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Introduction: The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing, changings, and suture removal since they are usually repaired with non-absorbable sutures. In a matter of fact, these visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the theoretical risk of wound infection. In this study, our aim was to determine whether absorbable sutures are better than non-absorbable sutures in repairing lacerations during the COVID-19 pandemic. The first and second objectives were to assess the rate of infection and the number of postoperative hospital visits. Method(s): A sample of 469 patients with traumatic skin lacerations were analysed during the COVID-19 pandemic in April-July 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone call follow-up after 21 days, several parameters regarding infection signs and hospital visits were compared between both groups. Result(s): No statistically significant difference was observed between both groups regarding wound infection (p-value= 0.623). Using absorbable sutures resulted in fewer postoperative hospital visits than non-absorbable sutures (p-value= 0.001). This study is limited because the assessment of wound infection was subjective to the patient by a phone call follow-up. Conclusion(s): Using absorbable sutures to close traumatic skin lacerations is safe. They should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.
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The COVID-19 pandemic has been affecting world economies, business revenues, and the livelihood of many individuals, and has also resulted in accumulated medical waste. Countries, governments, and health workers are striving to contain this virus by applying different strategies and protocols. This research investigates and identifies the significant determinants that influence the acceptance and Adoption of non-hazardous medical waste recycling behaviour in Kuwait. This article questions whether healthcare workers in Kuwait are actually behaving differently regarding non-hazardous medical waste recycling during the pandemic as opposed to previously. The study uses a deductive research approach involving a quantitative methodology by applying the theory of planned behaviour as a framework. From an overall perspective, individuals have positive intentions and behaviours toward recycling. However, COVID-19 and the fear of spreading the virus had a positive impact on the healthcare workers' recycling behaviour in public hospitals in Kuwait. © 2022 IGI Global. All rights reserved.
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Introduction: Kuwait has a large expatriate community, representing almost two thirds of the total population of 4,464,100. They are non-citizens with a temporary residency permit and have a limited access to public health care provided by ministry of health compared to Kuwaiti citizens. We examined differences in basic characteristics, management, and outcomes between Kuwaitis and non-Kuwaitis who developed acute kidney injury (AKI) Methods: Demographics, comorbidities, dialytic and non-dialytic management data, and kidney and patient outcomes at 30 days from nephrology consultation for all nephrology consultations for AKI in seven public hospitals in Kuwait, from January 1 to June 30, 2021, were prospectively collected and analyzed Results: The total number of AKI referrals was 3749 (hospital-acquired AKI: 50%;males: 59%;mean age: 63 years;patients with eGFR < 60: 42%). Patients with baseline eGFR < 60 were older than patients with eGFR of >= 60 (mean age: 68 vs. 59 years), had lower mean initial Hgb (10.1g/dL vs. 10.8g/dL) and had higher rates of DM (83% vs. 60%), HTN (86% vs. 62%), and cardiac disease (60% vs 38%). More than 50% of AKI cases were due to ATN. Non-Kuwaitis had a small but statistically significant higher rates of COVID-19 related AKI (9% vs 7% of AKI in Kuwaitis were related to COVID-19). During the course of AKI, 80% received fluids, 45% received diuretics and 42% received vasopressors. Expatriates represent two thirds of the total population of Kuwait;however, they accounted for only 43% of all AKI cases. They were younger than Kuwaitis (58 vs 67), had more male involvement (72% were men vs 50% men in the Kuwaiti group), had higher mean baseline eGFR (73 mL/min vs 62 mL/min for Kuwaitis), and higher mean baseline Hgb (10.8g/dL vs 10.3g/dL). More