Neonatal indirect hyperbilirubinemia and glucose-6-phosphate dehydrogenase deficiency / 소아과

PURPOSE: This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus. METHODS: This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed. Data on sex, age at presentation, hospitalization duration, need for ET, hemoglobin (Hb) level, reticulocyte count, direct Coombs test, serum total and indirect bilirubin levels, thyroid function, blood and urine cultures, G6PD status, and blood groups were collected and compared between the G6PD-deficent and G6PD-normal patients. RESULTS: Of 1,159 NIH patients admitted, 1,129 were included, of whom 646 (57%) were male. Among 1,046 patients tested, 442 (42%) were G6PD deficient, 49 (4%) needed ET, and 11 (1%) had suspected Kernicterus. The G6PD-deficient patients were mainly male (P<0.0001), and had lower Hb levels (P<0.0001) and higher maximum bilirubin levels (P=0.001). More G6PD-deficient patients needed ET (P<0.0001). G6PD deficiency (P=0.006), lower Hb level (P=0.002), lower hematocrit count (P=0.02), higher bilirubin level (P<0.0001), higher maximal bilirubin level (P<0.0001), and positive blood culture result (P<0.0001) were significant risk factors for ET. Maximal bilirubin level was a significant risk factor for kernicterus (P=0.021) and independently related to ET (P=0.03). CONCLUSION: G6PD deficiency is an important risk factor for severe NIH. In G6PD-deficent neonates, management of NIH should be hastened to avoid irreversible neurological complications.

Large atrial septal defects in adolescents and adults: a high incidence of sinus venosus type defects presenting late

Background: Isolated Atrial Septal Defect [ASD] is a common congenital heart disease that could present at any age. It is the most common form of heart disease presenting in adolescents and adults

Objective: To evaluate adolescents and adults presenting late with significant ASD's and their presentation, management and short-term outcomes

Design: A Retrospective Study

Setting: Mohammed Bin Khalifa bin Salman Al-Khalifa Cardiac Center, Bahrain

Method: A retrospective study was performed. Adolescents/adults more than 14 years of age with significant ASD referred to a tertiary cardiology unit over a three-year period were reviewed from 1 March 2012 to 31 March 2015. The data was obtained from a computerized database

Result: Thirty-two patients presented with large ASD. Twenty-five [78.1%] were females. The mean age was 29.4 years. The majority were diagnosed as an incidental finding of murmur during routine examination. A high number of Sinus Venosus Defects in the adolescent/adult group [22% compared to 7% in the pediatric group: P=0.01] was found, which were more common in males [42% compared to 17%: P=0.128]. Nine [28.1%] underwent successful device closure. Twenty three [71%] patients were referred for surgical correction. There was no mortality

Conclusion: Significant ASD is often undiagnosed until adolescence or adulthood. If not promptly diagnosed and managed, it is likely to present with symptoms and signs of pulmonary overload later in life. Sinus Venosus ASD's should be suspected in male adolescents and adults with significant ASD's in Bahrain and surgical closure is often required

accuracy of PET-CT scan in detecting axillary lymph node metastasis in breast cancer

Objective: To evaluate the accuracy of positron emission tomography CT scan in detecting axillary lymph node metastases compared to the pathology results in patients with primary breast cancer

Setting: Breast Surgery Unit, King Hamad University Hospital, Bahrain

Design: A Retrospective Comparative Study

Method: Twenty-one newly diagnosed females with invasive breast cancer and staged using FDGPET-CT scan. Images were evaluated by two experienced radiologists for any abnormal increase in axillary FDG uptake. Imaging results were compared to axillary lymph node pathology, such as sentinel lymph node biopsy, FNA cytology from axilla or axillary clearance

Result: All patients had histopathology results that matched the PET-CT finding except 2 [10%] patients who matched the CT scan alone but not the PET scan. The sensitivity of the PET-CT for detection of axillary lymph node metastasis in this series was 80% and the specificity was 100%. Both sensitivity and specificity were noted to be high compared to other published data

Conclusion: PET-CT scan is highly sensitive and specific in detecting axillary lymph nodes metastases in breast cancer. The sensitivity reached 80% and the specificity was 100% in our study; this could be attributed to the small number of patients and the improvement in the new generation of the PET-CT scanners with high resolution, which led to further increase in the diagnostic value. Therefore, recent evidence does not support the use of PET-CT scan to replace clinically negative axillary lymph nodes as initial assessment

