{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:03:56Z","timestamp":1789517036093,"version":"build-2803163510"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"DOI":"10.1186\/s12879-026-13893-4","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T11:06:01Z","timestamp":1782731161000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term survival probability and predictors of mortality among adult patients living with HIV initiating combination antiretroviral therapy in Oman: an ambidirectional cohort study, 1992\u20132024"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2993-2813","authenticated-orcid":false,"given":"Zainab M.","family":"Al-Zadjali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faryal","family":"Khamis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Malehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Jaju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaiman Dawood","family":"AlSabei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtisam Khalifa","family":"Al-Maskari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruhina","family":"Aimaq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jalila","family":"Al-Naamani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouthar","family":"Al-Alawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya M.","family":"Al-Farsi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"13893_CR1","unstructured":"UNAIDS, Global HIV. & AIDS statistics \u2014 Fact sheet [Internet]. 2026 [cited 2025 Jul 23]. Available from: https:\/\/www.unaids.org\/en\/resources\/fact-sheet."},{"issue":"2","key":"13893_CR2","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1155\/2013\/780852","volume":"24","author":"S Konrad","year":"2013","unstructured":"Konrad S, Skinner S, Kazadi GB, Gartner K, Lim HJ. HIV Disease Progression to CD4 Count\u2009<\u2009200 Cells\/\u00b5L and Death in Saskatoon, Saskatchewan. Can J Infect Dis Med Microbiol. 2013;24(2):97\u2013101. https:\/\/doi.org\/10.1155\/2013\/780852.","journal-title":"Can J Infect Dis Med Microbiol"},{"issue":"1","key":"13893_CR3","doi-asserted-by":"publisher","first-page":"20","DOI":"10.14710\/dimj.v2i1.9667","volume":"2","author":"ZM Kusumaadhi","year":"2021","unstructured":"Kusumaadhi ZM, Farhanah N, Sofro MAU. Risk factors for mortality among HIV\/AIDS patients. Diponegoro Int Med J. 2021;2(1):20\u201319. https:\/\/doi.org\/10.14710\/dimj.v2i1.9667.","journal-title":"Diponegoro Int Med J"},{"key":"13893_CR4","doi-asserted-by":"publisher","unstructured":"Alwahibia F, Al Ismaili F, Haider A, Al Kindi M, Al Lawati H, Balkhair A. Prevalence of metabolic diseases in HIV-infected patients receiving antiretroviral therapy at Sultan Qaboos university hospital, Oman. IJID Reg. 2025;100679. https:\/\/doi.org\/10.1016\/j.ijregi.2025.100679.","DOI":"10.1016\/j.ijregi.2025.100679"},{"key":"13893_CR5","unstructured":"UNAIDS. FACT SHEET 2025: Global HIV statistics [Internet]. 2025 [cited 2025 May 25]. Available from: https:\/\/www.unaids.org\/sites\/default\/files\/2025-07\/2025_Global_HIV_Factsheet_en.pdf."},{"key":"13893_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12981-020-00307-x","volume":"17","author":"A Kebede","year":"2020","unstructured":"Kebede A, Tessema F, Bekele G, Kura Z, Merga H. Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study. AIDS Res Therapy. 2020;17:1\u20138. https:\/\/doi.org\/10.1186\/s12981-020-00307-x.","journal-title":"AIDS Res Therapy"},{"issue":"3","key":"13893_CR7","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1007\/s44197-023-00129-w","volume":"13","author":"SA Awaidy","year":"2023","unstructured":"Awaidy SA, Ghazy RM, Mahomed O. Progress of the gulf cooperation council (gcc) countries towards achieving the 95-95-95 UNAIDS targets: a review. J Epidemiol global health. 