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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.

This study aimed to evaluate the clinical outcomes of patients with acute heart failure (AHF) stratified by mitral regurgitation (MR) in the Arabian Gulf. Patients from the Gulf CARE registry were identified from 47 hospitals in seven Arabian Gulf countries (Yemen, Oman, Kuwait, Qatar, Bahrain, the United Arab Emirates, and Saudi Arabia) from February to November 2012. The cohort was stratified into two groups based on the presence of MR. Univariable and multivariable statistical analyses were performed. The population cohort included 5005 consecutive patients presenting with AHF, of whom 1491 (29.8 %) had concomitant MR. The mean age of patients with AHF and concomitant MR was 59.2 ± 14.9 years, and 63.1 % (n = 2886) were male. A total of 58.6 % (n = 2683) had heart failure (HF) with reduced ejection fraction (EF) (HFrEF), 21.0 % (n = 961) had HF with mildly reduced EF (HFmrEF), and 20.4 % (n = 932) had HF with preserved EF (HFpEF). Patients with MR had a lower haemoglobin (Hb) level (12.4 vs. 12.7 g/dL; p

Abstract Background Cardiovascular diseases are responsible for a significant proportion of mortalities worldwide. Elderly patients are the most affected by cardiovascular diseases, and because of factors such as polypharmacy, multimorbidity, and age-related changes in drug availability and metabolism, they are highly susceptible to the occurrence of drug–drug interactions. Drug–drug interactions are among the many drug-related problems leading to negative outcomes among inpatients and outpatients. Thus, it is important to investigate the prevalence, involved drugs, and factors related to potential drug–drug interactions (pDDIs) to properly optimize pharmacotherapy regimens for these patients. Objective We aimed to determine the prevalence of pDDIs, drugs most frequently implicated, and significant predictors associated with these interactions among hospitalized patients in the Cardiology Unit at Sultan Qaboos University Hospital in Muscat, Oman. Methods This retrospective cross-sectional study included 215 patients. Micromedex Drug-Reax® was used to identify pDDIs. Data extracted from patients’ medical records were collected and analyzed. Univariable and multivariable linear regression was applied to determine the predictors associated with the observed pDDIs. Results A total of 2057 pDDIs were identified, with a median of nine (5–12) pDDIs per patient. Patients with at least one pDDI accounted for 97.2% of all the included patients. The majority of pDDIs were of major severity (52.6%), fair level of documentation (45.5%), and pharmacodynamic basis (55.9%). Potential drug–drug interactions between atorvastatin and clopidogrel were the most frequently observed (9%). Of all the detected pDDIs, around 79.6% of them included at least one antiplatelet drug. Having diabetes mellitus as a comorbidity (B = 2.564, p < 0.001) and the number of drugs taken during the hospitalization period (B = 0.562, p < 0.001) were factors positively associated with the frequency of pDDIs. Conclusions Potential drug–drug interactions were highly prevalent among hospitalized cardiac patients at Sultan Qaboos University Hospital, Muscat, Oman. Patients having diabetes as a comorbidity and with a high number of administered drugs were at a higher risk of an increased number of pDDIs.

This study explored parents’ attitudes towards vaccinating their children against COVID-19 and the rate of vaccine hesitancy in Oman. A cross-sectional, online, self-administered questionnaire, previously validated and administered between June 2021 and May 2022, was used. The questionnaire consisted of nine items. Parents of children younger than 12 years were eligible for participation. A total of 384 participants, including 207 males (54%), completed the questionnaire, resulting in an 86% response rate (384/447). The results showed that 69% of participants were hesitant to vaccinate their children aged 1–11 years. In parents of children aged 1–4 years, vaccination status was significantly associated with vaccine hesitancy (odds ratio [OR], 0.116; 95% confidence interval [CI], 0.044–0.306; p = 0.001). Furthermore, after multivariable analysis, compared to the fathers, mothers were significantly less likely to be associated with vaccine hesitancy (OR, 0.451; 95% CI, 0.240–0.848; p = 0.013).

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.

