Evaluation of metabolic, antioxidant and anti-inflammatory effects of Garcinia kola on diabetic rats

Garcinia kola (G. kola), is a plant characterized by its hypoglycemic properties. We recently reported our findings on the extracts of G. kola, in which we found that it prevented the loss of inflammation-sensible neuronal populations in streptozotocin (STZ)-induced rat models of type 1 diabetes mellitus (T1DM).

In the present study we assessed the effect of G. kola bioactive compounds extracted successively with water, hexane, methylene chloride, ethyl acetate, and butanol. through analyzing biochemical markers of oxidative stress, inflammation, and metabolic function in STZ-induced diabetic animals.

Animals made diabetic by a single injection with STZ (60 mg/kg, i.p.), were treated daily with either vehicle solution, insulin, or G. kola extracts and its fractions from the first to the 6th-week post-injection. Biochemical markers; glucose, insulin, C-peptide, neuron-specific enolase (NSE), creatinine kinase, glutathione peroxidase, malondialdehyde (MDA), resistin, soluble E-selectin (SE-Selectin), and C-reactive proteins (CRP) levels in the sera were determined in the study groups. A marked increase in blood glucose (209.26% of baseline value), and a decrease in body weight (−12.37%) were observed in diabetic control animals but not in animals treated with either insulin or G. kola extracts and its fractions. The sub-fraction F5, G. kola ethyl acetate had the highest bioactive activities, with a maintenance of blood sugar, malondialdehyde, C-peptide, E-selectin, C-reactive protein (CRP) and neuron-specific enolase (NSE) to levels and responses comparable to healthy non-diabetic vehicle group and the positive control diabetic insulin-treated group.

Our findings suggest that G. kola may have a strong therapeutic potential against T1DM and its microvascular complications.

Differential effects of experimental hyperthyroidism on declined immunity of broiler chicken

Thyroid hormones (THs) are involved in the development of lymphoid organs and regulation of immune function in birds. However, their role as an immune-modulator in the hyperthyroid state is still debatable. To explore the interrelationship of thyroxine (T₄ ) and the immune system, chicks were divided into three groups. Group I was comprised of control birds, who received the basal diet while group II and III were given diets supplemented with 5 μg and 10 μg thyroxine/kg feed, respectively, from 15 to 28 days of age. Cell-mediated immune response was evaluated through in vitro abdominal macrophage phagocytosis assay, macrophage nitric oxide (NO) production, heterophil-to-lymphocyte (H:L) ratio and delayed-type hypersensitivity response against phytohemagglutinin (PHA). Humoural immune response was assessed through serum IgG and IgM antibody production against sheep red blood cells (SRBCs) and antibody production against infectious bronchitis virus (IBV). Sampling was carried out at 7, 14 and 21 days of treatment. Results have shown higher levels (p < .001) of circulating T₄ in both treatment groups compared to the control group. There was a lower (p < .05) macrophage engulfment percentage, an increase in H:L ratio (p < .001) in treated birds, while their NO production remained higher (p < .05) in thyroxine supplemented groups after bacterial lipopolysaccharide stimulation. The humoural immune response revealed a significant decline (p < .001) in IgG, IgM antibody production against SRBCs but IBV circulating antibodies increased with age. In conclusion, hyperthyroidism has a strong co-relation with decreased immune performance of birds.

Perceived stress and associated factors among medical students

Background:

Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world.

Objectives:

To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia.

Materials and Methods:

This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors.

Results:

Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students’ stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age.

Conclusion:

Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.

Ontogenic development of corticotrophs in fetal buffalo (Bubalus bubalis) pituitary gland

To evaluate the subpopulation of corticotrophs in developing buffalo (Bubalus bubalis) fetus, pituitary glands were recovered (n=6 per group) from late first, second and third gestational female buffalo dams. The corticotrophs were identified by using specific antibodies against proopiomelanocortin (POMC) and adrenocorticotrophic hormone (ACTH) through immunohistochemistry. There was a significant (P≤0.05) increase of immunoreactive (ir) ir-ACTH cells during late 2^nd trimester while, ir-POMC cells were more (P≤0.05) at late 3^rd trimester of gestation as compared to other age groups. The quantity of co-localized cells for POMC and ACTH was significantly (P≤0.05) greater at the end of 1^st gestation rather than 2^nd and 3^rd gestational fetal adenohypophyseal cells. This study is the first to demonstrate co-localization of POMC+ACTH and the affect of gestational age on the expression of these cells in buffalo fetus adenohypophysis.

