Clinically functioning gonadotropin-secreting pituitary adenoma.

Summary: Gonadotroph adenomas are the most common type of nonfunctional pituitary adenomas. However, functioning gonadotroph adenomas causing clinical manifestations are rare. We present the case of a 42-year-old man with an incidental finding of a pituitary gland mass. A pituitary MRI revealed a 3 cm macroadenoma, and laboratory investigations revealed elevated follicle-stimulating hormone (FSH) and total testosterone levels. A diagnosis of functioning FSH-secreting pituitary adenoma was considered, with possible concomitant luteinizing hormone secretion, given the elevated testosterone, prompting further evaluation. Testicular ultrasound showed bilaterally enlarged testicles, and visual field testing revealed a monocular superior temporal defect. Transsphenoidal resection of pituitary adenoma was the treatment of choice. Histopathology assessment confirmed the diagnosis of gonadotroph-secreting adenoma, with positive staining for FSH. Within the 12-week postoperative period, FSH and testosterone levels normalized, and the patient experienced significant improvement in vision, along with the resolution of macroorchidism. While functional gonadotroph adenomas are rare, patients can present with a wide range of symptoms that are often unnoticeable due to their slow development. Careful evaluation can help guide multidisciplinary management to achieve full remission. Learning points: Endocrine evaluation is indicated in all cases of pituitary incidentalomas to determine functional status. Clinically functioning gonadotroph adenomas, while rare, pose a diagnostic challenge and require careful clinical evaluation. Transsphenoidal surgery is the mainstay of treatment of functioning gonadotroph adenomas, with the involvement of a multidisciplinary team to achieve desirable outcomes.

In-hospital Mortality Rates in SARS-CoV-2 Patients Treated with Enoxaparin and Heparin.

OBJECTIVES: This study aimed to investigate in-hospital mortality rates in patients with coronavirus disease (COVID-19) according to enoxaparin and heparin use. METHODS: This retrospective cohort study included 962 patients admitted to two hospitals in Kuwait with a confirmed diagnosis of COVID-19. Cumulative all-cause mortality rate was the primary outcome. RESULTS: A total of 302 patients (males, 196 [64.9%]; mean age, 57.2 ± 14.6 years; mean body mass index, 29.8 ± 6.5 kg/m2) received anticoagulation therapy. Patients receiving anticoagulation treatment tended to have pneumonia (n = 275 [91.1%]) or acute respiratory distress syndrome (n = 106 [35.1%]), and high D-dimer levels (median [interquartile range]: 608 [523;707] ng/mL). The mortality rate in this group was high (n = 63 [20.9%]). Multivariable logistic regression, the Cox proportional hazards, and Kaplan-Meier models revealed that the use of therapeutic anticoagulation agents affected the risk of all-cause cumulative mortality. CONCLUSION: Age, hypertension, pneumonia, therapeutic anticoagulation, and methylprednisolone use were found to be strong predictors of in-hospital mortality. In elderly hypertensive COVID-19 patients on therapeutic anticoagulation were found to have 2.3 times higher risk of in-hospital mortality. All cause in-hospital mortality rate in the therapeutic anticoagulation group was up to 21%.

Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-CoV-2: A retrospective study.

The goal of this study was to investigate in-hospital mortality in patients suffering from acute respiratory syndrome coronavirus 2 (SARS-CoV-2) relative to the neutrophil to lymphocyte ratio (NLR) and to determine if there are gender disparities in outcome. Between February 26 and September 8, 2020, patients having SARS-CoV-2 infection were enrolled in this retrospective cohort research, which was categorized by NLR levels ≥9 and < 9. In total, 6893 patients were involved included of whom6591 had NLR <9, and 302 had NLR ≥9. The age of most of the patients in the NLR<9 group was 50 years, on the other hand, the age of most of the NLR ≥9 group patients was between 50 and 70 years. The majority of patients in both groups were male 2211 (66.1%). The ICU admission time and mortality rate for the patients with NLR ≥9 was significantly higher compared to patients with NLR <9. Logistic regression's outcome indicated that NLR ≥9 (odds ratio (OR), 24.9; 95% confidence interval (CI): 15.5-40.0; p < 0.001), male sex (OR, 3.5; 95% CI: 2.0-5.9; p < 0.001) and haemoglobin (HB) (OR, 0.95; 95% CI; 0.94-0.96; p < 0.001) predicted in-hospital mortality significantly. Additionally, Cox proportional hazards analysis (B = 4.04, SE = 0.18, HR = 56.89, p < 0.001) and Kaplan-Meier survival probability plots also indicated that NLR>9 had a significant effect on mortality. NLR ≥9 is an independent predictor of mortality(in-hospital) among SARS-CoV-2 patients.

