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PubMed1989

Congenital hypothyroidism in Kuwait.

During a 7-year period (1981-1987), 25 children with congenital hypothyroidism were diagnosed in a regional hospital in Kuwait. The calculated incidence was 1:3476 live births. The diagnosis relied on clinical manifestation and confirmed by thyroid function tests. The age at diagnosis ranged between 3 weeks and 7 years with a mean of 18.5 months. Seven patients (28 per cent) were diagnosed in the first months, six in the following 5 months (24 per cent), and 12 diagnosed after the age of 6 months (48 per cent). Thyroid scan (TC-99M) was performed for 13 patients, four had thyroid aplasia, three had ectopia, and six had thyroid in normal position. In 1986-1987, two patients were detected by neonatal screening. Mental development was the best in the children who received thyroid hormone replacement in the first 6 months of life. Until a neonatal screening programme is widely available in developing countries, increased clinical awareness will remain the main way for the detection of congenital hypothyroidism.

Child↗

PubMed1990

Childhood idiopathic thrombocytopenic purpura: report of 60 cases from Kuwait.

Sixty children with idiopathic thrombocytopenic purpura (ITP) were admitted to a regional hospital in Kuwait over a 6-year period. A high annual incidence of ITP (12.5/10(5] was noted, probably related to viral infections during the period of the study. Forty-one were patients with acute ITP and 19 with chronic ITP. The initial treatment varied: corticosteroids were given in 33 cases, no therapy in 23 cases, and intravenous gamma globulin (IVGG) in four cases. Splenectomy was carried out in two children, of whom one died 2 years later as a result of septicaemia. This study showed that conservative management can be adopted in mild cases of ITP and active measurements should be reserved for patients presenting with moderate-severe mucocutaneous bleeding and significant thrombocytopenia.

Adolescent↗

PubMed1998

Congenital chloride diarrhoea in Kuwait: a clinical reappraisal.

Congenital chloride diarrhoea (CCD) is a recessively inherited disorder of chloride transport in the distal ileum and colon. Congenital chloride diarrhoea is a common metabolic disorder in Kuwait with an incidence of 1/3200. Clinical findings in 14 children with CCD are reported over a period of 4 years. Maternal polyhydramnios, abdominal distension, watery diarrhoea, and a high faecal chloride level > 90 mmol/l were the cardinal features in the neonatal period. In spite of the classical features of this disease 75 per cent of our cases were diagnosed beyond the neonatal period and all demonstrated chronic diarrhoea and failure to thrive, with hypochloraemia, hypokalaemia, and metabolic alkalosis. The practice of ultrasonic examination for pregnant women with polyhydramnios and, particularly, for those with previously affected siblings led to early identification of new cases among our population recently. The antenatal ultrasonic examination showed dilated intestinal loops which suggest CCD. The diagnosis was confirmed by a high faecal chloride level.

Child, Preschool↗

PubMed1998

beta-Thalassaemia major in Kuwait.

A combined retrospective and prospective study of 129 beta-thalassaemia major patients seen between 1965 and 1995 in Sabah Hospital, Kuwait has been carried out. The age range at diagnosis was 2 to 84 months, median 9 months. In approximately 80 per cent, the patients were outcomes of first- or second-cousin marriages. Nine (7 per cent) of the patients were HBsAg positive, while 42 (33 per cent) were hepatitis C seropositive. Eleven (9 per cent) patients had had bone marrow transplantation (BMT). There was no BMT-related mortality, but there were three graft rejections and two cases of chronic graft-versus-host disease (GVHD).

Bone Marrow Transplantation↗

PubMed1985

Doses from occupational exposure: a study of radiation doses to workers in Kuwait over a four-year period.

The personal monitoring facility in the Ministry of Public Health's Radiation Protection Department has provided service to all users of ionizing radiation in medicine, research and industry in Kuwait. Exposure results during 1980-1983 were compared and analysed to examine the efficiency of protection measures adopted by each occupation. The results indicate that annual doses received by workers in different occupations in recent years tend to be generally low, but remain higher than those received by similar workers in other countries. Several overexposures to radiologists, radiology nurses, medical radiographers, and industrial radiographers increased the overall annual collective doses. As a result, protective measures designed for radiologists and nurses involved with special radiographical procedures should be improved. The recent use of the after-loading technique in intra-cavitary therapy was responsible for a significant reduction in the overall average doses received by workers involved in radiotherapy.

Film Dosimetry↗

PubMed2006

Radon concentrations in elementary schools in Kuwait.

