Abdominal tuberculosis in Ahmadi, Kuwait: a clinico-pathological review.

For studying abdominal tuberculosis (TB) in Ahmadi, files off all patients admitted to our hospital with abdominal TB over 15 years (1981-1996) were reviewed. Nineteen patients are reported here. Young adults were predominant in our study. The non-Arab Asians were the most frequently affected group in relation to their population in Ahmadi, and Kuwaitis were the least frequently affected group. Abdominal pain, sweating, anorexia and fever were the most frequent presenting symptoms. Ascites and intestinal obstruction were the most frequent clinical presentations. Two patients presented with acute appendicitis and one patient had tuberculous pancreatitis. Abdominal lymph nodes, peritoneum, ileum and and caecum were the most frequently affected abdominal structures. We found laparoscopy very helpful in diagnosis of abdominal TB and we recommend it as the diagnostic method of choice. All our patients responded well to antituberculous chemotherapy. It should be kept in mind that abdominal TB still affects the indigenous and expatriate population of Kuwait.

Intracranial tuberculoma in Kuwait.

OBJECTIVE: To study the manifestations of intracranial tuberculoma in Kuwait and to provide guidelines for the diagnosis and management of intracranial tuberculoma in developing countries, where the disease is common and facilities are limited. DESIGN: Data were collected from patients with intracranial space-occupying lesions admitted to Adan Hospital Medical Department and the Neurosurgery and Neuromedical Departments at Ibn-Sina Hospital, Kuwait, from January 1987 to December 1995. RESULTS: Intracranial tuberculomas represented 1.4% of all cases with intracranial space-occupying lesions in these hospitals (13/925); 77% of the patients were males, and seizures were the most frequent presenting symptom. Nine patients (66.6%) responded well to medical treatment and four (33.3%) failed to respond. Those who responded to medical treatment showed remarkable improvement of the intracranial lesions within 6 weeks, and almost complete resolution within 12 weeks. Seven patients required surgery, three due to failure of medical treatment. We report a patient who needed emergency shunt operation, a patient with pituitary tuberculoma, and two patients whose lesions recurred several years after surgery. CONCLUSION: Bearing in mind the non-specific nature of computed tomography and magnetic resonance imaging in the diagnosis of intracranial tuberculoma, and the lack of advanced neurosurgical facilities in developing countries where the disease is common, we recommend a 6-week therapeutic test for patients with solitary or multiple enhancing intracranial space-occupying lesions without mass effect. Stereotactic biopsy is recommended in selected cases wherever facilities are available.

Malabsorption syndrome complicating tuberculous peritonitis.

A 22-year-old Nepali man presented with a 2-month history of fever, ill health, anorexia, loss of weight and diarrhoea. Apart from an ill-defined lower abdominal mass, physical examination was unremarkable. Investigations showed the picture of malabsorption syndrome with no evidence of structural gastro-intestinal tract involvement on barium meal, small bowel and large bowel enema, upper gastro-intestinal endoscopy, colonoscopy and mucous membrane biopsy. Laparoscopy showed typical features of tuberculous peritonitis. Liver biopsy showed tuberculous granulomatous hepatitis, and peritoneal biopsy showed caseating granulomata. The patient responded rapidly to antituberculosis chemotherapy.

Stroke in Kuwait: a three-year prospective study.

To study the pattern of stroke in Kuwait, prospective data were collected from all patients admitted with first-ever stroke to our hospital over 3 years: 1989, 1992 and 1993. The primary-care registry over the same period was examined to ascertain that all cases of stroke seen by the primary-care doctors were referred to a hospital. Death certificates issued for people who died outside the hospital were also examined. The study included: clinical evaluation, computed tomography, electrocardiography, blood laboratories, serum chemistry and other investigations as required. The overall annual crude incidence rate was 27.6/100,000 population. The age-adjusted annual crude incidence rate was 145.6/100,000 population. No seasonal variation in the stroke incidence was observed in our study. Carotid-territory large infarction represented 46.5% of all strokes followed by intracerebral haemorrhage in 19.9%, lacunar infarction in 17%, basilar infarction in 8.3% and subarachnoid haemorrhage in 1.7%. The overall case fatality rate was 10%. Mortality increased with age and when loss of consciousness was present. The study demonstrated that stroke incidence in Kuwait is very low due to the young average age of the Kuwaiti population.

Vitamin D deficiency in veiled Kuwaiti women.

