Epigenetic modifications, particularly DNA methylation, is commonplace and a remarkable factor in carcinogenesis transformation. Conspicuously, previous findings have presented a cluster of irregular promoter methylation alterations related with silencing of tumor suppressor genes, little is accepted regarding their sequential DNA methylation (hypo and hyper) modifications during the cancer progression. In this way, fluctuations of DNA methylation of many genes, especially MYC, SMAD2/3, and DNMT3A, have an impressive central key role in many different cancers, including colorectal cancer (CRC). CRC is distinguished by DNA methylation, which is related to tumorigenesis and also genomic instability. Importantly, molecular heterogeneity between multiple adenomas in different patients with CRC may show diverse developmental phenotypes for these kinds of tumors. Conclusively, studying factors that are involved in CRC carcinogenesis, especially the alterations in epigenetic elements, such as DNA methylation besides RNA remodeling, and histone modification, acetylation and phosphorylation, can be influential to find new therapeutic and diagnostic biomarkers in this type of malignancy. In this account, we discuss and address the potential significant methylated modifications of these genes and their importance during the development of CRC carcinogenesis.

Objectives: Escherichia coli (E. coli)-induced urinary tract infection (UTI) is a common infection associated with frequent use of antibiotics and the increase in global antibiotic resistances. We aimed to determine the susceptibility profile of extended-spectrum β-lactamase (ESBL) producing E. coli isolated from the urinary samples to fosfomycin and other antibiotics. Methods: We retrospectively analyzed urine samples with ESBL-producing E. coli isolates obtained between January 2018 and December 2019 in the Microbiology Section, Salmaniya Medical Complex, Bahrain. We collected and analyzed all the E. coli urinary isolates’ data and their antibiotic susceptibility patterns. Results: The study included 3044 E. coli isolates with 50.6% obtained in 2018 and 49.4% in 2019; 38.1% (1161 isolates) were ESBL E. coli, and 0.7% (21 isolates) were carbapenem-resistant Enterobacteriaceae (CRE). There were 1161 (38.1%) isolates with ESBL-producing E. coli, with 37.3% isolated in 2018 and 39.0% isolated in 2019. The antibiotic susceptibility of ESBL-producing E. coli during the study period showed susceptibility to trimethoprim/sulfamethoxazole in 46.1% of isolates (50.2% in 2018 dropped to 41.9% in 2019), to ciprofloxacin in 49.0% of isolates (49.5% in 2018 dropped to 48.4% in 2019), to nitrofurantoin in 91.8% of isolates (94.3 in 2018 dropped to 89.3% in 2019), and to fosfomycin in 97.6% of isolates (98.8% in 2018 dropped to 96.3% in 2019). Conclusions: ESBL-producing E. coli is an important cause of UTI in Bahrain. Fosfomycin is a very effective oral antimicrobial that retains high efficacy against ESBL-producing E. coli, which helps decrease the need for parenteral therapy and, consequently, hospitalization.

Keywords: Urinary Tract Infections; Escherichia coli; Fosfomycin; Bahrain.

Objectives: Despite the worldwide increase in health research, few studies have evaluated the health research productivity in member states of the Gulf Health Council (GHC). This study solicited the period-prevalence and publication rates of health research productivity in the seven GHC countries. Methods: We searched the Scopus database for publications between 1996 and 2018 and used the SCImago Journal and Country Rank portal to obtain the relevant information. We also recorded qualitative (citation-based) and quantitative (document recount) indicators. Overall and country-specific period-prevalence and publication rates were estimated and standardized to the corresponding overall Gulf Cooperation Council (GCC) population and country-specific population size. Results: Overall, 112 409 articles were enumerated during the study period. The majority (59.8%) were from Saudi Arabia, followed by UAE (11.9%). The GCC publications were associated with 1 315 778 citations, which revealed a 46.0 Hirsch-index. The period-prevalence of health publications for the overall GCC region was 1320 publications per million population over 22 years, and the publication rate estimate was 13.2 (95% confidence interval (CI): 13.1–13.3) publication per 10 000 population. The highest publication rate estimate was noted in Qatar (36.5; 95% CI: 35.8–37.3), followed by Kuwait, Bahrain, Saudi Arabia, UAE, Oman, and Yemen. Conclusions: This study is the first study in the context of GCC to utilize period-prevalence and publication rates to chart health research productivity in the GCC region. Concerted efforts are required to improve the quality and quantity of the health research output in the GCC region.

