Journal of the Oman Medical Association

Traumatic intracranial aneurysms are rare consequences of blunt or penetrating head injury, carrying significant morbidity and mortality. We report a 33-year-old male who sustained severe head trauma with base of skull fracture and subarachnoid hemorrhage following a motor vehicle accident. He underwent craniotomy with evacuation of an intracerebral hematoma and fixation of depressed fracture segments. During the third week, he deteriorated due to a re-bleed at the operated site. Cerebral digital subtraction angiography revealed a pseudoaneurysm from the proximal A2 segment of the left anterior cerebral artery, prompting re-exploration. This case highlights the importance of considering post-traumatic aneurysm in patients with delayed neurological decline after head injury associated with skull bone fracture and subarachnoid hemorrhage. Full article

Prediabetes is a critical precursor to type 2 diabetes (T2DM) and cardiometabolic diseases, yet its burden in Oman remains understudied. Leveraging data from Oman’s 2023 National Screening Program, this study quantifies the prevalence of prediabetes and its risk profiles among adults in Muscat Governorate—providing urgent evidence to guide diabetes prevention strategies in the Gulf region. Objectives: To estimate the prevalence of prediabetes and identify associated risk factors among Omani adults screened at primary health centers in Muscat Governorate (2023), given its critical role in preventing type 2 diabetes mellitus (T2DM) progression. Methods: This cross-sectional study analyzed data from Oman’s national screening program. Socio-demographics, clinical parameters (blood pressure, body mass index [BMI]), and laboratory results (fasting glucose, lipids, renal function) were extracted from the Al-Shifa electronic health system and National Screening Register. Multivariable logistic regression was performed using SPSS 30.0 (IBM Corp., Armonk, NY, USA). Results: Among 4862 participants (mean age 43.2 ± 6.3 years; 61.7% female), prevalences were: prediabetes 29.0%, T2DM 5.5%, obesity (BMI 30–40 kg/m²) 35.7%, hypertension 42.0%, hypercholesterolemia 48.8%, and renal involvement 51.8%. Males had significantly higher prediabetes prevalence than females (35.4% vs. 24.7%; adjusted odds ratio [aOR] = 1.43; 95% confidence interval [CI]: 1.21–1.70). Independent risk factors included each 1-year age increase (aOR = 1.05; 95% CI: 1.03–1.08), each 1-unit BMI increase (aOR = 1.03; 95% CI: 1.01–1.05), and family history of diabetes (aOR = 1.28; 95% CI: 1.09–1.50). Conclusions: The high burden of prediabetes and comorbid non-communicable diseases in Oman necessitates urgent public health strategies, including enhanced screening, lifestyle interventions, and gender-specific approaches to curb the T2DM epidemic. Full article

Central nervous system (CNS) tumors in children, though uncommon, pose distinct challenges due to their unique pathological and clinical features, which often differ from adult cases. Effective management of pediatric CNS tumors can be complicated, with complete surgical resection remaining a critical goal, in conditions like cerebra cavernous malformation (CCM), where it significantly impacts recurrence risk. However, achieving complete resection can be difficult, as preserving the surrounding healthy tissue is vital to avoid long-term neurological deficits, a particular concern in the developing brains of children. Photodynamic therapy (PDT) has emerged as a promising adjunctive treatment for pediatric CNS tumors due to its ability to selectively target tumor cells while sparing healthy tissue. PDT uses a photosensitizing agent. This targeted approach is advantageous in pediatric cases as it minimizes collateral damage, potentially reducing the long-term neurological and cognitive impacts seen with conventional treatments such as radiation. Despite its promise, the application of PDT for pediatric CNS tumors remains underexplored. Research is limited, primarily due to the rarity of these tumors in children and the ethical challenges involved in conducting pediatric trials. The current understanding of PDT’s effectiveness in CNS tumors largely stems from adult studies, which may not fully apply to children’s unique developmental and physiological characteristics, including differences in the tumor biology, metabolism, and pharmacokinetics of photosensitizers. To address this gap, our study conducted a comprehensive review of the available literature using PubMed, Google Scholar, and additional databases like Web of Science, aiming to summarize the existing knowledge on PDT for pediatric CNS tumors, incorporate recent advancements from the last years, and identify areas where further research is essential. The updated review includes new insights from ongoing sonodynamic therapy (SDT), which complements PDT by using ultrasound to enable deeper penetration. Full article

