliver lectures to other subspecialty residency programmes, such as those in the Emergency Medicine and Family Medicine & Public Health departments.

Training Courses & CME Activities Continuing medical education (CME) sessions are held every alternate Monday morning. Wednesday lunch- times are reserved for presentations by outside guest speakers.

Prof. Mansour Al-Moundhri delivers lectures regularly at the Pain Management Course organised by the Di- rectorate of Training & CPD (DTD) in conjunction with the Directorate of Nursing in SQUH. Drs. Ikram Burney and Muhammad Furrukh regularly deliver lectures at the Chemotherapy Administration Course organised by the DTD in conjunction with the Directorate of Nursing.

112 Clinical & Diagnostic Services Table 1: Department of Medicine inpatient and outpatient numbers in 2013 Specialty Inpatients Outpatients Totals Cardiology 905 7,943 8,848 Clinical Physiology, cardiology 0 3,102 3,102 Clinical Physiology, neurophysiology 0 2,955 2,955 Clinical Physiology, respiratory 0 1,442 1,442 Diabetic 36 6,971 7,007 Endocrinology 369 206 575 Gastroenterology 1,715 6,375 8,090 Infectious Diseases 82 1,017 1,099 departments

Lipid Clinic 0 2,264 2,264

Medicine 1,791 971 2,762 care

Nephrology 200 597 797 Neurology 585 7,193 7,778 patient Medicine

Oncology 4,109 2,615 6,724 and Pulmonology Clinic 325 4,776 5,101 Rheumatology 832 4,414 4,846 Thyroid 0 4,404 4,404

Totals 11,429 58,006 69,435 academic

Table 2: Consultation statistics in 2013 Specialty Inpatients Outpatients Totals Cardiology 181 33 214 Endocrinology 587 64 651 Gastroenterology 277 24 301

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Infectious Diseases 2,558 18 2,576 Lipid Clinic 5 36 41 Nephrology 286 15 301 Neurology 232 24 256 Oncology 13 5 18 Pulmonology 297 21 318 Rheumatology 113 33 146 Totals 4,542 287 4,822

Table 3: Gastrointestinal unit procedures in 2013 Procedure No. Oesophagogastroduodenoscopy 1,101 Colonoscopy 519 Endoscopic retrograde cholangiopancreaticography (ERCP) 57 ERCP and insertion of metal biliary stent 3 Push enteroscopy 16 Transnasal oesophagogastroduodenoscopy 16 Percutanuos endoscopic gastric tube insertion 5 Percutanuos endoscopic gastric tube replacement 1 Colonic polypectomy 36 Gastric polypectomy 6 Oesophageal metallic stent insertion 5 Duodenal metallic stent insertion 2 Gastric metallic stent insertion 1 Colonic metallic stent insertion 1 Oesophageal varices banding 29 Endoscopic oesophageal dilatation 16

114 Endoscopic clipping/injection for bleeders 66 Endoscopic argon plasma coagulation 23 Total 1,903

Table 4: Respiratory procedures in 2013 Procedure No. Bronchoscopy 99 Pleural procedures 28 Pulmonary function test 959 Total 1,086

departments Table 5: Invasive cardiology procedures in 2013 Procedure No. care

Elective coronary angiography 719 Emergency coronary angiography c. 15 patient Medicine Elective percutaneous coronary intervention 287

Emergency percutaneous coronary intervention - and

Intra-aortic balloon pump insertion 9 Catheter aspiration of coronary thrombus 24

Fractional flow coronary reserve study - academic Temporary pacemaker 31 Permanent pacemaker 10 Pericardiocentesis 6 Right-side heart catheterisation 32 Total 1,133

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Table 6: Non-invasive cardiology procedures in 2013 Procedure No. Electrocardiogram (ECG) 4,560 24-hour ECG Holter monitoring 595 24-hour blood pressure monitoring 186 Treadmill exercise test - Stress thallium scintigraphy 290 Transthoracic echocardiography (adult) 3,443 Transoesophageal echocardiography 7 Total 9,081

Table 7: Nephrology procedures in 2013 Procedure No. Haemodialysis 2,322

Research Research Projects The prognostic role of tissue, serum, and whole blood DNA global and site-specific promoter methylation and miRNA gene expression profile in locally advanced breast cancer during neo adjuvant chemotherapy treatment Code: RC/MED/MEDI/11/01 Dates: 2011–2013 Value: OR 108,000 Funder: The Research Council, Oman Investigator: Prof. Mansour Al-Moundhri, Dept. Medicine, SQU.

A comprehensive study of CNS demyelinating disorders in Omani patients: Clinical profile, serological profile of neuromyelitis optica autoantibody, optical coherence tomographic abnormalities and alterations in bone mineral density and metabolism Code: RC/MED/MEDI/13/01 Dates: 2013–2015 Value: OR 156,650 Funder: The Research Council, Oman Investigator: Dr. P. C. Jacob, Dept. Medicine, SQU.

116 Pulse wave velocity as a predictor of failure to mature of arterio-venous fistula AV( F) Code: IG/MED/MEDE/12/01 Dates: 2012–2013 Value: OR 2,445 Funder: SQU Investigator: Dr. Dawood Al-Riyami, Dept. Medicine, SQU.

Dynamic changes of global DNA methylation patterns during neo-adjuvant chemotherapy treatment: in vivo and in vitro models Code: IG/MED/MEDE/12/02 Dates: 2012–2013 Value: OR 7,164 Funder: SQU Investigators: Prof. Mansour Al-Moundhri, Dept. Medicine, SQU; Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Sirin Adham, Dept. of Biology, College of Science, SQU; Manal Al-Khanbashi, Ph.D. student, SQU.

A study of candidate biomarkers in epithelial ovarian cancers, and correlation with treatment outcomes Code: IG/MED/MEDE/13/01 Dates: 2013 Value: OR 3,000 Funder: SQU Investigators: Dr. Ikram A. Burney, Dept. Medicine, SQU; Dr. Moza Al-Kalbani, Dept. Obstetrics & Gynecol- departments ogy, SQU; Dr. Ritu Lakhtakia, Dept. Pathology, SQU; Dr. Asma Al-Balushi, Dept. Emergency Medicine, SQU. Dr. Ikhlas Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr Yahya Tamimi, Dept. Biochemistry, SQU. care The serological prevalence of Helicobacter pylori (H. Pylori) in Oman Code: IG/MED/MEDE/13/02 Dates: 2013–2014 Value: OR 15,664 Funder: SQU

Investigators: Dr. Jamal Sallam, Dr. Masoud Kashoob, Dept. Medicine, SQU; Dr. Mohammed Al-Bulushi, patient Medicine

Dept. Microbiology & Immunology, SQU; Dr. Mohammed Al-Hunaini, Dept. Haematology, SQU. and Clinical and electrophysiogical profile of patients with primary generalized epilepsy referred to SQUH Code: IG/MED/MEDE/13/03 Dates: 2013–2015 Value: OR 13,400 Funder: SQU Investigators: Dr. Abdullah Al-Asmi, Dr. Ramachandiran Nandhagopal, Department of Medicine, SQU; Dr.

Amna Al-Futaisi, Dept. Child Health, SQU; Dr. Ibrahim Al-Zakwni, Dept. Pharmacology & Clinical Pharmacy, academic SQU; Dr. Mohammed Al-Abri, Mr. Poothrikovil Rajesh P., Dept. Clinical Physiology, SQU; Dr. Fathiya Al-Murshe- di, Dept. Genetics, SQU.

Aetiology and outcome of patients presented to SQUH with acute pancreatitis from Jan 2008–Dec 2012 Code: MREC #663 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Aftab Siddiqiui, Dept. Medicine, SQU.

117 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Mutation status of EGFR, Kras, Braf, Fat4, ARID1A genes in an Omani gastric cancer cohort Code: MREC #679 Dates: 2012–2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Mansour Al-Moundhri, Dept. Medicine, SQU; Dr. Marwa Al-Riyami, Dept. Pathology, SQU.

Assessment of systolic, diastolic function and development of pulmonary hypertension in children with beta-thalassemia intermedia using conventional and tissue Doppler echocardiography Code: MREC #684 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mansour Sallam, Dept. Medicine, SQU.

Aortic root dimensions in Omani patients as measured by cardiac computed tomography Code: MREC #690 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Hatem Al-Farhan, Dept. Medicine, SQU.

The hemodynamics in normotensive and essential hypertensive individuals: A cross-sectional study through the thoracic electrical bioimpedance Code: MREC #698 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Arunodaya Gujjar, Dept. Medicine, SQU.

Epidemiology of breast cancer in Oman Code: MREC #705 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Mansour Al-Moundhri, Dept. Medicine, SQU.

AssessMent of heart rAte reduction, antianGinal efficacy and quality of life improvemeNt with the If inhibitor Ivabradine in Coronary artery disease patieNTs (MAGNIFICENT trial) Code: MREC #708 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mansour Sallam, Dept. Medicine, SQU.

Experience with totally implantable central venous access ports in patients with cancer in a single center: Sultan Qaboos University Hospital experience Code: MREC #711 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Shiyam Kumar, Dept. Medicine, SQU.

Effect of sitagliptin; DPP4 inhibitor as a second or third line oral agent to control blood glucose in type 2 diabetes Code: MREC #743 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Ali Al-Mamari, Dept. Medicine, SQU.

118 Aetiology, modality of treatment and outcome of patients presented to SQUH with thyroid disease and underwent iodine thyroid scan from Jan 2010 to Dec 2012 Code: MREC #748 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Nicholas Woodhouse, Dept. Medicine, SQU.

The outcomes of Omani patients with chronic kidney disease (CKD) in stage five who refused dialysis Code: MREC #765 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Dawood Al-Ryami, Dept. Medicine, SQU.

Serum immunoglobulin E (IgE) levels and asthma severity Code: MREC #768 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Jayakrishnan Nair, Dept. Medicine, SQU.

Clinico-pathological features and outcomes of cancer of cervix in Oman departments Code: MREC #775 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Ikram Burney, Dept. Medicine, SQU. care

Prevalence of hepatitis B core antibodies in volunteer blood donors Code: MREC #779 Dates: 2013 Value: Unfunded Project Approval: SQU patient Medicine Investigator: Dr. Wasif Rasool, Dept. Medicine, SQU. and Optimizing care pathways using routinely collected patient data Code: MREC #797 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Abdullah Al-Asmi, Dept. Medicine, SQU. academic Pattern and Clinical outcome of lupus nephritis in Omani patients Code: MREC #806 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Juma Al-Kaabi, Dept. Medicine, SQU.

Prevalence and clinico-histological features of Helicobacter pylori in patients undergoing esophagogas- troduodenoscopy at SQUH Code: MREC #807 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Said Al-Busafi, Dept. Medicine, SQU.

119 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Contrast induced nephropathy in patients with chronic kidney disease undergoing invasive coronary procedure: clinical and procedural risk factors Code: MREC #809 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mansour Sallam, Dept. Medicine, SQU.

Retrospective analysis of mortality among Omani patients with systemic lupus erythematosus over 17 year period admitted to squh Code: MREC #821 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Juma Al-Kaabi, Dept. Medicine, SQU.

Gastrostomy feeding tube insertion, indication and outcome: A comparison between radiological and endoscopic insertion Code: MREC #827 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Issa Al-Qarshoubi, Dept. Medicine, SQU.

Clinico-epidemiological features of Wilson’s disease in Oman: Single centre experience Code: MREC #828 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Said Al-Busafi, Dept. Medicine, SQU.

Characteristics of hepatitis C patients in Oman Code: MREC #844 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Said Al-Busafi, Dept. Medicine, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Baddar S, Jayakrishnan B, Al-Rawas OA, George J, Al-Zeedy K. Is clinical judgment of asthma control adequate? A prospective survey in a tertiary hospital pulmonary clinic. Sultan Qaboos Univ Med J 2013; 13:63–8. 2. Jayakrishnan B, Abid FB, Balkhair A, Alkabbi JK, Al-Rawas OA, George J, Al-Zeedy K. Severe pulmonary involvement in leptospirosis: Alternate antibiotics and systemic Steroids. Sultan Qaboos Univ Med J 13:318–22. 3. Furrukh M, Burney IA, Kumar S, Zahid KF, Al-Moundhri M. Improving outcomes in advanced lung cancer: Mainte- nance therapy in non-small-cell lung carcinoma. Sultan Qaboos Univ Med J 2013; 13:3–18. 4. Furrukh M, Al-Moundhri M, Zahid KF, Kumar S, Burney I. Customised, individualised treatment of metastatic non- small-cell lung carcinoma (NSCLC). Sultan Qaboos Univ Med J 2013; 13:202–17. 5. Burney IA, Al-Lamki N. Accreditation of graduate medical education programmes: One size fits all - or does it?S ultan Qaboos Univ Med J 2013; 13:198–201.

120 6. Nandhagopal R. Triple brain insults following cranial trauma. Neurosciences (Riyadh) 2013; 18:288–9. 7. Nandhagopal R. Visual impairment. BMJ 2013; 346:f2163. 8. Nandhagopal R. Seizure and skin lesions. Neurosciences (Riyadh) 2013; 18:91–2. 9. Kuramoto L, Cragg J, Nandhagopal R, Mak E, Sosssi V, de la Fuente-Fernandez R, et al. The nature of progression in Parkinson’s disease: an application of non-linear, multivariate, longitudinal random effects modelling. PLoS One 2013; 8:e76595. 10. al-Sinawi H, Nandhagopal R, Eluenedi A, Obaid Y, Al-Asmi A. Treatable neuropsychiatric syndrome of catatonia: A case report. Oman Med J 28: doi 10. 5001/omj.2013.108. 11. Qureshi A, Zahid, KF, Azzawi S, Burney IA. Osteosarcoma arising on a background of Paget’s disease report of an unusual case. BMJ Case Reports 2013. doi:10.1136/bcr-2012-007770. 12. ali A, Al-Belushi BS, Waly MI, Al-Moundhri MS, Burney IA. Dietary and lifestyle factors and risk of non-Hodgkin’s lymphoma in Oman. Asian Pac J Can Prev 2013; 14:841–8. 13. Lakhtakia R, Al-Wahaibi K, Zahid KF, Malik KA, Burney IA. Solid pseudo-papillary neoplasm of pancreas: A review of the diagnostic dilemma and tumor behavior. Oman Med J 2013; 28:441–4. 14. Al-Busafi SA, Michel RP, Deschenes M. Rituximab for refractory autoimmune hepatitis: Case report. Arab J Gastroen- terol 2013; 14:135–8.

15. Al-Busafi SA. Do we have guidelines for the prevention of hepatitis B virus perinatal transmission? Aust N Z J Obstet departments Gynaecol 2013; 53:231–5. 16. Congly SE, Wong P, Al-Busafi SA, Doucette K, Fung SK, Ghali P, et al. Characterization of hepatitis B virus genotypes

and quantitative hepatitis B surface antigen in North American tertiary referral liver centres. Liver Int 2013; 33:1363– care 9. 17. Al-Busafi SA. Hilzenrat N. Mild hypertransaminasemia in primary care. ISRN Hepatol 2013; Article ID: 256426. 18. al-Farsi K, Siddiqui AA, Sharef YW,...Al-Hashim H, Al-Ghailani M, Johnston WJ. Hemorrhagic cardioembolic stroke patient Medicine secondary to a left ventricular thrombus: A therapeutic dilemma. Oman Med J 2013; 28:56–9. 19. Tariq O, Siddiqui AA, Al Riyami A, Amir F, Mula-Abed YW, Ghillani MH. Pheochromocytoma with uncommon ECG

presentation. J Liaquat Univ Med Health Sci (JLUMHS) 2013; 12:128–30. and

20. Al Riyami D, Al Shaaili K, Al Bulushi Y, Al Dhahli A, Date A. The spectrum of glomerular diseases on renal biopsy: data from a single tertiary center in Oman. Oman Med J 2013; 28:213–5. 21. al Zaabi M, ShafiqS , Al Riyami D, Ali BH. Prescribing pattern and therapeutic drug monitoring of vancomycin at Sultan Qaboos University Hospital. Trop J Pharm Res 2013; 12:117–121. 22. Nandhagopal R, Schulzer M, Kuramoto L, Cragg J, Sossi V, de la Fuente-Fernández R, et al. Longitudinal changes in academic caudate dopamine processing in Parkinson’s Disease: A multi-tracer PET study. Neurology 2013; 80(Meeting Ab- stracts 1): S33.005.

CONFERENCE & SEMINAR PRESENTATIONS Poster Presentations International 1. Mumm S, El-Shafie O, Zhang X, Hussein S, Novack DV, Woodhouse N, et al. Juvenile Paget’s disease without mutation of TNFRSF11B (OPG) or TNFRSF11A (RANK). 1st Clinical Congress & Gulf Chapter Annual Meeting ‏American Associa- tion of Clinical Endocrinologists, Abu Dhabi, UAE, 3–5 Oct 2013.

121 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

2. Hussein S, Shukaily M, Elshafie O, Sankhla D, Woodhouse N. The role of thyroid scintigraphy with Tc99m pertechnetate in defining the spectrum of thyroid disorders in young Omanis. 1st Clinical Congress &G ulf Chapter Annual Meeting American Association of Clinical Endocrinologists, Abu Dhabi, UAE, 3–5 Oct 2013‏. 3. Elshafie O, Al Baddi Y, Al Azri F, Hussain S,...Al Mamari A, Woodhouse N. Catecholamine secreting carotid body paraganglionoma: Successful longterm preoperative control of the hypertension and clinical symptoms using high dose octreotide LA. 1st Clinical Congress & Gulf Chapter Annual Meeting American Association of Clinical Endocri- nologists, Abu Dhabi, UAE, 3–5 Oct 2013.

122 departments

care

Microbiology & Immunology patient

and

he Department of Microbiology & Immunology continues to play an important role in teaching, research and community service. It contributes to the B.Sc. Health Sciences, M.D. (old and new curriculum), the B.Sc. Biomedical Sciences (BMS), B.Sc. Nursing, M.Sc. and Ph.D. programmes, and to the Oman Medical Specialty Board (OMSB) residents’ teaching and Microbiology & Immunology academic Ttraining programmes. Microbiology research interests include basic molecular virology and microbiology, and the epidemiology of parasitic infections. The immunology research focuses on autoimmunity, immunity to hepatitis C virus infection and immunodeficiency, both primary and acquired, including HIV/AIDS. There is active international research cooperation between the Department and scientists in Austria, Canada, France, Germany, the UAE, the UK and the USA. The Department’s clinical divisions offer diagnostic services to SQU Hospital (SQUH) and other hospitals in Oman in the fields of bacteriology, virology, parasitology, mycology and immunology.

123 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Frank Serebour, Chief Biomedical Scientist Robert Toki, Chief Biomedical Scientist Head of Department SaidAl-Hinai, Chief Biomedical Scientist Norbert Nowotny, Professor Jacob George, Chief Biomedical Scientist Faculty Intesar Al-Balushi, Chief Biomedical Scientist Safiya Al-Harthy, Chief Biomedical Scientist Ali Al-Jabri, Professor Marvin Enriquez, Chief Biomedical Scientist Mohammed Idris, Professor Sam George, Senior Biomedical Scientist Sharanjit Thukral, Professor Sabaz A. Khan, Senior Biomedical Scientist Muhannad Al-Kobaisi, Assistant Professor Fathiya Al-Maskery, Senior Biomedical Scientist Basil Nzeako, Assistant Professor Nasra Al-Harrasi, Senior Biomedical Scientist Crystal Koh, Assistant Professor Ruwaida Al-Lamki, Senior Biomedical Scientist Elias Said, Assistant Professor Amna Al-Balushi, Senior Biomedical Scientist Akbar Rafay, Senior Consultant Sada Al-Harthy, Senior Biomedical Scientist Zakariya Al-Muharrmi, Senior Consultant Sumayya Al-Hosni, Senior Biomedical Scientist Khuloud Al-Ma’mari, Consultant Ibrahim Kutty, Biomedical Scientist Badriya K. Al-Adawi, Senior Registrar Faiza Al-Naamani, Biomedical Scientist Fatma S. H. Ba’Alawi, Senior Registrar Kiran Ali, Biomedical Scientist Jalila S. R. Al-Shukaily, Senior Registrar Sahim Al-Ghafri, Biomedical Scientist Munira Al-Siddiqui, Senior Registrar Issa Al-Samsami, Biomedical Scientist Zaaima Al-Jabri, Clinical Instructor Manawar Al-Quraini, Biomedical Scientist Mohammed Al-Balushi, Research Associate Faiza Al-Mujaizi, Biomedical Scientist Support Staff Marwa Al-Hinai, Biomedical Scientist College Jawahar Al-Hinai, Biomedical Scientist Ishraq A. Al-Kindi, Sidqi Hassan, Superintendent Biomedical Scientist Huda Al-Ghafri, Khuloud Al-Rahbi, Senior Biomedical Scientist Biomedical Scientist Suad Al-Ubaidani, Khazina Al-Harthy, Senior Biomedical Scientist Biomedical Scientist Ruqayya K. Al-Harrasi, Zamzam Al-Bimani, Senior Biomedical Scientist Biomedical Scientist Hafsa S. R. Al-Omairi, Situsekara Rajapakse, Senior Biomedical Scientist Biomedical Scientist Najah M. Al-Lawati, Juma Al-Busaidi, Senior Biomedical Scientist Biomedical Scientist Mohammed Al-Wahaibi, Amal Al-Hinai, Biomedical Scientist Clerk Yousuf Al-Sabty, Atika Al-Bimani, Biomedical Scientist Coordinator Zia-ul Q. Al Qureshi, Coordinator Hospital Masoud Al-Khayari, Chief Biomedical Scientist & Superintendent

124 Highlights of the Year 2013 During the year 2013, the Department continued to support its faculty members. Drs. Badriya Khamis Al-Ada- wi, Fatma Ba’Alawi, Jalila Al-Shukaily and Khuloud Al-Ma’mari completed their training abroad and returned to the Department, joining the Diagnostic laboratory, where they started to implement methods and tests which they had learnt abroad, thus broadening the Laboratory’s services. As a result, the number of tests performed by the laboratory staff increased significantly, as shown in Figure 1. A research (and financial) highlight of this year was a 166,000 OR research grant from The Research Council awarded to Dr. Mohammed Al-Balushi and colleagues on the causation of autoimmune inflammatory arthritis and other autoimmune diseases by cellular stress. The project will start in 2014. Also, the number of scientific papers in renowned international journals published in 2013 increased considerably compared to previous years.

Teaching Programmes UNDERGRADUATE PROGRAMMES departments

Old Curriculum The Department continued to offer its two main courses in the B.Sc. Health Sciences programme, namely

Immunology and Microbiology, to the 3rd and 4th year medical students, respectively. care

New Curriculum The Department continued to contribute and play a vital role in the new curriculum that was initially imple- patient mented in 2009–2010. The Department participated in all semesters of Phase II which included 10 different modules of core and system courses. and

B.Sc. Biomedical Sciences (BMS) As in the previous years, the Department also contributed substantially to the B.Sc. BMS programme. Seven different courses were offered during 2013. Microbiology & Immunology academic

B.Sc. Nursing The Department continued to offer a three-credit Microbiology and Immunology course that is taught to second year B.Sc. nursing students during the spring and fall semesters.

Clinical Programme (M.D. Programme) As in the past years the 5th year clinical students attended the integrated lecture series and case-oriented learning offered by the Department. Each of the five groups of the 7th year medical students undertook a one-week laboratory rotation that covered all the clinical microbiology and immunology laboratory sections. The students of each group were assessed on the final day of each rotation.

125 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Postgraduate Programmes The Department participated in the training of some of the OMSB residents.

M.Sc. Programme The Department continued to offer the Medical Microbiology programme for M.Sc. students in 2013. Four courses were taught in the M.Sc. programme.

Ph.D. Programme The Department is also running an active international Ph.D. programme in all sub-disciplines of the Depart- ment.

Clinical & Diagnostic Services The Department’s Microbiology & Immunology Diagnostic Laboratory, based at SQUH, continued to offer diagnostic services primarily to SQUH, but also to other government and private hospitals. The expansion in the diagnostic services in microbiology and immunology paralleled the increased inpatient and outpatient activity of SQUH. Although in 2013 a slight decrease in the number of diagnostic samples was noted, the number of tests performed rose substantially since a number of new tests were offered in 2013 for the first time to improve patient services. This was possible due to the return of several Omani clinical microbiolo- gists and immunologists from their training abroad. However, the individual counting of tests which have been performed together (e.g., multiplex qPCR assays) also contributed statistically to the observed steep

Figure 1: Microbiology and immunology specimens/tests in 2003–2013.

126 increase of performed tests. Figure 1 shows the activity of the Diagnostic Laboratory during the past 10 years. It should be noted that the surge in the number of tests in 2009 and 2010 was due to the increased requests of influenza virus testing during the H1N1 outbreak.

External Quality Assurance The Department continued to participate in the Royal College of Pathology of Australia External Quality Assurance Programme. According to these international standards, the diagnostic laboratories of the Depart- ment scored reasonably well.

Research In 2013, members of the Department worked on six research projects. The main projects were on the genetic and immunological determinates of AIDS patients on HAART, and the molecular and functional characterisation of gene polymorphisms associated with inflammatory diseases. departments

RESEARCH PROJECTS Factors leading to CD4 T-cell depletion in Omani HIV-infected patients who are immunologically

non-responding to treatment care

Code: IG/MED/MICR/13/01 Dates: 2013–2015 Value: OR 11,000 Funder: SQU Investigators: Dr. Elias Said, Prof. Ali Al-Jabri, Dr. Sidgi Hasson, Dr. Mohamad Al-Balushi, Dr. Crystal patient

Koh, Dept. Microbiology & Immunology, SQU; Dr. Abdullah Balkhair, Dept. Medicine, SQU.

Association of anti-phospholipids and other relevant autoantibodies with recurrent abortion in Omani and women Code: IG/MED/MICR/13/02 Dates: 2013–2014 Value: OR 16,362 Funder: SQU Investigators: Dr. Mohammed Al-Balushi, Prof. Ali Al-Jabri, Dr. Sidgi Hasson, Dr. Elias Said, Dr. Crystal Microbiology & Immunology Koh, Dept. Microbiology & Immunology, SQU; Dr. Moza Al-Kalbani, Dr. Wadha Al-Ghafri, Dept. Obstetrics & academic Gynaecology, SQU.

TLR7/9 single nucleotide polymorphisms and their association with systemic lupus erythematosus (SLE) among Omani population Code: MREC #627 Dates: 2013 Value: OR 1,600 Funder: SQU Investigators: Dr. Crystal Koh, Dr. Elias Said, Prof. Ali Al-Jabri, Dr. Sidgi Hasson, Dr. Mohammed Al- Balushi, Dept. Microbiology & Immunology, SQU; Dr. Batool Hassan, Dept. Medicine, SQU.

127 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Role of antigen presenting cells in liver damage and progression of liver disease due to hepatitis B and C infections Code: MREC #742 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Elias Said, Dept. Microbiology & Immunology, SQU; Dr. Marwa Al-Riyami, Dept. Pathology, SQU.

Detection and characterization of extended spectrum beta lactamases in clinical isolates of Escherichia coli and Klebsiella pneumonia at Sultan Qaboos University Hospital Code: MREC #787 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Sharanjit Thukral, Dept. Microbiology & Immunology, SQU.

Identification of metallo-beta-lactamases in clinical isolates of Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumonia at Sultan Qaboos University Hospital Code: MREC #789 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Sharanjit Thukral, Dept. Microbiology & Immunology, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al-Balushi MS, Al-Busaidi JZ, Al-Daihani MS, Shafeeq MO, Hasson SS. Sero-prevalence of Helicobacter pylori infection among asymptomatic healthy Omani blood donors. Asian Pac J Trop Dis 2013; 3:146–9. 2. al-Hamidhi S, Mahdy MAK, Al-Hashami Z, Al-Farsi H, Al-Mekhlafi AM, Idris MA, et al. Genetic diversity of Plasmodi- um falciparum and distribution of drug resistance haplotypes in Yemen. Malar J 2013; 12:244. 3. Al-Mahruqi SH, Zadjali F, Koh CY, Said EA,...Al-Balushi MS, Hasson SS, Al-Jabri AA. New genetic variants in the CCR5 gene and the distribution of known polymorphisms in Omani population. Int J Immunogenet 2013; 41:20–8. 4. Bakonyi T, Ferenczi E, Erdélyi K, Kutasi O, Csörg T,…Nowotny N. Explosive spread of a neuroinvasive lineage 2 West Nile virus in Central Europe, 2008/2009. Vet Microbiol 2013; 165:61–70. 5. Bakonyi T, Kolodziejek J, Rudolf I, Bercic R, Nowotny N, Hubálek Z. Partial genetic characterization of Sedlec virus (Orthobunyavirus, Bunyaviridae). Infect Genet Evol 2013; 19:244–9. 6. Balkhair A, Al-Maamari K, Alwai FB. The struggle against MERS-CoV (the novel Coronavirus). Oman Med J 2013; 28:226–7. 7. Beck C, Jimenez-Clavero MA, Leblond A, Durand B, Nowotny N, Leparc-Goffart I, et al. Flaviviruses in Europe: complex circulation patterns and their consequences for the diagnosis and control of West Nile disease. Int J Environ Res 2013; 10:6049–83. 8. Buchebner N, Zenker W, Wenker C, Steinmetz HW, Sós E,...Nowotny N. Low Usutu virus seroprevalence in four zoo- logical gardens in central Europe. BMC Vet Res 2013; 9:153. 9. Donadieu E, Lowenski S, Servely JL, Laloy E, Lilin T, Nowotny N, et al. Comparison of the neuropathology induced by two West Nile virus strains. PLoS One 2013; 8:e84473. 10. Hasson SS, Al-Balushi MS. In vitro antimicrobial activity of Brassica plant’s seed. Int J Res Rev Pharm Appl Sci 2013; 3:268–275.

128 11. Hasson SSA, Al-Balushi MS, Alharthy K, Al-Busaidi JZ,...Said EA,…Aljabri AA, Idris MA. Evaluation of anti-resistant activity of Auklandia (Saussurea lappa) root against some human pathogens. Asian Pac J Trop Biomed 2013; 3:557– 62. 12. Hasson SS, Al-Balushi MS, Al-Kalbani MM, Al-Harrasi BSA, Al-Busaidi JZ,...Al-Jabri AA. Prevalence of 25-B.S.A. hy- droxyvitamin D deficiency among a cohort of Omani AIDS patients. Int J Research Rev Pharm Appl Sci 2013; 3:296– 307. 13. Hasson SS, Al-Balushi MS,...Al- Busaidi JZ, Said EA, Idris MA, Al-Jabri AA. Prevalence of zinc- 2-glycoprotein binding peptide among Omani blood donors. J Med Lab Diagn 2013; 4:21–7. 14. Kuhn JH, Bekal S, Caì Y, Clawson AN, Domier LL, Herrel M,…Nowotny N, et al. Nyamiviridae: proposal for a new family in the order Mononegavirales. Arch Virol 2013; 158:2209–26. 15. nguema RM, Langard J, Galinier R, Idris MA, Shaban MA, Al Yafae S, et al. Genetic diversity, fixation and differentia- tion of the freshwater snail Biomphalaria pfeifferi G( astropoda, Planorbidae) in arid lands. Genetica 2013; 141:171–84. 16. pachler K, Rek D, Nowotny N. Molecular characterization of the African orthobunyavirus Ilesha virus. Infect Genet Evol 2013; 20:124–30. 17. pelletier S, Bédard N, Said EA, Ancuta P, Bruneau J, Shoukry NH. Sustained hyperresponsiveness of dendritic cells is associated with spontaneous resolution of acute hepatitis C. J Virol 2013; 87:6769–81. 18. reusken CB, Haagmans BL, Müller MA, Gutierrez C, Godeke GJ, Meyer B,…Nowotny N, et al. Middle East respiratory

syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study. Lancet departments Infect Dis 2013; 13:859–66. 19. rushton JO, Kolodziejek J, Tichy A, Nell B, Nowotny N. Detection of equid herpesviruses 2 and 5 in a herd of 266 Lip-

izzaners in association with ocular findings.V et Microbiol 2013; 164:139–44. care

20. rushton JO, Kolodziejek J, Tichy A, Nowotny N, Nell B. Clinical course of ophthalmic findings and potential influence factors of herpes virus infections: 18 month follow-up of a closed herd of Lipizzaners. PLoS One 2013; 8:e79888. 21. rushton JO, Lecollinet S, Hubálek Z, Svobodová P, Lussy H, Nowotny N. Tick-borne encephalitis virus in horses, patient Austria, 2011. Emerg Infect Dis 2013; 19:635–7. 22. rushton JO, Tichy A, Kolodziejek J, Nowotny N, Nell B. Prevalence of linear keratopathy in a herd of Lipizzaners over and

an 18-month period. Vet Rec 2013; 173:192. 23. scagnolari C, Caputo B, Trombetti S, Cacciotti G, Soldà A, Spano L,…Nowotny N, et al. Usutu virus growth in human cell lines: induction of and sensitivity to type I and III interferons. J Gen Virol 2013; 94:789–95. 24. seidel B, Silbermayr K, Kolodziejek J, Indra A, Nowotny N, Allerberger F. Detection of Plasmodium sp.-infested Anoph- Microbiology & Immunology eles hyrcanus (Pallas 1771) (Diptera: Culicidae) in Austria, 2012. Wien Klin Wochenschr 2013; 125:139–43. academic 25. sonnleitner ST, Simeoni J, Baumgartner R, Zelger R, Prader A,…Nowotny N, et al. The spreading of flaviviruses over the continental divide: a challenge for serologic diagnostics. J Med Microb Diagn 2013; S3:002. 26. weissenböck H, Bakonyi T, Rossi G, Mani P, Nowotny N. Usutu virus, Italy, 1996. Emerg Infect Dis 2013; 19:274–7. 27. Ziegler U, Angenvoort J, Fischer D, Fast C, Eiden M, Rodriguez AV,…Nowotny N, et al. Pathogenesis of West Nile virus lineage 1 and 2 in experimentally infected large falcons. Vet Microbiol 2013; 161:263–73. Books & Book Chapters 1. Al-Jabri AA, Al-Mahruqi S, Hasson S. Essential immune responses to HIV/AIDS. In: Berhardt LV, Ed. Advances in Med- icine and Biology, Vol. 72. Hauppauge NY: Nova Science Publishers, Inc., 2013. ISBN:978-1-62808-968-4.

129 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

CONFERENCE & SEMINAR PRESENTATIONS Poster Presentations International 1. Al-Jabri AA, El-Beeli M. HLA-A68 and HLA-B15 Alleles are correlated with poor immune response to highly active antiretroviral therapy among Omani AIDS patients. 15th International Congress of Immunology, Milan, Italy, 22–27 Aug 2013. P4.03.03, P.186. 2. Al-Jabri AA, Al-Mahruqi SH. New genetic variants of the CCR5 gene in the Omani population. 15th International Congress of Immunology, Milan, Italy, 22–27 Aug 2013. P2.09.01, P.172.

National 1. al-Hamidhi S, Mahdy MAK, Al-Hashami Z, Al-Farsi H, Al-Mekhlafi AM, Idris MA, et al. Genetic diversity and distribution of drug resistance genotypes among Plasmodium falciparum in Yemen and Saudi Arabia. SQU University Day, May 2013. 2. Al-Balushi M, Hasson SS, Al-Busaidi J, Springer S. Packaging of MHC class I molecules in Copii vesicles. SQU Univer- sity Day, May 2013. 3. Al-Kobaisi M, Al Saadi N, Al Muharrmi Z, Balkhair A, Al-Riyami D, and Al Khabori M. Seroprevalence of human herpes virus type 8 in HIV, renal transplant patients and blood donors in Oman. SQU University Day, May 2013. 4. Al Maamari K. Role of laboratory in HIV diagnosis and follow up. 3rd National Workshop on Management of HIV/ AIDS, Muscat, Oman, 3 Dec 2013. 5. Al Maamari K. Role of laboratory in HIV diagnosis and follow up. Update on Communicable Diseases. Directorate General of Health Services, Ministry of Health, Muscat, Oman, 19 Dec 2013.

THESIS SUPERVISION Student Name: amal Gadallah Qualification: Ph.D. Title: Genetic and environmental factors influencing gametocytes production among asymptomatic Plasmodium falciparum carriers Supervisors: Dr. Hamza Babiker and Prof. Mohamed A. Idris Date of completion: On-going

Student Name: Fawziya Al-Yafei Qualification: M.Sc. Medical Microbiology Title: The association between SNPs in TLR4 and TLR7 and HIV pathogenesis Supervisor: Dr. Elias Said Date of completion: Jun 2013

130 Student Name: noura D. K. Al-Saadi Qualification: M.Sc. Medical Microbiology Title: Seroprevalence of human herpes virus type 8 in patients and controls in Oman Supervisors: Dr. Muhannad F. M. Al-Kobaisi Date of completion: Jul 2013

Student Name: asiya H. E. Al-Zadjali Qualification: M.Sc. Medical Microbiology Title: Detection and characterization of extended spectrum-lactamase enzymes in clinical isolates of Escherichia coli and Klebsiella pneumoniae at Sultan Qaboos University Hospital (SQUH) Supervisors: Prof. Sharanjit S. Thukral departments

Date of completion: Dec 2013

Student Name: Maryam S. Al-Adhoobi care

Qualification: M.Sc. Medical Microbiology Title: Prevalence of human enteric viruses in Oman patient Supervisors: Dr. Muhannad F. M. Al-Kobaisi

Date of completion: On-going and

Student Name: sara Al-Sumri Qualification: M.Sc. Medical Microbiology Microbiology & Immunology Title: Identification of Carbapenemases in clinical isolates ofP seudomonas aeru- academic ginosa, Escherichia coli and Klebsiella pneumonia at SQUH Supervisors: Prof. Sharanjit S. Thukral and Dr. Badriya Al’Adawi Date of completion On-going

Student Name: samira Al-Mahrooqi Qualification: Ph.D. Medical Microbiology Title: Genetic determinants of AIDS patients’ variable response to HAART: insight into CCR5 genotypes Supervisors: Prof. Ali Al-Jabri Date of completion: On-going 131 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Student Name: iman Al-Risee Qualification: M.Sc. Medical Microbiology Title: Role of antigen presenting cells in liver damage and progression of liver disease due to hepatitis B and C infections. Supervisors: Dr. Elias A. Said Date of completion On-going

Student Name: iman Al-Saidi Qualification: M.Sc. Medical Microbiology Title: Effect of sleep deprivation on the immune system Supervisors: Dr. Elias A. Said Date of completion On-going

The Department of Microbiology & Immunology was also involved in the training of a large number of undergraduate M.D. and B.Sc. BMS research students as well as international students on exchange research programmes.

132 departments

care

Nursing Services Directorate patient

and

he Nursing Directorate plays a vital role in patient care and work flow activities inS ultan Qaboos University Hospital (SQUH). Its focus is on developing and transforming the nursing workforce into a vital resource for an evolving healthcare system. This process is guided by the Directorate as well as SQUH’s vision to be the model of excellence in academic teaching,T nursing practice, research and nursing leadership in Oman and beyond. Nursing Services Directorate The bedrock upon which this philosophy rests is our commitment to provide care of outstanding quality for patients as well as for our external and internal clients. This is achieved through proven quality improvement methods and techniques such as data analysis, key performance indicators, peer-review audits, surveys, learning and teaching strategies and the continuous professional development of staff members.

We believe that in our pursuit for excellence we must not lose our core values as nurses. These values are embodied in the way we practice nursing. People, integrity, respect, confidentiality, compassion, commitment, team work, continuous improvement, excellence, innovation and creativity characterise our values. We are also a learning organisation and thus fully involved in teaching and training nurses, medical students, paramedical and support staff in order to put our values into practice.

