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PubMedDate not supplied

Open eye injuries in the pediatric population in Kuwait.

OBJECTIVE: To report the epidemiological characteristics of pediatric open globe injuries and to discuss treatment, management and outcomes of such injuries. MATERIALS AND METHOD: The hospital records and operative notes of 95 patients 16 years old and younger who were treated for open eye injury at Ibn Sina Hospital, Kuwait between September 1995 and January 1999 were reviewed. The average age of patients was 6.6 years. Patients were divided into three groups according to their final visual acuity (FVA): group 1, FVA of 20/40 or better; group 2, 20/40-20/200, and group 3, 20/400 or worse. The FVA of each group was compared to initial visual acuity (IVA), wound entry site, injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries and medical treatment. RESULTS: Injury was most common in children 3-6 years old. Most injuries occurred during play at home (46%), between the months of July and November (58%), and evening time (42%). The most common causes were glass, pencil, stick, soft drink bottle, metal bar, and stone. The cornea was the most common entry site (59 cases). Seventy-three patients presented on the day of injury, and 38 of them had surgical repair that same day. The follow-up period ranged from 2 weeks to 58 months. Thirty-eight patients (40%) had an FVA of 20/40 or better (group 1), 23 (24%) between 20/40 and 20/200 (group 2), 12 (13%) 20/400 or worse (group 3), and 22 (23%) had no record of FVA. The difference between IVA and FVA of wound entry site was statistically significant (p < 0.005). Differences due to injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries, and the use of systemic antibiotics were found not to be statistically significant (p > 0.2). CONCLUSION: The prevalence of open globe injury among the pediatric population in Kuwait was high. Most injuries were due to household objects and occurred at home in the evening during the summer and autumn. IVA and anatomical location of the wound impacted on final outcome.

Adolescent↗

PubMed2003

Survival of cardiac function after brain death in patients in Kuwait.

BACKGROUND: Persistent cessation of all cerebral and brainstem function (brain death) is accepted in most countries as legal evidence of death. It is presumed that cardiac function will cease within a short time after brain death has occurred. In some countries, such as Kuwait, tradition and practice discourage application of the brain death criteria despite legal acceptance. OBJECTIVE: The study was designed to assess the duration of persistence of cardiac function in patients after the diagnosis of brain death had been made on the basis of generally accepted criteria. METHODS: We evaluated how long cardiac function persisted after brain function had ceased in 40 patients in Kuwait who were admitted to hospital and died during the 10-year period 1992-2001. RESULTS: It was found that the mean persistence of cardiac function after brain death was 8.20 days and the median survival time was 6 days. Two thirds of the patients survived longer than a week, but none had cardiac function for longer than 30 days. CONCLUSION: The study confirms that brain death is not automatically followed immediately by cessation of all other body functions. It may be speculated therefore that whole-body homeostasis is not as intimately associated with brain function as has hitherto been thought.

Adolescent↗

PubMedDate not supplied

Antimicrobial susceptibility, phage typing and plasmid profile of Salmonella enterica serotype paratyphi A strains isolated in Kuwait.

OBJECTIVE: To determine the antimicrobial susceptibility, phage type and plasmid profile pattern of Salmonella enterica serotype paratyphi A strains isolated in Kuwait. MATERIAL AND METHODS: From January 1995 to December 1999, 106 strains of S. enterica serotype paratyphi A isolated from an equal number of cases of enteric fever, attending the Infectious Disease and Mubarak Al-Kabeer Hospitals in Kuwait were investigated. The isolates were tested for antimicrobial susceptibility to 8 commonly used antimicrobial agents. Their phage type and plasmid profile patterns were determined using an international set of phages and Qiagen plasmid mini kit, respectively. RESULTS: All of the isolates were susceptible to ciprofloxacin, cefuroxime, ceftazidime, piperacillin and co-trimoxazole. One hundred isolates were susceptible to ampicillin, 99 to chloramphenicol and 98 to tetracycline. None of the isolates was multidrug resistant. Sixty-six percent of the isolates were phage type I, 27.4% phage type II and 6.6% were untypable. All phage type I and untypable strains had 3 plasmids of 2.2, 5 and 20 kb, whereas phage type II strains had only 1 plasmid of 20 kb. CONCLUSION: The findings indicate that while all of the isolates of the S. enterica serotype paratyphi A were susceptible to 4 of the drugs tested, some were resistant to ampicillin, chloramphenicol or tetracycline, thereby indicating the need for continued surveillance and monitoring of antimicrobial susceptibility of these isolates.