hospital acquired AKI than community acquired AKI in expatriates (54% vs 46%), whereas the opposite seen in Kuwaiti patients (53% community acquired vs 47% hospital acquired), and more AKI in the summer than the winter (62% in summer vs 38% in winter). However there was no seasonal difference for Kuwaiti patients. No difference in the need for invasive ventilation Dialysis was needed for 33.5% of the total cohort, significantly higher utilization for expatriates (35% vs 32% of Kuwaitis requiring dialysis). Continuous dialysis was the initial modality in 90% of cases. However, no difference at 30 days in percentage of patients still on dialysis At 30 days, 41% of the total cohort died with significantly higher death rates in Kuwaitis (39% of expatriates vs 43% of Kuwaitis died). Kuwaiti patients who died were older (69 years vs 58 years for expatriates). Of patients who needed dialysis, 55% died while on dialysis Mean final eGFR at 30 days for those who survived and were off dialysis was 49 mL/min, and was significantly higher for expatriates (54 mL/min vs 46 mL/min for Kuwaitis) Conclusion(s): Despite being two thirds of the population, expatriates accounted for only 43% of AKI case, since they were younger with higher baseline eGFR. However, they had higher rates of AKI in Summer (probably due to increased risk of lack of air conditioning where they work or live), higher rates of COVID-19 related AKI (probably due to delayed vaccination of expatriates compared to Kuwaitis) and higher need for dialysis. However, at 30 days, they had lower rates of mortality, similar rates of recovery from dialysis and higher mean final eGFR No conflict of interestCopyright © 2023
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Background: The first COVID-19 case was reported in Kuwait in February 2020, and the pandemic rapidly spread in the country. To better understand the impact of COVID-19 on children, a pediatric registry was established, recording all cases of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in children, focusing on disease presentation, complications, severity of the disease and early outcomes. Methods: A retrospective, national-level, cohort study was performed and included all children aged ≤ 12 years with a confirmed SARS-CoV2 infection by polymerase chain reaction (PCR) in Kuwait between February 24th to December 31st, 2020. Cases were identified through reviewing national electronic SARS-CoV-2 testing, hospital admission records, and medical transfer services. During the study period infected children were identified through symptomatic testing, contact tracing, routine screening upon hospitalization, and screening before and after travel. Children who were older than 12 years at the time of sample collection or had equivocal RT-PCR result were excluded. Also, patients who had positive SARS-CoV-2 specific antibodies without documentation of positive SARS-CoV-2 RT-PCR were excluded in the analysis. Patient demographics, medical history, SARS-CoV-2 testing, signs and symptoms, therapeutic and medical intervention, complications, laboratory tests and outcome were obtained using The Kuwait Pediatric COVID-19 Registry (PCR-Q8). Descriptive analysis was performed. Results: During the study period, a total of 14,322 children aged ≤12 were diagnosed with SARS-CoV-2 infection in Kuwait. The first pediatric case was reported in March 2020. The monthly number of cases peaked during the summer of 2020 (July-September), and this was followed by a rapid decline during the beginning of winter of 2020 (figure 1). The median age was 7.6 years (IQR 4.1- 10.5) and half were male. Less than one-third (29.4%) were symptomatic (table 1). The number of children with pre-existing comorbidities was 228 (1.59%);the most common comorbidities were asthma (54, 0.37%), chronic neurological disorder (29, 0.2%) and acquired/congenital heart disease (25, 0.17%). The number of hospitalized children was 1599 (11.2%). The most common symptoms of those who were hospitalized were fever (39.8%), cough (17.6%), runny nose (11.1%) and diarrhea (8.4%). A total of 32 children were admitted to intensive care (0.22%), and 5 deaths were recorded (0.035%). Conclusion: Overall, the pediatric COVID-19 registry has invaluable information about the effect of COVID-19 on children in Kuwait. Such information can guide clinical practices for better understanding and management of COVID-19 in children.
