Objectives: Noncommunicable diseases (NCDs) are the leading cause of mortality in all Gulf Cooperation Council (GCC) member countries and place a substantial economic burden on the governments and people. The escalating demand for NCD-related health services takes an enormous toll on health systems in these countries. There is an urgent need to make significant advances in the healthcare infrastructure and develop strategies to overcome the NCD challenge. This review aims to provide the status of national healthcare systems and national NCD policies in GCC countries to highlight the challenges and identify opportunities towards strengthening NCD management and control. Methods: We searched the PubMed database, the World Health Organization, and the Ministry of Health websites of GCC countries to identify relevant information. Results: Future strategies and investments in healthcare infrastructure to overcome the NCD challenge include continuing high-level commitment towards multisectoral actions, redesigning healthcare delivery to advance universal healthcare coverage, enabling integration of healthcare services through organizational alignment to maintain care continuum, building the capacity of health workforce, developing effective treatment strategies through research based on local populations, integrating mental health into general public health policy, and lastly, establishing reliable NCD surveillance and monitoring programs. Conclusions: Measures to address NCDs must be continued with focus on health-in-all policies, and whole-of-government and whole-of-society approaches.

Keywords: Gulf Cooperation Council; Mental Health; Noncommunicable Diseases; Prevention and Control.

Objectives: Patients with end-stage renal disease (ESRD) are known to experience poorer quality of life (QoL). The present study aimed to evaluate the effects of psychotherapy on QoL among patients with ESRD. Methods: We conducted a systematic search for studies in Medline, PubMed, and SAGE Journals databases from their dates of inception up to 10 April 2020. The inclusion criteria were studies on patients with ESRD, of randomized controlled trial design, published in English language, and with full-text content available online. Two researchers independently extracted articles that met the selection criteria and evaluated the quality of each study. A random-effects meta-analysis was conducted, and data was presented in weighted mean difference (WMD) with a 95% CI. Results: Eight studies were included in the systematic review of which five were entered for meta-analysis. Compared with the control group, the intervention group showed a significant enhancement in QoL, in both physical component summary (PCS) (WMD = 2.52, 95% CI: 0.48–4.57) and mental component summary (MCS) (WMD = 4.22, 95% CI: 1.54–6.89). The heterogeneity across studies for both PCS and MCS was found to be I2 = 0%. Conclusions: The findings indicate that psychotherapy may improve the QoL of patients with ESRD, as compared to the control group. Therefore, psychotherapy can be considered an essential component in the management of ESRD patients for improved psychological and physical outcomes.

Keywords: Psychotherapy; Quality of Life; ESRD; Systematic Review; Meta-analysis; Malaysia.

Objectives: To evaluate real-time polymerase chain reaction (PCR) as a diagnostic tool for pertussis (whooping cough), vis-à-vis culture, the long-time gold standard, with emphasis on the importance of clinical correlation in determining specificity. Methods: Nasopharyngeal/throat swab samples in charcoal media received from all over Oman at Central Public Health Laboratories from January 2014 to December 2016 were included in this study. These samples were tested using both culture and real-time PCR. PCR was compared with culture to calculate its sensitivity and specificity. Further clinical correlation was conducted for the discrepant cases using different case definitions. Results: A total of 590 nasopharyngeal/throat samples were included in the study. Out of the 590 samples, 73 were positive by PCR compared with 26 positive samples by culture (which were also positive by PCR). The sensitivity and specificity of PCR compared with those of culture were 100% (95% CI: 86.77−100) and 91.7% (95% CI: 89.07−93.81), respectively. To rule out false-positive results by PCR, clinical correlation was performed. Out of 47 cases that were positive by PCR but negative by culture, 44 cases were clinically evaluated by accessing clinical details. Out of these 44 cases, 21 (47.7%) met the pertussis clinical criteria according to the CDC-2014 case definition, 41 (93.2%) according to the Europe-2008 case definition, and 44 (100%) according to the Canada-2009 and Australia-2014 case definitions. With only positive PCR, these cases were classified as confirmed according to these case definitions, which increased the specificity of PCR to 95.7–100%. The mean turnaround time was 3.5 days for PCR compared to 6.2 days for culture. Conclusions: Real-time PCR is a highly sensitive and specific test for the diagnosis of Bordetella pertussis infection. Based on our results, we recommend setting up PCR diagnostic facilities in regional hospitals in Oman as this will lead to a timely and accurate diagnosis of pertussis.

