Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah最新文献

{"title":"External Ear Reconstruction By Antia-Buch Chondro-Cutaneous Advancement Flap in a Case of Human Bite – A Case Report","authors":"R. Gulreez, M. M. Abdelhamid, N. Louri","doi":"10.26715/jbms.34_2022_2_7","DOIUrl":"https://doi.org/10.26715/jbms.34_2022_2_7","url":null,"abstract":"Reconstruction of the external ear is a challenging problem encountered by plastic surgeons. Causes of external ear deformities can be of various etiologies (human bites, animal bites, fights, burns, infections, accidents, or even sports injuries). Full-thickness defects, which cannot be treated by approximating the wound edges, show good results with Antia-Buch’s chondro-cutaneous flaps. A 34-year-old male presented with a history of human bite to his right external ear. The patient had brought the amputated part with him. There was complete amputation of the superior part of the helix with exposed cartilage with a 2 cm defect on examination. The amputated part was an unhealthy crushedavulsed tissue. The patient underwent debridement and washout. Reconstruction of the external ear was done by Antia-Buch helical advancement flap designed over the posterior skin. Post-operatively, the external ear reconstruction yielded good cosmetic results. Animal or human bite defects used to be left open for fear of severe infections, and closure was planned later, but this can be complicated by fibrosis and can result in a change in the shape of the external ear. Primary repair using an Antia-Buch flap and appropriate antibiotic treatment shortens the hospital stay and dressing changes and improves the cosmetic outcome. Keywords: Amputation, Cartilage, External ear, Fibrosis, Human Bite, Reconstructive Surgical Procedures","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69074916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Acute Massive Pulmonary Embolism During Pharmaco-mechanical Thrombectomy for Acute DVT: A Case Report","authors":"Mubashra Butt, Rashad Al Qasim, Dhafer M. Kamal","doi":"10.26715/jbms.34_4_10","DOIUrl":"https://doi.org/10.26715/jbms.34_4_10","url":null,"abstract":"This case report describes an incident of MPE during lower limb endovascular pharmaco-mechanical thrombectomy under sedation, which was immediately identified and promptly managed with cardiopulmonary resuscitation. After return of spontaneous circulation, ECMO was initiated, as her haemodynamics were unstable, and MPE was diagnosed based on transoesophageal echocardiography findings. During intensive care unit stay, she was successfully weaned off from ECMO and ventilatory support. However, the patient developed right-sided body weakness. Echocardiography showed a patent foramen ovale, and stroke due to paradoxical embolism was diagnosed. She was transferred to the ward in a stable condition and later discharged home.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69074978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Factors Related to Endodontic Flare Up - A 1-year Retrospective Study","authors":"Jawaher Almudahki, R. Hassan, Emad Alagamawy","doi":"10.26715/jbms.34_4_4","DOIUrl":"https://doi.org/10.26715/jbms.34_4_4","url":null,"abstract":"Background: Endodontic flare up is a common complication of endodontic treatment that results from acute exacerbation of pulpal and peri-radicular pathosis; leading to unscheduled emergency visits that is disturbing for both clinicians and patients. Flare up causes are multifactorial that includes microbial, host, chemical and mechanical factors. Objective: The aim of this retrospective study was to evaluate the incidence and identify risk factors of flare up in a multispecialty dental and maxillofacial center over a period of one year from February 2019 to February 2020. Methods: Data was collected from 323 teeth belonging to 272 patients that completed their root canal treatment on multiple sessions during the evaluation period. The samples were classified based on inclusion criteria and variables according to teeth type; age; sex; pulpal and periapical pathosis; presence of intracanal medication between visits; and absence of coronal seal. Results: The incidence of flare up was 122(38%), the evaluated variables did not show statistical significance in any of the evaluated parameters. Conclusion: The incidence of flare up is widely diverse and may be due to a variety of reasons; and therefore, the management of flare up in each dental facility is different and varies according to their setup; number of clinicians and specialists available. Continuous training and skills improvement for clinician in charge of managing emergency patients with flare up is highly recommended.