Psychosis Related to Baclofen Withdrawal or Overdose: A Systematic Review.

OBJECTIVE: To systematically review case reports of psychosis related to withdrawal or overdose of baclofen, which is a gamma-aminobutyric acid (GABA) B agonist. METHODS: PubMed, MEDLINE, CINAHL, and PsychINFO were searched to identify articles related to psychosis secondary to withdrawal or overdose of baclofen using the terms 'baclofen' and ' psychosis'. Comparisons were made between cases in terms of concomitant antipsychotic use, diagnosis of delirium, and evidence of association. Quality of case reports was assessed using the CARE Case Report Guidelines checklist. RESULTS: In total, 34 patients from 28 case reports were reviewed. Twenty-three patients experienced psychosis upon baclofen withdrawal; among them, 18 had resolution of psychosis upon reinitiation of baclofen, whereas antipsychotic monotherapy was less successful (only four of eight patients responded). An additional baclofen withdrawal period led to recurrence of psychotic symptoms in four of seven patients. Eleven patients had psychosis on induction or after overdose of baclofen; among them, four patients had resolution of psychosis upon cessation of baclofen. The mean quality of the case reports was 6.4 of 13. CONCLUSION: Considering its GABAergic agonism, along with evidence of psychosis on induction or withdrawal, baclofen may have some antipsychotic and pro-psychotic properties.

Factors responsible for asthma and rhinitis among Kuwaiti schoolchildren.

OBJECTIVE: The aim of this study was to assess the prevalence of asthma among schoolchildren and to determine the level house dust mites in Kuwaiti homes and its role in asthma and rhinitis. SUBJECTS AND METHOD: The International Study of Asthma and Allergy in Children questionnaire was distributed to schoolchildren in the age group of 5-7 years, after random sampling from all the five governorates of Kuwait. The questionnaires were completed and initiated by parents with the help of the investigator and parents. House dust was collected from the bedroom floor of 549 houses in the same geographical areas where the schoolchildren were sampled, extracted and assayed for mite Der p 1 by ELISA method. RESULTS: The estimated prevalence of asthma was 22.4% and that of rhinitis was 23%. House dust collected from the bedroom floor was found to contain low levels of Der p 1. There was no significant difference (p = 0.969) in the level of Der p 1 between areas in Kuwait. The highest levels of Der p 1 ranged from 0.02 to 0.10 mg/g in 3.5% of the total samples examined. CONCLUSIONS: There is a high prevalence of asthma and rhinitis among the schoolchildren in Kuwait. However, the level of dust mitogens investigated in this study was below the level of concern, thus undermining their role in increasing asthma cases in Kuwait. Therefore, further studies are needed to understand the role of other mite allergens and other factors that contribute to the increased prevalence of allergic diseases in Kuwaiti children.

Haemoptysis: aetiology, evaluation and outcome--a prospective study in a third-world country.

Haemoptysis is an alarming symptom, and the management depends upon the aetiology. Emergency management depends upon localization of the site of bleeding by roentgenogram, computerized chest tompgraphy and bronchoscopy. We prospectively evaluated 52 patients with haemoptysis admitted to the Chest Hospital, Kuwait for 1 year (January 1998 to December 1998) and followed them up for 1 year (January 1999 to December 1999). There were 42 males (80.8%) and 10 (19.2%) females, with a mean age of 42.2 (16-86) years. Of these, 26.9% were Kuwaiti nationals, 36.5% were Arab non-Kuwaiti nationals, 34.6% were Asians and 1.9% were other nationals. The aetiologies of haemoptysis were bronchiectasis (21.2%), old pulmonary tuberculosis with bronchiectasis (17.3%), active pulmonary tuberculosis (15.4%), bronchitis (5.8%), aspergilloma, rheumatic heart disease and carcinoid (1.9%). Aetiology could not be identified in 25% of patients. The site of bleeding in haemoptysis could not be localized by the consultants in 18 (32%) by roentgenogram. 16 patients (37%) by CT scan and 23 patients (50%) by Fibreoptic bronchoscopy. Sequential estimation of hemoglobin showed a mean of 13.56 (SD 1.9) and 13.31 (SD 1.8) after 24 h. The difference in mean was statistically significant (p<0.036). Conservative management was given in 80.8%, and embolotherapy or surgical intervention in 19.2% of patients. Only 12% of patients had recurrent haemoptysis at 1-year follow up. In conclusion, bronchiectasis and pulmonary tuberculosis were the major causes of haemoptysis in this study. Roentgenogram, CT scan and fibreoptic bronchoscopy are useful for localizing the site of bleeding. Sequential estimation of haemoglobin may be helpful in assessing the severity of haemoptysis, but larger studies are required to address this observation. The outcome of haemoptysis is generally good, with a low mortality and recurrence rate.

