Objectives: Eye infections can be caused by several microorganisms and the most common causative bacterial agents are staphylococci, streptococci, and Pseudomonas aeruginosa. This study aimed to estimate the prevalence of Staphylococcus aureus, Staphylococcus epidermidis, viridans group streptococci, and P. aeruginosa as the cause of ocular infections in Iran. Methods: We conducted a systematic search on the studies published by Iranian authors from January 2000 to December 2020 in Web of Science, PubMed, Scopus, and Embase. Eligible studies were selected according to the defined inclusion/exclusion criteria. Statistical heterogeneity between and within groups was estimated by the Q-statistic and I2 index. The funnel plots, Duval and Tweedie trim, and fill methods were obtained to evaluate the evidence of publication bias. Results: Twenty-seven studies were included in this review. According to the meta-analysis results, the prevalence of S. epidermidis was 19.1% (95% CI: 12.5–28.1). It was estimated 6.9% (95% CI: 4.4–10.6), 6.7% (95% CI: 4.6–9.6), and 3.3% (95% CI: 1.8–5.8) for P. aeruginosa, S. aureus, and viridans streptococci, respectively. Conclusions: S. epidermidis is the prevalent bacterial agents responsible for eye-associated infections in Iran.

Keywords:Eye Infections; Staphylococcus aureus; Staphylococcus epidermidis; Viridans Streptococci; Pseudomonas aeruginosa; Systematic Review; Iran.

Sleep is an imperative physiological aspect that plays a vital role in maintaining hormonal and humeral functions of the body and hence a healthy life. Circadian rhythms are daily oscillations in human activities and physiology that prepare human beings to better react to and anticipate challenges in the surrounding environment, which are a consequence of diurnal changes of day and night. The sleep/wake cycle is one of the most prominent manifestations of the circadian rhythm and communicates tightly with the immune system with daily oscillation of immunity. Sleep deprivation is now recognized as a common condition inherent to modern society, and it is detrimental to certain body functions, particularly immune function. The aim of this review is to explore the role of sleep in maintaining a healthy immune system during the COVID-19 pandemic. The review discusses sleep-regulatory substances that are linked to host defense mechanisms such as interleukin-1β, interleukin-6, tumor necrosis factor alpha, and interferon gamma. Cytokine levels also fluctuate with sleep/wake homeostasis and our review explores the relationship between sleep and cytokines and proposed therapeutics. The review will also cover sleep and immune response in children, adolescents, and healthcare workers, and finally it will touch on the effect of obstructive sleep apnea on immune response and the severity of COVID-19.

Keywords:Sleep; Circadian Rhythm; COVID-19; Immunity.

Objectives: Myelodysplastic syndromes (MDS) are a group of clonal hematological disorders with a diverse clinico-hematological profile. Studies in India have shown a different biology from the West. This study aimed to assess the clinicopathologic profile of MDS patients, classify them according to the World Health Organization classification system, categorize them into International Prognostic Scoring System (IPSS) and the revised IPSS prognostic subgroups, and evaluate the treatment outcome. Methods: A cross-sectional study was conducted on 48 patients diagnosed with MDS from January 2017 to December 2019 from Rajagiri Hospital, India. Clinical, hematological, and cytogenetic features were analyzed. The patients were stratified according to the IPSS and revised IPSS and were followed-up for a minimum of six months. Results: The patients most affected were those in the seventh decade of life. We found a slight female preponderance and a mean age of 57.5 years in females and 67.7 years in males. Anemia was the most common manifestation of MDS. On the other hand, thrombocytopenia was found to be the least common cytopenia. MDS with multilineage dysplasia was the most common subtype. Cytogenetic abnormalities were seen in 29.5% of cases. Most of the patients were in the low-risk prognostic categories. Conclusions: Our patients were older when compared to those of other Indian studies, with most in the low-risk categories which were like Western data.

Keywords:Myelodysplastic Syndromes; Thrombocytopenia; India.