Chronic kidney disease (CKD) is a global health challenge, with a reported prevalence of around 10%. Prescribing for patients receiving hemodialysis (HD) is challenging and complicated by polypharmacy, comorbidities, and changes in clearance of medications. The aim of this study was to evaluate antibiotics utilization patterns and dosage appropriateness in patients receiving HD at a tertiary hospital. A retrospective study was carried on 287 adult inpatients, who received HD and at least one antibiotic in a tertiary hospital in Oman. Data were extracted using the hospital’s electronic patient information system. Dosage appropriateness was assessed by identifying the dosage and frequency of prescribed antibiotics and comparing them with international guidelines. The main outcome measures were antibiotics utilization patterns and dosing inappropriateness. The most commonly prescribed parenteral antibiotic was piperacillin + tazobactam (20%), while the most common prescribed oral antibiotic was azithromycin (41.7%). For prophylaxis, cefazolin (54.6%) was the main antibiotic prescribed. The most commonly used antibiotic for external use was mupirocin ointment (38.5%). The overall dosing inappropriateness was 29.5%. Vancomycin was the most common parenteral antibiotic subjected to dosing inappropriateness (19.8%). However, trimethoprim + sulfamethoxazole was more inappropriately prescribed among the oral route (28.6%).In conclusion, the most utilized antibiotic was piperacillin + tazobactam followed by vancomycin. The study reported some inappropriate dosing of antibiotics. Such a study opens the door for the establishment of local guidelines for the improved practice of antibiotics use in HD patients.

Antimicrobial resistance (AMR), a serious global public health challenge, may have accelerated development during the COVID-19 pandemic because antibiotics were prescribed for COVID-19. This study aimed to assess antibiotics use before and during the pandemic and correlate the results with the rate of resistant microorganisms detected in hospitalized patients during the study period. This single-center study looked retrospectively at four years of data (2018–2021) from Royal Hospital, Muscat, which is the biggest hospital in Oman with approximately 60,000 hospital admissions yearly. The consumption rate of ceftriaxone, piperacillin tazobactam, meropenem, and vancomycin was presented as the antibiotic consumption index, the ratio of defined daily dose (DDD) per 100 bed days. Analyses were performed using the nonparametric test for trend across the study period. Correlation between antibiotic consumption indexes and the isolated microorganisms in the four-year study period was performed using Spearman’s rank correlation coefficient. We compared data from the pre-COVID-19 to the COVID-19 period. Though more patients were admitted pre-COVID-19 (132,828 versus 119,191 during COVID-19), more antibiotics were consumed during the pandemic (7350 versus 7915); vancomycin and ceftriaxone had higher consumption during than before the pandemic (p-values 0.001 and 0.036, respectively). Vancomycin-resistant Enterococcus (VRE) and Candida auris were detected more during the COVID-19 period with p-values of 0.026 and 0.004, respectively. Carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococcus spp., and C. auris were detected more often during the pandemic with p-values of 0.011, 0.002, and 0.03, respectively. Significant positive correlations between antibiotic consumption and drug-resistant isolates were noted. This study confirms that the overuse of antibiotics triggers the development of bacterial resistance; our results emphasize the importance of antibiotic control.

This study aimed to determine the stability of refrigerated analytes of iMg concentration at different time intervals and to establish iMg reference range in a cohort of healthy Omani volunteers (≥18 years). The concentrations of iMg were measured using the direct ion-selective electrode technique. Pearson’s and Lin’s concordance correlation coefficients along with the Bland–Altman plot were used to assess the levels of agreement between iMg concentrations of fresh and refrigerated blood samples at different time intervals. The study included 167 volunteers (51% females) with a median age of 21 (range: 20–25) years. The median, 2.5th, and 97.5th percentiles for fresh iMg reference ranges were 0.55, 0.47, and 0.68 mmol/L, respectively. The overall agreement between the fresh and refrigerated iMg concentrations was poor (rho-c = 0.51; p < 0.001). However, according to Altman’s definition, iMg concentrations of the refrigerated samples for a period of ≤1 h had an excellent correlation with the fresh iMg concentrations (Lin’s rho-c = 0.80), with a small average bias difference of 0.009 (95%CI; −0.025–0.043). A cut-off refrigeration period within ≤1 h at 2–8 °C can be considered an alternate time frame for the gold standard measurement (fresh or within 0.5 h).

