Objectives: We sought to identify the chest radiography differences at presentation between two groups of hospitalized confirmed COVID-19 patients; intubated group compared to non-intubated group. Methods: We retrospectively collected the data of confirmed hospitalized COVID-19 patients at the Royal Hospital, Muscat, Oman, from March to April 2020. Radiographic and clinical data were collected from the hospital and radiology information systems and compared between two groups based on intubation status. Results: Twenty-six patients confirmed to have COVID-19 by reverse-transcriptase polymerase chain reaction test were included in the study; 15/26 were non-intubated, and 11/26 were intubated. Overall, 88.5% were males in the intubated group. Respiratory symptoms were the most common presentation (84.6%) followed by fever (76.9%), with no statistical difference between the two groups. There was a statistically significant difference in having diabetes mellitus (p = 0.020) in which 8/11 and 4/15 were recorded to have diabetes mellitus in the intubated and non-intubated groups, respectively. Other comorbidities showed no statistically significant difference. The radiographic analysis redemonstrates the peripheral lower zone distribution but no statistically significant difference among the two groups. There were no differences between the intubated and non-intubated chest radiography in laterality involvement, central and peripheral distribution, and lesions type. However, upper zones involvement was more noted in the intubated group with 10/11 (90.9%) compared to 7/15 (46.7%) in non-intubated cases (p = 0.036). There were higher numbers of zone involvement in intubated cases than non-intubated cases: 9/11 (81.8%) of intubated patients had 10–12 areas of involvement on chest radiographs compared to 3/15 (20.0%) in the non-intubated group. Half of the cases were discharged home; 3/11 from the intubated group and 10/15 from the non-intubated group. Five patients died from the intubated group (5/11) versus 3/15 from the non-intubated group. Five patients are still hospitalized (three from the intubated group and two from the non-intubated group). Conclusions: The radiographic findings among intubated and non-intubated hospitalized COVID-19 patients demonstrate differences in the number of zones involved. More upper zone involvement was noted in the intubated group. Male sex and diabetes mellitus carried a poorer prognosis and were more associated with the intubated group.

Keywords: COVID-19; Retrospective Studies; Intubation, Intratracheal; Radiography; Oman.

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.

Keywords:SARS-CoV-2; Respiratory Distress Syndrome; Coronavirus; COVID-19; Plasma; Treatment Outcome; Oman.

Objectives: Considering the increasing, significant burden that coronavirus disease 2019 (COVID-19) imposes on the healthcare system, the need for simple, rapid, and affordable diagnostic tests to support the existing costly and demanding polymerase chain reaction (PCR) assay becomes required. This prospective diagnostic test accuracy study aims to evaluate the performance of four different COVID-19 rapid antigen tests compared to real-time reverse transcription PCR (rRT-PCR) between June and July 2020 to determine the feasibility of integrating these tests into the diagnostic algorithm in clinical settings. Methods: Swabs were collected from 306 patients and analyzed using rRT-PCR and antigen tests from four different providers. Results: The antigen tests’ sensitivities were 65.8%, 69.8%, 64.0%, and 64.3% for the STANDARD™ Q COVID-19 Ag test, PCL COVID-19 Ag Rapid fluorescent immunoassay (FIA) test, BIOCREDIT COVID-19 Ag test, and Sofia SARS-CoV-2 antigen FIA test, respectively. Specificity was 94.1% for PCL COVID-19 Ag Rapid test and 100% for the other three assays. All assays showed a significant negative correlation between the reference rRT-PCR Ct values and Ag test results. Besides, sensitivities of the STANDARD™ Q COVID-19 Ag test, PCL COVID-19 Ag Rapid FIA test, and BIOCREDIT COVID-19 Ag test improved to ≥ 85% after exclusion of samples with PCR Ct values > 30. Conclusions: The high specificity of the rapid antigen tests and other parameters like simplicity, rapidity, and affordability suggest that antigen tests are likely to be helpful if integrated and interpreted appropriately in stepwise diagnostic algorithms. Given the low sensitivity of 64.0–69.8% of the antigen tests, we recommend that clinically relevant negative results undergo further testing Ag to confirm or exclude a COVID-19 diagnosis.

