Abdulaziz A. BinSaeed

Characteristics of pandemic influenza A (H1N1) infection in patients presenting to a university hospital in Riyadh, Saudi Arabia.

Background and Objectives : A national plan of management for flu-like illnesses was developed by the Saudi Ministry of Health after the first outbreak in Saudi Arabia in June. We describe the clinical presentation of the H1N1 cases attending King Khalid University Hospital (KKUH) between July through September 2009 and identify the high-risk age groups. Methods : All patients presenting with influenza-like illnesses (ILI) in the H1N1 clinics during the specified period were clinically examined and tested using reverse transcription polymerase chain reaction (RT-PCR). Those who were clinically diagnosed and confirmed positive for novel influenza A (H1N1) were included in the study. Results : Over a 6-week period, 117 cases of laboratory-confirmed cases were reported in KKUH with a mean (SD) age of 19.6 (16.7) years, of whom 72 (62.1%) were males. Most reported cases were Saudis (n=99, 85.3%); 94 (81%) had no travel history outside the country; 100 (86.2%) had had no contact with an H1N1-identified patient; 33% were aged 5-14 years and 28.4% were aged 15-29 years. The most commonly reported symptoms were fever in 99 (85.3%), cough in 9 (81%), runny nose (33.6%) and sore throat (21.3%). All 117 cases were confirmed positive using real time RT-PCR testing. Thirty-one cases (26%) were admitted and 22 of those (71%) recovered after receiving oseltamivir. Two deaths were attributed to the 2009 pandemic. One patient died of chronic pulmonary disease. The other cause of death was unknown. Conclusion : These findings indicate indigenous influenza A (H1N1) transmission, and confirm the urgent need for prevention strategies which specifically target children and young adults, who appear to have a higher risk of infection and hospitalization. Such measures include immunization, improved personal hygiene, and increased ventilation in habitations.

Determinants of asthma control among children in Saudi Arabia

Abstract Objective: Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children. Methods: A cross-sectional study was conducted among children with asthma aged 4–11 years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables. Results: Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR = 0.31, 95% CI = 0.10–0.96) and by 87% with four or more siblings (OR = 0.13, 95% CI = 0.04–0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR = 0.87, 95% CI = 0.81–0.93). Household incomes less than SAR 15 000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI = 1.02–5.21) and 3.33 (95% CI = 1.33–8.35), respectively. Conclusions: In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.

Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the neonatal intensive care unit: Does vancomycin play a role?

BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU. METHODS A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection. RESULTS During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors. CONCLUSION Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.

Caregiver knowledge and its relationship to asthma control among children in Saudi Arabia

Abstract Objective: The objective of this study was to examine caregiver responses to individual questions of the asthma knowledge questionnaire and to compare the prevalence of uncontrolled asthma among children according to caregiver responses (correct vs. incorrect). Methods: We conducted an analytical cross-sectional study among 158 children with asthma aged 4–11 who were attending the pediatric primary care clinic of the King Khalid University Hospital in Riyadh, Saudi Arabia. The asthma knowledge questionnaire for use with parents or guardians of children with asthma was used to measure the knowledge of caregivers. Asthma control in the children was measured using an Arabic version of the childhood asthma control test. Pearson’s chi-square or Fisher’s exact tests were used to compare the prevalence of uncontrolled asthma according to the caregivers’ responses. Results: This study showed substantial gaps in knowledge among caregivers of children with asthma. The answer to only one of 17 questions was well known (86.1%); this question involved the harm of smoking near a child with asthma. Answers on 11 of 17 questions were significantly (p < 0.05) associated with asthma control in children. Among the key questions explored, the prevalence of uncontrolled asthma was 3.0 (1.8–4.9), 2.5 (95% confidence interval = 1.7–3.9) and 1.8 (1.3–2.5) times higher among children of caregivers who did not disagree with the statements that it is not good for children to use an inhaler for too long, that inhalers can affect or damage the heart, and that children with asthma should use asthma medications only when they have symptoms. Conclusions: Although innovations are needed to help patients improve their adherence to treatment and to effectively utilize the benefits of contemporary asthma medications, we observe substantial knowledge-related problems in the asthma management of children in Saudi Arabia.

Communicability of H1N1 and seasonal influenza among household contacts of cases in large families

Please cite this paper as: Mohamed et al. (2011) Communicability of H1N1 and seasonal influenza among household contacts of cases in large families. Influenza and Other Respiratory Viruses 6(3), e25–e29.

