A Systematic Review of Chronic Diseases and Their Prevalence Among the Population of Northern Borders Province (NBP) in Saudi Arabia.

Estimation of the prevalence of chronic conditions is pivotal to effective healthcare planning and management. Therefore, our objective was to systemically review previous literature about the prevalence of chronic diseases among residents of Northern Borders Province (NBP) in Saudi Arabia. The electronic search has been done using scientific databases (PubMed, Ebsco, SciFinder, and Web of Science) and search engines up to September 2021. The following main key terms: chronic disease OR chronic conditions AND prevalence AND Northern Borders Province OR Northern Borders AND Saudi Arabia were applied. Other related terms with a more specific search were done with names of the main cities in the province and the most common diseases in Saudi Arabia. Duplicates were removed electronically by Endnote and manually. Extracted data were tabulated in the literature matrix. The risk of bias and quality of included studies were assessed using the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) checklist. Out of 63 observational studies that were assessed for eligibility, 21 observational studies were included to synthesize the evidence. These studies were conducted on Arar (n=16), Turaif (n=2), and Rafha (n=1), while the remaining were national studies in which NBP was one of the included regions (n=2). The most frequently studied diseases were diabetes (4 records), psychological diseases (4 records), and obesity (3 records). The most prevalent disease was gastroesophageal reflux disease (GERD), with an estimated prevalence of 61% among adults in Arar city. In conclusion, although some research is conducted about chronic diseases somewhere in NBP, further studies are needed to study chronic diseases using a representative sample of the whole NBP population.

A Sequalae of Lineage Divergence in Staphylococcus aureus from Community-Acquired Patterns in Youth to Hospital-Associated Profiles in Seniors Implied Age-Specific Host-Selection from a Common Ancestor.

The rapidly changing epidemiology of Staphylococcus aureus and evolution of strains with enhanced virulence is a significant issue in global healthcare. Hospital-associated methicillin-resistant S. aureus (HA-MRSA) lineages are being completely replaced by community-associated S. aureus (CA-MRSA) in many regions. Surveillance programs tracing the reservoirs and sources of infections are needed. Using molecular diagnostics, antibiograms, and patient demographics, we have examined the distributions of S. aureus in Ha'il hospitals. Out of 274 S. aureus isolates recovered from clinical specimens, 181 (66%, n = 181) were MRSA, some with HA-MRSA patterns across 26 antimicrobials with almost full resistances to all beta-lactams, while the majority were highly susceptible to all non-beta-lactams, indicating the CA-MRSA type. The rest of isolates (34%, n = 93) were methicillin-susceptible, penicillin-resistant MSSA lineages (90%). The MRSA in men was over 56% among total MRSA (n = 181) isolates and 37% of overall isolates (n = 102 of 274) compared to MSSA in total isolates (17.5%, n = 48), respectively. However, these were 28.4% (n = 78) and 12.4% (n = 34) for MRSA and MSSA infections in women, respectively. MRSA rates per age groups of 0-20, 21-50, and >50 years of age were 15% (n = 42), 17% (n = 48), and 32% (n = 89), respectively. However, MSSA in the same age groups were 13% (n = 35), 9% (n = 25), and 8% (n = 22). Interestingly, MRSA increased proportional to age, while MSSA concomitantly decreased, implying dominance of the latter ancestors early in life and then gradual replacement by MRSA. The dominance and seriousness of MRSA despite enormous efforts in place is potentially for the increased use of beta-lactams known to enhance virulence. The Intriguing prevalence of the CA-MRSA patterns in young otherwise healthy individuals replaced by MRSA later in seniors and the dominance of penicillin-resistant MSSA phenotypes imply three types of host- and age-specific evolutionary lineages. Thus, the decreasing MSSA trend by age with concomitant increase and sub-clonal differentiation into HA-MRSA in seniors and CA-MRSA in young and otherwise healthy patients strongly support the notion of subclinal emergences from a resident penicillin-resistant MSSA ancestor. Future vertical studies should focus on the surveillance of invasive CA-MRSA rates and phenotypes.

Prevalence and associated risk factors of Entamoeba histolytica infection among school children from three primary schools in Arsi Town, West Zone, Ethiopia.

