Table of Contents

Original Articles

Office Hysteroscopy: King Hamad University Hospital Experience

Hosni Malas1,* , Stephanie Hsu2 , Yasmin Mohammed1

Pages: 1-8
  • Abstract
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  • Background & Objective: Office hysteroscopy (OH) is an efficient alternative for diagnosis and management of intrauterine pathology. The main goal of this study is to determine the usefulness and tolerability of OH in the patient population of a tertiary teaching hospital in the Kingdom of Bahrain.

    Methods: The total population consists of 101 patients who were prospectively included in the study from 2018 to 2020. The main indication for OH were abnormal uterine bleeding followed by post-menopausal bleeding.

    Results: The procedure was tolerable without analgesia in 93% of cases, analgesia was required in 3.96% of cases, and minor complications consisted of abdominal pain and dizziness (0.99%), as well as uterine bleeding (0.99 %). Given a success rate of 90% using a 1.8mm diameter hysteroscope, it can be concluded that OH with Etonox (N2O2) as an analgesic is a safe and feasible procedure for patients of varying ages and parities.

    Conclusion: OH is particularly useful in the workup of abnormal uterine bleeding, post-menopausal bleeding, assisted IUCD removal, endometrial biopsy, and the removal of small polyps. 

    Keywords: Outpatient clinic, Office Hysteroscopy, Procedural sedation, Procedural tolerability, Gynecology, Minimally Invasive Therapy

Gender Difference in Knowledge, Attitudes and Practices towards Family Planning among Married Adults Attending Primary Health Care Centers in The Kingdom of Bahrain: Cross Sectional Study

Shereen M. Saleh1*, Sara S. Ahmed1 , Ghufran A. Al Sebea1 , Dalal A. Al Othman1 , Najla Y. Al Ansari1 , Behnaz E. Tadayyon2 , Adel S. Al-Sayyad3

Pages: 9-19
  • Abstract
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  • Objective: Family planning (FP) has become a fundamental part of healthcare and it can be achieved effectively by safe methods. This study was conducted to determine the gender difference in the knowledge, attitudes, and practices towards FP among married adults attending primary healthcare centers (PHCs) in Bahrain.

    Methods: This cross-sectional study was conducted at five PHCs from the four governorates in Bahrain over two weeks period in May 2021. A self-administered questionnaire was used to evaluate the knowledge, practice, and attitude of married adults towards FP.

    Results: The study included 1221 participants (705 females and 516 males). Our study showed that 83.6% of the population had heard of Family Planning Methods (FPM) in general. However, female participants heard more about FPM than males. The FPM practice revealed that 71.9% of the participants are using at least one method. The most common methods are withdrawal (42.4%), and male condoms (29.9%). However, 42.5% of participants still have fears about using FPM. The majority of these fears were related to side effects (57.7%).

    Conclusions: The study revealed that the level of knowledge, attitude and FP utilization in both sexes was lower compared to other studies. In order to improve the public’s practice of FP, more investment should be made in health promotion programs.

    Keywords: Knowledge, Attitudes, Practices, Family Planning, Gender Difference, Bahrain.

Patients’ Satisfaction with Teleconsultations during the COVID-19 Pandemic in the Kingdom of Bahrain

Marwa Shareef1*, Reem AlSherooqi1*, Sara Altamimi1*, Zahra Isa1*, Hamad Kamashki1*, Adel AlSayyad2

Pages: 20-33
  • Abstract
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  • Background: The SARS-CoV-2 pandemic led to the restructuring of traditional clinical activity; hence, globally, 58% of countries implemented the use of telemedicine to meet their healthcare needs.

    Objective: To examine patients' satisfaction with telemedicine medical service and experience at the level of primary care in the Kingdom of Bahrain.

    Methods: A retrospective cross-sectional study was conducted on 335 patients who used teleconsultations in January 2022 in primary care. A validated questionnaire was modified to assess patients' satisfaction with teleconsultation medical services and experience during the COVID-19 pandemic.

    Results: A total of 315 responses were included in the final analysis (response rate 94%). Almost all expressed extreme satisfaction with the medical service as they were able to easily explain their medical problem over the phone and fully understood their illness after the consultation. They were also satisfied with the ability of the doctor to understand their problem, explain their treatment, and provide appropriate management over the phone. Over 90% were satisfied with the consultation time that it does not require transportation and would like to use it in the future. Sharing private or personal information over the phone received the lowest satisfaction rate (77.5%).

    Conclusion: The overall satisfaction expressed by respondents of this survey with the teleconsultation medical service and experience is very high. Such a result confirms that patients have a positive attitude towards telemedicine services in primary care and are willing to use it again and, therefore, must be adopted as a proactive strategy to ensure long-term sustainability.

    Keywords: COVID-19 Pandemic, Satisfaction, Teleconsultation, Telemedicine.