Keywords: Diagnostic Tests, Routine; COVID-19; Reverse Transcriptase Polymerase Chain Reaction.

Objectives: The World Health Organization (WHO) published a global strategic response plan in February 2020 aiming to mitigate the impact of the novel coronavirus disease 2019 (COVID-19) outbreak. It identified immediate activities required for global preparedness and response to the outbreak and set eight priority areas (pillars) essential for scaling up countries’ operational readiness and response. Despite a semi-annual progress report on implementing the Global Strategic Plan in June 2020, there is limited granular information available on the extent of the national plan’s content and implementation, particularly in the Member States of the Gulf Cooperation Council (GCC). Therefore, we sought to review the preparedness and responsiveness towards the COVID-19 outbreak in the GCC in the first phase of the pandemic and to document lessons learned for improving the ongoing response efforts and preparedness for future pandemics. Methods: A rapid appraisal was conducted in June 2020 according to the WHO Strategic Preparedness and Response Plan and the accompanying Operational Planning Guidelines. The survey was administered to public health professionals or/and infectious disease experts in the states. The findings were cross-triangulated with secondary data that was publicly available for each country. Results: The preparedness and response efforts of Bahrain, Saudi Arabia, and the UAE were fully compliant with all 11 (100%) pillars of the modified strategic response measures. Kuwait, Oman, and Qatar complied with eight of the pillars. The component on conducting COVID-19 related research was the lowest-performing across all the six states. Conclusions: All GCC states demonstrated an effective response to the pandemic, enhanced existing infrastructures, and accelerated reforms that would have otherwise taken longer. The lessons learned through the early phase of the pandemic continue to steer the states in realigning their strategies and resetting their goals of controlling the outbreak, particularly in the current context of vaccine introduction and increasing preparedness capacities for future pandemics.

Keywords: Pandemics; SARS-CoV-2; COVID-19; Goals; United Arab Emirates; Qatar; Saudi Arabia; Oman; Kuwait; Bahrain.

Objectives: We aimed to determine epidemiological risk factors associated with acquiring severe coronavirus disease 2019 (COVID-19) in patients requiring hospitalization. Methods: A prospective cohort study was conducted using a questionnaire comprised of six closed-ended questions to identify potential risk factors for severe COVID-19. Using COVID-19 associated illnesses and complications (pneumonia, acute respiratory distress syndrome, need for mechanical ventilation, acute kidney failure, cardiac failure, and thromboembolic events), we derived an index variable to measure the severity of COVID-19 in patients. Results: We included 143 adult patients with confirmed COVID-19 of whom 62.2% (n = 89) were male and 37.8% (n = 54) were female. The average age of the cohort was 50.6±16.5 years. Our study found that being a female, working at the health care facility, being a healthcare worker, attending a mass gathering within the last 14 days, attending a gathering with 10 persons or less, and being admitted to a hospital were associated with increased risk of developing severe COVID-19. The only risk factor associated with severe COVID-19 was working at a health care facility (odds ratio = 33.42, p = 0.029). Conclusions: Intervention directed to control risk factors associated with acquiring severe COVID-19 should be a core priority for all countries, especially among high-risk occupations and workplaces, including working at a health care facility. A risk-based approach to prioritize vaccination among these high-risk individuals should be supported to strengthen the implementation of non-pharmaceutical interventions.

Keywords: COVID-19; Risk Factors; Hospitalization; Hospitals; Health Facilities; Oman.