Comparative study of physical activity of hypertensives and normotensives: A cross-sectional study of adults in Saudi Arabia

BACKGROUND

To formulate all intervention strategies for hypertension in the community, it is essential to quantify the magnitude of the disease and its risk factors. The patterns of physical activity have not been studied in terms of their being a risk factor or a predictor of hypertension in Saudi Arabia.

MATERIALS AND METHODS

This was a community-based cross-sectional study using the STEP-wise approach of adults and a multistage, stratified, cluster random sample. Data were collected using a questionnaire which included sociodemographics, blood pressure, patterns, levels and duration of physical activity.

RESULTS

Of a total of 4758, 1213 (25.5%) were hypertensives. Hypertension was significantly negatively associated with total levels and duration of physical activity in leisure, transport, and work. Significant predictors of hypertension included lower levels of work involving a moderate physical activity for 10 min, walking/cycling for 10 min continuously, and vigorous activity during leisure time.

CONCLUSIONS

Hypertension is prevalent among adults; physical inactivity is a significant risk factor and predictor. Targeting this modifiable risk factor can help in prevention, early diagnosis, and control.

Prevalence, Awareness, Treatment, and Control of Hypertension among Saudi Adult Population: A National Survey

This cross-sectional study aimed at estimating prevalence, awareness, treatment, control, and predictors of hypertension among Saudi adult population. Multistage stratified sampling was used to select 4758 adult participants. Three blood pressure measurements using an automatic sphygmomanometer, sociodemographics, and antihypertensive modalities were obtained. The overall prevalence of hypertension was 25.5%. Only 44.7% of hypertensives were aware, 71.8% of them received pharmacotherapy, and only 37.0% were controlled. Awareness was significantly associated with gender, age, geographical location, occupation, and comorbidity. Applying drug treatment was significantly more among older patients, but control was significantly higher among younger patients and patients with higher level of physical activity. Significant predictors of hypertension included male gender, urbanization, low education, low physical activity, obesity, diabetes, and hypercholesterolemia. In conclusion prevalence is high, but awareness, treatment, and control levels are low indicating a need to develop a national program for prevention, early detection, and control of hypertension.

Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia

OBJECTIVE

To determine the prevalence of smoking among medical students at the medical college at King Fahad Medical City in Riyadh, and assess the association between smoking and socio-demographical factors, smoking contacts, reasons for smoking and attempts to quit.

MATERIALS AND METHODS

Cross-sectional survey in which anonymous, self-administered questionnaire was used to survey the cigarette smoking habits of the first- and second-year medical students in the Faculty of Medicine, King Fahad Medical City in June 2009.

RESULTS

Overall 39.8 % of the investigated students (153) had smoked before, and 17.6% were current smokers. The mean age of initiating smoking was 15.8 (±3.3). There were significantly more males than females. The most important reasons for smoking were leisure, imitation of other people and a means of relieving psychological pressure. Reasons for not smoking were mostly health and religion-based. Smokers tended to have friends who smoked.

CONCLUSION

Cigarettes smoking is highly prevalent among medical students in the Faculty of Medicine, King Fahad Medical City. Contact with smokers particularly friends are the major risk factors for the initiation of the habit. Health and religious considerations are important motives for not smoking, quitting or attempting to quit. These findings can be of help in designing future intervention strategies.

Pilgrims satisfaction with ambulatory health services in Makkah, 2008

OBJECTIVE

The main objective of this study was to assess the level and correlates of patients' satisfaction with ambulatory health services provided for pilgrims during Hajj period in 2008.

MATERIALS AND METHODS

This was a facility-based, cross-sectional study conducted in the Makkah region during the Hajj season in December 2008. A two-stage technique was used to select 500 patients from those who attended the ambulatory health services. One hundred subjects were selected by systematic random sampling (every fifth) from each of the five hospitals included in the study and asked to fill in a pilot-tested self-administered questionnaire. A total of 487 questionnaires were analyzed. Descriptive statistics and t-test, Mann Whitney test and ANOVA, or Kruskal-Wallis test was used as appropriate after checking for normality. Level of significance level was set to be <0.05 throughout the study.

RESULTS

From 478 subjects analyzed, 390 (81.6%) were man, 345 (72.2%) were married, 28.9% had either intermediate or high secondary school education, and 2.4% were skilled laborers. The total satisfaction score for health facilities was 20.45 ± 4.03 of 25. The satisfaction scores were 20.15 ± 4.7 of 25 for patient satisfaction with physicians and 21.35 ± 4.5 for patient satisfaction with paramedical personnel. The overall satisfaction score was 61.5 ± 4.5 of 75 points. There were significant relations between total satisfaction of health facilities with education level and with occupation (P = 0.012, 0.001, respectively). The total satisfaction of patients with physicians was significant only with education level. The overall satisfaction score had a significant relation with occupation (P = 0.03), but a borderline relation with the education level (P = 0.056).