Factors influencing successful vaginal birth after cesarean delivery

Background: Cesarean delivery is one of the most common procedures performed worldwide; women giving birth by cesarean delivery are increasing over the past several decades. The demand to decrease the rate of repeat cesarean is an international drive. This goal needs to be achieved through safe approach

Objective: To evaluate the factors of successful Vaginal Birth after Cesarean [VBAC] Delivery

Setting: Bahrain Defence Force Hospital, Bahrain

Design: A Retrospective Study

Method: Cesarean section patients who had an attempt at vaginal delivery between 1 January 2014 and 31 January 2015 were reviewed. Maternal age, gestation age, maternal weight, birth weight, fetus sex, pervious vaginal delivery, previous VBAC, cervical dilation and other patient's characteristics were documented. Data was analyzed using StatsDirect software and P-value of less than 0.05 was considered statistically significant

Result: Five hundred sixty-eight patients with history of one previous cesarean delivery attempted VBAC. Successful VBAC was documented in 236 [41.5%]. We found significant successful VBAC in patients with previous vaginal birth, high parity, presented with cervical dilatation more than or equal to 4 cm, male fetus and patients with induced labor [P<0.0001]. Other factors negatively affected the success rate, such as recurrent cause for previous cesarean [P<0.0001], short interval [P<0.0001], ethnic background [P=0.0006], and IVF pregnancies [P=0.0106]. Patient and fetus weights did not affect VBAC outcome

Conclusion: Previous vaginal birth, advance cervical dilatation, induction of labor and proper interval after Cesarean increase the success rate of VBAC. Factors which negatively affect the vaginal birth after Cesarean are the history of recurrent indication and maternal diabetes

Impact of parenteral compared to oral vitamin D3 [25-OH cholecalciferol] therapy on the bone pain frequency and serum level of VD in adult patients with homozygous sickle cell anemia

Background: Bone pain frequency and optimal methods of vitamin D [VD] administration in adult patients with sickle cell anemia [SCA] are unclear

Objective: To assess bone pain frequency and level of VD in adult SCA patients after vitamin D medication

Setting: Salmaniya Medical Complex, Bahrain

Design: A Prospective Controlled Trial

Method: The study was performed from 1 January 2013 to 31 December 2014. Sixty-nine SCA patients were studied and compared with an age and gender-matched control group. Bone pain frequency was assessed using Visual Analogue Scale [VAS]. Measurement of serum level of VD, parathormone [PTH], calcium and alkaline phosphatase [ALP] at baseline, one and three months after treatment. Vitamin D Deficiency [VDD] was defined as <50 nmol/L. The mean difference of biochemical and clinical parameters was compared using paired Student t-test

Result: Fifty-one [74%] patients from the study group and 14 [20.3%] patients from the control group had VDD. Twenty-six [37.7%] patients were treated with IM injection of 600,000 IU once and 25 [36.2%] were treated with oral capsule of 50,000 IU weekly. Patients on IM treatment had pain frequency of 56 episodes per month before treatment, which was reduced to 43 [P<0.05] after one month; further reduction to 34 episodes [P<0.01] was achieved after three months. Patients on oral medication had pain frequency of 57 episodes per month before treatment, which reduced to 50 episodes after one month [P<0.05] and 40 after 3 months [P<0.01]. Vitamin D level increased to 54.15 +/- 2.73 in one month compared to 19.55 +/- 9.63 nmol/ml [P<0.05] before treatment. Patients on oral medication had VD increment of 31.64 +/- 4.44 compared to 22.11 +/- 9.46 nmol/ml [P<0.05] after one month and 53.69 +/- 2.37 nmol/ml after three months [P<0.001]

Conclusion: Frequency of bone pain was reduced significantly in adult SCA patients with VDD after one month of treatment of vitamin D3 injection with normalization of serum level

Antibiotic appropriateness for urinary tract infection in the emergency room

Background: Urinary Tract Infections [UTI] are a common cause of emergency room [ER] visits and antibiotic misuse

Objective: To evaluate the characteristics of UTI attending ER and to assess antibiotic prescription and inappropriate treatment implications

