strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States

The Gulf Cooperation Council Center for Infection Control [GCC-IC] has placed the emergence of antimicrobial resistance [AMR] on the top of its agenda for the past four years. The board members have developed the initial draft for the GCC strategic plan for combating AMR in 2014. The strategic plan stems from the WHO mandate to combat AMR at all levels. The need for engaging a large number of stakeholders has prompted the GCC-IC to engage a wider core of professionals in finalizing the plan. A multi-disciplinary group of more than 40 experts were then identified. And a workshop was conducted in Riyadh January 2015 and included, for the first time, representation of relevant ministries and agencies as well as international experts in the field. Participants worked over a period of two and a half days in different groups. International experts shared the global experiences and challenges in addressing human, food, animal, and environmental aspects of controlling AMR. Participants were then divided into 4 groups each to address the human, animal, microbiological and diagnostic, or the environmental aspect of AMR. At the end of the workshop, the strategic plan was revised and endorsed by all participants. The GCC-IC board members then approved it as the strategic plan for AMR. The document produced here is the first GCC strategic plan addressing AMR, which shall be adopted by GCC countries to develop country-based plans and related key performance indicators [KPIs]. It is now the role of each country to identify the body that will be accountable for implementing the plan at the country level

Knowledge, attitudes, and practices regarding travel health among Muscat International Airport travelers in Oman: Identifying the gaps and addressing the challenges

Although the majority of travel-associated communicable diseases can be prevented, the public health burden of these diseases remains significant. Relatively little is known about how travelers know and perceive the health risks associatedwith the travel and how they utilize preventive measures before and while Travel medicine- traveling abroad. This study was conducted to determine the level of the knowledge, attitudes, and practices [KAP] of Muscat International Airport travelers about travel health in order to assess the knowledge gap and the need for travel health services in Oman. A cross-sectional study was conducted over a period of 1 week using a self-administered questionnaire. The overall level of knowledge about vaccine-preventable diseases, food safety, and preventive measures against insect bites of the participants was inadequate. The practice concerning preventive travel health measures, such as the use of specific immunizations and antimalarial prophylaxis, was very limited, and influenced by some personal and travel-related factors. The inadequate level of travelers' knowledge and poor utilization of travel medicine services highlights the need for the provisions of specialized travel medicine services at the national level and to develop educational materials promoting the importance of pre-travel health advice

Epidemiology of rabies in Oman: a retrospective study [1991-2013]

Animal bites and rabies are under-reported in many developing countries and there is poor understanding of the disease burden. The aim of this study was to map the epidemiology of animal bites and rabies in Oman over the period 1991-2013. In a cross-sectional, descriptive, surveillance-based study, all data about animal bites and rabies from the national communicable disease surveillance system were analysed. A total of 22 788 cases of animal bites were reported. Most bites were to males [70%] and the 10-19 year age group [26%]. Cats were the most common animal and upper extremities were the most common bite site. There were 8 rabies cases reported during the study period, mostly due to bites from wild animals, with 100% mortality. Of 758 suspected animals tested, 56.1% were positive for rabies; foxes had the highest positivity rate [70.1%]. The high incidence of animal bites in Oman emphasizes the importance of a rabies prevention and control programme

Diabetic papillopathy with macular edema treated with intravitreal bevacizumab

A 46-year-old diabetic male presented with acute painless visual loss in his left eye [OS]. Visual acuity was 6/36 OS with an unremarkable anterior segment examination [OU]. Posterior segment showed a swollen left optic disc with large diffuse macular edema and moderate nonproliferative diabetic retinopathy [NPDR]. The right eye fundus showed only mild NPDR. Optical coherence tomography and fundus fluorescein angiography were performed which revealed left macular edema and a hyperfluorescent left optic disc. Computerized tomography scan orbit and brain was normal. The patient received an intravitreal bevacizumab injection OS followed by focal laser photocoagulation 1 month later. His optic disc swelling and the macular edema subsided rapidly after the injection and his visual acuity improved to 6/6 with disc pallor

