Dubai Hospital Research Articles

Assessment of Novel Inhaler Technique Reminder Labels in Image Format on the Correct Demonstration of Inhaler Technique Skills in Asthma: A Single-Blinded Randomized Controlled Trial.

Background: Prevalence of asthma in the United Arab Emirates (UAE) is high, and training patients on correct inhaler technique is vital. Objectives: To assess the effectiveness of inhaler technique labels incorporating the individual technique steps in image format on the retention of correct inhaler technique for patients with asthma living in the UAE and following inhaler training; secondly to investigate the effect of inhaler technique education using self-check pictorial labels on patients’ overall asthma control. Methods: This single-blinded randomized controlled study was conducted in 2019 and followed consecutive recruitment of asthma patients visiting respiratory clinics at Rashid Hospital in Dubai. Patients were using a controller inhaler (Turbuhaler (TH), Accuhaler (ACC), or pressurized metered-dose inhaler (pMDI)). Following recruitment, patients were randomized into active group receiving educational intervention plus the inhaler label, and control group receiving educational intervention without the label. Patients were assessed at baseline and at one-month on their inhaler technique and asthma control. Results: Participants (n = 245; 93 = TH, 70 = ACC, 82 = pMDI) showed a significant difference between the groups at one-month for inhaler technique scores for TH (active 5.29 ± 1.86 vs. control = 24.4 ± 21.28), ACC (active = 3.99 ± 1.43 vs. control = 25.45 ± 22.57), and pMDI (active = 4.59 ± 0.10 vs. control = 120.55 ± 17.2), p < 0.001 for all. Asthma control for active group indicated significant improvements compared to control for TH and pMDI (p < 0.001 for both), but not ACC group (p = 0.087). Conclusions: Retention of correct inhaler technique and improved asthma control can be enhanced by using a specialized inhaler technique label in image format.

Diabetes mellitus as a comorbidity in COVID-19 infection in the United Arab Emirates.

Objectives:To compare risk factors and clinical outcomes among COVID-19 patients with or without diabetes in the United Arab Emirates (UAE).Methods:Data of 350 COVID-19 positive patients, admitted to Al Kuwait Hospital in Dubai, UAE, from February to May 2020 was collected retrospectively, including demographic data, clinical symptoms, blood tests, as well as radiographical assessments, and clinical outcomes of COVID-19. The design of the study is a retrospective cohort study.Results:COVID-19 patients with diabetes belong to an older age group, had a higher percentage of male patients, exhibited more lymphopenia and neutrophilia, and higher ferritin levels. Additionally, patients with diabetes presented fever and shortness of breath (SOB), displayed more bilateral airspace consolidation and opacities in their chest x-ray and CT scans, compared to non-diabetics. A higher percentage of critical, ICU-admitted, and death of COVID-19 cases in the diabetic group was also reported. This was along with a concomitant increase in C-reactive protein, procalcitonin, and lactate dehydrogenase levels.Conclusions:Diabetes is considered a comorbidity as diabetic patients showed more severe COVID-19 symptoms that led to critical clinical outcomes such as ICU admission and death.

Preterm Infant with Severe Respiratory Distress and Intubation Difficulty.

1. Atef Alshafei, MRCPCH* 2. Jamal Kassouma, MD† 3. Anwar Khan, MD* 4. Moustafa Hassan, MD* 1. *NICU, Pediatric Department, Dubai Hospital, Dubai, United Arab Emirates; 2. †ENT Department, Dubai Hospital, Dubai, United Arab Emirates 1. Address correspondence to Atef Alshafei, MRCPCH, NICU, Neonatology Section, PO Box 7272, Dubai Hospital, Dubai, United Arab Emirates. E-mail: Ahalshafei{at}dha.gov.ae A preterm male infant is born via cesarean delivery at 35 weeks of gestation with birth weight of 2.720 kg to a 30-year-old Gravida 3 Para 3 woman with an uneventful pregnancy, except for polyhydramnios. The infant is born nonvigorous, and T-piece positive pressure ventilation is given with improvement of the heart rate. The Apgar score is 5 and 7 at 1 and 5 minutes, respectively. He is noted to have severe respiratory distress and cyanosis, with oxygen saturations ranging from 54% to 60%, and intubation cannot be achieved even after several attempts using a small endotracheal tube of 2-mm internal diameter. Although the vocal cords are seen clearly, the endotracheal tube cannot be maneuvered beyond the cords. A nasopharyngeal tube is advanced and connected to noninvasive ventilation support with fraction of inspired oxygen of 1.0. The infant is admitted to the NICU and an on-call ear-nose-throat surgeon is urgently called. Upon examination, the infant is irritable and distressed with bilaterally decreased air entry and significant subcostal retractions. Heart examination reveals normal S1 and S2 heart sounds and grade II/VI systolic murmur over the left parasternal border. Abdominal examination is normal with bilaterally descended testes. At 30 minutes after birth, he is …

