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Abstract Magnesium (Mg) is a vital trace element in cellular processes, including glucose metabolism and insulin action. This study aimed to assess the prevalence of dysmagnesemia among patients with type 2 diabetes mellitus (T2DM) and its relationship with glycaemic control and diabetic complications. A cross-sectional study was conducted at Sultan Qaboos University Hospital (SQUH) from August 1, 2023, to April 30, 2024. The study included adult patients with T2DM treated with oral hypoglycemic agents (OHA), insulin, glucagon-like-peptide 1 (GLP-1) injections or their combinations. Both ionized (iMg) and total (tMg) concentrations were measured and the iMg/tMg ratio was calculated. A total of 329 patients with T2DM of which179 females (54.4%), were studied. Hypomagnesemia was observed in 10.0% based on iMg concentrations and 56.2% based on tMg concentrations, while hypermagnesemia was observed in 11.85% (iMg) and 1.82% (tMg). A positive correlation was found between iMg and tMg (r = 0.589, p

Abstract Heart failure (HF) is a global epidemic with a prevalence of over 64.3 million cases worldwide. Several factors account for the increase in the prevalence of HF. The most significant factor is the growing population of older adults. Other factors include improved treatment and survival after myocardial infarction, poorly controlled hypertension (HTN), and diabetes mellitus (DM). As a modifiable construct, perceived control can be improved to promote healthier lifestyle choices, such as self-care, and consequently better health outcomes. A person’s perception of control is their conviction that they have the power to deal with adverse circumstances, like receiving an HF diagnosis, and produce favorable results, such as an improvement in symptom status. The objective of this study was to evaluate the factors influencing perceived control attitudes among patients with heart failure in Oman. In this sample of HF patients (N = 180), the mean perceived control attitude was 16.97 ± 2.25. Certain factors had higher effects than others. For example, females (p = 0.006), old age (p

Objectives:To evaluate the prognostic value (total mortality + repeated hospitalization for heart failure (HF)) of ultrasound diagnostic methods in patients with acute decompensated HF (ADHF). Methods: The subjects were patients with chronic HF, who were hospitalized for ADHF. Using ultrasound methods—lung ultrasound, ultrasound assessment of hepatic venous congestion as per the venous excess ultrasound (VExUS) protocol, and indirect elastometry—we assessed the number of B-lines, hepatic venous congestion, and liver density of the patients. Clinical outcomes were assessed using a structured telephone survey method at 1, 3, 6, and 12 months after discharge. Combined overall mortality and readmission rates associated with HF were assessed. Threshold values for different methods for detecting congestion were set as follows: the number of B-lines in ultrasound data > 5; liver density > 6.2 kPa. Results: The subjects were 207 patients (54.1% male; mean age = 70.7 ± 12.8 years). A total of 63 (30.4%) endpoints and 23 (11.1%) deaths were detected within 364 days (IQR = 197–365). Liver density > 6.2 kPa had a hazard ratio (HR) of 1.9 ( 95% CI: 1.0–3.3; p =0.029). Hepatic venous congestion (VExUS protocol) had HR of 2.8 (95% CI: 1.3–5.7; p =0.004). There was a significant increase in the risk of overall prognostic value in the presence of congestion, identified by liver fibroelastometry + lung ultrasound (HR = 10.5, 95% CI: 2.3–46.2; p =0.002). The ultrasound assessment of hepatic venous congestion (VExUS + lung ultrasound protocol) yielded HR of 16.7 (95% CI: 3.9–70.7; p < 0.001). For all three methods combined, the overall HR was 40.1 (95% CI: 6.6–243.1; p < 0.001). Conclusions: A combination of ultrasound diagnostic methods that include the number of B-lines, presence of hepatic venous congestion according to the VExUS protocol, and liver density according to indirect elastometry at discharge may have an independent prognostic value for patients with ADHF.

Objectives: Patient-centered clinical pharmacists’ activities play a major role in improving clinical outcomes by optimizing the efficacy of drug therapies and minimizing associated toxicities during hospitalization, at the transition of care, and upon discharge. We aimed to compare the impact of comprehensive versus partial clinical pharmacists-driven bundled of care services on the rate of 90-day hospital readmissions and emergency department (ED) visits. Methods: This retrospective study included all admitted patients who received a comprehensive or partial bundle of clinical pharmacy services (medication history, interventions, counseling, and discharge prescription review) from 1 January 2021 to 30 June 2021 at Sultan Qaboos University Hospital. The comprehensive bundle of care included the four services, while the partial bundle of care included one, two, or three services only. Analyses were performed using univariate and multivariate statistical techniques. Results: The study included 430 patients with a mean age of 56.0±21.0 years, and 43.7% (n = 188) were male. Of the patients, 12.1% (n = 52) received a comprehensive bundle of care. Compared with the partial bundle of care group, the comprehensive bundle of care group had significantly more patients with diabetes (65.4% vs. 42.9%; p =0.002), ≥ 3 comorbidities (50.0% vs. 29.4%; p =0.003), and polypharmacy (≥ 5 medications) (73.1% vs. 46.0%; p < 0.001). The comprehensive bundle of care group was significantly associated with a lower 90-day readmission rate (adjusted odds ratio (aOR) = 0.27, 95% CI: 0.90–0.82; p =0.021) but not with ED visits (aOR = 0.57, 95% CI: 0.13–2.57; p =0.461). Conclusions: This study demonstrated a significant reduction in the 90-day readmission rate for patients on a comprehensive bundle of care but not ED visits. These findings emphasize the importance of the comprehensive services provided by clinical pharmacists on the healthcare resources use and clinical outcomes.

