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PubMed1990

Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait.

An 8-year hospital-based retrospective study on the epidemiology of juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE) and other connective tissue diseases among children in Kuwait is described. There were 108 children with JCA, 20 children with SLE, 23 children with other connective tissue diseases and 24 children with arthritis of familial Mediterranean fever (FMF). The average annual incidence of JCA was 2.84 cases/10(5) children under the age of 12 years and the 1988 prevalence was 18.7/10(5). The polyarticular, systemic and oligoarticular onset types were observed in 42, 29 and 29%, respectively. The incidence and prevalence of SLE were 0.53 and 3.37/10(5), respectively. The findings are compared with those from other countries.

Arthritis, Juvenile↗

PubMed1990

Term infant asphyxia in Kuwait.

In the developing nation of Kuwait, we undertook a case-control study of 43 consecutively born, asphyxiated, term infants. The asphyxia incidence of 9.4/1000 was only slightly higher than that in more developed countries. Severe morbidity occurred in 1.1/1000, and mortality in 1.1/1000. We found significant associations between asphyxia and primiparity, maternal hypertension, consanguinity, increased length of labour, and instrumental deliveries. Maternal age, socio-economic class, maternal illnesses other than diabetes, and breech delivery did not seem to play a role. The fact that the chosen method of delivery failed for a number of the asphyxiated patients, necessitating emergency Caesarian section, suggests that obstetric factors may need closer analysis.

Apgar Score↗

PubMed1997

The utilization of a paediatric emergency room in a general hospital in Kuwait.

A descriptive study was conducted in Al-Amiri Hospital, Kuwait to evaluate the use of the paediatric emergency room (PER) by children under 12 years of age over an 11-week period. Socio-demographic data on the families, reasons for the visits, the pattern of referral and the diagnoses were reviewed and analyzed. A total of 277 children were enrolled in the study, the majority of whom (81%) were generally well, only 4% requiring admission to hospital. The paediatrician in the emergency room considered that 64% of visits were not emergencies. Some form of treatment and one to two routine investigations were needed in 21% and 21.6%, respectively. Stated reasons for seeking medical care were: symptoms of the child (34%), unavailability of primary clinic at night (22%) and perceived better services in hospital (20%). The median of parental satisfaction at the end of the visit was 95%. We conclude that most visits to the PER at Al-Amiri Hospital are inappropriate and that intensive health education is required to improve use of the PER and to increase public awareness of the difference between primary care and paediatric emergency facilities.

Age Factors↗

PubMed1999

Persistent hyperinsulinaemic hypoglycaemia of infancy (nesidioblastosis): a report from Kuwait.

We report nine Bedouin children from Kuwait with persistent hyperinsulinaemic hypoglycaemia (PHHI) seen over a 13-year period in two regional hospitals. The incidence of PHHI in this inbred community is high (1:20,000); five of them came from two families. All the children presented with seizures associated with severe and recurrent hypoglycaemia, eight presenting in the neonatal period and one at the age of 2 months. One child died soon after birth. All the others received diazoxide initially, which achieved remission in one while two siblings remain dependent on the drug. Long-acting somatostatin analogue (octreotide) was successfully used in one child. Four children underwent pancreatectomy, two showed diffuse and two had localized nesidioblastosis. Two children achieved normal neurodevelopmental milestones, four suffered mental retardation of varying degrees and three died. Early diagnosis and prompt treatment are essential to avoid the neurological damage associated with hypoglycaemia. In some cases, this condition is due to an autosomal recessive pattern of inheritance and it is therefore important to offer genetic counselling to families with one or more affected siblings.

Arabs↗

PubMed2003

Epidemiology of Candida colonization in an intensive care unit of a teaching hospital in Kuwait.

