# University Medical City Annual Research Day Oman, Convention and Exhibition Centre, 24th September 2025

## TL;DR

This paper presents multiple studies from Oman's University Medical City Annual Research Day, covering topics like AI in clinical trial risk assessment, orbital fracture repair outcomes, medication adherence in hematological diseases, germline methylation analysis in breast cancer, and improved PET/CT imaging for prostate cancer.

## Contribution

The studies introduce novel AI-augmented risk assessment methods, a bioinformatics pipeline for germline methylation analysis, and enhanced PET/CT reconstruction techniques for prostate cancer.

## Key findings

- AI-augmented risk assessment showed higher consistency and efficiency compared to traditional methods in clinical trials.
- MVCs were the primary cause of orbital fractures in Oman, with a 24.4% complication rate following surgical repair.
- Combining TOF and PSF reconstruction improved SUV_mean, SNR, CNR, and CRC in prostate cancer PET/CT imaging.

## Abstract

Risk-based assessment ensures participant safety, data integrity, and regulatory compliance in clinical trials. Institutional Review Boards (IRBs) lead evaluations; however, the absence of standardized tools can result in inconsistent risk evaluations. Artificial intelligence AI could enhance objectivity, efficiency, and reproducibility in risk assessments. This pilot study compared traditional methods (subjective judgment and the commonly used clinical trials risk assessment tool (SCTO) with AI-augmented approaches in Oman's IRB context, focusing on consistency, time efficiency, and output quality.

Four IRB members independently assessed five clinical trial protocols using professional judgement and the SCTO tool, while four AI systems analysed the same protocols using predefined risk variables.

AI-augmented risk assessment showed substantial inter-rater agreement (κ = 0.61), comparable to the SCTO tool (κ = 0.70) and superior to professional judgment (κ = 0.35). Cross-method agreement was highest between AI and the SCTO tool (80%). While professional judgment was fastest (5.0 min/trial), AI was more efficient than the SCTO tool (9.0 vs. 12.1 min/trial) and delivered richer outputs, including structured rationales and risk mitigation strategies.

Structured methods, particularly AI-assisted approaches, enhance the consistency and depth of clinical trial risk assessment. AI's ability to provide detailed, efficient, and consistent analysis makes it a promising complementary decision-support tool for IRBs.

This study aimed to investigate and analyze the complications and outcome following orbital fracture repair in Oman.

This multi-centre retrospective study was conducted at four tertiary hospitals; Sultan Qaboos University Hospital, Al-Nahda Hospital, Khoula Hospital, and Sohar Hospital. All patients with orbital floor and/or medial wall fractures who underwent orbital reconstruction between January 2014 and December 2023 were included in the study. Data collected included patient demographics, fracture etiology, surgical approach, reconstruction material, complications, and repair outcomes.

A total of 43 patients were included in the study. Of these, 26 had isolated orbital fractures, 13 had fractures associated with the zygomaticomaxillary complex, and 4 had fractures associated with naso-orbital ethmoidal structures. Motor vehicle accidents (MVCs) were the most common cause of orbital fractures, accounting for 53.7%. The transconjunctival approach was the most common surgical method (36.6%), followed by the infraorbital approach (24.4%). Titanium mesh was the primary implant material and was used in 63% of the cases. Post-operative complications occurred in 10 patients, giving an overall complication rate of 24.4%. The most common complications were enophthalmos and residual diplopia, accounting for 17.1% and 13%, respectively. Analysis of 26 post-operative CT scans revealed that the ideal implant positioning in the anterior, middle, and posterior zones was achieved in 89.5%, 47%, and 18% of the cases, respectively.

The study findings showed that MVCs were the primary cause of orbital fractures in Oman, and the complication rate of orbital reconstruction was low and comparable to published literature.

Medication adherence plays a crucial role in optimizing treatments outcomes for individual with chronic conditions. Inadequate adherence to prolonged treatment regimens significantly affects the success of the therapy. This study aimed to assess the level of medication adherence among Omani individuals with haematological diseases and the associated determinants.

This descriptive, cross-sectional, correlational study included 233 patients diagnosed with sickle disease and thalassemia. Participants were recruited from the Omani National Center for Haematology and Bone Marrow Transplantation. Medication adherence was assessed using Medication Adherence Report Scale-5 (MARS-5). Determinants of medication adherence were evaluated using Beliefs about Medication Questionnaire (BMQ), Fatigue Severity Scale (FSS) and clinical assessment questions. Data were analyzed using descriptive statistics, correlation analysis, and multiple liner regression.

