BACKGROUND: Hepatocellular Carcinoma (HCC) can be classified as one of the most common malignancies worldwide. There is scarcity of the published data on the risk factors for HCC in the Gulf Cooperation Council countries specifically Kuwait. Therefore, this case-control study sought to examine the risk factors associated with HCC in Kuwait.
METHODS: Fifty-three histopathologically confirmed HCC cases were recruited from the Kuwait Cancer Control Center Registry. One hundred ninety-six controls (1:4 ratio) were selected from medical and/ or surgical outpatient\'s clinics at all six public hospitals of Kuwait. A structured questionnaire was used to collect the data both from cases and controls through face-to-face interviews. A multivariable logistic regression model was fitted to the case-control data. Adjusted odds ratios (ORadj) and their 95% confidence intervals (CI) were computed using the parameters\' estimates of the final model and used for interpretation of the model.
RESULTS: The HCC cases compared with the controls were 41.6 times more likely to have had the history of non-alcoholic fatty liver disease (NAFLD) (ORadj = 41.6; 95% CI: 8.9-193.5; p < 0.001). The cases compared with the controls were more likely to have reported the history of heavy alcohol drinking (ORadj = 14.2; 95% CI: 1.2-173.4; p = 0.038). Furthermore, compared with the controls, the HCC cases tended to frequently consume milk and/or milk substitutes (≥ 3 glass/ week) (ORadj = 7.2; 95% CI: 1.2-43.4). Conversely however, there was a significant protective effect if the participants reportedly have had regularly used olive oil in their routine diet as a source of fat (ORadj = 0.17; 95% CI: 0.04-0.80) or regularly used non-steroid anti-inflammatory drugs (NSAIDs) (ORadj = 0.20; 95% CI: 0.05-0.71).
CONCLUSIONS: This study showed that heavy alcohol consumption, NAFLD history, and excessive consumption of milk/ milk substitutes were associated with a significantly increased HCC risk. Conversely however, regular use of olive oil in the diet as a source of fat or regular use of NSAIDs had a significantly protective effect against HCC risk. Adapting healthy dietary habits and preventing/ treating NAFLD may minimize the HCC risk. Future research with a larger sample size may contemplate validating the results of this study and unraveling additional risk factors contributing to HCC risk. The resultant data may help design and implement evidence-based educational programs for the prevention of HCC in this and other similar settings.