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Background: The rising incidence of diabetes mellites is a growing health concern in Kuwait, placing an overwhelming burden on the healthcare system. The overall prevalence of diabetes was estimated to be 19.1% according to last published data in 2020. As a result, the Kuwait National Diabetes Registry (KNDR) was established in the year 2018 by the Ministry of Health in collaboration with the Dasman Diabetes Institute to provide insight on the nature of the disease in this population. Aim: The aim of establishing the national web-based registry is to provide a sound database to investigate disease diagnosis, management, and outcomes and enable evaluation of clinical improvement focusing on identifying risk factors, treatment interventions and disease complications and assess morbidity in the adult and pediatric population. Method: Patients of all ages and nationalities residing in Kuwait diagnosed with any form of diabetes (type 1, type 2, gestational and atypical) were included in the KNDR. Data sources include electronic health records from primary healthcare centers (PHC), hospital outpatient clinics, Kuwait Diabetes Society (KDS) and patient self-register on the webpage. The register includes data on demographics, diabetes type, comorbidities, smoking habits, treatment modality, blood pressure, weight, height, and blood profile including glucose status, renal and lipid profile. Patient data was collected from one governorate as a pilot phase before extending the platform to other regions in Kuwait. Descriptive analysis was performed. Results: A sample of 36,447 patients with diabetes from PHCs in one Kuwaiti governorate, Al-Farwaniyah, collected from September 2019 to March 2020 (pre-SARS-CoV-2 pandemic) was studied. The median age was 54 years, most were men (63.4%), 33.4% were Kuwaiti and 11.3 % were smokers. The majority had type 2 diabetes (82.3%) and hypertension and dyslipidemia were found in 20.2% and 22.2% of the population, respectively. Over half the population (56.4%) with type 2 diabetes were on oral medication only, 3.7% on insulin only, 21.8% on oral and insulin medication and 18.1% were not on any medication and were recommended lifestyle modifications. Of the patients on insulin 60% were using long acting and 30% were using mixed insulin. In the registry, only 20% of those who have diabetes have a recorded HbA1c. Discussion: Creating a diabetes registry gathers invaluable information, aids as an essential tool for monitoring patients with diabetes and supports planning better healthcare services. However, the high missing data requires increased physician data entry training and improved and incorporated hospital information systems into the registry to ensure high ascertainment. The registry can be utilized to estimate incidence and prevalence, to translate into policy and improve standard of care.
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Introduction: The coronavirus disease 2019 (COVID-19) affected countless peoples' lives including pediatric patients with type 1 diabetes. Dasman Diabetes Institute, as a specialized diabetes center, collected routine patient clinical data from 2018 to date to improve quality of care and optimize outcomes. Objectives: We aim to investigate the impact of COVID-19 on glycemic control, diabetic ketoacidosis (DKA) occurrences, and diabetes management. Methods: Body mass index (BMI), blood pressure (BP), hemoglobin A1C (HbA1c), DKA and insulin treatment modality were analyzed in 152, 154 and 53 pediatric patients aged <18 years from March to December in the pre-pandemic years 2018, 2019 and during the pandemic in 2020. In March 2020, a nation-wide total lockdown was implemented. Glycemic control was defined as an HbA1c <7%. DKA occurrence was self-reported in the past 12 months. Chi-squared test for trend was used to assess differences between the years. Results: Most patients in 2018 (99.3%) and 2019 (99.3%) had at least 1 value of HbA1c, BP and BMI recorded, however in 2020, only 32.1% had at least 1 value of HbA1c and BMI and none had BP recorded (p<0.0001). Glycemic control was found in 15.8%,12% and 7.7% of the patients consulted in 2018, 2019 and 2020, respectively. DKA occurred in 6.5%, 3.2% and 5.7% of the patients in those years too. Of the 112 clinic visits in 2020, 99 (88.4%) were virtual consultations. Over time, pump use was 44.7%, 48.7% and 54.7% and continuous glucose monitoring remained the same in 21.1%, 20.8% and 20.8% of the study population from 2018-2020. Conclusions: COVID-19 interrupted access to care due to nation-wide lockdowns and curfews which led to a decrease in patient follow up and poor data monitoring. Despite the decrease in patient follow-up, markers of care were not different before and during COVID-19. The steep decrease in follow-up and lack of difference in quality of care could potentially be due to patients seeking medical care elsewhere. (Table Presented).
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Introduction: The alarming spread of the COVID-19 virus caused governments to impose imperative lockdowns and quarantines which negatively impacted vulnerable Type 1 diabetes children. Objectives: The study aim was to assess glycemic status and healthrelated quality of life (HRQoL) during the pandemic in a cohort of children with Type 1 diabetes (T1D) in Kuwait. Methods: Patients (aged 2-18) and their parents were recruited from the Childhood-Onset Diabetes electronic Registry (CODeR) and government hospitals. The Pediatric Quality of Life Inventory (PedsQL™) 3.0 Diabetes Module was used to evaluate disease specific total HRQoL through parent-proxy and self-reports. HbA1c results between February 24, 2020 and March 24, 2021 were collected from hospital records to assess glycemic status. Results: A total of 150 patients were included in the study (age 9.5 ±3.5 years, 51% males, diabetes duration 3.4±2.3 years). From the surveyed participants, 119 (84%) were on multiple daily injections, 26 (19%) had T1D family history and 132 (90%) were cared by both parents. Determined from 59 available results, mean HbA1c was 9.78%±1.61. Parent-proxy and patient HRQoL reports were similar in score (73.1±13.9 and 73.3±11.8). Patients reported lower QoL in the diabetes symptoms domain (p=0.04) and a higher QoL in the treatment barriers domain (p=0.002). Gender, nationality, and age did not affect HRQoL. Pump therapy and longer diabetes duration (>3 years) were associated with higher parent-proxy total HRQoL (p=0.01, p=0.03). Patients cared by both parents had slightly better glycemic status (9.6%±1.5 vs 10.9%±2.3) and better QoL scores in the diabetes symptoms domain (p=0.04). No statistical association was found between either HbA1c or COVID-19 history and total HRQoL. Conclusions: In this study, history of personal or family COVID-19 infection did not affect HRQoL. However, special support needs to be given to patients recently diagnosed with T1D, cared for by single parents, and treated with MDI to have a better HRQoL during the pandemic.
