Prevalence and factors associated with the use of illicit substances among male university students in Kuwait.

OBJECTIVES: To estimate the prevalence of illicit use of substances and identify the factors associated with illicit drug use among male students in the state-run Kuwait University and private universities in Kuwait. SUBJECTS AND METHODS: The study was a cross-sectional survey with a sample of 1,587 male students from both private universities (n = 869) and the public (n = 718) Kuwait University in Kuwait. A self-administered questionnaire was used to collect data. Overall lifetime prevalence of substance use was computed with 95% confidence interval. Logistic regression was used to identify the factors influencing substance use, which was adjusted for potential confounders. RESULTS: The total lifetime prevalence of illicit drug use was 14.4% and the most frequently used illicit substance was marijuana (11%). The substance use in general varied significantly (p ≤ 0.001) between private (18%) and public (10%) universities. Multivariate logistic regression model revealed that drug use was positively associated with age, poor academic performance, high family income, being an only child, divorced parents, and graduation from a private high school. CONCLUSION: Drug use among male university students in Kuwait was high and requires attention and appropriate intervention. The factors identified with drug use in this study could be utilized to develop appropriate public health policies and preventive measures that may improve the health status of the student population.

Type I retinopathy of prematurity in infants with birth weight less than 1251 g: incidence and risk factors for its development in a nursery in Kuwait.

PURPOSE: To report the rate of acute retinopathy of prematurity (ROP) and Type I ROP among infants with birth weight (BW) <1251 g and identify the risk factors for the development of Type I ROP. MATERIALS AND METHODS: A retrospective review of ROP records of infants with BW <1251 g was performed to identify infants with acute ROP and Type I ROP. Infants with Type I ROP were compared with those without Type I ROP to assess the risk factors for the development of Type I ROP. P < 0.05 was statistically significant. Multivariate analysis was performed and odds ratio (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Among the 207 infants with BW <1251 g, acute ROP occurred in 154 infants (74.4%) and Type I ROP in 95 eyes of 50 infants (24.4%). The numbers of infants with BW <750 g and BW <1000 g were 19.3% and 58.4%, respectively, and the incidences of Type I ROP were 50% and 36.4%, respectively, among them. Forty-four (46.3%) eyes were treated at stage 2+ ROP in zone I or II. All the eyes treated for Type I ROP showed complete regression. Gestational age at birth (OR 0.657, 95% CI: 0.521-0.827; P < 0.0001) and number of ventilated days (OR 1.017, 95% CI: 1.005-1.029; P = 0.006) were identified as independent risk factors for the development of Type I ROP. CONCLUSIONS: The rate of Type I ROP in this study is higher than that in previous studies due to the higher number of infants with BW <1000 g in our cohort and the treatment of more eyes with stage 2+ ROP. However, all the treated eyes had a favorable outcome. Gestational age at birth and number of ventilated days were independent risk factors for the development of Type I ROP.

Structural and functional results of indirect diode laser treatment for retinopathy of prematurity from 1999 to 2003 in Kuwait.

PURPOSE: The purpose was to report the structural, visual, and refractive outcomes of infants treated for retinopathy of prematurity (ROP) with laser and to identify the risk factors for unfavorable outcomes. MATERIALS AND METHODS: The charts of infants with severe ROP treated by diode laser in a tertiary center during the period April 1999 to November 2003 were reviewed. Treated infants were followed up for fundus examination, visual acuity assessment, and cycloplegic refraction. Data regarding ocular risk factors, like zones of ROP and the extent of extraretinal proliferations, and data regarding various systemic risk factors were collected. A minimum follow up of 6 months was needed for inclusion in the study of structural outcome. A minimum follow up of 24 months was needed for the study of visual and refractive outcomes. The outcomes measured were: rate of unfavorable structural outcome, unfavorable visual outcome (visual acuity < 20/40), and high myopia (myopia ≥ 5 diopters). The ocular and systemic risk factors were studied for their significance in the development of unfavorable outcomes. RESULTS: Two hundred seventy eyes of 148 infants were treated for severe ROP, out of which 20 eyes (7.4%) had unfavorable structural outcome. Visual data were available for 149 eyes of 81 infants, of which 70 eyes (47%) had unfavorable visual outcome. Refractive data were available for 131 eyes of 72 infants, and high myopia was present in 23 (17.6%) eyes. Zone I disease was the significant risk factor for unfavorable structural (P < 0.0001), unfavorable visual outcome (P = 0.03), and for high myopia (P < 0.0001). Lower post-conceptional age at treatment was significant for unfavorable structural outcome (P = 0.03) and high myopia (P < 0.0001). Presence of sepsis (P = 0.029) and extraretinal proliferation ≥ 6 hours were significant for unfavorable structural outcome (P = 0.002). CONCLUSION: ROP in zone I was the most significant risk factor for all the unfavorable outcomes. Laser-treated ROP infants need long term follow up.

