Objectives: To conduct a systematic review and meta-analysis of available studies regarding the effects of the traditional herb Rosa damascena (as topical application and oral intake) on the severity of acute pain in adults. Methods: A systematic search was performed on the following databases: Cochrane Central Register of Controlled Trials, PubMed, Scopus, Web of Science Core Collection, Embase, Cumulative Index to Nursing and Allied Health Literature, Scientific Information Database, and Magiran from inception to 20 March 2021. We included parallel-group and cross-over randomized controlled trials that compared the effects of any products containing R damascena in oral and topical administration forms to placebo, non-treatment, or conventional treatment. Two researchers independently performed the document screening and selection, data extraction, and risk of bias assessment. A random-effect model was used to pool the data. Results: From a total of 11 studies that met the inclusion criteria, four studies administered R damascena through topical application and seven by oral intake. Nine studies recruited only females. Ten studies had parallel-group design, while one adopted cross-over design. The oral intake of R damascena reduced pain severity non-significantly (standardized mean difference (SMD) = -0.55, 95% CI: -1.27–0.17; p = 0.132). However, the topical application of this treatment had no pain-alleviating effect (SMD = 0.10, 95% CI: -0.75–0.96; p = 0.814). One study reported mild allergic rhinitis as an adverse effect of the treatment. Risk of bias assessment revealed that three of the eleven studies had good methodological quality, six had fair quality, and two were of poor quality.Conclusions: This systematic review and meta-analysis suggests that the oral intake of R damascena may have a non-significant alleviating effect on acute pain severity in adults. However, its topical application has not shown pain-alleviating effect. More robust randomized controlled trials are needed for accurate estimation of the effects of oral and topical use of R damascena on the severity of different types of acute pain in adults.

Keywords: Acute pain; Adult; Analgesics; Rosa; Review; Iran.

A systematic review is a specific and reproducible method to search, identify, select, appraise, and summarize all studies relevant to a particular health care question. In this paper, we will review the concept of level of evidence, define the terms systematic review and meta-analysis, and outline the steps in performing a systematic review and meta-analysis with an illustrative example. We will also introduce some important concepts in systematic reviews and meta-analyses like heterogeneity, publication bias, forest plots, and quality assessment. Finally, this review will focus on systematic reviews addressing therapeutic research questions.

Keywords: Systematic Review; Meta-Analysis; Clinical Trial.

Objectives: Non-small cell lung cancer (NSCLC) accounts for 75–85% of all lung cancer diagnoses. This meta-analysis sought to estimate the overall survival (OS) of NSCLC based on randomized control trials which had compared docetaxel with kinase inhibitors, antineoplastic agents, and monoclonal antibodies as second-line chemotherapy for advanced NSCLC. Methods: We selected 18 randomized control trials which used docetaxel as the standard treatment arm, while kinase inhibitors, antineoplastic agents, and monoclonal antibodies constituted the experimental arm. The methodological quality of the trial was classified according to the Modified Jadad score. Several steps were taken to reduce publication bias. A forest plot was used to graphically summarize the meta-analysis. Results: The Hedge’s g value of antineoplastic agents was 0.11 (95% CI: -0.03–0.26), while for kinase inhibitors was 0.04 (95% CI: -0.10–0.17) and monoclonal antibodies was 0.05 (95% CI: -0.02–0.13). Forest plot showed a clear though only slightly higher overall survival using docetaxel compared to those of the antineoplastic agents, kinase inhibitors, and monoclonal antibodies, due to the existence of moderate heterogeneity and lower impact. Conclusions: Overall, the patients in these studies who were in the standard (docetaxel) treatment arm had slightly better OS than those in the intervention treatment arm. As per the results, docetaxel was more effective in the second-line treatment of advanced NSCLC than antineoplastic agents, monoclonal antibodies, and kinase inhibitors. We infer that docetaxel-based second-line therapy for patients with advanced NSCLC is supported by our meta-analysis.

Keywords: Non-Small Cell Lung Cancer; Meta-Analysis; Docetaxel; India.