The mean MARS-5 score was 18.73 ±3.56, with only 8.2% of patients reporting high adherence (with a score of 23 or higher out of 25 indicating a high level of medication adherence). The regression analysis revealed that Medication side effects (β = -1.89, p < 0.001), number of admission (β = -0.29, p < 0.01), hemoglobin level (β = 0.43, p = 0.04), BMQ-Harm (β = -0.31, p < 0.001), and Fatigue (β = -0.41, p = 0.02) significantly predicted medication adherence.

This study highlighted that the level of medication adherence among patients with hematological disorders was low, underscoring the importance of integrating fatigue management into treatment plans to improve adherence.

Accurate characterization of germline DNA methylation is crucial for understanding epigenetic contributions to cancer susceptibility. While structural variants (SVs) and copy number variants (CNVs) influence carcinogenesis, this work focuses on DNA methylation as a key regulatory mechanism. This study aimed to develop a robust bioinformatics pipeline for promoter methylation analysis using Oxford Nanopore Technologies (ONT) sequencing, with application to a triple-negative breast cancer (TNBC) germline sample.

Germline DNA from a TNBC patient was sequenced using ONT and processed through the Epi2me workflow. A customized pipeline was developed to categorize CpG methylation at promoter sites. Three machine learning models—Random Forest, Logistic Regression, and Support Vector Machine—were trained and compared to assess classification accuracy. Methylation distributions across TNBC-related genes were visualized, and promoter methylation patterns were classified based on risk flag categories.

Random Forest achieved the highest classification accuracy and identified methylation percentage as the most predictive feature for promoter-level classification. Visualization of gene-specific methylation revealed high promoter methylation in BRCA1, suggesting strong epigenetic silencing, while BRCA2 showed a more heterogeneous pattern, indicating partial regulation. Flag-stratified boxplots confirmed that genes classified as “high” risk exhibited higher methylation. This streamlined pipeline enabled efficient and accurate assessment of methylation from ONT data with minimal manual intervention.

This work introduces a robust and efficient pipeline for germline promoter methylation analysis using ONT sequencing. Future work will involve pipeline validation and optimization using publicly available datasets to enhance generalizability and support clinical translation of methylation-based risk assessment in cancer diagnostics.

Prostate cancer poses persistent challenges in precise detection and staging, demanding imaging modalities that combine sensitivity with quantitative accuracy. This study aimed to evaluate whether combining Time-of-Flight (TOF) and Point Spread Function (PSF) reconstruction enhances diagnostic and quantitative performance in ^68Ga-PSMA PET/CT.

A retrospective analysis of 36 prostate cancer patients (October 2022–February 2024) was conducted using a Siemens Biograph Vision 600 PET/CT system (TOF 210 ps, ~4.1 mm FWHM). Each dataset was reconstructed using TOF and TOF+PSF algorithms (OSEM: 3 iterations, 21 subsets, 2 mm filter). Quantitative parameters—SUV_mean, PSMA-tumor volume (PSMA-TV), total lesion uptake (TLU), signal-to-noise (SNR), contrast-to-noise (CNR), and contrast recovery coefficient (CRC)—were statistically compared using paired t-tests and Bland–Altman analysis.

TOF+PSF yielded significant improvements in SUV_mean (+1.30, p < 0.001), SNR (+24.8, p < 0.001), CNR (+25.1, p < 0.001), CRC (+8.0, p < 0.001), and TLU (+3.45, p < 0.05), while PSMA-TV remained stable (p = 0.08). Bland–Altman plots confirmed consistent positive bias favoring TOF+PSF reconstructions.

Integrating PSF modeling with TOF reconstruction markedly enhances image contrast, signal uniformity, and lesion conspicuity in ^68Ga-PSMA PET/CT without distorting volumetric accuracy. TOF+PSF reconstruction thus represents a powerful refinement for prostate cancer imaging, supporting improved clinical confidence in identifying small or low-contrast metastatic lesions.

This study aimed to assess the level of psychological distress—depression, anxiety and stress (DAS)—and its associated factors among primary infertile Omani women.

A descriptive cross-sectional study was conducted among 306 women with primary infertility attending infertility clinics at Sultan Qaboos University Hospital, Royal Hospital and Wattayah Polyclinic between July and December 2022. Data were collected using a structured self-administered questionnaire that included socio-demographic characteristics and the Depression, Anxiety and Stress Scale.

The mean age of participants was 32 ± 5.86 years, with an average marriage duration of 6.40 ± 4.34 years and infertility duration of 5.86 ± 4.17 years. Overall, 39.6% of participants reported moderate to severe levels of psychological distress. Strong, statistically significant positive correlations were identified between participants' age and both marriage duration and infertility duration. Women with lower family income demonstrated significantly higher levels of DAS.