First experience with hysterosalpingo-foam sonography (HyFoSy) for office tubal patency testing in Dubai hospital

Background: The present study was conducted to describe the first experience with hysterosalpingo-foam sonography (HyFoSy) as a routine office procedure to check for tubal patency in infertility clinic of Dubai Hospital. Materials and Methods: A retrospective, observational study was conducted. Hundred patients with subfertility and low risk of tubal pathology were examined. A non-toxic HyFoSy foam containing hydroxymethyl cellulose and glycerol was applied through the cervical applicator for contrast sonography. Tubal patency was determined by transvaginal ultrasound by demonstrating echogenic dispersion of foam in Fallopian tubes and or in the peritoneal cavity. Only in cases where patency could not be demonstrated, hystosalpingogram/laparoscopy was performed as a control. Inclusion Criteria: All patients who underwent HyFoSy in infertility clinic in Dubai hospital were included in the study. Exclusion Criteria: Any patient with active tubal disease such as pelvic inflammatory disease, endometriosis and previous ectopic pregnancy were excluded from the study. Results: One hundred patients were observed in the study. HyFoSy was successful in 97 patients (97%) and was failed in three patients (3%). Bilateral patency was seen in 72 patients (74%), bilateral blockage was seen in six cases (6.1%), delayed spill was seen in five patients (5%) and hydrosalpinx was found in 1 patient (1%). Antibiotics were given to 97 patients (100%). Out of the 97 patients who successfully underwent HyFoSy, 17 conceived within 6 months after the procedure. Conclusion: HyFoSy is a successful procedure to demonstrate tubal patency as the first step office procedure.

Food Intolerance In Children With Autism Spectrum Disorders

Objectives: Genetic and environmental factors is suggested to play a role in the etiology of Autism spectrum disorders (ASD). The aim of the study was to investigate the link between specific food intolerances and autism spectrum disorders, by comparing the food Intolerance test in children with ASD and typically developing children without known food allergy or mental disorders.Patients and Methods: This study included 100 patients diagnosed as ASD who attended the phoniatrics clinic in Dubai hospital in the period from Jun 2017 to Jun 2019. The control group involved 50 typically developing children. The diagnosis and severity of autism confirmed by childhood autism rating scale (CARS) and DSM V criteria. Food Intolerance test analyses IgG antibody levels to 222 specific foods to ascertain which food a person might be intolerant to.Results: The outcome measures were the percentage of children with elevated IgG in different food items and the mean level of IgG in each food item. The percentage of ASD children with positive food intolerance were 96% for milk, 94% for egg white, 96% for casein, 62% for gliadin, 74% for oat and 80% for wheat. There was a significantly higher level of IgG concentration (U/ml) in ASD than control group.Conclusions: A high prevalence of food intolerance was identified in the ASD children . The results of the present study suggested the presence of food intolerance to multiple food items in children with ASD suggesting their possible roles in ASD etiology or symptomatology.

The Clinical Characteristics and Survival Profiles of Wilms Tumor in the United Arab Emirates: A Single-center Retrospective Analysis