Objectives: To study the effect of the COVID-19 pandemic on the socio-demographic and clinical profiles of patients who were admitted to a tertiary psychiatric hospital in the UAE during 2020 compared with the corresponding period in 2019, and to evaluate the effect of the pandemic on the mental healthcare system. Methods: Socio-demographic and clinical data of the patients from March 11 to June 11 in 2019 and 2020 was collected anonymously from hospital electronic medical records. The characteristics of the two patient cohorts were compared statistically. Results: A total of 337 patient admissions to the hospital during March 11 to June 11, 2020 against 189 admissions in the corresponding period in 2019. In the multiple logistic regression model, the admissions in 2020 were significantly more likely to be diagnosed with bipolar disorder (odds ratio ( OR) = 1.902; p = 0.028) and were significantly to have no prior psychiatric history (OR = 4.255, p < 0.001), compared to those cases admitted in 2019. Conclusions: This study is unique for evaluating the patterns of hospitalization at a specific psychiatric hospital during the first three months of the pandemic in the UAE. The findings of this study will support the public health sector in designing mental health strategies in pandemic situations. A longitudinal multicenter study would give more insight into the overall impact of the pandemic on mental health.

Keywords: Mental Health; COVID-19; Psychiatry; Psychology; Bipolar Disorder; United Arab Emirates.

Objectives: Alopecia areata (AA) is a multifactorial autoimmune disease with a strong genetic predisposition. A variety of genes involved in immunity and inflammatory responses, such as cytokines, are suspected to increase the risk of developing AA. In which, different interleukin (IL) genes that associated with several autoimmune diseases and AA in varied populations. The objective of this study was to investigate the possible genetic association of AA with ten variants of single nucleotide polymorphism (SNP) in IL12B, IL13, IL16, IL17A, and IL18 genes among Jordanian patients. Methods: In this case-control study, peripheral blood samples of 152 Jordanian AA patients and 150 controls (total of 302 subjects) were collected, genomic DNA extracted and genotyped, based on which their allele and genotype frequencies were assessed. Results: In the rs11073001 SNP located in the exon region of the IL16 gene, the A allele was distributed more frequently in AA patients (p = 0.01). A difference was found between the patients and the controls for the rs17875491 SNP in the promoter region of the IL16 gene (p = 0.04). The mean age of onset was 27.3±12.6 with male predominance. Most patients (68.4%) were asymptomatic but some reported experiencing associated sensations before the hair loss episodes. The patchy patterns of alopecia were the most common (90.3%). Nail changes were found in 7.3% of the patients. Conclusions: The findings support the hypothesis of the involvement of IL16 gene in the etiology of AA. Moreover, it emphasizes the variations in the genetic component of AA, as well as the clinical phenotypes among different ethnic groups.

Keywords: Alopecia areata; Autoimmune Disease; Genetic Polymorphism; Hair Disease; Interleukins; Jordan.

Objectives: Extended-spectrum β-lactamases (ESBLs) mechanism of resistance in Enterobacterales leads to poor clinical outcomes. Ceftazidime/avibactam and ceftolozane/tazobactam are two broad-spectrum antimicrobial combinations that are effective against multidrug-resistant organisms with regional variations. This study aims to evaluate the antimicrobial susceptibility test (AST) for both combinations against ESBL-producing Enterobacterales isolated from intensive care units (ICUs) in tertiary hospitals from November 2012 to October 2013 in Qatar. Methods: A total of 629 Enterobacterales isolates from ICUs were screened for ESBL production using BD-PhoenixTM confirmed by double-disk potentiation, while ESBL-genes were detected by polymerase chain reaction. The ASTs for ceftazidime/avibactam and ceftolozane/tazobactam were assessed by minimum inhibitory concentration (MIC) test strips. A single isolate that was resistant to both combinations was subjected to whole-genome sequencing. Results: The prevalence of ESBL-producing Enterobacterales isolated from ICUs was 17.3% (109/629) with predominance of Klebsiella pneumoniae (56/109; 51.4%) and Escherichia coli (38/109; 34.9%). The susceptibility of ceftazidime/avibactam and ceftolozane/tazobactam against ESBL-producers was 99.1% (108/109) and most (81/109; 74.3%) had MICs < 0.5 for both combinations. The predominant ESBL-gene was blaCTX-M (72/109; 66.1%). A single isolate that was resistant to both combinations harbored multiple ESBL resistant-genes including blaVEB-5 and blaVIM-2. Conclusions: ESBL-producing Enterobacterales isolated from ICUs were predominantly K. pneumoniae and E. coli, mainly harboring blaCTX-M gene. They were highly susceptible to ceftazidime/avibactam and ceftolozane/tazobactam suggesting potential alternatives to currently available therapeutic options.

