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Background and aimHeart failure is still a leading cause of mortality and morbidity. Assist devices are reserved for advanced heart failure patients with no other therapeutic options.We aim in this paper to describe the characteristics and outcome of Lebanese left ventricular assist device (LVAD) patients.ResultsFrom 2010 till December 2019, 78 patients were implanted with assist devices at the Beirut cardiac Institute, 82 pumps were used. To the most recent follow up after 10 years, 26 patients died (34%). 24 patients of 35 (68%) survived more than 5 years. Seven patients only (9%) died during one month of surgery. One year mortality was 19% (15 patients). The leading cause of early mortality was infection, whereas cerebrovascular accidents CVA were the leading cause of late mortality. Pump thrombosis occurred in 12% of the cases. The most serious long term complication was haemorrhagic CVA. Only seven patients (9%) received heart transplantation, with a mean time on support prior to transplantation of 1303 ± 213 days.ConclusionIn this manuscript we reported the characteristics and outcome of the largest population of LVAD patients in Lebanon. The survival rate was 81% at one year. These findings were comparable to the international registries except for rates of heart transplantation. More efforts should be made to encourage organ donation in Lebanon.

Allelic diversity of human leukocyte antigen (HLA) class II genes may help maintain humoral immunity against infectious diseases. In this study, we investigated germline genetic variation in classical HLA class II genes and employed a systematic, unbiased approach to explore the relative contribution of this genetic variation in the antibody repertoire to various common pathogens. We leveraged a well-defined cohort of 800 adults representing the general Arab population in which genetic material is shared because of the high frequency of consanguineous unions. By applying a high-throughput method for large-scale antibody profiling to this well-defined cohort, we were able to dissect the overall effect of zygosity for classical HLA class II genes, as well as the effects associated with specific HLA class II alleles, haplotypes and genotypes, on the antimicrobial antibody repertoire breadth and antibody specificity with unprecedented resolution. Our population genetic studies revealed that zygosity of the classical HLA class II genes is a strong predictor of antibody responses to common human pathogens, suggesting that classical HLA class II gene heterozygosity confers a selective advantage. Moreover, we demonstrated that multiple HLA class II alleles can have additive effects on the antibody repertoire to common pathogens. We also identified associations of HLA-DRB1 genotypes with specific antigens. Our findings suggest that HLA class II gene polymorphisms confer specific humoral immunity against common pathogens, which may have contributed to the genetic diversity of HLA class II loci during hominine evolution.

Background and objectives: In Kuwait, information regarding public knowledge and attitudes towards organ donation are scanty This study aimed to evaluate public knowledge and attitude regarding organ donation and determine factors which predict them. Methods: This cross-sectional study was conducted among 630 participants recruited from 27 randomly selected public cooperative societies and private supermarkets in Kuwait. A self-administered questionnaire was used to collect data. Results : The prevalence rate of knowledge about organ donation was 68%, with a significantly higher rate among females than males (73% vs. 63%, respectively, p = 0.01). A composite score of knowledge was also higher among females than males (8.4 ± 5.8 vs. 6.8 ± 5.8, respectively, p = 0.001). In multivariate analysis, female gender ( OR = 1.7; 95% CI =1.2, 2.4) and an educational level of bachelor’s degree or higher ( OR = 2.6, 95% CI = 1.7, 3.9) were significant predictors of the knowledge. Among the barriers, more females than males mentioned about the fear of the operative procedures ( p

Determining the tangential mechanical properties of a tube is essential for simulation of various manufacturing processes that involve the use of a tubular geometry. The aim of this study is to develop a procedure to determine the tangential true stress-strain behavior of pipes. For this purpose a modified ring test setup is proposed consisting of a ring specimen loaded with two separate D-blocks. Using a finite element model, an optimized ring specimen geometry is obtained. The optimized ring specimen exhibits uniform tangential distribution in the gauge region of the specimen and necking occurs consistently at the center of the gauge length. It is found that friction has a substantial effect on the mechanical response of the ring test for which two different setups to reduce friction are proposed. One using lubricated D-blocks (DB) and one using lubricated D-blocks with needle roller bearing (RB). Assisted by the FE model, the friction during the experiment is account for and a data analysis procedure to determine the tangential stress-strain curve of the pipe is proposed. It is found that the results using this procedure show very good agreement with previously published results.

