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Clinicopathological features of extranodal lymphomas: Kuwait experience.

A total of 935 patients with extranodal non-Hodgkin lymphoma (NHL) diagnosed in the period between January 1985 and December 2000 in Kuwait Cancer Center, serving the whole population of Kuwait, were used to describe the clinicopathological and epidemiological features of extranodal lymphomas in Kuwait. Extranodal lymphomas accounted for 45% of all NHL observed during this time. All NHL cases from Kuwait Cancer registry were analyzed and pathologically reclassified using the latest WHO (2000) classification. The most common lymphoma observed was diffuse large B-cell lymphoma (58.60%) followed by Burkitt s lymphoma (BL) (3.80%). In the pediatric group, BL comprises more than two thirds of all patients (77.20%). The most common extranodal sites were stomach (19.70%) and skin (17.80%) in the adult group, large intestine (29.80%) and small intestine (19.30%) in the pediatric age group. The majority (73.40%) of adult extranodal lymphomas was in stage IE-IIE and had a very good prognosis. On the contrary, the majority of pediatric extranodal lymphomas were found to be in stage III and IV. Variations in treatment policies (single agent or combined chemotherapy, radiotherapy, combined modality treatment) adopted and changed during the time period of 16 years of this retrospective study were documented.

Adolescent↗

Self-reported medication use among adolescents in Kuwait.

OBJECTIVE: The objectives of this study were to describe and examine the pattern of medication use, including age and gender differences among adolescents in Kuwait, and to establish the sources of information on medicines in this age group. SUBJECTS AND METHODS: A cross-sectional survey of 1,110 male and female students (14-21 years) from 10 randomly selected public schools in Kuwait was conducted. The prevalence of self-medication was estimated. RESULTS: The prevalence of self-medication among the high school students was 92%. The prevalence increased by age from 87% among 14-year-olds to 95% among 18-year-olds. Sixty-five percent of medicines used were for pain relief, 54% for respiratory conditions, 39% for allergic conditions, and 37% for dermatological conditions. Twenty-two percent of medicines were nutritional supplements and vitamins, 21% gastrointestinal products, 17% antidandruff products, 15% hair products, 13% for migraine while 8% were for athlete's foot. Pain relief, respiratory, dermatologic and hair products were more prevalent in female adolescents than in male while antidandruff and athlete's foot preparations were used more by male adolescents. The most common sources of information on medicines were parents. CONCLUSION: The prevalence of self-medication among adolescents in Kuwait is high. Self-medication tended to increase with age and differed between male and female students. Few students consulted pharmacists for information on drugs. There is need to promote the image of the pharmacist in Kuwait as a provider of medication information.

Adolescent↗

Physicians' perceptions and expectations of pharmacists' professional duties in government hospitals in Kuwait.

OBJECTIVE: The objectives of this study were to evaluate the perceptions, expectations and experience of physicians with hospital-based pharmacists in Kuwait. MATERIALS AND METHODS: A piloted self-administered questionnaire was hand delivered to 200 physicians practicing in four government hospitals in Kuwait. Main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. RESULTS: One hundred and twenty (60%) questionnaires were returned. At least 57% of physicians in Kuwait appear comfortable with pharmacists carrying out patient-directed roles. In addition, they appeared to have high expectations of pharmacists, with 79% of them regarding pharmacists as knowledgeable drug therapy experts. Less than 60% considered pharmacists as applying their drug knowledge in practice and only 29% agreed that pharmacists routinely counselled their patients. There was no correlation between physician variables such as number of years since graduation from medical school, age, area of practice and their perceptions of pharmacists. CONCLUSION: Physicians in Kuwait appear comfortable with pharmacists providing a broad range of services but appear somewhat less comfortable with pharmacists' provision of direct patient care. Physicians considered pharmacists knowledgeable drug therapy experts, but regarded them as not routinely providing a broad range of higher-level pharmacy services.

Adult↗

Epidemiology and outcome of severe hepatitis A infection in children in Kuwait.

