Varicella-zoster infection in adult males: risk factors for varicella-zoster virus pneumonia

To study the risk factors for varicella pneumonia [VP] in adults and to predict the early progression to severe pneumonitis in order to establish early therapeutic intervention. Prospective study. Infectious Diseases Hospital. Fifty-two male patients with VP and 52 Varicella patients without pneumonia as control. Beside history taking and routine work-up, all cases were subjected to arterial blood gas analysis, and hypoxemic index [HI] was calculated as an indicator for severity of pneumonia. Arterial blood gas analysis. Occurrence of VP. Univariate analysis revealed significant associations between pulmonary findings, chronic diseases, severe varicella rash and smoking in patients with VP than those without pneumonia [p = 0.001, 0.03, 0.001, 0.03 respectively]. Blood gas analysis showed significantly lower mean values of PaO[2], SaO[2] and hypoxemic index in patients with VP than controls [p = 0.001]. However, the mean PaCO[2] was significantly higher in the same patient group [p = 0.001]. Multivariate analysis demonstrated that older age, clinical pulmonary findings, severe varicella rash, low PaO[2], low HI and FDPs > 1000 were significantly associated with VP. In adult males with VP, presence of HI < 150, generalized radiological pulmonary opacities, FDPs > 1000, low PaO[2] and SaO2% could be considered good predictors of progression to serve VP. These factors should alert the physician for an early intervention as VP is potentially lifethreatening

Knowledge, awareness, and practices concerning breast cancer among Kuwaiti female school teachers

Breast cancer is by far the most frequent cancer of women. However the preventive measures for such problem are probably less than expected. The objectives of this study are to assess the breast cancer knowledge and awareness and factors associated with the practice of breast self examination [BSE] among female teachers. This study is a cross-sectional survey of teachers working in schools in Al-Jahra, governorate. A sample of twenty schools was selected randomly by the stratified sampling method from all schools of the selected governorate that included primary, intermediate and secondary schools. All ever married Kuwaiti female teachers working in the selected schools were asked to fill a self administered questionnaire to investigate their knowledge about the risk factors of breast cancer, their awareness and screening behaviors. Data were collected from 421 female teachers with 87.5% response rate. The results of the study showed that 67.5% of the participants declared that they had information about breast cancer and their sources of information were mainly health professionals/workers [98.2%], friends/neighbors [83.5%], TV/Radio [76.0%] and printed materials [60.2%]. Of the participants, 18.5% reported positive family history of breast cancer, 49.9% did not know how to practice BSE, 29.0% knew the procedure but never applied it. Moreover, 81.9% has no breast examination by health professionals and 85.7% did not know what the mammography is. The factors that may have an impact on acquiring satisfactory level of knowledge were, women older than 40 years, married, user of contraceptive pills, with a history of child death. The study points to the insufficient knowledge of female teachers about breast cancer and identified the negative influence of low knowledge on the practice of BSE

Low birth weight, and risk factors in Kuwait 2006 a case control study

Low Birth Weight [LBW] and preterm birth [PB] are known risk factors of infant mortality, stunted growth and major morbid conditions for children, adolescents and adults. The association with diabetes, obesity and cerebrovascular disease [CVs] has been frequently reported. The major aim of the study was to assess the magnitude of the LBW in Kuwait, point out the probable risk factors and advice on the mitigations. Material and The study is based on analysis of the 2006 birth data; a case control study in which, 4458 LBW and 4456 normal birth weight [NBW] were compared. The newborn, maternal and environmental variables were elicited. Females had a higher incidence of LBW [52.2%]. More Kuwaiti newborns [63.9%] were included in the LBW group compared to the control and the differences in the distribution were statistically significant. The gestation age amounted to 36.2 and 39.1 weeks for the LBW and NBW. LBW was similar in all the health regions except slightly higher proportion in Farwania [23.9%] and Ahmadi [21.6%]. The incidence per 1000 life birth was lower in the 1992-2008 showed a persistent rise starting from 1995 for the Kuwaiti and the Non Kuwaiti. The age of the mothers were similar, however the difference in the father age was lower in the LBW group. The incidence according to the age of the mother showed a higher incidence with the group, <20 and over 45+. Newborns delivered in the Government hospitals were more likely to have LBW, probably a selection bias since the maternal complicated cases are better handled in the government hospitals. Primigravidas had more LBW [58.1%] compared to the multigravidas [47.6%] a history of a early neonatal deaths abortion, still birth and giving birth to a preterm baby were higher with the LBW mothers. The different pregnancy complications except for cord complications and retained placenta were higher among the LBW. LBW is relatively high and the incidence is growing the development of the obstetric management and innovation of fertility treatment may cause a higher incidence of the extremely low birth weight [ELBW], the proportion is already high and is rising

