Background: The incidence of women undergoing implant-based reconstruction (IBR) after mastectomy for breast cancer is significantly increasing, for that reason, a better understanding of the factors that might increase risk of complications is essential to improve the quality of life of patients that need such types of intervention. In this study, the authors investigated the association between the development of complications following IBR and various possible risk factors. Method: The files of patient's cohort that consisted of 150 patients who underwent implant reconstruction were initially screened. Only 73 cases who attended the Breast Care Center in Tawam Hospital, Al Ain, UAE and were diagnosed with breast cancer and underwent therapeutic mastectomy with IBR in the period between 2015 and 2022 were included. Results: The authors' results showed implant infection (31.81%) and skin necrosis (27.27%) as the most important complications that appeared following IBR. Out of the 73 patients in our cohort, 12 patients (16.4%) required implant removal. Among several clinicopathological characteristics, our results showed a significant association between the incidence of complications and the type of implant. While 26.86% of patients with fixed-volume implants showed evidence of implant complications, patients who use tissue expanders suffered from complications in (80%) of the cases (P=0.047). Another important factor that showed a trend of association (P=0.06) was the use of radiotherapy. All other factors, including BMI, age, subtype, and chemotherapy, showed no significant association with the presence or absence of complications. Conclusions: The type of implant and radiotherapy treatment are the most important risk factors for implant-related complications after IBR.

Background: Breast cancer is a chronic complex disease. Its progression depends partly on the interaction between tumor and immune cells. Whilst immunotherapy is the new promising treatment, many patients with breast cancer acquire resistance. Interferon gamma (IFN-γ) is a pleiotropic cytokine that is primarily released by T cells and natural killer (NK) cells and has always been praised for its antitumor activities. However, IFN-γ may induce different modulations in breast cancer cells that are expressing or not expressing the hormone receptors estrogen and progesterone. Methods: In this study, to examine the effect of IFN-γ on the subtypes of breast cancer in relation to the expression of estrogen and progesterone genes, we performed RNA-sequencing on the triple negative cells MDA-MB231 and ER/PR transfected MDA-MB231 cells (untreated or treated with 100 ng/ml IFN-γ). Various bioinformatics analyses were performed to investigate the affected functional pathways, and immune genes related to the different types of breast cancer cells. Results: The set of differentially expressed genes (DEGs) that are regulated by IFN-γ were unique, and specific to each breast cancer subtype. These unique DEG patterns in hormone-positive cells (GBP3, HLA-DPA1, HLA-DRB1, HLA-E, IL6) and triple negative cells (IFI6, ISG15, CCL5) showed significant but distinct effects on patients’ overall survival as well as noticeable differences in immune modulation and regulation. Conclusions: IFN-γ signaling can differentially affect the pattern of gene expression in breast cancer cells in an estrogen receptor (ER) / progesterone receptor (PR)-dependent manner. IFN-γ treatment of ER+/PR+ breast cancer cells upregulated the expression of genes related to immune cells and showed improved patient prognosis, while TNBC showed negative regulation of the expression of genes related to immune cells and worse patient prognosis.

Introduction Persistent postoperative pain significantly diminishes the quality of life in breast cancer patients. Effective pain management post-surgery is critical for patient satisfaction, reducing complications, and facilitating quick recovery and hospital discharge. This study addresses the lack of patient-centered postoperative pain management guidelines for breast cancer patients. Aim The primary goal of this study was to develop tailored postoperative pain management guidelines for the local community in the United Arab Emirates, integrating these into a broader network of oncology facilities. Methods and Materials Employing a mixed-methods approach with a qualitative emphasis, the study gathered data from 10 female breast cancer patients (aged 39-65 years) with postoperative satisfaction surveys. Additionally, semi-structured interviews with six healthcare professionals involved in guideline development were conducted. Results A significant 90% of patients reported experiencing moderate-to-extreme pain post-surgery, indicating a need for improved pain management. Key factors identified included the need for enhanced nurse training and patient education on pain management preoperatively. The study team unanimously recognized the necessity for dedicated postoperative guidelines. Conclusion The study underscores the critical need for adequate postoperative pain management in breast cancer care. The findings advocate for creating multidisciplinary, evidence-based guidelines focused on patient-centered care. Furthermore, the study highlights the importance of international collaboration and continuous quality improvement measures, such as the Plan-Do-Study-Act (PDSA) cycle, for developing and refining these guidelines.