hospital acquired outbreak of bacillus cereus gastroenteritis, Oman

To investigate the course of a hospital acquired outbreak of Bacillus cereus gastroenteritis outbreak, and the interventions that were taken to prevent such an outbreak from occurring again. On May 3-5 2008, 58 cases of gastroenteritis were reported among patients and their attendants in a referral hospital in Oman. All affected had eaten meals served by the hospital kitchen the previous day. An outbreak investigation team conducted active surveillance and interviewed people about symptoms and food consumed on the preceding day in the hospital. Food samples from the kitchen and faecal samples from the kitchen staff and those affected were cultured. An environmental audit of the kitchen was conducted. The majority of the 58 persons affected by the outbreak were adult females, predominantly attendants of patients. 90% had diarrhoea and 10% had vomiting, usually mild. All those affected were managed symptomatically except for two patient attendants who required intravenous rehydration. The meal exposure histories implicated at least one meal from the kitchen. Many violations of basic food hygiene standards were observed in the kitchen. Toxin producing B. cereus was isolated from faeces of 3/12 [25%] patients and 19/25 [76%] of food handlers, and 35/61 [57%] of food samples from the kitchen. This is the first report of a nosocomial outbreak of foodborne B. cereus infection from this region. The importance of appropriate epidemiological and microbiological investigation and public relations management is emphasized, in addition to the need for continuing training of food handlers and rigorous enforcement of food hygiene regulations

Half-fluence photodynamic therapy to treat chronic cental serous chorioretinopathy: a case series

To evaluate the efficacy and safety of half-fluence photodynamic therapy [PDT] in treating chronic central serous chorioretinopathy [CSC] in Omani population. A Retrospective chart review of all patients with chronic CSC treated with half-fluence PDT from November 2009 to December 2010 was carried out. Recorded parameters included best-corrected visual acuity, findings of clinical examination, results of fluorescein angiography and optical coherence tomography at baseline and during follow-up visits after treatment. Six eyes [of five Omani patients] with chronic CSC, of at least 9 months duration, were treated with half-fluence PDT. All eyes showed a complete resolution of CSC within 1 month following treatment. Four eyes showed visual improvement and two had unchanged stable vision. No complications from the treatment were noticed during the follow-up visits. Half-fluence PDT to treat chronic CSC in Omani population is a promising treatment that results in both structural and functional improvement

Epidemiology and outcome of snake bite cases evaluated at a Tertiary Care Hospital in Oman

To study the epidemiology of snake bite patients evaluated at the Royal Hospital, Muscat, Sultanate of Oman, and to study their clinical course and outcome. A retrospective study of 65 adult patients presenting at Royal Hospital following a snake bite from May 2006 to August 2008. The main symptoms were local pain at the bite site [26 patients, 40%] and swelling [17 patients, 26%]. Only five patients [7.7%] had signs of bleeding. After assessment, only 47 of the 65 patients were admitted. White cell count [WCC] was raised in 15 cases [23%] on presentation to the emergency room. Prothrombin time was prolonged in 34 patients [52%] and APTT was prolonged in 25 patients [38%] on presentation. Thirty-six patients received anti-snake venom [antivenom] at a mean time of 8 h after the bite and 4 h after arrival in the emergency department. Patients with deranged coagulation profile needed a mean of fourteen vials of antivenom for correction of the abnormal coagulation profile. Two patients died: both had delayed presentation to the hospital. Patients with envenoming following snakebite should receive antivenom as soon as possible: delayed presentation or administration may be very dangerous. The decision to give antivenom should be initiated as soon as possible after patients' arrival at the Emergency Department and the use of the whole blood clotting test [WBCT] may facilitate the early administration of antivenom

Outcome of pregnancy in patients possessing anticardiolipin antibodies

To analyse the outcome of pregnancy in a sample of patients with a history of fetal loss, and possessing anticardiolipin antibodies [ACAs], and to assess the effectiveness of therapy with aspirin and prednisolone. Data on a cohort of 21 Arab and 4 other Asian patients who had one or more episodes of fetal loss associated with raised levels of ACAs were analysed retrospectively. Statistical analysis was performed using X[2] test for assessment of isotype data and the Fischer test for assessment of the effects of therapeutic intervention. Where immunoglobulin G [IgG] ACAs were found alone, abortion rates occurred at the same rate in the first and second trimesters, which was significantly higher than in the third trimester. In the few cases where IgG and immunoglobulin M [IgM] ACAs coexisted, the rate of pregnancy loss was significantly higher in the first trimester than the second and the third. In the group who had received both aspirin and prednisolone, 75% pregnancies were successful compared to 54% in the group receiving aspirin alone and 17% in those who received no therapy. The presence of IgG antibodies appears to increase the risk of abortions. Low dose aspirin, either alone or with prednisolone, appears to significantly improve the chances for successful pregnancies in patients with ACAs. Further clinical trials are needed to ascertain optimal therapeutic protocols