Emirati Patients Research Articles

Germline Genetic Susceptibility Testing Among Emirati Nationals at Risk for Hereditary Breast and Ovarian Cancer Syndrome.

Breast cancer among Emirati patients is characterized by early-onset disease and later stages at presentation. Little is known about the germline genetic variants that may contribute to these observations. The goal of this study is to characterize the rate and implications of germline genetic variants among a cohort of Emirati patients at risk for hereditary breast and ovarian cancer syndrome. A retrospective study was performed to analyze the results of clinical germline genetic testing (March 2020-January 2023) among a cohort of consecutive Emirati patients at risk for hereditary breast and ovarian cancer syndrome: group A: patients with personal history of breast or ovarian cancer (n = 135); group B: unaffected patients with family history of breast or ovarian cancer (n = 37); and group C: patients presenting for cascade testing (n = 20). Management of patients identified to have pathogenic/likely pathogenic (P/LP) variants was analyzed. The rate of P/LP germline variants for each group was: group A: 17.3%, group B: 16.6%, group C: 57.9%. BRCA1 gene was the most commonly identified gene harboring P/LP variants, followed by BRCA2, among this cohort. Four unrelated patients had a recurrent BRCA1 pathogenic variant: c.4065_4068del (p.Asn1355Lysfs*10). Only two patients in this series elected risk-reducing mastectomy and four patients elected risk-reducing bilateral salpingo-oophorectomy. A higher rate of P/LP variants is seen among Emirati patients at risk for hereditary breast and ovarian cancer syndrome compared with reports of similar patients from Western populations. Efforts to increase utilization and awareness of germline genetic testing are warranted among Emirati patients.

Resilience and relapse risk in Emirate adult patients with substance use disorder: a national cross-sectional study from the United Arab Emirates.

The United Arab Emirates is among the countries affected by substance use disorders (SUDs), which have economic and social impacts. Relapse after successful rehabilitation is a major issue in the treatment of SUD. Several factors increase the risk of relapse in patients with SUD, such as craving and negative social experiences. Resilience could empower patients struggling with SUD. This study aims to explore levels of resilience and relapse risk in adult Emirati patients diagnosed with SUD, and also the possible correlation between the two variables. Two hundred eighty-six Emirati adult patients with SUD completed a self-administered questionnaire for demographics, resilience (Connor and Davidson Resilience Scale), and relapse risk (Stimulant Relapse Risk Scale). Descriptive statistics (frequency, percentage, mean, SD, etc.) were used to describe study participants and variables. Inferential statistics were used to analyze the relationships, associations, and correlations between resilience and relapse risk, the main variables, and the participants demographics. Participants' mean total score for resilience was 72.92 out of a maximum possible score of 100 (SD = 16.99), while their mean total score for relapse risk was 59.07 out of a maximum possible score of 105 (SD = 12.23). Furthermore, examining the correlation between the resilience subscales and the relapse risk subscales revealed similar significant, negative, low-to-moderate correlations between all the subscales (r = -0.486). Protective and risk factors to enhance resilience and reduce relapse risk in patients with SUD were discussed.

Usher syndrome in the United Arab Emirates

ABSTRACT Purpose Usher syndrome, a common form of syndromic inherited retinal dystrophy in the Arabian Gulf, has not been molecularly defined in the United Arab Emirates. The current study addresses this gap in knowledge. Methods A retrospective case series of Emirati patients referred to the Ocular Genetics Clinic of Cleveland Clinic Abu Dhabi who (1) were clinically diagnosed with Usher syndrome and underwent genetic testing (whole exome sequencing, 2019 to 2023, inclusive) and (2) were identified to have biallelic pathogenic variants in Usher syndrome genes during the same time period. Results Ten probands (thirteen patients) were identified—seven probands (nine patients) with clinically diagnosed Usher syndrome and three additional probands (four patients) with biallelic homozygous USH2A variants. Among the seven probands initially diagnosed with Usher syndrome, six had different homozygous variants (three in MYO7A, one in ADGRV1, and one in CLRN1), one had dual diagnoses rather than Usher syndrome (i.e. separate cause for retinal dystrophy and deafness), and one had no identifiable genetic cause. Regarding the three additional probands identified with homozygous USH2A variants, all three had retinitis pigmentosa only rather than Usher syndrome and all three had different variants. Discussion Clinically diagnosed Usher syndrome was genetically heterogenous without evidence for founder effect in this Emirati cohort. MYO7A was the most common associated gene. Dual diagnosis rather than single cause can mimic Usher syndrome. Homozygous USH2A variants were not identified as a cause for Usher syndrome in this cohort but were a recurrent cause for retinitis pigmentosa without hearing impairment and without founder effect.

