Issa Al-Jahdhami, Khalid Al-Naamani, Adhra Al-Mawali

Khadijah Rizky Sumitro, Martono Tri Utomo, Agung Dwi Wahyu Widodo

Objectives: We sought to analyze the neutrophil-to-lymphocyte ratio (NLR) as an alternative marker of neonatal sepsis. Methods: In this cross-sectional study, we undertook consecutive sampling in all inborn neonates admitted to the Neonatal Intensive Care Unit with clinical manifestations of neonatal sepsis. Neonates with congenital anomalies and referred neonates were excluded. Complete blood count, C-reactive protein (CRP), and blood culture were carried out as the septic workup examinations based on the local Clinical Practical Guidelines. NLR is obtained by dividing the absolute count of neutrophils from lymphocytes manually. A cut-off value of NLR is obtained using a receiver operating characteristic curve. Results: The median NLR value of the 104 neonates who met the inclusion and exclusion criteria was 3.63 (2.39–6.12). Neonates with NLR of 2.12 have the area under the curve of 0.630 (95% confidence interval (CI): 0.528–0.741) and 0.725 (95% CI: 0.636–0.814) when combined with CRP = 2.70 mg/dL. Neonates with NLR ≥ 2.12 in clinical neotnatal sepsis had almost double the risk of providing positive blood culture results (relative risk = 1.867, 95% CI: 1.077–3.235; p = 0.011). Conclusions: NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.

Keywords: Infant, Newborn; Neonatal Sepsis; Neutrophils; Lymphocytes; Intensive Care Units, Neonatal; C-Reactive Protein.

Saada K. Al Subhi, Rahma M. Al Kindi, Abdul Hakim Al Rawahi, Iman S. Al Seyabi, Ameena Al Mukhaini

Objectives: In 2013, the World Health Organization (WHO) recommended new criteria for diagnosing gestational diabetes mellitus (GDM). Our study aimed to compare the incidence of GDM and its complications among Omani pregnant women using the new diagnostic criteria compared to previous criteria published in 1999. Methods: This retrospective cohort study was conducted between January and December 2016 at the Bawshar Specialized Polyclinic in Muscat, Oman. A total of 613 Omani women were included in the study. Baseline maternal characteristics such as age, body mass index, parity, and socioeconomic status were recorded in addition to maternal and neonatal outcomes. Results: Based on the current diagnostic criteria, the incidence of GDM was 48.5% (n = 297); however, this dropped to 26.4% (n = 162) when applying the old criteria. Moreover, rates of maternal complications including polyhydramnios (5.6% vs. 4.6%), pregnancy-induced hypertension (3.2% vs. 1.5%), and preterm delivery (3.2% vs. 1.5%) were slightly higher among women with GDM diagnosed using the latest criteria. However, these differences were not statistically significant. Neonatal complications were also slightly more frequent among the first group, without any significant differences. Conclusions: The incidence of GDM among Omani women rose dramatically when utilizing the latest WHO diagnostic criteria, owing to a lower fasting blood glucose cut-off value. In addition, a comparison of the frequencies of maternal and neonatal complications supports the validity of the new criteria. These findings should be taken into consideration by decision-makers in Oman when planning antenatal and postnatal services.

Keywords: Diabetes, Gestational; Incidence; World Health Organization; Oman.

Yahya M. Al-Farsi, Nawaf H. Albali, Muneera K. Alsaqabi, Mohammed Sayed, Adhra H. Al-Mawali, Samir Al-Adawi

Wan Nor Fazila Hafizan Wan Nik, Noorazliyana Shafii, Noor Azlin Azraini Che Soh Yusof, Rosnah Bahar

Salah T. Al Awaidy, Rana Jawad Asghar, Saad Omais, Muhammad Salman, Hassan Zaraket

Shahina Daar, Muna Al Saadoon, Yasser Wali, Rawan Al Mujaini, Sarah Al Rahbi, Moon Fai Chan, Alya Al-Siyabi, Niveen Alansary, Sangeetha Mahadevan, Samir Al-Adawi

Thamra Al Ghafri, Fatma Al Ajmi, Lamya Al Balushi, Padma Mohan Kurup, Aysha Al Ghamari, Zainab Al Balushi, Fatma Al Fahdi, Huda Al Lawati, Salwa Al Hashmi, Asim Al Manji, Abdallah Al Sharji

Objectives: As coronavirus disease (COVID-19) was pervading different parts of the world, little has been published regarding responses undertaken within primary health care (PHC) facilities in Arabian Gulf countries. This paper describes such responses from January to mid-April 2020 in PHC, including public health measures in Muscat, Oman. Methods: This is a descriptive study showing the trends of the confirmed positive cases of COVID-19 and the undertaken responses to the evolving epidemiological scenario. These responses were described utilizing the World Health Organizations’ building blocks for health care systems: Leadership and governance, Health workforce, Service delivery, Medical products and technologies, and health information management. Results: In mid-April 2020, cases of COVID-19 increased to 685 (particularly among non-nationals). As the cases were surging, the PHC responded by executing all guidelines and policies from the national medical and public health response committees and integrating innovative approaches. These included adapting comprehensive and multi-sectoral strategies, partnering with private establishments, and strengthening technology use (in tracking, testing, managing the cases, and data management). Conclusions: Facilities in the Muscat governorate, with the support from national teams, seemed to continuously scale-up their preparedness and responses to meet the epidemiological expectations in the management of COVID-19.

Keywords: COVID-19; Oman; Muscat; Public Health; Leadership; Health Workforce; Delivery of Health Care; Primary Health Care.

Emmanuel Kumah, Aaron Asibi Abuosi, Samuel Egyakwa Ankomah, Cynthia Anaba

Objectives: Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods: We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results: The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions: Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.

Keywords: Glycated Hemoglobin A; Blood Glucose; Diabetes Mellitus, Type 2; Self-Management; Glycemic Control; Chronic Disease.