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Ischemic renal disease in Kuwait.

Ischemic renal disease (IRD) is a frequent cause of end-stage renal disease. Its prevalence is mainly known from autopsy or retrospective arteriographic studies. This prospective study was conducted in 115 subjects selected from 732 patients with advanced chronic renal failure (CRF). Only patients with clinical features suggestive of IRD were selected for this study. In addition to detailed clinical and laboratory evaluation, captopril renal scintigraphy was performed in selected cases. All subjects underwent renal arteriography and all were followed up for 18.4 +/- 11.4 months. Renovascular disease was seen in 15 patients and significant bilateral renal artery disease leading to IRD was observed in 13 (11.3%). Hence the prevalence of IRD in the advanced CRF patients was 1.7%. The majority of patients with IRD (8 [61%]) were above 46 years of age and there were more men than women (10:3). Atherosclerotic renovascular disease was the most common (10 [77%]), even though arthritis (1 [7.6%]), and fibromuscular dysplasia (2 [15.3%]) were also observed. Serum creatinine at time of presentation was significantly higher in patients with IRD (784 +/- 292, p = 0.043) compared to those who did not have IRD (359 +/- 126). Corrective procedures were performed in 5 patients. After treatment the improvement in serum creatinine in patients with IRD at 3 and 6 months (166 +/- 32 and 173 +/- 47, respectively) was significantly different (p < or = 0.05) compared to those who were not treated (610 +/- 194 and 645 +/- 220, respectively). Hyperlipidemia, coronary artery disease and peripheral vascular disease were more prevalent in patients who had IRD compared to those with renal failure. The incidence of diabetes mellitus were similar in both groups. This study denotes a lower prevalence of IRD in the advanced CRF population; they had more severe renal failure at presentation but specific corrective treatment delayed progression of renal disease significantly.

Adult↗

Extent and severity of atherosclerotic vascular disease in patients undergoing coronary angiography--the Kuwait Vascular Study.

Only a few angiographic studies have correlated the presence and severity of coronary artery disease with atherosclerosis in other arteries. The presence of disease in more than 1 area clearly has important implications on management. One hundred and seventy eight patients had angiographic evaluation of their peripheral arteries and abdominal aorta after routine diagnostic coronary angiography. The extent and severity of vascular disease was correlated with those of coronary artery disease. Of the 178 patients, 73.6% were men (mean age +/- sd was 52.93 +/- 10.12 years). Hypercholesterolemia (59%), systemic hypertension (56.7%) and diabetes mellitus (50.6%) were the major risk factors. Triple-vessel coronary artery disease was present in 48.9%, and 13.5% had normal coronaries. A new atherosclerotic vascular disease score, which reflects the presence and severity of atherosclerotic vascular disease elsewhere, was seen to correlate significantly with the extent of coronary artery disease. Of particular interest was the involvement of the first part of the vertebral artery in 41.6% of patients. The combined involvement of the abdominal aorta, renal artery, and iliac artery segments (together referred to as the lower body segment) was seen almost exclusively in those with 2- or 3-vessel coronary artery disease. Also there was a direct correlation between the extent of coronary artery disease and the score in the lower body segment as opposed to the upper body segment (subclavian, vertebral, and internal mammary arteries). The presence of atherosclerotic vascular disease correlated with the severity of coronary artery disease, particularly in respect to disease in the lower body segment. Thus early detection of such disease in the iliac or femoral arteries has a potential for early diagnosis of significant coronary artery disease.

Adult↗

Psychiatric morbidity among housemaids in Kuwait. III: Vulnerability factors.

BACKGROUND: Housemaids are a relatively homogenous immigrant subgroup in terms of their gender; ethnic origin; and socio-cultural, educational and occupational background. Psychiatric morbidity among housemaids is two to five times higher than the native female population. AIMS: To determine the possible pre-immigration risk factors for prospective psychiatric breakdown among the housemaids. METHODS: The sample consisted of all the housemaids (N = 197) hospitalised during the two-year study period. The controls comprised all the newly arrived housemaids (N = 502). The measures obtained included demographic characteristics and previous history of physical illness, psychiatric illness, hospitalisation and family history of psychiatric disorder. RESULTS: More than a quarter of the hospitalised group broke down within one month of their arrival. The hospitalised group had a significant excess of Sri Lankan housemaids; non-Muslims; those with less than four years of education and those with a previous history of physical illness, psychiatric illness or hospitalisation. CONCLUSIONS: A number of potential risk factors results in premature repatriation of housemaids on mental health grounds. Preventive measures involving recruitment procedures and pre-departure orientation courses are needed to minimise the expatriate failure among the housemaids.