Objectives: The Rajan’s heart failure (R-hf) score was proposed to aid risk stratification in heart failure patients. The aim of this study was to validate R-hf risk score in patients with acute decompensated heart failure. Methods: R-hf risk score is derived from the product estimated glomerular filtration rate (mL/min), left ventricular ejection fraction (%), and hemoglobin levels (g/dL) divided by N-terminal pro-brain natriuretic peptide (pg/mL). This was a multinational, multicenter, prospective registry of heart failure from seven countries in the Middle East. Univariable and multivariable logistic regression was applied. Results: A total of 776 patients (mean age = 62.0±14.0 years, 62.4% males; mean left ventricular ejection fraction = 33.0±14.0%) were included. Of these, 459 (59.1%) presented with acute decompensated chronic heart failure. The R-hf risk score group (≤ 5) was marginally associated with a higher risk of all-cause cumulative mortality at three months (adjusted odds ratio (aOR) = 4.28; 95% CI: 0.90–20.30; p =0.067) and significantly at 12 months (aOR = 3.84; 95% CI: 1.23–12.00; p =0.021) when compared to those with the highest R score group (≥ 50). Conclusions: Lower R-hf risk scores are associated with increased risk of all-cause cumulative mortality at three and 12 months.

Summary: Background: Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference values of arterial stiffness as assessed by pulse wave velocity (PWV). Methods: Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy participants published in three electronic databases between database inception and August 24th, 2020 were included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument. Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for Location, Scale, and Shape. Findings: The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included. PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval: 12.1–12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11–7.79 m/s) for cfPWV. Males had higher global levels than females of 0.77 m/s for baPWV (95% CI: 0.75–0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33–0.37 m/s), but sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s, P

Objectives: This study sought to determine whether early prone positioning of patients with moderate to severe COVID-19-related acute respiratory distress syndrome (ARDS) lowers the mortality rate. Methods: We conducted a retrospective study using data from intensive care units of two tertiary centers in Oman. Adult patients with moderate to severe COVID-19-related ARDS with a PaO2/FiO2 ratio < 150 on FiO2 of 60% or more and a positive end-expiratory pressure of at least 8 cm H2O who were admitted between 1 May 2020 and 31 October 2020 were selected as participants. All patients were intubated and subjected to mechanical ventilation within 48 hours of admission and placed in either prone or supine position. Mortality was measured and compared between the patients from the two groups. Results: A total of 235 patients were included (120 in the prone group and 115 in the supine group). There were no significant differences in mortality (48.3% vs. 47.8%; p =0.938) and discharge rates (50.8% vs. 51.3%; p =0.942) between the prone and supine groups, respectively. Conclusions: Early prone positioning of patients with COVID-19-related ARDS does not result in a significant reduction in mortality.

Objectives: Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19. Methods: A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI). Results: The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p =0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI. Conclusions: Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI.

Objectives: To study the quantum and pattern of the COVID-19-related medical research publications that had contributions from researchers in Oman, using bibliometric analysis. Methods: Data on the COVID-19-related medical research publications with contributions from authors in Oman were sourced from the Scopus database. The main search keywords were ‘COVID-19’ and ‘Oman’. The search included data from 1 December 2019 till 21 August 2021. A bibliometric method utilizing citation analysis and science mapping was applied to the selected data. VOSviewer software was used for constructing and visualizing various bibliometric networks. Results: The search query returned 360 documents which included those by authors from Oman. After excluding 83 of these due to irrelevance, 277 documents were finally selected for analysis. Three macro research themes emerged: treatment of COVID-19 cases, epidemiology and impact of COVID-19, and etiology and clinical manifestations of COVID-19. A total of 4533 sources were cited in the selected 277 documents. Most articles were published in the International Journal of Infectious Diseases (IJID),followed byOman Medical Journal, and SultanQaboos University Medical Journal. The most cited references included theLancet,followed by theNew England Journal of Medicine,and the Journal of the American Medical Association. The largest number of papers were authored by researchers from Sultan Qaboos University followed by the Oman Ministry of Health. Regarding the number of citations received per paper, the top rank went to the Ministry of Health, followed by Sultan Qaboos University Hospital and Khoula Hospital. Conclusions: Oman has significantly contributed to the COVID-19-related medical knowledge despite the challenges of conducting research amidst the increased workload during the pandemic. Most publications in Oman were collaborative projects. Based on the evaluated literature, further research focusing on vaccines and therapeutics is warranted.

Abstract. This study aimed to report on the use, predictors and outcomes of guideline-based medical therapy (GBMT) in patients with acute heart failure (HF) with reduced ejection fraction of

Objectives: We sought to estimate the percentage achievements of non-high-density lipoprotein cholesterol (non-HDL-C) target in patients with very high atherosclerotic cardiovascular diseases (ASCVD) risk stratified by triglyceride (TG) levels despite statin-controlled low-density lipoprotein cholesterol (LDL-C) in the Centralized Pan-Middle East Survey on the under treatment of hypercholesterolemia. Methods: The non-HDL-C target achievement in patients with diabetes mellites (DM) and patients with established ASCVD was defined according to European Society of Cardiology and European Atherosclerosis Society 2019 guidelines for managing dyslipidemia. Patients were stratified to controlled LDL-C defined as < 70 mg/dL (< 1.8 mmol/L) with normal TG < 150 mg/dL (< 1.7 mmol/L) and high TG between 150–400 mg/dL (1.7–4.5 mmol/L). Results: The mean age of our cohort was 58.0±11.0 years, 6.8% (n = 717) were male, 9.7% (104) were smokers, and 48.4% (n = 518) had body mass index of ≥ 30 kg/m2. Those with high TG levels male (76.5% vs. 63.8%; p < 0.001), smokers (16.1% vs. 7.7%; p < 0.001), have metabolic syndrome (77.6% vs. 17.1%; p < 0.001), and low HDL-C levels (79.2% vs. 49.4%; p < 0.001). The majority (93.9%, n = 1008) were on statins (atorvastatin and rosuvastatin) with only 2.2% (n = 24) on the combined statins plus fenofibrate/gemfibrozil. Only 27.4% (n = 294) of patients had non-HDL-C goal attainment. Goal attainment rates in patients with diabetes (3.1% vs. 34,4%; p < 0.001), coronary artery disease (CAD) (2.4% vs. 37.9%; p < 0.001), diabetes plus CAD (0% vs. 40.0%; p < 0.001), and CVD (0% vs. 30.0%; p =0.048) were significantly lower in those with higher TG levels. Conclusions: A large proportion of statin-controlled LDL-C diabetic patients and patients with established ASCVD with high TGs did not achieve the non-HDL-C target. Our study did not demonstrate an association between ASCVD and high TG levels; and therefore, a follow-up study is highly required to assess long-term ASCVD outcomes in this cohort.

