Osteomyelitis infection caused by Arcanobacterium haemolyticum in a diabetic patient: A first case report.

Arcanobacterium haemolyticum can cause deep infections, including osteomyelitis. In this study, an automated system misidentified this causal agent as Cellulomonas species but 16 s rRNA sequencing correctly identified it as A. haemolyticum. Recognizing the capability of A. haemolyticum to establish the disease is of great importance to enable accurate diagnosis and begin the suitable antibiotic therapy. Here we present the first case of successfully treated A. haemolyticum infective osteomyelitis in a 64-year-old Saudi patient with diabetes mellitus type 2 and review the characteristics of this seldom pathogenic agent.

Quality of diabetes care among patients with schizophrenia. A mixed-methods study.

Objectives: Patients with schizophrenia are at high risk of developing diabetes. Our study aimed to determine the prevalence of diabetes in patients with schizophrenia and assess their quality of diabetes care. We further aimed to explore the factors affecting diabetes care in patients with schizophrenia. Research design and methods: We conducted a retrospective review of medical records for patients presenting with schizophrenia from October 2017 to October 2018. Thereafter, we conducted semi-structured interviews based on the Theoretical Domains Framework to explore healthcare providers' attitudes and perspectives toward diabetes care in patients with schizophrenia at a tertiary hospital for mental health services in Saudi Arabia. Results: The prevalence of diabetes in patients with schizophrenia was 3.7%. The rates of annual testing for quality indicators of diabetes were 8.6% for HgbA1c and 31.4% for low-density lipoprotein cholesterol (LDL-C). Screenings for albuminuria and examinations of the eyes and feet were not conducted. Documentation of smoking status was done infrequently (8.6%). The in-depth interviews uncovered issues with managing diabetes in patients with schizophrenia. We identified four themes: the consequences of poor quality diabetic care provided to patients with schizophrenia; problems with the identification of diabetes in patients with schizophrenia; challenges in the management of patients with both diabetes and schizophrenia; and opportunities to improve the quality of diabetes care provided to patients with schizophrenia. Conclusions: This study identified areas that need a considerable amount of work to be undertaken in Saudi Arabia to help patients with schizophrenia. There are numerous opportunities for improving the quality of Type 2 diabetes care such as the involvement of pharmacists to effectively manage diabetes and expanding community-based health services to include mental health, which could accelerate improved care services.

Relative reduction of biological and phylogenetic diversity of the oral microbiota of diabetes and pre-diabetes patients.

BACKGROUND: A reciprocal relationship between oral health and systemic disease, such as type 2 diabetes, has been suggested, whereby a systemic disease is a predisposing factor for oral infection. If the infection occurs, it in turn aggravates the progression of the systemic disease. According to several studies, certain constituents of the oral microbiota are linked to diabetes, metabolic syndrome, and obesity. In the current study, we aimed to compare the microbial diversity and population structure of the oral microbiota of normoglycemic, impaired glucose tolerance (IGT), and diabetes patients. METHODOLOGY: The study followed a case-control design, with 15 type 2 diabetes patients, 10 IGT subjects, and 19 control subjects. All subjects underwent assessment of periodontitis and oral health. Saliva samples were collected, and DNA was isolated from these samples. Hypervariable regions of the 16Sr RNA gene were amplified and sequenced, and the generated sequences underwent bioinformatics analysis. Statistical analysis and diversity index calculations were made using the statistical software R, vegan R-package, and Past3.20 software. RESULTS: Overall, 551 operational taxonomic units (OTUs) were identified. Based on OTU analysis, a clear reduction of the number of species was observed in both IGT (412) and diabetes groups (372) compared with that in the normoglycemic group (502). This was associated with a similar pattern of reduction of biological diversity among the three groups. The phylogenetic diversity (PD-SBL) value in the normoglycemic group was higher than that in the diabetes group. The diabetes group exhibited the highest evenness value and the highest microbiota bacterial pathogenic content. CONCLUSION: A clear reduction of the biological and phylogenetic diversity was apparent in the diabetes and pre-diabetes oral microbiota in comparison with that in the normoglycemic oral microbiota. However, this was associated with an increase in the pathogenic content of the hyperglycemic microbiota. The results of this study may aid to better understanding of the directionality of the mysterious reciprocal relationship.

