Objectives: This study of surgical site infection (SSI) rates covers 29 International Nosocomial Infection Control Consortium (INICC) member hospitals in 22 cities across the Middle East, including Bahrain, Egypt, Kuwait, Lebanon, and Saudi Arabia. Methods: Prospective cohort multinational surveillance data were collected through the INICC Surveillance Online System. Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) definitions were applied for SSI. Surgical procedures (SPs) were categorized into 12 types according to the International Classification of Diseases, ninth revision (ICD-9) criteria, 9th edition. Results: From 2014 to 2023, we collected data on 304 SSIs associated with 21 322 SPs. Among the 12 observed types of SPs, comparable incidences were noted between the INICC hospitals of the Middle East and CDC/NHSN datasets across six types of SPs: breast, 1.1% vs. 0.9% (p = 0.870); cholecystectomy, 0.1% vs. 0.2% (p = 0.360); craniotomy, 3.0% vs. 2.1% (p = 0.510); herniorrhaphy, 0.8% vs. 0.7% (p = 0.770); abdominal hysterectomy, 1.2% vs. 1.1% (p = 0.880); and laminectomy, 1.6% vs. 0.7% (p = 0.100), respectively. INICC hospitals of the Middle East exhibited a significantly lower cesarean section rate compared to CDC/NHSN rates: 1.04% compared to 1.5% (relative ratio (RR) = 0.71, 95% CI: 0.58–0.87; p = 0.001). However, the following four types of SPs showed SSI rates significantly higher than those of CDC/NHSN: Appendix surgery, 1.8% vs. 1.1% (RR = 1.55, 95% CI: 1.02–2.36; p = 0.041); coronary artery bypass, 4.5% vs.1.4% (RR = 3.32, 95% CI: 1.82–6.08; p < 0.001); open reduction of fracture, 2.5% vs. 1.1% (RR = 2.24, 95% CI: 1.50–3.36; p < 0.001); and exploratory abdominal surgery, 3.8% vs. 1.7% (RR=2.30, 95% CI: 1.56–3.39, p < 0.001). Conclusions: Most SSI rates in this set of hospitals in the Middle East are similar to those of CDC/NHSN. It is recommended to focus on implementing effective interventions to reduce SSI rates for procedures with higher rates.

Keywords:Delivery of Healthcare; Surgical Wound Infection; Drug Resistance, Microbial; Lebanon; Bahrain; Kuwait; Saudi Arabia.

Objectives: In the UAE, the relationship between long-term statin use and new-onset diabetes mellitus (NODM) has never been studied. Therefore, this study investigates the incidence and risk of NODM among long-term statin-using UAE nationals with cardiovascular risk factors. Methods: We analyzed retrospective data of patients who were initiated on statin therapy from April to December 2008 and followed up till January 2020. Propensity score matching was applied to match statin users to an equal number of nonusers. Multivariable Cox proportional hazards regression analysis estimated the risk of NODM in statin users compared to nonusers. Results: Patients (N = 631) with one or more vascular risk factors were followed for a median of 10.1 years (IQR = 7.9–10.9 years). Age- and sex-adjusted incidence of NODM was higher among statin users than among nonusers (21.2 vs. 8.3 events per 1000 person-years). Statin users were also more than three times as likely to develop NODM over 10 years. We estimated that one in 19.2 patients (95% CI: 10.9–90.9) treated with statins for 10 years may develop NODM. Conclusions: Long-term statin use in Emirati patients is associated with an increased NODM risk. Though this risk is small relative to the anti-cardiovascular disease benefits of statins, clinicians should regularly monitor users of statin therapy for early indications of diabetes.

Keywords:Statins; Diabetes Mellitus; Dyslipidemia; Cardiovascular Disease; Incidence; Risk Factor; United Arab Emirates.

