The presence of atypical mycobacteria in the mouthwashes of normal subjects: role of tap water and oral hygiene.

BACKGROUND: The nontuberculous mycobacteria (NTM) have been found in different environmental sources. They tend to colonize different body surfaces and secretions. The purpose of this study is to evaluate the presence of NTM in the oral cavity of healthy individuals and its relationship to tap water or oral hygiene. MATERIALS AND METHODS: One hundred sixty-seven healthy subjects were recruited. Three consecutive early morning mouthwashes using tap water were performed and examined for the presence of Mycobacterium tuberculosis (MTB) and NTM. In addition we obtained mouthwashes from 30 control healthy individuals with good oral hygiene using sterile water and examined these for the presence of MTB and NTM. RESULTS: NTM was isolated from the mouthwash of 44 (26.3%) subjects that used tap water. On the other hand, NTM was isolated from the mouthwash of 10 (33%) subjects that used sterile water. Age, gender, social class oral hygiene and the regular use of toothbrush made no statistically significant differences in the isolation rate of NTM. CONCLUSION: The rate of isolation of NTM from mouthwash is high in normal subjects. It is independent of oral hygiene, the use of tap water or teeth brushing. Smear-positive sputum could be NTM rather than M. tuberculosis. Tuberculosis polymerase chain reaction or culture confirmation is essential in developing countries to avoid the unnecessary use of antituberculosis therapy when the clinical suspicion is very low.

Intrafamilial clustering of Helicobacter pylori infection in Saudi Arabia.

AIM: To study the pattern of Helicobacter pylori infection among family members in the Saudi population. METHODS: A cross-sectional, population-based, seroepidemiological study of family members was undertaken in a Saudi population using saliva H pylori immunoglobulin (Ig) G antibodies (Helisal kit). RESULTS: A total of 42 families comprising 271 children and 84 parents were studied (355 subjects; mean age 23 years, SD 19 years) The overall frequencies of H pylori IgG antibodies in mothers, fathers and children were 67%, 64% and 23%, respectively. There was no significant difference in the infection rate between mothers and fathers, or between boys and girls. The infection rate among children increased when one or both parents were seropositive, and the infection rate among parents was proportionally related to the number of infected children per family. The frequency of H pylori antibodies was significantly higher in spouses of seropositive parents than in spouses of seronegative parents (45% compared with 19.2%). CONCLUSIONS: These data confirm that the intrafamilial clustering of H pylori infection in Saudi Arabia occurs in a similar pattern to that described in the developed countries, and that living conditions and social conditions lead to person to person transmission of H pylori infection.

Helicobacter pylori and intestinal metaplasia with its subtypes in the gastric antrum in a Saudi population.

BACKGROUND: There is a close association between intestinal metaplasia (IM) and the development of gastric cancer as well as a relationship between Helicobacter pylori, IM, and gastric cancer. Our aim was to study the frequency and subtypes of IM in a Saudi population with dyspepsia, a population with a low prevalence of gastric cancer. METHODS: Endoscopic antral biopsy specimens were histologically studied for the presence of IM and H. pylori in consecutive patients who underwent upper gastrointestinal endoscopy for evaluation of dyspepsia. Hematoxylin and eosin and Giemsa stain were used to study IM, inflammation, and H. pylori, whereas Alcian blue, pH 2.5/periodic acid-Schiff and high iron diamine/Alcian blue, pH 2.5, were used to study IM subtypes. RESULTS: Seven hundred and seventy-eight consecutive patients were recruited in this study, 415 men and 363 women, with a mean age of 43 +/- 17.6 years. Of the 778 patients, IM was identified in 118 (15.2%). The mean ages of patients with IM (48.8 +/- 18.7) and without IM (41.9 +/- 17.4) were statistically significant (P < 0.0001), whereas the patients' sex did not influence the presence of IM. Most had type-I IM (59.3%), whereas 26.3% and 14.4% had types II and III, respectively. The overall rate of infection with H. pylori was 75.4%. There was no difference in the frequency of IM in patients with or without H. pylori (15.5% versus 14.1%; P = 0.65). Of the 118 patients with IM, the 91 patients (77.1%) who also had H. pylori were older (55 +/- 23 years) than those without H. pylori (47 +/- 17 years, P = 0.05). CONCLUSION: This study has documented mainly that the prevalence of IM and IM subtype III is low in our population. Furthermore, we found no significant relationship between a high rate of H. pylori infection with either IM in general or with IM subtype III in particular, possibly accounting for a low incidence of gastric cancer in the Saudi population.

Seroepidemiology of hepatitis B virus infection in Saudi children 8 years after a mass hepatitis B vaccination programme.