Measurements of indoor radon concentrations were performed in 25 classrooms in the capital city of Kuwait from September 2003 to March 2004 using track etch detectors. The investigation was focused on area, ventilation, windows, air conditioners, fans, and floor number. All the schools have nearly the same design. Mean indoor radon concentration was higher for case subjects (classrooms) than for control subjects (locations in inert gas, p < 0.001). The mean alpha dose equivalent rate for case subjects, 0.97 +/- 0.25 mSv y, was higher than the radiation dose equivalent rate value of control subjects, 0.43 +/- 0.11 mSv y. The average radon concentrations were found to be 16 +/- 4 Bq m for the first floor and 19 +/- 4.8 Bq m for the second floor after subtraction of the control. These values lead to average effective dose equivalent rates of 0.40 +/- 0.10 and 0.48 +/- 0.12 mSv y, respectively. The equilibrium factor between radon and its progeny was found to be 0.6 +/- 0.2.

Air Pollutants, Radioactive↗

PubMed2002

Nocardiopsis halotolerans sp. nov., isolated from salt marsh soil in Kuwait.

A polyphasic taxonomic study of a halotolerant micro-organism, isolated from Kuwait salt marsh soil, revealed that this strain represents a novel Nocardiopsis species. The strain produced substrate and aerial mycelium, grew at 28-35 degrees C in salt concentrations of 0-15% and was slightly keratinolytic. Results of the 165 rDNA sequence comparison revealed that strain F100T clustered with strains of the genus Nocardiopsis. This is consistent with other data such as: (i) growth characteristics, i.e. the formation of a white to yellow aerial mycelium and the typical zig-zag form of hyphae, which fragment when ageing; (ii) the presence of DL-diaminopimelic acid and glucose plus ribose in whole-cell hydrolysates; (iii) the presence of phosphatidyl choline, phosphatidyl inositol, phosphatidyl glycerol, phosphatidyl methylethanolamine and diphosphatidyl glycerol in polar lipid extracts; (iv) the presence of menaquinones MK-10(H(0-6)) and MK-11(H(0-6)) in the non-polar fraction; (v) the presence of iso/anteiso-branched plus 10-methyl-branched fatty acids, showing the diagnostic combination for Nocardiopsis spp. of 14-methyl-hexadecanoic acid (18%), oleic acid (9%) and tuberculostearic acid (2%); and (v) the absence of mycolic acids. Analysis of 16S rDNA revealed that strain F100T represents a distinct taxon within Nocardiopsis. Based upon phenotypic differences to other members of the genus, a novel species, Nocardiopsis halotolerans sp. nov., is proposed. The type strain of the species is F100T (= DSM 44410T = NRRL B-24124T).

Actinomycetales↗

PubMed2002

Saccharomonospora halophila sp. nov., a novel halophilic actinomycete isolated from marsh soil in Kuwait.

An actinomycete, strain 8T, was isolated from marsh soil in Kuwait. The strain was aerobic, gram-positive, halophilic and produced light blue to greyish aerial mycelium. The warty spores were sessile, occurring singly or in pairs on aerial mycelium. The mycelium was stable and did not fragment during ageing. Chemotaxonomic markers of the isolate were consistent with its classification as Saccharomonospora. The strain possessed meso-diaminopimelic acid as the diagnostic amino acid in the peptidoglycan. The diagnostic sugars were arabinose and galactose; polar lipids were phosphatidyl inositol, phosphatidyl ethanolamine, hydroxy-phosphatidyl ethanolamine, lyso-phosphatidyl ethanolamine and diphosphatidyl glycerol; the principal menaquinone was MK-9(H4); and the iso/anteiso-branched fatty acid pattern was combined with 10-methyl-branched and 2-hydroxy-branched fatty acids. Saccharomonospora cyanea DSM 44106T was the closest phylogenetic neighbour of strain 8T, showing 96.8% 16S rDNA sequence similarity. These data, together with distinct physiological traits, led to the conclusion that the novel isolate represents a new species within the genus Saccharomonospora for which the name Saccharomonospora halophila sp. nov. is proposed. The type strain is strain 8T (= DSM 44411T =NRRL B-24125T).

Actinomycetales↗

PubMed2000

Characterisation of methicillin-resistant Staphylococcus aureus from Kuwait hospitals with high-level fusidic acid resistance.

