Vitiligo in a patient receiving infliximab for refractory ulcerative colitis

Infliximab is a chimerical monoclonal antibody that inhibits pro-inflammatory activity of tumour-necrosis factor alpha [TNF alpha] and it is the primary biological agent used in the treatment of moderate-to-severe ulcerative colitis [UC]. We report a case of vitiligo following infliximab administration in a patient with refractory UC. The case serves as a reminder of adverse cutaneous reactions induced by TNF alpha -antagonist therapy

Adenomatous colorectal polyps in patients referred for colonoscopy in regional hospital in Kuwait

Adenomatous colorectal polyps [ACPs] are known to be the precursor lesions for colorectal cancer. The aim of the study was to determine the prevalence, endoscopic and pathological features of ACPs in patients referred for colonoscopy. The endoscopic and histological reports of adult patients who underwent complete colonoscopy in the gastroenterology unit of a regional Kuwaiti hospital between January 2008 and December 2008 were retrospectively studied. The specimens of polyps were reviewed by an experienced pathologist who was blinded to the clinical or endoscopic information. Non-neoplastic polyps were not included in the analysis. Of 530 eligible patients [mean age, 45 years; male-female ratio, 2:1], 54 [10%] had 103 ACPs. Of the patients with ACPs [mean age, 57 years], 43 [80%] were males and 36 [67%] were Kuwaitis. Histopathological examination of the most significant polyp in each patient revealed that 40 [74%] polyps were tubular adenomas [TAs]; 11 [20%], tubulovillous [TV] adenomas; and 3 [6%], villous adenomas. High-grade dysplasia was noticed in 4 [10%] adenomas. Fifteen [2.8%] of the 530 patients had advanced ACPs. Logistic regression analysis of some variables and their association with ACPs found that age [P<0.001; OR, 1.9; CI, 1.5-2.3], history of adenoma [P=0.001; OR, 6.4; CI, .2.1-19.4] and being Kuwaitis [P=0.029; OR, 2.1; CI, 1.1-4.1] to be independently associated with ACPs. The most common histological type of ACPs was tubular adenoma. Advancing age, being Kuwaiti nationals and prior removal of ACPs were significantly associated with the occurrence of ACPs

Endoscopic nodular gastritis in dyspeptic adults: prevalence and association with helicobacter pylori infection

To determine the prevalence and histological features of endoscopic nodular gastritis [NG] in adult dyspeptic patients and its relation to Helicobacter pylori infection. A retrospective endoscopic report review of 2,142 patients identified 67 patients with NG during the period from 1 September 2006 to 31 August 2007. A subset of 32 NG patients [group 1] who had had gastric biopsies during upper gastrointestinal endoscopy and had been evaluated for H. pylori infection were compared to 32 age- and gender-matched dyspeptic patients. They had undergone endoscopy during the same period, which yielded normal results, and had available biopsies that were similarly evaluated for H. pylori infection [controls, group 2]. Pertinent clinical data were obtained from the patients' records. An experienced pathologist assessed the biopsies for the presence and grade of inflammation, activity, glandular atrophy, intestinal metaplasia, presence and density of H. pylori and presence of lymphoid follicles or aggregates. NG was identified in 67 [3.1%] patients. On histological examination, group 1 had a significantly higher grade of gastritis [p<0.001]. The presence and density of H. pylori infection was significantly higher in group 1 [p <0.001]. The H. pylori density correlated significantly with the severity of gastritis [r = 0.57, p <0.001]. The endoscopic performance of NG on H. pylori infection had high specificity [96.8%] and positive predictive value [93.3%]. This study outlined the clinicopathological features of NG identified among a cohort of dyspeptic patients in Kuwait and confirmed the close association with H. pylori infection. However, our study has a limitation in that histopathologic assessment of all NG patients was not feasible

Prevalence and factors associated with chronic diabetic complications among patients attending primary health care, a multi-centric study in Kuwait

A substantial proportion of patients with diabetes develop long-term macrovascular and microvascular complications. Many risk factors have identified for development and progression of these complications. The aim of the present study was to determine the prevalence of these complications among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with especially those factors that can be considered avoidable. This study was carried out in five primary health care centers representing the five health regions in Kuwait. The sample included 704 adult diabetic patients who had been diabetic for at least 2 years. The first phase of study was a cross sectional study to determine the prevalence of chronic diabetic complications. The second one was a case-control study, whereas all patients with chronic diabetic complications [case group, n = 434] were compared to diabetic patients free from chronic complications [control group, n = 270] to determine the associated factors with cases. Analysis was initially carried out based on a series of univariate comparisons followed by multiple logistic regression analysis. Out of 704 diabetic patients 61.6% n= had one or more chronic diabetic complications. Cardiovascular complications were diagnosed in 30.3%, nephropathy in 12.4%, neuropathy in 32.1%, lower limb complications in 21.9%, and retinopathy in 30.7% of patients. Logistic regression analysis revealed that age, nationality, type and duration of diabetes, glycemic control, hypertension, obesity, physical exercises, and compliance with diet recommendations were proved as significant predictors of these complications. The high economic burden raised by diabetes and its complications challenges the Kuwaiti health care system to prevent the development and progression of diabetic complications. The study identified a group of predictor factors as hypertension and hyperglycemia, enhancement of patient' compliance with regular follow-up visit, the role of health care providers in supplying patients with health information groups of patients who needed priorities of screening programs for development of complication