Psychological distress is prevalent among Omani women with primary infertility. Enhancing social support and strengthening marital adjustment may help reduce emotional distress in this population. These findings emphasize the need for integrated psychosocial services and community awareness programmes within infertility care to improve women's emotional wellbeing.

The objective of this study was to examine the diagnostic efficacy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) in lung cancer, as well as to assess the utility of ultrasound elastography, which converts tissue stiffness into color-coded signals; a low elastic coefficient represented by red, yellow, or green hues, and the most rigid tissues by blue.

Data on all patients who underwent EBUS-TBNA at SQCCCRC, Muscat from January 2022 to December 2024 were analyzed. Elastography findings were classified as Type 1 (mostly non-blue), Type 2 (partially blue and partially non-blue), and Type 3 (mostly blue)

Sixty-eight lymph nodes were sampled in 41 patients with lung cancer out of a cohort of 113 patients. The mean age was 66.2 ± 9.1 years; 78% (32) were males. The indication was diagnostic in 28 (68.3%) and staging in 13 (31.7%). The size of the lymph nodes ranged from 4 to 50 mm and the number of passes from 3 to 18, with the predominant site being subcarinal (75%). The overall diagnostic yield was 90.2%. Among the 22 elastographies, 5 (22.7%), 6 (27.3%) and 11 (50%) were types 1, 2 and 3 respectively. All type 3 Lymph nodes were malignant, and all type 1 were benign while within type 2, four were reactive, one was malignant, and one was inconclusive (p < 0.001). Notably, the size of the lymph nodes was not related to malignancy (p = 0.055)

EBUS-TBNA has a high diagnostic yield for lung cancer and elastography could identify malignant involvement and can thus guide the node sampling

To investigate the incidence and risk factors of elevated intraocular pressure (IOP) following silicone oil (SO) tamponade in Omani patients, focusing on the pattern of IOP change after instillation and removal.

We conducted a retrospective review of patients over 18 who underwent pars plana vitrectomy (PPV) with SO tamponade from January 1, 2010 to December 31, 2019. The primary outcome measures included assessing the incidence of IOP elevation, and identifying associated ocular and systemic risk factors. The pattern of mean IOP change and the concurrent change in the mean number of antiglaucoma medications, from the time of SO instillation to 3 months post removal was analysed as a secondary outcome measure.

A total of 114 eyes from 108 Omani patients were analysed. Elevated IOP (≥21 mmHg) occurred in 62.3% of eyes within six months; with 16.67% showing late-onset elevation (>1 month). Preoperative IOP ≥21 mmHg significantly influenced post-SO tamponade IOP rise (P < 0.001). Aphakic status was consistently associated with IOP elevation. Among the 85 eyes that underwent SO removal, 61.2% (30/49 eyes with high IOP) normalized post removal (P = 0.001). Emulsification (P = 0.009) and elevated IOP (P < 0.001) at the time of SO removal was significantly associated with persistent IOP elevation in 38.8% (19/49 eyes).

High baseline IOP and aphakia are risk factors for IOP rise post SO tamponade. Mostly, SO removal can effectively normalise IOP. Presence of SO emulsification warrants caution as it is an important predictor of persistent IOP rise.

Central line-associated bloodstream infections (CLABSIs) are a major threat to acute leukemia (AL) patients, leading to treatment delays, sepsis and death. This study aimed to determine CLABSI incidence, causative pathogens, and the clinical impact on AL pediatric patients.

A retrospective cohort study analyzed AL patients (≤13 years) with central venous catheters at SQUH between 2014 and 2023. Data including CVC type, microbiology lab reports, clinical symptoms, treatments, and complications were extracted from SQUH medical records. CLABSI was defined using CDC protocols. Statistical analysis using Chi-square tests and Poisson distribution were applied to determine incidence rate ratios (IRR).

Among 237 CVC insertions, 41 CLABSI cases were identified, yielding an incidence rate of 0.63 per 1,000 CVC days. Patients with simple CVCs experienced a CLABSI rate that was 6.7 times higher than those with ports (IRR = 6.7; 95% CI 3.6–12.4; p < 0.001). Gram-negative organisms dominated (70.7%; n = 29), with Klebsiella pneumoniae being the most common pathogen (44.8%; n = 13). This pathogen exhibited high resistance to cephalosporins and other beta-lactams but remained susceptible to amikacin and meropenem. No afebrile CLABSI cases were observed in patients older than 3 years old. Catheters were removed in 68.3% of CLABSI episodes. Complications occurred in 51.2% of cases, with sepsis being the most common (64.3%, n = 26). Six patients (14.6%) died within 30 days. Sepsis was significantly associated with relapsed Acute Lymphoblastic (ALL) Leukemia (100%, p = 0.03).

