Kuwaiti Population Research Articles

Sequence analysis of tumor necrosis factor-α (TNF-α) promoter, 5'UTR and exon1 and association of rs361525 (-238 G>A) with BMI

Obesity is among the most common complex diseases with a high rate of morbidity and mortality globally and locally in Kuwait. Tumor Necrosis Factor-α(TNF-α) is a pro-inflammatory cytokine that is primarily secreted by monocytes/macrophage. Increased expression of TNF-α has been observed in the adipodse tissue of obese subjects that could disrupt lipid metabolism and lead to and lead to sustained obese state and obesity-related diseases. The human TNF-α promoter exhibits a high number of genetic variants, mainly single nucleotide polymorphisms (SNPs) that have been shown to influence the level of transcription in association with diseases. The human TNF-α genetic variants have never been fully reported in Arabs, therefore, we aimed to identify these variants by sequencing the TNF-α promoter, 5' UTR, and exon 1 in 290 Kuwaiti Arabs. As a result, we identified 14 genetic variants, including one novel SNP. Two promoter SNPs; rs1800750 (- 376G>A) and rs361525 (-238G>A) were found to be in strong linkage disequilibrium (r2 = 0.73) and (D′ = 1, LOD = 32). To investigate the association of rs361525 (-238G>A) with obesity, we genotyped an additional 573 samples of the general Kuwaiti population by Real-time PCR (total n=863). Linear and logistic regression analysis have not shown any significant association in carriers of the A allele of rs361525 with continuous and categorical BMI, respectively. This is the first study in the Middle East and Kuwait that has sequenced and identified the common, rare and novel genetic variants of TNF-α promoter, 5'UTR and exon 1 in Arabs.

Genetic association of LPL rs326 with BMI among the Kuwaiti population.

Lipoprotein lipase is a key enzyme in lipid metabolism with reported variants associated with obesity, hypertension, type 2 diabetes, and coronary heart disease. This study was performed to investigate the association between common lipoprotein lipase single nucleotide polymorphisms and metabolic disorders in a sample of Kuwaiti cohort (n = 494). Five lipoprotein lipase variants (rs1801177, rs295, rs326, ss2137497749, and ss2137497750) across the lipoprotein lipase gene were genotyped by real-time PCR employing the TaqMan allele discrimination assay. Genotype, allelic frequencies, and Hardy-Weinberg Equilibrium were determined for each variant in the cohort followed by multivariate and logistic regression analysis. A novel finding was observed for the G allele of single nucleotide polymorphism rs326 which was associated with increased BMI after adjusting for age and sex (β = 1.04; 95% confidence interval = 0.15-1.94; P = 0.02). Moreover, a significant difference in the distribution of the minor C allele of rs295 among coronary heart disease subjects compared with noncoronary heart disease, however, this significance was diminished after controlling for age, sex, and BMI. This study demonstrated that lipoprotein lipase rs326 may be indicative for the increased risk of obesity and possibly rs295 for coronary heart disease. The findings are also in agreement with other reports suggesting that intronic variants are important genetic markers in association studies. The findings warrant further studies in a large cohort to confirm and validate the results presented.

Knowledge, attitudes, beliefs and practices of the population in Kuwait about AIDS-a pilot study

Between January and April 1994, 116 people were interviewed in a pilot study to determine the feasibility a study on knowledge, attitudes, beliefs and practices [KABP] of the population in Kuwait about AIDS. A specifically designed questionnaire, based on the WHO AIDS programme KABP survey in 1988, was modified to suit Kuwaiti culture and norms. It was pretested on a sample of five categories of participant. Such studies can serve as baseline data for evolving strategies for AIDS awareness, prevention and control

