Elsayed Aboulmagd

Prevalence of Intestinal Parasitic Infections and Its Relationship with socio-demographics and Hygienic Habits among Male Primary Schoolchildren in Al-Ahsa, Saudi Arabia

Objective: To investigate the prevalence of different intestinal parasitic infection among male primary schoolchildren in Al-Ahsa, Saudi Arabia, and to explore the possible relative socioeconomic, environmental and behavioural sanitary correlates. Methods: A cross-sectional descriptive study was performed. A total of 1289 male students aged from 7 to 12 years were selected randomly from 20 urban and 12 rural primary schools by multistage sampling method. Data collection was carried out by self administered questionnaire form to the parents/guardians of students and included inquires about socio-demographics, environmental conditions, and behavioural sanitary habits. Stool analysis was carried out to examine the presence of intestinal parasitic infections. Results: Overall prevalence of parasitic infections was 27.2%, more among rural students. Frequently encountered infections included Entamoeba histolytica/dispar (8.2%), Giardia lamblia (6.5%), Entamoeba coli (4.0%) and Enterobius vermicularis (1.6%). Logistic regression revealed that lower maternal educational level and occupational status, low family income, big family size, poor personal hygienic practices and positive history of previous intestinal infections among family members increased the likelihood of infections. Conclusions: Although of low magnitude, intestinal parasitic infections still represent a public health concern among male schoolchildren in Al-Ahsa region. Socio-demographic and poor personal hygienic habits are the main predictors for these infections.

Preparation and evaluation of periodontal films based on polyelectrolyte complex formation.

Abstract Local intra-pocket drug delivery devices can provide an effective concentration of the antimicrobial agent at the site of action with avoidance of undesirable side effects. This study explored the application of chitosan-alginate and chitosan-pectin polyelectrolyte complex (PEC) films as drug release regulators for tetracycline HCl (Tc) to treat periodontal pockets. Periodontal films with 1:1 Tc:PEC ratio were prepared using 1:1 chitosan (Ch) to sodium alginate (A) or 1:3 Ch to pectin (P). The scanning electron microscope showed acceptable film appearance and differential scanning calorimetry analysis confirmed complex formation. The in vitro release studies for both films showed a burst drug release, followed by prolonged release for 70 h. A prolonged antibacterial activity of both films against Staphylococcus aureus ATCC 6538 was observed over a period of 21 days. Aging studies indicated that the five months storage period in freezer did not significantly influence the drug release profile or the antibacterial activity of both films. Clinical evaluation showed a significant reduction in pocket depth (p < 0.0001) to their normal values (≤3 mm). PEC films could be exploited as a prolonged drug release devices for treatment of periodontal pockets.

Dissemination of multiple carbapenem-resistant clones of Acinetobacter baumannii in the Eastern District of Saudi Arabia

It has previously been shown that carbapenem-resistant Acinetobacter baumannii are frequently detected in Saudi Arabia. The present study aimed to identify the epidemiology and distribution of antibiotic resistance determinants in these bacteria. A total of 83 A. baumannii isolates were typed by pulsed-field gel electrophoresis (PFGE), and screened by PCR for carbapenemase genes and insertion sequences. Antibiotic sensitivity to imipenem, meropenem, tigecycline, and colistin were determined. Eight different PFGE groups were identified, and were spread across multiple hospitals. Many of the PFGE groups contained isolates belonging to World-wide clone 2. Carbapenem resistance or intermediate resistance was detected in 69% of isolates. The blaVIM gene was detected in 94% of isolates, while blaOXA–23–like genes were detected in 58%. The data demonstrate the co-existence and wide distribution of a number of clones of carbapenem-resistant A. baumannii carrying multiple carbapenem-resistance determinants within hospitals in the Eastern Region of Saudi Arabia.

Clonal diversity of Acinetobacter baumannii from diabetic patients in Saudi Arabian hospitals.

Carbapenem-resistant Acinetobacter baumannii (CR-AB) represents a major health-care problem, causing high rates of morbidity and mortality. This study investigated the clonality of CR-AB isolated from diabetic patients from different regions in Saudi Arabia, as well as the relatedness of the β-lactamase genes. A total of 64 non-repetitive CR-AB clinical isolates were collected from 16 different regions in Saudi Arabia from intensive care patients. Isolates were identified phenotypically by the Vitek 2 compact system and genotypically by amplification of the blaOXA-51-like gene. The target sequences were amplified by PCR and the clonal diversity of the isolates was explored by PFGE. Resistance studies revealed that the prevalence of imipenem and meropenem resistance was 92% and 96%, respectively, while the vast majority of the isolates were susceptible to tigecycline and colistin. In addition, blaVIM and blaOXA-23 were the most prevalent genes in the isolates under investigation, while ISAba1 was the most dominant insertion sequence. PFGE results showed 13 clusters; clone H was dominant, comprising 20 isolates from four hospitals, followed by clones C and F, comprising 11 isolates each from three and six hospitals, respectively. Moreover, the current study signified the clonal diversity of CR-AB in Saudi Arabia and showed the ability of some clones to infect patients in many different cities.

