Table of Contents

Original Articles

Assessment of Sleep Quality Among Doctors with On-Call Duties in Bahrain Defence Force Hospital

Maryam Adam Ali1, Noora Adam Ali2, Waiel Alani3*

Pages: 1-7
  • Abstract
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  • Background: Sleep quality is influenced adversely or favorably by various intrinsic and extrinsic factors and sleep deprivation is a common problem facing doctors.

    Objectives: To assess the sleep quality and estimate the prevalence of excessive daytime sleepiness among physicians with on-call duties.

    Methods: This cross-sectional seven-month study included a total of 62 doctors working at the Bahrain Defense Force Hospital (BDF) with on-call duties. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth sleepiness scale (ESS).

    Results: The mean Global Score of PSQI in the analyzed sample was 8.34 (95% CI: 7.35 – 9.33). The prevalence rate of poor sleep quality (PSQI >5) was 77.4%. Logistic regression analysis showed that poor sleep quality was associated with female gender and doctors’ ranks, as 54.2% of female doctors and 62.5 % of junior doctors reported poor sleep quality. No significant association was seen between number of calls per month and sleep quality. The mean of ESS scores among participants was 8.87 out of 24. No significant correlation was found between ESS scores and sociodemographic factors.

    Conclusion: Sleep disturbance was mostly seen among female and junior resident doctors. More studiesare warranted to highlight this issue.

    Keywords: Doctors; Excessive daytime sleepiness; Mental health; On-call duties; Sleep

A Study on the Prevalence of Burnout Among Primary Care Physicians on the Kingdom of Bahrain

Basem Abbas Ahmed Al Ubaidi1*, Shaima Helal2, Kawthar Mohamed Abdulla Al-Eid1, Lulwa Rashid Hasan Al-Showaiter1, Kareema AlAsheeri3, Yasmeen AbdulRasheed1, Sharafuddin Sarwani1

Pages: 8-16
  • Abstract
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  • Background: Burnout is an emerging issue worldwide that has become an increasingly common phenomenon at health organizations, especially among primary health care physicians.

    Objective: The study aimed to examine the level of burnout among primary care physicians, and its related risk factors in the Kingdom of Bahrain.

    Methods: This cross-sectional study included 211 health care physicians whose data was gathered using the Maslach Burnout Inventory (MBI). MBI consists of 9 items categorized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). High EE and DP scores and the corresponding low PA scores were considered to be indicative of high levels of burnout.

    Results: The overall prevalence of high levels of burnout among primary care physicians in Bahrain was 41.2%. A total of 97.1% of participants showed signs of increased DP, whereas 45.9% were emotionally exhausted. Surprisingly, 82.6% scored low in terms of PA. Risk factors such as age, gender, nationality, marital, and professional status were significantly associated with EE, which was further exacerbated in patients who skipped appointments, had lengthy consultations, or had difficulties with i-seha ande-filing. Increased DP and low PA among physicians were notably linked to their financial income and professional status. Overwhelming delays and demands of patients also contributed to a sense of low PA.

    Conclusion: The results of this study represent the current rate of burnout experienced by physicians and indicate the potential health crisis that may ensue if this phenomenon is left unaddressed.

    Keywords: Depersonalization; Prevalence; Primary care physicians; Professional burnout; Risk factors

Knowledge, Attitudes and Practices of Primary Health Care Physician Towards Geriatric Health in Bahrain

Adel Salman AlSayyad1, Samya Bahram2, Fatima Hasan Al Nooh3*, Farishtah Frotin4, Zahra Al Herz5, Mariam Mandeel6

Pages: 17-25
  • Abstract
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  • Background: With the increase in the elderly population worldwide there is an increased likelihood of developing health problems, and therefore an increased demand for provision of a high standard of care. This places the emphasis on improved knowledge and commitment to work with older people as well as a demonstration of appropriate attitude when dealing with elderly patients to achieve improved quality of care. The study aimed to assess Primary Health Care Physicians' knowledge of ageing, their attitude towards geriatric population and possible contributing factors that affect their knowledge and attitude.

