P-144 THE ABDOMINAL BINDERS FOLLOWING ABDOMINAL WALL RECONSTRUCTIVE SURGERY: USEFUL OR USELESS? - A META-ANALYSIS

Aim

Despite a recent meta-analysis published in SAGE in 2021 by a group of chinese researchers, which included 10 RCTs, the research committee for this study felt that a substantial volume of recent literature, including 7 RCTs and 3 high value non-RCT newly published articles have not been included in the latest meta-analysis and a new study is required, to understand the clinical usefulness of abdominal binders, following abdominal wall reconstructive surgery. Furthermore, no recent studies looked at the long-term impact of abdominal binders and whether their use prevent hernia recurrence, if applied from the immediate post-op period.

Material & Methods

A thorough review of all medical literature published in english language since year 2000 and to date was carried out, using the following keywords: “hernia”, “hernia repair”, “abdominal wall reconstruction” and “abdominal binder”. 17 randomised control trials and 3 non-RCT studies (systematic reviews and surveys) were included in the study. A total of 5216 patients were included in the 20 studies included. The databases searched were PubMed, Medbase, Jama and Embase.

Results/Conclusions

The use of abdominal binders following abdominal wall surgery suggests a better pain control when compared with non-users group. This contributes to earlier mobilisation and by this preventing secondary post-op complications. There is building evidence that in long term the use of abdominal binders reduces the risk of hernia recurrence and this could be in relation to decreased post-op pain and earlier return to a normal activities in the immediate post-op period.

P-128 GET THE COMPLEX HERNIA PATIENT THEATRE READY: THE PERI-OPERATIVE OPTIMISATION PATHWAY PROFORMA WE UTILISE

Aim

In modern times, complex abdominal wall herniae are an area of increased sub-specialisation for the surgeon as well as the multidisciplinary team that work together. Recent advances in pre-op optimisation pathways and protocols, several pre- and intra-operative adjuncts available for these complex cases and a multitude of surgical techniques that can be deployed in open or minimally invasive fashion, have made it increasingly difficult for surgical teams to integrate all aspects of care for their patients. We are proposing for presentation our Hospital Pathway-Proforma used for diagnosis, pre-optimisation and peri-operative care in complex ventral and groin hernias.

Material and Method

“In-house” developed pre-optimisation planning proforma taking into consideration all evidence based interventions that can lower a patient's CEDAR score: BMI reducing, smoking cessation, blood sugar control, nutritional optimisation and skin decolonisation, as well as anaesthetic specific tests and interventions aimed at optimising patient's cardiac, respiratory, renal and metabolic status before undergoing complex abdominal wall reconstruction surgery. The proforma details specific diagnostics and intervention at pre-operative clinic visit one and two, then concentrates on pre-operative and intra-operative adjuncts to be used in each individualised case (e.g. Botox, Fasciotens). Finally the post-operative pathway details specific interventions to be taken for an uneventful post-op recovery.

Results and Conclusion

By using the Profoma-Pathway, the work of the complex hernia surgeon, anaesthestist and entire team taking care of CAWR patients became more organised and streamlined. The local pathway is also useful in auditing the local work in major abdominal wall hernia reconstruction patients.

P-121 RETROSPECTIVE REVIEW OF PRACTICE AND OUTCOMES USING A SINGLE BRAND BIOLOGIC MESH AT A DISTRICT GENERAL HOSPITAL

Aim

A retrospective review of all operated hernia patients in which a single brand of Biologic mesh was used, since it's first introduction in our Trust and to date, has been conducted. During last almost 5 years, twelve patients were identified and included. All patients operated with any other type of Biologic mesh and all patients operated with synthetic meshes were excluded, as the aim of the study was to look at the efficiency of a particular product, which was the cheapest biologic mesh at the time of contract with our Hospital.

Material and Methods

Retrospective review of patient's notes and outcomes, including post-op follow-up and long-term follow-up. The study looked at the following criteria: indication of use as per VHWG (ventral hernia working group) classification of the patients, LOS (length of stay) compared with patients operated with synthetic mesh, any post-op complications including SSO/SSI (surgical site occurrence and/or infection) and outcome at follow-up to date, including recurrence, chronic pain or mesh infection.

