Each year, approximately 10 million children worldwide die before reaching the age of five, yet two-thirds of these deaths could be prevented with effective, low-cost interventions. The Integrated Management of Childhood Illness (IMCI) strategy was adopted in 1996 by the World Health Organization and the United Nations Children's Fund to address the holistic well-being of children. The ultimate goals of IMCI are to develop a healthcare system that adheres to best practices and to improve the knowledge, attitudes, and skills of healthcare professionals. This paper describes the IMCI in pre-service education and training and the steps involved in integrating it into the nursing course on child health at Oman College of Health Sciences. The program aims to reduce the morbidity and mortality rate of children under five years of age, as well as the severity of their diseases. The Oman College of Health Sciences was the first healthcare academic institution in Oman to implement IMCI in nursing education to strengthen the nursing students’ knowledge, skills, and clinical practice.

Keywords:Child; Education; Training; Nursing; Oman.

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.

Keywords:Patient Readmission; Patient Discharge; Pharmacists; Hospitalization.

Objectives: To estimate the incidence, risk factors, and outcome of cytomegalovirus (CMV) infection during the first year following hematopoietic stem cell transplant (HSCT) among Omani patients. Methods: This retrospective study included allogenic HSCT recipients between January 2006 and December 2018. We investigated the possible factors associated with CMV infection and CMV impact on one-year mortality.Results: Among 556 recipients of allogenic HSCT, 308 (55.4%) were male, the median age was 12 years, and 366 (65.8%) had benign conditions. One-year after transplants, the prevalence of CMV infection was 59.4%, and that of CMV disease was 1.8%. Multivariate analyses revealed significant relationships between CMV infection and haploidentical transplant (p = 0.006), graft versus host disease (p = 0.013), myeloablative conditioning (p = 0.001), and patient age ≥ 12 years (p < 0.001). CMV infection was associated with an increased risk of one-year mortality (p = 0.001). One-year overall mortality was 8.3%. Conclusions: The incidence of CMV infection in this Omani cohort was comparable with earlier findings, but the disease incidence and overall mortality were lower. Older age, haploidentical transplant, myeloablative conditioning, and graft versus host disease were significantly associated with a higher risk of CMV infection. In addition, CMV infection was associated with an increased risk of overall mortality in the first year post-transplant. Our findings support early initiation of preemptive therapy at low-level CMV viremia.

Keywords:Cytomegalovirus; Bone Marrow Transplantation; Mortality; Graft Versus Host Disease; Oman.

Objectives: To assess the quality of life (QoL) of medical residents enrolled in the various postgraduate programs of the Oman Medical Specialty Board (OMSB). Methods: The data for this cross-sectional study was collected from January to June 2022. All postgraduate residents who were enrolled in all 19 OMSB training programs were targeted. An online English version of the validated 36-Item Short Form Health Survey (SF-36) was used to assess the participants’ self-reported QoL. Results: The participants were 425 OMSB residents (mean age = 29.6±2.2 years), of whom 289 (68.0%) were female, 259 (60.9%) were married, and 295 (69.4%) were enrolled in medical specialties. Overall, female residents reported significantly poorer QoL than male residents in all subscales of SF-36 (p = 0.001). Married residents reported lower bodily pain scores than unmarried residents (p = 0.005), although the latter endorsed better physical functioning, general health, and mental health. Residents in laboratory specialties had higher scores than those in medical and surgical specialties in most QoL dimensions including physical health, role functioning, energy/fatigue, emotional well-being, bodily pain, and general health (p ≤ 0.003). Psychiatry residents reported the lowest overall QoL. Conclusions: Postgraduate medical residents in Oman reported significant variations in QoL based on specialization, gender, and marital status. These findings underscore the need for targeted interventions to tackle health inequalities and improve the QoL of this population.

Keywords:Quality of Life; Graduate Medical Education; Internship and Residency; Health Status; Oman.

Objectives: Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening disease of chronic uncontrolled complement pathway activation that leads to thrombotic-microangiopathy, along with severe organ damage, including end-stage kidney disease. This study aimed to evaluate the epidemiology, management, and outcome of aHUS in an Omani population. Methods: This retrospective descriptive cohort study assessed all cases of aHUS diagnosed and followed up at two tertiary care centers in Oman from January 2008 to December 2019, based on clinical features, complement pathway assays, histopathological, and genetic testing. Results: The study accrued 19 patients who fulfilled the inclusion criteria, of whom 11 (57.9%) were male. The participants’ median age was 25.0 years (range = 0.1–69.0). Most (15; 78.9%) patients presented in the acute phase of the disease. The triad of hemolytic anemia, acute kidney injury, and thrombocytopenia was present in all patients. A trigger factor (e.g., infection) was identified in 68.4% of cases. Of the 14 (73.7%) patients who underwent kidney biopsy, 10 (71.4%) were found to have aHUS in native kidneys and three in grafted kidneys. Of the 11 (57.9%) patients who underwent genetic analysis, five (45.5%) were found to have a known pathogenic variant in their aHUS susceptibility genes. Plasma exchange followed by eculizumab was the treatment method in 11 (57.9%) cases. Complete renal recovery was achieved in seven (36.8%) patients, while four (21.1%) passed away during the study period. Conclusions: The wide spectrum and multiple expressions of aHUS make it a challenge to diagnose and consequently may delay the commencement of the targeted treatment. Eculizumab is considered the first-line therapy and should be commenced as early as possible.

