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PubMed2003

The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic.

OBJECTIVES: The aims of this study are to assess the feasibility of the Atraumatic Restorative Treatment (ART) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars. METHODS: This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001. The ART and amalgam restorations were placed randomly on comparable pairs of primary molars, if available. In addition, the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment. The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001. The mean follow-up period for the restorations was 8.3 months in the first assessment (2000) and 22 months in the second assessment (2001). The assessment was possible for 35 children (mean age = 5.7 years), 18 of whom had comparable pairs (n = 35 pairs) of restorations in their primary molars. In addition, 48 other ART restorations were assessed in 2000 and 42 in 2001. RESULTS: In a 2-year follow-up, 89.6% of all ART restorations were considered successful. The failure rate of the comparable pairs of ART and amalgam restorations was 5.7%. There was no significant difference in success rate between ART and amalgam techniques. CONCLUSIONS: Based on a 2-year follow-up evaluation, the class I ART restorations seemed to have a high success rate, indicating the appropriateness of the ART approach in primary teeth.

Chi-Square Distribution↗

PubMed2001

Initiation factors for substance abuse.

AIM: The study reported in this paper investigated factors that led to the initial use and abuse of drugs in 237 addicts receiving treatment at the Psychological Medicine Hospital, Kuwait. METHOD: A self-administered questionnaire was designed to elicit information regarding socio-demographic data and initiation patterns. Questions about initiation patterns were related to personal, familial and social variables in addition to accessibility to drugs. RESULTS: Almost all the sample were male (99.2%) and 42.6% were married. The findings were grouped into (1) factors associated with drug abuse and (2) initial/ significant factors for drug abuse. One way ANOVA showed that there was a significant statistical association between current age and source of drug. Also, there was a significant statistical association between the age of the addict when first started on drugs, and the source of drugs. Multiple regression analysis was also computed for initial significant factors. One factor 'excessive unsupervised free time' was statistically significant. RECOMMENDATIONS: Strategies for primary, secondary and tertiary interventions in addition to recommendation for further studies are suggested.

Adult↗

PubMed1999

Bartter's syndrome in Arabic children: review of 13 cases.

BACKGROUND: Bartter's syndrome (BS) is an inherited disease of renal potassium wasting characterized by hypokalemic alkalosis, normal blood pressure, vascular insensitivity to pressor agents and elevated plasma concentrations of renin and aldosterone. It is caused by generalized hyperplasia of the juxtaglomerular apparatus at the site of renin production caused by mutations in the Na-K-2Cl cotransporter gene, NKCC2. The objective of our study is to establish the prevalence and incidence of BS in Kuwait and to assess treatment modalities for it. METHODS AND RESULTS: Bartter's syndrome was diagnosed in 13 Kuwaiti children over a 14 year period (1981-1995) with the estimated incidence of 1.7/100,000 live births. The mean age at diagnosis was 9.3 months (range 2-32 months). There were five males and eight females (ratio 1:1.6). The mean duration of follow up was 5.6 years (1-14 years). Both consanguinity and familial history among our patients were high (69 and 54%, respectively). All patients had hypokalemia, hypochloremia with metabolic alkalosis, hyperreninemia and were normotensive. Clinical presentation was essentially similar to that in other series. Eleven patients (85%) had growth failure, two had nephrocalcinosis (15%) and one had renal failure. All patients were treated with supplemental potassium, an aldosterone antagonist (spironolactone) and a prostaglandin synthetase inhibitor (indomethacin or aspirin) sequentially. Significant catch-up of growth (four patients) and increases in serum potassium (eight patients) were recorded after administration of indomethacin therapy. One patient died of severe pneumonia with respiratory failure from hypokalemic myopathy. Clinical presentation, inheritance, complications and therapy of BS are briefly discussed. CONCLUSION: Bartter's syndrome is a rare disease, but should be considered in the differential diagnosis of other disorders with growth failure and/or hypokalemia. Early diagnosis, close follow up and compliance with treatment may lead to appropriate growth and development.

Bartter Syndrome↗

PubMed2001

Impact of glycemic control on serum lipoprotein (a) in Arab children with type 1 diabetes.

