This study surveyed tetracycline residues in foods marketed in Kuwait using various techniques to determine their prevalence above the threshold level. A total of 1517 locally produced and imported food samples of animal origin were collected for analyses, comprising dairy products, eggs and tissue samples (meat, poultry and fish) to give a representative picture of the current use and/or misuse of the drug in Kuwait. Screening was carried out using the Charm II test for tetracycline residues. Positive and suspect positive samples were confirmed by LC/MS/MS. Negative and positive controls, in triplicate, were applied to each method and showed 80-100% agreement. The results showed that 100% of tested eggs, meat, fish, ice cream and cheese were within the limit, while 5% of poultry and 18% of milk samples were above the permitted limit.

A number of potential risk factors results in premature repatriation of housemaids on mental health grounds. Preventive measures involving recruitment procedures and pre-departure orientation courses are needed to minimise the expatriate failure among the housemaids.

The OptiMAL test (Flow Inc., Portland, Oreg.), which detects a malaria parasite lactate dehydrogenase (pLDH) antigen, has not been evaluated for its sensitivity in the diagnosis of malaria infection in various epidemiological settings. Using microscopy and a PCR as reference standards, we performed a comparison of these assays with the OptiMAL test for the detection of Plasmodium falciparum andPlasmodium vivax infection in 550 immigrants who had come from areas where malaria is endemic to reside in Kuwait, where malaria is not endemic. As determined by microscopy, 125 (23%) patients had malaria, and of these, 84 (67%) were infected with P. vivax and 36 were infected with P. falciparum; in 5 cases the parasite species could not be determined due to a paucity of the parasites. The PCR detected malaria infection in 145 (26%) patients; 102 (70%) of the patients had P. vivax infection and 43 had P. falciparum infection. Of the five cases undetermined by microscopy, the PCR detected P. falciparuminfection in two cases, P. vivax infection in two cases, and mixed (P. falciparum plus P. vivax) infection in one case. Correspondingly, the OptiMAL test detected malaria infection in 95 patients (17%); of these, 70 (74%) hadP. vivax infection and 25 were infected with P. falciparum. In this study, 61 (49%) of the 125 malaria cases, as confirmed by microscopy, had a degree of parasitemia of <100 parasites per μl, and 23 (18%) of the cases had a degree of <50 parasites per μl. Our results show that the sensitivity of the OptiMAL test is high (97%) at a high level of parasitemia (>100 parasites/μl) but drops to 59% when the level is <100 parasites/μl and to 39% when it is <50 parasites/μl. In addition, the OptiMAL test failed to identify four patients whose blood smears contained P. falciparumgametocytes only. We conclude that the sensitivity and specificity of the OptiMAL test are comparable to those of microscopy in detecting malaria infection at a parasitemia level of >100 parasites/μl; however, the test failed to identify more than half of the patients with a parasitemia level of <50 parasites/μl. Thus, the OptiMAL test should be used with great caution, and it should not replace conventional microscopy in the diagnosis of malaria infection.

No abstract

Two hundred and ninety-nine of 428 patients diagnosed with acute myocardial infarction (AMI) in Kuwait during 1978 were matched with hospitalized controls by sex, nationality, and same year of age. Patients were almost six times as likely as controls to be smokers (odds ratio [OR] = 5.6; 95% confidence limits [CL] = 2.8-12.3; P less than 0.0001) and 50% more likely to be diabetic (OR = 1.49; 95% CL = 0.96-2.32; P = 0.06). Patients were less likely than controls to be currently married (OR = 0.23; 95% CL = 0.04-0.84; P = 0.02) or to have a personal history of hypertension (OR = 0.60; 95% CL = 0.39-0.92; P = 0.01). Each of these four exposures affected AMI risk more strongly when considered together with the other three than when considered separately. Although in this study personal history of hypertension appears to reduce AMI risk, selection bias from using a hospital source of controls does not fully account for this reduction. Neither occupation nor socioeconomic status affected AMI risk.

Methods: A Markov cohort model, populated using Netherlands epidemiological, cervical cancer screening, treatment pattern, and cost data was used to perform the analysis. Societal lifetime costs were included at 2006 prices. Initial vaccine efficacy of 95% against HPV-persistent infection with HPV-16/18 plus 30% efficacy against other oncogenic HPV types (''cross-protection'') was assumed in the base case.Reduction in cancer cases, associated quality-adjusted life years (QALYs) and costs for a vaccine against HPV-16/18, and other oncogenic HPV types with lifetime cervical cancer protection were compared with vaccine scenarios having less than lifetime protection. These scenarios included: 1) alternative combinations of HPV types that wane (HPV-18 alone, oncogenic non-vaccine HPV alone, HPV-18 + oncogenic non-vaccine HPV); 2) alternative durations of protection (range: 5-30 years); 3) alternative patterns representing the time of decline to 0% protection (linear 5-year, linear 10-year, other); 4) alternative rates of booster vaccine coverage (range 0% -100%) and protection (i.e. double original vaccine protection vs. lifetime protection)Results: In the hypothetical vaccine scenarios, overall duration of vaccine protection had the largest impact, followed by HPV-type-specific waning, then the pattern of waning decline. Waning impact depended on the relationship between age and HPV infection rate, as well as on HPV-type distribution in cervical cancer. Adding a booster increased the overall costs, but improved clinical outcomes and QALYs.Conclusion: Vaccine waning is an important characteristic to consider when assessing a vaccine's effectiveness against cervical disease related morbidity and mortality; a vaccine with more sustained protection is predicted to have better clinical outcomes at lower total costs.

No abstract

No abstract