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69075098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing Multiple Pedicled Muscle Flaps in Complex Soft Tissue Reconstruction - A Case Report","authors":"M. Elsakka, N. Louri, M. M. Abdelhamid","doi":"10.26715/jbms.34_2022_2_6","DOIUrl":"https://doi.org/10.26715/jbms.34_2022_2_6","url":null,"abstract":"Utilizing multiple muscle flaps is a safe and reliable technique to provide stable soft tissue cover for major post-traumatic defects of the lower limbs. A fifty-five-year-old female patient presented to the emergency department with a huge crush/degloving injury of the whole anteromedial aspect of the right lower limb with open comminuted fracture of the femur, the tibia, and the fibula. Radiological computerized tomography (CT) study showed displaced comminuted fractures involving the lower shaft of the femur, proximal fibula, and middle third of the shaft of the tibia, with tangential bone loss in the knee joint. The patient underwent multiple sessions of wound and bone debridement with bone fixation which was followed by multiple reconstructive surgeries. Patient recovered well and was discharged home with the ability to mobilize with Zimmer frame and knee brace support. Keywords: Comminuted fractures, Degloving injuries, Muscles, Reconstructive surgical Procedures, Surgical flap","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69074879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey of Primary Care Physicians’ Knowledge, Practices & Perceptions of Prediabetes in Bahrain","authors":"Bahnaz Tadayyon, Mona Qader, S. Al-Doseri, E. Ghuloom, Adel Alsayyad","doi":"10.26715/jbms.34_3_3","DOIUrl":"https://doi.org/10.26715/jbms.34_3_3","url":null,"abstract":"Background: Prediabetes is a condition that develops before diabetes and can be treated with intensive Lifestyle Modifications (LSM). This study aimed to assess the knowledge, practices, and perceptions of Primary Care Physicians (PCPs) toward prediabetes in Bahrain. Methods: PCPs in the study were surveyed using a cross-sectional questionnaire in all 28 governmentrun Primary Healthcare Centres (PHCs) in Bahrain. We used descriptive statistics to analyse the data, which were then reported as percentages. Results: From 378 PCPs, 263 completed the questionnaire. The physician’s knowledge of prediabetes Risk Factors (RFs) and HbA1C laboratory criteria to diagnose prediabetes was inadequate. As an initial step to manage prediabetes, 12.5% of PCPs refer patients to Diabetes Prevention lifestyle change Programs (DPPs). Moreover, 15.6% recommend 7% minimum weight loss, 57.8% recommend 150 minutes per week of physical activity and 67.7% recommend prescribing metformin. Overall, our study revealed that General Practitioners (GPs) had inferior knowledge to Family Physicians (FPs). According to PCPs, diabetes prevention is hindered by both individual and system-level challenges (e.g., Inadequate motivation and resources to lose weight). Furthermore, PCPs consider that improved access to DPPs and coordinated referrals to them could delay diabetes. Conclusion: Risk stratification, appropriate diagnosis, and intervention at the prediabetes stage are of critical importance for preventing diabetes. Increasing awareness of the public regarding prediabetes complications and educating healthcare providers, especially GPs, on screening guidelines, diagnostic criteria, and evidence-based management options for prediabetes can bring us one step closer to slowing the diabetes epidemic in Bahrain.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69074941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rituximab Therapy in Polymyositis-associated Severe Dysphagia: A Case Report","authors":"Fajer Altamimi, D. O’Gradaigh, C. Sheehy","doi":"10.26715/jbms.34_4_7","DOIUrl":"https://doi.org/10.26715/jbms.34_4_7","url":null,"abstract":"Polymyositis is one of the inflammatory myopathies. It is a chronic autoimmune disease that usually involves the proximal muscles. It is caused by an inflammatory infiltrate of the skeletal muscle. Notably, dysphagia occurs in one-third of the patients. Traditional treatment with steroids and immune modulators has been reported to have varied outcomes and recurrent symptomatic flares. The dysphagia which occurs in such myopathies may be one of the recurrent and severe symptoms of myopathies, often associated with considerable mortality and morbidity. Dysphagia, an often-noted clinical presentation of polymyositis (PM) /dermatomyositis (DM) can be the initial sign of idiopathic inflammatory myopathies. It can cause considerable morbidity in patients such as reduced pharyngeal contractility, hypomotility of the esophagus, cricopharyngeal dysfunction, and decreased laryngeal elevation. Here is a case of severe dysphagia in a patient with muscle and skin involvement in PM. Steroids are the first line of treatment for patients with myositis and the same was adopted initially for the current case. Rituximab was used after unsuccessful attempts with other recommended first-line treatments. Reversal of dysphagia and overall improvement were achieved with the use of rituximab and intravenous immunoglobulins. The patient demonstrated significant improvement in swallowing, with reasonable improvement, following which the percutaneous endoscopic gastrostomy (PEG) tube was removed. After 15 months, the patient showed 100% resolution of all symptoms and was advised to stop all medications. Therefore, we suggest that this combination may be considered in cases with dysphagia flares in DM, where traditional treatment options have shown no benefit.