Prevalence of Insomnia and Sleep Patterns among Liver Cirrhosis Patients

Background: Few studies are available regarding the prevalence of sleep disturbance in cirrhotic patients without overt hepatic encephalopathy. This study aimed to assess the prevalence of insomnia in stable liver cirrhosis patients who are attending the outpatient clinics at King Abdulaziz Medical City, Riyadh (KAMC-KFNGH). Methods: A cross-sectional study enrolled 200 stable patients with confirmed liver cirrhosis. We used the ICSD-2 definition to assess the prevalence of insomnia. We also collected information about sleep patterns, demographic data, the underlying cause of liver cirrhosis and the severity of liver cirrhosis using Child-Pugh scores (CTP). Results: The mean age was 58.9 (SD ± 12.2) years. Hepatitis C was the most common (60.2%) cause of liver cirrhosis among respondents. The prevalence of insomnia was 42% (84/200). Univarite analysis shows association between coffee intake and the presence of insomnia (56.9% vs. 35.9%, p-value = 0.006). The prevalence of insomnia was higher in hepatitis C (51.7%) compared to hepatitis B (36.8%) and other hepatitis (15%), p-value = 0.001. There was a significant relationship between severity of liver cirrhosis (CTP-A, CTP-C, CTP-B) and prevalence of insomnia: 55%, 36.1% and 32.1% respectively, p-value = 0.009. Insomniac patients were significantly older than non-insomniac (61.6 ± 12.0 vs. 57.0 ± 12.0 years, p = 0.008). Results from the multivariate stepwise analysis showed coffee intake (OR=2.7), hepatitis C (OR = 7.2), CTP-A (OR = 1.9), excessive daytime sleepiness (OR = 5.3) and short sleep duration (OR = 5.7) were the most strongly associated with the presence of insomnia. Conclusion: Our study showed a high prevalence of insomnia in patients with liver cirrhosis

Seismic structure of Kuwait

We have used data from the Kuwait National Seismic Network (KNSN) to estimate the seismic structure of Kuwait using a limited amount of seismic data. First, we made surface wave dispersion measurements and calculated receiver functions from the relatively small amount of data available from the broad-band station, KBD. Models were derived from the joint inversion of teleseismic receiver functions and Rayleigh and Love fundamental mode surface wave group velocity dispersion. While both surface waves and receiver functions by themselves can be used to estimate lithospheric structure, we have successfully combined the two to reduce non-uniqueness in estimates based on the individual data sets. The resulting KUW1 model features a thick (8 km) sedimentary cover and crustal thickness of 45 km. Crustal velocities below the sedimentary cover are consistent with global averages for stable platforms. We infer upper-mantle velocities (7.84 km s-1 P-wave velocity; 4.40 km s-1 S-wave velocity) that are slightly lower than expected for a stable platform. In comparison with other crustal structure estimates for the Arabian platform to the west, the crust is thicker and the mantle is slower in Kuwait. This is consistent with the overall tectonic trends of the region that find increasing crustal thickness between the divergent plate boundary at the Red Sea and the convergent plate boundary at the Zagros Mts, as well as slow mantle velocities beneath this nearby orogenic zone. The resulting model fits the traveltimes of regional phases (Pn, Pg, Sn and Lg). Independent inversion of local earthquake traveltimes recorded by KNSN (allowing for event hypocentre relocation) results in a remarkably similar velocity structure, providing confidence that the joint inversion of receiver functions and surface wave group velocities can impose accurate constraints on crustal structure for local event location and network operations. Relocation of events in Kuwait improves the clustering of events and results in shallower hypocentres

[32] Perceptions of robot-assisted surgery: Results of a survey of surgeons in Kuwait

Objective: To gain insight into local surgeons’ perceptions of robot-assisted surgery (RAS), as the use of RAS has rapidly increased amongst hospitals worldwide and the da Vinci® Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) was installed at Sabah Al-Ahmad Urology Center (SAUC) in February 2014 and at Kuwait’s Chest Disease Hospital in October 2017, with >200 robotic surgical procedures performed by robotic surgeons using these two systems, overall surgeons perceptions and acceptance of this new technology in Kuwait are largely unknown. Methods: We conducted a questionnaire-based survey distributed amongst surgeons of different subspecialties. The questionnaire had 28 questions related to the surgeon’s knowledge of RAS, it’s availability in Kuwait, and surgeons attitudes and concerns towards it. Results: There were 292 surveys, with 278 used for analysis (95.2% response rate). General surgeons, urologists, and gynaecologists constituted 54%, 23%, and 13%, respectively. The mean age of respondents was 36 years. There was a significant association between younger age groups and comfort using the technology (P< 0.05). In all, 250 surgeons (91%) had previously heard of RAS, and the majority (73%) agreed with its introduction into surgical practice mostly gynaecologists, urologists and general surgeons (P< 0.001) due to their belief of its enhanced precision and better visualisation. However, 50% of surgeons thought that laparoscopic surgery performs what RAS does. When surgeons were asked to rate factors according to their importance when choosing RAS they indicated faster recovery, lower complications, and patient demand were most important (P< 0.001) Conclusion: RAS seems to be an accepted modality amongst surgeons in Kuwait. However, surgeons remain concerned regarding the learning curve, device cost, and availability for use

Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients

Background/propose: Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients. Material and methods: A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and preliver transplant clinics. Results. We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). Conclusions. The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B

The Use of Spatial and Spatiotemporal Modeling for Surveillance of H5N1 Highly Pathogenic Avian Influenza in Poultry in the Middle East.

