Research on the application of Miller's pyramid theory combined with Bahrain's team activities in standardized residency training of burn surgeons / 中华医学教育探索杂志

Objective:To explore the application of Miller's pyramid theory combined with Bahrain's team activities in the standardized residency training (SRT) of burn surgeons.Methods:Seventy-four residents who were on the SRT program in the Department of Burns & Wound Care in The Second Affiliated Hospital of Zhejiang University were enrolled in the study. The students were divided into control group and observation group according to the teaching methods. Thirty-seven students in the control group were provided with conventional teaching, and 37 students in the observation group were provided with training based on Miller' pyramid theory combined with Bahrain's team activities. The two groups were evaluated for teaching effectiveness and doctor-patient communication skills. SPSS22.0 was used for the chi-square test and t test. Results:The evaluation outcome of teaching effectiveness in the observation group was better than that in the control group ( t=3.01, 3.47, 3.49, 3.32, and 2.54; P=0.004, 0.001, 0.001, 0.001, and 0.013). After the training, the scores of Set Elicit Give Understand End scale in the two groups increased, with significantly higher scores achieved in the observation group than in the control group ( t=3.23, 2.99, 2.07, 3.62, 3.00, and 7.89; P=0.002, 0.004, 0.042, 0.001, 0.004, and <0.001). Conclusion:The application of Miller's pyramid theory and Bahrain's team activities in the SRT of burn surgeons can improve students' evaluation of teaching effectiveness and improve their doctor-patient communication skills.

Comparison between the World Health Organization and Bahraini children growth standards / Comparação entre as curvas de crescimento para crianças do Bahrein e da Organização Mundial da Saúde

Abstract Objective: The aim of this study was to investigate the growth patterns of Bahraini female and male infants/young children aged 0-24 months in the Kingdom of Bahrain. Methods: A cross-sectional approach was employed to track the growth parameters among healthy Bahraini female and male infants/children aged 0-24 months. A multistage probability sampling criteria was used to collect information from official records. Anthropometric measurements (weight and length) and demographic characteristics on feeding practices were gathered. Generalized Additive Models for Location Scale and Shape (GAMLSS)/Lambda-Mu-Sigma methodology was implemented to select distribution type, optimize smoothing parameters, perform regression of growth models, and construct percentiles and Z-score charts and tables for weight for age, length for age, length for weight, and body mass index (BMI) for age. Results: Findings were compared with WHO Multicentre Growth Reference Study (MGRS) data. A total of 403 healthy infants/children (210 males and 193 females) were recruited. At birth, the mean weight, length, and BMI were 3.2±0.4 kg, 3.1±0.4 kg, 49.7±2.3 cm, 48.8±2.1 cm, 13.2±1.6 kg/m2, and 12.8±1.5 kg/m2 for males and females, respectively. Anthropometrics of males were all statistically significantly higher than those of females at all age levels. The length and weight of the Bahraini infants/children were slightly higher than those of the WHO-MGRS. Conclusion: The outcomes of this study, presented as charts and tables, showed significant differences in comparison with the WHO-MGRS reference charts. Specifically, Bahraini children aged between 0 and 24 months of both sexes were taller and heavier than their cohorts in the MGRS reference charts. Further longitudinal studies are needed for monitoring the growth pattern of children using body composition methods, adiposity markers, and determinant factors of growth to investigate this deviation from the WHO-MGRS.

