Background: Due to existence of highly infectious materials, the biomedical waste can be a probable source for transmission of diseases as well as occupational hazards among health care workers if not adequately managed. Objective: To assess the knowledge, attitude and practices of biomedical waste management among health care personnel in a secondary hospital of Al Buraimi Governorate, Sultanate Oman.

Patients with novel corona virus infection (COVID-19) can develop acute respiratory failure secondary to acute respiratory distress syndrome. Cytokine storm is suggested as one of underlying mechanisms for the rapid clinical decline. Immunocompromised patients and cancer patients are at particular risk for poor outcomes due to COVID-19 infection. This case report describes the presentation and clinical course of a cancer survivor who became critically ill and required mechanical ventilation. The patient was treated with hydroxychloroquine, azithromycin, and ceftriaxone; however, he remained febrile, hypoxemic, continued to require full mechanical ventilator support and his chest X-ray showed increased bilateral infiltrates. The patient was treated with tocilizumab, after which he improved and was successfully extubated. This report illustrates a possible role of tocilizumab in management of cytokine storm in critically ill patients with COVID-19 infection.

Background: Urinary tract infections (UTIs) is a worldwide problem of all age groups and gender. Emerging resistance to antibiotics making difficult in the choice of treatment and management of UTI cases. This study sought to determine the gender wise prevalence of common uropathogens from UTI patients and the resistance profile of uropathogens against commonly used antibiotics. Method:This cross sectional study was conducted in Al Buraimi Hospital, Sultanate of Oman. The data of UTI patients visited hospital was analyzed for the isolation of uropathogens from positive urine culture and antimicrobial sensitivity test was performed by disc diffusion method. Descriptive statistics was used to analyze the data using SPSS 21.0 and Microsoft Excel.Result: Total 4,480 urine samples were analyzed for isolation of uropathogens and significant bacteriuria were found in total 846 (19%) samples. Overall 728 (86%) Gram-negative and 118 (14%) Gram positive uropathogens were isolated from total (846) positive urine samples and the highest prevalence of isolates was observed in females 542(74%) than males 186(26%). E.coli was found the highest prevalent (50.3%) uropathogens followed by Klebsiella species (13.9%), Pseudomonas (6.3%), A.baumannii (4%), E.Cloacae (2.2%), Proteus species (1.4%), Citrobacter species (1.2%), M. morgani (0.3%) and Serratia species (0.1%). The highest (34.3%) antibiotic resistance was noticed in E.coli against Nalidixic Acid, however, susceptiblity was found against Ceftriaxone, Ceftazidime, Ciprofloxacin and Nitrofurantoin among female and males. Conclusion:Overall, β-lactam antibiotics, Cephalosporins, Fluroquiolones, Macrobids would be the first line of drugs and the most effective for the empirical treatment of Gram-negative and Gram-positive uropathogens; however Aminoglycosides, Carbapenems and Polymyxin could be used for the treatment of UTI infections as the second choice.

Background and aimsSystemic lupus represents a major autoimmiune disorder that leads to different major injuries to different organs of the body. Lupus nephritis can present with different disorders like nephrotic syndrome, acute kidney injury and rapidly progressive glomerulonephritis. Wise and tailored management of these cases is a must for nephrologists in order to gain the complete remission with the least side effects. If lupus nephritis is associated with other organs problems like heart failure, prosthetic valves and oral warfarin therapy, it needs more wise management. We clarify the tailored management of lupus nephritis induced nephrotic syndrome and acute kidney injury meanwhile the patient on oral warfarin therapy for prosthetic valve replacement and subsequent heart failue.MethodsWe report a case of heart failure with mitral and aortic valves replacement on oral warfarin therapy. She had nephrotic syndrome, AKI due to lupus nephritis. The patient recieved high dose of oral steroid and maintained on hemodialysis for 2 months with full recovery of the AKI and partial recovery of the nephrotic syndrome.ResultsThe patient recieved oral high dose steroid only. Partial remession of the nephrotic syndrome occured with full recovery of the acute kidney injury and she was maintained on once per week ultrafiltration session with improvement of the ejection fraction of the heart.ConclusionsLupus nephritis can present with complex situations. Individualization and tailoring the management for every patient in order to gain complete remission represents a challenge for nephrologists.

Osteosarcoma of the skull has poor outcomes. This case report describes the presentation and clinical course of a patient who was diagnosed with osteosarcoma of the skull involving the cribriform plate. After her initial diagnosis, she developed esotropia with severe unremitting headaches. She received palliative radiation, followed by chemotherapy, and responded well. Her initial symptoms involving the cranial nerves subsided, and her response was sustained. This report illustrates the need to effectively treat osteosarcoma of the skull despite its reported poor outcomes.