Pediatric migraine (PM) is one of the most prevalent neurological disorders in children. It has numerous variants and the sufferers often present to emergency departments with a wide variety of signs and symptoms that make diagnosis difficult. The trend in diagnosing and managing PM cases remain suboptimal despite the comprehensive diagnostic criteria and various therapeutic options. In this review, we discuss PM, provide an approach to the diagnosis, and describe the various available management options. However, the diagnosis of migraine is based on history and physical examination; no specific diagnostic test is available. The main management aspects are acute pain relief, prevention, and identifying triggering factors.

Keywords:Pediatric Migraine; Nonsteroidal Anti-Inflammatory Agents; Calcitonin Gene-Related Peptide Receptor; Triptans; Preventive Care; Oman.

Objectives: Despite a significant reduction in the global case incidence and mortality of malaria in the past 20 years, malaria continues to wreak havoc on people’s health across the globe. Oman is a malaria-free country, meeting the World Health Organization’s (WHO) criteria, having no indigenous malaria case documented since 2010, and maintaining that status for three consecutive years. Oman has a national strategy for prevention of re-establishment of malaria and to maintain their malaria-free status. In this paper, we explore Oman’s malaria elimination progress and provide recommendations for accelerating and sustaining malaria free status using WHO malaria elimination strategies. Methods: Secondary data from the years 1976 to 2020 was extracted from official sources utilized to assess progress. A review and epidemiological analysis of malaria cases, species classification, and source of infection was conducted. The data and situation were compared to WHO malaria elimination pillars. Results: The number of malaria cases reported from 1976 to 2020 was 298 070, a decline from 1.6 to 0.1 per 1000 population. Of the 4415 cases reported between 1994–2004, 98.0% were classified as imported and 73.0% of people diagnosed with malaria were 20–34 years old. The number of autochthonous cases began to decline in 1994 from a high of 4415 cases (3.6 per 1000 population) to zero by 2004 with no deaths attributed to autochthonous malaria cases after the year 2000. By 2020, Plasmodium falciparum accounted for 86.0% of cases, P. vivax cases declined to 9.0% and P. malaria and P. ovale comprised the remaining 6.0% of case notifications. Conclusions: Oman achieved malaria elimination status in 2013. To maintain this status, it is essential to adopt a national prevention strategy of re-establishment of malaria and maintain malaria-free status targets.

Keywords:Malaria; Incidence; Oman.

Objectives: Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality globally and in Oman. Stratifying the population under different risk levels based on the total CVD risk approach using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction chart would be more effective in primary prevention of CVD to prioritize and utilize valuable resources. Hence, this study aimed to assess the total 10-year CVD risk among adults in Oman and to ascertain the proportion of the population in need of pharmacotherapy. Methods: We used the data from the 2017 national community-based STEPS survey conducted among men and women in Oman aged 40–80 years. Ten-year total cardiovascular risk was measured using the WHO/ISH risk prediction chart for Eastern Mediterranean Sub-Region B. Independent t-test and Chi-square were used to test significance. Results: There were 2510 participants in the study. Their mean age was 51.5±10.1 years and 51.3% were male. The prevalence of low, moderate, and high CVD risk was 68.0%, 19.1%, and 12.9%, respectively, as benchmarked by the WHO/ISH chart. Immediate pharmacotherapy was needed by 30.3% of participants. Factors significantly associated with elevated CVD risk were the participant's age (p < 0.001), education level (p < 0.001), and employment status (p < 0.001). Conclusions: A substantial fraction of the population in Oman are at moderate or high CVD risk. Prompt pharmacological interventions are warranted for at least one in every five individuals in conjunction with lifestyle changes.

Keywords:Cardiovascular Diseases; Models, Statistical; Chart; Health Surveys; Oman.

