Survey of acne-related post-inflammatory hyperpigmentation in the Middle East.

Aim: Acne vulgaris is a common inflammatory skin disease in the Middle East, similar to other regions of the world. In the Middle East, there are a relatively large proportion of patients with darker pigmentation (Fitzgerald skin types III-VI) who are prone to developing post-inflammatory hyperpigmentation (PIH) as a sequela of acne. Data are sparse on the frequency and characteristics of PIH throughout the world. What information is available indicates that pigmentation problems can be very bothersome for patients and are often quite long-lasting. Thus, it is important for clinicians to be aware of the scope of the problem of acne-associated PIH as well as potential treatment options. Methods: Prospective non-interventional study of acne patients consulting dermatologists (n = 262) in the Middle East. Results: PIH was present in 87.2% of subjects. The majority of subjects (52.6%) reported that PIH had been present for one year or longer. Of note, 69.0% of subjects reported excoriating their acne lesions, suggesting that this may be a key modifiable risk factor for clinicians to stress during patient education efforts. Conclusions: PIH was bothersome for patients, with half of subjects indicating that PIH was more bothersome than acne. In addition to our study results, we present here a brief overview of PIH and its treatment.

Managing acne in the Middle East: consensus recommendations.

Acne has been estimated to affect the majority of people at some point in their life and is common in Middle Eastern countries. While acne is frequently perceived to be a self-limited disease of adolescence, there is an increasing population of adults with acne. Information about the management of acne in the Middle East is somewhat sparse; however, several studies have recently been conducted and will be discussed in this supplement.

Changes in the water quality conditions of Kuwait's marine waters: Long term impacts of nutrient enrichment.

This work analyses a 30 year water quality data set collated from chemical analyses of Kuwait's marine waters. Spatial patterns across six sites in Kuwait Bay and seven sites located in the Arabian Gulf are explored and discussed in terms of the changing influences associated with point and diffuse sources. Statistical modelling demonstrated significant increases for dissolved nutrients over the time period. Kuwait marine waters have been subject to inputs from urban development, untreated sewage discharges and decreasing river flow from the Shatt al-Arab River. Chlorophyll biomass showed a small but significant reduction; the high sewage content of the coastal waters from sewage discharges likely favouring the presence of smaller phytoplankton taxa. This detailed assessment of temporal data of the impacts of sewage inputs into Kuwait's coastal waters establishes an important baseline permitting future assessments to be made as sewage is upgraded, and the river continues to be extracted upstream.

Screening for contaminant hotspots in the marine environment of Kuwait using ecotoxicological and chemical screening techniques.

Kuwait is a country with low rainfall and highly concentrated industrial and domestic effluents entering its coastal waters. These can be both treated and untreated. In this study we sampled a series of coastal and open-sea sites and used a variety of analyses to identify those sites requiring the most attention. We used a high throughput GC-MS screen to look for over 1000 chemicals in the samples. Estrogen and androgen screens assessed the potential to disrupt endocrine activity. An oyster embryo development screen was used to assess biological effect potential. The chemical screen identified sites which had high numbers of identified industrial and domestic chemicals. The oyster screen showed that these sites had also caused high levels of developmental abnormalities with 100% of embryos affected at some sites. The yeast screen showed that estrogenic chemicals were present in outfalls at 2-3 ng/l E2 equivalent, and detectable even in some open water sites.

Baseline survey of marine sediments collected from the State of Kuwait: PAHs, PCBs, brominated flame retardants and metal contamination.

A geographically extensive baseline survey of sediment contamination was undertaken at twenty nine locations around Kuwait. Samples were assessed in relation to a wide range of industrial pollutants, including metals, PAHs, PCBs, PBDEs and HBCDs. The data generated indicated that levels of pollutants were generally low and below commonly applied sediment quality guidelines (SQGs). However, naturally high background concentrations of certain metals present in sediment from the region may prohibit the direct assessment against some of the routinely applied SQGs. Hot spots of contamination were identified for PAHs, PCBs and PBDEs, that were mainly associated with the Shuaiba Industrial Area, located south of the city, and known to contain a diverse mix of both light and heavy industry.

