Objectives: To identify and evaluate the prescribing pattern of antibiotics among hospitalized patients with SARS-CoV-2, Omicron variant in Oman, focusing on the prevalence of antibiotic use, rates of simultaneous infection, and potential overuse. Methods: This retrospective study analyzed data from the electronic medical records of patients with COVID-19 caused by SARS-CoV-2 Omicron variant who were hospitalized at the Royal Hospital, Muscat, during December 2021–February 2022. Information on demographic and clinical details (including existing infections and comorbidities), hospital stays, and outcomes were collected. The prevalence and pattern of antibiotic use were examined, an association with their disease characteristics and simultaneous infection status were assessed. Statistical analysis was performed using R software. Associations between categorical variables were evaluated using chi-square test. Results: The participants were 176 hospitalized COVID-19 patients (mean age 59.3 ± 18.6 years), of whom 69.9% had mild disease and 22.7% had severe disease. Simultaneous infection (coinfection or superinfection) was present in 11 (6.3%) patients, including 7 (4.0%) bacterial infections as revealed by culture tests. Despite the low rate of simultaneous infections, 104 (59.1%) patients received antibiotics, as follows: ceftriaxone (45.2%), piperacillin and tazobactam (45.2%), and vancomycin (21.2%). Half of the patients who received antibiotics used them for only one to three days with a median duration of four days (range = 1–16). Antibiotic use was significantly associated with patient sex (p = 0.030), and the presence of simultaneous infection (p = 0.029). The number and duration of antibiotic treatment also showed significant associations with various patient and disease characteristics. Conclusions: Despite low rates of confirmed bacterial infections, antibiotics were administered to majority of hospitalized patients with COVID-19 (Omicron variant). This finding emphasizes the need for strengthening antimicrobial stewardship to curb unnecessary antibiotic use and reduce the risk of antibiotic resistance during pandemics in Oman.

Keywords:Antibiotics; COVID-19; SARS-CoV-2; Omicron; Oman.

Objectives: Surfactant therapy is an established treatment for neonatal respiratory distress syndrome (RDS). We sought to compare two administration techniques, intubation-surfactant administration-extubation (INSURE) and minimally invasive surfactant therapy (MIST), for efficacy and safety in premature neonates with RDS. Methods: In this randomized clinical trial, premature neonates with RDS admitted to a neonatal intensive care unit in Iran from July to December 2020 were randomly assigned either to INSURE or MIST. In the MIST group, the surfactant was administered during spontaneous breathing via a thin vascular catheter without intubation. In the INSURE group, infants were intubated, surfactant administered, and then extubated. The key outcomes were the frequency of surfactant administration, duration of oxygen support, need for mechanical ventilation in the first 72 hours, and complications arising. Results: The baseline characteristics of the studied premature neonates (N = 82) were similar between the INSURE (n = 44) and MIST (n = 38) groups. The surfactant treatment time was much shorter for the INSURE group (10.5 ± 17.0 minutes) than for the MIST group (42.0 ± 42.5 minutes; p < 0.001). All infants received the first dose of surfactant, and requiring a second dose was obeserved in 17 (38.6%) in the INSURE group and 18 (47.4%) in the MIST group (p = 0.400). There were no significant differences between the groups in the incidence of intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, pneumothorax, pulmonary hemorrhage, or disseminated intravascular coagulation. The duration of nasal continuous positive airway pressure and the need for mechanical ventilation were also similar. Conclusions: Both INSURE and MIST techniques are effective and safe for administering surfactant therapy to premature infants with RDS, with no significant differences in outcomes or complications.

Keywords:Noinvasive Ventilation; Surfactant; Premature Infants; Neonatal Respiratory Distress Syndrome; Iran.

