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Background: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that causes anorexia, malabsorption, and increased energy requirements. Childhood IBD can significantly impact nutritional status and future health. Objective: This study aimed to analyze the nutritional status of patients with pediatric IBD at presentation and during follow-up and to identify predictors of nutritional outcome. Methods: This retrospective cohort study reviewed the medical records of children diagnosed with IBD in the Pediatric Department, Salmaniya Medical Complex, Bahrain, 1984 − 2023. Demographic data, clinical characteristics, and anthropometric data were collected. World Health Organization growth standards were used to interpret nutritional status. Results: Of the 165 patients, 99 (60%) had anthropometric data at presentation, and 130 (78.8%) had follow-up data. Most patients were males (64.6%) and had Crohn's disease (CD) (56.2%), while 43.8% had ulcerative colitis (UC). The median age at presentation was 10.9 years and the mean follow-up duration was 12.6 years. At presentation, 53.5% of the patients were malnourished, that decreased to 46.9% on follow-up. Thinness was reduced from 27.3% at presentation to 12.1% at follow-up (p = 0.003). There was an increased tendency to normal weight on follow-up (59.6%) compared to time of presentation (46.5%), p = 0.035. Overweightness showed a non-significant increase from 26.3% at presentation to 28.3% at follow-up (p = 0.791). Children with IBD were more likely to become obese when they grow up to adulthood (2.3% versus 20.5%, respectively, p < 0.001). Weight-for-age, and height-for-age at presentation were higher among CD compared to UC, but body mass index (BMI) at follow-up was higher among UC patients (p < 0.05). Thinness at follow up was associated with very early-onset disease (p = 0.02), lower weight and BMI at presentation (p < 0.001 each), younger age at follow-up (p = 0.002), pediatric age group (p = 0.023), lower hematocrit (p = 0.017), and higher C-reactive protein (p = 0.007). Overweight at follow up was associated with increased weight and BMI at presentation (p < 0.001 each), longer disease duration (p = 0.005), older age (p = 0.002), and azathioprine intake (p = 0.026). Considering follow-up duration, univariate analysis exhibited that Bahraini nationality, post-diagnosis disease duration, age at follow-up, occurrence of diarrhea, height, and BMI at presentation were factors that decreased liability to abnormal nutritional status, while CD, history of weight loss, perianal disease, and skin rash, and intake of prednisolone expressed increased liability of abnormal nutritional status (p < 0.05). Conclusion: Pediatric IBD is associated with a high incidence of malnutrition. Thinness is more prominent at presentation, while overweight is higher on follow-up. Multiple risk factors aggravating abnormal nutritional status were highlighted. Accordingly, nutritional counseling should be prioritized in a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Several countries, including Bahrain, used wastewater surveillance for disease activity monitoring. This study aimed to determine the presence of SARS‐CoV‐2 in untreated wastewater and to correlate it with the disease spread. Methods: A retrospective review was conducted for all wastewater samples tested for SARS‐CoV‐2 in public health laboratories from November 2020 to October 2022. Samples were collected weekly between February and October 2022 from different areas across Bahrain. Real‐time polymerase chain reaction was used to test for the presence of SARS‐CoV‐2 in wastewater, and the results were correlated with the number of COVID‐19 cases in the same area. Results: Of 387 wastewater samples, 103 (26.6%) samples tested positive for SARS‐CoV‐2. In late 2020, of 42 samples collected initially, four (9.5%) samples tested positive for SARS‐CoV‐2 in the four locations that hosted COVID‐19 isolation facilities. Between February and October 2022, 345 specimens of wastewater were tested, and 99 (28.7%) were positive. The highest detection rate was in February, June, and July (60%, 45%, and 43%, respectively), which corresponded to COVID‐19 peaks during 2022, and the lowest detection rate was in August and September (11% and 0%, respectively), corresponding to the low number of COVID‐19 cases. Conclusion: The detection rate of SARS‐CoV‐2 in wastewater samples from Bahrain was high and was significantly correlated with the number of reported COVID‐19 cases. Wastewater surveillance can aid the existing surveillance system in monitoring SARS‐CoV‐2 spread. [ABSTRACT FROM AUTHOR]