Bacteriophage Typing↗

PubMedDate not supplied

Burn septicaemia in Kuwait: associated demographic and clinical factors.

OBJECTIVE: To study the demographic and clinical factors associated with burn septicaemia patients in Kuwait. MATERIALS AND METHODS: All burn in-patients, who developed septicaemia at the Burns Unit, Al-Babtain Centre for Burns and Plastic Surgery, Kuwait, during a 9-year period (June 1992 to May 2001) were included in the study. The data were recorded for age, sex, nationality, cause and percentage of burns, inhalation injury, resuscitation, number of episodes, septicaemia on post-burn day, the microorganisms responsible in each episode, treatment and outcome for statistical analysis. Using SPSS (PC version 11.0) software, a probability level of p < 0.05 was considered significant. RESULTS: Of the 2,082 patients treated in the Burns Unit, 166 [8%; 99 (60%) males and 67 (40%) females] with a mean age of 26 years (range 1-70) had septicaemia. Significantly higher (p < 0.001) cases were recorded among Kuwaiti children (< or =14 years) and non-Kuwaitis (25-59 years) than other corresponding age groups. The total body surface area burned ranged from 2 to 95% (mean 42%) and the main cause of burn was flame (77.1%). Inhalation injury was diagnosed in 39 (23.5%) patients. A total of 253 septicaemic episodes occurred in all patients. The majority, 123 (74.1%), had a single episode and the remaining 43 (25.6%) had multiple (2-10) episodes. One hundred and fifty-five (61.3%) episodes were due to gram-positive organisms, mainly methicillin-resistant Staphylococcus aureus, and 32 (12.7%) were polymicrobial. One hundred and twenty-four (74.7%) patients had wound excision and skin grafting procedures and their survival was significantly higher (OR = 4.3; 95% CI: 1.98-9.31) than non-surgically treated patients. Thirty-nine (23.5%) patients died mainly due to multi-organ failure. CONCLUSION: The findings indicate that the patients with extensive flame burns were prone to developing septicaemia due mainly to gram-positive bacteria. The surgical excision of eschar and wound covering improved the outcome of the patients while prophylactic antibiotic treatment had no role in the incidence and outcome of the burn patients.

Adolescent↗

PubMedDate not supplied

Molecular characterization of nitroimidazole resistance in metronidazole-resistant bacteroides species isolated from hospital patients in Kuwait.

OBJECTIVES: The aim of this study was to screen for infections caused by metronidazole (MTZ)-resistant Bacteroides spp., and to characterize the genes that encode the MTZ resistance. MATERIALS AND METHODS: A total of 7 MTZ-resistant Bacteroides spp. were isolated from 5 patients with MTZ-resistant infections. These organisms were investigated for carriage of genes that encode MTZ resistance. The presence of these genes was investigated by PCR and the PCR products were subjected to PCR-RFLP analysis. RESULTS: The strains were MTZ-resistant with minimum inhibitory concentrations of > 32 microg/ml. The presence of nim genes was indicated by PCR in all 7 strains. PCR-RFLP analysis of the nim gene products demonstrated two of the five reported resistance genes, nimA-nimE. These two resistance genes were nimE in 5 of the 7 isolates and nimA in 2 strains. CONCLUSION: MTZ-resistant Bacteroides spp. have been isolated from patients in Kuwait. Nim genes, specifically nimE and nimA, mediate the drug resistance in these isolates. The methods used in detecting these genes are rapid, accurate and relatively inexpensive and could be adopted easily to help in monitoring emergence of MTZ resistance determinants in Kuwait.

Adult↗

PubMedDate not supplied

Radioanatomical measurements of the medullary cavity of the humerus in Kuwait: ethnic differences and clinical implications for fracture fixation.

OBJECTIVE: To compare the difference in diameter of the medullary cavity of the humerus in Arab and South Asian patients in Kuwait. SUBJECTS AND METHODS: In 46 patients (29 Arab, 17 South Asian) treated at Al-Razi Hospital, Kuwait, for diaphyseal fracture of the humerus, the medullary cavity of the humerus on the radiographs of the uninjured (contralateral side) was examined. Bone density was also measured. Statistical significance was calculated by parametric and nonparametric test using SPSS package. RESULTS: South Asians had a significantly narrower medullary cavity (p < 0.05) and higher cortical indices (p < 0.05) than Arabs, and also a narrower external diameter of the humerus at levels 5 and 6 (p < 0.05). CONCLUSION: In cases of fracture of the humerus, radiographic measurements of the diameter of the medullary cavity of the uninjured side were essential in selecting the appropriate fixation device.

