Background: Chronic Obstructive Pulmonary Disease (COPD) has systemic consequences, including cardiovascular disease. The endothelial functions are impaired in COPD patients, correlating with the severity of the disease. Our study is designed to examine the endothelial function in COPD patients by studying Flow Mediated Dilatation (FMD) and its correlation to severity of disease.

Methods: Patients more than 35 years of age with stable COPD were included in the study. Focused examination was carried out to record blood pressure, ankle brachial index and signs of heart failure. Detailed biochemical investigations were done along with ECG, Chest X-ray, Spirometry, FMD, and carotid intima media thickness in all patients. Age- and sex-matched healthy subjects without any evidence of systemic disease were recruited as controls.

Results: Fifty-nine consecutive COPD patients along with their age- and sex-matched controls were evaluated. Of the 118 patients, 06 (10.2%) in control group had carotid plaque, while 26 (44.1%) patients in the COPD group were observed to have carotid plaque (p<0.0001). Mean FMD in the control group was 13.765±4.428 and among COPD patients was 5.7440±3.2698 (p<0.0001).

Conclusions: Endothelial dysfunction measured by FMD was independently associated with Forced Expiratory Volume in the first second (FEV1) i.e., severity of COPD. We also found that there was higher likelihood of subclinical atherosclerosis and peripheral vascular disease to be present in COPD patients. Hence, cardiovascular risk factors should be evaluated in all COPD patients.

Keywords: Endothelial Function; Flow Mediated Dilatation; Atherosclerosis; COPD; FEV1

Background and Objectives: The human knee joint is complex, and understanding its kinematicsis important in the treatment of knee pathologies. Computational modeling is useful in medicine, biomedical engineering and other health sciences. Various methods have been developed to simulate the movement of joints and to pose computational anthropomorphic models. It is common to model the flexion-extension of the knee joint as planar rotation. Here, we propose a method to incorporate animation techniques into a truly 3D model of the knee joint from clinically derived scan data.

Methods: In this pilot study, we obtained the MRI-derived skeletal data of the lower limbs from BodyParts3D website. We also created in-house, the models of the cartilages, menisci and muscles. All models were imported into an open-source animation software, Blender. We developed techniques to identify the functional axes in the knee joint and their incorporation into the model. The same datawas also modeled with conventional planar rotations. We evaluated the models with bone collision and muscle contraction.

Results: Our anatomy-driven method minimized the collision of skeletal bones during posing and the muscle volume was conserved to within 0.01% of its original value.

Conclusion: We successfully exploited the simplicity of Blender and implemented a method to model the articulation of the human knee joint. This pilot study highlighted the ease of application and quantified its errors. Our technique is more anatomically and biomechanically accurate than conventional animation modeling.

Keywords: Knee joint; Biomechanical Phenomena; Kinematics; Three-Dimensional methods; Phantoms

Background and Objectives: Multidisciplinary team (MDT) meetings are an essential part of cancer management. While the importance of such meetings is generally acknowledged, the recent launch of Bahrain Oncology Centre and National Tumor Board provides an opportunity to assess the attitudes of its participants to the concept and its introduction to Bahrain.

Methods: This study was conducted at Bahrain Oncology Center on 96 attendees that were encouraged to complete a questionnaire that asked 14 questions including three main questions, (a) Do you think that the MDT-Tumor Board is beneficial? (b) Are you satisfied with the structure and function of the MDT?(c) What are your perceptions on how it may be improved? Quantitative data was produced by using Likert 5-points scale to measure participants’ agreement or non-agreement with different statements.

Results: A total of 60 forms were completed and returned. Of these, 49 (81%) of participants strongly agreed that MDT meetings were beneficial to patient management. In addition, general satisfaction levels with MDT meetings according to Likert 5-points scale calculated from 14 MDT related questions showed that 36/60 participants were very satisfied (1), 22/60 participants were moderately satisfied (2),one participant was neutral (3), while one participant was moderately unsatisfied (4).

Conclusion: This study confirmed that the majority of participants viewed MDT meetings as being beneficial to patient care. However, lack of patient information was considered a barrier to overall effectiveness, and 20% of the participants suggested that specialty specific meetings could improve the overall efficiency.

Keywords: Attitudes of professionals; Bahrain oncology center; Cancer in Bahrain; Multidisciplinary team meetings; Patient care team; Decision making.

Background: Torsion of the testes is one of the major urological emergencies, with an incidence of1/4,000 in males younger than 25 years. In this paper, we report our experience in the management of testicular torsion (TT) in Salmaniya Medical Complex (SMC).

Methods: Using SMC’s operative logbook, we undertook a retrospective review on all patients who underwent immediate scrotal exploration for a presumptive diagnosis of TT from January 2004 through December 2017. Using SPSS, we present descriptive statistics and report all significant relationships.