Objectives: When a married family member suffers from multiple sclerosis (MS), the collective physical and psychosocial well-being of the family is impacted and much of the burden is on the healthier spouse. The purpose of the present study was to determine the contribution of psychosocial support from spouses, friends, and others in overall family functioning in respect of Iranian patients with MS, considering the mediating role of spiritual experiences and moral foundations. Methods: Spouses of patients with MS were chosen through the judgmental sampling method. The research instruments comprised the Family Assessment Device, Social Support Appraisals Scale, Daily Spiritual Experience Scale, and Moral Foundations Questionnaire. Data analysis was done through the path analysis technique. Results: The subjects comprised 220 spouses of MS patients. We found a significant relationship between family support path and overall functioning mediated by the variable ‘spiritual experiences’, the root mean square error of approximation (RMSEA) value being < 0.001. Similarly, the relationship between spiritual experiences and moral foundations had a significant effect on overall family functioning (RMSEA < 0.001). After eliminating insignificant relationships and estimating fit indicators, the modified (adjusted) model indicated goodness of fit with data. Conclusions: This study found, for the first time in the Iranian community, a significant effect of family support focused on spouses of MS patients compared to the support from friends and others, with regard to family functioning. The mediating roles of spiritual experiences and moral foundations were confirmed. Further studies are suggested to delve into the role of family support for MS patients in developing countries.

Keywords:Psychosocial Functioning; Multiple Sclerosis; Social Support; Morality; Spiritual Experiences; Family Support; Iran.

Objectives: To investigate the prevalence of psychiatric symptoms/distress and posttraumatic stress (PTS) and associated factors among inpatients with COVID-19 before discharge from the hospital. Methods: This cross-sectional study was conducted in two teaching referral hospitals in Babol, Iran from July to November 2020. The subjects were inpatients diagnosed with COVID-19 who were clinically stable. Before their discharge from the hospital, the patients completed three questionnaires: demographic data, Brief Symptom Inventory, and Primary Care Post Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual-5. Results: The subjects were 477 inpatients diagnosed with COVID-19 including 40 (8.4%) admitted to intensive care units. Their average age was 60.5±17.9 years; 53.9% were female. Most had symptoms of significant psychological distress (96.0%) and PTS (8.1%) prior to discharge. A higher level of education (-0.18; standard error (SE) = 0.05; p < 0.001) was a negative predictor of psychiatric distress. The admission to intensive care units (0.86; SE = 0.08; p < 0.001) was a positive predictor of psychiatric distress. Conclusions: Most COVID-19 inpatients suffered significant psychiatric distress and PTS symptoms before discharge. Appropriate mental health crisis interventions are recommended for COVID-19 patients during hospitalization.

Keywords:Inpatients; Stress Disorders, Post-Traumatic; Psychological Distress; Intensive Care Unit; COVID-19; Iran.

Objectives: To investigate the prevalence, genotype distribution, and risk factors of hepatitis C virus (HCV) infection among patients undergoing regular hemodialysis in Bushehr province in southern Iran. Methods: All chronic hemodialysis patients from the cities of Dashtestan, Genaveh, and Bushehr participated in this study. Enzyme-linked immunosorbent assay was used to detect anti-HCV antibodies. Molecular detection of HCV infection was performed by semi-nested reverse transcription polymerase chain reaction assay, targeting 5’ untranslated region and core region of the genome, and sequencing. Results: Of 279 hemodialysis patients, 15 (5.4%) were positive for anti-HCV antibodies, and two (0.7%) patients had HCV viremia with genotype 3a. The hemodialysis patients had a significantly higher seroprevalence of HCV than the control group (p = 0.007). Patients with Arab ethnicity had significantly higher anti-HCV seroprevalence compared to those with Fars ethnicity (p = 0.026). Anti-HCV seropositivity was not statistically associated with the patients’ sex, age group, place of residence, level of education, duration of hemodialysis, or history of blood transfusion. Conclusions: Considering the high seroprevalence of HCV in hemodialysis patients, regular screening of these patients for HCV infection and prompt treatment of those found infected are recommended.

Keywords:Hepatitis C Virus; Hemodialysis; Prevalence; Genotype; Risk Factors; Iran.

