Purpose:The purpose of this study is to determine the incidence of retinopathy of prematurity (ROP) and the maternal/neonatal risk factors at a tertiary care hospital in Oman, compared to other countries.Patients and Methods:A retrospective analysis of premature neonates born with gestational age (GA) 24–32 weeks at Sultan Qaboos University Hospital, Oman, from January 2007 to December 2010. Maternal and neonatal in-hospital course was retrieved. The incidence of ROP was reported. Risk factors analyses were performed using univariate and multivariate statistics.Results:A total of 171 neonates (57% males, 43% females) were included for analysis. The incidence of ROP (any stage) was 69/171 (40.4%). Infants with ROP had significantly lower GA (27.7±2 weeks) compared to non-ROP group (30.2±1.7 weeks), P < 0.001),P < 0.001) and significantly lower birth weight (BW) (948 ± 242 g in ROP group vs. 1348 ± 283 g in non-ROP group;P < 0.001). Other significant risk factors associated with ROP were: small for GA, respiratory distress syndrome, requirement for ventilation, duration of ventilation or oxygen therapy, bronchopulmonary dysplasia, hyperglycemia, late onset sepsis (clinical or proven), necrotizing enterocolitis, patent ductus arteriosus, seizures, and number of blood transfusions. There was no significant difference in maternal characteristics between the ROP and non-ROP groups except that mothers of infants with ROP were found to be significantly younger. Logistic regression analysis revealed early GA, low BW, duration of Oxygen therapy, and late-onset clinical or proven sepsis as independent risk factors.Conclusion:ROP is still commonly encountered in neonatal practice in Oman and other countries. Early GA, low BW, and prolonged oxygen therapy continue to be the main risk factors associated with the occurrence of ROP in our setting. In addition, an important preventable risk factor identified in our cohort includes clinical or proven late-onset sepsis.

Aims: The aims of this study were identification of the causative organisms, uropathogens’ resistance, and extended-spectrum β-lactamase producing bacteria in primary and recurrent urinary tract infection. Study Design: A retrospective study included Omani children, less than 14 years, with any documented urinary tract infection. Place and Duration of Study: Sultan Qaboos University Hospital between September 2008 and August 2012. Methodology: Comparison was made between both groups using Chi-squared (χ2) test as appropriate. Results: The first group included 175 children with first attack of urinary tract infection. Escherichia coli was the leading pathogen (69%), Klebsiella pneumonia (17%; P<0.001), and extended-spectrum β-lactamase producing bacteria (3%). 230 isolated uropathogens from 74 patients with recurrent urinary tract infection. The most common isolated pathogen was Escherichia coli 187 (81.3%; P<0.001), followed by Klebsiella pneumonia 12 (5.1%), and extended-spectrum β-lactamase producing bacteria (7%; P=0.042). Overall resistance to parenteral antibiotics was less evident than oral antibiotics, with least resistance to Meropenem and Imipenem (1% each). Higher resistance was found in recurrent urinary tract infection to Augmentin, Cefuroxime, Ceftriaxone, and Cefotaxime. Oral Nitrofurantoin showed least resistance in first and recurrent urinary tract infection, but increased in non- Escherichia coli uropathogens. Conclusion: Escherichia coli and ESBL were more common in recurrent urinary tract infection, while Klebsiella pneumonia were found more in first urinary tract infection. Meropenem, Imipenem, Amikacin, and Piperacillin/Tazobactam can be used cautiously and selectively, while Cefotaxime and Ceftriaxone cannot be used in both groups. Our report shows high resistance rates to Ampicillin, Cefuroxime, and Amoxicillin/Clavulanate. First-generation cephalosporin is not recommended for use as empiric therapy. We recommend the use of Ciprofloxacin and Nitrofurantoin as empiric treatment in both groups, with close monitoring of clinical response. Indeed, a larger scale multicenter national and regional studies are recommended in Oman and gulf region.

