Rising cesarean sections rate

Objective: To identify cesarean section [CS] rate in Bahrain and evaluate the reasons for the rise of CS rate

Design: A Retrospective Cross-Sectional Analysis

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: All CS performed from 1 May 2011 to 31 October 2011 were included

The following patients' characteristics and clinical data were documented: age, nationality, maternal weight, parity, gestational age, number of gestation, birth weight and presentation. In addition to primary or repeat CS, indications of the procedure, uterine incision, type of anesthesia provided and immediate complications were documented

Result: One thousand five hundred thirty-five women had CS. Five hundred fifty-eight CS who had complete data were included in the study. The mean maternal age was 32 years +/- [SD 5.8]. Three hundred seventeen [56.8%] patients were Bahrainis

The mean gestational age was 37.1 weeks +/- [SD 2.7] with a mean neonatal birth weight of 3,012 grams +/- [SD 0.750]

One hundred sixty-one [28.9%] were primiparous and 397 [71.1%] were multiparous. Forty-six [8.2%] were performed for multiple gestations

Two hundred eighty-six [51.3%] were primary CS and 272 [48.7%] were repeat CS

The main indications for the procedure were repeat CS in 176 [31.5%], failure to progress in 104 [18.6%], non-reassuring fetal heart rate in 100 [17.9%] and breech presentation in 80 [14.3%]

Conclusion: CS rate is increasing in Bahrain; more than 30% of deliveries in Bahrain are by CS. Physicians should aim to reduce CS rate by lowering primary CS and allowing trial of scar in patients with previous CS

Comparison of low-dose versus conventional-dose prednisolone in the treatment of Idiopathic Thrombocytopenic Purpura [ITP]

Objective: To assess the efficacy of low-dose prednisolone in patients with ITP

Design: A Prospective Randomized Controlled Trial

Setting: Salmaniya Medical Complex, Kingdom of Bahrain

Method: A randomized controlled trial was conducted comparing the conventional-dose to a lowdose of prednisolone [0.25 mg/kg/day]. Forty-one patients with ITP were enrolled in the study; 21 patients were randomized to low-dose prednisolone [group I] and 20 patients received the conventional-dose [group II]

Result: The overall remission rate [OR] for both groups was 78.05%. There was no statistically significant difference between both groups in terms of group overall remission 17 [81%] versus 15 [75%], group complete remission 11 [52.4%] versus 10 [50%] or partial remission rate 6 [28.6%] versus 6 [25%]. In addition, failure rate, relapse rate, and splenectomy rate were similar and not statistically significant. Two [10%] patients developed complications related to steroids therapy, both were in group II, but were not statistically significant

Conclusion: Although the study had a small number of patients, it revealed that low-dose of prednisolone [0.25 mg/kg/day] is as effective as the conventional-dose [1 mg/kg/day] and probably, safer. Accordingly, we recommend the use of low-dose prednisolone as initial therapy for ITP rather than the high-dose

Predictors of in hospital mortality after acute myocardial infarction

Acute myocardial infarction remains a major cause of adult mortality. A steady decline in the mortality rate appears to be due to a fall in the incidence of acute myocardial infarction, a fall in the case fatality rate, identifying those patients who are at increased risk, and more aggressive prophylactic cardiovascular treatments to prevent it from occurring. To identify, patients who have higher risk of in-hospital mortality after the first acute myocardial infarction. The hospital mortality for the first acute myocardial infarction [AMI] was evaluated for 112 patients who were admitted to the coronary care unit in Baghdad Teaching Hospital during a total period of six months duration, between March and Sept. 2001. For each patient, history, clinical examination, electrocardiograms, fasting venous plasma glucose were done. Total mortality was 16.1%. The following factors were associated with higher in-hospital mortality: advanced age [more than 65 years], females, diabetic, and clinically evident heart failure. Other variables were not associated with increase or decrease in mortality: hypertension, smoking, admission heart rate, bundle branch block, previous angina pectoris, and the site of the infarction. Certain groups of patients tend to have higher mortality; patients older than 60 years, females, diabetic and patients with clinical heart failure. Other factors didn't affect survival; location of the AMI, the presence of bundle branch block, hypertension, angina pectoris, smoking and the high heart rate on admission

Transfusion-related acute lung injury [TRALI] and strategies for prevention

Transfusion-Related Acute Lung Injury [TRALI] is a serious complication of blood transfusion. In recent years, TRALI has been reliably shown to be the most common cause of transfusion-related fatalities in the United States and in the United Kingdom. Its prevalence is about 1 in 1323 transfused components; however, it is often under diagnosed. Classically, TRALI present as non- cardiogenic pulmonary oedema. Management is mainly supportive with 72% of cases requiring ventilatory support. The aim of the study was to highlight the condition, discuss the pathophysiology of the disease and the preventive measures. Retrospective study. Haematology/Oncology department, Salmaniya Medical Complex, Kingdom of Bahrain. Two patients with documented and proven TRALI were encountered at our department from January 2004 till end of December 2006. The records of these patients were reviewed for personal characteristics, clinical settings, the components transfused, time onset of the complication, and management and outcome. Two female patients were found, one 20 years old, was transfused 2 units of packed red blood cells [PRBC] because of low haemoglobin, she developed [TRALI] during the transfusion. The second case was 38 years old lady; she developed [TRALI] two hours following platelets transfusion for thrombocytopenia. Both were managed conservatively. TRALI is a rare and serious disease, however, we reported two critical cases to raise the awareness of the problem and build a high index of suspicion for these cases especially where the practice of transfusion is common. We also propose some recommendations for prevention

