P101. Research setting in the United Arab Emirates (UAE): Opportunities and Challenges

Suad Hannawi1, Haifa Hannawi1, Issa Al Salmi2

1Ministry of Health and Prevention, Dubai, United Arab Emirates, 2The Royal Hospital,

Muscat, Oman

Background: Evidence based knowledge is the cornerstone in the future humanistic strategic

planning for any nation. The inexorable advance of the medical knowledge fueled by higher

education and research. Therefore, each country must review and reorganize its capacity to access

and benefit from the research that shapes the whole population health. Hence, this article will

analyze the health research environment in the Ministry of Health and Prevention (MOHAP) of

the United Arab Emirates (UAE), its opportunities and its challenges.

Methods: Narrative review that aim to explore the setting of medical research in the UAE.

Results: The challenges of research in the United Arab Emirates occur because of the 1-complexity

of the mixed culture demography. The UAE’s population is made up of several different

demographic groups from different cultural, geographical, and socioeconomic backgrounds, as it

relies on the expatriate for the growing economy. 2-complexity of the health system; UAE’s health

service is delivered by various health authorities, with each authority build up their own regulations

resulting in absence of a unifying nationwide health policies and research regulations and

guidelines. 3-lack of the Organizational and administration support for the research and

researchers. 4-absence of Qualified research centers that focus on researches and researchers. 5-

lack of research allocated financial resources 5-absence of proper research environment including

basic research training and time allocated for research, and finally 6. Lack of public awareness

about research

Conclusions: Research is a complicated process that requires long-term commitment and support.

Therefore, there is an urgent need to establish an adequate framework and listed requirements that

can support the researchers and the research sites in getting the needed funds and resources to self-

sustain research activities for the best of public health care strategies.

P201. Acute Myocardial Infarction in the Young: a study of risk factors and cardiac

outcomes in patients aged less than 45 years compared to 45 years or more.

Kashif Bin Naeem1, Suad Hannawi1, Mohammad Ali1

1Al Kuwait Hospital, Dubai, UAE

Background: Acute myocardial infarction is mainly found in older age groups. However, recently

it is being increasingly reported in younger population as well. The disease carries a significant

morbidity, psychological effects, and financial constraints for the person and the family when it

occurs at a young age. Hence, we conducted a study on the risk factors and in-patient cardiac

outcomes in young patients with acute myocardial infarction compared to older patients.

Methods: A prospective study of 424 consecutive patients who were admitted to our centre with a

diagnosis of acute myocardial infarction (based on the 4th Universal Definition of Myocardial

Infarction, European Heart Journal, 2019). Patients were classified according to age into two

groups: group 1 = < 45 years; group 2 = ≥ 45 years. Risk factors and in-patient cardiac events were

analysed for both groups. Statistical analysis was performed using t-test for continuous variables

and Chi-square test for categorical variables. P-value <0.05 was considered significant.

Results: Total of 424 patients were studied. 115 patients belonged to group 1 (< 45 years age) and

309 to group 2 (≥ 45 years age). Compared to group 2, patients in group 1 (< 45 years age) were

more males (97% vs 87%, p=0.002), smokers (53% vs 28%, p=0.001) with family history of

premature CAD (14% vs 6%, p=0.015); more STEMI presentations (58% vs 44%, p=0.02); higher

mean total cholesterol (5.2 mmol/L vs 4.7 mmol/L, p= 0.005) and mean triglycerides (2.6 mmol/L

vs 1.7 mmol/L, p=0.01). There was no difference in body mass index, LDL-cholesterol and left

ventricular ejection fraction between the two groups. Regarding in-patient cardiac events, there

was no difference in cardiogenic shock, arrhythmias or mortality between the two groups;

however, more heart failure was seen in group 2, aged ≥ 45 years (24% vs 6%, p=0.01).

Conclusions: Acute myocardial infarction in young patients aged < 45 years occurs predominantly

in male smokers with high total cholesterol. They commonly present as ST-elevation myocardial

infarction. Risk of mortality, cardiogenic shock and arrhythmias is the same compared to older

patients, however, with less risk of heart failure.

P301. Self-Perceived Satisfaction with Personal Dental Appearance Among General

Population in The UAE

Simy Mathew1, Alsafa A Mahdi1, Budoor Jasim1

1Ajman University, Ajman, United Arab Emirates

Background: Self perceived satisfaction with respect to dental aesthetics is an important factor in

establishing self-esteem. This study was conducted to assess self-perception of general population

to their dental appearance and to assess if dental appearance satisfaction has a social &

psychological impact.

Methods: pre structured self-administered questionnaire was distributed among the students and

general populations at 3 different universities in the UAE. Sampling was based on convenience.

Results: 39% of the total sample were males while 61% were females. The mean age of the

sampled population was 20.07+9.8 years.46% of the population were satisfied with their dental

appearance and 40% wished their teeth looked better. Among the respondents, 44% want to change

their teeth color, 11% would like to change their teeth size, and 31% want to change the

arrangement of their teeth.

Conclusions: Perceived self-satisfaction of dental aesthetics was higher in dental students than

other students. Males were more impacted by the psychosocial factors than females.

P302. Validation of Informed Consent in Dental Practice

Alexander M Luke1, Muna Eisa1, Sahar Asim1

1Ajman University, Ajman, United Arab Emirates

Background: Informed consent is the process of providing the patient with relevant information

regarding their diagnosis and treatment, so that an educated decision can be made regarding their

treatment. The aim of our study was to identify the legitimacy of informed content & to assess if

the patients are well informed by the clinician.

Methods: Ethical approval was obtained. A cross sectional survey was conducted to take assess

the perception of patients on the informed consent process before undertaking dental treatment.

Results: Our results show that the informed consent was signed by all the participants, with

majority of the participants signing the informed consent in the reception before entering the clinic.

Most of the participants agreed that they understood the process of consent form. The treatment

offered was explained to the patient by the treating doctor.

Conclusions: There is a lack of knowledge among patients attending dental clinics with regard to

various kinds of treatment However, the proposed treatment was being explained to the patient by

the doctor.More emphasis should be made among dental students, regarding the fact that informed

consent process serves more than mere paper document that is added into patients files

P303. Use of cone-beam computed tomography to evaluate root canal morphology and C-

shaped root canal morphology in mandibular second molars in Emirati population: a

retrospective study

Summayah Khawaja1, Nouf Alharbi2, Jahanzeb Chaudhry1, Mohamed Jamal1

1Mohammed Bin Rashid University of medicine and health sciences, Dubai, UAE, 2Healthpoint, Abu Dhabi, United Arab Emirates

Background: A comprehensive knowledge of root canal morphology and it’s variants is essential

for the success of non- surgical and surgical endodontic therapy. Root canal morphology of

mandibular second molar shows a lot of variation, one of these variants is C- shape canal

morphology .

Many studies have been conducted around the world, using cone beam computed tomography

(CBCT) to evaluate the root canal morphology and C- shaped canals in mandibular second molars.

The prevalence of C- shape canal morphology of mandibular second molar, is influenced by

ethnicity. For example, the prevalence is 44% in Chinese population, while it is 7.8% in British

population. No study has been conducted to evaluate the mandibular second molar canal

morphology and C- shape canal prevalence in Emirati population.

The aim of this study is to describe the root canal morphology in mandibular second molars in

sample of Emirati population.

Methods: This is a retrospective study, in which 254 CBCT scans of patients treated at Healthpoint

Dental Center (Mubadala,Abu Dhabi), between 2016-2018, have been obtained and analyzed.

All CBCT scans were acquired using Orthophos SL (Dentsply Sirona, USA) using a standard

imaging protocol (CBCT at HDC are taken by same technician, using same CBCT machine with

same parameters; 85 Kv, 7 mAs, with exposure time of 5 seconds and voxel size of 0.15 mm).

Two evaluators reviewed and recorded the findings twice with an intersession delay of at least 30

days.

The canals were classified according to Vertucci classification and the C shaped canals were

classified according to the Modified Melton’s classification.

Results: More than two third of the mandibular second molars had two roots. Type II and Type I

Vertucci classification was the most frequent in the mesial and distal roots, respectively. The

Prevalance of C shaped mandibular second molars in Emirati population is 17.9%. In patients with

C shape mandibular second molar in one quadrant of the arch, 81% of these of patients had a C

shaped mandibular second molar in the other quadrant as well. In 95% of C shaped molars, the

canal morphology classification changed from coronal to apical.

Conclusions: According to our results, Type II is more common in the mesial roots and Type I is

the most frequent canal morphology in the distal root.

Our data reflects that mesial root is more complicated than the distal root.

There is a relatively high prevalence (17.9%) of C shaped canal morphology in Emirati

population.

P304. A systematic review and meta-analysis of primary teeth caries studies in Gulf

Cooperation Council

Wafa Obaid Alayyan1, Manal Alhalabi1, Iyad Hussien2, Amar Khamis4, Mawlood Kawash5

1Wafa Alayyan, Ras Alkaimah, UAE, 2, Dubai, United Arab Emirates, 3, Dubai, United Arab

Emirates, 4, Dubai, United Arab Emirates, 5, Dubai, United Arab Emirates

Background: Objectives: The aim of the study was to evaluate the prevalence and severity of dental

caries in pre-school children in the Gulf Cooperation Council (GCC) area.

Methods: Methods: A search of literature was conducted to identify articles of dental caries in

primary dentitions published during the period from January 1st, 1992 to June 30th, 2016.

PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant

articles. The search strategy employed both dental subject headings and free-text terms.

Results: Results: Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were

further excluded. Only 34 studies were included in the systematic review and meta-analyses. The

overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A

high level of heterogeneity in the selected studies was found as demonstrated by Q-value of

2538.501 (df=21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape

at the bottom in both dmft and prevalence studies indicating absence of publication bias, which

was also confirmed by insignificant result of Egger’s regression statistical test (Egger’s test P=

0.179– 0.358).

Conclusions: Conclusion: Caries in the primary dentition in the GCC States was high both in terms

of mean dmft (5.14) and prevalence (80.95%).

P305. Eco-Friendly dentistry in UAE and its practical application in various dental

practices in UAE

Ibrahim Dannoura1, Rafeh Abou Assali1, Obaid Al Shamsi1

1Ajman University, AJMAN, United Arab Emirates

Background: Eco-friendly dentistry is a newly evolving practice of dentistry, which encompasses

a simultaneous devotion to sustainability, prevention, precaution, and a minimally invasive

patient-centric, as well as global-centric treatment philosophy. It is also known as green dentistry

or ecodentistry. It is a budding concept in the western countries which is beneficial to the

environment, the patient, clinic staff, and also to the dentist. It not only helps control the waste

pollution in the dental practice but also saves water, energy, and other resources in the dental clinic.

This research was done in the UAE.

Methods: Getting ethical approval from MOH to do frequency analysis to sort out percentage of

clinics of the UAE that follow the eco-friendly regulations, after signing a consent between the

two parties.

The inclusion criteria was to study MOH Licensed dental clinics and hospitals in UAE.

Results: In our statistics more than 50% of the clinics that we inspected follow the regulations of

eco-friendly dentistry in some aspects.

In other aspects less than 50% of the clinics were following these regulations.

Conclusions: We noticed that public awareness has risen toward this issue, and dentists all over

the UAE were interested about the study.

Comparing to research that has been done in other countries, we found that UAE is ready to

develop in this field, based on the quality of its infra structure.

P306. A Systematic Review and Meta‑analysis of School Children’s Caries

Wafa Obaid Alayyan1

1Wafa Alayyan, Ras Alkaimah, UAE, 2Manal Al Halabi, Dubai, United Arab Emirates, 3Iyad Hussein, Dubai, United Arab Emirates, 4Amar Khamis, Dubai, United Arab

Emirates, 5Mawlood Kowash, Dubai, United Arab Emirates

Background: Objectives: The aim of the present study was to evaluate the prevalence and severity

of dental caries school children in the Gulf Cooperation Council (GCC) area, to help the

development of systematic approaches for preventive oral care programs in the GCC states and to

provide sound information for oral health promotion and public health care.