Etiologies underlying subtypes of long-standing type 2 diabetes.

Attempts to subtype, type 2 diabetes (T2D) have mostly focused on newly diagnosed European patients. In this study, our aim was to subtype T2D in a non-white Emirati ethnic population with long-standing disease, using unsupervised soft clustering, based on etiological determinants. The Auto Cluster model in the IBM SPSS Modeler was used to cluster data from 348 Emirati patients with long-standing T2D. Five predictor variables (fasting blood glucose (FBG), fasting serum insulin (FSI), body mass index (BMI), hemoglobin A1c (HbA1c) and age at diagnosis) were used to determine the appropriate number of clusters and their clinical characteristics. Multinomial logistic regression was used to validate clustering results. Five clusters were identified; the first four matched Ahlqvist et al subgroups: severe insulin-resistant diabetes (SIRD), severe insulin-deficient diabetes (SIDD), mild age-related diabetes (MARD), mild obesity-related diabetes (MOD), and a fifth new subtype of mild early onset diabetes (MEOD). The Modeler algorithm allows for soft assignments, in which a data point can be assigned to multiple clusters with different probabilities. There were 151 patients (43%) with membership in cluster peaks with no overlap. The remaining 197 patients (57%) showed extensive overlap between clusters at the base of distributions. Despite the complex picture of long-standing T2D with comorbidities and complications, our study demonstrates the feasibility of identifying subtypes and their underlying causes. While clustering provides valuable insights into the architecture of T2D subtypes, its application to individual patient management would remain limited due to overlapping characteristics. Therefore, integrating simplified, personalized metabolic profiles with clustering holds greater promise for guiding clinical decisions than subtyping alone.

Association of specific ACE2 and TMPRSS2 variants with circulatory cytokines of COVID-19 Emirati patients.

The COVID-19 pandemic represented one of the most significant challenges to researchers and healthcare providers. Several factors determine the disease severity, whereas none alone can explain the tremendous variability. The Single nucleotide variants (SNVs) in angiotensin-converting enzyme-2 (ACE2) and transmembrane serine protease type-2 (TMPRSS2) genes affect the virus entry and are considered possible risk factors for COVID-19. We compiled a panel of gene variants from both genes and used in-silico analysis to predict their significance. We performed biological validation to assess their capacity to alter the ACE2 interaction with the virus spike protein. Subsequently, we conducted a retrospective comparative genome analysis on those variants in the Emirati patients with different disease severity (total of 96) along with 69 healthy control subjects. Our results showed that the Emirati population lacks the variants that were previously reported as associated with disease severity, whereas a new variant in ACE2 "Chr X:g.15584534" was associated with disease severity specifically among female patients. In-silico analysis revealed that the new variant can determine the ACE2 gene transcription. Several cytokines (GM-CSF and IL-6) and chemokines (MCP-1/CCL2, IL-8/CXCL8, and IP-10/CXCL10) were markedly increased in COVID-19 patients with a significant correlation with disease severity. The newly reported genetic variant of ACE2 showed a positive correlation with CD40L, IL-1β, IL-2, IL-15, and IL-17A in COVID-19 patients. Whereas COVID-19 represents now a past pandemic, our study underscores the importance of genetic factors specific to a population, which can influence both the susceptibility to viral infections and the level of severity; subsequently expected required preparedness in different areas of the world.

