Severe diabetic ketoacidosis precipitated by an atypical antipsychotic drug

We report a case of a young Kuwaiti gentleman who presented with severe diabetic ketoacidosis [DKA] associated with atypical antipsychotic drug olanzapine. The current medical literature suggest that atypical antipsychotic drugs, including olanzapine lead to weight gain, insulin resistance, impaired glucose tolerance [IGT], diabetes mellitus [DM] and rarely patient may presents with serious side effects like DKA. Clinicians are urged to monitor the emergence of metabolic risk factors periodically and remain aware of potentially serious effects like DKA in schizophrenic patients taking olanzapine

Miliary tuberculosis in Kuwait: clinical presentation, diagnosis and treatment outcome

To assess the demographic, clinical and laboratory features, methods of diagnosis, treatment and outcome in patients with miliary tuberculosis [TB] in Kuwait Retrospective [medical records review] Tuberculosis department, Al Rashed Allergy Center, Kuwait Thirty-four patients with miliary TB admitted from January 1996 to December 2005 Demographic features, clinical presentation, investigation results, treatment history and follow up records There were 22 male and 12 female patients; mean age 33 years. 91% were expatriates. Fever [91%], weight loss [88%], cough [82%], night sweats [61%] and hemoptysis [17%] were common presenting symptoms. Lymphadenopathy [35%], hepatomegaly [26%] and meningeal signs [12%] were seen. Anemia [65%], leucocytosis [21%], thrombocytopenia [6%], thrombocytosis [12%], raised liver enzymes [32%] and hypoalbuminemia [85%] were common laboratory findings. Sputum culture for Acid-Fast Bacilli [AFB] was positive in 64%. AFB culture was positive from cerebro-spinal fluid in three patients, lymph node in two, pus, endometrium, bronchial biopsy, liver biopsy, joint aspirate, ileal biopsy, urine, trans-bronchial biopsy and bronchial lavage in one case each. 73% were sensitive to all first line anti-TB drugs. Hepatitis [23%], hyperuricemia [9%], skin rashes [3%], nephropathy [3%] were the sideeffects of anti-tuberculosis drugs. One patient [3%] died, 56% were cured, 35% left the country or were deported, and 6% defaulted. One patient had relapse. Diagnosis of miliary TB could be confirmed by clinical features, radiological features and AFB culture, even when classical miliary patterns were not present. Anti-TB drugs were generally safe. Majority of patients were cured completely when followed up regularly

Severe diabetic ketoacidosis precipitated by an atypical antipsychotic drug

We report a young Kuwaiti gentleman who presented with severe diabetic ketoacidosis [DKA] associated with atypical antipsychotic drug olanzapine. The current medical literature suggests that atypical antipsychotic drugs, including olanzapine lead to weight gain, insulin resistance, impaired glucose tolerance, diabetes mellitus [DM] and rarely patient may present with serious side effects like DKA. Clinicians are urged to monitor the emergence of metabolic risk factors periodically and remain aware of potentially serious effects like DKA in schizophrenic patients taking olanzapine

Kuwait acute coronary syndromes registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

To identify the characteristics of patients with acute coronary syndromes [ACS], their hospital management and in-hospital outcomes, through a prospective registry system in Kuwait. A registry involving all 7 general hospitals in Kuwait was set up. Consecutive patients diagnosed as having ACS over a period of 6 months were enrolled. Of 2,129 patients enrolled, 718 [34%] had ST segment elevation myocardial infarction [STEMI], 576 [27%] non-ST segment elevation myocardial infarction [NSTEMI] and 835 [39%] unstable angina [UA]. Thrombolytic therapy was used in 556 [77%] patients with STEMI. The median time from diagnostic electrocardiogram to administration of thrombolytic therapy was 38 min. Almost all patients with ACS [2,050, 96%] received aspirin during hospitalization. Only a minority received clopidogrel, 18 [3%] STEMI, 36 [6%] NSTEMI and 96 [12%] UA patients. The use of glycoprotein llb/llla antagonists was minimal [38 patients, 2%]. beta-blockers were used in 1,473 [69%] patients, while 982 [46%] received angiotensin-converting enzyme inhibitors. Coronary angiography during hospitalization was performed in 119 [17%], 120 [21%] and 126 [15%] patients with STEMI, NSTEMI and UA, respectively. In-hospital mortality occurred in 31 [4%] myocardial infarction patients and 4 [0.5%] UA patients [p < 0.0001]. This registry has enabled us to determine the incidence and characteristics of ACS patients in Kuwait. It has also enabled us to identify some barriers that we need to overcome for the full implementation of published guidelines for the management of patients with ACS

