Table of Contents

Case Reports

Persistent Encapsulated Seroma: A Common Early Complication Presenting Late in a Case of Abdominoplasty

Rashid Noaman AlHasan1,*, Sara AlSaad2, Nayef A. Lori3

Pages: 1-8
  • Abstract
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  • Abdominoplasty is a well-known procedure for body contouring in aesthetic plastic surgery. The riseof bariatric surgeries as well as the increase in awareness of cosmetic procedures and availability ofresources have all led to a significant increase in the rate of abdominoplasties performed. Seromaformation is the most common complication occurring in these types of procedures. It accounts for atleast 5% of the early complications. Seromas usually resolve spontaneously, with repeated aspirations,or by ultrasound-guided drain insertion or aspiration. In a few cases, however, they can becomechronic, with the formation of a pseudocapsule. In our case, a 52-year-old patient, who underwentabdominoplasty and remained asymptomatic for over two years, presented with abdominal swellingand fullness. In-spite of the repeated non-surgical management, in the form of multiple bedside needleaspirations and ultrasound-guided drain insertions, the seroma did not resolve. Surgical intervention forthis patient became mandatory, and the decision to excise the pseudocapsule was done to prevent anyrecurrence.

    Keywords: Abdominoplasty, Bariatric, Complications, Patient, Plastic, Pseudocapsule, Seroma

An uncommon intranasal foreign body

Mahmood Alawainati1*, Hala Radhi2, Mahran Kazerooni2, Abdulrahman AlAwadhi3

Pages: 9-12
  • Abstract
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  • Myiasis, an infestation of humans or animals with dipterous maggots, is rarely encountered in developed countries but should be suspected in patients who present with animate nasal foreign bodies. We reportthe case of an 18-year-old male who presented with bilateral nasal discharge to our tertiary hospital inBahrain. The diagnosis of nasal myiasis was confirmed by parasitological microscopic assessment and the patient was treated accordingly. Our patient had an excellent prognosis due to prompt diagnosisand treatment. Although the parasitological confirmation of nasal myiasis determines the type of larva,treatment should not be delayed in lieu of parasitological confirmation.

    Keywords: Myiasis, Sarcophaga spp., Larva, Diptera, Nasal discharge

Case Report: Malignant Pseudomyxoma Peritonei

Abdulkarim AbdulRahman1,*, Wael Tahseen2, Zuhal Ghandour1

Pages: 13-17
  • Abstract
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  • Pseudomyxoma peritonei (PMP) is a poorly understood condition characterized by mucinous ascitesdiffusely involving the peritoneal surfaces.There is considerable debate regarding the definition, pathology, site of origin and prognosis of PMP.In this article, we discuss how an asymptomatic middle-aged man who was being investigated for anincidental finding of ascites was finally diagnosed to have a malignant variant of PMP.

    Keywords: Abdominal pain, Appendix, Ascites, disseminated peritoneal adenomucinosis, Malignancy,peritoneal mucinous carcinomatosis, Pseudomyxoma peritonei

Neurosensory Macular Retinal Detachment after Intravitreal Ocriplasmin Treated Successfully with Oral Carbonic Anhydrase Inhibitor

Aysha S. Falamarzi, Mohammed Yusuf Shaikh , Khaled A. Helaiwa

Pages: 18-22
  • Abstract
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  • Ocriplasmin is an enzymatic drug used intravitreally to lyse focal vitreomacular adhesion and traction.We present a 45-year-old Bahraini female who developed a neurosensory macular retinal detachmentfrom subfoveal fuid collection four weeks after its successful release following an ocriplasminintravitreal injection. Subfoveal fuid is a well-known side effect of intravitreal ocriplasmin, mostlyresolving spontaneously and completely over a period of few months. In order to reduce the attendantvisual disability, rather than waiting for its natural recovery, we chose to treat it with oral carbonicanhydrase inhibitor, acetazolamide with an encouraging outcome. This drug is known to help inresorption of subfoveal fuid in the condition of central serous chorioretinopathy. However, to thebest of our knowledge, its role is not explored in post-ocriplasmin setting. The purpose of this casepresentation is to highlight the possible benefcial role of carbonic anhydrase inhibitors in ocriplasmin-related subfoveal neurosensory detachment.

