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Pernicious anemia in a young Bahraini female.

Pernicious anemia (PA) is an autoimmune disorder associated with atrophic gastritis, presence of antibodies to gastric parietal cells and intrinsic factor (IF) and vitamin B2 malabsorption leading to megaloblastic anemia. It has a comparatively higher prevalence in people of North European origin, is uncommon in Arabs and usually affects the elderly. This report, the first from Bahrain, describes a rare case of PA in young female. The presenting symptoms, clinical and laboratory features were similar to those described in classical elderly Caucasian patients. No association with any other autoimmune disease was detected.

Adult↗

Endocrine changes after laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovarian syndrome.

OBJECTIVE: To study the effects of laparoscopic ovarian drilling on the serum hormone levels in clomiphene citrate resistant women with polycystic ovarian syndrome (PCOS) and to determine the criteria which influenced their clinical response. METHODS: A prospective study that was carried out at Salmaniya Medical Complex in Bahrain. One hundred and eighty-one women with clomiphene citrate-resistant PCOS were treated with laparoscopic ovarian drilling, all procedures were performed over a 4-year period between June 1996 and June 2000. Fasting blood samples for determination of the serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH-FSH ratio, testosterone and prolactin were taken during the follicular phase before and one month after laparoscopic ovarian drilling. RESULTS: Responders who ovulated spontaneously after the drilling were obese and had higher preoperative LH levels and the LH-FSH ratio. Both responders and non-responders showed a significant decline in LH, LH-FSH ratio and testosterone with a significant increase in FSH but no significant change in prolactin mean values compared with pretreatment levels. The magnitude of change was significantly higher for LH and the LH-FSH ratio (p<0.05) in responders, while there were no significant differences in the corresponding values of the other hormones between the 2 groups. Moreover, the decrease in LH (p<0.01) and the LH-FSH ratio (p<0.05) was significantly greater in obese than non-obese women and this was only observed in the responders group. CONCLUSION: Laparoscopic ovarian drilling is an effective procedure in women with clomiphene citrate resistant PCOS. It produces significant endocrine changes with better results in obese patients with higher preoperative LH values and LH-FSH ratio. The magnitude of these changes was the highest in obese responders.

Adult↗

'No more exercises'.

Squadron Leader Shannon PMRAFNS discusses the preparation leading up to and including the days of the Iraqi conflict carried out by the Royal Air Force Hospital at Muharraq in the state of Bahrain.

Humans↗

Dermatological publications in the Gulf Cooperation Council countries. An analysis of 1966-2004 Medline papers.

OBJECTIVE: To investigate the publications in dermatology cited in the Medline from 6 countries of the Gulf Cooperation Council (GCC) from 1966 to 2004. METHODS: Medline was searched with the aid of Internet provider Pubmed using the same strategy at a given time for all countries. RESULTS: At the time of search, the Medline listed biomedical research papers from the GCC countries totaled 12837. Of these, 140 were in Dermatology. The Kingdom of Saudi Arabia followed by Kuwait was by far the most prolific contributor, whereas almost none were noted from Bahrain. The publications were highest during the year 2002 (19) followed by 2003 (13), most of them being in the English language in the International Journal of Dermatology (60 citations) and Pediatric Dermatology (13 citations). CONCLUSION: Though the GCC countries have seen a relatively small period in the history of development of medical research, data show that they are trying to keep pace with the rest of the developed world. What remains to be exploited is their good economy that should be directed to provide better infrastructure and improve the quality of training programs. Professional societies within the region must play an active role in ensuring optimum and judicious use of funds.

Dermatology↗

Pregnancy outcomes after laparoscopic ovarian drilling in women with polycystic ovarian syndrome.

OBJECTIVE: To study whether there is an increased risk of glucose intolerance and hypertensive complications during pregnancy in women with polycystic ovarian syndrome (PCOS) who conceived after laparoscopic ovarian drilling and to investigate if there is an adverse pregnancy outcome. METHODS: This prospective study took place at Salmaniya Medical Complex in Bahrain, between June 1996 and June 2003. We compared the pregnancy and neonatal outcomes of 134 patients with PCOS who were treated with laparoscopic ovarian drilling with 479 pregnant women without PCOS (controls). We used the multiple logistic regression analysis to assess the risk of PCOS on impaired glucose tolerance (IGT), gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy (HDP) and premature delivery. RESULTS: Subjects with PCOS had a significantly greater prepregnancy body mass index, prevalence of obesity and nulliparity as compared with controls. The incidence of IGT (p=0.007), GDM (p=0.01) and HDP (p=0.001) were significantly higher in pregnant PCOS compared with the control group. There were no significant differences in the neonatal outcomes and prevalence of premature delivery between the 2 study groups. When non-obese PCOS patients were compared with non-obese controls, the incidence of GDM (p=0.04) and HDP (p=0.004) were still significantly higher in the former. The prevalence of pregnancy complications were not significantly different when obese PCOS were compared with obese control patients. The PCOS was demonstrated as a risk factor for IGT (p=0.05), GDM (p=0.03) and HDP (p=0.03), but not for premature delivery. CONCLUSION: Women with PCOS who conceived after the drilling were at higher risk of IGT, GDM and HDP, and this risk seemed to be independent of maternal obesity.