These findings highlight the need for stringent infection control measures and tailored antimicrobial stewardship. The observed association between relapsed ALL and sepsis warrants vigilant clinical monitoring.

This study aimed to examine the causative pathogens, case burden, and epidemiologic trends of pediatric parapneumonic effusion and pleural empyema (PPE/PE) at Sultan Qaboos University Hospital (SQUH) and to compare hospital length of stay following video-assisted thoracoscopic surgery (VATS) versus chest drainage with or without intrapleural fibrinolytics.

A single-center retrospective review was conducted for children aged <13 years managed for PPE/PE at SQUH between January 2011and December 2023. Demographics, microbiological, therapeutic, and outcome data were analyzed.

Eighty-four cases met inclusion criteria (mean age = 2.9 years; 77% aged 3–5 y; 57% male), and 81% required PICU/high- dependency care. Case clusters were observed in 2019 and 2022. Pre-admission antibiotics use (76%), reduced culture positivity (blood 9.5% (8/84), pleural 10.3% (6/58)). Among tested cases, pleural pneumococcal PCR was positive in 81% (17/21) and viral PCR in 60.8% (45/74), most frequently detecting rhinovirus, influenza and parainfluenza. Empiric third-generation cephalosporins were prescribed in 85%, often with clindamycin (45%) or vancomycin (46%). Surgical intervention was frequent: VATS 56% and chest drainage ± fibrinolytics 14%, with comparable length of stay (15 vs 16.5 days, p = 0.23). Full recovery was achieved in 90% of patients.

Culture-based pathogen detection was low, whereas molecular testing markedly improved diagnostic yield. Findings highlight the need for enhanced diagnostics, standardized protocols and multicenter studies to optimize pediatric pleural infection management in Oman.

This study aims to assess neutrophil and platelet engraftment outcomes following bone marrow transplantation (BMT) at Sultan Qaboos University Hospital (SQUH). It also aims to identify patient- and treatment-related factors influencing engraftment.

A retrospective cohort study analyzed 154 BMT patients treated at SQUH (2018-2022). Data collected included demographics, diagnoses, donor type, HLA/ABO Rh match, stem cell source, conditioning regimen and time to neutrophil and platelet recovery. Neutrophil engraftment was defined as achieving an absolute neutrophil count (ANC) of ≥0.5 × 109/L for three consecutive days. Platelet recovery was defined as reaching a platelet count of ≥20 × 109/L for seven consecutive days without transfusion. Graft failure was considered when an ANC of 0.5 × 109/L was not achieved by day +30, accompanied by pancytopenia. Descriptive analysis, Chi-square & Mann-Whitney ‘U’ tests were performed using IBM SPSS Statistics. Statistical significance was set a p < 0.05.

Acute leukemia was the most common indication for BMT (31.8%), with peripheral blood stem cells (PBSC) being the predominant graft source (76.1%). Neutrophil engraftment occurred in 95.5% of patients and was significantly associated with age (p = 0.029) and diagnosis (p = 0.025). Platelet recovery was achieved in 146 patients and was associated with age (p = 0.019), donor type (p = 0.009), HLA match (p = 0.017) and conditioning regimen received (p = 0.015).

Neutrophil engraftment was significantly influenced by recipient age and diagnosis, while platelet recovery was associated with age, donor type, HLA match, and conditioning regimen. Further research is warranted to confirm our findings.

The main objective of this study is to assess the accuracy of combining breast ultrasound (USS) and mammography in evaluating the response of breast cancer after neoadjuvant chemotherapy. The secondary objective is to determine concordance between the radiologically predicted response and pathological response.

This retrospective study included 145 consecutive women who were diagnosed with breast cancer between January 2021 and June 2024 at our centre and required neoadjuvant chemotherapy (NAC). All underwent breast USS, mammography and image-guided core biopsy with some having MRI, as part of triple assessment. Clinical and radiological evaluation were used to assess the response two weeks after completion of NAC. Accuracy and concordance rates between radiological response and pathological response were calculated.