Severe asthma in Kuwait population: Phenotype-based approach

BackgroundThere is increasing recognition of marked phenotypic heterogeneity within severe asthma patients. MethodsSevere asthma patients on GINA step 4 or 5 treatment, followed up at Al-Rashed Allergy center Kuwait, were evaluated for: demographics (gender, age, age of asthma onset), comorbidities (allergic rhinitis (AR), chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyposis (CRSwNP), obesity), blood biomarkers (total serum Immunoglobulin E (IgE), peripheral eosinophils), and sensitization to inhalants allergens. ResultsA total of 169 patients were candidates for biological treatment. Patients were divided in two groups based on level of total IgE as a “low” group with IgE<160 IU/ml (n = 55) and “high” group with IgE≥ 160 IU/ml (n = 114). Both groups were further divided in subgroups, “low” and “high”, based on absolute number of eosinophils (Eos) in peripheral blood with <300 cells/μl or ≥ 300 cells/μl. Only 10% of patients were in low IgE/low Eos while majority (46%) were in the high IgE/high Eos group. Mean age of patients was 44.1 year with domination of females (n = 123). Majority of patients were obese. AR, CRS and CRSwNP were more common in group with IgE ≥160 IU/ml, while CRS and CRSwNP in group with Eos ≥300 cells/μl. ConclusionThe majority of severe asthma patients in Kuwait are obese females with adult-onset asthma (>18 years of age) who were allergic with comorbid conditions including AR, CRS and CRSwNP, which correlates well with the level of Eos.

Sixteen years analysis of PM2.5 and mortality in Kuwait

BACKGROUND AND AIM: Middle Eastern desert countries like Kuwait are notoriously known for dramatic dust storms and enormous petrochemical industries affecting ambient air pollution. However, local health authorities have not been able to assess health impacts of air pollution due to limited monitoring networks and lack of historical exposure data. We aimed to estimate the relationship between estimated historical fine particulate matter (PM2.5) and mortality in Kuwait stratified by cause, gender and age. METHODS: We developed a novel approach using machine learning and remote sensing to estimate spatially and temporally resolved daily urban PM2.5 exposures from 2001 to 2016 in the country. We then used over-dispersed generalized additive models to investigate the association with cause-specific, gender- and age-stratified mortality timeseries. RESULTS:There was a total of 70,321 deaths during the study period of 16 years. The average urban PM2.5 was estimated to be 46.2±19.8 µg/m3. A 10 µg/m3 increase in a 5-day moving average of urban PM2.5 was associated with 1.31% (95% CI: 0.56 to 2.07%) increase in all-cause mortality and a 1.15% (0.13 to 2.18%) increase in daily cardiovascular deaths. The corresponding associations among males and females were 1.23% (0.29 to 2.17%) and 1.44% (0.33 to 2.56%), respectively. For the elderly (above 65 years) there was a 1.23% (0.15 to 2.31%) increase in all-cause mortality. The associations were unchanged after adjusting for dust storm days. CONCLUSIONS:We leveraged available pollution, weather and remote sensing data to predict historical PM2.5 with high temporal and spatial resolution. Urban PM2.5 concentrations were above the international regulatory limits. Our findings suggest that, PM2.5 is associated with increased mortality across different strata of the Kuwaiti population. The approach we used can be implemented in other countries that lack historical pollution data or those with insufficient monitoring networks. KEYWORDS: Desert, Dust storm, Kuwait, Middle East, Air Pollution, Machine Learning

Epidemiological Evidence of the Recent Surge in MS in Asia and Australia: A Systematic Review

Context: Recently, the incidence and prevalence of multiple sclerosis (MS) have increased drastically in different regions of the world, including Asia. The present study aimed to systematically review the recent MS epidemiology in Asia, New Zealand, and Australia. Methods: A systematic literature search was performed in Medline and Embase databases to retrieve the available studies regarding MS epidemiology in Asia, New Zealand, and Australia. Results: Most of the studies were performed in hospital settings. The female-to-male ratio in the sample populations varied from 1.5:1 in Turkey to 5:1 in Malaysia. The total mean age at the onset of MS varied from the minimum of 28 years in Hong Kong to the maximum of 36 years in the United Arab Emirates. Among 16 pertinent studies in this regard, seven addressed the incidence rate of MS, and 13 addressed the prevalence of the disease. The highest prevalence rate was reported to be respectively 124.2 and 148.06 in Australia and Iran versus 2.73 in Malaysia (06 per 100,000 population), while a higher incidence rate was estimated at 6.88 and 6.7 per 100,000 population in Kuwait and Australia, respectively compared to the lower incidence rate per 100,000 population in China (0.2 in females, 0.12 in males). Conclusions: According to the results, the prevalence of MS has increased in Asia, while the prevalence of MS in this continent is lower compared to the rates reported in Australia, Europe, and North America.

