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The impact of drought on environmental flow (EF) in 27 catchments of the Indus Basin is studied from 1980–2018 using indicators of hydrologic alterations (IHAs). The standardized precipitation evapotranspiration index (SPEI) was systematically propagated from one catchment to another using principal component analysis (PCA). Threshold regression is used to determine the severity of drought (scenario 1, drought severity that causes low flows) and the month (scenario 2, months where drought has resulted in low flows) that trigger low flows in the Indus Basin. The impact of drought on low EFs is quantified using range of variability analysis (RVA), which is an integrated component of the IHA used to study the hydrological alterations in environmental flow components (EFCs) by comparing the pre- and post-impact periods of human and/or climate interventions in EFCs. The hydrological alteration factor (HAF) is calculated for each catchment in the Indus Basin. The results show that most of the catchments were vulnerable to drought during the periods of 1984 to 1986, 1991/1992, 1997 to 2003, 2007 to 2008, 2012 to 2013, and 2017 to 2018. On a longer timescale (SPEI-12), drought is more severe in the lower Indus Basin (LIB) than in the upper Indus Basin (UIB). The IHA pointed out that drought significantly impacts the distribution of EFCs, particularly extremely low flow (ELF) and low flow (LF). The magnitude and frequency of the ELF and LF events increase as drought severity increases. The threshold regression provided useful insights, indicating that moderate drought can trigger ELF and LF at shorter timescales (SPEI-1 and SPEI-6) in the UIB and middle Indus Basin (MIB). Conversely, severe and extreme droughts trigger ELF and LF at longer timescales (SPEI-12) in the LIB. The threshold regression also divided the entire study period (1980–2018) into different time periods (scenario 2), which is useful for quantifying the impact of drought on low EFs using the SPEI coefficient. Higher SPEI coefficients are observed in the LIB, indicating high alterations in EF due to drought. HAF showed high alterations in EF in most of the catchments throughout the year except in August and September. Overall, this study provided useful insights for analysing the effects of drought on EF, especially during low flows.

Haliotis arabiensis Owen, Regter & Van Laethem, 2016 was found near Muscat city of Oman in the Sea of Oman in September 2021. A total of 85 abalone specimens were collected under small boulders from a depth of 2–5 m during the scuba diving survey from seven stations located from Sidab to Bandar Khairan. The shell length (SL) of the abalone ranged between 10.0 and 30.0 mm, on average 19.9 ± 0.22 mm SL. The sex was determined in 15 females and 21 males. The study presents photos and a comparative table with morphological descriptions of four abalone species (H. arabiensis, H. mariae, H. rugosa multiperforata and H. unilateralis) which are important for differentiating the small abalone species from juveniles of H. mariae during monitoring surveys of this important commercial species in Oman.

BackgroundVitiligo, a common dermatological disorder in Saudi Arabia, is associated with significant psychological impacts. This study explores the relationship between vitiligo and the severity of major depressive disorder (MDD), highlighting the broader implications on mental health among affected individuals. ObjectiveWe aim to assess the prevalence and predictors of depression among adult patients with vitiligo, and to examine the relationship between MDD severity and vitiligo. MethodsUsing a cross-sectional design, the research used the vitiligo area severity index and the Patient Health Questionnaire-9 to measure the extent of vitiligo and depression severity, respectively. This study involved 340 diagnosed patients with vitiligo from various health care settings. Logistic and ordinal regression analysis were applied to evaluate the impact of sociodemographic variables and vitiligo types on MDD severity. ResultsThe prevalence of MDD was 58.8% (200/340) of participants. Depression severity varied notably: 18.2% (62/340) of patients experienced mild depression, 17.9% (61/340) moderate, 11.8% (40/340) moderately severe, and 10.9% (37/340) severe depression. Female patients had higher odds of severe depression than male patients (adjusted odds ratio [aOR] 3.14, 95% CI 1.93-5.1; P

