A point-prevalence survey of carbapenem-resistant Enterobacteriaceae in two different cities in Kuwait and Nigeria

Background: The family Enterobacteriaceae belongs to the order Enterobacterales, a large diverse group of Gramnegative, facultatively anaerobic bacteria that sometimes cause multidrug-resistant infections which treatment options are often challenging. They are the leading cause of nosocomial bloodstream infection (BSI) and urinary tract infections (UTI). The objective of the study was to carry out a point-prevalence survey of antimicrobial resistance and carbapenem-resistant Enterobacteriaceae (CRE) clinical isolates in two hospitals in Kuwait and Nigeria. Methodology: Clinically significant bacterial isolates of patients from Kuwait and Nigeria, identified by VITEK-2 and MALDI-TOF mass spectrometry analysis were studied. Susceptibility testing of selected antibiotics was performed using E-test and broth dilution methods. Genes encoding carbapenemase, ß-lactamases, and extended-spectrum ßlactamases (ESBLs) were detected by conventional PCR and sequencing, and whole genome sequencing (WGS) analyses. Results: Of 400 isolates from Kuwait and Nigeria, 188 (47.0%) and 218 (54.5%) were Escherichia coli and 124 (31.0%) and 116 (29.0%) Klebsiella pneumoniae, respectively. The prevalence of CRE was 14.0% in Kuwait and 8.0% in Nigeria. The resistance rates of CRE isolates against colistin and tigecycline in Kuwait were 6.6% versus 25.0%, and in Nigeria were 14.2% versus 14.2%, respectively. blaOXA-181 gene was the commonest in CRE isolates in Kuwait and blaNDM-7 in Nigeria. The commonest ESBL gene among the CRE isolates was blaCTX-M-15 in both countries. AmpC resistance genes were present in only Kuwait isolates and mediated by blaEBC, blaCIT and blaDHA. WGS analysis of 12 selected CRE isolates with carbapenem MICs>32µg/ml but no detectable genes from conventional PCR, revealed the presence of multidrug efflux pump genes such as major facilitator superfamily antibiotic efflux pump and resistance-nodulation-cell division antibiotic efflux pump groups. Conclusion: The prevalence of CRE was higher among isolates from Kuwait than Nigeria and the genes encoding resistance in CRE were different. The presence of efflux pump was a main mechanism of resistance in most of the Nigerian CRE isolates.

Speciation of heavy metals and their distribution in surface sediments of the northwestern part of the ROPME Sea Area

Aim: To analyze samples of marine sediment at 24 stations for heavy metals as per sequential Community Bureau of Reference protocol in order to obtain metal distribution pattern in Kuwait offshore.Methodology: In the present study, a centrifugal particle-size analyzer was used for measuring sediment grain size. The Community Bureau of Reference scheme was deployed for the sequential extraction of heavy metal speciation, and the fractionation was determined by Inductively Coupled Plasma-Mass Spectrometry. Results: Grain-size analysis showed that the study area contained 71.8% silt, 22.6% sand and 5.56% clay at most locations. The average abundance of total concentration of heavy metals was found in the following order: lead< cobalt< copper< zinc< chromium< nickel. The mobility order of exchangeable fraction of heavy metals decreased in the order lead> nickel> zinc> cobalt> copper; in the reducible fraction: lead> copper> zinc> cobalt> nickel; in the oxidizable fraction: lead> chromium> copper> nickel> cobalt> zinc and in the residual fraction:cobalt> chromium> nickel> zinc> copper>lead, respectively. Interpretation: The outcome of the present study cannot establish the actual form of species of a given metal in the sediment; though, it appears to be useful in categorizing the metals within several prevailing geochemical fractions.