Asthma control among adults in Saudi Arabia. Study of determinants

Objectives: To explore the determinants of uncontrolled asthma in Saudi Arabia. Methods: A consecutive series of adult asthma patients attending 3 pulmonary primary care clinics in Riyadh, Saudi Arabia for a scheduled appointment were interviewed. A multiple logistic regression analysis was used. Results: The proportion of patients with uncontrolled asthma was 68.1% (177/260). Daily tobacco smoking or monthly household income less than 15,000 Saudi Arabian Riyals were associated with a 4.6 (95% confidence interval [CI]=1.3-16.4) and 3.4 (95% CI=1.8-6.6) times increase in the odds of having uncontrolled asthma. Patients with less than a graduate degree (odds ratio [OR]=3.1; 95% CI=1.0-9.5) or patients who were unemployed, disabled, or too ill to work (OR=3.1; 95% CI=1.4-6.9) had poorer asthma control. Having heartburn during the past 4 weeks decreased the odds of asthma control by 2.5 (95% CI=1.3-4.9), and having chronic sinusitis during the past 4 weeks decreased the odds of asthma control by 2.0 (95% CI=1.0-4.0) times. Being female (OR=2.0; 95% CI=1.0-4.0) or ≥35 years of age (OR=2.0; 95% CI=1.0-3.9) was also associated with having uncontrolled asthma. Conclusion: Our findings suggest that most respondents had uncontrolled asthma. Less modifiable socio-demographic factors (for example, income, education, occupation, gender, and age) significantly increased the odds of having uncontrolled asthma. However, modifiable risk factors such as tobacco smoking and clinical factors such as heartburn and chronic sinusitis could also be targeted for intervention.

Outcome of strict implementation of infection prevention control measures during an outbreak of Middle East respiratory syndrome

Background: The objective of this retrospective cohort study was to assess the impact of implementation of different levels of infection prevention and control (IPC) measures during an outbreak of Middle East respiratory syndrome (MERS) in a large tertiary hospital in Saudi Arabia. The setting was an emergency room (ER) in a large tertiary hospital and included primary and secondary MERS patients. Methods: Rapid response teams conducted repeated assessments of IPC and monitored implementation of corrective measures using a detailed structured checklist. We ascertained the epidemiologic link between patients and calculated the secondary attack rate per 10,000 patients visiting the ER (SAR/10,000) in 3 phases of the outbreak. Results: In phase I, 6 primary cases gave rise to 48 secondary cases over 4 generations, including a case that resulted in 9 cases in the first generation of secondary cases and 21 cases over a chain of 4 generations. During the second and third phases, the number of secondary cases sharply dropped to 18 cases and 1 case, respectively, from a comparable number of primary cases. The SAR/10,000 dropped from 75 (95% confidence interval [CI], 55‐99) in phase I to 29 (95% CI, 17‐46) and 3 (95% CI, 0‐17) in phases II and III, respectively. Conclusions: The study demonstrated salient evidence that proper institution of IPC measures during management of an outbreak of MERS could remarkably change the course of the outbreak.

Sexual practices of young educated men: implications for further research and health education in Kingdom of Saudi Arabia (KSA)

BACKGROUND Considering the high prevalence of sexually transmitted infections (STIs) and other associated health problems among young people globally, it is important to identify sexual practices that could potentially compromise health. This study explored the sexual practices of young men in Riyadh city, the Kingdom of Saudi Arabia (KSA). Materials and methodology A cross-sectional study among young, male students was conducted using a pre-tested, structured, self-administered questionnaire. Descriptive analysis and adjusted odds ratio (OR) were calculated. RESULTS Among 225 study participants, 31% had engaged in premarital sexual activity at least once and 61% viewed pornographic movies/materials. Only 51% knew that condom use could prevent STIs, 20% were not aware that HIV could be transmitted through both homosexual and heterosexual contacts. Premarital sexual activity was associated with the use of illegal drugs (OR: 2.51), viewing of pornographic movies (OR: 6.79) and traveling alone abroad (OR: 3.10). CONCLUSION and recommendations Our study was the first to report the existence of premarital sexual practices among young educated men in KSA. There is a need to identify in detail the risks and the knowledge gaps, and base sexual health awareness among youth on such knowledge in order to prevent the spread of STIs and HIV.