This study aims to develop an integrated agricultural drought index (IADI) that incorporates multiple remote sensing-based agricultural drought indices, considering variations in climate and land use at a local scale in ten different agro-ecological zones (AEZs) of Pakistan from 2000 to 2020. The IADI focuses on soil moisture stress to vegetation, utilizing the soil moisture condition index (SMCI) derived from various soil moisture datasets. The correlation between SMCI and the Standardized Precipitation Evapotranspiration Index (SPEI) is assessed at different time scales (1-, 3-, 6-, and 12-month) using Pearson correlation coefficient (r). Results indicate that SMCIERA5-Land is superior to others and is selected to develop the IADI. To account for local variations in climate and land use, agricultural drought indices (ADIs) are calculated on a 0.25°×0.25° grids. These ADIs are then averaged over a 3×3 window and analyzed using structural equation modeling (SEM) to understand the causal relationship between SMCIERA5-Land and ADIs. Temperature condition index (TCI) and vegetation health index (VHI) demonstrate a significant causal relationship with SMCIERA5-Land in most AEZs, while the relationship between temperature-vegetation dryness index (TVDI) and vegetation condition index (VCI) with SMCIERA5-Land is insignificant across the AEZs except in northern Pakistan. The dominance of land surface temperature (LST)-derived indices in most AEZs highlights the role of temperature in drought onset and propagation. To develop the IADI, Bayesian principal component analysis (BPCA) is employed to calculate dynamic weights between the selected ADIs and SMCIERA5-Land. The distribution of BPCA weights exhibits extreme variability across different AEZs, with some windows being sensitive to LST-derived ADIs and others to NDVI-derived ADIs. The average BPCA weights for VCI, TCI, VHI, and TVDI range from 9.42%–23.05%, 23.20–49.83%, 13.00–31.08%, and 16.38–25.50%, respectively. The IADI demonstrates the best fit with TCI and VHI, while showing good agreement with SPEI, VCI, and TVDI. The correlation between IADI and TCI/VHI ranges from 0.62/0.72–0.94/0.97. Furthermore, ordinary least square regression (OLSR) is used to assess the accuracy of IADI, ADIs, and SPEI in analyzing the impact of drought on wheat/maize yield at the district level in Punjab province, Pakistan. OLSR analysis reveals the dominance of IADI, followed by VHI, in analyzing the role of drought on crop yield. For example, in Rajanpur district, one unit increase in drought severity results in an 11.94 t/ha decrease in maize yield, with IADI explaining 59% of the variations in maize yield. Similarly, one unit increase in drought severity leads to a 7.22 t/ha decrease in wheat yield, with IADI explaining 49% of the variations in wheat yield. Overall, results indicate that the developed IADI effectively captures agricultural drought with high spatial and temporal resolutions across different agro-ecological zones, providing valuable insights for monitoring agricultural drought in data-scarce regions.

Melioidosis is an emerging tropical infectious disease in travelers. We present a case of travel related melioidosis in a 65-year-old man with chronic obstructive pulmonary disease and end stage renal disease following a two-week business trip to Thailand and attendance of the Songkran festival. This case emphasizes that vigilance, heightened clinical suspicion, and use of appropriate microbiology diagnostic tools are of paramount importance for a timely diagnosis and successful management. With the ever-increasing global travel, infectious diseases specialists, microbiologists, and public health professionals are constantly challenged by unfamiliar infections in returned travelers.

Muhammad O Al-Heizan,1 Amna Shoman,2 Abdullah Tawffeq,3 Ansam Banamah,4 Fanar Balkhair,5 Shahd Filimban,4 Walla Alsinan,3 Omar Batouk,6 Taghreed Turkistani7 1Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Saudi Autistic Society, Jeddah, Saudi Arabia; 3King Khalid National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 4Sinad City for Special Education, Makkah, Saudi Arabia; 5Children with Disability Association, Makkah, Saudi Arabia; 6College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 7Occupational Therapy Department, Armed Forces Center for Health Rehabilitation, Taif, Saudi ArabiaCorrespondence: Muhammad O Al-Heizan, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia, Tel +966 503483618, Email malheizan@ksu.edu.saPurpose: Prior to a lower extremity joint replacement, many surgical candidates participate in a preoperative occupational therapy educational program that is meant to increase patient awareness, promote positive health behaviors, and improve health outcomes after surgery. With the limited number of occupational therapists in Saudi Arabia, patients may only receive one preoperative educational session. The objective of the study was to explore the efficacy of one preoperative occupational therapy educational session for patients undergoing a lower extremity joint replacement.Methods: A total of 19 participants were included in the study, 7 participants to the intervention and 12 participants to the control groups. Participants underwent either a total knee or total hip replacement. The intervention group received one preoperative educational session prior to the surgery and the control group received usual care. After the surgery, both groups were assessed on pain (SF-MPQ), Satisfaction (SPSQ), Quality of life (QOLS), functional performance (FIM). Mann–Whitney U-tests were used to compare between groups.Results: The findings showed significant improvements in both pain (12.14 ± 7.22 vs 21.25 ± 8.60; p=0.02) and satisfaction (106.28 ± 25.17 vs 78.08 ± 31.49; p=0.03) when compared to usual care. Although both FIM and QOLS scores indicated improvements when compared to usual care, these results were not statistically significant. Effect sizes showed moderate and large effects for score differences on both the SF-MPQ and SPSQ (r= 0.47, r=0.52) respectively. Whereas effect sizes for score differences on both the FIM and QOLS were small.Conclusion: An occupational therapy preoperative education session shows promise for patients undergoing lower extremity joint replacement; however, further research is needed to confirm these findings.Keywords: joint replacement, education, occupational therapy, pain, satisfaction, quality of life, FIM

