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Abstract
Objective To evaluate the extent of coronavirus infection in cancer patients along with their demographics, laboratory findings and outcomes in a tertiary care setting. METHODS The study was conducted in Muscat, Oman, from March 24 to October 23, 2020. The data was collected from the cancer registry of the Directorate-General of Non-Communicable Diseases, Ministry of Health, Oman. Data of inpatient coronavirus cases were retrieved from the electronic medical records system of the Royal Hospital, Muscat, all tertiary hospitals linked electronically to the registry and the coronavirus registry of Oman. The data of cancer patients infected with coronavirus was analysed and compared with non-cancer coronavirus-infected patients. Data was analysed using IBM SPSS 2019 v26. RESULTS Of the 16,260 cancer patients, 77(0.47%) were infected with COVID-19 compared to 111,837(2.17%) in the national population. Mortality among cancer patients with COVID-19 was high 27(35.1%) compared to 1,147(1.03%) in the national population. Cancer patients with COVID-19 also had diabetes 15(20%), hypertension 20(26%), renal complications 15(20%) and cardiac issues 9(12%). Of the total, 32(41.6%) cancer patients with COVID-19 had received active cancer treatment within the preceding 4 weeks. CONCLUSIONS The data on coronavirus infection outcome is emerging at a rapid pace focussing on the impact of underlying diseases, and the capacity of healthcare systems. Oncologists should customise cancer management, while cancer patients must practise social distancing, and seek prompt evaluation of suspicious symptoms.
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Affiliation(s)
- Bassim Jaffar Al Bahrani
- Department of Medical Oncology, National Oncology Centre, The Royal Hospital, Muscat, Sultanate of Oman
| | - Itrat Mehdi
- Department of Medical Oncology, National Oncology Centre, The Royal Hospital, Muscat, Sultanate of Oman
| | - Faryal Ali Khamis
- Department of Medicine, The Royal Hospital, Muscat, Sultanate of Oman
| | | | - Fatma Al Fahdi
- Department of Medicine, The Royal Hospital, Muscat, Sultanate of Oman
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Al Balushi A, AlShekaili J, Al Kindi M, Ansari Z, Al-Khabori M, Khamis F, Ambusaidi Z, Al Balushi A, Al Huraizi A, Al Sulaimi S, Al Fahdi F, Al Balushi I, Pandak N, Fletcher T, Nasr I. Immunological predictors of disease severity in patients with COVID-19. Int J Infect Dis 2021; 110:83-92. [PMID: 34216735 PMCID: PMC8245310 DOI: 10.1016/j.ijid.2021.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023] Open
Abstract
Background Identifying the immune cells involved in coronavirus disease 2019 (COVID-19) disease progression and the predictors of poor outcomes is important to manage patients adequately. Methods This prospective observational cohort study enrolled 48 patients with COVID-19 hospitalized in a tertiary hospital in Oman and 53 non-hospitalized patients with confirmed mild COVID-19. Results Hospitalized patients were older (58 years vs 36 years, P < 0.001) and had more comorbid conditions such as diabetes (65% vs 21% P < 0.001). Hospitalized patients had significantly higher inflammatory markers (P < 0.001): C-reactive protein (114 vs 4 mg/l), interleukin 6 (IL-6) (33 vs 3.71 pg/ml), lactate dehydrogenase (417 vs 214 U/l), ferritin (760 vs 196 ng/ml), fibrinogen (6 vs 3 g/l), D-dimer (1.0 vs 0.3 μg/ml), disseminated intravascular coagulopathy score (2 vs 0), and neutrophil/lymphocyte ratio (4 vs 1.1) (P < 0.001). On multivariate regression analysis, statistically significant independent early predictors of intensive care unit admission or death were higher levels of IL-6 (odds ratio 1.03, P = 0.03), frequency of large inflammatory monocytes (CD14+CD16+) (odds ratio 1.117, P = 0.010), and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (odds ratio 0.476, P = 0.03). Conclusion IL-6, the frequency of large inflammatory monocytes, and the frequency of circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.
