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Introduction The experience of pain is a complex phenomenon. A patient in the acute postsurgical pain setting may feel a constant bombardment of nociceptive input from the surgical site; this in turn influences psychological factors that determine the overall emotional experience of pain, which is significant. The aim of our study was to investigate the severity of pain in postsurgical patients three days after surgery using the 100 mm visual analog scale (VAS). Methods This was a cross-sectional assessment of postoperative pain. Participants were patients between 18 and 64 years of age who had undergone a surgical procedure (laparoscopic or open surgery), three days prior to the data collection and who were admitted or discharged postoperatively at the Al Salmaniya Complex, Manama, Bahrain. Participants were asked demographic questions about whether they had laparoscopic or open surgeries and completed self-reporting scales. Patient Health Questionnaire-9 (PHQ-9) was utilized to screen for both the presence and severity of depression; Generalized Anxiety Disorder 7-item (GAD-7) was administered to screen for anxiety; the Insomnia Severity Index (ISI) was used to evaluate insomnia; and the VAS was used to evaluate pain.  Results Sixty-seven patients were recruited, with a mean age of 61.53 years (SD = 7.37). Twenty-nine (43%) were females, 38 (57%) were males, 36 (54%) underwent elective surgery, 31 (46%) underwent emergency surgery, 31 (46%) underwent laparoscopic surgery, and 36 (54%) underwent open surgery. The average score on the Brief Pain Inventory Short Form (BPISF) was 8.12 (SD = 1.16), indicating a moderate level of pain. Twenty-six (43%) patients had moderate-severe insomnia, 21 participants (31%) had no insomnia, 17 participants (25%) had subthreshold insomnia, 28 (42%) had moderate depression, five (7%) had moderate-severe depression, and 34 (51%) had severe depression. Eighteen participants (27%) had mild anxiety, 46 (69%) had moderate anxiety, and 3 (4%) had severe anxiety. Six of the participants (9%) reported moderate pain, while 61 participants (91%) reported severe pain.

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Endometriosis is the presence of ectopic functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare condition that typically follows obstetrical and gynecological surgeries. Although the symptoms are non-specific and varying, scar endometriosis classically presents with cyclic pain at the site of incision during menstruation. The diagnosis of scar endometriosis remains challenging and requires a comprehensive approach, including clinical presentation and histological and radiological findings. Here, we present a case of extragonadal endometriosis at the cesarean section scar. The patient presented with cyclical menstrual pain at the surgical incision. Our aim in this case report is to present the approach to diagnosing such a condition with the associated presentation and histological findings.

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Introduction: A mesenteric inflammatory myofibroblastic tumor (IMT) is a rare solid tumor of intermediate malignant potential that affects children, adolescents, and young adults predominantly. IMT is mostly encountered in the lung. We report a case of malignant jejunal mesenteric IMT in a 61-year-old male patient who presented with vague abdominal pain and generalized weakness. CT scan revealed a mesenteric mass displacing the attached jejunum. Surgical resection was curative. Discussion: An extensive literature review was performed to update and further analyze the already available data. A total of 35 cases with mesenteric IMT were reported previously. Only five cases of jejunal mesenteric IMT were reported. Mesenteric IMT demands vast effort to reveal the diagnosis due to its vagueness in the clinical presentation. Mesenteric IMT resembles each other in plenty of pathological and immunohistochemical characteristics. Conclusion: To the best of our knowledge, this is the first case of malignant jejunal mesenteric IMT in the elderly. Surgical resection was curative.

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BACKGROUND: Laterality in breast cancer means an increased frequency of left-sided breast cancers compared to right-sided breast cancers ranging between 1.05 and 1.26. It was first described in 1935 by Fellenberg, Sweden. The explanation of this phenomenon is not clear, but the association with other factors was found. This study aimed to explore the laterality of breast cancer in Bahrain as a model for Arabian countries. The association of laterality with the clinicopathological characteristics of the tumor was also analyzed to explore any applied clinical value. METHODS: This is a cross-sectional, retrospective review of a particular ethnic population to study laterality of breast cancer versus a number of clinicopathological factors, as well as prognosis. The study analyzed 228 breast cancer patients treated in Arabian Gulf University facilities in Bahrain between 1999 and 2020. Three bilateral breast cancer and two malignant phyllodes patients were excluded. The following variables were analyzed: laterality ratio (Lt/Rt) and the association between laterality and clinicopathological characteristics (age at diagnosis, family history of malignancy, size of the tumor, tumor grade, histological type, hormonal receptors and HER2, axillary lymph node status, tumor stage, five-year survival rate, nulliparity, and multifocality). RESULTS: The laterality ratio (Lt/Rt) was 1.06 and was 0.97 for patients below 50 years of age, and 1.19 for patients 50 years of age and above. Analysis of our data showed a statistically significant association between laterality and tumor stage (p. value =0.025) at presentation, and laterality and family history of malignancy (p. value =0.052). Right-sided breast cancer was associated with a higher positive family history of malignancy and an increased ratio of locally advanced and metastatic disease, and a reduced 5-year survival in relation to size and stage. Left-sided breast cancer was associated with higher early tumor stage. CONCLUSION: This is the first study exploring the issue of breast cancer laterality in a defined Arabian population. The laterality ratio in this study was 1.06, which is consistent with the globally published range (1.05 to 1.26) and is increasing with increasing age. The association between breast cancer laterality, and the hormonal and HER2 is still not widely addressed in the available literature, although other clinicopathological characteristics were extensively analyzed.

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BACKGROUND: The current study aimed to evaluate the previously unexplored correlation between undergraduate medical students' attendance during their surgical clerkship and their academic performance. It also aimed to explore any difference in the attendance rate between male and female students and whether this difference, if present, affects the academic performance. METHODS: A retrospective descriptive cross-sectional study has been conducted on 331 undergraduate medical students during their surgical clerkships at the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU), Bahrain from September 2018 to June 2020. RESULTS: There was a positive statistically significant correlation between students' attendance during surgical clerkship and academic performance (r = 0.360, P <  0.01). Mean attendance rate was greater in each increasing category of academic performance: 47.95% in the weak category (less than 65%, n = 42), 57.62% in the good performance category (65% to less than 75%, n = 108), 67.82% in the very good performance category (75% to less than 85%, n = 126), 83.16% in the excellent performance category (85% and above, n = 55). The mean attendance rate of male students was 59.76% (SD = 25.73), compared to 66.92% (SD = 24.30) in the female students. T-test indicated that the difference between the mean attendance of the two groups of the students (male, female) was statistically significant (t = 2.483, p <  0.05). On the other hand, the difference between the mean academic performance for the two groups of students, male & female, (t = 0.284, p = 0.777) was not statistically significant. CONCLUSIONS: Our study showed a significant relationship between undergraduate medical students' attendance during their surgical clerkship and their academic performance. Further studies are needed to stratify this correlation according to clinical and theoretical teaching activities. No significant difference was observed in academic performance between female and male students.

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