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Health care for pesticide applicators in a locust eradication campaign in Kuwait (1988-1989).

Pesticide applicators in the Plant Protection Department of the Agriculture Affairs and Fish Resources Authority are monitored regularly by the Occupational Health Section of the Ministry of Health. The aim is to protect them from the adverse effects of pesticides and to prevent acute poisoning by removing from exposure those who have low cholinesterase (ChE) activity levels or low white blood cell counts. Thirty-eight workers routinely examined in July 1988 were reexamined at the onset of the locust invasion in Kuwait in November 1988; also examined were 36 farmers recruited for the first time to fight locusts and a matched control group of 38 firefighters. After 2 to 3 months, when the locust invasion decreased markedly and pesticide spraying nearly stopped, the exposed workers were reexamined. The pesticides used to control locusts were five organophosphates and one organochlorine (lindane). Sixty percent of normal for red blood cell (RBC) ChE activity and 50% of normal for plasma ChE activity were used as threshold levels for removing workers from continued exposure to ChE-inhibiting pesticides. The different reactions of study groups during the locust control period are described, including results from tests of pulmonary function, RBC and plasma ChE activity, and nerve conduction velocity.

Adult↗

Aspects of imported malaria at a district general hospital in non-endemic Kuwait, Arabian Gulf.

There is no indigenous mosquito-borne transmission of malaria in Kuwait. However, in a five year period at a district general hospital, the number of laboratory-diagnosed cases of malaria increased annually from 25 to 84, a rise of 336%. Except for two induced infections, all were imported, mainly from the Indian subcontinent. Plasmodium vivax was responsible for 87.29% of the cases; P.falciparum (12.05%), a mixed infection of P.vivax and P.falciparum (0.33%) and a case of P.ovale (0.33%) were also identified. Rapid preparation of acetone-fixed, Giemsa-stained thick blood films, a heightened awareness of the infection, examination of multiple samples of blood from patients and the general resurgence of malaria in endemic areas were some of the factors responsible for the high number of cases diagnosed. Most patients were young males and presented with clinical malaria due to P.vivax between May and October each year, an apparent seasonal peak. However, many were already resident in the country for a variable period. Patients with P.falciparum though, presented clinically within two weeks of arrival in the country. Parasite densities were calculated to monitor the progress of treatment and identify quickly any possible chloroquine-resistant P.falciparum strains. A policy of active prophylaxis is suggested to stem the tide of imported malaria.

Adolescent↗

Febrile neutropenia in cancer patients in Kuwait: microbial spectrum and outcome.

A sample of 100 consecutive febrile neutropenic episodes in cancer patients in Kuwait was studied. Acute leukaemias (44%) and lymphomas (29%) were the most frequent underlying cancers; 21 bacteraemis (gram-positive 10, gram-negative 9, polymicrobial 2) were encountered. Staphylococcous epidermidis and Escherichia coli were the commonest organisms. Urinary tract infection occurred in 30% of the microbiologically documented cases. A total of 84 episodes responded to therapy and 9 of the 14 deaths were secondary to infection.

Adolescent↗

Optimization of night and shiftwork plans among policemen in Kuwait: a field experiment.

A pilot survey was designed to define incidence, rotation period, rotation direction and cycle of shiftwork plans in the production and service units in Kuwait. Preliminary results from the Ministry of Interior showed that four different shift plans are widely used. Forty policemen, ten from each shift plan, volunteered to fill in a diary for a period of two or more cycles. The diary was comprised of a set of questions planned to reveal disturbances in sleep duration, sleep quality, food intake and appetite. The daily questionnaire also covered psychosomatic complaints and subjective judgement of recovery. A control group, on permanent day work, volunteered to fill in the diary for the same period. The results indicated that one of the four shift plans was quite satisfactory and least harmful to the policemen. Two plans were associated with excessive strain during working days, but the number of free days was sufficient to achieve complete recovery. The fourth plan was associated with excessive strain during working days and recovery was not achieved after 24 h of rest at the end of the shift cycle.

Adolescent↗

Plasmid-linked drug resistance in Salmonella typhimurium in Kuwait.

