Said A. Al Busafi

Robotic surgery is an advanced form of minimally invasive surgery, and its use has continued to grow worldwide. Despite this, undergraduate medical education has not expanded at the same rate, and formal exposure to robotic surgery remains limited in many settings, including Oman. A structured educational needs assessment is an important first step in curriculum development. Understanding medical students’ perceived knowledge, attitudes, and preferred learning approaches can help guide the introduction of robotic surgery into undergraduate and postgraduate training. This study therefore aimed to assess medical students’ perceived knowledge, attitudes, and curriculum preferences regarding robotic surgery in medical training in Oman. This cross-sectional observational study used a validated questionnaire adapted from a published robotic-surgery study and distributed electronically to medical students at Sultan Qaboos University (SQU). It was used as a local educational needs-assessment tool to examine students’ perceived knowledge, attitudes, and preferred learning approaches regarding robotic surgery. Convenience sampling was used. Data were analyzed using IBM SPSS Statistics version 26.0, and P ≤ 0.05 was considered statistically significant. A total of 519 medical students were included in the study. Although 71.5% had heard of robotic surgery, 87.3% felt that their knowledge of the field was insufficient. Greater precision was identified most often as an advantage (67.2%), whereas higher cost was the most frequently reported disadvantage (82.3%). Some students remained hesitant about undergoing robotic surgery themselves. Despite this, support for incorporating robotic surgery into training was high, with 81.3% favouring its inclusion in the MD curriculum and 88.2% supporting its inclusion in residency training. Simulation-based teaching was the preferred learning method (73.5%), followed by attending robotic procedures during surgical rotations (66.5%). Most respondents also believed that Oman should invest in robotic surgery. Medical students in Oman generally had a positive view of robotic surgery, but self-perceived knowledge gaps and cost concerns remain. Robotic surgery education could therefore be introduced gradually, beginning with basic concepts, patient counselling, simulation-based learning, and supervised clinical exposure. These findings may help guide the curricular integration of this subject into undergraduate and postgraduate medical training in Oman.

Data on the clinical impact of hepatitis B virus (HBV) exposure or human immunodeficiency virus (HIV) co‐infection in patients with chronic hepatitis C virus (HCV) from the Middle East are limited. This ambidirectional cohort study at Sultan Qaboos University Hospital included 702 Omani adults with chronic HCV (2009–2017), followed through November 2024, to assess prevalence and outcomes of HBV exposure (HBsAg‐negative/HBcAb‐positive,reflecting possible occult infection) and HIV co‐infection. Overall, 32.3% hadHBV exposure, 4.1% were HBsAg‐positive, and 1.7% HIV‐positive. Predictors of HBV exposure included older age (aOR: 0.34; p < 0.001), HIV co‐infection (aOR: 6.23; p = 0.009), intravenous drug use (aOR: 1.58; p = 0.041), and cirrhosis (aOR: 1.46; p = 0.049). HBV‐exposed patients demonstrated significantly higher rates of cirrhosis, hepatocellular carcinoma, and mortality, with lower 10‐ and 15‐year survival (68.3% and 67.6%, respectively) compared to non‐exposed patients (78.9% and 76.6%; p = 0.036). In conclusion, HBV exposure is highly prevalent among Omani chronic HCV patients and independently associates with advanced liver disease and reduced long‐term survival. These findings underscore the critical need for routine HBV screening and enhanced hepatocellular carcinoma surveillance in this population to improve clinical outcomes.

Colorectal cancer (CRC) is a major public health challenge in Oman and a leading cause of cancer-related mortality. The rising incidence has been associated with lifestyle changes, urbanization, and genetic factors. The CRC Subtyping Consortium has defined four consensus molecular subtypes (CMS1–CMS4); however, data on their distribution in the Gulf region, including Oman, remain limited. This study aimed to characterize the distribution of CMS subtypes in Omani CRC patients and assess their clinicopathologic correlations using a practical immunohistochemistry (IHC) panel supplemented by a limited targeted molecular approach. This study included 273 CRC patients diagnosed between 2023 and 2024 at two major referral hospitals in Muscat. Initially, the mismatch repair (MMR)-deficient tumors (dMMR) were assigned as CMS1, while the MMR-proficient (pMMR) tumors were further evaluated for β-catenin, P53, KRAS, and TGF-β expression. Mutations in BRAF, TP53, and KRAS were analyzed by sequencing. The cohort comprised 51.6% males, with a mean age of 59.1 years. Most tumors were left-sided (70.7%). dMMR (CMS1) comprised 31 cases (11.35%). Out of the pMMR tumors, 111 cases (40.65%) showed positive expression of β-catenin and P53 (CMS2), 63 cases (23.0%) showed KRAS mutations (CMS3), and 68 cases (24.9%) showed TGF-β-positive expression (CMS4). The cases were predominantly concentrated in Muscat (41%). This study demonstrated the feasibility and clinical relevance of CMS-based classification in Oman and its potential role in precision oncology and healthcare planning.

