Abdominoplasty Panniculus as a Source for Human Acellular Dermis: A Preliminary Report.

BACKGROUND: In extensive deep dermal burn injuries, split-thickness skin graft (STSG) has been the most preferred treatment option for resurfacing burn wounds. A thick split-thickness skin graft is ideal for preventing graft contracture but is associated with delayed donor healing and the lack of adequate donor skin. When applied with STSG, the dermal substitutes offer better-reconstructed skin than STSG alone. Human-derived acellular dermal matrix (HADM) obtained from cadaver skin is a dermal equivalent with good clinical outcomes. However, high cost and limited cadaver donor skin availability limit its clinical utility. Developing a low-cost preparation method and finding an alternate source of human donated skin can help reduce the cost. The objective of this study was to explore the feasibility of making HADM from abdominoplasty panniculus skin. METHODS: Skin samples were collected from the abdominoplasty panniculus of ten eligible donors with their informed consent. A combination of low-cost reagents-sodium chloride and hypotonic solution (water for injection) was used for decellularizing the skin. Characterization of the prepared Acellular Dermis Matrix prototype was done. RESULTS: The skin was deepidermized with one molar NaCl treatment at 37 °C for 24 h. The deepidermized dermis became acellular with hypotonic solution treatment at 4 °C for two weeks. The hematoxylin and eosin staining and cytotoxicity test confirmed the acellularity and non-cytotoxicity of the prepared HADM prototype. The HADM prototype also facilitated the formation of neo-epithelium in the 3D cell co-culture model. CONCLUSION: This study confirms that abdominoplasty panniculus can be a viable alternative for HADM preparation. Further characterization studies are required to prove the concept.

Efficiency of National Taskforce for Combating the Coronavirus (COVID-19) Protocol using real-time PCR testing in health facilities over a period of 8-weeks.

BACKGROUND: Following declaration of Corona Virus Disease 19 (COVID-19) as a global outbreak by the WHO with recommendation to do nasopharyngeal swabs for diagnosis. Many countries started to take different measures of precautions. The Kingdom of Bahrain COVID team (National Taskforce for Combating the Coronavirus) has introduced different protocols for different categories. OBJECTIVE: The aim of this study is to; determine the efficiency of the recent National Taskforce for Combating the Coronavirus (COVID-19) Protocol 5-day nasopharyngeal swab from diagnosis; by evaluating the period of time needed for a patient to retain a negative polymerase chain reaction result and to determine the number of patients who failed to retain a negative result. In addition to, evaluating the cycle threshold values of persistent positive and its relation to current evidence in literature. This study also aims to determine the number of patients that needed urgent medical care [i.e. shifting to an intensive care unit (ICU) facility] in that time frame. MATERIALS & METHODS: Data were collected from the daily index master sheets present in the facility from medical database systems; ALCARE by Royal Medical Services and ORACLE Reports by iSEHA. Search engines used were PubMed/MEDLINE, Oxford Academic Database, Cochrane Database system. The duration of study was from 1-July 2020 to 31-August 2020. RESULTS: The sample included 7196 male patients from ages 18-65 years. Median age was 36. Out of 7196 patients, 3506 retained a negative result on 5th day from diagnosis, 1594 retained a negative result on 7th day from diagnosis, and 1343 retained negative result on 9th day from diagnosis. While 618 patients failed to retain a negative result. CONCLUSION: This study estimated the efficiency of testing protocol based on the current prevalence state of COVID-19. They found that the current protocol was not enough for the clinical data. In addition, 7-day nasopharyngeal swab was an effective testing method. Among the patients with Ct value >24, negative infected persons should be paid close attention.

Establishing a 130-Bed Field Intensive Care Unit to Prepare for COVID-19 in 7 Days in Bahrain Military Hospital.

This article reports the establishment of an isolated, fully functional field intensive care unit (FICU) unit equipped with all necessary critical care facilities as a part of the national pre-emptive preparedness to treat an unexpected surge outbreak of coronavirus disease 2019 (COVID-19) patients in Bahrain. One floor of an existing car parking structure was converted into a 130-bed FICU set-up by the in-house project implementation team comprised of multidisciplinary departments. The setting was a military hospital in the Kingdom of Bahrain, and the car park was on the hospital premises. The FICU contained a 112-bed fully equipped ICU and an 18-bed step-down ICU, and was built in 7 d to cater to the intensive care of COVID-19 patients in Bahrain.

Intussusception after laparoscopic one anastomosis gastric bypass: A rare complication.

