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The exposure of concrete to elevated temperatures is known to cause diverse severe damages in concrete composites. Hence, measures to improve the performance of concrete during exposure to fire are continually proposed. The present study investigated the postfire residual strength and morphology of concrete incorporating natural rubber latex exposed to elevated temperature. Four different concrete mixes were considered for the investigation, namely, a control sample made without natural rubber latex, the second sample containing 1% natural rubber latex, the third sample containing 1.5% natural rubber latex, and the fourth sample containing 3% of natural rubber latex. The concrete samples (150 mm cubes and 100 × 200 mm cylinders) were exposed to varying temperatures 300°C, 800°C, and 1000°C, after the curing process. Nondestructive tests using Schmidt rebound hammer and ultrasonic pulse tester were carried out on samples. The compressive strength and split-tensile strength of concrete cubes and cylinders, respectively, were determined. Micrographs and elemental distribution in the sample were studied using the scanning electron microscopy (SEM-EDX) apparatus. It could be seen from the results that the concrete strength properties reduced as the exposure temperature increased. The results also showed that NRL could be sparingly utilized as a concrete admixture, at 1% content. The performance of concrete was not stable at over 300°C when NRL addition was above 1%.

Geopolymer (GP) concrete is a novel construction material that can be used in place of traditional Portland cement (PC) concrete to reduce greenhouse gas emissions and effectively manage industrial waste. Fly ash (FA) has long been utilized as a key constituent in GPs, and GP technology provides an environmentally benign alternative to FA utilization. As a result, a thorough examination of GP concrete manufactured using FA as a precursor (FA-GP concrete) and employed as a replacement for conventional concrete has become crucial. According to the findings of current investigations, FA-GP concrete has equal or superior mechanical and physical characteristics compared to PC concrete. This article reviews the clean production, mix design, compressive strength (CS), and microstructure (Ms) analyses of the FA-GP concrete to collect and publish the most recent information and data on FA-GP concrete. In addition, this paper shall attempt to develop a comprehensive database based on the previous research study that expounds on the impact of substantial aspects such as physio-chemical characteristics of precursors, mixes, curing, additives, and chemical activation on the CS of FA-GP concrete. The purpose of this work is to give viewers a greater knowledge of the consequences and uses of using FA as a precursor to making effective GP concrete.

Push-out-shear tests were used in this study to analyze lag screw connections in timber-concrete composite (TCC) slabs based on the embedment depth. The goal of this research is to look into the relationship between shear capacity and embedment depth in TCC, as well as to investigate the embedment strength of the wood. Experiments were carried out at different embedment depths (5.08 cm, 7.0 cm, and 8.9 cm). The prepared samples were examined in order to determine the failure modes and provide an accurate assessment of the influence of embedment depth on TCC slabs. The investigation on the embedment strength of the wood was performed then for the analysis of the crushing of wood fibers, lag screw yielding strength, and maximum load applied at embedment depths of 6.6 cm and 7.0 cm. The results indicate that between 5.08 cm and 7.0 cm, there was an apparent improvement in the relationship between embedment depth (ED) and shear capacity of TCC slabs in terms of the shear strength, while a significant difference was observed between 7.0 cm and 8.9 cm. The study suggests that the ED of the TCC slab should be maintained at around 7.33 times the diameter of the lag screw.

