With the global increase in the use of dietary supplements to provide nutrients in one\'s regular diet, these supplements\' potential health risks and benefits have become a topic of significant interest. Interestingly, as dietary supplements, the Food and Drug Administration (FDA) in the United States (USA), Europe, and most countries do not require manufacturers and distributors to obtain approval or provide safety assessments before marketing those products. This research explores for the first time 16 heavy, trace and macro-elemental contents, namely, As, Ni, Cd, Pb, Cu, Co, Mn, Cr, Zn, V, Fe, Al, K, Na, Mg, and Ca, within 24 nutraceutical and herbal supplements marketed in Oman. The research is focusing on ensuring their compositions, concentrations, and freedom of toxic elements. ICP-OES was utilized, preceded by a microwave digestion technique to digest the samples in concentrated HNO3 and HCl (3:1, v/v). The method was validated within linear ranges of 0.03-5.00 ppm and 1.0-200.0 ppm for micro- and macro-elements, respectively, with %recoveries ranging from 90 to 104%. The limits of detection ranged from 0.01 to 0.09 and 0.14 to 0.30 ppm, while the limits of quantification ranged from 0.03 to 0.28 and 0.46 to 0.91 ppm for micro- and macro-elements, respectively. The detected levels were compared to online databases for risk assessment. Although As and Cd were not detected in all samples, Pb was found in nine samples, with some exceeding regulated limits of exposure. About 80% of the samples contained Al, of which two samples were susceptible to serious health risks of exceeding exposure limits in their compiled doses. The locally harvested Omani herbal supplements revealed significant amounts of Zn, Mg, Mn, and Cu. The results highlighted the potential risks associated with both dosage compliance and labeling discrepancies.

UNASSIGNED: Cervical cancer remains a global health challenge, claiming the lives of millions annually and having a significant impact on Gulf Cooperation Council (GCC) countries. Human papillomavirus (HPV), the primary causative agent, plays a central role, with regional variations in prevalence.1 The process from HPV infection to neoplastic changes takes 5-25 years to occur, hence, knowing its prevalence in our community is vital.2.
UNASSIGNED: PubMed and SCOPUS were searched to identify articles related to cervical and anogenital HPV prevalence and genotypes in Qatar, Kuwait, Bahrain, Oman, the United Arab Emirates (UAE), and the Kingdom of Saudi Arabia (KSA) published between 2017 and 2024.
UNASSIGNED: A total of 19 articles were included in this review. Eight studies were from KSA, four were from Kuwait, three were from the UAE, one was from Qatar, Oman, and Bahrain, and one presented data collectively from the KSA, UAE, Qatar, and Bahrain. The prevalence of HPV ranged between 4.7% and 77% in studies from the KSA, between 15% and 54.3% in studies from Kuwait, between 14.7% and 88% in studies from the UAE, was 8.1% and 31.3% in the two studies from Qatar, and was 17.8% and 20% in the studies from Oman and Bahrain, respectively. HPV 16 was the most prevalent high-risk genotype found in studies conducted in the KSA, UAE, Kuwait, and Qatar. In Oman, HPV 82 predominated. In Bahrain, the majority had other non-HPV 16/18/45 genotypes. In the UAE and Kuwait, HPV 11 was the predominant low-risk type, followed by HPV 6. In Qatar, HPV 81 was the most common low-risk type, followed by HPV 11. In Oman, HPV 54 was the most common low-risk type, followed by HPV 42.
UNASSIGNED: There are no studies with data on HPV prevalence and genotypes among women who have been vaccinated against HPV in GCC countries.