Global School-Based Student Health Survey 2016-Bahrain: Mental health

Eman Haji1 , Fatema Jamsheer2 , Ghufran Jassim2*, Ashwaq Sabt1 , Amani Abdulla AlSabagh1 , Lama Mahmood Nasar1 , Khadija Ebrahim Hassan1 , Ebtisam Nuhaily2

Pages: 34-41
  • Abstract
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  • Background: The Global school-based student health survey (GSHS) was developed to help countries measure and assess students' health behaviors and protective factors. This report discusses results from the first GSHS carried out in Bahrain during 2015-2016 by the Ministry of Education in collaboration with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC).

    Methods: The GSHS includes students aged 13-17 years and employed a two-stage sample design involving a school and class level. 64 public and private schools were sampled out of 162 schools, and 320 classes of students in grades 7-11 were selected. Students completed a questionnaire addressing mental health, protective factors, sexual behaviors, violence, and unintentional injury.

    Results: 7,143 (89%) of the 8,068 sampled students completed the questionnaire. Of the students who responded, 3,685 (51.1%) were males, and 5,843 (84.5%) were between the ages of 13 to 17 years old. 27.2% of students were physically attacked, 41.4% were in a physical fight, and 28.6% were bullied one or more times during the past 12 months. 38.1% of the students never or rarely wore a seatbelt when in a car, and 30.7% never or rarely wore a helmet when riding a bicycle. 16.2% of students felt lonely most of the time or always, and 15.2% seriously considered attempting suicide during the past 12 months.

    Conclusion: The study reported rates of violence, physical fights, bullying, and unsafe practices among school-Age children. Raising awareness regarding mental health and emotional well-being, assessment and support among school children is vital.

    Keywords: Bahrain, Mental health, School, School health, WHO

Awareness of Radiation Dose and Incurred Risk Among Clinicians at a Tertiary Care Hospital in Bahrain

Mazna Al Khalifa*1, Salah Alghanem2 , Abdulraoof AM Mohamad3

Pages: 42-50
  • Abstract
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  • Background & Objectives: Literature has raised concern about the inadequate knowledge of radiation dose and risk among referring clinicians for radiological procedures. Therefore, we surveyed to assess the knowledge of radiation protection and dose assessment among clinicians.

    Methods: A cross-sectional web-based survey where the link was circulated to 87 clinicians who requested diagnostic radiological imaging. A validated questionnaire consisted of 20 multiple-choice questions divided into three sections, viz, demography, awareness of radiation risk, and knowledge of radiation dose, were asked to reply.

    Results: A total of 87 physicians from 15 different medical specialties were included in the analysis. Interns had the highest knowledge score in radiation protection (59.5%, P=0.198), while the dose assessment score was highest among radiologists (50.8%, P=0.013). The average knowledge of radiation protection was 43% ± 17%, and awareness of radiation dose was 30% ± 18%. Clinicians having experience >20 years were found with the least score (33.3%) of radiation protection knowledge, while those with <3 years of experience showed a better score (48%, P=0.064). Clinicians who claimed to be attending radiation protection courses regularly were found with better scores of knowledge (47.6%, P=0.340) and dose assessment (37%, P=0.161), although the difference was nonsignificant.

    Conclusion: The clinician’s knowledge of radiation protection and dose assessment is inadequate which could infer a propensity of the inappropriate use of radiation imaging. There is a substantial need for training/refresher courses to improve the knowledge of radiation dose and consequent risk in order to assure patient safety during radiological examinations.

    Keywords: Ionizing radiation, Radiation dose, Risk awareness, Radiological examination, Diagnostic imaging

Incidence of Posterior Capsule Rupture in Cataract Surgeries and its Association with Age and Hypertension

Rahimi Parastou1*, Rajmohan Archchana2 , Mian Muhammad Atif3

Pages: 51-56
  • Abstract
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  • Background and objectives: Cataract is common in aging populations, and causes blurry vision. Once it interferes with daily activity, it is treated surgically and may lead to complications such as posterior capsule rupture (PCR). The present study aims to calculate the rate of PCR and determine its correlation with age and hypertension.

    Methods: This retrospective study was conducted between 31st August, 2016 to 30th December, 2018 at the Department of Ophthalmology, King Hamad University Hospital (KHUH), Bahrain. A total of 458 Bahraini patients, including 199 (43.5%) women and 259 (56.5%) men with a mean age of 66.2 ± 9.186 years (S.D.), were studied. Data from medical records and the theater logbook depicted two types of procedures, phacoemulsification and extracapsular-cataract-extraction (ECCE), which were performed by a single surgeon. Data were analyzed using SPSS (Version 26.0).

