Table of Contents

Original Articles

Epidemiological and Clinical Features of the First Cohort of Patients Diagnosed with COVID-19 in Bahrain

Ghufran Jassim1*, Maryam Naser2 , Fatema Almadhoob3 , Alaa Alakri4 , Rawaa Al Sayegh5 , Abdulkarim Abdul Rahman6 , Salman Al Ali7

Pages: 1-8
  • Abstract
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  • Background: This study investigates the clinical characteristics of the first confirmed cases of Coronavirus disease-2019 (COVID-19) in Bahrain.

    Methods: This is a retrospective, cross-sectional study including the first 247 confirmed cases in Bahrain. Demographic, clinical, and laboratory data were extracted from electronic medical records.

    Results: Mean Standard Deviation (SD) age of patients was 44.15 (16.5) years. More males were affected by the disease (61%; 151/274). Mean (SD) of the duration between confirmation and discharge was 9.8 (5.1) days. Of 247 patients, 4 deaths were reported (1.6%); 17.5% (24/137) showed a temperature of >37- on admission, with 4% (6/148) yielding an oxygen saturation of 94% or less. Leukopenia was reported in 36.8% of patients (63/171). One quarter of patients (25.5%) received oseltamivir, 24.7% received hydroxychloroquine sulfate (24.7%), and 1.2% received steroids.

    Conclusion: In this study, the authors have captured the epidemiological and clinical profiles of the first cases of COVID-19 pertaining to the first wave of the pandemic in Bahrain. The early strict measures may have contributed to the lower incidence as well as lower morbidity and mortality of COVID-19 infection in Bahrain. Major gaps in our knowledge of the clinical spectrum of COVID-19 and its prognosis, outcomes, and associated risk factors indicate the need for further research.

    Keywords: Bahrain, COVID-19, SARS-CoV-2, Pandemics, Coronavirus

    Tables and Figures can be referred to in the PDF.

Factors Affecting Admission To Intensive Care Unit Of COVID-19 Patients In The Kingdom Of Bahrain

Jameela Al Salman1*, Adel Salman Alsayyad2, Wafa Fawzi Hasan3, Amani Al Arrayedh4, Mohamed Hameed Alrahim5, Eman Sadeq Mahdi6

Pages: 9-19
  • Abstract
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  • Supplementary Content
  • Objective: Coronavirus disease-2019 (COVID-19) is a newly emerging infectious disease that has become a global pandemic. This study aimed to identify the risk factors at presentation to predict intensive care unit (ICU) admissions.

    Materials & Methods: This retrospective observational study recruited 188 confirmed laboratory COVID-19 patients who were hospitalized in Jidhafs Maternity Hospital (JMH) from 1st June to 5th July 2020. Univariate and multivariate analyses were used to Explore risk factors associated with the increased risk of ICU admission.

    Results: The study revealed that older age (>60 years old) (16[38.1%], P=0.044), male gender (30 [40.0%], P=0.000) were significantly associated with the increased risk of ICU admissions. The most prevalent symptoms in admission were myalgia (13[40.6%], P=0.035), fever (39[34.2%], P=0.002) and cough (37[31.4%], P=0.032). In addition, raised serum level of alanine amino-transferase (ALAT) (34.7% vs. 20.7%, P=0.033), D-dimers (30.7% vs 12.2%, P=0.012), lactate dehydrogenase (LDH) (31.6% vs 0.0%, P=0.025) and ferritin (37.7% vs 16.7%, P=0.011) found to be important predictor of ICU admission.

    Conclusion: The finding indicates that older age, male gender, with increased alanine transferase (ALT), increased lactate dehydrogenase (LDH), high D-dimer and high ferritin was associated with an increased risk of ICU admissions. Identification of such factors will help to detect people who are more likely to develop severe COVID-19 disease and will help physicians to determine if patients need regular health care or ICU admission.

    Keywords: COVID-19, Emerging communicable diseases, Intensive care units, Physicians, Risk factors

    Tables and Figures can be referred to in the PDF.


