Annual Report 2009-2010

ACADEMIC &PATIENT CAREDEPARTMENTS OVERVIEW EXECUTIVE SUMMARY DEAN’S MESSAGE Overview 38 Biochemistry Research 34 Clinical &DiagnosticServices Training Courses &CME Activities Teaching Programmes Highlights oftheYear 2008-2009 Staff 31 Overview 30 Behavioural Medicine Research Clinical &DiagnosticServices Training Courses &CMEActivities Teaching Programmes Highlights oftheYear 2008-2009 Staff 25 Overview 24 Anaesthesia, ICU&PainManagement Clinical &DiagnosticServices Training Courses &CMEActivities Teaching Programmes Highlights oftheYear 2008-2009 Staff 17 Overview 16 Accident &EmergencyMedicine Sultan QaboosUniversityHopsital College ofMedicine&HealthSciences 20 28 28 34 32 25 27 27 19 33 18 21 3 2 31 9 5

academic and patient care departments Accident & Emergency Staff 39 Highlights of the Years 2008-2009 39 Teaching Programmes 40 Clinical & Diagnostic Services 41 Research 42 Child Health Overview 48 Staff 49 Highlights of the Year 2008-2009 50 Teaching Programmes 51 Training Courses & CME Activities 53 Clinical and Diagnostic Services 53 Research 54 Family Medicine & Public Health Overview 60 Staff 61 Highlights of the Year 2008–2009 61 Teaching Programmes 62 Training Courses & CME Activities 63 Clinical & Diagnostic Services 63 Research 64 Genetics Overview 72 Staff 73 Highlights of the Year 2008-2009 73 Teaching Programmes 73 Training Courses & CME Activities 75 Clinical & Diagnostic Services 75 Research 77 Haematology Overview 80 Staff 81 Highlights of the Year 2008-2009 82 Teaching Programmes 82 Clinical & Diagnostic Services 83 Research 85 Human & Clinical Anatomy Overview 90 Staff 91 Highlights of the Year 2008-2009 91 Teaching Programmes 92 Research 92 Medicine Overview 94 Staff 95 Highlights of the Year 2008-2009 96 Teaching Programmes 98 Clinical & Diagnostic Services 99 Research 101 Microbiology & Immunology Overview 110 Staff 111 Highlights of the Year 2008-2009 111 Teaching Programmes 112 Clinical & Diagnostic Services 113 Research 114 Nursing Services Directorate Overview 118 Staff 119 Highlights of the Year 2008-2009 120 Training Courses & CME Activities 122 Nutrition & Dietetics Overview 124 Staff 125 Activities in 2009 125 Training Programmes & CME Activities 126 Clinical & Diagnostic Services 127 Research 127 Obstetrics & Gynaecology Overview 130 Staff 131 Highlights of the Year 2008-2009 131 Teaching Programmes 132 Training Courses & CME Activities 132 Clinical & Diagnostic Services 132 Research 133 Ophthalmology Overview Staff 138 Highlights of the Year 2008-2009 139 Teaching Programmes 140 Training Courses & CME Activities 141 Clinical & Diagnostic Services 142 Research 144 Oral Health Overview 148 Staff 149 Highlights of the Year 2008-2009 149 Teaching Programmes 150 Clinical & Diagnostic Services 151 Research 151 Pathology Overview 154 Staff 155 Highlights of the Year 2008-2009 155 Teaching Programmes 156 Training Courses & CME Activities 158 Clinical & Diagnostic Servies 159 Research 160 Pharmacology & Clinical Pharmacy Overview 164 Staff 165 Highlights of the Year 2008-2009 165 Teaching Programme 166 Clinical & Diagnostic Services 167 Research 168 Pharmacy Overview 172 Staff 173 Highlights of the Year 2008-2009 173 Teaching Programmes 175 Research 200 Clinical &DiagnosticServices Training Courses &CME Activities Teaching Programmes Highlights oftheYear 2008-2009 Staff 207 Overview 206 Surgery Research 200 Clinical &DiagnosticServices Teaching Programmes Highlights oftheYear 2008-2009 Staff 197 Overview 196 Radiology &MolecularImaging Research 194 Clinical &DisgnosticServices Training Courses &CMEActivities Teaching Programmes Highlights oftheYear 2008-2009 Staff 191 Overview 190 Physiotherapy Research 185 Clinical &DiagnosticServices Training Courses &CMEActivities Teaching Programmes Highlights oftheYear 2008–2009 Staff 181 Overview 180 Physiology Research 178 Clinical Services 209 208 208 199 198 198 194 210 184 184 192 193 193 182 175 181

academic and patient care departments Accident & Emergency SUPPORT DEPARTMENTS

College Medical Library 214 Medical Education Unit 216 Sultan Qaboos University Medical Journal 221 Hospital Development & Quality Directorate 224 Information System Directorate 245 Medical Supply Directorate Patient Services Directorate 252 Public Relations & Information Directorate 229 Technical Affairs Directorate Training & Continuing Professional Development Directorate 234 Finance Department 240 Housing Department 242 Medical Records Department 248 Transport Department 262 APPENDICES

Appendix I Conferences & workshops organised by COMHS & SQUH in 2008-2009 264 Appendix II Curriculum information 265

Annual Report 2009-2010 Dean’s Message

t is my pleasure to present to you the report of the College of Medicine & Health Sciences for the academic year 2009-2010 and of Sultan Qaboos University Hospital for the calendar year 2010.

The College of Medicine was founded in 1986 and became the College of Medicine and Health Sciences I(CoMHS) in 2002 when the Nursing Program was added. From the beginning, the College and the Sultan Qaboos 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.

The College has a total of 75 faculty members including 14 Professors, 21 Associate Professors and 31 Assistant Professors. The CoMHS has grown and diversified, with well established programmes in the preclinical and clinical departments. Student intake is around 125 per year and the total student numbers around 1,100. The College runs an MSc programme in Biomedical Sciences and doctoral programmes are now approved in eight study areas.

The SQUH has 42 senior consultants and 61 consultants. It has had ISO 9001/2000 certification since 2005 is now implementing joint Commission International Accreditation and has introduced an electronic patient records system. SQUH and the CoMHS have state of the art laboratories and equipment.

Dr Mansour Al Moundhri

Dean College of Medicine & Health Sciences Sultan Qaboos University

2 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 and Tachievements during the year academic year 2009-2010 and the clinical calendar year 2010. Education In 2009-2010, the COM&HS admitted into the B.Sc. Health Sciences a total of 122 students of which 51% were female. Following successful completion of the B.Sc. Health Sciences degree, 130 students joined the MD programme in September 2009. A major contribution towards the training of B.Sc. Medical Laboratory Sciences students is also among the responsibilities of the COM&HS and SQUH, of whom 30 graduated in this year all of them female.

The College of Medicine and the University Hospital graduated a total of 107 medical doctors in 2009-2010. A total of 39 students have now graduated from the College’s Masters programme in Biomedical Sciences. 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 60 in 2009-2010. In this year, the University also sponsored 4 MD graduates for a 5–7 year residency and fellowship training programme abroad (usual destinations are Canada, USA, UK and Australia) and a total of 13 returned to Oman after such training.

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

Research and

In 2009-2010, the College undertook 109 research projects (more than double the number in 2009) to a total value of OR 1,205,121 (35% increase on 2009). In 2009-2010, staff of the College published a total of 277 research articles, 1 book and 1 book chapters. In the same period, College staff made a total of 291 conference and seminar presentations. Of these, 65 were international conference platform presentations and 52 university international poster presentations. Also 16 master’s theses were supervised (over 50% increase on 2009). The College and SQU Hospital organised 2 major conferences and 3 workshops in 2009-2010, some of them in cooperation with the Ministry of Health (see Appendix 1). qaboos

I ntroduction & E xecutive S ummary sultan

3 Clinical Activity The SQU Hospital saw further advances in the year 2010 with the continuation of the Joint Commission International (JCI) accreditation process. There was significant development and increase in the different clinical specialties and services with the opening of new specialties such as Orthopaedic surgery, Paediatric/ Neonatal surgery. By the end of 2010, the Hospital staff had increased to 2,400 (compared to 2,168 in 2009) comprising 408 doctors, 61 pharmacists, 509 administrative staff, 1,101 nurses and 321 technical staff.

Clinical activity at SQUH expanded in all areas in 2010. Outpatient visits increased to 378,131 compared 206,241 the previous year. The number of day care patients also increased to 8,907 compared to 8,786 in 2009. Inpatient admissions increased further to 28,524 surpassing the previous year’s figure of 25,592. The average length of stay decreased slightly to 5.0 days compared to 5.3 days in 2009. Finally, live newborn deliveries increased to 3,427 compared to 2,631 in 2009.

Dr. Kamlesh Bhargava,

,Chairperson, Annual Report Committee

Thanks are due for the preparation of this report to the following College staff:

Meriel Carboni, Vice-Chairperson , Annual Report Committee & Editor Dr. Jumana Saleh, Committe member Dr. Yaseen Al-Lawatia, Committe member Dr. Ahmed Al-Shukaily, Committe member Asma Al-Siyabi, Coordinator Taruna Dutt, Coordinator Amar Hussain, Graphic Designer & Photographer Sheherajoy Biruar, Assistant Graphic Designer

4 College of Medicine & Health Sciences 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, three Assis- tant Deans (Preclinical, Clinical and Research & Postgraduate Studies).

The College Board met 7 times during the academic year 2009-2010. The following key matters were discussed:

An overview of Research in the College Establishment of Core Laboratory Facilities Enhancing faculty research and career development Assessment Policy, Regulations and Guidelines Examination conduct General Foundation Program Guidelines for Appointment and Transfer of Omani doctors in the College Introduction of a Ph.D. Programme in the Clinical Departments of the College Knowledge-sharing Day on World Federation for Medical Education (WFME) Standards for accreditation hospital

Proposal for Admission Interviews to the College Proposal for Allied Health Sciences Programs and

Proposal for Bioethics Interim Committee Proposal for the establishment of a Medical Research Centre in the College Proposal to transfer the ownership of B.Sc. Medical Laboratory Sciences Degree Course from College of Sci- university

ence to College of Medicine, SQU Report of ad hoc Committee on Review of SQU Scholarships Bye-Laws as they affect MD Scholars Research and Postgraduate Retreat qaboos

O verview sultan

5 Annual Report 2009-2010 Overview

Research Cadre at Sultan Qaboos University Revised criteria for admission to College of Medicine Student Admission and Progression Regulations Superintendent Positions in the Colleges Working in College Laboratories after working hours

STAFF Dean Dr Mansour Al-Moundhri

Dean’s Office Sagar Hussain, Executive Assistant to the Dean Ahmed Al Wahaibi, Administrator, Dean’s Office Assistant Deans Dr. Omar Habbal, Preclinical Affairs Dr. Muna Al-Sadoon, Clincal Affairs Prof. Badreldin Ali, Postgraduate Studies & Research College Administration Badriyah Al-Hashar, Director of Administration Mahmoud Al-Abri, Assistant Director Ahmed Al Saadi, Administrator Zakiya Al-Omairi, Administrator Safaa Al-Harasy, Administrative Assistant Bakar Al-Hinai, Storekeeper Examinations Office Alphonsus Okoro, Examinations Officer Samson P, Coordinator Preclinical Affairs Muna Al-Alawi, Medical Education Office Zulfa Al-Busaidi, Administrative Officer for Student Academic Affairs Shabbir Patel, Coordinator

6 Clinical Elective Officer Dr. Mohammed Al-Azri, Clinical Elective Program Coordinator Salem Al Khaldi, Administrator, Elective Office Clinical Affairs Glorio Almeida, Coordinator, Clinical Affairs Research & Postgraduate Studies Asma Al Siaybi, Coordinator Support Staff Khalid Al-Hinai, Messenger Qassim Al-Salhi, Messenger Salem Al-Salhi, Photocopy Technician Hamed Bani Auraba, Driver EDUCATION PROGRAMMES Preclinical Programme – B.Sc. Health Sciences This is a four-year programme in general and basic medical sciences. The B.Sc. Health Sciences degree is awarded to students after successful completion of 120 credit hours at the end of semester 8 (see Appendi- ces). Students who wish to obtain the MD have to complete all course requirements for the B.Sc. Health Sci- ences before entering the clinical years. The student intake was 122 in September 2009. See http://www.squ. edu.om/medicine-health/tabid/2455/language/en- US/Default.aspx for details of the curriculum.

Clinical Programme This is a three-year clinical programme during which the knowledge acquired during the B.Sc. in Health Sci- ences degree is applied to the clinical practice of medicine. An MD degree is awarded upon completion of this hospital programme. See http://www.squ.edu.om/medicine-health/tabid/2455/language/en-US/Default.aspx for an and

overview of the MD programme.

Clinical Elective Programme An eight-week Elective Placement Programme is part of the second year of the Clinical Programme and is essential as one of the requirements to qualify for the MD degree. The programme provides students with university an opportunity to gain more experience and skills through working in a different environment mainly in a foreign country. This programme is sponsored by the University and different organisations locally and internationally. qaboos

O verview sultan

7 Annual Report 2009-2010 Overview

Internship Training Programme This consists of 3 rotations of 4 months each in General Medicine, Surgery and either Child Health or Obstet- rics/Gynaecology in hospitals approved for the purpose by the College of Medicine and Health Sciences. The programme involves not only SQU graduates but those of other medical programmes in Oman, and Omani medical graduates from institute abroad.

Postgraduate Studies The College introduced a two-year Masters Programme in Biomedical Sciences in 2001. It has the following eight specialisations: Biochemistry and Molecular Biology; Clinical Biochemistry; Clinical Pharmacy; Medical Microbiology; Epidemiology and Medical Statistics; Physiology; Radiology and Molecular Imaging, and Hu- man and Clinical Anatomy.

The College now offers the following 8 Ph.D. programmes: Biochemistry & Molecular Biology;

Medical Microbiology & Immunology; Epidemiology & Medical Statistics; Genetics; Pharmacology and Clini- cal Pharmacy; Physiology; Human & Clinical Anatomy; Radiology and 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 are to provide leadership in clinical, research and service endeavours and also boost the manpower resources of the Sultanate 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. Spe- cialty 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.

8 Sultan Qaboos University Hospital OVERVIEW Sultan Qaboos University Hospital (SQUH), with a total of 675 beds is the only teaching hospital in the Oman. It currently has 492 beds in use including the ambulatory service. The goals of SQUH include teaching of medical students from the College of Medicine & Health Sciences and Oman Medical Specialty Board (OMSB), research and promoting high quality specialised services.

During the year 2010, a number of developmental activities took place in the Hospital. It is worthy of note that the renal transplantation service which was stopped for a long time was reactivated and this year two Omani patients had successful kidney transplants from a donor. A total of 378,131 outpatients and over 28,524 inpatients were seen during the year. A total of 179 bone marrow transplants were also done. The increasing numbers of patients necessitated an increase in staff strength. The 2010 total staff strength was therefore 2,400 (compared to 2,168 in 2009) comprising 408 doctors, 61 pharmacists, 509 administrative staff, 1,101 nurses and 321 technical 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 Medical Advisory 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 at every meeting of the Hospital Board.

Similarly, the Hospital Board, comprising the top management team of the hospital and some senior officers in the hospital, also meets monthly during the academic year. Through the recurrent agenda items from the

Hospital Director-General’s office, the members are kept informed about important matters in hospital man- hospital agement and developments in patient related activities. and During the year under review, 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 budgetary con- straints. university Staff Ahmed Al-Mandhari, Hospital Director-General Hilal Al-Sabti, Deputy Director-General (Clinical Affairs) qaboos Ahmed Al-Kindi, Deputy Director-General (Administration & Finance) O verview sultan

9 Annual Report 2009-2010 Overview

Yusriya Al-Akbari, Deputy Director-General (Nursing Affairs) DEVELOPMENTAL ACTIVITIES Sultan Qaboos University Hospital is continuing the process of development and growth in order to fulfill its main aims which are health education, researches 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 continuous support of the University Administration.

PIONEER IN HEALTH CARE SERVICES By the end of 2010, the Hospital was opened at full capacity after the following developments:

- Significant development and increase in the different clinical specialties and services - 14 highly specialised doctors returned from their studies abroad in 2010. - Continuous professional development policy for doctors in fellowship and training - Purchase, commissioning, and installation of different types of new equipment like the following: - Digital Integrated Operating Room System - Replacement of X-ray systems in Radiology - Transport Ventilators - Non-Invasive Ventilator (Adult) - Gastrointestinal Videoscope System - Confugal Microscope (Confoscan 2) - Echocardiography System - Neuroendoscope A Complete System - Bedside Monitor for the Paediatric ICU - Upgrade and maintenance of the infrastructure of the wards and the Intensive Care Unit (ICU). MEDICAL SERVICES DEVELOPMENT The opening of new specialties such as Orthopaedic surgery, Paediatric/Neonatal surgery, and Neurosurgery has helped to achieve full operation of the hospital in terms of education, research and health care services. The following developments are worth highlighting:

- The opening of Breast Cancer Surgery unit and establishment of a multidisciplinary team for the care of breast cancer patients.

10 - The opening of an Ophthalmology Electrodiagnosis unit - The use of Cirrus High-Definition Optical Coherence Tomography (HD-OCT) equipment in the Ophthalmology department. - The use of the equipment for removal of birth marks in the Dermatology Clinic. - The use of new equipment in the treatment of acne and burns in the Dermatology Clinic - Use of endoscopic retrograde cholangio-pancreatography (ERCP) in the treatment of gallbladder and pancreas diseases. QUALIFIED HUMAN RESOURCES The Hospital Management believes in the training of Omani professionals abroad in order to achieve the goals of the hospital. Therefore, a total of 5–10 physicians are sent abroad yearly for higher education and fellowship training with 100 doctors having been sent to Canada, USA, Australia, and UK. Forty-five of these returned in previous years and 14 in 2010. Also, we have established and completed the CPD system for continuous professional development.

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.

FUTURE DEVELOPMENT Based on the Hospital’s aims and vision, the Hospital Development Committee plans to develop/update the current services through the following projects:

- Expansion of Radiology and Operating Room hospital

- New Haematology Centre building and - Expansion of the A & E building - Completion of the Medical Stores building Further into the future, the following projects are planned:

- Administration Building university

- Building a new Outpatients Department complex - Expanding the Central Sterile Supply Department qaboos

- Upgrading/expanding the Dialysis Unit O verview sultan

11 Annual Report 2009-2010 Overview

- Expanding the Intensive Care Unit. CLINICAL ACTIVITIES The increase in patient activities over the years has relied on strong commitment by all the medical, nursing, technical and administrative staff. The Hospital Management would like to acknowledge all their efforts towards continuous improvement. Such developments are unattainable without proper training; in-house and external training has witnessed yet further improvement during the year 2010.

The role of SQUH as a major Omani health service provider continued in this period with a total of 378,131 outpatients and over 28,524 inpatients seen during the year. A total of 179 bone marrow transplants were also done.

The number of day care patients was 8,907 compared to a higher figure of 8,786 recorded in the preceding year. This high 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 to 28,524 surpassing the previous year’s figure of 25,592. The average length of stay dropped encouragingly to 5.0 days compared to 5.3 days in 2009 reflecting continued efforts to deliver an efficient and fast high quality service compared to earlier years.

Finally, live newborn deliveries showed a significant increase to 3,427 compared to 2,631 in 2009. 380,000

230,000

210,000

190,000

170,000

150,000 Visitor

130,000

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90,000

70,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Figure 1: Outpatient activity

12 9000

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Figure 2: User of day care

9000

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Figure 3: Inpatient admissions

13 Annual Report 2009-2010 Overview

7.0

6.5

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5.5

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4.0

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3.0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

Figure 4: Length of inpatient stay

3500

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New Born Babies 1300

800 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Figure 5: New born deliveries Year

14 15 Annual Report 2009-2010 Accident & Emergency

he Accident and Emergency Department (ED) is a unique hospital environment because it is at the frontline of hospital medical patient care services. Its uniqueness also resides in its own primary existence – to provide emergency medical health care.

In the fulfillment of its mission, the ED strives to provide acute emergency care for all major medical and surgical emergencies, andT also acute minor emergencies, 24 hours a day, seven days a week all year round. While achieving this primary mission, the De- partment also attends to the health needs of people whose medical illnesses are not life threatening conditions, i.e. non-emergency cases.

In the effort to fulfill the vision of the Department to be a national model for the development of emergency medicine with the integration of international standards, diversified training and learning activities are organised for a wide range of healthcare professionals from within and outside the hospital. These include undergraduate and postgraduate medical and nursing students from Sultan Qaboos University Hospital (SQUH), Oman Medical Specialty Board (OMSB), medical staff of the Royal Court and Royal Affairs, the Ministry of Health, the Health Institute, the Royal Oman Police and students of the Oman Medical College in Sohar. In addition, the Department actively participates in the hospital and national planning of disaster management and research.

16 Ashraf Ali, Registrar Mohammed F. Khilji, Registrar Mohammed O. Mubashir, Registrar Khalid Al-Shibli, Registrar Asma Al- Balushi, Registrar Awatif Al-Alawi, Registrar Amal Al-Shibli, Registrar Suad Al-Abri, Registrar Sabina Naz, Registrar (Pediatric A & E) Umar Shahzad, Registrar Rasha Abdulhadi, Senior House Officer Mohammed Awais, Senior House Officer Vinod Abraham, Senior House Officer Aisha Al-Buraiki, Senior House Officer Aisha Al-Khamisi, Senior House Officer Nafisah Al-Borhan, Senior House Officer Nowfal Al-Sabri, Senior House Officer Reem Gaafar, Senior House Officer Magnus J. Rodrigues, Senior House Officer Mohammad S. Khan, Senior House Officer Bader Al-Amri, Senior House Officer Amal Al-Rashdi, Senior House Officer Staff Nursing Staff (Total 64) CN1 - 3 Acting Head of Department CN2 - 2 Khalfan Al-Amrani, Consultant CN3 - 2 departments CN4 - 3 Medical Staff Staff Nurse 1 (SN1) - 4 Nabil Al-Zadjali, Senior Consultant care

Staff Nurse 2 (SN2) - 48 Daniel O. Ogunjumo, Senior Consultant Abdullah Al- Reesi, Consultant Support Staff (Total 19) Magdy Shehata, Acting Consultant Ayida Al-Hadhrami, Coordinator patient

Moustafa Ashoor, Senior Registrar Mercy Gandhirajan, Coordinator Teodorico T. Diputado, Registrar Sabeel Al-Zadjali, Ambulance Attendant and Remanand Sudhir, Registrar Florenda Sicat, Emergency Medical Technician Sabah Awad, Registrar (Ambulance) academic accident & emergency

17 Annual Report 2009-2010 Accident & Emergency

Nino Arceo, Emergency Medical Technician (Ambulance) Ahmad Al-Shaqsi, Emergency Medical Technician Fahad Al-Abri, Emergency Medical Technician Medical Record Clerks – 2 Medical Orderlies – 12 Highlights of the Year 2009-2010 SQUH AWARD The Department was honoured in the Hospital Day Celebrations by being ranked third among SQUH departments for providing quality health services to patients according to international quality standards. This is a recognition of the Department’s efforts to be at the forefront of many hospital activities.

RE-ALIGNMENT OF EMERGENCY DEPARTMENT RESOURCES In addition to the structural modifications made in 2008–2009 to speed up patient flow, increase patient comfort and improve staff efficacy, a consultants’ office was created with a small library of the most recent medical reference books.

Medical staff work was re-aligned to speed up triaging and prevent patient overcrowding. A doctor was as- signed to triage on every shift except the night shift. This doctor separates emergency from non-emergency patients and deals with non-emergency cases by rapid treatment, as well as initiating radio-imaging studies for non life-threatening injuries. He/she also explains laboratory or imaging results to patients and relatives. If the doctor cannot resolve triage problems, he/she consults the shift medical leader for final patient disposi- tion.

A revised patient triage strategy was implemented to triage patients with minor emergencies and refer them to health centres. The Department drew up a list of patient symptoms which can be safely deferred to local health centres. This list is displayed in the A & E entrance for all patients to see. Treatments of medical symptoms outside this list are the responsibility of the triage nurse and doctor.

IMPROVE TEACHING ASSESSMENT FOR 6TH YEAR STUDENTS The senior medical teaching staff of the Department (consultants, senior registrars and board certified registrars) designed more objective evaluation forms for the assessment of knowledge and skills of 6th year medical students during their emergency medicine rotation.

The guidelines for the content and process of tutorials and workshops conducted for 6th year medical students were updated

18 The guidelines cover the approach to the assessment and management of undifferentiated chest pain, shortness of breath, multiple trauma, poisoning, wounds, and cardio-respiratory arrest and pre-arrest conditions in the ED. This is to ensure current evidence-based, adequate and effective coverage of the core contents of the curriculum by the members of staff participating in the teaching programme.

DISASTERS The Department participated in two disasters drills with Muscat International Airport. Subsequently, the Department revised its own disaster plan assigning specific tasks and activities to its medical and nursing man-power resources. This disaster plan is part of the master disaster plan adopted by the hospitals in the Muscat region.

During the A H1N1 pandemic in autumn 2009, Oman shared its responsibility of treating and preventing the disease and SQUH played an active role in this endeavour. The ED was at the forefront of fighting and containing the disease. It provided treatment on an outpatient basis, identified potential cases and informed the concerned medical or pediatric specialties. The Department worked closely with the laboratory, the infectious disease consultant, the infectious disease nurse and the Ministry of Health to contain this epidemic. The Department took careful patient histories, outlined the signs and symptoms of H1N1, sent swabs to con- firm the disease, initiated Tamiflu treatment in the Department, reported suspected cases to the concerned authorities and followed up the results of laboratory confirmation of H1N1.

Standby medical and nursing personnel coverage was provided by the ED at the time of the Phet cyclone in June 2010. They stayed on the campus in case the need for rapid deployment arose.

ACQUISITION OF NEW EQUIPMENT New equipment was acquired to improve patient care including new adjustable beds, equipment for ENT and Dental Care and two new defibrillators. ENT and Dental specialties were allocated a room adjacent to the trauma area to provide more focused initial emergency care with appropriate instruments and commonly departments used emergency medications. care Teaching Programmes

UNDERGRADUATE CLINICAL PROGRAMMES patient

Clinical Skills Course for 5th year medical students and The Department continues to coordinate and participate in the teaching of the clinical skills course for 5th year medical students. The course is held in the Training and Staff Development (TSD) centre of SQUH and academic A ccident & E mergency

19 Annual Report 2009-2010 Accident & Emergency

involves lectures and hands-on practice in intravenous techniques, basic life support, monitoring, electrical therapy with manual and automated external defibrillators, and aseptic techniques. The ED staff conducts the basic life support, monitoring and electrical therapy aspects of the course four times a year. The course director evaluates the course periodically.

Emergency Medicine for 6th year medical students. The Department receives 6th year students in batches of 16 to 18 every 4 weeks commencing from August to April/May of the following year. Each batch is divided into 4 groups and rotates through the emergency departments of SQUH, the Royal Hospital, and Khoula Hospital. The students are taught and supervised by the consultants, senior registrars and the resident doctors in the various hospitals.

In addition to bed-side teaching, manual skill laboratory sessions in wound care, basic life support, recognition and treatment of dynamic arrhythmias and defibrillator use are conducted in SQUH for each batch of students. The teaching is done by the emergency medicine consultants, assisted occasionally by registrars and senior registrars. Problem-based tutorials on common and potentially life-threatening complaints in the ED e.g. chest pain, multiple trauma, poisoning and shortness of breath, are conducted every week by the consultants assisted occasionally by registrars and senior registrars.

Student performance is assessed by the tutors during the workshops, tutorials, bed-side teaching, and at the end of the posting, with a one-hour multiple choice questions examination which covers the core contents of the curriculum. This is to ensure that they have a correct understanding of the basic principles of the sound practice of emergency medicine.

POSTGRADUATE PROGRAMME Intern Teaching and Training All interns rotate through the ED for one month during their postings to the Surgery Department, and some of them are also posted to the ED during their Paediatric Department rotation. An orientation hand-out guides the interns during the posting. In addition to bed-side teaching, they are taught during the departmental CME sessions.

Resident Teaching and Training The residents undergoing the training programmes of the OMSB in Emergency Medicine, Family and Com- munity Medicine and Surgery rotate through the Department at various periods of their training. They are taught on daily basis by the consultants and registrars during the course of their clinical duties. In addition, they are taught during the 4 hour weekly academic activities in which all the consultants actively participate, and through the various workshops and monthly journal clubs organised by the OMSB. The clinical du-

20 ties for these residents not only expose them to clinical aspects of real emergency situations, but also equip them in real time with skills to provide treatment, based on protocols and evidence-based medicine.

Clinical Electives The Department welcomes overseas elective medical student trainees and organises training programmes for them. The ED received eight trainees during this period.

Clinical Attachment The Department also accommodates medical foreign graduates for clinical attachments. Doctors came from

Sudan (2), India (1) and Pakistan (2) between January and July 2010. TRAINING COURSES & CME ACTIVITIES

Advanced Cardiovascular Life Support (ACLS) Courses One of the ED consultants is the director of the ACLS Courses in which the Department participates actively. The course is held bi-monthly between October and June or August of the following year. The course participants include all interns, key hospital and nursing staff in the University, the Ministry of Health, the Royal Court and Royal Affairs and some private hospitals. Recertification courses are conducted twice a year.

Departmental CME Activities/Workshops CME activities are organised in the Department every two weeks. These include case discussions, mortality and morbidity reviews, journal club sessions, and presentation and discussion of various topics relevant to the practice of emergency medicine. Formulations of protocols with regards to treatment of various life threatening diseases presenting to the ED are also discussed. All the doctors working in the Department participate in the activities. departments Several workshops were conducted for all staff whilst the ED was closed closure for maintenance work. These workshops mainly served to refresh and update the medical staff on the basic and advanced skills which care

every casualty health care provider must acquire, i.e. ACLS, wound lab, principles of casting, etc. patient

and

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21 Annual Report 2009-2010 Accident & Emergency

Clinical & Diagnostic Services A & E Monthly Statistic from Jan 2010 to Dec 2010 Category Jan Feb Mar Apr May Jun Ju Aug Sep Oct Nov Dec Total B 15 24 21 27 11 28 17 12 21 21 24 23 244 R 79 104 108 76 54 64 73 75 70 113 92 76 984 Y 3496 2933 3320 3163 1694 2666 2731 2902 2910 2808 2546 2809 33978 G 1752 1520 1580 1490 627 878 1006 997 1103 1559 1575 1717 15804 W 340 360 475 402 322 516 741 603 760 988 920 1155 7582 F/U 274 300 340 311 159 169 213 275 300 297 323 306 3267 Total 5956 5241 5844 5469 2867 4321 4781 4864 5164 5786 5480 6086 61859 FT 576 705 719 693 45 ------SSU 317 306 277 269 85 191 199 218 267 299 218 286 2932 DEF 444 340 475 447 402 568 652 226 672 837 837 963 6863 LWBS 259 181 205 181 27 48 51 73 95 111 113 204 1548 ADM 849 751 735 709 459 707 802 800 767 864 1012 861 9316 TRANS 27 30 27 33 13 20 44 32 12 19 11 11 279 DOA 4 14 8 19 7 19 9 4 10 13 14 14 135 DAA 0 0 0 0 0 1 0 1 25 1 1 0 29 SCD 599 550 607 641 415 685 583 606 611 740 630 547 7214 RTA 169 130 114 137 69 85 90 154 210 190 170 178 1696 ADULTS 4324 3924 4464 4170 2263 3386 3617 3750 3888 4333 3879 4277 46275 PEDS 1632 1317 1380 1299 604 935 1164 1114 1276 1453 1601 1809 15584 Ambulatory Activities Ward 25 52 21 19 13 24 33 28 20 24 27 20 306 A/E 18 20 27 40 9 31 25 20 13 15 7 11 236 Airport 8 7 7 3 2 2 5 4 6 3 2 3 52 Campus 5 3 5 3 0 3 1 1 2 4 5 3 35 Total 56 82 60 65 24 60 64 53 41 46 41 37 629 TOTAL PATIENTS IN 2010 (JAN to DEC 2010) = 61,859 Legend:

B = Blue category patients; R = Red category patients; Y = Yellow category patients; G = Green category patients; W = White category patients; F/U = Follow-up patients; FT = Fast track; SSU = 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

22 The highlights of the statistical data are as follows. A total of 61,859 patients were seen in 2010 as compared with 62,601 seen in 2009 (a decrease of 1.2%). The majority of the patients were in the yellow (urgent) category which means serious but non-life-threatening emergency cases. This group constituted 54.9% of the total number of cases. A total of 15.1 % of the patients seen were admitted, and 0.5 % of the patients seen were transferred to other hospitals.

In addition to the care of the acutely ill and injured patients, consultants conducted daily review clinics. Most of the patients reviewed sustained musculo-skeletal injuries, while some attended with other acute or sub- acute disorders which required close monitoring and follow-up.

The SQUH trauma team, which was established two years ago continues to operate under the leadership of the two trauma consultants. This has enhanced and improved the care of trauma victims and the education and training of the ED physicians in the management of trauma. This has also facilitated the rapid turnover of trauma cases in the Department.

The Department is also responsible for the recovery and care of emergencies on the University Campus, and also provides emergency coverage for sporting and other activities.

Research Under the Directive of Dr. Abdullah Reesi, a trained specialist in research, some research projects were planned and commenced by OMSB residents and some members of staff. These included studies of the H1N1 viral out break; myocardial infarction and injuries, and the combination of intravenous paracetamol and morphine in the management of renal colic. Work continues on the A H1N1 Data Base Review and Outcomes by Dr. Abdullah Al Reesi and Dr. Remanand Sudhir.

RESEARCH PROJECTS departments

H1N1 Swine Flu Data Base Review and Outcome Project Code: MREC# 340; Dates: 2010 care Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Remanand Sudhir, Dept. Emergency, SQU. patient RESEARCH PUBLICATIONS & BOOKS and

Journal Publications 1. Al-Zadjali N, Al-Senawi R, Al-Reesi A, Al-Zakwani I, Nemeth J, Perry JJ. Predictors of positive chest radiography in non-traumatic chest in the Emergency Department. Oman Med J 2009; 24:22. academic A ccident & E mergency

23 Annual Report 2009-2010 Accident & Emergency

CONFERENCE & SEMINAR PRESENTATIONS Poster presentations National 1. Al Hajri N. Comparison between visual reading of urine dipstick and an automated analyzer in the Emergency De- partment. OMSB 1st Annual Research Day, Muscat, Oman, 2010. Seminar Presentations National 1. Al Hinai N. Comparison between point of care Troponin T and Troponin I in Diagnosing ACS in the Emergency Department. OMSB 1st Annual Research Day, Muscat, Oman, 2010.

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25 Annual Report 2009-2010 Anaesthesia, ICU and Pain Management

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, managing critically ill patients. The Department provides twenty-four hour elective and emergency anaesthesia services to the entire hospital, including referrals from other health institutions. We manage a 25T bed Intensive Care Unit. 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 departmental functions with acute and chronic pain management services. Cardiopulmonary resuscitation is a significant function of this Department and now cardiothoracic anaesthesia has also been added. The Department forms a solid part of SQUH Trauma and Disaster management services.

The pre-Anaesthesia Assessment Clinic (PAC) has been fully functional since March 2009. Patients who have to undergo surgery are assessed here for surgical fitness at the Out Patient Department (OPD) level. This was initiated with the main aim of reducing inpatient cancellations—a key factor in improving hospital efficiency. The clinic is being run Saturday to Wednesday from 8 am to 2 pm.

26 Pradeep K. Sharma, Senior Registrar Jyoti Burad, Registrar Aravind Narayanan, Registrar Devaraj N. Dyamanna, Registrar Hatem Abd El Ghany, Registrar Amr A.H. Sewan, Registrar Qutaiba Tawfiq, Registrar P. Madhanagopal, Registrar Ahmed Khamis, Registrar Ali S. Faris, Senior House Officer Hussain Hamdan, Senior House Officer Ajai K. Arora, Senior House Officer Prasad Fonseka, Senior House Officer Vishnu Prasad, Senior House Officer Khadija Al-Abri, Senior House Officer Zainab Al-Breiki, Senior House Officer Zahra G. Ahmed, Senior House Officer Support Staff Leena Chacko, Coordinator Ibrahim Al-Farsi, Coordinator Mohammed Al-Badi, Technician Maheswariamma, Technician Staff Highlights of the Year Medical Staff Karin Nollain, Senior Consultant 2009-2010 departments Suresh Chengode, Senior Consultant The annual Scientific Session of the Oman Soci- Ram Narayan Rao, Consultant ety of Anaesthesia and Critical Care was held in care

Sinnakirouchenan, Consultant December 2009 at Sultan Qaboos University. Dr. Rajini Kausalya, Consultant Rajini Kausalya, Dr. Amarnath Shetty, Dr. Sinna- Ali Al-Abady, Consultant kirouchenan, Dr. Mohamed Al Ismaili and Dr. Pra-

Nasser Al-Kemyani, Consultant dipta Bhakta all acted as moderators. The theme patient

Mohammed Al-Ismaili, Consultant of the Session was “Anticoagulation and Regional

Jaswinder Sharma, Senior Registrar Anaesthesia”. and

Binoy Zachariah, Senior Registrar Pradipta Bhakta, Senior Registrar The Department organised 2 workshops on Ultra- academic anaesthesia, icu & pain management

27 Annual Report 2009-2010 Anaesthesia, ICU and Pain Management

sound in Anaesthesia and Critical Care along with the Anaesthesia Department of Royal Hospital. The workshops were held at Sultan Qaboos University in May and December 2009 respectively. Both the workshops were facilitated by international faculty. The response was very positive and both workshops were very successful.

The Department also participated in the Quality Day, which was held in SQUH in March 2010, presenting posters related to the Pain Management and the Pre-anaesthesia clinic.

NEW SERVICES The Department is proud to have introduced the new service of performing peripheral nerve blocks and vascular access under ultrasound guidance. The new ultrasound machine, which corporates the latest in portable ultrasound technology for clinical applications, has been a boon for the Department and has made it possible for this latest service to be initiated in the department. This machine is also going to be effectively put to use in the Intensive Care Unit for haemodynamic measurements and transthoracic echocardiogram.

NEW SUB-SPECIALTY In this period, anaesthesia for paediatric and neurological surgeries with postoperative intensive care monitoring started its services which are now fully operational.

Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME The 6th year medical students carry out a compulsory two week rotation in the Department participating in the clinical activities. Students are given ‘hands-on’ experience, on both manikins as well as patients, under the close supervision of anaesthesiologists. This is in order to witness and learn airway management, endotracheal intubation, intravenous cannulation, fluid management and monitoring of the anaesthetised patient. The tutorials are aimed at making the student understand the use of airway adjuncts, respiratory equipment, central venous and arterial cannulation, regional blocks, and drugs used in anaesthesia and cardiopulmonary resuscitation. The main topics of these lectures are pre-anaesthetic evaluation; management of patients under anaesthesia; postoperative pain relief; the pharmacology of anaesthetic drugs; acid base and electrolyte disorders, and hypovolemic shock. The lecture is given by senior doctors in the department on a rotation basis followed by a 30 minute case discussion.

28 POSTGRADUATE PROGRAMME Oman Medical Specialty Board (OMSB) A 4-year residency programme in anaesthesia was started in September 2007 under the OMSB. Two residents were enrolled in this programme. An exit examination is planned at the end of 4 years; after the successful completion, the residents would do a further year of specialised training. The Department is actively involved in developing the curriculum, accreditation and examination processes for this programme

TRAINING COURSES & CME ACTIVITIES The Department is actively involved in the teaching of training courses organised by the SQUH Training Directorate. These include the Advanced Cardiac Life Support (ACLS) provider course, ACLS recertification course, Basic Life support (BLS) provider course, BLS recertification course, AED (Accident & Emergency Dept) course and the Pain Management course. Every Saturday 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 beneficial to the staff. Residents are encouraged to attend. Members of the Department are also part of OSAAC which is involved in regular CME activities and scientific sessions.

Clinical & Diagnostic Services A total of 5,591 anaesthetic procedures were carried out in 2010 compared to 4,761 in 2009 and 4,056 in 2008.

Emergency Elective Total

448 441 430 420 412 410 398 393 384 386 379 364 356 366 340 340 344 342 departments 328 324 304 309 306 600 care

251 500

400 No. of Patients No. patient

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Figure 1: Anaesthesia200 Statistics 2010 98 and 84 75 36 66 69 64 55 62 54 100 39 44

0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec academic A naesthesia, ICU & P ain M anagement

29 Annual Report 2009-2010 Anaesthesia, ICU and Pain Management

Research RESEARCH PROJECTS Sickle Cell Disease in Adult Patients and Intensive Care Management- A 5 Year Retrospective Study in the ICU of SQUH Project Code: MREC# 348; Dates: 2010 Value: Unfunded; Project approval: Sultan Qaboos University Investigators: Dr. Qutaibah Tawfic, Dept. Anaesthesia, SQU RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Mishra P, Bhakta P, Janakiraman R, Darlong V. Intra-operative epidural catheter migration into subarachonoid space leading to massive subarachonoid injection of morphine-a case report. Middle East J Anaesthesiol 2009; 20:469−71. 2. Tawfic QA, Mishra P, Bhakta P, Kausalya R, Narayanan A. Missed congenital glottis web may mimic subglottic ste- nosis in a child. Eur J Anaesthesiol 2009; 27:217−9. 3. Bhakta P, Mishra P, Tawfic QA. Psychomimetic reaction after use of propofol in day care surgery: report of two cases. Middle East J Anaesthesiol 2010; 20:599−601. 4. Dyamanna DN, Bhakta P, Chouhan RS, Al Azri F. Anaesthetic management of a patient with pituitary adenoma for caesarean section. Int J Obstet Anaesth 2010; 19:460−1. 5. Tawfic QA, Bhakta P, Kumar S. Letter re Controlled hypotension for middle ear surgery: a comparison between remi- fentanil and magnesium sulphate. Br J Anaesth 2009; 103:247−9. 6. Tawfic QA, Bhakta P, Kausalya R. Unexpected cause of oesophageal obstruction due to accidental use of traditional medicine in a critically ill patient fed through naso-gastric tube. Ind J Crit Care Med 2010; 14:160–1. 7. Sharma D, Bithal PK, Dash HH, Chouhan RS, Sookplung P, Vavilala MS. Cerebral autoregulation and CO2 reactivity before and after elective supratentorial tumor resection. J Neurosurg Anesthesiol 2010; 22:132−7. 8. Kumar R, Goyal V, Chouhan RS. Venous air embolism during micro-electrode recording in deep brain stimulation surgery in an awake supine patient. Br J Neurosurg 2009; 23:446−8. CONFERENCE & SEMINAR PRESENTATIONS Conference presentations International 1. Chengode S. Intra operative transeosophageal echocardiography workshop. 3rd National Workshop on Intraopera- tive Transoesophageal Echocardiography. Bangalore, India, October 2009.

30 2. Chengode S. Ischemic mitral regurgitation. Where do we stand in 2010? 13th National Conference of Indian Associa- tion of Cardiac Vascular & Thoracic Anaesthesiologists. Kolkata, India, February 2010. 3. Chengode S. Basic TEE workshop - TEE in congenital heart diseases. 13th National Conference of Indian Association of Cardiac Vascular & Thoracic Anaesthesiologists. Kolkata, India, February 2010. National 1. Chengode S. Cardiac patient for non-cardiac surgery. 3rd International Conference and Annual Meeting of Oman Society of Anaesthesia and Critical Care. Muscat, Oman, November 2009. 2. Kausalya R. Medical errors. 2nd International Conference on Quality Management in Health Care. SQUH, Muscat, February 2010. SEMINAR PRESENTATIONS International 1. Chengode S. Haemodynamic calculations in TEE. 3rd National on Intraoperative Transoesophageal Echocardiogra- phy Workshop. Bangalore, India, October 2009. departments

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31 Annual Report 2009-2010 Behavioural Medicine

he Department of Behavioural Medicine’s mission is to promote excellence in research, development and teaching of psychiatry, psychology and its allied subjects and to apply and disseminate this knowledge with the aim of preventing mental disorders and developing treatment for the relief of suffering. The Department is both an academic preclinical and clinical department, responsible for teaching behavioural sciences and participates in teaching communication skills to preclinical students and psychia- tryT to clinical students. The Department endeavours to develop a learning culture of direct relevance to the psychiatric needs of the Omani population and develop in its students a professional, non-judgemental attitude towards psychiatric patients and society. It also provides both outpatient and inpatient services for psychiatric patients in SQU Hospital as well as liaising with other clinical departments for the provision of multidisciplinary care.

The main focus of our research interests and programme are the magnitude, culture-specific expressions and prevention of mental illnesses, which are most common among people living in Oman. The Department publishes contributions on various aspects of behavioural medicine in medical literature. Our research interests include all aspects of psychiatry, eating disorders, psychological aspects of specific physical health disorders, cognitive functions and genetics of schizophrenia, obsessive-compulsive disorder, bereavement, deliberate self-harm, alcohol misuse, epidemiology of mental disorders, presenting symptoms of schizophrenia, brain imaging in acute psychosis, somatic symptoms as a presenting symptoms in depression and psychiatric problems in childhood.

32 Harith Ghassany, Assistant Professor Claire Hallas, Assistant Professor Rodger Martin, Senior Consultant Amre El Guenedi, Consultant Ahmed S. Amer, Senior Registrar Hamed Al-Sinawi, Senior Registrar Yousif A. Obeid, Senior Registrar Aziz Al-Naamani, Registrar Nonna Viernes, Registrar Amaal Ambusaidi, Senior House Officer Amira Al-Hosni, Senior House Officer Ibrahim Elzein, Senior House Officer Support Staff Basma Al-Said, Mental Health Counsellor Zena M. Al-Sharbati, Clinical Psychologist Samira Al-Hamdan, Psychologist Salwa Al-Redha, Psychologist Hazar A. Al-Zadjali, Assistant Psychologist Abdullah Al-Sulaimani, Social Worker Ahmed Al-Salmi, Social Worker Khamis Al-Balushi, Social Worker Khoula Al-Wahaibi, Social Worker The Department supports the Royal Oman Police, Younis Al-Hashim, Social Worker the Ministry of Health and other organisations by Ravindran Kozhapatil, Coordinator providing its expertise in promoting mental health Govindan Mundayadan, Coordinator services in Oman and in the field of forensic psy- departments chiatry, alcohol and drug dependence problems and Highlights of the specialist psychotherapy services. care

Year 2009-2010 Staff The year 2009-2010 witnessed enormous growth and expansion in the Department. The psychiat-

Faculty ric residency programme, implemented in con- patient

Ala’Aldin Al-Hussaini, Professor junction with the Oman Medical Specialty Board

(OMSB), has also seen substantial development. and Samir Al-Adawi, Professor Marwan Al-Sharbati, Associate Professor In line with changes in medical education, the De- academic behavioural medicine

33 Annual Report 2009-2010 Behavioural Medicine

partment join with other College departments in running the clinical communication skills course as well as coordinating with other departments in interdisciplinary activities.

The Department was involved in national and international research collaborations and published a number of papers on various aspects of behavioural medicine, psychiatry, psychology and allied fields, for example: cross-cultural differences in morbid body preference; hazardous and harming drinking patterns in Oman; medical education and child psychiatry. In the Departmental database, much research has been amassed on topics such as how distress is experienced in Oman; psychological aspects of cardio-thoracic disease and surgery; cognitive functions of schizophrenic patients; genetics of schizophrenia and obsessive-compulsive disorders and adjustment difficulties and developmental disorders among infants, children and adolescents.

Teaching Programmes The Department offered the following two courses: Behavioural Sciences I; Behavioural Sciences II. The number of students for each of these courses was approximately 120. A clinical attachment in psychiatry with a rotation of 8 weeks was also run. The Department participates with other departments in the College in coordinating the clinical communication skills course. The number of students was approximately 98.

UNDERGRADUATE PRECLINICAL PROGRAMME The Department’s policy is to make learning student-centred as far as possible. Accordingly, the lectures, seminars and tutorials for preclinical students are of an interactive nature, designed to encourage participation in interactive learning. The Department conducts two inter-related courses of behavioural sciences. The first course focuses on socio-cultural roots of disease concept, doctor-patient relationship and other cultural issues relevant to the understanding of mental illness. The second concentrates on factors associated with individual differences: applied behavioural medicine as relevant to the promotion of health; clinical communication; cultural specific idioms of distress; personality and its development, and speech and language development.

UNDERGRADUATE CLINICAL PROGRAMME The interactive, student-centred approach of the Department is adopted even more strongly for teaching clinical students. During the rotation, our medical students are encouraged to develop skills in interviewing patients and their families, interpreting diagnostic tests, planning multidisciplinary treatment, developing behavioural interventions, and administering pharmacological treatment as well as acquiring basic skills in using psychotherapeutic modalities. Students are also encouraged to participate actively in clinical case presentations of common psychiatric problems.

The main thrust of psychiatry teaching is to equip future Omani doctors with the ability to prevent, diagnose

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OUTPATIENTS 12013 12783 14605 IN-PATIENTS 242 350 305 Statistics In & Outpatients Clinic (2008-2010)

and treat various mental illnesses in the community at large and to expose our students to empirical evidence that distress, disease and treatment are experienced in the context of cultural and social processes and also to introduce the idea of integrating mental health in primary care. The academic component includes a regular seminar in therapeutic skills of teaching and consultation; teaching on current issues in psychiatry; developmental psychology; psychological assessments; personality; bereavement; cross-cultural psychiatry; eclectic approaches to psychological intervention, and behavioural medicine. 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. departments 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 medi- care cine is being developed which has its primary focus within the pre-clerkship and junior clerkship training although it will be a contributing theme throughout the senior clerkship and junior internship phases. Be- havioural Medicine will be contributing specific lectures, case studies and training in the pre-clerkship stage

on the topics of clinical assessment (young people, working adults and older adults); vulnerability for mental patient 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 clin- and ical 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 academic B ehavioural M edicine

35 Annual Report 2009-2010 Behavioural Medicine

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.

POSTGRADUATE PROGRAMME The Department continued in this period to train Family and Community Medicine residents and contributed to revising 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 Oman which provides for specialist tertiary referrals. It has a multidisciplinary team approach designed for optimum treatment of patients and training of medical students. The Department has a support staff of psychologists, nurses, social workers and other clinicians.

A wide range of assessments and treatments including IQ and personality testing, neuropsychological tests, and various models of psychotherapy are offered. The Department also offers comprehensive liaison psychiatry with other branches of medicine as well as psychosocial intervention and various social work services. The Department offers unique clinical and diagnostic services. The assessments provided by our staff em- ploy specialised testing procedures to integrate medical, neurological, and behavioural data with 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 between functional and organic syndromes (e.g. depression versus dementia); b) delineation of spared and impaired cognitive functions secondary to central nervous system dysfunction; c) establishment of behavioural baseline measures to monitor recovery or progression of central nervous system dysfunction; d) comparison of pre- and post-pharmacological states, surgical, and behavioural interventions; e) assessment of cognitive/behavioural functions for the formulation of rehabilitation, management strategies, and/or educational or employment placement, and f) evaluation of neurocognitive status for the purpose of tests for disability, compensation and liability determinations in forensic cases.

36 Research RESEARCH PROJECTS Expatriate Doctors working in the Omani Health Care Sectors and Omanization Project Code: MREC # 318; Dates:2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Samir Al Adawi, Dept. Behavioural Medicine, SQU.

Prevalence of Anxiety & Depression among Patients with epilepsy at a tertiary care hospital in Oman Project Code: MREC # 329; Dates:2009 Value: Unfunded; Project Approval: Sultan Qaboos University

Investigators: Dr. Samir Al Adawi, Dept. Behavioural Medicine, SQU.

Determining the Culturally Specific Symptom Constellation of Posttraumatic Stress Disorder among Omani Project Code: MREC # 333; Dates:2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Samir Al Adawi, Dept. Behavioural Medicine, SQU.

The Ethics of Veracity in Health Care Project Code: MREC # 350; Dates:2010 Value: Unfunded; Project Approval: Sultan Qaboos University departments Investigators: Dr. Ahmed Amer, Dept. Behavioural Medicine, SQU.

RESEARCH PUBLICATIONS AND BOOKS care

Journal Publications 1. Al-Sharbati MM, Zaidan ZA, Dorvlo AS, Al-Adawi S. Characteristics of ADHD disorder among omani schoolchildren patient

using DSM-IV: Descriptive study. J Atten Disord (Epub ahead of print) 13 Jan 2010. 2. Al Farsi YM, Al-Sharbati MM, Al-Farsi OA, Al-Shafaee MS, Brooks DR, Waly MI. Brief report: Prevalence of autistic and spectrum disorders in the Sultanate of Oman. J Autism Dev Disord 2010; (Epub ahead of print) 31 Aug 2010. 3. Al-Adawi S, Al-Zakwani I, Obeid YA, Zaidan ZA. Neurocognitive functioning in women presenting with undifferen- academic B ehavioural M edicine

37 Annual Report 2009-2010 Behavioural Medicine

tiated somatoform disorders in Oman. Psychiatry Clin Neurosci 2010; 64:555–64. 4. El Shafie K, Al-Shaqsi A, Al-Mahrouqi B, Al-Lawati H, Ganguly SS,Al-Adawi S, Al-Shafaee M. The diagnostic yield of thyroid function tests and their cost-effectiveness in the Student Clinic at Sultan Qaboos University: Retrospective chart review. SQU Med J 2010; 10:215–20. 5. Sadowsky C, Whiting H, Pai S, Recio A, Becker D, Houdayer T, Al-Adawi S. Prevalence and risk factors for osteoporosis in individuals with paralysis. J Clin Densitom 2009; 12:388–9. 6. Al-Adawi S, Ali BH. West is West, East is East: The divide in science. Saudi Med J 2010; 31:1093–4. 7. Hallas CN, Burke JL, White DG, Connelly DT. A prospective one year study of changes in neuropsychological function following implantable cardioverter defibrillator surgery. Circ Arrhythm Electrophysiol 2010; 3:170–7. 8. Hallas CN, Burke JL, White DG, Connelly DT. Pre-ICD illness beliefs affect post-implant perceptions of control and patient-quality of life. Pacing Clin Electrophysiol 2010; 33:256–65. 9. Hallas CN, Wray J, Andreou P, Banner NR. Depression and perceptions of heart failure predict the quality of life of people with advanced heart failure. J Heart Lung Transplant 2010; doi:10.1016/j.hrtlng. 2009.12.008. 10. Hallas CN, Howard C, Wray J, Carby M. Understanding panic disorder in chronic respiratory disease. Br J Nurs 2009; 18:527–9. 11. Hallas CN, Wray J, Banner NR. A qualitative study of the psychological experience of patients during and after mechanical cardiac support. J Cardiovasc Nurs 2009; 24:31–9. 12. Howard C, Hallas CN, Wray J, Carby M. The relationship between illness perceptions, anxiety and panic in chronic obstructive pulmonary disease. Behav Res Ther 2009; 47:71–6. 13. Sharbati M, Al-Zaidi R, Al-Naamani R, Al-Futaisi A, Jain R. A rare presentation of attention deficit/hyperactivity disorder. SQU Med J 2010; 10:84–8. Book Chapters 1. Hallas CN. What are the roles of a health psychologist in clinical practice? Defining knowledge, skills and competen- cies. In: Forshaw M, Sheffield D, Eds. Health Psychology in Action. London: Wiley-Blackwell, 2010. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Al-Sharbati M. The ADHD preschoolers: when to treat by psycho-pharmacotherapy, and how? Medical Home, An Innovative Approach to ADHD. Riyadh, Saudi Arabia, 7–11 November 2009. 2. Al-Farsi Y, Wali M, Al-Shafie M, Al-Sharbati M. The prevalence of stunting, underweight, and wasting among autistic children in Oman. IMFAR Meeting. Pennsylvania,USA, 20–22 May 2010. 3. Wali M, Al-Farsi Y, Al-Shafie M,Al-Sharbati M. Measurement of reduced, oxidized and total glutathion levels in the sera of autistic children in Oman. IMFAR Meeting. Pennsylvania, USA, 20–22 May 2010.