Objectives: Anaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman. Methods: This retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records. Results: One hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0–16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1–0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25–8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0–972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p =0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p =0.010). Conclusions: Due to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

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.

Objectives: Dengue fever (DF) is the most common arthropod-borne viral illness with significant public health implications that can cause severe clinical symptoms and possibly death. We sought to determine the epidemiological and clinical characteristics of patients presented with DF to the Royal Hospital in a recent outbreak in Oman. Methods: We conducted a retrospective cohort study between 1 January and 18 April 2022, at the Royal Hospital, Oman, including all patients who presented with febrile illness and laboratory-confirmed DF. Descriptive statistics were used to summarize the results. Results: The cohort included 58 patients with laboratory-confirmed DF, of whom 39 (67.2%) required admission. The overall mean age was 41.0±20.0 years. Over half (55.2%) were females and the majority (86.2%) were Omani citizens. Eighty-one percent of the patients were residents of Bawshar in Muscat governorate. Dengue virus 2 was the isolated serotype. Fever (98.3%), muscular aches and pains (55.2%), and headache (53.4%) were the most common symptoms on presentation. All patients except two had no travel history. The most common comorbidities were hypertension (29.3%) and diabetes mellitus (17.2%). Upon admission, the most prominent hematological and biochemical abnormalities were severe thrombocytopenia (31.0%) with platelet counts of < 50 000/mm3 and hepatic impairment (15.5%). Antibiotics were prescribed to 27.6% of the patients. All patients improved clinically, and no deaths were reported during the study period. Conclusions: Fever and thrombocytopenia were the commonest presentations of DF. Identification of factors linked to increased risk of hospitalization in patients with DF can assist in recognizing individuals who need close monitoring and intensive support.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved into a pandemic affecting virtually every country in the world. We evaluated the demographic, clinical, laboratory, and all-cause mortality of moderate and severe COVID-19 patients admitted to a tertiary care hospital in Oman during the different COVID-19 waves and variant types. (2) Methods: A case-series retrospective study was carried out between 12 March 2020 and 30 June 2022. All adults over the age of 18 with laboratory-confirmed COVID-19 were enrolled. Analyses were performed using univariate and multivariate statistics. (3) Results: A total of 1462 confirmed cases enrolled with the mean age of the cohort was 55 ± 17 years with significant differences among the groups (p = 0.006). A total of 63% and 80% of the patients were males and citizens of Oman, respectively. Patients infected with the Alpha COVID-19 variant type were more likely to have acute respiratory distress syndrome (ARDS) (p < 0.001), stay longer in the hospital (p < 0.001), and get admitted to the intensive care unit (ICU) (p < 0.001). At the same time, those who had the Omicron COVID-19 type were more likely to have renal impairment (p < 0.001) and less likely to be associated with non-invasive ventilation (NIV) (p = 0.001) compared with other COVID-19 variant types. The Delta (adjusted odds ratio (aOR), 1.8; 95% confidence interval (CI): 1.22–2.66; p = 0.003) and Omicron (aOR, 1.88; 95% CI: 1.09–3.22; p = 0.022) COVID-19 variant types were associated with higher all-cause mortality when compared to the initial COVID-19 variant. Old age (aOR, 1.05; 95% CI: 1.04–1.06; p < 0.001), the presence of respiratory disease (aOR, 1.58; 95% CI: 1.02–2.44; p = 0.04), ICU admission (aOR, 3.41; 95% CI: 2.16–5.39; p < 0.001), lower eGFR (aOR, 1.61; 95% CI: 1.17–2.23; p = 0.004), and ARDS (aOR, 5.75; 95% CI: 3.69–8.98; p < 0.001) were also associated with higher mortality while NIV requirements were associated with lower odds of dying (aOR, 0.65; 95% CI: 0.46–0.91; p = 0.012). (4) Conclusions: Alpha and Delta variants were associated with a longer hospital stay, need for intensive care, mechanical ventilation, and increased mortality. Old age, cardiac renal dysfunction were commonly associated with Omicron variants. Large-scale national studies to further assess the risk factors for mortality related to COVID-19 waves are warranted.

Objectives: The novel severe acute respiratory syndrome coronavirus 2 pandemic continues to spread globally without an effective treatment. In search of the cure, convalescent plasma (CP) containing protective antibodies from survivors of coronavirus disease 2019 (COVID-19) infection has shown potential benefit in a non-intensive care unit setting. We sought to evaluate the effectiveness of CP therapy for patients with COVID-19 on mechanical ventilation (MV) and/or acute respiratory distress syndrome (ARDS). Methods: We conducted an open-label trial in a single center, Royal Hospital, in Oman. The study was conducted from 17 April to 20 June 2020. The trial included 94 participants with laboratory-confirmed COVID-19. The primary outcomes included extubation rates, discharges from the hospital and overall mortality, while secondary outcomes were the length of stay and improvement in respiratory and laboratory parameters. Analyses were performed using univariate statistics. Results: The overall mean age of the cohort was 50.0±15.0 years, and 90.4% (n = 85) were males. A total of 77.7% (n = 73) of patients received CP. Those on CP were associated with a higher extubation rate (35.6% vs. 76.2%; p < 0.001), higher extubation/home discharges rate (64.4% vs. 23.8%; p =0.001), and tendency towards lower overall mortality (19.2% vs. 28.6%; p =0.354; study power = 11.0%) when compared to COVID-19 patients that did not receive CP. Conclusions: CP was associated with higher extubation/home discharges and a tendency towards lower overall mortality when compared to those that did not receive CP in COVID-19 patients on MV or in those with ARDS. Further studies are warranted to corroborate our findings.

