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

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

Euglycemic diabetic ketoacidosis induced by sodium-glucose cotransporter 2 inhibitor in the setting of prolonged fasting: a case report.

BACKGROUND: We describe a case report of a patient with type 2 diabetes on sodium-glucose cotransporter 2 inhibitor and metformin therapy fasting for Ramadan (a holy month observed in the Islamic nation) diagnosed with euglycemic diabetic ketoacidosis. CASE PRESENTATION: The patient was a 51-year-old Moroccan male with history of type 2 diabetes mellitus on dapagliflozin and metformin. He presented with abdominal pain, vomiting, loss of appetite, and shortness of breath. He observed Ramadan month by fasting an average of 14 hours daily for 30 days. The patient was admitted with severe metabolic acidosis with a high anion gap and positive ketonuria in the setting of serum glucose of 13.5 mmol/L (243 mg/dL). The patient was rehydrated and started on insulin infusion according to the diabetic ketoacidosis protocol following the diagnosis of euglycemic diabetic ketoacidosis. CONCLUSION: Dapagliflozin is associated with euglycemic diabetic ketoacidosis in the setting of prolonged fasting. Counseling and possible medication adjustment should be added to clinical practice in those planning to decrease caloric intake through dedicated fasting including Ramadan or weight-loss-directed behavioral modifications, especially if taking sodium-glucose cotransporter 2 inhibitors.

Euglycemic Diabetic Ketoacidosis after Discontinuing SGLT2 Inhibitor.

Background: Sodium glucose cotransporter-2 (SGLT2) inhibitors have been proven to be very effective in the management of type II diabetes. These medications can cause adverse drug reactions such as genital mycotic infections. Another critical adverse drug reaction is euglycemic diabetic ketoacidosis (EDKA) under the setting of other contributing risk factors for developing diabetic ketoacidosis. Case Presentation. We report a case of a 45-year-old gentleman with type 2 diabetes mellitus on empagliflozin, metformin, and glimepiride who presented with abdominal pain, fatigue, and vomiting. Of note, he started a ketogenic diet three days before his presentation and self-stopped his antidiabetic medications two days before his presentation. The patient was found to have euglycemic diabetic ketoacidosis and was treated as per the protocol. He was discharged on metformin and pioglitazone. Two weeks following discharge, canagliflozin was added. Conclusion: Euglycemic diabetic ketoacidosis could still be precipitated despite discontinuation of SGLT2I under a ketogenic diet. Discussion related to the initiation of a ketogenic diet should occur between the care provider and the patient.

Cytological Sub-Classification of Atypia of Undetermined Significance May Predict Malignancy Risk in Thyroid Nodules.

BACKGROUND: Atypia/follicular lesion of undetermined significance (AUS/FLUS) carries a malignancy risk reaching up to 50%. Based on the reported malignancy rate in a given population, the clinical practice towards such a category varies. We hereby identify clinical parameters for risk stratification to aid in decision-making for either surgical referral or a clinical follow-up. Our aim is to identify clinical parameters that guided both clinicians and patients at our institutions to reach a clinical decision including atypia types. METHODS: A retrospective review of patients with Bethesda III category thyroid nodules from tertiary centres in the Emirate of Abu Dhabi during January 2011 through December 2015 was carried out. Malignancy risk in Bethesda category III nodules and repeat FNA utility were calculated. Parameters that guided both clinicians and patients for appropriate referral to surgery were studied. RESULTS: Two hundred and two cases were included in the study. Of these, 101 cases underwent surgery initially following the first FNA and 10 cases following FNA repeat. Histology confirmed malignancy in (41%) of cases that went initially to surgery and in (40%) of cases that underwent a repeat FNA. Repeat FNA resulted in 17 (44.74%) cases being re-classified into benign category, 10 (26.3%) being AUS/FLUS category, 6 (15.7%) being both suspicious and malignant, and 5 (13.16%) being unsatisfactory. Repeating FNA resulted in a definitive diagnostic utility in 50% of the cases. Eighty percent of malignant cases demonstrated nuclear atypia. CONCLUSION: The relatively high malignancy rate in our institutions, the suspicious radiographic features, the atypia groups, and the repeat FNA predictive value stratified Bethesda III category nodules for proper malignancy prediction and appropriate management.

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

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

Characteristics of patients with low-trauma vertebral fractures in the United Arab Emirates: a descriptive multi-center analysis.

Vertebral fracture is the most common type of osteoporotic fracture. However, the prevalence of osteoporosis and osteoporotic vertebral fractures were not explored previously in the United Arab Emirates (UAE). This study aims to describe for the first time the demographic and morphological characteristics of patients with fragility vertebral fractures in the UAE through a retrospective review of the medical records of patients with low-trauma vertebral fractures who visited two tertiary centers during 2011-2016. The sex, age at the time of fracture, nationality, body mass index (BMI), and anatomical fracture location were recorded for each patient. Overall, 143 subjects were diagnosed with low-trauma vertebral fractures in the Emirate of Abu Dhabi during 2011-2016. Of these, 98 were women (68.5%) and 45 were men (31.5%). The overall mean patient age at diagnosis was 62.5 years, and almost half were younger than 65 years. Approximately 60% of the patients were UAE nationals. Fifty-one patients (36.7%) were obese (mean BMI: 35.3 kg/m2), and women with vertebral fractures had a significantly higher mean BMI compared with men (p = 0.041). Nearly 40% of men had a normal BMI, compared with 20% of women. Most fractures were compression fractures (77.6%) in the thoracolumbar transition region. In conclusion, patients with fragility vertebral fractures were predominantly female and tended to be overweight or obese, although male patients tended to have a lower BMI than female patients.

Thyroid malignancy among patients with thyroid nodules in the United Arab Emirates: a five-year retrospective tertiary Centre analysis.

OBJECTIVES: Thyroid malignancy constitutes the sixth common cancer type in the United Arab Emirates (UAE). There are no epidemiological data outlining the prevalence of cancer in thyroid nodules, nor previous analysis of ultra-sonographic features correlating with thyroid malignancy in the UAE. This study aimed to estimate the prevalence of thyroid malignancy in patients with thyroid nodules and to describe the ultra-sonographic characteristics of thyroid nodules harbouring malignancy. METHODS: A retrospective electronic medical records review of all thyroid nodules in patients (aged 18 to 80 years) with normal thyroid-stimulating hormone (TSH) levels, who underwent ultrasound guided fine needle aspiration cytology (UG-FNA) at Sheikh Khalifa Medical City (SKMC) during 2011-2015. RESULTS: 436 patients with normal TSH underwent UG-FNA cytological examination of thyroid nodules (n = 555 nodules). The overall crude prevalence of thyroid cancer among patients was 10.1% (95% CI 7.5-13.3). The age-adjusted prevalence of thyroid cancer among UAE nationals, Arabs, Far East Asians, and Caucasians were 9.6% (3.6-15.6), 10.0% (6.2-13.8), 16.8% (4.5-29.0) and 16.3% (1.7-30.9), respectively. The crude prevalence was 14.5%(95% CI 6.2-22.8) in men, and 9.3%(95% CI 6.3-12.2) in women. The echogenicity features were significantly different between the cancerous and noncancerous nodules (p = 0.025). Cancerous nodules were relatively more hyper- and hypo-echoic, while noncancerous nodules were mostly complex. CONCLUSION: We report a higher prevalence of thyroid malignancy among patients with thyroid nodules relative to that reported in other parts of the world. The rate of thyroid malignancy was higher in patients of Far-East Asian and Caucasian ethnic background.