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Outcome of Screening Mammography for Women Attending Primary Healthcare Centers: One-Year Review

Muna Almohri1*, Fatema Al Jerdabi2 , Hala Al Asoomi2 , Mohamed Ali J. Mandeel3 , Hanan Abdulrahim4 , Lamya Ebrahim5 , Amal Buasali2 , Haya Al Subaei6

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  • Abstract
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  • Background: Breast cancer is the most prevalent cancer in women globally and in the Kingdom of Bahrain. Studies have shown that screening mammography is an effective way to identify early stages of breast cancer in women and has decreased breast cancer mortality. Therefore, determining the outcome of breast cancer screening is essential for proper assessment and improvement of the screening program.

    Objective: This study aims to assess the outcome of breast cancer screening by mammography for women attending Primary Healthcare Centers in the Kingdom of Bahrain.

    Methods: This is a cross-sectional study of women who had screening mammograms in primary healthcare centers in the Kingdom of Bahrain for one year. The study included 2438 women aged 40 years and older. Data were extracted from electronic medical records.

    Results: The most prevalent breast density level was scattered fibroglandular density (55.3%), while extremely dense breasts (5.3%) were the least common. The study showed that 68.3% of the reports were normal, while 31.7% of women were recalled for further imaging. The most common reasons for recalls were nodules/lumps in 34.2%. Additional imaging was done for 69.4% of the cases, while 30.6% of women missed follow-up appointments. Of the patients needing biopsies, the procedure was performed for 62.5% of the women; of these, there were histologically confirmed malignancies in 31.6%.

    Conclusion: The breast cancer detection rate in this study is 0.5%. A recall rate of about 32% is higher than in other studies. This study also shows a high percentage of women who didn’t follow up for the additional images and procedures requested by radiologists, which needs further studies to identify the reasons. Educating women on the importance of compliance with the additionally requested workups and close monitoring and follow-up of the screened women by health facilities are crucial for the success of the breast screening program.

    Keywords: Breast cancer, mammogram, screening, outcome, primary care

Wiskott – Aldrich Syndrome in Patients with Normal Platelet Size in Bahrain

Salem Alrowaijeh1*, Rana Taqi2, Ebrahim Almasry1, Jalal AlKhan1

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  • Abstract
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  • Regardless of ethnicity or geographical distribution, Wiskott-Aldrich syndrome affects 1 in every 100,000 live male births. It has been established that Wiskott-Aldrich syndrome may potentially be a source of autoimmune illnesses and reticuloendothelial malignancies, even though most patients present with the traditional triad of thrombocytopenia, eczema, and recurrent bacterial infections. This case report introduces a 4-year-old boy born with hematemesis, thrombocytopenia, eczema, recurring infections, and, most surprisingly, normal platelet size. Genetic testing confirmed the diagnosis, primarily based on clinical suspicion. Thus the case study attempts to increase awareness among doctors in Bahrain and globally in considering the diagnosis of Wiskott-Aldrich syndrome in any patient with eczema, recurrent infections and thrombocytopenia regardless of having a normal mean platelet volume .

    Keywords: Genetic testing, immunity disorder, primary immunodeficiency disorder, thrombocytopenia, Wiskott-Aldrich syndrome

Clinical Recommendations to Improve Utilization of Fissure Sealants in Primary Healthcare Centers in Bahrain

Eman Flaihan Alrowaili

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  • Abstract
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  • A situation analysis among which a cross-sectional survey of dental practitioners working in primary healthcare centers found that while 127 (94.8%) out of 134 respondents consider fissure sealants effective yet, most of them have misconceptions regarding which teeth to consider carious and which to seal as only 15 (11.2%) recognized that initial carious and non-cavitated carious lesions are the same and only around half sealed either. Fissure sealants are provided for free in primary healthcare centers, but they seem underutilized as only 35 (37.6%) dentists use them very often. To address these issues and others raised by dentists and dental hygienists on the indications and the use of fissure sealants; evidence-based clinical recommendations are provided keeping in mind the high level of caries among children and adolescents in Bahrain and the services provided in primary healthcare centers. Further studies will be needed to evaluate different reasons affecting dental practitioners' knowledge and use of fissure sealants as a method of preventing and controlling caries.

    Keywords: Fissure sealants, non-cavitated carious lesions, initial caries, high risk, prevention, dentists, dental hygienists

    Abbreviations used in manuscript: Primary health care centers (PHCC), International Caries Detection and Assessment System (ICDAS)

Comparing Postoperative Analgesia of Caudal and Penile Blockade using Bupivacaine in Children Undergoing Hypospadias Repair

Mohamed Magdeldin M. Ahmed1*, Ahmed Murad Bella2

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  • Abstract
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  • Background & Objectives: Caudal epidural and dorsal nerve penile blockade are commonly used for analgesia during and after hypospadias repair in children. Comparative studies to recommend the most effective block are in dearth. This study aims to compare penile block versus caudal block with bupivacaine for hypospadias repair in children in terms of post-operative effectiveness, pain management, and complications.

    Methodology: The study was conducted on 60 male children, aged 1-9 years, undergoing hypospadias surgery under general anesthesia. The subjects were randomly divided into two groups: (A: caudal block, n=30, and B: penile block, n=30). A postoperative pain assessment was conducted using FLACC scale until 24 hours post-surgery.

    Results: The patients from the A and B groups were comparable in age, weight, and ASA classification. All patients in the 2 groups did not feel pain post-operatively throughout the first 6 hours. One patient (3.4%) from each of the A and B groups started to feel pain 6 hours, and 9 hours, respectively after surgery. Eight patients (26.7%) in group A and 6 patients (20%) in group B felt pain throughout 6 to 24 hours after surgery. Four patients from group A and 1 patient from group B developed nausea and vomiting during the first 24 hours post-surgery.

    Conclusion: The penile blockade proved to be more effective in lowering postoperative pain scores, with fewer side effects, thereby decreasing the need for rescue analgesia.

    Keywords: Caudal block, bupivacaine, Caudal epidural, hypospadias repair, penile block