BACKGROUND AND OBJECTIVES:
The prevalence of chronic obstructive pulmonary disease (COPD) in Saudi Arabia is unknown. The aim of this study was to estimate the prevalence of COPD among smokers more than 40 years of age attending primary healthcare clinics in Saudi Arabia.
DESIGN AND SETTING:
A questionnaire was used in a cross-sectional collection of demographic data and other items related to diagnosis of COPD in patients visiting primary healthcare clinics.
Eligible subjects were current or ex-smokers and aged 40 years or above. Spirometry was performed according to American Thoracic Society criteria. Airflow obstruction was classified according to the 2003 update of the World Health Organization and Global Initiative for Chronic Obstructive Lung Disease criteria. COPD was defined as a ratio less than 0.70 of post-bronchodilator-predicted forced expiratory volume in the first second to forced vital capacity (FEV1/FVC <0.70).
Because of incomplete data or poor performance on spirometry, of 1380 subjects eligible for the study, only 501 subjects were eligible for data analysis. Seventy-one patients had an FEV1/FVC ratio <0.70, comprising 14.2% of the study population, of which 95.8% were males. Current smokers comprised 57 (80.3%) subjects. Of the 71 subjects who fulfilled the criteria for COPD diagnosis, none were found to be in COPD stage I; 40 (56.3%) were in stage II and 31 (43.6%) were in stage III of the disease.
Underdiagnosis of COPD in primary healthcare clinics in Saudi Arabia is common, but its extent is not different from the corresponding data available in the literature for other countries. Use of spirometry as a routine test for all patients older than 40 years of age and with a smoking history can help in early detection and proper diagnosis of COPD, which subsequently will help in implementation of preventive measures.
α-1 antitrypsin (AAT) deficiency results from mutations of the protease inhibitor (PI). The AAT gene is mapped on chromosome 14 and has been associated with chronic liver disease and chronic obstructive pulmonary disease (COPD).
To determine the frequency of AAT mutations on S and Z carrier alleles in healthy Saudi individuals from Qassim Province in Saudi Arabia.
Patients and Methods:
A total of 158 healthy, unrelated participants from Qassim Province were recruited. They were genotyped for the two AAT-deficiency alleles, PI*S and PI*Z, using polymerase chain reaction, with primers designed throughout to mediate site-directed mutagenesis.
Of the 158 subjects, 11.39% were carriers for the S mutation (i.e., had the MS genotype), whereas 2.53% were carriers for the Z mutation (i.e., had the MZ genotype). The SZ genotype was present in 3.8% of subjects, while the homozygous genotype SS was present in 1.9% of subjects. No subjects showed the ZZ mutant genotype. Accordingly, frequency of the mutant S and Z alleles of AAT gene was 9.49% and 3.19%, respectively.
The results obtained showed a high prevalence of the AAT deficiency allele in the Saudi population. This probably warrants adoption of a screening program for at-risk individuals, so that they might initiate adequate prophylactic measures.
α-1 antitrypsin; Saudi Arabia; S allele; Z allele
Inflammatory bowel diseases (IBD) are among the leading cause of financial burden, morbidity and employee absenteeism in developed countries because of their chronic remitting and relapsing courses. IBD is estimated to affect the Canadian economy to the tune of 100 million dollars per year. The data regarding exact prevalence in Asian countries, including Saudi Arabia, is still incomplete as there is underreporting and lack of proper registry of the diagnosed cases. The prevalence of inflammatory bowel disease (Ulcerative colitis, Crohn’s disease) has increased over the last decade in Saudi Arabia due to increased IBD awareness among population, as more patients seek medical help and also due to unknown reasons. There is a need of proper registration of IBD patients and establishment of Crohn’s & colitis foundation of Saudi Arabia (CCFSA) as in other parts of the world. The Crohn’s & colitis foundation of Saudi Arabia will be a forum which will co ordinate IBD treatment and research in the country in addition to health education among IBD population.
Follow-up epidemiologic studies are needed to assess trends and patterns of disease spread. No follow-up epidemiologic study has been done in the Kingdom of Saudi Arabia to assess the current prevalence of major chronic, noncommunicable diseases, specifically in the urban region, where modifiable risk factors remain rampant. This study aims to fill this gap.
