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Objective: Staging workup and detection of distant metastases is important in newly diagnosed breast cancer in order to make treatment decisions and establish the prognosis. There is wide variation in current recommendations for staging investigations in breast cancer. Routine staging is performed for all patients in Bahrain because of lack of consistent guidelines. Optimization of the criteria for staging is important for identification of metastases, while minimizing harm and costs. The aim of this study was to evaluate factors associated with distant metastases in newly diagnosed patients with breast cancer, in order to establish local guidelines for proper selection of patients for systemic staging. Materials and Methods: Patients with newly diagnosed breast cancer at Salmaniya Medical Complex in Bahrain who underwent staging investigations between January 2016 and December 2022 were identified from a pathology database. Patients with previous history of cancer, synchronous tumors, bilateral breast cancer and ductal carcinoma in situ were excluded. Clinical, radiological and pathological data were retrospectively analyzed. Results: A total of 593 patients underwent staging computed tomography and bone scans or a PET scan. Distant metastases were identified in 20.7% of cases. M1 disease was significantly associated with multifocality/multicentricity, high grade tumors, hormone receptor-negative cancers, high Ki67 index, advanced tumor stage, node-positive disease, triple-negative breast cancer, use of PET scans and those who underwent neoadjuvant chemotherapy. Age was not associated with identification of distant metastases. Conclusion: The prevalence of distant metastases in this population of newly diagnosed patients with breast cancer was higher than previously reported. Routine staging of all patients at presentation was not indicated, especially for asymptomatic patients with early breast cancer. This study identified certain groups of patients with a higher risk of distant metastasis, in whom metastatic workup should be performed. These findings may allow for the development of a local guideline that addresses the question of which breast cancer patients need staging investigations for distant metastases. [ABSTRACT FROM AUTHOR]

Background: Early detection of complicated appendicitis in suspected patients is essential because the complication could be fatal. One of the new potential predictors of severity is preoperative hyperbilirubinemia. Objective: To evaluate the bilirubin level in complicated appendicitis. Design: A Single-Center Cross-Sectional, Retrospective Study. Setting: Salmaniya Medical Complex, Bahrain. Method: Three hundred thirty-seven patients with acute appendicitis admitted between January and November 2018 were included in the study. Patients 14 years of age and above who underwent appendectomy were included. Normal appendix or other histopathological diagnoses, elevated bilirubin with hemolytic or liver disease, and age below 14 years (pediatric age group) were excluded. The analysis was performed by the Statistical Package for the Social Sciences (SPSS®) software and Microsoft Excel. Result: The age range was 14 to 77 years. Two hundred sixty (77.2%) were males and 129 (38.3%) were Bahrainis. Thirty-four (10.1%) patients were diagnosed with complicated appendicitis. Eighty-two (24.3%) patients were found to have elevated bilirubin and 12 (3.6%) were associated with complicated appendicitis, P-value of 0.1162. The majority of patients were found to have elevated WBC count, 234 (69.4%), and neutrophil percentage, 208 (61.7%). Conclusion: In our study, we found no significant correlation between high bilirubin levels and complicated appendicitis. Therefore, we do not recommend the routine use of bilirubin in diagnosing acute appendicitis in our center. [ABSTRACT FROM AUTHOR]

• The risk of asymptomatic spread of COVID-19 may be higher than anticipated. • Asymptomatic cases made up 50% of a random sample of index cases. • Infectivity rates were similar for asymptomatic and symptomatic index cases. • Asymptomatic-to-asymptomatic transmission was the most common transmission. • Middle-aged males were the most common transmitters of the virus. The COVID-19 pandemic has led to over 92 million cases and 1.9 million deaths worldwide since its outbreak. Public health responses have focused on identifying symptomatic individuals to halt spread. However, evidence is accruing that asymptomatic individuals are infectious and contributing to this global pandemic. Observational data of 320 index cases and their 1289 positive contacts from the National COVID-19 Database in Bahrain were used to analyze symptoms, infectivity rate and PCR Cycle threshold (Ct) values. No significant difference (p = 1.0) in proportions of symptomatic (n = 160; 50.0%) and asymptomatic index cases (n = 160; 50.0%) were seen; however, SARS-CoV-2 positive contact cases were predominantly asymptomatic (n = 1127, 87.4%). Individuals aged 0−19 years constituted a larger proportion of positive contact cases (20.8%) than index cases (4.7%; p < 0.001). A total of 22% of the positive contacts were infected by symptomatic male index cases aged between 30−39 years. The total numbers of exposed contacts (p = 0.33), infected contacts (p = 0.81) and hence infectivity rate (p = 0.72) were not different between symptomatic and asymptomatic index cases. PCR Ct values were higher in asymptomatic compared to symptomatic index cases (p < 0.001), and higher in asymptomatic compared to symptomatic positive contacts (p < 0.001). No differences between the infectivity rates of index cases with Ct values <30 and values ≥30 were observed (p = 0.13). These data reveal that the high asymptomatic incidence of SARS-CoV-2 infection in Bahrain and subsequent positive contacts from an index case were more likely to be asymptomatic, showing the high "silent" risk of transmission and need for comprehensive screening for each positive infection to help halt the ongoing pandemic. [ABSTRACT FROM AUTHOR]