Detection of mutations in NOD2/CARD15 gene in Arab patients with Crohn's disease.

Background:Mutations in NOD2/CARD15 gene have been linked to an increased risk of Crohn's disease (CD). The objective of this study is to determine NOD2/CARD15 gene mutations, and their association with the risk of CD in Arabs in Kuwait.Methods:Four NOD2 gene mutations, including Pro268Ser (SNP5), Arg702Trp (SNP8), Gly908Arg (SNP12), and Leu1007FsinsC (SNP13) were examined in Arab CD patients (n = 103) and control subjects (n = 100). The genomic DNA was isolated and used in polymerase chain reaction (PCR) with four sets of specific primers. The PCR-amplified DNA fragments were sequenced and analyzed for the NOD2 mutations. Logistic regression was used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI).Results:Of the four genotyped variants, the Arg702Trp (SNP8) and Leu1007FsinsC (SNP13) variants were not informative in our study sample due to minor allele frequency of <1%. The Pro268Ser (SNP5) mutation was detected in 17 (16.5%) CD patients and 32 (32.0%) controls. The Gly908Arg (SNP12) mutation was observed in 24 (23.3%) patients and 10 (10.0%) controls. In the dominant genetic risk model (i.e. carrying at least one minor allele), CD patients compared to controls were less likely to carry either the “CT” or “TT” genotype of variant Pro268Ser (SNP5; aOR = 0.43, 95% CI: 0.22–0.84). In contrast, CD patients compared to controls were more likely to carry the homozygous for the minor allele or the heterozygous genotypes of variant Gly908Arg (SNP12; aOR = 2.67, 95% CI: 1.19–5.97).Conclusions:In this Arab population, carrying at least one copy of the minor allele of Gly908Arg (SNP12) mutation in NOD2 gene was associated with increased susceptibility to CD, while having the heterozygous or homozygous for the minor allele genotype of the Pro268Ser (SNP5) mutation provided protection against CD. Mutations in Arg702Trp (SNP8) and Leu1007FsinsC (SNP13) were not detected in this sample of the Arab population in Kuwait.

Short Sleep Duration and Its Association with Obesity and Other Metabolic Risk Factors in Kuwaiti Urban Adults.

BackgroundEfficient sleep duration and its quality are increasingly recognized as important contributors for maintaining normal body weight. However, lifestyle and social structure within the Arab-gulf region differ compared to those in the western world. This study was specifically conducted in Kuwait’s population to investigate the link between sleep quality (SQ) and obesity in the absence of sleep apnea (SA) onset.MethodsSQ was measured by the Pittsburgh Sleep Quality Index (PQSI) in 984 participants, then verified in 60 individuals including 20 lean (Body mass index/BMI: 18.5–24.9 kg/m2), 20 overweight (BMI: 25–29.9 kg/m2) and 20 obese (BMI: ≥30 kg/m2) through actigraph worn over the right-hip for 7 consecutive days to characterize their sleep–wake cycle, rest-activity, and physical activity. Blood samples were collected for metabolic markers.Results59.6% of participants reported a PSQI score higher than 5, with 57.6% of the participants reporting less than 6 hours of sleep per day. The data show that both SQ and sleep duration are considered inadequate in comparison to the international SQ standards. We found a significant association between SQ and obesity independent of age and sex. Actigraph data further supported the independent association of sleep duration on BMI within the population (p < 0.001). Additionally, total sleep time (TST) was found to significantly correlate with several other metabolic factors including diastolic blood pressure, elevated resting heart rate (RHR), triglycerides, total cholesterol, homeostatic model assessment for insulin resistance (HOMA-IR), C-peptide, and C-Reactive Protein (CRP) secretion. Further multiple-regression analysis showed a significant independent association between blood pressure (p < 0.03), HOMA-IR (p < 0.04), and C-peptide (p < 0.3) and sleep duration.ConclusionThese findings suggest that sleep deprivation and disturbance could be indirect factors involved in the development of not only obesity in Kuwait but also other metabolic syndromes such as type 2 diabetes.