Awareness and implementation of hypertension guidelines in primary health care in Kuwait

World Health Organization / International Society of Hypertension [WHO/ISH] guideline makes recommendations on primary care management of hypertension. Hypertension control is based on physician awareness and familiarity with these guidelines and their attitudes in clinical practice. This study aimed to evaluate primary health care [PHC] physicians' awareness and attitude towards WHO / ISH guidelines for management of hypertensive patients, and their opinions regarding barriers for implementation of these guidelines. The study is a cross-sectional survey that was conducted from September to October 2008. Self-administered questionnaires were distributed to all physicians currently working in all PHC centers in the five health regions in Kuwait. The questionnaire included data about personal characteristics, level of knowledge and agreement with [WHO / ISH] guidelines as well as implementation of the guidelines and questions related to barriers to improve their hypertensive patient management. Although most physicians [90.7%] were familiar with the new WHO / ISH guidelines. 83.4% of them were in agreement with. Also, it was found that only 26.7% always follow these guidelines, 56.7% sometimes follow them. The median value of the correct answers was 5 from 10 statement with a range from zero to 9. About one fifth of the physicians [20.5%] could not attain 5/10 score, and none chose correctly the 10 correct statements. Results suggest that participants, in their clinical practice, accept higher BP levels than recommnended in clinical practice. Also, they tend to give more attention for hypertensive patients with co-morbidity. The most important barriers for improvement of hypertension control, that physicians stated, were lack of time, non availability of the drugs in the clinic, lake of patient knowledge, poor patient compliance to life style modifications, non adherence of patients to their medications, and follow up by different physicians. The results of this survey indicate that there is an urge tit need to establish nationwide educational and quality monitoring programs to facilitate the implementation of new hypertension guidelines vi PHC clinical practices in Kuwait

Knowledge and perception of primary health care doctors towards bariatric surgery in morbid obesity

Little is known about the level of knowledge and comfort with bariatric surgery among primary health care physicians. This study aims to explore the knowledge and perception of primary care doctors towards bariatric surgery in morbid obesity. The study design is a cross sectional descriptive one that was conducted from October to December 2007 including the Capital, Hawalli and Farwanyia health regions. Self-administered questionnaires were distributed to all primary care physicians currently working in 50 centers in the selected regions. The questionnaire included data on their personal characteristics, their perception and knowledge about the use of bariatric surgery in morbid obesity. Simple descriptive statistics were used. Of 259 participating physicians, 63.7% believed that morbid obesity was best controlled with diet regimen and exercise alone. Only 11.6% thought that surgery was the best method for dealing with morbid obesity. About one third of primary care physicians did not know the most common complications and side effects of bariatric surgery. Moreover, the majority of them did not have knowledge about the specific types of the surgery. However, 71.8% of them were interested to receive information about bariatric surgery. Additionally, 73.7% correctly listed a body mass index of 40 kg/m2 as qualifying for bariatric surgery in case of obesity without co-morbidities, whereas 56.8% correctly listed a body mass index of 30-40 kg/m[2] as qualifying for the surgery in case of obesity with co-morbidities, and 88.8% could define bariatric surgery as a group of surgical procedures to treat obesity. Only 27.8% were familiar with vertical bandage gastroplasty as a restrictive procedure, only 3.9% of the respondents listed correctly that bariatric surgery is safe in adolescent, and 22.4% knew that the average percentage of the excess weight loss after the surgery is 60%. Of the participants, 42.9% and 71.0% did not know the cause of Dumping syndrome and the most common risk of early death after the surgery respectively. Low level of knowledge and misconceptions about bariatric surgery exist among primary health doctors despite the increasing frequency of these procedures. Educational programs need to be designed to assist them in treating morbid obesity