The World Health Organization (WHO) MPOWER measures are a set of highly effective tobacco control measures drawn from the WHO Framework Convention on Tobacco Control (FCTC), designed to help countries reduce the prevalence of tobacco use. The WHO Report on the Global Tobacco Epidemic is published biennially to monitor global implementation of these measures.This review aimed to critically assess the status of MPOWER implementation in the Eastern Mediterranean Region.Data were collected for WHO Reports on the Global Tobacco Epidemic, focusing on the most recent 2019 edition. Regional population coverage figures were calculated using this data and population figures for the countries of the Region.Between 2007 and 2018, for any MPOWER measure, there were 29 cases of countries progressing to the highest level of achievement; 23 cases of countries progressing to the intermediate levels from the lowest level; 12 cases of countries falling from the highest level; and 18 cases of countries falling to the lowest level. 57.7% of people are covered at the highest level for the monitoring measure; 63.7% for the smoke-free policies measure; 6.7% for the cessation measure; 60.7% for the health warnings measure; 37.4% for the mass media measure; 29.4% for the advertising bans measure; and 16.1% for the taxation measure.Countries must work comprehensively to improve tobacco control. Regional priorities should include lifting more people out of lowest level coverage for the health warnings and mass media measures, increasing taxation on tobacco products and improving access to cessation services.وضع مكافحة التبغ في إقليم شرق المتوسط: تقدم في تطبيق التدابير الستة (MPOWER).فاطمة العوا، دوجلاس بيتشير، جواد اللواتي، رءوف الابشيهي، هبة جودة، تشارلز فريزر.تدابير منظمة الصحة العالمية الستة هي مجموعة من التدابير ذات الكفاءة العالية لمكافحة التبغ، وهي مبنية على اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ، وتهدف إلى مساعدة البلدان على تقليص معدل انتشار تعاطي التبغ. ويُنشَ تقرير منظمة الصحة العالمية بشأن وباء التبغ العالمي كل عامين بغرض رصد تطبيق هذه التدابير على مستوى العالم.هدف هذا الاستعراض إلى إجراء تقييم نقدي لحالة تطبيق التدابير الستة في إقليم شرق المتوسط.جُعت البيانات نحو إعداد تقارير منظمة الصحة العالمية بشأن وباء التبغ العالمي، مع التركيز على أحدث نسخة لعام 2019. وحُسبت أرقام التغطية السكانية الإقليمية باستخدام هذه البيانات وأرقام تعداد السكان لبلدان الإقليم.كانت هناك 29 حالة لبلدان تتقدم نحو أعلى مستويات الإنجاز، و23 حالة لبلدان تتقدم من أدنى المستويات نحو مستويات متوسطة، و12 حالة لبلدان تهبط من أعلى المستويات، و18 حالة لبلدان تهبط إلى أدنى المستويات، وذلك بين عامي 2007 و2018 وفيما يخص أي تدبير من مجموعة التدابير الستة. وشملت أعلى مستويات تدبير الرصد 57.7٪ من الأشخاص، و63.7٪ في تدبير السياسات الخاصة بالأماكن الخالية من التدخين، و6.7٪ في تدبير الإقلاع عن التدخين، و60.7٪ في تدبير التحذيرات الصحية، و37.4٪ في تدبير وسائل الإعلام، و29.4٪ في تدبير حجب الدعاية للتبغ، و16.1٪ في تدبير فرض الضرائب.يتعين على البلدان العمل بشمولية من أجل تحسين مكافحة التبغ. وينبغي أن تتضمن الأولويات الإقليمية رفع المزيد من الأشخاص من أدنى مستويات التغطية في تدابير التحذيرات الصحية ووسائل الإعلام، وزيادة الضرائب على منتجات التبغ، وتحسين الوصول إلى خدمات الإقلاع عن التدخين.Situation de la lutte antitabac dans la Région de la Méditerranée orientale : progrès dans la mise en œuvre des mesures MPOWER.Les mesures MPOWER mises en place par l’Organisation mondiale de la Santé (OMS) constituent un ensemble de recommandations très efficaces en matière de lutte antitabac issues de la Convention-cadre de l’OMS pour la lutte antitabac, destinée à aider les pays à réduire la prévalence de la consommation de tabac. Le rapport de l’OMS sur l’épidémie mondiale de tabagisme est publié tous les deux ans afin de suivre la mise en œuvre au niveau mondial de ces mesures.La présente étude avait pour objectif d’évaluer de manière critique la situation concernant la mise en œuvre des mesures MPOWER dans la Région de la Méditerranée orientale.Les données ont été collectées en vue de la rédaction des rapports de l’OMS sur l’épidémie mondiale de tabagisme, en privilégiant l’édition 2019 qui est la plus récente. Les chiffres concernant la couverture de la population régionale ont été calculés à l’aide de ces données et des chiffres de la population des pays de la Région.Entre 2007 et 2018, pour toute mesure MPOWER, on a observé 29 cas de pays ayant progressé au plus haut degré d’exécution ; 23 cas de pays étant passé du niveau le plus faible au niveau intermédiaire ; 12 cas de pays ayant régressé par rapport au plus haut niveau ; et 18 cas de pays ayant régressé au degré le plus bas. Cinquante-sept pour cent de la population est couverte au plus haut niveau d’exécution en ce qui concerne la mesure de suivi ; 63,7 % concernant la mesure relative aux politiques sur les environnements sans fumée ; 6,7 % pour la mesure relative au sevrage ; 60,7 % concernant la mesure relative aux mises en garde sanitaires ; 37,4 % concernant la mesure relative aux médias ; 29,4 % concernant la mesure relative à l’interdiction de la publicité et 16,1 % concernant la mesure relative à la taxation.Les pays doivent travailler de manière globale afin de renforcer la lutte antitabac. Les priorités régionales devraient inclure le passage du niveau de couverture le plus bas à un niveau supérieur pour un plus grand nombre de personnes en ce qui concerne les mesures relatives aux mises en garde sanitaires et aux médias, l’augmentation de la taxation sur les produits du tabac et l’amélioration de l’accès aux services de sevrage.

Objective: To evaluate the association of dual versus single antiplatelet therapy with major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Subjects and Methods: Data were analyzed from 3,559 patients with a diagnosis of ACS admitted to 29 hospitals in 4 Arabian Gulf countries (Bahrain, Kuwait, Oman, and United Arab Emirates) from January 2012 to January 2013. Dual antiplatelet therapy (DAPT), consisting of aspirin and clopidogrel, was compared to aspirin alone. MACE included 12-months cumulative stroke/transient ischemic attack (TIA), myocardial infarction (MI), all-cause mortality, and readmissions for cardiac reasons, post discharge. Analyses were performed using multivariable logistic regression. Results: A total of 74% (n = 2,634) of the patients were on DAPT. At 12-month follow-up, patients on DAPT were significantly less likely to experience MACE events (adjusted OR [aOR] 0.73; 95% CI: 0.61–0.86; p < 0.001). Lower cardiovascular (CV) event rates were also consistent across the following MACE components; MI (aOR 0.66; 95% CI: 0.49–0.88; p = 0.005), all-cause mortality (aOR 0.69; 95% CI: 0.51–0.94; p = 0.018), and readmissions for cardiac reasons (aOR 0.79; 95% CI: 0.66–0.95; p = 0.011). Conversely, DAPT was adversely associated with increased risk of stroke/TIA (aOR 1.68; 95% CI: 1.05–2.69; p = 0.030). Conclusions: DAPT, compared to aspirin therapy alone, was generally associated with better CV outcomes after an ACS event. However, DAPT was adversely associated with increased risk of stroke/TIA in ACS patients in the Arabian Gulf.

Objectives: We sought to investigate the epidemiology of lung cancer and its trends in Oman over 20 years. Methods: We analyzed all cases of primary lung cancer reported to the Oman National Cancer Registry between 1996 and 2015. The World Standard Population was used to obtain age-standardized incidence rates (ASR) of lung cancer per 100 000. Analyses were conducted using univariate statistics. Results: A total of 956 cases of primary lung cancer cases were registered in Oman between 1996 and 2015, with a male to female ratio of 3:1. In men, the ASR was 8.2 per 100 000, while in females it was 2.6 per 100 000 over the entire study period. There were no statistically significant differences in the ASR among men or women when the data was divided over three calendar periods (1996–2005, 2006–2015, and 1996–2015) (p= 0.332 and p=0.577, respectively). There was also no increasing trend in the incidence of lung cancer. The risk of lung cancer onset commenced in the 30–34 year age group and the mean age at diagnosis was 60.0 years for men and 61.0 years for women. Adenocarcinoma was the most common type of lung cancer among Omanis with a higher proportion in females compared to males. Conclusions: Oman has one of the lowest incidence rates of lung cancer in the world with no evidence of an increasing trend of this cancer type. This could be attributed to low uptake of tobacco smoking among both sexes. National authorities should capitalize on this finding to avoid any future lung cancer epidemics especially those driven by tobacco use.

