Population structure of indigenous inhabitants of Arabia.

Modern day Saudi Arabia occupies the majority of historical Arabia, which may have contributed to ancient waves of migration out of Africa. This ancient history has left a lasting imprint in the genetics of the region, including the diverse set of tribes that call Saudi Arabia their home. How these tribes relate to each other and to the world's major populations remains an unanswered question. In an attempt to improve our understanding of the population structure of Saudi Arabia, we conducted genomic profiling of 957 unrelated individuals who self-identify with 28 large tribes in Saudi Arabia. Consistent with the tradition of intra-tribal unions, the subjects showed strong clustering along tribal lines with the distance between clusters correlating with their geographical proximities in Arabia. However, these individuals form a unique cluster when compared to the world's major populations. The ancient origin of these tribal affiliations is supported by analyses that revealed little evidence of ancestral origin from within the 28 tribes. Our results disclose a granular map of population structure and have important implications for future genetic studies into Mendelian and common diseases in the region.

Determinants of mental health outcomes among people with and without diabetes during the COVID-19 outbreak in the Arab Gulf Region.

AIMS: To determine the prevalence and factors associated with depression and anxiety among people with and without diabetes during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: A cross-sectional questionnaire-based study collecting demographic and mental health data from 2166 participants living in the Arab Gulf region (568 with diabetes, 1598 without diabetes). Depression and anxiety were assessed using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale, respectively. RESULTS: The prevalence of depression and anxiety symptoms were 61% and 45%, in people with diabetes (PWD) and 62% and 44%, respectively, in people without diabetes. PWD who have had their diabetes visit canceled by the clinic were more likely to report depression and anxiety symptoms than those without diabetes (odds ratio [95% confidence interval]: 1.37 [1.02, 1.84] and 1.37 [1.04, 1.80], for depression and anxiety; respectively). PWD who had no method of telecommunication with their health care providers (HCP) during the pandemic, PWD with A1C of ≥ 10%, women, employees (particularly HCPs), students, unmarried individuals, and those with lower income were more likely to report depression and/or anxiety symptoms (all P < 0.01). Fear of acquiring the coronavirus infection; running out of diabetes medications; or requiring hospitalization for hypoglycemia, hyperglycemia, or diabetic ketoacidosis; and lack of telecommunication with HCPs were all associated with significantly higher odds of having depression and anxiety symptoms among PWD. CONCLUSIONS: The remarkably high prevalence of depression and anxiety symptoms during the COVID-19 pandemic, particularly among subgroups of PWD, calls for urgent public health policies to address mental health during the pandemic and reestablish health care access for PWD.

Reanalysis of the 2000 Rift Valley fever outbreak in Southwestern Arabia.

The first documented Rift Valley hemorrhagic fever outbreak in the Arabian Peninsula occurred in northwestern Yemen and southwestern Saudi Arabia from August 2000 to September 2001. This Rift Valley fever outbreak is unique because the virus was introduced into Arabia during or after the 1997-1998 East African outbreak and before August 2000, either by wind-blown infected mosquitos or by infected animals, both from East Africa. A wet period from August 2000 into 2001 resulted in a large number of amplification vector mosquitoes, these mosquitos fed on infected animals, and the outbreak occurred. More than 1,500 people were diagnosed with the disease, at least 215 died, and widespread losses of domestic animals were reported. Using a combination of satellite data products, including 2 x 2 m digital elevation images derived from commercial satellite data, we show rainfall and potential areas of inundation or water impoundment were favorable for the 2000 outbreak. However, favorable conditions for subsequent outbreaks were present in 2007 and 2013, and very favorable conditions were also present in 2016-2018. The lack of subsequent Rift Valley fever outbreaks in this area suggests that Rift Valley fever has not been established in mosquito species in Southwest Arabia, or that strict animal import inspection and quarantine procedures, medical and veterinary surveillance, and mosquito control efforts put in place in Saudi Arabia following the 2000 outbreak have been successful. Any area with Rift Valley fever amplification vector mosquitos present is a potential outbreak area unless strict animal import inspection and quarantine proceedures are in place.

