Table of Contents

Case Reports

Tuberculous osteomyelitis of the lumbar spine with discharging sinus

Rawan Al Agha1*, Safa Al Khawaja2, Mai Mattar3, Ahmed Serooti4

Pages: 1-5
  • Abstract
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  • Skeletal tuberculosis accounts for about 2–5% of all tuberculosis (TB) cases. We present a 29-year-old non-Bahraini female diagnosed tohave complicated form of Pott’s disease, who presented with discharging sinus accompanied with worsening back pain without any history of weight loss, fatigue, anorexia, fever, or night sweat and without pulmonary involvement or any neurological complication. Further radiological investigation revealed extensive involvement of lumbosacral vertebrae, soft tissue, and muscle through the tuberculous process.

Retroperitoneal perforation of the appendix complicated by pneumoretroperitoneum and abdominal wall emphysema: A case report

Wael Mohamed Tahseen1*, Hani Ebrahim Ahmed AlFadel1

Pages: 6-9
  • Abstract
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  • A 67-year-old Bahraini male patient, diabetic and hypertensive, presented to the Emergency department with complaints of 3-days history of shortness of breath, abdominal distension, and constipation without abdominal pain. Clinical evaluation and laboratory investigations revealed lower abdominal tenderness and rebound tenderness as well as status of septic shock. Contrast enhanced computed tomography revealed inflamed vermiform appendix with pneumoretroperitoneum and abdominal wall emphysema associated with abdominal wall edema. Surgical laparotomy was performed which revealed retroperitoneal perforation of the appendix associated with pus and air in the retroperitoneum and the abdominal wall. Appendectomy was performed along with drainage of retroperitoneal as well as abdominal wall pus. The case represents an uncommon complication of acute vermiform appendix inflammation with retroperitoneal perforation into the abdominal wall. This case indicates that a possibility of intra-abdominal pathology should be raised in patients with subcutaneous surgical emphysema of the chest and abdomen.

    Keywords: Acute appendicitis, atypical, computed tomography, subcutaneous emphysema, retroperitoneal

Original Articles

Prevalence of metabolic syndrome among Bahraini patients with schizophrenia

Haitham Ali Jahrami1*, Mazen Khalil Ali1,2

Pages: 10-16
  • Abstract
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  • Background and objectives: Metabolic syndrome comprises a few cardiovascular risk factors that increase morbidity and mortality. To evaluate the prevalence of metabolic syndrome among Bahraini schizophrenia patients.
    Methods: Using a case-control design, 50 patients with schizophrenia (cases) were compared to 50 age- and sex-matched healthy controls for the prevalence of metabolic syndrome. The workout included: anthropometric measurements such as weight, height, and waist and hip circumference, fasting blood glucose, lipid profile, blood pressure, and patient medical history. Descriptive statistics mean and standard deviations for continuous variables and frequency counts and proportions for categorical variables were used to summarize the demographic characteristics and the different variables of the metabolic syndrome. Odds ratio (OR) was computed to measure the levels of association between exposure (schizophrenia) and outcomes (metabolic syndrome).
    Results: Based on the International Diabetes Federation (IDF) criteria, 48% cases had metabolic syndrome in comparison to 34% controls. A statistical difference was observed among the cases and controls with respect to three metabolic abnormalities i.e., central obesity (OR) 4.5; 95% confidence interval (CI), 1.6-13.1; raised triglyceride level (OR 2.5; 95% CI, 0.9-7.3), and reduced level of high-density lipoprotein cholesterol (OR 0.4; 95% CI, 0.2-1.1).
    Conclusion: The prevalence of metabolic syndrome is extremely high among the Bahraini patients with schizophrenia. Clinicians are encouraged to monitor the physical health and its components in patients with schizophrenia to detect metabolic syndrome and reverse it. Future studies also need to merit racial variability in metabolic syndrome among patients with schizophrenia due to the difference in the predisposing factors. 

