Predictors of tachycardia-induced cardiomyopathy in patients with first-time decompensation of chro-nic heart failure with reduced left ventricular ejection fraction of nonischemic etiology and persistent atrial tachyarrhythmia.

Aim    To identify possible predictors of tachycardia-induced cardiomyopathy (TICMP) in patients with newly developed decompensated chronic heart failure (CHF) of nonischemic origin with reduced left ventricular ejection fraction (LV EF) and with persistent atrial tachyarrhythmias. Material and methods    This study included 88 patients with newly developed decompensated CHF of nonischemic origin with reduced LV EF and persistent atrial tachyarrhythmias. Resting 12-lead electrocardiography (EGC) and transthoracic echocardiography (EchoCG) were performed upon admission and following the electrical impulse therapy for all patients. Also, 24-h ECG monitoring was performed to confirm sinus rhythm stability. After recovery of sinus rhythm, outpatient monitoring was performed for three months, including repeated EchoCG to evaluate the dynamics of heart chamber dimensions and LV EF. Results    The patients were divided into two groups based on the increase in LV EF: 68 responders (TICMP patients with a LV EF increase by >10%) and 20 non-responders (patients with an increase in LV EF by <10% during 3 months following the sinus rhythm recovery). According to results of the baseline EchoCG, LV EF did not significantly differ in the two subgroups (TICMP, 40±8.3 %, 18-50 % and non-responders, 38.55±7.9 %, 24-50 %); moreover, the incidence of cases with LV EF <30% did not differ either (9 patients TICMP and 2 non-responders, р=1.0). TICMP patients compared to non-responders, had significantly smaller left atrial dimensions (4.53±1.14 (2-7) cm and 5.68±1.41 (4-8) cm, р=0.034; 80.8±28.9 (27-215) ml and 117.8±41.3 (46-230) ml, р=0.03, respectively) and left ventricular end-systolic volume (ESV) (67.7±33.1 (29-140) ml and 104.5±44.7 (26-172) ml, р=0.02, respectively). The effect of major EchoCG parameters on the probability of TICMP development was assessed by one-factor and multifactor regression analyses with adjustments for age and sex. The probability of TICMP increased with the following baseline EchoCG parameters: end-diastolic volume (EDV) <174 ml [odd ratio (OR), 0.115, 95 % confidence interval (CI): 0.035-0.371], ESV <127 ml [OR, 0.034, 95 % CI: 0.007-0.181], left atrial volume <96 ml [OR, 0.08 , 95 % CI: 0.023-0.274], right ventricular dimension <4 cm [OR, 0.042 , 95 % CI: 0.005-0.389].Conclusion    Among patients with newly developed decompensation of CHF with reduced LV EF of non-ischemic origin and persistent atrial arrhythmias, TICMP was detected in 72 % of patients. The probability of TICMP did not depend on baseline EF and duration of arrhythmias, but increased with the following baseline EchoCG parameters: EDV< 174 ml, ESV< 127 ml, left atrial volume <96 ml, right ventricular dimension <4 cm. The multifactorial analysis showed that a right atrial volume <96 ml is an independent predictor for the development of TICMP.

Volumetric comparison of autogenous bone and tissue-engineered bone replacement materials in alveolar cleft repair: a systematic review and meta-analysis.

The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts. Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).

Survey of patient experiences of orthognathic surgery: health-related quality of life and satisfaction.

The objective of this study was to assess changes in patient quality of life (QoL) after orthognathic surgery at the Kuwait University Dental Clinic. A self-administered Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ) and two different visual analogue scales (VAS) were used. Sixty-six patients participated (63.6% female). The deformities were corrected by bimaxillary jaw surgery (83.3%), Le Fort I (9.1%), and bilateral sagittal split osteotomy (7.6%). The most important reasons given for undertaking the surgery were facial aesthetics (80.3%) and bite correction (75.8%). Of the patients who had reported moderate to high levels of problems pre-surgery, the majority reported improvements in facial appearance (91.3%), appearance of the teeth (97.0%), biting (96.3%), chewing (92.3%), and eating function (76.5%). Overall, 93.9% of patients reported better conditions after surgery, and the satisfaction level was very high (VAS 91.6%). The VAS score for QoL increased significantly from pre-surgery (73.0%) to post-surgery (93.6%) (P=0.0001). The OQLQ score was also significantly decreased after surgery, reflecting improvements in the 'social aspects of dentofacial deformity', 'facial aesthetics', 'oral function', and 'awareness of dentofacial aesthetics' domains (P=0.0001). Overall, the patients who underwent orthognathic surgery were satisfied and had improved QoL. The satisfaction rate in the present study reflects successful treatment with orthognathic surgery.

Role of Intrinsic (Graft) Versus Extrinsic (Host) Factors in the Growth of Transplanted Organs Following Allogeneic and Xenogeneic Transplantation.

