Superior Ophthalmic Vein Thrombosis: A Case Report in a Previously Healthy Methicillin-Resistant Staphylococcus aureus-Positive Patient.

BACKGROUND Superior ophthalmic vein thrombosis (SOVT) is a rare condition, with an incidence of 3 to 4 cases per million per year. SOVT can be classified according to the underlying etiology into septic or aseptic SOVT. We present a case of right SOVT in a previously healthy patient with a positive blood culture of methicillin-resistant Staphylococcus aureus (MRSA). CASE REPORT A previously healthy 38-year-old female patient presented with a 2-week history of worsening right-sided headache associated with photophobia, phonophobia, right-sided ear pain, and tinnitus. The best corrected visual acuity was 6/12 in the right eye and 6/6 in the left eye. Ophthalmic examination revealed right eye upper lid edema, proptosis, and diplopia in all gazes, mainly vertical. The fundus examination showed a raised hyperemic right optic disc with blurred margins. Laboratory investigations showed a positive blood culture of MRSA and elevated levels of inflammatory markers erythrocyte sedimentation rate and C-reactive protein. Orbital computed tomography examination showed periorbital and orbital cellulitis with superior ophthalmic vein thrombosis. The patient was treated successfully with antibiotics and anticoagulants. At 1-month follow-up, the patient was compliant with medications and reported full resolution of symptoms, with no visual acuity impairment. CONCLUSIONS SOVT is a challenging ophthalmic condition and can be present concurrent with orbital cellulitis or cavernous sinus thrombosis. Early imaging studies and proper management are important to prevent serious complications. Ophthalmologists need to be alerted of the importance of tailoring antibiotics based on the causative agent, to decrease the risk of therapeutic failure and microbial resistance.

Lower Blood Vitamin D Levels Are Associated with Depressive Symptoms in a Population of Older Adults in Kuwait: A Cross-Sectional Study.

Low serum vitamin D has been associated with an increased risk of neuropsychiatry disorders. This study aimed to examine the association between vitamin D deficiency and depression in adults aged 65 years and older. This cross-sectional study was conducted in seven primary healthcare centers across Kuwait (November 2020 to June 2021). The participants (n = 237) had their serum vitamin D 25-(OH)-D concentrations (analyzed by LC-MS) classified as sufficient, ≥75 nmol/L (30 ng/mL); insufficient, 50−75 nmol/L (20−30 ng/mL); or deficient, <50 nmol/L (20 ng/mL). Depressive symptoms were evaluated using the 15-Item Geriatric Depression Scale (15-item GDS). The mean serum 25-OH-D levels (nmol/L) in volunteers with normal, mild, moderate, and severe depression were 100.0 ± 31.7, 71.2 ± 38.6, 58.6 ± 30.1 and 49.0 ± 6.93, respectively (p < 0.001). The participants in the vitamin D sufficiency group were significantly less likely to exhibit depressive symptoms (88.2%) than patients with mild (36%) and moderate (21%) depression (p < 0.001). Ordinal logistic regression showed that vitamin D deficiency (OR = 19.7, 95% CI 5.60, 74.86, p < 0.001) and insufficiency (OR = 6.40, 95% CI 2.20, 19.91, p < 0.001) were associated with higher odds of having depressive symptoms. A low serum vitamin D level is a significant predictor of symptoms of depression among older individuals.

Measuring the extent and nature of use of Social Networking Sites in Medical Education (SNSME) by university students: Results of a multi-center study.

There is a sharp rise in the use of social networking sites (SNSs) by university students for various purposes. However, little is known about the use of SNSs for educational purposes. This study aims to determine educational use of SNSs by the medical students of two Saudi and a Kuwaiti medical school. A cross-sectional study was conducted by administering a 20-statement questionnaire to the undergraduate medical and allied health sciences students of two Saudi universities: Taibah University (TU) and Imam Abdulrahman AlFaisal University (IAFU), and one Kuwaiti university, Kuwait University (KU). The data were collected and analyzed by SPSS 20. Of a total of 1312 respondents, 1181 (90%) students used SNSs and 131 (10%) did not use SNSs for any reason. Further, only 442/1181 (37%, p < 0.00) students used SNSs for education and found these sites to be useful. As many as 357 (27%) students used SNSs for sharing education-related information once a day, 306 (23%) 3-5 times a day, and 331 (25%) once a week. A maximum of 678 (52%) used Facebook for educational purpose and most of the students, 469 (38%), used SNSs for sharing lectures. There were significant variations in responses among genders and year of schooling. The use of online social media in medical education is a rapidly evolving arena of scholarship. Low use of SNSs for sharing information and significant variations in perceptions of medical students about social media should draw attention of policy-makers for promoting awareness and educational reforms.

