Salmaniya Medical Complex Research Articles

Quality of Life in Hemodialysis Versus Peritoneal Dialysis Patients in Bahrain.

Chronic diseases, including chronic kidney disease, affect patients' quality of life (QOL). Hemodialysis (HD) and peritoneal dialysis (PD) are renal replacement methods in these patients. This work aimed to study the relationship between QOLscores in patients with end-stage renal disease (ESRD) on HD and PD. This study was done at Salmaniya Medical Complex (SMC), Bahrain, from May to July 2023. A standard QOL index score instrument in Arabic form was used on 76 HDand 38 PDpatients. The inclusion criteria included dialysis for at least three months and an age of more than 18 years with no severe morbidities or psychological diseases. The mean age of HD and PD patients was 58.7 ± 11.2 and 55.9 ± 12.1 years, respectively. Thirty-five (46.1%) of the HD patients and 17 (44.7%) of the PD patients were females. In most dimensions, the QOL score of the patients treated with PD was better than that of the HD group. The number of hospital admissions was statistically significantly higher in the HD group (p = 0.007); however, there was no significant difference in the causes of admissions (p = 0.131).In this study, we observed the highest QOL score in the family subscale (93.2 ± 9.2 and 98.6 ± 4.7), followed by the psychological/spiritual subscale (81.1 ± 16.7 and 97.6 ± 3.9) in the HD and PD groups, respectively), but it was statistically significantly higher in the PD group (p < 0.001). Our findings show that patients starting PD had better QOL scores in all domains than patients starting HD. Moreover, patients on PD maintained more active social support and ultimately felt better emotional well-being and physical health than those undergoing HD.

A Retrospective Study of the Epidemiology, Histomorphological Features, Hormonal Status, and Radiological Features of Breast Cancer Diagnosed on Biopsies in Women in Bahrain Up to the Age of 40: A Single-Center Study.

Breast cancer is the most commonly diagnosed cancer in women worldwide. There are many risk factors that contribute to breast cancer which involvemodifiable and non-modifiable factors. Most of the patients diagnosed with breast cancer are over 50 years of age, with breast cancer in women less than 40 years of age being relatively rare and typically more aggressive variants. Moreover, radiological examination is essential for diagnosis and triaging patients for further diagnostic procedures including tissue biopsy sampling. Despite the rarity of malignancy amongthe younger age group, all of their breast lesions are usually biopsied. Hence, this paper outlines the percentage of benign and malignant breast lesions detected on biopsies obtained from female patients who presented to our hospital before or at the age of 40. We conducted a single institution retrospective study on 267 breast biopsies done for female patientsbefore or at the age of 40 in the period from January 2020 to January 2023. The data was obtained from the National Health Information System at Salmaniya Medical Complex. The data collected included clinical history, histological, and radiological findings. Data on prognostic markers (estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status) were also included. The distribution of samples was established according to age ranges, pathological diagnostic categories (B1-5), and prognostic marker interpretation. Further subdivision was performed on cases with malignancy according to tumor grade. The frequency distribution was obtained for ER, PR, and HER status jointly. The association between age and grade, as well as age and categories, was also determined. All the analyses were performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp), and the statistical significance was tested at a 5% level. Out of 267 samples, the majority (62.9%) were in patients with a range of age between 30 and 40. There were 68.5% of samples with the B2 (benign) category, followed by 20.2% with the B5b (malignant-invasive carcinoma) category. Out of 61 malignant samples, there were 17 (6.4%) samples positive on ER and PR but negative on HER2, 16 (6.0%) samples negative on ER, PR, and HER2, eight (3.0%) samples negative on ER and PR negative but positive on HER2, and five (8.2%) samples positive on ER, PR, and HER2. The majority of malignant cases were of grade II which accounted for 29 (10.9%) samples, followed by 23 (8.6%) with grade III. The association between age and grade was statistically not significant (p=0.113). However, the association between age and B categories was statistically significant with a p-value of 0.0002. A significantly higher proportion of cases with B5a (malignant-in situ carcinoma) or B5b (malignant-invasive carcinoma) categories were in the age range of 31-35 years and 36-40 years. Breast cancer is rare amongyounger women. It mostly occurs in women over the age of 40 years. In women under the age of 40, it usually presents as a self-detected palpable mass and can show various radiological findings in accordance with the histological grade. Ultrasonography is the main method for the diagnosis of breast cancer especially in younger women, whereas mammography and MRI can contribute to both diagnosis and assessment of the extent of the disease.

Accidental ingestion of foreign bodies/harmful materials in children from Bahrain: A retrospective cohort study.

