Table of Contents

Case Reports

A Conservative Surgical Approach Towards Central Giant Cell Granuloma: A Case Report

Ahmed Al-Qattan1* , Sara Al-Saad2, Mohammed Almuharraqi1, Abdulla Darwish2, Khalifa Alghatam1

Pages: 1-4
  • Abstract
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  • Central giant cell granuloma (CGCG) is an infrequent benign bony lesion of unpredictably aggressive behavior. The precise lesion character is debatable and remains inconclusive. However, three main theories were proposed: a sensitive lesion, a kind of neoplasm, or a developmental anomaly. This is a case presentation of a 16-year-old boy with a dental history of extraction of the lower right first molar, presented to hospital with two months history of swelling in the aforementioned area after the procedure. First biopsy of the swelling was performed outside the Kingdom of Bahrain. As per histopathological findings, the swelling was described as pyogenic granuloma. Second biopsy with necessary workup was conducted in the Kingdom of Bahrain and was confirmed as central giant cell granuloma through histopathological analysis; it was removed surgically.

    Keywords: Central giant cell granuloma, histopathology, intraosseous, mandibular lesion, surgical excision

Case of Papillary Carcinoma Arising from Thyroglossal Duct Cyst with Regional Lymph Node Metastasis

Tejal Shamik Shah1, Khalid Khan1*, Omran Naser Sarwani1

Pages: 5-9
  • Abstract
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  • Carcinoma originating from a thyroglossal duct cyst is a rare entity that is often identified onpostoperative histopathology after Sistrunk procedure. In this procedure the thyroglossal duct cystalong with the entire tract and some part of hyoid bone are excised to prevent recurrence. We presentthe case of a 39-year-old male with midline neck swelling who was preoperatively diagnosed oflocally advanced papillary carcinoma originating in a submental thyroglossal duct cyst and thepresence of cervical lymph node metastasis.

    Keywords: Papillary carcinoma; thyroglossal duct cyst carcinoma; thyroid gland

Original Articles

Prevalence of Depression and Anxiety Among Patients with Noncommunicable Diseases in The Kingdom of Bahrain

Wafa AlSharbati1, Sharifa Bucheeri1, Maha Alkawari1, Noora Alromaihi2*, Reham Algarf2, Wafa
Alfara2

Pages: 10-19
  • Abstract
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  • Background and objectives: There is a high coexistence between mental disorders and chronicnoncommunicable diseases (NCD). Patients with chronic illnesses have higher rates of depressionand anxiety when compared to the healthy individuals. The study aimed to estimate the prevalenceof depression and anxiety and to explore the associated risk factors.

    Methods: A cross sectional study conducted in the NCD clinics of five health centers in the Kingdomof Bahrain included all patients attending these clinics from January 2016 to March 2016. Hospitalanxiety and depression scale (HADS) was used to screen patients for depression and anxiety. Logisticregression analyses were used to identify risk factors associated with anxiety and depression. All theanalyses were conducted using STATA 12; P < 0.05 was considered statistically significant.

    Results: A total of 456 patients were included in the study. Mild and moderate to severe type ofdepression were observed in 71 (15.6%) and 53 (11.6%) patients, respectively. According to themultivariable model, the odds of having high depression score was significantly higher in patients aged< 45 years (adjusted odds ratio (OR) = 2.01; P = 0.01), with low income (adjusted OR = 1.99; P = 0.02),with personal history of mental illness (adjusted OR = 5.13; P = 0.001), and with lower educationallevels (P = 0.02). Mild and moderate to severe anxiety scores were observed in 55 (12.1%) and 34(7.5%) patients, respectively. According to the multivariate model, the odds of having high anxietyscore was significantly higher in females (adjusted OR = 2.85; P < 0.001), patients aged < 45 years(adjusted OR = 2.41; P = 0.005), in patients with low income (adjusted OR = 3.62; P < 0.001), and inthose with personal history of mental illness (adjusted OR = 4.5; P = 0.004).

    Conclusion: There is a high prevalence of depression and anxiety among patients attending NCDclinics in the Kingdom of Bahrain. Therefore, screening of mental health diseases should be established.

    Keywords: Anxiety, Bahrain, chronic diseases, depression, noncommunicable diseas

Overweight As a Risk Factor for Prostatic Enlargement in Bahraini Population: A Retrospective Study

Ahmed Abduljalil Al Rashed1*, Qasim M.A. Isa2

Pages: 20-24
  • Abstract
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  • Background and objectives: Benign prostatic hyperplasia (BPH) and overweight (BMI: > 25–30 kg/m2) are both highly prevalent amongst Bahraini males. The aim of this study is to evaluate the association between BPH and overweight.

    Methods: The study included 141 male patients who visited the Urology outpatient clinics between 1st April 2018 and 31st May 2018. Body mass index (BMI) was calculated and diagnosis of prostate enlargement was recorded along with prostate volume (ml) and prostate specific antigen (PSA). The collected data were analyzed using SPSS 23. Pearson correlation coefficient “r” and regression analysis were performed for prostate volume and PSA in relation to BMI. P < 0.05 was considered statistically significant.

    Results: Among 141 male patients, 67 (47.5%) were overweight and had prostate enlargement, 50 (35.4%) were overweight with normal prostate, 10 (7.1%) were normal weight with prostate enlargement, and 14 (10.0%) had normal weight with normal prostate. The odds ratio was calculated as 1.876. This signifies that an overweight male is at 1.876 times higher risk of developing prostate enlargement compared to a male with normal weight. Overweight had a statistically significant positive linear correlation with incremental increases in prostate volume (r = 0.4; B = 0.85; P = 0.012).

