Synergistic effects of tea polyphenol epigallocatechin 3-O-gallate and azole drugs against oral Candida isolates.

BACKGROUND: The antifungal drug resistance has become an emerging problem in the management of candida infections worldwide. The objective of this study was to examine the efficacy of epigallocatechin 3-O-gallate (EGCG) alone and in combination with fluconazole/ketoconazole drugs against oral Candida isolates. METHODS: Minimum inhibitory concentration (MIC) and minimum fungicidal concentrations (MFC) of EGCG against 60 oral Candida isolates and 4 ATCC strains were determined. Synergism of EGCG with azole drugs was evaluated by checkerboard micro-dilution method and calculated fractional inhibitory concentration index (FICI). Candida cells' ultrastructure was studied by electron microscopy. RESULTS: MIC and MFC values of EGCG were in the range of 3.91-15.63 and 15.63-31.25µg/mL, respectively. Minimum biofilm inhibitory concentration (MBIC) range of EGCG (62.5-125µg/mL), was less than the ketoconazole (64-256µg/mL) and fluconazole (128-512µg/mL). The combination of EGCG with fluconazole/ketoconazole exhibited synergistic effects (ΣFICI≤0.50). EGCG with azole drugs showed high sensitivity against the tested isolates in growth curve assays. Against the biofilm, the susceptibility of fluconazole/ketoconazole significantly increased (3 to 5 fold), after combination with EGCG (MBIC/4) (P≤0.001). Electron microscopy of EGCG treated cells showed deformation of cell structure, ruptured cell wall and release of intracellular content. In molecular docking experiments, a strong interaction was observed between EGCG and fungal cell membrane molecule ergosterol. CONCLUSION: We conclude that EGCG synergistically enhanced the antifungal potential of azole drugs. The synergistic potential of EGCG might be helpful in preventing the development of drug resistance, in lowering the drug dosage, and thus minimizing adverse effects.

Faculty of Dentistry, Kuwait University, designated as a World Health Organization Collaborating Centre for Primary Oral Health Care.

The Faculty of Dentistry, Kuwait University, was designated as a World Health Organization (WHO) Collaborating Centre for Primary Oral Health Care (POHC) in 2011. This article aimed to describe the following: (1) the background for this nomination, (2) the WHO Collaborating Centre for POHC, its terms of reference and 5 activities, (3) the primary health care concept as it was established in Alma-Ata, (4) the oral health situation in Kuwait and in the Middle-East region and, finally, (5) how POHC policy should be implemented in Kuwait and this region. It can be concluded that, because the caries experience is very high in Kuwait and in the other countries of the Eastern Mediterranean region, good POHC programmes should be designed and implemented in this region. The Faculty of Dentistry will strengthen its research tradition and as a WHO Collaborating Centre for POHC will try to collect information and experience from POHC in this region and exchange ideas between POHC experts in this region on how these programmes could be further developed. This will happen according to the terms of reference and activity plans of the WHO Collaborating Centre for POHC approved by the WHO Global Oral Health Programme.

War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation.

BACKGROUND: Contemporary warfare involving civilian populations is a growing public health concern. In addition to the psychological impact, war-related trauma may result in physiological alterations and even broader health effects. Associations were examined between war-related stressors and incident asthma in elderly Kuwaiti civilians following the Iraqi invasion. METHODS: A random sample of all Kuwaiti nationals aged 50-69 years on the day prior to the invasion were identified. Among the 7873 meeting eligibility criteria, 5567 (71%) agreed to participate and 5028 completed the questionnaire (91% of those eligible). Of these, 3759 were in Kuwait during the invasion, of whom 2294 were alive at follow-up. After exclusions for prevalent asthma or missingness on covariates, 2066 were available for analysis. War-related experiences were summarised into a continuous score using Rasch modelling. Relative Cox proportional hazard rates (HR) were calculated for asthma adjusting for covariates. RESULTS: Over 13 years of follow-up, physician-diagnosed asthma was reported by 66/996 (6.6%) men and 104/1070 (9.7%) women. In models adjusted for gender, socioeconomic status, smoking, BMI, and air pollution related to burning oil fires, those reporting highest stress exposure were more than twice as likely to report asthma (HR 2.3, 95% CI 1.3, 3.9) compared to civilians reporting no stressors. Experiences were more salient when anchored to fear for loss of life. CONCLUSIONS: War-related trauma is associated with increased asthma risk in these elderly civilians. Although prior research has documented the significant and persistent psychological toll of war, these findings implicate even broader health effects.