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69075171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary colorectal anastomosis, no preparation, no stoma needed","authors":"K. A. Beerdawood, F. Alhmoud, A. A. A. Namoura, A. H. S. A. Briezat","doi":"10.26715/jbms.25_2_6","DOIUrl":"https://doi.org/10.26715/jbms.25_2_6","url":null,"abstract":"Background: Mechanical bowel preparation was regarded for a long time as a vital prerequisite for successful colorectal surgery; this is now being questioned. The distressful effect of bowel preparation, alongside the safety of primary colorectal anastomosis in emergency cases, has led to a considerable change in the surgical protocol, making primary repair and anastomosis after colon resection safer without bowel preparation, and the role of colostomy has changed from mandatory to optional. Aim: To assess whether colorectal surgery can be performed safely without mechanical bowel preparation or colostomy. Method: A series of 130 patients, who underwent elective and emergency colorectal surgery, were followed prospectively over a three-year period in Al Bashir Teaching Hospital, Amman, Jordan. The patients were randomized into two groups. In one group (preparation group) 66 elective patients were selected from the outpatient department; the bowel was prepared using Fortran’s solution. In the second group (non-preparation group), 64 patients were selected from the emergency and outpatient departments, no bowel preparation was used. Colostomy was omitted in both groups. The main outcomes regarding operative time, hospital stay, rate of postoperative wound infection, anastomotic leak and intra-abdominal abscess were compared between the two groups. Results: Malignancy was the most prevalent pathology in both the preparation and non-preparation groups, 75.7% and 62.5% respectively, while benign diseases were present in up to 24.2% of the preparation group and in 1.5% of the non-preparation group. Anastomosis was ileo-colic in 33.3% and 37.5%, colo-colic or colo-rectal in 66.6% and 62.5% of the preparation and non-preparation groups respectively. There was no significant statistical difference in the overall postoperative complication rates between the two groups, 16.6% in the preparation group and 14% in the non-preparation group. Postoperative wound infection, wound dehiscence, intra-abdominal abscess and anastomotic leak occurred in 9.09%, 1.5%, 1.5% and 4.5% in the preparation group, as compared to 7.8%, 3.1%, 0% and 3.1% in the non-preparation group respectively. The mortality rate was nil in both groups. Conclusion: Resection of colorectal pathology followed by primary anastomosis, without stoma, can be performed safely with the omission of preoperative mechanical bowel preparation.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69073493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From junk science pawn to public-led trials","authors":"A. Price","doi":"10.26715/jbms.25_2_9","DOIUrl":"https://doi.org/10.26715/jbms.25_2_9","url":null,"abstract":"Junk scientists and unethical healthcare providers often tell the public that systematic reviewers reject real research because of bias or that universities and the FDA are paid off by the pharmaceutical industry. I was snared in this trap during my role in a spinal injury foundation after sustaining significant brain and spine injuries. I was too naïve and damaged to understand that not all doctors are ethical or that the role of the FDA is in protecting public health. As my brain started to recover I began attending classes at the Open University and I found the world of ethics, research methods and cell biology. Soon my days at the spinal organization were numbered as I pointed out errors in the protocols and discrepancies in what the participants should know. I shared that vulnerable persons need to be informed they are participants and not patients and that it was unethical to charge patients for experimental research or use them as shields against the recommendations of the FDA. The organization battled the FDA who won a permanent injunction against them. I was dismissed long before this but felt like I had blood on my hands. I decided I would become an informed healthcare provider and I proceeded to learn Evidence-Based Healthcare at the University of Oxford where I completed the Masters and went on to become a Doctor of Philosophy student to bring evidence-based healthcare and public led trials to the masses. This is my story.