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Mubārak al Kabīr, Kuwait

Adekile A.,Kuwait University | Mullah-Ali A.,Mubarak Al Kabeer Hospital | Akar N.A.,Mubarak Al Kabeer Hospital
Acta Haematologica | Year: 2010

Hemoglobin (Hb) SD-Los Angeles compound heterozygotes usually have a severe clinical course although the effect of an elevated Hb F on the clinical phenotype has not been reported previously. We describe 5 Kuwaiti children with Hb SD associated with Hb F levels >20%. They all presented with sickling-related symptoms by ≤2 years of age and have been followed for 3-15 years. All had severe clinical courses marked by varying degrees of splenic sequestration crises, acute chest syndrome, vaso-occlusive crises, osteomyelitis and avascular necrosis of the femoral head. This pattern is in contrast with the usually mild presentation in Kuwaiti Hb SS patients with elevated Hb F. It therefore appears that Hb F does not ameliorate the clinical phenotype in Hb SD-Los Angeles. The reasons for this are not quite clear. © 2010 S. Karger AG, Basel.

Alfadhli S.,Kuwait University | Ghanem A.A.M.,Mubarak Al Kabeer Hospital | Nizam R.,Kuwait University
International Journal of Rheumatic Diseases | Year: 2016

Background: Systemic lupus erythematosus (lupus) is an autoimmune disease characterized by multiorgan pathology, accelerated apoptosis and hyper-autoantibody production against self-components. The root cause of lupus remains unknown, although multiple susceptibility factors have been reported in different ethnic group. Objective: We aimed to explore the genome-wide differential expression spectrum of lupus and its severe form lupus nephritis (LN) in Arab females. Methods: A total of 98 subjects: 40 lupus, 18 LN and 40 age/gender/ethnically matched healthy controls (HC) were recruited. Carefully chosen subjects (n=11) were employed for whole human-genome expression profiling using high-density Human Exon 1.0.ST arrays (Affymetrix) and statistical analysis was carried out using appropriate software. Validation cohorts (n=98) were investigated to quantify the expression of the nine selected candidate genes relative to GAPDH as endogenous control. Results: Genome-wide differential analysis revealed seven candidate genes in lupus and 36 in LN, when individually compared to HC (anova Welch t-test, P≤0.005, Tukey's honestly post hoc analysis). Analysis of differentially expressed genes with a fold change of 2, revealed 16 Gene Ontology terms satisfying a P≤0.05. We further detected five distinct inflammatory and metabolic pathways such as TWEAK, osteopontin, endochondral ossification, fluropyrimidine activity and urea cycle and metabolism of amino groups that significantly contribute to the pathogenesis of lupus (P<0.05). Validation of selected candidate genes (IRF9, ABCA1, APOBEC3, CEACAM3, OSCAR, TNFA1P6, MMP9, SLC4A1) revealed significant differences in expression, indicating their promissory role in the pathogenesis of lupus. Conclusion: Our study provides central gene regulators of therapeutic potential, indicating the future prospects of the study. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Shehab D.,Kuwait University | Al-Jarallah K.,Kuwait University | Mojiminiyi O.A.,Kuwait University | Al Mohamedy H.,Mubarak Al Kabeer Hospital | Abdella N.A.,Kuwait University
Diabetic Medicine | Year: 2012

Aim Despite recent reports linking vitamin D deficiency with increased risk of diabetes mellitus and complications, there is limited data on patients with diabetic peripheral neuropathy. We aimed to evaluate the incidence and associations of vitamin D deficiency in 210 patients with Type 2 diabetes with and without diabetic peripheral neuropathy. Methods Renal, liver, lipid profile and HbA 1c were measured. Vitamin D status was determined by measuring 25-dihydroxyvitamin D. Presence or absence of coronary heart disease was determined and early-morning urine microalbumin:creatinine ratio was measured. All patients were assessed clinically using neuropathy symptom score, neuropathy disability score and nerve conduction study. Results Eighty-seven patients had diabetic peripheral neuropathy and these patients had significantly longer duration of diabetes and higher HbA 1c. Age, gender, incidence of retinopathy and coronary heart disease were not significantly different from those without neuropathy. Mean (SD) vitamin D was significantly lower in those with neuropathy [36.9 (39.9)nmol/l] compared with those without [58.32 (58.9)nmol/l] and 81.5% of patients with neuropathy had vitamin D deficiency compared with 60.4% of those without. Vitamin D showed significant (P<0.05) correlations with total cholesterol, LDL-cholesterol and urine microalbumin:creatinine ratio. Binary logistic regression analysis showed that diabetic peripheral neuropathy was significantly associated with vitamin D deficiency (odds ratio=3.47; 95% CI=1.04-11.56, P=0.043) after inclusion of potential confounders such as duration of diabetes, HbA 1c and LDL-cholesterol. Conclusion Vitamin D deficiency is an independent risk factor for diabetic peripheral neuropathy, and further studies are required to confirm if Vitamin D supplementation could prevent or delay the onset. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Abalkhail S.I.,Mubarak Al Kabeer Hospital
Kuwait Medical Journal | Year: 2014

Tuberculosis of the thyroid gland is rare. The true incidence is unknown. We describe the case of a 33-year-old woman who presented with a thyroid mass and cervical lymphadenopathy. She was thyrotoxic, an extremely rare presentation of thyroid tuberculosis. The diagnosis was established with fine needle aspiration cytology (FNAC) of the thyroid and histopathology of a lymph node. The patient was treated with anti-tuberculous therapy with complete resolution of her disease. Although thyroid tuberculosis is rare, it should be considered in the differential diagnosis of nodular thyroid enlargement and granulomatous thyroid lesions. © 2014, Kuwait Medical Association. All rights reserved.

Ghani A.A.,Mubarak Al Kabeer Hospital
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2010

Preoperative severe renal impairment is included in the risk scores to predict outcome after open cardiac surgery. The purpose of this study was to assess the impact of preoperative mild renal impairment on the early postoperative mortality after open heart surgery. Data of all cases of open cardiac surgery performed from January 2005 to June 2006 were collected. Cases with preoperative creatinine clearance below 60 mL/min were excluded from the study. Data were retrospectively analyzed to find the impact of renal impairment on short-term outcome. Of the 500 cases studied, 47 had preoperative creatinine clearance between 89-60 mL/min. The overall mortality in the study cases was 6.8%. The mortality was 28.7% in those who developed postoperative ARF, 33.3% in those who required dialysis and 40.8% in those with preoperative mild renal impairment. Binary logistic regression analysis showed that female gender (P = 0.01), preoperative mild renal impairment (P = 0.007) as well as occurrence of multi organ failure (P < 0.001) were the only independent variables determining the early postoperative mortality after cardiac surgeries. Among them, preoperative mild renal impairment was the most significant and the best predictor for early postoperative mortality after cardiac surgery. Our study suggests that renal impairment remains a strong predictor of early mortality even after adjustment for several confounders.

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