RESUMO Objetivo: Investigar os padrões de crescimento de lactentes de 0-24 meses dos sexos feminino e masculino, no Reino do Bahrein. Métodos: Estudo transversal de acompanhamento de lactentes saudáveis com 0-24 meses de idade dos sexos feminino e masculino, em Bahrein. A amostragem probabilística de estágios múltiplos foi utilizada para coletar informações dos registros oficiais. Medidas antropométricas (peso, comprimento), práticas alimentares e variáveis demográficas foram coletadas. A metodologia Generalized Additive Models for Location Scale and Shape (GAMLSS)/Lambda-Mu-Sigma (LMS) foi utilizada para selecionar o tipo de distribuição dos parâmetros antropométricos, otimizar os parâmetros de suavização, para fazer a análise de regressão de modelos de crescimento e para construir percentis e gráficos e tabelas de escore Z para peso para idade, comprimento por idade, comprimento por peso e índice de massa corporal (IMC) para idade. Os resultados foram comparados com os dados do Estudo Multicêntrico de Referência de Crescimento da Organização Mundial da Saúde (OMS). Resultados: O total de 403 lactentes (210 do sexo masculino e 193 do feminino) foi incluído no estudo. Ao nascimento, a média de peso, comprimento e IMC foi de 3,2±0,4 kg, 3,1±0,4 kg, 49,7±2,3 cm, 48,8±2,1 cm, 13,2±1,6 kg/m2 e 12,8±1,5 kg/m2 para o sexo masculino e para o feminino, respectivamente. Todos os índices antropométricos foram maiores no sexo masculino. O comprimento e o peso dos lactentes em Bahrein foram ligeiramente superiores aos da OMS. Conclusões: Os lactentes do Bahrein com idade entre 0 e 24 meses de ambos os sexos eram mais altos e mais pesados do que os lactentes analisados na coorte da OMS. Mais estudos longitudinais são necessários para monitorar o padrão de crescimento de crianças usando métodos de composição corporal, marcadores de adiposidade e fatores determinantes do crescimento para investigar esse desvio dos padrões da OMS.

Risk factors for critical care admission in acute pancreatitis

Background: Acute pancreatitis is one of the most common gastrointestinal causes of emergency hospital admissions. One in four patients will develop severe acute pancreatitis requiring critical care admission (CCA) frequently for a prolonged period leading to a considerable burden on health care resources. The main objective of this study was to analyse factors that may predict the need for CCA in patients diagnosed with acute pancreatitis.Methods: In this study, authors analyzed the health records of all patients (154 patients) admitted to Salmaniya Medical Complex (SMC) with the diagnosis of acute pancreatitis.Results: A total of 10 (6.5%) and 24 (15.6%) patients were admitted to the intensive care unit (ICU) and surgical high dependency unit (SHDU) respectively. There were no differences between different admission locations when it came to age, gender, comorbidities, frequency of attacks and number of computed tomography (CT) scans. After adjusting for all covariates in a multivariate binary logistic regression, the following factors were found to predict CCA: Nationality OR (95% CI): 7.64 (1.14-51.29), dyslipidaemia etiology OR (95% CI): 0.025 (0.001-0.755) and CT severity index - CTSI (95% CI): 1.463 (1.014-2.111). CCA was associated with higher length of stay (6 days vs. 9 day) OR (95% CI): 0.79 (0.015-0.413) and higher in-hospital mortality (1.7% versus 17.6%) OR (95% CI): 5.58 (3.38-7.78).Conclusions: This study results indicate that nationality, dyslipidaemia etiology and CTSI were associated with higher CCA. ICU admission was associated with longer length of hospital stay and higher mortality rates.

A comparative study on the effect of designated indoor smoking areas on the behavior and attitude of adults attending coffee shops in Bahrain toward smoking