Objectives: The discovery of microRNAs (miRNAs) has revealed a new level in gene expression post-transcriptional control. Several studies have been published to date looking at the relationship between miRNAs and viral (swine flu, HIV, and hepatitis B) or bacterial infections. We conducted a bibliometric evaluation of the existing literature on miRNAs in the infectious disease research area. The major purpose of this study was to investigate the significance of publications and identify research developments and clusters using bibliometric methods. Methods: Data was obtained from the Web of Science (WoS) database. The titles, document types, publication years, authors, affiliations, keywords, publishing journals, abstracts of each document, and citations within the WoS database were saved as TXT files and retrieved into Microsoft Office Excel 2019. Data for this investigation was obtained from the WoS database on 10 April 2022. The WoS database’s Results Analysis and Citation Report were used to analyze the number of publications from various viewpoints, such as years, journals, and authors. To visualize country collaboration networks and keywords we used the VOSviewer software version 1.6.18 for Microsoft Windows. Results: We found 623 documents of which 251 (40.3%) were articles. All the publications were published in English. The first document was published in 2007, and the maximum number of documents was published in 2021. The number of documents has been increasing since 2019. China dominated the scientific production with 398 (63.9%) publications. The top five leading scientifically productive countries on this topic also included the USA (n = 100; 16.1%), Japan (n = 24; 3.9%), Germany (n = 20; 3.2%), and Italy (n = 17; 2.7%). The documents originating from China were cited 5705 times (an average of 14.3/document). The documents originating from the USA were cited 2190 times (an average of 21.9/document). Conclusions: Since 2019, the number of studies on miRNA in infectious illnesses has steadily increased. China and the USA have made tremendous contributions to this field’s study. We discovered several deregulated miRNAs, including miR-122, miR-133a, miR-146, miR-155, and miR-370, were described in the context of sepsis and infection using bibliometric methods. Understanding these crucial factors, as well as how research is performed and directed, might lead to a new perspective in the creation of new strategies to manage variable infections in the coming years.

Keywords:Bibliometrics; MicroRNAs; Infectious Diseases.

Objectives: To determine the spectrum of kidney diseases in Omani children < 13 years of age and to evaluate the complications following kidney biopsy.Methods: This study retrospectively investigated the hospital data of children who underwent kidney biopsies from January 2014 to June 2019 at Royal Hospital, Muscat, Oman. Results: The subjects comprised of 78 children with a median age of 8.0 years (range = 0–13 years). Histopathology showed minimal change disease in 15 (19.2%) children, lupus nephritis in 13 (16.7%), and focal segmental glomerulosclerosis in 13 (16.7%). The most common post-biopsy complications were pain that required analgesia (38; 49.4%) followed by gross hematuria (10; 13.0%). No patient required blood transfusion or surgical intervention. Conclusions: Minimal change disease was the most common histopathological finding in this cohort of Omani children. The records did not mention any major complications following the renal biopsy procedure.

Keywords:Kidney Biopsy; Pediatric; Lupus Nephritic; Minimal Change Disease; Focal Segmental Glomerulosclerosis; Oman.

Objectives: This study sought to evaluate the relative efficacy of expressed breast milk (EBM) fortified using human milk fortifier (HMF) compared to commercial preterm formula (PF) on preterm and very low birth weight (VLBW) infants in a major tertiary healthcare center in Oman. Methods: This retrospective cohort study included two cohorts of preterm (< 32 weeks gestation) or VLBW infants (birth weight < 1500 g) treated in the neonatal intensive care unit (NICU). Cohort one included infants who were given PF-fortified EBM between January and December 2016, and cohort two were given newly-introduced HMF-fortified EBM between November 2018 and December 2019. Analysis was performed to compare the cohorts with respect to baseline characteristics, primary outcomes, and secondary outcomes. Results: A total of 103 neonates were included (cohort 1: n = 55, cohort 2: n = 48). There were no significant differences in the growth of the weekly length, the growth of the head circumference, or discharge growth parameters. Compared to PF, HMF was associated with significantly better weight gain velocity (g/kg/day) during the first week (p = 0.009) and second week (p = 0.050) after starting fortification, lower need for other adjunctive forms of fortification (p = 0.035), and lower rates of necrotizing enterocolitis in premature infants or VLBW (p = 0.018). Conclusions: This is likely to be the first study to analyze the relative efficacy of HMF and PF in the Middle East. The results of this study will be helpful in guiding standards of nutritional care in NICUs in Oman.

Keywords:Human Milk; Infant Food; Baby Formula.

