Utilization Pattern of Vancomycin in a University Teaching Hospital in Oman: Comparison with International Guidelines

Purpose: To assess the prescribing and utilization pattern of vancomycin in Sultan Qaboos University Hospital (SQUH) in Oman.Methods: A retrospective study that included in-patients at SQUH who had used vancomycin from January 1 2009 to December 31 2009 was conducted to determine the utilization patterns of the drug vis a vis to the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines and the North American Therapeutic Drug Monitoring Consensus (NATDMC) recommendations. Information regarding patient characteristics and vancomycin therapy were obtained from patients’ medical records.Statistical analyses were performed using descriptive statistics.Results: Out of 478 prescriptions for 365 patients, 79.1 % were considered inappropriate, based on HICPAC guidelines. This was mainly due to the continuous use of vancomycin following negative microbiological cultures for â-lactam-resistant Gram-positive microorganisms. Vancomycin wasprescribed mostly for treatment of sepsis (27.1 %), followed by prophylaxis against various clinical conditions (20.8 %). Therapeutic drug monitoring (TDM) practices at SQUH did not comply with NATDMC recommendations on the use of trough concentration in the specified range as a guide for monitoring of therapy.Conclusion: Irrational use of vancomycin was recorded in this study. The need for a restrictive policy and a revision of the current TDM in the setting are recommended..Keywords: Vancomycin, Drug utilization, Therapeutic drug monitoring, Infectio

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

Objective: To estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in the Sultanate of Oman. Methods: A cross-sectional retrospective study was conducted. All patients who presented to the emergency department at two public hospitals and underwent primary percutaneous interventions during the period of two years were included. Results: The sample included 426 patients. The median door-to-balloon time was 142 minutes. The result of bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were three times more likely to have a delayed DTB time compared with patients presenting with typical symptoms (OR = 3.003, 95% CI: 1.409–6.400, p = .004). In addition, patients who presented during off-hours were two times more likely to have a delayed DTB time compared with patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087, p = .005). Conclusion: To meet the door-to-balloon time recommendation, it is important to ensure that there is adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care. Keywords: Acute Myocardial Infarction; Clinical Management; Door-to-balloon Time; Emergency Care Systems; Staffing and Scheduling; Oman

The parasitic worm-derived immunomodulator, ES-62 and its drug-like small molecule analogues exhibit therapeutic potential in a model of chronic asthma

Chronic asthma is associated with persistent lung inflammation and long-term remodelling of the airways that have proved refractory to conventional treatments such as steroids, despite their efficacy in controlling acute airway contraction and bronchial inflammation. As its recent dramatic increase in industrialised countries has not been mirrored in developing regions, it has been suggested that helminth infection may protect humans against developing asthma. Consistent with this, ES-62, an immunomodulator secreted by the parasitic worm Acanthocheilonema viteae, can prevent pathology associated with chronic asthma (cellular infiltration of the lungs, particularly neutrophils and mast cells, mucus hyper-production and airway thickening) in an experimental mouse model. Importantly, ES-62 can act even after airway remodelling has been established, arresting pathogenesis and ameliorating the inflammatory flares resulting from repeated exposure to allergen that are a debilitating feature of severe chronic asthma. Moreover, two chemical analogues of ES-62, 11a and 12b mimic its therapeutic actions in restoring levels of regulatory B cells and suppressing neutrophil and mast cell responses. These studies therefore provide a platform for developing ES-62-based drugs, with compounds 11a and 12b representing the first step in the development of a novel class of drugs to combat the hitherto intractable disorder of chronic asthma

The parasitic worm-derived immunomodulator, ES-62 and its drug-like small molecule analogues exhibit therapeutic potential in a model of chronic asthma

Chronic asthma is associated with persistent lung inflammation and long-term remodelling of the airways that have proved refractory to conventional treatments such as steroids, despite their efficacy in controlling acute airway contraction and bronchial inflammation. As its recent dramatic increase in industrialised countries has not been mirrored in developing regions, it has been suggested that helminth infection may protect humans against developing asthma. Consistent with this, ES-62, an immunomodulator secreted by the parasitic worm Acanthocheilonema viteae, can prevent pathology associated with chronic asthma (cellular infiltration of the lungs, particularly neutrophils and mast cells, mucus hyper-production and airway thickening) in an experimental mouse model. Importantly, ES-62 can act even after airway remodelling has been established, arresting pathogenesis and ameliorating the inflammatory flares resulting from repeated exposure to allergen that are a debilitating feature of severe chronic asthma. Moreover, two chemical analogues of ES-62, 11a and 12b mimic its therapeutic actions in restoring levels of regulatory B cells and suppressing neutrophil and mast cell responses. These studies therefore provide a platform for developing ES-62-based drugs, with compounds 11a and 12b representing the first step in the development of a novel class of drugs to combat the hitherto intractable disorder of chronic asthma

Correlates of physical activity and sitting time in adults with type 2 diabetes attending primary health care in Oman

