Table of Contents

Original Articles

Screen-based Media Usage Among Children with Autism Spectrum Disorder and their Mothers

Ammar K Janahi1, Ahmed Malalla Al Ansari1*, Haitham A Jahrami2

Pages: 1-6
  • Abstract
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  • Background and Objectives: Screen-based media are becoming a popular tool for leisure and increasing productivity. Our objective was to compare the Screen-Based Media (SBM) usage between children with Autism Spectrum Disorders (ASD) and their mothers, in terms of the device type and duration of daily use.

    Methods: Ninety-seven (n=97) mothers of children diagnosed with ASD and attending Center A and Center B constituted the study sample (cases). The control group comprised healthy children whose SBM usage had been measured previously in a similar study using similar methodology (N=75). A special data collection sheet was designed to collect information such as demographic data, type of SBM devices used, and duration of daily usage, using a structured questionnaire.

    Results: Mothers used smartphones more frequently (P=0.001) whereas children with ASD used (P=0.001) tablets (P=0.001). Both mothers and children with ASD used television at the same rate (P=0.924). Mothers’ used SBM for >5 hours per day, which was similar to the screen time of children with ASD.

    Conclusion: Mothers’ SBM usage was high and was comparable to that of children with ASD. Clinical implications and future directions were discussed to modify such behaviors.

    Keywords: Autism Spectrum Disorder; Bahrain; Children; Leisure activities; Mother

Cyanotic Congenital Heart Disease in the Kingdom of Bahrain

Vimalarani Arulselvam1, Suad R Al Amer2, Neale Nicola Kalis2*, Habib Al Tarif3, Zaid Arakat4

Pages: 7-14
  • Abstract
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  • Background and Objectives: Cyanotic congenital heart disease (CCHD) is a high-risk condition in infants with congenital heart disease (CHD) and often requires urgent management. It is important to have reliable information about the various cyanotic CHDs and their management. As there is no data on CCHD in the Kingdom of Bahrain, we conducted this study to analyze the different types of CCHD, their management, and outcomes.

    Methods: This was a retrospective descriptive study conducted from 2000 to 2019 on 554 patients with confirmed diagnosis of CCHD.

    Results: Mean age at presentation was 1.8 years (range 0 day to 56 years) and 108 (19.5%) were diagnosed within 24 hours of life. The mean duration of follow-up was 7.9 years. The most common CCHDs included Tetralogy of Fallot (TOF) (44.9%), univentricular heart defects (UVH) (11.4%), and D-transposition of great arteries (D-TGA) (10.5%).The least common CCHD was hypoplastic right heart syndrome (HRHS) (0.4%). The overall mortality was 15% (n=83). The mortality rate was highest in patients with hypoplastic left heart syndrome (HLHS), noted in 52% cases.

    Conclusions: The most common CCHD was TOF, and the most common mode of presentation was cyanosis. The prognosis and outcomes were good in patients with biventricular repair but poor in patients with HLHS. Early diagnosis and timely intervention can reduce the morbidity and mortality associated with CCHD.

    Keywords: Congenital; Cyanotic; Defect; Diseases; Heart

Efficacy of Rapid Antigen Detection Test For Group A Streptococcus in Bahraini and Non Bahraini Children: A Retrospective Study

Dr. Kasim O. Ardati1*, Soni R. Murdeshwar2, Saramma T Chacko3

Pages: 15-20
  • Abstract
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  • Background: Group A Streptococcus (GAS) is accountable for 20-40% of pharyngitis in children. Rapid antigen detection test (RADT) provides important information for determining the need for antibiotics for patients presenting with GAS infections. As compared to the throat culture technique, RADT offers a quick diagnosis within 5 to 10 min. The study aims to assess the efficacy of RADT in comparison with conventional throat culture for the detection of GAS using clinical samples from pediatric patients.

    Methods: A retrospective study was carried out on pediatric patients of both genders aged up to 14 years, for a duration of five years at a tertiary care hospital of Bahrain. Tests such as RADT and throat culture were used for the analysis of throat swabs from these patients. Diagnostic performance characteristics were evaluated with conventional culture as the reference standard.

    Results: A total of 1085 samples were collected from patients belonging to different age groups out of which, 232 were culture-positive and 234 were RADT-positive. Majority of the culture-positive samples came from patients aged 5-9 y. The diagnostic characteristics test for RADT showed 90% sensitivity, 97% specificity, and 96% accuracy. The positive and negative predictive values were 89% and 97.30%.

