Acute epiglottitis is a potentially life threatening condition which can lead to fatal airway obstruction in previously healthy individuals. The present study was undertaken to assess the clinical features, management and patient outcomes of epiglottitis in Kuwait over an eight year period.
Al Sabah Hospital, Kuwait.
All patients admitted to the ENT department of Al Sabah hospital between January 2000 and January 2008 with the diagnosis of acute epiglottitis were included in this retrospective study. The diagnosis of acute epiglottitis was established by visualization of inflamed epiglottis either on indirect laryngoscopy or flexible fibreoptic/direct laryngoscopy.
47 cases were identified, 5 children and 42 adults. There were 32 males and 15 females, in the age range of 5 to 66 years. Peak incidence was in the third decade. 31 patients had co-morbid conditions, 18 patients (38.2%) had diabetes, 8 patients (17%) had hypertension and 3 patients (6.3%) had dental caries. Majority of the patients (89.3%) presented with sore throat as their chief complaint. All patients were febrile on presentation. The classical “thumb sign” on lateral neck radiograph was seen in 32 patients (68%). Blood cultures were collected from 22 patients (46.8%), all were negative. Ceftriaxone was the commonest empirical antibiotic prescribed. 7 patients required airway intervention (5 with endotracheal intubation and 2 with tracheostomy). There were no deaths in our study.
In Kuwait, acute epiglottis is commoner in adults than in children. It is imperative to secure the airway and to start the patients on broad spectrum antibiotics and steroids as early as possible. In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention, in the form of intubation / tracheostomy, for patients with stridor or shortness of breath.
Acute epiglottitis; Complications; Airway; Tracheostomy; H influenzae
Allergic Rhinitis (AR) is a worldwide spread disease and has an important impact on social life, sleep quality (SQ), school and work productivity and huge direct costs. ISMAR was designed to identify attitudes and medical trends among physicians managing AR in different parts of the world. This study presents the physicians´ view and attitudes.
ISMAR is an international, multicenter, non-interventional and cross-sectional study conducted in adults and children (≥6 years) with physicians-diagnosed AR from 11 countries (Egypt, Mexico, Brazil, Colombia, Guatemala, Iran, Venezuela, Argentina, Israel, Kuwait, United Arab Emirates). Doctors from 4 specialties were required in each country: (i) GPs/Family doctors/internists, (ii) pediatricians, (iii) allergologists/pulmonologists, and (iv) ENT. They were invited to participate in the study from master lists of physicians attending patients with AR in their respective countries and answered the Doctor Questionnaire that included questions about guidelines awareness, relevant AR symptoms, and preference for prescribing medication, among others.
Two hundred and thirty four physicians participated in the study. Most of them were awared about ARIA (82.5%), GINA (71.4%). They followed guidelines recommandations to classify patients severity (84.2%) and for choosing the treatment accordingly (84.6%). Key symptoms to make AR diagnosis were: congestion (84.8%), sneezing (79.1%), anterior watery rhinorrhea (75.9%). SQ and AR severity were assessed mainly by clinical history (97.1% and 98%). The main reasons to prescribe medication were: symptom severity/frequency (97.9%), drug efficacy (85.9%) and safety (76.5%). Other less relevant raisons were: personal experience (65%), cost (55.1%) and frequency of dosages (54.7%). The preferred medications were oral antihistamines (OH1A) and intranasal corticosteroids (INC) [5 in a 0–5 scale]. Other treatments (oral decongestants, leukotriene antagonists, SCIT/SLIT), among others were considered as second level in preference.
Guidelines are well known and useful to physicians. Clinical history was the main way to evaluate the patient's sleep quality, classification, severity and election of treatment. Objective measures for assessment were scarcely used. OH1A and INC were the most widely recommended treatment for AR and were considered effective and safe.
Obesity is a growing health concern in Kuwait. Obesity has been identified as a key risk factor for many chronic diseases including hypertension, dyslipidemia and type 2 diabetes mellitus. It has been shown that community pharmacists' involvement is associated with successful weight management in developed countries. This study was conducted to investigate the role of community pharmacists in obesity counseling, and to identify the barriers to counseling in Kuwait.
A descriptive cross-sectional study involved 220 community pharmacies that were selected via stratified and systematic random sampling. A pretested self-administered questionnaire collected information on frequency and comfort level with obesity counseling, and the perceived effectiveness of four aspects of obesity management (diet and exercise, prescribed antiobesity medications, diet foods, and nonprescription products and dietary supplements). Information on perceived confidence in achieving positive outcomes as a result of counseling and barriers to counseling was also collected. Descriptive and Spearman’ r analysis were conducted using SPSS version 17. Responses with Likert scale rating 1(low score) to 5 (high score) and binary choices (yes/no) were presented as mean (SD) and (95% CI), respectively.