Background: Neck and shoulder pain are prevalent occupational health issues among school teachers globally, impacting work performance and quality of life. This study aimed to assess the prevalence and factors associated with neck and shoulder pain among school teachers in Oman. Methods: A cross-sectional study using chi-square and logistic regression analyses was conducted in March–April 2025 among 419 full-time school teachers in three Omani governorates. A structured questionnaire was used to collect data on socio-demographic, behavioral, physical, psychosocial, and health-related factors. Results: A high prevalence of neck and shoulder pain among participants was observed, with 98.3% reporting pain in the past 12 months. Chronic pain lasting over a year was reported by 59.7%, with 37.0% experiencing severe pain. Psychological job demands were high, with 62.8% reporting high levels of stress. Conclusions: The study did not find significant associations with physical risk factors, but highlighted the importance of broader determinants such as low physical activity, obesity, and lack of supervisory support in relation to chronic neck and shoulder pain among teachers. Full article

Acute Respiratory Distress Syndrome (ARDS) represents a critical pathology often necessitating prolonged mechanical ventilation, a clinical course associated with significant complications and elevated mortality. This case report details the successful implementation of early Percutaneous Dilatational Tracheostomy (PDT) in a 61-year-old male presenting with severe ARDS secondary to sepsis-induced Community-Acquired Pneumonia (CAP) and Type I respiratory failure. This case suggests that early PDT serves as a safe and effective strategy to mitigate the risks associated with prolonged mechanical ventilation in patients with severe ARDS, potentially facilitating enhanced recovery and reduced ICU length of stay. Full article

Background: Help-seeking for mental health care remains low in Oman and globally, contributing to increased morbidity and mortality. Identifying barriers is essential to improving access. This study is the first to examine the prevalence of mental health problems and help-seeking behavior in Al Dhahira governorate, Oman. Methods: It is a cross-sectional study conducted between 1 August and 30 September 2023, in the three cities of Al Dhahira Governorate, Oman. It employed a convenient, proportionate sampling approach and involved willing Omani adults aged 18–64 from the 18 areas of Al Dhahira governorate. Data were collected using the Barriers to Access to Care Evaluation (BACE-III) Arabic Version questionnaire, which was self-completed by the participants. IBM SPSS Statistics (Version 23) was used for data analysis. Results: A total of 357 participants were involved in the study. It was found that the prevalence of mental health problems (self-reported) was 11.5% and only 5.3% sought professional help. Age (p-value = 0.046) and marital status (p-value = 0.028) were found to be significantly associated with having mental health problems. While the significantly associated factors with stigma barriers were city (p-value = 0.039) and education level (p-value = 0.023), the associated factor with attitudinal barriers was educational level (p-value = 0.049). The independent predictors for seeking mental health care and having mental health problems were government worker (p-value = 0.014) and Yanqul residency (p-value = 0.003). Conclusions: In the Al Dhahira governorate, the prevalence of mental health problems was found to be low. Stigma and attitudinal barriers affect seeking help significantly in the governorate. Integrating mental health into the primary care setting and increasing awareness to overcome these barriers will improve access to mental health services. Full article

Background: This cross-sectional study was conducted among adult Omani patients with a confirmed laboratory diagnosis of COVID-19 to determine the prevalence of dizziness, tinnitus and headache in the pre-, during and post-COVID-19 recovery phases. Methodology: The characteristics and severity of symptoms of dizziness, tinnitus and headache in the above three phases were determined by telephone interviews. The severity of symptoms was recorded using the visual analog score. Results: The total number of patients selected was n = 102 (M/F 50/50%; overall mean age = 33.52 ± 3.6 years). The pre-COVID-19 prevalence of dizziness was 16%, tinnitus 13% and headache 53%. During COVID, the prevalence of dizziness increased to 41%; for tinnitus, it remained the same; and for headache, it increased to 73%. Compared to the lower age group category (30–32 years); the pre-COVID-19 prevalence of dizziness was significantly higher in the 33–40 years age group. The severity of symptoms showed a significant correlation in different phases, pre- and post-COVID-19, for dizziness (r = 0.556), tinnitus (r = 0.714) and headache (r = 0.696), and tinnitus during and post-COVID-19 (r = 0.570). Conclusion: The prevalence of dizziness, tinnitus and headaches was high in COVID-19 patients. All symptoms pre-COVID-19 and during COVID-19 persisted post-COVID-19. Full article