The total number of study participants was 145. The mean age was 45 years. On immunohistochemistry testing, HR+/HER 2- subtype was predominant (46.9%). The overall sensitivity of combined breast ultrasound and mammogram was 86.2%, while accuracy was 94.5%.The subtype analysis showed that HR-/HER2+ subtype demonstrated the highest pCR rate (19/22), while the lowest rate was observed in the HR+/HER2 - subtype (8/68).Sensitivity of combined breast US and digital mammogram in detecting pCR was 100% in both HR+/HER-2 and HR-/HER2- subtypes. The highest accuracy was in HR-/HER2-, while the lowest was in HR-/HER2+. Concordance rate was 94.5%.

Breast ultrasound and mammogram done two weeks after completion of NAC should be used to assess response in all subtypes of breast cancer except in HR-/HER2+ where MRI Breast should also be done.

Whether certain PCOS phenotypes are associated with increased risk of pregnancy complications. PCOS is an endocrine disorder-affecting women. It is diagnosed using the Rotterdam criteria. Few studies have explored phenotypes of PCOS and their association with pregnancy complications in Arab women.

A prospective case-control study of 50 PCOS cases and 50 control females from the Gynecology clinic at a tertiary care hospital in Oman. Cases fulfilled Rotterdam criteria and were divided into phenotypes (A,B,C,D). Clinical data was analyzed using SPSS to compare pregnancy complications, neonatal outcomes with phenotypes.

37 (74%) PCOS cases and 38 (76%) controls achieved pregnancy. PCOS cases had significantly higher intrauterine growth restriction (IUGR) (N = 7, 18.9%) CI 1.00-37.83, P 0.02. 85.7% of IUGR cases had insulin resistance. Gestational diabetes mellitus (GDM) was slightly more in cases (N = 16, 43%) than controls (N = 13, 34%), CI 0.58-3.64, P 0.42. There was no difference in preterm deliveries among cases (N = 10, 27%) vs controls (N = 7, 18%), CI 0.55-4.66, P 0.37. Congenital anomalies were observed only in phenotype A (N = 3, 8.1%). Neonatal mortality was higher in Phenotype A (N = 2, 5.4%) than controls (N = 1, 2.6%). There were more GDM cases in phenotype A (N = 12, 41%) than C (N = 2) and D (N = 2). IUGR was most common in phenotype A (N = 4, 13.8%), compared to C (N = 1) and D (N = 2).

IUGR and GDM were higher in PCOS cases (mainly phenotype A). These findings suggest a need for studies on phenotype specific and metabolic targeted interventions in managing pregnancies in PCOS patients.

Multiple hereditary exostosis (MHE) is a rare autosomal dominant condition with a prevalence of 1 in 50,000. Malignant transformation into chondrosarcoma is rare and occurs in about 3-5%, however, usually at the 4th and the 7th decade of life. This literature review aims to assess the actual need for screening for chondrosarcoma transformation in MHE patients underage of 18.

The research question and inclusion criteria (All levels of evidence, MHE with documented malignant transformation, Patients ≤18 years, Both male and female patients, Studies involving human subjects) were established in advance. Online databases, PubMed, and Google Scholar, were used to identify relevant literature. No restrictions were applied regarding publication language or date. An Excel spreadsheet was used to record the relevant data obtained.

A total of 5 patients were identified, Four were male (80%), and the mean age was 11.4 years. The most common presenting symptoms were pain and swelling. In terms of chondrosarcoma grading, 4 patients had low-grade chondrosarcoma (80%). All patients underwent tumor resection. Three patients had follow-up data available, with a mean follow-up duration of 4.5 years, during which no recurrences were reported.

Given the extremely low prevalence of malignant transformation in MHE at pediatric age and the limited data primarily derived from case reports, our study does not support the necessity of routine screening for malignant transformation in patients with MHE. We recommended spacing the surveillance protocol by skeletal survey at interval of 2-3 years for asymptomatic children.

Primary microcephaly (MCPH) is a neurodevelopmental disorder characterized by a significantly reduced head circumference at birth. This study aims to explore the heterogeneous genetic and clinical landscape of primary microcephaly in a cohort from a consanguineous population.

This cross-sectional, retrospective study included 168 patients diagnosed with primary microcephaly between 2011 and 2023. Data collected include demographics, detailed clinical phenotype, radiological findings, and molecular genetic investigations. Molecular genetics investigations including exome sequencing were performed as standard for clinical laboratory. Genetic variants were classified according to ACMG guidelines.

A total of 168 patients met the inclusion criteria. Exome sequencing (ES) was the most frequently used diagnostic modality (61.3%), identifying variants associated with MCPH in 59 patients. Of these, 23 carried pathogenic variants, 13 had likely pathogenic variants, and 23 had variants of uncertain significance. Biallelic variants in the ASPM was the most frequently implicated cause. Clinically, seizures were reported in 47.6% of patients, and 64.8% had severe developmental delay. Nearly one-third (28.6%) had reduced birth weight and length in addition to microcephaly. Brain MRI, performed in 134 patients, revealed abnormalities in 60.4%, with brain atrophy being the most common finding.

