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Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

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Background: preoperative chemotherapy can reduce the size of the tumor, thus allow some patients with advanced tumors which is common the opportunity of conserving breast surgery. The aim of the study was to evaluate the efficacy of neoadjuvant chemotherapy (NC) on the possibility of breast-conserving surgery (BCS) in patients for whom mastectomy was the only accepted surgical option. Methods: thirty patients who had stage III breast cancer received neoadjuvant chemotherapy comprised of doxorubicin and cyclophosphamide, followed by surgery between 2016 and 2019. Results: thirty patients included in the study, 27(90%) presented with an invasive ductal carcinoma. The mean tumor size before NC, measured using MRI, was 37 mm (range, 20-75 mm) and 29 mm (range, 12.5-75 mm) after NC. Twenty patients (66.7%) underwent mastectomy while ten patients (33.3%) underwent BCS. The mean follow up survival time for all patients was 32±1.2 months range (29.8-34.8) months with (95% CI; 29.8-34.8).one case (3.3%) of BCS had locoregional recurrence and three cases (10%) had distant metastasis. Patients with IDC had significant higher DFS (33.5 ±1.04) months than patients with combined IDC+ILC (20±6) months and ILC(18) months.Patients with mastectomy had better numerical (not significant) DFS (32.25±1.5) months than patients with BCS (31.6±2.3) months. Conclusion: NC had a role in reducing the size of the tumor and could be applied in patients with advanced carcinoma. It increased the chance of BCS without affecting overall survival.

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