BACKGROUND: Lipoprotein (a) (Lp (a)) is an independent risk factor for coronary artery disease (CAD), a major cause of death in patients with type 1 diabetes mellitus. Both type 1 diabetes and CAD represent major problems in Kuwait. Data on the effect of metabolic control on Lp (a) in diabetic children are limited and this is particularly true for Arab children. The objectives of the present study were to analyze serum Lp (a) levels in patients with type 1 diabetes compared with non-diabetic children, taking into account the effect of glycemic control. METHODS: Circulating lipids, including Lp (a), were measured in serum samples from 60 prepubertal non-diabetic children and 58 prepubertal children with type 1 diabetes. Comparisons of Lp (a) concentrations were made between the non-diabetic and diabetic children with good to fair control (glycosylated hemoglobin (GHb) <11%) and a group of diabetic children with poor control (GHb > or = 11%). RESULTS: The mean serum Lp (a) level in all diabetic children was 187.62+160.43 mg/L, compared with 162.88+156.06 mg/L in the control group. The group of children with poor glycemic control had higher median Lp (a) levels (147.50 mg/L) than either the group of diabetic children with good to fair control (95 mg/L; P<0.028) or the group of non-diabetic children (125 mg/L; P<0.04). Moreover, 38.3% of poorly controlled diabetic children had elevated Lp (a) levels > or = 250 mg/L, compared with 12.5% of diabetic children with good to fair control and 16.7% of non-diabetic children (P<0.025 and P<0.039, respectively). No association was found between Lp (a), diabetes duration and insulin dose. CONCLUSIONS: In Arab children, highest Lp (a) levels are associated with poorest metabolic control. The prevalence of Lp (a) levels associated with cardiovascular risk is higher in poorly controlled diabetic children. Increased levels of Lp (a) may be another contributing factor to the high risk for CAD in diabetic patients.

Arabs↗

PubMed2002

Drug-resistant Plasmodium falciparum infection in immigrants and non-immune travellers.

OBJECTIVE: To detect the incidence of drug-resistant Plasmodium falciparum malaria infection in immigrants and travellers in non-endemic Kuwait. METHODS: Over a period of 3 years, July 1995 to September 1998, 1352 malaria patients were enrolled in the study. Of these, 1293 were immigrants from countries where malaria is endemic and 59 were non-immune travellers with a recent history of travel to these countries. The in vitro drug sensitivity was determined in 892 patients. RESULTS: In all, 892 of 1352 (66.0%) P. falciparum isolates were successfully cultured in vitro for drug sensitivity and 419 (47.0%) isolates showed in vitro resistance to chloroquine or mefloquine. Fifty-six (13.4%) isolates were resistant to both drugs. Chloroquine resistance was observed in > 70% of the isolates from Africa and India followed by Pakistan (39.9%) and Bangladesh (35.9%). The resistance to mefloquine ranged from 26.2% in isolates from Sri Lanka to 47.5% in isolates from African countries. CONCLUSION: The study highlights the important trend in drug resistance in P. falciparum malaria in immigrants from south-east Asian and African countries.

Adult↗

PubMedDate not supplied

Childhood lichen planus: a report of 23 cases.

Lichen planus (LP) in children is a rare entity. We report 23 cases of childhood LP seen over a period of 7 years. Ninety-six percent of the children were of Arab ancestry. There were 52% boys and 48% girls. Classic LP was the most common clinical variant (70%), followed by eruptive generalized LP (13%). A majority of the patients had mild, localized disease. Oral involvement was seen in 39% of patients. Topical steroids were the mainstay of treatment in most of the cases. Children with chronic and recurrent disease responded to dapsone therapy, whereas in those with eruptive and widespread disease, UVB phototherapy was found to be safe and effective. The present report highlights the salient clinical features, treatment, and course of LP in children in Kuwait compared to those reported in children of other countries as well as those of adults.

Administration, Topical↗

PubMedDate not supplied

Alopecia areata in children: a clinical profile.

Alopecia areata (AA) is prevalent among children in Kuwait. In this prospective survey we studied 215 children with AA to determine their clinical and epidemiologic features. Ninety-seven percent of the children were of Arab ancestry. Girls outnumbered boys by a 2.5:1 ratio. The peak age of onset was seen between 2 and 6 years of age with a mean age of onset at 5.7 +/- 2.8 years. A majority of the patients (80.5%) had mild disease and extensive disease (more than 50% hair loss) was seen in 13% of the children. A positive family history of AA was obtained in 51.6% of cases and nail changes were seen in 26.5% of the children. The age of onset, a positive family history of AA, and associated atopic disorders were observed to have no influence on the extent and severity of the disease. The results were compared with those reported elsewhere for this age group.

Age of Onset↗

PubMed2000

The Harderian gland of the Dhub lizard Uromastyx microlepis of the Kuwaiti desert: an ultrastructural approach.

