Investigating the Role of FABP4 in Diabetes and Obesity and the Influence of Age and Ethnicity: A Comprehensive Analysis of a Cohort from the KEDP-Study.

Adipocyte P2 (aP2), also known as FABP4, is an adipokine that adipose tissue produces and expresses in macrophages. Its primary role is to facilitate the transportation of fatty acids across cell membranes. Numerous studies have reported associations between FABP4 and the development of metabolic disorders. However, there is limited knowledge regarding FABP4 expression in diabetes and obesity, especially about different age groups, genders, and ethnicities. This study aims to investigate the association between FABP4 levels, diabetes mellitus, and obesity within various ethnic groups. We measured plasma FABP4 concentrations in a cohort of 2083 patients from the KDEP study and gathered anthropometric data. Additionally, we collected and analyzed clinical, biochemical, and glycemic markers using multivariate regression analysis. The average FABP4 concentration was significantly higher in female participants than in males (18.8 ng/mL vs. 14.4 ng/mL, p < 0.001, respectively), and in those over 50 years old compared to those under 50 years of age (19.3 ng/mL vs. 16.2 ng/mL, p < 0.001, respectively). In this study, significant positive associations were found between the plasma level of FABP4 and obesity markers: BMI (r = 0.496, p < 0.001), hip circumference (r = 0.463, p < 0.001), and waist circumference (WC) (r = 0.436, p < 0.001). Similar observations were also seen with glycemic markers, which included HbA1c (r = 0.126, p < 0.001), fasting blood glucose (FBG) (r = 0.184, p < 0.001), fasting insulin (r = 0.326, p < 0.001), and HOMA-IR (r = 0.333, p < 0.001). Importantly, these associations remained significant even after adjusting for age, gender, and ethnicity. Furthermore, FABP4 levels were negatively associated with male gender (ß: -3.85, 95% CI: -4.92, -2.77, p < 0.001), and positively associated with age (ß: 0.14, 95% CI: 0.096, 0.183, p < 0.001), BMI (ß: 0.74, 95% CI: 0.644, 0.836, p < 0.001), and fasting insulin (ß: 0.115, 95% CI: 0.091, 0.138, p < 0.001). In this study, plasma FABP4 levels were significantly higher in diabetic and obese participants, and they were strongly influenced by age, gender, and ethnicity. These findings suggest that FABP4 may serve as a valuable prognostic and diagnostic marker for obesity and diabetes, particularly among female patients, individuals over 50 years old, and specific ethnic groups.

Ethnic Variations in the Levels of Bone Biomarkers (Osteoprostegerin, Receptor Activator of Nuclear Factor Kappa-Β Ligand and Glycoprotein Non-Metastatic Melanoma Protein B) in People with Type 2 Diabetes.

The global incidence of Type 2 diabetes (T2D) is on the rise, fueled by factors such as obesity, sedentary lifestyles, socio-economic factors, and ethnic backgrounds. T2D is a multifaceted condition often associated with various health complications, including adverse effects on bone health. This study aims to assess key biomarkers linked to bone health and remodeling-Osteoprotegerin (OPG), Receptor Activator of Nuclear Factor Kappa-Β Ligand (RANKL), and Glycoprotein Non-Metastatic Melanoma Protein B (GPNMB)-among individuals with diabetes while exploring the impact of ethnicity on these biomarkers. A cross-sectional analysis was conducted on a cohort of 2083 individuals from diverse ethnic backgrounds residing in Kuwait. The results indicate significantly elevated levels of these markers in individuals with T2D compared to non-diabetic counterparts, with OPG at 826.47 (405.8) pg/mL, RANKL at 9.25 (17.3) pg/mL, and GPNMB at 21.44 (7) ng/mL versus 653.75 (231.7) pg/mL, 0.21 (9.94) pg/mL, and 18.65 (5) ng/mL in non-diabetic individuals, respectively. Notably, this elevation was consistent across Arab and Asian populations, except for lower levels of RANKL observed in Arabs with T2D. Furthermore, a positive and significant correlation between OPG and GPNMB was observed regardless of ethnicity or diabetes status, with the strongest correlation (r = 0.473, p < 0.001) found among Arab individuals with T2D. Similarly, a positive and significant correlation between GPNMB and RANKL was noted among Asian individuals with T2D (r = 0.401, p = 0.001). Interestingly, a significant inverse correlation was detected between OPG and RANKL in non-diabetic Arab individuals. These findings highlight dysregulation in bone remodeling markers among individuals with T2D and emphasize the importance of considering ethnic variations in T2D-related complications. The performance of further studies is warranted to understand the underlying mechanisms and develop interventions based on ethnicity for personalized treatment approaches.