Impact of COVID-19 partial lockdown on household activities in a sample of Kuwaiti and Saudi populations.

Since the World Health Organization (WHO) declared COVID‐19 a global pandemic, partial lockdown has been used as a strict mechanism to constrain the spread of the disease. This study aims to investigate whether there are significant differences between socio‐demographic variables and household and family activities before and during the partial lockdown in Kuwait and the Kingdom of Saudi Arabia due to the COVID‐19 pandemic. A descriptive cross‐sectional method was used in this study. Online surveys were distributed via WhatsApp to a convenience non‐probability sample of 728 participants. The survey contained socio‐demographic information and a 22‐item questionnaire of activities that participants practiced before and during the partial lockdown. An IBM SPSS (25.0) package was utilised to analyse the data. The study found that males and homemakers reported obvious changes for both house and family activities before and during the lockdown. Participants between 40 and 49 years old reported higher scores for family activities before the lockdown. Married participants reported higher scores for house and family activities during the lockdown. The outcomes of this study demonstrate that under certain circumstances in society, cultural gender activities may change due to various reasons such as health precaution regulations, prevention policies, and social isolation.

Dental Age Estimation: A comparison of three methods of estimating dental age in a population of Kuwaiti children and adolescents

BackgroundDental age estimation using the simple average method utilizing the Demirjian 8 stage tooth developments system has not previously been compared to the 14 stage system of Moorrees. Neither method has been previously used nor compared with the Atlas method in a Kuwaiti population. The recent development of a Kuwait reference data set provides the means to determine which of these methods is the most accurate for age estimation in Kuwaiti subjects. Patients, materials and methodsThe sample was dental panoramic tomographs (DPTs) from the archives of Kuwait Ministry of Health Dental Hospitals comprising 375 healthy children aged between 5 and 15 years.Each of the anonymized DPT was assessed in random order and personal details masked from the observer. ResultsIntra and inter examiner agreement were calculated using Cohen's Kappa with scores of 0.76 or above which is ‘good to excellent’ agreement.The chronological age (CA) minus dental age (DA) difference using the simple average method (SAM) is an overestimate of 0.39 years for females and an underestimate of 0.14 years for males. The London Atlas overestimated the chronological age by 0.60 years for females and 0.19 years for males. Moorrees technique gave an underestimate of 1.01 years for females and 0.89 years for males.Bland-Altman plots showed an even distribution of difference around the chronological age. The Bland Altman plots showed the spread of the differences between chronological age and dental age for each of the three methods. ConclusionsThe simple average method was the most accurate within, 2–3 months of chronological age. The London Atlas and Moorrees methods were less accurate.This makes the simple average method the favoured technique for dental age estimation in a forensic science setting where ethnic specific reference data are important.

Association between the lipoprotein lipase rs1534649 gene polymorphism in intron one with Body Mass Index and High Density Lipoprotein-Cholesterol

