Kuwait Experience Research Articles

320.15: Recurrence of focal segmental glomerulosclerosis among kidney transplant recipients: Kuwait experience.

320.15: Recurrence of focal segmental glomerulosclerosis among kidney transplant recipients: Kuwait experience.

The clinical profile of new-onset optic neuritis in arabs, a tertiary center experience in Kuwait

BackgroundOptic neuritis is an inflammatory disorder of the optic nerve and is often the initial manifestation of systemic demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optic spectrum disorder (NMOSD), and myelin-oligodendrocyte glycoprotein (MOG) antibody-mediated disease. There are ethnic variations in the etiology of optic neuritis across the world. While multiple sclerosis is common in the West, NMOSD and MOG are more common causes in Asian patients. There is a paucity of reports on the clinical profile of optic neuritis in the Middle East. ObjectivesTo study the demographic and clinical features of patients with new onset optic neuritis in a main tertiary care center. MethodsA retrospective study of cases with new-onset optic neuritis at a tertiary care center between 2012 and 2022. The clinical and demographic characteristics were obtained from medical records and were summarized using descriptive statistics. Univariate analysis and multivariate analysis to assess the short-term visual outcome. ResultsSeventy-one patients with new-onset optic neuritis (70 unilateral and one bilateral) were included in the study. The mean age was 33.3 years, they were predominantly females (73 %), and most of the cases were MS (53 %) followed by idiopathic optic neuritis (42.3 %). Final visual acuity of at least 20/40 was seen in at least 91.5 %. ConclusionWhile the clinical profile of patients in this study closely resembles the Optic Neuritis Treatment Trial with a high incidence of MS and a good visual outcome in most patients and a good response to intravenous steroids, there is a significant proportion of idiopathic optic neuritis cases that may need to be better characterized with longer follow up and repeated serum biomarker testing.

Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes.

People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions. A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected. The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all). The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.

Adolescents and Young Adults with Multiple Myeloma, Kuwait Experience

Background Multiple myeloma MM is an incurable plasma cell malignancy with a median age of 65 years at diagnosis worldwide, a small number of publications were focused on young adult Multiple myeloma MM with special characteristics and clinical outcomes. Objectives To evaluate the incidence of MM among adolescent and young adults (AYA) in Kuwait aged 40 and below. Also, to describe the clinical characteristics, high risk features and treatment outcomes at the Kuwait Cancer Control Centre (KCCC). Materials &amp; Methods We collected data retrospectively from the hematological malignancy registry at KCCC and looked at AYA patients (pts) with a confirmed diagnosis of Multiple myeloma at our center from 2015 till 2022, we looked at age of onset, gender, nationality, year of myeloma diagnosis, presence of extramedullary disease, International Staging System score (ISS score), cytogenetic aberrations, induction therapy, receipts of auto-transplant and maintenance therapy. Results From 2015 till 2022, 340 patients were diagnosed with MM in Kuwait, eleven patients were found 40 years old or younger, only one was female patients, the median age was 35 years old, around a third were Kuwaiti, 73% were non-Kuwaiti of middle eastern background, 4 patients were found to have extramedullary disease at diagnosis, with advanced stage ISS III found in 3/9 pts. One patient was found with 1Q gain and the rest of the 10 patients were with negative del17p, t (4,14), t(14,16), gain1q and t(11,14). Of note, interphase FISH cytogenetic is not done with CD138 selection. Six patients were treated with RVD induction (Lenalidomide, Bortizomib, Dexamethasone), two patients treated by CTD (Cyclophosphamide, Thalidomide, Dexamethasone), one pt treated by VCD (Bortizomib,Cyclophosphamide,Dexamethasone), one patient treated by Daratumumab RVD, and one patient treated by VTD. Overall response rate (ORR) was 90.9%, (10/11) responded patients proceeded to HDCT/ASCT and all these patients went on maintenance post-transplant, two patients were lost to follow up while 9 patients still under follow up, median follow up 33 months, one pt had a relapse after transplant. Conclusion MM is an uncommon disease among AYA in Kuwait (3.2%) of all myeloma patients, with favorable durable responses in this group of patients.