A comparative study on the effect of dispersed and undispersed Kuwait crude oil on egg hatching and larval survival of Epinephelus coioides

Aim: The objective of the present study was to investigate the effects of dispersed and undispersed Kuwait crude oil on egg hatching and larval survival of Epinephelus coioides. Methodology: In the present study, the toxic effects of crude and dispersed oil using three formulations of oil dispersants against multiple life stages of Epinephelus coioides was assessed. The lethal concentration was calculated by ToxCal® software developed by Tidepool Scientific, LLC. Results: Specifically, the following life stages were investigated: embryonated eggs (EE), larvae hatched during exposure (LHE) and hatched larvae (HL). Chemical analysis showed that Total Petroleum Hydrocarbon (TPH) concentrations were higher in dispersed than undispersed oil solutions, indicating accommodation of more petroleum hydrocarbons in the aqueous phase. Acute static toxicity tests produced variable LC50 values for all chemical preparations and all fish life stages. Crude oil dispersed with both Corexit® EC 9500A and Corexit® EC 9527A separately was more toxic to both EE and LHE stages than undispersed oil, but crude oil dispersed with Slickgone® NS resulted in lower toxicity. Furthermore, all three types of dispersed oil exerted higher toxicity than undispersed oil at HL stage. Interpretation: A life stage dependent effect demonstrated variation in the toxicity of both dispersed and undispersed crude oil to fish. Few life stages were more sensitive than others to either dispersed or undispersed crude oil toxicity. While dispersion of an oil slick with oil dispersant has proved to be an effective tool in the oil response strategy, the fate of dispersed oil can exert lethal effects on embryo-larval stages of marine fish present near the spill.

A cross-sectional survey of Indians in Kuwait with risk factors for coronary artery disease

Background: The Indian sub-population is the biggest among the foreigners in Kuwait. Due to the harsh weather conditions most of the time in the year there is less inclination towards a healthy lifestyle. The present study was conducted to determine the extent of the Indian population living in Kuwait having the risk factors for coronary artery disease (CAD).Methods: A cross-sectional survey was conducted including 400 subjects aged 18 years or more (346 males and 54 females). They were subjected to general physical examination, and were asked to respond to a standard questionnaire.Results: Significantly more females than males were found to be overweight (63% vs. 43.9%, p<0.01) or obese (16.7% vs. 4.3%, p<0.005). Females also had higher proportions than males in having inadequate physical activity (79.6% vs. 53.2%, p<0.001). Significantly more males were having an inadequate intake of fruits and vegetables as compared to females (34.7% vs. 18.5%, p<0.005). There was no significant difference between the genders in proportions of hypertension, smoking, and diabetes. Overweight, hypertension, and inadequate physical activity showed a rising trend with increasing age. The studied population was compared with several geographically different populations, as well as the different populations living in India.Conclusions: As the stay and the jobs of Indians in Kuwait depend upon their health-status, prevention of CAD is of paramount importance. Looking at the levels of the prevalence of several risk factors, multilevel interventions are needed for reducing the CAD-morbidity and mortality.

An Atypical Case of Middle East Respiratory Syndrome in a Returning Traveler to Korea from Kuwait, 2018

We report a case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 61-year-old businessman returning from Kuwait. The patient arrived there on August 16, 2018, developed watery diarrhea on August 28 (day 0), and came back to Korea on September 7 (day 10) as his condition worsened. Upon arrival, he complained of diarrhea and weakness, but denied any respiratory symptoms, and he directly went to visit an emergency room. Chest radiography revealed interstitial infiltrates in the lungs, and he was immediately transferred to an isolation unit. Quantitative real-time PCR analysis of sputum samples taken on day 11 returned positive for MERS-CoV. No secondary MERS-CoV infection was identified among people who had close contact with him. This case underscores the importance of a high index of suspicion of MERS-CoV infection in any febrile patients who present after a trip to the Middle East.

A Comparison of Rheumatoid Arthritis Patients in Kuwait with Other Populations: Results from the KRRD Registry.