Background: Wilms Tumor (WT) is the most common pediatric kidney tumor, yet the disease has variable clinical characteristics and prognostic outcomes across different populations. Objectives: This study aims to review the clinical characteristics and survival outcomes of children with WT who have received treatment at Dubai Hospital, UAE. Methods: A retrospective study was conducted involving the medical records of confirmed WT children (aged &lt; 14 years) who had received treatment between 2013 and 2018. Diagnosis should have been established based on the histopathological examination of operable tumors and needle biopsy for inoperable tumors. The Société Internationale d’Oncologie Pédiatrique (SIOP) WT 2001 protocol was used for patient management, and the UMBRELLA SIOP–RTSG 2016 Wilms tumor pathology and molecular biology protocol was used for histopathologic classification and clinical staging. The presenting sign and symptoms, the findings of diagnostic imaging techniques, histological grading, the received treatments, and follow-up outcomes were collected and analyzed. Kaplan-Meier survival analysis was used to carry out the survival analysis. Results: Ten children were diagnosed with WT (median age of 3.40 years, 60% males). All patients presented with abdominal masses without prominent pain. Synchronous bilateral lesions were found at diagnosis in one patient and metastatic lesions in three patients. Four children were discharged against medical advice; five received treatment according to the SIOP WT 2001 regimen, while the remaining patient was managed in the United States according to the National Wilms Tumor Study Group (NWTSG) protocol. The overall 6-year and relapse-free survival rates were 90% and 80%, respectively. Conclusion: The clinical characteristics and managemental outcomes of children presenting with WT are promising, possibly owing to adopting the SIOP protocol. Considering the small sample size, more large-scale, nation-wide studies are warranted.

Acute kidney injury in COVID-19 patients – Dubai Hospital experience: Incidence, risk factors and outcome

Acute kidney injury in COVID-19 patients – Dubai Hospital experience: Incidence, risk factors and outcome

Knowledge and Attitude of The Healthcare Staff towards Epilepsy: Experience from One Center in United Arab Emirates

Objective&#x0D; With this study, we wanted to assess the knowledge, awareness and attitude towards epilepsy of the healthcare staff from one of the specialized hospitals in Dubai, United Arab Emirates&#x0D; Method&#x0D; A self-administered online questionnaire was sent to all the medical, nursing and paramedical staff of Medcare Women and Children Hospital in Dubai, United Arab Emirates which is one of the specialized hospitals in Dubai. The questionnaire had total seven sections including the demographic information of the responder.&#x0D; Results&#x0D; The data was collected electronically on secure computer. Out of total 120 requests, 88 responses were collected (73%). 69% were staff nurses and 6% were doctors including consultants and junior doctors. 97% of the responders claimed to have some knowledge of ‘epilepsy’ as the disease and some of them had seen or dealt with a patient with an epileptic seizure. However, majority felt that there was further need for more training in this area.&#x0D; Conclusion&#x0D; From our cohort, we found out that despite self-reported awareness and knowledge about epilepsy, there was still negative and inappropriate attitude towards this condition. So not only clinical knowledge, but there seems to be more need for correcting the attitudes and beliefs towards epilepsy even in the healthcare staff.

Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study.

BackgroundRecent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death).ObjectiveThis study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment.MethodsThis cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients.ResultsOf the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1c level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (P<.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit.ConclusionsMajority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.

Hospital-Based Prevalence of Iron Deficiency Anemia among Pre-School Children in Dubai.

Introduction: Iron deficiency anemia (IDA) is an internationally recognized leading cause of disability and contributes to childhood morbidity and mortality. The prevalence of IDA is higher in developing countries, especially in Arab countries, compared to the west.Methods: To assess the prevalence of IDA, we analyzed the data of children aged between one to five years seen at Dr. Sulaiman Al-Habib Medical Group’s tertiary care hospital in Dubai, United Arab Emirates (UAE) from 2016 to 2018.Results: We found a high occurrence of IDA in male children and non-Emirati children.Conclusion: Appropriate screening and iron supplementation are required to see a decline in the rate of IDA. Further nationwide studies are required to identify the highly prevalent and high-risk areas of IDA in the UAE.

Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates

BackgroundThe use of Complementary and Alternative Medicine (CAM) among Type 2 Diabetes Mellitus (T2DM) patients is increasing to manage the complexities of their condition, enhance their health, and ease complications. The burden of T2DM in the United Arab Emirates (UAE) coupled with the high prevalence of CAM use and its associated risks among patients with T2DM necessitated the investigation of the use of CAM by this patients’ population. The aim of this study is to examine the prevalence, types, and correlates of CAM use among T2DM patients in the UAE.MethodsPatients with T2DM attending the outpatient clinics in the two governmental hospitals in Dubai and Sharjah, UAE were invited to participate in a cross-sectional survey. Face-to-face interviews were conducted with participants to complete a multi-component questionnaire. The questionnaire comprised of three main sections: demographic data, diabetes-related information, and CAM use details. Data analysis employed descriptive statistics, univariate and multivariate logistic regression to assess the prevalence and correlates of CAM use.ResultsTwo hundred forty-four T2DM patients completed the questionnaire (response rate: 80%). A total of 39.3% of participants were CAM users since diagnosis. After adjustment; the logistic regression results showed that CAM use was significantly associated with age, sex, education, employment, and having health insurance. The most commonly used type of CAM by participants were folk foods and herbs followed by spiritual and natural healing and vitamins and minerals supplements. The majority of CAM users were referred or encouraged to use CAM by family (42.7%), friends (25%) or social media (17.7%). Only 13.5% of participants used CAM because it was suggested by health care practitioners. Only 1 in four of CAM users disclosed CAM use to their treating physician.ConclusionCAM use among T2DM patients in the UAE is considerably high. Health policy and decision-makers are encouraged to dedicate particular attention to facilitating proper regulation and integration of CAM within conventional medicine to protect the health and wellbeing of patients. A concerted effort by medical schools and public health authorities should be committed to educating health care providers and patients on the safe and effective use of CAM therapies.

