Background: Safety climate is the behavior and perception of health care providers in maintaining a safe environment. The study of safety climate in primary health care was limited. In Bahrain the concept of assessing safety climate were understudied, which drew attention to this important aspect in health care quality to be studied.

Objective: The aim of the study was to evaluate the perception of safety climate practice in primary health care in Bahrain.

Methods: This was a cross sectional observational study. A Safety-Tool “Primary Care-Safe Quest” questionnaire was distributed among 28 health centers in Bahrain, to 279 doctors. The questionnaire consists of 30 items that are grouped into five subscales: Workload, Communication, Leadership, Teamwork and Safety system & Learning.

Results: There was no significant difference in perception of safety climate in primary care doctors according to region (p=0.753), and work experience (p=0.301). Male doctors had higher perception of workload compared to the female doctors(p=0.039). There was no significant difference in perception in communication, leadership, teamwork, safety system and learning. Workload aspect showed low level of safety perception, while the other domains showed moderate level of safety perception.

Conclusion: Overall the perception of safety climate among primary doctors in Bahrain was found to be moderate. Workload was an important area to be improved as it would lead to a better safety climate. Although the other domains were considered moderate there is still room for improvement.

Keywords: Communication, Leadership, Perception, Primary Health Care, Workload

Background: Diabetes mellitus results from defects in insulin secretion, resistance to insulin action, or both. Hyperglycemia causes small vessel diseases and thus affects the retina, kidneys, and nerves. An effect of diabetes that is not entirely understood is cognitive dysfunction.

Methods: This case-control study aimed to study the cognitive function of the participants, which included 25 diabetics and 72 without diabetes as per the inclusion exclusion criteria. Participants underwent assessment of cognition by 3MS exam, and personal data was collected. 23 participants were excluded by the exclusion criteria. Age, gender, comorbidities, education, and HbA1C were correlated with the scores. The data were analyzed by Excel version 2013.

Results: The group with diabetes showed a significant decrease in 3MS scores in comparison to the control group (90.11 ± 0.75 in controls versus 86.27 ± 1.24 in patients with diabetes, p < 0.05). People with diabetes of higher age groups scored significantly lower than the control of higher age groups (p<0.05). There was a significant relationship between cognitive scores and dyslipidemia in patients with diabetes and control samples (87 ±2.03 in patients with diabetes group with dyslipidemia versus 92.50 ± 2.09 in the control group with dyslipidemia, p< 0.05). Undergraduate controls scored higher than patients with diabetes undergraduates, p < 0.05. The correlation with gender as well as HbA1c was not significant (p>0.05).

Conclusion: It has been established that diabetes decreases cognitive function. It is important to highlight the importance of testing cognitive function routinely in patients with diabetes to prevent further complications by early detection and management.

Keywords: 3MS, Cognitive function, Diabetes Mellitus, HbA1c, Hyperglycemia

Introduction: The incidence of burnout amongst Health Care Workers (HCW) has become an important issue in recent years. This is mostly due to the potential harm and negative consequences it imposes, not only on the medical staff but also on the patient’s quality of care. The aim of this study was to find the prevalence of burnout amongst HCWs and to determine its associated factors.

Methods and materials: An online survey was sent out electronically in October 2021, to a large number of physicians and nurses practicing in both governmental as well as private hospitals. It included a total of 19 questions measuring overall physical and psychological fatigue and was filled anonymously. Burnout was considered a dependent variable, and data analysis was done using SPSS Ver. 24.

Results: The study shows that 165 (58.7%) participants worked in a High-Risk Environment (HRE), while only 38 (13.5%) participants replied that they seldom or never experience burnout. Burnout was experienced by 243 (86.5%) participants on a regular basis, either sometimes (39.5%), often (24.9%), or always (22.1%). Relative to two years ago, 217 (77.2%, p-value <0.001) respondents reported to have experienced more burnout 52 (18.5%) of them reporting that the symptoms have increased significantly over time.

Conclusion: It is clear that burnout levels amongst HCW in Bahrain are high with evidence suggesting that they are slightly increasing over time.

Keywords: Burnout, Health Care Workers, Bahrain, Stress

Background: The COVID-19 pandemic is a global health crisis with a likely long-term psychological impact on healthcare workers (HCWs). As the pandemic moves towards endemic status, little knowledge exists on how it has affected HCWs in the Kingdom of Bahrain. This study aims to evaluate the psychological impact and related factors of HCWs during the COVID-19 pandemic. Factors were assessed at two time periods: 1- July 2020 (T1: 6 months after the pandemic started in Bahrain) and 2- 6-month follow-up during January 2021 (T2: 12 months).

Methods: An online cross-sectional survey using standardized questionnaires; Impact of Event Scale-Revised (IES-R), the Beck Anxiety Inventory (BAI), and factors including lifestyle, exposure to COVID-19, and knowledge of the centre’s psychological support services was circulated during both the time periods.

Results: Based on a sample size of 366 (T1) and 537 (T2) HCWs, mild/positive PTSD prevalence increased from 18.9% (T1) to 19.6 % (T2), but anxiety decreased from 31.1% (T1) to 27.4% (T2). Sleep-related disturbances significantly decreased from T1 to T2 (32.5 % vs 24.8%, p = 0.013). Although the frequency of HCWs with psychological distress and anxiety did not change significantly over time, there was a decrease in severity of both psychological distress (p=0.06) and anxiety (p=0.005). HCWs (75%) who were aware of available psychological support services also had lower IES-R and BAI scores.

Conclusion: COVID-19 has caused psychological distress and anxiety to HCWs, but rates were lower compared to other studies. Further development of COVID-19 leadership strategies incorporating interventions focused on psychological support for HCWs is needed.

