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PubMed1993

A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis.

This preliminary study of Kuwaiti children confirms the significant impact of exposure to war atrocities on children. This pilot sampling provided evidence that: (1) many children who remained in Kuwait during the occupation had multiple war-related exposures; (2) more than 70 per cent of the children reported moderate to severe post-traumatic stress reactions; and (3) witnessing death or injury and the viewing of explicit graphic images of mutilation on television had measurable influence on severity of reaction. The highest mean Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) score was found for those children who reported hurting someone else. Older children had both greater exposure to atrocities and higher CPTSD-RI scores. Findings suggest the need for public policy to minimize children's exposure to graphic depictions of war-related injury, death and mutilation.

Adolescent↗

PubMed1998

Follow-up study of British military hostages and their families held in Kuwait during the Gulf War.

On 2 August 1990 Iraq invaded Kuwait and held hostage all its inhabitants. Amongst those forced to stay were 71 British servicemen and their families who were held hostage for up to four and a half months. This study investigated the mental health status of this group of individuals at 6 and 18 months after the final hostage was released. Participants completed the Impact of Event Scale and the 28-item version of the General Health Questionnaire at both 6 and 18 months. In addition they completed a questionnaire regarding background factors, the dimensions of the trauma and the effects of their hostage experience. The Impact of Event Scale scores changed little over time whereas the General Health Questionnaire scores reduced significantly (p = .001) over the 12-month period suggesting that despite ongoing intrusive and avoidance phenomena levels of psychological distress did reduce. Those variables most strongly associated with a poor psychological outcome were witnessing physical violence and perceived deterioration in physical and mental health. Poor outcome at 6 months was strongly correlated with poor outcome at 18 months.

Adult↗

PubMed1995

Serum antibody to lipopolysaccharide antigens of Shigella species among U.S. military personnel deployed to Saudi Arabia and Kuwait during Operations Desert Shield and Desert Storm.

During Operations Desert Shield and Desert Storm, U.S. troops were at high risk of diarrheal disease due to Shigella spp., particularly Shigella sonnei. In order to better understand the serologic response to Shigella infection, 830 male U.S. combat troops were evaluated before and after the deployment to Saudi Arabia and Kuwait for immunoglobulin A (IgA) and IgG anti-Shigella lipopolysaccharide (LPS) (antibody to S. sonnei form I and Shigella flexneri serotypes 1a, 2a, and 3a) in serum. Just before deployment, 10.3% of the subjects were seropositive for IgA and 18.3% were positive for IgG anti-Shigella LPS. IgA and IgG anti-LPS antibody levels in serum prior to deployment were significantly associated with nonwhite race and ethnicity, birth outside the United States, and antibody to hepatitis A virus and Helicobacter pylori. During the deployment, which lasted for a mean of 131 days, 60% of the subjects reported at least one episode of diarrhea and 15% reported an episode of diarrhea with feverishness; also, 5.5% of the subjects exhibited IgA seroconversion to Shigella LPS and 14.0% exhibited IgG seroconversion. A significant association between the development of diarrheal symptoms and either positive predeployment anti-LPS antibody or seroconversion was not found. These data indicate that in this population of U.S. Desert Storm troops who were at high risk of Shigella infection, there was no apparent relation between IgA or IgG anti-Shigella LPS in serum and diarrheal disease.

Adolescent↗

PubMed1987

Factors influencing visual outcome after cataract extraction among Arabs in Kuwait.

Of 409 consecutive Arab patients in Kuwait who had extractions for idiopathic (senile and presenile) cataract 385 were followed up for a minimum period of one year. Among these the final visual outcome was 6/12 or better in 208 eyes (54%) but visual acuity was 6/18 or less in 177 eyes (46%). Of these 177 eyes 127 eyes (71.8%) had poor vision due to preoperative ocular disorders and 31 (17.5%) due to surgical complications. The main ocular conditions which limited visual recovery were the presence of corneal opacities, hypermaturity of cataract, advanced glaucoma, senile macular degeneration, diabetic retinopathy, and postoperative retinal detachment in this order of frequency. The prevalence of these disorders in cataract patients among the Arab population was identified and is discussed.