Design: A Prospective Study

Setting: Salmaniya Medical Complex, Bahrain

Method: Patients aged more than 14 years who presented to the ER with UTI from 1 July 2014 to 31 July 2014 were reviewed. Data was obtained from patients' emergency records and classified according to the type of UTI as complicated, uncomplicated or UTI in pregnancy. Antibiotic treatment was considered appropriate if it followed the Local or International Guidelines

Result: A total of 239 patients were included in the study; 83 [34.7%] were males, 75 [31.4%] were pregnant females and 81 [33.9%] were non-pregnant females, the mean age was 37.56 years. One hundred forty-five [60.7%] patients had complicated UTI. The most prescribed antibiotics were cefuroxime and ciprofloxacin. Seventy-two [30.1%] of inappropriate antibiotics prescription were mostly due to improper duration. Inappropriate antibiotic treatment was significantly more common among males, 43 [17.9%] P-value <0.001; complicated UTI were 63 [26.4%], P-value <0.001. One hundred thirty-three [55.6%] prescriptions were written by emergency doctors, P- value <0.001. There was no significance among the different age groups

Conclusion: High rate of inappropriate antibiotics use in UTI patients mostly in complicated UTI and in patients treated by emergency doctors physicians

Suxamethonium apnoea: the forgotten episode in current practice

We present the first case in Bahrain of suxamethonium apnea in a parturient for an emergency Cesarian section. Immediate onset of action, optimal intubating conditions and rapid recovery are the key features that promote the use of suxamethonium. Suxamethonium apnea is critical and occurs in patients with pseudocholinesterase [PChE] deficiency either inherited or due to an acquired cause. Early suspicion of suxamethonium apnea and appropriate management with adequate sedation and mechanical ventilation whilst waiting for spontaneous recovery are all essential for a successful outcome

rate and reasons for discharge against medical advice

Objective: To evaluate the rate and reasons for discharge against medical advice

Design: A Prospective Cross-Sectional Study

Setting: King Hamad University Hospital, Bahrain

Method: All patients discharged against medical advice [DAMA] from the Emergency Medicine Department [EMD] and in-patients from 1 August 2015 to 31 December 2015 were included in this study

A preformed questionnaire was given to the patient or the family members who signed DAMA form

The data were analyzed using SPSS version 19.0

Result: Two hundred and ninety-nine patients were DAMA; the reasons for DAMA for adults and children combined were: 86 [28.8%] feeling better, 61 [20.4%] children at home, 51 [17.1%] long waiting time, 45 [15%] do not agree with the procedure or operation advised, 29 [9.7%] external obligations, 16 [5.4%] wish to have other treatment or consultation, 6 [2%] financial reasons, 3 [1%] dissatisfaction with medical or nursing care, 1 [0.3%] going on holiday and 1 [0.3%] the hospital does not allow husband to stay with his wife in the room

The rate of DAMA signed by patients is relatively high when EMD was considered. However, it was relatively low percentage when inpatient admission was taken into consideration

Conclusion: Our study revealed several predictors, which could be used for healthcare improvement

Lipohypertrophy among insulin-treated patients

Objective: To evaluate insulin injection practice, prevalence and risk factors of lipohypertrophy [LH] among insulin-treated patients

Design: A Retrospective Study

Setting: Two Primary Health Centers, Bahrain

Method: Ninety-five insulin-treated patients were included in the study from 3 January 2016 to 31 May 2016. The following data were documented: age, sex, educational level, type of diabetes, duration of diabetes, duration of insulin treatment, number of injections, type of insulin, daily insulin dose, needle size, site of injection, frequency of needle change, frequency of injection site rotation and frequency of checking the injection site. Diabetes control and Body Mass Index [BMI] were documented. Ultrasound examination of the injection site was performed

Result: Ninety-five insulin-treated patients were included in the study

Thirty-five [36.8%] patients had LH. Seventy-two [75.8%] patients were obese females with poorly controlled type 2 diabetes

Forty-seven [49.5%] patients were using insulin for less than five years. Ninety-three [97.8%] patients were using <6 mm needle; 85 [89.5%] were using the needle once at a time and were doing daily rotation

The injection site was never checked in all except one [1.1%] patient

There was a highly significant statistical association between LH and level of education, the number of injections and the site of injection. Mean subcutaneous fat thickness were 12.3 mm [arm], 17.8 mm [thigh] and 23.3 mm [abdomen]