Keywords: COVID-19, Trauma, Mental health, Anxiety, Psychological impact, Post-traumatic stress disorder

Depression in pregnancy is being recognized as a major contributor to adverse maternal and fetal outcomes. Recent years have seen significant research focused on the development of safe pharmacological methods to treat depression in pregnancy, resulting in the common use of selective serotonin reuptake inhibitors (SSRIs) as a first line of treatment. There have been a few reports of congenital birth defects associated with the consumption of SSRIs during pregnancy, particularly congenital heart defects. Several studies have attempted to evaluate the relationship between SSRI use and congenital heart defects in neonates, but they were inconclusive. In this report, a case where maternal SSRI intake during two consecutive pregnancies was associated with neonatal pulmonary valve stenosis, raising the possibility of a correlation between the usage of a certain SSRI, and a particular congenital heart defect has been described.

Keywords: Congenital heart defects, Depression, Pregnancy, Pulmonary valve stenosis, Serotonin uptake inhibitors

Utilizing multiple muscle flaps is a safe and reliable technique to provide stable soft tissue cover for major post-traumatic defects of the lower limbs.

A fifty-five-year-old female patient presented to the emergency department with a huge crush/degloving injury of the whole anteromedial aspect of the right lower limb with open comminuted fracture of the femur, the tibia, and the fibula. Radiological computerized tomography (CT) study showed displaced comminuted fractures involving the lower shaft of the femur, proximal fibula, and middle third of the shaft of the tibia, with tangential bone loss in the knee joint.

The patient underwent multiple sessions of wound and bone debridement with bone fixation which was followed by multiple reconstructive surgeries.

Patient recovered well and was discharged home with the ability to mobilize with Zimmer frame and knee brace support.

Keywords: Comminuted fractures, Degloving injuries, Muscles, Reconstructive surgical Procedures, Surgical flap

Reconstruction of the external ear is a challenging problem encountered by plastic surgeons. Causes of external ear deformities can be of various etiologies (human bites, animal bites, fights, burns, infections, accidents, or even sports injuries). Full-thickness defects, which cannot be treated by approximating the wound edges, show good results with Antia-Buch’s chondro-cutaneous flaps.

A 34-year-old male presented with a history of human bite to his right external ear. The patient had brought the amputated part with him. There was complete amputation of the superior part of the helix with exposed cartilage with a 2 cm defect on examination. The amputated part was an unhealthy crushedavulsed tissue. The patient underwent debridement and washout. Reconstruction of the external ear was done by Antia-Buch helical advancement flap designed over the posterior skin. Post-operatively, the external ear reconstruction yielded good cosmetic results.

Animal or human bite defects used to be left open for fear of severe infections, and closure was planned later, but this can be complicated by fibrosis and can result in a change in the shape of the external ear.

Primary repair using an Antia-Buch flap and appropriate antibiotic treatment shortens the hospital stay and dressing changes and improves the cosmetic outcome.

Keywords: Amputation, Cartilage, External ear, Fibrosis, Human Bite, Reconstructive Surgical Procedures

Juvenile parkinsonism is a rare disease affecting patients younger than the age of 21 years. When superimposed with pregnancy, most physicians fear its health complications and the role of the treatment and its safety for the fetus. This case presents a 37-year-old woman diagnosed with juvenile parkinsonism who was blessed with her second child, eight years after her first. Despite all the odds, concerns, and warnings from family and physicians, the patient was determined to conceive, avoiding all means of contraception. During pregnancy, the patient experienced multiple hypoglycemic attacks and was diagnosed with gestational diabetes mellitus, which was controlled accordingly. The patient also suffered from motor impairments that worsened with the progression of pregnancy. However, the patient regained previous motor function upon delivery. The expectation that pregnancy may permanently worsen the symptoms of Parkinson’s disease is not explicit; some pregnancies are uncomplicated by Parkinsonism yet complicated by pregnancy-induced medical conditions. As demonstrated in this case, family support and care, alongside continuous maternofetal monitoring, aids in the success of pregnancy in patients with juvenile Parkinson’s disease regardless of their risks.

Keywords: Female, Juvenile Parkinsonism, Pregnancy, Parkinson’s disease, Therapeutic Safety

Sacrococcygeal teratoma (SCT) is the most commonly diagnosed congenital tumor during the neonatal period. The outcome of SCT is dependent on the growth rate, the presence of solid components in cancer, and the presence or absence of high flow cardiac involvement of the fetus. This case report presents the management and outcome of a pregnant woman carrying a fetus with a rapidly growing SCT. Confirmation of diagnosis was based on the universal prenatal ultrasound examination standards. Eventually, the patient delivered a girl weighing 2.9 kg, including the neoplasm, by a planned Cesarean section. The newborn received one dose of surfactant and underwent complete resection of the teratoma on the second day with a favorable outcome. This case report aims to show that rapidly growing SCT requires frequent antenatal follow-up with serial prenatal ultrasound examinations, optimum timing, mode, and appropriate place of delivery for a better fetal outcome.

Keywords: Prenatal diagnosis, Preterm delivery, Rapidly growing neoplasm, Sacrococcygeal teratoma, Surgical resection of teratoma

Anterior cruciate ligament (ACL) rupture is more likely in young people who participate in sports that require pivoting, decelerating, and leaping. The objectives of treatment are to restore knee function, address psychological barriers to active participation, return to flying as soon as possible, prevent further injury and osteoarthritis, besides optimize long-term quality of life.

Practical suggestions are provided for educating and discussing treatment choices with patients, as well as explaining patient-related characteristics linked with a poorer ACL rupture result.

Keywords: Anterior cruciate ligament injuries, Knee joint, Magnetic resonance imaging, Quality of life, Rupture