Non-Invasive Ventilation an Alternative to Invasive Ventilation in Covid-19 Patients

Jyoti Sanjay Shinde1*, Moosa Awladthani2, Sanjay Laxman Shinde3, Sathiya Murthi Panchatcharam4

Pages: 20-26
  • Abstract
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  • Objectives: To study the role of non-invasive ventilation (NIV) in the treatment of COVID-19 patients with mild to moderate acute respiratory distress syndrome (ARDS).

    Material and methods: Patients with positive RT-PCR for SARS-CoV-2 who required intensive care unit (ICU) admission due to COVID-19 related pneumonia with mild to moderate ARDS were included in the study. ARDS was treated with NIV, or mechanical ventilation (MV) if NIV failed. NIV was considered for patients admitted to the ICU with mild to moderate ARDS. Primary outcomes were NIV success and failure, defined by intubation and mechanical ventilation, and mortality. Secondary outcomes were determined by the duration of NIV and the number of days stayed in ICU.

    Results: NIV was successful in 37 patients (50%), whereas 37 patients required endotracheal intubation and invasive mechanical ventilation (50%). In the study, 15 (40.5%) of the 37 failed NIV patients who required intubation were successfully extubated and discharged from the ICU, whereas 22 (59.5%) died. Disease progression to severe ARDS, infection, and agitation were the leading causes of NIV failure, accounting for 60% of the cases related to severe ARDS. The number of comorbidities and complications caused by the illness itself had a high association with the death rate.

    Conclusion: This study revealed that noninvasive ventilation can be used as an alternative to mechanical ventilation as respiratory support for mild to moderate ARDS in COVID-19 patients. However, future multi-centric studies with a larger sample are required for more reliable evaluation.

    Keywords: Noninvasive Ventilation, Respiratory Distress Syndrome, COVID-19, Aerosols, Pneumonia, Intensive Care Units.

    Tables and Figures can be referred to in the PDF.

Managing Health Education during the COVID-19 Pandemic: The RCSI Bahrain Experience

Jean Hughes1, Kathryn Strachan2, Husain Nasaif3*, Stephen Harrison-Mirfield4, Gary Brady5, Stephen Atkin6, Alfred Nicholson7, Ahmed Ansari8, Sameer Otoom9

Pages: 27-33
  • Abstract
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  • The pandemic of Coronavirus disease- 2019 (COVID-19) introduced great challenges to the higher education sector and at the same time opened the door for future opportunities. This review aims to present the experience of Royal College of Surgeons in Ireland-Medical University of Bahrain in managing teaching and learning during COVID-19 pandemic. In response to the pandemic, the university implemented several initiatives in ensuring that final year students graduate on time and quality of assessment in a fully digitised environment. The guiding principle for the university as the examination were redesigned, was to ensure that they remained valid to ensure students could demonstrate achievements of the core learning outcomes and be safely assessed as competent graduates. In achieving these goals, the university has well-developed formal and informal mechanisms to ensure the student voice is heard and listened to, and it was of paramount importance to ensure that this was continued and enhanced during these times. While university was successful in managing this unprecedented situation, more work must be done on analysing the author’s experience, and that of others, to implement the needed changes to ensure student access to learning, without compromising their safety or that of the staff. The university sees the current impetus to provide education through technology enhanced learning as an opportunity to expand and diversify learning opportunities and resources for students. In universities such as ours, which has only healthy subjects, practice become essential components of the programme, making a blended model of face-to-face and online delivery the ideal fit.

    Keywords: COVID-19, Learning, Pandemic, Students, Universities

    Tables and Figures can be referred to in the PDF.