A total of 9,149 adult Saudis ages seven to eighty years (5,357 males (58.6%) and 3,792 females (41.4%)) were randomly selected from the Riyadh Cohort Study for inclusion. Diagnosis of type 2 diabetes mellitus (DMT2) and obesity were based on the World Health Organization definitions. Diagnoses of hypertension and coronary artery disease (CAD) were based on the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and American Heart Association criteria, respectively.
The overall crude prevalence of DMT2 was 23.1% (95% confidence interval (95% CI) 20.47 to 22.15). The age-adjusted prevalence of DMT2 was 31.6%. DMT2 prevalence was significantly higher in males, with an overall age-adjusted prevalence of 34.7% (95% CI 32.6 to 35.4), than in females, who had an overall age-adjusted prevalence of 28.6% (95% CI 26.7 to 29.3) (P < 0.001). The overall crude prevalence of obesity was 31.1% (95% CI 30.1 to 32.0). The age-adjusted prevalence of obesity was 40.0%. The prevalence of obesity was higher in females, with an overall prevalence of 36.5% (95% CI 35.1 to 37.83), than in males (25.1% (95% CI 23.7 to 26.3)) (P < 0.001). The age-adjusted prevalence of hypertension and CAD were 32.6% (95% CI 31.7 to 33.6) and 6.9% (95% CI 6.4 to 7.4), respectively.
Comparisons of our findings with earlier data show that the prevalence of DMT2, hypertension and CAD in Riyadh, Saudi Arabia, has alarmingly worsened. Aggressive promotion of public awareness, continued screening and early intervention are pivotal to boosting a positive response.
Some 400 million people worldwide are currently infected with the hepatitis B virus (HBV), and the infection is common in the Middle East. Another 170 million people around the globe presently live with chronic hepatitis C virus (HCV) infection. Both HBV and HCV represent a worldwide epidemic. Despite significant decline in the prevalence of HBV and HCV infection in Saudi Arabia, these viral diseases cause significant morbidity and mortality, and impose a great burden on the country's healthcare system. On the other hand, Saudi epidemiology studies have shown that the hepatitis A virus seroprevalence in the country has reduced considerably over the past two decades. The progress in mapping the epidemiological pattern of viral hepatitis in Saudi Arabia has not only aided our understanding of the disease, but has also exposed the small but relevant gaps in our identification of the intricate details concerning the disease's clinical expression. In this review, we aim to document the timeline of viral hepatitis epidemiology in Saudi Arabia, while summarizing the relevant published literature on the subject.
Epidemiology; incidence; hepatitis B; hepatitis C; prevalence
There is little data surrounding the survival of patients with chronic obstructive pulmonary disease (COPD) who are admitted to the critical care unit with exacerbation of symptoms. We conducted a study to measure the in-hospital and intensive care unit (ICU) outcomes of patients admitted with COPD exacerbation, and identified the related prognostic factors.
We performed a retrospective cohort study of patients who were admitted to the adult ICU between January 2006 and July 2011 for COPD exacerbation in King Abdulaziz National Guard Hospital, Al-Hasa, Saudi Arabia.
During the study period, a total of 119 patients were admitted to the ICU with acute respiratory failure attributed to COPD exacerbation. The mean age was 72 ± 13 years, and 44 (37%) were females. The main cause of respiratory failure was infection, which occurred in 102 (86%) patients. Thirty-nine (33%) of the admitted patients were mechanically ventilated, and the median duration was 2.6 (1–42) days. The median lengths of the ICU and hospital stays were 3 (1–40) and 9 (2–43) days, respectively. The ICU mortality was 6%, and hospital mortality was 11%. Low Glasgow Coma Scale on admission, intubation, duration of mechanical ventilation, current smoking, tracheostomy, cardiopulmonary arrest, and the development of acute renal failure were associated with higher hospital mortality.