Ethnicity↗

The profile of parasucide repeaters in Kuwait.

A one-year cohort of 92 parasuicides was followed up at 6 monthly intervals for a period of 2 years since their index parasuicide to study the outcome and evaluate the level of social readjustment. One male patient died of suicide (1.1%) and 18 (19.6%) individuals repeated parasuicide using self-poisoning. The rate of repeated parasuicidal behaviour in this investigation was considerably higher than that reported in comparable studies from developing countries but similar to that from a number of western European cities. The data indicated that the probability of further episodes of parasuicidal behaviour increased in the few months after the index episode. Although the repeaters and non-repeaters were essentially similar in most of their sociodemographic characteristics, the former were a distinctive group in many respects. The factors found to be significantly associated with subsequent parasuicide included self-poisoning by prescribed drugs at the index parasuicide, previous parasuicidal behaviour prior to the index, occupational status of a housewife, past history of depression and/or dependence and precipitating life events in the family environment. Contrary to our hypothesized theory, none of the types of attitudes received by the patients from their family members at the index parasuicide related to outcome. The global level of social readjustment of non-repeaters was about three times higher than that of repeaters of parasuicide. The implications of these findings for future policy making were discussed with respect to prevention of parasuicide.

Adult↗

Lay explanations of symptoms of mental ill health in Kuwait.

The cognitive schemas of 208 subjects were elicited in relation to 12 hypothetical symptoms which are most commonly presented by patients suffering from psychiatric disorder. Three types of explaining schemas were recognised as physical, psychosocial and supernatural explanations. Somatic symptoms tended to have physical explanations and emotional symptoms tended to have psychosocial explanations although both are known in clinical practice to indicate psychiatric disorder and to disappear together when the disorder recovers. Supernatural explanations were most likely in elderly males and in extended families. Symptoms associated with supernatural cognitive schemas fit in with the cultural background and not with the level of modern education achieved.

Adult↗

Illness behaviour in mental ill-health in Kuwait.

Two hundred and eight individuals were interviewed in order to study the behaviour they adopt in relation to the most common somatic and emotional symptoms of mental ill-health. Illness behaviour included ignoring, brooding, self-help and consultation of others. Older individuals tended more frequently to resort to meditation, native healers and doctors. Males consulted doctors more than females. Brooding was more frequent in well educated subjects. A group of married expatriates who left their wives in their original countries were the most likely to consult doctors. Education and marital status were the most predictive of brooding and self-help behaviour. Self-help was the most commonly adopted illness behaviour. The results are explained in terms of the social and cultural background of the individuals studied because this influences their methods of expressing distress and their action in relation to symptoms.

Adult↗

Overweight and obesity in Kuwait.

The aim of this study was to determine the prevalence of overweight and obesity among adult females. A multistage stratified sample of 2999 adult females was examined. 52.5% were found to be overweight (10-20% above reference weight tables) and 42% obese (more than 20% above reference standards). The numbers increased with age. There were fewer obese and more overweight the higher the standard of education, with a similar pattern with the husbands' standard of education. Obesity was more prevalent (46.8%) in non-working women, 36.8% among those in management and 32.9% among those in technical work, while the corresponding figures for those overweight were 47.7%, 56.9% and 62.2%. The prevalence of obesity increased with family size while that of overweight fell. A similar pattern was found with the number of children. Family income was inversely related to the prevalence of obesity and positively related to overweight.

Adolescent↗

Nutrient intakes of university women in Kuwait.