The response rate was 93.6%. The overall mean (SD) responses indicated that pharmacists counseled obese patients sometimes to most of the time, 3.67 (1.19) and were neutral to comfortable with counseling about aspects of obesity management, 3.77 (1.19). Respondents perceived obesity management aspects to be somewhat effective, 3.80 (1.05). Of the four aspects of obesity management, diet and exercise, and diet foods were the highest ranked in terms of frequency of counseling, comfort level and perceived effectiveness. Pharmacists were neutral to confident in achieving positive outcomes as a result of obesity counseling, 3.44 (1.09). Overall mean responses of counseling obese patients by pharmacists were positively correlated with their perceived comfort with counseling and perceived effectiveness of obesity management aspects. The most anticipated barriers to obesity counseling were lack of patient awareness about pharmacists' expertise in counseling 76.2% (95% CI: 69.7-81.7) and pharmacists’ opinions that obese patients lack willpower and are non-adherent to weight reduction interventions 71.8% (95% CI: 65.1-77.8).
Strengths, weaknesses and barriers related to obesity counseling by pharmacists in Kuwait were identified, and suggestions were provided to strengthen that role.
Community pharmacists; Obesity; Obesity counseling; Kuwait
Background and Objectives
Varicella–Zoster virus (VZV) is a human herpes virus that usually attacks young children and commonly causes chicken pox (Varicella). Following primary infection, a lifelong latent infection is established. The virus often reactivates during adulthood or senesces to cause shingles (Zoster). Little is known regarding the genotypes of Varicella in Kuwait. The aim of this study was to genotype Varicella samples collected from patients in Kuwait.
Materials and Methods
Samples from 60 cases of chicken pox were typed. The DNA extraction was performed using the commercially available DNA extraction kit. Two sets of oligonucleotide primers were used to amplify the intervening sequences with polymerase chain reaction to identify VZV DNA in clinical samples. The BglI and PstI endonucleases were used to digest. The PCR amplicons for PCR-RFLP typing.
Relatively consistent restriction enzyme digestion profiles for different VZV strains were observed. Limited genetic differences between VZV samples were found. Three VZV strains were identified (A, B and C) with type B representing 86.6%, type A 11.7% and type C being 1.7%. We found that distinct restriction fragment length polymorphism isolates from the same origin or nationality were very similar.
Varicella strains with cutting sites for both enzyme PstI and BglI (typeB) were more prevalent. Molecular amplification of viral DNA by PCR and restriction digestion could be used for VZV typing as an alternative method to serological assays.
Varicella; RFLP; Genotyping; Restriction enzymes; Kuwait
Improved quality of life is an important treatment goal for children and adolescents with type 1 diabetes. While previous research supports a relationship between family environment and quality of life, little research has addressed the relationship of parenting style constructs to quality of life in children with chronic disease. The present investigation assesses the relationship of parent responsiveness and demandingness with diabetes-related quality of life among children and adolescents with type 1 diabetes.
Baseline and 12-month follow-up self-report assessments were collected on a sample of 81 children with type 1 diabetes participating in an efficacy trial of a behavioral intervention to enhance adherence. The sample had a mean age of 13.3 years (SD = 1.7) and duration of diabetes of 7.7 years (SD = 3.7). Multiple regression analyses were conducted to determine the relationship of parent responsiveness and demandingness to diabetes-related quality of life at each time point.
After adjusting for demographic and diabetes characteristics, as well as diabetes-specific parent-child behaviors, parent responsiveness was significantly associated with baseline diabetes-related quality of life (B=.23; p=.04). This relationship was sustained at 12-month follow-up (B=.22; p=.04) after adjusting for baseline quality of life and treatment group assignment, suggesting that parent responsiveness is associated with improved quality of life.
Findings indicate the importance of a supportive and emotionally warm parenting style in promoting improved quality of life for children with type 1 diabetes. Appropriate parenting skills should be an element of diabetes family management health care.
parenting style; quality of life; type 1 diabetes; responsiveness
Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i) assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU); ii) compare the pattern of satisfaction with those of similar studies; and iii) assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life.
Consecutive outpatients in stable condition and their family caregivers were interviewed with the VSSS-EU and measures of needs for care, caregiver burden, quality of life and psychopathology.