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69073578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The eye - the window to the soul of the diagnosis: CHARGE Syndrome, a case report","authors":"A. Hubail, J. Darwish","doi":"10.26715/jbms.25_2_10","DOIUrl":"https://doi.org/10.26715/jbms.25_2_10","url":null,"abstract":"The modality of inheritance in CHARGE syndrome is autosomal dominant, classically triggered by mutations in the chromo-domain helicase DNA binding protein-7 (CHD7) gene. CHARGE syndrome is characterized by the variable occurrence of coloboma, heart defects, atresia of the choanae, retarded growth and development, genital hypoplasia, ear anomalies and deafness. In this report, we describe an infant with a typical phenotype characterized by severe psychomotor retardation, facial asymmetry, coloboma, cortical blindness, unilateral choanal atresia, congenital heart anomalies, genital hypoplasia, cranial nerve IX/X dysfunction and global developmental delay that was diagnosed clinically. Following clinical diagnosis a complete sequencing of the CHD7 gene was carried out at the Institute for Medical Diagnostics GmbH in Ingelheim, Germany. Genomic DNA was screened for mutations in the CD7 gene (OMMIM 608892) on chromosome 8q12.1 The codon exon 2-38 and the respective exon-intron boundaries were amplified by polymerase chain reaction and analysed by direct sequencing. Resulting sequence data were compared with the reference sequence NM_017880.3 No mutation in CHD7 gene was detected as a genetic cause for the clinical phenotype of the patient. The MPLA multiplex ligation-dependent probe amplification analysis showed no copy number variation in the CHD7 gene. This case report underscores the importance of a detailed family history and physical examination in the diagnosis of CHARGE syndrome. Additionally, it provides valuable insight into the pathogenesis and clinical presentation of the syndrome as well as highlighting the benefits of a multidisciplinary approach. With supportive nurturing care, children with CHARGE syndrome can overcome the associated disabilities and develop necessary motor skills and a life-style enhancing level of fitness.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69073781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes of primary care physicians towards insulin initiation in people with type 2 diabetes in Bahrain","authors":"F. Habib, J. Nasser, J. Abbas, Z. AlMussali, N. Madan","doi":"10.26715/jbms.25_2_5","DOIUrl":"https://doi.org/10.26715/jbms.25_2_5","url":null,"abstract":"Objective: The aim of this study is to explore the beliefs and attitudes of primary care physicians (PCP) regarding insulin initiation in people with type 2 diabetes. Methods: A structured, adapted questionnaire was distributed to all primary care physicians. The questionnaire consisted of 2 parts: the first part collected information on physicians’ demographic characteristics; the second part contained 30 items measuring the beliefs and attitudes of physicians regarding insulin initiation. Results: A total of 171 physicians out of 245 completed the questionnaire with a response rate of 70%. Most of the physicians were between 30 and 59 years of age. The majority were females (79.4%), had been in practice for >10 years and were certified family physicians seeing more than 25 diabetic patients a week. About 75% of the physicians found initiation of insulin as one of the most difficult aspects of managing patients with type 2 diabetes. The main obstacles reported by physicians were: route of administration by injection, the risk of hypoglycemia, and the patients’ level of education. However, they agreed that the benefits of insulin outweighed the risks of hypoglycemia and weight gain. Only 45% of them agreed that patients will eventually need to go on insulin regardless of how well they adhere to treatment. Moreover, 31.8% of physicians stated that increased levels of plasma insulin will increase the risk of cardiovascular events. Conclusion: Physicians’ concerns and lack of knowledge regarding insulin use may act as barriers to insulin initiation. This may increase the risk for a higher rate of uncontrolled diabetes and its subsequent complications.","PeriodicalId":85027,"journal":{"name":"Journal of the Bahrain Medical Society = Majallat Jam'iyat al-Atibba' al-Bahrayniyah","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69073952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}