Results

The biologic mesh studied proved itself as a reliable product and provided a durable repair in the cases where it was used. It was noticed that majority of the cases were emergency presentations for complicated ventral or inguinal hernias, the complexity of the cases compared with elective cases being higher (higher ASA grade patients, non-optimised etc).

Conclusions

The outcome of the study recommends to continue utilising this product, as efficient and financially competitive.

344 A Rare Case of Meckel's Diverticulitis With a 3 Cm Enterolith

Meckel's diverticulum (MD) is a rare condition that affects only 2% of general population. Only 4 to 6% of those Meckel's diverticulea are symptomatic. Furthermore, having a MD containing enterolith is extremely rare, and herein we present a case of 55-year-old lady with Meckle's diverticulitis containing a 3 cm enterolith. The patient presented with symptoms mimic appendicitis; however, upon further evaluation with an enhanced abdomino-pelvic CT an MD containing enterolith was confirmed. An interval laparoscopically assisted diverticulectomy was performed and the patient recovery was un-eventful.

27 Do Microbiology Swabs Taken During Incision and Drainage of Acute Perianal Abscess Affect Clinical Management and Future Clinical Course?

Introduction

This study assesses whether microbiology swabs taken during incision and drainage of perianal abscesses have any impact on the post-operative clinical course and management.

Method

Data from emergency operative theatre lists were interrogated for patients undergoing incision and drainage of perianal abscess in the period March 2019 – March 2020. Each electronic medical record for patients who had perianal abscess surgery was interrogated for age, sex, smoking status, diabetic status, whether microbiology swab was taken for analysis, what organism was grown and any post-operative fistula development.

Results

71 patients met inclusion criteria. 55 (77.5%) patients had pus swabs sent at incision and drainage for microbiological analysis. Of the 55 patients swabbed, 20 (36%) had no organism growth, 22 (40%) had anaerobes growth – the most common organism in this study. Of all 55 swabs sent, only 14 (25%) were acknowledged. The presence of smoking (p < 0.05) was statistically significantly associated with development of fistula-in-ano longer term.

Conclusions

Our data may indicate that microbiology swabs do not influence management of patients with acute perianal abscess. There are discrepancies in whether swabs are taken and acted upon. No organism was associated with fistula development. We would suggest national scale studies to explore our conclusions.

How Alfvén waves induce compressive flows in the neighborhood of a 2.5D magnetic null-point

The aim of the present study is to provide insight on the induced compressive perturbations together with the modifications of the environmental parameters in the course of Alfvén wave interaction with a solar magnetic null-point. The shock-capturing Godunov-type code PLUTO is used to solve the set of ideal magnetohydrodynamic equations. The nonlinear effects connected with an initial Alfvén pulse nearing a magnetic null point induces fast and slow magnetoacoustic waves with anti phase conduct. The induced current density and flows are independent of the local plasma-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\beta$$\end{document}β at the reconnection site. The induced inflows and outflows highly depend on the polarization. The inflows have a stronger effect compared to the outflows in both the x and y directions showing its peak in the x-direction. The dominant wave that couples to flows is the fast wave due to the in-phase harmony between perturbations of the compressive parameters and the fast wave. The induced current density possesses a steady orientation at the reconnection site which governs the diffusion or propagation of the waves. Induced perturbations by the nonlinear forces together with their back reaction on the Alfvén wave have a significant role in the current density excitation being responsible for the creation of inflows and outflows that are possible candidates for the creation of solar jets which has a significant contribution towards coronal seismology.

Skin Toxicity in Early Breast Cancer Patients Treated with Field-In-Field Breast Intensity-Modulated Radiotherapy versus Helical Inverse Breast Intensity-Modulated Radiotherapy: Results of a Phase III Randomised Controlled Trial

AIMS

Skin toxicity is a common adverse effect of breast radiotherapy. We investigated whether inverse-planned intensity-modulated radiotherapy (IMRT) would reduce the incidence of skin toxicity compared with forward field-in-field breast IMRT (FiF-IMRT) in early stage breast cancer.

