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1
Miller, Joseph H., Holly A. Zywicke, James B. Fleming, Christoph J. Griessenauer, Thomas R. Whisenhunt, Mamerhi O. Okor, Mark R. Harrigan, Patrick R. Pritchard, and Mark N. Hadley. "Neurosurgical injuries resulting from the 2011 tornados in Alabama: the experience at the University of Alabama at Birmingham Medical Center." Journal of Neurosurgery 118, no. 6 (June 2013): 1356–62. http://dx.doi.org/10.3171/2013.3.jns121656.
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Object The April 27, 2011, tornados that affected the southeastern US resulted in 248 deaths in the state of Alabama. The University of Alabama at Birmingham (UAB) Medical Center, the largest Level I trauma center in the state, triaged and treated a large number of individuals who suffered traumatic injuries during these events, including those requiring neurosurgical assessment and treatment. Methods A retrospective review of all adult patients triaged at UAB Medical Center during the April 27, 2011, tornados was conducted. Those patients who were diagnosed with and treated for neurosurgical injuries were included in this cohort. Results The Division of Neurosurgery at UAB Medical Center received 37 consultations in the 36 hours following the tornado disaster. An additional patient presented 6 days later, having suffered a lumbar spine fracture that ultimately required operative intervention. Twenty-seven patients (73%) suffered injuries as a direct result of the tornados. Twenty-three (85%) of these 27 patients experienced spine and spinal cord injuries. Four patients (15%) suffered intracranial injuries and 2 patients (7%) suffered combined intracranial and spinal injuries. The spinal fractures that were evaluated and treated were predominantly thoracic (43.5%) and lumbar (43.5%). The neurosurgery service performed 14 spinal fusions, 1 ventriculostomy, 2 halo placements, 1 diagnostic angiogram, 1 endovascular embolectomy, and 1 wound debridement and lavage. Twenty-two patients (81.5%) were neurologically intact at discharge and all but 4 had 1 year of follow-up. Three patients had persistent deficits from spinal cord injuries and there was 1 death in a patient with multisystem injuries in whom no procedures were performed. Two patients experienced postoperative complications in the form of 1 wound infection and 1 stroke. Conclusions The April 27, 2011, tornados in Alabama produced significant neurosurgical injuries that primarily involved the spine. There were a disproportionate number of patients with thoracolumbar fractures, a finding possibly due to the county medical examiner's postmortem findings that demonstrated a high prevalence of fatal cervical spine and traumatic brain injuries. The UAB experience can be used to aid other institutions in preparing for the appropriate allotment of resources in the event of a similar natural disaster.
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Fei, Fei, Marisa B. Marques, Elizabeth M. Staley, and Lance A. Williams. "An Automated Method for Direct Antiglobulin Testing and the Resulting Amount of Phototherapy Used at a Large Academic Medical Center." Laboratory Medicine 51, no. 1 (May 31, 2019): 50–55. http://dx.doi.org/10.1093/labmed/lmz029.
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ABSTRACT Objective To evaluate how clinical practice was affected by the change in direct antiglobulin testing (DAT) methodologies and subsequent stronger reported DAT results at our large academic medical center. Method We retrospectively reviewed DAT results of umbilical cord blood from infants with blood type A or B born to mothers with antibody-negative type O blood, based on records kept at the University of Alabama at Birmingham (UAB) Hospital, a 1400-bed academic medical center. Results We randomly chose 50 neonates with positive DAT results who had been tested using the tube method and 50 whose testing had used the gel method. Although 86% of results with the tube method were positive microscopically, 52% and 40% of the DAT results with the gel method were 1+ and 2+ positive, respectively. Further, we observed an increase in the number of neonates treated with phototherapy who had been tested using the gel method. Conclusion We report that DATs performed using the gel method had increased DAT strength compared with tube testing, which led to increased use of phototherapy by our clinical colleagues.
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The, Angelina, Yufeng Li, Vishnu Reddy, Randall Davis, Melissa Baird, and James Foran. "A Comparative Study of Diffuse Large B-Cell Lymphoma (DLBCL) between African Americans and Caucasians: Single-Center Experience at the University of Alabama at Birmingham (UAB)." Blood 110, no. 11 (November 16, 2007): 4430. http://dx.doi.org/10.1182/blood.v110.11.4430.4430.
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Abstract Background: SEER data indicate that African Americans (AA) have a lower incidence of DLBCL but a higher mortality rate than Caucasians (C). To investigate this, we conducted a single-center analysis of AA and C patients with DLBCL at UAB. UAB is a primary care facility and the main tertiary referral center in Alabama. It is located in Jefferson County where the average African American population of 39% is nearly triple the national average. Methods: After IRB approval, patients diagnosed with DLBCL from 1995 to 2007 were identified from pathology, referral, and UAB tumor registry databases. Baseline demographic data including race, age at diagnosis, stage, treatment administered, response to treatment, and survival were extracted. Serum LDH levels and performance status were not consistently available in medical records and therefore not included in the final analysis. Patients with monomorphic post-transplant lymphoproliferative disease and primary CNS lymphoma were excluded. Associations between race and stage, treatment (first-line rituximab, anthracycline, or combination therapy), response, and outcome were analyzed using Chi-squared or Cochran Mantel-Haenszel statistical analysis. Results: A total of n=309 (n=32 AA and n=277 C) patients were identified. AA patients were diagnosed at a significantly younger age than C patients [median age 49 (range: 22–90) vs. 61 (range: 16–91), respectively; p=0.0131]. AA patients also presented with advanced stage disease (Ann Arbor stage III–IV) more frequently (69% vs. 52%, p=0.046). No difference in extranodal disease presentation or in complete response rate to first-line therapy was noted. As expected, those with early stage disease, age <60, and those given first-line rituximab +/− anthracycline therapy had superior survival regardless of race. No difference in overall survival was seen between AA and C patients (p=0.1306). However, AA patients had an inferior survival to C patients when the analysis was restricted to patients who received either first-line treatment with rituximab (p=0.0658), anthracycline (p=0.0188), or combination (p=0.0196). Figure Figure Conclusions: Compared to C patients, AA patients were diagnosed with DLBCL at a significantly younger age, more advanced stage, and had worse survival despite first-line rituximab +/− anthracycline therapy. This single-center experience confirms SEER data and suggests a possible difference in tumor biology or treatment effect, although potential socioeconomic factors can not be excluded.
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Salah, Shatha, Rachael A. Lee, Bernard Camins, and Frank Sidari. "From Outbreak to Compliance and Beyond: UAB Medicine’s Successful Implementation of a Water Safety Program." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s479. http://dx.doi.org/10.1017/ice.2020.1155.
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Background: Pre-emptive management of the water supply can reduce hospital-onset legionellosis associated with building water systems. In 2014, an outbreak of Legionella pneumonia occurred in a 1,150-bed academic medical center (with ∼0.557 km2 or ∼6 million ft2 of space) among hematology-oncology patients. A comprehensive water safety and management program was implemented after the outbreak was controlled. We describe our experience implementing this prevention program. Methods: After the Legionella outbreak was controlled, an air and water safety committee (AWSC) was established and cochaired by the healthcare epidemiologist and the chief facilities officer. The AWSC established protocols for proactive environmental testing and the development of the an infection control risk assessment (ICRA) dedicated to water safety known as the water system construction and renovation risk assessment (WSCRRA).The water system management plan (WSMP) was developed (prior to the publication of ASHRAE 188) to direct the risk assessments and mitigation of any risks throughout the campus. Results: The WSMP identifies critical control measures, points, and limits that need to be maintained to control and monitor Legionella growth in the water systems. A control point is any step in a process at which biological, chemical, or physical factors can be controlled. The UAB Medicine WSMP includes 7 control points that are monitored on a daily basis. Examples of these control steps include monitoring of the hot water temperatures at the water heaters and distal outlets, managing the levels of mono-chloramines and chlorines in the water system, and managing water system components. To validate the efficacy of the WSMP, >610 water samples are collected from 19 hospital buildings over a year to be tested for Legionella. The results of water testing have shown significant decrease in distal site positivity due to managing and controlling these control points. This WSMP also evaluated the efficacy of 2 different methods for disinfecting water systems on campus as a corrective measure to Legionella growth. These methods are hyperchlorination and temporary copper silver ionization; based on the culture results of the water samples collected post disinfection, WSMP data show that the copper silver ionization method was more effective than hyperchlorination in controlling Legionella growth and decreasing the distal site positivity. Conclusions: The WSMP has provided ongoing management of building water systems and proactive actions around construction and renovation projects that involve water systems to prevent healthcare-acquired legionellosis. We strongly recommend other healthcare facilities to implement a similar program to avoid outbreaks.Funding: NoneDisclosures: Rachael Anne Lee reports speaker honoraria from Prime Education, LLC.
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deMontigny, Danielle, Rachael A. Lee, Joshua Radney, and Ellen Eaton. "139. The Morbidity and Financial Burden of Infective Endocarditis in Persons Who Inject Drugs in the Deep South." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S97—S98. http://dx.doi.org/10.1093/ofid/ofz360.214.
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Abstract Background In the context of the opioid epidemic, infective endocarditis (IE) poses an economic challenge in Alabama. The objective of this proposal is to analyze the outcomes and financial burden of IE in persons who inject drugs (PWID) at The University of Alabama at Birmingham (UAB) Hospital, the largest tertiary referral center in this rural, Southern state. We hypothesized that those with the most severe substance use disorder would be most costly. Methods This is a retrospective study of PWID receiving care for IE at UAB Hospital from October 1, 2016 to March 1, 2019. IE was defined by Infectious Diseases consultation. Clinical data were obtained from the electronic medical record (EMR). Deaths were obtained from both the EMR and the regional medical examiner. Hospital costs (direct costs, overall charges) were obtained from financial accounts. To stratify patients by severity of substance use disorder, we used a 9-item risk assessment for PWID (see table). We then evaluated the association between clinical factors and outcomes (death, cost) using parametric and nonparametric tests when appropriate. A P-value < 0.05 was considered significant. Results A total of 69 persons met criteria (Table 1). The average length of stay was 30.8 days. Thirty-four (52%) had documentation of antibiotic completion (in or outpatient). Seventeen received surgery: 16 with valve replacement and one device removal. Overall, 14 (20%) died over the study period. There was no significant association between antibiotic completion or 9-item risk and death. When stratified into low risk (<4 items) vs. high risk (≥5), there was no difference in overall direct costs, LOS, or whether patients received surgery. Conclusion PWID with IE at a hospital serving a rural, Southern population have a greater length of stay, discharges against advice, surgical interventions, and costs than other regions, relative to existing literature. The lack of association between 9-item risk and outcomes suggests that death and high costs are attributable to factors beyond substance use. Costs of providing care for this population are exorbitant and likely devastating for rural county hospitals within the context of the current public health and payment framework, including Medicaid non-expansion. Disclosures All authors: No reported disclosures.
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Griffin, Drees, Zayd al-Nouri, Darrshini Muthurajah, John Ross, Riley Ballard, Deirdra Terrel, Sara K. Vesely, James N. George, and Marisa Marques. "First Symptoms In Idiopathic Thrombotic Thrombocytopenic Purpura (TTP): What Are They and When Do They Occur?." Blood 116, no. 21 (November 19, 2010): 1427. http://dx.doi.org/10.1182/blood.v116.21.1427.1427.
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Abstract Abstract 1427 Introduction: Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA) without an alternative explanation, caused by systemic platelet thrombi. Although TTP may be secondary to underlying diseases or drugs, it is often idiopathic. The latter is associated with severe deficiency (defined as ≤10% activity) of the plasma protease ADAMTS13. Low ADAMTS13 is caused by autoantibodies and allows for the accumulation of unusually large multimers of von Willebrand factor in the circulation, which causes spontaneous platelet aggregates and microvascular thrombosis. Therapeutic plasma exchange (TPE) decreases TTP mortality from 90% to 10%. Unfortunately, approximately 30% of treated patients will experience a relapse and require TPE again. The University of Alabama at Birmingham (UAB) Hospital is a referral center for TTP patients from throughout the state. The Oklahoma TTP-Hemolytic Uremic Syndrome (HUS) Registry is a population-based inception cohort of all consecutive patients treated for TTP in central-western Oklahoma since 1989. The aim of this collaboration between the two centers was to characterize the first symptoms experienced by patients with idiopathic TTP preceding their first episode and the timing of these symptoms in relation to the diagnosis (defined as the day TPE was started). Methods: We conducted a retrospective chart review of patients seen at the two centers from January 1, 2007 to June 30, 2010. Using apheresis and electronic medical records, we completed a data collection form with demographic information, clinical presentation, pre-existing risk factors, and clinical course. Results: At UAB, 31 patients were treated for idiopathic TTP; 26 had their first episode during the study window and were included in the analysis. At Oklahoma, 28 patients were identified and 23 fulfilled criteria for inclusion. Of the combined 49 patients, 35 (71%) were female and 14 (29%) were male (gender distribution almost identical between the two centers). The average age of the group was 46 years old (median: 44). At UAB, most patients were African-Americans (77%), followed by Caucasians (19%) and Asians (4%). In Oklahoma, 74% of patients were Caucasian, 18% were African-Americans, and 4% each were American-Indian or Other. These 49 patients reported 27 different first symptoms, with the most common in order of frequency being: abdominal pain (n = 9; 18%), nausea (n = 5; 10%), headache (n = 4; 8%), vomiting (n = 4; 8%), severe neurologic symptoms such as coma, seizures, aphasia (n = 3; 6%), and weakness (n = 3; 6%). Overall, 20 patients (41%) initially noted neurologic symptoms, 13 patients (26.5%) localized their symptoms to the gastrointestinal tract, and 5 patients (10%) reported hematologic symptoms such as mucocutaneous bleeding or signs of hemolysis. The median time to treatment from the onset of symptoms was 5 days (range: 0–132 days), while 82% of patients reported symptoms for 10 days or less. Of 45 patients in whom ADAMTS13 activity was measured, the median result was 4% (range: 4–100%), and 34 of them (75.5%) had an activity of ≤10%, which defines severe deficiency. Two patients (4%) died and the other 47 had resolution of their hematologic abnormalities. Conclusions: Our data confirm the heterogeneity of presentation and nonspecific nature of signs and symptoms of TTP. Thus, physician education and vigilance is necessary to suspect TTP and refer patients for TPE. While many patients were likely to have TTP for several days prior to the diagnosis, TPE must begin promptly once the findings of thrombocytopenia and microangiopathic hemolytic anemia without an alternative diagnosis are noted, in order to avoid a fatal outcome. Disclosures: No relevant conflicts of interest to declare.