Real world study of ocrelizumab in multiple sclerosis: Kuwait experience

BackgroundOcrelizumab is a humanized anti-CD20 antibody that has been approved for the treatment of patients with multiple sclerosis (MS). Real-world data in the Middle East is very limited. ObjectivesTo describe the effectiveness and safety of ocrelizumab treatment in MS patients in a real clinical setting. MethodsThis is an observational, registry-based study. MS patients who were treated with ocrelizumab and completed at least one-year follow-up post-treatment were included. Baseline clinical and radiological characteristics were collected before ocrelizumab initiation. The relapse rate, disability measures, magnetic resonance image (MRI) activity (new T2 lesions and/or GD+ enhancing T1 lesions), and adverse events (AE) at the last follow-up visits were assessed. ResultsData from 447 patients were analyzed, of which 260 (58.2%) were females. The mean age and mean disease duration were 37.39 ± 11.61 and 9.38 ± 7.57 years respectively. Most of the cohort was of a relapsing form (74.3%; n = 332), whereas active secondary and primary progressive forms represented 15.4% (n = 69) and 10.3% (n = 46) respectively. In the relapsing cohort, Ocrelizumab was prescribed in 162 (48.8%) patients due to highly active disease, and in 99 (29.8%) patients due to disease breakthrough while on prior therapies. In the last follow-up visits, most of the relapsing cohort was relapse-free (95.8% vs. 27.4%; p <0.001), had no evidence of MRI activity (3.6% vs. 67.5%; p <0.001) while EDSS score was stable (1.80+1.22 vs. 1.87+1.16; p < 0.104) when compared to baseline. NEDA-3 was achieved in 302 (91%) of RRMS patients. Confirmed disability progression was 27.5% and 23.9% in SPMS and PPMS respectively. Adverse events were observed in 139 (31.1%); infusion reactions and infections represented the most. ConclusionThis study showed that ocrelizumab is an effective and safe treatment for MS patients in a real clinical setting similar to what was observed in clinical trials.

A real-life study of alemtuzumab in persons with multiple sclerosis: Kuwait's experience.

Alemtuzumab, a humanized anti-CD52 monoclonal antibody, has been approved as a treatment in persons with active relapsing-remitting multiple sclerosis (RRMS). Real-world data in middle east is very limited. We aimed to evaluate the effectiveness and safety of alemtuzumab in a real-world clinical setting. This observational, registry based study assessed persons with multiple sclerosis (PwMS) who were treated with alemtuzumab and completed at least follow up one year after second course. Baseline clinical and radiological characteristics within one year prior to alemtuzumab initiation were collected. The relapse rate, disability measures, radiological activity and adverse events at last follow-up visits were assessed. Data of seventy-three persons with multiple sclerosis (MS) was analyzed, of which 53 (72.6%) were females. Mean age and mean disease duration were 34.25±7.62 and 9.23±6.20 years respectively. Alemtuzumab was started in32(43.8%)naïve patientsdue tohighly active disease and in 25 (34.2%) (PwMS) who were on prior therapies andin 16 (22%) patients due to adverse events on prior medications. Mean follow-up period was 4±1.67 years. In the last follow-up visits, most of our cohort was relapse free (79.5% vs. 17.8%; p<0.001) compared to baseline before alemtuzumab treatment while mean EDSS score was reduced (2.21±2.15vs. 2.41±1.85; p<0.059). The proportion of PwMS who had MRI activity (new T2/ Gd-enhancing) lesions were significantly reduced compared to baseline (15.1% vs. 82.2%; p<0.001). NEDA-3 was achieved in 57.5% of (PwMS). NEDA-3 was significantly better in naïve patients (78% versus. 41.5%; p<0.002) and in patients with disease duration < 5 years, (82.6% v 43.2%; p<0.002). Several adverse events such as infusion reactions (75.3%), autoimmune thyroiditis (16.4%) and glomerulonephritis (2.7%) were reported. The effectiveness and safety profile of alemtuzumab in this cohort were consistent with data of clinical trials. Early initiation of Alemtuzumab is associated with favorable outcome.