Early ICU and hospital mortality is low for COPD patients who have been admitted to the ICU with exacerbation. Low Glasgow Coma Scale scores on admission, intubation, prolonged use of mechanical ventilation, and the development of acute renal failure were identified as risk factors associated with increased hospital mortality.
intensive care unit; chronic obstructive pulmonary disease; mortality rates; acute respiratory failure
Type 2 diabetes mellitus (DM-2) is more common in patients with chronic liver disease (CLD) in general and chronic hepatitis C virus (HCV) infection in particular. We aimed to determine the prevalence and factors affecting the occurrence of DM-2 in Saudi patients with CLD.
Materials and Methods
Retrospective study at the King Fahd Central Hospital (KFCH), Gizan, Saudi Arabia. A total of 277 patients with either cirrhosis (CH) or hepatocellular carcinoma (HCC) were analyzed for patient demographics, severity of liver disease, HBsAg, and anti-HCV, associated diseases including DM-2, and presence of HCC. The prevalence of DM-2 was also estimated in 400 age- and sex-matched Saudi patients admitted for various nonliver diseases (control group). Chi-square test, univariate analysis, and multivariate regression.
Prevalence of DM-2 in patients with CH was higher than in controls (19.2 vs. 9.2%; P = 0.001). Although those with HCC had a higher prevalence, the difference was not significant (10.9 vs. 9.2%; P = 0.5). Seventy-six percent of patients with HCC had associated CH. On multivariate analysis, age and hypertension were more common in diabetics. Although patients with HCV-related disease had a higher prevalence of DM-2 compared to HBV-related disease, the difference was not significant (26.3 vs. 15.7%; P > 0.05).
DM-2 occurred more frequently in CLD patients, particularly in cirrhotics. Age and hypertension predicted the occurrence of DM-2. Small sample size of patients with HCV-related CH probably precluded higher prevalence of DM-2 in them.
Cirrhosis; diabetes mellitus; hepatocellular carcinoma; Saudi Arabia
The Kingdom of Saudi Arabia (KSA), similar to other countries in the Eastern Mediterranean, has been experiencing a recent rapid increase in the prevalence of chronic diseases and associated risk factors. To begin to take advantage of the chronic disease prevention and health promotion (CDPHP) knowledge available from other nations, researchers at a newly established University in the Qassim Province of the KSA have partnered with Stanford University in the United States of America. To ensure that CDPHP research and interventions are culturally relevant and appropriate, a participatory research approach has been adopted where local researchers are the target “community.” Contextual challenges of conducting CDPHP research in the KSA, at the individual, social/cultural, organizational and environmental/policy levels, are identified, as well as examples of CDPHP intervention strategies that may be culturally appropriate at each level.
Saudi Arabia; Chronic diseases; Community-based participatory approach
Sickle cell disease (SCD) is an autosomal recessive disorder characterized by production of abnormal hemoglobin S and is associated with high morbidity and mortality. Information about the prevalence of SCD in Saudi Arabia is patchy and probably underestimated, but studies have reported that SCD is a relatively common genetic disorder in this part of the world. The prevalence of SCD in Saudi Arabia varies significantly in different parts of the country, with the highest prevalence is in the Eastern province, followed by the southwestern provinces. The reported prevalence for sickle-cell trait ranges from 2% to 27%, and up to 2.6% will have SCD in some areas. Clinical and hematological variability exists in SCD in Saudi Arabia with two major phenotypes: a mild phenotype and a severe phenotype. Further studies on the prevalence, molecular and clinical epidemiology of SCD may help predict disease severity and risk stratification of patients to determine whether to receive early intensive care or continued symptomatic care.
Because of the enormous changes in the lifestyle of Saudis in the last three decades, the risk factors of coronary heart disease (CHD), including physical inactivity, are increasingly becoming prevalent in the society. This paper provides an overview of the importance of physical activity in health promotion and disease prevention, and discusses the public health burden of physical inactivity in Saudi Arabia. Available evidence clearly indicates that physical inactivity is extremely prevalent in the different ages and sex of the Saudi population. This high prevalence of inactivity in Saudi society presents a major public health burden, as evidenced by the high risk in the Saudi population as a risk of physical inactivity compared with the populations of United States and the United Kingdom. Unless concrete steps are taken to reduce physical inactivity in the Saudi population, the future public health cost would be enormous. It is well known that physical activity is associated with numerous health benefits and plays a major role in modifying many other CHD risk factors. Finally, several recommendations for reducing physical inactivity and promoting active life in the Saudi population have been discussed.
