Correlates of pulmonary function in children with sickle cell disease and elevated fetal hemoglobin

Objective: The current study was carried out to compare pulmonary function tests [PFTs] in pediatric Kuwaiti sickle cell disease [SCD] patients to age-matched normal controls and to investigate the association of PFTs with selected clinical and laboratory parameters

Subjects and Methods: There were 38 patients with SCD and 36 controls in the study. The patients were recruited from the Pediatric Hematology Clinics of Mubarak AI-Kabeer and AI-Amiri Hospitals, Kuwait, and were studied in steady state. The controls were healthy, non-sickle cell siblings of the patients. Forced expiratory volume in 1 s [FEV], forced vital capacity [FVC], total lung capacity, and other PFT parameters were obtained using a constant-volume, variable-pressure, body plethysmograph. Hemoglobin, fetal hemoglobin, serum bilirubin, and lactate dehydrogenase were determined using standard methods

Results: The mean ages of the patients and controls were 10.5+/- 3.2 and 10.5 +/-3.5 years, respectively. The FEV/o predicted of 84.1 +/- 15.4% among the patients was significantly lower than the 92.1 =/- 11.8% in the controls [p = 0.003]. The FVC% predicted was also significantly lower [p = 0.022] in the patients than in the controls, although the values were generally within the normal range. There was no association of FEV] with pain phenotype, acute chest syndrome [ACS], or blood transfusions. Also, there was nosignificant correlation with reticulocytes, bilirubin, or lac-tate dehydrogenase

Conclusions: In this study, changes in PFT, especially FEV1; developed early in the SCD patients. There was no demonstrable association with frequent vaso-occlusive crisis, ACS, and other variables. Hence, there is a need for follow-up studies with serial PFTs to identify vulnerable patients, who might need intervention to prevent early mortality

prevalence of human Bocavirus, human Coronavirus-NL63, human Metapneumovirus, human Polyomavirus KI and WU in respiratory tract infections in Kuwait

Objective: The aim of this study was to investigate the prevalence of human coronavirus [HCoV]-NL63, human metapneumovirus [hMPV], human bocavirus [Boca], human polyomavirus KI [KIV] and human polyomavirus WU [WUV] in respiratory tract infections [RTI] in Kuwait

Materials and Methods: Respiratory samples from 735 hospitalized patients with RTI from September 2010 to April 2013 were evaluated for the presence of HCoV-NL63, hMPV, Boca, KIV and WUV using molecular assays, polymerase chain reaction [PCR] and reverse-transcription PCR

Results: Of the 735 patients, 285 [38.8%] were diagnosed with viral RTI. The distribution of respiratory viruses was hMPV: 15 [5.3%], Boca: 14 [4.9%], WUV: 10 [3.5%] and KIV: 4 [1.4%]. HCoV-NL63 was not detected in any of the samples

Conclusions: These newly discovered viruses were associated with the development of RTI in Kuwait. The rapid identification of these viral infections could aid in the control of nosocomial transmission, reduce the use of antibiotics and improve treatment and management strategies

cost of asthma in Kuwait

To evaluate the direct costs of treating asthma in Kuwait. Population figures were obtained from the 2005 census and projected to 2008. Treatment profiles were obtained from the Asthma Insights and Reality for the Gulf and Near East [AIRGNE] study. Asthma prevalence and unit cost estimates were based on results from a Delphi technique. These estimates were applied to the total Kuwaiti population aged 5 years and over to obtain the number of people diagnosed with asthma. The estimates from the Delphi exercise and the AIRGNE results were used to determine the number of asthma patients managed in government facilities. Direct drug costs were provided by the Ministry of Health. Treatment costs [Kuwaiti dinars, KD] were also calculated using the Delphi exercise and the AIRGNE data. The prevalence of asthma was estimated to be 15% of adults and 18% of children [93,923 adults; 70,158 children]. Of these, 84,530 [90%] adults and 58,932 [84.0%] children were estimated to be using government healthcare facilities. Inpatient visits accounted for the largest portion of total direct costs [43%], followed by emergency room visits [29%], outpatient visits [21%] and medications [7%]. The annual cost of treatment, excluding medications, was KD 29,946,776 [USD 107,076,063] for adults and KD 24,295,439 [USD 86,869,450] for children. Including medications, the total annual direct cost of asthma treatment was estimated to be over KD 58 million [USD 207 million]. Asthma costs Kuwait a huge sum of money, though the estimates were conservative because only Kuwaiti nationals were included. Given the high medical expenditures associated with emergency room and inpatient visits, relative to lower medication costs, efforts should be focused on improving asthma control rather than reducing expenditure on procurement of medication