Hematological changes in malaria: relation to plasmodium species

To evaluate different hematological changes in patients with malaria and to establish a possible role of Plasmodium species in the pathogenesis of these changes. Hematological changes were prospectively studied in randomly selected patients, immediately on admission and on a daily basis after starting anti-malarial treatment. Infectious Diseases Hospital, Kuwait, during the year 2004. The study enrolled 103 patients with malaria, [37 infected with Plasmodium falciparum, 34 infected with Plasmodium vivax, and 32 infected with both species i.e., mixed infections]. Antimalarial drugs Beside history taking, clinical examination, and routine laboratory work, thick and thin blood films were prepared and examined from all patients for defining the species involved. In addition, blood picture [red and white blood cells, platelets, and reticulocytes] was studied in all patients. Anemia and thrombocytopenia were the two most important hematological abnormalities seen in cases of acute malaria infection. The degree of anemia was related more to P. falciparum infection, while, thrombocytopenia was associated with P. vivax infection and mixed infections. Hematological changes were mild in the first 24 hours, but continued to deteriorate for few days after anti-malarial therapy. One P. falciparum infection was associated with severe hematologic abnormalities, disseminated intravascular coagulopathy [DIC], and acute respiratory distress syndrome [ARDS]. We recommend that subsequent checkup of blood cells and platelets are of utmost importance particularly in cases infected with P. falciparum or mixed infections

Knowledge and attitudes towards HIV/AIDS of a population of primary health clinics attendees in Kuwait

This study is the first step towards establishing a knowledge base to help health educators towards their goal of combating the spread of HIV/AIDS in Kuwait. Six hundreds primary health care clinic attendees from 15 years of age and above in two governments of Kuwait completed the questionnaire during July 2006 - January 2007. Collected data included demographic characteristics, knowledge about HIV/AIDS and its modes of transmission, sources of information and attitudes towards the disease. Knowledge were scored and accordingly were categorized as good and poor. Simple description of collected data was followed by analysis of factors that may affect knowledge score. The findings indicated that the respondents had a fairly good to excellent knowledge about AIDS. The correct answers ranged from 35.5% to about 98.2%. Concerning the source of information, mass media was the main source of information among higher proportion of those with good knowledge score. Negative attitudes towards individuals who have contracted HIV were highly prevalent in the studied sample particularly regarding patients isolation and ending relationship with a friend infected with HIV/AIDS. However, positive attitudes were observed regarding testing for HIV/AIDS before marriage, informing others from HIV positive cases and teaching the disease to high school students. Multiple logistic regression analysis revealed that married and highly educated participants and those who got information from mass media were more liable to have good knowledge. Although participants have fairly good knowledge they have mainly negative attitudes towards AIDS and people with AIDS. Mass media were the main source of information. Such findings suggest that health educational programs should be encouraged and these might have the potential role to limit the emergence of HIV/AIDS epidemic in Kuwait

Metabolic syndrome among adults attending obesity clinics in Kuwait

Was to determine the main characteristics of adults attending obesity clinics in Kuwait and the prevalence of the metabolic syndrome [MS] among them. The study design is cross sectional one using data collected from 617 adults aged 15 years and over attending two obesity clinics in primary health care centers during April - May 2007 in Kuwait. The metabolic variables analyzed were fasting blood glucose [FBS], high density lipoprotein cholesterol [HDL], and triglycerides [TG]. In addition, measurements of obesity such as body mass index [BMI], and waist circumference [WC] as well as blood pressure were taken. Six hundred seventeen apparently healthy men arid women were recruited for participation in this study. Weight, height, waist girth, and blood pressure were recorded using standard procedures. Blood samples were taken after an overnight fasting and analyzed. The study revealed that the majority of adults attending the selected clinics were suffering from obesity [74.2%]. Abnormal physical and biochemical measurement were encountered among 86.5% of the participants for WC, 34.0% for diabetes, 63.5% for HDL, 25.6 for TG and 45.9% for high blood pressure. The prevalence of the metabolic syndrome was 46.8%. Comparing the main characteristics of the MS and non-MS subjects showed significant differences in almost all the variables except for nationality and smoking. Female gender, increased age, obesity and sedentary life style were significantly associated with MS. Metabolic syndrome is present in 46.8% patients aged 15 years and over. Low HDL, hypertriglyceridemia, obesity, increasead waist circumference, and high blood pressure were the most prevalent associated factors in this study

