Objectives: Stigma and discrimination undermine the quality of life of people with HIV and their access to health services. This study aimed to assess HIV-related knowledge, attitudes and practices among healthcare workers (HCWs) in Oman. Methods: This cross-sectional study took place between July and November 2016. A questionnaire was distributed to 1,400 government HCWs to determine HIV-related knowledge, attitudes and practices. Results: A total of 1,281 HCWs participated (response rate = 92%). Routine tasks, such as dressing wounds, drawing blood and touching clothes, were a cause of concern for 24–52% of HCWs. Only 69% correctly answered questions regarding the transmission of HIV via eating/drinking and mosquito bites. Compared to other HCWs, doctors had significantly higher knowledge (mean = 0.46, 95% confidence interval [CI]: 0.19 to 0.73; P <0.001), attitude (mean = 0.77, 95% CI: 0.31 to 1.24; P = 0.001) and practice (mean = 2.07, 95% CI: 1.59 to 2.55; P <0.001) scores. Expatriates also scored significantly higher in knowledge (mean = 1.08, 95% CI: 0.93 to 1.23; P <0.001), attitude (mean = 1.23, 95% CI: 0.98 to 1.48; P <0.001) and practice (mean = 1.08, 95% CI: 0.82 to 1.34; P <0.001) compared to Omani nationals. Finally, those with >15 years’ work experience scored significantly higher on knowledge (mean = −0.60, 95% CI: −1.12 to −0.08; P = 0.025) and attitude (mean = −0.99, 95% CI: −1.87 to −0.10; P = 0.029) compared to those with less experience. Conclusion: The high rate of HIV-related stigma among HCWs in Oman should be rectified in order to achieve the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS.Keywords: HIV; Social Stigma; Social Discrimination; Knowledge; Attitude; Professional Practice; Healthcare Providers; Oman.

Aim and objective: The aim and objective of this study is to report varied clinical manifestations of chikungunya amongst different pediatric age groups. Background: Chikungunya is an arboviral disease transmitted by Aedes mosquitoes, which has caused epidemic outbreaks in the past. The clinical manifestations vary widely among neonate, infant, and pediatric age groups. Case descriptions: We report four cases (two neonatal and two pediatric cases) of chikungunya. Neonates in this case series had predominant neurological and cutaneous manifestations. The older age groups in this series however had circulatory and cutaneous manifestations. All children reported in this case series had fever, lethargy, and thrombocytopenia. Chikungunya was confirmed by CHIKv PCR in all the cases. All cases reported recovered with appropriate neonatal/pediatric intensive care management. Conclusion:The spectrum of chikungunya disease is different in neonates and infants as compared to older children. Though it is predominantly a benign illness, its presentation can mimic commonly seen emergencies like viral encephalitis or septic shock. A high index of clinical suspicion is necessary for diagnosis. Clinical significance: Chikungunya should be considered as a differential diagnosis in neonates presenting with fever, typical hyperpigmentation, and encephalopathy. Neonates born to mothers with chikungunya should be closely observed for symptoms in the 1st week of life. Children, unlike adults, can have more of hematological and cutaneous than rheumatological manifestations. Management of chikungunya is predominantly symptomatic. Early clinical diagnosis can avoid irrational use of antibiotics.

This report describes two cases of tachycardia-induced cardiomyopathy secondary to incessant ectopic atrial tachycardia (EAT) in an infant presenting with severe left ventricular dysfunction and hemodynamic instability. The two cases were managed differently. The first required mechanical ventilation and was resistant to conventional antiarrhythmic drugs. After the initiation of enteral ivabradine (0.15mg/kg) the heart rate slowed with significant improvement in hemodynamics, peripheral perfusion and sinus rhythm was restored after 12 hours. Ivabradine was continued and the patient was discharged home after 10 days of hospitalization. The second case was managed by early initiation of ivabradine and resulted in restoration of sinus rhythm within 4 hours, thus avoiding trials of conventional anti-arrhythmic drugs with unstable hemodynamic profile. The infant was discharged after 5 days of hospitalization on ivabradine..

Acute hemorrhagic encephalomyelitis (AHEM) is a rare form of acute disseminated encephalomyelitis (ADEM) characterized by a fulminant course, poor response to immunomodulation, and unfavorable outcomes. Early clinical and radiological suspicion can enable aggressive use of immunotherapy, thereby improving outcomes. Pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease, with protean clinical manifestations being reported from all over the world. Although multiple neurological manifestations of PIMS-TS have been reported previously, AHEM has been less commonly reported. We describe a case of PIMS-TS with AHEM and highlight very rare presentation of this novel disease.

Background: Scrub typhus is a re-emerging acute infectious disease caused by Orientia (Rickettsia) tsutsugamushi, in India and globally. Scrub typhus goes undiagnosed at early stages of the illness because many factors like of low index of suspicion, nonspecific signs and symptoms. This study was done to analyse the various clinical demographic factors and their significance in making the clinical diagnosis of scrub typhus and also the analysis of other non-specific laboratory parameters present in the serologically confirmed cases of scrub typhus. The objective of this study was to study the clinical presentation and laboratory profile of scrub typhus in pediatric patients admitted in a tertiary care hospital.Methods: It was prospective and descriptive study conducted in the pediatric ward of a Medical College Hospital. The study population consisted of 50 children aged 5-15 years having fever of more than 5 days duration. Children with persistent fever with known focus and etiology were excluded from the study.Results: Among the study group of 50 children, majority were between 5 and 15 years age group. Male children constituted 66% (33 out of 50). Out of 50 children, 94% (47 children) had Eschar.  82% of children did not have any history of tick exposure. Less than 25% of children had Vomiting similar to conjunctival congestion. 94% children had lymphadenopathy and 98% children had mild anemia. 54% children had maculopapular rash and 20% had jaundice. 62% children had hepatomegaly and 96% had splenomegaly. Pedal edema was seen in 22% of cases and anasarca in 2% of cases 76% of children had normal WBC counts, 24% had leucocytosis. Platelet counts of 38,000 to 2,87,000 was noted in the study group and 26% of patients had thrombocytopenia. 98% children had hemoglobin less than 10 gms%. C reactive protein was positive in 96% of cases. Hypoalbuminemia was noted in 48% of children. 60% children were positive for urine albumin. Conclusions: Scrub typhus should be considered in early part of the illness and patient has to be examined for the presence of Eschar. A clinical diagnosis can be made based on the associated rash, splenomegaly, lymphadenopathy etc. and specific treatment with antimicrobials can be initiated for scrub typhus.