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Affiliation(s)
- Asma Al Balushi
- Tropical and Infectious Diseases Unit, The Royal Liverpool University Hospital, Liverpool, UK; Internal Medicine Department, Suhar Hospital, Suhar, Oman.
| | - Jalila AlShekaili
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Seeb, Oman.
| | - Mahmood Al Kindi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Seeb, Oman.
| | - Zainab Ansari
- Internal Medicine Department, Royal Hospital, Muscat, Oman.
| | | | - Faryal Khamis
- Internal Medicine Department, Royal Hospital, Muscat, Oman.
| | | | | | | | | | - Fatma Al Fahdi
- Internal Medicine Department, Royal Hospital, Muscat, Oman.
| | | | - Nenad Pandak
- Internal Medicine Department, Royal Hospital, Muscat, Oman.
| | - Tom Fletcher
- Tropical and Infectious Diseases Unit, The Royal Liverpool University Hospital, Liverpool, UK.
| | - Iman Nasr
- Internal Medicine Department, Royal Hospital, Muscat, Oman.
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Osman W, Al Fahdi F, Al Salmi I, Al Khalili H, Gokhale A, Khamis F. Serum Calcium and Vitamin D levels: Correlation with severity of COVID-19 in hospitalized patients in Royal Hospital, Oman. Int J Infect Dis 2021; 107:153-163. [PMID: 33892191 PMCID: PMC8057687 DOI: 10.1016/j.ijid.2021.04.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Studies have revealed hypocalcemia and low vitamin D levels in severe covid-19 that warrant further research. OBJECTIVE Our study investigates the correlation between calcium levels at presentation as a primary endpoint and pre-existing calcium levels as a secondary endpoint to the severity of disease presentation and progression. METHOD Observational cohort study in adults admitted with COVID-19 from March utill September 2020. Multiple clinical scales and laboratory parameters were used to correlate corrected calcium and vitamin D associations with risk factors and outcomes. RESULTS Four hundred and forty five patients were included in the study. Hypocalcemic patients had more abnormal laboratory parameters and longer hospitalization duration. Hypocalcemia was in 60-75% of all age groups (p-value 0.053), for which 77.97% were ICU admissions (p-value 0.001) and 67.02% were diabetic (p-value 0.347). There were non-significant correlations between Vitamin D and almost all the parameters except for chronic respiratory diseases, which had a P-value of 0.024. CONCLUSION It can be concluded that hypocalcemia is a significant and reliable marker of disease severity and progression regardless of underlying comorbidities. Vitamin D levels fail to reflect correlation with severity of COVID-19 infections.
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Affiliation(s)
- Wessam Osman
- Internal Medicine Department, The Royal Hospital, Muscat, Oman
| | - Fatma Al Fahdi
- Internal Medicine Department, The Royal Hospital, Muscat, Oman
| | - Issa Al Salmi
- Renal Medicine Department, The Royal Hospital, Muscat, Oman.
| | - Huda Al Khalili
- Anesthesia & ICU Department, The Royal Hospital, Muscat, Oman
| | - Antara Gokhale
- Anesthesia & ICU Department, The Royal Hospital, Muscat, Oman
| | - Faryal Khamis
- Infectious Diseases Department, The Royal Hospital, Muscat, Oman
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Khamis F, Memish Z, Al Bahrani M, Al Nummani H, Al Raisi D, Al Dowaiki S, Chhetri S, Al Fahdi F, Al Yahyai M, Pandak N, Al Bolushi Z, Alarimi Z, Al Hashmi S, Al Salmi I, Al-Zakwani I. The Role of Convalescent Plasma and Tocilizumab in the Management of COVID-19 Infection: A Cohort of 110 Patients from a Tertiary Care Hospital in Oman. J Epidemiol Glob Health 2021; 11:216-223. [PMID: 33605108 PMCID: PMC8242118 DOI: 10.2991/jegh.k.201222.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023] Open
Abstract
AIM As Coronavirus Disease-2019 (COVID-19) pandemic continues to evolve, the search for safe and effective therapeutic interventions remain essential. METHODS We conducted a retrospective cohort study on patients hospitalized with laboratory confirmed severe acute respiratory syndrome coronavirus-2 infection, comparing standard of care along with Convalescent Plasma with or without Tocilizumab (CP vs. CPT). RESULTS A total of 110 patients were enrolled with an overall mean age of 50 ± 16 years. Patients on CPT were more likely to have had acute respiratory distress syndrome (77% vs. 42%; p < 0.001), sepsis (9.7% vs. 0; p = 0.036), chest X-ray abnormalities (71% vs. 44%; p = 0.004), intensive care unit admission (84% vs. 56%; p = 0.001) as well as being on mechanical ventilation (79% vs. 48%; p = 0.001). After CPT treatment, all measured inflammatory markers, except interleukine-6, showed an overall steady decline over time (all p-values <0.05) and the ventilatory parameters showed significant improvement of PaO2/FiO2 ratio from 127 to 188 within 7 days (p < 0.001). Additionally, 52% (32/62) of the patients had favorable outcome, either as improvement of ventilatory parameters or extubation within 14 days of hospitalization. However, mortality rate in those on CPT was higher than those who received CP alone (24% vs. 8.3%; p = 0.041). CONCLUSION In patients with severe COVID-19 infection, using tocilizumab with convalescent plasma is associated with improvement in inflammatory and ventilatory parameters but no effect on mortality. These findings require validation from randomized clinical trials.