Objectives: We sought to determine the estimated glomerular filtration rate (eGFR) among patients with COVID-19 and to examine its correlation with different demographic, clinical, and laboratory characteristics. Methods: This study examined patients diagnosed with COVID-19 and enrolled at Al Kuwait Hospital, Dubai, UAE. eGFR was calculated using the Modification of Diet in Renal Disease equation, 186 × (SCr mg/dL)-1.154 × (age)-0203 × 0.742 [if female] × 1.212 [if black], and compared for 250 COVID-19 cases and 153 non-COVID-19 controls. Analysis were performed using univariate statistics. Results: The overall mean age of the cohort was 47.2±14.0 years, and 54.6% (n = 220) were males. The results showed that 45.3% of COVID-19 patients had mild-severe renal impairment, as reflected in the eGFR. When compared to patients with normal eGFR, those with severe renal impairment were older (62.5 vs. 40.2 years; p < 0.001), more likely to be male (100% vs. 71.1%; p = 0.016), and have comorbidities (90.9% vs. 40.0%; p < 0.001) including diabetes mellitus (72.7% vs. 21.5%; p < 0.001) and hypertension (72.7% vs. 25.2%; p = 0.003). They were also more likely to be associated with those that had severe (36.4% vs. 25.9%; p < 0.001) and critical (63.6% vs. 16.3%; p < 0.001) COVID-19 infection as well as intensive care unit admission (72.7% vs. 16.3%; p < 0.001). Correlational analysis showed a significant association between renal function indicators and different laboratory markers, including hematological indices and different liver enzymes. Conclusions: This is the first study to examine the renal function among COVID-19 cases in the Middle East. Nearly half of COVID-19 patients had moderate to severe renal impairment. Diabetes mellitus and hypertension were the most common underlying comorbidities associated with moderate-severe renal function impairment among COVID-19 patients.

Background and aimsFamilial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain).MethodsThe multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up.ResultsAmong 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p ConclusionsThis snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a "call-to-action" for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.

Objectives: We sought to identify the epidemiological characteristics of the first case series of patients with COVID-19 in Oman. Methods: We included national surveillance data of patients with laboratory-confirmed COVID-19 from 24 February to 17 April 2020. Analyses were performed using descriptive and univariate statistics. Results: Of the 1304 patients studied, the mean age was 37.0±13.0 years old, 80.3% were males, and 35.8% were Omanis. The other mostly affected nationalities were Indian (29.1%), Bangladeshi (20.0%), and Pakistani (10.7%). Out of the total, 80.1% were from the Muscat governorate. Omani patients were significantly more likely to be males than females and aged between 20 and 59 years old (p < 0.001). On presentation, 95.9% cases were mild, 3.6% moderate, and 0.5% severe. The case fatality rate was 0.5%. All deaths were from Muscat governorate; four from Mutrah, one from A'Seeb, and one from Bawshar. Conclusions: This case series provides epidemiological characteristics as well as the early outcomes of patients with laboratory-confirmed COVID-19.

Objectives: We sought to describe the clinical and genetic characteristics of patients with familial hypercholesterolemia (FH) that presented to the lipid clinic at Sultan Qaboos University Hospital, Muscat, Oman. Methods: Patients who presented with high low-density lipoprotein cholesterol (LDL-C) levels (> 189.0 mg/dL or 4.9 mmol/L) were recruited to the study. FH was diagnosed according to the Dutch Lipid Clinic Network criteria. Analyses were performed using univariate statistics. Results: The study enrolled 450 patients with a mean age of 48.0±12.0 years, 56.0% (n = 252) were males and 11.3% (n = 51) were smokers. At admission, the proportion of ‘probable/definite’, ‘possible’, and ‘unlikely’ FH were 27.6% (n = 124), 70.0% (n = 315), and 2.4% (n = 11), respectively. Overall, 26.0% (n = 117) of patients had hypertension, 22.4% (n = 101) had a history of coronary artery disease, and 17.3% (n = 78) had diabetes mellitus. Those with ‘probable/definite’ FH were more likely to be prescribed high-intensity statin therapy (75.8% vs. 54.5%; p < 0.001) and statin ezetimibe combination (50.8% vs. 27.3%; p < 0.001) when compared to the ‘unlikely’ FH cohort. Additionally, those with very high atherosclerotic vascular disease (ASCVD) risk were also associated with high-intensity statin therapy (54.7% vs. 42.7%; p = 0.006) and statin ezetimibe combination (26.4% vs. 17.2%; p = 0.023). Patients with ‘probable/definite’ FH were less likely to achieve their LDL-C goal attainment compared to those with ‘unlikely’ FH (13.0% vs. 57.1%; p < 0.001). Furthermore, those with very high ASCVD risk were less likely to achieve their LDL-C goals compared to the high ASCVD risk cohort (9.6% vs. 32.0%; p < 0.001). Conclusions: FH patients are underdiagnosed, undertreated, and less likely to attain their LDL-C goals in Oman.

Objectives: This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods: This retrospective crosssectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results: A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6–95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P

Objectives: In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates. Methods: We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization (WHO) staging, laboratory analyses, and treatment outcomes. Results: The overall mean age of the cohort was 36.0±15.0 years, and 60.4% (n = 197) were males. The majority of patients acquired HIV through heterosexual transmission (58.9%; n = 192). At the time of the first clinic visit, 26.1% (n = 85) of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was < 200 cells/mm3 in 38.0% (n = 124) of patients, 201–500 cells/mm3 in 30.1% (n = 99) of patients, and > 500 cells/mm

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.

