Recent publications
A high-pressure gas exploration well was drilled in May 2018. The main objective of the well was to explore for gas in three different formations. The well underwent a successful fracturing intervention which increased the total gas production, however, at a later stage, a leak point was observed at the tie-back seal followed by repetitive isolation plug failures. The criticality of the well status was due to the integrity failure while having above 9,000 psi of tubing head pressure. The objective of the paper is to describe the successful method of restoring well integrity in a high pressure well by retrieving the failed isolation barriers.
Prior to the intervention and due to the failed integrity of the high pressure well, a work cycle was developed to ensure the successful intervention was executed in a controlled manner. Due to the complexity of the restoration process, contingencies were aligned as part of the retrieval and isolation intervention.
Restoring the well took place in a sequence initiated firstly by the retrieval of a failed junk catcher and the top retrievable plug using the coiled tubing. This was followed by pushing the bottom failed retrievable plug to TD successfully without collapsing the Coiled Tubing string, at the live conditions of the well. The final restoration step included the utilization of a mechanical plug to be set followed by 300 m of cement, to ensure well isolation for next workover stage.
The most pivotal challenge was the intervention in a high pressure well of above 9,000 psi in the presence of a failed integrity issue. The strategy of well restoration was a complex combined intervention of utilizing multiple downhole tools to retrieve the well barrier, clean the unexpected debris accumulated and successfully control the leak that has resulted in the integrity failure of the well. Although controlling the failed retrievable plugs was difficult, due to the high pressure pushing the unset plugs shallower, manipulating the status of the well between opening the returns and shutting-in during the intervention was observed a secondary control parameter throughout the job.
The combined approach of Coiled Tubing's tubing force analysis, downhole tool configuration, well condition and contingency management throughout the intervention resulted in the successful restoration of a high-pressure gas well.
The paper presented highlights the successful restoration of a complex intervention executed through Coiled Tubing. This case helps to present the value, challenges, lessons learnt and opportunities existing in well restoration that would have previously been deployed through a costlier mean of workover operation.
Objectives:
Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19.
Methods:
A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI).
Results:
The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p = 0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI.
Conclusions:
Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI.
Background
The aim of this study was to validate R-heart failure (R-hf) risk score in ischemic heart failure patients.
Methods
We prospectively recruited a cohort of 179 ischemic and 107 non-ischemic heart failure patients. This study mainly focused on ischemic heart failure patients. Non-ischemic heart failure patients were included for the purpose of validation of the risk score in various heart failure groups. Patients were stratified in high risk, moderate risk and low risk groups according to R-hf risk score.
Results
A total of 179 participants with ischemic heart failure were included. Based on R-hf risk score, 82 had high risk, 50 had moderate risk and 47 had low risk heart failure scores. More than half of the patients having R-hf score of <5 had renal failure (n = 91, 50.8%) and anemia (n = 99, 55.3%). Notably, HFrEF was more prevalent in patients with high risk score (74, 90.2%). Patients with high risk score had significantly higher creatinine (2.63 ± 1.96, p < 0.001), Troponin-T HS (59.9 ± 38.0, p < 0.001) and PRO BNP (17842 ± 6684, p < 0.001) when compared to patients with low and moderate risk score. Patients with low risk score had significantly higher Hb (13.2 ± 1.85, p < 0.001), Albumin (3.69 ± 0.42, p < 0.001) and GFR (90.0 ± 8.04, p < 0.001). A R-hf score of <5 was a significant predictor of mortality in ischemic (OR = 50.34; 95% CI [16.94–194.00, p < 0.001) and non-ischemic (OR = 46.34; 95% CI [12.97–225.39], p < 0.001) heart failure patients.
Conclusions
Lower R-hf risk score is a significant predictor of mortality in ischemic and non-ischemic heart failure patients. Risk score can be accessed at https://www.hfriskcalc.in.
