Table of Contents

Original Articles

Outcome of Screening Mammography for Women Attending Primary Healthcare Centers: One-Year Review

Muna Almohri1*, Fatema Al Jerdabi2 , Hala Al Asoomi2 , Mohamed Ali J. Mandeel3 , Hanan Abdulrahim4 , Lamya Ebrahim5 , Amal Buasali2 , Haya Al Subaei6

Pages: 1-7
  • Abstract
  • Full-Text PDF
  • Background: Breast cancer is the most prevalent cancer in women globally and in the Kingdom of Bahrain. Studies have shown that screening mammography is an effective way to identify early stages of breast cancer in women and has decreased breast cancer mortality. Therefore, determining the outcome of breast cancer screening is essential for proper assessment and improvement of the screening program.

    Objective: This study aims to assess the outcome of breast cancer screening by mammography for women attending Primary Healthcare Centers in the Kingdom of Bahrain.

    Methods: This is a cross-sectional study of women who had screening mammograms in primary healthcare centers in the Kingdom of Bahrain for one year. The study included 2438 women aged 40 years and older. Data were extracted from electronic medical records.

    Results: The most prevalent breast density level was scattered fibroglandular density (55.3%), while extremely dense breasts (5.3%) were the least common. The study showed that 68.3% of the reports were normal, while 31.7% of women were recalled for further imaging. The most common reasons for recalls were nodules/lumps in 34.2%. Additional imaging was done for 69.4% of the cases, while 30.6% of women missed follow-up appointments. Of the patients needing biopsies, the procedure was performed for 62.5% of the women; of these, there were histologically confirmed malignancies in 31.6%.

    Conclusion: The breast cancer detection rate in this study is 0.5%. A recall rate of about 32% is higher than in other studies. This study also shows a high percentage of women who didn’t follow up for the additional images and procedures requested by radiologists, which needs further studies to identify the reasons. Educating women on the importance of compliance with the additionally requested workups and close monitoring and follow-up of the screened women by health facilities are crucial for the success of the breast screening program.

    Keywords: Breast cancer, mammogram, screening, outcome, primary care

Primary Healthcare Physicians’ Knowledge, Practice, and Attitude Towards Influenza Vaccination of Pregnant Women in Bahrain

Fatema K. Bindayna1, Noora A. AlHammadi1*, Noora K. Bindayna1, Qoot A. Alboainain1, Mustafa M. EzzlArab1, Behnaz E. Tadayyon2

Pages: 8-20
  • Abstract
  • Full-Text PDF
  • Background: Pregnancy is associated with immunological and physiological changes in many organ systems. Influenza in pregnancy has been associated with higher rates of morbidity and mortality. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) advocate antenatal influenza vaccination.

    Objective: This study aims to assess Primary Healthcare Physicians’ (PHPs) knowledge, practice, and attitude regarding influenza vaccination of pregnant women in Bahrain. Also, to identify the perceived facilitators and barriers to influenza vaccination for pregnant women among PHPs.

    Methodology: A cross-sectional study was conducted in all Primary Health Centers (PHCs) in Bahrain belonging to the Ministry of Health (MOH), which included 25 PHCs and 3 health clinics spread across five health regions. One hundred and nighty -two physicians responded to a survey about their awareness, practice, and attitude about influenza immunization in pregnancy.

    Conclusion: In general, physicians agree that influenza vaccination is necessary and safe for all pregnant women, not only those having high-risk pregnancies. Furthermore, good counseling can help overcome many fears or barriers.

    Keywords: Bahrain, Counseling, Fear, Female, Influenza, Human, Morbidity, Physicians, Pregnancy, Pregnant women, Vaccination

Comparing Postoperative Analgesia of Caudal and Penile Blockade using Bupivacaine in Children Undergoing Hypospadias Repair

Mohamed Magdeldin M. Ahmed1*, Ahmed Murad Bella2

Pages: 21-27
  • Abstract
  • Full-Text PDF
  • Background & Objectives: Caudal epidural and dorsal nerve penile blockade are commonly used for analgesia during and after hypospadias repair in children. Comparative studies to recommend the most effective block are in dearth. This study aims to compare penile block versus caudal block with bupivacaine for hypospadias repair in children in terms of post-operative effectiveness, pain management, and complications.

    Methodology: The study was conducted on 60 male children, aged 1-9 years, undergoing hypospadias surgery under general anesthesia. The subjects were randomly divided into two groups: (A: caudal block, n=30, and B: penile block, n=30). A postoperative pain assessment was conducted using FLACC scale until 24 hours post-surgery.

    Results: The patients from the A and B groups were comparable in age, weight, and ASA classification. All patients in the 2 groups did not feel pain post-operatively throughout the first 6 hours. One patient (3.4%) from each of the A and B groups started to feel pain 6 hours, and 9 hours, respectively after surgery. Eight patients (26.7%) in group A and 6 patients (20%) in group B felt pain throughout 6 to 24 hours after surgery. Four patients from group A and 1 patient from group B developed nausea and vomiting during the first 24 hours post-surgery.

    Conclusion: The penile blockade proved to be more effective in lowering postoperative pain scores, with fewer side effects, thereby decreasing the need for rescue analgesia.