2023;13(3):397\u2013406. https:\/\/doi.org\/10.1007\/s44197-023-00129-w.","journal-title":"J Epidemiol global health"},{"key":"13893_CR8","unstructured":"UNAIDS. Global HIV & AIDS statistics. [Internet]. 2023 [cited 2025 May 5]. Available from: https:\/\/reliefweb.int\/report\/world\/global-hiv-aids-statistics-fact-sheet."},{"key":"13893_CR9","unstructured":"CDC C for DC and P. HIV diagnoses, deaths, and prevalence: 2025 [Internet]. 2025 [cited 2025 Jul 23]. Available from: https:\/\/www.cdc.gov\/hiv-data\/nhss\/hiv-diagnoses-deaths-and-prevalence-2025.html."},{"issue":"S1","key":"13893_CR10","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s00038-017-1023-0","volume":"63","author":"GBD 2015 Eastern Mediterranean Region HIV\/AIDS Collaborators","year":"2018","unstructured":"GBD 2015 Eastern Mediterranean Region HIV\/AIDS Collaborators. Trends in HIV\/AIDS morbidity and mortality in Eastern Mediterranean countries, 1990\u20132015: findings from the Global Burden of Disease 2015 study. Int J Public Health. 2018;63(S1):123\u201336. https:\/\/doi.org\/10.1007\/s00038-017-1023-0.","journal-title":"Int J Public Health"},{"issue":"3","key":"13893_CR11","doi-asserted-by":"publisher","first-page":"222","DOI":"10.2991\/jegh.k.191208.001","volume":"10","author":"A Elgalib","year":"2020","unstructured":"Elgalib A, Shah S, Al-Wahaibi A, Al-Habsi Z, Al-Fouri M, Lau R, et al. The Epidemiology of HIV in Oman, 1984\u20132018: A Nationwide Study from the Middle East. JEGH. 2020;10(3):222. https:\/\/doi.org\/10.2991\/jegh.k.191208.001.","journal-title":"JEGH"},{"issue":"5","key":"13893_CR12","doi-asserted-by":"publisher","first-page":"3844","DOI":"10.3390\/ijerph20053844","volume":"20","author":"A Karbasi","year":"2023","unstructured":"Karbasi A, Fordjuoh J, Abbas M, Iloegbu C, Patena J, Adenikinju D, et al. An Evolving HIV Epidemic in the Middle East and North Africa (MENA) Region: A Scoping Review. IJERPH. 2023;20(5):3844. https:\/\/doi.org\/10.3390\/ijerph20053844.","journal-title":"IJERPH"},{"key":"13893_CR13","unstructured":"MOH. Royal Hospital [Internet]. Ministry of Health; 2023 [cited 2025 Apr 20]. Available from: https:\/\/moh.gov.om\/en\/hospitals-directorates\/hospitals\/royal-hospital\/."},{"issue":"1","key":"13893_CR14","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/hiv.70122","volume":"27","author":"HH Twabi","year":"2026","unstructured":"Twabi HH, Ueno A, Ives J, Murtagh R, Mukoka M, Mortazavi SA, et al. Diagnostic accuracy of the WHO clinical staging system for detection of immunologically defined advanced HIV disease: a systematic review and meta-analysis. HIV Med. 2026;27(1):120\u201335. https:\/\/doi.org\/10.1111\/hiv.70122.","journal-title":"HIV Med"},{"key":"13893_CR15","doi-asserted-by":"publisher","unstructured":"Gomes A, Costa B, Nunes V, Coelho C. Cox regression in survival analysis: practical insights for clinicians. Acta Med Port. 2026 Feb;13. https:\/\/doi.org\/10.20344\/amp.23078.","DOI":"10.20344\/amp.23078"},{"key":"13893_CR16","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jbi.2014.02.013","volume":"48","author":"K Hajian-Tilaki","year":"2014","unstructured":"Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193\u2013204. https:\/\/doi.org\/10.1016\/j.jbi.2014.02.013.","journal-title":"J Biomed Inform"},{"key":"13893_CR17","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ijid.2019.09.017","volume":"90","author":"A Elgalib","year":"2020","unstructured":"Elgalib A, Shah S, Al-Habsi Z, Al-Fouri M, Lau R, Al-Kindi H, et al. The cascade of HIV care in Oman, 2015\u20132018: A population-based study from the Middle East. Int J Infect Dis. 2020;90:28\u201334. https:\/\/doi.org\/10.1016\/j.ijid.2019.09.017.","journal-title":"Int