Keywords: Publications; Gulf Cooperation Council; Health research; Period-prevalence.

Objectives: Multiple sclerosis (MS) is a disabling neurological disorder with significant adverse effects on patients’ quality of life (QoL). Despite the increased prevalence of MS in Arabian Gulf countries in recent years, no study has assessed the impact of MS on the health-related QoL (HRQoL) of Omani patients. Therefore, the objective of this study was to determine the impact of MS on HRQoL of Omani patients using the validated disease-specific self-administered MS International QoL (MusiQoL) instrument. Methods: We conducted a descriptive cross-sectional survey between April and December 2019 on 177 Omani patients with MS attending Sultan Qaboos University Hospital and Khoula Hospital in Oman using the MusiQoL instrument. Results: The majority (51.4%) of patients had poor HRQoL, and 48.6% had moderate HRQoL. We found that being > 30 years, female, married, separated, widowed, or divorced, and having visual and sleep problems resulted in poorer HRQoL scores. Among the different HRQoL components, relationships with the healthcare system and relationships with family and friends were the most affected by the disease process. Our results also showed that psychological wellbeing and coping domains of MusiQoL questionnaires are significantly reduced in females compared to males. Conclusions: Understanding the HRQoL of Omanis with MS provides valuable knowledge that could help optimize the management of this disease.

Keywords: Quality of Life; Multiple Sclerosis; Cross-Sectional Studies; Surveys and Questionnaires; Oman.

Objectives: We sought to study the epidemiology of drowning among children reported at Sultan Qaboos University Hospital in Oman. Methods: We conducted a retrospective study of the patients who presented to the emergency department with a history of drowning over 10 years from January 2008 to December 2017. Patients with children aged one to 18 years old were included in the study. The data including demographics, timing and location of drowning, season, adult supervision, swimming ability, medical risk factors, duration of submersion, on spot resuscitation, emergency medicine department assessment, and hospital management and outcome were collected from electronic hospital information system using a preformed proforma. The outcome was categorized into either full recovery, severe neurological injury, or brain death based on the pediatric cerebral performance category (PCPC). A good outcome represents a score of 1–3 points, and a PCPC of 4–6 points corresponds to a poor outcome. We calculated correlation for all variables with the outcome by using chi-square and Fisher’s exact tests. A p-value of < 0.050 is taken as significant value. Results: A total of 74 patients were included in the study; 54 (73.0%) were male, and 47 (63.5%) were aged < 6 years old. More than half (59.4%) of drownings happened in swimming pool, 21 (28.4%) children were unsupervised during the incident, and 39 (52.7%) required cardiopulmonary resuscitation (CPR). Out of all studied subjects, three (4.1%) were brain dead, and two (2.7%) developed severe neurological injury. On univariate analysis, the following variables were statistically significant (p < 0.050), predicting the poor outcome like lack of adult supervision, duration of submersion >10 minutes, asystole, Glasgow Coma Scale < 8, temperature < 35 oC, pH < 7, anion gap > 20, blood glucose > 10 mmol/L, abnormal chest X-ray findings, rewarming, CPR, intubation, inotropic support, and pediatric intensive care unit admission. Conclusions: Our study suggests that children, especially males under the age of six with no swimming ability, need strict supervision next to bodies of water. Furthermore, preventive measures might include raising community awareness about the risk factors of drowning, commencing public CPR lessons, and strict pool safety regulation by related authorities.

Keywords: Drowning; Emergency Medicine; Intensive Care Units; Pediatrics; Oman.

