Assessing the knowledge and attitude towards HIV/AIDS among the general population and health care professionals in MENA region.

INTRODUCTION: Human Immunodeficiency Virus infection continue to represent a global health concern influenced by various social, economic, and cultural factors. The MENA are among the top regions in the world with the fastest-growing HIV epidemic. Thus, adequate knowledge and a positive attitude of people toward HIV/AIDS are of utmost importance to prevent the spreading of the disease. Accordingly, this study aims to evaluate the knowledge and attitude of the public and healthcare population toward HIV/AIDs. METHODS: A cross-sectional analysis was conducted among residents within our population from October 2018 until August 2019. An anonymous online questionnaire was used to investigate the population's demographic characteristics, HIV/AIDS-related knowledge, and attitudes toward HIV-infected patients. Participants completed a 40-item questionnaire designed to measure their knowledge and attitude toward HIV/AIDS. The data was collected via surveys, administered through electronic tablets to the participants at public places (n = 5,757) and through an online version of the questionnaire on Google Forms (n = 2500), which was sent through social media platforms. Descriptive statistics were used to analyse the data using the R-statistical software program. RESULTS: A total of 8,257 participants were included in our analysis. Saudi Arabian citizens represented 79% of the participants, while participants from the MENA countries represented 11.7% and 3% from the other Gulf Cooperation Council countries. Fifty-nine (59%) knew that HIV is a contagious infection, and 13.8% were unaware that HIV could be transmitted sexually. A few healthcare professionals reported negative attitudes toward HIV infected patients. Many risk factors, including age, gender, nationality, and education, significantly affected the knowledge and attitude scores. In this survey, we found that social media is the primary source of participants' information. CONCLUSIONS: Overall correct knowledge score of individuals about HIV/AIDS was relatively low. This study showed that the general population was knowledgeable to a certain degree about HIV/AIDS and its modes of transmission. Nevertheless, they lack a detailed understanding of the disease's nature, modes of transmission, and existing treatment. Policymakers in the region should further eliminate social discrimination and stigma in HIV-infected patients.

The Risk of Latent Tuberculosis Infection Among Healthcare Workers at a General Hospital in Bisha, the Kingdom of Saudi Arabia.

Background and objective Tuberculosis (TB) is a global health issue, often preceded by a latent tuberculosis infection (LTBI) in individuals. Significant global and local efforts have recently been directed toward this infection, focusing on TB control and eradication. This study aimed to assess the magnitude of LTBI among healthcare workers (HCWs) in the Kingdom of Saudi Arabia, by evaluating its prevalence and associated risk factors. Methods An analytical cross-sectional study was conducted among HCWs at the King Abdullah Hospital (KAH), from January to August 2018, by using two surveys: the first one involved data related to HCW demographics and the tuberculin skin test (TST) readings, and the second involved a questionnaire that assessed LTBI risk factors. Results Out of the total 561 HCWs who participated in the study, 66 had an induration reading of more than 10 mm in TST. Many factors were associated with LTBI cases, but multivariate analysis showed that age, gender, and nationality were statistically significant risk factors. Conclusion Given the nature of their work, HCWs are at a greater risk of TB and LTBI. At the same time, HCWs are uniquely positioned to play a crucial role in halting the spread of TB. Gaps in preventive measures may result in the increased spread of TB. Our study assessed risk factors associated with the increased risk of LTBI and proposed possible ways of addressing them.

Human immunodeficiency virus in Saudi Arabia: Current and future challenges.

INTRODUCTION: Understanding the pathophysiology of HIV infection has been crucial to the design of effective anti-viral strategies. HIV infection is declining worldwide due to early diagnosis and the effective long-term use of anti-retroviral therapy. New infections decreased from 3.3 million in 2002-2.3 million in 2012. However, in the Middle East and North Africa (MENA), an estimated 83,000 individuals still acquired the virus, with 37,000 morbidities reported. The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported in 1984. By the end of 2013, around 1509 patients had been diagnosed with HIV infection. HIV surveillance has improved in KSA with advances in medical care, counseling, family planning, diagnostic evaluation, and anti-retroviral therapy, but challenges remain. Patients receiving anti-retroviral therapy still show significant morbidity and mortality. Further targeted treatment regimens and preventive strategies are required to control HIV infection in KSA. Progress towards meeting the 90-90-90 goals for HIV in the MENA has also not been systematically monitored. METHOD: In this review, we examine current screening programs, therapeutic modalities, the emergence of drug resistance, and future perspectives for HIV-associated health care in KSA. CONCLUSION: The aim is to offer insight for healthcare policymakers to comply with the UNAIDS 2020 vision program and help establish the prevailing paradigms in the HIV community for an AIDS-free generation and the 90-90-90 goals for diagnosis.