Objectives: The aim of this study was to determine the phenotypic and genotypic characteristics of Stenotrophomonas maltophilia isolates obtained from blood culture samples of pediatric patients hospitalized in Borujerd and Hamadan hospitals in western Iran. Methods: Oxidase-negative isolates were collected from the blood cultures of pediatric patients. S. maltophilia isolates were identified and confirmed by routine microbiological and molecular testing. Antibiotic susceptibility of the isolates was determined. The phenotypic and genotypic biofilm-forming ability of the isolates were investigated. Molecular typing of all isolates was performed by repetitive element sequence-based polymerase chain reaction. Results: Out of 450 oxidase-negative bacilli, 72 (16.0%) were identified as S. maltophilia isolates. Biofilm assay results showed strong biofilm formation in 19 (26.4%) isolates, moderate in 38 (52.8%), weak in 10 (13.9%), and no biofilm formation in five (6.9%) isolates. Biofilm-associated genes rmlA, rpfF, and spgM were detected respectively in 59 (81.9%), 54 (75.0%), and 72 (100%) of isolates. Antimicrobial susceptibility testing showed that 67 (93.1%) isolates were sensitive to trimethoprim-sulfamethoxazole. All isolates were sensitive to levofloxacin and resistant to ceftazidime. The S. maltophilia isolates were grouped into 14 different types of repetitive sequence by repetitive element sequence-based polymerase chain reaction analysis. Conclusions: The results of this study indicate that S. maltophilia should be considered an important opportunistic pathogen in pediatric units. Different genotypes of S. maltophilia with the ability to form a biofilm (an important virulence factor) were circulating in the hospitals investigated. Levofloxacin and trimethoprim-sulfamethoxazole are recommended to treat S. maltophilia infections.

Keywords:Stenotrophomonas maltophilia; Pediatrics; Bacteremia; Antibiotic Resistance; Biofilm; Molecular Typing; Iran.

Objectives: Old age is often associated with a progressive decline in the capacity of individuals to maintain dynamic and static balance, leading to falls and fear of falling. This study aimed to validate the 9-item Berg Balance Scale (BBS-9) for the older Iranian population. Methods: The current psychometric study involved translation of the BBS-9 to Persian language and its validation among a cohort of Persian-speaking elderly people. Confirmatory factor analysis, exploratory factor analysis, internal consistency, construct validity, test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity of the BBS-9 (Persian) were investigated and statistically analyzed. Results: The participants were 9117 Iranians with an average age of 64.3±2.45 years. The cohort was 54.1% female. Nearly three quarters of the subjects (72.4%) lived alone, 92.9% needed help with activities of daily living, and 93.0% sustained falls in the previous two years. Internal consistency was confirmed using intraclass correlation coefficient and McDonald’s Omega (≥ 0.75). The receiver operating characteristic analysis represented the exact cut-off values for male and female and with or without fear of falling with good specificity and sensitivity. Analysis of variance revealed that fear of falling was significantly related to age, Aging in Place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.130, p ≤ 0.050). Conclusions: The Persian version of BBS-9, a psychometrically sound self-reported measure of fear of falling, retained the original’s satisfactory psychometric properties. It has the potential to be used among older Iranians in community-based and clinical settings.

Keywords: Reliability and Validity; Questionnaire; Accidental Falls; Elderly; Prevention and Control; Surveys and Questionnaires; Psychometrics; Iran.

Objectives: Hemoglobin constant spring (Hb CS) is a point mutational defect associated with α thalassemia. The aims of this study were to compare the hematological profiles between different Hb CS genotypes and to estimate the range for Zone 2 peak using capillary electrophoresis (CE) with different Hb CS genotypes. Methods: For this cross-sectional study, patient blood samples that showed a positive peak in zone 2 of CE were selected. Hemoglobin and DNA of the samples were investigated to ascertain the presence and levels of non-deletional and deletional α thalassemia. The results were statistically analyzed. Results: Of the 137 samples investigated, 118 (86.1%) were positive for termination codon Hb CS mutation. Heterozygous Hb CS was found in 92 (67.2%), compound heterozygous Hb CS in 22 (16.1%), and homozygous Hb CS in four (2.9%) samples. The ranges of Hb CS level for heterozygous Hb CS, compound heterozygous Hb CS, and homozygous Hb CS were within 0.2–2.7%, 0.3–2.2%, and 4.5–5.5%, respectively. Significant hematological differences in the Hb level, mean cell volume, mean cell hemoglobin, red cell distribution width, red blood cell count, and Hb CS level were observed between heterozygous, homozygous, and compound heterozygous Hb CS. Conclusions: In view of the overlapping prevalence range of Hb CS level for heterozygous and compound heterozygous Hb CS, only Hb CS level within the range 4.5–5.5% was helpful in the diagnosis of homozygous Hb CS.

Keywords:Capillary Electrophoresis; Hemoglobin Constant Spring; Malaysia.

