Khoula Hospital

Abstract Background : Labor pain and childbirth comfort significantly affect maternal satisfaction, labor progression, and psychological well-being. Non-pharmacological methods are increasingly explored to manage labor pain safely and holistically. Quran recitation, a culturally and spiritually rooted auditory intervention, may offer psychological and physiological benefits during childbirth. Objective : To evaluate the effectiveness of Quran recitation in reducing labor pain intensity, comfort during childbirth, and blood pressure among nulliparous women in Oman. Methods : A quasi-experimental study was conducted at Khoula Hospital, Oman, involving 120 nulliparous women with singleton term pregnancies. Participants were assigned to either the Quran recitation group (n = 60) or the back massage group (n = 60). Data were collected using the Visual Analogue Scale (VAS), Pain Behavioral Observation Scale (PBOS-3), Childbirth Comfort Questionnaire (CCQ), and physiological measures of blood pressure. Pre- and post-intervention comparisons were performed using paired t-tests and ANOVA. Results : Quran recitation significantly reduced mean VAS pain scores (76.45 ± 8.20 to 58.32 ± 7.16, p = 0.001) compared to back massage, which showed a non-significant change (62.88 ± 8.44 to 61.10 ± 7.98, p > 0.05). The intervention group also demonstrated significant improvements in pain behaviors, comfort levels (total CCQ score p = 0.002), and reductions in systolic and diastolic blood pressure ( p = 0.001). Conclusion : Quran recitation is a safe, culturally congruent, and effective non-pharmacological intervention for reducing labor pain and enhancing maternal comfort. It has physiological calming effects and can be considered as a complementary strategy in obstetric care for Muslim women.

Background: Antibiotic overuse in Neonatal Intensive Care Units (NICUs) is a major contributor to antimicrobial resistance and adverse neonatal outcomes. This study aims to evaluate baseline antibiotic utilization (AU), identify factors influencing variability, and assess the impact of neonatal characteristics and sepsis incidence. Methods: A multicenter retrospective analysis examined AU in seven NICUs from 2019 to 2023, involving 25,532 neonatal admissions during national antibiotic stewardship program implementation. Data encompassed neonatal clinical parameters, sepsis incidence, and AU metrics, including days of therapy (DOT) per 1000 patient-days. Statistical analyses included correlation assessments and multivariate regression to identify determinants of antibiotic use. Results: Overall, 43.8% of neonates received antimicrobials, with individual NICUs ranging from 24% to 73% (p < 0.001). Antimicrobial-exposed neonates had a mean gestational age of 35.1 weeks [SD ± 4.4] and a mean birth weight of 2360 g [SD ± 970]. Antimicrobial-exposed neonates were generally more premature [35.1 (±4.4) weeks vs. 37.5 (±2.5) weeks (p < 0.001)] and had lower mean birth weight [2360 g (±971) vs. 2817 g (±686) (p < 0.001)] compared to those not exposed to antimicrobials. Total antimicrobial days varied markedly (8761 to 37,683 days), with DOT per 1000 patient-days ranging from 322 to 1031. Antimicrobial use for culture-negative sepsis varied widely among centers, from 23% to 73%. Antimicrobial-exposed neonates had higher all-cause mortality compared to those who did not [(7.5% vs. 3.2%), (p < 0.001)]. Multivariate analysis revealed individual NICU practice patterns remained significant predictors after adjusting for neonatal characteristics. Conclusions: Neonatal antimicrobial use varied significantly among NICUs, driven primarily by institutional practices rather than neonatal demographics. These findings provide nationally representative baseline data to inform neonatal antimicrobial stewardship interventions and offer transferable lessons for other countries seeking to optimize antibiotic use in NICUs amid rising global antimicrobial resistance.

INTRODUCTION:Diabetic retinopathy (DR) is a leading cause of vision loss globally, and its burden is increasing, particularly in regions with a high prevalence of diabetes like Oman. Early detection and timely intervention are crucial for preventing vision loss and improving patient outcomes. This study aimed to evaluate referral patterns and screening outcomes for DR at Bowsher Specialized Polyclinics (BSP) in Muscat, Oman.METHODOLOGY:In this cross-sectional study conducted between January 1 and December 31, 2023, data were retrospectively collected from the electronic health records of 6677 patients referred to BSP. The assessment included referral sources, reasons for referral, patient demographics, waiting times, screening results, and follow-up plans.RESULTS:A high proportion of external referrals (79%), with 90.6% being routine. Nearly half of the referrals were for DR screening, and among those screened, 16.9% had abnormal findings, with mild nonproliferative DR (NPDR) being the most prevalent. Males showed a significantly higher proportion of abnormal screening outcomes. In addition, mean waiting times were long (145.8 days), and 39.5% of patients were defaulters.CONCLUSIONS:These findings highlight the need for targeted interventions to optimize referral pathways, expand screening capacity, and enhance patient engagement to improve DR management.