Seat-belt use still low in Kuwait: self-reported driving behaviours among adult drivers.

Kuwait mandated seat-belt use by drivers in 1976 and by front seat passengers in 1994. The study objectives were to identify and estimate current factors associated with seat-belt use and levels of potentially unsafe driving behaviours in Kuwait. In 2010, 741 adults were surveyed regarding driving habits and history. Only 41.6% of drivers reported always using a seat belt. Front seat passenger belt use was more common (30.5%) than rear seat belt use (6.5%). Distracted driving behaviours were common, including mobile phone use ('always' or 'almost always': 51.1%) and texting/SMS (32.4%). Logistic regression indicated that drivers who were young (18-19 years), male, Kuwaiti nationals or non-Kuwaiti Arabs, drove over the speed limit, had traffic violation tickets or >1 car crashes in the last year, were less likely to use seat belts. Targeted initiatives to increase public awareness and to enforce car-safety legislation, including use of seat belts, are necessary to decrease the health burden of car crashes in Kuwait.

Keeping our children safe in motor vehicles: knowledge, attitudes and practice among parents in Kuwait regarding child car safety.

Child safety restraints can reduce risk of death and decrease injury severity from road traffic crashes; however, knowledge about restraints and their use in Kuwait is limited. A cross-sectional, self-administered survey about child car safety was used among a convenience sample of parents of children aged 18 years or younger at five Kuwaiti university campuses. Of 552 respondents, over 44% have seated a child in the front seat and 41.5% have seated a child in their lap while driving. Few parents are aware of and fewer report using the appropriate child restraint; e.g., 36% of parents of infants recognised an infant seat and 26% reported using one. Over 70% reported wearing seat belts either "all of the time" (33%) or "most of the time" (41%). This new information about parents' knowledge and practice regarding child car seat use in Kuwait can inform interventions to prevent child occupant injury and death.

Hand hygiene practices among nursing staff in public secondary care hospitals in Kuwait: self-report and direct observation.

OBJECTIVE: To assess the compliance with hand hygiene guidelines among nursing staff in secondary care hospitals in Kuwait. SUBJECTS AND METHODS: A cross-sectional study was conducted through direct observation using the Lewisham observation tool and self-administered questionnaire in six major public secondary care hospitals in Kuwait. Only patient care activities that are described as 'dirty contacts' by the Fulkerson scale were considered as indications for hand hygiene while any attempt for hand hygiene was considered as compliance. A self-administered questionnaire was prepared and pilot tested and then distributed to nursing staff at each ward immediately after conducting the inspection; 550 were distributed and 454 were completed and returned. Among 204 observation sessions, a total of 935 opportunities and 312 hand hygiene practices were recorded. RESULTS: The overall compliance was 33.4%. The observed compliance significantly varied between different ward categories from 14.7% in emergency to 55% in medical wards. Of the 454 nursing staff who participated in self-reported compliance, 409 (90%) indicated that they always washed their hands upon practicing patient care activities. Nurses consistently reported higher compliance after conducting patient care activities rather than before. Being busy with work (42.2%), having sore/dry hands (30.4%) and wearing gloves (20.3%) were the most frequently reported hindrances to improving hand hygiene. CONCLUSION: Observed hand hygiene compliance among nursing staff in secondary care hospitals in Kuwait was poor. High self-reported compliance may reflect a high level of awareness of hand hygiene but may also suggest that improving compliance through increasing awareness has probably reached saturation.

Management of lipid exudates in Coats disease by adjuvant intravitreal triamcinolone: effects and complications.

