Multiple sclerosis (MS) in children and adolescents is increasingly recognized worldwide. Demyelinating disorders of the central nervous system may overlap considerably in their clinical presentation and radiological appearance. Therefore an exact categorization might be challenging and might not be readily attainable. Rigorous radiological and laboratory investigations and longitudinal follow up of the patient are needed in order to establish the diagnosis of a chronic demyelinating disorder especially in children. However, in the past few years many advances have been achieved in the field of pediatric MS and other white matter disease such as establishing diagnostic criteria, consensus definitions proposed for pediatric multiple sclerosis and related disorders and advances in treating such disorders. A wealth of knowledge regarding childhood MS have been established with vast speed and greater familiarity with the diagnosis and treatment options should lead to better care of children with such disorders. This review will present the important advances in childhood multiple sclerosis and related disorders that were achieved in the last few years.

Objective: The main objective of this study is to illustrate the various characteristics including care of patients and changes in lifestyle of type 2 diabetics during Ramadan in Dhahira region, Oman. Methods: This was a hospital-based study conducted during the month of Ramadan in 2006. Of the 453 recruited, 334 (73.7%) with complete data were analyzed. Student t test was used for comparison of means and Chi-square test for proportions. Results: We analyzed 334 patients with type 2 diabetes. The common complication associated with diabetes was coronary artery disease (19.5%) and nearly 60% of the study subjects had hypertension as co-morbidity. There was little or no change in the lifestyle activities and Insulin/Oral AntiDiabetic Drug (OAD) doses during Ramadan. Majority of diabetics had poorly controlled Fasting Blood Sugar (FBS) and Body Mass Index (BMI). The overall mean weight change was -0.49 ± 1.54 SD. There was a significant weight loss during Ramadan (p<0.05). Conclusion: The large proportions of uncontrolled type 2 diabetes patients in our region represent a challenge to our physicians during Ramadan. There is a need to improve diabetic management and intensive education before fasting. Clear guidelines for diabetic management including uncontrolled diabetics during Ramadan are essential in Oman.

In the modern era of management of disorders of the upper urinary tract, ureteroscopy forms an important part in the armamentarium for the diagnosis and treatment of a variety of disorders that occur in the upper urinary tracts. The modern ureteroscopes have better vision and are less traumatic, making ureteroscopy a relatively safe procedure. Major complications are rare. An audit of a total of 128 ureteroscopies done in the Department of Urology over a six year period from August 2001 till August 2006 at the Sultan Qaboos Hospital, Salalah, was undertaken. The results are discussed in detail and compared with results from other centers. The management of a rare but dreaded major complication is discussed in detail.

Introduction: Continuing medical education (CME) is important for professional   development, to improve doctors’ clinical performance that ultimately influences the quality of the health outcomes. In the presence of an increasing number of family physicians serve in the primary health care system upon graduation in Oman make us to consider the meta-cognition of the leaner and engaged them in learning process. The purpose of this paper is to examine ways of improving the continuing education methods for the physicians. Objective: To assess the preferred method of continuing education for primary health care physicians. Methods: We conducted a program evaluation among a group of general physicians who were involved in some of the activities in continuing education at end of their program in the Muscat region health centres in Oman. The main outcome measure was to study the preferred method for CME. Results: The majority of the participants believe that continuing medical education improves their practice. In addition, the finding suggests that small group learning and combination of methods are the preferred methods of continuing education for primary health care physicians. Conclusion: Interactive small group learning is shown to be more effective to achieve the learning objectives and ultimately improve practice. Practice-based small group learning is the method we recommended.

Objectives: To assess the safety and importance of diagnostic fast in the evaluation of hypoglycemia in children in a non-specialist set up. Method: The medical records of 116 patients with hypoglycemia, admitted to Pediatric Unit, Royal Hospital, Muscat, Sultanate of Oman, over a 15 year period, were reviewed. Of these, 96 (82.8%) patients, 52 boys and 44 girls, aged 8 days to 10 years were subjected to diagnostic fast. Results: Of these 96 patients fasted, 77 (80.2%) became hypoglycemic (HG group) and 19 (19.8 %) did not develop hypoglycemia on fast (NHG group). In the HG group, 69 (89.6%) patients developed symptomatic hypoglycemia of variable severity and none developed coma or convulsions during fasting. Conclusion: The study has proved that diagnostic fast is relatively a safe procedure with considerable amount of diagnostic yield.

Objective: To study the tear film profile of patients attending the eye clinic of Sur hospital of South Sharqiya region of Oman and to study the epidemiology of patients having abnormal tear film profile. Method: Patients attending the eye clinic of Sur hospital and B. Ali eye clinic were asked about the clinical symptoms relevant to dry eye and subjected to tear film tests namely TBUT (Tear Break up Time) and Schirmer’s 1 to assess tear film profile. Patients with irregular corneas were excluded from the study. Overall 127 patients were included in the study. Results: 42.5% (95% CI: 33.9% to 51.1%) of patients examined had abnormal tear film profile with patients >30 years 56.75% (95% CI: 45.4% to 68%) showing abnormality more often and females 40.3% (95% CI: 29.3% to 51.2%) outnumbered males. Burning was the main symptom in patients with abnormal tear film profile. Conclusion: We infer that a large number of patients had abnormal tear film profile most of them were asymptomatic and trachoma figured prominently amongst the diseases in cases with abnormal tear film profile.

