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

Prevalence and risk factors for vitamin D deficiency among mothers in labor and their newborns

Vitamin D deficiency is recognized as a global public health problem. Studies of vitamin D levels in mothers in labor and their newborns in Bahrain are lacking. The aim of this study is to identify the prevalence of vitamin D [25[OH]D] deficiency among mothers in labor and their newborns in Bahrain. A cross-sectional multicenter study. Four Public and Four Private Maternity Hospitals in Bahrain. The study was conducted in April 2012. It included mothers in labor and their newborns. Differences between the subgroups were analyzed using Chi-Square or Student's t-test as appropriate. Linear regression analysis was used to evaluate independent predictors of 25[OH]D level. The study included 403 mothers and 403 newborns. Overall prevalence of 25[OH]D deficiency [<50 nmol] was 358 [88.8%] of the mothers and 364 [90.3%] of the newborns. The mean maternal alkaline phosphatase level was significantly higher than the neonatal level and the maternal mean calcium was significantly lower than the neonatal level. Significant association with vitamin D deficiency was found among Bahraini and non-Bahraini Arab mothers, delivering in public rather than private hospital, living in flats, low education, the use of veil, gravida >/= 4, not using multivitamins, vitamin D or calcium supplements. Vitamin D deficiency among mothers and their newborns is high. This mandates increasing awareness, vitamin D supplementation among mothers in labor and their infants; in addition to the introduction of vitamin D fortification of dairy products and flour at the national level

Overseas Pakistanis seeking medical education in Pakistan

Background: Pakistanis migrated to western countries face difficulty in letting their children get higher education from abroad. It has been observed that many overseas Pakistanis feel secured to send their children to Pakistan to acquire higher education. The purpose of this study was to evaluate the reasons for overseas Pakistani students seeking medical education in Pakistan. Methods: A cross-sectional survey was conducted from October 2010 to May 2011 recruiting overseas Pakistani students studying in different medical colleges of Sindh, Pakistan. Cluster of 8 medical colleges were selected and a convenient sample [n=700] was recruited. Of the 700 administered questionnaires, 530 [76%] were returned and 25 were incomplete and therefore, rejected. A total of 505 [72%] were included in the analysis. Results: A statistical significance was found when origin of students was compared with the economic aspect of medical education in Pakistan [p=0.01]. Overall 71% students agreed that the cost of medical education in Pakistan is much less then their respective countries of origin. Another highly significant difference was observed [p<0.001] between student's origin and their reasons behind taking medicine as a career. Conclusion: The study establishes that Pakistan as a country offers quality medical education in minimum possible costs and more foreign students can pursue medical education in Pakistan

Twin reversed arterial perfusion sequence

Twin-Reversed Arterial Perfusion [TRAP] is a rare complication of monochorionic twins with a prevalence of 1 in 35,000 pregnancies. It is characterized by a structurally normal twin pump perfusing an anomalous recipient twin via an artery-to-artery anastomosis in a reverse direction. To highlight Twin-Reversed Arterial Perfusion sequence and its clinical variable presentation. Prospective review. Obstetrics and Gynecology Department, Salmaniya Medical Complex [SMC]. All patients with TRAP sequence, diagnosed by ultrasound were followed up until delivery. Clinical presentation, ultrasound findings, outcome and management were reviewed. Three patients with a diagnosis of TRAP sequence who had been managed conservatively were included in the study. The first two patients had amorphous acardius and presented with polyhydramnios and both had favorable outcomes for the surviving twin. The third case was triplet pregnancy, which ended unfortunately with extreme permaturity at 23 weeks of gestation of acepahlus acardius and two normal fetuses. TRAP sequence is a rare complication of monochorionic twins. Accurate antenatal diagnosis is essential to improve the prognosis of this rare entity

Nosocomial diarrhoea in relation to sanitation state: a study in Tikrit, Iraq

A cross-sectional hospital-based study of 259 children aged < 5 years was carried out in Tikrit, Iraq, to identify the prevalence of nosocomial diarrhoea and sources of contamination in the ward environment. Nosocomial diarrhoea was diagnosed in 84 children [32.4%]. Children with diarrhoea were more likely than unaffected children to be bottle-fed, given unboiled water, to have unclean food containers and contaminated bed sheets. Three out of 5 brands of formula milk [unopened cans] were contaminated. Three-quarters of medical staff and employees had contaminated hands. Enterobacter spp., Pseudomonas aeruginosa and Citrobacter spp. were the most commonly identified microorganisms. A greater emphasis on personal hygiene, improved care practices and promotion of breastfeeding is recommended

role of aspirin in thrombotic thrombocytopenic purpura: a randomized control trial