This study highlights the clinical and genetic heterogeneity of congenital microcephaly in a consanguineous population. Notably, 43.3% of patients (45/103) who underwent exome sequencing had no identifiable causative variants. Future direction of this study includes reanalysis of ES data for identification of causes or novel candidate genes.

The objective of this study was to ascertain the prevalence of iron deficiency (ID) among patients with heart failure (HF) at Sultan Qaboos University Hospital and to evaluate the effect of iron supplementation on clinical outcomes, such as mortality, emergency visits, and hospitalisations.

Between 2020 and 2023, 211 HF patients with complete iron profiles participated in a retrospective cohort study. The European Society of Cardiology (ESC) and American Heart Association (AHA) criteria were used to define ID. Patients were divided into three groups: non-ID, untreated ID, and treated ID. ANOVA, chi-square, and regression analyses were used to compare the clinical and biochemical results. Cox regression and propensity score matching were employed to evaluate mortality risk and account for confounders.

68.3% (AHA) and 71.1% (ESC) of patients had ID. Haemoglobin, ferritin, and TSAT levels were lower in treated ID patients, and the prevalence of HFpEF was significantly higher. ID patients were more likely to be admitted to the hospital, particularly those who were left untreated. While iron supplementation improved iron parameters (ferritin +32 ng/mL; TSAT +2.8%, p < 0.01), it had no discernible effect on survival or left ventricular ejection fraction (LVEF). Cardiovascular events and AF were more common in treated groups, indicating variations in baseline risk. Higher sensitivity was demonstrated by ESC criteria in identifying patients with functional deficiencies.

Clinical outcomes are negatively impacted by ID, which is very common in Omani HF patients. Although iron supplementation enhances biomarkers, its immediate effects on survival are minimal. To improve HF care outcomes, routine screening and ESC-guided ID management are crucial.

Cauda equina syndrome (CES) is a severe neurological condition caused by cauda equina nerve root compression, presenting with red-flag symptoms: bilateral sciatica, perineal sensory loss, urinary retention, and saddle anesthesia. Delayed recognition can result in irreversible neurological deficits, chronic pain, and bladder or bowel dysfunction. Emergent surgical decompression remains the standard of care to prevent permanent damage. Although tumor-related CES is uncommon, it presents major diagnostic and therapeutic challenges. This study aimed to assess the relationship between surgical timing and patient outcomes, including mortality, complications, and residual deficits in tumor-related CES.

A systematic search of PubMed and Embase (conducted April 6, 2025) identified studies examining surgical timing in neoplastic CES. Keywords included “cauda equina syndrome,” “tumor,” “neoplasm,” “surgical decompression,” and “laminectomy.” Studies involving human subjects with neoplastic CES treated surgically and reporting outcomes were included; nonsurgical and non-outcome studies were excluded. Thirty-six patients met inclusion criteria.

There was a male predominance (58.3%), with a mean age of 46.8 ± 15.8 years. Paragangliomas were the most frequent tumor type (38.9%). Pain (97.2%), weakness (69.4%), and incontinence (44.4%) were the most common presenting symptoms. Twenty-nine patients (80.5%) underwent emergent surgery, and seven (19.4%) underwent elective procedures. Persistent symptoms occurred in all elective cases, compared with 69% in emergent cases; 20.7% of emergent cases fully recovered, and 10.3% died of disseminated disease. Mean follow-up was 21.2 months.

Emergent decompression reduces symptom persistence risk in tumor-related CES. However, literature remains limited, warranting further studies quantifying the exact timing-to-surgery interval.

Cisplatin chemotherapy is associated with nephrotoxicity, but the relationship between treatment-induced inflammation and kidney function remains unclear. This study investigated temporal changes in inflammatory markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and estimated glomerular filtration rate (EGFR).

Patients with gynecological cancers who received cisplatin at SQCCCRC between January 2022, and December 2024 were analyzed. NLR, PLR, and eGFR measurements were taken at baseline, end of treatment, and at 1-, 3-, and 6-months post-treatment. The research ethics committee approved the study.