AIM To evaluate the role of intravitreal Triamcinolone (TA) in the early management of Coats disease. METHODS Retrospective, interventional case series. RESULTS 15 consecutive cases with Coats disease were managed with 4 mg/0.1 ml intravitreal TA injection on presentation and were followed for a minimum of 1 year duration. Additional management strategies including drainage of subretinal fluid through an inferior sclerotomy, peripheral laser ablation and/or cryotherapy, cataract extraction and vitrectomy were performed. Improvement of visual acuity could be achieved compared with preoperative vision in all cases in this series, even when 40% needed cataract extraction with intraocular lens implantation. One patient needed antiglaucoma treatment to control raised intraocular pressure in this series. CONCLUSIONS Triamcinolone has a role in improving the rate of absorption of subretinal fluid and macular exudates in Coats disease. The major complication of 4 mg/0.1 ml intravitreal triamcinolone is cataract in 40% of cases in children.

Perception of the educational environment by medical students undergoing a curricular transition in Kuwait.

OBJECTIVE: The aim of this study was to measure the students' perceptions of the educational environment in a medical school undergoing curricular transition from a traditional to a problem-based learning (PBL) program in the academic year 2006-2007. MATERIALS AND METHODS: The Dundee Ready Education Environment Measure (DREEM) was used to evaluate perception of the educational environment. Multivariate logistic regression models were used to identify the factors related to educational environment perception that differ between students following a traditional curriculum to those following a PBL program at Kuwait University Medical School. RESULTS: Mean DREEM score was 53%. When students moved from the traditional curriculum to the PBL system, Academic Self-Perception deteriorated, while Perception of Atmosphere improved. Academic Self-Perception deteriorated because conventional strategies of learning were perceived as no longer useful, while Perception of Atmosphere improved because of increased relevance of the studies. CONCLUSION: Our findings suggest that curricular changes require careful planning and thinking, with particular attention upon how they influence the educational climate. When new teaching strategies are introduced, new factors that may lead students to develop an adverse perception of their educational environment may be introduced as well. Identification of such factors can lead to an improved educational outcome.

Toy gun ocular injuries associated with festive holidays in Kuwait.

BACKGROUND: Ocular trauma is one of the important causes of preventable blindness and visual impairment among children worldwide. Prevalence of pediatric ocular trauma associated with toy guns appear to be on the rise, although they are fully preventable. The purpose of this study is to report ocular trauma secondary to toy-gun pellets in Kuwait. METHODS: We conducted a non-comparative case series based on review of the medical records of children who suffered ocular injury from toy-gun pellets and were admitted to a tertiary eye center during a 7-day Eid el-Fitr holiday season in Kuwait. RESULTS: A total of 19 children were identified. Mean age was 7.8 years. Mean days of admission per patient was 3.6 days, with a total of 68 days of hospitalization. Variable anterior segment findings were identified, including lid edema, sub-conjunctival hemorrhage, corneal abrasion, and abnormal intraocular pressure. Most notably, different grades of hyphaema were seen in all patients, and traumatic cataract was identified in a 30-month-old child. The final visual acuity was 6/18 or better in nine patients and worse than 6/18 in eight patients. CONCLUSIONS: Eye trauma with toy guns resulted in significant injuries that required medical intervention and hospitalization for variable lengths of time, with a potential of causing long-term ocular complications. Our findings should assist public health workers in formulating specific prevention strategies, including a health educational program to make parents and health care professionals aware of the potential harm of these toys.

Outcomes associated with community-based research projects in teaching undergraduate public health.

BACKGROUND: Community based research projects have been widely used in teaching public health in many institutions. Nevertheless, there is a paucity of information on the learning outcomes of such a teaching strategy. We therefore attempted to evaluate our experience with such a project based teaching process. AIMS: The objective of this study was to evaluate the factors related to quality, impact and relevance of a 6-week student project for teaching public health in the faculty of medicine at Kuwait University. METHOD: Interactive sessions familiarized students with research methods. Concurrently, they designed and completed a participatory project with a Community Medicine mentor. Questionnaires were used to assess quality, impact and relevance of the project, and these were correlated with multiple demographic, statistical and research design factors. RESULTS: We evaluated a total of 104 projects that were completed during the period of September 2001 to June 2006. Three dimensions of outcome were assessed: quality; impact and relevance. The average (mean + SE; maximum of 5) scores across all projects were 2.6 + 0.05 (range 1.7-3.7) for quality, 2.8 + 0.06 (range 1.7-4.3) for impact and 3.3 + 0.08 (range 1.3-5) for relevance. The analysis of the relationship between various factors and the scores on each dimension of assessment revealed that various factors were associated with improved quality, impact or relevance to public health practice. CONCLUSIONS: We conclude that use of more objective measurement instruments with better a priori conceptualization along with appropriate use of statistics and a more developed study design were likely to result in more meaningful research outcomes. We also found that a biostatistics or epidemiology mentor improved the research outcome.

