Patterns of evolution in MHC class II DQA and DQB exon 2 genes of Alpine mountain hares, Lepus timidus varronis, and sympatric and parapatric brown hares, L. europaeus, from Switzerland.

In natural populations, hybridization is known to occur between a wide range of species. However, its evolutionary significance is less clear. Genes involved in fighting pathogens are considered excellent candidates for studying adaptive introgression, although both introgression and balancing selection can generate similar patterns of diversity and differentiation. Here, we compared DQA and DQB MHC class II and microsatellite allelic diversity of sympatric and parapatric mountain (Lepus timidus) and brown hare (L. europaeus) populations from Switzerland. We detected higher genetic diversity in brown hares compared to mountain hares at both MHC and microsatellite loci. We consider the observed patterns of microsatellite diversity both for L. europaeus and L. timidus as result of stochastic demographic processes while the pattern of MHC polymorphism of the studied hare populations can be explained by pathogen-driven selection. Rare bidirectional gene flow between both hare species seems to occur specifically for MHC alleles. However, the high number of shared alleles showing similar high frequency in both species suggests that reciprocally exchanged MHC alleles are being maintained via balancing selection. Adaptation to similar pathogen communities can also lead to parallel selection of MHC alleles. Positive selection, recombination and mutations have played different roles in shaping the patterns of MHC allelic diversity in and differentiation between both species. Results for the latter evolutionary forces do not show a better matching between the sympatric populations compared to the parapatric ones, suggesting a minor role of introgression for the observed evolutionary patterns of the studied hare species.

Cancer Survival by Stage at Diagnosis in Kuwait: A Population-Based Study.

OBJECTIVE: To examine the distribution of stage at diagnosis for 12 cancers in Kuwait, to estimate stage-specific net survival at 1 and 5 years after diagnosis, and to assess differences in stage-specific survival between Kuwait and the United States. MATERIAL AND METHODS: Data were obtained from the Kuwait Cancer Registry, for Kuwaiti patients diagnosed during 2000-2013, with follow-up to 31 December 2015. The distribution of Surveillance Epidemiology and End Results (SEER) Summary Stage for 12 malignancies was examined. We estimated net survival by stage up to 5 years after diagnosis, controlling for background mortality with life tables of all-cause mortality in the general population by single year of age, sex, and calendar period. Survival estimates were age-standardised using the International Cancer Survival Standard (ICSS) weights. RESULTS: Only 14.2% of patients were diagnosed at a localised stage and 38.9% at the regional stage. The proportion of patients with known stage was 88.9% during 2000-2004 but fell to 59.4% during 2010-2013. During 2005-2009, 1- and 5-year survival for colon, rectal, breast, cervical, and prostate cancer was about 90% or higher for patients diagnosed at the localised stage. During 2004-2009, the proportion of patients diagnosed at a localised stage was lower in Kuwait than in the US for colon, breast, and lung cancer. Age-standardised 5-year net survival for all stages combined was lower in Kuwait than the US for colon, lung, and breast cancer, but stage-specific survival was similar. CONCLUSION: Since stage-specific survival is similar in Kuwait and the US, late stage at diagnosis is likely to be a major contributing factor to the overall lower survival in Kuwait than in the US. Increasing public awareness of cancer risk factors and symptoms and investment in early detection will be vital to reduce the proportion of patients diagnosed at a late stage and to improve survival.

Some epidemiological measures of cancer in Kuwait: national cancer registry data from 2000-2009.