MATERIALS AND METHODS

This phase III randomised controlled trial compared whole-breast irradiation with either FiF-IMRT or helical tomotherapy IMRT (HT-IMRT), with skin toxicity as the primary end point. Patients received 50 Gy in 25 fractions and were assessed to compare skin toxicity between treatment arms.

RESULTS

In total, 177 patients were available for assessment and the median follow-up was 73.1 months. Inverse IMRT achieved more homogeneous coverage than FiF-IMRT; erythema and moist desquamation were higher with FiF-IMRT compared with HT-IMRT (61% versus 34%; P < 0.001; 33% versus 11%; P < 0.001, respectively). Multivariate analysis showed large breast volume, FiF-IMRT and chemotherapy were independent factors associated with worse acute toxicity. There was no difference between treatment arms in the incidence of late toxicities. The 5-year recurrence-free survival was 96.3% for both FiF-IMRT and HT-IMRT and the 5-year overall survival was 96.3% for FiF-IMRT and 97.4% for HT-IMRT.

CONCLUSIONS

Our study showed significant reduction in acute skin toxicity using HT-IMRT compared with FiF-IMRT, without significant reduction in late skin toxicities. On the basis of these findings, inverse-planned IMRT could be used in routine practice for whole-breast irradiation with careful plan optimisation to achieve the required dose constraints for organs at risk.

Prevalence, Severity, and Correlates of Premenstrual Dysphoric Disorder Symptoms Among Women in the Arabian Peninsula

Objective

To study the prevalence of premenstrual dysphoric disorder (PMDD) symptom patterns among women in the United Arab Emirates and to measure the debilitating nature of PMDD symptoms and sociodemographic correlates.

Methods

This cross-sectional sample study used the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) and Premenstrual Symptoms Screening Tool (PSST) to screen for presence and severity of PMDD symptoms in Arab women attending ambulatory health services in Alain city, Emirate of Abu Dhabi, United Arab Emirates, for routine health care between May 2005 and September 2005.

Results

The study participants include 508 women (76% Emiratis, 15% Omanis, and 8% other Arabs) of childbearing age. In total, 94 women (18.6%) met MINI-Plus criteria for PMDD; of these, 21 (4.1%) met PSST criteria for severe symptoms, 29 (5.7%) for moderate symptoms, and 44 (8.7%) for mild or less symptoms. One woman (0.2%) with severe symptoms and 12 women (2.4%) with moderate symptoms had negative MINI-Plus scores. Presence of PMDD symptoms was significantly associated with higher education (P = .000), single marital status (P = .001), major life stressors (P = .001), and personal/family use of psychotropic medications (P = .000/P = .006), personal/family psychological problems (P = .000/P = .001), irregular/painful menses (P = .043/P = .001), and functional impairment on the Sheehan Disability Scale (P = .000). Multilogistic regression analysis showed higher education, major life stressor, personal use of psychotropic medications, personal/family psychological problem, and painful menses were independent predictors of PMDD symptoms.

Conclusions

PMDD symptoms were common among the Arab women in our study. The cyclically triggered mood disturbances were clustered in women with personal/familial psychological problems, perhaps linking biologic constitution to genetic predisposition for the development of PMDD symptomatology.

The prevalence and potential determinants of obesity among school children and adolescents in Abu Dhabi, United Arab Emirates

OBJECTIVES

To estimate the prevalence and determinants of obesity in childhood and adolescence and their association with blood pressure (BP) in Abu Dhabi, United Arab Emirates (UAE).

DESIGN

A cross-sectional population-representative study.

SUBJECTS

A total of 1541 students (grades 1-12; aged 6-19 years) were randomly selected from 246 schools (50% male). Anthropometric and demographic variables were measured, and CDC criteria were used to classify children's weights.