Children like to discover their environment by putting substances in their mouths. This behavior puts them at risk of accidentally ingesting foreign bodies (FBs) or harmful materials, which can cause serious morbidities. To study the clinical characteristics, diagnosis, complications, management, and outcomes of accidental ingestion of FBs, caustics, and medications in children. We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 2011 and 2021. Demographic data, type of FB/harmful material ingested, and investigations used for diagnosis and management were recorded. The patients were divided into three groups based on the type of ingested material (FBs, caustics, and medications). The three groups were compared based on patient demographics, socioeconomic status (SES), symptoms, ingestion scenario, endoscopic and surgical complications, management, and outcomes. The FB anatomical location was categorized as the esophagus, stomach, and bowel and compared with respect to symptoms. The Fisher's exact, Pearson's χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for comparison. A total of 161 accidental ingestion episodes were documented in 153 children. Most children were boys (n = 85, 55.6%), with a median age of 2.8 (interquartile range: 1.8-4.4) years. Most participants ingested FBs (n = 108, 70.6%), 31 (20.3%) ingested caustics, and the remaining 14 (9.2%) ingested medications. Patients with caustic ingestion were younger at the time of presentation (P < 0.001) and were more symptomatic (n = 26/31, 89.7%) than those who ingested medications (n = 8/14, 57.1%) or FBs (n = 52/108, 48.6%) (P < 0.001). The caustic group had more vomiting (P < 0.001) and coughing (P = 0.029) than the other groups. Most FB ingestions were asymptomatic (n = 55/108, 51.4%). In terms of FB location, most esophageal FBs were symptomatic (n = 14/16, 87.5%), whereas most gastric (n = 34/56, 60.7%) and intestinal FBs (n = 19/32, 59.4%) were asymptomatic (P = 0.002). Battery ingestion was the most common (n = 49, 32%). Unsafe toys were the main source of batteries (n = 22/43, 51.2%). Most episodes occurred while playing (n = 49/131, 37.4%) or when they were unwitnessed (n = 78, 57.4%). FBs were ingested more while playing (P < 0.001), caustic ingestion was mainly due to unsafe storage (P < 0.001), and medication ingestion was mostly due to a missing object (P < 0.001). Girls ingested more jewelry items than boys (P = 0.006). The stomach was the common location of FB lodgment, both radiologically (n = 54/123, 43.9%) and endoscopically (n = 31/91, 34%). Of 107/108 (99.1%) patients with FB ingestion, spontaneous passage was noted in 54 (35.5%), endoscopic removal in 46 (30.3%), laparotomy in 5 (3.3%) after magnet ingestion, and direct laryngoscopy in 2 (1.3%). Pharmacological therapy was required for 105 (70.9%) patients; 79/105 (75.2%) in the FB group, 22/29 (75.9%) in the caustic group, and 4/14 (28.8%) in the medication group (P = 0.001). Omeprazole was the commonly used (n = 58; 37.9%) and was used more in the caustic group (n = 19/28, 67.9%) than in the other groups (P = 0.001). Endoscopic and surgical complications were detected in 39/148 (26.4%) patients. The caustic group had more complications than the other groups (P = 0.036). Gastrointestinal perforation developed in the FB group only (n = 5, 3.4%) and was more with magnet ingestion (n = 4) than with other FBs (P < 0.001). In patients with FB ingestion, patients aged < 1 year (P = 0.042), those with middle or low SES (P = 0.028), and those with more symptoms at presentation (P = 0.027) had more complications. Patients with complications had longer hospital stays (P < 0.001) than those without. Accidental ingestion in children is a serious condition. Symptomatic infants from middle or low SES families have the highest morbidity. Prevention through parental education and government legislation is crucial.

Abdominal Imaging Findings in Laboratory-Confirmed COVID-19 Patients: A Retrospective Observational Study.