INTRODUCTION: Cancer is the second cause of death in Kuwaiti people after cardiovascular diseases. This study is the first in the country to describe epidemiological measures related to cancer in this population. METHODS: Data obtained from the Kuwait cancer registry included all Kuwaiti patients between years 2000-2009. Analyses were conducted using age-specific rates, the age-standardization-direct method, 95% confidence intervals (95% CI), cumulative risk by the age of 74 years, limited-duration prevalence, mortality and forecasting to year 2029. RESULTS: It was noted that the commonest cancer sites were colorectal with an age standardized incidence rate (ASIR) of 16.1/100,000 in males and breast (49.4/100,000) in the female population. The trend of cancer incidence (1974-2009) showed no statistically significant change. First causes of death due to cancer were female breast 8(6.4-9.6)/100,000 and lung (males) 8.1/100,000 (6.6-10.0). The risk of developing cancer by the age of 74 was 13.4% (1/8) and 14.3% (1/7) in males and females respectively, and the risk of dying from cancer in the same age group was 1/17 and 1/23. By the end of 2009, prevalent cases represented 0.52% of the Kuwaiti population. In the year 2029, the total number of cancer cases is expected to reach 1200 cases compared to 889 cases in 2009. CONCLUSIONS AND RECOMMENDATIONS: The most common cancers in Kuwait (breast, colorectal and lung) are largely preventable. Prompt and effective interventional prevention programs that vigorously involve diet, anti-smoking and physical activity for both sexes are urgently required.

Reliability of the Kuwait Cancer Registry: a comparison between breast cancer data collected by clinical oncologists and registry staff.

AIM: The quality of cancer registration is of great importance and the present study was conducted to assess the reliability of Kuwait Cancer Registry data on breast cancer. METHODS: Data from the clinical records extracted by a group of clinical oncologists for another study on 1,235 breast cancer cases diagnosed between 1999 and 2004 were used to audit the data held on these individuals by the Kuwait Cancer Registry (KCR). Only 902 cases met the eligibility criteria. Main measures were sex, nationality, laterality, morphology, stage of disease at time of admission to the center, type of treatment and status at last follow up (alive or dead). RESULTS: Full or high agreement between registry data and clinical oncologists collected data was recorded for sex, nationality and laterality. The rate of agreement for treatment with chemotherapy and status at last follow up was near perfect. Substantial agreement was also noted for morphology, tumor grade, TNM staging, surgical, radiotherapy and hormonal treatment. The majority of minor differences in morphology disagreements occurred when a more specific description was stated by registry staff, while major disagreement occurred due to difference in the codes used. CONCLUSIONS: The accuracy of the KCR data seems to be comparable to that found in reviews of other cancer registries. Stage was the hardest variable for the registry to collect accurate information on. KCR data could be improved by improving the quality of information provided to the registry.

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.

Systemic lupus erythematosus in Kuwait--hospital based study.

The present study describes the clinical characteristics of patients with systemic lupus erythematosus (SLE), from the rheumatology service of the two main teaching hospitals in Kuwait. It was a retrospective-cum-prospective clinical study of 108 SLE patients. There were 98 females and 10 males, with a median age of 31.5y. Kuwaitis constituted 69%, while 31% were expatriates. The mean disease duration was 62 months. The main clinical features were: musculoskeletal involvement (87%), photosensitivity (48%), malar rash (43%), discoid lesions (10%), oral ulcers (33%), vasculitic skin lesions (10%), haematological features (53%), constitutional symptoms (51.4%), neuropsychiatric manifestations (23%), renal involvement (37%), serositis (29%), clinical manifestations of antiphospholipid syndrome (21%), cardiac involvement (10%) and pulmonary manifestations (19%). In conclusion, the clinical features of SLE in Kuwait were similar to most major studies from developed countries. Main differences included prominent haematological and mucocutaneous manifestations and possibly a low prevalence of anti-Sm antibodies. Whether these differences are due to the environment or genetic factors, remains to be studied.

Characteristics of osteoarthritis among Kuwaitis: a hospital-based study.

Sixty-nine Kuwaiti patients with osteoarthritis (OA) were studied. Primary knee OA was seen in 65 (94.2%) patients. The mean age of this group was 53.18 years with a range of 39-97 years. The female to male ratio was 2.82:1. OA was bilateral in 84.62% and predominantly involved the medial tibiofemoral joint. According to Kellgren's grading of knee OA, grade 1 changes were present in 40.0%, grade 2 in 32.5%, grade 3 in 22.5% and grade 4 in 5.0%. Grade I obesity was seen in 13%, grade II in 64% and grade III in 23% of patients. Generalised primary nodular OA was seen in only four patients, all of whom were women. Primary OA of the hip joint and chondrocalcinosis were conspicuous by their absence.