Entamoeba histolytica is one of the major pathogenic intestinal parasites and is amongst the leading causes of diarrheal illness in children. Around 500 million people are infected worldwide, while 75,000 die of the disease annually. E. histolytica is associated with moderate to severe diarrhoea and increased mortality among children in African countries and negatively affects child growth and development. Malnutrition is also an important contributor to the prevalence of E. histolytica in Ethiopia. It is mostly associated with poor hygiene, poverty, illiteracy, lack of access to potable water, and a hot, humid tropical climate. Thus, the present investigation was aimed to assess the prevalence rate and associated factors of E. histolytica among schoolchildren in Arsi Town, West Zone, Oromia Regional State, Ethiopia. A cross-sectional study was conducted from February 1st to May 1st, 2020. A total number of 334 students were selected from three governmental elementary schools in the west zone using a systematic sampling method. A structured questionnaire was adopted to identify environmental, socio-demographic, and behavioral factors. Microscopically positive samples for E. histolytica cysts were further characterised using an E. histolytica II antigen detection kit. The statistical analysis of the data was done using SPSS software. A univariate and multivariate logistic regression analysis was done. P value < 0.05 was considered statistically significant. The overall prevalence of E. histolytica was 19.8%. Hand washing habits before eating [AOR = 0.32; 95% CI (0.12, 0.84)], hand washing habits after defecation [AOR = 0.396; 95% CI (0.165, 0.946)], and ameba awareness [AOR = 0.35; 95% CI (0.142, 0.889)] were factors associated with parasite prevalence. The findings of this study could assist the government in targeting infected areas, improving sanitation to prevent E. histolytica transmission, and implementing effective control measures in these rural communities, particularly among youngsters, who represent the nation's future.

A Multi-Point Surveillance for Antimicrobial Resistance Profiles among Clinical Isolates of Gram-Negative Bacteria Recovered from Major Ha'il Hospitals, Saudi Arabia.

The devastating nosocomial resistance is an on-going global concern. Surveillance of resistance is crucial for efficient patient care. This study was aimed to conduct a surveillance in four major Ha'il Hospitals from September to December 2020. Using a multipoint program, records of 621 non-duplicate Gram-negative cultures were tested across 21 drugs belonging to different categories. Major species were Klebsiella pneumoniae (n = 187, 30%), E. coli (n = 151, 24.5%), Pseudomonas aeruginosa, (n = 84, 13.6%), Acinetobacter baumannii (n = 82, 13.3%), and Proteus mirabilis (n = 46, 7%). Based on recent resistance classifications, A. baumanni, P. aeruginosa, and enteric bacteria were defined as pan-resistant, extremely resistant, and multi-drug resistant, respectively. A. baumannii (35%) and K. pneumoniae (23%) dominated among coinfections in SARS-CoV2 patients. The "other Gram-negative bacteria" (n = 77, 12.5%) from diverse sources showed unique species-specific resistance patterns, while sharing a common Gram-negative resistance profile. Among these, Providencia stuartii was reported for the first time in Ha'il. In addition, specimen source, age, and gender differences played significant roles in susceptibility. Overall infection rates were 30% in ICU, 17.5% in medical wards, and 13.5% in COVID-19 zones, mostly in male (59%) senior (54%) patients. In ICU, infections were caused by P. mirabilis (52%), A. baumannii (49%), P. aeruginosa (41%), K. pneumoniae (24%), and E. coli (21%), and most of the respiratory infections were caused by carbapenem-resistant A. baumannii and K. pneumoniae and UTI by K. pneumoniae and E. coli. While impressive IC, hospital performances, and alternative treatment options still exist, the spread of resistant Gram-negative bacteria is concerning especially in geriatric patients. The high selective SARS-CoV2 coinfection by A. baumannii and K. pneumoniae, unlike the low global rates, warrants further vertical studies. Attributes of resistances are multifactorial in Saudi Arabia because of its global partnership as the largest economic and pilgrimage hub with close social and cultural ties in the region, especially during conflicts and political unrests. However, introduction of advanced inter-laboratory networks for genome-based surveillances is expected to reduce nosocomial resistances.

Prevalence of obesity in Hail region, KSA: in a comprehensive survey.

