Background and objectives: There is no data regarding the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections (cSSTI) in the Kingdom of Bahrain despite its rapidly growing existence worldwide. This study aims to ascertain its prevalence at Bahrain Defence Force Hospital between 2010 and 2015. Since Bahrain is considered one of the top ranking countries with Diabetes Mellitus (DM), we aim to establish the percentage of patients with DM in MRSA cSSTI. Diabetic foot infections constitute a major complication of DM and contribute to the risk of amputation. We intend to identify the rate of MRSA cSSTI infections in the foot and the rate of amputation in patients with and without DM.
Methods: Retrospective cohort study of an electronic medical chart review of in- and outpatients who had documented swab collection for cSSTI.
Results: Out of 16,189 swabs collected, 702 were positive for MRSA cSSTI. The prevalence rate of MRSA in cSSTI was 4.3%. Out of 439 patients, 43% were positive for DM. There were higher odds of MRSA cSSTI occurring in the foot in patients with DM (OR = 5.2, 95% CI 3.1 to 8.6; P < 0.0001) compared to patients without DM (RR = 3.6, 95% CI 2.4 to 5.4; P < 0.0001). There were higher odds of patients with DM foot MRSA cSSTI undergoing amputation (OR = 46.1, 95% CI 2.7 to 786.1; P < 0.05) compared to patients without DM (RR = 25.1, 95% CI 1.6 to 395.9, P < 0.05).
Conclusion: This will be the benchmark study for the prevalence of MRSA in cSSTI in Bahrain to establish the awareness of its association with DM and its disease burden.

Keywords: Bahrain, MRSA, cSSTI, Prevalence, Diabetes, Foot, Amputation

Background and objectives: To describe patient characteristics and risk factors profile of patients in  a cardiac rehabilitation program.
Methods: This single-center, prospective, observational study included all the patients who completed the cardiac rehabilitation program with exercise sessions, including dietary plan, counseling, stress management, and relaxation sessions. Effects of pre- and postexercise program on patients’ baseline characteristics, blood pressure, blood chemistry and lipid profile status were recorded and compared.
Results: A total of 264 patients enrolled and completed the cardiac rehabilitation exercise program. The mean age of the patients was 52 years and 70.8% of the patients were men. Among 264 patients, 22.3% had diabetes mellitus, followed by hypertension (37.1%), and dyslipidemia (29.5%). Exercise training showed significant improvement in the functional outcomes, including 6-min walk distance (500 vs. 521.5 m; P<0.001), systolic blood pressure (130.7 vs. 123.2 mmHg; P<0.001), diastolic blood pressure (75.9 vs. 72.5 mmHg, P<0.001), HbA1c (5.2 vs. 3.4%, P=0.001), and total cholesterol (4.3 vs. 4.1 mmol/L, P<0.001).
Conclusion: Cardiac rehabilitation is an essential and an integral part in the care of cardiac patients. Overall, there was a reduction in blood pressure, blood sugar, and cholesterol levels with improved exercise tolerance. The benefits and the desired outcomes are achievable to improve the overall care provided.
Keywords: Coronary artery disease, cardiac rehabilitation, risk factors

Background and objectives: Prevalence of depression, anxiety, and stress (DAS) in primary care physicians (PCPs) have yet to be assessed in the Kingdom of Bahrain. The objectives of this study were to measure the prevalence of DAS in PCPs in the public health centers and examine the factors that influence the development of DAS.
Methods: A cross-sectional study was conducted in June 2014 using Lovibond’s short form of the Depression Anxiety Stress Scale-21, a self-report measure of DAS. A total of 336 PCPs working in the public sector at the time were identified from the Ministry of Health database and contacted to answer demographic questions included in the questionnaire.
Results: Out of 336 PCPs, 210 participated in the questionnaire with a response rate of 63%. Most of the PCPs were women (78.1%), aged between 35 and 50 years (60%), and were either family physicians or consultant family physicians. Also, 39.5% of the PCPs were found to be dissatisfied with their job. The prevalence rates of DAS were 38.6%, 37.6%, and 38.6%, respectively, ranging from mild to extremely severe. Working as nonconsultant family physicians, working for longer hours per week, dissatisfaction with the job, and taking more number of sick leaves were the risk factors for depression and/or anxiety. However, among PCPs aged less than 35 years, lower salary range and dissatisfaction with the job were the risk factors for stress.
Conclusion: The levels of mental health difficulties in PCPs cannot be ignored and need prompt action. These issues need to be addressed to provide support to PCPS and ensure the unaffected patient quality of care. Recommendations on how to improve current working conditions should be suggested to the relevant authorities.

