Journal of the Oman Medical Association doi: 10.3390/joma3010008

Authors: Eman Al Masroori Eslam Al-Abadi

Background: Wrist involvement in juvenile idiopathic arthritis (JIA) is associated with a more aggressive disease course and poorer long-term outcomes. However, data integrating imaging findings, treatment decisions, and procedural outcomes remains limited. Methods: We conducted a single-center retrospective cohort study of children with JIA and wrist involvement managed at a tertiary pediatric rheumatology center between 2014 and 2019. Clinical, treatment, and imaging data were collected, including magnetic resonance imaging (MRI) findings and their impact on management. Outcomes included disease activity, structural damage, and response to arthroscopic synovectomy. Results: Eighty-eight patients were included (81% female), with a mean age at diagnosis of 6.0 ± 4.5 years. Wrist involvement was present at diagnosis in 68% and became bilateral in 75%. In the overall cohort, the median time to wrist synovitis was 0 months, while the mean was 15 months, reflecting delayed onset in a subset of patients. MRI was performed in 55 patients (163 scans) and influenced management in approximately two-thirds of cases, prompting treatment escalation or modification, while preventing unnecessary escalation in one-third by demonstrating established damage. Erosive changes were detected early, with a median time of approximately 2.5–3 years from diagnosis. Most patients (88%) required biologic therapy, and 34% required two or more biologics. Twelve patients (14%) underwent arthroscopic synovectomy, with approximately half demonstrating improvement in pain and function and no perioperative complications. Conclusions: Wrist arthritis in JIA represents a severe disease phenotype characterized by early bilateral involvement, high treatment burden, and frequent structural damage. MRI plays a central role in distinguishing active inflammation from irreversible damage and directly informs clinical decision-making. Arthroscopic synovectomy appears to be a safe adjunct for selected refractory cases. These findings support the integration of structured imaging strategies into the management of high-risk joints in JIA.

Journal of the Oman Medical Association doi: 10.3390/joma3010007

Authors: Najah Abdullah Al-salmi Bushra Salman Yaman Walid Kassab Shireen Imam Bakhsh Al Zadjali Mullaicharam Bhupathyraaj Zainab Ali Al Lawati Murtadha Al-Khabori Salam AL-Kindi

Background: Myeloproliferative neoplasms (MPNs)—including primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocythemia (ET)—are clonal stem-cell disorders driven by JAK–STAT pathway activation within an inflammatory microenvironment. Ruxolitinib (RUX), a JAK1/2 inhibitor, improves splenomegaly and symptom burden in myelofibrosis and serves as second-line therapy in hydroxyurea-resistant/intolerant PV. However, real-world data from Middle Eastern populations remains scarce. This study evaluates the effectiveness, safety, and dosing practices of RUX in a heterogeneous Omani MPN cohort. Methods: Electronic records were reviewed for adults diagnosed with MF, PV, or ET who received RUX at Sultan Qaboos University Hospital or the National Hematology and BMT Center between 2018 and 2025. Only patients with at least six months of follow-up were included. Clinical variables, laboratory results, dosing information, and data on treatment responses and toxicities were extracted. Outcomes focused on spleen size changes, symptom improvement, hematologic responses, adverse events, and reasons for treatment discontinuation. Results: Twenty-eight patients were included (71% PMF; mean age 52.6 years). The median time from diagnosis to RUX initiation was 28 months. Among MF patients, mean spleen size decreased by 35% (p = 0.003); 28% achieved ≥35% reduction. Symptomatic improvement was reported by 60%. LDH levels remained unchanged. PV patients showed spleen control in 75% and symptom benefit in all cases, while ET responses were limited. Cytopenias (21%) and infections (11%) were the most common toxicities; discontinuation occurred in 8/28 of patients, and two patients died while on therapy. Initial dosing was frequently inappropriate, particularly underdosing in MF and overdosing in PV. Conclusions: RUX provided meaningful spleen and symptom improvement in MF and PV; however, toxicity, delayed initiation, and inconsistent dosing practices limited overall outcomes. Enhanced guideline-based dosing, proactive toxicity management, and structured multidisciplinary follow-up are essential to optimize RUX use in regional MPN practice.