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Community based schoolchildren's oral health programmes, Kuwait 1985--1998.

AIM: To describe the development of children's oral health programmes in Kuwait and present selected results and expected outcomes based on specific markers. To provide a basis for choosing best outcomes to develop public health policy and implement future programmes. METHOD: Assessment of the health, structural, cost and benefit changes in the oral health sector that resulted from policy decisions and implementation through different approaches in the period 1986--1998. RESULTS: Analysis has provided a basis for selection of appropriate methodologies to be implemented in the country. CONCLUSIONS: The regional programme consisting of full immediate prevention coverage with fluoride lozenges, periodic fluoride rinses, multi-operator care teams, flexible and moveable equipment appears to have provided the best potential within the Kuwait context during this period.

The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic.

OBJECTIVES: The aims of this study are to assess the feasibility of the Atraumatic Restorative Treatment (ART) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars. METHODS: This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001. The ART and amalgam restorations were placed randomly on comparable pairs of primary molars, if available. In addition, the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment. The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001. The mean follow-up period for the restorations was 8.3 months in the first assessment (2000) and 22 months in the second assessment (2001). The assessment was possible for 35 children (mean age = 5.7 years), 18 of whom had comparable pairs (n = 35 pairs) of restorations in their primary molars. In addition, 48 other ART restorations were assessed in 2000 and 42 in 2001. RESULTS: In a 2-year follow-up, 89.6% of all ART restorations were considered successful. The failure rate of the comparable pairs of ART and amalgam restorations was 5.7%. There was no significant difference in success rate between ART and amalgam techniques. CONCLUSIONS: Based on a 2-year follow-up evaluation, the class I ART restorations seemed to have a high success rate, indicating the appropriateness of the ART approach in primary teeth.

Dental education in Kuwait.

For a long time there has been a need to establish a dental school in Kuwait, due to the fact that the majority of dentists working in Kuwait are expatriates from various countries. An Amiri decree in 1996 made it possible, and the first dental students were admitted to the Kuwait University Faculty of Dentistry in 1998. The mission of the Faculty of Dentistry is 'to promote oral health in Kuwait through education, research and cooperation with other professional health care institutions as well as the community at large'. A 6.5-year dental curriculum was completed after 2 years of committee work and was accepted by the University Council in 2001. This curriculum incorporates current trends in medical and dental education, such as the evidence-based and community-based approaches, problem-solving methodology for outcome-based learning, and competency achieved through comprehensive patient care.

Over-the-counter use of oral contraceptives in Kuwait.

Oral contraceptive pills (OCPs) are available over-the-counter (OTC) in Kuwait, and constitute a leading method for spacing and limiting children. Data from a nationally representative survey of Kuwaiti women are used to examine OTC use of OCPs. One-fourth of the women initiated use without consulting a doctor, and 50% bought OCPs from the pharmacy. No socioeconomic or demographic differences were found between those who consulted a physician, implying that women of different background have similar accessibility to the physician. Using multivariate analysis, the odds of consulting a physician were found to be significantly lower for women who first bought OCPs directly from the commercial pharmacy. The duration of first time OCP use did not differ according to physician consultation. It is concluded that OTC availability of OCPs has many advantages and prevents unwanted pregnancy. However, there is a need for better packaging and instructions that would enable high-risk women to identify themselves and to use OCPs under physician supervision.

Prevalence of smoking among currently married Kuwaiti males and females.

A structured questionnaire was administered to a random sample of 608 Kuwaiti couples through a household face-to-face interview. Both spouses were non-smokers in more than half (50.8%) of all the couples, and there was a single couple (0.2%) with both spouses currently smoking. Only 0.5% of the wives reported current smoking. The prevalence of smoking was 3.2% among divorced/widowed women from the same households. The difference between the two groups of women remained significant upon controlling for the confounding effect of age. Among the husbands, frequencies of current and ex-smokers were 37% and 11%, respectively. Younger respondents consumed more tobacco and were initiated to smoking at an earlier age. Logistic regression showed that people with one to 11 years of formal education were more likely to be current smokers as compared to the rest of the respondents (adjusted relative risk: 2.07, 95% confidence interval (CI): 1.46-2.93). Reasons for the observed findings have been discussed.

