Spectrum of AIDS Defining Opportunistic Infections in a Series of 77 Hospitalised HIV-infected Omani Patients

Objectives: Most of the morbidity and mortality in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) result from opportunistic infections (OIs). Although the spectrum of OIs in HIV infected patients from developing countries has been reported, there is a paucity of data on the natural history, pattern of disease, and survival of hospitalised patients with HIV/AIDS, particularly in Arab countries. The aim of this study was to study retrospectively the spectrum and frequency of various OIs in a cohort of hospitalised HIV-infected Omani patients. Methods: Included in the study were 77 HIV-infected Omani patients admitted to a tertiary care teaching hospital in Muscat, Oman, between January 1999 and December 2008. They were diagnosed on their first admission and hence were not on highly active antiretroviral therapy (HAART) at presentation. The frequency of various clinical and laboratory findings and individual OIs were analysed. Results: In total, 45 patients (58%) had one or more AIDS-defining OIs. Pneumocystis jiroveci pneumonia (PCP) was commonest (25%), followed by cryptococcal meningitis (22%), cytomegalovirus (CMV), retinitis (17%), disseminated tuberculosis (15%), and cerebral toxoplasmosis (12.5%). Only one patient with Mycobacterium avium-intracellulare (MAI) was identified and one patient had disseminated visceral leishmaniasis. The majority of patients (77%) had CD4+ counts <200 cells/µL. Ten patients (22%) died during hospital stays, with five deaths (50%) being caused by disseminated CMV infection. Conclusion: A wide spectrum of OIs is seen in hospitalised HIV-infected patients in Oman. P. jiroveci pneumonia and cryptococcal meningitis were the commonest OIs, while disseminated CMV was the commonest cause of death. We hope these results will advance the knowledge of specialists treating HIV in Oman and the Gulf region.

Deterministic seismic hazard assessment for Sultanate of Oman

The Sultanate of Oman forms the southeastern part of the Arabian plate, which is surrounded by relatively high active tectonic zones. Studies of seismic risk assessment in Oman have been an important on-going socioeconomic concern. Using the results of the seismic hazard assessment to improve building design and construction is an effective way to reduce the seismic risk. In the current study, seismic hazard assessment for the Sultanate of Oman is performed through the deterministic approach with particular attention on the uncertainty analysis applying a recently developed method. The input data set contains a defined seismotectonic model consisting of 26 seismic zones, maximum magnitudes, and 6 alternative ground motion prediction equations that were used in four different tectonic environments: obduction zone earthquake (Zagros fold thrust belt), subduction zone earthquakes (Makran subduction zones), normal and strike-slip transform earthquakes (Owen and Gulf of Aden zones), and stable craton seismicity (Arabian stable craton). This input data set yielded a total of 76 scenarios at each point of interest. A 10 % probability that any of the 76 scenarios may exceed the largest median ground acceleration is selected. The deterministic seismic hazards in terms of PGA, 5 % damped spectral acceleration at 0.1, 0.2, 1.0 and 2.0 s are performed at 254 selected points. The ground motion was calculated at the 50th and 84th percentile levels for selected probability of exceeding the median value. The largest ground motion in the Sultanate of Oman is observed in the northeastern part of the country.Oman Ministerial Cabinet (Project 22409017

Probabilistic seismic hazard maps for the sultanate of Oman

This study presents the results of the first probabilistic seismic hazard assessment (PSHA) in the framework of logic tree for Oman. The earthquake catalogue was homogenized, declustered, and used to define seismotectonic source model that characterizes the seismicity of Oman. Two seismic source models were used in the current study; the first consists of 26 seismic source zones, while the second is expressing the alternative view that seismicity is uniform along the entire Makran and Zagros zones. The recurrence parameters for all the seismogenic zones were determined using the doubly bounded exponential distribution except the zones of Makran, which were modelled using the characteristic distribution. Maximum earthquakes were determined and the horizontal ground accelerations in terms of geometric mean were calculated using ground-motion prediction relationships developed based upon seismic data obtained from active tectonic environments similar to those surrounding Oman. The alternative seismotectonic source models, maximum magnitude, and ground-motion prediction relationships were weighted and used to account for the epistemic uncertainty. Hazard maps at rock sites were produced for 5 % damped spectral acceleration (SA) values at 0.1, 0.2, 0.3, 1.0 and 2.0 s spectral periods as well as peak ground acceleration (PGA) for return periods of 475 and 2,475 years. The highest hazard is found in Khasab City with maximum SA at 0.2 s spectral period reaching 243 and 397 cm/s[superscript 2] for return periods 475 and 2,475 years, respectively. The sensitivity analysis reveals that the choice of seismic source model and the ground-motion prediction equation influences the results most.Oman Ministerial Cabinet (project number 22409017

