Vaccination is one of the most successful public health initiatives in human history, significantly reducing the incidence and severity of infectious diseases. The success of any vaccination program depends on several factors, including effective leadership, funding, distribution management, and addressing vaccine hesitancy. Vaccine hesitancy, the delay or refusal to be vaccinated despite the availability of immunization services, has always been prevalent in societies but has become more pronounced during the COVID-19 pandemic. During the pandemic, anti-vaccine activists persistently promoted and increased vaccine hesitancy by using social media to spread rumors, propaganda, and conspiracy theories. The rising vaccine hesitancy among the public became a major challenge to the success of the COVID-19 immunization program. There are also indications that this hesitancy may have generalized against more traditional vaccines. This literature review explores the structure and evolving dynamics of COVID-19 vaccine hesitancy and the resultant generalized skepticism towards other vaccinations. It also suggests future strategies to address and mitigate the phenomenon of vaccine hesitancy.

Keywords:Anti-Vaccine; COVID-19 Vaccine; Vaccine Hesitancy; Pandemic; Vaccination.

Objectives: Globally, the preparedness of frontline healthcare providers (HCPs) to deliver timely and appropriate medical care has emerged as a significant concern. The training of HCPs in containment measures is considered pivotal in elevating the quality of care for COVID-19 patients while simultaneously mitigating the risk of viral transmission to both fellow patients and HCPs. This study investigates the impact of training on HCPs readiness to manage COVID-19 patients in a tertiary hospital in Oman. Methods: Employing a mixed-method design, we extended invitations to HCPs at the Royal Hospital in Muscat using electronic forms. We collected data about HCPs demographics, their comprehension of the hospital’s core objectives and protocols, and any knowledge acquired through official training or self-directed study. Our analytical approach encompassed descriptive and univariate statistical methods, complemented by thematic analysis for the qualitative component. Results: Our survey acquired responses from a total of 241 individuals. Among the respondents, 67.6% were female nurses, and 49.8% were aged between 31–40 years old. Significant differences were observed concerning gender (p = 0.018 and p = 0.001) and profession (p < 0.001 and p < 0.001) with the total score in awareness and knowledge, respectively. Stress and fear of handling confirmed or potentially contagious patients negatively impacted nearly half of the HCPs, with doctors and nurses reporting this effect significantly. Remarkably, 61.0% of HCPs expressed that their confidence in managing COVID-19 cases was positively influenced by their faith in national pandemic plans. Conclusions: While the hospital’s protocols and procedures were well comprehended, the lack of preparedness and skills training for managing highly contagious patients resulted in diminished confidence and heightened stress. To fortify their ability to respond to future outbreaks and work with resilience and confidence, HCPs require ongoing, comprehensive, and hands-on training.

Keywords:Training; COVID-19 Pandemic; Healthcare Professionals; Preparedness; Tertiary Care Hospital;Oman.

Objectives: This study was performed to assess the accuracy of standard electrocardiographic criteria in diagnosing of right ventricular (RV) involvement in patients with inferior myocardial infarction (IMI). Methods: This was a retrospective analysis of patients admitted with an IMI. Proximal occlusion of the right coronary artery before the origin of the RV branch on angiography was considered diagnostic of RV involvement. Results: The subjects were 129 patients (mean age = 55.8±13.1 years; 81.4% male) with inferior ST-elevation myocardial infarction. The most sensitive indicators of RV involvement were an ST elevation in V4R (72.9%) and a higher ST elevation in lead III than in lead II (80.4%). The most specific indicators were ST elevation in V1 (88.7%) and ST elevation in V1 with ST depression in V2 (97.1%). Combining all the criteria improved sensitivity to 85.7% but reduced specificity to 21.2%. Conclusions: No single electrocardiogram criterion was able to identify all cases of RV involvement in patients with IMI. Combining the different criteria helped pick up more cases at the cost of increasing false positives.

Keywords:Right Ventricular Infarction; Right Ventricular Involvement; Inferior Myocardial Infarction; Electrocardiogram; Oman.