    Results: Of the 458 patients studied, 7 patients (1.5%) developed complications. Out of these patients who developed complications, 4 (0.8%) cases were of PCR with no vitreous loss. On analysis, age was a significant risk factor for patients above 60 years (P=0.05), whereas hypertension was not a significant (P=0.760) risk factor for developing PCR as a complication.

    Conclusion: Low PCR rates were reported in this study. Contributing factors to this low occurrence of PCR could be the identification of high-risk patients and years of the surgeon’s experience. The study highlights that patients above 60 years were at higher risk of developing PCR complications. In contrast, patients with hypertension were at lesser risk of developing PCR complications.

    Keywords: Cataract, extracapsular cataract extraction, hypertension, phacoemulsification, posterior capsule rupture, vitreous loss, zonular dialysis.

Review Articles

Sleep Disturbance and the Risk of Cardiovascular Diseases

Adel Khalifa Sultan Hamad*

Pages: 57-63
  • Abstract
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  • In many observational studies, cardiovascular diseases as well as metabolic dysfunction have been identified as major manifestations of sleep disorders. Several mechanisms have been proposed to explain this association. In addition to the discoveries of interconnected mechanisms, a novel therapeutic approach needs to be explored. This review attempts to develop a better understanding of future research by examining the inter-relationship between sleep disorders and cardiovascular risk factors.

    Keywords: Sleep disturbance, Sleep apnea, Insomnia, Cardiovascular diseases, Arrhythmias

Case Reports

An Ocular Myasthenia Gravis: A Case Report

Dana I. Ajlan1*, Rana Al-Ghatam2

Pages: 64-67
  • Abstract
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  • Myasthenia gravis (MG) is an autoimmune disease involving the postsynaptic receptors in the neuromuscular junction, characterized by weakness of the muscles. Ocular myasthenia gravis is a subtype of disease where weakness of oculomotor muscles usually occurs with the presence of ptosis. MG is considered a rare disease in pediatric age groups. Acetylcholinesterase inhibitors and immune-modifying medications are usually the mainstays of medication. We report here, a case of a 2-year-old that presented with ptosis and was diagnosed as ocular myasthenia gravis. Our case report describes the clinical presentation, diagnostic tests, and treatments followed.

    Keywords: Myasthenia gravis, Ocular myasthenia gravis, Pediatric myasthenia gravis, Ptosis

Epithelioid Sarcoma of the Skull: A Differential Diagnostic Approach

Hazem Muhammed Almasarei1 , Darine Helmy Amin Saad2, Suad Muhammad Abu Tahoun3, Sufyan Sameer Sami Alsbahi4, Nandan Maruti Shanbhag5

Pages: 68-74
  • Abstract
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  • Epithelioid sarcoma of the scalp as a primary site of origin is a rare occurrence a and has a broad differential diagnosis. The radiological features for each of the differential diagnoses are similar but sometimes can be very unique. The present case study provides relevance and significance in considering the possibility of primary epithelioid sarcoma while examining benign lumps with no skin ulceration or pain. The case report focuses on imaging features of epithelioid sarcoma while employing to describe the lesion using multimodality imaging in addition to Computer Tomography, early intervention in the form of complete excision of these tumours through surgery and primary repair when required. Adequate adjuvant treatment is needed following the excision, with the goal of preventing recurrences.

    Keywords: Epithelioid Sarcoma, Skull imaging, Osteomyelitis.

Obstructive Uropathy as a Complication of Hematometrocolpos in an Adolescent Female: A Case Report

Marwa Sameer Abdulqader1*, Hiba Omar Mohamed2 , Gabriel Fox3 , Martin Corbally4

Pages: 75-78
  • Abstract
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  • Obstructive uropathy, secondary to mass obstructing effects such as hematometrocolpos and consequent acute urinary retention (AUR); is a proven but rare condition in females. Imperforated hymen, which is found in 0.05-0.1% of females, obstructs blood flow at the onset of mensuration with a resultant hematometrocolpos presenting most commonly with abdominal pain and urinary symptoms in the background of primary amenorrhea, which is similar to the presentation of the 11 years old female in the case report. She had abdominal pain and dysuria, which AUR followed for 16 hours. The patient was at Tunner stage 3, and the examination revealed a palpable tender pelvic mass up to the umbilicus level with a bulging introitus and an imperforated hymen. Ultrasonography confirmed hematometrocolpos and an associated bilateral grade 2 hydronephrosis. Therefore, hymenotomy and excision of hymenal edges were done. Although diagnosis can be directed by physical examination, it can be significantly delayed or missed due to generally low incidence rate and insufficient physical examination due to cultural and religious reasons. This case report directs toward the importance of high clinical suspicion of hematometrocolpos as a cause of AUR in adolescent females and the necessity of a complete detailed physical examination, although it is rare.

    Keywords: Imperforated Hymen, Adolescent, Urinary retention, Hematometrocolpos, Hydronephrosis