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ABSTRACT: Background: Gastroesophageal reflux disease (GERD) is one of the most diagnosed digestive disorders, with much-conducted research assessing its prevalence and risk factors associated with it worldwide. However, there are no published previous studies to determine such disease and its burden in Bahrain. Hence, this study aims to estimate the prevalence and evaluate the risk factors associated with GERD among adults attending primary care in Bahrain. Material and Methodology: A total of 385 adults aged 18 years and above participated in this descriptive cross-sectional study in the period from 1st to 27th of April 2023. The sample was collected randomly through an interview-based validated questionnaire from 10 health centers selected randomly. The questionnaire consisted of three sections: Demographic characteristics, risk factors that are associated with GERD and (GERD-Q) questionnaire with a scoring rate for the diagnosis of GERD, in which a score of 8 or more gives us the diagnosis of GERD. Results: A response rate of 93.6% was accomplished. Most of the participants were female (53.2%), Bahraini (88.6%), university-educated (50.9%) and married (71.2%). The mean age of the participants was 41.5 (SD = ±14.4 years). The prevalence of GERD was 41.5% which was statistically significant associated with family history of GERD, history of hypertension, sleeping within less than 1 hour after dinner, bariatric surgery and use of NSAIDs or Aspirin regularly (P < 0.05). Conclusions: The prevalence of GERD was 41.5%, which is higher than in the Middle East, East Asia and Western countries. Many modifiable risk factors where associate with it which deserves the conduction of national prevention programs and educational campaigns to prevent this disease and its complications. Further studies are needed to assess other risk factors and the effect of GERD on the overall health status and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. Methods: this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016–2018, were retrieved from four hospitals. Results: The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). Conclusions: We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis is a chronic relapsing-remitting dermatosis commonly presented in primary healthcare facilities. Although there is no cure for atopic dermatitis, early diagnosis, and appropriate treatment are essential in the management of atopic dermatitis and in preventing its complications. Primary healthcare physicians are the first to encounter most patients with atopic dermatitis; hence, correct practices and knowledge of atopic dermatitis are important among primary healthcare physicians. This study aims to assess the knowledge and practice of primary healthcare physicians concerning diagnosing and treating patients with atopic dermatitis. Methods: A cross-sectional study was conducted among primary health care physicians working at governmental primary health centers in Bahrain to determine the knowledge, attitudes, and practices towards atopic dermatitis. In addition, a self-administered online questionnaire was distributed among the participants using online surveys. Results: A total of two hundred and eighty (n=280) primary healthcare physicians were recruited (response rate 80%). The average knowledge score (correct answers) was 46.7 ± 14.0 out of 100. Being a general practitioner (P<0.002), having more years of experience (P=0.044), and being of older age (P=0.003) were significantly associated with a lower knowledge score. The study also showed a wide range of varying practices among participants in managing patients with atopic dermatitis. Conclusion: There were significant variations in the knowledge and practice amongst primary care physicians towards atopic dermatitis that could delay the treatment of the condition and, therefore, possibly decrease treatment adherence. Conducting targeted educational interventions and developing strategies by dermatologists could minimize such gaps in practice and knowledge. [ABSTRACT FROM AUTHOR]

Objective: We examined the protocol for drug selection and bone mineral density follow up for a sample of osteoporosis patients in Bahrain. Methods: This was a retrospective study. Data was collected from three hospitals in Bahrain over the period 2016-2018. We collected subject's demographic data, osteoporosis drug therapy, and the schedule of dual-energy X-ray absorptiometry (DXA) scan before and after therapy. Results: The number of subjects who were included in this study was 4572 (mean age 59.36 years: 92.5% females, 7.5% males). We found that 41.8% of the patients used osteoporosis medications, whereas the rest were not on any pharmacotherapy (58.2%). The following drugs were used: Vitamin D (82.4%), Calcium (76.6%), Denosumab (14.9%), Bisphosphonate (4.5%) and Tamoxifen (4.3%). Almost all subjects were offered BMD scan before therapy (96.5%), but minority received a follow up after starting medications (17.2%). The follow up scan was performed 2-3 years following therapy in 46.9% of subjects, whereas for the rest, it was requested 1-2 years (31.1%) or 3 years (17.1%) later. Pharmacotherapy was associated with age (p<0.001), female gender (p<0.05) and being postmenopausal (p<0.001). Follow up BMD was positively associated with age (p<0.001), postmenopausal status (p<0.001) and medication use (p<0.001). Conclusions: Osteoporosis patients were undertreated with anti-resorptive drugs and most of them were not offered a follow up DXA scan to assess response to therapy. Protocol for pharmacotherapy and follow up of osteoporosis in Bahrain needs review. [ABSTRACT FROM AUTHOR]