Objectives: Cystic echinococcosis is a worldwide zoonosis that is endemic in many countries including some in the Middle East. Exact prevalence rates for human echinococcosis are unknown for Oman. Methods: Following obtaining ethical approval, data from January 2010 to December 2021 were retrieved from hospital electronic records of Sultan Qaboos University Hospital, Muscat. Results: Over a 12-year period we saw nine cases of hydatid disease; two cases in females and seven cases in males. The median age of our patients was 31 years old. Four patients had pulmonary cysts, four had hepatic cysts, and one patient had pulmonary and hepatic cysts. The majority of patients were from the Ad Dakhiliyah governorate. Contact with animals was reported by three patients, denied by two, and unknown for four. Albendazole was prescribed to three patients with pulmonary cysts that subsequently ruptured reflecting the unfamiliarity of clinicians to best manage pulmonary hydatid cysts. Conclusions: The prevalence of cystic echinococcosis in Oman is unknown but appears rare. For optimal management of this disease, clinicians must become more aware of its diagnosis and management.

Hydatid Disease; Echinococcus; Liver Abscess; Albendazole; Oman.

Objectives: Nine strong cyclones have been recorded in Oman in the last 50 years, the last being tropical cyclone Shaheen in October 2021, in the northern Oman area. The aim of our study was to determine the relationship between property loss and the mental health of residents after cyclone Shaheen. Methods: We conducted a cross-sectional study among Omani citizens living in areas affected by cyclone Shaheen three to six months post-cyclone. In an online, self-reported questionnaire, we assessed the loss of participants’ properties due to the cyclone and the impact on their perceived mental health. Descriptive statistics, chi-square tests, and associations between demographics, loss of properties, and mental health were performed. Results: Of 440 participants, 79.3% had their houses directly damaged by the cyclone and 90.7% had their outside properties damaged. Most of the respondents reported that they suffered from mental health symptoms in the months following the cyclone. Women, people with a lower socioeconomic status, the unemployed, and those without a university degree were associated with poorer mental health outcomes. Mental health was significantly lower for respondents whose properties were mostly affected by the cyclone. Conclusions: With scant knowledge about how cyclones directly affect Omanis’ mental health, the results of this study are paramount for the planning of psychological care services to improve the country’s response to extreme weather events.

Keywords:Cyclone; Mental Health; Oman.

Objectives: This study aimed to assess the proportion of women who underwent postpartum evacuation and were histopathologically confirmed to have retained products of conception (RPOC), compare the reliability of histopathology and ultrasound (US) in determining the presence of RPOC, and assess the maternal complications associated with postpartum evacuation. Methods: A retrospective cross-sectional study was conducted on all women who delivered and had postpartum evacuation at a tertiary teaching hospital in Oman over 11 years from May 2009 to May 2020. The participants were divided into two groups based on their histopathology results. McNemar test was used to compare the sonographic results with the histopathological findings.
Results: A total of 151 women were included in this study. The diagnosis of RPOC was confirmed in histopathological reports of 64 (42.4%) women (group 1) but not in 87 (57.6%) women (group 2). There was no significant difference between the two groups in maternal characteristics. Parameters of clinical presentation including fever and abdominal pain were significantly different between the two groups (p = 0.026 and
p = 0.028, respectively). Vaginal bleeding was not significantly different between the groups (p = 0.255). Pelvic US detected RPOC in 135 (89.4%) women whereas the histopathology confirmed it in 64 (42.4%) women (p < 0.001). The sensitivity of US compared to histopathology in diagnosing RPOC was 98.4% (95% CI: 91.60–99.96) and the specificity was 17.2% (95% CI: 9.98–26.84). The overall diagnostic accuracy of US in detecting RPOC was 51.7%. Two (1.3%) women had hysterectomy as a result of the evacuation. Histopathology showed smooth muscle in 20 (13.2%) women. Significant bleeding during surgery occurred in 17 (11.3%) cases. Conclusions: Diagnosis of postpartum RPOC is challenging. Our results highlighted the complexity of diagnosing RPOC. Special training is needed for doctors to diagnose RPOC from transvaginal scans. A multicenter study in Oman with a larger sample size is recommended to confirm our findings.

Keywords:Pathology; Postpartum Period; Ultrasonography; Uterine Hemorrhage; Histopathology; Oman.