Revision of failed bariatric procedures to Roux-en-Y gastric bypass (RYGB).

Bariatric surgery for morbid obesity has been established as an effective treatment method and has been shown to be associated with resolution of co-morbidities. Despite its success, some patients may require revision because of weight regain or mechanical complications. From September 2005 to December 2009, 42 patients underwent revisional Roux-en-Y gastric bypass (RYGB). All procedures were performed by one surgeon. Demographics, indications for revision, complications, and weight loss were reviewed. Thirty-seven patients were treated with laparoscopic (n = 36) or open (n = 1) RYGB after failed laparoscopic adjustable gastric banding. Four patient were treated with laparoscopic (n = 3) or open (n-1) RYGB after failed vertical banded gastroplasty, and one patient underwent open redo RYGB due to large gastric pouch. Conversion rate from laparoscopy to open surgery was 2.5% (one patient). Mean operative time was 145.83 ± 35.19 min, and hospital stay was 3.36 ± 1.20 days. There was no mortality. Early and late complications occurred in six patients (14.2%). The mean follow-up was 15.83 ± 13.43 months. Mean preoperative body mass index was 45.15 ± 7.95 that decreased to 35.23 ± 6.7, and mean percentage excess weight loss was 41.19 ± 20.22 after RYGB within our follow-up period. RYGB as a revisional bariatric procedure is effective to treat complications of restrictive procedures and to further reduce weight in morbidly obese patients.

Evidence-based practice in the use of antibiotics for respiratory tract infections in primary health centers in Kuwait.

OBJECTIVES: The objective of this study was to evaluate the use of antibiotics in treating upper respiratory tract infections (URTIs) in primary health centers in Kuwait and investigate the extent to which antibiotic use follows international guidelines. SUBJECTS AND METHODS: A nationwide cross-sectional study was conducted with a sample size of 615 patients selected by using a multi-stage cluster sampling method. Of these, 270 patients had URTI and were included in the analysis. Data collection was done by observing the whole process starting from patient presentation and history taking to final diagnosis and treatment by the physicians. RESULTS: Our study showed that about 135 (50%) of the patients with URTIs were given antibiotics, of which only 8 (6%) could be justified according to the NICE guidelines. However, prescriptions for 132 (98%) patients who were not given antibiotics could also be considered as evidence-based. Patients presenting with symptoms such as fever (OR = 2.7; p < 0.001) and sore throat (OR = 1.9; p < 0.01) were more likely be given antibiotics than those presenting without such symptoms. Furthermore, patients diagnosed with tonsillitis (OR = 25; p < 0.002), otitis media (OR = 9; p < 0.004), common cold (OR = 3; p < 0.049) or pharyngitis (OR = 2.7; p < 0.003) were more likely be given an antibiotic treatment as well. We also found that non-Kuwaitis were prescribed antibiotics more often than Kuwaitis (OR = 2.0; p < 0.005). CONCLUSION: This study showed a very high percentage of non-evidence-based prescriptions of antibiotics in Kuwait, and should be of great public health concern. Although overuse of antibiotics in primary care settings has been well reported from around the world, our finding of non-evidence-based use at 94% is of great public health concern since this may be linked primarily to the lack of evidence-based practice in Kuwait.

Results of screening for retinopathy of prematurity in a large nursery in Kuwait: Incidence and risk factors.