Monogenic obesity prevalence and response to bariatric surgery in a cohort of Emirati patients

Monogenic obesity prevalence and response to bariatric surgery in a cohort of Emirati patients

Utilizing Pharmacogenomic Data for a Safer Use of Statins among the Emirati Population.

Statins are the most prescribed lipid-lowering drugs worldwide. The associated adverse events, especially muscle symptoms, have been frequently reported despite their perceived safety. Three pharmacogenes, the solute carrier organic anion transporter family member 1B1 (SLCO1B1), ATP-binding cassette subfamily G member 2 (ABCG2), and cytochrome P450 2C9 (CYP2C9) are suggested as safety biomarkers for statins. The Clinical Pharmacogenomic Implementation Consortium (CPIC) issued clinical guidelines for statin use based on these three genes. The present study aimed to examine variants in these pharmacogenes to predict the safety of statin use among the Emirati population. Analyzing 242 whole exome sequencing data at the three genes enabled the determination of the frequencies of the single nucleotide polymorphisms (SNPs), annotating the haplotypes and the predicted functions of their proteins. In our cohort, 29.8% and 5.4% had SLCO1B1 decreased and poor function, respectively. The high frequency warns of the possibility of significant side effects of some statins and the importance of pharmacogenomic testing. We found a low frequency (6%) of the ABCG2:rs2231142 variant, which indicates the low probability of Emirati patients being recommended against higher rosuvastatin doses compared with other populations with higher frequencies of this variant. In contrast, we found high frequencies of the functionally impaired CYP2C9 alleles, which makes fluvastatin a less favorable choice. Among the sparse studies available, the present one demonstrates all SLCO1B1 and CYP2C9 function-impairing alleles among Emiratis. We highlighted how population-specific pharmacogenomic data can predict safer choices of statins, especially in understudied populations.

Investigating the Impact of IL6 on Insulin Secretion: Evidence from INS-1 Cells, Human Pancreatic Islets, and Serum Analysis

Interleukin-6 (IL6) is a pleiotropic cytokine implicated in metabolic disorders and inflammation, yet its precise influence on insulin secretion and glucose metabolism remains uncertain. This study examined IL6 expression in pancreatic islets from individuals with/without diabetes, alongside a series of functional experiments, including siRNA silencing; IL6 treatment; and assessments of glucose uptake, cell viability, apoptosis, and expression of key β-cell genes, which were conducted in both INS-1 cells and human islets to elucidate the effect of IL6 on insulin secretion. Serum levels of IL6 from Emirati patients with type 2 diabetes (T2D) were measured, and the effect of antidiabetic drugs on IL6 levels was studied. The results revealed that IL6 mRNA expression was higher in islets from diabetic and older donors compared to healthy or young donors. IL6 expression correlated negatively with PDX1, MAFB, and NEUROD1 and positively with SOX4, HES1, and FOXA1. Silencing IL6 in INS-1 cells reduced insulin secretion and glucose uptake independently of apoptosis or oxidative stress. Reduced expression of IL6 was associated with the downregulation of Ins, Pdx1, Neurod1, and Glut2 in INS-1 cells. In contrast, IL6 treatment enhanced insulin secretion in INS-1 cells and human islets and upregulated insulin expression. Serum IL6 levels were elevated in patients with T2D and associated with higher glucose, HbA1c, and triglycerides, regardless of glucose-lowering medications. This study provides a new understanding of the role of IL6 in β-cell function and the pathophysiology of T2D. Our data highlight differences in the response to IL6 between INS-1 cells and human islets, suggesting the presence of species-specific variations across different experimental models. Further research is warranted to unravel the precise mechanisms underlying the observed effects of IL-6 on insulin secretion.