The incidence of Candida infections in intensive care units (ICU) is increasing. Although most cases of candidemia are caused by commensal strains colonizing the patients' own body sites, recent studies have suggested that the source of Candida infection can also be exogenous. This study was carried out to prospectively investigate the frequency of Candida colonization among patients and health care personnel of an ICU of a teaching hospital in Kuwait. A total of 57 patients and 45 nurses were investigated. Candida isolates were identified to the species level by the Vitek identification system. The typing of selected isolates was performed by randomly amplified polymorphic DNA (RAPD) using three different arbitrary primers (CARAPD1, AP3, CT5). Of the 526 samples collected from 57 patients, 180 (34%) yielded Candida species. These included 112 (62%) C. albicans, 37 (21%) C. glabrata, 15 (8%) C. parapsilosis, 11 (6%) C. tropicalis, 3 (2%) C. krusei and 2 (1%) C. lusitaniae isolates. Thirty-seven patients (65%) were colonized by Candida at some point of stay in the ICU. Seven (12%) patients yielded more than one Candida species from the sites/specimens tested. The frequency of Candida isolation was highest from oropharynx, followed by rectum, groin, urine and trachea. Twenty-five (6%) of the 448 swabs from the nurses yielded Candida and included C. albicans (n = 16), C. parapsilosis (n = 4) and C. famata (n = 5). While all the three primers yielded varying patterns in RAPD analyses for each Candida species, the results obtained by AP3 were most discriminatory. The data showed that the colonizing Candida isolates recovered from various body sites of the patients, as well as the nursing staff, were different. However, when RAPD profiles of three blood culture isolates from candidemic patients were analyzed, the DNA fingerprint produced by one C. parapsilosis blood culture isolate was similar to C. parapsilosis recovered from the hands of two nurses, suggesting exogenous acquisition of infection.

Adolescent↗

PubMed2004

Assessment of Kuwait's Al-Qurain landfill using remotely sensed data.

Kuwait's Al-Qurain landfill problem resulted from indiscriminate dumping of domestic and industrial waste in an abandoned quarry in the late 1970s and early 1980s. The landfill and surrounding areas were set aside for a government housing project without an environmental assessment of the impact of the landfill on the project. Inhabitants of the newly constructed housing area experienced persistent foul odor emanating from the landfill site. Since then, the issue has generated a lot of public interests, and several remediation measures have been adopted. In this preliminary study, several remotely sensed data consisting of Landsat Multispectral Scanner (MSS), Landsat Thematic Mapper (TM), IKONOS, and synthetic aperture radar (SAR) acquired between 1972 and 2000 were processed and assessed for their usefulness to study and monitor the landfill site. The imagery provided a historical perspective of how the areas had changed over the last 30 years. Other useful information of the landfill obtained from the satellite imagery included the spatial extent, spectral reflectance, surface temperature, and surface roughness. The landfill site showed higher surface temperatures compared to the immediate surrounding areas-a process that could accelerate the biodegradation and the release of landfill gases. Such dataset could be incorporated into a GIS for the long-term monitoring of the site.

Environmental Monitoring↗

PubMed2002

Characteristics of asthmatic children in Kuwait.

This article summarizes clinical characteristics and identifies sensitizing allergens in 135 asthmatic children under 13 years of age in Kuwait, a desert environment with scant vegetation and weather conditions least associated with asthma. There were 84 males (M:F 1.65:1). Almost 70% were breast-fed (1-24 months), 59% had eczema, 52% allergic rhinitis, 78% of first-degree relatives had atopy, and 52% of parents were consanguinous. Cough was the presenting symptom in 92% and together with wheezing occurred in 76%. Most (91%) were < or = 5 years of age at diagnosis and 42% < 2 years. Mean duration of symptoms prior to diagnosis was 9.3+/-2 months (1 week-1 year). Viral upper respiratory tract infections, cigarette smoke, and exercise were the commonest triggers of symptoms (79%, 68%, 62%). Fumes of traditional Bokhour (incense) constituted a major indoor hazard. The most common sensitizing allergens were pollens of imported plants, molds, house dust mites, cockroaches, and peanuts. Management showed considerable under-treatment and included alternative medicines. In conclusion, childhood asthma in this desert environment starts at an early age, and is associated with high rate of atopy and high frequency of sensitization to aero- and food allergens. Asthmatic children are disadvantaged by delay in diagnosis, undertreatment, exposure to indoor cigarette smoke, and local traditions.

