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Papers by Mahmood Alawainati
Research Square (Research Square), Mar 14, 2023
Background: Type-2 Diabetes Mellitus is a chronic metabolic disease characterized by inappropriat... more Background: Type-2 Diabetes Mellitus is a chronic metabolic disease characterized by inappropriate hyperglycemia and defects in insulin function. Vitamin B12 is an essential water-soluble vitamin that has a fundamental role in the synthesis of fatty acids, DNA and myelin. Metformin, an oral hypoglycemic agent, was linked to low levels of vitamin B12. This study aimed to determine the prevalence and determinants of vitamin B-12 de ciency among patients with type-2 Diabetes mellitus attending primary healthcare centers in Bahrain. Methods: A cross-sectional study was conducted at ve primary healthcare centers in Bahrain. Serum B-12 levels were measured for all patients. Vitamin B-12 levels ≤ 221 pmol/L were considered low, while vitamin B-12 levels of more than 221 pmol/L were considered normal. Results:A total of 691 patients were included in our study with an average age of 58.5±11.2 years. Most participants had hypertension (n=436, 63.1%) and hyperlipidemia (n=367, 53.1%). As high as 92% of the participants were on Metformin and 42.1% (n= 291) were using Insulin formulations. The mean vitamin B-12 level among participants was 278.0 ± 179.3 pmol/L. We found that 40.1% of the patients (n=277) had vitamin B-12 de ciency. Being treated with metformin was the only signi cant determinant of low vitamin B-12 levels among the cohort (P=0.022). Conclusion: Vitamin B-12 de ciency is prevalent among patients with type-2 diabetes, especially among those on Metformin. Screening for vitamin VB12 de ciency should be considered in diabetic patients especially if treated with Metformin.
Oman Medical Journal, 2020
Background: There is limited evidence regarding the utility of testing individuals who are asympt... more Background: There is limited evidence regarding the utility of testing individuals who are asymptomatic, such asymptomatic COVID-19 individuals tend to have higher Ct-value and tend to have better prognosis. The aim of this study is to illustrate the rate of positivity among admission screening to SMC and study their outcome and compare the age, sex and Ct-value of asymptomatic COVID-19 individuals with their counterpart symptomatic hospitalized COVID-19 patients. Method: Retrospective observational analysis of all patients admitted to Salmaneya Medical Center (SMC) during one month study period. Results: During the study period, total of 3101 patients were admitted to SMC, out of which 396 were referred as symptomatic COVID-19 patients, while among the remaining (2705) admitted patients they were all asymptomatic for SARS-CoV-2 infections but screened at the time of admission to the hospital by PCR testing, out of which 21 patients only turned to be positive for SARS-CoV-2 infections (< 1%), among hospitalized COVID-19 patients, advance 2
Journal of the Bahrain Medical Society, 2021
Background: Adaptation to chronic disease can be challenging. Compliance with medication, adjusti... more Background: Adaptation to chronic disease can be challenging. Compliance with medication, adjusting to lifestyle changes, attending health care facilities, and financial costs are among many obstacles encountered. Treatment burden is defined as the effort required by the patient or caregiver to manage the medical conditions of the patient and the impact that this has on their lives. The aim of this study was to help the health care system in establishing new strategies to address the treatment burden on patients with non-communicable diseases. Methods: A cross-sectional study was conducted among patients attending non-communicable disease clinics and central diabetic clinics in eight different primary health care centers in Bahrain, using the Treatment Burden Questionnaire through structured interviews. A value of 59 and above was considered as an unacceptable burden according to patient acceptable symptom state (PASS). Results: Of the 411 participants, around 18% had an unacceptabl...
Journal of the Bahrain Medical Society, 2019
Introduction: Thyroid nodules are commonly encountered in clinical practice and require laborator... more Introduction: Thyroid nodules are commonly encountered in clinical practice and require laboratory and radiological investigations for their evaluation. This study aimed to evaluate the correlation between ultrasonographic and pathological features of thyroid nodules and to determine the diagnostic accuracy of cytological assessment. Methods: A retrospective cross-sectional study was conducted at a tertiary care hospital in the Kingdom of Bahrain. Ultrasound and pathology reports were retrospectively reviewed for all patients who had their nodules excised from January 2016 to December 2018. All statistical analyses were conducted using Prism 7 (Graph Pad software, version 7) Results: A total of 287 patients had thyroid surgery during the study period but only 190 of them had an ultrasonographic assessment. Of the 190, 135 (71%) were diagnosed with benign pathologies. Multinodular goitre (n=86, 63.7%) was the most common benign pathology, whereas papillary thyroid carcinoma (n=48, 87.2%) was the most common malignant pathology. Most cases affected females (n=171), with a female-to-male ratio of 9:1. Non-cystic nodules, nodules ≥ 1cm, presence of calcification, increased vascularity and hypoechogenicity were significantly different between benign and malignant nodules. Conclusion: Ultrasonographic features and cytological assessment are useful in evaluating thyroid nodules. However, histological analysis may be inevitable as none of these diagnostic techniques are enough to exclude thyroid cancer.
