Glucose concentration affects recombinant interferon α-2b production in Escherichia coli using thermo-induction system.

In the present work, a recombinant Escherichia coli strain was used for the production of interferon α-2b in both shake flask and in bioreactor. The first part of this research was focused on the investigation of the effect of glucose concentration on the kinetics of cell growth, recombinant protein production and acetate formation. In general, glucose supplementation to culture medium enhanced cell growth when added in concentration between 0-20 g/L. Further increase in glucose level reduces biomass production and enhances acetate accumulation in culture. The results clearly demonstrated that maximal interferon production of 27.7 mg/L was achieved in culture supplemented with 20 g/L glucose. Further improvement in recombinant interferon production process was also achieved by scaling up from shake flask to 16-L stirred tank bioreactor. The maximal volumetric interferon production in bioreactor batch culture was 44.5. mg/L after only 6 hours.

Analysis of the underlying and multiple causes of death for the Kuwaiti population 40 years and over in Kuwait part I: demographics

Improved health care brought about major changes in mortality pattern; life expectancy has increased and the causes of death are more likely to result from chronic diseases, death rarely result from a single cause and the use of the underlying cause of death [UCD] will overlook many of the contributing diseases that are highlighted by multiple cause of death [MCD] analysis. The paper addresses the demographic and non-clinical variables related to the number of causes recorded in the death certificates notification [DCN]. All the DCN for the Kuwaiti population, 40 years or over for the period 1993-2001 were compiled and all the causes up to five additional causes were recorded. A total of 13960 cases [7966 males and 5994 females], reported in the period 1993-2001, were analyzed. The causes of death were provided according to the WHO ICD9. A single cause [UCD] was reported in 5.6% of the cases, 27.1% had 3 causes and 12.5% had 6 causes. The mean number of causes amounted to 3.64 and 3.8 for the males and females. Variability according to the year was not marked. Those dying in the hospitals had a relatively higher mean number of causes compared to those dying in other places, and this was common to the 2 gender groups. A rising trend was seen with age; with the males the 60-, 70- or 80+ age groups had higher mean number of causes compared to the younger groups. With females the means for the 60- and 70- groups were relatively higher than the other groups, the group 40+ was having lower means Compared to the other groups and this was common to the 2 gender groups, particularly with the males. The UCD alone was reported for less than 7% of the causes of death among the Kuwaiti population 40 years or over. Use of multiple cause of death will add a lot of useful information that can be used to highlight several disease conditions not shown by the UCD

Analysis of the underlying and multiple causes of death for the Kuwaiti population 40 years or over part II: causes

Death rarely results from a single cause; it can be caused by a variety of factors. Multiple causes of death [MCD] can provide information about the associations between causes of death revealing common combinations of conditions; moreover they can rectify inconsistencies in the death certificates [DC]. This paper is meant to highlight the importance of multiple causes of death and point out the contributing and associated disease conditions to the underlying cause of death [UCD]. The study was based on analysis of multiple causes of death for the Kuwaiti population 40 years or over in the period 1993-2001 All multiple causes up to 5 in the death certificate notification [DCN] were coded and analyzed. The data were coded according to ICD9 following the WHO rules. The ratios for the MCD/UCD were computed for the groups of diseases and for individual causes exceeding 50 entries. The relative ratios [Observed/Expected] were computed to show the associations between the groups of causes. A total of 13960 DCNs were analyzed, the ratios were low for neoplasms [1.51], followed by respiratory [2.50], nervous [2.97], and digestive conditions [3.01], ILL-defined conditions had the highest ratio [13.40]. Infections and genitourinary diseases had ratios of 4.19 and 4.56. Ranking changed when using MCD; circulatory, endocrinal, nervous and digestive conditions kept their position, with circulatory diseases on the top and nervous conditions occupying position 10. Relative risk [RR] was computed for the different groups; positive RR was found between infections and respiratory, digestive, genitourinary and ill-defined disease conditions. Neoplasms showed positive association was other neoplasms, and endocrine conditions were positively associated with circulatory, respiratory, and genitourinary conditions. A positive association was found between ill-defined conditions with circulatory and other ill-defined conditions. UCD is still essential to analyze historical trends, compare countries, and guide prevention of death; MCD offer a new sight into the study of mortality. The combination of the 2 methodologies is more useful than the isolated use of either approach. The Collection of MCD is essential, there has been major development in the area and soft ware was developed to analyze MCD data. MOH should start the development of data bases for MCD, make them available, and include the highlights in the MOH annual reports. Special reports discussing individual disease conditions particularly neoplasms and circulatory and respiratory conditions should be organized