Keywords:Atypical Hemolytic Uremic Syndrome; Epidemiology; Outcome; Oman.

Objectives: This study sought to assess the prevalence of persistent COVID-19-related symptoms in patients with mild, severe, and critical disease. Methods: We conducted a bidirectional cohort observational study that included all adult patients ≥ 18 years, admitted to Armed Forces Hospital, Muscat between July 2020 and June 2022, with COVID-19 infection and discharged alive. Patients were requested to attend outpatient clinic at weeks six and 12 post-discharge, where they filled out a questionnaire and underwent a chest X-ray. Additionally, blood tests were performed if necessary. Healthcare workers with mild infections were also requested to fill out a questionnaire about their initial symptoms, persistent symptoms, and comorbidities. Results: The study included 468 patients, comprising 261 hospitalized patients and 207 healthcare workers. On follow-up, 39.7% of patients presented with residual symptoms, such as cough, breathlessness, and joint pain. These symptoms were more common in patients with medical comorbidities, particularly hypertension, diabetes, and dyslipidemia. Notably, these symptoms were also observed in patients with mild disease. Post-COVID-19 pulmonary fibrosis was observed in 21 patients, mainly among those admitted to the intensive care unit or requiring prolonged hospitalization. Conclusions: This study highlights the persistence of symptoms and the prevalence of post-COVID-19 syndrome at two months post-discharge, especially among patients with severe and critical disease during the acute phase. Various predictors of post-COVID-19 syndrome were identified, including female gender, older age, presence of comorbidities, disease severity, and hypertension. Therefore, patients in these categories require thorough evaluation and long-term follow-up to manage residual symptoms.

Keywords:COVID-19 Pandemic; Post-Acute COVID-19 Syndrome; Long COVID; Oman.

Objectives: To identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in nine Middle Eastern countries. Methods: We conducted a prospective cohort study between 1 January 2014 and 2 December 2022 in 212 intensive care units (ICUs) of 67 hospitals in 38 cities in nine Middle Eastern countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, Turkey, and the UAE). To estimate CAUTI incidence, we used the number of UC days as denominator and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: patient sex, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, hospitalization type, ICU type, facility-ownership, country income level classified by World Bank, and time period. Results: Among 50 637 patients hospitalized for 434 523 patient days, there were 580 cases of acquired CAUTIs. The pooled CAUTI rate per 1000 UC days was 1.84. The following variables were independently associated with CAUTI: age, rising risk 1.0% yearly (adjusted odds ratio [aOR] = 1.01, 95% CI: 1.01–1.02; p < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09–1.56; p < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05–1.06; p < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06–1.14; p < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49–6.76; p < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83–7.68; p < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03–33.12; p < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07–18.53; p < 0.0001) when compared to cardiothoracic ICU. The periods 2014–2016 (aOR = 7.36, 95% CI: 5.48–23.96; p < 0.001) and 2017–2019 (aOR = 1.15, 95% CI: 3.46–15.61; p < 0.001) had a similar risk to each other, but a higher risk compared to 2020–2022. Conclusions: The following CAUTI RFs are unlikely to change: age, sex, ICU type, and country income level. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Keywords:Urinary Tract Infections; Risk Factors; Intensive Care; Incidence; Middle East.

