Development and validation of the CoV19-OM intensive care unit score: An early ICU identification for laboratory-confirmed SARS-CoV-2 patients from a retrospective cohort study in Oman.

OBJECTIVE: To develop and validate a clinical score that will identify potential admittance to an intensive care unit (ICU) for a coronavirus disease 2019 (COVID-19) case. MATERIALS AND METHODS: The clinical scoring system was developed using a least absolute shrinkage and selection operator logistic regression. The prediction algorithm was constructed and cross-validated using a development cohort of 313 COVID-19 patients, and was validated using an independent retrospective set of 64 COVID-19 patients. RESULTS: The majority of patients were Omani in nationality (n = 181, 58%). Multivariate logistic regression identified eight independent predictors of ICU admission that were included in the clinical score: hospitalization (OR, 1.079; 95% CI, 1.058-1.100), absolute lymphocyte count (OR, 0.526; 95% CI, 0.379-0.729), C-reactive protein (OR, 1.009; 95% CI, 1.006-1.011), lactate dehydrogenase (OR, 1.0008; 95% CI, 1.0004-1.0012), CURB-65 score (OR, 2.666; 95% CI, 2.212-3.213), chronic kidney disease with an estimated glomerular filtration rate of less than 70 (OR, 0.249; 95% CI, 0.155-0.402), shortness of breath (OR, 3.494; 95% CI, 2.528-6.168), and bilateral infiltrates in chest radiography (OR, 6.335; 95% CI, 3.427-11.713). The mean area under a curve (AUC) for the development cohort was 0.86 (95% CI, 0.85-0.87), and for the validation cohort, 0.85 (95% CI, 0.82-0.88). CONCLUSION: This study presents a web application for identifying potential admittance to an ICU for a COVID-19 case, according to a clinical risk score based on eight significant characteristics of the patient (http://3.14.27.202/cov19-icu-score/).

Convalescent Plasma Therapy in Critically Ill COVID-19 Patients: An Open Label Trial.

OBJECTIVES: The novel severe acute respiratory syndrome coronavirus 2 pandemic continues to spread globally without an effective treatment. In search of the cure, convalescent plasma (CP) containing protective antibodies from survivors of coronavirus disease 2019 (COVID-19) infection has shown potential benefit in a non-intensive care unit setting. We sought to evaluate the effectiveness of CP therapy for patients with COVID-19 on mechanical ventilation (MV) and/or acute respiratory distress syndrome (ARDS). METHODS: We conducted an open-label trial in a single center, Royal Hospital, in Oman. The study was conducted from 17 April to 20 June 2020. The trial included 94 participants with laboratory-confirmed COVID-19. The primary outcomes included extubation rates, discharges from the hospital and overall mortality, while secondary outcomes were the length of stay and improvement in respiratory and laboratory parameters. Analyses were performed using univariate statistics. RESULTS: The overall mean age of the cohort was 50.0±15.0 years, and 90.4% (n = 85) were males. A total of 77.7% (n = 73) of patients received CP. Those on CP were associated with a higher extubation rate (35.6% vs. 76.2%; p < 0.001), higher extubation/home discharges rate (64.4% vs. 23.8%; p =0.001), and tendency towards lower overall mortality (19.2% vs. 28.6%; p =0.354; study power = 11.0%) when compared to COVID-19 patients that did not receive CP. CONCLUSIONS: CP was associated with higher extubation/home discharges and a tendency towards lower overall mortality when compared to those that did not receive CP in COVID-19 patients on MV or in those with ARDS. Further studies are warranted to corroborate our findings.

Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: An experience from Oman.

INTRODUCTION: To identify the clinical characteristics and outcomes of hospitalized patients with COVID-19 in Oman. METHODS: A case series of hospitalized COVID-19 laboratory-confirmed patients between February 24th through April 24th, 2020, from two hospitals in Oman. Analyses were performed using univariate statistics. RESULTS: The cohort included 63 patients with an overall mean age of 48±16 years and 84% (n=53) were males. A total of 38% (n=24) of the hospitalized patients were admitted to intensive care unit (ICU). Fifty one percent (n=32) of patients had at least one co-morbidity with diabetes mellitus (DM) (32%; n=20) and hypertension (32%; n=20) as the most common co-morbidities followed by chronic heart and renal diseases (12.8%; n=8). The most common presenting symptoms at onset of illness were fever (84%; n=53), cough (75%; n=47) and shortness of breaths (59%; n=37). All except two patients (97%; n=61) were treated with either chloroquine or hydroxychloroquine, while the three most prescribed antibiotics were ceftriaxone (79%; n=50), azithromycin (71%; n=45), and the piperacillin/tazobactam combination (49%; n=31). A total of 59% (n=37), 49% (n=31) and 24% (n=15) of the patients were on lopinavir/ritonavir, interferons, or steroids, respectively. Mortality was documented in (8%; n=5) of the patients while 68% (n=43) of the study cohort recovered. Mortality was associated with those that were admitted to ICU (19% vs 0; p=0.009), mechanically ventilated (31% vs 0; p=0.001), had DM (20% vs 2.3%; p=0.032), older (62 vs 47 years; p=0.045), had high total bilirubin (43% vs 2.3%; p=0.007) and those with high C-reactive protein (186 vs 90mg/dL; p=0.009) and low corrected calcium (15% vs 0%; p=0.047). CONCLUSIONS: ICU admission, those on mechanical ventilation, the elderly, those with high total bilirubin and low corrected calcium were associated with high mortality in hospitalized COVID-19 patients.

