Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis

To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen [PSA] in patients investigated for prostatic disease in Kuwait. Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. Of the 331 tissue specimens, 18 [5.4%] did not show prostatitis, while 233 [70.4%] with benign prostate and 80 [24.2%] with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 [41%] with benign prostate disease and prostatitis and of the 72, 52 [76%] with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer

Differences in physician compliance with guideline on lipid profile determination within 24 h after acute myocardial infarction

To evaluate the American College of Cardiology/American Heart Association guidelines on blood lipid testing within 24 h of the onset of chest pain in patients with myocardial infarction. Subjects and This is a cross-sectional observational study on 83 patients [77 male, 6 female] admitted into the Coronary Care Units of the Al-Amiri and Mubarak Al-Kabeer Hospitals, Kuwait with myocardial infarction. The lipid profiles were obtained within 24 h of the onset of chest pain. Twenty patients were on treatment with statins prior to admission. Diagnosis of myocardial infarction in all patients was based on standard criteria. Total cholesterol [TC], high-density lipoprotein [HDL] cholesterol, and triglycerides [Tg] were measured and low-density lipoprotein [LDL] cholesterol was calculated. Twenty-three patients had normal cardiac markers on admission but later developed increased serum markers and ECG changes of acute myocardial infarction. Mean [95% confidence interval] TC, HDL, Tg and LDL were 5.1 [4.8-5.4]; 0.93 [0.88-0.98]; 1.85 [1.56-2.14], and 3.39 [3.13-3.65] mmol/l, respectively. 70% of the patients had normal or only mild elevations of LDL with low HDL and poor HDL:TC ratio [<20%]. Thirty-eight patients had low HDL [<0.9 mmol/l] and only 22 [27%] patients met the National Cholesterol Education Program guideline of target LDL <2.6 mmol/l. Fifty-six patients were classified as having the metabolic syndrome according to the criteria of the WHO. The findings indicate that HDL appears to be the main lipid risk factor in patients presenting with AMI in Kuwait, therefore primary prevention strategies should focus on treatment modalities that increase HDL. We recommend that the lipid profile should be done within 24 h of admission and lipid-lowering therapy initiated as part of secondary prevention strategy