Adenomatous colorectal polyps in patients referred for colonoscopy in regional hospital in Kuwait

Adenomatous colorectal polyps [ACPs] are known to be the precursor lesions for colorectal cancer. The aim of the study was to determine the prevalence, endoscopic and pathological features of ACPs in patients referred for colonoscopy. The endoscopic and histological reports of adult patients who underwent complete colonoscopy in the gastroenterology unit of a regional Kuwaiti hospital between January 2008 and December 2008 were retrospectively studied. The specimens of polyps were reviewed by an experienced pathologist who was blinded to the clinical or endoscopic information. Non-neoplastic polyps were not included in the analysis. Of 530 eligible patients [mean age, 45 years; male-female ratio, 2:1], 54 [10%] had 103 ACPs. Of the patients with ACPs [mean age, 57 years], 43 [80%] were males and 36 [67%] were Kuwaitis. Histopathological examination of the most significant polyp in each patient revealed that 40 [74%] polyps were tubular adenomas [TAs]; 11 [20%], tubulovillous [TV] adenomas; and 3 [6%], villous adenomas. High-grade dysplasia was noticed in 4 [10%] adenomas. Fifteen [2.8%] of the 530 patients had advanced ACPs. Logistic regression analysis of some variables and their association with ACPs found that age [P<0.001; OR, 1.9; CI, 1.5-2.3], history of adenoma [P=0.001; OR, 6.4; CI, .2.1-19.4] and being Kuwaitis [P=0.029; OR, 2.1; CI, 1.1-4.1] to be independently associated with ACPs. The most common histological type of ACPs was tubular adenoma. Advancing age, being Kuwaiti nationals and prior removal of ACPs were significantly associated with the occurrence of ACPs

Endoscopic nodular gastritis in dyspeptic adults: prevalence and association with helicobacter pylori infection

To determine the prevalence and histological features of endoscopic nodular gastritis [NG] in adult dyspeptic patients and its relation to Helicobacter pylori infection. A retrospective endoscopic report review of 2,142 patients identified 67 patients with NG during the period from 1 September 2006 to 31 August 2007. A subset of 32 NG patients [group 1] who had had gastric biopsies during upper gastrointestinal endoscopy and had been evaluated for H. pylori infection were compared to 32 age- and gender-matched dyspeptic patients. They had undergone endoscopy during the same period, which yielded normal results, and had available biopsies that were similarly evaluated for H. pylori infection [controls, group 2]. Pertinent clinical data were obtained from the patients' records. An experienced pathologist assessed the biopsies for the presence and grade of inflammation, activity, glandular atrophy, intestinal metaplasia, presence and density of H. pylori and presence of lymphoid follicles or aggregates. NG was identified in 67 [3.1%] patients. On histological examination, group 1 had a significantly higher grade of gastritis [p<0.001]. The presence and density of H. pylori infection was significantly higher in group 1 [p <0.001]. The H. pylori density correlated significantly with the severity of gastritis [r = 0.57, p <0.001]. The endoscopic performance of NG on H. pylori infection had high specificity [96.8%] and positive predictive value [93.3%]. This study outlined the clinicopathological features of NG identified among a cohort of dyspeptic patients in Kuwait and confirmed the close association with H. pylori infection. However, our study has a limitation in that histopathologic assessment of all NG patients was not feasible

Bloodstream infection due to bacillus cereus in a preterm neonate associated with necrotizing enterocolitis: a case report

A case of nosocomial bloodstream infection caused by Bacillus cereus [B.cereus] in a 33-day old preterm neonate in a teaching hospital in Kuwait who developed necrotizing enterocolitis [NEC] is described. The possible role of B. cereus in NEC is discussed

Streptococcus pneumoniae as a cause of early onset neonatal sepsis: first report from Kuwait

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis. We present a case of S. pneumoniae bacteremia that developed on the second day of life in a neonate born at 38 weeks of gestation to a mother who had prolonged rupture of the membranes [19 hours]. The isolate was penicillin sensitive. The child responded to a 14 day course of antibiotics. S. pneumoniae was isolated from the vagina of the mother by a swab culture collected prior to delivery, and isolates from the mother and the baby had the same sensitivity patterns. This case expands the spectrum of organisms responsible for early onset neonatal sepsis in Kuwait. To our knowledge, such an incident was not previously reported from Kuwait