BACKGROUND: Obesity contributes significantly to morbidity and mortality rates worldwide. We, therefore, aimed to provide epidemiological data on the prevalence of obesity in Hail, Kingdom of Saudi Arabia (KSA). METHODOLOGY: Data were collected during cross-sectional survey which included 5000 Saudi selected from 30 primary health care centers (PHCs) in Hail Region. RESULTS: The overall prevalence of obesity in Hail was 63.6%. Moreover, the prevalence of males was 56.2% and the prevalence of females was 71%. CONCLUSION: Obesity is prevalent in the Hail Region which necessitates urgent interventions including health education.

Recent developments in production and biotechnological applications of C-phycocyanin.

An extensive range of pigments including phycobiliproteins are present in algae. C-phycocyanin (C-PC), a phycobiliprotein, is one of the key pigments of Spirulina, a microalgae used in many countries as a dietary supplement. Algal pigments have massive commercial value as natural colorants in nutraceutical, cosmetics, and pharmaceutical industries, besides their health benefits. At present, increasing awareness of harmful effects of synthetic compounds and inclination of community towards the usage of natural products have led to the exploitation of microalgae as a source of natural pigments/colors. This review describes recent findings about the sources and production of C-PC, with emphasis on specific techniques for extraction and purification, along with potential industrial applications in diagnostics, foods, cosmetics, and pharmaceutical industries.

Cytological changes in oral epithelium due to Sudanese homemade alcoholic beverages

Introduction and Objective : The aim of this study was to assess the cytological changes in oral epithelium that might be induced by Sudanese homemade alcoholic beverages. Material and methods: Oral Exfoliative Cytology (OEFC) was applied to a case control study to assess the presence and severity of oral epithelial atypia (ET) in 300 subjects (150 alcohol abuse individuals (cases); 150 non-alcohol abuse individuals (controls)). All cases were using homemade alcoholic drinks, locally known as, Aragee, Marisa and others. Five patients with oral squamous cell carcinoma (OSCCs) were included as internal controls. Results: ET was detected in 7 subjects and was not observed in the remaining 293. All the 7 subjects with cytological atypia were cases. Cytological atypia were identified among those using Aragee, Marisa, and Aragee & Marisa together, representing 53%, 28.6%, 18%.4, respectively. Cytological atypia was found in all the 5 control cases with OSCCs. For the cytological atypia among alcohol abuse individuals, the adjusted OR and the 95% CI were found to be 5 (4.34-5.84) and P = 0.008. Inflammatory cells infiltrates were identified among 21 (14%) of the cases and only 12 (8%) of the controls and the adjusted OR and the 95% CI were found to be 5 (2.51-11.21) and P = 0.009. Conclusion: In view of these findings, Sudanese homemade alcoholic beverages cause oral epithelial atypical changes, which lead to oral precancerous and cancerous lesions. OEFC is a useful procedure for detection and assessment of oral ET.

Chemopreventive effects of cardamom (Elettaria cardamomum L.) on chemically induced skin carcinogenesis in Swiss albino mice.

The chemopreventive potential of cardamom was evaluated on 7,12-dimethylbenz[a]anthracene-initiated and croton oil-promoted mouse skin papillomagenesis. A significant reduction in the values of tumor incidence, tumor burden, and tumor yield and the cumulative number of papillomas was observed in mice treated orally with 0.5 mg of cardamom powder in suspension continuously at pre-, peri-, and post-initiational stages of papillomagenesis compared with the control group. The average weight and diameter of tumors recorded were also comparatively lower in the cardamom-treated mouse group. Treatment of cardamom suspension by oral gavage for 15 days resulted in a significant decrease in the lipid peroxidation level of the liver (P < .01). In addition, the reduced glutathione level was significantly elevated in comparison with the control group (P < .05) following cardamom suspension treatment. Taken together, these findings indicate the potential of cardamom as a chemopreventive agent against two-stage skin cancer.

Development and evaluation of study guide template for an integrated cardiovascular module.

The undergraduate medical curriculum in the King Abdulaziz University in Jeddah, Saudi Arabia, was reformed in 2002. It is integrated, organized in courses and modules, and has an increasing proportion of problem-based and self-directed learning. The new curriculum has presented the faculty and students with specific challenges. Accustomed to a traditional teacher-centred approach, and because the language of instruction is English, students needed much more support and encouragement in taking advantages of independent learning than their western counterparts would require. A well-designed study guide may be more effective student learning tool in the new integrated curriculum. This article describes to simplify and modern approach to the production of study guides. The approach is based on the development and the use of a study guide template. The guide is evaluated by second year medical students at King Abdulaziz University. The study guide is highly appreciated by student evaluations and 'study guide template' that includes a well-designed layout is a useful aid for medical teachers who have had no experience in producing a study guide. The template allows medical teachers to invest their time in the production of the content rather than in the layout and format of the guide.

