Prevalence of thyroid autoantibodies in children, adolescents and young adults with type 1 diabetes in Kuwait.

OBJECTIVE: To investigate the prevalence of thyroid autoimmunity among children and adolescents with type 1 diabetes in Kuwait. SUBJECTS AND METHODS: In a mixed cross-sectional and longitudinal study, anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) were measured in 232 subjects (118 males and 114 females) with type 1 diabetes. RESULTS: The mean age of the total study population was 10.9 ± 3.6 years (range 1-21), and the median diabetes duration was 3.9 years (range 0-16). At the initial screening, 57 out of 232 (24.6%) patients had positive antibodies, and of the remaining 175 patients, who were antibody negative,131 (74.3%) were followed up for 4-9 years. 23 out of these 131 (17.7%) patients became antibody positive, with a cumulative prevalence of elevated antibodies of 34.5%. Anti-TPO was present in 34 (14.7%), anti-TG in 23 (9.9%) and both antibodies in 23 (9.9%) patients. Thyroid antibodies presented early within the first 5 years of the onset of diabetes (63.2 vs. 36.8%, p < 0.05). The prevalence of elevated thyroid antibodies increased after the onset of puberty in both females and males (p < 0.0001). A total of 58.7% of the patients with positive antibodies were females compared to 41% males (p < 0.0001). The basal thyroid-stimulating hormone was higher in subjects with positive antibodies (5.1 ± 10.7 mIU/l) compared to those who were antibody negative (1.79 ± 0.87 mIU/l, p < 0.001). Furthermore, 30 out of 232 (12.9%) patients developed thyroid dysfunction. CONCLUSION: In this study, a high prevalence of thyroid autoimmune antibodies was found in patients either at the onset of type 1 diabetes or within the 4-9 years of follow-up.

The Kuwait-Scotland eHealth Innovation Network (KSeHIN): a sustainable approach to quality improvement in healthcare.

BACKGROUND: The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date. METHODS: The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system. RESULTS: The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date. CONCLUSION: KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of Kuwaitis with diabetes in Kuwait.

Controlling hybrid nonlinearities in transparent conducting oxides via two-colour excitation.

Nanophotonics and metamaterials have revolutionized the way we think about optical space (ɛ,µ), enabling us to engineer the refractive index almost at will, to confine light to the smallest of the volumes, and to manipulate optical signals with extremely small footprints and energy requirements. Significant efforts are now devoted to finding suitable materials and strategies for the dynamic control of the optical properties. Transparent conductive oxides exhibit large ultrafast nonlinearities under both interband and intraband excitations. Here we show that combining these two effects in aluminium-doped zinc oxide via a two-colour laser field discloses new material functionalities. Owing to the independence of the two nonlinearities, the ultrafast temporal dynamics of the material permittivity can be designed by acting on the amplitude and delay of the two fields. We demonstrate the potential applications of this novel degree of freedom by dynamically addressing the modulation bandwidth and optical spectral tuning of a probe optical pulse.

Corrigendum: Controlling hybrid nonlinearities in transparent conducting oxides via two-colour excitation.

This corrects the article DOI: 10.1038/ncomms15829.

Prevalence of childhood obesity in the state of Kuwait.

BACKGROUND: Overweight and obesity have reached an epidemic in Kuwait, with the highest rate of adult obesity in the region. National estimates of childhood obesity in Kuwait are scarce. The purpose of this study is to evaluate the prevalence of overweight and obesity among school children in Kuwait. METHODS: This is a cross-sectional study of a representative sample of 6-18 years old school children, randomly selected from 244 schools in Kuwait. Anthropometric data was measured from 6574 students in September 2012-June 2013. Overweight and obesity have been defined in accordance with the Centres for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF) and World Health Organization (WHO) 2007 criteria. RESULTS: The prevalence estimate overweight was based on the three different systems (CDC = 17.7%, IOTF = 23.3%, WHO = 21.6%). The prevalence of obesity was (CDC = 33.9%, IOTF = 28.2%, WHO = 30.5%). Boys had a higher percentage of obesity regardless of the classification system used. CONCLUSIONS: The prevalence of childhood obesity is alarmingly high in the State of Kuwait and exceeds the prevalence rates reported from neighbouring countries and from North America.