Adult↗

PubMed1993

Assessment of the effects of atmospheric oil pollution in post war Kuwait.

A prospective study was undertaken to assess and monitor the effects of oil pollution in soldiers exposed in Kuwait in 1991 after Op Granby. One hundred and twenty five soldiers were monitored over a five month period by measurement of Forced Expiratory Volume (in one second) (FEV1) and Forced Vital Capacity (FVC). Although no demonstrable changes were observed, this study has gone some way to filling the gap in research in this environmentally sensitive field.

Air Pollution↗

PubMed1975

Osmophilous fungi in the salt marshes of Kuwait.

During an investigation of the mycoflora inhabiting saline soils in Kuwait, special attention was focused on osmophilous fungi. A total of 101 species belonging to 46 genera were encountered from 40 soil samples collected from salt marshes using Czapek's agar supplemented with 40% sucrose. Soil samples were collected from different habitats at different distances from the water edge. Soils near to the water edge were poor in their fungal content, while those taken from areas covered by Juncus arabicus contained highest fungal populations. The recorded genera were classified as follows: 7 were of high frequency of occurrence, 8 moderate, 17 low, and 13 were rare. The order of dominance was Aspergillus, Alternaria, Penicillium, Cephalosporium, Fusarium, Stachybotrys, and Drechslera. Comparison between our results and those in other studies showed that there is no fungal flora characteristic of saline soils.

Ascomycota↗

PubMedDate not supplied

Hospital management of children with acute asthma exacerbations in Kuwait: adherence to international guidelines.

OBJECTIVES: To evaluate the in-patient management of children with acute exacerbation of bronchial asthma and its adherence to international guidelines. SUBJECTS AND METHODS: Medical records of 100 consecutive admissions for acute exacerbation of asthma to the paediatric wards at Mubarak Al-Kabeer Hospital, Kuwait, from October through December 1999 were retrieved. Data relevant to asthma symptoms, severity, treatment regimens and discharge plan were collected and evaluated. The mean age of patients was 4.3 years, ranging from 2 to 12 years. Admissions totalled 82 males and 18 females, with hospital stays ranging from 1 to 11 days (mean = 2.6 days). RESULTS: There were no fatalities. Reported episodes were severe (17%), moderate (11%) and mild (9%); degree of severity was not documented in 63 cases. Pulse, respiratory rate, colour and use of accessory muscles were not documented in 48, 48, 47 and 63% of the patients, respectively. Arterial blood gas was checked in 16 patients and pulse oximetry in 71. Full blood count, serum urea and electrolytes were obtained in 86 patients and chest radiographs in 76. All patients received nebulized salbutamol. However, some received additional medications: ipratropium bromide (79%), steroids (95%), intravenous aminophylline (5%) and antibiotics (43%). Two children were shifted to an intensive care unit, 1 of whom needed intubation. On discharge, there was no documentation of follow-up arrangements, or prophylactic anti-inflammatory drugs or other medications in 52, 81 and 32 patients, respectively. CONCLUSION: Patient management showed deficits, and documentation was inadequate. Areas of particular concern were assessment of patients, unnecessary investigations and use of antibiotics, and lack of post-discharge planning and prophylaxis with steroids. Adherence to the international guidelines was partial.

Acute Disease↗

PubMedDate not supplied

Point surveillance of Staphylococcus aureus carriage among medical staff in Infectious Diseases Hospital, Kuwait.