Thirty-two patients were analyzed. The median age was 56 years. Inflammatory markers increased substantially during treatment: NLR rose from 2.57 to 5.12 (155.1% increase) and PLR from 219.24 to 315.79 (135.2% increase). In contrast, eGFR remained relatively stable initially (baseline: 104.84, end of treatment: 101.93) but declined to 90.53 at 6 months post-treatment. Significant negative correlations were observed between NLR and eGFR at 1 month (r = -0.46, p = 0.0118) and between PLR and eGFR at 3 months (r = -0.40, p = 0.0410) post-treatment.

Elevated inflammatory markers may precede and contribute to the subsequent kidney function decline. Our results demonstrate that cisplatin induces a significant inflammatory response while eGFR changes occur more gradually. The temporal relationship and negative correlations between inflammatory markers and subsequent eGFR suggest that inflammation may play a role in cisplatin-induced nephrotoxicity. These findings highlight the potential utility of inflammatory markers as early predictors of kidney function decline in patients receiving cisplatin therapy.

Prognostic biomarkers are essential to optimize therapy in cervical cancer. cisplatin-based regimens are standard; however, reliable progression-free survival (PFS) predictors are still not well-established. This study evaluated the association of selected biochemical parameters with PFS.

This retrospective analysis evaluated patients with cervical cancer treated with cisplatin-based chemotherapy. Biochemical parameters—specifically calcium measured at the end of treatment and baseline alkaline phosphatase (ALP) were analyzed using Pearson correlation coefficients. Statistical significance was defined as p < 0.05, with sample sizes for the respective variables ranging from 28 to 31 subjects.

Thirty-eight patients with cervical cancers were included in the study. The mean age was 56.1 ± 15.6 years. Regarding comorbidities, 42.1% had hypertension, 26.3% had diabetes, and 5.3% had cardiovascular disease. Concurrent radiation therapy was administered to 86.8% of patients. The PFS had a mean of 22.5 ± 14.2 months. End-of-treatment calcium levels were significantly negatively correlated with PFS (r ≈ -0.495, p ≈ 0.007, n = 28). Additionally, baseline ALP levels were negatively correlated with PFS (r ≈ -0.361, p ≈ 0.046, n = 31).

The results indicate that elevated calcium levels at the end of treatment and high baseline ALP levels may serve as negative prognostic factors for PFS. This highlights the role pf these cost-effective prognostic tools in predicting early progression among patients in this group. Regular monitoring of these markers could enhance risk stratification and inform treatment decisions. Further prospective studies are needed to validate these markers as predictive tools in clinical practice.

To compare one-year follow-up outcomes of a single dose of hyaluronic acid (HA) versus stromal vascular fraction (SVF) injections in patients with knee osteoarthritis (OA), and to identify patient factors that predict a favorable response to one group over the other for better guidance in treatment selection.

This retrospective cohort study included patients diagnosed with primary knee OA who received a single intra-articular injection of either HA or SVF and were followed up for one year. Comparisons were made based on age, gender, body mass index (BMI), and x-ray–derived Kellgren–Lawrence (KL) grade. Treatment efficacy was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores recorded at baseline and after one year. Associations between WOMAC scores and the above variables were analyzed between the two treatment groups.

WOMAC scores in the SVF group compared to HA were significantly higher in male, younger patients (50–59 years), and in obese patients. A statistically significant difference in WOMAC scores was also found between the two groups for KL grade 2, with higher WOMAC scores in the SVF group compared to the HA group.

Autologous SVF was shown to be safe but less effective in younger age groups, obese patients, or patients with mild OA in comparison to HA injections. Further studies are required before conclusive findings can be made.

Sex-specific outcomes after transcatheter aortic valve replacement (TAVR) have been reported in Western populations, but data among Arab patients remain limited. This study aimed to compare baseline characteristics and early clinical outcomes between male and female Arab patients undergoing TAVR.

A retrospective cohort study was conducted at a single center from 2018 to 2024, including 185 Arab patients who underwent TAVR (103 males, 82 females). Baseline demographics and comorbidities were recorded, along with post-procedural complications and 30-day outcomes.

The mean age of the cohort was 72.1 years with no significant sex difference. Males had a higher body surface area and were more frequently current smokers. Pre-existing renal failure and coronary artery disease were more prevalent in males compared with females. Despite these baseline differences, early post-TAVR outcomes were similar between the sexes. Rates of new-onset renal failure (2.8%), stroke (4.4%), and acute limb ischemia (4.4%) did not differ significantly. Thirty-day mortality was 7.7%, with no significant difference between males and females, and 30-day readmission rates were also comparable.

Although male patients presented with a greater burden of cardiovascular risk factors before TAVR, early clinical outcomes after the procedure were similar between males and females in this Arab cohort. These findings indicate that sex-related baseline differences do not appear to translate into differences in short-term post-TAVR outcomes. Larger multi-center studies are warranted to confirm these results and explore potential long-term outcome variations.