Harderian glands exist in the orbits of most terrestrial vertebrates. The basic function of the gland is the lubrication of the eye. The present study was carried out to shed some light on the ultrastructure of the still enigmatic Harderian gland of the lizard Uromastyx microlepis, a common species in Kuwait and other Gulf areas. The Harderian gland of Uromastyx microlepis is well developed, relatively large in size and lingual in shape. The epithelial cells of the anterior part of the gland are characterized by the presence of membrane bound granules of almost homogeneous consistency. These secretory granules are gathered in compartments and separated by membranes and stacks of granular endoplasmic reticulum (GER). Most of the lumina were empty. Moderate amounts of GER, free ribosomes and pleiomorphic mitochondria were observed in the perinuclear area of the epithelial cells. The medial and caudal parts of the gland were rich in special secretory granules, GER, free ribosomes and pleiomorphic mitochondria. The anterior part of the gland could represent the future lacrimal gland of mammals. A network of myoepithelial cells was recognized around the gland tubules. While no melanocytes or lymphocytes were observed in the scarce interstitial tissue, macrophages, that might have an immune function in the gland, were observed.

Animals↗

PubMed1988

Hydatid liver disease: problems in diagnosis in the Middle East endemic area.

Imaging techniques such as ultrasound (US), liver scan and computerized tomography (CT) localize mass lesions in the liver and abdomen, and are valuable tools in the differential diagnosis of hydatid disease. However, we present two cases from Kuwait in the Middle East which demonstrate that these techniques alone are not as accurate as claimed in this geographical area. A sensitive and specific serological test is essential for a pre-operative diagnosis of hydatid disease. Discrepancies between radiological imaging and serological diagnosis are best resolved by cytology of the drained fluid and/or histopathological examination of the excised cyst. Negative serology would indicate ultrasound-guided aspiration of cyst fluid for cytological verification or enzyme immunoassay.

Aged↗

PubMedDate not supplied

Analysis of indoor concentrations of benzene using an air-quality model.

We performed measurements to determine indoor benzene levels in 26 residential houses in Kuwait, located in zones of different activity levels. Pumped (or active) sampling was conducted via use of 12 sampling tubes over a period of 24 hr for both indoor and outdoor concentrations simultaneously. Time-average indoor concentration varied linearly with time-average outdoor concentration in accordance with a mass-balance-based indoor air-quality model in which source and sink terms were incorporated. We used regression analysis to determine benzene adsorption rates, which appear in the removal and source terms of the model. The removal rate parameter varied between 0.12/hr and 2.16/hr, whereas source term parameter varied between 0.60 mg/hr and 76.07 mg/hr. Houses were then divided into three groups according to their benzene source strengths (i.e., < 1.0 mg/hr, 1-10 mg/hr, and 10-50 mg/hr). Qualitatively, these levels depended on the characteristics of occupants (e.g., smoking and gas cooker use, number of cars, and parking area) and location of the building.

Air Pollutants↗

PubMedDate not supplied

Height and lung function in preadolescent children of Kuwaitis and European origin: a pilot survey on health effects of gas cooking in the Middle East.

Spirometric testing, including forced vital capacity (FVC), forced expiratory volume in .5 s (FEV0.5), FEF25-75%, and peak expiratory flow resistance (PEFR), was conducted among 130 10-y-old children (67 Kuwaitis, 63 Europeans) who lived with their parents in the same area in Kuwait city. Lung function of children who lived in houses with gas stoves were compared with those who lived in homes supplied with electric cookers. The FEV0.5 for children who lived in households with gas stoves was significantly lower (average difference, 94 ml; p = .05; corrected to height and sex). Other lung function indices, i.e., FVC, FEF25-75%, and PEFR, were also lower but, after accounting for confounders, were not statistically significant. Children from households that were equipped with gas cookers were approximately 3 cm shorter than children who lived in homes with electric cookers. These findings suggest that children who live in a very hot and dry climate--even with efficient air conditioning systems--are susceptible to the same environmental hazards to which children from other climatic zones are exposed. This susceptibility may be more pronounced before or at the onset of puberty.

Air Pollution, Indoor↗

PubMed2005

Use of interaction cards to evaluate clinical performance.

Currently in-training evaluation in Kuwait depends on the use of the global rating scale at the end of clinical rotation clerkships. Such a scale is inconsistent, subjective, and suffers from deficiencies such as positive skewness of the distribution of ratings and poor reliability. The aim of the study was to assess the inter-rater variation and the reliability of the recently introduced Interaction Card (IC) method for evaluating clinical performance and to measure the agreement between trainees' overall performance evaluation by the currently used global rating scale and the IC summative evaluation. In the study, 370 evaluators encountered 50 trainees during their basic clinical training rotations (internal medicine, surgery, obstetrics and gynecology, and pediatrics) at six hospitals. A total of 9146 encounters were conducted focusing on six clinical performance domains: clinical skills (taking history, case sheet, and physical examination), professional behaviour, case presentation, diagnosis, therapy and handling of emergencies. The method demonstrated significant inter-rater variation in the overall IC ratings according to specialty, rank of evaluator and hospital (p < 0.001). The Interaction Card was found to be reliable, as shown by the internal consistency between the six domains (Cronbach's alpha = 0.914). There was low correlation (Spearman rank correlation coefficient, rs = 0.337), and low agreement (Kappa = 0.131) between the global rating scale and Interaction Cards summative evaluations. The IC method provided instantaneous formative feedback and summative evaluation for clinical performance to trainees. The method can be generalized to encompass training and examinations programmes for all categories of trainees in most clinical specialties.