Coronavirus disease 2019 (CO-VID-19) is known to predominantly present with respiratory symptoms; however, a significant proportion of patients present with digestive symptoms. These symptoms are often non-specific and as such prompt the treating physician to request further imaging evaluation. Understanding the abdominal imaging findings in COVID-19 and their possible associations is thus crucial to direct patient care and prevent misdiagnosis.The aim of this study was to describe abdominal imaging findings on both computed tomography (CT) and ultrasound scans in cases with positive COVID-19 polymerase chain reaction (PCR) tests performed at our institution, and also, to evaluate the reason for requesting these imaging studies, and to correlate these findings with patients' demographics. A retrospective observational study was conducted at Salmaniya Medical Complex, Bahrain, between February 2021 and March 2022. We examinedthe abdominal CT and ultrasound data for PCR-confirmed COVID-19 patients. The demographic data, reason for requesting imaging and imaging findings were gathered by reviewing the hospital's electronic health records and picture archiving and communicating system (PACS). The study included 97 patients, with the majority being male (57.7%). The most common reason for imaging was abdominal pain, as seen in over half of the patients (60.8%), followed by deranged liver enzymes (18.6%). More than 75% of imaging studies showed positive abdominal findings with the majority (19.6%) showing non-specific inflammatory findings, followed by gallbladder disease (13.4%). The CT studies were more likely to yield positive findings as compared to ultrasound, with only 7 (11.3%) CT scans yielding normal findings (χ2 = 14.65; P < 0.01). To our knowledge, the research conducted on the abdominal manifestations of COVID-19 is still limited, especially in our region. Our study showed that there are variable presentations of abdominal organ involvement in COVID-19 cases, and as such more data is required to direct choice of imaging study, protocol, and interpretation of findings to better guide patient management.

Effect of HMGB1 and HBD-3 levels in the diagnosis of sepsis- A comparative descriptive study

Sepsis is a life-threatening condition characterized by a dysregulated host response to infection. Early and accurate diagnosis of sepsis is crucial for timely intervention and improved patient outcomes. In recent years, there has been growing interest in identifying reliable biomarkers to aid in the diagnosis of sepsis. This study aims to evaluate the levels of two potential biomarkers, high-mobility group box 1 (HMGB1) and human β-defensin 3 (HBD-3), and compare their diagnostic efficacy in sepsis.We aimed to assess HMGB-1 and HBD-3 levels in sepsis and assess the combined diagnostic validity of HMGB-1 and HBD-3. In this case-control study, the plasma concentration of HMGB-1 and HBD-3 was measured using an enzyme-linked immunosorbent assay (ELISA). Two groups, totaling 144 people, were formed; 66 patients treated in the ICU for sepsis were included in the patient group. 78 Blood donors from the Salmaniya Medical Complex Blood Bank who had no prior infection or inflammatory disease made up the Control group. The statistical computations were performed using the STATA 8® statistical software tool (StataCorp LP, College Station, TX, USA).In patients' mean HMGB-1 levels were 2.1442 ng/ml, compared to 0.62141 ng/ml in the control group. The mean HBD-3 level was 1068.453 ng/ml in sepsis patients versus 589.935 ng/ml in controls. A significant difference between the two groups has been observed in both biomarkers (P < 0.05). The sensitivity of HMGB-1 was 75.8% and 41.3%, respectively. The sensitivity and specificity of HBD-3 were 63.6% and 93.5%, respectively.The levels of HMGB-1 and HBD-3 between healthy and septic subjects varied significantly. HMGB-1 and HBD-3 levels in the blood tested together might accurately identify sepsis. These findings contribute to the growing body of evidence supporting the utility of biomarkers in sepsis diagnosis, and may ultimately aid in the development of more effective diagnostic strategies for sepsis management.

Assessing indicators and clinical differences between functional and organic childhood constipation: a retrospective study in pediatric gastroenterology clinics.

Chronic constipation is common among children worldwide. Constipation includes functional constipation (FC) and organic constipation (OC). The early recognition of the causes of childhood constipation and its subsequent complications is important. This study aimed to evaluate the prevalence and causes of childhood constipation and compare the clinical characteristics, treatment, and outcomes of children with FC versus OC to identify the predictive factors. This retrospective cross-sectional study analyzed children with FC or OC diagnosed in pediatric gastroenterology clinics, Salmaniya Medical Complex, Bahrain, 2017-2021. The Rome IV criteria were used to define FC. A total of 7,287 gastroenterology appointments were attended by 4,346 children during the study period. Of the 639 children (14.7%) with constipation, 616 (96.4%) were included in the study. Most patients had FC (n=511, 83%), whereas 17% (n=105) had OC. FC was more common in females than in males. Children with OC were younger (P<0.001) and had lower body weights (P<0.001), more stunted growth (P<0.001), and more associated diseases (P= 0.037) than those with FC. Enuresis was the most associated disease (n=21, 3.4%). Organic causes included neurological, allergic, endocrine, gastrointestinal, and genetic diseases. Allergies to cow milk protein were the most common (n=35, 5.7%). The presence of mucus in the stool was more common in OC than in FC (P=0.041), but no other symptoms or physical findings differed. A total of 587 patients (95.3%) received medication, among which lactulose was commonly prescribed (n=395, 64.1%). There were no intergroup differences in nationality, sex, body mass index, seasonal variation, laxative type, or treatment response. A good response was observed in 114 patients (90.5%). Chronic constipation represented a significant proportion of outpatient gastroenterology visits. FC was the most common type. Young children with a low body weight, stunted growth, mucus in the stool, or associated diseases should be assessed for an underlying organic cause.

Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion.

Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patientage, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testiswas 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.

An Exploratory Qualitative Study of Oncology Nurses’ Experience in Providing Care for Terminally Ill Patients in Salmaniya Medical Complex in Bahrain

Oncology nurses are essential in palliative care for cancer patients, especially at end-of-life stages. Caring for terminally ill cancer patients is stressful, accompanied by negative and positive feelings, but oncology nurses have an unavoidable responsibility. However, little is known about oncology nurses' experience in the Kingdom of Bahrain caring for terminally ill cancer patients in their final weeks or days. This study aimed to explore the experience of oncology staff nurses in providing care for terminally ill patients in the Kingdom of Bahrain, and the research answered those questions: (a) What is the experience of oncology staff nurses in providing care for terminally ill patient? And (b) How does the experience of oncology nurses in providing care to terminally ill patients impact the quality of care provided to patients? A qualitative descriptive, interpretive exploratory research design was utilized for this study to explore the experience of oncology staff nurses with terminally ill patients, conducted in two hospital settings at Salmaniya medical complex (inpatient &amp; outpatient) oncology department. The data were collected using a purposive sampling to include 15 oncologist nurses whose experiences were across various characteristics with different professional roles and qualifications. The data were collected through 15 semi-structured interviews guided by a semi-structured interview protocol. Data were analyzed using Braun and Clarke's 2006 thematic analysis model without pretexting. The research findings revealed three key themes that emerged from thematic analysis: (1) exhausting versus rewarding experienced feelings; (2) Factors influencing Nursing care; (3) Moral Distress. End-of-life care in the Kingdom of Bahrain reflects and has been influenced by primary total nursing care. Oncology nurses reported suffering but also benefiting from their experiences. End-of-life cancer care training is needed and urged by oncology nurses, especially those younger and less experienced. Also, future studies are mandated to explore interventions to help overcome the challenges that are impeding nurses from providing high-quality care for terminally ill patients in the kingdom of Bahrain.

A Retrospective Study of the Prognostic Patterns in Colorectal Cancer Patients.

Introduction Colorectal cancer (CRC) management has advanced globally, leading to a steady decline in mortality rates. However, recent studies have shown that the prognosis of CRC varies based on the anatomical site of the primary tumor, histopathological grading, and type of mutation. With an increase in the incidence of CRC globally and in Bahrain, there is a need for a recent descriptive study to improve overall management. This study aims to investigate the anatomical, histopathological, and molecular prognostic factors in CRC patients presenting to the Salmaniya Medical Complex (SMC). Methods The study was conducted retrospectively using ISEHA electronic database over two years (January 2019 to December 2020). A total of 101 patientswith primary CRC registered in the General Surgery Department were included in this study. The sample size was further stratifiedand analyzed using descriptive statisticsbased ontheavailable dataof measured outcomes. Results Anatomical data showed that 65% of CRC patients had a tumor on the left side of the colon, 27.7% on the right side, and 7% in the transverse colon. Overall, 16.8% of all patients had rectal involvement. Histopathological data showed that 86% of the patients had a low-grade CRC adenocarcinoma. The most diagnosed tumor stage was pT3N0M0 (22.8%). In addition, there were ten metastatic cases (10 to the liver, of which three had concomitant lung involvement and two had concurrent brain metastases). The average tumor diameter was 46.2 mm, where 63% ranged between 30 mm to 69 mm. Most mutations involved theTP53(27.7%) and theKRAS(29%) genes. Conclusion The study found thatmajority ofCRC patients atSMCin Bahrain had relatively good overall anatomical,tumor staging and grading prognostic factorsbut somewhat poorermolecularprognostics.

Correlation between thyroid fine needle aspiration cytology and postoperative final histopathology: a 5-year single-centre retrospective study

Background: Thyroid nodules are common problems encountered in our routine practice. Fine needle aspiration cytology (FNAC) is the most accurate and cost-effective method for evaluating thyroid nodules. It is the procedure of choice for identifying patients who require surgical excision. Methods: This is a retrospective single-center observational study in Salmaniya Medical Complex, a tertiary care center, in Kingdom of Bahrain that aims to to correlate preoperative FNAC results with the post-surgical histopathology report, and to compare our diagnostic performance results to previously published literature. Results: The post-operative histology was reported as benign in 62% of patients and malignant in 38% of patients. Bethesda II was the most common category in our sample, with 14.3% having a final histopathological diagnosis of malignancy (false negative results). Malignancy was found in 84% and 96.8% of Bethesda V and VI, respectively. Our FNAC data achieved an 80.95% sensitivity, specificity of 93.51% specificity, and a total accuracy of 87.86%. The positive predictive value was 91.07%, and an 85.71% negative predictive value, which were comparable to data from published series. Conclusions: FNAC remains the most accurate and cost-effective method for evaluating thyroid nodules. However, its diagnostic value varies among different institutions. Our results demonstrated higher rates of malignancy compared to other published series in both category I and II. Due to the chance of false negative rates in these categories and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow up.