Journal of the Bahrain Medical Society, 2019
Methods: Yousif Engineer Health Center, which is the largest health centre in terms of coverage a... more Methods: Yousif Engineer Health Center, which is the largest health centre in terms of coverage and number of visits, was the target of this audit. The date selected, by simple randomization, was November 15th, 2017. Night shifts, weekends, and records, documented by trainee residents, were excluded from the analysis. On that day, 11 physicians were on duty, with 426 records. Every physician was considered as a cluster, and approximately 35 % (n = 147) of the total records (n = 426), were included in the analysis using systematic selection. Results: A total of 147 records were analyzed. The SOAP note was complete in 1 (1 %), partially complete in 142 (96 %), and incomplete in 4 (3 %), of the records. Subsequently, each part of SOAP note was separately assessed. For the Subjective part, 16 (11 %) were complete, 125 (85 %) partially complete, and 6 (4 %) incomplete. For the Objective part, 8 (6 %) records were complete, 37 (25 %) partially complete, and 102 (69 %) incomplete. The Assessment part was complete in 141 (96 %) and incomplete in 6 (4 %) of the records. The Plan part was complete in 127 (86 %) and incomplete in 20 (14 %) of the records. Conclusion: In comparison to other studies assessing the competition of electronic medical records, this audit showed a substandard completion rate of 1 %. Accordingly, recommendations were formulated, which can be adopted to improve the electronic medical documentation. Completion of Electronic Medical Records in General Clinics at Yousif Engineer Health Centre in Bahrain-A Clinical Audit ORIGINAL ARTICLE Background: Electronic medical records have largely replaced the conventional, paper-based documents, in many parts of the world, including Bahrain, due to increased portability, and easy accessibility. In primary-care setting in Bahrain, physicians use the SOAP note to document the patient's medical history. The aim of this audit is to estimate the rate of completion of documentation of patient's medical records by the physicians in Yousif Engineer Health Center using SOAP note in I-SEHA.
Case Reports in Hepatology, 2019
Background. There are multiple aetiologies for dyspnea in patients with liver disease, including ... more Background. There are multiple aetiologies for dyspnea in patients with liver disease, including pneumonia, pulmonary embolism, hepatic hydrothorax, portopulmonary syndrome, and hepatopulmonary syndrome. The aim of this paper is to emphasize the importance of early diagnosis and management of hepatopulmonary syndrome. Case Presentation. We report a case of a 65-year-old male who was known to have chronic hepatitis C presented with one-year history of shortness of breath and cyanosis. The initial impression of pulmonary embolism was excluded by comprehensive diagnostic investigations. The correlation between the clinical picture and investigations raised the possibility of hepatopulmonary syndrome which was confirmed by contrast-enhanced transthoracic echocardiography. Conclusions. High suspicion is required to diagnose hepatopulmonary syndrome in patients with liver disease and hypoxemia. Screening for this complication is appropriate in liver transplant candidates, and diagnosed pa...
Journal of Case Reports, 2017
Minimal change disease (MCD) is a glomerulopathy that may manifest as nephrotic syndrome. It is m... more Minimal change disease (MCD) is a glomerulopathy that may manifest as nephrotic syndrome. It is most common in children; while, it only accounts for 20–25% of cases of adult nephrotic syndrome. This article presents a case of an adult with MCD presented with generalized edema. Initially, Focal segmental glomerulosclerosis (FSGS) was suspected. However, the patient’s dramatic response to steroids, his acute presentation and the histopathology features of his renal biopsy favored MCD. The initial management comprised of steroids to which the patient responded. A year later, the patient relapsed and mycophenolate mofetil was added. There is lack of guidelines to manage adult MCD, in contrast to child MCD. The clinical picture of the patient is the key to guide decisions about management in absence of evidence-based guidelines.
