In‐hospital mortality in SARS‐CoV‐2 stratified by gamma‐glutamyl transferase levels

BackgroundThis study investigates in‐hospital mortality amongst patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and its relation to serum levels of gamma‐glutamyl transferase (GGT).MethodsPatients were stratified according to serum levels of gamma‐glutamyl transferase (GGT) (GGT<50 IU/L or GGT≥50 IU/L).ResultsA total of 802 participants were considered, amongst whom 486 had GGT<50 IU/L and a mean age of 48.1 (16.5) years, whilst 316 had GGT≥50 IU/L and a mean age of 53.8 (14.7) years. The chief sources of SARS‐CoV‐2 transmission were contact (366, 45.7%) and community (320, 40%). Most patients with GGT≥50 IU/L had either pneumonia (247, 78.2%) or acute respiratory distress syndrome (ARDS) (85, 26.9%), whilst those with GGT<50 IU/L had hypertension (141, 29%) or diabetes mellitus (DM) (147, 30.2%). Mortality was higher amongst patients with GGT≥50 IU/L (54, 17.1%) than amongst those with GGT<50 IU/L (29, 5.9%). More patients with GGT≥50 required high (83, 27.6%) or low (104, 34.6%) levels of oxygen, whereas most of those with GGT<50 had no requirement of oxygen (306, 71.2%). Multivariable logistic regression analysis indicated that GGT≥50 IU/L (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20–3.45, p=0.009), age (OR: 1.05, 95% CI: 1.03–1.07, p<0.001), hypertension (OR: 2.06, 95% CI: 1.19–3.63, p=0.011), methylprednisolone (OR: 2.96, 95% CI: 1.74–5.01, p<0.001) and fever (OR: 2.03, 95% CI: 1.15–3.68, p=0.016) were significant predictors of all‐cause cumulative mortality. A Cox proportional hazards regression model (B = −0.68, SE =0.24, HR =0.51, p = 0.004) showed that patients with GGT<50 IU/L had a 0.51‐times lower risk of all‐cause cumulative mortality than patients with GGT≥50 IU/L.ConclusionHigher levels of serum GGT were found to be an independent predictor of in‐hospital mortality.     

Renal vein renin measurement and arteriography in the investigation and management of severe childhood hypertension

Forty-two children aged one to sixteen years with persistent and severe hypertension were investigated by renal vein renin measurements. There were no serious complications in the 49 procedures performed and technical failure occurred on three occasions. Arteriography was performed in 35. Asymmetrical renin release was found in 22 patients and of these 15 underwent surgery. This was successful in 12 patients (80%) who became normotensive. Ten had unilateral disease (100% cure rate) but only 2 (40%) with bilateral disease became normotensive. Renal vein renin studies combined with arteriography have a useful role in the investigation and management of childhood hypertension.     

Ten years of clinical experience with adult onset Still’s disease: is the outcome improving?

This study aims to report on the clinical and laboratory picture and the disease course and outcome in patients having adult onset Still’s disease (AOSD), to briefly review existing literature on the subject, and to compare our findings with those previously reported. Results are reported for 28 patients with AOSD satisfying the preliminary criteria of Yamaguchi et al. seen in a teaching hospital over the last 10 years. A high percent of the patients with AOSD were women. The mean (+SD) age at disease onset was 27.8 (+8.4) years. We found fever in 100%, rash in 85%, arthritis in 64%, lymphadenopathy in 60%, splenomegaly in 57%, hepatomegaly in 35%, pleural effusion in 17.9%, and pericardial effusion in 3.6% of our patients. Leukocytosis was present in 96% of the patients, a normochromic, normocytic anemia in 54%, and an elevated erythrocyte sedimentation rate (ESR) in all. Serum ferritin levels were raised in 89% of the patients. The mean follow-up of the patients was 3.72 + 2.46 years. The mean delay in diagnosis was 7.32 + 18.0 months. The mean time to enter remission was 9.7 months. Self-limited, intermittent, and chronic disease course was seen in 14.3, 57.1, and 28.6% of patients, respectively. The outcome was good in about 89% of patients, and mortality was nil. No particular clinical or laboratory variable was found to predict the subsequent disease course and outcome in our patients. On comparing our data with important previous series, we found a higher percentage of women and of patients presenting in the age group 16–35 years, a lower frequency of arthritis and pericardial effusion, and some other notable differences. Importantly, the disease course was benign, probably as an outcome of heightened awareness and less diagnostic delay than in the past, allowing for early, aggressive, and appropriate treatment. It is concluded that AOSD is now a relatively benign disease if diagnosed early and treated appropriately.     