Background: Genus Dirofilaria consists of 27 species of parasitic nematodes, 7 of which have been reported to cause disease in humans. The transmission of the parasitic larva to humans and other mammals occurs through the bite of an infected mosquito, which, in this case, in addition to being the intermediate host, acts also as a disease transmission vector. The initial diagnosis of a patient with dirofilariasis is almost always incorrect, and in a large number of cases, the final diagnosis is only achieved retrospectively, thanks to the findings of the histopathological examination. Therefore, the purpose of the present review is to collect, analyze, summarize and present the relevant epidemiological, clinical, diagnostic, parasitological, therapeutic and prognostic data concerning the aforementioned localization of dirofilariasis in a systematic manner. Methods: An electronic search was performed in PubMed, the Scopus and Ovid databases and in Google Scholar, with them being accessed for the last time on 2 August 2025. This was followed by a manual search, and references were used to identify relevant articles. Results: The present review retrieved 32 publications discussing 43 cases of human intraoral dirofilariasis. As per the study design, the records were published in 2015–2025, and the cases presented by them were observed in 1951–2024. Conclusions: The aim of the present review is to summarize the relevant epidemiological, clinical, diagnostic, parasitological, therapeutic and prognostic data regarding the oral localization of dirofilariasis, a zoonotic helminthiasis which is transmitted by mosquitoes. Even though its manifestation in the oral cavity appears to be extremely rare, dentists and other clinicians should be familiar with this entity and should include it in the differential diagnosis of any solitary nodule with submucous localization, especially in patients living in endemic regions or who have a history of recent travel to an endemic region. Climate change on the one hand and the increase in international travel on the other are estimated to make dirofilariasis more common in countries from which it used to be absent. Full article

The widespread use of masks in the community was occasioned by the COVID-19 global pandemic. This study examined bacterial contamination on surgical and face masks used in Githurai Market during daily activities, focusing on the sources, accumulation, and antibiotic resistance of bacteria. Sixteen respondents were selected to wear masks, from which bacteria were isolated from the inside and outside surfaces, as well as from swabs of their nose, mouth, and skin. The bacterial load was monitored at intervals of 0 h, 2 h, 4 h, and 6 h using culture-dependent methods. The identified bacteria included Staphylococcus, Klebsiella, Stenotrophomonas, Enterococcus, and Bacillus, amongst others sourced from the users’ mouth, skin, nose, and the environment. Bacterial accumulation increased with time, peaking at 6 h of mask use. Most of the bacteria isolates showed multidrug resistance to commonly used antibiotics including cefotaxime, streptomycin, and amoxicillin. This raises concerns about potential role of masks as reservoirs for pathogenic and antibiotic-resistant bacteria. The study emphasizes the need for better mask hygiene practices to reduce microbial contamination and the risk of spreading antibiotic-resistant bacteria. It also highlights the importance of developing strategies to address these risks and ensure the continued effectiveness of masks as a part of public health measures Full article

Background and Aims: The majority of individuals with COVID-19 developed acute symptoms. Post-COVID-19 syndrome refers to the signs and symptoms of COVID-19 that persist for more than 12 weeks. The present study was conducted to estimate the prevalence and risk factors for post-COVID-19 syndrome in the Omani population. Methods: This is a cross-sectional study that was conducted at the University Hospital Center (UHC). All patients diagnosed with COVID-19 (through polymerase chain reaction PCR testing) between March 2020 and March 2022 were included. Eligible participants were interviewed through a phone call, informed about the study procedure, and invited to participate in the study. Results: The study enrolled 265 COVID-19 patients, of whom 156 (59.2%) were females and 204 (77.3%) had been vaccinated. The overall prevalence of post-COVID-19 syndrome was 48.5%. The most common symptom was fatigue (71, 26.9%), followed by joint pain (44, 16.7%). The other symptoms included loss of taste/smell (34, 12.9%), cough (32, 12.1%), palpitation (25, 9.5%), and hair loss (27, 10.2%). Unvaccinated patients showed a higher incidence of fatigue (p = 0.03) and loss of smell/taste (p = 0.01) on univariate analysis. Females were at high risk for the development of various symptoms, including fatigue, muscular pain, breathing difficulty, cough, chest pain, palpitation, headache, and hair loss. Multivariate analysis showed that female gender is a significant independent predictor (odds ratio: 3.1; p = 0.00) for the development of post-COVID-19 syndrome. Conclusions: The prevalence of post-COVID-19 syndrome among the Omani population was high, highlighting the need for targeted interventions to manage long-term symptoms in vulnerable groups. Full article