Physical inactivity; coronary risk factors; health promotion; public health burden; population attributable risk; Saudi Arabia
Pulmonary tuberculosis is a common disease in Saudi Arabia. As most cases of tuberculosis are due to reactivation of latent infection, identification of individuals with latent tuberculosis infection (LTBI) who are at increased risk of progression to active disease, is a key element of tuberculosis control programs. Whereas general screening of individuals for LTBI is not cost-effective, targeted testing of individuals at high risk of disease progression is the right approach. Treatment of those patients with LTBI can diminish the risk of progression to active tuberculosis disease in the majority of treated patients. This statement is the first Saudi guideline for testing and treatment of LTBI and is a result of the cooperative efforts of four local Saudi scientific societies. This Guideline is intended to provide physicians and allied health workers in Saudi Arabia with the standard of care for testing and treatment of LTBI.
The epidemiology of Alkhurma hemorrhagic fever disease is yet to be fully understood since the virus was isolated in 1994 in the Kingdom of Saudi Arabia.
Preventive Medicine department, Ministry of Health, Kingdom of Saudi Arabia.
Retrospective analysis of all laboratory confirmed cases of Alkhurma hemorrhagic fever disease collected through active and passive surveillance from 1st-January 2009 to December, 31, 2011.
Alkhurma hemorrhagic fever (AHFV) disease increased from 59 cases in 2009 to 93 cases in 2011. Cases are being discovered outside of the region where it was initially diagnosed in Saudi Arabia. About a third of cases had no direct contact with animals or its products. Almost all cases had gastro-intestinal symptoms. Case fatality rate was less than 1%.
Findings in this study showed the mode of transmission of AHFV virus may not be limited to direct contact with animals or its products. Gastro-intestinal symptoms were not previously documented. Observed low case fatality rate contradicted earlier reports. Close monitoring of the epidemiology of AHFV is recommended to aid appropriate diagnosis. Housewives are advised to wear gloves when handling animals and animal products as a preventive measure.
Background and objectives
Sickle cell disease (SCD) is a chronic, inherited haemoglobin disorder, associated with recurrent vaso-occlusive and haemolytic crises and chronic tissue ischemia which may adversely affect any organ system. Our objectives were to evaluate the left ventricular (LV) systolic and diastolic functions in Saudi patients with SCD originally from the Eastern Province of Saudi Arabia.
Design and setting
Prospective hospital based echocardiography study on adolescent and adult patients with SCD.
Forty-five patients with SCD were recruited for echocardiographic study while 45 patients, matched for age and sex, served as controls. Left and right ventricular dimensions and LV wall thicknesses, LV mass index (LVMI) and LV contractility variables were obtained. Left atrial dimension and volume and pulmonary artery systolic pressure (PASP) were also estimated. We also evaluated parameters of LV diastolic function, including early and late mitral flow velocities (E and A wave respectively), E/A ratio, deceleration time (MVDT), A wave duration (MVA D), LV isovolumic relaxation time (IVRT), and tissue Doppler velocities, such as lateral annular e‘ wave, a‘ wave, e‘/a‘ ratio and E/e‘ ratio.
There were increases in the LV dimensions, LV volumes, stroke volume, and LVMI of the SCD patients. The preload was increased (LV diastolic volume) and afterload was decreased (low diastolic blood pressure). The LVEF was equivalent, though there was evidence of LV diastolic dysfunction in 24%, and pulmonary hypertension (PH) in 40% of the SCD patients. The mean left atrial volume (LAV) was also increased in the SCD patients.
LV diastolic dysfunction (heart failure with preserved ejection fraction) and PH may complicate cases of the Arab-Indian haplotype of SCD.