In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid.

Objective: To investigate COVID-19 related mоrtаlity according to the use of corticosteroid therapy. Design: Retrospective cohort study. Setting: Two tertiary hospitals in Kuwait. Participants: Overall, 962 patients with confirmed SARS-CoV-2 infection, were stratified according to whether they were treated with corticosteroids (dexamethasone or methylprednisolone). The mean age of the patients was 50.2 ± 15.9 years and 344/962 (35.9%) were female. Main outcome measures: In-hospital mortality and cumulative all-cause mortality. Results: Compared to non-corticosteroid therapy patients, corticosteroid therapy patients had a higher prevalence of hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease; a longer hospital stay (median [IQR]: 17.0 [5.0-57.3] days vs 14.0 [2.0-50.2] days); and a higher in-hospital mortality (51/199 [25.6%] vs 36/763 [4.7%]). Logistic regression analysis showed a higher in-hospital mortality in the corticosteroid group (adjusted odds ratio [aOR]: 4.57, 95% confidence interval [CI]: 2.64-8.02, p < 0.001). Cox proportional hazards regression showed that corticosteroid use was a significant predictor of mortality (hazard ratio [HR]: 3.96, p < 0.001). Conclusions: In-hospital mortality in patients with SARS-CoV-2 on corticosteroid therapy was 4.6 times higher than in those without corticosteroid therapy.

In-hospital mortality in SARS-CoV-2 stratified by sex diffrences: A retrospective cross-sectional cohort study.

Background: The aim of this study was to determine in-hospital mortality in patients presenting with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and to evaluate for any differences in outcome according to sex differences. Methods: Patients with SRS-CoV-2 infection were recruited into this retrospective cohort study between February 26 and September 8, 2020 and strаtified ассоrding tо the sex differences. Results: In tоtаl оf 3360 раtients (meаn аge 44 ± 17 years) were included, of whom 2221 (66%) were mаle. The average length of hospitalization was 13 days (range: 2-31 days). During hospitalization and follow-up 176 patients (5.24%) died. In-hospital mortality rates were significantly different according to gender (p=<0.001). Specifically, male gender was associated with significantly greater mortality when compared to female gender with results significant at an alpha of 0.05, LL = 28.67, df = 1, p = 0.001, suggesting that gender could reliably determine mortality rates. The coefficient for the males was significant, B = 1.02, SE = 0.21, HR = 2.78, p < 0.001, indicating that an observation in the male category will have a hazard 2.78 times greater than that in the female category. Multivariate logistic regression confirmed male patients admitted with SARS-CoV-2had higher сumulаtive аll-саuse in-hоsрitаl mоrtаlity (6.8% vs. 2.3%; аdjusted оdds rаtiо (аОR), 2.80; 95% (СI): [1.61-5.03]; р < 0.001). Conclusions: Male gender was an independent predictor of in-hospital mortality in this study. The mortality rate among male SARS-CoV-2 patients was 2.8 times higher when compared with females.

In-hospital mortality in SARS-CoV-2 stratified by gamma-glutamyl transferase levels.