Background: The Phosphatidylinositol-4,5-bisphosphonate 3-kinase catalytic subunit alpha (PIK3CA) gene is mutated in about 30-40% of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2−) breast cancer (BC) patients. For HR+/HER2- advanced breast cancer patients with disease progression following endocrine-based therapy, the NCCN guideline recommends testing for PIK3CA mutations with tumour or liquid biopsy to identify suitable patients for targeted therapy with alpelisib, an oral α-specific PI3K inhibitor in combination with fulvestrant. The primary objective of this study was to evaluate the proportion and distribution of PIK3CA mutational landscape of HR+ve BC patients at the largest cancer centre in the United Arab Emirates (UAE). Material and methods: Retrospective review of consecutive HR+ve BC patients at Tawam Hospital for whom PIK3CA testing was requested. DNA was extracted from the samples and a targeted resequencing assay was used for mutation detection in exons 7, 9 and 20 of the PIK3CA gene. Sequencing was carried out using the Next Generation Sequencing platform Ion GeneStudio S5 Prime System with a detection limit of 2-5% of the mutant allelic content. Results: 124 patients with HR+ve BC were enrolled in the present study. The pathology samples were considered unsuitable/unsatisfactory in 18 cases. The median age was 51.5 years (range 31-90). All patients were female, 54% were post-menopausal and 49% presented with de-novo metastatic disease. Of the 106 eligible patients, PIK3CA mutations were detected in 33 (31%) patients, the most common being H1047R (45%) and E545K (30%) mutations in exons 20 and 9, respectively. Other less common mutations included C420R mutations (6%) in exon 7, E542 (6%) in exon 9 and H1047Y (3%) in exon 20. 9% of patients had more than one hotspot mutations, primarily in exons 9 and 20. Of the 12 HER2 +ve patients tested, 3 had PIK3CA mutations, most commonly the H1047R mutation in exon 20. Conclusion: The prevalence of PIK3CA mutations and the presence of most common hotspot mutations in exons 20 and 9 was consistent with prior published studies. The clinical relevance of PIK3CA mutations in HER2 +ve BC patients needs further assessment. Citation Format: Fathi Azribi, Mohammad Hourani, Sulaman Magdub, Aydah Alawadhi, Ali Yousif, Emad Dawoud, Khaled Al Qawasmeh, Mouza Al Ameri, Diaeddine Trad, Nouri Bennini, Mohamed Ahmed, Jawaher Ansari. PIK3CA mutation prevalence in hormone receptor positive breast cancer patients in United Arab Emirates [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-03-04.

Novel coronavirus-19 (COVID-19) variants continue to spread worldwide with the development of highly transmissible strains. Several guidelines addressing management of cancer patients during the COVID-19 pandemic have been published, primarily based upon expert opinion. The COVID-19 pandemic has affected all aspects of breast cancer care including screening, diagnosis, treatment, and long-term follow-up. Recent reports indicate that mRNA COVID-19 vaccines can provoke lymphadenopathy in both cancer patients and healthy individuals. Unilateral axillary lymphadenopathy (UAL) post-COVID-19 vaccination is a challenging presentation for cancer patients because of the potential for misinterpretation as malignancy. The World Health Organization's target to vaccinate 70% of the world's population by mid-2023 is likely to increase the incidence of post-COVID-19 vaccination UAL. In this article, we review the published evidence regarding UAL post-COVID-19 vaccination and present diverse cases of breast cancer patients where false-positive UAL post-COVID-19 vaccination proved to be a therapeutic challenge. The United Arab Emirates (UAE) vaccination program is well ahead of other countries in the world, having accomplished the target of 100% vaccination of the population with at least one dose. Therefore, an increasing number of recently vaccinated patients are likely to present with UAL, detected by surveillance imaging, post-vaccination. We have therefore made recommendations regarding the management of cancer patients with UAL post-COVID-19 vaccination in order to avoid misdiagnosis and unnecessary imaging or invasive biopsy procedures.

