Background/objective: The novel coronavirus disease 2019 (COVID-19) pandemic has posed a global threat to public health. An objective strategy is quintessential to handle resources prudently. This study assessed the utility of the quantitative polymerase chain reaction (qPCR) cycle of threshold (Ct) to evaluate the severity of the COVID-19 infection. The study also assessed the duration of the hospital and the management of healthcare resources.

Methods: This cross-sectional study was carried out among 306 patients admitted to COVID-19 care centers in the Kingdom of Bahrain from 20th March 2020 to 5th April 2020. Standard qPCR was used to estimate the viral load, and data was analyzed to investigate the relationship between Ct values and various variables.

Results: Out of 306 patients, two fatalities, one active stable case, and 303 recovered cases were reported. Ct value was negatively associated (P value <0.001) with the length of hospital stay. Viral clearance was also inversely associated with the Ct values.

Conclusion: Ct value was inversely associated with the duration of hospital stay (and time to viral clearance); the higher Ct value was indicative of a faster time to viral clearance. This association could aid in the management of both the infection and resources.

Keywords: Bahrain; COVID-19; Length of Stay; Public Health; Resource Allocation; Viral Load

*Kindly refer to PDF for tables/images for this article

Background: Coronavirus disease 2019 (COVID-19) has attracted global attention as it has expeditiously spread. Therefore, adherence to Personal Protective Equipment (PPE) has become a daily necessity, particularly among front-line personnel. However, PPE is associated with some adverse skin reactions; hence, this study aimed to investigate the characteristics and prevalence of adverse skin reactions from PPE usage.

Methods: This cross-sectional study with a random sample was carried out at Bahrain Defense Force Hospital (BDF) from January to March 2021, targeting the front-line personnel. An online questionnaire was sent regarding adverse skin reactions from PPE. A total of 145 healthcare workers (HCWs) were approached, and 132 (91%) responded. The results were analyzed through SPSS 21.0 software, and the Chi-square test or Fisher’s exact test was used to analyze discrete variables.

Results: A total of 100 (75.8%) respondents suffered from adverse skin reactions. The most common findings were skin dryness, 100 (75.8%); itchiness, 67 (50.8%); and acne, 48 (36.4%). The most affected distant site was hands, 92 (69.7%). Female gender was significantly associated with skin changes, and only 22 (22%) participants with adverse skin reactions took medical advice.

Conclusion: Adverse skin reactions from PPE were common. Therefore, improving awareness of practical methods is quintessential.

Keywords: COVID-19; Eczema; Hand Hygiene; Masks; Skin Care

*Kindly refer to PDF for tables/images for this article

Background & Objective: Children are prone to a plethora of infections. This study aimed to evaluate the prevalence of most common microorganisms isolated from the bacterial cultures infecting pediatric patients and their resistance to antibiotics in Bahrain.

Methods: This prospective study included 1146 isolates collected from pediatric patients of Bahrain. Demographic details such as age, gender, and nationality were recorded for each of the patients. Samples were cultured using different nutrient media (MacConkey agar, Sheep blood agar etc.), and analysis was done using standard microbiological techniques and Vitex automated analyzer. Application of Kirby- Bauer procedure and Vitex aided in the assessment of antibiotic resistance of the isolates. Proportion test was used to calculate the study outcomes. P value < 0.05 was considered statistically significant.

Results: Streptococcus group A (52.98%) and E. coli (35.97%) were the two most common microorganisms observed in pediatric patients. A high prevalence of Extended-spectrum beta-lactamases (ESBL), Campylobacter sp., and Methicillin-resistant Staphylococcus aureus (MRSA) were also observed (P<0.001). A majority of the organisms were identified from urine (27.66%) and throat cultures (25.22%). E-coli showed significant resistance towards trimethoprim /sulfamethoxazole (22.97%) and amoxicillin/ clavulanic acid (20.19%). Susceptibility patterns of gentamicin, amoxicillin, trimethoprim, ciprofloxacin showed significant association with the isolates. Odds of susceptibility of amoxicillin/ clavulanic acid (2.89 times), trimethoprim/sulfamethoxazole (2.29 times) was more for gram-positive isolates but for ciprofloxacin (2.08 times), which was more for gram-negative isolates.

