Hyperprolactinemia in Adults Treated With Anti-psychotic Drugs Attending Tertiary Hospitals in Oman: An Observational Study.

INTRODUCTION: Hyperprolactinemia is a common side effect associated with the use of anti-psychotic medications. This study aimed at exploring the rate of hyperprolactinemia induced by anti-psychotic drugs in adult patients admitted to Sultan Qaboos University Hospital (SQUH) and Al Masarra hospital (AMH). Additionally, factors associated with higher prolactin levels in anti-psychotic patients were explored. METHODS: Bespoke XL sheets on age, gender, region (place of stay), BMI, diagnosis, type of drugs, dose, symptoms, and prolactin levels were recorded from the existing health information system. All adult patients who were on anti-psychotic medication between January 2016 and June 2019 were included. Patients diagnosed with pre-existing endocrine conditions, pregnant females, and those with high prolactin levels at baseline were excluded. RESULTS: A total of 1103 cases were included in this study of which 34.1% were from the SQUH vs 65.9% from AMH. The mean (SD) age of the study population was 35.6 (12.1), 56.7% were females and 58.7% cases were from Muscat. The common diagnoses were schizophrenia (59.3%) and bipolar affective disorder (14.7%). High prolactin levels existed in 68.3% of the cases from which 59.6% were treated with atypical anti-psychotic drugs. The proportion of cases with high prolactin levels in AMH was significantly different (higher) compared to cases in SQUH (76.9% vs 51.6%, P<0.001). The most common symptoms were painful breasts (55.2%), galactorrhoea (10.5%), amenorrhea (14.3%) and irregular periods (20.0%). Type of drugs used [haloperidol (typical) vs risperidone (atypical) anti-psychotics (P<0.001)], older vs younger age (P=0.03), and presence vs absence of symptoms (P<0.001) were predictors for the high prolactin levels. CONCLUSION: Similar to evidence from the west, results from this study showed a high rate of hyperprolactinemia in adults treated with anti-psychotics. More work is required to standardize anti-psychotic management and monitoring guidelines for psychotic patients across all psychiatric hospitals in Oman.

The magnitude and effect of work-life imbalance on cognition and affective range among the non-western population: A study from Muscat.

The temporal relationship between work-life balance/imbalance, occupational burnout, and poor mental health outcomes have been widely explored. Little has been forthcoming on cognitive functioning among those with work-life imbalance. This study aimed to explore the rate of work-life imbalance and the variation in neuropsychological functioning. The relationship between affective ranges (anxiety and depressive symptoms) and work-life balance was also explored. The target population in this study are Omani nationals who were referred for psychometric evaluation. The study employs neuropsychology measures tapping into attention and concentration, learning and remembering, processing speed, and executive functioning. Subjective measures of cognitive decline and affective ranges were also explored. A total of 168 subjects (75.3% of the responders) were considered to be at a work-life imbalance. Multivariate analysis showed that demographic and neuropsychological variables were significant risk factors for work-life imbalance including age and the presence of anxiety disorder. Furthermore, participants indicating work-life imbalance were more likely to report cognitive decline on indices of attention, concentration, learning, and remembering. This study reveals that individuals with work-life imbalance might dent the integrity of cognition including attention and concentration, learning and remembering, executive functioning, and endorsed case-ness for anxiety.

Clinical Characteristics of Confirmed Cases of COVID-19 Admitted at Al Nahdha Hospital, Oman: A Cross-Sectional Descriptive Study.

