The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care.

BACKGROUND: COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients' and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients' glycemic outcome in Oman. AIM AND OBJECTIVES: To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients' glycemic outcome. METHODS: Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients' glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients' HbA1c and mode of consultation was measured using multivariable regression analysis. RESULTS: A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was -0.3 (-2.3 to 1.5), P = .734 for telephone consultation alone, -0.5 (-2.4 to 1.4), P = .613 for face-to-face alone, and -0.5 (-2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation. CONCLUSION: Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.

Depressive symptoms among primary healthcare workers during the novel SARS-CoV-2 coronavirus pandemic in the Muscat governorate.

BACKGROUND: With the unprecedented spread of the novel SARS-CoV-2 coronavirus, primary healthcare workers (PHCWs) are having to shoulder the increasing weight of this ongoing pandemic. AIMS: This study explored the rate and covariates of depressive symptoms among PHCWs in the Muscat governorate. METHODS: A cross-sectional online survey was conducted from 10 May to 10 June 2020 among PHCWs working in all primary healthcares across the Muscat governorate. Data on sociodemographic and risk factors of having at least one underlying physical health condition, a psychiatric history, family history of psychiatric disorders, and direct involvement with COVID-19 positive patients were sought. The Patient Health Questionnaire (PHQ-9) was then used to solicit the presence of depressive symptoms. Those with a cutoff point ≥10 were considered as showing depressive symptoms. Logistic regression was used to determine risk factors associated with depressive symptoms in PHCWs after adjusting for all sociodemographic factors. FINDINGS: A total of 432 (72%) out of 600 PHCWs with an average age of 39.2 years (SD = 7.8 years) ranging between 25.0 and 75.0 years responded to the survey. There were more females (n = 281, 65.3%) than males, and more than 45% (n = 195) of them were physicians. Additionally, more than 78% (n = 338) had been in contact with COVID-19 patients. There was a significant association between different age groups and profession (P < .001), having at least one underlying physical health condition (P = 0.001) and depressive symptom status (P = 0.038). A total of 78 out of the 423 subjects (18.1%) were considered to have depressive symptoms. After adjusting for all factors, the logistic regression model showed that an age of 34 years or below (OR = 2.079, P = 0.021) and having at least one underlying physical health condition (OR = 2.216, P = 0.007) were factors contributing significantly to depressive symptoms among the PHCWs.

Adolescent COVID-19-Associated Fatal Rhabdomyolysis.

Coronavirus disease 2019 (COVID-19) has become an urgent global health priority. Although most patients with COVID-19 manifest with fever and respiratory tract symptoms, COVID-19 infections may also involve other organs and extrarespiratory manifestations, including cardiac, gastrointestinal, hepatic, renal, and neurological symptoms. This case describes a 16-year-old boy who presented with fever, sore throat, myalgia, and subsequently with shortness of breath. A diagnosis of COVID-19 was confirmed by polymerase chain reaction. His condition deteriorated and he died within 3 days of admission. An evaluation of his past medical history confirmed an episode of viral illness which had progressed to myositis and rhabdomyolysis 1 year prior. Clinicians should be aware of this complication and maintain a high index of suspicion in cases of COVID-19 presenting with extrapulmonary symptoms.

The Experiences and Perceptions of Health-Care Workers During the COVID-19 Pandemic in Muscat, Oman: A Qualitative Study.

INTRODUCTION: Predominantly, studies on COVID-19 report quantitative data that often miss the social implications and other determinants of health. The objective of this study was to explore the experiences and perceptions of health care workers (HCWs) in primary health care in the management of COVID-19 with respect to medical response experiences, socio-cultural and religious reforms, psychological impressions, and lessons learned. METHODS: This was a qualitative study using an empirical phenomenological approach. Six focus group discussions were conducted across various stakeholders working frontline in the management of COVID-19 (managerial, public health/field/community and primary care health centers). They participated in semi-structured, in-depth group discussions from 11th to 20th May 2020. All discussions were audio-recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS: Forty participants were involved in this study. Three themes emerged related to the medical response experiences, including the rapid re-structuring of the PHC services, use of technology and challenges of working on COVID-19. Perceptions on the socio-cultural and religious reforms included changes in social and religious norms, and anticipated gaps in accessing health care among the vulnerable groups (elderly, expatriates, and individuals with low economic status). Perceptions on psychological disturbances were themed as consequences of social distancing, management of dead bodies, exhaustion among the health care workers, and risk of exposure. Finally, lessons learned were centered around building on the existing epidemiological and public health capacities, improving access to health care and overcoming resistance to change. Most participants labelled their experience in COVID-19 as an "experience of wisdom" in which learning was a continuous process. CONCLUSION: This qualitative study amongst primary HCWs revealed certain aspects of response to COVID-19 in Muscat, Oman. Results has unfolded various aspects of COVID-19. The situation was perceived by primary HCWs as a new experience that challenged the primary health care; enforced the utilization of public health/epidemiological skills, and linked to unfavorable socio-religious and psychological events.

The characteristics and patterns of utilization of healthcare services among Omanis with substance use disorders attending therapy for cessation.

BACKGROUND: It is indicated that Oman is witnessing an increase in issues pertinent to alcohol and psychoactive substance use. AIM: The aim of this study was to identify the characteristics of Omanis with substance use disorder attending a specialized hospital in Oman and the pattern of their utilization of healthcare services. A related aim was to ascertain the age group most vulnerable to alcohol and substance use in Oman. METHOD: A cross-sectional study was conducted in a tertiary care center specialized for treatment of those engaging in substance use in Oman. The participants in the study were selected from a convenience sample among patients seeking consultation at the center for alcohol and substance use. A six-part questionnaire was designed to obtain information regarding socio-demographic background, clinical history, healthcare utilization and perceived hurdles to access. Chi-square analyses were used to evaluate the significance of differences among categorical data. Logistic regression modelling was used to obtain measures of association after adjusting for confounding factors. RESULTS: Among the patients (n = 293) seeking cessation therapy, 99% were male and less than 30 years of age. Peer influences on the initiation of substance use were significant. Most patients had a history of polysubstance use, including intravenous substance use. Cannabis and alcohol were the first substances consumed by most patients and Hepatitis C and psychiatric disorders were found to be the most common co-morbidities. The participants that reported use of cannabis and benzodiazepines were more likely to perceive "improvement" upon receiving treatment. CONCLUSION: This study indicated that males below 30 years of age with a history of polysubstance use were likely to attend a hospital specialized in treating substance use disorder in Oman. This study identified information regarding socio-demographic background, risk factors and perceived hurdles to healthcare that could serve as groundwork for further studies conducted on newly emerging issues of substance use in Oman.