Biomarkers in neonates receiving potential nephrotoxic drugs.

OBJECTIVE: Novel biomarkers, such as kidney injury molecule-1 (KIM-1), cystatin, and neutrophil gelatinase-associated lipocalin (NGAL) were shown to predict acute kidney injury (AKI) earlier than serum creatinine in critically ill. We carried out the present study to evaluate these biomarkers in addition to conventional in our neonates. PATIENTS AND METHODS: We recruited 70 neonates of various gestational age groups receiving one or more potential nephrotoxic drug/s. Daily urine samples were collected for estimating KIM-1, cystatin, and NGAL. Modified neonatal kidney disease improving global outcomes (mKDIGO) classification was used in defining AKI. RESULTS: A significant trend in increased urine concentrations of KIM-1, cystatin, and NGAL were observed as we proceed from term to preterm categories. Strong positive correlation was observed between urine albumin and urine albumin creatinine ratio (ACR), and strong negative correlations between urine creatinine and urine cystatin, and between urine creatinine with urine NGAL. A moderate positive correlation was observed between urine KIM-1 and urine cystatin, between urine KIM-1 and urine NGAL, and between urine cystatin and urine NGAL; and a moderate negative correlation was observed between urine creatinine and urine KIM-1. Seven neonates met the mKDIGO criteria for AKI and ROC plot revealed that baseline KIM-1 and NGAL can significantly predict possible drug-induced AKI in neonates. CONCLUSIONS: Urine KIM-1, cystatin, and NGAL are significantly correlated with several other conventional biomarkers that reflect renal function in critically ill neonates. Baseline urine KIM-1 and NGAL concentrations can predict the AKI following potential nephrotoxic drug use in this population.

Intravenous frusemide does not interact pharmacodynamically with acetaminophen in critically ill preterm neonates with patent ductus arteriosus.

OBJECTIVE: Evidence is controversial regarding the effect of concomitant frusemide with acetaminophen therapy in neonates with patent ductus arteriosus (PDA). PATIENTS AND METHODS: Critically ill neonates diagnosed with hemodynamically significant PDA by echocardiography and receiving intravenous acetaminophen were recruited. Dosing regimens of frusemide, and acetaminophen, and the sizes of ductus arteriosus following treatment, were evaluated. RESULTS: Fifty-one neonates were recruited. Forty-six (90.2%) had moderate-sized, and five (9.8%) had large-sized ductus arteriosus. Forty (78.4%) neonates had a successful closure. Twenty-four received concomitant frusemide with a median (range) cumulative dose of 3 (0.8-13) mg; duration of 2 (1-13) days; and a fraction of overlapping days with acetaminophen therapy of 0.4 (0.2-1). Twenty-one (87.5%) neonates that received frusemide had a successful ductal closure compared to 70.4% of those without (p >0.05). CONCLUSIONS: We did not observe any significant influence in the outcomes of acetaminophen therapy with concomitant frusemide in preterm neonates with PDA.

Concentration, composition and sources of PAHs in the coastal sediments of the exclusive economic zone (EEZ) of Qatar, Arabian Gulf.

Surface sediments were collected from sixteen locations in order to assess levels and sources of polycyclic aromatic hydrocarbons (PAHs) in sediments of Qatar exclusive economic zone (EEZ). Samples were analyzed for 16 parent PAHs, 18 alkyl homologs and for dibenzothiophenes. Total PAHs concentration (∑PAHs) ranged from 2.6 ng g(-1) to 1025 ng g(-1). The highest PAHs concentrations were in sediments in and adjacent to harbors. Alkylated PAHs predominated most of the sampling locations reaching up to 80% in offshore locations. Parent PAHs and parent high molecular weight PAHs dominated location adjacent to industrial activities and urban areas. The origin of PAHs sources to the sediments was elucidated using ternary plot, indices, and molecular ratios of specific compounds such as (Ant/Phe+Ant), (Flt/Flt+Pyr). PAHs inputs to most coastal sites consisted of mixture of petroleum and combustion derived sources. However, inputs to the offshore sediments were mainly of petroleum origin.

Psychiatric disorders in two general hospitals: a survey of prevalence and treatment by nonpsychiatrist physicians.

This study reports an opinion survey of 211 nonpsychiatrist physicians in two general hospitals who estimated that 16.1% of their patients have psychiatric disorders and that they spent 13.8% of their time in treating the psychiatric components of their patients' illnesses. Physicians indicated that anxiety and psychosomatic and depressive illness were the most frequent psychiatric disorders and that one-third of them would personally treat such disorders without referral to psychiatric consultation. The findings also suggest that adequate undergraduate psychiatric education was associated with increased recognition of psychiatric disorders and more preference for their personal treatment. In addition, it provides a possible explanation for the discrepancy between the high prevalence of psychiatric disorders in general hospital patients and the low referral rate to psychiatric consultation.

Patterns of psychiatric consultations in Kuwait general hospitals.

Two hundred and nineteen consecutive referrals to psychiatric consultation services from all general hospitals in Kuwait over a 3-month period were studied and compared with a control group of 100 patients who were not referred for psychiatric consultation. The two groups differed significantly in age, sex, marital status, employment, and past psychiatric treatment. Inpatients were more often referred than outpatients with an overall low referral rate of 0.3%. The department of general medicine referred 74.4% of patients in contrast to 11.4% referred by the department of general surgery. The most common reason for referral was for assessment of a suicide attempt in the inpatient group, and the absence of organic cause for patients' physical symptoms in the outpatient group. Acute situational disturbance that resulted in a suicide attempt was the most common psychiatric diagnosis (26%), followed by depressive illness (19.5%) and organic psychotic disorders (8.2%). Our findings are similar to those reported in the literature, and the present study suggests a national underutilization of psychiatric consultation services in general hospitals.

The social complications of chronic alcohol abuse: relative influence of family history and severity of alcohol dependence.

Alcoholics with a family history of the disease are said to present more severe consequences than alcoholics without such a history. This study examined the frequency distribution of severe alcohol dependence and police arrests for public drunkenness across samples of alcoholics with (n = 77) and without (n = 37) a family history of alcoholism. Both the percentage of subjects presenting severe dependence and the history of police arrests were greater in the positive family history group, but these differences did not reach conventional levels of statistical significance. However, results of logistic regression analyses demonstrate that male sex, younger age and, above all, severity of alcohol dependence, are better correlates of the occurrence of police arrests than is the subject's family history of alcoholism. The picture presented by this sample of outpatient alcoholics appears to qualify some currently held assumptions of the influence of family history on the phenomenology of alcoholism.

Screening for alcoholism among alcohol users in a traditional Arab Muslim society.

The Short Michigan Alcoholism Screening Test (S-MAST) was applied to 140 alcohol users in the traditional Muslim society of Kuwait. One hundred were confirmed alcoholics and 40 were self-disclosed social drinkers in the community. The questionnaire significantly discriminated between the groups. Its sensitivity level was 100% and its specificity 82.5%. Although all except one of the S-MAST items elicited significant differences between the groups in question, it appears that the particular sociocultural conditions of the setting may influence the validity of some of them.

Schizophrenia in ICD-10: a field trial of suggested diagnostic guidelines.

A tenth version of the International Classification of Diseases (ICD-10) is currently being prepared by the World Health Organization, who called for field trials of suggested guidelines. A field trial of the guidelines for the diagnosis of schizophrenia is presented. There is a consistency with ICD-9-based diagnosis. Schneider's First-Rank Symptoms (FRS) acquire special importance in the suggested guidelines, but caution is necessary in detecting these symptoms in cultures in which socioculturally shared beliefs bear a resemblance to FRS.

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.