Journal of the Oman Medical Association doi: 10.3390/joma3010006

Authors: Alex Gabagambi Alexander Blandina T. Mmbaga Edna Paul Noela H. Daniel Mariam L. Barabara Aloyce G. Mlyomi Florida J. Muro John A. Barlett Charles Muiruri

Background: Assisted Partner Notification Services (APNS) support HIV disclosure and reduce HIV transmission. Despite this potential, APNS remains underutilized due to several barriers. A clearer understanding of APNS utilization, barriers, and the facilitators is essential to guide APNS improvement. Objectives: This study aimed to determine the level of APNS utilization, barriers, and facilitators for its uptake among people living with HIV (PLWH) in Singida. Methods: We employed a convergent mixed-methods design. A cross-sectional survey quantified APNS utilization and its associated factors among PLWH who have sexual partners, while complementary qualitative interviews explored perceived barriers and facilitators from the perspectives of both PLWH and healthcare providers. Results: In the Singida region, only forty percent of participants reported the use of APNS. Higher knowledge of HIV disclosure was positively associated with uptake (AOR = 2.65, 95% CI: 2.28–2.81; p = 0.02), whereas depressive symptoms reduced engagement (AOR = 0.95, 95% CI: 0.91–0.99; p = 0.027). Qualitative interviews in Singida identified multilevel barriers, including stigma, gender dynamics, and cultural constraints. Facilitators provided supportive medical advice, non-judgmental counseling, and assurances of confidentiality. Conclusions: Findings reveal low APNS uptake in Singida, constrained by stigma and cultural dynamics. Strengthening knowledge of disclosure, providing supportive medical advice, and ensuring confidentiality may enhance the use of APNS.

Journal of the Oman Medical Association doi: 10.3390/joma3010005

Authors: Venkatesh Govindaraju Rajeev Kariyattil Koshy Kochummen Ghusn Al Sideiri Sameer Raniga Faizal Al-Azri Noor Abdullah Al Shekaili Abdullah Al Lawati

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.

Journal of the Oman Medical Association doi: 10.3390/joma3010004

Authors: Fathiya Thabit Al-Shariqi Shaima Al-Mazrooei Abeer Al-Harrasi Mohei Ismail Fairuz Al-Kathiri Mohammed Al-Ismaili Rua Al-Harthi Zainab Al-Rajhi Samira Al-Maimani Zahir Al-Kharusi Khadija Riyadh Al-Raisi

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.

Journal of the Oman Medical Association doi: 10.3390/joma3010003

Authors: David Leksa David Aebisher Angelika Myśliwiec Wiktoria Mytych Klaudia Dynarowicz Jakub Tylutki Dorota Bartusik-Aebisher

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.

Journal of the Oman Medical Association doi: 10.3390/joma3010002

Authors: Maryam Musallam Salim Al-Harassi Ahmed Ibrahim Al Kharusi Narasimman Swaminathan

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.

Journal of the Oman Medical Association doi: 10.3390/joma3010001

Authors: Muthiara Adlin Azzahra Artha Wahyu Wardana Indiane Putri Ningtias Mochamad Renaldi

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.

Journal of the Oman Medical Association doi: 10.3390/joma2020015

Authors: Moza Sulaiman Albadi Sumaiya Mubarik Al A’amri Khalid Salim Al Dhuhli Assad Rashid Al Ghafri Eman El Sayed Abd-Ellatif

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.

Journal of the Oman Medical Association doi: 10.3390/joma2020013

Authors: Stylianos Papadopoulos Vasileios Zisis Konstantinos Poulopoulos Christina Charisi Athanasios Poulopoulos

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.

Journal of the Oman Medical Association doi: 10.3390/joma2020014

Authors: Nazik Tayfour Babiker Ahmed Rashid Khalfan Salim Al Abri Deepali Jaju

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.

Journal of the Oman Medical Association doi: 10.3390/joma2020012

Authors: Damaris Apiyo Ouma Mourine Mutai Ezekiel Mugendi Njeru John P. Oyore Johnstone O. Neondo Ambrose Jagongo George Omwenga Mathew Piero Ngugi Musa Otieno Ngayo Richard O. Oduor

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

Journal of the Oman Medical Association doi: 10.3390/joma2020011

Authors: Reem Ali Alhabsi Amani Abdullah Almukhladi Rania Ali Mahdi Kadhim Reham Ali Alhabsi Maisa Hamed Al Kiyumi Abdulaziz Al Mahrezi

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.