Background: Chronic constipation is common among children worldwide. Constipation includes functional constipa tion (FC) and organic constipation (OC). The early recognition of the causes of childhood constipation and its subsequent complications is important. Purpose: This study aimed to evaluate the prevalence and causes of childhood constipation and compare the clinical characteristics, treatment, and outcomes of children with FC versus OC to identify the predictive factors. Methods: This retrospective crosssectional study analyzed children with FC or OC diagnosed in pediatric gastroenterology clinics, Salmaniya Medical Complex, Bahrain, 2017-2021. The Rome IV criteria were used to define FC. Results: A total of 7,287 gastroenterology appointments were attended by 4,346 children during the study period. Of the 639 children (14.7%) with constipation, 616 (96.4%) were included in the study. Most patients had FC (n=511, 83%), whereas 17% (n=105) had OC. FC was more common in females than in males. Children with OC were younger (P<0.001) and had lower body weights (P<0.001), more stunted growth (P<0.001), and more associated diseases (P= 0.037) than those with FC. Enuresis was the most associated disease (n=21, 3.4%). Organic causes included neurological, allergic, endocrine, gastrointestinal, and genetic diseases. Allergies to cow milk protein were the most common (n=35, 5.7%). The presence of mucus in the stool was more common in OC than in FC (P=0.041), but no other symptoms or physical findings differed. A total of 587 patients (95.3%) received medication, among which lactulose was commonly prescribed (n=395, 64.1%). There were no intergroup differences in nationality, sex, body mass index, seasonal variation, laxative type, or treatment response. A good response was observed in 114 patients (90.5%). Conclusion: Chronic constipation represented a significant proportion of outpatient gastroenterology visits. FC was the most common type. Young children with a low body weight, stunted growth, mucus in the stool, or associated diseases should be assessed for an underlying organic cause. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory tract infection (SARI) is a major global health threat. This study aimed to examine risk factors associated with poor outcomes in patients with SARI. Methods: All patients who met World Health Organization's (WHO) SARI case definition and were admitted to Salmaniya Medical Complex from January 2018 to December 2021 were included. Epidemiological and virological data were obtained and analyzed. Results: Of 1159 patients with SARI included, 731 (63.1%) patients were below 50 years, and 357 (30.8%) tested positive for viral pathogens. The most prevalent virus was Flu‐A (n = 134, 37.5%), SARS‐CoV2 (n = 118, 33%), RSV (n = 51, 14.3%), Flu B (n = 49,13.7%), other viruses (n = 3, 0.8%), and combined infection (n = 2, 0.6%). Six hundred fifty‐eight (56.8%) patients had comorbidities, mainly diabetes (n = 284, 43%) and heart disease (n = 217, 33%). 183 (16%) patients were admitted to ICU, 110 (9%) needed mechanical ventilation, and 80 (7%) patients died. The odds of ICU admission were higher for patients with hematological (OR 5.9, 95% CI 3.1–11.1) and lung diseases (OR 2.7, 95% CI 1.6–4.6). The odds of mechanical ventilation were higher among patients with lung disease (OR 3.1, 95% 1.7–5.5). The mortality odds were higher among patients above 50 (OR 2.4, 95% CI 1.4–4.1) and chronic kidney disease (OR 2.5, 95% CI 1.1–5.2). Conclusions: Being 50 years or above or having kidney, lung, or heart diseases was associated with worse SARI outcomes. Efforts and actions in developing better strategies to vaccinate individuals at high risk and early diagnosis and treatment should help in reducing the burden of SARI. [ABSTRACT FROM AUTHOR]

