Ministry Of Health - Kuwait
  • Kuwait City, Kuwait
Recent publications
Introduction: Semaglutide (S) is a glucagon-like peptide-1 receptor agonist that is approved by Food and Drug Administration for treatment of type 2 diabetes and obesity. Moreover, it reduced the risk of renal failure, cardiovascular death rates, nonfatal myocardial infarction, and nonfatal stroke. Initially, adverse effects (AE) were mainly gastrointestinal. However, there is growing concern about rarer and more serious AE, such as higher risk of pancreatitis, bowel obstruction, gastroparesis, and venous thrombosis. Arterial disease, leading to renal infarction, has not been reported following its use. Case Report: A 51-years-old man presented with sudden left loin pain for two days. Computed tomography with contrast showed wedge-shaped avascular anterior aspect of left kidney. Arteriogram showed abrupt loss of flow in a corresponding 1 of the 2 feeding arteries to left kidney without focal abnormalities in its proximal portion, second left renal artery, right one, aorta, and its branches. The patient did not have family history or laboratory evidence of hypercoagulable disorder. Echocardiogram did not show mural and valvular disease. 24-hour Holter-monitoring did not show arrhythmia. S was the only medication he had received in the previous six weeks for moderate obesity. The drug was discontinued, and the patient was treated with heparin for three days then Rivaroxaban 20 mg daily for six months. On follow-up, he did not have subsequent thrombotic events up to 1 year of follow-up. Conclusion: In selected population, S can induce arterial thrombosis-in-situ.
The landscape of nuclear medicine is undergoing a profound transformation, driven by the rapid evolution of radiopharmaceuticals. These innovative agents are redefining the boundaries of diagnostic imaging and targeted therapy, offering unprecedented opportunities for precision medicine. This comprehensive review article provides a cutting-edge overview of the emerging trends and applications of radiopharmaceuticals in diagnostic imaging and therapy. We delve into the latest advancements in radiopharmaceutical design, synthesis, and application, including the development of novel isotopes, peptides, and antibodies. The article highlights the growing importance of Theranostics, immuno-PET, and alpha-particle therapy in cancer diagnosis and treatment, as well as their potential applications in neurology, cardiology, and infectious diseases. Furthermore, we examine the challenges and future directions in radiopharmaceutical development, including the need for standardized manufacturing processes, improved regulatory frameworks, and enhanced radiation safety measures. We also discuss the role of artificial intelligence, machine learning, and big data analytics in accelerating the development and application of radiopharmaceuticals. This review article aims to provide a roadmap for the future development and application of radiopharmaceuticals in diagnostic imaging and therapy, highlighting the vast potential of these innovative agents to revolutionize the field of nuclear medicine and improve patient outcomes. Key words: Radiopharmaceuticals, Nuclear medicine, Diagnostic imaging, Therapy, Oncology, Neurology, Cardiology, Infectious diseases, Theranostics, Immuno-PET, Alpha-particle therapy, Precision medicine, Personalized medicine, Artificial intelligence, Machine learning, big data analytics, Radiopharmaceutical development, Regulatory frameworks, Radiation safety, Molecular imaging.
A BSTRACT Introduction Bilateral sagittal split osteotomy (BSSO) is the most performed orthognathic surgery for mandibular dentofacial abnormalities. The most common complication is the neurosensory deficit. The current study was aimed at determining the incidence of inferior alveolar nerve neurosensory deficit (NSD) following BSSO surgery, and in assessing intra-operative nerve encounter status and possible relation to NSD. Materials and Methods The pilot study was conducted in the Oral and maxillofacial surgery department, KIMS Dental college and hospital, Amalapuram, Andhra Pradesh. The sample of thirty subjects were selected from the patients undergoing BSSO surgeries from April 2022- July 2023, as according to the inclusion and exclusion criteria. Patients were followed up for six months postoperatively. The evaluation was done preoperatively and postoperatively (1week, 1 month, 3 months, 6months) using subjective and objective methods. NSD was assessed by both subjective (Five-point scale) and objective (2-point discrimination, pin pressure, and thermal discrimination) tests. Statistical Analysis Descriptive statistics were used. Results Post-osteotomy, the inferior alveolar nerve was in the distal fragment in 36 (60%) of the sites, 14 (22%) on the proximal fragment and needed dissection, 10 (18%) not seen post osteotomy, and nil (0%) got transected. The incidence of prolonged NSD was highest seen in the proximal fragment needing dissection. The neurosensory deficit after BSSO was 21.5% in post-six-month follow-up. Conclusion The incidence of transient neurosensory deficit of the inferior alveolar nerve after BSSO surgeries is inevitable. Prolonged NSD is due to nerve manipulation depending on the nerve status intra-operatively.
