Purpose: The assessment of vitamin D status (25(OH)D) and dosing strategies for patients with rheumatic diseases (RDs) in Bahrain are lacking. The current study aimed to determine serum 25(OH)D levels at baseline and after Cholecalciferol (Vitamin D3) therapy and to assess the changes in serum levels in response to three different regimens in adult patients with RDs in Bahrain. Methods: Data was collected retrospectively from 158 patients with RDs, during a period 20132019- at King Abdullah Medical City. The mean age of the patients was 45 years (range 18 - 83 years). Two third (66.46%, 105) of them were females. The controls were adult sex- and age-matched healthy volunteers. All patients were investigated for vitamin D status during their first visits. Three regimens of Vitamin D3 therapy were assessed: Regimen1. A single parenteral dose of 600.000 IU. Regimen2. An oral dose of 50.000 IU weekly for 12 weeks, Regimen3. Maintenance oral dose whenever a patient achieved an optimal level. Results: The patients had lower serum levels of vitamin D3 compared to controls (P-Value=0.001; 95%C.I. (3.870, 15.599)). There was a statistically significant increase in mean serum levels of Vitamin D3 in Parenteral compared to Oral therapy (P-value<0.0005). In the patient group, vitamin D3 therapy leads to a statistically significant increase in its baseline level (P-value<0.0005), but the reduction in vitamin D3 from the therapeutic levels during maintenance was statistically not significant (P-value=0.177). Conclusion: The significant increase in serum 25(OH)D levels from baseline in response to Vitamin D3 regimens was best achieved with single parenteral therapy of 600.000 IU. Maintenance therapy to maintain optimal level year-round is a must, and the best dose was 50.000 IU orally every 24- weeks.

Background:Patients who suffers from central venous occlusion (CVO) or central venous stenosis (CVS) with no options for vascular access (VA) need urgent HD.Purpose: To evaluate CVO or CVS endovascular veinoplasty through an occluded access site to insert tunnelled catheter for HD.Patients and methods: Patients included had no options for VA and had CVO or CVS.Results: 124 patients on HD had endovascular veinoplasty. Technical success was 100% and 79% for CVS and CVO. Mean follow-up period was 36.16±12.6 months. Primary catheter site patency was 70%, 40%, 20%, and 5% after one, two, three, and four years. Assisted primary catheter site patency was 77%, 45%, 27%, and 12% and access vein survival was 100%, 80%, 40%, and 15% respectively at one, two, three, and four years, respectively. Conclusion:Recanalizing occluded veins for catheter insertion is simple, cost-effective, and safe.

Background: Vascular access (VA) for hemodialysis (HD) is the cornerstone of treatment of end-stage renal disease in children. Purpose:To evaluate the causes that may result in primary failures, to evaluate the long-term outcome of AVFs in the vascular access as regards primary and secondary access patency, and to study the effect of patients' demographics and type of VA upon patency.Patients and methods: Paediatric age group patients with ESRD from El Shatby University Hospital for Children were evaluated by duplex ultrasound and VA was constructed.Results: 218 children were evaluated.188 children had AVF. The initial success rate was 96.8%. Early failure occurred in 13.9%. The mean follow-up was 18.9 ± 11.2 months. 75% of our patients were blow 50th percentile. The mean maturation-time was 1.7±0.5 months. Primary and secondary patency rates at 1, 2, and 3 years of follow-up, were 80.1% (± 2%), 67.3% (±2%), 41.3% (±2%), and 85.4% (±1%), 75.6% (± 1%), and 67.4% (± 1%) respectively. Complications were stenosis, thrombosis, infection, venous hypertension, steal, aneurysms and pseudoaneurysm, and high-flow AVF. At the end of the follow-up period, 32 (17.3%) AVFs were complicated and eventually failed, 20 (10.8%) were abandoned due to death or patients lost follow-up, and 125 (67%) were patent. Conclusion:AVFs in paediatric age group have a good outcome and long-term patency provided by good choice of the patient, and operation by dedicated surgeons. Surveillance of the fistula and rapid correction of any complications are very crucial steps to keep the fistula functioning.