Conclusion: Antimicrobial susceptibility patterns were unique among the pediatric patients of Bahrain.

Keywords: Anti-bacterial Agents, Antimicrobial Stewardship, Escherichia coli, Child, Methicillin- Resistant Staphylococcus aureus.

*Kindly refer to PDF for tables/images for this article

Background and aim: The study aimed to estimate the prevalence of bone mineral density (BMD) disorders among women 34 years and older in Bahrain and evaluate risk factors linked to osteoporosis.

Methods: This cross-sectional study comprised of women ³ 34 years of age, attending primary health centers in Bahrain. Multistage stratified sampling technique was used to select the samples and participants were randomly selected from the waiting area at the centers. The objectives and procedures were explained to the subjects and informed consent was obtained. Following recording of the case, the participants were screened using Achilles InSight imaging bone ultrasonometer (GE Healthcare, Chicago, IL, USA), and the findings were confirmed using a DEXA scan. The data was analyzed using univariate statistics.

Results: The study comprised of 892 female subjects. Their mean age was 47 +11 years, 587 (66%) had normal BMD, 261 (29%) had osteopenia, 34 (3.8 %) were diagnosed with osteoporosis, and 10 (1.1%) had severe osteoporosis. History of fractures and early menopause were considerably higher in the severe osteoporosis group with a p-value < 0.001.

Conclusions: A significant fraction of the participants (34%) had osteoporosis or osteopenia.

Keywords: Bahrain; Osteoporosis; Prevalence; Primary health care; Risk factors

*Kindly refer to PDF for tables/images for this article

Gastric outlet obstruction is a surgical emergency that presents with epigastric pain and intractable non-bilious vomiting. As per a recent literature review, theleading cause of gastric outlet obstruction is malignancy. This report presents a patient with grade two pancreatic adenocarcinoma who presented with gastric outlet obstruction symptoms: apotentially life-threatening complication of disease progression.The patient experienced severe epigastric pain and intractable projectile non-bilious vomiting.Computed Tomography confirmed the cause of severe pain and vomiting as gastric outlet obstruction. The patient was successfully managed with laparoscopic palliative gastro-jejunostomy and jejuno-jejunostomy. Here is the first case reported in the kingdom of Bahrain, where a patient with pancreatic cancer presented with symptoms of gastric outlet obstruction.The case report aimed to increaseawareness amongst health practitioners regarding the presentation of pancreatic cancer.

Keywords: Adenocarcinoma; Gastric Outlet Obstruction; Jejunostomy; Laparoscopy; Pancreatic Carcinoma

*Kindly refer to PDF for tables/images for this article

Beta-thalassemia is caused by a genetically mediated deletion of beta-globin chain of hemoglobin. It is an autosomal recessive disease, which causes a severe medical condition that requires longterm blood transfusions. An impaired hypothalamic-pituitary-ovarian axis mainly causes infertility in such patients. This case report presents a 26-year-old female, a known case of beta-thalassemia major, that received monthly blood transfusions before conceiving. The patient sought consultation for the treatment of primary infertility at Bahrain Defence Force Royal Medical Services (BDF-RMS) Hospital. The patient underwent two trials of intrauterine insemination (IUI). The goal was to build up endometrial thickness by gonadotrophins administration for embryo implantation. To conclude, IUI combined with gonadotrophins for ovarian stimulation has shown success.

