The COVID-19 pandemic continues to move at record speed. Health systems and hospitals worldwide face unprecedented challenges to effectively prepare and respond to this extraordinary health crisis and anticipated surge. Hospitals should confront these unparalleled challenges with a comprehensive, multidisciplinary, coordinated, and organized strategy. We report our experience with the systematic application of the “4S” principle to guide our institutional preparedness plan for COVID-19. We used an innovative “virtual interdisciplinary COVID-19 team” approach to consolidate our hospital readiness.

Keywords: COVID-19; Pandemics; Hospitals; Health Facilities; Oman.

Electronic health and medical records are widely adopted in many healthcare settings worldwide to improve the quality of care. Users’ perception is a significant factor influencing the successful implementation and use of e-health technologies. This systematic review aimed to identify factors influencing the perceptions of healthcare professionals towards the adoption and use of electronic health and medical record systems to improve the quality of healthcare services in the countries of the Gulf Cooperation Council. We identified primary studies evaluating healthcare professionals’ perception towards electronic health records and/or electronic medical records in the Gulf region. Seven electronic databases, including Medline, CINAHL, Informit Health Collection, Science Direct, ProQuest, PubMed, and Scopus were used to search for the relevant articles published between January 2007 and December 2016. Thirteen articles met the inclusion criteria and were included in this systematic review. Both individual and system-related factors were found to positively or negatively influence healthcare providers’ perceptions towards the systems. Understanding the impact of healthcare professionals’ perception of health information technology is important for policymakers involved in the implementation programs to ensure their success. Future studies should evaluate other individual characteristics such as age, gender, and profession of the healthcare providers on their perceptions towards e-health technologies.

Keywords: Perception, Electronic Health Records, Quality of Health Care, Medical Informatics.

This review focuses on the role of gallium (Ga) nanoparticles (NPs) to enhance phagosome maturation into the Mycobacterium tuberculosis-infected macrophage and the role of magnetic iron NPs as nanocarriers of antituberculosis drugs. The literature shows that silver (Ag) and zinc oxide (ZnO) NPs with dimensions less than 10 nm can penetrate directly through the macrophage bilayer membrane. Ag NPs increase the permeability membrane by motiving the aggregation of proteins in the periplasmic space and forming nano-sized pores. ZnO NPs can interact with the membrane of M. tuberculosis, which leads to the formation of surface pores and the release of intracellular nucleotides. The colloidal Ag:ZnO mixture NPs with 1:1 ratio can eliminate M. tuberculosis and shows the lowest cytotoxicity effects on MCF-7 and THP-1 cell lines. Ag/ZnO nanocrystals are not able to kill M. tuberculosis alone ex-vivo. Hence, bimetallic gold (Au)/Ag NPs possessed high efficiency to inhibit M. tuberculosis in an ex-vivo THP-1 infection model. Co-delivery of mixed MeNPs into a polymeric carrier collaborated to selective uptake by macrophages through passive targeting, initial burst release of ions from the encapsulated metallic (Me) NPs, and eventually, reduction of MeNPs toxicity, and plays a pivotal role in increasing the antitubercular activity compared to use alone. In addition, Ga NPs can import drugs to the macrophage, inhibit M. tuberculosis growth, and reduce the inhibition of phagosome maturation. Magnetic encapsulated NPs exhibited good drug release properties and might be suitable as carriers of antituberculosis drugs.

Keywords: Mycobacterium tuberculosis; Pharmaceutical Preparations; Metal Nanoparticles; Macrophages.

Objectives: Blood bank centers routinely screen for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) to ensure the safety of blood supply and thus prevent the dissemination of these viruses via blood transfusion. We sought to evaluate the detection of transfusion-transmitted infection (TTI) markers using standard serological methods and nucleic acid testing (NAT) among blood donors in Hospital Universiti Sains Malaysia. Methods: Donated blood units were assessed for the presence or absence of HBV, HCV, and HIV using two screening method: serology and NAT. Reactive blood samples were then subjected to serological confirmatory and NAT discriminatory assays. Results: A total of 9669 donors were recruited from September 2017 to June 2018. Among these, 36 donors were reactive either for HBV, HCV, or HIV by serological testing and eight by NAT screening. However, only 10 (three for HBV and seven for HCV) donors tested positive using serological testing and five (two for HBV and three for HCV) by NAT discriminatory assays. Note that all five NAT positive donors detected in the NAT discriminatory assays were confirmed to be serologically reactive. Therefore, the prevalence of HBV, HCV, and HIV was 0.03%, 0.1%, and 0.0%, respectively, in our donor pool. Conclusions: Both serological and NAT screening and confirmatory assays should be used routinely to reduce the risk of infection transmission via the transfusion of blood and blood components.

Keywords: Hepatitis B virus; Blood Donors; Blood Banks; Malaysia; HIV Infections; Transfusion Reaction; Blood Transfusion; Hepatitis C.

Objectives: We sought to assess medications prescribed to patients attending the Dental and Maxillofacial Surgery (DMS) clinic at Sultan Qaboos University Hospital (SQUH), Oman. Methods: This was a retrospective cross-sectional study covering a six-month period from January to June 2018 including a sample of patients attending the DMS clinic. Drug utilization data like drug name, type, administration route, dosage frequency, and anatomical and therapeutic class were assessed. Results: The study included 400 patients, of which 190 (47.5%) were males and 210 (52.5%) were females. A total of 88 different drugs were prescribed. Only 140 (35.0%) patients were prescribed drugs for their dental conditions or other comorbidities per visit, and the rest 260 (65.0%) were not prescribed any drugs. The dentists prescribed drugs only in 116 (29.0%) patients. The most common diagnosis was dental caries (n = 177, 44.3%) followed by chronic gingivitis (n = 15, 3.8%). The most common comorbidities in patients were anemia (n = 45, 11.3%) and diabetes (n = 21, 5.3%). The most common drugs prescribed were chlorhexidine mouthwash (n = 43, 37.1%) and paracetamol (n = 36, 31.0%) followed by ibuprofen (n = 10, 8.6%) and amoxicillin/clavulanate (n = 5, 4.3%). Conclusions: Drugs prescribing pattern was within the international norms. Sixty-five percent of the patients were not prescribed any drug by the dentist. Oral antiseptics, analgesics, and antibiotics were the most common drugs prescribed by dentists.

Keywords: Mouthwashes; Pharmaceutical Preparations, Dental; Oman; Dental Caries; Drug Utilization; Drug Prescriptions; Analgesics.

Objectives: We sought to assess health literacy (HL) and its associated factors in the Bahraini community using a validated HL scale and address its deficient domains to inform policy. Methods: We carried out a conveniently sampled, cross-sectional survey using the All Aspects of Health Literacy Scale in the Bahraini community. The scale has three key aspects: basic or functional HL (FUN-4 items), which corresponds to basic reading and writing skills, and knowledge of health conditions and health systems; communicative or interactive HL (COM-3 items) on communicative and social skills to extract information from different forms of communication; and critical HL (CR-4 items), the advanced cognitive and social skills to critically analyze information and exert greater control over life events and situations relating to individual and community level wellbeing goals. We examined the association between sociodemographic and health information for the survey tool items using the chi-square test. The relationship between total scale score and subscale scores of the three domains of the survey tool to sociodemographic and health information was investigated using the t-test and ANOVA. Results: Of the 836 participants (mean age = 26.6 years), single (64.0%) and university students (76.6%) were predominant; 15.6% reported long-term sickness and visited the general physician often. The highest mean item scores were for empowerment (1.8) and lowest for functional HL (0.1). The significant domain-specific responses to the survey tool items were 12 for critical HL, 10 for functional HL, six for communicative HL, and five for empowerment. Participants aged < 30 years old, female, married, pursuing/completed Master’s program, employed, and whose self-rating of health was excellent had higher total HL scores. Conclusions: Older, less educated respondents with a poor self-rating of health had low HL scores. We recommend further studies to address the relative importance of functional, interactive, and critical HL in the community to promote health outcomes.

Keywords: Adult; Health Literacy; Cross-Sectional Studies; Bahrain; Outcome Assessment, Health Care.

Objectives: Patients with sickle cell anemia (SCA) are immunocompromised and at an increased risk of developing infections. Our aim was to establish the clinical, laboratory, and radiological manifestations of respiratory viral infections in SCA at Sultan Qaboos University Hospital (SQUH), Oman and assess its impact on disease morbidity and mortality, with special emphasis on H1N1. Methods: We undertook a retrospective study in SCA patients with respiratory viral infections following up at the hematology department at SQUH. We collected demographic data and clinical, radiological, and laboratory parameters. Results: In 84 SCA patients with 109 admission episodes for vaso-occlusive crisis (VOC), molecular diagnostic techniques confirmed 125 respiratory viral infections. Rhinovirus was the most prevalent infection (35.8%), whereas H1N1 virus infection was seen only in 10.1%. Laboratory investigations revealed a significant fall in mean hemoglobin levels, mean white blood cell, and platelet counts from baseline, whereas there was a significant rise in the mean lymphocyte and retic count, serum lactate dehydrogenase, and C-reactive protein levels during infective episodes (p < 0.050, Wilcoxon signed rank test). One-third (32.1%) of the VOC episodes progressed to acute chest syndrome (ACS), but in the H1N1 cohort, only two episodes of ACS was seen (18.2%). Conclusions: Rhinovirus was the commonest respiratory virus infections in SCA patients, whereas parainfluenza 3 was associated with a significant adverse outcome. H1N1 was associated with a mild course. ACS was seen in approximately one-third of this group of patients.