Objectives: Anti-Müllerian hormone (AMH), a glycoprotein that belongs to the transforming growth factor-beta superfamily, is important for women’s health. We aimed to determine the age-specific reference range of serum AMH in healthy Omani women from reproductive ages to menopause. Methods: This cross-sectional cohort study was conducted among a group of healthy 20–50 years old Omani women. The participants were required to have body mass index < 32 kg/m2 regular periods, no history of chronic illness, polycystic ovary syndrome, or gynecological operation. They were also required to not be using any hormonal contraceptive. Serum concentrations of AMH, follicle-stimulating hormone, luteinizing hormone, progesterone, and hemoglobin A1c were measured. AMH-age nomogram and AMH levels were compared between the six selected age groups. Results: The subjects were 319 Omani women aged 20–50 years. Serum AMH concentrations were found to decrease progressively with increasing age. An exponential model defined as √AMH = 479.02 × 0.91age was selected to explain the reduction in AMH with age (R2 = 0.298). The median AMH levels were 26.61 pmol/L for those aged 20–25 years, 20.89 pmol/L for 26–30 years, 19.92 pmol/L for 31–35 years, 13.71 pmol/L for 36–40 years, 9.24 pmol/L for 41–45 years, and 0.68 pmol/L for 46–50 years. The recommended 2.5th to 97.5th percentiles of AMH level, as reference ranges for various age groups, were found to be: 10.63–55.64 pmol/L (20–25 years), 3.74–61.88 pmol/L (26–30 years), 5.49–47.56 pmol/L (31–35 years), 2.15–48.91 pmol/L (36–40 years), 0.92–41.26 pmol/L (41–45 years), and 0.14–5.10 pmol/L (46–50 years).Conclusions: This study (the first in Oman) determined the age-specific reference ranges of serum AMH in healthy Omani women in the age range of 20–50 years.

Keywords:Anti-Mullerian Hormone; Reference Values; Fertility; Oman.

Objectives: Cardiopulmonary resuscitation (CPR) skills deteriorate within 6–12 months of formal basic life support (BLS) training. The impact of refresher BLS training timing and format on the retention of CPR-related psychomotor skills is still under investigation. This study aimed to assess the effectiveness of BLS refresher training on the retention of CPR psychomotor skills. Methods: This prospective randomized clinical trial was conducted between February 2018 to August 2020 at the Sultan Qaboos University Hospital, Muscat, Oman. Healthcare workers with prior CPR training were enrolled. Baseline CPR-related knowledge and skills were assessed; subsequently, all participants received CPR training until they achieved 100% performance. At six months, a preassessment test was conducted, after which the intervention group received refresher training while the control group did not. At 12 months, both groups underwent assessment. Little Anne® QCPR manikins (Laerdal Corp., Stavanger, Norway) were used to assess CPR performance at each stage. Results: A total of 38 personnel participated in the trial, comprising 19 in each arm. Overall, there were equal numbers of males and females; 21 participants (55.3%) were nurses, 15 (39.5%) were physicians, and two (5.3%) were paramedics. All participants demonstrated good baseline CPR knowledge. Within the intervention and control groups, CPR performance was 72.7% and 75.8% (p = 0.638) at baseline, 87.2% and 88.5% (p = 0.682) at six months, and 93.8% and 79.4% (p = 0.010) at 12 months, perspectively. Conclusions: Refresher CPR training six months after initial training was found to promote skills retention at 12 months.

Keywords:Prospective Studies; Heart Arrest; Cardiopulmonary Resuscitation; Oman.

Puffer fish (Lagocephalus sceleratus) is a well-known source of deadly food poisoning due to a neurotoxin, called tetrodotoxin. Cases of tetrodotoxin poisoning are common along the coasts of East Asian countries but rare in the Arabian Gulf region. Here, we report a case of a 19-year-old man who presented with signs and symptoms suggestive of puffer fish poisoning. Dietary history was the key to diagnosis though laboratory investigations and imaging yielded normal results. Early diagnosis and proper supportive management are essential for survival.

Keywords: Puffer Fish; Poisoning; Food Poisoning; Tetrodotoxin; United Arab Emirates.

COVID-19 is a relatively new disease whose complete pathogenesis and complications have not been elucidated. Apart from the morbidity and mortality caused by the virus itself, it is noted that patients affected with this virus have a higher susceptibility to bacterial and fungal co-infections. Mucormycosis is a rare and life-threatening fungal infection generally associated with uncontrolled diabetes mellitus and immunosuppression. It tends to rapid disease progression and poor prognosis if not diagnosed and managed promptly. There has been a sudden increase in the number of mucormycosis cases in patients with moderate to severe COVID-19 infection in the past few months. Herein, we present a series of 10 mucormycosis cases diagnosed over one week.