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Affiliation(s)
- Faryal Khamis
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, P.O. Box: 1111, A’Seeb, Muscat, Oman
| | - Ziad Memish
- Director Research & Innovation Centre, King Saud Medical City, Ministry of Health & College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, The Royal Hospital, Muscat, Oman
| | | | - Dana Al Raisi
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, P.O. Box: 1111, A’Seeb, Muscat, Oman
| | - Samata Al Dowaiki
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, P.O. Box: 1111, A’Seeb, Muscat, Oman
| | - Shabnam Chhetri
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, P.O. Box: 1111, A’Seeb, Muscat, Oman
| | - Fatma Al Fahdi
- Department of Acute Medicine, The Royal Hospital, Muscat, Oman
| | - Maha Al Yahyai
- Department of Hematology, The Royal Hospital, Muscat, Oman
| | - Nenad Pandak
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, P.O. Box: 1111, A’Seeb, Muscat, Oman
| | - Zakariya Al Bolushi
- Department of Infectious Diseases, The Royal Hospital, Ministry of Health, P.O. Box: 1111, A’Seeb, Muscat, Oman
| | - Zainab Alarimi
- Department of Blood Bank Services, Ministry of Health, Muscat, Oman
| | | | - Issa Al Salmi
- Department of Nephrology, The Royal Hospital, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
- Department of Research, Gulf Health Research, Muscat, Oman
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Al Ghafri T, Al Ajmi F, Al Balushi L, Kurup PM, Al Ghamari A, Al Balushi Z, Al Fahdi F, Al Lawati H, Al Hashmi S, Al Manji A, Al Sharji A. Responses to the Pandemic COVID-19 in Primary Health Care in Oman: Muscat Experience. Oman Med J 2021; 36:e216. [PMID: 33537154 PMCID: PMC7829858 DOI: 10.5001/omj.2020.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives As coronavirus disease (COVID-19) was pervading different parts of the world, little has been published regarding responses undertaken within primary health care (PHC) facilities in Arabian Gulf countries. This paper describes such responses from January to mid-April 2020 in PHC, including public health measures in Muscat, Oman. Methods This is a descriptive study showing the trends of the confirmed positive cases of COVID-19 and the undertaken responses to the evolving epidemiological scenario. These responses were described utilizing the World Health Organizations’ building blocks for health care systems: Leadership and governance, Health workforce, Service delivery, Medical products and technologies, and health information management. Results In mid-April 2020, cases of COVID-19 increased to 685 (particularly among non-nationals). As the cases were surging, the PHC responded by executing all guidelines and policies from the national medical and public health response committees and integrating innovative approaches. These included adapting comprehensive and multi-sectoral strategies, partnering with private establishments, and strengthening technology use (in tracking, testing, managing the cases, and data management). Conclusions Facilities in the Muscat governorate, with the support from national teams, seemed to continuously scale-up their preparedness and responses to meet the epidemiological expectations in the management of COVID-19.