ABSTRACT Tuberculosis (TB) originating from expatriates that hail from high TB-burden countries is hypothesized to play a role in continued TB transmission in Oman. Here, we used whole-genome sequencing (WGS) to assess national TB transmission dynamics. The annual incidence per 100,000 population per year was calculated for nationals and expatriates. A convenience sample of Mycobacterium tuberculosis (MTB) isolates from 2018 to 2019 was sequenced and analyzed with publicly available TB sequences from Bangladesh, Tanzania, the Philippines, India, and Pakistan. Relatedness was assessed by generating core-genome single nucleotide polymorphism (SNP) distances. The incidence of TB was five cases per 100,000 persons in 2018 and seven cases per 100,000 persons in 2020 (R2 = 0.34, P = 0.60). Incidence among nationals was 3.9 per 100,000 persons in 2018 and 3.5 per 100,000 persons in 2020 (R2 = 0.20, P = 0.70), and incidence among expatriates was 7.2 per 100,000 persons in 2018 and 12.7 per 100,000 persons in 2020 (R2 = 0.74, P = 0.34). Sixty-eight local MTB isolates were sequenced and analyzed with 393 global isolates. Isolates belonged to nine distinct spoligotypes. Two isolates, originating from an expatriate and an Omani national, were grouped into a WGS-based cluster (SNP distance < 12), which was corroborated by an epidemiological investigation. Relatedness of local and global isolates (SNP distance < 100) was also seen. The relatedness between MTB strains in Oman and those in expatriate countries of origin can aid inform TB control policy. Our results provide evidence that WGS can complement epidemiological analysis to achieve the End TB strategy goal in Oman. IMPORTANCE Tuberculosis (TB) incidence in Oman remains above national program control targets. TB transmission originating from expatriates from high TB-burden countries has been hypothesized to play a role. We used whole-genome sequencing (WGS) to assess TB transmission dynamics between expatriates and Omani nationals to inform TB control efforts. Available Mycobacterium tuberculosis isolates from 2018 to 2019 underwent WGS and analysis with publicly available TB sequences from Bangladesh, the Philippines, India, and Pakistan to assess for genetic relatedness. Our analysis revealed evidence of previously unrecognized transmission between an expatriate and an Omani national, which was corroborated by epidemiological investigation. Analysis of local and global isolates revealed evidence of distant relatedness between local and global isolates. Our results provide evidence that WGS can complement classic public health surveillance to inform targeted interventions to achieve the End TB strategy goal in Oman.

يتمحور هذا البحث حول دراسة التوجيهات الصوتية لابن هشام اللخميّ في كتابه (المدخل إلى تقويم اللسان وتعليم البيان)، فيما ردّ فيه على ابن مكيّ الصقليّ في كتابه (تثقيف اللسان وتلقيح الجنان). حيث صوّر ابن مكيّ الصقليّ حال العربية في صقلية في القرن الخامس الهجري، ولحّنَ عامّة زمانه وخطّأهم فيما استعملوه. وذهب ابن هشام اللخميّ إلى أنّ كثيراً مما لحّنَ فيه ابن مكيّ عامّة أهل صقلية إنّما هو صحيح وليس بلحن، ووصف ما ذكره ابن مكيّ بأنه أوهام. ومن هنا فإن هذا البحث يهدف إلى حصر الظواهر الصوتية لعربية أهل صقلية في القرن السادس الهجري من خلال تناول نماذج ممّا ذكره ابن هشام اللخميّ في كتابه السابق الذكر، ومعرفة موقفه من تلحين ابن مكيّ لهم في تلك الظواهر الصوتية.

Background: There are limited data on short- versus long-term changes in adaptive immune response across different COVID-19 disease severity groups. Methods: A multicenter prospective study of 140 adult patients with COVID-19 (a total of 325 samples) were analyzed for inflammatory markers and lymphocyte subsets at presentation, week 2, and week 24. Results: Inflammatory markers at presentation were higher in the critical/severe than in moderate and mild groups. A predominance of memory B cell response in the mild and moderate group was noted by week 2. In contrast, the immune system in the severe/critical group was dysfunctional, with expansion of exhausted CD8+ T cells and atypical memory B cells. By 24 weeks, there was a possible trend of normalization. Conclusion: There was substantial difference in the degree of inflammation and distribution of different B and T cell subsets in the different disease severity groups. Despite the initial dysfunctional immune response in the severe/critical group, a comparable memory B and CD8+ T cell responses to the mild group was achieved at 24 weeks.