Journal of the Oman Medical Association doi: 10.3390/joma2020010

Authors: Salim Al-Busaidi Nasiba Al-Maqrashi Usama Al Amri Nuha Al Habsi Sara Al Rasbi Masoud Kashoub Mohamed Al Rawahi Hoor Al Kaabi Abdullah M. Al Alawi

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010009

Authors: Jamila Al Mabsali Mudhar Al Adawi Warda Al Amri

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010008

Authors: Annisa Sabrina Iskandar Ghinaya Shaliha Nursaida Nisa Hanifa Queen Satutya Wicaksono Meircurius Dwi Condro Surboyo Diah Savitri Ernawati

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010007

Authors: Karen Brage Bo Mussmann Malene Roland Pedersen Marcus Nissen Oliver Brage Svea Deppe Mørup Mats Geijer Palle Larsen Janni Jensen

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010006

Authors: Eugenie Aimée Madiesse Kemgne Mariscal Brice Tchatat Tali Darline Dize Cyrille Armel Njanpa Ngansop Boniface Pone Kamdem Fabrice Fekam Boyom

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010005

Authors: Luca Galassi Gaia Harder Federica Facchinetti Andrea Cordovana Roberta Gilardi

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010004

Authors: Soumendu Patra Harshita Shand Sayan Ghosal Suvankar Ghorai

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010003

Authors: Imran Muhammad Khan Mashal Javed Hina Zuhra Rizwan Qaisar

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010002

Authors: Hediye Seval Akgün Tuğba Gürgen Erdoğan Mehmet Cenk Belibağlı Gamze Güneş Ali Haberal

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.

Journal of the Oman Medical Association doi: 10.3390/joma2010001

Authors: Hediye Seval Akgün Tuğba Gürgen Erdoğan Mehmet Cenk Belibağlı Gamze Güneş Ali Haberal

This research aims to investigate the associations between comorbidities and clinical outcomes, specifically their impacts on mortality rates among COVID-19 inpatients, while also assessing the varying significance of different comorbidities. We conducted this study to understand the interplay between SARS-CoV-2 infection, socio-demographic factors, disease severity, and co-morbid conditions in a sample of 26,835 hospitalized COVID-19 cases. Our analysis extended to examining the frequency of infection symptoms, pre-existing health issues, treatment strategies, intensive care unit (ICU) and hospital stays, clinical symptoms, and radiological findings. Among the 26,883 cases analyzed, comprising 53.7% males and 53.3% females with an average age of 48.5 years, we observed mean clinical values for temperature, heart rate, respiratory rate, and blood pressure. Leveraging logistic regression modeling helped untangle the complex relationships and confounding variables influencing COVID-19 mortality. Notably, our findings underscored the significance of total length of stay, prolonged ICU stays exceeding ten days, and the presence of significant symptoms in affecting mortality rates among COVID-19 patients. These insights unveil potential trends crucial for informing future management strategies tailored to the needs of COVID-19 patients, emphasizing the importance of addressing comorbidities and optimizing care approaches for better outcomes.

Journal of the Oman Medical Association doi: 10.3390/joma1010010

Authors: Zahida Niaz Babikir Ismail Abdullah Yahya Al Farai Ramesh Babu Telugu Muhammad Sharjeel Usmani Ibrahim Hassan Al Haddabi

Cytologic diagnosis of extra-adrenal paraganglioma presenting as a peripancreatic mass is challenging, with a high rate of diagnostic error. We present a case of a peripancreatic mass identified by radiology as a gastrointestinal stromal tumor. Endoscopic ultrasound-guided fine-needle aspiration (FNA) of the mass showed a moderately cellular tumor composed of small-to-medium-sized neoplastic cells with round-to-oval nuclei arranged singly and in loose clusters. The cells were positive for neuroendocrine markers (synaptophysin and chromogranin) and negative for CD117. A diagnosis of neoplasm with a neuroendocrine tumor (NET) was made based on FNA cytology. The subsequent surgical resection of the tumor revealed peripancreatic paraganglioma with immunohistochemistry positive for synaptophysin, chromogranin, and S100. The latter delineated the sustentacular cells. Although paraganglioma is a well-recognized tumor, a detailed comparison of peripancreatic paraganglioma versus pancreatic/gastrointestinal NET is still lacking.