Physician burnout is a multifaceted syndrome characterized by emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. It affects physicians at various stages of their medical training more prevalently than their peers in the general population. This article aims to explore the systemic challenges contributing to physician burnout and the role of individual resilience as a mitigating factor. The article highlights that burnout not only impacts physician well-being but also patient care, organizational performance and healthcare costs. Factors such as heavy workload, long hours and poor interpersonal relationships significantly contribute to burnout, while personal characteristics and coping mechanisms can influence its prevalence. By examining the interplay between systemic challenges and individual resilience, this article contributes to a deeper understanding of physician burnout. It offers insights into potential strategies for mitigation, highlighting the importance of both organizational and personal interventions in addressing this escalating crisis. Full article

Evidence-based practice in nursing supports clinical practice. Several studies have tested the knowledge and attitudes of nurses toward journal clubs (JCs) and evidence-based practice. However, no study has reported knowledge of and attitudes towards evidence-based practice (EBP) and journal club workshops in Oman whilst attending highly structured workshops with the aim of critiquing the method. This study aims to assess the knowledge of and attitude towards evidence-based practice (EBP) and JC sessions among nurses attending the EBP/JC workshop at Royal Hospital, Oman. Data were collected from 22 nurses who participated in the workshop through an online self-report validated questionnaire that examined knowledge, attitude, and satisfaction. The knowledge among the participants showed improvement after the EBP intervention (p = 0.002). There was no statistical difference (p = 0.33) between the pretest and post-test attitudes towards EBP. The indicators suggest that the workshop with the highest mean value (4.14 out of 5 points), followed by the EBP workshop, which is helpful for clinical practices (mean value = 4.09), should continue in the future. The participants of the EBP workshop also agreed that they would recommend others for similar workshops. Research and EBP workshops can increase nurses’ knowledge and effectively engage them in EBP activities. Care should be given to the organization of the workshops as it directly influences the level of satisfaction. Nurses who are satisfied with EBP workshops are more likely to recommend them to others and maintain their future attendance. Full article

Glycyrrhiza glabra (licorice) has been used as an herbal medicine for a long time due to its anti-inflammatory, antioxidant, and antimicrobial properties. Additionally, multiple reports have demonstrated its ability to promote wound healing. Several randomized controlled or clinical trials (RCTs) have demonstrated its potentially therapeutic effects in oral mucosal diseases, especially in recurrent aphthous stomatitis (RAS). This systematic review aims to summarize the evidence for Glycyrrhiza glabra in treating RAS. A systematic search was performed across five databases: PubMed (Medline), ScienceDirect, Scopus document, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Library Database of Systematic Reviews. This study was reported following the PRISMA guidelines. RCT study using Glycyrrhiza glabra for treating RAS was included in this study with several reported outcomes like changes in ulcer diameter, pain, and healing periods. Seven RCTs were included, which used Glycyrrhiza glabra in the form of patches, pastes, mucoadhesive tablets, and mouthwashes for treating RAS. Glycyrrhiza glabra treatment in various regimens showed significant improvements in pain, ulcer diameter, and healing time in patients with RAS. This review suggests the potential of Glycyrrhiza glabra as an alternative treatment option for RAS. Full article

