Table of Contents

Original Articles

Prevalence of Bacterial Pathogens and Antimicrobial Susceptibility Pattern in Bahrain Tertiary Care Hospital

Kasim O. Ardati1,*, Soni R. Murdeshwar2, Saramma T. Chacko3, Abhijeet Jagtap4, Sunitha Jacob4

Pages: 5-16
  • Abstract
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  • Background: Breach of human cell integrity triggers the development of infection by pathogenic bacteria. Although, antibiotics are competent in containment of bacteria, the emergence of antibiotic resistance has led to aggravated diseases and mortality rate, significantly. Hence, current study considered evaluating the frequently encountered bacterial species isolated from the clinical samples, and to examine their antimicrobial susceptibility pattern.

    Methods: Current retrospective study was conducted during January–December 2017, in a tertiary care hospital. A total of 1931 isolates were included for microbiological analysis. Organisms isolated from the same site with similar sensitivity patterns for one month were excluded. Clinical samples were cultured on appropriate nutrient medium and characterized by microbiological techniques as well as automated system—Vitex analyzer. Antimicrobial susceptibility of few isolates was evaluated by Kirby-Bauer procedure and the rest by Vitex analyzer. Data were analyzed using R-3.4.1.

    Results: Majority of the clinical samples were urine (29.7 %) and wound swabs (10.5 %). Escherichia coli (31.3 %) and Klebsiella pneumoniae (14.4 %) were predominant among the Gram-negative isolates, whereas, Staphylococcus aureus (70.6 %) was prevalent among the Gram-positive isolates. Higher resistance pattern was observed towards β–lactams and cephalosporins, and greater susceptibility pattern was observed towards carbapenems. Bahraini patients showed higher predominance of extendedspectrum β–lactamase producers.

    Conclusion: Urine and wound samples were the prominent sources and S. aureus, E. coli, and K. pneumoniae were the predominant organisms. Isolates were highly resistant to β–lactams as well as cephalosporins and were susceptible to carbapenems. Sensible utilization of antibiotics and reporting the susceptibility and resistance pattern of common organisms, periodically, assist in controlling antimicrobial resistance.

    Keywords: Antibacterial; β–lactams; Carbapenems; Infection; Pathogens; Resistance.

Percutaneous Interventions in Congenital Heart Disease in the Kingdom of Bahrain

Suad Al Amer1,*, Vimalarani Arulselvam2, Shereen Al-Shaikh2

Pages: 17-23
  • Abstract
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  • Background: The worldwide incidence of congenital heart disease (CHD) is 8 - 12 / 1000 live births. This results in a huge burden on societal resources. Recent advances in percutaneous interventions have resulted in fewer CHDs requiring surgery.

    Aim: To analyze the percutaneous interventions in CHD performed in Bahrain. Methods: This is a retrospective, descriptive study. All consecutive patients, who underwent percutaneous interventions for CHD, were analyzed from May 1, 2011 to December 31, 2017.

    Results: A total of 285 patients, aged day one to 62 years old (mean age = 10.7 years), and weight range of 2 – 113 kgs (mean weight = 27.5 kg), underwent cardiac interventions. The procedures performed were: device closure of patent ducts arteriosus (PDA, 63), atrial septal defect (ASD, 63), ventricular septal defect (3), patent foramen ovale (2), balloon dilatation of pulmonary stenosis (41), diagnostic cardiac catheterization (73), balloon dilatation of re-coarctation of aorta (11), balloon dilatation of aortic stenosis (13), coarctation stenting (4), percutaneous pulmonary valve implantation (5), balloon atrial septostomy (2), and pulmonary valve perforation (1). Success rate of device closure of PDA and attempted-ASD was 95 % and 85 %, respectively. Balloon dilatation of aortic and pulmonary valvular stenosis, and recoarctation of the aorta, resulted in > 50 % reduction in the peak gradient and increase in narrowed segment. There was one mortality in a neonate, due to the perforation of right ventricular outflow tract (0.3 %).