Research Square (Research Square), Mar 14, 2023
Background: Type-2 Diabetes Mellitus is a chronic metabolic disease characterized by inappropriat... more Background: Type-2 Diabetes Mellitus is a chronic metabolic disease characterized by inappropriate hyperglycemia and defects in insulin function. Vitamin B12 is an essential water-soluble vitamin that has a fundamental role in the synthesis of fatty acids, DNA and myelin. Metformin, an oral hypoglycemic agent, was linked to low levels of vitamin B12. This study aimed to determine the prevalence and determinants of vitamin B-12 de ciency among patients with type-2 Diabetes mellitus attending primary healthcare centers in Bahrain. Methods: A cross-sectional study was conducted at ve primary healthcare centers in Bahrain. Serum B-12 levels were measured for all patients. Vitamin B-12 levels ≤ 221 pmol/L were considered low, while vitamin B-12 levels of more than 221 pmol/L were considered normal. Results:A total of 691 patients were included in our study with an average age of 58.5±11.2 years. Most participants had hypertension (n=436, 63.1%) and hyperlipidemia (n=367, 53.1%). As high as 92% of the participants were on Metformin and 42.1% (n= 291) were using Insulin formulations. The mean vitamin B-12 level among participants was 278.0 ± 179.3 pmol/L. We found that 40.1% of the patients (n=277) had vitamin B-12 de ciency. Being treated with metformin was the only signi cant determinant of low vitamin B-12 levels among the cohort (P=0.022). Conclusion: Vitamin B-12 de ciency is prevalent among patients with type-2 diabetes, especially among those on Metformin. Screening for vitamin VB12 de ciency should be considered in diabetic patients especially if treated with Metformin.
Oman Medical Journal, 2020
Background: There is limited evidence regarding the utility of testing individuals who are asympt... more Background: There is limited evidence regarding the utility of testing individuals who are asymptomatic, such asymptomatic COVID-19 individuals tend to have higher Ct-value and tend to have better prognosis. The aim of this study is to illustrate the rate of positivity among admission screening to SMC and study their outcome and compare the age, sex and Ct-value of asymptomatic COVID-19 individuals with their counterpart symptomatic hospitalized COVID-19 patients. Method: Retrospective observational analysis of all patients admitted to Salmaneya Medical Center (SMC) during one month study period. Results: During the study period, total of 3101 patients were admitted to SMC, out of which 396 were referred as symptomatic COVID-19 patients, while among the remaining (2705) admitted patients they were all asymptomatic for SARS-CoV-2 infections but screened at the time of admission to the hospital by PCR testing, out of which 21 patients only turned to be positive for SARS-CoV-2 infections (< 1%), among hospitalized COVID-19 patients, advance 2
Journal of the Bahrain Medical Society, 2021
Background: Adaptation to chronic disease can be challenging. Compliance with medication, adjusti... more Background: Adaptation to chronic disease can be challenging. Compliance with medication, adjusting to lifestyle changes, attending health care facilities, and financial costs are among many obstacles encountered. Treatment burden is defined as the effort required by the patient or caregiver to manage the medical conditions of the patient and the impact that this has on their lives. The aim of this study was to help the health care system in establishing new strategies to address the treatment burden on patients with non-communicable diseases. Methods: A cross-sectional study was conducted among patients attending non-communicable disease clinics and central diabetic clinics in eight different primary health care centers in Bahrain, using the Treatment Burden Questionnaire through structured interviews. A value of 59 and above was considered as an unacceptable burden according to patient acceptable symptom state (PASS). Results: Of the 411 participants, around 18% had an unacceptabl...
Journal of the Bahrain Medical Society, 2019
Introduction: Thyroid nodules are commonly encountered in clinical practice and require laborator... more Introduction: Thyroid nodules are commonly encountered in clinical practice and require laboratory and radiological investigations for their evaluation. This study aimed to evaluate the correlation between ultrasonographic and pathological features of thyroid nodules and to determine the diagnostic accuracy of cytological assessment. Methods: A retrospective cross-sectional study was conducted at a tertiary care hospital in the Kingdom of Bahrain. Ultrasound and pathology reports were retrospectively reviewed for all patients who had their nodules excised from January 2016 to December 2018. All statistical analyses were conducted using Prism 7 (Graph Pad software, version 7) Results: A total of 287 patients had thyroid surgery during the study period but only 190 of them had an ultrasonographic assessment. Of the 190, 135 (71%) were diagnosed with benign pathologies. Multinodular goitre (n=86, 63.7%) was the most common benign pathology, whereas papillary thyroid carcinoma (n=48, 87.2%) was the most common malignant pathology. Most cases affected females (n=171), with a female-to-male ratio of 9:1. Non-cystic nodules, nodules ≥ 1cm, presence of calcification, increased vascularity and hypoechogenicity were significantly different between benign and malignant nodules. Conclusion: Ultrasonographic features and cytological assessment are useful in evaluating thyroid nodules. However, histological analysis may be inevitable as none of these diagnostic techniques are enough to exclude thyroid cancer.