The Sultanate of Oman has experienced rapid development over the last thirty years and has constructed environmentally friendly and sustainable infrastructure while it continues to find economical alternative resources to achieve the goals of the Oman 2040 vision. The primary concerns are preserving natural resources and reducing the impact of carbon dioxide (CO₂) emissions on the environment. This review aims to encourage the sustainable use of reclaimed asphalt pavement (RAP) materials in pavement construction and focuses primarily on employing RAP materials in new pavement projects. Currently, new construction projects utilise a significant percentage of demolished asphalt pavement to save costs and natural resources. The key issue that arises when mixing RAP into new asphalt mixtures is the effects on the mixtures’ resistance to permanent disfigurements, such as fatigue cracks, that influence asphalt mixture performance. Numerous studies have assessed the impact of using RAP in asphalt mixtures and found that RAP increases the stiffness of asphalt mixtures, and thus improves rutting resistance at high temperatures. Nevertheless, the findings for thermal and fatigue cracking were found to be contradictory. This review will address the primary concerns regarding the use of RAP in asphalt pavements, and aims to encourage highway agencies and academic researchers in the Gulf countries to develop frameworks for the practical usage of RAP in the construction of sustainable pavement systems.

Aims/Introduction To investigate and forecast type 2 diabetes mellitus epidemic, its related risk factors and cost in Oman by 2050. Materials and Methods An age‐structured mathematical model was used to characterize type 2 diabetes mellitus epidemiology and trends in Oman between 1990 and 2050. The model was parametrized using current and quality data, including six nationally representative population‐based epidemiological surveys for type 2 diabetes mellitus and its key risk factors. Results The projected type 2 diabetes mellitus prevalence increased from 15.2% in 2020 to 23.8% in 2050. The prevalence increased from 16.8 and 13.8% in 2020 among women and men to 26.3 and 21.4% in 2050, respectively. In 2020, 190,489 Omanis were living with type 2 diabetes mellitus compared with 570,227 in 2050. The incidence rate per 1,000 person‐years changed from 8.3 in 2020 to 12.1 in 2050. Type 2 diabetes mellitus’ share of Oman’s national health expenditure grew by 36% between 2020 and 2050 (from 21.2 to 28.8%). Obesity explained 56.7% of type 2 diabetes mellitus cases in 2020 and 71.4% in 2050, physical inactivity explained 4.3% in 2020 and 2.7% in 2050, whereas smoking accounted for, The prevalence of type 2 diabetes mellitus in Oman was projected to grow by 57% by 2050, whereas the incidence was projected to grow by 200% by 2050. By 2050, type 2 diabetes mellitus will consume 30% of Oman’s health expenditure. The type 2 diabetes mellitus epidemic in Oman is driven by the high obesity level.

Objectives: We sought to develop and validate a diabetic risk score model as a non-invasive and self-administered screening tool to be used in the general Omani population. Methods: The 2008 World Health Survey (WHS) data from Oman (n = 2720) was used to develop the risk score model. Multivariable logistic regression with the backward stepwise method was implemented to obtain risk factors regression coefficients for sex, age, educational attainment, marital status, place of residence, hypertension, body mass index (BMI), waist circumference, tobacco use, daily fruit and vegetable intake, and weekly physical activity. The model coefficients were multiplied by a factor of five to allocate each variable category a risk score. The total score was calculated as the sum of these individual scores. The score was validated using another Omani cohort (Sur Survey 2006 dataset, n = 1355) by calculating the area under the receiver-operating characteristic (ROC) curve (AUC), and optimal score sensitivity and specificity were determined. Results: A robust diabetes risk score model was produced composed of eight variables (age, sex, education level, marital status, place of residence, hypertension, smoking status, and BMI) with an optimal cutoff point of ≥ 15 to classify persons with possible prevalent type 2 diabetes mellitus (T2DM). At this cutoff point, the model had a sensitivity of 71.1%, specificity of 74.4%, and AUC of 0.80 (95% confidence interval (CI): 0.78–0.82), when internally validated (in the WHS 2008 cohort). When the model was externally validated (using the Sur 2006 cohort), the optimal cutoff point for the score was ≥ 13, with a lower sensitivity (54.0%), higher specificity (79.0%), and an AUC of 0.74 (95% CI: 0.70–0.78). In contrast, the test of the old Omani, Kuwaiti, Saudi, and Finnish diabetes risk scores in our study populations showed poor performance of these models among Omanis with poor sensitivity (29% to 63.5%) and reasonable specificity (70% to 80%). Conclusions: The developed diabetes risk score for screening prevalent T2DM, provides an easy-to-use self-administered tool to identify most individuals at risk of this condition in Oman. The score incorporates eight diabetes-associated risk factors that can also act as a tool to increase people’s awareness about the importance of diabetes-related risk factors and provide information for policymakers to establish diabetes prevention programs.

Objectives: We sought to investigate the epidemiology of thyroid cancer and its trends in Oman over a 20-year period. Methods: We analyzed all cases of primary thyroid cancer reported to the Oman National Cancer Registry between 1996 and 2015. Age-standardized incidence rates (ASR) were calculated using the World Standard Population. Joinpoint regression was used to assess trends and obtain annual percentage changes (APC) in incidence rates with 95% confidence intervals (95% CI) and p-values at the alpha = 0.050 level. Gender-specific APC was used to project thyroid cancer incidence rates in Oman over the next 20 years. Population attributable fraction was calculated for obesity and current non-smoking. Results: A total of 1285 cases of primary thyroid cancer cases were registered in Oman between 1996 and 2015, with a female to male ratio of 4:1. In men, the ASR was 2.0 per 100 000 while in females it was 7.6 per 100 000 (p < 0.010). Over 80.0% of thyroid tumors were of a papillary type and 19.0% follicular type. Statistically significant trends for thyroid cancer were detected in women from 2008–2015 (APC = 14.3%, 95% CI: 8.0–20.9, p < 0.010) and among both genders (APC = 16.7%, 95% CI: 4.9–29.9, p < 0.010). If current trends continue, thyroid cancer incidence will increase to 3.1, 16.6, and 11.8 per 100 000 by 2040 in men, women, and both genders, respectively. Nearly 10.0% of thyroid cancer can be prevented by controlling obesity in the Omani population. Conclusions: Oman has had moderate incidence rates of thyroid cancer with an increasing trend among women. Since projections estimate that the rates of this disease will double in women over the next 20 years, health authorities should consider providing sufficient resources to manage this condition and establish prevention programs that address obesity as part of the strategy for the prevention and control of noncommunicable diseases.