This study responds to the international widespread application of content-based instruction in foreign/second language teaching as well as the recent calls in Bahrain to promote literacy skills within the learning of English as a foreign/second language (EFL/ESL). The study achieves this through exploring the effectiveness of using designed content-based tasks in developing 97 Bahraini students’ literacy skills while learning EFL/ESL within a design-based research project as an initiative to support their school’s attempt to improve the general performance in learning English and respond to the quality assurance standards required in this regard. The main findings indicate the efficiency of the designed content tasks in developing the students’ literacy skills while learning EFL/ESL on different levels; development of cognitive and learning habits, language proficiency improvement and reinforcement of self-confidence as foreign/second language users. The study discusses these outcomes with their implications for the language learning as well as for possible future language policy in EFL/ESL instruction in Bahrain. [ABSTRACT FROM AUTHOR]

Background and Objectives. Jaundice is a common cause of hospital admission in infants presenting within the first month of life. This study is aimed at determining neonatal and maternal risk factors of indirect hyperbilirubinemia, at comparing neonates with risk factors and those without, and at assessing the type of management according to hyperbilirubinemia severity. Material and Methods. In this retrospective cross-sectional study, medical records of neonates with indirect hyperbilirubinemia who were admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2020 and December 2020 were reviewed. Neonatal demographic data, antenatal history, birth weight, feeding type, maternal and neonatal laboratory evaluations, management, and length of hospital stay were collected and compared. Results. Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n = 152 , 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n = 130 /400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n = 331 , 81.9%) followed by cesarean delivery (n = 137 , 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9 ± 68.5 versus 225 ± 82.2 mmol/L, respectively) (P = 0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P < 0.0001). Intravenous immunoglobulins (IVIG) and exchange transfusion were used in 44 (10.9%) and 14 (3.5%) patients, respectively. Neonates who received IVIG had significantly higher bilirubin levels than those who did not (P = 0.005). Male newborns (P = 0.008), Bahrainis (P = 0.001), those with reticulocytosis (P = 0.001), and those who received IVIG (P = 0.001) were more prone to have associated risk factors. Conclusion. ABO incompatibility, G6PD deficiency, and older maternal age were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Bahraini, male newborns, reticulocytosis, and IVIG use were associated with these factors. Early detection of such factors through screening can aid in immediate management to prevent serious complications of this common condition. [ABSTRACT FROM AUTHOR]

Ectopia cordis is a rare type of malformation where the heart is not located normally. It may be partially or completely located outside the thoracic cavity and can be associated with other congenital abnormalities. It results from failure of maturation of midline mesoderm and ventral body formation during embryogenic formation. The exact etiology remains unknown. The literature review reveals the prognosis for infants with ectopia cordis is very poor. Here, we are reporting the first case of a fetus that was prenatally diagnosed with ectopia cordis that was associated with omphalocele documented in our country. Considering the poor prognosis for the fetus, conservative management during the prenatal period was chosen. [ABSTRACT FROM AUTHOR]

Background and Objectives. Acute bronchiolitis is a common respiratory disease in children. C-reactive protein (CRP) is an indicator of bacterial coinfection. This study is aimed at assessing the frequency of elevated CRP in children with acute bronchiolitis and at comparing the clinical characteristics, laboratory and radiological findings, antibiotics use, and outcome according to CRP levels. Material and Methods. We retrospectively reviewed medical records of children with acute bronchiolitis admitted to Pediatric Department, Salmaniya Medical Complex, Bahrain, in 2019-2020. Demographic, clinical, laboratory and radiological data, and outcomes were collected. Patients with high CRP were compared with those with normal levels. Results. Of 287 patients, 229 (79.2%) were included. 132 (57.6%) were males. Median presentation age was 3.7 (interquartile range (IQR), 1.27-12.33) months. Median CRP level was 10.4 (IQR, 2.8-35.1) mg/L. CRP was high in 167 (72.9%) patients. 17.6% (33/187 patients) had confirmed bacterial coinfection. Respiratory syncytial virus (RSV) was detected in 84 (36.7%) patients. Mean CRP level was higher in RSV-negative compared to RSV-positive patients, 31.3 ± 44.3 versus 21.5 ± 27.7 mg / L , respectively (P = 0.042). Respiratory viral serology profile was positive in 34.7% (17/49 patients). 66.9% (107/160 patients) had positive chest X-ray. Antibiotics were used in 78.1% (179/227 patients). Thirteen (5.7%) patients required intensive care, five (2.2%) had surgical intervention, four (1.8%) required endotracheal intubation, and four (1.8%) died. Patients with high CRP were older at presentation (P < 0.0001) and had more fever (P < 0.0001) and cough (P = 0.002), but lower hemoglobin level (P < 0.0001) compared to those with normal CRP. Fever (P = 0.016) and hemoglobin level (P = 0.002) were independent factors. Conclusion. Most children with acute bronchiolitis had high rate of elevated CRP values that did not correlate with the rate of bacterial coinfection. High CRP levels were found in older children, those presented with more fever and cough, and had a lower hemoglobin level despite that those factors were previously reported to be associated with disease severity and bacterial coinfection. This study also showed a high overall rate of antibiotic prescriptions in mostly viral disease. [ABSTRACT FROM AUTHOR]

