Differential effects of experimental hyperthyroidism on declined immunity of broiler chicken.

Thyroid hormones (THs) are involved in the development of lymphoid organs and regulation of immune function in birds. However, their role as an immune-modulator in the hyperthyroid state is still debatable. To explore the interrelationship of thyroxine (T4 ) and the immune system, chicks were divided into three groups. Group I was comprised of control birds, who received the basal diet while group II and III were given diets supplemented with 5 µg and 10 µg thyroxine/kg feed, respectively, from 15 to 28 days of age. Cell-mediated immune response was evaluated through in vitro abdominal macrophage phagocytosis assay, macrophage nitric oxide (NO) production, heterophil-to-lymphocyte (H:L) ratio and delayed-type hypersensitivity response against phytohemagglutinin (PHA). Humoural immune response was assessed through serum IgG and IgM antibody production against sheep red blood cells (SRBCs) and antibody production against infectious bronchitis virus (IBV). Sampling was carried out at 7, 14 and 21 days of treatment. Results have shown higher levels (p < .001) of circulating T4 in both treatment groups compared to the control group. There was a lower (p < .05) macrophage engulfment percentage, an increase in H:L ratio (p < .001) in treated birds, while their NO production remained higher (p < .05) in thyroxine supplemented groups after bacterial lipopolysaccharide stimulation. The humoural immune response revealed a significant decline (p < .001) in IgG, IgM antibody production against SRBCs but IBV circulating antibodies increased with age. In conclusion, hyperthyroidism has a strong co-relation with decreased immune performance of birds.

What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016.

All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influemza, hepatitis A, polio and meningitis. Three mass gathering held in Africa during the Ebola outbreak accepted participants from West Africa and was able to handle the theoretical risk without any incident. Therefore we believe that the Olympc games in Rio de Janeiro should not be canceled. The number of visitors to the games is a tine fraction (1%) of other visitors to Zika endemic con tries and it will have no measurable effect on the risk of spreading Zika virus, if the games was cancelled.

Ontogenic development of corticotrophs in fetal buffalo (Bubalus bubalis) pituitary gland.

To evaluate the subpopulation of corticotrophs in developing buffalo (Bubalus bubalis) fetus, recovered pituitary glands (n=6 per group) from late first, second and third gestational female buffalo dams. The corticotrophs were identified by using specific antibodies against proopiomelanocortin (POMC) and adrenocorticotrophic hormone (ACTH) through immunohistochemistry. There was a significant (P≤0.05) increase of immunoreactive (ir) ir-ACTH cells during late 2nd trimester while, ir-POMC cells were more (P≤0.05) at late 3rd trimester of gestation as compared to other age groups. The quantity of co-localized cells for POMC and ACTH was significantly (P≤0.05) greater at the end of 1st gestation rather than 2nd and 3rd gestational fetal adenohypophyseal cells. This study is the first to demonstrate co-localization of POMC+ACTH and the affect of gestational age on the expression of these cells in buffalo fetus adenohypophysis.

Correlates of ever-smoking habit among adolescents in Tabuk, Saudi Arabia.

A cross-sectional questionnaire study of the correlates of ever-smoking among adolescents was made in Tabuk government schools in Saudi Arabia. Of 1505 students aged 12-19 years, 657 (43.7%) were ever-smokers (i.e. ever tried cigarette smoking, even 1 or 2 puffs); 65.0% of males and 23.1% of females. In logistic regression analysis significant predictors for ever-smoking were: male sex, belief that smoking helps people feel comfortable in social situations, owning something with a cigarette logo, having pocket money > or = 20 riyals/day, poor school performance and having friends or parents who smoked.

Factors influencing patient choice of hospitals in Riyadh, Saudi Arabia.

This study examined factors considered important in choosing a hospital. The sample consisted of 303 respondents selected from five randomly selected primary health care centres. The percentages of males, highly educated, high-income level, elder and private sector employees was higher in those choosing private sector hospitals, while marital status did not relate to type of hospital. The principal component analysis identified six factors accounting for 64% of the total variance. The most important component was 'medical services' accounting for 28% of the total variance. Stepwise discriminant analysis revealed that the main factors associated with choosing a hospital were medical services, accessibility, age, sex and education. Little importance was given to income and occupation. Future recommendations outline the need for consumers' perceptions, attitudes, suggestions and concerns to be taken into consideration when marketing the services to be provided.

Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers.

OBJECTIVE: To estimate quantitatively consumers' satisfaction and correlates of satisfaction with physicians' services provided by Ministry of Health Primary Health Care Centers in attending consumers. METHODS: Consumers (n = 540) attending the selected Primary Health Care Centers in Riyadh were asked about their satisfaction with physician's services. Eight Primary Health Care Centers were randomly selected according to the geographical location, two from each geographical zone. Seventy-five subjects were selected systematically where every tenth Saudi aged 15 years and above who visited the selected Primary Health Care Centers during the study period was chosen. Data was collected via a self administered pilot tested, internally consistent patient satisfaction questionnaire which included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of physicians' services in the selected Primary Health Care Centers rated in a scale of 1 5 points, the higher the score the higher the satisfaction. RESULTS: The results revealed that males constituted 60%, and 58% of all patients were married, more than 60% were employees and more than 70% have a monthly income of less than 6000 Saudi Riyals. Almost 95% have an open file in the Primary Health Care Center and 39% think that the distance to the Primary Health Care Center is far or very far. The summary satisfaction score was 3.77 points and the mean satisfaction with the services provided by physicians was 2.56 points out of a maximum of 5 points The highest satisfaction was for discussing psychological aspects of patients' problems (2.96 points) and the lowest was for attentive listening to patients' complaints (2.22 points). Physicians' communication skills were more satisfactory to patients than their professional skills and satisfying patients' wishes scored the lowest satisfaction- Unskilled laborers, literate patients and patients with higher income showed significantly higher mean satisfaction while students, illiterates, those aged less than 50 years and patients with income less than 6000 Riyals per months scored the lowest satisfaction. The longer the distance travelled the lower the satisfaction scores but having a file or not was not related to satisfaction. CONCLUSION: Some physicians' service items need corrective intervention and students and young patients appear to need more attention.

Patients' satisfaction with primary health care centers services in kuwait city, kuwait.

BACKGROUND: Assessment of patient satisfaction offers a way of optimizing health status and prevents waste of medical resources. The direct measurement of patient satisfaction is a new phenomenon in Kuwait. OBJECTIVE: Assess patient satisfaction with respect to primary health care services and study any patterns of association of sociodemographic variables on the patient satisfaction level. METHODS: The sample consisted of 301 patients selected systematically from five primary health care centers to represent various geographic areas in Kuwait City. Just over 56% of the sample were females, 59% were married, the great majority (70.4%) were government employees, more than 60% had a monthly income of less than 900 KD, more than 54% were intermediate and high secondary school graduates, and 37% were university graduates or had advanced degrees. The data was collected by personal interview using structured questionnaire. RESULTS: The overall mean satisfaction was 3.1 points out of five (62%). The mean satisfaction scores were 3.64, 3.29, 3.08, 3.05, 2.21 for laboratory, pharmacy, radiology, dental and physician services, respectively. The highest mean score for physician services was obtained for communication skills (2.23); for pharmacy services, the availability of medicine (4.01); for laboratory services, the availability of lab materials (3.73); for radiology services, the waiting time for x-ray (3.60); and for dental services, the adequacy of dentists (3.27). The results indicated that gender, income, marital status and occupation were the most consistent demographic predictors of satisfaction, with females, those with lower income, lower education levels and the unemployed having higher mean satisfaction scores. CONCLUSION: There is a need for corrective intervention in some service areas and for an educational program to inform patients of the objectives and limitations of primary health services.

Patients' satisfaction with physicians' services in primary healthcare centres in Kuwait City, Kuwait.

Enhancing patient satisfaction offers a way of optimising health status and helps in the reduction of wastage of medical resources. The direct measurement of patient satisfaction is new in Kuwait. This study aimed to assess patient satisfaction with respect to physicians' services in primary health care (PHC) and to determine the association of patients sociodemographic variables on their satisfaction level. The sample consisted of 301 patients selected systematically from five primary healthcare centres (PHCC) to represent various geographic areas in Kuwait. The data were collected by personal interview using a structured questionnaire. The overall mean satisfaction with physician services was 2.21 points out of a maximum of five points. The results from multiple regression analysis indicated that gender, marital status, occupation and income are the most important predictors, with females, married, labourers and higher income levels having the highest mean satisfaction score. The principal component analysis indicated that the most important aspect is 'communication' which accounted for 54% of the total variance. The results suggested a need for an educational programme to inform patients of the objectives and limits of primary health services.

