The objective of the study was to identify the causes, outcome and prognosis of severe illness in patients with systemic lupus erythematosus (SLE) requiring intensive care unit (ICU) care in a University Hospital over a five-year period. The design was a cohort study. Forty-eight SLE patients requiring ICU management over a five-year period (January 1997-December 2001) were studied prospectively. Of 48 patients, 14 (29.2%) died, predominantly with multiorgan dysfunction syndrome (MODS). Patients whose APACHE II score was equal to or greater than 20 had higher mortality than those with APACHE score below 20 (60 versus 7.1%; and P < 0.01). All the 18 patients whose health status rated as 'good' survived, while 46.7% of 30 patients whose health rated as 'poor' died (P < 0.01). Patients who had thrombocytopenia associated with sepsis and/or disseminated intravascular coagulopathy (DIC) had the highest mortality (75%, five-year survival). In conclusion, SLE patients admitted to the ICU had a lower mortality rate than some of the previous reports. Patients with SLE with high APACHE score, > or =20, poor health status, thrombocytopenia and multiorgan dysfunction syndrome had poor prognosis in the ICU.

BACKGROUNDBecause little has been reported about the outcome of severe asthma outside the US and western Europe, we performed a retrospective case analysis of patients treated in the medical intensive care unit (MICU) of a university hospital in Riyadh, Saudi Arabia, to determine the management, complications and outcome of severe asthma requiring ICU admission.METHODSThe records of patients with severe asthma admitted to the MICU between the periods of January 1996 to December 2003 were reviewed. Sixty-one episodes from 54 patients were studied, of which 27 (44%) were male.RESULTSAll patients were hypercapnic; 23 (38%) were ventilated. The Acute Physiological and Health Evaluation (APACHE) score II was significantly higher in the ventilated group (P<0.0001). The pH was significantly lower and PaCO2 was significantly higher in the ventilated group (P<0.0001). All patients survived. Only 42% of patients our series received inhaled corticosteroids before admission.CONCLUSIONOur results suggest that severe asthma requiring ICU admission is now safely managed in ICUs. Our results are comparable to recently published data on the treatment of severe asthma in the ICU.

The risk of cancer among end stage renal disease patients is higher than general population. Types of malignancy, age of patients, comorbid condition and functional status can influence management of cancer. The data regarding cancer among hemodialysis patients in Middle East area is rarely reported. We aim to study the types of cancers in hemodialysis patients in a tertiary oncology center in United Arab Emirate. Methods: Ethical approval was obtained to conduct a retrospective chart review study at Tawam Hospital from January 2009 to August 2019. We included end stage renal disease adult patients (age >18) with diagnosis of cancer after initiation of hemodialysis. Laboratory data and Clinical outcomes were analyzed using descriptive analysis. Results: A total of 1708 patients required hemodialysis during study period and 203 patients had diagnosis of cancer. 68 hemodialysis patients fulfilled the inclusion criteria (cancer after initiation of HD). The mean age was 68.8 years, and male to female ratio (2:1). National patients were 32 (47%). The duration of hemodialysis prior to cancer diagnosis was ranging from 0.5 to 10 years. Majority of patients had arteriovenous fistula (48) as access for HD and 20 patients had tunneled HD catheters. The comorbid conditions in our cohort were hypertension (61 [89.7%]), diabetes mellitus (50 [73.5%]), ischemic heart disease (33 [48.5%]), stroke (13 [19.1%]) and peripheral vascular disease (14[ 20.5%]). The most common type of cancers was urogenital 18 (26.4%)(renal cell carcinoma (7), bladder cancer (6), prostate cancer(5)). Hematological malignancies were as the following multiple myeloma (6), leukemia (chronic myeloid CML (1), plasma cell leukemia (1)), and lymphoma (3). Breast cancer has been identified in 5 HD female patients while ovarian cancer andcervical cancer were identified in 1.4 %. Lung cancer was found only in two HD patients with positive smoking history. Gastrointestinal cancers diagnosed in our cohort were colon cancer (7), gastric (3), esophageal cancer (3), liver cancer (2) and pancreatic cancer (2). Skin cancers were identified in patient who failed renal transplant (Basal cell carcinoma and Squamous cell carcinoma). 23 patients (33.8%) had metastatic disease at time of diagnosis. 23 patients (33.8%) had metastatic disease at time of diagnosis. Majority of patient received chemotherapy (29 [42.6%]). Oncology surgery and radiotherapy were done in selected patients (33.8%). The mortality rate was high especially with metastatic disease andfew patients opted for palliative care. Conclusions: The incidence of cancer in our hemodialysis patients over 10 years is low with predominance of urogenital cancers. Patients with metastatic disease had poor prognosis and palliative care is essential.