INTRODUCTION: Intussusception after one anastomosis gastric bypass is a rare postoperative complication that occurs with bowel obstruction. The diagnosis may be challenging because of long-standing, intermittent, nonspecific symptoms. Our paper describes an unusual case of antegrade intussusception that occurred 28 months after laparoscopic one anastomosis gastric bypass surgery. PRESENTATION: A 30-year-old female known to have diabetes mellitus type 2, who presented with epigastric pain. A computed tomography scan revealed a jejuno-jejunal intussusception. After resection and primary end-to-end hand-sewn anastomosis of the biliary limb, the patient was discharged on the 6th day postoperatively and recovered uneventfully. We belief this is the first report describing a case of intussusception post one anastomosis gastric bypass. DISCUSSION: Gastric bypass surgeries have recently become a popular method for the surgical treatment of morbid obesity worldwide. The reported intussusception incidence after Roux-en-Y gastric bypass (RYGB) is approximately 0.1-0.3%, but not described in one anastomosis gastric bypass surgery. Approximately two-thirds of patients show recurrent chronic and colicky pain. Surgical intervention is essential. CONCLUSION: Clinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.

Weight Loss and Glycemic Control after Sleeve Gastrectomy: Results from a Middle Eastern Center of Excellence.

Obesity and its associated metabolic disorders are strongly linked to both morbidity and mortality. Sleeve gastrectomy (SG) has been established as an effective means of weight loss for obese patients as well as a treatment for type 2 diabetes mellitus (T2DM). This study was designed to examine the short- and midterm outcomes of patients who underwent SG in a Middle Eastern Center of Excellence, a military training teaching hospital. The clinical outcomes of 59 patients with impaired glucose tolerance and T2DM who underwent SG between 2011 and 2014 with at least one and up to four years of follow-up were studied. Data were collected and compared, including the pre- and post-surgery measures of weight, body mass index, glycosylated hemoglobin (HbA1c), and fasting blood glucose. Complete remission was defined as a fasting blood glucose level ≤100 mg/dL, an HbA1c ≤6 mg/dL, without use of antidiabetic medications. All patients showed significant reduction in body mass index following SG. Tight glycemic control was achieved among both diabetic and prediabetic patients. In this study, 88.14 per cent of all patients (diabetic and prediabetic) achieved complete resolution from their impaired glucose tolerance and T2DM and maintained normal blood glucose and HbA1C levels from one to four years postoperatively. SG is beneficial both in terms of short- and midterm weight loss and glucose control in both diabetic and prediabetic obese patients.

Analyzing the Psychometric Properties of the Short Form-36 Quality of Life Questionnaire in Patients with Obesity.

PURPOSE: The Short Form-36 (SF-36) questionnaire is a valuable and easy-to-use tool for the measurement of quality of life in patients with obesity. To become a widely used tool, the questionnaire must be validated in many different contexts. Thus, the present study aimed to evaluate the construct validity and reliability of the SF-36 questionnaire among patients with obesity in Bahrain. METHODOLOGY: The 36-item questionnaire was administered to a study cohort scheduled to undergo bariatric surgery at the Bahrain Defence Force Hospital in Bahrain. Demographic data were extracted. Principal component analysis was used to extract component factors. Factor analysis was used to determine construct validity and fit. The Cronbach's alpha value of the extracted factors was used to determine the internal consistency reliability. Statistical analyses were performed using SPSS version 19.0 and IBM AMOS version 22.0. RESULTS: Most of the participants were female with a mean body mass index (BMI) of 43.24 kg/m2. A six-factor solution explaining 52.31% of variance was generated. The global fit parameter estimates indicated that the suggested model exhibited an acceptable-to-good fit. Overall, the internal consistency reliability estimate of the SF-36 questionnaire was greater than 0.70. CONCLUSION: The identified six-factor model of the SF-36 questionnaire is a valuable tool for the measurement of quality of life among patients with obesity in Bahrain.

Quality of life, food tolerance, and eating disorder behavior after laparoscopic gastric banding and sleeve gastrectomy - results from a middle eastern center of excellence.

BACKGROUND: Obesity is a major health problem in Arab countries. Bariatric surgery can improve the quality of life of an obese individual. However, different types of bariatric surgery result in varying levels of food intolerance as a side effect. Many patients who undergo bariatric surgery are also at risk of subsequently developing eating disorder behaviors. The aim of the study was to compare the quality of life, food tolerance, and behaviors of eating disorders related to laparoscopic sleeve gastrectomy and gastric banding. METHODS: A retrospective review of medical records and a questionnaire-based survey was completed for all patients who had undergone either bariatric sleeve gastrectomy or gastric banding at the Bahrain Defense Force Hospital between 2011 and 2014. Each patient was administered 3 questionnaires to assess the quality of life, food tolerance, and eating disorder behaviors. RESULTS: Forty-eight patients who had undergone sleeve gastrectomy and 36 who had undergone gastric banding participated in the study. Sleeve gastrectomy patients showed better food tolerance (P < 0.001) and better eating behaviors (P = 0.001) post-surgery compared with gastric banding patients. Health-related quality of life (HRQOL) did not differ significantly between the 2 groups. Only sleeve patients had preoperative evaluation of these parameters (HRQOL). However, in the gastric sleeve group, after the surgery, significant improvement was found in all parameters of HRQOL except for mental health status. CONCLUSION: Laparoscopic gastric sleeve surgery patients had superior outcomes in both food tolerance and eating disorder behaviors. The quality of life did not significantly differ between the gastric sleeve and gastric banding surgery groups.