Objectives: This study aimed to analyze the characteristics of coronavirus disease 2019 (COVID-19) infected health care workers (HCWs) and to measure their immunoglobulin G (IgG) response. Methods: This is a retrospective and prospective cohort study where details of COVID-19 infected HCWs were collected in a pre-designed database in Al-Nahdha Hospital between 2 April and 24 July 2020. A single serum sample was collected from participating HCWs to detect the presence of IgG in their sera. Results: Out of 974 HCWs, 103 (10.6%) were infected and tested positive for severe acute respiratory syndrome coronavirus 2 by real-time reverse transcriptase polymerase chain reaction. Nurses and doctors were the most affected groups. The source of infection was the hospital in 50.0% of cases. Nurses were more than four times likely to have a hospital-acquired COVID-19 infection (odds ratio = 4.63, 95% confidence interval: 1.71–12.52, p-value = 0.002). HCWs working in COVID-19 areas were more likely to have hospital-acquired infection than community-acquired infection (p < 0.005). All infected HCWs made a full recovery, with only 3.9% requiring admission. Out of 74 tested HCWs for IgG, 60 (81.1%) were positive. IgG positivity rate was significantly higher among HCWs in COVID-19 areas (p = 0.026) and among non-Omanis (p = 0.008). Moreover, the median IgG level was significantly higher among non-Omanis (p = 0.004). Conclusions: This study has highlighted the group at higher risk of hospital-acquired COVID-19 infection which was nurses and those working in COVID-19 areas. It highlighted as well the high seropositivity among this infected group. These findings support the national guidelines on priority groups for vaccination among HCWs working in COVID-19 areas with no previous laboratory-confirmed COVID-19.

Keywords: SARS-CoV-2; Reverse Transcriptase Polymerase Chain Reaction; Immunoglobulin G; COVID-19; Hospitals.

Objectives: The Coronavirus Disease 2019 (COVID-19) outbreak is a global pandemic and has caught the attention of the rheumatology fraternity, where patients are thought to be at higher risk of infection. We aimed to study the incidence of COVID-19 infection and depression and anxiety symptoms among patients with rheumatic disease (RD) in Hospital Selayang, Malaysia, during the COVID-19 pandemic. Methods: A cross-sectional study was conducted via phone interview using a structured questionnaire in patients with RD aged > 18 years old scheduled for clinic appointments from 4 to 28 May 2020, which coincided with the second wave of COVID-19 cases in Malaysia. The questionnaire included demographics, COVID-19 screening questions, depression and anxiety symptoms screening using questions derived from the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Results: Among the 361 patients enrolled, the majority were females (83.1%), and over half (54.3%) were ethnic Malays, 41.6% had rheumatoid arthritis, 34.6% had systemic lupus erythematosus, 12.2% had spondyloarthropathy, and only one (0.3%) patient had COVID-19 infection. The mean age of patients was 48.2 years (range: 16–80 years). The frequency of patients with depression and anxiety symptoms was 8.6% and 6.9%, respectively. Married patients reported feeling more anxious (p = 0.013), while patients with tertiary education levels reported feeling more depressed (p = 0.012). Conclusions: The incidence of COVID-19 infection is low, probably due to the low rate of testing. Depression and anxiety symptoms reported by patients in our cohort were modest. Our findings suggest that the COVID-19 pandemic has a greater impact on married patients with RD and those with a higher education level.

Keywords: Patient Health Questionnaire; COVID-19; Cross-Sectional Studies; Malaysia; Rheumatology;Depression; Anxiety; Rheumatic Diseases.

The Coronavirus disease-2019 (COVID-19) outbreak was classified as a global pandemic by the World Health Organization on 11 March 2020. It is caused by the novel severe acute respiratory syndrome coronavirus 2. The virus affects mainly the human respiratory system. Mycobacterium tuberculosis (TB) is another respiratory infection known to affect humans and may share joint clinical presentations and risk factors with COVID-19 infection. Therefore, clinicians must have a high index of suspicion that the two infections might coexist so that there is no delay in diagnosis and starting the appropriate treatment. There are few case reports about TB and COVID-19 coinfection. The first case report ever was from China and there have been a few others around the world. Here, we report two cases of coexisting COVID-19 and newly diagnosed pulmonary TB infection in Oman.

Keywords: SARS-CoV-2; Mycobacterium tuberculosis; Coinfection; COVID-19; Oman.

The novel coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. The most common symptoms include fever, cough, and shortness of breath (predominantly involving pulmonary function). However, there are lesser-known presentations that affect other systems too. Vascular complications have been reported in the literature focusing on venous thrombosis, which appears to be more common than arterial thrombosis. Among arterial thrombosis, mainly lower limb involvement is reported so far. Here, we report an unusual presentation in COVID-19, which presented with acute abdomen due to superior mesenteric artery thrombosis without respiratory symptoms. We report this case as a varied form of coronavirus complication presentation and highlight the need for eternal vigilance and a reactive approach for early diagnosis.