Objectives: Systemic lupus erythematous (SLE) is a chronic autoimmune disease that affects women primarily of childbearing age. The objective of this study was to determine the neonatal and maternal outcomes of pregnancies in SLE patients compared to pregnancies in healthy controls. Methods: We conducted a retrospective cohort study in a tertiary care hospital in Oman between January 2007 and December 2013. We analyzed 147 pregnancies and compared 56 (38.0%) pregnancies in women with SLE with 91 (61.9%) pregnancies in healthy control women. Disease activity was determined using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Results: The mean age of the cohort was 30.0±5.0 years ranging from 19 to 44 years old. Patients with SLE were treated with hydroxychloroquine (n = 41; 73.2%), prednisolone (n = 38; 67.8%), and azathioprine (n = 17; 30.3%). There was no disease activity in 39.2% (n = 22) of patients while 41.0% (n = 23), 12.5% (n = 7), and 7.1% (n = 4) had mild (SLEDAI 1–5), moderate (SLEDAI 6–10), and severe (SLEDAI ≥ 11) disease activity, respectively, at onset of pregnancy. Pregnancies in patients with SLE were associated with higher abortions (42.8% vs. 15.3%; p < 0.001), gestational diabetes (28.3% vs. 10.2%; p = 0.004), polyhydramnios (7.1% vs. 0.0%; p = 0.020), previous preterm pregnancies (8.9% vs. 1.0%; p = 0.030), and intrauterine growth retardation (21.4% vs. 0.0%; p < 0.001) when compared to pregnancies in healthy control women. Furthermore, the neonates born to mothers with SLE were more likely to be preterm (28.5% vs. 1.0%; p < 0.001), have a low birth weight (< 2500 g) (32.1% vs. 1.0%; p < 0.001), and were associated with stillbirth (7.1% vs. 0.0%; p = 0.010) when compared to neonates born to healthy control mothers. Conclusions: Pregnancies in women with SLE were associated with higher neonatal and maternal complications. Therefore, pregnant women with SLE should have their pregnancy accurately planned, monitored, and managed according to a multidisciplinary treatment schedule.

Objectives: To determine the characteristics of patients presenting with chronic pain in a primary health care setting in Oman. Methods: A retrospective cross-sectional study was carried out including all patients aged ≥ 18 years who attended Sultan Qaboos University Health Center during 2010. Patients were identified to have chronic pain if they were prescribed an analgesic medication for at least three months. Patients were compared to a control group which consisted of age- and gender-matched patients with no chronic pain. Results: Out of 6 609 patients, 241 (3.6%) were found to have chronic pain. The mean age of patients with chronic pain was 54.0±13.0 years. The majority of patients were female (n = 174; 72.1%), and most were Omani (n = 201; 83.4%). The prevalence of chronic pain was found to be significantly higher among females compared to males (4.5% vs. 2.5%; p < 0.001) and also among Omani nationals to non-nationals (83.4% vs. 70.1%; p < 0.001). Chronic pain was significantly associated with the following comorbidities; diabetes (33.1% vs. 20.7%; p < 0.001), obesity (35.2% vs. 26.5%; p = 0.001), and hypertension (51.0% vs. 38.5%; p = 0.002). Osteoarthritis was the most common pain condition (n = 104; 43.1%). Diclofenac was the most commonly prescribed drug (n = 168; 69.7%). Conclusions: The findings of our study point towards a higher prevalence of chronic pain in Omani females. These patients were also found to have a higher prevalence of other common comorbid conditions.

Objectives: We sought to estimate the mortality and morbidity in diabetic acute heart failure (AHF) patients stratified by left ventricular ejection fraction. Methods: We analyzed the data of patients with AHF from seven Middle Eastern countries (Bahrain, Oman, Yemen, Kuwait, UAE, Qatar, and Saudi Arabia) from February to November 2012, who were enrolled in a multinational registry of patients with heart failure (HF). Results: A total of 2258 AHF patients had diabetes mellitus. The mean age was 63.0±11.0 years (ranging from 18 to 99 years), and 60.3% (n = 1362) of the patients were males. The mean ejection fraction (EF) was 37.0±13.0%. HF with reduced EF (< 40%) (HFrEF) was observed in 1268 patients (56.2%), whereas 515 patients (22.8%) had mid-range (40–49%) (HFmrEF) and 475 patients (21.0%) had preserved EF (≥ 50%) (HFpEF). The overall cumulative all-cause mortalities at three- and 12-months follow-up were 11.8% (n = 266) and 20.7% (n = 467), respectively. Those with HFpEF were associated with lower three-months cumulative all-cause mortality compared to those with HFrEF (7.6% vs. 5.9%; adjusted odds ratio (aOR) = 0.54, 95% confidence interval (CI): 0.31–0.95; p =0.031), but not significantly different when compared to those with HFmrEF (aOR = 0.86, 95% CI: 0.53–1.40; p =0.554). There were largely no significant differences among the groups with regards to the 12-months all-cause cumulative mortality (11% vs. 11% vs. 10%; p =0.984). There were also no significant differences in re-hospitalization rates between the three HF groups not only at three months (23% vs. 20% vs. 22%; p =0.520), but at one-year follow-up (28% vs. 30% vs. 32%; p =0.335). Conclusions: Three-month cumulative all-cause mortality was high in diabetic HFrEF patients when compared to those with HFpEF. However, there were no significant differences in mortality at one-year follow-up between the HF groups. There were also no significant differences in re-hospitalization rates between the HF groups not only at three months but also at one-year follow-up in the Middle East.