MVE vel, mitral valve flow E wave velocity (cm. sec); MVA vel, mitral valve flow A wave velocity (cm. sec); E/A, E wave/A wave ratio; MVDT, mitral valve deceleration time (ms); MVAD, mitral valve A wave duration (ms); TDI, tissue doppler imaging; Lat e‘, lateral annular e‘ wave velocity by TDI (cm. sec); Lat a‘, lateral annular a‘ wave velocity by TDI (cm. sec); e‘/a‘, e‘ wave/a‘ wave ratio; E/e‘, mitral flow E wave velocity/lateral annular e‘ wave velocity by TDI; Sickle cell disease; Left ventricular diastolic function; Left ventricular systolic function; Tissue doppler imaging
Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology and considered traditionally as a disease of the western world. Recently, rising trends have been observed in countries previously known to have a low prevalence and incidence. The aim of this study is to collect epidemiological data on IBD outpatients and to add data from the Kingdom of Saudi Arabia (KSA) to the available IBD literature.
Patients and Methods:
The medical records of 693 Saudi patients with IBD over a period of 17 years, between 1993 and 2009, were reviewed. The demographic and clinical data and methods of diagnosis were retrieved.
The total number of patients in this cohort was 693. It constituted 238 (34.3%) ulcerative colitis (UC) and 455 (65.7%) Crohn's disease (CD) patients. UC was steady throughout the years, whereas only 1.2 CD patients were diagnosed per year in the first 11 years, and 73.7 per year in the last six years. The median age of UC patients was 34 years, ranging from 10 to 80 years with a peak between 21 and 40 years and in CD it was 27 years, ranging from 11 to 73 years with a peak between 11 and 30 years. There was a male preponderance of 1.5:1 and 2:1, respectively. The rest of the data is discussed in this study.
IBD is no longer a rare disease in KSA. UC is in a steady state, whereas CD is increasing significantly and far outnumbering UC.
Crohn's disease; rising trend; Saudi Arabia; ulcerative colitis
of the worldwide increases in asthma and allergic diseases in
childhood, which seem to relate to increasing prosperity, are unknown.
We have previously hypothesised that a reduction in the antioxidant
component of the diet is an important factor. An investigation was
undertaken of dietary and other risk factors for asthma in Saudi Arabia
where major lifestyle differences and prevalences of allergic disease
are found in different communities.
METHODS—From a cross
sectional study of 1444 children with a mean age of 12 (SD 1) years in
Jeddah and a group of rural Saudi villages, we selected 114 cases with
a history of asthma and wheeze in the last 12 months and 202 controls
who had never complained of wheeze or asthma, as recorded on the ISAAC
questionnaire. Risk factors for asthma and allergies (family history,
social class, infections, immunisations, family size, and diet) were
ascertained by questionnaire. Atopy was assessed by skin prick testing.
analyses, family history, atopy, and eating at fast food outlets were
significant risk factors for wheezy illness, as were the lowest intakes
of milk and vegetables and of fibre, vitamin E, calcium, magnesium,
sodium, and potassium. These differences were present also in the urban
children considered separately. Sex, family size, social class,
infections, and parental smoking showed no relationship to risk. In
multiple logistic regression analysis, urban residence, positive skin
tests, family history of allergic disease, and the lowest intakes of
vitamin E, magnesium and sodium related significantly and independently
to risk. The lowest tertile of intake of vitamin E was associated with
a threefold (95% CI 1.38 to 6.50) increase in risk when adjusted for
the other factors. Intake of milk and vegetables both showed inverse
linear relationships to being a case.
suggests that dietary factors during childhood are an important
influence in determining the expression of wheezy illness, after
allowing for urban/rural residence, sex, family history, and atopy. The
findings are consistent with previous studies in adults and with the
hypothesis that change in diet has been a determinant of the worldwide
increases in asthma and allergies.
Background and Aims:
Complementary alternative medicine (CAM) covers many types of treatments and procedures that are usually not included in conventional medicine and are used in addition to physician-prescribed drugs to “complement” treatment. Although liver disease is prevalent in Saudi Arabia, not much is known about CAM use among Saudi liver disease patients. Thus, this study aimed to assess the prevalence of CAM use in these patients and their attitudes toward it.
Materials and Methods:
Patients were recruited randomly from a tertiary care hepatology clinic at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia from February 4 to March 20, 2012. A four-page questionnaire was used to interview patients.