Lipoprotein lipase (LPL) is an enzyme involved in lipid metabolism and distribution of fatty acids hence its role in the initiation and development of dyslipidemia and adiposity. Single nucleotide polymorphisms (SNPs) across the LPL gene have been associated with dyslipidemia, however, the association with obesity has been limited towards specific populations. This study examined the association between LPL gene polymorphisms with plasma lipid levels and body mass index (BMI) in the Kuwaiti population. We examined a total of 486 adults (303 and 183 females and males respectively) with plasma lipid levels and BMI. DNA samples were genotyped for two LPL gene polymorphisms (rs1534649 and rs28645722) using TaqMan allelic discrimination. The relationship between the genotypes with both plasma lipid levels and BMI were assessed using linear regression using “SNPassoc” package from R statistical software. Using an additive genetic model, linear regression analysis showed the T-allele of rs1534649 to be associated with increased BMI in a dose-dependent trend β = 2.13 (95% CI 1.33–2.94); p = 1.7 × 10−7. In addition, a borderline significance was observed between the T-allele and low levels of high density lipoprotein-cholesterol β = −0.04 (95% CI −0.08, −0.006); p = 0.02. There were no associations between rs28645722 and plasma lipid levels (p > 0.05). However, a trend was observed between the A-allele and increased BMI β = 1.75 (95% CI 0.14–3.35); p = 0.03. Our study shows intron one polymorphism rs1534649 to increase the risk of obesity and dyslipidemia. Our findings warrant further investigation of the mechanism of LPL on the development of obesity along with the role of intron one and its impact on LPL gene activity.

Prevalence, Risk Factors, and Comorbidities of Obstructive Sleep Apnea Risk Among a Working Population in Kuwait: A Cross-Sectional Study.

Background: Obstructive sleep apnea (OSA) affects a considerable proportion of adults globally and is associated with elevated morbidity and mortality. Given the lack of epidemiologic data on the burden of OSA in Kuwait, this study sought to estimate its prevalence, associated risk factors, and comorbid conditions among a working population in Kuwait.Methods: This was a cross-sectional study of a sample of working adults (n = 651) from public institutions in Kuwait. High/low risk for OSA was ascertained according to the Berlin Questionnaire criteria. Participants self-reported their coexisting health conditions. Associations were assessed using Poisson regression with robust variance estimation; adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated.Results: Overall, 20.0% (130/651) of participants were classified as being at high risk for OSA, with more male than female subjects being at high risk (24.0% [56/233] vs. 17.7% [74/418], P = 0.053), though this difference did not gain statistical significance. Moreover, a high risk for OSA was more common among older and obese subjects. Factors associated with increased prevalence of a high risk for OSA included current smoking status (aPR = 1.58, 95% CI: 1.02–2.06), longer hours spent watching television (1.76, 1.10–2.81), and lower self-perceived physical health (2.11, 1.15–3.87). However, decreasing trends in the prevalence of high risk for OSA were observed with frequent engagement in vigorous physical activity and longer nightly sleep duration. Compared to those at a low risk for OSA, the subjects at high risk for OSA were more likely to have insomnia disorder (2.83, 1.81–4.41), diabetes (1.94, 1.15–3.27), hypertension (3.00, 1.75–5.16), and depression (4.47, 1.80–11.08).Conclusion: This study estimated that 1/5 of working adults in Kuwait were at high risk for OSA, and the prevalence varied according to personal characteristics and lifestyle factors. Also, a high risk for OSA classification was associated with multiple comorbid health conditions.

Unraveling a fine-scale high genetic heterogeneity and recent continental connections of an Arabian Peninsula population

Recent studies have showed the diverse genetic architecture of the highly consanguineous populations inhabiting the Arabian Peninsula. Consanguinity coupled with heterogeneity is complex and makes it difficult to understand the bases of population-specific genetic diseases in the region. Therefore, comprehensive genetic characterization of the populations at the finest scale is warranted. Here, we revisit the genetic structure of the Kuwait population by analyzing genome-wide single nucleotide polymorphisms data from 583 Kuwaiti individuals sorted into three subgroups. We envisage a diverse demographic genetic history among the three subgroups based on drift and allelic sharing with modern and ancient individuals. Furthermore, our comprehensive haplotype-based analyses disclose a high genetic heterogeneity among the Kuwaiti populations. We infer the major sources of ancestry within the newly defined groups; one with an obvious predominance of sub-Saharan/Western Africa mostly comprising Kuwait-B individuals, and other with West Eurasia including Kuwait-P and Kuwait-S individuals. Overall, our results recapitulate the historical population movements and reaffirm the genetic imprints of the legacy of continental trading in the region. Such deciphering of fine-scale population structure and their regional genetic heterogeneity would provide clues to the uncharted areas of disease-gene discovery and related associations in populations inhabiting the Arabian Peninsula.