Conclusion: Lipohypertrophy is prevalent among our patients and could be related to improper insulin injection technique and lack of regular check of the injection sites. Therefore, patients and health providers' education is necessary to reduce its prevalence

Hypoplastic maxillary antra

Background: Maxillary sinus hypoplasia is an uncommon pathology of the paranasal sinuses, which might be encountered in the clinical practice. Computed tomography scan confirms its existence and any associated anatomical anomaly and variations that might coexist

Objective: To present three cases of maxillary sinus hypoplasia which were diagnosed and managed surgically

Design: A Retrospective Study

Setting: Otorhinolaryngology Department, Bahrain Defence Force Hospital, Bahrain

Method: Three cases of maxillary sinus hypoplasia were managed from January 2012 to December 2015. The clinical presentation, radiological findings and surgical management of these patients were documented and found to be distinct from other cases

Result: The first case was a fourteen-year-old male with long-standing nasal symptoms, which were not relieved by medical treatment. Sinus CT scan revealed an ill-defined infundibular passage and complete opacified small right maxillary sinus; CT was classified as hypoplasia type 2 according to Bolger et al and was successfully treated surgically

The second case was a twenty-seven-year-old male with persistent left sided facial heaviness and left-sided headache. Sinus CT scan revealed left side normal uncinate process with well-defined infundibular passage indicating type 1 maxillary sinus hypoplasia

The third case was a thirty-four-year-old pregnant female with diplopia and left-sided headache. MRI revealed left maxillary sinus and inferiorly displaced left orbital floor with non-homogenous fluid-like signal intensity suggesting marked left long-standing sinusitis

The patient was managed by an antral lavage under local anesthesia. After delivery, she was reassessed by CT scan of the sinuses, which revealed left side small sized partial opacified type 2 maxillary sinus hypoplasia

Conclusion: Symptomatic maxillary sinus hypoplasia patients with a diseased blocked ostiomeatal complex have special diagnostic considerations and therapeutic challenges

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

Major lower limb amputation: causes, characteristics and complications

Background: The incidence rates of major amputations vary greatly between different countries. Amputation carries a significant psychological and socioeconomic burden on the individual and the community

Despite that, major lower limb amputation is a relatively frequent procedure in our center. To date, there has been no study published to identify the major cause of amputation and the personal characteristics of the patients

Objective: To identify the causes, patient characteristics and complications of major lower limb amputation

Design: A Prospective Study

Setting: Vascular and Thoracic Surgery Unit, Department of Surgery, Salmaniya Medical Complex, Kingdom of Bahrain

Method: All patients who underwent major amputation of the lower limb/s from 1 May 2015 to 30 April 2016 were included in the study

Result: Forty-five patients were included in this study. Forty-seven major lower limb amputations were performed during the study period. Forty-one [91.1%] patients were Bahrainis. Twenty-nine [64.4%] patients were males and the median age was 66 years. Thirty [66.7%] patients had no university education

Thirty-eight [84.4%] patients underwent amputations due to diabetes mellitus [DM] and its related complications. Seventeen [37.8%] patients had postoperative complications. Surgical site wound infection [SSI] was the most common postoperative complication, 8 [17.8%] patients

The overall 30-day mortality was 10.6%

Conclusion: Diabetes mellitus and its related complications is the main cause for major lower limb amputation in our study

Clinical profiling of stroke

Background: Stroke is the second leading cause of death worldwide. Defined by the WHO as 'Rapidly developing clinical signs of focal or global disturbance of cerebral function with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than vascular origin'. It is a major complication of hypertension

Objectives: To evaluate the personal and clinical characteristics of stroke patients

Setting: Salmaniya Medical Complex, Bahrain

Design: A Retrospective Cross-Sectional Study. I

Method: All patients diagnosed and admitted between 1 January 2010 and 31 December 2010 were included. One hundred eighty-three patients were included in the study

Personal and clinical data were documented. Data was entered and analyzed using SPSS program version 17

Result: Ischemic stroke was the most common, 115 [62.8%]

The majority of patients were males, 129 [70.5%]

The most notable outcome is the rehabilitated patients, 74 [40.4%]