BACKGROUND: Since the use of handheld electronic devises is prevalent among people of all ages, health organizations have specified appropriate screen times for the different age groups. The aim of this study was to investigate the prevalence of screen use and its association with sleep quality and obesity. MATERIALS AND METHODS: This cross-sectional study was conducted on people attending three Primary Healthcare Centers in the Makkah region between January and October 2019. The three-part questionnaire filled by parents collected data on sociodemographics, parental knowledge of guidelines, and asleep quality. Data were analyzed using STATA 14.2. For continuous variables, groups were compared using t-test; Pearson Chi-squared test or Fisher's exact test, as appropriate, was employed for categorical variables. RESULTS: A total of 450 individuals completed the questionnaire. Children 2–12 years old spent more time and used phones, tablets, and television (TV) more frequently, while those younger than 2 or older than 12 used phones and TVs more than other devices. High body mass index was associated with the daily usage of electronic devices. Fewer hours of sleep, longer time to fall sleep, and longer hours in bed were associated with the usage of all electronic devices. Furthermore, a good knowledge of the maximum time allowed for children and teenagers and content scoring system was associated with hours slept per night, and low knowledge was associated with higher frequency of using electronic devices. CONCLUSION: Children spent long periods using electronic devices, and despite knowing the guidelines, parents still allowed their children to exceed the time acceptable for the use of electronic devices, which could lead to future social problems.

Disseminated mucormycosis is a rare life-threatening fungal infection that is uniquely seen in severely immunocompromised patients including those with hematological malignancies. We report a case of disseminated mucormycosis with a biopsy-proven gastrointestinal and oral cavity involvement in a patient with acute myeloid leukemia during induction chemotherapy. The patient had a successful outcome with limited resection of the involvement bowel segment, multiple maxillary dental extractions, debridement of the alveolus and hard palate, and combined antifungal therapy. After clinical improvement, stable infection on serial abdominal imaging, and completion of 6 weeks of combined antifungal therapy, consolidation chemotherapy was given, and molecular remission was achieved. The patient remained clinically well on secondary antifungal prophylaxis.

Background. Data from developed/developed countries have shown that hospital-acquired blood infections (HA-BSIs) are one of the most severe nosocomial infections and constitute 20%–60% of hospitalization-related deaths. Despite the high morbidity and mortality rates and the enormous burden of health care costs associated with HA-BSIs, to our knowledge, there are few published reports on HA-BSI prevalence estimates in Arab countries, including Oman. Objectives. This study aims to explore the HA-BSI prevalence estimates over selected sociodemographic characteristics among admitted patients at a tertiary hospital in Oman over five years of follow-up. The regional variations in Oman were also examined in this study. Methods. This hospital-based cross-sectional study reviewed reports of hospital admissions over 5 years of retrospective follow-ups at a tertiary hospital in Oman. HA-BSI prevalence estimates were calculated over age, gender, governorate, and follow-up time. Results. In total, 1,246 HA-BSI cases were enumerated among a total of 139,683 admissions, yielding an overall HA-BSI prevalence estimate of 8.9 cases per 1000 admissions (95% CI: 8.4, 9.4). HA-BSI prevalence was higher among males compared to females (9.3 vs. 8.5). HA-BSI prevalence started as relatively high in the group aged 15 years or less (10.0; 95% CI 9.0, 11.2) and then declined as age increased from 36 to 45 years (7.0; 95% CI 5.9, 8.3) when it started to increase steadily with increasing age in the group aged 76 or more (9.9; 95% CI 8.1, 12.1). The governorate-specific estimate of HA-BSI prevalence was the highest among admitted patients who resided in Dhofar governorate, while the lowest estimate was reported from the Buraimi governorate (5.3). Conclusion. The study provides supportive evidence for a steady increase in HA-BSI prevalence over age categories and years of follow-up. The study calls for the timely formulation and adoption of national HA-BSI screening and management programs centered on surveillance systems based on real-time analytics and machine learning.

Background: Patients with hematological disorders are among the highly affected patient groups during the COVID-19 pandemic worldwide. Therefore, this study aimed to evaluate how physicians mitigated patients with hematological disorders during the COVID-19 pandemic in Saudi Arabia. In addition, the impact of the lockdown on hematologists and their recommendations according to their current experience was also assessed. Methods: This was a questionnaire-based cross-sectional survey conducted among 62 hematologists in Saudi Arabia during the COVID-19 pandemic from 6th to 29th June 2020. Results: The most common method of contact between physicians and their patients was the use of actual and virtual clinics and WhatsApp (22.6%). In addition, the most common cases that contacted the physicians were those suffering from hematological malignancies (such as lymphoma and leukemia) (37.1%), followed by sickle cell anemia (17.7%). Interestingly, majority of patients had contacted their physicians for general concerns (41.9%), followed by assurance purposes (35.5%). Furthermore, 53.2% of the physicians were satisfied with the experience of handling patients during curfew. Around 71% of the physicians thought that social media had a positive impact on communication with their patients, which was significantly correlated with male participants and those in the age group of 46-55 years (p-values 0.03 and 0.002, respectively). Conclusion: Telemedicine is one of the most useful solutions utilized during the COVID-19 pandemic. However, it needs to be improved and should be used routinely as a part of the healthcare system in Saudi Arabia. [SJEMed 2021; 2(1.000): 77-84]