38 4. Al-Sharbati M. Studies concerning preschoolers suffering from attention deficit hyperactivity disorder: When to treat and how? IIMA 5th Conference. Sharjah, UAE, 1–3 April 2010. 5. Al-Sharbati M. Autism and other developmental disorders in Oman. The 3rd Conference of Prevention, Diagnosis and Treatment of Developmental Delays and Neonatal Screening in Middle East and North Africa (MENA). Doha, Qatar, 27–29 April 2010. National 1. Al-Sharbati M. Communication skills. OMSB communication skills workshop. Muscat, Oman, 6–7 October 2009. 2. Al-Adawi S. Pre-occupation with body image and weight-loss behavior in cross-cultural samples. 17th International Child Health Conference – Chronic Childhood Illnesses. Sultan Qaboos University, 13–15 October 2009. 3. Al-Adawi S. Biopsychosocial approach for the management of obesity. Workshop on Food, Nutrition in Health and Disease. College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman. 10 May 2010 4. Al-Adawi S. Coping with chronic illness. Collaborative Nursing Conference on Deliberating Quality, Serving Com- munities, Nurses Leading Chronic Care. Sultan Qaboos University, Muscat, Oman, 28 April 2010. Poster Presentations International 1. Al-Adawi S, Al-Azri F, Hussain S, Dorvlo ASS. Neurocognitive, affective and vegetative functioning in patient presenting with vascular dementia in Oman. Sixth International Congress on Vascular Dementia. Barcelona, Spain, 19–22 November 2009. National 1. Al-Sharbati M, Al-Adawi S, Al-Lawati S, Al-Suleimani A, Obeid Y, Al-Hussaini A, Mirza H, Zaidan Z, Petrini K. Two- phase survey of social anxiety disorder in Omani adolescents reveals gender differences. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 2. Obeid Y, Viernes N, ElZien I, Al-Hussini A, Zaidan Z, Martin, R, Guenedi A, Al-Adawi S. Peer review in the management of inpatients with depression in Sultan Qaboos University Hospital. University Day. Sultan Qaboos University, Oman, Muscat, 2 May 2010. departments

3. Mirza H, Al-Adawi S, Al-Asmi A, Al-Azri F, Hussain S, Al-Sharbati M, Guenedi AA, Al-Hussaini A, Obeid YA. Jinn in the brain: Evaluation of regional cerebral blood flow in a patient with cacodemonomania of dissociative type. Uni- care

versity Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 4. Obeid Y, Al-Hussini, A, Martin R, Al-Sharbati, M, Zaidan Z, Al-Guenedi A, Al-Adawi S. Clinical audit on the use of de- pot antipsychotics in Sultan Qaboos University Hospital. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. patient

5. Obeid Y, Al-Guenedi A, Al-Hussini A, Hussain S, Al-Azri F, Al-Adawi, S. Supposed ‘Spirit possession’ may be associ-

ated with altered brain states: Case report from Oman. University Day. Sultan Qaboos University, Muscat, Oman, 2 and May 2010. 6. Al-Saadoon M, Al-Sharbati M, Rizvi S, et al. Bullying among children in elementary schools in Muscat region. Univer- academic B ehavioural M edicine

39 Annual Report 2009-2010 Behavioural Medicine

sity Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 7. Al-Sharbati M, Al-Sharbati Z, Al-Lawatiya S, Al-Jahwari S. Teachers’ awareness about ADHD in Oman. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 8. Al-Farsi Y, Al-Sharbati M, Wali M, Al-Shafee M. Prevalence of autistic spectrum disorder in Oman. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 9. Al-Sharbati M, Al-Attabi K. Atomoxetine in the treatment of ADHD in SQUH. University Day. Sultan Qaboos Univer- isity, Muscat, Oman, 2 May 2010. THESIS SUPERVISION Omar Al-Farsi Qualification: M.Sc. Title: The prevalence of Autistic Spectrum Disorders in Oman. Supervisor: Dr. Marwan Al-Sharbati Date of completion: August 2010

Maha Al-Khalili Qualification: M.Sc. Title: Nutritional Factors in Autism Supervisor: Dr. Marwan Al-Sharbati Date of completion: On going

Samia Al-Fahdi Qualification: M.Sc. Title: The clinical correlate of autism in Oman Supervisor Dr. Marwan Al-Sharbati Date of completion: On going

40 departments

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41 Annual Report 2009-2010 Biochemistry

he Department of Biochemistry 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 interpretation of biochemical data on patients. The Department is also engaged in teaching medical laboratory science to undergraduates; biochemistry to nursing students, and offers a graduate program leading to an M.Sc degree in Biomedical SciencesT and/or Clinical Biochemistry. A Ph.D. program by research has also been offered since 2009. The Department has also been recognised by the Royal College of Pathologists, London, in relation to postgraduate education through the Oman Medical Specialty Board (OMSB).

The major research activities are focused around the development of molecular tests for detecting and mapping mutations associated with various genetic disorders including hypertension, diabetes, deafness and hyperlipidaemias. The Department has a total of eight academic staff in addition to four consultants at SQUH who are also involved in the teaching programmes. There are seven biomedical research scientists in the College who are involved in research run by the Department.

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. Twenty one biomedical scientists serve the Department at SQUH.

42 Support Staff George Khaukha, Superintendent (College) Halima Adnan, Superintendent (Clinical) Mater Al-Maney, Chief Biomedical Scientist (Clinical) Adil Al-Wahaibi, Chief Biomedical Scientist (Clinical) Younis Al-Musafir, Senior Biomedical Scientist (Clinical) Romulo Cipriano, Senior Biomedical Scientist (Clinical) Suleiman Al-Riyami, Senior Biomedical Scientist (Clinical) Hamed Al-Riyami, Senior Biomedical Scientist (Clinical) Sameera Al-Harrasy, Senior Biomedical Scientist (Clinical) Nasser Al-Nazwani, Chief Technician (College) Mohammed Al-Kindi, Chief Biomedical Scientist (College) Hameeda Al-Barwani, Senior Biomedical Scientist (Col- lege) Mohammed Al-Toubi, Biomedical Scientist (College) Abdulrahim Al-Abri, Biomedical Scientist (College) Sana Hasari, Biomedical Scientist (College) Taruna Dutt, Coordinator (College) Marina Bendecio, Coordinator (Clinical) Highlights of the Year 2009-2010 Staff A workshop on Bioinformatics for Beginners was Faculty held by the Department from 11–15th April 2010. Jumana Saleh, Associate Professor Subjects covered included: 1) Basic DNA Sequence departments Hamza Babiker, Associate Professor Analysis; 2) Sequence comparison- identity, homol- Nadia Al-Wardy, Assistant Professor ogy and mutation matrices; 3) Determining Protein

Structure from Sequence using Computational care Clifford Abiaka, Assistant Professor Marit Delghandi, Assistant Professor Approaches; 4) Small and large scale expression Yahya Tamimi, Assistant Professor analysis, Genome data analysis, and 5) Phyloge- netic Analysis. The workshop was run by Mr. Da-

Yajnavalka Banerjee, Assistant Professor patient David Nkansa-Dwamena, Senior Consultant vid Judge, Cambridge University, UK and Prof. Riad Bayoumi. The overall objective of the workshop

Khalid Al-Rassadi, Consultant and

Nafila Al-Riyami, Consultant was to present a hands-on introduction to aspects Khalid Al-Waili, Consultant. of Bioinformatics central to the analysis and stor academic biochemistry

43 Annual Report 2009-2010 Biochemistry

130000

120000

110000

100000

90000

80000

70000

60000

50000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec No. of Tests Performed in 2010

age of genomic data. This was done via: a brief theoretical introduction; an overview of available software; a basic explanation of important algorithms; an opportunity to use appropriate software to tackle example problems, and an opportunity to discuss research projects with tutors and colleagues.

Dr. Hamza Babiker was promoted to Associate Professor in the month of May 2010. New staff members were Dr. Yajnavalka Banerjee and Dr. Nafila Al-Riyami who joined the Department in August and November 2009 respectively.

Teaching Programmes B.SC. MEDICAL LABORATORY SCIENCES (MLS) The Department is teaching on the MLS degree in Semesters 6 through 10. It also offers courses in Molecular Diagnostics and in Clinical Chemistry - Specialization I, II and III.

UNDERGRADUATE CLINICAL PROGRAMME The Department is teaching on the following MD courses: Molecular Biology & Introductory Genetics; Me- tabolism; Foundation Biochemistry; Enzymology and Metabolism; Alimentary System, and Applied Medical Sciences. The department also participates in various system courses like Hemopoietic System, Endocrine

44 1500

1250

1000

750

No. of tests x 1000 No. 500

250

0 2005 2006 2007 2008 2009 2010 Year Diagnostic Services 2005-2010

System, Respiratory System, Tissues, Urinary System, 7th year clinical rotations, the Integrated Lecture Series, and the student Research Project.

NURSING DEGREE The Department of Biochemistry is teaching Biochemistry for Nursing in the College of Nursing.

POSTGRADUATE PROGRAMME In the postgraduate programme, the Department offers the following courses: Biochemical basis of Disease; Instrumentation and Biochemical Techniques; Molecular Biology, and departments

Methodology in Clinical Biochemistry. The Department of Biochemistry has 9 students registered for the

M.Sc. degree and 2 students studying for their Ph.D. care

Clinical & Diagnostic Services patient

SERVICE PROVISION and The Department of Clinical Biochemistry provides service for a wide range of routine and specialised investigations. Some of the specialised tests are unique and hence the Department offers a referral labora- academic B iochemistry

45 Annual Report 2009-2010 Biochemistry

tory service for such investigations. Service is provided to the hospital on 24 hour basis. The estimated number of tests performed in 2010 is 1,295,000 [Figure 1], i.e. there has been an increase of 14.5% in the workload compared to 2009 [Figure 2]. The Clinical Biochemistry Department manages the Commercial Laboratory Services offered to some selected hospitals within the private sector e.g. Muscat Private Hospital and Hatat Polyclinic.

NEW TESTS Two new tests introduced in this period were: Serum Light Chains (Kappa and Lambda) quantitation in the protein section of the laboratory, and The Urine Metanephrines assay (HPLC).

POINT OF CARE TESTING (POCT) The Department maintains Quality Assurance of blood gas analysers outside the laboratory i.e. in the Acci- dent and Emergency Unit (A&E), Operating Theatre (OT), and Intensive Care (ICU) and Neonatal (NNL) units.

TEACHING Teaching is conducted by senior biomedical scientist staff (superintendent, chief and seniors) and clinical staff (professor and consultants). The mode of instruction includes lectures, seminars and practical demonstration of methods, techniques and instrument operation. The Department has introduced regular sessions to emphasise the importance of the pre-analytical phase to nurses. These sessions also include the I.V. Therapy course for nurses during the induction program.

EXTERNAL QUALITY ASSURANCE The department continues to participate in the ‘Royal College of Pathology of Australia’ External Quality As- surance program.

Research RESEARCH PROJECTS The Clinical and genetic characterization of type 2 diabetes mellitus in Omanis Project Code: RC/MED/BIOC/10/01; Dates: 2010 Value: OR 87,300; Project Funder: The Research Council, Oman Investigators: Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Prof. Mohammed Hassan, Dept. Physiology, SQU; Dr. Sulayma Albarwani, Dept. Physiology, SQU; Prof. Nicolas Woodhouse, Dept. Medicine, SQU; Dr. Omayma El-Shafie, Dept. Med- icine, SQUH.

46 Searching for the origin of human lactase persistence in the Southern part of the Arabian Peninsula Project Code: IG/MED/BIOC/10/02; Dates: 2010–2011 Value: OR 13,100; Project Funder: Sultan Qaboos University Investigators: Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Abdulrahim Al-Abri, Dept. Biochemistry, SQU.

The Cytokines Profile monitoring in a Cohort of Omani Population Undergoing Therapy for Rectal Cancer Project Code: IG/MED/BIOC/10/01; Dates: 2010 Value: OR 8,000; Project Funder: Sultan Qaboos University Investigators: Dr. Yahya Tamimi, Dept. Biochemistry, SQU.

Polymorphism of type 2 diabetes candidate genes among individuals of Oman Family Study. Project Code: IG/MED/BIOC/07/01; Dates: 2007–2010 Value: OR 17,300; Project Funder: Sultan Qaboos University Investigators: Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Prof. Mohammed O. Hassan, Dept. Physiology, SQU; Dr. Sulayma Al-Barwani, Dept. Physiology, SQU; Dr. Saeed Al-Yayhaee, Dept. Biochemistry, SQU.

Genetic linkage mapping of recessive deafness in Oman. Project Code: IG/MED/BIOC/08/01; Dates: 2008–2010 Value: OR 31,300; Project Funder: Sultan Qaboos University Investigators: Dr. Nadia Al-Wardy, Dept. Biochemistry, SQU; Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Mr. Mohammad Al-Kindi, Dept. Biochemistry, SQU; Dr.

Mazin Al-Khabori, Dept. Ear, Nose & Throat, Al Nahda Hospital, Muscat, departments Oman. care

Evaluation of vitamin D status of Omani adults with particular focus on pregnant Omani women Project Code: IG/MED/BIOC/09/01; Dates: 2009–2011 Value: OR 9,000; Project Funder: Sultan Qaboos University patient

Investigators: Dr. Clifford Abiaka, Dept. Biochemistry, SQU; Dr. David Nkasa-Dwamena,

Dept. Biochemistry, SQU, Dr. Lovina Machado, Dept. Obstetrics & Gynecol- and ogy, SQU. academic B iochemistry

47 Annual Report 2009-2010 Biochemistry

The brunt of mutations conferring drug resistance on the fitness of malaria parasites Project Code: IG/MED/BIOC/09/02; Dates: 2009–2011 Value: OR 18,800; Project Funder: Sultan Qaboos University Investigators: Dr. Hamza Babiker, Dept. Biochemistry, SQU, Gote Swedberg, Dept. Medical Biochemistry & Microbiology, Uppsala University, Sweden; Dr. Petra Schnei- der, Institute of Infection & Immunology Research, Edinburgh University, UK; Dr. Abdel-Muhsin AG Abdel-Muhsin, The Institute of Medical Research, Sudan.

A study of the effects of pregnancy-related thyroid autoimmunity and oxidative stress in Omani women from conception to parturition Project Code: IG/MED/BIOC/10/04; Dates: 2010–20102 Value: OR 7,000; Project Funder: Sultan Qaboos University Investigators: Dr. Clifford Abiaka, Dept. Biochemistry, SQU; Dr. David Nkansa-Dwamena, Dept. Biochemistry, SQU; Dr. Lovina Machado, Dept. Obstetrics & Gynaecol- ogy, SQU.

Identifying Candidate Genes for Heart Pacemaker Control in Oman Family Study Project code: IG/MED/BIOC/10/03; Dates: 2010 Value:` OR 3,353; Project funder: Sultan Qaboos University Investigators: Dr. Marit P. Delghandi, Dept. Biochemistry, SQU; Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Prof. Mohammed O. Hassan, Dept. Physiology, SQU; Dr. Sulayma Albarwani, Dept. Physiology, SQU.

A Study of the Highly Polymorphic Vitamin D binding Protein in a healthy Omani Population Project code: MREC # 328; Dates: 2010 Value: OR 1,893; Project funder: Sultan Qaboos University Investigators: Dr. Marit P. Delghandi, Dept. Biochemistry, SQU; Dr. Clifford Abiaka, Dept. Biochemistry, SQU.

Is Performance in Preclinical Assessment a Good Predictor of the Final MD Grade? Project Code: MREC #307; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University

48 Investigators: Dr. Nadia Al-Wardi, Dept. Biochemistry, SQU

Primary Immunodeficiency in Oman: First Report of the National Registry at Sultan Qaboos University Hospital Project Code: MREC # 312; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Marit Delghandi, Dept. Biochemistry, SQU; Mr. Abduallah Al-Muniri, Dept. Family Medicine & Public Health, SQU; Mr. Moosa Al-Kindi, SQU.

Evaluation of Fructosamine assay on cobas integra 800 and comparison of fructosamine concentration and glycated hemoglobin concentration in diabetic patients with hemoglobin variants Project Code: MREC # 339; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Ms. Huda Al-Saadi, Dept. Biochemistry, SQU RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al-Wardy NM, Rizvi SG, Bayoumi RA. Is performance is pre-clinical assessment a good predictor of final Doctor of Medicine grade? Saudi Med J 2009; 30:1590−4. 2. Bielas SL, Silhavy JL, Brancati F, Kisseleva MV, Al-Gazali L, Sztriha L, Bayoumi RA, et al. Mutations in INPP5E, encoding inositol polyphosphate-5-phosphatase E, link phosphatidyl inositol signaling to the ciliophaties. Nat Genet 2009; 41:1032−6. 3. Banerjee Y, Taranikanti V, Bayoumi R. Triglyceride-mediated pathways and coronary heart disease. Lancet 2010; 376:956.

4. Joshi SN, Fathalla M, Koul R, Maney MA, Bayoumi R. Biotin responsive seizures and encephalopathy due to biotini- departments

dase deficiency. Neurol India 2010; 58:323−4. 5. Saleh J, Al-Khanbashi M, Al-Maaroof M, Al-Lawati M, Cianflone K. Acylation stimulating protein increases and cor- care relates with increased progesterone levels during the luteal phase of the menstrual cycle. Eur J Endocrinol 2009; 160:301−7. 6. Reece S, Ali E, Schneider P, Babiker HA. Stress, drugs and evolution of reproductive restraint in malaria parasites. Proc patient

Roy Soc Lond B 264:553–9. E-pub ahead of print19 May 2010. 7. Kheir A, Nwakanma D, Akbarov Y, Al-Saai S, Al-Gazali A, Swedberg G, Babiker HA. Transmission and cross-mating of and high-level resistance plasmodium falciparum dhfr haplotypes in the Gambia. Am J Trop Med Hyg 2010; 82:535−41. 8. Burney IA, Al Sawai BS, Dawood AA, Babiker H, Al Moundhri MS. Association of polymorphisms in cytokine genes academic B iochemistry

49 Annual Report 2009-2010 Biochemistry

with diffuse large B cell lymphoma and its outcomes in Omani Arabs. Eur J Cancer 2009; 7:566. 9. Babiker HA. Seasonal fluctuation of drug resistant malaria parasites: a sign of fitness cost. Trends Parasitol 2009; 25:351−2. 10. Babiker HA, Hastings IM, Svedberg G. Impaired fitness of drug-resistant malaria parasites: evidence and implication on drug deployment policies. Expert Rev AntiInfective Ther 2009; 7:581−93. 11. Al-Saai, S, Kheir A, Abdel-Muhsin A, Al-Ghazali A, Nwakanma D, Swedberg G, Babiker HA. Distinct haplotypes of dhfr and dhps among plasmodium falciparum isolates in an area of high level of sulfadoxine-pyrimethamine (SP) resistance in eastern Sudan. Infect Genet Evol 2009; 9:778–83. 12. Hamdy H, Telmesani AW, Al Wardy N, Abdel-Khalek N, Carruthers G, Hassan F, et al. Undergraduate medical education in the Gulf Cooperation Council (GCC) – a multi-countries study (Part I). Med Teach 2010; 32:219–24. 13. Hamdy H, Telmesani AW, Al Wardy N, Abdel-Khalek N, Carruthers G, Hassan F, et al. Undergraduate medical education in the Gulf Cooperation Council (GCC) – a multi-countries study (Part II). Med Teach 2010; 32:290–5. 14. Theodorsson T, Shafie K,Al Wardy N, Anwar K, Al Shafaee M, Al Mahrezi A. Assessment of family doctors in Oman; getting the questions right preliminary findings of a performance analysis of multiple choice questions. Internet J Med Educ 2010; From: http://www.ispub.com/journal/the_internet_journal_of_medical_education/volume_1_ number_1_74/article_printable/assessment-of-family-doctors-in-oman-getting-the-questions-right-preliminary- findings-of-a-performance-analysis-of-multiple-choice-questions-2.html 15. Al Wardy NM. Assessment methods in undergraduate medical education. SQU Med J 2010; 10:203–9. 16. Al Wardy NM. Re: Evaluation Tools in Postgraduate Medical Education–Do we need “Made in Oman” tools? Letter to Editor. SQU Med J 2010; 10:280–1. 17. Banerjee Y, Bayoumi R, Farook SMS. Could deadly snake venom save lives? SQU Med J 2010; 10:142–3. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations National 1. Bayoumi RA. Lactose intolerance among Omanis. The 4th Pan Arab Conference of Human Genetics. Dubai, UAE, March 2010. 2. Al-Riyami N. Hepatic lipase deficiency in a Middle Eastern Arabic Male. th9 Annual National Lipid Association Scien- tific Sessions. Chicago, USA,14–17 May 2010. 3. Al Wardy N, Al Hussaini O, Al Zidjali L, Hussein S, Al Asmi A, Rizvi S, Al Rawahi Z. Evaluation of teacher-training workshops in the College of Medicine & Health Sciences, Sultan Qaboos University. AMEE Conference. Abstracts 9AA11. Malaga, Spain, 29 August – 2 September 2009. 4. Al-Wardy N, Al-Kindi M, Al-Khabouri M, Alasti F, van Camp G, del Castillo I, Bayoumi R. Otoferlin [OTOF] gene variants responsible for hearing loss in two Omani families. 3rd Pan Arab Human Genetics Conference. Abstracts P34. Dubai, UAE, 13–15 March 2010.

50 5. Wahab RA, Saleh J. Biochemical significance of small dense LDL measurement in assessing the risk for CAD using simple precipitation method. 4th International Conference of Biomarkers in Chronic Diseases. Riyadh, Saudi Arabia, 4–6 May 2010. 6. Al-Riyami N. Hepatic lipase deficiency in a Middle Eastern Arabic Male. Annual National Lipid Association Scientific Sessions. Chicago, USA, 14–17 May 2010. THESIS SUPERVISION Lamyaa Al-Anbouri Qualification: M.Sc. Title of Thesis: Identifying candidate genes for pacemaker control in Oman Family Study Supervisor: Marit Delghandi Date of Completion: June 2010 departments

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51 Annual Report 2009-2010 Child Health

he Department of Child Health is one of the most active departments of the College of Medicine and Health Sciences (COMHS) and SQU 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 sub-specialties. ItT 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 College educational activities and committees including the Curriculum and Examination Committees. Department members have contributed significantly the development and implementation of the new curriculum, as evidenced by the representation of the Department in the various committees (Dr Reem Ab- dwani in Phase III, Dr Dana Al-Nabhani in Pre-Clerkship, Dr Hashim Jawad in Pre-Internship, Dr Amna Al-Futaisi in Junior Rotation and Professionalism, and Drs Roshan Koul and Siham Al-Sinani in Senior Rotation; Dr Yasser Wali is the clinical coordinator of the clinical nutrition course in Phase II). In addition, the Department trains many foreign undergraduate medical students during their elective rotations.

The Department has also a highly integrated postgraduate training programme and is equipped with excellent Clinical Teaching Units (CTU’s) run by experienced teachers. Our Department started the first CTU in Oman and has been complimented on this by in-

52 ration with international centers of excellence in paediatrics has benefited a large number of sick children, especially those with haematological diseases.

The Department also takes great pride in continuing to serve the community, raising funds to serve children with all kinds of special needs in various ways.

Lack of space, technological support and personnel have limited performance in both academic and clinical areas. It is a long cherished dream of the Department to establish a world class Institute of Child Health in collaboration with the Ministry of Health.

Staff Faculty Zakia Al-Lamki, Professor Muna Al-Saadoon, Assistant Professor ternational medical educationists. The Department Hussein Al-Kindy, Senior Consultant teaches and trains junior doctors, preparing them Amna Al-Futaisi, Senior Consultant for various examinations affiliated to the Royal Saif Al-Yaarubi, Senior Consultant College of Paediatrics and Child Health (UK), Royal Ibtisam B. Elnour, Senior Consultant departments College of Physicians and Surgeons of Glasgow and Salem Al-Tamemi, Senior Consultant the Arab Board. The Department is the only centre S.N. Joshi, Senior Consultant in Oman offering subspecialty training of pediatric care Roshan L. Koul, Senior Consultant residents in metabolic diseases, neurology, immu- P.C. Alexander, Senior Consultant nology and haemato-oncology. Matthew Zachariah, Consultant

Hamed Abdoon, Consultant patient

Finally, the Department conducts high quality re- Siham Al-Sinani, Consultant search with state-of-the-art support from the ge-

Reem Abdwani, Consultant and netic laboratories producing publications in high Lalitha Krishnan, Consultant impact peer reviewed indexed journals. Collabo- academic child health

53 Annual Report 2009-2010 Child Health

Mohamed Abdellatif, Consultant Abdulhakim Al-Rawas, Consultant Dana Al-Nabhani, Consultant Adila Al Kindy, Consultant Anas Al-Wogud, Consultant Hashim Javad, Consultant Faraz Masud, Senior Registrar Zenaida Reyes, Senior Registrar Syed R. Haider, Senior Registrar Mohamed Elshinawy, Senior Registrar Wafa Bashir, Senior Registrar Kripail Mathew, Senior Registrar Mahmoud Fathalla, Registrar Maria F. Bataclan, Registrar Mohammed Fazalullah, Registrar Masood Ahmed, Registrar Surekha Tony, Registrar Manjusha Hira, Registrar Ismail Beshlawi, Registrar Mohammed A. El Naggari, Registrar Islam M.S. Elbaroudy, Registrar Amitha R. Aroor, Registrar Aamir Qais, Registrar Azza Al-Shidhani, Senior House Officer Ashfaq Khan, Senior House Officer Raghad Abdwani, Senior House Officer (on study leave) Hilal Al-Mandhari, Senior House Officer Renjit Mani, Senior House Officer Rana Abelrahim, Senior House Officer Shafiq U. Rehman, Senior House Officer Laila Al-Yazdi, Senior House Officer Yusriya Al Rawahi, Senior House Officer Eiman Abdalla, Senior House Officer Mazen A.M. Abuanza, Senior House Officer Ashraf A. Saad, Senior House Officer Sharef W.Sharef, Senior House Officer

54 Support Staff Ruth T. Mujal, Coordinator (Hospital) Aisha Al-Maskary, Coordinator (College) Najah Al-Maawaly, Social Worker Fatma Al-Farsi, Play Therapist Kawther Al-Khusaibi, Play Therapist Highlights of the Year 2009-2010 COMMUNITY SERVICE Consultancies are provided to various hospitals of the Ministry of Health, the Armed Forces and Royal Oman Police hospitals, at a rate of 2-3 per consultant per week. Guest appearances in the national media (televi- sion/radio) were about 7 in this year, while 4 guest columns appeared in the lnational newspapers. Medical services were provided to the Orphanage in Al-Khod; the Centre for Special Education, Darsait, and the Early Intervention Centre in Al Khuwair. There was departmental participation in various charity events and charity bazaars organized by Dar Al Atta and various women’s organisations, as well as in public seminars and awareness days (bronchial asthma, childhood diabetes, haemophilia, sickle cell disease). A total of 18 parties were held for inpatients, organised by Muscat Muncipality, National Bank of Oman, SQU students and the telecommunications company Nawras, in addition to two charity fairs and parties on Mother’s day, during Ramadhan, Eid Al-Fitr and Eid Al-Adha.

INTERNATIONAL VISITORS The Department received the following twelve international visitors during this period: Dr. Michael Shevell, Head, Pediatric Neurology, Montreal Children’s Hospital, McGill University, Canada; Dr. M.C. Mathew, Pro- fessor of Developmental Neurology, Christian Medical College, Vellore, India; Dr. Cristoph Klein, Chairman, Pediatric Neurology, Hannover Medical School, Germany; Dr. Marie-Claude Gingras, Associate Professor, Hu- departments man Genome Sequencing Centre, Baylor College of Medicine, USA; Dr. Alyaa Kotby, Professor of Pediatrics, Ain Shams University, Egypt; Dr. Hema Patel, Associate Professor, Ambulatory Pediatrics, McGill University,

Canada; Dr. Celia Rodd, Associate Professor, Pediatric Endocrinology, Mc Gill University, Canada; Dr. Qutayba care Hamid, James McGill Professor of Medicine, McGill Universty, Canada; Dr. Abdulrahman O. Musaiger, Head, Arab Centre for Nutrition, Bahrain; Dr. Mabu-Zekry, Department of Gastroenterology, Cairo Universty Chil- dren’s Hospital, Egypt; Dr. Anil Dhawan, Professor of Pediatric Hepatology and Liver Transplantation, King’s patient College London School of Medicine, UK; Dr. Moeen Al-Sayed, Head Department of Pediatric Metabolic Dis- eases, King Faisal Specialist Hospital and Research Centre, Kingdom of Saudi Arabia. and

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55 Annual Report 2009-2010 Child Health

RESEARCH Dr Yasser Wali, Dr Muna Al-Sadoon and Dr Zakia Al-Lamki served in this period on the Editorial Board of the SQU Medical Journal. Dr Amna Al-Futaisi, Dr Saif Al-Yaarubi and Dr Reem Abdwani served in this period on the Editorial Board of the Oman Medical Journal

Dr Roshan Koul was a member of the International Advisory Board of the Journal of Pediatric Neurology.

Dr Yasser Wali was a reviewer for the Journal of Pediatric Hematology/Oncology, the Postgraduate Medical Journal, Sultan Qaboos University Medical Journal, Oman Medical Journal, and the Alexandria Journal of Pe- diatrics. Dr Roshan Koul was a reviewer for the Oman Medical Journal, SQU Medical Journal, Saudi Medical Journal, Neurosciences, Neurology India and the Journal of Pediatric Neurology.

Dr. Yasser Wali was Chairman of the Organising Committee for “Towards Better Care”, 17th Child Health In- ternational Conferences on Chronic Childhood Illnesses held at Sultan Qaboos University, Oman from13−15 October 2009. The conference attracted 450 delegates, and had 15 invited speakers from 8 countries.

The Department organised four workshops during this period. A workshop on child maltreatment and child rehabilitation, supported by UNICEF was held on 15 October 2009.

A workshop on planning and developing services for children with neurodevelopmental disorders was chaired by Prof M.C. Mathew, India, on 15 October 2009. A workshop on child abuse and neglect was organised by Dr. Ibtisam Elnour and Dr. Muna Al-Sadoon at the

Sohar Hospital on 4 July 2010. A haemophilia Awareness Day was organised by Dr. Yasser Wali at Sultan Qaboos University on19 April 2010. Finally, staff participated in a workshop on family support in cancer care, organized by Dar Al-Atta on 15 October 2009.

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 years 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

56 monitored by the Department’s Examination Committee.

OLD CURRICULUM 5th Year Teaching The Department usually has about 13 students. The teaching of the 5th year students is divided into theoretical, clinical and self learning with guidance. In addition to clinical teaching, there are other teaching modalities that the Department implemented in the last 3 years that require one to one interaction between the students and tutors. The first modality is case presentation with each student presenting 5 cases to tutors (3 in SQUH). At the end of the 1 hour session, students receive feedback with a grade. The second modality is case write-up each student being required to submit 5 case write ups (3 in SQUH). In total, the Department provides 2,123 contact hours of teaching and academic activities for 5th year students.

Some of the Department members are also involved in the teaching of the Integrated Lecture Series courses: Haematology, Neurology, Gastroenterology and Respiratory.

7th Year Teaching At any time, the Department will have about 15 students. The teaching of the 7th year students is divided into theoretical, clinical elements and self-learning with guidance. The different teaching activities for this group of students accounts for about 1,400 hours per year.

In addition, there are other teaching modalities implemented in the last 3 years that require one to one interaction between the students and tutors. HOPE Evaluation in which each student present 2 cases to tutor (1 in SQU). At the end of the 1 hour session, students receive feedback with a grade. In total, the Department provides 1,540 contact hours of teaching and academic activities for 7th year students.

Preclinical Teaching departments

Members of the Department are involved in the following courses in the preclinical studies of the college: the clinical communication course and the clinical skill course. care NEW CURRICULUM In this period, the Department completed all the curriculum material for all of the different phases of the child health rotations (11 case scenarios for pre internship, 22 clinical scenarios for junior rotation, 11 case patient scenarios for senior rotation and 1 week in the pre-clerkship).Currently, the curriculum is being revised. The teaching modalities and daily teaching activities for the new curriculum are also ready. and

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57 Annual Report 2009-2010 Child Health

Postgraduate Teaching Dr Yasser Wali is the convener of the new Clinical PhD Program, a new degree programme for College of Medicine and Health Sciences

The Department usually has around 10-14 interns for training. The Department is involved in teaching OMSB residents as follows. At any time of the year, the Department will have around 3-4 child health residents for training. Three Department members are invited yearly to give presentations to Family Medicine & Public Health residents on common childhood diseases. One of the Department members is invited yearly to deliver a clinical presentation to A&E residents.

The Department organises and conducts Membership of the Royal College of Paediatrics & Child Health (MRCPCH) and Diploma of Child Health examinations every year, in collaboration with the concerned international bodies.

The Department run the following postgraduate courses: Neonatal Advance Resuscitation Course (3 times a year); Paediatric Advance Life Support (twice a year), and MRCPCH Course (once a year).

The Department also contributes to the Basic Life Support Course, which is conducted 12–14 times a year.

Clinical & Diagnostic Services Table 1: Paediatric Inpatients 2008-2010 Year No. of Admissions Av. Bed Occupancy (%) Av. Length of Stay (Days) 2010 4,753 70.1 3.3 2009 5,168 71.4 3.5 2008 4,481 65.8 3.6

Table 2: Paediatric Day care Unit

Year No. of Admissions No. of Discharges Av. duration of stay (hours) 2010 2,576 2,486 4−6 2009 1,048 954 5−8 2008 725 712 8−9

58 Table 3: Paediatric Outpatients Year Booked Total Seen Admitted Discharged 2010 13,534 10,970 301 924 2009 12,029 9,342 419 775 2008 11,223 8,637 296 972 Table 4: Neonatal Intensive Care Unit Year No. of Admissions Av. Bed Occupancy (%) Av. Length of Stay (Days) 2010 444 85 14 2009 417 85.6 11.3 2008 407 79.1 10.5

Table 5: Postnatal Ward Year No. of Admissions Av. Bed Occupancy (%) Av. Length of Stay (Days) 2010 2,490 80 2.3 2009 2,215 81 2.2 2008 2,636 75 2.5

Table 6: Paediatric Intensive Care Unit Year No. of Admissions Av. Bed Occupancy (%) Av. Length of Stay (Days) 158 80 8 2010 departments

2009 130 64 6.4 care

2008 76 114 11.9 patient

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Table 7: Paediatric services provided to the Department of Clinical Physiology: electroencephalogram (EEG), brainstem auditory evoked response (BAER), visual evoked potential (VEP), Somatosensory Evoked Potential (SSEP), Video EEG, electromyography (EMG), nerve conduction velocity (NCV), Echocardiography, 24 hours Oesophageal Ph Monitor- ing, Newborn audiometry

2010 1,081 2009 1,988 2008 1,856

Research RESEARCH PROJECTS Integrative investigation and applied molecular epidemiology of cystic fibrosis in Oman Project Code: IG/MED/CHILD/09/01; Dates: 2009–2010 Value: OR 19,900; Project Funder: Sultan Qaboos University Investigators: Dr. Hussein Al-Kindi, Dept. Child Health, SQU; Dr. Said Al-Yahyaee, Dept. Ge- netics, SQU; Dr Uwe Fass, Dept. Biochemistry, Oman Medical College; Qas- eem Al-Salmi, Dept. Child Health, Royal Hospital, Oman.

Genetic causes of congenital neutropenia Project Code: IG/MED/CHILD/10/01; Dates: 2010–2012 Value: OR 9,600; Project Funder: Sultan Qaboos University Investigators: Dr. Yasser Wali, Dept. Child Health, SQU; Dr. Christoph Klein, Dept. Pediatric Hematology-Oncology, Hannover Medical School, Germany; M. Al-Zalabany, Dept. Pediatric Immunology, Alexandria University, Egypt; Dr. Said Al-Yahy- aee, Dept. Genetics, SQU; Dr. Ismail El-Beshlawi, Dept. Child Health, SQU; Dr. Naglaa Fawaz, Dept. Haematology, SQU; Dr. Aisha Alkhayat, Dept. Biology, College of Science, SQU; Dr. Salem Al-Tamemi, Dept. Child Health, SQU; Ms Khalsa Al-Kharousi, Department of Genetics, SQU; Dr. Shahina Daar, Dept. Haematology, SQU; Dr. Martin Zimmermann, Dept. Statistics, Hannover Medical School, Germany.

60 Pulmonary function test in children with sickle cell disease in correlation with hemoglobin SB chain haplotypes Project Code: IG/MED/CHLD/07/01; Dates: 2007–2009 Value: OR 5,000; Project Funder: Sultan Qaboos University Investigator: Dr. Hussein Al Kindi, Dept. Child Health, SQU.

Assessment of some novel biomarkers in the diagnosis of acute kidney injury (AKI) in Oman. Project Code: MREC# 293; Dates: 2009 Value: OR 2,500 Project Funder: Sultan Qaboos University Investigator: Dr. Ibtisam Elnour, Dept. Child Health, SQU. The Department is also involved in international research collaborations as follows: with Dr. Yasser Wali as the principal investigator: 1) Genetic Predictors of Stroke in Patients with Sickle Cell Disease. This research is iIn collaboration with “Oakland Children’s Hospital (California). This is a multi centre trial with 5 centres in USA and ours is the one of the 2 participating Centre outside the USA. This project is funded by American col- laborators;. The Principal Investigator is Dr. Yasser Wali; 2) Hemophagocytic Lymphohistiocytosis, Molecular correlates and clinical outcome,. iIn collaboration with Karolinska Hospital, Stockholm;. The Principal Inves- tigator is Dr. Yasser Wali; 3) Social, Cultural, Legal and Ethical Issues Related to Gene Databases in Developing Countries. This is a WHO funded Project.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Roshan LK, Al Futaisi A, Al Sadoon M, Elnour IB, et al. Vehicular entrapment and heat stroke in 3 children: Is it a form of child neglect? Oman Med J 2010; 25:222−4.

2. Koul R, Al Futaisi A, Jain R, Al Azri F. Trigeminal neuralgia due to anterior inferior cerebellar artery loop: A case re- departments

port. J Child Neurol 2009; 24:989−90. 3. Koul R, Al Futaisi A. Paramyotomia congenital in an Omani kindred. J Child Neurol 2010; 25:212−5. care

4. Joshi SN, Fathalla M, Koul R, Maney MA, Bayoumi R. Biotin responsive seizures and encephalopathy due to biotini- dase deficiency. Neurol India 2010; 58:323–4. 5. Abdwani R, Mani R. Anti-CD20 monoclonal antibody in acute life threatening haemolytic anaemia complicating patient childhood onset SLE. Lupus 2009; 18:460−4.

6. Abdwani R, Scuccumarri R, Duffy K, Duffy CM. Nodulosis in systemic onset juvenile idiopathic arthritis: An uncom- and mon event with spontaneous resolution. Pediatr Dermatol 2009; 26:587−91. 7. Abdwani R. Challenges of childhood uveitis. SQU Med J 2009; 9:231−40. academic C hild H ealth

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8. Abdwani R, Abdel Rahim R, Ganesh A, Al Hamadani A. CA chronic granulomatous disease of childhood. Oman Med J 2009; 24:56−7. 9. Abdwani R, Koul R, Al Azri F, Al Futaisi A. Anasarca complicating juvenile dermatomyositis. J Pediatr Neurol 2010; 8:433–5. 10. Engelhardt KR, Mcghee S, Winkler S, Sassi AS, Al Tameimi S. Large deletions and point mutations involving the dedi- cator of cytokines 8 (DOCK 8) in the autosomal- recessive form of hyper IGE syndrome. J Allergy Clin Immunol 2009; 124:1289−302. 11. Koul RL, Al Futaisi, Al Aazri F, Jain R. A ten year old girl with band heteropias/double cortex. SQU Med J 2010; 10:136−7. 12. Koul RL, Al Futaisi, Jain R. Infantile spasms associated with lissencephaly-pachygyria in a female twin. Neurol India 2010; 04:30−1. 13. Al-Futaisi A, Wali Y, El-Beshlawi I, Al Riyami S, Almahrezi A. Case study: Using a continuous glucose monitoring system in a patient with diabetes and beta-thalassemia hemoglobinopathy. Pediatr Hematol Oncol 2009; 26:515−9. 14. Rafay MF, Cortez MA, Al Futaisi A. Predective value of clinical and EEG features in the diagnosis of stroke and HJIE in neonates with seizures. Stroke 2009; 40:240−7. 15. Wali Y, Mohib H. Effect of hydroxyurea on physical fitness indices in older children with sickle cell disease. Pediatr Hematol Oncol 2011; 28:43-50. Epub Nov 17 2010. CONFERENCE AND SEMINAR PRESENTATIONS Conference Presentations International 1. Wali Y. Immune thrombocytopenic purpura ( ITP) in Oman, When to do BMA, Who to Treat? 7th Egyptian Society of Pediatric Hematology/Oncology (ESPHO) Conference. , Cairo, Egypt, 26-27 March 2009. 2. Wali Y. Stem cell therapy for avascular necrosis of the hip in children with sickle cell disease. 25th International Fac- ulty of Medicine, Alexandria University Conference, Nano Technology in Medicine. Alexandria, Egypt, June 2009. 3. Koul RL Neuronal ceroid lipofuscinosis in Oman. 14th European Federation of Neurological Societies, Geneva, Swit- zerland, September 2010. 4. Wali Y. Childhood leukemias - Oman experience. 23rd Annual Conference of the American Society of Paediatric Haematology/Oncology (ASPHO). Montreal, Canada, April 2010. 5. Wali Y. Childhood leukemias - Oman experience. 23rd Annual Conference of the American Society of Paediatric Hae- matology/Oncology (ASPHO). Montreal, Canada, April 2010. 6. Koul RL. Neuronal ceroid lipofuscinosis in Oman. 14th European Federation of Neurological Societies, Geneva, Swit- zerland, September 2010. 7. Al-Tameimi S. Update on Management of Chronic Urticaria and Angioedema.Allergy, Asthma & Clinical Immunol- ogy Symposium. King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, November 2009.

62 Conference Abstracts International 1. Wali Y, Tony S, Daar S. MRI T2* in very young children with thalassaemia major: Logistics and outcome. 8th Egyptian Society of PediatricHematology/Oncology (ESPHO) Conference. Alexandria, Egypt, 25−26 March 2010. 2. Wali Y, Tony S, Riyami M, Shah W, Muslehi M, Zacharia M, Daar S. Double heterozygous Hb S-S Oman: A new syndrome of sickle cell disease presenting as thalassemia major. 23rd Annual Conference of the American Society of Paediatric Haematology/Oncology (ASPHO). Montreal, Canada, 7−10 April 2010. 3. Wali Y. Comprehensive management of thalassaemia in Oman. 8th Paediatric Hematology/Oncology Academic Day. King Faisal Specialist Hospital, Riyadh, Saudi Arabia, 26 May 2010. 4. Abdwani R, Duffy SK, Scuccumarri R. Nodulosis in systemic onset JIA. 11th World Congress of Paediatric Dermatology. Bangkok, Thailand, November 2009. 5. Abdwani R, Al Nabhani D, Hari M, Al Zakhwani I. Juvenils SLE in Oman. 9th Pan Arab Rheumatology Society Congress in Collaboration with Mayo Clinic. Amman, Jordan, April 2010. National 1. Wali Y. Management of immune thrombocytopaenic purpura (ITP) in childhood: A dilemma. 17th International Child Health Conference, Muscat, Oman, 13−15 October 2009. 2. Zakia Z, Sadoon M. Impact of living with thalassaemia major on the affected child, parents and siblings. 17th Interna- tional Child Health Conference, Muscat, Oman, 13−15 October 2009. Poster Presentations International 1. Al Futaisi A. Prevalence of HIE at SQUH. ICNA. Cairo, Egypt, May 2010. 2. Elnour IB, Al Reyes Z, Bataclan F, Naggari MA, et al. Outcome of prenatal hydronephrosis among infants born at SQUH. 15th Congress International Pediatric Nephrology Association. New York, USA, 298 August – 2 September 2010. 3. Al Sadoon M. Vehicular entrapment and heatstroke in 3 children: Is it a form of child neglect? 12th Australian Confer- departments

ence on Child Abuse and Neglect. Perth, Australia, November 2009. 4. Elnour IB, Nabhani D, Naggariu MA, Sankhla D. Renal malformations and scarring of children with UTI referred to th care

SQU Hospital. 15 International Pediatric Nephrology AssociationPNA International Congress. New York, USA, 29 Aug–2 Septust 2010. 5. Elnour IB, Sadoon M. Can we help when we do not have child protection services in Oman? Experience in Oman. 28th ISPCAN International Congress on Child Abuse and Neglect. Honolulu, Hawaii, USA, August 2010. patient

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th and 1. Abdwani R, Duffy SK, Scuccumarri R. Methotrexate induced nodulosis. 17 International Child Health Conference. Sultan Qaboos University, Oman, October 2009. academic C hild H ealth

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2. Al Mundher M, Joshi SN, Koul R, Al Futaisi A. Lysosomal disorders in Oman. 17th International Child Health Confer- ence. Sultan Qaboos University, October 2009. 3. Siham S. Pappenburg intestinal tuberculosis mimicking Crohn’s disease in a 9 year old child. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 4. Koul R, Al Futaisi A, Jain R. A monozygotic twin with pacchygria and West syndrome. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 5. Koul R, Al Futaisi A, Jain R. Neuronal migration disorders in Oman. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 6. Joshi SN, Bayoumi R. Spectrum of metabolic disorders in Oman. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 7. Al Barudy I, Al Futaisi A. Fulminant GBS with central and peripheral demyelination. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 8. Ala M, Bhatnagar S, Al Kindy H. Non CF bronchiectasis in children - Oman experience. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 9. Zachariah M, Bashir W, Al Lamki Z, Wali Y. Infantile leukemia at SQUH - A review. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 10. Zachariah M, Bashir W, Al Lamki Z, Wali Y. AML in children experience from one centre in Oman. 17th International Child Health Conference. Sultan Qaboos University, Oman. October 2009. 11. Zachariah M, Bashir W, Al Lamki Z, Wali Y. Is chemotherapy necessary for secondary HLH with treatable aetiology?. 17th International Child Health Conference. Sultan Qaboos University, Oman, October 2009. 12. Krishnan L, Bayoumi R, Joshi SN, Al Yaarubi S, Wali Y, Al Abri R. Universal newborn screening at SQUH. 17th Interna- tional Child Health Conference. Sultan Qaboos University, Oman, October 2009. 13. Khan A, Krishnan L, William R, Sankhla D. Scimitar syndrome in a neonate. 17th International Child Health Confer- ence. Sultan Qaboos University, Oman, October 2009. THESIS SUPERVISION Yahia Al-Mukhaini Qualification: M.Sc. Title: Impact of Breast feeding on Childhood Acute Lymphoblastic Leukemia in Oman Supervisors: Dr. Yasser Wali Date of Completion: May 2009

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65 Annual Report 2009-2010 Family Medicine & Public Health

he Department of Family Medicine and Public Health is a major clinical and teaching department established in 1986. The clinical services are provided through the University Health Center and the Student Clinic. The teaching activities include courses in Epidemiology and Medical Statistics, Nutrition, Health Education and Village Health Care. It also runs a Junior Clerkship for the 5th year clinical students and a Senior Clerkship for final MD students. The postgraduate programmes include the Master’s Program in TEpidemiology and Medical Statistics, a PhD programme in Epidemiology & Public Health, and the Family Medicine and Community Health Residency Program which has 53 residents. The Department conducts the MRCGP [INT] (Membership of the Royal College of General Practitioners - International) examination. The Department is also actively involved in research independently and also in collaboration with other departments.

66 Mohammed Al-Azri, Consultant Ahmed Al-Waily, Consultant Zakiya Al-Busaidy, Consultant Hamdan Al-Habsi, Consultant Kawther El-Shafie, Senior Registrar Anna Maria Serrano, Senior Registrar Rahma Al-Kindi, Senior Registrar Laila Ali Ramadhan, Registrar Aisha Al-Hinai, Registrar Vrunda Pimpalkhute, Registrar Sheela George, Registrar Nafisa Samir, Registrar Imran Saad, Registrar Wahida Al-Maskeri, Senior Chief Dietician Coordinators Perpetua Gabor Zulfa Al-Tobi Bahiya Al-Siyabi Highlights of the Year 2009–2010 Staff The Department offered the 9th diet of the MRCGP [INT] examination in March 2010. The examination Faculty was taken by 30 doctors including 15 from Saudi Shyam S. Ganguly, Associate Professor Arabia. The Royal College of General Practitioners departments Randa Youssef, Associate Professor has appreciated and recognised the progress made Syed Rizvi, Assistant Professor in the development of this examination The exami- care

Yahya Al-Farsi, Assistant Professor nation was accredited by the RCGP for three further Abdullah Al-Muniri, Assistant Professor years (until 2013) after the accreditation process. Kamlesh Bhargava, Senior Consultant A retreat day for all the teachers of the MD pro-

Thord Theodorson, Senior Consultant patient Abdulaziz Al-Mahrezi, Senior Consultant, Deputy gramme from the Ministry of Health (MOH) and SQU was held to review the MD teaching pro- Head, Clinical Services and

Ahmed Al-Mandhari, Senior Consultant & Director gramme and improve it. General SQU Hospital academic Family medicine & public health

67 Annual Report 2009-2010 Family Medicine & Public Health

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Department offers courses in Epidemiology & Statistics (Parts 1 & 2); Data Analysis Using SPSS; Epidemi- ology and Medical Statistics; Epidemiology & Environment Health; Biostatistics; Principles of Epidemiology; Special Epidemiology; Health Management; Village Health Care II & III; Nutrition & Health Education and a Hospital & Community Attachment

NEW CURRICULUM The Department of Family Medicine and Public Health is currently involved in Phase II and working on developing the Phase III of the new curriculum. In addition, the Department will be involved in the intercalated phase in the future. In Phase III, the Department will be responsible for Pre-clerkship, Senior Clerkship and Junior Clerkship programmes.

UNDERGRADUATE CLINICAL PROGRAMME Year 5 - Junior Clerkship in Family and Community Medicine About 130 students, in groups of 30, have a 10-week clinical rotation in the SQU Health Center and in 7 of the accredited MOH Health Centres. The aim of the rotation is to teach students the consultation skills and knowledge that are required to manage various health problems at the primary care level in Oman. Other courses included in this rotation are: evidence-based medicine, oral health and basic life support. Teaching strategies include Core Topics presentation and patient-centred case presentation.

Year 7 - Senior Clerkship In the final year of the MD programme, the students come for a 7 week rotation. The emphasis is on comprehensive management of the patient in the context of his/her family, culture, work and community. Daily clinical teaching takes place in the SQU Heath Center as well as in a number of accredited MOH health centres. The course also includes a full week of lectures on public health programmes (communicable and non- communicable diseases) in the Ministry of Health.

POSTGRADUATE PROGRAMME Family Medicine Residency training program The Department, along with the Oman Medical Specialities Board (OMSB), is actively involved in the teaching, training and examination of the Family Medicine residents. There were 53 Residents in the programme in this period at various levels of training. The exit examination MRCGP [INT] is accredited

68 by the Royal College of General Practitioners, UK.

M.Sc. Programme The following postgraduate courses were conducted by the Department’s Epidemiology and Medical Statis- tics Unit for the Master’s Programme: Statistics and Computers; Advanced Principles of Epidemiology; Ad- vanced Statistical Methods; Categorical Data Analysis; Applied Epidemiology; Statistical Methods in Quality Control; Epidemiology in Health Care Planning, as well as a Research Methodology course and a Research Project

Approval has now been received to start a Ph.D. programme in Epidemiology & Public Health

TRAINING COURSES & CME ACTIVITIES The Department arranged continuing medical education through journal clubs, seminars and workshops. These activities are open to doctors, nurses and paramedics from the Department, the MOH and also to Uni- versity Hospital personnel.

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

Patient services are provided at the SQU Health Center and Students Clinic. A total of 42,273 patients were seen at the Health Center. The Department has separate diabetes, antenatal & postnatal clinics besides the birth spacing and MOH Infertility programmes and the extended programme of immunisation for Mother & departments Child Health. The dermatology clinic gets referrals from all departments in SQU Hospital and different parts of the country for various procedures besides laser treatment. The Students Clinic serves all the University care

students for all of their primary health needs. The following clinics are offered: General Appointments, Walk- in, Diabetes, Antenatal & Postnatal, Immunisation/well baby, Birth spacing, Dermatology, Counselling. patient

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Clinical workload 2009-2010 in the Health Centre 2008 2009 2010 Total Patients Seen 39,000 43,073 42,273 Seen with appointments 19,222 23,539 21,165 Walk-in Patients 933 1,518 9,736 Vaccinations 4,057 9,481 7,078 Antenatal Clinics 1,247 1,467 1,111 Postnatal 127 126 30 Birth Spacing 61 161 47 Dermatology 3,510 4,092 4,704 Diabetic 299 311 253 Respiratory Therapist 182 89 95 Dietician 222 260 248 Treatment Room Services 1,631 1,817 2,005 Research RESEARCH PROJECTS Continuity of care in primary care - patient’s and health care professional’s views of continuity of care in Oman. Project Code: MREC #284; Dates: 2009 Value: OR 1,500; Project Funder: Sultan Qaboos University Investigators: Dr. Mohammed Al-Azri, Dept. Family Medicine & Public Health, SQU; Dr. Mohammed Al-Shafee, Dept. Family Medicine & Public Health SQU; Dr. Fat- ma Al-Ajmi, Directorate of Health Services, MOH, Oman; Dr. Salim Al-Saqri, Al Shadi Health Center, Directorate of Health Services, Ministry of Health, Oman; Dr.Abdullah Al-Maniri, Dept. Family Medicine & Public Health, SQU.

70 Assessing menopausal symptoms among healthy Omani families with the menopause rating scale. Project Code: MREC#303; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Kawther El Shafie, Dept. Family Medicine & Public Health, SQU; Dr. Mo- hammed Al Shafaee, Dept. Family Medicine & Public Health, SQU; Dr. Najat Al-Zadjali, Ministry of Health, Oman.

Impact of ACNE on the quality of life of SQU students Project Code: MREC#353; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Asma Al-Shidhani, Dept. Family Medicine & Public Health, SQU;; Dr. Samia Al-Rashdi, Dept. Family Medicine & Public Health, SQU.