Validation and psychometric properties of the Arabic psychological well-being post-traumatic changes questionnaire

Psychological Well-Being Post-Traumatic Changes Questionnaire (PWB-PTCQ) is an instrument for measuring positive changes after trauma that has shown reasonable psychometric properties in its original version in English. The aim of this study was to translate and validate the psychometric properties of an Arabic Psychological Well-Being Post-Traumatic Changes Questionnaire (A-PWB-PTCQ). A descriptive correlational design was used to conduct the study among 357 participants sampled from the Saudi population. Participants reported different traumatic events ranged between 59.5 % for sudden death of close person to 23.3% assault or attempted sexual assault incidents. The A-PWB-PTCQ demonstrated excellent internal consistency at 0.93 and test-retest reliability at 0.92. All inter-item and item-to-total correlations for the PWB-PTCQ scale were above the recommended criteria of 0.30. The A-PWB-PTCQ also showed a significant negative correlation with the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) (-0.46, p <.001), and those with clinical levels of PTSD had significantly lower scores on the A-PWB-PTCQ (t= 7.62, p <.001) than individuals with subclinical levels of PTSD. The A-PWB-PTCQ was found to be a valid and reliable instrument for measuring the Psychological Well-Being Post-Traumatic Changes among the Arabic population

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Khat (Catha edulis Forsk) - And now there are three.

For centuries, a large number of people living in the southwestern part of the Arabian Peninsula and eastern Africa have chewed the fresh leaves and twigs of the plant Catha edulis Forsk, more commonly known as khat, for its psychostimulatory effect. The main active compound in khat is cathinone, whose synthetic derivatives form a part of the new psychoactive substances list. This review summaries the prevalence of khat use, its harvesting and consumption, the biosynthetic pathway in khat, the mechanism of action, the results from animal and human studies, and its dependence potential. It is unlikely that khat use will be prohibited in countries where it is traditionally consumed and socially acceptable unlike in other countries of the world where both the importation and the consumption of khat and cathinone is banned. Khat users being mainly Muslims prohibited from using alcohol or other drugs probably represent the largest global number of mono-drug users of an amphetamine-like stimulant. Thus, khat use represents a unique situation and a neglected area of research in Africa.

How culture and migration affect risk assessment / Cómo influyen la cultura y la migración en la evaluación de riesgos

We systematically linked cross-cultural literature to the Central Eight risk factors as an example of risk assessment procedures. We expected offenders with a migration background (MB) from Turkey or Arab countries to score higher on criminal history, criminal attitudes, antisocial companions, and education and employment problems in comparison to German offenders without an MB. In contrast, for offenders with an MB from Turkey or Arab countries, a reduced risk for unsatisfactory relationships with their parents, alcohol, and leisure-related factors was assumed. The Central Eight risk factors were applied retrospectively for male offenders serving a sentence length of more than 12 months. German offenders without an MB (n = 214) were compared to offenders with a Turkish (n = 135) or Arab (n = 112) MB concerning risk profiles and predictive validity. Risk profiles of offenders with an MB deviated (d = 0.25-0.56) from risk profiles of German offenders without an MB. For offenders without an MB criminal history, antisocial personality, criminal attitudes, antisocial companions, and alcohol/drug problems significantly predicted (AUC = .56-.73) different recidivism events. Similar results were found for offenders with a Turkish MB (AUC = .60-.70) except for antisocial companions (AUC = .50). Results for offenders with an Arab MB were inconclusive; only alcohol/drug problems consistently showed good predictive values (AUC = .66-.68). Findings demonstrate that a culture-sensitive approach in risk assessment is inevitable and recommendations for culture-sensitive research, risk assessment, and offender treatment are discussed

Se ha relacionado sistemáticamente la literatura multicultural con los ocho factores centrales de riesgo, como ejemplo de procesos de evaluación de riesgo. Se esperaba que los delincuentes con origen migratorio (OM) en Turquía o en países árabes obtuviesen una puntuación más alta en historial y actitud delictivos, relaciones interpersonales antisociales y problemas de educación y empleo, en comparación con los delincuentes alemanes sin origen migratorio (OM). En contraste, se asumía que los delincuentes con origen migratorio en Turquía y países árabes tenian menor riesgo de relaciones insatisfactorias con sus padres, alcohol y factores relacionados con el ocio. Se utilizaron retrospectivamente los ocho factores centrales de riesgo con delincuentes masculinos condenados a más de 12 meses. Se compararon delincuentes alemanes sin origen migratorio (n = 214) y delincuentes con origen migratorio en Turquía (n = 135) o en países árabes (n = 112) con respecto a perfiles de riesgo y validez predictiva. Los perfiles de riesgo de los delincuentes con OM se desviaban (d = 0.25, 0.56) de los perfiles de riesgo de los alemanes sin OM. Para delincuentes sin OM de historial delictivo, personalidad antisocial, actitud delictiva, relaciones antisociales y problemas de alcoholismo y drogadicción se predijeron (AUC = .56-.73) diferentes episodios de reincidencia. Se obtuvieron resultados similares para delincuentes turcos con OM (AUC = .60-.70), excepto en relaciones antisociales (AUC = .50). Los resultados para los delincuentes árabes con OM fueron inconcluyentes; solo los problemas de alcoholismo y drogadicción mostraron invariablemente valores predictivos fidedignos (AUC = .66-68). Los resultados demuestran que es inevitable un acercamiento sensible a la cultura en la evaluación del riesgo. Se dan recomendaciones para una investigación sensible a la cultura, la evaluación del riesgo y el tratamiento de los delincuentes