Glimpse of the epidemiological research on Helicobacter pylori in Saudi Arabia.

Helicobacter pylori (H. pylori) is one of the most common infections that affects humans. Although H. pylori was only identified in 1983,[1] numerous studies reveal that it is encountered worldwide. It is estimated that half or more of the worlds population is infected.[2] Substantial differences in the prevalence of H. pylori infection have been observed between countries.[2,3] These differences conform to two major patterns that differ in developed and developing countries. The general trend of H. pylori prevalence in developed countries is slow increases during childhood, which continue through adolescence and early adulthood, with an abrupt increase around 50–60 years of age.[4] In the nonindustrialized countries, H. pylori prevalence increases more rapidly during childhood and most adolescents and adults are infected. Thus, differences in H. pylori prevalence between industrialized and nonindustrialized countries are greater at younger ages and get smaller at older ages.[2,3,5] Although the overall prevalence is generally lower in the Western world, high prevalence, approaching that of the nonindustrialized nations, have been observed within some subgroups in the industrialized nations. Differences in prevalence within populations are due to a variety of factors primarily relating to socioeconomic status and geographic origin. In this issue of this Journal, a report about H. pylori prevalence and its association with recurrent abdominal pain is published.[6] The authors of this publication have surveyed a group of school children for H. pylori using the 14C urea breath test. They further tried to establish a relationship between H. pylori and recurrent abdominal pain. In spite of the importance of this report, it has potential methodological problems. Using a radioactive material as a tool of diagnosis in the young agegroup is questionable, especially with the lack of credible evidence that supports that decision. Even in the presence of some references that probably mention its safety to be used in older children,[7] conducting a research on healthy people requires the use of the safest procedure ever, especially with the presence of better alternatives that can be used.[8,9] Other limitations of the report are the lack of very important information on demographic and socioeconomic factors that may explain some of the conflicting findings. These problems are not limited to this paper. Research from the region in this field is limited and most of the published papers that emanated from this region have had inherent problems related to their design and sample size. The issue requires further in-depth investigation in order to address various regional questions of epidemiological importance. A PubMed® search, using H. pylori as a keyword, shows a great interest in research of this infection. This interest is reflected by the exponential increase in the number of papers published on the subject from a total of 14 in 1984 to over 500 in 1990 and over 26,000 in 2007, making it one of the most active areas of research in the medical field. The Saudi contribution to this enormous literature is very minimal, with less than 70 publications. In contrast, publications from Australia, with a similar population but a lower prevalence of H. pylori, exceeded 500 articles. In conclusion, the strong effort and commitment of several medical disciplines with a large and proper collection of scientific data from Saudi population/subgroups will give significant support to this field of research.

Asthma quality of life in Saudi Arabia: Gender differences

Abstract Objectives: To explore potential gender differences in the factors associated with asthma-specific quality of life (AQL). Methods: A cross-sectional study of consecutive series of adult patients attending primary care centers at three major hospitals in Riyadh, Saudi Arabia, was performed. AQL was measured using a standardized version of the AQL questionnaire (min = 1, max = 7), with higher scores indicating a better AQL. Multiple linear regression analysis was performed. Results: The mean AQL was 4.3 (standard deviation [SD] = 1.5) for males and 4.0 (SD = 1.3) for females (p = 0.113). With each unit increase in asthma control, the AQL improved by 0.19 points (95% confidence interval [CI] = 0.14–0.23) in men and by 0.21 points (95% CI = 0.16–0.25) in women. Daily tobacco smoking was associated with a 0.72 point (95% CI = 0.14–1.30) decrease in the AQL among males. Women who had a household member who smoked inside the house had a significantly lower AQL (B = −0.59, 95% CI = −1.0 – −0.19). A monthly household income of 25,000 Saudi Riyals or more was associated with a better AQL among men (B = 0.51, 95% CI = 0.01–1.01), whereas being employed exhibited a protective effect in women (B = 0.48, 95% CI = 0.11–0.84). Higher levels of perceived asthma severity were associated with better AQL in women (B = 0.82, 95% CI = 0.36–1.28). Conclusions: Our findings revealed gender-specific differences in the correlates of AQL in Saudi Arabia, particularly in tobacco exposure, socio-economic factors and perceived asthma severity.