OBJECTIVES: On October 1 1989, a programme was begun in Saudi Arabia in which the HBV vaccine was added as the 'seventh' primary immunogen of the Extended Programme of Immunization (EPI). In 1990, another programme was launched by the Ministry of Health to vaccinate all school children. Eight years after this mass vaccination programme, the efficacy of HBV vaccine was evaluated in a community-based study. METHODS: A community-based study was carried out in Saudi children in urban and rural areas, covering all the regions of Saudi Arabia. After informed consent, blood samples were obtained and tested for HBV markers. RESULTS: Among 4791 vaccinated Saudi children aged 1-12 years, only 15 were found to be HbsAg-positive (0.31%). HbsAg-positivity was 0.16% in children vaccinated at birth compared with 0.7% in those vaccinated at school entry. The overall HbsAg carrier rate dropped from 6.7% in 1989 to 0.3% in 1997 (P<0.00001). Similarly, there was a significant reduction in the prevalence of anti-HBc from 4.2% in 1989 to 0.46% in 1997 (P<0.00001). The overall seroconversion rate to HB vaccine among 4087 Saudi children up to 12 years of age was about 77%. Seroconversion rate in those vaccinated at birth was 77% compared with 71% in those vaccinated at school entry. After 8 years of receiving the third vaccine dose, close to 65% of the children had an anti-HBs titre of more than 10 IU/l compared with about 28% who had an anti-HBs titre of more than 100 IU/l after the same period. CONCLUSION: The result of this study demonstrates the tremendous impact of the mass HB vaccination programme on the seroepidemiology of HBV infection in Saudi Arabia. The ultimate goal of preventing HBV-related chronic liver disease and hepatocellular carcinoma in Saudi Arabia is foreseeable in the near future.

Sleep disorders in Saudi health care workers.

BACKGROUND: The objective of the study was to screen for sleep habits and various sleep disorders, using a standard questionnaire. PATIENTS AND METHODS: The questionnaire was designed to assess sleep habits, the degree of daytime sleepiness using the Epworth Sleepiness Scale (ESS), and specific sleep problems. A random sample of Saudi employees working as medical or paramedical personnel was selected. RESULTS: There were 163 respondents (65%) comprising 33 females and 130 males. The mean ESS score was 9.4. Sixty-four respondents (39.3%) had an ESS score of more than 10, i.e., excessive daytime sleepiness (EDS). When subjects with poor sleep habits and/or sleep problems were excluded, there were 65 ânormalâ sleepers, with a mean ESS score of 8.9+/-3.6. This did not differ from the rest of the sample population, who had a score of 9.8+/-3.7 (P=0.15). Subjects with inadequate sleep or insomnia consisted of 17 females (51.5%) and 45 males (34.6%). There were seven subjects, all males (5.4%), with habitual snoring. Ten males (7.7%) and two females (6.1%) reported having breathing pauses while asleep. Symptoms of restless leg syndrome, sleep paralysis, and cataplexy were reported by 21 (12.9%), 26 (16.0%) and two (1.2%) subjects, respectively. CONCLUSION: The prevalence of EDS in the Saudi population is higher compared to that reported from other populations when a Western ESS normal range is used. Nevertheless, the range of normal score of ESS is probably broader for Saudis compared to other populations. In general, sleep disorders are common but unrecognized in our community.

Hepatitis A in Saudi Arabia: A comparative sero-epidemiological study.

Full text is available as a scanned copy of the original print version.

Pattern and factors associated with glycemic control of Saudi diabetic patients.

BACKGROUND: The pattern and factors which can be associated with the glycemic control of Saudi adult diabetic patients were examined in this study. PATIENTS AND METHODS: Confirmed diabetic patients from all regions of Saudi Arabia constituted the study population. Random blood glucose <10 mmol/L and >10 mmol/L was used to categorize patients into good and poor glycemic control patients, respectively. RESULTS: There were 613 confirmed non-insulin dependent diabetic patients (NIDDM), 50% with good glycemic control. Patients with poor glycemic control were significantly older than patients with good glycemic control (51.5 vs. 47 years, P=0.0001). The insulin-treated diabetic population amounted to 13%, compared with 43% and 44% for oral agent and diet, respectively. The rate of insulin users among poor glycemic control diabetic population was 18%, compared with 50% for oral agents. There was a significant relationship between glycemic control and age, and treatment modalities of DM. Subjects who had good glycemic control of DM were younger and following a diet regimen, while those who had poor glycemic control were older and on insulin treatment. Multivariate analysis comprising 415 individuals was conducted to find out the factors that can potentially influence, or may be associated with, the control of DM. CONCLUSION: The association of insulin therapy with poor glycemic control is not a cause-effect relationship. Insulin therapy in our study population is underutilized, given the high rate of poor glycemic control and high rate of relative occurrence of complication among the Saudi diabetic population. There is a need to address the importance of maintaining good glycemic control, and the reason for the low rate of insulin users. Close periodic monitoring of glycemic control, utilizing laboratories and home glucose monitoring devices, is required. Effective implementation of these measures, in addition to diabetes education, will have an impact on the future outcome of the Saudi diabetic population.

