Sultan Qaboos University Hospital Research Articles

Maternal and Neonatal Outcomes of Operative Vaginal Deliveries at a Single Tertiary Center.

ObjectivesOur study sought to assess the maternal and neonatal outcomes of operative vaginal deliveries (OVDs) at Sultan Qaboos University Hospital (SQUH). We assessed the proportion of OVDs along with the proportion of maternal and neonatal outcomes of kiwi OmniCup vacuum, metal cup vacuum, and forceps deliveries.MethodsWe conducted a retrospective cohort study in the Obstetrics and Gynecology Department at SQUH from June 2015 to March 2018. The hospital information system was utilized to obtain records of all women who delivered at SQUH by vacuum or forceps during the study period. We collected data on maternal demographics, maternal and neonatal outcomes, and total number of deliveries.ResultsDuring the study period, 3.8% of deliveries were OVDs. The most common instrument used was the Kiwi OmniCup vacuum device. No significant difference was found between the type of tears and instrument used except perineal tears (p = 0.003), which was seen more in the vacuum group, particularly Kiwi OmniCup. Neonatal birth weight (p = 0.046) was significantly higher in the metallic vacuum cup group. Thirty-one neonates (6.6%) were admitted to the neonatal intensive care unit, and most were born using Kiwi OmniCup vacuum (67.7%).ConclusionsOVD is an ideal alternative to cesarean section with fewer maternal and neonatal complications in women who cannot deliver spontaneously if performed by a well-trained obstetrician.

Preoperative Anemia is Associated with Increased Intraoperative Mortality in Patients Undergoing Cardiac Surgery.

ObjectivesWe sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes.MethodsA retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery at Sultan Qaboos University Hospital between 2008 and 2014 was performed. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin levels < 13 g/dL (males) and < 12 g/dL (females). Clinical variables were compared using chi-square and independent t-test. Factors influencing preoperative mortality were analyzed using multivariate binary logistics regression.ResultsA total of 599 patients (69.9% males and 30.1% females) were included in the study; 69.3% underwent coronary artery bypass surgery. Preoperative anemia was found in 76.1% of females and 26.7% of male patients. Rates of intraoperative red blood cell transfusions were higher among anemic patients (75.9% vs. 52.3%, p < 0.001). Anemic patients had a worse risk profile with higher incidence of diabetes mellitus (53.8% vs. 38.9%, p < 0.001), congestive heart failure (51.4% vs. 28.3%, p < 0.001), arrhythmia (16.5% vs. 8.6%, p = 0.004), and cerebrovascular disease (10.0% vs. 4.9%, p = 0.015). In addition, they had a higher risk of overall mortality (6.4% vs. 2.6%, p = 0.023). Preoperative anemia remained a risk factor for intraoperative mortality after logistic regression (odds ratio = 4.08, 95% confidence interval: 1.43–11.66; p = 0.009).ConclusionsPreoperative anemia in cardiac surgery is independently associated with increased intraoperative mortality and early readmission rates post-surgery.

Short-Term Outcomes of Atosiban in the Treatment of Preterm Labour at the Sultan Qaboos University Hospital, Muscat, Oman: A tertiary care experience.

ObjectivesThis study aimed to generate baseline evidence regarding the effectiveness of atosiban in delaying delivery by ≥48 hours among pregnant women presenting with threatened preterm labour (TPL). The secondary objective was to assess the relationship between atosiban success and various perinatal factors and neonatal outcomes.MethodsThis retrospective study was conducted between June 2008 and May 2018 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all pregnant women who received atosiban between 24–34 gestational weeks for TPL during this period were reviewed.ResultsA total of 159 women were included in the study. Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%). Approximately half of the women (50.9%) achieved uterine quiescence in <12 hours. Failure to delay delivery by ≥48 hours was significantly lower among women with normal versus abnormal cervical findings (11.1% versus 25.6%; P = 0.023). Only 9.4% of women experienced minor side-effects. Mean birth weight (2,724.55 versus 1,707.59 g; P <0.001) and Apgar scores at 5 minutes (9.66 versus 8.28; P <0.001) were significantly higher among neonates delivered at ≥48 versus <48 hours post-atosiban, whereas the rate of neonatal respiratory distress syndrome was significantly lower (18.4% versus 81.6%; P <0.001).ConclusionAtosiban was highly effective in delaying delivery by ≥48 hours and resulted in few adverse maternal side-effects and neonatal outcomes. To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the effectiveness of atosiban in preventing preterm labour.

