prevalence of human Bocavirus, human Coronavirus-NL63, human Metapneumovirus, human Polyomavirus KI and WU in respiratory tract infections in Kuwait

Objective: The aim of this study was to investigate the prevalence of human coronavirus [HCoV]-NL63, human metapneumovirus [hMPV], human bocavirus [Boca], human polyomavirus KI [KIV] and human polyomavirus WU [WUV] in respiratory tract infections [RTI] in Kuwait

Materials and Methods: Respiratory samples from 735 hospitalized patients with RTI from September 2010 to April 2013 were evaluated for the presence of HCoV-NL63, hMPV, Boca, KIV and WUV using molecular assays, polymerase chain reaction [PCR] and reverse-transcription PCR

Results: Of the 735 patients, 285 [38.8%] were diagnosed with viral RTI. The distribution of respiratory viruses was hMPV: 15 [5.3%], Boca: 14 [4.9%], WUV: 10 [3.5%] and KIV: 4 [1.4%]. HCoV-NL63 was not detected in any of the samples

Conclusions: These newly discovered viruses were associated with the development of RTI in Kuwait. The rapid identification of these viral infections could aid in the control of nosocomial transmission, reduce the use of antibiotics and improve treatment and management strategies

Transthoracic echocardiography and 6-minute walk test in Kuwaiti sickle cell disease patients

The aim of this study was to investigate cardiac abnormalities in Kuwaiti sickle cell disease [SCD] patients using markers such as tricuspid regurgitant jet velocity [TRJV], pulmonary artery systolic pressure [PASP], and the 6-minute walk [6MW] test and correlate these findings with clinical, hematological, and biochemical parameters. Seventy-three patients with SCD and 70 matched controls were studied. The cardiac status was investigated using transthoracic echocardiography in 57 patients; the 6MW test was carried out in patients and controls. Complete blood counts and hemolytic parameters were assessed. Reticulocytes, bilirubin, and lactate dehydrogenase were significantly higher [p < 0.0001] in patients, while hemoglobin [Hb] and haptoglobin were lower [p < 0.0001] than in controls. The mean fetal Hb among patients was 15.85 +/- 8.7%. Of the 57 patients, 14 [24.5%] and 15 [26%] had mild tricuspid and mitral regurgitation, respectively. The mean ejection fraction, TRJV, and PASP were 63.9 +/- 6.3%, 1.7 +/- 0.5 m/s, and 23.0 +/- 7.3 mm Hg, respectively. Three [5.2%] patients had mildly raised TRJV [2.6-2.97 m/s, normal range <2.5 m/s] while 8 [14%] had high PASP [mean 35.3 +/- 5.1 mm Hg, normal range <30 mm Hg]. Hb, hematocrit, and reticulocytes were different [p = 0.010, p = 0.006, and p = 0.011, respectively] between patients with normal and high PASP. All 3 patients who had a high TRJV had a high PASP, and 2 of these patients died during follow-up. The systolic and diastolic blood pressure, oxygen saturation before and after the 6MW test, and distance walked were lower [p = 0.006, p = 0.000, p = 0.002, p = 0.000, and p = 0.000, respectively] in patients compared to controls. Raised PASP was common in Kuwaiti SCD patients while raised TRJV was not

Allergic sensitization in healthy school children in Kuwait: an emerging public health concern