CONCLUSION

Satisfaction with ambulatory Hajj health services is acceptable. Some physicians and waiting area services need special attention to improve satisfaction levels with ambulatory health in the subsequent Hajj seasons.

Correlates of ever-smoking habit among adolescents in Tabuk, Saudi Arabia

A cross-sectional questionnaire study of the correlates of ever-smoking among adolescents was made in Tabuk government schools in Saudi Arabia. Of 1505 students aged 12-19 years, 657 (43.7%) were ever-smokers (i.e. ever tried cigarette smoking, even 1 or 2 puffs); 65.0% of males and 23.1% of females. In logistic regression analysis significant predictors for ever-smoking were: male sex, belief that smoking helps people feel comfortable in social situations, owning something with a cigarette logo, having pocket money > or = 20 riyals/day, poor school performance and having friends or parents who smoked.

Gender differences in smoking behavior among adolescents in Saudi Arabia

OBJECTIVE

To describe and assess gender differences in current cigarette smokers' according to certain variables including prevalence, access to tobacco, knowledge and attitude, environmental tobacco smoke, cessation of smoking, tobacco related advertisements, and education on tobacco in school among adolescents in grades 7-12 in Tabuk, Saudi Arabia.

METHODS

A random sample of schools in Tabuk city was obtained using a 2-stage cluster, in April 2005. A total of 16 governmental schools were selected. Within the schools, 48 classes were selected, targeting grades was 7 to 12. An anonymous, self-administered questionnaire was used to select 1,505 participants, with 96% response rate.

RESULTS

Out of 1,505 students, 22.3% (34% males, 11.1% females) were current cigarette smokers (students who had smoked on one or more days in the 30 days preceding the survey), and 5.8% (11.1% males, 0.7% females) were daily smokers. There were significant gender differences concerning source of cigarettes, usual place of smoke, intensity of smoking, knowledge on addiction of tobacco, exposure to education on tobacco, attitudes, and exposure to tobacco smoke in public places. While no significant gender differences were found with respect to age of initiation, knowledge of health hazards of tobacco, exposure to media, desire to quit, or exposure to tobacco smoke at home.

CONCLUSION

For the suppression of the use of tobacco by adolescents in Saudi Arabia differential intervention strategies and policies in males and females are needed, such as reducing youth access to cigarettes-in addition to intensive school and community anti-tobacco programs.

Factors influencing patient choice of hospitals in Riyadh, Saudi Arabia

This study examined factors considered important in choosing a hospital. The sample consisted of 303 respondents selected from five randomly selected primary health care centres. The percentages of males, highly educated, high-income level, elder and private sector employees was higher in those choosing private sector hospitals, while marital status did not relate to type of hospital. The principal component analysis identified six factors accounting for 64% of the total variance. The most important component was 'medical services' accounting for 28% of the total variance. Stepwise discriminant analysis revealed that the main factors associated with choosing a hospital were medical services, accessibility, age, sex and education. Little importance was given to income and occupation. Future recommendations outline the need for consumers' perceptions, attitudes, suggestions and concerns to be taken into consideration when marketing the services to be provided.

Patients' perspective on factors affecting utilization of primary health care centers in Riyadh, Saudi Arabia

OBJECTIVE

The aim of this study is to assess factors which the patients think can encourage, discourage or have no effect on utilization of Primary Health Care Centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia.

METHODS

Patients (n=540) attending the selected PHCCs in Riyadh were asked regarding their views on 21 (factors) items and whether they can encourage, discourage or has no effect on utilization of PHCCs services. Eight PHCCs were randomly selected according to the geographical location, 2 from each geographical zone. Seventy-five subjects were selected systematically, every 10th Saudi aged 15 years and above who visited the selected PHCCs during a one-month period (September 1998). The data was collected via a self administered pilot tested, internally consistent questionnaire which included patients' sociodemographic characteristics and their response to the 21 items rated as highly encouraging, encouraging, has no effect or discouraging utilization of offered health services.

RESULTS

More than 60% of the patients were males, aged 15-39 years, 47% finished secondary school, 5.2% were illiterate, 58% of all patients were married, more than 60% were employees and approximately 60% have a monthly income of less than 4500 Saudi Riyals. Manpower factors particularly the physician, Arabic speaking health team and free service were the most encouraging factors, while overcrowding and geographical location of the PHCCs, particularly location near public services, were the least encouraging factors. Patients' gender, education and occupation were the most important and age was the least important patients' characteristics associated with utilization factors.

