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Original Articles

Evaluation of Preschool Screening Program in the Kingdom of Bahrain: A Survey in Primary Healthcare Centers

Muna Al Mohri1*, Hala Al Asoomi2, Batool Hasan3

Pages: 1-8
  • Abstract
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  • Background: Preschool screening is one of the services provided by primary healthcare centers, in the Kingdom of Bahrain, for children aged 5 to 6 years. This service includes assessing growth and development parameters, which includes measuring hemoglobin levels, conducting vision examinations, and administering Purified Protein Derivative (PPD) tests. Objectives: To evaluate the prevalence of anemia, reduced visual acuity, and positive PPD tests, in children’s preschool screening.

    Methodology: This survey was conducted in 25 primary healthcare centers, between the period of January to March 2020, with a total sample size of 2,637 children. Electronic preschool screening visit sheets, of children who attended the health centers for screening, were reviewed and evaluated.

    Results: Out of the 2,637 records reviewed; anemia, reduced visual acuity, and positive PPD tests, were found in 19.9%, 4.7%, and 0.45% of children, respectively.

    Conclusion: The overall prevalence of reduced visual acuity and positive PPD tests was low. On the other hand, although the overall prevalence of anemia was also low, at about 20%, this can be reduced further by raising physicians’ adherence to anemia management guidelines, at earlier ages. Moreover, further studies are needed to assess the causes and risks of anemia in this age group.

    Keywords: Bahrain, Preschool, Screening, Primary Healthcare Centers, Prevalence

Knowledge, Attitude and Practice of Public School Teachers Regarding Traditional Bone Setters, Khartoum Locality

Moutaz M. Hassan1*, Bashier E. Shumo2, Ahmed M. Abdelhai3

Pages: 9-14
  • Abstract
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  • Background: In Sudan, traditional bone setting (TBS) is still popular and has serious complications. Therefore, awareness and education are essential for TBS. School teachers having a close association with students and parents could be an appropriate medium for health education about TBS after evaluating their awareness.

    Objectives: To review the knowledge, attitude, and practice among public school teachers toward TBS practice. Methodology: A community-based cross-sectional descriptive study 588 school teachers participated from Khartoum locality, Sudan. Data were collected using self-administered questionnaires.

    Results: Of 588 participants, 246 (41.8%) were males and 342 (58.2%) were females having the age range between 22 and 65 years, and (69.2%) received bachelor’s degrees. Around 249 (42.4%) believed that all/some of the TBSs had good basic knowledge and 331 (56.3%) participants thought that all/ some of the TBSs had clinical knowledge and skills. Half of the participants 300(51%) believed that some/all TBSs knew about trauma complications and 283(48.1%) participants believed that all/some of TBSs can make an accurate diagnosis. The two main reasons for the popularity of TBS were the cost (60%) and illiteracy (52.9%). Most of the teachers (79.8%) will take their injured students directly to the hospital. (41%) teachers visited TBS for themselves, and around 51% showed their commitment to TBS. Most teachers (96%) said that they will advise parents to take their child to the hospital, while only 4% said they will advise taking them to the TBS. In a situation, if the parents insist on taking their child to TBS, the majority (67.7%) teachers will advise the parents to take their students to the hospital.

    Conclusion: The study demonstrates that most participants’ knowledge level was below expectations and they have a positive attitude and strong beliefs toward the traditional bone setters. Making awareness in society is essential by organizing educational programs introducing how orthopedic hospitals are better for fracture treatment than traditional bone setters.

    Keywords: Traditional bone setters, knowledge, attitude, practice, fracture, school.

Survey of Primary Care Physicians’ Knowledge, Practices & Perceptions of Prediabetes in Bahrain

Bahnaz Tadayyon¹*, Mona Qader², Shahla Al-Doseri³, Eshrat Ghuloom4, Adel-AlSayyad5

Pages: 15-26
  • Abstract
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  • Background: Prediabetes is a condition that develops before diabetes and can be treated with intensive Lifestyle Modifications (LSM). This study aimed to assess the knowledge, practices, and perceptions of Primary Care Physicians (PCPs) toward prediabetes in Bahrain.

    Methods: PCPs in the study were surveyed using a cross-sectional questionnaire in all 28 governmentrun Primary Healthcare Centres (PHCs) in Bahrain. We used descriptive statistics to analyse the data, which were then reported as percentages.

    Results: From 378 PCPs, 263 completed the questionnaire. The physician’s knowledge of prediabetes Risk Factors (RFs) and HbA1C laboratory criteria to diagnose prediabetes was inadequate. As an initial step to manage prediabetes, 12.5% of PCPs refer patients to Diabetes Prevention lifestyle change Programs (DPPs). Moreover, 15.6% recommend 7% minimum weight loss, 57.8% recommend 150 minutes per week of physical activity and 67.7% recommend prescribing metformin. Overall, our study revealed that General Practitioners (GPs) had inferior knowledge to Family Physicians (FPs). According to PCPs, diabetes prevention is hindered by both individual and system-level challenges (e.g., Inadequate motivation and resources to lose weight). Furthermore, PCPs consider that improved access to DPPs and coordinated referrals to them could delay diabetes.