A review of gestational diabetes mellitus management, risk factors, maternal and neonatal outcomes in two major maternity hospitals in the United Arab Emirates: A report from Dubai.

This study was conducted in order to explore and analyze the status of gestational diabetes (GDM) amongst pregnant women in Dubai, United Arab Emirates (UAE); a country with high prevalence of diabetes. We aimed to describe GDM-associated risk factors and clinical outcomes of pregnant women and their neonates. Our objective was to contribute to the broader literature on reproductive health disparities and to inform efforts to improve GDM care at our region. Chart review of case records were used to collect data on both maternal and neonatal parameters and outcomes during the specified study period from two main maternity hospitals in Dubai. UAE national women with GDM were more prone to be obese or overweight compared to non-UAE women (p < 0.0001, and p < 0.0001 respectively). In addition, UAE national women with GDM had higher history of GDM in previous pregnancies (p < 0.0001) and more family history of diabetes (p < 0.0001).The neonate admission into NICU was significantly associated with cesarean section (p < 0.0001), twins (p < 0.0001), preeclampsia (p = 0.02), receiving MgSO4 (p = 0.02), birth weight less than 2500 g (p < 0.0001), low Apgar scores (p < 0.0001), baby with congenital anomaly (p < 0.0001), and neonatal hypoglycemia (p < 0.0001). Our results demonstrate that pregnant women with GDM who are UAE nationals and have higher parity need to be under special attention during their pregnancy in order to improve both maternal and neonatal outcomes.

Impact of a pain management program on nurses' knowledge and attitude toward pain in United Arab Emirates: Experimental-four Solomon group design

BackgroundLack of knowledge about pain is a common barrier to effective pain management. Educational pain management programs directed to health care professionals can improve knowledge and attitudes about pain. However, changing practice is more challenging, but can be achieved with more targeted educational interventions within the clinical setting. ObjectivesThe main objective of this study was to examine which of four separate pain management educational designs improved nurses' knowledge and attitudes toward pain over time. Secondary objectives were to compare and contrast nurse's knowledge and attitudes toward pain before and after the educational intervention. DesignThis randomized controlled trial using a four Solomon group design. SettingThis study took place in Dubai Hospital, Dubai Health Authority, in United Arab Emirates between January 2019–April 2019. ParticipantsThe sample consisted of 200 registered nurses who were randomly selected and assigned into four separate educational groups. Participants had at least one year of experience in Dubai hospital prior to data collection. Resultspaired t-test has shown the experimental group scored significantly higher than the control group (p < 0.01). One-way ANOVA revealed significant post-test score differences between groups p < 0.001. A repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean scores over three months was not statistically significant. Indicating that the level of knowledge did not change over time within any of the groups. Conclusion and recommendationsThe most important findings were the relatively low pre-test knowledge scores among staff nurses, and the significant improvement in knowledge for most test items following the educational intervention. Moreover, the level of knowledge and attitudes were maintained over three months. The pain management program proved to be effective in improving nurses' pain knowledge, attitudes, and assessment practices. Nurses in the experimental group increased their pain score significantly after the pain management program.Registration number: NETUBR.