A total of 143 strains of S. typhimurium isolated from clinical cases in Kuwait were investigated for drug resistance. Multidrug resistance (3 or more drugs) was seen in 76.9% of the strains. The common resistance patterns were ASuT (16), AKSuT (20), ASSuT (14), CKSSuT (14), ACKSSuT (10), ACGKSSuT (15) and ACKGSSuTTm (8). MIC of resistant strains was usually high. Sixteen isolates were examined for the transferability of the resistance. All had R-plasmids, both autotransferable and non-autotransferable which could be mobilised by factor X.

Anti-Bacterial Agents↗

Outbreak of neonatal listeriosis in a regional hospital in Kuwait.

Six newborns with Listeria monocytogenes infection were admitted to the same neonatal unit between 31 October and 3 December 1985. The index case, a preterm baby, was born to a mother who was febrile with an influenza-like illness at the time of delivery. This baby presented with Listeria sepsis and pneumonia. Another child was born from whose mother L. monocytogenes was isolated from the cervix with the same serotype as that in the CSF of her newborn. In the other cases blood and cervical cultures of the mothers were negative, while Listeria was isolated from the CSF of their babies. Five out of six infants developed meningitis between 9 and 12 days after birth. All isolates were serotype 4b and indistinguishable by phage typing. All babies were successfully treated without any major sequelae. Although cross-infection was strongly suggested, the source of the outbreak could not be established. This is the first documented report of human listeriosis in Kuwait.

Cross Infection↗

A study of fungal spore poupulations in the atmosphere of Kuwait.

The fungal air-spora of Kuwait was investigated using the Petri-dish trapping technique. During the period from 1st April, 1974 to 30th June, 1975, a total of 3685 colonies were recorded from 2% malt agar plates. Fifty-five genera and 116 species were identifed. Alternaria occupied the first place in the order of percentage incidence. being represented by 18.3% of the entire catch, followed by Aspergillus (17.1%), Penicillium (14%), Cladosporium (13.6%), Drechslera (13.3%), and Ulocladium (7.1%). The widest spectrum of species was displaced by Aspergillus (possessed 19 species) followed by Penicillium (17 species), Alternaria (6 species), Drechslera (5 species), and Ulocladium (4 species). The monthly total number of fungi showed marked seasonal periodicity with the greatest number of colonies occurring in March-April and November. The lowest counts were recorded in mid-summer (July) and mid-winter (January). Only 220 colonies and 17 species of thermophilous fungi were reported from plates incubated at 45 degrees C. The most common species were Aspergillus fumigatus and A. terreus.

Air Microbiology↗

Hydatidosis in camels in Kuwait.

Infection of indigenous camels, Camelus dromedarius, with hydatid cysts has been recorded for the first time in Kuwait. From February 1982 to April 1983, 293 camels slaughtered for human consumption were examined. The overall rate of infection was 39.6%: 18.5% in animals less than 6 years old, and between 40.1% and 45.2% in older animals. The infection rate in females (44.9%) was significantly higher than in males (24.7%). Females also showed higher susceptibility to infections in multiple organs (22.7%) than males (10.5%). The lung was the most predominant site infected (63.0%). Pulmonary cysts showed a higher fertility rate than hepatic cysts (71.7% vs 29.2%) and were smaller and more numerous. The high infection rate recorded for this animal is probably related to recent shifts in animal maintenance from the traditional free-grazing to the corralling system.

Animals↗

Primary nephrotic syndrome in Arab children in Kuwait.

Fifty-five Arab children with primary nephrotic syndrome (PNS) were seen at two regional hospitals in Kuwait over a 5-year period. There were 35 boys and 20 girls with a mean age of 5.3 years. The annual incidence was 7.2 and 6.0 per 100,000 children below 10 and 12 years of age, respectively. An initial response to steroids was noted in 84% with almost 50% responding within 1 week of therapy. Nine patients did not respond to steroids; histopathological classification of their renal biopsies showed 5 cases of membranoproliferative nephritis, 3 cases of focal segmental glomerulosclerosis and 1 case of membranous nephropathy. Microscopic haematuria was noted at presentation in 7 of 46 steroid responders, in all 5 patients with membranoproliferative disease and in 1 of 3 with focal segmental glomerulosclerosis. We conclude that the incidence of PNS seems to be higher among Arab children than in Western countries. With regard to initial biochemical abnormalities, steroid response and subsequent relapses, the pattern is the same as elsewhere.

