Table of Contents

Case Reports

Sanjad–Sakati Syndrome: An Anesthetic Challenge

Milda Ahmed1*, Nada Sarwani2, Owais Ahmed2

Pages: 1-4
  • Abstract
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  • Due to scarce data regarding “Middle Eastern Syndrome” or the Sanjad–Sakati syndrome, this case report aims to elaborate the significance of this rare autosomal recessive syndrome and the considerations to provide anesthesia to such patients. The patient discussed in this report is a diagnosed case of Sanjad– Sakati syndrome, indicated for surgical insertion of gastrostomy tube by laparotomy. The anesthetic concerns encountered included a difficult airway anatomy due to facial dysmorphic features and short stature, along with increased sensitivity to muscle relaxants. The case was further complicated by the presence of chest infection and electrolyte imbalance, particularly hypocalcemia, with the risk of seizures, cardiovascular collapse, and arrhythmias. A thorough preoperative assessment and multidisciplinary approach, including correction of electrolytes and optimization of the chest condition, followed by a cautious and vigilant intraoperative anesthetic management and close postoperative monitoring led to a smooth recovery and positive outcome with the avoidance of any morbidity or mortality.

    Keywords: Anesthesia, difficult airway, hypocalcemia, hypoparathyroidism-retardation-dysmorphism, Sanjad–Sakati syndrome

Stonefish (Synanceiea verrucosa) Envenomation in the Kingdom of Bahrain

Hytham Ghanem1*, Mohammad Tanvir Khan2, Salah Al-Ghanem3, Ghada Al-Qasem4

Pages: 5-9
  • Abstract
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  • Fishing, swimming, diving, and other water-based recreational activities are popular in the Kingdom of Bahrain and the Arabian Gulf. In this case report we describe a case of stonefish poisoning encountered by a 44-year-old fisherman on the coasts of Bahrain. Human envenomation is rare, and the Arabian Gulf is not the usual habitat of the stonefish. No accurate data is available on the incidence or international frequency of stonefish envenomation. This article describes the treatment and difficulties encountered with his management. We also review the proper management, medical guidelines, and care of stonefish poisoning. The patient presented with severe excruciating pain and edema of his upper limb. He was administered with intravenous analgesia for pain control and was admitted under surgical care for further management of impending compartment syndrome and underwent a fasciotomy. An antivenom for stonefish may be used, however is not available in Bahrain. He was discharged following treatment after 5 days of hospitalization. Although, stonefish is rare in our region, stonefish sightings have been reported in the Arabian Gulf. Management of stonefish and marine envenomation involves soaking the affected site in warm water to denature the venom, analgesia, and stonefish antivenom.

    Keywords: Fish envenomation, fish poisoning, stonefish, Syneceiea verrucosa

Original Articles

Evaluation of Satisfaction Level of Sickle Cell Disease Patients Regarding the Healthcare Services in Bahrain: A Cross-sectional Study

Amani Al Hajeri1*, Mariam Ali2 , Lana Saleh2 , Shaikha Alkowari2 , Aysha Al Saad3

Pages: 10-16
  • Abstract
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  • Background and objective: Sickle cell disease (SCD) has a relatively higher incidence in the Kingdom of Bahrain. The disease causes frequent crisis that may require hospitalization. The study aimed to evaluate the satisfaction level of SCD patients regarding the healthcare services provided in Bahrain.

    Methods: This cross-sectional study with a random convenience sample was conducted in the Medical and Surgical wards, SCD clinics, and the Hereditary Blood Diseases center at Salmaniya Medical Complex (SMC) during May 2015–April 2016. The Patient Satisfaction Questionnaire short form (PSQ)-18 was used in this study, and it was double translated to an Arabic version. SPSS 21 software, Microsoft excel 2010, and chi-square test were used to analyze data as well as measure P value.

    Results: The overall satisfaction rate regarding the healthcare services provided to SCD patients was 22% and 17% among males and females, respectively. Patients with higher education level had less satisfaction rate (43%). Moreover, patients stated that they waited for long duration to get the emergency treatment, whether it was in the Emergency department (88%), Hereditary Blood Diseases center (73%), or the Health center (63%).

    Conclusion: Overall, patients had a fair level of satisfaction. The educational level was found to have an inverse relation with the level of satisfaction. Most participants were dissatisfied with the long waiting duration before receiving the care needed. We believe that reducing the waiting time will help in improving patients’ satisfaction level.

    Keywords: Anemia, contentment, health service, sickle cell disease, emergency

Side Effects of Daily versus Weekly Iron Supplementation in Pregnant Women

Muhammad Rizki Yaznil1*, Muara Panusunan Lubis1 , Sarma Nursani Lumbanraja1 , Melvin Nova Gunawanto Barus1 , Adriani Sakina1 , Munauwarus Sarirah1

Pages: 17-22
  • Abstract
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  • Background & Objective: Iron supplementation in pregnant women is highly recommended, however there is reduced compliance due to the common gastrointestinal side effects. This study aimed to compare the clinical side effects between pregnant women with daily and weekly iron supplementation.

    Methods: Seventy-nine pregnant women who met the inclusion and exclusion criteria were given iron supplements every day (group 1, n=37) and twice a week (group 2, n=42). All numerical data were assessed by independent t-test. Side effects were assessed after one month of administration using a questionnaire containing complaints felt by pregnant women and were evaluated by chi-square test using SPSS 25. A P value <0.05 was considered as statistically significant.