CONCLUSION

An experienced physician, Moslem physicians and an Arabic speaking health team offering free service in PHCCs located near patients' homes can augment utilization of services.

Mothers' practices during pregnancy, lactation and care of their children in Riyadh, Saudi Arabia

OBJECTIVE

To study mothers' practices during pregnancy, lactation and care during the first 2 years.

METHODS

A cross section study was carried out in 5 Primary Health Care Centres (PHCC) in Riyadh, Kingdom of Saudi Arabia. Two hundred and fifty women (50 from each PHCC) who have children less than 2-years of age who visited the selected PHCCs during the study period were selected by systematic random sampling. Data was collected via a questionnaire which contained sociodemographic characteristics of the mother and their children and mothers' practices during pregnancy, lactation and the care of their children.

RESULTS

Approximately 73% of the mothers breast fed their children initially but only 37.6% are currently breast feeding their children. The majority of the mothers started breast feeding during 1-8 hours after delivery, 63% added supplementary foods to their children at 4-8 months. The majority of mothers visited antenatal clinics during pregnancy, vaccinated their children and followed up their children in well baby clinics. Half of the mothers are currently using contraceptives and 19% are consuming less food during pregnancy. The mothers' educational level was the most important factor associated with mothers' practices.

CONCLUSION

Some mothers' practices during pregnancy, lactation and child care needs corrective intervention.

Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers

OBJECTIVE

To estimate quantitatively consumers' satisfaction and correlates of satisfaction with physicians' services provided by Ministry of Health Primary Health Care Centers in attending consumers.

METHODS

Consumers (n = 540) attending the selected Primary Health Care Centers in Riyadh were asked about their satisfaction with physician's services. Eight Primary Health Care Centers were randomly selected according to the geographical location, two from each geographical zone. Seventy-five subjects were selected systematically where every tenth Saudi aged 15 years and above who visited the selected Primary Health Care Centers during the study period was chosen. Data was collected via a self administered pilot tested, internally consistent patient satisfaction questionnaire which included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of physicians' services in the selected Primary Health Care Centers rated in a scale of 1 5 points, the higher the score the higher the satisfaction.

RESULTS

The results revealed that males constituted 60%, and 58% of all patients were married, more than 60% were employees and more than 70% have a monthly income of less than 6000 Saudi Riyals. Almost 95% have an open file in the Primary Health Care Center and 39% think that the distance to the Primary Health Care Center is far or very far. The summary satisfaction score was 3.77 points and the mean satisfaction with the services provided by physicians was 2.56 points out of a maximum of 5 points The highest satisfaction was for discussing psychological aspects of patients' problems (2.96 points) and the lowest was for attentive listening to patients' complaints (2.22 points). Physicians' communication skills were more satisfactory to patients than their professional skills and satisfying patients' wishes scored the lowest satisfaction- Unskilled laborers, literate patients and patients with higher income showed significantly higher mean satisfaction while students, illiterates, those aged less than 50 years and patients with income less than 6000 Riyals per months scored the lowest satisfaction. The longer the distance travelled the lower the satisfaction scores but having a file or not was not related to satisfaction.

CONCLUSION

Some physicians' service items need corrective intervention and students and young patients appear to need more attention.

Knowledge and practices of mothers about infants' diarrheal episodes

OBJECTIVES

To study the socioeconomic correlates of infants' diarrhea as well as infants' mothers' knowledge and practice concerning diarrheal diseases.

METHODS

Study subjects included 300 infants (150 from Sulaimania Pediatrics Hospital and 150 from the Maternal and Childrens Hospital) with diarrheal episodes during the study period selected by systematic random sampling. Data was collected via a structured open ended pilot tested modified questionnaire filled in by trained Arabic speaking research assistants who interviewed mothers about the diarrheal aspects of their infants, assessed their knowledge and practices concerning diarrheal diseases in children as well as collecting the necessary sociodemographic characteristics of the mothers, fathers and infants themselves.

RESULTS

The majority of parents of infants with diarrhea were illiterate or can just read and write, mothers were mostly young aged 20 - 29 years, family income for about 40% of the subjects was less than 5000 Saudi Riyals per month. Diarrheal episodes were mostly in infants 6 months or less in age, mostly the first child in order with males more affected than females. Mothers' knowledge about many aspects of diarrhea was grossly deficient but tends to increase with increasing age, educational level, and birth order. Mothers' practices were better but still deficient and sources of information about diarrhea was mostly from non health professionals.

CONCLUSION

Intervention strategies to control infants diarrheal episodes needs to be through an integrated approach aiming at boosting mothers' knowledge and improving their practice concerning diarrhea and improving the families socioeconomic status and encouraging all health professionals to act as a readily available source for health information about diarrhea and other important health problems.