Incidence of Immune Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitors, Case Series from Two Tertiary Care Centeers in Dubai, UAE

Introduction: Immune checkpoint inhibitors (ICI) represent a major component of systemic therapy in advanced malignancy. Studies have reported unique spectrum of toxicity profile of ICI as compared to systemic chemotherapy. Aim of this study is to evaluate toxicities of ICI in our population and to compare this with published data. Material and Methods: We retrospectively reviewed medical records of patients treated with ICI at Dubai hospital and American hospital Dubai from November 2015 to April 2019. After patient identification from hospitals cancer registry, data regarding patients’ demographics, cancer type, type of ICI, adverse events, and duration of treatment were collected. Results: Forty-Five patients were identified with median age of 60 (27-80) years. 27 (60%) patients were male and 18 (40%) were female. Underlying diagnosis was lung cancer (n=25), renal cell cancer (n=6), melanoma (n=5), bladder cancer (n=3), Hodgkins lymphoma (n=3) and other malignancies (n=3). Majority of patients received Nivolumab (n=20, 44%) followed by Pembrolizumab (n=19, 42%), Atezolizumab (n=4, 9%) and Durvalumab (n=2, 5%) respectively. Thyroid dysfunction was the most common side effect observed in 17 (38%) patients including hypothyroidism (n=12, 27%) and hyperthyroidism (n=5, 11%). 53 % patients treated with Nivolumab developed thyroid dysfunction as compared to Pembrolizumab (22%). 7 patients (16%) had elevated liver enzymes. Grade II and III hepatotoxicity was noted in 1 patient (2.2 %) each. One patient (2.2 %) developed grade II skin toxicity. One patient (2.2 %) developed grade III colitis. Grade II, III and IV pneumonitis was observed in 2 (4.4 %), 1 (2.2%) and 1 (2.2%) patient respectively. Immune mediated adverse events were managed according to standard guidelines and 2 patients (4.4 %) had treatment discontinuation due to grade IV Pneumonitis and grade III Colitis. Conclusion: Our study reports relatively higher incidence of thyroid adverse events in patients treated with ICI. The incidence of grade III-IV immune related toxicity remains low. Overall treatment with ICI was tolerated reasonably well and toxicity was manageable.

A single-centre investigator-blinded randomised parallel-group study protocol to investigate the influence of an acclimatisation appointment on children\u2019s behaviour during N2O/O2 sedation as measured by psychological, behavioural and real-time physiological parameters

Aims and objectivesTo describe a study protocol of a randomised control trial (RCT) assessing the effectiveness, in reducing dental anxiety, of an acclimatising nitrous oxide sedation (N2O) session prior to actual dental treatment with N2O.Materials and methodsA single-centre investigator-blinded parallel-group RCT conducted in a postgraduate dental hospital in Dubai, United Arab Emirates (UAE). Anxious children requiring N2O (aged 5–15 years) will be randomly assigned to; a study group: children who will have a preparatory N2O trial experience or; a control group: children who will only have N2O explained to them. Treatment with N2O for both groups will start at the second visit. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment (using the Modified Child Dental Anxiety Scale faces), behaviour of the child (using Frankl Rating Behaviour Scale) and the acquisition of real-time physiological anxiety-related parameters (using E4® electronic wrist devices).ResultsThe data will be analysed statistically.DiscussionThere is a paucity of research regarding dental N2O acclimatising appointments. This RCT will supplement existing literature.ConclusionsThis RCT will report whether prior acclimatising of a child to N2O sedation is effective, or not, in improving dental treatment behaviour.

SAT-416 Pattern of Biopsy Proven Renal Disease in Adults: Single-Centre Experience from a Tertiary Care Hospital in Dubai, UAE

SAT-416 Pattern of Biopsy Proven Renal Disease in Adults: Single-Centre Experience from a Tertiary Care Hospital in Dubai, UAE