In our studies of life-supporting α-1,3-galactocyltransferase knockout (GalT-KO) pig-to-baboon kidneys, we found that some recipients developed increased serum creatinine with growth of the grafts, without histological or immunological evidence of rejection. We hypothesized that the rapid growth of orthotopic pig grafts in smaller baboon recipients may have led to deterioration of organ function. To test this hypothesis for both kidneys and lungs, we assessed whether the growth of outbred (Yorkshire) organ transplants in miniature swine was regulated by intrinsic (graft) or extrinsic (host environment) factors. Yorkshire kidneys exhibited persistent growth in miniature swine, reaching 3.7 times their initial volume over 3 mo versus 1.2 times for miniature swine kidneys over the same time period. Similar rapid early growth of lung allografts was observed and, in this case, led to organ dysfunction. For xenograft kidneys, a review of our results suggests that there is a threshold for kidney graft volume of 25 cm3 /kg of recipient body weight at which cortical ischemia is induced in transplanted GalT-KO kidneys in baboons. These results suggest that intrinsic factors are responsible, at least in part, for growth of donor organs and that this property should be taken into consideration for growth-curve-mismatched transplants, especially for life-supporting organs transplanted into a limited recipient space.

Cancer in Kuwait: magnitude of the problem.

UNLABELLED: Cancer registry data obtained from the Kuwait Cancer Registry at Kuwait Cancer Control Center (KCCC) of Ministry of Health, State of Kuwait. The data covers the years 1974 to 2007. AIM OF THIS STUDY: was to estimate the magnitude of the cancer problem in Kuwait over the period 1974-2007. MATERIALS AND METHODS: Age-adjusted incidence rates (ASR) with standard error (er) and 95% confidence intervals (95% CI) of age-standardized rates were estimated. Statistical significance was assessed by examining the standardized rate ratio (SRR). RESULTS: It was noted that by following the Cancer registry data there was a trend of increase in adjusted rates among both males and females. Looking into specific cancers it was noticed that comparing the ASR of colorectal cancer among Kuwaiti males, it increased by about 5 folds over the last 33 years and ranked the 1st most frequent site on the years 2003-2007. Prostate cancer incidence increased by 3 folds (14.5 cases /100,000 populations) and ranked the 4th most frequent site among Kuwaiti males. The incidence of Non Hodgkin's Lymphoma (NHL) and leukemia had increased by 1.5 to 2 folds over the same time period. The rise of lung cancer incidence declined to similar rates compared to that observed in the early 70s and 80s. For Kuwaiti females breast cancer had the highest incidence among Kuwaiti population (15 cases /100,000 populations), it increased by 3 folds (50 cases /100,000 populations) over the last 33 years. The incidence of colorectal cancer increased by about 4 folds; (13 cases /100,000 populations). NHL and leukemia increased by 2-2.5 folds over the same studied duration. Meanwhile Thyroid cancer increased by one fold. CONCLUSION AND RECOMMENDATIONS: Some of the differences in cancer rates over the last 33 years are likely to be attributable to the variation in exposure to specific etiologic factors that are caused by differences in lifestyle and habits, such as dietary, physical activity and obesity. Further research with a view to understanding these changes in cancer incidence is warranted. The need for an interventional prevention programs that vigorously involve, diet, anti-smoking and physical activity among both sexes.

Incidence of cancer in Gulf Cooperation Council countries, 1998-2001.

We describe the patterns of cancer incidence for common cancers in Gulf Cooperation Council countries during 1998-2001. A total of 32,291 cases of cancer were diagnosed (16,342 in males; 15,949 in females). Male preponderance was observed only in Saudi Arabia and Oman. The age-standardized incidence of all malignancies per 100,000 in both sexes was highest in Qatar followed by Bahrain, Kuwait, Oman, UAE and Saudi Arabia. Paediatric cancer ranged from 9.5% of total cancers in Saudi Arabia and UAE to 4.0% in Bahrain. In all countries, the mean age at diagnosis was higher in males than females; cancer of the lung and prostate were commonest among males, and cancer of breast and thyroid among females. Lung cancer ranked second among Bahraini women.

Incidence of cancer in Gulf Cooperation Council countries, 1998-2001

We describe the patterns of cancer incidence for common cancers in Gulf Cooperation Council countries during 1998-2001. A total of 32 291 cases of cancer were diagnosed [16 342 in males; 15 949 in females]. Male preponderance was observed only in Saudi Arabia and Oman. The age-standardized incidence of all malignancies per 100 000 in both sexes was highest in Qatar followed by Bahrain, Kuwait, Oman, UAE and Saudi Arabia. Paediatric cancer ranged from 9.5% of total cancers in Saudi Arabia and UAE to 4.0% in Bahrain. In all countries, the mean age at diagnosis was higher in males than females; cancer of the lung and prostate were commonest among males, and cancer of breast and thyroid among females. Lung cancer ranked second among Bahraini women

Nonlinear identification of NMR spin systems by adaptive filtering.