Prevalence and correlates of acute respiratory infections in children less than two years of age

OBJECTIVES

To study acute respiratory infections of children less than 2 years of age in Riyadh City and their sociodemographic and anthropometric correlates.

METHODS

Study subjects included 250 mothers selected by systematic random sampling from mothers attending 5 Primary Health Care Centers selected by simple random sampling from the 5 geographical zones (one from each zone) in Riyadh during a one month period. Data was collected via a structured pilot tested modified questionnaire filled in by trained research assistants who interviewed mothers regarding acute respiratory infections during the past 2 weeks in their children aged less than 2 years. Heights and weights of both children and mothers were measured and the necessary sociodemographic characteristics of the mothers, and children were collected by the research assistants in addition to mothers' practices concerning their child's acute respiratory infections.

RESULTS

The prevalence of acute respiratory infection in children was 24%, mostly in children whose mothers are less educated, aged 35 years or more, married at age 25 years or more and whose relatives take care of their children while working outside the home. The children affected were mostly 7 - 12 months of age, lighter in weight, not vaccinated, with no follow up cards and not weighed during the last 4 months. About 3 quarters of the mothers consulted somebody about acute respiratory infections, mostly at modern health facilities particularly government Primary Health Care Centers. Tachypnea, or diarrhea or both were the most important symptoms urging mothers to seek medical advice. Working mothers whose children are taken care of by relatives is the only significant predictor of acute respiratory infections, and children with a follow up card is the only significant predictor for consulting somebody about acute respiratory infections.

CONCLUSION

Intervention strategies to control acute respiratory infections in children less than 2 years of age should target working mothers, less educated mothers, malnourished unvaccinated children and encourage periodic follow up visits for children.

Patients' satisfaction with physicians' services in primary healthcare centres in Kuwait City, Kuwait

Enhancing patient satisfaction offers a way of optimising health status and helps in the reduction of wastage of medical resources. The direct measurement of patient satisfaction is new in Kuwait. This study aimed to assess patient satisfaction with respect to physicians' services in primary health care (PHC) and to determine the association of patients sociodemographic variables on their satisfaction level. The sample consisted of 301 patients selected systematically from five primary healthcare centres (PHCC) to represent various geographic areas in Kuwait. The data were collected by personal interview using a structured questionnaire. The overall mean satisfaction with physician services was 2.21 points out of a maximum of five points. The results from multiple regression analysis indicated that gender, marital status, occupation and income are the most important predictors, with females, married, labourers and higher income levels having the highest mean satisfaction score. The principal component analysis indicated that the most important aspect is 'communication' which accounted for 54% of the total variance. The results suggested a need for an educational programme to inform patients of the objectives and limits of primary health services.

Consumers' satisfaction with primary health services in the city of Jeddah, Saudi Arabia

OBJECTIVE

To study consumers' satisfaction and socio-demographic correlates of satisfaction with services provided by Primary Health Care Centres in the city of Jeddah.

METHODS

Study subjects included the consumers visiting the Primary Health Care Centres during the study period. Four Primary Health Care Centres were randomly selected from Jeddah according to the geographical location. Seventy five subjects were selected systematically where every tenth Saudi aged 15 years or above was chosen. Data was collected via a self administered pilot tested questionnaire which included socio-demographic characteristics, as well as the overall and differential satisfaction with the different services and facilities in the selected Primary Health Care Centres rated on a scale of 1 - 5 points, the higher the score the higher the satisfaction.

RESULTS

Male subjects constituted 60% of the visitors. More than half of the subjects were young 15-29 years of age, about 58% were married, 50% completed intermediate/secondary school, more than two fifths of the subjects were employees and more than three quarters have a monthly income of 6000 Saudi Riyals or less. The summary satisfaction score was 3.76 points and the overall satisfaction with the services provided was 2.45 points out of a maximum of 5 points. The highest satisfaction was for dental clinic (3.44 points) and the lowest for co- operation of the receptionist (1.95 point). Unskilled laborers showed the highest summary and overall satisfaction (4.31 and 2.71 points) and students showed the lowest satisfaction scores (3.54 and 1.89 points). Other socio-demographic variables were not significantly related to summary and overall satisfaction scores.

CONCLUSION

Measuring satisfaction by asking one summary question tends to give a significantly higher satisfaction score compared to satisfaction score taking in consideration of all services offered. Certain service components need corrective intervention measures to make them more satisfactory to consumers.