Patients’ Reported Experience Measures with Primary Care Physicians in Bahrain

Noof A. Abdulaal1, Mohamed F. Alalawi2, Muneera A. Al buainain3,Amina M. Almutawa4, Sara M. Al Tattan5, Eman M. Almoosa6, Mohammed A. Mandeel7

Pages: 34-41
  • Abstract
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  • Background: Patients’ experience is divided into relational and functional, in which the former is related to the relationship in terms of the treatment, while the functional experience is related to healthcare facilities. Patients’ experience differs from patients’ satisfaction in which the former tests the interaction that patients have with the healthcare system in the ideal way, rather than patients’ expectation from the encounter. There are limited studies in the Middle East region regarding patients’ experience.

    Objective: The aim of the study was to establish a cornerstone for patients’ experience in primary healthcare centers in Bahrain. Methods: The study was a cross-sectional one where a validated questionnaire consisting of 10 questions was used. A sample of 50 patients was taken from each of the ten randomly selected healthcare centers. The patients were approached after ending their consultation at the general clinics. A total of 502 patients participated and their response was analyzed and included in the final results.

    Results: Patients’ experience in primary healthcare centers in Bahrain scored a mean of 42.4 out of 50, 84.8%. More than 70% of the responders answered the questions as very good and excellent. In terms of statistical significance, the timing of the consultation, nationality, and consultation fees yielded a p-value of 0.017, 0.011, and 0.005, respectively. On the other hand, results of patients’ experience scores regarding patients’ gender, doctors’ gender, age, education level, and marital status were statistically not significant.

    Conclusion: Bahrain’s mean score for patients’ experience in primary health centers was 84.8%.

    Keywords: Bahrain, Consultation, Middle East, Patients’ Satisfaction, Primary Health Care

    Tables and Figures can be referred to in the PDF.

Clinical Characteristics and Management of Patients with Cystic Echinococcosis in Salmaniya Medical Complex – A Retrospective Descriptive Study

Narjis Jalal Al Qassab1, Mahmood Alawainati2, Safa Al-Khawaja3, Batool Alhejairi4

Pages: 42-49
  • Abstract
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  • Introduction: Cystic Echinococcosis, commonly known as hydatid cyst disease, is a zoonotic disease caused by Echinococcus granulosus and commonly affects hepatic and pulmonary tissues. Although it is prevalent in some countries in the middle east, no epidemiological studies have been conducted to determine the epidemiology of cystic echinococcosis in the Kingdom of Bahrain.

    Methods: This is a retrospective descriptive study of all cystic echinococcosis cases diagnosed in Salmaniya medical complex between 2015 and 2020. Descriptive analysis of clinical, radiological, and histological data using frequencies and percentages was conducted.

    Results: A total of 11 patients were identified with cystic echinococcosis. Most of them (n=9; 81.82%) reported a travel history to endemic areas and had liver involvement. While most laboratory data were within normal ranges, radiological investigations of hepatic lesions revealed characteristic features of hydatid cysts, including well-defined margins (n=9, 100%), hypoechoic liver cysts (n=9, 100%) and floating lily sign (n=5, 55.56%). All pulmonary (n=6, 100%) and most hepatic cysts (n=7, 77.78%) required surgical interventions. Reoperation rates were 33.33% (n=3) and 16.67% (n=1) for hepatic and pulmonary cysts, respectively.

    Conclusion: Hydatid cyst is a rare disease in Bahrain and is seen mainly in patients who travel to endemic areas. Thus, extracting a detailed travel history is essential for the diagnosis of this disease. Clinical presentations are variable due to different tissues involved, natural history of the disease, and patients’ characteristics. Although prolonged medical treatment and minimally invasive procedures are of value, surgical interventions are required in most cases.

    Keywords: Bahrain, Cysts, Echinococcus granulosus, Humans, Zoonoses

    Tables and Figures can be referred to in the PDF.

Assessment of Post Therapeutic Response of Uterine Artery Embolization for Treatment of Uterine Fibroids

Mohamed Ahmed Mansour1 , Mujahed Raheem2 , Wael Hamed Ibrahim3

Pages: 50-56
  • Abstract
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  • Background: Uterine fibroids are the most common benign gynecological tumors with an incidence rate reaching approximately 70% of women in their reproductive age and may cause serious complications in more than 50% of the patients, including vaginal bleeding, anemia, chronic pelvic pain, dyspareunia, infertility as well as secondary pressure manifestations. Uterine artery embolization (UAE) is an effective and widely used modality in managing uterine fibroids given that it is minimally invasive in managing the condition and its associated serious complications.