Methods: A comprehensive search to identify both published and unpublished articles concerning

relevant studies of dental caries in children aged 6–16 years for their permanent teeth published

from 1992 to 2016 with no language and time limit was performed. The search strategies employed

electronic databases and incorporated both dental subject headings and free‑text term.

Results: The overall mean decayed, missing and filled teeth in the permanent teeth was 2.57, and

the prevalence was 64.7% in the GCC area

Conclusions: Most of the studies were conducted in the Kingdom of Saudi Arabia. The results may

not be a true reflection, and other countries in GCC are urged to study the prevalence and severity

of caries in their children population.

P307. Oral Health Status, Oral Hygiene Practices And Utilization of Dental Services Among

Pregnant Women In Dubai- a Cross-sectional Study

Sosham John1, Hamda Sultan AlMesmar1, 1Dubai Health Authority, Dubai, United Arab Emirates

Background: Pregnancy is a physiological condition that brings about various changes in the oral

cavity along with other changes in the body. The oral changes include enamel erosion of teeth,

caries, gingivitis, periodontitis, loose teeth and pregnancy oral tumor. Oral health is an integral

part of preventive healthcare for pregnant women. The perinatal period is a ‘teachable moment’

for oral healthcare and can potentially have an effect on maternal and infant health. This study

aims to determine the oral health problems, oral hygiene practices and identify the patterns of

dental treatment utilization among a representative population of pregnant women in Dubai.

Methods: A cross sectional study was conducted using data from anonymous structured

questionnaires between May and December 2018. 1450 pregnant women from the different

geographical zones of Dubai filled the questionnaires distributed in English and Arabic. Mean and

standard deviation were calculated for continuous variables, frequency and percentage for

categorical variables. Descriptive and inferential statistics such as chi-square test were used to

analyze patient characteristics of pregnant women who did not visit a dentist during their

pregnancy barriers for the same.

Results: 48.86% (n=723) reported experiencing at least one dental problem in their pregnancy, but

only 17.4% (n= 253) of all the women surveyed reported visiting a dentist. 97.8% of women

brushed twice a day but only 21.6% used floss to clean their teeth. In general, the most cited reason

for not going to the dentist was no perceived dental problem (51.8%). 20.7% (n=300) reported that

their oral health problem affected their daily quality of life but only 26% (n=78) of them reported

visiting the dentist for treatment. Among those who did not attend (n=222) concerns regarding

safety of dental treatment during pregnancy was the most cited reason (60%, n=133). 23.7% had

received some information about oral health care during pregnancy from a healthcare professional.

Conclusions: Though a significant number of pregnant women experience dental problems,

currently only a few women visit the dentist during their pregnancy and receive information

regarding their oral care. In order to correct the misconception about the fear of dental treatment

in pregnancy, the dental professional along with other healthcare providers like the obstetrician,

gynecologist and midwives must work together to pass on important messages about the

importance of dental care and good oral hygiene. Strategic programs for the treatment of pregnant

women in Dubai must be designed and implemented to incorporate oral health promotion towards

an effort to allay unfounded fear of dental treatment and encourage referral for dental care.

P308. The new technological advances in the field of Oral and Maxillofacial Surgery

Dr.Amjid Mustafa Sadek1, Dr. Sabrin Ali Azim1, Dr.Osama Mheir AlSaadi1 1RAKCODS,

Ras Al-Khaimah, United Arab Emirates

Background: The preoperative planning of surgery is the most important part in modern surgical

treatments.

Nowadays many technological concepts have been developed and being used currently, in the

field of preoperative planning such as, virtual reality, augmented reality and 3D printing

technology.

The aim of this research is to check how to plan and perform a surgery through using Augmented

Reality and 3D Scanning technology, and measure its effectiveness in helping surgeons.

Methods: The research data was collected through using E-questionnaire that was created for this

study. This study aimed to survey the surgeons who are capable of using the VR technologies as

well as experienced in traditional surgical techniques.

An iPad was used to facilitate collecting the e-questionnaires data. The data was filled by the

surgeons of Maxillofacial Surgery department in Azerbaijan Medical University. The data then

was statistically analyzed.

Results: The Results had showed that the use of VR/AR technology in preoperative planning will

help in constructing better diagnosis for the patients of oral and maxillofacial surgery, which will

help in both decreasing the necessary time of the operation and improving the accuracy of the

surgeons.

Conclusions: It is useful effect on OMFS and also in medical aspects.

In this research we checked the effective of how to plan and perform a surgery through using the

digital technology in cranio-maxillofacial complex operation’s and how it helps the surgeons in

difficult cases that require a lot of time.

P309. Management of arthrosis in temporomandibular joint

Elchin Tayyar Ahmadov 1

Background: At this moment diagnostics, treatment of diseases and damages temporomandibular

joint are the basic actual problem of stomatology and maxillofacial surgery. Arthroses

temporomandibular joint differ distinctive clinic, pathogenesis and tactics of treatment for all

pathologies of maxillofacial area, including temporomandibular joint.

Methods: Clinical researches cover the prospective analysis of 70 patients with arthroses

temporomandibular joint. After studying the traditional clinic-laboratory indicators in diagnostics

of patients, we have entered a package anamnesis information, made by us.

Besides on the basis of the anamnesis heredity research of patients are conducted, and local

parameters are also studied. From visualization methods were used radiography,

orthopantomography, including 6-7-8-9 programs, are provided for temporomandibular joint, a

computer tomography and nuclear-magnetic resonance.

Results: Results of treatment of patients with arthroses temporomandibular joint have shown

clinical value, efficiency and practical importance of the methods of treatment. We develop the

basic aspects of features of treatment and practical recommendations are made. The remote results

of research have confirmed treatment firmness and perspective of the methods. For the purpose of

improvement of treatment process diagnostic criteria and algorithms are developed. Thus, as a

result the received results have proved efficiency of the conducted research.

Conclusions: purpose of improvement of treatment process diagnostic criteria and algorithms are

developed. Thus, as a result the received results have proved efficiency of the conducted research.

P310. The psycho-social and quality of life impacts of malocclusion and orthodontic

treatment in adolescents

Huda 1RAKCODS, RAK, UAE

Background: Malocclusion may have an impact on psycho-social aspects but the evidence is less

clear cut regarding the potential benefits associated with orthodontic treatment.

Methods: Participants completed a questionnaire regarding social impacts before and after

functional appliance treatment.

Results: 114 patients were recruited, 65 patients in the treatment group and 49 patients in the

control group. There was no statistically significant difference between the groups at T2.

Conclusions: Based on the questionnaires used, there were no significant social benefits associated

with functional appliance treatment.

P401. A Comparative assessment of Metabolic Syndrome and its association with Vitamin

D and other risk factors in Type 2 Diabetes Mellitus Patients

Ammar Abdulrahman Jairoun1, Moyad Jamal Shahwan2, Sabaa Saleh Al-Hemyari3

1Health And Safety Dubai Municipality, Dubai, UAE, 22College of Pharmacy and Health

Sciences, Ajman University, Ajman, United Arab Emirates, 3Pharmacy Department,

Ministry of Health and Prevention, Dubai, United Arab Emirates

Background: Diabetes mellitus (DM) is one of the most complex and rapid growing diseases

globally, affecting more than 415 million with estimated prevalence rate of 9% in adults around

the world. The overall aim of this study is to determine the overall prevalence of metabolic

syndrome using World health organization (WHO) ; National Cholesterol Education program

(NCEP) and International diabetic federation (IDF) guidelines and to study its association with

vitamin D and other biochemical parameters in patients with type 2 Diabetes mellitus.

Methods: A retrospective cross-sectional study was carried out at private health care center. A total

of 291 diabetic patients aged 18 years and above attended the clinic from August 2017 through

April 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from

the medical records of patients. Statistical analysis was carried out using (SPSS, version 23).

Results: A total number of 291 patients with type 2 diabetes mellitus (Male, 124; female; 167;

mean age, 54.6 years) were enrolled in this study. The overall prevalence of metabolic syndrome

among the study subjects was 48.1% [95%CI: 42.2-53.9], 87.3% [95%CI: 83.4-91.1], 64.9%

[95%CI: 59.4 -70.4] using WHO, IDF and NCEP-ATPIII criteria respectively. There was

moderate agreement between IDF and NCEP-III κ = 0.425 (95% CI, 0.325 - 0.525), p <0.0001,

fair agreement between IDF and WHO κ = 0.283 (95% CI, 0.212 - 0.354), p <0.0001 and moderate

agreement between WHO and NCEP-III κ = 0.490 (95% CI, 0.395- 0.584), p <0.0001 in the

diagnosis of metabolic syndrome. The highest prevalence was reported following IDF diagnostic

criteria. Sex, triglyceride and fasting blood sugar were associated factors of metabolic syndrome

by all the three diagnostic criteria of metabolic syndrome

Conclusions: A significant variance in the prevalence of metabolic syndrome was reported

between WHO, IDF and NCEP criteria. These results call for immediate intervention by the health

regulatory authorities to reduce this variation and to harmonize the guidelines used for diagnosis

of metabolic syndrome.

P501. Sensitivity and Specificity of Tympanometry in The Diagnosis of Serous Otitis Media

Eyad Darraj1, Yusur Abdulghafoor1, Mohannad Fakhoury1, Fateh AlSalem1

1Dubai hospital, Dubai, United Arab Emirates

Background: Serous Otitis media (SOM) is one of the most common conditions during childhood.

It’s estimated that 90% of children have SOM at some

time before school age, it might affect children as young as 6 months with peak incidence at 4

years old.

SOM is characterized by collection of fluid behind an intact eardrum, with subsequent symptoms

of hearing loss, clumsiness, ear discomfort and speech delay. Early diagnosis and management of

SOM are crucial to prevent these sequela.

On daily practice, ENT specialists depend on tympanometry in SOM diagnosis and patients

booking for surgery to evacuate the fluids. However, intraoperatively it is noticed that the accuracy

of this test is not always high.

The aim of this study is to evaluate the sensitivity and specificity of Tympanometry in diagnosis

of SOM.

Methods: 139 patients underwent myringotomy for the treatment of SOM were included in this

study. The evaluation included: the presenting complaint, physical examination, preoperative

tympanometry result and intraoperative findings.

The sensitivity and specificity of tympanometry results were calculated opposite to the gold

standard method of diagnosis: Myringotomy.

Results: The study included 139 patients 90 patients are male (64.7%) and 49 are female (35.3%)

with mean age of 5.2 year.

The most common complaint was hearing loss in 77 patient (55.4%).

Type B tympanometry found in 113 patients (82.5%) and fluid was found in 111 patients (79.9%).

The sensitivity and specificity of Type b tympanometry : 88.2% and 40.7% respectively. Statistical

tests found significant findings with P value < 0.05.

Conclusions: SOM is common in age group 3-6 years. History of hearing loss along with dull

tympanic membrane and type B tympanometry strongly suggest SOM. However, in our study we

found out that Type B graph highly suggests SOM, while the absence of this graph not necessarily

rule out fluid collections. So Physicians should be aware while interpreting tympanometry graphs

and evaluate these results in the context of patients history and examination.

P502. Appropriateness of CT Scan Paranasal Sinuses Requests for Rhino-sinus Disease in

all groups

Eyad Darraj1

1Dubai hospital, Dubai,

Background: CT Paranasal sinuses is one of the most commonly requested radiological

investigations from the ENT outpatient department. There are no formal guidelines for its use,

although guidance has been given via the European Position Paper on Rhinosinusitis and Nasal

Polyps (EPOS) and the American College of Radiology (ACR).

