Antisynthetase (AS) syndrome is a rare idiopathic inflammatory myopathy characterised by myositis, Raynaud's disease, fever, interstitial lung disease (ILD), 'mechanic's hands' and arthropathy, and it is associated with the presence of antibodies against aminoacyl-tRNA synthetase especially anti-Jo-1. We report the case of a 31-year-old Egyptian male who presented with fever, mechanic's hands, subclinical myositis, arthritis and ILD. He had been treated previously at another hospital with broad-spectrum antibiotics but without response. He was extensively worked up for infections and found to have mycoplasma infection and strongly positive anti-Jo-1 and anti-Ro/SSA antibodies. AS syndrome was confirmed based on clinical features and laboratory results. The patient was treated with high-dose steroids and subsequently with mycophenolate mofetil and dramatically improved. This case highlights the importance of awareness of this rare condition and that careful examination of the hands can be crucial as mechanics's hands is a unique manifestation of AS syndrome, occurring in ≈20% of cases. Mycoplasma infection may have been a triggering factor in this case.

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Introduction: Twin and higher-order multiple pregnancies are becoming increasingly common in obstetric practice and are associated with significant morbidity for both mothers and fetuses. A study of this type had not been carried out in the Dubai Health Authority area, or in the UAE. Therefore data from studies such as this can provide important insights for obstetricians in this region. Objectives: The aim of this study was to determine the prevalence of multiple pregnancy in a Dubai hospital in 2012 and to analyse the adverse maternal, perinatal and neonatal outcomes associated with these pregnancies. Methods: This is a retrospective study involving all multiple pregnancies delivered at Dubai Hospital, Dubai, between 1 January 2012 and 31 December 2012. All multiple pregnancies at or beyond 24 weeks of gestation delivered at Dubai Hospital during the study period were included. Data for patients with multiple pregnancy and their babies were obtained from the maternity register in Dubai Hospital's labour ward and antenatal files after obtaining ethics approval from the Dubai Health Authority's Medical Research Committee. We used Microsoft Excel 2013 (Microsoft Corporation, Redmond, WA, USA) to organise the data collected from patient medical records. Excel was also used for statistical analysis and presentation of data in tabular and graphical form. Results: In total, there were 106 multiple pregnancies over the period – 97 twin and nine triplet pregnancies – giving a multiple birth rate of 64.3/1000 live births. This is higher than any other documented multiple birth rate in the world. The mean maternal age was 30.5 ± 5.3 years (standard deviation). The most common morbidity in these multiple pregnancies was prematurity (72.6%), as expected, followed by maternal diabetes mellitus (22.6%). However, excluding premature delivery, almost 60% of mothers had no associated morbidities. Half of the multiple pregnancies were spontaneous conceptions, and half were the result of infertility treatments such as ovulation induction. Around one-third (30%) were conceived by in vitro fertilisation procedures, including intracytoplasmic sperm injection. As expected, triplets were delivered more prematurely than twins: the mean gestational age at delivery was 34.3 ± 3.7 weeks for twins and 31.0 ± 3.5 weeks for triplets. Around three-quarters (72.6%) of deliveries were by caesarean section, with the main indication (32.1%) being maternal request, 25.5% were delivered vaginally, 0.9% were delivered instrumentally and 0.9% were delivered vaginally (fi rst twin) and by caesarean section (second twin). Most of the newborns (58.4%) were of low birth weight. The vast majority (93.2%) had a 5-min Apgar score of ≥7, but the Neonatal Intensive Care Unit admission rate was around 38%, with triplets more likely to be admitted than twins (76.9% of all triplets vs. 33.3% of all twins). Overall, the results suggest a multiple pregnancy prevalence rate much higher than that of other developed countries, such as the USA, and even higher than that of Nigeria, which currently has the highest twin birth rate in the world. Conclusion: The increasing burden of multiple pregnancy in the United Arab Emirates may be attributable to the increasing availability and affordability of assisted reproductive technologies. Multiple pregnancy is associated with greater risks to both mothers and foetuses than singleton pregnancy, which warrants greater awareness of associated complications.