BackgroundEpilepsy is a prevalent neurological disorder that can adversely affect multiple life domains, including mental health, sleep quality, and overall well-being. In Oman, where modern healthcare services have expanded substantially, limited data exist on how these factors influence the health-related quality of life (HRQoL) of adults with epilepsy. Accordingly, this study aimed to evaluate HRQoL and its relationships with depression, daytime sleepiness, and fatigue in Omani adults with epilepsy.MethodsA cross-sectional descriptive study was conducted among 238 Omani adults with epilepsy at two tertiary hospitals in Muscat. HRQoL was assessed using the Quality of Life in Epilepsy-31 (QOLIE-31), while depression, daytime sleepiness, and fatigue were measured via the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Epworth Daytime Sleepiness Scale (EDSS), and the Fatigue Severity Scale (FSS), respectively. Independent t-tests and one-way ANOVAs examined differences in QOLIE-31 scores, and Pearson correlations assessed relationships among the four scales. Continuous variables are reported as mean ± standard deviation (SD) and categorical variables as frequencies and percentages. Statistical analyses were two-tailed; results with p < .05 were considered significant.ResultsParticipants had a mean age of 32.74 years (SD = 11.77), and 55.5% were male. About 52.5% experienced generalized-onset tonic-clonic seizures, while 47.5% reported focal-onset seizures. Idiopathic epilepsy was common (50.8%), and half of the participants (50.4%) were on monotherapy. Regarding QOLIE-31 categories, 10.5% of participants had low HRQoL, 71.4% had moderate HRQoL, and 18.1% had high HRQoL. On the NDDIE, 34.9% screened positive for depression. Excessive daytime sleepiness (ESS ≥ 11) was observed in 11.3% of participants, and 54.6% reported clinically significant fatigue (FSS ≥ 36). Higher QOLIE-31 scores were associated with living in Muscat (p < .01), having a higher income (p < .01), being employed (p < .01), having idiopathic epilepsy (p < .05), and receiving monotherapy (p < .001). Depression, daytime sleepiness, and fatigue each showed a significant negative correlation with QOLIE-31 (p < .01).ConclusionsThis study highlights the multidimensional impact of epilepsy on Omani adults, demonstrating that clinical and socioeconomic factors—along with depression, sleepiness, and fatigue—significantly shape HRQoL. Targeted interventions aimed at seizure control, mental‑health support, and social empowerment are critical for optimizing well‑being in this population.

The aim of this report is to assess deep infection rate in total knee arthroplasty (TKA), in a clean theatre, but without using laminar flow. This report is a retrospective case series of TKA conducted in the same hospital and same single operating room, by a single surgeon, to assess the percentage of post operative deep infection, that needed surgical intervention between June 2016 and December 2023. Infection rate was compared to the rate reported in the literature. A total of 430 knee replacements were reviewed, with data obtained from the electronic medical record system. All of these cases were performed under strict vigilance to prevent infection, all were given pre operative prophylactic antibiotics, and all had a surgical drain that was removed at the first post operative day. Prosthetic joint infections (PJI) was defined as a TKA that needed further surgical intervention for a clinical picture and investigations suggestive of deep infection. In this report, four patients out of a total of 430 patients (0.93%), who underwent primary TKA had developed PJIs as defined. Patient’s age ranged from 57 to 71 years (mean 66 years), with three females and one male patient. Two patients underwent staged revision TKA after confirmation of PJI, while other two patients underwent debridement, change of insert, and implant retention. This report has concluded a rate of deep infection that is comparable to the reported rate in the literature, despite that no laminar flow was used in this case series. Using a surgical drain did not seem to increase the infection rate. Two of the infected cases were from bacteria that cannot be surgically acquired, making the surgically acquired rate of infection even lower (0.47%).