    Methods: The cross sectional study was carried out on three hundred and fifty-one Primary Healthcare physicians using a self-answered modified “Facts on Ageing” questionnaire for knowledge assessment, and the University of California at Los Angeles Geriatric attitude scale (UCLA-GAS) to assess their attitudes.

    Results: A total of 237 primary health care doctors responded and filled in the questionnaire representing 67.5% of all PHC doctors working in the Ministry of Health in Bahrain. The key findings showed that the average percentage of the knowledge score of the participants was 57.3%. Statistically insignificant results were noted with respect to the participants’ characteristics and level of knowledge. A significant number of the participating physicians had a neutral attitude towards the elderly population, with no statistical significance noted when an association with the physicians' characteristics were studied.

    Conclusion: This study was the first to be conducted in the Kingdom of Bahrain to assess the knowledge and attitude of primary health care physicians towards the elderly population. It aimed to identify the gaps in knowledge, improve and encourage a more positive attitude and ultimately achieve a high standard of care towards the elderly population.

    Keywords: Attitude; Characteristics; Factors; Family physicians; Geriatrics; Knowledge

Review Articles

The Stipulation of Dental Cavity Lining Under Composite Resin Restoration: A Myth or Reality?

Ansari SN1,*, Ganguly KK2

Pages: 26-33
  • Abstract
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  • Excavation of carious lesions and restoration of the resulting cavities is a therapeutic activity older than the pyramids of Giza. A better understanding of the biological aspects of this procedure and the materials used has led to a silent revolution in the dental restorative materials and techniques. The fact that complete removal of caries is undesirable in deeper lesions is an intriguing concept. This paradigm shift in restorative dentistry has fueled parallel research in the utility of ‘liners’ underneath restorations. Liners that were traditionally used subjacent to dental amalgam restorations were extrapolated to be used under composite resin restorations also, albeit with glass ionomer cement (GIC), flowable resin composite, or resin-modified glass ionomer cement (RMGIC). Later research shows unclear evidence of any benefit of the use of any liner under dental composite material, whether in cavities devoid of caries or in cavities with residual caries. This article seeks to present the evidence that makes the step of applying a liner redundant in a concise manner for the benefit of restorative dentists who may be sitting on the fence on this issue.

    Keywords: Calcium hydroxide; Composite resin; Dental caries; Dental cavity lining; Zinc-oxide eugenol cement.

Cracked Teeth: A Review of the Literature

Dr. Muhammad Samiullah Zahir

Pages: 34-40
  • Abstract
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  • Teeth in their physiological state serve as mechanical devices for mastication and are able to handle highpressures along with flexing or bending during the chewing process. Many iatrogenic and non-iatrogenicfactors have been cited responsible for the compromised resistance to fracture in both endodonticallyand non-endodontically treated teeth. It is quintessential to determine the prognostic factors for verticalroot fractures to prevent and better manage cracked teeth. This article aims to review the factors leadingto the occurrence of cracks in teeth and vertical root fractures.

    Keywords: Cracked Tooth Syndrome; Root canal therapy; Nonvital tooth; Tooth crown; Tooth fracture

Case Reports

Dentinogenesis Imperfecta with Osteogenesis Imperfecta: A Case Report

Alani A1*, Alkhayyat H2, Saleh O3

Pages: 41-44
  • Abstract
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  • Dentinogenesis imperfecta (DI) is an autosomal dominant disorder of the dentine tissue that forms the majority of the hard structure in teeth. DI may appear as a solitary dentine inherited disorder (DI-2) or in association with OI (DI-1). DI affects both primary and permanent dentitions and the teeth appear dusky blue to brownish. Osteogenesis imperfecta (OI) is an inherited autosomal dominant disorder of collagen type 1 with many clinical varieties depending on its severity. Type 1 collagen is present in bone and other body tissues such as dentine in teeth. This case report describes a 5-year-old male patient with clinical and radiological features of DI-1, the patient had multiple bone fractures over the years, the patient had multiple carious teeth affecting the primary molars, and presented largely with grayish teeth. Additionally the etiology, clinical features, differential diagnosis, and treatment options have been explored.

