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Al-Mutairi N.,Farwaniya Hospital | Al-Farag S.,Farwaniya Hospital | Al-Mutairi A.,Ahmadi Hospital | Al-Shiltawy M.,Farwaniya Hospital
Journal of Dermatology | Year: 2010

Recent studies suggest that psoriasis patients have higher rates of comorbidities. We sought to determine the prevalence of comorbidities and co-medications in our psoriasis patients. We conducted case-control study in 1835 patients with psoriasis vulgaris and age- and gender-matched cohort without psoriasis. Patients were examined for clinical characteristics of psoriasis, PASI scores, and data of age, sex, body mass index (BMI), smoking status, comorbidities, and co-medications were analysed for both patients and controls. We identified 1661 (92.8%) patients with mild to moderate psoriasis (PASI < 10) and 129 patient's (7.03%) with severe psoriasis (PASI > 10). Patients with psoriasis were more likely to be current smokers (51.34% vs 32.51% controls). Respective prevalence rates of risk factors in those with mild-moderate psoriasis, severe psoriasis, and controls were as follows: inflammatory arthritis (20%, 31% and 10.68%); coronary heart disease (4.1%, 8.35% and 1.42%); obesity (BM1) (32.5%, 41% and 17%); diabetes mellitus type II (37.4%, 41% and 16%); hypertension (32%, 40.3% and 11.55%); dyslipidemia (14.1%, 22.48% and 4.96%); metabolic syndrome (16%, 26.35% and 6.76%); chronic obstructive pulmonary disease (COPD) (5.36%, 6.98% and 4.03%); cancer (0.3%, 1.55% and 0.16%). They had a higher odds of inflammatory arthritis, coronary heart disease, obesity, diabetes mellitus II, hypertension, dyslipidemia, and metabolic syndrome. They were receiving significantly wider varieties of drugs. Which most commonly included antidiabetic drugs, antihypertensives, and hypolipidemic drugs. © 2010 Japanese Dermatological Association.

Al-Mutairi N.,Farwaniya Hospital | Al-Mutairi N.,Kuwait University | Al Hadad A.,Farwaniya Hospital | Al Hadad A.,Kuwait University
Dermatologic Surgery | Year: 2012

OBJECTIVE: Pityriasis alba (PA) is the most common cause of facial hypopigmentation presenting to the dermatologist. The objective of the current study was to study the effect of the 308-nm excimer laser in the treatment of PA. MATERIALS AND METHODS: Twelve patients with 37 PA patches were enrolled in this study. The lesions were treated using the 308-nm excimer laser twice a week for 12 weeks. The hypopigmented areas were evaluated at baseline and at weeks 0, 3, 6, and 12 for scaling, hypopigmentation, and pruritus on a 4-point scale (0 = none to 3 = severe). All adverse effects were recorded. RESULTS: There were seven male and five female participants in (aged 5-21 years), with skin type III to V. After 1 month of laser therapy, the clinical scores were significantly lower than at baseline. Similar decreases were observed for the scaling and pruritus scores. Uneven skin color improved by the third week, and near-complete resolution was noticed by the end of 3 months. No serious or unpleasant side-effects were observed, and all patients completed the 12-week treatment. Patients were satisfied or very satisfied with the treatment. CONCLUSION: The 308-nm excimer laser is an effective therapeutic option for PA. © 2011 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Al-Mutairi N.,Kuwait University | AlKhalaf M.,Farwaniya Hospital
Acta Dermatovenerologica Alpina, Pannonica et Adriatica | Year: 2012

Introduction: Human papillomaviruses (HPV) cause cutaneous and mucosal infections in both adults and children. Warts are very common in children. Methods: All patients younger than 13 presenting with cutaneous warts in a 1-year period at Farwaniya Hospital in Kuwait were included in the study. In addition, their parents completed a questionnaire about possible environmental risk factors for warts. The treatment modalities used and their outcomes were recorded. Results: This study included 2,916 children with warts. Common warts affected male patients more frequently. Warts were mostly located on the hands, in 1,172 patients (40.19%), followed by the feet in 1,096 patients (37.59%). Frequently associated environmental factors were walking barefoot, using a swimming pool, or having a family member with warts. The first-line treatment used was cryotherapy, followed by topical salicylic acid preparations. A total of 2,128 (72.98%) patients were cleared of their warts, and 232 (10.90%) patients had a recurrence. The cure rate in patients with hand warts was slightly higher than with warts on the feet (78.67% versus 70.52%). Treatment side effects were a complaint of 1,796 (61.59%) patients. Conclusions: The prevalence of warts is lowest among children less than 6 years old. No particular therapy has been confirmed to be effective at achieving complete remission in every patient.