OBJECTIVE: To investigate the carriage of Staphylococcus aureus among doctors and nurses in Infectious Diseases Hospital, Kuwait, following the detection of 3 cases of methicillin-resistant S. aureus (MRSA). MATERIALS AND METHODS: A total of 260 nasal and throat swabs were obtained from 19 doctors and 111 nurses and cultured for the carriage of S. aureus. Forty-three S. aureus were identified based on their growth characteristics on mannitol-salt agar, catalase and tube coagulase and DNA hydrolysis. The isolates were tested for susceptibility to antibacterial agents and typed by phage typing; plasmid analysis and pulsed-field electrophoresis were carried out to determine their relatedness. RESULTS: Of the 19 doctors, 4 (21%) had nasal carriage while only 1 of them had a throat carriage. Sixteen (14.4%) nurses carried S. aureus in their noses and 20 (18%) in their throats. The combined nasal carriage rate for both doctors and nurses was 15.8%, and combined throat carriage was 16.6%. None of them carried MRSA. The isolates were resistant to penicillin G (90%), tetracycline (23.3%), erythromycin (9.3%) and cadmium (100%). Typing of the isolates showed a variety of phage types, plasmid and pulsed-field gel electrophoresis patterns. DISCUSSION: None of the doctors or nurses carried MRSA. Typing of the methicillin-susceptible strains that they carried demonstrated that the S. aureus were different, indicating an absence of a dominant clone capable of spreading. It is important to maintain a low carriage of S. aureus among health-care workers.

Bacteriophage Typing↗

PubMed2003

Ulcerative colitis in Kuwait: a review of 90 cases.

BACKGROUND: Chronic ulcerative colitis is a disease of unknown etiology. Its incidence is on the rise in various developing countries as has been reported in studies from South-East Asia and the Middle East. There seems to be significant differences in the pattern and the clinical course of this disease in our patient population. The aim of our study is to assess the incidence and the clinical course of the disease in Kuwait. METHODS: This is a retrospective study of cases identified over a period of 14 years (1985-1999). Three hundred forty-six patients were identified to have chronic ulcerative colitis. Ninety patients were interviewed for this study. RESULTS: Chronic ulcerative colitis is being identified with increasing frequency. Our local incidence was 2.8 per 100,000 persons per year. The disease was seen in both sexes with equal frequency. It peaks at the third decade of life, with no second peak observed in the sixth decade. The disease was of mild to moderate severity in 93% of the cases. The distribution of the disease in the colon showed pancolitis in 45%, left-sided colitis in 14%, proctosigmoiditis in 21% and proctitis in 20%. Arthritis and arthralgia were the most frequent extraintestinal manifestation seen in 31%. Perianal disease, although rare in ulcerative colitis, was seen in 8%. Of interest is the fact that over 14 years of follow-up, none of our patients developed high-grade dysplasia or colorectal cancer. Four patients required total colectomy mainly due to failure of medical therapy. CONCLUSIONS: Chronic ulcerative colitis is occurring with increasing frequency similar to that seen in Western countries. The disease observed in our patient population was of mild to moderate severity, with fewer complications than reported in Western countries. It peaks in the third decade with no second peak. None of our patients developed high-grade dysplasia or colorectal carcinoma.

Adolescent↗

PubMedDate not supplied

Dental health knowledge, attitudes and behaviour among students at the Kuwait University Health Sciences Centre.

OBJECTIVE: The aim of the study was to determine the extent of dental health knowledge among students at the Kuwait University Health Sciences Centre (HSC), as well as their attitudes toward dental health and their oral hygiene habits. METHODS: A structured questionnaire was distributed to 450 of the 800 students enrolled in 3 faculties of the HSC from March to April 2000. The questionnaire was completed anonymously by the students. RESULTS: Four hundred and ten students (91.1%) completed the questionnaire. Of these, 64.6% believed that the main cause of tooth decay was 'not brushing properly'. Only 19.3% of the students believed that sugar could cause dental decay. Half of the students did not know if sugar-free drinks are harmful to their teeth, and 29.5% did not know about any measures to prevent gums from bleeding. Self-assessment questions showed that 84.5% of the students were satisfied with their dental health. A large majority of the students (94.8%) brushed their teeth at least once a day. Female students brushed their teeth more frequently than male students, as did those students who had visited a dentist in the past 6-12 months and those who rated their dental health to be very good. The main reason given for a dental visit was toothache (70.0%). Coffee was consumed daily by 68.9% of students, 76.6% of whom added sugar to their coffee. CONCLUSIONS: The findings indicate that although most of the students at the HSC seem to be satisfied with their dental health, they did not have correct knowledge about the causes and prevention of dental diseases. In general, female students were more aware and concerned about dental health issues and more engaged in dental behaviour than male students.