Adult↗

PubMedDate not supplied

Seroepidemiological and microbiological study of brucellosis in Kuwait.

OBJECTIVE: The primary objective of the study was to determine the prevalence of brucellosis and the antimicrobial susceptibility pattern of local Brucellae isolates in the Infectious Diseases Hospital, Kuwait. SUBJECTS AND METHODS: A single serum sample was collected from each of 1,836 patients of different nationalities from January 2000 to December 2001. Any patient with a provisional diagnosis of fever or brucellosis had a standard tube agglutination (STA) test for the quantitation of Brucella antibodies. Blood cultures were done in 166 of 455 patients with significant STA titers, using the Bactec system. Antimicrobial susceptibility testing of 123 isolates of Brucella spp. was done against 8 antimicrobial agents. RESULTS: A total of 455 serum samples (24.8%) having an STA titer of > or =1:160 were presumptively diagnosed as cases of brucellosis. The peak isolation was in April and May. Brucella spp. were isolated from 123 blood cultures (74.1%). The blood culture isolation rate was significantly higher in patients with an STA titer of >/=1:1,280 than in those with an STA titer of </=1:160 (p < 0.05). Antimicrobial susceptibility testing showed good in vitro activity of tetracycline, gentamicin, amikacin, streptomycin and ciprofloxacin against all isolates. Azithromycin had good anti-Brucella activity against only 42% of the isolates, while rifampicin and trimethoprim-sulfamethoxazole showed low in vitro anti-Brucella activity against 8 and 25% of the isolates, respectively. CONCLUSION: Brucellosis is quite common in Kuwait. Kuwaiti and Bangladeshi nationals were most affected. Significant titers on the STA test were detected in 24.8% of serum samples. Good in vitro activity against all isolates was found with tetracycline, gentamicin, amikacin, ciprofloxacin and streptomycin, and low activity with azithromycin, rifampicin and trimethoprim-sulfamethoxazole.

Agglutination Tests↗

PubMedDate not supplied

Etiology and antibiotic susceptibility patterns of community-acquired urinary tract infections in a Kuwait hospital.

OBJECTIVE: The aim of this study was to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from patients with community-acquired urinary tract infections (UTIs) at the Infectious Diseases Hospital, Kuwait. MATERIALS AND METHODS: The study was conducted over a 7-year period. Patient information was obtained from medical record files. Antibiotic-sensitivity testing was performed by disk diffusion. E test and double disk diffusion methods were used to study the production of extended spectrum beta-lactamases. RESULTS: Of the 14,042 urine samples processed, significant bacteriuria (>10(5) cfu/ml) was detected in 1,606 (11.4%). The majority (74.5%) of the isolates were from women while the remaining 25.5% were from men. The majority of infections (75%) were due to Enterobacteriaceae, coagulase-negative staphylococci (10.3%) and group B streptococci (8.7%). Among the gram-negative enteric bacilli high prevalence of resistance to ampicillin, amoxicillin/clavulanic acid, cephalothin, and trimethoprim/sulfamethoxazole was observed. Increasing resistance to ciprofloxacin and gentamicin was observed in E. coli isolates over the 7 years. Multiple resistance was detected in 53.8 and 41% of E. coli and Klebsiella spp. strains, respectively. No glycopeptide-resistant enterococci were isolated. CONCLUSION: This study revealed that Enterobacteriaceae were the predominant bacterial pathogen of community-acquired UTIs in Infectious Diseases Hospital, Kuwait. It also demonstrated an increasing resistance to ciprofloxacin, gentamicin and the production of extended spectrum beta-lactamase among UTI pathogens in the community.

Adolescent↗

PubMedDate not supplied

BRCA1 gene expression in breast cancer in Kuwait: correlation with prognostic parameters.