Nosocomial infections in a medical - surgical intensive care unit

We aimed to describe the pattern of nosocomial infections in an adult medical-surgical intensive care unit [ICU]. A 2-year prospective cohort study of nosocomial infection surveillance in a 15-bed adult combined medical and surgical ICU of Farwaniya Hospital, Kuwait, was carried out. Data were collected between January 2004 and December 2005 using the standard surveillance protocols and nosocomial infection site definitions of the National Nosocomial Infections Surveillance System's ICU surveillance component. Of 1,173 patients hospitalized in the ICU for an aggregate duration of 6,855 days, 89 patients acquired a total of 140 nosocomial infections; 46 [33%] ventilator-associated pneumonia [VAP], 33 [24%] central-line-associated bloodstream infection and 15 [11%] catheter-associated urinary tract infection, 22 [16%] cutaneous infection and 24 [17%] other infections. The overall patient day rate was 20.6/1,000 patient days. The patient infection rate was 10.6/100 patients at risk. The mean VAP rate was 9.1/1,000 ventilator days [95% CI, 5-13.2], the central-line-associated bloodstream infection rate 5.5/1,000 central line days [95% CI, 3.2-7.8] and the catheter-associated urinary tract infection rate 2.3/1,000 catheter days [95% CI, 1.2-3.4]. Of all nosocomial infections, 119 [85%] were culture-confirmed and 21 [15%] were clinically defined culture-negative infections. Of the culture-confirmed nosocomial infections, 81 [68%] were Gram-negative, 32 [27%] Gram-positive and 6 [5%] fungal. The most frequent organism was Pseudomonas aeruginosa [20, 17%], followed by Acinetobacter baumannii [15, 13%], Klebsiella spp. [13, 11%] and Escherichia coli [10, 8%]. The crude mortality was 27% among ICU-infected patients. VAP was the most common nosocomial infection in our ICU. Gram-negative organisms were more commonly reported as etiologic agents of ICU infections

Pantoea agglomerans bloodstream infection in preterm neonates

To report an uncommon incidence of sporadic bloodstream infection [BSI] caused by Pantoea agglomerans in preterm neonates. Case Presentation and Intervention: Fives cases of nosocomial BSI with P. agglomerans in preterm neonates [weight 1,500 g; age 8-17 days; gestational age 26-30 weeks] are presented. All cases were late onset neonatal sepsis [> 7 days of age]. Lethargy, skin mottling and bradycardia were often present. Although there was no evidence of pneumonia, desaturation was a common feature. Thrombocytopenia developed in 4 patients, metabolic acidosis in 2 and jaundice in 2. No bleeding tendency or disseminating intravascular coagulation was recorded. Organisms cultured from blood were identified by the Vitek-2 system [bioMerieux, France] and the findings confirmed by testing the isolate on the API 20E system. All isolates shared in vitro susceptibility to gentamicin, amikacin, ciprofloxacin, piperacillin/tazobactam and meropenem. One patient was treated with a cefotaxime/amikacin combination, 2 with meropenem and the remaining 2 with tazocin. All patients responded well to antibiotic treatment and survived. P. agglomerans is an unusual pathogen in the etiology of neonatal sepsis. Despite significant clinical deterioration, early detection and proper antibiotic therapy carry a favorable outcome

Soluble intercellular adhesion molecule -1 in sera of patients with chronic hepatitis C

Soluble intercellular adhesion molecule-1 [sICAM-1] is a marker of inflammation and tissue damage. To determine the serum level of sIC AM-1 in patients with chronic HCV and to correlate the results with the histopathological changes. The study included thirty subjects divided into two groups: group I [GI] comprising 20 patients [mean age 39.7 +/- 8.5 years] with chronic hepatitis C virus infection and group II [Gil] of 10 healthy age and sex-matched control subjects [mean age 37.8 +/- 10.52 years]. Serum concentrations of sICAM were measured by enzyme linked immunosorbent assay [ELISA] kit as per manufacturer's instructions [R and D Systems, Europe, Abingdon, UK]. Diagnosis of HCV was done by detection of HCV-antibodies by 3[rd] generation ELISA, detection of HCV-RNA using a quantitative automated nested reverse transcriptase PCR assay [COBAS AMPLICOR HCV MONITOR Test, v 2.0., Roche Molecular Systems, Switzerland] and histopathological examination of Liver biopsy. Histological grading and staging were assessed with reference to modified histological activity index [HA1] scoring system. The level of sICAM in GI [mean 1046.5 +/- 1059.5 ng/ml] was significantly higher than Gil [mean 233.8 +/- 115.65 ng/ml] [t = 2.4; P = 0.02]. The levels of sICAM correlated positively in GI with serum bilirubin [r=0.65, P=0.003], ALT [r=0.63, P=O.OI], AST [r=0.64, P=0.02], grade and stage of hepatitis [r=0.75, 0.68; P=O.OOI, 0.005 respectively]. There was a significant negative correlation between sICAM and both serum albumin [r=-0.71; P=0.001] and prothrombin activity [r=-63; P=0.01]. However, sICAM was not correlated with the levels of HCV-RNA [r=0.38; P=0.1]. The level of HCV-RNA was not correlated to any of the liver function tests as well as grade and stage of hepatitis. The severity of liver disease was independent of serum level of HCV-RNA; the measurement of sICAM-1 serum levels in chronic hepatitis C patients can be considered as a useful non-invasive marker for monitoring liver disease activity