Objectives: We sought to explore the clinical characteristics of corneal ectasia and provide insights on related factors, including demography, ocular health, and the management trends in the Saudi population. Methods: We conducted a retrospective hospital-based chart review of patients with corneal ectasia in multiple medical centers in Saudi Arabia between 1 January and 31 December 2018. Eye care professionals diagnosed these patients based on their medical history, physical examination, and the use of Pentacam. The severity of the condition was assessed using the k median index from the Pentacam map following the modified Krumeich grading system. Results: We reviewed the medical records of 430 eyes of 215 patients with corneal ectasia. The majority (98.6%) of patients had bilateral corneal ectasia, with 202 (94.0%) having keratoconus and 13 (6.0%) having post-laser in situ keratomileusis ectasia. Males and age groups between 14 and 45 years were more affected. The mean age of onset was 7.1 years, ranging from 2–32 years, which was higher among patients from the western region. Regarding severity, 230 (53.5%) eyes presented in the initial stages, while 36 (8.4%) were in the severe stage with no significant difference between the regions studied. No significant differences were observed in mean central corneal thickness and power between patients from the central and western regions. Corneal rigid gas permeable contact lens was most used in treatment of 176 (40.9%) eyes followed by glasses in155 (36. 0%), while corneal cross-linking was the common surgical intervention (10.9%), followed by penetrating keratoplasty (3.0%). Conclusions: Most keratoconus patients had a bilateral mild stage of the disease and were in their third decade. This high rate of bilaterality of diseases during diagnosis may be due to misdiagnosis in the initial stages, which highlights the importance of community and eye care professionals’ awareness of comprehensive eye examinations and regular follow-up, including corneal topography assessments of both eyes.

Keywords:Keratoconus; Corneal Topography; Keratoplasty, Penetrating; Corneal Cross-Linking; Saudi Arabia.

Objectives: Vitamin D deficiency can harm both the infant and the mother, potentially altering the trajectory of the child’s life. This study aimed to delve into the potentially life-changing impact of vitamin D intake at birth on the prognosis of premature newborns. Methods: We conducted a double-blind, randomized clinical trial study, between 2021–2022, including 100 infants admitted to the neonatal intensive care unit of Ghaem Hospital in Mashhad, Iran. Premature infants with a gestational age of < 34 weeks and requiring the neonatal intensive care unit admission were randomly allocated into two groups. The intervention group consisted of infants who received 10 000 units of vitamin D, while the control group comprised infants who did not receive any vitamin D at birth. The infants were evaluated based on clinical symptoms, the requirement and duration of oxygen therapy, the necessity and length of mechanical ventilation, the method of oxygen therapy administered, and the length of their hospital stay. Results: This study included 56 (56.0%) boys and 44 (44.0%) girls. A significant difference was observed between the intervention and control groups regarding maternal age frequency (p = 0.013). Additionally, the frequency of mechanical ventilation (p = 0.030), surfactant administration (p = 0.009), and the number of times surfactant was administered (p = 0.020) also showed significant differences between both groups. Conclusions: Vitamin D intake at birth could potentially revolutionize the management of respiratory complications in premature infants, a crucial discovery for healthcare practitioners and researchers.

Keywords:Infant;  Respiration, Artificial; Infant, Premature; Vitamin D; Respiratory Distress Syndrome; Iran.

Objectives: Systemic fungal infections (SFIs) account for 12% of all late-onset sepsis among very low birth weight (VLBW) infants and result in adverse long-term neurodevelopmental outcomes among survivors. This study compared the prophylactic efficacies of systemic fluconazole or oral nystatin prophylaxis to prevent SFI in VLBW infants. Methods: In a randomized controlled clinical trial, 120 neonates with gestational age < 32 weeks and birth weight < 1500 g were randomly allocated in two groups. Patients in group A received fluconazole 3 mg/kg intravenously twice weekly from the first 72 hours of life. Patients in group B were administered oral nystatin 1 mL (100 000 units) every eight hours. The primary endpoint was SFI and its associated mortality rate during hospital stay. Results: The mean gestational age of the enrolled infants was 28.2±1.4 weeks. Demographic characteristics were similar in both groups. SFI was detected in six (5.0%) infants with three cases from each group. Three (2.5%) patients died, two of whom were in group B. Four (6.7%) patients in group B and one (1.7%) in group A were treated for retinopathy of prematurity (p = 0.040). Intraventricular hemorrhage was detected in brain ultrasound examination in three (5.0%) neonates in group B and seven (11.7%) in group A (p = 0.020). Conclusions: The intravenous fluconazole and oral nystatin were similarly effective in preventing SFIs in VLBW infants. Future studies are recommended with a larger number of patients before routine administration of nystatin prophylaxis.