Outcome of premarital genetic counseling for couples at risk of hemoglobinopathies in Kingdom of Bahrain.

Hemoglobinopathies are the commonest inherited blood disorders and form a serious burden worldwide, affecting communities, patient quality of life and healthcare resources. The Kingdom of Bahrain has issued a law obligating couples to undergo premarital screening to detect those at risk of having children affected with these disorders. The aim of this study was to analyze the marital decisions of couples at risk for hemoglobinopathies and follow up the outcomes. A retrospective study was conducted on couples at risk for hemoglobinopathies identified during the premarital screening program at local health centers in the Kingdom of Bahrain and referred to the genetics department in the Salmaniya Medical Complex for genetic counselling in 2018-2020. A total of 189 couples were found to be at risk for hemoglobinopathies, of whom 159 completed the survey. Of these, 107 (67%) decided to proceed with their marriage and 26 couples achieved pregnancy. Out of 24 at-risk pregnancies with known outcome, 83.3% were spontaneous whereas only 16.7% underwent in-vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD). Eight out of 20 infants born to couples after spontaneous conception were affected. A positive attitude toward IVF with PGD was held by 60% of at-risk couples. Despite undergoing premarital screening and genetic counselling, a large percentage of at-risk couples proceeded with their marriage. Most of them justified their decision due to the availability of advanced methods that aid in the prevention of having an affected child. However, the cost of such intervention was a major barrier for the majority of couples.

Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain.

Gastrointestinal bleeding (GIB) is a serious health problem worldwide, particularly during childhood. This can be an alarming sign of an underlying disease. Gastrointestinal endoscopy (GIE) is a safe method for the diagnosis and treatment of GIB in most cases. To determine the incidence, clinical presentation, and outcomes of GIB in children in Bahrain over the last two decades. This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex, Bahrain, between 1995 and 2022. Demographic data, clinical presentation, endoscopic findings, and clinical outcomes were recorded. GIB was classified into upper (UGIB) and lower (LGIB) GIB according to the site of bleeding. These were compared with respect to patients' sex, age, and nationality using the Fisher's exact, Pearson's χ 2, or the Mann-Whitney U tests. A total of 250 patients were included in this study. The median incidence was 2.6/100000 per year (interquartile range, 1.4-3.7) with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). The median age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIE alone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was more frequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormal endoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatory bowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%). IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P = 0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, and esophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029, respectively). Ten (4%) patients underwent one or more therapeutic interventions. The median follow-up period was two years (0.5-3). No mortality was reported in this study. GIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due to IBD, was more common than UGIB, commonly due to gastritis.

The Prevalence of Iron and Vitamin D Deficiencies in Pediatric Patients With Inflammatory Bowel Disease in Bahrain.