133 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Nursing plays a vital role within SQUH and our Fatiya Al-Tobi,Coordinator Directorate stands in solidarity with SQUH in Naema Al-Breiki, Coordinator meeting international standards and implement- Zahra Al-Zedjali,Coordinator ing evidence-based practices. This is an important Hilal Al-Zedjali, Messenger time as SQUH is in the process of achieving the Head Nurses - Inpatient Departments Accreditation Canada International (ACI) Annette Shirto, standards in order to continue to transform nurs- Cardiothoracic/ Cardiology Ward Noraini Yadi, ing into a vital resource for health. Evidence gath- General Medicine Female Ward Koh C. Fong, ered from 2013 tells us we did well but we can do Haematology/Oncology Female Ward Mega M. Nor, better. The Directorate uses data and evidence General Medicine Male Ward Bader Al-Mahrouqi, collected throughout the year to inform our Haematology/Oncology Male strategic planning for continuous quality improve- Ward Zaleha B. Zaman, ment and effective work force planning. Ophthalmology/ENT Male/Fe- male Ward Zairiyah Zainol, Special Nursing Ward Staff Sulaiman Al-Mahmoodi, General Surgery Male Ward Deputy Director Yoong Yoong, General Surgery Female Ward Shinoona Al-Harthy, Acting Deputy Director Sukhjit Singh, Psychiatry Ward Administration Head Nurses - Ambulatory Services Aina Al-Riyami, Head of Section, Nursing Affairs Warda Al-Lawati, Cardiac Catheterisation Lab. Yousuf Al-Hasani, Head of Section, Ambulatory Sapiah Abas, Day Care Unit Services (on scholarship) Haseena Saib, Operating Theatre/Recovery Room Zayana Al-Maskari, Head of Section, Inpatient Areas Salim Al-Sudairi, Emergency Department (on unpaid leave) Nasser Al-Kharusi, Outpatient Department Catherine Lausa, Acting Head of Section, Zuweina Al-Salami, Student Clinic Ambulatory Services Sarala Kodamala, Family Med & Public Health Clinic Daniel Birru, Acting Head of Section, Training & Ragunathan, Haemodialysis Unit Professional Development Judy Mathews, Oral Health Clinic Huda Al-Awaisi, Acting Head of Section, Nursing Brigitte Sam, Blood Bank Research Arnold Buenafe, Adult Intensive Care Unit Fatma Al-Dhabbari, Nursing Quality & Special Projects Head Nurses - Maternal & Child Health Parvi Ponambalam, Nursing Quality & Special Departments Projects Barbara Swales, Delivery Unit Samira Al-Rasbi, Acting Head of Section, Clinical Valsa Shelin, Neonatal Intensive and Special Care Nurse Specialist & Bed Flow Manager Unit Rahma Al-Mahrizi, Acting Head of Section, Suad Al-Bahri, Paediatric Day Care Unit & Paediat- Inpatients Area ric Ward for Cardio./Neuro./Endo. Afrah Al-Habsi, Coordinator Nancy Reyes, Metabolic/ENT 134 Umi Hassanbasri, Paediatric Ward for General Surgery/Immuno./Rheumo. Zuweina Al-Shabibi, Orthopaedic & Neurology Ward Norah Ngcamu, Paediatric Haematology/Oncology Ward Connie Lager, Bone Marrow Transplant Unit Thavamony Saravanan, Postnatal/Obstetric Ward Galie Pascua, Gynaecology Ward Highlights of the Year 2013 One of the highlights for the Nursing Directorate in 2013 was a continued focus on achieving higher standards. As part of this effort, we invited Ms. Angela Horsley, a nursing expert from the UK, to evaluate our leadership strategies and all the nursing areas. She also conducted two workshops for the staff. Her feedback was positive with recommendations for improvements. Next, we had two visitors from Thailand, Ms. Kannika and Ms. Kanjanee, specialists in Outpatient Management. Their visit was valuable and helped us to implement strategies that address operational processes within the Outpatient Department (OPD).

One of the highlights of 2013 that nurses especially enjoyed was the International Nurses Day celebration departments “Meet and Greet” event where top management and nurse administrators went to all areas and greeted the nurses as a token of their appreciation. care

This year also saw the first joint event between the Directorate and the Ministry of Health (MOH) when we debated “Professional Nursing and Midwifery License: Is it essential?” The debate was followed with great enthusiasm and SQUH came out as winners. patient

The building of the new Haematology Centre required collaborative commissioning work between the and

Directorate and various technical and engineering departments. We had the privilege of a visit from Ms. Marvelle Brown, an expert in bone marrow transplantation (BMT), who shared her experience with us.

There was a total of 1,213 nursing staff and 22 ward clerks in 2013. academic Nursing Services Directorate Events and activities Events and activities organised by the Directorate in 2013 were as usual aimed at team-building, learning and professional development to help foster the employee motivation and engagement that is vital to work productivity.

135 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Table 1: Other Nursing events and activities in 2013 Activities Date Clinical Audit Peer Review Group formulated January Nursing Debate: SQUH versus MOH January Establishment of Diabetic Foot Ulcer Course for nurses January Staff Day out February Patient & Family Education Open Day February–December First Recruitment trip to Tunisia for Midwives March Protected Mealtime - Patient Safety Initiative March–July Iftar gathering for nurses July 140-hour Shift Survey June–July Formulation of inpatient transfer checklist as per SBAR September–October Cath. lab. functioning 5 days/week for cardiology cases October Accreditation Canada International mock survey took place in var- October ious wards/units Nursing Department won 3rd Prize and Emergency Department November won the 2nd Prize at Quality Open Day Re-establishment of Discharge Planning and Transit Lounge November Quality Best Practice Audit December Nursing Food Fair December Revision of Nursing documents (90% completed) January–December

QUALITY IMPROVEMENT ACTIVITIES Patient flow Table 2 demonstrates the continuous expansion of bed utilisation; this has a significant impact on the demands made on nurses and the Directorate [Table 2]. The increase in patient activity in medical wards has impacted the nursing workload, adding an extra burden on nurses. Many patients admitted in medical wards require high-dependency care and significant amounts of nursing

136 interventions. Therefore, evidence show that current staffing levels in medical wards require re-evaluation to achieve safe staffing levels [Figure 1].

Table 2: Patient flow in 2013 Activity No. Admissions 32,525 Total visits in ambulatory areas 14,052 Discharges 28,937 Death 378 Total length of stay (in days) 127,021 Average length of stay (in days) 5 Bed occupancy rate % 74 departments

Key Performance Indicators care A key performance indicator (KPI) is one type of performance measurement used in the Nursing Directorate. The Directorate uses these KPIs to evaluate the success of a particular activity for further quality improvement. There are six main indicators which are measured and monitored on a monthly basis and patient

evaluated and analysed bi-annually: medication errors, falls, nurses satisfaction rate, patient satisfaction rate, nursing absenteeism and professional development opportunities. and

academic Nursing Services Directorate

Figure 1: Work load for Nursing in Intensive Care Unit, surgical, medical and paediatric wards. P = purple ward; B = blue ward; Y = yellow ward; R = red ward; PICU = Paediatric Intensive Care Unit; CICU = Cardiac Intensive Care Unit; NNL = Neonatal Intensive and Special Care Unit; ICU/CCU = Intensive Care Unit/ Critical Care Unit.

137 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 2: Results of the patient satisfaction survey in 2013.

Patient Satisfaction The Directorate received 63% of compliments for Nursing Services rendered to patients versus 37% complaints. Most of the compliments were on the excellent nursing care given. In the complaints category, attitudes and behavior and communication were the two areas that needed the attention of the Directorate and a functional Committee was formed to tackle this. Incident Reports

The highest number of incident reports in 2013 involved the mishandling of medical equipment, followed by falls and communication. In the category for "other" the volume for incident was significant and will require further root-cause analysis to mitigate the problems. Based on this data, the nursing coordinators have been given the task to monitor and analyse these reports and recommend corrective actions.

Staffing The results of the nurses satisfaction survey are shown in Figure 4. An average of 8.45% of staff were on sick leave each month in 2013. A total of 37 staff (3.2%) left SQUH in 2013. Exit interviews were carried out for all staff to identify ways to improve staff retention and satisfaction. Among various reasons given for their res- ignation, 15 staff (40%) cited family reasons and 13 (35%) work overload.

138

Figure 3: Categories of incidents in 2013. departments

Teaching Programmes care

In 2013, Directorate staff from clinical areas actively participated in teaching nurses through the following courses in collaboration with the Directorate of Training & Continuing Professional Development (DTD): Chemotherapy; Nursing Assessment and Documentation; Intravenous Therapy. patient

Training Courses & CNE Activities and The Training & Staff Development Section in the Directorate planned, organised and conducted the following training and staff development activities for nursing staff and students in collaboration with the DTD, the College of Nursing at SQU and nursing institutions in and outside Oman: Wound Care Management, Diabetic Foot Ulcer & Pressure Ulcer; Vascular Access Device Course; Preceptor Course; Baby academic Friendly Hospital Initiative; Basic Life Support, and Advanced Cardiovascular Life Support. Nursing Services Directorate

139 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 4: Results of the nurses satisfaction survey in 2013.

The following scheduled courses were also run with the number of staff attending shown in brackets: Basic Life Support (1,183); Intravenous Therapy (1,131); Fire Awareness (1,168); Hospital Orientation (1,065); Nursing Documentation (702); Lifting and Moving (764), and Fire Warden course (646).

A total of five nurses attended short courses in Oman and 15 nurses went on courses abroad (Canada - 4; UAE - 4; Saudi Arabia - 4; Kuwait - 2; UK - 1). Five nurses are currently on study scholarships abroad—one for a Ph.D. and five studying for a Master’s degree in Nursing.

140 Research Books & Journal Publications Journal Publications 1. al-Azri M, Al-Awisi H, Al-Rasbi S, Al-Moundhri M. Coping with a diagnosis of breast cancer amongst Omani women. J Health Psychol 2013; Epub. 21 Mar 2013. Nursing Bulletin The Nursing Newsletter, published bi-annually, covers all aspects of SQUH nursing activities such as departmental studies, conference, workshop and course attendance and any other activities undertaken in- ternally or externally that involve nurses.

Conference & Seminar Presentations Seminar Presentations departments

National 1. Al-Dhabbari F. Patient Safety Quality Initiation – Protected Meal Time Project. Medical Advisory Committee, SQUH, Oman, 16 Jan 2013. care

2. Mudaliar P. Professionalism in Nursing. National Seminar on Professionalism & Ethics in Neonatal & Pediatric Nursing, Ministry of Health & Oman Nursing Institute, Oman, 1 May 2103.

3. Al-Dhabbari F. Key Performance Indicators. Ministry of Health & Institute of Health Sciences, Oman, 5 Feb 2103. patient

4. Al-Harthy S. Feedback from SQUH Nursing Leadership. Evaluation of SQUH Nursing Leadership by UK Expert,

SQUH Hospital Board, Oman, Mar 2013. and

5. Al-Zidjali N. Outpatient Department Quality Improvement. SQUH Medical Advisory Board, Oman, 12 Nov 2013. Poster Presentations academic National Nursing Services Directorate 1. Al-Awaisi H, Al-Rasbi S. Evidence-based nursing practice. Symposium on Excellence in Nursing Leadership: research and evidence based practice. Oman Specialised Nursing Institute, Oman, Jun 2013.

2. Mudaliar P. National Neonatal Committee. World Quality Open Day. SQUH, Oman, 14 Nov 2013.

141 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

142 departments

care

Nutrition & Dietetics patient

and

he Department of Nutrition & Dietetics has responsibilities in a range of areas including dietetic counselling to Nutrition & Dietetics inpatients and outpatients, administration, health education and promotion through activities related to preventative medicine, and training. Several clinics are covered in both the adult and paediatric services. Adult clinics in- Tclude diabetic, renal, obesity and gynaecology, whereas paediatric clinics include pre-term, haematology, metabolic, neurology, academic respiratory, general, endocrine and nephrology. The Department consists of two main divisions: Nutrition & Dietetics and Catering Administration.

Nutrition & Dietetics Nutrition is the study of nutrients in food, how nutrients are used by the body, and the relationship between diet, health and disease. Nutritionists work mostly in food industries, media, health promotions, schools, sports or education. Dieticians, on the other hand, work mostly in hospitals; however, they can work in the community as health promoters and educators, as well as in sports or media. They assess the nutritional needs, diet restrictions and current health plans of hospital patients in order to develop and implement dietary management plans. They also educate patients on special diets as part of their medical treatment in areas such as: diabetes, oncology, renal and liver conditions, gastroenterology, paediatrics, food allergies, obesity and nutrition support.

143 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Catering Administration Highlights of the Year 2013 The purpose of the catering administration service is to ensure a supply of safe, nutritious, dietetic services well-presented food and to protect patients from The Department ran a Nutrition Day at the SQU contaminated, decomposed or injurious food. Hospital (SQUH). It also organised a one-day Continuous supervision and monitoring prevents international cross-sectional audit in all types of the use of left-over foods and misleading labels. wards, in association with the Medical University Further monitoring activities encourage health- of Vienna, Austria. This was part of a worldwide ier and safer food by better standards of quality cross-sectional multi-centre audit which aimed control in receiving food products from to generate a profile of the risks and levels of suppliers, correct storage, food preparation, cooking nutritional intervention for an individual unit/ and, finally, serving food to patients. ward based on case-mix, structures and social environment. Staff In 2013, improvements were made to the Inborn Er- rors of Metabolism Dietetic services. Patient educa- Head of Department tional materials were also updated. Salah Al-Shukaili Deputy Head of Department catering services Majda Al-Maamary Departmental key performance indicators were de- Dietetics Staff veloped in 2013. There was further improvement of the general catering services in 2013. The numbers Shadya Al-Harthy, Senior Dietician of complaints were lower than in 2012. Weekly food A’Shaima Al-Kindi, Senior Dietician safety meetings were conducted to ensure that Ayda Al-Nabhani, Dietician food was prepared and delivered hygienically. Pa- Fatma Al-Hashmi, Dietician tient meal recipes were introduced and updated to Salma Al-Mahrouqi, Dietician focus on meals prepared specifically for the SQUH Halima Al-Siyabi, Dietician catering operation and based on special patient Amal H. Al-Adawi, Dietician meal menus. Hanan Al-Alawi, Dietician Abeer Al-Saidi, Dietician There was further work on designing a professional Catering Staff standard catering unit which will operate accord- Razeen Hameed, Catering Admin. Superintendent ing to internationally recognised food safety stan- crit- Matar R. Al-Ruqaishi, Catering Supervisor dards, the ISO 22000:2005 hazard analysis and Thuraya Al-Abadi, Asst. Catering Supervisor ical control points. Coordinator Ali Al-Farai

144 other activities During 2013, the Department participated in various patient and community activities. In January/February, the Department participated in the CF Family Day and the Thalassemia Patient Education Day; in April, in the Physiotherapy & Rehabilitation Week, the SQUH Health Education Day and the Chemotherapy Education Day. There was also participation in the following other events during the year: the Diagnostic Day at the Special Care Centre in Al-Khoud; the SQUH Quality Day; Open Day on Kidney Diseases, and in the Gulf Food Exhibition in Dubai. Teaching Programmes Teaching was provided for 5th year medical students; speech and language therapists specialising in geriatrics; nutrition students of the College of Agriculture & Marine Sciences, and SQUH medical staff.

Training Courses & CME Activities The Department delivered nutrition and dietetics training programmes for different national organisations departments in Oman such as dieticians at the Ministry of Health and the Royal Court and catering personnel from different institutes, as well as an in-service training programme for diet clerks. It also conducted on-the-job train- care

ing for SQU food science and nutrition students. In addition, the Department conducted on-going training for the Tawoos catering company staff with the aim of upgrading and enhancing their knowledge to ensure better final patient care. patient The 3rd Oman Hospital Catering one-day Workshop was conducted by the Catering Unit in January. The Department actively participated in a workshop organised by the World Health Organization and the and Ministry of Health from 1–5 December and made an effective presentation on A' wareness of Food Safety/ Hygiene practices in Hospital and Industrial Catering Operations'

. Nutrition & Dietetics In association with the International Forum for Public Health (IFPH), London, UK, the Department conducted two intensive workshops on 'Dyslipidaemia and Cardioprotective Diet' and the 'Management and Treatment academic of Hypertension' on 3–4 April.

Finally, the Department coordinated and participated in the Baby & Infant Friendly Hospital Initiative Course.

Research The Department is successfully continuing to conduct the World Wide Nutrition Day Research Project, supported by the European Society for Parenteral and Enteral Nutrition. The Patient Satisfaction survey continues to be conducted annually to identify patient needs and obtain patients’ suggestions and comments in order to improve the catering services.

145 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Conferences & Seminar Presentations Oral Presentations International 1. Al-Mahrouqi S. The role of breast feeding on prevention of childhood leukemia. Asia Pacific Conference on Clinical Nutrition, Tokyo, Japan, 9–12 Jun 2013.

National 1. Hameed R. Food poisoning out breaks and public awareness. International Symposium on Food Poisoning, Aware- ness and Prevention, College of Agriculture & Marine Sciences, SQU, Oman, 7–8 May 2013. Poster Presentations National 1. Al-Hashmi F. Low Potassium Diet. Health Education Day, SQUH, Oman, 2 Apr 2013. 2. Hameed R. Quality control points in total catering operation. World Quality Day, SQUH, Oman, 14 Nov 2013. 3. Al-Ruqaishy M. Critical Control Points in Catering Operation. 2nd GCC Patient Safety Conference, SQU, Oman, 20–23 Jan 2013. 4. Al-Abbadi T. Good Hygiene Practices in Catering operation. Health Education Day, SQUH, Oman, 2 Apr 2013. 5. Al-Mahrouqi S. Toward Effective Patients Nutritional Care. 2nd GCC Patient Safety Conference, SQU, Oman, 20–23 Jan 2013. Seminar Presentations International 1. Al-Shukaili S. Obesogenic Environment. 1st Gulf Dietetic Elite Group. Dubai, UAE, 26 Jan 2013.

National 1. al-Shukaili S. Professional Kitchen Design. 3rd Oman Hospital Catering Workshop, SQUH, Muscat, Oman, 5 Jan 2013. 2. Al-Shukaili S. Non-Communicable Diseases. Management & Treatment of Hypertension Workshop, Muscat, Oman, 4 Apr 2013. 3. Al-Maamary M. Sleeve Gastrectomy Diet. Department of Physiotherapy, SQUH, Oman, 24 Mar 2013. 4. Al-Mahrouqi S. Foods & feeding during complementary period: Nutritive value and recipes. Baby & Infant Friendly Hospital Initiative Course, Directorate of Nursing Services, SQUH, Oman, 24 Jan 2013. 5. Al-Syabi H. Foods & feeding during complementary period: Nutritive value and recipes. Baby & Infant Friendly Hospital Initiative Course, SQUH, Oman, Nov 2013. 6. Hameed R. Awareness of Food Safety/Hygiene Practices in Hospital and Industrial Catering Operations. Food Safety Workshop, World Health Organization & Ministry of Health, Oman, 3 Dec 2013. 7. Al-Ruqaishi M. Analysis of patient satisfaction survey. Knowledge Forum, Directorate of Development & Quality, SQUH, Oman, 27 May 2013.

146 departments

care

Obstetrics & Gynaecology patient

and

he Department of Obstetrics and Gynaecology is one of the major departments in the College of Medicine & Health Sci- ences (COMHS) and Sultan Qaboos University Hospital (SQUH) involved in teaching undergraduates, postgraduates and

other allied professionals. It produces trained leaders in women’s health as an academic subspecialty, for community Obstetrics & Gynaecology Tpractice or research. We take care of women of all age groups and believe that women are the nucleus of the family, the com- academic munity and the nation. The goal of the Department is to provide excellent women’s healthcare through subspecialties in the Department like uro-gynaecology, infertility, endoscopic surgery, maternal fetal medicine and gynae-oncology. We value team work, intellectual curiosity, compassion and academic excellence. Our mission is to provide a structured educational environment in which dedicated teaching is integrated with graduated clinical responsibilities that promote intellectual growth in the operation room, delivery room, and inpatient and outpatient settings. Our undergraduate and postgraduate programmes train the students to provide comprehensive healthcare for women by applying an evidence-based approach to clinical management with a view to providing the best possible care to all our patients.

147 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Diya El-Hussain Omer, Senior House Officer Suhaila Al-Wahaibi, Senior House Officer Acting Head of Department Shahnaz B. Putul, Senior House Officer Vaidyanathan Gowri, Associate Professor Support Staff Faculty Aisha A. Al-Musalami Adel Abu-Heija, Professor Kawther S. Al-Abri Lamya Al-Kharusi, Senior Consultant & Deputy Philomena Sangameshwar Head of Department Mariam Mathew, Senior Consultant Highlights of the Year 2013 Lovina Machado, Senior Consultant Maha Al-Khaduri, Senior Consultant Conference and Workshops Wadha Al-Ghafri, Senior Consultant The Department organised the International Con- Tamima Al-Dughaishi, Senior Consultant ference in Obstetrics & Gynecology from 3–6 De- Mariam Al-Shukri, Senior Consultant cember 2013. The emphasis of the conference was Nihal Al-Riyami, Consultant on presenting recent advances in the field of obstet- Moza Al-Kalbani, Consultant rics and gynaecology and its subspecialties such as Rahma Al-Haddabi, Consultant Maternal Fetal Medicine, Reproductive Endocrinol- Shahila Tazneem, Senior Registrar ogy, Urogynaecology and Gynae-Oncology. A to- Durdana Khan, Senior Registrar tal of 13 international speakers were invited from Aneeta Bai, Senior Registrar Canada, the UK, Brazil, Italy, Egypt, Saudi Arabia, Silja A. Pillai, Senior Registrar Qatar and India. The total number of participants Girija Shivarudraiah, Senior Registrar was 400 over the three days. The participants were Manjunath A. Palaksha, Senior Registrar doctors, nurses and medical students from all over Majeda R. Al-Bash, Registrar Oman, Saudi Arabia and Australia and from vari- Hazel Gonsalves, Registrar ous other nations. There were four pre-conference Hana Al-Sayed, Registrar workshops: Hysteroscopy and Laparoscopy; Car- Asha Nair, Registrar diotocography in Obstetrics; Obstetric Emergency Jai Kumari, Registrar Drills, and Fetal Echocardiography. The feedback Sunita Kumari, Registrar was positive from the 120 people who participated in the four workshops. Seema Zulfikar, Registrar Sarya A. Bella, Registrar The Department invited the urogynaecologist, Dr. Farah Fathih, Registrar Saeed Al-Sary, Assistant Professor at King Saud Ayesha Salahuddin, Senior House Officer University for Medical Sciences, Saudi Arabia, to Mayesa T. Al-Din, Senior House Officer present a workshop on Urogynaecology and Re- Sara A. Zaid, Senior House Officer constructive Pelvic Surgery from 1–5 March 2013. A Nooren Ishrat, Senior House Officer

148 total of eight patients had advanced urogynaecological procedures during this period. The main emphasis was on the surgical management of vaginal vault prolapse. In addition, Dr. Saeed demonstrated modified techniques for vaginal vault suspension with uterine preservation. The highlight of the workshop was that for the first time at Sultan Qaboos University a series of laparoscopic sacrocolpopexies and sacrospinous vault suspensions were carried out. In addition, a modified technique of uterine suspension with uterine preservation was carried out. During the surgical procedure, the teaching highlighted the relevant anatomical landmarks, surgical techniques and variations of technique.

The Department also organised a second workshop, Advanced Urogynecology and Pelvic Floor Reconstruc- tive Surgery. The visitor this time was Prof. Ganesh from Coimbatore, India, invited by Dr. Lamya Al-Kharusi, Deputy Head of the Department. Prof. Ganesh did several operations in Gynaecology such as urethral recon- struction and his expertise was well appreciated. A half-day symposium on Urogynaecology was conducted in collaboration with the urologists, and Prof. Ganesh was one of the speakers along with Dr. Lamya and others.

Finally, the Department organised a hands-on ultrasound course for 12 doctors. The members of the training departments team were Dr. Maryam Al-Shukri, Dr. Tamima Al-Dughaishi and Dr. Lovina Machado. care Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME patient Pre-Clerkship Programme There are about 120 students in the Pre-clerkship phase. They are taught weekly for 9 weeks on such topics and as common symptoms during antenatal history-taking, as well as the demonstration of mannikins; a review of reproductive anatomy; common symptoms and signs in obstetrics and gynaecology, such as menstrual dysfunction; infertility; menopause; early pregnancy problems; antepartum and postpartum haemorrhage and normal delivery. A mini-clinical evaluation exercise (mini-CEX) is conducted at the end of each week for Obstetrics & Gynaecology the students. academic

Old Curriculum - 7th Year Medical Students There were about 120 students in the 7th year who rotated in the Department from July 2012 to June 2013. They rotated for 7 weeks and had a week of lectures followed by clinical rotation in three sites (SQUH, Royal Hospital and Khoula Hospital). There was an overlap of Senior Clerkship and 7th year medical students for six months from January to June 2013. The last group of old curriculum 7th year students finished their final M.D. in June 2013 and there were no failures.

149 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Senior Clerkship Programme The Senior Clerkship students started in January 2013 and their rotation finished in January 2014.T here were about 115 students. Their clerkship lasted 13 weeks: eight weeks in obstetrics and gynaecology, three weeks in Child Health, and two weeks in laboratories. The first two weeks of the obstetrics and gynaecology rotation consists of lectures and posting in the skills laboratory/simulation centre. After that they rotate for six weeks in three different sites, SQUH, Royal Hospital and Khoula Hospital. They have five in-course assessments including two mini-CEXs, one case-based discussion, one observed long case and one key feature question. At the end of the year they are assessed in blocks with a written component of multiple choice questions, extended matching questions and short answer questions with a blueprint, as well as an objective structured clinical examination (OSCE) for the whole Senior Clerkship rotation. There were four obstetrics and gynaecology questions in the OSCE.

POSTGRADUATE PROGRAMME Oman Medical Specialty Board Residency Programme Residents from the Oman Medical Specialty Board (OMSB) rotate in the Department. Both Junior (years 1 to 3) and Senior Residents are posted in the Department in the teams, wards and outpatient departments (OPDs). They are assessed every four weeks. The residents are also posted in the ultrasound clinic and research blocks. A site supervisor assesses them every four weeks. The Chair of the Obstetrics & Gynaecology Programme is Dr. Lamya Al-Kharusi, while Dr. Wadha Al-Ghafri is the Programme Director. Eight faculty from the Department are members of the Obstetrics & Gynaecology Scientific Committee and they are also members of various subcommittees.

International Students In 2013, the Department received three international elective students: two from the USA and one from Swe- den; they gave a good feedback on their training here. There were also three clinical attachées and two interns from Yemen during 2013.

Training Courses & CME Activities The Department has a daily morning meeting that includes discussion of the emergencies of the previous day, handover and important announcements from the College and Hospital. The CME programme consists of a monthly Journal Club; a pathology round once every 2–3 months; a monthly multidisciplinary Fetal Anomaly Group meeting attended by staff of the Neonatal Intensive Care Unit (NICU), the Department of Genetics and paediatric surgeons; weekly residents’ presentations; weekly intern presentations; a weekly CME session aimed at senior house officers and registrars; a weekly inter-departmental meeting between the Department and the NICU, and a monthly departmental meeting attended by all departmental staff, midwives and OPD nurses as needed.

150 Clinical & Diagnostic Services Table 1: Gynaecology Outpatient Department patient statistics in 2013 Patient category No. of patients General OPD visits 16,996 Antenatal 9,285 Gynaecological 6,030 Postnatal 74

Infertility Clinic 1605 Diabetics Clinic 600 Urogynaecology Clinic 392 Colposcopy Clinic 63

Intrauterine Growth Restriction Clinic 50 departments

Fetal Maternal Clinic 283 care Amniocentesis Clinic 13 Recurrent abortion 172

Oncology 176 patient

Adolescents 18 and Combined infertility 132

Table 2:

Obstetrics & Gynaecology Department procedures in 2013 Obstetrics & Gynaecology Procedure No. academic Ultrasound scans 4,017 Mirena insertion (intrauterine device) 52 Phlebotomy 11,883 Hydrosonography 36 Endometrial biopsy 132 Bartholin abscess incision 1 Non-stress test 1,842 Bladder scans 91 Uro-flowmetry 79 151 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

In the Labour Ward from January 2013 to December 2013, a total of 5,733 patients were seen (1,373 day cases and 4,360 admissions). The total number of deliveries was 3,812, of which 2,916 were vaginal deliveries; 136 were instrumental vaginal deliveries; 558 were emergency Caesarean sections, and 202 were elective Caesarean sections.

We had a total of 3,825 admissions in the Red 2 Ward (mainly postnatal). Of these, 1,489 patients who delivered were booked via the antenatal clinic and 2,336 were un-booked cases. The total number of gynaecology patients admitted in Yellow 2 Ward was 3,130; of these 1,428 were new cases and 1,691 were old cases, with 11 cases from other departments. The total number of antenatal patients admitted to Yellow 2 Ward were 1,774; 546 were postnatal and 1,228 were gynaecological patients.

Research Research Projects Retrospective cohort study of the prevalence and outcome of urinary tract infection during pregnancy in SQUH Code: MREC #676 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Mariyam Al-Shukri, Dr. Faiza Al-Darmaii, Dr. Tamima Al-Dughaishi, Dept. Obstetrics & Gynaecology, SQU.

Peer review audit on caesarean section: Morbidity and indications Code: MREC #677 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. V. Gowri, Dr. Silja Arumugam, Dept. Obstetrics & Gynaecology, SQU.

Pregnancy outcome in advanced maternal age (40 years or older) in a tertiary care center (Sultan Qaboos University Hospital) in Oman Code: MREC #737 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Mariyam Al-Shukri, Dr. V. Gowri, Ibtihal Al-Kindii (student), Balqees Al-Mahrizi (student), Dept. Obstetrics & Gynaecology, SQU.

Evaluation of diagnostic ability of novel techniques in endometrial biopsy Code: MREC #739 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Maha Al-Khaduri, Dept. Obstetrics & Gynaecology, SQU.

152 Major etiological factors of infertility and treatment outcomes in infertile couples attending Sultan Qaboos University Hospital, Oman Code: MREC #747 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. V. Gowri, Sara Al-Rasbi (student), Aseel Al-Rashdi (student), Dept. Obstetrics & Gynae- cology, SQU.

Attitudes towards oocyte cryopreservation among women of reproductive age in Oman Code: MREC #782 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Maha Al-Khaduri, Dept. Obstetrics & Gynaecology, SQU.

Association of young maternal age with reproduction outcomes Code: MREC #802 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Rahma Al-Haddabi, Dept. Obstetrics & Gynaecology, SQU. departments

Prevalence and outcomes of teenage pregnancy in Oman Code: MREC #803 Dates: 2013 Value: Unfunded Project Approval: SQU care Investigators: Dr. Rahma Al-Haddabi, Dr. Majeda Al-Bash, Najla Al-Maqbali (student), Dept. Obstetrics & Gynaecology, SQU.

Retrospective analysis of the demographic maternal characteristics and perinatal/neonatal outcomes of patient all RH negative pregnant women with alloimmunization who managed at SQUH from Jan 2008 to Dec

2012 and

Code: MREC #810 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Tamima Al-Dughaishi, Maymoona Al-Dhuhli (student), Yusra Al-Harrasi (student), Dept. Obstetrics & Gynaecology, SQU. Obstetrics & Gynaecology academic Prevalence and demographic maternal characteristics of minor RBC alloimmunization in Omani pregnant women at SQUH: 5 year rectropective study Code: MREC #823 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Tamima Al-Dughaishi, Dr. Ikhlass Al-Rubkhi, Dept. Obstetrics & Gynaecology, SQU.

A study of the prevalence of postnatal depression (PND) in the Sultanate of Oman and the validation of appropriate screening Code: MREC #831 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. V. Gowri, Dr. Nawal Al-Maamari (resident), Dept. Obstetrics & Gynaecology, SQU; Prof. Samir Al-Adawi, Dept. Behavioural Medicine, SQU.

153 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Cord blood C-peptide level and neonatal outcome in relation to maternal hemoglobin A c in last trimester of pregnancy Code: MREC #845 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Maryam Mathew, Dept. Obstetrics & Gynaecology, SQU.

Research Publications & Books Journal Publications 1. Gowri V. Abortion and ensoulment. (Editorial). Sultan Qaboos University Med J 2013; 13:1–2. 2. Gowri V. An unusual cause of postmenopausal bleeding. BMJ Case Reports 2013; doi: 1136/bcr-2012-008500. 3. al-Hinai M, Al-Muqbali M, Al-Moqbali A, Gowri V, Al-Maniri A. Effects of pre-pregnancy body mass index and gestational weight gain on low birth weight in Omani women: A case-control study. Sultan Qaboos Univ Med J 2013; 13:386–91. 4. Hossen A, Jaju D, Barhoum A, Gowri V, Hamdi I,...Al-Kharusi L. Investigation of the high frequency band of heart rate variability: Identification of preeclamptic pregnancy from normal pregnancy in Oman. Asian Biomed 2013; 7:339–46. 5. Al Ghafri W, Gowri V, Al-Khaduri M, Al-Shukri M. Life-threatening corpus luteal hemorrhage. Gynecology (Herbert Open Access Journals) 2013; doi: 10.7243/2052-6210-1-2. 6. Al-Shukri M, Al-Ghafri W, Gowri V. Pelvic nodules in a gynecologic patient. Oman Med J 2013; 28:292–3. 7. Al Khaduri M, Al Farsi Y, Al Najjar TAA, Gowri V. Hospital-based prevalence of polycystic ovarian syndrome among Omani women. Middle East Fertil Soc J 2013; doi: 10.1016/j.mefs.2013.06.006. 8. al Subhi T, Al Jashnmi RN, Al Khaduri M, Gowri V. Prevalence of tubal obstruction in the hysterosalpingogram of women with primary and secondary infertility. J Reprod Infertil 2013; 14:214–16. 9. Gowri V, Rizvi G, Saquib S. Relationship of high sensitivity C-reactive protein and other biochemical parameters of metabolic syndrome in women with polycystic ovarian syndrome and BMI matched controls. Res Endocrinol (IBI- MA Publishing) 2013; Article ID 503467. 10. al Mulhim AA, Abu-Heija AA, Al-Talib AA, Al-Turki HA, Gasim TG. Hormonal, metabolic and clinical profile ofS audi Women with polycystic ovary syndrome. Saudi J Med & Med Sci 2013;1:30–4. 11. saleh J, Machado L, Razvi Z. 2-hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in “appropriate for gestational age” neonates in healthy nondiabetic pregnancies. BioMed Res Int 2013; Article ID 757459. 12. Mathew M, Gonsalves H, Al-Azawi S, Saparamadu PAM. Asymptomatic ovarian mucinous cystadenoma with a solid mural leiomyoma: Case report and brief review. Sultan Qaboos Univ Med J 2013; 13:127–31. 13. Arumugham S, Mathew M, Deoskar S, Sharma J. Uterine torsion mimicking supine hypotension syndrome after regional anaesthesia. BMJ Case Rep 2013; doi:10.1136/ bcr-2013-010508. 14. al-Jabri AA, Yousef RM, Hasson SS, Balkhair AA, Al-Belush M,...Mathew M, et al. Knowledge, attitudes and untended behaviour towards mandatory HIV testing: A survey of Omani pregnant women. AIDS Educ Prev 2013; 25:255–67. 15. Sheikh S, Mathew M, Abdellatif M, Qureshi A, Mandan P. Multiple enteric duplication cysts in a twin fetus: Diagno- sis and management. Sultan Qaboos Univ Med J 2013; 13:593–6. 16. Mathew M, Khaskheli M, Bella SM, Pillai SA. An unusual cause of acute central chest pain during advanced pregnancy. J Arab Board Health Sci 2013; 14:62–4.

154 17. Al Riyami N, Al-Ruheili I, Al-Shezawi F, Al-Khabori M. Extreme premature rupture of membranes (PPROM): Risk factors and maternal (outcomes). Oman Med J 2013; 28:108–11. 18. al-Farsi SH, Al-Riyami NM, Al-Khabori M, Al-Huenini M. Maternal complications and the association with baseline variables in pregnant women with sickle cell disease. Hemoglobin 2013; 37:219–26. 19. abdullatif M, Alsinai S, Al-Balushi Z, Al-Dughaishi T, Abuanza M, Al-Riyami N. A case of fetal and neonatal resolution of abdominal ascites. Sultan Qaboos Univ Med J 2013; 13:175–8. 20. Al-Riyami N, Al-Haddabi R, Al-Dughaishi T, Al-Riyami M. Placental tumor: What could it be? Sultan Qaboos Univ Med J 2013; 13:E459–62. 21. Al-Riyami N, Al-Shezawi F, Al-Ruheili I, Al-Dughaishi T, Al-Khabori M. Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes (mid-trimester PROM), Sultan Qaboos Univ Med J 2013; 13:51–6. 22. Al Riyami N, Al-Rusheidi A, Al-Khabori M. Perinatal outcome of monochorionic in comparison to dichorionic twin pregnancies. Oman Med J 2013; 28:173–7. 23. tam G, Al-Dughaishi T. Case report and literature review of very echogenic amniotic fluid at term and its clinical significance. Oman Med J 2013; doi: 10.5001/omj.2013.129. 24. Ortashi O, Al-Kalbani M. Gynecological cancer services in Arab countries: Present scenario, problems and suggested solutions. Asian Pac J Cancer Prev 2013; 14:2147–50.

25. Qureshi A, Kumar S, Ismail SI, Al-Kalbani M, Burney I. C KIT negative extra intestinal GIST with no detectable muta- departments tions; a rare case. J Solid Tumor (SCIEDU) 2013; doi: 10.5430/jst.v3n5p25. 26. al-Farsi YM, Waly MI, Deth RC, Al-Sharbati MM, Al-Shafaee MA,...Al-Khaduri M, et al. Impact of prenatal and post-

natal nutrition on serum levels of docosahexaenoic acid (DHA) among Omani children with autism. Nutrition 2013; care 29:1142–6. 27. al-Farsi YM, Waly MI, Al-Sharbati MW, Al-Shafaee M, Al-Farsi OA, Al-Khaduri MM, et al. Levels of heavy metals in children with autism in Oman. Biol Trace Elem Res J 2013; 151:181–6. patient

28. al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O, Al-Khaduri MM, et al. Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism. Nutrition 2013; 29:537–41. and

29. al-Farsi YM, Waly MI, Al-Sharbati MM, Al-Shafaee M, Al-Farsi O,...Al-Khaduri M. Variation in socio-economic burden for caring the children with autism spectrum disorder in Oman: Caregiver perspectives. J Autism Dev Disord 2013; 43:1214–21. 30. Machado L, Al-Hamdani A, Sankhla DK, Al-Moundhri MS. Extraosseous Ewing sarcoma of the vagina: A rare entity: Case report and forty year literature review. Ann Saudi Med 2013, 33:182–6. Obstetrics & Gynaecology academic Conference & Seminar Presentations Oral Presentations International 1. Al-Dughaishi T. Incidence and outcome of triplet pregnancies in SQUH. 1st Saudi Maternal Fetal Medicine Congress, Riyadh, Saudi Arabia, 4–7 Feb 2013. 2. Al-Khaduri M. Overview of aromatase inhibitors in ovulation. Scientific Meeting of the Saudi Obstetrics & Gynecol- ogy Society, Jeddah, Saudi Arabia, 9–11 Apr 2013. 3. Al-Khaduri M. Overview of aromatase inhibitors in ovulation. “Best Practice Points in Gynecology, Obstetrics, Infer- tility & Endoscopy”, 2nd Annual Regional Meeting of Minimally Invasive Surgery Society of Egypt in collaboration with Wellcare Medical Center, Abu Dhabi, UAE, 7–9 Mar 2013.

155 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

4. Al-Kalbani M. Clinical management of cervical cancer. 1st International Congress on Oncology, Abu Dhabi, UAE, 24–25 Oct 2013.

National 1. Ghafri W, Al-Shukri M. Investigating recurrent miscarriages “one size fits all”. (Debate). 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 2. Al-Dughaishi T. Update on progestogens in pre-term labour. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 3. Al-Riyami N. Role of cerclage in twins and triplet pregnancies. 1st International Conference on Advances in Obstet- rics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 4. al-Kharusi L. Prevention and management of vault prolapse. 1st International Conference on Advances in Obstet- rics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 5. al-Khaduri M. Regulating infertility treatment. 1st International Conference on Advances in Obstetrics & Gynecol- ogy, SQU, Muscat, Oman, 4–6 Dec 2013. 6. Machado L. Morbid obesity in pregnancy. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 7. Al-Shukri M. Management of menstrual disorders in adolescent girls with malignancies.1st National Conference of Obstetric Ultrasound in Obstetrics & Gynaecology, Oman, Sep 2013. 8. Al-Shukri M. Septic miscarriges and their consequences. 1st National Conference of Obstetric Ultrasound in Obstet- rics & Gynaecology, Oman, Sep 2013. Poster Presentations International 1. Haddabi R, Riyami N, Dughaishi T. Placental tumor what could it be? World Congress on Building Consensus out of Controversies in Gynecology, Infertility & Perinatology (BCGIP-COGI), Istanbul, Turkey, 30 May – 2 Jun 2013. 2. Machado LSM, Saqib S, Zulfikar S, Rizvi G. Teenage pregnancy in Oman: Obstetric outcome. World Congress on Building Consensus out of Controversies in Gynecology, Infertility & Perinatology (BCGIP-COGI), Istanbul, Turkey, 30 May – 2 Jun 2013. 3. Gowri V, Shukri MA, Al Farsi FAM, Al Busaidi NAN, Al Farsi K, Daar S, et al. Clinical profile of patients presenting with premature menopause to the Sultan Qaboos University hospital, Sultan Qaboos University, Muscat, Oman. Royal College of Obstetricians and Gynecologists (RCOG) World Congress, Liverpool, UK, 24–26 Jun 2013. 4. Machado LSM, Al-Sayed H, Al-Riyami N. Intramural ectopic: Successful management with methotrexate. World Congress on Building Consensus out of Controversies in Gynecology, Infertility & Perinatology (BCGIP-COGI), Istan- bul, Turkey, 30 May – 2 Jun 2013, and 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 5. Mathew M, Ghayati M, Saquib S, Rizvi SG. Association between HbA1c levels and pregnancy outcome in diabetic pregnancies. 7th International Diabetes in Pregnancy (DIP) Symposium on Diabetes, Hypertension, Metabolic Syn- drome & Pregnancy, Florence, Italy, 13–16 Mar 2013. 6. Mathew M, Al Aamri NM, ZulfiqarS , Al Rasaadi K. Accuracy of Optium Xceed Glucose Meter for measuring blood glucose levels in pregnancy. 7th International Diabetes in Pregnancy (DIP) Symposium on Diabetes, Hypertension, Metabolic Syndrome & Pregnancy, Florence, Italy, 13–16 Mar 2013. 7. Sheik S, Mathew NR, Al-Sukaiti R, Al-Riyami N, Mathew M. A rare case of twin pregnancy with a live fetus and co-existing hydatidiform mole. 9th Singapore International Congress on Obstetrics & Gynecology, Singapore, 22–24 Aug 2013.