Microsimulation model of the cost-effectiveness of anifrolumab compared to belimumab in the United Arab Emirates

Introduction SLE imposes a significant morbidity and mortality as well as a substantial burden on the healthcare system. The model aimed to measure the cost-effectiveness of anifrolumab implementation against belimumab as an add-on-therapy to the standard of care (SoC) over a lifetime horizon for Emirati patients. Methodology A microsimulation model was used to assess the cost-effectiveness of anifrolumab against belimumab (IV/SC) as an add-on therapy to SoC in a hypothetical cohort of adult Emirati patients with systemic lupus erythematosus (SLE) over a lifetime horizon. The clinical data was captured from published clinical trials as; TULIP-1, TULIP-2, BLISS-52, BLISS-76 and BLISS‐SC. Health utility scores were constructed according to a linear regression model from the pooled data of the two TULIP Phase III trials of anifrolumab. Our model captures direct SLE-related medical costs from the Dubai Health Authority. Sensitivity analyses were conducted to assess model uncertainty. Results Using BICLA as a response criterion in the Johns Hopkins cohort, anifrolumab was found to be more effective than belimumab (IV/SC; the incremental discounted QALY of anifrolumab against belimumab was 0.42). The incremental cost-effectiveness ratio (ICER) of anifrolumab against belimumab IV and belimumab SC were AED 466,371 ($209,135) and AED 252,612 ($113,279), respectively, these ICERs are below the cost-effectiveness threshold in the United Arab Emirates (UAE) (three times gross domestic product capita; AED 592,278). In the Toronto lupus cohort, the ICER of anifrolumab against belimumab IV and belimumab SC were AED 491,403 ($220,360) and AED 276,642 ($124,055), respectively (anifrolumab was a cost-effective option vs. belimumab IV and belimumab SC). Conclusion The addition of anifrolumab to SoC is a cost-effective option versus belimumab for the treatment of adult patients with active, autoantibody-positive SLE, despite being allocated to SoC. Cost-effectiveness was demonstrated by a reduction in complications and organ damage, which reflected costs and outcomes.

Metabolic and Renal Outcomes of Empagliflozin among Emirati Patients with Type 2 Diabetes

Metabolic and Renal Outcomes of Empagliflozin among Emirati Patients with Type 2 Diabetes

Obesity Prevalence, Associated Factors and Complications among Adult Population Attending Family Medicine Clinic in Hatta Hospital, United Arab Emirates

Background: The United Arab Emirates (UAE) has experienced rapid economic growth in the last few decades, resulting in swift urbanization and an influx of foreign labor. This has facilitated an advanced, yet sedentary lifestyle characterized by increased reliance on technology, unhealthy dietary habits, and a reduction in physical activity levels. These factors significantly contributed to the rise in the prevalence of obesity. Objective: To determine the prevalence of obesity, it is associated factors, and complications among adults presenting to the primary care clinic at Hatta Hospital, located in the Hatta area UAE. Material & Methods: This cross-sectional study enrolled adult Emirati patients aged between 18-55 years. Body Mass Index (BMI) was categorized based on the World Health Organization’s threshold. Patients’ socio-demographic and clinical data was obtained and recorded. Results: A total of 600 Emirati patients were included in this study, with a median age of 33 (IQR=25-45) years. Gender distribution was kept equal with 50.5% male and 49.5% female participants. The median BMI among the participants was 28.2 (IQR=24.3-32.5) kg/m2. The prevalence of underweight, normal weight, overweight, and obesity was found as 4.3%, 23.5%, 33.7% and 38.5% respectively. After adjusting the co-variants in the multivariable model, lower education levels were found to be significantly associated with higher odds of obesity. Conversely, being single and adhering to a healthy lifestyle was associated with lower odds of obesity in the multivariable model. Conclusion: The present study identified that 38.5% of the adult population attending Hatta Hospital family medicine clinics were obese and 33.7% were overweight. Conclusively 72.2% of the adult population of the Hatta area have a BMI above normal, indicating a very high prevalence of obesity and overweight cases. Furthermore, a significant association of obesity was found with lower education levels, being married, having unhealthy dietary habits, and insufficient physical activity.