This research work aims at evaluating the accuracy of a clean-up endpoint set by Lebanese authorities for sandy beaches following an oil spill that hit Lebanon in 2006. This was done by evaluating two factors affecting clean-up endpoint determination: background levels of Total Petroleum Hydrocarbons (TPH) in beaches, and TPH mobility. To determine background TPH levels, TPHs were analyzed in beaches that were not affected by the oil spill, and in beaches that were affected by the spill but were subject to subsequent treatment. The TPH concentrations of the two types of beaches were not statistically different, and averaged 249 mg kg−1 of sand. To measure TPH mobility, leaching tests were performed on a stockpile of untreated contaminated sand (110 g of TPH/kg sand). The average TPH concentration in the sand leachate (19.9 mg L−1 ± 7.04) slightly exceeded the national TPH standard of 20 mg L−1. Since the mobility of pollution is associated with toxicity, the evaluation of the clean-up endpoint will depend essentially on the results of the TPH mobility tests. The maximum TPH concentration in treated sand should correspond to TPH levels below 20 mg L−1 in leachate, as per the national standard. More research work, particularly sand clean-up tests and bioassays, is necessary to determine the maximum TPH concentration to be observed in sandy leachates, which would enable us to determine the maximum total TPH concentration allowed in the sand, and thus decide on the accuracy of the clean-up endpoint of 5,000 mg TPH/kg sand.

BACKGROUND AND PURPOSE: The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%–99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes. MATERIALS AND METHODS: We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%–99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first. RESULTS: We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%–99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS. CONCLUSIONS: Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stent-placement arm compared favorably with the WASID results.

BACKGROUND AND PURPOSE: It is important to try to clarify the methodology of vertebroplasty such as amount of cement needed, how many needles to use and the significance of cement extravasation. This prospective study evaluated the potential of vertebroplasty to increase the likelihood of an adjacent vertebral compression fracture (VCF) 1 year or less after vertebroplasty, the correlation between the cement volumes injected and pain relief, and the consequences of cement extravasation. MATERIALS AND METHODS: Pain relief and the incidence of a subsequent fracture of adjacent vertebrae 1 year or less after vertebroplasty were evaluated in 357 patients (660 vertebrae) of mean age 77.5 years with osteoporotic VCFs. The correlation between cement volume and pain relief was assessed with a Pearson correlation coefficient; factors potentially predictive of subsequent adjacent VCFs were explored by multiple logistic regression analysis. RESULTS: Refracture of any vertebrae (adjacent or nonadjacent to the primary fracture) occurred in 18% of the patients 1 year or less after vertebroplasty. Refracture of adjacent vertebrae occurred 1 year or less after vertebroplasty in 12% of the patients. Neither cement volume nor extravasation of cement into the intravertebral disk was a significant predictor of adjacent VCFs. No correlation was found between cement volume and pain relief (r = −0.029). Extravasation of cement into the veins, soft tissue, or disk was observed in 33% of all of the treated VCFs and resulted in no complications. CONCLUSIONS: The incidence of an adjacent VCF 1 year or less after vertebroplasty was comparable with that expected for untreated osteoporotic VCFs. Neither the volume of cement injected nor extravasation of cement into the intravertebral disk affected the likelihood of subsequent adjacent VCFs. Cement volume did not correlate with pain relief.

Among immunocompromised individuals, hyper-infection with Strongyloides stercoralis may occur and lead to fatal strongyloidiasis. To clinicians and laboratory diagnosticians in non-endemic countries such as Kuwait, this severe infection poses a particular problem. The clinical histories and signs and symptoms of four Kuwaiti cases of S. stercoralis hyper-infection were reviewed. Each of the four was found not only to have lived in an area where S. stercoralis was endemic but also to have been treated with immunosuppressive steroids (for medical problems unrelated to the nematode infection). When they presented with undiagnosed hyper-infections their clinical features were confusing. Three of the cases, all with low eosinophil counts, died but the other, who was treated with thiabendazole, survived. In the light of these observations, healthy medical examinees who had recently moved from endemic zones were checked for asymptomatic S. stercoralis infection, both by stool examination and ELISA-based serology. Of 381 stool samples investigated over a 3-month period, 183 (48%) were found positive for helminths, 7% for S. stercoralis. Of 198 individuals from endemic zones who were screened after another medical examination, 71 (35.8%) were found positive for intestinal helminth parasites, including one (1.45%) infected with S. stercoralis. Although ELISA appear reliable in making a presumptive diagnosis of strongylodiasis, the results of such assays are not very specific and are best interpreted in conjunction with the patient's clinical status. The concurrent administration of anthelminthics to patients prescribed steroids who, because they live or have lived in an area where S. stercoralis is endemic, are at risk of infection with the nematode, should be considered.