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

Low birth weight among Kuwaitis 2002 national pattern

Low birth weight [LBW] is a major determinant of neonatal deaths, it is also a recognized risk of childhood disability, that will compromise the school achievement, and have long term adult health consequences including obesity, type 2 diabetes, hypertension, coronary artery disease and stroke. The principal aim of this study was to estimate the incidence of LBW among Kuwaiti population, point out the pattern and the underlying risk factors from birth certificate notification. Material The present study is based on the analysis of a full year data 2002 for the Kuwaiti births. Notification of birth is mandatory and probably represents total coverage. The demographic information for the parents together with the disease conditions suffered by the mother and any problems with the pregnancy or labor are reported. The gestation in weeks, the weight [gm] of the new born and the length [cm] were registered. The 10th percentile for the weight was 2540 gm very close to the figure 2500 taken to determine the LBW globally, the median was 3240 gm denoting a positive skewness, the proportion of children <2500 amounted to 8.8%, these included the VLBW <1500 [1.3%] and the MLBW 1500-2499 [7.4%]. Significant positive correlation was found between the weight, gestation period and length of the new born. Males had lower proportions of the VLBW [1.3%] and MLBW [6.7%]. The age of the mother and father both significantly affected the incidence of the LBW; the proportions of LBW were higher with the younger age groups. There was no effect for the season but significant differences were found between the different health regions. LBW was lower with better education of the parents and the number of pregnancies decreased. Mothers attending the hospitals, probably at risk, had more of LBW. A past history of preterm, abortion, and heart disease were associated with higher proportions of LBW. The incidence of LBW in Kuwait was higher than that for most developed countries. LBW is a problem of growing dimension in Kuwait. Prevention of LBW though difficult would be a viable option, better maternal care, a follow up study of LBW and the ELBW need to be designed and implemented

Distribution of ABO blood groups and Rhesus factor in Southwest Saudi Arabia

To document the distribution of the ABO and rhesus Rh blood groups in a random sample of Saudi students from the King Khalid University, Abha, Kingdom of Saudi Arabia, and to compare our results from that of other studies in the Kingdom and elsewhere. The subjects included in this study were 944 males from thesouthwest region of Saudi Arabia including Aseer, Jizan, and Najran regions. The ABO blood groups and Rh factor from 944 Saudi males were determined. The frequency of ABO blood groups and Rh status were calculated separately. This study was carried out at King Khalid University, Abha, Kingdom of Saudi Arabia, from January to March 2008, and the ethical approval was obtained from the Research Ethical Committee, College of Science, King Khalid University. The frequencies of ABO groups showed 56.8% for group O, 33.4% group A, 6% group B and 3.8% group AB trend. Only 7.2% of them were found to be Rh-negative. The frequencies of ABO and Rh phenotypes in the southwest population of Saudi Arabia are similar to those reported in most areas of the Arabian Gulf region

Physicians' perceptions about the newly implemented electronic medical records systems at the primary health care centers in Kuwait

Electronic medical record system [EMRS] is expected to improve the quality of patient care and is being adopted by more health care facilities in developed and developing countries. The aim of the paper was to elicit the opinion of the physicians working in the primary health care facilities in Kuwait to the newly introduced EMRS in the government clinics of Kuwait as well as their appreciation of its utilities and advantages. A random sample of 321 physicians response rate [71.3%] working in 78 PHCs, was included in the study. A structured questionnaire was used to elicit the demographic variables, work experience, and opinion as for the quality of the EMRS as regards efficiency satisfaction, improved care and communication. The results indicated a very positive perception of the EMRS by the respondents. They indicated that it provided easier access to their patients' medical history, it was instrumental in quickly reviewing their patients' healthcare data recorded on earlier visits, it provided them better access to the summary of their patient details, and it made easy for them to write referral letters for consultation, among others. However, they found the system lacking on such issues as the system's inability to procure lab results electronically. Better response was found from physicians working in the capital, age length of work experience, and specialty were not significantly different except for communication. Difference in response was also found according to the sex and nationality. Ministry of health would Endeavour to improve the system with the active cooperation of the physicians. It is also suggested that further studies of this type be made at the private healthcare centers and hospitals of Kuwait

Care providers' experience with the newly implemented electronic medical record system at the primary health care centers in Kuwait