In vitro conservation of embryogenic cultures of date palm using osmotic mediated growth agents.

This study was carried out to investigate the effect of mannitol, sorbitol and sucrose as osmotic agents on in vitro conservation of embryogenic cultures of date palm (Phoenix dactylifera, L.) Bartamoda and Sakkoty cultivars. Embryogenic cultures was obtained using MS medium supplemented with 10 mg/l 2,4-dichlorophenoxy acetic acid (2,4-D) and 3 mg/l isopentenyl adenine (2iP). Among the three types of osmotic substances used for slow growth conservation, sucrose at all concentrations gave the highest percentage of survival with Sakkoty cultivar. However, addition of 40 g/l or 60 g/l mannitol and 20 g/l sorbitol showed the highest percentage of survival percentage with Bartamoda cultivar. The different sucrose concentrations caused higher numbers of germinated embryos of the two cultivars compared with mannitol or sorbitol. Also, the number of germinated embryos was increased with increasing the storage periods till the ninth month. Genetic stability was determined using random amplified polymorphic DNA (RAPD) analysis. There were no clear genetic differences between the two osmotic agents used for preservation. The preserved cultures of Sakkoty cultivar gave the high percent of similarity while Bartamoda cultivar gave low percent of similarity. From the obtained results we can recommend using 40 g/l mannitol or 20 g/l sorbitol for in vitro preservation of Bartamoda cultivar of date palm and 20 g/l of sucrose for Sakkoty cultivar.

High incidence of childhood-onset IDDM in Kuwait. Kuwait Study Group of Diabetes in Childhood.

OBJECTIVE: To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children aged 0-14 years in Kuwait, as part of the World Health Organization Multinational Collaborative Study (DIAMOND), and to determine if the incidence rates have increased. RESEARCH DESIGN AND METHODS: All cases of IDDM diagnosed before the child's 15th birthday between 1 January 1992 and 31 December 1993 were recorded. Prospective notification of all children with newly diagnosed diabetes who were admitted to hospitals and periodic review of hospital medical records provided the primary source; notification by physicians working in diabetic clinics, in which registry of all new cases is mandatory, provided the secondary source of ascertainment. RESULTS: The degree of ascertainment was 92.2%. The annual incidence of IDDM for children aged 0-14 years over the 2-year period was 15.4/100,000 (95% confidence interval, 12.4-19), with a male:female ratio of 1.2:1. The age-specific annual incidence rates for the age-groups 0-4, 5-9, and 10-14 years were 12.8, 15.1, and 18.3/100,000, respectively, with a male:female ratio of 1.45:1 in the 0- to 4-year-old age-group and an equal sex ratio in the 5- to 9- and 10- to 14-year-old age-groups. No significant difference was detected between incidence rates of IDDM in boys and girls in the three age-groups. There was no significant linear trend toward an increase in IDDM incidence rates as age advanced. Compared with a previous study by Taha et al. (Taha T, Moussa M, Rashed A, Fenech F: Diabetes mellitus in Kuwait: incidence in the first 29 years of life. Diabetologia 25:306-308, 1983), there was a nearly fourfold increase of IDDM in the age-group 0-14 years, mainly in those children < 5 years old, suggesting a rapid increase in a short period of time. CONCLUSIONS: Kuwait has the highest incidence of IDDM in children in the region, and an apparently increasing incidence has been demonstrated over the last decade.

HLA associations in an Arab type 1 diabetic population.