However, the scan is not without complications. As with all CT scans, it delivers a large dose of

ionizing radiation to the patients. Additionally, the cumulative nature of the radiation present

increases risk of the long-term effects of radiation exposure and potential malignancies.

The aim of this audit is to evaluate the performance of the ENT Specialists - Dubai Hospital against

the international guidelines in one year, after presenting the results Doctors were educated about

the proper indications of CT paranasal sinuses and printout of the guidelines were distributed in

the clinics.

To close the audit-loop, a re audit cycle was carried out the following year to detect any practice

improvement.

Methods: Data Collection method: Retrospective

Data Source: Patients’ record

Population under study: all patients with CT Scan paranasal sinuses requested by ENT outpatient

Department

First Cycle: from 1st September 2017 until 1st September 2018 (336 patients)

Re-audit Cycle: from January 2019 until April 2019 (nearly 100 patients)

Exclusion Criteria: nil

Pilot study is planned

The requests were analysed for patient's symptoms, findings, treatment before imaging,

undergoing surgery and most importantly : compatibility with the guidelines

Results: First Cycle: 368 CT requests were ordered, the main complaint was nasal blockage in

55% followed by headache 25%. Deviated nasal septum was found in 35%, medical treatment was

given in about 77%. After overall assessment 61% of the requests were compatible with the

guidelines.

Reaudit Cycle: 111 requests were studied and found : nasal blockage as the main symptom in 53%

of the patient. Deviated septum in 33%. Luckily, treatment before CT requests increased to 99%

and after global assessment of the requests, the compatibility with the guidelines was 73%.

Comparing two cycles, the performance of our doctors improved by about 11%

Conclusions: Education of the healthcare providers resulted in improvement of medical practice

Emphasizing on the proper indications of CT paranasal sinuses as per the international guidelines

:rhinosinusitis refractive to medical therapy, a pre- operative tool for procedural guidance (FESS,

DCR), suspicious symptoms, trauma, and congenital anomalies and in patients with any

orbital/cerebral complications of sinusitis.

P601. Psychiatric Poly-pharmacy: An Audit Cycle

Dr Subas Chandra Pradhan1, Ms Shibimol Joseph1, 1Al Amla Hospital, Dubai, United Arab Emirates

Background: Background:

Poly pharmacy is rampart in clinical practice and is often reflective of diagnostic uncertainty and

wastage of clinical resources. Regular monitoring of prescriptions followed by ongoing education

are considered to be the cornerstones of changing the prescribing habits of physicians.

Aim of the study/audit:

This audit aimed at finding out the prevalence of poly pharmacy amongst Psychiatry OPD

attendees and compare it with that of another year after concerted educational interventions.

Methods: The audit cycle was conducted in two phases at Al Amla Hospital, Dubai.

Phase 1 (2015) consisted of collecting 100 physical case files (subsequent active cases seen

between January and June 2015) and marking them using a specially constructed audit form.

In phase 2 (2017) the same method was employed using another 100 case files. The interval period

was used to present the initial findings (multiple number of times during research meetings and

journal clubs) and educate clinical staff regarding the implications of the results.

Results: The average number of psychotropics per script was 3.4 in 2015 compared to 1.91 in

2017. Approximately 88% of patients received more than 2 medications per script.

Conclusions: The implications of these findings are discussed at length, especially keeping in mind

the issues surrounding medication optimization.

P602. How Artificial Intelligence help in estimating number of people with Autism

Spectrum Disorder in Dubai?

Dr KADHIM ALABADY1

1DHA, Public Health Protection Department, Dubai,

Background: Introduction: Autism is a complex developmental disability that typically appears

during the first three years of life and is the result of a neurological disorder that affects the normal

functioning of the brain, affecting development in the areas of social interaction and

communication skills.

Autism poses a particularly large public health challenge and an inspiring lifelong challenge for

many families; it is a lifelong challenge of a different kind.

Purpose: To estimate the number of people with Autism Spectrum Disorder (ASD) through

artificial Intelligence.

Methods: Method: In order to carry out this assessment we have used two approaches:

• Qualitative methodology (focus groups with mental health and neurological experts)

• Quantitative methodology. Prevalence or incidence modelling (Artificial Intelligence)

estimates based on international research.

Results: • Autism is the most common of the Pervasive Developmental Disorders. Dubai Autism

Center estimates it affects 1 in 146 births (0.68%). If we apply these estimates to the total number

of births in Dubai for 2014, it is predicted there would be approximately 199 children (of which

58 were Nationals and 141 were Non–Nationals) suffering from autism at some stage.

• 16.4% of children (through their families) seek help for ASD assessment between the age

group 6–18+. It is critical to understand and address factors for seeking late–stage diagnosis, as

ASD can be diagnosed much earlier and how many of these later presenters are actually diagnosed

with ASD.

Conclusions: • Autism spectrum disorder (ASD) is a public health concern in Dubai. Families do

not consult GPs for early diagnosis for a variety of reasons including cultural reasons.

• Training of GP’s to aid early diagnosis of Autism and increase awareness. Since not all

GP’s are trained to make such assessments increasing awareness about where to send families for

a complete assessment and the necessary support.

• There is an urgent need for an adult autism center for when the children leave the safe

environment of the school at 18 years. These individuals require a day center or suitable job

training/placements where appropriate.

• There is need for further studies to cover the needs of people with an Autism Spectrum

Disorder (ASD).

P603. Awareness and Knowledge of Attention Deficit Hyperactivity Disorders among

Primary School Teachers in Dubai, United Arab Emirates

Nariman Ali Ghader1, Dr. Muna Al Kuwari1, Hira Abdul Razzak1, Dr. Mohammad Bardi1,

Dr. Ateeq Qurashi1

1Ministry of Health and Prevention, Dubai, UAE

Background: Teachers often play a significant role in supporting and identifying students with

Attention-Deficit/Hyperactivity Disorder (ADHD). This study, therefore, assessed the level of

teachers' knowledge - prior to any training or exposure- on treatment, diagnosis/symptoms, and

general information about the outcomes, and causes of ADHD in primary schools of Dubai, UAE.

Methods: A cross-sectional study was conducted from December 2018 to September 2019

involving 394 primary school teachers currently working at primary schools in Dubai, United Arab

Emirates. A pre-validated questionnaire “Knowledge of Attention Deficit Disorder Scale”

(KADDS) along with demographic questions was utilized to gather the data. Statistical analysis

was carried out using SPSS version 20 to analyze descriptive statistics.

Results: Overall, 394 teachers responded to the questionnaire. Nearly, 95.9% (n = 378) of the

participants were female, while, only 4.1% (n = 16) were males. Most of the teachers had 6-10

years of experience and were teaching 4th graders. Overall, 48.35% had good knowledge about

ADHD, 31.45% of the teachers had insufficient knowledge (indicating misperceptions about

ADHD), while 20.19% of the people didn’t know the answers.

Conclusions: Our results are valuable for identifying areas where there is a lack of knowledge or

misperception regarding ADHD among primary school teachers in the United Arab Emirates. The

study, therefore, provides essential implications for the training of practicing teachers and

curriculum development. This will help to overcome the gaps in knowledge and misconception

about ADHD in UAE schools. Studies conducted in the future should integrate the use of teaching

strategies and classroom interventions for ADHD students, prior to and after training seminar for

a thorough examination of its effectiveness. Furthermore, replication of the same study in the

future in private schools and/or after training the teachers is recommended.

P701. Evaluation of antimicrobial activity of propolis on oral pathogens

HAFIZ AHMAD1, Mehria Wazin2, Juma Al Khabuli2

1RAK College of Medical Sciences,, Ras al Khaimah, United Arab Emirates, 2RAK college

of Dental Sciences, Ras al Khaimah, United Arab Emirates

Background: Propolis is a natural resinous substance collected by bees from various plants and it

has been found to have excellent antibacterial effects. It's overall effect on oral microbiota is

debated and varies depending on the source of propolis based on the flora of the given region. The

objectives of this study is to evaluate the antibacterial activity of propolis from UAE on selected

oral pathogens in-vitro. This was followed by a clinical pilot study to assess the actual

antimicrobial activity of propolis on oral pathogens in pre and post oral rinse saliva samples and

to study biofilm inhibition potential of commercially available propolis on dental pathogens.

Methods: Propolis from five different regions (China, Brazil, UAE, Bulgaria and India) were tested

in the laboratory against five common microorganisms found in the oral cavity: S.aureus,

S.mutans, C.albicans, E.coli and E.faecalis. Well diffusion method method for antibacterial testing

was used by growing the bacteria on Mueller Hinton agar plates and checking their zone of

Inhibition in millimeters.

Clinical study was performed on 30 children (7-12 years old). Baseline saliva (T0) was collected

and subjects of test group were given 15ml of propolis X, and saline for control respectively.

Children were asked to rinse their mouth with 15 ml of a diluted (1:10) propolis X for 1 minute

and then a second saliva sample (T1) was collected 30 minutes later. For adults (18-28 years old),

the same method with chlorhexidine 0.2% for control group and (T1) sample was taken after 2

days of propolis uses twice daily as mouthwash.

Biofilm forming potential of the isolates will be determined by crystal violet dye binding using

spectrophotometric method by growing the bacterial isolates in tubes or microtiter plates as per

standard protocol. Effect of propolis on biofilm producing oral pathogens will be studied and

compared between the samples using crystal violet binding assay. Part of the research work is still

under investigation.

Results: The results showed that the majority of the products had positive antibacterial effects.

Propolis from China and Brazil showed no effects on S.mutans, C.albicans and E.coli except

S.aureus. Propolis from India showed moderate effects against E. coli, S.mutans and S.aureus .

Finally, raw propolis from UAE, and Bulgaria showed the highest zone of inhibition (25-26mm)

on all bacteria especially on oral pathogens S.mutans, C.albicans and E.coli, S.aureus and

E.faecalis. Propolis is a promising agent in the prevention of oral diseases.

Conclusions: Our research confirms that propolis from different regions of the world has beneficial

effects on major bacteria especially on oral pathogens such as S.aureus, S.mutans, C.albicans,

E.faecalis and E.coli. Overall results show significant decrease of bacterial count after propolis

mouth rinse. Propolis from UAE show excellent results compared to propolis from other regions,

showing great promise against majority of oral pathogens. Furthermore, in the adult clinical study,

post propolis mouth wash results showed significant reduction in total oral bacterial burden when

compared to chlorohexidine as a control.

Our study suggest that the local propolis from UAE is an excellent candidate for a potential

commercial formulation as a natural mouthwash.

P801. Serum Beta-2 microglobulin level and its relation to kidney function at The Royal

Hospital

Harshini Asogan1, Issa Al Salmi2, Suad Hannawi3

1Kettering General Hospital NHS trust, Kettering, United Kingdom, 2The Royal Hospital,

Muscat, Oman, 3Ministry of Health, Dubai, United Arab Emirates

Background: In recent years, the effectiveness of monitoring serum Beta-2 microglobulin (B2M)

concentrations in various medical conditions has been constantly emphasised. The B2M is a low

molecular weight protein associated with Class I HLA antigens, present on the surface of all

nucleated cells and critical for antigen presentation. It is freely filtered by the kidney glomeruli,

and almost all of it is reabsorbed and metabolised in the proximal tubule. It is a novel glomerular

filtration marker that has stronger association with adverse outcomes than creatinine.

Methods: A retrospective study was performed that included data of individuals who were tested

for B2M levels at The Royal hospital, Oman over 11 years from January 2006 till December 2017.

Data was collected from medical records and IT system (Al-Shifa) adding up to 901 patients. The

collected data was then analysed using STATA software, Chicago, USA.

Results: Of the 901 patients, there were 54.8% males and 45.2% females with mean age 45.92 and

44.62 respectively. Data collected were from several departments including Nephrology (6.1%)

with mean B2M of 18.69 (18.9), Haematology-oncology ( 76.8%) with mean B2M of 4.59 (7.6)

and others (17.1%) with varying diagnoses ranging from haematological malignancies (21%),

solid tumours (12.3%), lymphoma (49%), CKD, connective tissue disorders and infective illness.

Data showed 866 patients had chronic kidney disease staged from 1 (63%), 2 (13.9%), 3 (10.5%),

4 (6.5%) and 5 (5%) and the remaining 35 patients were recorded to have normal renal functions

with no proteinuria. Among those with chronic kidney disease, the values showed a positive

correlation with increase in staging to increasing mean serum B2M levels in the patient. The B2M

levels were also analysed against numerous variables such as their comorbidity i.e., DM, HTN,

Dyslipidemia having mean B2M twice higher than individuals with no comorbids, lab values like

infection markers and auto antibodies and renal transplant status where B2M levels shows a

significant raise compared to those with patients with normal or negative markers.

Conclusions: This is the first study to evaluate serum B2M levels for the whole country among

various ages, gender and medical conditions across many medical departments. Majority had

eGFR above 60 ml/min/m2 with 75% in CKD stages I-II.

B2M serum level tend to increase with increasing advanced CKD stages in both female and male

patients and gets higher with presence of urinary WCC and blood cells. It has been found that B2M

is positively correlated with serum Creatinine with Pearson coefficient of 0.78 and negatively

correlated with GFR with Pearson coefficient of 0.85. Malignancies, autoimmune disorders and

chronic infections also showed high serum B2M levels. Elevated B2M levels are due to high cell

turnover or from altered cell binding to proteins.

The stage of kidney function is the main determinant of serum B2M levels by affecting both

filtration via glomeruli and generation. In addition, interference with the binding of B2M to MHC

molecules by various uremic solutes retained in kidney failure institutes a key cause for the sharp

increase of B2M in CKD.

Therefore, B2M is a promising marker to assess glomerular and tubular function in adults. It has

similar performance to the Creatinine-based estimating equations as a measure of kidney function,

but may be more strongly associated with cardiovascular morbidity and mortality than serum

creatinine, or other small molecular kidney filtration markers

P802. Bone Mineral Density by Dual-Energy X-ray Absorptiometry Scan of Different

Stages of Chronic Kidney Disease

Hilal Musabah Sulaiyam Al-kalbani1, Suad Hannawi1, Issa Al Salmi1, Sumaiya Al Siyabi1

1Royal hospital, Muscat, Oman

Background: Chronic kidney disease (CKD) is rising worldwide with increasing incidence and

prevalence. CKD is associated with loss of bone mineral density (BMD) and increased risk of

osteoporosis.

The aim of the study was to analyze the bone mineral density (BMD) determined by dual-energy

X-ray absorptiometry (DEXA) and bone turnover markers (calcium, vitamin D, PTH and ALP) in

CKD patients, over a year period.

Methods: Records of 1550 people who had been scanned for BMD in year 2015 were reviewed.

Data were obtained by electronic system then analyzed using SPSS

Results: Among 505 patients with abnormal BMD, 87.3% were in early stage CKD stage I-II,

8.5% were in CKD stage III-V and 4.2% did not have renal tests. 95 were male (18.8%) with a

mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patient of

≥65 years had more pathological T score than those who were younger than 65 years old in both

femoral and hip T scores (P < 0.001.). Among CKD patients, those with late CKD (stage III-V)

had less BMD measurements and more pathological T score than those with early CKD (stage I-

II) in both femoral and hip, P values of 0.007 and 0.027, respectively.

While there was significant positive correlation between parathyroid hormone (PTH) level and the

pathological T score of both femoral and hip, P values 0.003 and 0.008, respectively. There was

statistically non-significant negative relationship between lumbar T score and PTH.

Female had a worse T score at the lumbar region whereas male had a worse T score at the femoral

region. There was no significant difference between males and females for the T score at hip

region.

Conclusions: Measurements of BMD by DEXA might be a useful test to demonstrate bone loss in

CKD patients. Femoral and hip are more affected, however DEXA might not able to detect bone

loss in lumbar area of CKD patients. PTH level is associated proportionally to the degree of bone

loss. More studies are needed to determine if DEXA techniques is enough to distinguish the

quantity of bone loss between different stages of CKD.

P803. Pattern of Biopsy Proven Renal Disease in Adults: Single-Centre Experience from a

Tertiary Care Hospital in Dubai, UAE

Dhanya Mohan1, Aida Mumtaz Siddiki1, Fakhriya Alalawi1, Sima Abdolla Nejad1,

Mohammed Jaffer Hussein Railey1, Amna Khalifa Alhadari1

1Dubai Hospital, Dubai, United Arab Emirates

Background: Kidney biopsy is a vital tool in the evaluation of kidney disease as histological

diagnosis contributes towards best clinical practice. The pattern of glomerular disease varies

worldwide. There is limited data on the pattern of biopsy proven renal disease in the United Arab

Emirates, with only two studies published till date

Methods: All consecutive percutaneous kidney biopsies performed at Dubai Hospital from June

2007 to September 2019 were retrospectively analyzed. Data was collected from the handwritten

case files till August 2017, and from electronic medical records thereafter.

Results: A total of 287 consecutive patients (163 females and 124 males) aged from 13 to 86 years

(mean 37.04 years) who underwent ultrasound guided percutaneous renal biopsies were included

in this study. 61.32% of the study population was composed of expatriates and the remaining

38.68% was constituted by UAE citizens. Among the biopsy proven renal disease (BPRD),

primary glomerular diseases (PGD) were the most common (64.46%), followed by secondary

glomerular diseases (SGD) (30.31%), and the remaining comprised of tubulointerstitial diseases

(5.23%). Membranous nephropathy was the most common PGD (23.80%), followed by focal

segmental glomerulosclerosis (FSGS) (20.63%). Minimal change disease (12.17%), IgA

nephropathy (11.11%), and membranoproliferative glomerulonephritis (10.58%) were the other

common causes of PGD. Among SGD, Lupus nephritis was the most common (61.18%) followed

by Diabetic nephropathy (21.17%). Acute tubular necrosis (60%) was the most common among

tubulointerstitial diseases. Among the 31 total patients of DM who underwent renal biopsy with

suspicion of NDRD, 45.16% had NDRD, 16.13% had Diabetic nephropathy with NDRD, and

38.71% had Diabetic nephropathy alone

Conclusions: This study shows the changing pattern of BPRD within the UAE adult population in

comparison to the two studies undertaken in the past. As one of the initial attempts at categorizing

the histological pattern of renal disease, this study can serve as a key development towards the

eventual establishment of a full-fledged national registry of BPRD in the UAE

P804. Clinical Pharmacological Management Status of Systemic Lupus Erythematous

Population: Situational Analysis

Abdelmasieh Metry Atia1, Issa Al Salmi1, Farida Al Balushi1, Mohammed Abdalla Yousef1,

Suad Hannawi2

1Royal Hospital, Muscat, Oman, 2MOHAP, Dubai, United Arab Emirates

Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that has

various manifestations among different populations. This study aims to provide an overview of

medical pharmacological management that SLE population received immediately at time of

diagnosis.

Methods: This is a retrospective analysis using patients’ registry medical information system. All

patients diagnosed with SLE were reviewed by accessing their medical records including

pharmacy prescription and dispersions at the Royal hospital from 2006 to 2014. The following

comorbidities were analyzed: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, lung

disease, cardiovascular disease (CVD), cerebrovascular accident (CVA), chronic kidney disease

(CKD), end-stage kidney disease (ESKD), infections, thyroid disease, malignancy, and

miscarriages.

Results: There were 966 patients diagnosed with SLE during the period from 2006 to 2014. The

Mean (SD) of age at presentation was 35.5 (11.5) years. Most patients were female (88.7%) with

mean age of 27.6 (1.4) years.

Unsurprisingly anti-malarial drug, Hydroxychloroquine was used in 95% of SLE patients and

steroid therapy was used in 93% in which 60.95% received Methylprednisolone pulse. The

immunosuppressive agent of choice was Cyclophosphamide in 25.04%. Mycophenolic acid

(MPA) medication in 39.85% and azathioprine in 37.06% of patients. Anti CD20 monoclonal

antibodies, rituximab, was used in 20.91%. Calcineurin inhibitors were used in total of 11% of

patients (cyclosporin a in 6.72% and tacrolimus in 4.35%

Conclusions: The complexity of SLE presentation have led to diverse pharmacotherapeutic

strategies based on the organ systems involved. Management is individualized and depends on

presenting symptoms and reducing the likelihood of permanent damage to organs and tissues.

Strengthen health system at primary level and education of public and health work force is the main

challenge to further improve the management. The overall aim of management was to determine

the extent of disease and prevent extensive organ involvement and deal with various traditional

and non-traditional CVD risk factors. The involvement of clinical pharmacist is very important to

further strengthen the pharmacologicalmanagement of lupus patients

P805. The Burden of Various Comorbid Conditions at Initial Presentations of Systemic

Lupus Erythematosus population

Issa AlSalmi1, Abdelmasieh Metry1, Farida Al Balushi1, Mohammed Abdalla Yousef1,

Faisal Al Ismaili,1, Alan Hola1, Suad Hannawi2

1Royal Hospital, Muscat, Oman, 2MOHAP, Dubai, United Arab Emirates

Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that has

various manifestations among different populations.

We aimed to study the various medical comorbidities associated with SLE at the time of

presentation as per Rheumatologist review.

Methods: This is a retrospective analysis using patients’ registry medical information system. All

patients diagnosed with SLE were reviewed by accessing their medical records and laboratory

results of investigations at the Royal hospital from 2006 to 2014. The following comorbidities

were analyzed: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia, lung disease,

cardiovascular disease (CVD), cerebrovascular accident (CVA), chronic kidney disease (CKD),

end-stage kidney disease (ESKD), infections, thyroid disease, malignancy, and miscarriages.

Results: There were 966 patients diagnosed with SLE during the period from 2006 to 2014. The

mean (SD) of age at presentation was 35.5 (11.5) years. Most patients were female (88.7 %) with

mean age of 27.6 (1.4) years. Majority of the patients 786 (81.4%) were in the age group 18-45

years old, 40 (4.7%) patients were in age group 0-17years, 109 (11.2 %) patients were in age group

46-60 years, and 26 patients in age group >60 years.

At presentation, 30% had neuropsychiatry disorders, 24.5% had HTN, 19.1% hyperlipidemia,

12.2% miscarriages, 12.0 % with thyroid disease, 10.0% CVD, 5.81 % with DM, 5 % CVA, 4.07

% CKD, 2.8 % with ESKD, 2.5 % with lung disease, 1.49% with infections and 0.53% with

malignancy.

Conclusions: SLE patients have a great burden of various medical co-morbidities at time of

diagnosis and hence may present with CVD, stroke, CKD, ESKD and even requiring renal

replacement therapy at initial encounter with health-care professionals. Strengthen health system

at primary level and education of public and health work force is the main challenge to further

reduce the risk of these comorbidities and the consequences.

P806. Systemic Lupus Erythematous: Symptoms and Signs at Initial Presentations

Abdelmasieh Metry Atia1, Issa Al Salmi1, Farida Al Balushi1, Mohammed Abdalla Yousef1,

Faisal Al Ismaili,1, Alan Hola1, Suad Hannawi2

1Royal hospital, Muscat, Oman

Background: Systemic lupus erythematosus (SLE) is an autoimmune multisystem inflammatory

condition that causes microvascular inflammation with the production of various auto-

antibodies that play a major role in its pathogenesis. SLE can affect both sexes, all ages, and all

ethnic groups with widespread geographical and socioeconomic backgrounds. Asia

encompasses people of many sociocultural backgrounds with diverse ethnic.

Objective: Due to a lack of national epidemiological research, the incidence and prevalence

of SLE in Middle Eastern and Arab countries, have only recently been studied. This article

aims to explore the status of SLE in Oman and to record symptoms and signs of SLE at first

presentation.