There were 130 patients (66.1%m, mean age 36.8). While over two-thirds expressed satisfaction with the domains of "overall satisfaction", "professionals' skills", "access", "efficacy", and "relatives' involvement", only about one-third were satisfied with the domains of "information" and "types of intervention". The later two domains were the areas in which European patients had better satisfaction than our patients, while our patients expressed better satisfaction than the Europeans in the domain of "relatives' involvement". In multiple regression analyses, self-esteem, positive and negative affect were the most important correlates of the domains of service satisfaction, while clinical severity, caregiver burden and health unmet needs for care played relatively minor roles.
The noted differences and similarities with the international data, as well as the predictive power of self-esteem and affective state, support the impression that patients' attitudes towards psychiatric care involve a complex relationship between clinical, personal and socio-cultural characteristics; and that many of the factors that impact on satisfaction with service relate to individual psychological characteristics. The weaknesses in the system, highlighted by the pattern of responses of the participants, indicate possible gaps in the provision of comprehensive psychiatric care in the country and obviate the need for public mental health education and development of services to enhance the quality of care.
Current prevalence estimates for diabetes in Arabian Gulf countries are some of the world’s highest, yet regional trends and contributing factors are poorly documented. The present study was designed to determine temporal changes in the prevalence of impaired fasting glucose (IFG) and diabetes and associated factors in Kuwaiti adults.
Data analysis from the nationally representative cross-sectional Kuwait National Nutrition Surveillance System. 2745 males and 3611 females, aged 20–69 years, attending registration for employment or pensions and Hajj Pilgrimage health check-ups or accompanying children for immunizations from 2002 through 2009 were participated. Socio-demographic and lifestyle information, height and weight, and blood samples were collected.
During the 8 years (2002–09), prevalences of IFG in males and females decreased by 7.4% and 6.8% and of diabetes by 9.8% and 8.9% in males and females, respectively. Linear regression for blood glucose level with time, adjusted for age, BMI, blood cholesterol and education level, showed a greater decrease in males than females (1.12 vs 0.93 mmol/L); males also showed an increase in 2002–2003 followed by a marked decrease in 2006–2007 while females showed a significant decrease in 2008–2009. Both males and females showed the largest decrease in the 2nd half of the study accounting for the majority of the overall decrease (1.13 mmol/L for males and 0.87 mmol/l for females for the 4 years). Compared with 2002–03, the OR for IFG in males decreased with time, and becoming significantly lower (OR=0.32; 95% CI: 0.21-0.49) for 2008–09. In females, the OR for IFG decreased significantly with time, except in 2006–07. Similarly, the OR for diabetes in males decreased to 0.34 (95% CI: 0.24-0.49) and in females to 0.33 (95% CI: 0.22-0.50) in 2008–09. For both genders, age and BMI were independently positively associated with IFG and diabetes, while education levels and smoking were negatively associated with IFG and diabetes. No significant association was found for either hypercholesterolemia or exercise in either gender.
Continued monitoring of blood glucose is needed to see if negative trends observed in 2008–2009 endure and further research of contributing factors is required for development of targeted intervention strategies.
The global epidemic of diabetes has not spared the Arabic-speaking countries, which have some of the highest prevalence of type II diabetes. This is particularly true of the Arab Gulf, a conglomerate of high income, oil-producing countries where prevalence rates are the highest. The prevalence rates among adults of the Arabic speaking countries as a whole range between 4%–21%, with the lowest being in Somalia and the highest in Kuwait. As economic growth has accelerated, so has the movement of the populations to urban centers where people are more likely to adopt lifestyles that embrace increased high-calorie food consumption and sedentary lifestyles. These factors likely contribute to the increased prevalence of obesity and diabetes in the Arabic speaking countries.
There is a lack of high quality, child-centred and effective health information to support development of self-care practices and expertise in children with acute and long-term conditions. In type 1 diabetes, clinical guidelines indicate that high-quality, child-centred information underpins achievement of optimal glycaemic control with the aim of minimising acute readmissions and reducing the risk of complications in later life. This paper describes the development of a range of child-centred diabetes information resources and outlines the study design and protocol for a randomized controlled trial to evaluate the information resources in routine practice. The aim of the diabetes information intervention is to improve children and young people's quality of life by increasing self-efficacy in managing their type 1 diabetes.
We used published evidence, undertook qualitative research and consulted with children, young people and key stakeholders to design and produce a range of child-centred, age-appropriate children's diabetes diaries, carbohydrate recording sheets, and assembled child-centred, age-appropriate diabetes information packs containing published information in a folder that can be personalized by children and young people with pens and stickers. Resources have been designed for children/young people 6-10; 11-15; and 16-18 years.
To evaluate the information resources, we designed a pragmatic randomized controlled trial to assess the effectiveness, cost effectiveness, and implementation in routine practice of individually tailored, age-appropriate diabetes diaries and information packs for children and young people age 6-18years, compared with currently available standard practice.