We have studied HLA-A, -B, -C, -DR, and -DQ antigen frequencies in 63 Type 1 diabetic Arab patients resident in Kuwait. Both HLA-DR3 (relative risk (RR) = 5.80) and -DR4 (RR = 2.87) showed positive associations with Type I diabetes mellitus in these patients whilst -DR2 (RR 0.16) and -DR5 (RR = 0.15) were negatively associated. The strong positive association with both HLA-DR3 and -DR4 was confirmed in Non-Gulf Arabs (RR = 12.55 and 4.29, respectively) whereas the Gulf Arabs had a significant positive association with HLA-DR3 (RR = 4.41) only. The disease was negatively associated with HLA-DR2 (RR = 0.05) in Gulf Arab patients only and with HLA-DR5 (RR = 0.10) in Non-Gulf Arabs only. HLA-DRw52 and -DRw53 were increased in Non-Gulf Arabs only (RR = 3.14 and 4.63, respectively). In both groups there was strong association with HLA-DQ3 (Gulf, RR = 28.11; Non-Gulf, RR = 6.25). Amongst HLA-A, -B, and -C loci, there was a positive association with HLA-B8 (RR = 19.06).

Association of fasting insulin with serum lipids and blood pressure in Kuwaiti children.

To examine the association of hyperinsulinemia with the atherogenic risk profile in children, we studied the relationships of the fasting plasma insulin level with indices of obesity (body mass index [BMI] and sum of triceps and subscapular skinfold thickness [SFT]), body fat distribution (waist to hip ratio [WHR]), serum lipid, lipoprotein, and apolipoprotein levels, and blood pressure in a case-control study of 460 Kuwaiti prepubertal obese children aged 6 to 13 years matched by age and sex to 460 prepubertal non-obese controls. Obese children were ascertained in a representative cross-sectional study of 2,400 school children. Fasting insulin levels were positively correlated (P < .001) with serum triglyceride (TG) and very-low-density lipoprotein (VLDL) cholesterol levels and negatively correlated with high-density lipoprotein (HDL) cholesterol levels. No significant associations were observed between insulin and total cholesterol (TC), cholesterol, low-density lipoprotein (LDL) or apolipoprotein A-I (apo A-I). Stronger associations of insulin levels with lipoprotein fractions were observed in obese versus non-obese controls. Obese children had a higher concentration of apo B and a lower apo A-I:B ratio (P < .001). Insulin and the insulin to glucose ratio increased with age in obese children, whereas there were slight changes in non-obese children. TG and HDL cholesterol levels and systolic blood pressure (SBP) were significantly different across insulin quartiles in boys and girls. We conclude that the fasting plasma insulin level may be used as a marker for the development of obesity-associated metabolic disorders and elevated blood pressure in children.

Attitudes of a sector of the Arab-Muslim population in Kuwait towards alcohol and drug misuse: an objective appraisal.

The attitude of a sample of 1001 Arab Muslims living in Kuwait towards alcohol and drug misuse was examined by using a 30-item questionnaire. Eighty percent condemned drug misuse, 93.6% thought it was a contravention of Muslim religious teachings, yet 90% held an enlightened attitude compared to only 26% that chose the punitive attitude. The older generation, the less educated, females and Non-Kuwaiti Arabs were less likely to be sympathetic towards substance misusers. These findings while indicating the sample's strong religious condemnation of substance misuse demonstrated the adoption of Western concepts of care especially by the younger educated Kuwaiti males. Indirect evidence of drug misuse and smoking in the sample may be inferred from the low rates of denunciation of such behaviours.

Treatment of alcoholism in Kuwait: a prospective follow-up study.

The outcome of routine drug-supportive psychotherapy treatment of 100 patients with alcohol-related problem in Kuwait's only psychiatric hospital was evaluated in four 6 month's intervals. Patients were assessed on 9 post-treatment questions reflecting improvement or deterioration. Correlation of follow-up changes to pre-treatment data shows that non-Kuwaitis do better than Kuwaitis in resuming employment and social reintegration. Patients on chronic benzodiazepine prescription were less likely to become abstinent, had poor social re-integration and more re-admissions. Good relationships with the family were clearly associated with a better treatment outcome. Scores of weighted follow-up findings were calculated to assess patients' status at each follow-up. Progress during the whole follow-up period was measured by the direction of slope calculated from linear regression model for individual scores. The relationship between pre-treatment conditions and patterns of follow-up was evaluated cross-sectionally (answers distribution) and longitudinally (direction of slope). A pattern of shift emerged where different patient groups crossed over to the opposite end of the score scale. Kuwait society's indulgent attitudes towards Kuwaiti patients with alcohol-related problems in employment have to be changed and utilization of the role of the Arab extended family in therapy is stressed.