Depositional time trends of phosphorous accumulation in a dated sediment core from the northwestern Arabian Gulf: Can phosphorous be used to support 210Pb chronologies in coastal aquatic sediments?

The use of 210Pb dating for the reconstruction of contaminant profiles in undisturbed sediments is the most widely acceptable technique historically. Due to the uncertainties associated with the technique, dating of sediments have often been supported by ancillary evidence such as an alternative historical marker in the catchment that is preserved in the sedimentary records. The most widely used verification marker is 137Cs, which is attributed to global fallout from past nuclear weapons testing, and the Chernobyl accident. In the southern hemisphere, and the mid-latitudes, the 137Cs signal from Chernobyl fallout is often absent from the sedimentary records making it very difficult to verify the 210Pb chronologies in these natural archives. This study reports the spatial and temporal variability of total phosphorus (TP) and its forms in sediments from Kuwait Bay and provides evidence of the possibility of using Phosphorous as a potential marker to support dates derived from 210Pb dating.In the current study we report the spatial and temporal variations in the concentrations of Phosphorus from near-shore sediments from Kuwait. The mean (and range) of TP concentration in surficial sediments is 19.4 (12.2 to 24) μmol-P g−1 dry weight. The highest concentrations were measured in the deepest portions of the Bay which is characterized by fine grained sediments. The vertical profile of TP in the sediments was characterized by a gradual increase in concentration from lower layers to a subsurface maximum (at approximately 4–5 cm) followed by an exponential decrease to the sediment-water interface. The sedimentary TP profile correlated remarkably well with changes in the population of Kuwait over the last three decades, suggesting that wastewater inputs into the Bay from treatment plants are an important source of phosphorus in the coastal waters. The decrease in concentration in sediment deposited over the last five years of the core is explained by the commissioning of an improved wastewater treatment plant with higher phosphorus removal efficiency. These fluctuations preserved in the sedimentary records linked to identifiable historical events provides powerful evidence that this nutrient associated with wastewater inputs in coastal aquatic environments can be used as ancillary information to support 210Pb dating.

Epidemiology of adult congenital heart disease among the general population in Kuwait.

BackgroundAdult congenital heart disease (ACHD) is a highly underrepresented entity in medical literature, especially in the middle‐eastern region.HypothesisThis study is the first to assess the prevalence of adult congenital heart disease among the population of Kuwait.MethodsAfter a retrospective register review of patients in Kuwait being followed up in the chest diseases hospital was conducted, patients who fit the inclusion criteria were enrolled in the study. Using the American College of Cardiology Task Force 1 of the 32nd Bethesda conference classification of the severity of ACHD, the patients were classified into those with simple, moderate, and complex congenital heart diseases. The age and gender of the patients, as well as the type repair performed, and the residual cardiac findings were recorded to assess the association between the complexity and residuals. Associations were assessed using STATA 15.ResultsA total of 611 patients were evaluated over a period of 18 months. The youngest participant was 20 years of age, and the oldest participant was 88 years old. Male participants with moderate congenital heart disease class were more common in our study population. Patients with complex congenital heart disease have more residual cardiac lesion than the moderate or simple groups. Almost (70%) of patients with complex cardiac anomalies have undergone either partial or complete repair. The most prevalent cardiac defect was atrial septal defect (21.5%). Tetralogy of Fallot was the most prevalent defect in the moderate group, representing (13%) of the group. The most prevalent anomaly in the complex group was double outlet right ventricle (DORV) representing (15.38%).ConclusionAdult Congenital heart disease is a growing entity of heart disease due to advanced repair techniques. This population requires registries to document cases and assign specialists for the management and care of this special group of patients.Highlights First database of adult congenital heart disease in Kuwait.The most prevalent heart defect was ASD in Kuwait.TOF was the most prevalent defect in the moderate group; and DORV was the most prevalent in the complex group.Patients with moderate ACHD tended to have a more complete repair than those in the complex group.