Background The Sultanate of Oman is country a low TB-incidence, with less than seven cases per 105 population detected in 2020. Recent years have witnessed a persistence in TB cases, with sustained incidence rate among expatriates and limited reduction among Omanis. This pattern suggests transmission from the migrant population. The present study examined the genetic profile and drug resistance-conferring mutations in Mycobacterium tuberculosis collected from Omanis and expatriates to recognise possible causes of disease transmission. Methods We examined M. tuberculosis cultured positive samples, collected from Omanis (n = 1,344) and expatriates (n = 1,203) between 2009 and 2018. These isolates had a known in vitro susceptibility profile to first line anti-TB, Streptomycin (SM), Isoniazid (INH), Rifampicin (RIF), Ethambutol (EMB) and Pyrazinamide (PZA). The diversity of the isolates was assessed by spacer oligo-typing (spoligotyping). Drug resistance-conferring mutations resulted from full-length sequence of nine genes (katG, inhA, ahpc, rpoB, rpsL, rrs, embB, embC, pncA) and their phenotypic relationship were analysed. Results In total, 341/2192 (13.4%), M. tuberculosis strains showed resistance to any drug, comprising mono-resistance (MR) (242, 71%), poly-resistance (PR) (40, 11.7%) and multi-drug resistance (MDR) (59, 17.3%). The overall rate of resistance among Omanis and expatriates was similar; however, MDR and PZAR were significantly higher among Omanis, while INHR was greater among expatriates. Mutations rpsL K43R and rpoB S450L were linked to Streptomycin (SMR) and Rifampicin resistance (RIFR) respectively. Whereas, katG S315T and inhA –C15T/G–17T were associated with Isoniazid resistance (INHR). The resistance patterns (mono-resistant, poly-resistant and MDR) and drug resistance-conferring mutations were found in different spoligo-lineages. rpsL K43R, katG S315T and rpoB S450L mutations were significantly higher in Beijing strains. Conclusions Diverse drug resistant M. tuberculosis strains exist in Oman, with drug resistance-conferring mutations widespread in multiple spoligo-lineages, indicative of a large resistance reservoir. Beijing’s M. tuberculosis lineage was associated with MDR, and multiple drug resistance-conferring mutations, favouring the hypothesis of migration as a possible source of resistant lineages in Oman.

Abstract Background Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit upon the host. Knowledge and attitudes of health professionals have been reported to be at a medium level for probiotics. The objective was to evaluate the knowledge and practice styles about probiotics among pediatricians working in different regions of Saudi Arabia. Methods This cross-sectional study was conducted at pediatric hospitals in Saudi Arabia. A national survey of 550 pediatric providers (PPs) was conducted between January and March 2020 anonymously on their knowledge and practice styles regarding probiotics, and it was completed by pediatric residents (PRs), pediatric specialist (PSs), pediatric consultants (PCs), and pediatric gastroenterologists (PGs). Results The survey had a response rate of 82%. Among the respondents, 57.7% were aware of the probiotic’s definition. There were significant differences in the percentage of participants who had little knowledge of probiotics (P

Objectives: Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) -that can affect the cardiovascular system. The aim of our study was to assess the cardiovascular manifestations and its effect on the overall mortality among patients with severe COVID-19 who were admitted in the intensive care units (ICU). Methods: This is a retrospective, multicenter cohort study that included all adult patients admitted to the ICU with laboratory-confirmed COVID-19 in three major hospitals in Oman between March 1, 2020, and August 10, 2020. Results: A total of 541 patients (mean age of 50.57 ± 15.57 years; 401 [74.1%] male) were included in the study of which 452 (83.5%) were discharged and 89 (16.5%) died during hospitalization. Evidence of cardiac involvement was found in 185 (34.2%) patients, which included raised troponin (31.6%), arrhythmias (4.3%), myocardial infarctions (2.6%), or drop in ejection fraction (0.9%). High troponin of >100 ng/l was associated with higher mortality (odds ratio [OR] = 7.98; 95% confidence interval [CI]: 4.20–15.15); P< 0.001). Patients with any cardiovascular involvement also had a high risk of dying (OR = 8.8; 95% CI: 4.6–16.5; P< 0.001). Conclusion: Almost a third of patients in our study had evidence of cardiovascular involvement which was mainly myocardial injury. This was associated with increased mortality.

