Background: Sickle cell disease patients have a tendency for vaso-occlusive attacks involving their bones. Osteonecrosis results in  infarction of the articular surfaces and heads of long bones, leading  to chronic joint pain, significant interference in functioning and quality of life. Intraarticular Botox injection is safe andreduces  chronic pain while  patients’ mobility.

Objective: The study aimed to evaluate the symptomatic change and its duration after intra-articular Botox injection, in sickle cell disease patients with chronic pain.

Methods: Sickle cell disease patients with chronic joint pain observed at Salmaniya medical complex were included. Patients were injected with Botox intraarticularly and followed up for a year.Symptomatic parameters were assessed at every follow- up, raw data collected was entered into Microsoft Excel spreadsheet were the numerical variables analyzed and graphs were created.

Results: Forty-eight sickle cell disease patients were included.Postthe intraarticular injection at 3 months, the level of pain according to, Numerical rating scale (NRS) reduced by 44.6 % (p-value <0.005) and 27.8%( p-value < 0.001) at 6 months and 9.54% ( p-value <0.01) at 1 year, and significant improvement of other parameters.

Conclusion: Intraarticular BoNT/ A injection provides an alternative treatment in sickle disease patients with good results in reduction of pain, improved physical function, mood, and sleep pattern lasting at least 6 months. Although a small scale study, the results suggest that BoNT/ A is an effective and safe treatment.

Keywords: Avascular Necrosis of Bone; Botulinum toxin; Chronic Pain; Injections; Intra-Articular; Sickle cell disease (SCD)

Background: Medications are the primary tool used to prevent and manage non-communicable diseases (NCD). The medical literature is rich with studies related to the adherence issues of NCD patients to their medication regimen; however, there is a dearth of such studies on patients in Bahrain. Hence, this study was conducted to measure medication adherence among patients with NCD in Bahrain primary health centers (PHC).

Methods: A cross-sectional study was conducted on 400 patients with NCD who were following at PHC in either NCD department or general outpatient clinics between February and March 2019. The data was collected through face-to-face interviews and a questionnaire based on the Medication Adherence Rating Scale (MARS) to measure patient’s adherence to medications.

Results: Only 19.5% of the study participants were adherent. Use of medication reminders was associated with adherence; 49.8% of the participants were not using any reminding method, and 32.3% linked medication timing with their daily activities. Patients diagnosed with more than one disease and married patients were more adherent. There was no statistically significant association between the patients' demographic characteristics and adherence. Following a healthy diet and lifestyle was associated with adherence.

Conclusion: The low level of adherence in patients with NCD indicates the need for increasing awareness, especially regarding the health complications resulting from non-adherence to medications. Doctors must ensure that their patients are adherent to their medication and healthy lifestyles, before making changes in the dosage or medication.

Keywords: Adherence; Bahrain; Chronic disease; Medication; Primary health

Extraction of mandibular third molars is a common procedure that is usually performed in any oral and maxillofacial facility. Pain and dry socket are both common complications encountered. Other related complications include swelling, trismus, and nerve paresthesia. Multiple studies have established the correlation of mandibular molar extractions with specific complications. The aim of the article is to review the evidence relating the complications to the surgery, to understand what a dentist may encounter post-operatively.

Keywords: Complications; Mandibular; Postoperative; Surgery; Third Molar

Neglected developmental hip dysplasia can present with many complications, this case report presents a case where a bony prominence on the femoral neck occupied the acetabulum and functioned as a femoral head. This case report discusses the clinical and surgical approach to this unique presentation of a neglected case of developmental hip dysplasia and briefly reviews the relevant literature which reports few similar cases.

Keywords: Braces; Hip dislocation; congenital/diagnosis; Hip dislocation; congenital/therapy; surgery; complications; Infant; Orthopedics procedures

Legg Calve Perthes disease is a self-limiting disorder characterized by avascular necrosis of unknown etiology affecting the femoral capital epiphysis. Complete revascularization of the avascular epiphysis invariably occurs over a period of two years, and the need for treatment of Perthes disease may therefore be questioned. Most recently, it has been observed that the development of Perthes disease can be preceded by recurrent or prolonged transient synovitis (TS) of the hip joint. We present a case of a five-year-old girl who was brought to the clinic with a history of intermittent hip pain and a limp for over a period of nine months.

Keywords: Legg Calve Perthes Disease; Transient synovitis; Avascular necrosis; Supervised neglect

Cecal volvulus describes the rotation of a mobile cecum around its mesentery which frequently leads to large intestine obstruction. Anatomically, this can occur in a meso-axial or an organo-axial pattern. Thus, Cecal volvulus has a wide range of presentations which can vary from mild intermittent to severe acute abdominal pain. However, if not treated in a timely manner, it can result in high morbidity due to sepsis and intestinal strangulation.

Cecal volvulus predominantly affects female patients aged between 40–60 years specifically those with a history of chronic constipation.  Incomplete intestinal rotation during fetal life also plays an important embryological factor in cecal volvulus development.

In this case report, a 30-year-old female presented with severe lower abdominal pain continuously occurring for 6 hours. A previous history of constipation and minimal bowel movement was noted.

The purpose of this report is to highlight imaging findings needed for diagnosis and management of this rare serious condition.      

Keywords: Abdominal pain; Cecum; Intestinal obstruction; Intestinal strangulation; Volvulus                                   

The anterior teeth usually need immediate replacement after extraction to fulfill the esthetic and related psychosocial requirements of the patient. The numerous techniques available to clinicians for this purpose are either expensive, uncomfortable, technique-sensitive, laboratory-intensive, or fragile. This article describes a chairside method of creating an immediate bonded replacement that is tailor-made to the patient’s oral cavity and overcomes most of the limitations mentioned above. The life-like composite resin – ovate pontic – is fabricated at the chairside, rapidly and effortlessly. All the steps and materials used are described in detail to enable any dental clinician to emulate the same when faced with a similar situation. Additionally, the case has been recorded in vivid photographs that are self-explanator.

Keywords: Artificial tooth, Composite resins, Immediate partial denture, Resin-bonded Fixed Partial denture, Temporary dental restoration

Fetal volvulus without malrotation is a very rare neonatal surgical emergency. However, there is no reliable data on the incidence of fetal volvulus without malrotation. Fetal volvulus has variable degrees of presentation and survival rate of the fetus. Delay in diagnosis and timely intervention lead to increase in morbidity and mortality rates.

We report the case of a preterm neonate who was born at 30 weeks of gestation and was noted to have an intra-abdominal mass in utero. Intraoperatively, it turned out to be segmental midgut volvulus without malrotation.

Keywords: Fetal intestinal volvulus; Fetal midgut volvulus; Intrauterine volvulus; Prenatal diagnosis; Congenital midgut volvulus

Crown lengthening is performed to increase the length of the clinical crown for either restorative or esthetic reasons. Biological width is one of the important requirements to consider to avoid rebound of the gingival tissue. Indications for crown lengthening include excessive gingival display, short clinical crown, restorative procedure, and management of uneven gingival margins. In some cases, the gingival tissue does not retract to its full extent, leading to excessive gingival tissue display. This may affect the esthetics, necessitating crown lengthening. This article discusses the case of a 23-year-old female patient with excessive gingival display in the upper anterior segment that was treated with a crown lengthening procedure with osseous reduction.

Keywords: Crown lengthening; Gingivectomy; Surgical flap; Tooth crown; Wound healing