ABSTRACT
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.
ABSTRACT
BACKGROUND: In the era of Direct Observation Treatment (DOT) for tuberculosis, clinicians need to focus on high-risk groups. We present sputum conversion rate at one and two months following DOT and its predictors in Oman. STUDY DESIGN: Hospital-based clinical intervention type of case series. METHODS: Chest physicians in a referral hospital examined sputum-positive cases of tuberculosis between 2001 and 2006. Patients with HIV infection and treated in the past were excluded. History of smoking, diabetes and duration of symptoms were noted. Sputum was tested for bacillus density. Blood was tested for platelet count and blood sugar levels. One and two months following treatment, the sputum was retested to determine sputum conversion. Regression analysis was done to identify the predictor of late conversion. RESULTS: Of the 112 sputum-positive TB cases, 39 (34.8%) and 49 (43.7%) cases were sputum negative one and two months respectively after DOT. Lower platelet count was significantly associated with early sputum conversion. (Diff of mean = 38.3 cells x 9/L (95% CI 36.9 - 39.7). On univariate analysis, duration of symptoms, history of diabetes, smoking and ESR were not associated with the early sputum conversion. Knowledge of platelet count seems to assist the clinician to predict the early sputum conversion following DOT for pulmonary TB. CONCLUSIONS: Sputum conversion rate among tuberculosis patients treated with DOT for one and two months in Oman was 34.8% and 78.6% respectively. Platelet count could assist in predicting early sputum conversion.