Of all the 232 participants surveyed, 55.6% have used or are using CAM to treat their liver disease with 45.0% of CAM users stating that they believe it has a positive effect on their treatment. Honey was the most used CAM treatment among the participants (39.0%). Herb use was represented by 31.8% of all users, while 13.5% used bloodletting as a treatment. Cautery was the least used CAM method (3.4%). Nearly 76.6% of CAM users were satisfied with using alternative treatments to help control their disease. Nearly 69.4% of users and nonusers stated that they believe CAM treatments to have numerous beneficial effects. Nearly 60.5% of CAM users stated that their physician had no knowledge of their CAM use. Of the factors included in linear multivariate regression analysis (including: Age, gender, and family CAM use, among other socioeconomic factors) only family CAM use was considered a significant independent factor affecting participants CAM use (Beta = 0.582, 95% CI: 0.372-0.754, P = 0.0001).
More than half of the patients have reported CAM use. Overall, more than two-thirds of the entire sample believed that CAM treatments have numerous health benefits.
Complementary alternative medicine; herbs; liver disease; Saudi Arabia
The prevalence of obesity and overweight is increasing globally. Frequently coexisting with under-nutrition in developing countries, obesity is a major contributor to chronic disease, and will become a serious healthcare burden especially in countries with a larger percentage of youthful population. 35% of the population of Saudi Arabia are under the age of 16, and adult dietary preferences are often established during early childhood years. Our objective was to examine the dietary habits in relation to body-mass-index (BMI) and waist circumference (W_C), together with exercise and sleep patterns in a cohort of male and female Saudi school children, in order to ascertain whether dietary patterns are associated with obesity phenotypes in this population.
5033 boys and 4400 girls aged 10 to 19 years old participated in a designed Food Frequency Questionnaire. BMI and W_C measurements were obtained and correlated with dietary intake.
The overall prevalence of overweight and obesity was 12.2% and 27.0% respectively, with boys having higher obesity rates than girls (P ≤ 0.001). W_C and BMI was positively correlated with sugar-sweetened carbonated beverage (SSCB) intake in boys only. The association between male BMI and SSCB consumption was significant in a multivariate regression model (P < 0.0001). SSCB intake was positively associated with poor dietary choices in both males and females. Fast food meal intake, savory snacks, iced desserts and total sugar consumption correlated with SSCB intake in both boys (r = 0.39, 0.13, 0.10 and 0.52 respectively, P < 0.001) and girls (r = 0.45, 0.23, 0.16 and 0.55 respectively, P < 0.001). Older children reported eating significantly less fruit and vegetables than younger children; and less eggs, fish and cereals. Conversely, consumption of SSCB and sugar-sweetened hot beverages were higher in older versus younger children (P < 0.001). BMI and W_C were negatively correlated with hours of night-time sleep and exercise in boys, but only with night time sleep in girls, who also showed the lowest frequency of exercise.
A higher intake of SSCB is associated with poor dietary choices. Male SSCB intake correlates with a higher W_C and BMI. Limiting exposure to SSCB could therefore have a large public health impact.
Chronic hepatitis C (CHC) is a global infection. In Saudi Arabia, the prevalence of CHC is declining due to the implementation of a blood screening program. However, CHC still remains a leading cause of liver cirrhosis and hepatocellular carcinoma.
This is a retrospective study of CHC patients at the King Abdul Aziz University Hospital, Jeddah, Saudi Arabia.
Patients and Methods
Out of a total of 291 CHC patients from the hepatology clinic at King Abdul Aziz University hospital, Jeddah, 279 patients were included in the present study. They were primarily male (152, 54.5%), with a mean age of 50.41 ± 1.72 years. The majority of patients were either Saudi (108, 38.7%) or Egyptian (60, 21.5%). A total of 61 patients received combination treatment with pegylated interferon and ribavirin, and one patient with sickle-cell anemia received pegylated INF monotherapy. Demographic, clinical and laboratory features of the CHC patients, and their responses to treatment were studied.
Decompensated cirrhosis was documented in 60 patients (21.5%), and hepatocellular carcinoma in 14 (5%). The mean level of serum alanine aminotransferase was 83.6 ± 231 u/L. The predominant genotype among the 70 patients tested, was genotype 4, followed by genotype 1 (39 and 18 patients, respectively). The sustained viral response (SVR) rate was 82.99%. The main predictive factors for SVR were baseline HCV viral load and rapid virologic response (RVR). The mean duration of follow-up was 4.2 ± .85 years. There were 24 patients who had liver disease-related mortality.
our data showed that 22% of CHC patients progress to cirrhosis and another 22% had treatment. Liver related mortality was more common in patients with advanced cirrhosis.