Keywords: Acute Chest Syndrome; Influenza A Virus, H1N1 Subtype; Rhinovirus; Retrospective Studies;
Anemia, Sickle Cell.

Objectives: The literature has described several positive outcomes related to diabetes management via nurse-led clinics. This is especially true where a shortage of physicians is recorded within a team-based approach. We sought to explore the perceptions of patients with type 2 diabetes towards the current diabetes management visits at public primary health care centers in Muscat, Oman and their opinions towards nurse-led diabetes management clinics. Methods: This pilot qualitative study included seven semi-structured interviews with type 2 diabetes patients from four purposely selected public primary health care centers in Muscat. Qualitative thematic analysis was applied. Results: Patients with type 2 diabetes expressed their satisfaction with the present diabetes management visits at public primary health care. Their opinions towards nurse-led clinic were diverse and divided patients into three categories: those who totally refused the nurse-led clinics, those who accepted the clinics but with reservations, and patients that totally accepted the nurse-led clinics. The patients’ main concern was the nurses’ abilities to handle and understand the disease and its management. Conclusions: Our pilot study revealed type 2 diabetes patients’ satisfaction with the current diabetes management clinics. However, transformation to nurse-led clinics within team-based approach requires further studies with a bigger sample size. Further studies on requirements related to the Omani health care system and a better understanding of patients’ worries and their readiness to accept the concept of nurse-led clinics and their outcomes are also recommended.

Keywords: Diabetes Mellitus, Type 2; Pilot Projects; Practice Patterns, Nurses’; Patient Satisfaction; Oman; Primary Health Care.

Objectives: Continuous positive airway pressure (CPAP) compliance of > 4 hours per night has been considered acceptable to achieve clinical improvements in patients with obstructive sleep apnea (OSA). However, the factors determining CPAP adherence are unclear. This study aims to address the issue of acceptance and adherence to CPAP treatment in the Omani population and to determine the factors affecting adherence to CPAP. Methods: This retrospective study included adult OSA patients who underwent polysomnography between January 2008 and December 2014 (n = 3046). Demographic information, Epworth Sleepiness Scale (ESS), apnea/hypopnea index (AHI), and desaturation events were collected from the sleep laboratory records. Subjects were grouped as CPAP users and CPAP non-users. CPAP users were divided into compliers (> 4 hours/night) and non-compliers (< 4 hours/night). Student’s t-test was used to find differences in CPAP users and non-users, compliers, and gender differences in CPAP users. The association of CPAP compliers and non-compliers with age, gender, AHI, ESS, and comorbidities were assessed using the chi-square test. Results: Out of the 90.0% patients advised CPAP treatment, 34.7% came for regular CPAP follow-up. Total CPAP compliers were 59.3% (n = 274). The CPAP users had higher age, high ESS, baseline AHI, and more oxygen desaturation events than CPAP non-users (p < 0.010). Among the CPAP users, females were significantly older than males and had more oxygen desaturation events. CPAP compliers had significantly higher baseline AHI and more oxygen desaturation events. There was no association between CPAP compliance and age, gender, AHI, ESS, or comorbidities. Conclusions: CPAP users and compilers have severe OSA. CPAP acceptance and adherence are suboptimal and could not be predicted by age, gender, AHI, ESS, or comorbidities.

Keywords: Continuous Positive Airway Pressure; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Sleep.

Objectives: This study investigated the outcomes of multiple mini interviews and personal interview on personality traits, emotional intelligence, perceived educational environment, and stressors. Methods: This is a comparative cross-sectional study on two cohorts of pre-clinical medical students who were selected by multiple mini interviews and personal interview, respectively. Their personality traits, emotional intelligence, perceived educational environment, and perceived stressors were measured using different measurement tools. Results: Multiple mini interviews and personal interview demonstrated a similar ability to recruit medical students with a high level of emotional intelligence. The main advantage of personal interviews over multiple mini interviews in terms of personality traits is that it recruited candidates who had a higher level of conscientiousness trait. The main advantage of multiple mini interviews over personal interview on the educational environment is that medical students chosen by multiple mini interviews had a higher level of satisfaction with social aspects of medical training. Regardless of admission processes, the medical students were equally vulnerable to psychological distress due to various stressful events throughout medical training particularly related to academic loads. Conclusion: This study provided evidence to support the outcomes that multiple mini interviews and personal interview have on medical students’ emotional intelligence, personality traits, perceived educational environment, and perceived stressors during the pre-clinical medical training. Interestingly, personal interview had a better outcome on conscientiousness while multiple mini interviews had a better outcome on the social aspect.