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Ahmad, Masood, Eric L. Wallace, and Gaurav Jain. "Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?" Kidney360 1, no. 6 (May 1, 2020): 569–79. http://dx.doi.org/10.34067/kid.0000662019.
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Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.
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White, Cameron, Todd McCarty, Rachael A. Lee, Sixto M. Leal, and Peter Pappas. "248. Thirty-Day Mortality Among Patients with Candidemia Diagnosed by T2Candida Assay Alone: Influence of Risk Factors and Candida Species." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S140. http://dx.doi.org/10.1093/ofid/ofz360.323.
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Abstract Background Candidemia is a common cause of healthcare-associated bloodstream infection with high mortality rates despite antifungal therapy. Risk factors include prolonged ICU stay, immunosuppression, and exposure to broad-spectrum antibiotics. Blood cultures (BC) remain the gold standard for diagnosis but lack sensitivity and can take days to result. T2Candida (T2C) is a rapid diagnostic test utilizing PCR and magnetic resonance technology to detect five Candida species in whole blood in less than 6 hours. In this study we examined characteristics of patients with positive T2C assays in the absence of positive BC including risk factors and 30-day mortality rates. Methods We conducted a retrospective analysis of positive T2C cases at UAB Medical Center from 2016 to 2018 with either negative or no BC. For each patient we determined if clinical signs (e.g., hypotension, leukocytosis) and risk factors for candidemia were present at the time of collection. Our primary outcome of interest was 30-day mortality. Data were compared by multivariate analysis. Results A total of 173 patients with T2C positivity alone were included in the analysis. The most common risk factor was the use of broad-spectrum antibiotics followed by CVC (Table 1). The mean number of risk factors per patient was 3.6 (Figure 1). Overall 30-day mortality was 41%. Patients with a T2C result of C. albicans/C. tropicalis were almost 2.5 times more likely to die at 30 days (aOR 2.401, CI 1.159–4.974) compared with those with other positive results. Increasing number of risk factors (aOR 1.457, CI 1.126–1.886) and increasing age (aOR 1.052, CI 1.026–1.079) were significantly associated with increased odds of death at 30 days (Table 2). Conclusion In this study we demonstrate a significant association between increasing number of risk factors, older age, and A/T result with higher odds of 30-day mortality among patients with T2C positivity alone. While concern for false-positives exists when using T2C, our data suggest that this is an acutely ill population which warrants early and aggressive antifungal therapy. The lower limit of detection of T2C (1 cfu/mL) as compared with BC may explain lack of paired positive cultures in these patients despite clinical signs of and risk factors for candidemia. Disclosures All authors: No reported disclosures.
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Sui, Jingrui (Jean), Wenjing Cao, Mohammad Abdelgawwad, Nicole K. Kocher, Konstantine Halkidis, Bryan K. Guillory, Lawrence A. Williams, Marisa B. Marques, and X. Long Zheng. "Longitudinal Changes of Plasma ADAMTS13 Activity, Antigen, and Autoantibodies in Patients With Immune-Mediated Thrombotic Thrombocytopenic Purpura." American Journal of Clinical Pathology 152, Supplement_1 (September 11, 2019): S21—S22. http://dx.doi.org/10.1093/ajcp/aqz112.041.
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Abstract Background Severe deficiency of plasma ADAMTS13 activity resulting from anti-ADAMTS13 IgG is the primary cause of immune-mediated thrombotic thrombocytopenic purpura (iTTP). Anti-ADAMTS13 IgG may bind and inhibit plasma ADAMTS13 activity and/or accelerate clearance of ADAMTS13 from the circulation. The present study aims to determine the initial and longitudinal changes of plasma ADAMTS13 activity, antigen, and anti-ADAMTS13 IgG and their relationships with clinical responses and outcomes of patients with iTTP after standard treatment. Methods Thirty-eight patients with a confirmed diagnosis of iTTP who underwent therapeutic plasma exchange (TPE) at UAB Medical Center were enrolled into the study. The study spanned from May 2015 to December 2018. An informed consent was obtained from each participant. Clinical and laboratory information was extracted from the electronic medical record and stored in the Alabama TTP Registry database. Plasma samples were collected prior to the initiation of and every 3 to 5 days after TPE until discharge. Plasma ADAMTS13 activity, antigen, and anti-ADAMTS13 IgG were determined using commercially available reagents. Mann-Whitney test, Fisher’s exact test, Spearman rank correlation, Cox proportional hazard regression, and Kaplan-Meier survival analysis were used to determine statistical significances. Results The median age of this cohort was 46.5 years old; 26 (68%) patients were female and 12 (32%) were male. Twenty-three patients (60%) were experiencing their initial episode while 15 (39%) had an exacerbation/relapse at the time of enrollment. All patients were diagnosed based on the findings of thrombocytopenia, microangiopathic hemolytic anemia, plasma ADAMTS13 activity (<10 U/dL), and inhibitor titer ≥0.4 BU or elevated anti-ADAMTS13 IgG. Following treatment with standard therapy (TPE, corticosteroids, and/or other immunosuppressives), plasma levels of ADAMTS13 activity and antigen increased with a concurrent reduction of anti-ADAMTS13 IgG. However, there were at least three distinct patterns of dynamic changes of these markers over time: (1) rapid increase, (2) slow increase or fluctuation, and (3) persistently low. More interestingly, those with the highest quartile of anti-ADAMTS13 IgG (HR = 4.2) and inhibitor titer ≥1.2 BU (HR = 3.2) at presentation, ADAMTS13 activity <20 U/dL 3 to 7 days during therapy (HR = 2.5), and ADAMTS13 activity <20 U/dL (HR = 3.2) or the lowest quartile of ADAMTS13 antigen at clinical response (HR = 2.8) were all associated with a higher risk of TTP exacerbation (the disease recurred within 30 days following a sustained normalization of platelet counts). Conclusion Initial and longitudinal assessment of plasma ADAMTS13 activity, antigen, inhibitor titer, and anti-ADAMTS13 IgG may be useful not only for diagnosis but also for predicting the risk of exacerbation. This may influence how we select a therapeutic modality for a better outcome. Long-term follow-up is necessary to determine whether these ADAMTS13 biomarkers at patient discharge are predictive of relapse and mortality.
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White, Cameron, Peter Pappas, and Todd P. McCarty. "1173. Ocular Candidiasis in Patients with Candidemia Diagnosed by Blood Culture Versus T2Candida® Assay." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S612. http://dx.doi.org/10.1093/ofid/ofaa439.1359.
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Abstract Background Ocular candidiasis (OC) is a serious complication of candidemia. Current guidelines recommend dilated fundoscopic exam (DFE) in all patients with candidemia. In this study, we examined characteristics and outcomes of patients at UAB Medical Center with candidemia diagnosed by blood culture (BC) or T2Candida® rapid diagnostic assay (T2C) who were found to have evidence of fungal disease on ophthalmologic exam. Methods Patients from 2016-2019 with either 1) at least one positive BC for Candida species or 2) positive T2C assay and negative or no paired BC were identified and retrospectively reviewed. Patients with additional positive BC or T2C within 60 days were excluded from the analysis. Data collected included risk factors for candidemia, causative Candida species, and whether DFE was performed after diagnosis. Patients with evidence of OC by exam were compared by type of ocular involvement (chorioretinitis vs. vitritis), whether visual symptoms were present, and whether intravitreal injection was performed. Results A total of 360 episodes of candidemia diagnosed by BC and 288 by T2C alone were included. Of those who underwent DFE, 33 BC patients (12.9%) had findings concerning for OC compared to 18 (8.9%) T2C patients (p=0.177) (Table 2). T2C patients with OC were younger, were more likely to have a prolonged ICU stay and to be mechanically ventilated, and were less likely to be on TPN compared to the BC group. Identification of C. parapsilosis was significantly more common in T2C patients (Table 1). There were no significant differences in presence of visual symptoms, type of ocular involvement, need for intravitreal injection, or 30-day mortality (Table 3). Table 1. Demographics and risk factors Table 2. Episodes of candidemia and ocular candidiasis by year Table 3. Ocular findings and outcomes Conclusion The frequency of ocular disease was similar between groups. Significantly more T2C patients had candidemia due to C. parapsilosis, and the groups differed in terms of risk factors for candidemia. There were no differences in frequency of intravitreal injection, severity of eye disease, or mortality. Despite recent concerns about the necessity of DFE in asymptomatic patients with candidemia, we believe these results emphasize the importance of performing DFE in candidemic patients and also support the practice of doing so in patients with positive T2C even in the absence of positive blood cultures. Disclosures Peter Pappas, MD, SCYNEXIS, Inc. (Consultant, Advisor or Review Panel member, Research Grant or Support) Todd P. McCarty, MD, Amplyx (Scientific Research Study Investigator)Cidara (Scientific Research Study Investigator)
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Hamm, Jennifer, Lee Hilliard, Thomas H. Howard, and Jeffrey D. Lebensburger. "Maintaining High Level Of Care At Outreach Sickle Cell Clinics." Blood 122, no. 21 (November 15, 2013): 2976. http://dx.doi.org/10.1182/blood.v122.21.2976.2976.
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Introduction Parents of children with sickle cell disease often seek care at large, university based sickle cell clinics. A major health care barrier for children in Alabama involves the cost and time of travelling to and from university based clinics. To reduce this health care barrier, the University of Alabama at Birmingham (UAB) developed The Children and Youth Sickle Cell Network(®) (CYSN(®)). This network consists of the central sickle cell clinic located at UAB and four outreach sickle cell clinics located in Montgomery (100 miles south of UAB), Opelika (110 miles southeast of UAB), Huntsville (100 miles north of UAB), and Tuscaloosa (60 miles west of UAB). The goal for these clinics is to maintain a similar level of medical care while reducing the health care barrier of transportation. Objective To determine if the outreach clinics provide similar care to university based clinics, we evaluated three surrogate preventive care markers to compare access to care in central vs. outreach clinics: 1) attendance rates, 2) number of patients on hydroxyurea, and 3) percent of MRIs obtained for screening of silent infarct among eligible patients. Methods A retrospective review of all CYSN(r) clinic visits from June 2012 to June 2013 was performed to determine clinic attendance rates. All patients on hydroxyurea were categorized by clinic location. Every patient attending CYSN(r) clinic between ages of 6 and 15 years had their medical record reviewed for completion of a screening MRI/MRA. Results At the central Birmingham clinic, the appointment show rate was 59.8% as compared to the Montgomery, Opelika, Huntsville, and Tuscaloosa show rates which were 57.7%, 73.1%, 59.4%, and 70% respectively. At UAB, institutional guidelines were developed for offering hydroxyurea to patients based on clinical indications and applied to all clinics. The percentage of patients on hydroxyurea therapy in Birmingham is 22.2%, while the percentages in Montgomery, Opelika, Huntsville, and Tuscaloosa are 21.5%, 32%, 21.4% and 24.4%, respectively. Finally, screening MRI/MRA to evaluate for evidence of silent cerebral infarctions is performed in Birmingham but offered to children ages 6-15 years at all sickle cell clinics. In Birmingham, 63.6% of eligible patients completed MRI/MRA screening. This percentage is similar for patients in Montgomery, Opelika, and Tuscaloosa who were screened at 66.7%, 83.3%, and 67.7% respectively. Conclusions Our data suggests that outreach clinics can provide similar levels of medical care for children with sickle cell disease. Sickle cell centers treating patients that must travel long distances should consider developing outreach clinics to help reduce this major health care barrier. Disclosures: No relevant conflicts of interest to declare.
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Sui, Jingrui (Jean), Wenjing Cao, Mohammad S. Abdelgawwad, Konstantine Halkidis, Nicole K. Kocher, Bryan K. Guillory, Lance A. Williams, Marisa B. Marques, Radhika Gangaraju, and X. Long Zheng. "Longitudinal Assessment of Plasma ADAMTS13 Biomarkers Helps Predict Recurrence of Immune Thrombotic Thrombocytopenic Purpura." Blood 134, Supplement_1 (November 13, 2019): 2456. http://dx.doi.org/10.1182/blood-2019-126093.
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Background: Severe deficiency of plasma ADAMTS13 activity resulting from autoantibodies against ADAMTS13 is the primary cause of immune thrombotic thrombocytopenic purpura (iTTP). The anti-ADAMTS13 IgGs may bind and inhibit plasma ADAMTS13 activity and/or accelerate its clearance from circulation. Approximately 40% of iTTP patients who survived the initial episode may experience disease recurrence (e.g. exacerbation and/or relapse). However, a reliable biomarker that predicts disease recurrence is still lacking. The present study sought to determine the roles of plasma ADAMTS13 activity, antigen, inhibitors, and anti-ADAMTS13 IgG at various stages of the disease process in predicting recurrence (e.g. exacerbation and/or relapse) in adult patients with iTTP. Methods: 93 episodes from 83 unique iTTP patients who underwent therapeutic plasma exchange (TPE) therapy at UAB Medical center from April 2006 to December 2018 were enrolled into the study. Clinical and laboratory parameters were collected at diagnosis, and ADAMTS13 biomarkers (e.g. activity, inhibitors, antigen, and anti-ADAMTS13 IgG) were determined in samples collected on admission, 3-7 days following the first TPE, and at clinical response (prior to discharge). Various statistical analyses including Kaplan-Meier survival and Cox analyses were performed to assess the clinical relevance of each biomarker at various stages of the disease course. Results: We found that plasma ADAMTS13 activity and antigen on admission had no significant value in predicting iTTP exacerbation (disease recurrence within 30 days of discontinuation of TPE) or relapse (the disease recurrence after 30 days of discontinuation of TPE). However, high levels of anti-ADAMTS13 IgG on admission were associated with an increased risk of exacerbation (HR=2.1, 95% CI, 1.0-4.1, p=0.34) or recurrence within one year (HR=2.0, 95% CI 1.0-3.9, p=0.041). More interestingly, low plasma ADAMTS13 activity (<10 U/dL) 3 to 7 days after initiation of TPE (HR=3.8, 95% CI 1.3-11.0, p=0.015) or at clinical remission (median 7 days, IQC 6-10 days) when platelet counts and lactate dehydrogenase (LDH) levels had normalized (HR=4.3, 95% CI 1.6-11.8, p=0.004) and low levels of plasma ADAMTS13 antigen at clinical remission (HR=3.2, 95% CI 1.1-7.5), even when body mass index, race, and partial thromboplastin time (PTT) were all included as covariates for the analysis, were associated with the increased risks of iTTP recurrence. Conclusions: Longitudinal assessment of plasma ADAMTS13 biomarkers (e.g., activity, antigen and anti-ADAMTS13 IgG) is of a critical value for predicting iTTP recurrence. These results suggest the need for additional therapeutic coverage (such as the use of rituximab, corticosteroids, and caplacizumab) to prevent iTTP recurrence after discharge from the hospital and supports the concept for achieving the biochemical remission (e.g. the normalization of ADAMTS13 activity, antigen, and anti-ADAMTS13 IgG) for the long-term management of patients with iTTP. Disclosures Zheng: Shire/Takeda: Research Funding; Clotsolution: Other: Co-Founder; Ablynx/Sanofi: Consultancy, Speakers Bureau; Alexion: Speakers Bureau.
