Kuwait City, Kuwait
Kuwait City, Kuwait

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Al Rashidi A.,Al Adan Hospital | Hegazi M.O.,Al Adan Hospital | Mohammad S.A.,Al Adan Hospital | Varghese A.,Al Adan Hospital
Journal of Clinical Rheumatology | Year: 2013

Despite their disadvantages, glucocorticoids (GCs) remain a mainstay of therapy for polymyalgia rheumatica (PMR). Second-line antirheumatic and immune-modulatory drugs are not infrequently required because of disease relapses during GC tapering and GC adverse effects. Therapy with methotrexate or with an anti-tumor necrosis factor drug showed modest efficacy in this situation. Tocilizumab (TCZ) is an anti-interleukin 6 receptor antibody that is being recently studied in the treatment of PMR patients who are intolerant or refractory to GCs, especially after failure of a second-line agent. We report a case of PMR in which GCs were stopped because of adverse effects despite good response. The condition responded to neither methotrexate nor etanercept. Treatment with TCZ has led to significant improvement of the patient's clinical and biochemical PMR activity parameters, and she was kept in a solid remission for 1 year without any TCZ-related adverse effects. Tocilizumab is a promising drug in the management of PMR. Further studies are required to clearly define the indications and duration of TCZ therapy in the management of PMR. © 2013 by Lippincott Williams & Wilkins.


Hegazi M.O.,Al Adan Hospital | Ahmed S.,Al Adan Hospital
Journal of Thyroid Research | Year: 2012

Over the past few decades, there has been an increase in the number of reports about newly recognized (atypical or unusual) manifestations of Graves' disease (GD), that are related to various body systems. One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism. Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations. The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment. This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease. Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundice may develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients. Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD. © 2012 Mohamed Osama Hegazi and Sherif Ahmed.


Akhtar S.,Kuwait University | Alroughani R.,Amiri Hospital | Alroughani R.,Dasman Diabetes Institute | Al-Shammari A.,Al Adan Hospital | And 2 more authors.
Multiple Sclerosis Journal | Year: 2015

Background: Multiple sclerosis (MS) is a complex immune-mediated disorder of central nervous systemwith undefined etiology. This study examined the month of birth effect on subsequent MS risk later inthe life in Kuwait.Methods: The month of birth of MS patients enrolled in Kuwait MS Registry between 1 January 195030April 2013 was compared with the month of births in the general population during the comparableperiod. Multivariable log-linear Poisson regression model was used to analyze the data.Results: Data on 1035 confirmed MS patients were collected, of which 65.2% were female and 77.1%were Kuwaiti. The overall risk of MS births (per 105 births in general population) was 28.5 (95% confidenceinterval (CI): 26.830.3). Multivariable log-linear Poisson regression model showed a significant(p=0.004) peak in the number of MS births during December (θo=340o). During this month, the risk ofMS birth was 1.3 times the risk of MS birth in the trough month after adjusting for the effects of genderand nationality (adjusted relative risk=1.3; 95% CI: 1.11.6). The amplitude (α ± standard deviation:0.13 ± 0.014) of sinusoidal curve showed a significant (p=0.004) difference of 13% from the mean tomaximum MS births during peak month.Conclusions: This study showed a statistically significant month of birth effect on MS risk with 13%excess MS births during December in Kuwait. Future studies may contemplate ascertaining the seasonalfactors eliciting the observed association. The insight gained by unraveling such factors may help curtailMS risk in this and other similar settings in the region. © The Author(s), 2015.


Hegazi M.O.,Al Adan Hospital | Aldabie G.,Al Adan Hospital | Al-Mutairi S.,Al Adan Hospital | El Sayed A.,Al Adan Hospital
Journal of Clinical Pharmacy and Therapeutics | Year: 2012

What is known and objective: Treatment for hypertension with verapamil has a favourable renoprotective effect and is generally considered safe in patients with mild to moderate renal failure. In this report, we highlight the vulnerability of patients with mild to moderate renal failure to verapamil side effects especially in the presence of hyperkalaemia. Case summary and what is new: We report two cases of junctional bradycardia with slow release (SR) verapamil therapy in the presence of mild hyperkalaemia in patients with mild to moderate chronic renal failure. Verapamil and hyperkalaemia may synergistically increase the vulnerability to atrioventricular conduction delay. Conclusion: Renal failure patients with baseline mild hyperkalaemia are particularly liable to bradyarrhythmias with SR verapamil. In such cases, we would recommend verapamil dose reduction and avoidance of SR formulation. In cases of verapamil toxicity, actively treating any level of hyperkalaemia is recommended. © 2012 Blackwell Publishing Ltd.