156 8. Sheik S, Gowri V, Al-Ali F, Mathew M, Al-Kharousi L. Uterine rupture in second trimester due to placenta percreta. 9th Singapore International Congress on Obstetrics & Gynecology, Singapore, 22–24 Aug 2013. 9. Burney I, Al-Salmani J, Al-Kalbani M, Gowri V, Zahid F, Kumar S, et al. Pregnancy associated breast cancer: A report of outcomes of pregnancy and breast cancer from an Arab country. European Society of Gynaecological Oncology, 18th ESGO International Meeting, Liverpool, UK, 19–22 Oct 2013. 10. Al-Khalbani M. Patient information leaflets and colposcopy. 2nd International Gynecologic Cancer Society, Regional Meeting on Gynecologic Cancers, Bali, Indonesia, 11–13 Apr 2013. 11. Al-Khaduri MM, Al-Qadi H, Al Qarshoubi I. Rectovaginal and bladder involvement in stage four endometriosis. 1st Annual Middle East Society for Gynecological Endoscopy (MESGE) Congress with Turkish Society of Gynecological Endoscopy, Antalya, Turkey, 24–28 Apr 2013. 12. al-Farsi YM, Waly MI, Al-Sharbati MW, Al-Shafaee M, Al-Farsi OA, Al-Khaduri MM, et al. The potential role played by heavy metals toxicity in the etiology of autistic features. 18th Mediterranean & 9th Pan Arab Child Neurology Congress, Alexandria, Egypt, 17–18 Apr 2013. 13. Al-Khaduri M. Predicting and Preventing Ovarian Hyperstimulation Syndrome. 22nd Annual Scientific Meeting of the Saudi Obstetrics & Gynecology Society, Jeddah, Saudi Arabia, 9–11 Apr 2013. 14. al-Sharbati MM, Al-Farsi YM, Al-Shafaee MA, Waly MI, Al-Farsi OA, Al-Khaduri MM, et al. Misconceptions towards autism among school teachers in Oman: A cross-sectional study. 9th International Iraqi Medical Association World Conference, Sharjah, UAE, 28–31 Mar 2013. departments

15. al-Sharbati MM, Al-Farsi YM, Al-Shafaee MA, Waly MI, Al-Farsi OA, Al-Khaduri MM, et al. Autism awareness workshops for medical students can raise their interest. 9th International Iraqi Medical Association World Conference, Sharjah, UAE, 28–31 Mar 2013. care 16. Gowri V, Shukri MA, Al-Farsi FAM, Al Busaidi NAN, Al-Farsi K, Daar S, et al. Clinical profile of patients presenting with premature menopause to the Sultan Qaboos University Hospital, Sultanate of Oman. RCOG World Congress, Liverpool, UK, 23–26 Jun 2013. BJOG 2013; E-pub 21 Jun 2013. doi: 10.1111/1471-0528.12294. 17. Gowri V, Al-Mahrooqi M, Al-Shidhani AN, Rizvi G. Age of menarche in Omani school girls and their relationship patient

to body mass index (BMI). RCOG World Congress, Liverpool, UK, 23–26 Jun 2013. BJOG 2013; E-pub 21 Jun 2013. doi: 10.1111/1471-0528.12342. and National 1. eltayg M, Bai A, Jaikumari K, Gowri V, Rao K. Unilateral fallopian tube live twin gestation: Diagnosed pre-operative- ly and managed successfully. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013.

2. Al-Khaduri M, Al Farsi Y, Al Hajri H. Assessment of awareness about polycystic ovary syndrome among female Obstetrics & Gynaecology university students. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 academic Dec 2013. 3. Fatema Y, Alafifi I, Al-Kiyumi M, Al Farsi Y, Al Khaduri M. Clinical profile of women diagnosed with polycystic ovarian syndrome in a tertiary hospital in Oman: A case-control study. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 4. Manjunath AP, Girija SI, Kumari P. Recurrent aggressive angiomyxoma of vulva. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 5. al Hoqani F, Ambusaidi S, Al Ghafri W, Al Farsi Y, Gowri V, El Tayeb S. Recurrent Miscarriage and Consanguinity among Omani Women: A case-controlled study. 1st International Conference on Advances in Obstetrics & Gynecol- ogy, SQU, Muscat, Oman, 4–6 Dec 2013. 6. ambusaidi S, Al Hoqani F, El Tayeb S, Al Farsi Y, Gowri V, Al-Ghafri W. Etiology of recurrent miscarriage among Oma- ni women presenting to SQUH. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013.

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7. Al-Ghafri W, Al-Shukri M, Al-Riyami M, Al Amrani K. Mature cystic teratoma: Rare histopathologic presentation of mucinous cystadenoma in an appendix in the ovarian teratoma. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 8. Machado L, Saleh J, Rizvi Z. 2-hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in “appropriate for gestational age” neonates in healthy non-diabetic pregnancies. 1st Inter- national Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 9. Machado LSM, Omer D, Bai A, Al-Haddabi I. Giant borderline mucinous cystadenoma presenting as an acute abdomen in the early puerperium. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 10. Pillai SA, Mathew M, Ishrat N, Kakaria A, Quershi A, Gowri V. Ruptured rudimentary horn pregnancy diagnosed by preoperative MRI resulting in fetal salvage. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 11. Mubarak SA, Jesrani SK, Mathew M. Conservative management of twisted ischaemic adnexa in early pregnancy. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 12. salaluddin A, Mathew NR, Nandhagopal R, Mathew M. Idiopathic intracranial hypertension: An unusual cause of postpartum headache. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 13. Zulfikar S, Bai A, Begum PS, Mathew M. Pregnancy outcome following bariatric surgery. 1st International Confer- ence on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 14. Pillai SA, Al-Shukri M, Mathew M, Al-Dughaishi T,...Khan D, Gowri V, Rizwi G. An audit of caesarean sections by peer review. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 15. Al-Khaduri M, Al Farsi Y, Al-Alawi A. Evaluation of diagnostic ability of novel techniques in endometrial biopsy. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. 16. Khan D, Hadrami A, Al-Shukri M, Gowri V, Abdellatif M, Al-Dughaishi T. Outcome of triplet pregnancies in SQUH. 1st International Conference on Advances in Obstetrics & Gynecology, SQU, Muscat, Oman, 4–6 Dec 2013. Seminar Presentations

National 1. Al-Riyami N. Accreditation. Obstetrics & Gynaecology Annual Retreat Day for Trainers and Residents, SQUH, Oman, 19 Sep 2013. 2. Al-Riyami N. The basics of fetal wellbeing assessment. Obstetric Ultrasound Workshop, Royal Hospital, Oman, 4–5 Oct 2013. 3. Al-Riyami N. Recent advances on the management of IUGR. Obstetric Ultrasound Workshop, Royal Hospital, Oman, 4–5 Oct 2013. 4. Machado L. Pathophysiology of birth asphyxia. Obstetrics & Gynaecology Club, SQUH, Oman, May 2013. 5. gowri V. Communication in emergency obstetrics. Rustaq Intrapartum Updates, Rustaq Hospital, Oman, 5 Oct 2013. 6. al-Kalbani M. Breaking bad news to oncology patients. Continuing Nursing Education Seminar, SQUH, Oman, 12 Aug 2013. 7. Al-Kharusi L. ‘Snowed in’: Management of vault prolapse. Clinico-Pathologic Conferences, College of Medicine & Health Sciences, SQU, Oman, Sep 2013.

158 8. Al-Shukri M. Assessment of normal pelvis. Basic Hands-on Ultrasound Course in Obstetrics & Gynaecology, SQUH, Oman, 30 Oct – 1 Nov 2013. 9. Al-Shukri M. Placenta and its abnormalities. Basic Hands-on Ultrasound Course in Obstetrics & Gynaecology, SQUH, Oman, 30 Oct – 1 Nov 2013. 10. al-Shukri M. Post-partum ultrasound. Basic Hands-on Ultrasound Course in Obstetrics & Gynaecology, SQUH, Oman, 30 Oct – 1 Nov 2013. 11. al-Shukri M. Physiological changes, retained products and haematomas, cervical length assessment: Indications and methods. Basic Hands-on Ultrasound Course in Obstetrics & Gynaecology, SQUH, Oman, 30 Oct – 1 Nov 2013. 12. Al-Shukri M. Uterine ultrasound: Endometrial abnormalities. Basic Hands-on Ultrasound Course in Obstetrics & Gynaecology, SQUH, Oman, 30 Oct – 1 Nov 2013. 13. Al-Shukri M. Adnexal Masses. Basic Hands-on Ultrasound Course in Obstetrics & Gynaecology, SQUH, Oman, 30 Oct – 1 Nov 2013. departments

care

patient

and

Obstetrics & Gynaecology academic

159 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

160 departments

care

Ophthalmology patient

and Ophthalmology

he Department of Ophthalmology at the Sultan Qaboos University Hospital (SQUH) is a tertiary level eye-care centre and continues to be a recognised leader in providing an advanced level of patient care, teaching and research in ophthalmology in Oman. T academic Fully equipped with state of art diagnostic and therapeutic tools, the Department offers the best in ophthalmic subspecialty services. Besides managing routine eye problems, we also have the capability to treat patients with complicated eye diseases. We offer our patients the latest in intraocular lens (IOL) technology, including ResTOR and Toric IOLs for astigmatism correction capacity. Advanced vitreo-retinal procedures are performed by experienced surgeons in the Department.

The Paediatric Ophthalmology Unit has grown over the years to be a major referral centre in the country for paediatric eye disorders. Besides expertise in various facets of paediatric eye diseases including retinopathy of prematurity, the Unit also caters to patients with strabismus (ocular misalignment) and ocular genetic disorders.

The Department is now running a fully-fledged visual electrodiagnostic service—the only one in the entire country. Ocu- loplastic procedures with both functional and cosmetic significance are routinely performed by experts in the Department.

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Neuro-ophthalmic expertise was added to the De- Support Staff (College) partment in the last year. In collaboration with Laila Al-Kindi, Coordinator neurologists, we run a Botox clinic. The Department continues to be actively involved in research, teach- Support Staff (Outpatient Department) ing and training. Mangu Thomas, Staff Nurse, Adult Team Priya Khora, Staff Nurse, Paediatric Team Habiba Al-Belushi, Chief Technician Staff Bushra Al-Jabri, Optometrist Sreelatha O. K., Optometrist Head of Department Edgardo Go, Optometrist Nadiya Al-Kharousi, Senior Consultant Vidya Thomas, Optometrist, Paediatric Team Faculty Salim Al-Abri, Senior Technician Raya Al-Mughery, Senior Technician Ahmed Al-Hinai, Senior Consultant, Vitroretinal Sadika Al-Ajmi, Senior Technician Surgeon Harith Al-Hasani, Technician Sana Al-Zuhaibi, Senior Consultant, Paediatric Hanan Al-Harty, Technician Ophthalmology Unit Eman Al-Hasmi, Technician Abdullah Al-Mujaini, Senior Consultant, Iman Al-Harthy, Technician Oculoplasty Surgeon Melinda Manegdeg, Coordinator Anuradha Ganesh, Consultant, Paediatric Ophthalmology Unit Support Staff (4 BlueW ard) Mohammed Al-Abri, Consultant,Vitroretinal Zaleha Bzaman, Senior Charge Nurse Surgeon Shirley Angsa, Senior Charge Nurse Upender Wali, Senior Registrar Idawati Puteri, In-Charge Nurse 5 Archana Thakral, Senior Registrar Marylin Dagle, In-Charge Nurse 5 Nawal Al-Fadhil, Senior Registrar Alice Abraham, In-Charge Nurse 6 Buthaina S. Al-Sabt, Senior Registrar Remedios Ganibe, Staff Nurse 1 Aisha Al-Busaidi, Senior Registrar Fahima Julandani, Staff Nurse 1 Shahab Agha, Registrar Shafila Beevi, Staff Nurse 1 Sitara Azeem, Registrar Bindhu P. Ravi, Staff Nurse 1 Rana Al-Senawi, Registrar Jessy Jose, Staff Nurse 1 Samia Al-Jabri, Registrar Sherly Varghese, Staff Nurse 1 Beena Harikrisna, Registrar Jincy Geevarghese, Staff Nurse 1 Dalal Al-Zahra, Registrar Fatma Al-Maskari, Staff Nurse 1 Nouf H. Al-Farsi, Registrar Rahma Al-Hadhrami, Staff Nurse 1 Tysser A. R. Basi, Senior House Officer Minna Sunny V. I. P., Staff Nurse 1 Bindu Biju, Staff Nurse 2

162 Jennifer E Farenas, Staff Nurse 2 Hema Jacob, Staff Nurse 2 Joanna Martis, Staff Nurse 2 Liza Linda, Staff Nurse 2 Bindu K. Manuel, Staff Nurse 2 Sumaiya Al-Sarhani, Staff Nurse 2 Susan Jacob, Staff Nurse 2 Sunimol Mathew, Staff Nurse 2 Akhila Antoney, Staff Nurse 2 Racielle Balisi, Staff Nurse 2 Badriya Al-Ghazi, Ward Clerk Highlights of the Year 2013 The Joint International Ophthalmological Conference was held in Muscat between 12–14 December 2013. It was organised by the Oman Ophthalmic Society and SQU in collaboration with the German Ophthalmolog-

ical Society. The Department participated by making 12 presentations. departments

Prof. Gerd Holmström, a paediatric ophthalmologist from Uppsala University, Sweden, with around 55 care peer-reviewed scientific publications, visited the Department to share his knowledge and experience in order to improve the scope of the Department’s work and research. During the visit, Prof. Holmström gave a lecture on advances in the management of retinopathy of prematurity (ROP). He also participated in the Oman

Joint International Ophthalmological Conference where he presented a lecture on the recent advances in the patient screening and treatment of ROP. and Ophthalmology In 2013, three ophthalmologists came to the Department for clinical attachments.

Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME academic The main objective of the course run by the Department is to introduce students to ophthalmology as a branch of surgery and to provide them with core information which will allow them to recognise, diagnose and manage common diseases of the eye and the adnexa. Particular emphasis is laid on awareness of the most frequent blinding diseases and the largely preventable and curable maladies of the eye such as cataract, glaucoma, trachoma, diabetic retinopathy, trauma and congenital anomalies.

The residency programme in ophthalmology was launched in 2009 under the umbrella of the Oman Medi- cal Specialty Board (OMSB). A total of 14 residents have been accepted in the Department. The most import-

163 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

ant courses offered to residents are: Pediatric Ophthalmology; Corneal External Disease; Retinal Diseases; Optics and Refraction; Neuro-Ophthalmology; Glaucoma; Cataract; Oculoplastic procedures; Uveitis, and Phacoemulsification.

In the Pre-clerkship programme, the Department teaches new modules to 12–14 students per session for two days a week, nine weeks a year followed by a clinical examination. Students are exposed to different clinical cases in the eye clinic and encouraged to examine and present the case. They also need to keep a record of clinical and practical skills learned during their rotation both in log books and in the student electronic patient record.

In the Junior Clerkship program, students are divided in two groups, spending seven days in SQU Hospital and eight days at Al-Nahda Hospital, Muscat. During the first half of their rotation they have presentations on: red eye, trauma, visual loss, diplopia and pupillary reaction. In the second half, students rotate again; by then they should have completed these five modules and only necessary revisions are made.

Training Courses & CME Activities A total of 65 CME courses were run by Departmental staff in 2013 as follows:

1. Case Presentation 18. Multiple Cranial Neurophthalmitis 2. Laser Photocoagulation 19. Spectoral Domain Optical Coherence Tomography (OCT) 3. Retina Teaching – Macular table 20. Ophthalmic Echography II: Examination and Tech- niques 4. Oculo Plastic Lecture 21. Case Presentation 5. Electroretinogram 22. Optic Nueritis in Children 6. Retina Teaching 23. Papilloedema – Case Presentation 7. Quiz I 24. Posterior Segment Imaging 8. Quiz I (continued) 25. Esotropia – Case Presentation 9. Quiz II 26. Unilatheral 10. Ocular Manifestations of Leukaemia Ptosis 27. Endophthalmitis Neonatal Sepsis 11. Sebaceous Gland Carcinoma 28. Case Presentation 12. Diabetic Macular Oedema – Update 29. Air Bags and Eye Injury 13. Intraorbital Foreign Body 30. Purtscher’s Retinopathy 14. Advances in Surgical Treatment of Keratoconous 31. Symblepharon 15. Ophthlamic Echography 32. Azarga, Alcon Company 16. Discharge Summary Audit 33. 17. Fundus Fluorescein Angiography, Visual Acuity and Ptosis Autoflourescence Case Presentation 34. Central Serous Retinopathy – Case Presentation

164 35. Choroidal Neovascularisation Classification 51. Clinical Orthoptic Evaluation 36. Management of Paediatric Cataract 52. Case Presentation 37. Preseptal Cellulitis and Dacryocystitis 53. Advances in Cataract Surgery 38. Orbscan 54. Ocular Decompensation Syndrome 39. Quiz 55. Pneumatic Retinopexy 40. Laser Photocoagulation 56. Retinal Occlusion 41. How to Deal with Vitreous Haemorrhage 57. Diplopia Analysis 42. Blindness in a Child on Continuous Pericorneal Dialysis 58. Cataract Surgery 43. Visual Field Lecture I 59. Orbital Trauma 44. Visual Field Lecture II 60. Bilateral Retinoblastoma 45. Visual Field Lecture III 61. Fundus Fluorescein Angiography Rounds (Branch Reti- nal Vein Occlusion ) 46. Masquerade Syndrome 62. Peer-Review Topic: Intraocular Lens Technology 47. Accommodation of Presbyopia and Bifocals 63. Solar Retinopathy – Case Presentation 48. Orbital Complications of Functional Endoscopic Sinus departments

Surgery 64. Allergic Reaction 49. Paediatric Objectives Part I 65. Case Presentation

50. Paediatric Diagnosis care

patient

Clinical & Diagnostic Services In 2013 the total number of adult inpatients was 468. There were 61 paediatric inpatients. and Ophthalmology

Table 1: Ophthalmology Outpatient Department Table 2: Minor outpatient procedures in 2013 statistics in 2013 Procedure No. Category No. Minor operation 423 academic Patientsbooked 11,062 Blood extraction 489 Patients seen 13,877 Sedation 59 Patients admitted 662 Cannulation 140 Missed appointments 1,821 Dilatation 6,458 Patients discharged 413 Other 346 Patients for prescription only 1,555 Total 7,915 Total 29,390

165 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Table 3: Laser procedures in 2013 Table 4: Technical procedures in 2013 Procedure No. Procedure No.

Argon 171 Refraction 12,111 YAG 33 Ultrasound 304 Photodynamic therapy 2 Pachymetry 131 Avastin and lucentis injections 265 Visual field 454 Fundus fluorescein angiography 146 Optical coherence tomography 1,962 Diabetic screening 430 Confoscan 10 Contact lens 58 Orbscan 123 Low vision service 10 Photo 637 Electroretinogram and visual evoked- 129 Total 27,843 potential Table 5: Main Theatre surgeries in 2013 Orthoptic 328 Major Intermediate Minor Total Total 1,567 Total 297 62 122 665

Research In addition to the projects listed below, departmental staff worked on the following topics of research: Cy- cloplegic effect of atropine versus cycoplentolate in patients with accomodative esotropia; Effectiveness of different surgical modalities on treating cicatricial entropion in Oman; Full thickness tarsal fracture versus partial thickness (grooving technique); Eyelash resection using eyelid skin approach versus grey line approach, and Ocular manifestations in thalassaemic patients of SQUH. The following three projects were OMSB research projects: The comparison of cyclopentolate plus tropicamide versus atropine in patients with refractive accommodative esotropia by means of retinoscopy; Macular cysts in retinal dystrophy, and Elect- roretinography changes in Omani thalassaemic patients.

166 Research Projects Clinical and molecular characterization of mucolipidosis-IV in patients from Oman Code: MREC #723 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Anuradha Ganesh, Dept. Ophthalmology, SQU.

Practice and teaching of medical ethics in a tertiary hospital in Oman Code: MREC #728 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Anuradha Ganesh, Dept. Ophthalmology, SQU.

An observational, multi-center, open, study assessing the efficacy and safety of lucentis (ranibizumab intravitreal injections) in patients with visual impairment due to macular edema secondary to retinal vein occlusion (RVO) Code: MREC #729 Dates: 2013 Value: Unfunded Project Approval: SQU

Investigator: Dr. Ahmed Al-Hinai, Dept. Ophthalmology, SQU. departments

Utilizing raNibizumab intraVitrEal Injection in a real-world setting in diabetic macular oedema (UN- care

VEIL DME) Code: MREC #730 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohammed Al-Abri, Dept. Ophthalmology, SQU. patient

Variation and association of smoking habit in pterygium amongst Omani population and Ophthalmology Code: MREC #772 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Upender Wali, Dept. Ophthalmology, SQU.

Research Publications & Books academic Journal Publications 1. Ganesh A, Al-Mujaini A. Ocular genetics: A sub-specialty service for genetic eye diseases. Oman Med J 2013; 28:1–2. 2. Ganesh A, Bruwer Z, Al-Thihli K. An update on ocular involvement in mucopolysaccharidoses. Curr Opin Ophthal- mol 2013; 24:379–88. 3. al-Hajri R, Ganesh A. Infant with visual inattention and nystagmus. Oman J Ophthalmol 2013;6:131. 4. Ganesh A, Mai DT, Levin AV. Pediatric glaucoma terminology. Am J Med Genet Part A 2013; 161A:3205–15. 5. Al-Mujaini A, Wali UK, Azeem S. Clinical applications of optical coherence tomography in modern medicine. Oman Med J 2013; 28:86–91. 6. Al-Mujaini A, Wali UK. Visual outcome following extracapsular cataract extraction in mature cataracts with pseu- doexfoliation syndrome: A retrospective study. Oman J Ophthalmol 2013; 6:23–6.

167 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

7. al-Busaidi T, Wali U, Al-Shirawi A, Al-Mujaini A. Dacryoadenitis as first presenting feature in systemic lupus erythematosus. Lupus 2013; 22:1431–2. 8. Al-Mujaini A, Sabt B, Al-Hadabi I. It is not chalazion. Oman J Ophthalmol 2013; 6:63–9. Books & Book Chapters 1. Kharousi N, Wali UK, Azeem S. Current applications of Optical Coherence Tomography in Ophthalmology. In: Kawa- saki M, Ed. Optical Coherence Tomography. Croatia: Intech Publishing Inc., 2013. Pp. 3–31. ISBN: 978-953-51-1032-3.

Conference & Seminar Presentations Oral Presentations International 1. Alkharousi N. Practical approach to retinal vasculitis. Emirates Ophthalmic Conference, Dubai, UAE, 12–14 Dec 2013. 2. alkharousi N. Update on the management of Behçets disease. Emirates Ophthalmic Conference, Dubai, UAE, 12–14 Dec 2013.

National 1. Al-Hinai A. Experience of intra-vitreal injection in tertiary hospital in Oman. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 2. Al-Zuhaibi S. Can S-cone waves in fullfiled ERG be accurate in detecting NR2E3 mutation? Joint International Oph- thalmological Conference, Muscat, Oman, 12–14 Dec 2013. 3. Al-Abri M. Pneumatic Retinopexy: An option for rhegmatogenous retinal detachment repair. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 4. ganesh A. Resident Research: The Ophthalmology Residency program, OMSB. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 5. Al-Zuhaibi S. The efficacy of intavitreal bevacizumabA ( vastin®) injection for retinopathy of prematurity in Oman. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 6. Al-Jabri B. Case Presentation. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 7. OK S. Optometry in India: Updates. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 8. Ganesh A. Congenital fibrosis of the extraocular muscles: Overview and management challenges. Joint Internation- al Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 9. OK S. Efficacy of tele-based (remotely operated) visual acuity examination using computerized visual acuity measurement system in a hospital based multilingual population. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 10. Wali U. Successful restoration of structural eye integrity in a patient with corneal perforation associated with graft versus host disease. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 11. Harikrishna B. Retinal dysfunction associated with inborn errors of metabolism: Ophthalmic findings are crucial for diagnosis. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013. 12. Agha S. Congenital corneal opacification and persistent fetal vasculature in Sanjad Sakati syndrome: New ocular associations. Joint International Ophthalmological Conference, Muscat, Oman, 12–14 Dec 2013.

168 departments

care

Oral Health patient

Oral Health and

he Oral Health Department provides dental, oral and maxillofacial services for the Sultan Qaboos University community, hospital inpatients and referred outpatients. It also acts as a tertiary centre of referrals for oral and maxillofacial surgery and paediatric dentistry. The Department provides dental services including basic primary dental care, oral Thygiene therapy, restorative, endodontic, as well as comprehensive paediatric dentistry, orthodontics and oral and maxillofacial academic surgery treatments.

The Department is also a member of the trauma team of Sultan Qaboos University Hospital (SQUH) and is therefore, actively involved in the treatment of patients with facial injuries including the repair of facial bone fractures. In addition, the Department is also heavily involved in the diagnosis and treatment of a wide range of medically-compromised patients including those with haematological malignancies, sickle cell anaemias and bleeding disorders. The dental services are provided at the Department’s outpatient clinic or in the operating theatre for the inpatients or day care visitors.

169 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Support Staff Fatma Al-Siyabi, Central Sterile Supplies Dept. Head of Department Technician Salim Al-Sudairy, Consultant, Oral & Maxillofacial Nasra Al-Habsi, Medical Orderly (CSSD) Surgeon Khaled S. Al-Mahrizi, Medical Orderly Deputy Head of Department Khamis Al-Jabri, Medical Records Clerk Nadia Al-Ghafri, Abdulaziz Bakathir, Senior Consultant, Oral & Coordinator Maxillofacial Surgeon Highlights of the Year 2013 Faculty The Department maintained a high standard of Amur Al-Hajri, Consultant dental care to patients and continued to improve Ali Al-Mullahi, Consultant, Paediatric Dentist and expand its services with the aim of enhancing Muntasar Al-Hinai, Consultant, Orthodontist the services for the increasing number of patients Awatif Al-Maskery, Senior Registrar seen and treated at the Department. In addition, Sameera Al-Anqoodi, Senior Registrar in Restorative the Department provided continuous support to Dentistry (on study leave) the expanding and specialised medical and sur- Hana Al-Raisi, Registrar gical units of SQUH and continued to play an im- Rasha Ahmed, Senior House Officer portant role in the holistic multidisciplinary care of Madelin Hernandaz, Senior House Officer SQUH patients. Mehboob Pasha, Senior House Officer Aftab Malik, Senior House Officer The Department’s clinical staff were actively involved in local scientific events and dental con- Other Medical Staff ferences conducted by the Ministry of Health in Nasriya Al-Harthy, Dental Hygienist/Therapist 2013. Staff of the Department attended the Oman Zahra Al-Ghafri, Dental Hygienist International Dental Conference held in Muscat Judy Mathew, In-Charge Nurse in early February 2013. Dr. Abdulaziz Bakathir and Lovely Kuriakose, Senior Nurse Dr. Muntasar Al-Hinai presented scientific papers Ibrahim Al-Shizawi, Medical Nurse at the Oman International Dental Conference and Ibtisam Al-Ambusaidi, Medical Nurse at the South Sharqiya 1st Dental Conference held Blankaji Ouseph, Medical Nurse in Sur on 18 April 2013. Furthermore, Dr. Abdulaziz Afrah Abdulbaqi, Dental Surgery Assistant Bakathir presented one scientific paper and a post- Sulaiman Al-Maqimi, Dental Surgery Assistant er at the 21st International Conference on Oral & Mohammed Al-Alawi, Dental Surgery Assistant Maxillofacial Surgery held in Barcelona, Spain, 21– Khamis Al-Mufargi, Dental Laboratory Technician 24 October 2013. Sarah Al-Siyabi, Dental Surgery Assistant In 2013, Department continued with the production of a series of educational leaflets for patients

170 covering a range of dental and oral surgery conditions. This work was done by the Department’s dental hygienist, Ms. Zahra Al-Ghafri.

Teaching Programmes The Oral Health Department continues to provide teaching support to M.D. degree students at the SQU Col- lege of Medicine & Health Sciences (COMHS), Ministry of Health (MOH) and the Institute of Health Sciences of the MOH. This included: 1) Pre-clerkship and Junior Clerkship teaching of M.D. students at the COMHS; 2) Clinical training of the internship dentists from the MOH; 3) Teaching of dental surgery assistance (DSA) students at the Institute of Health Sciences, MOH; and 4) Daily clinical teaching to the DSA students during their oral health rotations.

Clinical & Diagnostic Services The Department continued to provide primary dental treatment as well as specialised comprehensive paediatric dentistry, orthodontic, craniofacial anomalies and oral and maxillofacial surgical treatments. The num- departments ber of patients treated in Department increased by 1,176 patients in 2013 compared to 2012, with an 8.5% increase in the total number of patients attending the outpatient clinic in 2013 compared to a 5% increase in

2012. This rise is a reflection of the increase in the number of referrals for specialised paediatric, orthodontic care and maxillofacial care from various hospital departments as well as from other regional hospitals and local patient

Oral Health and

academic

Figure 1: Number of outpatients treated at the Oral Health Department from 2011–2013.

171 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

health centres. It is also a reflection of the good quality and specialised standard of healthcare offered by the Department.

In 2013, the Department also recorded an increased number of complex medically-compromised cases admitted for dental and oral and maxillofacial surgery treatments. Furthermore, there was also a 6% increase in inpatient admissions for oral and maxillofacial surgery compared to 2013. The Department continued to be actively involved in the SQUH 24-hour on-call service in collaboration with the Emergency Department.

Research CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Bakathir A. Mandibular osteomyelitis: A rare complication of sickle cell anaemia. 21st International Oral & Maxillo- facial Conference, Barcelona, Spain, 21–24 Oct 2013.

National 1. Bakathir A. Medical emergencies in dental practice. Oman International Dental Conference, Muscat, Oman, 27 Feb 2013. 2. Al-Hinai M. An overview of class II malocclusion treatment options. Oman International Dental Conference, Mus- cat, Oman, 27 Feb 2013. 3. Bakathir A. Dental management of medically compromised patients. South Sharqiya 1st Dental Conference, Oman, 18 Apr 2013. 3. Al-Hinai M. Clear Aligners Limitations and Advantages. South Sharqiya 1st Dental Conference, Oman, 18 Apr 2013. Poster presentations International 1. Bakathir A. Successful surgical management of complex case of severe obstructive sleep aponea. 21st International Oral & Maxillofacial Conference, Barcelona, Spain, 21–24 Oct 2013.

172 departments

care

Pathology patient

Pathology and

he Department of Pathology is fully committed to the College of Medicine & Health Sciences' (COMHS) and Sultan Qa- boos University Hospital's (SQUH) mission of teaching, research and patient service.

TThe Department’s teaching mandate includes the M.D. (new and old curricula) and the B.Sc. Biomedical Sciences (BMS) academic programmes. It also participates in the Oman Medical Specialty Board (OMSB) Residency programme in Histopathology and other medical specialties. The postgraduate training programme is approved for Part I (FRCPath) of the Fellowship of the Royal College of Pathologists examination. The Department is sought after to run student workshops and to provide training in specialised histopathology techniques and electron microscopy for health professionals from Oman and abroad.

The Department provides specialist diagnostic services in histopathology, cytopathology, enzyme and immunohistochemistry, fluorescent microscopy and electron microscopy to SQUH. The Department is registered and subscribes to international external quality assurance programmes (EQA) in anatomic pathology, cytopathology and immunohistochemistry including both diagnostic and technical modules.

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The Department is actively engaged in research Radhiya A. Al-Ajmi, Senior House Officer in collaboration with other clinical departments Superintendents of SQUH and other colleges of SQU. Several fund- Khalaf Al-Gharibi, ed and unfunded research projects were initiated Superintendent (College) Kamla Al-Mawali, in 2013. The electron microscopy unit, in particular, Superintendent (Hospital) undertakes many research projects with other col- Biomedical Scientists leges within SQU as well as other institutions. Nasar Al-Wahaibi, Associate Researcher Johannes K. Solomon, Chief Biomedical Scientist With a total of three academic and six senior clin- (Clinical) ical faculty members and 24 biomedical scientists, Usha R. Bai, Chief Biomedical Scientist (Clinical) it functions as a major referral centre for many of Virgilio Cruz, Chief Biomedical Scientist (Clinical) the Ministry of Health (MOH) hospitals, the Armed Virginia Uy, Chief Biomedical Scientist (Clinical) Forces Hospital (AFH), the Royal Oman Police Hos- Sameera Al-Rawahi, Senior Biomedical Scientist pital (ROPH) as well as some of the private hospitals Kawther Al-Adawi, Senior Biomedical Scientist in the country. The junior staff includes three regis- Shadia Al-Sinawi, Senior Biomedical Scientist trars and two senior house officers.T wo of them are Khalid Al-Hosni, Senior Biomedical Scientist in the OMSB residency programme. Mohammed Al-Kindi, Biomedical Scientist Halima Al-Issaei, Biomedical Scientist James Vijayan, Biomedical Scientist Staff Najat Al-Dairi, Biomedical Scientist Head of Department Yusra Al-Belushi, Biomedical Scientist Amna Al-Shukeili, Anand Date, Professor (until Mar 2013) Biomedical Scientist Bader Al-Sumri, Ritu Lakhtakia, Associate Professor (from Mar 2013) Biomedical Scientist Muna Al-Sarkhi, Biomedical Scientist Acting Deputy Head of Department Horiya Al-Azri, Biomedical Scientist Ibrahim Al-Haddabi, Clinical Affairs Safaa Al-Rawahi, Biomedical Scientist Faculty Ahmed Al-Hinai, Mortuary Technician Afrah Al-Rashdi, Biomedical Scientist Aisha Al-Hamdani, Senior Consultant Maryam Al-Subhi, Biomedical Scientist P. A. M. Saparamadu, Consultant Zaina Al-Alawi, Biomedical Scientist Marwa Al-Riyami, Consultant Asim Qureshi, Consultant Coordinators Shadia Al-Bahlani, Assistant Professor Edna B. Ranada, College Asem Shalaby, Assistant Professor Nadeera K. Ammu, Hospital Maiya Al-Bahri, Registrar Shamla Sheriff, Hospital Asmaa Al-Shihi, Registrar Badriya Al-Hinai, Hospital Fathiya Al-Rahbi, Registrat Lubna Al-Abri, Hospital

174 Highlights of the Year 2013 The year 2013 witnessed an increase in academic recruitment with Dr. Asem Shalaby joining as Assistant Professor in the College section of the Department. At the same time there was an appreciable expansion both in College and SQUH staffing with the addition of six new members: one Omani Registrar, four Omani biomedical scientists and one administrative staff member. Prof. Anand Date retired in March 2013 and Dr. Ritu Lakhtakia took over as head of department.

The Department was a proud and active participant in the June 2013 visit of the Association for Medical Ed- ucation in the Eastern Mediterranean Region and the World Federation for Medical Education team for the accreditation of the M. D. programme of the COMHS. Several preparatory and mock visits by Accreditation Canada International (ACI) were instrumental in active departmental preparation towards the ACI accreditation of SQUH. The Department had several visits of note: the International Atomic Energy Agency (IAEA) Cancer Registry visit in January and the Histopathology Residency Training Program mock audit (site visit tour) on 28th April. A guest lecture by Dr. Abdel G. Selim, 'Molecular alterations in apocrine metaplasia and apocrine adenosis: Relation to breast carcinogenesis', was held in May 2013. A visit by schoolchildren from

Dura Al-Khaleej Private School, Ghubra, Oman, to the Pathology Museum reinforced the Department’s com- departments munity education efforts.T he electron microscopy facility remains an attraction for visits and short courses for Omani SQU scientists, enhancing the inter-institutional collaboration of the Department. care

Ms. Najat Al-Dairi was a recipient of one of his His Majesty’s Grants 2013 scholarships to pursue her M.Sc. studies abroad. In addition, seven biomedical scientists went abroad for short training courses in institutes of repute to enhance their skills. patient

Pathology The Department was awarded second prize for its presentation in the COMHS 2012–13 SCRAPS clinico-pa- and thology conference series, entitled '‘Walk with me’: A presentation on integrated medical education and multidisciplinary patient care'. The participating medical student, Mr. Majid Al-Badi, was awarded first prize for the best SCRAPS student presentation.

Staff of the Department attended various courses and conferences to update their knowledge and skills. Dr. academic Ritu Lakhtakia attended the five-day BANFF Pathology Course, Canada, in August and the Paediatric Liver Disease: Current update course in SQU. She also chaired the symposium on Troublesome Everyday Issues at the Annual CME of International Academy of Pathology in Mumbai, India, in October. Dr. Ibrahim Al-Haddabi attended the two-day MOH Glimpses Workshop on Health Vision 2050 in May. Dr. Anna Saparamadu was a resource person for the symposium on Clinical Case Presentations in Lymphoma at the 4th Joint International Conference of British Division International Academy of Pathologists & College of Pathologists of Sri Lanka on Hepato-biliary, Pancreatic & Haemato-lymphoid Pathology, held in Colombo, Sri Lanka in August. She also attended the three-day Emirates Surgical Pathology workshop in Abu Dhabi in February and the Examiner Workshop conducted by Royal College of Canada International in May, as well as an MCQ writing workshop.

175 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Dr. Shadia Al-Bahlani attended SQU workshops on Student Support and Assessment, SPSS Data Analysis and Health Professions Education. Dr. Khalaf Al-Gharibi attended an SQU workshop on Cardiovascular Diseases and Global Health Care, a Springer Publishing Author workshop and one on Biostatistics in Health Research. This last workshop was also attended by Ms. Najat Al-Dairi and Ms. Samira Al-Rawahi. Ms. Najat Al-Dairi also attended the 18th International Congress of Cytology: Toward a more personalized medicine through the art of cytopathology, in Paris in May. Ms. Samira Al-Rawahi and Ms. Amna Al-Shukeili attended SQU workshops on Biostatistics in Health Research and Medical Errors Disclosure, respectively. Ms. Muna Al-Sarkhi and Mr. Bader Al-Sumri attended one-month training programmes in Graz, Austria, on Histopathology, and Immu- nohistochemistry, Renal and Muscle Biopsy, respectively. Ms. Kamla Al-Mawali visited the UK National Exter- nal Quality Assessment Service in July. Finally, Dr. Ritu Lakhtakia and all the course coordinators attended the Curriculum Retreat on Phase II of the New Curriculum: Feedback and the way forward, in March.

The surgical pathology services continued to expand their support of clinical demands with the expansion of the immunohistochemical support of cancer diagnosis and prognosis. Both the weekly Tumour Board and the weekly Breast Unit multidisciplinary team (MDT) meeting are now hosted by the Department. These meetings ensure valuable multidisciplinary-based patient care and undergraduate and postgraduate educational enrichment. The renal pathology service provides complete diagnostic evaluation of renal biopsies for SQUH and MOH hospitals with active patient management MDT meetings on a regular basis.

The College core laboratories have received a fillip with the active remodelling and re-equipping of the histology laboratory with molecular pathology facilities. These will provide much needed support for research efforts and enhance the teaching standards of the B.Sc BMS programme.

Teaching Programmes UNDERGRADUATE PROGRAMMES M. D. Curriculum (Phase II) The Department has been involved in the full implementation of the new M.D. curriculum with the following modules in four semesters of Phase II: Response to Infection and Pathobiology, and systems modules including Cardiovascular, Respiratory, Uroreproductive, Alimentary, Locomotor, Endocrine, Human Nervous system and Integrated Modules I, II and III. The Department's faculty have guided undergraduate student research projects in the three semester Research Module. The Locomotor Module is being coordinated by Dr. Asim Qureshi.

M. D. Curriculum (Phase III) Six batches each of Junior and Senior Clerkship students (new curriculum) undergo laboratory rotations in pathology to orient them to basic and advanced laboratory techniques to improve their clinico-pathologi-

176 cal correlation in an integrated format. The integration of pathology with clinical dermatology training is achieved by small group teaching in pathology during this rotation, in addition to the previously mentioned laboratory exposure. These didactic exercises are further augmented through student attendance at the multidisciplinary meeting in Pathology with the Surgery, Breast Unit, Oncology, Paediatrics, Gynaecology and Haematology departments.