Methods: Medical records of all patients diagnosed with SLE at the Royal Hospital from 2006

to 2014 were reviewed for information recorded at first visit. SLE diagnosis was based on the

American College of Rheumatology classification criteria; ACR97 (which includes the clinical

manifestation and laboratory evidence). Patients with SLE disease manifestations extrapolated

and analyzed.

Results: There were 966 patients diagnosed with SLE during the period from 2006 to 2014. Mean

(SD) age at presentations was 35.5 (11.5) years. Majority of patients were female which constitutes

88.7 % of the total SLE patients with mean age 27.6 (1.4) years.

Constitutional symptoms were found in 48.68 of SLE population including fatigue in 35.22 %, and

weight changes in 13.43 %.

The cutaneous manifestations that were present included malar rash 37.69 %, photosensitivity 35.10

%, discoid lupus 17.63 %, and hair loss 39.29 %.

Musculoskeletal manifestations were commonly seen among the studied population including

arthralgia in 68.75 %, myalgia in 55.65 %, arthritis in 48.31%, whilst myositis, tendon

abnormalities and avascular necrosis were found in only 2.47 %, 0.31% and 1.98%, respectively.

Conclusions: This is the first study of the symptoms and signs at initial clinical presentation of

SLE patients compared to other studies done regionally where most have focused on clinical

manifestations during the progression course of SLE. SLE manifestations may be related to the

differences in the genetic make-up of the patients who come from various ethnic groups despite

similar geography or sociocultural background, or to referral bias, as some studies were

performed in the nephrology units and others in the rheumatology units. There is a pressing

need to establish a nationwide and regional collaboration to establish LUPUS and to put forward

a strategic planning with each MOH to provide a easy and efficient report of SLE cases and

provide various effective management for such a debilitating syndrome.

P807. Missed Hemodialysis Treatments: International Variation, Predictors, and Outcomes

Issa Al Salmi1

1The Royal Hospital, Muscat, Oman

Background: Missed hemodialysis treatments (MTs) not due to hospitalization have been

associated with poorer clinical outcomes and related in part to treatment non-adherence. Using

data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), phase 5 (2012-2015), we

report findings from an international investigation of MT among thrice-weekly hemodialysis

patients.

Methods: Study Design, Setting, and Participants: Prospective observational study from 20

countries of 8501 patients on dialysis >120 days. Longitudinal and cross-sectional analyses

performed for eight of these countries (4,493 patients) where 4-month MT risk was >5%.

Predictors: The main predictor of patient outcomes was ≥1 MT in the 4 months before DOPPS

enrollment; predictors of MT included country, patient characteristics, and clinical factors.

Outcomes: Mortality, hospitalization, laboratory measures, patient-reported outcomes, and 4-

month MT risk. Analyses were performed using Cox, logistic, and linear regression, adjusting for

case-mix and country.

Results: The 4-month risk of MT varied >50-fold across all 20 DOPPS countries, ranging from

<1% in Italy and Japan to 24% in the US. MT was more likely with younger age, less time on

dialysis, shorter hemodialysis treatment time, lower Kt/V, longer travel time to hemodialysis, and

more depression symptoms. MT was positively associated with all-cause mortality (hazard ratio =

1.68; 95% CI: 1.37, 2.05), cardiovascular mortality, sudden death/cardiac arrest, hospitalization,

serum phosphorus >5.5 mg/dL, parathyroid hormone >300 pg/mL, hemoglobin <10 g/dL, higher

kidney-disease burden, and worse general and mental health.

Conclusions: Hemodialysis patients from 8 countries with ≥1 MT in 4 months were more likely to

die, be hospitalized, and have poorer patient-reported outcomes and laboratory measure

achievement than patients with no MT. The huge variation in MT across 20 nations suggests MT

is potentially modifiable, especially in the US and other countries where MT risk is high.

P901. THE LIVED EXPERIENCE OF NURSES WORKING IN CARDIOLOGY

SERVICES WITH THE ONLINE CONTINUING PROFESSIONAL DEVELOPMENT

PROGRAMME IN ADVANCING THEIR SPECIALISED CLINICAL PRACTICE:

PHENOMENOLOGICAL STUDY

Umaima Al-Raisi1

1The national heart center, Muscat, Oman

Background: Working in cardiology services requires a body of knowledge and skills for

cardiology nurses to have a strong foundation for nursing practice. As indicated in previous studies,

online CPD enhances general nursing practice. However, advancing nursing practice in cardiology

requires a strong knowledge base. Online CPD has potential to deliver this knowledge. However,

the effectiveness of online courses to achieve the proficiency in the Benner’s clinical competency

model which is required for advancing nursing practice is poorly represented in the literature.

Methods: Hermeneutic phenomenology is the philosophical and the methodological research

approach that underpins this study. The incorporation between van Manen’s research

methodological structure and the Gadamerian hermeneutic approach was applied to unveil the

registered nurses (RN) experience of using online CPD courses to advance their cardiac nursing

practice.Six registered nurses working in different areas in the cardiology setting were interviewed

individually. The interviews transcribed and analyzed used Braun and Clarke six steps thematic

model.

Results: The online CPD course was identified as a valuable tool which can be blended with other

learning delivery methods. Also, the online course appeared to fulfil adult nurse principles: self-

directed learning, experience, orientation to learning, readiness to learn, the need to learn and

motivation; which in turn promoted positive leaning experience. The individuals learning needs

and learning style preferences variance impact on the learning outcome. Despite of the

convenience and the accessibility of online courses, the desire for class room and interactive

simulation sessions was very significant in the participant’s responses.

Conclusions: The phenomena of using online CPD courses for advancing nursing practice in

clinical settings is multifaceted. Advancing nursing practice is an emergent concept in relation to

CPD and needs to be further investigated, particularly in the context of clinical specialised settings.

Also, determining the skills, knowledge and competencies required to advance nursing practice

need further exploration. Using a valid clinical competency framework on which to base

development of online CPD courses is essential in the context of advancing nursing practice in the

specialised setting of cardiology.

P1001. Emerging Technology To Combat Counterfeit Medicine In The International

Criminal Trade Market

Hanady Yousef Shourrab1, Dr. Mohammed Waseem Islam1, 1

Background: Counterfeit & substandard drugs are a threat to public health and have devastating

consequences for patients; increased mortality and morbidity added to the ever-present danger of

evolving drug resistance (Theodore et al., 2007). There is an urgent need to systematically examine

drug quality, potency and efficacy to assess the extent and effect of replicas and to implement

effective counter measures.

Every day patients in need of effective treatment receive substandard or fake drugs and other

medical products. At best patients taking these compromised products get no relief from their

symptoms; at worst they may die (Amir et al., 2012).The prevalence of counterfeit drugs appears

to be rising and has not been opposed by close cooperation between drug companies, governments

or international organizations concerned with trade, health, customs and excise, and

counterfeiting.(Robert et al., 2015).

The existence of substandard, spurious, falsely labeled, falsified and counterfeit (SSFFC) medical

products is an unacceptable risk to public health (WHO, 2012). Recent incidents of counterfeiting

and adulteration have caused serious threats to public health (WHO, 2016).

SSFFC medicines are found everywhere in the world. They range from random mixtures of

harmful toxic substances to inactive, ineffective preparations. Some contain a declared, active

ingredient and look so similar to the genuine product that they deceive health professionals as well

as patients. But in every case, the source of a counterfeit medicine is unknown and its content

unreliable (Howards, 2014).

Methods: Objective & Method : The is a review Study to explains the various techniques used to

combat counterfeit drugs globally and in UAE all pose a challenge both in the field and in the

laboratory It is difficult to determine which tool can be useful and best to work through tests since

all of the techniques reviewed are relevant to microscopic molecules. Novel technology is

constantly being developed to detect falsified and substandard medicines.

Results: Importance of the study:

The purpose of this study is a review of the emerging technology to combat counterfeit drug in the

global criminal market. The need for sophisticated anti-counterfeit technology is ever growing as

the practices of counterfeiters become increasingly advanced. Overt visible markers on a drug’s

packaging have been commonly used to identify the genuine from the fake, but the holograms and

distinguishing markers applied to the blister foil, film or paper substrates of the packaging are

mimicked and imitated to a high level of accuracy. Technology as a countermeasure must

necessarily improve, especially in reaction to what is a multifarious problem. There is the

manufacturing concern, to ensure brand protection and reinforce intellectual property rights for

pharmaceutical companies, and the health concern, with the potential for counterfeit drugs to lead

to mortality. A counterfeit medicine’s content is often substandard, containing fewer or no active

ingredients or in incorrect measures, and it can contain contaminants or inappropriate excipients.

The result of this is the possibility of treatment failure or death.

The major Focus of the study is to determine the quality control parameters and the latest

technological inventions that’s exist globally and can be used against counterfeit medication and

the increasing sophistication of the illicit manufacturers has been the impetus for innovations or

the combination of technologies. The overt markers are now often merged with covert ones such

as UV print or anti-tamper tape and solutions. These covert technologies are either barely visible

or hidden entirely and can be of particular help in ensuring that genuine packaging is not reused

with illicit content. While this strategy is certainly a deterrent, these overt and covert markers can

be easily simulated, and to be effective require a knowledge and user education that is difficult to

filter to the community and patient level, particularly in the developing world.

In recent years, the benchmark technology has shifted towards forensic techniques and systems

that can carry unique authenticated information along the distribution line, right up to the point of

dispensation to the patient. Barcodes, 2D data matrix codes, tags and radio frequency identification

(RFID) can allow instantaneous remote authentication, making it much harder for counterfeit

products to enter the supply chain. These systems rely on a scan-and-send system, meaning that,

unlike the packaging markers, there is no interpretation of information by the user; the remote

device does all the work. The technology is relatively young and often expensive, and the

reliability of some of its systems is still questionable, but it offers a significant opportunity to

truncate the spread of counterfeit products if government agencies and pharmaceutical

manufacturers adopt variations of these strategies.

For anti-counterfeit technology to be at its most effective there is a need for various systems

working in tandem, either on the same product, i.e. the combination of overt and covert markers

or, indeed, remote authentication technology, or on different products. The combination of

technologies adds heightened security to the individual product, and the use of various systems in

a region can help to make the counterfeiters’ lives harder, as investing in fraudulent methods that

can only be applied in a limited number of settings lessens the scope of their activity.

Inevitably, combined systems come at a price and even the more sophisticated systems of track

and trace alone are enough for pharmaceutical companies to reconsider. In Europe, the EU

serialisation takes effect in 2014, requiring pharmaceutical manufacturers to adopt serialisation

systems. This directive will hope to produce a Europe-wide harmonization of authentication and

standards of protection. California has centralized e-pedigree tracking requirement takes effect the

following year. The practical hope of a global harmonization of systems, however, is yet elusive.

In the other hand it will participate against the Drug counterfeit which is a threat to the

pharmaceutical industry, continuous monitoring of the pharmaceutical formulation especially after

registration is important way to limit fake and counterfeit medicine.

The Study along with lab data will provide additional functional information about the stability

compatibility of the products and there compliance to the international standard methods.

Accordingly, the study emphasized the need of constant surveillance on marketed drug product by

the government, manufactures and independent research groups to ensure supply and availability

of quality medicines for the patients.

Conclusions: Summary and Conclusions:

There is a huge range of possible solutions ranging from the very simple to the highly complex,

from zero cost to highly expensive and from fragile to highly secure against compromise. The wide

range of options adds to the potential security by diluting the advantage gained by a counterfeiter

in defeating any one system, and manufacturers should choose widely and wisely for

optimum security gain. It is unlikely that any one solution will be appropriate for all applications

- the costs may not be affordable in developing markets, or for low margin products including

generics and OTCs. Pharmaceutical manufacture is not restricted to highly developed and

sophisticated societies, but is almost universal. Therefore, not all areas share the same accessibility

to technological solutions, and their supply infrastructure. It is also noted that reliable and secure

sources of supply may be wanting in some regions where there is a poor history of intellectual

property protection. Manufacturers may be confined to using only in-house technologies in such

territories. Virtually all of the available solutions carry some cost and administrative burden,

whereas the manufacturers’ business case for cost versus benefits is extremely difficult to quantify.