Genome sequencing and analysis of the first spontaneous Nanosilver resistant bacterium Proteus mirabilis strain SCDR1.

Background: P. mirabilis is a common uropathogenic bacterium that can cause major complications in patients with long-standing indwelling catheters or patients with urinary tract anomalies. In addition, P. mirabilis is a common cause of chronic osteomyelitis in Diabetic foot ulcer (DFU) patients. We isolated P. mirabilis SCDR1 from a Diabetic ulcer patient. We examined P. mirabilis SCDR1 levels of resistance against Nanosilver colloids, the commercial Nanosilver and silver containing bandages and commonly used antibiotics. We utilized next generation sequencing techniques (NGS), bioinformatics, phylogenetic analysis and pathogenomics in the characterization of the infectious pathogen. Results: P. mirabilis SCDR1 was the first Nanosilver resistant isolate collected from a diabetic patient polyclonal infection. P. mirabilis SCDR1 showed high levels of resistance against Nanosilver colloids, Nanosilver chitosan composite and the commercially available Nanosilver and silver bandages. The P. mirabilis -SCDR1 genome size is 3,815,621 bp. with G + C content of 38.44%. P. mirabilis-SCDR1 genome contains a total of 3533 genes, 3414 coding DNA sequence genes, 11, 10, 18 rRNAs (5S, 16S, and 23S), and 76 tRNAs. Our isolate contains all the required pathogenicity and virulence factors to establish a successful infection. P. mirabilis SCDR1 isolate is a potential virulent pathogen that despite its original isolation site, the wound, can establish kidney infection and its associated complications. P. mirabilis SCDR1 contains several mechanisms for antibiotics and metals resistance, including, biofilm formation, swarming mobility, efflux systems, and enzymatic detoxification. Conclusion: P. mirabilis SCDR1 is the first reported spontaneous Nanosilver resistant bacterial strain. P. mirabilis SCDR1 possesses several mechanisms that may lead to the observed Nanosilver resistance.

The bacterial contamination rate of glucose meter test strips in the hospital setting.

OBJECTIVES: To assess the rate of bacterial contamination of the multi-use vial and single-use packed glucose meter strips, and to identify the type and frequency of various bacterial contamination in different hospital wards. METHODS: This prospective observational study was conducted by a team from the Strategic Center for Diabetes Research in 7 general hospitals in the Central region of Saudi Arabia during the period from August to September 2014 to assess the bacterial contamination rate of the unused strips. A total of 10,447 strips were cultured using proper agar media and incubated both aerobically and anaerobically.  RESULTS: The total bacterial contamination rate for the multi-use vials glucose strips was 31.7%, while single-use packed strips were not contaminated at all. Ministry of Health hospitals had the highest contamination rates compared with other hospitals. Critical, obstetric, and surgical wards had the highest bacterial isolates number, where most were in the risk group 3 according to the National Institute of Health guidelines. Staphylococcus species were the most common bacteria found. CONCLUSION: Glucose meter strips should be recognized as a source of bacterial contamination that could be behind serious hospital acquired infections. The hospital infection control team should adopt proper measures to implement protocols for glucose meter cleaning and glucose strips handling.

Health care services provided to type 1 and type 2 diabetic patients in Saudi Arabia.

OBJECTIVES: To assess health care services provided to type 1 and type 2 diabetic patients and diabetes health care expenditure in the Kingdom of Saudi Arabia (KSA). METHODS: This study was part of a nationwide, household, population based cross-sectional survey conducted at the University Diabetes Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between January 2007 and December 2009 covering 13 administrative regions of the Kingdom. Using patients' interview questionnaires, health care services data were collected by trained staff. RESULTS: A total of 5,983 diabetic patients were chosen to assess health care services and expenditure. Approximately 92.2% of health services were governmental and the remaining 7.8% were in private services. The mean annual number of visits to physicians was 6.5±3.9 and laboratories was 5.1±3.9. Diabetic patients required one admission every 3 years with a mean admission duration of 13.3±28.3 days. General practitioners managed 85.9% of diabetic cases alone, or shared with internists and/or endocrinologists. Health care expenditure was governmental in 90% of cases, while it was personal in 7.7% or based on insurance payment in 2.3%. CONCLUSION: Health services and its expenditure provided to diabetic citizens in Saudi Arabia are mainly governmental. Empowerment of the role of both the private sector and health insurance system is badly needed, aside from implementing proper management guidelines to deliver good services at different levels.

