Trends in epithelial cell abnormalities observed on cervical smears over a 21-year period in a tertiary care hospital in Kuwait

This study aimed to analyse trends in epithelial cell abnormalities [ECAs] in cervical cytology at a tertiary care hospital in Kuwait. ECAs in 135,766 reports were compared over three seven-year periods between 1992 and 2012. Conventional Papanicolaou [Pap] smear tests were used in the first two periods and ThinPrep [Hologic Corp., Bedford, Massachusetts, USA] tests were used in the third. Significant increases in satisfactory smears, atypical squamous cells of undetermined significance [ASCUS] and atypical glandular cells of undetermined significance/atypical glandular cells [AGUS/AGCs] were seen in the second and third periods [P <0.001]. No significant increases were observed among low-grade squamous intraepithelial lesions [LSILs] or high-grade squamous intraepithelial lesions [HSILs] [P >0.05]. An increase was noted in carcinomas between the first and second periods although a significant decline was seen in the third [P <0.014]. Satisfactory smears, ASCUS and AGUS/AGC increased during the study period although no significant increases in LSILs, HSILs or carcinomas were observed

Clostridium difficile infections in HIV-positive patients with diarrhoea.

Background. Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients. Methods. We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine–cefoxitin–fructose agar and brain– heart infusion agar. Results. C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%–8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p<0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days. Conclusion. C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.

Isolation, characterization and therapeutic potential assessment of bacteriophages virulent to Staphylococcus aureus associated with goat mastitis

In the present study, the therapeutic potential of bacteriophages virulent to Staphylococcus aureus associated with goat mastitis were isolated, identified and assessed. Staphylococcus aureus [host or indicator bacterium] was isolated from a goat suffering from clinical mastitis. Based on cultural, morphological, biochemical tests and amplification of S. aureus specific thermonuclease gene in PCR, the identity of the organism was confirmed as S. aureus. Bacteriophages were isolated from soil and faecal samples [n=42] collected from different parts of the Mathura district in Uttar Pradesh [India], and their identity was confirmed by amplification of the bacteriophage-specific endolysin gene fragment in PCR. The thermal tolerance study revealed that all phage isolates were stable at 30 and 40°C with 100% lytic efficacy and their activities reduced to 62-80% at 50°C declining sharply at 60°C with less than 5% efficacy. Likewise, at pH = 6.5 and 7.5, the survivability of all isolates was 100% which reduced to 70-79% and 84-91% at pH = 5.5 and 8.5, respectively. All isolates were stable up to 3 months at 37°C, and for 16 months at 4°C but the stability of their respective endolysins only lasted for 12-23 days at 37°C and 6 months at 4°C. Three of the bacteriophage isolates, S. aureus phage/CIRG/1, S. aureus phage/CIRG/4 and S. aureus phage/CIRG/5 exhibited lytic activity against over 80% of the staphylococcal isolates. The results of the present study provide insight for the use of lytic bacteriophages for therapeutic interventions against multi-drug-resistant S. aureus inducing mastitis in goats

Closed percutaneous pleural biopsy. A lost art in the new era

To assess the association between size and number of biopsy specimens obtained by percutaneous closed pleural biopsy, with overall diagnostic yield in general, and histopathological evidence of tuberculosis pleurisy, in particular. One hundred and forty-three patients, with a high index of clinically having tuberculous pleurisy, were referred to the respiratory division of Mubarak Al-Kabeer Hospital in Kuwait during a 9-year period [January 1999 to December 2007]. All subjects with exudative lymphocytic predominant effusion underwent percutaneous closed pleural biopsy, looking for tuberculous granulomas. The clinical diagnosis and pathological characteristics [number and size of biopsy samples] were analyzed. Overall diagnostic yield of percutaneous closed pleural biopsy in all cases was noticed to be 52%. The larger biopsy sample size of 3 mm and more, and the higher number of specimens [>/= 4] were significantly associated with an increased diagnostic yield for tuberculous pleurisy [p=0.007 and 0.047]. Obtaining 4 or more biopsy samples, and larger specimens of 3mm and more for histopathological evaluation, through percutaneous pleural biopsy, results in a better diagnostic yield for tuberculous pleurisy

Effects of cigarette smoking on hematological parameters and von willebrand factor functional activity levels in asymptomatic male and female Arab smokers

This study aimed at determining the effects of cigarette smoking based on gender, on several hematological parameters and von Willebrand factor protein in the asymptomatic Arab population of Kuwait. Ninety-two subjects participated in this study: 55 males [31 smokers and 24 nonsmokers] and 37 females [18 smokers and 19 nonsmokers]. Complete blood count results were obtained using Beckman Coulter Hematology Analyzer. Von Willebrand factor functional activity was determined using an enzyme-linked immunoassay-based test in which anti-von Willebrand factor IgG monoclonal antibody was used that recognizes a functional epitope of the protein. The coagulation profile was obtained using ACL[R] 9000 coagulation analyzer. Male smokers had significantly higher levels of white blood cell count [p = 0.03] and von Willebrand factor protein levels [p = 0.029], and a significantly shorter thrombin time [p = 0.019] than nonsmokers. Smoking did not appear to affect any of the parameters analyzed in females as no significant difference was found between smokers and nonsmokers [p > 0.05]. Our results showed that smoking affected white blood cell count and von Willebrand factor levels in males and not in females, and as such could be potential markers for smoking-induced endothelial damage in asymptomatic Arab male smokers