Central venous catheterisation in very low birthweight infants.

Forty two premature babies (mean birth weight 980 g, mean gestation 27.6 weeks) had central venous lines inserted at a mean age of 10 days through the internal jugular vein because of poor peripheral venous access and for purposes of parenteral feeding and minimal handling. Eight babies died from complications of prematurity and four from septicaemia with a central line in situ, but the other 30 babies had lines in place for a mean of 20 days. A mean weight gain of 17.5 g/kg/day was recorded. Eight babies showed signs of infection at a mean of 22 days after insertion of the line. The other complications were thrombosis related to the catheter (three cases), embolisation (two), and hydrocephalus related to superior vena caval thrombosis (one). The policy of management is outlined, and the risks and benefits of the technique are analysed.     

Clinical and immunological profile of primary Sjogren's syndrome in Kuwait: First report from Middle East

Aim: To describe the clinical and serological findings in primary Sjogren's syndrome (SS) patients seen in a teaching hospital in Kuwait. Methods: Using the European and San Diego criteria for the diagnosis of SS, we studied 10 consecutive (nine female and one male) SS patients seen in our rheumatology clinic. All these patients fulfilled four or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993 as well as the more stringent San Diego criteria. Results: The mean age of the patients at presentation was 32.9 years (SE 4.4 years), ranging from 15 to 56 years. The mean disease duration was 3.5 years (SE 1.4 years). The most frequently observed clinical manifestations were: xerostomia (80%); xerophthalmia (70%); and parotidomegaly (30%). The main extraglandular manifestation was arthritis (50%). The Schirmer test was positive in 90% and the rose Bengal test in 90%. The immunologic study showed antinuclear antibodies in 80% of patients, rheumatoid factor in 90%, anti‐Ro/SS‐A in 90% and anti‐La/SS‐B in 90%. Lip biopsy could be done in only six patients and showed characteristic focal lymphocytic infiltration of minor salivary glands in 67%. There was no statistically significant difference in the occurrence of parotidomegaly or arthritis in patients with disease onset before or after the age of 40 years. Likewise, there was no difference in the positivity of ANA, RF, ant‐Ro/SS‐A or anti‐La/SS‐B in the two age groups. Conclusions: Although primary SS is typically said to be a disease of middle‐aged women, this does not seem to be the case in Kuwait, where 60% had disease onset below the age of 40 years. We could not find any notable differences in clinical and immunological characteristics between patients with primary SS from Kuwait and those reported from elsewhere, except for higher rates of serological abnormalities (RF, anti‐Ro/SS‐A, anti‐La‐SS‐B), probably due to genetic differences and the use of the strict San Diego criteria.     