Child↗

Prolonged unexplained pyrexia: a review of 221 paediatric cases from Kuwait.

Over a three year period (January 1985 through December 1987), 221 children with prolonged pyrexia were admitted to the paediatric departments in two regional hospitals in Kuwait. Infections, connective tissue diseases and malignancies constituted 78%, 5% and 2%, respectively, and 15% of the cases remained undiagnosed. Brucella was the most common infectious agent encountered (38% of all cases), followed by typhoid fever (9%). The duration of fever was more helpful in the differential diagnosis than its height or pattern. The erythrocyte sedimentation rate and the white blood count were of limited value, and the C-reactive protein was positive in bacterial infections, malignancies and connective tissue diseases. Since a child presenting with prolonged pyrexia in this country has over a 70% chance of having a bacterial infection, both diagnostic and therapeutic procedures should be performed as an emergency measure. Particular emphasis should be put on the exclusion of brucellosis.

Blood Sedimentation↗

Aminoacidopathies: a review of 3 years experience of investigations in a Kuwait hospital.

We present a summary of the results of quantitative amino acid analysis in 800 subjects over a three-year period in Al-Sabah Hospital, Kuwait. Thirty-five patients with aminoacidopathy were identified, all but two of whom were the offspring of first-degree consanguineous marriages: nine cases of phenylketonuria, one benign hyperphenylalaninaemia, seven non-ketotic hyperglycinaemia, five tyrosinaemia, five homocystinuria, four citrullinaemia, two cystinuria, one hyperprolinaemia, and one maple syrup urine disease. The clinical and biochemical findings in these cases are described.

Adolescent↗

Prevalence of congenital adrenal hyperplasia in Kuwait.

Between 1978 and 1988 congenital adrenal hyperplasia (CAH) was diagnosed in 60 children in Kuwait with an estimated prevalence of 1:9,000 livebirths, which is higher than that reported from Europe and Canada. In addition, there was presumptive evidence of CAH resulting in the death of 20 other children, giving a prevalence figure of 1:7000. There were 41 girls (68%) and 19 boys (32%). Thirty-one of the girls (75.6%) and 11 of the boys (57.9%) were saltlosers. Fifty-four patients (90%) were diagnosed as 21-hydroxylase deficient, 3 patients (5%) had a deficiency of the 3 beta-hydroxy-steroid dehydrogenase enzyme, and 3 patients (5%) showed a deficiency of 11 beta-hydroxylase.

Adrenal Hyperplasia, Congenital↗

Quantitative epidemiological studies on the prevalence of babesiosis in horses in Kuwait.

Racehorses imported into Kuwait were tested for serum antibodies to Babesia equi and B. caballi by complement fixation (CF) and indirect fluorescent antibody (IFA) tests. The prevalence of B. equi was high (77.1% by IFA) whereas that of B. caballi was much lower (11.4%). Data for B. equi showed that infection was acquired after about 6 months at risk and that in the following 12 months animals had antibody levels detectable by both CF and IFA tests by 24 months the CF reaction was no longer detectable. Estimates of incidence and inoculation rates were calculated and found to be consistent with a considerable infection pressure.

Animals↗

Control of brucellosis in Kuwait by vaccination of cattle, sheep and goats with Brucella abortus strain 19 or Brucella melitensis strain Rev. 1.

In Kuwait, approximately 12,000 dairy cows were vaccinated with a reduced dose of 3 x 10(9) Brucella abortus strain 19 and approximately 350,000 sexually mature sheep and goats with a reduced dose of 10(7) B. melitensis strain Rev. 1. Using the criteria of prevaccinal and postvaccinal incidences of antibodies, abortions, and human cases of brucellosis, the programme was very successful. Widespread vaccination of adult animals is the most effective method of controlling brucellosis among cattle, sheep and goats in many countries.