J Infect Dis"},{"issue":"1","key":"13893_CR18","doi-asserted-by":"publisher","first-page":"82","DOI":"10.4103\/idoj.IDOJ_468_18","volume":"10","author":"F Kaliyadan","year":"2019","unstructured":"Kaliyadan F, Kulkarni V. Types of variables, descriptive statistics, and sample size. Indian dermatology online J. 2019;10(1):82\u20136. https:\/\/doi.org\/10.4103\/idoj.IDOJ_468_18.","journal-title":"Indian dermatology online J"},{"key":"13893_CR19","doi-asserted-by":"publisher","unstructured":"Dudley W, Wickham PD, Rn, Aocn R, Coombs, Ms N. An introduction to survival statistics: Kaplan-Meier analysis. JADPRO. 2016;7(1). https:\/\/doi.org\/10.6004\/jadpro.2016.7.1.8.","DOI":"10.6004\/jadpro.2016.7.1.8"},{"key":"13893_CR20","unstructured":"Aschengrau A, Seage GR. Essentials of epidemiology in public health. Fourth edition. Burlington: Jones & Bartlett Learning; 2020. p.1."},{"issue":"2","key":"13893_CR21","doi-asserted-by":"publisher","first-page":"471","DOI":"10.21873\/anticanres.16835","volume":"44","author":"G Beis","year":"2024","unstructured":"Beis G, Iliopoulos A, Papasotiriou I. An Overview of Introductory and Advanced Survival Analysis Methods in Clinical Applications: Where Have we Come so far? Anticancer Res. 2024;44(2):471\u201387. https:\/\/doi.org\/10.21873\/anticanres.16835.","journal-title":"Anticancer Res"},{"key":"13893_CR22","doi-asserted-by":"publisher","unstructured":"Gebre TE, Taye G, Deressa W. Time-dependent predictors of loss to follow-up in HIV care in low-resource settings: a competing risks approach. Mugauri HD, editor. PLoS One. 2025;20(7):e0329132. https:\/\/doi.org\/10.1371\/journal.pone.0329132.","DOI":"10.1371\/journal.pone.0329132"},{"issue":"2","key":"13893_CR23","doi-asserted-by":"publisher","first-page":"217","DOI":"10.4103\/0970-0218.66859","volume":"35","author":"S Prinja","year":"2010","unstructured":"Prinja S, Gupta N, Verma R. Censoring in clinical trials: Review of survival analysis techniques. Indian J Community Med. 2010;35(2):217. https:\/\/doi.org\/10.4103\/0970-0218.66859.","journal-title":"Indian J Community Med"},{"key":"13893_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-017-2254-7","volume":"17","author":"O Eyawo","year":"2017","unstructured":"Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, et al. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis. 2017;17:1\u201315. https:\/\/doi.org\/10.1186\/s12879-017-2254-7.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"13893_CR25","doi-asserted-by":"publisher","first-page":"58","DOI":"10.5114\/hivar.2022.112758","volume":"21","author":"BM Teshale","year":"2022","unstructured":"Teshale BM, Awoke S. Survival analysis and predictors of mortality for adult HIV\/AIDS patients following antiretroviral therapy in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: a retrospective cohort study. HIV AIDS Rev. 2022;21(1):58\u201368. https:\/\/doi.org\/10.5114\/hivar.2022.112758.","journal-title":"HIV AIDS Rev"},{"issue":"3","key":"13893_CR26","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1089\/aid.2015.0058","volume":"32","author":"SJ Jeong","year":"2016","unstructured":"Jeong SJ, Italiano C, Chaiwarith R, Ng OT, Vanar S, Jiamsakul A, et al. Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD. AIDS Res Hum Retroviruses. 