Journal of the Oman Medical Association doi: 10.3390/joma1010009

Authors: Salim Al-Busaidi Leena Al Shandoudi Manal Al-Ghafri Muhammad Shoaib

Carbon monoxide (CO) poisoning is a leading cause of poisoning-related deaths, particularly affecting organs with high oxygen demands such as the heart and brain. Cardiac complications, including non-ST elevation myocardial infarction (NSTEMI), can occur due to CO poisoning but are not frequently reported in the elderly. We present the case of an 82-year-old female with a medical history of diabetes, hypertension, dyslipidemia, and previous ischemic heart disease. She was brought to the emergency department after being found drowsy in a closed room with a burning charcoal heater. The initial assessment revealed a carboxyhemoglobin level of 33.5%, which decreased to 9.3% after high-flow oxygen therapy and hyperbaric oxygen therapy (HBOT). Laboratory tests indicated elevated troponin levels, and an ECG showed asymmetrical T-wave inversion and ST depression. Despite the improvement in carboxyhemoglobin, the patient experienced persistent chest pain and rising troponin levels. She was treated with dual antiplatelet therapy and low molecular weight heparin as per acute coronary syndrome protocol, leading to a gradual improvement and a subsequent discharge in a stable condition. This case highlights the potential for CO poisoning to induce NSTEMI in elderly patients. A prompt diagnosis and appropriate management, including the use of HBOT, were crucial for the patient’s recovery.

Journal of the Oman Medical Association doi: 10.3390/joma1010008

Authors: Maria Abutair Sara Elkhatib Rawan Flayyih Dalal Alarabid Mohamed Nacer Rizwan Qaisar Shah Hussain Areesha Ashraf

Introduction: Hormone replacement therapy (HRT) prevents muscle loss associated with menopause; however, the relative role of the neuromuscular junction (NMJ) in post-menopausal women taking HRT is poorly known. We investigate the effects of HRT on plasma C-terminal agrin-fragment-22 (CAF22) in post-menopausal women taking HRT. Methods: We recruited three groups of women, including pre-menopausal (age = 45.3 ± 3.1 years, n = 48) post-menopausal HRT-users (age = 56.7 ± 4.1 years, n = 42) and non-users (age = 55.4 ± 3.9 years, n = 47) for measurements of handgrip strength (HGS), skeletal muscle mass index (SMI), short physical performance battery (SPPB; marker of physical capacity), and plasma CAF22 levels. Results: Post-menopausal non-users of HRT had lower HGS, SMI, gait speed, and SPPB scores and higher plasma CAF22 levels than pre-menopausal women (all p < 0.05). Conversely, HRT users had higher HGS and gait speed and lower plasma CAF22 than non-users among post-menopausal women. HRT users also exhibited SPPB scores similar to those of pre-menopausal women. We observed significant correlations of plasma CAF22 with HGS, gait speed, and total SPPB scores in pre-menopausal and post-menopausal women with HRT (ALL p < 0.05). Lastly, HRT users had lower markers of inflammation and oxidative stress than non-users among post-menopausal women (both p < 0.05). Conclusion: Altogether, menopause was associated with elevated markers of NMJ degradation along with reduced muscle strength and physical capacity. HRT partly reduced NMJ degradation and restored muscle strength and physical capacity in post-menopausal women.

Journal of the Oman Medical Association doi: 10.3390/joma1010007

Authors: Ahmed Alsibani Mohammed Alessa Fahad Alwadi Shams Alotaibi Hana Alfaleh Ali M. Moshibah Abdullah M. Alqahtani Abdulwahed AlQahtani Mohammad Almayouf Saleh F. Aldhahri Khalid Hussain Al-Qahtani