Keywords:Candidiasis; Fluconazole; Nystatin; Prophylaxis; Very Low Birth Weight Infants; Iran.

Objectives: To determine the prevalence of hypothermia among preterm infants born before 32 weeks of gestation and whether their temperature at admission is associated with neonatal and maternal risk factors and gestational age. Furthermore, the study evaluates the association between admission temperature, neonatal morbidity, and in-hospital mortality. Methods: This study involved an eight-year retrospective analysis of preterm neonates born < 32 weeks of gestation and admitted to the neonatal intensive care unit at a tertiary hospital in Oman, from 2010 to 2017. Results: The study included 587 preterm infants with a mean gestational age of 28.4 weeks, a mean birth weight of 1154.2 g, and a mean admission temperature of 35.5 °C. Hypothermia (axillary temperature < 36.5 °C) was present in 509 (86.7%) infants. In univariate analysis, only birth weight and neonatal resuscitation were associated with admission temperature
(< 36.5 °C). In the multivariate analysis, only intraventricular hemorrhage demonstrated a significant association with the incidence of hypothermia. Conclusions: Most preterm newborns had hypothermia upon admission to the neonatal intensive care unit, which is associated with essential morbidities. More aggressive interventions are warranted to reduce the incidence of hypothermia in preterm infants.

Keywords:Temperature; Hypothermia; Premature Birth; Low Birth Weight; Sepsis; Oman.

Objectives: We sought to report the frequency of non-typhoidal Salmonella (SNT) and Shigella spp. diarrhea and the antibiotic sensitivity in children. Methods: We conducted a retrospective study of children with bloody diarrhea seen at Rustaq Hospital between 1 June 2019 and 31 June 2023. We collected data related to demographic characteristics, symptoms, blood investigations, stool bacterial culture, and antimicrobial sensitivity. Stool samples were tested for Salmonella and Shigella growth. Results: Out of 1160 children with diarrhea, 153 (13.2%) had bloody diarrhea of which 129 (84.3%) were under five. Ninety-two (60.1%) children were positive for either Salmonella or Shigella. Among the positive cultures, 58 (63.0%) children had SNT, while 34 (37.0%) had Shigella infection. Three children had bacteremia, all under one year old. SNT demonstrated high sensitivity primarily to ceftriaxone (n = 41; 70.7%), ampicillin (n = 53; 91.4%), and ciprofloxacin (n = 54; 93.1%). In contrast, Shigella showed high resistance to ceftriaxone and only 15 (46.9%) patients showed sensitivity. Additionally, 29 children had Entamoeba histolytica trophozoites co-infection with Salmonella on stool microscopy. Conclusions: Salmonella is more prevalent than Shigella in children under five years, while Shigella is more common in children over five. Salmonella is sensitive to both ceftriaxone and ampicillin. Shigella demonstrates resistance to multiple antibiotics, including ciprofloxacin. It is recommended that children under the age of one be admitted and treated empirically with either ceftriaxone or ampicillin. In older children, antibiotic therapy should be guided by stool culture results. Ciprofloxacin is not a good empirical choice for Shigella in our population due to its high resistance and is contraindicated in patients with glucose-6-phosphate dehydrogenase.

Keywords:Salmonella; Shigella; Diarrhea; Infant; Child, Preschool; Retrospective Studies; Oman.