Hematological changes in malaria: relation to plasmodium species

To evaluate different hematological changes in patients with malaria and to establish a possible role of Plasmodium species in the pathogenesis of these changes. Hematological changes were prospectively studied in randomly selected patients, immediately on admission and on a daily basis after starting anti-malarial treatment. Infectious Diseases Hospital, Kuwait, during the year 2004. The study enrolled 103 patients with malaria, [37 infected with Plasmodium falciparum, 34 infected with Plasmodium vivax, and 32 infected with both species i.e., mixed infections]. Antimalarial drugs Beside history taking, clinical examination, and routine laboratory work, thick and thin blood films were prepared and examined from all patients for defining the species involved. In addition, blood picture [red and white blood cells, platelets, and reticulocytes] was studied in all patients. Anemia and thrombocytopenia were the two most important hematological abnormalities seen in cases of acute malaria infection. The degree of anemia was related more to P. falciparum infection, while, thrombocytopenia was associated with P. vivax infection and mixed infections. Hematological changes were mild in the first 24 hours, but continued to deteriorate for few days after anti-malarial therapy. One P. falciparum infection was associated with severe hematologic abnormalities, disseminated intravascular coagulopathy [DIC], and acute respiratory distress syndrome [ARDS]. We recommend that subsequent checkup of blood cells and platelets are of utmost importance particularly in cases infected with P. falciparum or mixed infections

Moyamoya syndrome with primary antiphospholipid syndrome

To report a rare case of moyamoya syndrome with primary antiphospholipid syndrome [APS]. A 41-year-old woman was admitted with sudden onset of left-sided hemiparesis. Magnetic resonance imaging and magnetic resonance angiography of the brain showed characteristic features of moyamoya vessels. Laboratory investigations revealed raised levels of anticardiolipin antibody. She made a complete and uneventful recovery with aspirin and intensive physiotherapy over a period of 2 weeks. The association of APS and moyamoya disease may present a dilemma in management. While APS is often considered to be an indication for giving anticoagulation, a trial of antiplatelet agents is preferable to anticoagulation because of the risk of bleeding from the fragile moyamoya vessels

Autoimmune thyroid disease in a patient with Usher's syndrome: case report

Usher's syndrome [US] is a rare genetic disorder characterized by congenital sensorineural deafness arid retinitis pigmentosa. Here, we describe the association of US and hypothyroidism due to autoimmune thyroid disease [AITD] in a 50-year-old Kuwaiti woman diagnosed clinically to have US. As far as we are aware, this is the first case report of US in Kuwait arid to our knowledge the association with AITD has not been previously reported

Retroperitoneal liposarcoma: an unusual cause of abdominal enlargement encountered in the medical outpatients'dept

A large retroperitoneal tumor [10kg] was excised from a 50 year old lady who presented to the Medical Outpatients' Department with abdominal enlargement. Retroperitoneal liposarcoma is a rare soft-tissue sarcoma which commonly presents as a painless abdominal mass. Diagnosis is usually by computerised tomography and histological examination. It has a poor prognosis and a high recurrence rate. Wide local surgical excision is the optimal therapy