B.Sc. Biomedical Sciences programme Dr. Ritu Lakhtakia chairs the management group for this programme with Dr. Shadia Al-Bahlani as the training coordinator. The following courses are taught: Introduction to BMS; Instrumentation; Advanced Instru- mentation; Pathology and Biochemistry Laboratory rotations; Principles of Histopathology; Research Meth- odology and Research Projects; Principles of Cytopathology; Clinical Correlations, and Subject Specialisation. A new Clinical Correlations module was designed by Dr. Marwa Al-Riyami for delivery in 2014.

POSTGRADUATE PROGRAMMES departments

Residency Programmes The Pathology Department is a training centre for the OMSB and is an approved centre for the Part I examination of the Fellowship of the Royal College of Pathologists (FRCPath), UK. Up to three residents are posted care at any one time for general pathology training and electives in renal pathology. The Department also offers an elective rotation (four weeks) for Dermatology, Haematology and Obstetrics and Gynaecology residents. This provides them with an opportunity to develop an understanding of dermatopathology, haematolym- patient phoid diseases and gynaecological pathology, respectively. In addition to OMSB residents, there is one senior Pathology house officer and one registrar employed byS QUH who rotate between surgical pathology and cytopathol- and ogy. One registrar has graduated from the OMSB programme. The training programme for postgraduate residents in pathology is five years. At present, there are eight OMSB trainees who rotate between SQUH, the Royal Hospital, Khoula Hospital, ROPH and the AFH. All faculty members are trainers and members of various subcommittees of the Histopathology Scientific committee of the OMSB. The end of year practical

assessment of all Pathology OMSB residents was conducted in COMHS in June 2013. academic

Training Courses & CME Activities Dr. Marwa Al-Riyami and Dr. Shadia Al-Sinawi contributed to a workshop entitled 'Use of Immunofluores- cence in Diagnosis and Research' organised under the aegis of SCORE. Dr. Ritu Lakhtakia contributed to a student debate entitled 'Stem Cell Research: bane or boon' under the aegis of SCOME. Dr. Ritu Lakhtakia and Ms. Yusra Al-Balushi contributed to a workshop on immunohistochemistry entitled 'Unmask cancer cells' organised under the aegis of SCORE. Dr. Ritu Lakhtakia presented a paper in the Mammography and Breast Biopsy Workshop organised by Department of Radiology, as well as organising and conducting the B.Sc. BMS Curriculum Retreat and Examination Assessment Workshop, sponsored by the COMHS, in Decem-

177 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

ber at Crowne Plaza Hotel, Muscat.

The Department of Pathology offers clinical attachments in laboratory medicine.T he Department also welcomed staff from other laboratories of the MOH and AFH who came to train in special techniques in cytology and immunohistochemistry. In the Electron Microscope Unit, Mrs. Huda Al-Hinai, Mrs. Hajar Al-Ghafri and Mrs. Asma Al-Nabhani each underwent a two-week summer training programme.

Clinical & Diagnostic Services With the expanding clinical and surgical services offered by SQUH, the Department has witnessed a surge in the number of biopsies and resection specimens received. This not only reflects the number but also the complexity of these specimens. The Department is also a centre for subspeciality reporting, particularly haematopathology and renal pathology. It acts as a referral centre for the MOH hospitals, the ROPH, the AFH, Royal Palace Hospital and clinics, Royal Diwan clinics and private hospitals within Oman for expert opinion on difficult diagnoses.

The renal pathology service is organised and delivered by Dr. Marwa Al-Riyami, providing comprehensive reporting of renal biopsies with light miscroscopic, ultrastructural and fluorescent inputs. Adult and paediatric multidisciplinary case discussions for patient management are conducted with participating faculty from SQUH, the Royal Hospital and the AFH.

The frozen section facility and urgent fine-needle aspiration cytology diagnostic support to the One-Stop Breast Clinic provide vital inputs for intraoperative decision-making and early diagnosis of breast cancer, respectively.

Table 1: Workload of histopathology/cytology/electron microscopy in 2013 Type of test Request / test Histology 6,856 / 32,865 Immunohistochemistry 1,496 / 13,349 Immunofluorescence 254 / 1945 Enzyme histochemistry 7 / 82 Molecular pathology 60 / 203 Cytology (gynaecological) 1,391 / 1,453 Cytology (non-gynaecological) 1,221 / 4,829 Electron microscopy 797 / 2369 Totals 12,082 / 54,726

178 Well-established Immunohistochemistry and Fluorescent Microscopy Units provide the ancillary support for resolving diagnostic dilemmas. The Electron Microscopy Unit supports problem-solving in renal, skin and muscle diseases.

Clinicopathological conferences are also playing an increasingly important role in patient management. The pathologists contribute to such meetings as core members, particularly in the breast and oncology MDTs held on a weekly basis. Monthly meetings are held with the Departments of Surgery, Child Health, Obstetric & Gynaecology and Haematology.

The quality of diagnostic services of the Department are evaluated by departmental internal quality assurance programmes. The Department is also registered with and subscribes to international external quality assurance programmes in histopathology, cytopathology and immunocytochemistry, as well as to a technical module. The Department’s Quality Assurance Committee, headed by Dr. Ibrahim Al-Haddabi, is actively engaged in preparations for the ACI accreditation of the hospital laboratory. departments

Research Research Projects care Effect of dietary supplementation of fruits grown in Oman on cognitive decline in Alzheimer’s dementia, mild cognitive impairment, vascular cognitive impairment and traumatic brain injury Code: RC/AGR/FOOD/11/01 Dates: 2012–2013 Value: OR 209,800 Funder: The Research Council, Oman patient

Investigators: Dr. Mohamed Essa, Dept. Food & Nutrition, College of Agriculture & Marine Sciences, SQU; Dr. Pathology

Ritu Lakhtakia, Dept. Pathology, SQU. and

Whole genome microarray expression analysis on Omani patients with colon cancer Code: IG/MED/PATH/12/01 Dates: 2012–2014 Value: OR 10,426 Funder: SQU

Investigators: Dr. Marwa Al-Riyami, Dept. Pathology, SQU; Dr. Abeer Al-Sayegh, Dept. Genetics, SQU, Prof. academic Mansour Al-Moundhri, Dept. Medicine, SQU.

Expression of tumor necrosis factor: Alpha and other cytokines in renal transplant patients and those with chronic renal disease Code: IG/MED/PATH/12/02 Dates: 2012–2014 Value: OR 8,200 Funder: SQU Investigators: Dr. Nasar Al-Wahaibi, Prof. Anand Date, Dr. Marwa Al-Riyami, Dept. Pathology, SQU; Dr. Mohammed Al-Balushi, Dept. Microbiology, SQU; Dr. Ahmed Shukaili, The Research Council, Oman; Dr. Abul- lah Al-Muniri, Dept. Family Medicine & Public Health, SQU.

179 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Mast cells in chronic gastritis: A morpho-immunophenotypic study with clinicopathologic correlation Code: IG/MED/PATH/12/03 Dates: 2012–2014 Value: OR 8,562 Funder: SQU Investigators: Dr. Ritu Lakhtakia, Dr. Anna Saparamadu, Dr. Ibrahim Al Haddabi, Dept. Pathology, SQU; Dr. Jamal Sallam, Dept. Medicine, SQU.

Study of clinicopathological features of papillary carcinoma of thyroid and morphologic evaluation of precursor lesions Code: MREC #611 Dates 2013 Value: Unfunded Project Approval: SQU Investigators: Dr. Asim Qureshi, Dept. Pathology, SQU; Ms. Ama Al-Hinai (Phase II M.D. student), COMHS, SQU.

Comparison of ultrafast Pap stain with the conventional method of various body cavity fluids in cytology Code: MREC #666 Dates 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Nasar Al-Wahibi, Dept. Pathology, SQU.

Chemoresistance breast cancer: The role of E2Fl activation and its modulation by Akt pathway Code: MREC #670 Dates 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Shadia Al-Bahlani, Dept. Pathology, SQU.

Assessment of duodenal biopsies which are performed on patients of suspected coeliac disease, qualitative assessment by March classification Code: MREC #712 Dates 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Asim Qureshi, Dept. Pathology, SQU.

Pathological findings of crescentic glomerulonephritis in Omani patients 2006–2012 Code: MREC #794 Dates 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Marwa Al-Riyami, Dept. Pathology, SQU.

Clinical features of crescentic glomerulonephritis in Omani patients during the period from 2006 to 2012 Code: MREC #795 Dates 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Marwa Al-Riyami, Dept. Pathology, SQU.

180 Correlation of proliferation marker Ki67 with hormone receptor status and Her-2 neu expression in Omani Women with breast cancer Code: MREC #794 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Ritu Lakhtakia, Dept. Pathology, SQU.

BOOKS & JOURNAL PUBLICATIONS Journal Publications 1. Lakhtakia R, Al-Wahaibi K, Zahid KF, Malik KA, Burney I. Solid pseudo-papillary neoplasm of the pancreas: A case report with review of the diagnostic dilemmas and tumor behavior. Oman Med J 2013; 28:441–4. 2. Lakhtakia R. Of animalcula, phthisis and scrofula: Historical insights into tuberculosis in the pre-Koch era. Sultan Qaboos Univ Med J 2013; 13:486–90. 3. al-Jarrah A, Taranikanti V, Lakhtakia R, Al-Jabri A, Sawhney S. Idiopathic granulomatous mastitis: Diagnostic strategy and therapeutic implications in Omani patients. Sultan Qaboos Univ Med J 2013; 13:241–7. 4. aljarrah A, Kamran MA, Khatib N, Aghbari S, Sawhney S, Lakhtakia R. Breast One Stop clinic: Experience at Sultan Qaboos University Hospital in the Sultanate of Oman. Surg Clin India 2013; 1(4). departments

5. al-Riyami N, Gowri V, Kakaria AK, Lakhtakia R. A case of postpartum choriocarcinoma: Delay in diagnosis and lessons learnt. J Obstet Gynecol India 2013; doi: 10.1007/s13224-013-0444-9.

6. Lakhtakia R. Conspicuous consumption and sedentary living: Is this our legacy to our children? Sultan Qaboos Univ care Med J 2013; 13:336–40. 7. Lakhtakia R. The history of diabetes mellitus. Sultan Qaboos Univ Med J 2013; 13:368–70. 8. Braidy N, Selvarju S, Essa MM, Vaishnav R, Al-Adawi S,…Lakhtakia R, et al. Neuroprotective effects of a variety of

pomegranate juice extracts (PJE) against MPTP-induced cytotoxicity and oxidative stress in human primary neu- patient

rons. Oxid Med Cell Longev 2013; 2013:685–909. Pathology

9. Kamran MA, Al-Jarrah A, Sawhney S, Lakhtakia R. Chondroid lipoma of breast: A rare pathology. J Liaquat University and Med & Health Sci (JLUMHS) 2013; 12:131–2. 10. Qureshi A, Furrukh M. Enteric adenocarcinoma lung: A rare presentation in an Omani woman. BMJ Case Rep 2013; doi: 10.1136/bcr-2012-007667. 11. Qureshi A, Zahid KF, Ibrahim SI, Burney I. Osteosarcoma arising on a background of Paget's disease report of an un-

usual case. BMJ Case Rep 2013; doi: 10.1136/bcr-2012-007770. academic 12. Furrukh M, Qureshi A, Saparamadu A, Kumar S. Malignant neuroendocrine tumour of the gall bladder with elevat- ed carcinoembryonic antigen: Case report and literature review. BMJ Case Rep 2013; doi: 10.1136/bcr-2013-008778. 13. Qureshi A, Hassan U, Loya A, Akhter N, Najam-ud-Din, Yusuf A. Diagnostic utility of endoscopic ultrasound guided aspiration cytology in evaluation of pancreatic masses. J Coll Physicians Surg Pak 2013; 3:484–6. 14. Qureshi A, Kumar S, Ismail SI, Al Kalbani MA, Burney IA. C-kit negative extra intestinal gastrointestinal stromal tumor with no detectable mutations: A rare case. J Solid Tumors 2013; 3:25–9. 15. Mathew M, Gonsalves H, Al-Azawi S, Saparamadu PAM. Asymptomatic ovarian mucinous cystadenoma with a solid mural leiomyoma: Case report and brief review. Sultan Qaboos Univ Med J 2013; 13:127–31. 16. ahmed MA, SureshKannan KS, Raouf ZR, Koliyadan SV, Grant CS,...Saparamadu PAM, et al. Adrenal oncocytic neoplasm with uncertain malignant potential. Sultan Qaboos Univ Med J 2013; 13:E334–8.

181 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

17. al-Jarrah A, Taranikanti V, Sawhney S, Furrukh M, Al-Hosni M, Saparamadu PAM, et al. Metastatic invasive lobular carcinoma of the breast masquerading as a primary renal malignancy. Sultan Qaboos Univ Med J 2013; 13:460–2. 18. al Marhoon MS, Saparamadu PAM, Venkiteswaran KP, Shareef O, Kunju KM. Squamous cell carcinoma arising in keratinizing desquamative squamous metaplasia (KDSM) of renal pelvis, UroToday Int J 2013; 6: Article 49. 19. Khan SY, Bhatti KM, Koliyadan SV, Al Riyami M. Asymptomatic ileal schwannoma presenting as a mesenteric tumour: Case report and review of literature. Sultan Qaboos Univ Med J 2013; 13:E330–3. 20. al-Zaabi K, Al Riyami M, Al-Abri R. A unilateral maxillary sinus tumor. Oman Med J 2013; 28:220–1. 21. Al-Riyami N, Al-Hadabi R, Al-Dughaishi T, Al-Riyami M. Placental tumour: What could it be? Sultan Qaboos Univ Med J 2013; 13:E459–62. 22. aljarrah A, Al-Hashmi M, Malik KA, Sukhpal S, Hussein S, Al-Riyami M, et al. Mucinous breast cancer with solitary metastasis to humeral head: A case report. Oman Med J 2013; 28:350–3. 23. el-Hawary AK, Shalaby A, Shebl AM, Khater S, Wadie BS, Abu Beih EA, et al. Synchronous ipsilateral transitional cell and papillary renal cell carcinomas. OA Case Rep 2013; 2:24. 24. sharawy MH, El-Agamy DS, Shalaby AA, Ammar el-SM. Protective effects of methyl palmitate against silica-induced pulmonary fibrosis in rats. Int Immunopharmacol 2013; 16:191–8. 25. Alwahaibi N, Almahrooqi BM, Alrawahi SA. The prevalence of helicobacter pylori and gastritis in Oman. J Dig Endosc 2013; 4:29–32. 26. Alwahaibi NY, Alhabsi TA, Alrawahi SA. Pattern of glomerular diseases in Oman: A study based on light microscopy and immunofluorescence. Saudi J Kidney Dis Transpl 2013; 24:387–91.

CONFERENCES & SEMINAR PRESENTATIONS Oral Presentations International 1. Lakhtakia R. Multidisciplinary discussion on breast cancer management. Annual CME of International Academy of Pathology, Unrest in the Breast, Nair Charitable Hospital, Mumbai, India, 12 Oct 2013. 2. Lakhtakia R. Cancer education and pathology: Thinking out of the box. Annual CME of International Academy of Pathology, Unrest in the Breast, Nair Charitable Hospital, Mumbai, India, 12 Oct 2013.

National 1. Lakhtakia R. Breast cancer: Pathologist’s contribution to personalized treatment. 5th Muscat International Oncolo- gy Conference, Oman, 17–19 Sep 2013. 2. Lakhtakia R. CUPS: Clues to diagnosis: Role of pathologist. 5th Muscat International Oncology Conference, Oman, 17–19 Sep 2013. 3. Al-Riyami M. New targets in renal cell carcinoma. 5th Muscat International Oncology Conference, Oman, 17–19 Sep 2013. Poster presentations International 1. Al-Haddabi I, Al-Waili K, Al-Majrafi N, Al-Darai M, Al-Rasadi K. Prevalence of metabolic and cardiovascular risk factors for non-alcoholic fatty liver disease among Omani patients attending a tertiary hospital. 5th International Con- gress on Prediabetes and the Metabolic Syndrome, Vienna, Austria, 18–20 Apr 2013.

182 2. Al-Haddabi I, Al-Rahbi F, Date A. Unusual splenic nodules in sickle cell disease. American Society for Clinical Pathol- ogy Annual Meeting, Chicago, USA, 18–21 Sep 2013. 3. Saparamadu PAM, Qureshi A, Furrukh M, Alkindy S. Adenocarcinoma and chronic lymphocytic leukaemia occurring simultaneously in prostate: A diagnostic challenge in a TRUS biopsy. 4th Joint International Conference of British Division International Academy of Pathologists & College of Pathologists of Sri Lanka on Hepato-biliary, Pancreatic & Haemato-lymphoid Pathology, Colombo, Sri Lanka, 14–16 Aug 2013. 4. Saparamadu PAM. Interactive cases discussion on an unusual presentation of ALL. 4th Joint International Confer- ence of British Division International Academy of Pathologists & College of Pathologists of Sri Lanka on Hepato-biliary, Pancreatic & Haemato-lymphoid Pathology, Colombo, Sri Lanka, 14–16 Aug 2013. 5. Al-Riyami M, Siddiqui W, Al-Shanfari A, Al-Riyami D, Moshin N. The aetiology of membranous nephropathy in the Omani population: A 6 year retrospective study. World Congress of Nephrology Meeting, Hong Kong, China, 31 May – 4 Jun 2013. 6. Al-Bahlani S. The regulation of p73 in cisplatin-induced apoptosis in human ovarian cancer. 3rd International Con- ference on Biotechnology, Kuala Lumpur, Malaysia, 2–4 Jul 2013. 7. Al-Kindi M, Baqir S. 39th Conference of International Embryo Transfer Society, Hannover, Germany, 19–22 Jan 2013. 8. Mourad M, Abdul-Aziz S, Shalaby A. Prognostic impact of D2-40 expression and BCL6 gene rearrangement in diffuse large B-cell lymphoma. 7th Joint Meeting British Division International Academy of Pathology and Pathological So- ciety of Great Britain & Ireland, Edinburgh, UK, 18 –21 Jun 2013. departments National 1. Qureshi A. Inter-observer agreement in reporting Her 2 Neu protein over expression. SQU University Day, SQU,

Oman, 5 May 2013. care

2. Qureshi A. Immunohistochemistry. World Quality Day Celebration, Muscat, Oman, 4 Nov 2013. 3. Qureshi A. Extra intestinal gastrointestinal stromal tumor (GIST) with a rare immune profile:A diagnostic challenge. SQU University Day, SQU, Oman, 5 May 2013. patient

4. Al-Kindi M. Qualitative assessment of the endangered Arabian Tahr/Ibex (Hemitragus jayakari) semen using Biox- Pathology cell® and Triladyl® extenders. SQU University Day, SQU, Oman, 5 May 2013. and

Seminar presentations National 1. al-Riyami M. Role of electron microscopy in the diagnosis of renal disease: The SQUH experience. SQU University Day, SQU, Oman, 5 May 2013. academic 2. Al-Riyami M. Understanding histopathology of transplant rejection. Nephrology Forum, Royal Hospital, Muscat, Oman, 11 Dec 2013. 3. Al-Hadhabi I, Al-Hamadani A, Qureshi A, Al-Riyami M. Inter-observer variation in Her 2 Neu reporting. MAC Meet- ing, Muscat, Oman, Jun 2013. 4. Lakhtakia R, Al-Riyami M, Qureshi A, Al-Badi M, Al-Obaidani A, Al-Ajmi A, et al. ‘Walk with me..’: Presentation on integrated medical education and multidisciplinary patient care. SCRAPS Clinico-Pathological Conference, SQU, Oman, 27 Feb 2013.

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Thesis Supervision Student Name: ikram Al-Abri Qualification: M.D. Title: Correlation of proliferation marker Ki67 with hormone receptor status and Her-2 expression in Omani women with breast cancer (MREC #830) Supervisor: Dr. Ritu Lakhtakia Date of completion: 2014

Student Names: saoud M. Al-Salhi and Haithum S. Al-Daghri Qualification: M.D. Title: Prevalence of Helicobacter pylori among patients attended SQUH with dyspepsia Supervisor: Dr. Ibrahim Al-Haddabi Date of completion: 2013

Student Name: Maitha H. S. Al-Sibani Qualification: M.D. Title: Pathological findings of crescentic glomerulonephritis in Omani patients (MREC #795) Supervisor: Dr. Marwa Al-Riyami Date of completion: 2013–2014

Student Name: Dalal O. Al-Harthi Qualification: M.D. Title: Clinical features of crescentic glomerulonephritis in Omani patients (MREC #796) Supervisor: Dr. Marwa Al-Riyami Date of completion: 2013–2014

184 Student Names: sumaiya Mohammed and Mariam M. A. Al-Harbi Qualification: M.D. (Phase II) Title: Histological evaluation of duodenal biopsies of patients of celiac disease, histopathological assessment by MARSH grading system Supervisor: Dr. Asim Qureshi Date of completion: 2013–2014

Student Name: abdullah M. D. Al-Salmi, Qualification: M.D. Title: Spectrum of histopathological changes in duodenal mucosa in Helicobacter pylori associated gastritis and its comparison to coeliac disease Supervisor: Dr. P. A. M. Saparamadu Date of completion: 2013–2014 departments

Student Name: asaad M.S. Al-Hinai care

Qualification: M.D. Title: Spectrum of histopathological changes in duodenal mucosa in Helicobacter pylori associated gastritis and its comparison to celiac disease in paediatric

patients patient

Pathology Supervisor: Dr. P. A. M. Saparamadu and Date of completion: 2013–2014

Student name: iman Al-Ressi Qualification: M.Sc. academic Title: Role of antigen presenting cells in liver damage during hepatitis B and C infections Supervisors: Dr. Marwa Al-Riyami, Prof. Ali Al-Jabri, Dr. Khalid Al-Naamani Date of completion: 2013–2014

185 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Student Name: amal S. Al-Kalbani Qualification: B.Sc. BMS Title: Measurement of tumor necrosis factor – alpha, IL-6 and IL-8 in renal transplant patients and those with chronic renal disease. Supervisors: Dr. Nasar Al-Wahaibi, Dr. Mohammed Al-Balushi Date of completion: 2013

Student Name: samya S. Al-Balushi Qualification: B.Sc. BMS Title: Measurement of TWEAK, IL-2 and IL-10 cytokines in renal transplant patients and those with chronic renal disease. Supervisors: Dr. Nasar Al-Wahaibi, Dr. Moahmmed Al Balushi Date of completion: 2013

Student Name: Maryam Al-Subhi Qualification: B.Sc. BMS Title: Comparison of ultrafast Pap stain with the conventional method of various body cavity fluids in cytology Supervisors: Dr. Nasar Alwahaibi, Ms. Najat Al-Dairi, Ms. Usha R. Bai, Ms. Amna Al-Shukeili Date of completion: 2013

186 departments

care

Pharmacology & Clinical Pharmacy patient

and

he Department of Pharmacology & Clinical Pharmacy plays an active teaching role in both the College of Medicine & Health Sciences’ (COMHS) curricula as well as in the College of Nursing’s educational programme. The Department also offers a Master’s and a Doctoral degree in Clinical Pharmacy and contributes to the teaching of other Master’s courses. The TDepartment coordinates the Research Method and Critical Analysis of Scientific Information course. In addition, the Department academic coordinates the Cellular Communication and Introduction to Drug Action, Integrated Module II and Alimentary System courses

in the M.D. programme and offers two elective courses (in Arabic): Drugs, Nutrients and Narcotics and History of Medicine. Pharmacology & Clinical Pharmacy

Research activities embrace different areas of experimental and clinical pharmacology and therapeutics.T he areas under investigation encompass: pharmacogenetics of drugs, e.g. tacrolimus and pharmacoeconomics, and the effect of several agents on experimental acute and chronic renal failure.

187 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff gel documentation system, a pH meter, a shaker, an ultra-low freezer, a flame photometer, a chloride Head of Department meter and a dry block heater. Mohammed Al-Za’abi, Associate Professor The research output for 2013 consisted of 16 research Faculty projects, 13 international poster presentations, and Musbah Tanira, Professor 44 publications in peer-reviewed journals. The De- Badreldin Ali, Professor partment also contributed to the world of medical Abdel H. Elhawary, Associate Professor science through its review and editorial activities Ibrahim Al-Zakwani, Associate Professor in various medical journals. Staff members were Ragini Vaishnav, Assistant Professor involved in different research activities and partic- Khalid Al-Balushi, Assistant Professor ipated in national and international conferences. Yousuf Al-Suleimani, Assistant Professor The Department serves in several committees in Support Staff the COMHS, Sultan Qaboos University Hospital (SQUH) and the University, as well as those in other Ikhlas A. Ahmed, Researcher national institutions. Mahfouda Al-Busaidi, Biomedical Scientist Ahmed Al-Mahrouqi, Biomedical Scientist Mercy Calma, Coordinator Teaching Programmes Highlights of the Year 2013 UNDERGRADUATE PROGRAMME In 2013, the Department was given the responsibili- At the preclinical level, the Department’s teaching ty of coordinating three courses: Cellular Communi- concentrates on the mechanisms by which drugs cation and Introduction to Drug Action, Alimentary affect various biological systems and functions, as System and Integrated Module II, and participated well as the actions of drugs on pathological pro- in many system module courses. Also, the Depart- cesses. ment was involved in Supportive Learning Topics (SLTs) in the Pre-clerkship (SLT-Pharmacology) and The Department contributes to undergraduate in Senior Clerkship (SLT-Therapeutics) programmes. teaching in Phase I and Phase II of the M.D. programme and coordinates several courses in Phase During the year, Dr. Mohammed Al-Za’abi was I as well as in Phase II. The Department contributes promoted to Associate Professor and Dr. Khalid to the B.Sc. Biomedical Sciences (BMS) degree with Al-Balushi was appointed as Assistant Dean of the courses in Diagnostic Toxicology and Therapeutic COMHS for Postgraduate Studies & Research. In Drug Monitoring and Medical Microbiology. The July 2013, Dr. Ragini Vaishnav left the Department. Department continues to contribute to the College of Nursing courses: Basic Pharmacology and Dos- In 2013, the Department acquired the following age Calculations and Pharmacology for Nurses are equipment for research activities and teaching: a delivered in both semesters.

188 The Department also delivers the College elective courses: Nutrients, Medicines and Narcotics and History of Medicine. Both courses are under the coordination of the Department.

In 2013, the Department was given the responsibility to coordinate Cellular Communication and Introduc- tion to Drug Action in Phase I. This module introduces the physiological, biochemical and pathophysiological processes and control of cellular communication. In Phase II, the Department is responsible for the coordination of the Alimentary System and Integrated Module II courses. The Department delivers lectures and tutorials for the following courses: Cellular Communication and Introduction to Drug Action; Response to In- fection and Pathobiology; Alimentary System; Respiratory System; Haemopoetic Lymphoid Immune System; Cardiovascular System; Uro-reproductive System; Endocrine System; Locomotor System; Nervous System, and Research Methodology I and II. Also, the Department is involved in case tutorials for Integrated Modules I, II and III. The Department is also supervising 10 undergraduate research projects.

In Phase III of the M.D. programme, the Department continues to be involved in the Pre-clerkship programme. Topics for SLTs were delivered to the students in collaboration with the clinical pharmacists of the Depart- ment of Pharmacy at SQUH. In 2013, the Department started the programme for the Senior Clerkship stu- departments dents; the SLT in Therapeutics, which was designed by the Department last year, is delivered over one full week, six times a year. The Department is also involved in the Obstetrics & Gynaecology and the Behavioural

Medicine Senior Clerkship clinical rotations. care

POSTGRADUATE PROGRAMME The Department plays an active role in teaching in the Master’s programme in Biomedical Sciences. The patient Department also offers a Master’s degree in Clinical Pharmacy. Major courses delivered by the Department

are: Pharmacokinetics and Therapeutic Drug Monitoring; Clinical Pharmacy I; Clinical Pharmacy II, and In- and troduction to Pharmacoeconomics. The Department has also introduced a new elective course, Pharmaco- therapeutics.

The Department started the Doctoral degree in Clinical Pharmacy and continues to coordinate the Master’s degree core course, Research Method and Critical Analysis for Scientific Information. academic

The Department is involved in the Pharmacy Working Group to establish a Pharmacy specialty for the Oman Pharmacology & Clinical Pharmacy Medical Specialty Board (OMSB).

189 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Research Research Projects Effect of gum arabic on an animal model chronic renal failure effect Code: RC/MED/PHAR/10/01 Dates: 2010–2013 Value: OR 50,000 Funder: The Research Council, Oman Investigators: Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU.

Pharmacogenetics of tacrolimus in Omani renal transplant patients Code: RC/MED/PHAR/12/01 Dates: 2012–2014 Value: OR 54,321 Funder: The Research Council, Oman Investigators: Dr. Khalid Al-Balushi, Dr. Mohammed Al-Za’abi, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Dawood Al-Riyami, Dept. Medicine, SQU.

Experimental studies on the interactions between pulmonary exposure to particulate air pollution and acute renal failure: Pathophysiologic mechanisms and influence of protectant drugs. Code: CL/SQU-UAE/12/01 Dates: 2012–2014 Value: OR 20,000 Funder: SQU & UAE University Investigators: Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Abderrahim Nemmar, Dept. Physiology, UAE University.

Analysis of molecular epigenetic programming of diabetes mellitus Code: CL/SQU-UAE/13/01 Dates: 2013 Value: OR 20,000 Funder: SQU & UAE University. Investigator: Dr. Khalid Al-Balushi, Dept. Pharmacology & Clinical Pharmacy, SQU.

The effect of cisplatin-induced acute renal failure and adenine-induced chronic renal failure on predictors of hepatic drug disposition Code: IG/MED/PHAR/12/01 Dates: 2012–2013 Value: OR 13,966 Funder: SQU Investigators: Prof. Badreldin Ali, Dr. Mohammed Al-Zaabi, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Mostafa Wali, Dept. Food Sciences & Nutrition, College of Agriculture & Marine Sciences, SQU; Mr. Isehaq Al-Husseini, Dept. Physiology, SQU.

Study of the effect of statins and some vasoactive drugs on the development and progression of diabetic nephropathy in the rat model Code: IG/MED/PHAR/13/01 Dates: 2013–2014 Value: OR 10,000 Funder: SQU Investigators: Dr. Abdel Hamid Elhawary, Prof. Badreldin Ali, Dr. Khalid Al-Balushi, Dr. Yousuf Al-Su- leimani, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Mostafa Wali, Dept. Food & Nutrition, College of Agriculture & Marine Sciences, SQU.

190 Impact of CYP2C19 and ABCB1 polymorphisms on the antiplatelet effect of clopidogrel in Omanis Code: MREC #664 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Khalid Al-Balushi, Dept. Pharmacology & Clinical Pharmacy, SQU.

Prescribing patterns of NSAIDs at Sultan Qaboos University Hospital Code: MREC #681 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Khalid Al-Balushi, Dept. Pharmacology & Clinical Pharmacy, SQU.

Prescribing pattern of antifungal medications at Sultan Qaboos University Hospital (a retrospective study) Code: MREC #683 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Khalid Al-Balushi, Dept. Pharmacology & Clinical Pharmacy, SQU.

Medication reconciliation at Sultan Qaboos University Hospital: Evaluation, implementation and out- departments comes Code: MREC #715 Dates: 2013 Value: Unfunded Project Approval: SQU care Investigators: Dr. Mohammed Al-Za’abi, Dr. Ibrahim Al-Zakwani, Dept. Pharmacology & Clinical Pharma- cy, SQU.

The effect of rosuvastatin therapy on glycemic status, bone profile and renal function in patient attend- patient ing lipid clinic of Sultan Qaboos University Hospital and

Code: MREC #725 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Abdel H. Elhawary, Dept. Pharmacology & Clinical Pharmacy, SQU.

Utilization pattern of antipsychotics among adult patients at Sultan Qaboos University Hospital

Code: MREC #776 Dates: 2013 Value: Unfunded Project Approval: SQU academic Investigator: Dr. Mohammed Al-Za’abi, Dept. Pharmacology & Clinical Pharmacy, SQU. Pharmacology & Clinical Pharmacy

191 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Paracetamol poisoning in Sultan Qaboos University Hospital (SQUH) Code: MREC #800 Dates: 2013 Value: Unfunded Project Approval: SQU Investigators: Prof. Musbah Tanira, Dr. Mohammed Al-Za’abi, Dept. Pharmacology & Clinical Pharmacy, SQU.

Utilization pattern of antidepressants at Sultan Qaboos University Hospital Code: MREC #801 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohammed Al-Za’abi, Dept. Pharmacology & Clinical Pharmacy, SQU.

Inhibition of receptor tyrosine kinase via Pgrmc1: A potential therapeutic target in gastric cancer Code: MREC #843 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Ikhlas S. Ahmed, Dept. Pharmacology & Clinical Pharmacy, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. abdwani R, Al-Abrawi S, Sharef SW, Al-Zakwani I. Geographical clustering of juvenile onset systemic lupus erythematosus within the Sultanate of Oman. Oman Med J 2013; 28:199–203. 2. abou Saleh M, Mafiana RN, Al-Za’abi M, Vaishnav R, Al Kindi S, Al-Zakwani I. Epidemiology of chemotherapy-induced neutropenia at a tertiary university hospital in Oman. Int J Clin Pharm 2013; 35:1036–9. 3. ahmed BM, Al-Zakwani IS. Incidence, outcome and predictors of bleomycin pulmonary toxicity in a university hospital in Oman. J Oncol Pharm Pract 2013; 19:3–7. 4. al Abri M, Al Hamhani A, Al Nabhani H, Al-Zakwani I. Validation of the Arabic version of the Epworth sleepiness scale in Oman. Oman Med J 2013; 28:454–6. 5. Al Balushi KA, Balkhair A, Ali BH, Al-Rawas N. Antimicrobial agent prescription patters for chemotherapy-induced febrile neutropenia in patients with hematological malignancies at Sultan Qaboos University Hospital, Oman. J Infect Public Health 2013; 6:216–21. 6. Al Balushi KA, Habib JQ, Al-Zakwani I. Comparative efficacy of irbesartan/ hydrochlorothiazide and valsartan/hydrochlorothiazide combination in lowering blood pressure: A retrospective observational study in Oman. Med Princ Pract 2013; 22:265–9. 7. al Kharousi N, Babiker H, Al Salam S, Waly M, Nemmar A,…Ali BH. The protective role of ellagic acid on cisplatin nephrotoxicity in rats. A dose dependent study. Eur Rev Med Pharmacol Sci 2013; 17:299–310. 8. al-Moundhri MS, Al-Salam S, Al Mahrouqi A, Beggam S, Ali BH. The effect of cucurmin on oxaliplatin and cisplatin neurotoxicity in rats: Some behavioral, biochemical and histopathological studies. J Med Toxicol 2013; 9:25–33. 9. Al Za’abi M, Al Asmi A, Ahmed R, Al-Masrouri S, Al-Lawati R,...Al-Zakwani I. Therapeutic antiepileptic drug monitoring pattern at a tertiary care hospital in Oman. Afr J Pharm Pharmacol 2013; 7:58–62. 10. Al Za’abi M, Shafiq S, Al-Riyami D, Ali BH. Utilization pattern of vancomycin in a university teaching hospital in Oman: Comparison with international guidelines. Trop J Pharm Res 2013; 12:117–21.

192 11. Al Za’abi M, Ali BH, Al Toubi M. HPLC-fluorescence method for measurement of the uremic toxin indoxyl sulfate in plasma. J Chromatogr Sci 2013; 51:40–3. 12. Al Za’abi M, Ali BH, Hussain A, Ali I. Fast HPLC analysis of adenine in human plasma using a new generation C28 column and different extraction methods. Anal Methods 2013; 5:1487–93. 13. albarwani S, Al-Siyabi S, Tanira MO. Lisinopril indifferently improves heart rate variability during day and night periods in spontaneously hypertensive rats. Physiol Res 2013; 62:237–45. 14. al-Hinai AT, Al-Abri A, Al-Dhuhli H, Al-Waili K, Al-Sabti H,…Al-Zakwani I, et al. First case report of familial hypercholesterolemia in an Omani family due to novel mutation in the low-density lipoprotein receptor gene. Angiology 2013; 64:287–92. 15. Ali BH, Al Husseini I, Beegam S, Al Shukaili A, Nemmar A, Schierling S, et al. Effect of gum Arabic on oxidative stress and inflammation in adenine-induced chronic renal failure in rats. PLoS One 2013; 8:e55242. 16. ali BH, Al-Salam S, Al Za’abi M, Waly MI, Ramkumar A, Beegam S, et al. New model for adenine-induced chronic renal failure in mice and the effect of gum acacia treatment thereon: Comparison with rats. J Pharmacol Toxicol Methods 2013; 68:384–93. 17. Ali BH, Al-Salam S, Al Husseini IS, Al-Lawati I, Waly M, Yasin J, et al. Abrogation of cisplatin-induced nephrotoxicity by emodin in rats. Fundam Clin Pharmacol 2013; 27:192–200. 18. Ali BH, Beegam S, Al-Lawati I, Waly M, Al Za’abi M, Nemmar A. Comparative efficacy of three brands of gum acacia on adenine-induced chronic renal failure in rats. Physiol Res 2013; 62:47–56. departments 19. ali I, Haque A, Wani WA, Saleem K, Al Za’abi M. Analyses of anticancer drugs by capillary electrophoresis: A review. Biomed Chromatogr 2013; 27:1296–311. care

20. al-Lawati JA, Barakat MN, Al-Lawati NA, Al-Maskari MY, Elsayed MK,...Al-Zakwani IS. Cardiovascular risk assessment in diabetes mellitus: Comparison of the general Framingham risk profile versus theW orld Health Organization/In- ternational Society of Hypertension risk prediction charts in Arabs: Clinical implications. Angiology 2013; 64:336–42. 21. al-Mandhari A, Al-Adawi S, Al-Zakwani I, Dorvlo A, Al-Shafaee M. Reasons for consultation among patients attend-

ing primary healthcare centres in Oman. Sultan Qaboos Univ Med J 2013; 13:248–55. patient

22. al-Maniri AA, Al-Reesi H, Al-Zakwani I, Nasrullah M. Road traffic fatalities in Oman from 1995 to 2009: Evidence

from police reports. Int J Prev Med 2013; 4:656–63. and

23. al-Mawali A, Pinto AD, Al Busaidi R, Al-Zakwani I. Lymphocyte subsets: Reference ranges in an age- and gender-balanced population of Omani healthy adults. Cytometry A 2013; 83:739–44. 24. al-Sinani S, Sharef SW, Al-Yaarubi S, Al-Zakwani I, Al-Naamani K, Al-Hajri A, et al. Prevalence of celiac disease in Omani children with type 1 diabetes mellitus: A cross sectional study. Oman Med J 2013; 28:260–3.

25. AlSuleimani YM, Hiley CR. Mechanisms of vasorelaxation induced by oleoylethanolamide in the rat small mesen- academic teric artery. Eur J Pharmacol 2013; 702:1–11.

26. al-Waili K, Al-Zidi WA, Al-Abri AR, Al-Rasadi K, Al-Sabti HA,…Al-Zakwani I, et al. Mutation in the PCSK9 gene in Oma- Pharmacology & Clinical Pharmacy ni Arab subjects with autosomal dominant hypercholesterolemia and its effect on PCSK9 protein structure. Oman Med J 2013; 28:48–52. 27. nemmar A, Al-Salam S, Subramaniyan D, Yasin J, Yuvaraju P,...Ali BH. Influence of experimental type 1 diabetes on the pulmonary effects of diesel exhaust particles in mice.T oxicol Lett 2013; 217:170–6. 28. nemmar A, Raza H, Subramaniyan D, Yasin J, John A, Ali BH, et al. Short-term systemic effects of nose-only cigarette smoke exposure in mice: Role of oxidative stress. Cell Physiol Biochem 2013; 31:15–24. 29. nemmar A, Raza H, Yuvaraju P, Beegan S, John A,…Ali BH. Nose-only water-pipe smoking effects on airway resistance, inflammation, and oxidative stress in mice. J Appl Physiol 2013; 115:1316–23.