Forty-seven fusidic acid- and methicillin-resistant Staphylococcus aureus isolates from clinical samples in four hospitals in Kuwait were studied for their relatedness by biotyping and pulsed-field gel electrophoresis (PFGE) and for the genetic location of their resistance determinants. Forty-four isolates were resistant to gentamicin, kanamycin and neomycin. Forty-one isolates were resistant to erythromycin and trimethoprim, 10 were resistant to chloramphenicol and four were resistant to ciprofloxacin. They contained two or three plasmids of c. 28, 2.8 and 1.8 kb. Genetic studies demonstrated that resistance to cadmium, propamidine isethionate and ethidium bromide were linked and were carried on the c. 28-kb plasmid. Chloramphenicol resistance was encoded by the 2.8-kb plasmid in resistant isolates. No resistance was associated with the 1.8-kb plasmid and this was considered to be a cryptic plasmid. Resistance to fusidic acid, methicillin, benzylpenicillin, gentamicin, kanamycin, neomycin, tetracycline, trimethoprim, erythromycin and ciprofloxacin were located on the chromosome. All the isolates produced urease, but varied in the production of haemolysins, pigments, lipase and lecithinase and were classified into nine biotypes. In contrast, PFGE divided the isolates into two major patterns with one PFGE type constituting the majority of isolates in all four hospitals. The presence of the dominant PFGE pattern in all four hospitals suggests that it is an epidemic MRSA clone with the capacity to spread. Infection control measures should be directed towards restricting the further spread of this clone.

Anti-Bacterial Agents↗

PubMed1999

Enterotoxin production by coagulase-negative staphylococci in restaurant workers from Kuwait City may be a potential cause of food poisoning.

Staphylococcus aureus and coagulase-negative staphylococci (CNS) were isolated from the hands of food handlers in 50 restaurants in Kuwait City and studied for the production of staphylococcal enterotoxins, toxic shock syndrome toxin-1, slime and resistance to antimicrobial agents. One or a combination of staphylococcal enterotoxins A, B or C were produced by 6% of the isolates, with the majority producing enterotoxin B. Toxic shock syndrome toxin-1 was detected in c. 7% of the isolates; 47% produced slime. In all, 21% of the isolates were resistant to tetracycline and 11.2% were resistant to propamidine isethionate and mercuric chloride. There was no correlation between slime and toxin production or between slime production and antibiotic resistance. The detection of enterotoxigenic CNS on food handlers suggests that such strains may contribute to food poisoning if food is contaminated by them and held in conditions that allow their growth and elaboration of the enterotoxins. It is recommended that enterotoxigenic CNS should not be ignored when investigating suspected cases of staphylococcal food poisoning.

Anti-Bacterial Agents↗

PubMed2003

Amycolatopsis keratiniphila sp. nov., a novel keratinolytic soil actinomycete from Kuwait.

A keratinolytic, nocardioform actinomycete, strain D2(T), was isolated from Kuwait marsh soil by the bait technique using animal wool. Strain D2(T) was an aerobic, Gram-positive organism that produced light-grey aerial mycelium but no specific spore chains. 16S rDNA sequence analyses and chemotaxonomic markers were consistent with the classification of strain D2(T) in the genus Amycolatopsis, i.e. it had meso-diaminopimelic acid in its peptidoglycan, arabinose and galactose as its diagnostic sugars, the polar lipids phosphatidylinositol, phosphatidylethanolamine, hydroxyphosphatidylethanolamine and diphosphatidylglycerol, menaquinone MK-9(H4) and an iso-/anteiso-branched fatty acid pattern combined with 10-methyl-branched and 2-hydroxy-branched fatty acids. Amycolatopsis japonica was the closest phylogenetic neighbour of strain D2(T), showing 99.4% 16S rDNA sequence similarity with the novel strain. A. japonica and strain D2(T) could be clearly separated from each other on the basis of their low DNA-DNA reassociation value (55.9%). These data, together with its distinct physiological traits, led to the conclusion that strain D2(T) represented a novel species within the genus Amycolatopsis, for which the name Amycolatopsis keratiniphila (type strain D2(T) = DSM 44409(T) = NRRL B24117(T)) is proposed.

Actinomycetales↗

PubMed2003

Species prevalence and antibacterial resistance of enterococci isolated in Kuwait hospitals.

This study investigated the species prevalence and antibacterial resistance among enterococci isolated in Kuwait hospitals. They consisted of 415 isolates of Enterococcus faecalis (85.3 %), Enterococcus faecium (7.7 %), Enterococcus casseliflavus (4.0 %), Enterococcus avium (1.2 %), Enterococcus durans (1.0 %), Enterococcus gallinarium (0.5 %) and Enterococcus bovis (0.2 %) isolated from urine (36.6 %), blood (10.4 %), wound swabs (11.0 %), stool samples (12.0 %), high vaginal swabs (9.0 %), endocervical swabs (3.0 %) and miscellaneous sources (18.0 %). All of them were susceptible to linezolid. Fifty-two (12.5 %) isolates were ampicillin resistant but none of them produced beta-lactamase. They were resistant to erythromycin (63.3 %), tetracycline (60.5 %), ciprofloxacin (40.0 %), chloramphenicol (28.0 %), vancomycin (2.6 %), and teicoplanin (2.6 %). Fourteen, 19 and 20 % of them expressed high-level resistance to gentamicin, kanamycin and streptomycin, respectively. All of the vancomycin-resistant strains carried the vanA phenotype and genotype. There was no evidence of clonal spread of the vancomycin-resistant isolates.

Acetamides↗

PubMed2004

Isolation and molecular identification of Candida dubliniensis from non-human immunodeficiency virus-infected patients in Kuwait.

Candida dubliniensis is an emerging pathogen capable of causing oropharyngeal, vaginal and bloodstream infections. Although C. dubliniensis is similar to Candida albicans in several phenotypic characteristics, it differs from it with respect to epidemiology, certain virulence factors and the ability to develop resistance to fluconazole rapidly. In this study, the first seven isolations of C. dubliniensis from Kuwait are described, all originating from non-human immunodeficiency virus (HIV)-infected patients. The isolates were initially identified by the Vitek 2 yeast identification system, positive germ tube test, production of rough colonies and chlamydospores on Staib agar and by their inability to assimilate xylose, trehalose or methyl alpha-D-glucoside. The species identity of the isolates was subsequently confirmed by specific amplification of rDNA targeting the internally transcribed spacer 2 (ITS2), restriction endonuclease digestion of the amplified DNA and direct DNA sequencing of the ITS2. Using the E-test method, the MICs of C. dubliniensis test isolates were in the range 0.125-0.75 microg ml(-1) for fluconazole, 0.002-0.75 microg ml(-1) for itraconazole, 0.006-0.125 microg ml(-1) for ketoconazole, 0.002-0.5 microg ml(-1) for amphotericin B and 0.002-0.016 microg ml(-1) for voriconazole. Two of the isolates were resistant to 5-flucytosine (>32 microg ml(-1)), but none against fluconazole. The study reinforces the current view that C. dubliniensis has a much wider geographical and epidemiological distribution.

Antifungal Agents↗

PubMed2004

Molecular characterization of imipenem-resistant, cfiA-positive Bacteroides fragilis isolates from the USA, Hungary and Kuwait.

Fifteen Bacteroides fragilis isolates from the USA, Hungary and Kuwait were examined for carbapenem resistance, for carbapenemase activity and, with the use of various PCR-based methods and nucleotide sequencing, for cfiA genes and activating insertion sequence (IS) elements. All the B. fragilis isolates were cfiA-positive, 10 of the cfiA genes being upregulated by IS elements that are already known. Of these 10, one was of a novel type (designated IS943) and two further ones (IS614B and IS614C) were suspected hybrids of IS612, IS614 and IS942. There were five cfiA-positive imipenem-resistant B. fragilis isolates with elevated imipenem MICs (minimal inhibitory concentration) that harboured no IS insertion upstream of the cfiA gene, but produced carbapenemase; these isolates might possess a novel activation mechanism. On the basis of the available phenotypic and genotypic evidence, the present data suggest that there are at least two cfiA activation mechanisms among B. fragilis isolates.

Amino Acid Sequence↗

PubMed2005

Large-scale evaluation of a single-tube nested PCR for the laboratory diagnosis of human brucellosis in Kuwait.

A single-tube nested PCR assay identifying a 52 bp fragment from the genus-specific Brucella IS711 gene was used prospectively in clinical practice for the diagnosis of human brucellosis in Kuwait. Patients with suspected brucellosis and with other infections were investigated as clinically indicated but in all of them culture, serology and PCR for Brucella were carried out. Out of 263 suspected cases of brucellosis, diagnostic tests were positive in 199, serology was positive in 199 and culture in 89, while the Brucella PCR was positive in 193 (sensitivity 96.98%, 95% confidence interval 94.5-99.5%). Chronic brucellosis, involving symptoms for more than 1 year, was diagnosed in 49 out of these 193 patients. Diagnoses in four out of the six patients with positive serology but negative PCR and culture were non-Brucella bacterial meningitis and viral meningitis. False-negative PCR results were possible in the remaining two; both had been on long-term antibiotics for previously diagnosed brucellosis but their adherence may have been questionable, allowing a relapse. The PCR was negative in 244 patients with other infections (specificity 100%) and in 180 control subjects with negative Brucella culture and serology. PCR results were available within 24 h of sample receipt, providing diagnostic information rapidly. The PCR is expensive and technically demanding and may not be appropriate for all cases. Future studies will help define how it may best be used. For example Brucella and tuberculous meningitides can be very similar, Brucella PCR may allow prompt distinction between the two, avoiding the need for prolonged empirical treatment for both.

