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.

Background and Aim: Oman’s rapid industrial development has resulted in changing occupational exposures, emphasizing the importance of enhancing physicians’ proficiency in occupational history-taking and disease identification. This study sought to evaluate physicians’ knowledge, attitudes, and practices (KAP) in diagnosing occupational diseases and collecting occupational histories, while also identifying perceived barriers to effective recognition and reporting. Method: Data were collected utilizing a structured, self-administered questionnaire adapted from a validated instrument that assesses physicians’ knowledge, attitudes, and practices (KAP) concerning occupational diseases. The survey was conducted among internal medicine and family medicine physicians at a tertiary academic hospital. Result: Of 252 eligible physicians, 146 (57.9%) responded. Moderate levels were most common for knowledge (45.2%) and attitude (65.1%), while practice was most frequently high (45.9%). Prior training strongly predicted high knowledge (aOR = 7.23, 95% CI: 2.99–17.49; p < 0.001). Family Medicine physicians were more likely to achieve high knowledge (aOR = 2.42, 95% CI: 1.03–5.72; p = 0.043) but less likely to report high attitude scores (aOR = 0.32, 95% CI: 0.14–0.76; p = 0.010). Training also showed non-significant trends toward improved attitude and practice. Conclusions: Occupational health training is strongly linked to improved knowledge, with indications of benefits for attitude and practice. Specialty differences highlight the need to integrate occupational medicine into curricula and strengthen institutional support to enhance recognition of occupational diseases.

Acute neurological deficits following seizures can be mistaken for an acute stroke. Computed Tomography Perfusion (CTP) reveals distinct patterns in acute ischemic stroke. This case series outlines CTP patterns in 4 patients with postictal neurological deficits (Todd's Paralysis) who were initially misdiagnosed with acute ischemic stroke. Two of the 4 cases displayed CTP patterns resembling ischemic stroke with a penumbra. Distinguishing between acute ischemic stroke and postictal Todd's paralysis based solely on CTP is challenging.

Objectives: To evaluate the efficacy of melatonin, a neurohormone regulating the sleep–wake cycle, in preventing delirium within 5 days of hospitalisation among older adult patients (≥65 years) admitted to general medical wards. Design: Single-centre, double-blinded, randomised, placebo-controlled trial. Setting: General medical wards of a tertiary hospital in Oman. Participants: Patients aged ≥65 years admitted within 24 hours to general medical wards were screened. Key exclusion criteria included prevalent delirium, use of vasopressors, non-invasive ventilation, intensive or high-dependency unit admission and aphasia. Interventions: Participants were randomly assigned to receive either 5 mg or 8 mg of melatonin or a placebo nightly for up to 5 days during hospitalisation or until discharge, whichever occurred first. Primary and secondary outcome measures: The primary outcome was the incidence of delirium within 5 days, assessed using the 3-Minute Diagnostic Confusion Assessment Method. Secondary outcomes included delirium treatment, average sleep duration or sleep maintained, 28-day mortality and 28-day readmission. Analyses followed the intention-to-treat (ITT) principle, with per-protocol (PP) analyses conducted for robustness. Results: The study was terminated early due to futility. At termination, a total of 115 participants were recruited, 109 of whom were included in the ITT analyses: 55 in the melatonin group (5 mg or 8 mg) and 54 in the placebo group. The overall incidence of delirium by day 5 was 2.75%, 3.64% in the melatonin group and 1.85% in the placebo group (p=1.000). No statistically significant differences were found in the average sleep duration (p=0.136), 28-day mortality (3.64% vs 1.85%, p=1.000) or 28-day readmission (21.82% vs 20.37%, p=0.853). PP analyses and subgroup sensitivity yielded similar findings. Conclusions: In this trial, melatonin did not significantly reduce the incidence of delirium. The lower-than-expected numbers of outcome events and resultant early termination for futility limited the study’s power. As a result, the study findings should be interpreted with caution, and further research is necessary before definitive recommendations can be made. Trial registration number: NCT06509191 .

A 27-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He had been having similar episodes for the last seven years, and all of the previous workups had been unremarkable. After excluding all organic causes of his presentation, the patient was diagnosed with cyclic vomiting syndrome (CVS) and managed accordingly. He has shown remarkable improvement and no further attack has been reported for almost five months since the diagnosis was made. This case report highlights the diagnostic challenge represented by CVS. Also, it summarizes the main aspects of management to achieve and maintain the remission of the condition.