Prevalence and social correlates to consanguinity in Kuwait.

BACKGROUND: Kuwait has one of the highest consanguinity rates in the world. Our objectives in this study were to assess the frequency and trend in consanguineous marriages, and to identify factors associated with inbreeding. PATIENTS AND METHODS: A representative sample of 482 households from the most developed (the Capital), and the least developed (Jahra), of the five governorates in Kuwait was selected. The study involved only Kuwaiti nationals. A structured questionnaire was administered by previously trained team members through a household face-to-face interview. RESULTS: Data were obtained for 959 current or previous marriages. Frequency of total (first and second cousin) consanguinity was much higher in Jahra governorate (42.1%) than the Capital (22.6%). Over the last decade, the inbreeding has decreased in the Capital but not in Jahra. Bivariate analysis indicated that several socioeconomic and demographic variables were significantly associated with consanguinity. The control of confounding factors by logistic regression showed, however, that Bedouin origin and year of marriage were the only variables significantly related to consanguinity. CONCLUSION: There is a widening gap between Bedouins and non-Bedouins in the practice of consanguinity in Kuwait.

Three root canals and dens formation in a maxillary lateral incisor: a case report.

A 19-yr-old female presented with three root canals and dens formation in a maxillary right lateral incisor. This rare condition was treated with conventional endodontic therapy.

Ethnicity, nationality and health care accessibility in Kuwait: a study of hospital emergency room users.

In mid-1994, non-Kuwaiti expatriates constituted 61.7% of the total population of Kuwait (1.75 million). Despite this numerical majority, non-Kuwaitis exist as a social minority. Non-Kuwaitis may be grouped into three broad categories along ethnic/nationality lines into Bidoon (without nationality), Arabs, and Asians. The objective of this paper was to compare the relative accessibility of the various groups to health care services in Kuwait. The study is based on data collected as part of a survey of 2184 Emergency Room (ER) users in January-February 1993. All patients attending the hospital ERs between 7:30 am and 9:00 pm were interviewed about their reasons for coming to the ER instead of going to the primary health care (PHC) centres, as required. The major reason given was low accessibility of the PHCs. Compared to Kuwaiti nationals, 92% of whom were registered at the PHC centres, only 62% of the Arabs and 39% of the Asians were registered. Multiple logistic regression of the factors in registration indicated that nationality was the most important reason for lack of registration, with Asians only about one-quarter as likely to be registered as Kuwaitis. Also, people who had been in Kuwait for shorter durations (< 5 years) were less likely to be registered than the Kuwaiti nationals or expatriates who had been here for 10 years or longer. In the absence of registration at the PHC centre, the civil identification card (ID) may be used as a valid means to enter the health system. Among the Arabs and Asians, 22% and 29% did not have a civil ID card. Thus, for many expatriates, the hospital ER, which does not provide the necessary follow-up care is often the only source of health care available.

Predictors of non-urgent utilization of hospital emergency services in Kuwait.

Utilization of the emergency rooms (ERs) in Kuwait has increased considerably during the last decade. Such an increase is a concern for health planners because of the burden on ER services, lack of continuous service provided by the ER and the higher cost of such services. Based on a study of 2011 patients attending the medical ERs in the six government hospitals in early 1993, the predictors of non-urgent utilization were analyzed. Patients were asked about their reasons for visiting the ER rather than the primary health care (PHC) centre. Both patients and doctors were asked to rate the urgency of the visit. According to the doctors' judgement, 61% of the visits were for non-urgent problems that did not require emergency care, while 23% of the patients viewed their visits to be non-urgent. Multiple logistic regression analysis indicated that perceived urgency of the visit was the most important predictor of a non-urgent visit to the ER, after controlling for several predisposing and enabling factors. Patients who perceived their visit to the ER to be non-urgent were about four times more likely to visit the ER for a non-urgent condition as judged by the doctor. The level of education had a significant, positive effect on non-urgent utilization among both Kuwaiti nationals and expatriates. Several factors may explain the above finding. Employment of educated persons in the hospital was one route through which education facilitated ER use. It is also likely that educated persons had more influential contacts or wasta in the hospital. Also, the less educated might have delayed seeking care while the educated consulted for non-urgent reasons as soon as they noticed the symptoms. Like education, the level of non-urgent utilization was higher among Kuwaiti nationals with higher incomes. Thus, a higher social class seems to facilitate ER use for non-urgent reasons. Among the non-Kuwaitis, lack of registration at the PHC centre was a significant reason for non-urgent use of the ER. It is recommended that hurdles in the utilization of PHC facilities should be removed. Registration of non-Kuwaitis at the PHC must be improved, and referrals to the PHC back from the ER should be instituted to ensure the necessary follow-up care.