A Study of the Nutritional and Metabolic Factors contributing to the Occurrence of Autistic Spectrum disorder among Children in the Sultanate of Oman Project Code: MREC#308; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Yahya Al-Farsi, Dept. Family Medicine & Public Health, SQU.

Health Care Provider’s Perceptions and Experiences of TB Control in Oman Project Code: MREC#309; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Abdullah Al-Muniri, Dept. Family Medicine & Public Health, SQU. departments Complementary and Alternative Medicine (CAM) in Diabetic Patients in Muscat Region Project Code: MREC#310; Dates: 2009 care

Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Raham Al-Kindi, Dept. Family Medicine & Public Health, SQU. patient A Comparison of Symptoms of Patients with Positive H1N1 Swab Test to the Symptoms of Patients with

Negative H1N1 Swab Test coming to H1N1 Clinic of SQUH and

Project Code: MREC#320; Dates: 2009 academic Family M edicine & P ublic H ealth

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Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Nafisa Samir, Dept. Family Medicine & Public Health, SQU.

Prevalence of Dysmenorrhea among adolescent girls in Muscat region Project Code: MREC#342; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Rahma Al Kindi, Dept. Family Medicine & Public Health, SQU.

Coping with diagnosis of breast cancer in Omani women Project Code: MREC#332; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Mohammed Al-Azri, Dept. Family Medicine & Public Health, SQU; Huda Al-Awisi, Dept. Family Medicine & Public Health, SQU; Dr. Mansour Al- Moundhri. Dept. Medicine, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. ElShafie K, Al Shaqsi A, Al Mahrouqi B, et al. The diagnostic yield of thyroid function testing and its cost-effectiveness in the student’s clinic in Sultan Qaboos University: A retrospective chart review. SQU Med J 2010; 10:93−9. 2. Theodorsson T, El Shafie K, Al Mahrezi A, Al Shafaee M, Al Wardy NA. Assessment of family doctors in Oman: Get- ting the questions right preliminary findings of a performance analysis of multiple choice questions. Internet J Med Educ 2010; 1: S 3. El Shafie K, Rizvi S. Control of hypertension among Type 11 diabetes. Oman Med J 2010; 25:32−6. 4. Gowri V, Shabnam S, Rizvi S. Saline infusion sonohysterography – An effective tool for evaluation of the endometrial cavity in women with abnormal uterine bleeding. Acta Obstet Gynecol Scand 2010; 89:140−2. 5. Al Jabri AA, AlMuharrani ZK, Balkhair AA, Ganguly SS. The importance of HIV antenatal screening programs for pregnant women. Saudi Med J 2010; 31:64−8. 6. Bousema T, Youssef RM, Cook J, Cox J, Alegana V, Amran J, Noor A, Snow R, Drakeley C. Serological markers can detect heterogeneity in malaria exposure in an area of very low transmission intensity in Somaliland. Emerg Infect Dis 2010; 16:392–9. 7. Youssef RM, Alegana V, Amran J, Absisalan N, Snow RW. Fever prevalence and management among three rural communities in the Republic of Somaliland. East Mediterr Health J 2010; 16:460–6. 8. Barakat MN, Youssef RM, Al Lawati JA. Pregnancy outcomes of diabetic women: Charting Oman’s progress towards saint Vvncent target. Ann Saudi Med 2010; 30:265–70.

72 9. Al Busaidi Z. Somatisation: A cross-cultural prospective. SQU Med J 2010; 10:180–6. 10. Al Busaidi Z. A qualitative study on the attitudes and beliefs towards help seeking for emotional distress in Omani women and general practitioners. Implication for post-graduate training. Oman Med J 2010; 25:190–8. 11. Al Farsi YM, Al Sharbati MM, Al Farsi OA, Al Shafaee M, Brooks DR, Waly MI. Prevalence of autistic spectrum disorders in Oman (brief report). J Autism Dev Disord 2010; doi:10.1007/s10803-010-1094-8. 12. Al Farsi YM, Brooks DR, Werler MM, Cabral HJ, Al Shafee MA, Wallenburg HC. Effect of high parity on the occurrence of prediabetes: A cohort study. Acta Obstet Gynecol Scand 2010; 89:1182−6. 13. Al Azri M, Ganguly S. Patient’s views of interpersonal continuity of care in four primary health care centres of urban Oman. SQU Med J 2009; 9:287−95. 14. Ganesh A, Pirouznia S, Ganguly SS, Fagerholm P, Lithander J. Consecutive exotropia after surgical treatment of childhood estropia: A 40-year follow-up study. Acta Opthalmol 2009 Nov 19 [Epub ahead of print]. 15. Ganguly SS, Al Shafaee MA, Bhargava K. Predicting dysglycemia in primary health care among the Omani adult population based on anthropometric measurements. J Diabetes 2009; 1: S. 16. Al Futaisi A, Wali Y, El Beshlawi I, Al Riyami S, Al Mahrezi A. Case study: Using a continuous glucose monitoring system in a patient with diabetes and beta-thalassaemia hemoglobinopathy. Pediatr Hematol Oncol 2009; 26:515−9. 17. De Costa A, Al Muniri A, Diwan VK, Eriksson B. Where are healthcare providers? Exploring relationships between context and human resources for health Madhya Pradesh Province, India. Health Policy 2009; 93:41−7. 18. Esmaily HM, Silver I, Shiva S, Gargani A, Maliki-Dizaji N, Al Maniri A, Wahlstrom R. Can rational prescribing be improved by an outcome-based educational approach? A randomized trial completed in Iran. J Contin Educ Health Prof 2010; 30:11−8. 19. Al Maniri A, Singh PJN, Al Rawas O, Al Busaidi S, Al Balushi L, Ahmed I, et al. A snapshot on biodiversity and clustering of mycobacterium tuberculosis in Oman using spolligotyping. Int J Tuberc Lung Dis 2010; 14:994−1000. 20. Al-Mandhari A, Al-Zakwani I, El-Shafie O,Al-Shafaee MA, Woodhouse N. Quality indicators of diabetes care: A cross sectional observational study in Oman. SQU Med J 2009:32–6. 21. Al-Mandhari A, Al-Adawi S, Al-Zakwani I, Al-Shafaee M, Eloul L. Relatives’ advice and health care seeking behaviour

in Oman. SQU Med J 2009; 9:264–71 departments

22. Al-Shafaee MA. Family medicine practice in Oman: present and future. SQU Med J 2009; 9:116–8. care

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CONFERENCE & SEMINARS PRESENTATIONS CONFERENCE PRESENTATIONS International 1. Al Waily A. Psioriasis. International Immune Mediated Diseases Conference. Derma Conference. Dubai, UAE, April 2009. 2. Theodorson T, El Shafie K, Al Mahrezi A, Khan A, Al Shafaee M. What makes a good question? Developing the MCQ/ Written paper in post graduate examination in Oman. A presentation at the AMEE Conference. Glasgow, UK, 5−8 September 2010.

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75 Annual Report 2009-2010 Genetics

enetics is at the heart of health sciences in Oman and the Arab World where genetic and congenital disorders are a serious health issue for many reasons: customary consanguineous marriage; high prevalence of haemoglobinopathies; high frequency of advanced parental age, and lack of public awareness and education about genetic disorders. Certain cultural traditions alsoG restrict the efforts for the prevention and control of genetic disorders. Genetics is a young department, with ample resources and potential, providing scientists and clinicians with unprecedented opportunities to make a difference to society. The mission of the Department is to provide state-of-the-art diagnostic services for patient care, education, research as well as public awareness raising in the field of genetics. While serving as a focal point for routine clinical services, the Department is committed to updating the ongoing routine diagnostic tests in cytogenetics and immunogenetics, and in addition to develop 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.

76 Molecular Genetics Rayhanah Al-Mjeni, Ph.D. Student Manal Al-Khanbashi, Ph.D. Student Khalsa Al-Kharousi, Biomedical Scientist Aisha Al-Naamani, Biomedical Scientist Feisal Al-Mahrizi, Biomedical Scientist Samia Al-Rashdi, Biomedical Scientist Clinical Genetics Fathiya Al-Murshedi, Registrar Maha Al-Awadi, Registrar Rahma Al-Jashmi, Biomedical Scientist Support staff Ghadeer Al-Zadjali, Coordinator Muna M. Al-Bimani, Research Assistant Lina N. Al-Mashhadani, Research Assistant Highlights of the Year 2009-2010 Cell culture was established as a core facility for the College of Medicine and Health Sciences. The icthyosis molecular diagnostic test has now been Staff introduced for routine molecular diagnostics. It is currently in the process of cross-validation in col- Faculty laboration with an accredited laboratory in the Cytogenetics Netherlands. Ms. Ghadeer Ahmed Al-Zadjali was departments Udayakumar, Associate Professor appointed as Coordinator of the Department. Robert Sigmani, Biomedical Scientist care

Lamya Al-Anbouri, Biomedical Scientist Shoma S. Raj, Biomedical Scientist Sami Al-Kalbani, Biomedical Scientist

Immunogenetics patient Varghese CM, Laboratory Supervisor

Hamad Al-Riyami, Chief Biomedical Scientist and

Faiza Al-Yahyai, Biomedical Scientist Suriyan Mani, Biomedical Scientist academic Genetics

77 Annual Report 2009-2010 Genetics

Teaching Programmes The Department of Genetics participates in teaching and training clinicians and medical science students.

UNDERGRADUATE PRECLINICAL PROGRAMME The Department is involved in a significant amount of teaching and training in the College of Medicine & Health Science. It contributes to the Molecular Biology and Principles of Genetics undergraduate preclinical courses with lectures on molecular genetics, cytogenetics, as well as participating in the annual teaching rotations and training of doctors and students proceeding to their 2nd or 3rd year of their degree. This is done through laboratory based workshops as follows: 1) a biannual workshop for training in standard laboratory techniques in molecular genetics, and 2) rotation of students and doctors in our laboratories (Cytogenetics, Immungenetics and Molecular genetics). This includes a training and observation course on genetic techniques organised in January and June of each academic year.

UNDERGRADUATE CLINICAL PROGRAMME The Department was involved in the following clinical teaching activities: 1) Clinical (bedside and outpatient) teaching for residents, senior house officers and registrars.2) 7th year MD student seminar in metabolic diseases in August 2010; 3) Man nursing institute, a two hours lecture in June 2010, and 4) a Genetics Lecture for 7th year medical Obstetrics & Gynaecology rotation students, repeated every 6 weeks with 25–28 students in each batch.

The Department participates in the teaching of the following courses in the Medical Laboratory Sciences (MLS) programme: Molecular Diagnosis and Biology of Disease, and provides lectures on cancer genetics and genethics.

Finally, the Department contributes to the teaching in the College of Nursing with lectures on genetics.

POSTGRADUATE PROGRAMME The Department takes part in senior house officer in-house training, and the Oman Medical Specialties Board residents training programme in Haematology/Biochemistry with lectures on cytogenetics, molecular genetics and immunogenetics.

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 for the staff and in genetics for Omani graduates from SQU and abroad.

78 Clinical & Diagnostic Services

200

Conventional karyotype 180 FISH

160

140

120

100

80 No. of Patients 60

LMM Urology Obs/Gyne Neonatal Genetics Medicine Child Health Royal Hosp.Diwan Clinic Delivery Ward Haematology (Adult) Paediatric NeurologyBehavioural Medicine Haematology (Paediatrics) Paediatric Endocrinology Departments Figure1: Patient Samples karyotyped and FISH tests done during (2010)

CLINICAL GENETICS The main objectives of the Clinical Genetics section is to provide a standard of care service for patients and families with genetic disorders including diagnosis, genetic counselling, management and social support in addition to teaching and research. During the period of June–October 2010, the clinical genetics team was involved in the management of hundreds of patients including inpatients consultations and outpatient clinics referrals. departments

For the time being, the service is trying to build up essential human and space resources to be capable of full functionality including recruiting genetic counsellors, a social worker and a clinical coordinator. The SQU care Hospital administration is strongly supporting these objectives by approving the needed staff posts and preparing patient care space for clinical genetics unit which is expected to be ready by early 2011. SQUH also started to support and fund molecular genetics testing in accredited international laboratories, in cases patient where genetic testing has a direct influence on patient and family care. and

The clinical genetics team also contributed to the care of metabolic patients and in teaching MD and postgraduate students. Research activities constituted a minor portion of the clinical genetics team activity, as we are still in the phase of establishing essential patient care resources. However, once established, research academic Genetics

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activities are expected to make up a significant portion of our duties in order to achieve our objectives of leading clinical genetics patient care, teaching and research in Oman.

CYTOGENETICS This section provides routine cytogenetic investigations (karyotyping) to clinical departments of SQUH using conventional and fluorescence in situ hybridisation (FISH) techniques. A prenatal diagnostic service was started in 2010. The total samples for conventional karyotyping were 546; total samples for FISH tests were 183, for prenatal cytogenetics (amniotic fluid) 1, and for product of conception (POC) 1. The grand total was 741. Figure 1 below shows major referrals from clinical department.

IMMUNOGENETICS The Immunogenetics Laboratory continued to provide diagnostic services to SQUH, and the Ministry of Health and Armed Forces hospitals. Compared to previous years, there was a significant increase in the number of samples received by the Laboratory. The tissue typing laboratory, run by 4 members of staff, is the only laboratory in Oman. Due to service expansion, the laboratory has been under extreme pressure. As SQUH is going to expand the Bone Marrow Transplantation Unit and reactivate it renal transplantation programme, this will lead to a further increased in workload. The laboratory is also in process of establishing a national bone marrow registry, an important development in the search for unrelated bone marrow donors.

In the year 2010, the Laboratory introduced three more techniques as part of its service for a trial period and validation: 1) Flow cytometry cross match for renal transplantation (FCXM); 2) Sequencer based tissue typing (SBT) i.e. high resolution technique. This is necessary for unrelated bone marrow transplantation and for the bone marrow registry; 3) Luminex technique, this will help for (PRA) lymphoscreening and post-transplant monitoring. In 2011, these tests are expected to be available as part of the laboratory diagnostic service.

The tissue typing laboratory is hoping to provide a high quality service and attain international standards. We are therefore in the process of establishing relationships with international laboratories which will support our effort for quality assurance, certification and accreditation.

Tables 1 and 2 summarise the number of tests performed by the National Tissue Typing Laboratory in the year 2010, also shown by category of patient/donor.

MOLECULAR GENETICS The Molecular Genetics section has been recently established section to provide routine molecular diagnosis in addition to banking DNA samples collected from the patients attending our recently initiated genetics clinic. Our aim is to develop new molecular tests for the most common genetic diseases observed at SQU Hospital. Pursuant to this goal, we are adopting the following strategy: 1) Identify the most common genetic

80 Table 1: Types of tests performed every month National Tissue Typing Laboratory in 2010

Tests Serological Method Extracted DNA Molecular Method Total AB X/M PRA A B C DR DQ

January 69 16 18 39 43 42 44 42 43 317 February 47 9 9 41 44 43 34 44 35 265 March 69 8 7 61 67 67 67 64 62 411 April 81 12 10 54 52 52 54 51 51 363 May 112 14 19 54 53 52 50 50 50 400 June 5 15 9 94 89 94 89 56 53 410 July 4 2 72 67 63 63 28 28 255 August 31 11 3 86 79 85 80 50 45 384 September 30 3 0 29 36 47 49 42 38 245 October 0 19 0 58 57 57 56 32 32 253 November 18 7 0 51 54 53 53 35 35 255 December 24 15 15 21 23 22 22 16 16 153 Total 486 133 92 660 664 677 661 510 488 3,711

Legend: X/M = Renal crossmatch; PRA (LYM-SCR) = Lymphoscreen departments

Table 2: Tests in 2010 according the patient/donor category care National Tissue Typing Laboratory tests in 2010 BMP BMD RP RD DIS TOTAL according to the patient’s category/donors

Totals 116 539 108 110 21 894 patient

Legend: BMP= Bone marrow patient; BMD= bone marrow donor; RP= renal patient ;RD= renal donor ; DIS= disease association. and

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81 Annual Report 2009-2010 Genetics

diseases observed at SQUH; 2) Identify technical and equipment needs to develop tests for these diseases; 3) Provide in–house or external specialised training of staff; 4) Develop tests (research and development), and cross validate them for a period of one year in an accredited diagnostic laboratory. Our molecular tests are divided into the following categories: 1) routine molecular diagnostic tests; 2) ichthyosis, and 3) acute lymphoblastic leukaemia. The following test are still at the research and development stage: inborn errors of metabolism; cystic fibrosis; spinal muscular atrophy (SMA); fragile X (FRAX); myotonic dystrophy (DM); Feingold syndrome, and colorectal cancer.

In 2010, 339 samples were received for both diagnosis and research and development towards establishment of diagnostics. In the same period, 179 samples were received for diagnosis (65 internal and 114 external). A total of 160 samples were received for research and development for different genetic disorders (SMA, FRAX, DM, Feingold syndrome and colorectal cancer) and for DNA banking.

Research RESEARCH PROJECTS From Gene Expression Analysis of Omani Breast Tumours to Biomarkers/Candidate Gene Discovery Project Code: SR/MED/GENT/10/01; Dates: 2010–2011 Value: OR 207,850; Project Funder: His Majesty’s Strategic Research Fund, Oman Investigators: Dr. Allal Ouhtit, Dept. Genetics, SQU; Dr. Yahya Al-Tamimi, Dept. Biochemis- try, SQU; Dr. Mansour Al-Moundhri, Dept. Medicine, SQU; Dr. Said Al-Yahy- aee, Dept. Genetics, SQU; Prof. Madhwa HG Raj, LSU Health Sciences Center, New Orleans, USA; Prof. Herlyn Meenhard, Dept. Dermatology, Wistar Insti- tute, Pennsylvania, USA.

Molecular Epidemiology and Diagnosis Study of Common Inborn Errors of Metabolism Disorders in Oman and UAE Project Code: CL-SQU/UAE/10/01; Dates: 2010–2011 Value: OR 20,000; Project Funder: Sultan Qaboos University and UAE University Investigators: Dr Said Al-Yahyaee, Dept. Genetics SQU; Dr. Bassam R.Ali, Dept. Pathology, UAE University; Dr. Allal Ouhtit, Dept. Genetics, SQU; Prof. Yousef Abdulraz- zaq, Dept. Paediatrics, UAE University; Dr. Jozef Hertecant, Dept. Paediatrics, Tawam Hospital, UAE; Dr Mahera Abdulrahman, Dubai Genetics Center, UAE; Dr. Hussein Al-Kindi, Dept. Child Health, SQU; Dr. SN Joshi, Dept. Child Health, SQU.

82 Family and Genetic Understanding of Autosomal Recessive Disorders: A Clinical Genetic, Cytogenetic, Molecular and Linkage Study in Oman. Project Code: SR/MED/GENT /06 /01; Dates: 2006–2011 Value: OR 168,850; Project Funder: His Majesty’s Strategic Research Fund, Oman Investigators: Prof. John Raeburn, Dept. Genetics, SQU; Dr. Aisha Al-Khayat, Dept. Biolo- gy, SQU; Dr. Ahmed Al-Mandhari, Dept. Family Medicine & Public Health, SQUH; Dr. A.M Udayakumar, Dept. Genetics, SQU; Ms. Rayhana Al-Mjeni, Dept. Genetics, SQU; Dr. Shyam Gangly, Dept. Epidemiology & Statistics, SQU; Dr. Mohamed Al-Shafaee, Dept. Family Medicine & Public Health, SQU; Dr. Anuradha Ganesh, Dept. Ophthalmology, SQUH; Prof. Riad Bayoumi, Dept. Biochemistry, SQU; Dr. Yasser Wali, Dept. Child Health, SQU; Dr. David Dennison, Dept. Haematology, SQU.

Cytogenetics and Molecular Characterization of Chronic Myeloid Leukaemia Project Code: IG/MED/GENE /08/01; Dates: 2008–2010 Value: OR 5,500; Project Funder: Sultan Qaboos University Investigators: Dr. A.M. Udayakumar, Dept. Genetics, SQU; Dr. Salam Al-Kindi, Dept. Hae- matology, SQU.

Assessment of the Role of Consanguinity & Cytogenetic Abnormalities in Individuals with Recurrent Miscarriage among Omani population Project Code: MREC# 345; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigator: Dr. A.M. Udayakumar, Dept. Genetics, SQU; 6th & 7th year students of Genet- ics Dept., SQU. departments

Molecular Epidemiology and Diagnosis of Common Inborn Errors of Metabolism Disorders in Oman and

UAE care

Project Code: MREC# 354; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University patient Investigators: Dr. Said Al-Yahyaee, Dept. Genetics, SQU and

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83 Annual Report 2009-2010 Genetics

Establishment of Molecular Genetics Diagnostics Project Code: MREC# 356; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Allal Ouhtit, Dept. Genetics, SQU

Signal transduction mechanisms of CD146 cell adhesion receptor in Breast Cancer in Oman Project Code: MREC# 334; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigator: Dr. Allal Ouhtit, Dept. Genetics, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Ouhtit A, Trappy A, Fernando A, Gaur R, Raj M. The shady side of sunlight: Current understanding of the mechanism underlying UV-induction of skin cancers. Front Biosci (Schol Ed). 2010; 2:11−7.

84 departments

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85 Annual Report 2009-2010 Haematology

he Department of Haematology functions both as a major clinical and laboratory medicine department. It plays a pivotal role in the teaching of haematology to undergraduate medical students (MD), postgraduate students of medicine who have opted to specialise in medicine, and Oman Medical Specialty Board (OMSB) residents in haematology, as well as medical laboratory technicians in the B.Sc. Medical Laboratory Sciences course. Our laboratory provides state of the art haematology testing for the Uni- versityT Hospital (SQUH) and referral services to other private hospitals, as well as highly specialised testing such as flowcytometric and molecular haematological analysis for haematological condition diagnostics for the whole of Oman.

86 Fehmida Zia, Registrar Fauzia Wasim, Registrar Abdulmanan Adulgafoor, Registrar Mehwesh Taj, Registrar Vinodh Panjwani, Senior House Officer Najwa Abdulhameed, Senior House Officer Ghasan Ageed, Senior House Officer Mohamed Rehan, Senior House Officer Moez HA Rhim, Senior House Officer Support Staff Stuart Donaldson, Superintendent David Gravell, Chief Biomedical Scientist Heidi M. Davis, Chief Biomedical Scientist Shakila Ashraf, Senior Biomedical Scientist Ali Al-Marhoobi, Senior Biomedical Scientist Hamood Al-Haddabi, Senior Biomedical Scientist Rodrigo Villacrusis, Senior Biomedical Scientist Maria Cicillia, Senior Biomedical Scientist Abdulrehman N. Rashid, Senior Biomedical Scien- tist Qamariya Al-Abri, Biomedical Scientist Mariyam Al-Brashdi, Biomedical Scientist Staff Sabah Al-Mahrooqi, Biomedical Scientist Sahima Al-Mamari, Biomedical Scientist Faculty Saif Al-Hosni, Biomedical Scientist Chao Hung Ho, Professor Hamed Al-Gheithi, Biomedical Scientist departments Shahina Daar, Associate Professor Shoaib Al-Zadjali, Biomedical Scientist David Dennison, Senior Consultant Sumaya Al-Hinani, Biomedical Scientist care

Anil Pathare, Senior Consultant Asma A. Musleh, Biomedical Scientist Naglaa Fawaz, Senior Consultant Karima Al-Falahi, Biomedical Scientist Mohammad Huneini, Consultant Badriya Al-Belushi, Biomedical Scientist Bushra Al-Said, Biomedical Scientist Khalil Al-Farsi, Consultant patient Murtadha Al-Kabori, Consultant Mohammed Al-Rawahi, Biomedical Scientist

Nadeem Nusrut, Senior Registrar Muna Al-Maskari, Biomedical Scientist and

Zeba Zabeen, Senior Registrar Ishaq Al-Salmi, Biomedical Scientist Hammad Khan, Senior Registrar Deuel M. Labrador, Biomedical Scientist academic haematology

87 Annual Report 2009-2010 Haematology

Enrique O. Pedojan, Biomedical Scientist Eufrosina Alverez, Biomedical Scientist Julian Neson, Biomedical Scientist Mohan Doraiswamy, Biomedical Scientist Nestor Naniong, Biomedical Scientist Rene Gabucay, Biomedical Scientist Allan S. Aurelio, Biomedical Scientist Adela Angeles, Biomedical Scientist Melani Tauro, Biomedical Scientist Malvin J. Wee Li, Biomedical Scientist Vardarajan Nelvoy, Biomedical Scientist Lancy Henry, Biomedical Scientist Rhea Misquith, Biomedical Scientist Rosamma Soney, Head Staff Nurse Binny Sam, Senior Staff Nurse Rose Saly, Staff Nurse 2 Mary Kurian, Staff Nurse - ICH3 Victoria G Menezes, Staff Nurse 2 Shiney Thomas, Staff Nurse 2 Salva Kumari, Staff Nurse 2 Bindu Shiby, Staff Nurse 2 Eman Al-Homaidi, Coordinator Tomichan Varghese, Coordinator Ibrahim Al-Amri, Coordinator Highlights of the Year 2009-2010 In 2009–2010, the clinical unit treated patients with a vast range of haematological disorders, both as inpatients and outpatients. In addition, the Department runs a thalassaemia day care unit. In 2010, it offered comprehensive care for about 142 patients with transfusion dependent thalassaemia. Of national interest is the successful bone marrow transplant programme, run by this department. By the end of Dec. 2010, a total of 175 allogeneic bone marrow transplants had been performed in this centre, with results as good as those from the best centres around the world.

88 Teaching Programmes UNDERGRADUATE PROGRAMME In this period the Department has: 1) participated in teaching the Haemato-Lymph-Vascular course to the third year students; 2) developed and taught a new module in phase 2 of the undergraduate curriculum on hemato-lymphatic-immunology; 3) participated and coordinated the various courses in phase 2 of the new curriculum, in particular Integrated modules I, II, III; 4) run a 5 week course on case-based learning, in Haema- tology for the 5th year students in the Integrated Lecture Series (ILS); 5) participated in bedside clinical teaching in Medicine; 6) run Laboratory rotations for 6 groups of 7th year students, each rotation of 5 days duration; 7) run a B.Sc MLS degree course for training undergraduate biomedical scientists.

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

Clinical & Diagnostic Services The clinical services centre on the following major areas; adult outpatients, adult inpatients; bone marrow transplantation, sickle cell anaemia programe; the leukaemia, lymphoma and myeloma programme, and the thalassaemia day care unit. The laboratory services likewise cover specialised areas: haemostasis, flowcy- tometry, haemoglobinopathy, molecular diagnostics, general laboratory haematology and the blood transfusion service which includes blood donation, storage, irradiation, plasmapheresis and exchange and apheresis facilities as well as the blood grouping and cross matching laboratory.

BONE MARROW TRANSPLANTATION PROGRAMME departments The bone marrow transplant programme, established in 1995 in the Department, serves the entire country and continues to provide curative treatment for patients with haematologic malignancy, bone marrow care failure and potentially fatal genetic diseases. In 2010, 22 transplants were performed, making a total of 175 transplants 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. patient

SICKLE CELL PROGRAMME and

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 academic H aematology

89 Annual Report 2009-2010 Haematology

has been highlighted through our community outreach programmes via the Hereditary Blood Disorders Society.

LEUKAEMIA LYMPHOMA AND MYELOMA PROGRAMME The Department is now an important tertiary care centre for most referrals for adult haematological malignancies particularly leukaemias, and myeloma. Our patients are able to receive state-of-the-art care both in terms of diagnostic and therapeutic modalities, including bone marrow transplant (BMT) and the advanced molecular diagnostics needed for proper follow-up.

THALASSAEMIA UNIT 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 and complications of the disease and its treatment. The unit is a centre of excellence in the region with heavy involvement in care and research including participation in an international drug trial (Exjade). The unit has recently acquired the latest state of art MRI T2* equipment for monitoring the cardiac and liver iron overload status which has improved the monitoring of iron overload in these patients.

HAEMATOLOGY CLINICS AT THE NEW 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- Madhani, from the Department of Medicine, Sohar Hospital.

GENERAL LABORATORY SERVICES The Haematology Laboratory caters to 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.

90 CORD BLOOD BANK The Department, in collaboration with the Department of Obstetrics & Gynaecology, 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 programs: a) sibling cord blood (SCB) and, b) unrelated cord blood (UCB). Up to August 2010, we had collected a total of 73 SCB units and 41 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 and Cobe Spectra apheresis systems and our apheresis nurses and technicians are trained in their use. Both of these systems are now in routine use for harvesting stem cells from donors in the Department’s Bone Marrow Transplantation program and platelet apheresis. Moreover, apheresis services are now made available, in consultation with the attending haematologist on duty, to the SQUH wards and ICU 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. The 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.

Table 1: Haematology Laboratory Activities

Year Number of Patients % increase over last Tests & Procedures % Change on year previous year Jan-Dec departments

2007 11,7631 -12.1% 48,5060 -2.5% 2008 14,7799 +25.6% 59,8309 +23.3% care 2009 17,7568 +20.1% 71,2520 +19.1% 2010 19,8109 +11.6% 77,8662 +9.3% patient

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91 Annual Report 2009-2010 Haematology

Table 2: Clinical Workload

Year Haematology % Change Haematology % Change Haematology % Change on Jan-Dec Inpatients on Previ- Day Care on Previ- Outpatients Previous Year ous Year ous Year 2007 1416 +5.3% 3078 -10.5% 2826 +6.2% 2008 1409 -0.5% 3035 -1.4% 3428 +21.3% 2009 1887 +33.9% 3127 +3.0% 4181 +22.0% 2010 1869 -1.0% 3271 +4.6% 4407 +5.4%

Research RESEARCH PROJECTS Establishment of a national facility in stem cell translation research for novel cellular-based therapies and tissue repair Project Code: SR/MED/ HAEM/09 /01; Dates: 2009–2011 Value: OR 165,000; Project Funder: His Majesty’s Strategic Fund, Oman Investigators: Dr. David Dennison, Dept. Haematology, SQU; Dr. Sultan Al-Maskari Dept. Surgery, SQU; Dr. Anil Pathare, Dept. Haematology, SQU; Dr. Salam Al-Kindi, Dept. Haematology, SQU; Dr. Khalil Al-Farsi, Dept. Haematology, SQU; Dr. Mohammed Al-Hunieni, Dept. Haematology, SQU; Dr. Nagla Fawaz, Dept. Haematology, SQU; Ms. Qamariya Al-Abri, Dept. Haematology, SQU; Ms. Sahima Al-Maamaari, Dept. Haematology, SQU; Ms. Sabah Al-Mahrooqi, Dept. Haematology, SQU; Ali Al-Mahroobi, Dept. Haematology, SQU; Hamed Al-Gheiti, Dept. Haematology, SQU; Shoaib Al-Zadjali, Dept. Haematology, SQU; Melanie Tauro, Dept. Haematology, SQU; Dr. Yasser Wali, Dept. Child Health, SQU; Dr. Abdulhakeem Rawas, Dept. Child Health, SQU; Dr. Mu- hanna Al-Muslahi, Dept. Haematology, Royal Hospital, Oman ; Dr. Hamoud Al-Dhuli, Dept. Radiology, SQU; Dr. Rashid Al- Sukaiti, Dept. Radiology & Mo- lecular Imaging, SQU; Dr. Shyam Ganguly, Dept. Family Medicine & Public Health, SQU; Dr. Helmut Schuster, Dept. Microbiology & Immunology, SQU; Dr. Adeeb Al-Zoubi, Jordan University, Jordan.

92 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 Project Code: RC/MED/HAEM/10/01; Dates: 2010-2012 Value: OR 68,300; Project Funder: The Research Council, Oman Investigator: Dr. Salam Al-Kindi, Dept. Haematology, SQU; Dr. Muhammed Al-Hunaini, Dept. Haematology, SQU; Dr. Khalil Al-Farsi, Dept. Haematology, SQU; Dr. Anil Pathare, Dept. Haematology, SQU; Dr. Nagla Fawaaz, Dept. Haematol- ogy, SQU; Shoaib Al-Zadjali, Dept. Haematology, SQU; Hamood Al-Haddabi, Dept. Haematology, SQU; Dr. R. Krishnamoorthy, INSERM U 763, Paris, France.

Pharmacogenomic factors affecting warfarin dosing: Rationale for prospective genetic screening before anticoagulation therapy Project Code: IG/MED/HAEM/09/01; Dates: 2009–2010 Value: OR 5,400; Project Funder: Sultan Qaboos University Investigator: Dr. Anil Pathare, Dept. Haematology, SQU; Dr. Salam Al-Kindi, Dept. Hae- matology, SQU; David Gravell, Dept. Haematology, SQU; Shoaib Al-Zadjali, Dept. Haematology, SQU; Hamood Al-Haddabi, Dept. Haematology, SQU; Dr. R. Krishnamoorthy, INSERM U 763, Paris, France.

Genetic basis of variable expression of fetal hemoglobin in sickle cell disease and beta thalassaemia patients from Oman Project Code: IG/MED/HAEM/10/01; Dates: 2010–2011 Value: OR 4,700; Project Funder: Sultan Qaboos University Investigator: Dr. Anil Pathare, Dept. Haematology, SQU; Dr. Salam Al-Kindi, Dept. Hae- departments matology, SQU; Mohammed Al-Hunieni, Dept. Haematology, SQU; Dr. Khalil Al-Farsi, Dept. Haematology, SQU; Dr. Shahina Daar, Dept. Haematol-

ogy, SQU; Shoaib Al-Zadjali, Dept. Haematology, SQU; Sahima Al-Maamari, care Dept. Haematology, SQU; Dr. R. Krishnamoorthy, INSERM U 763, Paris, France.

Safety profile and therapeutic use of back ink from Omani fishes in two experimental models of osteopo- patient

rosis in rats Project Code: IG/MED/HAEM/10/02; Dates: 2010–2011 and

Value: OR 11,500; Project Funder: Sultan Qaboos University Investigators: Dr. Haddia Berehi, Dept. Medical Physics, SQU; Prof. Badreldin Ali, Dept. academic H aematology

93 Annual Report 2009-2010 Haematology

Pharmacology & Clinical Pharmacy, SQU; Dr. Kamran Malik, Dept. Surgery, SQU; Dr. Khaled Malgat, Dept. Chemistry, SQU; Dr Aisha Al-Hamadani, Dept. Pathology, SQU.

Role of von Willebrand factor on the occurrence of vaso-occlusive crisis in patients with sickle cell disease. Project Code: IG/MED/ HAEM/10/02; Dates: 2010–2012 Value: OR 11,500; Project Funder: Sultan Qaboos University Investigator: Mohammed Al-Hunieni, Dept. Haematology, SQU; Dr. Anil Pathare, Dept. Haematology, SQU; Dr. Prof. Ho Chao-Hung, Dept. Haematology, SQU; Da- vid Gravell, Dept. Haematology, SQU; Shoaib Al-Zadjali, Dept. Haematology, SQU; Qamariya Al-Abri, Dept. Haematology, SQU; Vinod Panjwani, Dept. Haematology, SQU; Hamed Khan, Dept. Haematology, SQU.

Prevalence of abnormal bone densitometry findings in individuals with homozygous beta thalassaemia Project Code: MREC #325; Dates: 2010–11 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Shahina Daar, Dept. Haematology, SQU, Dr. Samir Hussein, Dept. Radiol- ogy & Molecular Imaging, SQU, Mohammed Al-Hunieni, Dept. Haematol- ogy, SQU.

Prevalence of optimal monitoring of kidney function in relation to patients with thalassaemia. Project Code: MREC #351 Dates: 2010–2011 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Shahina Daar, Dept. Haematology, SQU; Dr. Sunil Bhandari, Hull York Medical School, UK; Dr. Khalid Al-Rasadi, Dept. Biochemistry, SQU; Humoud Al-Dhuhli, Dept. Radiology & Molecular Imaging, SQU; Surekha Mevada, Dept. Child Health, SQU; Dr Hammad Khan, Dept. Haematology, SQU.

Evaluation of cardiac and liver iron load by MRI T2* Project Code: MREC #361; Dates: 2010–2011 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Shahina Daar, Dept. Haematology, SQU; Humoud Al-Dhuhli, Dept. Radi- ology & Molecular Imaging, SQU.

94 Prevalence of endocrinopathies in thalassaemia major patients, correlation with total body iron load and cardiac iron load Project Code: MREC #344; Dates: 2010–2011 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Shahina Daar, Dept. Haematology, SQU; Dr Khalil Al Farsi, Dept. Haema- tology, SQU; Dr. David Dennison, Dept. Haematology, SQU; Dr Fehmida Zia, Dept. Haematology, SQU; Dr Moez HA Rhim Dept. Haematology, SQU.

Clinical effects of Nicosan TM to reduce the occurrence vasoocclusive crisis patients with sickle cell disease Project Code: MREC# 352; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Salam Al Kindi, Dept. Haematology, SQU

Retrospective analysis of Sickle cell patient with PORT-A-CATH insertion to analyze complications of PORT-A-CATH in patients with Sickle cell Disease Project Code: MREC# 357; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Salam Al Kindi, Dept. Haematology, SQU

Evaluation of Cardiac and Liver Iron Load by Cardiac MRI (T2*) Project Code: MREC# 361; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Shahina Daar, Dept. Haematology, SQU departments

Causes and Outcome of Fever in patients with Sickle cell Disease care

Project Code: MREC# 362; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Khalil Al Farsi, Dept. Haematology, SQU patient

Acute Chest Syndrome in Sickle Cell Patients during Pregnancy: Risk Factors and Outcome and Project Code: MREC# 363; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University academic H aematology

95 Annual Report 2009-2010 Haematology

Investigators: Dr. Khalil Al Farsi, Dept. Haematology, SQU.

Causes of Prolonged Prothrombin Time and Activated Partial Thromboplastin Time Project Code: MREC# 364; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Khalil Al Farsi, Dept. Haematology, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Pathare AV, Taher A, Daar S. Deferasirox (Exjade(R)) significantly improves cardiac T2* in heavily iron-overloaded patients with beta-thalassemia major. Ann Hematol 2010; 89:405−9. 2. Alkindi S, Al Zadjali S, Al Madhani A, Daar S, Al Haddabi H, Al Abri Q, Gravell D, Berbar T, Pravin S, Pathare A, Krish- namoorthy R. Forecasting hemoglobinopathy burden through neonatal screening in Omani neonates. Hemoglobin 2010; 34:135−44. 3. Alkaabi JK, Pathare A. Pattern and outcome of vascular involvement of Omani patients with Behcet’s disease. Rheumatol Int 2010; Feb 4, [Epub ahead of print].

4. Battersby AJ, Knox-Macaulay HH, Carrol ED. Susceptibility to invasive bacterial infections in children with sickle cell disease. Pediatr Blood Cancer 2010; 55:401−6. 5. Alkindi S, Khan S, Riyami D, Farooqi M, Pathare A. Coexistence of immune thrombocytopenic purpura and idiopathic membranous glomerulonephritis successfully treated with rituximab. Platelets 2010; 12 July. [Epub ahead of print].

7. Taher AT, Musallam KM, Karimi M, El-Beshlawy A,Belhoul K, Daar S, Saned M, Cassaretti C, Cappellini M. Splenec- tomy and thrombosis: the case of thalassaemia intermedia. J Thromb Haemost 2010; June [Epub ahead of print].

8. Taher A, Musallam K, El-Beshlawy A, Karimi M, Daar S, Belhoul K, et al. Age-related complications in treatment- naïve patients with thalassemia intermedia. Br J Haem 2010; April [Epub ahead of print].

9. Taher A, Al Jefri A, Elalfy MS, Al Zir K, Daar S, Rofail D, et al. Improved treatment satisfaction and convenience with deferasirox in iron-overloaded patients with thalassaemia: Results from the Escalator Trial. Acta Hematologica 2010; 123:220−5. 10. Taher A, Musallam K, Karimi M, El-Beshlawy A, Belhoul K, Daar S, et al. Overview of practices in thalassemia intermedia management aiming for lowering complication-rates across a region of endemicity: the OP- TIMAL CARE study. Blood 2010; 115:1886−92.

96 11. Al-Khabori M, Minden MD, Yee KWL, et al. Improved survival using an intensive, pediatric-based chemotherapy regimen in adults with T-cell acute lymphoblastic leukemia. Leukemia & Lymphoma 2010; 51:61−5. 12. Khabori MA, El-Emary M, W Xu, Guyatt G, et al. Impact of intensity of the conditioning therapy in patients aged 40 to 60 years with acute myeloid leukemia/ myelodysplastic syndrome undergoing allogeneic transplantation. Bone Marrow Transplantation 2010; July [Epub ahead of print].

13. de Almeida JR, Al Khabori M, Guyatt GH, et al. Combined corticosteroid and antiviral treatment for Bell’s palsy: Asystematic review and meta-analysis. JAMA 2009; 302:985−93. 14. El-Emary M, Khabori MA, Buitron N, et al. Long term outcomes of allogeneic stem cell transplantation for chronic lymphocytic leukemia. Biol Blood Marrow Transpl 2010; 16:S275−6. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Pathare AV, Al Zadjali S, Misquith R, Alkindi S, Dennison D, Pravin S, Berbar T, Krishnamoorthy R. Pharmacoge- nomic variants of CYP2C9, CYP4F2 and VKORC1 and its relation to warfarin response in native Omani patients. 15th Congress of the European Hematology Association. Barcelona, Spain, 10–13 June 2010.

2. Daar S, Al Salmi F, Ableen V, Jacob W, Jabeen Z, PathareA. T2* MRI- an effective tool to increase chelation compliance in thalassaemia major. 15th Congress of the European Hematology Association. Barcelona, Spain, 10–13 June 2010. Conference Posters International 1. Al-Khabori MK, El-Emary M, Guyatt G, Galal A, Kuruvilla J, Lipton JH, et al. Impact of the intensity of conditioning therapy on the outcomes of patients aged 40 to 60 years with acute myeloidleukemia/myelodys- departments plastic syndrome undergoing allogeneic hematopoietic cell transplantation. American Society of Hae- matology, Annual Meeting. New Orleans, USA, 5−8 December 2009. Pub. in: Blood (ASH Annual Meeting care

Abstracts) 2009; 114:1202.

2. Al-Khabori MK, Almeida J, Guyatt G, Kuruvilla J, Crump M. High dose chemotherapy and autologous stem cell transplantation in the primary therapy of advanced follicular lymphoma in adults: A systematic review patient

and meta-analysis of randomized clinical trials. American Society of Haematology, Annual Meeting. New Orleans, USA, 5−8 December 2009. Pub. in: Blood (ASH Annual Meeting Abstracts), 2009; 114:2314. and

3. Khabori MA, El-Emary M, Messner H, et al. Two-digit resolution typing of class-I human leukocyte antigen (HLA) does not compromise outcomes in adults undergoing matched unrelated allogeneic bone marrow academic H aematology

97 Annual Report 2009-2010 Haematology

transplantation. Symposium of the American Society for Blood and Marrow Transplantation. Milano Italy, 27−29 March 2009. Pub. in: Blood Marrow Transpl 2010; 16:S219. 4. AlMadhani A, Alkindi S, AlZadjali S, Misquith R, Pathare A, Krishnamoorthy R. Neonatal screening of newborns: Targeted versus universal approach as a cost effective strategy. 15th Congress European Hematol- ogy Association. Barcelona, Spain, 10–13 June 2010.

5. Ho CH, Gravell D. Can very high value of D-dimer predict the presence of thromboembolic disorders? 15th Congress of the European Hematology Association. Barcelona, Spain, 10-13 June 2010. Pub. in: Haemato- logica 2010; 95:292 (Abstract 699).

6. Taher A, Musallam K, El-Beshlawy A, Karimi M, Daar S, Belhoul K, et al. Age-related complications in treatment- naïve patients with thalassemia intermedia. 15th Congress of the European Hematology Association. Barcelona, Spain, 10–13 June 2010.

7. Musallam K, Cappellini M, El-Beshlawy A, Karimi M, Daar S, Belhoul K, et al. Splenectomy and thrombosis: the case of thalassaemia intermedia. 15th Congress of the European Hematology Association. Barcelona, Spain, 10-13 June 2010. National 1. Pathare AV, Al Zadjali S, Misquith R, Alkindi S, Krishnamoorthy R. Pharmacogenomic variants of CYP2C9, CY- P4F2 and VKORC1 and its relation to warfarin response in native Omani patients. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2009. Seminar Presentations International 1. Alkindi S. Sickle cell disease program at the Sultan Qaboos University Hospital, 1st Haematology Update Conference. Manama, Bahrain, May 2010.

2. Daar S. Iron chelation in Beta thalasaemia, 1st Haematology Update Conference. Manama, Bahrain, May 2010. 3. Daar S. Myocardial T2* MRI for Diagnosis & Follow-up of cardiac Siderosis in Thalassaemia; 1st Haematology Update Conference. Manama, Bahrain, May 2010. 4. Daar S. Exjade – The Oman Experience. Gulf Thalassaemia Workshop. Dubai, UAE, Feb 2010, National 1. Alkindi S. Update on CML, Crown Plaza, Muscat, Oman, November 2009. 2. Alkindi S. Update on Current status of SCD in Oman. Advanced General Medical Conference, Sultan Qaboos Unvier- sity, Muscat, Oman, February 2010. 3. Alkindi S. Comprehensive care of patients with Sickle cell disease, Sohar Hospital, Oman, March 2010.

98 4. Alkindi S. General overview of hereditary blood disorders, Hereditary Blood Disorder Society, Muscat, Oman, April 2010. 5. Alkindi S. Update on Bortezomib. Grand Hyatt, Muscat, Oman, May 2010. 6. Alkindi S. Laboratory Investigations & Management of thrombophilia. Ibra Hospital, Oman, May 2010.

7. AlFarsi K. Clinical cases with thrombophilia. Oman Hematology Forum, Blood Club. Al Sawadi Hotel, Oman, Jan- uary 2010. departments

care

patient

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academic H aematology

99 Annual Report 2009-2010 Human & Clinical Anatomy

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 Department’s main teaching load is in the pre-clinical programme (B.Sc.. Health Sciences). It shares this with other basic medical sciences departments in the delivery of integrated system courses. However, it also teaches a few department-based courses. Teaching focuses on grossT 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 of Surgeons (FRCS), and students from the College of Nursing.

In addition, the Department’s input includes teaching clinical and applied anatomy and applied cytogentics to Oman Medical Spe- cialty Board candidates. Postgraduate teaching involves the teaching of advanced histology and embryology to candidates specialis- ing 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. The Department makes modest contributions to the College’s Master’s Programme.

100 Maimouna Al-Rawahi, Senior Registrar Adhari Abdullah Al-Zaabi, Senior House Officer Support Staff Aida Al-Wahaibi, Superintendent Abdulgaffar El-Hag, College Superintendent Nasser Al-Hashmi, Biomedical Scientist Nawal Al-Mukheini, Biomedical Scientist Sulaiman Al-Khiyari, Biomedical Scientist Talal Al-Hassani, Biomedical Scientist Prem Tilaka, Biomedical Scientist Indrani Arambewela, Biomedical Scientist Alexander George, Coordinator Highlights of the Year 2009-2010 Prem Tilaka and Indrani Arambewela joined the Department in October 2009 as biomedical scientists. Visiting consultants were Dr. Sadhana Roy- choudhury from September 2009 to June 2010 and Dr. Pushpa Dhar from January to June 2010. Mr. Abdulgaffar El-Hag was promoted to College Research continued to be pivotal to the academic Superintendent from January 2010. Dr. Aida Al- activities of the Department. This embraces hyper- Wahaibi was promoted to Department Superin- tension, immune response to pregnancy, calcifica- tendent from January 2010. Musallam Al-Alawi, tion and bone resorption, bone marrow cells and Biomedical Scientist, transferred to the Medical departments blood cells, medical education, medical informatics Laboratory Sciences laboratory in January 2010. and curriculum development. Nawal Al- Mukheini completed her MSc. in Octo- care

ber 2009. Staff patient Faculty Omar Habbal, Associate Professor and Luben Tchakarov, Assistant Professor Varna Taranikanti, Assistant Professor academic human & clinical anatomy

101 Annual Report 2009-2010 Human & Clinical Anatomy

Teaching Programmes PRE-CLINICAL PROGRAMME The Department offered several courses in the B.Sc. (Health Sciences) programme and contributed to most system-based courses in old as well as in the new curriculum.

Courses offered in the old curriculum were: Early Development, Tissues and Integuments; Alimentary Sys- tem; Locomotor System; Urinary System; Respiratory System; Cardiovascular System; Haematopoetic-Lym- phoid-Vascular System; Head and Neck; Human Nervous System and Special Senses; Applied Basic Medical Sciences; Endocrine & Reproductive System; Clinical Skills Course.

Courses offered in the new curriculum were: Introduction to Anatomy; Structure-Function Relationship; Growth & Development; The Integrated Module I; Cardiovascular System; Respiratory System; The Integrat- ed Module II; Alimentary System; Uro-reproductive System.

B.S.C. NURSING PROGRAMME The Department offered Anatomy and Physiology courses in the B.Sc. Nursing program in College of Nursing.

CLINICAL PROGRAMME The Department provided teaching during the clinical program and contributed to cytogenetics and the 5th Year Integrated Lecture Series (ILS).

POSTGRADUATE TEACHING The Department was involved in postgraduate teaching. The teaching of cytogenetics contributed to the Core Program of the Oman Medical Specialty Board (OMSB). The Department also contributed to the postgraduate programme (histopathology) and took part in the SCRAPS medical seminar programme in the Col- lege of Medicine & Health Sciences.

Research RESEARCH PROJECTS Effectiveness of Flexible Digital Media Platform in Anatomy Education Project Code: ORG/SQU/HER/09/007; Dates: 2010–2013 Value: OR 16,900; Project Funder: The Research Council, Oman

102 Investigators: Dr. Ibrahim Inuwa, Dept. Human & Clinical Anatomy, SQU; Mr. Abdullah Al-Sadi, College of Science, SQU

Human Anatomy in the Medical Curriculum at Sultan Qaboos University- the Clinicians Viewpoint Project Code: MREC# 358; Dates: 2010; Value: Unfunded; Project approval: Sultan Qaboos University Investigators: Dr. Ibrahim Inuwa, Dept. Human & Clinical Anatomy, SQU

Plastination Using Frankincense (Luban) as an Impregnation Resin Project Code: MREC# 327; Dates: 2010; Value: Unfunded; Project approval: Sultan Qaboos University Investigators: Dr. Aida Al-Wahaibi, Department of Human and Clinical Anatomy, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Banerjee Y, Taranikanti V, Bayoumi R. Triglyceride-mediated pathways and coronary heart disease. Lancet 2010; 376:956. 2. Bataineh MZ, Habbal OA, Moqattash ST. Variations in the superficial palmar arch of the hand. Ital J Anat Embryol 2010; 114:11−20. 3. Al-Sajee DM, Habbal OA, Reys ZS. A case of Freeman-Sheldon syndrome with cerebral venous thrombosis: Is it a coincidence? J Postgrad Med 2010; 56:37−9. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations departments International 1. Inuwa IM. Advantages of pitfalls in setting up of Clinical Skill Centers – the Sultan Qaboos University Experience.

rd th care The 3 International Conference on Medical Education in Sudan & 6 Scientific Meeting of the Scientific Society for Arab Faculties of Medicine. Sudan, November 2009. 2. Inuwa IM. On line and ‘On paper’ examination in Anatomy – from steeplechase to Moodle via WebCT. 7th GCC Medi-

cal Colleges Conference. King Faisal University, Saudi Arabia, November 2009. patient

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103 Annual Report 2009-2010 Medicine

he Department of Medicine endeavours to create an environment conducive for 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. TheT major research themes include asthma, breast cancer, gastric cancer, HIV, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and cerebrovascular disease. Research areas include epidemiology, molecular characterisation, study of genetic polymorphisms, and study of novel mechanisms of the aetiology of various diseases. Members of the Department are principal or co-investigators of several funded 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 disease, general internal medicine, infectious disease, nephrology, neurology, oncology, respiratory and rheumatology. These subspecialties offer medical services to patients in the capital area and accept complicated referrals from all over the country

104 William Johnston, Senior Consultant Mehar Ali, Senior Consultant Abdullah Al-Asmi, Senior Consultant Ikram Burney, Senior Consultant Abdullah Balkhair, Senior Consultant Hafidh Al-Hadi, Senior Consultant Ali Al-Mamari, Senior Consultant Juma K Al-Kaabi, Consultant B. N. Jayakrishnan, Consultant Dawood Al-Riyami, Consultant Omayma T Elshafie, Consultant Jojy George, Consultant Mansour Sallam, Consultant Aftab Siddiqui, Consultant R. Nandhagopal, Consultant Abdulhakim Al-Hashim, Consultant Hatem Farhan, Senior Registrar Mohammed Al-Ghailani, Senior Registrar Saif Khan, Senior Registrar Abdulmannan Kaskheli, Senior Registrar Shiyam Kumar, Senior Registrar Saeed Ahmed, Registrar Ammar Abdulrahman, Registrar Staff Hassan Ali, Registrar Adil Al-Riyami, Registrar Faculty Nagi Mohammed, Registrar Bazdawi Al-Riyami, Professor, Dean of Nursing Mohammed Misbah, Registrar departments

Nicholas Woodhouse, Professor Fatma B Abid, Registrar Arunodaya Gujjar, Associate Professor Osama Hassan, Registrar care Mansour Al-Moundhri, Associate Professor, Dean of Mohammed A Shah, Registrar the College Osama Tariq, Registrar Ali Al-Hinai, Assistant Professor Ali Mohammed, Senior House Officer

Masoud Al-Maskari, Assistant Professor patient

Mohammed Al-Rawahi, Senior House Officer Jamal Sallam, Assistant Professor Ibrahim Al-Busaidi, Senior House Officer

P.C. Jacob, Assistant Professor and Haifa Al-Abri, Senior House Officer Batool Hassan, Assistant Professor Noon Abdulghaffar, Senior House Officer Masoud Kashoob, Senior Consultant academic medicine

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Yasser Waadallah, Senior House Officer Nesreen Siddiq, Senior House Officer Angum Hassan, Senior House Officer Fathima Aamer, Senior House Officer Technologist Sawsan Baddar, therapeutist Saphia Al-Ajmi, Podiatrist Support Staff Rose Natividad, Coordinator Ibrahim Al-Shoaibi, Coordinator Ghaniya Al-Siyabi, Coordinator Highlights of the Year 2009-2010 A number of departmental staff received awards for their achievements. During the University Day event in May 2010, Dr. Omar Al Rawas and colleagues received the “Distinguished Research Paper Award” for their 2009 publication in Sultan Qaboos University Medical Journal, Management and control of asthma in patients attending a specialist centre in Oman, (by Al-Rawas OA, Jayakrishnan B, Ben Abid F, George J, Baddar S, Al-Riyami BM); Dr. Abdullah Al-Asmi won the award of Best Clinical Teacher for the academic year 2009– 2010, and Dr. Dawood Al-Riyami received the Certificate of Distinguished Physician in recognition of his outstanding achievements and contributions during the year 2009–2010. On the occasion of 20th SQU Hospital Anniversary Day, Dr. Ali Al-Mamari received the Distinguished Performance Prize. Dr. Omayma El Shafie and colleagues won the award for the Best SCRAPS (clinico-pathological conferences seminar series) presentation in 2009–2010, Beyond VIPoma. Dr. Arunodaya Gujjar was appointed Assistant Dean for Clinical Affairs.