Prospective study of alcoholism treatment in Kuwait: a 5-year follow-up report.

The outcome of a 5-year prospective follow-up study of 100 patients treated in the Kuwait Hospital for alcohol-related problems is reported using two parameters computed from weighted follow-up variables, i.e., Offset Score measuring patients' initial follow-up status and Direction of Slope summarizing consequent follow-up scores. Nineteen patients had died representing 14 times the age-corrected national rate. Univariate and multivariate analyses of outcome measures against prefollow-up patients' characteristics revealed that variables indicating heavy alcohol use independent of each other predicted negative outcome and mortality. The tendency of the group score distribution towards normalization uninfluenced by treatment is demonstrated. The pertinence of these findings to the medical profession in Kuwait is stressed.

Incidence and severity of ketoacidosis in childhood-onset diabetes in Kuwait. Kuwait Diabetes Study Group.

In 1992, the diabetes registry was started in Kuwait, as part of DiaMond, a WHO multinational collaborative project on the incidence of childhood-onset diabetes. Children (243) aged below 15 years, were identified between 1 January 1992 and 31 December 1995. Children (203) were Kuwaiti and 40 were non-Kuwaiti children but resident of Kuwait. For the years 1992, 1993, the annual incidence of childhood onset diabetes for Kuwaiti children was 15.4 per 100,000 (95% confidence interval 12.9-19), and the degree of ascertainment was 92%. Polyuria, polydypsia, weight loss and nocturia were the most frequently reported symptoms; four children were in coma and one in shock at presentation. Nearly half of the children (49%) presented ketoacidosis (venous pH < 7.3 and/or plasma bicarbonate level < 18 mmol/l). and in 53 children (23.5%) it was severe (venous pH < 7.1 and/or plasma bicarbonate level < 10 mmol/l). In 62 children (25.5%) it was mild to moderate (venous pH 7.1-7.3 and/or plasma bicarbonate level 10.1-18 mmol/l). The incidence of severe ketoacidosis was similar in all age groups and sexes. All children recovered completely without major complications and no deaths were recorded. We conclude that diabetic ketoacidosis is a common presentation at the onset of diabetes in childhood in Kuwait and attests to the lack of awareness of general practitioners and parents to the symptoms and signs of diabetes in childhood.

Acute gastroenteritis: clinical features according to etiologic agents.

The clinical manifestations in 595 children hospitalized with gastroenteritis during a 15-month time frame were studied. They were divided into eight groups according to etiologic agent: rotavirus (203 patients); Salmonellae (98); Escherichia coli (55); Campylobacter (36); Shigella (22); combined rotavirus and salmonellae (44); combined rotavirus and other bacteria (26); and no pathogen (111). The mean duration of diarrhea was shortest in the rotavirus and "no pathogen" groups (4.8 and 5.6 days, respectively) and longest with pure and mixed salmonella infections (12.3 and 12.9 days, respectively). Associated manifestations were most frequent with salmonellae and least frequent with rotavirus and E. coli infections. Malnutrition also was most common with salmonellae and lowest with rotavirus and E. coli. There were no differences in the frequency of hypernatremia. Hyponatremia was most frequently encountered with salmonella (25% compared to 9% in the rest of the patients). Evidence of septicemia was found in 22 patients, 21 of whom were in the salmonella groups. The four deaths in this series (0.7%) also were in the salmonellae groups. The clinical severity of salmonella infection in developing countries, particularly in young and malnourished children, warrants attention to more intensive management. The selective use of antibiotics may help reduce the mortality and morbidity of gastroenteritis.

Towards improving care for children with diabetes in Kuwait.

Presents the results of a medical audit of the records of 199 children diagnosed as diabetic and admitted to Al-Amiri Hospital, Kuwait. Uses the measurement of glycosylated haemoglobin (HbA1) to indicate the levels of control achieved. Finds that the degree of glycaemic control compares favourably with studies done in other hospitals, but unfavourably with specialized diabetic clinics. Proposes that glycaemic control could be improved by provision of the services of specialized support staff such as dietitian, educator, psychologist and health visitor.