One hundred sixty-six [90.7%] patients did not suffer confusion, whereas 84 [45.9%] had impaired speech and 77 [42.1%] had right-sided numbness and weakness

Conclusion: The most common type of stroke was the ischemic stroke, 115 [62.8%]

The most common symptom was weakness, 147 [80.3%]

The most common risk factor was hypertension, 136 [74.3%] and the most common outcome was rehabilitation, 74 [40.4%]

Collaborative Intervention of Middle East Respiratory Syndrome: Rapid Response Team / 감염과화학요법

On May 20th 2015, a 68 year old man was the first to be diagnosed with Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) in Korea. He travelled to Bahrain, Saudi Arabia, and Qatar for 16 days. On May 4th 2015, the patient entered Korea, with febrile sense and respiratory symptoms that appeared on May 11th. The MERS-CoV Outbreak became worse and several patients had to be admitted throughout various hospitals starting at the beginning of June. This situation led to a nationwide chaos. The Rapid Response Team (RRT) was organized after the Korean government's calling for specialists that were composed of 15 Infectious disease Doctors and 2 Infection Control professionals on the 8th of June 2015. The main purpose of the RRT were: 1) consultation to the Government controlling MERS-CoV outbreak. 2) Visit hospitals that were exposed to MERS-CoV infected patients, and to provide advice regarding infection control strategy for rehabilitating of the exposed hospitals. Since June 8th, the RRT visited more than 10 hospitals and an effective consultation was carried out. Most of the hospitals were recovering from the MERS outbreak since early July. Cooperation between the government and private sector experts was very effective. The efforts of government and private sector experts overcame the initial chaos situation. It could prevent further deterioration of the MERS outbreak.

Institutional Preparedness to Prevent Future Middle East Respiratory Syndrome Coronavirus-Like Outbreaks in Republic of Korea / 감염과화학요법

A year has passed since the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea. This 2015 outbreak led to a better understanding of healthcare infection control. The first Korean patient infected by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was diagnosed on May 20, 2015, after he returned from Qatar and Bahrain. Thereafter, 186 Korean people were infected with the MERS-CoV in a short time through human-to-human transmission. All these cases were linked to healthcare settings, and 25 (13.5 %) infected patients were healthcare workers. Phylogenetic analysis suggested that the MERS-CoV isolate found in the Korean patient was closely related to the Qatar strain, and did not harbor transmission efficiency-improving mutations. Nevertheless, with the same infecting virus strain, Korea experienced the largest MERS-CoV outbreak outside the Arabian Peninsula, primarily due to the different characteristics of population density and the healthcare system. We aimed to review the epidemiological features and existing knowledge on the Korean MERS outbreak, and suggest methods to prevent future epidemics.

Middle East Respiratory Syndrome Outbreak in Korea, 2015

Since April 2012, more than 1,600 laboratory-confirmed human infections with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported, occurring primarily in countries in the Arabian Peninsula; the majority in Saudi Arabia. The MERS outbreak in Korea, which began in May 2015 through the importation of a single case who had recently traveled to Bahrain, the United Arab Emirates, Saudi Arabia, and Qatar. As of November 28th, 186 secondary and tertiary cases had been reported; 38 deaths, mainly associated with underlying chronic illnesses, were reported. One case was exported to China and has been recorded as the first MERS case in China. Thirty-seven confirmed cases were associated with the index case, who was hospitalized from May 15 to May 17. Emergency room at one of the nation's largest hospitals had been affected by hospital-to-hospital and intra-hospital transmissions of MERS-CoV, resulting in an outbreak of 90 infected patients. The vast majority of 186 confirmed cases are linked to a single transmission chain associated with health facilities. The median age of patients is 55 years, with a range of 16 to 87 years. The majority (61%) of patients are men. Twenty-five (14%) of the cases involve healthcare workers. The overall median incubation period was six days, but it was four days for secondary cases and six days for tertiary cases. There has been no evidence of airborne transmission and sustained human-to-human transmission in communities. Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the MERSCoV under control in Korea. Since 4 July no new cases have been reported.