    Methods: A retrospective assessment of 41 patients who underwent UAE in a 4-year period (2016- 2020) was performed. The study evaluated the value of this new technique in the Kingdom of Bahrain, King Hamad University Hospital and included a follow up of its therapeutic response by monitoring the symptomatic status and confirmation by quantitative volumetric measurement by pre and post procedure multi parametric MRI.

    Results: Post-embolization MRI fibroid findings revealed an overall volume reduction rate (VRR) of 19.3% with statistically significant reduction in all outcome variables. Complete resolution of symptoms was reported by 80% of the patients.

    Conclusion: Uterine artery embolization is an effective treatment option for uterine fibroids.

    Keywords: Interventional radiology; MRI; Uterine artery embolization; Uterine fibroids; Uterine bleeding.

    Tables and Figures can be referred to in the PDF.

Case Reports

Aqueous Misdirection Glaucoma Following Uneventful Cataract Surgery

Abdulaziz Aldoseri1*, Wael Wagih2

Pages: 57-60
  • Abstract
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  • Aqueous misdirection glaucoma is a rare post ophthalmic surgery complication. It is mostly encountered after a glaucoma filtration surgery, and less commonly comes after cataract extraction surgery. The clinical scenario usually appears immediately after the procedure, in which the intraocular pressure increases, the anterior chamber becomes flat or shallow, and the peripheral iridotomy is appropriate and patent. Several theories have been proposed to determine the pathologic background of this condition. This case report is a supplementary evidence to the mechanism involved in which an aqueous misdirection to the posterior segment of the eye is the etiology of the disease.

    Keywords: Anterior Chamber, Cataract, Glaucoma, Intraocular Pressure, Pseudophakia, Vitrectomy

    Tables and Figures can be referred to in the PDF.

Gastric Adenocarcinoma In A Young Adult Female

Zahra Sayed Alawi Mahfoodh1, Zahra Abdulla Hasan2, Sayed Dhiyaa Noor Ebrahim3*

Pages: 61-65
  • Abstract
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  • Malignancy is not frequently encountered among young adults and is thus at the bottom of the list of differential diagnoses. As a result, it can be overlooked or falsely diagnosed as another less-debilitating medical condition. A similar situation is presented in this paper. A young female presented with no risk factors or specific red-flag symptoms for malignancy, and the initial investigational findings strongly supported her presenting symptoms, which masked the main cause of her complaint.

    Keywords: Abdominal pain, Adenocarcinoma, Biliary colic, Gallstones, Gastric cancer

    Tables and Figures can be referred to in the PDF.

Giant Renal Angiomyolipoma: A Case Report

Mahmoud Sharaf1*, Deyari Henari2 , Veena Negarat3 , Hani Alfadhel4 , Abdulla Darwish5, Khalid Ahmed6

Pages: 66-70
  • Abstract
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  • Renal Angiomyolipoma (AML), moreover known as a renal hamartoma, is a solid tumor with no malignant characteristics. The inheritance pattern of renal AML is autosomal dominant. If the lesion grows to a large size, a series of clinical manifestations and important complications might also occur. This research paper presents a case of huge renal AML in a 47-year-old lady, who visited the Emergency Department of Bahrain Defence Forces Hospital with right-sided abdominal pain of sudden onset. The patient underwent a total right nephrectomy. The resected mass was sized 10.5 x 13 x 14 cm. Postoperative histopathological examination confirmed the lesion as a huge renal AML. Due to the huge size of the tumor, it is crucial to record similar cases, along with their diagnosis and treatment.

    Keywords: Abdominal pain, Angiomyolipoma, Hamartoma, Kidney Neoplasms, Nephrectomy

    Tables and Figures can be referred to in the PDF.