Knowledge, Attitude, and Practice of Colorectal Cancer Screening Among Primary Healthcare Physicians in Riyadh Second Health Cluster.

BACKGROUND: Colorectal cancer is the third common cancer, and the second common cause of cancer death in the world. According to the 2014 Cancer Incidence Report of the Kingdom of Saudi Arabia, colorectal cancer account for 11.5% from all cancers reported among Saudi nationals. By the year 2030, the incidence of colorectal cancer could increase fourfold among both genders. AIM: The study aimed to conduct to understand the knowledge, attitude, and practice of primary healthcare physicians regarding colorectal cancer screening in Riyadh Second Health Cluster in the city of Riyadh, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study design, probability proportional to size sampling at the cluster zones level and convenient sampling for the physicians, were used among physicians working in the primary healthcare centers in the city of Riyadh between October 2022 and November 2022. RESULT: Of the 213 respondents, the mean age of the physician was 35, the majority were males (59%), Saudi Arabian nationality (60%), Resident Physicians (54%) and ≤ five years' work experience (45%). Sixty-four percent of the study participants believe that the majority of asymptomatic average-risk patients have to start the screening at the age of 45 years old. Ninety-seven percent believe that colorectal cancer screening for asymptomatic average-risk patients aged 45 years and older is effective. Ninety-two percent of the physicians perform colorectal cancer screening for asymptomatic average-risk patients aged 45 years. The mean knowledge score is 4.65 (SD=2.33) with a range of 0 to 10. The mean attitude score is 4.19 (SD=1.28) with a range of 0 to 6. CONCLUSION: The study found that the physicians had higher attitude and practice towards colorectal cancer screening and adequate knowledge towards colorectal cancer screening. The knowledge and attitude scores are associated with practicing colorectal cancer screening.

Correlates of Pulmonary Function in Children with Sickle Cell Disease and Elevated Fetal Hemoglobin.

OBJECTIVE: The current study was carried out to compare pulmonary function tests (PFTs) in pediatric Kuwaiti sickle cell disease (SCD) patients to age-matched normal controls and to investigate the association of PFTs with selected clinical and laboratory parameters. Subjects andMethods: There were 38 patients with SCD and 36 controls in the study. The patients were recruited from the Pediatric Hematology Clinics of Mubarak Al-Kabeer and Al-Amiri Hospitals, Kuwait, and were studied in steady state. The controls were healthy, non-sickle cell siblings of the patients. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), total lung capacity, and other PFT parameters were obtained using a constant-volume, variable-pressure, body plethysmograph. Hemoglobin, fetal hemoglobin, serum bilirubin, and lactate dehydrogenase were determined using standard methods. RESULTS: The mean ages of the patients and controls were 10.5 ± 3.2 and 10.5 ± 3.5 years, respectively. The FEV1% predicted of 84.1 ± 15.4% among the patients was significantly lower than the 92.1 ± 11.8% in the controls (p = 0.003). The FVC% predicted was also significantly lower (p = 0.022) in the patients than in the controls, although the values were generally within the normal range. There was no association of FEV1 with pain phenotype, acute chest syndrome (ACS), or blood transfusions. Also, there was no significant correlation with reticulocytes, bilirubin, or lactate dehydrogenase. CONCLUSIONS: In this study, changes in PFT, especially FEV1, developed early in the SCD patients. There was no demonstrable association with frequent vaso-occlusive crisis, ACS, and other variables. Hence, there is a need for follow-up studies with serial PFTs to identify vulnerable patients, who might need intervention to prevent early mortality.

Sinopulmonary Complications in Subjects With Primary Immunodeficiency.

BACKGROUND: The aim of this work was to describe the frequency and spectrum of sinopulmonary complications among subjects with primary immunodeficiency disorders. METHODS: The subjects included all patients with primary immunodeficiency who were registered prospectively between January 2004 and December 2013 in the Kuwait National Primary Immunodeficiency Disorders Registry. RESULTS: A total of 202 subjects were registered during the study period. Subjects with combined immunodeficiencies were the most prevalent (65 subjects, 32.1%), followed by well-defined syndromes with immunodeficiency (45 subjects, 22.2%) and predominantly antibody deficiencies (35 subjects, 17.3%). A total of 295 sinopulmonary manifestations were observed in 127 subjects (63%); 157 manifestations (53.2%) were observed among the presenting symptoms, and 138 manifestations (46.8%) occurred after establishment of the primary immunodeficiency disorder diagnosis. Sinopulmonary manifestations were more common in subjects with predominantly antibody deficiencies (2.3 manifestations/subject), followed by subjects with combined immunodeficiencies (1.75 manifestations/subject). Pneumonia was the most common manifestation (108 episodes affecting 80 subjects), followed by otitis media (81 episodes affecting 59 subjects), bronchiectasis in 28 subjects (13.8%), and asthma in 22 subjects (11%). Microbial organisms were isolated during 46 episodes of pneumonia (42.5%) (cytomegalovirus and Pneumocystis jirovecii were the most common). There were 57 deaths (28%) during the study period. Twenty-four deaths (42%) were due to pulmonary complications as follows: pneumonia (16 subjects, 8%), pulmonary hemorrhage (6 subjects, 3%), and aspiration pneumonia (2 subjects, 1%). CONCLUSIONS: Sinopulmonary complications are common in subjects with primary immunodeficiency. They can be serious and continue to occur even after proper treatment is initiated. The pulmonologist should play an important role in the management of subjects with primary immunodeficiency disorder.

