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Infective endocarditis (IE) is an uncommon but life-threatening infection. Despite advances in management, it still causes high morbidity and mortality. We report the case of an 8-year-old girl who presented with a prolonged fever of 2.5 months duration and a history of a small perimembranous ventricular septal defect. She was diagnosed with subacute bacterial endocarditis secondary to Streptococcus mutans. The patient developed a septic pulmonary embolism; however, with the use of appropriate antimicrobial therapy, she made an uneventful recovery. Clinicians should have a high index of suspicion for IE as the possible cause of a prolonged fever, especially in the presence of congenital heart disease (CHD). Currently, IE prophylaxis is not indicated for unrepaired acyanotic CHD. Nevertheless, with the new changes in the guidelines, more prospective studies are needed to investigate the incidence of IE in such lesions, before long-term conclusions can be drawn.

Polymorphisms in the regulatory region of the CCR5 gene affect protein expression and modulate the progress of HIV-1 disease. Because of this prominent role, variations in this gene have been under differential pressure and their frequencies vary among human populations. The CCR2V64I mutation is tightly linked to certain polymorphisms in the CCR5 gene. The current Omani population is genetically diverse, a reflection of their history as traders who ruled extensive regions around the Indian Ocean. In this study, we examined the CCR2-CCR5 haplotypes in Omanis and compared the patterns of genetic diversity with those of other populations. Blood samples were collected from 115 Omani adults and genomic DNA was screened to identify the polymorphic sites in the CCR5 gene and the CCR2V64I mutation. Four minor alleles were common: CCR5-2554T and CCR5-2086G showed frequencies of 49% and 46%, respectively, whereas CCR5-2459A and CCR5-2135C both had a frequency of 36%. These alleles showed moderate levels of heterozygosity, indicating that they were under balancing selection. However, the well-known allele CCR5!32 was relatively rare. Eleven haplotypes were identified, four of which were common: HHC (46%), HHE (20%), HHA (14%) and HHF*2 (12%).

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem (1 g every 8 hours), moxifloxacin (400 mg once daily), and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions.

Durations of monthly precipitation wet and dry spells are calculated using historical records and regional climate model (RCM) simulations for the Wadi Al-Lith basin in western Saudi Arabia. The characteristics of durations of wet and dry spells are based on the 50% risk level corresponding to the monthly records for average regional precipitation. The duration of wet spells in the model data is compared with observations for the base period 1971–2000. The impact of climate change on the durations of wet and dry spells is obtained using three global climate models projections with RCP4.5 and RCP8.5 scenarios downscaled by RCM. The probability distribution functions (PDFs) of the climate model scenarios and the precipitation records for the base period prove that climate change has a clear impact on the durations of wet and dry spells over the study area. There is an increase in wet spells frequency in the far future (2070–2099) compared to the near future (2020–2049). The increase in wet spells can be partly explained by the increase in extreme rainfall events and by the decrease in dry spells expected to occur over the study area towards the end of 21st century.

Objectives: Most of the morbidity and mortality in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) result from opportunistic infections (OIs). Although the spectrum of OIs in HIV infected patients from developing countries has been reported, there is a paucity of data on the natural history, pattern of disease, and survival of hospitalised patients with HIV/AIDS, particularly in Arab countries. The aim of this study was to study retrospectively the spectrum and frequency of various OIs in a cohort of hospitalised HIV-infected Omani patients. Methods: Included in the study were 77 HIV-infected Omani patients admitted to a tertiary care teaching hospital in Muscat, Oman, between January 1999 and December 2008. They were diagnosed on their first admission and hence were not on highly active antiretroviral therapy (HAART) at presentation. The frequency of various clinical and laboratory findings and individual OIs were analysed. Results: In total, 45 patients (58%) had one or more AIDS-defining OIs. Pneumocystis jiroveci pneumonia (PCP) was commonest (25%), followed by cryptococcal meningitis (22%), cytomegalovirus (CMV), retinitis (17%), disseminated tuberculosis (15%), and cerebral toxoplasmosis (12.5%). Only one patient with Mycobacterium avium-intracellulare (MAI) was identified and one patient had disseminated visceral leishmaniasis. The majority of patients (77%) had CD4+ counts