Objectives: Selective immunoglobulin A deficiency (SIgAD) is characterized by an isolated deficiency of serum IgA while immunoglobulin G (IgG) and immunoglobulin M (IgM) levels remain normal. Symptoms range from asymptomatic to recurrent infections. We aimed to determine the prevalence of IgAD and SIgAD among Omani patients undergoing screening for celiac disease. Methods: This cross-sectional study included Omani nationals aged above one year, who were screened for celiac disease with anti-tissue transglutaminase (anti-tTG) IgA at Royal Hospital, Muscat, from January 2005 to December 2023. IgAD was defined as a total serum IgA level below the age-dependent reference range. SIgAD was diagnosed when both IgG and IgM values were within their respective reference limits. The prevalence of IgAD and SIgAD was statistically reviewed. Results: Of the 9615 individuals who underwent screening for celiac disease, 114 had low IgA levels. The prevalence of IgAD was 1.2%, and among these, 0.4% were confirmed to have SIgAD. The majority were > 14 years. Patients aged 6–14 years and > 14 years were more likely to have IgAD compared to 1–2 years old. Only 39 (34.2%) patients underwent further testing to confirm SIgAD, while the remaining 75 (65.8%) did not undergo follow-up IgG and IgM testing. Among the patients with confirmed SIgAD, 11 (28.2%) underwent further testing with anti-tTG IgG antibody, with only one (9.1%) testing positive for celiac disease as confirmed by esophagogastroduodenoscopy (EGD) and histopathology. Patients with anti-tTG IgG and EGD exhibited a significantly increased risk of low IgA levels. The remaining 28 (71.8%) patients did not undergo further celiac disease workup (anti-tTG IgG antibody, EGD, or genetic testing). Conclusions: IgAD was present in 1.2% of Omani patients evaluated for celiac disease, and 0.4% had confirmed SIgAD. Referral to an immunologist is recommended when IgG/IgM levels are low or infections are recurrent.

Keywords:Immunoglobulin A; Immunoglobulin A Deficiency; Celiac Disease; Hypogammaglobulinemia; Oman.

Objectives: To examine the prevalence, characteristics, causes, and contributing factors of depression among university students to aid in the management of this condition through the identification of root causes and influencing factors. Methods: This cross-sectional study surveyed students enrolled in various colleges of Sultan Qaboos University, Muscat, between 1 September and 20 November 2023. Depressive symptoms were assessed using the self-report Patient Health Questionnaire-9. Results: Out of a total of 1036 participants, 349 had depression, revealing a prevalence rate of 33.7%. Most depressed students were female (n = 261, 74.8%) and lived on campus (n = 210, 60.2%). Depression was significantly more prevalent among female students (p < 0.001) and among those residing on campus (p = 0.028). The highest rate of depression was observed among students in the Colleges of Science (39.9%), Engineering (38.5%), and Agriculture and Marine Sciences (36.8%). There was no significant association between academic grade point average and depressive symptoms (p = 0.462). Conclusions: Over one-third of Sultan Qaboos University students had depressive symptoms, which was more prevalent among female students and those residing on campus, though an over representation of women in university housing confounds the latter association. Further research, especially in collaboration with other educational institutions, is recommended to assess the nationwide prevalence, identify vulnerable groups, and develop effective treatment strategies.

Keywords:Depression; Students; Universities; Young Adults; Surveys and Questionnaires; Prevalence; Oman.

Objectives: This study aimed to evaluate the screening rate and the prevalence of obstructive sleep apnea syndrome (OSAS) in patients with apparent resistant hypertension (ARH) attending Sultan Qaboos University Hospital, and to assess sex differences. Methods: A cross-sectional retrospective study was conducted using the data from 500 patients with ARH between January 2018 and January 2023. The cohort included 270 women and 230 men. Data extracted from hospital records included demographic and clinical characteristics, antihypertensive medications, results of OSA screening tools (e.g., Epworth Sleepiness Scale and STOP-Bang questionnaire), and polysomnography outcomes. Results: Of the 500 patients with ARH, 54 (10.8%) were diagnosed with OSAS. Only 6.6% (n = 33) were screened for OSA using the Epworth Sleepiness Scale or STOP-Bang questionnaire, while the majority (93.4%, n = 467) were not screened. Women constituted 54.0% of the cohort and had a higher mean body mass index than men (32.7 kg/m2 vs. 30.2 kg/m2, p < 0.001). OSAS prevalence was significantly higher in women than men (14.1% vs. 7.0%, p = 0.013). Conclusions: There was a low rate of screening for OSAS among patients with ARH at Sultan Qaboos University Hospital, which may explain the lower-than-expected prevalence observed. Contrary to published literature, OSAS was more frequently diagnosed in women, who were screened more often, suggesting that OSA may be underdiagnosed in men.