2016;32(3):255\u201361. https:\/\/doi.org\/10.1089\/aid.2015.0058.","journal-title":"AIDS Res Hum Retroviruses"},{"issue":"5","key":"13893_CR27","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.4269\/ajtmh.18-0386","volume":"99","author":"S Rao","year":"2018","unstructured":"Rao S, Av S, Unnikrishnan B, Madi D, Shetty AK. Correlates of Late Presentation to HIV care in a South Indian Cohort. Am J Trop Med Hyg. 2018;99(5):1331\u20135. https:\/\/doi.org\/10.4269\/ajtmh.18-0386.","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"13893_CR28","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12981-021-00353-z","volume":"18","author":"KL Workie","year":"2021","unstructured":"Workie KL, Birhan TY, Angaw DA. Predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy in Metema Hospital, Northwest Ethiopia: a retrospective follow-up study. AIDS Res Ther. 2021;18(1):27. https:\/\/doi.org\/10.1186\/s12981-021-00353-z.","journal-title":"AIDS Res Ther"},{"key":"13893_CR29","doi-asserted-by":"publisher","DOI":"10.5923\/j.phr.20140401.06","author":"RC Bajpai","year":"2014","unstructured":"Bajpai RC, Raj PY, Jha UM, Chaturvedi HK, Pandey A. Demographic Correlates of Survival in Adult HIV Patients Registered at ART Centers in Andhra Pradesh, India: A Retrospective Cohort Study. Public Health Res. 2014. https:\/\/doi.org\/10.5923\/j.phr.20140401.06.","journal-title":"Public Health Res"},{"key":"13893_CR30","doi-asserted-by":"publisher","unstructured":"Uma T, Srijayanth P, Valarmathi S, Sekar S, Kabilan N, Natarajan M. Socio-demographic profile of HIV\/AIDS patients at ART centres in Chennai. BMC Infect Dis. 2012;12(S1):P53. https:\/\/doi.org\/10.1186\/1471-2334-12-S1-P53.","DOI":"10.1186\/1471-2334-12-S1-P53"},{"key":"13893_CR31","doi-asserted-by":"publisher","first-page":"900028","DOI":"10.3389\/fragi.2022.900028","volume":"3","author":"KA Lee","year":"2022","unstructured":"Lee KA, Flores RR, Jang IH, Saathoff A, Robbins PD. Immune Senescence, Immunosenescence and Aging. Front Aging. 2022;3:900028. https:\/\/doi.org\/10.3389\/fragi.2022.900028.","journal-title":"Front Aging"},{"issue":"12","key":"13893_CR32","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.3390\/vaccines12121314","volume":"12","author":"P Goyani","year":"2024","unstructured":"Goyani P, Christodoulou R, Vassiliou E, Immunosenescence. Aging and Immune System Decline. Vaccines. 2024;12(12):1314. https:\/\/doi.org\/10.3390\/vaccines12121314.","journal-title":"Vaccines"},{"key":"13893_CR33","doi-asserted-by":"publisher","unstructured":"Thomas R, Wang W, Su DM. Contributions of age-related thymic involution to immunosenescence and inflammaging. Immun Ageing. 2020;17(1). https:\/\/doi.org\/10.1186\/s12979-020-0173-8.","DOI":"10.1186\/s12979-020-0173-8"},{"key":"13893_CR34","doi-asserted-by":"publisher","first-page":"1562537","DOI":"10.3389\/fmed.2025.1562537","volume":"12","author":"M Vassallo","year":"2025","unstructured":"Vassallo M, Durant J, Addou S, Ticchioni M, Fabre R, Chirio D, et al. Immunosenescence markers in T- and NK-cells according to the CD4\/CD8 ratio in successfully treated people living with HIV. Front Med. 2025;12:1562537. https:\/\/doi.org\/10.3389\/fmed.2025.1562537.","journal-title":"Front Med"},{"key":"13893_CR35","doi-asserted-by":"publisher","first-page":"100989","DOI":"10.1016\/j.lanepe.2024.100989","volume":"44","author":"C Kraef","year":"2024","unstructured":"Kraef C, Tusch E, Singh S, \u00d8stergaard L, F\u00e4tkenheuer G, Castagna A, et al. All-cause and AIDS-related mortality among people with HIV across Europe from 2001 to 2020: impact of antiretroviral therapy, tuberculosis and regional differences in a multicentre cohort study. Lancet Reg Health - Europe. 