Towards a green hospital approach in Oman: A case study of quantifying an environmental impact.

INTRODUCTION: The environmental impact of hospitals and healthcare providers practices is substantial, although often unnoticed and infrequently tracked. A green and healthy hospital is one that promotes public health by continuously monitoring and reducing its environmental impact. METHODS: We adopted a descriptive case study design with a multi-dimensional evaluation and monitoring of carbon emission equivalence (CO2e) using two examples from a tertiary care hospital practice in Oman. One example (1) was related to inhalation anaesthetic gases (IAG) consumption and the second example (2) was related to estimation of telemedicine clinics (TMCs) CO2e travel-related savings. RESULTS: The cumulative consumption of three different (1) IAG over three years (2019, 2020, 2021) was generated with estimated CO2e for each year for sevoflurane, isoflurane and desflurane. Desflurane had the lowest consumption with a yearly cumulative consumption of 6000 mL, 1500 mL, and 3000 mL for the years 2019, 2020 and 2021. The (2) TMCs during the first two years of the COVID-19 pandemic travel related CO2e savings were in the range of 12.65-3483.1 tonnes. In the second year of launching this service it doubled to a range of 24-6610.5 tonnes of CO2e savings. CONCLUSION: A green and healthy hospital approach of tracking and monitoring environmental impact of healthcare providers practices is critical for health planning and management of the environmental policy. This case study illustrated the importance of closely tracking hospital-based practices from an environmental perspective towards a green hospital approach.

Pulmonary Annulus Growth Pattern in Patients with Tetralogy of Fallot Prior to Surgical Repair.

Objectives: The size of the pulmonary valve annulus often determines the feasibility of pulmonary valve preservation at the time of intracardiac repair of Tetralogy of Fallot. Currently, there is limited available data regarding the growth pattern and the determining factors that contribute towards pulmonary valve annulus growth. Methods: This retrospective study included patients who underwent surgical repair of Tetralogy of Fallot with or without prior palliation. These patients had an echocardiogram at the time of initial diagnosis and a second echocardiogram prior to intracardiac repair. The sizes of the pulmonary annulus, the right and left pulmonary arteries with z-scores were recorded. Patients with improvement in the pulmonary annulus z-scores between the 2 echocardiographic examinations were allocated in Group I (n = 46) and Group II (n = 68) were those with no improvement. Results: A total of 114 patients were included in the study. The right and left pulmonary arteries size and z scores improved significantly between the 2 echocardiograms. Although the median size of the pulmonary annulus increased between the 2 echocardiograms (6 and 7.9 mm; P<0.001), there was no significant change in the z-score (-2.2, -2.34; P = 0.185). Multivariate logistic regression analysis showed that gender, blood group, presence of collaterals, and palliation with Blalock-Taussig shunt had no impact on the improvement in pulmonary annulus z-score. Conclusion: In Tetralogy of Fallot, the pulmonary valve annulus z-score may not change significantly prior to the intracardiac repair. Although in certain subgroups there may be an improvement, there was no specific factor that could be identified and had an influence on this improvement.

Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation.

Objectives: There is limited data published from outside North America and Europe comparing the outcomes of a modified Blalock-Taussig shunt (MBTS) and ductal stenting as the first palliative procedure for infants with duct-dependent pulmonary circulation. This study reports the National Heart Center's, in Muscat, Oman, experience in comparing the outcomes of these 2 interventions. Methods: This retrospective study included all infants with duct-dependent pulmonary circulation who received either a MBTS or ductal stenting from 2016-2019. The primary outcomes were death or re-interventions. Secondary outcomes included death, subsequent re-interventions, survival to subsequent surgical intervention, survival to hospital discharge, post-procedural mechanical ventilation and duration of intensive care unit stay. Results: A total of 71 patients were included in the study, 33 (46%) of whom received ductal stenting. The prevalence of the primary outcome (death or re-intervention) in the patent ductus arteriosus (PDA) stent group was 54.5% versus 31.6% in the MBTS group but this was not statistically significant (P = 0.06). There was no difference between the 2 groups in terms of time to next surgical intervention (P = 0.233). The PDA stent group had shorter post-procedural, mechanical ventilation and intensive care unit stay durations (P <0.05). Syndromic patients were at higher risk of mortality compared to non-syndromic patients. Conclusion: MBTS and ductal stenting are both acceptable modalities as a palliative intervention for infants with duct-dependant pulmonary circulation. Syndromic patients are at higher risk of mortality. This can be considered an important factor for patient selection.

Prevalence and Characteristics of Cystic Fibrosis in Omani Children: A Multi-center Cross-sectional Study.