Background and Aims Brachial plexus block (BPB) is advantageous for elective orthopaedic or reconstructive upper limb surgery. However, the optimal local anaesthetic in BPB remains debatable. Therefore, we aim to investigate the efficacy and safety of levobupivacaine versus ropivacaine in BPB for upper limb surgery. Methods A systematic review and meta-analysis synthesising randomised controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, Google Scholar, and CENTRAL since inception till June 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with a 95% confidence interval (CI), using Stata v. 17. We assessed heterogeneity using the Chi-square test and I ² statistic. Results Sixteen RCTs and 939 patients were included. Levobupivacaine was significantly associated with a longer sensory block duration [MD: 1.66 (95% CI: 1.43, 1.89), P < 0.001] and motor block duration [MD: 1.18 (95% CI: 0.11, 2.26), P = 0.03]. However, there was no difference between both groups in time to sensory block [MD: −0.30 (95% CI: −1.31, 0.71), P = 0.56], time to motor block [MD: −0.29 (95% CI: −1.26, 0.67), P = 0.55], pain score [MD: −0.48 (95% CI: −2.13, 1.16), P = 0.56], rescue analgesia rate [RR: 0.94 (95% CI: 0.74, 1.20), P = 0.64], and complications [RR: 0.47 (95% CI: 0.20, 1.13), P = 0.09]. Conclusions Levobupivacaine is significantly associated with a longer duration of sensory and motor block in patients undergoing BPB for upper limb surgery compared to ropivacaine, with a similar safety profile. However, there was no difference regarding the time to onset of the sensory or motor block.
Due to their superior physicochemical features, chitosan thermosensitive hydrogels are multipurpose platforms that are frequently used in the biomedical industry. Many investigations have been conducted recently to modify their pore dimensions, expansion, biodegradability, stimulus-reaction characteristics, and other characteristics in order to better tailor them to the complex craniofacial tissues. They have been the focus of various studies that have attempted to load biological cargos for therapeutic and regenerative uses in the oro-facial tissues. This article assesses the utility and advancements of chitosan thermosensitive hydrogel-based pharmaceutical delivery devices for the management of craniofacial disorders such as dental caries, endodontic diseases, periodontitis, temporomandibular disorders, mucosal diseases, cancer, and so forth.
Human papillomaviruses (HPV) are known to be a causative agent for a number of papillary lesions. The variants HPV-16 and HPV-18 have been linked with cervical, oropharyngeal, and lung cancers. HPV is also responsible for HPV-related oral lesions (HPVOL), which can clinically manifest as squamous papilloma, verruca vulgaris, condyloma acuminatum, and multifocal epithelial hyperplasia. This review paper presents cases of benign oral manifestations of HPV infections in patients attending oral medicine clinics in Kuwait. We present a case series of human papillomavirus-related oral lesions (HPVOL) presented to our oral medicine clinics, with emphasis on the possible risk factors for its increased incidence. Known risk factors for the development of an HPV infection have been highlighted with emphasis on changing sexual practices, smoking, alcohol consumption, and poor oral hygiene in the EMENA region. While the prevalence of oral HPV in men and women aged between 14 and 69 years is around 7%, unsafe sex practice was scored the lowest in Kuwait. Further, there tends to be a higher prevalence of HPV oral infection with smoking and alcohol intake, and both can act synergistically in the presence of an oral HPV infection, further increasing the oncogenic potential of HPVOL. Poor oral hygiene is also a known factor in HPVOL.The role of dental practitioners is to raise awareness of the risk of developing HPV and the preventive measures to reduce that risk. These include engaging in safe sexual practices, smoking cessation, and improving oral hygiene. Incorporating the HPV vaccine into the national immunization scheme could contribute to increase in vaccine uptake and hence better population immunity. The recognition of the clinical presentations of HPVOL as presented herein, facilitates dentists’ diagnostic skills and aids in making appropriate referrals.