Introduction Inflammatory bowel diseases (IBD) are chronic diseases that can affect nutrient absorption leading to micronutrient deficiencies and biochemical abnormalities.This study aimed to assess certain serum micronutrients and nutritionally related biochemical markers levels in patients with pediatric IBD and to compare the actual levels and the prevalence of micronutrients deficiencies and biochemical abnormalities between patients with Crohn's disease (CD) and those with ulcerative colitis (UC). Methods A retrospective cross-sectional study reviewing medical records of patients with IBD was conducted in the pediatric department,Salmaniya medical complex, Bahrain, from 1January 1984 to 31December 2021. Demographic data and laboratory resultsrelated to micronutrients and biochemical markers including full blood count, totalprotein,albumin,globulin,iron, ferritin, folic acid, vitamin B12, calcium, phosphorous, magnesium, and vitamin D levelswere collected upon presentation before starting the treatment. Nutritional deficiencies were compared based on sex, nationality, type of IBD, age at presentation, disease duration, weight at diagnosis, and inflammatory markers levels including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Results Of 157 patients with pediatric IBD, 117 (74.5%) were included. Sixty-six (56.4%) patients were males. Sixty-six (56.4%) had CD and 51 (43.6%) had UC. No patient had indeterminant colitis. The mean age at presentation was 10.8±3.8 years. Most patients had one or more micronutrient deficiencies (n=110, 94%). Anemia was a common finding (n=79/116, 68.1%), with iron deficiency anemia (IDA) being predominant. Low iron levels were noted in64/77 (83.1%) patients with a medianof 5.0 (2.0-9.3) µmol/L (normal range, 11.6-31.3);isolated iron deficiency (ID) in 11/18 (61.1%)and IDAin 53/59 (89.8%) patients. Vitamin D deficiency was the second most common (n=45/61, 73.8%). Serum albumin, ferritin, calcium, phosphorous, and magnesium were deficient in 29.2%, 27.8%, 31.7%, 12.5%, and 10%, respectively. One patient had vitamin B12 deficiency while nonehad folate deficiency. Patients with CD had significantly lower serum iron (5.4±5.6 versus 8.1±6.09 µmol//L, p=0.02) and lower serum protein (71.7±8.7 versus 75.4±9.9 g/L, p=0.043)but higher serum ferritin (45 (19-110.2) versus 21.3 (10.3-51.2) µg/L, p=0.046) compared to those with UC. Elevated ESR was noted in 62/105 (59.1%) patientswhile high CRP was found in 67/104 (64.4%).Patients with low ironhadhigher ESR (28 (17-47) versus 14 (10-33) mm/h, p=0.028) and higher CRP (13.3 (1.6-42) versus 1.8 (0.9-4.6) mg/L, p=0.019) levelscompared to those with normal levels. Conclusion Patients with pediatric IBD are at risk of multiple micronutrient deficiencies and biochemical abnormalities. Iron and vitamin D deficiencies are the most frequent. Patients with CD are more prone to have lower serum iron and protein levels than those with UC.ID was associated with elevated inflammatory markers.

Factors associated with poor outcomes in patients with severe acute respiratory infections in Bahrain.

Severe acute respiratory tract infection (SARI) is a major global health threat. This study aimed to examine risk factors associated with poor outcomes in patients with SARI. All patients who met World Health Organization's (WHO) SARI case definition and were admitted to Salmaniya Medical Complex from January 2018 to December 2021 were included. Epidemiological and virological data were obtained and analyzed. Of 1159 patients with SARI included, 731 (63.1%) patients were below 50 years, and 357 (30.8%) tested positive for viral pathogens. The most prevalent virus was Flu-A (n=134, 37.5%), SARS-CoV2 (n=118, 33%), RSV (n= 51, 14.3%), Flu B (n= 49,13.7%), other viruses (n= 3, 0.8%), and combined infection (n= 2, 0.6%). Six hundred fifty-eight (56.8%) patients had comorbidities, mainly diabetes (n= 284, 43%) and heart disease (n= 217, 33%). 183 (16%) patients were admitted to ICU, 110 (9%) needed mechanical ventilation, and 80 (7%) patients died.The odds of ICU admission were higher for patients with hematological (OR 5.9, 95% CI 3.1-11.1) and lung diseases (OR 2.7, 95% CI 1.6-4.6). The odds of mechanical ventilation were higher among patients with lung disease (OR 3.1, 95% 1.7-5.5). The mortality odds were higher among patients above 50 (OR 2.4, 95% CI 1.4-4.1) and chronic kidney disease (OR 2.5, 95% CI 1.1-5.2). Being 50 years or above or having kidney, lung, or heart diseases was associated with worse SARI outcomes. Efforts and actions in developing better strategies to vaccinate individuals at high risk and early diagnosis and treatment should help in reducing the burden of SARI.

Clinical Characteristics and Outcome of Infants with Biliary Atresia in Bahrain.

Though the prevalence of biliary atresia (BA) in the Middle East is low, its role in causing life-threatening liver diseases is disproportionately high. This study aimed to assess the prevalence, clinical presentations, diagnosis, surgical interventions, and long-term outcomes including survival rate, and to analyze prognostic factors affecting the survival of infants with BA in Bahrain. A retrospective cohort review of cases of infants diagnosed with BA between January 1993 and December 2021 at Salmaniya Medical Complex, Bahrain, was conducted. Demographic, clinical, laboratory, imaging, and histopathological data were analyzed. Outcomes measured included 5-year native liver survival (NLS) and overall liver survival (OLS) rates. Out of 27 infants diagnosed with BA, 26 were included in the study. The overall prevalence was 0.007% and was significantly higher among Bahraini (0.006%) compared to the non-Bahraini population (0.001%), p< 0.001. Most patients had clay-colored stool (19 of 22; 86.4%) and hepatomegaly (18; 81.8%). Kasai procedure was performed in 23 (88.5%) patients and primary liver transplant (LT) in three. Ten (38.5%) infants required LT after the Kasai procedure. The median age at diagnosis was 56 days with interquartile range (IQR) of 30-90, and the median age at the Kasai procedure was 61 days (IQR = 56-90). NLS and OLS rates were 53.8% and 65.4%, respectively. The overall mortality rate was 34.6%. Six of the 13 (46.2%) patients who were subjected to Kasai procedure alone died awaiting LT donors. Infants with lower birth weight and older age at diagnosis had significantly better odds of survival (p< 0.029 and p< 0.044, respectively). BA is uncommon among infants in Bahrain. Despite effective treatment options, late diagnosis can lead to significant morbidity and mortality. Our study found a relatively low prevalence of NLS (53.8%) and OLS (65.4%). Since the majority of the diagnosed patients had presented with clay-colored stools, implementing an infant stool card for screening may be beneficial in raising parental awareness and detecting BA early. Early detection and treatment using novel therapies are likely to improve the survival rates.