Evaluating the correlation of sclerostin levels with obesity and type 2 diabetes in a multiethnic population living in Kuwait.

Obesity and Type 2 Diabetes Mellitus (T2DM) are intricate metabolic disorders with a multifactorial etiology, often leading to a spectrum of complications. Recent research has highlighted the impact of these conditions on bone health, with a particular focus on the role of sclerostin (SOST), a protein molecule integral to bone metabolism. Elevated circulating levels of SOST have been observed in patients with T2DM compared to healthy individuals. This study aims to examine the circulating levels of SOST in a multiethnic population living in Kuwait and to elucidate the relationship between SOST levels, obesity, T2DM, and ethnic background. The study is a cross-sectional analysis of a large cohort of 2083 individuals living in Kuwait. The plasma level of SOST was measured using a bone panel multiplex assay. The study found a significant increase in SOST levels in individuals with T2DM (1008.3 pg/mL, IQR-648) compared to non-diabetic individuals (710.6 pg/mL, IQR-479). There was a significant gender difference in median SOST levels, with males exhibiting higher levels than females across various covariates (diabetes, IR, age, weight, and ethnicity). Notably, SOST levels varied significantly with ethnicity: Arabs (677.4 pg/mL, IQR-481.7), South Asians (914.6 pg/mL, IQR-515), and Southeast Asians (695.2 pg/mL, IQR-436.8). Furthermore, SOST levels showed a significant positive correlation with gender, age, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, HbA1c, insulin, total cholesterol, triglycerides, HDL, LDL, ALT, and AST (p-Value ≥0.05). South Asian participants, who exhibited the highest SOST levels, demonstrated the most pronounced associations, even after adjusting for age, gender, BMI, and diabetes status (p-Value ≥0.05). The observed correlations of SOST with various clinical parameters suggest its significant role in the diabetic milieu, particularly pronounced in the South Asian population compared to other ethnic groups.

Obesity during Adolescence and Feeding Practices during Infancy: Cross-Sectional Study.

BACKGROUND: Breastfeeding is proposed to play a role in reducing the risk of obesity throughout life. Kuwait has an extremely high prevalence of childhood obesity (45% of adolescents are overweight/obese) and extremely low breastfeeding indicators, particularly exclusive breastfeeding. In fact, little is known about the association between breastfeeding and obesity from Kuwait and the broader Middle East. AIMS: To estimate the prevalence of overweight/obesity in female adolescents in Kuwait and assess its association with breastfeeding during infancy. METHODS: This is a cross-sectional study that included 775 girls randomly selected from public and private high schools in Kuwait. The primary exposure was breastfeeding in the first four months of life, and the outcome was overweight/obesity during adolescence. Multivariable logistic regression was used to assess the association between breastfeeding and overweight/obesity while adjusting for potential confounders. RESULTS: Approximately 45% of adolescent girls were either overweight/obese. We found no significant association between breastfeeding (exclusive/mixed breastfeeding and formula feeding/no breastfeeding) and overweight/obesity neither in univariable analysis (Crude Prevalence Ratio: 1.14, 95%CI [0.92-1.36] & Crude Prevalence Ratio: 1.29, 95%CI [0.86-1.68]; p = 0.293) for mixed feeding and no breastfeeding respectively, nor in multivariable analysis (Adjusted Prevalence Ratio: 1.14, 95%CI [0.85-1.42] & Adjusted Prevalence Ratio: 1.20, 95%CI [0.68-1.68]; p = 0.589) for mixed feeding and no breastfeeding respectively. CONCLUSION: Breastfeeding during infancy was not significantly associated with overweight/obesity during adolescence. However, breastfeeding should be encouraged for its indisputable benefits for infants and their mothers alike. Further prospective studies are needed to assess the association.

Vitamin D level in relation to depression symptoms during adolescence.