Social entrepreneurship involves groundbreaking and pioneering methodologies to tackle concerns in the domains of education, environment, rational vocation, well-being, and health and human rights and is widely regarded as a building block of the sustainable development of a particular place. Social entrepreneurship is the aptitude an individual has which can transform several economic, environmental, social, and political issues at local and global levels. It is believed that acquaintance of youth to social entrepreneurial practice can impact this change. Social entrepreneurial orientation could be social vision, social attentiveness, innovativeness, and risk-taking. In this chapter, the authors have made an attempt to understand the youth's intention towards the social entrepreneurship. The data is collected from 123 students studying in different institutes and universities, as well as from the individual who are working or have their own startups. The study used partial least squares-based structural equation modelling.
Objectives:
We sought to estimate the percentage achievements of non-high-density lipoprotein cholesterol (non-HDL-C) target in patients with very high atheroscleroticcardiovascular diseases (ASCVD) risk stratified by triglyceride (TG) levels despite statin-controlled low-density lipoprotein cholesterol (LDL-C) in the Centralized Pan-Middle East Survey on the under treatment of hypercholesterolemia.
Methods:
The non-HDL-C target achievement in patients with diabetes mellites (DM) and patients with established ASCVD was defined according to European Society of Cardiology and European Atherosclerosis Society 2019 guidelines for managing dyslipidemia. Patients were stratified to controlled LDL-C defined as < 70 mg/dL (< 1.8 mmol/L) with normal TG < 150 mg/dL (< 1.7 mmol/L) and high TG between 150-400 mg/dL (1.7-4.5 mmol/L).
Results:
The mean age of our cohort was 58.0±11.0 years, 6.8% (n = 717) were male, 9.7% (104) were smokers, and 48.4% (n = 518) had body mass index of ≥ 30 kg/m2. Those with high TG levels male (76.5% vs. 63.8%; p < 0.001), smokers (16.1% vs. 7.7%; p < 0.001), have metabolic syndrome (77.6% vs. 17.1%; p < 0.001), and low HDL-C levels (79.2% vs. 49.4%; p < 0.001). The majority (93.9%, n = 1008) were on statins (atorvastatin and rosuvastatin) with only 2.2% (n = 24) on the combined statins plus fenofibrate/gemfibrozil. Only 27.4% (n = 294) of patients had non-HDL-C goal attainment. Goal attainment rates in patients with diabetes (3.1% vs. 34,4%; p < 0.001), coronary artery disease (CAD) (2.4% vs. 37.9%; p < 0.001), diabetes plus CAD (0% vs. 40.0%; p < 0.001), and CVD (0% vs. 30.0%; p = 0.048) were significantly lower in those with higher TG levels.
Conclusions:
A large proportion of statin-controlled LDL-C diabetic patients and patients with established ASCVD with high TGs did not achieve the non-HDL-C target. Our study did not demonstrate an association between ASCVD and high TG levels; and therefore, a follow-up study is highly required to assess long-term ASCVD outcomes in this cohort.
Today, we could describe the Internet of Things (loT) as the pervasive and global network that provides a system for monitoring, controlling, processing, and analyzing the data generated by IoT devices. The huge amount of data generated by IoT devices when transported and routed through the internet presents several challenges. One of the common routing protocols in IoT networks is RPL (Routing Protocol for Low Power and Lossy Networks), but it is prone to security issues and attacks. Due to the presence of sensitive data in IoT and its exchange in the open network, issues of privacy and security in this network should be given special attention. In addition, the nodes in the Internet of Things have limited resources, and the symmetric encryption key is used to encrypt the data of all nodes, which has security weaknesses. Therefore, an efficient and secure authentication scheme is needed so that IoT nodes can authenticate each other and share a secure session key. In this article, we review security aspects of RPL protocols focusing on selective forwarding attacks. Further, we propose a key agreement and authentication mechanism based on ECDH (Elliptic-Curve Diffie–Hellman). We show that our design is very secure, that it meets security requirements, and that it can withstand known attacks while having low costs for computation and communication.