Different types of infant foods categorized as formulas, cereals, and purees imported from seven different countries and available on the Kuwaiti retail market were collected to determine the elemental content, including essential trace elements namely chromium (Cr), manganese (Mn), iron (Fe), copper (Cu), zinc (Zn), selenium (Se), and molybdenum (Mo); potentially toxic trace elements such as aluminum (Al), nickel (Ni), tin (Sn), antimony (Sb), and uranium (U); and toxic trace elements including arsenic (As), lead (Pb), cadmium (Cd), and mercury (Hg). The samples were analyzed using ICP-MS. An extensive literature search illustrated the uniqueness of this study since seven different essential elements, five different potentially toxic elements, and four different toxic trace elements were measured in a variety of infant foods; in addition, the different trace etlemental levels measured in the investigated infant foods were compared to the ones associated with the different infant foods types reported in the literature. The essential trace element concentrations detected in this study were implemented to calculate their total daily intake, where the calculated daily intake values were compared to their recommended dietary allowance (RDA) to assess the percentage total daily intake for the essential trace elements. Further, the calculated potentially toxic and toxic trace elements daily intake values were used to assess the potential health risks to infants incurred by consuming different infant foods by calculating the hazard quotient (HQ), while the margin of exposure (MOE) was calculated for the toxic ones only. It was concluded that infant formulas and foods should be added to the infant diet in addition to breast milk to meet specific nutritional needs. This study confirms that infants are exposed to toxic trace elements via diet, warranting careful attention to diet choices both to limit this exposure and to avert potentially hazardous adverse health effects to the infants. However, based on the calculated hazard quotients (HQs) and margin of exposures (MOEs), consuming breast milk in addition to almost all different types of infant foods is considered safe and unlikely to contribute to infants\' non-cancerous health hazards.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, autoimmune disease that mostly affects the synovial joints. It has been hypothesized that dietary and other environmental and lifestyle factors contribute to the development of RA and its severity.
OBJECTIVE: The present study aims to measure the effect of the Mediterranean diet (MedDiet) on the disease activity scores (DAS28) among patients with RA.
METHODS: Adult patients who satisfied the American College of Rheumatology (ACR) classification criteria for RA from major hospitals in Kuwait were evaluated. A cross-sectional study conducted on 754 RA patients visits aged (21-79) years. Patients were evaluated using the DAS28. Patients\' levels of adherence to the MedDiet are assessed using a validated 14-item Questionnaire (paper or web-based). The data was analyzed using both multivariate and univariate statistics. Multivariate logistic regression was used to analyze the statistical relationship between MedDiet and RA disease activity.
RESULTS: The finding suggests that a MedDiet can have a positive impact on DAS28 among patients with RA. In the DAS28 cohort (DAS28 < 3.2, DAS28 ≥ 3.2), several Mediterranean survey components showed statistically significant differences. Patients with a Mediterranean score ≤ 5 was more likely to have hazard effects for DAS28 than those with a Mediterranean score of ≥10 (HR = 0.17, CI [0.08-0.37], p < .001). The finding shows that, Mediterranean levels ≤5, on biologics treatment, CRP, and patient global assessment were significantly associated with overall survival. Additionally, the MedDiet was found to be a significant predictor of DAS28 in the random forest decision tree plot, along with tender, RF, and creatinine. MedDiet patients had a lower DAS28 score than others.
CONCLUSIONS: The findings suggest that optimal drug treatment and a restrictive diet can help to improve DAS28 score for patients with RA. More patients in the cohort DAS28 <3.2 used olive oil, servings of vegetables, fruits, and legumes. In contrast, more patients in the cohort DAS28 ≥ 3.2 consumed red meat, butter, sweetened or soft drinks, cakes, cookies, or biscuits, and tomato sauce.

Trichophyton indotineae is an emerging dermatophyte that has remarkable impact on public health worldwide. In addition to producing severe extensive skin lesions, this species is frequently resistant to terbinafine, used as a first line agent. As a result, the infection is often refractory, making treatment very challenging. The current report describes the first case of Trichophyton indotineae infection in Kuwait. The infected woman had no recent travel history. She failed to respond to several courses of antifungals, but finally responded to voriconazole. The report suggests that T. indotineae is under recognised, hence, active surveillance of dermatophytes is warranted.

Heavy metal pollution can adversely impact marine life, such as crabs, which can accumulate it in different organs and potentially transfer and biomagnify along the food chain in aquatic ecosystems. This study aimed to examine the concentrations of heavy metals (Cd, Cu, Pb, and Zn) in sediment, water, and crab tissues (gills, hepatopancreas, and carapace) of the blue swimmer crab Portunus pelagicus in the coastal areas of Kuwait, northwestern Arabian Gulf. Samples were collected from Shuwaikh Port, Shuaiba Port, and Al-Khiran areas. The accumulation of metals in crabs were higher in the carapace > gill > digestive gland, and the highest metal concentration was found in crabs collected from Shuwaikh > Shuaiba > Al-Khiran. The metal concentrations in the sediments were in the order Zn > Cu > Pb > Cd. Zn was the highest metal concentration detected in marine water sampled from the Al-Khiran Area, whereas the lowest metal was Cd sampled in water from the Shuwaikh Area. The results of this study validate the marine crab P. pelagicus as a relevant sentinel and prospective bioindicator for evaluating heavy metal pollution in marine ecosystems.