RESULTS

A total of 1440 (93%) students provided complete results. Crude prevalences were: 7.6% underweight, 14.7% overweight and 18.9% obesity. Further analyses were restricted to UAE nationals (n=1035), of whom these figures were: 8.3% underweight (females 6.5%, males 10.1%; P=0.06), 14.2% overweight (females 16.7%, males 11.6%; P<0.01), 19.8% obesity (females 18.1%, males 21.4%; P=0.09). Obesity significantly (P<0.001) increased with age. The majority (61.3%) of students had body mass index (BMI) percentiles above the 50th CDC percentile. Stepwise linear regression of BMI percentile on age, sex, dairy consumption, exercise and family income showed a significant (P<0.01) positive association with age and lack of dairy consumption, but not exercise and income. BP significantly (P<0.01) increased with BMI percentile.

CONCLUSIONS

The prevalence of childhood obesity is high across the age spectrum in the UAE. Older age, male sex, lack of dairy intake and higher parental BMI, are independent determinants of childhood obesity in this population. Higher BMI percentile is associated with a higher BP. Prevention strategies should focus on younger children, particularly children of obese parents. Longitudinal studies are needed to investigate trends and the impact of childhood obesity on the risk of non-communicable diseases.

Safety and efficacy of self-expanding removable metal esophageal stents during neoadjuvant chemotherapy for resectable esophageal cancer

Patients with esophageal cancer may present with dysphagia and weight loss. Resectable lesions require consideration of neoadjuvant chemotherapy, which improves survival but have side effects, which compound already poor intake. Prevention of malnutrition has historically required interventions such as surgical jejunostomy or percutaneous endoscopic gastrostomy, which carry associated morbidity. With established roles in palliation, self-expanding removable metal stents (SERMS) may provide an alternative intervention in resectable disease. We sought to evaluate outcomes from our unit's introduction of SERMS in dysphagic patients prior to esophagectomy. All dysphagic patients presenting with esophageal cancer and considered for curative surgery between April 2006 and November 2008 were offered preoperative treatment of dysphagia with SERMS during neoadjuvant chemotherapy. Baseline and preoperative outcomes assessed included dysphagia score and nutritional markers. Sixteen patients underwent esophageal stenting during neoadjuvant therapy of whom 7/16 (44%) were female with mean age 63 (53-76). In 12/16 (75%), tumors were located in the lower one third of the esophagus. There was a significant fall in mean dysphagia score from 2.5 (range 1-4) to 1.1 (range 0-3) immediately preoperatively. There was no significant change in serum albumin, weight, or body mass index. Stent-related morbidity occurred in 4/16 (25%) patients and stomach migration occurred in 7/16 (43.8%). All were resolved endoscopically and there was no stent-related mortality. Of 10/16 (62.5%) patients ultimately progressing to esophagectomy, 30-day mortality was 6.3%. Anastomotic leak occurred in one patient (10%) and R1 resection rate was 20%. SERMS are a safe and effective intervention in dysphagic patients undergoing neoadjuvant chemotherapy for esophageal cancer. Complications are minor and readily treatable with endoscopy. Objective parameters suggest nutritional status is maintained and symptoms are improved. SERMS do not appear to compromise resection.

Subjective life satisfaction and mental disorders among older adults in UAE in general population

BACKGROUND

Life satisfaction is widely considered to be a central aspect of human welfare. Many have identified happiness with it, and some maintain that well-being consists largely or wholly in being satisfied with one's life. Empirical research on well-being relies heavily on life satisfaction studies.

AIMS

The aim of this study was to examine the relationships of psychiatric disorders and physical disorders on life satisfaction among Arab older adults in general population.

METHODS

Face-to-face interviews with Geriatric Mental State Interview (GMS-A3) were conducted with a nationwide sample of 2000 household in 2001. Total samples of 610 elders (above 60 years) were interviewed.

RESULTS

There were 347 males (56.9%) and 263 females (43.1%). The mean age was 68.6 years (SD = 8.3). The commonest diagnoses were depression (20.2%), anxiety (5.6%), hypochondriasis (4.4%), and organic brain syndrome with or without dementia (3.6%). The findings suggest that having depressive disorder was significantly associated with less life satisfaction in the whole sample of older adults' people. In addition, anxiety, hypochondriacal disorders, and organic brain syndrome were significantly associated with low life satisfaction. Meanwhile, other psychiatric disorders e.g., phobia, Obsessive Compulsive disorder (OCD), schizophrenia were not significantly associated with life satisfaction. No significant relationship was found with any physical disorders alone. The data further reveal that low level of life satisfaction was especially significant in the age group above 85 years and people who live alone or only with wife/husband.