This study assessed the nutrient intakes of 203 female college students, aged 20-31 years, mean 21 years. Results from computer analysis of 3-day food records showed that, on the basis of group means, two thirds of Recommended Daily Allowance (RDAs) was met for all nutrients except iron, zinc, folacin and vitamin D. Nutrient intake and RDAs showed no significant differences related to marital status with the exception of vitamin D and manganese (p less than 0.05). The indexes of Nutritional Quality indicated that, on average, diets of the students met or exceeded nutrient density allowance for protein, vitamin A, vitamin C, thiamin, riboflavin, niacin, vitamin B6 and phosphorus. Nutrients for which the average female student consumption was below recommended standards on a calorie basis, were carbohydrates, fat, vitamin D, folacin, calcium, iron, zinc and sodium. The diets were limited in fibre, high in sugar, high in caffeine and slightly above recommendations in cholesterol. Female college students needed guidance in selecting nutrient dense foods. Attention in nutrition education programmes should be directed toward the individual student rather than the group.

Adult↗

Prognostic significance of CEA and CA 19-9 in colorectal cancer in Kuwait.

Preoperative CEA and CA 19-9 levels have been used in the past as prognostic indicators in colorectal cancer, but Dukes' stage is still considered to be the most important prognostic factor. Recent survival estimates may have been influenced by the fact that in the last decade adjuvant chemotherapy and postoperative irradiation have been included in the routine management of advanced-stage disease. In a heterogeneous Kuwaiti population higher reference levels (95th percentile) of CEA and CA 19-9 have been found than those usually employed. In the present study 62 patients with Dukes' stage B + C could be analyzed for two-year disease-free survival (DFS). Relapse was observed in 19 patients, 28 patients were disease free and 15 patients with censored observations were included. No significant difference in DFS was observed in Dukes' B (69%) versus Dukes' C (48%) patients (p = 0.09). On the other hand, Dukes' stage B + C patients with elevated preoperative levels of CEA or CA 19-9 had a significantly poorer DFS than patients with normal levels. For CEA levels below or above the cutoff the DFS was 74% versus 23% (p = 0.003); for CA 19-9 levels below or above the cutoff the DFS was 71% versus 33% (p = 0.004). In 54 patients with Dukes' stage B + C for whom preoperative levels of both CEA and CA 19-9 were available multivariate analysis revealed a decreasing risk of relapse in the following order: CEA and/or CA 19-9 elevated (chi-square 7.09; p = 0.008), CA 19-9 elevated (chi-square 6.27; p = 0.01), CEA elevated (chi-square 5.47; p = 0.02), and Dukes' C (chi-square 2.08; p = 0.15 n.s.). Hence, novel treatment protocols may have improved the disease-free survival, but the use of adjuvant chemotherapy and/or radiotherapy is of questionable benefit in patients who have elevated levels of CEA and/or CA 19-9 prior to treatment.

Biomarkers, Tumor↗

Prevalence and susceptibility of Shigella species to 11 antibiotics in a Kuwait teaching hospital.

During the 5-year period 1990-1993 and 1996, 202 Shigella spp. were isolated from stool specimens of symptomatic patients of all age groups seen in our hospital. Over these periods the trend of the incidence of shigellosis showed that 18% of the total strains were isolated during the invasion year (1990) followed by an upsurge (24%) during the Gulf War period (1991) and a steady decline in the post-war period, 17% in 1992 and 14% in 1993. There was another wave of increased isolation rate (27%) during a period of relative calm in the country (1996) studied for comparison. The predominant Shigella species was S. flexneri which accounted for 46% of the 202 isolates, followed by S. sonnei (42%), S. dysenteriae (7%) and S. boydii (5%). Fifty-four percent of the 202 Shigella isolates were resistant to ampicillin, 56% to trimethoprim/sulfamethoxazole, 35% to chloramphenicol, 13% and 9% to cephalothin and amoxicillin/clavulanic acid respectively. All the isolates were fully susceptible to ciprofloxacin, the aminoglycosides and the second- and third-generation cephalosporins. Eighty-seven (43%) of the 202 isolates were resistant to two or more antibiotics. Of the 87 multiply resistant Shigella spp., 58 (67%) were S. flexneri while 19 (22%) were S. sonnei. Shigella resistance to the first-line antibiotics is a major problem that frequently limits the therapeutic options with orally available active antibiotic therapy.

Anti-Bacterial Agents↗

High frequency of isolation of antibiotic-resistant oral Viridans streptococci from children in Kuwait.