Smoking habits of King Saud University students in Abha, Saudi Arabia.

BACKGROUND: The aim of this study was to estimate the prevalence of smoking among university students of King Saud University in Abha City, to determine ecological factors for the problem, and to assess the studentsâ knowledge about the health effects of smoking, and attitudes towards public action against smoking. MATERIALS AND METHODS: All medical students at the University College of Medicine (MC) (n=202), and a representative sample of students of the College of Education (CE) (n=300), were subjected to a modified Arabic version of the World Health Organization standard questionnaire for young people to study their knowledge, attitudes and practices of smoking. RESULTS: The study revealed the following results among students of the CE and those of the MC, respectively. Prevalence of regular smoking (17.5% vs. 13.6%; P=0.25); heavy smokers (39.5% vs. 27.8%; P=0.38); smokers of moderate- to high-nicotine yield (92.7% vs. 50%, P=0.0004), and tar yield (48.8% vs. 16.7%, P=0.02). Curiosity was the main reason for initiation of smoking (41.2% vs. 51.9%), followed by the desire to show off (27.5% vs. 51.9%, P=0.03), and peer pressure (27.5% vs. 7.4%, P=0.04). Friends were the main source of the first cigarette (53.1% vs. 55.6%), followed by parents (2% vs. 40.7%, P=0.0001). Most students were knowledgeable about smoking and had favorable attitudes against it. However, MC students were significantly more knowledgeable than those of the CE. CONCLUSION: Smoking still constitutes a major problem among university students in Abha, in spite of their knowledge of its hazards. This may be due to the addictive effect of smoking, peer pressure, negative parental attitudes and other reasons. There is a need to implement an anti-smoking program for college students, and possibly legislation to limit the amount of tar and nicotine in cigarettes.

Population-based epidemiological study on characteristics of risk factors of hypercholesterolemia in Saudi Arabia.

OBJECTIVES: To study the characteristics of risk factors for hypercholesterolemia among the Saudi population. DESIGN: Population-based cross-sectional national epidemiological randomized household survey. SUBJECT: 4548 Saudi subjects, aged 15 years and above. Sample was representative and in accordance with the national population distribution with respect to age, gender, regional and residency, urban vs. rural, population distribution. MEASUREMENT: Height and weight with calculation of body mass index, blood samples were drawn and assayed for glucose and total cholesterol concentration. Hypercholesterolemia (HC) was defined: borderline high HC (5.2-6.2 mmol l-1) and high HC (> 6.2 mmol l-1). Univariate, multivariate, simple logistic, multiple logistic, odd ratio and chi-square were employed in the statistical analysis. RESULTS: The risk of developing HC increased with age by 2% and 1% for each year increase in age for borderline high HC and high HC. The risk of developing HC was significantly higher among female subjects. There was no significant relation between the spectrum of BMI group, underweight to obesity, with risk of developing borderline high or high HC. There was a significant increase in the risk of developing HC among residents of urban communities. There was no significant regional variation for risk of borderline high HC, however, there was a significant increase in the risk of developing high HC among residents of Central and Eastern regions, compared with other regions. CONCLUSION: The characteristics of risk factors for HC among the Saudi population differ in many respects from other populations. Overweight and obesity are not significant risk factors for HC. Rural communities are more at risk of HC than urban communities. The population of the Eastern and Central regions were at significantly higher risk of developing HC. The relatively recent urbanization may account for the low prevalence of HC. It may partially explain the dissociation between obesity and HC. Food habits, both in quantity and quality in rural communities in genetically predisposed homogenous populations may account for the increase in the prevalence of HC in rural communities. There is a need to propagate information about the potential health hazard of obesity and HC among Saudi communities, at large, and specifically in the Eastern and Central regions. There is a need to study the food patterns of rural communities which may explain partially the relative increase in the prevalence of HC in rural communities.

Non-neoplastic changes in gastric antrum: are they different in distally located intestinal and diffuse-type gastric adenocarcinoma?

