Khalil E. Rajab

Objective: To determine the incidence and trends of gestational diabetes mellitus (GDM) in Bahrain from 2002 to 2010, and to investigate 2 possible risk factors within the affected population.Methods: In a retrospective survey, data on maternal body weight and age were collected from women who gave birth in government maternity units in Bahrain and who were screened for GDM during pregnancy using the 2‐step approach and criteria of the US Expert Committee on the diagnosis and classification of diabetes.Results: Among 49 552 pregnant women, 4982 (10.1%) were diagnosed with gestational diabetes. The Cox–Stuart test for trend analysis suggested that there was an increase in the incidence of gestational diabetes from 7.2% in 2002 to 12.5% in 2010 (P < 0.01). For the period 2006–2010, maternal age, and weight at onset of pregnancy and at time of delivery were positively associated with risk of GDM with an odds ratio (95% confidence interval) of 1.094 (1.081–1.107), 1.081 (1.001–1.104), and 1.027 (1.013–1.040), respectively.Conclusion: A combination of increasing maternal weight, maternal age, and incidence of GDM among women in Bahrain indicates a significant future burden on health services.

The discovery that stem cells (SCs) can be obtained from umbilical cord blood instead of the more controversial source of embryonic SC's, has renewed interest on the new, exciting therapeutic potentials of this technology. Several therapeutic targets have been cited as candidates for treatment such as, malignant blood disease, hematological disorders, complex neurological illnesses, genetic and autoimmune diseases, benign and malignant blood diseases, skeletal anomalies, and the ultimate promise of using this technique in delaying the process of human aging. Parallel to this rise in popularity of SC research, SC banking has become a growing commercial enterprise. This review will attempt to present a concise account on the present status of the uses of SC in general, and cord blood (CB) in particular. An evaluation of the debate on the claims, and counter-claims in commercializing CB banking has been summarized.

To determine the morbidity and outcome of pregnancies complicated by homozygous sickle cell disease (SCD) in Bahrain. A controlled study was conducted of all the pregnancies of women with SCD who were delivered at Salmaniya Medical Complex and affiliate hospitals in Bahrain between January 1, 1998, and December 31, 2002. There were 351 pregnancies with SCD, giving an incidence of 0.67%. The mean+/-S.D. age of women with SCD was 28.8+/-5.7 years. These women, who were mostly from Shia villages, had more spontaneous abortions than the 351 controls (32% and 12%, respectively). Compared with the control group, the mean+/-S.D. number of pregnancies among women with SCD was 5.0+/-1.9 vs. 5.7+/-3.1; birth weight, 2,965+/-540 g vs. 3,457+/-497 g; rate of preterm deliveries, 25.9% vs. 12%; incidence of intrauterine growth restriction, 10% to 13% vs. 4% to 7%; Apgar scores at 1 and 10 min, 8.1+/-0.8 and 8.8+/-0.8; and cesarean section rate, 19.0% vs. 12.7%. There were no differences in the rates of pre-eclampsia, antepartum and postpartum hemorrhage, or stillbirth. There were 4 maternal deaths directly related to SCD complications. Hemoglobin analysis was performed in 86% of the women with SCD. Of these women, 60.6% had homozygous SCD with raised levels of fetal hemoglobin (more than 5% HbF); 9.6% had sickle cell hemoglobin with beta-thalassemia disease; and 1.4% had sickle cell hemoglobin only. Vaso-occlusive crises were the most common cause of hospital admissions during pregnancy (42.2%), while hemolytic and sequestration crises accounted for 28.0% and 0.6% of admissions. Mortality, morbidity, and perinatal loss are still considerable among women with SCD in Bahrain. To reduce mortality and morbidity, there is a need for a multidisciplinary team able to deal with pregnancy complications due to SCD.

This is a report of a young infertile woman with a history of 8 years amenorrhea, who presented with history of vaginal bleeding of 2 months duration. Investigations revealed a small cell neuroendocrine carcinoma of the endometrium, which penetrated half of the thickness of uterine wall. We have described the clinical progress and management of this rare and highly malignant cancer. A review of the pathological types and behavior of clear cell neuroendocrine carcinoma is presented.

We present an unusual case of paraplegia which occurred on the second postnatal day. Investigations revealed a spinal mass at D-7 level. Histopathology of the tumor showed it to be a spinal metastasis from a solitary thyroid malignant nodule. The patient had laminotomy and biopsy, followed later by total thyroidectomy. She also had radiotherapy and radio-iodine ablation. We discuss the therapeutic modalities of such a condition.

Recent advances in the pathophysiology, clinical investigations, and management of sickle hemoglobinopathies enables all physicians to better manage these disease states and their sequelae. Patients with sickle cell disease SCD are living longer and are thus more likely to contract unrelated diseases that require surgery and anesthesia. Patients with SCD continue to be a challenge to all branches of medicine particularly in obstetrics, surgery and anesthesia; however, the armamentarium of new knowledge and practice places a different perspective on the care of this old disease. In general, the literature to date suggests that neither prophylactic transfusion of pregnant sicklers nor the selection of an anesthetic in labor have a major impact on patient outcome; however, perioperative management can greatly affect the consequences. A thorough knowledge of the impact of the disease on clinical status can determine how, when, and why to manage parturients with SCD.

(a) To test the sensitivity and specificity of measuring fasting plasma glucose levels (FPG) as a screening test for gestational diabetes mellitus (GDM). (b) To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test (GCT) for predicting GDM. One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26-32 weeks gestation, giving a 13.5% incidence of GDM (using the Third International Workshop cutoff values of 7.8 mmol /l). All patients also had an FPG estimation followed by the three-hour oral glucose tolerance test (oGTT). Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves (ROC) were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. FPG levels of 5.6 mmol /l and 5.4 mmol /l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. Using FPG levels at a cutoff value of ≥ 5.5 mmol /l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT.

Objectives: (a) To test the sensitivity and specificity of measuring fasting plasma glucose levels (FPG) as a screening test for gestational diabetes mellitus (GDM). (b) To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test (GCT) for predicting GDM. Methods: One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26–32 weeks gestation, giving a 13.5% incidence of GDM (using the Third International Workshop cutoff values of 7.8 mmol /l). All patients also had an FPG estimation followed by the three-hour oral glucose tolerance test (oGTT). Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves (ROC) were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. Results: FPG levels of 5.6 mmol /l and 5.4 mmol /l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. Conclusion: Using FPG levels at a cutoff value of ≥ 5.5 mmol /l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT.

Although the clinical features of appendicitis in children are well established, diagnosis can be compounded when a young girl having just had menarche presents with unusual and untoward symptoms. The gynecological and surgical diagnoses and subsequent findings will be discussed in detail, along with the respective management regimens. Pelvic abscesses in particular will be discussed relative to accessing problems.

This report describes the clinical findings and outcome of a patient suffering from septic postpartum ovarian vein thrombosis. Treatment modalities are well described and range from hysterectomy and thrombectomy to the use of vena cava filters in combination with anticoagulation and antibiotics. Defervescence with a combination infusion of tissue plasminogen and heparin were used. This treatment approach has been found particularly successful in cases of ilio-femoral, hepatic, renal and vena caval thromboses.