    Keywords: Caudal block, bupivacaine, Caudal epidural, hypospadias repair, penile block

Review Articles

Clinical Recommendations to Improve Utilization of Fissure Sealants in Primary Healthcare Centers in Bahrain

Eman Flaihan Alrowaili

Pages: 28-38
  • Abstract
  • Full-Text PDF
  • A situation analysis among which a cross-sectional survey of dental practitioners working in primary healthcare centers found that while 127 (94.8%) out of 134 respondents consider fissure sealants effective yet, most of them have misconceptions regarding which teeth to consider carious and which to seal as only 15 (11.2%) recognized that initial carious and non-cavitated carious lesions are the same and only around half sealed either. Fissure sealants are provided for free in primary healthcare centers, but they seem underutilized as only 35 (37.6%) dentists use them very often. To address these issues and others raised by dentists and dental hygienists on the indications and the use of fissure sealants; evidence-based clinical recommendations are provided keeping in mind the high level of caries among children and adolescents in Bahrain and the services provided in primary healthcare centers. Further studies will be needed to evaluate different reasons affecting dental practitioners' knowledge and use of fissure sealants as a method of preventing and controlling caries.

    Keywords: Fissure sealants, non-cavitated carious lesions, initial caries, high risk, prevention, dentists, dental hygienists

    Abbreviations used in manuscript: Primary health care centers (PHCC), International Caries Detection and Assessment System (ICDAS)

Case Reports

Management of Two Years Old Child with Russell-Silver Syndrome - A Case Report

Maryam Buenq1*, Mohamed Aziz Ullah Khan2

Pages: 39-42
  • Abstract
  • Full-Text PDF
  • Russell-Silver syndrome (RSS) is a rare genetic malformation characterized by the growth of a 2-year-old male child with RSS who underwent hip spica surgery under general anesthesia. The patient had a history of mild developmental delay, failure to gain weight, and frequent vomiting. Anesthetic implications of RSS, including airway management, glucose homeostasis, hypothermia, and pharmacological considerations, were considered during the patient's pre-operative assessment and intraoperative management. The patient was induced with propofol and fentanyl, and maintenance anesthesia was achieved with sevoflurane. The patient's airway was safely secured, and extubation was performed smoothly. The anesthetic management proceeded without complications, ensuring a successful outcome. This case report highlights the importance of considering the specific anesthetic implications of RSS in the perioperative management of patients with this rare genetic syndrome.

    Keywords: Child, Russell-Silver syndrome, Anesthesia, Micrognathism, Intubation.

Case Report: Wiskott – Aldrich Syndrome in Patients with Normal Platelet Size in Bahrain

Salem Alrowaijeh1*, Rana Taqi2, Ebrahim Almasry1, Jalal AlKhan1

Pages: 43-47
  • Abstract
  • Full-Text PDF
  • Regardless of ethnicity or geographical distribution, Wiskott-Aldrich syndrome affects 1 in every 100,000 live male births. It has been established that Wiskott-Aldrich syndrome may potentially be a source of autoimmune illnesses and reticuloendothelial malignancies, even though most patients present with the traditional triad of thrombocytopenia, eczema, and recurrent bacterial infections. This case report introduces a 4-year-old boy born with hematemesis, thrombocytopenia, eczema, recurring infections, and, most surprisingly, normal platelet size. Genetic testing confirmed the diagnosis, primarily based on clinical suspicion. Thus the case study attempts to increase awareness among doctors in Bahrain and globally in considering the diagnosis of Wiskott-Aldrich syndrome in any patient with eczema, recurrent infections and thrombocytopenia regardless of having a normal mean platelet volume .

    Keywords: Genetic testing, immunity disorder, primary immunodeficiency disorder, thrombocytopenia, Wiskott-Aldrich syndrome

Traumatic Cervical Disc Herniation Manifesting as Brown-Sequard Syndrome: A Case Report

Ahmed Mohamed Hazeem1*, Faheem Nawaz2, Mohammed Saleh Al-Blooshi3

Pages: 48-51
  • Abstract
  • Full-Text PDF
  • Brown-Sequard syndrome (BSS) is an uncommon condition caused by a localized injury to one side of the spinal cord. It is rarely reported to present because of cervical disc herniation (CDH), especially as a result of 2 consecutive discs prolapse, with only 8 cases reported worldwide, 4 of which have the cervical disc levels of C5-C6, C6-C7 being affected just like the case we are presenting. A 45 years male had complained of left-sided body pain and numbness following a fall, his symptoms progressing over two weeks to left side hemiparesis and impaired sensation; MRI of C spine revealed C5-C6, C6- C7 disc prolapse with cord compression resulting in BSS. The patient was treated surgically by anterior cervical discectomy and fusion (ACDF) followed by physiotherapy. The patient showed complete recovery in terms of sensory and motor deficits in both the right and left upper and lower limbs. We are stressing the role of detailed history, comprehensive neurological examination, and proper imaging in the early diagnosis of BSS. Treatment with anterior surgical intervention is the recommended approach in most reported cases and is associated with an excellent prognosis.

    Keywords: Brown-Sequard syndrome, cervical disc herniation, cervical discectomy, cervical fusion and decompression, cervical spine injuries, spinal cord syndromes

Combined MRSA Spondylodiscitis Managed Conservatively in a Dialysis Patient: A Case Report

Omar Jamal Alalaiwi1*, Nahed Kamal2, Bedoor Alomran3

Pages: 52-57
  • Abstract
  • Full-Text PDF
  • Spinal infections comprise a large spectrum of clinical manifestations with multiple etiologies. Therefore, early detection and management are imperative to reduce morbidity and potential mortality associated with such conditions. Treatment modalities include using antibiotics based on the etiological agent and the neurosurgical team's possible intervention involvement. We present the case of a 52-year-old male patient who presented with lower back pain and was diagnosed with MRSA spondylodiscitis confirmed radiologically with MRI spine on a background of recent admission with MRSA line sepsis that was confirmed microbiologically through blood cultures. The patient was treated conservatively with a prolonged course of antibiotics and was followed up routinely to monitor response to treatment. Our case report describes MRSA spondylodiscitis clinical manifestation, diagnostic tests, treatment plan, and long-term outcome.

    Keywords: Epidural Abscess, MRSA, Spinal Infection, Spondylodiscitis, Vancomycin.