Two experiments on the rearing of the spiny lobster Panulirus homarus were conducted in land-based tanks at Mirbat Aquaculture Unit from June to December 2009 and January-December 2010. In the first experiment 14 lobsters with an average size of 64.9±7.4 mm CL and weight of 297.8±98.0 g were reared to an average of 71.7±7.2 mm CL and weight of 384.0±114.8 g over 187 days. In the second experiment 45 lobsters were reared from an initial length of 45.4±4.6 mm CL and weight of 118.9 g to a length 66.0±7.1 mm CL and a weight of 304.1 g over 335 days. Total length increment was 45.8% and weight increment 155.1%. The daily food ration was 3.0-8.8%. The survival rate in the first experiment was 92.9%, in the second experiment it was also high (86.7%) during the first six months. In both experiments males grew faster than females. While the water temperature, pH, salinity and dissolved oxygen reflected the ambient condition of the Arabian Sea, these were not optimal levels for lobsters culture. The salinity was higher (37.5 ppt), while the water temperature was low (

Oysters are commonly found on rocky shores along the Dhofar coast of Oman, but the species composition has not yet been studied. In an attempt to determine the species of these oysters, samples from four sites (Mirbat, Sadah, Hadbin, and Hasik) were collected and analyzed using DNA sequences that were compared with the database of GenBank/National Center for Biotechnology Information (NCBI) and Barcoding of Life Data Systems (BOLD). BLAST results of DNA sequences showed that there were no existing sequences available on NCBI/GenBank and BOLD. The DNA barcode sequences generated in this study can be employed as standards for this species and may be of use in taxonomic studies. Phylogenetic analysis demonstrated that the oysters from Oman exhibit homology with Saccostrea species cucullata or mordax.

Surveys were conducted along the eastern Dhofar coast of Oman to investigate densities and habitat preferences of juvenile Haliotis mariae (< 3 cm SL). Average density was 0.62 m-2 (SD 0.56); average urchin density was 3.4 urchins m-2 (SD 3.9). Relationships between juvenile abalone densities and small boulders ( 50 cm Ø, respectively. B values were highest for urchins (6 times that for small boulders), and for boulders

Immune reconstitution inflammatory syndromes (IRIS) in patients with acquired immune deficiency syndrome (AIDS) are characterised by atypical manifestations of opportunistic pathogens. These occur in patients experiencing improvement in CD4 cell counts following receipt of highly active anti-retroviral therapy (HAART). Although well established as a syndrome, IRIS still presents challenges in diagnosis and management. We report five cases of IRIS with diverse clinical presentations and due to different infectious aetiologies. A review of the published literature on this syndrome is also included.

We present the case of a 37 year-old female who had disseminated tuberculosis (TB) with bilateral adrenal involvement resulting in primary adrenal failure (Addison’s disease) with refractory hyponatraemia and possible extrapontine ‘myelinolysis’. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB.

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Varicella zoster infections are considered to be mild and ubiquitous infections predominantly affecting the paediatric population. However, in adults and in specific groups of patients, such as those who are immunosuppressed, varicella infections can be fulminant and life threatening. We here present a case report of a young female patient with a normal immune system who had a fulminant varicella infection with multiorgan involvement.

Objectives: Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum β-lactamase (ESBL) isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital (SQUH), Oman. Methods: During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed . Results: 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine (46.2%) and blood (42.6%). The main risk factors for ESBL in these children were previous exposure to antimicrobials (100%), prolonged hospital stay, severe illness (92.3%) and female gender (84.6%). Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin. Conclusion: ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives.