AIMS To evaluate the impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs)/ Angiotensin Receptors Blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in Acute Heart Failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East. METHODS AND RESULTS Data was analysed from 2,683 consecutive patients admitted with AHF and Left Ventricular Ejection Fraction (LVEF) (

Cancer (IARC) estimated that over 18 million new cases of cancer were diagnosed and nearly 10 million people lost their lives to this group of diseases. Yet, cancer is not invincible and can be abated through effective cancer control programs that implement evidence-based strategies for prevention, early detection, treatment, palliation, and making the best use of available resources. Such programs aim to reduce cancer incidence, its associated morbidity and mortality, and improve quality of life. However, this requires careful planning, continuous monitoring and evaluation of processes, and output and outcome indicators to assess whether program objectives are achieved. One of the most common methods to obtain such indicators is through cancer surveillance systems in the form of population-based cancer registries that systematically collect, analyze, and report cancer data of a well-defined geographical area.

Tobacco use is the world’s leading cause of preventable morbidity and mortality. Although Oman remains a country with the lowest tobacco use in the Arab Gulf States, the prevalence of tobacco use is projected to increase to 33.3% by 2025. In 2005, Oman acceded to the World Health Organization’s Framework Convention on Tobacco Control, an international treaty with numerous obligations aiming to reduce the global burden of tobacco use. This paper documents, for the first time, Oman’s experience in tobacco control by providing a descriptive analysis of the evolution of tobacco control policies in relation to the country’s international obligations. In order to curb tobacco use and maintain current low prevalence levels, the paper concludes that Oman needs to accelerate action in adopting the highest attainable policies recommended by the World Health Organization’s MPOWER package.

We investigated the role of systolic blood pressure (SBP) in relation to in-hospital and postdischarge mortality in patients admitted with acute heart failure (AHF). The SBP of 4848 patients aged ≥18 years admitted with AHF was categorized into 5 groups: ≤90, 91 to 119, 120 to 139, 140 to 161, and >161 mm Hg. After adjusting for several confounders, multivariate logistic regression models showed that admission SBP was a significant predictor of mortality among both patients with preserved left ventricular function (defined as left ventricular ejection fraction [LVEF] ≥40%) and patients with left ventricular dysfunction (LVEF 161 mm Hg), respectively. We conclude that low admission SBP is an independent predictor of mortality in patients with AHF. The higher the admission SBP, the better the prognosis, regardless of age or LVEF.

Hypertension (HTN) is a major independent risk factor for the development of stroke, coronary artery disease (CAD), peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD). HTN is a growing public health problem in Oman, almost certainly the most prevalent modifiable risk factor for cardiovascular disease (CVD). The risk of CVD in patients with HTN can be greatly reduced with lifestyle modifications and effective antihypertensive therapy. Randomized trials have shown that blood pressure (BP) lowering produces rapid reductions in CV risk. Several studies have shown that the majority of the hypertensive patients remain uncontrolled. It is well established that the observed poor control of the disease is not only related to poor adherence to medications, but also to limited awareness and adherence to evidence-based management of hypertension among physicians. Several guidelines for the management of patients with hypertension have been published. However, the aim of this document is to provide the busy physicians in Oman with more concise and direct approach towards implementing these guidelines into clinical practice.

We compared baseline characteristics, clinical presentation, and in-hospital outcomes between Middle Eastern Arabs and Indian subcontinent patients presenting with acute coronary syndrome (ACS). Of the 7930 patients enrolled in Gulf Registry of Acute Coronary Events II (RACE II), 23% (n = 1669) were from the Indian subcontinent. The Indian subcontinent patients, in comparison with the Middle Eastern Arabs, were younger (49 vs 60 years; P < .001), more were males (96% vs 80%; P < .001), had lower proportion of higher Global Registry of Acute Coronary Events risk score (8% vs 27%; P < .001), and less likely to be associated with diabetes (34% vs 42%; P < .001), hypertension (36% vs 51%; P < .001), and hyperlipidemia (29% vs 39%; P < .001) but more likely to be smokers (55% vs 29%; P < .001). After multivariable adjustment, the Middle Eastern Arabs were less likely to be associated with in-hospital congestive heart failure (odds ratio [OR], 0.65; 95% confidence interval [CI]: 0.50-0.86; P = .003) but more likely to be associated with recurrent ischemia (OR 1.33; 95% CI: 1.03-1.71; P = .026) when compared to the Indian subcontinent patients. Despite the baseline differences, there were largely no significant differences in in-hospital outcomes between the Indians and the Middle Eastern Arabs.