    Conclusion: Risk stratification, appropriate diagnosis, and intervention at the prediabetes stage are of critical importance for preventing diabetes. Increasing awareness of the public regarding prediabetes complications and educating healthcare providers, especially GPs, on screening guidelines, diagnostic criteria, and evidence-based management options for prediabetes can bring us one step closer to slowing the diabetes epidemic in Bahrain.

    Keywords: Bahrain, Primary care physician, Knowledge, Practice, Perception, Prediabetes

End Stage Renal Disease in Children in Bahrain: Etiology and Outcome

Deena Mohamed AL Mastoor*, Fatima Shabib

Pages: 27-31
  • Abstract
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  • Background: End-stage renal is an overwhelming illness associated with high morbidity and mortality worldwide. Identifying the risk factors in children and planning preventive strategies is of great significance. The aim of the present study is to assess the etiology and outcome of end-stage renal disease in children in Bahrain.

    Methods: As a part of the retrospective analysis, all children with end-stage renal disease were below 16 years and were on renal replacement therapies between 2008 and 2018. Data were collected from patients' chart and electronic medical records.

    Results: Out of the total 50 children (with end-stage renal disease) who enrolled for the study, the subjects were 37 (74%) and 13 (26%) were boys and girls, respectively. Among the subjects, 19 patients (38%) were diagnosed with congenital anomalies of the kidneys and urinary tract as the main cause of end-stage renal disease. Posterior uretheral valve was the main abnormality seen in 12 (24%) patients. Inherited renal diseases were the second leading cause of end-stage renal disease in children 15 (30%) patients. Glomerulopathies accounted for 12% of the total patients, focal segmental glomerulosclerosis was the most common glomerulopathy seen in 5 (10%) patients. 28 patients (56%) received hemodialysis; 18 patients (36%) received peritoneal dialysis. 24 (48%) children had renal transplantation, 4 children (8%) underwent preemptive kidney transplantation, while 3 (6%) children died.

    Conclusions: Congenital anomalies of the kidneys and urinary tract is the leading cause of end-stage renal disease in children followed by hereditary diseases. Thus, planning preventive strategies and counselling support for the children and their families are of great importance. 

    Keywords: Bahrain, Chronic kidney disease, kidney transplantation, peritoneal dialysis, renal dialysis, urogenital abnormalities

Spectrum of thyroid nodules in a tertiary care center in the Kingdom of Bahrain

Safa Alshaikh1, Kameela Sayed Majed1, Nisha Chandran2, Sayed Ali AlMahari2

Pages: 32-36
  • Abstract
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  • Background: This study investigates and analyses the thyroid nodules in Bahrain, and correlates the diagnosis of cytopathology with a subsequent excision histopathology.

    Materials & Methods: We conducted a retrospective study for all thyroid cases diagnosed at the Salmaniya Medical Complex during a 7-year period (January 2013 to December 2019).

    Results: A total of 1218 thyroid nodules were diagnosed during the study period. Among them, 1,037 (85%) of the patients were females and 181 were males (15%), with an average age of 48.2 years. Surgical excision was performed on 263 out of 1,037 (25%) of the cases.

    Conclusions: The study revealed that the prevalence of thyroid nodules is higher among females. The most common nodules are benign multinodular goiters. A statistically significant correlation was observed between fine needle aspiration cytology (FNA) and surgical excision of the thyroid nodule.

    Keywords: Thyroid, FNA, thyroid nodules, cytology, excision

Review of Patients Referred to the Emergency Department

Ghada Al Qassim1*, Abubaker Mohammed2, Hytham Ghanem3, Ehab Musbah4, Aysha Khamis Alkaabi5, Salah Al Ghanem6

Pages: 37-42
  • Abstract
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  • Background & Objectives: The main role of emergency care involves providing immediate treatment and attention to patients with life threatening conditions. Critical patients are referred to the emergency department through primary medical services. In this study we reviewed referrals made to the Emergency Department (ED) from primary health care facilities in order to maintain adequate and quality care to patients in need of emergency services.

    Methods: Patient hospital records were reviewed and analyzed over a period of 3 months. We included all patients who were referred to our ED through primary health care services during this period. Data was collected on the date, time, indication for referral, triage level, diagnosis, and outcome.

    Results: In this study with 1094 patients, referrals for patients below 14 years (59.1%) were higher compared to adult referrals (40.9%). The leading causes of referral from all primary health centers to our ED was trauma and injury related (28.8%). This was followed by conditions presenting with abdominal pain (11.3%) and respiratory problems (9.7%). Most of these referrals were safely discharged without the need for further follow up.

