Incidence of thyroid cancer in Abu Dhabi, UAE: A registry-based study.

Context: Thyroid cancer is the most common endocrine malignancy. It is ranked second among females of the Gulf Cooperation Council States and the sixth most common cancer among the United Arab Emirates population. Aims: We herein describe the incidence and distribution of different types of thyroid cancers and the demographic features of patients diagnosed with thyroid cancer in the Emirate of Abu Dhabi. Settings and Design: The study design was Abu Dhabi cancer registry and retrospective chart review. Subjects and Methods: This is a retrospective cancer registry description of patients with the different types of thyroid cancers diagnosed between January 2012 and December 2015 in the Emirate of Abu Dhabi. The incidence of thyroid cancer throughout the study period was calculated. Gender, age, ethnicity, and type of thyroid cancer were described. Statistical Analysis Used: Descriptive statistics of patients' characteristics are reported as means (standard deviation) for continuous variables and total and relative frequencies (percentage) for categorical variables. Results: The incidence of thyroid cancer was found to increase annually, reaching 7.9 cases per 100,000 population in 2015. A total of 603 patients were diagnosed with thyroid cancer in the Emirate of Abu Dhabi from 2012 to 2015. Of these, 431 (71.5%) were women and 172 (28.5%) were men. The overall mean age at diagnosis was 40.2 years. Over a third of the patients were between 30 and 39 years. The classical papillary thyroid cancer type was found in 67.7% of cases. Conclusions: A substantial increase in thyroid cancer rates was found between 2012 and 2015. The majority of thyroid cancer cases were diagnosed in women between the ages of 30 and 39 years. Classical papillary thyroid cancer was the most common type.

The Effect of Protein Consumption on Fat-Free Mass, Fat Mass, and Weight Loss 1 Year After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass.

OBJECTIVE: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) both limit protein and calorie intake and result in loss of fat-free mass (FFM), fat mass (FM), and weight. This study examined protein consumption and body composition changes after bariatric surgery. METHODS: A prospective study of patients undergoing SG and RYGB between January 1 and December 31, 2016, with 1-year follow-up. Dietary, body composition, and physical activity data were collected at 3, 6, and 12 months post-operatively by bioelectric impedance and food records. Clinical laboratory data were obtained pre- and post-surgery. RESULTS: One hundred and five patients (62 [59%] SG and 43 [41%] RYGB) were included in this study. Mean age was 31.8 ± 7.22 years. TWL% after 1 year in SG was 27.11% (p < 0.001) and that in RYGB was 30.41% (p < 0.0001). Reported protein consumptions after RYGB increased from 41.59 ± 22.86 g/day at 3 months (p = 0.004) to 57.90 ± 19.24 g/day at 12 months compared to 52.36 ± 25.04 g and 53.54 ± 29.75 g in SG. Similarly, energy intake after RYGB at 3 and 12 months increased from 895.9 ± 422.61 to 1188.15 ± 463.86 kcal/day compared to 1007.67 ± 422.62 to 1068 ± 575.89 kcal/day after SG (p = 0.009). There was a significant loss of fat-free mass and muscle mass in SG patients at 3 and 12 months from 61.58 ± 3.61 kg and 58.47 ± 3.09 kg to 54.18 ± 11.05 (p < 0.001) and 51.55 ± 10.62 (p = 0.004) but not in RYGB patients. Physical activity levels were similar in SG and RYGB patients. CONCLUSION: There was a significant preservation of muscle mass after RYGB. Protein intake in majority of the patients was below 60 g/day during the first year after SG and RYGB.

Clinicopathological characteristics of gene-positive breast cancer in the United Arab Emirates.

INTRODUCTION: Breast cancer is the most prevalent cancer in the United Arab Emirates (UAE). This is the first study to provide data on predisposition of breast cancer susceptibility genes with associated clinical and pathological aspects in the UAE. MATERIAL & METHODS: A retrospective chart review for breast cancer patients undergoing genetic testing from 2016 to 2018. According to National Comprehensive Cancer Network (NCCN) guidelines genetic testing was offered. The analyzed data included; age, ethnicity, family cancer history, pathogenic variant, histopathology, stage, molecular subtype and proliferation. RESULTS: 309 patients underwent genetic testing with a positive result in 130 patients (11.9%) over a period of 36 months. In 34.6% pathogenic and likely pathogenic variants were identified. BRCA2 was the most common gene identified. The mean age was 42.9 years (±9.01). Positive family history was identified in 66 patients (50.7%). Majority had stage 1 or 2 disease (66.2%), invasive ductal carcinoma (81.5%) and hormone receptor positive cancer (45.3%). CONCLUSIONS: This is the first study in the UAE to describe the clinical and pathological characteristics of hereditary breast cancer in a mixed ethnic group with dominant Arabic population. Further genetic studies will be required in the UAE population, as the prevalence of breast cancer continues to rise.

Seizure and coma secondary to Conn's syndrome: a case report.

BACKGROUND: Conn's syndrome is a curable condition if identified properly. It is characterized by autonomous secretion of aldosterone from the adrenal gland cortex. Its morbidity is related to the increased risk of cardiovascular diseases. CASE PRESENTATION: We report the case of a 48-year-old man of African descent presenting with generalized tonic-clonic seizure and coma secondary to hypertensive encephalopathy. A biochemical evaluation revealed a very high aldosterone level and an undetectable renin level, both are compatible with primary aldosteronism. The presentation of the following confirms the diagnosis of primary aldosteronism: spontaneous hypokalemia, an undetectable renin level, and a high aldosterone level. Abdominal computed tomography revealed a left adrenal adenoma. Adrenal venous sampling confirmed lateralization of aldosterone excretion from the left adrenal gland. Our patient underwent left laparoscopic adrenalectomy that confirmed a left functional adrenal adenoma. After 12 months of follow up, his hypertension was controlled on only one antihypertensive drug which was down from four drugs preoperatively. CONCLUSION: Conn's syndrome, in this case, was complicated by coma secondary to seizure. Adrenalectomy normalized the hypokalemia and improved resistant hypertension. Potassium supplementation and several antihypertensives were discontinued as our patient became normokalemic and normotensive on one antihypertensive agent.

Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass.

BACKGROUND: Internal hernia rate after Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is variable (0.5%-9%). METHODS: We retrospectively reviewed all patients who underwent diagnostic laparoscopy for possible internal hernia after RYGB from 2009 to 2016. All internal hernia defects were closed. RESULTS: We performed 574 RYGB cases between 2013 and 2016, 33 diagnostic laparoscopies were performed (6 after RYGB done at our institution & 27 after RYGB done at outside institutions). Diagnostic laparoscopies after RYGB done at our institution showed internal hernia in 3/6 (50%), none at Petersen space, none had incarcerated small bowel or were converted to open. While 20/27 (74%) of diagnostic laparoscopies after RYGB done at outside institutions had an internal hernia, 18/20 (90%) at Petersen space, 15/27 (55%) had incarcerated small bowel and 3.7% needed small bowel resection or were converted to open. Our internal hernia rate after RYGB was 0.5%. Computerized Tomography (CT scan) was falsely negative in 44-50% of patients with laparoscopy after RYGB. CONCLUSION: Diagnostic laparoscopy is more accurate than CT scan in evaluating patients with abdominal pain after RYGB.

Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients.

INTRODUCTION: Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. METHODS: Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. RESULTS: During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. CONCLUSION: Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.