    Keywords: Neurosensory retinal detachment, Subfoveal fuid, Ocriplasmin, Vitreomacular adhesion,Vitreomacular traction, Carbonic anhydrase inhibitor

Original Articles

Knowledge, Attitudes and Practices of Training Doctors in a Tertiary Care Hospital in Bahrain Towards Health Research

Adel Salman AlSayyad1,* , Shaima Al Nashaba2, Kawthar Al Eid3, Manal Al Maskati4, Mirvat Al Alawi3

Pages: 23-29
  • Abstract
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  • Background: Health research methodology is becoming essential research types in current clinicalpractice. Training for necessary research skills and practicing research early in the career are foundto be associated with continued professional academic growth. The aim of this study is to assess theresearch-related knowledge, attitude, and practices of training doctors, in the main tertiary care andtraining hospital, in Bahrain.

    Methods: Cross-sectional study was conducted among 142 trainee doctors, recruited in the SpecialtyTraining Residency Program (STRP) at all levels, in Salmaniya Medical Complex (SMC). They completed self-flled questionnaire which was developed using questionnaires from previous studiesand included demographic, knowledge, attitude, and practice, related to health research.

    Results: A total of 142 training doctors participated in the study. More than half of them (55.6%)considered their level to be good, while only 12 (8.5%) assessed themselves to be excellent. Although majority of the respondents (87.3%) thought that training doctors should participate in research, onlyone-third (34.5%) of them felt confdent in interpreting and writing research. When asked about themain limitation to conduct health research, the participants ranked lack of mentors and/or assistants asthe frst limitation (63.4%), followed by lack of time (49.3%), and lack of research curriculum (40.1%).

    Conclusion: Training doctors have an excellent attitude towards health research and good knowledge,but their participation in research does not match with their attitude and knowledge. An urgent changein the curriculum and training of the postgraduate programs is needed to include health researchparticipation.

    Keywords: Knowledge, Attitudes, Practices, Doctors, Bahrain, Health Research.

Physicians Approach to Hypospadias in Kingdom of Bahrain

Ahmed Al Rashed1*, Mohammed Mubarak2, Mahmood Abbas3, A.K. Singal4

Pages: 30-34
  • Abstract
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  • Background and objectives: Hypospadias is a congenital condition affecting the urethral opening inmales where the opening is present on the underside of the penile shaft rather than at the tip of the glans.The aim of this research was to evaluate the general knowledge and approach of Pediatricians, FamilyPhysicians and General Practitioners (GP) in the Kingdom of Bahrain towards hypospadias.

    Methods: This is a descriptive study in which an anonymous online questionnaire was sent topediatricians, family physicians and general practitioners in Bahrain. The questionnaire included bothyes and no questions, open ended short answer as well as multiple choice questions. The questionnaireincluded components aimed at finding the professional background as well as to assess the knowledgeand approach of these physicians regarding hypospadias.

    Results: The total number of participants in this study was 60 physicians. An average of 11.3 years of postgraduate experience was present among the participants. The average number of hypospadiascases seen per year by the participants was 3.1. The age of referral to a surgical specialty was onaverage 4 months and 65% of participants believed that the optimal age for surgery was between 12-18 months. A majority of 75% participants believed that there were congenital anomalies associatedwith hypospadias, with the commonest one described being undescended testis. Finally, 38 (63.3%) physicians answered that they would refer cases to pediatric surgery while 22 (36.7%) answered thatthey would refer these cases to pediatric urology.

    Conclusion: Most physicians had an appropriate knowledge of when to refer and when to intervenesurgically in cases of hypospadias. However, several components of the approach, including whether itwas a hereditary condition or if investigations needed to be performed prior to referral were inaccurate.