    Keywords: Bone fractures; Deciduous dentition; Dentinogenesis imperfecta; Osteogenesis imperfecta

Surgical Management of Stillman’s Cleft Using Free Gingival Graft

Jawaher Abdulla Al Mudahki1, *, Kanak Ketan Ganguly2

Pages: 45-49
  • Abstract
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  • Stillman’s cleft is a mucogingival triangular shaped defect, commonly observed on the buccal orlabial surface of the gingiva. The etiology behind this lesion is believed to be multifactorial andunclear. The prognosis of Stillman’s cleft varies depending on the extent of the cleft; some lesions mayrepair spontaneously while others require precise examination and evaluation to provide the propermanagement. This paper reports a case of a patient with Stillman’s cleft that was treated by free gingivalgrafting.

    Keywords: Gingiva; Gingival recession; Gingivitis; Inflammation; Periodontitis.

Diagnosis of Molar-Incisor Pattern Periodontitis in a Paediatric Patient

Aania Adil Ilyas1,*, Kanak Ketan Ganguly2, Omar Saleh Mustafa3

Pages: 50-55
  • Abstract
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  • This is a case report of a 4 year old female child with deciduous dentition exhibiting rare clinical signs ofgingival inflammation, clinical attachment loss and bone resorption around the primary lower first molarsand upper central incisors bilaterally resulting in bone loss. Previously this condition was referred to asLocalised Aggressive Periodontitis or Juvenile Periodontitis. The recent 2017 classification identifiesthis as Stage III Grade C periodontitis of Molar Incisor pattern. There was no syndrome or systemiccondition associated.

    Keywords: Aggressive periodontitis; Bone resorption; Deciduous tooth; Gingivitis; Inflammation

A 3D Printed Total Hip Arthroplasty in Adult with Sickle Cell Disease: A Case Report

Duaa Ebrahim Ahmed*1, Fatema Jalal AlQassab2, Stefan Dragulescu3

Pages: 56-61
  • Abstract
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  • Sickle cell disease (SCD) is an inherited blood disorder that distorts the red blood cells into a sickle shaped. These deformed cells can interrupt the blood vessels supply to the bones and lead to Avascular Necrosis (AVN). Femoral head is the most vulnerable bone owing to vascular damage. In patients with SCD, the condition progresses rapidly, the femoral head collapses and causes severe pain and limited range of motion. In the advanced stages of the femoral head necrosis where there is no existing standard medical management, the orthopaedic surgeons conventionally recommends Total Hip Arthroplasty (THA). This option is challenging and carries a high risk for serious complications both peri-operatively and post-operatively.The present report illustrates a case of pre-operative 3D planning for ideal bone geometry and personalized care before, during, and after THA in a young adult which was a competent technique for the management of SCD.

    Keywords: Articular range of motion; Femur Head Necrosis; Hip Replacement Arthroplasty; SickleCell Anaemia.

Perinatal Testicular Torsion - Is it a Rare Occurrence?

Jemila James1,*, Emad Shatla2, Minoosh Nasef2, Hussein Ahmed3

Pages: 62-66
  • Abstract
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  • Supplementary Content
  • Clinical diagnosis of perinatal testicular torsion can be a challenging task as most of the cases area symptomatic, with no tenderness but may have slight scrotal induration and discoloration. Perinatal testicular torsion has been subdivided into prenatal and postnatal torsion (event occurring from birth to 1 month of life). Although Doppler ultrasound is frequently used as an adjunct to facilitate the diagnosis of borderline cases, it has its own limitations. Clinical features, treatment options, and fertility outcome depend on when the torsion occurs - prenatally versus postnatally – and when it is discovered. In this report, we present three cases of unilateral prenatal testicular torsion diagnosed during the routine physical examination prior to hospital discharge and advised to follow up for delayed orchiopexy of the contralateral testicle.

    Keywords: Neonatal testicular torsion; Neonatal torsion; Perinatal torsion; Testis; Testicular Torsion;