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Sui, Jingrui (Jean), Konstantine Halkidis, Nicole K. Kocher, Lance A. Williams, Radhika Gangaraju, Bryan K. Guillory, Marisa B. Marques, Wenjing Cao, and X. Long Zheng. "Plasma Levels of Histone-DNA Complex and Cell-Free DNA Predict Mortality in Patients with Immune Thrombotic Thrombocytopenic Purpura." Blood 134, Supplement_1 (November 13, 2019): 1070. http://dx.doi.org/10.1182/blood-2019-131585.
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Background: Deficiency of plasma ADAMTS13 activity resulting from acquired autoantibody against ADAMTS13 is the primary cause of immune thrombotic thrombocytopenic purpura (iTTP). Therapeutic plasma exchange plus corticosteroids and immunosuppression is the standard of care for patients with iTTP. However, mortality rate remains high and clinical factors or laboratory biomarkers that predict mortality are not fully established. Previous studies have demonstrated that plasma levels of histone-DNA complexes and cell-free DNA are dramatically elevated in patients with acute disease but reduced during remission. We hypothesize that elevated histone-DNA complexes or cell-free DNA may have a predictive role for mortality in patients with acute iTTP. Methods: 102 unique patients with a confirmed diagnosis of iTTP who underwent therapeutic plasma exchange (TPE) at UAB-Medical Center from April 2006 to December 2018 were enrolled into the study. Demographic information and laboratory parameters were collected on admission and during the follow-up. Plasma levels of histone-DNA complexes and cell-free DNA were determined by an enzyme-linked immunosorbent assay and PicoGreen dsDNA assay, respectively. Mann-Whitney, Fisher's exact, t test, log-rank test, and Cox proportional hazard regression analysis were performed to determine the significance of each marker in predicting death. Results: In this cohort, age was 44.7 ± 1.3 (mean ± SD) years old, 56.9% were female, 82.4% were African Americans, 61.8% had an initial episode, the median (IQR) body mass index (BMI) was 33.6 (29.3-41.5). 52.9% of patients had hypertension, 21.6% diabetes, 18.6% systemic lupus erythematous and 8.7% HIV. The overall mortality rate was 10.8% (11/102). Plasma levels, median (IQR), of histone-DNA complexes and cell-free DNA on admission were 56.3 (35.8-136.4) AU/mL and 952.2 (799.7-1431.4) ng/mL, respectively. Mann-Whitney test revealed that high plasma levels of histone-DNA complex (≥134.9 U/mL) (p=0.007) and cell-free DNA (≥952.2 ng/mL) (p=0.009) were associated with the increased risks of myocardial injury (e.g. elevated troponin). Cox proportional hazard regression analysis demonstrated that the increased levels of histone-DNA complexes and cell-free DNA were also predictive for the increased mortality rates in patients with iTTP with hazard ratios (HRs) of 4.1 (95% CI, 1.2-13.4) (p=0.02) and 8.5 (95% CI, 2.2-33.3 (p=0.002), respectively. Kaplan-Meier survival analysis revealed significant differences in the disease-free survival rates of patients with high levels (≥75 percentile) vs. low levels (<75 percentile) of plasma histone-DNA complexes and cell-free DNA, respectively (see Fig. 1). Conclusion: Our results demonstrate that the elevated plasma levels of histone-DNA complexes and cell-free DNA predict the worse outcome (e.g. the increased mortality rates) in patients with iTTP. *SD, standard deviation; IQR, interquartile range; 95% CI, 95% confidential interval. Disclosures Zheng: Ablynx/Sanofi: Consultancy, Speakers Bureau; Alexion: Speakers Bureau; Shire/Takeda: Research Funding; Clotsolution: Other: Co-Founder.
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Aprilia, Dian Nirmala, Budi Prasetyo, and Sulistiawati Sulistiawati. "Correlation Between Nutritional Status of Pregnant Women Based on Upper Arm Circumference and Preeclampsia/Eclampsia Severity Degree at Jagir Public Health Center During January 2014 - March 2014." Biomolecular and Health Science Journal 1, no. 2 (November 26, 2018): 120. http://dx.doi.org/10.20473/bhsj.v1i2.9533.
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Introduction: Preeclampsia/eclampsia is one of the causes of maternal mortality besides bleeding and infection. The exact etiology of this condition is still unknown. Nutritional status of pregnant women who are overweight can increase the risk. This study aims to determine the correlation between obesity and the severity of preeclampsia/eclampsia through upper arm circumference (UAC) measurement.Methods: This study is a cross-sectional analytic study. Data on preeclampsia/eclampsia and UAC obtained from patient medical records in Jagir Public Health Center Surabaya. Data were analyzed using Chi-square test.Results: Prevalence of mild preeclampsia was greater than severe preeclampsia (87.5% and 12.5%). The majority of patients with mild preeclampsia have normal UAC size (91.3%). Severe preeclampsia found higher in obesity group than normal nutritional status group (22.2% and 9.1%). From Chi-square test analysis, found that p = 0.557.Conclusion: There was no significant correlation between the nutritional status of pregnant women based on UAC measurement of and the severity of preeclampsia/eclampsia.
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Kabyemera, Rogatus, Neema Chami, Neema Kayange, Respicius Bakalemwa, Antke Zuechner, Tumaini Mhada, Gustave Buname, Adolfine Hokororo, and Johannes Kataraihya. "Reversible Severe Pulmonary Hypertension after Adenotonsillectomy: A Case Report of a Child Treated at Bugando Medical Centre, Northwestern Tanzania." Case Reports in Pediatrics 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/2897320.
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Upper airway obstruction (UAO) due to adenotonsillar hypertrophy represents one of the rare causes of pulmonary hypertension in children. We report a case of adenotonsillar hypertrophy, managed at pediatric and otorhinolaryngology departments in Bugando Medical Centre (BMC), northwestern Tanzania, with complete remission of symptoms of pulmonary hypertension following adenotonsillectomy. A 17-month-old boy presented with difficulty breathing, dry cough, and noisy breathing since 1 year. He had facial and lower limb oedema with a pan systolic murmur at the tricuspid area, fine crepitations, and tender hepatomegaly. A grade II tonsillar hypertrophy and hypertrophied adenoids were seen on nasal and throat evaluation. A 2D-echocardiography showed grossly distended right atrium and ventricle, dilated pulmonary artery, and grade III tricuspid regurgitation. His final diagnosis was severe pulmonary hypertension with right-sided heart failure due to adenotonsillar hypertrophy. He had complete remission of cardiopulmonary symptoms after adenotonsillectomy and had normal control echocardiography six and twelve months after surgery. Children with symptoms of upper airway obstruction and cardiopulmonary involvement could benefit from routine screening for pulmonary hypertension. Adenotonsillectomy should be considered for possible complete remission of both UAO and cardiopulmonary symptoms.
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Narchi, Hassib, Junu V. George, Sania M. Al-Hamad, Fawaghi Robari, Mariam Al-Teniji, Hussain Chaqfa, Ahmed Alsuwaidi, Lolowa Al-Mekhaini, and Abdul-Kader Souid. "Nasopharyngeal Isolates from a Cohort of Medical Students with or without Pharyngitis." Sultan Qaboos University Medical Journal [SQUMJ] 20, no. 3 (October 5, 2020): 287. http://dx.doi.org/10.18295/squmj.2020.20.03.007.
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Objectives: Few studies have investigated pharyngeal colonisation in the United Arab Emirates (UAE). This study aims to identify the pharyngeal organisms present in a cohort of medical students with and without symptomatic pharyngitis. Methods: This study was conducted between September 2016 and June 2018 at the College of Medicine and Health Sciences, UAE University, Al-Ain. Nasopharyngeal swabs were collected from preclinical and clinical medical students attending the college during the study period. The specimens were tested for 16 viral and nine bacterial pathogens using a real-time polymerase chain reaction assay. Results: A total of 352 nasopharyngeal swabs were collected from 287 students; of these, 22 (7.7%) had pharyngitis symptoms. Overall, the most common isolates were human rhinovirus, Streptococcus pneumoniae and Haemophilus influenzae, with no significant differences in terms of gender, year of study or stage of study. The prevalence of S. pyogenes in asymptomatic and symptomatic students was 1.1% and 0%, respectively. A Centor score of ≥2 was not associated with S. pyogenes-positive samples. Six pathogens were isolated from symptomatic students including H. influenzae. Fusobacterium necrophorum was not detected in any of the samples. Conclusion: The diagnosis and management of pharyngitis should be tailored to common pathogens in the region. This study found that S. pyogenes and F. necrophorum were not detected among students with symptoms of pharyngitis; moreover, Centor scores of ≥2 were not associated with the presence of S. pyogenes. This cut-off score therefore should not be employed as an empirical measure to initiate penicillin therapy in this population.Keywords: Pharyngitis; Pharynx; Asymptomatic Infections; Carrier State; Fusobacterium necrophorum; Streptococcus pyogenes; Penicillins; United Arab Emirates.
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Fourkiotis, Verena, Oliver Vonend, Sven Diederich, Evelyn Fischer, Katharina Lang, Stephan Endres, Felix Beuschlein, et al. "Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism." European Journal of Endocrinology 168, no. 1 (January 2013): 75–81. http://dx.doi.org/10.1530/eje-12-0631.
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ObjectivePrimary aldosteronism (PA) has deleterious effects on kidney function independent of blood pressure levels. Up to now, data on effectiveness of different PA therapies regarding renal function are scarce.Design and methodsThis prospective multi-center study included 29 patients with newly diagnosed PA evaluated before and 1 year after treatment initiation, and a second cohort including 119 patients who were evaluated 5.3 and 6.8 years after treatment initiation. Glomerular filtration rate (GFR), spot urine albumin excretion/urinary creatinine (UAE/Ucrea) ratio, biochemical parameters, and 24-h blood pressure were measured. In a larger cross-sectional cohort, renal function was evaluated depending on the type of treatment (adrenalectomy (ADX; n=86); spironolactone (n=65); and eplerenone (n=18)).ResultsGFR and UAE/Ucrea ratio significantly decreased in newly diagnosed PA patients after treatment initiation. In the second cohort, GFR and UAE/Ucrea ratio did not change during study period, and blood pressure was well controlled. In the larger cross-sectional cohort, no differences were seen in GFR and UAE/Ucrea ratio between PA patients on different treatment regimens. However, eplerenone treatment showed lower potassium levels and higher number of required antihypertensive medications.ConclusionsRenal dysfunction with elevated albuminuria was seen in PA patients and was reversible after treatment initiation. Medical therapies with spironolactone or eplerenone seem to be as effective as ADX regarding renal function and blood pressure; however, sufficient daily doses need to be given.
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Finneran, Matthew M., Courtney A. Ware, Jessica Russo, Shaylyn Webster, Susanne Mathew, Irina A. Buhimschi, and Catalin S. Buhimschi. "Use of birth weight- vs. ultrasound-derived fetal weight classification methods: implications for detection of abnormal umbilical artery Doppler." Journal of Perinatal Medicine 48, no. 6 (July 28, 2020): 615–24. http://dx.doi.org/10.1515/jpm-2020-0068.
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AbstractObjectivesTo compare a birth weight-derived (Brenner) and multiple ultrasound-derived [Hadlock, National Institute of Child Health and Human Development (NICHD), International Fetal and Newborn Growth Consortium (INTERGROWTH)] classification systems’ frequency of assigning an antenatal estimated fetal weight (EFW) <10% and subsequent detection rate for abnormal umbilical artery Doppler (UAD).MethodsWe analyzed 569 consecutive non-anomalous singleton gestations identified by ultrasound with either an abdominal circumference (AC) <3% or EFW <10% at a tertiary medical center between 1/2012 and 12/2016. The biometric measurements were exported for all serial ultrasounds and the sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated for the diagnosis of any abnormal UAD, absent or reversed end-diastolic flow (AREDF), and small for gestational age (SGA) for each classification method.ResultsBrenner classified less patients with EFW <10% (49.7%) vs. the comparison methods (range: 84.2–85.0%; P < 0.001). The sensitivity was highest using Hadlock for detection of any abnormal UAD [96.6%; confidence interval (CI) 92.8–98.8%], AREDF (100%; CI 95.1–100%), and SGA (89.0%; CI 85.4–91.6%). However, there was minimal variation between the Hadlock, NICHD, and INTERGROWTH methods for detection of the studied outcomes. The AUCs for any abnormal UAD, AREDF, and SGA were highest for the Brenner method, but there were a substantial number of false-negative results with lower overall detection rates.ConclusionsUse of a birth weight-derived method to assign a fetal weight <10% as the threshold to initiate UAD surveillance has a lower detection rate for abnormal UAD when compared to ultrasound-derived methods. Despite substantial methodological differences in the creation of the Hadlock, NICHD, and INTERGROWTH methods, there were no differences in the detection rates of abnormal UAD.
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Griffiths, RN, BAN, MHP, Jane L., Aurora Estipona, BSN, and James A. Waterson, RN, BA (Hons), MMed Ed. "A framework for physician activity during disasters and surge events." American Journal of Disaster Medicine 6, no. 1 (January 1, 2011): 39–46. http://dx.doi.org/10.5055/ajdm.2011.0043.