Adolescent↗

PubMedDate not supplied

Streptococcus agalactiae (Group B Streptococci) carriage in late pregnancy in Kuwait.

OBJECTIVES: This study investigated the vaginal colonization rate of Streptococcus agalactiae (group B streptococci, GBS) in an antenatal population in a maternity hospital. SUBJECTS AND METHODS: Anal, vaginal and combined anal and vaginal specimens were obtained from 110 pregnant women (mean age 30.7 +/- 5.5 years) at 35-37 weeks of gestation, using a commercially prepared culturette, and transported in 0.5 ml of Stuart's transport medium. The specimens were then cultured in standard selective Todd-Hewitt broth medium, supplemented with gentamicin and nalidixic acid. After 36 h of incubation, the broth culture was subcultured onto sheep blood agar and incubated in 5% carbon dioxide for 18-24 h. Representative colonies morphologically resembling GBS were tested with latex agglutination kit. Each culture-positive woman was given ampicillin or piperacillin prophylactically and followed up through labour and postpartum. Detailed records of biodata, antecedent antenatal events and pregnancy outcome were reviewed. RESULTS: The combined vaginal and anal specimens were positive for GBS in 18 (16.4%) women. Gestational age at delivery was 39.01 +/- 1.79 weeks. The deliveries were uneventful and no neonate developed sepsis. Diabetes mellitus and pregnancy-induced hypertension/hypertension were detected antenatally in 16.6 and 11.5%, respectively. GBS carriage was not associated with adverse outcome of pregnancy. CONCLUSION: The colonization rate of GBS in pregnant women in Kuwait is high, and on the basis of the documented benefits of antenatal screening in Western countries, we recommend routine screening especially for our at-risk patients.

Adult↗

PubMedDate not supplied

Clinical patterns of diffuse parenchymal lung disease in Kuwait: a prospective study.

OBJECTIVE: To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease (DPLD). SUBJECTS AND METHODS: Over a 4-year period, 75 patients (41 males, 34 females), aged 13-76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography (HRCT), pulmonary function test and lung biopsy. RESULTS: Of the 75 patients 60 (80%) were over 40 years of age. The duration of symptoms in 34 patients (45%) was less than 6 months and longer than 1 year in 28 (37.7%) patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity (FVC), total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers (p < 0.05). The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases. CONCLUSION: DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear.

Adult↗

PubMedDate not supplied

The bacteriology of the supragingival plaque of child dental patients in Kuwait.

OBJECTIVE: To investigate the bacterial flora of the gingival plaques of pediatric dental patients in order to establish baseline data for future studies on the complex microbiota of the oral cavity of this group of child dental patients. SUBJECTS AND METHODS: Forty subjects, aged 3-12 years, were enrolled and investigated after informed consent was obtained. During the patients' first visit to the dental clinic supragingival plaque samples were collected from the gingival area of buccal and lingual tooth surfaces of all primary and permanent molar teeth using sterile curettes. Serially diluted samples were inoculated onto a set of selective and nonselective media and then incubated at the appropriate atmospheric conditions and temperatures. Representative colonies of isolates were identified by standard methods, including hemolytic characteristics on blood agar and profiling on API 20S and API 20A as appropriate. RESULTS: A total of 183 isolates (123 aerobes and 60 anaerobes) were recovered from the 40 patients with a mean count of 3 per sample of aerobes compared to 1.5 per sample for the anaerobes. Streptococcus sanguis was the predominant aerobic species (23.6%) isolated from 29 (72.5%) of the 40 patients, followed by Streptococcus mitis, 19.5 and 60%, Streptococcus salivarius, 17.1 and 52.5% and Streptococcus mutans, 17.1 and 52.5%. The frequency of isolation of anaerobic bacteria was Prevotella spp. 50% from 30 (75%) of the 40 patients, Fusobacterium spp., 18.3 and 27.5%, Bacteroides spp., Porphyromonas spp. and Peptostreptococcus spp., 6.7 and 10%, 6.7 and 10%, and 5 and 7.5%, respectively. Prevotella intermedia was the single most common species. CONCLUSION: The results show that there were more aerobic/facultative anaerobic bacteria than the obligate anaerobes in the dental plaque of the pediatric dental patients in Kuwait. The high prevalence of the pioneering streptococci as well as black-pigmented Prevotella spp. and Fusobacterium spp. indicates that the dental plaques of the children were in the developing stage, a precursor to the development of periodontal diseases.

