Complicated subacute bacterial endocarditis in a patient with ventricular septal defect

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

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women [51.9%] reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy

Antimicrobial agent prescription patterns for chemotherapy-induced febrile neutropenia in patients with hematological malignancies at Sultan Qaboos University Hospital, Oman

The aim of this study was to describe the antimicrobial prescription patterns of patients with hematological malignancies who developed febrile neutropenia [FN] at Sultan Qaboos University Hospital [SQUH] in Oman. This was a retrospective observational study covering a period of 3 years [January 2007-February 2010]. FN episodes were studied in patients with hematological malignancies in three different wards at SQUH. A total of 176 FN episodes were analyzed. Overall, 64% of the 107 patients studied experienced at least 2 episodes during the analysis period. Approximately, 69% of the febrile neutropenia episodes had severe neutropenia. The duration of neutropenia was less than 1 week in the majority of the episodes [57%]. The mean duration of treatment was approximately 7 days, with no significant difference between specialties or different types of malignancies. Only 34 [19%] episodes had positive cultures, and most of these were from blood samples [30 episodes, 88%]. The majority of isolates were gram-negative organisms [63%]. The initial empirical treatment included monotherapy [37%], dual therapy [60%] and triple therapy [3%]. This study demonstrates that there is a large variation in the antimicrobial treatment of FN episodes in patients with hematological malignancies at SQUH. All chosen drugs were within international guideline recommendations

Spectrum of AIDS defining opportunistic infections in a series of 77 hospitalised HIV-infected Omani patients

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. 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. 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 <200 cells/ micro L. Ten patients [22%] died during hospital stays, with five deaths [50%] being caused by disseminated CMV infection. A wide spectrum of OIs is seen in hospitalised HIV-infected patients in Oman. P. jiroveci pneumonia and cryptococcal meningitis were the commonest OIs, while disseminated CMV was the commonest cause of death. We hope these results will advance the knowledge of specialists treating HIV in Oman and the Gulf region

importance of HIV antenatal screening programs for pregnant women

To investigate retrospectively the prevalence of human immunodeficiency virus [HIV]-1 and among pregnant women during a 10-year period. The total number of pregnant women attending the Sultan Qaboos University Hospital [SQUH]. Muscat, Oman between January 1995 and December 2005 was 11553 women. Their age range was 16-45 years [average of 28.6 +/- 7.6 years]. The women were tested for HIV- 1 and 2 using the standard enzyme-linked immunosorbent assay [ELISA]. Positive samples were further tested by Western Blot. The data were statistically analyzed using the Statistical Package for Social Sciences Version 10.0. By ELISA testing, 21 women were positive for HIV-1 [prevalence rate: 0.2%] and 3 women were weakly positive for HIV-1 [24 women; 0.2% prevalence rate]. However, 15 women were confirmed HIV- 1 positive using the Western Blot method [prevalence rate: 0.13%] with an average of 1.5 positive women per year. None of the women were found positive for HIV-2. This relatively high prevalence of HIV-1 among pregnant women attending SQUH, highlights the need for screening all pregnant women attending different hospitals and antenatal clinics in Oman. This is essential for preventing the transmission of HIV-1 and 2 to the infants and to the community, and for the appropriate medical treatment and counseling of affected women