Compared to studies performed in urban hospitals in other countries, (1) the annual rate of poisoning-related Accident & Emergency Department visits was substantially lower, (2) psychoactive drugs were less frequently incriminated in intentional ingestions, and (3) we found a significantly higher frequency of poisoning by animals and traditional remedies than reported by urban hospitals in other Middle Eastern countries. The limitations of our study (Accident & Emergency Department-based data collection in an urban hospital) do not permit extrapolation to the rest of the country.

Objective To evaluate nurses' knowledge of oral solid dosage forms that should not be crushed at Sultan Qaboos University Hospital (SQUH), Oman, the methods used in crushing and the references consulted prior to crushing. Method A questionnaire‐based study of a convenience sample of nurses in inpatient practice areas of SQUH, Oman, from 14 to 21 of November 2012. Key findings  One hundred twenty‐six (76.51%) of nurses regularly crushed oral solids for patients who are unable to swallow. Eighty‐seven point thirty per cent (145) are aware that there are some specially formulated oral solids that should not be crushed, but only 38% (63) could correctly indicate how such medications can be recognised. Only half of nurses check the pharmaceutical characteristics of oral solids before crushing. When multiple medications are prescribed for a patient who cannot swallow, 42.16% (70) crush all together and mix with some water before giving to the patient. Five point seven per cent (10) of nurses put on personal protective equipment all the time before crushing, 26.58% (27) rarely and 25.95% (49) never do. Sixty‐nine point three per cent (115) consult their pharmacist when they are in doubt about crushing. Conclusions Crushing of oral solid dosage forms was common among nurses in SQUH. There were knowledge deficits regarding special formulations that should not be crushed. When oral solids were crushed, attention to possible drug–drug, drug–food interactions, contamination and safety was overlooked. Majority of nurses consulted their pharmacist when in doubt about crushing. Further research is required to see if collaboration among nurses and pharmacists would improve this practice.

ObjectiveLittle is known into the prudent use of antibiotics in hospitals in Oman. This study is to evaluate antibiotic prescribing by measuring the overall compliance with the local antibiotic prescribing guidelines.MethodsAn observational study involving 366 patients’ admission episodes as determined by power analysis on patients (≥18 years) on oral and/or parenteral antibiotic during admission, in the period of 10 weeks (1 February–15 April, 2014). The adapted audit tool of the Barking, Havering and Redbridge University Hospitals NHS Trust was used for this study. Analyses were performed using descriptive statistics. Main outcome measures: antibiotic prescribing compliance with the local guidelines as well as the overall restricted antibiotic policy adherence at Sultan Qaboos University Hospital (SQUH).ResultsThe number of prescribed and audited antibiotics totalled 825, compliance with local guidelines was suboptimal at 63% (n=520), and of 211 restricted antibiotics prescribed, the overall adherence to restricted antibiotic policy was inadequate at 46% (n=98). The majority of the antibiotics prescribed were broad spectrum at 90% (n=739), mainly penicillins at 31% (n=256) and cephalosporins at 17% (n=139).ConclusionThe study has provided valuable baseline details of antibiotic prescribing patterns in SQUH. The diagnosis was documented in 89% (n=327) of the admission episodes. However, the compliance with SQUH antibiotic prescribing guidelines was suboptimal, and the overall compliance with SQUH restricted antibiotic guidelines was in 46% of the prescriptions. Further studies are required to address the reasons behind the non-compliance with local guidelines.

In SCD patients, low-dose regimen of HU is a feasible option that ensured safety and yet did not affect efficacy.