    Keywords: Syndrome X, Schizophrenia, metabolic syndrome, insulin resistance syndrome

A Comparison of the Mental Health, Quality of Life, and General Functioning of Mothers of Young Children and Adolescents with Autism

Ahmed Malallah Al Ansari1*, Haitham Ali Jahrami1, 2, Rami Ghazi Hafedh3, Isa Mohammed Sharif1

Pages: 17-24
  • Abstract
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  • Background and objectives: The impact of caring for a child with autism has been observed among mothers of children with autism spectrum disorders (ASDs) in western countries, however, there is a scarcity of data in the Arab countries. The study aimed to compare the mental health, quality of life (QOL), and general functioning of mothers of young children and adolescents with autism.

    Methods: This cross-sectional study, including 60 mothers of children with ASD was conducted in the Child Psychiatry Unit of Psychiatric Hospital, Bahrain. Data regarding the mothers’ demographic characteristics, general health, QOL, and functioning were collected through interviews. The children were consecutively diagnosed and followed-up at the Psychiatric Hospital, Bahrain. The differences between the mothers of young children and the mothers of adolescent children with ASD were compared.

    Results: The mothers of both the groups reported elevated physical health complaints, mental health symptomatology, and decreased experience of QOL. Mothers of young children with ASD reported depressive symptoms, less physical illness, and fewer comorbidities in the young children with ASD, when compared to mothers of adolescents who reported anxiety symptoms, more physical illness, and better QOL-related psychological wellbeing and environmental factors.

    Conclusion: The issue of mothers’ health requires attention and should be addressed in the management of children with ASD, especially in clinical practice with interventions specific to the child’s age.

    Keywords: Autism spectrum disorders, mothers, stress, quality of life, health

Impact of Fetal Diagnosis on Neonates with Congenital Heart Defects in the Kingdom of Bahrain

Neale Nicola Kalis1*, Manal Al Taraif2

Pages: 25-30
  • Abstract
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  • Background and objectives: Fetal echocardiography is used for prenatal diagnosis of congenital cardiac malformations. The impact on the neonatal outcomes in the Middle East remains unknown; therefore, the study aimed to determine the impact of fetal echocardiography on short- and intermediateterm postnatal outcomes.

    Methods: This is a retrospective case-control study, including 35 infants with a prenatal diagnosis of congenital heart defects (CHD). The cases were matched to 35 controls diagnosed postnatally with the same CHD. Demographic, clinical, and procedural variables were collected on a pretested form and compared. Statistical analysis was performed using SPSS 25.0. Contingency tables were created, and the grouped data were compared using the Fisher’s exact test.

    Results: Mean age at diagnosis in the prenatal and postnatal diagnosed group was 1 day and 12.58 days, respectively (P = 0.001). In the prenatal group, 23 (65.71%) deliveries were performed in a tertiary healthcare setup compared to 13 (37.14%) in the postnatal group (P = 0.03). Duct-dependent CHD requiring prostaglandins was observed in 13 (41.94%) neonates in the prenatal group compared to 9 (28.13%) in the postnatal group (P = 0.3). There were 11 (31.43%) deaths in the prenatal group compared to 7 (20.00%) in the postnatal group (P = 0.4). There were no statistically significant differences among the procedural variables.

    Conclusion: Fetal echocardiography aided in identifying neonates with complex CHD resulting in better parental counseling and delivery at a tertiary care center. However, this did not result in significantly short- and intermediate-term outcomes. Due to the small sample size, future follow-up studies are encouraged.

    Keywords: Critical congenital heart defects; fetal echocardiography

Causes of Cancellations of Surgeries in the Operation Theater at Salmaniya Medical Complex

Moutasem Almashour1*, Hazem Al-Aali1, Eslam Mohamed2

Pages: 31-37
  • Abstract
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  • Background and objectives: Cancellation of cases on the day of surgery carries significant burden on the patient’s health and the facility. The study aimed to evaluate the rate and causes of cancellation of surgeries.

    Methods: In this observational study, 46,496 operations were studied between the years 2016 and 2017. The records of the main operation theater were examined at the Salmaniya Medical Complex to evaluate the rate and causes of cancellation of operations. Cancellation was defined as a surgery that was not performed after the patient entered the operation theater on the day of surgery.