A Review of Radiological Investigations in Cases of Acute Appendicitis in a Tertiary Care Hospital.

Acute appendicitis is the most common non-traumatic surgical emergency and early diagnosis and management are crucial to decrease morbidity and mortality. There is a variety of scoring systems and radiological investigations that have been used in the diagnosis of acute appendicitis. Hence, the aim of this study is to assess the diagnostic approach in patients with suspected appendicitis in a tertiary care hospital, focusing on the radiological burden. This is a cross-sectional study reviewing the electronic and manual medical records of all adult patients admitted with the diagnosis of acute appendicitis between January 2018 and December 2018 in Salmaniya Medical Complex, Manama, Bahrain. A review of the method of diagnosis (clinical, ultrasound, computed tomography, or others) was done, with a comparison to histopathological results in those that underwent surgical intervention to determine sensitivity and specificity. In the study period, 488 patients were admitted with acute appendicitis; out of these, 461 underwent surgical intervention. A total of 66 CT scans and 148 ultrasounds were conducted for these patients, out of which 57% of ultrasounds and 86% of CT scans accurately diagnosed acute appendicitis based on histopathological diagnosis, resulting in a sensitivity of 65% and 92%, respectively, and a specificity of 56% and 25%, respectively. The most accurate method of diagnosis of acute appendicitis (highest sensitivity) is CT scanning. However, a prospective study with a detailed assessment of complications of appendicitis is recommended.

Patterns of Corneal Disorders in Corneal Button Specimens: Descriptive Study in a Tertiary Referral Hospital in Bahrain

Introduction: Corneal injuries and disorders are among the commonest clinical scenarios that are encountered in the ophthalmology clinical practice. Penetrating Keratoplasty (PKP) surgeries count for the most frequent efficient surgical management of diseased corneas. The latter are usually sent as button specimens for histopathology examination for further describing the pattern of the corneal disorders. Aims and Objectives: The aims of this study are to discuss the rate of Penetrating Keratoplasty (PKP) surgeries in SMC in 6 years interval (2016-2022) along with to determine the most common histopathological and microbiological diagnosis of corneal specimens from Penetrating Keratoplasty (PKP) and to study the clinical spectrum with age and sex distribution of corneal disorders in Bahrain alongside correlation with the comorbidities and the pathological diagnosis. Patients and Methods: It is a retrospective analysis of one-hundred and one histopathology reports of corneal button specimens at Salmaniya medical complex during the last 6 years (1-1-2016 till 31-3-2022). Medical records, surgical notes and histopathology reports of patients were retrieved from ISEHA system. Statistical analysis was done using Microsoft Excel 2019. Results: Corneal scarring (44%) was the most common pathological diagnosis, followed by Keratoconus (KC) (15%), acute keratitis (14%), degeneration (9%), chronic keratitis with fibrosis (5%), decompensated cornea and failed graft (5%), pseudophakic bullous keratopathy (3%) and herpetic keratitis (3%). There was Bahraini nationality (98%) and male preponderance (66%). The most common age group affected was 70–79 years with the median age of 51.5 year. Conclusion: Our study shows the importance of determining the most common histological diagnoses of corneal button specimens along with the correlation of the latter with the age, gender, surgical complications and systemic comorbidities. Knowing the exact pathology of the diseased cornea would assist in providing the proper post-operative management and to avoid possible elements that could promote complications.

Clinical, Laboratory, Radiological, and Genetic Characteristics of Pediatric Patients with Alagille Syndrome.