Malallah M.A.,Al Adan Hospital | Al-Shaiji T.F.,Al Amiri Hospital
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2015

Introduction and hypothesis: Treatment escalation from conservative directly to surgical in the management of pure stress urinary incontinence (SUI) reveals a gap for effective pharmacological treatments. The introduction of a drug therapy would fill this gap and widen the treatment options. Nevertheless, various pharmaceutical agents have been used off-label and are being investigated and becoming more widely available. In this review, we examined the latest published data regarding pharmacotherapy used in the treatment of SUI. Methods: We performed a literature review to evaluate the relevant studies pertaining to any pharmacotherapy used in the management of SUI, examining the English language literature. Results: Currently, no drug exists that is approved by the food and drug administration for the management of SUI. A few oral pharmacological agents are occasionally used off-label. Lack of proven efficacy and high incidence of bothersome side effects of these agents limit their use. Duloxetine, a serotonin norepinephrine reuptake inhibitor, represents a major therapeutic advance for the treatment of SUI based on findings from a number of controlled clinical trials. Conclusions: Several pharmacological agents have been used off-label and investigated for safety and efficacy, but none has demonstrated sufficient effectiveness to receive widespread verification for its use in the treatment of SUI. © 2015, The International Urogynecological Association.


El Ghoussein H.,Al Adan Hospital | Hegazi M.O.,Al Adan Hospital
Medical Principles and Practice | Year: 2011

Objective: To report a very rare form of brucellosis presenting with hypothermia and pneumonia. Clinical Presentation and Intervention: A 41-year-old male shepherd presented with a depressed level of consciousness. Clinically, his rectal temperature was 29.5°C, and he was cold, apathetic, hyporeflexic, and hypotensive, with atrial fibrillation. He had clinical and radiological evidence of bilateral bronchopneumonia. Blood culture and serologic testing were positive for Brucella melitensis. The patient recovered completely after proper management of the hypothermia and treatment of the brucellosis with antibiotics (doxycycline 100 mg orally twice daily for 6 weeks and streptomycin 1 g i.m. daily for 21 days). Conclusion: This case shows that brucellosis should be considered in the differential diagnosis of septicemic patients presenting with hypothermia. Copyright © 2011 S. Karger AG, Basel.


Hegazi M.O.,Al Adan Hospital | Mashankar A.,Yaco Al Adan Center
Medical Principles and Practice | Year: 2013

Objective: To report a rare association of central pontine myelinolysis (CPM) with hyperosmolar hyperglycaemic state (HHS). Clinical Presentation and Intervention: A diabetic female presented with HHS and prolonged severe hypernatraemia. The metabolic derangement was adequately treated with proper correction of both hyperglycaemia and hypernatraemia. Lack of improvement in the presenting confusional state and the development of a fresh neurological deterioration led to the suspicion of CPM that was confirmed with magnetic resonance imaging. She fully recovered after 4 weeks with no specific medical treatment. Conclusion: This case report showed that osmotic demyelination was linked to hypernatraemia and that CPM could result from severe hypernatraemia of HHS. Copyright © 2012 S. Karger AG, Basel.


Rashidi A.A.,Al Adan Hospital | Alajmi M.,Al Adan Hospital | Hegazi M.O.,Al Adan Hospital
Lupus | Year: 2011

Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of systemic lupus erythematosus (SLE). Cases complicated with DAH often have active SLE with multi-organ involvement, especially lupus nephritis. We describe a rare case of DAH as the first presenting manifestation of SLE in the absence of lupus nephritis. Remission was induced by IV methylprednisolone, IV cyclophosphamide, and plasmapheresis. Further cycles of cyclophosphamide were prevented by recurrent infections. Maintenance of remission was successfully achieved with oral mycophenolate mofetil 1 g twice daily, with a good control of SLE and without further DAH episodes. © The Author(s), 2011.


AlShati M.H.,Al Adan Hospital | Kumar R.,Al Adan Hospital | Kannan S.,Al Adan Hospital
Canadian Respiratory Journal | Year: 2013

Multiple myeloma, a disorder commonly encountered in elderly patients, represents a malignant proliferation of plasma cells that primarily affects bone marrow. Pleural effusion as the presenting manifestation of the disease is uncommon. The authors report a case of multiple myeloma with unusual features presenting at a relatively young age with massive spontaneous hemothorax and multiple thoracic masses completely obscuring rib shadow on plain chest imaging. The patient demonstrated a good response to melphalan chemotherapy without recurrence of effusion or the need for additional chemical or surgical pleural interventions. © 2013 Pulsus Group Inc. All rights reserved.


Joshi R.M.,Radiology Nuclear Medicine and Laboratory Center Medical Co. K.S.C.C | Alkhalegy A.A.,Al Adan Hospital
International Journal of STD and AIDS | Year: 2012

A case of acute Fitz-Hugh-Curtis syndrome in a young woman with purulent peritonitis and acute purulent appendicitis and oophoritis is presented. Open emergency appendectomy was performed and peritoneal pus was drained. Neisseria gonorrhoeae was cultured from the peritoneal pus. The hepatic enzymes were found to be raised. The patient was successfully managed and is asymptomatic after three months follow-up. To our knowledge, this is the first case of Fitz-Hugh - Curtis syndrome reported from Kuwait.

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