A review of coccidiosis in Old World camels.

Domesticated Old World camels (Camelus dromedarius and C. bactrianus) are important for the economy of several countries in Asia, Africa, and the Arabian Peninsula, and coccidiosis is important as a cause of mortality in juvenile camels. There is confusion concerning the species of coccidian parasites in camels and their life cycles. The objective of the present paper is to review biology of the Eimeria and Cystoisospora species in camels. The following conclusions were drawn. Although five species of Eimeria; E. cameli, E. rajasthani, E. dromedarii, E. bactriani, and E. pellerdyi were named from camels, only E. cameli, E. rajasthani, E. dromedarii have been consistently found in numerous surveys and they are morphologically distinct. We consider E. pellerdyi and E. bacterini as species enquirende/ not valid. E. cameli oocysts are distinctive, dark brown and up to 108 µm long. Its gametogonic stages and oocysts are present in the lamina propria of small intestines; only sexual stages have been confirmed. The remaining species of Eimeria (E. rajasthani and E. dromedarii) in camels are <40 µm long and their endogenous stages are unknown. There is one valid species of Cystoisospora, C. orlovi in camels and is associated with severe disease in young camels, both pastoral and stall fed camels. Camels as young as nine days old can develop severe diarrhea and can die before oocysts are detected in feces. Lesions and endogenous stages are confined to the large intestine. The main lesion is hemorrhagic, diphtheroid to hemorrhagic colitis-associated with sexual stages; asexual stages are unknown. Oocysts are rarely excreted by adult camels, and in low numbers. Therefore, infection in very young camels remains unexplained.

Wetlands, wild Bovidae species richness and sheep density delineate risk of Rift Valley fever outbreaks in the African continent and Arabian Peninsula.

Rift Valley fever (RVF) is an emerging, vector-borne viral zoonosis that has significantly impacted public health, livestock health and production, and food security over the last three decades across large regions of the African continent and the Arabian Peninsula. The potential for expansion of RVF outbreaks within and beyond the range of previous occurrence is unknown. Despite many large national and international epidemics, the landscape epidemiology of RVF remains obscure, particularly with respect to the ecological roles of wildlife reservoirs and surface water features. The current investigation modeled RVF risk throughout Africa and the Arabian Peninsula as a function of a suite of biotic and abiotic landscape features using machine learning methods. Intermittent wetland, wild Bovidae species richness and sheep density were associated with increased landscape suitability to RVF outbreaks. These results suggest the role of wildlife hosts and distinct hydrogeographic landscapes in RVF virus circulation and subsequent outbreaks may be underestimated. These results await validation by studies employing a deeper, field-based interrogation of potential wildlife hosts within high risk taxa.

Characteristics of Arabic Websites with information on autism.

OBJECTIVE: To explore the characteristics of Arabic websites with information on autism spectrum disorder (ASD). METHODS: The word autism in Arabic was entered into 2 popular search engines in September 2013 to locate the top 80 websites featuring the term. Websites were sorted using 10 characteristics, previously used to evaluate the characteristics of English websites with information on ASD. RESULTS: Most websites were registered using a .com top-level domain (69%), were an individual`s site, forum, or blog (44%), and were updated after September 2012 (60%); they contained images or texts that seemed to persuade viewers to purchase products (43%); they provided information with the name of author(s) (64%); they described the basic characteristics of ASD; and they promoted various types of treatments, most of which lack empirical support (63%). However, few websites contained information with references to peer review resources (3%) or a warning statement that such information should not replace the opinion of a qualified professional (8%). CONCLUSION: Internet users may not find Arabic websites to be reliable sources to obtain information on ASD. Given the increased use of the internet, creation of websites that contain trusted information on ASD could potentially aid parents in accessing available services, help them learn about empirically validated interventions, and enable them to advocate for their children`s rights.

