Şabāḩ as Sālim, Kuwait
Şabāḩ as Sālim, Kuwait

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Al-Herz W.,Kuwait University | Al-Herz W.,Al Sabah Hospital | Al-Mousa H.,King Faisal Specialist Hospital And Research Center | Al-Mousa H.,Alfaisal University
Journal of Allergy and Clinical Immunology | Year: 2013

Previous reports about primary immunodeficiency disorders have shown variations in the frequency and distribution among populations from different ethnic and geographic backgrounds. In this review we describe peculiarities about combined immunodeficiencies (CIDs) in the Middle East. The frequency and type of genetic defects causing CIDs in this region differ in comparison with those in other populations because of the common practice of consanguineous marriage in the Middle East, which results in the relative increase in autosomal recessive diseases. We highlight some of the challenges in the awareness, diagnosis, and therapy of CIDs in the region and the research opportunities, especially those directed toward the identification of novel disease-causing genes. © 2013 American Academy of Allergy, Asthma & Immunology.


Silveira P.P.,Federal University of Rio Grande do Sul | Agranonik M.,Federal University of Rio Grande do Sul | Faras H.,Al Sabah Hospital | Portella A.K.,Federal University of Rio Grande do Sul | And 3 more authors.
Pediatric Research | Year: 2012

Introduction: Low birth weight is associated with obesity and an increased risk for metabolic/cardiovascular diseases in later life. Results: The results of the snack delay test, which encompassed four distinct trials, indicated that the gender × intrauterine growth restriction (IUGR) × trial interaction was a predictor of the ability to delay the food reward (P = 0.002). Among children with normal birth weights, girls showed a greater ability to delay food rewards than did boys (P = 0.014).In contrast, among children with IUGR, there was no such differential ability between girls and boys. Furthermore, in girls, impulsive responding predicted both increased consumption of palatable fat (P = 0.007) and higher BMIs (P = 0.020) at 48 mo of age, although there was no such association with BMI at 36 mo. Discussion: In girls, the quality of fetal growth may contribute to impulsive eating, which may promote an increased intake of fats and consequently higher BMIs. As with the original thrifty phenotype, such a mechanism would be adaptive when food supplies are sparse, but would be problematic in societies with ample access to calorically rich foods.Methods:We examined whether the quality of intrauterine growth programs obesogenic eating behaviors, by investigating (i) the relationship between birth weight and impulsive eating in 3-year-old children (using the snack delay test), and (ii) whether impulsive eating predicts fat intake and/or BMI at 4 years of age (using a laboratory-based test meal). © 2012 International Pediatric Research Foundation, Inc.


Faras H.,Al Sabah Hospital | Al Ateeqi N.,Al Sabah Hospital | Tidmarsh L.,McGill University
Annals of Saudi Medicine | Year: 2010

Pervasive developmental disorders are a group of neurodevelopmental disorders characterized by impairments in communication, reciprocal social interaction and restricted repetitive behaviors or interests. The term autism spectrum disorders (ASD) has been used to describe their variable presentation. Although the cause of these disorders is not yet known, studies strongly suggest a genetic basis with a complex mode of inheritance. More research is needed to explore environmental factors that could be contributing to the cause of these disorders. The occurrence of ASD has been increasing worldwide, with the most recent prevalence studies indicating that they are present in 6 per 1000 children. The objectives of this article are to provide physicians with relevant information needed to identify and refer children presenting with symptoms suggestive of ASDs to specialized centers early, and to make them feel comfortable in dealing with public concerns regarding controversial issues about the etiology and management of these disorders.


Nadar M.S.,Kuwait University | Dashti M.H.,Kuwait University | Cherian J.,Al Sabah Hospital
PLoS ONE | Year: 2013

Purpose: The purpose of this study was to compare the properties of the median nerve and the flexor retinaculum within the carpal tunnel with Magnetic Resonance Imaging (MRI) under two conditions: (a) fingers extended, and (b) fingers in an isometric squeeze grip. Methods: Thirty-Four volunteers participated in this experimental study. The flexor retinaculum and median nerve characteristics were measured during both conditions using MRI. Results: The isometric squeeze grip condition resulted in significant palmar bowing of the flexor retinaculum (t = 7.67, p<.001), a significant flattening-ratio of the median nerve (t = 4.308, p<.001), and no significant decrease in the crosssectional area of the median nerve (t = 2.508, p = 0.017). Conclusion: The isometric squeeze grip condition resulted in anatomical deformations within the carpal tunnel, possibly explained by the lumbrical muscles incursion into the carpal tunnel during finger flexion. © 2013 Nadar et al.