Thyroid Autoimmune Disease among Emirati Patients: A Retrospective Analysis of the Patients’ Characteristics

Background: Autoimmune thyroid disease (AITD) is a serious and treatable disease that could be associated with other autoimmune disorders. It is a common cause of hypothyroidism in adult females. The diagnosis is established by detecting serum antithyroid antibodies. The disease slowly progresses, and the treatment includes thyroid hormone replacement in cases of hypothyroidism. Objective: The aim of this study is to investigate the clinical presentation, laboratory findings, and comorbidity factors involved in autoimmune thyroid disease among Emirati citizens in the UAE. Methods: Medical records from Advanced Cure Diagnostic Centers were reviewed in a retrospective study over the period of four years from 2018 to 2022. The patients population included those who attended the Endocrinology Unit and others seen by the rest of the medical staff. Patients were considered to have AITD if they tested positive for thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), or both. The data collected was evaluated using descriptive analysis to provide a basic summary of the patients sample and dataset. Unpaired t-test was used to compare the mean value of elevated autoantibodies in males and females. Results: Of the 366 Emirati nationals who were tested for autoimmune thyroiditis, 220 (60%) had an abnormal result for TPOAb and/or TgAb. Among the 220 patients who had an abnormal result for TPOAb and/or TgAb, 188 (85.5%) were females, and 100 patients (45.5%) were in the age group between 31 and 40 years. 42% were in a euthyroid state and 42% presented with hypothyroidism. Only 7% presented with hyperthyroidism, 5% with subclinical hypothyroidism, and 2% with subclinical hyperthyroidism. An analysis of the comorbidity factors revealed that 142 (65%) patients with obesity, 82 (37%) with a family history of thyroid disease, 77 (35%) with hyperlipidemia, 14 (6%) with hypertension, and 11 (5%) with diabetes. Conclusion: This is the first publication intended to address AITD in Emirati citizens. Our findings concur with the international data regarding the prevalence among middle-aged females. Eighty-four percent of the positive patients either presented with no abnormality of their thyroid gland function or with hypothyroidism. With the alarming increase of obesity in the UAE, we found it to be the single most important and preventable comorbidity factor present in 65% of the studied population. This is followed by a family history of first-degree relatives with thyroid disease in 37% of the participants, due to the high rate of consanguineous marriages in the UAE.

Characteristics of Seropositive Neuromyelitis Optica Spectrum Disorder in Emirati Patients at Cleveland Clinic Abu Dhabi

Characteristics of Seropositive Neuromyelitis Optica Spectrum Disorder in Emirati Patients at Cleveland Clinic Abu Dhabi

Predictors of Pathological Gastroesophageal Reflux among Emirati Patients with Reflux Symptoms Who Undergo Wireless pH Monitoring.

Background: Diagnosis of gastroesophageal reflux disease (GERD) relies on recognizing symptoms of reflux and mucosal changes during esophagogastroduodenoscopy. The desired response to acid suppression therapy is reliable resolution of GERD symptoms; however, these are not always reliable, hence the need for pH testing in unclear cases. Our objective was to identify potential predictors of a high DeMeester score among patients with potential GERD symptoms to identify patients most likely to have pathological GERD. Methods: We conducted a retrospective case-control study on patients who underwent wireless pH monitoring from January 2020 to April 2022. Cases were patients with a high DeMeester score (more than 14.7), indicating pathological reflux, and controls were those without. We collected clinical and demographic data, including age, sex, body mass index (BMI), smoking status, non-steroidal anti-inflammatory drugs (NSAIDs) use, and presence of atypical symptoms. Results: 86 patients were enrolled in the study. 46 patients with high DeMeester scores were considered cases, and 40 patients with DeMeester scores less than 14.7 were considered controls. Esophagitis (grade A) was found in 41.1% of the cases and in 22.5% of the control group. In our study, age of more than 50 years compared with age of 20-29 years and being overweight appeared to be predictors of true pathological reflux among patients with reflux symptoms who underwent wireless pH monitoring. Conclusion: Age above 50 years compared with age between 20-29 years and being overweight appeared to be predictors of true pathological reflux among patients with reflux symptoms who underwent wireless oesophageal pH monitoring. The presence of oesophagitis was approximately four times more likely to be associated with true pathological reflux.