Objectives: Though the prevalence of biliary atresia (BA) in the Middle East is low, its role in causing life-threatening liver diseases is disproportionately high. This study aimed to assess the prevalence, clinical presentations, diagnosis, surgical interventions, and long-term outcomes including survival rate, and to analyze prognostic factors affecting the survival of infants with BA in Bahrain. Methods: A retrospective cohort review of cases of infants diagnosed with BA between January 1993 and December 2021 at Salmaniya Medical Complex, Bahrain, was conducted. Demographic, clinical, laboratory, imaging, and histopathological data were analyzed. Outcomes measured included 5-year native liver survival (NLS) and overall liver survival (OLS) rates. Results: Out of 27 infants diagnosed with BA, 26 were included in the study. The overall prevalence was 0.007% and was significantly higher among Bahraini (0.006%) compared to the non-Bahraini population (0.001%), p < 0.001. Most patients had clay-colored stool (19 of 22; 86.4%) and hepatomegaly (18; 81.8%). Kasai procedure was performed in 23 (88.5%) patients and primary liver transplant (LT) in three. Ten (38.5%) infants required LT after the Kasai procedure. The median age at diagnosis was 56 days with interquartile range (IQR) of 30–90, and the median age at the Kasai procedure was 61 days (IQR = 56–90). NLS and OLS rates were 53.8% and 65.4%, respectively. The overall mortality rate was 34.6%. Six of the 13 (46.2%) patients who were subjected to Kasai procedure alone died awaiting LT donors. Infants with lower birth weight and older age at diagnosis had significantly better odds of survival (p < 0.029 and p < 0.044, respectively). Conclusions: BA is uncommon among infants in Bahrain. Despite effective treatment options, late diagnosis can lead to significant morbidity and mortality. Our study found a relatively low prevalence of NLS (53.8%) and OLS (65.4%). Since the majority of the diagnosed patients had presented with clay-colored stools, implementing an infant stool card for screening may be beneficial in raising parental awareness and detecting BA early. Early detection and treatment using novel therapies are likely to improve the survival rates.

Keywords:Biliary Atresia; Infants; Prevalence; Cholestasis; Treatment; Outcome; Hepatic Portoenterostomy; Liver Transplantation; Bahrain.

Objectives: This study aimed to compare four COVID-19 vaccines for their potential extensive side effects and the relationship between the side effects and age, body mass index (BMI), and history of COVID-19 infection. Methods: This cross-sectional study was conducted from June to August 2021 among 1474 healthcare workers of seven selected hospitals in Tehran, Iran. All the subjects were vaccinated (91.7% received two doses and 8.3% received one dose) with one of four vaccines, Sputnik, Covaxin, AstraZeneca, and Sinopharm, at least 10 days before the study. The incidence of 47 side effects was measured after vaccination. Results: Over half of the participants (59.4%; n = 876) were 20–29 years of age, with the mean and average BMI being 26.1±9.0 and 23.5±3.4, respectively; 36.0% (n = 530) were previously diagnosed with COVID-19. There was no significant relationship between age and the incidence of side effects for AstraZeneca, Sputnik, and Covaxin; however, the occurrence of side effects of Sinopharm was significantly higher (p < 0.001) among younger healthcare workers. There was no significant relationship between BMI and the incidence of side effects for all four vaccines. However, in the group with a history of COVID-19 disease, health care workers vaccinated with the Sinopharm vaccine showed significantly (p < 0.001) more complications. The occurrence rate of at least one adverse effect and referral to medical centers for AstraZeneca, Sputnik, Covaxin, and Sinopharm vaccines were 24.9–93.9%, 18.2–86.0%, 14.8–77.0%, and 3.5–37.2%, respectively. The highest and lowest rates were found for AstraZeneca and Sinopharm showing a significant (p < 0.001) difference. The most commonly observed side effects for the AstraZeneca vaccine included fever (64.4%), fatigue (62.5%), and muscle pain (59.9%); for Sputnik muscle pain (59.8%), fever (49.5%), and fatigue (49.5%); for Covaxin fever (49.2%), topical reaction (41.0), and fatigue (34.4%); and for Sinopharm fever (18.7%), topical reaction (17.9%), and fatigue (16.6%). Inactivated virus vaccines (Sinopharm and Covaxin) showed a lower (39.7%) occurrence rate of side effects compared to viral vector vaccines (AstraZeneca and Sputnik; 90.6%). The most likely time for the vaccines to exert side effects was the first 24 hours after vaccination. Conclusions: We found no significant relationship between age, BMI, history of COVID-19 disease, and the incidence of side effects in healthcare workers vaccinated with any of the four vaccines. All four vaccines are safe and have controlled side effects.

Keywords:COVID-19; COVID-19 Vaccines; Adverse Effects; Body Mass Index; Age Groups; Health Personnel.