Keywords:Coronavirus; Abdomen, Acute; COVID-19; Mesenteric Artery, Superior; Thrombosis; Abdomen.

Neurobehavioral impairment associated with COVID-19 infection has been recently documented in the literature. COVID-19 infection has also been associated with an increased risk for developing psychiatric symptoms, including rare reports on psychosis. We report a case of a 46-year-old male with no significant medical, family, and psychiatric history admitted to the hospital with COVID-19-related psychosis. Possible contributory factors for his condition are discussed, including the relationship between infections and the brain circuitry, inadvertent iatrogenic effects of pharmaceuticals used to manage COVID-19, as well as diathesis-stress associated with the tribulation of the prevailing pandemic.

Keywords: COVID-19; Psychotic Disorders; Iatrogenic Disease.

Coronaviruses are a large family of single-stranded RNA viruses infecting humans and animals, causing a multitude of symptoms. COVID-19 is not only known to affect the respiratory system, but shows unusual gastrointestinal complications. Pancreatitis can be caused by biliary stones, alcohol abuse, viruses, drug intake, metabolic syndromes, or trauma. Diagnosis of acute pancreatitis requires any two of the three criteria: acute onset of severe upper abdominal pain, consistent with pancreatitis; elevation of serum amylase or lipase, three times the upper limit of normal; and/or characteristic imaging findings. COVID-19 associated pancreatitis is thought to be mediated by the angiotensin-converting enzyme-2 receptor on the host cells, which are highly expressed in the pancreatic cells. Here, we report a unique case of acute necrotizing pancreatitis caused by COVID-19 with hyperglycemia and normal amylase and lipase levels.

Keywords: Coronavirus; COVID-19; Pancreatitis, Acute Necrotizing; Tomography.

Hemodialysis is a medical procedure to correct electrolyte imbalance and remove fluids and waste products from the blood of patients with end-stage renal disease. Dialysis patients are immunosuppressed and hence at risk of complications of coronavirus infection. In addition, dialysis for most patients is performed in-center, with therapy offered three times per week for 3.5 hours per session in sites highly exposed to virus contamination. A weak immune system and low cytokine storm explain why COVID-19 may be less severe in dialysis patients as death due to COVID-19 or effects on comorbidities in COVID-19 patients is due to overresponse against the virus by the immune system and cytokine storm. However, during the frequent trips between the dialysis center and home, the risk of coronavirus infection could be high. Moreover, hemodialysis patients constitute a distinct and high-risk group that is often associated with low immunity, decline or loss of the ability to work, substantial economic burden, the inability to fulfill family responsibilities and participate in an active social life, and suffer from various complications such as muscle weakness, pruritus, fatigue, diabetes, hypertension, and restless legs. These factors are associated with lower quality of life and poor clinical outcomes, leading to a higher risk of psychological problems than in the general population. We report a rare case of new-onset psychosis (mostly delirium) following COVID-19 infection in a middle-aged hemodialysis patient with
rapid recovery.

Keywords: COVID-19;  Renal Dialysis;  Delirium.

The COVID-19 has a wide range of symptoms. This novel infectious disease may also trigger a vast range of neurological involvements. The current report describes a case of COVID-19 complicated with Bell’s palsy. A 64-year-old woman with diabetes was admitted due to abrupt left hemifacial weakness. On examination, her left hemifacial expression ability was impaired so that her face seemed asymmetrical during smiling, and numbness around the left nasolabial fold was detected. Furthermore, her ability to wink was impaired, and her eyebrow drooped. A brain computed tomography (CT) scan did not show any abnormalities. A lung CT scan was performed, which demonstrated bilateral ground-glass opacity (GGO), along with RT-PCR results indicative of COVID-19. A diagnosis of Bell’s palsy in the setting of COVID-19 infection was made. She received antiviral agents and corticosteroids. At two week follow-up, her symptoms had improved. During the COVID-19 epidemic, any newly occurred neurological involvement raises the suspicion of COVID-19 infection.

Keywords: Bell Palsy; COVID-19; corticosteroids.