Context: Water is a scarce and precious resource in many parts of the world. The COVID-19 pandemic has reemphasised the importance of handwashing and sanitisation. The world is moving back to opening the surgical procedures once again. Aims: The aim is to analyse the impact of water consumption and the cost associated with surgical hand sanitisation. Settings and Design: Quality Improvement Project. Subjects and Methods: This is a quality improvement project; members of the surgical team were asked to scrub and amount of flowing water for 5 min was collected in a measuring bucket. The hospital sinks are equipped with either manual or automatic motion sensor taps. This was reflected in the total amount of water and cost that was calculated for the operative cases of 2019. Statistical Analysis Used: Descriptive statistics, calculating the mean. Results: Three minutes was the average scrub time for the six participants. Thirty litres of water were consumed using a manual tap with continuous flow for 5 min. In comparison just 7.5 L of water were consumed using a motion sensor tap. A total of 7060 cases were operated in the year of 2019 with an annual cost that ranged from 1.8 to 7.5 million United Arab Emirates Dirham. Conclusions: The surgical handwashing technique is associated with a considerable amount of water. Motion sensor taps have the advantage to decrease wasting with water flowing only during actual washing. Techniques to decrease that amount are available and can be considered to preserve the water.

The Breast JournalVolume 26, Issue 11 p. 2283-2285 COMMENTARY In vitro fertilization and its correlation with different breast cancer characteristics: single-center experience in Al Ain, United Arab Emirates Mouza Al Ameri MBBS, FACHARZT, Mouza Al Ameri MBBS, FACHARZT Oncology Department, Breast Care Center, Tawam Hospital, SEHA, Al Ain, UAESearch for more papers by this authorIbrahim Y. Hachim MBBS, PhD, Corresponding Author Ibrahim Y. Hachim MBBS, PhD ihachim@sharjah.ac.ae orcid.org/0000-0001-6438-9455 Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE Correspondence Ibrahim Y. Hachim, Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE. Email: ihachim@sharjah.ac.aeSearch for more papers by this authorFatima Y. AL Hashmi MBBS, Fatima Y. AL Hashmi MBBS General Surgery Department, Sheikh Shakhbout Medical City, SEHA, Abu Dhabi, UAESearch for more papers by this authorFatima AlHarmoodi MBBS, Fatima AlHarmoodi MBBS General Surgery Department, Tawam Hospital, SEHA, Al Ain, UAESearch for more papers by this authorDina Al Awlaqi MBBS, Dina Al Awlaqi MBBS General Surgery Department, Sheikh Shakhbout Medical City, SEHA, Abu Dhabi, UAESearch for more papers by this authorAnood Alshehhi MBBS, Anood Alshehhi MBBS General Surgery Department, Tawam Hospital, SEHA, Al Ain, UAESearch for more papers by this author Mouza Al Ameri MBBS, FACHARZT, Mouza Al Ameri MBBS, FACHARZT Oncology Department, Breast Care Center, Tawam Hospital, SEHA, Al Ain, UAESearch for more papers by this authorIbrahim Y. Hachim MBBS, PhD, Corresponding Author Ibrahim Y. Hachim MBBS, PhD ihachim@sharjah.ac.ae orcid.org/0000-0001-6438-9455 Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE Correspondence Ibrahim Y. Hachim, Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE. Email: ihachim@sharjah.ac.aeSearch for more papers by this authorFatima Y. AL Hashmi MBBS, Fatima Y. AL Hashmi MBBS General Surgery Department, Sheikh Shakhbout Medical City, SEHA, Abu Dhabi, UAESearch for more papers by this authorFatima AlHarmoodi MBBS, Fatima AlHarmoodi MBBS General Surgery Department, Tawam Hospital, SEHA, Al Ain, UAESearch for more papers by this authorDina Al Awlaqi MBBS, Dina Al Awlaqi MBBS General Surgery Department, Sheikh Shakhbout Medical City, SEHA, Abu Dhabi, UAESearch for more papers by this authorAnood Alshehhi MBBS, Anood Alshehhi MBBS General Surgery Department, Tawam Hospital, SEHA, Al Ain, UAESearch for more papers by this author First published: 28 July 2020 https://doi.org/10.1111/tbj.13993Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume26, Issue11November 2020Pages 2283-2285 RelatedInformation