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Objectives: Delineation of the problem of physician role during disaster activations both for disaster responders and for general physicians in a Middle East state facility.Setting: The hospital described has 500 medicalsurgical beds, 59 intensive care unit beds, eight operating rooms (ORs), and 60 emergency room (ER) beds. Its ER sees 150,000 presentations per year and between 11 and 26 multitrauma cases per day. Most casualties are the result of industrial accidents (50.5 percent) and road traffic accidents (34 percent). It is the principle trauma center for Dubai, UAE. The hospital is also the designated primary regional responder for medical, chemical, and biological events. Its disaster plan has been activated 10 times in the past 3 years and it is consistently over its bed capacity.Interventions: A review of the activity of physicians during disaster activations revealed problems of role identification, conflict, and lack of training. Interventions included training nonacute teams in reverse triaging and responder teams in coordinated emergency care. Both actions were fostered and controlled by a Disaster Control Centre and its Committee.Results: Clear identification of medical leadership in disaster situations, introduction of a process of reverse triage to meet surge based on an ethical framework, and improvement of flow through the ER and OR.Conclusions: Reverse triage can be made to work in the Middle East despite its lack of primary healthcare infrastructure. Lessons from the restructuring of responder teams may be applicable to the deployment to prehospital environments of hospital teams, and further development of audit tools is required to measure improvement in these areas.
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Ezquivel, Nadia Ivanna González, Mitzy Dafne Ramírez Romero, Josefina Ruiz Esparza, Carlos Olvera Sandoval, and Daniela González Valencia. "Implementation of the Nutritional Health Promotion Center in University Students of the Faculty of Mexicali Medicine." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 192. http://dx.doi.org/10.1093/cdn/nzaa043_043.
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Abstract Objectives To implement the Nutritional Health Promotion Center (CEPSAN) in the population student of the Mexicali medical school during 2019. Methods Descriptive study. It was performed in university students and external volunteers, both sexes; each participant had a nutritional medical history; anthropometric measurement, estimation of the Body Mass Index and analysis of body composition by electrical bioimpedance in ioi 353 equipment; total energy expenditure was determined and an individualized food plan was provided, a challenge system based on the health recommendations of the World Health Organization 2012 was established, food consumption frequency questionnaire (one week) was applied. The results were coded and captured in The Food Processor ESHA version 2016 to estimate nutrients, the protocol was repeated every 15 days. Results Nutritional consultations were carried out with initial medical assessment to a total of n = 84 participants, 50% (n = 42) were university students and the other 50% were external volunteers. 52% of university students were normal weight, while 34% overweight, 12% obese and 2% underweight. 71% of external volunteers were overweight and obese. The average energy consumption in university students was 3000 kcal per day, a guideline to indicate an adequate consumption in quality and quantity during nutritional counseling. The average waist-to-hip index value in university women was 0.82 and in men 0.93, both below the risk point. In external volunteers, the waist-to-hip index was 0.87 and 0.95, women and men, respectively. Conclusions In the first stage of CEPSAN, it was possible to standardize the general care procedure, the timely identification of health risk in patients and the promotion of nutritional health through individualized meal plans. Funding Sources Programa para el Desarrollo Profesional Docente, 2019. UABC-PTC-775.
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Ahmed, Dr Mohaid Mubark, Dr Osman Hamid Abdulhamid, and Dr Imad Eldin Eljack Suleiman. "The Prevalence and Factors associated with Burnout among Sudanese Health Care Professionals at Primary Health Care Centers in Wad Madani Al-Kubra (Sudan), and Sharjah (UAE), 20 October – 20 November 2020." Academic Journal of Research and Scientific Publishing 3, no. 26 (June 5, 2021): 5–27. http://dx.doi.org/10.52132/ajrsp.e.2021.261.
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Burnout has long been recognized as a major problem among healthcare professionals and has become much more prevalent in the last decades. Beside healthcare professionals, it also negatively impacts the quality of health care services and patients. To identify the prevalence and factors associated with burnout among health care professionals at primary health care center in Wad Madani Al-Kubra (Sudan) and Sharjah (UAE). This is a comparative, analytical, cross-sectional health facility-based study conducted in primary health care (PHC) at Wad Madani Al-Kubra (Sudan) and Sharjah (UAE). The study assessed burnout among (75 participants in Wad Madani) out of 77 health care professionals with response rate of (97.4%), as well as it assessed (75 participants in Sharjah) out of 86 health care professionals with response rate of (87.2%). For assessment of burnout, the study calculated its prevalence and grade using method of evaluation modified from Maslach Burnout Inventory. All participants whose score was >10 out of 30 considered as positive for burnout. Low, moderate and high burnout was reported for cases score (<10, 11-20, 21-30). Chi-Square test was used for calculation of significance at P value < 0.05 and 95% CI. The data was analyzed by using Statistical Package for Social Sciences (SPSS, ver. 25). Females in Wad Madani & Sharjah groups were (82.7% and 77.3% respectively).Prevalence of burnout in Madani and Sharjah groups was reported with a considerable percentage (45.3% and 57.3%), (P value = 0.096). Low burnout was reported in 52(69.3%) for each of Wad Madani and Sharjah group. High burnout was reported in only 3 participants in Wad Madani group. Burnout is significantly higher among females when compared to males (57.5% vs. 26.7% respectively, P = 0.002). Burnout is significantly increase within increasing in number of patients met per day. The prevalence rate of medical personnel burnout in Alsharja primary health centers, UAE was found slightly higher than Wad Madani group, but no a statistically significant difference between the two groups. Recognition of burnout by health authorities and putting measures to rectify it.
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Al-Dmour, Jumanah A., Assim Sagahyroon, AR Al-Ali, and Salah Abusnana. "A fuzzy logic–based warning system for patients classification." Health Informatics Journal 25, no. 3 (November 6, 2017): 1004–24. http://dx.doi.org/10.1177/1460458217735674.
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Typically acute deterioration in sick people is preceded by subtle changes in the physiological parameters such as pulse and blood pressure. The Modified Early Warning Score is a scoring system developed to assist hospital staff in gauging these physiological changes and identifying patients in need of urgent medical care to avoid catastrophic deterioration. This work discusses the design and implementation of an equivalent warning system that utilizes fuzzy logic techniques to categorize patients’ status. The system is implemented and tested in Rashid Centre for Diabetes and Research in UAE. Results are compared with those obtained using the Modified Early Warning System that is currently used in practice. We demonstrate that the implemented system provides reliable results that are in agreement with the current Modified Early Warning Score system, with the added benefit of a scoring scheme that provides a better insight into the status or medical condition of each patient.
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AlJassmi, Abdulrahman Mohammad, Asim Noor Rana, Hani Humad, and Anjan Madasu. "The Clinical Characteristics and Survival Profiles of Wilms Tumor in the United Arab Emirates: A Single-center Retrospective Analysis." New Emirates Medical Journal 2, no. 1 (February 12, 2021): 84–90. http://dx.doi.org/10.2174/0250688203666210111153116.
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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: To review the clinical characteristics and survival outcomes of children with WT who have received treatment at Dubai Hospital, UAE. Results: Ten children were diagnosed with WT (median age of 3.40 years, 60% males). All patients presented with abdominal masses without a 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.
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Attlee, Amita, Nour Atmani, Viktor Stromtsov, Fatima Ali, Rim Tikarly, Sarah Ryad, Ghada Salah, Hayder Hasan, and Reyad Obaid. "Assessment of Weight Management Practices among Adults in the United Arab Emirates." Journal of Nutrition and Metabolism 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/1050749.
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With a rise in global incidence of overweight and obesity, the number of patients seeking weight management (WM) advice is likely to increase. Our aim was to explore the prevalence of WM practices and investigate association of WM goals with sociodemographic variables and practices among United Arab Emirates (UAE) adults. An exploratory, cross-sectional research was conducted on 1275 adult males and females, residing in UAE. A structured questionnaire was administered. WM goals to lose/maintain/gain weight were reported in 88.3% participants. WM goals were significantly associated with age, sex, marital status, education, current body weight perception, and medical condition. Out of 21 selected WM practices, popular strategies included increasing physical activity (52.9%), eating less fat (51.1%), consuming fewer calories (43.3%), joining gym (27.5%), skipping meals (26.1%), and consuming natural herbs and teas (20.7%). Visiting dietitian (12.3%) ranked ninth in the order of preference. Males focused on physical activity, gyms, and wellness centers and females on calories counting, dietitian visits, meals replacement, skipping meals, and natural herbs/teas. Married adults reported eating less fat (54.3% versus 47.3%, p=0.020); singles opted calories counting, gyms, and meals replacement. Frequent referral sources were friends (37.8%) and Internet (32.1%). Most UAE adults had WM goals that were associated with sociodemographic variables and WM practices. Awareness about the ill-effects of unhealthy WM practices and importance of dietitian’s consultation are imperative.
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Humphries, Laura S., Tulsi Roy, Anne Huang, John Collins, Fuad M. Baroody, and Russell R. Reid. "Airway Morphological Changes in Pierre Robin Sequence: A Retrospective Study." Cleft Palate-Craniofacial Journal 57, no. 7 (January 22, 2020): 828–39. http://dx.doi.org/10.1177/1055665619900624.
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Objective: To investigate airway morphology changes in patients with Pierre Robin sequence (PRS) pre–/post–mandibular distraction osteogenesis (MDO) and to compare morphologic changes to age-matched controls. Design: Retrospective case–control study. Setting: Urban, academic, tertiary medical center. Patients, Participants: Fifteen patients with PRS after MDO to relieve upper airway obstruction (UAO) (2008-2018); age-matched controls for post-MDO patients. Interventions: Mandibular distraction osteogenesis, curvilinear internal mandibular distractors. Main Outcome Measures: (1) Physiologic improvement after MDO (apnea–hypopnea index; minimum oxygen saturation); (2) airway size (volume, surface area, length, mean/minimum cross-sectional area), shape (lateral:anterior–posterior ratio, cross-sectional area ratios, uniformity, sphericity), and changes with MDO; and (3) post-MDO airway size, shape versus age-matched controls. Results: Airway size increased after MDO (volume, P = .01; surface area, P = .02; length, P = .01), as did cross-sectional area (mean, P = .02; minimum, P = .02; minimum retropalatal, P = .05, mid-retroglossal, P = .02). Post-MDO PRS airways were larger than controls (volume, P < .01; surface area, P < .01; length, P < .01, cross-sectional area, P = .03). Airway shape remained nonuniform and flat post-MDO; control airways were round. Two syndromic patients required repeat MDO and had subphysiologic post-MDO airway cross-sectional area. Post-MDO PRS patients with supraphysiologic cross-sectional area along the entire airway had no UAO recurrence. Conclusions: In this small, heterogenous patient sample, MDO increases airway size, may preferentially affect the retropalatal airway, and often results in supraphysiologic airway dimensions. These retropalatal changes may be important in relieving severe UAO in patients with PRS. Generalizability of our results is limited by small cohort size and patient heterogeneity.
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Lorenz, Birgit, Joana Tavares, L. Ingeborgh van den Born, João P. Marques, and Hendrik P. N. Scholl. "Current Management of Inherited Retinal Degeneration Patients in Europe: Results of a Multinational Survey by the European Vision Institute Clinical Research Network." Ophthalmic Research 64, no. 4 (2021): 622–38. http://dx.doi.org/10.1159/000514540.
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<b><i>Purpose:</i></b> An increasing number of gene therapies are developed for Inherited Retinal Degenerations (IRD). To date, 1 treatment has been approved for clinical use (FDA USA 2017, EMA Europe 2018, MoHAP UAE 2019, SFDA Saudi Arabia 2019, Swiss Medic Switzerland 2020, TGA Australia 2020, and BFR Brazil 2020). While such therapies do not provide complete cure, they may halt degeneration or partially restore function. Identification of well-characterized patients is an emerging need. We conducted the first multinational survey to understand the management of IRDs in Europe. <b><i>Methods:</i></b> An electronic survey questionnaire containing 112 questions was developed and sent to the 101 EVICR.net clinical centers (14 European countries and Israel). <b><i>Results:</i></b> The overall response rate was 49%. Only 14% of responding centers do not see IRD patients; 52% that manage IRD patients follow <i>≥</i>200 patients, 16% > 1,000. Databases exist in 86% of the centers; of these, 75% are local files, 28% local Web-based database, and 19% national Web-based. IRD patients are referred to EVICR.net centers mainly by general ophthalmologists, patient self-referrals, and medical retina specialists. Most IRD patients are first seen in adulthood. Most prominent signs and symptoms depend on the age of onset, for example, nystagmus in infancy, or night blindness, and reduced visual acuity at older age. The time from inquiring for first appointment and clinical diagnosis varies among countries: in 29% of centers, the mean time is <4 weeks, although can be up to 35 months in others. The time to genetic diagnosis is ≥4 weeks, the maximum 10 years, likely depending on access to genetic testing, and the improvement of the tests available. Comprehensive eye examination always includes autofluorescence imaging and perimetry (86% static, 76% kinetic, and 21% microperimetry), and frequently optical coherence tomography (OCT) (95%), electroretinography (93%), and fundus photography (93%). Identified genotypes were reported in 40–80% patients by 69% of centers, and in 80–100% by 5%. Genetic testing is provided by public health insurance in 77% of centers, private health insurance in 38%, center budget in 13%, research funds in 18%; and 15% of centers do not have access to genetic testing. <b><i>Conclusion:</i></b> At the start of this era of ocular gene therapy for IRD patients, this first international survey on management of IRDs in Europe highlights significant heterogeneity between centers and across countries and provides important baseline data for researchers, clinicians, pharmaceutical companies, and investors.
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Anderson, Jami L., Becky Reamey, Emily Levitan, Alia Tunagur, and Michael J. Mugavero. "73061 The UAB COVID-19 Collaborative Outcomes Research Enterprise (CORE): Developing a Learning Health System in Response to the Global Pandemic." Journal of Clinical and Translational Science 5, s1 (March 2021): 128. http://dx.doi.org/10.1017/cts.2021.728.