Since 2005, H5N1 highly pathogenic avian influenza virus (HPAIV) has severely impacted the economy and public health in the Middle East (ME) with Egypt as the most affected country. Understanding the high-risk areas and spatiotemporal distribution of the H5N1 HPAIV in poultry is prerequisite for establishing risk-based surveillance activities at a regional level in the ME. Here, we aimed to predict the geographic range of H5N1 HPAIV outbreaks in poultry in the ME using a set of environmental variables and to investigate the spatiotemporal clustering of outbreaks in the region. Data from the ME for the period 2005-14 were analyzed using maximum entropy ecological niche modeling and the permutation model of the scan statistics. The predicted range of high-risk areas (P &gt; 0.60) for H5N1 HPAIV in poultry included parts of the ME northeastern countries, whereas the Egyptian Nile delta and valley were estimated to be the most suitable locations for occurrence of H5N1 HPAIV outbreaks. The most important environmental predictor that contributed to risk for H5N1 HPAIV was the precipitation of the warmest quarter (47.2%), followed by the type of global livestock production system (18.1%). Most significant spatiotemporal clusters (P &lt; 0.001) were detected in Egypt, Turkey, Kuwait, Saudi Arabia, and Sudan. Results suggest that more information related to poultry holding demographics is needed to further improve prediction of risk for H5N1 HPAIV in the ME, whereas the methodology presented here may be useful in guiding the design of surveillance programs and in identifying areas in which underreporting may have occurred

The Use of Spatial and Spatiotemporal Modeling for Surveillance of H5N1 Highly Pathogenic Avian Influenza in Poultry in the Middle East.

Since 2005, H5N1 highly pathogenic avian influenza virus (HPAIV) has severely impacted the economy and public health in the Middle East (ME) with Egypt as the most affected country. Understanding the high-risk areas and spatiotemporal distribution of the H5N1 HPAIV in poultry is prerequisite for establishing risk-based surveillance activities at a regional level in the ME. Here, we aimed to predict the geographic range of H5N1 HPAIV outbreaks in poultry in the ME using a set of environmental variables and to investigate the spatiotemporal clustering of outbreaks in the region. Data from the ME for the period 2005-14 were analyzed using maximum entropy ecological niche modeling and the permutation model of the scan statistics. The predicted range of high-risk areas (P &gt; 0.60) for H5N1 HPAIV in poultry included parts of the ME northeastern countries, whereas the Egyptian Nile delta and valley were estimated to be the most suitable locations for occurrence of H5N1 HPAIV outbreaks. The most important environmental predictor that contributed to risk for H5N1 HPAIV was the precipitation of the warmest quarter (47.2%), followed by the type of global livestock production system (18.1%). Most significant spatiotemporal clusters (P &lt; 0.001) were detected in Egypt, Turkey, Kuwait, Saudi Arabia, and Sudan. Results suggest that more information related to poultry holding demographics is needed to further improve prediction of risk for H5N1 HPAIV in the ME, whereas the methodology presented here may be useful in guiding the design of surveillance programs and in identifying areas in which underreporting may have occurred

GPS Measured Response of a Tall Building due to a Distant Mw 7.3 Earthquake

The response of a 413‐m‐tall building to the 12 November 2017 M[subscript w] 7.3 earthquake 642 km from the building is measured with a Global Positioning System (GPS) receiver located near the top of the building and operating with a 1 Hz sampling rate. Nearby GPS and seismic stations measure the ground motion near the building. The ground motions have amplitudes of ∼40  mm⁠, while the top of the building moves by up to 160 mm. The building motion continues with levels greater than the noise level of the GPS measurement for about 15 min after the earthquake. After the ground‐motion excitation ends, the building motion decays with a time constant of ∼2  min and the beat between the two lowest frequency modes of deformation of the building can be seen. There are two large amplitude peaks in the building motion with magnitudes of 120 and 160 mm. The timing of the peaks is consistent with ground excitation in an 8.3–6.5‐s‐period (120–180 mHz) band, which covers the 7.25 and 5.81 s periods (138 and 172 mHz frequencies) of the fundamental modes of the building. The ground motions in this band show two large pulses of the excitation, which have timing consistent with the large amplitude building signals. The response of the top of the building is amplified by an order magnitude over the ground motions in this band. There is no apparent permanent displacement of the top of the tower.National Aeronautics and Space Administration (Grant NNX09AK68G

Ground Motion in Kuwait from Regional and Local Earthquakes: Potential Effects on Tall Buildings

Abstract In recent years, the construction of tall buildings has been increasing in many countries, including Kuwait and other Gulf states. These tall buildings are especially sensitive to ground shaking due to long period seismic surface waves. Although Kuwait is relatively aseismic, it has been affected by large (Mw > 6) regional earthquakes in the Zagros Fold-Thrust Belt (ZFTB). Accurate ground motion prediction for large earthquakes is important to assess the seismic hazard to tall buildings. In this study, we first analyze the observed ground motions due to two earthquakes widely felt in Kuwait: the 08/18/2014 Mw 6.2 earthquake, 360 km NNE of Kuwait City, and the 11/12/2017 Mw 7.3 earthquake, 642 km NNE of Kuwait City. The peak spectral displacement periods of the ground motion from the 08/18/2014 Mw 6.2 earthquake matched well with the ambient vibration spectra of the tallest building—the Al-Hamra Tower. We calculate the ground motions from potential regional and local earthquakes. We use a velocity model obtained by matching the observed seismograms of the 2014 and 2017 earthquakes. We calculate ground motions in Kuwait due to a regional Mw = 7.5 earthquake, and a local Mw = 5.0 earthquakes. Our study shows that a significant source of seismic hazard to tall buildings in Kuwait comes from the regional tectonic earthquakes. However, local earthquakes have the potential to generate high peak ground accelerations (~ 98 cm/s2) close to their epicenters