The 10th Advanced General Medicine Conference was organised jointly by the Department of Medicine with the Royal College of Physicians and the Ministry of Health from 20–22 February 2010. The lectures, given by expert international and national speakers, covered a wide range of general medical topics, disease mechanisms and cutting edge advances in clinical practice. It was attended by more than 300 physicians and allied health professionals from Oman and different parts of the country.

The Department‘s Annual Research Retreat, in which almost all staff participated, was held on 20 May 20 at the Grand Hyatt Hotel, Muscat. Following an overview of departmental research activities in the preceding year, ten research papers were presented.

The Department organised the Membership examinations of the Royal College of Physicians of UK on 8th and 10th of November 2009, and on 31st May 2010 for the Royal College of Physicians of the Ireland in liaison with

106 the Department of Haematology.

The Department continues to attract undergraduate and postgraduate students from national and international universities to spend their electives here. This year there were about 16 students from various universities in Oman as well as other countries including New Zealand, Jordan, Pakistan, and Bahrain.

The staff of the department participated in a number of courses and workshop organised by the Medical Education Unit (MEU) of the College of Medicine & Health Sciences (CoMHS) in order to improve teaching and assessment skills for undergraduate and postgraduate level courses. These included: 1) Certificate in Pro- fessional Health Education (CPHE); 2) Student Assessment Workshop; 3) Continuous Assessment of Clinical Skills and Professional Behaviour workshop, and 4) Designing Integrated Questions Workshop.

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Department participates in the teaching of the following courses to 4th year students during semester 8 (old curriculum): Clinical Communication Skills and Clinical Methods with approximately 108 students participating. Dr. Nandhgopal is the departmental coordinator of the Clinical Communication Skills course and Dr. Mansour Sallam is the departmental coordinator of the Clinical Methods course.

The Department is playing a major role in the development and implementation of the new curriculum. Dr. Ikram A Burney is Phase III coordinator (Member of the College Curriculum Committee); Dr. Ahmed Al- Farqani, is the coordinator for Junior Clerkship Phase III, and Endocrinology Phase II; Dr Dawood Al-Riyami is Senior Clerkship coordinator, Phase III; Dr. Adil Al-Riyami is Pre-Internship coordinator, Phase III; Dr. Jamal Sallam has worked on Alimentary System, Phase II, Dr. B. Jayakrishnan, on Respiratory System, Phase II, Dr. Mansour Sallam on Cardiovascular system, Phase II, and Dr. Arun Gujjar on Nervous system Phase II.

The staff of the department is heavily involved in the teaching of the new curriculum courses. departments

UNDERGRADUATE CLINICAL PROGRAMME care

Approximately 30 5th year students are posted for a total of 11 weeks in the Department in each rotation (total of 4 rotations). These students rotate between the Royal Hospital (RH) and SQUH. The clinical programme consists of self-directed learning, clinical bedside teaching, demonstration of procedures and seminars. The patient seminars are presented by the students and supervised by staff. Furthermore, the problem-based series (previously known as the integrated lecture series is conducted every Wednesday and covers all major subspe- and cialties. Students are required to sit an end of rotation examination held at both SQUH and the RH. Logbooks are also used for assessment of the clinical activities as are also cases write-ups. academic M edicine

107 Annual Report 2009-2010 Medicine

Approximately 20–22 final year students (7th year) are posted for clinical rotation in the Department for a period of 7 weeks, divided between the RH and SQUH (total of 5 rotations). Students are posted to two subspecialties and they are attached to the team throughout their daily activities e.g. ward rounds, outpatients, meetings, consultations, etc. By the end of their rotation, they are assessed by the team in clinical skills, data interpretation and management of a variety of diseases. There is a formal end of rotation examination using short cases and an objective structured clinical examination (OSCE). The overall assessment is based on performance throughout rotation in both the in-course assessment and end of rotation examination which is conducted both in SQUH and the RH. The Department continued to develop the curriculum for the final year medical students to meet with the objectives of the rotation and better prepare them for the internship. For the academic year which started on 31st July 2010, the students are divided into three groups and are attached to the general medicine units. Students will be fully integrated with the team and will be given responsibilities of patients’ care under direct supervision by the seniors. Also the new curriculum “common clinical presentations” with their objectives were incorporated in their teaching with students expected to present these topics in tutorials. More emphasis was given to continuous assessment in their overall assessment of the rotation.

POSTGRADUATE PROGRAMME Interns About 10–12 interns are posted for 4 month rotations in the Department. Every intern rotates in one subspecialty for one month with a one month mandatory rotation in the Haematology Department. Interns have supervised training by senior staff. By the end of their rotation, all interns are formally assessed on issues such as knowledge, clinical skills, attitude and professionalism. Since September 2007, the Department has been receiving 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. CME sessions are held every alternate Monday morning and Wednesday lunch-time is used for presentations by outside guest speakers.

OMSB Residency Programme Members of the Department actively participate in postgraduate teaching of interns, house officers and the OMSB residents in internal medicine as well as residents from other subspecialties (such as Family Medi- cine and Public Health, dermatology, laboratory sciences and Accident and Emergency) rotating through Medicine. During the last year, the section of Internal Medicine was created, and is currently led by two consultants. Residents receive supervised training on ward rotations and during electives to 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, members of the

108 Department of Medicine are invited to deliver lectures to other sub-specialty residency programs, such as those in the Emergency Medicine and Family Medicine and Public Health departments.

Nursing Programme Dr. Mansour Al Moundhri delivers lectures regularly at the Pain Management Course organised by the Train- ing Directorate in conjunction with the Directorate of Nursing SQUH.

Dr. Ikram A Burney delivers lectures regularly at the Chemotherapy Administration Course organised by the Training Directorate in conjunction with the Directorate of Nursing SQUH

Clinical & Diagnostic Services In and Outpatient numbers 2010

Specialty In-patients Out-patients Totals Cardiology 1,065 8,920 9,985 Clinical Physiology - Cardiology 2 4,922 4,924 Clinical Physiology - Neurophysiology 3 3,946 3,949 Diabetic 12 4,384 4,396 Endocrinology 127 804 931 Gastroenterology 481 5,901 6,382 Infectious diseases 76 929 1,005 Lipid Clinic 0 1,169 1,169 departments Internal Medicine 1,079 775 1,854 Nephrology 268 1,697 1,965 care

Neurology 479 6,637 7,116 Medical Oncology 995 1,983 2,978 patient Pulmonology 339 4,843 5,182 and

Rheumatology 101 3,783 3,884

academic M edicine

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Thyroid 193 4,205 4,398 Totals 5,220 54,898 60,118

Procedures Gastroenterology, Cardiology and Respirology

Oesophagogastroduodenoscopy (OGD) 722 Colonoscopy 206 OGD + colonoscopy 46 Percutaneous endoscopic gastrostomy (PEG) 6 Endoscopic retrograde cholangio-pancreaticography (ERCP) 70 Gastroenterology Total 1,050

Coronary angiogram (CAG) 588 Emergency CAG 19 Percutaneous coronary intervention (PCI) 223 Emergency PCI 15 Intra-aortic balloon pumps 10 Aspiration 14 Fractional flow reserve 8 Pericardiocentesis 1 Permanent pacemaker insertion 17 Temporary pacemaker Insertion 20 Cardiology Total 915

Haemodialysis 2,488 Chemotherapy (no. of courses) 260 Bronchoscopy 60 Pulmonary function tests 936

110 Research RESEARCH PROJECTS The ameliorative effect of cysteine prodrug L-2-oxothiazolidine-4-carboxylix acid on oxaliplatin-induced neurotoxcity in rats Project Code: IG/MED/MEDI/09/01; Dates: 2009 Value: OR 7,000; Project Funder: Sultan Qaboos University Investigators: Dr. Mansour Al-Moundhri, Dept. Medicine, SQU; Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU.

Clinical, Laboratory and Demographic Profile of Hospitalized Adult Omani Patients with 2009 H1N1 Influenza-A Infection Project Code: MREC#315; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Abdullah Balkhair, Dept. Medicine, SQU; Dr. Zachariah M, Dept. Child Health, SQU; Dr. Omar Al-Rawas, Dept. Medicine, SQU; Dr. B.N. Jayakrish- nan, Dept. Medicine, SQU. Dr. Jojy George, Dept. Medicine, SQU; Dr. Jay- akrishnan B. Nair, Dept. Medicine, SQU; Dr. Osama Ahmed, Dept. Medicine, SQU; Dr. Fatma ben Abid, Dept. Medicine, SQU; Mr. Emmanuel Serebour, Dept. Microbiology & Immunology, SQU.

Centralization Pan-Middle East Survey on the Undertreatment of Hypercholesterolemia Project Code: MREC#317; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University departments Investigators: Dr. Ali Al Hinai, Dept. Medicine, SQU.

Clinical Profile and Outcome of Patients with Poisoning or Overdose of Prescribed or Illicit Drugs Present- care ed to a Tertiary Hospital in Oman Project Code: MREC#337; Dates: 2009

Unfunded; : Sultan Qaboos University patient Value: Project Approval Investigators: Dr. Al-Asmi A, Dept. Medicine, SQU; Dr. B.N. Jayakrishnan, Dept. Medicine, and SQU. academic M edicine

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Knowledge, attitude, behavior, and source of information in Omani type 2 diabetic patients regarding their oral health Project Code: MREC#338; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Masoud Al-Maskari, Dept. Medicine, SQU

Clinical Measurement of Respiratory Acoustic Signals in Normal Subjects and in Patient with Respiratory Diseases. Project Code: MREC#327; Dates: 2009 Value: OR 2,000; Project Approval: Sultan Qaboos University Investigators: Dr. B.N. Jayakrishnan, Dept. Medicine, SQU; Dr. Abraham K. George, Dept Phyics, College of Science, SQU; Dr. Azzouz Sellai, Dept Phyics, College of Sci- ence, SQU; Dr. Omar Al-Rawas, Dept. Medicine, SQU.

Quantitative D–Dimer Assay and CT Angiography in the Diagnosis of Acute Pulmonary Embolism Project Code: MREC#313; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. B.N. Jayakrishnan, Dept. Medicine, SQU; Dr. Dilip Sankhla, Dept. Radi- ology & Molecular Imaging; Dr. Omar Al-Rawas, Dept. Medicine, SQU; Dr. Khalil Al-Farsi, Dept. Haematology, SQU; Dr. Abdulla Al-Muniri Dept. Family Medicine & Public Health, SQU.

Estimating Glomerular Filtration Rate in Omanis with Chronic Kidney Disease by Use of the Modification of Diet in Renal Disease, Cockcroft-Gault and Cystatin C Based Equations Project Code: IG/MED/MEDE/10/01; Dates: 2010 Value: OR 3,000; Project Funder: Sultan Qaboos University Investigators: Dr. Dawood Al-Riyami, Dept. Medicine, SQU; Dr. Khalid Al-Rasadi, Dept. Bio- chemistry, SQU; Dr. David Nkansa-Dwamena, Dept. Biochemistry, SQU; Dr Haddia Bererhi, Dept. Radiology & Molecular Imaging, SQU; Dr Seyed Rizvi, Dept. Family Medicine & Public Health, SQU.

112 Non-Invasive Hemodynamic Profile in Acute Stroke -Study with ThoracicElectrical Bioimpedance Project Code: MREC# 280; Dates: 2009 Value: OR 2,000; Project Approval: Sultan Qaboos University Investigators: Dr. Arunodaya R.Gujjar, Dept. Medicine, SQU; Dr. Deepali Jaju, Dept. Physiol- ogy, SQU; Dr. P.C. Jacob, Dept. Medicine, SQU; Dr. Mohan Dikshit, Dept. Physi- ology, SQU.

Four Score – A New Coma Score: Study of Inter-Observer Reliability and Relation of Serial Assessment to Outcome Project Code: MREC# 329; Dates: 2010 Value: OR 2,000; Project Approval: Sultan Qaboos University Investigators: Dr. Arunodaya R.Gujjar, Dept. Medicine, SQU; Dr. P.C. Jacob, Dept. Medicine, SQU; Dr. R. Nandhagopal, Dept. Medicine, SQU.

Stroke Registry at Sultan Qaboos University Project Code: MREC#324; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Arunodaya R.Gujjar, Dept. Medicine, SQU; Dr. Abdullah Al-Asmi, Dept. Medicine, SQU; Dr. PC Jacob, Dept. Medicine, SQU; Dr. R. Nandhagopal, Dept. Medicine, SQU.

Insulin Resistance and its Correlation with Risk Factors for Developing Diabetes Mellitus in Young Omanis Project Code: MREC#316; Dates: 2009 departments

Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Humaid Alfarai, Medical Student,SQU; Issa Al-Aboodi, Medical Student, SQU; care

Noora Al-Busaidi, Medical Student, SQU; Azza Al-Sawwafi, Medical Student SQU; Dr. Nagi Mohammed, Dept. Medicine, SQU; Dr. Omayma El-Shafie, Dept. Medicine, SQU; Prof N.J.Y. Woodhouse, Dept. Medicine, SQU. patient Bone Mineral Density Measurement in Healthy Young Omanis; A Pilot Study to Establish Local Reference Values and

Project Code: MREC#360; Dates: 2010 Value: OR 1675; Project Approval: Sultan Qaboos University academic M edicine

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Investigators: Prof. N.J.Y. Woodhouse, Dept. Medicine, SQU; Dr. Omayma El-Shafie, Dept. Medicine, SQU; Dr. Samir Hussein, Dept. Radiology & Molecular Imaging, SQU; Abdullah Al-Zakwani, Center for Innovative Industrial Design, Muscat, Oman; Dawood Al-Kindi, Medical Student, SQU; Jawaher Al-Sulaimi, Medi- cal Student, SQU; Sumiya Al-Hadhrami, Medical Student, SQU.

Practical Implementation of ADA/EASD Consensus Algorithm in Patients with Type 2 Diabetes: Timely Initiation and Titration Project Code: MREC#355; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Ali Al-Maamri, Dept. Medicine, SQU.

The Importance of 24 hour Ambulatory Blood Pressure Monitoring and its Value over the Traditional Of- fice Measurements of Blood Pressure Project Code: MREC#359; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Mansour Sallam, Dept. Medicine, SQU

A new Come ScoreL Study on inter-observer Reliability and Relation of Serial Assessment to Outcome Project Code: MREC#329; Dates: 2010 Value: OR 2,000; Project Funder: Sultan Qaboos University Investigators: Dr. Arundoaya Gujjar, Dept. Medicine, SQU.

Genetic association study of breast cancer in Omani Population Phase I Project Code: MREC#333; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Mansour Al-Moundhri, Dept. Medicine, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al Moundhri MS, AlNabhani M, Burney IA, AlFarsi AA, AlBahrani B. Gastric cancer risk predisposition and prognostic significance of vascular endothelial growth factor (VEGF) gene polymorphisms - A case-control study in an Omani population. Mol Carcinog 2009; 48:1170−6.

114 2. Al Asmi A, Nandhagopal R, Jain R, Burney IA. Full blown picture of Wernicke’s encephalopathy. Q J Med 2010; 11:891−2. Epub 2009 Dec 7. 3. Burney IA. The trend to seek a second opinion abroad amongst cancer patients in Oman: Challenges and opportunities. SQU Med J 2009; 9:260−3. 4. Nandhagopal R, Al Asmi A, Gujjar AR, Jacob PS, Al Azri F, Burney IA. Gliomatosis cerebri: Clinical picture, Q J Med. Epub 2010 June 8. 5. Al Moundhri MS, Al Khanbashi M, Al Kindi M, Al Nabhani M, Burney IA, Al Farsi A, Al Bahrani B. Association of E- cadherin (CDH1) gene polymorphisms and gastric cancer risk. World J Gastroenterol 2010; 16:3432−6. 6. Burney IA, Author’s response Re: The trend to seek a second opinion abroad among cancer patients in Oman. SQU Med J 2010; 10:277. 7. AlAzri M, AlAwisi H, AlMoundhri M. Coping with a diagnosis of breast cancer-literature review and implications for developing countries. Breast J 2009; 15:615−22. 8. AlShukaili A, AlKaabi J, Hassan B, AlMuneeri A. Quantification of CD4+ CD25+ regulatory T cells in peripheral blood of patients with systemic lupus erythematosus and rheumatoid arthritis. Open Autoimmun J 2009; 1:5−9. 9. Al Kaabi J, Pathare A. Pattern and outcome of vascular involvement in Omani patients with Behcet’s Disease. Rheu- mato Int 2010; Epub Feb 4. 10. Balkhair A. The Struggle against pandemic Influenza A (H1N1) 2009. SQU Med J 2009; 9:257−60. 11. Al Jabri AA, AlMuharrami ZK, Balkhair AA, Ganguly SS. The importance of HIV antenatal screening programs for pregnant women. Saudi Med J 2010; 31:64−8. 12. Gujjar A, AlMamari A, Jacob PC, Jain R, Balkhair A, AlAsmi A. Extrapontine myelinolysis as presenting manifestation of adrenal failure: a case report. J Neurol Sci 2010; 290:169−71. 13. Balkhair A, Al Muharrmi Z, Darwish L, Farhan H, Sallam M. Treatment of vancomycin-intermediate Staphylococcus aureus (VISA) endocarditis with linezolid. Int J Infect Dis 2009; Epub Dec 14. 14. Nzeako BC, Al Rushiedi S, Neilson F, AlBalkhair A. Types of bacteria on some medical devices used in Sultan Qaboos University Hospital wards. Mid East J Sci Res 2010; 5:449−53. departments

15. AlJabri AA, AlMuharrmi Z, Balkhair A, Alenzi FQ, Omar A. Overview of factors affecting AIDS progression. Int J Med Biol Front 2010; 16:211−36.

16. Sallam M, AlHadi H, Rathinasekar S, Chandy S. Comparative study of the radial and femoral artery approaches for care

diagnostic coronary angiography. SQU Med J 2009; 9:272−8. 17. Farhan HL, Kowthar S, Ali H, AlBelushi A, Sallam M, AlZakwani I. Diagnostic value of electrocardiographic T wave inversion in lead aVL in diagnosing coronary artery disease in patients with chronic stable angina. Oman Med J patient 2010; 25:124−7.

18. Sallam M, AlHadi H. The higher cross-over rate from transradial to transfemoral coronary angiography do we have and the explanation? SQU Med J 2010; 10:269−71. 19. Nandhagopal R, AlAsmi A, Gujjar AR. Neuromyelitis optica: an overview. Postgrad Med J 2010; 86:153−9. academic M edicine

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20. Poothrikovil RP, Al Asmi A. Systemic reference electrode artifacts mimicking alpha coma and electrographic seizures in EEG. Am J Electroneurodiagnostic Technol 2009; 49:280−8. 21. Ansari MA, Rahman R, Siddiqui AA, Zaidi SZH. Association of order of birth with schizophrenia. Pak J Med Sci 2010; 26:1−5. 22. Rahman R, Ansari MA, Khan AG, Hayder Z, Siddiqui AA. Preferred antipsychotic by mental health professionals of Sindh and Balauchistan. J Liaquat Uni Med Health Sci 2010; 9:95−100. 23. Siddiqui AA, Jabeen R, Ansari MA, Soomro MA, Ahmed S, Khashoub MB. Use of intravenous vs. intramuscular hepatitis B immunoglobulin in prevention of relapse of hepatitis B in post liver transplant patients. J Liaquat Uni Med Health Sci 2010; 9:49−52. 24. Siddiqui AA, Ansari MA, Rahman R, Jabeen R, Qureshi NR, Kashoob MB. Comparison between helicobacter pylori fecal antigen detection and endoscopic gastric biopsy in diagnosis of h. pylori infection in 50 adult cases. J Liaquat Uni Med Health Sci 2010; 9:23–6. 25. Foliaki S, Pearce N, Björkstén B, Mallol J, Montefort S, von Mutius E, ISAAC Phase Three Study Group. (study group includes Al-Rawas OA). Antibiotic use in infancy and risk of symptoms of asthma, rhinoconjunctivitis, and eczema in 6 to 7 year old children: ISAAC Phase Three. J Allergy Clin Immunol 2009; 124:982−9. 26. Odhiambo J, Williams H, Clayton T, Robertson C, Asher MI, ISAAC Phase Three Study Group (study group includes Al-Rawas OA). Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009; 124:1251−8. 27. Quanjer PH, Stanojevic S, Stocks J, Hall GL, Prasad KV, Cole TJ, Rosenthal M, Perez-Padilla R, Hankinson JL, Falaschetti E, Golshan M, Brunekreef B, AlRawas O, et al., for and on behalf of Global Lung Initiative. Changes in the FEV1/FVC ratio during childhood and adolescence: an intercontinental study. Eur Respir J 2010; Epub Mar 29. 28. AlManiri AA, Singh JPN, AlRawas OA, Al Busaidi S Al Balushi L, AlAhmed I, Mahruqi S, AlZadjali S, Patel, Melles H, Diwan V, Hoffner S. A snapshot on biodiversity and clustering of mycobacterium tuberculosis among nationals and immigrants in Oman using spoligotyping. Int J Tuberc Lung Dis 2010; 14:994−1000. 29. AlManiri A, De Costa A, AlRawas OA, Fochsen G. Immigrants and health system challenges to TB control in Oman -A qualitative study. BMC Health Serv Res 2010; 10:210. 30. Jayakrishnan B, AlRawas OA. Asthma inhalers and colour coding: Universal dots. Br J Gen Pract 2010; 60:690−1. 31. Al Manthari A, Al Zakwani I, ElShafie O, Al Shafie M,Woodhouse NJY. Quality indicators of diabetes care: A crossec- tional oberservational study in Oman. SQU Med J 2009; 9:32−6. 32. Woodhouse NJY, ElShafie O, Hashim N, AlMamari A, Raeburn S. Clinically defined MODY in young Omanis; Absence of the common caucasian gene mutations. SQU Med J 2010; 10:80−3. 33. ElShafie O, Hussein S, Bererhi H, Woodhouse NJY. Multiple bone metastases in a patient with a differentiated thyroid cancer: Complete resolution following thyroidectomy and 4 ablation doses of 1-131. SQU Med J 2010; 10:101−5. 34. Khan S, AlRiyami D, AlGhailani M, AlDhuhli M. An under-recognized complication: Diabetic myonecrosis. Oman Med J 2009; 24:228−30. 35. Pathare A, Alkindi S, Khan S, Riyami D, Farooqi M, Coexistence of immune thrombocytopenic purpura and idio-

116 pathic membranous glomerulonephritis successfully treated with rituximab. Platelets 2010; 21:575−7. 36. Baluchi F, Khan S, Riyami D, Ghilaini M, Farooqui M. Incidence, etiology and outcome of acute kidney injury at a teaching hospital in Oman. SJKDT; Accepted for publication 29 Oct 2009. 37. Jacob PC, AlAsmi A, Gujjar A, AlMamariA, AlBalkhair A, William R. Clinical quiz. Lower cranial nerve palsies. Oman Med J 2010; 25:240−1. 38. AlMamari A. Atherosclerosis and physical activity (review). Oman Med J 2009; 24:173−8. 39. AlMaskari M, AlShukaili A, AlMammari A. Pro-inflammatory cytokines in Omani type 2 diabetic patients presenting anxiety and depression. Iran J Immunol 2010; 7:124−9. 40. Nandhagopal R, Troiano AR, Mak E, Schulzer M, Bushnell MC, Stoessl AJ. Response to heat pain stimulation in idiopathic Parkinson’s disease. Pain Med 2010; 11:834−40. 41. Gujjar AR, Srikanth SG, Umamaheshwara, Rao GS. HHH Regime for arteritis secondary to TB meningitis: A prospective randomized study. Neurocrit Care 2009; 10:313−7. 42. Suliman H, Wali Y, Al Saadoon M, Zechariah M, William RR, Gujjar AR, Pathare A. Hydroxyurea or chronic exchange transfusions in patients with sickle cell disease: role of transcranial doppler ultrasound in stroke prophylaxis. J Pedi- atr Hematol Oncol 2009; 31:42−4. 43. Gujjar AR, Muralidhar K, Bhandopadhyaya A, Sathyaprabha TN, Janaki P, Mahalla BK, Gupta R, Banakal S, Jairaj PS. Transthoracic electrical bioimpedence cardiac output: Comparison with multigated equillibrium radionuclide car- diography. J Clin Monit Comput 2010; 24:155−9. 44. Burney IA, Al Sawai BS, Dawood AA, Babiker H, Al Moundhri MS. Association of polymorphisms in cytokine genes with diffuse large B cell lymphoma and its outcomes in Omani Arabs. Eur J Cancer 2009; 7:566. 45. Saquib S, Gowri V, Al Hamdani A, Burney I, Jain R. Pendant on a necklace – Case of Sertoli-Leydig cell tumor. Proceed- ings of the Sultan Qaboos University Clinical – Pathological Conferences. SQU Med J 2010; 10:296. 46. Mathew M, Saquib S, Kumar S, Lokuhetty D, Jain R. Successful management of a case of gestational trophoblastic neoplasia in young woman. Proceedings of the Sultan Qaboos University Clinical – Pathological Conferences. SQU Med J 2010; 10:297.

47. Alhadi HA, Fox KAA. Validity of cardiac markers as diagnostic and prognostic indicators of complications in patients departments undergoing percutaneous coronary intervention. SQU Med J 2010; 10:31–40. 48. Alhadi HA, Fox KAA. Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction – care The potential for influencing patient management. SQU Med J 2010; 10:41–9. 49. Alhadi HA, Sallam M. Asymptomatic permanent left bundle branch block (LBBB) complicating diagnostic left heart catheterisation. SQU Med J 2010; 10:114–9. patient 50. Alhadi HA, Fox KAA. Cardiac markers in the early diagnosis and management of patients with acute coronary syndrome. SQU Med J 2009; 9:231–46. and 51. Sallam M, Alhadi HA. Comparative study of the radial and femoral artery approaches for diagnostic coronary angiography. SQU Med J 2009; 9:272–8. academic M edicine

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52. Alhadi HA, William B, Fox KA. Serum level of heart-type fatty acid-binding protein in patients with chronic renal failure. SQU Med J 2009; 9:311–4. Books 1. Al Rawas OA, Baddar S, Jayakrishnan B. Guidelines for the Management of Asthma in Oman. 2nd ed. Muscat: Oman Respiratory Society, Oman FAMCO Society & Ministry of Health, 2010. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Burney IA. Etiogenesis of non-Hodgkin’s lymphoma in Oman/developing countries. Hematology Conference 2009. Karachi, Pakistan, 15−18 Oct 2009. 2. Burney IA. Management of metastatic renal cell carcinoma. Sultan Qaboos University Hospital experience. Experts Consensus Meeting. Dubai, 13 Nov 2009. 3. Burney IA. DLBCL in Oman and developing countries: A propos of a different disease. 15th Annual Cancer Conference. Pakistan Society of Clinical Oncology, Lahore, Pakistan, 21 Nov 2009. 4. Burney IA. Management of triple negative breast cancer. 15th Annual Cancer Conference. Pakistan Society of Clinical Oncology, Lahore, Pakistan, 22 Nov 2009. 5. Burney IA. Measurement of quality in oncology practice. Liaquat National Hospital Symposium. Karachi, Pakistan, 12 Dec 2009. 6. Burney IA. nab Paclitaxel –It’s Uses and Indications. Registration Meeting. Karachi, Pakistan, 5 April 2010. 7. Al Asmi A. Pain and Fatigue: Treatment Strategy MS Awareness Conference. Kuwait, 12−14 Nov 2009. 8. Jayakrishnan B. Inhaled antibiotics. 11th NAPCON 2009, Combined National Conference of Indian Chest Society and National College of Chest Physicians. Calicut Medical College, India,12 November 2009. 9. Al-Rawas OA. Where are we from asthma management goals? Xolair Symposium (organised by Novartis). Beirut, Lebanon, 6−7 November 2009. 10. Al-Rawas OA. Respiratory research in Oman: Opportunities and Challenges. University of Sunderland, UK, 15 No- vember 2009. National 1. Burney IA. Measuring quality in oncology: Pros and Cons of Different Methods. 2nd International Conference on Quality Management. Muscat, Oman, January 2010. 2. Burney IA. Lymphoma is different here. Advanced General Medicine Symposium. Royal College of Physicians of the UK, Sultan Qaboos University and Ministry of Health. Muscat, Oman, 20−22 Feb 2010. 3. Al-Rawas OA. Asthma management: The Guidelines Practice Gap. Advanced General Medicine Symposium. Royal College of Physicians of the UK, Sultan Qaboos University and Ministry of Health. Muscat, Oman, 20−22 Feb 2010.

118 4. Burney IA. Breaking bad news: Challenges that remain to patient and their families. Collaborative Nursing Confer- ence. Delivering Quality, Serving Communities, Nurses Leading Chronic Care. Sultan Qaboos University, Muscat, Oman, 28 April 2010. 5. Al Asmi A. Migraine management. Muscat Family Physician Group. Muscat, 20 Jan 2010. 6. Al Asmi A. MS and nutrition workshop titled “Food, Nutrition in Health and Disease”. Department of Food Science and Human Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman, 10 May 2010. 7. Jayakrishnan B. Classification of asthma. Symposium on the Launching of National Asthma Guidelines. December 2009. 8. Jayakrishnan B. Asthma; Recent advances. Work Shop on Asthma for Visiting Iraqi Primary Care Physicians. Muscat, Oman, January 2010. 9. Gujjar AR. Epilepsy in the pregnant woman. Advanced General Medicine Symposium. Sultan Qaboos University, Muscat, Oman, 20–22 February 2010. 10. Gujjar AR. Management of status epilepticus and management of acute stroke. ICON 2010, Internal Medicine CME. Ministry of Health, Sultan Qaboos Hospital. Salalah, Oman, September 2010. Poster presentations International 1. Al Qarbooshi I. Efficacy and safety of cyanaloacrylate (Crazy Glue) injection for the treatment of extraesophageal varices. Gastroenterology Research Day. University of Toronto, 29 June 2009. 2. Al Qarbooshi I. Resobium agrobacterium in Crohn’s disease patient receiving anti-TNF alfa. The Gastroenterology Residents In-Training Course. Calgary, Canada. 2009. 3. Gujjar AR, Al Asmi A, Al Lamki Z, Wali Y, Zacharia M, Al Kindi S, Bashir W, Pathare A, Jain R, William R. Transcranial doppler ultrasonography in sickle cell disease – An experience from Oman. World Congress of Neurology. Bangkok, Thailand, October 2009. 4. Gujjar AR, Al Asmi A, Jacob PC, Jain R, William R. Transcranial doppler ultrasonography in acute ischemic stroke – An departments

Experience from Oman. World Congress of Neurology. Bangkok, Thailand, October 2009. National care 1. Balkhair A, Al-Jabri A, Al-Muharrami Z Ganguly S. Spectrum of AIDS defining opportunistic infections in a series of 77 hospitalized HIV-infected Omani patients. University Day, Sultan Qaboos University, Muscat, Oman, May 2010. 2. Burney IA, Sawwafi A, Awladthani S, Sallam M, Kumar S, Al Moundhri MS. Doxorubicin-induced systolic dysfunc-

tion in patients with non-Hodgkin’s lymphoma. University Day. Sultan Qaboos University, Muscat, Oman, May 2010. patient

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Seminar Presentations International 1. Furrukh M. Anal carcinoma; Oncologic intervention in SCC nus conserves organ & preserves function, without com- promising survival. Anorectal Diseases Surgical Symposium. North West Armed Forces Hospital, Saudi Arabia, Feb 2009. 2. Furrukh M. Story of adjuvant chemotherapy in colon cancer. North West Armed Forces Hospital, Saudi Arabia, June 2009. 3. Furrukh M. Evolving era of customized, individualized therapy in advanced/ metastatic cancer lung. Oncology News Bulletin, North West Armed Forces Hospital, Saudi Arabia, 1 March 2009. 4. Furrukh M. Venous thromboembolism in cancer patients.General Surgery Symposium. North West Armed Forces Hospital, Saudi Arabia, 30 May 2009. 5. Al Qarbooshi I. Treatment of fundic varices. St. Micheal’s Hospital Therapeutic Endoscopy Experience, St. Micheal’s Hospital Gastroenterology Research Day. University of Toronto, Ontario, Canada, 2009. National 1. Burney IA. Ethics consultative services. Workshop for OMSB Residents. Sultan Qaboos University, Muscat, Oman, 4 Oct 2009. 2. Burney IA. Integration of clinical sciences. First New Curriculum Retreat. Sultan Qaboos University, Muscat, Oman, 10 Dec 2009. 3. Burney IA. Overview of the departmental research activities in the last year. Departmental Annual Research Re- treat. Sultan Qaboos University, Muscat, Oman, 20 May 2010. 4. Balkhair A. Spectrum of AIDS defining opportunistic infections in hospitalized HIV-infected adult Omani patients. Department of Medicine Research Retreat. Sultan Qaboos University, Muscat, Oman, 20 May 2010. 5. Al Asmi A. Current and future needs of MD: The hospital strategic plans for 2011−2015. Hospital Retreat Day. Dec 2009. 6. Ali Bulushi, A Al-Asmi. The role of the LMWH (Enoxaparin) in the management of acute non-cardioembolic ischemic stroke. Sultan Qaboos University Hospital Experience. OMSB Research Retreat, 6 May and 27 September 2010. 7. Nandhagopal R. A clinical conundrum: A worthwhile therapeutic exercise. Oman Neuroclub Muscat, Oman, May 2010. 8. Nandhagopal R. Thermal pain response in idiopathic Parkinson’s disease. Annual Research Retreat. Muscat, Oman, 20 May 2010.

120 THESIS SUPERVISION Samira Al-Mahruqui Qualification: M.Sc. Title: Correlation between Human Leukocyte Antigens and response to Antiretro- viral Treatment amongst Omani AIDS Patients Co-Supervisor: Dr. Abdullah Balkhair Date of Completion: 2011

Rowayda H. Ahmed Qualification: M.Sc. Title: Utilization Patterns of AEDs among Epileptic Patient in SQUH Co-Supervisor: Dr. A Al-Asmi Date of Completion: 2010

Gheith A. Jassim Qualification: M.Sc. Clinical Pharmacy Title: Prescribing patterns and the Cost Impact of Proton Pump Inhibitors in Out- patient Clinics in SQUH: A Retrospective Study Co-Supervisor: Dr.Aftab Ahmed Siddiqui Date of Completion: October 2010

Abdullah Al-Manairi

Qualification: M.Sc. departments

Title: Tuberculosis Control in Oman: Challenges to Elimination PhD thesis from

Karolinska Institute, Sweden care

Co-Supervisor: Dr. Omar Al-Rawas Date of Completion: December 2009 patient

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121 Annual Report 2009-2010 Microbiology & Immunology

he Department of Microbiology and Immunology contributes significantly to teaching, research and community service in the College of Medicine & Health Sciences. The Department takes part in the B.Sc. Health Sciences, the MD (the old and new curriculum), the B.Sc. in Medical Laboratory Sciences (MLS), as well as in the Nursing, M.Sc., Ph.D., Residence and Oman Medical SpecialtyT Board (OMSB) teaching and training programmes. Microbiology research interests include basic molecular virology and the microbiology and epidemiology of parasitic infections. Im- munology research focuses on autoimmunity and immunodeficiency, both primary and acquired including HIV and AIDS. There is active international research cooperation between the Department and scientists in the UAE, Britain, Germany, France and the USA. The Department’s clinical divisions offer diagnostic services to SQU Hospital and other hospitals in Oman in bacteriology, virology, parasitology, mycology, serology and immunology.

122 Mahmood Al-Kindi, Senior House Officer Khloud Al-Ma’mari, Senior House Officer Badriya Al-Adawi, Senior House Officer Fatma Ba’Alawi, Senior House Officer Turkiya Al-Siyabi, Senior House Officer Support Staff Jameel Nograles, Superintendent (Diagnostic) Sidqi Hassan, Superintendent (Immunology) Ahmed Al-Badawi, Chief Biomedical Scientist Robert Toki, Chief Biomedical Scientist Frank E. Serebour, Chief Biomedical Scientist Intesar Al-Balushi, Senior Biomedical Scientist Masoud Al-Kheyari, Senior Biomedical Scientist Said N Al-Hinaee, Senior Biomedical Scientist Khazina Al-Harthy, Senior Biomedical Scientist Al Haj Zia-ul-Qamar Qureshi, Coordinator Mohammed Al-Wahibi, Clerk Yousuf S Al-Sabty, Coordinator Highlights of the Year 2009-2010 Staff During the academic year 2009-2010, our departmental external examiners continued their ap- Faculty pointment. Professor Farouk Shakib, Head of the Sharanjit S Thukral, Professor Division of Immunology at the Faculty of Medicine departments Ali Al-Jabri, Associate Professor & Health Sciences, University of Nottingham, UK, Muhannad Al-Kobaisi, Assistant Professor served his last term as an external examiner in care

Basil Nzeako, Assistant Professor Immunology. Professor Tibor Pal from the Micro- Crystal Koh, Assistant Professor biology & Immunology Department at UAE Uni- Akbar Rafay, Senior Consultant versity in Al Ain, continue to serve as the external

Ashok Shenoy, Consultant examiner in Microbiology. patient Zakariya Al-Muharrmi, Consultant Dr. Ali Al-Jabri wrote five articles for the Al-Masar Muneera Al-Siddique, Registrar and

Ahmed Al-Shukaily, Research Associate and Horizon national newspapers entitled: Our im- Mohammed Al-Baloshi, Research Associate mune system and the effect of fasting; Happiness academic microbiology & immunology

123 Annual Report 2009-2010 Microbiology & Immunology

affects all; Vaccine for disease prevention. Mind over matter; The importance of vaccination for the protection against disease, and A drop of blood.

During this year, the department of Microbiology and Immunology continued to support its faculty members (immunologists, bacteriologist, a virologist, and a parasitologist) with a good number of biomedical scientists with B.Sc., M.Sc. and Ph.D. qualifications.

In 2009, Dr. Yaseen Al-Lawatia, Assistant Professor, was seconded to the Oman Medical College. Dr. Helmut Schuster, Senior Consultant, resigned. Dr. Zakariya Al-Muharrmi, was promoted to Consultant microbiolo- gist. Dr. Mohammed Al-Baloshi, was appointed as a Research Associate in the College of Medicine. Mr. Ja- meel Nograles was appointed as a Superintendent to replace Mr. John Prentis, who left the Department. Ms. Fadhila Al-Tooqi, Senior Biomedical Scientist took early retirement and seven new technical staff joined the diagnostic unit on the Hospital side.

Staff of the Department attended the following conferences and workshops on AIDS: First Regional Meeting on National AIDS coordination in the Middle East and North Africa Region, organized by UNAIDS in Muscat; the National AIDS Workshop organized by the Ministry of Health’s Directorate of Infectious Diseases, and the AIDS Strategy & Action Plan (ASAP) Capacity Building Workshop in The Middle East and North Africa held in Tunisia. They also attended a number of College workshops on strategic planning, the new curriculum, scientific writing and peer review and research and postgraduate studies.

The Department suffered a great loss when Ms. Zahra Al-Mahrooqi, (Microbiology Superintendent) passed away.

Teaching Programmes PRE-CLINICAL PROGRAMME (OLD CURRICULUM) The Department continues to offer its two main courses in the B.Sc. Health Sciences programme, namely Im- munology and Microbiology, to the 3rd and 4th year medical students respectively.

124 PRE-CLINICAL PROGRAMME (NEW CURRICULUM) As the new curriculum was implemented in 2009-2010, the Microbiology Department started to contribute and play a vital role in this new curriculum. The Department’s participation started on Phase II Semester 1 and included the following different core courses and system courses: Response to infection and pathobiology; Cardiovascular System; Respiratory System; Haematological and Lymphatic Immune Systems, and a Research project. This contribution will continue to expand next year as Semester III and IV courses come on stream.

B.SC. MEDICAL LABORATORY SCIENCE PROGRAMME The Department also contributed substantially to the B.Sc. MLS programme. The following were offered in 2009-2010 academic year: General Medical Microbiology; Immunology; General Medical Microbiology II; Medical Microbiology III; Advanced Medical Microbiology I & II, and Projects

B.SC. NURSING The Department continues to offer a 3 credit Microbiology course which is taught to second year B.Sc. nursing students during the spring and summer semesters.

CLINICAL PROGRAMMES (MD PROGRAMME) The Department contributed to the teaching of the integrated lecture series and case-oriented learning for the 5th year clinical students. As in the past, five groups of the 7th year medical students carried out a one week laboratory rotation. Normally this covers all the clinical laboratory sections of the Department and students are assessed on their final day of the rotation.

POSTGRADUATE PROGRAMME There were two microbiology first/second year residents who did various rotations in clinical microbiol-

ogy and immunology. The Department also participated in the training of some of the OMSB residents. The departments

Department continued to offer the Medical Microbiology programme for the M.Sc. students in 2009–2010. The courses taught in the M.Sc. programme are: Bacteriology; Bacteriology and Mycology; Parasitology, and care Virology. In an effort to expand the postgraduate programme in the Department, one student was enrolled during 2009 in the Ph.D. programme. patient CLINICAL & DIAGNOSTIC SERVICES The two major units of the Department – Microbiology and Immunology – continue to offer diagnostic ser- and vices primarily to SQUH, but also to other government and private hospitals. As a result of the expansion in the diagnostic services in molecular microbiology and immunology services, and in parallel with the in- academic M icrobiology & I mmunology

125 Annual Report 2009-2010 Microbiology & Immunology

creased patient activity within SQUH, there was an increase in the number of samples (specimens) and tests carried out in our laboratories in 2010. The Microbiology diagnostic laboratory was heavily involved in the diagnosis of Influenza A H1N1 during the pandemic that occurred at the end of 2009. The increase due to the high demand from the different hospital wards for microbiology diagnostic services is shown in the diagram below. 2001 2002 2003 500000 2004 400000 2005 300000 2006 200000 2007 100000 2008 0 2009 Specimens Tests 2010 Figure1: Patient Samples karyotyped and FISH tests done during (2010)

The Department continues to participate in the Royal College of Pathology of Australia External Quality As- surance programme. According to the international standards, the diagnostic laboratory of Microbiology and Immunology Department scores quite high.

Research RESEARCH PROJECTS Epidemiology of Hepatitis A in United Arab Emirates and Sultanate of Oman: A Study to Assess the Need for Vaccination Programmes Project Code: CL/SQU-UAE/07 /01; Dates: 2007−2009 Value: OR 22,500 + O.R. 23,365; Project Funders: SQU and UAE universities

126 Investigators: Dr. Youssef A. Abou-Zeid, Dept. Biology, College of Science, UAE University; Dr. Muhannad Al-Kobaisi, Dept. Microbiology & Immunology, SQU; Dr. Sa- lem Awad, Gastroenterology Medical Consultant, UAE; Dr. Taoufik A. Zou- beidi, College of Business & Economics, UAE University.

Epidemiology and Laboratory Investigations of Respiratory Virus Infections among Omani Infants and Young Children in Sultan Qaboos University Hospital Project Code: IG/MED/ MEDE/08/02; Dates: 2008−2009 Value: OR 18,400; Project Funder: Sultan Qaboos University Investigators: Dr. Muhannad F. Al-Kobaisi, Dept. Microbiology & Immunology, SQU; Dr. Faryal A. Khamis, Dept. Medicine, Royal Hospital; Dr. Hussein Al-Kindi, Dept. Child Health, SQU; Dr. Ahmed Al-Manthari, Dept. Family Medicine & Public Health, SQU.

A Study to Investigate Antibodies and other Immunological Parameters to Monitor Response of Omani Patients with AIDS to Highly Active Antiretroviral Therapy (HAART) Project Code: IG/MED/ MICR/08/01; Dates: 2008−2009 Value: OR 21,900; Project Funder: Sultan Qaboos University Investigators: Dr. Abdullah Balkhair, Dept. Medicine, SQUH; Dr. Ali Al-Jabri, Dept. Microbi- ology & Immunology, SQU.

Detection and Characterization of Ampc Beta-Lactamases in Clinical Isolates of Escherichia Coli and Kleb- siella Spp Project Code: IG/MED/MICR/09/01; Dates: 2009-2011 Value: OR 11,000; Project Funder: Sultan Qaboos University departments Investigators: Prof. Sharanjit S. Thukral, Dept. Microbiology & Immunology, SQU; Dr. Ak- bar Rafay, Dept. Microbiology & Immunology, SQU; Dr. Ashok Shenoy, Dept.

Microbiology & Immunology, SQU. care

Molecular and Functional Charaterization of P2X7 gene coding Polymorphisms in Omani Patients with gastric cancer patient Project Code: IG/MICR/09/02; Dates: 2009-2011

Value: OR 11,000; Project Funder: Sultan Qaboos University and

Investigators: Dr. Ahmed Al-Shukaili, Dept. Microbiology & Immunology, SQU; Dr. Man- sour Al-Moundhri, Dept. Medicine, SQU; Dr Alia Al-Ansari, Dept. Biology, Col- academic M icrobiology & I mmunology

127 Annual Report 2009-2010 Microbiology & Immunology

lege of Science, SQU.

HIV/AIDS in Oman: Awareness, knowledge and attitudes of Omani pregnant and non-pregnant women towards HIV/AIDS Project Code: IG/MED/MICR/10/01; Dates: 2010–2011 Value: OR 2,500; Project Funder: Sultan Qaboos University Investigators: Dr. Ali Al-Jabri, Dept. Microbiology & Immunology, SQU; Prof. Moham- med Idris, Dept. Microbiology & Immunology, SQU Dr. Abdullah Balkhair, Dept. Medicine, SQU; Dr. Shyam Ganguly, Dept. Family Medicine and Public Health, SQU; Dr. Zakaryia Al-Muharrmi, Dept. Microbiology & Immunolo- gy, SQU; Dr. Muna Al-Sadoon, Dept. Child Health, SQU; Dr. Mariam Mathew, Dept. Obstetrics and Gynaecology, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al Jabri AA, AlMuharrami Z, Balkhair AA, Alenzi FQ, BaOmar AA.. Overview of factors affecting AIDS progression. Int J Med Biol Front 2010; 16:211−36. 2. Al Jabri AA, AlMuharrmi ZK, Balkhair AA, Ganguly S. The importance of antenatal screening of HIV among pregnant women. Saudi Med J 2010; 31:64−8. 3. Al Jabri AA, Hasson S. Influenza H1N1 2009: To vaccinate or not to vaccinate. SQU Med J 2009; 9:224−9. 4. Al Enzi FQ, AlEnzi BQ, Ahmed SY, AlEnazi MM, Matter EH, Salem ML, AlJabri AA, Lotfy M, Bamaga MS, Wyse RN. Role of caspase activation and mitochondrial depolarization in cultured human apoptotic eosinophils. Saudi JBiol Sc 2010; 17:29−36. 5. Al Enzi FQ, AlRabia MW, AlEnzi BQ, Mubaraki AM, Lotfy M, Salem ML, Siddiqui HM, Arif JM, Ahmed S, AlJabri AA, Wyse RK. Role of CTLA-4 in xenotransplantation. Pakistan JPhysiol 2009; 5:40−5. 6. Hasson SS, Mothana RA, Sallam TA, AlBbalushi MS, AlJabri AA. Novel serine protease variants encoged by Echis ocellatus venos gland cDNA: Cloning and sequencing analysis. J Biomed Biotechnol 2010; ID134232:12. [on line publication]. 7. Hasson SS, AlJabri AA, Mothana RAA, Algowshaie H, Sallam TA. Anti-snake venom activity of hibiscus plant against Echis ocelatus. JToxicol 2010; ID837864:1−8. [on line publication]. 8. Liu L, Mondal MMH, Idris MA, Lokman HS, Rajapakse PRVJ, Satrija F, Diaz JL, Upatham ES, Attwood SW. The phylo- geography of Indoplanorbis exustus (Gastropoda: Planorbidae). Parasit Vect 2010; 3:1−18. 9. Al Muharrmi Z. Understanding the influenza A H1N1 2009 pandemic. SQU Med J 2010; 10:187–95. 10. Al Jabri A, Hasson SS. Influenza A (H1N1) 2009 – To vaccinate or not to vaccinate? SQU Med J 2009; 9:224–7

128 CONFERENCE & SEMINAR PRESENTATIONS Poster presentations International 1. Idris MA, Deugoué NV, Doenhoff M, Shaban M, Ruppel A. Serological follow-up of praziquantel-treated children in a recent schistosomiasis mansoni focus in Dhofar Governorate, Sultanate of Oman. 12th International Congress of Parasitology. Melbourne, Australia, August 2010. 2. Attwood SW, Liang L, Mondal MMH, Idris MA, Lokman HS, Rajapakse JRP, Satrija F, Diaz JL, Upatham SE. The phylo- geography of Indoplanorbis exustus (gastropoda: planorbidae) in Asia. 12th International Congress of Parasitology. Melbourne, Australia, August 2010. National 1. Thukral SS, Rafay A, Al-Ghafri SS, Al-Hattali HS. Phenotypic detection of AmpC β-lactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae at Sultan Qaboos University Hospital (SQUH). University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 2. Al-Kobaisi MF, Al-Areimi WS, Khamis FA, Al-Kindi H,Al-Mandhari A. A newly emerging respiratory virus among children in Oman. University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 3. Idris MA, Degoué NV, Doenhoff M, Shaban M, Mone H, Mouahid G, Ruppel A. Epidemiological and serological follow- up of schistosomiasis mansoni in Dhofar, Oman. University Day. Sultan Qaboos University, Muscat, Oman, May 2010. THESIS SUPERVISION Abdullah A. Al-Hatmi Qualification: M.Sc. Title: Pathogenic Fungi Isolated from Clinical Samples departments Supervisor: Dr. Yaseen Al-Lawatia care

Hafidha Salim Al-Hattali Qualification: M.Sc. Title: Phenotypic and Molecular Detection and Characterization of AmpC beta patient lactamases in Clinical Isolates of Escherichia coli and Klebsiella spp. from SQUH and Supervisor: Prof. Sharanjit Thukral academic M icrobiology & I mmunology

129 Annual Report 2009-2010 Microbiology & Immunology

Hissa Al-Farsi Qualification: M.Sc. Title: Genetics of Plasmodium falciparum Resistance to SP in Saudi Arabia Supervisor: Dr. Hamza Babiker

Ms Wafaa S. Al-Areimi Qualification: M.Sc. Title: Viral Respiratory Infections among Omani Infants and Young Children at Sultan Qaboos University Hospital (SQUH) Supervisor: Dr. Muhannad Kobaisi

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131 Annual Report 2009-2010 Nursing Services Directorate

he Nursing Services Directorate is the largest department in the hospital and provides a 24 hour service. The Directorate is dedicated to provide outstanding, safe and quality patient care which includes performance improvement methodologies and indicators, quality control, assessment, peer review, teaching strategies to ensure nursing related processes are continuously improved. Nursing makes essential contributions to patient safety and quality care. Desirable patient outcomes are an empirical part ofT our goals. The vision of the Nursing Directorate is to strive for practice which is safe, caring, innovative, scientific and empowering based on a solid foundation of leadership. The Directorate seeks to be a model of excellence for all nursing services in the country. It aims to provide evidence-based practice and seeks to maintain a high standard in caring, teaching and training.

The mission of the Nursing Directorate is to be responsible and accountable in the provision of high standard nursing care to patients. It is committed to the teaching of medical and nursing students and to the professional development of nurses.

The Directorate is committed to an environment that fosters evidence based practice, critical thinking and adapts innovations that enhance delivery of quality patient care and teaching. It seeks to provide coordination of health care delivery across the contin-

132 tal of 1101 staff posts of which 1068 were occupied. This is compared to 908 staff in post at the end of 2009.

Yusriya Al-Akbary, Deputy Hospital Director for Nursing Affairs Roseliyah Shamsudin, Quality Management Daniel Birru, Assistant to Director for Training &Staff Development Catherine Lausa, Assistant to Director for Supple- mentary Services Shinuna Al-Harthy, Assistant to Director for Mater- nal &Child Health Ayna Al-Riyamy, Assistant to the Director for Gen- eral Area Fatma Al-Dhabari, Quality Management Yousuf Al-Hasani, Assistant to Director for Ambu- latory Services Padma Singh, Nursing Coordinator Lucia Pelser, Nursing Coordinator Khairom A. Rashid, Nursing Coordinator Phang Ah Looi, Nursing Coordinator Rose George, Nursing Coordinator uum using approaches that conform to interna- Amelita Villamora, Head Nurse, Ward 1 Blue tional standards; demonstrate patient advocacy Norah Ngcamu, Head Nurse, Ward 2 Blue while providing comprehensive, mutually defined Thavamony Saravanan, Head Nurse, Ward 2 Red care; empower nurses to exercise sound judgment Sotinah Tariono, Head Nurse, Ward 2 Yellow departments which will promote their professional develop- Zita Montesclaros, Head Nurse, Ward 2 Purple ment, and support and complement teaching and Rahma Al-Mahrazi, Head Nurse, Ward Bone Mar- training activities. care row Transplant Meqawati Md Nor, Head Nurse, Ward 3 Red Belingeria Jaafar, Head Nurse, Ward 3 Yellow

Staff Lau Pek Hoon, Head Nurse, Ward 3 Blue patient

The Directorate of Nursing has a multinational Koh Choy Fong, Head Nurse, Ward 3 Purple

Janet Ogonjumo, Head Nurse, Ward 4 Blue and

team responsible for the provision of nursing care services to SQUH. At the end of 2010, it had a to- Vijayarani Reddy, Head Nurse, Ward 4 Yellow academic nursing services directorate

133 Annual Report 2009-2010 Nursing Services Directorate

Suliaman Mahmoudi, Head Nurse, Ward 4 Red Umi K. Head Nurse, Ward 1 Purple Zairiyah Zainol, Head Nurse 4P Sarala Kodamala, Head Nurse, Family Medicine & Public Health Clinic Haseena Saib, Head Nurse, Operating Theatres Sapiah Abbas, Head Nurse, Day Care Unit Zayana Al-Maskary, Head Nurse, A&E Parvi Ponambalam, Head Nurse, Neonatal Ward Barbara Swales, Head Midwife, Delivery Ward Michael Lee, Head Nurse, Psychiatry Ward Nooraini Yadi, Head Nurse, Intensive Care Unit/CICU/Paediatric ICU Rabia Al-Saadi, Out Patients Coordinator Moey, Nursing Coordinator Robert Dimaiwat, Nursing Coordinator Hafidh Al-Hashmi, Head, CSSD Yacoub Al-Maharazi, Director for Support Services Abdulla Al-Qasmi, Medical Orderly On call Supervisor Bader Al-Nadhabi, Medical Orderly On call Supervisor Saleh Al-Akbari, Medical Orderly On call Supervisor Ghanim Shamsi, Medical Orderly On call Supervisor Support Staff like coordinators, medical orderlies (120) and ward clerks provides support on all areas.

Highlights of the Year 2010 In the year 2010, Directorate of Nursing made dramatic improvements in the provision of 24-hour patient centered nursing care. While 2009 proved challenging with new goals and initiatives, 2010 marked the jour- ney toward excellence. The focus on different improvement processes and efforts became an integrated body through Nursing Standards. The SQUH nursing staff is committed to this endeavour through its vision, mission and philosophy which guided the Department in achieving success. Directorate of Nursing earned the accolade of leadership, teamwork, excellence and smooth operational system through the continuous support of the top management and the staff and expresses its gratitude to them for all their support.