Adult↗

Prolonged use of phenytoin, carbamazepine or valproate monotherapy on plasma levels of folate and B(12): a comparison between epileptic patients with or without cardiovascular disorders.

PURPOSE: Previous studies showed an association between the blood levels of folate and vitamin B(12) and the risk for cardiovascular disease. The aim of this study is to investigate the effect of chronic use of phenytoin, carbamazepine or valproate monotherapy on the plasma levels of folate and B(12), and to compare folate and B(12) levels in epileptic patients with or without cardiovasular disorders. METHODS: The study was conducted in the outpatient neurology clinic at Bahrain Defence Force (BDF) Hospital between January-July, 2005. Medical information was obtained by interviewing the patients and examining their hospital records. Blood folate and vitamin B(12) were measured by Immulite immunoanalysis assay using chemoluminescence. RESULTS: A total of 26 consecutive outpatients (17 males, 9 females) were recruited in the study. Their mean age +/- SD was 38.2 +/- 20.1 year (range 15-77 year). Five (19.2%) had complex partial epilepsy and the remainder had tonic-clonic seizures. They had epilepsy for 15.7 +/- 8.1 years (range 2-35 years). Thirteen of them used phenytoin, nine carbamazepine and four used valproate. The duration of the treatment (years), dose (mg/day) and serum concentration (micromol/l) were 18.3 +/- 10.6, 376.9 +/- 180.4, 41.6 +/- 25.6, for phenytoin, 14.5 +/- 11.7, 422.2 +/- 175.0, 31.1 +/- 15.9 for carbamazepine and 18.3 +/- 6.3, 400, 567.7 +/- 78.1 for valproate, respectively. Eleven (42.3%) had established cardiovascular disorders such as hypertension, myocardial infarction or stroke. The mean level of plasma folate (12.94 +/- 6.76 ng/ml) and B12 (484.94 +/- 191.25 pg/ml) in epileptic patients with cardiovascular disorders compared to their values (11.27 +/- 5.84), (514.49 +/- 225.31) respectively in epileptics with no cardiovascular disorders were not statistically significant in the two groups. CONCLUSION: In epileptic patients on chronic therapy with phenytoin, carbamazepine or valproate folate and B(12) levels were not different in patients with or without cardiovascular disorders.

Adolescent↗

[Imbalance of distribution of physicians in the Arab world].

The Arab world, as a whole, now has 8.5 medical doctors per 10,000 population. This average covers a great diversity of national situations; for example 0.6 doctors per 10,000 population in Somalia, and 17.5 doctors per 10,000 population in Qatar. From the viewpoint of medical staffing, the Arab countries can be grouped into four categories: (i) Countries with low medical density: their national staff is scarce, they do not have a long academic tradition, and they have to rely on foreign physicians (Yemen, Djibouti, Somalia, Mauritania). (ii) Countries with acceptable medical density: they have strengthened their medical training system during the last decades, their production of medical graduates is now fairly high, and there is seemingly a threat of oversupply (Algeria, Tunisia, Syria, Iraq). (iii) Countries with relatively high medical density: their medical staffing is below that of developed countries, but their economic possibilities are reduced, which leads to an oversupply; these countries are exporters of medical manpower (Egypt, Jordan). (iv) Countries that import medical manpower although their own medical density is quite high: their medical training is recent or non-existent and their health system relies to a great extent on foreign doctors (Saudi Arabia, Bahrain, Qatar, United Arab Emirates, Libya, Kuwait). They are all oil producers. In brief, a shortage and an oversupply of medical doctors coexist in the Arab world, and concerted action is required.

Africa, Northern↗

Hematologic values and prevalence of anaemia in Libyan school children.

The hematologic values and prevalence of anemia in Libyan school children 6-19 yrs of age were investigated. The mean values of boys followed the normal pattern of rise with age. In girls, the mean values increased with age until age 15 yrs, and subsequently declined. The prevalence of low hemoglobin and of low hematocrit values was 3.2% and 11.3% respectively. The highest prevalence of low hemoglobin in boys and in girls was 4.6% (13-15 yrs) and 6.2% (16-19 yrs) respectively. The highest prevalence of low hematocrit was observed in age group 6-9 yrs in both sexes (boys 17.0%, girls 20.2%). Rates of prevalence of anaemia in Libyan school children were compared with those in Bahrain, Oman and USA.