Children and young people will be stratified by gender, length of time since diagnosis (< 2years and > 2years) and age (6-10; 11-15; and 16-18 years). The following data will be collected at baseline, 3 and 6 months: PedsQL (generic, diabetes and parent versions), and EQ-5 D (parent and child); NHS resource use and process data (questionnaire and interview). Baseline and subsequent HbA1c measurements, blood glucose meter use, readings and insulin dose will be taken from routine test results and hand-held records when attending routine 3-4 monthly clinic visits.
The primary outcome measure is diabetes self-efficacy and quality-of-life (Diabetes PedsQL). Secondary outcomes include: HbA1c, generic quality of life, routinely collected NHS/child-held data, costs, service use, acceptability and utility.
Clinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP) in Kuwait. This study was undertaken to draw a picture of trainees' understanding of the audit project with attention to the knowledge of audit theory and its educational significance and scrutinize the difficulties confronted during the experience.
The materials included the records of 133 audits carried out by trainees and 165 post course questionnaires carried out between 2004 and 2011. They were reviewed and analyzed. The majority of audit projects were performed on diabetic (44.4%) and hypertensive (38.3%) care. Regarding audits done on diabetic care, they were carried out to assess doctors' awareness about screening for smoking status (8.6%), microalbuminuria (19.3%), hemoglobin A1c (15.5%), retinopathy (10.3%), dyslipidemia (15.8%), peripheral neuropathy (8.8%), and other problems (21.7%). As for audits concerning hypertensive care, they were carried out to assess doctors' awareness about screening for smoking status (38.0%), obesity (26.0%), dyslipidemia (12.0%), microalbuminuria (10.0%) and other problems (14.0%). More than half the participants (68.48%) who attended the audit course stated that they ‘definitely agreed’ about understanding the meaning of clinical audit. Most of them (75.8%) ‘definitely agreed’ about realizing the importance of clinical audit in improving patients' care. About half (49.7%) of them ‘agreed’ that they can distinguish between ‘criteria’ and ‘standards’.
The eight years of experience were beneficial. Trainees showed a good understanding of the idea behind auditing the services provided. They demonstrated their ability to improve the care given in health centers in which these projects were undertaken.
The Kuwaiti perspective on quality of life (QOL) in breast cancer is important because it adds the contribution from a country where the disease affects women at a relatively younger age and seems to be more aggressive. We used the EORTC QLQ – C30 and its breast-specific module (BR-23) to highlight the health-related QOL of Kuwaiti women with breast cancer, in comparison with the international data, and assessed the socio-demographic and clinical variables that predict the five functional scales and global QOL (GQOL) scale of the QLQ – C30.
Participants were consecutive clinic attendees for chemotherapy, in stable condition, at the Kuwait Cancer Control Center.
The 348 participants were aged 20–81 years (mean 48.3, SD 10.3); 58.7% had stages III and IV disease. Although the mean scores for QLQ – C30 (GQOL, 45.3; and five functional scales, 52.6%–61.2%) indicated that the patients had poor to average functioning, only 5.8% to 11.2% had scores that met the = 33% criterion for problematic functioning, while 12.0% to 40.0% met the >66% criterion for more severe symptoms. Most (47.8%–70.1%) met the >66% criterion for "good functioning" on the BR-23 functional scales. The mean scores of the QLQ – C30 indicated that, despite institutional supports, Kuwaiti women had clinically significantly poorer global QOL and functional scale scores, and more intense symptom experience, in comparison with the international data (i.e., = 10% difference between groups). For the BR-23, Kuwaiti women seemed to have clinically significantly better functional scale scores, but more severe symptoms, especially systemic side effects and breast symptoms. Younger women had poorer HRQOL scores. In regression analysis, social functioning accounted for the highest proportion of variance for GQOL.
The relatively high number that met the criterion for good functioning on the functional scales is an evidence base to boost national health education about psychosocial prognosis in cancer. In view of the poor performance on the symptom scales, clinicians treating Kuwaiti women with breast cancer should prepare them for the acute toxicities of treatment and address fatigue. The findings call for the institution of a psycho-oncology service to address psycho-social issues.
Non-adherence to preventive and therapeutic lifestyle recommendations among patients at high risk of cardiovascular disease is more prevalent and varied than previously thought. The problem needs to be addressed by those who are involved in the care of these patients.
To measure adherence and barriers of complying with lifestyle recommendations among patients with high cardiovascular risk factors.
Design of study
Six family-practice health centres in Kuwait.