Objectives: The quality of asthma management in tertiary hospitals’ emergency departments (EDs) is key to sustained asthma control. We assessed the quality of asthma care and adherence to guidelines at the Royal Hospital in Oman. Methods: We conducted a retrospective, observational study examining the medical records of asthma patients who presented to the ED between 1 June 2014 and 1 June 2016. Results: A total of 217 patients were included in the study. Lack of proper documentation was observed throughout the study. Only 80 patients (59.7% of 134 available records) were on controller therapy and 51 were reported to be compliant. No asthma severity assessment was conducted, and 57 (32.9%) patients experienced respiratory distress. Peak expiratory flow rate measurements were not performed for all patients; chest X-ray was performed for 145 (66.8%) patients, and blood gas analysis for 83 (38.2%). The mean±SD time from the initial assessment to the treatment initiation was 12.0±11.0 minutes. Systemic steroids and nebulizers were used for initial management in 70.5% (n = 153) and 96.3% (n = 209) of patients, respectively. Reassessments at one and two hours following initial assessment were not done for all patients; reassessment records were missing for 50 (54.9%) patients after the first hour, and 50 patients after the second hour. Out of the total sample, 45 (20.7%) patients required hospital admission, with the majority (93.3%) admitted to the medical ward. Post-discharge procedures recommended by guidelines were rarely employed. Conclusions: There is a serious lack of adherence to asthma management guidelines in the ED. The 2009 Omani Ministry of Health guidelines should be updated, considering the recent updates of Global Initiative for Asthma strategies, adopted as the standard of care, and disseminated with regular monitoring to ensure compliance.

Keywords:Asthma; Emergency Service, Hospital; Oman.

Objectives: Research indicates that active smokers are at risk of cognitive impairment. However, the correlation between chronic passive smoking and the risk of cognitive impairment remains underexplored. This study aimed to determine the association between smoking, passive smoking, and cognitive impairment and examined the dose-response effect. Methods: This population-based two-year survey was conducted in four rural public health centers from 2021 to 2023 in Central Java, Indonesia, each center caters to approximately 30 000 people. The participants were selected using simple random sampling from the health center visitors aged 30–60 years. Smoking and passive smoking were determined by self-assessment. Mini-Mental State Examination was used to evaluate cognitive impairment. The potential impact of confounding variables such as lifestyle, sociodemographic factors, and chronic diseases were considered and excluded during statistical analysis. Results: The participants were 409 individuals aged 30–60 years. The majority were men (264; 64.5%). Among them, 308 (75.3%) were active smokers, 271 (66.3%) were passive smokers, and 138 (33.7%) were not exposed to tobacco smoke. There was a significant relationship between cognitive impairment and increasing pack years of active smoking. The highest and most significant risk was observed in those who smoked ≥ 20 pack-years with an adjusted odds ratio (aOR) of 1.61 and 95% CI: 0.98–2.31. Passive smokers had a slightly lower risk of cognitive impairment than those who did not smoke and never smoked (aOR = 2.01; 95% CI: 1.37–2.70). They were comparable with OR of 10–19 pack-years total exposure to active smoking (aOR = 1.86; 95% CI: 1.24–2.42). Conclusions: There was a dose-response relationship between smoking and cognitive impairment with a significant effect on ≥ 20 pack-years of exposure. Passive smoking also indicated a significant risk of cognitive impairment equivalent to an estimated 10–19 pack-years of active smoking.

Keywords:Neurodegenerative Diseases; Cognitive Impairments; Dementia; Smoking; Epidemiology; Indonesia.

The superior cornu of the thyroid cartilage is a versatile structure, and anatomical variations can lead to diverse clinical presentations. We describe a case of a patient with a medialized superior part of the thyroid cartilage caused by pressure from a large thyroid mass, detected during laryngoscopy before thyroidectomy. A neck computed tomography scan revealed an elongated and medially displaced superior cornu of the right thyroid cartilage, resulting from the push exerted by the right thyroid mass. As the patient remained asymptomatic and refused surgical intervention, no further consideration was given to surgically addressing the medialized superior thyroid cornu.

Keywords:Thyroid Cartilage; Laryngeal Cartilage; Thyroid Nodule.