BACKGROUND: This study investigates in-hospital mortality amongst patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relation to serum levels of gamma-glutamyl transferase (GGT). METHODS: Patients were stratified according to serum levels of gamma-glutamyl transferase (GGT) (GGT<50 IU/L or GGT≥50 IU/L). RESULTS: A total of 802 participants were considered, amongst whom 486 had GGT<50 IU/L and a mean age of 48.1 (16.5) years, whilst 316 had GGT≥50 IU/L and a mean age of 53.8 (14.7) years. The chief sources of SARS-CoV-2 transmission were contact (366, 45.7%) and community (320, 40%). Most patients with GGT≥50 IU/L had either pneumonia (247, 78.2%) or acute respiratory distress syndrome (ARDS) (85, 26.9%), whilst those with GGT<50 IU/L had hypertension (141, 29%) or diabetes mellitus (DM) (147, 30.2%). Mortality was higher amongst patients with GGT≥50 IU/L (54, 17.1%) than amongst those with GGT<50 IU/L (29, 5.9%). More patients with GGT≥50 required high (83, 27.6%) or low (104, 34.6%) levels of oxygen, whereas most of those with GGT<50 had no requirement of oxygen (306, 71.2%). Multivariable logistic regression analysis indicated that GGT≥50 IU/L (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20-3.45, p=0.009), age (OR: 1.05, 95% CI: 1.03-1.07, p<0.001), hypertension (OR: 2.06, 95% CI: 1.19-3.63, p=0.011), methylprednisolone (OR: 2.96, 95% CI: 1.74-5.01, p<0.001) and fever (OR: 2.03, 95% CI: 1.15-3.68, p=0.016) were significant predictors of all-cause cumulative mortality. A Cox proportional hazards regression model (B = -0.68, SE =0.24, HR =0.51, p = 0.004) showed that patients with GGT<50 IU/L had a 0.51-times lower risk of all-cause cumulative mortality than patients with GGT≥50 IU/L. CONCLUSION: Higher levels of serum GGT were found to be an independent predictor of in-hospital mortality.

A proportional odds model of risk behaviors associated with recurrent road traffic crashes among young adults in Kuwait.

BACKGROUND: The aims of this cross-sectional study were to i) assess one-year period prevalence of one, two, three or more road traffic crashes (RTCs) as an ordinal outcome and ii) identify the drivers' characteristics associated with this ordinal outcome among young adult drivers with propensity to recurrent RTCs in Kuwait. METHODS: During December 2016, 1465 students, 17 years old or older from 15 colleges of Kuwait University participated in this cross-sectional study. A self-administered questionnaire was used for data collection. One-year period prevalence (95% confidence interval (CI)) of one, two, three or more RTCs was computed. Multivariable proportional odds model was used to identify the drivers' attributes associated with the ordinal outcome. RESULTS: One-year period prevalence (%) of one, two and three or more RTCs respectively was 23.1 (95% CI: 21.2, 25.6), 10.9 (95% CI: 9.4, 12.6), and 4.6 (95% CI: 3.6, 5.9). Participants were significantly (p < 0.05) more likely to be in higher RTCs count category than their current or lower RCTs count, if they habitually violated speed limit (adjusted proportional odds ratio (pORadjusted) = 1.40; 95% Cl: 1.13, 1.75), ran through red lights (pORadjusted = 1.64; 95%CI: 1.30, 2.06), frequently (≥ 3) received multiple (> 3) speeding tickets (pORadjusted = 1.63; 95% CI: 1.12, 2.38), frequently (> 10 times) violated no-parking zone during the past year (pORadjusted = 1.64; 95% CI: 1.06, 2.54) or being a patient with epilepsy (pORadjusted = 4.37; 95% CI: 1.63, 11.70). CONCLUSION: High one-year period prevalence of one, two and three or more RTCs was recorded. Targeted education based on identified drivers' attributes and stern enforcement of traffic laws may reduce the recurrent RTCs incidence in this and other similar populations in the region.

Risk Factors for Mortality in Patients with COVID-19: The Kuwait Experience.

OBJECTIVES: To describe the baseline characteristics and to evaluate the risk factors for in-hospital mortality in patients admitted to hospitals with coronavirus disease (COVID-19) in Kuwait. SUBJECTS AND METHODS: This retrospective cohort study analyzed data of patients admitted to two hospitals in Kuwait with COVID-19. The outcome was assessed by using multivariable analysis of factors affecting survival and mortality. RESULTS: In 962 patients, the case fatality ratio was 9.04%. The mean age of nonsurvivors was 63.5 ± 14.8 years, and most deaths occurred in males (80.5%). For the whole sample, the source of transmission was significantly related to mortality and the median duration of in-hospital stay was 15 days (interquartile range: 2-52 days). In patients with high oxygen requirements, the case fatality rate was 96.6%. Multivariable analysis identified age, hypertension, cardiovascular disease (CVD), and dyspnea on presentation as independent risk factors for COVID-19 mortality. CONCLUSIONS: The mortality rate was higher in older patients with comorbidities such as hypertension and CVD. Early recognition of high-risk patients may help to improve care and reduce mortality.

Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients.

INTRODUCTION: This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 Ñ€Ð°tients strаtified by serum ferritin levels. METHODS: Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). RESULTS: Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21-0.62; p < .001), male sex (OR = 2.63, 95% CI = 1.43-5.06; p = .003), hypertension (OR = 4.16, 95% CI = 2.42-7.36; p < .001) and pneumonia (OR = 8.48, 95% CI = 3.02-35.45; p < .001) had significance in predicting in-hospital mortality. Additionally, the Cox proportional hazards analysis and Kaplan-Meier survival probability plot showed a higher mortality rate among patients with ferritin levels > 1000. CONCLUSION: In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity.

In-hospital mortality in SARS-CoV-2 stratified by hemoglobin levels: A retrospective study.

This study is to estimate in-hospital mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients stratified by hemoglobin (Hb) level. Patients were stratified according to hemoglobin level into two groups, that is, Hb <100 g/L and Hb >100 g/L. A total of 6931 patients were included. Of these, 6377 (92%) patients had hemoglobin levels >100 g/L. The mean age was 44 ± 17 years, and 66% of the patients were males. The median length of overall hospital stay was 13 days [2; 31]. The remaining 554 (8%) patients had a hemoglobin level <100 g/L. Overall mortality was 176 patients (2.54%) but was significantly higher in the group with hemoglobin levels <100 g/L (124, 22.4%) than in the group with hemoglobin levels >100 g/L (52, 0.82%). Risk factors associated with increased mortality were determined by multivariate analysis. The Kaplan-Meier survival analysis showed hemoglobin as a predictor of mortality. Cox proportional hazards regression coefficients for hemoglobin for the HB ≤ 100 category of hemoglobin were significant, B = 2.79, SE = 0.17, and HR = 16.34, p < 0.001. Multivariate logistic regression showed Hb < 100 g/L had a higher cumulative all-cause in-hospital mortality (22.4% vs. 0.8%; adjusted odds ratio [aOR], 0.33; 95% [CI]: [0.20-0.55]; p < 0.001). In this study, hemoglobin levels <100 g/L were found to be an independent predictor of in-hospital mortality.

Period prevalence and factors associated with road traffic crashes among young adults in Kuwait.

OBJECTIVES: This cross-sectional study assessed one-year period prevalence of road traffic crashes (RTCs) and examined the factors associated with RTCs among young adults in Kuwait. DESIGN AND SETTINGS: During December 2016, 1500 students enrolled in 15 colleges of Kuwait University were invited to participate in the study. Students 18 years old or older and who drive by themselves were eligible. Data were collected using a structured self-administered questionnaire. One-year period prevalence of RTCs (≥1 vs. none) was computed. Multivariable log-binomial regression model was used to identify the risk factors associated with one-year period prevalence of RTCs. RESULTS: Of 1500 invited individuals, 1465 (97.7%) participated, of which 71.4% (1046/1465) were female, 56.4% (804/1426) were aged between 21 and 25 years, and 67.1% (980/1460) were Kuwaitis. One-year period prevalence of RTC was 38.9%. The final multivariable log-binomial regression model showed that after adjusting for the influences of other variables in the model, participants were more likely to have had at least one RTC during the past year, if they habitually sped over limit (adjusted PR = 1.19; 95% confidence interval (CI): 1.04-1.36), crossed a red light (adjusted PR = 1.33; 95% CI: 1.16-1.52), or if they have had three or more speeding tickets (adjusted PR = 1.40; 95% CI: 1.13-1.73) compared to those who reportedly had no RTC during the same period. CONCLUSION: One-year period prevalence of RTCs among university students in Kuwait, though relatively lower than the reported figures in similar populations elsewhere in the region, is yet high enough to warrant diligent attention. Habitual speeding, having had three or more speeding tickets, and the practice of crossing a red light were significantly and independently associated with at least one RTC during the past year. Targeted education and enforcement of existing traffic laws may reduce the RTCs frequency in this relatively young population. Future studies may look at impact of such interventions.