OBJECTIVE: To describe the epidemiology, clinical features and outcome of hepatitis A virus (HAV) infection in children in Kuwait. SUBJECTS AND METHOD: The medical records of 350 patients (age 0-16 years) admitted to the Infectious Diseases Hospital, Kuwait, between January 2000 and December 2002, with hepatitis A infection were reviewed. RESULTS: The mean age was 8.6 +/- 3.8 years and 47% of patients were between 7 and 12 years old. Kuwaiti children comprised 44% of admitted patients. The largest proportion of children with hepatitis A (34%) were from the northern part of the country. HAV infection was prevalent throughout the year with a peak during the months of August to October. Of the Kuwaiti children, 31% reported a history of contact with jaundiced patients, while 52% of the non-Kuwaiti children had a history of recent travel prior to their illness. Patients had symptoms for a mean of 6 +/- 3.6 days prior to presentation. The mean length of hospitalization was 5.8 +/- 2.9 days. The rate of complications of HAV infection was 6% and only one child required admission to the intensive care unit for fulminant hepatitis. None of the patients had permanent sequelae. CONCLUSIONS: HAV infection is a significant cause of morbidity for children in Kuwait. The disease is mostly prevalent in preschool and school age children. Despite the excellent outcome of all patients, a considerable number of patients tend to have a complicated course and prolonged hospitalization. In view of these data, hepatitis A vaccine should be considered as a part of routine childhood immunization in Kuwait.

Adolescent↗

Developments in the instruction of biostatistics at the Kuwait University Health Science Centre in a decade.

BACKGROUND: Kuwait has witnessed many changes that influenced, among other things, the structure of medical education including biostatistics. This article describes the developments in biostatistics instruction and curriculum in the Health Science Centre, University of Kuwait, during the past 10 years. DESCRIPTION: Instead of teaching biostatistics as an independent component, the university has developed an integrated course (35 hr of lectures and 12 hr of tutorial sessions) of biostatistics, epidemiology, and demography that is taught to undergraduate medical and dentistry students to ensure interdisciplinary interaction, to remove redundancies, and to standardize terminology across the three disciplines. The core curriculum of the biostatistics course is compatible with the recommendations of the American Statistical Association. Separate biostatistics courses are also offered to pharmacy and allied health students to address their diverse interests. In addition, new biostatistics and computer applications instruction courses were developed and are taught to the students of the Master of Science (MSc), Master of Public Health (MPH), and PhD programs. For continuing medical education, a workshop on biostatistics and computer applications is organized annually for the medical profession as a collaboration between the Health Science Centre and the Kuwait Institute for Medical Specialization. EVALUATION: The instructor and curriculum content of the biostatistics courses are confidentially evaluated and independently analyzed by the office of the Vice Dean for Academic Affairs. Overall, students evaluate the biostatistics instructors highly and are pleased with the content of the biostatistics curriculum. CONCLUSIONS: During the last decade, biostatistics instruction in the Kuwait Health Science Centre had many new developments. An integrated course on biostatistics, epidemiology, and demography was developed with emphasis on problem solving and small group learning. Another biostatistics course is offered to the students of the new faculty of pharmacy. Further biostatistics courses became operational for the postgraduate programs: (MSc), (MPH), and PhD. Continuing medical education is supported by workshops, which is a sign of collaboration with the health community, and a consultancy office has been established. Overall, biostatistics instruction is well received by students, and the role of biostatistics is recognized by researchers from the medical profession.

Biometry↗

Divergent, criterion-related, and discriminant validities for the Kuwait University Anxiety Scale.

Three analyses were carried out. Analysis I estimated the correlation between the total score of the Kuwait University Anxiety Scale and a self-rating scale of happiness with large sample of male (n = 1,312) and female (n = 1,272) Kuwaiti adolescents. Pearson product-moment correlations were -.43 and -.44 (p < .001) for boys and girls, respectively, suggesting divergent validity of the anxiety scale. Analysis II examined the correlations between scores on the Kuwait University Anxiety Scale and the Somatic Symptoms Inventory for a nonclinical sample of women (n = 30), and female outpatients with anxiety disorder (n = 30). Pearson product-moment correlations were, respectively, .85 and .53, (p < .001), which support the criterion-related validity of the Kuwait University Anxiety Scale with respect to the Somatic Symptoms Inventory. In Analysis III a sample of 60 male and female outpatients with anxiety disorder and 60 nonclinical participants were matched on age, education, and occupation. All responded individually to the Kuwait University Anxiety Scale. Significant differences among groups, especially noticeable for men, support the discriminant validity of the scale. So, the clinical as well as research use of the scale can be recommended. By and large, the divergent, discriminant, and criterion-related validities of the scale have been adequately supported so subsequent replication is expected.

Adolescent↗

Caries experience in a selected group of children in Kuwait.