Success of any electronic Medical Record System [EMRS] depends heavily on the acceptance of the medical staff to use the system. Many users have resisted computerization, seeing the system as dehumanizing, confusing and uncaring. This study was conducted to evaluate the user interaction satisfaction with the newly implemented EMRS in the primary health care centers in Kuwait, and to compare the pattern of reactions to the implemented EMRS among the PHC providers in Kuwait. A random sample of 321 physicians, 186 pharmacists and 332 receptionists [end users] working at PHC was selected for this study. A structured questionnaire was used to measure the impression of PHC providers working in Kuwait towards computerization. A short form of the user interaction satisfaction questionnaire [QUIS], developed by the researchers from the Human Computer Interaction Laboratory at the University of Maryland, was used for the study. The majority of the respondents reported the system as easy to use. About 48% of the receptionists reported seldom occurrence of system error while 18% of the pharmacists reported the occurrence of such error at all times. PHC providers with more computer experience had more positive views towards the system, education and training positively influenced the attitudes; and younger and less experienced care providers had more positive attitudes. With adequate training, the implementation of computerized health information systems may be effective for PHC in providing better quality health care

Knowledge and factors affecting breast self-examination among Kuwaiti women

To determine the frequency of practicing breast self-examination [BSE] among Kuwaiti females and factors that may influence it Questionnaire based cross-sectional survey Multi-Ministries Compound, Kuwait Data was collected from 966 educated Kuwaiti female volunteers through a self-administered questionnaire. Data regarding the practice of BSE and factors influencing it Among the study sample 357 [37.0%] were practicing BSE. Their mean age was 31.6 +/- 8.8 years. The main reasons for not practicing BSE were fear of cancer discovery [13.5%], forgetfulness and failure to realize its importance [15.3%]. Moreover, 28.9% did not know the method of examination and 27.8% wished to learn. Only 21.6% reported that they did BSE practice on monthly basis. Women aged 20-29 years, married with middle income were insignificantly less likely to practice BSE than other categories. Students were more likely to practice BSE than working ladies [OR = 0.3, 95% CI 0.1-0.7]. There was a lower possibility of practicing BSE among women receiving their knowledge from TV / radio, newspapers / magazines and friends / relatives than those receiving from doctors. Moreover, the possibility of not practicing BSE decreased if the main source of knowledge were friends/relatives, nurse, media/newspapers respectively compared to those with no source of information. The frequency of BSE is low. It appears that a health education and training program will improve the rate of correct BSE performance

Civil identification as a unique patient identifier for hospital in Kuwait

A unified patient identifier is an essential item in improving the quality of health care delivery. This is the trend and major progress has been achieved in many developed and developing countries. In Kuwait each hospital had its own identifier and linking the patient data is rather difficult. The Public Authority for Civil Identification [PACI] Civil Identification number [CID] is the most promising candidate and all the hospitals have been instructed and persuaded to include the CID in the discharge forms, this was stressed since 1995. The aim of the study is to find out the availability of the PACI lCD on the hospital discharge forms. The data-bases storing hospital discharge data for the government hospitals were reviewed for the presence of CID number during the period 1996- 2005. A retrospective approach using the discharge summary data-base of the Statistical and Medical Record Department, MOH, Kuwait was used. The rate of inclusion of the CID was very small in 1996 [13.6%.] increased in 1997 to 30.2% and, remained approximately at that level until 2002. Since 2003 the rates increased substantially and amounted in 2005 to 68.1%. Marked variability was seen between the hospitals, Sabah and lbn Sina were the least reporting, being around 7%, Mobarak and the Chest Hospital scored above 66%. Getting a unified patient identifier is not a goal by itself; it is a step on the road to improve the health services. A major advantage, which was not addressed in this survey, is the inclusion of the CID in the Death certificate. This will provide the potential of linking the 2 data bases at a later stage. PACI CID includes the basic information that can make it an appropriate deterministic identifier. The response of the hospitals is favorable and the system should be field tested

Enteropathogenic Escherichia coli in raw and cooked food.

A total of 402 Escherichia coli isolates were obtained from a variety of food samples and screened for enteropathogenic E. coli (EPEC). Screening was carried out using 15 specific monovalent antisera from Murex Diagnostic Limited. A total of 19 E. coli isolates were serotyped as EPEC. The EPEC strains were shown to belong to 8 serotypes. Eight out of 19 EPEC strains belonged to serotype 018C:K77 (B21). Seventeen out of 19 of the EPEC strains were isolated from cooked food. The presence of E. coli in cooked food is an indicator of fecal contamination and a sign of unhygienic food handling. The presence of EPEC in food could be a potential source of food-borne outbreak. Hygiene training for every food-handler is a necessity.

