Predictors of Hypersensitivity Reactions to Platinum-Based Chemotherapy in a Tertiary Hospital in Oman: A case-control study

Objectives: Platinum-based compounds (PBC) play an important role in cancer therapy. However, one of the drawbacks of PBC is the occasional occurrence of hypersensitivity reactions (HSR) which can lead to serious consequences. The aim of the study is to estimate the prevalence and evaluate risk factors of HSR to PBC in cancer patients. Methods: A case-control study of patients who received any PBC for the management of non-haematological cancers from 2013 to 2020 at Sultan Qaboos University Hospital, Oman. Data regarding demographic features and diseases and treatment details were collected from the hospital’s electronic patients record. We quantitatively described the data, and Student’s t-test and Wilcoxon Man-Whittney tests were used to detect significant differences. Results: A total of 38 cases and 148 matched controls were studied. The prevalence of HSR to PBC in our cohort was 4.7% (95% confidence interval: 3.33%-6.37%), more with carboplatin compared to cisplatin and oxaliplatin. In our study, female gender (p=0.032), concomitant taxanes (p=0.002) and concurrent radiation (p<0.001) were significant predictors of HSR to PBC. The majority of reactions were of mild to moderate severity and the rechallenge rate after HSR development was 13%. Conclusion: HSR to PBC impact therapy decisions and understanding the risk factors are important to improve treatment outcomes in cancer patients. Keywords: Hypersensitivity; Platinum; Anti-neoplastic; Oncology; Oman

Identification of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections among Healthcare Workers at Sultan Qaboos University Hospital, Oman

Objectives: This study aimed to describe the incidence and features of asymptomatic COVID-19 infections among HCWs at a tertiary hospital in Oman. Methods: This cross-sectional study was conducted between August 2020 and February 2021 among HCWs with no history of COVID-19 infection using an online questionnaire to collect sociodemographic and clinical data. COVID-19 infection was diagnosed using nasopharyngeal/throat swabs, which were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Analyses were performed using Chi-squared test, Fisher’s exact test, or univariate ordinary least squares regression, as appropriate. Results: A total of 583 HCWs participated in the study. Most were female (56.6%) and the mean age was 35 ± 8 years . Only 9.6% (95% confidence interval [CI]: 7.3–12.3%) of the HCWs were at high exposure risk as they were directly involved in the care of COVID-19-infected patients. Overall, 4.1% (95% CI: 2.7–6.1%) of the HCWs screened positive for SARS-CoV-2; of these, five (20.8%) developed symptoms within two weeks. The frequency of SARS-CoV-2 positivity among HCWs working in high, intermediate, low, and miscellaneous risk areas was 1.8% (95% CI: <0.1–9.6%), 2.6% (95% CI: <0.1–6.5%), 5.3% (95% CI: 0.3–9.3%), and 4.8% (95% CI: <0.1–69.3%), respectively. Working in high-risk areas was associated with increased compliance with various infection control strategies (P <0.001). Conclusion: There was a greater frequency of SARS-CoV-2 positivity among HCWs working in lower-risk areas, whereas HCWs who worked in high-risk areas were significantly more likely to report increased compliance with infection control strategies. Keywords: SARS-CoV-2; COVID-19 Nucleic Acid Testing; Asymptomatic Infections; Health Personnel; Occupational Exposure; Infection Control; Real-Time Polymerase Chain Reaction; Oman

Frequency of Dimethyl Fumarate Induced Lymphopaenia Among Omani Patients with Multiple Sclerosis

Objectives: Dimethyl fumarate (DMF) is known to cause lymphopenia in treated multiple sclerosis (MS) patients. There is a dearth of research on DMF therapy in the Arab world, especially in Oman. This study aimed to analyse the prevalence of lymphopenia among Omani MS patients and the reasons for discontinuing DMF. Methods: In this retrospective study, we reviewed the medical records of Omani MS patients who were treated using DMF at two tertiary hospitals in Muscat from the period 2017 February to 2023 February. Their demographic, clinical, and laboratory data were retrieved and analysed. Absolute lymphocyte count (ALC) values at baseline and at the last follow up, as well as the reasons for discontinuing DMF were collected. Descriptive and inferential statistical techniques were used for data analysis. Binary-logistic regression analysis was used to identify the risk factors for DMF-induced lymphopenia. Results: The study included a total of 64 MS patients and the majority (40; 63%) were female. The DMF therapy was started at mean age of 33 7.7 years. After administration of DMF, 14 (21.9%) patients developed 1–3 grades lymphopenia with the following breakup: grade-1: 5/64 (7.81%) patients; grade-2: 8/64 (12.5%) patients; grade-3: 1/64 (1.6%) patient. DMF was discontinued in 23 (36.0%) patients, mainly in response to adverse events or confirmed pregnancy. Female sex was the only significant predictor of DMF-induced lymphopenia (p = 0.037). Conclusion: Most Omani MS patients had mild lymphopenia (grades 1–2), like other regional and international reports. Early adverse events and pregnancy were the main reasons provided for discontinuing DMF therapy. Keywords: Multiple Sclerosis; Dimethyl Fumarate; Absolute Lymphocyte Count; Lymphopenia; Oma

