Knee osteoarthritis in type 2 diabetes mellitus: does insulin therapy retard osteophyte formation?

Objective: The aim of this study was to investigate whether or not radiographic changes observed in knee osteoarthritis [OA] in type 2 diabetes mellitus [T2DM] patients on insulin therapy differed from those not on insulin

Material and Methods: A cross-sectional study was performed in 311 subjects: 211 T2DM patients and 100 without diabetes [controls] in Mubarak Hospital, Kuwait. Patients were categorized into 3 groups: T2DM patients not on insulin [G1, n = 99], T2DM patients on insulin [G2, n = 112] and a nondiabetic control group [G3, n = 100]. Plain X-ray of both knees was used to assess the changes of knee OA and graded using the Kellegren-Lawrence scale [0-4] and the Osteoarthritis Research Society International Atlas grading scale [0-3]. A total of 622 knee X-rays were evaluated. SPSS version 21.0 was used for data analysis

Results: A highly significant association [p < 0.0001] was observed for joint space narrowing [JSN] as well as for osteophyte formation between the three groups. Comparing G2 and G3, a highly significant association [p < 0.0001] was retained for JSN [201 [89.7%] vs. 199 [99.5%]] and for osteophyte formation [26 [11.7%] vs. 72 [36.0%]]. Comparing G1 and G2, significantly less osteophyte formation was noted in G2 patients compared to G1 patients [26 [11.7%] vs. 39 [19.7%], p = 0.02]. Multivariate logistic regression analysis showed that the G2 group had less chance of osteophyte formation than either the G1 group or G3 control group [OR = 0.294, p = 0.008 and OR = 0.098, p < 0.001, respectively]

Conclusion: Our findings show that T2DM patients with OA knees on insulin therapy have less radiographic osteophytes compared to T2DM patients not on insulin

Are 25[OH]D levels related to the severity of knee osteoarthritis and function?

To investigate the effect of 25-hydroxyvitamin D [25[OH]D] in Kuwaiti patients with primary knee osteoarthritis [OA] and to assess its relation with radiological grading and functional status. In this cross-sectional study, 25[OH]D was measured using radioimmunoassay in 99 patients [90 women and 9 men; mean age 56.5 +/- 9.1 years [range: 36-80]] with clinical and radiological findings of primary knee OA. X-ray grading using the Kellgren-Lawrence grading scale and the Osteoarthritis Research Society International [OARSI] Atlas grading scale and functional assessments using Lequesne's indices were evaluated in relation to the 25[OH]D level. Other variables studied were age at onset of symptoms, body mass index and duration of disease. The age of the patients at the onset and the duration of disease were 51.58 +/- 7.14 and 3.88 +/- 2.51 years, respectively. Mean scoring for functional assessment was 10.31 +/- 4.35 and mean Kellgren-Lawrence radiological grading was 2.43 +/- 0.85. Radiological finding according to the OARSI Atlas revealed joint space narrowing of grades 2-3 in 87 [87.9%] patients and the presence of osteophytes in 55 [55.6%] patients. The mean value of 25[OH]D level was 11.4 +/- 6.07 ng/ml. Of the 99 patients, 92 [92.9%] were vitamin D deficient. Comparison of 25[OH]D levels to radiological findings and different functional classes showed no significant association. Most of our patients had vitamin D deficiency, but the level of 25[OH]D was not related to the severity of the knee X-ray grading or to the functional assessment in our patients with primary knee OA

Ossification of ligamentum flavum in middle east Arabs: a hospital-based study

To investigate the frequency of ossification of the ligamentum flavum [OLF] in the spine among the Arab population in Kuwait using magnetic resonance imaging [MRI] surveillance of the whole spine. A consecutive series of 102 patients with low back pain were recruited from the outpatient clinic of Mubarak Al-Kabeer Hospital, Kuwait. MRI of the whole spine in the sagittal plane was obtained in at least two sequences [T[1] and T[2]]. The OLF was defined as low signal intensity thickening of the ligament in both T[1] and T[2] sequences on the posterior margin of the spinal canal, causing indentation of the theca with or without cord compression. Of the 102 cases, 19 [18.6%] patients had OLF. Of the 19 positive cases, 12 [63.2%] were present at a single level, and 7 [36.8%] at multiple levels. A total of 26 OLF segments were identified in the following anatomical distribution: cervical: 15 [57.7%]; upper thoracic [T1-T4]: 1 [3.8%]; mid thoracic [T5-T8]: 4 [15.4%]; lower thoracic [T9-T12]: 4 [15.4%], and lumbar region: 2 [7.7%]. Of the 19 OLF patients, 2 [10.5%] had tandem ossification of the posterior longitudinal ligament in the cervical spine and were symptomatic. The frequency of OLF appears to be high among this hospital-based cohort of the Arab population. OLF should be kept in mind if a patient presents with radiculopathy, particularly in the cervical region, for which surgical intervention is contemplated

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, [h and ling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected st and ard, 3 = At expected st and ard, 4 = Above expected st and ard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31.8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%] A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Confidence in performing core clinical skills: preliminary results of a survey of trainees completing internship training in Kuwait

Several surveys suggest the underemphasis of the learning of practical skills during internship training. While the proportion of interns that had performed some of the common practical procedures during training appeared inadequate, the interns themselves had rated their development of practical skills as not high. Many interns had also indicated that they felt confident to initiate management of conditions although they were not experienced in those areas. We did not encounter any publications dealing specifically with internship training in the Arabian Gulf region. This study was aimed at determining the confidence of interns in performing core clinical skills. Interns who completed rotations in the major specialties during 2005/06 responded to a questionnaire that listed 48 core clinical skills. Out of the 124 eligible for the study, 85 responded. They indicated their confidence to perform the skills in future and the number of times these had been performed. The majority of the interns felt confident with routine skills, while approximately half felt confident with emergency resuscitation skills. A third of the trainees were confident in performing artificial ventilation and endotracheal intubation. Similarly, a half was confident in performing pericardiocentesis, indirect laryngoscopy, lumbar puncture irrigation of the ear, insertion of thoracic drainage, venous cutdown and insertion of central venous catheter. Only about a third of trainees, with no significant gender variation, felt confident to perform common skills in obstetrics and gynecology. While half the trainees were confident in performing emergency resuscitative measures, many others lacked confidence in doing these skills or clinical skills needed in routine situations. Interns who may not acquire competency in the core skills need to be identified early and corrective measures taken. The findings may have implications in the review of the medical undergraduate curriculum as well as in internship training

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions, who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, handling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected standard, 3 = At expected standard, 4 = Above expected standard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31 .8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category, Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%]. A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the Heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Development of the academic manpower of the faculty of medicine, Kuwait University [1995/96-2001/02]

Objectives Determine the size and structure of the academic members of the Kuwait University, Faculty of Medicine, with emphasis on nationality, gender, and academic rank distributions in different academic departments in order to identify scarcity of Kuwaiti nationals at different departments. Methods Survey involving review of the records in the Personnel Department, Faculty of Medicine about academic staff during the 7 years 1995/96 to 2001/2002. Available data included academic rank, gender and nationality. Results Out of total 114 academic positions during 95/96, Kuwaiti nationals occupied 30 positions [26%]; whereas, out of 179 academic positions during 2001/2002, Kuwaiti nationals occupied 82 positions [45%]. The majority of Kuwaiti members were in the clinical departments [33% in 95/96 and 56% in 2001/2002 respectively], in particular, Departments of Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, and Radiology. In the basic sciences departments, Kuwaiti academic staff were progressively increasing in Pathology and Microbiology. Female Kuwaiti academic staff are improving in Departments of Microbiology, Medicine, Obstetrics and Gynecology, and Pediatrics. Conclusion Clinical sciences departments progressively attracted Kuwaiti national academic staff. The proportion of Kuwaiti faculty members is also improving in the two basic sciences departments, Microbiology and Pathology. However, there is scarcity of Kuwaiti members in the Departments of Anatomy, Nuclear Medicine, and Psychiatry

Acute low back pain: diagnosis and management

Acute low back pain [LBP] is commonly encountered and treated by primary health care physicians and different specialists. Although acute low back pain is generally a self limiting condition in the majority of cases, physicians must be aware of warning signs or red flags that may suggest infections, malignancy, inflammatory and neurologic disorders. Recurrences and functional limitations can be minimized with appropriate conservative management including medication, physical therapy modalities, exercises and patient education. Physicians should know when to refer the patient for surgery. This artide briefly reviews the etiology, diagnosis, and management of acute low back pain aimed at minimizing disability and returning patient to usual daily activity