Background: According to the world health organization, smoking causes five–six death cases annually. “Smoking areas” according to research done in La Salle University helps in reduction in exposure to second hand cigarettes. Aims and Objectives: The aim of the study was to evaluate the attitude of all adults attending coffee shops toward designates smoking areas and compare the effect of coffee shops with designated smoking areas in Bahrain on the change of behavior on smokers and non-smokers. Materials and Methods: A cross-sectional, two group comparative, and questionnaire-based study was carried out in coffee shops with and without designated smoking areas in Bahrain. A questionnaire was used to collect data which were entered and analyzed using SPSS program version 18. Results: It was shown that smoking inside a smoking areas will reduce the number of cigarettes smoked. As smokers inside smoking area, smoked 20 or more cigarettes having count 9 (10.3%) and outside the smoking area were 17 (17.7%), respectively. Furthermore, smokers who attend smoking area find it more difficult to refrain from smoking 48 (44.4%) in comparison to those who do not attend smoking area 19 (24.4%). Conclusion: Smoking inside designates smoking area may halt the amount of cigarettes smoked by smokers. Smokers within coffee shops with smoking area find it more difficult to refrain from smoking compared to smokers in coffee shops with no smoking area.

Knowledge, attitudes, and practices of primary health-care physician in Bahrain toward antibiotics use

Background: Antimicrobial resistance was listed among the most dangerous threats to global health security. Antimicrobial use is influenced by the interplay of the knowledge, expectations, and interactions of prescribers and patients, economic incentives, characteristics of the health system(s) and the regulatory environment. Knowledge, attitudes, and practice of antibiotic prescription among primary health-care doctors are important to understand the antimicrobial resistance; hence, this study aimed to examine these aspects in Bahrain. Objective: The objective of the study was to assess the knowledge, attitudes, and practices of the Primary Health Care Physician (PHP) in Bahrain toward antibiotics use. Materials and Methods: Cross-sectional study have been conducted among PHP working in primary health care centers (PHC) in Bahrain. A structured, anonymous, self-administered questionnaire was used to conduct the study. The following items were collected for each participant: Demographic (age, sex, nationality.etc), work factors (qualification, years of experience, morning or shift.etc) and knowledge, attitude, and practice toward antibiotics use. Each questionnaire was coded and assigned a special identity number for data entry and processing. Data were entered into a data base program (Statistical Package for the Social Sciences). Frequency tables were produced for each item. Cross tabulation with chi square test was done for certain variables with demographic and work related items. Results: A sample of 155 primary care physicians was taken; 138 (89%) were Bahrainis and 17 (11%) were non-Bahrainis, from which 39 (25.2%) were males and 116 (74.8%) were females. They were asked to judge their level of knowledge about antibiotics use in general and 94 of them (61.8%) classified their level as being “good” and 37.5% as excellent. More than half of the doctors (55.2%) admitted that they have not received any kind of formal training about antibiotic use. Almost all the doctors (95.5%) agreed that prescribing antibiotics in an inappropriate way puts the patients at risk. Majority of the doctors (89%) ranked patients’ clinical condition as being the most influencer on their judgment to prescribe antibiotics, followed by obtaining a positive microbiological result in symptomatic patients (85.1%). More than three-quarter of doctors (80.5%) agreed that providing local antimicrobial guidelines will help in decreasing the problem of antibiotics overuse and resistance. More than 85% agree that using antibiotics appropriately will be the ultimate key to decrease antimicrobial resistance. Conclusion: In general, there is a good attitude toward the importance of antibiotics use among PHC doctors, but the knowledge is not as good with only 61.8% of PHC doctors considered their knowledge as good toward antibiotics use and around half (55.2%) stated that they did not receive any formal training in this field. Antibiotics use and antimicrobial resistance should be strengthened in the curriculum of undergraduate and postgraduate training programs.

Vitamin D study: a retrospective comparison between two tropical countries: India and Bahrain