Seismic microzonation for Muscat region, Sultanate of Oman

Site characterization was carried out for Muscat region using the ambient noise measurements applying the horizontal-to-vertical spectral ratio (HVSR) technique and using active seismic survey utilizing the multichannel analysis of surface waves (MASW) of survey data. Microtremors measurements were carried out at 459 sites using short-period sensors. This extensive survey allowed the fundamental resonance frequency of the soft soil to be mapped and areas prone to site amplification to be identified. The results indicate a progressive decrease in the fundamental resonance frequencies from the southern and eastern parts, where the bedrock outcrops, toward the northern coast where a thickness of sedimentary cover is present. Shear wave velocity (Vs) was evaluated using the 2-D MASW at carefully selected 99 representative sites in Muscat. These 99 sites were investigated with survey lines of 52 m length. 1-D and interpolated 2-D profiles were generated up to a depth range 20–40 m. The vertical Vs soundings were used in the SHAKE91 software in combination with suitable seismic input strong motion records to obtain the soil effect. Most of the study area has amplification values less than 2.0 for all the considered spectral periods. The estimated fundamental frequencies obtained using the H/V spectral ratio method and using SHAKE91 are found to be in a relatively good agreement. Maps of spectral amplification, earthquake characteristics on the ground surface for peak ground and spectral accelerations at 0.1, 0.2, 0.3, 1.0, and 2.0 s, for 475 years return period are produced. The surface ground motion maps show that the hazard level is moderate with expected PGA in the range 0.059–0.145 g for 475 years return period.Oman Ministerial Cabinet (project # 22409017

Comparative Assessment of Toxic Metals Bioaccumulation and the Mechanisms of Chromium (Cr) Tolerance and Uptake in Calotropis procera

Progressive pollution due to toxic metals significantly undermines global environmental sustainability efforts. Chromium (Cr) is one of the most dangerous to human health. The use of plants to rid the environment of such pollutants "phytoremediation" proves to be a promising alternative to the current remediation methods. In the present study, inductively coupled plasma optical emission spectroscopy (ICP-OES) determined Cadmium (Cd), Chromium (Cr), Copper (Cu), Nickel (Ni), and Lead (Pb) concentrations in the soil, and plants (Atriplex leucoclada, Calotropis procera, Salsola imbricata, Typha augustifolia, and Phragmites australis) root and shoots. Results showed that compared to other studied metals, Cr concentration was the highest in the soil at 111.8 mg/kg, whereas Cd records the least concentration of 0.04 mg/kg. Cr also accumulated in higher concentration in C. procera than in the soil and other plants, with up to 188.2 and 68.2 mg/kg concentration in the root and shoot, respectively. In order to understand the mechanism of Cr tolerance and uptake in C. procera, germinated seeds were irrigated with 20 mg/kg Cr and control treatment (no Cr applied) for six (6) weeks under greenhouse conditions. Fourier transformed infrared spectroscopy (FTIR) results showed high Cr complexation and binding to C. procera tissues via hydroxyl and carboxylic groups. Enzymatic assay reveals increased activities of superoxide dismutase (SOD), catalase (CAT), and glutathione reductase (GR) in Cr treated C. procera than in the control. SOD activity increased by up to six (6) folds. Therefore, we conclude that C. procera is suitable for the phytoremediation of Cr polluted arid soil. Additionally, regulation of cellular homeostasis via redox signaling is essential to the Cr tolerance and detoxification mechanism. Copyright 2020 Usman, Al Jabri, Abu-Dieyeh and Alsafran.This work was supported by the Qatar University vegetable factory project QUEX-CAS-MJF-VF-18-19.Scopu