A study to set base-line data for future interventions to develop young children's oral health care was carried out in November 1993 in Kuwait. The study population comprised a random sample of 450 3- to 7-year-old children drawn from the students in Kindergarten and Primary Departments of Kuwait English School in the Salwa District of Kuwait. The mean dmft and mean d values were highest at the age of 6 (4.1, SD = 3.6, and 2.1, SD = 2.4, respectively) and lowest at the age of 4 (1.4, SD = 2.5, and 1.0, SD = 2.0, respectively). The proportion of caries-free children (dmft = 0) was 39%. Molars and maxillary incisors were most prevalently affected by caries. There seems to be a distinct need for both organized dental health care and preventive programs for the very young children in Kuwait.

Age Factors↗

Meningococcal carriage in adolescents and young adults in Kuwait.

BACKGROUND: Neisseria meningitidis is a major cause of invasive meningococcal disease (IMD), with asymptomatic carriage playing a crucial role in transmission. Adolescents (15-17&#x202f;years) and young adults (18-20&#x202f;years) have the highest carriage rates, yet data from Kuwait remain limited. This study aimed to estimate the prevalence of N. meningitidis carriage among adolescents and young adults in Kuwait. METHODS: A cross-sectional study was conducted from July 2023 to May 2024, enrolling 1,398 participants aged 15-20&#x202f;years. Randomly selected individuals provided oropharyngeal swabs, and demographic, behavioral, and vaccination data were collected via standardized questionnaires. Carriage prevalence was determined using selective culture-based methods. Whole genome sequencing was performed on culture-confirmed isolates. Descriptive statistics were used to summarize participant characteristics; carriage prevalence was reported as proportions, and associations were explored using Fisher's exact or chi-square tests and logistic regression where feasible. RESULTS: The overall meningococcal carriage rate was 0.21% (3/1,398). All isolates were non-groupable (NG), with one carrying the capsule null locus (CNL). Self-reported MenACWY vaccination coverage was 94.8%. No significant associations between demographic, geographic, or behavioral factors and carriage status were identified due to the small number of positive cases. CONCLUSION: This study provides a population-based estimate of meningococcal carriage among adolescents and young adults in Kuwait using a random sampling approach. The low carriage rate, alongside high vaccination coverage, suggests that existing immunization programs in Kuwait may be effective in reducing N. meningitidis transmission. However, the presence of NG strains stresses the need for continued surveillance. Further research is required to evaluate long-term vaccination impacts and potential gaps in disease protection.

Humans↗

Pharmacy education in Jordan, Saudi Arabia, and Kuwait.

The practice of pharmacy, as well as pharmacy education, varies significantly throughout the world. In Jordan, Kuwait, and Saudi Arabia, the profession of pharmacy appears to be on the ascendance. This is demonstrated by an increase in the number of pharmacy schools and the number of pharmacy graduates from pharmacy programs. One of the reasons pharmacy is on the ascendance in these countries is government commitment to fund and support competitive, well-run pharmacy programs. In this report we describe pharmacy education in 3 Middle East countries: Jordan, Kuwait, and Saudi Arabia. All 3 countries offer bachelor of pharmacy (BPharm) degrees. In addition, 2 universities in Jordan and 1 in Saudi Arabia offer PharmD degree programs. The teaching methods in all 3 countries combine traditional didactic lecturing and problem-based learning. Faculties of pharmacy in all 3 countries are well staffed and offer competitive remuneration. All 3 countries have a policy of providing scholarships to local students for postgraduate training abroad. The majority of students in Jordan and Kuwait are female, while the ratio of male to female students in Saudi Arabia is even. Students' attitudes towards learning are generally positive in all 3 countries. In Saudi Arabia and Kuwait, most pharmacy graduates work in the public sector, while in Jordan, the majority work in the private sector.

Education, Pharmacy↗

Medical ethics and human rights violations: the Iraqi occupation of Kuwait and its aftermath.

Immediately after the liberation of Kuwait by a coalition of allied forces in March 1991, representatives of Physicians for Human Rights traveled to Kuwait and conducted an inquiry into human rights violations allegedly perpetrated by Iraqi forces. The inquiry focused on the abuses that were said to have occurred in health care institutions. Human rights abuses by the Iraqis in Kuwaiti hospitals were documented, but certain allegations proved to be unfounded. However, Kuwaiti abuses of those accused of collaborating with the Iraqi invaders, in particular Palestinian citizens of Kuwait, were also observed. The trip and inquiry generated questions about the scope and applicability of medical ethical principles to physicians in different cultures and in situations unlike those in which medicine is normally practiced. In light of the Kuwait experience, Physicians for Human Rights has drawn tentative conclusions about the universal nature of medical ethics.

Ethical Relativism↗

An oral health programme for schoolchildren in Kuwait 1986-97.