Adolescent↗

Hospital dietetics and food service in developing countries: I. The Middle East.

A survey of hospital food service and dietetics was conducted in the largest hospitals of six Middle Eastern countries: Bahrain, Jordan, Kuwait, Lebanon, Saudi Arabia, and Syria. There were very few individuals with training in food service and dietetics in any of the countries. The effect of this lack of training on hospital food service and dietetics is discussed. Recommendations are made that would result in improvements in hospital food service and dietetics in the Middle East.

Developing Countries↗

Women's health: how it scored in Beijing.

The Beijing Conference on Women has come and gone, leaving in its wake a Platform for Action that has raised mixed feelings about its content-reached mostly by compromise-yet gives some promise of success if-the big if-governments transform the flowery wording into the called-for reforms and measures. Over the previous two years ICN, in close collaboration with the UK's Advocacy for Women's Health Group (AWHG), encouraged its associations to campaign hard to put women's health high on the agenda. In Beijing ICN worked with AWHG in a workshop on adolescent health, participated in the Thailand Nurses' Association workshop on empowerment of women in health and lobbied delegates (aided by nurse delegates from Bahrain, Korea, USA and Zimbabwe) to ensure that the NGO's recommendations in the health area were included in the Platform for Action.

Female↗

Prevalence of factor V G1691A (factor V-Leiden) and prothrombin G20210A gene mutations in a recurrent miscarriage population.

Factor V G1691A (FV-Leiden) and prothrombin G20210A mutations are major inherited risk factors for venous thrombosis. Recently, it was suggested that both mutations, through stimulation of venous and placental thrombosis events, were strongly associated with recurrent idiopathic miscarriages, although other studies disputed such a link. The aim of this study was to determine the prevalence of prothrombin G20210A and factor V G1691A (R506Q, FV-Leiden) mutations in women with recurrent idiopathic abortions and to recommend management for high-risk mutation carriers. One hundred ten women with two or more consecutive unexplained first-trimester miscarriages (mean age +/- SD, 32.3 +/- 5.3) were compared to 67 parous women with uncomplicated pregnancies (mean age +/- SD, 33.9 +/-7.3) (P = 0.134) from the same ethnic background. The presence or absence of the prothrombin G20210A and FV-Leiden mutations was assessed by PCR and RFLP analysis, using HindIII and MnlI digestion, respectively. In women with primary habitual abortion, 45 (40.91%) carried the FV-Leiden mutation, of whom 7 were in the homozygote and 38 were in the heterozygote states, and 15 (13.64%) carried the prothrombin G20210A mutation all as heterozygotes, compared to 16.42% and 2.99% carrier rates among controls, respectively, all of whom were heterozygote carriers. Of the other risk factors analyzed, smoking (OR 1.76; 95% CI = 0.79-3.94) was more prevalent in habitual aborters compared to controls. Both FV-Leiden and factor II G20210A mutations are major inherited risk factor associated with primary recurrent miscarriages. Women with a family or personal history of thrombosis should be screened before or early in the pregnancy for FV-Leiden and factor II G20210A mutations.

Abortion, Habitual↗

Gene frequencies of human platelet alloantigens in Bahraini Arabs.

Human platelet antigens (HPA) are implicated in the pathophysiology of certain hematological disorders, and as varied distribution of HPA-1 alleles and genotypes were reported fordifferent countries and ethnic populations, we determined the distribution of HPA-1, -2, -3, -4, and -5 alleles, genotypes and haplotypes for 194 healthy Bahraini subjects by polymerase chain reaction with sequence specific primers. The distribution of the HPA polymorphisms was in Hardy-Weinberg equilibrium. Allele frequencies of 0.76 and 0.24 (HPA-1a and -1b), 0.77 and 0.23 (HPA-2a and -2b), 0.57 and 0.43 (HPA-3a and -3b), 0.93 and 0.07 (HPA-4a and -4b), and 0.86 and 0.13 (HPA-5a and -5b) were seen. With the exception of HPA-3a/a (30.4%), the frequencies of homozygous HPA-1a/a (56.8%), 2a/a (60.1%), 4a/a (87.2%), and 5a/a (75.7%) were higher than those of heterozygous (a/b) or homozygous (b/b) variants. Our results provide basic information for further studies of the HPA system polymorphism, which in turn will be instrumental in understanding and treating immune-mediated platelet disorders.

Adult↗

Teaching of anatomy in a problem-based curriculum at the Arabian Gulf University: the new face of the museum.