WHO MPOWER aims to help countries prioritize tobacco control measures in line with the WHO Framework Convention on Tobacco Control.This paper assessed the progress and challenges in implementing the 6 priority policies of MPOWER in countries of the WHO Eastern Mediterranean Region since 2011.A checklist was developed and scores assigned based on the MPOWER indicators (maximum score 37). MPOWER data for the Region in the 2015 and 2017 tobacco control reports were extracted and scored. Data from similar analyses for 2011 and 2013 were also included. Countries were ranked by scores for each indicator for 2015 and 2017 and for overall scores for 2011 to 2017.The Islamic Republic of Iran, Egypt and Pakistan had the highest scores in 2015 (33, 29 and 27 respectively) and the Islamic Republic of Iran, Pakistan and Yemen had the highest scores in 2017 (34, 31 and 27 respectively). The indicators with the highest and lowest combined score for all countries were for advertising bans and compliance with smoke-free policies: 67 and 18 respectively in 2015, and 73 and 15 respectively in 2017. Most countries (15/22) had higher total scores in 2017 than 2015: Afghanistan, Bahrain and Syrian Arab Republic had the greatest increases. The total score for the Region increased from 416 out of a maximum score of 814 in 2011 to 471 in 2017.Although notable achievements have been made in the Region, many challenges to policy implementation remain and require urgent action by governments of the countries of the Region.مبادرة التحرّر من التبغ، الاحتياجات والتحديات: الاتجاهات السائدة في تنفيذ اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ في إقليم شرق المتوسط.غلام رضا حيدري، غازي زعتري، جواد بن أحمد اللواتي، فاطمة العوا، هبة فؤاد.تهدف مبادرة منظمة الصحة العالمية للتحرّر من التبغ إلى تحديد الأولويات المتعلقة بتدابير مكافحة التبغ تمشياً مع اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ. ولقد قامت هذه الدراسة بتقييم التقدم المحرز والتحديات المُصادفة في تنفيذ السياسات الست ذات الأولوية لمبادرة التحرر من التبغ في بلدان إقليم شرق المتوسط منذ عام 2011.تم تصميم قائمة مرجعية وإسناد درجات على أساس مؤشرات مبادرة التحرر من التبغ (بحد أقصى 37 درجة). واشتُقّت بيانات المبادرة المتعلقة بالإقليم في عامي 2015 و 2017 والواردة في تقارير مكافحة التبغ وأسندت إليها درجات. كما أُدرجت بيانات مشتقة من تحليلات مماثلة لعامي 2011 و 2013. وصُنفت البلدان حسب الدرجات المسندة لكل مؤشر لعامي 2015 و 2017 وحسب المجموع الكلي للدرجات في الفترة من 2011 إلى 2017.سجّلت جمهورية إيران الإسلامية ومصر وباكستان أعلى الدرجات في عام 2015 (33 و 29 و 27 درجة على التوالي)، في حين سجّلت جمهورية إيران الإسلامية وباكستان واليمن أعلى الدرجات في عام 2017 (34 و 31 و 27 درجة على التوالي). وسجّل مؤشراً حظر الإعلان عن التبغ والامتثال لسياسات حظر التدخين أعلى وأدني درجة مجمّعة لجميع البلدان (67 و 18 على التوالي) في عام 2015 و (73 و 15 على التوالي) في عام 2017. وحقق معظم البلدان (15/22) مجموع درجات أعلى في عام 2017 منه في عام 2015 : حيث سجلت الجمهورية العربية السورية وأفغانستان والبحرين أعلى الزيادات. وارتفع مجموع درجات الإقليم من 416 درجة، من أصل 814 وهي الدرجة القصوى في عام 2011 ، إلى 471 درجة في عام 2017.على الرغم من الإنجازات المهمة التي تحقّقت في الإقليم، لا يزال هناك الكثير من التحديات القائمة على مستوى تنفيذ السياسات، وهو ما يتطلب اتخاذ إجراءات عاجلة من جانب حكومات دول الإقليم.Programme MPOWER – besoins et défis : tendances dans la mise en oeuvre de la Convention-cadre de l’OMS pour la lutte antitabac dans la Région de la Méditerranée orientale.Le programme MPOWER de l’OMS vise à aider les pays à accorder la priorité aux mesures de lutte antitabac, conformément à la Convention-cadre de l’OMS pour la lutte antitabac.La présente étude a évalué les progrès et les défis de la mise en oeuvre des six politiques prioritaires du programme MPOWER dans les pays de la Région OMS de la Méditerranée orientale depuis 2011.Une liste de contrôle a été mise au point et des scores ont été assignés sur la base des indicateurs MPOWER (score maximum de 37). Des données sur le programme MPOWER dans la Région en 2015 et en 2017 publiées dans des rapports sur la lutte antitabac ont été extraites et se sont vues attribuer une note. Des données issues d’analyses similaires pour les années 2011 et 2013 ont également été incluses. Les pays ont été classés selon les notes attribuées pour chaque indicateur pour 2015 et 2017, et pour l’ensemble des scores pour 2011 et 2017.La République islamique d’Iran, l’Égypte et le Pakistan ont obtenu les scores les plus élevés pour 2015 (33, 29 et 27 respectivement), et la République islamique d’Iran, le Pakistan et le Yémen ont obtenu les scores les plus élevés pour 2017 (34, 31 et 27 respectivement). Les indicateurs comportant les scores combinés les plus élevés et les plus bas pour l’ensemble des pays concernaient les interdictions de publicité et la conformité avec les politiques non-fumeur en 2015 (67 et 18 respectivement) et en 2017 (73 et 15 respectivement). La plupart des pays (15/22) ont obtenu des scores totaux plus élevés en 2017 qu’en 2015 : l’Afghanistan, Bahreïn et la République arabe syrienne, affichaient les augmentations les plus importantes. Le score total pour la Région a connu une augmentation, passant de 416 pour un score maximum de 814 en 2011, à 471 en 2017.Bien que des réalisations considérables soient à noter dans la Région, de nombreux défis entravant la mise en oeuvre des politiques demeurent et requièrent une intervention de toute urgence au niveau des gouvernements des pays de la Région.

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.

Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients.To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS).Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: ≤50 years, 51-70 years and70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months.One-way ANOVA test for continuous variables, Pearson chi-square (X (2)) test for categorical variables and multivariate logistic regression analysis for predictors were performed.Among 7930 consecutive ACS patients; 2755 (35%) were ≤50 years, 4110 (52%) were 51-70 years and 1065 (13%)70 years old. The proportion of women increased with increasing age (13% among patients ≤50 years to 31% among patients 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03-1.60), heart failure (OR 2.8; 95% CI 2.17-3.52) and major bleeding (OR 4.02; 95% CI 1.37-11.77) and in-hospital mortality (age 51-70: OR 2.67; 95% CI 1.86-3.85, and age70: OR 4.71; 95% CI 3.11-7.14).Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.