• There is increasing concern regarding waning immunity against SARS-CoV-2, breakthrough infections and immune-evasive variants. • Heterologous prime-boost strategies are gaining attention due to theoretical superiority of immune stimulation, supply shortage and adverse event concerns with certain vaccine platforms. • More robust humoral response was observed in the heterologous BNT-boosted group compared to the homologous BBIBP primed and boosted group. • Significantly greater levels of spike (S) protein specific antibodies were observed in the heterologous group compared to the homologous one. • The heterologous BNT-boosted group had a higher rate of non-serious adverse events, all of which were self-limiting, indicating it to be a safe and well-tolerated approach. Booster vaccine doses against SARS-CoV-2 have been advocated to address evidence of waning immunity, breakthrough infection, and the emergence of immune-evasive variants. A heterologous prime-boost vaccine strategy may offer advantages over a homologous approach, but the safety and efficacy of this approach with the mRNA vaccine BNT162b2 (BNT: Pfizer) and inactivated BBIBP-CorV (BBIBT: Sinopharm) vaccines have not been studied. We conducted a non-randomized, non-blinded phase II observational community trial across Bahrain, investigating the reactogenic and immunogenic response of participants who had previously received two doses of BBIBP, followed by a third booster dose of either BBIBP (homologous booster) or BNT (heterologous booster). Immunogenicity through serological status was determined at baseline and on the following 8th week. Reactogenicity data (safety and adverse events) were collected throughout study period, in addition to participant-led electronic journaling. 305 participants (152 BBIBP and 153 BNT booster) were enrolled in the study, with 246 (127 BBIBP and 119 BNT booster) included in the final analysis. There was a significant increase in anti-SARS-CoV-2 antibody levels post booster administration in both groups; however, the heterologous BNT arm demonstrated a significantly larger mean increase in the level of spike (S) antigen-specific antibodies (32.7-fold increase versus 2.6, p < 0.0001) and sVNT neutralising antibodies (3.4-fold increase versus 1.8, p < 0.0001), whereas the homologous arm demonstrated a significant increase in the levels of nucleocapsid (N) antigen-specific antibodies (3.8-fold increase versus none). Non-serious adverse events (injection site pain, fever, and fatigue) were more commonly reported in the heterologous arm, but no serious adverse events occurred. Heterologous prime-boost vaccination with the mRNA BNT162b2 (Pfizer) vaccine in those who had received two doses of inactivated virus BBIBP-CorV (Sinopharm) vaccine demonstrated a more robust immune response against SARS-CoV-2 than the homologous BBIBP booster and appears safe and well tolerated. Clinical Trial Registry Number (ClinicalTrials.gov): NCT04993560. [ABSTRACT FROM AUTHOR]

Objectives: To define the histological types of primary lung cancer in Bahrain and to determine prevalence of EGFR and ALK mutation in patients with non-small cell lung carcinoma., Methods: Data regarding Bahraini patients diagnosed with primary lung cancer between January 2013 and December 2018 were collected from the lab information system in Salmaniya medical complex, Manama, Bahrain., Results: One hundred and forty-three Bahraini patients were diagnosed with lung cancer in the study period. 67.1% of the patients were male. The mean age at diagnosis was 68 years. The most common histological type was adenocarcinoma (58%), followed by squamous cell carcinoma (19%). EGFR mutation was found in 21.5% of non-small cell lung cancer cases with predominance of exon 19 deletions (29%) and exon 21 nucleic acid changes (21%). ALK mutation was found in 10.5% of EGFR negative patients., Conclusion: Adenocarcinoma is the most common primary lung cancer in Bahrain. Genetic mutations of EGFR and ALK genes were found in 21.5% and 10.5% of adenocarcinoma cases, respectively.