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Introduction: The COVID-19 pandemic brought forth distressing challenges in numerous countries including Kuwait. To minimize the spread of the virus, lockdowns were imposed through closure of schools and the enforcement of social distancing. T1D children may be critically impacted during this period due to these restrictions. To maintain efficient disease management and outcomes, virtual diabetes clinics were implemented. Objectives: This study aimed to evaluate glycemic control of T1D children and its association with demographic variables before and during the pandemic. Methods: A convenient sample of children and their parents were randomly selected from the Childhood-Onset Diabetes electronic Registry (CODeR). Patient demographics and diabetes history were obtained through phone calls and direct interviews. HbA1c results were recorded after reviewing medical charts of 12-month periods before and during the pandemic (Feb 24, 2019-Feb 23, 2020 vs Feb 24, 2020-Feb 24, 2021) and compared to evaluate glycemic control. Results: Forty-nine children with T1D (age 9.3±3.2 years, 44.9% males, diabetes duration 3.5±1.9 years) participated in the survey. Majority of patients were receiving multiple daily injection therapy (88.9%) compared to continuous subcutaneous insulin infusion therapy (11.1%). No significant changes in HbA1c results prior to and during the pandemic (10.01%±1.72 vs 9.66%±1.59, p>0.05) were observed. Gender, nationality and age did not affect glycemic variations during the two time periods. However, children with a shorter diabetes duration (<5 yrs) showed slightly improved HbA1c results during the pandemic (9.89%±1.71 vs 9.66%±1.68, p=0.04). Conclusions: Virtual diabetes clinics may have allowed patients frequent contact with their physicians and facilitates communication from home environments which resulted in insignificant improvement of metabolic status. These are preliminary findings on T1D children in Kuwait and future studies are necessary to evaluate glycemic outcomes prior to and during the pandemic.
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Introduction: The COVID-19 pandemic might have a multifaceted effect on children with Type 1 Diabetes (T1D), either directly through infection itself or indirectly due to measures implemented by health authorities to control the pandemic. Objectives: To compare data on children newly diagnosed with T1D in Kuwait during the COVID-19 pandemic to the pre-pandemic period. Methods: We analyzed data on children aged 12 years or less registered in the Childhood-Onset Diabetes electronic Registry (CODeR) in Kuwait. Data were incidence rate (IR), Diabetic ketoacidosis (DKA) and its severity and admission to the Pediatric Intensive Care unit (PICU). Results: The IR of T1D was 40.2 per 100,000 (95%CI;36.0-44.8) during the COVID-19 pandemic period and was not statistically different from pre-pandemic. A higher proportion of incident T1D cases presented with DKA and were admitted to the PICU during the pandemic (52.2% vs 37.8%: p<0.001, 19.8% vs 10.9%;p=0.002 respectively). The COVID-19 pandemic was positively associated with presentation of DKA and admission to PICU (AOR=1.73;95% CI, 1.13-2.65;p=0.021, AOR=2.04;95% CI, 1.13-3.67;p=0.018 respectively). Children of families with a positive history for diabetes were less likely to present with DKA and get admitted to the PICU during the COVID-19 pandemic (AOR=0.38;95% CI, 0.20-0.74;p=0.004, AOR=0.22;95% CI, 0.08-0.61;p=0.004, respectively). Conclusions: High rates of DKA at presentation and admission to PICU in incident T1D cases during the COVID-19 pandemic warrant further studies and effective mitigation efforts through increasing awareness, early detection, and timely intervention.