Objectives: To evaluate the nutritional status, to screen for the presence of malnutrition, and to study the possible risk factors associated with malnutrition in patients with cystic fibrosis (CF). Methods: A retrospective cross-sectional review of medical records of all diagnosed CF patients in the Pediatric Department, Salmaniya Medical Complex, Manama, Kingdom of Bahrain, between January 1984 and May 2015 was conducted. Demographic and anthropometric data were collected from records of last visit to CF clinic. Nutritional status and risk factors of malnutrition were assessed. Results: All records of 109 CF patients were reviewed. Forty-seven pediatric patients were included in the study. All included patients were on pancreatic enzyme replacement and 42 (89%) received high-calorie supplementation. Growth failure was noted in 34 (72%) patients, 19 (56%) were wasted and stunted, 8 (23.5%) were wasted only, and 7 (20.5%) were stunted. Low birth weight ( p =0.032), and the presence of gastroesophageal reflux disease (GERD) ( p =0.039) were the significant risk factors for malnutrition. Conclusions: Most CF patients in Bahrain (72%) are malnourished. Low birth weight and the presence of GERD are risk factors. Saudi Med J 2016; Vol. 37 (3): 293-298 doi: 10.15537/smj.2016.3.13476 How to cite this article Isa HM, Al-Ali LF, Mohamed AM. Growth assessment and risk factors of malnutrition in children with cystic fibrosis. Saudi Med J 2016; 37: 293-298.

Myiasis is the infestation by dipterous larvae of the tissues of humans, other mammals and some other vertebrates, most commonly affecting cutaneous tissues close to natural orifices or wounds. Suc...

ObjectiveTo detect the incidence of cryptosporidial infection in children presenting with gastrointestinal symptoms at the local hospital in Kuwait.MethodsOver a period of 3 years, September 1995 to August 1997, a single fecal sample from 3549 children was analyzed by modified saframin-methylene blue (SM-B) staining and a direct immunofluorescence test for the presence of Cryptosporidium oocysts.ResultsCryptosporidium oocysts were detected in 51 (10%) children with diarrhea. Prevalence was highest (73%) in children >2 years of age compared with children

Methods which measure masticatory performance include gravimetric, volumetric and direct observation which depend on the weight, volume and size, respectively, of a test food once chewing is completed. Almonds, one of the most common test foods used, have a convenient size and texture. However, due to their oily content and mixing with saliva, washing and drying is required to overcome the clumping of chewed particles. A method has been developed using bagged almonds to exclude saliva and preventing loss of almond particles in the mouth. In addition, microwaving the whole almond reduces the oil content of the almond, reducing clumping, and potentially eliminating the need for washing and drying the particles. A dentate volunteer was asked to chew seven blanched almonds and seven microwaved almonds. The chewed particles were separated using two sieves, weighed and optically scanned to measure the number and area of the particles. Results were obtained both before and after washing and drying of the chewed particles. The overall results for the test of masticatory performance is very similar whether or not a washing stage is used for microwaved almonds. For untreated almonds washing has a more noticeable effect and may still be considered necessary.

The aim of this study was to investigate the effect of the loss of posterior teeth on the effectiveness of mastication. To evaluate this, chewing performance and occlusal contact area were investigated in 10 edentate subjects having implants stabilising a mandibular overdenture. A copy of the original lower denture was made for each subject, with removable teeth, which could be separated to convert a complete dental arch to a shortened dental arch, an extremely shortened dental arch, or a broken dental arch. Both post canine occlusal contact area and chewing performance demonstrated significant differences between the different arches. It was concluded that chewing performance is reduced by removing posterior teeth from implant stabilised mandibular complete dentures.