Coastal aquifer is a fragile environment due to the interaction of groundwater with seawater, especially in arid environments. Groundwater along Kuwait\'s Bay is polluted due to discharge of waste from desalination plants, power plants, and other anthropogenic activities. Earlier studies on submarine groundwater discharge in Kuwait\'s Bay region have reported the transfer of nutrient flux from the groundwater to Kuwait\'s Bay. The current study focused on nitrate sources and processes governing their distribution in groundwater samples collected from the southern part of Kuwait\'s Bay. The concentration of nitrate in the samples ranged from 22.7 to 803.9 mg/L. Higher values were noted in the samples collected inland and a few samples adjacent to the Bay. Spearman\'s correlation analysis of the data indicated that NO3- has a strong positive correlation with SO42- and moderate positive correlation with Na + , TDS/EC. The PCA analysis and factor scores revealed the different sources for groundwater nitrate contamination as follows: leakage of sewer lines in the urban region has led to the infiltration of contaminated sewage, high saline environment due to seawater intrusion, chemical weathering, and influence of denitrifying bacteria. The health risk has resulted due to the NO3- concentration being above the standard limit for adults. Furthermore, the nitrate concentration was higher in the region adjoining the landfills. In addition, the discharge of groundwater with higher nitrate to the adjacent open water in the Bay may lead to eutrophication. Hence, proper management strategies are to be adopted to control the nitrate pollution in groundwater.

Electronic waste (e-waste) has become one of the major causes of environmental concerns due to its large volume, high generation rate and toxic environmental burdens. Recent estimates put e-waste generation at about 54 million tonnes per annum with figures reaching approximately 75 million tonnes per annum by 2030. In this manuscript, the state-of-the-art technologies and techniques for segregation, recovery and recycling of e-waste with a special focus on the valorisation aspects of e-plastics and e-metals which are critically reviewed. A history and insight into environmental aspects and regulation/legislations are presented including those that could be adopted in the near future for e-waste management. The prospects of implementing such technologies in the State of Kuwait for the recovery of materials and energy from e-waste where infrastructure is lacking still for waste management are presented through Material Flow Analysis. The information showed that Kuwait has a major problem in waste accumulation. It is estimated that e-waste in Kuwait (with no accumulation or backlog) is generated at a rate of 67,000 tpa, and the imports of broadcasting electronics generate some 19,428 tonnes. After reviewing economic factors of potential recovered plastics, iron and glass from broadcasting devices in Kuwait as e-waste, a total revenue of $399,729 per annum is estimated from their valorisation. This revenue will open the prospect of ventures for other e-waste and fuel recovery options as well as environmental benefits and the move to a circular economy.

The rapid growth and urbanization rate, coupled with hot climate and scarce rainfall, makes it essential for a country like Kuwait to have several power and desalination plants with high-generating capacity. These plants are entirely reliant on burning fossil fuels as a source of thermal energy. These plants are also universally accepted to be the largest CO2 emitters; hence, they present a potential for carbon capture and storage (CCS). Having established the suitability of the existing conditions for post-combustion CCS, a techno-economic-based feasibility study, which took into consideration local power generation technologies and economic conditions, was performed. Relying on fifteen case study models and utilizing the concept of levelized cost of electricity (LCOE), the statistical average method (SAM) was used to assess CCS based on realistic and reliable economic indicators. Zour power station, offering the highest potential CO2 stream, was selected as a good candidate for the analysis at hand. Heavy fuel oil (HFO) was assumed to be the only fuel type used at this station with affixed price of USD 20/barrel. The analysis shows that the internal rate of return (IRR) was about 7%, which could be attributed to fuel prices in Kuwait and governmental support, i.e., waived construction tax and subsidized workforce salaries. Furthermore, the net present value (NPV) was also estimated as USD 47,928 million with a 13-year payback period (PBP). Moreover, 1-3% reductions in the annual operational cost were reflected in increasing the IRR and the NPV to 9-11% and USD 104,085-193,945 million, respectively, and decreasing the PBP to 12-11 years. On the contrary, increasing the annual operational cost by 1% made the project economically unfeasible, while an increase of 3% resulted in negative IRR (-1%), NVP (-USD 185,458 million) and increased PBP to 30 years. Similarly, increasing the HFO barrel price by USD 5 resulted in negative IRR (-10%) and NVP (-USD 590,409); hence, a CCS project was deemed economically unfeasible. While the study considered the conditions in Kuwait, it is expected that similar results could be obtained for other countries with an oil-driven economy. Considering that around 62% of the fossil fuel blend in Kuwait is consumed by electricity and water generation, it is inevitable to consider the possibility and practicality of having a carbon network with neighboring countries where other oil-driven economies, such as Kingdom of Saudi Arabia and Iraq, can utilize a CCS-based mega infrastructure in Kuwait. The choice of Kuwait is also logical due to being a mid-point between both countries and can initiate a trading scheme in oil derivatives with both countries.