OBJECTIVES: This study assessed the BRCA1 gene expression in breast cancer in Kuwait, and compared it with other known prognostic factors for the disease. MATERIALS AND METHODS: Forty-eight random samples of archival paraffin-embedded breast cancer tissues were studied for BRCA1 gene expression. Immunohistochemical method utilizing antibodies against different epitopes on the BRCA1 protein was used to study BRCA1 protein expression. In addition, for 29 patients, reverse transcription-polymerase chain reaction was used to detect BRCA1 mRNA expression. BRCA1 expression was correlated with age, histological type and grade of breast cancer, estrogen and progesterone receptor status, and C-erbB-2 expression. RESULTS: No demonstrable BRCA1 mRNA and protein expression was found in 79 and 83% of the breast cancer tissues, respectively. A positive relationship was demonstrated between lack of BRCA1 (mRNA and protein) expression and high histological grade, negative estrogen and progesterone receptor status, and overexpression of C-erbB-2 in the breast cancer tissues. CONCLUSIONS: The study demonstrated lack of BRCA1 gene expression (mRNA and protein) in the majority of breast cancers in Kuwait and confirmed the inverse relationship between BRCA1 expression and parameters that determine poor prognosis in breast cancer.

Adult↗

PubMedDate not supplied

Blood component transfusion in primary coronary artery bypass surgery in Kuwait.

OBJECTIVE: The aims of this study were to determine the rate of blood product transfusion, associated perioperative factors and cost of such blood product transfusion in primary coronary artery bypass surgery (CABG). SUBJECTS AND METHODS: The medical records of 159 consecutive primary CABG patients (142 male, 17 female) from January 1, 2003 to June 30, 2003 at Chest Diseases Hospital, Kuwait, were reviewed. Urgent and emergency cases were included. RESULTS: The mean age of the patients was 57.2 (range 36-77 years). Overall, 128 (80.5%) patients received blood product transfusion during primary CABG: 113 (70.5%) packed red blood cells (RBC), 54 (33.9%) fresh frozen plasma, and 13 (8%) platelets. Overall, 23 patients (12.6%) received more than two RBC transfusions intraoperatively. Significant factors for intraoperative RBC transfusion were: age >60 years, female gender, preoperative hemoglobin <12 g/dl, and 3 or more coronary bypass grafts constructed. One hundred and fifty-nine patients consumed 342 units of RBC at an average of 2.1 RBC units per patient. The cost per patient was 80 Kuwaiti dinar (KD; USD 240). CONCLUSION: The findings indicate a high rate of blood component transfusion in primary CABG patients in Kuwait that could expose the patients to the possible adverse effects, and such transfusions have high economic impact.

Adult↗

PubMed2005

Epidemiology of multiple sclerosis in Kuwait: new trends in incidence and prevalence.

The epidemiology of multiple sclerosis (MS) is undergoing dramatic changes; MS is occurring with increased frequency in many parts of the world. In this retrospective study, we examined the changes in incidence and prevalence of MS in Kuwait in the period between 1993 and 2000. We analyzed the records of patients with clinically defined and laboratory supported MS. The total incidence rate increased from 1.05/100,000 population in 1993 to 2.62/100,000 in 2000. The increased incidence of MS was most pronounced among Kuwaiti women (from 2.26/100,000 in 1993 to 7.79/100,000 in 2000. The total prevalence rate increased from 6.68/100,000 in 1993 to 14.77/100,000 in 2000. It was much higher for Kuwaitis (31.15/100,000), as compared to non-Kuwaitis (5.55/ 100,000), in a complete reversal of the pattern observed before 1990. The prevalence was also higher among Kuwaiti women (35.54/100,000), as compared with Kuwaiti men (26.65/100,000). In conclusion, the incidence and prevalence of MS in Kuwait has increased between the early and late 1990s with no signs of leveling off. In a geographic area that was previously associated with low prevalence, local environmental factors may be responsible for these dramatic changes.

Adolescent↗

PubMedDate not supplied

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait.

OBJECTIVES: The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia (CAP) in Kuwait. SUBJECTS AND METHODS: The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team (PORT) severity index. The microbial etiology was determined using standard methods for bacteria and serological tests for atypical and viral pathogens. RESULTS: The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3+/-18 years. The severity class distribution was: class I 31%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients (35%), with one pathogen in 31 (25%), two in 9 (7%), and three or more in 4 (3%). The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients (11%), Legionella pneumophila in 10 (8%), Chlamydia pneumoniae in 8 (6%), influenza B virus in 8 (6%), influenza A virus in 5 (4%), Haemophilus influenzae in 4 (3%), Streptococcus pneumoniae in 3 (2%), Staphylococcus aureus in 3 (2%), gram-negative enterobacteria in 5 (4%), Moraxellacatarrhalis in 2 (2%), and viruses in 4 (3%). The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. CONCLUSION: Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait. Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides.