SAT-130 5-YEARS MORTALITY ANALYSIS IN HAEMODIALYSIS PATIENTS IN A SINGLE CENTRE IN DUBAI

Objective The purpose of this study is to determine the mortality among patients on haemodialysis. This observational cohort study was conducted at Dubai Hospital during the period between January-2012 till Dec-2016. All adults' patients with ESRD on haemodialysis irrespective of their age, gender and duration of dialysis were enrolled. Mortality among these patients along with certain information like age at the time of death, gender, cause of ESRD, co-morbidities and serology report were collected. Out of a total of 411 patients, 112 (27.3%) patients died during the study period, 56% were male and their median age at the time of initiation of dialysis and at time of death was 59.38±13.5 and 63.8±13.6 respectively. 13 patients suffer early mortality i.e. died within 365 days of initiation of dialysis. Diabetes mellitus was the most common cause of ESRD (73%) among the deceased populations, whereas Hypertension was the most prevalent comorbidity in our study group. Low levels of haemoglobin (46%), albumin (54%) and parathyroid hormone (72%), whereas high ferritin (63%) and abnormal phosphorus (61.6%) were predominant biochemical parameters in the deceased patients. The leading cause of death was cardiovascular in 48 patients (42.85%) followed by infection /sepsis (21patients, 18.75%), unknown causes/sudden death (including sudden death at home) in 18 patients (16.07%) and cerebrovascular events in 7 patients (6.2%). Other causes include gastrointestinal haemorrhage, liver disease and pulmonary embolism. Generally, older age group, diabetes mellitus, prolonged duration on dialysis and cardiac diseases were the common causes of mortality in our study population. Out of a total of 411 patients, 112 (27.3%) patients died during the study period, 56% were male and their median age at the time of initiation of dialysis and at time of death was 59.38±13.5 and 63.8±13.6 respectively. 13 patients suffer early mortality i.e. died within 365 days of initiation of dialysis. Diabetes mellitus was the most common cause of ESRD (73%) among the deceased populations, whereas Hypertension was the most prevalent comorbidity in our study group. Low levels of haemoglobin (46%), albumin (54%) and parathyroid hormone (72%), whereas high ferritin (63%) and abnormal phosphorus (61.6%) were predominant biochemical parameters in the deceased patients. The leading cause of death was cardiovascular in 48 patients (42.85%) followed by infection /sepsis (21patients, 18.75%), unknown causes/sudden death (including sudden death at home) in 18 patients (16.07%) and cerebrovascular events in 7 patients (6.2%). Other causes include gastrointestinal haemorrhage, liver disease and pulmonary embolism. Generally, older age group, diabetes mellitus, prolonged duration on dialysis and cardiac diseases were the common causes of mortality in our study population.

SAT-239 VASCULAR ACESS OUTCOME-MULTIDISCIPLINARY APPROACH IN THE VASCULAR ACESS CARE CLINIC

The vascular accesses are prone to thrombosis, infection and other complications, which can decrease the adequacy of dialysis treatment leading to under dialysis and increased hospitalizations. To ensure the patency of AV access and decrease complications, regular monitoring, and surveillance is mandatory. Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines enlist regular monitoring and surveillance of AV access. These include physical examination, blood flow and venous pressure monitoring and access recirculation. Vascular access stenosis in AV fistula being diagnosed by Doppler ultrasound and angiography showed a sensitivity of 96% and specificity of 76%. Aim is early detection of the vascular access problems and reduce the surgical interventions and maintain the patency. Vascular access care clinic ( VACC) was designed in Dubai hospital since there are no in house vascular surgeons available in hospital. So a dedicated vascular access care team comprising of nephrologist, vascular surgeon and nurses with experience in cannulation were formed. The team was assigned for the surveillance and care of all vascular accesses and present the problematic cases in the clinical meetings with documentation of access blood flow, dynamic venous pressure, hematoma, prolonged bleeding, hand swelling, steal syndrome, and dialysis adequacy. Further evaluation was done in VACC. Doppler study by vascular surgeon substantiated the need for fistulogram or surgical intervention. This prospective study was done from January 2017 to September 2019.236 patients with problematic vascular access were detected during the study Majority of patients were in the age group of 40-70yrs (68%) Of which females were 47% and males were 53%. 55% of patient had diabetic ESKD. Selected patients were seen in our VACC which was conducted 2 times per month with the vascular surgeon, and the team. Patients were evaluated in the clinic with the aid of color Doppler. The anastomotic site, velocity of the blood flow, length and depth of the fistula, presence of accessory veins etc were assessed. Out of 236 patients, 140 (59.3%) had a corrective procedure done.86 patients had fistulogram, of which 74 patients had fistuloplasty .21 patients had superficialization.96 (41%) patients were managed with non-surgical intervention like ultrasound-guided cannulation; AVF was accessed for maturation Out of 236 patients, 170 (72%) were successfully able to use the AVF of cannulation. Out of 140 patients who had intervention, 115 (82.1%) had successful procedure and AVF was used 40 patients had failure of the procedure and AVF was non salvageable so was advised creation of new AVF 16 patients refused procedure In our study 41% patients were managed with non-surgical intervention because their problems were detected early and necessary measures was taken so we were able reduce the financial burden.A dedicated team approach to monitoring the vascular access in dialysis patients can immensely help in early identification of complications and by appropriate, timely intervention, we can ensure better vascular access patency rates in patients on hemodialysis. This can minimize fistula failure and decrease morbidity in dialysis-dependent patient population. Our vascular access distribution - 74 % of patients on hemodialysis have functional AVF /AV graft

