Background: Iron deficiency anaemia (IDA) is a recognised feature of coeliac disease in adults and can be its only presentation. Objective: To determine the yield of routine distal duodenal biopsies in diagnosing coeliac disease in adult and elderly patients with IDA whose endoscopy revealed no upper gastrointestinal cause of iron deficiency. Study design: Prospective study in a teaching hospital endoscopy unit. Method: Altogether 504 consecutive patients with IDA, aged 16-80 years, attending for endoscopy were included in this study. At least two distal duodenal biopsies were taken if endoscopy revealed no cause of iron deficiency. Result: In nine (1.8%) patients duodenal biopsies revealed typical histological features of coeliac disease. Of these, five patients were above 65 years old. Conclusion: In adult and elderly patients undergoing endoscopy for IDA, the endoscopist should take distal duodenal biopsies to exclude coeliac disease if no upper gastrointestinal cause of anaemia is found. Coeliac disease is not an uncommon cause of IDA in patients .65 years of age and a history of chronic diarrhoea increases diagnostic yield in this age group.
Introduction:Female breast cancer (BC) is the most frequent malignancy diagnosed globally, about 23% of the diagnosed cancers. BC incidence varies geographically, highest in Western Europe and lowest in Africa. BC in females is strongly correlated to age, the highest incidence rate amongst older women reinforcing the importance of hormonal status. BC in young females has an aggressive phenotype. There is a shared observation amongst practicing oncologists that BC in Middle East and the developing world presents at an earlier age.Aim and Objective:The aims of this study are to evaluate the age at presentation of female BC in Oman, and to compare our data with international and regional published data. It discusses the impact of young age Breast Cancer.Materials and Methods:All diagnosed female BC cases registered from 1996-2010 all over the country, were retrieved from the National Cancer Registry, Ministry of Health. BC cases were analyzed with respect to age at presentation. The data were compared with regional and international data.Results:A total of 14,109 cancer cases were recorded during the period of study. BC was the leading malignancy as 1,294 cases (9.1%). Female BC patients were 1,230; denoting 19.2% of all female cancers. 53.5% of female BC presented below 50 years of age. Male BC constituted 5% of total, with 67% of male BC occurring over 50 years of age. Compared with data from Oman, the highest rates in UK and other Western countries are above 50 years of age. These rates are four to 10 times higher than local in different age groups. Interestingly, these rates increase with increasing age in UK from 40-45 to up to 85+, keep on increasing and go up to four times higher with higher age. This phenomenon, of increasing incidence rates with age, is not observed in our local population.Discussion:BC is significantly correlated to age as reported from Western population. BC is reported at a younger age from developing and Arab World, which need to be further studied and validated. This phenomenon of BC in younger age may have significant implications and effects ranging from screening, diagnosis, management, prognosis, and cost of treatment.Conclusion:The impact on young women diagnosed with BC is enormous, ranging from psychosocial to healthcare services and economics. There is a need to study it further in depth in developing World.
219 Background: Breast cancer is the commonest malignancy and major health issue globally. There is initial evidence and high possibility of molecular differences across the ethnic and geographic groups; responsible for variation in presentation, responses to treatment, and outcome. Methods: Breast cancer data from 2006 to 2010 at National Cancer Center, The Royal Hospital Oman was retrospectively retrieved from electronic record system, and analyzed with respect to ER, PR, and HER2 status. The molecular subtypes were correlated with age, histology, and treatment out come. The results were compared with published international/regional data. Results: Total 542 cases were available for evaluation (535 male and 7 male: 459 Omani and 83 Non-Omani). Right, left, and bilateral tumors were 42.6%, 51.4%, and 6%. IDC were 79.6%. G1 were 7.7%, while other grades were equally distributed. Luminal A, B, basal-like (TNBC), and HER2 positive were 35.9%, 15.8%, 25.5%, and 22.8% respectively. Their age (cut off 50 years) was a significant factor in basal-like (63.8% vs. 36.2%) and HER2 tumors (61% vs. 39%). High-grade tumors were highest (41%) in basal tumors and lowest in Luminal A (19%). Higher stage at presentation (stage 3 and 4) was highest in HER2 tumors (59%). Mortality was recorded higher 22.4% in basal-like/TN tumors. Table shows comparison with selected published data. Conclusions: The molecular classification and subtyping have shown ethnic and geographic variation in taxonomy. These differences may have diagnostic, therapeutic, and prognostic implications. Large scale and multicenter studies may confirm these findings. They can be translated and incorporated to management strategies wherever applicable. [Table: see text]
Lean, as it applies to business, has come to signify simplicity, swift response, and efficiency. The concept is to do more with less; namely, to use resources in the most productive way possible through the elimination of all types of waste. The Lean approach can be applied to any field, including healthcare, in which the exponential growth of costs is widespread. Hospitals began experimenting with Lean healthcare in 1990s. Equal accessibility to healthcare is consistent with the tenets of social justice and a society’s duty to ensure basic healthcare to everyone. However, the gap between a state’s constitutional responsibility and resource availability is widening, creating a need for an evolution in healthcare provision based on relevance, objectivity, and impartiality. Health-services providers must juggle limited resources to ensure even-handed healthcare availability to all in the era of cost explosion.