Objectives: This study sought to determine the confidence level of mental health practitioners in Oman regarding the use of antidepressants during pregnancy and breastfeeding, assess their knowledge and need for further training in this area, and examine their current prescribing patterns and preferences. Methods: A questionnaire-based survey was conducted from May to June 2017 among all practitioners in the psychiatry specialty, including medical officers authorized to prescribe medications, at the Behavioral Medicine Department of Sultan Qaboos University Hospital and Al Masarra Hospital. Results: Forty-two practitioners (response rate = 89.4%) responded to the questionnaire. Of them, 10 (23.8%) had no experience, while 30 (71.4%) had experience in prescribing antidepressants during both pregnancy and breastfeeding periods. Twenty-seven (64.3%) respondents felt that they were confident in prescribing antidepressants for women during their perinatal period, while 30.0% were neutral. Moreover, 35 (83.3%) participants expressed the need for more training in this area. Furthermore, 34 (81.0%) believed that more training in perinatal psychiatry should be included in the psychiatry curriculum. There was no consistent prescribing pattern (either prescribing or avoiding) among our participating practitioners during the first trimester of pregnancy and breastfeeding periods. The drug of choice in the first trimester of pregnancy was fluoxetine preferred by approximately 85.0% of the practitioners, but avoided by 10.0% of practitioners in the same period. This was followed by amitriptyline (50.0% vs. 23.0%), sertraline (50.0% vs. 9.0%), imipramine (28.0% vs. 84.0%). During breastfeeding, the drug of choice for approximately 74.0% of the practitioners was paroxetine, but avoided by 15.0% of practitioners. This was followed by sertraline (50.0% vs. 8.0%). The most common reasons for prescription during pregnancy were safety, evidence-based practice, and low teratogenicity. For breastfeeding, the main reasons for prescription were low levels of the drug in breast milk, safety, and evidence-based practice. On the other hand, high teratogenicity, neonatal side effects, limited data, and lack of evidence were among the most common reasons behind avoiding prescribing during pregnancy, while high levels of breast milk, neonatal side effects, limited evidence, and safety concerns were the most common reasons during the breastfeeding period. Conclusions: There was inconsistency among mental health practitioners in making prescription decisions and in their prescribing patterns.

Keywords:Antidepressive Agents; Pregnancy; Breast Feeding; Prescriptions; Psychiatry; Oman.

Objectives: Exploring the possibility of healthy aging among older persons is crucial for achieving optimal health in the growing older population. This study aimed to determine the prevalence, pattern, and determinants of healthy aging among older persons in Terengganu, Malaysia. Methods: We conducted a community-based cross-sectional study involving older persons aged ≥ 60 years. An interviewer-guided questionnaire, anthropometric measurements, and physical assessments were administered to operationalize healthy aging based on a multidimensional concept. Results: Among the 765 older persons surveyed, only 14.1% (95% CI: 11.64–16.59) were classified as healthy agers. Multiple logistic regression analysis revealed that superior intrinsic religiosity (odds ratio (OR) = 3.42; 95% CI: 1.34–8.73), higher social interaction (OR = 2.82; 95% CI: 1.32–6.04), larger calf circumference (OR = 2.05; 95% CI: 1.24–3.38), taking water intake ≥ 5 cups per day (OR = 2.01; 95% CI: 1.23–3.30), better gait speed (OR = 1.71; 95% CI: 1.04–2.80), having savings (OR = 1.71; 95% CI: 1.10–2.66), and normal waist circumference (OR = 1.63; 95% CI: 1.04–2.55) were found positively associated with healthy aging. Conclusions: Only one in 10 older persons in the state met all the criteria for healthy aging. Specific aspects of religious status, social interaction, socioeconomic, behavioral, physical, and nutritional factors were found to predict healthy ageing in this population. These important determinants should be considered in developing a well-defined and comprehensive public health policy to promote healthy aging in the nation.

Keywords: Healthy Aging; Prevalence; Determinants; Elderly.

Objectives: Pulmonary embolism (PE) is increasingly prevalent in Oman. The aim of this situational analysis of PE among Omani patients was to study its predisposing factors, diagnostic issues, and optimal management. Methods: In this retrospective cross-sectional situational analysis, the subjects were Omani patients who were diagnosed with acute PE using computed tomography pulmonary angiogram from 2010–2021. The required data was collected from the hospital database and statistically analyzed. Results: The subjects were 438 patients diagnosed with PE, with a mean age of 53.3±18.5 years and mean body mass index of 29.7±7.3 kg/m2. Males were in a slight majority (223; 50.9%) and were older (55.0±18.5 years) than females (51.5±18.3 years). Two-thirds of the PE patients had hypertension and one-third had diabetes mellitus. Most patients presented with dyspnea and chest pain. Syncope was more common in females compared to males who mostly presented with hemoptysis. Nearly half of the patients had abnormal echocardiogram, and males had lower mean ejection fraction compared to females. Different modalities of management were used to treat patients' PE. Heparin was the most used anticoagulant followed by warfarin and direct oral anticoagulants. Out of the 122 PE patients who died during the study period, PE was the direct cause of death of 68 patients. The mortality was higher in males than in females. Conclusions: The incidence of acute PE was similar among both male and female Omani patients. However, there were sex differences in risk factors, symptoms, investigations, and management of PE. Females presented with more severe PE, but mortality was higher in males.

Keywords:Pulmonary Embolism; Computed Tomography Angiography; Hypertension; Diabetes; Obesity; Oman.