The Incidence of Needlestick and Sharps Injuries Among Healthcare Workers in a Tertiary Care Hospital: A Cross-Sectional Study.

Background Needlestick injuries (NSIs) and sharps injuries (SIs) remain significant hazards in most healthcare facilities that expose healthcare workers (HCWs) to blood-borne pathogens (e.g., HIV, hepatitis B, and hepatitis C). This study aims to review the incidence of NSIs and SIs in King Fahad Medical City (KFMC) and correlate this incidence with several parameters related to the event, including age, sex, length of work experience, type of injury, type of instrument causing the injury, type of activity during which the injury happened, nature of the job of the HCWs, and location within the hospital where the injury happened. Methodology This cross-sectional study involves all self-reported documents related to needlestick and sharp injuries among HCWs at King Fahad Medical City (KFMC) in Riyadh, Kingdom of Saudi Arabia, from January 2017 to December 2020. The data of 389 reports of needlestick and sharp injuries detailing incidence and site, shift, type, and instrument related to the incidents were reported to the infection control department for coding and analysis using the Statistical Package for the Social Sciences (SPSS) version 22 (IBM SPSS Statistics, Armonk, NY, USA). Results Our data showed that NSIs/SIs could be caused by a wide range of objects used by healthcare workers, including needles, suture needles, scalpels, and sharp devices. Remarkably, the most common cause of NSIs was handling the sharp object (38.8%), followed by disposing of the sharp object (19.3%). Furthermore, nurses were found to be the highest at-risk category of HCWs experiencing NSIs (49.9%), while medical waste handlers (1.5%) and dentists (1.3%) were least likely to incur injuries. Conclusion This study sheds some light on the incidence rates of NCIs and SIs at KFMC and correlates these rates with several demographical, occupational, and experiential parameters related to these events.

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections.

The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported back in 1984, and by the end of 2013, around 1509 patients were diagnosed with HIV infection. Recently in 2018, the Saudi ministry of health released that the incidence of HIV in Saudi Arabia is 3 cases of HIV for every 10,000 of the population. Having said that, the surveillance of HIV will face a range of challenges in KSA despite proper medical care, counseling, family planning, diagnostic, evaluation, and the use of effective anti-retroviral therapy. Patients who underwent anti-retroviral therapy showed significant reduction in morbidity as well as mortality. On the other hand, further targeted treatment and preventive strategies are warranted to control HIV co-infections in the KSA. In addition, progress towards meeting the WHO 90-90-90 goals for HIV not only at KSA but at the MENA region too, which is that of the population, 90% are diagnosed, 90% undergoing treatment, and 90% under viral control, is not being systematically monitored. In this review, we discuss the common co-infections with HIV infections that are reported in KSA, which when compared to international trends, it is similar for both viral hepatitis and tuberculosis. Although those co-infections exist, they are presented in different ratios and percentages when compared to the international reported data. These differences mandates defining and introducing new resilient methods of treatment and preventive measures. In this review, we offer an insight into healthcare policymakers to be compliant with UNAIDS 2020 vision program. We also discuss some of the gaps and recommendations to achieve the WHO 90-90-90 goal.

Effect of Pegylated Interferon and Mitomycin C on Ocular Surface Squamous Neoplasia in Xeroderma Pigmentosum: A Case Series.

BACKGROUND Xeroderma pigmentosum (XP) is an autosomal recessive disease caused by mutations in DNA repair genes. Clinical manifestations include extreme sensitivity to ultraviolet (UV) rays, freckle-like pigmentation, ocular abnormalities, and an increased risk of developing neoplasms in sun-exposed areas of the skin, mucous membranes, and eyes. This paper describes the clinical outcome of pegylated interferon alpha 2b (PEG-IFN-alpha-2b) subconjunctival injections and topical mitomycin C (MMC) in the treatment of ocular surface squamous neoplasia (OSSN) in patients with XP. CASE REPORT A series of 3 patients with histopathologically-proven biopsy specimens of XP-associated neoplasia of the eyelids and ocular surface underwent subconjunctival injections of PEG-IFN-alpha-2 band topical cycles of MMC. There was a noticeable decrease in the size and severity of ocular surface squamous neoplasia, with minimal adverse effects of flu-like symptoms with mild fever and generalized malaise. Transient mental depression was reported in 2 of our patients, and only 1 patient developed autoimmune diabetes mellitus, which required insulin therapy after the discontinuation of the PEG-IFN-alpha-2b. CONCLUSIONS The literature on the specifics of ocular care using PEG-IFN-alpha-2b for XP-associated OSSN is sparse. However, according to our clinical experience, the combination of PEG-IFN-alpha-2b subconjunctival injection and the topical cycles of MMC is a promising long-term medical therapy to minimize the development and recurrence of OSSN in XP patients.