Safety and efficacy of Cladribine in real life sitting, Kuwait Experience (P8-3.014)

<h3>Objective:</h3> To study the effectiveness and the safety of Cladribine treatment in MS patients in a real-world clinical setting. <h3>Background:</h3> Cladribine was approved for treatment of multiple sclerosis (MS). Real-world data is very limited. <h3>Design/Methods:</h3> This observational, prospective study included MS patients who had at least one year follow-up after second course of Cladribine treatment. Baseline patient clinical and radiological characteristics recorded within one year prior to Cladribine initiation. The relapse rate, disability measures, radiological activity and adverse events at last visit were assessed. <h3>Results:</h3> A total of seventy-two patients, 59 (81.9%) were females, mean age 36.32 ±10.06 years old, mean disease duration 7.21±6.19. Most patients (n=32; 44.4%) were naïve to any treatment. Forty patients (55.6%) completed two courses of treatment. At the end of observational period, most of our cohort was relapse free (85% versus 25%; P&lt;0.001) and few had new T2 lesions (7.5% versus 70.8%; P&lt;0.001 and gadolinium enhancement 5% versus 66.7%; P&lt;0.001) in MRI compared to baseline. ARR was significantly reduced 0.15 ±0.36 versus 0.85±0.53; P&lt;0.01). Most of cohort 90% has no progression of disability. No evidence of disease activity 3 (NEDA-3) was achieved in 30 (75%) patients. It was achieved in 87.5% of naive patients versus 66.7% in patients who received prior disease modification drugs before Cladribine initiation. Infections 6 (n=6; 8.4%) lymphocytopenia (n=3; 4.2%), and elevated liver enzymes (n=1; 1.4%) were reported. <h3>Conclusions:</h3> The effectiveness and safety profile of cladribine in this study were consistent with data of phase 3 clinical trials. Early initiation of cladribine is associated with favorable outcome. <b>Disclosure:</b> Dr. AlMojel has nothing to disclose. Dr. Al-Hashel has nothing to disclose. Dr. Alroughani has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen, Bayer, Novartis, Merck, Roche, Sanofi. Dr. Alroughani has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bayer, Biogen, Novartis, Merck, Roche, Sanofi. Dr. Ahmed has nothing to disclose.

Ethnic Disparities and Outcomes of Edwards Sapien Transcatheter Aortic Valve Implantation in Kuwait

Introduction: Clinical outcomes after transcatheter aortic valve implantation (TAVI) have not been reported in the Gulf region. This study aims to identify baseline characteristics of patients undergoing TAVI, based on nationality, and analyze their overall outcomes at a single center in Kuwait. Methods: A retrospective study of 61 patients with severe aortic stenosis undergoing TAVI between 2018 and 2021 in Sabah Al Ahmad Cardiac Centre in Kuwait. Clinical and baseline demographics data along with preprocedural computed tomography (CT) and echocardiography were reviewed. Postprocedural outcomes, including conduction disturbances and inhospital mortality rates, were analyzed. Patients were analyzed according to Kuwaiti and non-Kuwaiti citizens' status. Results: The mean age of Kuwaiti patients was 72.2 ± 9.2, whereas the mean age of non-Kuwaiti citizens was 78.8 ± 5.5. No significant differences were observed between Kuwaiti and non-Kuwaiti in electrocardiogram (ECG) and CT parameters (P &gt; 0.05). A statistically significant difference among Kuwaiti and non-Kuwaiti patients was observed only laboratory parameters, white blood cell (WBC) count, international normalized ratio (INR), and C-reactive protein (CRP). The mean value of WBC count (WBC), INR, and CRP was higher among non-Kuwaiti patients when compared to Kuwaiti patients (P &lt; 0.05). Inhospital mortality was low 1/61 (1.6%). Conclusion: Cumulative inhospital mortality in TAVI was 1.6%. TAVI experience in Kuwait with Edwards SAPIEN valve is comparable to international cohorts. No significant differences in procedural outcomes, including conduction disturbance and mortality, were observed between the two subgroups.