Background
Childhood obesity is a public health concern that in expanding globally. Of those aged between 5-19 years in Oman, 32% were found to be overweight in 2016.
Method
An electronic survey was distributed to in-training and post residency paediatricians in Oman.
Results
A total of 69 responses met the inclusion criteria and were analysed. 50% of participants were less than 30 years-old (53.6% female). 70% were in training residency (R1, R2 24.6%, R3, R4 36.2%,) and 30% were post residency. 72% had their training in Oman. About half of participants measure child’s weight and Height, however, only 24.4% document BMI and compare with previous records. 75% regularly obtain family history of obesity and related conditions along with dietary intake. More than half of participants were not confident on discussing weight and related complication with the child, but 62.3 % were confident in discussing it with the parents. 50% were confident in initiating treatment for childhood obesity and providing dietary advice. Attitudes towards exposure to childhood obesity and management varied and overall excellent exposure accounted for less than one third of responses (Medical school 21.7%, Residency 26.1%, 27.5%). In general, only 20.6% believe they are confident in managing childhood obesity and only 29% attended seminar or training on childhood obesity. 93% believe there is a need for a more focused training on childhood obesity prevention and management.
Conclusions
Great efforts need to be targeted towards strengthening Paediatricians’ confidence in childhood obesity prevention and management via in residency-training and continuous professional development.
Background
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer with an estimated incidence of 8 per 100,000 person-years and mortality of 7 per 100,000 person-years worldwide.
Method
A narrative review of the literature was conducted. PubMed, Web of Science and Cochrane database were searched for all published papers in Pancreatic cancer post Bariatric surgery from 1990 to November 2020.
Results
Epidemiological evidence in the literature has shown that obesity as a risk factor for the development of PDAC is a dose dependent risk. The review found that the risk of developing pancreatic cancer in obese or overweight individuals is 1.5 times higher than individuals with a normal BMI. At the same time, evidence from literature demonstrated that weight reduction by dietary restriction, physical activities, pharmacotherapy or weight reduction surgery reduces risk of PDAC.A total of 24 cases of pancreatic cancer were identified in the literature reported post Bariatric Surgery. The average age at diagnosis was 57.2 years and onset from surgery to diagnosis ranged from 2 months to 25 years. Of the identified cases, 23 cases were post Roux-en-Y Gastric Bypass and one case post Duodenal Switch. The review found that PDAC was the commonest reported pancreatic cancer post bariatric surgery accounting for 85.3%, followed by Neuroendocrine Tumours (NET) 16.7%.
Given the variation in onset of diagnosis, bariatric surgery did not increase cancer risk but rather accelerated the diagnosis of pancreatic cancer.
Conclusions
Along with weight reduction and improving comorbidities, Bariatric surgery reduces risk of obesity-related carcinogenesis.
Objective
To evaluate the clinical and financial impact of clinical pharmacists’ interventions (CPIs) on antimicrobial use at a 500-bed multidisciplinary tertiary care hospital in Oman.
Methods
A retrospective analysis of CPIs related to antimicrobials use at Sultan Qaboos University Hospital (SQUH) from January to December 2018. Interventions were recorded using an electronic CPI form and were reviewed by two independent CPs. Data on the type and clinical significance of the interventions were extracted. Cost analysis was done using a previously defined cost avoidance model in addition to direct cost reduction estimation. Descriptive data were used to describe the results.
Results
In 2018, 26% of CPIs were related to antimicrobial use with more than 60% of these interventions done on intensive care unit patients. The most common intervention type was adjustment of the dosing regimen with 42% of the total interventions, followed by deletion of the antimicrobial order in 34% of the cases. The most common type of clinical impact of CPIs were improving efficacy in 45% of the interventions followed by preventing unnecessary exposure to the antimicrobials in around 30% of the interventions. The interventions were of major significance in 64% of the cases. This translated into a projected net cost saving of approximately 200,000 US$/year.
Conclusions
CPs interventions on antimicrobial use had a positive impact on both the clinical and financial outcomes.