Objective: Data on rheumatoid arthritis (RA) in Kuwait and The Middle East is scarce. Available data from Western countries may not be representative of the region. We describe RA patients in Kuwait and compare them with other RA populations and with Kuwaiti general population. Methods: Adult RA patients from Kuwait Registry for Rheumatic Diseases (KRRD), the first RA registry in The Middle East, were studied from February 2013 through February 2015. Demographic, clinical and serologic data were compared with other RA populations and with Kuwaiti general population. Results: 835 patients were enrolled, 62.3% female. Mean age 50.6±12 years and disease duration 6.1±6 years. RA was diagnosed at a mean age of 44.9±12 years. 17.1% had family history of autoimmune rheumatic diseases. 3.1% had rheumatoid nodules. Rheumatoid factor (RF) and anti-citrullinated peptide (ACPA) were detected in 75.6% and 57.8%, respectively. Both were positive in 49% (r=0.287, p=0.001). ANA was positive in 19.1%. Both ACPA and a combination of positive RF and ACPA were more in males (p=0.017, 0.004 respectively), whereas ANA was more in females (p=0.01). One third of male patients were smokers versus 1.9% of females. Smoking was correlated to RF (p=0.009) and ACPA (p=0,002). Difference in ACPA between genders was statistically explained by the predominance of smoking in males. Comorbidities included diabetes mellitus (DM) (20.8%), hypertension (20.2%), hyperlipidemia (10.5%) and coronary artery disease (CAD) (3.1%). 4 cases of cancer were reported. Conclusion: RA population in Kuwait includes less women than other RA populations but more than Kuwaiti general population. Family history is more common. A higher positive ACPA in males was explained by smoking difference. Hypertension and hyperlipidemia were less reported than in both Kuwaiti general population and other RA populations. CAD was similar to other RA populations. DM was more reported, reflecting its high background prevalence in Kuwait.

Potential Zoonotic Trematodes Recovered in Stray Cats from Kuwait Municipality, Kuwait

Stray cats are a common feature roaming the streets and alleys of Kuwait; they could be a source of parasites, including trematodes, that affect humans. A survey was conducted to identify feline trematodes and throw the light on their public health significance in Kuwait. Out of 240 stray cats trapped from different localities of Kuwait from June 2011 to May 2012, 59 (24.6%) were found to be infected with 14 species of trematodes. The most common were trematodes of the genus Heterophyes, particularly H. heterophyes and H. dispar that were found in respectively 15.8% and 10.8% of the cats examined. Other trematodes recorded, with lower prevalences, were Heterophyes nocens (2.9%), Haplorchis taichui (3.8%), Stictodora sawakinensis (2.1%), Stellantchasmus falcatus (1.6%), Echinochasmus japonicus (1.6%), and Mesostephanus dottrensi (1.3%). Centrocestus cuspidatus, Galactosomum fregatae, Ascocotyle sp., Mesostephanus appendiculatus, Haplorchis yokogawai, and Pygidiopsis genata showed the lowest prevalence (0.4%) and intensity. The majority of the trematodes are recorded for the first time in Kuwait and even in the Gulf region. The study reveals that stray cats are good indicators of fish-borne trematodes in the environment. As all trematodes recovered are zoonotic, their significance to public health should be considred.

Splenic Rupture in Plasmodium vivax Malaria: A Case Report from Kuwait.

We describe a case of malaria vivax in a 31 year old Afghan male complicated by spontaneous splenic rupture one month after returning from Pakistan. The ruptured and enlarged spleen displaying multiple subcapsular hemorrhages was surgically resected. Malaria was diagnosed by peripheral blood smear. The patient underwent antimalarial therapy with chloroquine and primaquine. While numerous diseases can result in splenic complications, such as splenic rupture malarial infection is known as the most common cause. Consequently, It is recommended that malaria be always considered in all cases of suspected splenic rupture in the differential diagnosis of all acute fevers, especially among those with a history of travel to an endemic area.

The Effects of Supervised Exercise Program on Health-Releated Physical Fitness in Kuwait.