193 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

30. nemmar A, Subramaniyan D, Yasin J, Ali BH. Impact of experimental type 1 diabetes mellitus on systemic and coagulation vulnerability in mice acutely exposed to diesel exhaust particles. Part Fibre Toxicol 2013; 10:14. 31. nemmar A, Yuvaraju P, Beegam S, John A, Raza H, Ali BH. Cardiovascular effects of nose-only water-pipe smoking exposure in mice. Am J Physiol Heart Circ Physiol 2013; 305:H740–6. 32. waly M, Ali BH, Al-Lawati I, Nemmar A. Protective effects of emodin against cisplatin-induced oxidative stress in cultured human kidney (HEK 293) cells. J Appl Toxicol 2013; 33:626–30. 33. younis MS, Al-Noaimi AS, Zaidan ZAJ, Al-Rubayie AF, Al-Farsi Y, Al-Zakwani I, et al. Clinical and demographic profile of attendees at Baghdad’s walk-in psychiatric clinic. Oman Med J 2013; 28:365–70. 34. albarwani S, Al-Husseini I, Al-Siyabi S, Al-Ismail A, Tanira MO. Lisinopril augments the combined effect of nitric oxide and potassium channels on endothelium-dependent relaxation in spontaneously hypertensive rats. FASEB J 2013; 27:1b642. 35. al-Rassadi KH, Al-Saleh M, Al-Hashmi K, Al-Dhuhli H, Al-Mukhaini S, Al-Zakwani I, et al. Evaluation of lipids in children with type 1 diabetes mellitus compared to controls. J Clin Lipidol 2013; 7:243–4. 36. al Saadi T, Sallam M, Al Hashmi K, Elhawary AM. Effect of carvedilol versus carvedilol/ivabradine combination on heart rate, quality of life, morbidity and mortality in patients with stable ischemic heart failure. Clin Ther 2013; 35:e70 37. Al Suleimani Y, Hiley CR. Characterization of calcium signals evoked by lysophosphatidylinositol in the human microvascular endothelial cells. (Abstract ICAMS Conference). Res Updates Med Sci 2013; 1:55. 38. Al Za’abi M, Al Asmi A, Ahmed R, Al Masrouri S, Al Lawati R,...Al Zakwani I. Therapeutic antiepileptic drug monitoring pattern at a tertiary care hospital in Oman. (Abstract ICAMS Conference). Res Updates Med Sci 2013; 1:55. 39. Ali BH, Al Za’abi M, Waly MI, Ramkumar A, Madanagopal T, Lawati I, et al. Effect of charcoal treatment on rats with adenine-induced chronic renal failure. (Abstract). FASEB J 2013; 27:889.1. 40. Ali BH, Waly MI, Nemmar A. Effect of diesel exhausts particles on cisplatin-induced toxicity on human kidney cells, and the influence of cucurmin thereon. A( bstract). Clin Ther 2013; 35:e107 41. ramkumar A, Madanagopal TT, Al-Abri S, Waly MI, Tageldin M,…Ali BH. Motor and behavioral changes in mice with cisplatin-induced acute renal failure. (Abstract) Clin Ther 2013; 35:e107 42. Tanira MO, Al Qutiti A, Al Jahwari B. The effect of shifting food-intake period on rat body weight and plasma levels of glucose, leptin, melatonin, cholesterol and triglyceride. (Abstract). FASEB J 2013; 27:1153.1 43. Vaishnav R, Al Zaabi B. Prescribing pattern of vancomycin in the accident and emergency, hematology, and oncology departments at Sultan Qaboos University Hospital. (Abstract ICAMS Conference). Res Updates Med Sci 2013; 1:35. 44. waly MI, Ali BH, Deth RC. Glutathione efficacy as a dietary antioxidant against azoxymethane-induced colon carcinogenesis in rats. (Abstract). FASEB J 2013; 27:861.8

Conference & Seminar Presentations Poster Presentations International 1. al Barwani S, Al Husseini I, Al Siyabi S, Al Ismail A, Tanira MOM. Lisinopril augments the combined effect of nitric oxide and potassium channels on endothelium-dependent relaxation in spontaneously hypertensive rats. Experi- mental Biology Conference 2013, San Diego Convention Center, Boston, USA, 20–24 Apr 2013. 2. Al Suleimani Y, Hiley CR. Characterization of calcium signals evoked by lysophosphatidylinositol in the human microvascular endothelial cells. International Conference on Advances in Medical Science, Kuala Lumpur, Malaysia, 16–18 Apr 2013.

194 3. Al Za’abi M. Therapeutic antiepileptic drug monitoring pattern at a tertiary care hospital in Oman. International Conference on Advances in Medical Science, Kuala Lumpur, Malaysia, 16–18 Apr 2013. 4. Ali BH, Al Za’abi M, Waly MI, Ramkumar A, Madanagopal T, Lawati I, et al. Effect of charcoal treatment on rats with adenine-induced chronic renal failure. Experimental Biology Conference 2013, San Diego Convention Center, Boston USA, 20–24 Apr 2013. 5. Ali BH, Waly MI, Nemmar A. Effect of diesel exhausts particles on cisplatin-induced toxicity on human kidney cells, and the influence of cucurmin thereon. 11th Conference European Association for Clinical Pharmacology and Ther- apeutics (EACPT), Geneva, Switzerland, 28–31 Aug 2013. 6. Elhawary AH. Reduced carotid, renal, hindquarter but not mesenteric blood flow in diabetic rats:T he possible mechanisms. 2nd China Congress on Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy), Shang- hai, China, 9–11 May 2013. 7. ramkumar A, Madanagopal TT, Al Abri S, Waly MI, Tageldin M,...Ali BH. Motor and behavioral changes in mice with cisplatin-induced acute renal failure. 11th Conference European Association for Clinical Pharmacology and Thera- peutics (EACPT), Geneva, Switzerland, 28–31 Aug 2013. 8. Tanira MOM, Al Qutiti A, Al Jahwari B. The effect of shifting food-intake period on rat body weight and plasma levels of glucose, leptin, melatonin, cholesterol and triglyceride. Experimental Biology Conference 2013, San Diego Conven- tion Center, Boston USA, 20–24 Apr 2013. 9. vaishnav R, Al Zaabi B. Prescribing pattern of vancomycin in the accident and emergency, hematology, and oncol-

ogy departments at Sultan Qaboos University Hospital. International Conference on Advances in Medical Science, departments Kuala Lumpur, Malaysia, 16–18 Apr 2013. 10. Vaishnav R. Teaching antimicrobial stewardship based on lessons learned from a study of the prescribing pattern

of piperacillin/tazobactam in a tertiary care hospital. 10th European Association for Clinical Pharmacology & Ther- care apeutics (EACPT) Summer School 2013, Edinburgh, UK, 4–6 Jul 2013. 11. Ahmed IA. S2RPgrmc1 promotes NSCLC migration, survival and tumor growth and associates with EGFR. 5th Euro- pean Molecular Biology Organization (EMBO) Meeting, Amsterdam, Netherlands, 21–24 Sep 2013. patient

12. Al Balushi K. Antibiotic prescribing trends in an Omani paediatric population. Pharmacology 2013, Meeting of Brit- ish Pharmacological Society, London, UK, 17–19 Dec 2013. and

13. al Saadi T, Elhawary AM, Sallam M, Al Hashmi K. Effect of carvedilol versus carvedilol/ivabradine combination on heart rate, quality of life, morbidity and mortality in patients with stable ischemic heart failure. 11th Conference European Association for Clinical Pharmacology and Therapeutics (EACPT), Geneva, Switzerland, 28–31 Aug 2013.

THESIS SUPERVISION

Student Name: amna Al-Hashar academic Qualification: Ph.D. Clinical Pharmacy Pharmacology & Clinical Pharmacy Title: Medication Reconciliation at Sultan Qaboos University Hospital (SQUH): Evaluation, Implementation and Outcomes Supervisors: Dr. Mohammed Al-Za’abi, Prof. Musbah Tanira, Dr. Ibrahim Al-Zakwani Date of completion: On-going

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Student Name: Muna M. Al-Balushi Qualification: M.Sc. Clinical Pharmacy Title: Effect of rosuvastatin on glycemic control, bone profile and renal failure in patients attending Lipid Clinic of Sultan Qaboos University Hospital Supervisor: Dr. Abdel H. Elhawary Date of completion: On-going

Student Name: Juhaina M. Al-Moqbali Qualification: M.Sc. Clinical Pharmacy Title: Evaluation of Sampling Time and Indications for Therapeutically Monitored Drugs at Sultan Qaboos University Hospital Supervisor: Dr. Mohammed Al-Za’abi Date of completion: On-going

196 departments

care

Pharmacy patient

Pharmacy and

he Pharmacy Department at the SQU Hospital (SQUH) is considered to be the centre of excellence in Oman for the provision of general and specialised pharmaceutical services, and the promotion of pharmaceutical research and teaching. The Department’s mission is to dispense the correct, safe and most effective and economic medication to a properly Tidentified patient at the appropriate time with sufficient written and verbal patient information as well as to disseminate academic appropriate and unbiased drug-, poison- and disease-related information to patients, medical, pharmacy, nursing and allied healthcare professionals.

The Department is divided into six major sections: Pharmacy Administration and Training; Outpatient Pharmacy; Inpatient Clinical Pharmacy; Manufacturing/Aseptic Preparations; Medicine Information, and the Pharmacy Sub-Store.

There has been a significant increase in the number of clinical services and patients in the last five years, however, the Depart- ment has maintained its high quality services and the outpatient waiting time has also been maintained below 30 minutes, even during in the busiest months.

197 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

The Department is recognised nationally and re- Janardhanan Nair, Senior Pharmacist gionally as a training centre that supports a range Mohammed Al-Ghafri, Pharmacist of quality programmes. It is responsible for teach- Family Medicine Clinic and Emergency ing healthcare providers and students from the Colleges of Medicine and Pharmacy and for the Dept. Pharmacy provision of in-service training for pharmacy staff. Nagwa Mohammed, Pharmacist It also provides individualised work experience Safiya Al-Jabri, Pharmacist placements for graduate pharmacy personnel. Maryam Al-Riyami, Assistant Pharmacist Zakariya Al-Habsi, Assistant Pharmacist The Department has carried out a number of re- Medicine Information search projects with the aim of further improving Intisar Al-Busaidi, Senior Pharmacist its services and the effectiveness of certain drug Nibu Nair, Pharmacist therapies. Bushra Al-Busaidi, Pharmacist Aseptic Preparations Unit Staff Dawood Al-Salhi, Pharmacist Felicidad Dizon, Pharmacist Head of Department Ali Al-Jabri, Assistant Pharmacist Ibrahim Al-Zakwani, Associate Professor Ali Al-Maawali, Assistant Pharmacist Deputy Head & Training Coordinator Pharmacy Sub-Store Aqeela Taqi, Clinical Pharmacist Khalid Al-Zadjali, Pharmacist Inpatient Clinical Pharmacy Azza Al-Harthi, Assistant Pharmacist Badriya Al-Zadjali, Clinical Pharmacist Hafidha Al-Rahbi, Assistant Pharmacist Asmahan Al-Barram, Clinical Pharmacist Pharmacy Computer System Management Maryam Al-Kindi, Pharmacist Bruno Louis, Senior Pharmacist Samiya Al-Ajmi, Pharmacist Amal Al-Rahbi, Pharmacist Technical Services Mafiana Rose, Pharmacist Ahmed Al-Mahruqi, Pharmacist Anwar Al-Mahrizi, Pharmacist Coordinators Intisar Al-Riyami, Pharmacist Mahfoudh Al-Rawahi Shireen Imam, Pharmacist Faiza Al-Zadjali Manal Al-Hatrushi, Pharmacist Outpatient Pharmacy Issa Al-Rashdi, Pharmacist Soud Al-Shabibi, Pharmacist

198 Highlights of the Year 2013 In May 2013, the Department organised the first Pharmacy Practice Symposium in collaboration with Oman Pharmaceutical Society in May 2013. The symposium was held at the Oman Medical College (OMC) and attended by 150 participants, including a number of delegates from Gulf Cooperation Council countries.

The Department was awarded with the Best Department Award during the World Quality Day Celebration in November 2013. The event was organised by the Directorate of Development & Quality of SQUH with a theme of "Collaboration counts".

The Department organised the Medicine Information (MI) course in collaboration with the Directorate for Training & CPD (DTD) in December 2013. The course was conducted at both basic and advanced levels to address the needs of both pharmacists and assistant pharmacists. Held at the College of Nursing at SQU, the course attracted 33 participants, including four from the Ministry of Health (MOH).

The Department organised a workshop on Scoping and Writing your Work for Publication at the College of Nursing in collaboration with the DTD. The workshop was attended by 25 senior pharmacists including three departments from the MOH. Mr. David Wood, a consultant in medicine information, was the facilitator on both the MI course and the publication workshop. care The Department developed and implemented a number of new policies to comply with Accreditation Can- ada International requirements. These included policies for high-alert medications policy, medication reconciliation and concentrated electrolytes risk mitigation policy, as well as total parenteral nutrition (TPN) prescribing guidelines. patient

Pharmacy and Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME Staff of the Department participated in the following undergraduate teaching programmes: anE nglish for

Medicine course entitled 'SQUH Pharmacy at a Glance' for 1st year medical students; a clinical nutrition academic course on TPN for 5th year medical students, and lectures on patient adherence to prescribed medications and talking to patients about their medications for Pre-clerkship medical students.

Training Courses & CME Activities In 2013, staff of the Department contributed to CME activities by teaching on the following topics/courses: Pain Management Course - Pharmacotherapy and Pain Management; Chemotherapy Course; Central Sterile Supplies Department Course - Chemical Agents and Antiseptics; Nursing (Pharmacist and Nurse collaboration) in SQUH, and a Knowledge forum entitled Clinical Pharmacy Interventions at SQUH.

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Training was also provided for students from Nizwa University, the OMC, the Oman Assistant Pharmacist Institute and the Higher College of Technology. Additionally, 15 CPD/CME sessions were organised in the De- partment and delivered by Pharmacy staff.

Clinical & Diagnostic Services Outpatient Pharmacy (OP) Dispensing prescriptions to ambulatory patients is the major activity of this section. This service is offered at four different locations: the main hospital pharmacy, the Family & Community (FAMCO) Clinic, the Emergen- cy Department pharmacy (24-hour service) and the Student Clinic pharmacy. At the main SQUH pharmacy, one room is dedicated for counselling patients. In 2013, more than 560 patients received detailed counselling on the use of their medications. During 2013, the OP pharmacies dispensed a total 229,391 prescriptions, for a total of 585,256 items.

Figure 1: Total number of prescriptions dispensed from all outpatient pharmacies between 2009–2013.

Inpatient Clinical Pharmacy Clinical pharmacy is a service provided by qualified clinical pharmacists to promote rational drug therapy that is safe, appropriate, and cost effective. Clinical pharmacists work in teams with other healthcare providers to achieve this goal. Clinical pharmacists perform a number of clinical activities, e.g. medication chart review and provision of medicine information. Clinical pharmacists also intervene to optimise drug therapy by connecting doses and frequencies.

200

Figure 2: Outcome of clinical interventions in 2013. departments The development of clinical treatment guidelines and patient educational material is a major activity of clinical pharmacists. In 2013, the following guidelines were produced or updated: Intrahaemorrhagic stroke care guidelines; Administration of palivizumab in SQUH; Vancomycin IV dosing guideline for neonates; Zanamivir administration guideline; Eculizumab paediatric administration guideline; Guidelines and poster for stress ulcer and venous thromboembolism prophylaxis in critically-ill patients; Know your medications, a patient

information leaflet; Antibiotic administration guideline for paediatrics (update); Alglucosidase (Myozyme®) patient administration guideline; Tuberculin purified protein derivative administration; Guidelines on prescribing, Pharmacy and

dispensing, and administering remixed total parenteral nutrition (TPN); Patient leaflets on safe handling and administration of antineoplastic medication; Disposal of medications and how to store your medications; Rituximab administration guideline (update); Dosing protocol of recombinant coagulation factor VII (No- voSeven®) for paediatric haemophilia patients; IV Pentamidine protocol, and Guidelines for noloxene and flumazenil. academic

In 2013, clinical interventions have increased by 11% to 3,110 compared to 2012. This was due to the availability of the interventions form in electronic format as part of the SQUH electronic patient records system set up in 2011.

Aseptic Preparations Unit This section is responsible for the preparation of TPN, chemotherapy preparations, sterile and non-sterile products and the repackaging of medicines.

201 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Table 1: Aseptic Preparation Unit manufacturing activities in 2010–2013 Activity 2010 2011 2012 2013 Total parenteral nutrition bags prepared 3,030 3,388 3,627 4,346 Cytotoxic doses prepared 9,928 10,659 10,093 11,252 Sterile and non-sterile preparations 2,740 2,886 3,029 2,520 Repackaged items 322 238 242 253

The production of TPN increased by 20% compared to 2012, with 55% of the bags being prepared for Neonatal Ward. The Unit also prepared 346 (8%) TPN bags for the Armed Forces Hospital (AFH) leading to an additional income of OR 22,490 for SQUH. Home TPN was prepared for the first time for one paediatric patient with tufting enteropathy.

The total number of prepared doses of cytotoxic preparation increased by 11.5% with the preparation of 11,252 doses compared with 10,093 doses in 2012. The total number of patient receiving them was 701. Outside SQUH, we prepared 69 cytotoxic doses for the AFH.

Medicine Information Services (MIS) MIS provides unbiased, evidence-based and critically-evaluated information about medicines, poisons and diseases in order to improve patient care. Table 2 shows the number of documented enquiries, adverse drug reactions (ADR) and poisoning reports from 2010 to 2013.

Figure 3: Clinical significance of interventions in 2013.

202 Table 2: Medicine Information Services activities in 2010–2013 Service 2010 2011 2012 2013 Enquiries 621 681 558 392 Adverse drug reaction reports 603 549 571 803 Poisoning reports 118 128 140 102

MIS also provides the essential information base for SQUH’s Pharmacy & Therapeutics Committee meetings. In 2013, information was provided on more than 21 drugs, which led to the addition of 12 drugs to the formulary and accepting the addition of one sample. Requests for six drugs were not accepted for addition by the committee while two drugs were deleted from the formulary.

Pharmacy Journal Club sessions were organised with the participation of pharmacy staff, during which papers selected from more than 50 medical and pharmaceutical journals were critically appraised. departments

Pharmacy Sub-Store

The Pharmacy Sub-Store is the link between the hospital main stores and the Pharmacy Department. It plays care an important role in ensuring the availability and smooth distribution of general pharmaceuticals, IV fluids, narcotics and psychotropic drugs to hospital wards and units. It facilitates the control of expiries and helps in the estimation of the quantities of pharmaceuticals to be purchased. The Pharmacy Sub-Store aims to patient

ensure the availability of all critical items as soon as possible in co-operation with the main store and the Pharmacy Procurement Department. The Pharmacy Sub-Store is responsible for the supply of medicines on requisitions and for other satellite pharmacies and different clinics and units in the Hospital. academic

Figure 4: Types of total parenteral nutrition prepared in 2013.

203 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 5: Cytoxic doses by specialty in 2013.

Figure 6: Number of requisitions issued by Pharmacy Sub-Store for 2010–2013.

Research RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Farhan H, Albulushi A, Taqi A, Al-Hashim A, Al-Saidi K,…Al-Zakwani I, et al. Incidence and pattern of thyroid dysfunction in patients on chronic amiodarone therapy: Experience at a tertiary care center in Oman. Open Cardiovasc Med J 2013; 7:122–6. 2. al-Abri M, Al-Hamhami A, Al-Nabhani H, Al-Zakwani I. Validation of the Arabic version of the Epworth sleepiness scale in Oman. Oman Med J 2013; 28:454–6. 3. abou Saleh M, Mafiana RN, Al Za’abi M, Vaishnav R, Al Kindi S, Al-Zakwani I. Epidemiology of chemotherapy-induced neutropenia at a tertiary university hospital in Oman. Int J Clin Pharm 2013; 35:1036–9.

204 4. Kilani H, Alyaarubi S, Zayed K, Alzakwani I, Bererhi H, Shukri R, et al. Physical fitness attributes, vitamin D, depression, and BMD in Omani children. Eur Sci J 2013; 9:156–73. 5. al Balushi KA, Al-Sawafi F, Al-Ghafri F, Al-Zakwani I. Drug utilization pattern in an Omani pediatric population. J Basic Clin Pharm 2013; 4:68–72. 6. younis MS, Al-Noaimi AS, Zaidan ZA, Al-Rubayie AF, Al-Farsi Y, Al-Zakwani I, et al. Clinical and demographic profile of attendees at Baghdad’s walk-in psychiatric clinic. Oman Med J 2013; 28:365–70. 7. al-Maniri AA, Al-Reesi H, Al-Zakwani I, Nasrullah M. Road traffic fatalities in Oman from 1995-2009: Evidence from police reports. Int J Prev Med 2013; 4:656–63. 8. al-Sinani S, Sharef SW, Al-Yaarubi S, Al-Zakwani I, Al Naamani K, Al-Hajri A, et al. Prevalence of celiac disease in Omani children with type 1 diabetes mellitus: A cross-sectional study. Oman Med J 2013; 28:260–3. 9. al-Mandhari A, Al-Adawi S, Al-Zakwani I, Dorvlo A, Al-Shafaee M. Reasons for consultation among patients attending primary healthcare centres in Oman. Sultan Qaboos Univ Med J 2013; 13:248–55. 10. al-Mawali A, Pinto AD, Al-Busaidi R, Al-Zakwani I. Lymphocytes subsets: Reference ranges in an age- and gender-balanced population of Omani healthy adults. Cytometry A 2013; 83:739–44. 11. abdwani R, Al-Abrawi S, Sharef SW, Al-Zakwani I. Geographical clustering of juvenile onset systemic lupus erythematosus within the Sultanate of Oman. Oman Med J 2013; 28:199–203. 12. al-Za’abi M, Ahmed R, Al Asmi A, Al-Zakwani I. Utilization patterns of antiepileptic drugs among adult epileptic

patients at a tertiary hospital in Oman. Int J Pharm Pract 2013; 21:117–22. departments

13. apostolakis S, Zubaid M, Rashed WA, Alsheikh-Ali AA, Almahmeed W,…Gulf Survey of Atrial Fibrillation Events In- vestigators, et al. Assessment of stroke risk in Middle Eastern patients with atrial fibrillation:T he Gulf SAFE registry. care

Int J Cardiol 2013; 168:1644–6. 14. al-Za’abi M, Al-Asmi A, Ahmed R, Al-Masrouri S, Al-Lawati R,…Al-Zakwani I, et al. Therapeutic antiepileptic drug monitoring pattern in a tertiary care hospital in Oman. Afr J Pharm Pharacol 2013; 7:58–62. 15. al-Waili K, Al-Zidi WA, Al-Abri AR, Al-Rasadi K, Al-Sabti HA,…Al-Zakwani I, et al. Mutation in the PCSK9 gene in Oma- patient

ni Arab subjects with autosomal dominant hypercholesterolemia and its effect on PCSK9 protein structure. Oman Pharmacy Med J 2013; 28:48–52. and

16. al-Balushi KA, Habib JQ, Al-Zakwani I. Comparative efficacy of irbesartan/hydrochlorothiazide and valsartan/ -hy drochlorothiazide combination in lowering blood pressure: A retrospective observational study in Oman. Med Princ Pract 2013; 22:265–9. 17. al-Hinai AT, Al-Abri A, Al-Dhuhli H, Al-Waili K, Al-Sabti H,…Al-Zakwani I, et al. First case report of familial hypercholesterolemia in an Omani family due to novel mutation in the low-density lipoprotein receptor gene. Angiology

2013; 64:287–92. academic 18. al-Lawati JA, Barakat MN, Al-Lawati NA, Al-Maskari MY, Elsayed MK,…Al-Zakwani IS, et al. Cardiovascular risk assessment in diabetes mellitus: Comparison of the general Framingham risk profile versus theW orld Health Organi- zation/International Society of Hypertension risk prediction charts in Arabs: Clinical implications. Angiology 2013; 64:336–42.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Al-Zadjali B. The challenges in taking medication history in a tertiary care hospital in Oman. 6th Medication Safety Conference Abu Dhabi, UAE, 22–24 Nov 2013.

205 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

National 1. Al-Rahbi A. Updates on Sepsis. Sur Pharmacy Symposium, Sur Hospital, Oman, 16 May 2013. 2. Al-Zadjali B. The challenges in taking medication history: Medications reconciliation initiative. Pharmacy Practice Symposium - Toward Better Pharmaceutical Care, Oman Medical College, Muscat, Oman, 25 May 2013. 3. Al-Ajmi S. Expanding knowledge and improving skills. Pharmacy Symposium, Royal Hospital, Muscat, Oman, 10 Jan 2013. 4. Al-Busaidy I. Pharmacovigilance and patient safety: The pharmacist role. 2nd GCC International Conference on Pa- tient Safety, SQUH, Oman, 21–23 Jan 2013. 5. Al-Busaidy I. Pharmacovigilance and patient safety: The pharmacist role. Pharmacy Practice Symposium - Toward Better Pharmaceutical Care, Oman Medical College, Muscat, Oman, 25 May 2013. Poster presentations International 1. Al-Busaidy I, Al-Hatrushi M. A survey of ADR reporting among pharmacists in SQUH. International Pharmaceutical Federation (FIP) World Congress - Towards a Future Vision for Complex Patients 2013, Dublin, Ireland, 31 Aug – 5 Sep 2013.

National 1. Al-Busaidy I, Al-Hatrushi M. A survey of ADR reporting among pharmacists in SQUH. Pharmaceutical Care Conference, Al Bustan Palace Hotel, Muscat, Oman, 20–22 Feb 2013. 2. Al-Busaidy I, Al-Hatrushi M. A survey of ADR reporting among pharmacists in SQUH. 2nd GCC International Conference on Patient Safety, SQUH, Oman, 21–23 Jan 2013. 3. Imam S. An Audit of Medication Reconciliation in an Acute Medication. 3rd Pharmaceutical Care Conference, Muscat, Oman, 20–22 Feb 2013. 4. imam S. What is Thalassaemia. Thalassaemia Open Day, SQUH, Oman, 23 Feb 2013. 5. Imam S. What is Medication Reconciliation. Medication Safety Open Day, SQUH, Oman, Mar 2013. Seminar Presentations National 1. Al-Siyabi E. ADR reporting. Tabuk Pharmacy CME Program, Ruwi Hotel, Ruwi, Oman, 16 Apr 2013. 2. al-Siyabi E. ADR reporting. Tabuk Pharmacy CME Program, Tulip Inn Hotel, Al Khuwair, Oman, 18 Apr 2013. 3. imam S. Pharmaceutical care plan in ALL. Tabuk Pharmacy CME Program, Ruwi Hotel, Ruwi, Oman, 16 Apr 2013. 4. Imam S. Pharmaceutical care plan in ALL. Tabuk Pharmacy CME Program, Tulip Inn Hotel, Al Khuwair, Oman, 18 Apr 2013. 5. Imam S. Counselling geriatric patients. 9th Annual Workshop of Good Pharmacy Practice, Hotel Muscat Holiday, Oman, 19 Dec 2013. 6. imam S. When dealing with leukaemia. Pharmacy Clinical Room for Pharmacy Staff, SQUH, Oman, 30 May 2013. 7. al-Rahbi A. 2013 Sepsis guidelines. Pharmacy Clinical Room for Pharmacy Staff, SQUH, Oman, 24 Sep 2013. 8. al-Hatrushi M. Tips for patient counselling. SQUH, Oman, Aug 2013.

206 9. Imam S. Anticoagulation clinic. Pharmacy Clinical Room for Pharmacy Staff, SQUH, Oman, 29 Sep 2013. 10. nair N. ADR reporting. Awareness Workshop for Nursing Staff, Golden Tulip Hotel, Seeb, Oman, 19 Jun 2013. 11. Nair N. ADR reporting. Awareness Workshop for Nursing Staff,Y ellow 1 Ward, SQUH, Oman, 8 Aug 2013. 12. nair N. ADR reporting. Awareness Workshop for Medical Students, Department of Pharmacology, SQUH, Oman, 23 Jun 2013. 13. Al-Busaidy I. ADR reporting: SQUH experience. Workshop on Pharmacovigillance. Ibri Hospital, Oman, 4 Sep 2013. 14. Al-Busaidy I. ADR reporting: SQUH experience. Workshop on Pharmacovigillance, Hamdan Plaza Hotal, Salalah, Oman, 26 Sep 2013. 15. al-Busaidy I. ADR reporting: SQUH experience. Workshop on Pharmacovigillance. Al-Buraimi Hospital, Oman, 14 Nov 2013. departments

care

patient

Pharmacy and

academic

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208 departments

care

Physiology patient

Physiology and

he Department of Physiology has two divisions: Basic Physiology and Clinical Physiology (CPH) located in the College of Medicine & Health Sciences and the University Hospital (SQUH), respectively. The Department teaches basic and clinical physiology and also familiarises medical students with various clinical physiological procedures. Physiology teaching is academic coordinatedT with other basic science departments in an integrated and multidisciplinary fashion. The curriculum is further for- tified by live models as well as simulated basic and clinical case demonstrations at different levels of medical training. Clinical students are taught hands-on the diagnostic skills of the most common clinical measurements that they are likely to encounter after graduation. The Department participates in postgraduate teaching and offers Master’s and Ph.D. programmes.

The Department of Clinical Physiology at the Hospital (CPH) provides advanced clinical diagnostic services for SQUH and also for the whole of Oman. It is the only Department of its kind in the country where such procedures are carried out under one roof with fully digital equipment, good quality assurance and cost effectiveness.

The Department lays major emphasis on research into cardiovascular and metabolic disorders, both basic and clinical. It has strong collaboration with other departments interested in the same field and internationally with universities and institutes conducting similar research. Technical and medical staff members receive regular training and are audited to meet international standards. 209 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Highlights of the Year 2013 Several research projects were carried out in phys- Head of Department iology and clinical physiology in 2013 in collabo- Khamis Al-Hashmi, Assistant Professor ration with other departments. Cardiovascular re- Faculty search is the high point of departmental research Mohammed Hassan, Professor expertise and activity. It spans topics from mem- Sulayma Al-Barwani, Associate Professor brane and vascular physiology to genetics and Abdul A. Khan, Assistant Professor clinical research. Research on sleep physiology and Hajar Al-Rajaibi, Assistant Professor disorders and its association with other metabolic Ammar A. Boudaka, Assistant Professor disorders is also one of the active research areas in Mohammed Al-Abri, Senior Consultant the Department. Sami Al-Rawas, Consultant Apart from the addition of new diagnostic pro- Talal Al-Mashkani, Acting Consultant cedures, the number of existing clinical tests in- Deepali Jaju, Senior Registrar creased in all specialties, with some having shown Amira Al-Kharusi, Clinical Lecturer (on study leave) a substantial increase. Medical research has also Support Staff increased and results from various projects have Adila Al-Tooqi, Superintendent (CPH) (on study been published. leave) Mariam Al-Hooti, Acting Superintendent & Senior Technologist (CPH) Teaching Programmes Susan Al-Nabhani, Senior Technologist (CPH) UNDERGRADUATE PHASE I AND Farid Al-Dhuhli, Superintendent (Physiology) II PROGRAMMES Isehaq Hussaini, Biomedical Scientist The Department has contributed extensively to the Hajer Ba-Omar, Research Assistant development and delivery of various systems mod- Sultan Al-Siyabi, Research Assistant ules which have been incorporated into the med- Jessy George, Coordinator ical curriculum. The Department of Physiology Iluminada Calupig, Coordinator (CPH) offers one departmental course and makes major contributions to: Structure-function Relationship; In addition, there are 31 technicians (of which 20 Alimentary System; Uro-reproductive System; Car- are Omani) in the support staff team working in the diovascular System; Respiratory System; Human sections of Cardiology, Pulmonology, Neurophysiol- Nervous System; Endocrine System and the Inte- ogy and in the Sleep Disorders laboratories. grated Modules I, II and III. The Department also teaches the following courses in the Nursing degree programme: Anatomy & Physiology courses I

210 & II and Pathophysiology for Nursing. The Integrated Module course is a problem-based course shared with all clinical departments. Seven academic staff of the department are involved as module coordinators.

Most of the above courses have relevant clinical applications. Case presentations and the appropriate clinical procedures are taught to the students during these courses and elaborated upon during the clinical years. Students are evaluated in their theoretical and practical components as well as in their basic clinical skills.

The Department participated significantly in the research module. Almost all faculty members in the De- partment supervise one or two students. They provide the required training and guide them during the writing of the project report.

UNDERGRADUATE PHASE III CLINICAL PROGRAMME In the Phase III clinical programme, the Department is involved in the teaching of the Pre-clerkship, Junior Clerkship and Senior Clerkship programmes.

POSTGRADUATE TEACHING departments The Department offers M.Sc. and Ph.D. programmes. There is currently one student enrolled in the M.Sc. program and there are two Ph.D. students registered and working in two different fields towards the achieve- care ment of their degrees. One Ph.D. student is working in basic science research and the other one on the clinical side.

The Department contributes to the core programme of the Oman Medical Specialty Board (OMSB) and to patient

the preparation of trainees for the Membership of the Royal College of Physiologists (MRCP) and Fellowship Physiology of the Royal College of Surgeons (FRCS) examinations. Departmental faculty participated as facilitators in and different workshops conducted by the OMSB.

Training Courses & CME Activities

Regular in-house training is conducted for newly recruited technicians. As a part of this course, the tech- academic nicians attend the Anatomy & Physiology course for nursing students when required. Continuing medical education (CME) sessions are held on a monthly basis. Support staff members are all actively involved in the training, teaching and research activities of the Department in both the College and Hospital programmes.

In-house training programmes are provided to the CPH technologists based on their speciality and their administrative responsibility—according to the courses offered by the SQUH Directorate of Training & CPD.

211 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Clinical & Diagnostic Services The CPH offers diagnostic services which cover most of the spectrum of neurophysiology, cardiology, pulmonology, sleep medicine and other discrete tests. All critical CPH diagnostic services are fully functional to date. Many of the diagnostic areas have further improved their services. The implementation of the policy of reconfirming the referral reasons, established in 2012, also continued in 2013. In this year, new equipment for the estimation of adult and paediatric full pulmonary functions with diffusion capacity was acquired.

The total number of patients attending CPH clinics during the year 2013 was 22,487. This is a 3% increase on the 2012 figures.T he monthly distribution of procedures is shown in Figure 1, with the highest number of patients attending in March followed by December.

The Cardiology service had the highest number of procedures (10,562), followed by neurology and pulmonary function tests [Figure 2]. The highest number of CPH procedures were in non-invasive cardiology (5,701); followed by audiometry and newborn screening (4,933); ECHO (4,560); invasive cardiology (1,331); pulmonary function tests (959), and polysomnography (571). Figure 3 shows the comparative distribution of invasive cardiology tests per month for 2012 and 2013.

Out of the total 22,487 procedures in 2013, there were 11,011 outpatients (a 3.5% increase on 2012) and 8,556 inpatients (a 2.6% increase on 2012). A total of 2,877 patients were referred from hospitals other than SQUH (a 3.8% increase on 2012) [Figure 4].

Figures 5 and 6 depict the total number of patients investigated in CPH as a department and in each section of CPH since 2009. There has been significant and consistent increase in the number of patients investigated in CPH in all sections.

Figure 1: Number of patients attending the SQUH Department of Clinical Physiology in 2013.

212

Figure 2: Types and number of procedures in the SQUH Department of Clinical Physiology in 2013. departments

care

patient

Physiology and

Figure 3: Number of patients attending for cardiac catheterisation in 2012 and 2013. academic

Figure 4: Monthly distribution of referrals to the SQUH Department of Clinical Physiology in 2013. 213 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 5: Comparative analysis of total patients investigated in the SQUH Department of Clinical Physiology since 2009.

Figure 6: Comparative analysis of total patients investigated in each section of the SQUH Department of Clinical Physiology since 2009.

Research Research Projects An investigation into lethal ischaemia/reperfusion injury and anti-apoptotic therapies (caspase inhibitors) in the human myocardium Project Code: IG/MED/PHYS/10/04 Dates: 2010–2013 Value: OR 14,600 Project Funder: SQU Investigators: Dr. Hajar Al-Rajaibi, Dr. Sulayma Al-Barwani, Dept. Physiology, SQU; Dr. Hilal Al-Sabti, Dept. Surgery, SQU; Ms. Kamla Al-Maawali, Dept. Pathology, SQU.

214 Interaction between ageing and exercise training in the regulation of coronary vascular tone: Role of intracellular calcium signaling and BKCa channels Project Code: IG/MED/PHYS/11/01 Dates: 2011–2013 Value: OR 14,600 Project Funder: SQU Investigators: Dr. Sulayma Al-Barwani, Prof. Mohammed Hassan, Ms. Hajer Ba-Omar, Mr. Sultan Al-Si- yabi, Dept. Physiology, SQU.

Evaluation of eXforge hCt Efficacy and safety in a real world setting (EXCEED) Code: MREC #745 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Khamis Al-Hashmi, Dept. Physiology, SQU.

Non-dipping blood pressure and metabolic disorder in SQUH patients Code: MREC #781 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Prof. Mohammed Hassan, Dept. Physiology, SQU. departments

Sleep apnea and hemodynamic and autonomic profile in patients undergoing CABG: A longitudinal study care

Code: MREC #820 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Deepali Jaju, Dept. Clinical Physiology, SQUH. patient

Student Research Projects The following student research projects were supervised in the Department: (1) Non-dipping blood pressure Physiology and and the metabolic syndrome by Prof. Mohammed Hassan; (2) Non-dipping blood pressure and metabolic dysfunction by Prof. Mohammed Hassan, and (3) Effect of siesta (day time sleeping) on dipping status of blood pressure in the Oman Family Study by Dr. Khamis Al-Hashmi.

RESEARCH PUBLICATIONS & BOOKS academic Journal Publications 1. Campos La, Pereira VL Jr, Muralikrishna A, Albarwani S, Brás S, Gouveia S. Mathematical biomarkers for the autonomic regulation of cardiovascular system. Front Physiol 2013; 4:279. 2. Zadjali F, Al-Yahyaee S, Hassan MO, Albarwani S, Bayoumi RA. Association of adiponectin promoter variants with traits and clusters of metabolic syndrome in Arabs: family-based study. Gene 2013; 527:663–9. 3. Albarwani S, Al-Siyabi S, Tanira MO. Lisinopril indifferently improves heart rate variability during “inactive” compared to “active” period in spontaneously hypertensive rats. Physiol Res 2013; 62:237–45. 4. Hossen A, Jaju D, Al-Ghunaimi B, Al-Faqeer B,...Hassan MO, Al-Abri M. Classification of sleep apnea using wave- let-based spectral analysis of heart rate variability. Technol Health Care 2013; 21:291–303.

215 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

5. Al-Abri M, Al-Hamhami A, Al-Nabhani H, Al-Zakwani I. Validity of the Arabic Epworth Sleepiness Scale (ESS) in Omani population. Oman Med J 2013; 28:454–6. 6. al-Sabti HA, Al-Kindi A, Al-Rasadi K, Banerjee Y, Al-Hashmi K, Al-Hinai A. Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft. J Saudi Heart Assoc 2013; 25:247–54. 7. albarwani S, Al-Husseini I, Al-Siyabi S, Al-Ismail A, Tanira MO. Lisinopril augments the combined effect of nitric oxide and potassium channels on endothelium-dependent relaxation in spontaneously hypertensive rats. (Abstract). FASEB J 2013; 27:lb642. 8. al-Rasadi KH, Al-Saleh M, Al-Hashmi K, Al-Dhuhli H, Al-Mukhaini S. Evaluation of lipids in children with type 1 diabetes mellitus compared to controls. J Clin Lipidol 2013; 7:243–4.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations International 1. Albarwani S, Al-Kaabi A, Al-Busaidi M, Al-Hadhrami S, Al-Lawatiya I, Al-Husseini I, et al. Aging reduces the vasodila- tory response of mesenteric resistance arteries to calcium channel blockers. International Congress of Physiological Sciences, Birmingham, UK, 20–26 Jul 2013. 2. Boudaka A, Mihara H, Sugiyama T, Moriyama Y, Tominaga M. Transient receptor potential vanilloid 4-dependent calcium influx and ATP release in mouse esophageal keratinocytes. International Union of Physiological Sciences (IUPS) 2013, Birmingham, UK, 21–26 Jul 2013. Poster Presentations International 1. Al-Abri M, Al-Shukari A, Al-Qanobi A, Al-Asmi A. Association between seizure disorders and obstructive sleep apnea (Pilot study). Sleep 2013, Baltimore, USA, 1–5 Jun 2013.

216 departments

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Physiotherapy & Rehabilitation patient

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he Department covers three different disciplines: physiotherapy, occupational therapy, and speech and language therapy. Physiotherapy views human movement as central to the health and well-being of individuals. Physiotherapists identify and maximise movement potential through health promotion, preventive healthcare, treatment and rehabilitation. Occupational therapy helps clients who have orthopaedic, neurological and psychiatric handicaps in academic T Physiotherapy & Rehabilitation their daily living to live a normal life. Surgical and chronically-ill patients can also benefit from it. Speech and language therapy is concerned with improving clients’ communication skills.

Physiotherapy services cover inpatient, outpatient, emergency and day care patients. The services are available seven days a week in all the hospital wards, including pre- and post-cardiac rehabilitation. Treatment modalities include electrotherapy, manual therapy, hydrotherapy, acupuncture, reflexology, neuro-rehabilitation, respiratory therapy, paediatric rehabilitation, cupping, women’s health (pre- and postnatal and female urinary incontinence), sports injuries, public health education and splinting. Physiotherapists are also involved in the clinical teaching of physiotherapy and medical students.