Keywords: Enterobacterial; beta-lactamase TEM-11; Antimicrobial drug resistance; Ceftazidime-Avibactam; Ceftolozane-Tazobactam; Qatar.

Objectives: We sought to evaluate the incidence of 28-day hospital readmission in a tertiary hospital in Oman and identify potential factors associated with increased risk of hospital readmission. Methods: We conducted a retrospective study of all adult patients (≥ 18 years) admitted under the care of the General Internal Medicine unit from 1 June to 31 December 2020 at Sultan Qaboos University Hospital. Elective admissions and COVID-19 infection-related admission were excluded from the study. Results: There were 200 patients admitted during the study period. The mean age was 58.6±19.3 years, and 106 (53.0%) patients were males. Forty-eight (24.0%) patients had unplanned readmission within 28-days after discharge from the hospital. Patients with 28 days unplanned readmission were older (66.6 vs. 56.0 years, p < 0.001) and had a longer length of hospital stay (6.0 vs. 4.0 days, p < 0.001). Also, hypertension (77.1% vs. 55.3%, p = 0.007), diabetes mellitus (64.6% vs. 48.0%, p = 0.045), and comorbidity (≥ 3 comorbidities, [43.8% vs. 23.8%, p = 0.005]) were more prevalent in the unplanned readmission group. Patients with poor functional status (43.7% vs. 26.3%, p < 0.001), requiring feeding tube (25.0% vs. 5.3%, p < 0.001), and with polypharmacy (75.0% vs. 50.0%, p = 0.003) were at increased risk of readmission. Conclusions: 28-day hospital readmission is prevalent in our health care setting. Old age, polypharmacy, comorbidities, and poor functional status were associated with an increased risk of hospital readmission. Therefore, evidence-based interventions must be implemented in our health care system to minimize the risk of hospital readmission.

Keywords: Patient Readmission; Patient Discharge; Internal Medicine; Length of Stay; Comorbidity.

Objectives: We sought to examine stressors and coping strategies adopted by Omani adults during the COVID-19 pandemic and explore the relationships between coping strategies (avoidant and approach coping) and sociodemographic characteristics. Methods: This national cross-sectional survey was conducted throughout Oman between September and December 2020. An online questionnaire was distributed to collect information concerning sociodemographic characteristics, potential stressors experienced during the pandemic, and coping strategies. Results: A total of 790 Omani adults submitted completed questionnaires (response rate 88.4%). High, moderate, and low stress were reported by 492 (62.3%), 139 (17.6%), and 159 (20.1%) participants, respectively. Approach coping mechanisms received a higher mean score than avoidant mechanisms (22.01±6.55 vs. 8.88±4.80). Regarding specific coping strategies, planning had the highest mean score (5.15±1.31), followed by acceptance (4.95±1.34), religion (4.56±1.52), and positive reframing (4.28±1.89), while substance use (0.01±0.19) was the least reported followed by humor (0.86±1.43), denial (0.97±1.56), and behavioral disengagement (1.02±1.60). Associations were observed between the different coping strategies and participants’ gender, age, marital status, exercise level, and stress level (p ≤ 0.05). Conclusions: During a large-scale pandemic, the psychological impact on the general population is significant, even among individuals not infected with the disease. These results underscore the need for a mental health support system in Oman that can address the general population’s needs. Public education on coping strategies and stress management may be helpful.

Keywords: COVID-19; Psychological Stress; Coping Behaviors; Quality of Life; Mental Health; Psychological Distress; Pandemic; Oman.

