Khaled Alsaeid

Incidence of musculoskeletal pain in adult Kuwaitis using the validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire.

BACKGROUND The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We estimated the incidence of musculoskeletal pain in the first community-based COPCORD study in Kuwait. SUBJECTS AND METHODS The validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire was used in a survey of 2500 randomly selected Kuwaiti households to assess the frequency of musculoskeletal pain, disability, and health-seeking behavior in adult Kuwaitis. Those subjects reporting no musculoskeletal pain were identified and followed-up for a period of one year by contacting them every 2 weeks. Once a respondent reported pain, an appointment to report to hospital was offered and the subject was examined by a rheumatologist using American College of Rheumatology (ACR) criteria. RESULTS Of 5159 adults who were non-complainers in an earlier prevalence phase of the study, 3341 responded to phone calls (response rate of 65%). The incidence of musculoskeletal pain was 6.6% (95%CI, 3.4%-9.7%). Age- and sex-adjusted incidence rates were 7.2% (95%CI, 3.4%-10.5%) for females and 6.1% (95%CI, 3.1%-9.2%) for males. The incidence rate increased with increasing age, body mass index, and with being married. The common sites of pain were knee, low back and shoulder. CONCLUSION The incidence of musculoskeletal pain among Kuwaiti adults is reported for the first time. Further studies adopting the same instrument in other communities are warranted to compare with our findings.

Human leukocyte antigen DRB1*04 is associated with rheumatoid arthritis in Kuwaiti patients

OBJECTIVES Rheumatoid arthritis (RA) is a common, complex autoimmune disease known to be associated with inheritance of certain human leukocyte antigen (HLA)-DR alleles in different populations. This study investigated the association of DRB1 alleles in Kuwaiti patients with RA. MATERIALS AND METHODS DRB1 alleles were analyzed in 47 Kuwaiti patients and 70 ethnically matched controls using a DNA-based sequence specific primer (SSP) method. RESULTS The frequency of DRB1*04 allele was higher in patients compared to the controls (P < 0.012). The association with of HLA-DRB1*04 allele in our patients with RA was accounted for mainly by the seropositive group of patients (P < 0.05). Moreover, five patients were homozygous for DRB1*4 compared to none in the controls. None of the other DRB1 alleles tested was significantly higher in the patients. All patients homozygous for the DRB1*04 allele were females. There was no statistically significant difference in the frequency of DRB1*04 allele in patients classified according to presence of erosive disease or extra-articular manifestations. CONCLUSION Our results indicate that in Kuwaiti patients, RA is associated with the presence of DRB1*04 allele. The lack of association with severity or the phenotype of RA is not surprising since this is a hospital-based study where patients tend to have a more severe disease.

Serum lipoprotein (a) concentrations among Arab children: a hospital-based study in Kuwait

Elevated lipoprotein (a) [Lp(a)] is an independent risk factor for premature atherosclerosis and coronary heart disease, both of which are prevalent among Kuwaitis. Our objective was to measure serum lipids, including Lp(a), in Arab children and compare them with values reported for other ethnic groups. To that end, serum concentrations of Lp(a), total cholesterol [T-CHOL], high density lipoprotein [HDL], low density lipoprotein [LDL], and triglyceride [TG] were assessed in 103 Arab children. The mean and median Lp(a) were 140.4 mg/l and 95 mg/l, respectively. The Lp(a) frequency distribution was skewed to the right with the highest frequencies appearing at low levels. Serum Lp(a) correlated positively with T-CHOL and LDL but did not correlate with age, HDL and TG. Only nine children (8.7%) had serum Lp(a) levels associated with increased cardiovascular risk, namely > or = 300 mg/l.

The prevalence of human leukocyte antigen (HLA) DR/DQ/DP alleles in Kuwaiti children with oligoarticular juvenile idiopathic arthritis

We have determined the prevalence of human leukocyte antigen (HLA)-DR, DQ and DP alleles in Kuwaiti children with oligoarticular juvenile idiopathic arthritis (OA-JIA) and healthy controls using the PCR-SSP (sequence specific primers) method. The analysis took into account the presence of antinuclear antibodies and chronic anterior uveitis. DRB1*03 (RR 2.20, P<0.001), DRB1*08 (RR 5.280, P<0.026), DQA1*0501 (RR 1.930, P<0.001), DQB1*0304 (RR 7.920, P<0.002), DQB1*0501 (RR 3.080, P<0.007) and DPB1*0101 (RR 8.8, P<0.001) were the main HLA alleles associated with OA-JIA in Kuwaiti Arabs in this study. DRB1*03 was detected in 71% of children with positive ANA, and in 50% of children with anterior uveitis. DQA1 alleles *0501, *0103 and *0105 (P<0.001; 0.029 and 0.024 respectively) were found to be associated with OA-JIA. In contrast, DQA1*0301 and DQA1*0302 alleles appear to be protective in Kuwaiti children (RR 0.153, P<0.001 and RR 0.278, P<0.016 respectively). The DQB1 alleles *0304 and *0501 were associated with OA-JIA (P<0.002 and P<0.007 respectively). In the case of DPB1, only one allele (*0101) was associated with OA-JIA (P<0.001). Most Kuwaiti Arab patients with OA-JIA who carried a DQ or DP susceptibility allele also had an accompanying DRB1*03 or *8 allele.