Objectives: To describe the demographic distribution of cystic fibrosis (CF) in Omani children, estimate the national prevalence, and provide updated mutational panels of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Methods: We conducted a retrospective cross-sectional study of all CF patients who had been diagnosed and followed-up at Sultan Qaboos University Hospital and Royal Hospital in Oman between 2006 and 2020. Data were collected from electronic hospital records and telephone interviews. Results: A total of 227 patients with CF were included in the study. Geographical clusters of the disease were identified in the governorates of Al-Batinah, A'Dhahirah, and A'Dakhiliyah. Parental consanguinity and family history of CF were present in 68.3% and 69.6% of the patients, respectively. The most common CFTR mutation was p.Ser549Arg (52.0%), followed by p.Phe508del (12.3%), and c.2988+1G>A (4.4%). Three novel CFTR mutations were identified, viz., Leu88TyrFs*, p.Asp192Val, and c.4242+1G>C. Conclusions: The estimated prevalence of CF in Oman is 10.3 per 100 000 individuals. Premarital genetic counseling and preimplantation genetic testing are recommended in CF-prevalent regions.

Oman's COVID-19 publication trends: A cross-sectional bibliometric study.

Public health crises, such as the COVID-19 pandemic led researchers and clinicians to stretch their capacities in conducting, writing, reviewing, and publishing a wealth of pandemic-related research. Oman scholars, researchers, and clinicians are no different in their quest for rapid dissemination of relevant scientific knowledge, which is of paramount importance nationally and internationally. Given the intense international interest in COVID-19 research. The study aim is to describe the COVID-19 research output in Oman in relation to publication type, journal impact factor, collaboration, author affiliation and compared it with national scholarly output over the decade. Study Design: We carried out a bibliometric cross-sectional study. Methods: We included all Oman COVID-19 publications for the period February 14 and 25, February 2021. Data retrieved using search engines PubMed, Google Scholar and Directory of Open Access Journals. Results: The COVID-19 publications search generated 210 articles. There were 36.7% review articles and 30% original articles. Of note, 2.4% randomized controlled trials articles were produced during the search period, 1.4% systematic and meta-analysis articles. The 85.7% of the publications were in journals with defined impact factor (IF) and 89.4% of articles with IF < 5. There was 53.8% international collaboration. Conclusion: The need to increase research published in journals with high impact factors and there was a high international collaboration in reviews and report articles, which may require building national research capacity.

Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman.

Objectives: Stroke is a significant public health problem and one of the most important preventable non-communicable diseases. Preventive stroke programmes with a better focus on increasing awareness among those who are currently at risk are yet to be properly established in Oman. This study was conducted to describe the characteristics of stroke patients presenting to a tertiary care hospital in Oman. Methods: This cross-sectional hospital-based study included 193 stroke cases which were prospectively recruited from the Emergency Department of Khoula Hospital, Muscat, Oman. Data were collected from November 2017 to April 2018. Results: The total number of patients was 193 with 82.9% of strokes being ischaemic strokes. Of this, 58% were male. The mean age of stroke patients was 61.05 years. Risk factors included hypertension (72.5%) and diabetes mellitus (54.4%). Dyslipidaemia, atrial fibrillation and ischaemic heart diseases were not particularly prevalent in the studied population and 24.4% of ischaemic strokes had large artery atherosclerosis while 21.9% had small vessel occlusion. Significantly more patients had lower Glasgow Coma Scale scores, required intensive care unit admission and experienced in-hospital deaths due to haemorrhagic stroke compared to ischaemic stroke. Conclusion: This study provides essential data regarding stroke characteristics specific to Oman's population. Most of the information obtained appears to be in-line with what has been described internationally and, hence, preventive strategies similar to those indicated in extant literature can be implemented. This information can be utilised by health administrators in planning resource allocation. Further research is needed to explore rehabilitation aspects and long-term outcomes.

Impact of Screening Programs on Stage Migration in Breast Cancer.

