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PubMedDate not supplied

Psychiatric morbidity among housemaids in Kuwait. a. Prevalence of psychiatric disorders in the hospitalized group of housemaids.

OBJECTIVES: To determine the first hospital admission rates and the nature of psychiatric disorders among housemaids and compare them with the Kuwaiti female patients. SUBJECTS AND METHODS: Based on the International Classification of Diseases (10th revision; ICD-10) symptom checklist, a semi-structured interview was administered to all the housemaids and the Kuwaiti female patients hospitalized during the 2-year study period. RESULTS: The hospital admission rates were 1.86 times higher in housemaids than in the Kuwaiti female patients and the nature of psychiatric disorders was also different in the two groups. The stress-related disorders were more common among housemaids while schizophrenia was the commonest disorder among Kuwaiti patients. Duration of hospital stay was significantly shorter for housemaids, and four fifths of them were repatriated on mental health grounds. CONCLUSIONS: The psychiatric morbidity is higher among housemaids than Kuwaiti females and a substantial number of them are prematurely repatriated on health grounds. Further studies are needed to explore the possible pre-immigration risk, and post-immigration precipitating factors, to prevent this 'expatriate failure'.

Adolescent↗
PubMedDate not supplied

A novel germline mutation in the von Hippel-Lindau gene in patients in Kuwait.

OBJECTIVE: To determine the germline mutation in an extended family in which 1 member was diagnosed clinically with von Hippel-Lindau (VHL) disease and to investigate 3 generations of the family. SUBJECTS AND METHODS: The polymerase chain reaction-single strand conformation polymorphism sequencing techniques were used to identify the germline mutation in the VHL gene in the patient and also to study 9 other members of the extended family over 3 generations. RESULTS: The patient and 3 other members of the family were shown to have the same mutation in the splice donor site of the first intron. The mutation was identified as IVS1 + 1 G-->T. CONCLUSION: The findings of this study indicate the presence of VHL mutation in a Kuwaiti family with Arab parentage. It is hoped that the study would contribute to understanding the types of mutation in VHL in the Middle East. Its early detection and diagnosis would help in genetic counseling of VHL patients.

Adult↗
PubMedDate not supplied

Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait.

OBJECTIVE: To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. RESULTS: Seventy-four of 104 (71%) hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 +/- 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients (78%) had a baseline FEV1 <50% before hospitalization and 45 (64%) had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen (19%) died on admission. Risk factors identified included severity of disease (p < 0.05); presence of comorbid disease (p < 0.01); acidemia (p < 0.0001); hypercapnia (p < 0.0001); previous hospitalization (p < 0.01), and assisted ventilation (p < 0.001). CONCLUSION: This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Aged↗
PubMedDate not supplied

Evaluating diabetic foot infection with magnetic resonance imaging: Kuwait experience.

OBJECTIVE: The aim of this study was to evaluate the capability of magnetic resonance imaging (MRI) to depict and characterize the changes seen in diabetic foot infections. SUBJECTS AND METHODS: MRI studies of 29 diabetic patients with suspected foot infection were evaluated. Sagittal and transverse T1-weighted images before and after intravenous gadolinium, and transverse fat-suppressed T2-weighted images were performed on the affected regions. The MRI findings were compared to subsequent clinical and/or histopathological findings. RESULTS: The MRI findings were: osteomyelitis in 14 patients, abscess in 5, cellulitis in 26, tenosynovitis in 4 and neuropathic joint in 8. Three cases were normal. Pathological confirmations were obtained in 19 patients. MRI and histological diagnosis were in concordance in 79% of osteomyelitis cases, 100% of neuropathy cases and 100% of cellulitis cases. The sensitivity and specificity of MRI in diagnosing osteomyelitis were 100 and 63%, respectively. The positive predictive and negative predictive values, and the accuracy were 79, 100 and 84%, respectively. MRI helped surgical planning for limb salvage procedures in 6 of the osteomyelitis cases and in a cellulitis case. CONCLUSION: The results indicate that MRI is a sensitive and accurate imaging modality for the evaluation of foot infections in diabetic patients and for planning proper treatment.

Adult↗
PubMedDate not supplied

Cementless Zweymüller hip replacement: a short-term follow-up in Al Razi Hospital, Kuwait.

OBJECTIVE: To present initial experience of the first 71 cases of cementless total hip replacement in Al Razi Hospital. SUBJECT AND METHODS: Between 1996 and 2004, total hip replacement was performed in 71 patients (40 male, 31 female, average age 40.7 years, range 17-74) using Zweymüller cementless prosthesis. The patients were followed clinically and radiologically over an average period of 36 months (range 6-84). The results were assessed according to Merle d'Aubigne clinical score. Radiological assessment included position of the implant, behavior of the prosthesis/bone interface and signs of osteointegration. RESULTS: Average clinical score during the 3 years' follow-up period was 17.8 points. Most of the implants were in optimal positions. No significant radiological modifications of the implant-bone interface were observed. CONCLUSION: Zweymüller total hip prosthesis gives excellent clinical and radiological results in short-term follow-up.