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Introduction: The pressure experienced during diving can cause a variety of pressure-induced injuries to the head, face and oral regions. The most common oral complications are odontocrexis (dislodgement of dental restorations), barometric-related dental pain caused by air bubbles and increased pressure at the restoration–tooth interface or by flaring of periapical infections, temporomandibular joint disorders caused by heavy or poorly designed mouthpieces and cross-contamination of pathogens caused by improper disinfection of shared equipment. Objective: This study aims to identify the most common effects of frequent pressure variation on the oral health of divers from Ras Al Khaimah (RAK) Police and assess the in vitro survival of composite and amalgam restorations. Materials and Methods: A questionnaire eliciting demographic, occupational and barotrauma-related information was completed by members of RAK Police and the data were analysed. High-quality composite and amalgam restoration were performed on extracted teeth before exposure to 0.5–0.6 MPa at 37°C, simulating deep-diving conditions and repeated seven times for 10 min. Survival of the restorations was monitored. Results: Questionnaire data revealed that deep divers experience periodontal damage, enamel fissures and odontocrexis of metal and composite restorations, which could be associated with diving depth and frequency. These observations were supported by the in vitro assessment. Odontocrexis was observed earlier and more severely in amalgam restorations than in composite restorations. Increased pressure during diving can, therefore, affect the integrity of both amalgam and composite restorations, but composite restorations can withstand increased pressure for a longer duration than amalgam restorations before eventually showing damage, as observed both in vitro and in vivo. Conclusion: Divers with more experience and who dive deeper are affected to a greater extent by barotrauma than those with less experience or who do not dive as deep. Composite restorations are considered safer than amalgams for patients who dive.

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Neonatal diabetes mellitus (NDM) is not uncommon amongst extreme preterm or extremely low-birth-weight (ELBW) neonates. The treatment for NDM to achieve normoglycemia is not without challenges because of lack of one ideal strategy for appropriate treatment. The management of NDM begins with insulin, but it is very difficult to adjust the doses and route of administration because of the dilemma of frequently developing hypoglycaemia and then hyperglycaemia again after stopping insulin. We report here an ELBW baby initially treated with regular insulin and then glargine, long-acting insulin, was administered subcutaneously as once daily dose with successful control of hyperglycaemia. Previously, two cases have been reported where glargine was used to control NDM. The possibility of recommendation for successful treatment with subcutaneous long-acting insulin to treat NDM amongst ELBW neonates is discussed.

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Hydatid cyst of adrenal gland is rare and is usually incidentally discovered as a part of disseminated disease. Herein, we report a rare case of primary large adrenal gland hydatid cyst who presented with a palpable mass on the left loin, with dull pain only.

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Aim: The purpose of this study was to estimate the present incidence of Treatable Retinopathy of prematurity (ROP) in Dubai. To share our experience following bevacizumab monotherapy for treatable ROP. Design: It is a prospective nonrandomized, interventional case series. Method: Infants of two major government hospital in Dubai, Latifa hospital and Dubai Hospital, Neonatal Intensive care unit (NICU) were screened for Retinopathy of prematurity (ROP). ROP screening was based on American Academy of Pediatrics (AAP) guidelines. The Inclusion Criteria for treatable ROP were the infants with Type 1 ROP; Stage 2 plus and Vascular stage 3 plus ROP in zone I and II disease. Intravitreal injection of 0.75 mg/0.03 ml bevacizumab was given under topical anesthesia. The follow up period was from 6 months to 1 year after the treatment. Results: Eight hundred and ten premature infants were screened from April 2010 to April 2014. Among them 215 had ROP (26.54%). One hundred and twelve eyes of 56 neonates (6.9%) developed treatable ROP. Ninety- four eyes of 47 infants underwent bevacizumab monotherapy. In 92.6% eye the ROP regressed. There was recurrence of ROP in 7.4%. Conclusion: The incidence of pre-term births is rising in Dubai due to increase in the population and fertility treatment trend in Dubai. Anti-VEGFs are effective treatment for vascular ROP with back up laser being mandatory. However, long term effects of Anti-VEGFs on neuro motor development needs to be monitored