Cross-cultural challenges in assessing medical professionalism among emergency physicians in a Middle Eastern Country (Bahrain): feasibility and psychometric properties of multisource feedback.

BACKGROUND: Multisource feedback (MSF) is an evaluation tool whereby surveys assessing physicians are administered among medical peers and colleagues. Such evaluations provide physicians with non-biased valuations of both their strengths and their weaknesses, offering an opportunity for improvement in their work. Studies have shown that MSF is particularly effective for emergency care physicians. METHODS: The study was undertaken in a military teaching hospital in Bahrain. A total of 30 emergency physicians (the total number of emergency physicians in our hospital), 16 males and 14 females, were evaluated using multisource feedback. Each emergency physician was assessed by three groups of raters, including 4 emergency physicians, 4 referral physicians from other departments, and 4 coworkers from within the emergency department. Feasibility of the questionnaire was analyzed via response rates, average time required to complete it, and the number of raters required to produce reliable results. We used exploratory factor analysis to examine for the construct validity. Cronbach's coefficient was calculated to measure the internal consistency reliability of the instrument. RESULTS: The total mean response rate was 74.2 %, and the self-reported average time needed to fill out each survey was 4.3 min, indicating a good feasibility of the questionnaire. Reliability analysis indicated that the full-scale instrument had high internal consistency (Cronbach's α 0.98). Factor analysis showed that the data on the questionnaire decomposed into three factors, which accounted for 72.6 % of the total variance: professionalism, collaboration, and communication. The generalizability coefficients (Ep(2)) were 0.76 for the surveys. Out of the 30 candidates, 26 participated in the knowledge test. The total mean score of the knowledge exam was 34.52, with scores ranging from 17 to 54. CONCLUSIONS: Based on this study's results, we conclude that the instruments and procedures used have high reliability, validity, and feasibility in assessing the emergency physician in the emergency department in our clinical setting in the Middle East. The item analyses, reliability, and factor analyses all indicate that these instruments are effective in assessing emergency physicians.

Cross-cultural challenges for assessing medical professionalism among clerkship physicians in a Middle Eastern country (Bahrain): feasibility and psychometric properties of multisource feedback.

BACKGROUND: We aimed to design, implement, and evaluate the feasibility and reliability of a multisource feedback (MSF) system to assess interns in their clerkship year in the Middle Eastern culture, the Kingdom of Bahrain. METHOD: The study was undertaken in the Bahrain Defense Force Hospital, a military teaching hospital in the Kingdom of Bahrain. A total of 21 interns (who represent the total population of the interns for the given year) were assessed in this study. All of the interns were rotating through our hospital during their year-long clerkship rotation. The study sample consisted of nine males and 12 females. Each participating intern was evaluated by three groups of raters, eight medical intern colleagues, eight senior medical colleagues, and eight coworkers from different departments. RESULTS: A total of 21 interns (nine males and 12 females) were assessed in this study. The total mean response rates were 62.3%. A factor analysis was conducted that found that the data on the questionnaire grouped into three factors that counted for 76.4% of the total variance. These three factors were labeled as professionalism, collaboration, and communication. Reliability analysis indicated that the full instrument scale had high internal consistency (Cronbach's α 0.98). The generalizability coefficients for the surveys were estimated to be 0.78. CONCLUSION: Based on our results and analysis, we conclude that the MSF tool we used on the interns rotating in their clerkship year within our Middle Eastern culture provides an effective method of evaluation because it offers a reliable, valid, and feasible process.

The construct and criterion validity of the multi-source feedback process to assess physician performance: a meta-analysis.