Serum B2-microglobulin concentration correlates with urinary concentrations of type 1 collagen cross-linked N-telopeptides and deoxypyridinoline in rheumatoid arthritis.

BACKGROUND: Determination of serum ss2-microglobulin concentration, an invasive procedure, has been advocated for monitoring patientsA centAA response to treatment in rheumatoid arthritis. The object of this study was to find out if serum ss2-microglobulin concentration correlated with urinary excretions of type 1 collagen crosslinked N-telopeptides (NTx) and deoxypyridinoline (Pyrilinks-D) in rheumatoid arthritis (RA). SUBJECTS AND METHODS: Using chemiluminiscent assay, serum ss2-microglobulin concentrations were estimated in 25 female patients with active RA, 25 female with inactive disease, and 25 age-matched healthy female controls. Concentrations of NTx and Pyrilinks-D were also determined by immunoabsorbent assays in spot urine samples from these subject groups. RESULTS: The serum concentration of ss2-microglobulin in patients with RA (7.45+/-2.10 mg/L) was significantly higher (P<0.001) than the concentrations in patients with inactive disease (3.33+/-0.76 mg/L), or than in normal healthy controls (2.747plusmn;0.52 mg/L). Similarly, in patients with active RA, the spot urinary concentrations of NTx (123.08+/-25.53 nmol BCE/mmol creatinine) and Pyrilinks-D (15.087plusmn;3.29 nmol/mmol creatinine) were significantly higher (P<0.01) than those in patients with inactive disease (58.42AA+/-12.65 nmol BCE/mmol creatinine and 10.10+/-2.43 nmol/mmol creatinine, respectively). In patients with active RA, serum concentration of ss2-microglobulin correlated positively with spot urinary NTx concentrations (r=0.9910, P=0.0001), and Pyrilinks-D concentration (r=0.6177, P=0.001). CONCLUSION: In patients with active RA, the spot urinary concentrations of NTx and Pyrilinks-D correlated positively with serum AA2-microglobulin. Therefore, the estimations of these urinary markers may take the place of serum ss2-microglobulin estimation in monitoring the patientA centAAs response to treatment in rheumatoid arthritis.

Hughes syndrome: a common problem in Kuwait hospitals.

The objective was to study antiphospholipid antibody syndrome (APS or Hughes syndrome) in two major teaching hospitals in Kuwait. patients with suspected Hughes syndrome were investigated with tests for anticardiolipin antibodies (aCL) and lupus anticoagulants (LAC) over 1 yr. Diagnosis was considered confirmed if significant levels of either or both antibodies with no obvious cause (primary), or with systemic lupus erythematosus (SLE) or SLE-like illness (including SLE serology) (secondary) were present. Twelve (37.5%; seven females, 58%) primary and 20 (62.5%; 18 females, 90%) secondary Hughes syndrome patients were seen during this period. patients were Kuwaiti, Middle-Eastern and North-African Arabs (29). Filipinos (2) and White (1). None were from the Indian subcontinent. The main presentation was thrombosis in 75% (arterial in 25% and venous in 50%), and recurrent abortions in 50% of married women. Haematological and dermatological manifestations were limited entirely to the secondary variety, seen in 25% and 19%, respectively. Clinical manifestations were severe, leading to death in one, intensive-care management in 31% and with partial or complete warfarin resistance or brittleness in 25%. Neurological/eye and cardiac manifestations were not seen, as these patients may be attending separate speciality hospitals for these diseases in Kuwait. The approximate prevalence of this syndrome was 2.66/1000 admissions in medical wards. Projected to the total referral areas of the two hospitals, an approximate figure of 52 patients/million population/year was obtained. Hughes syndrome was a common problem among Arabs, Filipinos and possibly Whites in Kuwait. Its manifestations were severe, often requiring intensive-care management, and in one case it was fatal. Patients from the Indian subcontinent were conspicuous by their absence, despite the fact that they were well represented in all other rheumatic disease groups. Ethnic and/or geographical factors could be important in this syndrome. To the best of our knowledge, this is the first report of Hughes syndrome from the Middle East.