Al-Mutairi N.,Kuwait University | El-Khalawany M.,Farwaniya Hospital
Journal of the European Academy of Dermatology and Venereology | Year: 2010

Background Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, for which no effective treatment is available. Objectives The aim of this study was to determine the clinical, epidemiological and histopathological characteristics of LPP patients in Kuwait. Methods Thirty-three LPP patients who attended the Dermatology outpatient clinics at Farwaniya Hospital, Kuwait from the year 2002 to 2008 were studied for clinical, epidemiological and histopathological findings. Thirteen of these patients were treated with topical tacrolimus 0.03%. Ointment applied topically twice daily for the duration varying from 6 to 12 weeks. Results Of the 33 patients, 21 were men and 12 were women. The duration of eruption ranged from 6 weeks to 3 years. The face and neck were the commonest sites, affecting 18 (54.5%) patients. The pattern of pigmentation was diffuse in 18 (54.54%) patients, reticular in seven (21.2%), blotchy in five (15.2%), linear in two (6.1%) and perifollicular in one (3%). Twenty patients had positive serology for hepatitis C virus (HCV), with significantly higher serum liver enzymes (ALT and AST). Of the 13 patients, who were treated with tacrolimus Ointment, seven (53.8%) showed appreciable lightening of the pigmentation after an average of 12 weeks. Conclusions We conclude that HCV may be one of the factors associated with LPP, in those who have a tendency to develop LPP. However, this possible association should be interpreted carefully. In addition, tacrolimus ointment could have a beneficial role in the treatment of LPP. © 2009 European Academy of Dermatology and Venereology.

Al-Mutairi N.,Kuwait University | Nour T.,Farwaniya Hospital | Al-Rqobah D.,Farwaniya Hospital
Expert Opinion on Biological Therapy | Year: 2013

Introduction and objective: The association between patients of psoriasis on anti TNF therapy and onychomycosis has not been explored. The aim of this study was to determine the rate of onychomycosis in patients of psoriasis with nail involvement on anti TNF therapy. Materials and methods: All patients of psoriasis with nail involvement seen between February 2007-July 2012 were examined. All the patients with negative nail scrapings for fungus were enrolled. Patients found fit for biologics after investigations were randomly divided into 3 groups (Group A: Infliximab, Group B: Etanercept and Group C: Adalimumab). The patients were followed up every 4 weeks for 24 weeks. Repeat nail scrapings were done at week 24. The results were compared with controls. Result: In total, 315 (178 males and 137 females) patients were enrolled. The mean age was 37.5 ± 11.4 years. The results for scraping for fungus at the end of 24 weeks were as follows: 33% (33/100) in patients on Infliximab followed by 15.45% (17/110), 13.33% (14/105) in patients on treatment with Etanercept and Adalimumab respectively as compared to 13.89% (25/180) among controls. Onychomycosis in association with nail psoriasis was more common in males. Conclusion: This study revealed statistically significant association between fungal infections of the nail in patients of psoriasis on treatment with Infliximab. © 2013 Informa UK, Ltd.