Relationship between plasma angiotensinII, leptin and arterial blood pressure.

OBJECTIVE: Obesity and hypertension are 2 closely associated conditions and obesity probably predisposed to hypertension. The mechanism of the association between obesity and hypertension is not clear. The aim of the present study was to clarify the relationship between blood pressure (BP), body mass index (BMI), serum angiotensinII (AGII) and serum leptin levels and to investigate the relation between serum AGII and leptin. This study also aimed to rule out if there is a difference in serum AGII and leptin levels between lean and obese hypertensive females. METHODS: We measured fasting serum AGII and leptin levels in 16 normotensive lean (LN) females, 25 obese normotensive (ON) females, 12 lean hypertensive (LH) females and 25 obese hypertensive (OH) females. All subjects had no evidence of preexisting cardiovascular disease, were non pregnant, had no previous history of ill health or smoking and were not on antihypertensive therapy. This study was performed in King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January 2002 through to January 2003 RESULTS: In lean groups, there were a significant increase in BMI and serum AGII in hypertensive group compared to normotensive group while the serum leptin level was insignificantly higher in hypertensive group than in normotensive group. On the other hand, there was a significant increase in serum AGII, BMI and serum leptin for obese hypertensive compared to obese normotensive group. The mean arterial blood pressure (ABP) was significantly correlated to serum AGII, serum leptin and BMI in all groups. A significant correlation was found between serum AGII and serum leptin if all studied females (LN, LH, ON and OH) or obese females (ON and OH) were analyzed (P=0.000 and 0.04). However, in lean females (LN and LH) there was no relation between serum AGII and serum leptin. CONCLUSION: When obesity is present, both serum AGII and serum leptin were strong predictor of BP, which is not the case in lean females in whom only serum AGII is a predictor of BP. Elevation of serum AGII and serum leptin levels when associated with increased BMI may contribute to the pathophysiology of obesity induced hypertension. Further study on leptin resistance in obese persons and its relation to increased ABP has to be carried out.

Effects of snake venom from Saudi cobras and vipers on hormonal levels in peripheral blood.

OBJECTIVE: Knowledge about the effects of snake venoms on endocrine glands in the Kingdom of Saudi Arabia (KSA) is meager. The aim of the present study is to investigate the acute and chronic envenomation from 4 snakes out of 8 species of Saudi Cobras and Vipers on the tissues of endocrine glands and peripheral hormonal levels in male rats. METHODS: The peripheral blood levels of 4 hormones mainly testosterone, cortisol, insulin and thyroxin were investigated in male Wistar rats following acute and chronic treatment of the rats with poisonous snake venoms at the Department of Physiology, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia between September 2000 to May 2001. RESULTS: Using radio immunoassay for hormonal analysis, a rise in testosterone levels in peripheral blood was obtained following acute treatment, which is due to the effect of the venoms on vascular permeability and increased blood flow. In contrast, the chronic treatment with venoms resulted in a delayed effect on vascular permeability and testicular degeneration resulting in a decreased blood flow and a significant drop in testosterone concentration. Cortisol levels were no different from the controls during acute treatment but it demonstrates gradual rise following chronic treatment to withstand the stress imposed on the animals. Similar results were obtained for insulin, which showed normal values with acute treatment but decreased levels of chronic treatment suggesting insulin insufficiently. Likewise, the thyroxin levels were decreased with chronic treatment suggesting a toxic effect of the poison on the rich blood supply of the thyroid follicles with a subsequent decrease in blood flow to the tissues and therefore, decreased thyroid hormone levels. CONCLUSION: The effects of venom toxicity on testosterone levels were either normal or stimulatory with acute treatment or inhibitory with chronic treatment depending on the vascular blood flow and testicular degeneration. Cortisol levels were normal at acute treatment but showed a gradual rise reflecting the stress imposed on the animals. The rise in cortisol levels was visualized to potentiate the cardiovascular and metabolic changes. The effects on insulin and thyroxin were similar to those of testosterone level showing normal or stimulatory effect with acute treatment followed by decreased levels of hormones with chronic treatment.