    Conclusion: There is evidence to support the hypothesis that overweight BMI is associated with a higher risk of development of prostate enlargement. The higher the BMI, the larger the prostatevolume; however, the same association was not observed with PSA.

    Keywords: Benign prostatic hyperplasia, body mass index, overweight, prostate specific antigen, prostate volume

Awareness of Heart Attack Symptoms Among Bahraini Adults Attending Primary Healthcare Centers

Shooq Alsooreti1*, Batool Alalawi2, Hesa Abdulkarim1, Sara Mohamed1, Wafa AlSharbati3

Pages: 25-33
  • Abstract
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  • Background and objectives: Worldwide, mortality due to cardiovascular diseases (CVD) is a concern of great magnitude. The mortality rate in Bahrain, due to CVD, was 19.5%, 32%, and 21.5% in the years 2005, 2011, and 2013, respectively. The objective was to assess the awareness of Bahraini adults of the early warning symptoms of heart attack (HA) and the need to activate rapid emergency care by calling 999 once recognized.

    Methods: An observational cross-sectional study included 400 Bahraini adult patients attending primary healthcare centers in Bahrain. Respondents were asked to identify the five warning symptoms of a HA and the first action to be performed while witnessing a HA. HA knowledge score was calculated for each respondent. The study was approved by Bahrain Public Health Research Committee.

    Results: Based on the evaluation of the knowledge scores of HA symptoms, 71.9% and 28.1% of the participants scored poor and good level of knowledge. In the study, the most recognized symptom of HA was chest pain (70.9%) followed by shortness of breath (60%). In response to the first action to be performed while witnessing a HA, only 59.5% reported that they would contact the emergency services.

    Conclusion: The level of public awareness about HA symptoms in Bahrain is poor. Community campaigns are required to increase public health knowledge.

    Keywords: Chest pain, Heart attack, Knowledge, Public awareness, Symptom

Correlation Between Carotid Intima-Media Thickness and the Activity of Rheumatoid Arthritis: A 1-Year Cross-Sectional Study

Arif Maldar*1, Suhas M1

Pages: 34-41
  • Abstract
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  • Background and objectives: Among several non invasive techniques available, a high-resolution B-mode ultrasonography is the widely used technique to measure carotid intima-media thickness (CIMT) in rheumatoid arthritis (RA) patients with elevated cardiovascular risk. The present study was undertaken to explore the clinical relationship between CIMT and disease activity in patients with RA.

    Methods: This study involved 50 adult patients with RA. Demographic, physical, systemic, and clinical data and history of the patients were recorded. Investigations, such as erythrocyte sedimentation rate, highly sensitive C-reactive protein, renal and liver function tests, RA factor, and anticyclic citrullinated peptide antibody tests were performed. CIMT was assessed using high resolution B-mode ultrasonography and the disease severity was assessed based on disease activity score (DAS) 28.

    Results: The mean age of the RA patients was 49.88 ± 12.12 years with male predilection. The mean duration, mean European League Against Rheumatism (EULAR) criteria score, and mean DAS 28 score in RA patients were 3.62 ± 3.25 years, 8.10 ± 1.58, and 4.91 ± 1.11, respectively. The mean CIMT observed in RA patients was 0.94 ± 0.31 cm. Significant difference was observed in the mean CIMT values of different variables, including duration of joint pain (P = 0.007), tender joint count(P < 0.001), swollen joint count (P < 0.001), EULAR criteria score (P < 0.001), and DAS 28 score(P < 0.001). Also, CIMT correlated positively with tender joint count (r = 0.711; P < 0.001), swollen joint count (r = 0.673; P < 0.001), EULAR criteria score (r = 0.611; P < 0.001), and DAS 28 score (r = 0.729; P < 0.001).

    Conclusion: A strong correlation was observed between CIMT and disease activity in patients with RA. Hence, CIMT can be a useful surrogate marker for detecting atherosclerosis in patients with RA.

    Keywords: Atherosclerosis, carotid artery intima-media thickness, European League Against Rheumatism, High-resolution B-mode ultrasonography, rheumatoid arthritis

Review Articles

Systematic Review Comparing Laparoscopic and Open Appendectomy

Heba Al Saad*, Ashish Mhatter

Pages: 42-51
  • Abstract
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  • Various prospective randomized controlled trials were conducted to compare open and laparoscopic appendectomies. The aim of this systematic review is to compare both the surgical appendectomy interventions and to evaluate the most favored, safe, and effective choice of treatment for appendicitis. In this review, 2462 studies have been retrieved from three major databases: Medline, Scopus, and Cochrane. The inclusion criteria were clinical diagnosis of appendicitis, publication date, and patient’s age. Of these, six studies that met both inclusion and exclusion criteria were chosen. The studies selected were assessed for quality using the CONSORT PRO tool. The data extracted was later analyzed using NCCS 2007 software and Microsoft excel. The means and P values were calculated using the student t test and chi square test provided by the studies. The six studies chosen met the inclusion criteria and achieved an average quality of 15.5 over 25, which is in line with the CONSORT PRO tool. The results indicated that further elaboration on the randomization method should’ve been provided; however, the methodology was the same across the six studies showing a strong correlation and homogeneity in the outcomes. The primary outcomes were all favored in laparoscopic appendectomy (LA) except for intra-abdominal abscesses. The secondary outcomes were all favored by LA exceptfor cost and mortality, which weren’t favored by both the interventions. In conclusion, LA is a safer and more effective surgical procedure than open appendectomy.

    Keywords: Appendectomy, laparoscopy, open surgery, outcomes, prospective studies, randomized controlled trials