IntroductionBreast cancer is the most prevalent cancer in the United Arab Emirates (UAE). This is the first study to provide data on predisposition of breast cancer susceptibility genes with associated clinical and pathological aspects in the UAE.Material & methodsA retrospective chart review for breast cancer patients undergoing genetic testing from 2016 to 2018. According to National Comprehensive Cancer Network (NCCN) guidelines genetic testing was offered. The analyzed data included; age, ethnicity, family cancer history, pathogenic variant, histopathology, stage, molecular subtype and proliferation.Results309 patients underwent genetic testing with a positive result in 130 patients (11.9%) over a period of 36 months. In 34.6% pathogenic and likely pathogenic variants were identified. BRCA2 was the most common gene identified. The mean age was 42.9 years (±9.01). Positive family history was identified in 66 patients (50.7%). Majority had stage 1 or 2 disease (66.2%), invasive ductal carcinoma (81.5%) and hormone receptor positive cancer (45.3%).ConclusionsThis is the first study in the UAE to describe the clinical and pathological characteristics of hereditary breast cancer in a mixed ethnic group with dominant Arabic population. Further genetic studies will be required in the UAE population, as the prevalence of breast cancer continues to rise.

Background: Invasive candida infection is a growing problem in critically ill patients. Candida species are the most common agent responsible for invasive fungal infections in children. Timely diagnosis and proper selection of antifungal therapy are of paramount importance for a favorable outcome. The increasing rate of non-albiacans candida is becoming a real challenge when choosing an empirical antifungal therapy since a large percentage of them are resistant to azoles. This study aims at identifying the most commonly used antifungal agents in our institute and their success measured by the time needed to reach a negative culture (TNC) in cases of candidemia and candiduriaMethods:We performed a retrospective cohort study of all children (15 years and younger) with invasive candida infection, admitted to Tawam Hospital from 2008 to 2015.Results: Fluconazole seems to be the most common choice of our pediatricians in treating urine ICI (65%)while Amphotericin B Lipid complex is the most common choice in treating blood ICI(56%). Amphoteric B Lipid Complex was associated with the shortest TNC both in treating urine ICI (3 days) and blood ICI (4.4 days0Conclusions: Unfortunately, there aren’t many prospective studies in the literature comparing the efficacy of the major antifungal agents in treating pediatrics ICI. Therefore, we hope that this study, despite being retrospective, will shed some light on the utilization of Amphotericin B Lipid Complex in treating pediatrics ICI.

Several recent studies have suggested that brain CB2 cannabinoid receptors play a major role in alcohol reward. In fact, the implication of cannabinoid neurotransmission in the reinforcing effects of ethanol (EtOH) is becoming increasingly evident. The CB2 receptor agonist, β-caryophyllene (BCP) was used to investigate the role of the CB2 receptors in mediating alcohol intake and ethanol-induced conditioned place preference (EtOH-CPP) and sensitivity in mice. The effect of BCP on alcohol intake was evaluated using the standard two-bottle choice drinking method. The mice were presented with increasing EtOH concentrations and its consumption was measured daily. Consumption of saccharin and quinine solutions was measured following the EtOH preference tests. Finally, the effect of BCP on alcohol reward and sensitivity was tested using an unbiased EtOH-CPP and loss of righting-reflex (LORR) procedures, respectively. BCP dose-dependently decreased alcohol consumption and preference. Additionally, BCP-injected mice did not show any difference from vehicle mice in total fluid intake in a 24-hour paradigm nor in their intake of graded concentrations of saccharin or quinine, suggesting that the CB2 receptor activation did not alter taste function. More importantly, BCP inhibited EtOH-CPP acquisition and exacerbated LORR duration. Interestingly, these effects were abrogated when mice were pre-injected with a selective CB2 receptor antagonist, AM630. Overall, the CB2 receptor system appears to be involved in alcohol dependence and sensitivity and may represent a potential pharmacological target for the treatment of alcoholism.

Urokinase plasminogen activator, uPA, is a serine protease implicated in addiction to drugs of abuse. Using its specific inhibitor, B428, we and others have characterized the role of uPA in the rewarding properties of psychostimulants, including cocaine and amphetamine, but none have examined the role of uPA in ethanol use disorders. Therefore, in the current study, we extended our observations to the role of uPA in ethanol consumption and ethanol-induced conditioned place preference. The general aim of the present series of experiments was to investigate the effects of the administration of the B428 on voluntary alcohol intake and ethanol conditioned reward. A two-bottle choice, unlimited-access paradigm was used to compare ethanol intake between vehicle-and 3, 10, and 30 mg/kg B428-administered mice. For this purpose, the mice were presented with an ethanol solution (2.5%-20%) and water, at each concentration for 4 days, and their consumption was measured daily. Consumption of saccharin and quinine solutions was also measured. Systemic administration of B428 dose-dependently decreased ethanol intake and preference. Additionally, B428 mice did not differ from vehicle mice in their intake of graded solutions of tastants, suggesting that the uPA inhibition did not alter taste function. Also, ethanol metabolism was not affected following B428 injection. More importantly, 1.5 g/kg ethanol-induced conditioned place preference acquisition was blocked following B428 administration. Taken together, our results are the first to implicate uPA inhibition in the regulation of ethanol consumption and preference, and suggest that uPA may be considered as a possible therapeutic drug target for alcoholism and abstinence.

