Objectives: Interest to join the intercalated phase of the Doctor of Medicine (MD) programme, at the Sultan Qaboos University (SQU), Muscat, Oman, has steadily decreased over the recent years; the reasons behind this decline are not known. Therefore, this study aimed to examine the reasoning behind medical students' decisions not to intercalate, and to develop a framework of interventions aiming at strengthening existing educational strategies at the College of Medicine and Health Sciences, SQU. Methods: This study used a mixed-methods approach integrating a structured questionnaire and focus group discussions; undergraduate medical students who were entering clinical rotations and opting not to intercalate were enrolled in this study. The study was conducted between 2023 and 2024 at the SQU, Muscat, Oman. Results: A total of 150 questionnaires were analysed (response rate = 95.5%). The median age was 22 years, with a female to male ratio of 2:1. The decision to choose medical professions as a future career was self-determination in 46.6% of cases with no significant differences between genders (P = 0.78). Almost one third of students preferred going abroad for post-graduate medical training and only a small proportion, mainly females, were interested in academic positions. Three themes were identified related to reasons for non-intercalating: (1) length of MD educational programme, (2) previous research activities and (3) career challenges. Conclusion: This study's findings identified various practical measures that curriculum designers can implement to attract more medical students to the intercalated phase. Improving research mentorship in earlier years and demonstrating to students the number of opportunities available when intercalating may increase medical students' interest in the intercalated phase.
Objectives: Published data on melanoma in Oman are scarce. This study aimed to describe epidemiological, clinicopathological and molecular characteristics of melanoma patients in a single institution in Oman. Methods: This retrospective study included patients with a histopathological diagnosis of invasive melanoma who were assessed at Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman, between July 2021 and February 2025. Data on patient demographics, comorbidities, melanoma type, localisation, stage, key histopathological and molecular characteristics were extracted from electronic clinical charts and quantitatively described. Results: A total of 31 patients were included. The median age at diagnosis was 52.9 years (interquartile range [IQR]: 41.6–66.0). Patients from the Middle East comprised 90.3% of the cohort (n = 28), while Western individuals accounted for 9.7% (n = 3). Cutaneous melanoma was the most frequent type, observed in 83.9% of cases (n = 26), followed by ocular melanoma in 6.5% (n = 2). Mucosal melanoma, central nervous system melanoma and melanoma of unknown primary site were each found in 3.2% of patients (n = 1 each). Among cutaneous melanomas, acral and skin non-acral subtypes were equally represented, each comprising 41.9% (n = 13). Staging data were available for 27 patients; Stage III was the most common at presentation (40.7%, n = 11), followed by Stage II (29.6%, n = 8) and Stages I and IV (14.8%, n = 4 each). The median tumour mutational burden (TMB) was 4.95 mutations per megabase (IQR: 3.86–6.4). Activating BRAF mutations were detected in 35.0% of tested patients (n = 7/20). Brisk tumour-infiltrating lymphocytes were present in 28.6% of evaluated cases (n = 4/14). Conclusions: Early-stage diagnosis was uncommon. Acral and sun-unexposed non-acral melanoma subtypes were highly prevalent and median TMB was low. These findings suggest that clinicopathological and molecular features of melanoma in Oman may differ from those in Western and Asia-Pacific countries, with potential implications for treatment and prevention strategies.
Objectives: Fear of childbirth is commonly reported among primigravida women and may negatively influence labour and birth outcomes. This study aimed to evaluate the effectiveness of a structured prenatal educational programme in reducing fear of childbirth among primigravida women. Methods: A quasi-experimental single-group pretest-post-test design was conducted from January to June 2025. The study included primigravida women attending antenatal clinics in selected health centres in Muscat Governorate, Oman. No control group was included. Participants completed the baseline assessment during the third trimester (28–40 weeks of gestation) prior to the intervention. Post-intervention assessment was conducted at two weeks postpartum using the Self-Evaluation Questionnaire. Results: A total of 79 primigravida women were included. Following the intervention, the mean fear-of-childbirth score decreased from 4.35 ± 0.63 at baseline to 1.79 ± 0.74 at 2-week postpartum follow-up, representing a mean reduction of 2.56 points (95% CI: 2.38–2.74; t = 27.8; P <0.001; Cohen's d = 3.12), indicating a statistically significant improvement after participation in the prenatal educational programme. Conclusion: The structured prenatal educational programme was associated with a reduction of fear of childbirth among primigravida women. Incorporating such programmes into routine antenatal care may enhance maternal psychological well-being in Oman and in similar maternal health settings.