Pythium sensu lato (s.l.) is a pathogenic oomycete. The present study was conducted to isolate and identify Pythium s.l. species associated with the rhizosphere and roots of greenhouse-growing cucumbers showing damping-off symptoms in 10 Omani governorates (provinces). A total of 166 isolates were recovered from 276 rhizosphere soil and root samples and were identified based on the ribosomal DNA (rDNA) internal transcribed spacer (ITS) region and the cytochrome c oxidase subunit I (COX I) gene region. Pythium aphanidermatum, P. myriotylum, Globisporangium spinosum, Globisporangium sp.1 (isolates Kb003/PySyCu-1 and Kb004/PySyCu-2), and Globisporangium sp.2 (isolate Ib002R) were identified. Among these species, P. aphanidermatum was the most abundant species, represented by 143 isolates (86.1%), followed by G. spinosum with 18 isolates (10.8%), Globisporangium sp.1 and P. myriotylum each with 2 isolates (2.4%), and Globisporangium sp.2 with 1 isolate (0.6%). Pathogenicity tests were also conducted for 38 isolates, including P. aphanidermatum (25), P. myriotylum (2), Globisporangium sp.2 (1), G. spinosum (8), and Globisporangium sp.1 (2). Among the tested isolates, only Globisporangium sp.2 isolate was avirulent, and none of the seeds were rotted at the end of the treatment. However, the other species induced the symptoms of seed decay with the incidence ranged from 86.7 to 100%. Phylogenetic analyses were conducted based on 222 ITS and 53 COX I sequences, and confirmed morphological identification. In addition, the genetic diversity of 93 P. aphanidermatum isolates was assessed via the amplified fragment length polymorphism (AFLP) method. The analysis produced 93 genotypes and 449 polymorphic loci. Pythium aphanidermatum populations were found to have moderate levels of genetic diversity (H = 0.2) and a moderate Shannon information index (I = 0.3793). Analysis of molecular variance (FST = 0.1, P = 0.0) revealed a moderate level of genetic differentiation among P. aphanidermatum isolates between Oman governorates. The sensitivity of 15 P. aphanidermatum isolates was evaluated against hymexazol at different concentrations (10, 100, and 1000 ppm). The results revealed that P. aphanidermatum could grow well at concentrations of up to 100 ppm hymexazol. However, hymexazol at 1000 ppm retarded the growth of P. aphanidermatum. This study showed that P. aphanidermatum is the most prevalent species in greenhouses in Oman and exhibited a moderate level of genetic diversity. Most of the isolates exhibited differences in tolerance to hymexazol but showed no resistance.

BACKGROUND: Misuse and overuse of antibiotics comprise leading causes of antimicrobial resistance. The study aims to assess the pattern of antibiotic prescription among primary healthcare general practitioners in the South Batinah Governorate of Oman.
METHODS: A cross-sectional study of 600 antibiotic prescriptions issued in the South Batinah Governorate in 2019 was conducted to verify the triggering diagnoses and determine the appropriateness of the prescribed antibiotic. Logistic regression analysis was used to determine the association between predictors and inappropriate use.
RESULTS: Respiratory infections accounted for 62% of antibiotic prescriptions, of which 92.2% were inappropriately prescribed. Extended-spectrum antibiotics were inappropriately prescribed in 33.3% of cystitis cases, while 14.3% of gastroenteritis received incorrect spectrum of antibiotics. Amoxicillin represented 46.2% of antibiotic prescriptions, of which 84.4% were unnecessarily prescribed. Lower inappropriate antibiotic prescribing rate was linked to patients ≥ 18 years (OR = 0.46, 95% CI: [0.26, 0.82]), those who underwent laboratory tests (OR = 0.22, 95% CI: [0.12, 0.39]), and consultations at health centers (OR = 0.44, 95% CI: [0.24, 0.79]). Arabic-speaking physicians were more likely to prescribe antibiotics inappropriately.
CONCLUSIONS: Inappropriate antibiotic prescription was frequently observed in mild respiratory infections and associated with specific patient and physician characteristics. Appropriateness of antibiotic prescriptions issued can be improved through enhanced testing capacities as well as implementation of physician and community awareness campaigns.

