Table of Contents

Original Articles

Contact Tracing for COVID-19 Outbreak in Bahrain: Resource Allocation and Use of Non-health Volunteers

Mohamed Abdulmajeed Alawadhi1*, Adel Al Sayyad2, Afaf Merza3, Kubra Al Sayed4, Najat Abu Alfatah5, Maryam Alhajeri6

Pages: 1-5
  • Abstract
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  • The Disease Control Section in the Public Health Directorate is responsible for contact tracing amid the Coronavirus Disease-2019 (COVID-19) pandemic. The Section recruited volunteers to strengthen their contact tracing team. Moreover, a nationwide call for volunteers was ignited in order to support the groups with vigilant case investigation and tracing in order to limit the spread of the infection in the community. This viewpoint report shares the experience of the disease control section with the COVID-19 pandemic in 2020, shedding light on the use of non-healthcare background volunteers and their roles in contact tracing. The utilization of volunteers during outbreaks and emergencies helped multiple entities to continue their operations and thrived through expanding themselves into teams and units. Regardless of the skills and backgrounds of the volunteers, they were allocated efficiently according to their area of interest. This experience indicates that a sustainable volunteer pool is valuable to have, even in non-emergency occasions.

    Keywords: COVID-19, Contact tracing, Coronavirus, Disease outbreaks, Volunteers

Epidemiology and Clinical Characteristics of Staphylococcal Bacteremia in Bahrain

Safaa Al Khawaja1*, Nermin Kamal Saeed2, Mahmood Al Awainati3

Pages: 6-15
  • Abstract
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  • Background and Objectives: Staphylococcus aureus bacteremia (SAB) is a significant health problem with high morbidity & mortality. The aim of this study was to evaluate the epidemiology of SAB in Bahrain along with withs clinical characteristics and outcomes.

    Methods: This study was conducted at Salmaniya medical complex (SMC) microbiology laboratory including all patients with SAB for one year period (2019). Demographic, lab data & outcomes were obtained from the electronic record system of patients.

    Results: A total of 164 episodes of SAB were identified during the study period. About 137 were encountered among inpatients, while 27 cases among outpatients attending hemodialysis unit. Bahraini nationality & male gender were predominant (141, 85.98% & 108, 65.85% respectively). Nosocomial SAB accounts for only 29.37%, while the majority of SAB cases were of community-onset (116, 70.37%), but among such community-onset cases; 83 (50.61% of total) were of health care-associated category (56 had prior hospitalization and 27 were on regular dialysis). Among all patients with SAB, diabetes was the commonest risk factor encountered, followed by dialysis dependence and sickle cell diseases (SCD). Mortality rate was 25.6% (42 patients). Among the 122 survivors of the initial SAB episode, recurrence of bacteremia was documented among 26 cases (21.3%).

    Conclusion: SAB was a significant health problem among the Bahraini. Diabetes Mellitus, SCD and dialysis dependence were found to be important risk factors. Recurrence of bacteremia was a common complication among the patient’s dependant on hemodialysis

    Keywords: Staphylococcus aureus, Bacteremia, Nosocomial, Community onset, Hemodialysis

Treatment Burden Of Non-Communicable Diseases On Patients Attending Primary Health Care In Bahrain 2020: A Cross-Sectional Study

Fatema Almousawi1, Zahra Ayoob*2, Amna Shehab3, Ismaeel Bakhsh4, Mahmood Alawainati5, Zahra Zabar6, Basma Al-Saffar7

Pages: 16-23
  • Abstract
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  • Background: Adaptation to chronic disease can be challenging. Compliance with medication, adjusting to lifestyle changes, attending health care facilities, and financial costs are among many obstacles encountered. Treatment burden is defined as the effort required by the patient or caregiver to manage the medical conditions of the patient and the impact that this has on their lives. The aim of this study was to help the health care system in establishing new strategies to address the treatment burden on patients with non-communicable diseases.

    Methods: A cross-sectional study was conducted among patients attending non-communicable disease clinics and central diabetic clinics in eight different primary health care centers in Bahrain, using the Treatment Burden Questionnaire through structured interviews. A value of 59 and above was considered as an unacceptable burden according to patient acceptable symptom state (PASS).

    Results: Of the 411 participants, around 18% had an unacceptable burden. Female subjects reported a five times higher treatment burden. The younger population of less than 65 years scored higher treatment burden by three folds. Injectable medications were associated with a two-fold increase in treatment burden compared to other medication modalities.

    Conclusion: Although treatment burden is an emerging and insufficiently addressed concept in the literature, this study revealed an overall low treatment burden. Further studies should be conducted to assess treatment burden and suggest strategies accordingly. Health care providers are encouraged to integrate all patient aspects in the management. New recommendations to formulate updated guidelines with the aim of minimizing the treatment burden are warranted.