AlFadhli S.,Kuwait University | Nanda A.,Al Sabah Hospital
Immunology Letters | Year: 2013

To explore the genetic association of single nucleotide polymorphisms (SNPs) in the coding region of the NOTCH4, exon 3 C+1297T and exon 5 A+3063G, in a case-control analysis of 58 rheumatoid arthritis (RA) and 98 alopecia areata (AA) and 100 ethnically matched healthy subjects. NOTCH4 polymorphisms were genotyped by standard PCR followed by restriction digestion. Analysis of C+1297T SNP revealed a significant association of allele C+1297 (p= 0.03, OR = 1.66, 95%CI 1.04-2.64) and genotype CT (p= 0.002, OR = 2.82, 95%CI 1.42-5.59) with susceptibility to RA. Analysis of A+3063G SNP revealed a significant association of allele A+3063 (p= 0.05, OR = 0.59, 95%CI 0.35-1.008) and genotype AA (p= 0.002, OR = 0.39, 95%CI 0.17-0.87) with RA. Over all analysis between alopecia patients and the studied SNPs failed to show any significant association. Classifying the patients by severity of disease, confined the risk role of CT genotype to the severest form of alopecia universalis (p= 0.006, OR = 3.82, 95%CI 1.39-3.82) and AG genotype to semiuniversalis alopecia (p= 0.004, OR = 4.3, 95%CI 1.5-15.3). Present study is the first to report a statistically significant association between RA and NOTCH4 polymorphisms. © 2013 Elsevier B.V.


Mokaddas E.,Kuwait University | Burhamah M.H.A.,Al Sabah Hospital | Khan Z.U.,Kuwait University | Ahmad S.,Kuwait University
BMC Infectious Diseases | Year: 2010

Background: Surveillance cultures may be helpful in identifying patients at increased risk of developing invasive candidiasis. However, only scant information exists on the effect of Candida colonization on serum levels of diagnostic biomarkers. This prospective surveillance study determined the extent of Candida colonization among pediatric cancer patients and its possible impact on serum levels of (1-3)-β-D-glucan (BDG), Candida mannan and Candida DNA.Methods: A total of 1075 swabs originating from oropharynx (n = 294), nostrils (n = 600), rectum (n = 28), groin (n = 50), ear (n = 54), and axilla (n = 49) of 63 pediatric cancer patients were cultured for the isolation of Candida spp. Patients yielding Candida spp. from any sites were considered as colonized. Serum samples were collected from patients at the time of first surveillance culture for detection of BDG by Fungitell kit and Candida mannan by Platelia Candida Ag. Candida DNA was detected by using panfungal primers and identification was carried out by using species-specific primers and DNA sequencing.Results: Seventy-five (7.6%) swab cultures from 35 (55.5%) patients yielded Candida spp. These isolates included C. albicans (n = 62), C. dubliniensis (n = 8), C. glabrata and C. tropicalis (n = 2 each) and C. krusei (n = 1). Eleven patients were colonized at three or more sites. Eight of 36 serum samples from 6 colonized patients yielded BDG values higher than the currently recommended cut-off value of ≥80 pg/ml. However, none of the serum samples yielded Candida mannan levels ≥0.5 ng/ml and PCR test for Candida DNA was also negative in all the serum samples of colonized patients. During the study period, only two colonized patients subsequently developed candidemia due to C. tropicalis. Besides positive blood cultures, C. tropicalis DNA, BDG and Candida mannan were also detected in serum samples of both the patients.Conclusions: The present study demonstrates that while mucosal colonization with Candida species in pediatric cancer patients is common, it does not give rise to diagnostically significant levels of Candida mannan or Candida DNA in serum specimens. However, BDG values may be higher than the cut-off value in some pediatric patients without clinical evidence of invasive Candida infection. The study suggests the utility of Candida mannan or Candida DNA in the diagnosis of invasive candidiasis, however, the BDG levels in pediatric cancer subjects should be interpreted with caution. © 2010 Mokaddas et al; licensee BioMed Central Ltd.


El-Reshaid W.,Kuwait University | Abdul-Fattah H.,Al Sabah Hospital
Medical Principles and Practice | Year: 2014

Objective: To assess the normal sonographic values of renal length and cortical thickness in healthy adults and establish reference ranges in our population for comparison when examining renal disease. Subjects and Methods: Sonographic assessment of renal length and cortical thickness were performed from January 2006 to December 2011 in 252 healthy individuals who were self-referred to the El-Reshaid Renal Clinic in Kuwait. They were screened for the absence of renal abnormalities. Weight and height were measured, and body mass index (BMI) and body surface area calculated. Patients were divided into 5 age groups: 18-30, 31-40, 41-50, 51-60 and 61-80 years, in order to generate reference graphs for renal length and cortical thickness. Results: The mean renal lengths for the right and left kidney were 10.68 ± 1.4 and 10.71 ± 1.0 cm, respectively (p = 0.56) without a significant change with age. The minimum cortical thickness was 0.6 cm. The renal length correlated with the weight of the patients (p < 0.01) and their BMI (p < 0.01) but not with their height. There was no difference in renal size or cortical thickness in patients older than 60 years despite an age-related decline in the glomerular filtration rate (p < 0.001). Conclusions: Renal length and cortical thickness did not vary significantly with age. Renal length correlated well with weight and BMI but not with height. Hence, establishing normal ranges of renal parameters is essential for comparison in situations where possible renal disease is being investigated. © 2014 S. Karger AG, Basel.