Clinical Presentations of Brucellosis Over a Four-Year Period at Sultan Qaboos University Hospital and Armed Forces Hospital, Muscat, Oman.

ObjectivesBrucellosis is a highly contagious zoonotic disease which can have serious health implications for affected humans and livestock. This study aimed to evaluate the clinical presentation, geographical distribution and risk factors of brucellosis cases admitted over a four-year period to two hospitals in Muscat, Oman.MethodsThis observational study was conducted from January 2015 to December 2018 at the Sultan Qaboos University Hospital and Armed Forces Hospital in Muscat. All patients with probable or definitive diagnoses of brucellosis according to the diagnostic criteria of the World Health Organization were included. Relevant data were gathered from the patients’ medical records, including results from standard agglutination tests, Brucella enzyme-linked immunosorbent assays, bacterial blood or tissue/aspirate cultures and Brucella polymerase chain reaction tests.ResultsA total of 64 patients were diagnosed with brucellosis over the study period. The median age was 31.5 years and 73.4% were male. The majority (95.2%) presented with fever, followed by weight loss (51%), transaminitis (48.4%), peripheral arthritis/arthralgia (15.9%) and back pain (spondylodiscitis/sacroiliitis; 23.4%). Overall, 75.5% reported having consumed raw dairy products, while only 25.9% gave a positive history of animal contact.ConclusionPatients with brucellosis presented with a wide range of clinical features, the most predominant of which was fever. The majority of patients were residents of or had recently visited Salalah and had consumed raw dairy products. These findings highlight the need for healthcare practitioners to maintain a high index of suspicion for this diagnosis. Moreover, further regulatory measures are necessary to oversee the sale of raw/unpasteurised dairy products.

Attitudes Towards Cancer Patients

ObjectivesMany cancer patients experience social difficulties and feelings of isolation. This study aimed to evaluate patients’ and attendees’ attitudes towards cancer patients.MethodsA cross-sectional study was conducted of patients and attendees attending Sultan Qaboos University Hospital (SQUH), Muscat, Oman, from December 2018 to March 2019.ResultsA total of 1,190 people participated (response rate: 91.5%). The majority (90.7%) did not express reluctance to help cancer patients. Most agreed that cancer patients were productive (76.2%) and are respected by the public (75.0%). However, many participants (63.1%) felt that cancer patients might face difficulties getting married. Multivariate analysis showed that participants who had a family history of cancer or had previously been a caregiver for cancer patients were more likely to believe that cancer patients could be productive (odds ratio [OR] = 1.92, 95% confidence interval [CI]: 1.31–2.82; P <0.05). Less-educated participants were more likely to believe that cancer patients feared not being productive (OR = 1.49, 95% CI: 1.01–2.19; P <0.05). Male and single participants were more likely to perceive that cancer patients faced difficulties getting married (OR = 1.56, 95% CI: 1.20–2.02 and OR = 1.68, 95% CI: 1.22–2.32, respectively; P <0.05 each).ConclusionPatients and attendees attending SQUH in Oman appeared to have positive and supportive attitudes towards cancer patients, although some felt that cancer patients might encounter social obstacles. Healthcare professionals should consider reassuring cancer patients of such positive sentiments. Governmental and non-governmental organisations should act to promote a supportive environment for cancer patients in Oman.

Determination of the Expression of Latent Epstein Barr Virus in Omani Nasopharyngeal Carcinoma Patients