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Affiliation(s)
- Thamra Al Ghafri
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Fatma Al Ajmi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Lamya Al Balushi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Padma Mohan Kurup
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Aysha Al Ghamari
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Zainab Al Balushi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Fatma Al Fahdi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Huda Al Lawati
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Salwa Al Hashmi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Asim Al Manji
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Abdallah Al Sharji
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
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Al Ghafri T, Al Ajmi F, Anwar H, Al Balushi L, Al Balushi Z, Al Fahdi F, Al Lawati A, Al Hashmi S, Al Ghamari A, Al Harthi M, Kurup P, Al Lamki M, Al Manji A, Al Sharji A, Al Harthi S, Gibson E. The Experiences and Perceptions of Health-Care Workers During the COVID-19 Pandemic in Muscat, Oman: A Qualitative Study. J Prim Care Community Health 2020; 11:2150132720967514. [PMID: 33089729 PMCID: PMC7585886 DOI: 10.1177/2150132720967514] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Predominantly, studies on COVID-19 report quantitative data that often miss the social implications and other determinants of health. The objective of this study was to explore the experiences and perceptions of health care workers (HCWs) in primary health care in the management of COVID-19 with respect to medical response experiences, socio-cultural and religious reforms, psychological impressions, and lessons learned. METHODS This was a qualitative study using an empirical phenomenological approach. Six focus group discussions were conducted across various stakeholders working frontline in the management of COVID-19 (managerial, public health/field/community and primary care health centers). They participated in semi-structured, in-depth group discussions from 11th to 20th May 2020. All discussions were audio-recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS Forty participants were involved in this study. Three themes emerged related to the medical response experiences, including the rapid re-structuring of the PHC services, use of technology and challenges of working on COVID-19. Perceptions on the socio-cultural and religious reforms included changes in social and religious norms, and anticipated gaps in accessing health care among the vulnerable groups (elderly, expatriates, and individuals with low economic status). Perceptions on psychological disturbances were themed as consequences of social distancing, management of dead bodies, exhaustion among the health care workers, and risk of exposure. Finally, lessons learned were centered around building on the existing epidemiological and public health capacities, improving access to health care and overcoming resistance to change. Most participants labelled their experience in COVID-19 as an "experience of wisdom" in which learning was a continuous process. CONCLUSION This qualitative study amongst primary HCWs revealed certain aspects of response to COVID-19 in Muscat, Oman. Results has unfolded various aspects of COVID-19. The situation was perceived by primary HCWs as a new experience that challenged the primary health care; enforced the utilization of public health/epidemiological skills, and linked to unfavorable socio-religious and psychological events.
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Al-Abri SS, Kurup PJ, Al Manji A, Al Kindi H, Al Wahaibi A, Al Jardani A, Mahmoud OA, Al Balushi L, Al Rawahi B, Al Fahdi F, Al Siyabi H, Al Balushi Z, Al Mahrooqi S, Al Manji A, Al Sharji A, Al Harthi K, Al Abri B, Al-Raidan A, Al Bahri Z, Al-Mukhaini S, Amin M, Prasanna AR, Petersen E, Al Ajmi F. Control of the 2018-2019 dengue fever outbreak in Oman: A country previously without local transmission. Int J Infect Dis 2019; 90:97-103. [PMID: 31639520 DOI: 10.1016/j.ijid.2019.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In December 2018, routine surveillance identified an autochthonous outbreak of dengue fever in Muscat Governorate, Oman, a region previously free of dengue fever. METHODS Routine surveillance confirmed locally acquired cases in the second week of December, leading to a rapid public health response including case management guidance and epidemiological investigations. The main activity was the vector survey using systematic sampling to assess extent of previously unreported Aedes aegypti presence followed by a campaign aimed to eliminate breeding sites of A. aegypti". RESULTS During a 5-month period, 343 suspected cases were reported from Muscat Governorate with 122 from the outbreak affected area. Out of 207 probable cases eligible for laboratory testing as per guidelines issued, 59 cases were confirmed. The vector elimination campaign started on January 8, 2019 after a media advocacy using television and social media and concluded on January 23. By the end of campaign, the case load had decreased significantly in the affected area with no reports of locally acquired cases from adjoining areas of Muscat Governorate, indicating no further spread. CONCLUSIONS Rapid notification and early community-wide, extensive vector control activities effectively contained the autochthonous dengue fever virus outbreak.
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Affiliation(s)
- Seif S Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Padmamohan J Kurup
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Abdulla Al Manji
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Hanan Al Kindi
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman.
| | - Adel Al Wahaibi
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Amina Al Jardani
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman.
| | - Osama Ahmed Mahmoud
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Lamia Al Balushi
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Bader Al Rawahi
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Fatma Al Fahdi
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Huda Al Siyabi
- Directorate General for Primary Health Care, Ministry of Health, Muscat, Oman.
| | - Zainab Al Balushi
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Samira Al Mahrooqi
- Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman.
| | - Asim Al Manji
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Abdulla Al Sharji
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Khalid Al Harthi
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Bader Al Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Amira Al-Raidan
- Directorate General for Primary Health Care, Ministry of Health, Muscat, Oman.
| | - Zakiya Al Bahri
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - Said Al-Mukhaini
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Mohammed Amin
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
| | - A R Prasanna
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman.
| | - Eskild Petersen
- Directorate General for Disease Surveillance and Control, Ministry of Health, PO Box 393, 113 Muscat, Oman; Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Nordre Ringgade 1, 8000 Aarhus C, Denmark; Emerging Infections Task Force, European Society for Clinical Microbiology and Infectious Diseases, P.O. Box 214, 4010 Basel, Switzerland.
| | - Fatma Al Ajmi
- Directorate General for Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman.
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