A total of 126 cases of primary adenocarcinoma of distal (antrum and/or adjacent body) stomach were reviewed. These cases were collected from the histopathology laboratory of Asir Central Hospital, Southwestern Saudi Arabia over an 8 year period (1987-94). Only gastrectomy specimens with non-neoplastic antral mucosa available for histological examination were included. Of 126 cases, 85 (67.5%) were of the intestinal type and 41 (32.5%) were of the diffuse type. Histological examination of the non-neoplastic antral mucosa showed: gastritis in 100% of these cases; Helicobacter pylori in 103/126 cases (81.8%); multifocal atrophic gastritis (MAG) in 53/126 cases (42.1%); intestinal metaplasia (IM) in 62/126 (49.2%); and type III intestinal metaplasia in 30/62 cases (47.7%). None of these non-neoplastic changes of antral mucosa was significantly different when the prevalence of these changes in intestinal and diffuse type gastric adenocarcinoma were compared using the chi 2 test. The prevalence of these non-neoplastic lesions were calculated in a 126 dyspeptic age- and sex-matched control patients and were as follows: H. pylori 91%; gastritis 78%; MAG 7.4%; IM 19% and type III IM 1.6%. The prevalence of H. pylori bacilli and gastritis was not significantly different between the cancer patients and the controls. The prevalence of MAG, IM and type III IM was significantly higher among cancer patients compared with the control group.

Cutaneous leishmaniasis: schedules for intralesional treatment with sodium stibogluconate.

BACKGROUND: Various therapeutic modalities have been used for treating cutaneous leishmaniasis. Intralesional pentavalent antimonial injection is one of the effective therapeutic modalities. In this study, the efficacy of three different intralesional schedules with sodium stibogluconate have been investigated. METHODS: Ninety-six patients with 129 lesions were entered into the study, all with confirmed diagnosis of cutaneous leishmaniasis. The lesions were treated with three different schedules, including daily, alternate day, and weekly interlesional injections of sodium stibogluconate. The clinical response was then compared to arrive at the most effective schedule. RESULTS: The clinical responses (complete and partial cure) were 67%, 97%, and 91% for the daily, alternate-day, and weekly schedules, respectively. Lesions with either partial cure or failure of treatment were injected weekly with the same medication until complete cure had been achieved. The final overall success rate of complete cure was 99.2%. CONCLUSIONS: Alternate day or weekly intralesional treatment of cutaneous leishmaniasis with sodium stibogluconate are more effective than daily treatments.

The population survey as a tool for assessing family health in the Keewatin region, NWT, Canada.

The population survey is an important tool in community health assessment, including the physical and psychological aspects of family health. It provides data on health status and health determinants not available from vital statistics and health service utilization. The Keewatin Health Assessment Study (KHAS), which was designed in collaboration with the Keewatin Regional Health Board (KRHB), surveyed a representative sample of the predominantly Inuit population in 8 communities in the central Canadian Arctic. The entire survey included 874 individuals in all age groups, of whom 440 were children and adolescents under 18 years of age, and consisted of questionnaires, clinical examination and laboratory tests. Of the large number of variables on which data were collected, some were of particular relevance to the health of children and the well-being of the family, including: (1) Child growth and development; (2) Nutrition and diet; (3) Social pathologies: suicide attempts and sexual abuse; (4) Oral health; and (5) Audiologic health. In addition to providing cross-sectional data, survey participants constitute a cohort which, if followed up longitudinally, can be used to determine the incidence of specific conditions and identify risk factors which promote or prevent their occurrence. An example of such a cohort study is one on acute respiratory infection. Surveys serve many functions--providing data for planning and evaluation, promoting community awareness of health issues, and addressing basic research questions. The KHAS is one of several surveys launched over the past several years which jointly will begin to provide a circumpolar perspective on the health of Inuit people.

Determinants of tuberculin sensitivity in a child population covered by mass BCG vaccination.

A cross-sectional survey of 701 Indian children aged 1-15 in five northern Canadian communities showed that 82% had a documented history of BCG vaccination while only 78% had a visible scar. The prevalence of 5 mm or more induration on Mantoux testing varied from 6 to 26%. Multiple logistic regression indicated that community, age, past use of isoniazid and time since the last Mantoux test were positive predictors of sensitivity. The presence of a BCG scar and the number of past vaccinations were not significantly associated but the elapsed time since the last BCG was negatively associated with a positive reaction. Overcrowding, nutritional status and past history of household and community contact with an active case of tuberculosis were also investigated but their independent effect could not be demonstrated. Despite the presence of mass BCG vaccination in this population, tuberculin testing is still a useful tool in assessing the risk of infection.