Abstract Background The ACR 1997, SLICC 2012 and EULAR/ACR 2019 classification criteria were validated based on adult patients. To date, there are no classification criteria specific for children with SLE. The aim of the study is to compare the performance characteristics among the three SLE classification criteria (ACR-1997, SLICC-2012 and EULAR/ACR-2019) in childhood onset SLE (cSLE) cohort of Arab ethnicity from Oman. Methods We conducted a retrospective multicenter study in Oman of cSLE patients as cases and patients with other rheumatic disease with a positive ANA titer as controls. The cSLE cases recruited were children diagnosed with SLE before 13 years of age. Data was retrospectively collected to establish the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria fulfilled at first visit, first year follow up and last follow up. Results Study population included 113 cSLE cases (mean age at diagnosis of 7.3 ± 3.4 years with disease duration of 6.1 ± 4.6 years) and 51 controls (mean age at diagnosis 5.0 ± 3.4 with disease duration 5.7 ± 3.9). The cSLE cases had higher frequency of familial SLE than controls (38% vs 7.8%; p

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.

Objective: To evaluate the clinical and financial impact of clinical pharmacists’ interventions (CPIs) on antimicrobial use at a 500-bed multidisciplinary tertiary care hospital in Oman. Methods: A retrospective analysis of CPIs related to antimicrobials use at Sultan Qaboos University Hospital (SQUH) from January to December 2018. Interventions were recorded using an electronic CPI form and were reviewed by two independent CPs. Data on the type and clinical significance of the interventions were extracted. Cost analysis was done using a previously defined cost avoidance model in addition to direct cost reduction estimation. Descriptive data were used to describe the results. Results: In 2018, 26% of CPIs were related to antimicrobial use, with more than 60% of these interventions done on intensive care unit patients. The most common intervention type was adjusting the dosing regimen (42% of the total interventions), followed by deletion of the antimicrobial order in 34% of the cases. The most common clinical impact of CPIs was improving efficacy in 45% of the interventions, followed by preventing unnecessary exposure to the antimicrobials in around 30% of the interventions. The interventions were of major significance in 64% of the cases. This translated into a projected net cost saving of approximately $200,000 USD/year. Conclusions: CPs interventions on antimicrobial use had a positive impact on both the clinical and financial outcomes.

Background: The severity and mortality from COVID-19 infection vary among populations. The aim of this study was to determine the prevalence and predictors of mortality among patients hospitalized with COVID-19 infection in a tertiary care hospital in Oman. Methods: We conducted a retrospective study using database that included: demographic, clinical characteristics, laboratory parameters, medications and clinical outcomes of all patients hospitalized in Royal Hospital, Muscat, Oman, between March 12, 2020 and December 1st 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk of death of COVID-19 infected patients. Results: In total,1002 patients with COVID-19 infection with mean age of the cohort was 54 ± 16 years (65% (n = 650) male) were included, with an overall and intensive care unit (ICU) mortalities of 26% (n = 257) and 42% (n = 199/473), respectively. The prevalence of ICU admission was 47% (n = 473) and the need for mechanical ventilation was 41% (n = 413). The overall length of stay in the ICU was 13 (9–21) days. Adjusting for other factors in the model, the multivariable logistic regression demonstrated that in-hospital mortality in admitted COVID-19 patients was associated with old age (p

Objectives: To identify risk factors and outcomes of patients with critical pertussis. Design: Retrospective observational cohort study. Setting: Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman. Subjects: Children aged

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: International cardiovascular guidelines recommend prescribing a combination of five evidence-based medications (EBM) for acute coronary syndrome (ACS) patients post-revascularization. This study aims to assess the prevalence and impact of prescribing the full (five medications) versus partial (four medications or fewer) EBM combination on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS post-revascularization. Methods: Data from patients with ACS who had revascularization between January 2016 and September 2021 were collected retrospectively. Patients were then followed up until March 2022 for MACCE. Results: The full EBM combination was prescribed to 70% of the patients. However, after taking into account the presence of contraindications and clinical factors, the actual adherence to the guidelines was 95%. Patients who received the full EBM combination were younger (58 versus 62 years; p = 0.0 and 3) and had lower rates of chronic kidney disease (11% versus 41%; p < 0.001) and heart failure (9% versus 20%; p = 0.012) when compared to patients who received the partial EBM. Compared to the partial EBM group, the full EBM group was associated with lower MACCE rates (54% versus 37%, p = 0.012). After employing the propensity score technique utilizing the 1:1 nearest neighbor matching method without replacement, the univariate findings were further re-affirmed with those on full EBMs (compared to those on partial EBMs) associated with a significant reduction in the MACCE rate (average treatment effect of −25%; 95% confidence interval: −10–−40%; p = 0.001). Conclusions: The full EBM utilization was significantly high in our setting and in line with international guidelines. The full EBM combination was predominantly prescribed in younger and less comorbid patients and was associated with lower MACCE rates. The findings were further reaffirmed by the propensity score matching method.