Occupational therapy (OT) services include home modifications, adaptive devices, splinting and help to improve patients' oral motility, cognitive skills and to overcome learning disabilities. Adaptive devices are advised or provided to compensate any

217 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

disability and improve their functional ability. OT Staff aims to enable clients to reach their maximum level of functional independence in all their ac- Head of Department tivities of daily living (ADL) so as to enable them Suleiman Al-Alawi to become independent members of society. In Deputy Head of Department paediatrics, problems such as posture (proper Saif Al-Riyami seating); mobility (wheelchair and mobility devices); ADL (adaptive devices); deformities (splint- Therapists ing); hyperactivity; sensory concentration and Kauther Al-Busaidi, Senior Chief Physiotherapist A coordination; integration dysfunction, and Omar Al-Tamimi, Chief Physiotherapist A dysphagia (feeding and eating troubles) are Nasser Al-Hajri, Chief Physiotherapist B tackled to bring the child’s development to as Said Al-Balushi, Chief Physiotherapist B normal a level as possible. Treatment includes fam- Zuwaina Al-Bahri, Chief Physiotherapist B ily counselling and home programmes. Ahlaam Al-Mazrui, Chief Physiotherapist B Hilal Al-Rashdi, Senior Physiotherapist Speech and language therapy services provide as- Najma Al-Mahruqi, Senior Physiotherapist sessments, management and treatment for a wide Huda Al-Saadi, Senior Physiotherapist range of cases related to hearing impairment; cog- Moza Al-Amri, Senior Physiotherapist nitive, or other developmental delays; birth defects Sabah Al-Touqi, Senior Physiotherapist such as cleft lip and/or palate; motor planning Safiya Al-Hashmi, Senior Physiotherapist problems; dysphagia; traumatic brain injury; neu- Madiha Al-Kindi, Senior Physiotherapist rological problems affecting communication, or Hasna Al-Rashdy, Senior Physiotherapist voice disorders. In addition, speech and language Shaima Al-Saidi, Physiotherapist therapists supervise speech and language therapy Hammad Al-Subhi, Physiotherapist students during their training in SQUH. Further- Mahmoud Al-Hinai, Physiotherapist more, great efforts are made to educate other pro- Halima Al-Mahrooqi, Physiotherapist fessionals (e.g. physicians, dieticians and nurses) Hilal Al-Balushi, Physiotherapist about speech and language therapy. We also re- Fathiya Al-Harthy, Physiotherapist ceive other trainee medical students and educate Mohamed Al-Shamli, Physiotherapist them on the role of speech and language therapists. Mohamed Al-Hinai, Physiotherapist Kamla Al-Qasmi, Physiotherapist Sumaiya Al-Mahrizi, Physiotherapist Said Al-Yaarobi, Physiotherapist Senthikumar Ravindran, Physiotherapist Ibtisam Al-Wardi, Senior Speech & Language Therapist

218 Fathiya Al-Amri, Speech & Language Therapist Zahra M. Mohsin, Speech & Language Therapist Authaima A. Al-Farsi, Occupational Therapist Support Staff Laureana P. Valderama, Coordinator Fathiya Al-Akhzami, Receptionist Hamood Al-Amri, Messenger Highlights of the Year 2013 Services The Department continued conducting the Parent-Infant Massage classes (parent-infant bonding and attachment). The class was conducted once a week for 1.5 hours; parents learn theoretical and practical aspects of massage—not only how to massage their infants but also infant cues, behavioural states and other issues related to infants such as colic relief. The four main principles of infant massage are interaction, stimula- departments tion, relief and relaxation. Nurturing touch provides interaction between parents and infants that promotes bonding, secure attachment and verbal and non-verbal communication. It also enhances stimulation of var-

ious body systems and improves learning ability and mind/body awareness. Nurturing touch can help in care relieving gas and colic, constipation and growing pain. By achieving the three principles, relaxation will be achieved and babies have better sleeping patterns and more enjoyable play times.

In OT services, a new occupational therapist, Ms. Authaima Al-Farsi, joined the Department of Physiotherapy patient

& Rehabilitation in March 2013. and The speech and language therapy service focused on both adult and paediatric patients (both in- and outpatients) who presented with hearing impairments; cognitive, or other developmental delays; motor planning problems; dysphagia; traumatic brain injury; neurological problems affecting communication or voice disorders. Caregivers also received training as necessary. A variety of therapeutic techniques are employed, including speech and language stimulation, voice exercises, e.g. the Lee Silverman Voice Treatment academic Physiotherapy & Rehabilitation (LSVT programme) and dysphagia management. In addition, the speech and language therapists supervised newly graduated speech and language therapists during their training in SQUH. Furthermore, great efforts were made to educate other professionals (e.g. physicians, dieticians and nurses) about the speech and language therapist’s role by providing an introduction to the profession, making brochures and handouts and organising a workshop on dysphagia. A Child Development Progress Clinic is run in the hospital by a team consisting of a speech therapist, an occupational therapist and a paediatrician.

The Department published a Rehabilitation Newsletter in June. The Department held its annual Rehabilita- tion Event focusing mainly on Paediatrics entitled “Our Kids Our Wealth”. The event highlighted the impor-

219 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

tance of early detection of and intervention for paediatric diseases and increased awareness of children’s rights, particularly those of children with special needs. The “Our Kids Our Wealth” event also organised two additional events; a walk-a-thon in Al-Khuwair in January and an open rehabilitation exhibition in SQUH in April.

Continuing Professional Development During 2013, members of staff participated in the following training courses: Balanced Score Cards, Injaz, Platinum Hotel, Oman; Mulligan Concepts, Turkey General Osteopathic Treatment Course, SQUH; Physical Activity & Clinical Exercise for Cardio-vascular Disease, London, UK; S1 Module: Foundation & Neuroscience Paediatrics, Birmingham, UK; Certificate inS pinal Manual Therapy, Bali, Indonesia; Modern Secretarial and Office Management Course, Centre for Community Service & Continuing Education, Oman; Clinical Neuro- dynamic Course, Dubai, UAE; More Than Words Advanced Workshop, Manchester, UK; Preceptors Training Workshop, Institute of Health Sciences, Oman; Medical Error Disclosure Workshop, SQUH, Oman; It Takes Two To Talk, San Francisco, USA; Paediatric Orthopaedic Symposium, Armed Forces Hospital, Muscat, Oman; Etiquette & Protocol, Oman; Tape Concepts, SQUH, Oman; Accreditation Canada International, Golden Tulip Hotel, Oman; Symposium of Hand Hygiene in Healthcare Settings, SQUH, Oman; Problem-Solving & Deci- sion-Making, SQUH, Oman; Dynamic Core Across The Life Span, SQUH, Oman; General Osteopathic Treat- ment Course, SQUH, Oman and Global Manual Osteopathic Approach Certification Course, SQUH, Oman.

Members of staff participated in the following one-month clinical attachment in 2013: Sports Injury and Musculoskeletal Departments, Sheffield, UK.

Members of staff participated in the following conferences in 2013: 1stW orld Congress on Abdominal & Pelvic Pain, Netherlands; 43rd Annual Meeting of the International Continence Society, Spain; Arthroplas- ty Congress, Dubai, UAE; America Speech & Hearing Association Convention, San Francisco, USA; 2nd GCC International Conference on Patient Safety, SQU, Oman; Oman International Sports Medicine Conference, Oman; 1st National Physiotherapy Students Conference, Oman; 1st Salalah International Physiotherapy & Rehabilitation Conference, Oman; Oman Thoracic 2013 Conference, SQU, Oman; International Conference on Paediatric Intensive Care, Sohar Hospital, Oman, and the Rehabilitation Conference, Sinaw Hospital, Oman.

Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME The Department participates as an external examiner in applied anatomy theory and practical and professional issues. The Department participates in the quality audit in the Institute of Health Sciences. The Department is involved in clinical teaching, practical hands-on training, and in supervising students and interns both from Oman and abroad. This ranges from undergraduates in physiotherapy, speech therapy and occupational therapy to qualified doctors.

220 In 2013, 17 students from the Institute of Health Sciences in Muscat had a six-week full-time clinical placement; a physiotherapy student from Jordan had a three-week full-time clinical attachment; an Indian physiotherapist had a six-week full-time clinical attachment; an Omani physiotherapy clinical tutor from the Institute of Health Science had a four-month clinical attachment and an Omani physiotherapy clinical tutor had a two-month clinical attachment.

Tutorial sessions were provided on the Importance of Physical Activity to nutrition students; Infantile Colic for physiotherapy students at the Institute of Health Sciences; Physiotherapy Management in Acute Coro- nary Syndrome for nurses in the paediatric ward; Women Health Awareness in Nakhal, Oman; Physiothera- py in the Elderly for 5th year medical students; Locomotors Skills for 4th year medical students; Introduction to Physiotherapy for nursing students from the College of Nursing; Physiotherapy Workshop to arts students from the College of Arts & Social Sciences, SQU.

Training Courses & CME Activities On a rotation basis, each therapist conducts in-service lectures and speaks at the departmental journal club. departments

We also invite doctors, nurses and other paramedical staff to give lectures.T herapists write articles for the bi-annual Rehabilitation Newsletter on a rotation basis. Articles included in the June issue were: Dashboard

Femoral Fracture; Infant Colic; Critical Appraisal of Knowledge Management Practice; Mirror Therapy in care

Stroke Rehabilitation and the Back Clinic.

Department staff ran training courses for SQUH and other hospitals in 2013 on the following topics: Role of patient

Physiotherapy in the Elderly; Basic Acupuncture Course for Health Professionals; Medical Taping Workshop; Tape Concepts; Dynamic Core Across the Life Span, and Global Manual Osteopathic Approach Certification. and

The Department also ran a weekly in-service training session for its own staff as well as other SQUH staff including nurses. The topics covered were: Introduction to Career Development Plan; Acoustic Neuroma; Upper Cervical Spine Assessment & Treatment; Allgrove Syndrome; Health & Beauty; Vitamin D Deficiency; Quali- ty of Life Post Renal Transplantation; Problem-Solving & Decision-Making; More than Words; Dysphagia; Hip academic

Replacement; Sensory Integration Theory; ICU Flow Sheet; Art Therapy; Muscle and Joint Bleed in Haemo- Physiotherapy & Rehabilitation philia; Dashboard Femoral Fracture; Balance Score Card Concept and Objectives; Sacroiliac Joint Dysfunction; Total Elbow Arthroplasty; Communication and Patient Care; Wilson Disease; Core Stability in Relation with Knee Dysfunction; Knee Injuries; Re-assessment; Asian Knee and Total Knee Arthroplasty; Constant Induced Movement Therapy; Attitude and Positive Thinking; Supportive Positioning in the Neonatal Intensive Care Unit, and Body Language

Lifting and Moving Course for Nurses and Medical Orderlies in the SQUH Directorate of Training & CPD (DTD) programme was conducted once a month by physiotherapists in the Department. Lectures were given in the DTD programme on Other Modalities of Pain Management. The Department participates in the Clini- cal Methods Course and the Interdisciplinary Activity Week in collaboration with the College of Medicine & Health Sciences. The Department also participated in the evaluation of university students with disabilities.

221 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Clinical & Diagnostic Services The total number of patients seen by the Department is shown in Table 1.

Table 1: Number of patients in 2013 Service No. of No. of Total inpatients outpatients Physiotherapy 4,832 7,414 12,246 Occupational therapy 148 518 666 Speech and language therapy 283 768 1,051

Research CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations National 1. Al-Mahrooqi N. Infantile Colic. Institute of Health Sciences, Wattayah, Oman, 2 March 2013. 2. Al-Riyami S. Mobilisation Techniques in Musculoskeletal Conditions. National Conference on Mental Rehabilita- tion, Al-Masarra Psychiatric Hospital, Oman, 26 Dec 2013. 3. Al-Mahrooqi N. Infantile Colic. Multidisciplinary Services Awareness on Newborn, Institute of Health Sciences, Oman, 2 March 2013. 4. Al-Riyami S. Shoulder Stability. 1st Salalah International Physiotherapy & Rehabilitation Conference, Sultan Qaboos Hospital, Salalah, Oman, 31 Aug – 1 Sep 2013. 5. Al-Busaidi K. Physiotherapy Management of Pelvic Organ Prolapse. 1st Salalah International Physiotherapy & Reha- bilitation Conference. Sultan Qaboos Hospital, Salalah, Oman, 31 Aug – 1 Sep 2013. 6. Al-Tamimi O. Core Stability in Relation to Knee Disorders. 1st Salalah International Physiotherapy & Rehabilitation Conference, Sultan Qaboos Hospital, Salalah, Oman, 31 Aug – 1 Sep 2013. 7. Al-Riyami S. Physiotherapy Management of Shoulder. Rehabilitation Conference, Sinaw, Oman, 31 Oct 2013. 8. Al-Busaidi K. Women Health Awareness. Rehabilitation Conference, Sinaw, Oman, 31 Oct 2013. 9. Al-Hajri N. Physiotherapy in Paediatrics. Paediatrics Orthopaedic Symposium, Oman, 10 Nov 2013. 10. Al-Riyami S. Mobilisation Techniques in Musculoskeletal Conditions. National Conference on Mental Rehabilita- tion, Oman, 26 Dec 2013.

222 departments

care

Radiology & Molecular Imaging patient

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he Department of Radiology & Molecular Imaging serves the community through advanced innovation and clinical application of imaging sciences. The Department is committed to excellence in the training of the next generation of radiologists, technologists, residents and Senior Clerkship students. The Department’s goal is to provide the highest quality of patient care with predictive, diagnostic and therapeutic imaging-based approaches. academic T Radiology & Molecular Imaging The Department offers specialised diagnostic services and operates state-of-the-art outpatient, inpatient and emergency imaging services. These include magnetic resonance imaging (MRI), digital subtraction angiography (DSA), nuclear medicine (NM), computed tomography (CT), ultrasound (US) and medical physics (calibration of radiation equipment, research, etc.) as well as routine radiological imaging.

The Department has 59 technologists covering all major subspecialties, including body imaging, cardiothoracic imaging, interventional radiology, musculoskeletal radiology, neuro-radiology, nuclear medicine, and paediatric and women’s imaging.

The Department has been fully digitised since May 2002 after the installation of a complete picture and archiving communication system (PACS). Radiological examinations can be viewed by all doctors from any computer outlet at Sultan Qaboos Uni-

223 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

versity Hospital (SQUH) on an internal web system together with the radiological report. The old PACS/ RIS system was replaced with a new system - Philips PACS/RIS: iSite/XIRIS in May 2011. The new system has several significant improvements in the functionality, storage and accessibility over the previous system. The most notable features are: integration with the SQUH hospital information system (HIS) and MedTrack, a modern web-based archiving system which ensures availability of all studies 24/7.

The clinical services offered by the Department are increasing rapidly in parallel with the expansion of SQUH clinical services. Approximately 85,000 studies are performed per year in the Radiology/Nuclear Medicine section alone and the number is rapidly rising. This does not include the services offered by the Medical Physics section to various departments and colleges of SQU as well as the community at large. The Medical Physics services include thermoluminescent dosimeter radiation protection for many institutions in Oman, as well as teaching and the checking of radio-activity in other resources. In addition to diagnostic services, the Nuclear Medicine section also delivers four therapeutic procedures, especially radioiodine therapy for thyroid cancer and hyperthyroidism.

Research, teaching and training at both undergraduate and postgraduate level involves all 13 members of faculty from the Department’s college and hospital staff; they are also involved in the training of radiographers. Radiology technicians are also involved in the teaching of radiographers from the Institute of Health Sciences. We have been successful as a Department in sending our young Omani technologists abroad to study for university degrees.

The teaching and training of Oman Medical Specialty Board (OMSB) radiology residents has been underway since 2005. We have trained 32 radiology residents, of which 10 are graduating this year as radiology specialists. In addition, we train about 20 residents a year from other clinical services who rotate through the Department. We are actively involved in teaching medical students (4th to 7th year in both the old and new curricula).

The Department is divided administratively into six sections, each one with its own supervisor. General Radiology & Mammography; Ultrasound (US) both general and gynecology and obstetrics US; Computed Tomography (CT); Magnetic Resonance Imaging (MRI); Vascular & Intervention, and Nuclear Medicine.

General Radiology & Mammography The clinical mission of this subsection is to provide individually tailored comprehensive evaluation for the early detection and diagnosis of breast diseases.

The service offers state-of-the-art dedicated breast imaging modalities which include full field digital mammography and dedicated breast ultrasound. The other services include stereotactic-guided biopsy and stereotactic hook wire localisations. US-guided interventional procedures such as US-guided biopsies, fine-needle aspiration cytology and clip placements are some of the other procedures provided.

224 A ‘One-stop Breast Clinic’ is held once a week in collaboration with surgeons and pathologists. The aim is to achieve the diagnosis and establish a management of plan for each patient at the initial outpatient visit. This clinic allows optimum patient management, minimises the anxiety associated with symptomatic breast disease and maximises the utilisation of outpatient resources. The patient is thus able to have her clinical examination, radiology imaging, biopsy and pathology results all on the same day. The optimal management of breast cancer patients requires expertise from different specialties.T herefore, a weekly multi-disciplinary team meeting is held so that key professionals from surgery, pathology, medical oncology, and radiology can discuss individual breast cancer patients and contribute to clinical decisions.

Nuclear Medicine This section has installed a new hybrid single photon emission tomography and X-ray CT 16 slices (SPECT/ CT) machine, the first in Oman. It will improve the accuracy of the diagnosis and decrease the time of examination in many types of studies, such as myocardial perfusion for the detection of coronary arteries disease. Currently, this section has four nuclear medicine technologists. There are four rooms for radionuclide therapy where thyroid cancer and thyrotoxicosis patients are treated with radioactive iodine. Patients can also be departments treated with yttrium 90 for chronic synovitis. SQUH is the only centre in Oman which provides this service. care Interventional Radiology This section carries out angiography procedures with the latest machines. The section has pioneered interventional endovascular treatments in Oman, such as endovenous ablation and mechanical thrombectomy. patient

The section has three vascular interventional radiologists and one neuro-interventional radiologist as well as six technologists and 10 nurses shared between the Department and the cardiac catheter laboratory. and

The section’s services including interventional oncology, peripheral vascular disease, trauma embolisation, gastrointestinal tract embolisation, drainage, biopsies and transplant interventions. The following diagnostic and interventional vascular procedures are performed: (1) Aortic, pulmonary, mesenteric and peripheral arteriography; (2) Aortic and peripheral stent-graft placement; (3) Arterial and venous angioplasty and academic

stenting; (4) Arterial and venous thrombolysis and thrombectomy; (5) Arterial and venous embolisation; Radiology & Molecular Imaging (6) Arteriovenous malformation treatment; (7) Venous ablation and management of venous insufficiency; (8) Transarterial liver-directed therapy including bland, chemo- and drug-eluting beads; (9) Uterine artery (fibroid) embolisation; (10)V aricocele embolisation; (11) Endocrine tumor venous sampling; (12) Vena cava filter placement; (13) Foreign body retrieval; (14) Dialysis access management, and (15)V enous access and port placement.

The section also performs all the diagnostic and interventional percutaneous non-vascular procedures, such as: (1) Thoracoabdominal, hepatobiliary, renal, gastrointestinal, transplant organ and soft tissue drainages, dilations and stents; (2) Renal and hepatic biopsy and ablations; (3) Transhepatic cholangiograms; (4) Biliary stenting; (5) Nephrostomy; (6) Ureteral stenting, and (7) Gastrostomy and gastroenterostomy.

225 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Ultrasound This section has a high workload. The examinations include breast US which are performed in the Mammography section, US-guided interventional procedures, and portable US examinations. Currently, the section has 10 sonographers, two of which are dedicated to obstetrics and gynaecology US, while one rotates between obstetrics and gynaecology, and general US.

Medical Physics The Radiation Protection Service (RPS) provides technical and consultancy support to ensure that sources of ionising radiation and radiation-generating equipment are handled in a manner that complies with Omani regulations and relevant international safety standards. It has been operating since 1990, providing support services, advice and consultations to the University, other ministries and private companies. The RPS consti- tutes the only fully professional national resource service of its kind in Oman. It is well equipped with a wide range of measuring and calibration equipment for dealing with its main functions in medical and industrial uses of ionising radiation.

All radionuclides purchased by SQUH are first delivered to the Medical Physics section for contamination survey and input into the radionuclide database. After this, a trained nuclear medicine technologist collects them.

The personal dosimetry service provides monitoring of radiation doses received by radiation workers to the university and external organisations (e.g. Ministry of Defense, Technical Inspection Services and Muscat Private Hospital). The badges are worn for one calendar month and then read by the Department TLD reader. The reported doses are maintained for all staff. Personnel reports are sent to the employers to make them available to each radiation worker.

Radiation measuring, instruments should be calibrated annually, sometimes more frequently depending on the instrument and its use. The RPS provided calibration and maintenance services for portable radiation survey instruments (Mini900, Mini1000, Ludlum) used in SQU/SQUH, external organisations and industries throughout Oman (e.g. Ministry of Environment & Climate Affairs, Petroleum Development of Oman, Shal- eem Petroleum, Midwesco and Halliburton).

Annually quality control (QC) tests are performed by the medical physicists on X-ray equipment. Maintain- ing a QC programme ensures that image quality is maintained whilst reducing the radiation dose to patients and staff, as per ALARA (As Low As Reasonably Achievable) principles. The results are sent to the relevant departments. In case of malfunction, a report is sent to the Biomedical Engineering Department where the necessary action is taken. The tests are repeated after repair.

226 US units in SQUH undergo annual QC tests to identify problems with the units before they cause diagnostic problems. The results are conveyed to the relevant departments. If a unit is found to be malfunctioning a report is sent to the Biomedical Engineering Department. The tests are repeated after repair.

Daily measurements for image uniformity were carried out by the technical staff of the Nuclear Medicine section. The medical physicists perform extensive monthly quality assurance tests. Daily radiopharmaceu- tical QC tests are also performed before radiopharmaceuticals are administered to patients. Dose calibrators for patients are tested daily for consistency and also annually.

Medical physicists perform acceptance testing and also commission newly purchased US, X-ray and SPECT/ CT machines.

Medical physicists provide support to the Radiation Therapy Unit (Psychiatry Department) by performing patient and room surveys, recording radiation doses taken from patients, and giving instructions to patients at discharge to protect relatives and the environment from unnecessary radiation exposure and contamination. departments

Liquid and solid radioactive waste from the Nuclear Medicine section and the I-131 Therapy Unit is regularly

monitored and records are kept in the Medical Physics section. When necessary the waste is stored in a des- care ignated storage area and disposed of by the medical physicists only when it becomes non-radioactive.

Gamma spectroscopy is a very sensitive method for identifying presence of radionuclides and measuring patient very small concentrations in samples. The measurements are routinely performed on irrigation water and sludge samples from the sewage treatment plant at SQU for radionuclides originating from the nuclear and medicine department and particularly I-131 from the therapy unit. Certain foodstuffs from Omani industrial plants for export to certain countries require a certificate stating they are free from man-made radionuclides. Such certificates are supplied along with an analysis report for each sample. Petroleum companies have been identifying naturally-occurring radioactive material (NORM) at several of their production facilities. Samples of water, oil, scale and sludge are regularly sent for gamma spectroscopy analysis by the RPS to determinate academic the appropriate method of disposal. Radiology & Molecular Imaging

227 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Mohammed Al-Abri, Senior Technologist (B) Abdullah Al-Siyabi, Senior Technologist (A) Head of Department Adnan Al-Kharousi, Senior Technologist (A) Faisal Al-Azri, Senior Consultant Matheo Dilao, Senior Technologist (B) Deputy Head of Department Mahmood Al-Abri, Senior Technologist (B) Faiza Al-Salmi, Senior Technologist (A) Humoud Al-Dhuhli, Senior Consultant Umaima Al-Ajmi, Senior Technologist (A) Faculty Aziza Al-Jabri, Senior Technologist (A) Dilip Sankhla, Senior Consultant Mohammed Al-Saqri, Senior Technologist (B) Samir Hussein, Senior Consultant Nabila Al-Hesani, Senior Technologist (B) Sukhpal Sawhney, Senior Consultant Ahmed Al-Shuhaimi, Senior Technologist (B) Haddia Bererhi, Senior Consultant Sultan Al-Naamani, Senior Technologist (B) Nader Atari, Associate Professor Hamoud Al-Ghafri, Senior Technologist (B) Rashid Al-Sukaiti, Senior Consultant Aida Al-Rahbi, Technologist (A) Anupam Kakaria, Consultant Rania El-Tigani, Senior Technologist (B) Sinan Al-Azawi, Consultant Hanan Al-Qassabi, Technologist (A) Ibrahim I. Suliman, Assistant Professor Khitam Al-Hijri, Technologist (A) Alaa Manzalawy, Senior Registrar Ruqaya Al-Rawahi, Senior Technologist (B) Rana S. Hamid, Senior Registrar Lubna Al-Esry, Technologist (A) Amna Al-Jabri, Demonstrator Mathew George, Technologist (A) Badriya Al-Qassabi, Senior Registrar (Resident) Kalthoom Al-Shesawi, Technologist (A) Eiman Al-Ajmi, Registrar (Resident) Victor Arulnathan, Technologist (A) Khulood Al-Riyami, Registrar (Resident) Kuriakose K. P., Technologist (A) Saleh Al-Baawain, Senior House Officer (Resident) Unnikrishnan Nair, Technologist (A) Luz Solo-Esguerra, Technical Staff Senior Technologist (B) Joji Mathew, Technologist (A) Ahmed Al-Shuhaimy, Departmental Superintendent Ahmed Al-Anqoodi, Technologist (B) Per Rude, Deputy Superintendent, Senior Chief Ra- Faisal Al-Ghusaini, Technologist (B) diographer (A) Shurooq Al-Alawi, Technologist (A) Salvador De Vera, Chief Technologist (A) Lourdes Hernandez, Technologist (A) Virginia Ablen, Chief Technologist (A) Paul Martinez, Technologist (A) Antonio Velarde, Chief Technologist (A) Arthur De Guzman, Chief Technologist (B) Merlie Vanderlipe, Chief Technologist (A) Marievic De Guzman, Senior Technologist (A) Editha San Diego, Chief Technologist (B) Lovella Parfina, Senior Technologist (B) Manuel Gaerlan, Chief Technologist (B) Thomas Jefferson B., Senior Technologist (B) Meda Bersaba, Senior Technologist (A) Ravichandran V. K., Senior Technologist (B) Ahmed Abdou, Senior Technologist (A) Devid Devaraj, Technologist (A)

228 Moath Al-Jabri, Technologist (B) Sonya Dominic, Nurse Alya Al-Julandani, Technologist (B) Aleyamma Lalu, Nurse Nawal Al-Kharusi, Senior Technologist (B) Nusrat Rizvi, Nurse Dalal Al-Shabibi, Technologist (A) Choong L. Joo, Nurse Rabiya Al-Mahrouqi, Senior Technologist (B) Chanthriga Govindasamy, Nurse Medussa Samar, Senior Technologist (B) Amani M. Saif, Senior Technologist (B) Highlights of the Year 2013 Ruqaya A. Ali, Technologist (A) Muna Al-Muqbali, Technologist (A) New Equipment and Services Abdullah Al-Azwani, Technologist (A) The Nuclear Medicine section has installed a new Vinod Raj, Senior Technologist (B) hybrid machine for single photon emission tomog- Ramachandran Murugesan, Senior Technologist (B) raphy and X-ray CT 16-slices (SPECT/CT), which is the Prathap J. W. M. V., Senior Technologist (B) first in Oman and the Middle East. It will improve the Muzna Al-Harthy, Technologist (B) accuracy of the diagnosis and decrease time of examination in many types of studies such as myocar- Medical Physics dial perfusion for the detection of coronary arteries departments Ibtissam Al-Maskery, Medical Physicist disease. Amaal Al-Rasbi, Medical Physicist

Hilal Al-Zeheimi, The Interventional Radiology section has acquired a care Medical Physicist Naima Al-Naamani, Medical Physicist new Angiography machine, the Philips Clarity Sys- Mohammed Al-Subhi, Coordinator tem FD 20/20. It is only the second one of its kind in the Middle East and Gulf Region. The Interventional patient Administrative and Clerical Staff Radiology Room is the first hybrid suite in Oman. Rhodora Campo, Coordinator and Laddie Lara, Coordinator In 2013, transcranial Doppler imaging (TCDI) was Jeraldine Arante, Coordinator introduced for severe haemoglobinopathy patients. Fatma Al-Bahrani, Coordinator Several TCDI awareness days for both paediatric and Mirfat Al-Kharusi, Coordinator adults were successfully held.

Mohammed Al-Farai, Clerk academic Khamis Al-Farsi, Clerk Workshops and Courses Radiology & Molecular Imaging Sultan Al-Busaidi, Medical Orderly An Interventional Radiology Workshop was held on 7 Nursing Staff February 2013 organised by Dr. Rashid Al-Sukaiti. The Warda S. Al-Lawati, Nurse hands-on Interventional Radiology Workshop was Bindu V. P., Nurse held from 17–18 December 2013. The Mammography Marichu Lorica, Nurse and Breast Biopsy Workshop was held on 28 March Bini Prathapan, Nurse 2013 organised by Dr. Sukhpal Sawhney. The Digital Lenny Netto, Nurse Radiography Workshop was held on 5 October 2013 organised by Dr. Sinan I. Al-Azawi. Dr. Samir Hussein

229 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

was a facilitator at the Evidence-Based Medicine Workshop held at the Oman Medical Specialty Board in January 2013. He was also a facilitator and a member of the organising committee for both the Workshop on Student Assessment and the Certificate in Health Professions Education course. Both were held at SQU in February 2013.

Teaching Programmes Undergraduate Preclinical Programme The Department teaches over 100 4th year medical students in the Integrated Lecture Series (ILS) in Anatomy in coordination with the Department of Anatomy and participates in the Clinical Skills Examination for the same students.

The Department teaches approximately 40 5th year students in the ILS, contributing to the following courses: Respiratory System; Cardiovascular System; Gastro-Intestinal System; Neurology; Infectious Disease, and Uro/Nephrology.

Undergraduate Clinical Programme In Phase III of the curriculum, the Department provides a rotation for Senior Clerkship students. There are a total of 20 students per group rotating every two weeks: 10 are in SQUH, five at Royal Hospital and five at Khoula Hospital. Lectures include radiation safety to pre-clinical medical students doing their Senior Clerk- ship. These courses are designed to teach the students the basic radiation safety for patients and staff that a clinician should know before starting to practise.

For approximately 30 7th year medical students, the Department contributes to the Obstetrics & Gynaecol- ogy lecture.

The Medical Physics section offers the following four medical physics courses for College ofS cience physics students: Monitoring in Medical Physics; Ionizing Radiation; Non-ionizing Radiation and Radiobiology, as well as the Medical Physics Projects A & B.

Postgraduate Programme For OMSB radiology residents, 5–7 residents rotate through the Department on a four-week rotation with a total of about 37 residents. Courses include lectures in physics for radiology residents preparing for Parts 1 and 2 of the Fellowship of the Royal College of Radiologists (FRCR) examination.

230 Clinical & Diagnostic Services A total of 1,491 patients had nuclear medicine studies in 2013 and most of these patients had more than two nuclear medicine procedures during their studies, although there were few patients to study from January to April due to the installation of the new SPECT/CT machine.

There are four rooms for radionuclide therapy where 73 thyroid cancer and 90 thyrotoxicosis patients were treated with radioactive iodine in 2013. In addition three patients were treated with yttrium 90 for chronic synovitis.

The US section was again very busy in 2013 with a total of 12,661 US examinations performed.

Table 1: Radiology and molecular imaging examination workload in 2013 Service Total General X-ray (plain X-ray and intravenous urogram) 47,021

Special procedures (fluoroscopy-guided procedures) 1,125 departments

Ultrasound (inc. ultrasound-guided interventions) 16,611 care CT scanning (inc. CT-guided interventions) 8,741 Vascular and intervention (inc. oral health procedures) 1,043

Nuclear medicine 1,637 patient

Bone densitometry 1,083 and

Magnetic resonance scanning 3,314 Mammography 485 Oral health 3,013 academic

Lithotripsy 162 Radiology & Molecular Imaging Total 84,235

CT = computed tomography.

231 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Figure 1: Total examinations performed between 2009–2013.

Research RESEARCH PROJECTS Optical coherence tomographic patterns in diabetic macular edema: Prediction of visual outcome after intravitreal bevacizumab (Avastin) injections Code: MREC #708 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohammed Al-Abri, Dept. Radiology & Molecular Imaging, SQU.

Optical coherence tomographic patterns in diabetic macular edema (DME): Prediction of outcome after intravitreal triamcinolone acetonide (Triesnces) injections Code: MREC #709 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Mohammed Al-Abri, Dept. Radiology & Molecular Imaging, SQU.

Prognostic value of myocardial perfusion imaging Code: MREC #710 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Samir Hussein, Dept. Radiology & Molecular Imaging, SQU.

Structured radiology reporting: A feedback of clinicians at a university hospital in Oman Code: MREC #717 Dates: 2013 Value: Unfunded Project Approval: SQU

232 Investigator: Dr. Rana S. Hamid, Dept. Radiology & Molecular Imaging, SQU.

A retrospective study of the effect of iodised salt on thyroid cancer patients presented in SQUH before and after iodised salt was introduced into the market Code: MREC #719 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Samir Hussein, Dept. Radiology & Molecular Imaging, SQU.

Safety and complications of tunneled cuffed double lumen dialysis catheters in Omani patients: Clinical and radiological perspective Code: MREC #840 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Rana S. Hamid, Dept. Radiology & Molecular Imaging, SQU.

RESEARCH PUBLICATIONS & BOOKS Journal Publications departments

1. Kakaria AK, Sawhney S. Lost and found: Unusual location of a urinary tract calculus. Sultan Qaboos Univ Med J 2013; 13:323–4. 2. al Riyami N, Gowri V, Kakaria AK, Lakhtakia R. A case of postpartum choriocarcinoma: Delay in diagnosis and les- care sons learnt. J Obstet Gynaecol India 2013; 2013:1–3. 3. al-Jarrah A, Taranikanti V, Lakhtakia R, Sawhney S. Idiopathic granulomatous mastitis: Diagnostic strategy and therapeutic implications in Omani patients. Sultan Qaboos Univ Med J 2013; 13:241–7.

4. al-Jarrah A, Kamran MA, Khatib N, Aghbari S, Sawhney S, Lakhtakia R. Breast One Stop Clinic - Experience at Sultan patient Qaboos University Hospital in the Sultanate of Oman. Surg Clin India 2013; 1 (4).

5. aljarrah A, Al-Hashmi M, Malik KA, Sawhney S, Hussein S, Al-Riyami M, Al-Moundhri M. Mucinous breast cancer and with solitary metastases to humeral head: A case report. Oman Med J 2013; 28:350–3. 6. al-Jarrah A, Sawhney S, Taranikanti V, Furrukh M, Al-Hosni M, Saparamadu PAM, et al. Metastatic invasive lobular carcinoma of the breast masquerading as a primary renal malignancy. Sultan Qaboos Univ Med J 2013; 13:460–2. 7. vassileva J, Rehani MM, Applegate K, Ahmed N, Al-Dhuhli H, Al-Naemi H. IAEA survey of paediatric computed to-

mography practice in 40 countries in Asia, Europe, Latin America and Africa: Procedures and protocols. Insights academic Imaging 2013; 23:623–31. Radiology & Molecular Imaging 8. al-Hinai AT, Al-Abri A, Al-Dhuhli H, Al-Waili K, Al-Sabti H, Al-Yaarubi S, et al. First case report of familial hypercholesterolemia in an Omani family due to novel mutation in the low-density lipoprotein receptor gene. Angiology 2013; 64:287–92.

CONFERENCE & SEMINAR PRESENTATIONS Oral Presentations National 1. Sukaiti R. Role of interventional radiology in GI bleeding. 2nd National Gastroenterology Conference, Nizwa, Oman, 21 Feb 2013. 2. Hussein S. Comprehensive Nuclear Medicine Facilities for Diagnosis and Management: The set up and utility. Thy- roid Cancer Update 2013: A Multidisciplinary Approach, American Association of Clinical Endocrinologists, Gulf Chapter, Oman, 19 Apr 2013. 233 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Conference Posters International 1. al-Hussaini AA, Guenedi AM, Obeid YA, Hussein S. Dinner with the Jinn. 2nd European Conference on Clinical Neu- roimaging, Lille, France, 11–12 Feb 2013.

National 1. Sankhla D. The role of thyroid scintigraphy with Tc99m pertechnetate in defining the spectrum of thyroid disorders in young Omanis. SQU University Day, SQU, Oman, 5 May 2013. 2. Hussein S, Elshafie O,A l Hadhrami S, Al Sulaimi J, Al Kindi D, Al Zakwani A, et al. Osteoporosis and osteopenia are overdiagnosed in Oman: Our therapeutic strategies must be changed. SQU University Day, SQU, Oman, 5 May 2013. 3. Hussein S, Shukaily M, Elshafie O, Sankhla D, Woodhouse N. The role of thyroid scintigraphy with Tc99m pertechnetate in defining the spectrum of thyroid disorders in young Omanis. SQU University Day, SQU, Oman, 5 May 2013. Seminar Presentations National 1. Hussein S. Introduction to Evidence Based Medicine. Evidence Based Medicine Workshop. Oman Medical Specialty Board, Oman, 23–24 Jan 2013. 2. Hamid RS. Modern Imaging Techniques in Stroke. Radiology Symposium, Sultan Qaboos Hospital, Salalah, Feb 2013. 3. Kakaria A. Ultrasound-guided Breast Biopsy. Mammography and Breast Biopsy Workshop, Department of Radiolo- gy & Molecular Imaging, SQUH, Oman, 28 Mar 2013. 4. Sawhney S. Mammographic diagnoses of breast cancer: A systematic approach for beginners. Mammography and Breast Biopsy Workshop, Department of Radiology & Molecular Imaging, SQUH, Oman, 28 Mar 2013. 5. Sukaiti R. Breast Biopsy Workshop. Mammography and Breast Biopsy Workshop, Department of Radiology & Mo- lecular Imaging, SQUH, Oman, 28 Mar 2013. 6. Hamid RS. Artifact in Digital Radiography. Digital Radiography Workshop, Department of Radiology & Molecular Imaging, SQUH, Oman, 5 Oct 2013. 7. al-Azzawi SI. Radiology of Acute Abdomen. Digital Radiography Workshop, Department of Radiology & Molecular Imaging, SQUH, Oman, 5 Oct 2013. 8. idris I. Introduction to Digital Radiography. Digital Radiography Workshop, Department of Radiology & Molecular Imaging, SQUH, Oman, 5 Oct 2013. 9. Hussein S. Nuclear Cardiology I. CME, Cardiology Unit, SQUH, Oman, 2013. 10. Hussein S. Nuclear Cardiology II. CME, Cardiology Unit, SQUH, Oman, 2013.

