Nature of bacteria found on some wards in Sultan Qaboos University Hospital, Oman.

This study aims to determine what objects lying in the hospital environment or brought in from outside contribute to the introduction of bacteria associated with nosocomial infections. One hundred swab specimens collected from children's toys, sinks, door handles, telephone handsets and flowers brought into the hospital were plated on different culture media. Colonial growth on the media was purified and identified subsequently using standard bacteriological methods. Of the 100 samples cultured, 61 (61%) grew a range of bacteria including Pseudomonas aeruginosa (n=14, 23.0%), Acinetobacter spp. (n=13, 21.3%), Serratia spp. (n=9, 14.7%), Staphylococcus epidermidis (n=9, 14.7%), Stenotrophomonas maltophilia (n=4, 6.6%), Staphylococcus aureus (n=4, 6.6%), Enterobacter cloacae (n=3, 4.9%), Pantoea sp. (n=2, 3.3%), Chryseobacterium sp. (n=2, 3.3%) and Klebsiella pneumoniae (n=1, 1.6%). Although all the Serratia, Enterobacter, Klebsiella and Pantoea species isolates showed varying degrees of resistance to gentamicin, ceftriaxone, cefuroxime and cefotaxime, all were resistant to ampicillin. Chryseobacterium and Stenotrophomonas species isolates were resistant to amikacin, imipenem, gentamicin and ceftazidime, to which only three isolates of Pseudomonas species were resistant. All the staphylococcal isolates were susceptible to methicillin. Although there has been no major outbreak of a nosocomial infection in the hospital, it is strongly recommended that effective control measures (e.g., sampling the hospital water supply, disinfecting children's toys, use of appropriate hand washing and checking some of the disinfectants for presence of bacteria) are needed. These measures are necessary to ensure that the antibiotic-resistant strains identified in this study are not allowed to spread in the hospital.

Case report. Successful outcome of invasive nasal sinus zygomycosis in a child with relapsed acute lymphoblastic leukaemia due to liposomal amphotericin B.

We report a case of life-threatening nasal sinus zygomycosis that developed during remission induction therapy for a relapsed acute lymphoblastic leukaemia. The patient was successfully treated with liposomal amphotericin B and granulocyte-colony stimulating factor followed by surgical reconstruction of the resultant cutaneous defect.

Orbital involvement in sickle cell disease: a report of five cases and review literature.

PURPOSE: To present five cases of orbital infarction in sickle cell disease and review relevant literature. METHOD: We reviewed the hospital records of 5 patients with sickle cell disease who developed a periorbital swelling during a vaso-occlusive crisis and were managed at our hospital between April 1992 and June 2000. RESULTS: The 5 patients (4 with homozygous sickle cell disease and 1 with sickle cell-beta-thalassaemia disease) were aged 6-15 years with a history of multiple admissions for vaso-occlusive crises. The periorbital swelling spread to the orbit in 4 cases and resulted in proptosis (2 cases), restriction of ocular motility and visual impairment. In all 4 cases, computed tomography and/or magnetic resonance imaging of the orbits showed a mass adjacent to the orbital wall. In 2 cases the mass was identified as a haematoma. Orbital wall infarction was demonstrated in 3 cases by bone/bone marrow scintigraphy. Epidural haematomas were detected by computed tomography in one case. All patients received intravenous fluids, analgesics, broad spectrum antibiotics and steroids, as well as simple or exchange transfusion, and responded well to medical management. CONCLUSIONS: Infarction of orbital bones during vaso-occlusive crises in sickle cell disease presents acutely with a rapidly progressive periorbital swelling. Haematomas frequently complicate the condition and, along with the inflammatory swelling, may lead to orbital compression syndrome. The condition is therefore sight-threatening, and necessitates prompt diagnosis and appropriate management for resolution without adverse sequelae. Imaging techniques are invaluable in the evaluation of patients. The majority of cases resolve with conservative treatment that includes steps to combat the vaso-occlusive crisis and use of systemic steroids under antibiotic cover.

A community-based study of common hereditary blood disorders in Oman.

We assessed the prevalence of three common hereditary blood disorders (sickle-cell and beta-thalassaemia traits and glucose 6-phosphate dehydrogenase deficiency) among the Omani population. We interviewed a representative sample of 6103 Omani households and blood samples from 6342 children aged 0-5 years were collected. About 27% of Omani males had inherited glucose-6-phosphate dehydrogenase deficiency (compared with 11% of females) while countrywide prevalence rates for the sickle-cell and beta-thalassaemia traits were estimated to be 5.8% and 2.2% respectively and showed no significant gender differences. There was a significant association between all three disorders and region of the country.

A community-based study of common hereditary blood disorders in Oman

We assessed the prevalence of three common hereditary blood disorders [sickle-cell and beta-thalassaemia traits and glucose 6-phosphate dehydrogenase deficiency] among the Omani population. We interviewed a representative sample of 6103 Omani households and blood samples from 6342 children aged 0-5 years were collected. About 27% of Omani males had inherited glucose-6-phosphate dehydrogenase deficiency [compared with 11% of females] while countrywide prevalence rates for the sickle-cell and beta-thalassaemia traits were estimated to be 5.8% and 2.2% respectively and showed no significant gender differences. There was a significant association between all three disorders and region of the country

Cardiovascular function in Omani children with sickle cell anaemia.

Systolic murmurs were detected in 22 (61%) of the 36 children with sickle cell anaemia (SCA) who completed the study. Cardiomegaly was detected in 14 (39%). Mean values of left and right ventricular dimensions were higher in SCA than in controls (p < 0.05). Left atrial chambers and aortic root dimensions followed the same pattern. The dilated cardiac chambers in SCA were not associated with any abnormality in systolic or diastolic left ventricular function nor with significant pulmonary hypertension.