This study aims to comprehend the propagation of meteorological drought [expressed by the standardized precipitation evapotranspiration index (SPEI)] into hydrological drought [expressed by the standardized runoff index (SRI)] using the combined application of principal component analysis (PCA) and wavelet analysis for a period of 39 years (1980–2018) in the Indus basin, Pakistan. PCA was used to calculate principal components of precipitation, temperature, and streamflow, which were used to systematically propagate drought from one catchment to another, resulting in a catchment-scale drought assessment. The systematic propagation of drought was useful in capturing the effects of local climate variability in the 27 catchments of the Indus basin. Wavelet analyses are used to calculate the variability of SPEI/SRI and propagation (analyzed with the wavelet coherence) from SPEI to SRI. The propagation time from SPEI to SRI was cross correlated. SPEI/SRI time series showed extreme/severe droughts in 16 out of the 39 years, where relatively weak apparent wet and drought events are observed at short periods (1 month) and apparent at longer periods (6 and 12 months). Propagation from SPEI to SRI is catchment specific, with most catchments showing transition in early years (1997–2003). Propagation rate is higher in the upper Indus basin (UIB) and lower Indus basin (LIB) than in the middle Indus basin (MIB), suggesting that climate plays an important role in drought development and propagation. Results also showed a shorter and longer propagation time in the UIB and LIB, respectively. This study has helped us understand the behavior of droughts at catchment scale and will therefore help in the development of drought mitigation plans in Pakistan and similar regions around the world. [ABSTRACT FROM AUTHOR]

The impact of drought on environmental flow (EF) in 27 catchments of the Indus basin is studied from 1980-2018 using the Indicators of Hydrologic Alterations (IHA). Standardized Precipitation Evapotranspiration Index (SPEI) was systematically propagated from one catchment to another using principal component analysis (PCA). Threshold regression is used to determine the severity of drought (scenario-1) and month (scenario-2) that trigger low flows in the Indus Basin. The impact of drought on low EFs is quantified using Range of variability analysis (RVA). Hydrological alteration factor (HAF) is calculated for each catchment in the Indus basin. The results show that most of the catchments are vulnerable to drought during the periods 1984-1986, 1991/1992, 1997 to 2003, 2007 to 2008, 2012 to 2013, and 2017 to 2018. On a higher time scale (SPEI-12), drought is more severe in Lower Indus Basin (LIB) than the Upper Indus Basin (UIB). IHA pointed out that drought significantly impacts the distribution of environmental flow components, particularly extreme low flow (ELF) and low flow (LF). The magnitude and frequency of the ELF and LF events increase as drought severity increases. The threshold regression provided useful insights indicating that moderate drought can trigger ELF and LF at shorter time scales (SPEI-1 and SPEI-6) in the UIB and Middle Indus Basin (MIB). Conversely, severe and extreme drought triggers ELF and LF at higher time scales (SPEI-12) in LIB. The threshold regression also divided the entire study period (1980-2018) into different time zones (scenario-2), which is useful in quantifying the impact of drought on low EFs using the SPEI coefficient. Higher SPEI coefficients are observed in LIB, indicating high alterations in EF due to drought. HAF showed high alterations in EF in most of the catchments throughout the year except in August and September. The alterations are subject to several factors, including climate change, seasonality of the river flow, land use changes, topography, and anthropogenic activities. Overall, this study provided useful insights for analyzing the effects of drought on EF, especially during low flows. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the pattern of viral infections in infants and children admitted to the Paediatric Intensive Care Unit (PICU) at Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: A retrospective review of patient records was carried out on all patients admitted to the PICU between January 2011 and December 2012. In order to detect viruses, polymerase chain reaction (PCR) technology was used to detect viruses in nasopharyngeal aspirates, tracheal aspirates, plasma, stool and urine samples. All infants and children below 13 years old, who were admitted to the PICU at SQUH during the study period and with confirmed viral infections, were included in the study. Results: A total of 373 infants and children were admitted to the PICU during the study period. Viruses were detected in 34 patients. The most frequently detected viruses were cytomegalovirus (CMV) in 29.4%; this virus was noted predominantly in immuncompromised patients (80%, P = 0.023) and was associated with increased mortality (50%, P = 0.031) and prolonged PICU stay (70%, P = 0.045). Fatalities before discharge were recorded in 23.5% of the patients. The most frequent risk factors for viral infections were an age of