Keywords: Cross-Sectional Studies; Medical Students; Personality; Emotional Intelligence; Educational Measurement; Mental Health.

Objectives: We sought to assess the impact of the COVID-19 pandemic on female doctors and nurses’ mental health in Oman. Methods: We conducted a cross-sectional, web-based survey of 402 female doctors and nurses recruited from several health facilities in Oman. We used the Generalized Anxiety Disorder (GAD-7) scale, the Perceived Stress Scale (PSS-10), the WHO-5 Well-Being Index (WHO-5), and the Sleep Quality Scale to determine the prevalence rates of anxiety, stress, well-being, and sleep quality. Results: A total of 231 (57.5%) Omanis and 171 (42.5%) non-Omanis participated in this study. Of the total 402 participants, 28.4% were physicians and 71.6% were nurses. One in four (27.9%) participants reported caring for COVID-19 patients. One in four (27.9%) had moderate to severe anxiety. A higher proportion of Omanis (32.0%) had moderate to severe anxiety than non-Omanis (22.2%). Six in 10 (60.7%) scored at or above the mean on the PSS-10. Doctors and nurses who cared for COVID-19 patients reported higher levels of stress than those who did not. Almost half (45.3%) of the participants scored 50% or less on the well-being scale. A higher proportion of Omanis and those who cared for COVID-19 cases scored ≤ 50. Four in 10 (39.3%) had poor sleep quality; this was particularly prevalent among Omanis. A multiple regression analysis revealed that anxiety, stress, and well-being were significant predictors of poor sleep quality. Conclusions: The COVID-19 pandemic is having a significant effect on the mental health of health care workers in Oman. In this study, nurses, Omanis, and frontline health care workers were the most impacted by the global health crisis. Urgent psychological, social, and administrative interventions and support should be implemented to mitigate mental health risks in these groups.

Keywords: Anxiety; Sleep; COVID-19; Nurses; Physicians; Oman; Mental Health.

Objectives: Psychiatric disorders in patients with Parkinson’s disease (PD) and their caregivers play an important role in patients’ treatment and follow-up. Our study aimed to examine the prevalence of psychiatric symptoms among patients with PD and their caregivers, demographic risk factors, and the influence of severity and manifestations of PD on psychiatric distress. Methods: We included 125 patients with PD and 125 of their primary caregivers in this descriptive cross-sectional study. The severity of PD was evaluated according to the Hoehn and Yahr severity scale from the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale. PD patients and their caregivers completed the Symptom Checklist-25 to determine the presence of psychiatric distress. Also, demographic factors, including age, high level of education, occupation, residence, and cigarette smoking, were assessed in the PD patients and their caregivers. Results: The prevalence of psychiatric distress was 47.2% for PD patients and 18.4% for caregivers. Female sex, city residency, and medical disease were risk factors for more psychiatric symptoms in PD patients. Also, the female sex, single status, living in a village, and having a medical disease were risk factors for greater psychiatric symptoms in caregivers. PD patients in more advanced stages of disease suffered significantly from psychiatric distress, somatization, anxiety, interpersonal sensitivity, obsessive-compulsive disorder, and phobia compared to the lower severity of disease. PD patients with manifestation of postural instability showed a higher score of somatization, phobia, and psychiatric distress as compared with tremor, hypokinesia, and rigidity. Conclusions: Progression of PD influenced the psychiatric symptoms of both patients and their caregivers. A higher stage of PD is associated with higher scores of psychiatric distress, phobia, and somatization in the patients and their caregivers.

Keywords: Parkinson Disease; Caregivers; Cross-Sectional Studies; Depression; Anxiety; Anxiety Disorders.

Acrodermatitis enteropathica is a rare autosomal recessive disease caused by a genetic mutation leading to zinc deficiency. Clinical manifestation includes skin lesions, diarrhea, and alopecia. We report the case of a two-month-old girl, admitted with erythematous scaly lesions in the neck and vesiculopustular lesions in the perioral region, associated with alopecia and diarrhea. Clinical diagnosis of the disease was made from her first presentation. She was started on zinc therapy and her lesions resolved entirely after one month of treatment.

Keywords: Acrodermatitis Enteropathica; Zinc; Alkaline Phosphatase; Infant; Mutation.