Clinical Competence↗

PubMed1984

Standards for growth in prepubertal primary school Kuwaiti children, a cross-sectional study.

In a cross-sectional study, anthropometric measurements were made in Kuwaiti primary school children aged six to nine years. The sample included 6765 children, of whom there were 3534 boys and 3231 girls. A minimum of 400 children were included in each of the 16 age-sex groups studied. Anthropometric data are presented as percentiles for weight-for-age, height-for-age, and weight-for-height. The results were smoothed and figures were constructed for the three growth standards. A comparison between locally constructed standards and a Western reference growth standard (Tanner et al.) revealed marked similarities in attainable growth. We think that the Western reference standards are suitable for use in Kuwait and probably in other similar developing countries, and the setting of lower targets for those countries is not recommended.

Age Factors↗

PubMed1986

Hypoparathyroidism in Arab children.

Four children with hypoparathyroidism are reported. We believe that this is the first report of this condition from Kuwait or Saudi Arabia. Treatment and course of disease are discussed. Two children have hypoparathyroidism as part of DiGeorge Syndrome.

Child↗

PubMed1987

Neonatal listeriosis: a report of seven cases.

Seven neonates with listeriosis admitted to Farwaniya Hospital, Kuwait, are reported. Six had the meningitic type and one the septicaemic type. Serotyping showed 1/4b in all neonates. The response to 2 weeks ampicillin and amikacin was excellent with no mortality or morbidity.

Amikacin↗

PubMed1993

Laron dwarfism in the Arabian Gulf: a report of a sibship.

Laron dwarfism is a rare inherited form of short stature. Most cases reported have been in people of Mediterranean origin, particularly Oriental Jews. We describe the first sibship in an Arab Muslim family from Kuwait in the Arabian Gulf. This type of growth hormone insensitivity is caused by defects in the growth hormone receptor gene. The recently available recombinant human insulin-like growth factor I has shown promise as a promoter of growth in children with Laron syndrome.

Age Determination by Skeleton↗

PubMed1994

Autosomal recessive osteopetrosis in Arab children.

Nineteen Arab children including six boys and 13 girls in ten sibships were diagnosed as having osteopetrosis over a 5-year period in various hospitals in Kuwait. Eighteen patients had an isolated autosomal recessive form and one had autosomal recessive osteopetrosis associated with renal tubular acidosis. The mean age of diagnosis was 24 months. Parental consanguinity was high amongst them (68%). Anaemia, hepatosplenomegaly, failure to thrive, recurrent infections and neurological manifestations were common. Associated congenital abnormalities were found in 26%. Deafness, hydrocephalus and dental caries were relatively less common. A high mortality (37%) owing to infection was noted. The medical management and recommendations for patient care are discussed briefly.

Acidosis↗

PubMed2000

Comparison between young and old patients with bronchogenic carcinoma.

The aim of this study was to compare the clinical characteristics, histological type, stage at diagnosis, treatment and survival of young (< or = 45 years) and older patients with bronchogenic carcinoma. The study was designed as a retrospective review of all lung cancer patients referred to the Kuwait Cancer Control Center over a 10-year period from 1985 to 1994. The study comprised 590 patients with primary bronchogenic carcinoma, of whom 72 (12%) were < or = 45 years of age at the time of diagnosis. Median (range) duration of symptoms, percentage of smokers and male to female ratios for the younger and older patients were 8 (2-48) weeks vs. 8 (1-52) weeks (p = 0.9), 74% vs. 83% (p = 0.06) and 5.5 vs. 5.3, respectively. The majority of patients had advanced stage disease at presentation; 91% of the younger patients had stage III or IV compared with 88% of the older patients (p = 0.1). The histological types for the younger and older patients were 32% vs. 20% for adenocarcinoma (p = 0.01) and 33% vs. 45% for squamous cell carcinoma (p = 0.1). There were more patients in the younger group who had surgery (21% vs. 7.5%) than in the older group (p = 0.001). Follow-up data were available for 177 patients out of 190 Kuwaiti national patients (93%). The median (range) survival rates for young and old patients were 8 (3-62) months and 7 (1-174) months, respectively (p = 0.09). Only 6 patients survived for more than 5 years, one (7.6%) from the younger group and 5 (3%) from the older group. Our study shows a relatively high percentage of young patients in our population of lung cancer patients. Apart from the higher incidence of adenocarcinoma in the young group and the fact that these patients had more surgery than the older group, there were no other significant differences between the two groups.

Adult↗