The reference total serum immunoglobulin (IgE) values and the usefulness of total IgE values in the diagnosis of allergy have not been established for the Kuwaiti population. The literature reference values may not be applicable since such values often vary among ethnic nationalities.The aim of this study was to establish the reference IgE values for the young adult Kuwaiti population and to determine the usefulness of such values in the diagnosis of allergic diseases in the community.A total of 1057 randomly selected young adults were screened for atopy using the Pharmacia CAP-PhadiatopR method. Atopy was detected in 423 individuals (40.0%). Total serum IgE was then measured in 542 randomly selected Phadiatop-negative (non-atopic) cases in the age range 18-50 years (mean 28.9 years) and male:female ratio of 1.3.Serum total IgE values in non-atopics covered a very wide range (2-1993 kU/L) with a geometric mean (GM) value of 43.7 kU/L. The reference range, calculated as the 95% confidence interval of the log IgE (95% CI) was 3.2-602.5 kU/L. The 90% CI was 11.7-162 kU/L. The GM was significantly higher for males than females, (53.7 vs. 35.5 kU/L, P0.001) and for smokers than non-smokers, (64.6 vs. 40.7 kU/L, P0.01), but was independent of age. Although the GM for the non-atopics (43.7 kU/L) was significantly lower than those of the asymptomatic atopics (213.8 kU/L) and allergic asthmatics (626.6 kU/L), the 95% CI for the three groups showed considerable overlap.These results show that the normal total IgE values in the young adult Kuwaiti population are generally high and that the distribution of the values is so wide that the diagnostic value of total serum IgE in this community is likely to be very limited.

We report for the first time four cases of ophthalmomyiasis due to the larvae of Oestrus ovis in Kuwait, before and after Operations Desert Shield and Desert Storm. The larvae were easily removed under local anaesthetic. The symptom complex of acute foreign body sensation, irritation, redness, lacrimation and photophobia resolved rapidly. Ophthalmic antibiotic and corticosteroid drops were also instilled and recovery was uneventful. The ophthalmomyiasis may not always be associated with contact with sheep-rearing per se. Medical personnel should therefore be aware that in cases of what might appear initially as acute, non-specific catarrhal conjunctivitis, patients with the persistent symptom complex should be re-examined to exclude ophthalmomyiasis due to the larvae of O. ovis in endemic areas.

During a 9-month hospital-based survey, the intestinal parasite Blastocystis hominis was detected in high numbers (five or more organisms per oil immersion field) in faecal specimens from 39 (2%) of 1960 children under 13 years old. Abdominal pain or discomfort with or without diarrhoea was present in 32 children categorized as acute (14), subacute (7) or chronic (11) cases with respective mean ages of 6.4, 7.3 and 8.7 years. They included three with other enteropathogens (Giardia lamblia, Cryptosporidium sp. or Hymenolepis nana). The remaining seven children had no gastrointestinal symptoms. The 14 acute cases (symptoms duration 1-11 days) were characterized by cramp-like abdominal pain, watery diarrhoea and vomiting. The seven subacute (3-4 weeks) and 11 chronic (3-12 months) cases presented with abdominal discomfort and/or loose non-watery stools. Four complained of flatus and eosinophilia was noted in six. All symptoms resolved with eradication of B. hominis or reduction to low numbers after metronidazole chemotherapy (28 cases) or with no treatment (four cases). This study would appear to support the role of the parasite as an enteropathogen in some children. A case control study is clearly needed to clarify the status of B. hominis as a pathogen.

During an 18 months' survey of children admitted to hospital with gastroenteritis, oocysts of the protozoan Cryptosporidium were detected in 35 cases (1.6% of the total 2205 surveyed). The affected children (age range 5 months to 8 years; mean 34.2 months) were immunocompetent, and had green and offensive watery diarrhoea. Vomiting (94%) with dehydration (80%), fever (66%) and abdominal pain (26%) were major clinical features of the diarrhoeal illness which lasted a mean 8.2 (range 3-14) days. Five children were infected with other enteropathogens. The illness was self-limiting in all cases and none were excreting oocysts 2 weeks after cessation of diarrhoea. Peak incidence occurred during the months of March and April, with no cases during the hottest months of July and August. There was no known contact with animals or pets; 4 children had other siblings affected and 2 conformed to cases of travellers' diarrhoea. The significance of cryptosporidiosis in Kuwait and the need for epidemiological studies are discussed.

During a 3-month pilot study, we identified ten children with cryptosporidiosis; they all presented with diarrhoea, most also with fever, vomiting and dehydration. For diagnosis, the formalin-acetate concentrate of the stool, and direct smears were stained for oocysts in safranin-methylene blue (S-MB). The negative staining of oocysts in trichrome-stained specimens was indicative and was confirmed by destaining and restaining in S-MB. Constraints contributing to the absence of reports from the Arabian Gulf were the lack of awareness of Cryptosporidium sp. as a cause of diarrhoea in children, inappropriate laboratory diagnostic techniques and, possibly, the initial referral of patients to polyclinics where mild cases may go undetected. Contaminated drinking water and close contact with domestic animals are possible modes of transmission of Cryptosporidium sp. but further studies are recommended to confirm this.