Background: Nasopharyngeal carcinoma(NPC) is a rare malignant carcinoma that develops in the epithelial lining of the nasopharyngeal mucosa It is the most common neoplasm of the Nasopharynxand it is associated with many risk factors; one of them is Epstein-Barr virus infection. An Epstein-Barr virus is a tumorigenic herpes virus that infects and persists in B-lymphocytes without causing disease. This virus is associated with significant pathological conditions, such as benign and malignant lymphoproliferation. Objectives: To determine Epstein -Barr encoded RNA 1&amp;2 (EBER1,2) and latent membrane protein (LMP) expressionin formalin-fixed paraffin-embedded tissue samples obtained from Omani patients diagnosed with nasopharyngeal carcinoma.Also, to identify the pattern and the type(s) of cells infected with EBV in nasopharyngeal carcinoma tissue samples obtained from Omani patients. Moreover, to compare the sensitivity of Immuno histochemistry and in-situ Hybridization for the detection of EBV in the nasopharyngeal carcinoma tissue sample. Materials and Method:Thirteen formalin-fixed paraffin-embedded nasopharyngeal carcinoma tissue samples archived from the period 2010 to 2017, were obtained from the Pathology Departments of Sultan Qaboos University Hospital and the Armed Force Hospital. These tissue samples were processed using two different methods Immunohistochemistry (IHC) and In situ hybridization (ISH). Results:Eleven out of thirteen NPC Omani patients were positive for EBV (84.61%) by either LMP-IHC or EBER-ISH. All cells stained positive for EBV in NPC tissue samples was of malignant type rather than normal cell type. EBV is mostly detected in patients in the age group of less than 50 years old. Also out of the 13 NPC patients, seven females (58.34%), and six males (46.15%) were positive for EBV. Conclusion:This study may provide evidence indicating an association between EBV and nasopharyngeal carcinoma. In addition, the detection of EBV in NPC obtained from Omani patients may encourage the physician to consider using anti-herpes virus drugs in the treatment of EBV positive NPC patients as an additional tool for the treatment of this kind of malignancy.

Percutaneous Ultrasound-guided Pigtail Catheter for Pleural Effusions: Efficacy and Safety.

ObjectivesSmall-bore pigtail catheters are now being used more frequently for draining pleural effusions. This study aimed to measure the efficacy, safety, and tolerability of these devices in different clinical conditions.MethodsWe retrospectively collected data from 141 patients with pleural effusions of various etiologies who underwent ultrasound-guided pigtail catheter insertion at Sultan Qaboos University Hospital, Muscat, Oman.ResultsThe majority 109 (77.3%) of patients had exudates. The mean age was 50.0±18.6 years in patients with exudates and 67.3±15.5 in patients with transudates (p < 0.001). There was no significant difference (p = 0.232) in the median drainage duration between exudates (6.0 days) and transudates (4.5 days). The incidence of pain requiring regular analgesics, pneumothorax, and blockage were 36.2% (n = 51), 2.8% (n = 4), and 0.7% (n = 1), respectively. The overall success rate of pleural effusion drainage was 90.1%. Among the 109 cases of exudative pleural effusion, 89.0% were successful compared to a 93.8% success rate among patients with transudative effusion (p = 0.737). Short-term success rates were high in all causes of effusions: lung cancer (100%), metastasis (90.0%), pleural infections (83.3%), cardiac failure (94.7%), renal disease (85.7%), and liver disease (100%).ConclusionsUltrasound-guided pigtail catheter insertion is an effective, comfortable, and safe method of draining pleural fluid. It should be considered as the first intervention if drainage of a pleural effusion is clinically indicated.

Urinary Tract Infection in Omani Children: Etiology and Antimicrobial Resistance. A Comparison between First Episode and Recurrent Infection

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.&#x0D; Study Design: A retrospective study included Omani children, less than 14 years, with any documented urinary tract infection.&#x0D; Place and Duration of Study: Sultan Qaboos University Hospital between September 2008 and August 2012.&#x0D; Methodology: Comparison was made between both groups using Chi-squared (χ2) test as appropriate.&#x0D; 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&lt;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&lt;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.&#x0D; 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.

Recurrent Miscarriage and Consanguinity among Omani Women– A Cross Sectional Study

Objective: to determine the prevalence of explained and unexplained recurrent miscarriages (RM) and to find out if there is a significant relationship between recurrent miscarriages and consanguinity. Methods: A cross sectional in which the cases group included all women with RM attending the outpatient clinic at Sultan Qaboos University Hospital from July 2006 to April 2012 and the controls group included women with no history of RM after matching them with cases for age (case to control ratio was 1:1). The main outcome measures were the prevalence of consanguinity in women with or without recurrent miscarriages. Results: During study period a total of 290 women with RM were seen. Of which, 150 (51.7%) women had unexplained RM. Control group with no history of RM were 300 women. Consanguinity rate among cases (49.5%) %) was less than the controls (52.7 %%). Both first cousin and second cousin marriages were more common in the controls than the cases and it was not statistically significant (p value 0.476, chi squared test). Conclusion: In this study we found that more than half of RM cases were unexplained and there was no significant association between RM and consanguinity.