Data are from 334 Kuwaiti adult males and females with hypertension, type 2 diabetes, or both, who completed a routine clinic visit in one of six family practice centres. Trained staff used a structured questionnaire to obtain a detailed medical history regarding exercise habits and barriers to compliance with diet and exercise programmes. Clinical criteria assessed were height, weight, and the control of blood pressure and blood sugar.
From the study sample, 63.5% of patients reported that they were not adhering to any diet regimen, 64.4% were not participating in regular exercise, and 90.4% were overweight and obese. The main barriers to adherence to diet were unwillingness (48.6%), difficulty adhering to a diet different from that of the rest of the family (30.2%), and social gatherings (13.7%). The main barriers to adherence to exercise were lack of time (39.0%), coexisting diseases (35.6%), and adverse weather conditions (27.8%). Factors interfering with adherence lifestyle measures among the total sample were traditional Kuwaiti food, which is high in fat and calories (79.9%), stress (70.7%), a high consumption of fast food (54.5%), high frequency of social gatherings (59.6%), abundance of maids (54.1%), and excessive use of cars (83.8%).
The majority of individuals in the sample were overweight, did not engage in recommended levels of physical activity, and did not follow dietary recommendations. Additional cultural and demographic variables need to be considered to improve adherence to lifestyle measures.
hypertension; lifestyle measures; patient adherence; type 2 diabetes
To examine the relationships among maternal and child depressive symptoms and child and family psychosocial factors.
Secondary analysis of baseline data for a coping skills intervention for school-age children (ages 8-12) with type 1 diabetes (T1D) and their mothers. Children and mothers completed measures of depressive symptoms, coping, quality of life, and family functioning.
There was a strong relationship between maternal and child depressive symptoms (r = .44, p < .001). Maternal depressive symptoms were negatively related to child quality of life, perceptions of coping, and family functioning. Impact of diabetes on quality of life, upset related to coping, and family warmth mediated the relationship between maternal and child depressive symptoms.
Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.
Aim: To culturally adapt the diabetes- specific quality of life (QOL) instrument PedsQL 3.0 Diabetes Module (DM) and the generic QOL instrument PedsQL 4.0 Generic Core Scales (GCS) to the population of Greek diabetic children. Also, to evaluate QOL in youths with type 1 diabetes, compare it with that of healthy youths, and identify relationships between QOL and metabolic control and intensity of treatment.
Patients and methods: Eighty nine (89) children and adolescents with type I diabetes and 89 without diabetes, all with their parents (2-18 years of age, diabetes duration >6 months) completed the Greek GCS. Those with diabetes also completed the Greek DM.
Results: Cronbach α coefficient of child and parent report of both instruments, in general approached 0.70, indicating their internal consistency reliability. Both instruments demonstrated positive intercorrelations with their total scores and subscales of DM demonstrated positive intercorrelations with total score of the generic instrument, supporting the validity of both instruments for the evaluation of QOL of Greek diabetic children. No statistically important differences were found among patient and parent report of diabetes and control group in both instruments. Exception was "Social functioning" in which children with diabetes reported better QOL. Growing age, female gender, large BMI, poor metabolic control and intensity of treatment did not influence QOL of children with diabetes.
Conclusions: Greek PedsQL GCS and DM have sufficient acceptability, reliability and validity so as to be used for the purposes of a comparative study. Youth with diabetes reported similar QOL with non-diabetic youth of the same age and socioeconomic status.
children, adolescents; type 1 diabetes; health-related quality of life (HRQOL); Pediatric Quality of Life Inventory (PedsQL)
International guidelines on type 1 diabetes advocate routine screening of health-related quality of life (HRQOL). DISABKIDS questionnaires are the first instruments developed across cultures and nations to provide age-appropriate measures of HRQOL in children with chronic diseases. DISABKIDS includes a Chronic Generic Module 37 (DCGM-37) and disease-specific modules. The purpose of this study was to examine reliability and validity of the Norwegian versions of the DISABKIDS questionnaires in children and adolescents with type 1 diabetes.
The DCGM-37 and the Diabetes Specific Module-10 (DDM-10) were translated into Norwegian using standard forward-backward translation. Eight to 19 year old children and adolescents with type 1 diabetes scheduled for routine follow-up at three diabetic clinics in Norway and one of their parents were invited to complete the DCGM-37 and the DDM-10. Internal consistency was determined using Cronbach's alpha. Results were compared with those of the Child Health Questionnaire Children Form-87 (CHQ-CF87) and Child Health Questionnaire Parent Form-50 which are established generic questionnaires. DISABKIDS results were related to age, gender, duration of diabetes, mode of insulin delivery and metabolic control. Clinical data were obtained from the Norwegian Childhood Diabetes Registry.