Production of silver nanoparticles with strong and stable antimicrobial activity against highly pathogenic and multidrug resistant bacteria.

AIMS: To synthesize, characterize, and analyze antimicrobial activity of AgNPs of Escherichia hermannii (SHE), Citrobacter sedlakii (S11P), and Pseudomonas putida (S5). METHODS: The synthesized AgNPs were examined using ultraviolet-visible spectroscopy (UV-vis) and, zeta potential, and the size and the morphology obtained from the three different isolates were also confirmed by TEM. RESULTS: Among the three isolates tested, SHE showed the best antimicrobial activity due to the presence of small (4-12 nm) and stable (-22 mV) AgNPs. Stability of AgNPs was also investigated and found to be dependent on the nature of isolates. CONCLUSION: Produced AgNPs showed particle stability and antimicrobial efficacy up to 90 days of production. Our AgNPs exhibited greater antimicrobial activity compared with gentamicin against P. aeruginosa isolates and vancomycin against S. aureus and MRSA isolates at very low concentration (0.0002 mg per Microliters).

A Web-based interactive diabetes registry for health care management and planning in Saudi Arabia.

BACKGROUND: Worldwide, eHealth is a rapidly growing technology. It provides good quality health services at lower cost and increased availability. Diabetes has reached an epidemic stage in Saudi Arabia and has a medical and economic impact at a countrywide level. Data are greatly needed to better understand and plan to prevent and manage this medical problem. OBJECTIVE: The Saudi National Diabetes Registry (SNDR) is an electronic medical file supported by clinical, investigational, and management data. It functions as a monitoring tool for medical, social, and cultural bases for primary and secondary prevention programs. Economic impact, in the form of direct or indirect cost, is part of the registry's scope. The registry's geographic information system (GIS) produces a variety of maps for diabetes and associated diseases. In addition to availability and distribution of health facilities in the Kingdom, GIS data provide health planners with the necessary information to make informed decisions. The electronic data bank serves as a research tool to help researchers for both prospective and retrospective studies. METHODS: A Web-based interactive GIS system was designed to serve as an electronic medical file for diabetic patients retrieving data from medical files by trained registrars. Data was audited and cleaned before it was archived in the electronic filing system. It was then used to produce epidemiologic, economic, and geographic reports. A total of 84,942 patients were registered from 2000 to 2012, growing by 10% annually. RESULTS: The SNDR reporting system for epidemiology data gives better understanding of the disease pattern, types, and gender characteristics. Part of the reporting system is to assess quality of health care using different parameters, such as HbA1c, that gives an impression of good diabetes control for each institute. Economic reports give accurate cost estimation of different services given to diabetic patients, such as the annual insulin cost per patient for type 1, type 2, and gestational diabetes, which are 1155 SR (US $308), 1406 SR (US $375), and 1002 SR (US $267), respectively. Of this, 72.02% of the total insulin cost is spent on type 2 patients and 55.39% is in the form of premixed insulin. The SNDR can provide an accurate assessment of the services provided for research purposes. For example, only 27.00% of registered patients had an ophthalmic examination and only 71.10% of patients with proliferative retinopathy had laser therapy. CONCLUSIONS: The SNDR is an effective electronic medical file that can provide epidemiologic, economic, and geographic reports that can be used for disease management and health care planning. It is a useful tool for research and disease health care quality monitoring.

Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes.

PURPOSE: The aim of this study is to assess the prevalence of urinary tract infection (UTI) and its risk factors among Saudi diabetics. METHOD: A total of 1,000 diabetic patients were included. Patients were interviewed and examined at each visit every 6 months. RESULTS: The prevalence of UTI was 25.3 % in total diabetic population and 7.2 and 41.1 % in males and females, respectively. Females have highest risk of UTI (RR = 6.102; CI = 4.343-8.573; P < 0.001). Age, duration of diabetes and HbA1c did not influence the incidence of UTI, while BMI above 30 kg/m(2) increased the risk (RR = 1.722; CI = 1.532-1.935; P < 0.001). The incidence of UTI in both type 1 and 2 diabetics was similar (23.7 and 25.6 %). There was no significant risk in patients aged above 60 years (RR = 1.054; CI = 0.841-1.321; P = 0.651). The risk factors found to be associated with UTI were hypertension (RR = 1.202; CI = 1.061-1.361; P = 0.006), insulin therapy (RR = 1.411; CI = 1.262-1.578; P < 0.001) and nephropathy (microalbuminuria) (RR = 1.417; CI = 1.036-1.939; P = 0.031). CONCLUSION: The present study has shown that prevalence of UTI is more in diabetic females and diabetics with BMI above 30 kg/m(2). The other risk factors associated with UTI in general diabetic population were found to be microalbuminuria, hypertension and insulin therapy.

