Availability of Antidotes in Kuwait: A National Audit.

BACKGROUND: Effective management of poisoning requires adequate stocking of antidotes in hospitals that provide emergency care. Antidote stocking represents a major challenge to hospitals all over the world, including Kuwait. OBJECTIVE: This study aimed to evaluate antidote stocking in public and private hospitals that provide emergency care in Kuwait. METHODS: A cross-sectional study using a self-administered questionnaire was conducted from January to December 2018. The questionnaire was designed to assess immediate and non-immediate availability of 41 antidotes in 6 public and 13 private hospitals in Kuwait that provided emergency care. The questionnaire was provided to the pharmacy departments of these hospitals, which were asked to report the availability of antidotes and the reasons for non-availability. Descriptive statistics were used to report demographical data and independent t-test analysis was used to analyze continuous variables. RESULTS: All of the six public hospitals in Kuwait and eight private hospitals returned the completed questionnaires. Among the 14 hospitals surveyed, none had a complete stock of all essential antidotes. The mean (standard deviation [SD]) availability of immediate antidotes in public hospitals was 79.6% (32.6%) compared to 52.1% (44.4%) in private hospitals. Moreover, the mean (SD) availability of non-immediate antidotes was 64.5% (37.7%) in public hospitals compared to 14.7% (22.8%) in private hospitals. CONCLUSIONS: Public and private hospitals in Kuwait have suboptimal stocks of essential antidotes. There is an urgent need to develop expert consensus guidelines to assist hospitals to reduce costs and improve patient care by adequately stocking essential antidotes.

Self-medication among undergraduate medical students in Kuwait with reference to the role of the pharmacist.

OBJECTIVE: The practice of self-medication is growing world-wide. It is associated with problems that may lead to potentially life-threatening complications represent a priority to be investigated. The aim of this study was to estimate the prevalence of self-medication among undergraduate medical students and to evaluate the possible role of the pharmacist in self-medication in Kuwait. METHODS: A descriptive cross-sectional study was performed, using the questionnaire on a sample of 900 male and female students randomly selected from three health faculties in Kuwait. The prevalence of self-medication, as well as the contribution of pharmacist in self-medication was assessed. In addition, the role of the pharmacist as drug consultant for the students after getting the medication was evaluated. FINDINGS: The overall prevalence of self-medication was 97.8%. The age was significantly inversely proportional to self-medication. There was a significant difference between male and female students in self-medication practice. Headache was the highest health conditions that most frequently motivated self-medication with 90.1% prevalence, followed by 84.7% for dysmenorrhea and 60.3% for constipation. Contribution of the pharmacist as a part of self-medication care was low totally, with the highest rate for cough conditions 40.1%. However, the role of the pharmacist as a drug consultant was more noticeable after obtaining the drug, not before. Around 80.1% of the students request information from the pharmacist about doses, duration of treatments and side-effects. CONCLUSION: The prevalence of self-medication among undergraduate students in Kuwait is high and there were significant differences for age and gender. The contribution of the pharmacist was low in self-medication, while it was high after getting the drugs for obtaining drug related information. The practice of self-medication is alarming. Improved awareness about the role of pharmacist as a drug consultant for careful and cautious use of medicines available for self-medication would be strongly recommended.

Association and symptom characteristics of irritable bowel syndrome among bronchial asthma patients in Kuwait.

CONTEXT: Excess prevalence of irritable bowel syndrome in asthma has been reported, suggesting a link between these two conditions. AIMS: To investigate the association between irritable bowel syndrome (IBS) and asthma, and explore the symptoms of IBS among asthma patients in Kuwait. SETTINGS AND DESIGN: Case control study. METHODS: In a tertiary center, for allergy and asthma, 138 patients aged 20-65 years, with asthma, diagnosed clinically and by spirometry, were compared with 145 healthy, non-asthmatic controls matched for age, gender and nationality. Cases and controls completed a self-administered questionnaire of irritable bowel syndrome diagnosis (ROME II criteria). STATISTICAL ANALYSIS USED: The data were analyzed using SPSS software, and proportions were tested with Chi-square or Fisher's test. Odds ratio (OR) with 95% Confidence Interval (CI) were calculated to identify the associated risk factors. The demographic variables were selected for logistic regression analysis. RESULTS: A significantly large proportion (39.13%) of asthmatics had IBS as compared to 7.93% controls (P < 0.001). A higher proportion of females with IBS were observed in cases and controls (74%, 61.54%). IBS was seen in 87% cases using inhalers, and in 13% with additional oral theophylline (P < 0.001). As many as 66.6% cases, had IBS with relatively short duration of asthma (1-5 years, P < 000). Predominant symptoms of IBS in asthmatics were abdominal discomfort or distension (64.8% vs. 11.5%), (P < 0.000, OR = 14.1; 95%CI: 3.748-53.209), bloated feeling of abdomen (74.1% vs. 34.62% (P < 0.001, OR = 5.38; 95%CI:1.96-14.84)), increased frequency of stools (63%, P < 0.006). CONCLUSIONS: Irritable bowel syndrome in asthmatics was significantly high, more in the female asthmatics. Abdominal discomfort, persistent bloated feeling, increased frequency of passing stools were the most common IBS symptoms observed.