Objectives: Cerebral malaria remains poorly understood despite being a common manifestation of severe malaria in children, often associated with poor outcomes. We sought to describe the burden of childhood cerebral malaria and identify factors predictive of poor hospitalization outcomes (death and neurological outcomes) and short-term neurological sequelae. Methods: We conducted a retrospective review of children diagnosed with cerebral malaria at a tertiary hospital in northwestern Nigeria from 1 January 2019 to 31 December 2022. We retrieved relevant information, including hospitalization outcomes (discharge, death, and neurological sequelae) and neurological status at follow-up. Results: Of 8295 pediatric admissions, 948 cases were severe malaria; from those, 284 cases of cerebral malaria were identified, representing a prevalence of 3.4% and 30.0%, respectively. Clinical and laboratory features were comparable between survivors and non-survivors, except hypoxemia (p = 0.016), duration of loss of consciousness (p < 0.001), acidosis (p = 0.002), white blood cell count (p = 0.006), serum sodium (p = 0.005), and serum creatinine (p < 0.001). Hypoxemia (adjusted odds ratio (AOR) = 6.071; 95% CI: 1.672–22.043), serum creatine > 1.5 mg/dL (AOR = 6.720; 95% CI: 2.160–20.905), and the first 24 hours of hospitalization (AOR = 5.934; 95% CI: 2.423–14.535) were predictors of hospitalization death. Forty-nine (19.6%) of 250 survivors had neurological complications at discharge. Age under five years increased the odds of neurological complications at discharge (OR = 2.059; 95% CI: 1.094–3.876). At follow-up, 24 (49.0%) of the 49 patients with neurological complications recovered fully. Conclusions: This study demonstrates that cerebral malaria is associated with a high mortality rate and significant neurological complications, particularly in children under five years old. Hypoxemia and elevated serum creatinine levels were associated with an increased risk of in-hospital death.

Keywords:Malaria, Cerebral; Child; Follow-up Studies; Africa.

Objectives: Hepatic fibrosis remains a potential complication for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection. The affected individuals, known as inactive HBV carriers, tend to have a favorable prognosis. This study aimed to determine the prevalence of significant fibrosis and associated risk factors among Omani patients diagnosed as inactive HBV carriers. Methods: A retrospective study was conducted on Omani inactive HBV carriers visiting a tertiary hospital in Muscat, Oman, between January 2017 and December 2018. Significant hepatic fibrosis (stage F2 or higher) was identified using two-dimensional shear-wave elastography, with baseline clinical, laboratory, and radiological data analyzed for associations. Results: Among the selected 200 participants (mean age = 44.6 ± 9.3 years), 53.0% were male. Significant fibrosis was present in 40 (20.0%) patients, with a preponderance of male (p = 0.007) and those aged ≥ 60 years (p = 0.024). Fatty changes, as detected by liver ultrasound, were independent risk factors (p = 0.044). Conclusions: The findings underscore the importance of periodic assessment and monitoring of inactive HBV carriers in Oman, particularly those with risk factors for fibrosis progression, such as male sex, older age, and fatty liver. Non-invasive tests can aid in early detection and management of fibrosis, thereby improving patient outcomes.

Keywords:Inactive Hepatitis B Virus Carriers; Hepatic Fibrosis; Prevalence; Risk Factors; Oman.

Objectives: This study aimed to examine the prevalence, etiology, management, and outcomes of postpartum hemorrhage (PPH) following vaginal and cesarean delivery. Methods: We conducted a cross-sectional study on women who delivered at Sultan Qaboos University Hospital from January 2017 to December 2021 and experienced PPH. PPH was defined as per World Health Organization criteria of blood loss > 500 mL after vaginal delivery and 1000 mL after cesarean delivery. The study evaluated demographic parameters, pre-delivery and discharge hemoglobin, estimated blood loss, etiology, pharmacological, mechanical, and surgical interventions for PPH, and the need for blood products. Results: There were 18 136 vaginal deliveries, of which 729 women had PPH, with a prevalence of 4.0%. Among 2771 cesarean sections, 360 women had PPH, with a prevalence of 13.0%. Hemoglobin < 11 g/dL was found in 278 (38.1%) and 140 (38.9%) women before vaginal delivery and cesarean section, respectively. Grand multiparas had the highest prevalence of PPH after vaginal delivery (42.7%). In cesarean deliveries, the majority (48.6%) were women with parity 2–4. Poor uterine tone was the cause of PPH in 616 (84.5%) vaginal deliveries and 263 (73.1%) cesarean deliveries. Surgical interventions were required in 244 (33.5%) women after vaginal delivery and 82 (22.8%) women after cesarean section. The average blood loss was 860 mL after vaginal delivery and 1400 mL after cesarean section. Blood transfusion was required in 74 (10.2%) women after vaginal delivery and 127 (35.3%) women after cesarean section. There was one maternal mortality due to atonic PPH after vaginal delivery. Conclusions: Active management of the third stage of labor and repeated emergency obstetric drills have reduced adverse outcomes. Addressing anemia in pregnancy and further research on carbetocin use in cesarean sections are recommended.

Keywords:Postpartum Hemorrhage; Oxytocics; Hysterectomy.