Purpose: The purpose of this scoping review was to systematically identify and summarize the existing literature on non-spinal clinical applications of EOS imaging and identify related evidence gaps. Method: The study followed the PRISMA-ScR guidelines. A systematic literature search was conducted in Embase, MEDLINE, CINAHL, Scopus, Cochrane, Academic Search Premier, and OpenGrey databases in November 2022 and updated in December 2023. Original research from 2003 to 2023 was eligible if in English, Danish, French, German, Norwegian, or Swedish. Two authors screened articles by title and abstract, while data extraction from full texts was performed by seven authors using a structured template. Results: A total of 8176 articles were identified, with 1350 selected for full-text review and 268 included in data extraction. Among adults, 187 articles were included, with 88 focused on surgical applications like hip arthroplasty or osteotomy. In pediatrics, 68 general and 13 surgery-related articles were included. Lower extremity analysis was the most frequent topic, with other uses identified, such as rib cage geometry, patellar dislocation, and X-linked hypophosphatemia. Conclusions: Key clinical applications of EOS imaging include lower extremity analysis, e.g., leg length assessment and knee/hip arthroplasty planning), pelvic and spinal alignment studies, and emerging uses in rib cage geometry. Evidence gaps include limited research on the diagnostic accuracy of EOS for cerebral shunt placement, reliability in bone age estimation, and an unclear role in foot and ankle morphology. Full article

The serendipitous discovery of antiparasitic drugs, such as quinine and artemisinin, of plant origin reveals that searching new chemical pharmacophores from medicinal plants is valuable. The present study sought to explore the antiplasmodial, antileishmanial, and antitrypanosomal activities of Lippia adoensis extracts. Crude extracts of L. adoensis leaves and twigs, which were obtained by extraction using 70% ethanol in water, were assayed for antiplasmodial activity against P. falciparum 3D7 and Dd2 through the SYBR green I-based fluorescence assay; and for antileishmanial, antitrypanosomal, and cytotoxic effects on Leishmania donovani, Trypanosoma brucei brucei, and Vero cells, respectively, using resazurin colorimetric assays. In vitro phytochemical analysis of L. adoensis extracts was performed using standard methods. Moreover, liquid chromatography–mass spectrometry (LC-MS) feature-based detection and molecular networking flow on Global Natural Product Social (GNPS) were also used for the phytochemical screening of L. adoensis extracts. Crude extracts from L. adoensis inhibited the growth of P. falciparum (3D7 and Dd2) (IC₅₀s; (3D7): 10.00 and 97.46 μg/mL; (Dd2): 29.48 and 26.96 μg/mL), L. donovani (IC₅₀s: 22.87–10.52 μg/mL), and T. brucei brucei (IC₅₀s: 2.30–55.06 μg/mL). The extracts were found to be non-cytotoxic to Vero cells, thus yielding median cytotoxic concentrations (CC₅₀s) above 100 μg/mL. In vitro phytochemical analysis of the crude extracts revealed the presence of alkaloids, terpenoids, phenolic compounds, and carbohydrates. The LC-MS tandem molecular networking flow predicted that the extracts contained valsafungin A and bacillamidin in the first cluster, and fatty acids, ketone, and aldehyde derivatives in the second cluster. Overall, the present study demonstrated the antiparasitic effects of L. adoensis extracts, thus justifying the use of this plant in the traditional treatment of fever and malaria conditions. Nevertheless, detailed metabolomic studies and antiparasitic mechanisms of action of the extracts are expected to unveil the potential antiparasitic hit compounds. Full article

Background: Oncoplastic surgery combines oncological resection with esthetic breast reconstruction, offering significant advancements in breast cancer management. Local perforator flaps, such as lateral intercostal artery perforator (LICAP) and anterior intercostal artery perforator (AICAP) flaps, are promising options for small-to-medium breast reconstructions. These flaps preserve underlying muscle and nerve structures, minimizing donor-site morbidity and enhancing esthetic outcomes and patient satisfaction. This study evaluates the clinical outcomes of LICAP and AICAP flaps for immediate breast reconstruction following quadrantectomy. Methods: A retrospective study was conducted at ASST Santi Paolo e Carlo Hospital, Milan, from September 2023 to March 2024. Twenty-five female patients who underwent quadrantectomy and immediate breast reconstruction with LICAP or AICAP flaps were included. Outcomes assessed included oncological safety, reoperation rates, flap viability, and esthetic outcomes using the BREAST-Q scale at 1 and 3 months postoperatively. Results: All patients achieved negative margins with no reoperations for oncological reasons. Flap viability was 100%, with no complications. BREAST-Q scores showed significant improvements in breast symmetry, shape, and quality of life, alongside enhanced emotional well-being and reduced postoperative pain. Conclusions: LICAP and AICAP flaps are safe and effective for immediate breast reconstruction, offering excellent esthetic outcomes, minimal donor-site morbidity, and improved patient satisfaction. Full article