Background and aims
Familial hypercholesterolemia (FH) is a common autosomal dominant disorder that can result in premature atherosclerotic cardiovascular disease (ASCVD). Limited data are available worldwide about the prevalence and management of FH. Here, we aimed to estimate the prevalence and management of patients with FH in five Arabian Gulf countries (Saudi Arabia, Oman, United Arab Emirates, Kuwait, and Bahrain).
Methods
The multicentre, multinational Gulf FH registry included adults (≥18 years old) recruited from outpatient clinics in 14 tertiary-care centres across five Arabian Gulf countries over the last five years. The Gulf FH registry had four phases: 1- screening, 2- classification based on the Dutch Lipid Clinic Network, 3- genetic testing, and 4- follow-up.
Results
Among 34,366 screened patient records, 3713 patients had suspected FH (mean age: 49±15 years; 52% women) and 306 patients had definite or probable FH. Thus, the estimated FH prevalence was 0.9% (1:112). Treatments included high-intensity statin therapy (34%), ezetimibe (10%), and proprotein convertase subtilisin/kexin type 9 inhibitors (0.4%). Targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol were achieved by 12% and 30%, respectively, of patients at high ASCVD risk, and by 3% and 6%, respectively, of patients at very high ASCVD risk (p <0.001; for both comparisons).
Conclusions
This snap-shot study was the first to show the high estimated prevalence of FH in the Arabian Gulf region (about 3-fold the estimated prevalence worldwide), and is a “call-to-action” for further confirmation in future population studies. The small proportions of patients that achieved target LDL-C values implied that health care policies need to implement nation-wide screening, raise FH awareness, and improve management strategies for FH.
This study evaluated the monitoring and security requirements of local area networks for the development of an effective monitoring software through literal study and prototyping. The objective is to compare the performance of the developed prototype to the performance of prevailing proprietary counterparts. A survey questionnaire was used to gather data from the two different groups of respondents; the technical people from the industry (referred to as the Management Information System group) and the technical people from the education sector (referred to as the outside group). Two sets of evaluations were also conducted; the first set involved only the Management Information System group. They were asked to evaluate the Real-time Remote Monitoring System in comparison with an existing software counterpart. The second set involved both groups, they were asked to both evaluate the Real-time Remote Monitoring System in terms of usability, capability, user-friendliness, and effectiveness. Statistical tools applied to responses gathered include mean, frequency distribution, variances, and t-test. Results of the statistical analysis showed that the developed software provided satisfactory monitoring and control capability as compared with the existing systems. The developed software is recommended for use in the Management Information System department to monitor workstation activity and to implement remote control functions either for security purposes or for emergency repair or technical support.
This paper evaluated the student-related factors associated with the academic performance of the non-accounting Omani students in their first undergraduate accounting module. Qualitative research method was employed through a self-made survey tool. The tabular data were integrated with percentages to supplement the analysis. The students’ academic performance can be attributed to learning approach and study habits not prior learning. Students prefer surface learning approaches which do not fit the demands of the accounting module while the positive study habits mainly focus on passing the assessments rather than building knowledge and skills. There is a strong need for a student-centered classroom which are focused on knowledge acquisition than assessments. A pre-requisite module to basic accounting can be considered as a bridging program. The teachers are also expected to employ methodologies such as formative assessments to enhance the students’ learning and entice effective habits. This study has various statistical and scope limitations. For this, other student-related factors such as demographic profile, performance in other modules and commitment to learning should also be considered in the future studies. Moreover, the actual module performance of the students can be statistically correlated to their prior knowledge, study habits and learning approach.
Autism spectrum disorder (ASD) is an ongoing neurodevelopmental disorder, with repeated behavior called stereotypical movement autism (SMM). Some recent experiments with accelerometer features as feedback to computer classifiers demonstrate positive findings in persons with autistic motor disorders for the automobile detection of stereotypical motor motions (SMM). To date, several methods for detecting and recognizing SMMs have been introduced. In this context, the authors suggest an approach of deep learning for recognition of SMM, namely deep convolution neural networks (DCNN). They also implemented a robust DCNN model for the identification of SMM in order to solve stereotypical motor movements (SMM), which thus outperform state-of-the-art SMM classification work.
