Table of Contents

Letter to the Editor

COVID-19 Pandemic & Undergraduate Surgical Education-Challenges and Solutions

Jamal Hasan Jamal Abdulhaleem Hashem*, Martin Corbally, Nuha Birido, Thomas Noel Walsh

Pages: 1-2

Original Articles

Oral Rehabilitation Under General Anesthesia for Pediatric Patients at Bahrain Defense Force Hospital: A Retrospective Study

Farah Najib1*, Aania Adil Ilyas2

Pages: 3-7
  • Abstract
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  • Objective: To analyze data on full mouth rehabilitation under general anesthesia (GA) performed at the Bahrain defense force (BDF) Military Hospital with focus on patient characteristics, type of procedures, reasons of treatment under general anesthesia and post-operative complications.

    Material and Methods: Retrospective review of 281 patients treated under GA at the BDF day case surgery unit. Patient’s (sex, age) clinical data (diagnosis, reasons of treatment, number of stainlesssteel crowns (SSCs) used, extracted teeth, endodontic treatment, fluoride applications and prophylaxis treatment, postoperative complications were collected.

    Results: Two hundred and sixty patients were treated under GA due to their uncooperative behavior, 13 patient were medically compromised, and 7 patients were elective patients. All patients were discharged on the same day, with no complications, excluding 4 patients, who reported within two of months follow-up with pain.

    Conclusion: Within the limitations of this study, it is important to educate parents on oral hygiene and caries preventions in order to minimize future failures and the need to repeat the GA, for their children. Oral rehabilitations under GA may be required for the treatment of non-compliant patients. Treatment under GA is safe and effective in providing dental care for non-compliant and medically complex patients.

    Keywords: Dental Care; General Anesthesia; Mouth Rehabilitation; Oral Hygiene; Patient Compliance

Undescended testis: Knowledge and Practice Among Primary Care Physicians in Bahrain

Sara A. Ahmed1*, Mohamed Mubarak2, Mahmood Abbas3, Shaikh A. Hamid4, Arbinder K.Singal5

Pages: 8-13
  • Abstract
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  • Background & Objectives: Un-descended testis (UDT) is the most common congenital anomaly in male newborns. Spontaneous descent of testes does not occur beyond six months of age. As Bahrain has a universal child screening program, primary care physicians are the first physicians to encounter these children. This study aimed to investigate the knowledge of UDT, its work up and management among primary care physicians in Bahrain. Awareness of recent guidelines and current recommended practices in management were evaluated.

    Materials & Methods: This cross-sectional study was based on a self-administered 12-item questionnairewith questions about incidence, pathophysiology, examination, management and complications of undescended testes, which was distributed among 101 among primary care physicians. Data was expressed as mean±standard deviation and measures of central tendency were used for descriptive analysis. P value was set at <0.05.

    Results: An equal number of family physicians and pediatricians completed the survey, while general practitioners formed the lowest proportion of responders. Most of the responders had at least 5 years of experience (72.3%) and encountered an average of one to four cases of UDT per year (70.3%). With respect to the knowledge of UDT and specialty (p >0.05), work experience (p >0.05) or annual case load (p >0.05) was observed. The average score in this cohort was 5.9 out of a maximum of 10 points. About 50.5% of the respondents scored between 5 and 6 points (50.5%).

    Conclusions:A remarkablegap in the knowledge about the different aspects of UDT amongst primary care physicians was documented.

    Keywords: Bahrain; Cryptorchidism; Male; Newborn infant; Primary care Physicians; Surveys and Questionnaires

Incidence and Causes of Open Globe Injury in Pediatric Age Group in Salmaniya Medical Complex between 2015–2020

Maryam Alkhayat1*, Amani Alzayani2

Pages: 14-17
  • Abstract
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  • Objectives: To report the epidemiological characteristics of pediatric traumatic open globe injuries (OGI) and to discuss the outcomes of such injuries in Salmaniya medical complex in Bahrain. To provide data for OGI in pediatric age group in Bahrain.

    Methods: All the hospital records of pediatric patients who were treated for open eye injuries at Salmaniya Medical complex between January 2015 to December 2020 were reviewed. Patients were divided into two groups according to their final visual acuity (FVA): Group 1, FVA better than 6/60, and Group 2, 6/60 or worse. The FVA of each group was compared to initial visual acuity (IVA), wound entry site, associated injuries, and medical treatment. Further comparison was made between school-age children (≥6 years old), and younger children.

    Results: A total of 21 children formed the study population. The injury was more common in school-age children (67%). Most injuries occurred while playing at home, during January and July (48%). The most common objects causing OGI were sharp pieces of either glass or metallic (62%) and pencil (9.5%). About 75% of patients had a final visual acuity outcome (FVA) of better than 6/60 (Group1), 25% had 6/60 or worse.