Age of Onset↗

PubMed2003

Glomerulopathy in Kuwait: the spectrum over the past 7 years.

There are few studies that examine, prospectively, the epidemiological profile of glomerulopathy (GP) and its clinicopathological correlation. All patients referred to Al-Amiri renal center in Kuwait from January 1st, 1995 to December 31st, 2001 were screened for GP. Detailed clinical data were collected and serological markers were done. Renal biopsy was performed whenever indicated. During those 7 years, a total of 584 patients were diagnosed, on histological basis, to have GP, 315 of whom were Kuwaiti nationals. During the same period of the study, 26 patients presented with bilateral small kidneys, history of proteinuria > 2 g/day and lacked systemic manifestations of autoimmune disease. Furthermore, 164 patients with clinical manifestations of diabetic glomerulosclerosis were not subjected to kidney biopsy. Hence, the calculated annual incidence rate of GP in Kuwaiti nationals was 34.5 per 100,000 population (PTP). The calculated rate of diabetic glomerulosclerosis was 13.4 PTP and that of nondiabetic 21.1 PTP. The calculated incidence rates of GP increased with age and were twice as high in males compared to females. Vasculitis was more common in elderly males while SLE nephritis was a disease of adults, 88.7% of whom were females. In the subgroup of primary GP, focal segmental glomerulosclerosis was the most common histological lesion accounting for 18.0% of the total biopsies in Kuwaiti patients, yet only 36.8% of those who fulfilled the criteria of primary type. Minimal change disease was the second primary GP (13.0%), followed by immunoglobulin A deposition disease (7.9%) and membranous glomerulonephritis (5%). Autoimmune diseases such as systemic lupus erythematosus (SLE) and vasculitis were common. Interestingly, only 44 of 72 (61.1%) of patients with SLE and 11 of the 62 (17.7%) of patients with vasculitis presented with rapidly progressive glomerulonephritis. On the other hand, 10 of 58 (17.2%) patients with nephroangiosclerosis presented with renal failure and protein excretion > 2 g/day simulating primary GP. Furthermore, only 21 of 40 (52.5%) patients with IgA nephropathy presented with "benign disease". Prospective studies are essential to ascertain the actual incidence and etiology of GP. The loose clinicopathological correlation in GP dictates an aggressive diagnostic approach in its study and management.

Adolescent↗

PubMed1998

Genetic background of congenital chloride diarrhea in high-incidence populations: Finland, Poland, and Saudi Arabia and Kuwait.

Congenital chloride diarrhea (CLD) is an inherited intestinal disorder caused by mutations in the down-regulated in adenoma gene. In Finland, the disease is prevalent because of a founder effect, and all but one of the CLD-associated chromosomes carry the same mutation, V317del. In Poland, another area with a high incidence of CLD, as many as seven different mutations have been detected so far. A third known cluster of CLD, around the Persian Gulf, has not been genetically studied. We studied the allelic diversity of CLD in Poland, in Saudi Arabia and Kuwait, and in three isolated families from North America and Hong Kong. Altogether, eight novel mutations were identified, making a total of 19 known CLD gene mutations. The Polish major mutation I675-676ins was found in 47% of the Polish CLD-associated chromosomes. Haplotype analysis and clustering of the I675-676ins mutation supported a founder effect and common ancestral origin. As in Finland, a major founder effect was observed in Arab patients: 94% of the CLD-associated chromosomes carried a nonsense mutation, G187X, which occurred in either a conserved ancestral haplotype or its derivative. Our data confirm that the same locus is mutated in all cases of CLD studied so far. In Poland, a relatively common founder mutation is likely to highlight a set of rare mutations that would very rarely produce homozygosity alone. This suggests that mutations in the CLD locus are not rare events. Although the disease is thought to be rare, undiagnosed patients may not be uncommon.