Heart failure (HF) is a global epidemic with a prevalence of over 64.3 million cases worldwide. Several factors account for the increase in the prevalence of HF. The most significant factor is the growing population of older adults. Other factors include improved treatment and survival after myocardial infarction, poorly controlled hypertension (HTN), and diabetes mellitus (DM). As a modifiable construct, perceived control can be improved to promote healthier lifestyle choices, such as self-care, and consequently better health outcomes. A person\'s perception of control is their conviction that they have the power to deal with adverse circumstances, like receiving an HF diagnosis, and produce favorable results, such as an improvement in symptom status. The objective of this study was to evaluate the factors influencing perceived control attitudes among patients with heart failure in Oman. In this sample of HF patients (N = 180), the mean perceived control attitude was 16.97 ± 2.25. Certain factors had higher effects than others. For example, females (p = 0.006), old age (p < 0.001), those who smoke (p < 0.001), current health compared to one year back (p < 0.001), higher ejection fraction (p = 0.008), and comorbidities (p = 0.026) have significant relationships with perceived control attitude. The perceived control attitude in this sample was found to be adequate. Female gender, old age, smoking, current health, higher EF, and comorbidities were the associated factors of a perceived control attitude. Thus, interventions targeting attitudes, barriers, and social support may improve perceived control. Clinicians should assess and manage perceived control to maintain or improve quality of life.

OBJECTIVE: Career indecision is a broad term that refers to the uncertainty and difficulty of decision-making regarding future careers among junior professionals. This study aims primarily to estimate the prevalence of career indecisiveness among senior medical students and medical interns in Oman. Secondly, it assesses the association of sociodemographic factors influencing it. Finally, it examines the association between participation in career development activities and career indecision among them during the academic year of 2022-2023.
METHODS: A cross-sectional study was conducted using an anonymous self-administered questionnaire in the English language. Unpaired t-test and ANOVA test were used to compare means between groups. A 21-item Career Factors Inventory (CFI) was used to determine the career indecision score. These scores were further classified as low-level (score 27-71) and high-level (score 72-105).  Results: The total number of participants was 161. The minimum sample size calculated was 153 participants for 95% confidence intervals. The prevalence of high-level career indecision was 63.4% (95%CI 55.4%-70.8%) among the participants. Participants with one of their parents in healthcare professions and those who did not participate in career development activities had high career indecision scores with P-values of 0.002 and 0.022, respectively. Moreover, participants younger than 25 years of age in comparison to older participants had higher need-for-self-knowledge (NSK) scores (p-value 0.018).
CONCLUSIONS: A high prevalence of high-level career indecision was seen among senior medical students and medical interns in Oman. Few factors were found to be statistically associated with career indecision, especially participation in career development activities. Further studies are recommended to investigate the causality of high-level career indecision among junior professionals in Oman and the contributing factors. Curricular and extra-curricular career development activities and counseling may reduce career indecision.

BACKGROUND: To estimate the impact of reducing obesity, smoking, and physical inactivity (PIA) prevalence, and of introducing physical activity (PA) as an explicit intervention, on the prevalence, incidence, and mortality of type 2 diabetes mellitus (T2DM) in Oman.
METHODS: A deterministic population-level mathematical model was employed to investigate the impact of different scenarios for reducing T2DM risk factors on T2DM epidemiology. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status and parameterized with nationally representative data. Intervention scenarios were calculated and compared with a baseline (no-intervention) scenario for changes in T2DM prevalence, incidence, and mortality among adult Omanis between 2020 and 2050.
RESULTS: In the no-intervention scenario, T2DM prevalence increased from 15.2% in 2020 to 23.8% in 2050. Achieving the goals of halting the rise of obesity, reducing smoking by 30%, and reducing PIA by 10% as outlined in the WHO\'s Global Action Plan for Non-communicable Diseases (implemented between 2020 and 2030 and then maintained between 2031 and 2050) would reduce T2DM prevalence by 32.2%, cumulative incidence by 31.3%, and related deaths by 19.3% by 2050. Halting the rise of or reducing obesity prevalence by 10%-50% would reduce T2DM prevalence by 33.0%-51.3%, cumulative incidence by 31.9%-53.0%, and related deaths by 19.5%-35.6%. Reducing smoking or PIA prevalence by 10%-50% would lead to smaller reductions of less than 5% in T2DM prevalence, cumulative incidence, and related deaths. Introducing PA with varying intensities at a 25% coverage would reduce T2DM prevalence by 4.9%-14.1%, cumulative incidence by 4.8%-13.8%, and related deaths by 3.4%-9.6% by 2050.
CONCLUSIONS: Intervention-for-prevention efforts targeting obesity reduction and introducing PA could result in major reductions in the T2DM burden. Prioritizing such interventions could alleviate the burden of T2DM in Oman and other countries with similarly high T2DM and obesity burdens.

