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Obesity, type 2 diabetes (T2D), cardiovascular disease (CVD), and chronic kidney disease (CKD) are overlapping conditions that drive premature morbidity and mortality worldwide. Care remains siloed and reactive despite shared risk factors and strong evidence for early intervention. To support integrated disease management, the American Heart Association (AHA) recently introduced the concept of cardiovascular–kidney–metabolic (CKM) syndrome, recognizing the bidirectional links between metabolic, kidney, and cardiovascular health. Kuwait faces one of the highest burdens of CKM-related diseases globally. Three-quarters of adults are overweight or have obesity, and 28
BackgroundCritical pertussis continues to cause significant morbidity and mortality in infants necessitating pediatric intensive care. Despite advances in supportive care, knowledge gaps persist. This study aimed to examine institutional capacity, physician knowledge, and practice variability in managing critical pertussis among pediatric intensive care units (PICUs) across the Gulf Cooperation Council (GCC) countries.MethodsA cross-sectional internet-based survey was distributed to PICU physicians across the six GCC countries between December 1, 2024, and January 31, 2025. Demographic information, clinical experience, diagnostic resources, and therapeutic approaches were collected. A multivariable generalized linear regression (Gamma) model identified factors associated with pertussis knowledge scores.ResultsAmong 185 respondents, almost 70% of participants were male, 62.7% were specialists or consultants, and around half (47%) were certified pediatric intensivists. Access to mechanical ventilation was almost universal (98.4%), yet extracorporeal membrane oxygenation was available in only 24.3% of centers. Polymerase chain reaction-based diagnosis was widely available, but more than one-third (36.2%) of participants reported a test turn-around-time of at least two days. A majority (66%) of physicians used exchange transfusion for hyperleukocytosis, but white blood cell thresholds varied widely. Institutional protocols were lacking in over 40% of centers. The average pertussis knowledge score was 9.52 out of 13 questions (SD ±1.72). Physician's clinical experience showed a strong and graded association with pertussis knowledge.ConclusionsThis study highlights the heterogeneity in pertussis management practices across the GCC PICUs, compounded by variability in resources and different institutional guidelines. Findings highlight the urgent need for standardized protocols to harmonize pertussis care.
Introduction:Gangliocytic paraganglioma is rare duodenal tumor characterized by distinctive histological features including neuroendocrine, ganglion and Schwann-like cells. It is typically benign, though occasional regional lymph node metastasis have been reported, and most patients present with gastrointestinal bleeding or obstruction. Recurrence after resection is rare. Case presentation:We present a 46-year-old male presented with a 15-day history of melena, fatigue and dizziness. Initial hemoglobin was 10.7 g/dl, which dropped to 8.2 g/dl during admission. Upper GI endoscopy revealed a large pedunculated lesion in the second part of duodenum. Endoscopic ultrasound (EUS) demonstrated a 3-4 cm submucosal mass without lymphadenopathy and EUS-guided biopsy confirmed gangliocytic paraganglioma. CT scan showed a 2.7 × 3.5 × 2.7 cm exophytic duodenal lesion. The patient subsequently underwent duodenal mass resection. Final histopathology was consistent with gangliocytic paraganglioma. postoperative recovery was uneventful and he remained asymptomatic at 6 months follow-up. Discussion:Duodenal gangliocytic paraganglioma is a rare neoplasm that may present with variable symptoms, most commonly gastrointestinal bleeding. Radiological imaging plays an important role in localizing the lesion and excluding metastatic disease, though definitive diagnosis relies on histopathology. While endoscopic resection may be feasible for small, localized tumors. surgery is often required for definitive management in cases of significant bleeding or concern for incomplete excision. Conclusion:Duodenal gangliocytic paraganglioma should be distinguished from other neuroendocrine tumors. The possibility of malignant behavior with nodal or distant spread should be excluded prior to surgery. Careful treatment planning and long-term follow-up are essential.