INTRODUCTION: Breast cancer (BC) is the leading malignancy globally with consequent morbidity, mortality and burden on health care resources when diagnosed at an advance stage. Early-stage diagnosis is crucial to the better outcome. Screening is pivotal to early detection at an early stage. It is understood to reduce mortality, improve outcome, and is cost effective. OBJECTIVE: The objective of the study was to see the impact of screening program on Breast cancer stage in Oman. In this study we looked into the trends in stagespecific breast cancer incidence during two pre-specified time periods 2006-2010 and 2015-2017, before and after the introduction of a national screening programme in Oman. PATIENTS AND METHODS: It is a retrospective analysis, where breast cancer patient's data was retrieved from Oman national cancer Registry ministry of health Sultanate of Oman, for two pre-specified time periods 2006-2010 before the introduction of cancer screening programs and 2015-2017. The cases included were those who had confirmed histopathology diagnosis and where a composite stage, based on TNM stage, was available to be analysed and compared in these two pre-specified time periods to find out the difference between these two time periods. The statistical analysis was carried out and p values were determined. Ethical approval obtained from Royal Hospital medical ethics and scientific research committee. RESULTS: There was a 41% reduction in stage IV breast cancer from 23.01% to 13.58 %, and 86.15% increase in stage 0-1 from 6.86 % to 16.98%. (p Value<001). The stage 0 cases increased from 0% to 4.26 %. With regard to tumour size, T0-1 tumours increased from 14.16% to 26.03%, while T4 tumours decreased from 16.59% to 7.69%. There was increase in node negative breast cancer cases in Oman. The N0 increased from 28.43% to 37.64%. The diagnosis as Non-metastatic M0 disease increased from 39.77% to 60.23%, while diagnosis as metastatic M1 disease decreased from 55.32% to 44.68%. DISCUSSION AND CONCLUSIONS: The introduction of national screening programme in Oman resulted in a continued increase in localized cancers and a decline in advanced disease. Screening programmes should be evaluated continuously and systematically to ensure their targeted objectives. The causal link between stage distribution and mortality needs to be investigated further in the context of screening. Health planners, policymakers, and other stakeholders; including clinicians, educators, community members, and advocates, should be aware of the health system requirements, as well as overall costs of these approaches to breast cancer early detection, to make effective investments, plans, and policies. Key Words: Breast Cancer; Screening; Oman; Royal hospital; early detection; early stage; OCA.

Risk Factors for Ischaemic Stroke in an Omani Community: A case-control study.

OBJECTIVES: Stroke is recognised as the third most common cause of mortality and it has an increasing incidence in developing countries. Recognition and control of risk factors are of prime importance in the prevention of stroke. This study aimed to examine the characteristics of ischaemic stroke (IS) patients in Oman and quantify its various risk factors using a case-control model. METHODS: This case-control study was conducted from January 2012 to March 2013 at Sultan Qaboos University Hospital and Royal Hospital, Muscat. Adult Omani patients with IS who were admitted to either hospital were compared to age- and gender-matched controls. Demographic factors and frequency of various conventional risk factors were documented. Univariate and stepwise multivariate logistic regression analyses were performed to evaluate the risk factors associated with IS. RESULTS: A total of 255 patients and age-and gender-matched controls were included in this study. The mean age was 62.2 ± 13.2 years and 63.14% were male. Most cases (89.02%) were above 45 years of age. Cardio-embolism (31.76%) was the commonest mechanism of IS. Stepwise multiple logistic regression model revealed that family history of stroke was the strongest independent risk factor, followed by hypertension and high-density lipoprotein levels (odds ratio: 10.10, 5.17 and 3.34, respectively; P <0.01 each). CONCLUSION: Cardio-embolism was the predominant mechanism of IS in this study. Family history of stroke, hypertension and reduced high-density lipoprotein were the leading independent risk factors. Strong emphasis on screening for risk factors, control of hypertension and lifestyle modification for those with a family history of stroke would be expected to emerge as the major stroke-preventive measures in Oman.

SocioCultural and Religious Impacts Upon Covid-19 Pandemic Physical Distancing Public Practices.

INTRODUCTION: COVID-19 is the first pandemic event that has happened in Oman which requires all residents and nationals to practice quarantine and physical distancing. METHODS: This cross-sectional study targeted the population of Oman and was carried out during the first wave of the COVID-19 pandemic from 11th August 2020 to 7th September 2020. This study utilized the online survey most appropriately designed for the population. The survey was distributed to the public through social media and text messages. The survey was translated into the four main spoken languages in Oman, which are Arabic, English, Swahili, and Hindi. RESULTS: A total of 943 residents responded to the online survey. The majority of respondents reported that they are ready/ready to a great extent to practice physical distancing (61.9%) during the pandemic compared to 34.9% not sure/ready to some extent and 3.2% not ready at all for physical distancing. It was found that financial factors, religious and cultural-norms had the strongest negative-impact to maintain physical distancing. While level of responsibility, governmental legislations, and fear of getting or transmitting the infection had the strongest positive impact to maintain physical distancing. Males reported a greater financial and religious negative impact of physical distancing with p-values of 0.002 and 0.001, respectively. Females reported a greater positive impact of family and friend's support and legislation with p-values of 0.046 and 0.008, respectively. CONCLUSION: Religious practices mainly negatively affected the male gender during this pandemic which hindered the adherence to physical distancing. This could be due to culture and norms that derive from human behavior within communities and may affect the safety measures during an outbreak or pandemic. Hence, even with availability of vaccinations, campaigns on public health and the utilization of faith leaders should be the national practice to continue emphasizing compassionate attitudes towards physical distancing.

