Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice. Methods: A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software. Results: The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas. Conclusion: The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

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BACKGROUND: Health Information disclosure is the cornerstone in respecting the patients’ autonomy and beneficence, particularly in the context of serious illness. Some Middle Eastern cultures prioritise beneficence over patient autonomy. This may be used as a justification when patient’s family takes over the decision-making process. Although guidelines and protocols regarding information disclosure are fast evolving, there are no sufficient data regarding the application of these guidelines in the clinical context. The objective of this study is to explore the truth disclosure practices of physicians in Bahrain. METHOD: In this cross sectional study, a random sample of 234 physicians was obtained from the database of Salmaniya Medical Complex (the largest public hospital in Bahrain). We used self-administered 21-item questionnaire to assess the practices and attitudes of physicians regarding disclosure of information to patients with serious illnesses. RESULTS: A total of 200 physicians completed the questionnaire with a response rate of 69.6%. The question about the usual policy of disclosure revealed that 62.5% (125) of the doctors would always disclose the diagnosis to the patients, 26% (52) would often disclose the diagnosis and only 1% would never disclose the real diagnosis to a competent adult. Only 15% of the physicians would never make exceptions to their policy of “telling the patient” while all remaining physicians (85%) made exceptions to their policy either often, occasionally or rarely. The most common reason for not disclosing the diagnosis was family request (39.5%). About 64.5% of the physicians were not aware of any existing protocol or policy for diagnosis disclosure to patients. There was no statistically significant association between doctors’ policy of disclosure and other demographic variables. CONCLUSION: Most physicians opt to disclose the truth; however, the majority would make exceptions at some point particularly upon family request. Regional truth disclosure policies should take into consideration the interplay and balance between patient autonomy and the role played by the family in the decision-making process.

Background Abducens nerve is the most common nerve affected among other cranial nerves in terms of isolated ocular palsy. Despite its prevalence and progression made in neuroimaging, incidence of idiopathic cases continues to rise. Case presentation We report a young adult male with no previous illnesses, who presented with sudden onset of binocular diplopia and headache and was later diagnosed with an isolated ipsilateral abducens nerve palsy secondary to an unknown cause and treated with steroids. The palsy and diplopia had resolved in 2-month time but the patient still continued to suffer from a migraine, such as headache. Conclusion Although, we labelled the patient as idiopathic initially, another plausible cause for this kind of presentation could be recurrent painful ophthalmoplegic neuropathy (RPON) owing to the nature of the presentation. Cases labelled as idiopathic could be attributed to a defined pathogenesis with detailed history and follow-up. Follow-up is vital for all patients, especially those labelled as idiopathic as recurrence of the illness have the chance of changing the diagnosis if supported by the detailed history and physical examination findings.

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