    Keywords: Hypospadias, Undescended Testis, Chordee, Pediatric Urology, Bahrain.

Prevalence of Resistant Uropathogenic Escherichia coli in Bahrain: A Community Based Study

Safaa Al Khawaja1*, Rawan Al Aagha2, Nermin K Saeed3, Nashwa Fawzy4

Pages: 35-43
  • Abstract
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  • Background and objectives: Urinary tract infections (UTIs) are amongst the most common infectionsdescribed in outpatients setting. This study was conducted to study the uropathogenic Escherichiacoli isolated from patients with clinical diagnosis of community onset UTI. Such studies are crucialto assess the local antimicrobial resistance rates for the common uropathogens in our community andaccordingly to suggest the best empirical therapy of UTI relying on the predictability of the agentscausing UTI and knowledge of their antimicrobial susceptibility patterns.

    Materials and Methods: Total of 829 consecutive non duplicate urine specimens with positive growthof significant E.coli collected from patients presenting to the primary health centers in the Kingdomof Bahrain with clinical suspicion of UTI during the year 2017 were included. Urine samples wereprocessed in the Microbiology laboratory. Bacterial isolates were identified using standard conventionalmethods and antimicrobial susceptibility testing was performed using disk diffusion technique followingKirby-Bauer method.

    Results: There was relatively high rate of resistance to commonly prescribed oral agents for UTI suchas cotrimoxazole (42.7%), amoxicillin-clavulanic acid (34.6%), cefuroxime (32.21%), and norfloxacin(23.6%), which are the available first line options for treating UTI in primary health centers, but mostisolates retains their susceptibility to nitrofurantoin (resistance of 5.19%). MDR phenotype (defined asexhibiting resistance to at least one agent in ≥3 antimicrobial classes) was observed among 34.8% ofthe isolates, ESBL production was confirmed among 27.39% of tested E. coli isolates.

    Conclusion: Resistant strains of E. coli are prevalent in the community acquired UTI, nitrofurantoin isthe only drug that showed an excellent sensitivity pattern and should be the preferred drug for empiricaltherapy of uncomplicated lower UTI as an outpatient.

    Keywords: Escherichia coli, fever, outpatients, antimicrobial resistance, urinary tract infection.

Ultrasonographic and Pathological Features of Surgically Excised Thyroid Nodules- A cross-sectional study

Mahmood Alawainati1*, Mohammed Radhi2, Zainab Shawqi3, Ahmed Al Sharakhat4

Pages: 44-52
  • Abstract
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  • Introduction: Thyroid nodules are commonly encountered in clinical practice and require laboratory and radiological investigations for their evaluation. This study aimed to evaluate the correlation between ultrasonographic and pathological features of thyroid nodules and to determine the diagnostic accuracy of cytological assessment.
    Methods: A retrospective cross-sectional study was conducted at a tertiary care hospital in the Kingdom of Bahrain. Ultrasound and pathology reports were retrospectively reviewed for all patients who had their nodules excised from January 2016 to December 2018. All statistical analyses were conducted using Prism 7 (Graph Pad software, version 7).
    Results: A total of 287 patients had thyroid surgery during the study period but only 190 of them had an ultrasonographic assessment. Of the 190, 135 (71%) were diagnosed with benign pathologies. Multinodular goitre (n=86, 63.7%) was the most common benign pathology, whereas papillary thyroid carcinoma (n=48, 87.2%) was the most common malignant pathology. Most cases affected females (n=171), with a female-to-male ratio of 9:1. Non-cystic nodules, nodules ≥ 1cm, presence of calcification, increased vascularity and hypoechogenicity were significantly different between benign and malignant nodules.
    Conclusion: Ultrasonographic features and cytological assessment are useful in evaluating thyroid nodules. However, histological analysis may be inevitable as none of these diagnostic techniques are enough to exclude thyroid cancer.
    Keywords: Thyroid nodules, Ultrasound, Neck sonography, Histopathology, Fine needle aspiration