Background and objective Coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. Several characteristics of hospitalised cases, including variations in symptoms as well as radiological and laboratory findings, have been described. However, the exact clinical spectrum of hospitalised patients with COVID-19 in Oman is currently unclear. The objective of this paper was to describe the sociodemographic, clinical, laboratory, and radiological characteristics, as well as the treatment and clinical outcomes of the confirmed cases of COVID-19 at Al Nahdha Hospital, Oman. Additionally, factors associated with the severity of the disease were identified. Methodology This was a cross-sectional descriptive study of hospitalised COVID-19 patients. The required data were retrieved from the electronic health information system for the period from 3rd March to 9th May 2020. Information was recorded in a bespoke sheet and exported to SPSS Statistics (IBM, Armonk, NY) for analysis. Results A total of 102 admissions were included in this study. The mean age of the cohort was 49.9 (14.7) years. The majority were males (77.5%), and more than half were expatriates (56.9%). Diabetes and hypertension were found in 39.2% and 36.3% of the study population, respectively. Common symptoms encountered were dry cough (78.3%), fever (76.5%), and shortness of breath (SOB) (69.6%). Radiologically, bilateral infiltrations were present in 73.5% of the patients. Only 19 cases required critical care (18.6%), and those were mostly older [54.1 (13.4) years], males (89.5%), and non-nationals (63.2%). Significant factors associated with requiring critical care were symptoms of SOB (89.5% vs 65.1%, p=0.03), diabetes (68.4% vs 32.5%, OR=1.5, p=0.004), chronic artery disease (15.8% vs 3.6%, OR=1.7, p=0.04), and diagnosis of acute respiratory distress symptoms (63.2% vs 6.0%, p<0.001). Additionally, the mean ferritin levels were significantly higher in cases requiring critical care [2350.4 (423.8) vs 795.7 (554.3), p=0.005]. Depending on disease severity, the treatment included antibacterials, antivirals, heparin, and steroids. The utilisation of steroids was significantly higher in the cases requiring critical care (63.2% vs 26.5%, p=0.001). Among cases that required critical care (n=19), nine died (death rate=47.4%). Conclusions This study has provided fundamental information about the clinical characteristics of confirmed COVID-19 cases in Oman, including factors associated with the disease's severity. Results from this study can be utilised to update the COVID-19 management guidelines for hospitalised patients.

Reporting at Least One Adverse Effect Post-COVID-19 Vaccination From Primary Health Care in Muscat.

Introduction Vaccinations against COVID-19 were licensed with limited testing assurances to the public triggering a widespread hesitancy around expected adverse reactions. Limited data was reported from Arabian Gulf countries on vaccine adverse effects. Objectives This study looked at the rate of reporting at least one side effect post-COVID-19 vaccination and its associated factors (sociodemographic characteristics, clinical condition, and type of vaccines). Additionally, questions about safety and willingness to recommend them were included. Study design Phone interviews on post-COVID-19 vaccination adverse effects were utilized to record responses related to reporting at least one side effect post vaccinations across the studied variables. Data collection continued for two months (from 1st March to 30th April 2021). Methodology Participants were adults (Omani citizens and non-citizens) who received AstraZeneca (AZ) or Pfizer (PF) vaccines from primary care facilities in Muscat and were randomly selected from the health information system. Responses were saved in a bespoke Google form/questionnaire. Chi-squared tests were utilized to determine potential factors associated with the dependent variable. Results A total of 753 participants completed the phone interviews. The mean age was 52 (3.5), males (54.1%), and 65.1% were Omanis. Hypertension (39.7%), diabetes (34.1%), and asthma (16.7%) were the commonest comorbidities. AZ and PF were administered to 78% and 22% of the participants. Of them, 49.8% reported at least one adverse effect post-COVID-19 vaccination. The proportion of participants with at least one adverse effect was significantly more in individuals who were younger, females, with more than secondary education, and employed (p value < 0.001, 0.01, <0.001, and <0.001, respectively). There was no severe reaction (anaphylactic shock) to the vaccines, and most adverse effects were mild-moderate. The proportion of individuals who reported adverse effects were higher with AZ vs PF (53% vs 38.6, p = 0.001). The most common reported localized adverse effects were pain and tenderness (28.3% and 12.1%). Fever and body aches were the commonly reported systemic adverse effects (33.5% and 29.2%). The safety of COVID-19 vaccines was well perceived, and most participants were willing to recommend them to others. Conclusions The current study confirms findings from existing literature on the mild to moderate adverse effects of AZ and PF vaccines. Despite the subjective nature of this study, it is reassuring that the studied COVID-19 vaccines can be administered safely. However, more longitudinal studies are needed to test their efficacy in disease prevention.

Study protocol: behaviour change intervention to promote healthy diet and physical activity in overweight/obese adults with diabetes attending health care facilities in Muscat: a cluster rendomised control trial.