Cystic fibrosis (CF) is a multisystem disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. CFTR is expressed in the apical surface of cholangiocytes. Homozygous CFTR gene mutation results in viscous and acidic bile secretions secondary to deficient surface fluid and bicarbonate efflux. Viscous, inspissated bile causes ductular obstruction and hepatotoxicity from retained bile components, leading to fibrosis and ultimately cirrhosis, known as CF liver disease (CFLD). CFLD is the third leading cause of death in CF patients. CFLD manifestations can take many forms. They range from asymptomatic elevation of transaminases to cirrhosis and end-stage liver disease. CFLD is diagnosed after excluding other causes of chronic liver disease. To date, there is no effective therapy to prevent or treat CFLD. Management of CFLD emphasizes on optimizing nutritional status. Ursodeoxycholic acid is the only available treatment that may prevent progression of CFLD at present. All CF patients with CFLD need annual investigations and follow-up for early detection of the disease. Liver transplantation should be considered in patients with decompensated cirrhosis and portal hypertension, with acceptable long-term outcomes. Novel therapies of CFLD are promising. This review article aims to summarize the published literature on CFLD, its pathophysiology, clinical features and complications, and management including new therapeutic options.

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Background: COVID-19 is a global pandemic that was first reported in Iraq on 24th February 2020, while it appeared in Nineveh on March 22nd, 2020. Infection prevention and control (IPC) is so important to minimize the risk of spreading infections.   Objectives: To assess the adherence to IPC measures among medical staff working in Nineveh governorate during COVID-19 pandemic.   Methods: A cross sectional study, using an online survey sent to different medical staff in Nineveh. The questionnaire was composed of two parts, the first included demographic information, and the second covered IPC measures. Survey was completed by medical staff witnessed COVID-19 pandemic in Nineveh governorate.   Results: The total sample was 412, of whom, 316 (77%) were males and 142 (35%) were physicians. Overall, the percentage of staff following different IPC measures was ranging from 31 % in wearing head cover, to 97% in keeping clean hands constantly. Main missed points were found in respiratory hygiene, physical distancing and self-isolation. Females were more likely to apply bandages to wounds and wearing gloves before examining patients. Compared to other medical staff, physicians were less compliant to washing hands, putting waste in designated places and wearing protective cloths. Those who work in hospitals were better compliant with sterilizing hands before entering home.   Conclusion: The adherence to IPC measures was ranging from less than one-half in wearing sterile head cover, to nearly all respondents in keeping clean hands. There is a great need to provide support as well as training in regards to IPC in Nineveh governorate city.

abstract:Objectives: Trauma surgeons are essential in hospital-based trauma care systems. However, there are limited data regarding the impact of their presence on the outcome of multi-trauma patients. This study aimed to assess the outcomes of multi-trauma road traffic crash (RTC) cases attended by trauma surgeons versus those attended by non-trauma surgeons at a tertiary hospital in Oman. Methods: This retrospective study was conducted in December 2015. A previously published cohort of 821 multi-trauma RTC patients admitted between January and December 2011 to the Sultan Qaboos University Hospital, Muscat, Oman, were reviewed for demographic, injury and hospitalisation data. In-hospital mortality constituted the main outcome, with admission to the intensive care unit, operative management, intubation and length of stay constituting secondary outcomes. Results: A total of 821 multi-trauma RTC cases were identified; of these, 60 (7.3%) were attended by trauma surgeons. There was no significant difference in mortality between the two groups (P = 0.35). However, patients attended by trauma surgeons were significantly more likely to be intubated, admitted to the ICU and undergo operative interventions (P <0.01 each). The average length of hospital stay in both groups was similar (2.6 versus 2.8 days; P = 0.81). Conclusion: No difference in mortality was observed between multi-trauma RTC patients attended by trauma surgeons in comparison to those cared for by non-trauma surgeons at a tertiary centre in Oman.

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