Journal of the Bahrain Medical Society, 2019
Methods: Yousif Engineer Health Center, which is the largest health centre in terms of coverage a... more Methods: Yousif Engineer Health Center, which is the largest health centre in terms of coverage and number of visits, was the target of this audit. The date selected, by simple randomization, was November 15th, 2017. Night shifts, weekends, and records, documented by trainee residents, were excluded from the analysis. On that day, 11 physicians were on duty, with 426 records. Every physician was considered as a cluster, and approximately 35 % (n = 147) of the total records (n = 426), were included in the analysis using systematic selection. Results: A total of 147 records were analyzed. The SOAP note was complete in 1 (1 %), partially complete in 142 (96 %), and incomplete in 4 (3 %), of the records. Subsequently, each part of SOAP note was separately assessed. For the Subjective part, 16 (11 %) were complete, 125 (85 %) partially complete, and 6 (4 %) incomplete. For the Objective part, 8 (6 %) records were complete, 37 (25 %) partially complete, and 102 (69 %) incomplete. The Assessment part was complete in 141 (96 %) and incomplete in 6 (4 %) of the records. The Plan part was complete in 127 (86 %) and incomplete in 20 (14 %) of the records. Conclusion: In comparison to other studies assessing the competition of electronic medical records, this audit showed a substandard completion rate of 1 %. Accordingly, recommendations were formulated, which can be adopted to improve the electronic medical documentation. Completion of Electronic Medical Records in General Clinics at Yousif Engineer Health Centre in Bahrain-A Clinical Audit ORIGINAL ARTICLE Background: Electronic medical records have largely replaced the conventional, paper-based documents, in many parts of the world, including Bahrain, due to increased portability, and easy accessibility. In primary-care setting in Bahrain, physicians use the SOAP note to document the patient's medical history. The aim of this audit is to estimate the rate of completion of documentation of patient's medical records by the physicians in Yousif Engineer Health Center using SOAP note in I-SEHA.
Case Reports in Hepatology, 2019
Background. There are multiple aetiologies for dyspnea in patients with liver disease, including ... more Background. There are multiple aetiologies for dyspnea in patients with liver disease, including pneumonia, pulmonary embolism, hepatic hydrothorax, portopulmonary syndrome, and hepatopulmonary syndrome. The aim of this paper is to emphasize the importance of early diagnosis and management of hepatopulmonary syndrome. Case Presentation. We report a case of a 65-year-old male who was known to have chronic hepatitis C presented with one-year history of shortness of breath and cyanosis. The initial impression of pulmonary embolism was excluded by comprehensive diagnostic investigations. The correlation between the clinical picture and investigations raised the possibility of hepatopulmonary syndrome which was confirmed by contrast-enhanced transthoracic echocardiography. Conclusions. High suspicion is required to diagnose hepatopulmonary syndrome in patients with liver disease and hypoxemia. Screening for this complication is appropriate in liver transplant candidates, and diagnosed pa...
Journal of Case Reports, 2017
Minimal change disease (MCD) is a glomerulopathy that may manifest as nephrotic syndrome. It is m... more Minimal change disease (MCD) is a glomerulopathy that may manifest as nephrotic syndrome. It is most common in children; while, it only accounts for 20–25% of cases of adult nephrotic syndrome. This article presents a case of an adult with MCD presented with generalized edema. Initially, Focal segmental glomerulosclerosis (FSGS) was suspected. However, the patient’s dramatic response to steroids, his acute presentation and the histopathology features of his renal biopsy favored MCD. The initial management comprised of steroids to which the patient responded. A year later, the patient relapsed and mycophenolate mofetil was added. There is lack of guidelines to manage adult MCD, in contrast to child MCD. The clinical picture of the patient is the key to guide decisions about management in absence of evidence-based guidelines.