Clinical profiling of Acanthosis nigricans in Emirati patients and its association with sex-specific differences in insulin secretion and insulin resistance: a case-control study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Enhancing cultural competency and empathy toward foreign patients for Korean nursing students through a simulation: A quasi-experimental study

AimThis study aimed to develop a transcultural nursing simulation-based learning program with patients from the United Arab Emirates and evaluate its effects on cultural competence and empathy among undergraduate nursing students in South Korea. BackgroundThe importance of cultural competency and empathy has increased with the increased number of foreign patients in Korea. The United Arab Emirates (UAE) is one of the top Middle Eastern countries from which patients visit Korea for medical services. Because South Korea is a largely homogenous country, foreign patients often experience difficulties in their hospitalizations when Korean nurses lack cultural competency in caring for them. To improve cultural competency, a practical form of education, such as a simulation, is necessary. In addition, the simulation module based on cultural competency model allowing nursing students to provide effective and culturally responsive services to ethnically diverse patients. DesignThis quasi-experimental study used a non-randomized control group design with a convenience sample. MethodsThe program was administered to 53 Korean undergraduate nursing students (26 control and 27 experimental). Fourteen teams of two students practiced infection prevention training with the mother of a 7-year-old child with immunodeficiency. Participants’ cultural competency and empathy were assessed before and after the TN-SBL using an online survey. The effects of cultural competency and empathy were analyzed using a generalized estimation equation. ResultsNursing students in the TN-SBL group showed more positive improvement in cultural competence and had increased cognitive empathy levels than students in the control group. ConclusionThe simulation module developed in this study improved students’ cultural competency and empathy levels. It is valuable because the scenario was developed based actual clinical cases of Emirati patients and their families. The simulation module was designed based on the cultural competency model to raise awareness of cultural diversity and allow students to directly practice culturally competent care. It can be used to educate Korean nurses and improve the quality of care provided to Arabic-speaking Muslim patients.

Estimating aspect ratio of the distal femur and proximal tibia in the Emirati population from MRI scans of the knee: a preliminary experience

Size and shape of knee implants play an important role in the success of total knee arthroplasty. Several studies have identified anthropometric differences of the distal femur and proximal tibia between the genders and ethnicities. Ill-fitting prosthesis can cause overhang or under-fit resulting in persistence of pain, periprosthetic fracture and decreased range of motion. The purpose of this study was to estimate the aspect ratio of distal femur and proximal tibia in the Emirati population and determine whether gender differences exist within this group. Magnetic resonance imaging datasets of unilateral knees scans performed on adult Emirati patients at a tertiary care hospital were retrospectively examined. Knee parameters were obtained from 65 males and 46 females (n = 111). Females showed significantly smaller AP and ML dimensions of distal femur and lower aspect ratios compared to males (p < 0.001). Proximal tibial dimensions (AP and ML) of Emirati women are also significantly smaller compared to men. However, aspect ratio of proximal tibia did not show gender variation (p = 0.956) within the Emirati population. Emirati knees showed significant gender differences in bony dimensions and aspect ratio of the knee, and also have smaller aspect ratios when compared with most other population groups.

Investigating the Association between Diabetic Neuropathy and Vitamin D in Emirati Patients with Type 2 Diabetes Mellitus

(1) Background: Vitamin D deficiency is a common public health problem in the United Arab Emirates (UAE) and globally, and interestingly, improvements in diabetic neuropathy after taking Vitamin D supplementation for a short time have been reported. Despite living in a country that is sunny all year round, hypovitaminosis D, indicated by an obvious low serum vitamin D level, has been recurrently noted in the UAE, as well as in the surrounding Arabian Gulf countries. This problem is receiving much attention and attracting clinical and academic interest. Therefore, the main objective of the present study is to identify the association, if any, between vitamin D deficiency and the development of diabetic neuropathy in the UAE population with T2DM. (2) Methods: a total of 600 Emirati patients (male and female) with T2DM, aged between 20 and 80, were recruited from University Hospital Sharjah (UHS). The medical records of the patients were reviewed and analyzed. (3) Results: The results of the present study showed that among the 600 patients, 50% were affected with diabetic neuropathy. Vitamin D level in patients with neuropathy were estimated to be around 20 ng/mL (IQR 14-25), and vitamin D levels were significantly higher (33 ng/mL (IQR 20-42)) among patients without neuropathy, with p < 0.001. Another important finding was that patients without neuropathy had a better vitamin D status, with only 19% being deficient and 18% having insufficient vitamin D levels, compared to patients with neuropathy, where 39% were deficient (vitamin D < 20 ng/mL) and 44% had insufficient vitamin D levels (20-30 ng/mL). (4) Conclusion: The findings of the present study show that the prevalence of vitamin D deficiency (low serum 25-hydroxy vitamin D 25-OHD level) is significantly high in diabetic neuropathy in Emirati patients with T2DM.