Background and Objectives. Gastrointestinal (GI) endoscopy is a medical field that has been evolving in the last decades. Innovative advances in pediatric endoscopy led to more accurate diagnosis of various GI diseases. This study aimed to assess the appropriateness of endoscopic procedures' indications and to evaluate the diagnostic and therapeutic yield of pediatric GI endoscopy, considering the limitations to access this facility. Material and Methods. Retrospective, cross-sectional, and analytical chart review was performed for children who underwent GI endoscopy at Salmaniya Medical Complex, Bahrain, from 1995 to 2020. Demographic data, endoscopic indications, and findings were collected and compared. Results. Of 1,111 patients, 1,101 (99.1%) were included in the study. 589 (53.6%) patients were males. Median age at the time of endoscopy was 8 (interquartile range 3, 11) years. 1534 endoscopies were performed (1193 upper GI endoscopies (UGIE) and 341 colonoscopies) in 1296 sessions. The mean number of endoscopies per year was 59 ± 30.9 procedures with 81.4% reduction noted after coronavirus pandemic (P < 0.0001). Ratio between UGIE to colonoscopy was 3.5 : 1. Median number of endoscopies per patient was one, ranging from one to eight procedures. 1153 (89%) sessions were diagnostic, and 143 (11.0%) were therapeutic. Main endoscopic indication was chronic abdominal pain (451 (40.9%) patients) followed by upper GI bleeding (302 (27.4%) patients). Overall positive yield was 68.1% (716/1052 procedures). Endoscopic yield varies according to the type of procedure (P = 0.003). Colonoscopy alone gave a higher yield (82.6%, 38/46 procedures) compared to combined procedures (75.4%, 141/187) and UGIE alone (65.6%, 537/819). Conclusions. This study emphasizes a careful selection of the type of endoscopic procedures, based on the expected endoscopic yield, to diagnose and treat pediatric GI diseases. In patients with chronic abdominal pain, endoscopy should be reserved as a second-line tool to avoid unnecessary use of invasive procedures. [ABSTRACT FROM AUTHOR]