Prevalence of overweight and obesity among adolescents in eight Arab countries: comparison between two international standards (ARABEAT-2) / La prevalencia de sobrepeso y obesidad en los adolescentes de ocho países árabes: comparación entre dos normas internacionales (ARABEAT-2)

Objective: The aim of this study was to highlight the prevalence of overweight and obesity among adolescents in eight Arab countries. Methods: A school-based cross-sectional study was conducted in eight Arab countries: Iraq, Jordan, Kuwait, Libya, Palestine, Saudi Arabia, Sudan and Tunisia. The total sample included was 6,447 adolescents aged 15-18 years (3,111 males, 3,336 females). The International Obesity Task Force (IOTF) and World Health Organization (WHO) reference standards were used to determine obesity levels. Results: The WHO standard provided lower prevalence of overweight but higher prevalence of obesity than the IOTF standard. According to the IOTF standard, overweight among males was highest in Kuwaiti adolescents (24.8%), followed by Saudi Arabian (23.2%). Among females, the highest prevalence was reported in Kuwaiti adolescents (22.1%), followed by Jordanian (20.0%). Regarding obesity, Kuwaiti adolescents showed the highest prevalence of obesity for both males (28.6%) and females (21.1%). Conclusion: Findings revealed no progress in reducing prevalence of obesity (AU)

Objetivo: el objetivo de este estudio fue poner de relieve la prevalencia del sobrepeso y la obesidad en los adolescentes de ocho países árabes. Métodos: estudio transversal basado en escolares, que se llevó a cabo en ocho países árabes: Irak, Jordania, Kuwait, Libia, Palestina, Arabia Saudí, Sudán y Túnez. La muestra total estuvo compuesta por 6.447 adolescentes de 15-18 años (3.111 hombres, 3.336 mujeres). Se utilizaron para determinar los niveles de obesidad de la Fuerza Internacional de Obesidad (IOTF) y los patrones de referencia de la Organización Mundial de la Salud (OMS). Resultados: el estándar de la OMS presentó menor prevalencia de sobrepeso, pero mayor prevalencia de obesidad que el estándar de la IOTF. De acuerdo con la norma IOTF, el sobrepeso entre los varones fue más alto en los adolescentes kuwaitíes (24,8%), seguido de Arabia Saudí (23,2%). Entre las mujeres, se informó de la más alta prevalencia en adolescentes kuwaitíes (22,1%), seguido por las jordanas (20,0%). En cuanto a la obesidad, los adolescentes kuwaitíes presentaron la mayor prevalencia de obesidad tanto en hombres (28,6%) como en mujeres (21,1%). Conclusión: los resultados revelaron que no se ha conseguido ningún progreso en la reducción de la prevalencia de la obesidad (AU)

Middle East respiratory syndrome: An emerging coronavirus infection tracked by the crowd.

In 2012 in Jordan, infection by a novel coronavirus (CoV) caused the first known cases of Middle East respiratory syndrome (MERS). MERS-CoV sequences have since been found in a bat and the virus appears to be enzootic among dromedary camels across the Arabian Peninsula and in parts of Africa. The majority of human cases have occurred in the Kingdom of Saudi Arabia (KSA). In humans, the etiologic agent, MERS-CoV, has been detected in severe, mild and influenza-like illness and in those without any obvious signs or symptoms of disease. MERS is often a lower respiratory tract disease associated with fever, cough, breathing difficulties, pneumonia that can progress to acute respiratory distress syndrome, multiorgan failure and death among more than a third of those infected. Severe disease is usually found in older males and comorbidities are frequently present in cases of MERS. Compared to SARS, MERS progresses more rapidly to respiratory failure and acute kidney injury, is more often observed as severe disease in patients with underlying illnesses and is more often fatal. MERS-CoV has a broader tropism than SARS-CoV, rapidly triggers cellular damage, employs a different receptor and induces a delayed proinflammatory response in cells. Most human cases have been linked to lapses in infection prevention and control in healthcare settings, with a fifth of virus detections reported among healthcare workers. This review sets out what is currently known about MERS and the MERS-CoV, summarises the new phenomenon of crowd-sourced epidemiology and lists some of the many questions that remain unanswered, nearly three years after the first reported case.

Prevalence of drug resistance in clinical isolates of tuberculosis from GCC: a literature review from January 2002 to March 2013.