High resolution computed tomography in asthma

High-resolution computed tomography [HRCT] can detect the structural abnormalities in asthma. This study attempts to correlate these abnormalities with clinical and pulmonary function test [PFT] data. Consecutive stable asthma patients attending Mubarak Al Kabeer Hospital, Kuwait, were subjected to HRCT during a six month period from July 2004 to December 2004, after initial evaluation and PFT. Of the 28 cases, sixteen [57.1%] had moderate, 6 [21.4%] had mild and 6 [21.4%] had severe persistent asthma. Thirteen [46.4%] patients had asthma for 1 to 5 years and 12 [42.9%] were having asthma for >10 years. Bronchial wall thickening [57.1%], bronchiectasis [28.6%], mucoid impaction [17.9%], mosaic attenuation [10.7%], air trapping [78.6%] and plate like atelectasis [21.4%] were noted. Bronchial wall thickening [p=0.044] and bronchiectasis [p=0.063] were most prevalent in males. Ten [35.7%] patients exhibited mild, 9 [32.1%] had moderate and 3 [10.7%] had severe air trapping. The difference in Hounsfield units between expiratory and inspiratory slices [air trapping] when correlated with percent-predicted FEV1 in right upper [r=0.25; p=0.30], left upper [r=0.20; p=0.41], right mid [r=0.15; p=0.53], left mid [r=-0.04; p=0.60], right lower [r=0.04; p=0.86] and left lower zones [r=-0.13; p=0.58] showed no relation. The same when correlated as above with the percent predicted FEF 25-75 did not show any significant association. The presence of air trapping was compared with sex [p=0.640], nationality [p=1.000], disease duration [p=1.000] and severity of symptoms [p=0.581]. Abnormal HRCT findings are common in asthma; however, air trapping when present was not related to the duration or severity of the illness or to the FEV1

Demographic pattern and clinical characteristics of patients with smear positive pulmonary tuberculosis in Kuwait

The aim of this study was to document various clinical factors that are likely to be of help in the control of tuberculosis in Kuwait. Details of patients with sputum positive for acid-fast bacilli in the period from January 1998 to December 2000 were collected retrospectively from the case records and population statistics from government sources. The data were then tabulated and analyzed. Of the 526 cases, 83.5% were expatriates and 16.5% Kuwaiti; 373 [70.9%] were male. Of the expatriates, 66.7% were from Asia and the Far East, 5.7% were >/= 60 years. The annual incidence was 8.34 per 100,000 population. The lowest incidence was observed in the Jahrah governorate with an overall incidence of 5 [2.0 among Kuwaitis and 6.4 among expatriates] per 100,000 population. The highest incidence overall [10.2] and among Kuwaitis [4.1] was observed in the Farwaniya governorate, while the highest incidence among expatriates was seen in the Capital governorate [13.4]. Radiologically, 94 [19.5%] had minimal, 246 [51.5%] had moderately advanced and 141 [29.3%] far-advanced disease. The majority of the patients [72%] had only + status for AFB in the smear. Hypercalcemia [25.7%], hyponatremia [22.15%] and hyperglycemia [29.9%] were common in the patients. Mean serum albumin was low [28.7 +/- 5.5 g/l]. Two hundred and forty-seven [47.2%] were declared cured while 116 [22.2%] completed treatment. Comparison between nationals and expatriates showed a significant difference only for age, smoking status, defaulter rate and place of residence. The lowest regional incidence was found in the Jahrah governorate. Both biochemical abnormalities and radiologically advanced presentations were common. Disease pattern and response to treatment was purely individual and did not differ with respect to nationality or race

Fiberoptic bronchoscopy in the evaluation of pulmonary disorders in Kuwait: a report of a two year experience

The introduction of fiberbronchoscopy has radically affected the investigation and management of patients with pulmonary disorders. This communication presents a two year experience of the use of fiberbronchoscopy at the Mubarak Al-Kabeer Hospital. Kuwait. Two hundred and eight bronchoscopies were performed under local anesthesia between 1995 and 1996. The findings revealed that about fifty percent of the patients were over the age of 40. mainly in the age group 41-50 and 51- 60. The most common indication for bronchoscopy was an infective process in thirty-three percent of cases, followed by suspected malignant lesion. Abnormality was found at bronchoscopy in thirty-five percent of cases on direct vision. The yield from tissue biopsy and cytology of bronchial washings was found to be lower than expected, judging by findings in similar studies at other centers. Similarly the culture of organisms from bronchial washings recovered from bronchoscopy was below the expected result. The reasons for these discrepancies are given and measures to ensure improved yield in future bronchoscopies are suggested. Complications resulting from the procedure in this series were very low [1%]. It is recommended that bronchoscopy should be adopted for routine use in all hospitals in Kuwait for the investigation and management of pulmonary diseases