Keywords:Hypertension; Sleep Apnea, Obstructive; Sleepiness.

Objectives: To assess the knowledge levels, attitudes, practices, and associated factors regarding herpes zoster (HZ) vaccination among primary healthcare physicians in Jazan, Saudi Arabia. Methods: A cross-sectional study was conducted in 2023, among 281 primary healthcare physicians in Jazan, Saudi Arabia. Data were collected using a self-administered questionnaire, which included a 15-point knowledge assessment scale and a Likert-type scale for attitudes and practices. Knowledge was deemed sufficient if the median score was achieved. Multivariate logistic regression analysis identified predictors of knowledge sufficiency. Results: Of the 288 physicians invited, 281 participated with a response rate of 97.6%. The mean age was 35.2 ± 8.4 years, with a male majority (n = 164; 58.4%). Adequate knowledge of HZ vaccination was observed in 176 (62.6%) participants. Knowledge was associated with a professional level (p = 0.027); years of experience (p = 0.020)—especially those with ≥ 5 years of experience (p = 0.038)—were significant predictors of adequate knowledge. Most physicians (71.5%) perceived the vaccine as safe, and 65.8% considered it a clinical priority; however, 47.3% cited time constraints as a barrier to recommending it to patients. Conclusions: While knowledge levels among primary healthcare physicians in Jazan are acceptable overall, gaps in vaccination practices persist. Experience was a significant determinant of knowledge sufficiency, whereas time constraints were the primary barrier to vaccine recommendation. Targeted educational interventions and systemic adjustments were recommended to address time management challenges.

Keywords:Herpes Zoster; Vaccination; Healthcare Providers; Knowledge; Attitudes; Practices; Saudi Arabia.

Objectives: Cystic fibrosis (CF) is a multisystemic genetic disease. Progressive decline in lung function is the major cause of morbidity and mortality in this population, primarily related to chronic airway infection and recurrent pulmonary exacerbations. We sought to assess the pattern of airway bacterial growth among patients with CF in Oman and identify possible risk factors for the hypothesized early Pseudomonas aeruginosa acquisition among this population. Methods: We conducted a retrospective single-center cross-sectional study that included all patients who attended the CF clinic at Royal Hospital, Oman between 2004 and 2020. Collected data included age, sex, geographic region, date of CF diagnosis, CF genotype, number of siblings with CF, and the date and results of all positive respiratory cultures. Early P. aeruginosa acquisition was defined by a positive respiratory culture for P. aeruginosa before the age of two years. Multi-drug resistant P. aeruginosa was defined as P. aeruginosa not susceptible to ≥ 1 agent in ≥ 3 classes of antimicrobials. The above factors were compared between the early and late P. aeruginosa acquisition groups. Results: A total of 114 patients were included, and 2393 positive bacterial cultures were analyzed. Eighty-four (73.7%) patients were identified to have a positive culture for P. aeruginosa, including 40 (47.6%) who acquired it before the age of two years. P. aeruginosa remained the most common organism across all age groups. Twenty-six (22.8%) patients were positive for P. aeruginosa on their first respiratory culture, while 56 (49.1%) patients had three or more positive respiratory cultures for P. aeruginosa. Methicillin-resistant Staphylococcus aureus accounted for 7.2% of all positive cultures under the age of one year and peaked at 14.8% between the ages of four and five years. A significant association were found between early P. aeruginosa acquisition and male sex. No significant association was observed between CF genotype, geographic region, age at diagnosis, or the presence of a sibling with CF and early P. aeruginosa acquisition. Conclusions: Our study demonstrated earlier acquisition of P. aeruginosa and its predominance among children with CF in Oman. Male sex was associated with a higher risk for early P. aeruginosa acquisition. Further prospective studies are needed to confirm this association and identify other possible risk factors. These findings will impact the clinical practice of CF physicians in Oman.

Keywords:Cystic Fibrosis; Pseudomonas Aeruginosa; Pseudomonas Infections.