إن ظاهرة النسبة تعد نموذجاً لهذا التكامل بين مستويات التحليل اللغوي، فعلى الرغم من كونها ظاهرة صرفية في المقام الأول بالنظر إلى أنها صيغة صرفية ناتجة عن إلحاق لاصقة صرفية فهي تتضمن بوضوح جانباً صوتياً يتمثل في وصف طبيعتها الصوتية المجردة المفترضة، ثم وصف التتابعات الصوتية المكونة لبنية الاسم المنسوب إليه، وهنا يكمن التداخل بين مستويين من مستويات التحليل اللغوي هما الصوتي والصرفي، ناهيك عن الترابط بين المستويين الدلالي والتركيبي. تصنف ظاهرة النسبة ضمن الظواهر الصرفية التركيبية؛ وذلك لأن صيغة المنسوب إليه تتم بإلصاق ياء النسبة آخر الاسم بغية الوصول إلى دلالة النسب وهذا ينشئ حالة صرفية تركيبية ذات شقين في المجمل أحدهما: يشمل النواحي الشكلية أي الصوتية الصرفية التي تعنى بوصف ياء النسب المشددة صوتياً على المستوى النطقي المجرد أولاً ثم المستوى المقطعي وذلك بتحليل بعض التتابعات الصوتية التي تكتنف هذه الياء ضمن السياق الذي توجد فيه. أما الشق الثاني فيتمثل في النواحي الدلالية والتركيبية لياء النسب، الذي يشتمل بدوره على الوظيفة الدلالية الصرفية للصيغة وعلى الوظيفة السياقية كذلك لهذه اللاحقة الصرفية، فياء النسب تجعل الاسم الذي اتصلت به قادراً على العمل فيما بعده، شأنها في ذلك شأن المشتقات الوصفية التي تعمل عمل الفعل، لذا توجب البحث في مقومات عمل الاسم المنسوب عمل الفعل، مع إيراد الآراء المختلفة حول ذلك كله ومناقشتها.

Objectives: We sought to investigate the prevalence of HIV in pregnant women and the maternal, obstetrical, and neonatal outcomes over 13 years (2005–2017) at Sultan Qaboos University Hospital, a tertiary hospital in Muscat, Oman. Methods: Our study design was a retrospective descriptive cross-sectional study of HIV-positive women in the department of obstetrics and gynecology. We had an unlimited sample size due to the rarity of the disease. We aimed to include all pregnant Omani women who tested positive for HIV in their antenatal screening from 1 January 2005 to 31 December 2017. The patient records were reviewed using the hospital information system service. Results: There were a total of 13 688 women with 104 281 pregnancies over the study period. The prevalence of Omani pregnant women with HIV was 0.1% (1:1000) with 0.03% of seropositive pregnancies (3:10 000). Of these seropositive pregnancies, 78.6% were known HIV carriers, while 21.4% were newly diagnosed cases. The live birth rate was 90.3%, with 9.7% resulting in miscarriage. All the miscarriages were to known HIV-positive mothers who were managed in accordance with international guidelines. Of the live births, 10.7% were unknown HIV-positive mothers with a mean gestational age of 39.67 weeks and a mean birth weight of 3.2 kg. The rate of mother-to-child transmission (MTCT) of HIV in this group was 33.3%. In contrast, 89.3% of the live births to known HIV-positive mothers delivered neonates with a mean gestational age of 37.4 weeks and a mean birth weight of 2.6 kg with 0.0% MTCT. Modes of delivery, antepartum, intrapartum and postpartum complications as well as long-term neonatal outcomes were analyzed according to the status of the mother at first presentation. Conclusions: Strategies have been placed by programs in Oman to focus on the wellbeing of pregnant women and the protection of newborns against HIV infection. Strict implementations on preventing MTCT allowed preventing HIV in children possible. Antiretroviral therapy significantly reduces vertical transmission of HIV, in addition to abstinence of breastfeeding. More importantly, all HIV-positive pregnant women should follow the prevention of MTCT programs set out by the Ministry of Health.

Aim: To assess the prevalence of peripheral arterial occlusive disease (PAOD) in human immunodeficiency virus (HIV)-infected Omani patients and to assess the potential risk factors in this group. Methodology: This was a single-center, cross-sectional study. All patients attending the infectious disease clinic between July 2017 and March 2018 were included in the study; their peripheral pulses were examined and pre- and postexercise ankle–brachial pressure index (ABPI) was measured. Normal ABPI was considered as being in the range of 1.0 ± 0.1, and a reduction of >15% postexercise ABPI was considered as a cutoff limit to define PAOD. The Edinburgh Claudication Questionnaire was answered by all patients, and CD4 count, viral load, albumin and Vitamin D (25-OH) levels, and glycated hemoglobin (HbA1c) were measured. The data were analyzed using IBM SPSS Statistics version 22. Results: Eighty-eight patients who were retroviral positive were enrolled in the study. Fifty-three (60.2%) patients were male and 35 (39.8%) were female, with a mean age of 43 years (24–71). The dorsalis pedis artery pulsation was absent bilaterally in 3 (3.4%) patients. None of the patients had a history of claudication; 1 (1.1%) had an abnormal ABPI; 17 (19.2%) had a reduction of >15% postexercise ABPI; 7 (8%) had CD4 count