Objectives: To establish a reference range for acylcarnitines (ACs) and amino acids (AAs) concentrations in dried blood spot (DBS) samples of Omani neonates to detect inborn errors of metabolism (IEM), and to evaluate the effect of age and sex on ACs and AAs. Methods: Electrospray-ionization tandem mass spectrometry (+ESI-MS/MS) was used to determine ACs and AAs concentrations in DBS samples collected from 1302 healthy newborns (0–7 days) delivered at Sultan Qaboos University Hospital between August 2008 and May 2009. Results: More than fifty biomarkers that allow diagnosis of various IEMs were measured, their 1st and 99th percentile values determined, and compared with published international data. Our results were comparable with the corresponding figures from Collaborative Laboratory Integrated Report, despite a much smaller sample size. We found that age had a significant effect on most ACs and AAs except decadienoylcarnitin, decenoylcarnitine, adipylcarnitine, palmitoylcarnitine, steatoylcarnitine, tyrosin, phenylalanine, and valine. Sex of the neonate had insignificant effect on most ACs and AAs except free-carnitine, acetylcarnitine, hexanoylcarnitine, octanoylcarnitine, malonylcarnitine, decanoylcarnitine, dodecenoylcarnitine, dodecanoylcarnitine, and tetradecanoylcarnitine. Conclusions: Tandem mass spectrometer is a highly effective tool for high throughput screening of IEM. This study is the first to publish reference intervals for ACs and AAs from DBS samples of Omani newborns. The results may prove to be of significance when determining cut-off values for newborn screening in the near future.

Keywords: Oman; Tandem Mass Spectrometry; Inborn Errors of Metabolism; Reference Range; Acylcarnitine; Amino Acids.

Objectives: Information regarding the magnitude of hepatitis C virus (HCV) infection among thalassemia patients is of great importance for health care providers to assess blood safety and improve the quality of screening systems. Therefore, this study evaluated the prevalence, risk factors, and genotypic pattern of HCV infection among β-thalassemia patients in South Iran. Methods: This descriptive-analytical cross-sectional study was conducted from March to June 2019. All patients with β-thalassemia major from Borazjan, Bushehr, Delvar, Kangan, and Ahram cities participated in the study and attended the transfusion center of the Bushehr University of Medical Sciences located in southern Iran. Serum samples were tested for the presence of anti-HCV antibodies by an enzyme-linked immunosorbent assay. The seropositive serum samples were tested for detection of HCV viremia and genotypes by semi-nested reverse transcriptase-polymerase chain reaction and sequencing. Results: Of 125 thalassemia patients, 22 (17.6%) were positive for anti-HCV antibodies and two (1.6%) had HCV viremia with genotype 3a. HCV seroprevalence increased with age, so anti-HCV seropositive thalassemia patients had significantly higher mean age than anti-HCV seronegative patients. HCV seroprevalence was higher among female patients, residents of Kangan, patients with blood transfusion every two weeks, Fars patients, and thalassemia patients with alanine aminotransferase levels of < 20 IU/L and aspartate aminotransferase levels of > 80 IU/L. Nevertheless, anti-HCV seroprevalence among thalassemia patients was not statistically associated with these variables. Conclusions: These results indicate ongoing HCV incidence among the thalassemia population in this region. Transfusion of HCV-seronegative viremic blood units donated during the infectious window period contributes to HCV infection in thalassemia patients. These findings highlight the need to include sensitive molecular assays in the screening process of donated blood for HCV infection in Iran.

Keywords: Hepatitis C; beta-Thalassemia; Prevalence; Genotype; Risk Factor; Iran.

Objectives: To investigate the relationship between attitudes toward COVID-19 vaccines and disapproval of the policy of mandatory COVID-19 vaccination among unvaccinated physicians and nurses in Oman. Methods: The subjects were (N = 346) unvaccinated physicians and nurses in Oman. Their demographic data and attitudes regarding COVID-19 vaccines and mandatory vaccination policy were collected through an anonymous web-based survey and statistically analyzed. Results: The participants’ negative attitudes toward COVID-19 vaccines were positively related (r = 0.68, p < 0.001) to the extent of their non-support for COVID-19 mandatory vaccination policy. Analysis of variance test showed that after controlling for age, male healthcare providers were more likely to endorse mandating COVID-19 vaccinations. There was no difference between physicians and nurses in support of mandatory vaccination, after controlling for age. Conclusions: Regardless of job type, male, and older physicians, and nurses in Oman were more supportive of mandatory COVID-19 vaccination than their younger and female counterparts. This research provides insights from an Arabian Gulf country about the attitudes of its unvaccinated healthcare providers toward compulsory COVID-19 vaccination.