Human papillomavirus (HPV) infection poses significant public health issues for both men and women. Recent studies have brought attention to the substantial impact of HPV-linked cancers in men despite historically focusing more on its effects on women. It was revealed that in 2019, HPV was the root cause of approximately 70,000 cancer cases in men. Modes of transmission for HPV include sexual contact, encompassing various practices such as vaginal, anal, and oral intercourse, as well as the use of sexual devices. Moreover, HPV-associated cancers are becoming increasingly common in men, with anal, penile, and oral cancers being the most prevalent. Although the human body can clear HPV infection in about 90% of cases, it’s crucial to take preventive measures to lower the risk of transmission and developing cancer. Using condoms, quitting smoking, and male circumcision are identified as essential factors in preventing HPV among heterosexual couples. However, the most promising preventive measure is HPV vaccination. There are ongoing discussions regarding its protective efficacy and cost-effectiveness; vaccinating boys before their sexual debut presents a compelling rationale. The existing literature primarily focuses on HPV-linked cancer in women and lacks a comprehensive review of the development and prevention methods specifically related to HPV-related cancers in men. This review strives to bridge this gap by offering a detailed overview of HPV-linked cancers in males, particularly anal, penile, and head & neck cancer. It will cover important aspects of prevention and treatment strategies to provide valuable information for public health initiatives and clinical practice. Full article

Burn injuries cause severe muscle wasting and weakness. However, the relative contribution of neuromuscular junction (NMJ) degradation remains elusive. We investigated the associations of plasma c-terminal agrin fragment-22 (CAF22), a marker of NMJ degradation, with muscle decline in burn patients. We recruited male patients with burns (n = 32, age = 32.3 ± 4.5 years, percent burn area = 15.2 ± 2.3) and age-matched controls to evaluate handgrip strength (HGS), skeletal muscle mass index (SMI), phase angle, and creatine kinase and plasma levels of CAF22, c-reactive protein, and 8-isoprostanes. We used an unpaired t-test and regression analysis for statistics. The burn patients had lower HGS, SMI, and phase angle than the controls (all p < 0.05). These patients also exhibited higher plasma CAF22, CRP, 8-isoprostanes, and creatine kinase than the controls (all p < 0.05), suggesting NMJ degradation and heightened inflammation and oxidative stress. Correlation analysis revealed significant correlations of plasma CAF22 with HGS and phase angle in the burn patients, suggesting the potential contributions of NMJ degradation to muscle weakness and atrophy (both p < 0.05). We also found correlations of plasma CRP with HGS and phase angle in these patients (both p < 0.05). Altogether, NMJ degradation appears to play a significant role in burn-induced muscle injury and may warrant further investigation for potential therapeutic interventions. Full article

Numerous factors contribute to COVID-19 symptoms, with individuals who have pre-existing health conditions at the highest risk for severe SARS-CoV-2 infection. This study investigated the socio-demographic and comorbidity profiles within a large Turkish population diagnosed with SARS-CoV-2, including 47,875 patients diagnosed between March 2020 and May 2022 across six hospitals in different Turkish cities. Patients with SARS-CoV-2 confirmed via laboratory tests and presenting symptoms were included. The data collected covered socio-demographic details, infection onset dates, COVID-19 symptoms, pre-existing health conditions, radiological findings, treatments, disease progression, and relevant variables. A total of 47,875 files were included in the analysis. The median age was 43.7 years, with 84.5% testing positive for PCR SARS-CoV-2, often correlating with severe symptoms. Notably, 11.8% of the participants exhibited mild symptoms, and approximately 12.8% had comorbidities, increasing to 17.6% among severe cases. Females with PCR-positive COVID-19 had a comorbidity rate of 13.8%, compared to 12.5% in males. Among the patients with comorbidities, those aged 70 and above had the highest rates, at 22.1% (n = 1103). The most prevalent comorbidity was hypertension, followed by diabetes and cardiovascular diseases. Severe cases had a significantly higher prevalence of comorbidities (58.4%) compared to non-severe cases (27.6%). We hope that the evaluation of our findings will contribute to the research and treatment processes of the COVID-19 outpatients. Full article