Objective: To evaluate the therapeutic effectiveness of favipiravir combined with inhaled interferon beta-1b in adult patients hospitalized with moderate to severe COVID-19 pneumonia. Methods: A randomized, open-label controlled trial of oral favipiravir in adults hospitalized with moderate to severe COVID-19 pneumonia from June 22nd 2020 to August 13th 2020 was conducted. Patients were randomly assigned to receive either a combination of favipiravir with interferon beta-1b by inhalation aerosol or hydroxychloroquine (HCQ). The outcome endpoints included improvement in inflammatory markers, lower length of hospital stay (LOS), discharges and lower overall 14-day mortality. Results: A total of 89 patients underwent randomization with 49% (n = 44) assigned to favipiravir and 51% (n = 45) assigned HCQ. The overall mean age was 55 ± 14 years and 58% (n = 52) were males. There were no significant differences in the inflammatory biomarkers at hospital discharge between the two groups; C-reactive protein (p = 0.413), ferritin (p = 0.968), lactate dehydrogenase (p = 0.259) and interleukin 6 (p = 0.410). There were also no significant differences between the two groups with regards to the overall LOS (7 vs 7 days; p = 0.948), transfers to the ICU (18.2% vs 17.8%; p = 0.960), discharges (65.9% vs 68.9%; p = 0.764) and overall mortality (11.4% vs 13.3%; p = 0.778). Conclusions: No differences in clinical outcomes were found between favipiravir plus inhaled interferon beta-1b and hydroxychloroquine in adults hospitalized with moderate to severe COVID-19 pneumonia.

Abstract Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in‐hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence‐based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in‐hospital death (1.6%), and after 1 year of follow‐up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.

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.

Objective: To evaluate the therapeutic use of plasma exchange in COVID-19 patients compared to controls. Methods: A case series of critically ill adult men and non-pregnant women, ≥18 years of age, with laboratory-confirmed COVID-19, was studied at the Royal Hospital, Oman, from April 17 to May 11, 2020. Therapeutic plasma exchange (TPE) was performed on patients admitted to the intensive care unit (ICU) with confirmed or imminent acute respiratory distress syndrome (ARDS) or severe pneumonia. The analysis was performed using univariate statistics. Results: A total of 31 COVID-19 patients were included with an overall mean age of 51 ± 15 years (range: 27–76 years); 90% (n = 28) were males, and 35% (n = 11) of the patients had TPE as a mode of treatment. The TPE group was associated with higher extubation rates than the non-TPE cohort (73% versus 20%; p = 0.018). Additionally, patients on TPE had a lower 14 days (0 versus 35%; p = 0.033) and 28 days (0 versus 35%; p = 0.033) post plasma exchange mortality compared to patients not on TPE. However, all-cause mortality was only marginally lower in the TPE group compared to the non-TPE group (9.1% versus 45%; p = 0.055; power = 66%). Laboratory and ventilatory parameters also improved post TPE (n = 11). Conclusions: The use of TPE in severe COVID-19 patients has been associated with improved outcomes, however, randomized controlled clinical trials are warranted to draw final, conclusive findings.

Introduction: To identify the clinical characteristics and outcomes of hospitalized patients with COVID-19 in Oman. Methods: A case series of hospitalized COVID-19 laboratory-confirmed patients between February 24th through April 24th, 2020, from two hospitals in Oman. Analyses were performed using univariate statistics. Results: The cohort included 63 patients with an overall mean age of 48 ± 16 years and 84% (n = 53) were males. A total of 38% (n = 24) of the hospitalized patients were admitted to intensive care unit (ICU). Fifty one percent (n = 32) of patients had at least one co-morbidity with diabetes mellitus (DM) (32%; n = 20) and hypertension (32%; n = 20) as the most common co-morbidities followed by chronic heart and renal diseases (12.8%; n = 8). The most common presenting symptoms at onset of illness were fever (84%; n = 53), cough (75%; n = 47) and shortness of breaths (59%; n = 37). All except two patients (97%; n = 61) were treated with either chloroquine or hydroxychloroquine, while the three most prescribed antibiotics were ceftriaxone (79%; n = 50), azithromycin (71%; n = 45), and the piperacillin/tazobactam combination (49%; n = 31). A total of 59% (n = 37), 49% (n = 31) and 24% (n = 15) of the patients were on lopinavir/ritonavir, interferons, or steroids, respectively. Mortality was documented in (8%; n = 5) of the patients while 68% (n = 43) of the study cohort recovered. Mortality was associated with those that were admitted to ICU (19% vs 0; p = 0.009), mechanically ventilated (31% vs 0; p = 0.001), had DM (20% vs 2.3%; p = 0.032), older (62 vs 47 years; p = 0.045), had high total bilirubin (43% vs 2.3%; p = 0.007) and those with high C-reactive protein (186 vs 90 mg/dL; p = 0.009) and low corrected calcium (15% vs 0%; p = 0.047). Conclusions: ICU admission, those on mechanical ventilation, the elderly, those with high total bilirubin and low corrected calcium were associated with high mortality in hospitalized COVID-19 patients.

Objectives: The aim of this study was to evaluate the use of meropenem in terms of indication and continuation of treatment at Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Methods: A retrospective observational study, conducted by reviewing the medical records of 400 adults, admitted patients who received at least one dose of meropenem during the study period (January 2017 to September 2017). The analysis was performed using univariate statistics. Results: Meropenem was prescribed empirically in 382/400 (96%) of the cases. The majority (315/361 (87%)) of the patients received the proper meropenem dose. The indication for meropenem was considered appropriate in only 196/400 (49%) of the cases. The continuation of treatment was evaluated according to culture and sensitivity results in 202 cases, out of which 112 (55%) were justified. Most of the inappropriate uses were seen in oncology and hematology cases (31/42 (74%) and 61/101 (60%), respectively) and among respiratory and urinary tract infections (126/155 (81%) and 40/46 (87%), respectively). Conclusions: Approximately half of the meropenem orders at SQUH in Oman were inappropriate and unjustified by culture-test results. New strategies are needed to optimize the rational use of meropenem and to ensure appropriate de-escalation and discontinuation of meropenem whenever indicated.

Abstract Background Few recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America. Methods This analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries. Results The proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption. Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p

Abstract Aims The aim of this study is to determine the impact of diabetes mellitus on all‐cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). Methods and results We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (

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: 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.

(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: 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.

Objectives: Pharmaceutical interventions are implicit components of the enhanced role that clinical pharmacists provide in clinical settings. We aimed to study the clinical significance and analyze the presumed cost avoidance achieved by clinical pharmacists’ interventions. Methods: A retrospective study of documented clinical pharmacists’ interventions at a tertiary care hospital in Oman was conducted between January and March 2022. The interventions were electronically recorded in the patients’ medical records as routine practice by clinical pharmacists. Data on clinical outcomes were extracted and analyzed. Cost implications were cross checked by another clinical pharmacist, and then, cost avoidance was calculated using the Rx Medi-Trend system values. Results: A total of 2032 interventions were analyzed, and 97% of them were accepted by the treating physicians. Around 30% of the accepted interventions were for antimicrobials, and the most common type was dosage adjustment (30%). Treatment efficacy was enhanced in 60% and toxicity was avoided in 22% of the interventions. The presumed cost avoided during the study period was USD 110,000 with a projected annual cost avoidance of approximately USD 440,000. Conclusion: There was an overall positive clinical and financial impact of clinical pharmacists’ interventions. Most interventions have prevented moderate or major harm with a high physician acceptance rate. Optimal documentation of the interventions is crucial for emphasizing clinical pharmacists’ value in multi-specialty hospitals.

Background: Identifying and quantifying potentially inappropriate prescribing (PIP) practices remains a time-consuming and challenging task, particularly among the pediatric population. In recent years, several valuable tools have been developed and validated for assessing PIP. This study aimed to determine the prevalence of PIP and related risk factors in pediatric patients at a tertiary care hospital in Oman. Materials and Methods: A retrospective study was conducted by reviewing the medical records of pediatric patients (Results: A total of 685 patients were included; 57.5% were male, and 30.5% had at least one comorbidity. Polypharmacy was identified in 70.2% of these patients, with a median of 2 (1–3) medications. PIM was observed in 20.4% of the cohort, with the highest in ENT-pulmonary disease (30.5%), followed by dermatological disorders (28.6%). PPO was identified in 6.9% of the patients with digestive and neuropsychiatric disorders, with the highest rate of 54% and 24%, respectively. Age (p = 0.006), number of medications (p = 0.034), and prescriber rank (p = 0.006) were identified as significant predictors of PIM, whereas age (p = 0.044) was the only significant predictor for PPO. Conclusions: The rates of PIM and PPO were high in this study population. In light of these findings, educational and interventional activities and programs are needed.

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: 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.

Aim: As Coronavirus Disease-2019 (COVID-19) pandemic continues to evolve, the search for safe and effective therapeutic interventions remain essential. Methods: We conducted a retrospective cohort study on patients hospitalized with laboratory confirmed severe acute respiratory syndrome coronavirus-2 infection, comparing standard of care along with Convalescent Plasma with or without Tocilizumab (CP vs. CPT). Results: A total of 110 patients were enrolled with an overall mean age of 50 ± 16 years. Patients on CPT were more likely to have had acute respiratory distress syndrome (77% vs. 42%; p < 0.001), sepsis (9.7% vs. 0; p = 0.036), chest X-ray abnormalities (71% vs. 44%; p = 0.004), intensive care unit admission (84% vs. 56%; p = 0.001) as well as being on mechanical ventilation (79% vs. 48%; p = 0.001). After CPT treatment, all measured inflammatory markers, except interleukine-6, showed an overall steady decline over time (all p-values

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: 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: 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

Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in‐hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52–0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31–0.70) covariate adjustment. With the propensity score–derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36–1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.

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

Abstract Background Little is known about sex gap in the management and outcomes of dyslipidemia among diabetics in the Arabian Gulf. The aim if this study was to determine sex differences in the management and outcomes of dyslipidemia in diabetic patients in the Arabian Gulf. Methods This study was derived from the Centralized Pan-Middle-East Survey on the management of hypercholesterolemia. Patients recruited were aged ≥18 years on lipid lowering drugs for ≥3 months (stable medication for ≥6 weeks). Outcomes were based on the joint Consensus Statement of the American Diabetes Association and American College of Cardiology Foundation. Analyses were performed using univariate and multivariate logistic regression techniques. Results The mean age of the cohort (n = 3336) was 57 ± 11 years and 45% (n = 1486) were females. Females were less likely to be on rosuvastatin (7.6% vs 12%; P

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.

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: 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.

Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles for each profession within a standardized medication reconciliation process.

Background: There is controversy regarding the relationship between gender and acute coronary syndrome (ACS). Objective: To study the impact of gender on presentation, management, and mortality among patients with ACS in the Middle East. Methodology: From January 2012 to January 2013, 4057 patients with ACS were enrolled from four Arabian Gulf countries (Kuwait, Oman, United Arab Emirates, and Qatar), representing more than 85% of the general hospitals in each of the participating countries. Results: Compared to men, women were older and had more comorbidities. They also had atypical presentation of ACS such as atypical chest pain and heart failure. The prevalence of non-ST-segment elevation myocardial infarction (49 vs. 46%; P < 0.001) and unstable angina (34 vs. 24%; P < 0.001) was higher among women as compared to men. In addition, women were less likely to receive evidence-based medications such as aspirin, clopidogrel, beta-blocker, and angiotensin-converting enzyme inhibitors on admission and on discharge. During hospital stay, women suffered more heart failure (15 vs. 12%; P = 0.008) and were more likely to receive blood transfusion (6 vs. 3%; P < 0.001). Women had higher 1-year mortality (14 vs. 11%; P < 0.001), the apparent difference that disappeared after adjusting for age and other comorbidities. Conclusion: Although there were differences between men and women in presentation, management, and in-hospital outcomes, gender was shown to be a nonsignificant contributor to mortality after adjusting for confounders.

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.