Al-Mutairi N.,Kuwait University | Issa B.I.,Farwaniya Hospital | Nair V.,Kuwait University
Indian Journal of Dermatology, Venereology and Leprology | Year: 2012

Background: The primary cause of skin cancers is exposure to ultraviolet (UV) radiation. And, for decades sun protection has been promoted in various public health education campaigns. Recently, however, vitamin D deficiency has been related to increased risk of skin cancers. And, skin being the primary site for the synthesis of active form of vitamin D, excessive sun protection could lead to vitamin D-deficient states. But, the results have so far been conflicting. Aims: To study the level of awareness, knowledge and attitude of representative groups from the general population from Kuwait towards sun protection. And, also study the correlation of the level of sun protective measures used and vitamin D levels in these groups. Methods: The study constituted of two main parts. First part comprised a questionnaire-based survey of representative group of people aged 18 and above to assess their knowledge, awareness and attitude towards sun protection. The second part consisted of measuring serum vitamin D levels in 150 volunteers amongst the responders of the questionnaire, who had been regularly using sunscreens for at least 2 years and compare to the levels seen in 150 age and sex-matched responders of similar skin phototypes, who had never used sunscreens. Results: Out of the total of 1044 responders, 80% of them had adequate knowledge of the beneficial and harmful effects of sun exposure, and had been using sunscreens regularly, and adopting other sun protective measures in their daily life. The levels of vitamin D were found to be deficient in both sunscreen users and those who had never used sunscreens. The difference between the two groups was statistically insignificant (60.67% vs 54.67%; P value>0.001). Conclusion: Population at large seems to be adequately informed about the beneficial and deleterious effects of sun exposure. Vitamin D levels are deficient in majority of our people, and there is a need to do larger surveys covering all parts of the country and give supplemental doses of vitamin D to those found deficient.

Al-Mutairi N.,Kuwait University | Nour T.,Farwaniya Hospital
Expert Opinion on Biological Therapy | Year: 2014

Background: Obesity has long been associated with psoriasis and it is considered to be an independent risk factor for chronic heart diseases in these patients. Recently, some of the biologic drugs used for psoriasis have been reported to cause increase in body weight. It is currently not clear if this increased body weight seen in psoriasis patients on biologics leads to decrease in there efficacy or vice versa. We carried out this study to see if reduction in body weight leads to increased efficacy of biologics in obese psoriasis patients. Objective: To evaluate the effect of weight reduction by dietary control on treatment efficacy of biologics in obese patients as indicated by the Psoriasis Area and Severity Index (PASI) score. Methods: Obese patients with psoriasis receiving biologic therapy, satisfying the inclusion criterion, were randomized in a 1:1 ratio to receive low-calorie diet versus normal diet (control group). We included 262 patients with moderate to severe, stable plaque psoriasis with a PASI score 20:50 on anti TNF-α biologic therapy (infliximab, etanercept, ustekinumab and adalimumab). The patients in the dietary intervention group were given a low calorie diet (≤ 1000 kcal per day) for 8 weeks to induce weight loss. The treatment outcome was assessed using PASI. The PASI scores were assessed at baseline and every 4 weeks up to week 24. Results: There were no significant differences in age, sex distribution, body weight, body mass index, waist circumference, psoriasis duration, or PASI score between the two studied groups at base line. At week 24, the mean (±SD) weight loss was 12.9 ± 1.2 kg in the diet intervention group, and -1.5 ± 0.5 kg in the control group. The average improvement in mean PASI score was 84% for the diet group, and 69% for the control group. PASI 75 was achieved by 85.9% in the diet group, and 59.3% in the control group (p < 0.001). The mean (±SD) body surface area values at week 24 were 3.3 ± 4.4% and 8.1 ± 6.9% in the diet group and control group. Conclusions: Body weight reduction in obese patients on biologics may increase the efficacy of the drug. © 2014 Informa UK, Ltd.

Al-Mutairi N.,Kuwait University | Eldin O.N.,Farwaniya Hospital
Indian Journal of Dermatology, Venereology and Leprology | Year: 2011

Background: Alopecia areata (AA) is the most common cause of localized, non-scarring alopecia. Stress and other psychological factors have been implicated in the causation of the disease, and it is also found to alter the course of the disease process. Unfortunately no one has studied the impact of AA on the quality of life, which includes the social life of the patients. Aim: To study the clinical profile and impact of alopecia areata on the quality of life, including the social life of adult patients with severe forms of the disease. Methods: The present study determined the clinical pattern of AA and its impact on the quality of life (QOL) in all the patients with severe forms of alopecia areata attending the Dermatology Outpatient Department. Results: The male: female ratio was 1.86: 1. Most (58.03%) of the patients were between 21 and 40 years of age. Almost 40% of the patients had associated systemic disease or other dermatological disorders. A family history of AA was found in 593 (20.02%) of the patients. Nail changes were observed in 297 (10%) of the patients. There were significant differences between the mean Dermatology Life Quality Index (DLQI) score in cases with severe forms of AA and controls (p0 < 0.001). Conclusions: Severe forms of alopecia areata had a major impact on the psychosocial well-being of the patients. These individuals had to be treated early, and they required more than just prescription drugs. Educational and psychological support in addition to medical therapy for AA could improve their long-term physical outcomes.