Knowledge and practices of mothers about infants' diarrheal episodes.

OBJECTIVES: To study the socioeconomic correlates of infants' diarrhea as well as infants' mothers' knowledge and practice concerning diarrheal diseases. METHODS: Study subjects included 300 infants (150 from Sulaimania Pediatrics Hospital and 150 from the Maternal and Childrens Hospital) with diarrheal episodes during the study period selected by systematic random sampling. Data was collected via a structured open ended pilot tested modified questionnaire filled in by trained Arabic speaking research assistants who interviewed mothers about the diarrheal aspects of their infants, assessed their knowledge and practices concerning diarrheal diseases in children as well as collecting the necessary sociodemographic characteristics of the mothers, fathers and infants themselves. RESULTS: The majority of parents of infants with diarrhea were illiterate or can just read and write, mothers were mostly young aged 20 - 29 years, family income for about 40% of the subjects was less than 5000 Saudi Riyals per month. Diarrheal episodes were mostly in infants 6 months or less in age, mostly the first child in order with males more affected than females. Mothers' knowledge about many aspects of diarrhea was grossly deficient but tends to increase with increasing age, educational level, and birth order. Mothers' practices were better but still deficient and sources of information about diarrhea was mostly from non health professionals. CONCLUSION: Intervention strategies to control infants diarrheal episodes needs to be through an integrated approach aiming at boosting mothers' knowledge and improving their practice concerning diarrhea and improving the families socioeconomic status and encouraging all health professionals to act as a readily available source for health information about diarrhea and other important health problems.

Prevalence and correlates of acute respiratory infections in children less than two years of age.

OBJECTIVES: To study acute respiratory infections of children less than 2 years of age in Riyadh City and their sociodemographic and anthropometric correlates. METHODS: Study subjects included 250 mothers selected by systematic random sampling from mothers attending 5 Primary Health Care Centers selected by simple random sampling from the 5 geographical zones (one from each zone) in Riyadh during a one month period. Data was collected via a structured pilot tested modified questionnaire filled in by trained research assistants who interviewed mothers regarding acute respiratory infections during the past 2 weeks in their children aged less than 2 years. Heights and weights of both children and mothers were measured and the necessary sociodemographic characteristics of the mothers, and children were collected by the research assistants in addition to mothers' practices concerning their child's acute respiratory infections. RESULTS: The prevalence of acute respiratory infection in children was 24%, mostly in children whose mothers are less educated, aged 35 years or more, married at age 25 years or more and whose relatives take care of their children while working outside the home. The children affected were mostly 7 - 12 months of age, lighter in weight, not vaccinated, with no follow up cards and not weighed during the last 4 months. About 3 quarters of the mothers consulted somebody about acute respiratory infections, mostly at modern health facilities particularly government Primary Health Care Centers. Tachypnea, or diarrhea or both were the most important symptoms urging mothers to seek medical advice. Working mothers whose children are taken care of by relatives is the only significant predictor of acute respiratory infections, and children with a follow up card is the only significant predictor for consulting somebody about acute respiratory infections. CONCLUSION: Intervention strategies to control acute respiratory infections in children less than 2 years of age should target working mothers, less educated mothers, malnourished unvaccinated children and encourage periodic follow up visits for children.

Consumers' satisfaction with primary health services in the city of Jeddah, Saudi Arabia.

OBJECTIVE: To study consumers' satisfaction and socio-demographic correlates of satisfaction with services provided by Primary Health Care Centres in the city of Jeddah. METHODS: Study subjects included the consumers visiting the Primary Health Care Centres during the study period. Four Primary Health Care Centres were randomly selected from Jeddah according to the geographical location. Seventy five subjects were selected systematically where every tenth Saudi aged 15 years or above was chosen. Data was collected via a self administered pilot tested questionnaire which included socio-demographic characteristics, as well as the overall and differential satisfaction with the different services and facilities in the selected Primary Health Care Centres rated on a scale of 1 - 5 points, the higher the score the higher the satisfaction. RESULTS: Male subjects constituted 60% of the visitors. More than half of the subjects were young 15-29 years of age, about 58% were married, 50% completed intermediate/secondary school, more than two fifths of the subjects were employees and more than three quarters have a monthly income of 6000 Saudi Riyals or less. The summary satisfaction score was 3.76 points and the overall satisfaction with the services provided was 2.45 points out of a maximum of 5 points. The highest satisfaction was for dental clinic (3.44 points) and the lowest for co- operation of the receptionist (1.95 point). Unskilled laborers showed the highest summary and overall satisfaction (4.31 and 2.71 points) and students showed the lowest satisfaction scores (3.54 and 1.89 points). Other socio-demographic variables were not significantly related to summary and overall satisfaction scores. CONCLUSION: Measuring satisfaction by asking one summary question tends to give a significantly higher satisfaction score compared to satisfaction score taking in consideration of all services offered. Certain service components need corrective intervention measures to make them more satisfactory to consumers.