INTRODUCTION: The prevalence of drug resistance in clinical isolates of Mycobacterium tuberculosis from the Gulf Cooperation Council (GCC; Saudi Arabia, Qatar, Bahrain, Kuwait, Oman, United Arab Emirates [UAE]) countries was appraised using reports published between January 2002 and March 2013. METHODOLOGY: A total of 11,393 tuberculosis (TB) isolates from the GCC were studied through published literature and were analyzed statistically. RESULTS: Most of the isolates were resistant to isoniazid, followed by streptomycin, rifampin, ethambutol, and pyrazinamide. The highest prevalence rate of multidrug-resistant-TB (MDR-TB) was found in UAE (9.2%), followed by Kuwait (5.9%) and Saudi Arabia (4.3%). The overall MDR-TB prevalence rate was recorded as 4.0% in the entire GCC region. Automated linear modeling revealed that isoniazid resistance had a strong relationship with the prevalence of MDR-TB in all the GCC countries and was found to be the strongest predictor for MDR-TB. Interestingly, rifampicin resistance was significantly associated with the prevalence of MDR-TB in Oman, Kuwait, and Saudi Arabia, while isoniazid was identified for UAE. On the basis of a number of reports and isolates, the principal component analysis showed that, among all GCC member countries, the highest burden of TB was in Saudi Arabia and Kuwait, and maximum drug resistance was present in UAE. CONCLUSION: The study demonstrates that the prevalence of MDR-TB in GCC countries is almost equal to other developing and developed countries, and requires immediate attention for surveillance and control.

Regional consensus opinion for the management of Beta thalassemia major in the Arabian Gulf area.

Thalassemia syndrome has diverse clinical presentations and a global spread that has far exceeded the classical Mediterranean basin where the mutations arose. The mutations that give rise to either alpha or beta thalassemia are numerous, resulting in a wide spectrum of clinical severity ranging from carrier state to life-threatening, inherited hemolytic anemia that requires regular blood transfusion. Beta thalassemia major constitutes a remarkable challenge to health care providers. The complications arising due to the anemia, transfusional iron overload, as well as other therapy-related complications add to the complexity of this condition. To produce this consensus opinion manuscript, a PubMed search was performed to gather evidence-based original articles, review articles, as well as published work reflecting the experience of physicians and scientists in the Arabian Gulf region in an effort to standardize the management protocol.

The malaria transition on the Arabian Peninsula: progress toward a malaria-free region between 1960-2010.

The transmission of malaria across the Arabian Peninsula is governed by the diversity of dominant vectors and extreme aridity. It is likely that where malaria transmission was historically possible it was intense and led to a high disease burden. Here, we review the speed of elimination, approaches taken, define the shrinking map of risk since 1960 and discuss the threats posed to a malaria-free Arabian Peninsula using the archive material, case data and published works. From as early as the 1940s, attempts were made to eliminate malaria on the peninsula but were met with varying degrees of success through to the 1970s; however, these did result in a shrinking of the margins of malaria transmission across the peninsula. Epidemics in the 1990s galvanised national malaria control programmes to reinvigorate control efforts. Before the launch of the recent global ambition for malaria eradication, countries on the Arabian Peninsula launched a collaborative malaria-free initiative in 2005. This initiative led a further shrinking of the malaria risk map and today locally acquired clinical cases of malaria are reported only in Saudi Arabia and Yemen, with the latter contributing to over 98% of the clinical burden.

Breaking the chain: Rift Valley fever virus control via livestock vaccination.

Rift Valley fever virus is a mosquito-borne pathogen of livestock and humans that causes widespread and devastating outbreaks of severe and often fatal disease throughout Africa and portions of the Arabian Peninsula. Outbreaks can involve tens to hundreds of thousands of human cases, and millions of livestock. The severity of the disease varies by species, but in sheep and cattle 'abortion storms', high neonatal (∼70%), and adult mortality (20-30%) are features. Human cases are generally self-limiting, but severe complications such as hepatitis, retinitis, delayed-onset encephalitis, or a hemorrhagic syndrome with a case fatality of 10-20% can occur. There are no commercially available human vaccines. Livestock provide key ecological links between the Aedes sp. mosquito vector and humans. High viremias in livestock lead to spillover of RVFV into other anthrophillic vectors (Culex and Anopheles sp. mosquitoes), and, importantly, close contact with infected animal tissues and fluids or aborted fetal materials from these animals is a major risk factor for severe and lethal human infections. Vaccination programs targeting livestock during non-epidemic periods or as an early countermeasure against nascent outbreaks could therefore eliminate one of the main sources of human infection and limit the overall scope of epidemics. To this end, research groups have recently reported novel next generation RVFV vaccines that are safe for use in pregnant and young animals. Preventing RVFV infection of livestock by vaccination is a key element in breaking the chain of human epidemics, and could lead to control of this significant public health threat.