BACKGROUND: This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) and depression symptoms among adolescents in Kuwait, a country with a high prevalence of vitamin D deficiency. METHODS: A school based cross-sectional study was conducted on randomly selected 704 adolescents in middle schools. Data on depression symptoms were collected using the Children's Depression Inventory (CDI). Data on covariates were collected from the parents by self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were analyzed in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. RESULTS: Of 704 adolescents, 94 (13.35%; 95%CI:10.35-17.06%) had depression symptom (a score of 19 or more on the CDI). There was no significant difference in the median CDI score between different vitamin D status (p = 0.366). There was also no significant correlation between serum 25(OH)D concentration and CDI score (Spearman's rank correlation = 0.01; p = 0.825).There was no significant association between 25(OH)D and depression symptoms whether 25(OH)D was fitted as a continuous variable (crude odds ratio (OR) 0 .99 [95%CI: 0.98, 1.01], p = 0.458 and adjusted OR 1.01 [95%CI: 0.99, 1.02], p = 0.233), categorical variable as per acceptable cut-of points (crude analysis p = 0.376 and adjusted analysis p = 0.736), or categorical variable as quartiles (crude analysis p = 0.760 and adjusted analysis p = 0.549). CONCLUSION: Vitamin D status does not seem to be associated with depression symptoms among adolescents in our setting. Nevertheless, it is important to have sufficient vitamin D levels during adolescence for several other health benefits.

Spiritual Health in Iranian Patients With Cardiovascular Diseases: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate the spiritual health status of Iranian patients with cardiovascular diseases. A literature search was conducted in national (MagIran and Scientific Information Database) and international (Scopus, PubMed, and Web of Science/ISI) databases from inception to December 2021. A random-effects model was used to estimate the pooled score of spiritual health. Based on the eligibility criteria, 22 articles were selected for the final analysis. The pooled score of spiritual health in Iranian patients with cardiovascular diseases was 61% (95% confidence interval: 54%-68%). In subgroup analysis, the pooled score in patients with heart failure was higher than other patients (67% vs. 58%). Publication bias was not significant (p = 0.554). Results indicated that the spiritual health of Iranian patients with cardiovascular diseases was moderate. Therefore, it is recommended that proper training be provided to these patients to enhance their adaptation to the complications of cardiovascular diseases.

Assessing the correlation between FDG PET findings of IDC breast carcinoma and histopathology of coexisting ductal carcinoma in-situ.

BACKGROUND: Ductal carcinoma in-situ (DCIS) often coexists with invasive ductal carcinoma (IDC) of the breast. DCIS is considered as a non-obligate precursor of IDC when both coexist. 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) imaging is commonly used in the staging and follow-up assessment of breast cancer. In this study, we aimed to assess if there is any correlation between primary tumor PET and histopathology findings and histopathological features of the coexisting DCIS. MATERIAL AND METHODS: FDG PET/CT images and histopathology results of the patients with newly diagnosed breast cancer (IDC) with coexisting DCIS were analyzed in this retrospective study. The grade and size of the primary tumor and histopathological features of the coexisting DCIS (nuclear grade and architectural pattern) were obtained from the postoperative histopathology results. Maximum standardized uptake values (SUV: SUVmax and SULmax) of the primary tumor normalized by weight and lean body mass were measured. Statistical analysis was performed to assess the correlation between various parameters of IDC and DCIS. RESULTS: This study included sixty-two (62) patients with IDC-DCIS. Primary tumor grade was significantly correlated and associated with the nuclear grade of the coexisting DCIS (polychoric correlation r = 0.736, and Fisher exact test, PV < 0.001, respectively). Primary tumor SUV was not correlated with the nuclear grade and architectural pattern of the coexisting DCIS (polyserial correlation r = 0.172, PV = 0.155, and Point Bi-Serial correlation r = -0.009, PV = 0.955, respectively). Median primary tumor size was marginally significantly different among DCIS nuclear grades but it was not significantly different in comedo and non-comedo cases (Kruskal-Wallis test PV = 0.053, and Mann-Whitney U test PV = 0.890, respectively). CONCLUSIONS: Primary tumor grade is correlated with the nuclear grade of the coexisting DCIS. SUV of primary tumor does not seem to be correlated with the histopathological features of coexisting DCIS (nuclear grade and architectural pattern) but this may be further studied in a larger number of patients.

Assessing the Correlation Between 68Ga-PSMA-11 Renal PET Parameters and Renal Function Tests.