Chlorides↗

PubMed2002

Variations in the occurrence of the S315T mutation within the katG gene in isoniazid-resistant clinical Mycobacterium tuberculosis isolates from Kuwait.

The worldwide threat of drug-resistant tuberculosis (TB) to human health has led to the development of molecular methods for rapidly determining the resistance of clinical Mycobacterium tuberculosis isolates to the two front-line antituberculous drugs, isoniazid and rifampin. The prevalence of the S315T mutation within the katG gene, which confers clinically significant resistance to isoniazid, was determined in isoniazid-resistant clinical M. tuberculosis isolates recovered from TB patients in Kuwait. A total of 67 isoniazid-resistant and 18 susceptible clinical M. tuberculosis isolates were tested. The mutation S315T was found in 46 (69%) of the 67 resistant strains, whereas none of the susceptible strains contained this mutation. The prevalence of this mutation was highest (32 of 40, 80%) in isolates recovered from patients of South Asian origin and lowest in isolates from patients of Middle Eastern origin (8 of 18, 44%). The genotyping performed on isolates carrying the S315T mutation showed that the isolates belong to several different types as they exhibited unique DNA banding patterns. The results point to a varying prevalence of the S315T mutation within the katG gene in clinical M. tuberculosis isolates recovered from patients of different ethnic groupings within the same country. The results also suggest that detection of the S315T mutation in the katG gene may be used as a rapid screening method for identifying isoniazid-resistant clinical M. tuberculosis isolates recovered from majority of patients in some ethnic groupings.

Antitubercular Agents↗

PubMed1999

A store-forward ophthalmic telemedicine case report from deployed U. S. Army forces in Kuwait.

This telemedicine test was developed to determine the relative ease with which an off-the-shelf ophthalmic telemedicine package could be successfully applied from within a remote theatre of operations. The project was conducted at the Camp Doha Health Clinic, located just outside Kuwait City, during the period from April 12(th) through April 23(rd), 1998. The deployed signal unit had contracted for a direct T-1 commercial satellite link (via MCI), which allowed for direct internet connectivity using a PCMCIA network card. Digital images were sent via this connection to 140 e-mail sites throughout the world, including an unsolicited image to each of 134 Army optometry officers for their review, analysis, and diagnosis. Return responses to this unsolicited survey were 53 out of 134, for a 39.7% response rate. Half of the respondents were able to view the image with ease and clarity, rendering an accurate clinical diagnosis. The other half of the respondents either did not have the software to display an image on their clinical desktop PC, or did not know how to use their provided software. This project clearly indicates that an off-the-shelf ophthalmic digital system can be successfully used from a remote deployed site. However, the consulting clinicians require up-to-date training, and their computer packages should have as wide a capability base as possible.

Humans↗

PubMed1995

Antimicrobial resistance of coagulase-negative staphylococci from a Kuwait hospital.

This study investigated the incidence of antimicrobial resistance in clinically significant coagulase-negative staphylococci at the Mubarak Al Kabeer Hospital, Kuwait. A total of 104 isolates of coagulase-negative staphylococci consisting of S. epidermidis (67), S. haemolyticus (16), S. saprophyticus (6), S. simulans (2), S. hominis (4), S. albus (2), S. sciuri (3), S. warneri (2), S. capitis (1), and S. xylosus (1) were isolated from clinical specimens over a 6-7 month period and tested for resistance to 22 antibacterial agents and the ability to produce slime. They were all susceptible to vancomycin and mupirocin but intermediate resistance to teicoplanin was detected in seven isolates: 83 and 47.7% were resistant to penicillin G and methicillin, respectively, 57% were resistant to gentamicin, 49.5% to erythromycin, 50.4% to tetracycline, and 52.3% to trimethoprim. Resistance to heavy metals and the nucleic-acid binding compound was also detected. More than half of S. epidermidis, S. saprophyticus, S. simulans, S. hominis, and all of S. haemolyticus were multiply resistant to three or more groups of antibiotics and there was a significant association between slime production and resistance to multiple antimicrobial agents in S. epidermidis. The results revealed a high level of resistance to commonly used agents.