An intake of 26 Omani Nursing Graduates (Cohort 5) joined the Department in December 2010.

OPEN DAYS AND OTHER EVENTS The year started with an Open Day organised by the Professional Code of Conduct with the goal of making each staff aware as to their scope of duties defined by the Oman Midwifery and Nursing Council. The Support

134 Group actively participated in the Open Day.

The annual Nursing Food Fair was on 24 February an activity that promotes team work not just in the clinical arena, but also in other activities like this.

A Patient and Family Education Day was organised by Patient Services. The Directorate of Nursing participated in the event as nurses are the key advocate of PFE.

The SQUH Open Day organised by Public Relations Office was held on 2 May. As the biggest department in the hospital, the Directorate participated by presenting all its ongoing quality initiatives and best practice projects through poster presentations.

The Department participated in the Quality Open Day organised by DDQ in November through poster presentations on nursing quality activities.

QUALITY IMPROVEMENT On going quality improvement initiatives like Key Performance Indicator (KPI) monitoring on Patient Falls, short studies on the deployment of Nursing Staff, and on Medication Error were continuously implemented as a Nursing Coordinators project.

The first of the BSI bi-annual audits took place on 22 February and produced an excellent result of zero non- conformity.

A Patients Classification Study Taskforce was organised mainly to review resources and the amount of workload needing to be staffed.

A Call bell Audit was conducted from June 23 to 19 July. This is one of the ongoing key indicators which mea- sure the promptness of staff’s response to patient calls and compliance to the guidelines. departments

Competency Based Performance Appraisal (CBPA) has been reviewed and to ensure the validity and effectiveness of the tool, a pilot study was conducted for 1 year. care

The Best Practice Award Audit 2010 was carried out with the aim of benchmarking nursing practices in between wards. This is an annual event which promote, recognises and rewards the ward which complies with the standards. patient The Hospital Board approved the Competency based Performance Assessment tool (CBPA) for all nursing staff. and

The revision and updating of the nursing manual / guidelines is ongoing. “Our News”, a nursing newsletter, academic N ursing S ervices D irectorate

135 Annual Report 2009-2010 Nursing Services Directorate

is published twice a year by the nurses for the nurses.

One of the achievements of the Neonatal Unit was the effective and successful management of triplets.

Work on the Career Path for Omani Nurses is an on going process conducted by the Directorate. It focuses mainly on the developmental needs of staff and on their inclination, interest and vision for their future.

EDUCATIONAL & RESEARCH PROJECTS AND SURVEYS Departmental Studies, CNE and Patients Bedside stories were amongst 2010’s Quality & Educational Projects in which different wards participated on a monthly basis. These aimed to foster competitiveness between wards. Departmental studies entitled “Meeting Patient Needs – Evidence Based” was presented by FAMCO and “Nurse’s Perspective on Nursing Documentation” by the Documentation Working Group were the first of the many studies that were presented.

Patients Bedside Story is a new initiative for inpatient areas whereby patient’s actual hospital experiences are portrayed. This promotes staff confidence in presenting talks and increases empathy towards patients.

The Nurses Awareness in Disaster Management Preparedness survey was undertaken to assess the knowledge and readiness of all staff in the event of a disaster. This was done in conjunction with the new Disaster Plan introduced by the Disaster Planning Committee.

The staff participated actively on the following studies: 1) Effect of Defepion on thalassaemia children; 2) Impact of Paediatric Oncology Day care on the Hospital Cost; 3) Patient and family’s perceptions of Paediatric Day Care Surgery, and 4) Community Health Education in schools.

Departmental Studies was organised as a whole year activity for the ambulatory areas which facilitates the orientation, preparation and exposure of staff to research study, surveys and data analysis. This also aimed to develop the staff’s public speaking skills through interview. The activity is a competitive activity focused on Patient Satisfaction and Safety.

IN-HOUSE TRAINING A Wound Care Study Day was held February to disseminate relevant and interesting information on this specialisation. The 4th Middle East Wound Care Academy was held on 4 March 2010 and the SQUH Tissue Viability nurse was invited to speak during the event.

The ward head nurses participated in the 1st Nursing Retreat Day on 23rd March. This was an interactive group session for head nurses and administrative level staff which discussed a number of issues including: Leadership and Management; Professional Growth; Quality Issues; Professional Nursing Practice; Service Ex- cellence, and Resources Management.

136 An awareness raising talk on the “Role of nurses in Patient Safety” was presented to the staff.

The Nursing Assessment and Documentation Course commenced on 31 May and continued throughout the year with an average attendance 400 nurses. This course is part of the Patient’s Safety and Quality Initiative which educates and train nurses to be competent in patient assessment and producing acceptable patient notes.

A series of educational updates, organised by the Directorate for Training & Continuing Professional Devel- opment (DTCPD), were attended by various staff. These included: Attitude and Professional Responsibility; Communication Skills, and a Nephrology Course for Nurses handling renal transplant cases.

A Nursing Debate on “Nursing Audits are basically fault finding” was held in the College of Nursing in Au- gust. The “Against the Motion Team” was declared the winner.

A Staff Induction and Orientation Program for new arrivals was initiated with the following objectives: 1) receive a positive and consistent introduction to SQUH; 2) receive the information and team integration needed to carry out interactions required, and 3) achieve rapid staff assimilation into the work environment.

A Dysphagia Workshop was conducted on 27 September and attended by 12 nurses.

A Clinical Nurses Audit Workshop was held last October 18 until 20th, 2010. Delegates from the Directorate – Nursing Quality attended to enhance their knowledge of the mechanics of Clinical Audit.

A Preceptor Workshop was conducted on 20 October for senior nurses. It aimed to enhance the knowledge of the head nurses and their deputies on mentoring the nursing students affiliated to the Hospital.

From 6–8 October, an Emotional Intelligence Course was attended by 5 staff from the Directorate. The course focused on attitudes and approaches needed to handle situations in a positive manner.

A CBPA Workshop for head nurses was held last November. It aimed to strengthen and enhance the nursing departments leaders’ objectivity when assessing their staff through the appropriate utilisation of the tool.

A Nursing Administration Workshop was conducted for Head Nurses on 14 November to guide each head care nurse on the different aspects of ward management.

A Trauma Course was organised by the A& E ATLS certified instructors to refine staff skills and enhance their

knowledge of trauma management. patient

The High Dependency Training Course ran from July to October. High dependency nurses completed their and training, both theoretical and clinical, in 2 weeks. This is in conjunction with the plans to open high dependency beds on all Paediatric, Medical, Surgical and Obstetrics & Gynaecology wards. academic N ursing S ervices D irectorate

137 Annual Report 2009-2010 Nursing Services Directorate

The Directorate of Nursing is continuously engaged in teaching and training both medical and nursing students at the ward and departmental level. Nursing students came from OSNI, Oman Nursing Institute, Mus- cat Nursing Institute and SQUH College of Nursing.

An E-Learning Tutorial Workshop was held in April in the College of Nursing. Five nurses attended to learn about this new learning strategy.

Continuing Nursing Education is held monthly with selected nursing topics presented by invited speakers from the Medical Team.

EXTERNAL VISITS AND TRAINING The Nursing Team from the Psychiatric Unit visited the Ibn Sina Hospital on 17 August to network with them and gain a better insight into the management and care of mental health patients in Oman.

SQUH Delegates (DTCPD, Directorate of Nursing and the top management team) visited the University Ma- laya Medical Centre to explore training opportunities in October.

Five Omani nurses were sent to the California School of Health & Sciences for 3 months training in Emer- gency Trauma, Genetic Nursing, Emergency and Trauma Care, Paediatric Respiratory Nursing and Gastroen- terology Nursing.

CONFERENCES On 28 April, a collaborative conference was organised by the SQUH Directorate of Nursing and the College of Nursing with the theme of “Delivering Quality, Serving Community - Nurses leading Chronic Care” with participation from nurses all over Oman.

The 1st National Nursing Mental Health Conference was held in October organised by the Behavioural Medi- cine Department nurses and was attended by 500 nurses from all over Oman.

VISITORS Visitors from St Luke’s Episcopal Hospital (SLEH), Texas, USA, came in April and visited different key areas of the hospital: the ICU, Catheter Laboratory, A&E and the operating theatres. Positive feedback was received on the standards of these areas. Cross-training of SQUH staff with SLEH was also discussed.

138 A group of visitors from Hull University, UK, visited the Directorate to discuss potential clinical attachments for nursing staff.

A Patient Flow Management resource person from Adelaide, Australia visited from 5–17 December to advice on bed utilisation strategies. She also conducted a KPI Workshop for the Head Nurses on 11 December. departments

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139 Annual Report 2009-2010 Nutrition & Dietetics

he Department of Nutrition & Dietetics has responsibilities in a range of areas including dietetic counselling to inpatients and outpatients, administration, health education and promotion through activities related to preventative medicine, and training. Several clinics are covered in both adults and paediatrics. Adult clinics include diabetic, renal, lipid, obesity and gynaecology, whereas paediatric clinics include pre-term, haematology, metabolics, neurology, respiratory, general, endocrine and nephrology. The DepartmentT consists of two main divisions: Nutrition & Dietetics and Catering Administration 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 also work in the community as health promoters, educators, as well as in sports or media. They assess nutritional needs, diet restrictions and current health plans to develop and implement dietary management plans for patients mainly in the Hospital, and educate them on special diets as part of their medical treatment in several areas such as: Diabetes; Oncology; Renal conditions; Liver conditions; Gastroenterology; Paediatrics; Food Allergies; Obesity, and Nutrition Support.

The purpose of the Catering Administration service is to ensure a supply of safe, nutritious, well presented food and to protect patients from contaminated, decomposed or injurious food. The monitoring also prevents the use of misleading labels. Further moni-

140 Salma Al-Mahrouqi, Dietician Support Staff Mohammed R Hameed, Catering Administration Superintendent Matar R Al-Ruqaishi, Assistant Catering Superin- tendent Ali S Al-Farai, Coordinator Highlights of the Year 2009–2010 One of the main events of 2010 was the return of the Head of Department Mr. Salah Al-Shukaili in January 2010 from Australia after successfully completing his two year M.Sc. course. On 23 March 2010, Mr. Matar Al-Ruquishi obtained a Level 3 Award in Supervising Safety in Catering from the Charted Institute of Environment Health, UK.

From 3–5 May 2010, the Department organised a 3 day course for Department dieticians on Behaviour Change Skills in Clinical Practice. The course was toring activities encourage healthier and safer food delivered by Mrs. Dympna Pearson, a Consultant by better standards of quality control in receiving Dietician, and Ms. Joanne Jones both from the UK. food products from suppliers, correct storage, food The Department conducted a Product Orientation preparation, cooking and serving food to patients.

programme for doctors and nurses with each dieti- departments

cian giving a talk to their allocated wards to raise awareness of products available and used in the care Staff Department. Majda Al-Maamary, Deputy Head of Department Yahya Al-Mukhaini, Chief Dietician Ms. Shadya Al-Harthy and Ms. AShaima Al-Kindy

Shadya Al-Harthy, Senior Dietician compiled and designed a pocket guide for the Nu- patient

A’Shaima Al-Kindi, Dietician trition Support booklet for dieticians in October

2009. and

Ayda Al-Nabhani, Dietician Fatma Al-Hashmi, Dietician This year, food safety improvements were made academic nutrition & dietetics

141 Annual Report 2009-2010 Nutrition & Dietetics

in the catering Operations: 1) the introduction of an improved patient meal service menu in March 2010; 2) bimonthly replacement of dishwashing chemicals, previously only done monthly; 3) from January 2010, frequent monitoring of the dosage level of these chemicals was implemented. This is vital otherwise they can deposit as residue on the crockery; 4) from March 2010, chicken thawing was done inside the thawing chiller – an important food safety requirement; 5) from May 2010, extra areas were identified for frequent sanitisation in order to minimise cross-contamination, e.g. chiller doors and the areas of frequent hand contact at all entrance doors to the kitchen, and 6) in June 2010, food safety training was given to all senior food service staff.

Teaching Programmes POSTGRADUATE PROGRAMME From February to April 2010, the Department trained one graduate student from College of Agriculture & Marine Sciences’ Department of Food Science & Nutrition as part of the accredited course FSHN 4800.

TRAINING COURSES & CME ACTIVITIES A special catering training programme was provided from January to April 2010 for one dietician from Royal Court Affairs. A total of 11 Infant Feeding four-hour workshops were provided for 5th year medical students between September 2009 and August 2010. In the Infant Baby Feeding Hospital Initiative (IBFHI), 5 lectures, food testing panels and demonstrations were provided in the year October 2009 to October 2010.

Clinical & Diagnostic Services The total number of meal complaints was reduced from over 35 in 2009 to only 6 in 2010. This increase in customer satisfaction was achieved by: 1) Innovation of colour-coding and continuous monitoring; 2) Disin- fection of vegetables and fruits; 3) Checking that the meal production process complies with HACCP and food safety regulations; 4) Regular auditing of supplier premises to that food is supplied in compliance with food safety regulations; 5) Continuous monitoring of HACCP records, and 6) Continuous on the job staff training.

142 100% 99% 96.70 99% 95.10% 93.50% 93% 92% 90% 85.40% 80% 78% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9

Figure 1: Results of patient satisfaction survey June - July 2010 showing percentage of positive answers to the questions listed below.:

1. Does a diet clerk visit you daily to take your menu selection? 2. Do you receive all items ticked on the patient menu? 3. Do you find there is enough variety on the patient menu? 4. Is your tray clear of all spoilage? 5. Are your cutlery and crockery clean when delivered? 6. Is the temperature of your food at a level which you are happy with? 7. Do you receive enough food? departments

8. Have you experienced any problems with the in between meals, beverage service?

9. Do you always have water and a glass within your reach? care

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Statistics-Patients Counselled 2010

250

200

150

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0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

In-Patient (Adults & Paediatrics) Out-Patients Paediatrics Out-Patients Adults Total Patient for each Month

Research CONFERENCE & SEMINAR PRESENTATIONS Seminar Presentations National 1. Al-Mukhaini Y. The Function and Roles of the Nutrition and Dietetics Department. 5th Year Nursing student presentation. SQU Hospital, Oman, October 2009. 2. Al-Harthy S, Al-Kindy A. Introduction to “A Pocket Guide to Nutrition Support”. Dietetic Review Session. Ministry of Health, Oman, October 2009. 3. Al-Mukhaini Y. General Dietetic Practice and Principles. The Dietary Management of Chronic Diseases Training Workshop. Oman Institute of Public Health, Oman, December 2009. 4. Al-Mukhaini Y. Nutrition and Health. Nutrition and Physical Activity Workshop, Oman, December 2009. 5. Al-Mukhaini Y. Nutrition Care Process. The Dietary Management of Chronic Diseases Training Workshop. Oman Institute of Public Health, Oman, December 2009. 6. Al-Mukhaini Y. Healthy Diet. Participation in national TV programme Kahwat AlSabah, January 2010. 7. Al-Mukhaini Y. Healthy Diet. Village Health Care III (Nutrition) for the Academic Year 2009-2010. College of Medi- cine and Health, SQU, 30 January 2010.

144 8. Al-Mukhaini Y. Communication. Village Health Care III (Nutrition) for the Academic Year 2009-2010. College of Medicine and Health, SQU, 30 January 2010. 9. Al-Mukhaini Y. The Nutritional Management of Diabetes Mellitus. Role of Dietetics on Chronic Diseases Workshop. Samail Hospital, Oman, 16–17 February 2010. 10. Al-Mukhaini Y. Role of Catering Supervisor in Hospitals. The National Gathering of Nutrition North Sharqiya Re- gion. Ibra, Oman, 23–24 March 2010. 11. Al-Mukhaini Y. Diet and Disease. Current Challenges in Nutrition Related Health Problems in Oman. SQU, Oman, March 2010. 12. Hameed RS. HACCP based food safety management system. 1st Clinical Workshop. Department of Hospital Affairs, Ministry of Health, Oman, 16 June 2010. 13. Al-Shukeili S. Clinical Nutrition. 1st Clinical Workshop. Department of Hospital Affairs, Ministry of Health, Oman, 16 June 2010. 14. Al-Shukeili S. Nutritional Management in Cerebral Palsy. Nutritional Management in Cerebral Palsy Workshop. Care Centre of Handicapped Children, Muscat, Oman 19 and 28 June 2010. 15. Al-Mahrouqi S. The Effect of Cancer Chemotherapeutic Agents on Nutritional Status. Food and Drug Interaction Workshop. Ministry of Health, Oman, 14 July 2010. departments

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145 Annual Report 2009-2010 Obstetrics & Gynaecology

he Department of Obstetrics and Gynaecology is one of the major departments involved in teaching undergraduates, postgraduates and other allied professionals. It produces trained leaders in women’s health whether as an academic subspecialty, community practice or research. We take care of women of all age groups and believe that women are the nucleus of the family, the community and the nation. The goal of the Department is to provide excellent women’s health care through the academic subspecialtiesT 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, inpatient and outpatient settings. Our undergraduate and postgraduate programmes train the students to provide comprehensive health care for women by applying an evidence-based approach to clinical management with a view to providing the best possible care to all our patients.

146 Moza Al-Kalbani, Consultant Asma Al-Ojaili, Senior Registrar Evelyn Moral, Senior Registrar Rahma Al-Haddabi, Senior Registrar Shabnam Saquib, Senior Registrar Shahila Tazneem, Senior Registrar Majeda R. Al-Bash, Registrar Hazel Gonsalves, Registrar Silja A. Pillai, Registrar Hana Al-Sayed, Senior House Officer Sadaf Ayoob, Senior House Officer Sarya A. Bella, Senior House Officer Farah Fathih, Senior House Officer Seema Zulfikar, Senior House Officer Maya Kumari, Senior House Officer Musarrat Musarrat, Senior House Officer Soha Abdel Gadir, Senior House Officer Zamzam Al-Bimani, Senior House Officer Support Staff Philomena Sangameshwar, Coordinator Samson P, Coordinator Staff Highlights of the Faculty Year 2009-2010 Lamya Al-Kharusi, Consultant & Deputy Head of The Department continues to develop the new departments Department subspeciality clinics in the Out Patient Depart- V. Gowri, Assistant Professor ment (OPD): Urogynaecology, Oncology, Maternal care

Lovina Machado, Consultant Fetal Medicine and Endoscopic Surgery. Mariam Mathew, Consultant Maha Al-Khaduri, Consultant In the Department, this year has witnessed an increase in the complexity of gynaecological sur-

Wadha Al-Ghafri, Consultant patient Tamima Al-Dughaishi, Consultant geries done, especially by continuing advanced urogynaecological procedures such as tension free Nihal Al-Riyami, Consultant and

Mariam Al-Shukri, Consultant vaginal tapes for the management of stress uri- Sheikha Al-Jabri, Consultant nary incontinence and major gynae-oncology op- academic obstetrics & Gynaecology

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erations. In addition, more laproscopic surgeries for benign gynaecology conditions have been carried out. A Fetal Anomaly clinic with a multidisciplinary approach has been started.

Two important continuing medical education activities were held this year. The first was the International Symposium: Update on Women’s Health on 31st December 2009. It was organised by Dr. Lamya Al-Kharusi and Dr. V. Gowri. The invited international speakers were both from the UK: Prof. John Studd Prof. Margaret Johnston. The second event was also, the Advanced Life Support in Obstetrics course organised by Dr. Moza Al-Kalbani, Dr. Lamya Al-Kharusi and Dr. Wadha Al-Ghafri under the Oman Medical Specialty Board (OMSB on 16 and 17 June 2010). This course was very important in training all medical personnel involved with management of the delivery ward. The aim was to improve the management of obstetric emergencies thus decreasing morbidity and litigation.

The Department acquired new equipment in this year: three ultrasonography (USG) machines (1 in the La- bour and Delivery Ward and two in the OPD). The Multichannel Urodynamic Unit has been restarted after obtaining new software/machine that is being used in conjunction with the urology department.

In the development of the new curriculum, the Phase II departmental representative/coordinator was Dr. Mariam Mathew and the Phase III departmental representative Dr. V Gowri

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME In the 4th year, the Department is involved in the clinical methods and communication skills programme. The clinical methods course in obstetrics and gynaecology involves 3 staff members teaching 2 hours for each of 3 days. The communication skills programme has students weekly spending 2 hours in lectures and 2 hours in ward exposure for 16 weeks. One lecture is given as an interdisciplinary activity to 5th year students.

UNDERGRADUATE PRECLINICAL PROGRAMME In 2009 and 2010, 114 and 110 students respectively presented for the MD examination in obstetrics and gynaecology. For 6th year students, we have 4 weeks training in the Department. Each student has to do 2 case write-ups and present one case. Students are exposed to didactic lectures, outpatient clinic, bedside teaching and operative procedures in the Obstetrics and Gynaecology department. Students in 7th year spend 7 weeks on placement: 3 weeks at SQUH, 2 weeks at the Royal Hospital and 2 weeks at Khoula Hospital. They are exposed to problem solving seminars and ward rounds with consultants. They also rotate to the operating theatre, outpatient clinic and wards. In the OPD, they are exposed to a wide spectrum of obstetrics and gynaecology patients, attend the high risk pregnancy clinic and are exposed to ultrasound procedures.

148 POSTGRADUATE PROGRAMME The Oman Medical Speciality Board (OMSB) programme started in September 2007; 3 residents are posted at a time in the Department where they are actively involved in patient care, oncall rota and presentations such as the Journal Club. Dr. Lamya Al-Kharusi was Chairperson, of the Obstetrics & Gynaecology Scientific Com- mittee, while Dr. Wadha Al-Ghafri was its Programme Director. Active committee members were: Dr. Maha Al-Khaduri, Dr. Lovina Machado, Dr. Tamima Al-Dughaishi and Dr. Nihal Al-Riyami.

TRAINING COURSES & CME ACTIVITIES The CME programme consists of the following monthly activities: departmental meeting attended by all staff, midwives, and OPD nurses as needed; Journal Club; Pathology Rounds, and Fetal Anomaly group meeting (multidisciplinary with NICU, genetics, Paediatric Surgeons). The following weekly activities were organised: resident and intern presentations; a CME session aimed at senior house officers and registrars, and an inter-departmental meeting between Obstetrics & Gynaecoloy and the Neonatal Intensive Care Unit (NICU).

Clinical & Diagnostic Services In the Gynaecology OPD, 17,248 patients were seen in general OPD. There were 9,925 antenatal patients, 5,872 gynaecological patients and 44 postnatal patients. Besides these, the following patients were seen: Infertil- ity Clinic – 1,443; Diabetics Clinic (pregnancy with diabetes) – 531; Uro-Gynaecology Clinic – 230; Colposcopy Clinic – 44; Intra Uterine Growth Restriction (IUGR) Clinic –88; Fetal-Maternal Clinic – 129; Amniocentesis Clinic – 152 patients; Recurrent Abortion ¬– 125; Oncology – 18; Adolescents – 5, and Combined Infertility – 118 patients.

In the Labour ward from January to December 2010, a total of 5,059 (day cases and admissions) patients were seen. The total number of deliveries was 3,427 of which 2,630 were normal vaginal deliveries; 472 emergency cesarean sections; 219 elective cesarean sections, and 106 instrumental deliveries. departments We had a total of 3,108 admissions in the Red 2 (mainly postnatal) ward. Of these, 1,937 patients who delivered were booked via the antenatal clinic and 1,171 (32.2%) were unbooked cases. There were 668 patients who un- care

derwent cesarean sections out of 3,108 admissions. Emergency cesarean sections were done on 450 patients and elective cesarean sections were done on 218 patients.

A total of 2,960 patients were admitted in Yellow 2 ward, mainly with gynaecological problems. Of these, patient 1,515 were new cases and 1,445 were existing cases and patients with antenatal problems. The total number of antenatal patients admitted to this ward was 1,297 and 538 with postnatal problems. We had total 1,043 and inpatients and 591 outpatients. The total number of patients discharged was 2,051. academic O bstetrics & Gynaecology

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Research RESEARCH PROJECTS The Relationship between Birth Weight and Shoulder Dystocia at Sultan Qaboos University Hospital. Project Code: MREC #347; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Maha Al-Khaduri, Dept. Obstetrics & Gynecology, SQU; Dr Yahya Al-Far- si, Dept. Family Medicine & Public Health.

Comparison of Transvaginal Sonography, Saline Infusion Sonohysterography and Hysteroscopy in the Evaluation of Women with Abnormal Uterine Bleeding Project Code: MREC #287; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigator: Dr. Mariam Mathew, Dept. Obstetrics & Gynecology, SQU.

Clinical Patterns and Major Causes of Infertility in Sultan Qaboos University, Oman Project Code: MREC #288; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigator: Dr. Vaidyanathan Gowri, Dept. Obstetrics & Gynecology, SQU.

Prevalence of Cesarean Delivery in Pre Eclamptic Patients with Elevated Uric Acid and Correlation of Blood Urea, Creatinine and Serum Uric Acid Project Code: MREC #289; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigator: Dr. Vaidyanathan Gowri, Dept. Obstetrics & Gynecology, SQU.

Aetiology and pattern of recurrent pregnancy loss in women referred to a tertiary care centre in Oman Project Code: MREC #289; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigator: Dr. Vaidyanathan Gowri, Dept. Obstetrics & Gynecology, SQU.

150 RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Gowri V, Zakwani I Prevalence of cesarean delivery in pre-eclamptic patients with elevated uric acid. Hypertens Pregnancy 2010; 29:231–5. 2. Gowri V, Jain R. Congenital skeletal dysplasia. BMJ Case Reports 2009. DOI: 10.1136/bcr.01.2009.1456. 3. Gowri V, Jain R. Investigating infertility. BMJ 2009; 339:b3390. 4. Gowri V, Mathew M. Ultra Sound location of misplaced levonorgestrel releasing intrauterine system (LNG-IUS) – is it easy? Oman Med J 2009: 24:54−5. 5. Mathew M, Gowri V, Rizvi SG. Saline infusion sonohysterography – An excellent tool for evaluation of the endometrial cavity in women with abnormal uterine bleeding.Acta Obstet Gynecol Scand 2010; 89:140−2. 6. Gowri V, Rizvi S, Shabnam S, Futaisi A. High sensitivity CRP is a marker of ovarian syndrome per se in obesity and not of polycystic. Fertil Steril 2010; 94:2832-4. 7. Gowri V, Jain R, Rizvi R. Magnetic resonance pelvimetry for trial of labour after previous caesarean section. SQU Med J 2010; 10:210−4. 8. Gowri V, Venkiteswaran KP, Al Zakwani I, Mathew J, Rahman KA, Al Marhoon M. Comparison of the demographics, semen parameters and hormone profiles in men with primary and secondary infertility. SQU Med J 2010; 10:350–3. 9. Al Khaduri M, Shawki O. Adenomyosis diagnosed by hysteroscopoy. J Minim Invasive Gynecol 2009; 16:S53. 10. Mathew M, Burney I, Al Hamdani A, Rao K. Bilateral breast metastases in a pregnant woman with disseminated cutaneous melanoma. Indian J Cancer 2009; 46:342−4. 11. Saquib S, Mathew M, Jain R. Torsion of a nongravid uterus with leiomyoma mimicking broad ligament leiomyoma. Saudi Med J 2009; 30:851−2. 12. Mohan AK, Al-Senavi R, Mathew M, Ganesh A, Al-Mujaini A. Exudative retinal detachment in a case of severe pre eclampsia. Saudi Med J 2009; 30:302−3. 13. Machado N, Machado L, Laparoscopic cholecystectomy in the third trimester of pregnancy – a report of 3 cases and departments

review of literature. Journal of Surgery, Laparoscopy, endoscopy, percutaneous technique (SLEPT) 2009; 19:439–41 14. Machado N, Machado L. Sigmoid volvulus complicating pregnancy managed by resection and primary anastamo-

sis. SQU Med J 2009:9:342−6. care

15. Al Hashami H, Bataclan MF, Mathew M, Krishnan L. Caudal regression syndrome with partial agencies of corpus callosum and partial lobar holoprosencephaly: a case report, SQU Med J 2010; 10:89−93.

16. Mathew M, Saquib S, Kumar S, Lokuhetty D, Jain R. Successful management of a case of a gestational trophoblastic patient neoplasia in a young women, SQU Med J 2010; 10:297−98. and

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CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Al Kharusi L. Outcome of cystocele repair with and without stress urinary incontinence using a synthetic mesh. 19th FIGO World Congress in Obstetrics and Gynaecology. Cape Town, South Africa, 4−9 October 2009. 2. Al Kharusi L. 2nd International Forum on CPD Accreditation. The Royal College of Physicians & Surgeons of Canada & Royal Australian College of Surgeons. Sydney, Australia. 19−20 March 2010. 3. Machado L. Extraosseous Ewing’s sarcomaprimitive neuroectodermal tumor of the vagina – case report and review of literature. 19th FIGO World Congress in Obstetrics & Gynaecology. Cape Town, South Africa, 4−9 October 2009. 4. Al-Khaduri M, Shawki O. Adenomyosis diagnosed by hysteroscopy. The 38th Global Congress of Minimally Invasive Gynaecology. Orlando, Florida, USA, 15–19 November 2009. National 1. Al Kharusi L. Urogynecology Symposium. Nizwa Hospital Directorate. May 2010. 2. Al-Khaduri M, Al-Farsi Y. Technicity as a quality indicator of excellence in gynaecology at Sultan Qaboos University Hospital. Second International Conference of Quality Management in Health Care. Muscat, Oman, 1−3 Feb 2010. Poster Presentations International 1. Machado L, Mohan A. Ruptured interstitial ectopic pregnancy following ipsilateral salpingectomy in a spontaneous conception cycle. The 19th FIGO Congress. Cape Town, South Africa, 4–9 October 2009. 2. Mathew M. Cornual pregnancy- successful management of a rare case. 19th FIGO World Congress in Obstetrics & Gynaecology, Cape Town, South Africa, 4–9October 2009. 3. Mathew M. Necrotic leimyoma postpartum masquerading as an abscess. 19th FIGO World Congress in Obstetrics & Gynaecology. Cape Town, South Africa, 4–9 October 2009. 4. Mathew M. Torsion of a non gravid uterus with leiomyoma mimicking as broad ligament leiomyoma – a rare case. RCOG Conference. Abu Dhabi, UAE, 6–9 Dec 2009. 5. Mathew M, Mohan A, Al Kalbani A, Al Aamari S. Cornual pregnancy–Successful management of a rare case. 19th FIGO World Congress on Obstetrics & Gynaecology. Cape Town, South Africa, 4–9 October 2009. 6. Mathew M, Saquib S, Gowri V, Rao K. Necrotic leiomyoma postpartum masquerading as an abscess. 19th FIGO World Congress on Ostetrics & Gynaecology. Cape Town, South Africa, 4–9 October 2009. 7. Saquib S, Mathew M, Jain R. Torsion of a non gravid uterus with leiomyoma mimicking as broad ligament leiomyoma–a rare case.RCOG Conference. Abu Dhabi, UAE, 6–9 December 2009. 8. Machado L, Saquib S, Shahila S. Co-twin demise at 27 weeks gestation in a monochorionic monoamniotic twins–a management dilemma. Royal College of Obstetrics & Gynaecologists Conference. Abu Dhabi,7 –9 December 2009.

152 9. Elnour I, Moral E, Reyes Z, Bataclan F. Antenatal hydronephrosis in SQUH and its outcome. Urology Paediatrics Con- ference. New York, USA, August 2010. National 1. Al Kharusi L, Gowri V, Al Suketty R, Al Gafri W, Rao K. A rare case of submyomatous cornual pregnancy managed surgically after failed medical treatment. University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 2. Moral E, Mathew M, Rao K. Bilateral ovarian dermoid cyst torsion in an adolescent. University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 3. Mathew M, Abreo M, Jain R. Advanced endometriosis–A diagnostic dilemma. University Day. Sultan Qaboos Univer- sity, Muscat, Oman, May 2010. 4. Mathew M, Saquib S, Kumar S, Lokuhetty D, Jain R. Through the “vine(vein) yard”–Successful management of a case of gestational trophoblastic neoplasia in a young women.University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 5. Machado L, Mohan A. Successful conservative management of ruptured corneal ectopic pregnancy. University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 6. Machado L, Shahila S. Endometriosis-an educational poster.University Day, Sultan Qaboos University, Muscat, Oman, May 2010. Seminar Presentations National 1. Al- Khaduri M, Al-Farsi Y. Technicity as a quality indicator of excellence in gynaecology at Sultan Qaboos University Hospital. University Day. Sultan Qaboos University, Muscat, Oman,May 2010. 2. Abudraz R, Al-Farsi Y, Al-Khaduri M. The relationship between birth weight and shoulder dystocia at Sultan Qaboos University Hospital.University Day. Sultan Qaboos University, Muscat, Oman, May 2010. 3. Al-Khaduri M, Daar S. Successful pregnancy following iron chelation and ovulation induction for hypogonadotropic hypogonadism associated with beta thalassemia major: A case report and literature review.University Day. Sultan Qaboos University, Muscat, Oman, May 2010. departments 4. Al-Khaduri M. Challenges facing research at SQUH. College of Medicine & Health Sciences Research and Postgradu- ate Studies Retreat. Muscat, Oman, 6 May 2010. care 5. Al-Khaduri M. Cornual Ectopic Pregnancy. ULSTER Obstetrics & Gynaecology Society CME IV. Muscat, Oman, 11 March 2010. 6. Mathew M, Saquib S, Kumar S, Lokuhetty D, Jain R. Through the Vine(vein)yard. SCRAPS Pathological Clinical Confer-

ence. College of Medicine, SQU, Oman, 28 October 2009. patient

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THESIS SUPERVISION Student Name: Farhat M. Al-Naabi Qualification: MSc. Title: Assessment on Omega 3 fatty acid among postpartum Omani women Supervisor: Dr. Lamya Al-Kharusi Date of Completion: Ongoing

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he Department of Ophthalmology at the Sultan Qaboos University Hospital (SQUH) has long been recognised as a leader in patient care, research and education in the country. The Department’s staff of doctors, optometrists, orthoptists, and ophthalmic technicians is committed to advancing the treatment and understanding of ocular disorders in Oman. Our subspecialties are general ophthalmology; cornea and external diseases; uveitis; medical retina; paediatric ophthalmology; ophthalmogenetics, and vitreoretinaT surgery The Department is proud to have the first electrophysiology diagnostic clinic unit in the country. As part of an academic health care system, the Department provides clinical experience for medical students and residents under the auspices of the Oman Medical Specialty Board (OMSB). The Department conducts a number of CME activities, participates in various conferences and meetings, and conducts research with ensuing publications.

156 Shahab Agha, Registrar Sitara Azeem, Registrar Rana Al-Senawi, Senior House Officer Samia Al-Jabri, Senior House Officer Beena Harikrisna, Senior House Officer Tysser A. Basi, Senior House Officer Dalal Al- Zahra, Senior House Officer Support Staff Janet Ogunjumo, Superintendent Kuan Yok Leng, Assistant Head Nurse Jessy Jose, Senior Staff Nurse Mangu Thomas, Staff Nurse Habiba Al-Belushi, Chief Technician Bushra Al-Jabri, Optometrist Sreelatha OK, Optometrist Edgardo Go, Optometrist Pascale Cooymans, Orthoptist Salim Al-Abri, Senior Technician Raya Al-Mughery, Senior Technician Sadika Al-Ajmi, Senior Technician Harith Al-Hasani, Technician Hanan Al-Harty, Technician Staff Eman Al-Hasmi, Technician Iman Al Harthy, Technician Faculty Melinda Manegdeg, Coordinator (Hospital) Sana Al-Zuhaibi, Senior Consultant Laila Al-Kindi, Coordinator (College) departments Abdullah Al-Mujaini, Consultant Anuradha Ganesh, Consultant Highlights of the care

Ahmed Al-Hinai, Consultant Mohammed Al-Abri, Senior Registrar Year 2009-2010 George Manayath, Senior Registrar For the second time, the Department was awarded

Upender Wali, Senior Registrar the first prize in quality management by SQUH in patient

Archana Thakral, Senior Registrar recognition of it excellent performance. It was also

Nawal Al-Fadhil, Registrar awarded the prize for the best presentation in the and

Buthaina Saad Sabt, Registrar SCRAPS, College’s Clinico-Pathological Workshop Carolina Montana, Registrar academic ophthalmology

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Series. Finally, Dr. Sana Al-Zuhaibi was awarded a prize on University Day in May 2010 in recognition of her excellent service for the University.

NEW TEACHING PROGRAMMES In 2009, the teaching programme for the medical students was changed to involve Al-Nahdha Hospital in the lectures series as well as the end of rotation exams, An objectively structured clinical examination (OSCE) was introduced for the first time for students in the ophthalmology rotation. The residency programme in ophthalmology was launched in 2009 under the umbrella of OMSB. A total of four residents were accepted with two of them rotating at SQUH at a time and three more accepted for the 2010-2011 academic year.

NEW SUBSPECIALTIES A new Retina Unit has been established headed by Dr. Ahmed Al-Hinai along with Dr. Mohammed Al -Abri and Dr. George Manayath. The Unit is fully equipped with the latest technology to perform modern retina surgeries.

NEW SERVICES OFFERED A new electroretinography (ERG) clinic was launched this year to provide special ophthalmic care to patients with special needs. It is the first in the country and is valuable for diagnostics and research, as well as for boosting the residency training programme.

RESEARCH Work on a Glaucoma project with the postgraduate student, Ms. Rayhana Al- Mujaini is continuing. Mem- bers of the Department have published five journal articles this year and made three poster presentations.

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME As in previous years, the Department continued its teaching in the Integrated Lecture Series (ILS) for 5th year medical students and conducted 3 days of lectures on extra-ocular muscle evaluation and ophthalmoscopy. Ophthalmology also contributed to the Endocrine ILS with a topic on the diabetic eye for 5th year medical students.

158 UNDERGRADUATE CLINICAL PROGRAMME The main objective of the course is to introduce students to ophthalmology as a branch of medicine 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 Department conducted a 4 week course in ophthalmology for the 6th year medical students. They spent 2 weeks in SQUH and 2 weeks at the Ministry of Health’s Al-Nahdha Hospital. They attended a two hour lecture on basic ophthalmology every morning for the first 2 weeks. These lectures are divided between SQUH and Al-Nahdha Hospital. In the spring semester, the following 9 lectures were presented under the new curriculum to cover the most important topics in ophthalmology: Introductory lecture – Anatomy and Physi- ology; Red Eye; Acute Visual Loss – Primary Narrow Angle Glaucoma (PNAG); Chronic Visual Loss – Primary Open Angle Glaucoma (POAG); Ocular Trauma; Uveitis and Neuro-ophthalmology; Systemic Diseases of the Eye; Amblyopia and Strabismus; Optics and Refraction, and Paediatric Ophthalmology.

Students also maintain a logbook of the patients they have seen are given a model case write-up to enable them to submit case reports for evaluation. After their 2 week rotation in MOH hospitals, they returned to SQUH for an end of posting examination.

POSTGRADUATE PROGRAMME The Department had one Phd. student, Ms Rayhana Al-Mjeni, doing research is on clinical and genetics studies of glaucoma in Oman.

CLINICAL ATTACHMENTS Two ophthalmologists came to the Department for clinical attachments: Dr.Haider Al-Tamimi from Nizwa Hospital and Dr. Nouf Al-Farsi who was also an intern from January 2010. departments

TRAINING COURSES & CME ACTIVITIES care The Department established two structured teaching course in two subspecialties: 1) Cornea and External Diseases, composed of 14 lectures covering all aspects of this field based on the American Academy of Oph- thalmology (AAO) guidelines. 2) Pediatric Ophthalmology, composed of 16 lectures covering all aspects of this patient again based on AAO guidelines. Both of these courses were followed by an examination of 50 A type multiple choice questions. A third course on Vitreoretina Diseases is currently in preparation. A three day ERG training and course was conducted for staff by an external expert. Internal CME programmes are held two to three times a week after the Department daily morning meeting. Discussions are held on difficult and interesting cases seen in the clinics or on current departmental research. A total of 55 CME sessions were conducted during academic O phthalmology

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2009-2010. A lecture in the College Clinico-Pathological Workshop (SCRAPS) series was given by the Depart- ment in October 2010. It was entitled Is it Frozen? and was given in collaboration with the departments of Radiology & Molecular Imaging and Haematology.

Clinical & Diagnostic Services There was a total of 414 surgeries in 2010 in the Main Theatre. There was a total of 492 adult and 53 paediatric inpatients in 2010. Ophthalmology Outpatient Department 2010 Minor Operating Theatre Procedures

Patients booked 12,741 Minor operation 285 Patients seen 14,861 Blood Extraction 332 Patients admitted 392 Sedation 149 Patients who did not attend 2,545 Cannulation 196 Patients discharged 182 Dilatation 5,759 Patients for treatment 830 Other 258 Total 6,979

Laser Procedures Technical Procedures Argon 157 Refraction 455 Yag 54 Ultrasound 346 Photodynamic therapy 20 Pachymetry 372 Avastin & Lucentis Injections 71 Visual Field 738 Fundus fluorescein angiography 212 Optical coherence tomography 2,021 Diabetic screening 368 Confoscan 22 Contact Lens 26 Orbscan 82 Low Vision Service 5 Microperimetry 238 Orthoptic 333 Photo 560 Total 1,246 Total 4,826

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Total no. of surgeries 414 Research RESEARCH PROJECTS Clinical and genetic studies of glaucoma in Oman Project Code: IG/MED/GENT/10/01; Dates: 2010–2012 Value: OR 13,500; Funder: Sultan Qaboos University Investigators: Dr. Nadia Al-Kharousi, Dept. Ophthamology, SQU; Dr. Said Al-Yahyaee, Dept. Genetics, SQU; Dr. Anuradha Ganesh, Dept. Ophthamology, SQU; Dr. Upend- er Wali, Dept. Ophthamology, SQU; Ms. Rayhanah Al Mejeni, Dept. Genetics, SQU.

Correlation of central corneal thickness (CCT) with intraocular pressure (IOP) in Omani children: The importance of CCT in pediatric aphakic and pseudophakic glaucoma Project Code: IG/MED/GENT/10/02; Dates: 2010–2012 Value: OR 6,600; Funder: Sultan Qaboos University Investigators: Dr. Sana Al Zuhaibi, Dept. Ophthamology, SQU; Dr. Anuradha Ganesh, Dept. Ophthamology, SQU; Dr. Rana N Senawi, Dept. Ophthamology, SQU; Dr. Seyed Rizvi, Dept. Family Medicine & Public Health, SQU; Mrs. Raya Al-Mu- gheiry, Dept. Ophthamology, SQU; Mr. Harith Al-Hasani, Dept. Ophthamol- ogy, SQU. departments

RESEARCH PUBLICATIONS & BOOKS Journal Publications care 1. Cooymas P, Al-Zuhaibi S, Al-Senawi R, Ganesh A. Congenital fibrosis of the extraocular muscles. Oman J Ophthal- mol 2010; 3:70−4. 2. Diab F, Al-Sabah K, Al-Mujaini A. Successful surgical management of optic disc pit maculopathy without internal

membrane peeling. Middle East Afr J Ophthalmol 2010; 17:278−280. patient

3. Al-Mujaini A. Towards a structured ophthalmology residency program in Oman. Oman J Ophthalmol 2010: 3:1. and 4. Al-Mujaini A, Wali U, Al-Senawi R. Canaliculitis: Are we missing the diagnosis?Oman J Ophthamol 2009; 2:145−6. 5. Al-Mujaini A, Al-Senawi R, Al-Duhli H, Dennison D. Abrupt onset of unilateral third nerve palsy secondary to central academic O phthalmology

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nervous system relapse in acute myeloid leukemia. SQU Med J 2010; 10:297. 6. Al Kharousi NS, Wali, UK. Culture negative confoscan positive acanthamoeba keratitis. SQU Med J 2009; 9:337–40. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Ganesh A, El-Gayar S, Al-Zuhaibi S, Al-Senawi R, Chavarria-Soley G, Al-Mjeni R, Raeburn S, Bialasiewicz AA. Mo- lecular Analysis of the CYP1B1 gene in Omani patients with Primary Congenital Glaucoma: A Pilot Study. 1st World Congress of Pediatric Ophthalmology and Strabismus. Barcelona, Spain, 12–13 September 2009. 2. Penetrating orbital foreign body: observe vs. intervene. 1st World Congress on Controversies in Ophthalmology. Prague, Czech Republic, 4–7 March 2010. National 1. Al-Mujaini A. Ptosis in Infancy. International Pediatric Ophthalmology Conference. Salalah, Oman, 21–22 July 2010. 2. Al-Mujaini A. Congenital Eyelid Anomalies. International Pediatric Ophthalmology Conference. Salalah, Oman, 21–22 July 2010. 3. Al-Mujaini A. Propranolol for the Treatment of Infantile Facial / Periorbital Hemangioma International Ophthalmic Conference. Muscat, Oman, 15–18 March 2010. 4. Al-Mujaini A, Ganesh A, Senawi R.Satisfaction and Perceived Performance Quality of an Electronic Medical Record System in a Tertiary Hospital in Oman. International Conference of Quality Management in Health Care. Muscat, Oman, 1–3 February 2010. Poster presentations International 1. Manayath GJ, Al Kharousi N, Narendran V. International graded subthreshold transpupillary thermotherapy for chronic cnetralk serous retinopathy: A pilot study. .American Academy of Ophthalmology Annual Meeting. San Fransisco, USA, 2009. National 1. Al-Senawi R, Al-Jabri B, Al-Yarubi S, Al-Zuhaibi S, Al-Futaisi A, Koul RL, Al-Azri F, Ganesh A. The syndrome of septo- optic dysplasia in Omani children. 17th International Child Health Conference. Sultan Qaboos University, Muscat, Oman, 13−15 October 2009. 2. Al-Nabhani D, Al-Senawi R, Fazallulah M, Chacko A, Ganesh A. Nephropathic cystinosis: the first in Oman. 17th Inter- national Child Health Conference, Sultan Qaboos University, Muscat, Oman, 13−15 October 2009. 3. Al-Mujaini A, Ganesh A, Senawi R. Satisfaction and Perceived Performance Quality of an Electronic Medical Record System in a Tertiary Hospital in Oman. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010.

162 4. Al-Mujaini A, Senawi R. Third Nerve Palsy and Central Nervous System Relapse in a Leukemia Patient. International Ophthalmic Conference. Muscat, Oman, 15-18 March 2010. departments

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163 Annual Report 2009-2010 Oral Health

he Oral Health Department provides dental, oral and maxillofacial services for the 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 continues to provide dental services including basic primary dental care, oral hygiene therapy, restorative, endodontic,T as well as comprehensive paediatric dentistry and oral and maxillofacial surgery treatments. The Department is also a member of the trauma team of the Hospital, 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 clinical setting or in the operating theatre for the inpatients or day care visitors.

164 Madelin Hernandaz, Senior House Officer Other Staff Nasriya Al-Harthy, Dental Hygienist/ Therapist Zahra Al-Ghafri, Dental Hygienist Judy Mathew, Senior Nurse Lorena Mendoza, Senior Nurse Lovely Kuriakose, Senior Nurse Marcedes Estimada, Senior Nurse Afrah Abdulbaqi, Dental Surgery Assistant Sulaiman Al-Maqimi, Dental Surgery Assistant Mohammed Al-Alawi, Dental Surgery Assistant Support Staff Fatma Al-Siyabi, Central Sterile Supplies Technician Khamis Al-Jabri, Medical Records Clerk Nadia Al-Ghafri, Coordinator Highlights of the Year 2009-2010 The Department maintained a high standard of dental care to patients and continued to improve and expand its services. One of the main events Staff of 2009 was the return of Zahra Al-Ghafri, Dental Deputy Head of Department Hygienist, following successfully gaining a B.Sc.. Abdulaziz Bakathir, Consultant Oral & Maxillofa- Degree in Dental Hygiene in Jordan. The Depart- departments cial Surgeon ment continued to provide a highly specialised consultancy service, diagnosis and treatment in Faculty the subspecialty of paediatric dentistry, as well care

Amur Al-Hajri, Consultant as the existing oral and maxillofacial surgery ser- Ali Al-Mullahi, Consultant Paediatric Dentist vices. In addition, the Department provided con- Awatif Al-Maskery, Senior Registrar tinuous support to the expanding and specialised patient Sameera Al-Anqoodi, Registrar, Restorative Den- medical and surgical units of the University Hospi- tistry tal (SQUH) and continued to play an important role and Hana Al-Raisi, Senior House Officer in the holistic multidisciplinary care of patients at Rasha Ahmed, Senior House Officer SQUH. academic oral health

165 Annual Report 2009-2010 Oral Health

The Department’s clinical staff were actively involved in national scientific events and dental conferences conducted by the Oman Dental Society during 2009-2010. Dr. Abdulaziz Bakathir continued to hold the posi- tion of Deputy Chairman of the Oman Dental Society. Furthermore, our clinical staff participated in many dental conferences and workshops conducted in Oman, United Arab Emirates, Turkey, the Philippines and Switzerland. Dr. Abdulaziz Bakathir and Dr. Ali Al-Mullahi presented scientific papers and poster presentations at international dental conferences in Philippine and Turkey. In addition, Dr. Abdulaziz Bakathir attended the 15th International Sialendoscopy Hands-on Course at the European Sialendoscopy Training Centre, Geneva, Switzerland, from 2–4 July 2010.

In 2010, Department produced a series of educational leaflets for patients covering a range of dental and oral surgery conditions. This work was by the Department’s dental hygienist, Zahra Al-Ghafri.

Teaching Programmes The Oral Health Department continues to provide teaching support to MD degree students at the University College of Medicine and Health Sciences and the Institute of Health Sciences of the Ministry of Health as follows: 1) Regular teaching seminars during the Oral Health Rotation for 5th year MD students; 2) Examination of oral cavity in clinical skills laboratory teaching for 4th year MD students; 3) Daily clinical teaching to the Dental Surgery Assistance (DSA) students during their oral health rotation on room preparation and aseptic technique for surgical patients and infection control, and 4) Teaching of DSA students at the Institute of Health Sciences, Ministry of Health.

Clinical & DIagnostic Services The Oral Health Department continues to provide primary dental treatment as well as specialised comprehensive paediatric dentistry and oral & maxillofacial surgical treatments. The Department has shown an increase of 5% in the total number of patients attending the Outpatient Clinic Department’s in 2010 compared to of 2009. This rise is a reflection of the increase in the number of referrals for specialised paediatric and maxillofacial care from various hospital departments as well as from other regional hospitals and local health centres. The Department has also recorded an increase in the number of inpatients admitted for oral maxillofacial surgery and dental treatment of complex medically compromised patients especially in the paediatric group in 2010 compared to 2009. The Department continued to be actively involved in a 24-hour on-call service in collaboration with the Accident & Emergency Department of SQUH.

166 Research RESEARCH PROJECTS Dental health indices in Omani patients with Beta thalassaemia Major Project Code: MREC #336; Dates: 2010–11 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Ali Al-Mullahi, Oral Health, SQU, Dr. Abdulaziz Bakathir, Oral Health, SQU, Dr. Shahina Daar, Dept. Haematology, SQU, Dr. Yasser Wali, Child Health, SQU, Dr. Salahuldeen Al Bulushi, MOH, Dr Surekha Mevada, Child Health, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Bakathir AA. Minor Oral Surgery Procedures in Patients Taking Warfarin : A 5-year retrospective study at Sultan Qaboos University Hospital, Sultanate of Oman. SQU Med J 2009; 279−86. 2, Bakathir AA, Moos KF, Ayoub AF, Bagg J. Factors Contributing to the Spread of Odontogenic Infections : A prospective pilot study. SQU Med J 2009; 296−304. 3. Al Mullahi A, Toumba KJ. Effect of slow-release fluoride devices and casein phosphopeptide/amorphous calcium phosphate nanocomplexes on enamel remineralization in vitro. Caries Res 2010; 44:364−71. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Bakathir A. Minor Oral Surgery Procedures in Patients Taking Warfarin : A 5-year retrospective study at Sultan Qa- departments boos University Hospital, Sultanate of Oman. IVth International Congress on Oral & Maxillofacial Surgery, Turkish Society of Oral & Maxillofacial Surgery. Antalya, Turkey, 28 May 2010. care POSTER PRESENTATIONS International

1. Bakathir A, Margasahayam MV, Al-Ismaily M. Uremic Leontiasis Ossea. IV International Congress on Oral & Maxil- patient lofacial Surgery, Turkish Society of Oral & Maxillofacial Surgery, Antalya, Turkey, 26–30 May 2010. and

2. Bakathir A, Al-Hashmi A. Oromandibular Dystonia. IVth International Congress on Oral & Maxillofacial Surgery, Turkish Society of Oral & Maxillofacial Surgery, Antalya, Turkey, 26–30 May 2010. 3. Al Mullahi A. Regional odontodysplasia associated with generalized enamel hypomineralization. 7th Biennial Con- academic O ral H ealth

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ference of the Pediatric Dentistry Association of Asia. Manila, Philippines 7–9 July 2010. Seminar Presentations National 1. Bakathir A. Haematological Disease: Dental Prospective. 2nd Ibri Dental Symposium. Ibri Hospital, Oman, 24 April 2010. 2. Bakathir A. Dental Management of Patients with Haematological Disorders. Nizwa Hospital, Oman, 14June 2010.

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169 Annual Report 2009-2010 Pathology

he Department of Pathology takes part in the B.Sc. Health Sciences, MD, and the B.Sc. Medical Laboratory Sciences teaching and training programmes. It also participates in the Oman Medical Specialty Board (OMSB) postgraduate medical training programmes in pathology and other medical specialties. InT addition to its academic activities, the Department offers specialised diagnostic histo¬pathology, cytology, immuno¬pathology, enzyme-histochemistry and electron microscopy services for SQU Hospital. It functions as a referral centre for the Ministry of Health, the Armed Forces Hospital and other hospitals in Oman. The Department runs a central diagnostic and research facility (electron microscopy) for SQU, SQUH and the local community and is involved in many academic and postgraduate research projects.

The Department is registered and subscribes to international external quality assurance programmes (EQA) in cytopathology, immunohistochemistry, renal pathology and anatomical pathology including a technical module. The postgraduate training programme is approved for Part I (FRCPath) of the Fellowship of the Royal College of Pathologists examination.