Keywords:Mucormycosis; COVID-19; Coinfection.

Malignant otitis externa (MOE) is an aggressive infection of the external auditory canal that primarily affects diabetic patients. Some literature supports the effectiveness of hyperbaric oxygen therapy (HBOT) as a treatment modality for MOE. A case series was conducted of all patients diagnosed with MOE and treated with HBOT at the Said Bin Sultan Naval Base Polyclinic in Oman between January 2014 and December 2019. A total of 20 patients were included in the study. All participants presented with persistent ear discharge, 95.0% with otalgia, and 75.0% with granulation in the external auditory canal. Moreover, 100% showed abnormally high levels of inflammatory markers and abnormal computed tomography findings. The patients underwent an average of 29.0±8.9 HBOT sessions. Overall, 19 (95.0%) patients were considered cured by the end of the treatment. The use of HBOT in the management of MOE appears promising and may cure MOE.

Keywords:Otitis Externa; Ear Canal; Hyperbaric Oxygenation; Diabetes Complications; Oman.

Due to overlapping clinical features, scrub typhus infection may be missed in presence of dengue. Concurrent infection with those two pathogens is rare and creates a diagnostic dilemma. We present a case of a 65-year-old male who was admitted with a high-grade fever and maculopapular rash. A complete hemogram revealed thrombocytopenia with raised hematocrit and positive diagnostic tests for dengue. The patient was treated conservatively with intravenous fluids and antipyretic medications in response to which the hematocrit improved, and the rash disappeared. But fever with thrombocytopenia continued to persist. On further clinical examination, a small eschar was noted on his abdomen. Doxycycline was started upon which the fever subsided, and thrombocytopenia improved. This case illustrates the importance of early recognition of coinfection in unremitting febrile illness in tropical countries to prevent potentially dangerous complications.

Keywords:Dengue Fever; Scrub Typhus; Eschar; Thrombocytopenia; Doxycycline; India.

Down syndrome (DS) is the most common chromosomal abnormality found in humans. In Oman, the birth prevalence of DS is 2.4 in 1000 (about 120 affected births per year). Underlying compromised cardiopulmonary status and intellectual disabilities predispose these patients to be particularly vulnerable to serious respiratory viral infections. They also tend to have exaggerated cytokine storms due to underlying immune dysregulation. We report our experience with three DS patients who contracted COVID-19 pneumonia and were admitted to our intensive care unit where they were successfully managed and discharged. Patients with DS are highly susceptible to serious outcomes due to COVID-19. They should be given top priority in immunization programs.

Keywords:Respiratory Distress Syndrome; COVID-19; Down Syndrome; Mechanical Ventilation; Non-Invasive Ventilation; Pneumonia; Oman.

Branchial cleft cysts generally occur unilaterally at the lateral aspect of the neck. Bilateral branchial cysts are rare and may have familial associations. We report a rare case of non-syndromic bilateral branchial cyst in a 23-year-old woman who presented with chronic bilateral, progressively enlarging painless neck swellings. Complete surgical excision of the bilateral cyst was done. A histopathological examination confirmed the diagnosis. Precise diagnosis with early and complete surgical excision of branchial cysts may help prevent recurrence and other complications.

Keywords:Branchial Cleft Cyst; Branchial Arches; Hearing Loss, Bilateral; Congenital Disorders; Malaysia.

Although cardiac lesions have been known to the existence since the Middle Ages, a search on Google or PubMed for cardiac lesions yields very few results. There are few original articles, case series, or clinical trials available on these rare but significant lesions. Cardiac lesions are usually asymptomatic and are detected only incidentally. Symptoms, if present, are varied and depend on the location of the area involved. The overall prevalence of primary cardiac tumors is between 0.17% and 0.19%. Cardiac tumors may be primary (benign or malignant) or metastatic (malignant). Only 25% of primary cardiac tumors are malignant, whereas metastatic tumors to the heart are 30 times more common. The aim of this case series is to highlight the clinical picture, presenting signs and symptoms, and the line of diagnosis of five such primary cardiac lesions that otherwise could remain undiagnosed until a late stage.

Keywords:Cardiac Tumors; Lipoma; Myxoma.