Keywords: COVID-19; Vaccination; Attitude of Health Personnel; Surveys; Physicians; Nurses; Healthcare Providers; Oman.

Individuals born with trisomy 13 tend to be susceptible to Meckel’s diverticulum. It is rarely symptomatic and reported cases are extremely rare. We describe here a neonate with feeding intolerance and bilious aspirates as a result of Meckel’s diverticulum and peritoneal band which caused intermittent volvulus with obstruction.

Keywords: Trisomy 13 Syndrome; Bile; Meckel Diverticulum; Volvulus; United Arab Emirates.

Tracheobronchial mucoepidermoid tumors (METs) typically occur in the head and neck region but rarely in the trachea and lung. They are salivary-type tumors that arise from the glandular component of the tracheobronchial epithelium. The most common type, mucoepidermoid carcinoma (MEC) has histological features that overlap with more aggressive lung carcinomas such as adenosquamous carcinoma. It is important to realize the histological features and limitations of a diagnostic biopsy. This case illustrates this point where an initially diagnosed lung adenocarcinoma turns out to be MEC. We report a case of a 43-year-old woman with a one-year history of recurrent episodes of cough and fever. Initial bronchial biopsy diagnosed her as having adenocarcinoma of the lung. However, her surgical biopsy confirmed it was MEC. High clinical suspicion that the diagnosis may not have been correct saved her from a potential pneumonectomy. She instead underwent bi-lobectomy sleeve resection. This case illustrates the importance of recognizing less common and less aggressive lung tumors that may appear histologically as adenosquamous carcinoma. High clinical suspicion, not only biopsy results, from clinical history, imaging and gross appearance is always needed in all cases. The use of intraoperative frozen section is mandatory. It is important to be aware that because of morphological limitations of small endobronchial biopsies, diagnosis of a more common pathology may be favored.

Keywords: Carcinoma, Mucoepidermoid; Carcinoma, Adenosquamous; Operative Procedures.

Elizabethkingia meningoseptica is a gram-negative rod-shaped bacterium commonly found in soil and water. This organism is associated with nosocomial infections, especially in neonatal wards, as it has been isolated from contaminated medical equipment. Prompt diagnosis and early institution of appropriate combination therapy for prolonged period are crucial in the management of such infections. Herein, we describe two premature neonates admitted to our special care baby unit at 31 and 36 weeks old, respectively, who were diagnosed with neonatal bacterial sepsis. In both patients, blood and/or cerebrospinal fluid cultures indicated that E. meningoseptica was the causative organism. This bacterium is generally resistant to multiple antibiotics, including combination therapy. Therefore, E. meningoseptica can cause severe infection with a high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions and involvement of an infection control team are crucial for effectively managing and preventing these infections.

Keywords: beta-lactamase GOB-1, Elizabethkingia meningoseptica; Infant, Newborn; Neonatal Sepsis.

Albinism results from a deficiency of the protein responsible for melanin production in melanocytes. Albinos are at an increased risk of dermatoses and malignancies. Primary carcinosarcoma of the skin is an exceedingly rare biphasic tumor composed of malignant epithelial and mesenchymal elements with an unclear histogenesis. To our knowledge, this has not been reported in an African albino. Here, we report the index case of this rare tumor in an albino of African descent.

Keywords: Albinism; Carcinosarcoma; Immunohistochemistry; Skin Cancer; Nigeria.

Peripherally inserted central catheterization is a common procedure in neonatal intensive care units. However, in preterm low birthweight newborns, achieving good vascular access can be a challenge. We describe our experience in achieving peripherally inserted central catheterization in a preterm baby through an unusual vascular tract. The line inserted through one of the superficial abdominal veins traversed the epigastric vein, the internal thoracic vein, the superior vena cava, and successfully reached the cavoatrial junction. The line was confirmed radiologically and used safely and effectively for almost 20 days.

Keywords: Catheterization, Peripheral; PICC Placement; Infant, Premature; Oman.