    Conclusions: Percutaneous interventions were performed safely in infants and adults with CHD. Recent advances in catheter-based interventions and techniques will provide alternative options in managing CHD.

    Keywords: Balloon valvuloplasty; Congenital heart disease; Device closure of septal defects; Percutaneous cardiac interventions; Pulmonary valve implantation

School Screening Program in Kingdom of Bahrain: Obesity and Overweight Outcome

Ashwaq Abdulla Sabt1,*, Eman Ahmed Haji2, Wafa Al Sharbati3, Lama Mahmood Nassar4, Mariam Ebrahim Al-Hajeri5, Buthaina Yusuf Ajlan6

Pages: 24-30
  • Abstract
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  • Background and objective: Overweight and obesity is one of the most common chronic disorders among adolescents and in adulthood. Obese adolescents are more likely to have high cholesterol, high blood pressure, and high blood glucose levels and be at a higher risk for cardiovascular diseases, and diabetes. The aim of this article is to describe the anthropometric status of males and females, aged between 10 and 12 years, based on data collected during pre-intermediate school entrance examination, between 2012 and 2014. Recent researches on this aspect are few, which create the need for establishing the updated studies as an outcome of school screening program in the Kingdom of Bahrain. Setting: Primary health care centers in Bahrain.

    Methods: A retrospective review of the records of all the students, attending pre-intermediate school entrance examination, between January 2012 and December 2014, was conducted. Body mass index was calculated for each individual, and the World Health Organization 2007 references were used to estimate the prevalence of overweight, obesity, underweight and stunting. Logistic regression analyses were used to identify factors associated with overweight and obesity.

    Results: The prevalence of overweight and obesity was 21.7 % and 22.5 %, respectively. Multiple logistic regression analysis showed that, belonging to a younger age group, and lack of physical activity, were the only factors significantly associated with overweight and obesity in our study. The problems of underweight and stunting were less common, with a prevalence of 3.3 % (95 % CI: 2.7, 4.0 %) and 4.2 % (95 % CI: 3.5, 5.0), respectively.

    Conclusion: The prevalence of overweight and obesity among adolescents has reached an unprecedented high level, which necessitates an immediate intervention, to halt this increase. Under-nutrition is still an important health issue among adolescents in Bahrain and needs to be tackled, appropriately.

    Keywords: Obesity; Adolescent; Overweight; School screening

Completion of Electronic Medical Records in General Clinics at Yousif Engineer Health Centre in Bahrain–A Clinical Audit

Zahra Ayoob1, *, Ismaeel Bakhsh2, Amna Shehab2, Fatema Almousawi2, Mahmood Alawainati2, Zahra Zabar2

Pages: 31-38
  • Abstract
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  • Background: Electronic medical records have largely replaced the conventional, paper-based documents, in many parts of the world, including Bahrain, due to increased portability, and easy accessibility. In primary-care setting in Bahrain, physicians use the SOAP note to document the patient’s medical history. The aim of this audit is to estimate the rate of completion of documentation of patient’s medical records by the physicians in Yousif Engineer Health Center using SOAP note in I-SEHA. 

    Methods: Yousif Engineer Health Center, which is the largest health centre in terms of coverage and number of visits, was the target of this audit. The date selected, by simple randomization, was November 15th, 2017. Night shifts, weekends, and records, documented by trainee residents, were excluded from the analysis. On that day, 11 physicians were on duty, with 426 records. Every physician was considered as a cluster, and approximately 35 % (n = 147) of the total records (n = 426), were included in the analysis using systematic selection. 

    Results: A total of 147 records were analyzed. The SOAP note was complete in 1 (1 %), partially complete in 142 (96 %), and incomplete in 4 (3 %), of the records. Subsequently, each part of SOAP note was separately assessed. For the Subjective part, 16 (11 %) were complete, 125 (85 %) partially complete, and 6 (4 %) incomplete. For the Objective part, 8 (6 %) records were complete, 37 (25 %) partially complete, and 102 (69 %) incomplete. The Assessment part was complete in 141 (96 %) and incomplete in 6 (4 %) of the records. The Plan part was complete in 127 (86 %) and incomplete in 20 (14 %) of the records. 