Of 198 eligible child-parent dyads, 103 (52%) completed the questionnaires. Mean age was 13.6 (2.6), range 8-19 yrs, 52% were boys. Cronbach's alpha was > 0.70 for all the DISABKIDS sub-scales except two (physical ability and social inclusion). There were moderate to high correlations (0.65-0.81) between the DISABKIDS scales and mental/emotional sub-scales of CHQ-CF87. Increasing age and higher HbA1c were significantly associated with reduced HRQOL scores. Parents tended to score their child's HRQOL lower than the children/adolescents themselves.
The study shows that the DISABKIDS instruments are applicable to a Norwegian childhood diabetes population. They seem to be a relevant supplement to other clinical indicators in medical practice and research.
Health-related quality of life; Type 1 diabetes; Children; Adolescents; Psychometrics; Reliability; Validity; DISABKIDS
Inflammatory bowel disease (IBD) was previously thought a rare disease among children in Kuwait since most diarrhea cases were attributed to infections. In the past few years we observed an increase in the number of patients presenting with IBD. In this study we aimed to determine the epidemiology of IBD among children in the State of Kuwait.
Patients and Methods:
The charts of all children with IBD who were referred to the pediatric gastroenterology unit during the period February 1998 to January 2008 were retrospectively reviewed.
Out of a total of 130 children with IBD, 92 (71%) had Crohn's disease, 36 (28%) had ulcerative colitis and two (1%) had indeterminate colitis. The estimated annual incidence for IBD was 2.16/105 /year. The age range was nine months-15 years (median: 11 years). Fifty-three percent of all patients were females and 77% were Kuwaiti nationals. Positive family history was found in 23%. The commonest presenting symptoms were abdominal pain (87%) and diarrhea (82%). Failure to thrive was detected in 35% and short stature in 20% at presentation. The ileocolonic region was the most common presentation site affected in Crohn's patients and pancolitis was the commonest in ulcerative colitis.
Inflammatory bowel disease is not uncommon in our children. We found no differences regarding disease presentation and clinical features compared to the Western world.
Children; Crohn's disease; inflammatory bowel disease; Kuwait; ulcerative colitis
Wound management can often be a challenging experience, especially in the presence of diabetes mellitus, vascular or immunological compromise. While no single technique can be considered by itself to be ideal, vacuum-assisted healing, which is a recent innovation, is fast becoming a necessary addition as adjuvant therapy to hasten wound healing.
To determine the efficacy of vacuum-assisted healing.
Settings and Design:
Plastic surgery centre. Ministry of Health Hospital, Kuwait.
Materials and Methods:
Patients from Kuwait in a wide variety of clinical situations were chosen for study: Patients (n=50) were classified by diagnosis: Group 1: pressure sore- sacral (n= 3), trochanteric (n=6), ischial (n= 2); Group 2: ulcers (n= 11); Group 3: traumatic soft tissue wounds (n =15); Group 4: extensive tissue loss from the abdominal wall perineum, thigh and axilla (n =5); Group 5: sternal dehiscence wounds (n =4) and Group 6: wounds from flap necrosis (n =4). All wounds were subjected to vacuum by wall unit or portable unit, using pressure of 100-125 mm - continuous or intermittent. Closure of wounds, significant reduction in size and refusal by patient for continuation of vacuum-assisted closure therapy were end points of vacuum application.
Sixteen per cent of patients showed complete healing of the wound. Seventy per cent of patients showed 20-78% reduction in wound size. In 14% of patients treatment had to be discontinued. All patients showed improvement in granulation tissue and reduction in bacterial isolates and tissue oedema.
The application of subatmospheric pressure or negative pressure promotes healing in a wide range of clinical settings and is an advanced wound healing therapy that can optimize patient care, promote rapid wound healing and help manage costs. It may be used in most instances in both hospital and community settings.
Vacuum-assisted healing vaccum assisted closure; wound healing; VAC therapy
This study was designed to develop a diabetes-specific questionnaire on parents' quality of life and satisfaction with their child's diabetes treatment, the WEll-being and Satisfaction of CAREgivers of Children with Diabetes Questionnaire, and to conduct psychometric validation of the WE-CARE.
Parents of 116 children aged 6 to 11 years were enrolled in the United States. Children had type 1 diabetes mellitus for > 1 year, had been treated with subcutaneous insulin for ≥ 2 months, and had a recent glycosylated hemoglobin (HbA1C) measurement. Recruiting clinicians provided clinical information on the children. Over a two-week period, parents completed WE-CARE (initial 68 items) and two other questionnaires (the 36-item Short Form of the Medical Outcomes Study and the 50-item Child Health Questionnaire-Parent Form) twice.