Bacteria, Aerobic↗

PubMedDate not supplied

Hodgkin's disease: Kuwait experience.

OBJECTIVE: To describe histologic subtypes, clinical presentation and treatment outcome of Hodgkin's lymphoma in Kuwait. SUBJECTS AND METHOD: Patients older than 15 years, diagnosed with Hodgkin's lymphoma between 1980 and 1998, were included in this retrospective analysis. Data were collected using a standardized form that included demographics, histologic subtypes, clinical presentation, stage, extranodal involvement, treatment modality and follow-up. Histology reports were obtained from hospital records. RESULTS: There were 83 (59%) males and 57 (41%) females. Dominant histologic subtypes were nodular sclerosis 65 (46.4%) and mixed cellularity 42 (30%). Constitutional symptoms were reported by 54 (38.6%) of the cases. Two thirds (64%) of the cases were advanced. Primary extranodular involvement included liver (8%), gastrointestinal tract (7%), lung and bone marrow (4% each). Disease-free survival according to treatment groups were: radiotherapy alone 100%, chemotherapy alone 88%, and combined modality 65%. The 5-year Kaplan-Meier estimates of overall disease-free survival was 84%. CONCLUSION: In the cohort of 137 patients with Hodgkin's disease the treatment with combined radiotherapy and chemotherapy had a remarkable outcome. However, evaluation of long-term treatment complications is needed.

Adolescent↗

PubMedDate not supplied

The prevalence of atrial fibrillation among acute medical admissions in Kuwait.

OBJECTIVE: To establish the prevalence of atrial fibrillation (AF) among acute medical admissions to the Adan Hospital, Kuwait, and to evaluate the clinical features of the patients. SUBJECTS AND METHODS: Of 2,833 acute medical admissions to the Adan Hospital from January 1 to May 31, 2003, 120 patients with AF were included in the study. The patients were divided into paroxysmal or persistent (PPAF), and chronic atrial fibrillation (CAF). The prevalence of stroke and clinical features of the CAF patients with and without strokes were studied. All the patients with AF underwent echocardiography to evaluate left ventricular ejection fraction (LVEF) and left atrial dimension (LAD). RESULTS: The prevalence of AF in the study period was 4.24%, of which 68.3% had CAF and 31.7% had PPAF. The prevalence of heart failure, ischemic heart disease, systemic hypertension, and diabetes mellitus was 27.5, 55.8, 65.8, and 53.3%, respectively. Patients with CAF were older and had a higher prevalence of heart failure compared to PPAF patients. Of the patients with CAF, 26.8% had at least one episode of stroke. The CAF patients had lower LVEF and larger LAD than PPAF patients. Stroke patients with CAF had lower LVEF and larger LAD as compared to those without stroke. CONCLUSION: Atrial fibrillation is a common admission diagnosis in our hospital. Patients with AF commonly suffer from heart failure, hypertension, diabetes mellitus, and ischemic heart disease. There was a high prevalence of stroke among CAF patients.

Acute Disease↗

PubMedDate not supplied

Postmortem biopsies: the experience in Kuwait.

OBJECTIVE: To report our 4-year experience in postmortem needle biopsy of liver, heart, kidney and lung tissues when formal autopsy could not be performed. SUBJECTS AND METHODS: In the period from January 2000 to December 2003, postmortem biopsies were done at Al-Amiri Hospital, Kuwait, in 19 cases where the original diagnosis or cause of death was not clear. The procedure was performed by a dedicated trained medical team using a biopsy needle or limited incisions guided by the knowledge of the clinical presentation and results of laboratory and radiological investigations. RESULTS: The actual diagnosis was established in 8 cases by postmortem histological findings and corrected in another 9 cases. In the remaining 2 cases with systemic sepsis, autopsy only confirmed the antemortem clinical diagnosis. CONCLUSION: Our study shows that needle biopsy is an adequate technique for postmortem examination and should be considered as the minimum alternative to conventional autopsy.