The Sultanate of Oman is located on the Arabian Peninsula and is part of Western Asia. Oman has a relatively young population. The economy is based on oil, agriculture, fishing, and overseas trading. Oman spends around 3% of its GDP on health care. Omani nationals have free access to public healthcare. Due to increased incomes and changing lifestyles, the rate of Non-Communicable Diseases (NCD) including cancer is rising. This is slowly saturating the system and increasing health care costs. Cancer is now the third leading cause of mortality. The age-adjusted annual incidence of cancer ranges from 70 to 110 per 100,000 population. Oman has an operational national NCD action plan. This multi-sectoral plan was launched in 2018 and focuses on the government approach in addressing NCDs including cancer, highlighting the prevention and control strategies. There is an integrated cancer care service, cancer registry, and cancer control program; under the auspices of the Directorate general of Non-communicable diseases—Ministry of Health. Oman has envisioned an ambitious long-term health care plan called “Health care Vision 2050”, which includes the development and progression of cancer care services as well. This plan has an emphasis on development, patient empowerment, public awareness, health education, integration and accessibility of services, screening, and early detection, public–private partnership, indulgence for NGOs, research, and capacity building.
Introduction: Colorectal cancer (CRC) is the first most predominant malignancy in men, a bit less 3rd commonest in women. The prevalence rate is higher in developed than in developing economies, though the pattern is gradually changing. In Oman, CRC prevalence rate has shown a significant escalating pattern in the recent past. From 1996 to 2012, CRC incidence in Oman has increased by 282% in females and 386% in males. There is emerging data that right and left sided lesions are different in terms of aetiology, pathogenesis, biologic behaviour, genetic makeup, response to treatment and outcome. This study has looked at this issue in the Omani population of CRC. Methods: Eligible CRC patients treated at the Royal Hospital were identified from electronic medical record (Al-SHIFA 3) and Oman cancer registry data base (Ministry of Health) from 1998-2013. The BMI (body mass index), age, gender, stage, tumour location, K-Ras status, and Diabetes mellitus (DM) were explored. The RAS mutation status test (mutant type MT or wild type WT) was carried out in Lab21. Log regression was conducted to estimate the association between food intake, BMI, presence of metabolic syndrome, and level of physical activity with both cancers. Data was analysed using the SPSS. Results: Total number of patients treated at Royal Hospital were 492, 193 females (44%) and 214 males (56%). About 71.9% of patients were less than 60 years of age. The obese and overweight patients were 201 (57.3%). The rectum was found to be the predominant site of the tumor. The left sided tumors were significantly higher, 4 out of every 5 tumors (80.3% Vs 16.4%). The patients with right sided CRC were slightly younger, had a higher BMI, and more likely to be diabetic. The tumors of the left colon are more K-ras wild while those of the right colon are more K-ras mutant. Conclusions and Discussion: The right sided tumors as per our study are younger; with significant obesity, diabetes, and K-Ras mutant, and this correlates with high meat and protein consumption in the Omani population. The sidedness or laterality of CRC needs further study in Oman. There is emerging data that right and left-sided lesions are different in terms of etiology, pathogenesis, biologic behaviour, genetic makeup, response to treatment and outcome.
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