Chromosome 1q Terminal Deletion and Congenital Glaucoma: A Case Report.

BACKGROUND This paper aims to highlight the presence of primary congenital glaucoma (PCG) in a patient with chromosome 1 q31 and q42.1 deletion of the distal long arm. The characteristic combination of phenotypic features in this deletion include dysmorphic features, psychomotor retardation and neurological signs; however, PCG has never been recognized as part of these features before. CASE REPORT This is a case of an 8-year-old female with chromosome 1 q31 and q42.1 deletion with congenital glaucoma since birth. She was found to have bilateral buphthalmos and large cloudy corneas and was also unable to follow or fixate in any directional gaze with either eye. Family history was negative for congenital glaucoma and both parents are healthy and non-consanguineous. Karyotyping showed chromosome 1 microdeletion, 46, XX, del (1) (q31q42.1) on high resolution G-banding. Further genetic testing showed no mutations in the CYP1B1 gene. CONCLUSIONS In summary, we describe a rare presentation of congenital bilateral glaucoma in the context of chromosome 1 q31 and q42.1 deletion. This clinical manifestation is uncommon when compared with that of other subsets of chromosome 1 deletions. Thus, we emphasize the need to explore factors contributing to the development of PCG in patients with chromosomal 1 deletion.

Asymmetrical Ocular Manifestations of Nephropathic Cystinosis; A Case Report.

BACKGROUND Infantile nephropathic cystinosis is the most common and severe variant of cystinosis, which is a rare autosomal recessive condition related to a defect in the transportation of the protein cystine resulting in its deposition in various organs. Due to the rarity of this condition, only 1 case with extensive ocular involvement has been found in the English-language literature. Here, we report a second such case to highlight the significance of early diagnosis in avoiding devastating but preventable vision loss. CASE REPORT We describe the extensive asymmetrical ocular involvement in a 22-year-old woman who had nephropathic cystinosis since childhood. Despite frequent follow up and systemic and topical cysteamine therapy, she developed ocular complications, including increased intraocular pressure, uveitis, and retinal changes with complete loss of vision in her left eye. In addition, her general condition requires a renal transplant in the near future. CONCLUSIONS Ophthalmologists should be aware of cystinosis and the sequalae of ocular involvement in this disease, despite its rarity. Identification of the earliest corneal deposits should not be overlooked, especially in the context of other systemic manifestations that are indicative of the nephropathic variant of cystinosis.

Unusual Association of Aniridia with Aicardi-Goutières Syndrome-Related Congenital Glaucoma in a Tertiary Care Center.

BACKGROUND Aicardi-Goutières syndrome (AGS) is a rare autosomal recessive encephalopathy of early onset. AGS visual dysfunction range from nystagmus and optic atrophy to cortical blindness in affected individuals; however, congenital glaucoma has been recently noticed among AGS pediatric patients. According to the literature, aniridia has never been recognized among AGS patients. CASE REPORT We report the case of a 4-year-old boy with AGS who had multiple congenital anomalies in the eyes. He was found to have congenital glaucoma, nystagmus, spherophakia with shallow chambers, and aniridia in both eyes. Family history was positive for glaucoma, with consanguineously married parents. According to the genetics report, both parents are carriers of congenital glaucoma genes. A whole-exome sequencing identified IFIH1 heterozygous missense mutation of the patient, which is associated with AGS Type 7. Also, he was diagnosed as having congenital glaucoma with CYP1B1 mutation, homozygous recessive. This case demonstrates the unusual coexistence of bilateral aniridia, a feature not previously reported in ocular findings of AGS. CONCLUSIONS In summary, this is the first reported case of aniridia with AGS-related congenital glaucoma in the literature. This paper summarizes the usual ocular manifestation of AGS, also it highlights atypical ocular features in both; AGS as well as congenital glaucoma. The aim of this paper is to lay the foundation for a national database on AGS in Saudi Arabia, which will help create a bridge between genetic data and clinical findings of AGS patients.