Indirect hemagglutination antibodies against Burkholderia pseudomallei in normal blood donors and suspected cases of melioidosis in Malaysia.

Interpretation of the indirect hemagglutination test (IHA) for melioidosis in endemic areas is difficult because of the presence of antibodies in apparently healthy individuals. Fifty-three out of 200 healthy blood donors in Malaysia showed positive antibody titers (> or = 1 : 40) against Burkholderia pseudomallei. Seven percent had an IHA titer of 1 : 40, 11% had an IHA titer of 1 : 80 while 8.5% had a titer > or = 1 : 160. Out of 258 sera sent for melioidosis serology, 7% of the patients had an IHA titer of 1 : 40, 9% had an IHA titer of 1 : 80 while 20% had an IHA titer of > or = 1 : 160. If a titer of > or = 1 : 80 is taken as cut off point for positivity, 29% of the patients had positive melioidosis serology. Increasing the positivity threshold may jeopardize the sensitivity of the test. A more specific and sensitive test is needed.

Cryptosporidiosis among HIV positive intravenous drug users in Malaysia.

A study conducted at the Tampin Drug Rehabilitation Center in Malaysia established a high prevalence (23%) of asymptomatic carriers of Cryptosporidium among exposed HIV positive intravenous drug users (IVDUs). A majority of them were young adults and among the ethnic groups, the Malay HIV positive inmates had the highest prevalence of Cryptosporidium infection.

Ipsilateral concomitant fractures of the hip and femoral shaft

Eighteen cases of ipsilateral hip and femoral shaft fractures were treated in our clinics. Eight cases were fractures of the neck of the femur and, 10 were pertrochanteric fractures in addition to femoral shaft fracture. All cases were treated by internal fixation, long D.H.S. was used to fix both fractures in 12 cases, short D.H.S. and D.C.P. in two cases, cancelous screws and D.C.P. in two cases and long 95°Condylar plate in one case. One case of missed fracture neck was operated upon after eight months by short D.H.S. and removal of the intramedullary nail which was used for fixation of the shaft fracture. We found that treating both fractures with internal fixation allows early mobilization, easier patient care, fewer complications, and, shorter hospital stay, despite the seventy of multiple injuries. We concluded that internal fixation of both fractures should be considered to achieve optimum results

Ocular and orbital neoplasms in children

The study included 120 children presented with various ocular and orbital neoplasms. The incidence, the clinical presentations and the investigative findings were thoroughly assessed. The surgical techniques as well as the histopathological features were briefly discussed. The study revealed that retinoblastoma was the commonest primary intracular tumor 43%, followed by hemangioma 13%. Rhabdomyosarcoma was the third in order of frequency 8% and was the commonest primary intraorbital neoplasm

Renal functional and morphological changes after PCNL

Morphology and function of the kidney were studied before and after percutaneous nephrolithotripsy [PCNL] in 54 patients to assess the changes secondary to these procedures. Morphology changes were evaluated using excretory urography and nephrostograms. Renal function was evaluated with renal scintigraphy using 99m-Tc-DTPA and 99m-Tc-DMSA both before and after [PCNL] morphologically, apart from evidence of decompression of the pelvicalyceal system, no other significant changes were observed after uneventful stone extraction. As regards renal function, the data indicate slight decrease in the split function of the involved kidney in 56 of cases and slight increase in 44%. So, there was no statistically significant changes in renal function. So, we can conclude that [PCNL] procedures cause definite but insignificant damage and is well tolerated by the kidney in experienced hands

Conjunctional flap in management of pterygium

Forty four patients having pterygia [36 primary and 8 recurrent] were surgically managed by a rotational conjunctival flap, performed either from the upper or from both upper and lower bulbar conjunctiva. All cases were followed up for at least 6 months. The success rate was 98% in patients with primary pterygia and 84% in patients with primary pterygia and 84% in patients with recurrent pterygia

Fertility in Kuwait: Pattern and trends.

The tree components of population growth are fertility, mortality and migration. The fertility data in this study were collected from various sources; namely, annual reports, Ministry of Public Health Kuwait, Annual Statistical ABSTract, Central Statistical Office and Child and Mother Survey 1987. The study shows that total fertility for Kuwaiti population was high in 1975 and declined in 1985. The gross reproduction and crude birth revealed a similar trend for constant fertility since 1980 for Kuwaiti population. However, for non- Kuwaiti, the three measures of fertility showed a decline. Data for 1974-1980 revealed higher fertility in all age groups for Kuwaitis than non-Kuwaitis mothers, except for the age group 20-24