Hepatocellular Carcinoma in Oman: An analysis of 284 cases

Objectives: Hepatocellular carcinoma (HCC) is the most common type of primary liver tumour worldwide and is increasing in incidence. This study aimed to describe the clinical characteristics of HCC among Omani patients, along with its major risk factors, outcomes and the role of surveillance. Methods: This retrospective case-series study was conducted between January 2008 and December 2015 at the three main tertiary care hospitals in Oman. All adult Omani patients diagnosed with HCC and visited these hospitals during the study period were included. Relevant data were collected from the patients’ electronic medical records. Results: A total of 284 HCC patients were included in the analysis. The mean age was 61.02 ± 11.41 years and 67.6% were male. The majority had liver cirrhosis (79.9%), with the most common aetiologies being chronic hepatitis C (46.5%) and B (43.2%). Only 13.7% of cases were detected by the HCC surveillance programme. Approximately half of the patients (48.5%) had a single liver lesion and 31.9% had a liver tumour of >5 cm in size. Approximately half (49.2%) had alpha-fetoprotein levels of ≥200 ng/mL. The majority (72.5%) were diagnosed using multiphase computed tomography alone. Less than half of the patients (48.9%) were offered one or more HCC treatment modalities. Conclusion: The majority of Omani HCC patients were male and had cirrhosis due to viral hepatitis. In addition, few patients were identified by the national surveillance programme and presented with advanced disease precluding therapeutic or even palliative treatment.Keywords: Hepatocellular Carcinoma; Liver Cirrhosis; Human Viral Hepatitis; Public Health Surveillance; Early Detection of Cancer; Alpha-Fetoprotein; Oman

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Clinical and Epidemiological Characteristics of Pituitary Tumours using a Web-based Pituitary Tumour Registry in Oman

Objective: From a recently instituted web-based pituitary tumour registry at Sultan Qaboos University Hospital, Oman, this study explores the results of comprehensive clinical evaluation, hormonal levels, radiological evidence of pituitary mass lesion using magnetic resonance (MRI) and the different treatment modalities. Methods: All patients who were diagnosed with pituitary mass tumours in our tertiary care endocrinology clinic between January 1998 and February 2006 were registered in the Oman pituitary tumour registry. Two physicians performed hospital chart review and data entry. Results: A total of 160 entries were made into the pituitary tumour registry. The overall mean age of the cohort was 32 ±12 years (age range 8-73 years). The majority of registrations were female (n=114; 71%). There were 81 patients with non-functioning adenomas (50.6%), 59 with prolactinoma (36.9%) eight with acromegaly (5%), seven with craniopharyngioma (4.4%), four with Cushing’s disease (2.5%) and one with sarcoidosis (0.6%). Sub-group analyses were done only for the subjects with the 3 most prevalent pituitary tumours (non-functioning adenomas, prolactinomas, and acromegaly). The most prevalent symptoms are amenorrhea-galactorrhea (n=55; 37%), headache (n=31; 21%) and fatigue (n=23; 16%). The most common treatment modality was medical (n=58; 39%), followed by observation (n=56; 38%), surgery (n=31; 21%) and surgery plus medical (n=3; 2%). None of the patients in this registry are recorded to have died. Conclusion: To our knowledge, this is the first pituitary tumour registry in the Arabian Gulf countries using a web-based programme. This tumour registry will enable us to characterize clinical and the epidemiological features of pituitary tumours in the Sultanate of Oman.

Clinical and Epidemiological Characteristics of Pituitary Tumours using a Web-based Pituitary Tumour Registry in Oman

Objective: From a recently instituted web-based pituitary tumour registry at Sultan Qaboos University Hospital, Oman, this study explores the results of comprehensive clinical evaluation, hormonal levels, radiological evidence of pituitary mass lesion using magnetic resonance (MRI) and the different treatment modalities. Methods: All patients who were diagnosed with pituitary mass tumours in our tertiary care endocrinology clinic between January 1998 and February 2006 were registered in the Oman pituitary tumour registry. Two physicians performed hospital chart review and data entry. Results: A total of 160 entries were made into the pituitary tumour registry. The overall mean age of the cohort was 32 ±12 years (age range 8-73 years). The majority of registrations were female (n=114; 71%). There were 81 patients with non-functioning adenomas (50.6%), 59 with prolactinoma (36.9%) eight with acromegaly (5%), seven with craniopharyngioma (4.4%), four with Cushing’s disease (2.5%) and one with sarcoidosis (0.6%). Sub-group analyses were done only for the subjects with the 3 most prevalent pituitary tumours (non-functioning adenomas, prolactinomas, and acromegaly). The most prevalent symptoms are amenorrhea-galactorrhea (n=55; 37%), headache (n=31; 21%) and fatigue (n=23; 16%). The most common treatment modality was medical (n=58; 39%), followed by observation (n=56; 38%), surgery (n=31; 21%) and surgery plus medical (n=3; 2%). None of the patients in this registry are recorded to have died. Conclusion: To our knowledge, this is the first pituitary tumour registry in the Arabian Gulf countries using a web-based programme. This tumour registry will enable us to characterize clinical and the epidemiological features of pituitary tumours in the Sultanate of Oman.

Vitamin D Status in Pregnant Omanis: A disturbingly high proportion of patients with low vitamin D stores

Objectives: The objective of this study was to determine the vitamin D status of pregnant Omanis by measurement of their circulating 25 hydroxy vitamin D levels. Methods: Blood samples were obtained from a cohort of 103 consecutive healthy pregnant Omanis at the Armed Forces Hospital, Muscat, on their first antenatal visit. The study took place in May, June and July 2010. Results: Vitamin D deficiency was present in 34 (33%) of patients (25OHD3 <25 nmol/L), ‘at risk’ levels were found in 67 (65%) patients (25OHD3 25–50 nmol/L); two patients (1.9%) had values between 50 and 75 nmol/L, and no patients in the optimal range >75 nmol/L. Conclusion: If confirmed, these findings indicate the need for vitamin D replacement during pregnancy and lactation. Although not evidence based we recommend at least 1000 IU of cholecalciferol, (vitamin D3) daily