Aspects of imported malaria at a district general hospital in non-endemic Kuwait,Arabian Gulf

There is no indigenous mosquito-borne transmission of malaria in Kuwait. However, in a five year period at a district general hospital, the number of laboratory-diagnosed cases of malaria increased annually from 25 to 84, a rise of 336%. Except for two induced infections, all were imported, mainly from the Indian subcontinent. Plasmodium vivax was responsible for 87.29% of the cases; P. falciparum (12.05%), a mixed infection of P. vivax and P. falciparum (0.33%) and a case of P. ovale (0.33%) were also identified. Rapid preparation of acetone-fixed, Giemsa-stained thick blood films, a heightened awareness of the infection, examination of multiple samples of blood from patients and the general resurgence of malaria in endemic areas were some of the factors responsible for the high number of cases diagnosed. Most patients were young males and presented with clinical malaria due to P. vivax between May and October each year, an apparent seasonal peak. However, many were already resident in the country for a variable period. Patients with P. falciparum though, presented clinically within two weeks of arrival in the country. Parasite densities were calculated to monitor the progress of treatment and identify quickly any possible chloroquine-resistant P. falciparum strains. A policy of active prophylaxis is suggested to stem the tide of imported malaria.Corresponding author.     

Factors determining the performance of medical students of the Faculty of Medicine, University of Kuwait

An investigation was undertaken to determine the factors influencing performance of medical students at the Faculty of Medicine, University of Kuwait. Data were collected for the first batch of 42 candidates who successfully passed the 7-year medical programme. Results showed high correlations between high-school admission grades and subsequent performance during the medical programme. Similar results were also obtained with English proficiency. A partial correlation controlling for English proficiency, however, showed a systematic decline in the magnitude of the correlations between high-school grades and performance during the medical programme. In fact the relationship between high-school GPA and clinical GPA was non-significant. A prominent influence of English proficiency on performance is indicated.     

GENDER AND AGE DIFFERENCES IN ANEMIA PREVALENCE DURING THE LIFECYCLE IN KUWAIT

Anemia remains a significant worldwide public health problem. Most studies of anemia and iron deficiency, the major cause of anemia, have targeted small children and reproductive age women. Much less is known about anemia in other lifecycle groups, especially preschool age children, prepubertal boys and girls, or in older adults. Yet recent studies indicate that anemia may increase the risk for chronic diseases and accelerate declining function in older adults. We examined anemia throughout the lifecycle in Kuwait by analyzing data from the 2002 Kuwait Nutrition Surveillance Program. Over 13,000 individuals of both sexes representing all ages were studied. The prevalence of anemia was higher in females than males between 6 months and 3 years. From age 4 to 14 years, there was a reversal with males having a higher rate of anemia. Older females had a lower prevalence of anemia than younger females. These results imply certain policy options.     

Significance of early two-dimensional echocardiography after acute myocardial infarction

We performed serial two-dimensional echocardiography (2D echo) in 35 patients with a first transmural myocardial infarction, to correlate initial left ventricular wall motion abnormalities with subsequent in-hospital cardiac complications, peak total creatine kinase level, and haemodynamic alterations, and to observe serial changes in the left ventricular wall motion. A wall motion score was derived by analysing endocardial motion in 15 left ventricular segments. Left ventricular wall motion could be analysed in 30 patients, 14 without (Group 1) and 16 with complications (Group 2). The initial wall motion score in Group 1 patients was 5.2 +/- 0.7 (+/- SEM) compared to 14.2 +/- 1.2 in Group 2 patients (P less than 0.001). A wall motion score of greater than or equal to 10 correlated with the occurrence of complications in 15 of 16 patients (sensitivity 93%, specificity 92%). Initial wall motion score did not correlate significantly with peak total serum creatine kinase and did not change significantly during the first 72 hr in both the groups. In 12 patients who underwent right heart catheterization together with 2D echo, the average wall motion score was 16.4 +/- 2.0 and cardiac index 2.4 +/- 0.3. Wall motion score correlated inversely with the cardiac index in these patients (r = -0.78; P less than 0.01). Thus, 2D echo performed in first transmural myocardial infarction patients soon after admission can identify those likely to have in-hospital complications. 2D echo wall motion score correlated significantly with the cardiac output in this study.     