Clinical and Epidemiological Studies of Tinea Versicolor in Kuwait

Summary: Tinea versicolor in Kuwait was found to be more predominant among males (60.9%) than females (39.1%). Patients of the age group 20–29 years had higher frequency of infection (48.2%). These patients had had the longest durations of infection and the most frequent rate of occurrence: Their infection tended to be chronic and recurrent. The most common sites of tinea versicolor infection were the chest and neck in both male and female patients. Anatomical distribution of infection was remarkably different in males than females. Although lesions of tinea versicolor were typically observed in locations such as the shoulders, arms and abdomen, eruptions in the interdigital spaces, axillae, face and groin were also seen. The observation of tinea versicolor lesions in the interdigital spaces adds another atypical site of infection with M. furfur. Hyperpigmented lesions were more predominantly observed than hypopigmented type of lesions. This predominance of hyperpigmentation might be due to the presence of M. furfur which was found in abundance in the hyperpigmented lesions. Genetic transfer of susceptibility to tinea versicolor infection was not substantiated in our investigation, although we found that 17.7% of our patients had positive family history. Occurrence of tinea versicolor was more common in the summer and spring months (89.7%) and gradually dissipated during the autumn and winter months. This predominance of tinea versicolor might be related to the hot climate in Kuwait during the months of April to September. Our findings suggest that sweating may have no role in determining the intensity of tinea versicolor infection or the extent of lesions, rather it seems likely that it could be an important factor in producing the unpleasent symptoms of tinea versicolor once infection has been established. Zusammenfassung: In Kuwait kommt die Pityriasis versicolor unter Männern (60,9%) häufiger vor als bei Frauen (39,1%). Besonders betroffen war die Altersgruppe zwischen 20 und 29 Jahren mit einem Anteil von 48,2%. Diese Patienten hatten auch die längste Dauer der Infektion und zeigten die größte Rückfallrate: Bei ihnen tendierte die Mykose zu besonders chronischem und häufig rezidivierendem Verlauf. Die Pityriasis versicolor war am häufigsten an der Brust und am Hals bei männlichen und weiblichen Patienten lokalisiert. Bei Männern wies im übrigen die anatomische Verteilung der Erkrankung deutliche Unterschiede zu der Verteilung bei Frauen auf. Obwohl die Veränderungen der Pityriasis versicolor in typischer Lokalisation wie Schultern, Armen, Abdomen beobachtet wurden, fanden sich auch Herde in den Interdigitalräumen, in den Achselhöhlen, im Gesicht und in den Leistenbeugen. Die Beobachtung von Pityriasis versicolor-Herden in den Fingerzwischenräumen stellt eine neue atypische Lokalisation dar. Hyperpigmentierte Herde wurden häufiger beobachtet als hypopigmentierte. Das Überwiegen der Hyperpigmentierung ist möglicherweise auf die Gegenwart von Malassezia furfur zurückzuführen, da der Erreger in den hyperpigmentierten Herden besonders reichlich gefunden wurde. Die genetische Übertragung einer Anfälligkeit für Pityrasis versicolor wurde durch unsere Untersuchungen nicht gestützt, obwohl wir feststellten, daß 17,7% unserer Patienten eine positive Familienanamnese hatten. Das Auftreten der Pityriasis versicolor war in den Sommer- und Frühlingsmonaten häufiger (89,7%) und nahm während der Herbst- und Wintermonate langsam ab. Dieses gehäufte Auftreten der Pityriasis versicolor ist möglicherweise durch das heiße Klima während der Monate von April bis September in Kuwait bedingt. Unsere Untersuchungen deuten darauf hin, daß das Schwitzen keine Rolle für die Intensität oder die Ausdehnung der Herde bei der Pityriasis versicolor spielt. Es scheint eher wahrscheinlich, daß das Schwitzen ein wichtiger Faktor für die Entstehung unangenehmer Symptome bei der Pityriasis versicolor ist, wenn diese Infektion bereits vorliegt.     

Thyrotropin receptor antibodies associated with post-operative relapse of thyrotoxicosis in a pregnancy complicated by neonatal thyrotoxicosis

This case describes the clinical, biochemical and immunological features associated with relapse of thyrotoxicosis during pregnancy in a patient who had recently undergone a subtotal thyroidectomy for Graves' disease. The baby, shortly after birth, showed clinical and biochemical features of thyrotoxicosis which responded to carbimazole therapy. Thyrotropin receptor antibodies and thyroid stimulating antibodies were present in the blood of the mother and baby. The clinical course of the neonatal thyrotoxicosis correlated with the TSH receptor antibody levels.     

Maternal narcotic abuse and the newborn.

In 50 infants born to women who continued to take heroin during all or part of their pregnancy the drug withdrawal symptoms were mild and were noted in 21 infants (42%). Only nine infants required treatment. Sudden infant death syndrome occurred in two infants at 4 and 6 months.     

Risk Factors for Mortality in Patients with COVID-19: The Kuwait Experience

ObjectivesTo describe the baseline characteristics and to evaluate the risk factors for in-hospital mortality in patients admitted to hospitals with coronavirus disease (COVID-19) in Kuwait.Subjects and MethodsThis retrospective cohort study analyzed data of patients admitted to two hospitals in Kuwait with COVID-19. The outcome was assessed by using multivariable analysis of factors affecting survival and mortality.ResultsIn 962 patients, the case fatality ratio was 9.04%. The mean age of nonsurvivors was 63.5 ± 14.8 years, and most deaths occurred in males (80.5%). For the whole sample, the source of transmission was significantly related to mortality and the median duration of in-hospital stay was 15 days (interquartile range: 2–52 days). In patients with high oxygen requirements, the case fatality rate was 96.6%. Multivariable analysis identified age, hypertension, cardiovascular disease (CVD), and dyspnea on presentation as independent risk factors for COVID-19 mortality.ConclusionsThe mortality rate was higher in older patients with comorbidities such as hypertension and CVD. Early recognition of high-risk patients may help to improve care and reduce mortality.