    Results: The most common side effects of iron supplementation in both groups were black feces (35.4%) and nausea (31.6%). Nausea (45.9% vs. 19.0%; P<0.05) and constipation (35.1% vs. 11.9%; P<0.05) were more frequent in group 1 than in group 2, respectively. Other side effects, such as heartburn, flatulence, vomiting, black feces, and urine discoloration did not differ significantly between the two groups (P>0.05).

    Conclusion: The daily iron supplementation elevated the episodes of nausea and constipation during pregnancy than the weekly supplementation. The daily iron supplementation in pregnant women increases the risk of side effects, potentially reducing compliance.

    Keywords: Iron supplement, pregnancy, side effects, daily, weekly

Screen-Based Media Use Among Children of Working Mothers and Homemakers

Ahmed Malallah Al-Ansari*1 , A. Rahman J. Al-Tourah2

Pages: 23-29
  • Abstract
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  • Background and objectives: In recent times, use of screen-based media (SBM) has increased due to the growing availability of screen-based electronic devices in everyday life. The aim of the study is to evaluate the use of SBM among children of working mothers in comparison to homemakers.

    Methods: The present cross-sectional study involved 200 children to study the SBM usage. The children were divided into two equal groups: group 1 included working mothers (n=100) and group 2 included homemakers (n=100). The data, including the type of SBM, the duration, and each child’s reaction to the devices being withheld were obtained by direct interview through a predesigned form.

    Results: The children from both groups reported use of SBM greater than that which is recommended internationally for their age (>2 hours/day; P=0.014). Children of working mothers who use videogames/ smartphones reacted in a more violent and irritable manner to removal of SBM device than the children of the homemakers (P=0.001). However, the children of homemakers used television significantly more than the children of the working mothers (P=0.006).

    Conclusion: Children of working women tend to use SBM, probably overuse the social media, in comparison to children of homemakers. Children of both, working mothers and homemakers spent time that exceeded the recommended two hours per day rule by the American Pediatric Association SBM use guidelines. Future research should focus on SBM parental strategies and their SBM use.

    Keywords: Bahrain, homemaker, overuse, screen-based media, working mother

Financial burden of ventilator associated pneumonia among patients in intensive care unit: Kosovo case study

Samir Selimi1 , Gazmend Spahija2 , Lul Raka3, 4*

Pages: 30-36
  • Abstract
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  • Background and objective: Ventilator-associated pneumonia (VAP) is a predominant type of healthcareassociated infection (HAI) in intensive care units (ICU), associated with increased length of stay(LOS), mortality rates, and costs. We aimed to assess the financial burden of VAP in terms of direct medical costs incurred by the patients treated in ICU.

    Methods: A local surveillance dataset was used to perform the assessment of direct medical costs incurred by the patients while being treated for VAP in the ICU at University Clinical Centre of Kosovo (UCCK).

    Results: Overall, incidence rate of HAIs in the ICU at UCCK was 62.1% with VAP dominating the infection account (73.2%). The LOS in ICU ranged from 2–44 days with a median time of six days, while the distribution between VAP affected and unaffected patients ranged between 13.5 and 5.4 days, respectively. The mean cost to patients with VAP is estimated as €647±487, which is significantly higher than in patients without VAP (€227±174).

    Conclusion: An immediate action is required to introduce better VAP prevention and control measures in the ICU. Evidence-based practices confirm that compliance to hand-hygiene practices, ICU staff education, introduction of regular surveillance, and adequate antibiotic therapy can significantly decrease VAP incidence, save lives, decrease LOS, and reduce costs.

    Keywords: Costs, intensive care unit, Kosovo, ventilator-associated pneumonia

Prevalence of Overweight and Obesity Amongst Bahraini Adolescents Aged 12-15 years Attending Primary Care Health Centers

Amina Taher1*, Leena Al Saffar2 , Ahmed Al Jamri1

Pages: 37-43
  • Abstract
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  • Background and objective: The increase in obesity amongst adolescents is one of the most important public health concerns in many countries, including the Kingdom of Bahrain. The objective of the current study was to measure the prevalence of overweight and obesity among Bahraini adolescents. This study will aid in a better understanding of the issue and in pursuing preventive measures and campaigns to alleviate the problem.

    Methods: The weight, height, and body mass index of 9057 Bahraini adolescents was obtained from the Ministry of Health via the nation-wide health electronic file—I-Seha. The final sample consisted of 8463 adolescents; of which 4687 and 3776 were female and males, respectively. References standards from the World Health Organization were used to qualify the adolescents into normal weight, underweight, overweight, obese, and morbidly obese.

    Results: The overall prevalence of overweight and obesity was 42.3%. Among females the prevalence of overweight and obesity was 21.5% and 20.8%, respectively, whereas in males. the prevalence was 18% and 24.3%, respectively. The lowest prevalence of overweight and obesity was among males aged 15 years (36.4%) and highest among males aged 12 years (47.4%). While in females the prevalence of overweight and obesity was lowest and highest amongst 15-year-olds (38.3%) and 12-year-olds (48.5%).

    Conclusion: The prevalence of overweight and obesity is high in adolescents in the Kingdom of Bahrain, especially in the younger age group. This increases the urgency to undertake measures to control the problem in the younger population, in order to reduce serious outcomes.

    Keywords: Adolescents, Bahrain, obesity, overweight, prevalence