Ischial pressure ulcer reconstruction requires durable coverage while preserving local donor options for possible recurrence. The inferior gluteal artery perforator (IGAP) flap is a muscle-sparing option, but superthin elevation requires precise knowledge of the superficial fascial plane and the subcutaneous course of the selected perforator. This technical note describes colour Doppler ultrasonography-guided superficial fascial plane mapping before superthin IGAP flap elevation in a 27-year-old paraplegic patient with a chronic left ischial pressure ulcer who presented in 2025 to a tertiary care university hospital in Muğla, Turkey. Preoperative high-frequency colour Doppler ultrasonography identified the dominant perforator, measured the relevant fascial intervals and guided a controlled dissection above the superficial fascia. The technique allowed elevation of a thin, pliable flap while preserving deeper gluteal structures and perforator integrity. Colour Doppler-guided fascial mapping may support safer superthin perforator flap elevation in selected pressure ulcer reconstructions.
Objectives: The bidirectional Glenn (BDG) procedure, a key palliative intervention for single-ventricle physiology, is conventionally performed using cardiopulmonary bypass (CPB) despite its associated complications and costs. However, the comparative impact of CPB versus off-pump techniques on perioperative safety, neurological risk and long-term outcomes remains controversial. Therefore, this meta-analysis aimed to determine whether performing the BDG procedure without CPB improves perioperative outcomes (including morbidity, mortality, and neurological events), resource utilisation, and long-term survival compared to the conventional on-pump approach. Methods: This review systematically searched PubMed, EMBASE and Cochrane Central from inception until January 2025 for comparative randomised and observational studies reporting outcomes in patients undergoing the BDG procedure with versus without CPB. The primary outcome was perioperative mortality (≤ 30 days or discharge); secondary outcomes included operative duration, recovery parameters (ventilation time, vasoactive support, intensive care unit (ICU)/hospital stay) and postoperative complications (infection, bleeding, neurological events, arrhythmias). Results: A total of 5 studies (2 randomised controlled trials, 3 observational studies; N = 339, 55% with CPB, 45% without CPB) were included. Patients had a mean age range of 6–66 months and mean weight of 6–16 kg. Common anomalies included double-outlet right ventricle and tricuspid atresia. Perioperative mortality did not differ significantly between groups (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 0.31–4.20; P = 0.83). Significant benefits favouring the off-pump approach were observed for operation duration (mean difference [MD] = 31.98 min, 95% CI = 14.97–48.99; P = 0.0002), duration of inotropic support (MD = 7.05 hours, 95% CI = 5.48–8.63; P <0.00001), duration of mechanical ventilation (MD = 4.09 hours, 95% CI = 3.26–4.92; P <0.00001) and ICU length-of-stay (MD = 0.73 days, 95% CI = 0.55–0.91; P <0.00001). No significant differences were found for hospital length-of-stay, postoperative bleeding, neurological complications, oxygen saturation, superior vena cava pressure, infection or arrhythmias. Risk of bias was assessed via the ROBINS-I and ROB2 assessment tools for non-randomised and randomised trials, respectively; a funnel plot was constructed to assess for publication bias. Conclusion: The findings suggest that, although off-pump BDG procedure is associated with shorter operative and recovery times than the on-pump approach, it does not demonstrate superior perioperative mortality or hospital discharge outcomes. Given the risk of conversion and lack of extended follow-up in reporting studies, further randomised multicentre studies with standardised outcomes are warranted before off-pump is deemed a superior option.