Anti-Bacterial Agents↗

PubMedDate not supplied

The nature of human brucellosis in Kuwait: study of 379 cases.

Three hundred seventy-nine Kuwaiti patients with brucellosis were admitted to Adan General Hospital, Kuwait, during the period 1984-1985. Of these 231 were males and 148 were females. Diagnosis was based on symptoms and signs compatible with the disease and on the detection of significantly elevated antibody titer and/or positive blood culture. The primary means of exposure were the consumption of raw milk and contact with goats, sheep, or camels. Patients most frequently presented with fever (91%), chills (40%), sweats (39%), gastrointestinal symptoms (30%), headache (23%), respiratory symptoms (23%), and musculoskeletal symptoms (22%). The major signs were osteoarticular involvement (37%), hepatosplenomegaly (27%), and lymphadenopathy (9%). Different regimens of treatment were used, but the highest rate of cure was achieved with triple therapy--tetracycline, streptomycin, and rifampin.

Adolescent↗

PubMed1982

Risk factors associated with acute myocardial infarction in Kuwait, 1978.

Two hundred and ninety-nine of 428 patients diagnosed with acute myocardial infarction (AMI) in Kuwait during 1978 were matched with hospitalized controls by sex, nationality, and same year of age. Patients were almost six times as likely as controls to be smokers (odds ratio [OR] = 5.6; 95% confidence limits [CL] = 2.8-12.3; P less than 0.0001) and 50% more likely to be diabetic (OR = 1.49; 95% CL = 0.96-2.32; P = 0.06). Patients were less likely than controls to be currently married (OR = 0.23; 95% CL = 0.04-0.84; P = 0.02) or to have a personal history of hypertension (OR = 0.60; 95% CL = 0.39-0.92; P = 0.01). Each of these four exposures affected AMI risk more strongly when considered together with the other three than when considered separately. Although in this study personal history of hypertension appears to reduce AMI risk, selection bias from using a hospital source of controls does not fully account for this reduction. Neither occupation nor socioeconomic status affected AMI risk.

Adult↗

PubMed1997

The spectrum of renal disease associated with microscopic polyangiitis and classic polyarteritis nodosa in Kuwait.

BACKGROUND: This study was conducted to examine prospectively the epidemiological profile of renal disease associated with microscopic polyangiitis (MPA) and classic polyarteritis nodosa (classic PAN) in Kuwait and its clinicopathological correlation. METHODS: Between 1 January 1993 and 31 December 1996, all patients referred to Al-Amiri renal centre were subjected to renal biopsy and/or arteriography if they manifested systemic manifestations of vasculitis or had rapid or unexplained renal failure with or without proteinuria. Patients who fulfilled the criteria of MPA and classic PAN, according to the Chapel Hill Consensus Conference (CHCC), were included in the study. RESULTS: Over those 4 years, 47 patients were diagnosed as having such vasculitides, 22 of whom were Kuwaiti nationals. This gave an average annual incidence of 45 cases/million adult Kuwaiti nationals (95% CI, 27-64). Histological examination revealed necrotizing glomerulonephritis (GN) in 11 patients and crescentic GN in 13, while isolated small- and/or medium-sized-arteritis were evident in six more patients. In 10 of the remaining patients; bands of fibrosis alternating with healthy renal tissue were seen and on arteriography non-atherosclerotic stenoses, infarctions, and/or microaneurysms were evident. The remaining seven patients were diagnosed by arteriography alone, five of whom had bilateral small kidneys. Constitutional manifestations of vasculitis were present in 32 patients (68%) and multisystem involvement in 19 (40%). ANCA levels were high in 24 (55%) of the 44 patients tested and seropositivity, as an antimyeloperoxidase, was a constant finding. Only six patients presented with rapidly progressive renal failure, while 31 presented with chronic renal disease, 18 of whom had protein excretion in excess of 2 g/day. CONCLUSIONS: These findings emphasize the limited role of clinical assessment in establishing a definite diagnosis of renal vasculitis and put in question its value in retrospective analysis of causes of ESRD in different populations.