68Ga-prostate-specific membrane antigen (PSMA) ligands are used for prostate cancer but also show high renal cortical uptake. In this study, we aimed to assess whether there is any correlation between renal PSMA PET parameters and renal function tests using the images of prostate cancer patients. Methods: 68Ga-PSMA-11 PET/CT images of the patients with prostate cancer were retrospectively evaluated. The following PET parameters were obtained: SUVmax, SUVmean, SUVmax corrected for lean body weight, SUVmean corrected for lean body weight, volume, lean body weight--corrected total lesion glycolysis (TLGSUL), and counts of both kidneys, as well as SUVmean of the liver, blood pool, and spleen. Total TLGSUL, total volume, kidney-to-liver ratio, and kidney-to-blood pool ratio were calculated. Creatinine values were obtained, and glomerular filtration rate (GFR) was calculated using the "Modification of Diet in Renal Disease" formula. Statistical analysis was performed to understand whether there is a correlation between the above parameters and renal function tests. Results: Twenty-five patients were included in this study. GFR was significantly and positively correlated and creatinine was significantly and negatively correlated with the ratios of renal SUV to liver SUV and renal SUV to blood pool SUV. GFR was marginally positively correlated with renal SUVmean corrected for lean body weight, and creatinine was marginally negatively correlated with total TLGSUL Total renal parenchymal volume was significantly and directly (positively) associated with GFR and significantly and inversely (negatively) associated with creatinine. Conclusion: Renal 68Ga-PSMA uptake appears to be correlated with renal function tests. Our method of measuring approximate renal parenchymal volume on PET images appears to be reliable.

Psychometric properties of the Arabic version of the hospital anxiety and depression scale in hemodialysis patients.

The literature lacks a rigorous psychometric evaluation of the Arabic version of Hospital Anxiety and Depression Scale (HADS) in hemodialysis (HD) patients. This study aims to evaluate reliability, determine the underlying factor structure of the Arabic version of HADS and assess its suitability as screening tool for depression and anxiety among Arabic HD patients.A sample of 370 HD patients were recruited from all health districts in Kuwait. Reliability for HADS (all items) and its subscales HADS-A (anxiety) and HADS-D (depression) were estimated using Cronbach's alpha and item analysis was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to extract and test the factor structure for the Arabic version of HADS. Eight models were tested using CFA to determine goodness-of-fit.The Cronbach α for the Arabic HADS (all items), HADS-A and HADS-D were 0.884, 0.852 and 0.764, respectively. Pearson correlation coefficient between HADS-A and HADS-D subscales indicated significant correlation (r = +0.69, PV < 0.001). EFA indicated two factors with eigenvalues >1, which accounted for 48.5% of the total variance. CFA revealed the one-factor model had the poorest fit, the two-factor models with acceptable fit, and three-factor models showed good fit.The Arabic HADS has good reliability and internal consistency, which warrants its use in screening for anxiety and depression among Arabic HD patients. Furthermore, the three-factor structure has shown a better fit which warrants further exploration in HD patients with the advancement in theory of psychological models for anxiety and depression.

Stunting and Combined Overweight with Stunting among Schoolchildren in Kuwait: Trends over a 13-Year Period.

OBJECTIVES: This study aimed to investigate the sex- and age-specific trends of stunting and combined overweight with stunting among schoolchildren over a 13-year period in Kuwait. SUBJECTS AND METHODS: The Kuwait Nutrition Surveillance System objectively measured the height of 172,573 schoolchildren (5-19 years) over a 13-year period (2007-2019). Data on gender and date of birth were extracted from school records. Stunting was defined as height 2 standard deviations (SD) below the World Health Organization growth reference median. Logistic regression models were used to examine the trends of stunting over the study period while stratifying by gender. RESULTS: In males, the prevalence of stunting increased from 2.46% in 2007 to 4.18% in 2019 (p for trend <0.001). In females, the prevalence of stunting fluctuated but remained around 3.80% in both 2007 and 2019. The odds of stunting significantly increased in the period 2017-2019 compared to the period 2007-2010 among males, adjusted odds ratio (AOR) 1.04 (95% confidence interval [CI]: 1.14-1.76); p = 0.009, but not females, AOR 0.89 (95% CI: 0.73-1.07); p = 0.176. Although not statistically significant, there was a tendency for the odds of combined overweight with stunting to increase in males, AOR 1.65 (95% CI: 0.90-3.04); p = 0.087, but not females, AOR 1.13 (95% CI: 0.88-1.45); p = 0.248. CONCLUSION: Although the prevalence of stunting and combined stunting with overweight is low, there is an emerging upward trend in schoolboys that warrants further investigation and monitoring. This highlights the need for gender-specific interventions to reduce nutritional abnormalities in high-income countries in the Middle East countries like Kuwait.