Objectives: Data on the prevalence of tuberculosis (TB) in healthcare workers (HCW) in Oman and the Arabian Gulf is scarce. The aim of this study was to estimate the prevalence of latent tuberculosis (LTB) among HCW exposed to active TB in one of the tertiary care hospitals in Muscat. Methods: Exposed HCW were screened for LTB from January to June 2012 using skin tuberculin and serum interferon tests. Candidates were followed-up for a total of nine months. Descriptive statistics were used to summarize the data. Results: A total of 371 exposed HCW were involved in the study. The incidence of LTB in exposed HCW was 33.2% (n = 123). Almost 54% (66/123) of the HCW started treatment and only 42.4% (28/66) completed the full nine-month treatment course. Conclusions: The high prevalence of LTBI in exposed HCW merits further evaluation of the screening and treatment programs in the country. Future countrywide studies are warranted to provide more precise statistics on the prevalence and management of this public health issue.

Objectives: We sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF) as part of the Gulf aCute heArt failuRe rEgistry (CARE) project. Methods: Data were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012. Results: The mean age of our patients was 63±12 years. Over half (57%) were male and 95% were Omani citizens. Fifty-seven percent of patients presented with acute decompensated chronic heart failure (ADCHF) while 43% had new-onset AHF. The primary comorbid conditions were hypertension (72%), coronary artery disease (55%), and diabetes mellitus (53%). Ischemic heart disease (IHD), hypertensive heart disease, and idiopathic cardiomyopathy were the most common etiologies of AHF in Oman. The median left ventricular ejection fraction of the cohort was 36% (27–45%) with 56% of the patients having heart failure with reduced ejection fraction (< 40%). Atrial fibrillation was seen in 15% of patients. Acute coronary syndrome (ACS) and non-compliance with medications were the most common precipitating factors. At discharge, angiotensin converting enzyme inhibitors and beta-blockers were prescribed adequately, but aldosterone antagonists were under prescribed. Within 12-months follow-up, one in two patients were rehospitalized for AHF. In-hospital mortality was 7.1%, which doubled to 15.7% at three months and reached 26.4% at one-year post discharge. Conclusions: Oman CARE was the first prospective multicenter registry of AHF in Oman and showed that heart failure (HF) patients present at a younger age with recurrent ADCHF and HF with reduced ejection fraction. IHD was the most common etiology of HF with a low prevalence of AHF, but a high prevalence of acute coronary syndrome and non-compliance with medications precipitating HF. A quarter of patients died at one-year follow-up even though at discharge medical therapy was nearly optimal. Our study indicates an urgent need for prevention, early diagnosis, and treatment of AHF in Oman.

There is a spurt of interest in research productivity in the Gulf Cooperation Council (GCC) to lay the foundation for national development. From a global perspective, increased research productivity could conceivably be accompanied by an exponential increase in research misconduct (RM). Inevitably, erroneous or falsified data will be expected to adversely affect public health by misleading policy makers and clinicians alike into embarking on health policy and allocation of resources that are byproducts of RM. This will contribute significantly to the emerging crisis of confidence of the public in the integrity of scientific research. For a long time, RM has been considered only as plagiarism or data fabrication and falsification. However, the concept of RM nowadays encompasses more and, in this review, we discuss its possible implications in emerging economies, such as those of the GCC countries. We suggest that GCC countries ought to consider implementing remedial and punitive policies to deal with RM.

Objectives: Antimicrobial stewardship programs have been designed to measure and improve the use of antimicrobials to achieve optimal clinical outcomes and reduce bacterial resistance. The aim of this study was to review patterns of antimicrobial prescribing for hospitalized patients in the acute care setting and assess the appropriateness of antimicrobial use among prescribers in a tertiary care hospital in Oman. Methods: We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a four-week period (1 November to 28 November 2012). The data of all discharged patients were retrieved from the department databases. Patient records and prescriptions were reviewed by an infectious disease consultant. The rationality of antimicrobial use was evaluated, analyzed, and judged based on local standard guidelines and the experience of the evaluating consultant. Results: There were 178 patients discharged from acute medical teams over the study period. Sixty-four percent of the patients received a total of 287 antimicrobial agents during admission. The average number of antimicrobials prescribed per patient in those prescribed antimicrobials was 2.5±1.1. The most commonly prescribed antimicrobial agent was piperacillin/tazobactam. Most patients had infections from gram-negative organisms, and high rates of extended spectrum beta-lactamase producing organisms were observed. Cultures were obtained before antimicrobial initiation in 25% of patients. Variability in antimicrobial selection for common infections was observed. Conclusions: National guidelines for the management of common infections are needed to minimize the overuse and misuse of antimicrobial agents in tertiary care hospitals. A large surveillance study on antimicrobial prescribing appropriateness in different hospital settings is warranted.

Objectives: Parenteral nutrition-associated cholestasis (PNAC) is one of the most challenging complications of prolonged parenteral nutrition (PN) in neonates. There is a lack of research investigating its incidence in newborn infants in Oman and the Arab region. Therefore, this study aimed to assess the incidence of PNAC and its risk factors in Omani neonates. Methods: This retrospective study took place between January and April 2014. All neonates who received PN for ≥14 days during a four-year period (June 2009 to May 2013) at the neonatal intensive care unit (NICU) in Sultan Qaboos University Hospital, Muscat, Oman, were enrolled. Results: A total of 1,857 neonates were admitted to the NICU over the study period and 135 neonates (7.3%) received PN for ≥14 days. Determining the incidence of PNAC was only possible in 97 neonates; of these, 38 (39%) had PNAC. The main risk factors associated with PNAC were duration of PN, duration of enteral starvation, gastrointestinal surgeries, blood transfusions and sepsis. Neonates with PNAC had a slightly higher incidence of necrotising enterocolitis in comparison to those without PNAC. Conclusion: This study found a PNAC incidence of 39% in Omani neonates. There were several significant risk factors for PNAC in Omani neonates; however, after logistic regression analysis, only total PN duration remained statistically significant. Preventive strategies should be implemented in NICUs so as to avoid future chronic liver disease in this population.