Microscopic bacteriuria in the diagnosis of symptomatic urinary infection [Bacteriuria in urinary infection]

A prospective study was conducted by examining midstream urine specimens from 100 patients [82 females, 18 males, mean age 42.3 years] microscopically with and without centrifugation for the presence of bacteria and comparing the findings with quantitative bacterial cultures. The optimum levels for separating infected from uninfected urine, i.e. levels with highest combination of sensitivity, specificity and predictive values were five and three bacteria per high power field for centrifuged and uncentrifuged specimens respectively. The likelihood ratios and probabilities of infection for various levels of bacteriuria were also calculated

Comparison of blood pressure measurements on clothed arm and forearm

The aim was to evaluate the practice of measuring blood pressure on a clothed arm or on the forearm in circumstances when it is difficult to unclothe the upper arm. In a hundred volunteer medical students [19 to 24 year old, 9 females and 91 males], measurements were made on the bare upper arms, clothed upper arms and bare forearms and the results compared. There were no significant differences between the bare and the clothed arm measurements in systolic [114.7 [SD 10] versus 115.6 [SD 10.5]] nor diastolic pressures [71.2 [8.3] versus 72.3 [8.3]]. Measurements of diastolic pressure in the forearm was not possible in many subjects because the sounds could not be heard. The systolic pressure by palpation was significantly lower than in the upper arm [95.5 [SD 26.2] versus 113.4 [11.4] with widely variable differences. Measuring blood pressure by auscultation on a clothed upper arm is satisfactory in circumstances when unclothing the upper arm is practically difficult

Diurnal variations in plasma urea of hospital patients

Morning and evening plasma urea concentrations in 72 hospital patients were compared using the paired t-test. In 43 patients with normal renal function, the evening plasma urea [39. 16 +/- 10.84 mg/dl] was slightly but significantly higher than the morning one [36.93 +/- 10.03 mg/dl]. In 29 patients with renal failure, the evening [207.77 +/- 120.77 mg/dl] and the morning [207.27 +/- 121.36 mg/dl] figures were similar. Morning collection of specimens for plasma urea estimations is generally desirable but immaterial in patients known to be in renal failure

Protein loss during isolated ultrafiltration patients with chronic renal failure

Six hypertensive overhydrated maintenance dialysis patients [4 women, 2 men] were treated with isolated ultrafiltration and sequential dialysis for 1 to 3 months. Two to 5.5 liters of fluid were removed each time in 2-4 hours of isolated ultrafiltration. Haemoglobin concentration and haematocrit increased in proportion to the volume of fluid extracted. Serum protein concentration increased to a lesser extent indicating protein loss during ultrafiltration. The ultrafiltrate contained 0.432 +/- 0.084 g/Liter of immunognobulins. The proportion of filtered IgA relative to its plasma concentration was highest and that of IgG lowest, probably due to differences in the shapes of their molecules

Predialytic isolated ultrafiltration in overhydrated patients on maintenance hemodialysis

Six hypertensive grossly overhydrated maintenance dialysis patients [2 men, 4 women] were treated with sequential ultrafiltration-haemodialysis for 1-3 months. Two to 5.5litres of fluid were removed in 2-4 hours of isolated ultrafiltration. During it, blood pressure was relatively stable, pulse rate slightly decreased and patients did not experience headache, vomiting or faintness. Dyspnoea and signs of pulmonary oedema subsided, There was no significant change in serum sodium, potassium and urea while serum creatinine slightly increased. In about 4 weeks oedema disappeared in all patients and blood pressure came down to normal in four. A distinct rise in serum creatinine was noticed in 3 patients after 3 months

Double blind comparison of trimethoprim-sulphamethoxazole and trimethoprim-sulphadiazine in the treatment of urinary tract infections

A double blind comparison of Trimethoprim - Sulphamethoxazole[TMP 160 mg. - SMZ 840 mg. twice daily] and Trimethoprim - Sulphadiazine [TMP 160 mg. - SDZ 840 mg. twice daily] in the treatment of urinary tract infections was carried out Sixty three adult patients were treated, 52 of whom were available for final evaluation. Twenty two out of 27 patients [81%] treated with TMP - SMZ, and 17 out of 25 patients [68%] treated with TMP - SDZ were cured. The difference of 13% [S.E 12] was not statistically significant. Apart from one Patient who stopped TMP - SDZ because of abdominal pain, both combinations were well tolerated. Trimethoprim-Sulphadiazine is a useful alternative to Trimethoprim-Sulphamethoxazole in the treatment of urinary tract infection

Acute renal failure in Mosul renal unit: retrospective analysis of eight years

Sixty-five patients with acute renal failure were treated in Mosul Renal Unit over the 8 years period 1974 - 1982. Adequate data for analysis were available in 48 patients which form the basis for the study. No identifiable cause was found in 8 of these cases. Acute tubular necrosis was the most common cause of acute renal failure accounting for 37.5% of cases and acute glomerulonephritis came next [20%]. One striking feature of the analysis was the paucity of surgical cases compared to other reports in the literature. Many patients were referred for dialysis very late in advanced uraemia a factor which probably contributed significantly to the relatively high recorded mortality of 48%