Exposures in the Indoor Environment and Prevalence of Allergic Conditions in the United States of America.

Our study examines the association of the presence of mildew, cockroaches, and pets in homes as well as household dust allergens with the prevalence and/or severity of allergic diseases. No study has concurrently assessed home environment exposures in relation to allergic conditions in the general US population. Data from 5409 participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) living in their current homes for ≥one year were analyzed. Multivariate logistic regression analyses between home exposures and allergic diseases prevalence and severity were performed. In adjusted analyses, mildew was associated with higher current asthma, allergies, and allergic rhinitis prevalence; endotoxin, with higher current asthma prevalence; and dust Canis familiaris (Can f) 1, with higher allergic rhinitis prevalence. However, presence of cockroaches and dust Dermatophagoides farinae (Der f) 1 were associated, respectively, with lower current asthma and allergies prevalence. Presence of mildew, dust Der f1, Dermatophagoides pteronyssinus (Der p) 1, Felis domesticus (Fel d) 1, and endotoxin were all associated with asthma and/or wheeze severity. Non-atopic asthma was more frequent with mildew and/or musty smell dust and higher dust Fel d1 concentration, while atopic asthma was more prevalent with higher Can f1 and endotoxin concentrations in dust. This study confirms previous relationships and reports novel associations, generating hypotheses for future research.

The relationship between depression and risk of metabolic syndrome: a meta-analysis of observational studies.

INTRODUCTION: The link between metabolic syndrome and depression has always been controversial. Different studies that have examined the relationship between metabolic syndrome and depression have reported different results. Therefore, the goal of the present study was to examine the association between depression and MetS by meta-analysis. METHODS: Embase, Scopus, PubMed, and ISI were searched for publications in English from January 1990 to February 2020. Search included cohort and cross-sectional studies aimed at examining the association between depression and MetS. The risk of bias was assessed by Newcastle-Ottawa Scale. Heterogeneity and publication bias were tested, subgroup analysis and meta-regression were conducted. RESULTS: 49 studies with total sample size 399,494 were analyzed. Results indicated the odds of MetS was higher in depressed compared to non-depressed individuals [OR: 1.48; 95 %CI: 1.33-1.64) vs. (OR: 1.38; 95 %CI: 1.17-1.64)]. For cross-sectional studies, depressed patients in Europe (OR = 1.35; 95 %CI: 1.47-1.99) were at higher odds of MetS compared to those in America and Asia. For cohort studies, depressed patients in America (OR = 1.46; 95 %CI: 1.16-1.84) were at higher odds of MetS than those in Europe. Cross-sectional studies indicated women with depression were at higher odds of MetS (OR = 1.95; 95 %CI: 1.38-2.74) compared to men. In both types of studies, the odds of MetS decreased with age. CONCLUSIONS: Metabolic syndrome is more common in depressed compared to non-depressed individuals.

Association of health literacy and other risk factors with glycemic control among patients with type 2 diabetes in Kuwait: A cross-sectional study.

BACKGROUND: Poor health literacy (HL) has received much attention recently as a risk factor for poor health outcomes especially among patients with chronic diseases. The degree to which HL affects health outcomes is unknown among patients with type 2 diabetes mellitus (T2DM) in Kuwait. This study aimed to investigate the association between HL and glycated hemoglobin (HbA1c) among patients with T2DM. METHODS: 356 patients with T2DM were selected from 27 primary care clinics covering the state of Kuwait. HL was measured by the Short Test of Functional Health Literacy in Adults (STOFHLA). Prevalence of uncontrolled HbA1c was estimated and its association with HL was modeled and tested using Poisson regression with log-link function and robust variance-covariance matrix, while adjusting for several confounders. RESULTS: The prevalence of uncontrolled HbA1c was 77.8%. Among those with inadequate or marginal HL, about 50.7% have uncontrolled HbA1c. The prevalence of uncontrolled HbA1c among those on diet alone was 36.3% lower compared to those on mixed treatment regimen (APR = 0.637, 95% CI: 0.455-0.891, PV = 0.008). The prevalence of uncontrolled HbA1c among patients on oral hypoglycemic (OH) drugs alone was 22.3% lower compared to those on mixed treatment (OH plus Insulin) regimen (APR = 0.777, 95% CI: 0.697-0.865, PV < 0.001). For every one-year increase in age, there is 1.4% reduction in the prevalence of uncontrolled HbA1c (APR = 0.986, 95% CI: 0.978-0.994, PV < 0.001). For one STOFHLA score increase, there is 0.3% reduction in the prevalence of uncontrolled HbA1c (APR = 0.997, 95% CI: 0.994-1.00, PV = 0.055). Finally, for every year increase since T2DM onset, there is 1.1% increase in the prevalence of uncontrolled HbA1c (APR = 1.011, 95% CI: 1.003-1.019, PV = 0.008). CONCLUSIONS: The prevalence of uncontrolled HbA1c among patients with T2DM in Kuwait is high. Half of T2DM with inadequate or marginal HL have uncontrolled HbA1c. Patients on diet alone or OH alone have lower prevalence of uncontrolled HbA1c compared to those on mixed treatment regimen. Older T2DM patients or those with higher STOFHLA score have lower prevalence of uncontrolled HbA1c, while those with longer T2DM onset have higher prevalence of uncontrolled HbA1c. Future interventions should focus on younger patients, improve HL, and establish better communications between physicians and patients with T2DM for better glycemic control.