Abstract PS1-40: Can sentinel lymph node biopsy be avoided in patients of breast cancer with normal preoperative ultrasound of axilla

Abstract Introduction: Need for any form of surgery for axillary lymph nodes in breast cancer with clinical and radiologically negative axilla is being increasingly questioned. Randomized controlled trials are underway to answer this question. This study was undertaken to evaluate the results of sentinel node lymph biopsy (SLNB) in patients with normal preoperative axillary ultrasound (AUS) after obtaining institution ethics committee approval. Materials and Methods: All patients of operable breast cancer seen in the Breast Cancer Clinic at Sultan Qaboos University Hospital, underwent routine preoperative AUS as part of staging work up. In patients with suspicious lymph nodes, fine needle aspiration cytology (FNAC) was performed. Patients with clinical and radiologically normal axilla underwent BCS/ mastectomy with SLNB (Group 1), while patients with positive lymph nodes underwent neoadjuvant chemotherapy (NACT) and repeat AUS after completion of chemotherapy. Patients who were reported to have normal AUS post NACT underwent SLNB (Group 2). Negative Predictive Value (NPV) and probability of positive SLN when AUS was normal were calculated for the entire cohort, group 1 and group 2. A comparison of NPV between two groups was performed at a 5% level of significance (MedCalc 12.7, 2013). Results: Between 2016-2018, 165 patients with normal AUS underwent SLNB. One hundred and thirteen of these patients underwent ‘upfront’ SLNB, while 52 patients had received NACT and then underwent SLNB. Mean age of patients was 49.33 years (range: 32-74 years ) and was similar in both groups. Mean number of lymph nodes obtained was 4.7 (range 2-8) in group 1 and 4.69 (range 2-6) in group 2. Mean number of positive lymph nodes was 1.69 in group 1 and 2.4 in group 2. Out of 165 patients with normal AUS, 51 patients had metastasis in SLNs. Twenty nine of 113 patients in group 1 showed metastasis in SLNs while 22 out 52 patients in group 2 showed metastasis. NPV for AUS for the whole group was 69.1% (95% CI=62.0%-76.2%), and for group 1 &amp; 2 were 74.3% (95%CI=66.2%-82.4%) and 57.6% (95% CI=44.2%-71.0%), respectively. A significant higher NPV was found in group 1 than in group 2 (χ2=3.873, p=0.049). Thus, the probability of positive SLN even when AUS was normal was 0.31 for whole group, 0.25 for group 1 and 0.42 for group 2. Conclusion: Probability of metastasis in SLN when AUS with or without FNAC is normal is more than 20%. Thus there is need for better preoperative imaging of axilla in patients of breast cancer with clinically and radiologically negative axilla before abandoning SLNB altogether. Citation Format: AlJarrah Adil, Seenu V, Badriya Al Qassabi, Hajar Nasser Alsaadi, Safa Abdullah Al-abadi, Srineil Vuthaluru, Moon-Fai Chan, Radiya Al Ajmi. Can sentinel lymph node biopsy be avoided in patients of breast cancer with normal preoperative ultrasound of axilla [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-40.

Dopamine Dysregulation Syndrome in Parkinson Disease and Remission After Treatment With Aripiprazole.

Department of Medicine, Neurology Unit, Sultan Qaboos University Hospital, Al Khould, Oman Oman Medical Specialty Board, Muscat, Oman [email protected] Department of Medicine, Neurology Unit, Sultan Qaboos University Hospital, Al Khould, Oman Directorate General of Health Services, Muscat, Oman Received June 15, 2021; accepted after revision July 29, 2021.

Complications and Management of Totally Implantable Central Venous Access Ports in Cancer Patients at a University Hospital in Oman.

ObjectivesTotally implantable central venous access ports (port-a-caths) are increasingly used for the safe administration of chemotherapy; however, their use is associated with complications. This study reviews patterns of complications, reasons for premature removal and the duration of the use of port-a-caths in patients receiving cancer treatment at Sultan Qaboos University Hospital (SQUH) and compares the infection rate with the literature and the researchers’ experiences.MethodsThis retrospective follow-up study included patients who had received cancer treatment through a port-a-cath and were admitted to SQUH between January 2007 and April 2019. Demographic features, underlying diagnosis, clinical stage, treatment, duration of use and the cause of premature removal of the port-a-cath were recorded.ResultsA total of 516 port-a-caths were inserted in 482 cancer patients. The majority of devices were implanted by interventional radiologists (n = 459; 89.0%) and the right internal jugular vein was most frequently accessed (n = 396; 76.7%). The mean indwelling time of a port-a-cath was 288 days (range: 3–1,872 days) for patients with complications and 550 days (range: 7–3,123 days) for patients without complications. Port-a-cath-related infection was the main complication (n = 63; 12.2%). Patient age, gender, treatment intent, underlying diagnosis, clinical stage, chemotherapy regimen, number of treatment courses, operator implanting the port, the type of micro-organism isolated from the port-a-cath and body mass index were significant factors affecting catheter indwelling time (P <0.05). On multivariate analysis, however, none of the factors was found to be significant.ConclusionInfection was the most common complication necessitating port-a-cath removal. The infection rate was much lower than the researchers’ previous experience and compares favorably with several published reports.