What influences early hypothyroidism after radioiodine treatment for Graves' hyperthyroidism?

OBJECTIVE: The objective of this study was to evaluate the factors influencing the occurrence of early hypothyroidism after radioiodine treatment of Graves' hyperthyroidism. MATERIAL AND METHODS: Of 147 patients with Graves' disease (GD) treated with radioactive I-131 (RAI) in our thyroid clinic between July 2003 and December 2004, 84 were followed at 2 and 4 to 5 months after treatment. The age range was 12 to 75 years and the dosage range in these patients was 7.4 to 29.9 mCi. Twenty-four were males and 60 were females. Factors possibly contributing to post-RAI hypothyroidism are: dosage of I-131, age, gender, size of the gland, initial serum free T4, free T3, thyroid-stimulating hormone (TSH) levels, pretreatment with antithyroid drugs, radioactive iodine uptake, and duration of disease. RESULTS: All patients had low TSH, elevated FT4, and elevated radioactive iodine uptake (RAIU) at 4 and/or 24 hours. Of the 84 patients followed, 46% of the males and 62% of the females became hypothyroid at 4 to 5 months (57% of the total). Twenty-one patients remained hyperthyroid and 14 patients became euthyroid. Multivariate analysis of these 84 patients showed no statistically significant single contributing factor for the development of early hypothyroidism. CONCLUSION: The early onset of hypothyroidism after RAI in GD is very common (57%) and unpredictable. Thus, after RAI treatment, all patients must be closely monitored for the development of this disorder.

Interventional radiology strategies in the treatment of pseudomyxoma peritonei.

PURPOSE: To describe percutaneous maneuvers to treat the unusual entity symptomatic pseudomyxoma peritonei (PMP). METHODS: Four patients with PMP were treated by interventional radiology techniques that included large catheters (20-30 Fr) alone (n = 3), multiple catheters (n = 4), and dextran sulfate as a catalytic agent through smaller catheters (n = 1). The causes of the PMP were tumors in the ovary (2 patients), appendix (1 patient), and colon (1 patient). Each patient previously had undergone at least two operations to remove the PMP, and all patients had symptomatic recurrence. An in vitro analysis of catalytic agents also was performed. RESULTS: All four patients improved symptomatically. Follow-up CT scans demonstrated marked reduction of PMP material in all cases. One patient underwent another interventional radiology session 5 months after the first; the other three patients had no recurrence of symptoms. One patient had reversible hypotension 2 hr after the procedure. The amount of material removed varied from 3 to 6 L. CONCLUSION: These interventional radiology techniques were effective and safe for PMP and suggest options for this difficult medical and surgical problem.

CD4 lymphocytes in the blood of HIV(+) individuals migrate rapidly to lymph nodes and bone marrow: support for homing theory of CD4 cell depletion.

The mechanism(s) by which human immunodeficiency virus (HIV) causes depletion of CD4 lymphocytes remains unknown. Evidence has been reported for a mechanism involving HIV binding to (and signaling) resting CD4 lymphocytes in lymphoid tissues, resulting in up-regulation of lymph node homing receptors and enhanced homing after these cells enter the blood, and induction of apoptosis in many of these cells during the homing process, caused by secondary signaling through homing receptors. Supportive evidence for this as a major pathogenic mechanism requires demonstration that CD4 lymphocytes in HIV(+) individuals do migrate to lymph nodes at enhanced rates. Studies herein show that freshly isolated CD4 lymphocytes labeled with (111)Indium and intravenously reinfused back into HIV(+) human donors do home to peripheral lymph nodes at rates two times faster than normal. They also home at enhanced rates to iliac and vertebral bone marrow. In contrast, two hepatitis B virus-infected subjects displayed less than normal rates of blood CD4 lymphocyte migration to peripheral lymph nodes and bone marrow. Furthermore, the increased CD4 lymphocyte homing rates in HIV(+) subjects returned to normal levels after effective, highly active antiretroviral therapy treatment, showing that the enhanced homing correlated with active HIV replication. This is the first direct demonstration of where and how fast CD4 lymphocytes in the blood traffic to tissues in normal and HIV-infected humans. The results support the theory that the disappearance of CD4 lymphocytes from the blood of HIV(+) patients is a result of their enhanced migration out of the blood (homing) and dying in extravascular tissues.