Prevalence of depression, anxiety, and their associations among end-stage renal disease patients on maintenance hemodialysis: a multi-center population-based study.

Depression and anxiety are the most common mood disorder among end-stage renal disease (ESRD) patients, which can negatively affect quality-of-life and treatment outcomes. This study aimed to estimate the prevalence of depression and anxiety symptoms among ESRD patients undergoing hemodialysis (HD) and test associations with several covariates. In across-sectional study, we collected data from 457 patients using Hospital Anxiety and Depression Scale (HADS). We used multinomial logistic regression to model the associations between depression/anxiety symptoms and several covariates. The prevalence of depression (anxiety) symptoms was 21.7%(21.4%). About 12.6% had both depression and anxiety. Males were significantly less likely to have anxiety (depression) compared to females. Married with children were significantly less likely to have anxiety compared to divorced/widowed. Patients with Glomerulonephritis were significantly more likely to have anxiety (depression) compared to other causes of dialysis. Depression and anxiety are prevalent among HD patients with their HADS scores significantly positively correlated. This requires regular screening for symptoms of anxiety/depression. Future interventions should target females, those on dialysis between one and three years, and those with glomerulonephritis as ESRD cause. Finally, HADS is ascreening tool for symptoms of anxiety and depression for which aspecialist should assess the definitive diagnosis clinically.

The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis.

Pressure ulcer is a health problem worldwide that is common among inpatients and elderly people with physical-motor limitations. To deliver nursing care and prevent the development of pressure ulcers, it is essential to identify the factors that affect it. This global systematic review and meta-analysis was conducted with the aim of evaluating the incidence of pressure ulcers in observational studies. In this study, databases including Web of Science, Embase, PubMed, Scopus, and Google Scholar were searched to collect data. Articles published from 1997 to 2017 about the factors influencing the incidence of pressure ulcers were retrieved and their results were analyzed using meta-analysis according to the Random-Effects Model. The heterogeneity of studies was investigated using the I2 statistic. Data were analyzed using the R and Stata software (version 14). In this study, 35 studies were included in the final analysis. The results showed that the pooled estimate of the incidence rate of pressure ulcer was 12% (95% CI: 10-14). The incidence rates of the pressure ulcers of the first, second, third, and fourth stages were 45% (95% CI: 34-56), 45% (95% CI: 34-56), 4% (95% CI: 3-5), and 4% (95% CI: 2-6), respectively. The highest incidence of pressure ulcers was observed among inpatients in orthopedic surgery ward (18.5%) (95% CI: 11.5-25). According to the final results, better conditions should be provided to decrease the incidence of pressure ulcers in different wards, especially orthopedics, and in patients with diabetes.

Predictors of Multiple Sclerosis Severity Score in Patients with Multiple Sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a demyelinating autoimmune disorder. Several factors have been shown to associate with MS clinical severity. The influence of different lifestyle factors on MS clinical severity as assessed by the Multiple Sclerosis Severity Score (MSSS) was investigated. METHODS: A questionnaire was administered to 128 Kuwaiti MS patients to assess the association of smoking, nutritional supplement use, food allergy, physical activity (PA), and educational level with MSSS. A multiple linear regression model was used to test for associations. Regression model results were adjusted for sex, history of blood transfusion, age at MS onset, and marital status. RESULTS: Smoking status, passive smoking, and food allergy are not associated with MSSS. Patients with MS with a college education and graduate/professional degrees score, on average, 2.56 lower on the MSSS compared with those with less than a high school education (ß= -2.22, P = .045; and ß = -2.90, P = .048, respectively). Patients who perform PA score, on average, 2.32 lower on the MSSS compared with those with no PA (moderate exercise, P = .003; rigorous exercise, P = .001), and PA correlated significantly with MSSS outcomes (r2 = 0.452, P < .001). CONCLUSIONS: Educational level and PA are significantly associated with reduced MSSS, and both contribute to a less severe MS clinical course. Current MS management protocols should consider lifestyle changes to improve the quality of life of patients with MS.