Keywords: Bordetella pertussis; Culture; Polymerase Chain Reaction; Whooping Cough; Oman.

Objectives: We sought to identify the predictors of not achieving remission or low disease activity (LDA) among axial spondyloarthritis (SpA) patients in four Middle Eastern countries. Methods: In this multicenter prospective real-world study, adult patients with axial SpA diagnosed clinically during January–June 2019, and who met the Assessment of SpondyloArthritis International Society classification criteria for axial SpA, were enrolled from the participating centers of four countries—Lebanon, Oman, Qatar, and the UAE. Patient demographics, disease history, comorbidities, treatment, and compliance data were obtained at baseline. The primary outcome was to determine the percentage of patients who did not achieve the clinical target of remission or LDA as indicated by Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) < 2.1 after a three-month follow-up period. Secondary outcomes were assessing the demographic and clinical characteristics of ‘achievers’ and ‘non-achievers’ and to study the predictors of ASDAS-CRP ≥ 2.1 in different clinical subsets. Results: The participants were 309 patients of both sexes, with a median age of 43 years. Women had a slight majority (53.7%). At the end of the study, 72.2% of patients achieved the clinical target of ASDAS-CRP < 2.1. Non-achievers were significantly more likely to have enthesitis, positive human leukocyte antigen B 27 status, psoriasis, peripheral involvement, fibromyalgia, and a lower score on Compliance Questionnaire for Rheumatology (CQR). Multiple regression analysis showed that low CQR score, enthesitis, psoriasis, and family history of SpA were independent predictors of ASDAS-CRP ≥ 2.1. Conclusions: This real-world study suggests that low compliance, positive human leukocyte antigen B 27 status, peripheral involvement, and presence of enthesitis, psoriasis, and fibromyalgia are predictors of not achieving remission or LDA in axial SpA patients.

Objectives: This study aimed to determine the prevalence of blood transfusion-transmitted infections (TTIs), among blood donors in Pakistan, specifically HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and malaria. Methods: Data records of all registered blood donors (n = 120 968) during 2008–2019, at a blood transfusion center in a tertiary care hospital were assessed. Frequency of the seropositive donors for HIV, HCV, HBV, syphilis, and malaria was analyzed. Results: The overall age range of the donors was 25–65 years. Nearly all were male (99.0%). HCV, syphilis, and malaria were more prevalent among those aged 26–35 years. Most donors (81.1%) were residents of Islamabad city. The infection with the highest prevalence among the screened blood donors was HCV (1.5%; 95% CI: 0.423–0.661) followed by syphilis (0.8%; 95% CI: 1.149–1.432). HCV and syphilis were most frequently observed in blood group B positive (B+) donors while HIV was more common in those who were O+. The frequency of co-infection of syphilis with HCV and HIV was 0.02% and 0.01%, respectively. Conclusions: Among male blood donors, the most prevalent TTI infection was HCV followed by HIV; the latter is on the rise. HCV and syphilis are the most frequent co-infections.

Keywords: Blood Transfusion; Blood-Borne Infections; Hepatitis; Malaria; HIV; Blood Donors; Blood Safety; Pakistan.

Objectives: We sought to investigate the healing efficacy of thermosensitive in situ gelling formulation containing metronidazole and diclofenac potassium on ligature-induced periodontitis (LIP) in rats. Methods: We used 30 adult male Sprague-Dawley rats; 24 rats were subjected to LIP, while the remaining six rats were used as control. The 24 rats with LIP were subdivided into four groups of six rats each. Group 1 received 5% metronidazole loaded gel, group 2 received 0.2% diclofenac potassium loaded gel, group 3 received 5% metronidazole and 0.2% diclofenac potassium, and group 4 (the control group) did not receive any treatment. Treatment was administered on day 0, and the rats were monitored over seven days. Specimens were collected for histological examination to assess the healing process. Results: We found a statistically significant difference (p < 0.050) in the inflammatory and repair parameters of the healing process between different treatments. Combining the two drugs significantly accelerated the healing compared to the drugs given alone. Conclusions: Using a combination of diclofenac and metronidazole could potentially accelerate the healing process compared to the use of a single drug of either diclofenac or metronidazole.