The impact of drought on environmental flow (EF) in 27 catchments of the Indus Basin is studied from 1980–2018 using indicators of hydrologic alterations (IHAs). The standardized precipitation evapotranspiration index (SPEI) was systematically propagated from one catchment to another using principal component analysis (PCA). Threshold regression is used to determine the severity of drought (scenario 1, drought severity that causes low flows) and the month (scenario 2, months where drought has resulted in low flows) that trigger low flows in the Indus Basin. The impact of drought on low EFs is quantified using range of variability analysis (RVA), which is an integrated component of the IHA used to study the hydrological alterations in environmental flow components (EFCs) by comparing the pre- and post-impact periods of human and/or climate interventions in EFCs. The hydrological alteration factor (HAF) is calculated for each catchment in the Indus Basin. The results show that most of the catchments were vulnerable to drought during the periods of 1984 to 1986, 1991/1992, 1997 to 2003, 2007 to 2008, 2012 to 2013, and 2017 to 2018. On a longer timescale (SPEI-12), drought is more severe in the lower Indus Basin (LIB) than in the upper Indus Basin (UIB). The IHA pointed out that drought significantly impacts the distribution of EFCs, particularly extremely low flow (ELF) and low flow (LF). The magnitude and frequency of the ELF and LF events increase as drought severity increases. The threshold regression provided useful insights, indicating that moderate drought can trigger ELF and LF at shorter timescales (SPEI-1 and SPEI-6) in the UIB and middle Indus Basin (MIB). Conversely, severe and extreme droughts trigger ELF and LF at longer timescales (SPEI-12) in the LIB. The threshold regression also divided the entire study period (1980–2018) into different time periods (scenario 2), which is useful for quantifying the impact of drought on low EFs using the SPEI coefficient. Higher SPEI coefficients are observed in the LIB, indicating high alterations in EF due to drought. HAF showed high alterations in EF in most of the catchments throughout the year except in August and September. Overall, this study provided useful insights for analysing the effects of drought on EF, especially during low flows. [ABSTRACT FROM AUTHOR]

Objectives: Tenofovir disoproxil fumarate (TDF) has been reported to cause nephrotoxicity necessitating cessation in some patients. No information is available on the nephrotoxic effect of TDF in Omani or regional patients with HIV infection. We sought to determine the prevalence of the nephrotoxic effects of TDF in our cohort of Omani patients with HIV and investigate the nephrotoxic effects of other cofactors. Methods: We conducted an observational cohort study on 83 Omani patients currently on TDF-containing antiretroviral therapy. Renal dysfunction was monitored by measuring the serum creatinine estimated glomerular function rate (eGFR), urinary protein creatinine ratio (uPCR), and fractional excretion of phosphate (FEPi). Fisher’s exact test was used to determine any additional nephrotoxic effects of cofactors. Results: The median values for the duration of TDF use, patient age, and body mass index (BMI) at the time of the study were 178 weeks (range = 3–554), 42 years (range = 21–80), and 27 (range = 17.4–42.7), respectively. The median initial CD4 count and viral load were 205 × 106/L (range = 3–1745) and 37 250 copies/mL (range = undetectable–9 523 428), respectively. FEPi was high in two (2.4%) patients, moderate in 26 (31.3%), and low in 55 (66.3%) patients. uPCR was high in 10 (12.0%) patients, moderate in 28 (33.7%), and low in 45 (54.2%) patients. No cofactors added to the nephrotoxicity except hypertension (p = 0.045). Conclusions: Better definitions for TDF-associated toxicity are needed. uPCR is not a very good indicator of TDF-associated tubular dysfunction. Omani patients with HIV on TDF have a 4% prevalence of renal toxicity, but a study with a larger number of patients is required to explore this observation further. Cofactors like duration of TDF use, age, BMI, gender, diabetes mellitus, and use of protease inhibitors did not have an impact on the severity of FEPi and uPCR.