Aims: Physical activity improves health in terms of cardiovascular fitness, musculoskeletal fitness, body composition, and metabolism. The study aims to examine the effects of supervised exercise training on metabolic profile and health-related physical fitness parameters in Kuwait. Study Design: A prospective observational study. Place and Duration of Study: Fitness and Rehabilitation Center (Dasman Diabetes Institute, Kuwait) between January 2012 and December 2013. Methodology: We included 90 participants (44 women), mean age 48.6 (±14.4) years with adherence exceeding 50%. Outcome measures health-related physical fitness (measured by cardiopulmonary exercise testing) and other secondary outcome measures including anthropometric data, vital signs, and glycemic profile values. Results: Paired t-test was used to evaluate the effects of exercise training. Both diabetic and non-diabetic participants showed significant increase in peak oxygen consumption (3.0 ml∙min-1∙kg-1; 95% CI: 2.3 to 3.7; p <0.001). There was significant reduction in BMI (- 0.6 kg/m2; 95% CI: -0.9 to -0.3; p<0.001), waist circumference (-2.2cm; 95% CI: -3.4 to - 1.0; p = 0.002) and body fat percentage (-0.9%; 95% CI: -1.4 to -0.3; p = 0.002). Theglycated hemoglobin significantly decreased (p=0.001). Fasting blood glucose and lipid profile improved but were not statistically significant. The exercise intervention reduced the systolic blood pressure (BP) and diastolic BP by a mean of 0.6 (95% CI: -3.2 to 1.9; p = 0.63) and 2.6 mmHg (95% CI: -4.9 to -0.3; p=0.03) respectively, with the latter being statistically significant. Significant changes were also noted in variables of total handgrip (4.2 kg; 95% CI: 1.4 to 7.0; p=0.04) and push-up (4.2 repetition; 95% CI: 1.9 to 6.4; p < 0.001). Conclusion: The 12-week supervised exercise intervention used seems to improve cardiorespiratory fitness, glycemic control, diastolic BP and anthropometric measurements. This improvement can indicate that exercise decrease cardiovascular events and mortality.

Evaluation of leptin, interleukin-1 beta and tumor necrosis factor alpha in serum of malaria patients as prognostic markers of treatment outcome

<p><b>OBJECTIVE</b>To analyze serum leptin levels in patients with malaria falciparum and compare them with healthy controls and correlate with development and outcome of malaria infection.</p><p><b>METHODS</b>Sixty cases of malaria falciparum were included in this study as patients. Thirty healthy individuals of comparable age, racial and body mass index were taken as controls. All patients were diagnosed by clinical picture and the presence of malaria parasites in blood film. Estimation of liver function test, kidney function test, complete blood count, fasting blood sugar, fasting serum insulin, pro-inflammatory cytokine tumor necrosis factor alpha (TNFα) and interleukin 1 (IL1), estimation of morning serum leptin and calculation of body mass index (kg/m(2)) were done in both groups on the day of admission, on discharge and 7 d after discharge.</p><p><b>RESULTS</b>At admission, leptin levels were significantly higher in patients group than in control while fasting serum insulin levels were not significantly different between the two groups. There were significant increases as regard to TNFα and IL1 in malaria patients. Significant differences were observed between the control and the patient group for leptin, TNFα and IL1 at the time of admission and discharge. After discharge for 7 d, a significant decline in serum leptin levels, TNFα and IL1 in the patients group was observed as compared with time of admission and time of discharge, a positive correlation between serum leptin levels and TNFα and IL1.</p><p><b>CONCLUSIONS</b>Leptin hormone level might play an important role in development and outcome of malaria infection.</p>

Penicillin allergy evaluation: experience from a drug allergy clinic in an Arabian Gulf Country, Kuwait

BACKGROUND: Hypersensitivity to penicillin has been studied worldwide, but data regarding patterns of sensitization in Arabian Gulf countries are scarce. OBJECTIVE: To describe the patterns of penicillin hypersensitivity during a 6-year study in Kuwait in terms of demographics, type of the culprit drug, in vivo and in vitro allergy testing. METHODS: One hundred and twenty-four patients referred to the drug allergy clinic for penicillin allergy were fully evaluated by skin prick and intradermal testing. Drug provocation test was done on patients with negative results. RESULTS: A total of 124 patients were evaluated for penicillin allergy. Mean age was 37.8 (standard deviation, 12.7) years, range from 8 to 74 years. Thirty-nine male (31.5%) and 85 female patients (68.5%) were included. Diagnosis of penicillin allergy was confirmed in 46 patients (37.1%). Among the 44 confirmed allergic patients by skin evaluation we had 15 (34.1%) positive skin prick test, and 29 (65.9%) positive intradermal testing. Among patients with positive skin testing, 47.7% were positive to major determinant benzylpenicilloyl poly-L-lysine, 20.4% to minor determinant mixture, 50.0% to penicillin G and 40.9% to ampicillin; 13.6% of patients were positive to amoxicillin by skin prick test. One patient had a positive radioallergosorbent test and one had a positive challenge test. CONCLUSION: Penicillin allergy is a common problem with an incidence of about one third in our study subjects.