2024;44:100989. https:\/\/doi.org\/10.1016\/j.lanepe.2024.100989.","journal-title":"Lancet Reg Health - Europe"},{"key":"13893_CR36","doi-asserted-by":"publisher","first-page":"757","DOI":"10.2147\/HIV.S274747","volume":"12","author":"F Nigussie","year":"2020","unstructured":"Nigussie F, Alamer A, Mengistu Z, Tachbele E. Survival and Predictors of Mortality Among Adult HIV\/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A Retrospective Study. HIV. 2020;12:757\u201368. https:\/\/doi.org\/10.2147\/HIV.S274747.","journal-title":"HIV"},{"issue":"12","key":"13893_CR37","doi-asserted-by":"publisher","first-page":"e70285","DOI":"10.1002\/hsr2.70285","volume":"7","author":"S Haumba","year":"2024","unstructured":"Haumba S, Arora S, Williams V, Maseko T, Mafukidze A, Ojoo S. Prevalence, Predictors, and Outcomes of HIV Care in HIV-Positive Clients Entering HIV Care With Advanced HIV Disease in Sub\u2010Saharan Africa 2010\u20132022: Systematic Review and Meta\u2010Analysis. Health Sci Rep. 2024;7(12):e70285. https:\/\/doi.org\/10.1002\/hsr2.70285.","journal-title":"Health Sci Rep"},{"key":"13893_CR38","unstructured":"WHO. Maximizing the treatment and prevention potential of antiretroviral drugs: early country experiences towards implementing a treat-all policy: programmatic update [Internet]. World Health Organization. 2015 [cited 2025 Apr 20]. Available from: https:\/\/iris.who.int\/handle\/10665\/183599."},{"key":"13893_CR39","doi-asserted-by":"publisher","unstructured":"Damtew B, Mengistie B, Alemayehu T. Survival and determinants of mortality in adult HIV\/Aids patients initiating antiretroviral therapy in Somali Region, Eastern Ethiopia. Pan Afr Med J. 2015;22(1). https:\/\/doi.org\/10.11604\/pamj.2015.22.138.4352.","DOI":"10.11604\/pamj.2015.22.138.4352"},{"key":"13893_CR40","doi-asserted-by":"publisher","first-page":"1614619","DOI":"10.3389\/fpubh.2025.1614619","volume":"13","author":"Y Huang","year":"2025","unstructured":"Huang Y, He M, Zhang J, Mu L, Tang C. Survival analysis and factors influencing survival time of adult HIV\/AIDS patients receiving antiretroviral therapy from 2012 to 2022 in Chongqing, China: a retrospective cohort study. Front Public Health. 2025;13:1614619. https:\/\/doi.org\/10.3389\/fpubh.2025.1614619.","journal-title":"Front Public Health"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-13893-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13893-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13893-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:36:04Z","timestamp":1789515364000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-13893-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["13893"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-13893-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-9490985\/v1","asserted-by":"object"}]},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]},"assertion":[{"value":"22 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study protocol was approved by the Scientific Research Committee at the Royal Hospital, Ministry of Health, Oman (Approval No. MoH\/CSR\/24\/28820). The study was conducted in accordance with the Declaration of Helsinki. All data were fully anonymized before analysis, and confidentiality was strictly maintained through de-identification using unique study codes. No personally identifiable information was accessed, recorded, or disclosed. For the retrospective cohort (1992-26 August 2024), the requirement for informed consent to participate was waived by the Scientific Research Committee at the Royal Hospital, Ministry of Health, Oman, as the study used de-identified routinely collected hospital records. For the prospective cohort (27 August 2024-31 December 2024), data were obtained as part of routine clinical care from the hospital electronic medical record system (Shifa3+), without direct patient contact or interviews, and informed consent was not required in accordance with the approval of the Scientific Research Committee.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this manuscript, the author used Grammarly software to assist with grammar, spelling, and sentence clarity.","order":3,"name":"Ethics","label":"AI-assisted technologies","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1663"}}