Automated detection of diabetic retinopathy: results of a screening study.

BACKGROUND: This study evaluated the operating characteristics of a reading software (Retinalyze System, Retinalyze A/S, Hørsholm, Denmark) for automated prescreening of digital fundus images for diabetic retinopathy. METHODS: Digital fundus images of patients with diabetes were retrospectively selected from the Bro Taf diabetic retinopathy screening program in Wales, UK in the period of 2002-2004, which has been superseded by the Diabetic Retinopathy Screening Service for Wales. A gold standard reference was defined by classifying each patient as having or not having diabetic retinopathy based on overall visual grading of the digitized images using the Bro Taf reading protocol. Automated grading was applied using automated red or bright lesion detection at varying detection sensitivities and adjusting for image quality. Operating characteristics included sensitivity, specificity, positive predictive values, and negative predictive values (PPV and NPV, respectively). RESULTS: Automated analysis of four hundred fundus photographs of 192 eyes from 96 patients with diabetes was performed. The automated red lesion detection had a sensitivity of 82%, specificity of 75%, PPV of 41%, and NPV of 95%. Combined automated red and bright lesion detection yielded a sensitivity of 88%, specificity of 52%, PPV of 28%, and NPV of 95%. Performance of the combined red and bright lesion detection at elevated thresholds in images of good quality demonstrated a sensitivity of 93%, specificity of 78%, PPV of 46%, and NPV of 98%. CONCLUSIONS: Prescreening for diabetic retinopathy by automated detection of single fundus lesions seem to be achieved with minimal false negativity and can help to decrease the burden of manual diabetic retinopathy screening.

Scleral buckle infection with Aspergillus flavus.

PURPOSE: To present a case of scleral buckle infection with Aspergillus flavus in a tertiary eye center in Saudi Arabia. METHODS: A retrospective case report of a 28-year-old Saudi male who presented with a six-month history of conjunctival injection and discharge from the left eye which had undergone uncomplicated conventional retinal detachment surgery, at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, in the form of cryopexy, subretinal fluid drainage and scleral buckle (grooved segmental sponge and circumferential band with sleeve) for a macula on retinal detachment four years earlier. A diagnosis of infected extruded scleral buckle was made and the buckle was removed. RESULTS: The infected scleral buckle was removed under local anesthesia with administration of sub-conjunctival irrigation of 50 mg solution of Vancomycin, and sub-conjunctival injection of 25mg of Vancomycin. Post operative microbiological studies revealed infection with silver staining of moderate Aspergillus flavus hyphae. Visual acuity of the left eye improved from 20/200 before surgery to 20/60 in the two years follow-up visit. CONCLUSION: This case report indicates the importance of considering infection with multiple organisms - including fungal ones - in cases of scleral buckle infections in our population.

The Association between Dominant Macular Drusen and Central Retinal Artery Occlusion in Young Females with Cardiac Valve Disease.

To describe uncommon association between central retinal artery obstruction and dominant macular drusen in two young female patients. First patient, a 22-year-old female was presented with right central artery obstruction associated with bilateral dominant macular drusen. Systemic evaluation disclosed the presence of mitral valve regurge. Second patient, a 34-year-old female with a previous history of right central retinal artery obstruction diagnosed elsewhere. Fundus exam showed bilateral dominant macular drusen and her systemic evaluation revealed severe rheumatic valve stenosis, moderate aortic regurge with moderate to severe tricuspid regurge and she underwent mitral valve replacement. To the best of our knowledge, the association between central retinal artery obstruction and dominant macular drusen was not previously reported.