In this paper, we present two new methods for identifying NMR spin systems. These methods are based on nonlinear adaptive filtering. The spin system is assumed to be time-invariant with memory. The first method uses a truncated discrete Volterra series to describe the nonlinear relationship between excitation (input) and system response (output). First-, second-, and third-order kernels of this series are estimated employing the least mean square (LMS) algorithm. Three parallel filters can then model the NMR spin system so that its output is no more than simple sum of three convolution products between combinations of the input signal and filters coefficients. It is also shown that the contribution of the Volterra second-order term to the total system response is neglected compared with the contributions of the first- and the third-order terms. In the second identification method, the output signal is related to the input signal through a recursive nonlinear difference equation with constant coefficients. The LMS algorithm is used again to estimate the equation coefficients. The two methods are validated with a simulated NMR system model based on Bloch equations. The results and the performances of these methods are analyzed and compared. It is shown that our methods permit a simple identification of NMR spin systems. The field of applications of this study is promising in the optimization of NMR signal detection, especially in the cases of low signal-to-noise ratios where optimum signal filtering and analysis must be performed.

Clinical importance of pre-morteum blood lymphocytes in cadaver donor tissue typing.

We have refined our immunomagnetic bead (IM bead) procedures to isolate pure and viable lymphocyte subpopulation from pre-morteum (PM) blood for cadaver donor HLA typing, preliminary and final crossmatches (XMs). The results of 1220 XMs were compared using T/B lymphocytes isolated either from PM blood or spleen/lymphnode (SPLN) tissue. IM bead technique was used to isolate T/B cells from PM blood and nylon wool column (NWC) technique was used to isolate T/B cells from SPLN. When we compared the outcome of 800 T-cell crossmatches using T cells from PM blood or SPLN of 5 separate cadaver donors, NWC TXMs tended to be more falsenegative for high PRA (> 10%, total 500 XMs) as well as low PRA (< 10%, total 300 XMs) did not reach statistical significance. In contrast, NW BXM (420 B XM) were found to be far more false negative than IM bead BXM regardless of the PRA of the patients. In order to ensure that NWC BXMs were indeed false negative, 23 sera with known anti-DR antibodies were BXMed where antigen-specific B cells were isolated by both the techniques. Our results showed that IM bead BXM identified the DR specificities greater than 90% of the time, the titers of ab specificities were stronger (1:8). In comparison, NWB cell XMs were weak (titers 1:2), and the false negative rate for some ab was as high as 73%. Using IM bead and NWC techniques we compared our turnaround time (TAT) for cadaver donor typing, preliminary and final XMs.(ABSTRACT TRUNCATED AT 250 WORDS)

A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis.

This preliminary study of Kuwaiti children confirms the significant impact of exposure to war atrocities on children. This pilot sampling provided evidence that: (1) many children who remained in Kuwait during the occupation had multiple war-related exposures; (2) more than 70 per cent of the children reported moderate to severe post-traumatic stress reactions; and (3) witnessing death or injury and the viewing of explicit graphic images of mutilation on television had measurable influence on severity of reaction. The highest mean Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) score was found for those children who reported hurting someone else. Older children had both greater exposure to atrocities and higher CPTSD-RI scores. Findings suggest the need for public policy to minimize children's exposure to graphic depictions of war-related injury, death and mutilation.

Platelet crossmatches of single-donor platelet concentrates using a latex agglutination assay.

A latex agglutination assay was evaluated for the purpose of identifying compatible platelet donors for alloimmunized recipients. Assay reagents were prepared by adsorbing detergent-solubilized, donor-specific platelets to polystyrene latex beads. Semiquantitative results for up to 30 donors can be completed in less than 1 hour. These reagents retained their immunoreactivity for at least 3.5 months. A retrospective study has established the assay's upper limit of compatibility. The prospective study evaluated transfusions to a group of multiply transfused patients. Part I evaluated 143 crossmatched, single-donor platelet transfusions given to 50 patients. In 96 percent of the cases, a positive crossmatch was associated with an unsuccessful transfusion outcome; in 84 percent of the transfusions, a negative crossmatch predicted a satisfactory platelet increment. The overall predictability, sensitivity, and specificity were 87, 62, and 99 percent, respectively. Part II evaluated 105 transfusions given to the 43 patients (of 50) in whom no incidence of fever, sepsis, or bleeding could be documented. A positive crossmatch was 96-percent efficient in predicting an unsuccessful transfusion, whereas a negative crossmatch was associated with an adequate platelet increment following 89 percent of the transfusions. The overall predictability was 91 percent, the sensitivity was 72 percent, and the specificity was 99 percent. Within-run and between-run variations were 6.3 and 6.2 percent, respectively. These results demonstrate that detergent-solubilized platelet antigens, immobilized on latex particles, can be used in a cost-effective crossmatching procedure.

Brucellosis: atypical presentation with peritonitis and meningitis.

A case of brucellosis associated with peritonitis, intestinal obstruction, granulomatous hepatitis, inappropriate antidiuretic hormone (ADH) secretion and meningitis is reported. Initially, the patient was diagnosed as a case of disseminated tuberculosis and treated accordingly. However, the serologic tests for brucellosis were strongly positive and the patient was subsequently treated as a case of brucellosis and recovered fully. The gastrointestinal manifestations of brucellosis are reviewed.