Keywords: Metronidazole; Diclofenac; Periodontitis; Rats, Sprague-Dawley.

Objectives: To evaluate the knowledge, attitude, and acceptance of COVID-19 vaccine among the general population of Oman, on the eve of the rollout of vaccination program in the country. Methods: A cross-sectional study was conducted using a structured and validated online questionnaire. Adults residing in Oman were invited to participate in the study between 22 and 24 December 2020. Logistic regression analysis was used to identify the factors associated with COVID-19 vaccine acceptability. Results: Of the total of 966 participants, the majority (612; 63.4%) were women. Most participants were younger than 40 years (572; 59.3%). Participants displayed good awareness about COVID-19 (946; 97.9%) and the global vaccine development initiatives (831; 86.0%). Only 265 (27.4%) participants were willing to get themselves vaccinated. The majority were either uncertain 365 (37.8%) or unwilling 336 (34.8%). The main driver of vaccine acceptance was to protect oneself and others (186/265; 70.0%). The main reasons given for vaccination hesitation/refusal were concerns over possible side-effects (505/701; 72.0%), safety concerns (386/701; 55.0%), and ineffectiveness of the vaccine (107/701; 15.3%). Conclusions: On the eve of the first-ever rollout of COVID-19 vaccine in Oman in December 2020, the surveyed residents of the country expressed significant hesitancy to get themselves vaccinated. Participants’ perceptions of risk of contracting COVID-19, their trust in vaccines, government, and their health system were important predictors of vaccine acceptance. These results enabled development of strategies to address such concerns to facilitate vaccine acceptance among the residents of Oman. The results of this study can be used by researchers to conduct comparative research in future, with more emphasis on Omani youth (< 40 years).

Keywords: COVID-19; COVID-19 Vaccines; Awareness; Attitudes; Health Belief Model; Community Surveys; Oman.

Objectives: The incidence and prevalence of chronic kidney disease (CKD) are rising worldwide. It is becoming more common in the developing world with the increasing impact of non-communicable diseases in these countries. Also, autoimmune disorders, including thyroid dysfunction are more common and may worsen the clinical status of patients with CKD. We sought to determine the thyroid status in patients with CKD and explore the clinical, biochemical, immunological, and hematological parameters that can be affected by thyroid dysfunction among CKD patients. Methods: We conducted a cross-sectional observational study at the Royal Hospital, Muscat. The data was progressively collected for all newly diagnosed CKD patients with no known history of thyroid disease from January 2018 to December 2019. Assessment of thyroid status was performed at their initial diagnosis. Results: During the study period, 121 females (40.3%) and 179 males (59.7%) were diagnosed with CKD with no prior thyroid diseases. The mean age for females and males were 53.6±16.5 and 49.5±16.5 years, respectively. There were 35 patients with thyroid dysfunction with a prevalence of 11.7%. Of these, 22 patients (62.9%) had subclinical hypothyroidism, and 13 (37.1%) had subclinical hyperthyroidism. Total cholesterol and low-density lipoprotein were higher in hypothyroid patients. Urea was higher in hyperthyroid patients with CKD, and hemoglobin level was significantly lower. Conclusions: Thyroid dysfunction was not uncommon among CKD patients, with subclinical hypothyroidism more common than subclinical hyperthyroidism. Thyroid dysfunctions coexisted with kidney dysfunction. These hormonal axis dysfunctions may not be apparent at first presentation; and therefore, may require close clinical and laboratory evaluations.

Keywords: Glomerular Filtration Rate; Cross-Sectional Studies; Hypothyroidism; Hyperthyroidism; Renal Insufficiency, Chronic.

