Oman identified child maltreatment as a national health priority almost two decades ago and has since set in motion various measures to address the issue. These measures include capacity-building for healthcare professionals, establishing a governance system for response and treatment, and creating a legal framework and database for reporting cases. This review documents the efforts made by the Ministry of Health and other stakeholders to manage child maltreatment. It benchmarks the various initiatives against the INSPIRE Strategy’s key components: Implementation and enforcement of laws, Norms and values, Safe environments, Parent and caregiver support, Income and economic strengthening, Response and support services, and Education and life skills. Data were collected by reviewing the literature and information by examining available literature on child protection in Oman, relevant policies and regulations, and implemented programs identified by stakeholders. The findings indicate that the child protection system aligns with the INSPIRE strategies, but improvements are needed in coordination with stakeholders. An electronic case management system is urgently required to enhance cooperation, alongside capacity-building efforts for professionals engaged in child care.

Keywords:Child abuse; Child Maltreatment; Child Welfare; Oman.

Objectives: Genetic predisposition is one of the factors that contribute to the etiology of heart failure (HF). This study aimed to compare the prevalence of human leukocyte antigen (HLA)-DQ2 and HLA-DQ8 haplotypes in patients with HF with reduced ejection fraction (HFrEF) and healthy controls. Methods: This case control study was conducted in Western Türkiye, and included 100 participants: 50 patients diagnosed with HFrEF and 50 healthy matching controls. The frequency and distribution of HLA-DQ2 and HLA-DQ8 were compared between the groups. Results: No statistically significant differences in haplotype distribution were observed between patients and controls for any of the assessed parameters. HLA-DQ2 positivity was observed in 16.0% of the HFrEF group and 20.0% of controls, while HLA-DQ8 positivity was found in 24.0% and 26.0%, respectively. Subgroup analyses stratified by sex and HF etiology also did not reveal differences. Conclusions: The HLA-DQ2 and HLA-DQ8 haplotypes are not significantly associated with HFrEF in the population studied. Therefore, the utility of these haplotypes as standalone markers for early detection of HFrEF appears limited.

Keywords:Autoimmune Diseases; Heart Failure; Human Leukocyte Antigens; Turkey.

Objectives: We sought to assess the prevalence of tobacco use among adolescent males in Oman and identify sociodemographic factors influencing usage and attitudes towards tobacco products. Methods: A cross-sectional study was conducted between January and March 2024 among male adolescents in public schools (grades 9–12) in Sohar, Oman. A two-stage cluster sampling approach was employed: six schools were randomly selected proportional to enrollment size, followed by random selection of classrooms within each school. Data were collected using a validated Arabic version of the Global Youth Tobacco Survey, administered in-person. Results: All participants completed the survey in classroom settings (100% response rate; n = 227). Forty participants (17.6%) reported having tried tobacco, with the age at initiation largely between 14 and 15 years. Current smoking prevalence was 7.5% (n = 17), and exposure to secondhand smoke (SHS) was reported by over 40% of participants, both in enclosed and open spaces. Awareness of the harmful effects of tobacco was high, with 61.7% (n = 140) acknowledging the health risks associated with tobacco use. However, misconceptions concerning tobacco use remained prevalent, notably regarding the risks of SHS, perceived prevalence of peer smoking, and social desirability associated with smoking. Conclusions: Despite relatively high awareness of harmful effects, tobacco use among adolescents in Sohar remains an important public health concern, particularly regarding SHS exposure and social influences. Appropriate intervention strategies should target persistent misconceptions and address social influences. Strengthening public health initiatives and enforcing smoking bans in public spaces are recommended to limit tobacco exposure among Omani youth.

Keywords: Cross-sectional Studies; Adolescents; Smoking; Tobacco Use; Oman.

Objectives: Colorectal cancer (CRC) age-standardized mortality rates (ASMR) are increasing in the North Africa and Middle East (NAME) region, in contrast to the global trend. While the upward trend of the CRC mortality in the NAME region is evident, the key drivers of this increase are still not fully established. We sought to examine the impact of 11 risk factors on the rise in CRC mortality in the region. Methods: We obtained data from the Global Burden of Disease study 1990–2019. We examined changes in risk-related ASMR (ASMRΔ) for high body mass index (BMI), high fasting plasma glucose (FPG), low physical activity, smoking, alcohol, and six dietary factors. Analyses were stratified by sex. Rates and rate differences were expressed per 100 000. Results: CRC ASMR in the NAME region increased by 19.5% (ΔASMR = 1.6). ASMR increased by 25.0% (ΔASMR = 2.1) in men and 16.5% (ΔASMR = 1.3) in women. High FPG and high BMI had the highest risk-attributed ASMRΔ in the NAME population (0.56 and 0.55, respectively). In men, high BMI had the highest risk-attributed ΔASMR (0.85), while in women, high FPG had the highest risk-attributed ΔASMR (0.50). ΔASMR, related to all metabolic risks, (high FPG and high BMI) explained 64.4% of the CRC mortality increase in the region, 63.8% of the increase in men, and 53.8% of the increase in women. Conclusions: CRC mortality is increasing in the NAME region; hyperglycemia and obesity are the key drivers of the increasing trend. Interventions targeting metabolic risks are needed.