Adult↗

PubMed2005

Characterization of Trichosporon species isolated from clinical specimens in Kuwait.

Invasive trichosporonosis is an emerging infection of severely immunocompromised patients. It is principally caused by Trichosporon asahii, although some other species of the genus have also been implicated in the aetiology. In this work, 29 clinical isolates of Trichosporon species recovered from 29 different patients over a 6-year period were studied for phenotypic and genotypic characteristics. Two morphotypes were recognized on the basis of colony characteristics. The colonies of 25 isolates appeared flat and centrally wrinkled, while the other four isolates appeared dry and irregularly folded or verrucosed. Based on substrate assimilation profiles, all 29 isolates were identified as T. asahii using the Vitek 2 system. However, PCR amplification of rRNA gene sequences identified only 25 of the 29 isolates as T. asahii. The identity of the remaining four isolates was established as Trichosporon asteroides by direct DNA sequencing of the internally transcribed spacer (ITS)-1 and ITS-2 regions in the rRNA gene fragment amplified by PCR using panfungal primers. Fingerprinting carried out by randomly amplified polymorphic DNA analysis showed genotypic heterogeneity among the 25 T. asahii and four T. asteroides isolates. These data suggest that T. asahii is the major species associated with clinical specimens in Kuwait.

Base Sequence↗

PubMed2006

Characterization of extended-spectrum beta-lactamase (ESBL)-producing Kuwait and UK strains identified by the Vitek system, and subsequent comparison of the Vitek system with other commercial ESBL-testing systems using these strains.

Two hundred and fifty-one unique patient isolates of Klebsiella pneumoniae (123), Escherichia coli (114), Klebsiella oxytoca (7), Enterobacter cloacae (5) and Citrobacter freundii (2), flagged as extended-spectrum beta-lactamase (ESBL) positive by the Vitek system (GNS-526 card), were collected. These strains were isolated from a variety of clinical specimens submitted to the clinical bacteriology laboratories of the Royal Infirmary of Edinburgh (RIE), Edinburgh, UK (and associated GP practices), Hairmyers Hospital, Glasgow, UK, and the Amiri and Farwania Hospitals, Kuwait. Of the 101 RIE strains tested, 15 E. coli strains were found to be ESBL negative by Etest ESBL strips. On retesting the 15 E. coli strains with the Vitek GNS-532 card, 14 were found to be ESBL negative, despite being originally flagged as ESBL positive. The remaining 236 ESBL-producing strains were also subjected to the double disc-diffusion (DDD) technique for the detection of ESBLs. Of these, two were false negatives by Etest ESBL test strips (using both cefotaxime and ceftazidime strips), and 38 were false negatives by the DDD method. The Etest false-negative ESBL-producing strains of K. pneumoniae were positive by DDD. Technically, the Vitek method was the least demanding method to perform, as it was an integral part of the routine susceptibility test card. Etest strips were reliable, but were the most expensive of all the techniques used. The DDD test, while relatively inexpensive, was technically subjective, and in our hands, seven of the ESBL-positive strains that were confirmed by the other two techniques were not detected. Despite the false-positive ESBL-producing E. coli strains, the Vitek susceptibility card with its integral ESBL test offers the clinical laboratory a valuable and quick option to screen for ESBL-producing Klebsiella spp. and E. coli as part of the routine laboratory methodology.

Anti-Bacterial Agents↗

PubMed2006

A comparison study of sampling and analyzing volatile organic compounds in air in Kuwait by using Tedlar bags/canisters and GC-MS with a cryogenic trap.

Kuwait experiences desert climatic weather. Due to the extreme hot and dry conditions in this country, some analytical phenomena have been discovered. Therefore, a systematic study of sampling and analyzing volatile organic compounds in air by using GC-MS with a cryogenic trap is reported in this paper. This study included comparisons of using different sample containers such as Tedlar bags and SUMMA canisters, and different cryogenic freezing-out air volumes in the trap. Calibration curves for different compounds and improvement of replicated analysis results were also reported here. The study found that using different sample containers produced different results. Analysis of ambient air samples collected in Tedlar bags obtained several volatile organic compounds with large concentrations compared to using SUMMA canisters. Therefore, to choose a sample container properly is a key element for successfully completing a project. Because GC-MS with a cryogenic trap often generates replicated results with poor agreement, an internal standard added to gas standards and air samples by using a gas syringe was tested. The study results proved that it helped to improve the replicated results.

Air Pollutants↗