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ABSTRACT IMPACT: Interdisciplinary networks represent critical components of translational science and learning system development. Our work impacts translational research by presenting an evidence-based approach to developing interdisciplinary networks in response to the COVID-19 pandemic; the approach presented may have broad applications within other academic institutions and medical centers. OBJECTIVES/GOALS: As a local response to the COVID-19 pandemic, we established the University of Alabama at Birmingham COVID-19 Collaborative Outcomes Research Enterprise (CORE) as an interdisciplinary learning health system (LHS) to achieve an integrated health services and outcomes research response amid the pandemic. METHODS/STUDY POPULATION: We adapted a learning system framework, based upon a scoping review of the literature and the Knowledge to Action Framework for implementation science. Leveraging this framework, we developed an institutional-level collaborative network of extant expertise and resources to rapidly develop an interdisciplinary response to COVID-19. The network was designed to quickly collect newly published or clinical information related to COVID-19, to evaluate potential usefulness of this information, and to disseminate the new knowledge throughout the interdisciplinary network; we strove to engage a wide variety of expertise and skills in the network. Thus, we subsequently used social network analysis to examine the emergence of informal work patterns and diversified network capabilities based on the LHS framework. RESULTS/ANTICIPATED RESULTS: We identified three principal characteristics of institutional LHS development including: 1.) identifying network components; 2.) building the institutional collaborative network; and 3.) diversifying network capabilities. Seven critical components of LHS were identified including: 1.) collaborative and executive leadership, 2.) research coordinating committee, 3.) oversight and ethics committee, 4.) thematic scientific working groups, 5.) programmatic working groups, 6.) informatics capabilities, and 7.) patient advisory groups. Evolving from the topical interests of the initial CORE participants, three scientific working groups (health disparities, neurocognition, and critical care) were developed to support the learning network. DISCUSSION/SIGNIFICANCE OF FINDINGS: Interdisciplinary collaborative networks are critical to the development of LHS. The COVID-19 CORE LHS framework served as a foundational resource that may support further institutional-level efforts to develop responsive learning networks. The LHS approach presented may have broad applications within other academic institutions and centers.
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Aryasinghe, L., D. Moezzi, TA Ansari, E. Mathew, SA Sharbatti, and RB Shaikh. "Congenital Anomalies at Birth: A Hospital Based Study in UAE." Journal of Nepal Paediatric Society 32, no. 2 (October 1, 2012): 105–12. http://dx.doi.org/10.3126/jnps.v32i2.5995.
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Introduction: It is widely acknowledged that congenital anomalies heavily contribute to infant morbidity and mortality worldwide, with an estimated 9 million infants (7% of all births) born annually having a serious congenital anomaly that result in death or lifelong disability. The objective of our study was to estimate the frequency of congenital anomalies at the Gulf Medical College Hospital and Research Center, Ajman and to estimate the proportion of births with congenital anomalies per 1,000 live births. Materials and Methods: It was a Hospital-Record based descriptive study of the 1,222 consecutive live births from December 2007 to June 2008. Results: There were 84 cases of congenital anomalies among the 1,222 live births; the rate of anomalous births was 68.7 per 1,000 live births or 6.9%. Anomalies of the genitourinary system (40.5%) were the most common, followed by musculoskeletal (28.6%) and cardiovascular (10.7%). Gastrointestinal, chromosomal and multiple system anomalies accounted for 3.6% each and miscellaneous anomalies were seen in 7.1%. Central Nervous system (2.4%) anomalies were the least. Congenital hydrocele (19.0%) was seen to have the highest frequency amongst all recorded anomalies, followed by Talipes or Clubfoot (14.3%). 9.3% of the male and 4.3% of the female population of live births had a congenital anomaly. Birth Weight (p=0.005) and Gender (p=0.001) were found to have significant association with the frequency of birth defects. Maternal Age, gravidity, parity, previous abortions, VDRL and Hepatitis B status, Gestational Diabetes, Pregnancy Induced Hypertension, gestational age, maternal and infant blood group, nationality and consanguinity showed no statistically significant association with congenital anomalies. Conclusion: The proportion of congenital anomalies found in our study is alarmingly high and emphasizes the need for more accessible nationwide screening, counseling and surveillance systems. J. Nepal Paediatr. Soc. 32(2) 2012 105-112 doi: http://dx.doi.org/10.3126/jnps.v32i2.5995
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Naveed, Mohamed, Yousif Al-Serkal, Sumaya Al-Nuaimi, Kalthoom Al-Blooshi, Noor Majed Al-Mahiri, Yasir Khan, Sadaf Ahsan Naqvi, and Neema Preman. "Improved efficiency and patient safety through bespoke electronic thalassaemia care module." BMJ Health & Care Informatics 26, no. 1 (September 2019): e100094. http://dx.doi.org/10.1136/bmjhci-2019-100094.
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ObjectivesTo investigate the impact of electronic medical record (EMR) on improvement of healthcare parameters in a thalassaemia centre located at the Fujairah Hospital, Fujairah, UAE.Materials and methodsA hospital-wide EMR system (Wareed) was implemented across the hospitals in the Ministry of Health and Prevention, UAE, including two major thalassaemia centres. We aim to investigate the impact of this intervention across a number of healthcare parameters over two quarters (before and after implementation of the system).ResultsSince preimplementation data were not available for one facility, comparisons were made between parameters in two quarters in Fujairah hospital only. After introduction of Wareed, we found an increase in number of appointments (12%) (p=0.00), decrease in the number of appointment cancellations due to non-availability of blood products (p=0.02), reduction in the time to cannulation (p=0.00), decrease in number of physician days (p=0.295) among other parameters observed.DiscussionResearch shows that EMR systems have a positive impact on reduction in medical expenditure, improvement of healthcare quality and overall health outcomes. thalassaemia is highly prevalent in the Middle Eastern countries and drains the medical, social and financial resources of these nations. Our study is an attempt to create an insight into the difference in healthcare parameters before and after introduction of the system.ConclusionBeing the first of a kind in this region, our study created favourable evidence that introduction of an EMR has an overall positive impact on the healthcare delivery system for thalassaemia care.
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Al-Maroof, Rana Saeed, Khadija Alhumaid, Ahmad Qasim Alhamad, Ahmad Aburayya, and Said Salloum. "User Acceptance of Smart Watch for Medical Purposes: An Empirical Study." Future Internet 13, no. 5 (May 12, 2021): 127. http://dx.doi.org/10.3390/fi13050127.
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This study aims to investigate the most effective and interesting variables that urge use of the smartwatch (SW) in a medical environment. To achieve this aim, the study was framed using an innovative and integrated research model, which is based on combining constructs from a well-established theoretical model’s TAM and other features that are critical to the effectiveness of SW which are content richness and personal innovativeness. The Technology Acceptance Model (TAM) is used to detect the determinants affecting the adoption of SW. The current study depends on an online questionnaire that is composed of (20) items. The questionnaire is distributed among a group of doctors, nurses, and administration staff in medical centers within the UAE. The total number of respondents is (325). The collected data were implemented to test the study model and the proposed constructs and hypotheses depending on the Smart PLS Software. The results of the current study show that the main constructs in the model contribute differently to the acceptance of SW. Based on the previous assumption, content richness and innovativeness are critical factors that enrich the user’s perceived usefulness. In addition, perceived ease of use was significantly predictive of either perceived usefulness or behavioral intention. Overall findings suggest that SW is in high demand in the medical field and is used as a common channel among doctors and their patients and it facilitates the role of transmitting information among its users. The outcomes of the current study indicate the importance of certain external factors for the acceptance of the technology. The genuine value of this study lies in the fact that it is based on a conceptual framework that emphasizes the close relationship between the TAM constructs of perceived usefulness and perceived ease of use to the construct of content richness, and innovativeness. Finally, this study helps us recognize the embedded motives for using SW in a medical environment, where the main motive is to enhance and facilitate the effective roles of doctors and patients.
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Gomathi, K., IA Shaafie, K. Mummigatti, S. Shahid, and J. Sreedharan. "Biochemical Parameters in Women with Polycystic Ovary Syndrome in Ajman, UAE." Nepal Journal of Obstetrics and Gynaecology 6, no. 2 (September 2, 2012): 7–10. http://dx.doi.org/10.3126/njog.v6i2.6748.
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Aims: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5 -10% of women and is a major cause of anovulatory infertility. Prevalence varies among population based on genetic and environmental factors. Etiology of PCOS remains unknown but hyperandrogenism and insulin resistance have both been associated with PCOS. The aim of this study was to measure levels of Homocysteine and other biochemical parameters in women diagnosed with PCOS attending Gulf Medical College Hospital & Research Centre (GMCHRC), Ajman, UAE. Methods: Young women, aged between 18 and 35 years of age, diagnosed with PCOS (N =37), not on any treatment, attending GMCHRC were included in the study. Biochemical parameters were measured using standard procedures. Laboratory normal reference ranges were used for comparison. Results: 54 % of the women with PCOS were overweight or obese according to the Body mass index (BMI) and 51% had a waist circumference >88cm. Fasting and postprandial Glucose and Insulin levels and HOMA-IR were within the normal reference range indicating that no Insulin resistance was seen in these women. 40% of the women had a serum total Cholesterol level above 200 mg/dL, while Low Density Lipoprotein (LDL) Cholesterol was above and High Density Lipoprotein (HDL) cholesterol was lower than the desirable value. Serum Triacylglycerol was within the normal reference range. Serum Testosterone, Estradiol, Prolactin Thyroid Stimulating Hormone (TSH) and Plasma Homocysteine level were found to be within the normal reference ranges. Homocysteine levels correlated with Testosterone, total Cholesterol and LDL cholesterol levels. Conclusions: BMI was high in 54% of the women. No Insulin resistance was seen in these patients. Hormone levels and Homocysteine were within normal reference ranges. Dyslipidermia was observed. These findings differ from reports in literature where Insulin resistance, Hyperandrogenism and high Homocysteine levels have been associated with PCOS. NJOG 2011 Nov-Dec; 6 (2): 7-10 DOI: http://dx.doi.org/10.3126/njog.v6i2.6748
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Graham, T. A., M. Ballermann, E. Lang, M. Bullard, D. Parsons, L. Mercuur, P. San Augustin, and S. Ali. "P050: Electronic health record perceptions and utilization by physicians in urban emergency departments." CJEM 18, S1 (May 2016): S95. http://dx.doi.org/10.1017/cem.2016.226.
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Introduction: In 2006, Alberta implemented an Electronic Health Record called the Alberta Netcare Portal (ANP). The ANP provides provincial read-only access to lab tests, diagnostic imaging, medication information and numerous text reports. There is no computerized order entry, and care is coordinated using a hybrid of paper charting and various electronic systems. Here, we quantify observed ANP use by physician participants providing care in four urban Emergency Departments (EDs) in Alberta. The results form part of a larger mixed methods research project aimed at detecting broader implications of ANP use for patient care. Methods: Between October 2014 and July 2015, ED physicians at four EDs (University of Alberta Hospital [UAH], Grey Nuns Community Hospital [GNCH], Foothills Medical Centre [FMC], Peter Lougheed Centre [PLC]) participated in structured clinical observations. Observations were purposively sampled during the first hours of shifts, when physicians orient themselves to the patients they will see during the rest of their shift, including reviewing available historic patient information. Observers used a tablet based tool to generate a time-stamped record of the information tools used alongside patient care. Information tools included permanent paper records, paper excluding permanent documentation, the ANP, clinical and other applications accessed via desktop computers, and mobile devices. Observers also recorded contextual data, including participant commentary, on paper field notes. Results: Across the 4 sites, 142 physicians participated in 376 sessions for a total of 566 observed physician-hours. Participants accessed information in different computerized applications and on paper (i.e., a ‘hybrid’ care environment). The highest proportion of observed physician time interacting with ANP was observed at the UAH (7.0%-8.1%, all values 95% Confidence Intervals). Physicians spent less time using ANP at GNCH (4.1%-4.8%), which was similar to the Calgary EDs (FMC: 4.4-5.3% and PLC: 5.2%-5.9%). Thematic analysis of field notes showed that ANP acceptance was very high. Patient safety concerns were recorded related to care provided alongside ‘hybrid’ patient records. Conclusion: We found high physician acceptance of ANP based on documented comments and observed usage. We posit a high potential for EHRs such as ANP to support improved care coordination which remains partly realized.
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Rodrigues, Anette Marina. "Knowledge, Attitude and Behavior on Overweight and Obesity, Health Consequence and Adaptation to Lifestyle Changes among Early Middle Age Medical and Non-medical Health Care Staffs of NMC Day Care Centre, Abu Dhabi, UAE." TEXILA INTERNATIONAL JOURNAL OF NURSING 3, no. 2 (December 15, 2017): 183–91. http://dx.doi.org/10.21522/tijnr.2015.03.02.art018.
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Nasser, Sara, Jonathan Berek, Andreas Ullrich, Livia Giordano, and Jalid Sehouli. "A report on the Marrakech International Women’s Cancer Days: dialogs and implications." International Journal of Gynecologic Cancer 29, no. 2 (December 21, 2018): 417–21. http://dx.doi.org/10.1136/ijgc-2018-000059.
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The MarrakechInternational Women’s Cancer Days showcased a first-time international meeting of healthcare professionals worldwide to discuss, over the course of 3 days, aspects of public health, prevention, and treatment of gynecological cancers in the Arabic region. The focus was particularly on promoting globally sustainable research initiatives. The event was a joint initiative organized by the Gynecological Cancer Intergroup and the Pan-Arabian Research Society of Gynecological Oncology. The first conference day focused on the early diagnosis and screening of cervical cancer and the required action to establish equity within screening programs and improve cancer control strategies in the Euro-Mediterranean region. The second day highlighted current screening, diagnosis, and treatment strategies for ovarian cancer in the Arabic region, with particular discussion on the incidence of germline mutations in Arabic women with ovarian cancer. Centers from the Arabic region such as Jordan, Tunesia, Sudan, and Morocco presented their own data on ovarian cancer patients and local clinical practice, and barriers to treatment. It was highlighted that more support is required in surgical training and medical therapies. On the third day , the focus was on cervical cancer therapies and treatment. Interesting surveys on patient awareness of screening programs and cervical cancer were presented from various centers including Lebanon, Sudan, and the UAE. The conference ended with emphasis on patient education, and quality of life. The meeting provided a first-time platform for sustainable worldwide dialog and exchange on all aspects of gynecological cancers focusing on the Arabic woman and the particular barriers, unchartered territories, and challenges this patient population presents to the global healthcare community.