Objectives: Regular blood transfusions are essential for patients with thalassaemia major. However, infections with hepatotropic viruses remain a major concern. The objective of this study was to evaluate the prevalence and characteristics of hepatitis C viral (HCV) infection among patients with homozygous beta thalassaemia in a single centre in Oman. Methods: A retrospective chart review of 200 patients treated at the Thalassemia Unit of Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, between August 1991 and December 2011 was performed. Relevant demographic and clinical characteristics were collected, including age, gender, HCV status and the presence of endocrinopathies. Results: A total of 81 patients (41%) were found to be anti-HCV-antibody (anti-HCV)-positive. HCV ribonucleic acid tests were performed on 65 anti-HCV-positive patients and were positive among 33 (51%); the remaining 16 patients died before these tests were available. Anti-HCV-positive patients were significantly older than anti-HCV-negative patients (P

Objectives: This study aimed to evaluate antibiotic prescribing patterns for paediatric patients at Sultan Qaboos University Hospital (SQUH), a tertiary care hospital in Muscat, Oman. Methods: This retrospective cross-sectional study included all 1,186 prescriptions issued for 499 patients at the paediatric outpatient clinic and paediatric inpatient ward at SQUH between March and May 2012. Results: Of the 499 patients, 138 (27.6%) were prescribed a total of 28 different antibiotics. A total of 185 (15.6%) antibiotic prescriptions were issued among the total drug prescriptions. Preschool children aged 0–6 years were prescribed antibiotics most frequently (n = 110). Co-amoxiclav was the most commonly prescribed antibiotic in both inpatients and outpatients (27.0% and 33.9%, respectively), followed by cefuroxime in inpatients (13.5%) and azithromycin in outpatients (18.6%). Co-amoxiclav was the most commonly prescribed antibiotic in both 0–6 (31.3%) and 7–11 (23.3%) year-olds, while cefuroxime was most commonly prescribed in children ≥12 years old (25.0%). Conclusion: Antibiotic prescription patterns in this population were similar to those in North America, Europe and Asia. To confirm the findings of this study, further research on antibiotic prescription trends across the wider paediatric population of Oman should be initiated.

Objective: To illustrate the patient safety culture in Oman as gleaned via 12 indices of patient safety culture derived from the Hospital Survey on Patient Safety Culture (HSPSC) and to compare the average positive response rates in patient safety culture between Oman and the USA, Taiwan, and Lebanon. Methods: This was a cross-sectional research study employed to gauge the performance of HSPSC safety indices among health workers representing five secondary and tertiary care hospitals in the northern region of Oman. The participants (n=398) represented different professional designations of hospital staff. Analyses were performed using univariate statistics. Results: The overall average positive response rate for the 12 patient safety culture dimensions of the HSPSC survey in Oman was 58%. The indices from HSPSC that were endorsed the highest included ‘organizational learning and continuous improvement’ while conversely, ‘non-punitive response to errors’ was ranked the least. There were no significant differences in average positive response rates between Oman and the United States (58% vs. 61%; p=0.666), Taiwan (58% vs. 64%; p=0.386), and Lebanon (58% vs. 61%; p=0.666). Conclusion: This study provides the first empirical study on patient safety culture in Oman which is similar to those rates reported elsewhere. It highlights the specific strengths and weaknesses which may stem from the specific milieu prevailing in Oman.

ypertension (HTN), also known as high blood pressure (BP), is a global public health concern. It is associated with significant morbidity and mortality contributing to coronary heart disease (CHD), stroke, and kidney failure as well as premature death and disability. In 2008, the World Health Organization (WHO) approximated that 40% of adults, aged ≥ 25 years, had been diagnosed with HTN with the prevalence highest in Africa (46%) and lowest in the USA (35%). In the WHO Eastern Mediterranean Region, the prevalence of HTN was estimated at 42%. There has been a progressive increase in the prevalence of HTN in Oman in the last few decades. Recent data from the Oman World Health Survey estimated the prevalence of HTN in Oman at 41.5% compared to 27% reported by the National Blood Pressure Survey, which was conducted in 1991. This increased prevalence is in parallel with increases in obesity and other cardiometabolic diseases as a sequel for aging and changes in diet and lifestyle.

Subjects with Familial hypercholesterolemia are at increased risk for cardiac events such as premature myocardial infarction and early death from coronary heart disease, especially in patients with severe forms of the disease if left unattended. Therefore, there is an ardent need for the early diagnosis followed by aggressive therapeutic intervention and lifestyle modification. Three groups have developed clinical diagnostic tools for Familial hypercholesterolemia: the US MedPed Program, the Simon Broome Register Group in the United Kingdom, and the Dutch Lipid Clinic Network. In this article, the individual criteria are reviewed with particular emphasis on their advantage(s) and disadvantage(s), and in turn assess their suitability in diagnosing Familial hypercholesterolemia in the Omani Arab population. A brief insight into the process of "Cascade Screening" is also provided, this is a procedure that we are in the process of establishing in Oman.

Objective: Few studies have examined clinical and demographic profile of attendees of a walk-in psychiatric clinic in countries ravaged by wars. The aim of this study is to quantify the characteristics of attendees of an open walk-in psychiatric clinic in a general hospital in Baghdad and the suburb towns of Iraq in the year 2010.Methods: As part of a retrospective survey, information on specific variables (socio-demographic background, clinical characteristics and attendance rate) were sought from medical records in the year 2010 (January to December).Results: Despite the shortcomings expected from a country coming out of the ravage of war, the survey included 2,979 attendees (1,864 [63%] males and 1,115 [37%] females) of a walk-in psychiatric clinic who fulfilled the inclusion criteria. The profile of attendees indicated that a majority of the cohort was self-referred with a predominance of employed males, aged 19 to 49 years, residing in Baghdad City. Depression and psychosis were the most common diagnosis given.Conclusion: The observed patterns are discussed within the available literature relevant to consultation liaison psychiatry, and specific to situations in Iraq and Arab/Islamic cultural patterning.