Background and Objectives. Benign strictures are the main cause of esophageal strictures in children. They can be managed by different modalities but endoscopic dilatation is the standard therapy. This study is aimed at reviewing the efficacy and safety of endoscopic dilatations in children with esophageal strictures. Materials and Methods. In this retrospective cross-sectional single center study, records of patients with esophageal strictures presented to the pediatric department, Salmaniya Medical Complex, Bahrain, in the period between 1995 and 2019 were reviewed. Demographic data, indications of endoscopic dilatations, the procedure success rate, and possible complications were assessed. Results. Forty-six children were found to have esophageal strictures. Twenty-five (54.3%) patients were males. Most patients presented during infancy (86.5%, 32/37 patients). Twenty-six (56.5%) patients required 88 dilatation sessions, while the remaining 20 (43.5%) patients did not require dilatations. The median number of dilatation sessions per patient was three (interquartile range = 2 –5). Savary-Gilliard bougienages were the main dilators used (80.8%, 21/26 patients). Anastomotic stricture (post esophageal atresia/tracheoesophageal fistula repair) was the main cause of esophageal strictures and was found in 35 (76.1%) patients. Patients with nonanastomotic strictures had more frequent dilatations compared to those with anastomotic strictures (P = 0.007). The procedure success rate was 98.8%. Yet, it was operator dependent (P = 0.047). Complete response to dilatation was found in 18 (69.2%) patients, satisfactory in seven (26.9%), and an inadequate response in one (3.9%). Those with satisfactory responses still require ongoing dilatations based on their symptoms and radiological and endoscopic findings. No perforation or mortality was reported. Patients with dilatations had more recurrent hospitalization (P < 0.0001), more dysphagia (P = 0.001), but shorter hospital stay (P = 0.046) compared to those without dilatations. Surgical intervention was required in one patient with caustic strictures. The median follow-up period was six years (interquartile range = 2.25 –9.0). Conclusions. Endoscopic esophageal dilatation in children with esophageal strictures is effective and safe. Yet, it was operator dependent. Nonanastomotic strictures require more dilatations compared to anastomotic strictures. Findings of this study are comparable to those reported worldwide. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) is a chronic autoimmune enteropathy. It results from genetic predisposition and exposure to gluten-containing food. The prevalence and presentation of CD vary among populations. Purpose: This study aimed to describe the prevalence and clinical characteristics of CD in children in Bahrain. Methods: We retrospectively reviewed the medical records of children diagnosed with CD in the pediatric department, Salmaniya Medical Complex, Bahrain, in 1988--2018. Their clinical, biochemical, serological, and histopathological findings were documented. Adherence to the recommended gluten-free diet (GFD) was assessed. Results: Of 86 patients with CD, 67 were included. The CD prevalence was 0.02%. A significant increase in prevalence in the last decade was observed (P<0.0001). Thirty-eight patients (56.7%) were males. The median (interquartile range) age at presentation was 4.45 (1.5--7.3) years. A family history of CD was positive in 13 out of 43 patients (30.2%). Pallor and failure to thrive were the most common presentations. The most frequent associated disease was iron-deficiency anemia in 23 patients (69.7%). Positive serology was found in 32 of 45 patients (71.1%). Marsh-Oberhuber type III was found in 16 of 35 patients (45.7%). Seropositive patients were significantly older (P=0.025) and had more severe duodenal histology (P=0.002). Adherence to GFD was poor in 27 patients (64.3%). Conclusion: This study revealed a significant increase in CD prevalence over the last decade. Atypical presentations were frequent. Most patients had poor adherence to GFD. [ABSTRACT FROM AUTHOR]

Background: Esophageal stricture is commonly encountered in adults. Yet, it is not uncommon among children. Objective: To evaluate the clinical presentations and causes of esophageal strictures in children. Design: A Retrospective Cross-Sectional Study. Setting: Pediatric Department, Salmaniya Medical Complex, Bahrain. Method: A review of medical records of patients diagnosed with esophageal strictures between 1995 and 2019 was performed. The patients were diagnosed based on clinical, radiological and endoscopic findings. Data including patients’ characteristics, clinical presentations, stricture etiologies and proton pump inhibitors use were documented. Result: Forty-six pediatric patients had esophageal strictures. Twenty-five (54.3%) were males. Thirty-six (78.3%) patients were Bahraini. Thirty-two (69.5%) patients were infants. Thirty-two (69.5%) presented with dysphagia and 27 (58.7%) with vomiting. Anastomotic post-esophageal atresia/tracheoesophageal fistula (EA/TEF) repair strictures was the main cause and found in 35 (76.1%) patients. Twenty-two (47.8%) patients had associated diseases; 10 (21.7%) had congenital heart disease. Twenty-six (56.5%) had esophageal stricture of the upper esophagus. Twenty (43.5%) patients received proton pump inhibitors. The Median follow-up period was five years. Conclusion: Esophageal stricture is not a rare disease in children. It is more common in males. Dysphagia and vomiting are the most frequent clinical presentations. The most common cause of esophageal strictures in children is anastomotic post EA/TEF repair. Congenital heart diseases are the most commonly associated anomalies. [ABSTRACT FROM AUTHOR]