Objectives: Allergic rhinitis (AR) is a common condition among schoolchildren in various regions of Saudi Arabia, manifesting primarily through nasal symptoms. It significantly affects sleep, mood, and academic performance due to exposure to allergens. AR places a considerable burden on the quality of life (QoL), often leading to moderate to high levels of stress. We aimed to assess the prevalence and impact of AR on the QoL among children. Methods: This cross-sectional observational study was conducted from September 2023 to April 2024 in Tabuk, Saudi Arabia. Data was collected from a self-administered questionnaire adapted from previous studies. Results: The study included 235 pediatric patients. The prevalence of diagnosed AR among the participants was 64.3% (n = 151). Symptoms duration varied, with seasonal allergies affecting 63.4% (n = 149) and perennial allergies affecting 41.7% (n = 98) of the children. Notably, sleep quality was significantly compromised in 79.1% (n = 186) of cases, and emotional well-being was impacted in 78.3% (n = 184). AR was significantly correlated with impaired daily activities, school performance, and social interactions (p < 0.001). It also had a profound impact on sleep quality (p < 0.001), emotional well-being (p < 0.001), and physical activity (p < 0.001), indicating a broad and severe effect on QoL. Management strategies demonstrated significant associations, with education or counseling (p = 0.009) and psychological support (p = 0.043), showing the strongest correlation with the prevalence and management of AR. Conclusions: This study demonstrated that AR has a significant and multifaceted impact on pediatric patients in Tabuk, Saudi Arabia, affecting daily activities, sleep, emotional well-being, and physical activities. While educational initiatives and psychological support showed promise in managing the condition, further efforts are required to address environmental factors and enhance comprehensive management strategies.

Keywords:Allergic Rhinitis; Prevalence; Child; Quality of Life; Saudi Arabia.

Autosomal recessive polycystic kidney disease is one of the most prevalent inherited cystic kidney diseases in infants and children, common in highly consanguineous societies such as Oman. Karyomegalic interstitial nephritis is a rare cause of hereditary chronic kidney disease presenting with progressive renal impairment and hematoproteinuria. We report a rare case of concurrent karyomegalic interstitial nephritis and autosomal recessive polycystic kidney disease in a two-year-old Omani boy. He presented with failure to thrive, developmental delay, hypotonia, recurrent urinary tract infection, proteinuria, and hematuria. Abdominal ultrasonography showed bilaterally enlarged kidneys with distorted parenchyma, loss of corticomedullary differentiation, and multiple small cysts in addition to an enlarged liver. Whole exome sequencing of the patient DNA revealed a homozygous likely-pathogenic variant in FAN1(NM_014967.4:c.2854C>T, p.R952*) segregating from each parent, in addition to a homozygous missense variantin polycystic kidney and hepatic disease 1 (NM_138694.3:c.406A>G, p.T136A). Familial carrier testing in parents and a similarly affected brother revealed segregation of the polycystic kidney and hepatic disease 1 variant in a homozygous state in the father and brother, and in a heterozygous state in the mother. This case demonstrates two rare genetic causes of chronic kidney disease within a highly consanguineous family, mimicking an autosomal dominant pattern of inheritance of cystic kidney disease. We recommend whole exome sequencing as a routine molecular diagnostic tool for children with cystic kidney disease, especially those from consanguineous families.

Keywords:Autosomal Recessive Polycystic Kidney Disease; Chronic Kidney Disease; Whole Exome Sequencing; Oman.

Sleep-related hyperkinetic seizures are a frequent symptom of frontal lobe epilepsy that occurs at night. Although temporal lobe-originating sleep-related seizures have been documented, they often lack hyperkinetic activity. Furthermore, episodic nocturnal wandering is rarely observed and is believed to represent an unusual form of nocturnal epilepsy that responds to anti-seizure medications. In this report, we present a case of a 14-year-old right-handed girl with recurrent sleepwalking and wandering. Interictal electroencephalography revealed an epileptogenic focus in the left temporal lobe and intermittent slow-wave activity originating from that region. During her nighttime wanderings, the patient exhibited unusually violent and nonviolent conduct, putting herself at risk of minor or serious injuries.

Keywords:Somnambulism; Epilepsy, Frontal Lobe; Epilepsy, Temporal Lobe; Electroencephalography.

We describe a case of a young woman who presented with delayed secondary sexual development and primary amenorrhoea. She had low levels of oestradiol, follicle-stimulating hormone, and luteinizing hormone with normal levels of other pituitary hormones. Genetic testing revealed a rare diagnosis of autosomal recessive hypogonadotropic hypogonadism 8. She was treated with hormone therapy to promote the growth of the uterus and secondary sexual characteristics. Combined contraceptive pills were initiated. A pelvis ultrasound taken after six months revealed a growing uterus.

Keywords:Hypogonadotropic Hypogonadism; Receptors; Kisspeptin; Amenorrhea; Oman.