This study aims to discover how the daily usage of social media platforms affects the users’ second language learning. The study has been conducted in public high schools in Kuwait from different areas. A questionnaire has been distributed to the high school students to seek their opinions about social media usage and to test their language skills in English. The questionnaire was distributed on a random sample of 300 volunteering participants has been obtained through the online survey. An interview has been also conducted with high school English teachers to get sufficient information about the social media usage and its effect on their students. Four teachers were asked to provide random grades of their students to check how they are affected. Another questionnaire has been added to know whether the social media platforms usage during the Covid-19 Pandemic helps in the language skills. The approach that has been used to conclude our results is a mixed method of qualitative and quantitative approaches. The results have shown that the skills of the language can be improved by the usage of the social media platforms specially the listening, speaking, and reading skills. The writing skill, however have not shown any improvement after using the social media platforms. Therefore, social media applications can be a reliable tool for learning a second language but it has to be under the guidance and supervision of professional teachers.
Background Multisystem inflammatory syndrome in children (MIS-C) is a severe complication arising from SARS-CoV-2 infection, with indications that rare inborn errors of immunity may play a role in its pathogenesis. Recent studies suggest that genetic predispositions, particularly monogenic forms, could significantly influence the immune responses to SARS-CoV-2 in MIS-C. Methods We analysed 24 children under 12 years old, all of whom met the criteria provided by the World Health Organization, 2020 for MIS-C diagnosis, from the Paediatric COVID-19 Registry in Kuwait (PCR-Q8). Demographic and clinical data were collected from medical records, and exome sequencing was performed on the children and their parents to identify rare exonic variants. These variants were prioritized using two approaches: a candidate genes approach employing trio segregation analysis, and a candidate variants approach using a gene panel informed by previous studies on MIS-C-related genetic variants and datasets of differentially expressed genes in MIS-C patients. Results The candidate genes approach identified 53 unique genes in 20 of the 24 probands, including DDX60 and TMEM154, which were also differentially expressed between MIS-C and control groups. The candidate variants approach identified 33 rare, predicted deleterious heterozygous variants across 19 unique genes in 19 of the 24 probands, including both previously described and novel candidate variants for MIS-C. Pathway analysis of the identified genes from both approaches revealed significant involvement in immune response, viral defence, and inflammatory pathways. Conclusion This study underscores the monogenic susceptibility to MIS-C, enhancing the evidence base through comprehensive genetic analysis. The findings highlight the critical role of genetic predispositions in MIS-C and suggest that further functional genomics work is necessary to explore the mechanistic contributions of these genes, facilitating the development of targeted diagnostic strategies.
The current study investigated the relationship between the working memory tasks and the phonological processes of Arab dyslexics in the primary stage in the State of Kuwait. The researchers used the descriptive research design. The sample of the study consists of 500 pupils (250 males and 250 females), their ages range from (9.05 ± 0.49) years old. The researchers used the working memory scale, the phonological awareness scale and the dyslexia examination scale. Findings of the study revealed that there is a negative correlation between Rapid Object Naming Test and both Forward Spatial Span Test and Backward Digit Recall Test. Also, there is a negative correlation between Backward Digit Recall Test and Rapid Letter Naming Test. Results also show that there is no correlation between some phonological processes (Syllables &Sound Deletion Test, Non-Word Repetition Test, and Non-Word Reading Accuracy Test) and the working memory tasks. It is shown that male pupils were slower than their female counterparts in the Rapid Object Naming Test and the Rapid Letter Naming Test. In addition, male pupils better performed in the Syllables & Sound Deletion Test, Non-Word Repetition Test, Non-Word Reading Accuracy Test, Forward Spatial Span Test and Backward Spatial Span Test tasks, Forward Digit Recall Test and Backward Digit Recall Test. It is also revealed that there is no significant difference between males and females in the tests of Sentence Repetition Test and Listening Span Test. With regard to nationality, it is revealed that there are significant differences between Kuwaiti and non-Kuwaiti pupils in the Syllables & Sound Deletion Test, Non-Word Repetition Test, Non-Word Reading Accuracy Test, Sentence Repetition Test and Forward Digit Recall Test in favor of non-Kuwaiti pupils. It is also revealed that there is no significant difference between males and females in the tests of Sentence Repetition Test and Listening Span Test. In addition, it is revealed that the performance of Kuwaiti pupils is slower than that of their non-Kuwaiti counterparts in the tests of Rapid Object Naming, Rapid Letter Naming. Whereas, no significant differences were detected regarding to nationality variable in the Forward Spatial Span Test, Backward Spatial Span Test and Backward Digit Recall Test.