Study aim. Effective Tuberculosis (TB) control measures in Oman have reduced the annual incidence of tuberculosis cases by 92% between 1981 and 2016. However, the current incidence remains above the program control target of Mycobacterium tuberculosis infection dynamics among nationals and foreigners over a period of 10 years. Methods. The study examined TB cases reported between 2009 and 2018 and examined the spatial heterogeneity of TB cases and the distribution of M. tuberculosis genotypes defined by spoligotypes and MIRU-VNTR among Omanis and foreigners. Results. A total of 484 spoligoprofiles were detected among the examined isolates (n = 1295). These include 943 (72.8%) clustered and 352 (27.2%) unique isolates. Diverse M. tuberculosis lineages exist in all provinces in Oman, with most lineages shared between Omanis and foreigners. The most frequent spoligotypes were found to belong to EAI (318, 30.9%), CAS (310, 30.1%), T (154, 14.9%), and Beijing (88, 8.5%) lineages. However, the frequencies of these lineages differed between Omanis and foreigners. Of the clustered strains, 192 MTB isolates were further analysed via MIRU-VNTR. Each isolate exhibited a unique MIRU-VNTR profile, indicative of absence of ongoing transmission. Conclusions. TB incidence exhibits spatial heterogeneity across Oman, with high levels of diversity of M. tuberculosis lineages among Omanis and foreigners and sub-lineages shared between the two groups. However, MIRU-VNTR analysis ruled out ongoing transmission.

The COVID-19 pandemic continues to move at record speed. Health systems and hospitals worldwide face unprecedented challenges to effectively prepare and respond to this extraordinary health crisis and anticipated surge. Hospitals should confront these unparalleled challenges with a comprehensive, multidisciplinary, coordinated, and organized strategy. We report our experience with the systematic application of the “4S” principle to guide our institutional preparedness plan for COVID-19. We used an innovative “virtual interdisciplinary COVID-19 team” approach to consolidate our hospital readiness.

INTRODUCTION: depressive symptoms have been widely reported among people living with HIV (PLHIV) around the world. The extent of this on PLHIV in the Arabian Peninsula is unclear. This study aims to examine the prevalence of depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) in adult Omani patients with HIV attending a tertiary care hospital. It also aims to investigate the relationship between clinical and socio-demographic variables and depressive symptoms. METHODS: LHIV, age 18 (n=101), participated in the study who were followed up at a teaching hospital in Muscat, Oman. Participants were identified by a convenient and consecutive sampling of eligible patients who came for consultation on the days that the investigator conducted recruitment. The presence of depressive symptoms was quantified by the Patient Healthcare Questionnaire-9 (PHQ-9). Various socio-demographic backgrounds and risk factors will be also sought as well as activities of daily living (ADL). Chi-square test, Fisher’s exact test, t-test and logistic regression were used to explore which variables were associated with patients having depressive symptoms. RESULTS: the prevalence rate of depressive symptoms in this cohort was 41.6%. Depression among PLHIV was found to be significantly associated with age (p =0.001), HIV disease duration (p =0.001), total dependency for ADL (p =0.001) and comorbid hypertension (p =0.001). CONCLUSION: depressive symptoms are common in Omani patients living with HIV. HIV care providers are urged to be vigilant to recognize depressive symptoms in these mood-vulnerable populations and to call for a multidisciplinary team with mental health professionals, for the prevention and treatment of depressive symptoms among PLHIV in Oman.

Throughout history, infectious diseases have caused havoc among societies. Emerging and re-emerging infectious diseases are now occurring at unprecedented speed. According to the World Health Organization (WHO), the world has witnessed the emergence of several disease outbreaks and epidemics caused by more than 20 infectious agents over the past decade. Some of these epidemics were caused by novel infectious agents such as H1N12 and MERS.

Background: Staphylococcus and Streptococcal infections are a matter of serious concern in the dialysis population especially those having tunnel catheter access. Importance of these organisms is their virulent nature, higher incidence and prevalence in tunnel catheters resulting in significant morbidity and mortality. Staphylococcal toxic shock syndrome (STSS) is an uncommon but potentially fatal disease with multisystem involvement. This is a case of toxin-producing methicillin sensitive staph aureus (MSSA) which is known to have high mortality. A high degree of clinical suspicion and prompt management is necessary to avoid fatality. The aim of the study was to get the idea for the management of the toxic shock in terms of reducing the morbidity and mortality rate. Case presentation: This case progressed to state of shock within few hours of presentation to emergency room and admission, attributed to be toxic shock with multi-organ failure. Management and Results: In the management of the patient at the very beginning, the infected catheter was removed further aggressive resuscitation and empirical antibiotics were administered but this case resulted into a fatality. Conclusion: The early action for source removal of the infection, appropriate antibiotic therapy and adjuvant therapy including clindamycin and immunoglobulin can effectively treat the toxic shock and its related complications.

The case of a patient with disseminated strongyloidiasis following chemotherapy for lymphoplasmacytic lymphoma is presented. Keywords: Disseminated strongyloidiasis, Lymphoma, Alveolar hemorrhage, Meningitis, Subcutaneous ivermectin