Hepatitis C, Chronic; Saudi Arabia; Liver Cirrhosis; Genotyping Techniques; Carcinoma, Hepatocellular; Ribavirin
Rift Valley fever (RVF) is an emerging viral zoonosis that impacts human and animal health. It is transmitted from animals to humans directly through exposure to blood, body fluids, or tissues of infected animals or via mosquito bites. The disease is endemic to Africa but has recently spread to Saudi Arabia and Yemen. Our aim was to compare two major outbreaks of RVF in Saudi Arabia (2000) and Sudan (2007) from a One Health perspective.
Using the terms ‘Saudi Arabia’, ‘Sudan’, and ‘RVF’, articles were identified by searching PubMed, Google Scholar, and web pages of international organizations as well as local sources in Saudi Arabia and Sudan.
The outbreak in Saudi Arabia caused 883 human cases, with a case fatality rate of 14% and more than 40,000 dead sheep and goats. In Sudan, 698 human cases of RVF were recognized (case fatality, 31.5%), but no records of affected animals were available. The ecology and environment of the affected areas were similar with irrigation canals and excessive rains providing an attractive habitat for mosquito vectors to multiply. The outbreaks resulted in livestock trade bans leading to a vast economic impact on the animal market in the two countries. The surveillance system in Sudan showed a lack of data management and communication between the regional and federal health authorities, while in Saudi Arabia which is the stronger economy, better capacity and contingency plans resulted in efficient countermeasures. Studies of the epidemiology and vectors were also performed in Saudi Arabia, while in Sudan these issues were only partly studied.
We conclude that a One Health approach is the best option to mitigate outbreaks of RVF. Collaboration between veterinary, health, and environmental authorities both on national and regional levels is needed.
Rift Valley fever; Saudi Arabia; Sudan; One Health; outbreak; climate; mosquito; trade ban
The epidemiology of headache in Arab countries was systematically reviewed through Medline identification of four papers reporting headache prevalence in the Arab nations of Qatar, Saudi Arabia (2 papers) and Oman. The prevalence of headache varied from 8 to 12% in Saudi Arabia to 72.5% in Qatar and 83.6% in Oman. Headache was commoner in females and younger people. The prevalence of tension headache was 3.1–9.5% in Saudi Arabia and the 1-year prevalence in Qatar was 11.2%. The migraine prevalence was 2.6–5% in Saudi Arabia and 7.9% in Qatar, while the 1-year migraine prevalence was 10.1% in Oman. The results show a migraine prevalence within that estimated worldwide. However, it is clear that epidemiological data from Arab countries are lacking, and there is disparity in the reported prevalence from Saudi Arabia when compared with its two neighbours, Qatar and Oman. Wider study adopting the same methodology in the six Gulf countries (Saudi Arabia, Qatar, Oman, Bahrain, United Arab Emirates and Kuwait) is needed to examine variations in headache and migraine prevalence.
Headache; Migraine; Prevalence; Epidemiology; Arab countries
The published data on Helicobacter pylori (H. pylori) prevalence and its relationship with abdominal pain in Saudi Arabia is scarce. This study was carried out to determine the prevalence of H. pylori and its relationship with chronic recurrent abdominal pain (RAP) among school students in Makkah City, Saudi Arabia.
Materials and Methods:
Three hundred and fourteen school students, 103 at the intermediate level (grades 7-9) aged 12-15 years and 211 at the secondary level (grades 10-12) aged 15-18 years were tested for H. pylori. Urea breath test (UBT) was used for this purpose. Children with chronic RAP were identified as per the Apley criteria.