This is not helped by many unsubstantiated claims for the level of counterfeits in the global

medicines market. The true business case is more realistically based on risk management and

corporate ethical responsibility for public health and safety, except in those few areas where the

counterfeit level is measurable. Page 12 Page 12 of 13 Finally, there is no single solution to every

problem, and a secure strategy will almost certainly involve a mixture of technologies, often in

combination. An overt feature will almost certainly include a secure covert element for added

security, and any one product may carry several different features on various levels of the pack

and components. But as long as counterfeiters target medicines for illegal profit, a product with no

form of anti-counterfeit marker represents a significant potential risk to public health and

safety.(Impact,2007)

Various techniques used to combat counterfeit drugs all pose a challenge both in the field and in

the laboratory. It is difficult to determine which tool can be useful and best to work through tests

since all of the techniques reviewed are relevant to microscopic molecules. Novel technology is

constantly being developed to detect falsified and substandard medicines. Among the different

types of technology as complementary solutions, the digital technology appears to be the shaping

future techniques to combat fake medicine. Investment in this next generation technology is

essential to ensure the future security and integrity of the global drug supply chain preventive

measures said the country has been fighting the spread of counterfeit medicines in the local market

by implementing preventive measures, building a quality control laboratory, and conducting

research on medical and other health products.

P1002. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) HAS A CENTRAL

PART TO PLAY IN COMMUNITIES HEALTH IMPROVEMENT

Dr KADHIM ALABADY1

1DHA, Public Health Protection Department, Dubai,

Background: Background: A community health needs assessment (CHNA) is a systematic method

for reviewing the health issues that the community faces, leading to agreed priorities and resource

allocation that will improve health and reduce inequalities. Health Needs assessments are:

• A recommended public health tool to provide evidence about a population on which to plan

services and address health inequalities.

• Ability to provide an opportunity to engage with specific populations and enable them to

contribute towards targeted service planning and resource allocation.

• Ability to provide an opportunity for cross–sectorial partnership to work and develop

creative and effective interventions.

Purpose: To assess how community health needs assessments is a planning tool used to maximize

health improvement.

Methods: Method: In order to carry out the assessment of community health needs assessments we

have:

• Conducted literature review to assess community health needs assessment.

• Conducted oncology and mental health needs assessment

Results: • CHNA strengthened community involvement in decision-making.

• Improved teamwork between partners.

• Professional development of skills and experience.

• Improved communication with other agencies and the public.

• Better use of resources.

Conclusions: • There are four approaches in conducting community health needs assessments

(CHNA), these are; epidemiological, comparative, corporate, and participatory appraisal.

P1003. Emerging Technology to Combat Counterfeit Medicine in the International

Criminal Trade Market.

Hanady Yousef Shourrab1, Hanady Yousef Shourrab1, 1Ajman university Of Science and technology, Ajman, UAE

Background: The globalization of the pharmaceutical supply chain has posed multifarious

problems, first and foremost, fighting the international criminal trade in counterfeit drug market.

A counterfeit medicine’s content is often substandard, containing fewer or no active ingredients or

in incorrect measures, it may also contain contaminants or inappropriate excipients. The result of

this is the possibility of treatment failure or death. The World Health Organization has reported

that counterfeit medicines potentially make up more than 50% of the global drug market, with a

significant proportion of these fake products being encountered in developing countries.

The emerging sophisticated anti-counterfeit technology is growing as the practices of

counterfeiters become increasingly advanced. Innovative technologies to detect falsified and

substandard drugs are currently being developed. The present presentation provides an emerging

view of the advanced technologies and identifies most convenient, useful and cost effective

techniques to detect substandard and falsified drugs, keeping in mind the high costs of the

laboratory analysis and expertise.

Promising digital tools including barcodes, 2D data matrix codes, tags and radio frequency

identification (RFID). Block chain plays a key role in digitizing supply chains, enabling online

verification of genuine items and protection against fakes. Our presentation deals with the

emerging technology, that are instantaneous in the field of remote authentication based on a scan-

and-send system. The emerging new techniques including GPHF-Minilab, Minitab TLC kit,

NanoGardian, TruTag and TruScan, have been described and compared for their efficiency and

practicality.

Various techniques used to combat counterfeit drugs all pose a challenge both in the field and in

the laboratory. It is difficult to determine which tool can be useful and best to work through tests

since all of the techniques reviewed are relevant to microscopic molecules. Novel technology is

constantly being developed to detect falsified and substandard medicines.

Among the different types of technology as complementary solutions, the digital technology

appears to be the shaping future techniques to combat fake medicine. Investment in this next

generation technology is essential to ensure the future security and integrity of the global drug

supply chain.

Methods: Method: Article review

Objective: The objective of Study explains the various techniques used to combat counterfeit drugs

globally and in UAE all pose a challenge both in the field and in the laboratory It is difficult to

determine which tool can be useful and best to work through tests since all of the techniques

reviewed are relevant to microscopic molecules. Novel technology is constantly being developed

to detect falsified and substandard medicines.

Results: Result & Discussion: Counterfeit which is a threat to the pharmaceutical industry,

continuous monitoring of the pharmaceutical formulation especially after registration is important

way to limit fake and counterfeit medicine.Multidisciplinary review of the science/health,

information technology,Our review identified five distinct categories of Technology including

Mobile, Radio frequency Identification, advanced Computational methods, OnlineVerification,

and Blockchain technology.Measuresto Combat Counterfeit Medicines1-Ensuring Security of

Distribution.(Protecting the Drug Supply Chain ).2- Protecting the integrity and inviolability of

the Pack (Manufacturers’ Secure Packaging).3-On-dose brand protection weapon .4- On Field

screening Portable analyzers .5-International collaboration and efforts .

Conclusions: There is a greater need for collaboration between government agencies and

pharmaceutical manufacturers to address the concern of cost, for the manufacturer so that anti-

counterfeit technology is not a barrier to their production of quality medicines for those who need

it, and for the patient.

P1004. Changes in sitting time and step counts in participants of the “MOVEdiabetes”

study: A trial to increase physical activity in diabetes primary health care in Oman Thamra

Said Al Ghafri1, Saud Mohamed Al harthi1, Yahya Al-Farsi2, Elaine Bannerman3, Angela

M. Craigie4, Annie S Anderson4

1Ministry of health, Muscat, Oman, 2Sultan Qaboos University, Muscat, Oman, 3Edinburgh

university, Edinburgh, United Kingdom, 4Dundee University, Dundee, United Kingdom

Background: Sedentary behaviour namely sitting more than 8h/day increases the risk of all-cause

mortality. Information on sitting time in the Arabic speaking countries is limited. This paper

examined the impact of a multi-component intervention “MOVEdiabetes” study on changes in PA,

sitting time and step counts in adults with type 2 diabetes (T2D) in Oman.

Methods: The “MOVEdiabetes” is a cluster randomised study where participants in the

intervention group (IG) received PA consultations (delivered by trained dieticians), pedometers

and WhataApp messages, vs usual care in the comparison group (CG).1 The primary outcome was

change in PA (MET.min/week) after 12 months assessed by the Global PA Questionnaire.

Secondary outcomes such as step counts and sitting time were measured objectively using

accelerometers (ActivPAL) and pedometers.

Results: Of the 232 participants [59.1% female, mean (SD) age 44.2(8.1) years], 75% completed

the 12 months follow up study. At 12 months, there was a significant between group difference in

PA of +447.4 (95%CI 150.7 to 744.1) MET.min/week in favour of the IG. Sitting time (hours/day)

was found to change from 13.1(2.4) at baseline to 12.2(2.2) at 12 months within the IG with no

significant changes within the CG. Moreover, there was a significantly greater reduction in sitting

time (hours/day) in the IG vs CG at both 3 and 12 months, by -1.3 (95%CI -2.2 to -0.6) and -

1.5(95%CI -2.4 to -0.7) hours/day, respectively. Significant between group differences in favour

of the IG were also detected for mean steps/day [+757 95%CI 18 to1531].

Conclusions: The “MOVEdiabetes” study was effective in increasing PA, reducing sitting time

and improving step counts in adults with T2D attending primary care. This piece of evidence

supports the promotion of positive PA behaviour within clinical diabetes settings.

P1101. The Cleveland Clinic Abu Dhabi research journey so far

Bartlomiej Piechowski-Jozwiak1, Maria Marques1, Murat Tuzcu1

1Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Background: The interest in clinical research is growing in the United Arab Emirates (UAE).

Multiple organizations contribute in this including UAE universities and governmental healthcare

providers. There is a growing research activity in the private healthcare sector. The aim of this

work is to present CCAD research activity.

Methods: We analyzed research department structural changes, accreditations, and all research

activities from 2016 to date at CCAD. We included REC operations; type of projects approved and

executed as well as the number of subjects recruited into interventional (INT) and non-

interventional (nonINT) projects.

Results: CCAD was licensed by the Department of Health to conduct research in human subjects

(phase 2 and higher) in November 2016. At the same time, CCAD Research Ethical Committee

(REC) was founded and composed of 16 clinical, non-clinical and lay members. In October 2018

CCAD received Joint Commission International Accreditation for Human Subject Research. In

2019 Research Advisory Group (RAG) was formed to support REC activities in assessing

scientific merit, feasibility, legal, compliance and budgetary aspect of research projects. RAG is

composed of representatives of medical and pharmacy institutes, it is led by the Director of

Research. REC is led by REC Chair and supported by REC coordinator. CCAD REC approved

154 projects to date (37 INT, 117 nonINT). There were 16800 subjects recruited at CCAD to date

to INT (n=1250) and nonINT (15550) projects. There are currently five phase 4, 1 phase 3 and 1

phase 2 studies, as well as 6 prospective observational running across various disease portfolios.

CCAD was awarded UAE academic grants and is expecting more support from other sources

(private-public partnerships) to support research activities.

Conclusions: The example of CCAD illustrates the successful journey of private-sector provider

into the well-being and future health of the UAE population.

P1201. Estimating The Infiltration of Immune Cells in Synovium of Rheumatoid Arthritis

compared to Osteoarthritis and Healthy Control Using Transcriptional Profiling Mahmood

Yaseen Hachim1, Noha Mousaad Elemam1, Ibrahim Yaseen Hachim1, Suad Hannawi2,

Rifat Hamoudi1, Azzam A. Maghazachi1

1Sharjah Institute for Medical Research, College of Medicine, University of Sharjah,

Sharjah, United Arab Emirates, 2Ministry of Health and Prevention, Department of

Rheumatology, Dubai, United Arab Emirates

Background: Rheumatoid arthritis (RA) is one of the most prevalent autoimmune and prototypic

inflammatory diseases. It is a heterogeneous autoimmune disease with local and systemic features.

The molecular triggers for the synovium transition from healthy to inflammatory and then to

rheumatoid arthritis are still not clearly defined. Recently, studying synovial tissue in RA is gaining

more attention in order to have a better understanding of the early stages of the disease.

Transcriptomic profiling of synovial samples is a promising approach to identify reliable

biomarkers, assess the effects of medical interventions, and predict the outcomes. One limitation

of such an approach is the masking effect of the local gene expression signature by the infiltrating

immune cells, thus making it difficult to distinguish the trigger from the consequence. Stringent

bioinformatic pipeline is needed to process, filter, and combine microarray transcriptomic data;

such precise data can be used to estimate the inflammatory cell infiltration to identify synovium

specific genes. In this study, we used an in-house pipeline to identify novel synovium related

biomarkers, and then we used a recently available tool called ESTIMATE (Estimation of Stromal

and Immune cells in MAlignant Tumor tissues using Expression data) to estimate the differences

in immune cells infiltrating healthy, osteoarthritis (OA) and RA synovium.