Keywords:Colorectal Neoplasms, Global Burden of Disease, Risk Factors, Middle East, North Africa.

Objectives: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. It is suggested that mechanisms of many diseases involve ‘sterile inflammation’ triggered by oxidative stress in the absence of infection. Inflammasomes regulate such inflammatory processes. Antioxidants can counter oxidative stress, but their exact relationship with inflammasome activity in MS is unclear. This study aimed to investigate the association between inflammasome markers and antioxidant vitamins D and E in Jordanian patients with MS. Methods: We enrolled 100 patients with MS and 100 healthy controls. Their blood samples were analyzed by enzyme-linked immunosorbent assay (ELISA) for levels of interleukin-18 (IL-18), IL-1 beta (IL-1β), nucleotide-binding oligomerization domain, leucine-rich repeat, and pyrin domain–containing protein 3 (NLRP3), and vitamins D and E. Results: Patients with MS had significantly higher serum levels of IL-18 (p = 0.020), IL-1 β (p < 0.001), and NLRP3 (p = 0.040) compared with the controls. Serum NLRP3 had an inverse correlation with vitamin D (r = -0.20; p = 0.020). Moreover, a significant negative correlation existed between IL-1 β and vitamin E (r = -0.14; p = 0.040). Conclusions: Our findings suggest that inflammasome activation in MS is linked to decreased levels of antioxidant vitamins. Hence, inflammasome marker levels may serve as future potential biomarkers of disease activity and progression in MS.

Keywords:Inflammation; Inflammasome; Multiple Sclerosis; Vitamin D; Vitamin E; Jordan.

Objectives: Inflammatory bowel disease (IBD) is a global health concern with increasing incidence. Many patients with IBD have impaired immunity, leading to suboptimal response to vaccines. Hepatitis B Virus (HBV) vaccination has been part of compulsory childhood immunization program since 1990 in Oman. Given the concerns about vaccine immunogenicity in patients with IBD, we designed this study to quantify the immune response to scheduled HBV vaccination in Omani patients with IBD and compare it with that in a matching control cohort of healthy Omani blood donors. Methods: This retrospective case-control study was conducted from 1 January to 31 May 2024, at Sultan Qaboos University Hospital. We enrolled a total of 252 participants: 126 patients with IBD and 126 controls. Baseline demographics, comorbidities, and viral serologies before and after vaccination were collected. The primary outcome was long term immune response to HBV vaccination. Secondary outcomes included identifying factors associated with suboptimal vaccine response. Results: Durable protective immune response to HBV vaccine was achieved in 29 (23.0%) patients with IBD and 109 (86.5%) controls. Prednisolone and esomeprazole therapies were both significantly associated with suboptimal vaccine response (p = 0.016 and p < 0.001, respectively). There was no significant correlation between low immunogenicity to HBV vaccine and age, sex, type of IBD, comorbidities, or body mass index. Conclusions: Omani patients with IBD show markedly reduced long-term immunogenicity to HBV vaccination. Esomeprazole and corticosteroid therapies may be associated with this diminished response. These findings highlight the importance of reassessing the immunogenicity to HBV vaccination, and potentially other protective vaccinations, in all patients with IBD as part of their standard of care.

Keywords: Hepatitis B; Inflammatory Bowel Disease; Hepatitis B Vaccines; Antigens, Immune Response; Immunogenicity, Vaccine; Oman.

Objectives: To evaluate the levels of circulating erythrocyte-derived microparticles (EMPs) and platelet-derived microparticles (PMPs)in children with non-transfusion-dependent beta-thalassemia (NTDT), and explore their contribution to hypercoagulability. Methods: This case-control study included 50 children diagnosed with NTDT and 50 age- and sex-matched healthy controls. The children were recruited from the hematology/oncology unit of Alexandria University Children’s Hospital, Egypt from November 2022 to May 2023. Results: The percentage of EMPs and PMPs was significantly higher in NTDT patients compared with healthy controls. Serum B-type natriuretic peptide was higher in NTDT patients compared to controls; however, it didn’t reach a statistical significance. Conclusions: The significantly higher levels of EMPs and PMPs in NTDT patients may contribute to the hypercoagulable state associated with the disease. Measurement of proB-type natriuretic peptide, though not statistically significant in this cohort, may hold potential as an early biomarker for pulmonary hypertension in NTDT patients, for which larger prospective studies are recommended.