    Conclusion: Most of OGI occurred at home and during student’s holidays. Objects causing OGI were sharp common household items. Emphasis on education to prevent such injuries is essential.

    Keywords: Amblyopia; Bahrain; Child; Eye Injuries; Holidays.

Effectiveness of Different Irrigation Agitating Devices on Debris and Smear Layer Removal: An In Vitro Comparative Study

Emad Alagamawy1*, Lamiaa Ibrahim2

Pages: 18-25
  • Abstract
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  • Background: Sodium hypochlorite (NaOCl) and Ethylenediaminetetraacetic acid 17% (EDTA) are the most commonly used irrigants in endodontic treatment. However, delivering these irrigants into the entire length of the canal remains a point of interest as conventional needle irrigation is unable to reach and clean the entire length of the canal. Numerous devices have been proposed to increase the efficacy of irrigant delivery including sonic devices, ultrasonic devices, negative apical pressure irrigation, mechanical, as well as laser activation devices.

    Objective: This study compared different irrigation agitation techniques to manual dynamic agitation using conventional side-vent needle irrigation in removal of smear layer and canal cleanliness when used with NaOCl and EDTA irrigation. Methods: Forty extracted teeth were selected and prepared using ProTaper next files and irrigated with NaOCl & EDTA. Specimens were divided into 4 groups (n=40); Group 1 was irrigated with conventional side-vent needle without activation, Group 2 was irrigated and activated with sonic energy (EndoActivator), Group 3 was irrigated and mechanically activated using XP-Endo Finisher, Group 4 was irrigated and activated with ultrasonic energy (Irrisafe).

    Results: Specimens showed similar score in coronal and middle segments for Groups 2, 3, 4, while XP-Endo finisher group was more effective in smear layer removal from the apical segment. Conventional needle irrigation group had the highest scores of remaining debris and smear layer in all segments.

    Conclusion: EndoActivator, Irrisafe, and XP-Endo finisher were more effective in smear layer removal that conventional needle irrigation, XP-Endo finisher was more effective in smear layer removal at the apical segment.

    Keywords: Root Canal Irrigants; Scanning Electron Microscope; Smear Layer; Sodium Hypochlorite; Ultrasonics.

Current State of Vascular Access in Patients on Hemodialysis in Bahrain

Rani Al Agha1, Asma Al Qaseer2*, Amer AlDurazi3, Ali Al Aradi4, Abdulraqeeb Taher4Salaheldin El Sharkaqi4, Sharif Khashaba5, Sughra Alhayki6, Afrah Aljamri6

Pages: 26-30
  • Abstract
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  • Background & Objective: Patients on hemodialysis (HD) require well-functioning vascular access for its initiation and successful transition to dialysis. Arteriovenous fistula is recognized internationally as the first choice of vascular access due to its long lifespan and low incidence of complications in comparison to other methods. Despite this, the rates remain poor. The aim of the study was to document the trend of vascular access currently observed in the hemodialysis centers.

    Methodology: This is cross-sectional study in Hemodialysis Centers in Ministry of Health, Kingdom of Bahrain. All patients undergoing regular hemodialysis in May 2020 were included in this study.

    Results: A total of 536 patients undergoing regular renal replacement therapy were recruited. Majority of the patients; 478 (89.2%) were on hemodialysis. Of them, 214 (44.8%) patients were on arteriovenous fistula/graft (AVF/ AVG), while the remaining 264 (55.2%) were on tunnel line. Causes of tunnel line hemodialysis were further evaluated. About 137(51.9%) patients were undergoing investigations. This was followed by patient refusal and unfit for surgery among thirty-five (13.3%) and 23 (8.7%) patients, respectively. The remaining patients were either awaiting surgery, or experienced complications post arteriovenous fistula/graft creation.

    Conclusion: In this study, a high use of tunnel line vascular access in HD was observed in comparison to AVF. A potential for higher utilization of AVF/AVG up to 60% was observed in this practice. Further studies and strategies to increase the usage of AVF is highly recommended to reach international standards and improve patient care.

    Keywords: Arteriovenous fistula; Bahrain; Central venous catheter; Renal Dialysis; Renal Replacement Therapy.

Case Reports

Natal and Neonatal Teeth in Bahrain: A Review of 19 Cases

Fajer S. Al-Buainain1*, Aania Adil2, Omar Mustafa3

Pages: 31-37
  • Abstract
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  • Background: This paper aimed to present 29 natal/neonatal teeth in 19 patients and subsequently described clinical characteristics, associated disorders, and treatments.