    Results: The prevalence of cancellation was 0.92%. The main cause for cancellation was high blood pressure (41.2%), followed by cardiac issues (7.3%) and upper respiratory tract infections (6.8%). Further, 3.7% of the cancelled surgery cases were due to lengthy list. While grouping the cancelled surgeries based on specialization, it was observed that the highest (28.9%) cancellation rate was in the general surgery. Poor utilization of the preoperative assessment clinic was observed in 9.3% cases in the main operation theater during the year 2017.

    Conclusion: Despite the low cancellation rate in Salmaniya Medical Complex, as compared to other centers, improvement in the preoperative care and assessment would further reduce the cancellation rate significantly.

    Keywords: Cancellation, Salmaniya Medical Complex, preoperative care, surgery, operation theatre

Psychometric Assessment of Daily Life Properties in Relation to Severity of Depression at Outpatient Clinic in Bahrain Defense Force Hospital

Waiel Hikmet Salman Alani1, Mohamed Ahmed Serageldein2*, Wafa Khalid Almutawaa3, Haya Mohamad Al-Noaimi4, Zain Jassim Buallay5

Pages: 38-46
  • Abstract
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  • Background and objectives: According to the WHO Global Burden of Disease, the lifetime prevalence of major depressive disorder (MDD) is about 15%. Most of the MDD patients ranging between 18–45 years cause economic and social burden on the families and the country as a whole. The objective was to assess the quality of life (QoL) of patients with depression and to evaluate whether the impairment of QoL is specific for MDD or it is a general phenomenon.

    Methods: The case–control cross-sectional study, including 30 patients aged between 18 and 45 years fulfilling the criteria of MDD according to the Diagnostic and Statistical Manual of Mental Disorders–4th ed., were recruited from the outpatient psychiatric clinics at the Bahrain Defense Force (BDF) Hospital. The case group was compared with age- and sex-matched control group, including 20 healthy volunteers selected among employees of the BDF Hospital. All patients underwent (a) general medical and neurological examinations, (b) a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders–4th ed., Axis-I (SCID-I), (c) 17-item Hamilton Depression Rating Scale (HAMD-17), and (d) Short-Form 36 Health Survey Arabic Version 1.0 (SF-36). The control group was subjected to a physical examination, SCID-I (nonpatient version). Statistical analysis of the data was conducted.

    Results: The educational level (P < 0.001) and the types of employment (P = 0.002) were statistically significant when compared between cases and controls. In the case group, quality of life as greatly affected by the severity of MDD with marked impairment in the social function and the overall mental function (P < 0.001). A significant decrease was observed in the physical function (P < 0.001) and vitality (P = 0.010) of the cases when compared to their healthy counterparts. A high statistical difference (P < 0.001) between the cases and controls was observed with respect to the eight domains of the QoL scale.

    Conclusion: Depression has a markedly significant impact on the QoL of MDD patients. There is a marked reduction in functioning of patients who suffer from depression in comparison to the nondepressed population.

    Keywords: Severity of depression, major depressive disorder, Quality of life related health, Short form-36, physical component scale, mental component scale

Patterns and Practice of Complementary Feeding in Children in Primary Care

Amal Abbas1, Batool Al Nawah1, Fatema Makhlooq1, Zainab Hubail1, Amani Al Hajeri2*

Pages: 47-53
  • Abstract
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  • Background and objectives: Complementary food patterns play a fundamental role in infant growth and health, especially in the first two years of life. This study aimed to explore the pattern and practice of complementary feeding of infants in Bahrain.

    Methods: A cross-sectional study, including 364 children attending the primary healthcare clinics in four primary health centers was conducted in Bahrain. A pre-tested structured questionnaire, including a one week recall food frequency was administered. Data was collected via face to face interview with caregivers.

    Results: Of the 364 caregivers interviewed, only 56% followed the recommendation of introduction of food at the age of six months, whereas, 41.8% caregivers followed the recommended number of meals at the age of nine months. Mothers experience was associated with complementary food introduction age (P < 0.008).

    Conclusion: The pattern and practice of complementary feeding in Bahrain is not meeting the WHO recommendations.

    Keywords: Complementary feeding, age of introduction, meal frequency, malnutrition