AIMS: The aim of the study was to report the incidence of retinopathy of prematurity (ROP) and severe ROP and identify the risk factors for their development in a large nursery in Kuwait. MATERIALS AND METHODS: This was a retrospective, interventional, non-comparative, hospital-based study. Retrospective review of ROP records of premature babies having either birth weight of less than 1501 g or gestational age at birth of 34 weeks or less and born between January 2001 and August 2003. STATISTICAL ANALYSIS: By univariate and multivariate logistic regression analysis. RESULTS: Out of the 599 babies studied, 38.9% developed ROP and 7.8% needed treatment for severe ROP. Multivariate analysis showed low birth weight (OR 13.753, 95% CI 3.66-51.54; ( P < 0.001), gestational age (OR 13.75, 95% CI 3.66-51.54; P < 0.001), surfactant (OR 1.72, 95% CI 1.04-2.83; P = 0.032) and stay in the intensive care unit for longer than 15 days (OR 2.25, 95% CI 1.05-4.85; P = 0.033) to be significant for the development of any ROP. Low birth weight (OR 22.86, 95% CI 3.86-134.82; P = 0.001), bacterial sepsis (OR 3.27, 95% CI 1.51-7.05; P = 0.002) and need for surfactant (OR 4.41, 95% CI 0.94 -20.56; P = 0.059) were found to be the risk factors for severe ROP needing laser treatment. CONCLUSION: The incidence of both any ROP and ROP needing treatment are comparable to other studies. Low birth weight is the most important risk factor for both any ROP and severe ROP.

Vitamin D status of mothers and their neonates in Kuwait.

BACKGROUND: There has been a resurgence of nutritional rickets in children in many developing countries and some of the developed countries. Children between 6 and 18 months old are commonly affected. In order to find out the association between vitamin D and rickets we studied the vitamin D status of the neonates and their mothers in Kuwait. METHODS: Two hundred and fourteen full-term pregnant mothers and their neonates were selected from two hospitals in Kuwait. All mothers had normal vaginal delivery. On the day of delivery 2.5 mL of maternal blood and 2.5 mL of cord blood samples were withdrawn. Serum 25-hydroxyvitamin D (25OHD) was determined in duplicate by radioimmunoassay using an Incstar kit. Quality control analyses were done using several between and within run experiments. RESULTS: A total of 128 mother-neonate pairs were selected from the Al-Adan hospital and 86 from the Maternity Hospital. The mean age and parity of the mothers were similar in both hospitals. The mean (+/- SD) 25OHD levels of the mothers and the neonates in the Adan hospital were 13.3 (6.5) ng/mL and 8.2 (6.5) ng/mL, respectively. The corresponding values in the Maternity Hospital were 17.6 (12.4) and 8.1 (7.3) ng/mL for the mothers and the neonate, respectively. Serum 25OHD of the mothers and their newborn infants were highly correlated (r = 0.790, P < 0.001). CONCLUSIONS: Results demonstrate that 40% of the mothers and 60% of the neonates are vitamin D deficient on the day of delivery. The vitamin D of the mothers and neonates are highly correlated (r = 0.790, P < 0.001).

Diabetes mellitus as a contributor to the in-hospital mortality after acute myocardial infarction in Kuwait.

OBJECTIVES: First, to compare the in-hospital mortality after acute myocardial infarction (AMI) among diabetic versus non-diabetic patients. Secondly, to evaluate if this association remains the same across gender and ethnic groups. METHODS AND RESULTS: We used a 1:2 individually matched retrospective case-control study. All patients admitted to Mubarak Al-Kabeer hospital in Kuwait, with a confirmed diagnosis of AMI during August 1997 and July 2002 made up the study population. All 149 patients who died during this period made up the cases. Two control subjects to match each case were randomly chosen from survivors, after hospitalization with AMI. Cases and controls were individually matched by age, sex and ethnicity. History of diabetes mellitus (DM) was found to be significantly associated with in-hospital mortality after AMI (odds ratio: 1.9, 95% CI: 1.2-3.0). None of the other cardiovascular related histories were associated with mortality. Further analyses on the type of diabetes showed that the NIDDM (non-insulin dependent diabetes mellitus) risk of mortality was significantly raised after AMI. Also among women (odds ratio: 2.7, 95% CI: 1.2-5.9), and non-Kuwaiti population (odds ratio: 3.4, 95% CI: 1.1-9.9) the risk was significantly elevated. CONCLUSIONS: Risk of in-hospital mortality after AMI is almost doubled among diabetic patients. This association was found to be significantly higher among NIDDM, women and non-Kuwaiti population.