To assess the safety and efficacy of aspirin in acute Thrombotic Thrombocytopenic Purpura [TTP] and to evaluate it as a maintenance therapy. Randomized controlled trial. Hematology/Oncology Department, Salmaniya Medical Complex [SMC], Kingdom of Bahrain. Nine patients with TTP admitted between August 2003 to December 2005 were included in the study. Seven were females [77.8%] and one was pregnant. Five Patients were randomized to receive the standard therapy with aspirin [group I] and four [group II/control] received the standard therapy only [plasma exchange, one single plasma volume daily using fresh frozen plasma from healthy donors and Methylprednisolone 1 gram intravenously once daily for three days]. Safety and efficacy of aspirin were assessed during the acute phase [4 weeks] and as maintenance for one year. Statistically significant reduction in the number of plasma exchange sessions were noted in the aspirin group [p = 0.0315]. Other parameters such as days of hospitalization, red blood cells transfusion were lower in the aspirin group compared to non aspirin group. No cases of mortality or morbidity were observed in patients receiving aspirin. Two patients [50%] developed deep vein thrombosis [DVT] in the control group and one of them eventually died [25%]. Though these were statistically insignificant, possibly due to the small number of patients, it would suggest the efficacy of aspirin in TTP. The study showed a significant reduction in the number of plasma exchange sessions in the aspirin group and probable advantages. Accordingly, we recommend a multicenter RCTs to address the role of aspirin in the management of TTP patients

Blood zinc and iron levels in children of out patient department at tertiary care hospital of Multan

The purpose of this study was to assess the blood levels of zinc [Zn] and iron [Fe] in of children. This descriptive was carried out in the Department of Chemistry, Bahauddin Zakariya University, Multan, PMRC Research Center, Nishtar Medical College, Multan, Department of Paediatric Medicine, Nishtar Medical College, Multan, Pakistan. 2004-2005. One hundred children [boys and girls] aged 1-10 years belonging to rural and urban areas attending the out patient department for minor illnesses at Nishtar Hospital, Multan were included in this study. Information regarding age, height, weight, history of past illnesses and dietary food frequency were recorded. Flame atomic absorption spectrometry was used as an analytical tool to quantify zinc and iron concentrations. Whole mean blood Zn and Fe levels in children were found to be as 759 +/- 243 microg/100 ml and 38.8 +/- 5.5 mg/000 ml respectively. Relationship of blood Zn and Fe levels with age of the children were determined. Results indicate that blood zinc and iron levels in the children were lower than the normal reference values. This study suggests that mineral rich diet should be given to the children of this region for their healthy growth

Fracture penis with complete urethral disruption during intercourse

We present a rare case of fracture penis with complete urethral disruption in a 38 years old male. This resulted in an erect penis during sexual intercourse. He presented with diffuse and tense swelling of the penis along with acute urinary retention and distended urinary bladder. Emergency exploration revealed complete urethral disruption with tears in both corpus cavernosa. Evacuation of haematoma, repair of corpora and primary urethral repair was performed. Post-operative recovery was smooth and the patient developed satisfactory erectile and voiding function

Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital

A cross-sectional hospital-based study was carried out at Tikrit teaching hospital, Iraq, from October 2004 to September 2005, to identify the prevalence and etiology of nosocomial infectious diarrhoea among children under 5 years of age. Of 259 children admitted to the paediatric ward for reasons other than diarrhoea and hospitalized for more than 3 days, clinical and laboratory analysis of stool samples showed nosocomial diarrhoea in 84 children [32.4%]. The most common causative agents were enteropathogenic Escherichia coli [25.9%], Clostridium difficile [21.0%] and rotavirus [18.5%]. Single infectious agents caused 63.1% of the cases, while mixed infections were detected in 16.7%; in 20.2% of children the cause remained unknown

Cross inoculation studies: Response of Vigna Mungo to inoculation with rhizobia from tree legumes growing under arid Environment