School Operational Room Guidance for Reopening Primary and Secondary Schools During COVID-19 Pandemic Kuwait Experience

School Operational Room Guidance for Reopening Primary and Secondary Schools During COVID-19 Pandemic Kuwait Experience

Treatment Free Remission (TFR) in Chronic Myeloid Leukemia-Chronic Phase (CML-CP), Kuwait Experience

Introduction: CML is one of the successful stories in oncology. Treatment of CML has evolved and goals of therapy have changed over the years. Treatment free remission (TFR) is becoming an attractive goal in CML patients (pts) especially in younger population. Aim: To evaluate the trend of TFR in CML treated pts in Kuwait. Method: Retrospective analysis of CML pts treated in Kuwait Cancer Control Center (KCCC) who had a trial of TFR. Data were collected from the charts and electronic medical records. Pts who stopped tyrosine kinase inhibitor (TKI) due to intolerance or pregnancy were included if they were in deep molecular remission (DMR) (³MR4.0) regardless of the duration of therapy. Results: A total of 42 pts was eligible for TFR. Most of our pts were treated with imatinib (93%). All patients achieved optimal milestones, however pts who stopped treatment in DMR due to intolerance or pregnancy were included. Most of our pts were young with a median age of 38 yrs and had a low risk Sokal/ELTS score. Our cohort of pts had a long duration of TKI exposure (103 mons) and DMR (70 mons). At a median follow up of 50 mons, TFR rate was 74%. As shown in table 2, 10 pts (24%) lost TFR and were able to regain DMR upon re-starting TKI. All of them were treated with imatinib. Conclusion: Successful TFR rates are high among pts treated in Kuwait. This is largely due to a longer duration of therapy and higher percentage of pts with low risk Sokal/ELTS score. Keywords CML, treatment free remission, TFR

Applying health design thinking to uncover actors in the sustenance of health and wellbeing during hotel quarantine in kuwait

This visual essay centers on the author’s hotel quarantine experience in Kuwait. While many quarantine stories have been recorded, personal stories involving the relationship between human and non-human actors within a quarantined space are still overlooked. By focusing on the maintenance of health and wellness during quarantine, this essay visually communicates the hotel quarantine experience by using a health design thinking approach. By presenting a series of photographs, actors’ interactions, and journey maps, the author attempts to convey a connection between human and non-human actors during quarantine, and prompts a discussion on what can be done to improve hotel quarantine systems in the future.

CML-415 Treatment Free Remission (TFR) in Chronic Myeloid Leukemia-Chronic Phase (CML-CP), Kuwait Experience

CML is one of the successful stories in oncology. Treatment of CML has evolved and goals of therapy have changed over the years. Treatment free remission (TFR) is becoming an attractive goal in CML patients (pts) especially in younger population. To evaluate the trend of TFR in CML treated pts in Kuwait. Retrospective analysis of CML pts treated in Kuwait Cancer Control Center (KCCC) who had a trial of TFR. Data were collected from the charts and electronic medical records. Pts who stopped tyrosine kinase inhibitor (TKI) due to intolerance or pregnancy were included if they were in deep molecular remission (DMR) (3MR4.0) regardless of the duration of therapy. A total of 42 pts was eligible for TFR. Most of our pts were treated with imatinib (93%). All patients achieved optimal milestones, however pts who stopped treatment in DMR due to intolerance or pregnancy were included. Most of our pts were young with a median age of 38 yrs and had a low risk Sokal/ELTS score. Our cohort of pts had a long duration of TKI exposure (103 mons) and DMR (70 mons). At a median follow up of 50 mons, TFR rate was 74%. As shown in table 2, 10 pts (24%) lost TFR and were able to regain DMR upon re-starting TKI. All of them were treated with imatinib. Successful TFR rates are high among pts treated in Kuwait. This is largely due to a longer duration of therapy and higher percentage of pts with low risk Sokal/ELTS score.