The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) stratifies patients with thyroid nodules for further evaluation. We evaluated the accuracy of this risk stratification and compared it with that of fine-needle aspiration cytology (FNAC) and final pathology. The nodules (n = 381) of 329 patients (mean age, 45.5 y; 251 female) who underwent thyroid surgery from January 2021 to September 2023 were retrospectively analyzed for the ACR TI-RADS, FNAC, and final pathology results. The nodules were categorized according to risk of malignancy as 75.9% ACR TI-RADS 5, 72.6% ACR TI-RADS 4, 38.9% ACR TI-RADS 3, and 33.3% ACR TI-RADS 2. Considering ACR TI-RADS 5 and 4 as high-risk categories, the sensitivity, specificity, positive-predictive value, and negative-predictive value of the ACR TI-RADS categories were 77.9%, 57.3%, 73.8%, and 62.8%, respectively. With both ACR TI-RADS and FNAC high-risk categories combined, the sensitivity and specificity improved to 82.4% and 58.6%, respectively. The ACR TI-RADS score effectively predicts malignancy in higher-risk categories; however, some malignant cases were found within lower-risk categories, implying the need for careful utilization of this system. Combining high-risk ACR TI-RADS and FNAC results improves the diagnostic accuracy of thyroid nodules. Confirmation from further prospective studies is required.

Journal of the Oman Medical Association doi: 10.3390/joma1010006

Authors: Huda Al Menji Asiya Al Zadjali Mustafa Al Lamki Zakiya Al Shamsi Lamees Al Kiyumi Khadija Al Harrasi Kawther Al Rashdi Issa Al Salmi

Objectives—This study aimed to investigate the factors contributing to increased absenteeism among nurses in primary healthcare institutions in Oman. Methods—A quantitative descriptive cross-sectional design included a structured written questionnaire that uses a quantitative self-repot technique was used. The study was conducted between January 2022 to November 2022 on a random selection of 300 nurses working in the primary and secondary healthcare institutions and regional hospitals in the Muscat governorate. Results—A total of 229 questionnaire were returned with a response rate of 76%. Almost 97% (222) participants were females, and 7 (3.1%) were males. Almost 51% of nurses were 25–34 years old. The respondents considered minor physical alignments, chronic medical conditions, and stress-related factors to be the predominant factors contributing to absenteeism among nurses. In addition, the coercive attitude of the leader, nurses whose performance was always criticized by the leader, and the nurse leader having inadequate support and guidance in performing patient care were considered important factors contributing to absenteeism. Conclusions—Nurses’ absenteeism is considered a threat to the quality of services provided for society at the primary healthcare level. The most common factors leading to increased absenteeism among nurses were found to be linked with demographic, leadership, and work characteristics. The most significant factors were considered to be within work characteristics, specifically the shortage of staff leading to workload, shift duties with limited flexibility, extra tasks, and absence of supportive policies. Additionally, leadership factors such as involvement, regular feedback, respect, and active listening to concerns were among the contributing factors to increased nursing absenteeism.

Journal of the Oman Medical Association doi: 10.3390/joma1010005

Authors: Uzma Tayyaba Shariq Wadood Khan Asfia Sultan Fatima Khan Anees Akhtar Geetha Nagaraj Shariq Ahmed Bhaswati Bhattacharya

Whole genome sequencing (WGS) has the potential to greatly enhance AMR (Anti-microbial Resistance) surveillance. To characterize the prevalent pathogens and dissemination of various AMR-genes, 73 clinical isolates were obtained from blood and respiratory tract specimens, were characterized phenotypically by VITEK-2 (bioMerieux), and 23 selected isolates were genotypically characterized by WGS (Illumina). AST revealed high levels of resistance with 50.7% XDR, 32.9% MDR, and 16.4% non-MDR phenotype. A total of 11 K. pneumoniae revealed six sequence types, six K-locus, and four O-locus types, with ST437, KL36, and O4 being predominant types, respectively. They carried ESBL genes CTX-M-15 (90.9%), TEM-1D (72.7%), SHV-11 (54.5%), SHV-1, SHV-28, OXA-1, FONA-5, and SFO-1; NDM-5 (72.7%) and 63.6%OXA48-like carbapenamases; 90.9%OMP mutation; dfrA12, sul-1, ermB, mphA, qnrB1, gyrA831, and pmrB1 for other groups. Virulence gene found were Yerisiniabactin (90.9%), aerobactin, RmpADC, and rmpA2. Predominant plasmid replicons were Col(pHAD28), IncFII, IncFIB(pQil), and Col440. A total of seven XDR A. baumannii showed single MLST type(2) and single O-locus type(OCL-1); with multiple AMR-genes: blaADC-73, blaOXA-66, blaOXA-23, blaNDM-1, gyrA, mphE, msrE, and tetB. Both S. aureus tested were found to be ST22, SCCmec IVa(2B), and spa type t309; multiple AMR-genes: blaZ, mecA, dfrC, ermC, and aacA-aphD. Non-MDR Enterococcus faecalis sequenced was ST 946, with multiple virulence genes. This study documents for the first-time prevalent virulence genes and MLST types, along with resistance genes circulating in our center.