234 departments

care

Surgery Sugery patient

and

he Department’s mission is to teach and train students and doctors, conduct research and provide specialised clinical services and patient care. T academic

235 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Mooayad Ahmed, Senior Registrar (General) Shahzad Younas, Senior Registrar (General) Head of Department Zaid Raouf, Senior Registrar (General) Chris Grant, Professor (to Oct 2013) Arif Kolethekkat, Senior Registrar (ENT) Hani Al-Qadhi, Senior Consultant (from Oct 2013) Sudesh Kumar, Senior Registrar (ENT) Faculty Wameed Al-Bassam, Senior Registrar (ENT) Khalid Rahman, Senior Registrar (Urology) Khalifa Al-Wahaibi, Assistant Head of Department Shahid Aquil, Senior Registrar (Urology) Abdullah Al-Harthy, Senior Consultant (Trauma) Ehab Rajab, Senior Registrar (Cardiothoracic) Nayil Al-Kindy, Senior Consultant (General) Mirdavron Mukaddirov, Senior Registrar Norman Machado, Senior Consultant (General) (Cardiothoracic) Pradeep Chopra, Senior Consultant (General) Mohammed Siddiqi, Senior Registrar Rashid Al-Abri, Senior Consultant (ENT) (Cardiothoracic) Krishna Prasad, Senior Consultant (Urology) Paresh Kuba, Senior Registrar (Cardiothoracic) Qassim Al-Busaidi, Senior Consultant (Urology) Rahil Muzaffar, Senior Registrar (Orthopaedic) Ashok Sharma, Senior Consultant (Cardiothoracic) Venkatesh G., Senior Registrar (Neurosurgery) Hilal Al-Sabti, Senior Consultant (Cardiothoracic) Ahmed Yaseen, Senior Registrar (Orthopaedic) Rajeeva Pieris, Senior Consultant (Cardiothoracic) Najib Draz, Registrar (General) Tarek Alameddine, Senior Consultant Sareyah Al-Sibai, Registrar (General) (Cardiothoracic) Ghassan Elshafie, Registrar (General) Hatem Sherif, Senior Consultant (Paediatric) Vivek Abraham, Registrar (ENT) Mohamed Khalid, Senior Consultant (Orthopaedic) Omar Sharef, Registrar (Urology) Sultan Al-Maskari, Senior Consultant (Orthopaedic) Ibrahim Abdelhady, Registrar (Vascular) Rajeev Kariyattil, Senior Consultant (Neurosurgery) Adham Said, Registrar (Orthopaedic) Unnikrishnan M., Senior Consultant (Neurosurgery) Madni AbdulAziz, Registrar (Orthopaedic) Adil Al-Ajmi, Consultant (General) Mohammed Nagy, Registrar (Orthopaedic) Sreedharan V. K., Consultant (General) Ali Al-Hilali, Registrar (Orthopaedic) Mohammed Al-Hashmi, Consultant (Endocrine) Khalid M. Bhatti, Registrar (Paediatric) Mohammed Okbi, Consultant (ENT) Mohammed Toufique, Registrar (Paediatric) Yahya Al-Badaai, Consultant (ENT) Koshy Kochumen, Registrar (Neurosurgery) Joseph Mathew, Consultant (Urology) Abdullah Al-Jabri, Senior House Officer (General) Mohammed Al-Marhoon, Consultant (Urology) Yousuf Al-Shaqsi, Senior House Officer (Paediatric) Adil Al-Kindi, Consultant (Cardiothoracic) Mohammed AbdelRahim, Senior House Officer Zainab Al-Balushi, Consultant (Paediatric) (General) Kamran Malik, Senior Registrar, (General) Ahmed Essam, Senior House Officer (General) Muhammad Baloch, Senior Registrar (General) Edem Ziadinov, Senior House Officer (Cardiothoracic) Suresh Kannan, Senior Registrar (General)

236 Al Ghalya Al-Maawali, Clinical Lecturer (General) Sadiq Al-Khaboori, Clincal Lecturer (General) Humaid Al-Adawi, Senior House Officer (General) Qasim Al-Abri, Senior House Officer (Cardiothoracic) Humaid Al-Farai, Senior House Officer (Orthopaedic) Support Staff Balan Baskaran, Perfusionist Sayed Rizvi, Perfusionist Zainab Al-Hashmi, Perfusionist Saif M. Al-Kharusi, Technician Badar Al-Mazidi, Technician Maria T. Ablen, Coordinator Ruel Natividad, Coordinator Luluwah Al-Farsi, Coordinator departments Highlights of the Year 2013 The Department hosted an international conference, the Oman International Vascular Conference at the Al care

Bustan Hotel, Muscat, from 13–14 March. Dr. Khalifa Al-Wahaibi was the chief organiser. A total of 34 international guests’ speakers participated in the conference. The Orthopedic Surgery Division organised the 1st Oman Hand & Wrist Symposium at the Al-Fahm Hall, Cultural Centre, SQU, Oman, from 2–3 March 2014. Sugery patient

Teaching Programmes and

UNDERGRADUATE PRE-CLINICAL PROGRAMME The Department was also involved in the following courses in Phase II of the new curriculum: the Locomo- tor System; the Uro-Reproductive System; Endocrinology; the Human Nervous System, and the Alimentary

Module. academic

UNDERGRADUATE CLINICAL PROGRAMME The Department participated in the teaching for the Junior Clerkship rotation, catering for 117 students in 2012–2013. The students rotated in groups of 18–21; each group spent two weeks at Sultan Qaboos University Hospital (SQUH), the Royal Hospital and Khoula Hospital. For the Pre-clerkship rotation, the Department catered for 96 students in 2013. The students rotated in groups of 8–14 and spent their 10-week rotation in SQUH only. For the 7th year senior rotation, the Department received final year students in groups of 14–21 in rotation for seven-week courses; altogether, there were 82 students. The 7th year students had their final M.D. examination in June 2013; this was the final rotation of the old curriculum.T he Senior Clerkship rotation

237 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

(new curriculum) began in January 2013. The Department catered for 111 students in groups of 18–21. Each group rotated for two weeks in the ENT Unit and three weeks in Surgery as part of the surgery and allied block.

POSTGRADUATE PROGRAMMEs Internship A total of 55 interns undertook their surgical rotations in the Department in the year 2013.

Oman Medical Specialty Board (OMSB) Residents For the OMSB Residency Programme, 24 residents undertook their rotations in general surgery in the Depart- ment in the academic year 2013. A total of 48 weekly lectures for the senior residents and 48 weekly lectures for junior residents were delivered.

Training Courses & CME Activities Dr. Joseph Mathew organised a Laparoscopy Workshop in association with Arab-German Urology at SQUH on 7–8 October 2013.

Dr. Pradeep Chopra delivered a talk on 'Physiology of wound healing: Which dressing to choose?' at the Wound Study Days for the SQUH nurses on 19 January, 23 February and 1 September 2013. He also delivered a talk on 'Etiology and the management of peripheral neuropathy and vasculopathy in diabetic patients' on Diabetic Foot Day, 17 February 2013 at SQUH.

Research RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al-Marhoon M, Shareef O, Al-Habsi I, Al-Balushi A, Mathew J, Prasad K. Extracorporeal shock-wave lithotripsy success rate and complications: initial experience at Sultan Qaboos University. Oman Med J 2013; 28:255–9. 2. Al-Marhoon M, Prasad K, Al-Busaidi Q, Mathew J. The relation of Helicobacter pylori infection to prostate cancer and benign prostatic hyperplasia: Is it real? Proceedings of The 33rd Congress of the Société Internationale d’Urolo- gie 2013, Canada. Urology 2013; 82:S109–10. 3. Al-Marhoon M, Venkiteswaran KP, Shareef OW. Urolithiasis in adult with primary obstructive megaureter: A case report. Oman Med J 2013; 28:357–9. 4. Al-Marhoon M, Saparamadu PAM, Venkiteswaran KP, Shareef O, Mathewkunju J. Squamous cell carcinoma arising in keratinizing desquamative squamous metaplasia (KDSM) of the kidney. UroToday Int J 2013; 6: Article 49. 5. Machado N, Chopra P, Raouf Z, Khatib N, Sinnakirouchenan. Axillary lymph node metastasis from thyroid malignancy: Unusual presentation with ominous implications. Br J Med Med Res 2013; 3:1634–45.

238 6. Kolethekkat AA, Paul RR, Kurien M, Kumar S, Al-Abri R, Kurien T. Diagnosis of adult chronic rhinosinusitis: Can nasal endoscopy predict intrasinus disease? Oman Med J 2013; 28:427–31. 7. Khan SY, Al-Balushi ZN, Bhatti KM, Ehsan T, Mandhan P. Cost comparison between laparoscopic and open appen- dectomies in children. Sultan Qaboos Univ Med J 2013; 2:275–9. 8. Khan SY, Bhatti K, Koliyadan SV, Al-Riyami M. Asymptomatic ileal schwannoma presenting as mesenteric tumor. Sultan Qaboos UnivMed J 2013; 2:E330–3. 9. samad A, Khanzada T, Kumar B, Malik KA. Accuracy of references: Comparison between the two premier Pakistani medical journals. J Pak Med Assoc 2013; 63:445–7. 10. al-Ajmi A, Kamran MA, Khatib N, Al-Aghbari S, Sukhpal S, Lakhtakia R. Breast One Stop Clinic: Experience at Sultan Qaboos University Hospital in the Sultanate of Oman. Surg Clin India Editorial SCI 2013; 1(4). 11. Malik KA, Al-Ajmi A, Razvi H, Al-Khanbashi L. Negative appendectomy rate in Sultan Qaboos University Hospital, Oman. J Surg 2013;1:43–5. 12. Al-Ajmi A, Al-Hashmi M, Malik K, Al-Hashmi M, Sukphal S, Hussein S, et al. Mucinous breast cancer with solitary metastasis to humeral head: A case report. Oman Med J 2013; 28:350–3. 13. Malik K, Al-Ajmi A, Sukhpal S, Lakhtakia R. Chondroid lipoma of breast: a rare pathology. J Liaquat Univ Med Health Sci (JLUMHS) 2013; 12:131–2. 14. Lakhtakia R, Al-Wahaibi K, Zahid K, Malik KA, Burney I. Solid pseudopapillary neoplasm of the pancreas: A case departments

report with review of the diagnostic dilemmas and tumor behavior. Oman Med J 2013; 28:441–4. 15. Govindaraju V, Bharathi R. Post-traumatic blepharocele in an adult. Sultan Qaboos Univ Med J 2013;13:E479–81.

16. Sobhy E, Alameddine T, Al-Sabti H. Successful treatment of right-sided heart thrombus with pulmonary embolism care with thrombolytic therapy. J Cardiovasc Dis Diagn 2013; 1:121. 17. revannasiddaiah S, Sood A, Kumar S, Thakur P. Cervical nodal metastasis in head and neck cancer: A clinical conun- drum. BMJ Case Report 2013; doi:10.1136/bcr-2013-010364. Sugery patient CONFERENCE & SEMINAR PRESENTATIONS and Oral Presentations International 1. Al-Marhoon M. Clinical Topics in Urology: Lithiasis. 1st International Congress, Athens, Greece, 5–6 Jul 2013. 2. al-Marhoon M. The relationship of Helicobacter pylori infection to prostate cancer and benign prostatic hyperplasia: Is it real? 33rd Congress of Société Internationale d’Urologie (SIU), Vancouver, Canada, 8–12 Sep 2013. academic 3. Al-Marhoon M. The 69th American Society of Reproductive Medicine (ASRM) Annual Meeting, Boston, USA, 12–17 Oct 2013.

National 1. Mathew J. Management of male urinary incontinence. Uro-Gynaecology Symposium, Muscat, Oman, 3 Feb 2013. Poster Presentations International 1. Malik K. Idiopathetic Granulomatous Mastitis. The Emirati–German Healthcare Congress, Dubai, UAE, 4–6 Mar 2013. 2. Venkatesh G. Post-operative assessment of dorsolumbar pedicle screw placement accuracy using CT scan at Sultan Qaboos University Hospital. XV WFNS World Congress of Neurosurgery, Seoul, Korea, 8–13 Sep 2013.

239 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Medical Library Overview The main thrust of our library policy has always been the evaluation and development of the Medical Library (ML) resources and the increasing the effectiveness of our services. A major achievement in this respect was online searching to support the programmes of the College of Medicine & Health Sciences (COMHS), College of Nursing and University Hospital (SQUH), especially in respect to research activities.

The ML replaces around 300 to 500 books every year and is planning on digitalising the audio video stock which includes 1,300 tapes.

Staff Director Mohammed Al-Wardi Deputy Director Mariam Al-Sinani Librarians Mohammed Al-Higgi, Chief Librarian C Huda Al-Farsi, Chief Librarian C Huda Al-Haddabi, Chief Librarian C Saif Al-Muharbi, Senior Librarian B Abdulla Al-Hinai, Librarian Jassim Al-Hasani, Librarian Saif Al-Abri, Assistant Librarian Support Staff Sultan Al-Shereiqi, Clerk/Coordinator Amal Al-Hashami, Clerk Hanan Al-Jashami, Clerk Ahmed Al-Ghafri, Graphic Camera Operator

240 Activities in 2013 CIRCULATION In this period, the total number of checked-out materials was 1,508 as compared to 1,813 in 2012. The numbers of users increased from 3,736 users in 2012 to 4,896 in 2013. Also, the number of external users increased from 8 in 2012 to 58 in 2013. Moreover, the number of orientation groups increased by five from 315 in 2012 to 320 in 2013. Finally, the number of users from the Oman Medical Specialty Board decreased to 147 in 2013 from 152 in 2012.

ACQUISTIONS In 2013, 74 new book titles were added to the library collection. This number was made up of 18 books from Dowson, 39 monographs received gratis from the Ministry of Health, Oman, the World Health Organization and others, as well as 17 theses from the COMHS.

SERIAL DEPARTMENT departments In 2013, the number of subscription print journals decreased from 74 to 69. On the other hand, the electronic journal subscriptions increased from 185 to 191 as we move gradually to using electronic journals. The num- care

ber of database subscriptions remained the same at four databases. A total of 39 journals from the Gulf Co- operation Council region were received gratis. In 2013, the ML sent three batches of books for binding; these included 393 volumes and 1,555 issues at a cost of OMR 1,807. patient

INTERLIBRARY LOANS and Medical Library The total number of requested articles from different libraries by the ML was 110; the number of articles sent to different libraries was 491.A total of 216 articles were requested by different departments of the COMHS and SQUH. In addition, 22 articles were requested by the Oman Medical Specialty Board and 44 articles were requested by postgraduate students. academic TRAINING OF LIBRARY USERS A total of 134 students were trained to use the library. Of these, 12 students were from COMHS, 30 students were from the Language Center, 20 students were from the SQUH Central Sterile Supply Department, 12 students were from the Department of Library Science & Information in the College of Arts & Social Science and 60 students were from other departments and institutions.

241 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

E-RESOURCES STATISTICS Table 1: Searches performed on bibliographic databases Databases Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total CINAHL-R-Database 518 409 652 2048 667 522 1155 173 397 735 999 1055 9330 (from AAS) McGraw Hill’s Access 90 233 301 142 96 89 85 98 159 220 251 165 1929 Medicine Package Medline (from PRQ) 15 87 184 89 213 155 83 20 36 133 142 224 1381 Medline (from AAS) 648 1282 2144 3229 769 504 1133 162 347 705 1005 974 14283

Up-To-Date Medical 5192 4254 3813 5560 2133 1109 3676 2678 1140 2300 5002 4640 41497 Package Total 68,420

Table 2: Full text downloads from e-journals Databases Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total All BMJ & BMJ 557 672 863 641 1033 606 608 415 677 779 1015 1075 8941 Group journals Lippincott (Ovid) 90 226 118 104 160 75 177 1126 1360 164 172 61 3833 Nature Publishing 142 141 203 220 148 103 102 89 101 203 183 754 2345 Group journals (13 titles) NBER Working Pa- 14 22 34 18 22 10 9 1 20 30 34 51 265 pers (New) ProQuest: Health 597 954 1329 1571 1026 531 687 237 593 1102 1481 1165 11273 & Medical Com- plete ProQuest: Nursing 52 82 66 109 64 53 28 76 31 97 67 91 816 & Allied Health Source Total 27,473

242 IT SERVICES In 2013, a total of 2,162 e-journals could be accessed through our website (www.squ.edu.om/med-Lib/index. htm) as well as Science Direct, Oxford Journals, UpToDate online, Academic Search Complete, Cambridge University Press, Lippincott Williams & Wilkins, Springer Link, the BMJ group and Taylor Francis Online. Da- tabases such as Medline, Cinhal, Biological Abst, Access Medicine and ISI Web of Knowledge and two books databases (e-brary and e-books) could also be accessed through our website.

STAFF DEVELOPMENT Conferences and Workshops In order to develop and improve the skills of ML staff, various staff members were sent to different conferences, workshops and courses as follows: (1) Mr. Qasim Al-Harrasi, Mr. Abdullah Al-Hinai, Mr. Saif Al-Abri, Mr. Mohammed Al-Higgi and Mr. Sultan Al-Shereiqi attended a conference at SQU in February 2013, Health Information Under Microscope: Challenges and Solutions; (2) Mr. Mohammed Al-Higgi attended a one-week training course in Malaysia, Building and Managing Digital Collections of Libraries and Information Centers; (3) Mr. Saif Al-Abri attended a conference in Singapore in August 2013, the IFLA Library and Information Con- gress; (4) Mr. Mohammed Al-Higgi and Ms. Huda Al-Haddabi attended a workshop in November 2013, New Cataloging Rules: Describe the sources and accessible RDA; (5) Mr. Sultan Al-Shereiqi attended a three-month English Course at SQU from 29 September 2013–9 January 2014; (6) Mr. Abdullah Al-Hinai attended a three- month intensive English course in Bristol, UK, from October 2013 – January 2014; (7) Ms. Maryam Al-Sinani departments attended a three-day short course on Assertiveness Skills in Malaysia in December 2013. Medical Library support

243 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Medical Education & Informatics Unit Overview The Medical Education & Informatics Unit (ME&IU) was established under the Dean’s Office in 2006 with a mission to raise the standards of medical education in the College of Medicine & Health Sciences (COMHS). The Unit has a full-time staff, but draws mainly on the voluntary participation of staff from the different departments of the COMHS and from the Ministry of Health, who have either a formal qualification or a strong interest in the field of medical education.

The ME&IU is very active in providing educational support to the COMHS, the University Hospital (SQUH) and affiliated staff and other health professionals through faculty development workshops in the areas of teaching and learning, assessment and e-learning. The ME&IU has also established the IDEAL (International Databank for Enhancement of Assessment and Learning) office which houses theI DEAL secure assessment databank, liaises with the IDEAL Consortium Office and offers the service of item analysis.

The Clinical Skills Laboratory plays a very active role in the COMHS as it is equipped with a variety of instruments, simulators and mannikins to support the training of clinical skills. It has evolved into a learning environment that supports a wide range of skills across the spectrum of the curriculum and facilitates the acquisition of theoretical and clinical knowledge. The facility provides medical students with the opportunity to develop and maintain competence in clinical skills and allows them to practice physical assessment and procedural skills safely—and to demonstrate these skills under simulated conditions prior to attempting them on a patient.

The Medical Informatics section of the Unit strengthens the integration of medical informatics technologies in teaching, research and service; increases the competency of faculty in the use of medical informatics tools; conducts effective telemedicine conferences and workshops with international institutes; evaluates the effectiveness of various medical informatics technology products in teaching and learning medicine; analyses and specifies the COMHS requirements for medical informatics equipment and infrastructure; supports hardware maintenance, and provides a troubleshooting service.

Staff Head of Unit Nadia Al-Wardy, Associate Professor, Biochemistry Faculty Ken Masters, Assistant Professor, Medical Informatics Ibrahim Inuwa, Associate Professor, Anatomy

244 Muna Al-Sadoon, Assistant Professor, Child Health Syed Rizvi, Assistant Professor, Family Medicine & Public Health Samir Hussein, Senior Consultant, Radiology & Molecular Imaging Omar Al-Hussaini, Ministry of Health Laila Al-Zadjali, Ministry of Health Support Staff Buthaina Baqar, Counselling and Guidance Specialist Hisham A. Hadi, College IDEAL Administrator Moosa Al-Rawahi, e-Learning/e-Assessment and Multimedia Designer Salim Al-Harthi, Programmer Bader Al-Ismaili, Computer Technician Talal Al-Kindi, Computer Technician Almaqdad Al-Lawati, Systems Analyst Somaya Al-Shuraqi, Systems Analyst Aida Al-Hajri, Computer Technician Thuraiya Al-Batashi, Computer Technician Taha M. El-Sayed, Chief Technician, Clinical Skills Laboratory Ahmed Al-Hadhrami, Technician, Clinical Skills Laboratory Rahima Al-Maashari, Technician, Clinical Skills Laboratory departments Asila Al-Harthy, Coordinator Activities in 2013 A new staff member, Ms. Buthaina Baqar, Counselling and Guidance Specialist, joined the Unit at the end support of 2013.

In this period, several new workshops were conducted by the ME&IU. These were attended by staff members from the COMHS, SQUH and the Ministry of Health.

During the year 2013, around 2,150 medical students were trained in the Clinical Skills Laboratory. Several self-practice sessions on all procedures taught during the courses and objective structured clinical examinations were conducted in the Laboratory. Medical Education & Informatics Unit

The Clinical Skills Laboratory was also used for conducting local and international workshops:

- international Orthopedic Workshop on Hand Surgery - national US workshop in Anaesthesia (central and subclavian catheters insertion) - Certificate Course in Health Professions Education (CHPE)

245 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

- Membership of Royal College of General Practitioners (MRCGP) for the Family Medicine & Public Health Dept. - national Workshop for Emergency Medicine (US and trauma cases) - pre-Congress Course on Hysteroscopy and Basic-Intermediate Laparoscopic Gynaecological Surgery

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Medical Informatics section of the ME&IU was involved in teaching the following core and elective courses to undergraduate medical and nursing students: Medical Informatics I and II, and Health Informatics.

Training Courses & CME Activities Several educational workshops, conducted by internationally-renowned faculty and local staff in medical education, were offered by the Unit.

A two-day workshop on Data Analysis using the Statistical Package for the Social Sciences, with a total of 25 participants from the COMHS and SQUH was conducted in January 2013 by Dr. Syed G. A. Rizvi, Department of Family Medicine & Public Health and Member of the ME&IU.

The CHPE (Certificate Course in Health Professions Education), a three-day course in February in 2013, was conducted by Prof. Hossam Hamdy, University of Sharjah, United Arab Emirates; Prof. Raja Bandaranayake, Sydney, Australia, and Dr. David Taylor, Liverpool, UK. A total of 45 COMHS, SQUH, affiliated staff and other health professionals participated in the course.

A three-day Student Assessment Workshop was also held in February in 2013, conducted by Prof. Bandaran- ayake and Dr. David Taylor. A total of 25 COMHS, SQUH and affiliated staff participated in the workshop.

In the lecture series in medical education, two lectures were presented: Edgar Dale’s Learning Pyramid and Medical Education, in February 2013 by Dr. Ken Masters, Assistant Professor of Medical Informatics in the ME&IU; and Objective Structure Teaching Evaluation (OSTE), in March 2013 by Dr. Omar Al-Hussaini, Minis- try of Health, and member of the ME&IU.

Moodle Workshops were conducted twice in 2013, in April and October. Two workshops on e-assessment were conducted in April and November 2013 entitled How To Create and Mark Assignments. Two workshops on Creating a Stunning & Eye Catching Presentation using Prezi Application were conducted in March and December 2013. The aim was to demonstrate how Prezi tools can enhance the effectiveness of delivering a message through a presentation

246 Research Research Projects Doctors as content creators: Teaching medical students to develop mHealth Apps Code: MREC #811 Dates: 2013 Value: Unfunded Project Approval: SQU Investigator: Dr. Kenneth Masters, Medical Education & Informatics Unit, SQU.

Research Publications & Books Journal Publications 1. Masters K. Edgar Dale’s Pyramid of Learning in medical education: A literature review. Med Teach 2013; 35: e1584–93.

Conference & Seminar Presentations Poster Presentations International 1. Al Wardy N. Are Supplementary/Re-sit Examinations Valid? (Abstracts 2DD/9). AMEE Conference, Prague, Czech Republic, 24–28 Aug 2013. 2. Al Wardy N. Regional/Inter-institutional Examinations. 9th GCC Medical Education Conference, Bahrain, 23–25 Nov 2013. departments

support Medical Education & Informatics Unit

247 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Sultan Qaboos University Medical Journal Overview Sultan Qaboos University Medical Journal (SQUMJ) was founded in 1997. By December 2013 a total of 26 issues had been published, with a total of 593 articles. SQUMJ’s Editorial Board has 38 members; all of them are staff of either the College of Medicine & Health Sciences (COMHS), Sultan Qaboos University Hospital (SQUH) or the Armed Forces Hospital, Muscat (AFH).

The vision of SQUMJ is to be a leading regional medium of medical and scientific communication covering both clinical and basic science research and other medically relevant observations that will be recognised and accepted internationally. Its objectives are to:

• Promote a culture of scientific publications at SQU as well as build capacity in all aspects of medical publishing and enhance the research profile of the University. • Provide a medium for dissemination of medical research by attracting high-quality original research and review articles, special contributions and editorials, brief communications, case reports, etc. from SQU, Oman, the Gulf region, the Middle East and the wider international community. • Achieve indexing by major international indexes, such as the US National Library of Medicine, and increase the online visibility of SQUMJ.

Editorial Board Editor-in-Chief Lamk Al-Lamki, Professor, Radiology & Molecular Imaging and Adviser to the Vice-Chancellor on Health Affairs Editor Samir Al-Adawi, Professor, Behavioural Medicine Associate Editors Badreldin Ali, Professor, Pharmacology and Arabic Editor Abdulaziz Bakathir, Consultant, Oral Health (Oral & Maxillofacial Surgery) and Arabic Editor Zainab Al-Balushi, Consultant, Surgery (Paediatric) Sulayma Al-Barwani, Associate Professor, Physiology Ikram Burney, Senior Consultant, Medicine (Oncology) Jayakrishnan B., Senior Consultant, Medicine (Respirology) Shahina Daar, Associate Professor, Haematology Shyam Ganguly, Associate Professor, Epidemiology & Statistics Vaidyanathan Gowri, Assistant Professor, Obstetrics & Gynaecology

248 Arunodaya Gujjar, Professor, Neurology Omar Habbal, Associate Professor, Human & Clinical Anatomy Ali Al-Jabri, Professor, Microbiology & Immunology Maha Al-Khaduri, Senior Consultant, Obstetrics & Gynaecology Mary Kurien, Senior Consultant, Surgery (ENT) Ritu Lakhtakia, Associate Professor, Pathology Neela Al-Lamki, Professor, Radiology & Molecular Imaging Norman Machado, Senior Consultant, Surgery Abdulaziz Al-Mahrezi, Senior Consultant, Family Medicine & Public Health Ali Al-Mamari, Senior Consultant, Endocrinology Sultan Al-Maskari, Senior Consultant, Surgery (Orthopaedic) Joseph Mathew, Consultant, Surgery (Urology) Abdullah Al-Mujaini, Senior Consultant, Ophthalmology Khalid Al-Naamani, Senior Consultant, Gastroenterology, AFH Karin Nollain, Senior Consultant, Anaesthesia Allal Ouhtit, Associate Professor, Genetics Muna Al-Saadoon, Assistant Professor, Child Health (Community Paediatrics) Jumana Saleh, Associate Professor, Biochemistry and Arabic Editor Mansour Sallam, Senior Consultant, Cardiology

Sukhpal Sawhney, Senior Consultant, Radiology & Molecular Imaging departments

Marwan Al-Sharbati, Associate Professor, Behavioural Medicine Ashok Sharma, Senior Consultant, Surgery (Cardiac) Yasser Wali, Professor, Child Health and Arabic Editor

Editorial Staff support Meriel Carboni, Managing Editor Sheherajoy Biruar, Technical Editor Alaister Denoyo, Assistant Editor Natasha Smith, Assistant Editor Activities in 2013 In 2013, there were 285 submissions to SQUMJ, an 11.5% increase compared to 2012. The rejection rate rose to 73% from 58% in 2012. More than 450 experts from 42 countries reviewed SQUMJ manuscripts in 2013. Four Sultan Qaboos University Medical Journal issues of SQUMJ were published in 2013, with a total of 116 articles, the highest annual number ever. This included 46 original studies and 8 reviews or special contribution articles. A total of 46% of published articles were from SQU; 12% from Oman; 21% from Gulf countries and the Middle East, and 21% from other countries.

249 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

SQUMJ has been indexed in the WHO’s Index Medicus for the EMRO region since 2007 and in Scopus since 2011. Since 2012, the full text of all SQUMJ articles has been available through PubMed, the premier international online medical database. The most recent impact factor (2012) for SQUMJ was 0.77.

Since 2012, SQUMJ has used Editorial Manager, an online journal management system from Aries Systems Corp., for all its submissions and reviews. This development has enabled the SQUMJ team to cope with the increasing number of manuscripts.

SQUMJ is printed by the SQU Printing Press with a print run of 2,000 copies. It is distributed free of charge both within SQU and to the Ministry of Health, and all hospitals and medical training establishments in Oman. In addition, it is sent to medical libraries in the region; all Gulf area medical colleges and selected medical colleges in the Middle East, North Africa, India and Pakistan, the UK, USA, Canada, Australia and beyond.

Table 1: SQUMJ submission statistics from 2010–2013 2010 2011 2012 2013 Submissions received (% increase on previous year) 139 199 (43%) 256 (29%) 285 (11.5%) Rejection rate % 43 50 58 73 Number of clinical and basic research studies published 20 25 30 46

250 Directorate of Development & Quality Overview The Directorate of Development & Quality (DDQ) of Sultan Qaboos University Hospital (SQUH) is responsible for maintaining and continuously improving the standards of quality and safety in the hospital through establishing an efficient quality management system. Continually working towards improving SQUH quality and safety is made possible by having been awarded the ISO 9001:2000 certificate in May 2005 and achieving re-certification with ISO 9001:2008 in May 2008 and again in June 2011. The DDQ is committed to providing SQUH with support in structuring and maintaining quality standards in all clinical, educational, research and support services. Achievements are through the main sections of quality assurance, development, documentation and studies, and risk management. These provide support and encouragement to hospital-wide quality activities through teamwork and best practice. The DDQ also coordinates the on-going hospital-wide education on quality and participates in education in similar activities in other organisations in Oman to promote quality and safety culture in healthcare in the country. Furthermore, the DDQ seeks to promote excellence through continual improvement in teaching, research, patient services and staff development.T his is supported by effective process delivery and efficient resource utilisation throughout the hospital.T he DDQ works on enabling the following outcomes:

- identify objectives and focus on the needs and expectations of customers. departments

- Facilitate establishing a baseline for improving performance and outcomes. - provide a basis for certification and accreditation conformance and ensure applicability to Omani laws, legislation and regulations. - provide and practise internationally recognised standards of care. support - Monitor hospital activities and coordinate the implementation of corrective and preventive actions through audit- ing and site visits. - Monitor healthcare service outcomes through key performance indicators (KPIs). - identify and mitigate the risk and hazards of the hospital environment. - provide a common framework for effective internal communication though controlled policies, protocols and procedure documents. The Directorate is divided into four sections: Quality Monitoring; Documentation and Studies; Risk Manage- ment and Patient Safety, and Special Projects. Directorate of Development & Quality

251 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Director Salem Al-Tamemi Deputy Director Yasmeen Al-Hatmi, (on study leave) Support Staff Hamdan Al-Siyabi, Lead Auditor Yusuf Al-Khamisi, Risk Facilitator Sumaiya Al-Busaidi, Risk Facilitator Fatma Al-Sharji, Document Controller Jamal Al-Busaidi, Senior Technician Roseliyah Shamsudin, Senior Head Nurse Carolina Vacalares, Coordinator Activities in 2013 The year 2013 was a very busy year for the Directorate. Besides continuing with the routine work-flow, the Accreditation Canada International Project brought some challenges in terms of resources, time frame and workload. The Directorate is a national resource for healthcare quality management in the country. The staff members were invited to speak on the following occasions:

- “Promoting Excellence in Patient Safety, Mutual Accountability Winning Ways”. 2nd GCC International Conference on Patient Safety, January, Muscat, Oman, Jan 2013. - Quality Awareness Day, Royal Hospital, Muscat, Oman, Feb 2013. - risk Management and Patient Safety workshop, Sur Hospital, Oman, Oct 2013. - training Workshop in Internal Quality Audit, Nizwa Hospital, Oman, Aug 2013. Staff from different institutions in Oman joined us in 2013 for learning and training experience in quality and safety management in health organisations. They were exposed to different sections in the Directorate to maximise their experience together with involvement in live quality and safety audits in the hospital:

- yusra Al-Hashmi: 1–15 January - Badriya S. Al-Akhzami: 5–22 January - shaima Al-Balushi: 12 May–11 July - Fatma Al-Jahwari: from the Royal Hospital, 3 November to 5 December - Buthaina: from Massirah Hospital

252 Quality Monitoring Section The section conducted external ISO9001:2008 quality audits by the British Standards Institute (BSI) certification body in May and November 2013.

There were 24 areas/departments audited with zero non-conformity and 27 opportunities for improvement raised during the two audits.

Action plans were created and distributed among the concerned departments. The majority of issues raised have already been tackled and corrected. The rest are in progress.

Prior to external audits, internal audits were conducted twice in April and October 2013. There were 23 departments audited. The total number of issues raised was 115 (non-conformance reports = 22; opportunity for improvement = 83) Follow-up plans are in place and most of the issues have already been solved.

Risk Management and Patient Safety Section The section conducted its multidisciplinary environmental and risk assessments or facility tour of departments such as Family Medicine & Public Health, Oral Health, the Emergency Department, the Intensive Care Unit, the Directorate of Hospital Information Systems and outpatient departments (OPD). The results and findings of the facility tours were forwarded to the departments concerned for improvement and resolution departments

of the issues.

This section also conducted a Process Risk Assessment for Blood Extraction in the OPD, blood gas analysis, and the pneumatic system. Furthermore, the Enterprise Risk Management Awareness (Risk Register) and

Incident Reporting Awareness were introduced into the Directorate of Nursing Services. support

Quality Rounds were conducted on a regular basis throughout the year, depending on the need. Sources of need include: Incident Reports, Audit Reports, Risk Assessment Reports, Departmental correspondence, Top Management Directives, Customer Voice (patients and staff), DDQ Initiatives for improvement, and other means of identifying the need. Rounds are conducted with the cooperation of nurses, technicians and other healthcare professionals where necessary. Directorate of Development & Quality Documentation and Studies Section A total of 124 documents were uploaded in the system in 2013 (24 new and 100 revised documents). A new electronic system was introduced to control documentation.

253 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Special Projects Section World Quality Day Celebration This was celebrated on 14 November 2013, with the theme announced by Chartered Quality International “Making Collaboration Count”, in order to promote quality and encourage departments’ development and the organisation’s prosperity. A total of 22 departments participated. Three posters were chosen as the best and were awarded a trophy during the BSI Closing Meeting on 21 November.

Key Performance Indicators A three day KPI course was organised by the Directorate for Training & Continuing Professional Develop- ment from 2–4 February to train 20 multispecialty staff.

The selected staff were the Quality Improvement Committee Members in charge of their departmental KPIs. Almost all the departments are doing KPIs with limitations as the data collection and the analysing of reports are done manually.

Accreditation Canada International Project The hospital staff has been involved in the accreditation process since January 2013. A total of 17 teams were formed to look into setting standards and developing new policies, procedures and protocols to meet the requirements. An extensive Mock Survey was conducted from 6–9 October. Besides giving a feel of the real survey for all staff members, it also offered major opportunities for improvements as recommended by the surveyors in their report. It is clear that all departments in the hospital are working together very closely to achieve the goal of obtaining accreditation in 2014. The Complete On-Site Survey is scheduled for 16–20 March 2014.

Knowledge Forum This is presented fortnightly with the objective of sharing knowledge on various topics of interest and concern. Staff attendance is recorded as evidence of participation.

Newsletter This has been developed and uploaded for staff to view some important quality activities organised by the Directorate.

254 Directorate of Hospital Information Systems Overview The Directorate of Hospital Information Systems (HIS) primarily provides information technology (IT) services to Sultan Qaboos University Hospital (SQUH) which greatly aids SQUH’s mission of providing the highest standard of healthcare to patients. To achieve this goal, HIS uses comprehensive state-of-the-art information technology (IT) services in healthcare systems and constantly upgrades the systems with the latest updates. HIS has a dedicated team of qualified and specialised personnel in the various fields of information technology to provide these services. They constantly develop new systems and maintain the current systems to provide round-the-clock services to SQUH.

In addition to providing network access (wired and wireless) throughout SQUH, HIS’s two flagship projects are Medical Systems and Edges. The Medical Systems software is maintained by HIS in state-of-the-art serv- ers using high speed networks. A failover mechanism is installed in the system so that if one server goes down, another one takes over without affecting the end-users.T his provides a high level of system availability to patient caregivers. HIS is developing in-house enterprise resource planning (ERP) software called Edges. The software includes many modules. Some of the modules have already been commissioned and are used by the administration in the management of the hospital.

Services offered by the HIS include: departments

- planning information system software needs and related budgetary requirements. - project management for large-scale computer system implementations. - evaluation and development of enterprise and departmental software solutions (Edges). support - analysis of business needs and information system requirements. - Design of business workflow, databases, interfaces, documents, reports and processes. - Development and installation of application software. - testing of computer software to validate performance against design specifications. - Documentation, including preparation of user manuals/procedures and system documentation. - Maintenance of applications software, programs and data files to provide enhanced functionalities. - support for users of HIS applications including support for Help Desk issues. - security administration for HIS user accounts and permissions. Directorate of Hospital Information Systems

The HIS staff works closely with the SQUH user-community to provide comprehensive 24/7 support for the Hospital’s mission-critical healthcare computer applications.

255 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Ibraheem Al-Balushi, Technician Moosa Al-Khanbshi, Technician Director Naima K. Al-Naamani, Technician Amer H. Al-Habsi Nasra Al-Mahrouqi, Clerk Research & Development Rashid Al-Mudalwi, Clerk Abdullah Al-Mahrouqi, Head Medical Systems Badriya Al-Amri, Programmer Jokha Al-Kalbani, Head Nuha Al-Amri, Programmer Vishnu Mampatta, Technician Jawahir Al-Busaidi, Programmer Yahya Al-Salmi, Programmer Aisha Al-Hosni, Programmer Widad Al-Mamary, Senior Programmer Ahlam Al-Maqbali, Programmer Taheya Al-Habsi, Programmer Zaina Al-Maskari, Programmer Maryam Al-Balushi, Technician Abir Al-Rashdi, Programmer Administration & Finance Systems Muna Al-Salmi, Programmer Suad Al-Bimani, Sumaya Al-Sawafi, Programmer Programmer Fatema Al-Faliti, Hassan Al-Balushi, Technician Programmer Salma Al-Mayahi, Khalifa Al-Balushi, Technician Programmer Rashid Al-Fori, Technician Application Section Salim Al-Sulaimani, Technician Ahmed Al-Shaibani, Head Network Section Mohsin Al-Zadjali, Chief Systems Analyst Bader Al-Kiyumi, Head Hardware Maintenance Said Al-Harassi, Senior Network Engineer Younis Al-Harthy, Technician Amur Al-Jabri, Network Engineer Amur Al-Mamari, Technician Mohsin Al-Salmi, Network Engineer Fahad Al-Shukaily, Technician Support Staff Dorothy Paul, Ahmed Al-Hoqani, Technician Coordinator Abdulaziz Al-Badwi, Medical Orderly System Administration & Security Nasser Al-Azwani, Head Activities in 2013 Nakia Al-Riyami, System Security Specialist The Department conducted the following activities Al Marwah Al-Kharoosi, Technician in 2013:

Users Support - installation of 200 computers and their peripherals in Mustafa Al-Hadhrami, Head various SQUH departments. Younis Al-Mandhari, Technician - implementation of new active network equipment Fatima Al-Masoudi, Technician (switches). Hamed Al-Muslhi, Technician - replacement of old fire alarm system in the Data Centre.

256 - Completion of wireless (WiFi) project. Studies conducted - addition of new network points and devices in the The following studies were conducted in 2013: identified SQUH locations. - installation of network points in the new Radiology - patient Flow Management System building. - Cabling standards at SQUH - Finalisation of number of points required in the new - security requirements for SQUH Administration and Bone Marrow Transplant buildings. - replacing of designated National Authorities Help- Desk System - implementation of Business Intelligent module in TrakCare system. - Health share with Ministry of Health - implementation of Dashboard system for TrakCare, - asset Management module for Biomedical, Mainte- Edges and Incident Reporting systems. nance, Housing and HIS - Maintaining of Short Message Service server. - national identity card reader for TrakCare system - implementation of E-Recruitment in Edges system. - Dashboard system - enhancement of the external and internal hospital - stock Management for Pharmacy in TrakCare system websites. - new policies for health services provided by SQUH - started working on labeling system for medical stores. - Labelling system for close-loop cycle medication in SQUH. - addition of new features on TrakCare and TrakLab to meet the Accreditation Canada International accreditation standards.

- addition of new security features on Edges system. departments

- enhancement of Store module in Edges. - enhancement of Procurement module in Edges. - implementation of new features in Asset Manage- ment module in Edges. support - enhancement of Incident Report system. - work on integration of the TrakCare and Edges systems. - provision of required statistical reports to SQUH departments. - support of the TrakCare scheduling system for the clinical departments. - training in the use of the TrakCare system for doctors, interns, nurses, laboratory staff and clerks. Directorate of Hospital Information Systems - summer training for students from SQU and outside colleges.

257 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Directorate of Patient Services Overview The role of the Directorate of Patient Services is to provide a 24-hour, compassionate, accessible and high-quality service to Sultan Qaboos University Hospital (SQUH) clients and visitors. The Directorate also works to resolve any misunderstandings that might arise between staff and clients so that the hospital runs with minimal interruptions. Directorate staff liaise with other internal/external departments so that clients receive maximum help.

The Directorate’s responsibilities include the following:

• Looking into the different problems that may occur between staff and SQUH clients and finding appropriate solutions. • Attesting sick leaves and certificates. • Coordinating with doctors when medical reports are requested. • Translating medical reports and administrative work when required. • Coordinating with the Royal Oman Police regarding accidents and providing accident reports. • Releasing oxygen concentration machines to patients who fulfill specific conditions. • Supervising the SQUH security guards. • Providing health education. • Receiving complaints/suggestions and following them up with the concerned departments. • Providing psychological counselling for patients. In the unfortunate event of a patient dying, the Directorate has the following responsibilities:

• Informing the relatives. • Esnuring that all documents such as the death notification and dead body release forms are properly done. • Helping the relatives to find appropriate transportation to transfer the dead person. • If the deceased patient is a non-Omani, the Directorate guides the relatives through the required procedures to transfer the body abroad.