BACKGROUND: Healthy behavior is an essential component in type 2 diabetes (T2D) management. Promoting healthy lifestyle is one of the priorities of primary health care in Oman. This study aims to evaluate the effectiveness of a multi-component intervention in promoting physical activity (PA) and healthy diet and its implications on body mass index and glycemic control in adults with diabetes attending primary care. METHODS: A one year 1:1 cluster randomized controlled trial will be utilized to compare the use of phone consultations, a multi component interactive phone application and pedometers with the usual diabetes care on promoting PA and healthy diet. Participants will be screened for inactivity and should be T2D, aged18-65 years, and overweight or obese. Eight primary centers will be randomly selected in each arm (n = 375). The primary outcome is the between arms differences in PA and diet scores, BMI and HbA1c over 12 months from baseline. Additionally, secondary outcomes will include cardiovascular outcomes (BP, and lipids). The trial has received ethical approval from the Omani Research and Ethical Review and Approval Committee. All eligible participants will be invited to their respected health centers to provide informed consent. DISCUSSION: This study will contribute to the integration of healthy lifestyle approach using artificial intelligence to primary diabetes care. Results from this study will be disseminated through workshops, policy briefs, and peer-reviewed publications, local and international conferences. TRIAL REGISTRATION: Trial registration number ISRCTN71889430 . Date applied: 28/11/2020. Date assigned: 01/12/2020.

Changes in Self-Efficacy and Social Support after an Intervention to Increase Physical Activity Among Adults with Type 2 Diabetes in Oman: A 12-month follow-up of the MOVEdiabetes trial.

OBJECTIVES: This study aimed to describe changes in self-efficacy (SE) and social support (SS) 12 months after the MOVEdiabetes trial, an intervention designed to increase physical activity (PA) among adults with type 2 diabetes mellitus in Oman. METHODS: The original MOVEdiabetes trial was conducted between April 2016 and June 2017 in Muscat, Oman. The intervention group (IG) received personalised PA consultations, pedometers and monthly messages using a web-based application, while the comparison group received usual care. Self-reported SE and SS from family and friends were assessed using validated psychosocial scales. RESULTS: Of the 232 original participants in the trial, a total of 174 completed the 12 months follow-up study period (response rate: 75%). However, based on intention-to-treat analysis with several imputation procedures for missing data at 3 and/or 12 months, there was a significant increase in SE scores in the IG (+10.3, 95% confidence interval [CI]: 7.1-13.5; P <0.001); however, the correlation with PA levels was weak (+4.2, 95% CI: 2.7-5.7; P <0.001). Higher SE scores were noted in those without comorbidities (+12.2, 95% CI: 6.8-17.6; P <0.001) and with high income levels (+9.7, 95% CI: 5.2-14.2; P <0.001). Additionally, SS scores increased significantly among those in the IG who received support from friends (+2.3, 95% CI: 1.1-3.7; P <0.001), but not family (+1.2, 95% CI: -0.4-2.8; P = 0.110). The reliability of the scales was acceptable for SE and SS from family, but poor for SS from friends (Cronbach's alpha coefficients = 0.82, 0.82 and 0.40, respectively). CONCLUSION: The PA intervention was associated with positive changes in SE and SS from friends. However, further tools for assessing psychosocial influences on PA are needed in Arab countries.

Characteristics of the First 102 Severe COVID-19 Cases Treated With Convalescent Plasma or Tocilizumab or Both in Al-Nahdha Hospital, Oman.

BACKGROUND: In the absence of an effective vaccine, the coronavirus disease (COVID-19) continues to cause more deaths. Evidence on the effectiveness of various COVID-19 management plans is inconclusive. This paper describes the characteristics of the first 102 severe COVID-19 in-patients treated with Convalescent Plasma (CP) therapy or Tocilizumab or both at Al-Nahdha hospital in Muscat, Oman. Additionally, differences in requiring critical care were explored across the treatment groups. METHODS: Data of all the positive cases in Al-Nahdha hospital were retrieved from the electronic health information system retrospectively from April 1st to July 31st 2020. The required information was recorded in a bespoke sheet and exported to SPSS for further analysis. The primary outcome was defined as improved (discharged home) vs worsening (requiring critical care). RESULTS: Out of the 102 severe cases of COVID-19 admissions, 20.6%, 59.8% and 20.6% received CP, Tocilizumab and both respectively. In average, CP was introduced at day 3.7(4.8) whereas Tocilizumab at day 7.8(5.1) from admission. The between-group differences in the proportion of patient who improved vs worsened were not significant (P = 0.7). However, the within-group difference in the proportion of patient who improved vs worsened was significant in the Tocilizumab treatment group (P = 0.03). All socio-demographics were not significantly different across the treatment groups. Most improvements in the studies parameters [CBC (total WBC, Lymph and neutrophil counts), oxygen and immune response "cytokine storm" parameters] post-treatment was attributed to the use of Tocilizumab. There was a statistically significant difference in the mean hospital stay between the improved and worsened cases across all treatment categories [at the population level: 8.2(5.0) improved vs 4.7(3.7) worsened-P < 0.001]. CONCLUSIONS: Results from this study provided baseline information about the characteristics of confirmed COVID-19 cases in Al-Nahdha hospital who received CP, Tocilizumab or both. Results obtained seems to be promising in preventing critical care, especially for Tocilizumab. However, further randomized studies are needed.