High prevalence of blaCTX-M in Enterobacteriaceae isolates from the Kingdom of Bahrain

OBJECTIVE@#To determine the molecular epidemiology of extended-spectrum β-lactamase (ESBL) by testing a cohort of clinical ESBL-producing bacterial isolates that were isolated in the Kingdom of Bahrain.@*METHODS@#ESBL producing Enterobacteriaceae isolates (based on phenotypic tests) were collected from Microbiology Laboratory of the Salmaniya Medical Complex, Bahrain between January-June 2006. Antibiotic susceptibility to a panel of antibiotics was performed and bla(CTX-M) genes were detected by multiplex PCR.@*RESULTS@#A total of 230 isolates (Escherichia coli, n=180; Klebsiella pneumoniae, n=50) were studied, 98% were CTX-M type. For Escherichia coli isolates, 65 (36.1%) harbored CTXM+TEM combination and 68 (37.8%) had CTX-M alone. In contrast, for Klebsiella pneumoniae isolates only 5 (10.0%) harbored the CTX-M combination, and none had CTX-M only. The bla(CTX-M) gene was found predominantly in urine isolates (n=145/230; 63.0%). Sensitivity to imipenem and nitrofurantoin was 100% and 60%, respectively. CTX-M carriage was associated with the resistance to fluoroquinolones, trimethoprim-sulfamethoxazole and aminoglycosides.@*CONCLUSIONS@#Our study documentes high prevalence of CTX-M ESBL type among Escherichia coli and Klebsiella from the Kingdom of Bahrain. The apparent dissemination of CTX-M producers could represent a substantial barrier in the treatment of community-acquired infections. The use of extended-spectrum cephalosporins, quinolones, and aminoglycosides is compromised, leaving carbapenems as the therapeutic option for severe infections caused by ESBL producers.

Gender-based treatment outcomes in diabetic hypertension.

BACKGROUND: In developing countries, gender-based treatment disparities in cardiovascular preventive therapy have received little attention. AIMS: To evaluate the gender-based differences in cardiovascular disease risk profile, drug prescribing pattern, and blood pressure (BP) and glycemic control rates in diabetic hypertensives treated at primary care setting in Bahrain. SETTINGS AND DESIGN: A retrospective study at primary care setting. MATERIALS AND METHODS: An audit of the medical records of 392 diabetic hypertensives (127 men, 265 women). RESULTS: BP and glycemic targets were achieved in < 10% and < 13% of diabetic hypertensives, respectively. Angiotensin converting enzyme inhibitors monotherapy was more often prescribed in males. Apart from this, no significant differences in prescribing pattern were observed between male and female diabetic hypertensives treated with either antihypertensive mono or multidrug therapies. With the exception of insulin which was more often prescribed to females, a similar prescribing pattern and rank order of antidiabetics, either as monotherapy or combinations, was observed in both genders. The majority of diabetic hypertensives were at high cardiovascular risk. The body mass index and total cholesterol level were greater in females. Prescribing lipid-lowering drugs and aspirin were suboptimal; aspirin was more often prescribed to males. There was no gender-based difference with regard to the use of lipid-lowering drugs. CONCLUSIONS: BP and glycemic controls were suboptimal in both male and female diabetic hypertensives treated by primary care physicians. Cardiovascular disease preventive strategies have received little attention regardless of gender or other risk factors. Gender-based treatment inequities also need to be addressed.

Management of acute diarrhoea in primary care in Bahrain: self-reported practices of doctors.

This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August-30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system.

Detection of Helicobacter pylori cagA gene in gastric biopsies, clinical isolates and faeces.

PURPOSE: Helicobacter pylori infection is common in the developing countries. The cagA gene is a marker of pathogenicity island (PAI) in H. pylori . The aim of this study was to determine the prevalence of cagA among dyspeptic patients in Bahrain directly from gastric biopsy and stool specimen. METHODS: A total of 100 gastric biopsy samples, 16 clinical isolates and 44 faecal specimens were collected from Bahraini adult dyspeptic patients. cagA gene of H. pylori was assessed using polymerase chain reaction (PCR). RESULTS: The cagA gene was detected in 59 (59%) from biopsy specimens, 10 (62%) clinical isolates and in 10 (22.7%) faecal specimens. The detection of cagA positive H. pylori was significantly higher in patients with duodenal ulcer (80%) compared to those with other endoscopic finding (42%) (P < 0.05). CONCLUSIONS: Using PCR to detect cagA gene directly from biopsy is a rapid and reliable technique. However, using stool specimen for genotyping in our patients showed reduced sensitivity.