Methods: Gene expression profile of synovial tissue from 33 RA, 26 OA, and 20 healthy controls

from three datasets (GSE55235, GSE55457, GSE55584) were extracted using the Gene

Expression Omnibus (GEO) public repository. Raw cell files were re-analyzed using in house

pipeline for normalization and filtration. Gene Set Enrichment analysis was used to identify genes

that are differentially expressed (DEG) between the three groups, as shown in Figure 1. To estimate

the difference in immune cells’ infiltration between the three groups using their transcriptomic

profile, ESTIMATE R package was used.

Results: In comparison to OA and healthy controls, RA synovium showed significant enrichment

for immune-related pathways namely: lymphocytes differentiation, βT cell activation, IL12

pathway, B cell activation, T cell differentiation, regulation of interferon-gamma production and

lymphocytes mediated immunity, Figure (2). The most immune-related genes significantly altered

in RA were chemokines (CXCL13, CXCL9, CCR2, CXCL10, XCL1, XCL2, and CXCL11),

interleukins (IL7R, IL21R, IL32, and IRF4), and B cell-related (TPD52, SLAMF8, IGHM, CD27,

CD79A). Interestingly, NK related gene NKG7 (natural killer cell granule protein 7) was

significantly upregulated in RA patients. Using ESTIMATE, it was shown that RA synovium

contains more infiltrating immune cells than OA or healthy synovium, Figure (3). Healthy

synovium contained the highest non-immune cells (64±5%), compared to OA (58±2%), and RA

(52±3%).

Conclusions: Using proper bioinformatical analysis of the synovium in RA to identify synovium

specific biomarkers that are not masked by infiltrating immune cells may pave the way for

understanding the molecular basis of RA.

P1202. Natural Killer Cells Gene Expression Can Differentiate Rheumatoid Arthritis

Patients From Healthy Controls

Noha Mousaad Elemam1, Mahmood Yaseen Hachim1, Suad Hannawi2, Azzam A.

Maghazachi1

1Sharjah Institute for Medical Research, College of Medicine, University of Sharjah,

Sharjah, United Arab Emirates, 2Ministry of Health and Prevention, Department of

Rheumatology, Dubai, United Arab Emirates

Background: Rheumatoid arthritis (RA) is the most prevalent autoimmune disease (1-3% of the

world’s population). RA is a prototypic inflammatory disease, being characterized by an altered

state of homeostasis, in which immunological stimulation and unwanted inflammation prevail

(Pincus, Brooks, et al. 1994). The molecular triggers for the development of RA in healthy subjects

are still not clearly defined. Identification of RA specific transcriptional signature can shed light

on the molecular pathogenesis of RA. Such a signature facilitates the selection of biomarkers that

can be used for early detection of RA and prediction of the effectiveness of RA treatment. Most of

the current transcriptome analyses in RA had focused on whole peripheral blood mononuclear cells

(PBMCs). Few studies have indicated that natural killer (NK) cells may play either a pathogenic

or a protective role in RA (Shegarfi, Naddafi, et al. 2012, Yap, Tee, et al. 2018). Hence, in this study,

we aimed at exploring NK cell markers that could possibly be used to aid in evaluating the

differences between healthy controls and RA patients.

Methods: Publicly available transcriptome dataset of sorted immune cells from RA patients and

healthy volunteers were reanalyzed using in house pipeline for normalization and filtration of the

raw probes’ expression. Gene Set Enrichment analysis was used to identify genes that are

differentially expressed (DEG) between different immune cells as compared to NK cells. Next,

DEG between NK cells of RA patients and healthy controls were selected. Both lists of identified

DEG were validated in peripheral blood collected from 16 healthy controls and 16 RA patients

(satisfying the 2010 ACR/EULAR classification criteria for RA). PBMCs were separated by Ficoll

density gradient method, while NK cells were isolated using RosetteSep negative selection

method. RNA was extracted and gene expression was assessed using qRT-PCR. Statistical analysis

was done using the Mann-Whitney test.

Results: Similar to CD56, a known marker for NK cells and interferon-gamma (IFNG), a prototype

cytokine secreted by these cells, PECAM-1, IBTK, ITGB7, and RELA were expressed in NK cells.

Furthermore, chemokine ligands and receptors were specifically expressed by NK cells in

comparison to PBMCs. Additionally, as predicted by bioinformatic analysis, CXCL16, CD56,

PECAM-1, ITGB7, IBTK, BTK, TLR10, IL1RN, and IL-1β were significantly differentially

expressed in NK cells of RA patients when compared to healthy controls.

Conclusions: Therefore, the gene expression of these molecules in NK cells might be used as

promising biomarkers for RA disease.

P1203. Rheumatoid Arthritis Patients Have vitamin-D Deficiency Compared to their Age-

Sex Matched Controls: What determine Vitamin-D level?

Suad Hannawi1, Haifa Hannawi1, Issa Al Salmi2

1Ministry of Health and Prevention, Dubai, United Arab Emirates, 2The Royal Hospital,

Muscat, Oman

Background: Vitamin-D (vit-D) is believed to have an immunomodulatory and anti-inflammatory

action. As a result, low vit-D has been proved to increase susceptibility to the development and to

increase the inflammatory activities of rheumatoid arthritis (RA). This study looked at 25-vit-D

level in RA patients and in their matched age and sex controls, and investigated what contribute to

the risk of low 25-vit-D in RA. The study looked at RA diseases activities, renal function,

demographic features and blood biochemistry relation to 25-vit-D level.

Methods: 62 RA patients and 82 control were recruited for the study. 25-vit-D level, RA diseases

activity parameters and blood biochemistry (full blood count, liver function test, and renal profile)

were obtained on the same day. Estimated glomerular filtration rate (eGFR) calculated with

Modification of Diet in Renal Disease (MDRD) formula. Body mass index (BMI) calculated as

mass (kg) / Height (m)2 . Univariate regression analysis was carried out to determine the

relationship between 25-vit-D level and all the parameters of interest (as above).

Results: 65 RA, and 82 controls matching for age (48±13 years for RA, and 47±14 years for the

controls, p=0.58) and sex (57 F (88%), M=8 (12%) RA, 67 F (82%), 5 M (18%) controls, p=0.23)

were included for the study. The mean 25-vit-D level was 41±31 nmol/l for the RA patients

(normal range: 50-80), and 52±33 nmol/l for the controls (p=0.03).

Univariate linear regression among RA patients revealed a positive linear relationship between 25-

vit-D level and age of the patients (p=0.02, CI: 0.08, 1.24), creatinine level (p=0.01, CI: 0.13,

0.96), body surface area (p=0.02, CI: 9.47, 111), body mass index (BMI) (p=0.03, CI: 0.17, 3.18),

and calcium level (p=0.04, CI: 1.38, 69.6). 25-vit-D level was negatively associated with eGFR

(p=0.04, CI: -0.20, -0.01), microalbuminuria level (p=0.03, CI: -0.26, -0.00), and CRP level

(P=0.03, CI: -0.47, -0.02).

Conclusions: Vit-D receptors are present in most cells in the body and in the T and B lymphocytes.

The active form of vit-D (1, 25 vit-D) is one of the most potent modulators of the immune system.

Hence, the negative relationship between 25-vit-D and CRP support 25-vit-D deficiency role in

the exacerbation of the inflammatory status, and possibly in the subclinical renal impairment; as

shown by the negative association between eGFR and the 25-vit-D. The relation between the

subclinical renal impairment and the vit- D deficiency is further supported by e the negative linear

relationship between 25-vit-D and the urine microalbumin level and the positive linear relationship

association between 25-vit-D and the serum creatinine level. The positive association between 25-

vit-D and the age of the participants might reflect the awareness of the older population about the

importance of sun exposure for health. Screening for vit-D deficiency might be an important step

to detect subclinical renal insufficiency in RA. Vit-D supplement might help in ameliorating the

inflammation of RA and the subclinical renal impairment especially its well known that our general

population is already Vit-D deficient and this worsen by the inflammatory conditions that they

develop.

P1204. Subclinical Thyroid Dysfunction is a Cardiovascular Disease Risk Factor in Female

Rheumatoid Arthritis Patients

Suad Hannawi1, Haifa Hannawi1, Issa Al Salmi2

1Ministry of Health and Prevention, Dubai, United Arab Emirates, 2The Royal Hospital,

Muscat, Oman

Background: Rheumatoid arthritis (RA) is a multisystem autoimmune disease that proved to be

associated with other autoimmune diseases particularly hypothyroidism. Subclinical

hypothyroidism had been reported in RA. As well, RA patients are at double the risk of

cardiovascular diseases (CVD). The increased risk of CVD is not fully explained by the traditional

and non-traditional CVD risk factors. In general population, hypothyroidism had been reported as

a CVD risk factor. This study aimed for the first time to investigating the relationship between

thyroid function parameters and the CVD risk as manifested by the carotid intima media thickness

(cIMT) among RA patients.

Methods: All the RA patients were recruited through a specialized rheumatology clinic at the

Ministry of Health and Prevention of UAE, from April 2016 to December 2018. Fasting Free

thyroxine (FT4), Free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) were

assessed in all the participants within the same week of the cIMT measurement. Linear regression

analysis used to look for the correlation of the thyroid function test (TSH, T$, and T3) and the

cIMT.

Results: A total of 154 female RA patients satisfying ACR/EULAR criteria for diagnosis of RA

were recruited. None of the patients had history of thyroid, renal, or hepatic disorders. None of the

patients were pregnant. The mean age for the participants was 50 ±12 years (Min16 –Max 87). The

mean FT4 was 15.7 ± 3.6 (NR: 12-22 pmol/L), mean FT3 was 4.54± 1.0 (NR: 4-6.8 pmol/L), and

mean TSH was 2.60 ± 3.3 (NR:0.27-4.2 mlU/L). The mean cIMT was 0.57±0.11 mm. correlating

TFT with cIMT showed that while there was no correlation between each of the FT3 and FT4with

the cIMT (P value 0.46 and 0.19, respectively), there were a significant negative linear relationship

between TSH value and the cIMT (P=0.03, β=- -0.006).

Conclusions: Subclinical thyroid dysfunction might be an additional non-traditional CVD risk

factors that can help in filling the gap of understanding the increased risk of CVD in RA. Further

studies at a larger scale are needed to confirm the study findings. Also, there is a need to confirm

if management of thyroid dysfunction in RA may help in overall improvement of this subset of

population.

P1205. Cardiovascular Risk in the Rheumatoid Arthritis patients of the Gulf Corporation

Council-GCC: What Contribute to the Carotid Intima Media Thickness

Suad Hannawi1, Haifa Hannawi1, Issa Al Salmi2

1Ministry of Health and Prevention, Dubai, UAE, 2The Royal Hospital, Muscat, Oman

Background: Rheumatoid arthritis (RA) is a common inflammatory joints disease that occurs in 1-

3% of population. RA patients are at higher risk of cardiovascular disease (CVD). This accelerated

atherosclerosis can’t be fully explained by the traditional CVD risk factors. The CVD risk factors

had never been investigated in the RA patients of Gulf Corporation Council (GCC).

For the first time, this study assesses the CVD as manifested by carotid intima media thickness

(cIMT) and the CVD risk factors (traditional and non-traditional) in RA GCC-population.

Methods: 216 RA (179 (83%) F and 37 (17%) M) GCC patients, who were free of atherosclerosis

(CVD & Cerebrovascular diseases) included over 5 years (2013-2018). Diabetic, hypertensive,

gout, renal and thyroid patients, pregnant, current smokers and those with history of smoking, and

patients on diuretics medications were excluded. cMIT ultrasound (US) measurements were

obtained using a real-time US scanner equipped with a 7.5-MHz linear probe. Blood tests (full

blood counts, liver function, renal profile, and inflammatory markers), demography details, and

body mass index (BMI) had been obtained within the same week of the cIMT scan. The correlation

between cIMT and other variables were calculated using simple linear and multivariate regression

analysis.