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Jia, Shuang-Zheng, Yang Xiang, Jun-Jun Yang, Jing-hua Shi, Cong-Wei Jia, and Jin-Hua Leng. "Oncofertility outcomes after fertility-sparing treatment of bilateral serous borderline ovarian tumors: results of a large retrospective study." Human Reproduction 35, no. 2 (February 2020): 328–39. http://dx.doi.org/10.1093/humrep/dez307.
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Abstract Study question What are the oncofertility outcomes of young women (≤40 years old) with bilateral serous borderline ovarian tumors (SBOTs) after fertility-sparing surgery? Summary answer Fertility preservation with the bilateral ovarian cystectomy procedure is feasible for bilateral SBOTs, with an acceptable oncological outcome and worthwhile pregnancy rates. What is known already Fertility-sparing approaches are becoming the standard management of young patients with unilateral SBOTs and other borderline histological subtypes. However, there is a paucity of evidence to dictate the best management in bilateral SBOTs. Study design, size, duration This was a retrospective observational study performed at the Peking Union Medical College Hospital in Beijing, China, between January 1999 and January 2019. Participants/materials, setting, methods Ninety-four women (≤40 years old) with pathologically confirmed bilateral SBOTs were included. Following preoperative counseling, patients self-selected into one of three treatment modalities: bilateral ovarian cystectomy (n = 48), unilateral adnexectomy plus contralateral cystectomy (UAC; n = 31), and radical surgery (n = 15). Univariate and multivariate analyses were used to determine the clinical and pathological features associated with disease-free survival and reproductive outcomes. Main results and the role of chance During the median follow-up of 64 months (range, 4–243 months), 61 patients (65%) developed relapse, including 3 (20%) in the radical group, 26 (84%) in the UAC group and 32 (67%) in the bilateral cystectomy group. In the multivariate analyses, preoperative CA-125>300 U/mL, fertility preservation and micropapillary pattern were independently associated with adverse disease-free survival (P = 0.001, 0.03 and 0.026, respectively). Fourteen patients (15%) experienced invasive recurrence, and three (3%) died of progressive disease. The micropapillary pattern was significantly associated with invasive evolution risk (P = 0.006). Of the 49 patients who attempted to conceive, 23 (47%) achieved 27 pregnancies (24 spontaneous and three after IVF-ET), resulting in 19 live births. There was no significant difference in disease-free survival (P = 0.13) or pregnancy rate (41 vs. 50%, P = 0.56) between the UAC and bilateral procedures. Limitations, reasons for caution As a retrospective study conducted in a referral center, inherent biases exist. The nonrandom allocation to treatment groups and relatively small number of patients attempt to conceive might limit the statistical power of our findings. Only 41 patients (43.6%) received complete staging during their initial surgeries, so an underestimation bias in terms of the FIGO stage and extraovarian implants might have occurred. Wider implications of the findings The ultraconservative bilateral ovarian cystectomy procedure should be proposed in bilateral SBOTs when technically feasible. Invasive evolution occurs frequently in these women, and intense follow-up and oncofertility counseling are warranted, especially for those with micropapillary patterns. Study funding/competing interest(s) No external funding was used for this study. There are no conflicts of interest to declare. Trial registration number N/A.
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Salvi, Meena. "Prevalence of vulvovaginal candidiasis in females in the reproductive age group." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 2 (January 25, 2019): 647. http://dx.doi.org/10.18203/2320-1770.ijrcog20190299.
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Background: Vulvovaginal candidiasis (VVC) is a common infection among reproductive age group females. The objective of present study is to determine the prevalence of vulvovaginal candidiasis, its distribution and association of risk factors among reproductive age group females, attending the outpatient department of obstetrics and gynaecology of our Prime Medical Centre, Sharjah attached with Prime Hospital, Dubai, United Arab Emirates (UAE).Methods: It was cross-sectional descriptive study over a period of six months. Patients who came to our outpatient department with complains of vaginal discharge and itching in reproductive age group were included in this study. Patients characteristics i.e. age, parity, risk factors like diabetes, pregnancy, use of oral contraceptive pills (OCPills) and intrauterine contraceptive device (IUCD) were noted. High vaginal swabs (HVS) were collected and sent for culture. Candida positive cases were noted, and results were analyzed.Results: A total of 224 high vaginal swabs were collected. Prevalence of vulvovaginal candidiasis was found to be 31.6%. It was found more in 26-30 years age group and multiparous women. Previous history of candidiasis and diabetes were the commonest risk factors. Frequency of C. albicans was more (76.05%) than non-albicans candida (23.94%).Conclusions: Present study concluded that vulvovaginal candidiasis is more prevalent in reproductive age group females, therefore a routine high vaginal swab culture must be performed in every woman presenting with vaginal discharge and itching for correct diagnosis. Women should be educated on clinical symptoms.
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Deeb, Asma, Khulood Khawaja, Nida Sakrani, Abdulla AlAkhras, Ahmed Al Mesabi, Ravi Trehan, Palat Chirakkara Kumar, Zahir Babiker, Nico Nagelkerke, and Emmanuel Fru-Nsutebu. "Impact of Ethnicity and Underlying Comorbidity on COVID-19 Inhospital Mortality: An Observational Study in Abu Dhabi, UAE." BioMed Research International 2021 (March 1, 2021): 1–7. http://dx.doi.org/10.1155/2021/6695707.
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Background. The UAE reported its first cluster of COVID 2019 in a group of returned travellers from Wuhan in January 2020. Various comorbidities are associated with worse disease prognosis. Understanding the impact of ethnicity on the disease outcome is an important public health issue but data from our region is lacking. Aim. We aim to identify comorbidities among patients hospitalized for COVID-19 that are associated with inhospital death. Also, to assess if ethnicity is correlated with increased risk of death. Patients and Method. The study is a single-centre, observational study in Shaikh Shakhbout Medical City, Abu Dhabi. Patients admitted with COVID-19, between 1st of March and the end of May, were enrolled. Records were studied for demography, comorbidity, and ethnicity. Ethnicity was divided into Arabs (Gulf, North Africa, and the Levant), South Asia (India, Pakistan, Bangladesh, Nepal, and Afghanistan), Africans, the Philippines, and others. The study was approved by the Department of Health of Abu Dhabi. Results. 1075 patients (972 males) were enrolled. There were 24 nationalities under 5 ethnicity groups. Mean (average) age was 51 years (20–81). 101 (9.4%) died with deceased patients being significantly older. Death risk was not significantly influenced by sex. Duration of hospitalization among survivors was 6.2 days (0.2–40.4) with older patients and men staying longer ( P < 0.01 ). Comorbidities of diabetes, hypertension, cardiovascular disease, chronic renal disease, liver disease, and malignancy were associated with higher risk of mortality univariate, but only liver disease reached statistical significance after adjustment for age. The highest percentage of death was seen in Arab Levant (21.2) followed by the Asian Afghan (18.8); however, differences among ethnicities did not reach statistical significance ( P = 0.086 ). Conclusion. COVID-19 outcome was worse in older people and those with comorbidities. Men and older patients required longer hospitalization. Ethnicity is not seen to impact the risk of mortality.
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Deeb, Asma, Palat Chirakkara Kumar, Nida Sakrani, Ravi Kumar Trehan, and Vijay Ram Papinenei. "Neurological Presentations of COVID-19: Characteristic Features in a Case Series of Hospitalized Patients from Abu Dhabi, UAE." BioMed Research International 2021 (August 6, 2021): 1–10. http://dx.doi.org/10.1155/2021/5822259.
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Background. COVID-19 patients can present with neurological manifestations in the form of headache, dizziness, hyposmia, myalgia, peripheral neuropathy, acute cerebrovascular disease, and encephalopathy. Neurological involvement could be due to virus-induced brain hypoxia, brain infection, or immune reaction. We aim to describe the neurological presentation of COVID-19 patients and study their neuroimaging findings and disease outcome. Method. The study is a single-centre, retrospective, observational study in Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Patients diagnosed with COVID-19 between March and May 2020 who presented with neuropathological features with or without respiratory manifestations of COVID-19 were enrolled. Electronic records were studied for age, sex, duration of hospitalization, detailed neurological presentation, history or documented concomitant fever and respiratory features of COVID-19, inflammatory markers, neuroimaging, progress, and disease outcome. Results. Thirty-three patients of 10 nationalities presented with neurological manifestations. Mean (range) age was 51.4 (21–86) years. Twenty-four had comorbidities, and 18 had no prior or concomitant respiratory symptoms. Ten patients presented with encephalopathy and exhibited altered behavior/sensorium: 7 presented with myositis, 8 with stroke, and 4 with seizures, and 4 had peripheral and cranial nerve involvement. The mean (average) duration of hospital stay was 11.4 days (1-38) with the longest observed in stroke patients. Fifteen patients (45%) died and 3 (9%) had residual weakness. Serum ferritin, CRP, and procalcitonin were higher in the severe disease group and correlated with risk of death. Twelve of 22 brain images showed abnormalities including haemorrhage, infarcts, small vessel ischemia, and oedema. Risk of death was higher in older age but did not differ based on the underlying neuropathology. Conclusion. COVID-19 patients who present with neurological involvement have a higher risk of mortality which is aggravated by older age and higher inflammatory markers. The type of neurological pathology does not seem to influence the risk of mortality.
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Abdulrazzaq, Najiba, Kashif Bin Naeem, Abdalla Alhajiri, Ayman Chkhis, Vinod Choondal, Mona Osman, and Kusay Almusa. "Multiple Organ Dysfunction Reduces In-Hospital Survival in COVID-19 Patients." International Journal of Innovative Research in Medical Science 5, no. 09 (September 14, 2020): 389–94. http://dx.doi.org/10.23958/ijirms/vol05-i09/951.
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Background: Although primarily a respiratory illness, COVID-19 involves multiple organs when the disease is severe or critical. Hence, we conducted this study to evaluate the incidence of multiple organ dysfunction in COVID-19 patients and its implications on survival. Methods: A retrospective analysis of laboratory-confirmed COVID-19 patients presenting to our center in Dubai, UAE between April 2020 and July 2020. Data was collected from the electronic medical records and analyzed to evaluate multiple organ damage observed during hospital admission. Findings: Five-hundred patients were studied. Overall mean age was 49.5 years (range 13-94), 76% males, 33% diabetics, 31% hypertensives. 97/500 (19.4%) had evidence of single organ damage; 37/500 (7.4%) had two organ damage; and 105/500 (21%) had more than two organ damage. Acute respiratory distress syndrome was the most prevalent organ damage,153/500 (30.6%); followed by acute cardiac injury, 120/500 (24%); acute kidney injury 107/500 (21.4%); acute liver injury 96/500 (19.2%); septic shock 93/500 (18.6%); disseminated intravascular coagulation 27/500 (5.4%), and heart failure 17/500 (3.4%). We found that in-hospital survival reduced as the number of organs involved increased; only 20% patients survived who had more than 2 organ damage. Also, the chances of survival reduced considerably once other organs were involved in addition to the acute respiratory distress syndrome (91.6% survival in ARDS alone vs. 28.6% survival in ARDS with acute kidney injury vs. 10.4% survival in ARDS with shock/acute cardiac injury/acute kidney injury). Conclusion: Multiple organ dysfunction is common in COVID-19 as 21% had evidence of more than two organ damage in our study. The survival in COVID-19 reduces significantly once multiple organs are involved. Early monitoring and recognition of multiple organ dysfunction is necessary to prevent adverse outcomes and improve survival.
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Saputri, Dini Deviana, and Teguh Endah Saraswati. "Sintesis Carbon Nanotubes (CNT) Berbasis Bahan Alam Limbah Tempurung Kelapa dan Aplikasinya dalam Pembuatan Polimer Komposit Polimida-CNT: Review." Proceeding of Chemistry Conferences 6 (September 15, 2021): 38. http://dx.doi.org/10.20961/pcc.6.0.55088.38-46.
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<p><em>Carbon nanotubes</em> (CNT) menjadi salah satu material unggul teknologi nano yang membawa banyak keuntungan karena memiliki sifat kimia dan mekanik yang baik. Hal ini menjadikan CNT dimanfaatkan di berbagai aplikasi <em>nano-device </em>ataupun material komposit. Beberapa metode yang sering digunakan untuk menumbuhkan CNT adalah deposisi uap kimia (<em>Chemical Vapor Deposition</em>), laser ablasi dan <em>arc discharge</em>. Kebanyakan sumber prekursor karbon dalam sintesis CNT diambil dari bahan bakar fosil yang memiliki kelemahan bahan tidak bisa diperbaharui dan menghabiskan biaya yang mahal. Limbah bahan alam atau hasil biomassa dapat menjadi alternatif bahan baku pembuatan CNT yang membawa keunggulan biaya murah, ketersediaan melimpah, dan hemat energi, contohnya seperti limbah tempurung kelapa yang mengandung unsur karbon tinggi. Tempurung kelapa telah dilaporkan sebagai salah satu bahan baku potensial produksi CNT. Aplikasi CNT dalam polimer komposit contohnya penggabungan dengan polimida. Keunggulan polimida adalah sifat mekaniknya yang sangat baik, stabilitas termal, dan ketahanan kimia. Namun, polimida memiliki kelemahan dalam konduktivitas termal yang rendah. Penambahan CNT ke dalam polimida dapat meningkatkan konduktivitas termal sehingga meningkatkan kinerja polimer tersebut. </p><p><strong>Synthesis of Coconut-Shell Waste-based Carbon nanotubes (CNT) and Its Application in Polymer Composite Polyimide-CNT Fabrication: Review. </strong><em>Carbon nanotubes (CNTs) have become one of the excellent materials for nanotechnology which brings many advantages because of their good chemical and mechanical properties, inducing CNTs to be used in various nano-device applications or composite materials. Some of the methods commonly used to grow CNTs are chemical vapor deposition, laser ablation, and arc discharge. Most sources of carbon precursors in CNTs synthesis are taken from fossil fuels which have the disadvantages of non-renewable materials and high cost. Natural waste or biomass products can be an alternative raw material for CNTs production which brings the advantages of low cost, abundant availability, and energy-saving, for example, such as coconut shell waste which contains high carbon elements. Coconut shell has been reported as one of the potential raw materials for CNT production. CNT applications in composite polymers are for example collaboration with polyimides. The advantages of polyimides are their excellent mechanical properties and chemical resistance. However, polyimides have a disadvantage in their low thermal conductivity. The addition of CNT into polyimides can increase its thermal conductivity enhancing polyimide performance.</em></p><p align="center"> </p>
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Alzaabi, Mariam Rashed, Inaam bashir Hassan, Martin S. Tallman, Arif Alam, Khalid Al qawasmeh, and Jorgen Kristensen. "Patient Characteristics and Early Death Predictors in Acute Promyelocytic Leukaemia Patients; Experience from United Arab Emirates (UAE)." Blood 126, no. 23 (December 3, 2015): 4963. http://dx.doi.org/10.1182/blood.v126.23.4963.4963.