Objectives: Postpartum services are the most important factor in preventing unwanted maternal and neonatal outcomes. Considering the COVID-19 pandemic and the stress associated with the risk of infection, one way to improve midwifery services in the postpartum period and reduce unwanted maternal and neonatal outcomes is the participatory care model. Therefore, we aimed to assess the effect of the participatory care model on quality of life and performance in the postpartum period.
Methods: This quasi-experimental study was performed on 200 women in the third trimester of pregnancy living in Bojnourd, Iran in 2020. Health-promoting interventions, including self-care training based on the participatory care model, were performed in four sessions for mothers, spouses, and their supporters. Quality of life and postpartum performance questionnaires were completed two and eight weeks after delivery.
Results: Mean quality of life in two weeks after delivery in the intervention and standard care groups were 115.5 and 114.7, respectively, and in the eight weeks after delivery were 121.0 and 116.8, respectively. Mean postpartum performance life in two weeks after delivery in the intervention and standard care groups were 74.7 and 73.6, respectively, and in the eight weeks after were 81.7 and 75.8, respectively. The results of repeated-measure analysis of variance showed that the intervention group had higher quality of life and performance scores than the standard care group (p < 0.001). Conclusions: The participatory care model can effectively improve the quality of life and performance of mothers, and we recommend its use.

Keywords: Quality of Life; Mothers; Postpartum Period; Iran.

Objectives: This study aimed to assess knowledge, attitudes, and screening practices related to cervical cancer and Papanicolaou (Pap) smear testing among Omani women who were visitors to a family medicine and public health (FMPH) clinic. A secondary aim was to correlate the above with the subjects’ sociodemographic characteristics. Methods: This cross-sectional study was carried out from February 2020 to April 2021 at the FMPH Clinic of Sultan Qaboos University Hospital, Muscat. A self-administered questionnaire assessed the participants’ sociodemographic characteristics, cervical cancer-related risk factors, and their knowledge, attitudes, and practices related to cervical cancer, cervical cancer screening, and Pap smear testing. Results: The participants were 285 Omani women. The vast majority (256/285; 89.8%) had heard about cervical cancer and 208/285 (73.0%) about Pap smear testing. Only 32/285 (11.2%) and 179/285 (62.8%) demonstrated high levels of knowledge in the respective topics. Cervical cancer knowledge scores were associated with education level (p = 0.039), whether the qualification was related to healthcare (p < 0.001), and the nature of employment (p = 0.033). Pap smear knowledge scores were also associated with age (p = 0.001), education level (p < 0.001), whether the qualification was related to healthcare (p < 0.001), the nature of employment (p = 0.001), and number of children (p = 0.001). Most women were aware of the availability of Pap smear testing in Oman (206/285; 72.3%) and 114/285 (40.0%) had previously undergone this test. Among those who had never undertaken Pap smear testing (171/285; 60.0%), many were willing to do so in the future (103/171; 60.2%). Conclusions: Our results provide an increased understanding of Omani women’s level of perceptions, attitudes, and screening practices related to cervical cancer. These findings will help develop strategies to improve Omani women’s knowledge of cervical cancer symptoms and screening facilities and promote optimum utilization of the available screening services.

Keywords: Cervical Cancer; Papanicolaou Test; Cancer Screening; Health Knowledge, Attitudes, Practice; Human Papilloma Virus; Oman.