Airway and Anaesthetic Challenges in a Child With Bronchus Suis and Superimposed Double Aortic Arch

Bronchus suis or tracheal bronchus is an accessory bronchus arising from the trachea above the carina. Double aortic arch is a congenital vascular anomaly with persistence of both left and right aortic arches beyond fetal life which can form a vascular ring compressing the major airways and may be symptomatic. We report the case of a 16-month-old girl who had recurrent episodes of respiratory distress requiring multiple hospitalisations and was diagnosed at the Sultan Qaboos University Hospital, Muscat, Oman in 2019 with a double aortic arch compressing upon a tracheal bronchus causing symptomatic emphysema of the right upper lobe. This report presents anaesthetic and airway challenges during the patient’s lobectomy. A single lumen cuffed endotracheal tube was successfully used as a bronchial blocker to occlude the origin of the aberrant bronchus. The position of the tube was confirmed intraoperatively using fibreoptic bronchoscopy. Following her discharge, she continued to have recurrent episodes of respiratory distress and three months after her last appointment she succumbed to her illness. To the best of the authors’ knowledge, this is the first such reported case in Oman.

Managing Vascular Surgery Emergencies and Referrals During the COVID-19 Pandemic at a Tertiary Centre in Oman.

ObjectivesThis study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome.MethodsThis study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas.ResultsOnly one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail.ConclusionsWith the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.

Utilization of Antihypertensive Drugs in Diabetic Patients in Sultan Qaboos University Hospital

Hypertension is a major worldwide health issue causing cardiovascular morbidity that affects about 26% of all adults worldwide...

Complications associated with the use of two types of silicone oil in vitreoretinal surgeries: A single tertiary center experience in Oman.

OBJECTIVES:The objective of this study is to describe complications associated with the use of two types of silicone oil (SO) (1000 centistokes [cs] and 5000 cs) in vitreoretinal surgery in Oman.MATERIALS AND METHODS:This is a retrospective descriptive study on all patients who underwent vitreoretinal surgeries in which SO injection or removal was done. The study was conducted at Sultan Qaboos University Hospital between January 1, 2010, and December 31, 2017. Demographic data, lens status of the eye at the time of SO injection, type of SO used (1000 cs or 5000 cs), and complications associated with SO were collected.RESULTS:A total of 107 eyes of 103 patients were included in the study. SO 1000 cs was used in 66 eyes and SO 5000 cs was used in 41 eyes. A total of 29 eyes (27%) developed SO-related complications, which included SO emulsification in 14 eyes (13.1%), raised intraocular pressure (IOP) >21 mmHg in 19 eyes (17.8%), and band keratopathy in 4 eyes (3.7%). SO emulsification was seen in eight eyes (12.1%) in whom SO 1000 cs was used and in five eyes (12.2%) in whom SO 5000 cs (P = 1.000).CONCLUSION:SO was found to be a relatively safe adjunct in vitreoretinal surgery. SO-related complications such as SO emulsification, raised IOP, and band keratopathy were observed in less than one-third of study eyes. No difference was noted in emulsification rate between SO 1000 cs and SO 5000 cs. Further studies with larger sample size and longer follow-up period are warranted.