170 Support Staff Emmanuel Odor, Superintendent Joseph Ogunfiditimi, Chief Biomedical Scientist Ishmael Nwabuebo, Chief Biomedical Scientist Issa Al-Amri, Senior Biomedical Scientist, Electron Microscopy Unit Kamla Al-Mawali, Senior Biomedical Scientist, Im- munohistochemistry Usha R. Bai, Senior Biomedical Scientist, Cytopathol- ogy Ahmed Al-Hinai, Mortuary Technician Edna B. Ranada, Coordinator Nadeera K. Ammu, Coordinator Highlights of the Year 2009-2010 In this year, the Electron Microscopy Unit acquired a state of the art 200kV high resolution analytical field emission scanning transmission electron microscope. This microscope is capable of generat- ing TEM and SEM images, EDS elemental analysis, EELS elemental analysis and energy filtering, dif- Staff fraction pattern, electron holography images, and Faculty electron tomography images. In addition, a full set Aisha Al-Hamdani, Senior Consultant of sample preparation equipment for Nanomateri- departments Anna Saparamadu, Consultant als analysis was also required. This high resolution Dilani Lokuhetty, Consultant microscope can generate images at magnifications

of 16,000,000 (TEM) and X90,000,000 (SEM) with care Ibrahim Al-Haddabi, Consultant, Deputy HoD, Clini- cal Affairs resolution of 0.1 nm. Dhuha Alwan, Senior House Officer Prof. Anand Date was elected to the Board of Gov-

Maiya Al-Bahri, Senior House Officer patient

ernors of the American Osler Society, a worldwide Radiya Al-Ajmi, Senior House Officer organisation concerned with Medical History, Hu-

Asmaa Al-Shihi, Senior House Officer and manities and Medical Ethics. Nasar Al-Wahaibi, Researcher & Lecturer academic pathology

171 Annual Report 2009-2010 Pathology

Another highlight during the year was the 3 month visit of Professor Clive Harper, a distinguished neuropa- thologist and the Head of Department of Neuropathology at the University of Sydney, Australia. During his time in the Department as visiting Professor, he helped with neuropathology teaching and the reporting of slides in the hospital.

Visitors who were invited to the Department in 2009–2010 and presented a Dean’s lecture were: Dr. Anshoo Agarwal, Professor and Chair, Ras Al Khimah Medical College and Health Sciences University, who presented a lecture on “Epidemic Dropsy” in October 2009; Dr. Mulazim Hussain Bukhari, Associate Professor (Pathol- ogy), King Edward Medical University, Lahore, Pakistan, gave a Dean’s lecture on “Molecular Classification of Breast Cancer and Role of Immunohistochemistry for detection of cell types that predicts response to chemotherapy” in February 2010; Prof Chandu de Silva, Professor and Head of Department, Faculty of Medicine, University of Colombo, Sri Lanka, presented a lecture on “ Poorly differentiated synovial sarcomas-diagnosis and prognostic implications” followed by a brief presentation: “My vision for teaching undergraduate Pathol- ogy” in March 2010; Prof Ritu Lakhtakia, Professor of Pathology, College of Medicine, King Faisal University, Saudi Arabi, presented a lecture entitled “The Spirit of Inquiry” in April 2010, and finally Dr. Hassan Kamel, from Hamad Medical Corporation, Doha Qatar, presented a lecture on “Trends and Challenges in Pathology Practice: Choices and Necessities” in June 2010.

Teaching Programmes PRECLINICAL PROGRAMME The Department taught semester 7 and summer courses, including general pathology with some applied content. This year the department was also involved in the full implementation of the new curriculum: MEDI 2104, Response to Infection and Pathobiology, Cardiovascular System and Respiratory System, and in the old curriculum, in the Integrated Lecture Series and problem-based learning.

CLINICAL PROGRAMME The Department taught in the following courses for the 5th year students in the old curriculum: Integrated Lecture series: Cardiovascular System, Nervous System, Respiratory System, Endocrinology, Gastrointestinal Tract System, and Urinary System. It also took part in the rotation and laboratory work for 7th year students.

B.SC. MEDICAL LABORATORY SCIENCES (MLS) COURSES In the B.Sc. Medical Laboratory Sciences (MLS) programme, staff taught in the following courses: Introduc- tion to MLS, Biology of Disease, Applied MDLS, Cellular Pathology I, Cellular Pathology II, Biology of Cancer, Advanced Instrumentation in Cellular pathology and the Project course.

172 POSTGRADUATE TEACHING The Pathology Department is a training centre for the Oman Medical Specialty Board (OMSB) and is an approved centre for the Part I examination of the British Fellowship of the Royal College of Pathologists (FRC- Path), UK. There are up to 3 residents posted at any one time for general pathology training. The Department also offers an elective rotation (4 weeks) for Dermatology, Haematology and Obstetrics and Gynaecology residents. This provides them with an opportunity to develop an understanding about Dermatopathology and Gynaecological pathology, respectively. In addition to OMSB residents, there are 3 senior house officers employed by SQUH. They rotate between surgical pathology and cytopathology and acquire basic training before they travel abroad for further studies. The training programme for postgraduate residents in Pathol- ogy is 5 years. At present, there are eleven OMSB trainees who rotate between the Royal Hospital, Khoula Hospital, the Armed Forces Hospital and SQUH.

A delegation from the Royal College of Pathologists visited the Department to evaluate the postgraduate training programme in histopathology and our continuing accreditation by the College. The team was led by the President of the College, Prof. Peter Furness. The feedback was very positive and we also had an opportunity to discuss placements for our residents in the UK. This is a difficult time because of changes in British government regulations regarding training programmes for foreign students so the visitors were unable to make any immediate commitments.

TRAINING COURSES & CME ACTIVITIES Clinico-pathological conferences/seminars are held at least once a month in the Department. Under CME activities, consultant pathologists participated in presentations in the fields of: paediatrics, surgery, haematology and obstetrics and gynaecology. There were six inter-hospital meetings covering diagnostic and renal pathology. Consultant pathologists provided input for the College in the SCRAPS CME presentations,

The Department of Pathology offers clinical attachments for laboratory medicine. The technical staff undertook the training of three Omani students from various hospitals and schools who are studying medical departments laboratory techniques. care Clinical & Diagnostic Services The Department maintains a high level of diagnostic services in different subspecialties. It acts as a referral centre for the Ministry of Health Hospitals, the Royal Oman Police Hospital, the Armed Forces Hospital, Royal patient Palace Hospital and clinics, Royal Diwan clinics, and private hospitals within Oman. and The diagnostic services offered include: diagnostic histopathology service, diagnostic cytopathology, diagnostic immunocytochemistry, diagnostic enzyme histochemistry and diagnostic electron microscopy. academic P athology

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Tests done in 2010 Histopathology Laboratory SQU Hospital

SQUH Requests SQUH Tests Other Hospital Other Hospital Requests Tests Histology 4,882 26,440 332 1,154 Immunopathology 1,020 10,108 337 4,108 Cytology-Gynaecoloy 1,506 1,670 3 3 Cytology-Non-Gyn- 1.034 4,214 5 40 aecology Electron Microscopy 600 2,081 75 596 Teaching 74 361- -- -- TOTAL 9,116 44,874 752 5,901

Total No. of tests done 2008-2010

55000 50775 45000 47764 37998 35000

25000

15000

Total No. of Tests Done 5000

0 2008 2009 2010 Year

174 Dr. Ibrahim Al Haddabi, Consultant, who is a lymphoma expert, received cases from different institutions in Oman for second opinion. Prof. Anand Date received all renal biopsies done in Oman including those from the SQUH, Ministry of Health Hospitals and some private hospitals.

In 2010 with 50,775 tests and 9,868 requests and tests handled in the Department, there was an increase of 8.5% over the 2009 figures. The overall increase in 2009 compared to 2008 was 24%. The diagnostic service activities 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 immuocytochemistry. We also subscribe to a technical module.

Research RESEARCH PROJECTS Medicinal herb polpala (Aerva lanata) and its effect on the structure of the urinary tract of rat: an ultra structural analysis Project Code: MREC #296; Dates: 2009 Value: OR 250; Project Funder: Sultan Qaboos University Investigators: Dr. Menaka D. Lokuhetty, Dept. Pathology, SQU; Prof. Anand Date, Dept. Pa- thology, SQU.

Pathogenesis of Breast Cancer in Omani Women Project Code: MREC #321; Dates: 2009 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Shadia Al-Sinawi, Dept. Pathology, SQU. departments

Using Paraffin Blocks for Lung Cancer Cases

Project Code: MREC #341; Dates: 2010 care

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RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Bakathir AA, Al Hamdani A. Relapse of acute lymphoblastic leukaemia in the Jaw: A case report. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontol 2009; 107:e14–16. 2. Al Wahaibi N, Mohamed J, Budin SB, Al Hamadani A. The effects of supra-nutritional dose of sodium selenite on chemically induced hepatocarcinogenesis in male rats. Ann Med Healthcare Res 2009;, Proceedings 2009 Interna- tional Online Medical Conference, Universal Publisher, ISBN 978-59942-908-3, 2009. 3. Mathew M, Sheik S, Rao K, Burney I, Sawhney S, Al Hamdani A. Metastatic malignant melanoma during pregnancy - Case report and review of the literature. SQU Med J 2009; 9:79−83. 4. Mathew M, Burney I, Al Hamdani A, Rao K. Bilateral breast metastases in a pregnant woman with disseminated cutaneous melanoma. Indian J Cancer 2009; 46:342−4. 5. Abdwani R, Abdul Raheem R, Ganesh A, Al Hamdani A. A chronic granulomatous diseases of childhood. Oman Med J 2009; 24:56−7. 6. Al Mamari A, Balkhair A, Gujjar A, Ben Abid F, Al Farqani A, Al Hamdani A, Jain R. A case of disseminated tuberculosis with adrenal insufficiency. SQU Med J 2009; 9:324−7. 7. Machado N, Chopra, P Al Hamdani A. Papillary carcinoma of the thyroid presenting as cervical lymphadenopathy: an approach to management. SQU Med J2009: 9:328−32. 8. Al Wahaibi N, Mohamed J, Al Hamadani A. Supplementation of selenium reduces chemical hepatocarcinogenesis in male Sprague-Dawley rats. J Trace Elem Med Biol 2010; 24:119−23. 9. Al Wahaibi N, Mohamed J, Al Hamadani A. Nuclear factor -kappa B as a promising target for selenium chemoprevention in rat hepatocarcinogenesis. J Gastroenterol Hepatol 2010; 25:788−91. 10. Alwan D, Al Hamdani A. A case of gastric and duodenal strongyloidiasis. SQU Med J 2010; 10:262−5. 11. Al Wahaibi N, Mohamed J, Budin SB, Al Hamadani A. NF-κB as a promising target for selenium chemoprevention in rat hepatocarcinogenesis. J Gastroenterol Hepatol 2010; 25:786−91. 12. Al Wahaibi N, Mohamed J, Budin SB, Al Hamadani A. The effects of supra-nutritional dose of sodium selenite on chemically induced hepatocarcinogenesis in male rats. Ann Medicine Healthcare Res. Proceedings 2009 Interna- tional Online Medical Conference, 2009. p. 69–76. 13. Kadim IT, Mahgoub O, AlMarzooqi W, Khalaf S, AlSinawi S, AlAmri I. Effects of transportation during the host sea- son, breed and electrical stimulation on histochemical and meat quality characteristics of goat longissimus muscle. Anim Sci J 2010; Epub 2010 DOI: 10.1111/j.1740-0929.2009.00722.x. 14. Kadim IT, Mahgoub O, AlMarzooqi W, Khalaf S, AlSinawi SSH, AlAmri I. Effects of transportation during the hot sea- son and low voltage electrical stimulation on histochemical and meat quality characteristics of sheep longissimus muscle. Livest Sci 2009; 126:154–61. 15. ZM, Melghit KK, AlAmri I, AlKindi MA. Soft chemistry preparation of layered Al0.3V2O5 5H2O. Ceram Int 2010; 36:807–9.

176 16. Mothershaw AS, Gaffer T, Kadim I, Guizani I, AlAmri I, Mahgoub O, AlBahry S. Quality characteristics of broiler chicken meat on salt at different temperatures. Int J Food Prop 2009; 12:681– 90. 17. AlBahry SA, Mahmoud I, Elshafie A, AlHarthy A, Sabha A, AlGhafri A, AlAmri I, Al Kindi A. Bacterial flora and antibiotic resistance from eggs of green turtles chelonia mydas: An indication of polluted effluents. Mar Pollut Bull 2009; 58:720–5. 18. AlHarthi A, AlSaadi M, AlOmari I, Sitepu H, Melghit K, AlAmri I, AlHinai AT, Thomas S. Structural analysis and band gap tailoring of Fe3+-doped Zn–TiO2 nanoparticles. Appl Phys A 2009; 99:237– 44. 19. Kadim IT, Mahgoub O, AlMarzooqi W, Khalaf SK, Mansouri MH, AlSinani SSH, AlAmri I. Effects of electrical stimulation on histochemical muscle fiber staining, quality, and composition of camel and cattle longissimus thoracis muscles. J Food Sci 2009; 74:S44– 52. 20. Khaled M, AlShukeili OS, AlAmri I. Effect of M-doping (M = Fe, V) on the photocatalytic activity of nanorod rutile TiO2 for Congo red degradation under the sunlight. Ceram Int 2009; 35:433– 9. 21. Jibril B, AlMaamari RS, AlAmri I. Effects of potassium distributions in carbonizations of bituminous coal. J Anal Appl Pyrolysis 2009; 85:529–33. 22. Al-Sajee DMA, Al-Hamdani A. A case of gastric and duodenal strongyloidiasis. SQU Med J 2010; 10:262–4. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Al Wahaibi N, Mohamed J, Al Hamadani A. Effects of sodium selenite on chemically induced hepatocarcinogenesis in male rats. Bengkel Penulisan Sainstific Patologi Dan Anatomi 2009. Negeri Semilan, Malaysia, 2009. 2. Al Wahaibi N, Mohamed J, Al Hamadani A. Effects of sodium selenite on biochemical profile on chemically induced hepatocarcinogenesis in male rats Bengkel Penulisan Sainstific Patologi Dan Anatomi 2009. Negeri Semilan, Malay- sia, 2009. 3. Tageldin MH, Al Ismaily SI, AlRawahi AM, Safwat A, AlBusaidi S, AlAmri I, Al Adawi K. Lumpy skin disease of cattle: An emerging problem in the Sultanate of Oman. European Buiatrics Forum, EBF. Marseilles, France, 1–3 December departments 2009. care

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177 Annual Report 2009-2010 Pharmacology & Clinical Pharmacy

he Department of Pharmacology & Clinical Pharmacy plays an active teaching role in both the College’s old and new curricula as well as in the College of Nursing’s educational programme. The Department also offers a Master’s degree in Clinical Phar- macy, and contributes to the teaching of other Master’s courses. The Department coordinates the Research Methods and Critical Analysis of Scientific Information course. In addition, the Department now coordinates the Cellular Communication and Introduction toT Drug Action course in the new curriculum. Research activities embrace different areas of experimental and clinical pharmacology and therapeutics. The areas under investigation encompass: study of genotyping of drug metabolising enzymes in Omanis with emphasis on cancer patients; toxicity and composition of Omani traditional remedies and plants; cyclooxygenase-2 inhibitors and cardiovascular function; the effect of several agents on experimental acute and chronic renal failure; the elucidation of cardiovascular and behavioural effects of some medicinal plants; a study of use/misuse of antibiotics; a study of the knowledge, attitudes, perceptions and use of sheesha (water pipe smoking).

178 Highlights of the Year 2009-2010 In the old curriculum, the Department continued to teach in the pre-clinical B.Sc. (Health Sciences) programme as well as in the MD programme. With the implementation of the new curriculum in the College, the Department was given the responsibility to coordinate Cellular Communication and In- troduction to Drug Action, and participate in many system module courses.

Mr. Yousuf Al-Suleimani and Ms. Ikhlas Ahmed, continued their studies at University of Cambridge, UK, and University of Kentucky, USA, respectively.

The Department acquired a drying air oven to be used for preparing samples for drug analysis without decomposition. Several items of equipment have also been acquired like a bone densitometer, fluoroscan, and behavioural pharmacology equipment e.g. hot plate and tail flick test.

The research output for 2009–2010 consisted of Staff 5 research projects, 11 national and international Faculty poster presentations, and 27 publications in peer- Badreldin Ali, Professor reviewed journals. Our associate researchers were departments Ragini Vaishnav, Assistant Professor involved in some of these activities and featured as Mohammed Al-Za’abi, Assistant Professor first and co-authors. The Department also contrib-

uted to the world of medical science through its care

Ibrahim Al-Zakwani, Assistant Professor Khalid Al-Balushi, Assistant Professor review and editorial activities in various medical Yousuf Al-Suleimani, Lecturer journals. Staff members were involved in different research activities and participated in national and

Hamoud Al-Salmy, Associate Researcher patient Ikhlas Ali Ahmed, Associate Researcher international conferences. The Department serves in several committees in the College, SQUH and and Support Staff University and other institutions. Internationally, Mercy Calma, Coordinator the Department has representation on the Execu- academic pharmacology & clinical pharmacy

179 Annual Report 2009-2010 Pharmacology & Clinical Pharmacy

tive Council of the International Union of Basic and Clinical Pharmacology (IUPHAR) Education Section.

The Department, through the Head of Department and Chairman of the Accreditation and Quality Assur- ance Committee, organised two accreditation meetings, the first was a Knowledge Sharing Exercise held on 1 April 2010. In May 2010, two consultants from the renowned World Federation for Medical Education (WFME) gave talks on accreditation procedures and processes in the ‘WFME Standards for Accreditation Meeting’. These meetings were held to prepare the College for the WFME accreditation process.

Teaching Programmes PRECLINICAL PROGRAMME The Department contributes to undergraduate teaching in the B.Sc. (Health Sciences), MD and B.Sc. Medi- cal Laboratory Sciences degrees as well as in Phase I of the new curriculum. The Department offers several courses in the B.Sc. Health Sciences programme and contributes to all system-based courses. The courses for B.Sc. Health Sciences are: Alimentary System, General Pharmacology, Respiratory System, Cardiovascular System, Urinary System, Haematopoietic, Lymphoid & Vascular System, Human Nervous System, Endocrine & Reproductive System and Applied Pharmacology for Medical Students. The courses for B.Sc. MLS are Biol- ogy of Disease, Diagnostic Toxicology and Therapeutic Drug Monitoring.

At the preclinical level, the teaching concentrated on mechanisms by which drugs affect various biological systems and functions, as well as the actions of drugs on pathological processes. In addition, the General Pharmacology course introduced students to basic pharmacological concepts.

The pharmacology contribution is also designed to teach the students the basic concepts of the mechanism of action, pharmacological effects and interactions of drugs and to apply this knowledge through case studies. General Pharmacology and Applied Pharmacology for Medical Students (offered in both semesters) are fully delivered by the Department. The courses are composed of lectures and case-based discussions, the lat- ter presented by the students as a preparation for their clinical years.

The Department continues to contribute to the College of Nursing courses. Basic Pharmacology and Dosage Calculations and Pharmacology for Nurses are delivered in both semesters.

The Department also delivers the University elective course, Nutrients, Medicines and Narcotics, during the spring semester.

With the implementation of the new curriculum in the College, the Department was given the responsibility to coordinate Cellular Communication and Introduction to Drug Action in Phase I. This module introduces the physiological, biochemical and pathophysiological processes and control of cellular communication. The

180 Department delivers lectures and tutorials for the following courses: Response to Infection and Pathobiol- ogy; Respiratory System Module; Cellular Communication and Introduction to Drug Action; HLI Module; Car- diovascular System Module, and the Research Project.

CLINICAL PROGRAMME The Department is involved in teaching in the clinical programme. Pharmacology contributed to the Inte- grated Lecture Series (ILS) with courses on Gastroenterology, Endocrinology, Nephrology, Neurology, and to clinical rotations in different clinical specialties.

The Department, solely, coordinates the Therapeutics Course which is provided for the 6th year medical students. Most of this teaching was based on the concept of case-based learning. The Department also contributed to the interdisciplinary activities of 5th and 6th year medical students in Medical Ethics and Gerontology.

POSTGRADUATE PROGRAMME The Department plays an active role in the teaching in the Master’s in Biomedical Sciences. The Department also offers a Master’s degree in Clinical Pharmacy. Major courses delivered by the Department are: Clinical Pharmacokinetics and Therapeutic Drug Monitoring; Clinical Pharmacy I; Clinical Pharmacy II; Pharmaco- therapeutics I and II.

The Department was given the responsibility of coordinating the Master’s Degree core course, Research Method and Critical Analysis for Scientific Information. The Master’s student numbers continuously increased so the course had to be offered in both semesters.

The Department is involved in the organisation and curriculum development of the Core Programme of the Oman Medical Specialty Board (OMSB). departments

Research RESEARCH PROJECTS care

Renal Hemodynamics in rats with cisplatin-induced nephrotoxicity: Influence of tetramethylpyrazine pretreatment

Project Code: IG/MED/PHAR/09/02; Dates: 2009–2010 patient

Value: OR 5,700; Project Funder: Sultan Qaboos University and Investigators: Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Aly Abdelrahman, Dept. Pharmacology & Clinical Pharmacy, SQU; Mr. Yousuf academic P harmacology & C linical harmacy

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Al-Suleimani, Dept. Pharmacology & Clinical Pharmacy, SQU

Fluorouracil-based chemotherapy in Omani patients; a pharmaco-genomic and – kinetic overview Project Code: IG/MED/PHAR/09/01; Dates: 2009–2010 Value: OR 11,000; Project Funder: Sultan Qaboos University Investigators: Dr. Mohammed Al-Zaabi, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Mansour Al-Moundhri, Dept. Medicine, SQU; Prof. Musbah Tanira, Dept. Pharmacology & Clinical Pharmacy, SQU.

Comparative protective effects of N-acetylcysteine, dimethyl sulfoxide and tetramethylpyrazine on the paracetamol-induced hepatotoxicity in mice Project Code: IG/MED/PHAR/10/01; Dates: 2010 Value: OR 4,700; Project Funder: Sultan Qaboos University Investigators: Dr. Mohammed Al-Zaabi, Dept. Pharmacology & Clinical Pharmacy, SQU; Prof. Badredlin Ali, Dept. of Pharmacology & Clinical Pharmacy, SQU; Dr. Hamza Babiker, Dept. of Biochemistry, SQU.

Effect of Gum Arabic on an Animal Model Chronic Renal Failure Effect Project Code: RC/MED/PHAR/10/01; Dates: 2010–2011 Value: OR 50,000; Project Funder: The Research Council Investigators: Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU.

The Effect of Different Classes of Antidepressant drugs on Thiamine status in Rats Project Code: MREC #330; Dates: 2010 Value: OR 2,000; Project Funder: Sultan Qaboos University Investigators: Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Mo- hammed Al-Zaabi, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Samir Al-Adawi, Dept. Behavioral Medicine, SQU.

182 RESEARCH PUBLICATIONS & BOOKS JOURNAL PUBLICATIONS 1. Abdelrahman AM, Al Salam S, Al Mahrouqi AS, Al Husseini IS, Mansour M, Ali BH. N-acetylcysteine improves renal hemodynamics in rats with cisplatin –induced nephrotoxicity. J Appld Toxicol 2010; 30:15−21. 2. Ahmed IS, Rohe HJ, Twist KE, Craven RJ. Pgrmc1 (progesterone receptor membrane component 1) associates with epidermal growth factor receptor and regulates erlotinib sensitivity. J Biol Chem 2010; 285:24775–82. 3. Ahmed IS, Rohe HJ, Twist KE, Mattingly MN, Craven RJ. Progesterone receptor membrane component 1 (Pgrmc1): a heme-1 domain protein that promotes tumorigenesis and is inhibited by a small molecule. J Pharmacol Exp Ther 2010; 333:564−73. 4. Al Adawi S, AlZakwani I, Obeid Y, Zaidan Z. Neurocognitive functioning in women presenting with undifferentiated somatoform disorders in Oman. Psychiatry Clin Neurosci 2010; 64:555−64. 5. Al Moundhri MS, Al Kindi M, Al Nabhani M, Al Bahrani B, Burney IA, Al Habsi H, Ganguly SS, Tanira M. Combined polymorphism analysis of glutathione S-transferase M1/G1 and interleukin-1B (IL-1B)/Interleukin 1-receptor antago- nist (IL-1RN) and gastric cancer risk in an Omani Arab population. J Clin Gastroenterol 2009; 43:152−6. 6. Al Suleimani YM, Abdelrahman AM, Al Mahruqi AS, Al Husseini IS, Tageldin MH, Mansour ME, Ali BH. Interaction of nimesulide, a cyclooxygenase-2 inhibitor, with cisplatin in normotensive and spontaneously hypertensive rats. Food Chem Toxicol 2010; 48:139−44. 7. Ali BH, Al Husseini I, Kayed R, AlMasroori N, Al Harthi T, Al Zaabi M, et al. Effect of gum arabic on adenine-induced chronic renal failure in rats. Exp Biol Med 2010; 235:373−82. 8. Ali BH. Amelioration of oxaliplatin neurotoxicity by drugs in humans and experimental animals. A mini-review of recent literature. Basic Clin Pharmacol Toxicol 2010; 106:272−9. 9. Ali BH, Al Salam S, Al Husseini IS, Nemmar A. Comparative protective effect of N-acetyl cysteine and tetramethylpyrazine in rats with gentamicin nephrotoxicity. J Appld Toxicol 2009; 29:302−7. 10. Ali BH, Ziada A, Blunden G. Biological effects of gum Arabic: a review of some recent research. Food Chem Toxicol 2009; 47:1−8. departments

11. Al Mandhari A, Al Adawi S, Al Zakwani I, Al Shafaee M, Eloul L. Relatives’ advice and health care seeking behaviour in Oman. SQU Med J 2009; 9:261−71.

12. AlZadjali N, AlZakwani I, AlSenawi R, Nemeth J, Al Reesi A, Perry JJ. Predictors of positive chest radiography in non care traumatic chest pain in the Emergency Department. Oman Med J 2009; 241:22−6. 13. Farhan HL, Hassan KS, AlBelushi A, Sallam M, AlZakwani I. Diagnostic value of electrocardiographic T-Wave inversion in Lead aVL in diagnosing coronary artery disease in patients with chronic stable angina. Oman Med J 2010; 25: patient

124−7. 14. Gowri V, Al Zakwani I. Prevalence of cesarean delivery in pre-eclamptic patients with elevated uric acid. Hypertens and Pregnancy 2010; 29:231−5. 15. Koul R, Al Othmani FI, Alfutaisi A, Al−Abri M, Al Zakwani I. Narcolepsy-cataplexy in children: report of two cases. J academic P harmacology & C linical harmacy

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Pediatr Neurol 2009; 7:389−91. 16. Nemmar A, Al Salam S, Zia S, Dhanasekaran S, Shudadevi M, Ali BH. Time-course effects of systemically adminis- tered diesel exhaust particles in rats. Toxicol Lett 2010; 194:58−65. 17. Nemmar A, Al Salam S, Zia S, Yasin J, Al Husseini I, Ali BH. Diesel exhaust particles in the lung aggravate experimental acute renal failure. Toxicol Sci 2010; 113:267−77. 18. Panduranga P, Sulaiman K, AlLawati J, AlZakwani I. Characteristics, management and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman. Saudi Med J 2010; 31:520−4. 19. Panduranga P, Sulaiman K, AlZakwani I, Zubaid M, Rashed WA, AlMahmeed W, et al. Utilization and determinants of in-hospital cardiac catheterization in acute coronary syndrome patients from the Middle East. Angiology 2010; 744−50. 20. Rohe HJ, Ahmed IS, Twist KE, Craven RJ. PGRMC1 (progesterone receptor membrane component 1): a targetable protein with multiple functions in steroid signaling, P450 activation and drug binding. Pharmacol Ther 2009; 121:14−9. 21. Rollinson G, Hardy AD, Vaishnav R. Lead compounds in traditional eye cosmetics (“kohls”) available in Morocco. Household Per Care Today 2010; 3:12−15. 22. Al Adawi S, Ali BH. West is West, East is East: The Divide in Science (Editorial). Saudi Med J 2010; 31:1093−4. 23. Vaishnav R. Book Review: Pharmacology and Therapeutics Principals to Practice, Waldman and Terzic, Elsevier Pub- lishing. SQU Med J 2010; 10:48−9, 24. Wei M, Hamoud AS, Yamaguchi T, Kakehashi A, Morimura K, Doi K, et al.Potassium bromate enhances N-ethyl-N-hy- droxyethylnitrosamine-induced kidney carcinogenesis only at high doses in Wistar rats: indication of the existence of an enhancement threshold. Toxicol Pathol 2009; 37:983−91. 25. Vaishnav R. A novel approach to a small group activity in an integrated course. Proceedings of 16th IUPHAR World Congress of Basic and Clinical Pharmacology, Teaching Section Pre Conference Symposium - Empowering Effective Teaching Pharmacology for a Safer Tomorrow, IUPHAR 2010; 4.4.13, 30. 26. Al Husseini I, Albarwani S, Ali BH, Tanira MO. The effect of 28 days administration of betaine on blood pressure and arteriolar contractility in normal and spontaneously hypertensive rats. FASEB J 2010; 24:786.23. 27. Suleimani YM, Abdelrahman AM, Almahruqi AS, Alhseini IS, Tageldin MH, Mansour ME, Ali BH. Interaction of nimesulide, a cyclooxygenase-2 inhibitor, with cisplatin in normotensive and spontaneously hypertensive rats. Food Chem Toxicol. 2009. Epub 25 Sept 2009. CONFERENCE & SEMINAR PRESENTATIONS Conference presentations International 1. Abdwani R, Hira M, AlNabhani D, AlZakwani I. Juvenile systemic lupus erythematosus in the Sultanate of Oman: Clinical and Immunological comparison between familial and non-familial cases. 9th Pan-Arab Rheumatology So- ciety Congress & the 2nd Jordanian Rheumatology Congress in collaboration with Mayo Clinic. Amman, Jordan, 20 April 2010.

184 POSTER PRESENTATIONS International 1. Ali BH, Al Salam S, Al Husseini I, Nemmar A. Comparative protective effect of NAC and tertamethylpyarize in rats with gentamicin nephrotoxicity. FASEB Meeting. Manheim, California, USA, April 2010. 2. Ali BH, et al. The effect of adenine-induced chronic renal failure on some behavioral aspects in rats: Influence of Gum Arabic. IUTOX Congress. Barcelona, Spain, July 2010. 3. Abdwani R, Hira M, AlNabhani D, Al-Zakwani I. Juvenile systemic lupus erythematosus in the Sultanate of Oman: Clinical and Immunological comparison between familial and non-familial cases. 9th International Congress on Sys- temic Lupus Erythematosus. Vancouver, Canada, 24−27 June 2010. 4. Afzalhussein Y, Zubaid M, AlZakwani I, AlSheikh AA, AlMallah MH, Al Suwaidi J, et al. Validation of the GRACE risk score for hospital mortality in patients with acute coronary syndrome in the Arab Middle East. World Congress of Cardiology, World Heart Foundation with 3rd International Conference on Women, Heart Disease and Stroke. Beijing, China, 16−19 June 2010. 5. AlHamhami A, AlNabhani H, AlZakwani I, AlAbri M. Validity and reproducibility of Epworth sleepiness scale ESS in Omani population. 7th Scientific Conference for Medical Students in the GCC Countries. King Abdul Aziz University (KAU), Jeddah, Saudi Arabia, 13−16 February 2010. 6. Prashanth P, Sulaiman K, AlZakwani I. Relationship between admitting (non-fasting) blood glucose and in-hospital mortality stratified by diabetes mellitus among acute coronary syndrome patients in Oman. 15th Annual Interna- tional Meeting, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Atlanta, Georgia, USA, 15−19 May 2010. 7. Vaishnav R. A novel approach to a small group activity in an integrated course. World Pharma 2010: 16th IUPHAR World Congress of Basic and Clinical Pharmacology, Teaching Section Symposium. Copenhagen, Denmark, July 2010. National 1. Al Za’abi MA, Ali BH, Al-Bahri FA. A new, sensitive and rapid HPLC method for the determination of thiamine and thiamine diphosphate concentration in whole blood. University Day. Sultan Qaboos University, Oman, 2 May 2010. 2. AlHusseini I, Albarwani S, Ali BH, Tanira MO. The effect of administration of betaine on blood pressure and arterio- departments lar contractility in normal and spontaneously hypertensive rats. University Day. Sultan Qaboos University, Oman, 2 May 2010. care

3. Ali BH, Ziada A, AlHusseni I, Beegam S. Some motor and behavioral changes in rats with adenine-induced chronic renal failure: Influence of acacia gum treatment. University Day. Sultan Qaboos University, Oman, 2 May 2010. 4. Vaishnav R, Al-Naeem W, Al-Omrani F. Evaluation of antibiotic prescribing in upper respiratory tract infections. University Day, Sultan Qaboos University, Oman, 2 May 2010. patient

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THESIS SUPERVISION Samreen Shafiq Qualification: M.Sc. Clinical Pharmacy Title: Prescribing Pattern and Therapeutic Drug Monitoring of Vancomycin at a Tertiary Hospital in Oman Supervisors: Dr. Mohammed Al-Za’abi, Prof. Badreldin Ali Date of Completion: September 2010

Nada O. Al-Rawas Qualification: M.Sc. Clinical Pharmacy Title: Prescribing Pattern of Antimicrobial Agents for Chemotherapy-Induced Fe- brile Neutropenia in Patients with Hematological Malignancies at Sultan Qaboos University Hospital Supervisors: Dr. Khalid Al-Balushi, Prof. Badreldin Ali Date of Completion: September 2010

Rowaydah H. Ahmed Qualification: M.Sc. Clinical Pharmacy Title: Utilization Patterns of Antiepileptic Drugs among Adult Epileptic Patients at Sultan Qaboos University Hospital Supervisors: Dr. Mohammed Al-Za’abi, Dr. Ibrahim Al-Zakwani Date of Completion: September 2010

Israa N.A. Al-Metwali Qualification: M.Sc. Clinical Pharmacy Title: Gylcemic and Non-glycemic Control in Diabetic Outpatients Receiving Oral Antidiabetic Drugs at Sultan Qaboos University Hospital Supervisor: Dr. Ragini Vaishnav Date of Completion: September 2010

186 Gheith A. Jassim Qualification: M.Sc. Clinical Pharmacy Title: Omeprazole Prescribing and Its Cost Impact in Outpatient Clinics at Sultan Qaboos University Hospital: A Retrospective Study Supervisors: Dr. Ragini Vaishnav, Dr. Ibrahim Al-Zakwani Date of Completion: October 2010

Jannat Q. Al-Lawati Qualification: M.Sc. Clinical Pharmacy Title: Comparative Effectiveness between Valsartan (plus hydrochlorthiazide) and Irbesartan (plus hydrochlorthiazide) with Respect to Blood Pressure Control at Sultan Qaboos University Hospital in Oman Supervisors: Dr. Khalid Al-Balushi, Dr. Ibrahim Al-Zakwani Date of Completion: On-going (to be completed 2010)

Mohsin M. Maqbool Qualification: M.Sc. Clinical Pharmacy Title: Analysis of pharmacists’ interventions of prescriptions and its impact on pharmaceutical care provision at Sultan Qaboos University Hospital in Oman Supervisors: Professor Musbah Tanira, Dr. Ibrahim Al-Zakwani Date of Completion: On-going departments

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he Pharmacy Department at SQU Hospital is considered the centre of excellence within the country in providing general and specialised pharmaceutical services, and promoting pharmaceutical research and teaching. The Department’s mission is to dispense the correct, most effective, safe and most economic medication to a properly identified patient at the appropriate time with sufficient written and verbal patient information and to disseminate appropriate and unbiased drug, poison and disease related informationT to patients, medical, pharmacy, nursing and allied health care professionals. The Department is divided into 6 major sections: Pharmacy Administration and Training; Outpatient Pharmacy; Inpatient Clinical Pharmacy; Manufacturing/Aseptic Preparations; Medicine Information (MI) and the Pharmacy Sub-Store.

The Department is recognised nationally and regionally as a training centre that supports a range of quality programmes. It is responsible for teaching health care providers and students from the colleges of Medicine and Pharmacy and for the provision of in-service training for pharmacy staff. It also provides individualised work experience placements for graduate pharmacy personnel.

The Department has carried out a number of research projects with the aim of further improving its services and the effectiveness of certain drug therapies.

188 Mafiana Rose, Pharmacist Anwar Al-Mahrizi, Pharmacist Outpatient Pharmacy Issa Al-Rashdi, Pharmacist Soud Al-Shabibi, Pharmacist Janardhanan Neelkantan Nair, Senior Pharmacist FAMCO, A&E Pharmacy Nagwa Mohammed, Pharmacist Maryam Al-Riyami, Assistant Pharmacist Medicine Information Intisar Al-Busaidi, Senior Pharmacist Nibu Nair, Pharmacist Manufacturing/ Aseptic Preparations Felicidad Dizon, Pharmacist Ali Al-Jabri, Assistant Pharmacist Pharmacy Sub-Store Khalid Al-Zadjali, Pharmacist Pharmacy Computer System Manage- ment Staff Dr. Bruno Louis, Senior Pharmacist Technical Services Faculty Ahmed Al-Mahruqi, Pharmacist Amna Al-Hashar, Deputy Head & Training Coordi- departments nator, Clinical Pharmacist Coordinators Aqeela Taqi, Assistant Head, Clinical Pharmacist Mahfoudh Al-Rawahi

Faiza Al-Zadjali care Inpatient Clinical Pharmacy Badriya Al-Zadjali, Clinical Pharmacist Dr. Ahmed Abusham, Clinical Pharmacist patient

Asmahan Al-Barram, Clinical Pharmacist Maryam Al-Kindi, Pharmacist and Samiya Al-Ajmi, Pharmacist Amal Al-Rahbi, Pharmacist academic pharmacy

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Highlights of the Year 2009-2010 PATIENT SATISFACTION A survey to assess patient satisfaction rate showed an improvement of 92% as compared to 87% in 2009 and 73% in 2006. A reasonable average waiting time of less than 19 minutes was maintained. Improvement can be attributed to the introduction of new software that facilitates quick retrieval and dispensing of uncollected prescriptions, a system that has been very well received by the patients.

PHARMACISTS’ INTERVENTIONS The main goal for the provision of pharmaceutical care is to promote rational drug therapy that is safe, appropriate, and cost effective for all patients. As a result, pharmacists would recommend changes in drug therapy or perform certain activities that will eventually lead to the achievement of such a goal. These activities are also called clinical interventions and are part of the day-to-day work of all pharmacists. The total number of interventions documented by both, outpatient and clinical pharmacists for 2009 was 1,790. There were about 1,100 interventions documented by clinical pharmacists between January and September 2010. Every year those interventions are analysed and the results are presented in national and international conferences.

NEW EQUIPMENT A new total parenteral nutrition (TPN) compounder was introduced in the pharmacy sterile preparation services in September 2009. This is a one unit compounder that can mix large and small volume solutions with a high production capacity. It is noteworthy to mention that Pharmacy prepares an average of 15 TPN bags per day, mainly to support premature neonates and patients in the ICU.

NEW PROGRAME FOR UNCOLLECTED PRESCRIPTIONS A new programme to locate and retrieve uncollected prescriptions was introduced in the out-patient dispensing section in March 2010. The program was developed and designed by the Hospital Information Ser- vices in liaison with Pharmacy staff. It has enabled pharmacists to easily identify and retrieve uncollected prescriptions and then facilitate their timely dispensing upon patients’ later arrival later.

ACCIDENT & EMERGENCY PHARMACY The A&E pharmacy was completely renovated and expanded in June 2010. This major renovation and expansion work provided adequate storage space for all stocked medications and eliminated the risks associated with uncomfortable seating for staff. This pharmacy is located within the A&E department and functions 24 hours a day to dispense an average of 50 prescriptions from the A&E and day care units per day.

190 DRUG AND FOOD BOOKLET A booklet on drug administration in relation to food has been developed and edited by a number of pharmacy staff and trainees. This booklet is intended to be used by health care providers while prescribing, dispensing, administering and/ or counselling a patient on whether to take a medication before, with or after food. Information on crushing or chewing tablets and some important remarks are also included. The information is compiled from several references such as the respective manufacturer’s package inserts, the Micromedex and others. It is an important and a user friendly source of quick and handy information.

MEDICINE INFORMATION AND CRITICAL APPRAISAL In response to the training needs of pharmacy staff and other health care providers, four courses were organised and delivered in November 2009: Basic Skills in Medicine Information; Critical Appraisal of a Scientific Paper; Adverse Drug Reactions, and Adverse Drug Events. These courses were attended and well received by pharmacists, doctors and nurses from SQUH and other hospitals in the country. All courses were accredited by the Oman Medical Specialty Board (OMSB).

Teaching Programmes PRECLINICAL PROGRAMME During the year, our courses, each attended by twelve 5th year medical students, were held on Prescription Writing and Asthma Inhaler Devices.

POSTGRADUATE PROGRAMME A course on Safe Prescribing was taught for 20 OMSB residents and a Therapeutic Drug Monitoring course run for 7 M.Sc. Biochemistry students. departments TRAINING COURSE & CME ACTIVITIES In this year, courses on the following topics were organised for a total of 192 participants: Medicine Infor- care

mation (Basic Skills); Critical Appraisal; Adverse Drug Reactions; Adverse Drug Events; Pain Management course: Pharmacotherapy and Pain Management; Chemotherapy course; CSSD course: Chemical Agents and Antiseptics, as well as weekly continuing professional development sessions. Training has been provided for students from Oman Medical College, Nizwa University, Dubai School of Pharmacy, Oman Assistant Pharma- patient cist Institute and Higher College of Technology as well as others. and

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Clinical & Diagnostics Services OUTPATIENT PHARMACY 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 Medicine & Public Health clinic, the A&E Pharmacy (which offers a 24 hrs service) and the Student Clinic Pharmacy. At the main Hospital Pharmacy, one room is dedicated for counselling patients. During 2010, the OPD pharmacies dispensed a total of 168,623 prescriptions, which accounted for 414,306 items [Figure 1].

50000 47469 48908 Rxs 45000 143152 Items 42054 42551 41414 39491 39298 40000 37998 37639 35446 36688 35000 30000 25000 19595 19474 20000 17765 17647 17257 16442 16753 15000 15349 14829 15919 14346 14876 10000 5000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Figure 1: Total number of prescriptions and items dispensed from different OPD pharmacies in 2010.

IN-PATIENT 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 health care providers to achieve this goal. Reviewing discharge prescriptions by the clinical pharmacists continues to be an important and major requirement before dispensing of medications to the patients to make sure that the prescription is appropriate. Clinical pharmacists perform a number of clinical activities and interventions in their day-to-day work.

Interventions documented from January to December 2009 were analyzed (n = 677). The most common interventions performed were on drug regimen modification (n = 402; 59%), drug choice (n = 164; 24%) and drug information issues (n = 54; 8%). Dose change (n = 230; 34%) and frequency change (n = 75; 11%) were the most frequent interventions performed in the drug regimen change. Toxicity risk was reduced and efficacy

192 was improved in 40% (n = 269) and 33% (n = 224) of the interventions, respectively. Death, major permanent injury, or organ damage was avoided in 3.25% (n = 22) of the cases while interventions of major significance were recorded in 25.11% (n = 170) of the interventions.

The data showed that clinical pharmacists play an important role in drug safety and efficacy to optimise pharmaceutical care as part of the multi-disciplinary team approach in the hospital.

In addition, an audit was carried out over 3 weeks in April 2010 to analyse interventions carried out on discharge prescriptions and find out the reasons for delay of review. A total of 462 (46%) prescriptions were reviewed. Seventy two prescriptions (15.5%) had interventions. The most common interventions performed were on drug regimen change (52%), drug choice (38%) and prescribing issues (9%).The most common reasons for delay were: prescriber not responding straight away to the pager (n = 16; 34%) and prescriber taking a long time to make the change after being contacted by the clinical pharmacist (n = 12, 25.5%). Recommen- dations were to emphasise the prescribing policy of the hospital: an SHO or above must review and coun- tersign the prescription once it is written by the intern. Moreover, the communication system needs to be improved and handheld computers linked to the main computing system should be made available to all health care providers.

MANUFACTURING (ASEPTIC PREPARATIONS) This section is responsible for the preparation of TPN, chemotherapy preparations and some sterile and non- sterile products. There has been a significant increase in number of preparations this year compared to previous year [Table 1].

Activity 2009 2010 % Difference TPN Bags 1,484 3,224 + 117.25 % Cytotoxic Doses 6,633 9,191 + 38.56 % departments

Sterile and non- 1,653 2,735 + 65.46 % sterile prepara- care

tions Repacked Items 298 264 - 11.4 % patient MEDICINE INFORMATION SERVICES Medicine Information Services (MIS) provides unbiased evidence-based and critically evaluated information and about medicines, poisons and diseases in order to improve patient care. The following table shows the number of documented inquiries, adverse drug reaction (ADR) and poisoning reports from 2007 to 2010. academic P harmacy

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Year/Number 2007 2008 2009 2010 Inquiries 458 743 736 630 ADR Reports 96 270 526 596 Poisoning Reports 30 76 78 114

MIS also provides the essential information base for the Hospital’s Pharmacy & Therapeutics Committee meetings. Information was provided on more than 26 drugs, which led to the addition of 17 drugs to the for- mulary. Additionally, the availability of essential drugs and the IV immunoglobulin use in SQUH were presented to the committee.

One issue of the ADR newsletter was published in 2009-2010. Six Pharmacy Journal Club sessions were organised with the participation of 7 pharmacy staff, during which papers selected from more than 50 medical and pharmaceutical journals were presented.

PHARMACY SUB-STORE The Pharmacy Sub-store is the link between the hospital main stores and the Pharmacy Department. It plays 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 quantities of pharmaceuticals to be purchased. The Pharmacy Sub-store aims at ensuring the availability of all critical items as soon as possible in co-operation with the main store and the procurement department. Thirteen items were not available for >30 days; however; they were made available within 3 months. Pharmacy Sub-store is responsible for the supply of medicines on requisitions for other satellite pharmacies and different clinics and units in the Hospital.

Requisition statistics in 2009-2010

40000 35532 35000 31253 30000 No. of requisitions 25000 No. of Items 20000

15000

10000

5000 1711 1830 0 2009 2010

YEAR Figure 2: Number of items and requisitions issued by the Pharmacy Sub-store in 2010

194 Research The following internal research was carried out by Pharmacy staff in this period: 1) Documentation and Anal- ysis of clinical pharmacists’ interventions in SQUH. 2009–2010 by Abusham A, Al-Rahbi A, Al-Mahrizi A, Al- Baram Asmahan, Al-Zadjali B, Loius B, Al-Lawati B, Al Salhi D, Al-Riyami I, Al-Kindy M, Mafiana R, Al-Ajmi S, Al- Hinai M and Nair N; 2) Analysis of clinical pharmacists’ interventions on discharged patients’ prescriptions in April 2010 by Al-Shargi N, Al-Kindy M and Al-Zadjali B, and 3) HbA1c level monitoring in diabetes mellitus patients and patients knowledge from May 2009 – June 2010 by Al-Alawi S and Al-Ajmi S.

RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al-Adawi S, Al-Zakwani I, Obeid Y, Zaidan Z. Neurocognitive functioning in women presenting with undifferentiated somatoform disorders in Oman. Psychiatry Clin Neurosci 2010; 64:555–64. 2. Panduranga P, Sulaiman K, Al-Zakwani I, Zubaid M, Rashed WA, Al-Mahmeed W, et al. Utilization and determinants of in-hospital cardiac catheterization in acute coronary syndrome patients from the Middle East. Angiology 2010; 61:744–50. 3. Panduranga P, Sulaiman K, Al-Lawati J, Al-Zakwani I. Characteristics, management and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman. Saud Med J 2010; 31:520–4. 4. Gowri V, Al-Zakwani I. Prevalence of cesarean delivery in pre-eclamptic patients with elevated uric acid. Hypertens Pregnancy 2010; 29:231–5. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations National 1. Al-Rahbi A. Insulin properties and administration. Ibra Hospital Symposium. Ibra, Oman, 4 March 2010. departments 2. Taqi A. Pharmaceutical care in haemophilia. Haemophilia Awareness Day, Sohar, Oman, 29 April 2010. 3. Abusham A. Prevalence and predictors of sub-optimal serum gentamicin levels in sickle cell disease patients utilis-

th care ing the Hartford protocol. 5 Khoula Hospital Pharmacy Symposium. Muscat, Oman 29 April 2010. 4. Abusham A. Antibiotics: Prescribing considerations. 4th Nizwa Regional Symposium. Nizwa Hospital, Oman 27 May 2010. patient

5. Taqi A. Novel Drug Delivery and patient care. Oman Pharmaceutical Conference. Muscat 20–21 October 2010. and

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1. Al Mahrizi A, Al Rahbi A, Al Riyami I, Ahmed B, Al Ajmi S. Analysis of clinical pharmacists’ interventions in a university teaching hospital in Oman (2009). 39th ESCP European Symposium on Clinical Pharmacy 2010. Lyon, France, 21–23 October 2010. National 1. Al-Zadjali B, Al-Baram A, Al-Kindi M, Al-Siyabi K. Analysis of clinical pharmacists interventions in a tertiary care teaching hospital in Oman. 5th Patient Safety Symposium. Sultan Qaboos University, Muscat, Oman, 1–3 February 2010. 2. Al-Zadjali B, Al-Ajmi S, Shaik S, Al-Siyabi K. Caution! Look-alike sound-alike medications. 5th Khoula Hospital Phar- macy Symposium, Muscat, Oman 29 April 2010. 3. Al-Zadjali B, Al-Baram A, Al-Kindi M, Al-Siyabi K. Analysis of clinical pharmacists interventions in a tertiary care teaching hospital in Oman. 5th Khoula Hospital Pharmacy Symposium. Muscat, Oman 29h April 2010. 4. Al-Zadjali B, Al-Ajmi S, Shaik S, Al-Siyabi K. Caution! Look-alike sound-alike medications. 5th Patient Safety Sympo- sium. Sultan Qaboos University, Muscat, Oman, 1–3 February 2010. Seminar Presentations National 1. Al-Riyami I. Pharmacological management of SCD patients in pediatrics. Sultan Qaboos University Hospital, Phys- iotherapy Department, March 2010. 2. Mafiana R. Safe handling of Hazardous Drugs. Awareness presentation to nurses in Child Health. Sultan Qaboos University Hospital, May 2010. 3. Mafiana R. To Crush or Not to Crush. Sultan Qaboos University Hospital, Knowledge Forum, June 2010. 4. Al-Rashdi I. Quality of Dispensing Practice at Outpatient Pharmacy-SQUH. Medical Advisory Committee Meeting, Sultan Qaboos University Hospital, June 2010.

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he Department of Physiology has two divisions: Basic Physiology and Clinical Physiology located in the College of Medicine 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 coordinated with other basic science departments in an integrated and multidisciplinary fashion. The curriculum is further fortified by live models as well as simulated basic and clinicalT case demonstrations at different levels of medical training. Clinical students are taught hands-on as well as diagnostic skills of the most common clinical measurements that they are like to encounter after graduation.

The Department of Clinical Physiology provides advanced clinical diagnostic services for SQUH and 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 has a major emphasis on cardiovascular research and has strong links with the universities of McMaster and Toronto in Canada; Oxford, UK; Wisconsin, USA; Graz in Austria and Groningen in the Netherlands as well as with the US National Heart & Lung Institute and the Southwest Foundation for Biomedical Research, San Antonio, USA. Researchers from the Department interact regularly with these universities through exchange programmes. Technical and medical staff members receive regular training and

198 Deepali Jaju, Senior Registrar Amira Al-Kharusi, Clinical Lecturer Support Staff Adila Al-Tooqi, Acting Superintendent Mariam Al-Hooti, Senior Technologist Susan Al-Nabhani, Senior Technologist Hajer Ba Omar, Research Assistant Sultan Al-Siyabi, Research Assistant Isehaq Hussaini, Biomedical Scientist Farid Al-Dhuhli, Biomedical Scientist Jessy George, Coordinator Iluminada Calupig, Coordinator In addition, there are 25 technicians (of which 15 are Omanis) in the support staff team working in the sections of Cardiology, Pulmonology, and Neu- rophysiology, and in the Sleep Disorders laboratories.

Highlights of the Year 2009–2010 are audited to meet international standards. Cardiovascular research is the high point of departmental research expertise and activity. It spans topics from membrane and vascular physiology Staff to genetics and clinical research. Two strategic re- departments search projects on the genetics and epidemiology Faculty of hypertension, and metabolic syndrome and life-

Mohammed Hassan, Professor style interventions are underway. Both projects care

Sulayma Al-Barwani, Associate Professor receive SQU His Majesty’s Research Trust funds as Abdul A. Khan, Assistant Professor well as National Institutes of Health grants. Amal Ziada, Assistant Professor patient Khamis Al-Hashmi, Assistant Professor All the equipment used in this Department is now Sami Al-Rawas, Consultant digital and therefore the Department is ready to be and Mohammed Al-Abri, Consultant linked to other hospitals in Oman for remote inves- Hajer Al-Rujeibi, Senior Registrar tigation and patient management. Apart from the academic physiology

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1200 Pulmonary Cardiology Neurology

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800

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Feb April May July March June January August October September November December Figure 1: Types and number of procedures in the Department of Clinical Physiology in 2010

addition of new diagnostic procedures, the number of existing clinical tests has increased in all specialties, with some having shown a substantial increase. Medical research has also increased and results from various projects have been published.

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Department of Physiology offers one departmental course and makes major contributions to system- based courses in: Early development Tissues and Integuments; Alimentary System; Respiratory System; Car- diovascular System; Urinary System; Nervous System & Special Senses; Endocrine & Reproductive System; Applied Medical Sciences. Each of these courses has approximately 140 students. The Department also teaches the following courses in the Nursing degree programme: Anatomy & Physiology courses I & II and Pathophysiology for Nursing. The Applied Medical Science course is a problem-based course shared with the departments of Anatomy and Biochemistry. During the 2009–2010 academic year, the Department has been involved in the development of the new clinical based curriculum. This curriculum was implemented in spring 2009 with Introduction to Human Physiology and Cellular Communication. Subsequently, the Department has taken a lead in the development and delivery of various systems modules which have been incorporated into the new curriculum.

200 December Paying

November Other hospitals SQUH out patients October SQUH in patients

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0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200

No. of referrals Figure 2: Monthly distribution of referrals in the Clinical Physiology Hospital department of CPH in the year 2010

The Department has therefore contributed extensively to the successs of the new curriculum. departments 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 on during the clinical years.

Students are evaluated in their theoretical and practical components as well as in their basic clinical skills. care

UNDERGRADUATE CLINICAL PROGRAMME

In the clinical program, the Department is heavily involved in the Integrated Lecture Series teaching in the patient

Cardiovascular System; Alimentary System; Respiratory System; Family and Community Medicine courses th th as well as providing Clinical Physiology rotations for 5 and 7 year students of the MD program. and

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2007 12000 2008 2009 10307 10000 9402 2010

8000 8174 6812 6794

6000 6129 5204

4000 3747 1684 1463 1322 1268 0 Cardiology Neurology Pulmonary Figure 3: Comparative analysis of total patients investigated in CPH by section 2007–2010

POSTGRADUATE TEACHING The Department contributes to the core programme of the Oman Medical Specialty Board (OMSB) and to the preparation of trainees for the Membership of the Royal College of Physiologists (MRCP) and Fellowship of the Royal College of Surgeons (FRCS) examinations. Clinical Physiology senior house officers spend one year rotating in two units of Medicine of their choice and one year training in clinical physiology before going abroad for further training and higher qualifications.

TRAINING COURSES & CME ACTIVITIES Regular in-house training is conducted for newly recruited technicians. As a part of this course, the technicians attend the Anatomy & Physiology course for nursing students. Continuing medical education 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 College and Hospital programmes. Clinical & Diagnostic Services

The Department of Clinical Physiology continues to offer its diagnostic services which cover most of the

202 spectrum of Neurophysiology, Cardiology, Pulmonology, Sleep Medicine and other discrete tests. With a fully functional sleep laboratory, Clinical Physiology (CPH) now also extended its state-of the art services to the Cardiac Catheterization laboratory and screening of newborns for hearing deficiencies.