Adolescent↗
PubMed2006

Epididymo-orchitis and testicular abscess caused by Salmonella enteritidis in immunocompromised patients in Kuwait.

OBJECTIVE: To report relatively uncommon presentations of epididymo-orchitis and testicular abscess caused by Salmonella spp. in 2 immunocompromised patients. CLINICAL PRESENTATION AND INTERVENTION: A 56-year-old man, a known case of systemic lupus erythematosus on azathioprine and prednisolone therapy, developed urinary tract infection followed by bacteremia and epididymo-orchitis. Both urine and blood cultures yielded Salmonella enteritidis strains, which were demonstrated by pulsed-field gel electrophoresis typing method to be genotypically identical. The second patient, a 55-year-old diabetic (type II), presented with a testicular abscess from which a pure culture of S. enteritidis was obtained. Both were treated with intravenous piperacillin and amikacin followed by oral ciprofloxacin, responded well to the therapeutic regimen and were discharged home well. Their follow-ups were uneventful. CONCLUSION: This report shows that it is important to consider Salmonella infection in the differential diagnosis of inflamed and tender testis in immunocompromised patients and to include blood, urine and stool cultures in all cases.

Abscess↗
PubMed2006

Percutaneous fixation of comminuted fractures of the humerus: initial experience at Al Razi hospital, Kuwait.

OBJECTIVE: To present initial experience of 12 cases of percutaneous plating of the comminuted fractures of the humerus using minimal access surgery and standard low-contact dynamic compression plate. PATIENTS AND METHODS: Twelve patients (11 males and 1 female) with an average age of 29.8 years (range 17-46 years) with comminuted diaphyseal fractures of the humerus were treated by minimal access surgery using standard AO/ASIF implants. Fracture was reduced indirectly either by manipulation or by a femoral distractor. Image intensifier was used to monitor the reduction and fixation. The plate was fixed on the anterior surface of the humerus using proximal and distal minimal incision on the anterior aspect of the upper arm. RESULTS: All fractures were united, and all patients had a good range of motion in the adjacent joints. In 1 patient, there was a transient neurological deficit. CONCLUSION: Percutaneous fixation of comminuted fractures of the humeral shaft is an alternative to standard open surgery, reducing the surgical impact and giving an excellent functional result.

Adolescent↗
PubMed2007

Baseline staging of newly diagnosed breast cancer--Kuwait cancer control center experience.

OBJECTIVE: To determine the value of staging investigations in detecting metastases in newly diagnosed asymptomatic patients with breast cancer. MATERIALS AND METHODS: A retrospective review of patients' files with newly diagnosed breast cancer in the period from 1993 to 1998 was performed. Due to inadequate information, thirty-eight files were excluded leaving 785 files for analysis. RESULTS: Of the total 785 patients, we found distant metastases at the time of primary diagnosis in 36 (4.6%) patients, bone metastases in 29 (3.7%) patients, pulmonary metastases in 6 (0.8%) patients and liver metastases in 5 (0.6%) patients. Overall, 0.7% of patients with clinical stage I and II disease had metastases compared with 16.2% of patients with clinical stage III disease (statistically significant p = 0.0001). CONCLUSION: The results confirm the low yield of routine bone scans, liver ultrasound and chest X-ray among patients with asymptomatic early-stage breast cancer. These tests are therefore not recommended for such patients, although intensive investigations are appropriate for more advanced tumors.

Bone Neoplasms↗
PubMed1990

Prognosis and risk factors in febrile convulsions: a prospective study of 150 children in Kuwait.

One hundred and fifty children with febrile convulsions (FC) were followed up for 3-10 years. They were divided into two groups: group A consisted of 120 children whose disorder was under control, and group B 30 patients in whom the disorder was not under control. Risk factors for uncontrolled FC and later development of epilepsy were looked into. In group A, 8 patients (6.6%) developed epilepsy, while another 3 (2.5%) had a single afebrile seizure. In group B, 10 (33.3%) children developed epilepsy, while 1 (3.3%) had a single afebrile seizure. The difference in the later occurrence of epilepsy between the two groups was statistically significant.

Anticonvulsants↗
PubMed1989

Bacterial corneal ulcers among Arabs in Kuwait.

A retrospective clinicomicrobiological study of 228 patients with bacterial corneal ulcers was performed. Positive cultures of corneal ulcer samples were obtained from 68% of all patients. A high incidence of Staphylococcus epidermidis was isolated from patients' ulcers, Staphylococcus aureus, Pseudomonas, Streptococcus pneumoniae, and Streptococcus were the next most frequent pathogens. Of some help in identifying the causative organism were the locations of the ulcer, the presence or absence of hypopyon and the frequency of perforation of the ulcer. Cephaloridine, gentamicin and polymyxin were found to be the most effective therapy. Gram strains of ulcer samples were positive for organisms in only 13% of patients and accordingly were not considered useful in determining initial therapy of ulcers. Since corneal and conjunctival cultures in the majority of the control group were negative, one can presume that most of the S. epidermidis isolated from patients' ulcers was exogenous in nature.