Many procedures are described in the literature for the surgical management of hallux valgus. There are over 130 surgical procedures described but the surgeon usually limits these to a few which he is comfortable with and which gives the best aesthetic and functional result to the patient. There is ever rising enthusiasm among orthopaedic surgeons regarding diaphyseal osteotomy ever since Burutaran described the procedure in 1973. Weil in United States and Barouk in Europe popularized the technique. Scarf is a double chevron diaphyseal osteotomy which is inherently more stable than other osteotomies on the first metatarsal and allows early return to work. The author reports his early experience with SCARF osteotomy, which is a comparatively new technique for hallux valgus correction which was done in Ibri Regional Hospital in the Sultanate of Oman. All patients who presented with symptomatic hallux valgus were taken up and there were three patients who required surgical intervention for hallux valgus. The purpose of this study was to find its effectiveness in terms of stability of the osteotomy and early return to work. Proximal phalangeal osteotomy was not found necessary in none of the three cases operated by us. Scarf osteotomy is safe and found to give better aesthetic and functional result and early return to work. All our three patients had good functional recovery and early return to work.

Background: The percentage of Omani physicians from total number of physicians working in the Sultanate tripled from 9 % in 1999 to 27% in 2006 and is expected to increase to 50% by 2010. The study aimed to asses community attitudes towards Omani doctors and to investigate the different socio-demographic variables related to these attitudes. Method: It was done in two selected Primary Health Care (PHC) facilities by simple random technique in Batinah region. Face-to-face interview was made on 305 randomly selected samples of PHC customers by trained researchers from Sultan Qaboos University (SQU). Omani Doctors Acceptance Scale (ODAS) was adapted and used to assess participants acceptance of the communication skills of the Omani doctor, care to the patient, absence of language barrier, competence level, preference to be seen by doctor from the same sex, embarrassment from seeing an Omani doctor, qualification, experience, knowledge and skills of the Omani experience of the Omani doctor, and trust on the Omani doctor. Chi squared tests of significance was used in analysis. Results: Males reported more satisfaction about communication skills of the Omani doctors, whereas female respondents reported higher likelihood of being embarrassed from the latter. Elder age cohort, those reported ever treated by an Omani doctor, married respondents, and those of lower level of education were more likely to report higher level of acceptance than others. Those aged 26-40 and those above 40 years of age were 2.41 and 3.41 times higher than the youngest age cohort respectively. Similarly, older age cohort reported having more trust than the middle age respondents relatively to the youngest age group. Conclusion: The current study showed an accepted level of acceptance to Omani doctors. Looking for crucial issues in patient-doctor relationships as acceptance, satisfaction, trust, gender preference especially for PHC doctors ensure the continuity of care.

A case of acute lead poisoning in an infant without overt clinical manifestations of encephalopathy is reported for the first time in Oman. The case was diagnosed at Rustaq Hospital on the basis of (i) history by the mother of giving the child a traditional remedy for treating constipation (ii) X-ray of abdomen showing radio-opaque speckles and (iii) detection of high blood lead levels (83.3 g/dL) at the toxicology laboratory of the poison control centre. The source of lead was confirmed by high content of inorganic lead (20.2%) found in the sample of the traditional remedy (bint al dahab). The blood lead levels significantly decreased, after the intravenous calcium edetate (EDTA) therapy was given to the baby. The case highlights that early detection and treatment of acute lead poisoning in children can prevent morbidity and sequelae associated with encephalopathy. It also indicated the need for awareness and prevention programme for parents on this issue.

Congenital amniontocele also known as congenital dacryocystocele is an uncommon variant of a very common condition (Naso-Lacrimal Duct Obstruction, NLDO) that affects newborn babies. The congenital amniontocele causes obstruction of the lacrimal drainage system creating a cystic swelling of the lacrimal sac. It usually presents at birth or soon after birth, as a bluish swelling, below and nasal to the medial canthus. If the congenital amniontocele is associated with intranasal cystic swelling of the NLD and if it is large and bilateral it can cause severe respiratory distress particularly during milk feeding. We report a case of 24 days old female newborn baby who were presented to us from pediatric clinic of Rustaq Hospital with bluish cystic swelling below the left medial canthus soon after the birth. Congenital amniontocele is relatively rare and the literature describes a variable natural course of these lesions with resultant controversy in their management. Usually congenital amniontocele resolves spontaneously with conservative management, and if not, dacryocystitis might develop. Treatment of congenital amniontocele comprises digital sac massaging and early probing the lacrimal system,8 or some times, intranasal surgery in the form of marsupialization of the intranasal cyst, this is usually performed endoscopically. We report successful conservative management in our case and recommend this with oral and topical antibiotics with lacrimal sac massage for 7 to 10 days and, if there is no response, to consider surgical intervention in the form of lacrimal probing.

Hemolytic anemia has occasionally been described in association with insect bites. The venom of certain spiders, bees and wasps, and some snakes can rarely cause intravascular hemolysis. We report here a case of Coombs positive hemolytic anemia due to an insect bite. These bites often pose diagnostic challenges and when associated with systemic manifestations necessitate early intervention. This communication reviews the clinico- hematologic spectrum in these cases and also emphasizes the need to capture the insect as identification would help in early diagnosis and management.

Five girls aged 4 to 13 years presented with clinical features of classical Rett syndrome - loss of acquired developmental skills including speech and hand function, progressive microcephaly and characteristic stereotyped “hand washing” movements. Two patients had generalized tonic, clonic seizures and one had atonic seizures with electroencephalogram (EEG) evidence of Lannox Gastaut syndrome. Cranial CT was normal in all except two patients, which showed marked perisylvian atrophy, and metabolic screening revealed non specific mild hyperammoniaemia in three. The aim of the study is to illustrate the unique clinical features of Rett syndrome and reiterate the importance of the diagnosis of this rare condition, clinically.