Prevalence of infectious organisms observed in cervical smears between 1997-2014 at mubarak al kabeer hospital, kuwait

Objectives: This study aimed to examine gynaecological infectious agents observed in conventional and modified Papanicolaou cervical smears [CS] at a tertiary care hospital in Kuwait

Methods: This retrospective study analysed 121,443 satisfactory CS samples collected between 1997–2014 at the Mubarak Al-Kabeer Hospital, Kuwait. Conventional CS samples were obtained between 1997-2005, while modified CS were obtained between 2006-2014 following the introduction of ThinPrep testing [Hologic Corp., Bedford, Massachusetts, USA]. All samples were initially screened by cytoscreeners before being analysed by cytopathologists to determine the presence of specific infectious agents

Results: Overall, 8,836 [7.28%] of the cervical samples had infectious agents; of these, 62.48% were conventional and 37.52% were modified CS samples. The most frequently observed infectious agents were Candida species [76.05%], Trichomonas vaginalis [9.72%], human papillomavirus [HPV; 9.3%], Actinomyces-like organisms [3.23%], Chlamydia trachomatis [1.27%] and the herpes simplex virus [HSV; 0.43%]. There were significantly more cases of Candida species, HPV-associated changes, C. trachomatis, T. vaginalis and Actinomyces-like organisms detected in conventional compared to modified CS samples [P <0.050 each]. However, there was no statistically significant difference in the frequency of HSV-associated changes [P = 0.938]. The presence of two infectious agents in the same sample was identified in 0.87% of samples

Conclusion: Among CS samples collected during an 18-year period, Candida species were most frequently detected, followed by T. vaginalis and HPV. The identification of potential infectious agents is a valuable additional benefit of Papanicolaou smear testing

Oral Cancer awareness among dentists in Kuwait

The aim of this study was to assess oral cancer awareness among dentists in Kuwait. A cross-sectional survey was conducted among 200 dentists working at the Ministry of Health Dental Centers and Kuwait University Dental Center using a structured questionnaire. Dentists' knowledge about risk factors of oral cancer and about diagnostic concepts, current practices and opinions, preferred point of referral as well as interest in continuing education were assessed and the responses were analyzed. Of the 200 dentists surveyed, 153 responded [76.5% response rate]. The mean knowledge score of the respondents was 20.6 +/- 4.0 out of a total score of 30. Thirty-five [22.9%] dentists had consistently high knowledge scores for both risk factors and diagnostic concepts. Of the 153 dentists, 132 [86.3%] were interested in obtaining further information about oral cancer. This study highlighted the need for improved knowledge and education of dental practitioners on oral cancer

Clinical pharmacokinetics of gentamicin. Estimation of initial dosing parameters in hospitalized patients at Al-Amiri Hospital Kuwait

The objectives of this study were to: [1] derive equations for estimating gentamicin clearance [Clgent] and volume of distribution [Vd] based on the local population attending Al-Amiri Hospital, Kuwait; [2] independently evaluate these equations by comparison with other published methods in their predictive ability to estimate Clgent and Vd. Clgent and Vd were calculated in 47 patients [group 1] using the Sawchuk-Zaske method. Regression analysis was used to derive a correlation between creatinine clearance [Clcr] and Clgent, Vd and actual body weight [ABW]. Based on actual Clgent and Vd values, the predictive ability of the estimated parameters from the regression equations was validated and compared with 4 published methods using mean error [ME], i.e. bias, and mean squared error [MSE] and root mean squared error [RMSE], i.e. precision. All equations were also evaluated in an independent second group [group 2] of 23 patients. The mean +/- SD values of Clgent and Vd were 4.0 +/- 1.8 lúh-1 and 16.8 +/- 6.7 liters, respectively. The derived equations were: Clgent = [0.760] [Clcr] + 1.117 [r = 0.701] and Vd = [0.165] [ABW] + 5.604 [r = 0.532]. In comparison to the 4 published methods, the derived equations were less biased [ME = 0.00] and more precise [MSE = 1.68, RMSE = 1.02] in predicting Clgent [p < 0.05], and less biased [ME = -0.01] with no difference in precision [MSE = 36.22, RMSE = 4.59] in predicting Vd [p > 0.05]. This precision was confirmed in the second group of 23 patients, where the derived equations were less biased [ME = -0.1] and more precise [MSE = 3.22, RMSE = 1.48] in predicting Clgent [p < 0.05], whilst no difference was found for prediction of Vd [p > 0.05]. The equations developed in this study provided a reliable estimation of Clgent and Vd. It is planned to use them at Kuwait Hospitals to help provide more individualized patient dosing information to physicians

Therapeutic drug monitoring of gentamicin: evaluation of five nomograms for initial dosing at Al-Amiri Hospital in Kuwait

To compare five published nomograms [Thomson guidelines, Mawer nomogram, rule of eights, Hull-Sarubbi table and Dettli method] for calculating the initial gentamicin dosage regimen in a Kuwaiti population. Based on measured peak and trough gentamicin concentrations, the elimination rate constant and volume of distribution of gentamicin were calculated for each patient [n = 56], using a modified two-point Sawchuk-Zaske method. The calculated individual set of pharmacokinetic parameters and the initial dose regimen recommended by each of the five methods were used to predict the steady-state peak and trough of gentamicin concentrations. The Thomson guidelines produced consistent results in predicting gentamicin concentrations within the target ranges of peak plus trough, peak only and trough only [63, 75 and 75%, respectively]. The Mawer nomogram, Hull-Sa-rubbi table and Dettli methods achieved similar percentages of patients [46-50%] within the target ranges [5-10 mg l[-1] for peak and 0.5-2 for trough], whereas empirical dosing and the rule of eights showed the lowest percentages of patients within the peak plus trough target range [25 and 37%, respectively]. However, with respect to the underdosing target range [predicted concentration <5 mg l[-1]], the Thomson guidelines showed that 21% of patients were underdosed. The results show that a large number of patients [37-63%] were outside the target ranges in all initial gentamicin dosing methods evaluated in this study. Therefore, serum concentration measurement can be advised to assist in the optimization of gentamicin dose selection