Germline variants in BRCA1 and BRCA2 (BRCA1/2) genes are the most common cause of hereditary breast cancer. However, a significant number of cases are not linked to these two genes and additional high-, moderate- and low-penetrance genes have been identified in breast cancer. The advent of next-generation sequencing (NGS) allowed simultaneous sequencing of multiple cancer-susceptibility genes and prompted research in this field. So far, cancer-predisposition genes other than BRCA1/2 have not been studied in the population of Bahrain. We performed a targeted NGS using a multi-panel covering 180 genes associated with cancer predisposition to investigate the spectrum and frequency of germline variants in 54 women with a positive personal and/or family history of breast cancer. Sequencing analysis revealed germline variants in 29 (53.7%) patients. Five pathogenic/likely pathogenic variants in four DNA repair pathway-related genes were identified in five unrelated patients (9.3%). Two BRCA1 variants, namely the missense variant c.287A>G (p.Asp96Gly) and the truncating variant c.1066C>T (p.Gln356Ter), were detected in two patients (3.7%). Three variants in non-BRCA1/2 genes were detected in three patients (1.85% each) with a strong family history of breast cancer. These included a monoallelic missense variant c.1187G>A (p.Gly396Asp) in MUTYH gene, and two truncating variants namely c.3343C>T (p.Arg1115Ter) in MLH3 gene and c.1826G>A (p.Trp609Ter) in PMS1 gene. Other variants of uncertain significance (VUS) were also detected, and some of them were found together with the deleterious variants. In this first application of NGS-based multigene testing in Bahraini women with breast cancer, we show that multigene testing can yield additional genomic information on low-penetrance genes, although the clinical significance of these genes has not been fully appreciated yet. Our findings also provide valuable epidemiological information for future studies and highlight the importance of genetic testing, and an NGS-based multigene analysis may be applied supplementary to traditional genetic counseling. [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]

Background: The Kingdom of Bahrain was ranked among the 20 countries with the highest prevalence of inherited blood disorders. As a consequence, an obligatory law for premarital testing and counseling was passed by Bahrain's Government to all couples who are planning to get married. Objectives: To assess the extent of Bahraini university students awareness and understanding regarding the premarital testing, and to determine their tendency of compliance with the premarital test results, and finally to compare the level of conversance amongst medical and non-medical students for both genders. Study Design: Cross-sectional study. Setting: Arabian Gulf University and Bahrain Teachers College. Methods and materials: This study was conducted in Bahrain from July to September 2019. Data were collected using online questionnaires which were sent via social media to 313 students from both universities. Data were entered and analyzed using SPSS version 25. Results: About 313 students were included in this study, and the majority were practically aware that the test was mandatory and that the compliance to its results was optional. According to the survey, more than fifty percent of non-medical students responded positively and stated that they would comply with the test's results if both partners were carriers of the same hereditary disease. However, 80 (51.6%) medical students might have gotten married against the counselor's advice if they were under such a circumstance. Conclusion: The results showed that students' major does not affect one's Knowledge and compliance to premarital test results. [ABSTRACT FROM AUTHOR]