Sequence diversity of TT virus in geographically dispersed human populations

TT virus (TTV) is a newly discovered DNA virus originally classified as a member of the Parvoviridae. TTV is transmitted by blood transfusion where it has been reported to be associated with mild post-transfusion hepatitis. TTV can cause persistent infection, and is widely distributed geographically; we recently reported extremely high prevalences of viraemia in individuals living in tropical countries (e.g. 74% in Papua New Guinea, 83% in Gambia; Prescott & Simmonds, New England Journal of Medicine 339, 776, 1998). In the current study we have compared nucleotide sequences from the N22 region of TTV (222 bases) detected in eight widely dispersed human populations. Some variants of TTV, previously classified as genotypes 1a, 1b and 2, were widely distributed throughout the world, while others, such as a novel subtype of type 1 in Papua New Guinea, were confined to a single geographical area. Five of the 122 sequences obtained in this study (from Gambia, Nigeria, Papua New Guinea, Brazil and Ecuador) could not be classified as types 1, 2 or 3, with the variant from Brazil displaying only 46-50% nucleotide (32-35% amino acid) sequence similarity to other variants. This study provides an indication of the extreme sequence diversity of TTV, a characteristic which is untypical of parvoviruses.

Antigenic variation of core, NS3, and NS5 proteins among genotypes of hepatitis C virus

Assays that detect antibody to hepatitis C virus (HCV) are used to screen blood donors and patients with hepatitis. Current enzyme-linked immunosorbent assay (ELISA)-based methods are invariably based upon antigens from expressed recombinant proteins or oligopeptides from HCV type 1. Some HCV antigens used in screening assays are coded by regions of the HCV genome that show extensive variability; therefore, HCV type 1-based assays may be less effective for the detection of antibody elicited by infection with other genotypes. In this study, we have measured antibody reactivity of sera from 110 hepatitis C patients infected with type 1b, 3a, or 4a to genotype-specific and cross-reactive epitopes present in recombinant proteins from HCV genotypes 1b (core, NS3, and NS5), 3a (NS3, NS5), and 4a (core, NS3), corresponding to those used in current third-generation screening ELISAs. By comparing the serological reactivities of sera to type-homologous and type-heterologous antigens, we detected a significant type-specific component to the reactivity to NS3 (61 to 77% of the total reactivity) and NS5 (60% of the total reactivity). Furthermore, despite the similarities in the amino acid sequences of the core antigens of type 1b and type 4a, we also found significantly greater reactivity to type-homologous antigens, with approximately 25% of reactivity being type specific. These findings are consistent with previous findings of fivefold weaker reactivity of sera from HCV type 2- and HCV type 3-infected blood donors in the currently used third-generation ELISAs and suggest that these assays are suboptimal for screening populations in which the predominant genotype is not type 1.

Complete nucleotide sequence of a type 4 hepatitis C virus variant, the predominant genotype in the Middle East

Hepatitis C virus (HCV) type 4 is the predominant genotype found throughout the Middle East and parts of Africa, often in association with high population prevalence as in Egypt. To investigate more fully its evolutionary relationship with other genotypes of HCV, and to study its overall genome organization, we have determined the entire sequence encompassing the coding region of the genotype 4a isolate ED43, obtained from an HCV-infected individual from Egypt. The sequence of ED43 contained a single open reading frame encoding a polyprotein of 3008 amino acids (aa), smaller than that reported for other HCV genotypes which vary from 3010 aa to 3037 aa. The nucleotide and amino acid sequences were compared with the full-length sequences already reported for genotypes 1a, 1b, 1c, 2a, 2b, 2c, 3a, 3b and those of isolates JKO49 and JKO46 described as types 10a and 11a. The differences in length of the polyprotein originated in variable regions in the E2 and NS5A genes. The complete sequence of ED43 confirmed the classification of type 4 as a separate major genotype.

Seasonal variation and weather effects on road traffic accidents in Riyadh city

The monthly variation of Road Traffic Accidents (RTAs) in Riyadh city in the period 1989-1993 has been studied with reference to time of day, lighting conditions and prevalent weather conditions. Total RTA accidents were significantly more common, being directly correlated, with increased dry and wet bulb temperatures and significantly less common, being inversely correlated, with increased relative humidity and amount of precipitation of rain, snow, hail etc. However, RTAs recorded on rainy days only were significantly more common and directly correlated with precipitation (Note days of snow and hail are very rare in Riyadh city). Seasonal variation in RTAs was evident being maximal during the summer season particularly between 12 noon and 3 pm. This period is characterized by heavy traffic and intense sunlight. The role of hot weather prevalent in Saudi Arabia, where average temperatures of 34.4-34.7 degrees C with maximum of 40-42.7 degrees C are common in summer, have been suggested to be an important factor leading to increased stress and decreased performance of intellectual tasks which require considerable physical effort and motor skills. Increased heart rates, exacerbation of existing pathologic conditions such as heart disease and emphysema and loss of visual acuity have been reported. Consequently, prolonged exposure to heat must be considered as a hazard to the safety and health of drivers and a factor leading to an increased incidence of RTAs.

Aetiological factors contributing to road traffic accidents in Riyadh City, Saudi Arabia

The study analysed 13,390 police records of road traffic accidents (RTAs) covering a three and a half year period according to different suspected aetiological factors. The majority of the accidents were recorded for vehicles in good condition on well-paved straight roads with well-operating traffic light systems. Adverse weather conditions such as precipitation, fog and dust were of minimal importance, with most of the accidents being reported during sunny days during the rush period of 12 noon to 3 pm. Driver's error was identified as the main contributing factor in about two thirds of all RTAs mainly as reckless driving and excess speeding. About 27% of the drivers were professional drivers and 41% were in the age group 25-35 years in good health with no alcohol or drug intake. Hence, human errors may be attributed to carelessness, experience, lack of knowledge or attention, over-exhaustion or fatigue. The effects of physical stressors on performance of drivers need to be further explored and clarified but this need not underestimate the importance of vehicle and environment since most accidents are multifactoral and a slight change in them may effectively enhance perception and minimise personal error. Recommendations for remedial measures adopting an interdisciplinary approach are presented.

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia

OBJECTIVE

To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia.

DESIGN

Cross-sectional survey.

SETTING AND SUBJECTS

Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994.

MAIN OUTCOME MEASURES

Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures.

RESULTS

25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies.

CONCLUSIONS

Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.

Smoking habits of students in secondary health institutes in Riyadh City, Saudi Arabia

The smoking habits of all male and female students enrolled in Riyadh Secondary Health Institutes of the Ministry of Health in 1990 were studied using a self-administered questionnaire. The overall smoking prevalence was 22%. Cigarettes were virtually the only form of tobacco used. Males smoked about twice the females in terms of prevalence (24% and 14%) and intensity (14 and 6 cigarettes per day). The majority of smokers for both sexes started the habit at or before the age of 16 years and the majority of them thought seriously about quitting and attempted to quit but only 12% of them were so far successful. Psychologic pressures, smoking contacts and foreign travel were important factors in relapses. Religious, health and professional considerations were the most important motives for attempting to quit the habit among smokers and for not attempting the habit itself for the non smokers.

Sequence variability in the 5' non-coding region of hepatitis C virus: identification of a new virus type and restrictions on sequence diversity

We have analysed the pattern of nucleotide sequence variability in the 5' non-coding region (5' NCR) of geographically dispersed variants of hepatitis C virus (HCV). Phylogenetic analysis of sequences in this region indicated the existence of a new virus type, provisionally termed type 4, the identity of which was confirmed by further analysis of the more variable part of the HCV core protein coding region. The geographical distribution of HCV type 4 was distinct from that of other HCV types, it being particularly widespread in Africa and absent or rare in Europe and the Far East. Much of the variability in the 5' NCR appears to be constrained by a requirement for specific secondary structures in the viral RNA. In one of the most variable regions of the 5' NCR (positions -169 to -114), most of the nucleotide changes that are characteristic of different HCV types were covariant, with complementary substitutions at other positions. According to the proposed secondary structure of the 5' NCR, such changes preserved base pairing within a stem-loop structure, whereas the nucleotide insertions found in a proportion of 5' NCR sequences, including those of type 4, localized exclusively to the non-base-paired terminal loop. The specific nucleotide substitutions in the 5' NCR that differentiate each of the four HCV types can be detected by restriction enzyme cleavage, providing a rapid and reliable method for virus typing.

The association between hepatitis C virus antibody and hepatocellular carcinoma in relation to hepatitis B viral infection (RAFH experinece)

Forty-two patients with hepatocellular carcinoma (HCC) were seen during two years at Riyadh Armed Forces Hospital (RAFH), Saudi Arabia. As viral hepatitis is common in this country, serological markers for hepatitis B virus (HBV) and the newly identified hepatitis C virus (HCV) were also studied in these patients. Fourteen (33.3%) patients were HBsAg positive, 11 (26.2%) were anti-HCV positive, two (4.8%) were positive for both HBsAg and anti-HCV and five (11.9%) were anti-HBc and anti-HBs positive. The remaining ten patients all were negative for markers. Serological markers were also studied in 1472 blood donors (control group) during the same period. Twenty-two (1.5%) were positive for anti-HCV, 59 (4%) for HBsAg and two (0.1%) for both markers. Our results are in accordance with previous studies carried out elsewhere, and it is suggested that hepatitis C virus like hepatitis B, may play an important etiological role in hepatocellular carcinoma in Saudi Arabia.