Objective: Published studies on the prevalence of celiac disease in type 1 diabetes mellitus from the Arab World are scant. We aim to report the prevalence of celiac disease in Omani children with type 1 diabetes mellitus.Methods: Children with type 1 diabetes mellitus were prospectively screened for celiac disease, at Sultan Qaboos University Hospital, Muscat, Oman over a period of one year (June 2011 - May 2012). Serum anti tissue transglutaminase IgA, endomysial IgA antibodies and total IgA were measured for screening of celiac disease. Children with positive anti-tissue transglutaminase and/or endomysial IgA antibodies underwent endoscopy.Results: A total of 103 children with type 1 diabetes mellitus were initially included. Ten patients were lost to follow up. Ninety-three patients aged 2-17 years underwent screening for celiac disease. Sixteen patients had positive anti-tissue transglutaminase (17%). Fourteen patients underwent endoscopy with duodenal biopsies, while two were lost to follow-up. Five patients with positive anti-tissue transglutaminase had intestinal biopsy proven celiac disease. The prevalence of celiac disease is 5.5% in our cohort of children and adolescents with type 1 diabetes mellitus.Conclusions: The prevalence of celiac disease in Omani children and adolescents with type 1 diabetes mellitus is similar to the World’s reported prevalence, but is less than that reported for Middle Eastern Arab children. To our knowledge, this is the first reported study on the prevalence of celiac disease in Omani children with type 1 diabetes mellitus.

Objectives: Pathways to care or care-seeking, which translate into healthcare utilisation, have been investigated in many parts of the world, but there is a dearth of studies in the Arabian Gulf. The aim of this study was to examine the characteristics of attendees at primary healthcare centres in northern Oman and their reasons for visiting. Methods: Face-to-face interviews were conducted with 676 participants attending 12 primary healthcare centres between June and July 2006. The catchment area was selected to represent the population structure in Oman. The 12-item questionnaire was read to every fifth eligible patient entering each healthcare centre for a routine appointment. Analyses were conducted using univariate statistics. Results: About a third (n = 200; 29.6%) of the participants had a history of chronic illness; 231 (34%) were on regular medications; 211 (31%) were taking part in health education programmes; 130 (19%) were open to complementary medicine. The majority of the participants mentioned physician's advice (n = 570; 84%) as the strongest reason for seeking consultation. Conversely, physician's advice was strongly related to particular demographic factors.Conclusion: This observational study identified some characteristics and reasons for visiting healthcare facilities in northern Oman. These are discussed within the context of prevailing sociocultural factors. The implications for the prevention and detection of ill health in Oman are also discussed.

Objective: While SLE is found worldwide, there is diversity in clinical presentation of the disease according to geographical variations. The aim of this study is to describe geographical distributions of childhood onset SLE within Oman to identify geographical clustering and to compare the demographic, clinical, and immunological characteristics of this cluster against the rest of Oman.Methods: We retrospectively reviewed the hospital charts of 104 consecutive children with childhood onset SLE who were seen in pediatric rheumatology centers in the Sultanate of Oman over a 15-year period between 1995 and 2010.Results: Geographical clustering of childhood onset SLE was identified in Sharqiya region, which constituted 41% (n=43) of all cases in Oman. This cohort of patients had characteristic disease features which consisted of significantly more boys affected with SLE compared to the rest of the country (42% versus 15%; p=0.002). These children also tended to be younger (10.3 versus 16.5 years; p=0.001), diagnosed at an earlier age (6.4 versus 9.4 years; p

Differences in the management of atrial fibrillation (AF) between men and women were investigated by using Gulf SAFE data in the Middle East. The study included 2,043 patients presenting with AF to emergency room (ER) were prospectively enrolled and followed for one-year. Women were older, have higher body mass index (BMI), comorbidities, and health complications than men. With regard to management of AF, cardioversion was recommended more often for men (16.7% vs. 9.3%), and underwent electrical cardioversion (2.2% vs. 1.1%). Women were prescribed digoxin more frequently than men (25.6% vs. 17.4%) and a significant number women received warfarin alone (31.1% vs. 8.7%). No difference between the sexes was noticed in One-year rates of stroke/transient ischemic attacks (TIA) and all-cause of mortality after one-year follow-up (3.1% men vs. 3.3% women, and 7.5% vs. 7.4%). Older age (≥ 65 years), smoking, alcohol use, CHADS2 scores ≥5 were some of the significant risk factors in men with AF. Suboptimal use of anticoagulants, higher mortality and stroke/TIA events at one year are high but similar between the sexes. ER management revealed high use of rate control strategy and high rate of hospital admission was noticed in women.

Background: Fatalities from road traffic crashes (RTCs) are a public health challenge for low- and middle-income countries, especially those experiencing epidemiological transition. This paper aims to describe demographics and trend analysis of fatalities of RTCs in Oman from 1995 to 2009. Methods: The RTC data from 1995 to 2009 were obtained from the published reports of the Royal Oman Police (ROP). Data were extracted on the distribution of deaths by age, sex, nationality, mode of travel (driver, passenger, pedestrians), and type of vehicle (four- vs. two-wheelers). Trend analyses were carried out using the Chi-square for the percentages of deaths and linear regression for rates. Results: A total of 9,616 deaths from RTCs were reported from 1995 to 2009. Of 9,616 fatalities, 4,666 (48.5%) were aged 26-50 years, 7,927 (82.4%) were males, 7,215 (75.0%) were Omanis, and 2,278 (23.8%) were pedestrians. Overall, mortality increased by around 50% from 479 deaths during 1995 to 953 deaths during 2009. There was a significant increase in the proportion of deaths ( P < 0.05) and death rates ( P < 0.05) among individuals aged 26-50 years, males, Omani nationals, and drivers. The number and rate of RTC fatalities due to overspeeding was also increased ( P < 0.05). Conclusions: Fatalities due to RTCs in Oman are increasing, especially among those aged 26-50 years, males, drivers, and Omani nationals with overspeeding as a major cause of road traffic fatalities. There is a need for more research in understanding the risk-taking behaviors of young drivers, and sociocultural factors, especially among Omani nationals to target interventions.