OBJECTIVES: To assess whether it was possible to implement an oral health programme in Kuwait which followed guidelines underlying the public Danish Child Oral Health Service, and thereby improve the oral health of Kuwaiti children. DESIGN: Successive cross-sectional surveys were carried out in one governorate in Kuwait (Al-Ahmadi) during the period 1986-97 interrupted by the Gulf War. Data were collected by clinical examinations. SETTING: The programme was initiated by the Ministry of Health in Kuwait in order to improve the community services through a school-based oral health care programme. PARTICIPANTS: The study population comprised incrementally all children in the four primary school classes in the governorate. INTERVENTIONS: The children received bi-weekly tooth brushing instructions with fluoridated toothpaste and fluoride rinsing, fissure sealing, oral health education, and restorative treatment of dental caries. OUTCOME MEASURES: The children were clinically examined each year before the start of the treatment. Dental caries was scored at surface level in accordance with the Danish registration system, using the WHO criteria for dental caries. RESULTS: The average participation rate was 94%. The percentage of caries-free children, exemplified by second class, increased from 64% in 1987 to 78% in 1990, dropped to 71% in 1992 and increased again to 79% in 1997. CONCLUSION: It is concluded that it has been possible to adapt the principles from the Danish Child Oral Health Service programme to Kuwait, that parents and teachers accepted the principle of treating the children during school hours, and that the oral health of the children improved. Whether the improvement in the oral health is due to the programme or to changes in the society is discussed.

Child↗

Survey of rats (Rattus norvegicus) in Kuwait for the presence of Leptospira.

A survey of brown rats (Rattus norvegicus) was made in Kuwait in 1979 for the presence of Leptospira organisms. Kidney tissue from 49 rats, trapped mostly from various Kuwait City districts, were cultured on E.M.J.H. and Stuart media. Eight leptospira strains were isolated; all strains were identical and belonged to Leptospira interrogans Canicola serogroup; they were later identified as a new serovar kuwait. The frequency of L. interrogans group Canicola carriers among the local rats in Kuwait was 16.3%, which is higher than reported so far. A summary of published data on the isolation of Leptospira other than L. interrogans serogroup Icterohaemorrhagiae from rats, particularly the brown rat, is presented with emphasis on the Middle East.

Animals↗

Genotoxicity to human cells induced by air particulates isolated during the Kuwait oil fires.

In an effort to examine the potential of exposure to soot from the 1991 oil fires in the Kuwait desert for inducing genetic effects we studied the in vitro genotoxicity of this material. Air particulates isolated near the Kuwait oil fires were studied using three assays. Dose-dependent increases were observed for both sister chromatid exchanges in human peripheral blood lymphocytes and mutation at the hprt locus in the metabolically competent human lymphoblast cell line AHH-1. Similar magnitudes of response were seen using these two assays when testing a standard air particulate sample which had been isolated from the Washington, DC, area. Using the 32P-postlabeling assay, no increase in DNA adduct formation was observed in AHH-1 cells treated with particulates isolated from sampling in Kuwait.

Air Pollutants↗

Hospitalization of diabetics 12-30 years of age in Kuwait: patients' characteristics, and frequency and reasons for admission.

In an observational study, we investigated the patient characteristics, frequency and reason for admission in young diabetics (aged 12-30 years) admitted at a major hospital in Kuwait. During the 3-year period, there were 88 evaluable admissions in 59 patients (30 males, 29 females; 34 Kuwaiti nationals, 25 expatriates). Admissions were more frequent in females than males: overall (55 vs. 33, p < 0.05), in the sub-group aged 12-19 years (31 vs. 10, p < 0.05), and in Kuwaitis (41 vs. 17, p < 0.05). The female preponderance reflected a higher re-admission rate than in males (1.9 vs. 1.1, p < 0.05). Females also had longer duration of diabetes (median, 3 vs. 0.75 years, p = 0.01). The main causes of hospitalization were acute hyperglycemia with ketonuria (75 admissions) or with established ketoacidosis (DKA) in 35 admissions. Hypoglycemia was not a cause in any patient. Female excess was also observed in those with DKA (23 vs. 12 in males, p > 0.05). Non-adherence to insulin therapy was the most common identifiable cause of DKA (11/35) and infection was a factor in only 2 cases. Among hospitalized young diabetic patients in Kuwait, adolescent females with Kuwaiti nationality were most commonly affected. Studies on psychosocial disorders in young diabetic patients could be beneficial and may help to improve metabolic control and reduce diabetes-related admissions for young diabetics in Kuwait and other countries of the region.

Adolescent↗

Characterization of Trypanosoma (Trypanozoon) evansi from dromedary camels in Kuwait by isoenzyme electrophoresis.