Cross-inoculation experiments were conducted in the greenhouse to test the rhizobia isolated from nodules of seven tree legumes for their effectiveness in Vigna mungo plants. The tree legumes included Albizia lebbeck, Dalbergia sissoo, Leucaena leucocephala, Pithecellobium dulce, Prosopis cineraria, Prosopis glandulosa and Prosopis juliflora, all growing under arid environment. Rhizobia from these legumes formed nodules on the roots of Vigna mungo except isolates from Albizia lebbeck. Dry weight and nitrogen contents of Vigna mungo plants increased significantly [P<0.05] in response to cross inoculation as compared to uninoculated control. Rhizobia from Leucaena leucocephala and Prosopis glandulosa showed significant increase in dry weight [P<0.05] and nitrogen contents [P<0.05] than other inoculated treatments. The natural rhizobia of wild tree legumes growing under arid environment show higher tolerance to prevailing adverse conditions like salt stress, elevated temperatures and drought. These rhizobia may be used to inoculate wild as well as crop legumes cultivated in reclaimed desert lands. These rhizobia may have specific traits that can be transferred to other rhizobia through genetic engineering tools. The cross infection of agriculturally important legumes with isolates from wild legumes may prove a useful means of increasing nitrogen contents within these plants

Effect of extract of Aloe vera, Querous infectoria and Catha edulis on the isolated rabbit duodenum

The aim of this study is to detect the pharmacological effect of aloe [fresh plant and dried Aloe socotrana], gall and the extract of khat leaves [Catha edulis Forsk] on the isolated rabbit duodenum. Extracts of aloe, gall and khat leaves were assayed using isolated rabbit duodenum technique. Mechanical activity of the tissue was registered with a frontal ink isotonic lever on a kymograph drum under continuous oxygen bubbling. The aqueous extract of gall showed a contraction, which was persistent after incubating the tissue with atropine. Fresh extract from the plant aloe as well as aqueous extract of the dried aloe reduced the tone of the mechanical activity of the isolated rabbit tissue. Incubating the tissue with propranolol did not change this response. Ethyl acetate extract of khat leaves from Aldhalae and Yafae provinces did not modify the tone of the tissue, but Yafae khat extract changed the motility. The findings suggest that the gall induced contraction was not based on cholinergic activity, while relaxation, produced by aloe, seemed not to be associated with adrenergic agonism. Yafae khat leaves disturbed the mechanical activity of the tissue

Amniotic bands: Are they all threat for the fetus?

Amniotic band syndrome [ABS] or amniotic band disruption is a common cause of sporadic miscellaneous fetal malformation involving limbs, trunk and the craniofacial region. Diagnosis is mainly suspected by ultrasound imaging, where the fetus is seen attached to the amniotic bands. Clinical manifestation is variable from minor constriction rings to fetal or neonatal demise secondary to severance of the umbilical cord or the associated malformation. Therefore, management options vary depending on the associated anomalies. The aim of this report is to highlight this condition, emphasize that subsets of amniotic bands exist which do not pose a threat to the fetus. Prospective study. Ultrasound unit in the Department of Obstetrics and Gynaecology, Salmaniya Medical Complex, Kingdom of Bahrain. Patients with suspected diagnosis of amniotic bands by ultrasound scanning during the study period [January 2005 to December 2007] were followed up till delivery to confirm the diagnosis. Patients Characteristic, clinical presentation, gestational age at the time of presentation, ultrasound images and outcome were reviewed. Three patients were encountered during the study period. The first patient was twenty years old primigravida, while the other two were middle age multiparous ladies. The clinical presentations were variable, however, they all presented with hydramnios. Two cases had typical severe malformations with fetal demise in the neonatal period. The third presented with only amniotic bands demonstrated in the scan but no fetal attachment, which had good outcome. Amniotic band syndrome is a common cause of sporadic and bizarre form of fetal malformation. An isolated finding exists where the amniotic band floats freely in the amniotic fluid and do not attach to the fetal parts. These pose no threat for the fetus. We are reporting three cases of Amniotic bands. The first two cases were the typical presentation of Amniotic band syndrome; whereas the third case highlights the possibility that a subset of amniotic sheets exist that do not disturb the fetus

Neural tube defects among infants delivered of mothers with tobacco smoke exposure

To verify the occurrence of congenital neural tube anomalies among the newborns of pregnant women who had experienced exposure to tobacco smoke. A cross sectional study of pregnant women at delivery considering their newborns as a gestational cohort. A systematic random sample of 2300 pregnant women who attended for labour at Maternity and Children hospital in Najaf city were interviewed for history of tobacco smoke exposure during the period 2002-2004. The sample was subdivided into exposed and unexposed women to tobacco smoke. The newborns were clinically examined by a pediatrician for presence of any congenital anomalies especially neural tube defects. The over all newly delivered newborns with congenital anomalies were 3.4% among smoker mothers, and 1.9% among nonsmokers [including small defects]. The most frequent neural tube defects among smoker mothers were anencephaly [1.8%] and spina bifid a [1.2%], versus 0.7% and 0.6% respectively among non smokers or unexposed women [P<0.05]. There was some increase in the risk of such defects among exposed women to tobacco smoke who did not take folic acid in relation to unexposed in spite of no statistically significant difference. Also there was no significant difference in the distribution of neural tube defects between those women who live in urban or rural areas or between different age groups. Smoking is a risk factor for neural tube defects