BACKGROUND: Fatigue among patients with end-stage kidney disease (ESKD) receiving haemodialysis imposes a substantial burden on patients\' quality of life and expected treatment outcomes. This study explores the perspective on ESKD-related fatigue and contributing factors among Omani patients receiving haemodialysis.
METHODS: An exploratory qualitative design was used. Participants (N = 25) were recruited from two Omani haemodialysis centres, and data were collected through semi-structured interviews, which were transcribed and analysed using a thematic analysis approach. NVivo 11 is used to manage qualitative data and create memos, nodes, and codes.
RESULTS: Findings highlighted three themes: (i)\"Inevitability of fatigue,\" (ii)\"Contributors to physical fatigue,\" and (iii)\"Contributors to mental fatigue.\" Theme one alluded to the inevitability of fatigue and the unique experience encountered by patients. Theme two addressed the physical fatigue associated with ESKD-related factors, such as chronically low haemoglobin levels, and the exhausting impact caused by the frequency and travelling distance for treatment sessions. Theme three, mental fatigue, was notably driven by heightened emotional disturbance, encompassing frustration, guilt, anxiety, and distress, that in turn impacted family interactions, frequently triggering anger and remorse. Moreover, mental fatigue is a result of disturbances in expressing physical sexuality in marriage, as physical fatigue was found to be a significant contributor to unsatisfactory sexual experiences and, thus, straining the relationships between couples.
CONCLUSIONS: This study offers an explanation of fatigue among Omani patients with ESKD who are receiving haemodialysis. The study emphasises close links between physiological change, the haemodialysis process, and mental tiredness, together with their contribution to supporting the need for a holistic approach and care strategies in managing these patients and promoting patient and family well-being.

Melioidosis is an emerging tropical infectious disease in travelers. We present a case of travel related melioidosis in a 65-year-old man with chronic obstructive pulmonary disease and end stage renal disease following a two-week business trip to Thailand and attendance of the Songkran festival. This case emphasizes that vigilance, heightened clinical suspicion, and use of appropriate microbiology diagnostic tools are of paramount importance for a timely diagnosis and successful management. With the ever-increasing global travel, infectious diseases specialists, microbiologists, and public health professionals are constantly challenged by unfamiliar infections in returned travelers.

OBJECTIVE: Colorectal cancer (CRC) is considered one of the most common cancers in the world. Serrated polyps were found to be precursor lesions for CRC. BRAF mutation (V600E) has been strongly linked to the development of these lesions. No previous study concerning BRAF immunohistochemical expression in serrated polyps- was done in Oman. The primary objective of our study was to assess the prevalence of BRAF (V600E) mutation in serrated colorectal polyps in the Omani population. The secondary objectives were to assess the prevalence of serrated polyps and their characteristic features: type, site and size as well as the relationship between BRAF (V600E) mutation and polyp type, site and size.
METHODS: Ninety-one hyperplastic polyps (HP) (76.5%), 24 sessile serrated lesions (SSL) (20.2%) and 4 cases of tubular adenomas with low grade dysplasia (3.4%) were studied for BRAF (V600E) immunohistochemical expression. No case of traditional serrated adenoma (TSA) was present. Control cases of craniopharyngioma and papillary thyroid carcinoma were included.
RESULTS: BRAF (V600E) IHC was positive in 63 of the HP polyps (69.2%), 13 SSLs (54.2%) and none of the adenomatous polyps. The majority of positive polyps (75.0%) were ≤5 mm in size, 17.9% were 5-10 mm and 7.1% were ≥10 mm in size.  The majority of BRAF (V600E) positive polyps (68.1 %) were in the distal colon and 31.9 % were in the proximal colon. The majority of positive cases for BRAF (V600E) were showing multiple polyps (61.8 %). None of the tubular adenomas showed any BRAF (V600E) positivity.
CONCLUSIONS: Serrated polyps are now well known for their potential to develop CRC. Immunohistochemistry is an easy and reproducible way to detect BRAF (V600E) mutation. Our study showed there is high prevalence (64.3%) of BRAF mutation in serrated polyps in the Omani population. The majority of these polyps- were HP and SSL; and ≤5 mm in size and located in the distal colon.