    Methods: This is a retrospective study of Bahraini neonates with natal or neonatal teeth who reported to the pediatric dental clinic, Dental and Maxillofacial Center, Bahrain Defense Forces-Royal Medical Services, Kingdom of Bahrain, conducted over a decade. Information about age, gender, mothers’ chief complaint, the clinical appearance of natal/neonatal teeth, location, associated complications, and treatments were collected.

    Results: A total of 29 teeth (20 natal, 9 neonatal) were diagnosed in 19 infants. There was a female predilection (14 females, 4 males). Twenty-eight of the natal/neonatal teeth were located in the lower central incisor area and one tooth in the lower lateral incisor area. Almost half of the infants (n=9, 47.4%) were diagnosed with a pair of teeth, and only one infant was distinguished with a total of three natal/ neonatal teeth. Three cases were associated with Riga-Fede disease, five with gingival hyperplasia, and one with enamel hypoplasia. Intraoral radiographs were taken selectively for some of the patients. Extraction was the most common treatment choice.

    Conclusion: The occurrence of a natal/neonatal tooth is considered a rare phenomenon. It showed diverse clinical characteristics which could lead to various complications. In this study, natal teeth were more common than neonatal teeth, with a preference for females. The decision to retain or extract a natal/ neonatal tooth should be evaluated in each case, keeping in mind multiple factors like scientific evidence-based knowledge, clinical judgment, and parental opinion.

    Keywords: Dental Enamel Hypoplasia; Gingival Hyperplasia; Oral Ulcer; Natal teeth; Vitamin K.

Biphasic Treatment of Class II division 1 Malocclusion Using Twin Block Appliance Coordinated with Fixed Orthodontics

Ghada Khamis Al-Kuwari*

Pages: 38-41
  • Abstract
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  • Early treatment of Class II division 1 malocclusion using functional appliance not only corrects the skeletal disproportion by altering growth pattern but also creates a significant improvement of the facial profile which enhances the patient’s self-esteem. Moreover, functional appliance therapy enables treatment of such cases by non-extraction approach rather than by extractions. The aim of this paper was to present a case report describing the treatment of a young male patient with retruded mandible using a removable functional appliance called the ‘Twin Block’ for growth modification and correction of the increased overjet followed by pre-adjusted edgewise appliance. Successful results were obtained with improvement in facial profile and correction of Class II malocclusion.

    Keywords: Angle’s Class II malocclusion; Functional Orthodontic Appliances; Mandible; Retrognathia.

Effect of Extracorporeal Membrane Oxygenation in Treatment of COVID-19 Patient with Acute Respiratory Distress Syndrome

Fathelrhman Ali Eltayeb*, Jalal Abdulla Alkhan

Pages: 42-46
  • Abstract
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  • Coronavirus disease 2019 (COVID-19) is a contagious infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus causing from very mild symptoms to severe symptoms associated with high morbidity and mortality. The most common symptoms of COVID-19 are fever, dry mouth and tiredness, sore throat, headache, loss of taste or smell, diarrhea, conjunctivitis, and sometimes a skin rash. In severe cases, some patients require mechanical ventilator support in a prone position to improve their oxygenation. In extreme cases, despite all the above measures, patients are required to have extracorporeal membrane oxygenation (ECMO) support to improve oxygenation. The two most common types of ECMO are veno-arterial (VA) and venovenous (VV). This case report presents a positive outcome when VV-ECMO was used in COVID-19 patients with acute respiratory distress syndrome at the hospital’s field intensive care unit.

    Keywords: COVID-19; Dyspnea; Extracorporeal Membrane Oxygenation; Hypoxia, Respiratory Distress Syndrome.

Ivemark Syndrome: Syndrome of Right Isomerism, a Case Report and Review of Literature

Razan Abdulrahim Alsayed, Jemila James, Emad Shatla, Neale Nicola Kalis, Ahmed Fawzy Elbehery, Abdulaziz Abdulrahman Shehab

Pages: 47-50
  • Abstract
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  • Right isomerism (Ivemark syndrome) is a rare disorder associated with multiple congenital malformations. It is the result of embryological anatomical disturbances, characterized by absence of spleen, malformations of the heart and abnormal arrangement of the internal organs of the chest and abdomen. This case report describes a rare occurrence in a newborn, presented at 4 hours of age with bluish discoloration of the extremities and low oxygen saturation and diagnosed with complex cyanotic congenital heart defect with situs ambiguous, which was undetected in the antenatal period.

    Keywords: Asplenia; Heterotaxy; Isomerism; Ivemark; Situs ambiguous.