99mTc-dimercaptosuccinic acid scan versus MRI in pyelonephritis: a meta-analysis.

PURPOSE: Tc-dimercaptosuccinic acid (DMSA) scan is the current gold standard in detecting parenchymal changes, particularly scarring, in pyelonephritis. Recently, magnetic resonance imaging (MRI) is gaining popularity in the diagnosis of pyelonephritis. The aim of this study is to perform a meta-analysis on studies directly comparing MRI to DMSA scan in patients with pyelonephritis. MATERIALS: Systematic searches of PUBMED and EMBASE databases were performed to extract studies comparing MRI and DMSA scan in patients with pyelonephritis. The relevance of articles was assessed by two authors according to predefined inclusion and exclusion criteria. The pooled estimates of the sensitivities of MRI and DMSA scan were computed using random-effects meta-analysis model following DerSimonian and Laird's method. Subgroup analysis and publication bias were performed. RESULTS: Seven studies were included (164 patients). Using random effect model, the pooled estimate of the sensitivities of MRI and DMSA scan were 0.62 (95%CI: 0.44 - 0.77) and 0.59 (95%CI: 0.48 - 0.70), respectively. The pooled estimates of sensitivities of MRI and DMSA scan for acute pyelonephritis were 0.73 (95%CI: 0.49- 0.89) and 0.66 (95%CI: 0.56 - 0.75), respectively, and for scar detection were 0.48 (95%CI: 0.31- 0.66), and 0.50 (95%CI: 0.30 - 0.71), respectively. CONCLUSION: The overall sensitivities of MRI and DMSA scan were equivalent in detecting parenchymal changes in pyelonephritis. MRI and DMSA scan appeared to be equivalent to scar detection. In a small number of studies, MRI appeared to be better than the DMSA scan in acute pyelonephritis but this should be further studied in a larger number of patients.

Is there a difference in FDG PET findings of invasive ductal carcinoma of the breast with and without coexisting DCIS?

OBJECTIVES: Studies have reported that invasive ductal carcinoma (IDC) with coexisting ductal carcinoma in situ (DCIS) show lower metastatic potential and recurrence and better overall survival than pure IDC. In this study, we assessed F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images of patients with newly diagnosed IDC to determine if there is any difference in PET findings in IDC-DCIS and pure IDC cases. METHODS: FDG PET/CT images of patients with newly diagnosed IDC of the breast who subsequently underwent breast surgery and had histopathology result in our records were further evaluated. Tumor grade, pathological staging, and presence of DCIS were noted from the histopathology results. Standardized uptake value (SUV) of the primary tumor (SUVmax and SULmax), other hypermetabolic foci in the breast, and ipsilateral normal breast were measured. Presence of axillary and distant metastases was noted. RESULTS: Fifty seven (57) patients with IDC were included. Coexisting DCIS was present in 44 (IDC-DCIS) and not present in 13 (pure IDC) cases. Per histopathology, the primary tumor was unifocal in 33 IDC-DCIS (75%) and 12 pure IDC (92.3%) cases, and multifocal in 11 IDC-DCIS cases (25%), and 1 pure IDC case (7.7%). FDG uptake was multifocal in 20 IDC-DCIS cases (45.5%) and 1 pure IDC case (7.7%), and unifocal in 24 IDC-DCIS (54.5%), and 12 pure IDC (92.3%) cases. There was no significant difference in patient age, size of the primary tumor, SUVmax and SULmax of the primary tumor and SUVmax of the normal breast in IDC-DCIS and pure IDC cases (p>0.05). Pathology showed axillary metastasis in all 13 pure IDC (100%), and 27 IDC-DCIS (61.4%) cases. PET showed axillary uptake in 25 IDC-DCIS (56.8%), and 8 pure IDC (61.5%) cases, and abnormal/questionable distant uptake in 12 IDC-DCIS cases and 1 pure IDC case. CONCLUSION: In our preliminary findings, multifocal breast FDG uptake and multifocal tumor appear to be more common in IDC-DCIS than pure IDC. There is no significant difference in SUV and size of the primary tumor in IDC-DCIS and pure IDC cases. Axillary metastases appear to be more common in pure IDC than IDC-DCIS cases.