Objectives: This study aimed to evaluate the epidemiology and coronary risk factors of acute coronary syndrome (ACS) in Oman. Methods: Data were collected through a prospective, multinational, multicentre survey of consecutive patients, hospitalised over a 5-month period in 2007 with a diagnosis of ACS, in Yemen and five Arabian Gulf countries (Oman, Bahrain, Kuwait, Qatar, United Arab Emirates). Here we present data of Omani patients aged ≥20 years who received a provisional diagnosis of ACS and were consequently admitted to 14 different hospitals. Results: There where 1,340 confirmed ACS episodes in 748 men and 592 women (median age 61 years). The overall crude incidence rate of ACS was 338.9 per 100,000 person-years (P-Y). The age-standardised rate (ASR) of ACS was 779 and 674 per 100,000 P-Y for men and women, respectively. The ASR male-to-female rate ratio washighest in the ST-elevation myocardial infarction (STEMI) group (2.26, 95% confidence interval ([CI], 1.63 to 3.15)followed by the non-STEMI (NSTEMI) group (1.68, 95% CI 1.28 to 2.21) and unstable angina (0.79, 95% CI 0.66 to 0.99). Unstable angina accounted for 55%, STEMI for 26% and NSTEMI for 19% of ACS cases. Among the coronary risk factors, there was a high prevalence of hypertension (68%), diabetes mellitus (DM) (36%), hyperlipidaemia(63%), and overweight/obesity (65%), with a relatively low rate of current tobacco use (11%). Conclusion: Our study confirms a high incidence of ACS in Omanis and supports the notion that the cardiovascular disease epidemic is also sweeping developing countries.

Objectives This study aimed to evaluate the epidemiology and coronary risk factors of acute coronary syndrome (ACS) in Oman. Methods Data were collected through a prospective, multinational, multicentre survey of consecutive patients, hospitalised over a 5-month period in 2007 with a diagnosis of ACS, in Yemen and five Arabian Gulf countries (Oman, Bahrain, Kuwait, Qatar, United Arab Emirates). Here we present data of Omani patients aged ≥20 years who received a provisional diagnosis of ACS and were consequently admitted to 14 different hospitals. Results There where 1,340 confirmed ACS episodes in 748 men and 592 women (median age 61 years). The overall crude incidence rate of ACS was 338.9 per 100,000 person-years (P-Y). The age-standardised rate (ASR) of ACS was 779 and 674 per 100,000 P-Y for men and women, respectively. The ASR male-to-female rate ratio was highest in the ST-elevation myocardial infarction (STEMI) group (2.26, 95% confidence interval ([CI], 1.63 to 3.15) followed by the non-STEMI (NSTEMI) group (1.68, 95% CI 1.28 to 2.21) and unstable angina (0.79, 95% CI 0.66 to 0.99). Unstable angina accounted for 55%, STEMI for 26% and NSTEMI for 19% of ACS cases. Among the coronary risk factors, there was a high prevalence of hypertension (68%), diabetes mellitus (DM) (36%), hyperlipidaemia (63%), and overweight/obesity (65%), with a relatively low rate of current tobacco use (11%). Conclusion Our study confirms a high incidence of ACS in Omanis and supports the notion that the cardiovascular disease epidemic is also sweeping developing countries.

Objectives: To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c (HbA1c) levels compared to older patients, and to determine the factors associated with higher HbA1c levels. Methods: Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios (OR), and 95% confidence intervals (CI) from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate (eGFR), tobacco use, and healthcare index as predictors of good (HbA1c

Background: Despite the high burden of type 2 diabetes mellitus (T2DM) in Oman, there are scarce data from a nationally representative sample on the level of glycaemia and other cardiovascular (CVD) risk factor control. Objective: To estimate the proportion of patients with T2DM at goal for glycaemia and CVD risk factors using the National Diabetes Guidelines (NDG) and the American Diabetes Association (ADA) clinical care guidelines; and to assess the quality of selected services provided to patients with T2DM. Methods: A sample of 2,551 patients (47% men) aged ≥20 years with T2DM treated at primary health care centers was selected. Patient characteristics, medical history and treatment were collected from case notes, Diabetes Registers and computer frameworks including the use of the last 3 laboratory investigations results and blood pressure (BP) readings recorded in 2007. Results: The overall mean age of the cohort was 54±13 years with an average median duration of diabetes of 4 (range 2 to 6) years. Over 80% of patients were overweight or obese (body mass index (BMI) of ≥25 Kg/m2). Sixty-nine percent were on oral anti-diabetic medication, 52% on anti-hypertensives and 40% on lipid lowering drugs. Thirty percent of patients were at goal for glycosylated haemoglobin level (1 mmol/l for men, >1.3 mmol/l for women), and 61% for triglycerides ( Conclusion: Control of hyperglycaemia and other CVD risk factor appears to be suboptimal in Omani patients with T2DM and need to be addressed in the triad of patient, physician and health system.

We used prospective cohort data of patients with acute coronary syndrome (ACS) to compare their management on weekdays/mornings with weekends/nights, and the possible impact of this on 1-month and 1-year mortality. Analyses were evaluated using univariate and multivariate statistics. Of the 4,616 patients admitted to hospitals with ACS, 76% were on weekdays. There were no significant differences in 1-month (odds ratio (OR), 0.88; 95% CI: 0.68-1.14) and 1-year mortality (OR, 0.88; 95% CI: 0.70-1.10), respectively, between weekday and weekend admissions. Similarly, there were no significant differences in 1-month (OR, 0.92; 95% CI: 0.73-1.15) and 1-year mortality (OR, 0.98; 95% CI: 0.80-1.20), respectively, between nights and day admissions. In conclusion, apart from lower utilization of angiography (P < .001) at weekends, there were largely no significant discrepancies in the management and care of patients admitted with ACS on weekdays and during morning hours compared with patients admitted on weekends and night hours, and the overall 30-day and 1-year mortality was similar between both the cohorts.