The total number of patients attending Clinical Physiology clinics in the 12 months of 2010 was 18,789. This is 6.0% more than last year. The highest number of patients was seen in March followed by May and January. Cardiology showed the largest number of procedures (10,307), followed by Neurology (6,794) and Pulmonary Function tests (1,684) [Figure 1]. Other prominent procedures include Non-Invasive Cardiology (5,306), Inva- sive Cardiology (945), Skin Tests (748), Audiometry and Newborn Screening (2,978), Polysomnography (411) and Electroencephalogram (EEG) (1,785). Out of the total procedures (18,789) during the year 2010, there were 9,135 outpatients and 6,556 inpatients. A total of 3,007 patients (5.6% more than 2009) were referred from non-governmental hospitals and private practitioners [Figure 2].

The demand for the increased number of in 2010 was met due to efficient continuation of available services and management of patient scheduling. The total number of patients investigated in CPH as a whole department has risen from 11,156 in 2007 to 18,789 in 2010 an increase of 68%. There has been a significant and consistent increase in the number of patients investigated in all sections.

Research RESEARCH PROJECTS The impacts on structural and functional characteristics of blood vessels in dyslipidaemic patients; a randomized clinical trail comparing Simvastatin alone versus Simvastatin plus Ezetimibe. Project Code: IG/MED/PHYS/10/01; Dates: 2010–2011 Value: OR 16,250; Project Funder: Sultan Qaboos University departments

Investigators: Dr. Khamis Al-Hashmi, Dept. Physiology, Dr. Mohammed Al-Abri, Dept. Clinical Physiology, SQU; Dr. Deepali Jaju, Dept. Clinical Physiology, SQU; Dr. Omar Al-Rawas, Dept. Medicine, SQU; Prof. Mohammed Hassan, Dept. care Physiology, SQU.

Assessment of the beneficial effect of gum Arabic with or without treadmill exercise in experimentalos-

teoporosis in rats: Comparison with the standard drug residronate patient

Project Code: IG/MED/PHYS/10/02; Dates: 2010–2011 and Value: OR 19,000; Project Funder: Sultan Qaboos University Investigators: Late Dr. Amal Ziada, Dept. of Clinical Physiology, SQU; Prof. Badreldin Ali, academic P hysiology

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Dept. of Pharmacology & Clinical Pharmacy, SQU; Dr. Ibrahim Inuwa, Dept. of Human & Clinical Anatomy, SQU.

Estimation of reference values for arterial stiffness indices in normotensive adult subjects and assessment of lifestyle effect Project Code: IG/MED/PHYS/10/03; Dates: 2010–2011 Value: OR 2,000; Project Funder: Sultan Qaboos University Investigators: Prof. Mohammed Hassan, Dept. Physiology, SQU; Dr. Khamis Al-Hashmi, Dept. of Physiology, SQU.

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: 2010–2011 Value: OR 14,600; Project Funder: Sultan Qaboos University Investigator: Dr. Hajar Al-Rajaibi, Dept. Clinical Physiology, SQU

Effect of Hibiscus Sabdariffa on hemodynamics, myocardial structure and male reproduction in normal and genetically hypertensive rats. Project Code: IG/MED/PHYS/09/01; Dates: 2010–2011 Value: OR 19,000; Project Funder: Sultan Qaboos University Investigators: Late Dr. Amal Ziada, Dept. Clinical Physiology, SQU; Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr. Ibrahim Inuwa, Dept. Human & Clinical Anatomy, SQU.

Effect of 10 Weeks Lisinopril Administration on EDHF-Mediated Relaxation on Mesenteric Arteries of Spontaneously Hypertensive Rats Project Code: MREC #314; Dates: 2010–2011 Value: OR 600; Project Funder: Sultan Qaboos University

Investigators: Dr. Sulayma Al- Barwani, Dept. Physiology, SQU. RESEARCH PUBLICATIONS & BOOKS

JOURNAL PUBLICATIONS 1. Hassan MO, Bayoumi RA, Lopez-Alvarenga JC, Snieder H, Jaju D, Al-Yahyaee S, Al-Hadabi S, Comuzzie AG, Albarwani

204 S. Heritability of hemodynamic reactivity to laboratory stressors in a homogenous arab population: ‘Oman family study’. Twin Res Hum Genet 2009; 12:541−8. 2. Albarwani S, Al-Siyabi, S, Baomar H, Hassan MO. Exercise training attenuates ageing-induced BKCa channel down- regulation in rat coronary arteries. Exp Physiol 2010; E-pub 5 2010, doi: 10.1113/expphysiol.2009.051250. 3. Dikshit MB. Pilot accidents: Case studies of two military aircraft accidents: Possible mechanisms of human failure. SQU Med J 2010; 10:122–7. 4. Albarwani S, Al-Hashmi K, Al-Abri M, Jaju D, Hassan MO. Effects of overweight and leisure-time activities on aero- bic fitness in urban and rural adolescents. Metab Syndr Relat Disord 2009; 7:369–73. 5. Parthasarathy H, Alhashmi K, McDonald A, Struthers A, Connell JMC, McInnes GT, et al. Ratio of serum aldosteroneto to plasma renin activity and antihypertensive efficacy of diuretics in hypertension. Results of the RENALDO study. J Hypertens 2010; 28:170–7. CONFERENCE & SEMINAR PRESENTATIONS CONFERENCE PRESENTATIONS International 1. Abri M, Al-Hashmi K, Jaju D, Al-Rawas O, Al-Riyami B, Hassan MO. Relationship of apnoea/hypopnoea index with BMI and age in Omani population. Australian Sleep Meeting Conference. Melbourne, Australia, October 2009. 2. Hassan MO, Albarwani S, Al-Yahyaee S, Jaju D, Bayoumi RA. Genomewide linkage analysis reveals novel quantitative trail loci of haemodynamics under mental and physical stress in large Arab pedigrees of the “Oman Family Study”. TWAS (Academy of Sciences for the Developing World) Meeting. Alexandria, Egypt, 21–22 Dec 2009. 3. Hassan MO, Bayoumi RA, Jaju D, Rizvi SG, Al-Yahyaee SAS, Albarwani SA. Multiparity and High Prevalence of the metabolic syndrome using the international diabetes federation criteria in Omani Arab women “Oman Family Study”. 6th International Conference on Functional Foods for Chronic Diseases: Diabetes & Related Diseases. Texas, USA December 2009. 4. Hassan MO, Albarwani S, Al-Yahyaee S, Al-Haddabi S, Comuzzie AG, Bayoumi R. Sharing genetic results of large Arab pedigrees Achievements and challenges. UCLA Center for Society and Genetics. Denver, USA 22–25 2010. departments 5. Al-Hashmi K, Jaju D, Al-Lawati Z, Al-Lawati T, Albarwani S, Bayoumi R, Al-Yahyaee S, Hassan MO. Age and gender- dependent ambulatory arterial stiffness index in a homogenous population of the “Oman family study”. Abstract,

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19 European Meeting on Hypertension. Milan, Italy, June 2009. patient

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CONFERENCE POSTERS International 1. AlBarwani S, Jaju D, Al-Yahyaee S, Alvarenga JC, Commuzie AG, Bayoumi R, Hassan MO. Mental stress and sleep: A novel approach to unfold the genetic control of hemodynamics in large Arab pedigrees of Oman Family Study. The 36th International Congress of Physiological Sciences (IUPS 2009). Kyoto, Japan, July 2009. 2. Al-Hashmi K, Jaju D, Al-Lawati Z, Al-Lawati T, Albarwani S, Bayoumi R, Al-Yahyaee S, Hassan MO. Age and gender- dependent ambulatory arterial stiffness index in a homogenous population of the Oman Family Study. The 19th European Meeting on Hypertension. Milan, Italy, June 2009. National 1. Jaju DS, Albarwani S, Bayoumi R, Al Yahyee S, Hassan MO. Cardiovascular reactivity to mental and physical stress in offspring of hypertensive parents from large Omani Arab families: “Oman Family Study”. Research Day. Sultan Qaboos University, Oman, May 2010.

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207 Annual Report 2009-2010 Physiotherapy

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 their daily living to live a normal life. Surgical andT chronically ill patients can also benefit from it. Speech and language therapy is concerned with improving clients’ communication skills.

Physiotherapy Services cover in-patients, outpatients, Accident & Emergency and Day Care patients. They are available seven days a week in all the hospital wards including cardio-rehabilitation. Treatment modalities include electrotherapy, manual therapy, hy- drotherapy, acupuncture, reflexology, neuro-rehabilitation, respiratory, paediatric rehabilitation, cupping, women’s health, (pre- and postnatal, and female urinary incontinence), sports injury, public health education and splinting. Physiotherapists are involved in clinical teaching of physiotherapy and medical students.

Occupational Therapy (OT) services include home modifications, adaptive devices, splinting, and help to improve oral motility, cognitive skills and to overcome learning disabilities. Adaptive devices are advised or provided to compensate any disability and improve

208 Speech and Language Therapy services provide assessments, management and treatment for a wide range of cases related to hearing impairment; cognitive, or other developmental delays; birth defects such as cleft lip and/or palate; motor planning problems; dysphagia; traumatic brain injury; neurological problems affecting communication, or voice disorders. In addition, speech and language therapists supervise speech and language therapy students during their training in SQUH. Further- more, great efforts are made to educate other professionals (e.g., physicians, dieticians and nurses) about speech and language therapy.

Staff Therapists Saif Al-Riyami, Deputy Head Kauther Al-Busaidi, Chief Physiotherapist B Omar Al-Tamimi, Chief Physiotherapist B Nasser Al-Hajri, Chief Physiotherapist B Said Al-Balushi, Senior Physiotherapist their functional ability. OT aims to enable clients to Zuwaina Al-Bahri, Senior Physiotherapist reach their maximum level of functional indepen- Ahlaam Al-Mazrui, Senior Physiotherapist dence in all their activities of daily living (ADL) so as Karthikeyan G. Nair, Senior Physiotherapist to enable them to become independent members

Hilal Al-Rashdi, Senior Physiotherapist departments of society. In paediatrics, problems such as posture Najma Al-Mahruqi, Senior Physiotherapist (proper seating), mobility (wheelchair and mobility Huda Al-Saadi, Senior Physiotherapist devices), activities of daily living (adaptive devices), care Moza Al-Amri, Physiotherapist deformities (splinting), problems, hyperactivity Sabah Al-Touqi, Physiotherapist and sensory concentration and coordination inte- Safiya Al-Hashmi, Physiotherapist gration dysfunction and dysphagia (feeding and patient

Aisha Al-Talei, Physiotherapist eating troubles) are tackled to bring the child’s de- Madiha Al-Kindi, Physiotherapist velopment to as normal a level as possible. Treat- and

Hasna Al-Rashdy, Physiotherapist ment includes family counselling and home pro- Shaima Al-Saidi, Physiotherapist grammes. academic physiotherapy

209 Annual Report 2009-2010 Physiotherapy

Hammad Al- Subhi, Physiotherapist Mahmoud Al-Hinai, Physiotherapist Inas I. Ali, Physiotherapist Halima Al-Mahrooqi, Physiotherapist Hilal Al-Balushi, Physiotherapist Basma Al-Araimi, Occupational Therapist Vasant Naganur, Occupational Therapist Ibtisam Al-Wardi, Speech & Language Therapist Fathiya Al-Amri, Speech & Language Therapist Support Staff Laureana P. Valderama, Coordinator Fathiya Al-Akhzami, Receptionist Hamood Al-Amri, Messenger Highlights of the Year 2009–2010 The Department was able to provide pre- and post cardio-rehabilitation to both in and outpatients.

The Speech and Language Therapy service was focused on both adults and pediatrics presented with hearing impairments; cognitive, or other developmental delays; motor planning problems; dysphagia; traumatic brain injury; neurological problems affecting communication or voice disorder both inpatients and outpatients. Caregivers also received training as necessary. A variety of therapeutic techniques are employed, including speech and language stimulation, voice exercises (e.g., LSVT program) and dysphagia management. In addition, the speech and language therapist 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.

Occupational therapy services focused mainly on children of different ages with developmental delay, feeding and eating problems, sensory integration issues, seating and mobility, activities of daily living and splinting. The oral motor programme is the most important aspect of treatment with neonates having sucking difficulty and children who have feeding and eating problems. An introduction to occupational therapy was provided to medical, nursing, physiotherapy, dieticians, and speech and language therapy students.

The Department provided a physiotherapy service to the Oman Football Association. The Department published a Rehabilitation Newsletter in both April and October. The Department held its annual Rehabilitation Day in the Oman Women’s Association with the theme Women’s Health Education. Paediatric physiotherapists gave a lecture to schoolgirls to raise awareness on women’s health.

210 Departmental staff attended various national and international conferences, courses and workshops including: the 6th Regional Workshop on Evidence-Based Medicine, SQU; Introduction to Clinical Research and Health Informatics, SQU; 2nd Physical Medicine Symposium, Crown Plaza Muscat; 2nd International Confer- ence of Quality Management in Health Care, SQU; 17th International Child Health Conference, SQU; Sports Physiotherapy Symposium Dry Needling and Myofascial Pain, Al Ain, UAE; Cardiac Rehabilitation, USA; Med- ical Taping, Saudi Arabia; Diagnostic Tools and Management of Adverse Neural Tension with Neurodynamic Techniques, Saudi Arabia; Evidence-based Practice, Pain Management Course, Australia; Clinical Attachment for training in CBT of Pain, Australia; Clinical Certificate Course in Neuro-Rehabilitation, Korea; Spinal Pelvis and Scapular Mobilisation, Italy; Certificate in Spinal Manual Therapy, Sharjah UAE; Moving and Handling People, UK; Cardiovascular and Pulmonary Physiotherapy Workshop, Institute of Health Sciences, Muscat; Physiotherapy Preceptorship, Institute of Health Sciences, Muscat, and finally a workshop on Writing Scien- tific Papers, held at SQU.

Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME The Department is involved in clinical teaching, practical hands-on training, and in supervising of students and interns from both inside and outside Oman. This ranges from undergraduates in physiotherapy, speech therapy and occupational therapy to qualified doctors. In 2010, thirty-one students from the Institute of Health Sciences in Muscat had 1 to 6 week part-time clinical placements, and one student from Australia one from India had 9 and 12 week placements respectively. Tutorial sessions on an introduction to joint assessment and alternative medicine for 5th year medical students, and on locomotors skills for 4th year medical students, as well as teaching sessions for trainee dieticians, were also provided.

POSTGRADUATE PROGRAMME Two Omani physiotherapists had 6 week attachments in the Department and two physiotherapists from the departments Royal Court Affairs are on two year attachments with us; one Physiotherapist from India worked as a volun- teer for 9 months; and three speech and language therapists had 4 week attachments with us. care

TRAINING COURSES & CME ACTIVITIES On a rotation basis, each therapist conducts in-service lectures and speaks at the journal club. We also invite patient visitors, i.e. doctors, nurses and other paramedics, to give lectures. Therapists write articles for the bi-annual Physiotherapy Newsletter on a rotation basis. Therapists also conduct a weekly lifting and handling lecture and for nurses, paramedics, medical orderlies and other hospital staff.

For its own staff, the Department conducted a one day workshop on Pain Management in December 2009; a academic P hysiotherapy

211 Annual Report 2009-2010 Physiotherapy

2 day course on Medical Taping in March 2010; and a 3 day workshop on Comprehensive Breast Cancer Reha- bilitation Program in April 2010, Thirteen topics were covered in this workshop including: the development of a post-operative breast cancer rehabilitation program; effective exercise programmes for postoperative patients, and sessions on manual lymphatic therapy (MLT) as a treatment technique for oedema. Finally, a two day course on Psychosocial Intervention Model for Physiotherapists in Musculoskeletal Rehabilitation was held in July 2010. Nine topics were covered in this course including: bio-psycho-social assessment of patients at risk of long-term disability, or already disabled by persisting pain; evidence from a cognitive- behavioural program in Malaysia that cultural issues are not a barrier to a self-management approach to chronic pain; principles of cognitive-behavioural management of patients with persisting pain.

The Department also ran a weekly in-service training session for its own staff as well as other Sultan Qaboos University Hospital (SQUH) staff including nurses. Examples of the topics covered were: physiotherapy in H1N1; investigation and management of dysphagia; pharmacological management of pain associated with sickle cell disease (SCD); safe mobilisation of critically ill patients; the physiotherapy approach in Hunting- ton’s disease (HD); quality of leadership in professional development; Precht’s Method for qualitative movement assessment in preterm, term and young infants, and the importance of play.

Lectures were given in the Training Services Directorate programme on Other Modalities of Pain Manage- ment and the Department participated in the Clinical Methods Course and the Interdisciplinary Activity Week in collaboration with the College of Medicine & Health Sciences.

Clinical & Diagnostics Services Table 1: Patient statistics for 2010

Type of service No. of Patients No. of New Patients Physiotherapy 11,044 4,285 Occupational Therapy 966 308 Speech & Language Therapy 639 221

212 CONFERENCE & SEMINAR PRESENTATIONS POSTER PRESENTATIONS National 1. Al-Riyami S, Al-Balushi S. Knee and Ankle Trauma. Sports Physiotherapy Symposium. Nizwa Hospital, Oman, 8 April 2010. 2. Al-Mahruqi N, Al-Hajry N. Haemophilia and Physiotherapy. Haemophilia Awareness Day. Sohar, Oman, 29 April 2010. SEMINAR PRESENTATIONS National 1. Al-Riyami S. Common Sports Injury. College of Medicine, SQU, Oman, 15 March 2010 2. Al-Riyami S, Al-Hajry N. Physiotherapy Workshop. Buraimi, Oman, 12 May 2010. 3. Al-Riyami S. Back Pain Management (in Arabic). Petroleum Development of Oman Co., 25 May 2010. 4. Al-Riyami S. Back Pain Management, Petroleum Devel opment of Oman Co., Oman, 1 June 2010. departments

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213 Annual Report 2009-2010 Radiology & Molecular Imaging

he Department of Radiology offers specialised diagnostic services which 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. TheT Department became fully digitised in May 2002 after installation of a complete PACS (Picture and Archiving Communication Sys- tem). Radiological examinations can be viewed by all doctors from any computer outlet at SQU Hospital (SQUH) on an internal web system together with the Radiological Report. MagicWeb is also available to the radiologists from their homes through the internet when they are on-call. The savings on films and chemicals have been substantial. It has also significantly improved patient management and made comparisons easier. We are now working on improving the database of the MagicWeb so that we can see more studies at a time and faster. We have also purchased a new PACS system, which is just installed and now under trial run.

The clinical services offered by the Department are increasing rapidly with the expansion of the clinical services of SQUH. We are currently performing 86,500 studies a year in the Radiology/Nuclear Medicine Section alone and the numbers are rising rapidly. This does not include the services offered by the Medical Physics Section various Departments and Colleges of SQU as well as the community at large. Medical Physics provides thermoluminescent dosimetry Radiation Protection services to many institutions in Oman,

214 nologists to study abroad for university degrees. The teaching and training of Oman Medical Spe- cialty Board (OMSB) radiology residents started in 2005. So far, 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 the teaching of medical students (4th, 5th, 6th and 7th year in old and new curriculum as detailed below).

Staff Faculty Faisal Al-Azri, Deputy Head, Consultant Dilip Sankhla, Senior Consultant Samir Hussein, Senior Consultant Sukhpal Sawhney, Senior Consultant Haddia Bererhi, Senior Consultant Nader Atari, Associate Professor Ranjan William, Assistant Professor as well as teaching and checking of radio-activity in Humoud Al-Dhuhli, Consultant other resources. Nuclear Medicine Services, besides Rashid Al-Sukaiti, Consultant the Diagnostic Services, also delivers four therapeu- Anupam Kakaria, Senior Registrar tic procedures mainly radioiodine therapy for thy-

Sinan Al-Azawi, Senior Registrar departments roid cancer and hyper-thyroidism. Support Staff

Research, teaching and training, at both undergrad- care

Mohammed El-Gindy, Departmental Superinten- uate and postgraduate level, involves all 13 mem- dent bers of faculty, from both college and hospital staff, Per Rude, Deputy Superintendent, Chief Radiogra- who are also involved in the training of radiogra- pher patient phers. Radiology technicians are also involved in Bernardo Ramos, Technologist the teaching of radiographers from the Institute Salvador De Vera, Technologist – CT and of Health Sciences. We have been successful as a Virginia Ablen, Technologist – MRI Department in sending our young Omani tech- Antonio Velarde, Technologist academic radiology & molecular imaging

215 Annual Report 2009-2010 Radiology & Molecular Imaging

Merlie Vanderlipe, Technologist Shurooq Al-Alawi, Technologist Editha San Diego, Technologist – US Lourdes Hernandez, Technologist Manuel Gaerlan, Technologist Paul Martinez, Technologist Meda Bersaba, Technologist – NM Arthur De Guzman, Technologist Ahmed Abdou, Technologist – NM Marievic De Guzman, Technologist Mohammed Al-Abri, Technologist Lovella Parfina, Technologist Abdullah Al-Siyabi, Technologist Thomas Jefferson,Technologist - MRI Adnan Al-Kharousi, Deputy Superintendent, Tech- VK Ravichandran,Technologist nologist Devid Devaraj, Technologist Matheo Dilao, Technologist Moath Al-Jabri, Technologist Mahmood Al-Abri, Technologist Alya Al-Julandani, Technologist Faiza Al-Salmi, Technologist – MRI Nawal Al-Kharusi, Technologist Umaima Al-Ajmi, Technologist Dalal Al-Shabibi, Technologist Aziza Al-Jabri, Technologist – NM Warda SAl-Lawati, Radiology Nurse Mohammed Al-Saqri, Technologist – NM VP Bindu,Radiology Nurse Nabila Al-Hesani, Technologist – US Kunnappillil Ranipol, Radiology Nurse Ahmed Al-Shuhaimi, Deputy Superintendent, Tech- Marichu Lorica, Radiology Nurse nologist Bini Prathapan, Radiology Nurse Sultan Al-Naamani, Technologist Lenny Netto, Radiology Nurse Hamoud Al-Ghafri, Technologist – CT Sonya Dominic, Radiology Nurse Jamal Al-Rubaiey, Technologist Aleyamma Lalu, Radiology Nurse Aida Al-Rahbi, Technologist – US Support Staff Rania El-Tigani, Technologist – US Rhodora Campo, Coordinator Hanan Yousuf, Technologist Laddie Lara, Coordinator Khitam Al-Hijri, Technologist Jeraldine Arante, Coordinator Ruqaya Al-Rawahi, Technologist Sharifa M. Al-Tobi, IT & Network Support Lubna Al-Esry, Technologist Mohammed Al-Farai, Clerk Mathew George, Technologist – CT Khamis Al-Farsi, Clerk Kalthoom Al-Shesawi, Technologist Ahmed Al-Badawi, Clerk Victor Arulnathan, Technologist Sultan Al-Busaidi, Medical Orderly Kuriakose KP, Technologist Medical Physics Unnikrishnan Nair, Technologist Afkar Al-Farsi, Associate Researcher Wesley S J Asirvatham, Technologist – MRI Amaal Al-Rasbi, Biomedical Scientist Luz Solo-Esguerra, Technologist – US Ibtissam Al-Maskery, Biomedical Scientist Joji Mathew, Technologist Hilal Al-Zeheimi, Biomedical Scientist Ahmed Al-Anqoodi, Technologist Mohammed Al-Subhi, Coordinator Faisal Al-Ghusaini, Technologist

216 Highlights of the Year 2009–2010 We have continued developing the following nine sections in our Department to serve our patients and clinical staff better, and also develop research in these fields: Neuro-Radiology; Interventional Radiology; Body Imaging; Emergency & General Radiology; Chest; Paediatrics; Mammography; Nuclear Medicine; Medical Physics.

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Department teaches more than 100 students in the Integrated Lecture Series (ILS) Anatomy Lecture Se- ries in coordination with the Anatomy Department. There is also a Clinical Skills Exam.

The Department teaches about forty 5th year students in the ILS on the following topics: Respiratory System; Cardiovascular System; Gastro-Intestinal System; Neurology; Infectious Disease, and Uro/Nephrology.

UNDERGRADUATE CLINICAL PROGRAMME Approximately 180 students in the 6th Year rotate through the Department in groups of 6 to 7 students per group every two weeks. In the 7th year there are approximately 30 students and they also receive an Obstet- rics & Gynaecology lecture.

POSTGRADUATE PROGRAMME The Department is involved in the training of 37 OMSB radiology residents. departments

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Clinical & Diagnostic Services

Table 1: Radiology Procedures Statistics 2010

Exams Total General X-Ray 39,947 Special Procedures 848 Ultrasound 19,072 Computed Tomography Scanning 12,378 Vascular & Intervention 1,020 Nuclear Medicine / Bone Marrow Density 3,654 Magnetic Resonance Imaging Scanning 3,926 Mammography 573 Oral Health 2,150 Lithotripsy 140

Research RESEARCH PROJECTS

Safety profile and therapeutic use of back ink from Omani fishes in two experimental models of osteoporosis in rats Project Code: IG/MED/RADI/09/01; Dates: 2009–2011 Value: OR 9,000; Project Funder: Sultan Qaboos University Investigators: Dr. Haddia Berehi, Dept. Medical Physics, SQU; Prof. Badreldin Ali, Dept. Pharmacology & Clinical Pharmacy, SQU; Dr Kamran Malik, Dept. Surgery, SQU; Dr. Khaled Malgat, Dept. Chemistry, SQU; Dr. Aisha Al-Hamadani, Dept. Pathology, SQU.

218 Impact of Volume Rendering (VR) of Thin-Section Multi-Detector CT (MDCT) Images in Diagnosis of Acute Abdomen Pain Project Code: MREC #285; Dates: 2009 Value: Unfunded; Project Funder: Sultan Qaboos University Investigators: Dr. Rajeev Jain, Dept. Radiology & Molecular Imaging, SQU; Dr. Anupam Kakaria, Dept. Radiology & Molecular Imaging, SQU; Dr. Sukhpal Sawhney, Dept. Radiology & Molecular Imaging, SQU

Whole body diffusion weighted magnetic resonance imaging: A biomarker for malignancy and a tool for assessment of tumour response to therapy Project Code: MREC #294; Dates: 2009 Value: OR 600; Project Funder: Sultan Qaboos University Investigators: Dr. Rajeev Jain, Dept. Radiology &Molecular Imaging, SQU; Dr Anupam Ka- karia, Dept. Radiology & Molecular Imaging, SQU; Dr Sukhpal Sawhney, Dept. Radiology & Molecular Imaging, SQU; Dr Ikram Burney, Dept. Medi- cine, SQU

Image guided drainage of pyogenic spondylodiscitis abscesses: Clinical results Project Code: MREC #343; Dates: 2009 Value: Unfunded; Project Funder: Sultan Qaboos University Investigators: Dr. Rashid Al Shukhaiti, Dept. Radiology & Molecular Imaging, SQU RESEARCH PUBLICATIONS & BOOKS Journal Publications departments 1. Lamki L. Editorial: Evaluation Tools in Postgraduate Medical Education: Do we need “Made in Oman” tools? SQU Med J 2009; 9:219−23. care

2. Lamki L. Editorial: Life loss and disability from traffic accidents: It is imperative we all act now. SQU Med J 2010; 10:1−5. 3. Lamki L. Editorial: Stress in medical profession and its roots in medical school. SQU Med J 2010; 10:156−9. patient

4. Koul RL, Alfuitasi AM, Sankhla DK, Javad H, William RR. Pattern of childhood neuronal migrational disorders in Oman. Neurosciences 2009; 14: 158−62. and 5. Sankhla D, Hussein S, George J, William R, Al-Azawi S, Al-Qasabi B. Absence of left pulmonary artery - A case report. SQU Med J 2009; 9:180−3. academic R adiology & M olecular I maging

219 Annual Report 2009-2010 Radiology & Molecular Imaging

6. Machado NO, Chopra PJ, Sankhla D. Portal vein thrombosis post laparoscopic splenectomy presenting with infarction of gut - Review of risk factors, investigations post operative surveillance and management. Surg Laparosc En- dosc Percutan Tech 2010; 20:273−7. 7. El Shafie O,Hussein S, AlHamdani A, Bererhi H, Woodhouse N. Multiple bone metastases in a patient with differentiated thyroid cancer (DTC): Complete resolution following thyroidectomy and four ablation doses of I-131: Case report. SQU Med J 2010; 10:101−5. 8. AlTamimi E, AlDhuhli H. Coronary arteries ectasia. SQU Med J 2009; 9:354−6. 9. AlDhuhli H. Role of magnetic resonance cholangiopancreatography in the evaluation of biliary disease. SQU Med J 2009; 9:341−53. 10. AlMujaini AS, AlDhuhli HH, Dennison D. Acute unilateral third nerve palsy as an early manifestation of central nervous system relapse in a patient with acute myeloid leukemia. Saudi MedJ 2009; 30:961−3. 11. AlMujaini A, Ganesh A, AlZuhaibi S, AlDhuhli H, AlMashani A, AlKindi H, AlMamari A, AlFutaisi A, AlAsmi A. A lymphocytic infundibulo-neurohypophysitis: Anunusual cause of recurrent optic neuropathy in a child. JAAPOS 2009; 13:207−9. CONFERENCE & SEMINAR PRESENTATIONS Conference Presentations International 1. Sankhla D. Clinical and imaging spectrum in neuronal migrational disorders in Oman. 9th Asian Oceanic Society of Pediatric Radiology Congress. Kuala Lumpur, Malaysia, 19−21 November 2009. 2. Sankhla DK, Reyes Z, Florideza M, Elnour IB, Hussein SS. Postnatal outcome of fetal hydronephrosis in infants born at Sultan Qaboos University Hospital, Oman. 10th Congress of Asian Oceanic Society of Paediatric Radiology & 9th Annual Academic Session of Sri Lanka College of Radiologists. Colombo, Sri Lanka, 20−22 August 2010. 3. Sankhla D. Clinical imaging. 9th Asian Oceanic Society of Pediatric Radiology Congress. Kuala Lumpur, Malaysia, 19−21 November 2009. 4. Sankhla D. Postnatal outcomes of fetal hydronephrosis in infants born at SQUH.10th Congress of Asian Oceanic So- ciety of Pediatric Radiology. Colombo, Sri Lanka, 20−22 August 2010. National 1. Al Dhuhli H. Non invasive imaging of sub-clinical coronary atherosclerosis with MDCT. Symposium on Non-invasive Imaging of Sub-clinical Atherosclerosis. Muscat, Oman, 16 March 2010. Conference Posters International 1. Al-Adawi S, Al-Azri F, Hussain S, Dorvlo ASS. Neurocognitive, affective and vegetative functioning in patient presenting with dementia in Oman. 6th International Congress on Vascular Dementia. Barcelona, Spain, 19−22 Novem- ber 2009.

220 2. Sankhla DK, Elnour IB, Hussein SS, Nabhani D, MA Alnaggari. Urinary tract infection and associated urinary tract anomalies – Our experience at SQU Hospital, Oman. 10th Congress of Asian Oceanic Society of Paediatric Radiology and 9th Annual Academic Sessions of Sri Lanka College of Radiologists. Colombo, Sri Lanka, 20−22 August 2010. 3. Elnour IB, Reyes Z, Bataclan MAF, Hussein SS, Sankhla DK. Outcome of prenatal hydronephrosis in infants born at Sultan Qaboos University Hospital, Oman. 15th International Pediatric Nephrology Congress. New York, USA, 29 Au- gust – 2 September 2010. 4. Elnour IB, Nabhani D, Alnaggari MA, Hussein SS, Sankhla DK. The incidence of renal malformation and scarring in children with urinary tract infection referred to SQU Hospital, Muscat, Oman. 15th International Pediatric Nephrol- ogy Congress. New York, USA, 29 August – 2 September 2010. National 1. Guenedi AA, Al Hussaini AA, Abdel YAO, Hussain S, Al-Azri F. Al-Adawi S. Alteration in brain states or possessed by the Spirit? Case report from Oman. University Day. Sultan Qaboos University, Muscat, Oman, May 2009. 2. Sankhla D. Scimitar syndrome. International Pediatrics Conference. Muscat, Oman, October 2009. 3. Elnour IB, Reyes Z, Bataclan MAF, Hussein SS, Sankhla DK. Outcome of prenatal hyronephrosis in infants born at Sultan Qaboos University Hospital, Oman. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 4. Elnour IB, Nabhani D, El Naggari MA, Hussein SS, Sankhla DK. The incidence of renal malformation and renal scarring in children with u rinary tract infection referred to SQUH. University Day. Sultan Qaboos University, Muscat, Oman, 2 May 2010. 5. Mirza H, Hussain S, Al-Adawi S, Al-Asmi A, Al-Azri F, Al-Sharbati M, et al. Jinn in the brain: Evaluation of regional cerebral blood flow in a patient with cacodemonomania of dissociative type. University Day. Sultan Qaboos Univer- sity, Muscat, Oman, 2 May 2010. SEMINAR PRESENTATIONS National 1. Lamki L. How to write a manuscript: Perspective of a reviewer and an editor. Paper Writing Workshop. College of Post Graduate Studies & Research, Sultan Qaboos University, Muscat, Oman, 7 October 2009. departments

2. Lamki L. Peer Review. College of Nursing, Sultan Qaboos University, Muscat, Oman, 7 October 2009. 3. Lamki L. Continuous quality assurance. Quality Improvement Seminar. Royal Hospital, Muscat, Oman, 13 October

2009. care

4. Lamki L. Plagiarism and Recommendation. College of Nursing, Sultan Qaboos University, Muscat, Oman, 14 October 2009.

5. Lamki L. How to write a manuscript: Perspective of a reviewer and an editor. Paper Writing Workshop. College of patient

Post Graduate Studies & Research, Sultan Qaboos University, Muscat, Oman, 18 November 2009. and

6. Lamki L. Ethics of publishing a scientific paper. Interdisciplinary Week – Medical Students. Sultan Qaboos Univer- sity, Muscat, Oman, 7 February 2010. academic R adiology & M olecular I maging

221 Annual Report 2009-2010 Radiology & Molecular Imaging

7. Lamki L. How to write a manuscript: Perspective of a reviewer and an editor. Paper Writing Workshop. College of Post Graduate Studies & Research, Sultan Qaboos University, Muscat. Oman, 3 February 2010. 8. Shukaily M, Hussein S. The role of thyroid scintigraphy with Tc-99m pertechnetate in defining the spectrum of pediatric thyroid disorders in SQUH. Radiology Research Day. Sultan Qaboos University, Muscat, Oman, 13 May 2010. 9. Hussein S. Coronary Arteries: Evaluation with Nuclear Medicine. Radiology Club Meeting. Oman, 30 December 2009. 10. Hussein S. Evidence Based Guidelines. The 6th Regional Workshop on Evidence Based Medicine, Introduction to Clin- ical Research & Health Informatics. Sultan Qaboos University, Muscat, Oman, 9−13 January 2010. 11. Hussein S. Myocardial perfusion, Cardiology Academic Rounds. Sultan Qaboos University Hospital, Muscat, Oman, 9 March 2010. 12. Hussein S. Introduction to Evidence Based Medicine. Evidence Based Medicine in ENT. ENT Society CME. Oman, 31 March 2010. 13. Hussein S. Medline Search. Research Methodology in ENT. ENT Society CME. Oman, 29 April 2010.

14. Hussein S. PubMed Search. Research Workshop. Sur Hospital, Oman, 20 May 2010. 15. Hussein S. Introduction to Evidence Based Medicine. Research Workshop. Sur Hospital, Oman, 20 May 2010. 16. Al Dhuhli H. Imaging of the coronary arteries using MDCT. Radiology Club. Sultan Qaboos University Hospital, Mus- cat, Oman, 30 December 2009. 17. Sukaiti R. Catheter-Directed Thrombolysis. Hematology Club Meeting. Al-Sawadi Beach Hotel, Oman, 14 January 2010. 18. Sukaiti R. Clinical application of angiographic study. Institute of Health Sciences, Muscat, Oman, 20 February 2010.

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223 Annual Report 2009-2010 Surgery

he Department’s mission is to teach and train students and doctors, conduct research, and provide specialised clinical services and patient care. T

224 Prakash Mandhan, Senior Consultant (Paediatric) Rajeev Kariyattil, Senior Consultant (Neurosurgery) Unnikrishnan M, Senior Consultant (Neurosurgery) Adil Al-Ajmi, Consultant (General) Pradeep Chopra, Consultant (General) Sreedharan VK, Consultant (General) Mohamed Al-Hashmi, Consultant (Endocrine) Khalifa Al-Wahaibi, Consultant (Vascular) Abdullah Al-Harthy, Consultant (Trauma) Deepa Bhargava, Consultant (ENT) Joseph Mathew, Consultant (Urology) Hilal Al-Sabti, Consultant (Cardiothoracic) Zainab Al-Balushi, Consultant (Paediatric) Kamran Malik, Senior Registrar, (General) Muhammad Baloch, Senior Registrar (General) Naveed Khatib, Senior Registrar, (General) Syed M. Ali, Senior Registrar (General) Anjali Abraham, Senior Registrar (ENT) Mohammed Okbi, Senior Registrar (ENT) Yahya Al-Badaai, Acting Senior Registrar (ENT) Khalid Rahman, Senior Registrar (Urology) Mohammed Al-Marhoon, Senior Registrar (Urol- ogy) Staff Mirdavron Mukaddirov, Senior Registrar (Cardio- thoracic) Faculty Mohammed S. Siddiqi, Senior Registrar (Cardiotho- Hani Al-Qadhi, Consultant, Deputy HOD for Clinical racic) departments

Affairs (Trauma) Paresh Kuba, Senior Registrar (Cardiothoracic) Nayil Al-Kindy, Senior Consultant (General) Muhammad Arain, Senior Registrar (Paediatric) care Norman Machado, Senior Consultant (General) Venkatesh G, Senior Registrar (Neurosurgery) John Mathew, Senior Consultant (ENT) Bahaeldin Moh’d. Salih, Registrar (General) Rashid Al-Abri, Senior Consultant (ENT) Intisar Al-Hashmi, Registrar (General)

Krishna Prasad, Senior Consultant (Urology) patient

Mohammed Al-Hosni, Registrar (General) Qassim Al-Busaidi, Senior Consultant (Urology) Mooayad Ahmed, Registrar (General)

Ashok Sharma, Senior Consultant (Cardiothoracic) and Shahzad Younas, Registrar (General) Rajeeva Pieris, Senior Consultant (Cardiothoracic) Suresh Kannan, Registrar (General) Sultan Al-Maskari, Senior Consultant (Orthopaedic) academic sugery

225 Annual Report 2009-2010 Surgery

Zaid Raouf, Registrar (General) Sudesh Kumar, Registrar (ENT) Wameed Al-Bassam, Registrar (ENT) Shahid Aquil, Registrar (Urology) Ehab Rajab, Registrar (Cardiothoracic) Ahmed Yaseen, Registrar (Orthopaedic) Madni A. Aziz, Registrar (Orthopaedic) Mohamed Al-Mutani, Registrar (Orthopaedic) Charles Okoro, Senior House Officer (General) Ghassan Elshafie, Senior House Officer (General) Khalid Bhaiti, Senior House Officer (General) Najib Draz, Senior House Officer (General) Sareyah Al-Sibai, Senior House Officer (General) Nesrin Qader, Senior House Officer (ENT) Ghalib Al-Baddai, Senior House Officer (Urology) Omar Sharef, Senior House Officer (Urology) Adham Said, Senior House Officer (Orthopaedic) Ayman Al-Amri, Senior House Officer (Orthopaedic) Support Staff Balan Baskaran, Perfusionists Sayed Rizvi, Perfusionist Saif M. Al-Kharusi, Technician Badar A. Al-Mazidi, Technician Maria T Ablen, Coordinator Ruel Natividad, Coordinator Highlights of the Year 2009–2010 NEW SERVICES The Urology division restarted the renal transplantation programme in April 2010 after about ten years of dormancy. The division also embarked on penile prosthesis implantation surgery and expanded the uro- laparoscopic surgery. The newly established Neurosurgery Division started operative procedures (spine and brain trauma surgery) in July 2010.

VISITORS TO THE DEPARTMENT Prof. Maximo Guida, Head of Cardiovascular Surgery Department, Metropolitan Hospital, Valencia, Venezu-

226 ela, visited the Department and conducted a workshop on Minimally Invasive Coronary Artery Bypass Sur- gery on 10–11 October 2009. Dr. Mario Patricolo, Paediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi, UAE, visited the Paediatric Surgery Division on 14 December 2009 and gave a talk on Neurogenic Bladder in Children. Prof. Simon Frostick, Orthopaedics Department, Liverpool University, UK, visited the Department from 11–13 January 2010. He conducted clinics, operated, and gave lectures on Soft Tissue Sarcomas: Genetic Abnormalities in Mesothelial Cells, and on Undergraduate and Postgraduate Medical Education: Where do we stand? Professor Frostick visited SQUH again from 12–16 June 2010 and carried out similar clinical activities. Dr. Ganesh Gopalakrishnan, former Head of Urology at Christian Medical College Hospital, Vellore, India, visited the Urology Division on 22 March 2010 and gave a talk on the Management of Complicated Posterior Urethral Strictures. Prof. N. K. Mohanty, Consultant and Head of Urology Department, Safdarjang Hospital, New Delhi, India, visited the Urology division from 1–5 April and delivered the Dean’s Invitational Lecture, entitled Newer Trends and Targeted Therapy in Kidney Malignancy. He also participated in the Surgical Grand Rounds on 5 April 2010 and gave a talk on New Horizons and Paradigms in the Management of Benign Prostat- ic Hyperplasia. Prof. J. A. Grotenhuis, Chairman of Neurosurgery Department, Radboud University Nijmegen Medical Center, Netherlands, gave a talk on Endoscopic Neurosurgery on 7 June 2010. Prof. Nikolai Rainov and Prof. Volkmar Heidecke from Klinikum Augsberg, Germany visited on 4 July 2010. Prof. Rainov gave a talk on Current Standards and Experimental Strategies for Therapy of Malignant Brain Tumours.

Teaching Programmes UNDERGRADUATE CLINICAL PROGRAMME The Department participated in the teaching of the Clinical Methods and Communication Skills course for 4th year MD Students. In the 5th year junior rotation, the Department catered for 130 students in 2009–2010. The students rotated in groups of 29–36, each group spending half of the 11 week rotation at Sultan Qaboos University Hospital (SQUH) and half at the Royal Hospital. In problem-based learning, the annual six-week clinical course on the gastrointestinal tract, liver and pancreas for 5th Year students was organised by the

th departments Department. For the 6 Year ENT rotation, the ENT Division, in collaboration with the ENT Department in Al Nahdha Hospital, delivered the course for 120 students. The students rotated in groups of 16–17, spending 1 th week each at SQUH and Al Nahdha Hospital. For the 7 year senior rotation, the Department received final care year students in groups of 20–23 in rotation for seven week courses. Altogether, there were 108 students. The 7th year students had their final MD exam in June 2010. patient POSTGRADUATE PROGRAMME and Internship A total of 46 interns undertook their surgical rotations in the Department in the year 2009–2010. A one week academic S ugery

227 Annual Report 2009-2010 Surgery

Hospital Orientation Programme was also conducted for interns in July.

Oman Medical Specialty Board (OMSB) Residents For the OMSB Residency Programme, 13 residents undertook their rotations in general surgery in the Depart- ment in the academic year 2009–2010. A total of 41 weekly lectures for the surgical residents were delivered.

TRAINING COURSES & CME ACTIVITIES Dr. Pradeep Chopra delivered a talk on: Physiology of wound healing and which dressing to choose? at the 4 Wound Study Days for SQUH nurses in November 2009, and February, May and August 2010. He also gave a lecture on Wound healing: Factors that promote and impede healing at OMSB on 25 July 2010 for the OMSB ENT Residents.

Sixteen surgical trainees attended the annual two-day Basic Surgical Skills Course (BSSC) conducted by the Department at the Skills Laboratory, College of Medicine & Health Sciences, on 17–18 October 2009 which was coordinated by Dr. Norman Machado. This was followed by a one-day course on Basic Endoscopy attended by 6 surgical residents on 19 October 2009.

The Department hosted the Bariatric Surgery Workshop at SQUH on 15–16 May 2010 which was conducted by Dr. Karl Miller from Belgium.

The Department hosted the 2nd Advanced Laparoscopic G.I. Course in association with the European Associa- tion for Endoscopic Surgery (EAES), at the Skills Laboratory, College of Medicine & Health Sciences, SQU, from 12–16 December 2009. The EAES tutors were Prof. Abe Fingerhut (France), Prof. Jack Jakimowicz (Netherlands) and Dr. Ahmad Nasser (U.K.). Dr. Ahmad Nasser and Prof. Grant co-directed the course, with Dr. Norman Machado as the chief coordinator of the course. Twenty three surgeons, from 10 different countries including Oman, participated in the course.

Dr. Abdullah Al-Harthy conducted a Trauma Workshop on 3 November 2009 for the OMSB Emergency Medi- cine Program. He was also an instructor in the ATLS Provider and Instructor Courses held at Fujairah, UAE from 13–18 May 2010 together with Dr. Khalifa Al-Wahaibi. The Urology division organised an in-house workshop on Urinary Diversion Techniques on 17 and 18 March 2010 at the Animal Laboratory, SQU; Dr. Moham- med Al-Marhoon was the course coordinator.

228 Clinical & Diagnostic Services

2009-2010 Surgical Clinical Services

Outpatients 18,000 Admissions Procedures 16,000 14,000 12,000 10,000 8000 6000 4000 2000 0 2009 2010 Outpatients 15,447 17,307 Admissions 3,996 4,372 Procedures 3,122 3,339

Research RESEARCH PROJECTS Prophylactic Antibiotics for Flexible Cystoscopy Project Code: MREC# 245; Dates: 2009–2010 departments Value: OR 500; Project Funder: Sultan Qaboos University Investigator: Dr. Mohammed S. Al-Marhoon, Dept.Surgery, SQU. care

The Causes of Amputation among Omani Population Project Code: MREC # 311; Dates: 2009 patient

Value: Unfunded; Project Approval: Sultan Qaboos University and

Investigators: Dr. Khalifa Al-Wahaibi, Dept. Surgery, SQU; Dr. Khalid Al-Amri, Dept. Sur- gery, OMSB. academic S ugery

229 Annual Report 2009-2010 Surgery

RESEARCH PUBLICATIONS AND BOOKS JOURNAL PUBLICATIONS 1. Machado N, Chopra P. Al-Hamdani A. Crohn’s Disease of the appendix with enterocutaneous fistula post appendicectomy: An Approach to management. N A J Med Sci 2010; 3:158–61. 2. Machado N, Chopra P. Al-Hamdani A. Papillary carcinoma of thyroid presenting primarily as cervical lymphadenopathy: An approach to management. SQU Med J 2009; 3:305–9. 3. Machado N, Machado L. Laparoscopic cholecystectomy in third trimester of pregnancy: Report of 3 cases. Surg Lapa- rosc Endosc Percutan Tech 2009; 6:439–41. 4. Machado N, Grant CS. Laparoscopic appendicectomy in all trimesters of pregnancy. JSLS 2009; 13:384–90. 5. Machado N. Neutropaenic enterocolitis: A continuing medical and surgical challenge. N A J Med Sci 2010; 7:293–300. 6. Machado N, Chopra P, Al-Hamdani A. Pancreatic metastasis from colon carcinoma nine years after a hemicolec- tomy, managed by distal pancreatectomy: A review of the literature regarding the role and outcome of pancreatic resection for colorectal metastasis. J Pancreas 2010; 4:377–81. 7. Machado N, Chopra P, Sankla D. Portal vein thrombosis postlaparoscopic splenectomy presenting with infarction of gut: Review of risk factors, investigations, postoperative surveillance and management. Surg Laparosc Endosc Percutan Tech 2010; 4:273–7. 8. Aquil S, Mathew J, Prasad K, Rehman K, Sharef O, Al-Badaai G. Surgical technique for retroperitoneoscopic nephrec- tomy: A case report. SQU Med J 2009; 3:333–6. 9. Chopra P. Re: The trend to seek a second opinion abroad among cancer patients in Oman. SQU Med J 2010; 2:276–7. 10. Al-Marhoon M. Small incidental renal masses in adults: Review of the literature. SQU Med J 2010; 2:196–202. 11. Abdulwani J, Bhargava D, Sawhney A, Al-Abri R. Bimanual intra-operative fluoroscopic-guided removal of nasopha- ryngeal migratory fish bone from carotid space. J Laryngol Otol 2010; 124:786–9. 12. Bhargava D, Al-Abri R, Bhargava K. Evolving trends in evidence based practice; use of internet to retrieve evidence at point of care. Oman Med J 2010; 25:2. 13. Kumar S, Al-Abri R, Sudairi S. Palatal mass. Oman Med J 2010; 25:55. 14. Singh A, Kumar S. ENT Disorder in rural India. Indian J Otolaryngol Head Neck Surg 2010; 2:121–4. 15. Kumar S. Utility of LMA in emergency trachestomy for Pierre Robin syndrome. Paediatr Anaesthes 2009; 4:409–10. 16. Kumar S, Gupta A, Yadav B, Ghoshal S. Primary Sinonasal Malignant Melanoma: Clinicopathologic and Prognostic Study. Ear Nose Throat J 2009; 12:1269–72. 17. Al-Wahaibi K, Al-Harthy A, Al-Qadhi H, Elshafie G, Al-Azri A. Port site herniation of the small bowel following laparoscopic-myomectomy: A case report. SQU Med J 2010; 1:106–13. 18. Al-Maskari S, Giotakis N, Panchani S, Narayan B, Larkin J, Nayagam S. Segmental fractures of the tibia treated by external fixation. J Bone Joint Surg Br 2010; 92B:687–92.

230 19. Aquil S, Mathew JK, Prasad KV, Rehman K, Sharef OW, Al-Baadi G. Surgical technique for retroperitoneoscopic ne- phrectomy – A case report. SQU Med J 2009; 9:333–6. CONFERENCE AND SEMINARS PRESENTATIONS CONFERENCE PRESENTATIONS International 1. Machado N. Pancreatic Resections for Metastatic Tumour of Pancreas. 19th World Congress of the International As- sociation of Surgical Gastroenterologists and Oncologists. Beijing, China, 23–26 September 2009. 2. Grant CS. Laparoscopic Appendectomy in Pregnancy. 18th International Congress of the European Association for Endoscopic Surgery (EAES). Geneva, Switzerland. 16–19 June 2010. 3. Prasad K. Penile Prosthesis Implantation. The Urological Society of India (USI) Annual Conference. Agra, India, 4–7 February 2010. 4. Prasad K. Clinical Audit for the Practicing Urologist. South Zone Urological Society of India Annual Conference. Ker- ala, India. 6–8 August 2010. 5. Al-Wahaibi K. Replacement of the Infra-hepatic Inferior Vena Cave for Leiomyosarcoma: A case report and literature review. 8th International Symposium on Vascular Update. Riyadh, Saudi Arabia. 10–11 January 2010. 6. Al-Wahaibi K. Transplant Renal Artery False Aneurysm: A case report and literature review. 8th International Sym- posium on Vascular Surgery Update. Riyadh, Saudi Arabia. 10–11 January 2010. 7. Al-Maskari S. Immediate FWB Ambulation in Patients with Multiple Limb Fractures. 15th Pan Arab Orthopaedic As- sociation Congress. Marrakech, Morocco, 19–22 May 2010. 8. Al-Maskari S. Distraction Arthrodiatasis of the Hip Joint in Patients with Sickle Cell Disease. 15th Pan Arab Orthopae- dic Association Congress. Marrakech, Morocco. 19–22 May 2010. National 1. Al-Wahaibi K. The Vascular Access in Diabetic Nephropathy Patient-Special Consideration. 4th National Nephrology Conference. Sohar Hospital, Sohar, Oman, 13 May 2010. departments 2. Al-Wahaibi K. Vascular Therapy: Three legged approach; Medical, Surgical and Endoluminal. 2nd National Diabetic Foot Conference. Muscat, Oman. 16–18 April 2010.

nd care 3. Al-Wahaibi K. Abdominal Vascular Injuries. 2 National Diabetic Foot Conference. Muscat, Oman, 16–18 April 2010. 4. Al-Wahaibi K. Quality Assessment in Surgery: Do we need it? 2nd International Conference of Quality Management in Health Care. Sultan Qaboos University, Muscat, Oman, 1–3 February 2010.

th patient 5. Al-Maskari S. Angular Deformity of the Lower Limb: Role of Growth Guidance and Gradual Correction. 17 Interna- tional Child Health Conference: Chronic Childhood Illness, Towards Better Care. Sultan Qaboos University, Muscat, and

Oman, 13–15 October 2009. academic S ugery

231 Annual Report 2009-2010 Surgery

POSTER PRESENTATIONS National 1. Al-Shehi R, Baloch M, Al-Harthy A, Al-Qadhi H. Recurrent Right Iliac Fossa Pain After Appendicectomy: Stump Ap- pendicitis, Case Report. University Day. Sultan Qaboos University, Muscat, Oman. May 2010. 2. Al-Hinai R, Baloch M, Al-Harthy A, Al-Wahaibi K, Al-Qadhi H. Self Inflicted Abdominal Stab During Pregnancy: Case Report. University Day. Sultan Qaboos University, Muscat, Oman. May 2010. SEMINAR PRESENTATIONS National 1. Mathew J. Current Concepts in the Medical Management of Lower Urinary Tract Symptoms. Muscat, Oman, 10 March 2010. 2. Bhargava D. Introduction to Clinical Research and Health Informatics. 6th Regional Workshop on Evidence Based Medicine. OMSB, WHO and Centre for Evidence Based Medicine, Oxford. Muscat, Oman, 9–13 January 2010. 3. Bhargava D. Evidence Based Medicine. 1st Regional Workshop. Nizwa University, Oman. 28–29 April 2010. 4. Bhargava D. Evidence at Point of Care. CME Oman Medical Association. Muscat, Oman 31 March 2010.

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233 Annual Report 2009-2010 Medical Library

Overview The main thrust of our library policy has always been towards developing and evaluating library resources, as well as providing services more effectively. The major achievement in this respect was online searching to support the programmes of the College of Medicine & Health Sciences and University Hospital especially in research activities.

Staff Mohammed Al-Wardi, Director Mariam Al-Sinani, Librarian A Mohammed Al-Higgi, Chief Librarian C Huda Al-Farsi, Chief Librarian C Huda Al-Haddabi, Chief Librarian C Suad Al-Busaidi, Senior Librarian A Salim Al-Farei, Senior Librarian A Saif Al-Muharbi, Senior Librarian B Mohammed Al-Yahmadi, Senior Librarian B Abdulla Al-Hinai, Assistant Librarian Jassim Al-Hasani, Assistant Librarian Saif Al-Abri, Assistant Librarian Qassim Al-Harrasi, Senior Programmer B Support Staff Luthgarda Bongsalo, Clerk/Coordinator Said Al-Alawi, Clerk Ahmed Al-Ghafri, Graphic Camera Operator Highlights of the Year 2009–2010 CIRCULATION In this period, the total number of checked out materials was 8,976 as compared to 6,640 of last year. The number of registered library members was 220.