The College of Medicine and Medical Sciences of the Arabian Gulf University has an undergraduate medical curriculum that uses problem-based learning as the principal teaching strategy. Teaching of anatomy comes at various places in the curriculum, and the anatomy museum serves as an important resource and engages the students in self-directed learning. Although the museum had sufficient resource materials, the emphasis on individualized instruction and self-directed learning in anatomy has resulted in the need for an effective approach and a reorganization of the facilities in the museum. Thus, we recently rearranged the museum to create 42 modules or stations (learning carrels) focusing on specific organ systems for self-study by students. Computer-assisted programs, videocassettes, ultrasound, and structured living anatomy sessions in the clinical professional skills program facilitated such an arrangement. An increased utilization by the students was observed in the reorganized museum. Thus, the museum can play an effective role in the study of anatomy through problem-based integrated learning modules.

Anatomy↗

Assessment of anatomy in a problem-based medical curriculum.

In the problem-based learning (PBL) approach to medical education, students are expected to be trained more by applying processes of reasoning than by memorization of facts. In a PBL curriculum, as with others, it is necessary to match the assessment to the learning process. A detailed description of the testing of anatomical teaching-learning outcomes at the Arabian Gulf University (AGU) is presented. In addition to describing the general principles and guidelines as well as the process of continuous assessment, we have given examples of the multiple-choice questions, patient management problems, and objective-structured practical examinations, which compose our end-of-unit examination and test both vertical and horizontal integration of themes. Students have the opportunity to review the examination after publication of the results. We believe that our approach to the assessment of anatomy tests effective integration of factual knowledge with the principles of problem-solving through the different formats of the components of our examinations.

Anatomy↗

Nonischemic cardiomyopathy after orthotopic liver transplantation: a report of three cases and a review of the literature.

In 2002 there were more than 5,000 liver transplantations performed in the United States. As of February 2004 there were more than 17,000 registrations for liver transplantation. As more organs are transplanted and surgical techniques improve, unique causes of morbidity and mortality will become apparent. We describe three cases of postoperative nonischemic dilated cardiomyopathy in patients who underwent orthotopic liver transplantation (OLT), one of whom underwent diagnostic myocardial biopsy. This paper will discuss the three patients, including biopsy results, and briefly review the relevant literature.

Biopsy↗

Integrating applied anatomy in surgical clerkship in a problem-based learning curriculum.

Little attention has been given to structured teaching of applied anatomy to senior medical students in problem-based learning (PBL) medical schools. A course named "Anatomical Principles in Surgical Practice" was introduced at the Arabian Gulf University (AGU) in 2001 for fifth- and sixth-year medical students during their surgical clerkship rotation. The course aims to emphasize, update and integrate applied anatomical concepts that are essential for surgical practice. The course consists of 15 interactive sessions held weekly to ensure topics coincide with the surgical problem-solving sessions. A questionnaire was administered to students completing their surgical rotations (n = 131) seeking their perceptions about the new course during the academic years 2001, 2002 and 2003. To measure learning outcome, 70 students were also given pre- and post-tests. Positive responses were given by 85.2% of the students for course arrangement, by 92.0% for course content, by 88.3% for clinical correlation, by 95.2% for level of teaching and by 87.2% for overall judgment. The students' mean scores in the post-test (71.7%+/-11.7) was significantly higher than their mean scores in the pre-test (42.3%+/-12.6, p < 0.001). Students liked the course and reported feeling more confident in correlating anatomy with surgery during their rotations. By extending anatomical teaching into the clerkship phase, a link between basic medical and clinical sciences has been established that further enhances vertical integration within a PBL curriculum in a spiral fashion.

Anatomy↗

Distribution of HLA class II (DRB1/DQB1) alleles and haplotypes among Bahraini and Lebanese Arabs.

The genetic relationship between Bahraini and Lebanese Arabs in terms of HLA class II (DRB1 and DQB1) gene and haplotype frequencies was investigated in a group of 90 Lebanese and 52 Bahraini Arabs. Subjects of both sexes were unrelated and HLA-DRB1 and DQB1 genes were genotyped using the polymerase chain reaction-sequence specific primer (PCR-SSP) technique. Analysis of the HLA-DRB1 alleles showed that the DRB1*040101 and DRB1*110101 alleles were more common among Lebanese, whereas DRB1*030101, DRB1*130701/1327, and DRB1*160101 alleles were more common among Bahrainis. Similarly, of the 7 HLA-DQB1 alleles analyzed, the presence of DQB1*0201 was higher among Bahrainis, whereas DQB1*030101 was higher among Lebanese. The DRB1*160101-DQB1*050101 (23.08%) and DRB1*030101-DQB1*0201 (21.15%) haplotypes were more frequent among Bahrainis, while the DRB1*110101-DQB1*030101 (56.67%), DRB1*040101-DQB1*0302 (28.89%) and DRB1*040101/DQB1*030101 (25.56%) haplotypes were more frequent in Lebanese subjects. Our results underline significant differences between these two populations in HLA class II distribution, and provide basic information for further studies of MHC heterogeneity among Arab-speaking countries, and as a reference for further anthropologic studies.

Alleles↗