Recent evidence suggests that epigenetic mechanisms such as chromatin modification (specifically histone acetylation) may play a crucial role in the development of addictive behavior. However, little is known about the role of epigenetic modifications in the rewarding properties of ethanol. In the current study, we studied the effects of systemic injection of the histone deacetylase (HDAC) inhibitor, valproic acid (VPA) on ethanol consumption and ethanol-elicited conditioned place preference (CPP). The effect of VPA (300mg/kg) on voluntary ethanol intake and preference was assessed using continuous two-bottle choice procedure with escalating concentrations of alcohol (2.5–20% v/v escalating over 4 weeks). Taste sensitivity was studies using saccharin (sweet; 0.03% and 0.06%) and quinine (bitter; 20µM and 40µM) tastants solutions. Ethanol conditioned reward was investigated using an unbiased CPP model. Blood ethanol concentration (BEC) was also measured. Compared to vehicle, VPA-injected rats displayed significantly lower preference and consumption of ethanol in a two-bottle choice paradigm, with no significant difference observed with saccharin and quinine. More importantly, 0.5g/kg ethanol-induced-CPP acquisition was blocked following VPA administration. Finally, vehicle- and VPA-treated mice had similar BECs. Taken together, our results implicated HDAC inhibition in the behavioral and reinforcement-related effects of alcohol and raise the question of whether specific drugs that target HDAC could potentially help to tackle alcoholism in humans.

Recent evidence suggests that the cannabinoid receptor subtype 2 (CB2) is implicated in anxiety and depression disorders, although few systematic studies in laboratory animals have been reported. The aim of the current experiments was to test the effects of the CB2 receptor potent-selective agonist β-caryophyllene (BCP) in animals subjected to models of anxiolytic- and antidepressant-like effects. Therefore effects of BCP (50mg/kg) on anxiety were assessed using the elevated plus maze (EPM), open field (OF), and marble burying test (MBT). However for depression, the novelty-suppressed feeding (NSF), tail suspension test (TST), and forced swim tests (FST) were used. Results indicated that adult mice receiving BCP showed amelioration of all the parameters observed in the EPM test. Also, BCP significantly increased the time spent in the center of the arena without altering the general motor activity in the OF test. This dose was also able to decrease the number of buried marbles and time spent digging in the MBT, suggesting an anti-compulsive-like effect. In addition, the systemic administration of BCP reduced immobility time in the TST and the FST. Finally, BCP treatment decreased feeding latency in the NSF test. Most importantly, pre-administration of the CB2 receptor antagonist AM630, fully abrogated the anxiolytic and the anti-depressant effects of BCP. Taken together, these preclinical results suggest that CB2 receptors may provide alternative therapeutic targets for the treatment of anxiety and depression. The possibility that BCP may ameliorate the symptoms of these mood disorders offers exciting prospects for future studies.

When Emirati (Muslim) women (n = 218) were asked about their preferred physician (in terms of gender, religion, and nationality) for three personal clinical scenarios, a female was almost exclusively preferred for the gynecological (96.8%) and “stomach” (94.5%) scenarios, while ±46% of the women also preferred a female physician for the facial allergy scenario. Only 17% considered physician gender important for the prepubertal child scenario. Just over half of the women preferred a Muslim physician for personal examinations (vs. 37.6% for the child). Being less educated and having a lower literacy level were significant predictors of preferred physician religion for some personal scenarios, whereas a higher education level was a significant predictor for physician gender not mattering for the facial allergy scenario. Muslim women's preference for same gender physicians, and to a lesser extent religion, has implications for health care services beyond obstetrics and gynecology.

CONTEXT:Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation.METHODS:Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors.RESULTS:Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004).CONCLUSIONS:As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.