Sequence diversity of TT virus in geographically dispersed human populations.

TT virus (TTV) is a newly discovered DNA virus originally classified as a member of the Parvoviridae. TTV is transmitted by blood transfusion where it has been reported to be associated with mild post-transfusion hepatitis. TTV can cause persistent infection, and is widely distributed geographically; we recently reported extremely high prevalences of viraemia in individuals living in tropical countries (e.g. 74% in Papua New Guinea, 83% in Gambia; Prescott & Simmonds, New England Journal of Medicine 339, 776, 1998). In the current study we have compared nucleotide sequences from the N22 region of TTV (222 bases) detected in eight widely dispersed human populations. Some variants of TTV, previously classified as genotypes 1a, 1b and 2, were widely distributed throughout the world, while others, such as a novel subtype of type 1 in Papua New Guinea, were confined to a single geographical area. Five of the 122 sequences obtained in this study (from Gambia, Nigeria, Papua New Guinea, Brazil and Ecuador) could not be classified as types 1, 2 or 3, with the variant from Brazil displaying only 46-50% nucleotide (32-35% amino acid) sequence similarity to other variants. This study provides an indication of the extreme sequence diversity of TTV, a characteristic which is untypical of parvoviruses.

Intrafamilial person-to-person spread of bacillary dysentery due to Shigella dysenteriae in southwestern Saudi Arabia.

OBJECTIVE: To identify the factors that influence transmission of bacillary dysentry (BD) within families during a propagated outbreak of bacillary dysentery. DESIGN: A retrospective cohort study. SETTING: Eighteen neighbouring villages in rural Gizan, southwestern Saudi Arabia. SUBJECTS: Two hundred and thirty three cases of BD were identified among seventy nine families. RESULTS: Secondary cases of BD occurred in 57 of 79 families with a primary case of BD. The secondary attack rate per cent (AR%) within families ranged between 7.7% and 80%. Age of primary cases did not correlate with degree of secondary AR% in exposed families (p > 0.04; p > 0.05); however, within households, the age of the first secondary cases (median = two years) was usually less than the age of the primary case (median = six years). Children under five years of age constituted 43% of secondary cases. The median interval between successive cases within a house ranged from three and seven days. Two hundred and twenty cases (94.4%) gave history of close contact within another case of BD. Cases of BD were exposed to close relatives with BD (79.1%), neighbours (11.4%), and friends (9.5%). Risk factors influencing the spread of BD within families included two rooms or fewer per house (OR = 4.3, 9.5% CI 1.3-14.3), family size of five or more (p = 0.012, two-tailed Fisher's exact test), and presence of more than two persons per room (OR = 11.2, 95% CI 3.1-42.4). CONCLUSION: Person-to-person secondary transmission can amplify the spread of bacillary dysentery within households and neighbouring villages. Crowding was a risk factor that amplified transmission of BD within families.

Antigenic variation of core, NS3, and NS5 proteins among genotypes of hepatitis C virus.