Effect of various blood glucose levels on regional FDG uptake in the brain.

OBJECTIVES: Studies have mainly assessed the effect of hyperglycemia on 18F-fluorodeoxyglucose (FDG) uptake in the brain. In this study, we assessed the FDG uptake of the brain not only in normo- and hyperglycemia but also in hypoglycemia to compare the effect of various blood glucose levels on regional FDG uptake in the brain. METHODS: This retrospective study was conducted on whole-body FDG positron emission tomography/computed tomography (PET/CT) images including the brain. The inclusion criteria included adult patients with no known history of diseases or symptoms affecting the brain, lack of abnormal brain findings on both PET and CT images, no image artifacts, and lack of any factors affecting brain FDG uptake. Maximum standardized uptake values (SUVmax) were measured in the lateral and medial frontal, temporal, parietal, and occipital cortices, lateral cerebellar cortex, posterior cingulate cortex, caudate nucleus, putamen, thalamus, brain stem (BS), and scalp in patients with normal (91-100 mg/dl), low (61-70 mg/dl), and high (171-200 mg/dl) blood glucose (BG) levels. Mean SUVmax of the brain regions for each BG range was calculated and statistically analyzed. RESULTS: In all BG levels, FDG uptake was at the highest level in the lateral frontal cortex and lowest level in the medial temporal cortex (MTC) and BS. The SUVmax in all assessed brain regions was significantly lower in hyperglycemia (P<0.001). However, this value was not significantly different in hypoglycemia (P>0.05) as compared to that in normoglycemia. At the BG range of 171-200 mg/dl, hyperglycemia-induced reduction in regional SUVmax had a range of 55.9-63.7% (60%±2.4%). This reduction was below 60% in the MTC, cerebellum, and BS and above 60% in other regions. Scalp activity was lower in hyperglycemia (P<0.001) and not different in hypoglycemia (P>0.05) as compared to normoglycemia. CONCLUSION: The FDG uptake appears to be at the highest level in the lateral frontal cortex and the lowest level in the MTC and BS in normo-, hypo-, and hyperglycemia. Hyperglycemia-induced reduction in FDG uptake was approximately the same as that in various regions of the brain. However, the MTC, cerebellum, and BS may be slightly less affected than the other regions. Hypoglycemia does not seem to have a significant effect on FDG uptake in the brain.

Predictors of Acne Vulgaris among Adolescents in Kuwait.

OBJECTIVES: The prevalence of acne vulgaris (AV) among adolescents in Kuwait has remained mostly unknown. This study aimed to estimate the prevalence of AV and its predictors among adolescents in Kuwait. SUBJECTS AND METHODS: A cross-sectional study was conducted on 714 participants who were randomly selected from public schools using multistage cluster random sampling. The presence or absence of AV, as well as severity of AV, were assessed using the Global Acne Grading Scale. Data on risk factors and potential confounders were collected from the parents through a self-administered questionnaire, and from the adolescents by face-to-face interview. Weight and height were measured in a standardized manner. RESULTS: Of 714 participants, 320 (44.8%; 95% CI 41.1-48.6%) self-reported AV. By clinical examination, AV was found among 479 (67.1%; 95% CI 63.5-70.5%) participants. Factors that were found to be significantly associated with AV in multivariable analysis were age, gender, nationality, and BMI categories. Females compared to males (adjusted prevalence ratio [APR] 1.16 [95% CI 1.05-1.25]; p = 0.006) and overweight or obese adolescents compared to normal weight (APR 1.15 [95% CI 1.02-1.26] and 1.14 [95% CI 1.02-1.23], respectively; p = 0.026) were more likely to have AV. None of the food items studied showed an association with AV in multivariable analysis. CONCLUSION: The prevalence of self-reported AV seems to be lower than that reported in other settings, while the prevalence of AV by clinical examination resembles that reported in many other countries. BMI was the only modifiable risk factor associated with AV in multivariable analysis, and none of the food items studied was related to the presence or absence of AV in multivariable analysis.