Since the first cases were reported in Wuhan, China, COVID-19 has spread swiftly worldwide and is caused by SARS-CoV-2. The development of myocardial injury is associated with significantly worse clinical course and increased mortality. However, currently, it is unclear whether cardiac injury occurred in COVID-19 patients. Histological results obtained directly from the viral infection of the myocardium (i.e., SARS-CoV-2 viral myocarditis) or indirectly from the complications of COVID-19, showed that only a portion of patients infected with the virus developed viral myocarditis. Therefore, it is possible that with more autopsy evidence of SARS-CoV-2 and more correlation with the severity of the viral infection, viral myocarditis will emerge. Although COVID-19 manifests primarily as respiratory disease, few cases of cardiac injury without respiratory involvement or febrile illness have been reported. The pathogenesis of cancer and viral infections is due to the inability of the immune system to distinguish between self and non-self. Several oncogenic (hepatitis B virus, hepatitis C virus, human papilloma virus, Epstein-Barr virus, and HIV) and oncolytic viruses (coxsackievirus, reovirus, vaccinia virus, and adenovirus) are known to cause and regress various cancer types. We report a case of atypical manifestation of COVID-19-induced acute myocarditis and thyroid gland follicular neoplasm in a hemodialysis patient with no respiratory symptoms. This case illustrates that COVID-19 can present atypically and affect non-respiratory organ systems.

Keywords:COVID-19; SARS-CoV-2; Myocarditis; Thyroid Neoplasm; Hemodialysis; Hypertrophy, Left Ventricular; Cardiomyopathy, Dilated; Myocardial Reperfusion Injury.

We present a rare case of congenital thoracic aortic aneurysm (TAA) complicated with dissection in a nine-year-old girl with Noonan syndrome and atrial septal defect. She presented with rapid breathing and upper respiratory tract symptoms. Chest X-ray revealed a huge upper mediastinum with cardiomegaly. Echocardiogram showed possible ascending TAA. Computerized tomography angiogram of the aorta revealed huge aortic root-ascending TAA with small aortic dissection. Despite immediate treatment, the patient passed away due to severe airway compromise.

Keywords:Atrial Septal Defect; Computed Tomography Angiography; Noonan Syndrome; Malaysia.

Adenovirus infections are common and self-limiting in young children except those with compromised cellular immunity. However, serious adenovirus infections are rare in children with acute leukemia. We report a rare case of a toddler with acute myeloid leukemia who developed a disseminated adenoviral infection complicated by hemorrhagic enterocolitis and septic shock that led to a fatal outcome.

Keywords:Adenovirus; Enterocolitis; Acute Myeloid Leukemia; Pediatrics; Oman.

Commonly, herpes simplex virus (HSV) causes infectious encephalitis among children. A neurological relapse after primary HSV encephalitis in the weeks or months after presentation is well recognized. Relapsing symptoms of post-HSV encephalitis can present either as a true relapse or an immune-mediated disorder. A relationship is predicted between immune-mediated disorder and N-methyl-D-aspartate receptor (NMDAR) antibodies. This study presents two cases of patients suffering from anti-NMDAR encephalitis that appeared after treatment for proven HSV encephalitis. The first patient was treated immediately after the presentation as autoimmune encephalitis and had an excellent outcome. The second patient had delayed initiation of treatment and suffered from intractable epilepsy and severe global developmental delay. An important role is played by recognizing anti-NMDAR encephalitis symptoms and its variable presentation for timely diagnosis and quick initiation of treatment for anti-NMDAR encephalitis, thus, improving the outcome for those patients.

Keywords:Herpes Simplex Virus; Encephalitis; N-Methyl-D-Aspartate Receptor; Antibodies.

To mitigate the impact of the COVID-19 pandemic, several vaccines have been developed and administered to the public since 2021. A spectrum of cutaneous reactions has been reported among some of the vaccinated individuals. In this case series, we describe three cases of pityriasis rosea and pityriasis rosea-like eruption that manifested after COVID-19 vaccinations, which might suggest the vaccines as a possible trigger.

Keywords:COVID-19 Vaccine Pfizer-BioNTech; mRNA Vaccines; Oxford-AstraZeneca COVID-19 Vaccine; Pityriasis Rosea; Pityriasis Rosea-like Eruption; Oman

Rectal lymphoma is a rare condition, presenting in less than 0.5% of all primary rectal neoplasms. Due to the disease’s primary non-specific symptoms, its diagnosis is usually made at advanced stages. Clinically, it is indistinguishable from rectal carcinoma. The optimal approach for managing rectal lymphoma has still not been determined. We report a case of primary rectal diffuse large B-cell lymphoma (stage IV) in a 71-year-old Omani woman.

Keywords:Rectal Lymphoma; B-Cell Lymphoma; Rectal Neoplasm; Oman.