The Prevalence of Human Bocavirus, Human Coronavirus-NL63, Human Metapneumovirus, Human Polyomavirus KI and WU in Respiratory Tract Infections in Kuwait.

OBJECTIVE: The aim of this study was to investigate the prevalence of human coronavirus (HCoV)-NL63, human metapneumovirus (hMPV), human bocavirus (Boca), human polyomavirus KI (KIV) and human polyomavirus WU (WUV) in respiratory tract infections (RTI) in Kuwait. MATERIALS AND METHODS: Respiratory samples from 735 hospitalized patients with RTI from September 2010 to April 2013 were evaluated for the presence of HCoV-NL63, hMPV, Boca, KIV and WUV using molecular assays, polymerase chain reaction (PCR) and reverse-transcription PCR. RESULTS: Of the 735 patients, 285 (38.8%) were diagnosed with viral RTI. The distribution of respiratory viruses was hMPV: 15 (5.3%), Boca: 14 (4.9%), WUV: 10 (3.5%) and KIV: 4 (1.4%). HCoV-NL63 was not detected in any of the samples. CONCLUSIONS: These newly discovered viruses were associated with the development of RTI in Kuwait. The rapid identification of these viral infections could aid in the control of nosocomial transmission, reduce the use of antibiotics and improve treatment and management strategies.

Mixed viral infections circulating in hospitalized patients with respiratory tract infections in kuwait.

The aim of this study was to determine the frequency of viral mixed detection in hospitalized patients with respiratory tract infections and to evaluate the correlation between viral mixed detection and clinical severity. Hospitalized patients with respiratory tract infections (RTI) were investigated for 15 respiratory viruses by using sensitive molecular techniques. In total, 850 hospitalized patients aged between 3 days and 80 years were screened from September 2010 to April 2014. Among the 351 (47.8%) patients diagnosed with viral infections, viral mixed detection was identified in 49 patients (14%), with human rhinovirus (HRV) being the most common virus associated with viral mixed detection (7.1%), followed by adenovirus (AdV) (4%) and human coronavirus-OC43 (HCoV-OC43) (3.7%). The highest combination of viral mixed detection was identified with HRV and AdV (2%), followed by HRV and HCoV-OC43 (1.4%). Pneumonia and bronchiolitis were the most frequent reason for hospitalization with viral mixed detection (9.1%). There were statistical significance differences between mixed and single detection in patients diagnosed with bronchiolitis (P = 0.002) and pneumonia (P = 0.019). Our findings might indicate a significant association between respiratory virus mixed detection and the possibility of developing more severe LRTI such as bronchiolitis and pneumonia when compared with single detection.

Hospitalization patterns and outcomes of infants with Influenza A(H1N1) in Kuwait.

INTRODUCTION: Infants represent an important risk group for influenza associated hospitalizations and mortality. This study evaluated the clinical presentations, hospitalization course and outcome of infants hospitalized with the pandemic influenza A H1N1 [Influenza A(H1N1)pdm09] in relation to their previous health status. METHODOLOGY: We conducted a retrospective chart review of hospitalized infants with laboratory-confirmed Influenza A(H1N1)pdm09 infection in two hospitals in Kuwait. Demographic characteristics, pre-existing high-risk medical conditions, clinical presentations, complications and mortality were analyzed. Previously healthy infants' data were compared with infants with pre-existing high-risk medical conditions for severity of the illness and outcome. RESULTS: We identified 62 infants comprising 32% of all admissions with Influenza A(H1N1)pdm09.  The median age ± SD was 7 ± 4 months.  Nineteen (31%) had pre-existing high-risk medical conditions. Complications were documented in 53% of previously healthy infants compared to 47% in high-risk infants.  Mean duration of hospitalization was 4.9 days in healthy infants and 6.7 for infants with high-risk medical conditions. Bacterial pneumonia complicated 7% of previously healthy infants compared to 26% with high-risk conditions (P = 0.03). Four infants (6.5%) required admission to the intensive care unit (ICU), of whom three had high risk medical condition. CONCLUSION: The majority of hospitalized infants with Influenza A(H1N1)pdm09 were previously healthy. Prolonged hospitalization, ICU admission and mortality were more observed in infants with high-risk medical conditions. According to the latest Advisory Committee on Immunization Practices (ACIP) recommendations, annual influenza vaccination is recommended for any child six months of age and older, particularly those with risk factors.