The digital nature of ICD-11, the diversity of its professional users, and the wide range of its applications call for rethinking of ICD-11 training. We recommend an inside-out training approach that starts with the Coding Tool which, like Google, is an easy-to-use search engine. Learners can then expand on the original core in concentric circles of knowledge. Storytelling using the 5P’s structure (Purpose, Place, Person, Process, Platform) can be an effective way of teaching ICD-11 to adult learners for learner-led training and online self-learning courses. Screenshots of ICD-11 tools, including from EHISs with which they are integrated, speech bubbles and emojis bring about familiarity and proximity making training informative, realistic and engaging. Leveraging the power of social media to disseminate training material enables us to reach a broader audience, while visual simulation on local EHIS platforms can reduce the need for in-person computer lab sessions. Today's trainees are different from the trainees of 30 years ago, so why should training stay the same? It shouldn’t!
Objective: To conduct a systematic review and network meta-analysis to evaluate the safety and efficacy of intrapolyp steroid injection compared with oral steroids, nasal steroid wash, nasal steroid spray, and a control group in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Data Sources: PubMed, Scopus, Web of Science, Embase, and CENTRAL. Review Methods: Both randomized and non-randomized clinical trials were included. For risk of bias assessment, we used the RoB-2 and ROBINS-I tools. Our outcomes focused on safety and efficacy, including rates of visual disturbance and bleeding, as well as improvements in nasal polyps evaluated through three domains: endoscopic, radiologic, and patient-reported assessments. Safety data were pooled as events (%), while efficacy data were pooled as mean difference (MD) or standardized mean difference (SMD). Results: Eight clinical trials involving 579 patients were analyzed. The pooled analyses showed low event rates for visual disturbances (event rate = 0.64%, 95% CI [0.00%, 2.23%]) and bleeding (event rate = 0.61%, 95% CI [0.00%, 2.25%]). Additionally, intrapolyp steroid injections were found to be comparable with oral steroids, with no statistically significant differences. Moreover, intrapolyp steroid injections demonstrated some superiority over nasal sprays, nasal washes, and the control group. Conclusion: This network meta-analysis confirms that intrapolyp steroid injections have a favorable safety and efficacy profile as a viable management option for CRSwNP. The injections showed comparable efficacy with oral steroids and demonstrated certain advantages over other treatments, such as nasal sprays and washes. Further research with larger sample sizes and standardized protocols are needed.
Objective . Despite the establishment of a link between telomere status and carcinogenesis, lack of a consensus in the cancer specific pattern of telomere length has a severe impact on the use of relative telomere length (RTL) in cancer diagnosis. The disparity in assessing the relationship between telomere length and cancer risk is complex and may vary as it is influenced by other factors. The objective of this study is to thoroughly examine the intricate relationship between telomere length and cancer incidence in Papillary Thyroid Cancer (PTC) depending on the tumor type, stage, patients’ sex and age. Therefore, the current study is focused on the association of RTL in PTC patients with different clinicopathological characteristics and compared with controls to determine the risk of PTC and expected survival time after surgery. Method . This study included 126 patients with PTC and 80 controls. RTL in thyroid tissues was measured using quantitative (q) PCR. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression analysis. Kaplan-Meier and Cox regression were used to analyze postsurgical outcomes. Result . The RTL of patients was significantly shorter than that of controls. A short RTL was significantly correlated with an elevated risk of PTC in patients aged ≥ 55 years, female sex, classic subtype, and tumor size > 2 cm. A short RTL did not affect the overall survival of patients with PTC; however, it was associated with poor survival in patients with tumor size > 2 cm and tumor invasion. Conclusion . This unique study combines the use of RTL with various clinicopathological features of patients with PTC. In conclusion, RTL is a promising tumor marker that correlates with the clinical characteristics of patients with PTC. Specifically, RTL < 0.6 could be used with age, sex, tumor size > 2 cm and tumor invasion to predict the risk of PTC development and prognosis of the disease. This study will open new horizon in the use of molecular marker such as RTL for understanding its association with increased cancer risk in patients with different clinicopathological features.