234 ACQUISITIONS In this period, 413 new book titles were added to the library collection. This number was made up of 160 titles of nursing books from the College of Nursing and 253 monographs received gratis from the Ministry of Health, Oman, World Health Organization and other sources.

Total cost for the subscriptions to journals was $331,757.04. The amount was made up of 94 print journals at $124,363.67 and 162 electronic journals at $207,393.37. A total of 39 journals from the Gulf Cooperation Council region were received gratis.

INTERLIBRARY LOANS The requests for journal articles not available in our collection totaled 149. A total of 25 articles at the cost of £383.75 were procured from the British Library Document Supply Centre, London and 124 articles from the different Gulf Biomedical Libraries were received gratis.

IT SERVICES 2,162 e-journals can be accessed through our website (http://www.squ.edu.om/med-Lib/index.htm) and Sci- ence Direct.

TRAINING OF LIBRARY USERS Eleven students from the Sultan Qaboos University College of Arts, Department of Library Science and In- formation, 108 from the College of Medicine & Health Sciences and 21 from CSSD, University Hospital were trained to use the Library.

A total of 177 external students were also trained to use the Library. There were 110 from Royal Oman Police, Ambulance Division, 40 from Institute of Health Sciences and 27 from Oman Specialized Nursing Institute. departments

support M edical L ibrary

235 Annual Report 2009-2010 Medical Education Unit

Overview The Medical Education Unit (MEU) was established in 2006 under the Dean’s Office with a mission to raise the standards of medical education in the College. The Unit has full-time staff, but draws mainly on the vol- untary participation of staff, from the different departments of the College and from the Ministry of Health, with either a formal qualification or a strong interest in the field of medical education

The Unit is very active in providing educational support to College, Hospital and affiliated staff and other health professionals through faculty development workshops in the areas of teaching and learning, assessment, and e-learning. The Unit has also established the IDEAL (International Databank for Enhancement of Assessment and Learning) office which houses the IDEAL secure assessment databank, liaises with the IDEAL Consortium Office, and offers the service of item analysis.

The recently restructured clinical skills laboratory is equipped with a variety of instruments, simulators and manikins to support the training of clinical skills. It is evolving into a learning environment that will support a wide range of skills across the spectrum of the curriculum and will facilitate the acquisition of theoretical and clinical knowledge. The facility will provide medical students with the opportunity to develop and maintain competence within the clinical skills area and allow them to practise safely physical assessment and procedural skills, and to demonstrate them 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 College requirements for medical informatics equipment and infrastructure; supports hardware maintenance, and provides a troubleshooting service.

Staff Head of Unit Nadia Al-Wardy, Assistant Professor, Dept. Biochemistry Members Zahra Al-Rawahi, Assistant Professor, Medical Informatics, MEU Ken Masters, Assistant Professor, Medical Informatics, MEU

236 Ibrahim Inuwa, Associate Professor, Dept. Anatomy, SQU Muna Al-Saadoon, Assistant Professor, Dept. Child Health, SQU Syed Rizvi, Assistant Professor, Dept. Family Medicine and Public Health, SQU Abdullah Al-Asmi, Senior Consultant, Dept. Medicine, SQU Samir Hussein, Senior Consultant, Dept. Radiology & Molecular Imaging, SQU Adil Al-Ajmi, Consultant, Dept. Surgery, SQU Khalil Al-Farsi, Consultant, Dept. Haematology, SQU Omar Al-Hussaini, Dept. Medicine, Royal Hospital, Ministry of Health, SQU Laila Al-Zadjali, Director, Training & Scholarships, Ministry of Health, SQU Kamila Al-Alawi, Director, Education & Training, Royal Hospital, Ministry of Health Support Staff 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 Almuqdad Al-Lawati, System Analyst Taha M. El-Sayed, Chief Technician, Clinical Skills Lab Ahmed Al-Hadhrami, Technician, Clinical Skills Lab Asila Al-Harthy, Coordinator Musab Masood, Coordinator Highlights of the Year 2009–2010 The year was very busy and productive with the restructuring of the Clinical Skills Laboratory. With this restructuring, a more efficient and purpose-made environment has been created that provides students with the opportunity to practice clinical skills on simulators, manikins, and simulated patients, thus providing a non-threatening environment in which practical skills can be perfected, prior to attempting these skills on a patient.

Two new staff members were recruited to the Unit, Dr. Ken Masters, Assistant Professor in Medical Infor- matics, and Mr. Taha El-Sayed, Chief Technician, for the Clinical Skills Laboratory. Their addition has already boosted the Unit and raised its profile.

Several new workshops were conducted by the Unit. These were attended by staff members from the Col- lege, SQU Hospital and Ministry of Health. departments

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237 Annual Report 2009-2010 Medical Education Unit

Teaching Programmes UNDERGRADUATE PRECLINICAL PROGRAMME The Medical Informatics section of the MEU was involved in teaching the following core and elective courses to undergraduate medical and nursing students:

- Medical Informatics I and II

- Creative Thinking

- Health Informatics

TRAINING COURSES & CME ACTIVITIES Workshops Several educational workshops conducted by internationally renowned faculty and national staff in medical education were offered by the Unit. These were:

- Designing Online Courses, a two-hour workshop on 2 November 2009. - Creating Online Assessments, a two-hour workshop on 4 November 2009. - Configuration of mailing system using Microsoft Outlook and Outlook Express on 4 November 2009. - Instructional Designing Course for online courses, a two-hour seminar on 24 November 2009. - CHPE (Certificate Course in Health Professions Education) – a three-day course in February 2010 conducted by Professor Hamdy, University of Sharjah, UAE; Professor Banadaranayake, Sydney, Australia, and Professor Gibbs, Scotland, UK. A total of 45 College, Hospital, and affiliated staff and other health professionals participated in the course. - Student Assessment Workshop – A three-day workshop, also in February in 2010, conducted by Professor Banadaranayake, Sydney, Australia, and Professor Gibbs, Scotland, UK. A total of 29 College, Hospital, and affiliated staff participated. - Continuous Assessment of Clinical Skills and Professional Behaviour workshop – A one day workshop in February 2010, conducted by Professor Nigel Bax, University of Sheffield, UK. A total of 34 College and Hospital staff participated. - Designing Integrated Questions Workshop – A one day workshop in May 2010 was conducted by Professor Banadaranayake, Sydney, Australia. A total of 32 invited participants attended the work-

238 shop. - Small group training sessions were held on the “IDEAL PC version” software. The participants were academic staff of the College. Training areas included general introduction to using the “IDEAL software” and specifically, retrieval of the IDEAL database items that would be later used in the final examinations at the College of Medicine. - Moodle Workshops Level 1 – Three two-hour workshops were conducted in November 2009 and October 2010. These were mainly focused on staff but a large number of students also attended. - Moodle Workshops Level 2 – Two two-hour workshops were conducted in November 2009 and Febru- ary 2010. These were focused on advanced features of Moodle and a large number of staff attended. - Moodle Workshop – A full-day Moodle workshop was conducted in May 2010. Large number ofstudents and staff attended the workshop. - Updating Windows, Configuring Outlook and Adding SQU Mailbox to Personal Gmail account – A two-hour workshop was conducted in November 2009. Staff and students attended and participated in the lab activities. - How to Design a Poster using Powerpoint – A two-hour workshop was conducted in November 2009, aiming to equip the staff with poster designing techniques. A large number of staff and students -at tended. - Instructional Design for Online Courses – A two-hour workshop was conducted in November 2009 and focused on methodologies on how to make the online courses easy to understand and enjoyable. Many staff attended the workshop. - Using Aspects of Medical Informatics to Assist Research – A full-day workshop conducted in March 2010 by Dr. Ken Masters was a great success. It involved Systematic Literature Reviews, Data Encryption and Measuring Levels of English. A large number of staff attended the workshop. TELEMEDICINE COURSES Audio/visual live broadcasting from operating theatres to the Annex Building through a plasma screen:

- First International Sialendoscopy Symposium - Basic Surgical Skills Course

- Bariatric Surgery Program departments

- Navigation Panel Unit Demonstration (NPU) support M edical E ducation U nit

239 Annual Report 2009-2010 Medical Education Unit

- Ultrasound in Critical Care Workshop - Cardiothoracic Surgery Workshop: Mitral Valve Repair - Instructional Course on Colbation - Hysteroscopy Workshop VIDEOCONFERENCING - First International conference on Indian Ocean Tropical Cyclones & Climate Change (expert meeting) - Global Hospitals Health City - The Cross-Gulf Pediatrics Respiratory Round Research RESEARCH PROJECTS Internet-based sharing of institutions’ library database access codes on a medical web-site: the institutions Project Code: MREC# 349; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Ken Masters, Medical Education Unit, SQU

The Use of M-Learning Technology by 6th year Medical Students in a Minimally-Supported Environment Project Code: MREC# 365; Dates: 2010 Value: Unfunded; Project Approval: Sultan Qaboos University Investigators: Dr. Ken Masters, Medical Education Unit, SQU; Dr. Zahra Al-Rawahi, Medical Informatics Group, SQU. RESEARCH PUBLICATIONS & BOOKS Journal Publications 1. Al Wardy NM, Rizvi SG, Bayoumi RA. Is performance in pre-clinical assessment a good predictor of the final Doctor of Medicine grade? Saudi Med J 2009; 30:1590–4. 2. Hamdy H, Telmesani, Al Wardy N, Khalek N, Carruthers, Fuad, Kassab S, Abuhijleh M, Alroomi K, Galal, Gitaar, Sheikh J. Undergraduate Medical Education in the Gulf Cooperation Council (GCC) – a multi-countries study (Part I). Medical Teacher 2010; 32:219–24.

240 3. Hamdy H, Telmesani, Al Wardy N, Khalek N, Carruthers, Fuad, Kassab S, Abuhijleh M, Alroomi K, Galal, Gitaar, and Sheikh J. Undergraduate Medical Education in the Gulf Cooperation Council (GCC) – a multi-countries study (Part II). Medical Teacher 2010; 32:290–5. 4. Theodorsson T, Shafie K, Al Wardy N, Anwar K, Al Shafaee M, Al Mahrezi A. Assessment of Family Doctors in Oman; getting the questions right Preliminary findings of a performance analysis of multiple choice questions. Internet J Med Ed 2010; 1:1. From: http://www.ispub.com/journal/the_internet_journal_of_medical_education/volume_1_ number_1_74/article_printable/assessment-of-family-doctors-in-oman-getting-the-questions-right-preliminary- findings-of-a-performance-analysis-of-multiple-choice-questions-2.html 5. Al Wardy NM. Assessment Methods in Undergraduate Medical Education. SQU Med J 2010; 10:203–9 6. Al Wardy NM. Letter to Editor, Re: Evaluation Tools in Postgraduate Medical Education–Do we need “Made in Oman” tools? SQU Med J 2010; 10:280–1. 7. Masters K. I found it on the Internet: Preparing for the e-patient in Oman. SQU Med J 2010; 10:169–79. CONFERENCE & SEMINAR PRESENTATIONS Poster Presentations International 1. Al Wardy N, Al-Hussaini O, Al-Zidjali L, Hussein S, Al-Asmi A, Rizvi S, Al-Rawahi Z. Evaluation of Teacher-Training Workshops in the College of Medicine & Health Sciences, Sultan Qaboos University, AMEE (International Associa- tion for Medical Education) Conference. Malaga, Spain, August 2009. Seminar Presentations National 1. Al Wardy NM. Item Analysis. College of Nursing, Sultan Qaboos University, February 2009 2. Al Wardy NM. Principles of Assessment. College of Agriculture, Sultan Qaboos University, April 2009 3. Al Wardy NM. Assessment. Al Nahdha Hospital, Ministry of Health, Oman, April 2010 4. MEU Team. Workshop on Assessment. Oman Medical College, Sohar Campus, Oman, May 2009 departments

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241 Annual Report 2009-2010 Sultan Qaboos University Medical Journal

Overview The Journal was officially launched in 1997 with 7 issues published up to 2005. The Journal was relaunched in 2006 and renamed Sultan Qaboos University Medical Journal, SQUMJ. Up to December 2010 a total of 14 issues with 266 articles had been published and the Editorial Board had grown from 15 to 32 members, all of them staff of either the College of Medicine & Health Sciences or Sultan Qaboos University Hospital

The vision of the SQUMJ is 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 as follows:

- To promote a culture of scientific publications in the medical and related disciplines at SQU. - To provide a medium for dissemination of research results and reviews of important clinical and basic science topics. - To attract a wide variety of peer reviewed articles including original research and review articles, editorials, case reports, interesting medical images, special contributions, continuing medical education articles, brief communica- tions, book reviews and abstracts. - To attract quality scientific contributions from SQU staff, the region and the wider international community. - To build capacity in all aspects of scientific publishing at SQU. - To enhance the research profile of SQU. - To be Indexed with the US National Library of Medicine and with the Community of Science (COS); thus it will ap- pear in PubMed and Medline online databases of health related citations and abstracts. - To be published both on line as well as in print and ultimately be fully electronic in dealings with authors and re- viewers - online submission and review via our existing Website. Members of the Editorial Board Editor-in-Chief Lamk Al-Lamki, Professor Radiology & Molecular Imaging Editor Samir Al-Adawi, Associate Professor Behavioural Medicine & Editor Associate Editors Rashid Al-Abri, Consultant, Surgery

242 Badreldin Ali, Professor, Pharmacology Abdullah Al-Asmi, Senior Consultant, Medicine (Neurology) Sulayma Al-Barwani, Associate Professor, Physiology Riad Bayoumi, Professor, Biochemistry Ikram Burney, Senior Consultant, Medicine Shyam Ganguly, Associate Professor, Epidemiology & Statistics Vaidyanathan Gowri, Assistant Professor, Obstetrics & Gynaecology Omar Habbal, Associate Professor, Human & Clinical Anatomy Ali Al-Hinai, Assistant Professor, Medicine (Cardiology) Ali Al-Jabri, Associate Professor, Microbiology & Immunology Rajeev Jain, Radiology & Molecular Imaging Nadia Al-Kharousi, Consultant, Ophthalmology Salam Al-Kindy, Assistant Professor, Haematology Neela Al-Lamki, Professor, Radiology & Molecular Imaging Zakia Al-Lamki, Associate Professor, Child Health Norman Machado, Consultant, Surgery Prakash Mandhan, Senior Consultant, Surgery (Paediatric) Allal Ouhtit, Associate Professor, Genetics Omar Al-Rawas, Professor, Medicine (Respirology) Muna Al-Sadoon, Assistant Professor, Child Health Jumana Saleh, Associate Professor, Biochemistry Sukhpal Sawhney, Senior Consultant, Radiology & Molecular Imaging Marwan Al-Sharbati, Associate Professor, Behavioural Medicine Ashok Sharma, Senior Consultant, Surgery (Cardiac) Thord Theodorson, Senior Consultant, Family Medicine & Public Health Yasser Wali, Associate Professor, Child Health Nicholas Woodhouse, Professor, Medicine (Endocrinology) Meriel Carboni, Managing Editor Amar Hussein, Technical Editor Rosamund Pollock, Assistant Editor Sheherajoy Biruar, Editorial Assistant Highlights of the Year 2010 In 2010, 138 articles were submitted to SQUMJ, a 35% increase compared to 2009. The rejection rate increased-

to 43% from 35% in 2009. Three issues of SQUMJ were published with a total of 81 articles. Over 340 experts, departments

65% of them from outside Oman, reviewed manuscripts for SQUMJ. SQUMJ was indexed in the WHO’s Index support S ultan Q aboos U niversity M edical Journal

243 Annual Report 2009-2010 Sultan Qaboos University Medical Journal

Medicus for the EMRO region and awaited news of indexing applications with MedLine and Scopus. The Journal was accepted for archiving by PubMed Central which means that it will be listed in PubMed. For this purpose, all 3 issues of 2010 were converted to XML format.

SQUMJ had a print run of 2,500 copies in order to reach local, regional and international medical and other scientific audiences. It was distributed free of charge to all staff of the College and SQUH and senior staff in the University. It was also distributed in multiple copies to the Ministry of Health, and all hospitals and medical training establishments in Oman. In addition, it was 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 and Australia.

Numbers and Sources of Articles

Source of Papers Received 2008 % 2009 % 2010 % SQU – College & Hospital 45 46 50 50 56 41 Ministry of Health & Hospitals in Oman 18 18 9 9 24 17 Gulf & Middle East 24 25 29 28 33 24 Other countries 11 11 13 13 25 18 Totals 98 100 101 100 138 100

244

Overview The Directorate of Development and Quality (DDQ) of Sultan Qaboos University Hospital (SQUH) has taken the responsibility of improving quality assurance in the Hospital through establishing an efficient Qual- ity Management System (QMS). Continually working towards improving SQUH quality 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.

The DDQ is committed to providing SQUH with support in structuring and maintaining quality standards in all clinical, educational and support services. It is also is committed to enabling the provision of compassionate, ethical, and accessible general and specialised tertiary care to the community with integrity, commitment and respect towards patients and their families. The DDQ’s work is highly productive and it is staffed by experienced and skilled team members who facilitate all departments of the hospital.

The DDQ achieves the above though the main departments of quality assurance, development, patient safety and documentation and studies. It provides support and encouragement to hospital-wide quality activities through teamwork and best practice and by coordinating the ongoing hospital-wide education on quality, as well as conducting similar activities in other organisations. Furthermore, it seeks to promote excellence through continual improvement in teaching, research, patient services and staff development. This is supported by effective process delivery and efficient resource utilisation throughout the hospital. The DDQ works on enabling the following outcomes:

• Identification and mitigation of the risks and hazards in the organisation. • Identification of objectives and focus on the needs and expectations of patients and other customers. departments

• Monitoring of health care service outcomes. support H ospital D irectorate of evelopment & Q uality

245 Annual Report 2009-2010 Hospital Directorate of Development & Quality

• Monitoring of hospital activities and coordination of the implementation of corrective and preventive actions. • Provision of a common framework for eﬀective internal communication though controlled documents such as effective policies, protocols and procedures. • Provision of evidence of capability to customers and potential customers. • Provision and practise of internationally recognised standards of care. • Assistance in establishing a baseline for improving performance and outcomes. • Provision of a basis for certification and accreditation conformance and ensuring applicability to Omani laws/legis- lation and regulations. Staff Rashid Al-Abri, Director Yasmeen Al-Hatmi, Deputy Director Hamdan Al-Siyabi, Lead Auditor Sultan Al-Marhoobi, Document Controller Sumaiyya Al-Busaidi, Risk Prevention Facilitator Fatma Al-Sharji, Clerk Jamal Al-Busaidi, Senior Technician Carolina Vacalares, Coordinator Activities in 2010 Hospital Improvement Achievements

- New electronic Hospital Quality Document Control System - Weekly Quality Rounds conducted to assess and monitor current situations relative to concerns raised or pending issues. - Weekly Knowledge Forum conducted every Monday throughout the year, organised by DDQ staff members - Organisation of the 2nd International Conference for Quality Management in Health Care – 1–3 Febrary 2010. Two members of staff presented talks on patient safety culture, patient safety education and indicators and posters rep- resenting quality improvements and achievements. - The Quality Open Day took place 10 November 2010 for all departments to display and share their initiatives and best practice. This year SQUH collaborated with the Chartered Quality Institute, in coordination with World Quality Day, celebrated internationally. - Internal Audits were conducted in April and October 2010 with closures being performed on a continuing basis, in a consistent manner.

246 - The 11th and 12th Management Reviews took place in January and June 2010 illustrating all hospital activities and achievements at a 6-month interval. - The external British Standards Institution (BSI) performed the ISO audit in June 2010, which the hospital passed with one minor non-conformity, followed by immediate and satisfactory corrective action achieved within 4 weeks. - In June 2010, the BSI report was distributed to all heads of departments for action plan participation with short/long term plans put in place - A benchmarking visit to an accredited hospital in Lebanon in July 2009 included visiting different care departments, looking at the level of care and examining their quality improvement activities such as Key Performance Indicators (KPIs), based on Joint Commission International (JCI) standards and discussing the benefits gained from JCI. - Creation of Task Force Committee in September 2009 to investigate near miss incidents - Risk Assessment conducted November 2009 - Patient Health Education management introduced and coordinated with newly established “Health Education Committee”, including committee membership representation from the DDQ. - A Patient Satisfaction Survey was conducted in November 2009, analysed and then presented in the Management Review. - Evaluation of Best Department was conducted in collaboration with the newly formed “Excellence Performance Award Committee” to assist departments with preparation and scoring of mandatory requirements. - Direct involvement in many departmental quality initiatives and activities - Direct involvement with audit report closures utilising corrective and preventative actions and best practices. SQUH INTERNAL TRAINING - New Staff Orientation Training on Quality conducted monthly by member of staff through the Training Directorate. - Various quality awareness lectures given regularly through the Knowledge Forum - Root Cause Analysis Workshop training was conducted to improve the feedback and follow-up of the Hospital Inci- dence Reporting System. - Quality in Healthcare Workshop conducted in-house through the Training Directorate on 12–14 June 2010 - Risk Management Workshop conducted in-house through the Training Directorate on 27–29 November 2010 EXTERNAL TRAINING The majority of the external training and workshops conducted by DDQ staff was directed to the Ministry of Health hospitals throughout Oman. The areas of training provided included Quality Audit, Documenta- tion, Risk Management and Assessment, Healthcare Standards and Patient Safety. The Royal Diwan Medical departments (2009) and Armed Forces Medical Services (2010) were given a one-day workshops on quality improvement. support H ospital D irectorate of evelopment & Q uality

247 Annual Report 2009-2010 Hospital Directorate of Development & Quality

TRAINEES Trainees who joined the Directorate in 2009–2010 included Administrative Nurses from the Oman Special- ized Nursing Institute, and various Ministry of Health staff, mainly from Quality departments.

INTERNATIONAL CONFERENCE PARTICIPATION - DDQ worked in the Organising Committee of the 2nd International Conference of Quality Management in Health- care at SQU, 1–3 February 2010. - One staff participated as an international speaker in the 2nd Quality Congress in August 2010 in Canada and delivered a talk on “Safety as a Priority in a Healthcare Institution”. PUBLICATIONS 1. Hospital Quality Newsletter, “An Open Door to Quality’, was published in November 2010. This issue offered articles on topics such as Learning Organizations & Healthcare, Quality in Islam, Panoramic Look at Patient Safety, Six Sigma, Total Quality Management, Health & Safety Awareness and Prevention, Tips on JCI Safety Goals, and Team Spirit. It also included a section for all departments to share their experiences, improvements and best practices to bring the Hospital closer to excellence 2. Al Hatmi YS. Quality audit experience for excellence in healthcare. Clin Govern Int J UK 2010; 15: 2. 3. Al-Abri R, Al Hatmi YS. Abstracts of Quality Management in Healthcare Conference. Oman Med J 2010.

248 Overview The Directorate of Hospital Information Systems (HIS) serves to help the SQUH’s mission of providing the highest degree of health care to the patients by continuing to provide comprehensive state-of-the-art information technology (IT) services in Health Care Systems.

Services offered by the HIS include:

• Planning information system software needs and related budgetary requirements. • Project management for large-scale computer system implementations. • Evaluation of enterprise and departmental software solutions. • 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. The Hospital Information Systems staff work closely with the SQUH’s user community to provide comprehensive 24/7 support for the Hospital’s mission-critical Health Care Computer Applications.

Staff Yaqoob Juma Al-Raisi, Director Ahmed Al-Shaibani, Acting Deputy Director, Development Division Bader Al-Kiyumi, Acting Deputy Director, Support Division Said Al-Harassi, Acting Head, Networking Jokha Al-Kalbani, Acting Head, Lab Systems Nasser Al-Mandhari, Acting Head, Medical Systems departments

Mustafa Al-Hadhrami, Acting Head, User Support Section Akinyemi A. Koyi, Acting Head, Admin & Finance Systems Section support H ospital D irectorate of I nformation S ystems

249 Annual Report 2009-2010 Hospital Directorate of Information Systems

Naeem Al-Shukaili, Head of Operations Abdullah Al-Mahrooqi, Senior Network Administrator Vishnu Mampatta, Chief Systems Analyst Mohammed K. Shaikh, Senior Network Engineer Mohsin Al-Zadjali, Senior Systems Analyst Abdullah Al-Rashdi, Senior Programmer Nasser Al-Azwani, Systems Security Specialist Widad Al-Mamary, Programmer Suad Al-Bimani, Programmer Ghalib Al-Mahrooqi, Technician Moosa Al-Rawahi, Technician Fatima Al-Masoudi, Technician Younis Al-Harthi, Technician Yahya Al-Salmi, Technician Fahad Al-Shukaily, Technician Ibraheem Al-Balushi, Technician Younis Al-Mandhari, Technician Ahmed Al-Hoqani, Technician Ahmed Al-Kiyumi, Technician Al Marwah Al-Kharoosi, Technician Hamed Al-Muslhi, Technician Moosa Al-Khanbshi, Technician Ahmed Al-Yamani, Programmer Dorothy Paul, Coordinator Yaqoub S. Al-Harthy, Medical Orderly Highlights of the Year 2010 - Implementation of New Blade Servers for HIS Applications and Network infrastructures - Implementation of TRAKCARE Applications upgrade. - Implementation of new active Network equipment (switches and routers). - Upgrade of the HIS Data Centre. - Replacing Purchase and Store Module in Trust System with a new in-house developed software [Edges]. - Expansion of office facilities for HIS Staff. - Reconfiguration of the Application to stabilise the HIS System.

250 - Wireless Expansion. - Improving the quality of services provided by the HIS Directorate. - Evaluation of the Integration between SQUH and Ministry of Health (Referring System). - Developing Incident Reporting System, Version 3.0. - Installing 250 PCs, 50 Laptops and other peripherals in various departments in the Hospital. - More than 3,000 calls have been attended to by HIS Operation and Development Divisions during 2010. - Implementation of the new WI-FI (802.11n standard) high speed wireless in SQUH. - Training of TRAKCARE System for doctors, interns, nurses, laboratory staff and clerks. - Conducting summer training programs for college students. STUDIES CONDUCTED - Queuing System - Radio Frequency Identification - Information security at SQUH - Passive Network audit - Medical System Reengineering - Medical System upgrade - Inventory/Asset Management/Biomedical/Maintenance/Housing/Budget modules required at SQUH - Active network in SQUH - Security requirements for SQUH - Upgrade Independent Distribution Frame room from 110 to RJ 45 patch panel - Patient Services Interactive Voice Response departments

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251 Annual Report 2009-2010 Hospital Directorate of Medical SupplySupplpy

Overview Medical Supply Directorate (MSD) is one of the key departments in the hospital as it has responsibility to keep the hospital continuously supplied with commodities for health care uses. The Directorate carries out the procurement of health commodities such us pharmaceutics, medical, surgical and laboratory items.

The MSD is looking forward to improve its performance and achieve its aim. Despite the difficulties faced by MSD to ensure the availability of items, all staff in each section of MSD does their best to cut costs; procure cost effective items; deliver items on time; improve the logistics system, and to be a competitive department with a modern supply system.

Sections of MSD There are seven main sections in the Medical Supply Directorate:

1. Pharmacy Section.

2. Medical Surgical Section.

3. Laboratory Section.

4. Stationary Section.

5. Biomedical & Hospital Maintenance Section.

6. Stock Control Section.

7. Linen Section

Activities Medical Supply Directorate is the key department in the logistics cycle of the hospital. The figure below shows the important activities that are processed by MSD in coordination with other key department like the Purchasing and Finance department.

252 Stock Item Non-Availability Comparison Chart 2008-2010 70

No. of Items 30

0 2008 2009 2010

PRODUCT SELECTION The MSD coordinates with committees in the hospital to select the right product that meet the needs of the hospital. Quality, effectiveness and affordability are the most important selection criteria considered by the MSD staff and committee members.

FORECASTING AND PROCUREMENT After the selection of items, the list of selected items is created and the required quantities are estimated (forecasted) taking in to consideration number of patient who will be benefiting from the item. Thereafter the consumption rate and the movement is used to forecast the future quantities to be ordered to ensure adequate stock levels and buffer stocks.

Once the supplier has been identified the MSD, the procurement department then issues tenders for the selected items and the quantities needed. It also ensures the timely delivery of shipments, the clearance of items from customs, and the final quality control check which is done following Ministry of Health (MOH) regulations.

STOCK CONTROL Once the item arrives in MSD the stock control activity takes place. This includes the checking of the delivered items and tallying then with the specifications mentioned in the purchase order. Then the storage

process starts making sure that each item is stored in an appropriate climate. Distribution to various levels departments departments throughout the hospital sections then begins at the request of the department concerned. support support H ospital D irectorate of M edical S upply H ospital D irectorate of M edical S upply departments

253 support H ospital I nformation S ystem Annual Report 2009-2010 Hospital Directorate of Patient Services

Overview The Patient Services Department’s role is to provide a 24 hrs, compassionate, accessible and high quality service to SQUH clients and visitors. The Department also works to resolve any misunderstandings that might arise between staff and clients so that the hospital runs with minimal interruptions. Directorate staff liaises 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 Hospital Security guards. • Providing health education. • Receiving complaints and suggestions and following them up with the departments concerned. • Providing Psychology counseling for patients. In the unfortunate event of a patient dying, the Directorate has the following responsibilities: • Informing the relatives. • Making sure that all documents such as death notification and dead body release forms are properly done. • Helping the relatives to find appropriate transportation to transfer the dead patient. • If the deceased patient is a non-Omani, the Directorate guides the relatives through the required procedure to transfer the body abroad.

254 Staff All staff members are Omanis.

Ahmed Al-Khayari, Director Ahmed Al-Barwani, Deputy Director Younis Al-Farsi, Secretary Khalsa Al-Salmi, Translator Ghosen Al-Ghaafri, Counseling Psychologist Fakhria Al-Amri, Health Education Specialist 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, Clerks Ibrahim Al-Ghafri, Clerks Yousif Al-Habsi, Receptionist Khalid Al-Moaini, Receptionist Sultan Al-Sadi, Receptionist Juma Al-Muharbi, Receptionist Salim Al-Mamari, Receptionist Activities in 2010 • In cooperation with doctors, approximately 2,575 medical reports were issued. • Approximately 5,000 visiting passes were issued and 2,372 attendants’ passes given. • Our visitors pass unit was transferred to the main reception area at the new main entrance of the Hospital. • 175 materials were translated within the Directorate, including medical reports and leaflets. Also, 7 students were trained in the translation section. • 48 lectures for inpatients were conducted on various topics attended by 450 patients, besides 62 private visits for patients. • 30 SQU & other colleges’ students were trained within the Directorate. • Meetings were conducted with inpatients and attendants. departments

• More security guards were added to the A&E and outpatient departments. support H ospital D irectorate of P atient S ervices

255 Annual Report 2009-2010 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 Re- lations & Information Directorate, therefore, works relentlessly on building and maintaining the positive image that Sultan Qaboos University Hospital (SQUH) deserves. The Directorate also provides top quality services to SQUH staff through its contacts with different governmental and private agencies. 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, and to work continuously on producing an excellent, realistic image of SQUH.

Staff Sultan H. Al-Abri, Director Khamis S. Al-Farsi, Head of Department Yahya E.K. Al-Hasani, Head of Deparment Salim M. Al-Hinai, Acting Head of Department Mohameed A. Al-Zidi, Clerk Talib A. Al-Abri, Clerk Abdullah J. Al-Owaisi, Clerk Maryam M. Al-Qureshi, Clerk Mohammed A.Al-Salmi, Clerk Ahmed S. Al-Hinai, Clerk Saif M. Al-Ghaithi, Clerk Yahya N. Al-Aamri, Clerk Hashim A. Al-Balushi, Yonis A. Al-Habsi, Clerk Ali K. Al-Hatmi, Clerk Activities in 2010 The Public Relations & Information Directorate serves the hospital through its four different departments.

256 256 JOURNALISM & INFORMATION DEPARTMENT AND PRINTING & PUBLISHING DEPARTMENT

Activities Number of Activities during 2010 Covering all SQUH events in national media 51 Designing event invitation cards 8 Designing certificates of appreciation 17 Designing patient educational materials (leaflets, posters) 9 Announcement of vacancies, tenders and training programmes 22 Providing banners for hospital events 24 Coordinating with media agencies regarding interviews with hospital staff (doc- 43 tors) Designing annual calendar 1 Producing educational and awareness films 2 Designing pop-up materials 486

CULTURAL & SOCIAL ACTIVITIES DEPARTMENT

Series Activities Number of Activities during 2010 A Supporting all SQUH departments in organising conferences, sympo- 57 sia and workshops B Arranging all the needs for training programmes in coordination with 301 Training Directorate C Organising the graduation ceremony (SQU) 1 D Organising the SQUH Annual Exhibition Day 1 E Patient visits and gift distribution 33 departments

F Fun activities for children 13 support H ospital D irectorate of P ublic R elations & I nformation

257 Annual Report 2009-2010 Hospital Directorate of Public Relations & Information

G Official visits 27 H Picnic for staff 1 I Opening ceremony (new department) 0 J Others 19

EMPLOYEE SERVICES DEPARTMENT Activities Number of Activities during 2010 Police station visits 2 Court visits 0 Receiving employees from airport 375 Farewells 75 Visas issued 1350 Visas deposited 223 ID cards issued 3250 Road passes issued 275 Others 198

TRAINING & SCHOLARSHIPS Mr. Khamis Al-Farsi attended short training courses in the year 2010 in Malaysia; Mr. Yahya Al-Hasani, Head of Depatment, is completing a Bachelor’s Degree in Business Administration in 2011, and Mr Abdullah Al- Owaisi has completed a Bachelor’s Degree in Business Administration.

258 Overview 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 the new hospital development.

Technical Affairs Directorate has five departments: Projects; Bio-Medical Engineering; Hospital Engineering and Maintenance; Health, Safety and Fire Prevention, and Laundry and Cleaning.

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, compiles briefs of requirements and preliminary sketches in consultation with user departments. It also compiles tender documents for consultancy services for design and supervision for 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 recom- mendations. Finally, it carries out contract administration works with supervision of sites and monitoring the progress of projects to ensure quality work is produced within the time schedules.

HEALTH, SAFETY AND FIRE PREVENTION DEPARTMENT

This Department, in coordination with the Health and Safety Committee, formulates health, safety and fire echnical A ffairs 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 MRI machines, CT Scanners, X-Ray machines, Vital Sign Monitoring and all diagnostic and life saving equipment.

HOSPITAL MAINTENANCE DEPARTMENT This Department is responsible for all Hospital buildings and all equipment except bio-medical equipment. The department is sub-divided into three sections: departments

support H ospital D irectorate of T

259 Annual Report 2009-2010 Hospital Directorate of Technical Affairs

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 con- trols; uninterruptible power supplies; nurse call systems; intercom systems; public address systems; road barriers and the audio-visual distribution system.

CIVIL SECTION Responsible for buildings maintenance; soft landscaping maintenance; keys; sign posting; minor modifications and upgrading; renovation of all facilities and the infrastructure system.

LAUNDRY & CLEANING DEPARTMENT This Department is responsible for cleaning services of the buildings and washing of linen of the Hospital wards and clinical staff uniforms.

Staff Juma S. Al-Jabri, Director Muhammed Mustafa, Coordinator PROJECTS Mohan R. Kailas, Senior Civil Engineer Subhash Sule, Mechanical Engineer Arun K. Singh, Electrical Engineer Benjamin George, Mechanical Engineer Muthuraj, Civil Engineer Mabruka Al-Siyabi, Senior Civil Engineer Mohammed Kunhi, Draughtsman

260 HEALTH, SAFETY & FIRE PREVENTION Vaseem A.M. Mirza, Health & Safety Officer Ahmed Al-Mahruqui, Fire Officer Nasser Al-Manai, Fireman BIOMEDICAL ENGINEERING Abdullah M. Al-Hashmi, Head, Biomedical Engineering Khalid M. Al-Mahrizi, Senior Engineer Shuwaina N. Al-Harrasi, Clerk Zuwaina A. Al-Tooqi, Coordinator Edgar K. Sanz, Senior Engineer Dominador De Guzman, Senior Engineer Santiago O. Buniag, Engineer Khamis H. Al-Lamki, Engineer Ravindra Inamdar, Senior Engineer Madhan G, Engineer Amur Al-Sindi, Engineer Hamid M. Al-Mayahi, Engineer Ghassan S. Al-Ghassani, Engineer 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 echnical A ffairs 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-Belushi, Civil Engineer Ahmed Al-Busaidi, Maintenance Technician Adel Al-Ghafri, Technician departments

Fahad, Technician Murad Al-Saadi, Clerk support H ospital D irectorate of T

261 Annual Report 2009-2010 Hospital Directorate of Technical Affairs

Maniha Q. Al-Shanfari, Clerk

LAUNDRY & CLEANING Sulaiman Al-Farei, Head – Laundry & Housekeeping Ayub Al-Hadhabi, Housekeeping Supervisor Sateesh T.N., Housekeeping Supervisor Nasser Al-Shargi, Store In-charge Mohsin Al-Zadjali, Laundry Supervisor Maryam, Tailor Activities in 2010 EQUIPMENT During this period, we acquired many new items of equipments to improve patient care and to support research. Some of the major equipment items are:

Biomedical Equipment for 2010

Sl.No Name of Equipment item Value (OR) 1. Video camera 12,088.700 2. Digital camera (still picture & video) 3. High Frequency Ventilator 13,975.000 4. Ventilator Neonatal 27,750.000 5. Transport Ventilator 21,162.000 6. Non Invasive Ventilator (Adult) 98,945.000 7. Non Invasive Ventilator (Paediatric) 89,950.000 8. Ventilator Adult (Anaesthesia) 160,044.000 9. Colonifiberscope 26,870.000 10. Gastronintestinal Videoscope 36,260.000 11. Video Processor for Endoscope System 19,818.000

262 12. Infusion Stand 31,338.350 13. Retcam 120 (retinal camera) 78,700.000 14. Confocal Microscope (Confoscan 2) 49,700.000 15. CRRT Machine (Multifiltrate Fresenius) 39,315.300 16. Phototherapy Light 11,520.000 17. Echocardiography System 76,020.000 18. Monitor Bedside 93,770.000 19. Ultrasonic Surgical Aspirator 96,971.250 20. Neuro-endoscope A Complete System 61,979.000 21. Vital Signs Monitor Portable 92,580.000 22. Bedside Monitor for Paediatric ICU 60,510.000 23. Data Migration 14,750.000 24. Humidifier 11,025.000 Total OR 1,225,041.600

Maintenance Department Equipment 2010 Sl.No Name of Equipment item Value (OR) echnical A ffairs 1. Stainless steel worktop tables 4,710.000 2. Paging System (POCSAG) 14,750.000 3. Extract Ducts for Safety Cabinets in Block 9 7,994.000 4. A/C Split System Free Standing Down Flow for HIS 8,670.000 5. Air-conditioning under false ceiling 3 Ton 3,540.000 6. Supply, installation, commissioning of Ducted Split A/C- CCU 6,700.000 7. Laboratory Refrigerators – 158 Ltrs 2,000.000 8. Boiler Monitoring & Diagnostic System 68,770.000 departments 9. Patient Transfer Chairs 22,500.000 support H ospital D irectorate of T

263 Annual Report 2009-2010 Hospital Directorate of Technical Affairs

10. Deioniser - Output 5 to 6 Ltrs 5,750.000 11. Cooking Oven Gas - heavy duty 12,060.000 12. Operating Table 25,959.100 13. Medication Cart Trolley 9,940.000 14. Gas Leak Detector & Shutoff System 15,500.000 15. Decomat Disinfector 26,720.000 16. Medical Refrigerator 340 Ltrs 1,250.000 17. Microwave Ovens 1,167.000 18. Commode Chairs 6,480.000 19. Trolleys for Sterile Procedures & Multipurpose 16,695.600 20. Cytotoxic Dispensing Isolator 14,500.000 21. Blood Bank Refrigerator MBR 1404 GR 3,664.000 22. Sanyo Refrigerator MPR-721 R 2,574.000 23. New Extractor Fan 3,150.000 24. Sanyo Refrigerator – 340 Ltrs 2,235.750 Total OR 310,529.450

Building Modifications

S.No Description Value (OR) 1. Modification works for Doctor’s Offices in Wards & Delivery 8,900.000 2. Waterproofing for External Expansion Joints 13,803.255 Total OR 22,703.255

264 PROJECTS To meet the hospital expansion plans the following projects were under taken:

Projects under Design S.No. Description Value (OR) 1. Haematology and Bone Marrow Transplant Centre 189,648.000 2. Expansion of Operating Theatres (8 new) and expansion of 48,400.000 Radiology Department 3. Expansion of Accident & Emergency Department 15,786.000 4. Staff Accommodation Blocks 129,785.000 5. Extension to CCTV System 50,000.000 Sub-Total 433,619.000

Projects under Execution/Construction S.No. Description Value (OR) 1. Construction of Medical Stores Annexe Building 1,715,492.000 2. Public Address System 35,851.000 3. Door Access System for IDF Rooms 15,179.900

4. Additional Cooling Server Room 125,000.000 echnical A ffairs 6. Chillers Replacement/District Cooling System 4,100,000.000 7. Grading and Leveling the Areas on North East Sector 100,000.000 8. Racking & Mezzanine Floor in Medical Store 150,000.000 10. Modifications in Block 17 Building to create Genetics Clinic 80,000.000 11. Modifications in Block 17 to create Genetics Clinic – HVAC 80,000.000 Works 12. Biochemistry Lab – Renovation Works 1,700.000

13. Modifications to create High Dependency Bays in Wards 27,255.818 departments

Sub-Total 6,430,478.718 support H ospital D irectorate of T

265 Annual Report 2009-2010 Hospital Directorate of Technical Affairs

Projects Completed

S.No. Description Value (RO) 1. Modification in Anaesthesia Offices area to create Cardiothoracic 28,210.000 ICU

2. Shaded Car Parking behind Block 2 Building 60,720.000 3. Modifications in Operating Theatres (Delivery Suite) 8,800.000 4. Modifications in Old BME Workshop near operating theatres to cre- 3,000.000 ate relatives waiting areas (AWCA) 5. Modifications in HIS for extending the Server Room facilities 15,000.000 6. UPS Systems in HIS Server Room 22,000.000 7. Auto Change Over Switches 14,000.000 8. Generator for Block 9 Building 45,567.000 Sub-Total 197,297.000

Summary

S.No. Description Value (RO) 1. Project under Design 433,619.000 2. Project under Execution/Construction 6,430,478.718 3. Projects Completed 197,297.000 GRAND TOTAL 7,061,394.718

266 Expenditure

2008 2009 2010 Amount (OR) Amount (OR) Amount (OR) Projects 986,016.000 2,681,159.000 7,061,394.718 Engineering Equipment Replacement 253,318.000 158,500.000 365,294.450 Biomedical Equipments 726,747.000 425,431.898 1,225,041.600 Building Modifications 92,359.000 28,667.593 22,703.255 Maintenance of Plants and Equipment 788,423.000 649,118.439 729,249.437 Maintenance of Biomedical Equipment 250,977.000 25,988.000 462,302.031 Cleaning Services - - 461,497.805 Laundry Services - - 120,675.440 GRAND TOTALS 3,097,840 3,968,864.930 10,448,158.736

Energy Consumption

Year 2008 Year 2009 Year 2010 Amount (RO.) Amount (RO.) Amount (RO.) Electricity (kwh) 1,151,347.000 1,199,166.000 1,130,487.990 echnical A ffairs Water (ltrs.) 80,120.000 80,120.000 82,606,259 Gas (m3) 4,031.000 2,849.000 4,124.805 Totals 1,235,498.000 1,282,135.000 1,217,219.054 departments

support H ospital D irectorate of T

267 Annual Report 2009-2010 Hospital Directorate of Training & Continuing Professional Development

Overview The vision of the Directorate of Training & CPD (DTCPD) is to be a training centre of excellence in Oman as- suming a leadership role in continuing education, research and providing highest standard of programmes meeting the growing educational needs of Sultan Qaboos University Hospital staff. The mission of the Di- rectorate is to offer excellence in providing opportunities for training, professional development, continuing education, and in-house training for all Sultan Qaboos University Hospital staff, thereby promoting the delivery of highest quality patient/client care.

Staff Khalsa M. Al-Maawali, Actg. Director Kirsten Rude, Teaching Staff Barbara Hall, Teaching Staff Esther H. Bonam, Teaching Staff Khairom A. Rashid, Teaching Staff Salha Al-Alawi, HoD-Scholarships Samson Pakalapati, Admin staff Rashid Al-Hajri, Admin staff Ali Al-Owaisi, Admin staff Najla Al-Rashidi, Admin staff Hind Al-Ghailani, Admin staff Yahya Al-Rawahi, Messenger Activities in 2010 - Conducted courses and programmes as published in the bi-annual course schedules - Conducted a study “DTCPD customer satisfaction survey of knowledge utilization in a practice setting – SQUH 2008/2009” - Attachments: conducted an attachment programme and processed attachment requests from institutions/individuals - Conducted teaching and consultations as per requests

268 - Admission process for CSSD Technician course - Revised old policies, procedures and processes - Participated as a member of various SQUH committees - Revised and published course curricula - Revised and published course books - Developed/revised Department documentation to meet ISO 9001-2000 requirements - Prepared and submitted equipment budget - Departmental training needs assessed for all categories of courses from departments - Updated Departmental Training Committee members list - 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 prospective candidates for the Personnel Affairs Department - Scrutinised scholarship applications and forwarded to Hospital Training Committee (HTC) - Developed a proposal for reimbursing instructors coming from clinical areas of SQUH - Updated all forms used in DTCPD - Implemented new course – ACLS/PALS ECG Rhythm Identification Workshop - Departmental Fire Audit conducted - Implemented new course on Chemotherapy Administration - Developed & Revised Key Performance Indicator (KPI) plan to new format and submitted quarterly progress report raining & C ontinuing P rofessional D evelopment on KPI to Directorate of Development & Quality - Applied and obtained accreditation and credit points for scheduled and unscheduled in-house development programmes from Oman Medical Specialty Board (OMSB) - Amended database to document individual training credits of staff - Presented a Study Report of “DTCPD Customer Satisfaction Survey of Knowledge utilization in a practice setting- SQUH 2008/2009” at the 2nd International Conference of Quality Management in Healthcare - Presented a paper on “Quality Assurance in Training & Education” at National Staff Development Conference held at Khoula Hospital, Oman DEVELOPMENTS UNDERTAKEN

- Updated guidelines for smooth processing of training requests departments

- Developed action plan for Risk Management support H ospital D irectorate of T

269 Annual Report 2009-2010 Hospital Directorate of Training & Continuing Professional Development

- Updated colour-coded Bi-annual Course Programme Schedule indicating eligibility requirements - Scrutinised and revised Quality Manual, Policies, Procedures, Processes, Guidelines and Standards - Implemented IV Instructor Program - Changed the certificates/cards and other relevant forms/policies etc. incorporating the new name of the directorate “Directorate of Training & Continuing Professional Development (DTPCD) - Introduced 2010 AHA/ILCOR Guidelines to BLS, PALS, ACLS courses - Started DTCPD Newsletter DEVELOPMENT OF DTCPD STAFF - Emergency First Responder course

- “Quality management in Healthcare” – International Conference

- “Training of Trainer Workshop” – DGET

- “Sharing Best Practices in Staff Development” – National Staff Development Conference

- Knowledge Forum lectures, SQUH

- Scientific Update in Travel Medicine, RCPS (Glasgow)

OMANISATION Appointment of a new Omani clerical/coordinator staff

270 Overview The responsibilities of the Hospital Finance Department involve:

1. The preparation of Hospital annual budget for approval by the Ministry of Finance, monitoring the approved funds for effective utilisation, monitoring of the staff induction against staff budget approval; the maintenance of various statistics pertaining to staff, patients etc. 2. The processing of staff salary on monthly basis and ensuring timely payments; the processing of leave salaries; the timely settlement of terminal benefits of staff leaving the hospital permanently etc. 3. The processing of supplier’s and contractor’s bills for payments in coordination with supplies and stores departments 4. The maintaining of petty cash account. 5. The collection of revenue from paying patients, private hospitals, etc. 6. Liaising with Ministry of Finance and other government agencies 7. Finalising the item price list for paying patients and submitting it for approval of the Ministry of Finance Staff Nasser S.M. Al-Salmi, Director, Financial Affairs Ahmed S.A. Al-Farsi, Acting Deputy Director, Financial Affairs M.S.Subba Rao, Senior Technician/Statistician Adnan J. Al-Mosawi, Head, Treasury section Awadh S. Al-Bulushi, Accountant Suleiman S. Al-Abri, Head, Revenue Section Khamis M. Al-Muzaini, Head, Contracts Section Salim H.H. Al-Sinawi, Accountant Hamoud S. Al-Farsi, Accountant Hilal A. Al-Daghaishi, Head, Salary section Sulaiman D.O. Al-Bulushi, Accountant Salah S.S. Al-Nadabi, Head, Expenditure Section Zakiya S.A. Al-Husni, Accountant Zuweina A.M. Al-Habsi, Accountant

Suroor M.K. Al-Rubaiey, Accountant departments

Naeema J.R. Al-Saadi, Accountant support H ospital Finance

271 Annual Report 2009-2010 Hospital Finance Department

Azhar S.S. Al-Dhugaishi, Accountant Mohammed J.S. Al-Ramadhani, Accountant Hamad S.H. Al-Sabti, Accountant Khalfan S. Al-Farei, Accountant Ibtisam J.J. Al-Malki, Accountant Nadia S.S. Al-Ramadhani, Coordinator Sulaiman H.S. Al-Talei, Messenger Activities in 2010 1. During the year ending 2010, the number of staff to whom salaries were paid was 2,407. 2. The Hospital budget for the year 2010 was prepared and submitted on time to the Ministry of Finance for approval. 3. The Department also processed 3,626 vouchers of suppliers and contractors for payment during the year ending 2010. 4. The Hospital revenue collection for the year ending 2010 was OR 420,923.489 which was an increase of 9.2% over 2009. 5. Constant monitoring of the budgetary allocation and timely intervention resulted in a 100% utilisation of the budget for the year ending 2010. 6. The petty cash disbursement for purchase of day to day urgent items for the year 2010 was OR 24,519.417.

272 Overview The Housing Department is responsible for arranging accommodation for all the SQU Hospital 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 Housing Department plays a vital role in the preparation of residential premises, ensuring they are fit for occupancy. Inspections and housekeeping are carried out by Housing Department staff and any required work is referred to the appropriate hospital department.

Staff Bader Al-Hasni, Head of Department Bader Al-Habsi, Deputy Head Naeema Al-Jufaili, Coordinator Mahboob Al-Belushi, Residence Furnishing Officer Abullah Al-Jaradi, Residence Furnishing Suleiman Al-Esmaily, Inspection & Maintenance Inspection Follow-up Officer Khalid Al-Hossaini, Development Assistant Khalifa Al-Hinai, Offices Furnishing Officer Mohammed Al-Malki, Housekeeping Bader Al-Hadabi, Housekeeping The Department has ten employees and four workers. The Department is fully Omanised.

Activities in 2010 - Follow up the request of providing training for housing staff with the Training Services Directorate. - New purchase for residential requirements.

- Renewal of lease contracts for one more year. departments

- Increase the number of hired accommodation to cover the shortage on campus for hospital expansion. support H ospital ousing

273 Annual Report 2009-2010 Hospital Housing Department

- Contribution to quality management activities for ISO 9001:2000. BSI - Preparation of obsolete items for auction. - Follow-up of administration top management of housing request for supply of extra vehicles. - Follow-up the request to appoint more staff to the Department due to increasing job responsibilities. - New store for housing department and new extension to existing medical store. HOUSING ALLOWANCE In order to cover residential accommodation shortages, there has been provision of housing allowances for newly recruited employee nurses after they vacated their junior nurse accommodation.

MAINTENANCE Most maintenance requests and other requirements have been successfully met through appropriate liaison.

RESIDENCE CLEANING The cleaning and preparation of residential units have successfully been completed before occupancy.

274

Overview The goal of the Medical Records Service is to create and maintain systems which support health care providers, public studies, financial organisations and, most important of all, the needs of the patient. The hospital currently has a hybrid records system that involves most information being held in the new Hospital In- formation System, TrakCare, which have been recently updated with new version P9. 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 2011.

The Department operates with a sincere and highly committed staff team, consisting of 51 young Omanis, in its six sections. An Omani head leads the Depart- ment.

Filing and retrieval 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.

The processing and assembling 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 timely manner and signed-in in the system. Also, they scan all the important documents in the new electronic patient record which is not entered directly, such as consent forms.

Admission & Registration section: Largest section, in it is all clerks and receptionists of OPDs clinics, X-ray, Physiology, Oral health, Family & Community health and the Student Clinic. Registration of patients in the Accident & Emergency Department is an important part of our activity as it is a crucial and critical area in the Hospital, which runs 24 hours. departments Statistics section: Preparation of statistics for administration, hospital departments, and outside agencies such as the Ministry of Health. It also provides health information for physicians, nurses and students for support H ospital M edical R ecords D epartment

275 Annual Report 2009-2010 Hospital Medical Records Department

10853 14873 9790

43273 125342

7897

19005

82617

Out-patient clinics Radiology Clinical Physiology Day Care Unit Famco Oral Health Student Clinic Physiotherapy

medical research purposes.

Coding Section: Analyses all inpatient’s discharge records and assigns a numeric code to diagnostic data based on (ICD-10) the International Classification of Diseases classification system and (ICD-9-CM) for procedures.

Births & Deaths section: Issues electronic birth notifications for new born babies, and death notification for those who died in SQUH, in both Arabic and English language. The Royal Oman Police, Directorate of Civil Services issues the certificates. A copy of the register is send to the Ministry of Health every single month.

Staff Salim Khloof Al-Wahaibi, Head of Department – ADD PHOTO!! Ahmed Al-Farsi, Deputy Head of Department Saif Al-Raqadi, Supervisor Mubarak Al-Habsi, Supervisor Abdullah Al-Wahaibi, Supervisor Yousif Al-Falahi, Supervisor Huda Al-Suwaidi, Supervisor Mahfoudhah Al-Zadjali, Supervisor

276 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 Nassir H. Al- Gaffari, Head of Department Essa K. Al-Raisi, Staff member Drivers: 28

Activities in 2010 VEHICLES In 2010, the Transport Department got a new ambulance.

EXPENDITURE The following was the expenditure for 2010:

Maintenance: OR 4,791,000

Fuel: OR 7,225,673 ransport departments

support H ospital T

277 Annual Report 2009-2010 Annexes

Appendix I CONFERENCES & WORKSHOPS ORGANISED BY COMHS & SQUH IN 2009-2010 Conference Name Start Chronic Childhood Illness: Better understanding and cure 14–16 October 200 General Medicine Conference - organised with the Royal College of Physicians (UK), the Ministry of Health, Oman and the Oman Medical 21–23 February 2010 Specialty Board

Workshop Name Start Sixth Regional Evidence-based Medicine Workshop; Basic Clinical 9–13 January 2010 Research Design, and Health Informatics Research Methodology 6 May 2010 Postgraduate Studies & Research Retreat 6 May 2010

278 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 hospital

and

university

qaboos

A nnexes sultan

279