Results: The mean cIMT was 0.58 ± 0.11 mm (Min 0.28, Max 0.98). The mean age was 48 ± 13

years (48 ±12 yrs for females, 50±16 yrs for males, p= 0.279).

univariate regression analysis showed a positive linear relationship between cIMT and age of the

participants (p=0.001, CI: 0.00, 0.01), hemoglobin (Hb) (p=0.006, CI: 0.004, 0.023), hematocrit

(p=0.006, CI: 0.001, 0.008), mean cell volume (MCV) (p=0.027, 0.000, 0.004), mean cell

hemoglobin (p=0.04, CI: 0.000, 0.009), platelet (p= 0.000, CI: -0.001, -0.000), monocytes (p=

0.02, CI: 0.001, 0.018), eosinophils (p= 0.011, CI: 0.002, 0.018), erythrocyte sedimentation rate

(ESR) (p=0.04, CI: 0.000, 0.001), creatinine (p=0.002, CI: .000, 0.002), uric acid (p=0.002, CI:

0.0001, 0.0004), triglycerides (p=0.033, CI: 0.002, 0.044), low density lipoprotein (LDL)

(p=0.002, CI: 0.010, 0.045), C-reactive protein (p= 0.000, CI: 0.001, 0.002), ferritin (p=0.000, CI:

0.000, 0.001), body weight (Kg) (p=0.018, CI: 0.000, 0.002), body mass index (Kg/Ht2) (p=0.026,

0.000, 0.006), systolic blood pressure; Sbp (p= 0.000, CI: 0.001, 0.003), and diastolic blood

pressure; dbp (p=0.001, CI: 0.001, 0.003).

Negative linear relationship between cIMT and transferrin (p=0.001, CI: -0.001, 0.000), high

density lipoprotein (p=0.000, CI: -0.103, -0.036), and glomerular filtration rate (GFR, ml/min)

(p=0.024, CI: -0.0009, -0.00007).

Multiple linear regression analysis showed a positive linear relation between cIMT and age of the

participants (p= 0.000, CI: 0.002, 0.005), LDL (p= 0.003, CI: 0.012, 0.053), eosinophils (p=

0.025, CI: 0.001, 0.023), Sbp (0.004, CI: 0.001, 0.003), and the ESR (p= 0.016, CI: 0.002, 0.003).

And, negative linear relationship with the GFR (p= 0.022, CI: 0.000, 0.002), and transferrin

(p=0.000, CI: -0.001, -0.000). The R2 of the model was 0.65.

Conclusions: For the first time we show that high hemoglobin, transferrin level and eosinophils

count seem to have a role as a CVD risk factors in RA. The glucose fasting level is important CVD

risk factor even in non-diabetic RA patients. The rest of the CVD risk factors in RA GCC

population are like what had been demonstrated in other population (older age, high Sbp, ESR,

LDL, and GFR level).

P1301. Comprehension of Ethical issues of University research projects, presented to

Ethical Committee in Middle East.

Dr. Mohammad Waseemul Islam1

1Ajman University, Ajman, United Arab Emirates

Background: Introduction and objectives:

It has been the task of research ethics committees to assess the methodological, ethical and legal

aspects of all research carried out on humans or human biological samples. The aim of the study

is to analyze the experience of the research ethics committee from the ethical reviews of the

projects presented in the ethical assessment of research proposals involving human subjects and

animals with the aim to evaluate ethical problems of research proposals submitted to an ethics

committee to comprehend the ethical issues in University research in a similar region, to study.

Methods: Methods:

A descriptive study of the observations made on research projects received from various faculties

including Pharmaceutical and Medical Sciences, dentistry and Humanities. involving humans,

animals submitted within from 2018- 2019.

Results: Results:

The research projects submitted often involve ethics which becomes a challenging situation. It was

realized from the analysis that the majority of the cases involving faculty misconduct are not

intentional but rather due to misunderstanding or lack of awareness. This paper will discuss

different ethical issues in research, including study design and ethical approval, data analysis,

informed consent, problems related to the methodological aspects of the research, confidentiality

of information, following the data analysis and interpretation.

Conclusions: Conclusion:

According to the International principle of ethics we analyze ethical problems and suggest

judgement elements for them.

P1302. Leaning clinical round in pediatrics child health department

Hilal Saif AL Hashami 1Royal Hospital, Muscat, Oman

Background: Child health Department at the Royal hospital is the main tertiary care center for sick

children in the country. The department consist of different subspecialties which serve as tertiary

care level for complicated medical cases from all over the country. In addition; the department

survey as secondary care center to children population in and around Muscat region.

With growing population and increase number and complexity of referred medical cases and

limited bed availability in the department and limited tertiary care facilities in other regions in

addition to serving as a secondary case facility for Muscat region; bed management in very critical

to accommodate the demand especially during bed crisis season which usually take place from

September to March.

Methods: Multi-displenary approach applied to verify the factors affecting bed utilization in the

department including In-charge ward nurses, medical ward coordinator, discharge planner and

senior medical registrars. LEAN management tools such as VSM Value stream Mapping, A3 also

used to facilitate understanding the process and help in improving the bed utilization management.

These includes:

• Insufficient pre-clinical round team preparation and knowing each patient plan

• Insufficient patient handover plan prior to the clinical round

• Late start of the clinical round among different teams

• Improper organization of the clinical round in both prospective: time management:

(starting time and finishing time allocated for the clinical round and time located for each patient

clinical encounter) and distributing clinical responsibilities and duties among clinical team

members

• Insufficient work description among clinical team members: consultant, registrar level,

resident, interns.

• Insufficient work distribution among team members: team time keeper, hand hygiene

supervisor, inter-team communications

• Insufficient work organization between different health care workers involved in the

patient care: In-charge ward nurse, bed manager and ward coordinators

• Late preparation of clinical discharge summary for admitted patients

• Improper utilization of the patient waiting langue located for discharge patients

What was the proposed solution for this problem?

Implementing LEAN principles as VSM help to identify the bottle neck where most of the delay

in the clinical round take place.

Applying active clinical round with multi-level of handover and active time monitoring of the

round with distributing the responsibilities among team members.

The first active handover starts with morning clinical handover meeting for the whole department

where the admitted patients discussed during the meeting.

The second active handover take place when the senior registrar discusses the clinical cases briefly

with the active plan among the team members before the start of patients list distribution between

team members which usually does take between 25 to 30 minutes.

Then each team member will review his patient both clinically and review their files and

investigations in the Al Shifa electronic system which usually take between 20 to 30 minutes

The team then will gather for the clinical round where the following points should be taken into

considerations:

- If the number of patients more than 15; then the team can divide into two sub-teams

- A person should be assigned to be a time keeper so he/she will be responsible to monitor

the time of the team and to assure that each patient encounter should not exceed the estimated time

for that particular patient and to remind the team members when the time is close to exceed the

located period

- A suggested time for each patient encounter is 7to 10 minutes for old patient and 10 to 15

minutes for new patient

- A person should be assigned to be observer for the hand hygiene during the clinical round

- A person should be assigned to be responsible to any calls during the clinical round so that

the team workflow will not be affected

- If a patient was planned for discharge before the clinical round; then a doctor who is taking

care of that particular patient should finish the paper work and round on that patient with senior

registrar before the start of team clinical round and discharge summary should be made ready to

be handed over to the nurse assigned for that patient

- If a patient is decided for discharge during early team briefing meeting; then a doctor who

is taking care of that particular patient should finish the paper work and round on that patient with

senior registrar before the start of team clinical round and discharge summary should be made

ready to be handed over to the nurse assigned for that patient

- If a patient is ready for discharge but the transport facility is not yet available for her/him;

then the patient should be sent to the patient waiting langue allocated for such purpose.

- Discharge planner and bed manager play an important role in following up patients

admitted in the child health department in regard to the followings:

- Patients planned for early discharge on daily basis

- Monitoring patient length of stay and clarifying with the team the management plan for

each particular patient

- identifying patients who can be transferred back to the regional hospital and continue their

management plan there

- Facilitating any issue relating the patient management plan in form of: communicating with

other hospitals bed managers and also facilitating non medical related requirements that can help

in early discharge of the inpatient or transfer to another hospital

- Communicate with different team registrars, ward in charge nurses, and medical ward

coordinator on daily basis to discuss any concern related to the bed utilization in the department

Results: Applying LEAN tools such as VSM help in better understanding aspect where clinical

rounds can be improved and resulted in improve clinical round dynamics and improve bed

utilization within the department of child health, early discharges and it results in the following

advantages:

- Improve Communication among health care providers involved in patient care.

- Improve Efficiency of the clinical round.

- Better bed utilization in the medical wards

- Eliminate the Motion and over processing in patient care for patient admitted in the child health

department

- improve the number of early discharges for admitted patients

Conclusions: •Applying lean management of the clinical round resulted in better bed utilization

and improve early discharges

Team members appreciate the effect of LEAN management of the clinical round in their daily

work and improving the efficacy of the round

• Spreading Awareness of the proposed new clinical round management among different

levels of health care providers improve the acceptance of the idea

• Direct and continuous communication between all the involved stakeholders involved in

the patient care of the admitted children help in recognition of any possible challenges and

facilitate finding solution for them

P1303. The Effectiveness of applying for Formative Assessment Objective Structured

Clinical Examination (OSCE) for Undergraduate Students in Faculty of Medicine Sumaiah

Alabdulwahab1

1King Abdulaziz University, Jeddah, Saudi Arabia

Background: Background: (Introduction)

This study of monitoring the effectiveness of the formative OSCE was conducted over five years

from 2014 until 2018 and still this monitoring is going on for 2019.

The purpose of this study is to determine the effectiveness of applying formative assessment

Objective Structured Clinical Examination (OSCE) for undergraduate 5th year medical students

in clinical skills module, Also to measure the effectiveness of Self Direct Learning (SDL) sessions.

Methods: Check list of 10 questions survey (questionnaire) were distributed to all undergraduate

medical students who had participated in the formative (OSCE) so to measure their competency

and proficiency. The formative is conducted before summative OSCE. This method was applied

in 2014 and the residents were the examiners. In 2018 this method was amended to accept more

challenges in inviting house officers (interns) to be examiners. Since most of the standardized

patients (SP) who are participating in the formative OSCE from Interns who have finished their

rotations in all the clinical departments and were retained in the inactive stations.

Results: In 2014, the number of students were 208 (95 males & 113 females) who participated in

the formative assessment had reported not enough time since it was 5 minutes; it should more than

10 minutes. About 8% were incomplete questionnaire nothing to report.43% had reported it

highlighted area of weaknesses in their clinical skills and 48% felt safe to make errors without

accountability and confidentiality. But students had reported difficulty with the residents; they

were inexperience to provide feedback since they were not involved in their teaching planeIn 2015

and 2016, about 50% of the students did not participate in the formative assessment OSCE since

it was not compulsory. In 2018, we have accepted more challenges in inviting house officers

(interns) to be examiners. All the incomplete surveys were discarded and omitted from the analysis.

Conclusions: Overall, 5th year medical students' feedback was infavor of having formative

(OSCE) more often in clinical skills module. The formative assessment is powerful tools had

assisted them in learning and to overcome their weakness and gave them the opportunity to

improvement and to prepare them for the summative (OSCE), as result repetition of this module

was reduced, Also suggested that residents should be involved in teaching the curriculum to be

familiar with students’ syllabus.

Faculty had diversity of opinion about for formative OSCE which was reported that it's time

consuming, budget consumption and lack of incentive; on the other hand, students expressed high

satisfaction with this type of examination and their outcome after participating was found

remarkably.