ABSTRACT
Background: New referrals to tertiary cardiac centers have and continue to increase despite the static prevalence of congenital heart disease
Objective: To evaluate the referral patterns to a pediatric tertiary cardiac unit
Setting: Cardiac Center, Bahrain Defense Force Hospital, Bahrain
Design: A Retrospective Study
Method: Two thousand three hundred eight patients were referred to a specialist pediatric cardiology unit over a ten-year period. Six-hundred seventy-five were excluded as they had known or previously diagnosed cardiac disease; therefore, the study sample is 1,633
Result: One thousand six-hundred thirty-three patients were reviewed; the mean age was 3 years. The main reasons for referral were cardiac murmurs, chest pains, palpitations or syncope attacks. Six hundred and eighty-seven [42%] murmurs were innocent. One hundred fifty-four [9.4%] murmurs were pathological, only 33 [2%] required intervention. One hundred and twenty-five [7.6%] of children referred with chest pain; 121 had non-cardiac chest pains and 4 were of cardiac origin. Palpitations were seldom significant. No child with syncope was of cardiac origin
Conclusion: One thousand five hundred fifty-one [95%] referrals had normal hearts. Heart murmurs are seldom pathological and rarely require any intervention. Chest pains, palpitations and syncope attacks in children without previously diagnosed heart disease are rarely of cardiac origin. Continued education and training of primary care physicians improve the skills in the clinical assessment and limit unnecessary referrals. Programs in performing basic echocardiogram could be initiated and monitored within a supported network
ABSTRACT
There are no published data documenting possible previous acute hemorrhagic conjunctivitis [AHC] outbreaks in Bahrain. We report an outbreak of adenoviral-related AHC in two Bahraini siblings. AHC is a rare form of conjunctivitis that is highly infectious. Diagnosis of AHC is mainly based on clinical presentation. Signs and symptoms usually occur after 24 to 48 hours of incubation. The infection is of short duration, self-limited and associated with good visual prognosis requiring only supportive care. Patient education regarding personal hygiene and close contact with infected individuals plays an important role in its management to prevent the spread of this highly contagious form of conjunctivitis