Adolescent↗

PubMedDate not supplied

Antibiotic susceptibility profile of group B streptococcus (Streptococcus agalactiae) at the Maternity Hospital, Kuwait.

OBJECTIVES: This study was designed to determine the antibiotic susceptibility profile of clinical isolates of group B streptococcus(GBS, Streptococcus agalactiae) and to use the information for formulating appropriate intrapartum antibiotic policy for GBS carriage in pregnancy. MATERIALS AND METHODS: A total of 1,166 clinical isolates (single isolates) of GBS obtained from vaginal/rectal samples of pregnant mothers seen at the Maternity Hospital, Kuwait were studied over a period of 43 months between May 1998 and December 2001. The isolates were identified by standard methods and their susceptibility to penicillin, ampicillin, cephalothin, clindamycin and erythromycin was determined by disk diffusion technique, minimal inhibitory concentration (MIC) using the Vitek automated sensitivity card system and E-test methods. RESULTS: All the GBS isolates were fully susceptible to penicillin, ampicillin and cephalothin. Only 0.7 and 1.7% were resistant to erythromycin and clindamycin, respectively. Disk diffusion results interpreted by the standard interpretative criteria recommended by the National Committee on Clinical Laboratory Standards correlated well with Vitek results as well as the E-test for penicillin. The MIC of penicillin against all isolates ranged between 0.016 and 0.064 microg/ml. For the 6 months of 1998 and throughout 1999, the percentages of isolates susceptible at MICs of 0.016, 0.023, 0.032, 0.047 and 0.064 microg/ml were 6.5, 9.9, 31, 38.8 and 12%, respectively. The trend was similar in the subsequent years except that the percentage of isolates susceptible at MIC of 0.064 microg/ml increased to 26.6% in 2000, but went down to 4.4% in 2001. CONCLUSION: The trend in susceptibility of GBS to a variety of often used antibiotics for therapy and prophylaxis remained unchanged over nearly a 4-year period. The apparent increase in the number of isolates susceptible at higher MIC values of penicillin (0.047 and 0.064 microg/ml) in 2000 appears to be a bleb that cannot be explained by any event in the hospital for that year. Our data, based on susceptibility profiles, supports the use of penicillin or ampicillin for intrapartum chemoprophylaxis to prevent early-onset neonatal GBS infections.

Anti-Bacterial Agents↗

PubMed2005

Mutations associated with beta-thalassemia intermedia in Kuwait.

OBJECTIVE: To identify the beta-globin gene mutations associated with beta-thalassemia (beta-thal) intermedia in Kuwait. SUBJECTS AND METHODS: Eighteen patients from 13 unrelated families, mean age 12.7 +/- 8.1 years, range 4-31 years, were involved in the study. They did not require regular blood transfusion. Complete blood count and cation exchange high-performance liquid chromatography hemoglobin quantitation were carried out using standard techniques. Beta-thal mutations were identified with a combination of PCR amplification, allele- specific oligonucleotide hybridization or direct DNA sequencing. The patients were also screened for the alpha2-globin gene (-3.7 kb) deletion. RESULTS: Of the 13 families, 4 were homozygous for the IVS-I-II (G-->A) and 4 for the IVS-I-6 (T-->C) mutations, while 1 each was a compound heterozygote for the following mutation combinations: CD 8 (-AA) and -101 (C-->T); IVS-I-6 (T-->C) and CD 19 (A-->G); IVS-II-1 (G-->A) and -28 (A-->C); IVS-I-110 (G-->A) and deltabeta0 deletion. Therefore, homozygosity for two typically mild mutations (IVS-II-1 and IVS-I-6) accounted for 61% of the genotypes in our patients. CONCLUSION: Our results indicate that screening should commence with these two common alleles in Kuwaiti patients presenting with beta-thal syndrome. Early identification of intermedia patients will avoid the complications following an unnecessary hypertransfusion program.

Adolescent↗