Prevalence and Its Feto-Maternal Outcome in Placental Abruption: A Retrospective Study for 5 Years from Dubai Hospital

Introduction: Placental abruption (PA) is a major obstetric complication leading to increased risk of maternal and neonatal morbidity and mortality globally. This study aims to determine the prevalence and its feto-maternal outcome in cases of placental abruption in our population. Methods: A retrospective descriptive case study was conducted from January 2013 till December 2017 in Dubai Hospital, Dubai, UAE. All patients admitted with suspicion of placental abruption at 28 weeks of gestation and beyond were included in the study. The clinical information like maternal age, parity, antenatal risk factors, gestational age at delivery, mode of delivery, postpartum complications and perinatal outcome were studied. Result: A total of 15,079 deliveries occurred during the study period; PA accounted for 0.61%. 62% of the women had revealed abruption and 38% had concealed abruption. The antenatal risk factors associated with abruption were diabetes (26%), chronic hypertension (2.2%), pre-eclampsia (19.5%), previous cesarean section (26%), and multiple pregnancy (9.8%). Cesarean section was the mode of delivery in 78% of abruption cases. 33% had postpartum hemorrhage and 20% had received blood products. Adverse fetal outcomes were as follows: 51% of the cases had preterm delivery, 47% of the babies had a birth weight of less than 2.5 kg, 8 cases died of intrauterine fetal death and there was 1 neonatal death. Conclusion: Even when being aware of the risk factors, placental abruption still remains unpredictable or unpreventable. Having better equipped obstetric and neonatal units with multidisciplinary management can improve both maternal and perinatal outcome in cases of placental abruption.

Impact of Serum Albumin and B2-Microglobulin level on 2-Year Overall Survival among Newly Diagnosed Multiple Myeloma Patients: A retrospective Study

Background: Multiple myeloma accounts for 1% of all cancers and approximately 10% of all hematologic malignancies. Evaluation and initial staging of the disease is made once the diagnosis is confirmed. The recommended staging system is the International Staging System (ISS). Which determines the Myeloma prognosis by 2 factors: beta-2 Microglobulin and Serum albumin. Goal and Objective: The main goal of this study is to assess the effect of Beta-2 microglobulin and Serum albumin on patient’s survival rate with Multiple Myeloma. The secondary objective is to compare the age at diagnosis with other literature. Methodology: The current study was carried out in Hematology Unit, Dubai Hospital, Dubai, Dubai Health Authority (DHA), United Arab Emirates. Chart review was done retrospectively for 49 newly diagnosed patients with Multiple Myeloma diagnosed between the period 2012-2016. Purposive sample was used to those patients who met the inclusion criteria of this study, to be diagnosed and treated in DH. diagnosed and received regular treatment in Dubai Hospital. Results: Medina follow-up of the patients in this study was (12.8) months. The 2-year overall survival rate for patients with Multiple Myeloma (n = 49) was approximately 80%. While, the 2-year OS rate based on Albumin level. Patients with albumin level &gt; 3.5 mg\dl was significantly higher compared to those who had an albumin level &lt;3.5 mg\dl. 100%, 65% respectively, P = 0.033. Moreover, the 2-year OS rate in terms B2MG level. Patients who had a B2MG &lt; 3.5 mg\dl OS was slightly higher compared to those who had (3.5-5.5 and 5.5 mg\dl). OS rate approximately 85 %, 80 % and 75 respectively, P = .737 Conclusion: Multiple myeloma (MM) is a very heterogeneous disease. For this reason, various prognostic factors and staging systems have been developed to predict the disease outcome. International Staging System (ISS) is very useful in determine the survival based on serum β2- microglobulin and serum albumin levels. The age at diagnosis in Dubai hospital, United Arab Emirates is much younger compared to other studies conducted worldwide. The sample used in the study was also highly diverse in terms of culture and nationality. Such diversity is largely typical in Gulf especially in United Arab Emirates. Therefore, this can play important role in age at diagnosis.