    Conclusion: RADT is an efficient, reliable, highly specific, and sensitive technique which gives rapid results to rule out GAS in pediatric patients in contrast to the conventional throat culture assessment methods, thereby enabling the clinicians to take a better clinical decision and limiting the unnecessary use of antibiotics.

    Keywords: Sensitivity; Specificity; Sore Throat; Streptococcus; RADT

Combined Subcostal and Posterior Transversus Abdominis Plane Block for Postoperative Pain Relief after Abdominoplasty: A Randomized Clinical Trial

Haytham El Sayed¹*, A Shaheed Fadhul², M Al Falaki³, M Nasr Awad4

Pages: 21-28
  • Abstract
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  • Background: Abdominoplasty is a common esthetic surgery. For adequate pain management during the postoperative period, transversus abdominis plane block (TAPB) is a therapeutic complement for analgesia for postoperative pain following abdominal surgery.

    Aim: To compare the outcomes of TAPB and systemic opioids in patients undergoing abdominoplasty.

    Methods: Fifty-eight patients undergoing abdominoplasty were randomly assigned to two groups: Combined subcostal and posterior TAPB group (BG, n=29) and Control group (CG, n=29). The standard postoperative analgesic regimen for both groups consisted of IV Paracetamol 1 g every 6 h. The visual analog scale (VAS) scores for pain were recorded postoperatively, and once the patient had a VAS ≥4, IV pethidine was administered. The primary outcome was pethidine consumption in the first 72 h postoperatively; the secondary outcomes included VAS scores at rest and during movement in the first 72 h postoperatively, time to first ambulation, and time to first incentive spirometer at 900 mL/min.

    Results: Pethidine consumption in the first 72 h was 208.62±85.64 in the CG group and 20.69±25.06 in BG (p<0.05). VAS was lower in BG during the first 72 h both at rest and during movement (p<0.05). Time to first ambulation was 12.41±5.04 h in the CG group and 4.62±1.08 h in BG (p<0.05), time to first incentive spirometer at 900 mL/min was 11.45±5.05 h in CG and 4.27±1.09 h in BG (p<0.05).

    Conclusion: Combined subcostal and posterior TAPB offers a longer postoperative analgesic effect and reduced postoperative opioid requirements with fewer postoperative complications.

    Keywords: Abdominoplasty; surgical complications; postoperative pain; transversus abdominis plane block.

Human Immunodeficiency Virus-Related Stigma and Discrimination Among Primary Health Care Physicians in the Kingdom of Bahrain

Hessa Hussain Al Kaabi1*, Aayat Salah Jadallah2, Hafsa Jamal Abdullah3, Mariam Haitham Al Qahtani4, Maysam Ali Abu Saeya5, Basma Mahmood Al Saffar6

Pages: 29-36
  • Abstract
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  • Background: The World Health Organization-2015 guidelines described the need to address barriers, such as stigma and discrimination by health care providers, to accessing human immunodeficiency virus (HIV) treatment. In our study, we assessed HIV-related stigma among primary health care physicians in the Kingdom of Bahrain.

    Methods: This was a cross-sectional study conducted on 404 family physicians working in primary health care centers in Bahrain in 2017. A standardized, self-administered questionnaire approved by the United States Agency for International Development was used to collect data. Statistical analysis for descriptive variables was performed using SPSS 23.0.

    Results: The response rate of primary health care physicians in this study was 80%. Although 63.9% of the physicians trusted their facilities and equipment for protecting people from HIV, majority of them had an evident stigma in dealing with HIV patients during highly invasive procedures. Moreover, 64.9% of them were hesitant to work with HIV co-workers. Interestingly, 56.5% of the primary health care physicians were unaware of the written HIV related-guidelines available at the Public Health Directorate.

    Conclusion: Despite the low prevalence of HIV in the Kingdom of Bahrain, there is obvious stigma and discrimination among primary health care physicians against HIV patients. This may act as a barrier for the affected patients in accessing health care systems and getting appropriate care. The stigma associated with HIV could be due to the lack of training and knowledge about this disease, its transmission, and protection.

    Keywords: HIV Infections; Social Stigma; Bahrain; Primary Health Care.

Case Reports

Anesthesia Management in a Rare Case of Closed Subtalar Dislocation with Posterior Process Talus Fracture: A Case Report and Review of Literature

Abdelaziz Shokry Abdelaziz*, Jalal Abdullah Al Khan, Mohammed Azizullah Khan

Pages: 37-40
  • Abstract
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  • Isolated closed subtalar joint dislocation is a very rare injury that accounts for only 1% of all joint dislocations. Subtalar joint dislocations are usually associated with fractures of the adjacent bones such as the calcaneus, malleolus, fifth metatarsal, or talus. The management of such cases is usually done as a closed reduction under general anesthesia. The use of regional anesthesia for such injuries has not been highlighted in the literature. In this case report, a patient presented with severe subtalar joint dislocation, which was managed with regional popliteal and saphenous nerve blocks. However, the closed reduction failed, and the surgeon proceeded with open reduction and internal fixation with no perioperative adverse events.