Lipoprotein A profiles in Arab newborns

Abstract Background: Lipoprotein A (LpA) is an intriguing lipoprotein with unquestionable genetic determination which is expressed early in life. The increasing interest in LpA is due to its established recognition as an important independent risk factor for premature atherosclerosis in cardiovascular diseases. Coronary heart disease is a major cause of morbidity and premature mortality in Kuwait. The present study was designed to measure serum LpA concentrations in Arab newborns to establish reference values for LpA in newborns and its relationship to factors present in the mother and baby.

Measurement of the Functional Status in Juvenile Rheumatoid Arthritis: Evaluation of the Arabic Version of the Childhood Health Assessment Questionnaire

Objectives: To evaluate the metric properties, reliability and validity of the translated Arabic version of the Childhood Health Assessment Questionnaire (CHAQ-A) for children with juvenile rheumatoid arthritis (JRA). Methods: The original questionnaire was translated into Arabic without modification and was applied to 38 consecutive children with JRA attending the Out-Patient Rheumatology Clinic in the main teaching hospital of Kuwait. All patients were diagnosed according to the American College of Rheumatology criteria. The questionnaire was given to each patient during a clinic visit and the retest was done after a 7- to 10-day interval. Test-retest reliability was assessed based on the intraclass correlation coefficient. The construct validity was assessed with Spearman’s correlation coefficient between the CHAQ-A and both clinical and laboratory variables of the disease activity. Results: The test-retest reliability was 0.94 for the overall score and ranged between 0.707 (grip) to 0.936 (hygiene) for the subscale score. The construct validity ranged between 0.39 (erythrocyte sedimentation rate) and 0.71 (functional class). Conclusion: This study provides evidence of the reliability and validity of the CHAQ-A in assessing patients with JRA.

Seroprevalence of human parvovirus B19 in children of a desert region

A seroepidemiological study was conducted in Kuwait to evaluate the pattern of acquisition of human parvovirus B19 by children in Kuwait and to compare it with patterns described in other regions in different climatic zones. A total of 218 serum samples from children less than 16 years of age were tested for the presence of anti-B19 IgG by enzyme immunoassay. The overall seroprevalence was 17.4%. Infants in Kuwait had low levels of maternally-acquired anti-B19 IgG (8.6%). The age of peak exposure to parvovirus B19 was 10-15 years compared with less than 10 years in England and Wales and more than 20 years in Singapore. The results of this study indicate an influence of geographic differences on transmission of parvovirus B19.

Case of the month: A 20-month-old boy with fever, respiratory distress and necrotizing skin lesions

tercostal recessions were present but air entry was not diminished. Results of initial laboratory investigations are summarized in Table 1. CSF examination was normal except for 18 mononuclear cells/mm3. Intravenous cefotaxime was started soon after blood cultures were taken. The patient’s condition deteriorated over the next few hours with a rise in respiratory rate, heart rate and episodes of bradycardia. Small 1.5 × 1.5 cm erythematous skin lesions developed over the trunk and the extremities. Some of the lesions had necrotic centres (Fig. 1). The patient was noticed to have difficulty swallowing his own secretions; and a lateral roentgenogram of the neck showed mild swelling of the epiglottis suggestive of epiglottitis. A diagnostic procedure was performed and result of blood culture was obtained. YOUR DIAGNOSIS? Eur J Pediatr (1996) 155 :341–342

Evaluation of undergraduate students in paediatrics at Kuwait University

Medical schools use a variety of methods to assess the clinical competence of students. The aim of this study was to evaluate the system in use at the Department of Paediatrics at Kuwait University. The analysis of the performance of 142 second clinical year students in three consecutive batches revealed that their performances in the final examination correlated well with the paediatric clerkship scores (r = 0.85, p < 0.0001). There was high correlation (p < 0.01) between the MCQs, short cases and long-case components of the final examination and the total final score (r = 0.79, 0.73 and 0.73 respectively) while the essay-type tests had a lower but significant correlation (r = 0.63, p < 0.01)). It may be concluded that, since end-of-block and final examinations assessed similar competences, one or the other can be discontinued. An alternative is to use the two stages of the examination to assess the candidates in different competences, thus increasing the content validity of the system.

Juvenile rheumatoid arthritis—clinical manifestations

Chronic inflammatory arthritis in childhood could be due to an obvious cause (e.g. sepsis, rheumatic fever, systemic lupus erythematosus etc.), or it could be idiopathic. After excluding those with obvious cause there still remains a large group of chronic inflammatory arthritis in childhood. This category has been variously called ‘juvenile rheumatoid arthritis’, ‘juvenile arthritis’, ‘juvenile chronic arthritis’, and more recently, ‘idiopathic arthritis of childhood’, The present article reviews the various classification criteria used for defining this group of disorders with emphasis on the common features as well as the major differences between these criteria. The major classes within this group with their characteristic clinical and laboratory features are also discussed.