Influence of HumDN1 VNTR polymorphism on DNASE1 expression in systemic lupus erythematosus and rheumatoid arthritis

The purpose of this study was to analyze the effect of the HumDN1 VNTR polymorphism on DNASE1 mRNA expression and enzyme activity in lupus (SLE) and rheumatoid arthritis (RA) compared to healthy control (HC). Kuwait subjects (n?=?500) matched by age/gender/ethnicity were genotyped by fragment-analysis. DNASE1 expression was analysed using quantitative Real-Time-PCR and sera from subjects were screened for DNase1 reduction activity by ELISA. Allele and genotype distribution of HumDN1 VNTR revealed a significant association with susceptibility to SLE and RA (p?<?0.05, OR?>?1). Relative expression analysis revealed a significant increase in DNASE1 mRNA in SLE (p?=?0.0001) and RA (p?=?0.002) compared to HC. Stratification of subjects revealed, increased DNASE1 expression in SLE with 5/5 (p?=?0.0001), 3/4 (p?=?0.0001) and 3/5 genotype (p?=?0.01). A reduction in DNASE1 expression was specifically observed in SLE with 4,4 genotype (p?=?0.0004). RA patients with 3/4 genotype (p?=?0.02) showed a significant increase in DNASE1 expression. Similarly a significant association was observed between DNase1 reduction activity and SLE (p?=?0.0001). SLE patients with 3,4 (p?=?0.0001) and 5,5 genotype (p?=?0.0001) showed increased DNase1 reduction activity, while a lack of association was observed with RA. The present study is the first to reveal the effect of HumDN1 VNTR on DNASE1 expression in SLE and RA.     

Glycemic control in Kuwaiti diabetes patients treated with glucose-lowering medication

BackgroundDiabetes is prevalent in Kuwait. We aimed to assess the level of glycemic control in Kuwaiti adults with diabetes.MethodsThe World Health Organization’s STEPS non-communicable disease risk factor survey was conducted in Kuwait in 2014. Participants’ demographics, medical history, physical measurements and blood biochemistry were assessed. A total of 2561 Kuwaiti men and women aged 18–69 years completed all three survey steps. Glycemic control in 278 individuals with diabetes who were on glucose-lowering medication was determined using the US National Institutes of Health guidelines of fasting plasma glucose (FPG) ≤7.2 mmol/l and the American Diabetes Association guidelines of glycated hemoglobin (HbA1c) <7% (53 mmol/mol).ResultsAdequate glycemic control in people with drug-treated diabetes was 34.5% when determined by HbA1c, 37.8% when determined by FPG level, and 24.5% when both criteria were met. Mean body-mass index and fasting serum triglycerides were significantly higher and serum high-density lipoprotein-cholesterol significantly lower in individuals with an inadequate glycemic control than in those with adequate control. Women with diabetes were almost twice as likely to have inadequate HbA1c levels as men with diabetes (OR, 1.9, [95% CI, 1.03, 3.5]).ConclusionsGlycemic control in Kuwaiti adults with treated diabetes is low. A systemic, multi-disciplinary public health approach is needed to improve diabetes education and adherence to treatment.     

The Psychometric Properties and Correlates of the Reynolds' Suicide Ideation Questionnaire with Kuwaiti and American Students

In samples of Kuwaiti (n = 460) and American (n = 273) college students, the Reynolds Suicide Ideation Questionnaire (SIQ) proved to have good internal consistency and concurrent validity with measures of anxiety, optimism, pessimism, death obsession, obsession-compulsion, and ego-grasping. The SIQ was factorially complex in both samples, but the eight critical items showed a similar two-factor pattern in both samples. It is important to note that in spite of the great differences between Kuwait and US students and their cultures, the findings were quite similar. By and large, the psychological correlates of the SIQ may have cross-cultural generality.