OBJECTIVE: To study vitamin D deficiency in veiled Kuwaiti women. DESIGN: Prospective on cases and volunteers. SETTING: The medical department in a general hospital in Kuwait serving about 300000 persons (Adan Hospital). SUBJECTS: The authors saw four cases of unexplained vitamin D deficiency osteomalacia in otherwise healthy veiled Kuwaiti women. This stimulated us to study 50 veiled volunteer Kuwaiti women aged between 14 and 45 years old who had three children or less, and 22 unveiled volunteer Kuwaiti women with matched age and number of children as control. INTERVENTIONS: Blood samples were taken to check levels of 25-hydroxy cholecalciferol, calcium, phosphorus and alkaline phosphatase. Blood urea, serum creatinine, serum bilirubin, serum alanine transaminase, serum aspartate transaminase, serum lactic dehydroginase, prothrombin time, urine for proteins and pH were checked to exclude renal and hepatic disease. RESULTS: showed subclinical vitamin D deficiency among veiled women and two cases of clinically overt osteomalacia were discovered among the veiled volunteers suggesting a high prevalence of the disease among veiled Kuwaiti women.

Acute renal failure, compartment syndrome, and systemic capillary leak syndrome complicating carbon monoxide poisoning.

CASE REPORT: Five Indian labourers sharing one room were found lying on the floor unconscious. A coal fire had been lit to provide heat during the cold night and was still burning inside the room. Two of the men were pronounced dead at the scene. The other three were transferred to the hospital in critical condition. This paper contains the case reports of the three patients who were transferred to the hospital. One of the patients died 60 h after admission. The other two patients were successfully treated and released. The three patients developed severe rhabdomyolysis complicated by compartment syndrome. The patient who died developed compartment syndrome in three extremities. Two patients required blood transfusion due to very severe hemolysis. The hemolysis in the third patient was less severe and did not require blood transfusion. Two patients developed anuric acute renal failure due to acute tubular necrosis as shown by renal biopsy. Two patients developed the full blown picture of systemic capillary leak syndrome. Gross and microscopic examination of specimens taken at autopsy showed extensive necrosis of all skeletal muscles, myocardial necrosis and acute tubular necrosis affecting both kidneys.

Microcytosis: guidelines for family doctors.

In our studies of microcytosis, the complete blood count (CBC) of 82,830 randomly selected patients was analysed. Of these 34.3% showed microcytosis, and 5.5% were not anaemic. Emphasis was given to study the extent, causes and patterns of non-iron deficient microcytosis. Haematological data was adequate to differentiate iron deficient (ID) from non-iron deficient (NID) patients with microcytosis in 285 subjects. Of these 21.4% were found to be NID. A majority (73.8%) had showed a form of haemoglobinopathy, the commonest being beta-thalassaemia minor (60.7%). Of non-invasive investigations, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), red cell size distribution width (RDW), anisocytosis in blood smears, serum iron (SI) and haemoglobin electrophoresis, the parameter which separated ID from NID patients most effectively was haemoglobin electrophoresis. It showed an abnormal pattern in 82% of NID subjects and normal pattern in 96.4% ID subjects. In the 18% of the NID subjects with a normal pattern, raised serum iron levels characterized 11% additional subjects with NID.

Multiple intracranial tuberculomas mimicking brain metastases.

A 50-year-old woman was admitted to our hospital with upper gastro-intestinal tract (GIT) bleeding, and complaining of severe headache and recurrent generalized tonic clonic seizures for the last year. Physical examination showed no focal neurological deficits. The patient was diagnosed with multiple brain metastases with occult primary depending on computerised tomography (CT) findings. Biopsy of enlarged left axillary lymph nodes showed caseating tuberculoid lymphadenitis compatible with tuberculosis. Intracranial lesions resolved completely on antituberculosis treatment.

Hypokalaemic paralysis precipitated by working in hot weather.

Twenty-two cases of hypokalaemic paralysis seen over the past 7 years, are presented here. They included five Chinese, five Bangladeshis, six Arabs, four Philippinos and two Indians. The number of cases related to the population of each nationality in our area showed that the Chinese had the biggest number of cases in relation to their population in our area, followed by Philippinos then Bangladeshis. All patients were men admitted in the hot season, dehydrated and not able to walk. It seems that dehydration was an important precipitating factor in our cases. Although family history was positive in one patient, apart from four thyrotoxic patients, the others were apparently healthy. Patients improved dramatically with i.v. potassium and rehydration. Four patients were readmitted with the same picture.