    Conclusion: In comparison to other studies assessing the competition of electronic medical records, this audit showed a substandard completion rate of 1 %. Accordingly, recommendations were formulated, which can be adopted to improve the electronic medical documentation.

    Keywords: Electronic medical records; I-SEHA; Bahrain; SOAP; Primary healthcare

Antimicrobial Susceptibility Pattern of Bacterial Pathogens in a Tertiary Care Hospital in the Kingdom of Bahrain

Kasim O. Ardati1,*, Soni R. Murdeshwar2, Saramma T. Chacko3, Abhijeet Jagtap4, Sunitha Jacob4

Pages: 39-48
  • Abstract
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  • Background & objectives: Antimicrobial resistance leads to higher mortality rates, especially with the emergence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria. Hence, current study evaluated the prevalence of MDR, XDR, and PDR bacteria among various clinical samples.
    Methods: The study was conducted at the department of Microbiology from January–December 2017. The bacteria were isolated and identified based on the conventional techniques, such as morphological characters and Gram-staining as well as the automated methods, such as Vitek analyzer. Antibiotic susceptibility was evaluated using Kirby–Bauer disc-diffusion method and Vitek analyzer. Based on the antimicrobial resistance pattern, isolates were categorized into MDR, XDR, and PDR. Data were analyzed using Microsoft Excel.
    Results: Out of 1862 bacterial isolates analyzed, 61.6% and 38.4% were Gram-negative and Grampositive isolates, respectively. Majority of the isolates were belonged to susceptible (65.2%) group, followed by MDR (30.8%) and XDR (3.9%) isolates group. Among MDR isolates, both extendedspectrum β–lactamases and nonextended-spectrum β–lactamase-producing Escherichia coli (40%), Methicillin-resistant Staphylococcus aureus (16.4%), Methicillin-resistant S. epidermidis (14.32%), and extended-spectrum β–lactamase-producing Klebsiella pneumoniae (11.3%) were prevalent. Among XDR isolates, Methicillin-resistant S. epidermidis (68.7%), Methicillin-resistant S. aureus (18.7%), and extended-spectrum β–lactamase-producing K. pneumoniae (12.5%) were predominant.
    Conclusion: Among all the isolates, E. coli, K. pneumoniae, Streptococci, Methicillin-resistant S. aureus, and Methicillin-resistant S. epidermidis were the most common drug-resistant isolates; however, no PDR isolates. Isolates were predominantly procured from urine samples. Further, the drug-resistant isolates were encountered exclusively in nosocomial infections. The escalation of MDR bacteria can be reduced by antibiotic stewardship programme and implementing programs for hospital staff regarding hygiene compliance.
    Keywords: Antimicrobial susceptibility; Bacterial pathogens; Bahrain; Extensively drug-resistant; Multidrug-resistant

Case Reports

Insomnia is a Prodromal Symptom for Psychosis

Mohamed A. Serageldin1*, Waiel Hikmet Salman Alani2

Pages: 1-4
  • Abstract
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  • A 23-year-old male patient, complaining of insomnia for the last two years, has been unresponsive to several trials of sedatives and hypnotics. Moreover, he has experienced multiple fluctuating symptoms of dysphoric mood, isolation, anhedonia, and easy provocation; accordingly, he was prescribed a dosage of escitalopram (20 mg/day) and quetiapine (50 mg/day), at night. Later, the symptoms were resolved, except for insomnia. Consequently, other trials of psychotropic medication were received, without any improvement till he presented with delusion of persecution, auditory hallucinations (second person with ordering type), television broadcasting, and depersonalization. At that time, olanzapine 20 md/day, in addition to depakine chrono (500 mg, BID) and risperidone (2 mg/day), were prescribed; but, he showed minimal improvement. This case indicates that a possibility of insomnia, to be the prodromal symptom for psychosis, should be given considerable attention in young patients, with resistant insomnia.

    Keywords: Insomnia; Schizophrenia; Psychosis; Prodromal symptom; Polysomnogram