Mokaddas E.,Kuwait University | Khan Z.U.,Kuwait University | Ahmad S.,Kuwait University | Nampoory M.R.N.,Hamed Al Essa Organ Transplant Center | Burhamah M.,Al Sabah Hospital
Clinical Microbiology and Infection | Year: 2011

This study determined the value of (1,3)-β-d-glucan (BDG), Candida mannan (MN) and Candida species-specific DNA as surrogates for diagnosis of candidaemia. Thirty-nine patients yielding Candida species in blood cultures were investigated for presence of BDG, MN and Candida species-specific DNA in serum samples. The Candida spp. bloodstream isolates included C. albicans (n=16), C. tropicalis (n=10), C. parapsilosis (n=7), C. glabrata (n=3) and C. dubliniensis (n=3). Positivity of the three markers was as follows: Candida DNA for corresponding Candida species, 100%; BDG, 87%; MN, 59%. Despite varying sensitivities of these biomarkers, they provided a useful adjunct to the diagnosis of candidaemia. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.


Al-Adsani A.,Al Sabah Hospital
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2012

There are no available data about the factors associated with diabetic nephropathy (DN) in Kuwaiti individuals with type 2 diabetes. This study was conducted on 154 consecutive Kuwaiti adults with type 2 diabetes who attended the diabetic out-patient clinic at Al-Sabah Hospital to determine the factors associated with albuminuria among them. Albuminuria was considered to be present if the urinary albumin:creatinine ratio test or 24-h collection was positive on two occasions. There were 102 (66.2%) women and 52 (33.8%) men, with a mean age of 49.1 ± 10.1 years and a median duration of diabetes for 6 years. Hypertension was found in 60.8% of the patients and 16.3% had an HbA 1c <7%. Albuminuria was found in 43.5% of the patients. The prevalence of microalbuminuria and macroalbuminuria was 27.3% and 16.2%, respectively. In the univariate analysis, the factors that were significantly associated with albuminuria were hypertension - both systolic and diastolic blood pressure levels, HbA 1c , retinopathy, duration of diabetes, and modality of treatment. Multiple logistic regression analysis indicated that hyper-tension was the main independent risk factor associated with albuminuria (OR 4.1, 95% CI 1.1- 15.0; P = 0.03). In conclusion, although albuminuria is common among Kuwaiti adults with type 2 diabetes, the prevalence is lower than that reported for other populations in spite of the poor glycemic control and the high prevalence of hypertension. Factors associated with albuminuria appear to be similar to other populations, and hypertension was the most independent factor. Early recognition and treatment of hypertension is an important strategy to prevent or delay DN as well as cardiovascular morbidity and mortality. A population-based study is warranted to confirm these findings and to search for genetic linkage for the development of DN.


Al-Herz W.,Al sabah Hospital | Nanda A.,Al sabah Hospital
Pediatric Dermatology | Year: 2011

Skin manifestations are prevalent in primary immunodeficiency disorders (PID). In a large proportion of patients, they manifest as presenting signs and serve as important factors for the early diagnosis of PID. Only a few studies describing the spectrum of skin disorders in PID are available. The objective of the current study was to determine the prevalence and characteristics of skin manifestations in children with PID. Participants were 128 pediatric patients with PID (aged <16 years) registered prospectively over 6 years. Skin manifestations were observed in 61 patients (48%), and those manifestations were the presenting features in 50 (39% of total PID and 82% of those with skin lesions). Skin infections were the most prevalent manifestations, seen in 39 patients (30%), followed by eczemas in 24 (19%). Skin infections were significantly more prevalent in those with congenital defects in phagocyte number, function, or both, as well as in those with well-defined immunodeficiencies. Although widely present in all participants with PID, eczema was a consistent feature (100%) in patients with hyper IgE syndrome and Wiskott-Aldrich syndrome (WAS). Erythroderma of infancy with diffuse alopecia was seen exclusively in patients with severe combined immunodeficiency disorders, telangiectasia in patients with ataxia telangiectasia, and partial albinism with silvery gray hair in those with Chediak-Higashi syndrome. Autoimmune skin manifestations were observed in 6% of reported cases of PID. This study highlights the importance of awareness of skin manifestations of PID to assist in the early diagnosis and management of these disorders. © 2011 Wiley Periodicals, Inc.

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