Surgical management of scalp cirsoid aneurysms: Kuwait experience. (case series)

BackgroundCirsoid aneurysms are arteriovenous malformations of the scalp region that usually manifest as a painless pulsatile mass. These are present in the younger age group and frequently associated with trauma. ObjectivesSeveral treatment algorithms have been proposed, and we report our experience with sole surgical management. MethodsRetrospective review of all the scalp vascular malformation cases performed in the main national Vascular Surgery Service of Kuwait. Pre-operative data, including patient demographics were obtained. All patients underwent diagnostic vascular Duplex ultrasound and angiography. Intra-operative and post-operative data, including outcomes and follow up were recorded. ResultsSix patients with Cirsoid aneurysm, four females and two males, had a mean age of 19.7 years (range, 10–33 years). All the patients presented with a painless pulsating mass in the scalp (4 Anterolateral and 2 posterior), and one case had associated dizziness and headache. These malformations were found to be solely fed by the extra-cranial vessels with no intra-cranial communication. One patient had pre-operative embolization prior to excision, and the rest had sole surgical excision. No postoperatively complications or recurrence were seen at 2–5 year follow up. ConclusionsCirsoid aneurysms are amenable to sole surgical excision with excellent results after excluding intra-cranial communication.

COVID-19 Vaccination in People with Multiple Sclerosis. the Kuwait Experience

COVID-19 Vaccination in People with Multiple Sclerosis. the Kuwait Experience

Effect of Structured Diabetes Education on Diabetic Angiopathies Among Kidney Transplant Recipients With Posttransplant Diabetes: Kuwait Experience

Diabetes knowledge among kidney transplant recipients with posttransplant diabetes has not been exhaustively assessed. Here, we evaluated the effects of structured diabetes education on development of diabetic micro- and macroangiopathies in kidney transplant patients with posttransplant diabetes. This prospective randomized controlled study categorized 210 renal transplant patients with posttransplant diabetes mellitus into 2:1 groups according to type of diabetes education. Group 1 (n = 140) received structured education, and group 2 (n = 70) received conventional education. Patient data were collected through patient identification and metabolic control parameter forms. Most patients in groups 1 and 2, respectively, were Kuwaiti (60.7% vs 58.6%), men (57.9% vs 68.6%), and had high school-level education (43.6% vs 48.6%). Chronic glomerulonephritis was the original disease in 36.4% versus 35.4% of patients. Most patients (72.8% vs 78.6% in group 1 vs 2) received pretransplant hemodialysis. At study start, the rate of patients with diabetic neuropathy was comparable between groups (32.4% vs 27.9%). Moreover, after completion of 24 months of education, neurological evaluation by electromyograph and nerve conduction studies did not show any significant differences between the groups (P > .05). Similarly, the number of patients with fundus imaging showing retinopathy was comparable between groups at start and end of study (P > .05). Although macroangiopathic events were higher in group 1, this finding was not significant (P > .05). However, although the percentage of patients with nephropathy was comparable in both groups at start of study, the percentage decreased significantly in group 1 at 24 months after completion of education compared with group 2 and baseline value (P = .016). Structured diabetes education was associated with reduced diabetic nephropathy but had no significant effects on other micro- or macroangiopathies. However, we recommend education for all kidney transplant recipients with diabetes.

Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience

Introduction: Wound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications. Methods: This was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher’s exact test and two-tailed t test were used where appropriate. Results: 391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142–33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960–4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349–4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305–4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181–6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients. Conclusion: Diabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.

Risk Factors for Mortality in Patients with COVID-19: The Kuwait Experience

Objectives: To describe the baseline characteristics and to evaluate the risk factors for in-hospital mortality in patients admitted to hospitals with coronavirus disease (COVID-19) in Kuwait. Subjects and Methods: This retrospective cohort study analyzed data of patients admitted to two hospitals in Kuwait with COVID-19. The outcome was assessed by using multivariable analysis of factors affecting survival and mortality. Results: In 962 patients, the case fatality ratio was 9.04%. The mean age of nonsurvivors was 63.5 ± 14.8 years, and most deaths occurred in males (80.5%). For the whole sample, the source of transmission was significantly related to mortality and the median duration of in-hospital stay was 15 days (interquartile range: 2–52 days). In patients with high oxygen requirements, the case fatality rate was 96.6%. Multivariable analysis identified age, hypertension, cardiovascular disease (CVD), and dyspnea on presentation as independent risk factors for COVID-19 mortality. Conclusions: The mortality rate was higher in older patients with comorbidities such as hypertension and CVD. Early recognition of high-risk patients may help to improve care and reduce mortality.

Don't close the book on tocilizumab for the treatment of severe COVID-19 pneumonia-the jury is still out: The Kuwait experience.

This cross-sectional observational study aims to report preliminary data from the first experience using tocilizumab for patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in three of Kuwait's largest public hospitals City. This chart review study examined the benefits of tocilizumab treatment among 127 patients diagnosed with severe coronavirus disease of 2019 (COVID-19) pneumonia. 90 of 127 patients (71%) survived. Mortality was highest in the elderly with multiple medical conditions. Despite the small sample size and retrospective nature of the work, our findings are consistent with recent studies suggesting tocilizumab administration in patients presenting with severe COVID pneumonia with associated hyperinflammatory features conferred mortality benefit.

Antenatal depressive symptoms and adverse perinatal outcomes

BackgroundThe association of antenatal depression with adverse pregnancy, birth, and postnatal outcomes has been an item of scientific interest over the last decades. However, the evidence that exists is controversial or limited. We previously found that one in five women in Kuwait experience antenatal depressive symptoms. Therefore, the aim of this study was to examine whether antenatal depressive symptoms are associated with preterm birth (PTB), small for gestational age (SGA), or large for gestational age (LGA) babies in this population.MethodsThis was a secondary analysis based on data collected in the Transgenerational Assessment of Children’s Environmental Risk (TRACER) Study that was conducted in Kuwait. Logistic regression analysis was used to examine whether antenatal depressive symptoms assessed using the Edinburgh Depression Scale (EDS) were associated with preterm birth, small for gestational age, and large for gestational age babies.ResultsA total of 1694 women had complete information about the outcomes of interest. Women with depressive symptoms in pregnancy had increased, albeit non-significant, odds of having PTB (OR = 1.41; 95%CI: 0.81, 2.45), SGA babies (OR = 1.26; 0.80, 1.98), or LGA babies (OR = 1.27; 0.90, 1.79). Antenatal depressive symptoms had similar increased odds for the three outcomes even after adjusting for several covariates though none of these reached statistical significance.ConclusionsIn the present study, the depressive symptoms in pregnancy did not predict adverse birth outcomes, such as PTB, SGA, and LGA, which adds to the currently non-conclusive literature. However, further research is needed to examine these associations, as the available evidence is quite limited.

Safety efficacy and tolerability of the calcitonin gene-related peptide monoclonal antibodies for migraine prevention treatment of migraine, Kuwait experience. (1816)

Safety efficacy and tolerability of the calcitonin gene-related peptide monoclonal antibodies for migraine prevention treatment of migraine, Kuwait experience. (1816)