El-Shazly M.,Farwaniya Hospital | Eissa B.,Cairo University
Urologia Internationalis | Year: 2013

Introduction: Varicocele affects up to 15% of men in the general population. In couples with subfertility, the prevalence of varicocele in male partners was about 12%. In certain countries like the Middle East and Arabian Gulf, it is not rare to find people in their 5th or 6th decades or even older, who are seeking infertility clinics wishing to achieve paternity. Objectives: What are the results of laparoscopic varicocelectomy in relatively older infertile men (>40 years) in comparison with young infertile men (<40 years)? Methods: It is a prospective observational study done in Farwaniya Hospital, Kuwait. Patients (83 cases) were categorized into two age groups: group I (55 patients) with age ranging from 25 to 40 years, and group II (28 patients) with age >40 years (range 41-53 years). Cases with clinically detectable varicocele only were included (grade II and III). Cases who underwent varicocelectomy for pain were excluded from the study as well as cases with previous abdominal surgeries. Cases with subclinical and mild varicocele (grade I) were also excluded from the study. The intra- and postoperative parameters as well as the improvement in semen quality were compared in both groups. Patients were seen after 3 and 6 months as outpatients. Cases were followed up for a mean period of 1 year (range from 6 to 22 months). Results: The intraoperative and postoperative parameters as well as the improvement in semen quality were compared in both groups. There was colonic adhesion to the posterior peritoneum covering internal spermatic veins in 3 cases in group I (3.6%) and in 5 cases in group II (17.8%). This required more dissection to retract the colon and to expose the internal spermatic veins. The mean operative duration for laparoscopic varicocelectomy was significantly longer in group II (75 vs. 45 min in group I). After 3 months, 26 cases (47.2%) of group I and 11 cases (39.2%) of group II had improvement in semen quality. After 6 months, there was improvement in semen quality in 32 cases (58.2%) in group I and in 15 cases in group II (53.5%). Conclusions: Laparoscopic varicocelectomy in relatively old men is sometimes more difficult technically with relatively longer operative duration. However, it can achieve improvement in semen quality comparable to relatively younger patients. Further randomized controlled trials are needed to draw a more relevant conclusion about the impact of age in the outcome of laparoscopic varicocelectomy. © 2013 S. Karger AG, Basel.

Ismail E.A.,Farwaniya Hospital | Seoudi T.M.,Farwaniya Hospital | Al-Amir M.,Farwaniya Hospital | Al-Esnawy A.A.,Farwaniya Hospital
Pediatrics International | Year: 2013

Background Neonatal suppurative parotitis is a rare disease. Only 32 cases were reported in the English-language literature between 1970 and 2004. Methods We searched Medline for acute, neonatal, bacterial, suppurative, parotitis, facial, preauricular swelling starting from 1970, limiting our search to the English-language literature. We reviewed all the reported cases together with three more managed in our department. Results We identified nine new cases since 2004. The total number of patients reviewed was 44, including our patients. Most of them were male (77%). The majority developed unilateral inflamed parotid swelling (77%) and exuded pus from the ipsilateral Stensen duct. Fever was seen in fewer than half of them (47%). Premature babies constituted a third of the patients. Staphylococcus aureus was the leading causative agent (61%). Most patients responded well to conservative treatment with antibiotics (77%). The most frequently used combination of antibiotics was an anti-staphylococcal agent with either an aminoglycoside or a third-generation cephalosporin. A minority required surgical drainage. No deaths were reported in the group studied after 1970. Conclusion Neonatal suppurative parotitis is rare but easy to diagnose and if readily treated with appropriate antibiotics the outcome is excellent. © 2012 The Authors.

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