Background/Objectives: Obstructive sleep apnea (OSA) is a sleep condition characterized by intermittent hypoxia, systemic inflammation, and metabolic dysfunction. Contemporary diagnosis criteria depend on polysomnography (PSG), a procedure that is limited by cost and accessibility. Identifying reliable circulating biomarkers may facilitate disease diagnosis and treatment monitoring. Methods: Insulin-like growth factor binding protein-7 (IGFBP-7) has been implicated in pathways relevant to OSA, although its precise role remains elusive. While we previously identified IGFBP-7 as a candidate of interest, in this report, we assessed circulating IGFBP-7 levels in a single-cohort study of 164 participants (124 with OSA, 40 controls) at the Dasman Diabetes Institute. A Type I PSG test was performed in a level 1 sleep laboratory to diagnose sleep apnea. Among the 124 patients with OSA who underwent multilevel sleep surgery (MLS), 67 completed the 3-month postoperative follow-up and were included in the longitudinal analyses. In these participants, we evaluated the apnea-hypopnea index (AHI) at baseline and 3 months after surgery and examined the associations between circulating IGFBP-7 levels, OSA severity indices, and metabolic parameters. Results: Our data revealed a significant increase in IGFBP-7 levels in people with OSA compared to controls (p < 0.001). Importantly, the increase in IGFBP-7 was positively correlated with AHI (r = 0.272, p < 0.001), indicating a potential link with this condition. IGFBP-7 levels declined significantly following MLS (p < 0.001), paralleling improvements in AHI and suggesting responsiveness to therapeutic intervention and a reduced hypoxic burden. IGFBP-4 levels increased significantly in patients with OSA (p = 0.006) but were not correlated with IGFBP-7. The receiver operating characteristic (ROC) analysis identified IGFBP-7 with a cut-off value of 14,003.21 pg/mL as a potential biomarker for OSA, with moderate performance (AUC = 0.722, 95% CI: 0.636-0.808; sensitivity 73%, specificity 84%). Notably, combining IGFBP-7 with IGFBP-4 resulted in a modest improvement (AUC = 0.755). Conclusions: Our data suggest that IGFBP-7 shows a modest association with OSA severity and may have exploratory value as part of a multi-marker or risk-stratification approach. Further large-scale and longitudinal studies are warranted to extensively explore the potential utility of IGFBP-7 within multi-marker approaches.
IntroductionThe significance of the human skeleton as an endocrine organ has been emphasized in recent literature where it may have the ability to regulate metabolic pathways including insulin signaling and glucose homeostasis. Therefore, the consequences of T1D can significantly impact bone health and structural formation, leading to osteoporosis later in life. This study aimed to evaluate lumbar spine size adjusted bone mineral density (BMD) and bone turnover biomarkers in Kuwaiti youth with childhood-onset T1D, and to examine its association with diabetes duration and glycemic control.MethodsIn this cross-sectional study, 132 Kuwaiti participants aged 5 to 18 years with T1D were recruited from a pediatric diabetes clinic. Anthropometric measurements, pubertal status, and clinical histories were recorded. Dual-energy X-ray absorptiometry (DXA; Hologic Discovery W, Hologic APEX Software version 5.6.0.5) was used to assess lumbar spine bone mineral apparent density (BMAD). Bone formation (osteocalcin, P1NP, P1CP) and resorption (urine CTX) biomarkers were measured. Multivariable linear regression models adjusted for age at diagnosis, sex, pubertal status, height, and HbA1c were used to assess associations between (i) diabetes duration and BMAD Z-score and (ii) diabetes duration and each bone biomarker.ResultsMedian diabetes duration was 3.5 years (LQ-UQ: 1.01-6.98 years). Each additional year of diabetes duration was associated with a non-significant decrease in BMAD Z - score after adjustment for age at diagnosis, sex, Tanner pubertal status, average HbA1c, and height (effect size: –0.11, 95% CI: –0.22 to 0.01). Higher average HbA1c was significantly associated with lower BMAD Z - score (–0.18 per unit increase, p=0.005). Each additional year of diabetes duration was associated with lower osteocalcin levels by 30.6% (95%CI: 37.5-22.9%) amongst females and 14.5% (95% CI: 24.7-2.8%) amongst males, and lower Urine CTX levels by 14.3% amongst females (95% CI: 8.5-19.7%), but not amongst males.ConclusionHigher mean HbA1c was associated with a lower lumbar-spine BMAD Z-score, whereas diabetes duration was not significantly associated with BMAD Z-score. Sex-specific associations were observed between diabetes duration and selected bone-turnover markers. These cross-sectional findings require confirmation in longitudinal studies incorporating appropriately matched controls and population-appropriate DXA reference data.