Educational environment in traditional and innovative medical schools: a study in four undergraduate medical schools.

INTRODUCTION: The undergraduate curricula of medical schools in King Abdul Aziz University, Saudi Arabia, Umm Al-Qura University, Saudi Arabia and Sana'a University, Republic of Yemen are traditional, like most of the medical schools in the Middle East region. The curriculum in Dundee University Medical School, UK, claims to follow the prescriptions of the UK General Medical Council to be outcome based with three interlocking phases and students encouraged to take responsibility for their own learning. The aim of this study is to measure the educational environment, using the 50-item Dundee Ready Education Environment Measure (DREEM), in each medical school and to compare the educational environment as perceived by the responding students of the traditional medical schools in developing countries with that of the "modernised" medical school in Dundee University, UK. METHODS: The DREEM was administered to 1072 medical students in the four different universities. Using SPSS, data were expressed as means of scores. Comparisons between schools, years of study and gender were made using non-parametric tests. RESULTS: For all three traditional medical schools, the mean scores of the inventory were lower compared with Dundee Medical School. Students from traditional schools rated their learning and teaching environment significantly lower than their counterparts in Dundee Medical School. Similarly, they rated their academic self-perceptions, social-self perceptions and their atmosphere more poorly than the Dundee students. CONCLUSION: The DREEM provides useful diagnostic information about medical schools, whether it is in developing or western developed countries.

Perceptions of the educational environment of the medical school in King Abdul Aziz University,saudi Arabia.

The present paper reports data from the undergraduate medical school at King Abdul Aziz University in Saudi Arabia using the 50-item Dundee Ready Education Environment Measure (DREEM), which has been validated and found to be reliable in a range of cultural contexts. The mean total score was 102/200. The mean total score for Perception of Learning was 22/48; for Perceptions of Teaching 24/44; for Academic Self-perceptions 17/32; for Perceptions of Atmosphere 23/48 and for Social Self Perceptions 15/28. The mean score of 0.9 for Item 3--There is a good support system for students who get stressed--was the lowest and is indicative of the pressures felt by the students. These scores give a clear indication of the priorities for reform of the curriculum. These data can also serve as a baseline for a longitudinal quality assessment of students' perceptions of the changes planned for the medical school at King Abdul Aziz University, Saudi Arabia. Further studies are needed to analyse educational environment down to the year levels and to detect any gender differences.

Heart rate variability in patients with mitral stenosis: a study of 20 cases from King Abdulaziz University Hospital.

BACKGROUND: Left atrial enlargement in mitral stenosis predisposes to atrial fibrillation (AF). Analysis of heart rate variability (HRV) prior to the onset of an arrhythmia may show alterations in autonomic balance that are known to predispose to the development of AF. The aim of this study was to determine whether HRV in patients with rheumatic mitral stenosis (MS) is abnormal in comparison to normal controls, and to find the relationship between left atrial size and HRV in patients with MS in sinus rhythm and in AF. SUBJECTS AND METHODS: A series of 24-hour ambulatory Holter electrocardiogram recordings were obtained for 10 consecutive, newly diagnosed untreated subjects with pure mitral stenosis in sinus rhythm, 10 with mitral stenosis complicated by atrial fibrillation and 10 age-matched normal controls. Digitized records were processed using time domain and power spectral analysis. RESULTS: In patients with mitral stenosis in sinus rhythm, we observed significant decrease of the standard deviation of the RR intervals (SDRR), as well as of the root mean square of successive RR interval differences (RMSSD) and Edinburgh index (sNN50), while in patients with AF, the RMSSD and sNN50 were much larger than those in normal. The areas under all spectral bands were markedly increased in patients with AF compared with normal. Furthermore, the high low frequency/high frequency (HLF/HF ratio) ratio was very small compared to normal. HRV measures were independent of atrial size in both groups. CONCLUSION: Decreased HRV in mitral stenosis patients with sinus rhythm suggests increased sympathetic activity in patients prone to atrial fibrillation, while marked increased of HRV in patients with AF may indicate that parasympathetic activity modulates the intrinsic behavior of the atrioventricular node during atrial fibrillation. The evaluation of HRV may be a useful tool for the identification of patients predisposed to AF.