Association of MHC class I with spondyloarthropathies in Kuwait.

This study is the first to assess the prevalence of HLA B27 in Kuwaiti patients with ankylosing spondylitis (AS) or related spondyloarthropathies compared to healthy controls. Positive HLA B27 was found in nine (25.7%) of 35 patients, but only in 22 (4%) of 544 controls (P = 0.000). A significant difference in Cw2 and Cw6 between patients and controls was also found (P < 0.01 and 0.000, respectively), suggesting a linkage disequilibrium between B27 and Cw2 (P < 0.000) in the Kuwaiti population. These findings suggest that B27-positive Kuwaitis are at high risk of developing AS and spondyloarthropathies, especially if they carry Cw2 and Cw6: The importance of HLA Cw loci is becoming increasingly apparent in disease association studies.

Lifestyle and the risk of acute myocardial infarction in a Gulf Arab population.

BACKGROUND: Recent statistics indicate that acute myocardial infarction (AMI) is becoming very common in the State of Bahrain. A population-based case-control study was carried out to explore the importance of lifestyle in the occurrence of AMI in Bahrain among those aged 30-79 years. METHODS: Seventy consecutive cases with a first episode of AMI were identified from a register, which included all hospital admissions, during the period 1 February 1992 to 31 July 1992, and compared with 516 subjects obtained from a random sample of the same community. Multiple logistic regression was used to control for demographic variables as well as for the mutual confounding effects of the investigated risk factors. RESULTS: Of the patients with first-time AMI, 64% did not walk regularly for exercise compared with 34% of community controls (adjusted odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.24-5.15). In all, 12% of community controls has a history of hypertension and 9% had diabetes. The comparative figures for AMI patients were 44% for hypertension (adjusted OR = 5.04, 95% CI: 2.82-9.00) and 22% for diabetes (adjusted OR = 3.28, CI: 1.73-6.20). Cigarette smoking and infrequent consumption of fruits and vegetables also appeared to be associated with an increased risk of AMI. CONCLUSION: There is scope for lifestyle change in reducing AMI risk, by changes in physical activity, smoking and dietary habits. In addition, measures to control hypertension and diabetes should be given a high priority in any national health policy to prevent AMI.

The effect of adding essential amino acids and vitamins to the rations of broilers.

Four experiments were carried out to investigate the amino acid and vitamin requirements of broilers. The performance of birds fed on control diets formulated according to the recommendations of the National Research Council (1977) was compared to that of birds fed on experimental diets containing additional amounts of essential amino acids (L-lysine and DL-methionine) and vitamins. The control diets varied in protein and metabolizable energy content; the experimental diets were obtained by adding varying additional amounts (10 to 50%) of one or both amino acids and vitamins to the control diets. The experimental diets resulted in consistently better body weight gains than the control diets. The results showed that under the conditions of these experiments, the levels of amino acids and vitamins in the control diets were not optimal for the proper growth and development of broilers and must be increased.

Murine typhus in Kuwait in 1978.

Murine typhus occurred in 254 individuals in Kuwait between April and August 1978; 81% of patients were aged between 15 and 44 years, and 63% were male. The highest attack rate occurred among people in the lowest socioeconomic class. The outbreak coincided with a period of high rat and flea density. A study of the first 104 cases suggested that infection was acquired in the home, but a case - control study revealed no significant differences between patients and control subjects in terms of exposure to rats or domestic animals, and other factors. This suggests that murine typhus is hyperendemic rather than epidemic in Kuwait. The disease is being controlled through reduction of both flea and rat populations. Murine typhus may be much more common in many areas than is generally realized, and its status should be re-evaluated regularly in all known and potential foci.