We estimated the prevalence of cardiovascular disease (CVD) risk and its clinical implications among 1 110 Omani patients with type 2 diabetes mellitus (DM) using 2 different CVD risk tools: the general Framingham risk profile (GFRP) and the joint World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts. The GFRP tool identified higher proportion of patients compared with joint WHO/ISH tool at 10-year CVD risk 10% to

Although antiplatelet therapy effectively reduces ischemic events, the cardiovascular (CV) outcome in some cases is still unpredictable. The objective of this study was to evaluate the impact of prior single or dual antiplatelet (PAP) use in patients presenting with acute coronary syndromes (ACS). Data were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were grouped according to whether they were PAP users or not (NAP). Patients’ characteristics and outcomes were analyzed and compared. Mortality was assessed at 1 and 12 months. Among 7827 consecutive ACS patients, 41% were PAP users (70% aspirin, 1% clopidogrel, and 29% dual antiplatelet agents). In comparison with NAP use, PAP use was associated with a higher rate of comorbidities, atypical presentation, severe left ventricular dysfunction, three-vessel disease, and a high GRACE risk score. After adjustment for relevant covariates, PAP use was an independent predictor for recurrent ischemia in unstable angina (odds ratio [OR] 1.7; 95% CI 1.17, 2.57) and non-ST-elevation myocardial infarction (NSTEMI) [OR 1.9; 95% CI 1.38, 2.65] and for heart failure in NSTEMI (OR 1.5; 95% CI 1.11, 2.15) and STEMI (OR 1.4; 95% CI 1.08, 1.93). Although PAP use was associated with high mortality in STEMI and NSTEMI, it was not an independent predictor for mortality. Among PAP patients, percutaneous coronary intervention independently reduced the risk of hospital (adjusted OR 0.25; 95% CI 0.20, 0.32), 1-month (OR 0.31; 95% CI 0.26, 0.37), and 12-month mortality (OR 0.28; 95% CI 0.24, 0.33). PAP use identified a high-risk population across the ACS spectrum. Early coronary revascularization may improve CV outcomes in these patients.

Hypertension is a significant predictor for cardiovascular diseases and is the most important preventable or modifiable cause of morbidity and mortality from these diseases. Undiagnosed cases of hypertension and poor control are important factors in controlling hypertension worldwide, including Oman.The aim of this study was to identify the important risk factors and predictors of the state of unawareness of the presence of hypertension, as well as the risk factors for poor control of blood pressure, among hypertensive patients.Data from Oman World Health Survey (OWHS), 2008, were used in this study. The OWHS adopted a multistage stratified cluster sampling to select study participants. An interview questionnaire was used to collect data related to risk factors. Other parameters included blood pressure, anthropometric and biochemical measurements.The prevalence of hypertension in Oman was estimated to be 41.5%. Of those who were hypertensive, three-quarters of them (75.7%) were unaware of being hypertensive and 65.5% of them had inadequately controlled hypertension. Male sex, higher wealth, and paying fewer visits to health facilities were found associated with high proportions of unawareness and high proportion of uncontrolled hypertension.The study highlights high levels of unawareness of being hypertensive and high proportion of uncontrolled hypertension in Oman that need to be considered when developing health policies and strategies. Intersectorial collaborative and innovative strategies that focus on improving awareness, detection, and control of hypertension should be considered, especially with attention to young adults and men.

Background: Acute Coronary Syndrome (ACS) can occur in patients with prior coronary artery bypass grafting (CABG). In the Gulf Registry of acute coronary events (Gulf RACE), we identified the clinical characteristics and in- hospital outcomes of these patients. Methods: Clinical characteristics and in-hospital outcomes for 461 ACS patients with prior CABG are compared to 7715 ACS patients without prior CABG enrolled from 64 hospitals in 6 Gulf countries over a 6-month period. Results: The overall incidence of ACS with prior CABG was 5.6% out of 8176 patients. The ACS with prior CABG were older (63 vs 55 years, P

We describe the baseline characteristics, management, and outcomes of acute coronary syndrome (ACS) in patients of age ≤40 in the Gulf region of the Middle East. We studied 8176 hospitalized patients (≤40 years) with ACS. Ten percent (805) of the recruited patients were ≤40 years. The mean age was 37 years and 89% were males. The prevalence of smoking and diabetes in the young patients was high (58% and 21%, respectively). The most common ACS was ST elevation myocardial infarction. Younger patients were more aggressively treated with more frequent use of glycoprotein inhibitors, thrombolytics, and primary percutaneous coronary intervention. They had less in-hospital heart failure, left ventricular dysfunction, shock, stroke, and low rate of in-hospital mortality (1%). Measures to combat the rising prevalence of diabetes and smoking are needed.

The aim was to report the prevalence and significance of hypertension (HTN) in patients with acute coronary syndrome (ACS).Over a 6-month period in 2007, 8171 consecutive patients (49.4% hypertensive and 50.6% non-hypertensive) presenting with ACS were enrolled in a prospective, multicenter study from six Middle Eastern adjacent countries. Patients with HTN were older (59.2 vs 53.1 years, p0.001), and more likely to be female (34% vs 14.4%, p0.001) when compared with patients without HTN. Patients with HTN were also more likely to have diabetes mellitus, hyperlipidemia, cerebrovascular disease, prior history of coronary artery disease, peripheral artery disease but less likely to be cigarette smokers. At admission, HTN patients had higher Killip class, heart rate and GRACE risk scoring. In-hospital mortality was higher in hypertensive patients with ST-elevation myocardial infarction (STEMI) but not in patients with non-STEMI or unstable angina. The incidence of heart failure complications was significantly higher among patients with HTN in overall ACS type (OR = 1.2, 95% CI 1.001-1.338, p= 0.04).In this large cohort of patients with ACS, HTN was an independent predictor of heart failure and was associated with an increased rate of in-hospital mortality in STEMI only.