    Keywords: Bahrain, Chronic disease, Non-communicable disease, Primary health care, Surveys and Questionnaires

Demographic and Risk Factor Profile of Stroke Among Women in the Kingdom of Bahrain

Raisa Minhas1*, Zara Turk2 , Firas Al-Nidawi3

Pages: 24-29
  • Abstract
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  • Background and Objectives: Stroke has increasingly become a major health problem worldwide and shows an increasing incidence amongst the Arab population in recent years. A study held in the Middle East (ME) revealed that with the increasing number of Stroke cases amongst the Arab population, the mortality rates secondary to stroke is expected to double by the year 2030.The aim of this study was to conduct a descriptive analysis of stroke in the Bahraini female population and assess the associated risk factors leading to stroke.

    Methods: This retrospective study at a tertiary setting was carried out in Bahrain from the year 2016-2019 with a sample size of 108 female stroke patients.

    Results: Ischemic stroke was the most reported form of stroke, with the large artery being the most prevalent underlying etiology. Diabetes Mellitus, Hypertension, Dyslipidemia, Coronary Artery disease/ atrial fibrillation) (p= 0.003) were the associated risk factors. Amongst the mentioned risk factors, the most prevalent factor was seen to be Hypertension, with an overall mortality rate of 10%.

    Conclusion: The study emphasizes the contribution of metabolic syndrome in the causation of stroke cases in the female Bahraini population.

    Keywords: Female, Hypertension, Quality of life, Risk factor, Stroke

Primary Antiphospholipid Syndrome: A Hidden Predisposing Factor for Retinal Vein Occlusion and Choroidal Neovascular Membrane Formation Among Young Population

Romysaa Abdulla Aldanasoury1*, Abdulla Almoosa2, Seemantini Ayachi3, Saad Al-Khalifa4

Pages: 30-35
  • Abstract
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  • Background & Objectives: Antiphospholipid syndrome can lead to variable systemic and ophthalmic manifestations. The study aims to establish the relationship between retinal vein occlusion (RVO) or choroidal neovascular membrane (CNVM) with Antiphospholipid Syndrome (APS).

    Methods: A multicentric prospective cross-sectional study was carried out in three major eye centers in Bahrain that included The Eye Infirmary, Bahrain Royal Hospital, and King Hamad University Hospital. All young patients aging from 35 to 50 years, presenting with either RVO or CNVM and not known to have any underlying systemic disease were included in the study. Antiphospholipid confirmatory tests and coagulation profiles were done for all patients.

    Results: Total number of fourteen eyes of ten patients were enrolled in the study. Six patients had RVO, three out of them had central retinal vein occlusion (CRVO) and three had branch retinal vein occlusion (BRVO). Four patients had bilateral CNVM (total of 8 eyes). All patients recorded high activated partial thromboplastin time (aPTT) readings, six out of ten patients were labeled as primary APS, four of them had positive anti-cardiolipin antibodies and the other two patients were positive for plasma lupus anticoagulant.

    Conclusion: APS should be considered as an etiological factor in all cases of retinal vein occlusion and choroidal neovascular membrane affecting young otherwise healthy individuals. In this study, 60% of patients who fit the inclusion criteria were labeled as primary APS patients. Timely investigations and treatment in these cases can prevent major catastrophic thrombotic events which may involve any system or organ in the body.

    Keywords: Antiphospholipid syndrome, Blood coagulation tests, Eye, Lupus coagulation inhibitor, Retinal vein occlusion

Case Reports

Rhabdomyolysis After Implementing Whole-Body Electromyostimulation: A Case Study

Najla Waleed Alaraifi1, Basem Mohammed Mustafa2

Pages: 36-40
  • Abstract
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  • Whole-body electromyostimulation is a new approach used to achieve weight loss and build muscles by activating different muscles groups through voluntary contractions generated by electrical impulses. This alternative approach is operated by a certified personal trainer, regulating the intensity of the electrical impulses to aid the muscular system to contract. Unaccustomed use of this technique leads to muscle destruction and a rise in creatine kinase level. A 25-year-old female began this therapy and experienced right flank tenderness associated with elevated serum creatine kinase (CK) levels. An impression of Rhabdomyolysis in the Emergency Department was given, followed by intravenous (IV) fluid administration. The patient consequently improved and was discharged with instructions. The study was projected to spread awareness regarding Whole-body electromyostimulation, which is tremendously promoted in Bahrain. This therapy may aid in client monitoring and improve the prognosis.