Results: A total of 259 scrotal explorations were undertaken for suspected TT. The mean age of patients presenting with suspected TT in our cohort was 20 years, ranging from (11-58 years). Around 42%(n=109) of these had non-viable testes on exploration and a unilateral orchidectomy was performed, 28.5% (n=74) had TT for which detorsion was done while 27.8% (n=72) had a negative exploration. Amongst the patients with TT, 60% (n=183) had an orchidectomy whereas only 40% of testes were salvageable by detorsion and orchidopexy. Although we had an equal number of patients presenting with right and left TT, patients with left sided TT had a significantly higher orchidectomy rate than patients with right sided TT, 61 % (n=66) compared with 39% (n=43) respectively, p<0.029. Conversely the chance of salvaging the right testes was better than the left testes with an OR of 1.969 (95% CI, 1.069-3.626). Patients with salvageable testes, unsalvageable testes and negative explorations had varying contralateral orchidopexy rates of 90%, 71% and 62% respectively.

Conclusions: These findings indicate that our testicular salvage rate is low. As time to presentation is the most important factor in predicting outcome, more effort should be invested into increasing public awareness about TT in Bahrain.

Keywords: Testicular torsion; Orchidopexy; Orchidectomy; Testicular salvage rate; scrotal exploration.

Typhoid fever is a systemic illness that is characterized by abdominal pain and fever. It is caused by Gram negative rod Salmonella enterica serotype Typhi and Paratyphi A, B, C. The disease goes through stages and its clinical manifestations varies according to the stage of illness. In this case report, we present a case of a young healthy male who presented with abdominal pain which was initially diagnosed with an impression of acute surgical abdomen due to bowel obstruction and later identified to have intestinal intussusception secondary to enteric fever. This type of gastrointestinal complication is considered an uncommon complication of the infective process of Typhoid fever. Reporting this case would help in raising the attention toward such complications which may be confused with other differentials of acute abdomen.

Keywords: Fever; Typhoid; Bowel obstruction; Antibiotics; Salmonella typhi

Patients presenting to the Emergency Department (ED) with traumatic injuries constitute one of the leading causes of morbidity and death, mainly due to hemorrhagic shock. Whether due to penetrating or blunt injury, management of hemorrhagic shock, usually presenting initially as sinus tachycardia, remains the priority in the ED. Although there maybe other causes for tachycardia following trauma, it is important to recognize and treat hemorrhagic shock immediately and efficiently. In this case study, a unique pediatric case of blunt abdominal trauma and splenic injury with supraventricular tachycardia (SVT) presented to the ED of the Bahrain Defense Force Hospital (BDF). Hemorrhagic shock with tachycardia followed a handlebar injury to the abdomen, and continued persistent tachycardia was observed despite the aggressive management of hemorrhagic shock. An electrocardiogram (ECG) was done to confirm the diagnosis of SVT, following which the case was appropriately managed and reverted to normal sinus rhythm.

Keywords: Supraventricular tachycardia; Emergency department; Hemorrhagic shock; Tachycardia

Cleidocranial dysostosis (CCD) is a congenital disability that may affect bones and teeth. It is a rare disease that can be caused by inheritance or a genetic mutation, irrespective of ethnic group. Treatment of CCD aims to achieve optimum function and aesthetic results, and improve the patient’s quality of life and self-confidence. In this case report, we present a nine-year-old male patient with CCD seeking treatment due to delayed eruption of teeth. Many other dental problems are also presented in this case, such as supernumerary teeth, retained deciduous teeth, malformed teeth, and multiple impacted permanent teeth. The patient underwent both surgical and orthodontic procedures. Early diagnosis of CCD leads tooptimum management, resulting in improvement of patient’s quality of life.

Keywords: Cleidocranial dysplasia; Dysostosis; Dentofacial deviation; Supernumerary teeth; Claviculardefect.

Herpetic stromal keratitis activates a cascade of inflammatory processes that stimulate angiogenic factorssuch as VEGF (Vascular Endothelial Growth Factor) causing the development of blood vessels in the cornea. In this case report, we describe an unusual case of a 35-year-old man with a known history of herpetic keratitis presenting to the emergency department with pain, haziness, and itchiness of the right eye dueto extensive neovascularization at the inferotemporal sclera of the corneal stroma extending to the 3o’clock position. Acyclovir, anti-VEGF (avastin), and argon laser were used in successfully managing the patient. The triple therapy reversed neovascularization and prevented its further extension, leading to a good prognosis for the patient.

Keywords: Argon Laser; Coagulation; Phototherapeutic; Keratitis; Avastin.

Hypodontia or tooth agenesis is a developmental anomaly characterized by missing teeth (excluding allthird molars), which can range from single tooth to anodontia (complete absence of teeth). Hypodontiais the most common developmental anomaly in humans, affecting primary teeth (rarely) or permanent teeth, and may occur as part of a genetic syndrome or can be non-syndromic. This report is aimed to demonstrate alternative treatment modalities for hypodontia considering various factors. We present two clinical cases of congenital missing upper permanent lateral incisor that created an aesthetic problem in conjunction with impacted canine and microdont lateral incisor. Case One involves a 19-year-old female who complained of spaces in her upper front teeth. The space of congenital missing maxillary permanent lateral incisor was closed by mesialisation of the canine and posterior teeth, followed by canine transformation with lateral incisor. Case Two is about 18 years old boy who disliked his smile. The treatment was carried out by a multidisciplinary approach with orthodontics and restorative dentistry for improvement of aesthetics.

Keywords: Hypodontia; Dental anomalies; Impacted canine; Missing teeth; Multidisciplinary.