Oral mucosal involvement of autoimmune progesterone dermatitis is exceedingly rare. This report presents a woman with very painful ulcerative stomatitis that recurred with every menstrual period, in the absence of other clinical manifestations. Ulcers were eventually controlled with oral tamoxifen treatment for three months. Subsequent follow-up visits showed complete resolution of her oral ulcerative lesions. The non-specific nature of her oral ulcers resulted in multiple medical and dental consultations and a delay in reaching the final diagnosis. Clinicians should be aware of the possibility of progesterone hypersensitivity when painful oral ulcerative lesions appear concurrently with each progesterone surge.

Keywords: Autoimmune progesterone dermatitis; Progesterone; Oral Ulcer.

PHACES syndrome comprises posterior fossa malformations, segmental hemangioma, arterial anomalies, cardiac defects, eye anomalies and less commonly, sternal cleft, or supraumbilical raphe. We report a case of PHACES syndrome associated with intestinal hemangioma causing recurrent intussusceptions. A full-term infant female presented at the age of three months with segmental distribution of telangiectatic patch with red swelling involving the right periorbital area, right forehead, and lips. After a full workup and evaluation, the diagnosis of PHACES syndrome was confirmed based on the presence of facial segmental hemangioma, hypoplastic right internal carotid artery, intracranial hemangioma, and right optic disc anomaly. At the time of workup, she developed typical symptoms of intussusception. Diagnostic laparoscopy was performed, and she was found to have hemangioma covering the whole ileal wall and a thickened circumferential hemangioma covering the mid ilium causing the lead point of the intussusception. Control of this patient’s hemangiomas was achieved by surgical resection of the thickened circumferential hemangioma covering the mid ilium along with oral propranolol. We reviewed the literature to explore the relationship between gastrointestinal (GI) hemangioma and PHACES syndrome and compared other associated extracutaneous hemangioma of the same series. We found 18 (58%) reported cases of GI hemangioma compared to other visceral hemangiomas on the same series of confirmed PHACE syndrome. All of the reported cases in this series present with anemia and GI bleeding except our patient who had intussusception. This might indicate the significant association of GI hemangioma as extracutaneous hemangioma in PHACES syndrome, emphasizing the importance of investigating symptomatic patients.

Keywords: PHACE association; Hemangioma; Intussusception.

The majority of hemolytic disease of the fetus and newborn (HDFN) reported in the literature is due to ABO and rhesus incompatibility. However, there are also other minor blood groups that have been identified as a cause of HDFN, although the occurrence is much rarer. The antibody screening program for D negative mother and the anti-D immunoglobulin treatment showed a significant reduction of the occurrence of HDFN secondary to anti-D. In a developed country, the screening for red blood cell antibody in the pregnant mother other than anti-D reduced the possibility of HDFN occurrence hence reduced the fetal morbidity and subsequently increased the fetal well being during pregnancy and after the postnatal period. In this case report, we discuss HDFN in a primigravida patient secondary to multiple alloantibodies (anti-Jka and anti-E). The baby developed jaundice with bilirubin levels approaching the exchange transfusion level. However, with extensive phototherapy and immunoglobulin treatment, the child did not require exchange transfusion. We also included the importance of the routine antenatal antibody screening program. This practice will help the transfusion center to find the antigen negative blood in a timely manner and reduce the morbidities and mortalities of HDFN among the newborns.

Keywords:

Hemolytic Disease of Newborn; Infant, Newborn; RHO(D) antibody; Blood Group Antigens; Phototherapy.

Malignant mesenchymoma is a rare tumor in which there are two or more distinct mesenchymal components. These are generally considered as high-grade neoplasms and are usually associated with a poor prognosis. Here, we report a case of malignant mesenchymoma containing undifferentiated spindle cell sarcoma, leiomyosarcoma, chondrosarcoma, osteosarcoma, and areas with rhabdoid differentiation in a 54-year-old male. The primary tumor measured 5.5 × 4 × 3 cm and weighed 135 g arising from the left submandibular salivary gland. Fine-needle aspiration cytology showed the presence of pleomorphic spindle cell clusters with atypia and myxoid stroma. An impression of malignant salivary gland neoplasm was given. Diagnosis of malignant mesenchymoma was made on histopathological examination supported by immunohistochemistry showing strong positivity with p53, Ki-67, and focal positivity for smooth muscle actin, S-100, desmin, and negativity for cytokeratins. The exact histogenesis of malignant mesenchymoma and the optimal management strategy to decide the prognosis remains uncertain as it is a rare tumor.

Keywords: Malignant mesenchymal tumor; Mesenchymoma; Salivary Glands; Biopsy,
Fine-Needle.