The coexistence of spinal muscular atrophy (SMA) with other diseases has been rarely described. We report a unique case with dual pathogenic gene mutations: survival motor neuron 1 (SMN1) gene causing SMA and SLC13A5 gene causing citrate transporter deficiency-induced epilepsy (early infantile epileptic encephalopathy 25, OMIM 615905). A girl presented with recurrent focal seizures with semiology of eyelid blinking, deviation of eyes, and facial twitches, which started on the second day of her life. Interictal EEG showed bilateral multifocal and generalized discharges. Brain MRI revealed delayed myelination and generalized volume loss. PET scan showed diffuse cortical hypometabolism. She had refractory seizures, including two episodes of status epilepticus while being treated with various antiseizure medications. Genetic analysis revealed a homozygous deletion of the SLC13A5 gene at 17p13.1. At 1 year of age, progressive hypotonia, initially ascribed to seizures and antiseizure medications, the appearance of tongue fasciculations and the need for respiratory support, prompted testing for SMA. Mutation at the SMN1 gene locus (5q11.2-13.2) was found and an SMA type I diagnosis was established. EMG/nerve conduction velocity revealed a motor neuron disorder. She was started on nusinersen at the age of 2.5 years once it became available. She was tracheostomized for bilevel positive airway pressure support. At the age of 4.5 years, she had a cardiac arrest and passed away. This is a case report of coexistent mutations in the SMN1 and SCL13A5 genes with overlapping and diagnostically confusing features of progressive hypotonia. The constellation of these separate genetic entities constitutes a clinical phenotype that has not been reported previously.
Background: Myocardial perfusion imaging (MPI) is a type of single-photon emission computed tomography (SPECT) used to evaluate patients with suspected or confirmed coronary artery disease (CAD). Detection and diagnosis of CAD are complex processes requiring precise and accurate image processing. Proper segmentation is critical for accurate diagnosis, but segmentation issues can pose significant challenges, leading to diagnostic difficulties. Machine learning (ML) algorithms have demonstrated superior performance in addressing segmentation problems. Methods: In this study, a deep learning (DL) algorithm, U-Net, was employed to enhance segmentation accuracy for image segmentation in MPI. Data were collected from 1100 patients who underwent MPI studies at Al-Jahra Hospital between 2015 and 2024. To train the U-Net model, 100 studies were segmented by nuclear medicine (NM) experts to create a ground truth (gold-standard coordinates). The dataset was divided into a training set (n = 100 images) and a validation set (n = 900 images). The performance of the U-Net model was evaluated using multiple cross-validation metrics, including accuracy, precision, intersection over union (IOU), recall, and F1 score. Result: A dataset of 4560 images and corresponding masks was generated. Both holdout and k-fold (k = 5) validation strategies were applied, utilizing cross-entropy and Dice score as evaluation metrics. The best results were achieved with the holdout split and cross-entropy loss function, yielding a test accuracy of 98.9%, a test IOU of 89.6%, and a test Dice coefficient of 94%. The k-fold validation scenario provided a more balanced true positive and false positive rate. The U-Net segmentation results were comparable to those produced by expert nuclear medicine technologists, with no significant difference (p = 0.1). Conclusions: The findings demonstrate that the U-Net model effectively addresses some segmentation challenges in MPI, facilitating improved diagnosis and analysis of mega data.
Danon disease (DD) is a rare X-linked disorder secondary to lysosomal-associated membrane protein 2 (LAMP2) deficiency that manifests as hypertrophic or dilated cardiomyopathy. We report an obscure presentation of DD in a 14-year-old female patient diagnosed using cardiac imaging including echocardiography and cardiac magnetic resonance imaging. A final diagnosis of DD was made after identification of LAMP2 genetic variant. The diagnosis of DD requires a high index of suspicion, particularly in female patients with atypical phenotypes. This case highlights the necessity of a holistic approach for early detection.