Microbial water quality and sedimentary faecal sterols as markers of sewage contamination in Kuwait.

Microbial water quality and concentrations of faecal sterols in sediment have been used to assess the degree of sewage contamination in Kuwait's marine environment. A review of microbial (faecal coliform, faecal streptococci and Escherichia coli) water quality data identified temporal and spatial sources of pollution around the coastline. Results indicated that bacterial counts regularly breach regional water quality guidelines. Sediments collected from a total of 29 sites contained detectable levels of coprostanol with values ranging from 29 to 2420 ng g(-1) (dry weight). Hot spots based on faecal sterol sediment contamination were identified in Doha Bay and Sulaibikhat Bay, which are both smaller embayments of Kuwait Bay. The ratio of epicoprostanol/coprostanol indicates that a proportion of the contamination was from raw or partially treated sewage. Sewage pollution in these areas are thought to result from illegal connections and discharges from storm drains, such as that sited at Al-Ghazali.

Histopathology and contaminant concentrations in fish from Kuwait's marine environment.

Kuwait has witnessed major socioeconomic and industrial development in recent decades. Consequently, a variety of contaminants related to these activities have been discharged directly into the marine environment. This paper describes the application of a histopathology baseline survey in two potential sentinel species, the Giant sea catfish (Arius thalassinus) and the Fourlined terapon (Pelates quadrilineatus) to assess the health of biota inhabiting Kuwait's marine environment. Histological analysis revealed several lesion types in both species, although the prevalence was generally considered low with no discernible differences between sampling locations. The analysis of contaminant burdens (metals, PCBs, PBDEs, HBCDD) in A. thalassinus, along with the analysis of bile for PAH metabolites in both species, indicated that levels of contaminant exposure was low. Overall the data show that both species appear to be susceptible to pathologies associated with environmental contaminants and therefore suitable for further investigation as sentinel organisms for biological effects monitoring.

Histopathological survey of potential biomarkers for the assessment of contaminant related biological effects in species of fish and shellfish collected from Kuwait Bay, Arabian Gulf.

The marine environment in Kuwait is dominated by Kuwait Bay, a shallow, depositional habitat vital for the breeding and propagation of marine organisms. The bay receives effluent inputs from industrial centres, ports, sewage outflows along with discharges from power and desalination plants. The major classes of pollutant discharged into the bay include petroleum hydrocarbons, metals, nutrients, cooling water and hyper-saline water. Further, the bay has been historically impacted by a deliberate release of oil and contamination with ordnance and shipwrecks during the 1991 Gulf war. With an aim to establish an integrated pollution effects monitoring programme in Kuwait, this paper describes the application of a quality assured approach to conduct a histopathology baseline survey in oriental sole (Synaptura orientalis) and the large-toothed flounder (Pseudorhombus arsius), which are two potential sentinel flatfish species present in the Arabian Gulf. Liver and gonadal histopathology revealed a range of pathologies similar to those previously observed in European and American pollution effects surveys that utilise flatfish (including pathology markers indicative of possible carcinogenesis and endocrine disruption). Further, we extended these studies to invertebrates (Jinga prawn, Metapenaeus affinis and the grooved tiger prawn, Penaeus semisulcatus) found within the Arabian Gulf. Such baseline data is essential before attempts are made to develop integrated monitoring programmes that aim to assess the health of fish and shellfish in relation to chemical contamination.

One patient, two lymphomas, three primaries.

Concomitant adenocarcinoma and non-Hodgkin's lymphoma, both located in the intestinal tract, are unusual. Collision tumors of the colon on the other hand are extremely rare neoplasms. A case of true collision tumor of a marginal zone lymphoma and a moderately differentiated adenocarcinoma of the ascending colon (hepatic flexure) is reported. Simultaneously, a third primary is identified as follicular lymphoma involving the terminal ileum. Correlation with clinical history, radiology investigations, endoscopic findings and histological examination of the resected specimen as well as the use of ancillary techniques such as immunohistochemistry are the most useful in making the correct diagnosis of a synchronous three primaries involving the small bowel and colon. Therefore, we present these three primary synchronous neoplasms involving two different parts of the gastrointestinal tract, with two of these three primaries colliding at one organ.