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Abstract Background: Acute promyelocytic leukemia (APL) is a highly curable subtype of acute myeloid leukemia (AML). APL has unique morphological, cytogenetic and molecular characteristics. Although extensive data regarding APL are available from developed countries only few studies have been published from developing countries. They describe higher early death rates with lower complete remission rate compared to patients from developed countries. In a retrospective analysis, we evaluated the characteristics features at presentation and predictor of early death in 67 patients with APL diagnosed between 2000 and 2015 at two centers in UAE. To our knowledge there are no published data on APL early death rates from the United Arab Emirates (UAE) Patients and Methods: All patients age >15 years with a newly diagnosis of APL between January 2000 and January 2013 at Tawam hospital and Sheikh Khalifa Medical City (SKMC) were included. The initial diagnosis was typically based on clinical, morphological & phenotypic (negative expression of CD34 and HLA-DR but positive expression of CD2 and CD9) suspicion of APL. Subsequently the diagnosis was confirmed with genetic study for detection of t(15:17). Oral ATRA was immediately started at the standard dose 45 mg/m2 per day in addition to supportive care to correct the coagulopathy (fresh-frozen plasma, cryoprecipitate to maintain fibrinogen at >1.5 g/l, and platelets was maintained at >30x109/l). Early death was defined as death within 30 days of a patient being diagnosed with APL. Data were analyzed using SPSS version 21 (IBM SPSS Inc., Chicago, IL). Results: The median age was 33 years (15 - 57) with only 18 (26.9%) of the patients were older than 40 years. Patients were more likely to be male (42, 62.7%), present with bleeding (53, 80.3%) at the time of diagnosis, have a WBC count greater than 10x109/L in 59.9% while in 40% of the patients it was < 5 x109/L. They tend to have platelet count < 30x109/L in 76.1%, high INR in 66.7% and < 1.5g/L fibrinogen in two third of them. 69.2% of them had bcr1 and 10 of the patients (14.9%) had t(15:17) with additional chromosomal abnormalities include monosomy7 (2 patients), trisomy 8 (1 patients), del 9 (1 patients), ring chromosome 6 (2 patients), der 21 (1 patients) and complex karyotype (3 patients). Early death rate was 11.9%(8/67 patients). In a univariate analysis of the prognostic factors, early-deaths occurred significantly more frequent in patients who were >40 years of age (27.8% versus 6.1%; p= 0.015), those who presented with fever (21.2% versus 2.3%; p=0.030), WBC count >20 x 109/L (26.1% versus 4.5%; p=0.010), high INR (17.7% versus 0.0%; p=0.047), high APTT (40% versus 7.4%; p=0.021) at the time of diagnosis. Although fibrinogen level <1.5g/L was not identified as a significant predictor (21.1% versus 5.1%; p=0.062) of early death, a level of <1.0 g/L emerge as a significance (30.0% versus 4.3%; p=0.010) predictor in addition to the breakpoints other than bcr1 (25.0% versus 3.7%; p=0.043). Time to start of ATRA (>24h versus within 24h) therapy failed to show statistical significance (13.3% versus 12.5%; p=0.9). Patients with WBC count <5.0x109/L have tendency to less frequent early death (3.7% versus 17.5%; p=0.08). None of the patients with additional chromosomal abnormalities experienced early death (0.0% versus 14.0%). However the difference was not statistically significant (p=0.26). Conclusion: The patient characteristics of UAE APL patients at presentation are similar to other published data. Early death rate is comparable to that published from developed countries. Our data support that coagulopathy at presentation is a major contributor to early death and that treatment of APL with improvement of early death rate is feasible at centers in developing countries provided access to facilities for aggressive supportive care. Disclosures No relevant conflicts of interest to declare.
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Wasko, Molly, Elaine Morrato, Nicholas Kenyon, Suhrud Rajguru, Bruce Conway, Sara Love, Nate Hafer, Pamela Bhatti, Jonathan Fay, and Seth Zonies. "2389." Journal of Clinical and Translational Science 1, S1 (September 2017): 38–39. http://dx.doi.org/10.1017/cts.2017.142.
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OBJECTIVES/SPECIFIC AIMS: The goal of this abstract/presentation is to share lessons learned from participation in the NIH SBIR I-Corps Train-The-Trainer Program, discuss our experiences offering programs at our local institutions, and communicate our plans to develop an I-Corps@NCATS program that can be disseminated across the CTSA network. We believe that an I-Corps@NCATS program will enhance the process of scientific translation by taking best practices from NSF I-Corps and adapting the program to meet the needs of biomedical scientists in academic medical centers. By integrating I-Corps@NCATS training, we hypothesize that the clinical and translational investigator base will be better prepared to identify new innovations and to accelerate translation through commercialization. METHODS/STUDY POPULATION: The diverse, interdisciplinary team of investigators involved in this project span 9 CTSA Hubs, including UAB, Rockefeller, UC Denver, HMC-Penn State, UMass, UC Davis, Emory/Georgia Tech, Miami and Michigan. This team was funded by NCATS in 2015–2016 to participate in the CTSA I-Corps Train-The-Trainer Program in conjunction with the NIH-SBIR/STTR I-Corps national program. The goals were to observe the curriculum, interact with and learn from the NSF National Teaching Team and begin implementation of similar programs at our home institutions. Our I-Corps@NCATS team has been holding monthly, and more recently weekly, conference calls to discuss our experiences implementing local programs and to develop a strategy for expanding CTSA offerings that include innovation and entrepreneurship. Our experience revealed several challenges with the existing NSF/NIH I-Corps program offerings: (1) there is no standard curriculum tailored to academic clinical and translational research and biomedical innovations in the life sciences, and (2) the training process to certify instructors in the I-Corps methodology is a much more rigorous and structured process than just observing an I-Corps program (eg, requires mentored training with a national NSF I-Corps trainer). Our team is proposing to address these gaps by taking best practices from NSF I-Corps and adapting the program to create the I-Corps@NCATS Program, tailored to meet the needs of researchers and clinicians in academic medical centers. RESULTS/ANTICIPATED RESULTS: There are 3 primary anticipated results of our project. First, develop a uniform curriculum for the I-Corps@NCATS Program using the National Teaching Team of experts from the NIH’s SBIR I-Corps program. Second, build the I-Corps@NCATS network capacity through a regional Train-The-Trainer Program. Third, develop a set of common metrics to evaluate the effectiveness and impact of the I-Corps@NCATS Program across the community of CTSA Hubs and their respective collaborative networks. DISCUSSION/SIGNIFICANCE OF IMPACT: Over the past 10 years, CTSA Hubs have accelerated science by creating/supporting programs that provide research infrastructure, informatics, pilot funding, education/training, and research navigator services to investigators. These investments help to ensure that we are “doing science right” using the best practices in clinical research. Even so, it is equally important to make investments to ensure that we are “doing the right science.” Are our investigators tackling research problems that our stakeholders, patients, and communities want and need, to make sure that our investments in science have real-world impact? In order to accelerate discoveries toward better health, scientists need to have a better way to understand the needs, wants and desires of the people for whom their research will serve, and how to overcome key obstacles along the path of innovation and commercialization. To fill this gap, we propose that the CTSA Hubs should include in their portfolio of activities a hands-on, lean startup program tailored after the highly successful NSF Innovation Corps (I-Corps) program. We hypothesize that by adapting the NSF I-Corps program to create an I-Corps@NCATS program tailored to medical research, we will better prepare our scientists and engineers to extend their focus beyond the laboratory and broaden the impact of their research. Investigators trained through I-Corps@NCATS are expected to be able to produce more innovative ideas, take a more informed perspective about how to evaluate the clinical and commercial impact of an idea, and quickly prototype and test new solutions in clinical settings.
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I.H. Lende, Maria Wiwin, Setyo Mahanani Nugroho, and Nonik Ayu Wantini. "The Relationship Between Pregnant Women’s Perceptions Of Family Support And The Motivation For HIV/AIDS Examination In Gedong Tengen Public Health Center. Yogyakarta City." Jurnal Ners dan Kebidanan Indonesia 6, no. 2 (March 31, 2019): 21. http://dx.doi.org/10.21927/jnki.2018.6(2).21-28.
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<p><em>In 2016 the number of pregnant woman who required the prevention of transmission trough sexual reached 278 pregnant women. Efforts that have been made by government to prevent mother-to-child transmission of HIV/AIDS are HIV/AIDS comprehensive service which are sustainable that cover all froms of services for HIV and se</em><em>x</em><em>ual transmitted infections. In 2015, the lowest coverage of HIV/AIDS examination in Yogyakarta City was at Gedong Tengen </em><em>Public </em><em>Health Center, which was 3,7%. In addition to medical efforts, pregnant women need psychological and social support from people around the family and surronding environment, and motivation to have HIV/AIDS examinations.</em><em> </em><em>The purpose of study is t</em><em>o find out the relationship between pregnant women’s perceptions of family support and the motivation for the HIV/AIDS examination in Gedong Tengen </em><em>Public </em><em>Health</em><em> </em><em>Center, Yogyakarta City.</em><em> </em><em>The study used the analytical descriptive method with the cross-sectional design. The resea</em><em>r</em><em>ch population comprised 48 pregnant women and the sampel consisted of 43 pregnant women. The sampling thecnique was accidental sampling technique. The data analysis in the study used Kendall tau.</em><em> </em><em>The results of the data analysis showed thats most of the pregnat women were 20-35 years old (86%), had </em><em>secondary education </em><em>(60</em><em>.</em><em>5%), </em><em>unemployed</em><em> (74</em><em>.</em><em>4%), and were multipara</em><em>e</em><em> (62</em><em>.</em><em>8%). Perceptions of family support were negative (58</em><em>.</em><em>1%), and their motivation for the HIV/AIDS examination was moderate (72</em><em>.</em><em>1%). The result of the analysis using Kendall tau test showed p-value = 0</em><em>.</em><em>001 and z table = 4</em><em>.</em><em>35</em><em>. </em><em>There is relationship between pregnant women’s perceptions of family support and the motivation for the HIV/AIDS examination in Gedong Tengen </em><em>Public </em><em>Health Center, Yogyakarta City.</em><em></em></p><p><em> </em></p><strong>Keywords</strong>:<em> </em>Perceptions; motivation; HIV/AIDS
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Sayegh, Faisal Al, Wael Almahmeed, Mahmoud Marashi, Ahmed Bahr, Hasan Al Mahdi, Sherif Bakir, Salah Al Humood, and Maha Al Farhan. "Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) in Five Gulf Countries." Blood 104, no. 11 (November 16, 2004): 4067. http://dx.doi.org/10.1182/blood.v104.11.4067.4067.
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Abstract Background: The Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) was the first prospective multicenter registry conducted in five Gulf countries to explore the epidemiology of venous thromboembolic (VTE) disorders and to provide data on diagnosis and disease management. Methods: Data on 242 patients with confirmed VTE were submitted between September 2003 and November 2003 by multidisciplinary specialists from 28 contributing hospitals in the Gulf region (Kuwait, Bahrain, Qatar, Oman, and the UAE). Patients with a suspected diagnosis of VTE were included. The data management team at a sponsor-independent study coordinating center ensured data quality. Differences between groups were assessed by the Chi square test or Fisher exact test for categorical variables. The Student t-test was used for testing proportions. A two-tailed P value <0.05 was considered significant. Doppler ultrasound and lung scans were the most preferred modalities in the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE). Results: The table shows the incidence of VTE. The most common symptoms of DVT and DVT/PE patients were calf pain (72%), calf swelling (63.8%), and localized tenderness (52.2%). Calf pain and localized tenderness were significantly greater (P <0.001) in cases of DVT alone than in cases of DVT/PE. The most common symptoms in patients with PE alone and DVT/PE were dyspnea (83.6%), thoracic pain (69.1%), and cough (40%). Cough and hemoptysis occurred more frequently in PE cases than in cases of DVT/PE (P <0.001). Risk factors for VTE were immobilization >3 days (41.3%), age >65 years (28.9%), a history of VTE (20.7%), and trauma (19%). Surgical intervention in the previous year was an independent risk factor for VTE, 83.8% of such patients experiencing VTE within 4 weeks of surgery. There was a strong association between VTE and orthopedic procedures (P=0.0016). Among surgical interventions, orthopedic procedures induced the greatest number of VTE cases, followed by general surgical procedures and gynecological procedures. Low molecular weight heparins (LMWHs) were chosen to treat 33.7% of DVT cases, while unfractionated heparin (UFH) was used in 21.9% of cases. UFH use in PE and DVT/PE was 57.1% and 55%, respectively, and LMWHs use was 14.3% each for PE and DVT/PE. Oral anticoagulant use in DVT/PE, DVT, and PE was 30%, 19.8%, and 2.9%, respectively. Conclusion: The main risk factors predisposing to VTE are immobilization, age >65 years, a history of VTE, and trauma. The highest incidence was observed in medical patients, necessitating prophylaxis in patients at risk. Previous surgical interventions were independent risk factors for VTE, requiring extended prophylaxis, including outpatient thromboprophylaxis, in patients undergoing extensive surgical procedures. Incidence of DVT, PE, and DVT/PE DVT PE DVT/PE Frequency of cases - n (%) 187 (77.27%) 35 (14.46%) 20 (8.26%) Departments Medical 74 (39.5%) 19 (54.28%) 10 (50%) Surgical 61 (32.62%) 9 (25.71%) 6 (30%) Others 52 (27.8%) 7 (20%) 4 (20%)
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Lin, Sherry. "Reviewer Acknowledgements for Higher Education Studies, Vol. 9, No. 4." Higher Education Studies 9, no. 4 (November 29, 2019): 226. http://dx.doi.org/10.5539/hes.v9n4p226.