A literature review and one-on-one interview with caregivers and pediatricians led to the development of a draft questionnaire consisting of 68 items. Factor analysis suggested retention of 37 of the 68 initial items grouped into four multi-item scales (Psychosocial Well-being, Ease of Insulin Use, Treatment Satisfaction, and Acceptance of Insulin Administration as well as a Total Score). The four multi-item domains of WE-CARE were found to be psychometrically robust – they had negligible floor and ceiling effects, excellent internal consistency and test-retest reliability, high item-discriminant validity and good concurrent, divergent, known-group and clinical validity. Moderate interscale correlations among the four WE-CARE domains indicated that the concepts they measure were related but distinct.
These data suggest that WE-CARE provides a reliable and valid measure of parents' well-being and treatment satisfaction related to their child's diabetes. While these results show promise, additional validation of WE-CARE is warranted.
A simple quality of life measure is needed for use in diabetes, particularly for the assessment of new treatments and technologies. We devised and validated a patient-centered quality of life (PCQoL) measure that should be applicable to routine clinical practice or trial of therapies.
People with diabetes completed a two-part, PCQoL questionnaire where they nominated five aspects of general- and diabetes-related life judged most important for their overall quality of life and rated each for current level of satisfaction. Scores derived from the questionnaire were compared with a reference measure—the Diabetes Control and Complications Trial diabetes quality of life (DQoL) score. Both were repeated after 1 month. The participants were 72 diabetic patients (60% with type 1 diabetes); 29 people with type 1 diabetes were treated by continuous subcutaneous insulin infusion (CSII) and 14 were treated by multiple daily insulin injections (MDI).
Patients most often cited family and relationships or fear of complications and hypoglycemia as important facets of quality of life for them. The PCQoL measure was highly correlated with the reference DQoL measure (r = 0.73, p < 0.0001), had high repeatability (r = 91, p < 0.0001), and could be completed in less than 5 minutes. The test was sensitive enough to detect a better quality of life in CSII-treated patients vs MDI-treated patients.
The PCQoL measure is simple, quick, valid, and suitable for routine use in diabetes or trials of new treatments.
continuous subcutaneous insulin infusion; diabetes mellitus; patient centered; quality of life
Exclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding.
A sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.
In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery.
The reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.
The relatively high frequency of primary brain tumors (PBT) observed in childhood and adolescence in Kuwait has necessitated this epidemiological study. It is based on the records of the Department of Pathology, Al-Sabah Hospital, which examined all brain tumor biopsies done in this age group in Kuwait between 1995 and 2011. During this period, 75 boys (49%) boys and 77 (51%) girls had histologically confirmed PBT. They comprised 122 children (0–14 years) and 30 adolescents (15–19 years). The boys/girls ratio was 1.03 in childhood and 0.76 in adolescence. The age-adjusted incidence rate was 11.2/ million person-years. Early childhood (0–4 years) had the peak frequency of tumors (33%), highest adjusted age-specific incidence rate (3.8/million person-years) of all tumors and the least boys/girls rates ratio (0.38) for astrocytic tumors. Low grade and high grade tumors peaked in 5–9 and 0–4 years respectively. Risk factors (hereditary syndromes or previous radio-therapy) were identified in three patients. Three (2%) tumors were congenital. High grade tumors comprised 47% of childhood and 23% of adolescence PBT. The most common tumors in childhood were astrocytoma (37%), embryonal tumors (31%), ependymoma (8%), and in adolescence astrocytoma (27%), pituitary adenoma (23%) and glioblastoma (13%). Embryonal tumors formed 44% of PBT in early childhood. Gliomas constituted 54% and 43% of all PBT, but 25% and 57% of high grade tumors in childhood and adolescence respectively. Most common tumor locations were cerebellum (47%), ventricles (19%) and cerebral lobes (17%) in childhood and pituitary (30%), cerebellum (27%) and 13% each for cerebral lobes and ventricles in adolescence. Approximately 57% of childhood and 23% of adolescence PBT were infratentorial.
In conclusion, despite the high relative frequency of PBT before the age of 20 years in Kuwait, its incidence rate is apparently low. Compared with Western countries, Kuwait has a lower incidence of malignant gliomas, but a higher frequency of cerebellar and intraventricular tumors. Embryonal tumors are remarkably common in early childhood.
Epidemiology; Primary brain tumors; Childhood; Adolescence; Kuwait
To assess the factor structure of the PedsQL Diabetes Module, and to compare the PedsQL general and diabetes-specific quality of life (QOL) measures regarding psychometric properties and relations to relevant outcomes.