Epidemiological and Clinical Characteristics of HIV Infected Patients at a Tertiary Care Hospital in Oman.

OBJECTIVES: In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates. METHODS: We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization (WHO) staging, laboratory analyses, and treatment outcomes. RESULTS: The overall mean age of the cohort was 36.0±15.0 years, and 60.4% (n = 197) were males. The majority of patients acquired HIV through heterosexual transmission (58.9%; n = 192). At the time of the first clinic visit, 26.1% (n = 85) of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was < 200 cells/mm3 in 38.0% (n = 124) of patients, 201-500 cells/mm3 in 30.1% (n = 99) of patients, and > 500 cells/mm3 in 27.0% (n = 88) of patients. The baseline HIV RNA titer was greater than 1000 copies/mL3 in 74.5% (n = 243) of the cohort. A total of 96.3% (n = 314) of patients received antiretroviral therapy, most commonly non-nucleoside reverse transcriptase inhibitor-based regimens. HIV genotype resistance testing was performed in 165 patients (50.6%) either at baseline in treatment naïve patients or following treatment failure. Among the 326 patients included, 22 patients (6.7%) died, and 29 patients (8.9%) were lost to follow-up. CONCLUSIONS: Regarding the UNAIDs 90-90-90 target, over a quarter of the patients presented late with WHO stage 4 HIV disease, 96.3% of cohort patients received antiretroviral treatment, and 71.5% achieved virological suppression.

A Study of Prescribing Valsartan in Out-patient Clinics at the Royal Hospital, Muscat, Oman.

OBJECTIVES: Angiotensin Receptor Blockers such as Valsartan, are a newer class of drugs associated with significant reductions in cardiovascular morbidity and mortality. They are commonly used in hypertension, chronic heart failure, diabetes-related nephropathy and post-myocardial infarction in patients who are intolerant to Angiotensin Converting Enzyme inhibitors (ACEi). A review of medicines used in Royal Hospital (an Omani tertiary health care centre) during 2004 and 2005 showed that Valsartan was one of 20 most expensive drugs used. The main objective of this study was to evaluate the pattern of prescribing valsartan in out-patient clinics. METHODS: a retrospective study, applying medicines use evaluation, to describe the pattern of prescribing Valsartan in comparison with international guidelines. The study carried out in the outpatient pharmacy setting, Royal Hospital from 15th May to 30th June 2006. It included 120 adult patients who had been prescribed Valsartan at the outpatient clinics during the study period. RESULTS: among the 120 patients only 109 patients were finally included in the study. Elevenpatients who had had duplicated prescriptionswere excluded from the study. 78% of the patients were on Valsartan for its FDA-approved indications while 22% of patients were for other non-approved indications. Half of the patients were initiated on an ACEi before shifting to Valsartan. The other half of the patients was started with Valsartan as a first line choice without any clinical justification. CONCLUSION: The study showed that half of the patients were initiated on Valsartan without being prescribed an ACEi prior to that, while the recommendation in most of the international guidelines based on indication stated that ARBs are used in patients who are intolerant to ACEi. The study emphasizes the need for further research to highlight the need for developing national guidelines and adhering to these guidelines for rational prescribing.

Prophylaxis for opportunistic infections for kidney transplantation recipients at the royal hospital in oman.

OBJECTIVES: The main objective of this study is to ensure all patients undergone kidney transplantation receives appropriate standard PCP prophylaxis soon after transplantation, unless contraindicated. METHODS: A prospective study included all kidney transplantation recipients from January 2008 to August 2008. A data collection sheet was designed and reviewed in focus group meetings and modified accordingly. The subjects were followed-up during the admission for transplantation to the date of discharge. The discharge prescriptions were screened to ensure all the kidney transplantation recipients were prescribed appropriate PCP prophylaxis before discharge. All prescriptions with NO PCP prophylaxis were intervened by the clinical pharmacist. The focus group meetings suggested designing a questionnaire using likerts scale. The purpose was to highlight doctors' perception towards PCP prophylaxis for renal transplant recipients. The questionnaires were distributed to all the nephrology doctors (consultants, senior specialists and medical officers). The data were entered in the data collection sheet and were analyzed by using simple statistical methods. RESULTS: Almost 80% of the prescriptions did not included (TMP/SMX) for PCP among which 20% of the prescriptions were for patients with G6PD deficiency. The clinical pharmacist's interventions resulted that all discharge prescriptions were modified and (TMP/SMX) was prescribed for patients who were legible for a PCP prophylaxis CONCLUSION: In the absence of prophylaxis, the incidence of PCP in solid organ transplant recipients ranges from 6.8% to 22%, necessitating PCP prophylaxis for at least 6 months following transplantation. Despite the widespread knowledge on PCP prophylaxis, most of the patients were discharged with no prophylactic treatment for PCP. After pharmacist's intervention the prescriptions were edited and PCP prophylaxis was added.