Planning for a Multi-Well Artificial Recharge Field in Kuwait with the Help of Numerical Modeling

Kuwait, an arid country, wants to have a reserve of water for emergency use and has planned to create an underground reserve of water through multi-well artificial recharge at Kabd area. Numerical modeling of different recharge-recovery scenarios was carried out to chalk out an optimum strategy for implementation of the project. These scenario runs suggested that apart from the aquifer parameters and the quality of the groundwater and the recharge water, the well spacing and well construction, orientation of the field with respect to the prevailing hydraulic gradient, and the injection and the pumping schedule would determine the overall recovery efficiency of the setup. For the selected site, following strategies were found to have positive impact on meeting the goals of the creation of a reserve of water for use in an emergency: (1) during the reserve creation stage, simultaneous recharge and pumping through alternate wells; (2) the compensation of the water lost from the reserve created due to the flow down the hydraulic gradient during the waiting period; and (3) the orientation of the long axis of the field perpendicular to the regional hydraulic gradient. The adoption of cyclic injection and recovery option for the creation of the reserve eliminates the need of the first two steps but calls for several cycles of injection followed by recovery and adequate and consistent supply of water for injection over that period. An optimum field design and two alternative recharge options have been suggested based on the above observations.

Comparing trastuzumab-related cardiotoxicity between elderly and younger patients with breast cancer: a prospective cohort study

OBJECTIVE

Trastuzumab is an HER-2 targeted humanized monoclonal antibody that significantly improves metastatic and non-metastatic breast cancer therapeutic outcomes. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC).

PATIENTS AND METHODS

In a prospective comparative observational study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab between April 2016 and April 2019 were included and divided into two cohorts based on their age (<60 and ≥60 years old). The individual decline in the LVEF from the baseline was calculated and compared between the two age cohorts. Logistic regression analysis was applied to investigate the association between age, comorbidities, BMI, anthracycline treatment, and baseline LVEF value, and trastuzumab-induced cardiotoxicity after adjustments made for the disease stage.

RESULTS

The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients, respectively). Whereas the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients, respectively (IQR 8%; p-value = 0.22), even though older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1%, respectively; p-value <0.001). 86.7% and 55.6% of older and younger patients, respectively, developed ≥10% decline in their LVEF from the baseline. Statistically, age was the only factor that significantly correlated with developing ≥10% decline in the LVEF (OR 4; p-value <0.012).

CONCLUSIONS

Breast cancer patients aged 60 years and above in Kuwait were at a 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline value compared to younger patients during trastuzumab treatment. Previous exposure to anthracyclines and comorbidities were not associated with a significantly increased cardiotoxicity risk in this study.