Abstract Phytochemicals or herbal medicines (HMs) with neuroprotective and nootropic properties are being increasingly utilized in various neurological conditions owing to their antioxidative, anti-inflammatory, and antiapoptotic properties, as well as their role in immune regulation, hormonal regulation, and modulation of neurotransmitters and ion channels. While HMs are often regarded as safe, they are not without risks. The aim of this review was to know the various neurological and non-neurological side effects of long-term consumption of neuroprotective and nootropic phytochemicals. An electronic search was conducted using the following databases from January 2000 to December 2023: PubMed, PubMed Central, Embase, Scopus, and Science Citation Index (Web of Science). Only studies published in the English language were considered. The search used key terms such as “Herbs,” “Phytochemicals,” “India,” “Asia,” “Neuroprotection,” “Neurological diseases,” and “Complications.” The sources included research articles, systematic reviews and meta-analyses, narrative reviews, and editorials. Letters to the editor, commentaries, abstracts only, and unpublished data were excluded. While HMs are increasingly being used therapeutically for various neurological and non-neurological conditions, they also carry the risk of adverse effects due to contamination, adulteration, direct effects of metabolites, herb–drug interactions, interindividual susceptibility, and other factors. In addition, widespread availability, over-the-counter sale, and unsupervised dosing are the key reasons for their unregulated prolonged use. As such, correct identification of HMs and consequent assessment of their toxicological profile are deemed extremely crucial. Neurotoxicity testing for HMs is challenging considering the limitations of traditional methods (morphological, microscopic, and chemical); nevertheless, in the recent years, several novel procedures have been developed. Large studies are warranted to establish the safety profile of consuming HMs either alone or in combination in humans.

Traumatic brain injury (TBI) is a known health burden worldwide; however, no literature is available on its economic burden in developing countries, this study aims to highlight the cost of pediatric TBI and compare mild, moderate, and severe cases. A retrospective study was conducted in the neurosurgery department of a tertiary hospital in a developing country. Data on pediatric cases presenting with TBI from January 2015 to December 2019 was collected from electronic medical records; this included patients' demographics, neuro-vital signs, mechanism of TBI, intervention, diagnosis on imaging, investigations, medications, duration of hospital and intensive care unit stay. Costs of interventions, investigations, and hospital stay were retrieved from the hospital finance division, total costs were calculated, and analysis was done to compare the relation of age, diagnosis, mechanism of injury, and intervention to total cost. The sample included 921 cases (M: F, 1.7:1), with 67.1% aged less than 5years. Falls and motor vehicle collisions had the highest total costs. Cases with normal radiological findings and skull fractures constituted 35.9% and 30.2%, respectively, and consequently had the highest costs; epidural hematoma followed in highest costs. TBI severity, surgical intervention, age < 5years old, and longer hospital stays were significantly associated with higher total costs (P < 0.001). Pediatric TBI is a health and economic burden, most notably in children less than 5years old and those with severe injuries. Programs advocating children's safety and hospital guidelines for the diagnosis and appropriate timely management need to be implemented.

The Eastern Mediterranean Region stretches from Morocco in the west to Pakistan in the east. A key drug utilization research (DUR) strength within the region is the use of DUR to support the optimal use of antimicrobials and minimize antimicrobial resistance. The Eastern Mediterranean Region faces significant challenges impacting the rational and safe use of medicines. Drug utilization data can be used to identify needs and targets for improvements, to inform the design and implementation of healthcare interventions, and to evaluate the impact of these interventions. Understanding the factors driving medication use and prescribing behavior in the area is critical for developing targeted strategies to improve sub-optimal medication use. Drug utilization studies use various descriptive and analytical methods to facilitate the safe and effective use of medicines in populations. Funding, human resources, capacity building, and structures are essential to promote the sustainability of DUR and ultimately improve health outcomes in the region.

Background Coronavirus disease-2019 (COVID-19) infection originated in China and was very quickly seen in the Middle East North Africa (MENA) region. This study was undertaken to evaluate COVID-19-related cerebrovascular involvement in the MENA+ region. Methods Retrospective observational regional multicenter study aiming to identify acute stroke presentation and functional independency in patients with COVID-19 infection in the MENA region. The diagnosis of COVID-19 was established by polymerase chain reaction testing in all patients. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke symptoms. Functional independency was assisted by a modified Rankin Scale (mRS) at 90 days. Results There were 209 patients including 65 COVID-19-related stroke group (CRSG). The mean age was 62.85 ± 15.94 for (CRSG) and 58.69 ± 14.73 in non-COVID-19 stroke group (NCSG). The most prevalent risk factor for both groups was hypertension 45 (69.2%) and 105 (72.9) respectively. Intravenous thrombolysis therapy was delivered to 6/65 (9.2%) in (CRSG) compared to 11 (7.6) in (NCSG). The mean NIHSS at baseline for the (CRSG) was 12.94 ± 9.46, versus 6.08 ± 4.9 in (NCSG). This was statistically significant ( P &lt; 0.001). Functional outcome at the 90-day measured using mRS was worse in the (CRSG) compared to (NCSG) 3.61 ± 2.53, 2.20 ± 2.60 respectively and this was statistically significant ( P = 0.001). Conclusion In this study from multiple countries from the MENA+ region, we showed that acute stroke in patients with active COVID-19 had more severe symptoms at onset and worse 90 days’ outcomes despite the young age. There were no regional differences noted in severity and outcome in the MENA region.