Objectives: An estimated 887 000 deaths were due to chronic hepatitis B (CHB) related complications in 2015 worldwide. Most of these deaths were related to decompensated liver cirrhosis and hepatocellular carcinoma (HCC). Oman is a country with an intermediate prevalence of CHB. The Hepatitis B vaccine was introduced in Oman in 1990, with a vaccine coverage rate of > 95% reported in 2005. Despite the association between CHB and liver cirrhosis and HCC, no available data from Oman demonstrates CHB-related liver cirrhosis. We sought to estimate the prevalence of CHB among patients with liver cirrhosis from Oman. Methods: We conducted a retrospective chart review of patients diagnosed with liver cirrhosis at Sultan Qaboos University Hospital and Armed Forces Hospital between January 2006 and April 2013. All pediatric and adult patients with liver cirrhosis were included. We collected demographic data and liver cirrhosis investigations. Results: A total of 419 patients were included. Two-thirds of the patients were males. The median age was 59 years. Omani patients represented the majority (97.1%) of patients with cirrhosis. Diabetes mellitus was present in almost half of the patients, and 22.2% indicated alcohol consumption. Evidence of previous or current hepatitis B virus (HBV) infection was found in about half of the cohort (51.3%). Only 3.3% of CHB patients were positive for hepatitis B e-Antigen. HBV DNA was detected in 47 patients (21.9%), of which 20 patients had a high viral load > 2000 IU/ml. More than a third (36.7%) had positive hepatitis B surface antibody (anti-HBs), indicating immunity to HBV, and 27.1% was due to previous HBV infection, 5.2% was immune due to vaccination, and 3.7% had positive anti-HBs and unknown anti-HBc status. Negative anti-HBs was found in 34.1% of the cohort and 29.9% had unknown immunity status. HBV coinfection with HCV was found in 24.7% of HBV patients with cirrhosis. Conclusions: Serological markers of CHB are common among liver cirrhosis patients in Oman. CHB related cirrhosis was more common in old age males than females (70.7% vs. 29.3%, respectively; p < 0.010). Evidence of past or present HBV infection was found in > 50% of the patients.

Keywords: Hepatitis B virus; Hepatitis B, Chronic; Liver Cirrhosis; Oman.

Thyroid storm is a rare, life-threatening condition in children. We report the case of a 16-year-old girl who presented with fever, cough, chest pain, and breathing difficulty. On the initial evaluation, a working diagnosis of left-sided pneumonia with empyema was made. She also had persistent tachycardia which was out of proportion to fever, and a staring look. She was found to have a thyroid storm. Timely diagnosis and appropriate management of thyroid storm proved to be lifesaving.

Keywords: Empyema; Hyperthyroidism; Thyroid Storm.

Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are oral hypoglycemic agents that have insulin-independent glucose-lowering effects mediated by increasing the renal excretion of glucose by inhibiting the SGLT2-mediated renal glucose reabsorption. An increasingly recognized complication induced by SGLT2i is euglycemic diabetic ketoacidosis (eDKA). Here, we describe the case of a 26-year-old male patient with type 2 diabetes mellitus and morbid obesity. Prior to presentation he was on multiple oral hypoglycemic agents including SGLT2i. He developed life-threatening severe prolonged eDKA associated with SGLT2i (Canagliflozin), precipitated by adenovirus infection. The acidosis was not responding to standard DKA therapy and renal replacement therapy but was managed effectively with insulin titration based on capillary ketone measurements. After reviewing the literature on severe prolonged eDKA induced by SGLT2 and treatment modalities used, we present previously reported cases similar to ours.

Keywords: Sodium-Glucose Transporter 2 Inhibitors; Canagliflozin; Diabetic Ketoacidosis; Acidosis; Renal Dialysis.

Mixed connective tissue disease (MCTD) is a unique disorder characterized by the presence of a high titer of anti-U1 ribonucloprotein antibody with overlapping features of various connective tissue disorders including systemic lupus erythematosus, scleroderma, and myositis. Severe renal or neurological involvement is unusual with this disorder. We describe a case of biopsy-confirmed severe sensorimotor axonal polyneuropathy in a middle-aged gentleman as his first presentation for MCTD.

Keywords: Mixed Connective Tissue Disease; Polyneuropathies; Pulmonary Arterial Hypertension.

Neurofibromatosis type 1 (NF1) (von Recklinghausen’s disease) is an autosomal dominant disorder characterized by café-au-lait spots, pigmented hamartomas of the iris, and multiple neurofibromas. Patients can present with hemorrhage secondary to trauma or rarely with spontaneous hemorrhage, both of which can be lethal and life-threatening. We report a 14-year-old girl with a rapidly expanding hematoma in a rare presentation of spontaneous bleed into the NF1 lesion in her scalp. Soon after presentation, she went into hemorrhagic shock. Emergency coiling of the left maxillary artery and branches successfully arrested the bleeding, while resuscitation reversed the hemorrhagic shock.

Keywords: Neurofibromatosis 1; Hematoma; Scalp; Oman.