To determine the current level of sensitization in healthy school children in Kuwait. Prospective cross-sectional study. Al-Rashid Allergy Center, Kuwait. Healthy school-children between the ages of 8 -15 years. Skin prick test [SPT] and measurement of serum specific IgE levels. Skin wheal diameter [> 3 mm] and IgE levels [> 0.35 KIU/1]. 47% of children showed positive specific IgE levels and 38% showed a positive SPT to at least one allergen. Poly-sensitization was common in the population [IgE 32%, SPT 20%]. One in three [31%] children showed sensitization to Bermuda Grass [IgE], around one in five showed sensitization to Prosopis juliflora tree [20% IgE], grass mix [19% SPT], to cockroach [18% IgE, 12% SPT] and just slightly less to cat [15% IgE and SPT]. One in 10 healthy children were sensitized to dog [11% IgE, 10% SPT], few to house dust mite [D pteronyssinus] [IgE 8%, SPT 4%], ascaris [IgE 7%]. The lowest rates of sensitization were to Alternaria alternata [IgE 4%, SPT 2%], aspergillus [SPT 4%], and cladosporium [SPT 2%]. Frequent, severe sensitization [Classes 3-6 for specific IgE] was found for Bermuda Grass [16%], prosopis tree [6%] and cat allergen [5%]. Kuwait may be an example of conflict between two aspects of public health endeavour in a desert environment. Practices that make the desert habitable, viz, aforestation and air-conditioning may be the same ones that encourage exposure to allergens, allergic sensitization and allergic disease

Idiopathic pulmonary hemosiderosis

Idiopathic pulmonary hemosiderosis [IPH] is a rare disorder that is usually characterized by the triad of bilateral pulmonary infiltrates, hemoptysis and iron deficiency anemia.The disease is well known to affect the pediatric age group with conflicting treatment trials. We report a case of a 19 year- old girl with IPH and respiratory failure who had excellent initial response to systemic steroids. To the best of our knowledge this is the first reported case in this age group in the region

Wegener's granulomatosis: a case reports

Wegener's Granulomatosis is a rare disorder, presenting with granulomatous vasculitic lesions, mainly involving the respiratory tract [including the lungs] and associated with glomerulonephritis. We present the case of a 33-year old male patient who was admitted with complaints of cough and hemoptysis associated with vasculitic skin lesions. He had high levels of serum cytoplasmica ntineutrophil cytoplasmic antibody [C-ANCA]. The chest X-ray revealed extensive infiltrates in both lung fields. As the patient was too ill on account of severe hypoxia, lung biopsy could not be carried out, but skin biopsy revealed leukocytoclastic vasculitis. Based on these findings, a clinical diagnosis of We gener' s granulomatosis was made and combined therapy of steroids and cyclophosphamide started. The patient showed dramatic improvement and recovered fully from this life threatening condition

Flexible fiberoptic bronchoscopy. Diagnostic yield

Fiberoptic bronchoscopy is a minimally invasive procedure with a high diagnostic yield. The aim of this study was to document the usefulness of the procedure in the diagnosis of various respiratory disorders in a Middle East country. Data on all bronchoscopies carried out in Chest Diseases Hospital, Kuwait from January 1996 to December 1998 were retrospectively collected. Out of 968 cases, only 620 [64%] patients had a full follow up. Suspected pulmonary tuberculosis [TB] [51.6%], unresolving pneumonia [16.1%], hemoptysis with a normal chest radiograph [8.4%], lung mass [7.7%] and hilar lymphadenopathy [3.2%] were the most common indications. Eleven% of patients who underwent bronchoscopy had a normal chest radiograph, the reason being hemoptysis in 75.4%, inhalation injury in 21.8% and suspected upper airway obstruction in 2.9%. In smear negative suspected TB cases, 22.5% proved to have active disease. Acid fast bacillus was identified in bronchoalveolar lavage, either by smear or culture, in 44 [73.3%] patients with suspected pulmonary TB and in 6 [54.5%] patients with miliary shadows. An underlying cause was identified in 28 [28%] patients with unresolving pneumonia. Ninety-four% of cases with clinical impression of bronchogenic carcinoma could be diagnosed. Transbronchial biopsy was diagnostic in 79% patients with diffuse parenchymal lung disease. No complications other than transient hypoxemia and controllable bleeding were noticed. Generally, the indications for flexible fiberoptic bronchoscopy remained similar to elsewhere. Unlike western series, the majority of the cases were for the diagnosis of pulmonary infections especially TB