Blood from 115 camels in Kuwait was examined for blood parasites. Two camels of a local herd (1.7%) were found to be infected with Trypanosoma (Trypanozoon) evansi and three camels (2.6%) with microfilarial nematodes. The Trypanosoma stocks isolated from these two camels were screened for isoenzyme patterns of 10 enzymes using thin-layer starch-gel electrophoresis. The results revealed that these two stocks were identical to camel stocks of T. evansi from certain countries in Africa, as well as to two stocks isolated from dogs in Kuwait. This is the first record of Trypanosoma (Trypanozoon) evansi isolates and microfilariae from camels in Kuwait.

Animals↗

Pediatricians' knowledge, attitudes and experience regarding child maltreatment in Kuwait.

OBJECTIVES: This cross-sectional survey was conducted to evaluate the awareness and actual professional experience of pediatricians in Kuwait regarding child maltreatment, a topic rarely explored in this part of the world. METHODS: Data were obtained from all pediatricians in public hospitals with pediatric emergency services using a structured detailed self-completed questionnaire. RESULTS: The experience of child neglect was more common than that of child abuse in the clinical practice of surveyed pediatricians. Fifty percent of 117 pediatricians (69% of all eligible) reported having encountered at least 1 case of abuse and up to 3 cases of neglect in the past year. Women and younger doctors more commonly recognized hypothetical situations as maltreatment, and believed child abuse and neglect as being common or very common in Kuwait. Other demographic or professional variables did not affect recognition of maltreatment. Participants would most likely alert social workers about suspected maltreatment cases. More than 80% did not know whether there is a legal obligation to report or which legal authorities should receive reports of suspected cases. DISCUSSION AND CONCLUSIONS: National ethical guidelines regarding reporting suspected cases of maltreatment must be established. Laws protecting maltreated children and reporting physicians must be immediately enacted. Additional training is required to help pediatricians, especially expatriates from other cultures, to diagnose with certainty cases of child maltreatment in their practice in Kuwait.

Adult↗

Investigation of the efficiency of existing air pollution monitoring sites in the state of Kuwait.

The use of mathematical modelling for investigation of the efficiency of existing monitoring sites for the impact of SO(2) emissions from power stations in the state of Kuwait is described. The Industrial Source Complex Short Term (ISCST3) model is utilised to obtain the spatial and temporal variations of SO(2) over residential areas. Statistical comparison between the 50 highest daily measured and predicted SO(2) concentrations at six monitoring sites shows that the model is capable of generating results with accuracy of 60--94%. An important conclusion of this work is that the existing locations of the Kuwait-EPA monitoring stations are not suitable for measuring the actual impact of SO(2). Therefore, there is a need for relocation of these sites to register the highest levels of SO(2) emitted from the current power stations in the state of Kuwait.

Air Movements↗

Pattern of antibiotic prescription in the management of oral diseases among dentists in Kuwait.

OBJECTIVES: The use and abuse of antibiotics have been of concern to the medical and the dental profession for sometime now, due mainly to the emergence of antibiotic-resistant bacteria. The objective of this project was to determine the rationale and the pattern of antibiotic prescription for dental management in Kuwait. METHODS: A questionnaire was distributed to 200 dental practitioners working in the Ministry of Health dental centers in Kuwait. The questionnaires sought answers to the clinical and non-clinical factors; signs, clinical conditions and dental treatment modalities for which the practitioners would prescribe antibiotics. RESULTS: Of the 200 questionnaires sent out, 168 (84%) respondents returned fully completed forms. A total of 107 (63.7%) of the respondents were males. Of respondents, 90% would prescribe antibiotics for patients with elevated body temperatures and evidence of systemic involvement, gross or diffuse facial swelling and closure of the eye due to inflammatory swelling. However, over 50% would prescribe antibiotics for cases with localized fluctuant swelling without any systemic involvement, while 59.6% would prescribe for patients with difficulty in swallowing as a result of an oral infection. Many respondents would consider antibiotic prescription for routine dental extraction, and for non-clinical reasons such as uncertainty of diagnosis, convenience, expectation of the patient and lack of time to treat immediately. Amoxicillin was the most frequently prescribed antibiotic. Higher knowledge regarding adequate indications for antibiotic use was associated with longer professional experience. CONCLUSIONS: The results of this analysis suggest that there is lack of uniformity in the rationale for antibiotic use among dental practitioners in Kuwait. There is an urgent need for the formulation of evidence-based guidelines, which should take into account the peculiar behavioral characteristics of the community.

Adult↗