Empyema caused by Streptococcus constellatus in e-cigarette or vaping product use-associated lung injury (EVALI) can result in fatal outcomes. Empyema as a presentation of EVALI is rarely reported. S. constellatus is a known causative pathogen in empyema, typically associated with the elderly and immunocompromised states. We report the case of a 13-year-old male with a history of active e-cigarette use who presented to our center with right lung empyema, complicated by a suspected bronchopleural fistula. Despite chest drainage, antibiotic therapy, inotropic support, and mechanical ventilation, the patient ultimately succumbed to his illness. This case highlights a rarely reported severe complication of EVALI. Clinicians should be vigilant about obtaining a history of e-cigarette use in patients presenting with unexplained empyema.

Keywords:Electronic Nicotine Delivery Systems; Vaping; Lung Injury; Empyema; Streptococcus constellatus.

Zoledronic acid is commonly used to treat osteoporosis and it is generally well tolerated. We describe the case of a woman with osteoporosis, who developed a flare-up of osteoarthritis hours after receiving a single dose of zoledronic acid. She developed fever with chills, generalized body aches, and severe low back pain. This was followed by severe bilateral knee pain, wrist pain, and minor joint pain in the hands. Radiography revealed signs of osteoarthritis in the following joints: proximal and distal interphalangeal joints of the hands, trapeziometacarpal joint, patellofemoral, and medial tibiofemoral joint on both sides. Investigations excluded septic arthritis, gout arthritis, and systemic infection. A diagnosis of a flare-up of osteoarthritis secondary to zoledronic acid infusion was made. Symptomatic treatment and supportive care led to the patient’s recovery. Treating physicians need to be aware of the possibility of such rare symptom flare-ups following zoledronic acid infusion.

Keywords:Zoledronic Acid; Symptom Flare-up; Adverse Drug Event; Osteoarthritis; Osteoporosis; Oman.

Immunoglobulin A vasculitis, formerly known as Henoch-Schoenlein purpura, is a rare acute auto-immune condition often associated with infections. We describe an adolescent girl who had recently recovered from COVID-19 infection. She presented with painless hematuria, high blood pressure, purpuric skin rash, bilateral ankle pain and swelling, abdominal pain, and inability to walk. She was admitted and clinically diagnosed with immunoglobulin A vasculitis and started on steroid treatment, to which there was a dramatic response, only to relapse as the steroid was being tapered off. Treatment with azathioprine as a steroid-sparing agent led to complete remission without recurrence. This case also suggests that SARS-CoV-2 infection may trigger the development of autoimmune diseases.

Keywords:COVID-19; Henoch-Schoenlein Purpura; Immunoglobulin A Vasculitis; Azathioprine; Steroids; Oman.

Undifferentiated pleomorphic sarcoma of the laryngeal ventricle is extremely rare. We report a case of an elderly man with this condition, where a multidisciplinary team, involving an otorhinolaryngologist, pathologist, and oncologist developed a management plan, with a good outcome for the patient. We recommend a multidisciplinary team approach for diagnosing and treating undifferentiated pleomorphic sarcoma to achieve an optimal outcome.

Keywords:Undifferentiated Pleomorphic Sarcoma; Laryngeal Neoplasm; Radiation Oncologyy; Malaysia.

A previously healthy five-year-old boy was seen in the rheumatology clinic with a five-month history of migrating joint discomfort, followed by right knee and left ankle arthritis. He showed no signs of lymphadenopathy, organomegaly, rashes, or fever. He could not bear weight and had nocturnal pain that was out of proportion to juvenile idiopathic arthritis. Blood tests revealed no pancytopenia. Whole-body magnetic resonance imaging showed extensive enhancement in nearly all bones, suggestive of chronic recurrent multifocal osteomyelitis. However, bone biopsy followed by marrow aspiration confirmed a diagnosis of pre-B-cell leukemia. This case highlights the importance of considering the possibility of childhood malignancies mimicking juvenile idiopathic arthritis and chronic recurrent multifocal osteomyelitis, even in the absence of typical neoplasm symptoms.

Keywords:Pediatrics; Musculoskeletal System; Acute Lymphoblastic Leukemia; Juvenile Idiopathic Arthritis; Chronic Recurrent Multifocal Osteomyelitis; Oman.