Staff Director Ahmed Al-Khayari Deputy Director Ahmed Al-Barwani

258 Support Staff Younis Al-Farsi, Secretary Khalsa Al-Salmi, Translator Fakhria Al-Amri, Health Education Specialist Alia Al-Habsi, Clerk Saleh Al-Hinai, Duty Administrator Said Al-Harthy, Duty Administrator Masoud Al-Harthy, Duty Administrator Mansoor Al-Hinai, Duty Administrator Muneer Al-Belushi, Duty Administrator Ali Al-Belushi, Duty Administrator Juma Al-Ghafri, Clerk Ibrahim Al-Ghafri, Clerk Yousif Al-Habsi, Receptionist

Sultan Al-Sadi, Receptionist Juma Al-Muharbi, Receptionist Salim Al-Mamari, Receptionist Shihab Al Jaradi, Counselling Psychologist Mokhtar Ambusaidi, Duty Admin. Assistant

departments

All staff members are Omani.

Activities in 2013 support The following activities were performed by the Directorate in 2013:

• In cooperation with doctors, approximately 3,484 medical reports were issued. • Approximately 8,855 visiting passes and 3,753 attendants' passes were issued. • A total of 180 materials were translated within the Directorate, including medical reports, leaflets and other administrative materials. Directorate of Patient Services • A total of 30 suggestion boxes were placed at different locations in SQUH. We received a total of 294 complaints and 109 compliments. • Conducting meetings with inpatients and attendants. • A total of 39,641 units of health education materials (leaflets, posters and booklets) were distributed for the use of patients. • The Directorate organised a number of important events like the Health Education Day, the Walking Day and the Patient Safety Conference.

259 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Department of Procurement Overview The Department of Procurement is one of the key departments of Sultan Qaboos University Hospital (SQUH) as it has the responsibility to keep the hospital continuously supplied with commodities for healthcare use. The Department carries out the procurement of health commodities such as pharmaceutical, medical, surgical and laboratory items.

Despite the difficulties the Department can face to ensure the availability of items, the Department’s constant concern is to improve its performance and achieves its objectives. All staff members in each section of the Department do their best to cut costs; procure cost-effective items; deliver items on time; improve the logistics system, and be a competitive department with a modern supply system.

Sections of Procurement The Department has 11 main sections dealing with the needs of the following SQUH departments:

1. Pharmacy 2. Medical Surgical Supplies 3. Biochemistry, Microbiology, Histopathology and Haematology Laboratories 4. Stationery 5. Biomedical Supplies 6. Maintenance and Technical Affairs 7. support Services 8. Hospital Information Services 9. Clinical Physiology and Cardiac Catheter Laboratory 10. Housing 11. Transport 12. Ticketing 13. petty Cash

Activities in 2013 The figure below shows the work-flow of the Department which operates in close coordination with other key departments such as Medical Stores, the Finance Department, end-users and suppliers.

260 Product Selection The Department of Procurement coordinates with the various SQUH committees to select the right product that meets the hospital’s needs. Quality, effectiveness and affordability are the most important selection criteria considered by departmental staff and committee members. departments

Procurement process The Department receives all the specifications from the various SQUH departments and then issues tenders for the required quantities of the selected items. Once the quotations have been received from suppliers, the assigned staff make a comparative statement and coordinate with the committee in charge of deciding on the purchase of that specific item in order to evaluate the quotations and make the appropriate selection. Af- support ter the selection of items, a recommendation (in English and Arabic) is created in the online system showing the reasons for each selection.

Coordination with end-users, suppliers and SQUH Finance Department of Procurement Department In case of any changes to the price, delivery, shelf-life, country of origin, cancellation, extension or to any other specification of the item, it is the Department’s responsibility to convey this information to the end-users and get comments on their acceptance of or objection to that specific change. Accordingly, a letter is sent from the Department to the supplier with the reply from the end-user. Also, if the end-user wishes to post- pone or bring forward the delivery of a certain item or make some other change, they request the Depart- ment to coordinate with the supplier. Copies of these letters are forwarded to the end-user, Medical Stores and the Finance Department so that they are informed about all amendments.

261 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Directorate of Public Relations & Information Overview An organisation’s success and reputation is dependent on its image in the customer’s eye. The Public Rela- tions & Information Directorate, therefore, works tirelessly on building and maintaining the positive image that Sultan Qaboos University Hospital (SQUH) deserves. The vision of the Directorate is that the public associates the terms ‘top-quality’ and ‘excellence’ with the Public Relations & Information Directorate and associates ‘excellent reputation and image’ with SQUH. The mission of the Directorate is to provide top-quality public relations services to SQUH staff and clients through its contacts with different governmental and private agencies and to work continuously on producing an excellent, realistic image of SQUH.

Staff Director Sultan H. Al-Abri Support Staff Yahya E. Al-Hasni, Head, Cultural & Social Activities Khamis S. Al-Farsi, Head, Staff Services Salim M. Al-Hinai, Acting Head, Media & Information Ahmed S. Al-Hinai, Clerk Talib A. Al-Abri, Clerk Abdullah J. Al-Owaisi, Clerk Maryam M. Al-Qureshi, Clerk Mohammed A. Al-Salmi, Clerk Hani M. Al-Shibli, Video Editor Salim A. Al-Farsi, Journalist Saif S. Al-Tamimi, Multimedia Designer Mohammed A. Al-Wahibi, Clerk Yahya N. Al-Aamri, Clerk Hashim A. Al-Balushi, Clerk Yonis A. Al-Habsi, Clerk Rashid A. Al-Hatmi, Driver Ali K. Al-Hatmi, Messenger Activities in 2013 The Public Relations & Information Directorate serves the hospital through its four different departments and continually strives to provide high quality services and support to SQUH departments and individual staff.

262 Table 1: Journalism & Information Department and Printing & Publishing Department Activities No. Covering all SQUH events in local media 69

Design of event invitation cards 15 Design of certificates of appreciation 30 Design of patient educational materials (leaflets, posters) 33

Announcement of vacancies, tenders and training programmes 81 Providing banners for hospital events 45 Coordinating with media agencies regarding interviews with hospital staff (doctors) 16 Design of annual calendar 1 Production of educational and awareness films 4 Design of pop-up materials 255

Table 2: Cultural & Social Activities Department Table 3: Employee Services Department departments SR. Activities No. Activities No. A Supporting all SQUH departments in 65 Police station visits 5 organising conferences, symposia and Information Court visits 0 workshops support Receiving employees at airport 470 B Making arrangements for training pro- 402 grammes in coordination with the Farewells 80 Directorate of Training & CPD Visas issued 1,613 C Organising the SQU Graduation Ceremony 1

Visas deposited 251 Directorate of Public Relations & D Organising the SQUH Annual Exhibition 1 ID cards issued 3,779 Day Road passes issued 312 E Official visits 68 F Opening ceremony (new department) 0 G Arranging appointments for VIPs in the 23 Hospital

263 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Directorate of Technical Affairs Overview The Technical Affairs Directorate is responsible for the operation and maintenance of all buildings, services, plants, equipment and infrastructure in the Hospital to ensure they are available for the smooth running of the Hospital. The Department is also responsible for planning and execution of new buildings to cater for new hospital developments.

The Directorate has four departments: Projects, Health, Safety & Fire Prevention, Bio-Medical Engineering, and Hospital Engineering & Maintenance.

Projects Department This Department is responsible for carrying out feasibility studies with land surveys and field orientations according to the requests received from various departments. It compiles preliminary data to suit the facilities and prepares briefs of requirements and preliminary sketches in consultation with user departments. It also compiles tender documents for consultancy services for the design and supervision of major projects, while minor projects are dealt with in-house. It reviews designs and documentation produced by consultants and liaises for the processing of various statutory approvals. It then reviews the tenders with analysis and recommendations. Finally, it carries out contract administration work with supervision of sites and monitoring of the progress of projects to ensure quality work is produced within the time schedules.

Health, Safety & Fire Prevention Department This Department, in coordination with the Health & Safety Committee, formulates health, safety and fire policies; monitors and ensures strict adherence to the policies; investigates any incident that may have an impact on health and safety, and trains hospital staff in health, safety and fire prevention.

Biomedical Engineering Department This Department is responsible for the procurement and maintenance of biomedical equipment, such as magnetic resonance imaging and computed tomography scanners, X-ray and vital signs monitoring machines and all diagnostic and life-saving equipment.

Hospital engineering & Maintenance Department This Department is responsible for all Hospital buildings and all equipment except bio-medical equipment. The Department is sub-divided into four sections:

264 Mechanical Section Responsible for water services; kitchen equipment; medical gases; disinfection and sterilisation equipment; the natural gas system; sewage; lifting stations; hospital beds; fire fighting equipment, and safety cabinets.

HVAC Section Responsible for heating; ventilation and air conditioning (HVAC) systems, and refrigeration equipment.

Electrical Section Responsible for the power distribution system; lifts; lighting; the paging and telephone systems; HVAC controls; uninterruptible power supplies; nurse call systems; intercom systems; public address systems; road barriers, and the audio-visual distribution system.

Civil Section Responsible for building maintenance; soft landscaping maintenance; keys; sign-posting; minor modifications and upgrading; renovation of all facilities, and the infrastructure system.

Laundry & House Keeping Department Responsible for the building cleaning services and the washing of Hospital ward linen and clinical staff uni-

forms. departments

Staff

Director support Juma S. Al-Jabri Support Staff Muhammed Mustafa, Coordinator Waleed Al-Nasseri, Clerk Affairs Directorate of Technical Abdul M. Al-Rahbi, Messenger Projects Mohan R. Kailas, Civil Engineer Muthuraj, Civil Engineer Mabruka Al-Siyabi, Senior Civil Engineer Subhash Sule, Senior Mechanical Engineer Benjamin George, Mechanical Engineer

265 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Arun K. Singh, Electrical Engineer Ahmed Al-Busaidi, Maintenance Technician Mohammed Kunhi, Draughtsman Adel Al-Ghafri, Technician Fahad S. Al-Belushi, Health, Safety & Fire Prevention Technician Murad Al-Saadi, Clerk Vaseem A. M. Mirza, Health & Safety Maniha Q. Al-Shanfari, Clerk Ahmed H. Al-Mahruqui, Fire Officer Mazin A. M. Al-Zadjali, Fire Assistant Support Services & Maintenance Nasser Al-Manai, Fireman Sulaiman Al-Farei, Head, Laundry & Housekeeping Nasra Al-Rawahi, Biomedical Engineering Clerk Sateesh T. N., Housekeeping Supervisor Abdullah M. Al-Hashmi, Head of Department Khamis Al-Belushi, Housingkeeping Supervisor Khalid M. Al-Mahrizi, Senior Engineer Nasser Al-Shargi, In-Charge of Store Shuwaina N. Al-Harrasi, Clerk Sultan Al-Busaidi, Laundry Supervisor Zuwaina A. Al-Tooqi, Coordinator Naif Al-Belushi, Laundry Supervisor Edgar K. Sanz, Senior Engineer Maryam, Tailor Dominador De Guzman, Senior Engineer Santiago O. Buniag, Engineer Khamis H. Al-Lamki, Engineer Activities in 2013 Ravindra Inamdar, Senior Engineer EQUIPMENT Madhan G., Engineer During 2013, we acquired many new items of equip- Amur Al-Sindi, Engineer ments to improve patient care and to support re- Hamid M. Al-Mayahi, Engineer search. Some of the major equipment items are de- Ghassan S. Al-Ghassani, Engineer tailed in Tables 1 and 2. Saif K. Al-Hinai, Engineer Adil M. Al-Harthy, Engineer Mohsin S. Al-Naamani, Engineer Sultan H. Al-Qalhaty, Technician Taha I. Al-Husseini, Technician Jassim S. Al-Rusheidi, Technician Hospital Engineering & Maintenance Abdullah S. Al-Hinai, Chief Engineer Manikonda V. Rao, Coordinator Salem Al-Hadhrami, Electrical Engineer Venkatesh Prasad, Electrical Engineer Tariq Al-Lawati, Mechanical Engineer Prabu D. Singh, Mechanical Engineer Jamal Al-Mutairi, Civil Engineer

266 Table 1: Biomedical equipment purchased in 2013 Sl. No. Name of the equipment Value in OR 1. Gene Xpert Stystem 16 with 4 Modules 15,000.000 2. DNA Sequencer/Fragment Size Analyser 83,988.000 3. Centrifuge, Table Top High-Spec 3,777.500 4. Polymerase Chain Reaction Workstation 10,000.000 5. Refrigerated Centrifuge 2,264.000 6. Spectrophotometer 17,280.000 7. DX 96-well thermal cyclers 0.2 ml (PCR Instrument) 15,600.000 8. Vortex/Mixer 559.800 9. Mini Centrifuge (Quick Spin Downs and Microfiltration) 2,028.000 10. Lease Contract for Coagulation Analyser 5,000.000 11. Automated Nucleic Acid Extractors 14,000.000 12. Fax Machines 735.000 departments

13. Gastroscope, Ultrasound (Gastrointestinal Videoscope) 91,000.000 14. Dry Incubator (Heating Block) 3,000.000

15. Anaesthesia Machine 31,000.000 support 16. Optical Coherence Tomography Unit 60,000.000 17. Ultrasound Probe Driving Unit for Endoscopy 15,000.0000 18. Vital Sign Monitor, portable 6,660.000 Directorate of Technical Affairs Directorate of Technical 19. Long-term Electroencephalogram Machine 26,000.000 20. Air Oxygen Blender 600.000 21. Service Contract for Siemens SYNGO.VIA Radiology software 30,000.000 22. Ophthalmic Cryo Machine 10,000.000 23. Continuous Passive Motion machine 8,188.000 Subtotal 451,680.300

267 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Brought forward 451,680.300 24. Electro-Surgical Unit 14,000.000 25. Food Compression Systems 10,559.500 26. Portable Slit Lamp (Paediatric) 2,000.000 27. Phototherapy Light 2,550.000 28. Gastrointestinal Videoscope 85,000.000 29. Anaesthesia Machine Services (contract renewal) 50,000.000 30. Service Contract for Maquet Ventilators 13,200.000 31. Electroencephalogram System 94,557.180 32. CAPNO Meter 4,000.000 33. Echocardiogram Unit (Portable) 38,975.000 34. Renewal of Service Contract for Philips X-Ray Machine 96,405.000 35. Patient Hoists 38,000.000 36. Bedside Monitors 52,200.000 37. Total Body Cooling Devices 10,000.000 38. Cerebral Oxymeter 833.667 39. Electrocardiogram Recorder 13,779.999 40. Angiography System 917,100.000 41. Single-photon emission computed tomography-computed tomography 833,702.000 (SPECT-CT) scanner 42. Service Contract for Philips C-ARM Spectroscopy 26,700.000 Grand total 2,755,242.646

268 Table 2: Equipment ordered by Hospital Maintenance Department in 2013 Sl. No. Name of the equipment Value in OR 1. Trollies for Washed Linen (stainless steel) 2,570.000

2. Freezer -40° C (482 litres) 2,664.600 3. Automatic Door 5,499.000 4. Medication Refrigerators (520 litres) 1,793.900 5. Stainless Steel Cabinet (with transfer hatches) 5,250.000 6. Multi-purpose Trollies 900.000 7. Tray Dispenser 2,142.000 8. Plate Dispenser 2,616.000 9. Universal Dispenser 4,014.000 10. Freezer Medical -20° C 1,152.000 11. Entonox Cylinder 216.000 12. Freezer – food sample preserving 1,750.000 departments

13. Synchronised Clocks 15,912.000 14. Microbiological Safety Cabinets 8,222.000

15. Procedure Trollies 355.000 support 16. Uninterruptible Power System (UPS) - 160 KVA 18,755.000 17. Refrigerator for Medications (50 litres) 650.000 18. Trollies for Patient Transport 1,361.000 Directorate of Technical Affairs Directorate of Technical 19. Medical Refrigerators (1,200 litres) 5,990.000 20. Rotary Cabinets 3,500.000 21. Paediatric Beds 11,080.000 22. Bedside Tables 2,184.000 Subtotal 98,576.500 Brought forward 98,576.500 23. Trollies (stainless steel, 3 shelves) 738.000 24. Examination Light Fitting (with halogen bulb) 3,250.000 269 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

25. Trollies for Non-Infected Linen (with cover) 20,205.000 26. Trollies for Patient Transport 2,376.000 27. Refrigerator Medical (50 litres) 1,590.000 28. Water Coolers (wall inserted) 1,700.000 29. Kitchen Equipment 15,000.000 30. Safety Cabinets and Fume Cupboard 40,000.000 30. Laundry Equipment 15,000.000 31. Diesel Generator Set # 2 in Block 10 105,000.000 32. Replacement of 3200 A ACBs of 4 x transformer and 2 x generator incomers in 81,400.000 Block #10 LV Switch Board Grand total 384,835.500

PROJECTS To meet the Hospital expansion plans the following projects were undertaken, as detailed in Tables 3 and 4:

Table 3: Projects under design/execution in 2013 S. No. Description Value in OR 1. Audiometry Lab Facility in Clinical Physiology Department 34,525.060 2. Relocation of O&M Contractor’s Workshop and Offices 180,000.000 3. Extension to Hospital Director General’s Office 165,000.000 4. Construction of Block 10 Plant Room Annexe 335,000.000 5. Creating Garden for Psychiatry Patients in Courtyard 7,500.000 6. ModificationW orks in Laundry Area 7,500.000 7. Connecting Bridge between old and new Medical Stores Buildings (cost pro- 5,000.000 jected for consultancy services only) 8. GENSET 120 KVA and Automatic Mains Failure Panel in FAMCO Clinic 25,000.000 9. Installation of Closed Circuit TV System in Hospital 350,000.000 10. Replacement of Operating Theatre Lighting 85,000.000 11. Replacement of 11 x 300 TR existing Chillers by 11 x 325 TR Chillers 1,500,000.000 12. Replacement of Air Handling Units (AHUs) 4, 5, 16 and 17 710,000.000 13. Replacement of Pumps 223,544.180 270 Subtotal 3,523,069.240 Table 4: Projects completed in 2013 S. No. Description Value in OR 1. Modifications in Clinical Physiology Department to create Sleep Lab and Re- 9,334.200 porting Rooms (Civil, Elect. & HVAC work) 2. Construction of Partition to create Store Room in Room No. 21708 – Training 370.618 Department 3. Improvement to Counter Arrangement for Medical Records in A&E 160.925 4. Replacing Floor Covering in Operating Theatres 9,350.000 5. Coordination for pre-installation works for SPECT-CT Facility Contract through 69,800.000 BME 6. Coordination for Pre-installation works for Angiography Facility, Contract 75,000.000 through BME 7. Store Room for Gym Area in 1 Yellow Ward 290.675 8. ModificationW orks in TADH Offices area 360.000 9. Modifications/improvements to Children’s Play Area in front of Hospital 4,255.390 departments 10. Modifications/improvements to Children’s Play area and waiting in Paediatric 7,361.750 Outpatient Department (OPD) 11. Modification work inW ards to create On-Call Rooms 138,319.870 support 12. Modification work in A&E Department 107.775 13. Modification work in Delivery Suite 5,007.981 14. Creating Additional Office in place of reception counter – Hospital Information 2,447.010 Systems (HIS) Directorate of Technical Affairs Directorate of Technical 15. Partition works in Male and Female Treatment areas and Counter Arrangement 2,375.784 in Physiotherapy Department 16. Bridge over Storm-Water Channel near Block-11 1,600.000 17. Modifications in Paediatric OPD to create additional Consultation Rooms 35,725.475 18. Modifications in Paediatric OPD – Day Care Unit Area 5,753.044 19. Foundation Works for A/C Out Door unit – A&E Department 308.446 20. Modular Partition work in QMD Office Area 2,500.000 21. Moving of Sliding Door from Cafeteria to Medical Store 275.000 Subtotal 370,703.943 Carried forward 370,703.943 271 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

22. Providing Pavement around the Civil Defence Offices Area 350.000 23. Modification works in existing racking system in Medical Store Annexe – Con- 300.000 veyor Area 24. Paediatric OPD and Day Care Unit in Paediatric OPD – Reception Counters 6,035.700 25. Conversion of Postmortem Room into Pathology Laboratory 19,700.000 26. Paediatric OPD and Day Care Unit in Paediatrics OPD – Replacing Floor Covering 11,311.850 27. Modifications in Paediatric OPD – 2 Nos. Isolation Rooms to create ECHO Room 13,900.000 28. Floor Covering in Gym Area of Ward 1 Yellow 6,71.000 39. Additional works in New Medical Stores Building 5,755.000 30. Upgrading LV Panel of Blocks 3 & 8 11,200.000 31. External Lighting in front of Hospital 2,745.000 32. Hoisting Device/Conveyor for Medical Store 11,250.000 33. HVAC Modification in Administration OfficesV ariable Refrigerant Volume 19,200.000 (VRV) System Phase I 34. HVAC Modification in Administration OfficesVRV System Phase II 26,850.000 35. Additional PMG outlets for 1 Purple ward 1,600.000 36. Air Conditioning of HIS Server Room 48,920.000 37. Renting of Chillers 115,407.520 38. Replacement of AHUs in Block 9 231,378.000 39. Alternate Cooling of Magnetic Resonance Imaging Scanner 15,500.000 40. UPS for Catheter Laboratory 18,755.000 41. Fire Suppression System in HIS 23,165.000 42. Sub-Station for Block-10 32,226.000 43. Nurse Call System for Wards 1 Purple, 1 Blue and 1 Red 45,973.000 Grand total 1,038,963.013

272 Table 5: Expenditures for 2011–2013 Amount in OR 2011 2012 2013 Projects 4,245,869.334 2,471,877.392 1,038,963.013 Engineering equipment replacement 733,947.800 147,176.300 384,835.500 Biomedical equipments 1,457,618.845 840,151.100 2,755,242.646 Building modifications 33,130.000 90,365.145 74,635.600 Maintenance of plants and equipment 720,415.374 699,330.399 711,161.032 Maintenance of biomedical equipment 489,434.819 183,935.170 651,910.068 Cleaning and pest control services 487,168.800 598,942.377 623,139.603 Laundry services 123,952.224 123,952.224 123,952.224 Grand total 8,291,537.196 5,155,730.107 6,363,839.686

Table 6: Energy consumption for 2011–2013 departments

Amount in OR 2011 2012 2013

Electricity in kwh 1,055,688.495 1,025,950.430 1,088,611.870 support Water in litres 71,922.245 84,634.100 97,804.139 Gas in M3 7,303.261 9,366.325 9,104.032 Total 1,134,914.001 1,119,950.855 1,195,520.041 Directorate of Technical Affairs Directorate of Technical

273 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Directorate of Training & Continuing Professional Development

Overview The vision of the Directorate of Training & Continuing Professional Development (DTD) at Sultan Qaboos University Hospital (SQUH) is to be a training centre of excellence in Oman, assuming a leadership role in continuing education and research, and providing the highest standard of programmes to meet the educational and competency-based training needs of SQUH staff.T he mission of the Directorate is to provide excellent opportunities for training, professional development, continuing education and in-house training for all SQUH staff, thereby promoting the delivery of the highest quality patient/client care.

Staff Director Abdullah Al-Mujaini, Senior Consultant, Ophthalmology Support Staff Kirsten Rude, Teacher Barbara Hall, Teacher Esther H. Bonam, Teacher Munira Al-Belushi, Teacher Huda Al-Hosni, Teacher Joan Henderson, Teacher Samson Pakalapati, Administrator Rashid Al-Hajri, Administrator Ali Al-Owaisi, Administrator Najla Al-Rashdi, Administrator Hind Al-Ghailani, Administrator Fatma Al-Mushrfai, Admininstrator Amal Al-Mayahi, CPD Administrator Yahya Al-Rawahi, Messenger

274 Activities in 2013 The following activities were undertaken by the Directorate in 2013:

- Conducted courses and programmes as published in the bi-annual course schedules - submitted the 2012 Event Reflection TD D Study Report to the SQUH Director General (HDG) - processed attachment requests from institutions/individuals - Conducted teaching and consultations as per requests

- admission process for Central Sterile Supply Department (CSSD) Technician course 2013–2014 - revised all policies and forms of the Directorate - participated in various SQUH committees - revised and published course curricula - revised and published course books - prepared and submitted the equipment budget - Departmental training needs assessed for all categories of courses from departments - worked on and implemented various proposals for unscheduled in-house development courses - identified external short-term courses for departments and processed the applications - Conducted typing tests for the SQU Department of Personnel Affairs for prospective candidates - scrutinised scholarship applications and forwarded them to the Hospital Training Committee (HTC) departments - Developed and revised the key performance indicators (KPI) plan to a new format and submitted the 2013 report on KPI to the Directorate of Development and Quality (DDQ) - updated the Intravenous (IV) Therapy course manual - updated the IV Therapy Instructor course manual support - Conducted practical sessions for two groups of students from the College of Agriculture & Marine Sciences on the safe collection of blood - Conducted a Phlebotomy course for nurses

- Developed a Cultural Competency workshop Professional Development - Developed the Pressure Ulcer Prevention & Care course as part of the Wound Care Update series - undertook the Departmental fire audit Directorate of Training & Continuing Directorate of Training - initiated the American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) accreditation process - invited AHA Faculty from the Regional Office in Dubai to conduct anA HA-certified Basic LifeS upport (BLS) course for accreditation of the course - revised the General Hospital Orientation programme as per the recommendation of the Accreditation Canada In- ternational(ACI)/Directorate of Development & Quality (DDQ) - applied and obtained accreditation and credit points for scheduled and unscheduled in-house development programmes from the Oman Medical Specialty Board (OMSB)

275 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

- Conducted a Certificate Award Function for the 2012–2013 CSSD technician graduates - submitted the Accredited Courses Evaluation Summary of the DTD and other SQUH departmental courses to comply to the OMSB with their requirements - submitted new and renewal application forms of the DTD and other SQUH departments to the OMSB for accreditation.

New Developments in 2013 The following new developments were undertaken in 2013:

- implemented the DTD Quality Improvement Committee (part of the ACI process) - updated the colour-coded Bi-Annual Course Programme Schedule indicating eligibility requirements - Developed and conducted the Medical Terminology course for Library Science diploma students of the SQU College of Arts & Social Sciences - published a DTD newsletter - Developed a curriculum and course book for the Medical Terminology course for clinical staff - Conducted a Medical Terminology course for clinical staff - submitted the report of the Customer Satisfaction Survey to the DDQ - presented a paper at the 1st International Conference on Epidemiological Research for Advanced Nursing Practice: A global health scenario, New Delhi, India, July 2013 - Developed a policy and procedures for a Tobacco Free Environment for the DTD and SQUH - submitted evidence on the ACI assessment and road map to ACI

Development of DTD Staff Staff of the TD D attended various conferences in 2013, including the 1st International Evidence Based Medical Education Workshop, the 13th Conference of the International Society of Travel Medicine and the 13th Inter- national Neonatology Conference. They also attended courses on simulation-based training and training of trainers.

Omanisation One Omani teaching staff and one Omani clerical staff were recruited.

276 Department of Finance Overview The responsibilities of the Hospital Finance Department involve:

1. preparing the Sultan Qaboos University Hospital (SQUH) annual budget for approval by the Ministry of Finance, monitoring the approved funds for the effective utilisation of the same, monitoring staff induction costs against the approved staff budget and maintaining various statistics pertaining to staff, etc. 2. processing staff salaries on a monthly basis and ensuring timely payments; processing leave salaries; the timely settling of termination benefits for staff leaving the hospital permanently, etc. 3. processing suppliers’ and contractors’ bills for payments in coordination with the supplies and stores departments. 4. Maintaining the petty cash account. 5. Collecting revenue from paying patients, private hospitals and insurance companies, etc. 6. Liaising with the Ministry of Finance and other government agencies. 7. Furnishing various statistics and other information requested by the University Administration and government ministries. 8. undertaking specific assignments requested by the SQUH Management.

Staff departments

Director Nasser S. M. Al-Salmi

Acting Deputy Director support Ahmed S. A. Al-Farsi

Support Staff Department of Finance M. S. Subba Rao, Senior Technician/Statistician Adnan J. Al-Mosawi, Head, Treasury Section Suleiman S. Al-Abri, Head, Revenue Section Khamis M. Al-Muzaini, Head, Contracts Section Hilal A. Al-Daghaishi, Head, Salary Section Salah S. S. Al-Nadabi, Head, Expenditure Section Salim H. H. Al-Sinawi, Accountant Hamoud S. Al-Farsi, Accountant Sulaiman D. O. Al-Bulushi, Accountant Zakiya S. A. Al-Husni, Accountant

277 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Zuweina A. M. Al-Habsi, Accountant Nasser M. K. Al-Rubaiey, Accountant Naeema J. R. Al-Saadi, Accountant Azhar S. S. Al-Dhgaishi, Accountant Mohammed J. S. Al-Ramadhani, Accountant Hamad S. H. Al-Sabti, Accountant Khalfan S. Al-Farei, Accountant Ibtisam J. J. Al-Malki, Accountant Younis K. Al-Siyabi, Accountant Saada H. K. Al-Maamri, Accountant Dalal S. Al-Wahaibi, Accountant Nada N. Al-Kindi, Accountant Nadia S. S. Al-Hinai, Coordinator Asma S. Al-Musalhi, Clerk Ali K. Al-Abri, Clerk Laila A. Al-Amri, Clerk Jaber S. Al-Bakri, Clerk Sulaiman H. S. Al-Talei, Messenger Activities in 2013 During the year 2013, the number of staff paid salaries was 2,788.T he Hospital budget for the year 2014 was prepared and submitted on time to the Ministry of Finance for approval. The Department also processed 5,423 vouchers of suppliers and contractors for payment during the year. The Hospital revenue collection for the year ending 2013 was OR 1,275,643.628 which accounted for an increase of around 13.2% over 2012 in revenue generation. Constant monitoring of the budgetary allocation and timely intervention resulted in a 100% utilisation of the budget for the year ending 2013. The petty cash disbursement for purchase of some day-to-day urgent items for 2013 was OR 23,089.264.

278 Department of Housing Overview The Housing Department is responsible for arranging accommodation for all the SQU Hospital (SQUH) employees. Assignment of residences is allocated as per housing rules and policy according to provisions of employment contracts.

Residences on-campus are available in different types of categories such as family, single and sharing for senior and junior staff. In addition, the Department hires/rents accommodation units, in order to cover the shortage in the number of residences available on-campus.

The Department plays a vital role in the preparation of residential premises, ensuring that they are fit for occupancy. Inspections and housekeeping are carried out by the Department’s staff and any maintenance work required is referred to the appropriate SQUH department.

Staff Head of Department Bader Al-Hasni departments Deputy Head of Department Bader Al-Habsi Support Staff Mahboob Al-Belushi, Residence Furnishing Officer support Abullah Al-Jaradi, Residence Furnishing Thani Al-Habsi, Housekeeping Department of Housing Khalifa Al-Hinai, Offices Furnishing Officer Bader Al-Hadabi, Housekeeping Said Al-Maanei, Housekeeping Fahad AlBelushi, Furnishing Rahma Al-Hosni, Coordinator Saif Al-Hadrami, Housing store Salim Al-Mabsali, Worker Wani Al-Shuaibi, Worker Younis Al-Adwani, Worker

The Department has fourteen employees and is fully Omanised.

279 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital Activities in 2013 Most of the Department’s activities were achieved successfully throughout the year.

Housing Provision The responsibilities of this section include:

- renewal of lease contracts for one more year. - increase in the number of hired accommodation units to cover the shortage on campus due to the expansion of SQUH. - in order to cover residential accommodation shortages, there has been provision of housing allowances for newly-recruited nurses after they vacate their junior nurse accommodation. - a total of 25 housing allowances were approved to remedy the housing shortage for new employees. - provision of more than 12 rooms on campus for the medical internship programme.

Housing equipment & Maintenance The responsibilities of this section include:

- establishment of new housing furniture store. - Most housing furniture requests have been met. - Furniture provided to newly-rented accommodation . - new purchases for residential requirements. - preparation of obsolete items for auction. - Most maintenance requests and other requirements have been successfully met through the appropriate liaison. - the cleaning and preparation of residential units have successfully been completed before occupancy.

Training The responsibilities of this section include:

- Follow-up to the request for housing staff training with the Directorate ofT raining & Continuing Professional Development. - Contribution to the SQUH orientation programme.

Quality Management The responsibilities of this section include:

- Contribution to quality management activities for ISO 9001:2000 of the British Standards Institute. - Contribution to the Accreditation Canada International programme. - Contribution to executing the yearly housing planned preventative maintenance through the SQUH Directorate of Technical Affairs (Maintenance Department).

Human Resources and Transport - Follow-up with the SQUH Administration about the Department’s request for additional vehicles. - Follow-up to the request to appoint more staff to the Department due to increasing job responsibilities. 280 Department of Medical Records Overview The Medical Records Department is one of the most important departments at Sultan Qaboos University Hos- pital (SQUH). Its main goal is to create and maintain systems which support healthcare providers, public studies, financial organisations and, most importantly of all, the needs of the patient. SQUH currently has a hybrid records system that involves most information being held in the new Hospital Information System, TrakCare. A small amount of information is still held on paper records. The goal is to have a full electronic health record functioning by the end of 2014.

Admission & Registration Section This is the largest section, employing the clerks and receptionists of all the clinics: Outpatient, Radiology, Physiology, Oral Health, and the Family Medicine & Community Health and Student Clinics. The registration of patients in the Emergency Department is an important part of our activity as it is a crucial and critical area in SQUH which operates 24 hours a day. At the beginning of 2013, a communication office was established to dealing with the enquiries and appointments of all the medical and surgical clinics.

Processing & Assembling Section This section ensures that all records have a complete discharge summary and all other notes and reports are present. In addition, they ensure that records are assembled in an orderly and time- departments ly manner and signed in on the system. Also, all important information, which cannot be entered directly in to the new electronic patient records system, such as consent forms, is scanned for inclusion in the system. support Coding Section This section analyses all inpatient discharge records and assigns a numeric code to diagnostic data based on the International Classification of Diseases (ICD-10) system and (ICD-9-CM) for procedures.

Statistics Section Department of Medical Records This section prepares statistics for the SQUH administration and departments, and outside agencies such as the Ministry of Health (MOH). It also provides health information for physicians, nurses and students for medical research purposes.

Births & Deaths Section The Births & Deaths Section issues electronic birth and death notifications in both Arabic and English. The Directorate of Civil Services of the Royal Oman Police issues the full death certificates. Deaths are reported by fax within 24 hours to the Ministry of Health, whereas the births are reported monthly to the same ministry.

Filing & Retrieval Section This section retrieves records for treatment and provides services for medical students, doctors, nurses and other paramedical staff who need to perform retrospective research or study. 281 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Staff Head of Department Salim K. Al-Wahaibi Deputy Head of Department Ahmed Al-Farsi Support Staff Saif Al-Raqadi, Supervisor Mubarak Al-Habsi, Supervisor Abdullah Al-Wahaibi, Supervisor Yousif Al-Falahi, Supervisor Huda Al-Suwaidi, Supervisor Salim Al-Hadi, Supervisor Naji S. Azzan, Supervisor Khamis S. Al-Farsi, Supervisor

The head of department and all other staff are Omani, whom are committed to deliver high quality and efficient technical and administrative work.

Activities in 2013 The volume of activity in the Medical Records Department for 2013 is shown in the tables below.

Table 1: Activity in 2013 Table 2: Patient registration in 2013 Activity 2013 Patient registration No. Patients registered in Emergency 61,630 Outpatient clinics 124,206 Dept. Radiology Dept. 84,235 Inpatient coded records 28,937 Clinical Physiology Dept. 22,193 Birth notifications issued 3,927 Day Care Unit 10,392 Death notifications issued 645 Family Medicine Clinic 39,864 Oral Health Clinic 13,871 Student Clinic 14,327 Physiotherapy Dept. 14,052 Total 323,140

282 Department of Transport Overview The Department provides the following services:

- transport services for SQUH staff. - transfer of patients either by car or ambulance to another hospital or the airport. - Delivery and collection of mail and medical reports to and from other governmental institutions. - transport for female students and patients between their residential complex and the Hospital.

Staff Head of Department Nassir H. Al-Gaffari Support Staff Essa K. Al-Raisi, Staff Member Drivers: 28 departments

support Department of Transport

283 Annual Report 2013 College of Medicine & Health Sciences and Sultan Qaboos University Hospital

Appendices Appendix I Clinico-Pathologic Conferences: SCRAPS 2012–2013 Surgery, Clinical disciplines, Radiology, Anatomy, Psychia- try and Laboratory Sciences Throughout the academic year, the College of Medicine & Health Sciences (COMHS) conducts weekly Sur- gical Pathological Conferences (SCRAPS) where multidisciplinary cases are presented to medical students, residents, clinicians and academics in the University as part of continuing medical education.

The objectives of SCRAPS are to:

1. Teach students how to conduct multidisciplinary clinical case presentations. 2. Increase the knowledge of undergraduate and postgraduate students in different fields of medicine. 3. Present updates on advancements in different fields of laboratory and clinical medicine. 4. Spread knowledge of research conducted in different medical specialties. 5. Improve the presentation skills of undergraduate and postgraduate students. SCRAPS is the oldest and only regular academic activity that brings together the students and staff of the COMHS and Sultan Qaboos University Hospital (SQUH). SCRAPS was started in the late 1980s during the term of the College’s first Dean, Prof. Gilbert Heseltine, and was initiated by Prof. William Jeans. Responsibili- ty was passed successively to Prof. Christopher Grant, Prof. Gordon Reeves, Prof. Keith Whaley, Prof. Mansour Al- Moundhri, Prof. Anand Date and Dr. Aisha Al-Hamadani. The SCRAPS activity is organised by the office of the Dean of the COMHS. The current organizer is Dr. Maha Al- Khaduri, Department of Obstetrics & Gynae- cology, assisted by Ms. Aisha Al-Wardi, from the Dean’s Office.

On average there are 30 scheduled SCRAPS sessions in each academic year. The case-based presentations are made by all the departments in the COMHS and SQUH in turn, with contribution from other departments depending on the nature of the case. The content includes basic sciences, clinical updates and research conducted at SQU. The presentation lasts 45 minutes followed by an open discussion. The discussions at SCRAPS have been a forum in which suggestions for policies in healthcare at an institutional and national level have been made and this has been a basis for constructive contributions to community service. The target audi- ence includes medical students, postgraduate residents, Masters and Ph.D. students, faculty, junior and senior doctors. In 2010, the Best Student SCRAPS Presentation Award was introduced. In addition, since January 2012, the activity has been accredited by the Oman Medical Specialty Board (OMSB) for CPD credits. The activity is awarded 0.5 credit points in Category II, while speakers are awarded 2 credit points per presentation. The maximum is 21 points.

284 The SCRAPS presentations are evaluated by the staff, students and theS CRAPS Committee. Two evaluation forms are used for this process: one to evaluate the SCRAPS presentation overall and one to evaluate medical student presentations. At the end of the academic year these presentations are ranked in order of their overall score. There are also 3 prizes for the best SCRAPS every year.

There were a total of 23 SCRAPS presentations in 2012–2013.

PRIZES FOR 2012–2013 Best Student Presentation Award ‘Walk With Me’, Department of Pathology. Presented by: Mr. Majid Al-Badi, Senior Clerkship student.

Best SCRAPS Awards First place hospital ‘Capturing Smoke’, Department of Emergency Medicine. Presented by: Dr. Marwan Al-Raisi, Dept. Emergency Medicine, Dr. Muna Al-Sadoon, Dept. Child Health and Dr. Saif Al-Ghafri, Dept. Emergency Medicine. and

Second place ‘Walk With Me’, Department of Pathology. Presented by: Ms. Athari Al-Obaidani and Mr. Majid Al-Badi, Se- nior Clerkship students; Prof. Ritu Lakhtakia, Dr. Marwa Al-Riyami and Dr. Asim Qureshi, Dept. Pathology; Dr.

Sukhpal Sawhney, Dept. Radiology & Molecular Imaging; Dr. Mohammed Furrukh, Dept. Medicine and Dr. university

Adil Al-Ajmi, Dept. Surgery. Annexes

Third place qaboos ‘Lewis Lives, Kell Kills, JSB?’, Department of Obstetrics & Gynaecology. Presented by: Dr. Tamima Al-Dughai- shi, Dept. Obstetrics & Gynaecology; Dr. Arwa Al- Riyami, Dept. Haematology; Dr. Mathew Zachariah, Dept. Child Health and Dr. Qamriya Ambusaidi (Resident), Dept. Obstetrics & Gynaecology. sultan Appendix II curriculum information Full information on all College of Medicine & Health Sciences curricula can be found on our website at: http://www.squ.edu.om/medicine-health/tabid/2455/language/en-US/default. aspx

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