Objectives: We sought to investigate the prevalence of HIV in pregnant women and the maternal, obstetrical, and neonatal outcomes over 13 years (2005–2017) at Sultan Qaboos University Hospital, a tertiary hospital in Muscat, Oman. Methods: Our study design was a retrospective descriptive cross-sectional study of HIV-positive women in the department of obstetrics and gynecology. We had an unlimited sample size due to the rarity of the disease. We aimed to include all pregnant Omani women who tested positive for HIV in their antenatal screening from 1 January 2005 to 31 December 2017. The patient records were reviewed using the hospital information system service. Results: There were a total of 13 688 women with 104 281 pregnancies over the study period. The prevalence of Omani pregnant women with HIV was 0.1% (1:1000) with 0.03% of seropositive pregnancies (3:10 000). Of these seropositive pregnancies, 78.6% were known HIV carriers, while 21.4% were newly diagnosed cases. The live birth rate was 90.3%, with 9.7% resulting in miscarriage. All the miscarriages were to known HIV-positive mothers who were managed in accordance with international guidelines. Of the live births, 10.7% were unknown HIV-positive mothers with a mean gestational age of 39.67 weeks and a mean birth weight of 3.2 kg. The rate of mother-to-child transmission (MTCT) of HIV in this group was 33.3%. In contrast, 89.3% of the live births to known HIV-positive mothers delivered neonates with a mean gestational age of 37.4 weeks and a mean birth weight of 2.6 kg with 0.0% MTCT. Modes of delivery, antepartum, intrapartum and postpartum complications as well as long-term neonatal outcomes were analyzed according to the status of the mother at first presentation. Conclusions: Strategies have been placed by programs in Oman to focus on the wellbeing of pregnant women and the protection of newborns against HIV infection. Strict implementations on preventing MTCT allowed preventing HIV in children possible. Antiretroviral therapy significantly reduces vertical transmission of HIV, in addition to abstinence of breastfeeding. More importantly, all HIV-positive pregnant women should follow the prevention of MTCT programs set out by the Ministry of Health.

Keywords: Infant, Newborn; Pregnancy; Cross-Sectional Studies; Infectious Disease Transmission, Vertical; HIV; Pregnant Women; Obstetrics; Oman.

Objectives: Neurocognitive dysfunction has been established in several studies in children with beta-thalassemia major (TM). However, despite its wide occurrence in populations across the Arabian Peninsula, scant attention has been paid to shedding light on neuropsychological functioning among adults with TM. This study aimed to examine the level of neuropsychological functioning among Omani adults with TM regularly followed-up at a tertiary care hospital in Oman. A related aim was to examine the factors associated with neuropsychological performance. Methods: Standard neuropsychological tests were used to measure attention and concentration, learning and remembering, verbal fluency, and executive functioning. Participants were also gauged on indices of intellectual ability and affective range. As normative data for neuropsychological functioning in Oman is scarce, healthy age- and sex-matched controls underwent the same testing procedure. The log-linear model was used to identify factors associated with TM patients on demographic and neuropsychological performance. Results: This study recruited 28 adult patients with TM (age 30.0±6.5) and 39 healthy controls (age 29.2±6.1). Findings suggested that having a diagnosis of TM was significantly associated with symptoms of depression (p < 0.001) and anxiety (p < 0.001), indices of executive functioning (verbal fluency) (p = 0.003), working memory (digit span) (p < 0.001), and verbal and auditory attention scores (California Verbal Learning, p = 0.002). Conclusions: The data appears to suggest that short-term memory capacity, verbal fluency, and verbal and auditory attention may be impaired in TM compared to controls. Studies on a larger cohort are therefore warranted.

Keywords: B-Thalassemia; Memory, Short-Term; Neuropsychological Tests; Anxiety; Cognition; Executive Function; Depression; Oman.

Objectives: We sought to identify leukemia-associated immunophenotypes (LAIPs) in 50 acute myeloid leukemia (AML) patients at diagnosis using an eight-color multiparameter flow cytometry (MFC) panel and to detect if they showed any alteration in relapsed/refractory cases. Methods: We used the eight-color MFC panel with CD45/side scatter log gating strategy to analyze LAIPs in 50 AML patients presenting to Alexandria University Hospitals, Egypt at diagnosis and relapse and refractory cases. Twenty age and sex matched bone marrow samples from patients performing bone marrow aspirate for non-malignant hematological indications were included as controls. Results: LAIPs were observed in 43 (86.0%) cases. Only one aberrant immunophenotype was identified in four cases (9.3%), while two to 12 aberrant immunophenotypes were found in the other 39 (90.7%) cases. Strong LAIPs were obtained by combining CD2, CD4, CD56, with either CD34 or CD117, in contrast to CD19, which has to be combined with CD117. Refractory cases showed the presence of the same LAIPs at both initial diagnosis and persistent disease. One case showed the acquisition of new LAIPs after relapse. Conclusions: The good choice of LAIPs depends on their specificity rather than their frequency. The results of this study can help in increasing the sensitivity of LAIPs strategy in minimal residual disease using MFC in AML patients, which is considered an important post-diagnosis parameter associated with prognosis and clinical outcome.