Keywords:beta-Thalassemia; Pediatric; Microparticles; Erythrocytes; Platelet Activation; Egypt.

Thyroglossal duct cysts are commonly seen in the midline of the neck, accounting for 7% of cases presenting with midline swelling. Carcinoma within a thyroglossal duct cyst is extremely rare, occurring in fewer than 1% of cases, and lateral occurrences are particularly uncommon. This case describes a 25-year-old female with papillary carcinoma identified in the left lateral thyroglossal duct cyst, along with de novo papillary carcinoma in the right thyroid lobe.

Keywords:Thyroglossal Duct Cyst; Thyroid Gland; Carcinoma, Papillary.

A 39-year-old multiparous woman underwent emergency cesarean section after pathological findings in her cardiotocograph. A biopsy taken from the peritoneal mass confirmed the diagnosis of disseminated peritoneal leiomyomatosis. Postoperatively, the patient developed status epilepticus. Computed tomography image of the brain with angiography revealed a right frontal meningioma. With increasing ascites, excision of the tumor and total abdominal hysterectomy with bilateral salpingectomy were performed.

Keywords: Leiomyomatosis; Meningioma; Seizure; Status Epilepticus; Oman.

It has been hypothesized that increased intracranial pressure (ICP) may cause sick sinus syndrome (SSS) due to its effect on vagal discharge to the heart, resulting in disruption to the sinus cycle, despite age-related degeneration of the sinoatrial node being the most common intrinsic factor leading to sinus node dysfunction. In this case report, a 47-year-old man with unknown medical conditions presented to the emergency department at King Saud Medical City with a four-day history of headache, confusion, and chest pain. He also reported dizziness and lightheaded. Extensive cerebral venous thrombosis (CVT) and SSS were identified. We investigated the SSS etiology and its relation to CVT, concluding that SSS was caused by elevated ICP secondary to CVT.

Keywords: Sick Sinus Syndrome; Thrombosis; Sinoatrial Node; Saudi Arabia.

A 24-year-old primigravida at 12 weeks of gestation, with a history of hyperemesis gravidarum, presented on an early morning with mental confusion and weakness. She was diagnosed with Wernicke encephalopathy and successfully treated with thiamine. After a full-term pregnancy, she gave birth to a healthy baby.

Keywords: Wernicke Encephalopathy; Hyperemesis Gravidarum; Thiamine; India.

Kikuchi disease is a rare condition, typically characterized by cervical lymphadenopathy and fever. Although its association with systemic lupus erythematosus (SLE) is well established, the majority of SLE cases do not present with Kikuchi disease. We report a case of a young patient who presented with fever and cervical lymphadenopathies for two-weeks. This presents a broad differential, initially suggesting the possibility of infections or malignancies. However, after further clinical evaluation, including cervical node biopsy, direct histological examination revealed Kikuchi disease. Combining all clinical information and laboratory data, we concluded that the patient’s condition was consistent with Kikuchi disease associated with SLE and probable autoimmune hepatitis. This case illustrates a young female patient with clinical presentations of SLE associated with Kikuchi disease as the first manifestation.

Keywords: Kikuchi Disease; Lupus Erythematosus, Systemic; Lymphadenopathy.

Systemic lupus erythematosus (SLE) is a quintessential autoimmune disease once thought to be rare among Africans. Neuropsychiatric manifestations of SLE range from headaches, mood/behavioral disorders, to seizures. There are documented reports of seizures accompanying the diagnosis of SLE, with varying prevalence according to specific regions. However, seizures rarely precede the diagnosis of SLE. We present a case report of a 19-year-old African woman with adult-onset seizures preceding an overt diagnosis of negative anti-dsDNA SLE. A preceding short course of anti-malarial and carbamazepine prompted early consideration of drug-induced lupus erythematosus. However, the clinical features of SLE progressed and persisted despite their discontinuation. Among high-risk groups, it is important to recognize SLE as a potential cause of adult-onset seizures. In the absence of clear offending agents, metabolic or structural disease, baseline antinuclear antibody may be imperative in the diagnostic workup of such patients.

Keywords: Systemic Lupus Erythematosus; Neuropsychiatry; Autoimmune Disease; Nigeria.