The authors tested the efficacy and safety of intermittent high doses of iv deferrioxamine (DFX) on a twice-weekly basis through an externalized venous catheter on 14 thalassemic children who were heavily iron-loaded and poorly or noncomplaint to subcutaneous DFX. The main reasons for their noncompliance were resistance of the child because of severe local reactions or more than one family member affected, with very high burden on the mother to look after all the affected children. There were 9 males and 5 females and their age range was 7-13 years (mean 10.93 +/- 1.9 years). All patients were given a 48-h continuous iv infusion of DFX 200-240 mg/kg/day (approximately 10 mg/kg/h) every 2 weeks, combined with subcutaneous 10-h infusion of DFX 3 days/week. One month after the start of the intermittent high-dose DFX program, the 24 h urinary iron excretion was 29.1-1.50 mg/kg/24 h (mean 69.7 +/- 32.5 mg/kg/24 h). These values dropped significantly to 29-53 mg/kg/24 h (mean 39.8 +/- 7.9 mg/kg/24 h) 1 year after the study (p <.004) and remained almost the same over the second year (mean 39.07 +/- 6.58 mg/kg/24 h). Serum ferritin levels markedly elevated before the start of high-dose chelation fell steadily during iv high-dose DFX therapy. Mean values were 6215.5 +/- 578.3, 3971.5 +/- 321.6, 2507.2 +/- 131.2, and 1866.5 +/- 110 ng/mL at 0, 6, 12, and 24 months, respectively. No serious side effects were reported. Intermittent high-dose DFX therapy combined with 3 days of subcutaneous DFX is safe and effective in reducing iron stores and improving the compliance of these heavily iron-loaded thalassemic children.

Objective: To determine the incidence and pattern of thyroid dysfunction (TD) in patients on chronic amiodarone therapy. Methods: A retrospective study which evaluated 59 patients who had received amiodarone therapy regularly for at least 12 months from a period of 3 years from October 2007 to October 2010. The patients were followed-up at the cardiac clinic at Sultan Qaboos University Hospital, Muscat, Oman. Results: The mean age of the cohort was 63 ± 13 years ranging from 27 to 98 years. Fifty-one percent (n = 30) of the patients were female. There were 11 (19%) cases of thyroid dysfunction (TD). Seven (12%) patients were hypothyroid, 3 (5%) had hyperthyroidism and 1 (2%) patient had sub-clinical hypothyroidism; no cases of sub-clinical hyperthyroidism were noted. Female gender and presence of anti-thyroid peroxidase antibodies were significantly associated with amiodarone-induced hypothyroidism (p = 0.001) while age, amiodarone dose and duration of therapy were not correlated with the development of TD (all p-values > 0.05). Conclusion: Amiodarone-induced thyroid dysfunction is prevalent. Hypothyroidism was more frequent and seen more in female patients and those who had positive anti-thyroid peroxidase antibodies. Initial screening and periodic monitoring of thyroid function is mandatory for all patients on amiodarone therapy.

Objectives: Biologic disease modifying anti-rheumatic drugs (bDMARDs) are the cornerstone of active rheumatoid arthritis (RA) treatment when traditional DMARDs are no longer effective. The objective of this study is to evaluate recent real-world treatment choices and switching in the US. MethOds: Patients initiating a bDMARD for RA between 10/2015-09/2016 were identified from the Symphony Health claims database. A minimum age of 18 years and 6 months of pre-and post-initiation medical and pharmacy claims activity was required. The study examined market share among biologic starts and switching patterns. Results: In the 12-month period, 19,288 patients initiated a new biologic: 15,337 (79.5%) were female, mean (SD) age was 54.7 (12.9) years, mean (SD) number of biologics was 1.4 (0.7). The top 3 biologics were: adalimumab (5,824; 28.8%), etanercept (5,817; 28.8%), abatacept (2,013; 10.0%). For 16,301 patients on first biologic, the top 3 biologics were: etanercept (5,203; 31.9%), adalimumab (5,010; 30.7%), infliximab (1,496; 9.2%); for 3,042 patients on second biologic, top 3 biologics were adalimumab (742; 24.4%), etanercept (564; 18.5%), tofacitinib citrate (429; 14.1%); for 865 patients on third biologic or more, top 3 biologics were tofacitinib (207; 23.9%), abatacept (172; 19.9%), tocilizumab (154; 17.8%). Tumor-necrosis factor inhibitors (TNFi) were used in 77.9% of first-line, 67.0% of second-line, and 62.0% of third-line or higher therapies. Of 3,913 switchers, 30.5% switched from etanercept (48.4% to adalimumab), 28.6% switched from adalimumab (38.7% to etanercept), and 10.9% switched from abatacept (25.4% to tocilizumab, 24.5% tofacitinib) with mean (SD) time to switch of 345.5 (132.7), 334.1 (152.3), and 338.3 (149.1) days respectively. cOnclusiOns: RA patients receive multiple lines of bDMARD therapy. Despite availability of drugs with alternative mechanisms of action, TNFi are preferred agents with adalimumab and etanercept dominating as first and second biologics. Comparative effectiveness research is needed to evaluate optimal sequencing.

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