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Due to the spread of applying standardized national examinations in addition to the normal centralized formal exams in English language teaching, EFL teachers have been urged to reshape their teaching pedagogies to respond to the demands and competencies which EFL students are required to fulfil in these exams. This study sheds light on this phenomenon by investigating the influence of applying the standardized English national exam policy in a non-native English-speaking context on the teaching practices and beliefs of EFL teachers in secondary schools. A mixed research method was employed to identify the aspects of the teaching learning process of English as an EFL that were affected by the application of the standardized testing as well as exploring the teachers' beliefs of these effects on their teaching as EFL teachers in a none-native speaking context. The quantitative data was gathered using questionnaires and the results revealed a high effect of the application of the standardized national English exam on students' learning and welfare with a mean of (4.164) but with an average effect on the aspects of language competence and implementation of innovative teaching pedagogies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the trends in pediatric researches performed at the main hospital in Bahrain and to identify existing research gaps. Setting: Pediatric Department, Salmaniya Medical Complex, Bahrain. Design: A Retrospective Study. Method: All scientific contributions produced by the pediatric department were identified between 1 January 1977 and 31 May 2018. Annual and cumulative trends of scientific production were calculated. Articles were stratified based on publication type, medical subspecialties and types of publishing journals. Pediatrician's gender, job description and current job were documented. Result: Out of 416 scientific contributions, 309 scientific publications were analyzed (293 journal articles, 5 books, 9 book chapters, 2 booklets). There was a significant increase in the number of publications over the last four decades (P-value<0.0001). Hematology and gastroenterology were the most researched specialties, 38 (12.3%) publications each. Publications on infectious diseases were eight (2.6%) and seven (2.3%) on oncology. Out of 257 (83.2%) publications, 125 (40.5%) articles were published in international journals. Forty-seven (51.1%) out of 92 pediatricians had scientific publications. Of the 47 pediatricians, 36 (76.6%) were consultants and 11 (23.4%) were residents (P-value <0.0001). Gender (P-value=0.838) and position (P-value=0.633) had no effects on publication. Conclusion: In the last four decades, there has been a remarkable increase in the number of pediatric publications at the main hospital in Bahrain, with special emphasis on hematological and gastrointestinal problems. Yet, there is a continuous need to study important health problems, such as cancer and infections. [ABSTRACT FROM AUTHOR]

Zeta Chain-Associated Protein Kinase 70 (ZAP-70) is a protein kinase involved in the T-cell receptor (TCR) signaling; therefore, it plays a significant role in T-cell functioning. ZAP-70 related severe combined immune deficiency (SCID) is a rare autosomal recessive disorder. Various clinical presentations of the condition were described in the literature; it was suggested that this clinical heterogeneity may delay the diagnosis. A ten-month-old infant presented with fever and cough. He was admitted to the PICU. Investigations revealed a tracheal aspirate positive for candida. This case is the first case of ZAP-70 related SCID to be reported in Bahrain. [ABSTRACT FROM AUTHOR]

Sanjad Sakati Syndrome (SSS) is a rare autosomal recessive congenital disorder. It was reported exclusively in people of Arabian origin. SSS comprises of congenital hypoparathyroidism, severe growth retardation, mental retardation and dysmorphic facial features. The typical metabolic derangements lead to several morbid manifestations. SSS is also known as hypoparathyroidism-retardation- dysmorphism (HRD) which was listed in Online Mendelian Inheritance in Mean (OMIM) #241410. We present the first case of SSS in Bahrain in a 40-days-old female. She was thin and lean. She had a narrow face, deep-seated eyes, peaked nose, long philtrum, thin lips, and micrognathia. She had short stature, small hands and feet, long tapering fingers and clinodactyly. Parathyroid hormone was 0.3 pmol/L (normal range 0.99-6.05) and and 25-Hydroxy vitamin D was 7 nmol/L (normal range 53-150). The infant is the 4th child of consanguineous parents. The elder male brother who had features suggestive of SSS died at the age of 7 years. The patient was treated with calcium and vitamin D therapy. Her convulsions were controlled. However, her anthropometric measure did not improve despite aggressive nutritional support via gastrostomy tube feeding. The patient is still alive at the age of 14 years and eight months. [ABSTRACT FROM AUTHOR]