Abstract Background Despite evidence of the benefits of physical activity in the management of type 2 diabetes, it is poorly addressed in diabetes care. This study aimed to identify the prevalence and correlates of meeting ≥600MET-min/wk. (150 min/wk) of physical activity and sitting time in adults with type 2 diabetes in Oman. Approaches to encourage physical activity in diabetes care were explored. Methods A cross-sectional study using the Global Physical Activity Questionnaire was conducted in 17 randomly selected primary health centres in Muscat. Clinical data including co-morbidities were extracted from the health information system. Questions on physical activity preferences and approaches were included. Patients were approached if they were ≥18 years, and had been registered in the diabetes clinic for >2 years. Results The questionnaire was completed by 305 people (females 57% and males 43%). Mean age (SD) was 57 (10.8) years and mean BMI (SD) was 31.0 (6.0) kg/m2. Duration of diabetes ranged from 2 to 25 (mean 7.6) years. Hypertension (71%) and dyslipidaemia (62%) were common comorbidities. Most (58.4%) had an HbA1c ≥7% indicating poor glycaemic control (55% in males vs 61% in females). Physical activity recommendations were met by 21.6% of the participants, mainly through leisure activities. Odds of meeting the recommendations were significantly higher in males (OR 4.8, 95% CI 2.5–9.1), individuals ≤57 years (OR 3.0, 95% CI 1.6–5.9), those at active self-reported stages of change for physical activity (OR 2.2, 95% CI 1.2–4.1) and those reporting no barriers to performing physical activity (OR 2.7, 95% CI 1.4–4.9). Median (25th, 75th percentiles) sitting time was 705 (600, 780) min/d. Older age (>57 years) was associated with longer sitting time (>705 min/d) (OR 2.8, 95% CI 1.7–4.6). Preferred methods to support physical activity in routine diabetes care were consultations (38%), structured physical activity sessions (13.4%) and referrals to physical activity facilities (5.6%) delivered by a variety of health care providers. Conclusions The results suggest that intervention strategies should take account of gender, age, opportunities within daily life to promote active behaviour and readiness to change. Offering physical activity consultations is of interest to this study population, thus development and evaluation of interventions are warranted

Registration-Based Encryption from Standard Assumptions

The notion of Registration-Based Encryption (RBE) was recently introduced by Garg, Hajiabadi, Mahmoody, and Rahimi [TCC\u2718] with the goal of removing the private-key generator (PKG) from IBE. Specifically, RBE allows encrypting to identities using a (compact) master public key, like how IBE is used, with the benefit that the PKG is substituted with a weaker entity called key curator who has no knowledge of any secret keys. Here individuals generate their secret keys on their own and then publicly register their identities and their corresponding public keys to the key curator. Finally, individuals obtain rare decryption-key updates from the key curator as the population grows. In their work, they gave a construction of RBE schemes based on the combination of indistinguishability obfuscation and somewhere statistically binding hash functions. However, they left open the problem of constructing RBE schemes based on standard assumptions. In this work, we resolve the above problem and construct RBE schemes based on standard assumptions (e.g., CDH or LWE). Furthermore, we show a new application of RBE in a novel context. In particular, we show that anonymous variants of RBE (which we also construct under standard assumptions) can be used for realizing abstracts forms of anonymous messaging tasks in simple scenarios in which the parties communicate by writing messages on a shared board in a synchronized way

Registration-Based Encryption: Removing Private-Key Generator from IBE

In this work, we introduce the notion of registration-based encryption (RBE for short) with the goal of removing the trust parties need to place in the private-key generator in an IBE scheme. In an RBE scheme, users sample their own public and secret keys. There will also be a ``key curator\u27\u27 whose job is only to aggregate the public keys of all the registered users and update the short public parameter whenever a new user joins the system. Encryption can still be performed to a particular ecipient using the recipient\u27s identity and any public parameters released subsequent to the recipient\u27s registration. Decryption requires some auxiliary information connecting users\u27 public (and secret) keys to the public parameters. Because of this, as the public parameters get updated, a decryptor may need to obtain a few additional auxiliary information for decryption. More formally, if $n$ is the total number of identities and $\kappa$ is the security parameter, we require the following. Efficiency requirements: (1) A decryptor only needs to obtain updated auxiliary information for decryption at most $O(\log n)$ times in its lifetime, (2) each of these updates are computed by the key curator in time $poly(\kappa,\log n)$, and (3) the key curator updates the public parameter upon the registration of a new party in time $poly(\kappa,\log n)$. Properties (2) and (3) require the key curator to have \emph{random} access to its data. Compactness requirements: (1) Public parameters are always at most $poly(\kappa,\log n)$ bit, and (2) the total size of updates a user ever needs for decryption is also at most $poly(\kappa,\log n)$ bits. We present feasibility results for constructions of RBE based on indistinguishably obfuscation. We further provide constructions of \emph{weakly efficient} RBE, in which the registration step is done in $poly(\kappa, n)$, based on CDH, Factoring or LWE assumptions. Note that registration is done only once per identity, and the more frequent operation of generating updates for a user, which can happen more times, still runs in time $poly(\kappa,\log n)$. We leave open the problem of obtaining standard RBE (with $poly(\kappa,\log n)$ registration time) from standard assumptions