Sleep duration and quality associated with obesity among Arab children.

The link between sleep duration and obesity has been well established in adults, but several epidemiological studies revealed inconsistent findings in adolescents and younger children. This study aimed to investigate the relationship between sleep length and obesity in Saudi students. A total of 5,877 Saudi students, boys (55.2%) and girls (44.8%), aged between 10 and 19 years were randomly selected from elementary, intermediate, and secondary schools in different regions of Riyadh. A questionnaire on sleep behaviors was given. Anthropometry included BMI and waist and hip circumferences. Sleeping

Incidence and risk factors of hypertension among Saudi type 2 diabetes adult patients: an 11-year prospective randomized study.

AIMS: Insofar as hypertension is a risk factor for cardiovascular morbidity and mortality in Type 2 diabetes mellitus (T2DM), this study investigated the incidence of hypertension and associated risk factors in Saudi T2DM patients. METHODS: A hospital-based, 11-year (1993-2004) prospective study of 916 adult originally normotensive T2DM Saudi patients (488 male and 428 female). T2DM was diagnosed as per World Health Organization (WHO) criteria, while hypertension was assessed according to the Seventh Joint National Criteria for Hypertension Classification (JNVII). Risk factors were analyzed on those who developed hypertension. RESULTS: The hypertension incidence was 17.2/100 person-years, based on 2833.63 person-years of cohort group follow-up. Age-adjusted Cox regression coefficient showed that the significant risk factors for developing hypertension were older age, higher HbA(1c), BMI, elevated triglycerides (>1.8 mmol/l) and creatinine (>115 mmol/l), smoking, proteinuria, microalbuminuria, lack of physical exercise, and retinopathy, while anti-platelet and lipid-lowering drugs had lower hypertension hazard ratios. Cox proportional hazard showed that older age, male gender, higher BMI, diabetes duration (<5 years), and retinopathy were independent predictors of hypertension, while exercise, lipid-lowering, and anti-platelet medications were associated with reduced hypertension incidence rate. CONCLUSIONS: Incidence of hypertension in Saudi T2DM patients is comparable to other communities, with older age, male gender, higher BMI, diabetes duration of <5 years and retinopathy being strong predictors for hypertension development.

Graves' disease in Saudi Arabia: a ten-year hospital study.

OBJECTIVE: To determine clinical manifestation and mode of treatment of Graves' disease at King Khalid University Hospital Riyadh, Saudi Arabia. METHODS: A retrospective study of all cases of Graves' disease diagnosed at the hospital in the period between January 1995 and December 2004, who received a minimum of two years treatment were included in the study. RESULTS: A total of 194 patients were seen with female: male ratio of 2.9:1 and mean age of 32 +/- 0.9 years. Sixty nine percent of the patients had positive thyroid antibodies. Palpitations, tremors, weight loss and nervousness were the most common presenting manifestations. Forty nine percent of patients were treated with radioiodine, 38% with antithyroid drugs, and 13% underwent subtotal thyroidectomy. CONCLUSION: Clinical manifestations of Graves' disease in our patients distinctly differed from those reported in the West and Pacific Islanders with notable rarity of pretibial myxoedema and hyperpigmentation respectively. We also noted higher male to female ratio and an increasing utility of radioactive iodine therapy while use of antithyroid drugs and surgery are declining.

Treatment of Graves' hyperthyroidism--prognostic factors for outcome.

OBJECTIVE: To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. METHODS: We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS: At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi (481-555 MBq)] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine (odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01). Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation (p=0.003). CONCLUSION: In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi (481-555 MBq) seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients.