Management of pediatric urinary tract infections in Kuwait: current practices and practicality of new guidelines

To evaluate the practicality of applying the new international guidelines for urinary tract infection [UTI] tertiary care hospital in Kuwait Retrospective study Pediatric wards at the Mubarak Al Kabeer Hospital; period of study: from June 2011 - May 2012 Children up to 12 years of age with pyuria and at least 50,000 colonies per ml of a single uropathologic organism in an appropriately collected urine sample Intervention: None Incidence of vesico-ureteric ultrasound [RUS] One hundred and forty nine children were included. 53% were male. Recurrent UTI was present in 15% of cases. The most commonly isolated bacteria were: E.coli [69%], Klebsiella pneumoniae [11.4%] and Pseudomonas aeruginosa normal RUS and in 50% of children with abnormal RUS. In children with recurrent UTI, 23% had VUR. Renal scarring practice for the diagnosis and management of UTI to recent guidelines safe and valuable

Trends and variations in the epidemiology of meningococcal disease in Kuwait 1987-2013

The introduction of Haemophilus influenzae type b [Hib] conjugate vaccine and conjugate pneumococcal vaccine into routine childhood vaccination in Kuwait has resulted in the emergence of Neisseria meningitidis as the leading cause of invasive bacterial infection in children. Currently, a quadrivalent ACYW-135 meningococcal polysaccharide vaccine is administered as part of routine childhood vaccination in Kuwait at the age of 2 years. Conjugate meningococcal vaccines have been shown to be more effective in preventing meningococcal infection in young children. The objective of this study was to describe the epidemiology of meningococcal disease [MD] in Kuwait and evaluate the need for conjugate vaccine in routine childhood immunization. We have reviewed the MD surveillance data from the communicable disease unit, Ministry of Health, Kuwait during the period from 1987 to 2013. The analysis included microbiologically confirmed cases of N. meningitidis in the blood and cerebrospinal fluid. There were 293 cases of confirmed MD during the study period. Two hundred and four cases [70%] were in children

Pneumococcal disease in the Arabian Gulf: recognizing the challenge and moving toward a solution

Pneumococcal disease has substantial incidence, morbidity and mortality in older adults. Decreased birth rates and longer lifespans indicate that the global population is aging, although rates of aging differ between countries[1]. In 2010, the proportion of the population aged >60 years in the general Arab Region was 7%, and this proportion is expected to rise to 19% by 2050 for the region as a whole[2]; the United Nations estimates for the individual countries of the Arabian Gulf by 2050 are 25.7%, 24.9%, 20.7%, 26.7% and 10.5% in the Kuwait, Bahrain, Qatar, United Arab Emirates [UAE] and Oman, respectively, which are comparable to the 26.9% predicted for the USA and lower than that predicted in European countries, in which the 2050 estimates are 32.7%, 34.0% and 38.1% for France, the UK and Germany, respectively [1]. Globally and in the Gulf Region, pneumococcal disease is an increasingly important public health burden in the elderly. The burden of pneumococcal disease can be reduced by effective vaccination programs, but the recommendations on pneumococcal vaccination in adults vary widely. The major barriers to vaccine implementation among healthcare professionals are an incomplete awareness of pneumococcal disease and the vaccination options in adults. The Gulf Advocate Group calls for healthcare providers in the countries of the Arabian Gulf [Kuwait, Bahrain, Qatar, United Arab Emirates and Oman] to support awareness and education programs about adult pneumococcal disease, particularly in high-risk groups such as those >65 years of age, those with type 2 diabetes mellitus, hematological malignancy, organ and bone marrow transplantation or chronic kidney or lung diseases and pilgrims undertaking the Hajj to improve pneumococcal disease surveillance and optimize and disseminate recommendations for adult vaccination. The Gulf Advocate Group recommends following the U. S. Centers for Disease Control and Prevention [CDC] guidelines for pneumococcal vaccination [3, 4]

Epidemiology and clinical presentation of pandemic influenza A [H1N1] among hospitalized children in Kuwait

To describe the epidemiological and clinical characteristics of children hospitalized for the 2009 influenza A H1N1 infection in Kuwait. A retrospective chart review of hospitalized children with laboratory-confirmed influenza A H1N1 infection in two hospitals in Kuwait was conducted. Epidemiological characteristics, clinical features, risk factors for severe disease, complications and mortality were analyzed. The medical records of 197 children hospitalized for the 2009 pandemic H1N1 infection from August 2009 to January 2010 were reviewed. The majority of the children [104; 52.8%] were admitted during the month of October. The median age was 2 years. Most of the admitted children were in two age categories: 64 infants 5 years [31%]. The most frequent presentations were fever in 193 [98%], cough in 155 [79%] and runny nose in 105 [53%] cases. The majority of the admitted children [109; 55%] had been previously healthy. All children received an antiviral agent [oseltamivir], and antibiotics were administered to 147 [75%]. Bacterial co-infections occurred in 3 [1.5%] of all hospitalized children. Six [3%] children were admitted to the intensive care unit, of whom 4 [66%] required artificial ventilation. There was only 1 mortality. The pandemic H1N1 infection was associated with a wide spectrum of clinical manifestations. The majority of hospitalized children had previously been healthy. Most of the admitted children had an uncomplicated clinical course

Epidemiology and clinical presentation of hospitalized children with influenza A [H1N1] in Kuwait

WHO had declared the global pandemic of influenza A [H1N1] in June 2009. The age group mostly reported to be at risk of infection are children and young adults. To review the epidemiological and clinical features of children hospitalized with influenza A[H1N1]. A retrospective view of medical record of children admitted to the department of paediatrics-Amiri Hospital-with diagnosis of influenza A [H1N1] during August-November 2009. Only patients with positive nasopharyngeal swab were included. Epidemiological and clinical data were collected and analyzed. A total of 55 children were admitted with influenza A [H1N1] during the study period. Majority [71%] of the admissions were in October. Females comprised 58% of the studied children. Previously healthy children were 62% of the sample with a mean age of 4 years. The most common presenting symptoms were; fever [100%], cough [83%], runny nose [71%]. Complications were noted in 25 [45%] patients and were as follows: Febrile convulsions 9 [36%], neutropenia 7 [28%], Pneumonia 8 [32%], arrhythmia 1 [4%]. Antibiotics were administered to 62% of the children. Patients were admitted for a mean of 5 days. All patients had an uneventful hospitalization except for 3 patients who were transferred to the intensive care unit, and they recovered. Influenza A [H1N1] in children peaked in October 2009 with the dominance of previously healthy children. All children recovered and there was no mortality in our studied group

Perceptions and attitude towards lumbar puncture [LP] among parents in Kuwait

To assess the knowledge, understanding and acceptance of lumbar puncture [LP] among parents of pediatric patients in hospitals Questionnaire- based cross sectional survey Department of Pediatrics in three hospitals in Kuwait, namely, Al-Amiri, Al-Adan and Al-Jahra hospital Three hundred and fifty-eight parents of children admitted with various underlying diagnoses A self-administered questionnaire. Rate of acceptance of LP, characteristics of parents accepting and refusing LP, reasons for rejecting LP and means to improve LP acceptance among parents in Kuwait. A total of 358 parents responded to the questionnaire. Only 15.3% agreed for LP, 42.5% did not agree and 42.2% preferred taking a second opinion. Relationship to the child, nationality and educational level of the parent were significantly associated with acceptance of LP [p < 0.05]. The majority [79.1%] answered that LP is unsafe because it might cause complications like paralysis [46.2%], pain [16.6%], infertility [17.2%], and deterioration of child's health [12.8%]. Out of the parents who did not accept LP, 67.0% said that they might have changed their mind, if the procedure was fully explained by a doctor with the use of a diagram. Another group [66.0%] felt that the media can help to increase the acceptance of LP among parents. Parent's refusal of LP is a common problem among parents in Kuwait. The main reasons are lack of knowledge and the misconception that this is a harmful procedure. There is a great need to educate parents about the safety of LP in children

Aseptic meningitis among children in Kuwait

To describe the epidemiology, clinical features, and the morbidity caused by aseptic meningitis in children in Kuwait. A multicenter retrospective study of previously healthy children hospitalized with a diagnosis of aseptic meningitis in the period 2001-2003 was carried out. There were 172 children with the diagnosis of meningitis based on changes in the cerebrospinal fluid. Aseptic meningitis was diagnosed in 86 [50%] of the cases; their mean age was 3.2 +/- 3.8 years. There were two peaks of cases, one during the months of May and June and the other in November/December. Older children [>/= 5 years] presented more frequently with signs and symptoms suggestive of meningeal irritation than younger children [<5 years] [p