Acute rheumatic fever in Kuwait: The declining incidence.

The incidence of acute rheumatic fever in children aged 5-14 years in Kuwait was studied prospectively over a period of five years (1984 through 1988). The mean annual incidence in the study period was 2.9/100,000 children. There was a decline in the incidence from 3.7/100,000 in 1984 to 2.5/100,000 in 1988. Twenty-seven percent of children with acute rheumatic fever presented as recurrences in 1985; this also declined to 11% in 1988.

Insulin resistance and acanthosis nigricans, type A: case report.

A 9-year-old Somali girl was referred to the Paediatric Diabetic Clinic, Al-Amiri Hospital for control of her diabetes. On physical examination, she was found to have several somatic abnormalities and acanthosis nigricans. Biochemical and hormonal investigations revealed no major abnormalities apart from that of glucose metabolism. Insulin resistance was detected early on initiating treatment and, even with high doses, it was impossible to achieve normoglycaemia. This case is similar to other cases described in the literature with insulin resistance and acanthosis nigricans type A.

Implication of Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) and Interleukin-3 (IL-3) in Children with Acute Myeloid Leukaemia (AML).

Granulocyte-macrophage colony stimulating factor (GM-CSF) and Interleukin-3 (IL-3) are increasingly used to stimulate granulopoiesis in neutropenic patients but these are rarely used in the lights of knowledge of the endogenous CSF-levels. In this study we measured serum levels of GM-CSF and IL-3 at diagnosis and after remission in children with acute leukaemia, using an enzyme linked immuno-sorbent assay (ELISA) techniques in 14 patients with acute myeloid leukaemia (AML) and 27 patients with acute lymphoblastic leukaemia (ALL). Twelve healthy age-matched children were used as a reference group. AML patients showed a highly significant increase in serum levels of GM-CSF and IL-3 before induction of therapy (p < 0.0001) compared to the reference control group, with a highly significant decline of both GM-CSF and IL-3 (p < 0.0001) after successful remission. On the other hand, ALL patients showed no significant elevation of GM-CSF and IL-3 at diagnosis (p > 0.5), with no significant difference between preinduction and postinduction serum levels of either (p > 0.5). Since these cytokines are known to be fundamental for the growth of AML cells, we postulate that the pretreatment levels of both GM-CSF and IL-3 could play a role in the pathogenesis of AML.

Anti-schistosomal IgE and its relation to gastrointestinal allergy in breast-fed infants of Schistosoma mansoni infected mothers.

To study the relationship between presence of gastrointestinal allergic manifestations in breast-fed infants and presence of IgE against Schistosoma mansoni antigens, sixty breast-fed infants of S. mansoni infected mothers were selected. Of them, thirty infants were suffering from manifestations of gastrointestinal allergy (patients) and the other thirty were not suffering from such manifestations (controls). Levels of IgE against S. mansoni adult worm antigen (AWA), soluble egg antigen (SEA) and cercarial antigen (CA) were determined, by ELISA, in sera of these infants. There was significant association between presence of allergic manifestations and presence of IgE against AWA (P = 0.018), SEA (P < 0.001) and CA (P = 0.002). Also, concentration of IgE against AWA was significantly higher in patients group than the control group (P = 0.024). IgE against AWA showed significant negative correlation with haemoglobin concentration (P = 0.009) and serum albumin level (P = 021) and significant positive correlation with absolute eosinophilic count (P = 0.005). Also, IgE against CA showed significant negative correlation with haemoglobin concentration (p = 0.047) and serum albumin level (0 = 0.036). It was concluded that gastrointestinal allergy in breast-fed infants of S. mansoni infected mothers may be due to hypersensitivity of Schistosoma mansoni antigens present in mothers' milk. Schistosoma mansoni should be investigated and treated in mothers from endemic localities when their breast-fed infants are suffering from manifestations suggestive of gastrointestinal allergy.