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Higher Education Studies wishes to acknowledge the following individuals for their assistance with peer review of manuscripts for this issue. Their help and contributions in maintaining the quality of the journal are greatly appreciated.
Higher Education Studies is recruiting reviewers for the journal. If you are interested in becoming a reviewer, we welcome you to join us. Please find the application form and details at http://recruitment.ccsenet.org and e-mail the completed application form to hes@ccsenet.org.
Reviewers for Volume 9, Number 4
Abdelaziz Mohammed, Albaha University, Saudi Arabia
Alina Mag, University Lucian Blaga of Sibiu, Romania
Ana Maria Carneiro, University of Campinas, Brazil
Anna Liduma, University of Latvia, Latvia
Antonina Lukenchuk, National Louis University, USA
Arwa Aleryani, Saba University, Yemen
Aynur Yürekli, İzmir University of Economics, Turkey
Bahar Gün, İzmir University of Economics, Turkey
Bo Chang, Ball State University, USA
Deniz Ayse Yazicioglu, Istanbul Technical University, Turkey
Dibakar Sarangi, Teacher Education and State Council for Educational research and Training, India
Donna.Smith, The Open University, UK
Geraldine N. Hill, Elizabeth City State University, USA
Hüseyin Serçe, Selçuk University, Turkey
Jisun Jung, University of Hong Kong, Hong Kong
Kartheek R. Balapala, University Tunku Abdul Rahman, Malaysia
Laith Ahmed Najam, Mosul University, Iraq
Lung-Tan Lu, Fo Guang University, Taiwan
Mei Jiun Wu, University of Macau, China
Meric Ozgeldi, Mersin University, Turkey
Najia Sabir, Indiana University Bloomington, USA
Okedeyi Sakiru Abiodun, Adeniran Ogunsanya College of Education, Nigeria
Prashneel Ravisan Goundar, Fiji National University, Fiji
Qing Xie, Jiangnan University, China
Rafizah Mohd Rawian, Universiti Utara Malaysia, Malaysia
Ranjit Kaur Gurdial Singh, The Kilmore International School, Australia
Sadeeqa Sadeeqa, Lahore College For Women University Lahore, Pakistan
Samuel Byndom, Parkland College, USA
Semiyu Adejare Aderibigbe, American University in the Emirates, UAE
Suat Capuk, Adiyaman University, Faculty of Education, Turkey
Teguh Budiharso, Center of Language and Culture Studies, Indonesia
Tuija A. Turunen, University of Lapland, Finland
Xiaojiong Ding, Shanghai Normal University, China
Zahra Shahsavar, Shiraz University of Medical Sciences, Iran
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Silina, Elina, Asnate Jurgele, Arturs Viksne, Zane Abola, Arnis Engelis, and Aigars Petersons. "Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors." Acta Chirurgica Latviensis 16, no. 2 (December 1, 2016): 12–16. http://dx.doi.org/10.1515/chilat-2017-0003.
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SummaryIntroduction.For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens.Aim of the Study.The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations.Material and methods.A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed.Results.Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597).The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge.Conclusions.Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.
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Tanous, Osama, Yossi Azulay, Tal Dujovny, Netta Schwarz, Raul Colodner, Ariel Koren, and Carina Levin. "Renal Function in Transfusion-Dependent β-Thalassemia Patients: A Decade of Follow-up and Comparison between Chelation Regimes." Blood 130, Suppl_1 (December 7, 2017): 949. http://dx.doi.org/10.1182/blood.v130.suppl_1.949.949.
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Abstract Introduction: Glomerular and tubular dysfunctions in β-thalassemia major (β-TM) patients (pts) have been attributed to iron overload, chronic anemia and iron-chelation therapy (ICT) toxicity. We studied glomerular and tubular function in β-TM pts treated with 2 different ICT regimes. Patients and methods: We studied 36 β-TM pts (18 females and 18 males). Mean age was 20.92 ± 9.7 (range 5-45) years. Pts were treated at Emek Medical Center under standard protocols for regular blood transfusions and ICT: 26 pts received deferasirox (DFX) for a mean period of 59 months; this was the first ICT for 6 of them; 10 pts were treated with deferoxamine (DFO) or DFO + deferiprone (DFP) (4 and 6 pts, respectively; hereafter DFO+/-DFP group). Clinical data were collected from pts' files. We evaluated serum urea, creatinine (sCr) and electrolytes, and estimated glomerular filtration rate (eGFR) according to the Schwartz formula for pediatric pts and the Chronic Kidney Disease Epidemiology Collaboration formula for adults; fractional excretion of sodium (feNa), fractional excretion of potassium (feK), calcium-to-creatinine ratio (Ca/Cr), uric acid excretion (UAE), and tubular phosphorus reabsorption were calculated. Urinary N-acetyl-β-D-glucosaminidase (uNAG) was also measured as a marker of tubular injury. Results: No significant differences were found in age, gender or mean hemoglobin (Hb) level between the groups. Levels of sCr, K, Na and feNa were in the normal range for all pts, as was eGFR (mean 104.6 ± 19 mL/min per 1.73 m2); in the DFX group, eGFR was slightly lower than in the DFO+/-DFP group (100.9 ± 17.09 vs. 114.0 ± 22.31 mL/min per 1.73 m2; p= 0.0676). Hypercalciuria (Ca/Cr > 0.25) was found in 28% of pts, increased feK (>15%) in 33%, high UAE (>0.56 mg/dL) in 64%, and high levels of TmP /GFR (>5mg/dL) in 25%. There were no differences in these parameters between the DFX and DFO+/-DFP groups. Increased uNAG was found in 9 pts (25%)-30% in the DFX group vs. 10% in the DFO+/-DFP group, and was significantly higher in the DFX group (mean 10.4 ± 6.1 vs. 5.3 ± 2.7 IU/L, p= 0.012). A moderate negative correlation was found between uNAG levels and mean serum ferritin for the prior 10 years (r= -0.35, p= 0.03). In the DFO+/-DFP group, a strong positive correlation was found between uNAG levels and the amount of iron transfused over the prior 10 years (r= 0.7647, p= 0.021); this correlation was not found in DFX pts. A moderate negative correlation was found for urinary Ca/Cr ratio with 10-year mean serum ferritin level and with 10-year amount of transfused iron (r= -0.35, p= 0.34; r= -0.4, p= 0.014, respectively). These correlations were stronger in the DFO+/-DFP group. A positive correlation was found between urinary Ca/Cr ratio and Hb levels, strongest in the DFO+/-DFP group than the DFX group (r= 0.41, p= 0.001, r= 0.7, p= 0.018), respectively. Renal function had been previously evaluated in 20 pts treated with DFO (Smolkin et al, 2008) and those results were compared with the current values. The eGFR significantly declined in pts switched to DFX (mean eGFR in first study 113.5 ± 26 vs. 100.1 ± 17 mL/min per 1.73 m2, p= 0.0093) but not in pts who continued DFO+/-DFP. A significant increase in sCr compared to the previous study was found in pts who switched to DFX (mean 0.51 ± 0.9 vs. 0.67 ± 0.1 mg/dl, p= 0.0008), but not in pts who continued treatment with DFO+/-DFP. The same observation was made regarding urine Ca/Cr (mean 0.08 ± 0.11 vs. 0.176 ± 0.12, p= 0.001). Conclusion: Ahigh prevalence of renal tubular abnormalities was observed in our pediatric and adult β-TM pts, particularly in the DFX group. The marker of tubular injury-uNAG-was negatively associated with mean 10-year serum ferritin, suggesting ICT's involvement in tubular injury. Moreover, uNAG was associated with transfusional iron burden in the DFO+/-DFP group, but not in the DFX group, proposing a mechanism other than iron overload for the pathogenesis of tubular injury in DFX-treated pts. Finally, glomerular function remained within the normal range in all pts; however a significant decline in glomerular function compared to a decade earlier was observed only in the pts currently treated with DFX. Strict follow-up of renal function in β-TM pts, especially children, is warranted. Disclosures No relevant conflicts of interest to declare.
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Mukherjee, Amrita, Howard Wiener, Russell Griffin, Lisle M. Nabell, Carrie G. Lenneman, Cora E. Lewis, and Sadeep Shrestha. "Abstract 16935: Cardiovascular Disease in Head Neck Squamous Cell Carcinoma Patients - A Case-Control Study Using Electronic Medical Records Data." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.16935.
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Introduction: Cancer survivors have higher rates of cardiovascular disease (CVD) compared to age-adjusted general population. However, traditional CVD risk factors alone do not fully explain increased CVD risk in cancer patients. Cancer-related factors like cancer site, stage and chemotherapy may also contribute to CVD. Despite increase in head neck squamous cell carcinoma (HNSCC) cases in recent years, little is known about CVD risk in HNSCC patients. We aim to assess association of traditional risk factors and cancer-related factors with CVD in HNSCC patients. Methods: Electronic medical records data of 2391 HNSCC patients diagnosed between 2012-2018 at the UAB O’Neal Comprehensive Cancer Center, were included. ICD-9/10 codes were used to identify HNSCC patients, CVD cases and traditional risk factors. CVD cases were defined as those with composite events of ischemic heart disease and/ or heart failure; controls were without any CVD diagnosis. Cancer site, stage and treatment were included. Logistic regression [OR(95%CI)] was used to assess association of risk factors with CVD, adjusting for age, race, and gender. Results: HNSCC patients were mostly white (82.7%), male (74.7%) and had Stage III/IV cancer (46.6%). Oral cavity was the most common cancer site (32.9%), followed by oropharynx (31.7%); 55.4% patients had hypertension, 23.0% had dyslipidemia, and 16.1% had diabetes. CVD was diagnosed in 16.1% patients, who were more likely to be older [median age 67.0 vs 60.0 years, p<0.0001]. In the multivariable model, hypertension [2.08(1.54-2.80)], diabetes [2.03(1.52-2.70)] and dyslipidemia [2.36(1.82-3.07)] were associated with CVD. Smoking status was not associated. Association of cancer stage with CVD varied by cancer site. Stage III/IV oropharynx cancer patients had lower odds of CVD than stage I/II oropharynx patients [0.38(0.30-0.92)]. No association with cancer stage was observed in oral cavity patients. Compared to chemotherapy, surgery [0.85(0.63-1.14)] and other treatments {0.61(0.41-0.89)] had lower odds of CVD. Conclusions: Traditional CVD risk factors remain associated with CVD in HNSCC patients. In addition, cancer-related factors (oropharynx cancer, advanced cancer stage and chemotherapy) are also associated with CVD.
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Hamour, I. M., R. Ferrer, B. Atallah, G. Gabra, M. Soliman, H. Sabbour, and F. Bader. "Defying challenges: mid-term outcomes of international collaborations for a successful heart transplantation program in the middle east." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.2694.
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Abstract Introduction Heart transplantation (HTx) is a successful treatment strategy for advanced heart failure. Survival rates exceed those achieved by medical therapy alone. Lack of suitable donors and cultural perception remain obstacles for receiving this novel therapy. Methods Overcoming challenges we adopted a first-of-a-kind multicenter HTx program, collaborating between Cardiac Centers in India and the United Arab Emirates (UAE). Patients were worked up as part of our newly established HTx program in the UAE, then referred to India for successful HTx. All post HTx follow-up care was continued in the UAE thereafter. Results We assessed 10 HTx recipients, [90% male; mean age 34 yrs]. Five patients required inotropes while one LVAD support pre transplant. Our data outline short waiting-list time and excellent 3 years clinical outcomes. All patients are maintained on Tacrolimus and Mycophenolate Mofetil. Two patient developed acute rejection (celluar and humoral) with graft dysfunction within 18 months. Seventy percent had non-ischemic cardiomyopathy pre-transplant. Three acquired donor transmitted coronary vascular disease. One patient developed aggressive allograft vasculopathy requiring coronary artery bypass grafting. Acute kidney injury requiring renal replacement therapy occurred in 1 patient. Conclusion Defying logistic challenges, donor availability and long HTx waiting list times, we have established a successful multi-center new concept HTx program with excellent mid-term outcome result. Diverse genetic background is evident in the presence of early coronary vascular disease in young donor hearts, requiring extra care in donor screening. This international collaboration has a promising future for new programs in the Middle East. Funding Acknowledgement Type of funding source: None
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"Medical Student and Physician Burnout in the Gulf Region: A Systematic Review." International Journal of Psychiatry 5, no. 2 (June 3, 2020). http://dx.doi.org/10.33140/ijp.05.02.04.
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Background: Physician burnout is highly prevalent throughout medical education, training and practice, and substantially comprises the personal and professional well-being of those affected. This report is the first to comprehensively review published studies on physician burnout coming from the Gulf Region, examining the manner in which burnout is diagnosed, prevalence rates, and unique risk factors. Methods: We conducted a systematic literature review on studies of burnout among medical students, residents, general physicians, specialist physicians and consultant physicians in Arab Gulf countries (Kingdom of Saudi Arabia (KSA), United Arab Emirates (UAE), Kuwait, Kingdom of Bahrain, Qatar, Yemen and Iraq). Results: Our results demonstrate the increased recognition of, and interest in, physician burnout in the Gulf Region. For the most part, our findings parallel reports from other regions around the world. While there is great variability in the reported rates of burnout, at least in part to the different ways burnout is measure and defined, most studies of medical student, resident and attending-level physicians report burnout rates of between 30-50% in each cohort. Findings related to risk factors are inconsistent. Some reports suggest that working in the same center for long time, time on-call, shift work, tests/examinations, unfair assessment from superiors, lack of support from superiors, work demands affecting personal/home life, less satisfaction with career, less satisfaction with income, disorganized patient flow to clinics, patient pressure and violence, more paper work, less cooperative colleagues and job insecurity all may be related to burnout. Personal factors like having chronic disease, taking psychotropic drugs, smoking, sleeping less than 6 hours, suffering from sleep deprivation, back pain or having social problems also are associated with burnout, while participating in sports and having hobbies seem protective. Paralleling reports from other regions of the globe, burnout in the Gulf Region is associated with physical, psychological and occupational disturbances. Conclusions: This systematic review of burnout in the Gulf Region confirms the universality of physican burnout regardless of age, gender, race, geography, religion, cultural background or positions in the medical job hierarchy, and the critical need to find effective preventative strategies.