BACKGROUND: Little is known about the relationship between physical activity (PA) and metabolic syndrome in the Kuwaiti population. This is the first study to examine the relationship between PA and metabolic syndrome in a nationally representative sample of adult Kuwaitis. METHODS: Data from the STEPS survey of noncommunicable disease (NCD) risk factors in Kuwait were used for this secondary cross-sectional study with a total of 1616 adults (726 males; and 890 females) aged 18-69 randomly sampled from the target population using the database of the Public Authority of Civil Information (PACI). RESULTS: The Body Mass Index (BMI) of females was higher than males (31.5±7.7 vs. 29.4±5.1). Males had higher metabolic equivalent than females (2202±3394.8 vs. 1180±2379.5). The total prevalence of metabolic syndrome in Kuwaiti males and females was 28.4%. The relationship between total metabolic equivalent and the Metabolic syndrome was negatively correlated (r=-0.196), also annual household income was negatively correlated with Metabolic syndrome; the higher level of income the lower presence of metabolic syndrome. Finally, Metabolic Syndrome Score can be predicted by gender, age, BMI and Total Metabolic Equivalent (MET) as a predictors which explain approximately 32.6% of the variance in Metabolic Syndrome Score. CONCLUSIONS: The prevalence of metabolic syndrome in Kuwait is alarmingly high. Sedentary lifestyles and high caloric intake are few of the responsible factors. Therefore, the Ministry of Health and Policy makers should adapt strategies to promote higher levels of physical activity such as using sidewalks and bicycling facilities and promoting public health messages to decrease caloric intake.
Weight recurrence (WR) is a frequent complication in patients post metabolic and bariatric surgery (MBS) ⁽¹⁾ . However, there is no consensus on WR definitions ⁽²⁾ . Patients’ preoperative characteristics are believed to have an association with WR ⁽¹⁾ . This study aimed to evaluate WR 3 to 13 years after laparoscopic sleeve gastrectomy (LSG) using three commonly used definitions and investigate potential risk factors. A retrospective analysis examined data from patients’ medical records who underwent primary LSG between 2008 and 2019. Inclusion criteria were patients aged 18 years or older, eligible for MBS, and with at least three years of follow-up. Those with previous MBS, revised surgical procedures post-LSG, or who had the surgery in 2019 were excluded. Dividing the analysis into three post-LSG periods (1st year, 2nd year and >2nd year). The primary outcome was WR over time utilizing three definitions: >10% increase in nadir weight, >10% increase in nadir weight (nadir 1 to 2 years), and percentage of excess weight loss (EWL) <50% with a body mass index (BMI) >35 kg/m ² . Survival analysis techniques were used to assess the occurrence and timing of WR. Potential risk factors of WR including age, gender, BMI, obesity-related comorbidities, duration post-LSG, and attendance to follow-up visits were assessed using binary logistic regression. Only 219 out of 2982 patients met the inclusion criteria and were included in the analysis. Patients’ mean age and BMI were 37.21 ± 10.44 years and 45.92 ± 6.99 kg/m ² , respectively, with females constituting the majority (64%). Weight recurrence varied between different definitions, ranging from 31% to 61%. The estimated median time for WR was significant starting from 9 years when applying the nadir weight definitions while from 6 years when EWL<50% & BMI>35 kg/m ² definition was used. Binary logistic regression analysis identified several risk factors for WR considering the definition of EWL <50% with BMI >35 kg/m ² : older age [OR 1.104, 95% CI (1.0591.151), p -value <0.001] and higher preoperative BMI [OR 1.352, 95% CI (1.242-1.473), p -value <0.001]; while male gender [OR 0.314, 95% CI (0.137−0.720), p -value 0.006] and frequent follow-up visits [OR 0.528, 95% CI (0.382−0.730), p -value <0.001] were protective factors against WR. Other definitions did not demonstrate significant associations except for a longer duration post-LSG as a risk factor for WR when applying the definition of >10% increase from nadir weight (nadir weight 1 to 2 years) [OR 1.153, 95% CI (1.050-1.267), p -value 0.003]. This study explored factors that influenced WR post-LSG. Potential risk factors including age, gender, BMI, and time varied according to the WR definition applied. More research is necessary to establish a consensus on a suggested definition that aligns with the clinical parameters and comorbidity status of patients for application in upcoming research and clinical settings.