CONCLUSIONS

The strong influence of psychiatric disorders e.g., depression, anxiety, organic brain syndrome, and hypochondriasis rather than physical disorders suggests that a lack of meaning and worries are more detrimental to life satisfaction than physical frailty. The findings underscore the need to develop interventions that help older people deal more effectively with psychiatric disorders and its comorbidities. Moreover, the results suggest that providing family support, by not allowing older adults to live alone, may be especially helpful for older adults.

Help-seeking behaviour of patients attending the psychiatric service in a sample of United Arab Emirates population

BACKGROUND

Many patients suffering from psychiatric disorders seek non-professional care before attending specialized services.

AIMS

To study the help-seeking behaviour of patients referred to the psychiatric department of Al-Ain Hospital, which is the main university teaching hospital in UAE.

METHODS

This study was a descriptive cross-sectional epidemiological survey. All new patients attending the psychiatry out-patient clinic at Al-Ain Hospital were screened for nine consecutive months from March to November 2003 inclusive.

RESULTS

The sample consisted of 106 patients (52 male; 54 female). Prior to presenting to the psychiatric service, 44.8% consulted faith healers, 31% of whom had had a previous experience with them; 45% reported some improvement but their symptoms recurred later, while 47% reported no improvement. In 8% their symptoms worsened for the current episode. Treatments received were herbal (29.8%) and prayer (70.2%). Of the sample, 43.4% consulted a primary care physician before presenting to the secondary psychiatric care.

CONCLUSION

In this sample a sizable number of patients sought alternative methods of treatment before attending the specialized psychiatric services.

Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates

AIMS

To determine the prevalence of diabetes mellitus (DM) and its complications in the adult population of the United Arab Emirates (UAE) and assess the degree of metabolic control in subjects with diagnosed DM.

METHODS

A random sample of houses of Emirati citizens living in Al Ain, UAE was surveyed. Fasting blood glucose was determined by glucose meter and an oral glucose tolerance test (OGTT) was conducted if blood sugar was <7 mmol/l. DM was defined according to the WHO criteria. Pre-diabetes status was based on fasting venous blood glucose concentration of 5.6-6.9 mmol/l or 2h post-OGTT venous blood glucose level of 7.8-11.0 mmol/l.

RESULTS

There were 2455 adults (>18) living in the 452 surveyed houses of which 10.2% reported having the diagnosis of DM. A total of 373 men and non-pregnant women underwent testing, and after adjustment for factors affecting participation probability the prevalence of diagnosed DM, undiagnosed DM and pre-diabetes was 10.5, 6.6 and 20.2%, respectively. Age-standardized rates for DM (diagnosed and undiagnosed) and pre-diabetes among 30-64 years old were 29.0 and 24.2%, respectively. Logistic regression analysis showed that only age and body mass index (BMI) were significantly independently related to undiagnosed DM. In patients with diagnosed DM, the prevalence rates for retinopathy, neuropathy, nephropathy, peripheral vascular disease and coronary heart disease were 54.2, 34.7, 40.8, 11.1 and 10.5%, respectively. A significant proportion of subjects with undiagnosed DM and pre-diabetes also had micro- and macro-vascular complications. The proportion of subjects with diagnosed DM who achieved internationally recognized targets for HbA1c (<7%), LDL-C (<2.6 mmol/l) and blood pressure (<130/80 mmHg) was 33.3, 30.8 and 42.1%, respectively.

CONCLUSION

This study confirms the previously reported high prevalence of DM in the UAE. Diabetic complications were highly prevalent among subjects with diagnosed and undiagnosed DM. Metabolic control was suboptimal in most subjects with diagnosed DM. Greater efforts are urgently needed to screen early and effectively treat DM in the UAE in order to prevent long-term complications.