Hepatitis C virus infection in chronic liver disease and hepatocellular carcinoma in Saudi Arabia

The prevalence of antibody to hepatitis C virus (HCV) was determined in 139 patients with chronic liver disease (CLD) and 42 patients with hepatocellular carcinoma (HCC) during one year at the Riyadh Military Hospital, Saudi Arabia. The anti-HCV was detected in 36 of 96 (37.5%) HBsAg-negative patients with chronic liver disease and six of 43 (13.9%) HBsAg-positive patients with chronic liver disease. In addition, 11 (42.3%) HBsAg-negative hepatocellular carcinoma patients and two of 16 (12.5%) HBsAg-positive hepatocellular patients had antibody to HCV. The anti-HCV prevalence was 1.5% in 4818 healthy blood donors and 1% in 385 antenatal patients. The overall HCV seropositivity of 30.4% in 181 liver disease patients (CLD and HCC) in Saudi Arabia is lower than that reported from European countries.

Attitudes and behaviour of physicians towards smoking in Riyadh city, Saudi Arabia

In Riyadh city 698 physicians were studied for their smoking habits, attitudes and behaviour; 48% were smokers and 34% are currently smoking. Males smoked significantly more than females currently and in the past. Smoking prevalence and intensity tended to decrease with age and quitting periods were longer. More than 60% of the physicians agreed that smoking is a major contributing factor in the causation of coronary artery disease, lung cancer and chronic bronchitis; less than 20% said the same for bladder cancer and neonatal death. Setting a good example for children was the most important reason for not smoking.

Self-medication among primary care patients in Farazdak Clinic in Riyadh

Four hundred and thirty new adult patients were interviewed using a questionnaire for their attitudes and practices regarding self-medication. 69% of the patients were males and 40% were Saudis. 58% of the patients attempted self-medication due to the triviality of their symptoms or to save time and money. They used mostly analgesics, vitamins, tonics and oral antibiotics. 41.6% of the patients did not practise self-medication because of lack of information about the drugs or for fear of complications. Self-medication was associated with literacy and morbidity. Literate patients self-medicated significantly more than illiterates. Patients who perceived their symptoms as minor self-medicated significantly more than those who perceived them as major. No association was found between self-medication and age, sex or occupation.

Loa loa: the use of a blood cell separator to reduce microfilaraemia before specific chemotherapy

Three years after returning to the U.K. a 58-year-old British engineer, who had worked in the Nigerian oilfields for 24 years, was found to have Loa loa. His midday microfilarial count ranged between 12 X 10(6) and 16 X 10(6) parasites per litre. Before starting treatment, I litre of leucocyte/platelet-rich plasma was removed by means of a blood cell separator. Six intermittent cycles of blood separation were performed during a single 4-h session around midday in order to coincide with the period of maximum microfilarial presence in the peripheral circulation. This resulted in a 50% reduction of the microfilaraemia. Where facilities for blood cell separation are available, this procedure, together with appropriate chemotherapy, should be particularly beneficial in the management of heavy filarial infections.

Utilization of primary health services in Port Sudan, Sudan

The utilization of primary health services provided by two health centres and a hospital out-patient department was studied. The epidemiologic pattern was similar in the three health care facilities; minor gastrointestinal tract, respiratory tract and skin conditions formed the majority of cases. Distance was a limiting factor for utilization of health services in the health centres and not in the hospital. The average consultation time per patient was two minutes. Lack of drugs was the universal problem. Suggestions and recommendations to solve some of the problems and improve services are presented.

A study of the specific IgM antibody response in Mycoplasma pneumoniae infection in man

Sera from 96 patients with Mycoplasma pneumoniae infection were examined for specific IgM antibody. The complement fixation test was used to measure the IgM after separation by ultracentrifugation through sucrose density gradients. Of patients under the age of 20 years 78% displayed positive specific IgM titres. In older patients only 34% were IgM positive. The specific IgM remained detectable, but at decreasing levels, during the follow-up period of 5 months. This diagnostic technique appears to be of value in children and young adults experiencing primary infection with M. pneumoniae.

A new serotype of calicivirus associated with an outbreak of gastroenteritis in a residential home for the elderly

An outbreak of gastroenteritis involving residents and members of staff in a nursing home for the elderly is described. The agent associated with this episode was a calicivirus which is serologically distinct from two strains causing gastroenteritis in children. We believe that this is the first report of calicivirus infection in adults.