This study aimed to develop and internally validate a statistical model for mortality prediction in preterm infants with respiratory distress syndrome (RDS) in Oman, and to identify significant risk factors associated with adverse outcomes.

The retrospective cohort included preterm infants <37 weeks with clinical signs and radiographic features of RDS admitted to the Special Care Baby Unit at Sohar Hospital between January 2020 and December 2023. Data was extracted from the electronic health records using a structured proforma. The primary endpoint was death versus discharge. A logistic regression model was developed through forward selection to identify predictors of mortality. Model performance was assessed via ROC curve analysis, with validation performed on a separate dataset. Ethical approval was obtained from the Ministry of Health Ethics Committee (MOH/CSR/24/27964).

Among 148 infants (mean gestational age 32.2 weeks; mean birthweight 1,566 g; 62.8% male), overall mortality was 13.5%. Fourteen predictors were retained, including admission SpO2 and PaO2, outborn status, bronchopulmonary dysplasia, intraventricular hemorrhage, pulmonary hemorrhage, 5-minute Apgar, antenatal steroids, patent ductus arteriosus, and maternal BMI (all p < 0.05). Non-survivors had lower gestational age (28.8 vs 32.6 weeks) and birthweight (1279.5 vs 1611.3 g; p < 0.01). The final model outperformed the null (χ2 = 72.877, p < 0.0001) and showed excellent discrimination in training (AUC = 0.97) and good discrimination in validation datasets (AUC = 0.85).

RDS remains a major contributor to neonatal mortality in Oman. Our validated statistical model demonstrated strong predictive performance and may potentially enable early risk stratification and targeted care of high-risk neonates in Oman's healthcare settings.

Medical students face intense academic pressure, long study hours and emotionally demanding clinical tasks, which make them particularly prone to stress-related outcomes. The aim of this study was to assess the level of stress perceived and to explore the role of optimism and different coping strategies in predicting the resilience of medical students.

A cross-sectional correlative study was carried out among 172 undergraduate medical students at the Faculty of Medicine and Health Sciences in Oman. Participants were recruited by means of a convenient online sample and completed an online survey that included socio-demographic questions and four standardized scales: the Perceived Stress Scale (PSS- 10), Connor-Davidson Resilience Scale (CD-RISC-10), the Coping Self-Efficacy Scale (CSES) and the Life Orientation Test (LOT-R).

Pearson's correlation revealed that Resilience was positively correlated with: Optimism, Problem-focused coping, Emotion-focused coping, Social support coping. While, Perceived stress had no significant relationship with resilience. Multiple regression analysis showed that the overall model significantly predicted resilience, explaining that: Optimism, problem-focused coping, emotion-focused coping are a significant predictors of resilience, while perceived stress and social support are not significant predictors.

Optimism, together with effective coping strategies - especially problem-oriented and emotional coping - are the key factors for the resilience of medical students. Targeted interventions to strengthen these psychological assets can improve students' ability to cope with academic stress and promote long-term professional well-being.

Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is approved for improving glycemic control in adults with type 2 diabetes mellitus (T2DM). This study evaluated the real-world effectiveness of dapagliflozin on glycemic control among Omani patients with T2DM.

A retrospective cohort study at Diwan Poly Clinic, Oman (January 2020–December 2022) included adults with T2DM who started dapagliflozin. Glucose results were monitored from baseline through three to twenty-four months. Multivariate regression identified predictors of HbA1c change, while two-way ANOVA evaluated treatment and time effects on HbA1c.

A total of 124 patients (mean age 61 ± 8.4 years; 50.8% female) were included. Mean baseline HbA1c was 8.74% (SD 2.07). After >17–24 months of dapagliflozin therapy, mean HbA1c decreased by 1.22% (95% CI: 0.87–1.57, p = 0.001). At follow-up, 71.3% of patients achieved target HbA1c levels. Patients on quadruple or quintuple antidiabetic combinations showed greater reductions in HbA1c than those on fewer medications. Multivariate analysis showed baseline HbA1c (positive association) and microalbumin/creatinine ratio (negative association) as significant predictors of HbA1c outcomes.

Dapagliflozin significantly improved glycemic control in Omani patients with type 2 diabetes mellitus (T2DM), especially when used as part of an intensive combination therapy. A personalized treatment plan that includes dapagliflozin alongside multiple oral agents is recommended for patients with inadequate glycemic control on standard therapy to help optimize outcomes.