Onabotulinumtoxin A Improves Psychological Aspects in Chronic Migraine Patients.

Background: Chronic migraine (CM) affects 5.4% of the Kuwaiti population. It is associated with significant headache-related disability, psychiatric comorbidity and reduced quality of life. The aim of this study is to assess the efficacy of Onabotulinumtoxin A on psychological aspects of chronic migraine patients.Methods: This prospective study over 36 months included chronic migraine patients in a tertiary headache center. Eligible patients met International Classification of Headache Disorders disorders-third edition, beta version (ICHD-III) revision criteria for chronic migraine. Patients with history of psychiatric or medical problems other than migraine disorders were excluded. Patients who received less than 4 injections cycles of Onabotulinumtoxin A were excluded. Identified patients received 155 units of Onabotulinumtoxin A quarterly according to the Phase III Research Evaluating Migraine Prophylaxis Therapy Trail (PREEMPT) protocol. Quality of life, the seven-item Generalized Anxiety Disorder (GAD-7) scores, the nine-item Patient Health Questionnaire (PHQ9), and the Pittsburgh Sleep Quality Index (PSQI) were collected before injection and at the end of the study. Mean comparison tests were performed using the independent sample t-test to assess the effects of Onabotulinumtoxin A on quality of life and comorbid symptoms of anxiety, depression, and quality of sleep.Results: The study identified 131 chronic migraine patients with a mean age of 44.92 years, mean disease duration of 12.20 years and a mean treatment sessions of 7.58. In their last visit, most of our sample showed improvement in quality of life (81%), GAD-7 (81%), PHQ9 (79%), and PSQ1 (76%). The mean score of patient satisfaction was 7.21. Onabotulinumtoxin A treatment for CM improved quality of life significantly (72.92 vs. 103.62; P < 0.0001). It was also associated with significant reduction in anxiety [GAD-7 (12.00 vs. 6.61; P < 0.0001)] and depression [PHQ-9 (17.91 vs. 12.52; P < 0.0001)] scores, as well as reduced difficulty in sleeping [PSQI (12.60 vs. 6.66; P < 0.0001)] at the last visit.Conclusion: Prophylactic Onabotulinumtoxin A treatment for CM was associated with significant improvement of quality of life, reduction in symptoms of anxiety and depression, as well as improved symptoms of poor sleep.

Population genetics and forensic utility of 23 autosomal PowerPlex Fusion 6C STR loci in the Kuwaiti population

This study evaluates the forensic utility of 23 autosomal short tandem repeat markers in 400 samples from the Kuwaiti population, of which four markers (D10S1248, D22S1045, D2S441 and SE33) are reported for the first time for Kuwait. All the markers were shown to exhibit no deviation from Hardy–Weinberg equilibrium, nor any linkage disequilibrium between and within loci, indicating that these loci are inherited independently, and their allele frequencies can be used to estimate match probabilities in the Kuwaiti population. The low combined match probability of 7.37 × 10–30 and the high paternity indices generated by these loci demonstrate the usefulness of the PowerPlex Fusion 6C kit for human identification in this population, as well as to strengthen the power of paternity testing. Off-ladder alleles were seen at several loci, and these were identified by examining their underlying nucleotide sequences. Principal component analysis (PCA) and STRUCTURE showed no genetic structure within the Kuwaiti population. However, PCA revealed a correlation between geographic and genetic distance. Finally, phylogenetic trees demonstrated a close relationship between Kuwaitis and Middle Easterners at a global level, and a recent common ancestry for Kuwait with its northern neighbours of Iraq and Iran, at a regional level.