Journal of the Oman Medical Association doi: 10.3390/joma1010004

Authors: Mahmood Mausd Al Awfi Maryam Nasser Algheilani Salma Al Shamsi Nabila Ali Al Julandani Smitha Mahesh

Background: Primary breast lymphoma is a rare entity in that it accounts for less than 1% of breast cancer and 2.2% of extranodal lymphoma. The most common histological type is diffuse B-cell lymphoma. Early stages of the disease have relatively good prognosis. Case Presentation: In this case, we are reporting on a forty-four-year-old lady presenting a large fungating right breast mass that turned out to be a primary breast lymphoma and whose outcome was unfortunate due to late presentation. Conclusions: Despite significant evolvement on treatment of lymphoma, negligence and social stigmatization still have a role in patients’ demise. Efforts toward awareness and anti-stigmatization are of paramount importance.

Journal of the Oman Medical Association doi: 10.3390/joma1010003

Authors: Zalikha Khamis Al-Marzouqi Nawal Said Alsereahi Safiya Khalfan Al Maqbali

Background: Gestational anemia is one of the most confronted problems during gestation. Nevertheless, the number of pregnant women with gestational anemia is growing in Oman. This study aimed to explore the perception of pregnant women regarding gestational anemia and iron supplements. This study would help us to comprehend pregnant women’s perceptions, attitudes, and factors regarding gestational anemia and iron supplements, as well as to understand the factors behind iron-deficiency anemia among pregnant women. Method: This study utilized a qualitative method directed by a grounded theory (constructivist) approach. The researchers conducted semi-structured (in-depth) interviews with 36 pregnant women with gestational anemia in the North Batinah Governorate in Oman. The researchers selected three primary healthcare institutions and one secondary healthcare institution, intending to reach pregnant women with gestational anemia. Both purposive sampling and theoretical sampling were used in this study. Results: From constant comparative analysis, four categories were developed: “Knowing the Problem”, “Believing in Treatment”, “Influencing Factors”, and “Trying To Manage”. Conclusion: Understanding pregnant women’s perception of gestational anemia and iron supplements could assist the Ministry of Health in developing ways to provide proper education and service for expectant mothers in Oman.

Journal of the Oman Medical Association doi: 10.3390/joma1010002

Authors: Michael Otorkpa Alan Kirk Nichola Philp Asmaa Omran

Echocardiography is fundamental to diagnostic medicine, yet medical students seldom learn it. Simulation-based training to improve echocardiography learning is promising. This study examined how simulation-based echocardiography training affects final-year medical students’ knowledge and abilities. The study involved 16 medical students. Prior ultrasound experience and self-assessed competence were assessed using a pre-test that also had six multiple-choice questions on cardiac anatomy and physiology. The students went through an echocardiography teaching session using a simulator and a post-test with similar questions as the pre-test was administered thereafter. We compared both tests, and data analysis was performed using Microsoft Excel. Most students had little echocardiography experience before the class. After the teaching, scores averaged 5.07, up from 4.13 in the pre-test. Differences in pre-test and post-test scores were statistically significant (p = 0.007). The responses represented an improvement in self-assessed competence after the session. Simulation-based echocardiography improved medical students’ knowledge and skills. This study emphasizes the need for simulation-based training research to determine its long-term effects on clinical practice.

Journal of the Oman Medical Association doi: 10.3390/joma1010001

Authors: Rashid Al Abri

It is with both great pleasure and a considerable sense of excitement that we present this inaugural issue of the Journal of the Oman Medical Association (ISSN: 2813-8759) [...]