Antimicrobial resistance among the Viridans group of streptococci (VGS) has emerged as a hindrance to effective antibiotic therapy. Our objective was to evaluate the prevalence of antibiotic-resistant VGS in healthy children. Plaque samples were collected from tooth and tongue surfaces of 102 healthy subjects. Serially diluted samples were inoculated onto BHI agar plates and Mitis Salivarius Agar (MSA) plates and incubated as appropriate. Representative colonies were identified to species level by standard methods. Susceptibility of the VGS was performed by determining the minimum inhibitory concentrations (MICs) of 11 antibiotics using Etest. Of the 540 VGS isolates from both sites, 58% were from the tooth surfaces and 42% from the tongue. The most prevalent were S. salivarius (21.5%) and S. sanguis (16.3%). Imipenem and vancomycin had excellent activities. Resistance rates to trimethoprim, amoxicillin, piperacillin, erythromycin, cefuroxime and cephalothin, were 60.7, 40.8, 34.7, 32.6, 27.5 and 25.3%, respectively. Resistance rates to penicillin and clindamycin were 15.9% and 15.4%, respectively. The majority of the erythromycin-resistant isolates were from the tongue; 41% versus 29%. At the species level, 26% and 23% of S. salivarius and 23% and 14% of S. mutans from the tooth and tongue, respectively were resistant to penicillin. The data show species-related and site-related variations in the susceptibility pattern and an emerging high prevalence of antibiotic-resistant VGS. The difference in the susceptibilities between the species underscores the importance of accurate-identification and the need for surveillance of antimicrobial resistance among clinical isolates in our hospitals.

Anti-Bacterial Agents↗

In vitro activity of linezolid and other antibiotics against Gram-positive bacteria from the major teaching hospitals in Kuwait.

Multidrug-resistant Gram-positive bacteria are an increasingly pressing problem in the clinic. Consequently, linezolid, a recently introduced oxazolidinone with Gram-positive activity, was tested in comparison with 10 other antibiotics against 8103 clinically significant Gram-positive cocci by Etest, disk diffusion and Vitek methods. Linezolid demonstrated excellent activities against all isolates. Vancomycin and teicoplanin demonstrated equally excellent activity against almost all isolates. The methicillin-resistant Staphylococcus aureus (MRSA) strains were all susceptible to the glycopeptides and linezolid, but resistant to erythromycin (96%), fusidic acid (91.5%), gentamicin (84%) and clindamycin (73%). Forty one and 39% of the Streptococcus pneumoniae isolates were resistant to penicillin (MIC >0.5 microg/ml) and erythromycin (MIC >1 microg/ml), respectively. S. agalactiae susceptibility was 9% and 10% resistant to clindamycin and erythromycin, respectively. In conclusion, all the Gram-positive isolates tested were susceptible to linezolid. With its oral bioavailability profiles, it obviously holds great promise. Our data should be a useful addition to the literature from the Middle East.

Acetamides↗

Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans.

Military personnel deployed to the Persian Gulf War have reported a variety of symptoms attributed to their exposures. We examined relationships between symptoms of respiratory illness present 5 years after the war and both self-reported and modeled exposures to oil-fire smoke that occurred during deployment. Exposure and symptom information was obtained by structured telephone interview in a population-based sample of 1,560 veterans who served in the Gulf War. Modeled exposures were exhaustively developed using a geographic information system to integrate spatial and temporal records of smoke concentrations with troop movements ascertained from global positioning systems records. For the oil-fire period, there were 600,000 modeled data points with solar absorbance used to represent smoke concentrations to a 15-km resolution. Outcomes included respiratory symptoms (asthma, bronchitis) and control outcomes (major depression, injury). Approximately 94% of the study cohort were still in the gulf theater during the time of the oil-well fires, and 21% remained there more than 100 days during the fires. There was modest correlation between self-reported and modeled exposures (r = 0.48, p < 0.05). Odds ratios for asthma, bronchitis, and major depression increased with increasing self-reported exposure. In contrast, there was no association between the modeled exposure and any of the outcomes. These findings do not support speculation that exposures to oil-fire smoke caused respiratory symptoms among veterans.

Adult↗