Intraspecific variation of Haloxylon salicornicum (Amaranthaceae) seed germination under salinity and simulated drought

Haloxylon salicornicum (Moq.) Bunge ex Boiss. is a suitable species for desert and coastal restoration for its forage production and dune stabilization. Inter-population variation of seed parameters has previously received little attention. Variation in seed germination response to drought and salinity stress was evaluated for three Kuwaiti populations for use in restoration projects. Germination parameters varied significantly among populations. Seeds from Kabd were larger and germinated at a higher percentage than the other two populations, Mutla and Liya, under conditions of saline (62.8%, 40.0%, and 50.7% respectively) and moisture (58.2%, 32.6%, and 45.6%) stress. Increasing salinity and drought simulation progressively inhibited seed germination across all populations. Drought simulation by PEG 6000 inhibited germination from −0.3 MPa, while salinity affected the germination proportion from 400 mM NaCl for all the studied populations. All populations exhibited a high recovery from NaCl and PEG stress, indicating the species is broadly adapted to survival through drought and saline conditions. Our findings indicate that revegetation success with this species will be influenced by the population characteristics of the maternal seed source.

Acceptance of a COVID-19 Vaccine and Its Related Determinants among the General Adult Population in Kuwait

Objective: The objective of this study was to determine the acceptance of a coronavirus disease 2019 (COVID-19) vaccine among the general adult population in Kuwait and assess its determinants. Subjects and Methods: A web-based cross-sectional study was conducted by enrolling adults living in Kuwait (n = 2,368; aged ≥21 years). Acceptance of a COVID-19 vaccine was inferred if participants indicated that they “definitely or probably will accept vaccination against COVID-19 once a vaccine is available.” Associations were explored by applying a modified Poisson regression to estimate and infer adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI). Results: In total, 53.1% (1,257/2,368) of the participants were willing to accept a COVID-19 vaccine once available. Male subjects were more willing to accept a COVID-19 vaccine than females (58.3 vs. 50.9%, p < 0.001). Subjects who viewed vaccines in general to have health-related risks were less willing to accept vaccination (aPR = 0.39, 95% CI: 0.35–0.44). Moreover, participants who previously received an influenza vaccine were more likely to accept a COVID-19 vaccine (aPR = 1.44, 95% CI: 1.31–1.58). Willingness to get vaccinated against COVID-19 increased as the self-perceived chances of contracting the infection increased (p < 0.001). Conclusion: Overall, 53.1% of the study participants demonstrated willingness to get vaccinated against COVID-19. We found several factors influencing the level of acceptance. Since vaccination appears to be an essential preventive measure that can halt the COVID-19 pandemic, factors relating to low vaccine acceptance need to be urgently addressed by public health strategies.

Attitude (Acceptance) of the COVID-19 Vaccine among Adult Kuwait Oil Company Workers

Objective: To measure the acceptance of a coronavirus disease 2019 (COVID-19) vaccine among the sector of the oil company adult population in Kuwait and assess its determinants. Subjects and Methods: A cross-sectional email study enrolled adults working for Kuwait oil companies (n = 1689; aged ≥21 years). Acceptance of a COVID-19 vaccine was considered if participants selected the options and received the vaccine, definitely or probably will accept vaccination against COVID-19 once a vaccine is available.” A modified Poisson regression was used to investigate the associations and calculate the adjusted prevalence ratios (aPRs) and their 95% confidence intervals (CIs). Results: In total, 92.5% (1563/1689) of the participants were willing to accept COVID-19 vaccines once available. No difference in sex was observed in the willingness to accept a COVID-19 vaccine (92.5 vs. 92%, p 0.5). Responders who believed vaccines in general to have health-related risks were less likely to get vaccinated (aPR = 0.39, 95% CI: 0.35 - 0.44). In addition, participants who received the influenza vaccine were more willing to have a COVID-19 vaccine (aPR = 1.44, 95% CI: 1.31 - 1.58). Acceptance of the vaccine against COVID-19 increased as the self-perceived chances of contracting the infection increased (p < 0.001). Conclusion: Overall, 92.5% of the study participants demonstrated a willingness to be vaccinated against COVID-19. However, we found that public health authorities should address several factors influencing the level of acceptance.