We report a case of an elderly male who presented with enlarged abdominal lymph nodes and was diagnosed as having Epstein-Barr virus-positive diffuse large B-cell lymphoma, not otherwise specified (EBV+ DLBCL, NOS). He was started on chemotherapy which had to be discontinued after three cycles due to the development of life-threatening pneumocystis carinii pneumonia and poor performance status. Within two years, the patient presented with features of relapse. A repeat histopathological examination of the lymph node showed features of peripheral T-cell lymphoma, NOS and the clonality was confirmed by T-cell receptor gamma chain rearrangement assay. More studies are needed to understand the association of EBV+ DLBCL, NOS with other lymphomas.

Keywords:Epstein-Barr Virus Infection; Diffuse Large B-Cell Lymphoma; Composite Lymphoma; Metachronous Neoplasms; India.

The frequency of Rhesus D negative blood group in Omanis is 8.35% but the molecular background of this phenotype is unknown in the Omani population. The Rhesus D negative phenotype has a high molecular diversity. We report a rare case of serological D negative with existence of complete RHD gene in a 43-year-old Omani male blood donor. Molecular analysis of RHD exons showed duplication across the boundary of intron 3 and exon 4. This is a 37 bp insert in RHD exon 4 along with c.609 G>A mutation. We are uncertain if the presence of RHDΨ is homozygous (RHDΨ/RHDΨ) or hemizygous (RHDΨ/del). Therefore, molecular basis of D zygosity determination would be a good approach to further explore the case.

Keywords:Antigen; Alleles; Pseudogene; Oman.

The incidence of end-stage kidney disease (ESKD) has been increasing over the past few years as a direct result of the growing percentages of individuals with metabolic syndrome. From 2001 to 2015 there were 2805 individuals diagnosed with ESKD in Oman with a growing number of patients undergoing renal transplant as the gold standard management of renal replacement therapy. Mycophenolate mofetil (MMF) is one of the most frequently used medications as a part of immunosuppressive medications in renal transplant specifically and solid organ transplant generally. We are reporting a case of MMF-induced colitis in a young female patient that underwent a living-related kidney transplant. She presented with a three-month history of watery non-bloody and afebrile diarrhea. Investigations confirmed the diagnosis of MMF-induced colitis. Histopathological examination of colonic biopsies obtained during the colonoscopy procedure showed mildly increased crypt apoptosis, mild architectural disarray, and focal crypt attenuation; features consistent with MMF-induced colitis. The patient was treated by stopping the causative agent and replacing it with another immunosuppressive medication, which led to complete resolution of the symptoms on follow-up appointments. In this case report, we highlighted the underlying mechanism, pathogenesis, and clinical features of MMF-induced colitis.

Keywords:End-Stage Kidney Disease; Transplantation; Mycophenolate Mofetil; Colitis; Colonoscopy; Histology.

Based on experience with other viral respiratory illnesses, patients with cystic fibrosis were believed to have worse prognosis when infected with COVID-19. We report a case of a 14-year-old female with cystic fibrosis who developed COVID-19 with short-term evolution and made a good recovery with no known major long-term sequelae.

Keywords:Cystic Fibrosis; COVID-19; Steroids; Interleukin-6; Oman.

Cyclosporine A is an immunosuppressant drug known to cause several side effects. One of the most common side effects is hypertrichosis, with a rare presentation of hair repigmentation rarely presenting. Here, we report a case of a 65-year-old Omani male who presented to the dermatology clinic at Rustaq Polyclinic in Rustaq, Oman, with exfoliative erythroderma. The patient had hair repigmentation after three months of treatment with cyclosporine A .

Keywords:Cyclosporine; Dermatitis, Exfoliative; Hair Color; Oman.

Basal ganglia-based movement abnormalities are the hallmark of the neuropsychiatric presentation of Wilson’s disease. Seizures are rarely reported in Wilson’s disease, especially as the initial presentation. We report a case of a 17-year-old male who was admitted with recurrent seizures and initially treated as a case of encephalitis and on subsequent follow-up diagnosed with Wilson’s disease. This case highlights the importance of considering the possibility of Wilson’s disease in young patients presenting with unexplained encephalopathy.

Keywords:Wilson’s Disease; Encephalopathy; Seizure; Oman.