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Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed. Haemorrhage has been divided into two broad categories; primary, occurring <24 h after surgery and secondary, occurring >24 h post-operation although commonly 5–10 days after the operation. Objectives: This study was conducted to determine the rate of post-tonsillectomy bleeding in our hospital, to review the rate of bleeding between different methods of tonsillectomy and to encourage surgeons with high bleeding rate to change to different techniques. Methods: It was a retrospective study conducted at the Department of Otolaryngology (ENT), Dubai Hospital, Dubai, United Arab of Emirates. It was conducted from 1^st June 2014 to 30^th September 2015. Study population were 554 patients who underwent tonsillectomy or adenotonsillectomy during this period. The patients were grouped into four groups according to the tonsillectomy technique. Results: Twenty-two patient presented with bleeding (3.97%). Out of these, one was primary post-tonsillectomy bleeding and 21 were secondary post-tonsillectomy bleeding. The highest rate of secondary post-tonsillectomy bleeding was in bipolar tonsillectomy group (8.98%), while the lowest rate was in radiofrequency group. The primary bleeding was encountered in one patient in cold dissection group while no primary bleeding was encountered in other groups. 40.9% of cases were managed surgically, while 59.1% were managed medically. Conclusion: Post-tonsillectomy bleeding is still a clinically significant complication despite advances in surgical techniques. Radiofrequency tonsillectomy has the lowest bleeding rate. Our hospital rate of bleeding stand in the international range and we are going to be better regarding secondary bleeding, but we are one of the best regarding primary.

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Patients with hopeless residual dentition due to advanced periodontal disease or failing fixed or removable partial dentures frequently present with difficulties and concerns regarding the provisional phase until their final prosthetic restoration. As removable dentures are generally not preferred – not even as a provisional – the transition to a fixed rehabilitation should be quick, aesthetically appealing and restoring function in terms of chewing as well as phonetics. The immediate All-on-4^® implant treatment concept at the Academy for Oral Implantology in Vienna (Austria) relies on implant placement at the day of tooth extraction and immediate fixed restoration within a few hours. The key factor is the placement of angulated implants (to avoid vital anatomic structures as well as invasive bone grafting procedures) that allows for immediate occlusal loading due to the increased anchorage in the native jawbone. Highly aesthetic provisional implant bridges can thus be provided at the day of surgery.

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Losing teeth – particularly in the aesthetic zone of the anterior maxilla – represents a great dilemma for a patient and a challenge for the attending dentist. Immediate placement of dental implants at the day of tooth extraction is an established treatment concept that offers the possibility to provide fixed provisional crowns within few hours. Troublesome removable prostheses can thus be avoided, and the psychological trauma of tooth loss is minimised. The Copy-abutment technique was developed at the Academy for Oral Implantology in Vienna (Austria) and guarantees the best possible preservation of soft-tissue aesthetics by immediate implant restoration using custom-made abutments composed of highly aesthetic zirconia ceramic. On the basis of a modern all-digital workflow and a close cooperation with the affiliated dental laboratory, it is possible to provide the patient with a new tooth in just 1 day.

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Psychoradiology is a newly emerging filed describes the application of the neuroimaging techniques in analysing psychiatric conditions. Previously in psychiatry only gross structural abnormalities, that might cause psychosis, could be detected. Neuroimaging was used to detect and to differentiate depression from neurodegenerative disorders or brain tumours. Recently, functional neuroimaging, mostly in the form of functional magnetic resonance imaging, molecular neuroimaging with positron-emission tomography or single photon emission tomography, facilitates the identification of therapeutic targets, the determination of the dose of a new drug needed to occupy its target in the brain, following up the effect of the treatment and the selection of patients for clinical trials.

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