The instruments were completed by 447 children age 9 to 15.5 with type 1 diabetes >1 year from four US paediatric diabetes clinics; parents completed the parallel parent-proxy measures. Principal components factor analysis was used to examine the factor structure of the PedsQL diabetes module. Analyses of the generic and diabetes QOL measures included psychometric properties, parent-child correlations, and correlations with depression, adherence, and A1c.
The factor structure of the PedsQL diabetes module did not support the original 5 subscales. Both one and two factor models were supported; however parallel parent and child subscales did not emerge. While the generic and diabetes-specific measures of QOL were moderately to highly correlated with each other, the constructs were differentially associated with relevant diabetes outcomes. Generic QOL was more highly associated with depression than diabetes QOL. Conversely, diabetes QOL was more highly associated with adherence and A1c, though this was seen to a greater extent for parent-proxy report than for child report.
Factor analysis of the PedsQL diabetes module supports the use of a total diabetes QOL score. Findings regarding the associations of the generic and diabetes modules with diabetes outcomes underscore the unique contribution provided by both generic and diabetes QOL.
Quality of life; Children; Type 1 diabetes; Measurement
We studied health utilities in patients with type 1 diabetes to understand potential differences in health utilities as function of age, type of respondent (self-report vs. proxy-report), and method of assessment (direct versus indirect).
Research Design and Methods
We elicited self-reported health utilities for adults (n=213) and children (n=238) with type 1 diabetes, and by parent proxy-report (n=223) for overall quality of life (Health Utilities Index [HUI] Mark 3 and experienced time-tradeoff [TTO] questions) and hypothetical complication states (TTO questions).
Mean health utilities for overall quality of life (QOL) ranged from 0.81 to 0.91. Children had significantly higher overall QOL compared with adults (0.89 vs. 0.85, p<0.01) by HUI, but had no significant difference in QOL by TTO. There were no significant differences in QOL between child self-report and parent proxy-report. Utilities were higher for HUI vs. TTO for parent proxy-report (p<0.01) but not for adult or child self-report. Utilities for hypothetical complication states were lower than for current QOL. Values were lower for stroke (0.34-0.53), end stage renal disease (0.47-0.55), and blindness (0.52-0.69) than for amputation (0.73-0.82) and angina (0.74-0.80). Complication utilities for parent proxy-report were higher compared with adult self-report for most hypothetical complication states.
Individuals with type 1 diabetes with few complications report a relatively high QOL; however, future end stage complications are rated as having a significant impact on QOL. Differences in utilities by age, self-report vs. proxy-report, and method raise important questions about whose utilities should be used in economic analyses.
The purpose of this study was to examine the relationship between sleep quality and health-related and diabetes-related quality of life in adults with type 2 diabetes.
Three hundred individuals with type 2 diabetes (mean age 63.9 years) completed questionnaires assessing sleep quality, health-related quality of life, diabetes-related quality of life, comorbidities, and depressive symptoms.
More than half of the participants (55%) were “poor sleepers” according to the Pittsburgh Sleep Quality Index. After controlling for covariates, poor sleep quality was found to be a significant predictor of lower health-related quality of life as indicated by lower scores on both the physical and mental component scores of the Medical Outcomes Study 36-item Short Form health survey (SF-36). Poor sleep quality was also associated with worse diabetes-related quality of life, in particular lower scores on the Diabetes Quality of Life measure total score and the Satisfaction With Treatment and Diabetes Impact subscale scores.
These results suggest that poor sleep is common in type 2 diabetes and may adversely impact quality of life. Interventions to improve sleep hygiene can be suggested to patients by diabetes educators as part of diabetes self-management education programs.
Genetic analysis was performed on 13 hepatitis D virus (HDV) isolates from Ethiopia, Somalia, Jordan, Kuwait, Bulgaria, Moldavia, and Sweden. The complete nucleotide sequence and genomic organization are described for the first time for two African HDV isolates. Phylogenetic analysis showed all the African isolates to be intrarelated and to form a novel group within HDV genotype I; the suggested designation for this group is IC. The genetic distance to previously described type I isolates was about 0.15. The HDV genotype I isolates (total of 22 examined) phylogenetically formed three clusters, each of them corresponding to certain geographic regions; the "western" group consisted of six HDV isolates from western Europe and the United States plus one from Kuwait; the "eastern" group consisted of two isolates from Moldavia and one each from Bulgaria, Nauru, mainland China, and Taiwan; and the "African-Middle East" group consisted of six HDV isolates from Ethiopia and one from Somalia, Jordan, and Lebanon.