Background and Objectives: In the current COVID-19 pandemic, children below the age of 12 could manifest COVID-19 symptoms and serve as a reservoir for the virus in the community. The present study was conducted to evaluate the reactogenicity, and immunogenicity of BBIBP-CorV, prior to involving this age group in the vaccination program in the kingdom of Bahrain. Subjects and Methods: The study included 582 children from 3 to 12 years old of Bahraini and non-Bahraini nationality, all of which contributed to the reactogenicity study. Of those, 401 contributed to the immunogenicity study. All children received 2 doses of BBIBP-CorV inactivated virus 3 weeks apart. To assess reactogenicity, children were followed up for 5 weeks to evaluate any vaccine-related adverse events (AE). To assess immunogenicity, blood was collected on day 0 and day 35 to assess antibody titer against S, N, and neutralizing antibody. Results: Of the 582 participants, (45.4%) were female, (54.61%) were male, with 49% in 9–12 age group. Of the 401 children contributing to the immunogenicity study, 274 (68.3%) had no prior exposure to COVID-19. The overall incidence of AE was 27.7%. No significant difference was found among different age groups. The most frequent AE was local (at the injection site) and occurred in 16% of children, followed by fever in 9.3%. No serious adverse events were reported. The Seroconversion rate was 100% among children with no prior exposure to COVID-19. Children with previous COVID-19 exposure had higher averages of anti-S (2379 U/mL compared to 409.1), anti-N (177.6 U/mL compared to 30.9) and neutralizing antibody (93.7 U/mL compared to 77.1) than children with no prior exposure at day 35. Conclusions: Two doses of COVID-19 BBIBP-CorV on the subjects aged between 3 to 12 has good safety and tolerance and can induce an effective immune response and neutralizing antibody titer. [ABSTRACT FROM AUTHOR]

Introduction: Hydroxychloroquine (HCQ) is an antimalarial drug that received worldwide news and media attention in the treatment of patients with coronavirus disease 2019 (COVID-19). This drug was used on the basis of its antimicrobial and antiviral properties despite lack of definite evidence of clinical efficacy. In this study, we aim to assess the efficacy and safety of using HCQ in treatment of patients with COVID-19 who were admitted in acute care hospitals in Bahrain. Methods: We conducted a retrospective cohort study on a random sample of patients admitted with COVID-19 between 24 February and 31 July 2020. The study was conducted in four acute care COVID-19 hospitals in Bahrain. Data was extracted from the medical records. The primary endpoint was the requirement of non-invasive ventilation, intubation, or death. Secondary endpoint was length of hospitalization for survivors. Three methods of analysis were used to control for confounding factors: logistic multivariate regression, propensity score adjusted regression, and matched propensity score analysis. Results: A random sample of 1571 patients were included, 440 of whom received HCQ (treatment group) and 1131 did not receive it (control group). Our results showed that HCQ did not have a significant effect on primary outcomes due to COVID-19 infection when compared to controls after adjusting for confounders (OR 1.43, 95% CI 0.85–2.37, P = 0.17). Co-administration of azithromycin had no effect on primary outcomes (OR 2.7, 95% CI 0.82–8.85, P = 0.10). HCQ was associated with increased risk of hypoglycemia (OR 10.9, 95% CI 1.72—69.49, P = 0.011) and diarrhea (OR 2.8, 95% CI 1.4–5.5, P = 0.003), but not QT prolongation (OR 1.92, 95% CI 0.95–3.9, P = 0.06) or cardiac arrhythmia (OR 1.06, 95% CI 0.55–2.05, P = 0.85). Conclusion: Our results showed no significant beneficial effect of using hydroxychloroquine on the outcome of patients with COVID-19. Moreover, the risk of hypoglycemia due to hydroxychloroquine would possess a significant risk for out-of-hospital use. [ABSTRACT FROM AUTHOR]

The Kingdom of Bahrain has reported more than 696,000 cases of coronavirus disease 2019 (COVID-19) and 1548 associated deaths as of December 26, 2022. To better inform responses to future public health threats, this narrative review documents the challenges and responses to the COVID-19 pandemic in the Kingdom of Bahrain. A PubMed search was conducted focusing on severe acute respiratory syndrome or COVID-19 in Bahrain. Additional relevant references were also included from the authors' personal reference collections. The search indicated that Bahrain achieved well-established control of the pandemic through robust public health measures, including an early, comprehensive vaccination program. Bahrain was among the first countries to grant emergency authorization for COVID-19 vaccines; as of December 2022, nearly 73% of the eligible population has been fully vaccinated, and approximately 60% has been boosted. Low case rates in recent months highlight Bahrain's successful response to the COVID-19 pandemic. Early organization, robust and systematic protective measures, and a comprehensive vaccination program were key components of the Kingdom's response to the pandemic; traveler quarantines and attempts to combat misinformation were of little or no benefit. These lessons provide guidance for future preparedness to minimize the public health impacts of another pandemic. (Curr Ther Res Clin Exp. 2024; XX:XXX–XXX). [ABSTRACT FROM AUTHOR]