Alagille syndrome (ALGS) is an autosomal dominant disease caused by JAG1 or NOTCH2 mutation. It is diagnosed by the presence of three out of five features: characteristic facies, posterior embryotoxon, peripheral pulmonary stenosis, vertebral defects, and interlobular bile duct paucity. This study aimed to review the prevalence, clinical presentations, diagnosis, treatment, and outcome of patients with ALGS. This is a retrospective review of patients with ALGS at the Pediatric Department, Salmaniya Medical Complex, Bahrain, between August 1994 and October 2022. The diagnosis was based on clinical, laboratory, radiological, histopathological, and genetic findings. Five patients were found to have ALGS. The prevalence of ALGS in Bahrain was 1.04 patients per 100,000 (0.001%). Four were Bahraini and three were females. Median birth weight was 2.3 (2.3-2.5) kg. All patients presented at the time of birth with low birth weight, cholestatic jaundice, clay-colored stool, heart murmur, and dysmorphic facial features. All had congenital heart diseases, two had butterfly vertebrae, and one had posterior embryotoxon. All had elevated liver enzymes and normal abdominal ultrasound. Three had positive hepatobiliary iminodiacetic acid scan and one had bile duct paucity in liver biopsy. Three had intraoperative cholangiogram. Four were positive for JAG1 mutation. All received ursodeoxycholic acid and fat-soluble vitamins. Two required liver transplantation. ALGS is a rare disorder in Bahrain. Diagnosis is challenging as the disease can be associated with or misdiagnosed as biliary atresia. Patients with ALGS are at high risk of morbidity either by unnecessary intraoperative cholangiogram or unavoidable liver transplantation.

Implementation of Ventilator-Associated Pneumonia Prevention Bundle among ICU Nurses in Salmaniya Medical Complex, Bahrain: A Quasi-Experimental Study

Objective: To evaluate the effectiveness of an educational intervention to improve the knowledge regarding ventilator-associated pneumonia (VAP) and practices of VAP prevention bundle among the intensive care unit (ICU) nurses in Salmaniya Medical Complex in Bahrain. Methods: A quasi- experimental study was conducted in the main ICU of Salmaniya Medical Complex in Bahrain from October 2021 to January 2022. A convenience sampling technique was used, and 58 ICU staff nurses were enrolled in the study. Tools used for data collection were a self-administered questionnaire to assess ICU nurses knowledge and an observational checklist to assess the adherence of ICU nurses to the VAP prevention bundle. Results: Of 58 total study subjects, almost three-quarters of the ICU nurses 42 (72%) had poor knowledge of VAP prior to the educational intervention. However, after the implementation, the proportion increased with 46 (79%) of the nurses acquiring good knowledge about the VAP and 56 (97%) of the ICU nurses acquiring good knowledge of the VAP prevention bundle. Overall, there was a significant improvement in the median score of adherences to the VAP prevention bundle elements before and after the intervention (p-value ≤ 0.05). Conclusion: This study concluded that the levels of knowledge about VAP and practices of the VAP prevention bundle can be improved by implementing a relevant educational program for ICU nurses. The findings of this study also provide evidence of the importance of a continuous training program for ICU nurses to ensure quality patient care in the critical care units.

Knowledge, Attitudes, Practice and Related Factors among Nurses Regarding Evidence-Based Practices in Bahrain

Objective: The study aimed to determine the factors related to knowledge, attitudes, and practice of nurses regarding evidence-based practice (EBP) in Bahrain. Methods: A descriptive, cross-sectional study was conducted in Salmaniya Medical Complex hospital in Bahrain from 2017 to 2018. Nurses from all shifts, both genders, and age range between 30–65 years old work in different inpatient departments were included in the study. Research instruments were distributed and completed during the nurses' shift duty which comprised of nurses' demographic characteristics questionnaire and the validated English version of Upton &amp; Upton's self-reported Evidence-Based Practice Questionnaire (EBPQ)Results: Of 404 nurses' the majority of nurses were females 369 (91.6%), with a mean age was 37.7 + 7.7 years. most of the nurses 313 (77.5%) had moderate score of knowledge, and 312 (77.2%) were moderate implementers for EBP, and 179 (44.3%) had a positive attitude. Nurses who were working in the gynecology units reported significantly higher knowledge about EBP with mean scores 68.6 ± 7.06 as compared to pediatrics 67.0 ± 4.78, critical care 65.9 ± 4.67, surgical 65.8 ± 4.94 and medical 66.4 ± 4.20 (p-value 0.004) respectively. An insignificant association between attitude (p-value 0.123) and practice (p-value 0.123) of EBP was found in a work setting. Conclusion: The EBP is a vital and effective instrument for raising the quality of health care. Healthcare organizations should focus more on developing training programs for nurses to improve their clinical skills, knowledge, and attitude on the use of EBP to elevate the quality of care.