Adolescent↗
PubMed1990

Seasonal variations of retinal detachment among Arabs in Kuwait.

The seasonal variation in the incidence of retinal detachment over the period from 1981 to 1987 inclusive was investigated. Highly significant associations were observed between this variation and both sunshine and temperature. Hence, it is suggested that heat or cold may be important additional factors in the development of retinal detachment in an already damaged retina. The occurrence of retinal detachment peaks over the winter months with the highest level being in the month of November, while there is a trough over the summer months.

Adolescent↗
PubMed1991

Incidence of posttrabeculectomy cataract among Arabs in Kuwait.

Trabeculectomy was performed in 466 glaucomatous eyes of 342 patients. Of these eyes, 54% appeared to have lens opacities. However, 35% of these cases had the cataract preoperatively and in 19% the cataractous changes appeared to develop postoperatively. The risk of development of posttrabeculectomy cataract seemed to increase with patient age. In addition, our results show that 51% of the patients developing a postoperative cataract had hypotony with a flat anterior chamber, 24.4% had hyphema and 20% had uveitis. Our findings suggest that the main risk factors involved in the posttrabeculectomy development of cataract are age, hypotony, hyphema, uveitis and probably minor trauma to the lens by continuous circulation of the aqueous humor through the surgical fistula.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration cytology of Hodgkin's lymphoma: A cytohistologic correlation study from a cancer center in Kuwait.

OBJECTIVE: To assess the diagnostic accuracy offine needle aspiration cytology (FNAC) in the diagnosis of Hodgkin's lymphoma (HL). STUDY DESIGN: We selected all the cases in which a cytologic diagnosis of HL, suggestive of or suspicious for HL, or HL as the prime differential diagnosis was offered on FNAC. These cases were correlated with histopathologic follow-up. Cases of primary HL diagnosed on cytology but without histopathology were excluded from the study. RESULTS: Histopathologic follow-up was available in 46 cases. Of these, 42 were correctly diagnosed as HL, and there was a discorrelation in 4 cases, comprising 3 cases of non-HL (T-cell-rich B-cell lymphoma [TCRBCL]-2, anaplastic large cell lymphoma-1) and 1 case of metastatic carcinoma. Overall accuracy was 91.3%. In 14 cases, the cytologic features were diagnostic ofrecurrence; hence, no histopathologic examination was done. No follow-up was available for the remaining 19 cases, which were excluded from the study. CONCLUSION: FNAC is very useful for rapid and accurate approach to the diagnosis of recurrent and most cases of primary HL. Because of morphologic similarities, it is difficult to differentiate HL from anaplastic large cell lymphoma and TCRBCL on FNAC. It is advisable to request a histopathologic examination in all cases of primary HL.

Adolescent↗
PubMedDate not supplied

Performance of monolayered cervical smears in a gynecology outpatient setting in Kuwait.

OBJECTIVE: To compare ThinPrep (TP) Papanicolaou smears (Cytyc Corp., Box-borough, Massachusetts, U.S.A.) with matching conventional Papanicolaou (CP) smears for specimen adequacy, cytologic quality, diagnostic accuracy and screening time. STUDY DESIGN: In this prospective study of 1,024 women a split-sample, matched-pair design in favor of CP slides based on single-blind criteria was followed with a smear on a glass slide for CP and the remaining material collected in Preserv-Cyt solution (Cytyc) for a TP smear. A Cytobrush (Medscand, Hollywood, Florida, U.S.A.) was used for smear preparation for CP. TP smears were processed in ThinPrep 2000 (Cytyc). Smears were stained with Papanicolaou stain and were interpreted according to the Bethesda system. RESULTS: The number of satisfactory but limited (SBL) cases with TP were 77 (7.5%) as compared to 127 (12.4%) with the CP method. This reduction in SBL smears with the TP method and consequent increase in satisfactory smears were highly significant (P < .001) by McNemar's test. As regards unsatisfactory smears in discordant pairs, although the number of unsatisfactory smears was higher with TP (41 cases) as against CP (27 cases), the difference was not statistically significant (P < .05). The split-sample method showed a high correlation between the CP and TP diagnoses. TP smears had a significant advantage over CP smears in the reduction in the number of ASCUS and AGUS cases (14 vs. 29) (P < .05) and increased the pickup rate of LSIL, 6 vs. 1. Time taken to screen the TP smears was half that of CP smears. No cases of LSIL or HSIL were missed on TP smears. CONCLUSION: The liquid-based processor significantly improved the adequacy and quality of smears, resulting in fewer recall cases for SBL smears, leading to more definitive diagnoses in atypical cases, increasing the pickup rate of LSILs and reducing the screening time. A machine handling multiple specimens automatically would decrease cost and be an asset to a cytopathology laboratory.

Adolescent↗