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.

Perceived Changes in General Well-being: Findings from the 'MOVEdiabetes' Physical Activity Randomized Control Trial.

OBJECTIVES: Studies have consistently reported the health benefits of physical activity (PA) in diabetes care. Our study aimed to explore perceptions of general well-being in participants of the 'MOVEdiabetes' intervention aimed at increasing PA in adults with type 2 diabetes in Oman. METHODS: 'MOVEdiabetes' is a cluster-randomized study where participants in the intervention group (IG) received PA consultations, pedometers, and WhatsApp messages versus the usual care in the control group (CG). At baseline and 12 months, perceptions on well-being were assessed using an English translated to Arabic 13-item questionnaire. Between groups differences in responses were compared using chi-squared tests. Spearman correlation analysis was utilized to explore associations between changes in responses and self-reported PA levels (metabolic equivalent of task.min/week). RESULTS: Of the 232 participants in the 'MOVEdiabetes' study, 75.0% completed the study. Overall, findings indicate a positive effect of the intervention on perceived general health, sleep, mental health, pain, and responses to quality of life. For the IG and CG, significant associations were shown between changes in self-reported PA and general health (r = 0.70 and 0.36, p < 0.001), feeling calm/peaceful (r = 0.86 and 0.93, p < 0.001), energetic (r = 0.86 and 0.82, p < 0.001), and depressed (r = -0.35 and -0.30, p < 0.001). However, the Cronbach's alpha value was 0.50, indicating insufficient internal consistency of the assessment tool. CONCLUSIONS: The intervention has a positive effect on many parameters of well-being. Further studies are needed to identify robust tools to measure associations between well-being and PA in culturally bounded Arabic speaking countries.

Acceptability of the "MOVEdiabetes" physical activity intervention in diabetes primary care settings in Oman: findings from participants and practitioners.

BACKGROUND: Adequate physical activity (PA) is considered essential in diabetes management. However, evidence on the best method of promoting PA within diabetes care is inconclusive. The current work identifies perceptions on the acceptability of Intervention Group Participants (IGP) and Project Officers (POs) about the "MOVEdiabetes" intervention programme aimed at increasing PA in adults with type 2 diabetes in Oman (a retrospectively registered trial). METHODS: The "MOVEdiabetes" programme (PA consultations, pedometers and WhatsApp messages) was delivered by the POs (primary health care practitioners) in four primary care centres within a one-year cluster randomised control trial. Recruitment and retention were measured from trial attendance records. Programme satisfaction, appropriateness, and content suitability were assessed using exit surveys for both the IGP (interview based) and POs (self-administered). Open text questions on perceptions to the study programme were also included. RESULTS: Participants were randomised to an intervention group (IG, n = 122) or comparison group (CG, n = 110). The overall retention rate at three and 12 months was 92.7% [110(90.2%) IG vs 105(95.5%) CG] and 75% [82(67.2%) IG vs 92(83.6%) CG] respectively. Most (n = 14, 87.5%) POs and more than half (n = 49, 59.8%) IGP perceived the programme as very appropriate and many reported that they were "quite/ very satisfied" with the programme (n = 16, 100% PO's and n = 71, 86.6% IGP). Two thirds (n = 55, 66.0%) of IGP were very/quite likely to recommend the programme to others. PA consultations, use of pedometers and Whatsapp messages were well perceived by all. Participants recommended the inclusion of dietary advice and PA promotion for the general public. Exploring PA facilities within the community was suggested by POs. CONCLUSIONS: The "MOVEdiabetes" programme achieved a high retention rate and was perceived as satisfactory and appropriate. Results from this study suggest that it is worthwhile exploring the use of the "MOVEdiabetes" programme in clinical practice and further community links. TRIAL REGISTRATION: International Standard Randomised Controlled Trials No: ISRCTN14425284. Registered retrospectively on 12th April 2016.

Mixed gynecomastia.

