Royal Hospital

In the published publication [...].

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.

With current evidence of homologous recombination deficiency (HRD) emerging as a predictive and prognostic biomarker in high-grade serous/endometrioid ovarian cancers (HGSOC/HGEOC), the HALO study (NCT04991051) evaluated the prevalence of the HRD in patients with HGSOC/HGEOC, primary peritoneal cancer (PPC), and fallopian tube cancer (FTC) across Asia, Middle East and Africa (MEA), and Russia. The MEA subset of this cross-sectional, non-interventional study enrolled patients with newly diagnosed stage III/IV (International Federation of Gynaecology and Obstetrics [FIGO] classification) HGSOC/HGEOC, PPC, FTC during May 2021-Jan 2022 with formalin-fixed paraffin-embedded tumour block(s) collected within 120 days of enrolment. Primary endpoints included prevalence of HRD, genomic instability (GI) excluding tumour BRCA mutations (tBRCAm), and tBRCAm. Logistic regression model predicted the risk factors associated with HRD positivity and tBRCAm. Of 195 patients (median [range] age, 58.2 [24.0-89.0] years), 88.7% had primary ovarian tumour. The HRD status was analysed in 180 patients; 52.2% (94/180) were HRD positive – 23.9% (43/180) had high GI scores excluding tBRCA1/2m, and 28.3% (51/180) had tBRCAm. More than two-thirds (71.3%) of patients underwent debulking surgery, 45,1% received neoadjuvant and 50.8% received adjuvant therapy. No patients received PARPi therapy. In univariate analysis, nulliparity was associated with lower odds of HRD positivity (odds ratio [OR]: 0.27, p=0.003). Family history (OR: 0.39, p=0.02) and nulliparous women (OR: 0.19, p=0.03) were associated with lower odds of high GI score. Higher odds of tBRCAm were observed in ex-smokers (OR: 6.77, p=0.02), family history (OR: 3.11, p=0.0009), and surgically resected tissue (OR: 2.00, p=0.04); lower odds in patients with FIGO stage IV (OR: 0.26, p=0.004). In multivariate analysis, h/o genetic-related cancer (OR: 3.75, p=0.002), h/o contraceptive use (OR: 5.19, p=0.009) was associated with higher odds of tBRCA1m whereas FIGO stage IV disease (OR: 0.24, p=0.006) had lower odds of tBRCAm. In the Middle East subset of HALO study, a substantial proportion of patients were HRD positive and had tBRCA1/2m, supporting the clinical relevance of these biomarkers for guiding novel targeted therapies. The study provides real-world evidence of HRD and tBRCA prevalence, informing future research and policy development in precision oncology for the region. Number-NCT04991051 (Date of Approval-September 2020).

Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disorder affecting the central nervous system, often misdiagnosed as multiple sclerosis. The identification of aquaporin-4-IgG (AQP4-IgG) has improved diagnostic precision and enabled targeted therapies. Given the unique regional challenges in healthcare delivery across the Middle East and North Africa (MENA) region, the Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) convened an expert panel to develop evidence-based, region-specific consensus recommendations for diagnosis and management. These guidelines endorse the 2015 International Panel for NMO Diagnosis (IPND) criteria, emphasizing AQP4-IgG testing via cell-based assays. Differential diagnosis should consider multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and acute disseminated encephalomyelitis (ADEM). For acute treatment: initiate high-dose intravenous methylprednisolone promptly and use plasma exchange early for severe or steroid-refractory attacks. For long-term immunotherapy, monoclonal antibodies (rituximab, inebilizumab, eculizumab, ravulizumab, satralizumab, or tocilizumab) are recommended according to availability and patient factors; conventional immunosuppressants remain alternatives when biologics are inaccessible. Guidance is provided for pediatric patients and for pregnancy and breastfeeding, including planning after ≥ 12 months of disease stability and early postpartum treatment resumption. These MENACTRIMS guidelines aim to improve NMOSD outcomes across the region by promoting accurate diagnosis and timely, effective therapy.

SummaryUnilateral pulmonary artery agenesis, typically affecting the right pulmonary artery, is a rare condition that may lead to congestive heart failure or pulmonary hypertension in infants and early surgical intervention improves outcomes. We report 5 cases from Muscat, Oman, of unilateral pulmonary artery agenesis who underwent surgical correction between November 2019 and August 2023, at an average age of 4.4 months. Most presented with cyanosis or respiratory distress and all had pulmonary hypertension confirmed by imaging. Surgical approaches included Gore-Tex conduit placement, autologous pericardial reconstruction and patent ductus arteriosus unifocalisation. All patients successfully restored pulmonary blood flow with no perioperative mortality. The median intensive unit care stay was 13 days and the median hospital stay was 20 days. Only 1 patient required repeat surgery for graft compression. Over a 27.6-month follow-up period, 4 patients showed regression of pulmonary hypertension and 2 underwent pulmonary angioplasty, reinforcing the benefits of timely intervention.

Abstract Introduction: Stable cardiac patients after their visit at cardiology outpatient department (OPD) clinic are given a referral letter to follow-up in local health centers for their monthly medications. However, majority come as walk-in for medications which causes overcrowding. Objective: The aim of this quality-improvement project was to evaluate use of a messaging App in reducing outpatient visits for patient’s re-prescription. Methods: We used a messaging App to communicate between patients and pharmacy. We employed Lean and Six Sigma quality improvement methodologies such as value-stream mapping (VSM), a lean manufacturing technique to compare project efficiency before and after implementation of a messaging App to dispense monthly refill medications. Results: Patients spent about 109 min (total lead time), when they come to the clinic without an appointment. The ratio of value added time (VAD) to lead time was 17% (VAD %). After initiation of the project, patients spent about 9 min (total lead time). The ratio of VAD to lead time was 80% (VAD %). Two hundred and four patients attended the OPD for prescriptions in the 1 st month which reduced every month and finally to 0 in the following month’s, i.e., 100% reduction. Simultaneously, the messaging App pharmacy request messages/dispensation increased from 32 to 150 numbers by the end of the 8 th month, i.e. from 18% to 87%. Conclusions: The use of a messaging App for monthly medication refill eliminated walk-in OPD visits and significantly reduced total waiting time by 90%.

ABSTRACTWe report a rare association between Schimke immune‐osseous dysplasia and myasthenia gravis. Clinicians should be aware of potential autoimmune neuromuscular complications in SIOD, as early recognition and tailored immunosuppression may improve prognosis.