Experiences and Challenges of a New Palliative Care Service in the United Arab Emirates

Introduction Palliative care as a medical subspecialty in the United Arab Emirates (UAE) is very much in its formative stage of development. There are a small number of healthcare facilities that provide a specialist palliative care service, the most recent of which is the Palliative and Supportive Care Service at Burjeel Medical City (BMC), a private hospital in Abu Dhabi. Aim This retrospective review of all the referrals to our palliative and supportive care service within the first 9-months of operation is a direct reflection of the challenges we currently face in the day-to-day delivery of palliative care in the UAE. Result Of a total of 360 referrals received during the study period, under 50% were for local, Emirati patients with international expatriates making up the rest. Most of the referrals received were for symptom control (including pain) and end-of-life care (EoLC), with 85% of the patients having a diagnosis of cancer. One third of the referrals received were for EoLC, with 90% of the patients who received EoLC on a hospital ward having a valid do not attempt resuscitation (DNAR) status in place. For the patients who received EoLC, all but one patient received EoLC in the hospital setting. Conclusion Our experiences are consistent with the challenges that other colleagues in the Middle East and North Africa (MENA) region face in providing palliative care. The majority of referrals to the palliative and supportive care service were for patients with a diagnosis of cancer with only 15% reflecting a non-cancer diagnosis. Of the 150 decedents cared for during this study period, more than 75% had a valid DNAR status in effect suggesting a growing awareness and acceptance of a less medicalized EoLC period.

The pattern of mandibular third molar impaction and its relationship with the development of distal caries in adjacent second molars among Emiratis: a retrospective study

ObjectivesThe purpose of this study was to investigate the pattern of mandibular third molar (MTM) impaction and associated carious lesions in adjacent mandibular second molars (MSMs) in a sample of Emirati individuals.MethodsThis retrospective study assessed 2000 orthopantomograms of Emirati patients who visited the Specialized Fujairah Dental Center between 2015 and 2020. The depth, ramus relation and angulation of the impacted MTMs were assessed according to the Pell and Gregory classification and Winter’s classification. In addition, carious lesions in adjacent MSMs associated with the evaluated parameters were identified.ResultsA total of 461 (23.05%) of the patients had at least one impacted MTM. The mean age of the study population was 26.24 years. Mesioangular, level B, and class II impactions were the most common, at 47.37% (χ2 = 382.134; p < 0.001), 45.48% (χ2 = 56.889; p < 0.001), and 74.05% (χ2 = 513.099; p < 0.001), respectively. There was a higher percentage of level C impaction among females than among males (χ2 = 19.178; p < 0.001). A total of 126 impacted teeth (18.36%) had associated carious lesions. These carious lesions were predominantly found in teeth with mesioangular impactions (χ2 = 59.430; p < 0.001), level A and B impactions (χ2 = 23.301; p < 0.001), and class II and I impactions (χ2 = 17.918; p = 0.006).ConclusionsIt is imperative to raise awareness of soft tissue mesioangular-impacted MTMs, as they are the most frequently associated with the development of carious lesions in adjacent MSMs. Approximately one quarter of evaluated Emiratis had at least one impacted MTM, with the most prevalent pattern being class II, level B, and mesioangular impactions. Furthermore, surgical removal is expected to be more challenging for females than for males.