Background: Hypovitaminosis D is a very common prevalence in India as well as Middle East. Studies indicate the frequency to be anywhere between 44-96% among adults in Middle east, while in India it is estimated to range in between 50 – 94%. Our report is an attempt to study vitamin D status from two tropical countries; India and Bahrain and present status of vitamin D deficiency as well as insufficiency in a comparison summary.Methods: This retrospective study in our reference lab included data from a total of 2591 samples from Bahrain and 2596 samples from India. Serum vitamin D estimation was done by chemiluminescence immunoassay or CLIA and reported as per the classification given by the US Endocrine Society. Our reference laboratory provides diagnostic services to Bahrain and thus data from both the countries were available for analysis.Results: Our analysis detected vitamin D deficiency to be 66.2% among samples from India in comparison to 41.4% from Bahrain, and this difference was statistically significant at p<0.0001. Further, the average vitamin D levels in the cohort were detected to be higher in Bahrain samples at 24.0±11.6 ng/ml in comparison to samples from India at 18.2±14.4 ng/ml and statistically significant at p<0.0001.Conclusions: Many studies have documented the prevalence of hypovitaminosis D in a region-specific manner. Our report presents the picture of vitamin D status between two tropical countries to highlight the difference in vitamin D deficiency prevalence in two arid and semi-arid regions of the world.

Surrogates of Poor Prognostic Sign in Adult Patients with Homozygous Sickle Cell Disease: An Echocardiographic Study.

Background: Pulmonary Arterial hypertension (PAH) is a late complication in adult patients with homozygous sickle cell Anaemia (SCA). The early identification of PAH may be of paramount importance. Aim: This study is aimed at evaluating the usefulness of NT pro BNP in the assessment of diastolic function of RV in adult patients with sickle cell disease. It is also aimed at the assessment of the predictive risk of serum level of NT pro BNP hormone and ferritin with other pulsed and tissue Doppler indices for the development of pulmonary hypertension in patients with SCA. In addition, we measured the usefulness of tissue Doppler velocity of lateral annulus of tricuspid valve in the assessment of diastolic function of RV in adult patients with SCD. Method: In this cross sectional prospective study, 103 patients with homozygous SCD were studied and compared with age and gender matched healthy control. Every patient had a clinical assessment, pulsed and tissue Doppler evaluation. Blood samples were withdrawn for the level of haemoglobin, ferritin and NT pro BNP hormone. The mean Original Research Article British Journal of Medicine & Medical Research, 4(26): 4431-4443, 2014 4432 difference between the two groups for echo Doppler and biometric variables were assessed. Multiple regression analysis applied for measuring the odds ratio of different biometric and Doppler variables for risk of PAH in SCD. Results: The study group consist of 103 patients with SCA, mean age of 28.52±14.11 year, (range 14-42), with 68 male (66.0%) Patients with SCA compared with control had a significantly low diastolic pressure, lower haemoglobin level but high serum level ferritin and pro BNP hormone. Further, there was a significant increment in the left atrium area (LA), higher right ventricle (RV) wall thickness and diameter. The RV tricuspid annular systolic excursion (TAPSE) was high of 1.42±0.21 vs. 1.11±0.23, P<0.05. RV Pulsed Doppler data showed restrictive filling pattern with significant higher E wave velocity, higher early diastolic filling wave (E)/ atria wave velocity (A) ratio and short Deceleration Time (DT). Further, the ratio of upper pulmonary vein for systolic/diastolic Doppler velocity was significantly lower 1.5±0.12 vs.2.4±0.11, p<0.05. The tissue Doppler of lateral annulus of tricuspid valve in SCA patients showed a significantly lower S wave of 6.7±1.7 vs 11.3±1.9, p<0.01, higher pulsed early velocity( E)/ early Tissue velocity (E-) ratio and lower atria wave velocity (A). The incidence of pulmonary hypertension in SCD patients via tricuspid valve velocity defined as ≥2.5 m/s was 28%. There were positive correlation between the serum level of ferritin, NT pro BNP hormone and tricuspid valve velocity of (r= 0.38) and (r=0.43) respectively. The odds ratio for development of PAH was 3.1 for E/E- ratio ≥13, 2.5 for DT of <160msec, 2.2 for Left ventricle mass Index (LVMI)>121 gm/M2, 1.9 for ferritin ≥600g/l, 1.6cm for left atrial area ≥20cm, 1.3 for pro- BNP ≥150Pmol/L. Conclusion: Adult patients with SCA have normal Systolic function but increase of LV mass and restrictive diastolic dysfunction. RV has increase wall thickness, systolic and diastolic dysfunction of restrictive pattern. The prevalence of pulmonary hypertension in SCA is 28% with positive correlation between ferritin, pro BNP level and tricuspid valve velocity on echo. The risk of PAH in SCA patients is higher if the patient had on echo DT <160msec, LVMI >121gm/M2, cm, E/E- ratio ≥13 or RV wall thickness >3mm.