Keywords: Flow Cytometry; Leukemia, Myeloid, Acute;  Immunophenotyping; Neoplasm, Residual.

Objectives: Epilepsy is the most common neurological disorder in children and comorbid depression is common. This study aimed to assess the frequency of depressive symptoms along with demographic and clinical factors in children diagnosed with epilepsy in a tertiary care institution in Oman. Methods: This cross-sectional study was conducted between June 2016 and August 2018 and included children (n = 75) aged 6–12 years old attending the epilepsy clinic at Sultan Qaboos University Hospital, Oman. The cohort constituted of children with epilepsy (CWE) following up at a dedicated unit. We used the Center for Epidemiologic Studies Depression Scale for Children to assess the presence of depressive symptoms. Associated factors, including history of seizure in the last three months, compliance with antiepileptic medications, and type of epilepsy were also examined. Results: Depressive symptoms were endorsed in 52.0% of CWE and 96.0% were compliant to medications. Recurrent seizures were present in the last three months among 48.0% of the CWE. The type of epilepsy was significantly associated with the presence of depressive symptoms. Conclusions: Depression is prevalent among Omani CWE. Certain clinical factors appeared to increase the risk of depression among this population. The findings of this study fill a gap in the existing literature and call for further work aiming to explore possible tailored recognition and CWE.

Keywords: Epilepsy; Cross-Sectional Studies; Depression; Tertiary Care Centers; Neurology; Oman.

Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem involvement. Superior vena cava (SVC) syndrome is mainly caused by malignant tumors such as lung carcinoma, lymphoma, and metastatic tumors. We report a 20-year-old woman who was admitted with features of SVC syndrome secondary to SVC thrombus. Further evaluation confirmed the diagnosis of SLE without associated antiphospholipid syndrome (APS). The patient was treated with heparin with oral anticoagulant, steroids, and hydroxychloroquine. Complete resolution of thrombus was documented within a few weeks. SVC thrombosis as an initial presenting feature of SLE without associated APS has not been reported so far in the literature.

Keywords: Superior Vena Cava Syndrome; Lupus Erythematosus, Systemic; Inflammation; Thrombosis.

Superior herniation of normal mediastinal thymus is a rare cause of anterior neck swelling, and only a few cases are reported in the literature. It clinically presents as a suprasternal swelling in the neck that appears during increased intrathoracic pressure. It is a benign condition that requires clinical and radiological awareness to avoid unnecessary investigations and invasive procedures. Ultrasound is the imaging of choice for the diagnosis, and management is conservative. This is a case report of a three-week-old male neonate who presented with anterior neck swelling and stridor, diagnosed as a case of superior herniation of normal thymus and was managed conservatively.

Keywords: Infant, Newborn; Mediastinum; Valsalva Maneuver; Ultrasonography; Neck; Diagnostic Imaging.

Cryptosporidium is a rare but important pathogen, especially in children with immunodeficiency. Intestinal cryptosporidiosis is well described in immunocompetent and immunocompromised children, but respiratory and disseminated cryptosporidiosis in immunodeficient children is not often reported. We describe an Omani infant with disseminated cryptosporidiosis and failing pharmacological therapy in the context of severe combined immunodeficiency. Chronic diarrhea can be an initial symptom of immunodeficiency in the pediatric population. Awareness of cryptosporidiosis is critical to early detection and management for such patients. As antiparasitic agents are often ineffective, amelioration of immunosuppression in immunodeficient children should be a priority.

Keywords: Child; Cryptosporidium; Severe Combined Immunodeficiency; Diarrhea; Oman.

Disseminated tuberculosis (TB) is a mycobacterial infection in which the mycobacteria have spread from the lungs to other parts of the body through the blood or lymph system. We report a 38-year-old patient who presented with fever and severe weakness for five days. His initial workup in the emergency room showed severe hypokalemia resistant to multiple doses of potassium replacement. The patient later showed features of meningitis. His cerebrospinal fluid analysis confirmed tuberculous meningitis. After starting on anti-tuberculous medications, his hypokalemia improved significantly. Sputum culture was positive for TB, and the patient labeled as disseminated TB. Despite severe hypokalemia being a rare association with TB, disseminated TB can be considered the possible cause in patients presenting with severe hypokalemia and fever. Renal tubular defect could be the proposed mechanism causing potassium losing nephropathy.

Keywords: Mycobacterium tuberculosis; Hypokalemia; Potassium.