Living-Donor Liver Transplant in Oman: A Quantitative Cross-Sectional Study of Donors' Experiences and Challenges.

BACKGROUND: In Oman, the first liver transplant was performed at the Royal Hospital (RH) in September 2017. Since then, thirteen cases have been operated on at the RH. All of these cases were living-donor liver transplants (LDLT), and the remaining cases were treated in India with a total of approximately 193 recipients. To provide an in-depth overview of donor experiences, challenges, and perceptions, a cross-sectional study was conducted. METHODS: A cross-sectional study was conducted at one tertiary hospital in 2019. The survey was designed to collect data composed of closed and open-ended questions to reveal a thorough knowledge of the topic. RESULTS: A total of 50 of 120 donors responded to the survey with male dominance in the sample (68%) and 64% were aged 28 to 38 years. 66% of the respondents came to know about the donation through hospital staff. Interestingly, respondents (n = 8/12) who reported that fear of operation is the cause that prevents people from donating are among the male gender, while more men believe that the main cause is lack of knowledge. 90% of the respondents felt satisfied after donation. More men reported ambiguous feelings before donation. Moreover, married donors reported ambiguous feelings before donation (p = 0.008). The younger age group reported anxiety and doubt as a challenge through their donation experience. CONCLUSION: This study revealed that donors have a positive feeling after donating as they have saved a life, as well as being empowered by family and community. The donors encourage individuals to donate a portion of their liver. Some crucial questions arose, such as anxiety before surgery, ambiguous feelings before surgery, and fatigue after surgery. These findings underscore the importance of a holistic approach that would enable donors to be well informed prior to surgery.

SEAMHCRD deterministic compartmental model based on clinical stages of infection for COVID-19 pandemic in Sultanate of Oman.

The present novel coronavirus (COVID-19) infection has engendered a worldwide crisis on an enormous scale within a very short period. The effective solution for this pandemic is to recognize the nature and spread of the disease so that appropriate policies can be framed. Mathematical modelling is always at the forefront to understand and provide an adequate description of the transmission of any disease. In this research work, we have formulated a deterministic compartmental model (SEAMHCRD) including various stages of infection, such as Mild, Moderate, Severe and Critical to study the spreading of COVID-19 and estimated the model parameters by fitting the model with the reported data of ongoing pandemic in Oman. The steady-state, stability and final pandemic size of the model has been proved mathematically. The various transmission as well as transition parameters are estimated during the period from June 4th to July 30th, 2020. Based on the currently estimated parameters, the pandemic size is also predicted for another 100 days. Sensitivity analysis is performed to identify the key model parameters, and the parameter gamma due to contact with the symptomatic moderately infected is found to be more significant in spreading the disease. Accordingly, the corresponding basic reproduction number has also been computed using the Next Generation Matrix (NGM) method. As the value of the basic reproduction number (R0) is 0.9761 during the period from June 4th to July 30th, 2020, the disease-free equilibrium is stable. Isolation and tracing the contact of infected individuals are recommended to control the spread of disease.

Characteristics of healthcare workers infected with COVID-19: A cross-sectional observational study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a new emerging infectious disease, first identified in China in December 2019, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study describes the characteristics of healthcare workers (HCWs) who tested positive for COVID-19 in a tertiary care hospital in Oman. METHODS: This was a cross-sectional descriptive analysis of HCWs with COVID-19. RESULTS: During the study period, 204 HCWs tested positive for COVID-19 by rRT-PCR test, with a test positivity rate of 21.2%; the percentage of infected hospital staff was 4.3%. Their mean age was 36 years. Overall, 2.2% of the male staff were infected, while 9.3% of the female staff were infected. Among the clinicians, 4.7% were infected; among the nurses, 4.1% were infected. Regarding acquisition, 61.3% of infections (n = 125) were community-acquired and 25.5% (n = 52) were hospital-acquired; no source was identified in 13.2% of cases (n = 27). There was a significant difference between hospital-acquired and community-acquired COVID-19 according to the different HCW categories (p < 0.001), sex (p = 0.041), and being at risk of COVID-19 exposure in the hospital (p < 0.001). There were no significant differences in relation to nationality (p = 0498), age (p = 0.119), or the presence of co-morbidities (p = 0.326). Seventy-eight percent (n = 160) had no chronic diseases and 44% presented with fever and an acute respiratory infection (n = 90); all made an uneventful full recovery. The peak of infection acquisition was after the Eid Al Fitr festival. CONCLUSIONS: HCWs are at an increased risk of COVID-19 in the workplace. The strengthening of infection control measures to prevent exposures from infected patients and colleagues and to reduce the spread of COVID-19 is a necessity.