    Keywords: Adult; Electric stimulation therapy; Muscle; Musculoskeletal physiological phenomena; Rhabdomyolysis; Weight loss

Case Report of an Undisturbed Ectopic Pregnancy with Very High Human Chorionic Gonadotrophin (beta-hCG)

Gulmeen Raza1*, Maha Abdelwahab Ghorabah2

Pages: 41-45
  • Abstract
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  • This is a case report of a patient with an undisturbed ectopic pregnancy and very high levels of human chorionic gonadotrophin (β-HCG). The patient presented to the emergency room at 9+1 weeks of gestation with mild abdominal pain and vaginal bleeding. She had an obstetric history of two previous cesarean section deliveries. On presentation, her human chorionic gonadotropin (β-HCG) was measured to be 26,530 mIU/ml, and after 18 hours, the β-HCG level was 25,660 mIU/ml. An ultrasound scan revealed no evidence of intrauterine pregnancy, a left ovarian cyst measuring 2.86 cm x 2.17 cm, and the presence of a mixed mass near the ovary measuring 3.92 cm x3.62 cm. The patient was diagnosed with a left tubal ectopic pregnancy and was taken for an immediate laparoscopy. Intraoperatively, the left tubal ectopic pregnancy was undisturbed and measured about 4-5 cm involving more than half of the fallopian tube. The mixed mass, along with the left fallopian tube, was removed as a whole.

    Keywords: Abdominal pain, Cesarean Section, Ectopic-pregnancy, Laparoscopy, Tubal pregnancy, Ultrasonography

Alport Syndrome: The Eye as a Window to the Human Body

Aysha Tareq Nusef1*, Abdulla Almoosa2, Wael Wagih Aly3

Pages: 46-48
  • Abstract
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  • Alport syndrome (AS) is a rare genetic disease affecting type four collagen production, causing renal, auditory, and ophthalmic manifestations. This case report is about a 32-year-old male who was a known case of renal insufficiency and secondary hypertension and was referred to the ophthalmology department due to blurred vision. Based on the patient‘s history and ophthalmological findings, AS was diagnosed. Ophthalmic examination showed anterior lenticonus associated with sensorineural hearing loss (SNHL) and impaired renal function. This clinical case report sheds light on the role of ophthalmology in diagnosing AS.

    Keywords: Collagen, Crystalline lens, Hereditary nephritis, Ophthalmology, Renal insufficiency, Sensorineural hearing loss

A Case Report of Spino-Pelvic Dissociation with Neurological Deficit in Pediatric Age Group

Tariq Mohammed Muhialdin Alkhalifa1, Ayman Merza Abdulla Mohamed2*, Ali Hasan Zainaldeen3, Sharif Omar Ali Ahmed4, Harleen Luther5

Pages: 49-53
  • Abstract
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  • Transverse sacral fracture is a rare entity in the pediatric age group, primarily resulting from a fall from height. This case report stresses the importance of proper neurological assessment, adequate imaging and highlights different modalities of management of this fracture. We report a case of a 13-year-old child with type III Roy-Camille sacral fracture with associated bladder and bowel dysfunction. The patient underwent spinopelvic fixation and decompression of the sacral canal. The patient partially regained bowel and urinary function and had improved motor function after three months of follow-up. Operative management is generally advocated for such fractures.

    Keywords: Decompression; Bone fractures; Neural tube; Pediatrics; Sacrum

Ellis-van Creveld Syndrome

Saeeda Mubarak AlMuhanadi1, Rana Al Ghatam2

Pages: 54-58
  • Abstract
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  • Ellis-van Creveld syndrome, also known as chondroectodermal dysplasia, is a complex genetic disorder caused by the mutation of particular genes, characterized by dwarfism, polydactyly, abnormal nail structure, and dental malformations. Dental manifestations include enamel hypoplasia and hypodontia. Patients with Ellis-van Creveld syndrome may also have heart defects that would require specific diagnostic tools. The exact prevalence of this disorder remains poorly investigated because most risk groups are the Amish population, who refuse to share personal information voluntarily. We hereby present a case report of an eighteen-year-old young woman who presented with the chief complaint of poor appearance of teeth. The medical history includes ventricular hypertrophy and epilepsy. The patient had mandibular natal teeth that were removed. The first line of treatment was offered when the girl was seven, and standard check-ups and orthodontic manipulations were made within the last ten years. Overall, this case proves the importance of radiographic and physical examination, along with the multidisciplinary cooperation of dentists, surgeons, orthodontists, anesthetists, and cardiologists.

    Keywords: Dental enamel hypoplasia; Dwarfism; Ellis-van Creveld syndrome; Epilepsy; Malformed nails; Natal teeth