Keywords: Artificial Insemination, Beta-Thalassemia, Hypogonadism, Infertility, Pregnancy

*Kindly refer to PDF for tables/images for this article

Total Abdominal Hysterectomy is a major invasive abdominal surgery which is accompanied with severe post-operative pain. Multimodal analgesia techniques can provide efficient analgesic coverage with minimal side effects, Quadratus Lumborum Block is an abdominal wall block which gives good analgesic effect for abdominal surgery with lower pain score and less requirement for opioids. A 67-year-old female was scheduled to undergo total abdominal hysterectomy surgery. The patient presented with comorbidities, morbid obesity, bronchial asthma, obstructive sleep apnea and hypothyroidism. The procedure was performed under general anesthesia and by the end of surgery, a Quadratus Lumborum Block was carried out using ultrasound-guided technique. Quadratus Lumborum Block bilaterally was successfully performed which was able to provide a sufficient analgesic effect post total abdominal hysterectomy, thus, provided the patient's with not only an opportunity for early ambulation but also avoided the adverse effects of opioids (especially the respiratory complications).

Keywords: Quadratus Lamborum Block and Abdominal Wall Nerve Block, Asthma, General Anesthesia, Hysterectomy, Obstructive Sleep Apnea

*Kindly refer to PDF for tables/images for this article

Hailey-Hailey disease (HHD) is a rare genodermatosis characterized by acantholysis and dyskeratosis of the intertriginous areas. This article presents the case of a 41-year-old Bahraini male, not known to have any medical illness, who presented with a two-year history of bilateral, painful, fissured skin lesions on the groin and axilla. The diagnosis of HHD was confirmed by biopsy. The patient was treated with a course of acitretin 25mg once daily orally for three months, and the treatment led to significant improvement. Up to date, this is the first case to be reported in Bahrain. The case report demonstrated the benefit of using acitretin in the management of HHD.

Keywords: Acantholysis, Acitretin, Axilla, Benign Familial Pemphigus, Groin, Skin Disease

*Kindly refer to PDF for tables/images for this article

Temporomandibular joint (TMJ) ankylosis is an intracapsular union of the disc–condyle complex to the temporal articular surface that confines the mandibular drive, including the fibrous adhesions/ bony fusion between condyle, disc, glenoid fossa, and eminence. It is a severe and incapacitating ailment that can cause mastication, digestion, speech, appearance, and hygiene concerns. This is an unusual case of a 42-year-old adult patient, who suffered from bilateral recurrent TMJ ankylosis and reported following trauma to the face. The patient had a history of mandibular condyle fracture at ten years of age. Excision of existing ankylotic mass followed by reconstruction with patient-specific total joint replacement (TJR) was carried out. Postoperative physiotherapy exercises in the presented case improved patient’s mouth opening, and mandibular movement. Patient-specific TJR procedures and postoperative physiotherapy will be helpful in cases with TMJ ankylosis.

Keywords: Genioplasty; Mandibular Condyle; Mandibular fractures; Temporomandibular Ankylosis; Temporomandibular Joint

*Kindly refer to PDF for tables/images for this article

When pulpal necrosis occurs in immature teeth, one of the treatment alternatives is the creation of an artificial apical barrier through the placement of an apical plug. However, controlling the mineral trioxide aggregate (MTA) during placement has proven difficult. Several studies evaluated the use of resorbable barriers to act as an internal matrix to prevent accidental extrusion of MTA. The aim of this case report was to document the effectiveness of Surgicel as a modified internal matrix for proper placement of MTA during management of immature teeth with necrotic pulp using the apical plug technique. A 12-year-old female patient reported with the chief complaint of a badly mutilated lower right second premolar. The tooth suffered enamel hypoplasia and had a defective coronal structure. It was asymptomatic except for slight tenderness to percussion. Based on the clinical and radiographic findings, a diagnosis of pulpal necrosis with symptomatic apical periodontitis was made. The 3- and 6-month followup showed radiographic evidence of continued root and hard tissue formation. Based on these findings, we infer that Surgicel can be used as a modified internal matrix to prevent extrusion of the MTA into the periapical area and allow for proper MTA placement.

Keywords: Apexification; Apical plug; Mineral trioxide aggregate; Calcium hydroxide; Surgicel; Modified internal matrix

*Kindly refer to PDF for tables/images for this article