Central venous catheter (CVC) placement in the intensive care unit (ICU) is a common practice and is being increasingly used also in general wards. Its use is associated with both mechanical and infectious complications. OBJECTIVE: To determine the infectious and mechanical complication rate of central venous catheterization in an ICU. DESIGN: A retrospective study about complications of 1319 central venous catheter placements. SETTING: An 11-bed adult medical, surgical, neuro-trauma ICU at salmaniya medical complex, Bahrain. MATERIALS AND METHODS: This was a retrospective review of all central venous catheter inserted over 4 year's period from October 2002 to December 2006. RESULTS: There were 12 mechanical complications and 128 infectious complications total of 1319 CVCs placed. CONCLUSIONS: The CVC can be performed safely in an ICU if done by a competent physician with all aseptic precautions. [ABSTRACT FROM AUTHOR]

Background: Autoimmune hepatitis (AIH) in childhood has variable modes of presentation, and the disease should be suspected and excluded in all children presenting with symptoms and signs of prolonged or severe acute liver disease. In AIH, the liver biopsy histopathology shows inflammation in addition to presence of serum autoimmune antibodies and increased levels of immunoglobulin G (IgG)., Objectives: To investigate the situation of childhood autoimmune hepatitis in Bahrain and to compare it with other studies worldwide., Methods: A retrospective study describing the AIH pediatric cases diagnosed during the period of Jan 2005 to Dec 2009. We report the clinical, biochemical, histopathological, and immunological findings, mainly autoimmune profile, in addition to response to treatment, of Bahraini children with autoimmune hepatitis., Results: Five Bahraini children, three females and two males were diagnosed as autoimmune hepatitis during the study period. Their ages at presentation ranged from 9 to 15 (median 10.6) years. One of our patients had a fulminating type. Two had other autoimmune related conditions, namely autoimmune sclerosing cholangitis and ulcerative colitis. All were AIH type 1. Variable response to conventional immunosuppressive therapy was found, from an excellent response with good prognosis, to cirrhosis, hepatic failure and liver transplantation., Conclusion: Childhood AIH is a rare medical problem in Bahrain, with both sexes affected and a variable response to immunosuppressive therapy.

Objective: To review clinical presentations, diagnosis, response to treatment, and outcome of infants with neonatal hemochromatosis (NH)., Methods: This is a retrospective review of all cases admitted to the Pediatric Department at Salmaniya Medical Center, Manama, Bahrain between March 2008 and May 2011. The diagnosis was based on serum iron and ferritin, alpha-fetoprotein levels (AFP), liver and buccal biopsies, and abdominal MRI scan., Results: Ten patients (8 males and 2 females) were diagnosed with NH. Two patients were intrauterine growth restriction (IUGR) and 6 were preterm. The median birth weight was 1.700 grams. The median age at presentation was 16 days, and at diagnosis was 23 days. Two patients had positive consanguinity. Clinical presentations of the infants were hepatosplenomegaly (n=5), ascites (n=3), and hypoglycemia (n=6). All patients had raised ferritin levels, prolonged prothrombin time, and 9 patients had high serum iron and serum AFP. Abdominal MRI showed iron overload in the liver (n=8). Liver biopsies showed evidence of hemochromatosis (n=3). Buccal biopsies stained positive for iron (n=1). Eight patients received antioxidant therapy and survived. Two patients passed away., Conclusion: Neonatal hemochromatosis is a rare liver disease of newborns with a spectrum of clinical severity. Elevated serum ferritin and AFP support the diagnosis after excluding other causes of neonatal liver failure. The use of antioxidant therapy helps to improve the outcome.