Overall, the UBT was positive in 86/314 (27.4%) students. It was positive in 45/103 (43.7%) intermediate school students and 41/211 (19.4%) secondary students. Out of the 55 students with chronic RAP, 40 (73%) were positive for H. pylori. Further, 62.9% and 82.1% were positive among the intermediate and secondary school students with RAP, respectively. The overall and specific odds ratios of RAP were 12.35 [95% confidence interval (C.I.) 6.30-24.22] and 10.40 (95% C.I. 1.75-11.73) for the intermediate school students and 22.69 (95% C.I. 7.99-64.44) for the secondary school students.
The prevalence of H. pylori among the school children in Makkah, Saudi Arabia, is relatively low compared with developing countries. The prevalence was found to be higher among the younger age group. Further, there was a significant relation between H. pylori infection and RAP among the school students.
Abdominal pain; children; H. pylori; Saudi Arabia; urea breath test
The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.
Asthma; guidelines; Saudi Arabia
The health hazards related to smoking are well known. Smoking is a recognized risk factor for coronary artery disease (CAD). Despite rejection of smoking by the Saudi community, we are still seeing smokers in our population. This study is designed to determine the prevalence of smoking in the Kingdom of Saudi Arabia (KSA), and to find out its relation to CAD. This study is part of the Coronary Artery Disease In Saudis (CADIS) study.
This health survey was conducted by collecting data regarding smoking status among adult Saudis aged between 30 and 70 years of both sexes in KSA over a five year period from 1995 up to 2000. The study sample was of normal distribution and representative of all regions of KSA. The data were analyzed to provide the prevalence of smoking and its relation with CAD.
The total number of subjects was 17,350, and current smokers were 2217; accordingly the overall prevalence of smoking among Saudis was 12.8%. Males (1555) were significantly smoking more than females (662) with a prevalence of 18.7% and 7.3%, respectively (P < 0.0001). Smoking is more prevalent among Saudis living in urban, northern, western, and eastern regions compared to other regions of KSA. Smokers are more likely to develop CAD compared to non-smokers (P < 0.0001).
Smoking is a prevalent health problem among Saudis that requires intervention for eradication. We found clear association between cigarettes smoking and CAD particularly among males. Persistent education of the health hazards related to smoking is recommended particularly at early age in-order to prevent initiation of smoking.
Smoking; Prevalence; Saudi Arabia; Coronary artery disease
Eosinophilic gastroenteritis is a rare disease characterised by tissue eosinophilia that can involve any layer or part of the gut from the oesophagus to the rectum. In Saudi Arabia, the disease has not been reported in the literature before. We report the disease entity as an unusual cause of gastric outlet obstruction. A 50-year-old man was admitted through the gastrointestinal clinic with complaints of epigastric pain associated with dyspepsia for 1 month, and weight loss of 4 kg in 2 months. Examination revealed only the epigastric tenderness on deep palpation. Laboratory investigations including full blood count, liver function tests and renal function tests were normal. Gastroscopy disclosed stenosis of the second and third part of the duodenum. Biopsies were taken and the patient underwent endoscopic dilatation of the pylorus and duodenal bulb. Histopathology showed chronic active eosinophilic inflammation. The patient was successfully treated with a tapering course of steroids and had a complete recovery post-endoscopic dilatation.
The objective of this study was to determine the frequency and pattern of pulmonary manifestations in febrile patients with sickle-cell disease (SCD), a condition prevalent in the Eastern Province of Saudi Arabia.
The main pulmonary complications in febrile adult SCD patients were studied between January 1986 and December 1990.
Material and Methods:
The medical records, chest X-rays and microbiological data of all febrile (temperature >38°C) SCD patients >12 years of age admitted to KFHU during the study period were retrospectively reviewed.
Of the 164 patient-episodes in 49 male and 19 female SCD patients, chest X-rays were abnormal in 33 (20.1%) episodes. Of these 33, there was consolidation in 17 (52%), pleural effusion in 6 (18%), pleural effusion and consolidation in 4 (12%), consolidation with collapse in 3 (9%), pleural thickening in 2 (6%) and bronchogenic carcinoma in one.
Pneumonia was the most common complication in Saudi SCD patients with abnormal chest X-rays. Chest X-rays are most useful in SCD patients with symptoms of chest infection, abnormal chest signs, or those with persistent fever during vaso-occlusive crisis.
Chest X-ray; sickle cell disease; pulmonary manifestations