Potential of novel desert microalgae and cyanobacteria for commercial applications and CO2 sequestration

CO2 fixation by phototrophic microalgae and cyanobacteria is seen as a possible global carbon emissions reducer; however, novel microalgae and cyanobacterial strains with tolerance to elevated temperatures and CO2 concentrations are essential for further development of algae-based carbon capture. Four novel strains isolated from the Arabian Gulf were investigated for their thermotolerance and CO2-tolerance, as well as their carbon capture capability. Two strains, Leptolyngbya sp. and Picochlorum sp., grew well at 40 °C, with productivities of 106.6 ± 10.0 and 87.5 ± 2.1 mg biomass L−1 d−1, respectively. Tetraselmis sp. isolate showed the highest biomass productivity and carbon capture rate of 157.7 ± 10.3 mg biomass L−1 d−1 and 270.8 ± 23.9 mg CO2 L−1 d−1, respectively, both at 30 °C. Under 20% CO2, the biomass productivity increased over 2-fold for both Tetraselmis and Picochlorum isolates, to 333.8 ± 41.1 and 244.7 ± 29.5 mg biomass L−1 d−1. These two isolates also presented significant amounts of lipids, up to 25.6 ± 0.9% and 28.0 ± 2.0% (w/w), as well as presence of EPA and DHA. Picochlorum sp. was found to have a suitable FAME profile for biodiesel production. Both Tetraselmis and Picochlorum isolates showed promising characteristics, making them valuable strains for further investigation towards commercial applications and CO2 capture.The authors would like to thank Mahroof Eroth, Dr. Ahmed Easa, and Dr. Abdulrahman Al Muftah from Qatar University, Andy Selwood from Cawthron Institute, and the QDVC team for their support. This work was supported by QDVC and Qatar University [Project QUEX-CAS-QDVC-14/15-7]

Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs) in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR) recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males) reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males) in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%), incorrect doses (16.2%), unnecessary medications (8.1%), contra-indications (7.1%), incorrect drug duration (2%), and untreated conditions (1%). The physicians implemented 37 (37.4%) pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1) to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11) than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72) when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of MPEs in hospitals. Physician specialty and pharmacist gender and patient gender significantly influenced physician agreement with the pharmacist comments. Only one-third of the pharmacist recommendations were implemented. Phone drug applications would be helpful for daily hospital pharmacy practice. More pharmacist-physician collaboration is needed to address MPEs. Pharmacist-led MRR can identify and address MPEs to improve patient safety.   Type: Original Researc

Celiac disease: how complicated can it get?

In the small intestine of celiac disease patients, dietary wheat gluten and similar proteins in barley and rye trigger an inflammatory response. While strict adherence to a gluten-free diet induces full recovery in most patients, a small percentage of patients fail to recover. In a subset of these refractory celiac disease patients, an (aberrant) oligoclonal intraepithelial lymphocyte population develops into overt lymphoma. Celiac disease is strongly associated with HLA-DQ2 and/or HLA-DQ8, as both genotypes predispose for disease development. This association can be explained by the fact that gluten peptides can be presented in HLA-DQ2 and HLA-DQ8 molecules on antigen presenting cells. Gluten-specific CD4+ T cells in the lamina propria respond to these peptides, and this likely enhances cytotoxicity of intraepithelial lymphocytes against the intestinal epithelium. We propose a threshold model for the development of celiac disease, in which the efficiency of gluten presentation to CD4+ T cells determines the likelihood of developing celiac disease and its complications. Key factors that influence the efficiency of gluten presentation include: (1) the level of gluten intake, (2) the enzyme tissue transglutaminase 2 which modifies gluten into high affinity binding peptides for HLA-DQ2 and HLA-DQ8, (3) the HLA-DQ type, as HLA-DQ2 binds a wider range of gluten peptides than HLA-DQ8, (4) the gene dose of HLA-DQ2 and HLA-DQ8, and finally,(5) additional genetic polymorphisms that may influence T cell reactivity. This threshold model might also help to understand the development of refractory celiac disease and lymphoma