J Clin Hypertens (Greenwich). The objective of this study was to evaluate the prevalence and effect of the metabolic syndrome (MetS) on patients with acute coronary syndrome (ACS) in six Middle Eastern countries using the new definition of MetS. Analysis of the Gulf Registry of Acute Coronary Events (Gulf RACE), which included 8716 consecutive patients hospitalized with ACS, was conducted and patients were divided into two groups: patients with and patients without the MetS. Overall, 46% of patients had MetS. Patients with MetS were more likely to be female and less likely to be smokers. In‐hospital mortality and cardiogenic shock were comparable between the two groups, although MetS patients were more likely to have congestive heart failure and recurrent ischemia. In ST‐elevation myocardial infarction, MetS was also associated with increased risk of recurrent myocardial infarction and stroke. Using the recent MetS definition, MetS is highly prevalent among Middle Eastern patients presenting with ACS. MetS is associated with higher‐risk profile characteristics and increased risk for development of heart failure and recurrent myocardial ischemia without an increase in hospital mortality. J Clin Hypertens (Greenwich). 2010;12:890–899.

The aim of this study was to evaluate the gender differences in baseline characteristics, therapy, and outcomes in patients with acute coronary syndromes in 6 Middle Eastern countries. Over a 6-month period in 2007, 8,169 consecutive patients (74% men, 24% women) presenting with acute coronary syndromes were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. Women were 9 years older than men and more likely to have diabetes, hypertension, and dyslipidemia. Women were more likely to present with unstable angina and more often had atypical presentations of ST elevation myocardial infarction. Compared to men, women were significantly less treated with beta blockers and antiplatelet therapy, whereas reperfusion therapy was nonsignificantly less used in women. In all patients with acute coronary syndromes, women not only ranked higher on Global Registry of Acute Coronary Events risk score but also had increased in-hospital mortality, 1.75 times that of men. This mortality difference persisted after adjusting for all confounders (odds ratios 1.76, 95% confidence interval 1.1 to 2.8, p0.01). In conclusion, in addition to presentation with higher risk factors, female gender also independently predicted poorer outcomes in patients with ST elevation myocardial infarction.

We describe the patterns of cancer incidence for common cancers in Gulf Cooperation Council countries during 1998-2001. A total of 32,291 cases of cancer were diagnosed (16,342 in males; 15,949 in females). Male preponderance was observed only in Saudi Arabia and Oman. The age-standardized incidence of all malignancies per 100,000 in both sexes was highest in Qatar followed by Bahrain, Kuwait, Oman, UAE and Saudi Arabia. Paediatric cancer ranged from 9.5% of total cancers in Saudi Arabia and UAE to 4.0% in Bahrain. In all countries, the mean age at diagnosis was higher in males than females; cancer of the lung and prostate were commonest among males, and cancer of breast and thyroid among females. Lung cancer ranked second among Bahraini women.

Tobacco use among Omani physicians and dentists has not been studied, so we conducted a cross-sectional survey using a WHO questionnaire to measure prevalence and to learn about smoking practices among this population and about their knowledge and attitudes of the health effects of tobacco use and tobacco control. The 1191 subjects who participated (787 men and 404 women) ranged in age from 24 to 65 years with a mean (SD) of 41.7 (6.8) years for men and 38.1 (6.9) years for women. The prevalence of tobacco use was 16.4% among males and less than 1% among females. Manufactured cigarettes were the most common form of tobacco used (14.7%), followed by smokeless tobacco (2.2%) and waterpipes (1.7%). Tobacco users were significantly less favorable to strict control and policy measures than never tobacco users and had less knowledge of some of the heatlh effects of tobacco use. Tobacco use among physicians and dentists in Oman is lower than in other countries in the region, but remains a cause of concern. Programs and policies should strive to maintain the low level of tobacco use or reduce it further.

We aimed to determine the gender-specific optimal cut-points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with risk of cardiovascular disease, using Framingham risk score and receiver-operating characteristic (ROC) analysis, among Omani Arabs. Nine percent of men, compared to 3% of women, had a 10-year total coronary heart disease (CHD) risk ≥ 20%. In both genders, WHR was a better predictor of CHD (area under the ROC curve 0.771 for men and 0.802 for women), followed by WC (0.710 and 0.727) and BMI (0.601 and 0.639), respectively. For a 10-year CHD risk of ≥ 20%, the optimal cut-points to assess adiposity in Omani men and women were > 22.6 and 22.9 kg/m2for BMI, > 78.5 and 84.5 cm for WC, and > 0.96 and > 0.98 for WHR, respectively. To identify obesity among Omani Arabs, different cut-points for BMI, WC and WHR than the currently recommended ones are needed.

Access to glycosylated hemoglobin (HbA1c) assays in clinical practice remains limited. We investigated the relationship of fasting plasma glucose and HbA1c to determine optimal glucose levels for predicting HbA1c.We retrospectively analyzed data on 2888 patients with type 2 diabetes mellitus agedor=20 years using a linear regression of HbA1c against fasting plasma glucose. A receiver-operating characteristic analysis was used to determine optimal cut-points for fasting glucose in relation to HbA1c, area under the curve, sensitivity and specificity, and 95% confidence intervals (CI) for each cut-point.The mean (standard deviation) for the age of patients was 52+/-11.6 years. The average HbA1c was 8.9+/-2.46% and mean fasting plasma glucose was 10.1+/-3.62 mmol/L. The prevalence of HbA1cor=7.0% and6.5% was 76% and 82%, respectively. Overall, fasting plasma glucose and HbA1c were linearly correlated (r=0.62, P=0.001). A fasting plasma glucose of9.0 mmol/L predicted HbA1cor=7.0% with an area under the curve = 0.807 (95% CI, 0. 0.794 to 0.821), while fasting plasma glucose8.2 mmol/L predicted HbA1c6.5%, with an area under the curve = 0.805 (95% CI, 0.791 to 0.818). The sensitivity of both cut-points was 64.5% and 70.7%, the specificity was 82.7% and 76.4%, the positive likelihood ratio was 3.73 and 2.99, and the positive predictive value was 92.2% and 93.2%, respectively.When HbA1c determination is not available, fasting plasma glucose levels may be used to identify patients with uncontrolled type 2 diabetes and initiate timely intensification of therapy to avoid long- term complications of diabetes.