Adolescent↗

PubMed2005

Phenotypic and molecular characterization of Candida dubliniensis isolates from clinical specimens in Kuwait.

OBJECTIVE: This study was carried out to characterize Candida dubliniensis using phenotypic and molecular methods and to determine the occurrence of C. dubliniensis in clinical specimens in Kuwait. MATERIALS AND METHODS: A total of 880 clinical specimens for isolation of fungi were processed according to standard procedures. Of these, 390 germ-tube-positive clinical isolates of Candida species were examined for rough colonies with hyphal fringes and chlamydospore production on simplified sunflower seed agar for their presumptive phenotypicidentification as C. dubliniensis. The identification of C. dubliniensis isolates was further confirmed by the Vitek 2 yeast identification system, semi-nested (sn) PCR amplification of high-copy rDNA and direct DNA sequencing of the internally transcribed spacer 2 (ITS2) region. RESULTS: Of the 390 isolates of Candida species investigated, 12 were identified as C. dubliniensis, giving an overall occurrence of 3%. All the C. dubliniensis isolates formed rough colonies with hyphal fringes and abundant chlamydospores on sunflower seed agar, did not assimilate trehalose, lactate and alpha-methyl-D-glucoside, and were isolated from human immunodeficiency virus (HIV)-negative patients. Four C. dubliniensis isolates utilized D-xylose. The species-specific primer derived from the ITS2 sequence of C. dubliniensis and used together with the panfungal reverse primer in the reamplification step of the snPCR specifically amplified rDNA from reference and clinical C. dubliniensis isolates and not from C. albicans or other Candida species. The identity of two representative isolates was confirmed by DNA sequencing of the ITS2 region. CONCLUSIONS: The identity of 12 C. dubliniensis isolates was first established by phenotypic characteristics and then by snPCR using species-specific primers derived from ITS2 sequences. The recovery of C. dubliniensis from HIV-negative patients from Kuwait reinforces the existing view that this novel yeast species has a worldwide distribution and its occurrence is not restricted to any particular immunocompromised population.

Antifungal Agents↗

PubMed2006

Clinical and neurophysiological pattern of Guillain-Barré syndrome in Kuwait.

OBJECTIVE: To study the clinical and neurophysiological pattern of Guillain-Barré syndrome (GBS) in Kuwait. MATERIALS AND METHODS: The clinical records of consecutive GBS patients admitted to Ibn Sina Hospital, Kuwait, during a 7-year period between 1997 and 2003 were analyzed. RESULTS: Of the 41 cases, 77% were male. The majority of the cases presented during the winter months and a preceding infection was reported in two thirds of them. Proximal lower limb (LL) weakness was the predominant clinical presentation. Nerve conduction studies (NCS) demonstrated a demyelinating pattern in 70%, an axonal pattern in 15%, mixed type in 5% and no abnormality in the remaining 5%. The majority of the patients (73%) improved with one course of intravenous immunoglobulin (IV IG). Mean recovery time (MRT) was 4.4 weeks. Delayed recovery (MRT > or =6 weeks) was noted in patients with predominant distal weakness in the LL (MRT 7.8 weeks; p = 0.001), proximal weakness in the upper limb (UL) (MRT 6 weeks; p = 0.005), autonomic disturbance (MRT 6.5 weeks; p = 0.05), and axonal type GBS (MRT 6 weeks; p = 0.001). CONCLUSION: The presence of predominant distal weakness in LL, proximal weakness in UL, autonomic disturbance and axonal pattern in NCS predict a poor outcome. Hence we recommend early immunomodulatory therapy in patients presenting with these features.

Adolescent↗

PubMed2006

The Kuwait cataract outcome study: a 12-month evaluation.