Prevalence and psychosocial correlates of global developmental delay in 3-year-old children in the United Arab Emirates

OBJECTIVE

Developmental disabilities are lifelong conditions with considerable public health impact, incurring substantial financial and societal costs. Data on prevalence and associated factors can provide the basis for setting priorities and designing interventions.

METHODS

A representative random sample of 694 United Arab Emirates national children aged 3 years were evaluated in a two-stage epidemiological study.

RESULTS

Stage 1 screening using the Denver Developmental Screening Test found that 8.4% [confidence interval (CI): 6.4-10.7] had global developmental delay (GDD). Using clinical diagnostic interview in Stage 2, the weighted prevalence for clinically significant developmental disability was estimated to be 2.44% (CI: 1.28-3.56). GDD was associated with pregnancy and birth complications, poor maternal education, family history of developmental problems, and major traumatic life events, as well as behavioral problems in children.

CONCLUSION

Our findings suggest the need for comprehensive and early screening programs for developmental problems, and the importance of training medical and child care professionals accordingly.

Sociodemographic and clinical characteristics of patients with dissociative disorders in an Arabian society

OBJECTIVE

The aim of the study was to determine the sociodemographic and clinical characteristics of patients with dissociative disorders among psychiatric patients in the population of the United Arab Emirates.

SUBJECTS AND METHODS

Six hundred inpatients with dissociative disorders were approached during the period 1997-2003, and 468 agreed to participate in the study. These patients were recruited from Al-Ain and Tawam Teaching Hospitals and Al-Jahili Primary Health Care Centers in Al-Ain, United Arab Emirates. The study is based on a questionnaire that included sociodemographic and clinical variables. Dissociative disorders were diagnosed according to the classification set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the International Classification of Diseases (ICD-10) of the World Health Organization.

RESULTS

Of the 468 patients studied, the majority (67.9%) were young, under the age of 25 years; 55% were UAE nationals, 59.4% female and 40.6% male. Disorganized movement was significantly lower among females (34.2%) than males (44.2%, p < 0.03). Disapproving of the key relative behaviour was higher in females (24.1%) compared to males (13.2%); comorbid anxiety was higher in females (37.4%) vs. males (25.3%). Disturbed relationships were more common in females (40.3%) while precipitating factors, such as intolerable stressful events, were significantly higher in males (42.6%, p < 0.01). Furthermore, males (20.5%) had a significantly higher history of similar episodes and other psychiatric illnesses (7.5%) than females. Finally, females (41%) showed more statistically significant improvements compared to males (29.5%, p < 0.001).

CONCLUSION

Patients under 25 years of age suffered more from dissociative disorders with no correlation to educational level as a predisposing factor. The most common symptoms were fits or unorganized movements.

Correlation between hypertension and income distribution among United Arab Emirates population

To determine the correlation between hypertension and income distribution among United Arab Emirates (UAE) population. Case-control study matched for age, sex, nationality and education. The survey included 500 hypertensive adults aged 20-65 years ascertained from Primay Health Care (PHC) Clinics along with a randomly selected sample of 500 control subjects from the community. Face-to-face interviews were done where data were gathered on socio-demographic-economic status (SES) and lifestyle habits. Hypertension was defined according to WHO criteria as having Systolic Blood Pressure (SBP) > or = 140 mm Hg and/or Diastolic Blood Pressure (DBP) > or = 90 mm Hg and/or being on antihypertensive treatment. The survey was carried out in urban and semi-urban PHC Clinics. A total of 818 subjects were included in this study from a sample of 1000; 409 cases and 409 controls. There were 422 males and 396 females in this study, with 255 UAE nationals and 438 expatriates. Hypertension was found to be significantly higher among the low income group (35.2% vs. 24.9% controls, p = 0.002; while mean SBP in the low income group was 130.2 +/- 17.6 vs. 128.0 +/- 17.4 controls, p = 0.022). Among males, smoking and alcohol consumption were higher among the group with low income level but only smoking showed significant difference (p value = 0.016). Activity level was higher among the low income groups. This study supports the importance of socio-economic factors as an income distribution effect on life-style habits and hypertension.