Pharmacokinetic studies of ranitidine tablets on healthy human subjects using two binders

Ranitidine is an effective H2 receptor antagonist. Ranitidine is a specific, long acting H2 receptor antagonist. It is indicated for the treatment of duodenal ulcer, gastric ulcer, GERD and Zollinger Ellison syndrome. In this study two formulations of Ranitidine 300 mg tablets were prepared and film coated. Starch and poly vinyl pyrolidone were used as binding agents to check the effect of the binding materials on the pharmacokinetic parameters of Ranitidine tablets. Different in vitro tests were used to evaluate Ranitidine tablets like disintegration test and dissolution test. Then in vivo evaluation was performed on these two formulations. Tablets were administered to eight normal human subjects comprising of two groups, each group consisted of four normal human subjects one by one in a crossover manner after one week washout period. Blood samples were collected and plasma was obtained and analyzed by HPLC. Statistical analysis was performed and the values for Cmax for formulation 1 were found to be 4.63 +/- 0.47 micro g/ml, and for formulation 2 it was 4.76 +/- 1.02 micro g/ml. The value for Tmax for formulation 1 was found to be 2.0 +/- 0.37 hours, and for formulation 2 it was 1.5 +/- 0.46 hours. The value for AUC for formulation 1 was found to be 18.57 +/- 6.122 micro g/hr/ml and for formulation 2 it was 26.43 +/- 22.38 microg/hr/ml. It was also concluded that different binders affect the bioavailability of the tablets and Ranitidine tablets prepared by polyvinyl pyrolidine have better bioavailability than those tablets prepared by starch as binding agent

Studies on resistance / sensitivity pattern of bacteria related with urinary tract infections

In order to determine the resistance pattern against five different groups of antimicrobial agents, six different species of bacteria were isolated from among two hundred cases of UTIs. The front line antibiotics for treating urinary tract infection due to Escherichia coli, Klebsiella species, Staphylococcus aureus and Proteus species should include Cephradine, Ofloxacin, Cefaclor, Cephalothin and Pipemidic acid. However, for treating UTI due to Pseudomonas species, the drug of choice must be a member of fluoroquinoline group [norfloxacin, ofloxacin and ciprofloxacin]

Treating acute diarrhea according to the WHO program in comparison with the traditional method

Acute diarrhea is a common pediatric problem, which may lead to death if not treated properly. It is defined as passing watery stool at least three times a day. The study aims at encouraging the application of the WHO program in treating diarrhea and hence to limit the use of antibiotic therapy. The study was conducted at the Teaching Hospital in Tikrit from the 1st of April through September 2001. It included patients under 2 years of age suffering from acute diarrhea only; who were examined clinically for the signs of dehydration and for the nutritional status. Malnourished children and those suffering from diseases accompanied with diarrhea were excluded from the study. The sample of 102 patients with acute diarrhea who had moderate to severe dehydration, were divided into two groups: group [A] represented [45] cases who were managed according to the WHO program, while group [B] represented [57] cases and who were treated with the traditional method. Males were encountered more frequently than females. The most frequently encountered age group was under six months. Of the total cases, [23.4%] had bloody diarrhea and [55.9%] of cases were given antimicrobial therapy before admission to hospital. Of those, [25.5%] used a single drug and [29.4%] used a combination of two drugs. The most common drug prescribed before admission to hospital was trimethoprim-sulfamethaxazole [56.5%] followed by metronidazole [30.4%] and gentamicin [12%]. Patients in group A recovered from dehydration during the first 2 days of admission to hospital, with a higher percent than in group B [95.6% and 66.7%] respectively. The recovery from diarrhea during the first 2 days was higher among group A than in group B [46.7% and 19.3%] respectively. The antimicrobials were given to [42%] of patients in group A in comparison to [100%] in group B. The study reflected the practical application of the WHO program in treating acute diarrhea regarding time, efforts and cost. Accordingly, we encourage the application of this program and discourage the use of antimicrobials unless there is a real indication