Autism spectrum disorder (ASD) is a neuro disorder in which a person's contact and connection with others has a lifetime impact. In all levels of development, autism can be diagnosed as a "behavioural condition," since signs generally occur within the first two years of life. The ASD problem begins with puberty and goes on in adolescence and adulthood. In this chapter, an effort is being made to use the supporting vector machine (SVM) and the convolutionary neural network (CNN) for prediction and interpretation of children's ASD problems based on the increased use of machine learning methodology in the research dimension of medical diagnostics. On freely accessible autistic spectrum disorder screening dates in children's datasets, the suggested approaches are tested. Using different techniques of machine learning, the findings clearly conclude that CNN-based prediction models perform more precisely on the dataset for autistic spectrum disorders.
Objectives:
To identify risk factors and outcomes of patients with critical pertussis.
Design:
A retrospective observational cohort study.
Setting:
Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman.
Subjects:
Children <13 years presenting to the Emergency Departments and diagnosed with laboratory-confirmed pertussis by PCR, between January 2013 and December 2018.
Measurements and main results:
There were a total of 157 patients with pertussis, of which 12% (n = 19) had critical pertussis. Those with critical pertussis had higher counts of white blood cell (WBC) (adjusted odds ratio (aOR), 1.05; 95% confidence interval (CI): 1.02-1.08; p = 0.003), absolute lymphocyte count (ALC) (aOR, 1.08; 95% CI: 1.03-1.15; p = 0.004) and absolute neutrophil count (ALC) (aOR, 1.05; 95% CI: 1.01-1.10; p = 0.032) even after multivariate adjustment. The area under the curve (AUC) for discriminatory accuracy of laboratory variables were 0.75 (95% CI: 0.65-0.85), 0.74 (95% CI: 0.64-0.84) and 0.72 (95% CI: 0.60-0.83), for maximum WBC, ALC and ANC, with the Youden's cut-off values of 31.5 x109/L, 19.9 × 109/L and 5.0 × 109/L, respectively.
Conclusions:
In children, higher counts of WBC, ALC and ANC were significant predictors of critical pertussis. A 31.5 × 109/L WBC cut-off was also associated with critical pertussis.
Objectives:
The novel severe acute respiratory syndrome coronavirus 2 pandemic continues to spread globally without an effective treatment. In search of the cure, convalescent plasma (CP) containing protective antibodies from survivors of coronavirus disease 2019 (COVID-19) infection has shown potential benefit in a non-intensive care unit setting. We sought to evaluate the effectiveness of CP therapy for patients with COVID-19 on mechanical ventilation (MV) and/or acute respiratory distress syndrome (ARDS).
Methods:
We conducted an open-label trial in a single center, Royal Hospital, in Oman. The study was conducted from 17 April to 20 June 2020. The trial included 94 participants with laboratory-confirmed COVID-19. The primary outcomes included extubation rates, discharges from the hospital and overall mortality, while secondary outcomes were the length of stay and improvement in respiratory and laboratory parameters. Analyses were performed using univariate statistics.
Results:
The overall mean age of the cohort was 50.0±15.0 years, and 90.4% (n = 85) were males. A total of 77.7% (n = 73) of patients received CP. Those on CP were associated with a higher extubation rate (35.6% vs. 76.2%; p < 0.001), higher extubation/home discharges rate (64.4% vs. 23.8%; p =0.001), and tendency towards lower overall mortality (19.2% vs. 28.6%; p =0.354; study power = 11.0%) when compared to COVID-19 patients that did not receive CP.
Conclusions:
CP was associated with higher extubation/home discharges and a tendency towards lower overall mortality when compared to those that did not receive CP in COVID-19 patients on MV or in those with ARDS. Further studies are warranted to corroborate our findings.
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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