OBJECTIVE: To assess the frequency of intraopertive difficulties, postoperative complications and the visual outcome in cataract surgery performed at the Al-Bahar Eye Center, Kuwait. SUBJECTS AND METHODS: This case series study is comprised of 350 eyes from 325 subjects (169 male, 156 female; 30-78 years, mean age 64 years) undergoing consecutive cataract surgery performed at the Al-Bahar Eye Center, Kuwait from July 2001 to June 2002. All the eyes underwent extensive ophthalmic examinations before and after surgery. Details of surgical procedures, including the type of the cataract surgery, intraoperative difficulties or complications, postoperative complications, and the visual outcome were documented. RESULTS: The extracapsular cataract extraction (ECCE) technique was used for 50.2% of the eyes and for the remaining 49.8%, the small-incision phacoemulsification technique was used. Of the 350 eyes operated upon, 9.7% had coexisting ocular disease which may have affected the best spectacle corrected visual acuity (BSCVA). Complications included posterior capsule tears and vitreous loss (10%), cystoid macular edema (0.6%) and endophthalmitis (0.9%) of the eyes. A BSCVA of 6/12 or better was achieved in 78.3% of the cases. CONCLUSION: A high success rate in terms of visual acuity outcome was achieved in the cataract surgery. The operative and postoperative complications were similar for both techniques, ECCE and phacoemulsification.

Adult↗

PubMed2006

Residual need for early orthodontic treatment and orthodontic treatment experience among 13- to 14-year-old school children in Kuwait.

OBJECTIVE: Our purpose was to determine the residual need for early orthodontic treatment and the parameters associated with orthodontic treatment experience in 13- to 14-year-old school children in Kuwait. SUBJECTS AND METHODS: A total of 788 boys and 795 girls, representing about 6.7% of the target population, were selected according to cluster sampling methods. Information on nationality, family income and orthodontic treatment experience was collected through subject and family interviews. The occlusal morphology was recorded in a well-lit classroom or from initial study models of subjects with orthodontic treatment experience. RESULTS: Only 6.7% of the 225 subjects with early treatment need, defined as overjet >or=6.5 mm, and functional posterior and anterior crossbite on 1 or more teeth, had treatment experience. Residual need for early treatment was present in 13.4% of the subjects. Only 26.8% of the subjects with treatment experience met our criteria for early treatment need. The odds of treatment experience were higher in the subjects attending private schools (p < 0.05), in those from families with an income of KWD >2,000 (USD 6,600; p < 0.01) and in subjects meeting the criteria for early treatment need (p < 0.01). CONCLUSIONS: About 15% of each birth cohort of school children in Kuwait need early orthodontic treatment. Less than 10% of those with a need have treatment experience at 13-14 years of age, and about 75% of those with treatment experience at that age do not need early treatment. The predictors for treatment experience at 13-14 years of age are private-school attendance, a high family income and need for early treatment.

Adolescent↗

PubMed1997

Stroke in Kuwait: a three-year prospective study.

To study the pattern of stroke in Kuwait, prospective data were collected from all patients admitted with first-ever stroke to our hospital over 3 years: 1989, 1992 and 1993. The primary-care registry over the same period was examined to ascertain that all cases of stroke seen by the primary-care doctors were referred to a hospital. Death certificates issued for people who died outside the hospital were also examined. The study included: clinical evaluation, computed tomography, electrocardiography, blood laboratories, serum chemistry and other investigations as required. The overall annual crude incidence rate was 27.6/100,000 population. The age-adjusted annual crude incidence rate was 145.6/100,000 population. No seasonal variation in the stroke incidence was observed in our study. Carotid-territory large infarction represented 46.5% of all strokes followed by intracerebral haemorrhage in 19.9%, lacunar infarction in 17%, basilar infarction in 8.3% and subarachnoid haemorrhage in 1.7%. The overall case fatality rate was 10%. Mortality increased with age and when loss of consciousness was present. The study demonstrated that stroke incidence in Kuwait is very low due to the young average age of the Kuwaiti population.

Adolescent↗

PubMed2002

Report: management problems of solid waste landfills in Kuwait.

This paper evaluates current operational practices in municipal solid waste landfills in Kuwait to provide existing knowledge on uncontrolled landfilling and associated problems of solid waste disposal in developing countries. The current landfilling practices are safe neither for humans nor for the environment. The landfill sites receive all kinds of wastes such as food wastes, oil products, debris, dead animals, agricultural wastes, chemical wastes, wastewater and sewage sludge. The wastes are dumped, spread and compacted in an uncontrolled manner and cover material is not applied regularly. Dust created within the landfill site and gas emissions cause a public nuisance. The characteristics of leachate formed indicate high organic content and presence of heavy metals, salts and nutrients. There are no provisions for leachate or landfill gas collection at the landfill sites. Recommendations for adjustment in landfill operation have been made in recognition of the transition period that is experienced in proceeding from the past and present to the future management of landfills in Kuwait to safeguard the public health and protect the environment.

Environmental Monitoring↗