    Conclusion: The findings in our study despite the small number and time period of the study provide useful preliminary basis for further research in this area as well as development in the referral system planning and modification.

    Keywords: Emergency Medical Services, Primary Health Care, Quality of Health Care, Referral and Consultation

Case Reports

Spheno-orbital Meningiomas: A Case Report

Hasan E1*, Bushager F2

Pages: 43-46
  • Abstract
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  • Spheno-orbital meningiomas are benign tumors. They arise intracranially from the sphenoid ridge arachnoid villi cap cells, extending into the orbit. Herein, the authors report a case of a 50-year-old female who presented to Ophthalmology department with a complaint of right eye proptosis. Magnetic resonance imaging and biopsy showed a right sphenoid-orbital meningioma. The tumor was excised and the patient symptomatically improved. Patient had gross tumor reduction for right sphenoidal orbital extra-axial brain tumor with hyperostosis of the lateral wall of the orbit and sphenoidal ridge.

    Key words: Arachnoid, Brain neoplasms, Exophthalmos, Hyperostosis, Meningioma, Magnetic resonance imaging

Rotational Atherectomy Stuck Burr Retrieval, A Percutaneous Approach

Jasim Hasan1*, Fawaz Bardooli2, Shereen al Shaikh3, Sadananda Padavagodu Shivappa4

Pages: 47-51
  • Abstract
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  • Cardiovascular disease remains the leading cause of death worldwide. Besides conventional therapies to treat coronary artery disease, which ranges from preventative measures to invasive intervention, complex percutaneous coronary intervention techniques have been developed that yield several techniques including rotational atherectomy (RA). It is evident that RA has benefits primarily in treating calcific coronary artery lesions predominantly lesion modification. Similar to other invasive procedures, RA carries variable risks such as perforation, entrapped burr, slow-flow and dissection. Entrapped burr can lead to devastating complications, where it may end up by emergency surgery. The authors report a rare complication of RA, Kokeshi phenomenon, where the stuck burr was successfully retrieved percutaneously.

    Keywords: Coronary Angiography, Atherectomy, Coronary, Coronary Artery Disease, Cardiovascular Diseases, Percutaneous Coronary Intervention, Drug-Eluting Stents, Coronary Restenosis, Coronary Artery Bypass

Pyridoxamine 5’-Phosphate Oxidase Deficiency: A Potentially Treatable Epileptic Encephalopathy

Lateefa Almutawea1*, Ayman Khalil2

Pages: 52-56
  • Abstract
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  • Pyridoxal phosphate-responsive neonatal epileptic encephalopathy due to pyridoxamine-5-primephosphate oxidase deficiency is a rare cause of epileptic encephalopathy. A neonate with this condition presents early in life with refractory seizures which does not respond to conventional anti-epileptic medications, depressed level of consciousness, and severe psychomotor retardation if left untreated. Early initiation of active cofactor pyridoxal-5’-phophate can be curative. We are describing a rare neurometabolic condition; the first case in the Kingdom of Bahrain to the best of our knowledge.

    Keywords: Pyridoxal-5’-phosphate, pyridoxamine 5’-phosphate oxidase, pyridoxine dependent epilepsy, epileptic encephalopathy, neonatal seizure

Non-Vital Internal Tooth Bleaching using 35% Hydrogen Peroxide Gel: A Case Report

Belal Abou Basha1*, Emad Alagamawy2

Pages: 57-61
  • Abstract
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  • Tooth discolouration affects esthetics and has a psychological impact on self-confidence and behaviour. Treatment modalities include polishing and bleaching. The purpose of this case report was to document the effect of walking bleach method using 35% hydrogen peroxide on esthetics, surrounding tissue. and psychological impact. A 39-year-old female patient reported with a discolored maxillary left central incisor. On examination, the tooth was asymptomatic and exhibited tooth discoloration. Radiographic findings indicated an acceptable root canal treatment. On the first visit, the tooth shade of the tooth was D3. Composite occluding the pulp chamber and 3 mm of the cervical radicular filling were then removed to allow for placement of a protective barrier. Then, 35% hydrogen peroxide was placed, and the cavity was sealed. The patient was recalled after five days and the change in shade of the tooth was recorded as A1. The bleaching agent was irrigated and flushed off the pulp chamber and the cavity was permanently filled with composite restoration. Recall sessions were scheduled at 1 & 4 months. In conclusion, management of non-vital tooth discoloration with the walking bleach method using 35% hydrogen peroxide was effective, safe, and had a positive impact on the patient’s self-confidence and self-perception.

    Keywords: Hydroperoxide, Tooth Bleaching, Tooth Discolorations, Walking Bleach Technique