Adolescent↗

PubMed2004

Radiation dose to premature infants in neonatal intensive care units in Kuwait.

Entrance surface dose (ESD) and effective dose (E) to premature infants were estimated at three neonatal intensive care units in Kuwait for three standard X-ray examinations--abdominal, chest and skull X rays using a simple water phantom. The ESD was found to vary between 58 and 102 microGy for abdominal X rays, between 51 and 102 microGy for chest X rays and between 58 and 145 microGy for skull examinations. These doses are comparable to the entrance skin doses published elsewhere. The E-values were estimated using normalised organ dose dataset from the National Radiological Protection Board. The E-values for abdominal, chest and skull examinations were in the ranges of 30-46, 20-36 and 8-18 microSv per examination, respectively. The risk of developing childhood cancers from each of the three examinations was estimated to be in the range (9-117) x 10(-6) for infants undergoing 25 of these X-ray examinations during their stay in the NIC unit.

Body Burden↗

PubMed2004

Prevalence of reported insomnia and its consequences in a survey of 5,044 adolescents in Kuwait.

STUDY OBJECTIVES: To examine the psychometric characteristics of a short scale to assess insomnia complaints and their consequences, to estimate the prevalence rates of reported insomnia, and to explore the sex differences in reported insomnia. METHODS: 5,044 male and female nonclinical secondary-school students in the State of Kuwait participated. Their ages ranged from 14 to 19 years. An insomnia scale (IS) comprising 12 items was administered in group sessions. It has acceptable test-retest and alpha reliabilities and good convergent validity. Two factors were disclosed: consequence of insomnia and difficulty in initiating and maintaining sleep. Point prevalence rate was computed as the summation of the percentages of responses in the two options: "Much" and "Very much" on each item during the most recent month. RESULTS: The prevalence of the 12 IS items ranged from 6.4% to 31.7% in boys, and between 6.5% and 35.9% among girls. The highest reported insomnia complaint was early morning awakening, ie, 31.7% in boys, and 35.9% in girls. It was found that 14.6% of boys and 20.3% of girls reported difficulty initiating sleep, while 8.6% of boys and 15.7% of girls reported difficulty maintaining sleep. Girls had higher mean scores in most of the IS items. CONCLUSIONS: Adolescents in the present sample have reported high rates of insomnia. There is a great need to agree upon the methodology, especially the assessment tool, for epidemiology of sleep disorder research.

Adolescent↗

PubMed1989

Erythrocyte protoporphyrin screening for lead poisoning in Bedouin children. A study from Kuwait.

Screening for lead poisoning can be performed by measuring either blood lead (PbB) or a haematological indicator such as erythrocyte protoporphyrin (EP). We have screened 902 infants and children aged from 3 months to 5 years amongst those attending three primary health care centres in AI Jahra governorate of Kuwait. Blood specimens were collected by finger prick on Guthrie filter paper and the dried blood samples were mailed to the Central Laboratory of the Children's Hospital, Buffalo, USA. One hundred and eighty-four (20 per cent) had an elevated EP (greater than 50 micrograms/dl). Of those 11 had values above 159 micrograms/dl; 140 children were further tested for blood lead levels (PbB) haemoglobin, mean cell volumes, and percentage of transferrin saturation; 41 had blood lead levels greater than 25 micrograms/dl which is the current definition of elevated blood lead levels. Two children (2 per cent) were in Class IV, 17 (15 per cent) and 16 (14 per cent) were in Class II and Class III, respectively. There was a significant correlation between EP and PbB (r = 0.686; P = less than 0.001). Of 72 children with elevated EP and normal PbB, 32 were anaemic (Hb less than 11 g/dl) and 20 had iron deficiency. The role of tribal practices using lead contaminated preparations and their contribution to elevated blood lead levels is discussed.

Biomarkers↗