Marjolins ulcer developing in electric burns: a rare case report

Marjolin's ulcer is defined as a malignant, ulcerating neoplasm occurring in cicatricial tissue, and is thought to be more aggressive than the other more common varieties of skin cancers. It has been reported in chronic scars of diverse origins. Here we describe a patient who suffered extensive electric burns 25 years ago and has now presented as squamous cell carcinoma of the trunk

Headache and blood pressure in primary health care setting in Kuwait

To identify the types of headache among patients, presenting at a primary health care setting, and to determine the correlation between headache and high blood pressure [BP]. This was a cross-sectional study administered in 2 primary health care centers [Fintas and AbuHalifa] of a regional health district in Kuwait from March 2003 to June 2003. Our study included 290 patients with different types of headache, and requested for BP measurement. The sample included patients, in the age group 15-80 years with an overall mean age of 41 [+13 SD] years. The male to female ratio was 1:2.7 and the majority [85%] of patients were Kuwaitis. Tension headache was the most frequent diagnosis [61.7%] among patients presenting with headache, followed by migraine [11.7%]. The normal systolic BP was <140 mm Hg [52.8%], while 59% had normal diastolic BP, below 90 mm Hg. Increasing age was found to be associated with high BP levels [p<0.001]. Diastolic BP was found significantly higher among males [p<0.01] Tension headache had higher levels of BP while migraine was found to have low levels. None of the sinusitis headache patients had high BP. Positive history of hypertension was found associated with high systolic and diastolic BP in tension and other type of headache [p<0.001]. Headache is a very common symptom among patients presenting at the general practice health care setting, with most cases diagnosed with tension-type headache, and females out numbering males. There was no positive correlation between headache and high BP. Physicians should discourage their patients from considering headache as a measure of their BP status

Burn septicaemia in Kuwait: associated demographic and clinical factors

To study the demographic and clinical factors associated with burn septicaemia patients in Kuwait. Materials and All burn in-patients, who developed septicaemia at the Burns Unit, Al-Babtain Centre for Burns and Plastic Surgery, Kuwait, during a 9-year period [June 1992 to May 2001] were included in the study. The data were recorded for age, sex, nationality, cause and percentage of burns, inhalation injury, resuscitation, number of episodes, septicaemia on post-burn day, the microorganisms responsible in each episode, treatment and outcome for statistical analysis. Using SPSS [PC version 11.0] software, a probability level of p < 0.05 was considered significant. Of the 2,082 patients treated in the Burns Unit, 166 [8%; 99 [60%] males and 67 [40%] females] with a mean age of 26 years [range 1-70] had septicaemia. Significantly higher [p < 0.001] cases were recorded among Kuwaiti children [

Risk Factors, subtypes and outcome of ischaemic stroke in Kuwait - A hospital-based study

To report on stroke subtypes, associated risk factors and outcome in Kuwait. The records of 62 patients [30 male, 32 female] admitted with diagnosis of stroke to Kuwait Oil Company Hospital, Kuwait, a tertiary care hospital, during a 5-year period [1995-1999], were retrospectively reviewed. Small artery infarction was the most common subtype and occurred in 37 subjects [59.7%]; less common were atherosclerotic large artery strokes [19 patients, 30.6%] and strokes of cardio-embolic origin [6 patients, 9.7%]. Identifiable risk factors or associated morbidities were hypertension [72.5%], diabetes mellitus [69.4%], ischaemic heart disease [14.5%], history of migraine [8.1%], lone atrial fibrillation [5.0%], and valvular heart disease [1.6%]. The most important determinants of a deleterious 30-day outcome, as indicated by severe disability or death, were female gender, lack of use of anti-platelet drugs, presence of a large artery infarction stroke subtype, and cardio-embolic stroke. Prevalence of hypertension and diabetes is high among patients with stroke in Kuwait, with rates higher than those found in any previous reports from the Gulf region. Two unusual observations were that women had a rather high frequency of stroke, and infarction of the small artery was more common than that of the large artery. Outcome, as indicated by severe disability or death, was worse among women, elderly patients, and those with large artery atherosclerotic and cardio-embolic strokes. There is some evidence that such a deleterious outcome might be ameliorated with use of anti-platelet drugs

Effect of digenous drugs on changes inmorphology and cholesterol level of aorta in early atherosclerotic progression a comparative experimental study

Abnormalities in lipid metabolism are among the best known cardiovascular risk factors. Use of medicinal plants in preventing alterations in lipid metabolism has received wide attention by several workers. The present work compared the antihyperlipidaemic effect of guar gum, fenugreek and ginger extracts in hypercholesterolemic rabbits and results compared with Gemfibrozil used as a standard drug. The data pertaining to macroscopic aortic lesions and aortic cholesterol is presented here. The study showed that extracts of guar gum, ginger and fenugreek significantly reduced the sclerotic component and deposition of cholesterol in vessel wall