Animals↗

Renal diseases in Kuwait. Experience with 244 renal biopsies.

The biopsy slides and clinical data on 244 patients who underwent percutaneous renal biopsies in the last 4 years in Kuwait were retrospectively reviewed. The data were analysed to show a correlation between clinical presentation and histological findings. We noted a high incidence of membranoproliferative glomerulonephritis (MPGN) presenting as nephrotic syndrome in association with schistosomal infection, an endemic disease in many of the neighbouring countries. Lupus nephritis was also observed at a relatively increased incidence compared with the West. On the other hand, amyloidosis and IgA nephropathy were less common, 5% for each.

Adult↗

Mycotoxins in poultry feed in Kuwait.

A survey was conducted at a poultry feed production unit in Kuwait for mycotoxin contamination in the samples of yellow maize, soybean meal, wheat bran used as raw material and the poultry feed prepared for broiler starter, broiler finisher, and layer mash. Individual aflatoxins were determined by high-pressure liquid chromatography after immunoaffinity column purification. Repeated analysis revealed average aflatoxin concentration in maize at 0.27 ppb (range 0 to 1.69 ppb), soybean meal at 0.20 ppb (range 0 to 1.27 ppb), wheat bran at 0.15 ppb (range 0 to 1.07 ppb), prepared poultry feed for broiler starter at 0.48 ppb (range 0 to 3.26 ppb), broiler finisher at 0.39 ppb (range 0 to 1.05 ppb), and layer mash at 0.21 ppb (range 0 to 1.30 ppb). Other mycotoxins (ochratoxin, fumonisin, deoxynivalenol (DON), and zearalenone), were detected by quantitative enzyme-linked immunosorbent assay. The average levels of ochratoxin A ranged from 4.6 to 9.6 ppb, fumonisin from 1.4 to 3.2 ppm, DON from 0.17 to 0.29 ppm, and zearalenone from 46.4 to 67.6 ppb in various commodities and prepared feed samples. The study revealed the coexistence of determined mycotoxins, although their concentrations in general were found to be lower than the permissible levels, wherever defined, for the poultry feed.

Animal Feed↗

Malignant bone tumors in Kuwait: a 10-year clinicopathological study.

Between 1995 and 2004, 142 malignant bone tumours comprising 76 primary and 66 secondary tumours were identified in the Pathology Department of Al-Sabah Hospital, Kuwait. Pathological fracture was the presenting sign in 35% of the cases. The mean incidence of primary tumours/year was 3.3 cases/million inhabitants. The primary tumours showed a male predilection and 42% occurred below the age of 20 years. The most frequent in the descending order of frequency were Ewing's sarcoma, multiple myeloma, osteosarcoma, chondrosarcoma and non-Hodgkin's lymphoma. The femur was the most common site for secondary tumours; more than half of the tumours with metastases at this site originated in the breast. The high frequency of Ewing's sarcoma is noteworthy and requires further investigation.

Adolescent↗

Infective arthritis in adults--experience at a teaching hospital in Kuwait.

Infective arthritis (InfectA) has a variable geographical pattern. A 'Medline' search did not yield any earlier series on epidemiological pattern of InfectA from Kuwait or the Gulf region. Therefore, an observational prospective study of sequential cases seen over a period of 4 years was carried out. Of a total of 2021 patients seen during this period, 36 (1.8%) were diagnosed to have InfectA. There were 6 (16.7%) cases of neisserial and 30 (83.3%) of non-neisserial InfectA. Predisposing factors were seen in 17 (47.2%), all with non-neisserial InfectA. Microbiological diagnosis was proven in 15 (41.7%) cases, and included Neisseria gonorrhoeae in 5, Brucella spp. in 4, Staphylococcus aureus in 3, and Neisseria meningitidis, Salmonella spp. and Mycobacterium tuberculosis in 1 each. In the remaining 21 (58.3%) cases the diagnosis was made on clinical grounds and confirmed on therapeutic response. The most common presentation of neisserial InfectA was acute polyarthritis while that of non-neisserial InfectA was acute monoarthritis. All patients recovered with little disability and no mortality.

Adolescent↗