Clinical course of repeated supratherapeutic ingestion of acetaminophen.

BACKGROUND: Repeated supratherapeutic ingestion (RSTI) of acetaminophen (APAP) is recognized as an important cause of APAP-related morbidity and mortality. This study describes the characteristics and clinical course of patients with RSTI, and identifies the risk factors for developing hepatotoxicity and death. METHODS: This secondary analysis of a multicenter retrospective chart review studied patients treated with IV and/or oral N-acetylcysteine for acetaminophen poisoning. For this analysis, we included all subjects coded as RSTIs, defined as ingestions of greater than 4 g of APAP per 24 h over a period longer than 8 h. Data collected include demographics, coingestants, comorbidities, presenting laboratory data, and outcomes. The analysis includes descriptive statistics and associations of demographic and clinical factors with patient outcome. RESULTS: Of the 503 patients enrolled, 119 (23.7%) were RSTI. The mean age was 39.6 years (SD ± 15); 63.9% of the patients were females, 60.5% Caucasians, 27.7% alcoholics, 5% malnourished, 10.9% had viral hepatitis, and 3.4% had other liver diseases. Coingestants included ethanol, opioids, and antihistamines (17.6, 48.7, and 19.3%, respectively). Among this group, 44 patients developed hepatotoxicity, two received liver transplants, and four died (37.0, 1.7, and 3.4%, respectively). The risk for hepatotoxicity increased with a history of alcoholism, viral hepatitis, and other liver diseases. A history of alcoholism and an elevated presenting serum creatinine were associated with increased risk for death/transplant. The lowest presenting ALT levels in a subject who developed hepatotoxicity and who died were 252 and 426 IU/l, respectively. CONCLUSION: RSTI-induced hepatotoxicity and poor outcomes can be predicted at the patient's presentation. All patients with RSTI who developed hepatotoxicity presented with an abnormal ALT. A history of alcoholism and an elevated creatinine at presentation are markers of increased risk for hepatotoxicity and death.

Alkhurma haemorrhagic fever--a viral haemorrhagic disease unique to the Arabian Peninsula.

The emergence and re-emergence of human and animal pathogens on a global scale continues unabated. One such pathogen is the arbovirus that causes Alkhurma haemorrhagic fever, which emerged in the Kingdom of Saudi Arabia in the mid 1990s. It has since re-emerged in other regions of the country and threatens to widen its area of endemicity beyond the peninsula. Human and animal movements, especially those associated with the annual mass gathering event of Hajj (pilgrimage) may facilitate introduction into other continental masses, where it must be differentiated from dengue and other similar arboviral haemorrhagic fevers. In addition to dengue and Kadam viruses, which are known to be endemic in Saudi Arabia, it is thought that other flaviviruses exist in the region, though undetected. Collectively, these viruses present diagnostic challenges that may confound the recognition of clinical cases of Alkhurma haemorrhagic fever. The Saudi Ministry of Health is making concerted efforts to expand the evidence base in order to enhance the diagnostic and preventive protocols used to address the challenge of Alkhurma haemorrhagic fever.

Sacred herbs

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Basal cell carcinoma of the maxillofacial region: site distribution and incidence rates in Arab/Jordanians, 1991 to 2000.

PURPOSE: We sought to estimate the incidence rates and disease trends for basal cell carcinoma (BCC) of the maxillofacial region in the civilian population in the north of Jordan. METHODS: A retrospective study was undertaken of all BCCs of the maxillofacial region diagnosed at the Regional Histopathology Department during the period 1991 to 2000. RESULTS: The age-adjusted rate for BCC in 1992 was 6.3:100,000, and in 2000, it was 8.8:100,000. However, several disease trends were observed during the study period. Age- and gender-specific incidence rates apparently increased during the study period. Lesions were most commonly seen on the nose, facial skin, and periorbital skin. The proportions of BCC in the various anatomic sites that were reviewed remained fairly constant over the 10-year period. CONCLUSIONS: In comparison with populations from other geographic areas, the incidence of BCC in the north of Jordan is low. Further studies are needed to identify behavioral and environmental factors that contribute to the development of BCC and to determine whether changes in diagnostic practices could account for the apparent rise in the incidence of this tumor in this population in recent years.