The symptoms of malignant pleural mesothelioma can be mimicked by some other malignancies, clinically and radiologically. We describe a case of a 57-year-old man whose clinical and radiological findings were consistent with malignant pleural mesothelioma; however, a pleural biopsy showed undifferentiated epithelioid malignant neoplasm.

Keywords:Malignant Pleural Effusion; Malignancy; Oman.

We report a rare case of a middle-aged Omani woman who was known to have primary antiphospholipid syndrome, glucose-6-phosphate dehydrogenase deficiency, and iron deficiency anaemia. Cannulation attempts caused bulla which progressed to ulceration. A pathergy phenomenon with high suspicion of pyoderma gangrenosum was postulated. Management with corticosteroids, cyclosporin, and finally ustekinumab, a novel biologic agent, yielded a beneficial response.

Keywords:Antiphospholipid Syndrome; Pyoderma Gangrenosum; Bullous Lesion; Ustekinumab; Oman.

Polyangiitis overlap syndrome (POS) is a systemic vasculitis characterized by overlapping features of more than one well-defined vasculitic syndrome. We present the case of a 38-year-old Malay man with progressive dyspnea and palpable purpura in his lower limbs. The diagnostic evaluation revealed right-sided segmental pulmonary consolidation with pleural effusion, systolic cardiac dysfunction with the presence of an intracardiac thrombus, and left vocal cord palsy secondary to laryngeal mononeuropathy. Anti-neutrophil cytoplasmic antibodies testing yielded negative results, and skin biopsy revealed leukocytoclastic vasculitis (LCV) with negative immunofluorescence studies. The patient fulfilled the American College of Rheumatology diagnostic criteria for polyarteritis nodosa and idiopathic LCV. Only three case reports of POS with a combination of polyarteritis nodosa overlapping with idiopathic LCV have been reported in the medical literature. To the best of our knowledge, this is the first report of POS with cardiopulmonary involvement and laryngeal mononeuropathy. This patient had an excellent response to remission induction therapy using high-dose corticosteroids and mycophenolate mofetil and remains in remission while undergoing a steroid taper. Timely initiation of treatment is essential to prevent vasculitic complications and irreversible organ dysfunction. Mycophenolate mofetil may serve as an acceptable alternative to cyclophosphamide as a remission induction agent in this condition.

Keywords:Leukocytoclastic vasculitis; Polyarteritis Nodosa; Pleural Effusion; Thrombus; Vocal Cord Palsy; Corticosteroid; Mycophenolate Mofetil.

Gigantomastia is a rare benign disorder characterized by excessive breast enlargement. Although a standard definition has yet to be established, it is generally known as an excess of approximately 1.5 kg tissue per breast that requires reduction. We report a case of a 10-year-old girl who presented with enlarged breasts. The hormonal assay was normal. Breast ultrasound revealed increased fibroglandular breast tissue with an area of interstitial fluid, prominent vascularity, and dilated veins. There was no evidence of focal masses or collections, ductal ectasia, or axillary lymphadenopathy. Magnetic resonance imaging revealed extremely dense breasts with more than 75% fibroglandular tissue, consistent with juvenile breast hypertrophy. Bilateral reduction mammoplasty with nipple-areola complex graft was performed. The histopathological report confirmed benign gigantomastia.

Keywords:Breasts; Juvenile Gigantomastia; Mammoplasty; Breast Diseases; Bahrain.

Acute myeloid leukemia (AML) is rarely associated with central diabetes insipidus (CDI) with unclear underlying pathophysiological mechanisms. The most commonly reported cytogenetic abnormality in cases of AML-associated CDI is monosomy 7, followed by chromosome 3 abnormalities. We report a case of a woman with newly diagnosed AML with 9q34 deletion (ABL1 gene region), who developed symptoms of polyuria and polydipsia with an investigation confirming CDI. This is the first reported case of cytogenetic abnormality of 9q34 deletion (ABL1 gene region) in AML with CDI.

Keywords:Central Diabetes Insipidus; Acute Myeloid Leukemia; Polyuria; Polydipsia; Cytogenetics; United Arab Emirates.