Epidemiology and clinical presentation of pandemic influenza A (H1N1) among hospitalized children in Kuwait.

OBJECTIVE: To describe the epidemiological and clinical characteristics of children hospitalized for the 2009 influenza A H1N1 infection in Kuwait. MATERIALS AND METHODS: A retrospective chart review of hospitalized children with laboratory-confirmed influenza A H1N1 infection in two hospitals in Kuwait was conducted. Epidemiological characteristics, clinical features, risk factors for severe disease, complications and mortality were analyzed. RESULTS: The medical records of 197 children hospitalized for the 2009 pandemic H1N1 infection from August 2009 to January 2010 were reviewed. The majority of the children (104; 52.8%) were admitted during the month of October. The median age was 2 years. Most of the admitted children were in two age categories: 64 infants ≤1 year (32%) and 62 schoolchildren >5 years (31%). The most frequent presentations were fever in 193 (98%), cough in 155 (79%) and runny nose in 105 (53%) cases. The majority of the admitted children (109; 55%) had been previously healthy. All children received an antiviral agent (oseltamivir), and antibiotics were administered to 147 (75%). Bacterial co-infections occurred in 3 (1.5%) of all hospitalized children. Six (3%) children were admitted to the intensive care unit, of whom 4 (66%) required artificial ventilation. There was only 1 mortality. CONCLUSIONS: The pandemic H1N1 infection was associated with a wide spectrum of clinical manifestations. The majority of hospitalized children had previously been healthy. Most of the admitted children had an uncomplicated clinical course.

Cellular oxidative stress and peroxisomal enzyme activities in pediatric liver transplant patients.

OBJECTIVES: In this study, we examined the activities of key peroxisomal enzymes in peripheral blood lymphocytes (PBLs) of pediatric liver transplant patients. SUBJECTS AND METHODS: Venous blood was drawn from 14 patients aged 5-16 years on FK-506 treatment and 18 healthy subjects for isolation of lymphocytes. ß-Oxidation of very long chain fatty acids (VLCFAs) and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), NADPH oxidase (NOX), catalase and peroxisomal enzyme acyl CoA oxidase (ACO) were measured in cellular homogenates. Levels of malondialdehyde (MDA) were measured as an index of lipid peroxidation. Protein content and mRNA levels of catalase, peroxisomal membrane protein-70 (PMP-70) and ACO were measured using Western blotting and PCR techniques. RESULTS: PBLs isolated from liver transplant patients showed significantly (p < 0.01) increased levels (226.9 ± 24.5 µmol/mg protein) of MDA as compared to the levels in controls (162.8 ± 19.6 µmol/mg protein), whereas enzyme activities of SOD and NOX remained unaltered in patients' cells. Enzyme activities of catalase and GPx were markedly (p < 0.01) decreased in cells isolated from liver transplant patients. ACO activity and ß-oxidation of VLCFAs in PBLs from liver transplant patients were however found to be significantly increased by 38 and 52% respectively when compared with controls. Gene expression of PMP-70 and ACO was also significantly increased (p < 0.01) in PBLs of patients. CONCLUSION: Our results clearly showed that peroxisomal metabolic activities are markedly altered in lymphocytes of liver transplant patients and might contribute to the development of cellular oxidative stress.

Nitric oxide-mediated activation of NADPH oxidase by salbutamol during acute asthma in children.

A wide variety of reactive oxygen species (ROS) such as superoxide anion, hydroxyl radical and hydrogen peroxide, and reactive nitrogen species such as nitric oxide (NO) and peroxynitrite are known to be involved in pathophysiology of bronchial asthma. We have investigated, in this study, the status of NADPH oxidase (NOX), a major source of superoxide anion production, in peripheral blood lymphocytes (PBL) from asthmatic patients in relation to salbutamol treatment. PBL isolated from patients with bronchial asthma were found to have a significantly increased activity of NOX. Plasma levels of malondialdehyde (MDA), an index of lipid peroxidation, and NO were also markedly elevated in asthmatic patients compared to control samples. A significantly decreased catalase activity observed in PBL from our patients underscored the severity of oxidative stress during asthma. Treatment of PBL with salbutamol (10 microg ml(-1)), prevented the attenuation of catalase activity but significantly increased the levels of NO and NOX activity. Levels of NOX-1 mRNA were significantly (p < 0.001) increased in PBL following treatment with NO donor (500 microM), S-nitroso-N-acetyl penicillamine (SNAP). Western blot analysis revealed that gp91phox protein was also significantly (twofold-threefold) increased following treatment with SNAP. The observed transcriptional regulation of NOX-1 and gp91phox by NO was observed to result in an increased NOX activity as well. This study concludes that salbutamol treatment enhances superoxide anion production in asthma patients through NO-mediated mechanisms, however it exerts beneficial antioxidant effects through activation of catalase and attenuation of lipid peroxidation.