Pattern of ABO and Rh blood groups in Multan region

The discovery of various blood group systems has an immense importance in transfusion medicine and medico legal field. The association of certain blood groups with various diseases like peptic ulcer is well established. ABO and Rh blood groups are the main systems to cause blood transfusion reactions. An individual blood group today, is as important as national identity card. In cases of emergency blood transfusion, the blood group data of a population is very much important. The frequency of ABO and Rh blood groups vary throughout the world. It has been observed that group B diminishes in frequency from East to West. ABO and Rh blood group data is well established in Karachi and Lahore areas, but the data is not available from Multan region. In this study six thousands young healthy voluntary blood donors of either sex belonging to Multan region comprising of 5476 males and 524 females were included from "Blood Transfusion Center Nishtar Hospital Multan" and "Fatmid Blood Transfusion Center Multan". The commonest blood group observed in this study was "B" with frequency of 36.95%. The next common was group "0" with frequency of 33.8% followed by group "A" with frequency of 21.92% and group "AB" 7.33%. The frequency distribution of Rh blood group shows that 92.17% of the subjects are Rh-+ve and 7.83% are Rh--ve

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait

The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia [CAP] in Kuwait. The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team [PORT] severity index. The microbial etiology was determined using st and ard methods for bacteria and serological tests for atypical and viral pathogens. The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 +/- 18 years. The severity class distribution was: class 131%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients [35%], with one pathogen in 31 [25%], two in 9 [7%], and three or more in 4 [3%]. The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients [11%], Legionella pneumophila in 10 [8%], Chlamydia pneumoniae in 8 [6%], influenza B virus in 8 [6%], influenza A virus in 5 [4%], Haemophilus influenzae in 4 [3%], Streptococcus pneumoniae in 3 [2%], Staphylococcusaureus in 3 [2%], gram-negative enterobacteria in 5 [4%], Moraxella catarrhalis in 2 [2%], and viruses in 4 [3%]. The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait, Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides

Predictors of successful conception in a clinical trial of 30 patients with primary amenorrheic hypogonadotrophic hypogonadism treated by ovulation induction

A clinical trial was designed to assess the association between the treatment of infertile females with Hypogonadotrophic Hypogonadism and their fertility state considering conception as the desired outcome. Serum hormones, LH, FSH and estradiol, endometrial thickness and count of active ovarian follicles were assessed by U/S to evaluat their role in anticipating a successful conception. Standard protocols of ovulation induction were used in a clinical trial [historical cohort design] of 30 patients with primary hypogonadotrophic hypogonadism. For ethical reasons no attempt was made to fix the number of induction courses given to the female patient [such a variability is suspected to confound the result to a limited extent], so a female was followed up with several courses of ovulation induction [according to the advice of the physician in charge] for a median duration of I year with conception as the final outcome of interest. Four serum hormonal markers [FSH, LH, Prolaction and estradiol] were assessed before and 12-14 days after initiating therapy. Transvaginal U/S was done to measure endometrial thickness and the number of dominant follicles in both ovaries after 12-14 days of treatment. Serum estradiol concentration, endometrial thickness and number of dominant follicles were significant predictors of successful conception. Using endometrial thickness as a decision rule to predict successful conception at a cutoff value of 7 mm, considering the rule as positive if equal or greater than 7 mm, resulted in a positive predictive value [PPV] of 50% [Relative risk of having conception was 4.3 times]. The confidence in a positive rule was increased to 71.4% [PPV =11.4%] when the cutoff value was set higher at 8 mm endometrial thickness. Using the number of dominant follicles as a decision rule at a cutoff value of 4 resulted in a PPV of 60%. This PPV was further increased to 72.7%] when the cutoff value was set higher at 5. An U/S finding of 5 or more dominant follicles increased the.probability of having conception by 12.6 times. A serum estradiol concentration at day 12 of 114 pgm/ml and higher predicted successful conception with a PPV of 50% [relative risk of having conception was 7], increasing this cutoff value of serum estradiol to a maximum of 498.5 pgm/ml increased the PPV to 66.7%. a clinician can predict successful conception after the first 2 weeks of initiating therapy with a moderate degree of confidence depending on serum estradiol, endometrial thickness and number of dominant follicles in the ovary. Other factors however need to be considered to increase the confidence of prediction, such as the type of insemination technique, sperm count of husband. A larger sample size and a survival analysis design is needed to assess the exact risk of having conception after each course of treatment