Keywords: Depression, anxiety, stress, DASS-21, family physician, Bahrain

Abstract
Background and objectives: Iron deficiency anemia (IDA) is the most common nutritional anemia in children, worldwide. No recent data are available about its prevalence in Bahrain. This study was conducted to measure the prevalence of IDA among 3-year-old children attending child screening clinic at healthcare centers and evaluate the adequacy of management interventions.
Methods: This retrospective study was conducted among 3-year-old children attending child screening clinics at local healthcare centers in Bahrain. A total of 450 children were included in the study using multistage stratified proportional sampling. The data were collected from child screening booklets, family medical records, and laboratory data. Data included demographic characteristics, capillary hemoglobin levels, additional tests for anemic patient such as complete blood count, reticulocyte count, serum iron and ferritin levels, management, and follow-up plans.
Results: The prevalence of anemia was 30%. Only 40% of children received treatment for anemia. The iron dose prescribed was adequate in the majority of cases (97%). Diet advice and follow-up plans were reported for one-third of the anemic patients. The percentage of defaulter was 33%.
Conclusion: A significant percentage of 3-year-old children in Bahrain suffer from IDA. This raises the need to increase adherence to IDA guideline and management protocols in local healthcare centers in Bahrain.

Keywords: Anemia, iron deficiency, hemoglobin, children, prevalence.

Background and objectives: Sickle cell disease (SCD) is a major health problem in the Kingdom of Bahrain. Several studies have found a strong association between chronic diseases and depression, some studies have specifically associated depression with SCD. The aim of this study was to assess the prevalence of depression in SCD patients in Bahrain.

Methods: In this cross-sectional study, the Arabic version of Beck Depression Inventory-II scale was used to measure the level of depression in 196 SCD adult patients. Demographic data were collected and assessed against the level of depression.

Results: The prevalence of mild to severe depression was observed in 58.5% (n=115) of patients, 39% (n=76) were normal, and 2.5% (n=5) were extremely depressed. The most prevalent symptoms were fatigue, change in sleeping pattern, and loss of energy, while suicidal ideation was the least common. The degree of sleep disturbance was associated with the level of depression (P=0.0005). Gender was significantly associated with the level of depression (P=0.031). Prevalence of mild to extreme depression in women and men was 74% and 57%, respectively (odd’s ratio=2.19; 95% confidence interval=1.05–4.56; P=0.035).

Conclusion: Our results support the findings of previous studies, as they have revealed the high prevalence of depression in SCD patients. Thus, identifying and treating depression in SCD patients can improve their quality of life and their medical outcome.

Keywords: Anemia, sickle cell disease, depression, Bahrain

The association between the occurrence of influenza and cryptogenic organizing pneumonia is very important in the clinical practice. In this case report, we presented a 58-year-old woman who came to seek medical advice for fever, abdominal pain, and diarrhea. A few days later, she got desaturated and was diagnosed with influenza A. Computed tomography of the chest showed interstitial pneumonitis symptoms. This case study highlights the role of glucocorticoids in improving the outcome of such patient.

Abstract
The aim of this study was to highlight the importance of a diagnostic approach to photodermatoses, selectively review the literature of the past 25 years, and describe the modern nosology of photodermatoses, their clinical features, diagnosis, and treatment.
Photodermatoses are a non-life-threatening condition; however, can cause considerable suffering. Without treatment and preventive measures, symptoms gradually worsen over a number of years and become chronic. 

Keywords: Photodermatoses, Polymorphic light eruption, Erythematous lesions, PUVA

Violence or abuse among domestic partners is the leading cause of morbid-dysfunctional families. Physicians usually deal with either acute or chronic presentation of intimate partner violence. Many victims of an abusive relationship are hesitant to seek help, yet the abusive problem is often overlooked, excused, or denied. Physicians need to understand the risk factors leading to an increase in the violent incidents and use specific screening questionnaires to assess the patient’s living condition with an abusive partner.

Keywords: Intimate partner violence, Bahrain, psychological, physical