BACKGROUND: The purpose of this study was to conduct a meta-analysis on the construct and criterion validity of multi-source feedback (MSF) to assess physicians and surgeons in practice. METHODS: In this study, we followed the guidelines for the reporting of observational studies included in a meta-analysis. In addition to PubMed and MEDLINE databases, the CINAHL, EMBASE, and PsycINFO databases were searched from January 1975 to November 2012. All articles listed in the references of the MSF studies were reviewed to ensure that all relevant publications were identified. All 35 articles were independently coded by two authors (AA, TD), and any discrepancies (eg, effect size calculations) were reviewed by the other authors (KA, AD, CV). RESULTS: Physician/surgeon performance measures from 35 studies were identified. A random-effects model of weighted mean effect size differences (d) resulted in: construct validity coefficients for the MSF system on physician/surgeon performance across different levels in practice ranged from d=0.14 (95% confidence interval [CI] 0.40-0.69) to d=1.78 (95% CI 1.20-2.30); construct validity coefficients for the MSF on physician/surgeon performance on two different occasions ranged from d=0.23 (95% CI 0.13-0.33) to d=0.90 (95% CI 0.74-1.10); concurrent validity coefficients for the MSF based on differences in assessor group ratings ranged from d=0.50 (95% CI 0.47-0.52) to d=0.57 (95% CI 0.55-0.60); and predictive validity coefficients for the MSF on physician/surgeon performance across different standardized measures ranged from d=1.28 (95% CI 1.16-1.41) to d=1.43 (95% CI 0.87-2.00). CONCLUSION: The construct and criterion validity of the MSF system is supported by small to large effect size differences based on the MSF process and physician/surgeon performance across different clinical and nonclinical domain measures.

The impact of sleeve gastrectomy on hyperlipidemia: a systematic review.

BACKGROUND: Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG). Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. METHODS: A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. RESULTS: A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI) was 48 ± 7.0 kg/m(2) (range 37.2-65.3). The mean postoperative BMI was 35 ± 5.9 kg/m(2) (range 26.3-49). The mean percentage of excess weight loss (EWL) was 63.1% (range 37.7-84.5), with a mean followup of 19.1 months (range 6-60). The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178-213) and 181 ± 16.3 mg/dL (range 158-200), respectively. CONCLUSION: Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients.

Multisource feedback to assess surgical practice: a systematic review.

BACKGROUND: The assessment, maintenance of competence, and recertification for surgeons have recently received increased attention from many health organizations. Assessment of physicians' competencies with multisource feedback (MSF) has become widespread in recent years. The aim of the present study was to investigate further the use of MSF for assessing surgical practice by conducting a systematic review of the published research. METHODS: A systematic literature review was conducted to identify the use of MSF in surgical settings. The search was conducted using the electronic databases EMBASE, PsycINFO, MEDLINE, PubMed, and CINAHL for articles in English up to August 2012. Studies were included if they reported information about at least 1 out of feasibility, reliability, generalizability, and validity of the MSF. RESULTS: A total of 780 articles were identified with the initial search and 772 articles were excluded based on the exclusion criteria. Eight studies met the inclusion criteria for this systematic review. Reliability (Cronbach α ≥ 0.90) was reported in 4 studies and generalizability (Ep2 ≥ 0.70) was reported in 4 studies. Evidence for content, criterion-related, and construct validity was reported in all 8 studies. CONCLUSION: MSF is a feasible, reliable, and valid method to assess surgical practice, particularly for nontechnical competencies such as communication skills, interpersonal skills, collegiality, humanism, and professionalism. Meanwhile, procedural competence needs to be assessed by different assessment methods. Further implementation for the use of MSF is desirable.

Reduction in weight and BMI and changes in Co-morbidities following laparoscopic adjustable gastric banding procedure for morbidly obese patients in Bahrain: a five year longitudinal study.

BACKGROUND: Obesity and its related illnesses are pan-endemic health problems which require intervention. Laparoscopic Adjustable Gastric Banding (LAGB) is seen as a safe surgical procedure with satisfactory results on weight reduction and improvement in obesity related illness. METHODS: Data were collected in a repeated-measures longitudinal five year study for 143 morbidly obese patients who underwent laparoscopic adjustable gastric banding (LAGB). Follow up was continued from 3 to 60 months post operatively. Patients were assessed for diabetes, hypertension and dyslipidemia. RESULTS: Repeated measures ANOVAs revealed that both men and women lose weight and reduce their BMIs at a consistent rate. At 3, 6 and 9 months post-operative there are no differences in percent weight loss between men and women with mean weight loss at 8.9%, 13.1% and 16.0% respectively of pre-operative weight. At 12, 24 and 60 months post-operatively, however, men significantly increase the percentage of weight loss as well as improve their BMI compared to women (p < .05). At 24 months post-operative, men and women have BMIs of 36.03 and 32.85, both still in the obese range. By 60 months men have achieved a BMI that is slightly under the obese range into the overweight range (30.76) while women (BMI = 36.61) were still in the obese range. At 60 months, men have lost a total of 33.75% of their pre-operative body weight while women have lost a total of 21.50. Diabetes, hypertension and dyslipidemia were significantly reduced in the sample post-operatively (p < .01). CONCLUSION: LAGB is a safe and effective surgical procedure for morbidly obese patients resulting in weight loss, BMI decrease and reduction in co-morbid illnesses.