Characterization of cephalosporin-resistant clinical Enterobacteriaceae for CTX-M ESBLs in Bahrain

Objective: To detect the presence of specific CTX-M class of extended spectyum β-lactamases (ESBLs) in a collection of cephalosporin-resistant Enterobacteriaceae isolates from Bahrain. Methods: A subset of 80 cephalosporin-resistant Enterobacteriaceae collected from Salmaniya Medical Complex, Bahrain, were characterized further for the presence of specific genogroups of CTX-M β-lactamases by multiplex- and monoplex- PCRs. The primers used for the multiplex and monoplex PCRs were of genogroups- 1, 2, 8, 9 and 25. Sequencing of the representative isolates was performed to find the circulating CTX-M-types. Results: A total of 93.8% (75/80) isolates showed the amplicons corresponding to any of the genogroups (1, 2, 8, 9, 25) and the remaining 6.2% isolates turned out negative in multiplex PCR. Some of the isolates demonstrated multiple bands corresponding to the sizes of different genogroups. Further confirmation with respective monoplex PCR on these 75 isolates demonstrated that 93.3% (70/75) harbored CTX-M genogroup-1 and 6.7% (5/75) harbored genogroup-9. We did not find the presence of genogroups 2, 8, and 25 in these isolates by monoplex PCR. Sequencing results of genogroup-1 isolates demonstrated the presence of CTX-M-15-like ESBL, however, discrepant results were noticed in genogroup-9 isolates, sequencing showed them as CTX-M-55-like ESBL. Conclusions: This is the first report from Bahrain characterizing the CTX-M genogroups of ESBLs and reporting the emergence of bla

Characterization of cephalosporin-resistant clinical Enterobacteriaceae for CTX-M ESBLs in Bahrain

OBJECTIVE@#To detect the presence of specific CTX-M class of extended spectyum β-lactamases (ESBLs) in a collection of cephalosporin-resistant Enterobacteriaceae isolates from Bahrain.@*METHODS@#A subset of 80 cephalosporin-resistant Enterobacteriaceae collected from Salmaniya Medical Complex, Bahrain, were characterized further for the presence of specific genogroups of CTX-M β-lactamases by multiplex- and monoplex- PCRs. The primers used for the multiplex and monoplex PCRs were of genogroups- 1, 2, 8, 9 and 25. Sequencing of the representative isolates was performed to find the circulating CTX-M-types.@*RESULTS@#A total of 93.8% (75/80) isolates showed the amplicons corresponding to any of the genogroups (1, 2, 8, 9, 25) and the remaining 6.2% isolates turned out negative in multiplex PCR. Some of the isolates demonstrated multiple bands corresponding to the sizes of different genogroups. Further confirmation with respective monoplex PCR on these 75 isolates demonstrated that 93.3% (70/75) harbored CTX-M genogroup-1 and 6.7% (5/75) harbored genogroup-9. We did not find the presence of genogroups 2, 8, and 25 in these isolates by monoplex PCR. Sequencing results of genogroup-1 isolates demonstrated the presence of CTX-M-15-like ESBL, however, discrepant results were noticed in genogroup-9 isolates, sequencing showed them as CTX-M-55-like ESBL.@*CONCLUSIONS@#This is the first report from Bahrain characterizing the CTX-M genogroups of ESBLs and reporting the emergence of blaCTX-M-55-like gene in this region.