Extended-spectrum B-lactamase producing escherichia coli and klebsiella pneumoniae in septicemic neonates

Extended spectrum beta-lactamase [ESBL] producing E. coli and K. pneumoniae [EK] are on the rise globally. To highlight the prevalence, predictors for infection and outcome of ESBL-EK septicemia in neonates. In a prospective study, all septic neonates in a neonatal intensive care unit and special care baby unit [NICU/SCBU] from whom blood culture was positive for EK between January 1, 2006, and June 30, 2007, were included. Cases were identified as inpatients with ESBL-EK while the control patients were those with non-ESBL-EK during the same period. Antibiotic susceptibility was performed on Vitek-2 using the AST-N020 card. Vitek-2 system was used for screening ESBL. Potential ESBL-EK underwent a confirmatory test using either the E-test ESBL screen [AB Biodise, Solna, Sweden] or the double-disk diffusion test. During the study period, of 167 septic episode, 38 [23%] were EK; 16 of them [42%] were ESBL-EK. Of the 16 cases, 13 [81%] were caused by E. coli and 3 [19%] were caused by K. pneumoniae. The most significant predictor of ESBL in EK was co-resistance to gentamicin [OR: 63, CI: 6.3-630.4] and pipracillin /tazobactam [OR: 13.9, 31:2.9-65.9] and the organism being E. coli [OR: 19.5, CI:3.71-102.4]. Other independent predictors were prior exposure to cefotaxime or amikacin [OR: 9.9, CI: 2.7-45], exposure to >/= 2 courses of antibiotics [OR: 10, CI: 1.7-57.7], WBCs count >/= 25x10[9]/L [OR: 12.6, CI: 1.3-119] and associated NEC [OR: 21, CI: 2.3-195.5]. The crude mortality was 31%.In septic neonates, ESBLs were significantly found in E. coli and showed gentamicin and pipracillin / tazobactam co-resistance. Prior exposure to cefotaxime or amikacin, >/= 2 courses of antibiotics before infection, neutophilia >/= 25x10[9]/L and associated NEC were independent predictors of ESBL-EK sepsis. No significant difference in mortality between ESBL-EK and non- ESBL-EK infected patients

Ochrobactrum anthropi bacteremia in a child with inborn error of mitochondrial fatty acid oxidation

To report an incident of bacteremia caused by Ochrobactrum anthropi. The case of a female child aged 2 years and 10 months with a known history of long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency who developed O. anthropi bacteremia during hospital stay is presented. Patient's history, clinical findings, laboratory and radiological investigations were thoroughly reviewed. The cultured organism was identified using Micro Scan Walk Away 96 SI [Dade Behring] as well as by conventional techniques. Imipenem resistance was confirmed by the conventional Kirby-Bauer disk diffusion technique on Muller-Hinton agar with no zone of inhibition around a 10-microg imipenem disk [Hi Media] using the 0.5 McFarland standard. This report shows O. anthropi as a rare nosocomial pathogen that affected a patient who was immunocompromised. The O. anthropi showed multidrug resistance

Occupationally related outbreak of chickenpox in an intensive care unit

To report occupationally related outbreak of chickenpox in intensive care unit [ICU]. Case Presentation and Intervention: The index patient was a 4-year-old child who presented with a 3-day history of fever and rash and was clinically diagnosed as chickenpox encephalitis. She was admitted to an isolation room in ICU, kept on oxygen mask and given intravenous fluids, anticonvulsant, antipyretic and acyclovir. Twelve hours later, the patient was transferred to Infectious Diseases Hospital. Secondary cases were three unvaccinated ICU staff nurses who developed chickenpox 16-21 days following exposure. They were also transferred to Infectious Diseases Hospital. The affected nurses were interviewed and filled out a questionnaire. Individual immune status was verified by reviewing previous varicella zoster-IgG screening data for all ICU staff. The chickenpox case was defined according to the CDC case classification. All were treated with no complications. This report shows that adherence to isolation precautions, exclusion of susceptible staff from attending the affected patient, education, pre-employment anti-VZV-IgG screening and vaccine coverage of staff could have prevented the occurrence of this outbreak

Listeria monocytogenes bloodstream infection in the main ICU of a general hospital in Kuwait- a case report

Invasive listeriosis is rarely reported in adult hospitalized patients in Kuwait. A case of Listeria monocytogenes bloodstream infection in an adult in the main ICU of A Kuwaiti general hospital is presented. A possible explanation for its occurrence is discussed