Adenotonsillar hypertrophy: a precipitating factor of cerebrovascular accident in a child with sickle cell anemia.

Cerebrovascular accident is one of the most serious complications of sickle cell anemia. The specific factors that predispose patients with sickle cell anemia to stroke are increased disease severity, higher baseline white blood cell count and lower baseline hematocrits. Likewise the presence of a co-existent alpha thalassemia trait and/or high fetal hemoglobin (HbF%) may reduce the risk. We report a child with sickle cell anemia and marked adenotonsillar hypertrophy resulting in obstructive sleep apnea syndrome. There was no other known risk factor for developing cerebrovascular accident in this child during her hospitalization for adenotonsillectomy.

Munchausen syndrome by proxy.

Five children (3F:2M), in the age group 1 years to 11 years, with Munchausen syndrome by proxy are reported from the Sultanate of Oman. They were seen over a four years period from 1996-1999. In all these children, the mother came up with history of uncontrolled epilepsy. Carbamazepine was the most common antiepileptic drug used. One of these children remained hospitalized elsewhere for nearly 9 months, as a case of uncontrolled status epilepticus. It took 18 months to 6 years (mean 2.8 years) to establish the diagnosis and the mother was the offender in all. The main lead to diagnosis, was the disparity between history and clinical presentation to hospital. The carbamazepine levels were several times above the upper limit of therapeutic range. Munchausen syndrome by proxy very much exists here, but is possibly less recognized and needs immediate attention to formulate policies to identify and manage these children. It is necessary to create awareness even in the medical community, to recognise this problem. There is an urgent need to develop a child protection council at the national or regional level.

Munchausen syndrome by proxy.

Five children (3F:2M), in the age group 1 years to 11 years, with Munchausen syndrome by proxy are reported from the Sultanate of Oman. They were seen over a four years period from 1996-1999. In all these children, the mother came up with history of uncontrolled epilepsy. Carbamazepine was the most common antiepileptic drug used. One of these children remained hospitalized elsewhere for nearly 9 months, as a case of uncontrolled status epilepticus. It took 18 months to 6 years (mean 2.8 years) to establish the diagnosis and the mother was the offender in all. The main lead to diagnosis, was the disparity between history and clinical presentation to hospital. The carbamazepine levels were several times above the upper limit of therapeutic range. Munchausen syndrome by proxy very much exists here, but is possibly less recognized and needs immediate attention to formulate policies to identify and manage these children. It is necessary to create awareness even in the medical community, to recognise this problem. There is an urgent need to develop a child protection council at the national or regional level.

Localized cisplatin hyperpigmentation induced by pressure. A case report.

BACKGROUND: The spectrum of side effects induced by chemotherapy includes skin hyperpigmentation. This is prone to occur following treatment with alkylating agents and doxorubicin. More recently, hyperpigmentation was discovered in patients treated exclusively with intra-arterial cisplatin and was likely to develop over the dorsal surfaces of the hands and feet, elbows and knees, and operative incisions (trauma). METHODS: We followed the clinical course of a patient with osteosarcoma treated with intravenous (i.v.) cisplatin, doxorubicin, and high-dose methotrexate. RESULTS: Following two courses of chemotherapy, hyperpigmentation developed along the sides of the thorax juxtaposed to the rubber shoulder pads of the patient's crutches. It appeared that the pigmentary change was due to localized pressure in the skin of the patient exposed to i.v. cisplatin. CONCLUSIONS: Factors associated with skin hyperpigmentation as a complication of chemotherapy are discussed. We believe that cisplatin was the major contributing factor. The mechanism for cisplatin-induced hyperpigmentation is undetermined. However, it has occurred in patients treated exclusively with intra-arterial cisplatin and can possibly be attributed to an effect on the melanocytes. / This is supported by experiences in which cisplatin extravasated into the tissues and resulted in a similar phenomenon. Reasons for excluding doxorubicin and methotrexate as causative agents are presented.

Acute urticaria and hepatitis complicating high-dose methotrexate therapy.

We report an unusual case of anaphylaxis and hepatitic dysfunction in a child with the administration of the twenty-third course of high-dose methotrexate. The latter had been used as an adjuvant to prevent pulmonary metastases and the prior 22 courses had been well tolerated. An attempt to reinstate methotrexate after the twenty-third course was again followed by a similar reaction.

Malignant tumours in Omani children.

In an effort to understand better the epidemiology of childhood cancer in Oman, a retrospective review of hospital-based biopsy-proven malignant tumours was undertaken. A total of 313 cases of malignant diseases in children between the ages of 0 and 12 years were diagnosed in Oman during the 5-year period from January 1988 to December 1992, inclusive. Leukaemias were the most commonly occurring malignancies (32.3%), followed by lymphomas (29%) and brain tumours (11.2%). The male:female ratio was 1.3:1. The commonest presenting age group was 2 years, the majority of which were leukaemias and lymphomas. Differences and similarities between Omani data and those from other countries are discussed.

A community-based study of childhood handicap in Oman.

This paper reports the findings of a preliminary survey carried out in an Omani community to assess the prevalence of handicap amongst children, and its impact on the family. The sample comprised of 492 children less than 15 years of age. The disabilities identified related to chromosomal abnormality, genetic, perinatal, and infectious factors. The presence of mental retardation, with associated social taboos, confounds the problem in Oman. The study showed that, although some handicapped children may be accepted within the family, there was a sense of shame and rejection vis-à-vis the community. The prevalence of 2 per cent is only the tip of the iceberg. The study defines the sociocultural aspects of the Omani society which are conducive to the perpetuation of this important health and social problem.