    Keywords: Subtalar; Joint dislocations; Nerve block; Regional anesthesia; Popliteal.

A Case of Relapsing-Remitting Illness Due to Varicella Zoster Virus Vasculopathy in an Immunocompetent Adult

Piyush Ostwal*

Pages: 41-44
  • Abstract
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  • Varicella zoster virus (VZV) is an uncommon cause of meningitis in immunocompetent adults and has been implicated as the cause of vasculopathy, in literature. Here, we describe a case of aseptic meningitis which was followed by relapsing-remitting illness that was ultimately attributed to VZVrelated vasculopathy. This case report emphasizes the importance of appropriate virologic testing in cases of aseptic meningitis and maintaining a high index of suspicion for VZV as a causative etiology even in immunocompetent subjects without typical herpes zoster infection.

    Keywords: Varicella Zoster Virus Infection; Stroke; Aseptic Meningitis; Central Nervous System Vasculitis; Varicella Zoster Encephalitis.

An Unplanned Pregnancy with Life-Threatening Paroxysmal Nocturnal Hemoglobinuria: A Case Report

Mohammed Abouelela*, Amir Mostafa, Keith Johnson, Ahmed El Desoky, Aysha Al Rowaiei

Pages: 45-47
  • Abstract
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  • A 26-year-old Bahraini female with a past medical history significant for diabetes type 2 on metformin and paroxysmal nocturnal hemoglobinuria. An allogenic stem bone marrow transplantation was done from full match siblings approximately one year ago. The patient presented to the labor and delivery ward for possible normal vaginal delivery at 39 weeks gestational age. After hematology review the patient was taken to caesarian section due to failure of progress and the surgery was done successfully under neuraxial anesthesia (epidural top-up). The case illustrates the effectiveness of neuraxial anesthesia in such patient with such rare disease with possible coagulopathy.

    Keywords: Bone marrow disorders; Epidural; Neuraxial anesthesia; Paroxysmal nocturnal hemoglobinuria; Unplanned pregnancy

Pulp Revascularization in an Immature Mandibular Premolar Associated with Pulp Necrosis and Sinus Tract Discharge: A Case Report

Emad Alagamawy

Pages: 48-53
  • Abstract
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  • Owing to the popularity of pulp regenerative procedures, the American Association of Endodontics (AAE) issued guidelines based on clinically proven protocols that govern such procedures. Our aim was to follow the pulp regeneration guidelines recommended by the AAE and evaluate the outcome. A 12-year-old male patient reported with the chief complaint of dull, spontaneous, repetitive pain episodes related to the lower left second premolar accompanied by sinus tract discharge. A diagnosis of pulpal necrosis with symptomatic chronic periapical abscess was made. Following endodontic access, irrigation with sodium hypochlorite was done followed by the application of a triple antibiotic paste as intracanal medication. At the second visit, irrigation, blood clot induction through laceration of the periapical area, and placement of a mineral trioxide aggregate seal were performed. The third visit involved clinical assessment and placement of a permanent coronal seal. Followup was done after 3 and 6 months. Clinical resolution was achieved within 3 weeks of initiation of treatment, and radiographic evidence of continued root development was observed during the 3rd month followup visit. In conclusion, adherence to the AAE guidelines for pulp regeneration resulted in resolution of the clinical symptoms with an outcome that may be considered successful both clinically and radiographically.

    Keywords: Anti-bacterial agents, Bicuspids, Mineral trioxide aggregate, Periapical abscess, Sodium hypochlorite

Enamel Renal Syndrome in a Bahraini Child: A Rare Case Report

Rawan Khaled Hasan1*, Aania Adil Ilyas2, Omar Saleh Mustafa3

Pages: 54-57
  • Abstract
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  • Enamel renal syndrome is considered a rare phenomenon found in patients diagnosed with amelogenesis imperfecta when it is associated with nephrocalcinosis, resulting in severe renal damage as age progresses. We report the case of a patient with typical features of amelogenesis imperfecta and nephrolithiasis. This case presentation highlights the role of a general dental practitioner in the recognition of such unique syndromes.

    Keywords: Amelogenesis Imperfecta; Nephrocalcinosis; Amelogenesis Imperfecta Nephrocalcinosis; Renal Insufficiency; Kidney Calculi.