Background Understanding of the factors influencing oesophageal cancer trends is crucial. Therefore, this cross-sectional cohort study sought to disentangle the age, period and cohort effects on the trends of oesophageal cancer in Kuwait. Methods The data on incident oesophageal carcinoma cases diagnosed between January 1, 1980, through December 31, 2019, and reference population were obtained. Age-period-cohort (APC) analysis was conducted using a loglinear Poisson regression model. Results A total of 496 oesophageal carcinoma cases in 12.8 million person-years (i.e. squamous-cell carcinoma, 269, 54.23%), adenocarcinoma,147, 29.64% and unspecified cases, 80,16.13%) were diagnosed. The overall age-standardized incidence rate (per 105 person-years) of oesophageal carcinoma during the study period was 10.51 (95% CI: 6.62–14.41). The APC analysis results showed that the age and birth cohort effects were the significant determinants of declining, and subsequently steadying the oesophageal carcinoma incidence rates. Conclusions A substantial decline in oesophageal carcinoma incidence rates was recorded, which significantly varied in all three temporal dimensions. The observed birth cohort patterns suggest changing lifestyle and dietary patterns seem to be responsible for decreasing oesophageal carcinoma risk in Kuwait. Future studies may look for the component causes maintaining the endemicity of oesophageal carcinoma risk in this and similar countries in the region.
Background In a global effort to assess expert perspectives on the use of recombinant gonadotropins, recombinant human luteinizing hormone (r-hLH) and recombinant human follicle-stimulating hormone (r-hFSH), a consensus meeting was held in Dubai. The key aim was to address three critical questions: What are the factors that influence follicle response to gonadotropins? Which categories of patients are most likely to benefit from LH supplementation? And what are the optimal management strategies for these patients? Methods A panel of thirty-six experts reviewed and refined the initial statements and references proposed by the Scientific Coordinator. Consensus was defined as agreement or disagreement by more than two-thirds (66%) of the panel members for each statement. Results Thirty-five statements were formulated, of which thirty-one reached consensus. For patients with Hypo-Response to Gonadotropin Stimulation (20 statements), all identified risk factors, including advanced age, high BMI, and chronic conditions, achieved unanimous agreement. Diagnostic approaches, such as the inclusion of POSEIDON criteria and hormone level monitoring, were endorsed by the majority, with over 90% agreement. Management strategies, particularly individualized stimulation protocols and optimized scheduling, garnered broad consensus, with only one statement falling short of the threshold. Additionally, in cases of severe FSH and LH deficiency, combining r-hFSH with r-hLH was found to improve pregnancy rates and cost efficiency compared to human menopausal gonadotropin (hMG). For patients with Advanced Maternal Age (AMA) (15 statements), there was strong agreement on the use of oral contraceptive pills and estrogen priming. Recommendations concerning antagonist protocols and dosing of r-hLH and r-hFSH also achieved high levels of consensus. Significant agreement supported r-hLH supplementation and a tailored approach to luteal phase support. However, there were mixed opinions on the route of progesterone administration, with some experts expressing neutral or disagreeing views. Despite these differences, unanimous consensus was reached on markers of treatment success, particularly live birth rates, pregnancy rates, and embryo development, underscoring the importance of these outcomes in evaluating treatment efficacy. Conclusion This consensus provides a practical clinical perspective to a wide range of global professionals on the strategies employed during key phases of Assisted Reproductive Technology (ART) treatment. To further improve outcomes, incorporating additional clinical insights on ART approaches, alongside existing guidelines and policies, may offer valuable guidance for optimizing patient care.
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371 members
Anas Alyousef
  • Department of Nephrology
Maddi Shyama
  • Pedodontics with Preventive Dentistry
Torki Al-Otaibi
  • Department of Nephrology
Petr Schütz
  • Oral&Maxillofacial Surgery, Al-Farwaniya Dental Center
Mahmoud A Alfeeli
  • Department of Nuclear Medicine
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Kuwait City, Kuwait