Influence of smoking on cutaneous delayed-type hyper sensitivity reaction by tuberculin skin test.

Tuberculin test (purified protein derivative) is currently accepted as a standard investigation used in the diagnosis of tuberculosis (TB). Although the sensitivity of the test is reliable, a substantial number of those subjected to screening for TB by such test are cigarette smokers. This study is designed to investigate the effect of smoking on cell-mediated delayed-type cellular hypersensitivity (DTH) reaction by PPD. Prospective, case-control study was conducted at the Chest and TB unit of Chest Hospital Kuwait. The study population consisted of 357 healthy volunteers serving as controls and 200 in-patients under direct medical supervision and treatment for tuberculosis as cases. The mean age was 33.69 +/- 8.6 SD; 286 were current smokers and 271 were lifetime non-smokers. PPD test was done using 2TU RT23 SSI-Denmark on all subjects. Median PPD was significant among the cases (P=0.03) between smokers and non-smokers and was highly significant among the healthy controls (P<0.001). No significant difference was seen between median pack years of smoking and PPD levels among the patient group (P=0.264) but the difference was significant among the control group (P<0.001). Univariate analysis of variance (ANOVA) on PPD, taking into account age, pack years of smoking, ethnic groups and BCG scar showed sufficient response but was not statistically significant to all these factors. Smoking habit does not appear to influence the cutaneous delayed type hypersensitivity reaction by tuberculin skin test.

Hemophagocytic lymphohistiocytosis (HLH) presenting on the 3rd day of life.

Hemophagocytic lymphohistiocytosis (HLH) embraces the frequently indistinguishable conditions, namely familial hemophagocytic lymphohistiocytosis (FHLH), sporadic hemophagocytic lymphohistiocytosis (SHLH) and virus associated hemophagocytic syndrome (VAHS). The disease is very rare and invariably lethal. Evidence suggests that the disease may be due to an inherited defect in immunoregulation that predisposes to an uncontrolled proliferation of activated histiocytes in response to a stimulus such as viral infection. We report here a 3-day-old neonate with confirmed HLH who had a stormy course and a fatal outcome to the disease process, in spite of early chemotherapy. To our knowledge, we believe this is the youngest reported case of HLH from Middle East. No familial or infective cause could be attributed.

Hospital admissions and death rates from asthma in Kuwait during pre- and post-Gulf War periods.

BACKGROUND: The aim of the present study is to compare hospital admissions and death rates from asthma between pre (1987 to 1989)- and post (1992 to 1994)-Gulf War periods. METHODS: Data on annual hospital admissions by nationality and age, per International Statistical Classification of Diseases 493, were collected from the Health Statistics Department, Ministry of Health, Kuwait, and were analyzed with population data from the Annual Statistical Reports, Ministry of Planning, Kuwait. RESULTS: A total of 12,113 patients with asthma were admitted to various hospitals in Kuwait during the pre-Gulf War period compared with 9,771 patients during the post-Gulf War period. The average annual admissions rates per 100,000, people were 205 and 217, respectively, for the pre- and postwar periods. Total number of admissions showed an increase among Kuwaiti nationals during the study period. There were 95 deaths during the prewar period compared with 72 deaths during the postwar period. The mean annual death rates per 100,000 people were 1.60 and 1.59 respectively, for the pre- and post-Gulf War periods. CONCLUSIONS: This study did not show any statistically significant differences in either hospital admissions for or death rates attributable to asthma in the pre- and post-Gulf War periods in Kuwait. However, the number of hospital admissions in young adult Kuwaiti nationals increased. This study suggests hospital admissions and deaths from asthma did not increase after the invasion of Kuwait.