Systematic Surveillance of Arteriovenous Fistula Patency in Renal Failure Patients – Our Early Experience

Objective: Does systematic surveillance help improve arteriovenous fistula (AVF) patency and health economics in renal failure patients? Materials and Methods: As part of a quality initiative project, prospective data were maintained in the electronic medical records at the Sultan Qaboos University Hospital by our clinical nurse specialist, of AVFs created for patients requiring renal replacement therapy from December 2015. Beginning in January 2018, a surveillance program of patients undergoing intervention to improve patency of AVF was started. The records of these patients up to December 31, 2019, were accessed to see if the program helped improve patency, thereby reducing the number of emergency admissions and improving health economics. The minimum follow-up period was 8 weeks. Results: A total of 143 patients had AVFs created during the study period. Fifty-one patients required fistulogram with or without fistuloplasty. Thirty-six out of 51 (70%) fistulas remain patent, whereas 9 (18%) thrombosed and 6 (12%) were either lost to follow-up or deceased. The number presenting to the emergency department reduced by 50%. In addition, we observed a noticeable reduction in the number of emergency procedures required to sustain the fistula. Both duration of in-hospital stay and repetitive investigations were reduced. Conclusion: A surveillance program requires liaising with the patient, their relatives, local health center, regional dialysis unit, interventional radiology, nephrology, and vascular surgery team. We have seen a significant reduction in emergency interventions, increase in overall patency rate of AVFs, shorter in-patient hospital stays, and a decrease in number of laboratory investigations repeated.

Risk factors for severe bronchiolitis in children less than 2 years old: a retrospective cohort study

Background: Bronchiolitis is the most common reason for hospitalization and frequent cause of viral infection. This study aimed to determine the risk factors for severe bronchiolitis in children admitted through the emergency department at Sultan Qaboos University Hospital in Oman. Methods: A retrospective chart review was conducted among children

Assessing Family Medicine Residents’ Communication Skills in Oman Using the Communication Assessment Tool: A Cross-sectional Study

Objective: Primary care physicians are the first means of access to further healthcare services and act as a doorkeeper for different specialties at the secondary and tertiary levels; thus, communication skills are one of the most vital skills to be taught to residents in the family medicine specialty. This study aimed to evaluate the communication skills of family medicine residents in Oman from the perspective of their patients. Methods: This cross-sectional study was performed at the Family and Community Medicine Clinic of Sultan Qaboos University Hospital as well as various Ministry of Health training health centers in Muscat, Oman. An Arabic version of the validated 14-item Communication Assessment Tool (CAT) was used to evaluate patients’ perceptions regarding the communication skills of family medicine residents at the end of their consultation. Data were collected between September 2020 and May 2021 from 602 patients who received care or interacted with 60 residents from the Oman Medical Specialty Board (OMSB) Family Medicine Residency Program at different residency levels. Results: The mean percentage of CAT items rated as excellent was 73.8%. The item “Treated me with respect” was most commonly rated as excellent (84.2%), whilst the item "Involved me in decisions as much as I wanted" was least frequently rated as excellent (62.0%). Various factors were found to significantly affect CAT rating, including residency level, type of clinic, number of times seeing the same resident, and the patient's education level. In contrast, other factors such as time of consultation, the gender of either the resident or the patient, and the nationality of the patient did not affect CAT rating. Conclusion: Some areas of weakness especially with the item "encouraged me to ask questions" and involved me in decisions as much as I wanted" identified in the communication skills of OMSB family medicine residents. These findings are comparable with those reported by similar studies worldwide.

Antibiotic Susceptibility Pattern of Bacterial Isolates from Wound Infections Among Patients Attending A Tertiary care Hospital in Oman

Background:Wound infections are considered as a major cause of morbidity and mortality around the world and it is associated with long hospital stays and increased costs. Aims:To determine the prevalence of bacterial pathogens, associated risk factors and the antibiotic susceptibility patterns of wound infections amongpatients attending a tertiary care hospital in Oman. Methods:One hundred and sixty wound swabs were collected using clean, sterile swabs from patients attending Sultan Qaboos UniversityHospital(SQUH), as a tertiary care hospital in Oman. These wound swabswere inoculated into appropriate culture media. A microscopical examination was carried out in order to have a preliminary idea of the causative microorganism untilthe culture reports were available.Bacterial growth was identified by morphological aspects of colonies, followed by different biochemical tests.BD PhoenixTMsystem was used to confirm microbial identification and to determine the antibiotic sensitivities. Results:Out of 160 wound swabs, 93(58.1%) were positive for wound infections.Staphylococcus aureuswas the most prevalent microorganism. Elderly patients above 70 years had more wound infections compared to other age groups. Most of the isolated Gram-positive bacteria were sensitive to vancomycin except Enterococcus gallinarum.Isolated Gram-negative bacteria were 100% resistant to ampicillin except for Proteus mirabilis. Conclusion:Multi-drug resistant (MDR) organisms had quit high prevalence in wound infections among Omani patients, therefore there is a need for adequate intervention to limit the spread and evolution of further resistance.