Evaluation of leptin, interleukin-1 beta and tumor necrosis factor alpha in serum of malaria patients as prognostic markers of treatment outcome

Objective: To analyze serum leptin levels in patients with malaria falciparum and compare them with healthy controls and correlate with development and outcome of malaria infection. Methods: Sixty cases of malaria falciparum were included in this study as patients. Thirty healthy individuals of comparable age, racial and body mass index were taken as controls. All patients were diagnosed by clinical picture and the presence of malaria parasites in blood film. Estimation of liver function test, kidney function test, complete blood count, fasting blood sugar, fasting serum insulin, pro-inflammatory cytokine tumor necrosis factor alpha (TNFα) and interleukin 1 (IL1), estimation of morning serum leptin and calculation of body mass index (kg/m

Evaluation of leptin, interleukin-1 beta and tumor necrosis factor alpha in serum of malaria patients as prognostic markers of treatment outcome

Objective: To analyze serum leptin levels in patients with malaria falciparum and compare them with healthy controls and correlate with development and outcome of malaria infection.Methods:healthy individuals of comparable age, racial and body mass index were taken as controls. All patients were diagnosed by clinical picture and the presence of malaria parasites in blood film. Estimation of liver function test, kidney function test, complete blood count, fasting blood sugar, fasting serum insulin, pro-inflammatory cytokine tumor necrosis factor alpha (TNFα) and interleukin 1 (IL1), estimation of morning serum leptin and calculation of body mass index (kg/m2) were done in both groups on the day of admission, on discharge and 7 d after discharge.Results:Sixty cases of malaria falciparum were included in this study as patients. Thirty while fasting serum insulin levels were not significantly different between the two groups. There were significant increases as regard to TNFα and IL1 in malaria patients. Significant differences were observed between the control and the patient group for leptin, TNFα and IL1 at the time of admission and discharge. After discharge for 7 d, a significant decline in serum leptin levels, TNFα and IL1 in the patients group was observed as compared with time of admission and time of discharge, a positive correlation between serum leptin levels and TNFα and IL1. At admission, leptin levels were significantly higher in patients group than in control Conclusions: Leptin hormone level might play an important role in development and outcome of malaria infection.

An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait.

Objective: This study reports an outbreak of Klebsiella pneumoniae infections in 14 patients during a 2-month period (August-September, 2008) in the intensive care unit (ICU) of a teaching hospital in Kuwait. Materials and Methods: The clinical sources were blood (9), urine (3) and respiratory secretions (2) identified by the automated VITEK-2 ID System. Susceptibility testing was performed by the E-test method. Extended-spectrum β-lactamase (ESBL) production was assessed using the ESBL E-test and confirmed by PCR. Carriage of bla genes was determined by PCR and sequence analysis. The transferability of resistance phenotypes was demonstrated by conjugation experiments and clonal relatedness was determined by PFGE. Results: The isolates were susceptible to imipenem, meropenem, and tigecycline and produced ESBL. All isolates yielded an amplicon of 499 bp with universal consensus primers (MA primers). DNA sequence analysis showed that they all harboured blaCTX-M-15 and blaTEM-1 genes. The environmental isolate obtained from a suction machine was also CTX-M-15/TEM-1 producer. The resistance phenotypes were transferrable to the Escherichia coli J53 r strain. PFGE, revealed two clones, A and B, related with a Dice coefficient of >94.1%. A mortality rate of 21.4% was recorded. Conclusion: The outbreak was contained by robust and aggressive infection control measures. This study highlights the first outbreak of CTX-M-15-producing K. pneumoniae associated with high mortality in an adult medical ICU in Kuwait.