Background and Objectives: Colorectal cancer (CRC) is the most common gastrointestinal malignancy in Oman and among the top three cancers nationally, with an increasing burden of early-onset CRC (EOCRC) diagnosed before age 50. Despite national CRC guidelines, the lack of an organized screening program means most cases are detected symptomatically and at advanced stages. This study evaluated age-related differences in colonoscopic findings and advanced neoplasia risk in symptomatic adults to inform early detection and screening strategy development. Materials and Methods: A cross-sectional analysis of 2041 colonoscopies performed at two national tertiary referral centers, Sultan Qaboos University Hospital and Royal Hospital, was conducted (2018–2021). Patients were categorized by age (Results: Of 2041 procedures, 742 (36.3%) were in patients p < 0.01). Among younger adults, rectal bleeding (OR 2.17, 95% CI 1.15–4.08, p = 0.026) and abdominal pain (OR 2.14, 95% CI 1.15–3.98, p = 0.022) were significantly associated with ACRN. Diagnostic efficiency (NNS) was highest for loss of appetite in both age groups (4.7 in Conclusions: This bicenter study demonstrates clear age-related disparities in colorectal neoplasia, with a clinically important burden of advanced disease in symptomatic adults under 50 years. These findings highlight the importance of prompt colonoscopic evaluation for younger adults presenting with alarm symptoms, particularly rectal bleeding and abdominal pain, and provide evidence supporting risk-stratified diagnostic approaches. While age-related differences suggest potential value in earlier screening initiation, our predominantly symptomatic tertiary care cohort cannot directly determine optimal screening age thresholds. Prospective screening trials and cost-effectiveness analyses are needed to establish population-based detection rates and inform evidence-based screening policy development in Oman.

Advances in artificial intelligence (AI), soft robotics, and miniaturized imaging technologies have accelerated the development of endorobotic platforms that aim to enhance detection accuracy and improve patient experience. In this narrative review, we synthesize evidence on AI-assisted detection and characterization systems (CADe/CADx), robotic locomotion mechanisms, adhesion strategies, imaging modalities, and material and power constraints relating to next-generation CRC screening technologies. Reported performance metrics are interpreted within their original methodological contexts, acknowledging the heterogeneity of datasets, limited representation of diverse populations, underreporting of negative findings, and scarcity of large, real-world comparative trials. We introduce a conceptual translational framework that links engineering design principles with validation needs across in silico, in vitro, preclinical, and clinical stages, and we outline safety considerations, workflow integration challenges, and sterility requirements that influence real-world deployability. Regulatory alignment is discussed using the U.S. FDA Total Product Life Cycle (TPLC) and Good Machine Learning Practice (GMLP) frameworks to highlight expectations for data quality, model robustness, device–software interoperability, and post-market monitoring. Collectively, the evidence demonstrates promising technological innovation but also highlights substantial gaps that must be addressed before AI-enabled endorobotic systems can be safely and effectively integrated into routine CRC screening. Continued interdisciplinary work, supported by rigorous validation and transparent reporting, will be essential to advance these technologies toward meaningful clinical impact.

Objectives: Feeding problems are among the most common in patients with advanced dementia. This study aimed to assess the prevalence of feeding problems and evaluate survival outcomes following the onset of feeding problems in patients with advanced dementia. Methods: A retrospective cohort study of adults with advanced dementia identified from the electronic patient record using diagnostic codes and keyword searches was conducted. This multicentre study took place at Sultan Qaboos University Hospital, Muscat, Oman and the Royal Hospital, Muscat, Oman, from January 2010 to December 2023. Results: A total of 202 patients were included. The median age was 78.5 years (interquartile range [IQR]: 72.0–83.0); 58.9% were male. Median follow-up was 25.9 months; 70.8% (n = 143) died and overall median survival was 33.3 months following the diagnosis of advanced dementia. Feeding problems developed in 71.8% (95% confidence interval [CI]: 65.1–77.6) of patients with a median time from diagnosis to onset of 5.9 months (IQR: 1.0–25.6). Patients with feeding problems were older (80 versus 75 years) and more often had prior stroke history (37.2% versus 19.3%). Survival was shorter with feeding problems (28.8 versus 48.0 months; log-rank P = 0.010). In the adjusted Cox models (C-index = 0.64), feeding problems were not an independent predictor of mortality (hazard ratio [HR] = 1.409, 95% CI: 0.878–2.260; P = 0.155). The stroke × feeding interaction was not significant (HR = 0.831, 95% CI: 0.280–2.463; P = 0.738). Conclusions: Feeding problems identify a subgroup with poorer unadjusted survival, but the association with mortality was not significant after adjustment for confounders. Male sex independently predicted higher mortality. These findings support the need for prospective studies with standardised feeding assessments and nutritional measures.

Metabolic dysfunction–associated fatty liver disease (MAFLD) is now the leading indication for liver transplantation (LT), reshaping the landscape of transplant hepatology. Its close association with obesity, type 2 diabetes, cardiovascular disease, and extrahepatic malignancies poses unique challenges throughout the transplant continuum. This narrative review synthesizes current evidence across the pre-, peri-, and post-transplant spectrum, with a focus on practical implications for clinical management. We explore pre-transplant evaluation, focusing on how metabolic comorbidities, frailty, and organ allocation disparities intersect with emerging interventions such as GLP-1 receptor agonists, bariatric surgery, and structured weight loss programs. The increase in pediatric MAFLD, especially its early-onset aggressive form, indicates an evolving and concerning future burden on transplant programs. In the peri-operative and post-transplant periods, we address MAFLD recurrence, cardiometabolic complications, and the rising incidence of new cancers, particularly in relation to calcineurin inhibitor (CNI) exposure. Customized immunosuppression strategies, using mTOR inhibitors and mycophenolate mofetil, are discussed for their role in balancing graft protection with reducing cancer risk. We also review the application of machine perfusion technologies to optimize and expand the pool of steatotic donor livers. Future directions include the development of non-invasive diagnostic biomarkers, precision immunosuppression, and genomics-based risk stratification. Collectively, these insights emphasize the urgent need for multidisciplinary, patient-specific approaches and prospective, multicenter studies to optimize outcomes and equity in the era of MAFLD-driven liver transplantation.