Assays that detect antibody to hepatitis C virus (HCV) are used to screen blood donors and patients with hepatitis. Current enzyme-linked immunosorbent assay (ELISA)-based methods are invariably based upon antigens from expressed recombinant proteins or oligopeptides from HCV type 1. Some HCV antigens used in screening assays are coded by regions of the HCV genome that show extensive variability; therefore, HCV type 1-based assays may be less effective for the detection of antibody elicited by infection with other genotypes. In this study, we have measured antibody reactivity of sera from 110 hepatitis C patients infected with type 1b, 3a, or 4a to genotype-specific and cross-reactive epitopes present in recombinant proteins from HCV genotypes 1b (core, NS3, and NS5), 3a (NS3, NS5), and 4a (core, NS3), corresponding to those used in current third-generation screening ELISAs. By comparing the serological reactivities of sera to type-homologous and type-heterologous antigens, we detected a significant type-specific component to the reactivity to NS3 (61 to 77% of the total reactivity) and NS5 (60% of the total reactivity). Furthermore, despite the similarities in the amino acid sequences of the core antigens of type 1b and type 4a, we also found significantly greater reactivity to type-homologous antigens, with approximately 25% of reactivity being type specific. These findings are consistent with previous findings of fivefold weaker reactivity of sera from HCV type 2- and HCV type 3-infected blood donors in the currently used third-generation ELISAs and suggest that these assays are suboptimal for screening populations in which the predominant genotype is not type 1.

Complete nucleotide sequence of a type 4 hepatitis C virus variant, the predominant genotype in the Middle East.

Hepatitis C virus (HCV) type 4 is the predominant genotype found throughout the Middle East and parts of Africa, often in association with high population prevalence as in Egypt. To investigate more fully its evolutionary relationship with other genotypes of HCV, and to study its overall genome organization, we have determined the entire sequence encompassing the coding region of the genotype 4a isolate ED43, obtained from an HCV-infected individual from Egypt. The sequence of ED43 contained a single open reading frame encoding a polyprotein of 3008 amino acids (aa), smaller than that reported for other HCV genotypes which vary from 3010 aa to 3037 aa. The nucleotide and amino acid sequences were compared with the full-length sequences already reported for genotypes 1a, 1b, 1c, 2a, 2b, 2c, 3a, 3b and those of isolates JKO49 and JKO46 described as types 10a and 11a. The differences in length of the polyprotein originated in variable regions in the E2 and NS5A genes. The complete sequence of ED43 confirmed the classification of type 4 as a separate major genotype.

Seasonal variation and weather effects on road traffic accidents in Riyadh city.

The monthly variation of Road Traffic Accidents (RTAs) in Riyadh city in the period 1989-1993 has been studied with reference to time of day, lighting conditions and prevalent weather conditions. Total RTA accidents were significantly more common, being directly correlated, with increased dry and wet bulb temperatures and significantly less common, being inversely correlated, with increased relative humidity and amount of precipitation of rain, snow, hail etc. However, RTAs recorded on rainy days only were significantly more common and directly correlated with precipitation (Note days of snow and hail are very rare in Riyadh city). Seasonal variation in RTAs was evident being maximal during the summer season particularly between 12 noon and 3 pm. This period is characterized by heavy traffic and intense sunlight. The role of hot weather prevalent in Saudi Arabia, where average temperatures of 34.4-34.7 degrees C with maximum of 40-42.7 degrees C are common in summer, have been suggested to be an important factor leading to increased stress and decreased performance of intellectual tasks which require considerable physical effort and motor skills. Increased heart rates, exacerbation of existing pathologic conditions such as heart disease and emphysema and loss of visual acuity have been reported. Consequently, prolonged exposure to heat must be considered as a hazard to the safety and health of drivers and a factor leading to an increased incidence of RTAs.

Aetiological factors contributing to road traffic accidents in Riyadh City, Saudi Arabia.

The study analysed 13,390 police records of road traffic accidents (RTAs) covering a three and a half year period according to different suspected aetiological factors. The majority of the accidents were recorded for vehicles in good condition on well-paved straight roads with well-operating traffic light systems. Adverse weather conditions such as precipitation, fog and dust were of minimal importance, with most of the accidents being reported during sunny days during the rush period of 12 noon to 3 pm. Driver's error was identified as the main contributing factor in about two thirds of all RTAs mainly as reckless driving and excess speeding. About 27% of the drivers were professional drivers and 41% were in the age group 25-35 years in good health with no alcohol or drug intake. Hence, human errors may be attributed to carelessness, experience, lack of knowledge or attention, over-exhaustion or fatigue. The effects of physical stressors on performance of drivers need to be further explored and clarified but this need not underestimate the importance of vehicle and environment since most accidents are multifactoral and a slight change in them may effectively enhance perception and minimise personal error. Recommendations for remedial measures adopting an interdisciplinary approach are presented.

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia.

OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.