Postmortem diagnosis of diabetes mellitus: comparative study of the diagnostic value of commonly used parameters

In medico-legal practice, undiagnosed diabetes has been suggested as a possible cause of death in otherwise unexplained deaths, and the postmortem diagnosis of diabetes mellitus can be of utmost importance for confirming death from metabolic derangement, or if medical malpractice is suspected. The aim of the present work was to study and compare the usefulness of some markers to diagnose diabetes during postmortem examination, and to ascertain their sensitivity and specificity. The study was conducted on vitreous humor and blood samples collected from 68 cadavers during postmortem examination. Based on medical records, cases were classified into two groups [31 cases with previous diagnosis of diabetes mellitus, and 37 cases without such diagnosis]. Collected samples were analyzed for fructosamine in blood; glycated hemoglobin; fructosamine, glucose and lactate [to determine glucose plus lactate] in vitreous humor. The results obtained in the present study indicate that the measurement of glycated proteins [fructosamine] in vitreous and serum, glycated hemoglobin, and the combined glucose and lactate levels in vitreous humor are useful indicators for diagnosis of diabetes mellitus in postmortem settings. The differences among the discriminatory potentials of the studied parameters were not statistically significant [as determined by comparing the areas under the receiver operating characteristic -ROC- curve]. The diagnostic potential of any of the studied parameters surpasses that of glucose levels in vitreous humor

Discharges of patients from general hospitals against medical advice in Kuwait [1999]

This study tries to determine the main diagnoses of patients discharged against medical advice [AMA] as well as their demographic features. Data used were collected from hospital discharge summaries from general hospitals in Kuwait for the year 1999. The target population was all patients discharged AMA, equal sample discharged with physician approval matched by age and sex was selected as controls. Data from general hospitals in Kuwait revealed that patients discharged AMA constituted 6.0% from all discharges from these hospitals in 1999. Farwania and Jahra hospitals had the highest proportion of discharge AMA. The results also revealed that AMA group differed significantly from routinely discharged group in a number of factors including, nationality, type of admission, average length of stay and discharging diagnoses. Patients discharged AMA had serious untreated conditions like abnormal laboratory findings, possible delivery complications and ischaemic heart diseases. The results revealed that the risk of discharge AMA increases among Kuwaiti nationality, single, patients admitted through casualty, patients suffering from possible delivery complications and patients suffering from ischaemic heart diseases

Youth and middle aged mortality in Kuwait [1987 - 1998]

This study assesses the proportionate mortality [PM] from the major causes of death among youth [20-34 year] and middle-aged population [35-64 year] in the years 1987-1998 in Kuwait. Deaths in the records were classified according to the Ninth Revision of the international Classification of Death [ICD-9], proportionate mortality computed for all causes of death combined and for the upper ranked 10 cause groups. The results revealed that PM among youth increased significantly from 7.6% in the pre-invasion period [1987-1989] to 10.8% in the early post-invasion period [1991-1994] and then started to decline reaching to 9.8% in the late post-invasion period [1995-1998]. On the other hand, the PM among middle aged population increased steadily from 32.1% in the pre-invasion to 33.3% and 34.9% in the post-invasion periods. The study also revealed that fatalities due to external causes constituted a major health problem among youth in Kuwait and the main cause of death is road transport accidents which accounted for 28.5% of all deaths among youth each year during the study periods. The second and third causes were ischaemic heart disease [7.6%] and consequences of violence [6.8%]. On the other hand, fatalities due to cardiovascular diseases constituted a major health problem among the middle aged individuals and the three leading causes of death were ischaemic heart disease. hypertensive disease and road transport accidents respectively Digestive system malignancy ranked fifth and malignancy of respiratory and intrathoracic organs ranked tenth. The results revealed that the main causes of death are the same among Kuwaiti and non-Kuwaiti segments with some differences in ranking order and frequency