World Malaria Day : Our story with malaria in Oman

N

The role of non-ionic surfactant vesicles on the course of Plasmodium chabaudi chabaudi as infection in BALB/c mice

The pro-inflammatory cytokine, TNFalpha has been linked with several patologies like malaria, toxic shock and rheumatoid artheritis. Moreover the circulating levels of TNFalpha have been shown to correlate positively with disease severity in both murine and human malaria. Among clinical features thought to be produced by TNFalpha are fever and cachexia. TNFalpha, however, has also been shown to play a protective role in malaria. Indeed protection against the asexual stages of the murine malaria Plasmodium chabaudi chabaudi AS has been shown to depend on the sequential appearance of Thl and Th2 cell functions with the Thl stimulation leading to the early production of TNFalpha through activation of macrophages by IFN? released from the Thl cells. This indicates, therefore, that certain levels of this cytokine are essential for protection but excessive levels are detrimental to the host. Various methods have been used to suppress excessive levels of circulating TNFalpha levels in various pathologies. These include, the use of anti TNFalpha monoclonal antibodies and the use of soluble TNFalpha receptors. In the studies presented here, a new method for suppressing circulating TNFalpha was investigated. It involves the use of empty non-ionic surfactant vesicles (NISV) which had been shown previously to cause a less degree of weight loss in Toxoplasma gondii-infected mice than infected but untreated mice. Since high circulating TNFalpha levels have been shown to be linked with cachexia, the mechanism suggested for the reduced weight loss in the T. gondii-infected mice was the possibility that empty NISV were suppressing the release of TNFalpha from the activated macrophages. In the present studies, empty NISV were used in P. chabaudi chabaudi AS-infected mice to investigate their potential in reducing the amount of weight loss caused by this particular infection. It was also investigated in these studies the hypothesis that the reduced weight loss was due to suppression of the TNFalpha production by NISV from the macrophages and the mechanisms involved in this suppression. (Abstract shortened by ProQuest.)

Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion Despite Treatment with Appropriate Antimicrobials: Case report

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. The pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.Keywords: Mycoplasma pneumoniae; Bacterial Pneumonia; Pleural Effusion; Antimicrobial Agents; Drainage; Case Report; Oman

World Malaria Day: Our story with malaria in Oman

N

Infective Endocarditis of the Aortic Valve caused by Pseudomonas aeruginosa and Treated Medically in a Patient on Haemodialysis

Infective endocarditis (IE) in patients on dialysis is a serious infection with a high mortality rate. It is usually caused by Gram positive bacteria with Gram negative organisms being relatively rare as a cause. Recommended treatment usually involves surgical valve replacement and the extended use of antibiotics. Successful treatment with antibiotics alone is rare. We report a case of IE caused by Pseudomonas aeruginosa in a patient on dialysis treated solely with antibiotics

Clinical Presentations of Brucellosis Over a Four-Year Period at Sultan Qaboos University Hospital and Armed Forces Hospital, Muscat, Oman

Objectives: Brucellosis is a highly contagious zoonotic disease which can have serious health implications for affected humans and livestock. This study aimed to evaluate the clinical presentation, geographical distribution and risk factors of brucellosis cases admitted over a four-year period to two hospitals in Muscat, Oman. Methods: This observational study was conducted from January 2015 to December 2018 at the Sultan Qaboos University Hospital and Armed Forces Hospital in Muscat. All patients with probable or definitive diagnoses of brucellosis according to the diagnostic criteria of the World Health Organization were included. Relevant data were gathered from the patients’ medical records, including results from standard agglutination tests, Brucella enzyme-linked immunosorbent assays, bacterial blood or tissue/aspirate cultures and Brucella polymerase chain reaction tests. Results: A total of 64 patients were diagnosed with brucellosis over the study period. The median age was 31.5 years and 73.4% were male. The majority (95.2%) presented with fever, followed by weight loss (51%), transaminitis (48.4%), peripheral arthritis/arthralgia (15.9%) and back pain (spondylodiscitis/sacroiliitis; 23.4%). Overall, 75.5% reported having consumed raw dairy products, while only 25.9% gave a positive history of animal contact. Conclusion: Patients with brucellosis presented with a wide range of clinical features, the most predominant of which was fever. The majority of patients were residents of or had recently visited Salalah and had consumed raw dairy products. These findings highlight the need for healthcare practitioners to maintain a high index of suspicion for this diagnosis. Moreover, further regulatory measures are necessary to oversee the sale of raw/unpasteurised dairy products. Keywords: Brucellosis; Bacterial Infections; Zoonotic Bacterial Infections; Risk Factors; Epidemiology; Oman

Diagnostic Value of Electrocardiographic T Wave Inversion in Lead aVL in Diagnosing Coronary Artery Disease in Patients with Chronic Stable Angina

Objectives: The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease (CAD) remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina.Methods: Electrocardiograms (ECGs) of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded (66 patients). The remaining 191 patients constituted the study population. Detailed ECG interpretation and coronary angiographic findings were conducted by experienced cardiologists.Results: T wave inversion in aVL was identified in 89 ECGs (46.8%) with definite ischemic Q-ST-T changes in different leads in 97 ECGs (50.8%). Stand alone aVL T wave inversion was found in 27 ECGs (14.1%) while ischemic changes in other leads with normal aVL were identified in 36 ECGs (18.8%). The incidence of CAD was 86.3%. Single, two- and multi-vessel CAD were found in 38.8%, 28.5% and 32.7% of cases respectively. The prevalence of left main, left anterior descending, left circumflex and right coronary arteries were 4.7%, 61.2%, 29.3% and 44.5%, respectively. T wave inversion in aVL was found to be the only ECG variable significantly predicting mid segment left anterior descending artery (LAD) lesions (Odds Ratio 2.93, 95% Confidence Interval 1.59-5.37, p=0.001).Conclusion: This study provides new information relating to T wave inversion in lead aVL to mid segment LAD lesions. Implication of this simple finding may help in bedside diagnosis of CAD typically mid LAD lesions. However, further studies are needed to corroborate this finding