Ethnic differences in contraceptive use in Kuwait: a clinic-based study.

The Arab, Muslim, oil-rich nation of Kuwait has achieved unusually high levels of knowledge and use of contraception for a developing, high fertility country. Almost all women know of contraceptive pills without prompting, and 57-86% report having ever used a method (usually the oral pill or IUD) in recent studies. Based on a survey of six randomly selected clinics the present study compares the knowledge and use levels of two major ethnic groups--the Beduins and non-Beduins. It also analyses preference for various contraceptive methods and probable reasons for this. While Census or Survey data do not provide information about the size of ethnic groups analyzed in this paper, it is estimated that at least one-third of the population of Kuwait is Beduin. There is a significant difference between the levels of knowledge and use of contraception between the Beduin and non-Beduin women; current use being 42% and 65%, respectively. The differentials between the two groups are particularly marked among women of lower socioeconomic status, and tend to reduce notably once variables such as education and income are controlled. Within the subgroup of non-Beduins, socioeconomic differences in contraceptive use have virtually disappeared; the illiterate and relatively less affluent women are as likely to use a contraceptive method as the university educated, and richer women. However, among the Beduins, the usually expected differences by socioeconomic characteristics still persist. The oral pill is the best known and most commonly used method. Male sterilization is the least known and not practiced at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental knowledge, attitudes and behavior among Kuwaiti mothers and school teachers.

In one region in the state of Kuwait children in first grade have been offered a systematic dental health care program. The purpose of this study was to assess (1) dental knowledge, attitudes, and health behavior among the mothers of children in first grade, and (2) dental knowledge and attitudes of schoolteachers, and their involvement in health education. Before the children were enrolled in the program 187 mothers (response 76%) were interviewed. Self-administered questionnaires were used to collect data on schoolteachers (n = 135, response 695). Most of the mothers (74%) answered that dental caries is caused by sweets/candy; the role of bacteria was mentioned by 9%. Half of the mothers were aware of the harmful effect of sugary drinks, and 50% knew about the preventive effect of fluoride. Knowledge about causes and prevention of periodontal disease was diffuse. According to the mothers, 68% of the children were in need for dental treatment; 37% were seen by a dentist once a year for symptomatic reasons, and 49% brushed their teeth at least twice a day. Sixteen-percent of the mothers helped their child in brushing every day. Sugar consumption among mothers and children was high, e.g. 66% of the children had chocolate bars and 44% had soft drinks several times a day. The level of dental knowledge was higher among teachers than mothers; the mothers were mostly informed through television/radio, while teachers had received information from various sources, including the dentists. The teachers responded positively to prevention of dental diseases among children and should be considered key persons in dental health education. For the Kuwaiti children and the mothers the active involvement principle, group presentations, and one-to-one communications are recommended for the school based dental health program.

Severity of nursing-bottle syndrome and feeding patterns in Kuwait.

On the basis of extensive clinical experience, a classification scheme for nursing-bottle syndrome (NBS) has been empirically constructed to reflect the progression and severity of the disease. Patients who do not have NBS are assigned a score of zero. Patients with NBS are given a score of 1 if they have caries on the facial or lingual surface of at least one of the primary maxillary incisors and optionally the primary maxillary first molars, a 2 if the buccal surface of one or both of the primary mandibular first molars are also involved, or a 3 if specific multiple surfaces are involved. The feeding pattern classification is as follows: 0 = non abusive, 1 = mildly, 2 = moderately, and 3 = severely abusive. The scoring depends upon the number of feeding times/day, the frequency with which the bottle or breast feeding is given during the might, and the duration of the feeding pattern (in months). Eighty-six cases were reviewed for classification. A chi-square test of a two-way contingency table showed a strong and significant relationship between disease severity and degree of feeding abuse. The findings support the validity of the classification schemes, illustrate the general pattern of NBS progression, and indicate that disease severity is a function of specific combinations of factors.