While the non-communicable disease (NCD) burden in the countries of the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) has surged over the past decades, the costs and return on investment (ROI) of implementing cost-effective, WHO-recommended NCD interventions have not been established.
We performed an economic analysis to estimate the ROI from scaling up four sets of NCD interventions over 15 years. We estimated the direct costs of the four main NCDs (cancer, diabetes, cardiovascular diseases and chronic respiratory diseases) using a prevalence-based, bottom-up cost-of-illness approach. We estimated indirect costs based on productivity loss due to absenteeism, presenteeism and premature deaths. We costed the scaling up of interventions using the WHO Costing Tool and assessed the health impact of interventions using the OneHealth Tool. We calculated ROI by comparing productivity and social benefits with the total costs of implementing the interventions.
The four main NCDs cost the GCC economy nearly US$50 billion in 2019, equal to 3.3% of its gross domestic product. The indirect costs are estimated at US$20 billion or 40% of the total burden. Implementing the four modelled intervention packages in the six GCC countries over 15 years will cost US$14 billion, with an ROI of US$4.9 for every US$1 invested and significant health and social benefits, including 290 000 averted premature deaths.
Based on the results of these six investment cases, we recommend actions to scale up current WHO-recommended cost-effective interventions, strengthen whole-of-government action, drive the NCD legislative agenda, build out the evidence base, generate additional advocacy material, and increase regional collaboration and data-sharing to establish best practices and monitor impact.

Cystinosis is the most frequent cause of the inherited renal Fanconi syndrome and is also potentially treatable. In this study, we have reported our single-center experience of the longterm outcomes of kidney transplant in patients with cystinosis.
Pediatric patients with cystinosis (n = 17) were compared with a matched control group without cystinosis (n = 126). The 2 groups were compared with regard to demographic data, posttransplant complications, and graft and patient outcomes.
Most patients with cystinosis were male teenagers (52.9%) with comparable mean age (12.4 ± 4.1 vs 14 ± 3.1 years) versus the group without cystinosis. The 2 study groups were comparable with regard to type of dialysis, type of donor, blood group, and pretransplant comorbidities (P > .05). Patients with cystinosis received significantly more potent induction therapy (P < 0.05), but both groups were maintained on comparable immunosuppressive regimens (mostly tacrolimus based) (P > .05). Most grafts in both groups displayed immediate graft function. The percentage of patients with cystinosis with primary graft function was significantly higher than the percentage of those patients without cystinosis who had primary graft function (P = .024); this was associated with a relatively lower baseline creatinine level, although this was not significant (P > .05). Posttransplant complications, especially posttransplant diabetes, cytomegalovirus viremia, or BK nephropathy, were comparable (P > .05). Moreover, patient and graft survival rates were similar in the 2 groups (P > .05).
Under standard immunosuppression, renal transplant and cysteamine therapy were safe with good long-term outcomes in patients with cystinosis. Studies that can include more patients and that have longer follow-up are needed to better understand the nature of this genetic disease and to discover the best treatment options.