Gynecomastia is an enlargement of male breast resulting from a proliferation of its glandular component, and it is usually due to an altered estrogen-androgen balance. It should be differentiated from pseudogynecomastia, which is characterized by fat deposition without glandular proliferation and from breast carcinoma. Gynecomastia could be physiological in neonates and pubertal or pathological due to drug intake, chronic liver, or renal disease, hyperthyroidism, testicular or adrenal neoplasms, and hypogonadism whether primary, or secondary. Properly organized work-up is needed to reach the cause of gynecomastia. Here, we reported a case of a young Omani man with gynecomastia with the aim of creating awareness of the occurrence of Klinefelter's syndrome (KS) in patients with gynecomastia, to observe any differences in clinical presentation of KS from those reported in the literature, and highlight the needed diagnostic work-up and treatment.

Assessment of glomerular filtration rates by cockcroft-gault and modification of diet in renal disease equations in a cohort of omani patients.

OBJECTIVES: Glomerular filtration rate (GFR) is the best index of renal function and is frequently assessed by corrected creatinine clearance (CCLcr). The limitations of CCLcr have inspired researchers to derive easy formulas to estimate GFR, with Cockcroft-Gault (C-G) and the modification of diet in renal disease (MDRD) being the most widely used. This study aimed to evaluate the validity of these equations by finding the relation between CCLcr and estimated GFR (eGFR) by C-G, modified C-G and MDRD equations. METHODS: From 2007 to 2011, 158 subjects were analysed for serum creatinine and CCLcr at Bowsher Polyclinic, Muscat, Oman. The C-G equation was used to obtain eGFRC-G which was adjusted to body surface area (BSA) to obtain eGFRmC-G, and the MDRD equation was used to obtain eGFRMDRD. The eGFRMDRD, eGFRmC-G and eGFRC-G were then compared to CCLcr. RESULTS: The eGFRMDRD, eGFRmC-G and eGFRC-G significantly correlated with CCLcr, with a slightly stronger correlation with eGFRMDRD (r = 0.701, 0.658 and 0.605, respectively). A receiver operating characteristic curve analysis showed that the diagnostic accuracy of eGFRMDRD for diagnosing chronic kidney disease (CKD) was higher than that of eGFRmC-G, which in turn was higher than that of eGFRC-G (area under the curve was 0.846, 0.831, and 0.791; cut-off limits were 61.9, 58.3 and 59.5, respectively). CONCLUSION: C-G and MDRD equations can be an alternative to the CCLcr test for assessing GFR, thus avoiding the need for the cumbersome and expensive GFR test. The MDRD formula had greater validity than the C-G equation and the C-G equation validity was improved by an adjustment to BSA.

Clinical Features and Outcome of 65 Laboratory Confirmed Cases of H1N1 in Muscat, Sultanate of Oman.

OBJECTIVES: Responding to Pandemic Influenza A (H1N1) virus alert in 2009, Ministry of Health (MoH), Sultanate Of Oman arranged task force to deal with the emergency. MOH published articles in newspapers, prepared guidelines and hospitals were assigned to admit patients of H1N1. All the patients suspected of H1N1 were admitted and isolated as per the guidelines. This report describes clinical features and outcomes of 65 laboratory confirmed cases of H1N1 in Muscat, Sultanate of Oman. METHODS: From July to October 2009, 101 cases suspected of suffering from Pandemic Influenza A (H1N1) virus were admitted and isolated in Al Nahdha Hospital in Muscat. All the patients on admission were tested for H1N1, by real time reverse transcriptase polymerase chain reaction (RT-PCR). Immediately on admission, all of them were treated with Oseltamivir and antibiotics. RESULTS: Of the 65 confirmed cases of H1N1, 53.84% were males. Age of patients varied from 14 to 60 years, while 53.7% were aged between 31 to 55 years. Results showed that 70.8% had underlying co-morbidity; among which diabetes mellitus and respiratory illness were common. The most common presenting symptoms were fever (95%) and cough (94%). Also, 20% of the patients had leucopenia and 10.8% leucocytosis. Deranged LFT was observed in 26 (42.6%) of cases while 14 (21.5%) had hypokalemia. One patient (0.01%) with underlying severe co-morbidity died. Two patients (3.1%) had ARDS (Acute Respiratory Distress Syndrome); both recovered. Radiological infiltration was documented in 84.6% of cases, with lower zone involvement as the common finding. Hospital stay was between 1 to 12 days, 49.2% of patients were discharged within 3 days. CONCLUSION: Mainly adult population was affected during this epidemic. H1N1 infection can lead to severe illness. Incidence of H1N1 was higher in patients with underlying co-morbidity. Timely intervention and administration of Oseltamivir may need to be modified.