A Framework for a Competency Based Medical Curriculum in Saudi Arabia

Background: We recently adopted a competency based curriculum based on the CanMEDs model. This shift required the cross-mapping of all key CanMEDs competencies with the competencies for higher education in Saudi Arabia as per the Saudi National Commission for Academic Accreditation & Assessment (NCAAA) guidelines. Objectives: To formulate competencies for our curriculum and to create a framework aligned with NCAAA, CanMEDs and Saudi Meds. Methods: After finalization of program outcomes, the program goals were cross-mapped with CanMEDs and Saudi Meds competencies and then the CanMEDs competencies were reverse mapped with our outcomes. Finally benchmarking of outcomes with the programs of the Universities of Manitoba and Toronto was done. Results: We were able to cross-map and match major outcomes of our program with both the CanMEDs and the Saudi Meds frameworks, ensuring that the outcomes are in line with NCAAA, CanMEDs and Saud Meds. Also, our program objectives were bench marked with two of the Canadian medical schools. Conclusion: We propose that our framework can be a model for other universities in Saudi Arabia to consider when shifting to a competency based curriculum.

ESBL-producing E. coli and K. pneumoniae in Al-Ahsa, Saudi Arabia: antibiotic susceptibility and prevalence of blaSHV and blaTEM

Introduction Antibiotic resistance is a serious problem in clinical medicine [1]. Production of inactivating enzymes is one of the most common mechanisms by which different microorganisms can acquire resistance against several antimicrobial agents, especially βlactams. Extended spectrum β-lactamases (ESBLs) mediate resistance against different broad spectrum cephalosporins and monobactams [2]. There are different types of ESBLs, namely TEM, SHV, and CTX, but most of these enzymes are mutants of TEM1, TEM2, and SHV1 that are caused by point mutation of the original encoding genes [3]. These genes are carried on plasmids that may harbor other genes encoding resistance against different antimicrobial agents. These plasmids are easily transferred among different bacterial species, leading to widespread of multi-drug resistant bacteria [4]. E. coli and Klebsiella spp. are the most common producers of ESBLs and are responsible for many hospitaland community-acquired infections. Due to the extensive use of cephalosporins for treatment of different bacterial infections, the prevalence of ESBLproducing bacteria became significantly high worldwide [5]. In Saudi Arabia, limited data are available on the susceptibility patterns of ESBL-producing bacteria. The aim of the current study was to evaluate the susceptibility of ESBL-producing K. pneumoniae and E. coli clinical isolates to different antimicrobial agents and to estimate the prevalence of blaSHV and blaTEM in the tested isolates.

Antimicrobial activity of commercial "antibacterial" handwashes and soaps

Spiny keratoderma and porokeratosis have similar histologic features. But spiny keratoderma does not show vacuolization and/or dyskeratosis of underlying spinous layer, cornoid lamella, or lymphocytic infiltration of the papillary dermis as seen in porokeratosis. Differentiation between punctate keratoderma and porokeratosis is essential because the latter is associated with basal and squamous cell carcinoma.

Fungal Vaccines: Recent Trends

The concept that fungal vaccines could be useful is no longer merely an illusion. There is a need for either preventive or therapeutic vaccines to curb the rising incidence of fungal infections. With the advent of AIDS and the use of increasingly potent immunosuppressive therapies to combat autoimmune diseases, malignancies, and transplant rejection, the incidence of opportunistic fungal infection has increased. To combat such conditions, an appropriate fungal vaccine needs to be developed apart from antifungal therapy. Prior to the development of any fungal vaccine, one should know the mechanism of immune response elicited by a fungal infection, i.e., both humoral and cell-mediated. In addition, there are dormant states of infection. Because a high proportion of the fungal diseases are thought to involve reactivation of dormant foci, therapeutic immunization becomes a compelling approach to eliminate dormant organisms or to heal active infection, especially in life-threatening disease. In animal models of fungal infection, protective responses have been elicited with vaccines composed of whole organisms, soluble cell-free fractions, purified proteins, glucans, and nucleic acids. Methods to boost the immune response to vaccination include the use of adjuvants and antigen-loaded dendritic cells (DCs). The recognition that antibodies are effective against fungal pathogens has spawned interest in developing vaccines that elicit antibody-mediated protection. Recently, a novel polysaccharide–protein conjugate vaccine that uses the algal antigen laminarin was shown to elicit antibodies to β-glucan in fungal cell walls, and to mediate protection against both experimental candidiasis and aspergillosis. Conventional methodologies of vaccination are giving way to newer approaches, of which DNA vaccination represents one of the most exciting, not only for fungal diseases but also for all diseases mediated by pathogenic microbes. The primary method at present is to use plasmid-encoded DNA that does not replicate and is delivered by intramuscular injection producing Th1 response, thus clearing the pathogenic fungi. DNA vaccination holds promise in the field of mycology. One of the major controversies and challenges surrounding fungal vaccination is the case of the immunocompromised host. The challenge will be to enhance the effect of a vaccine when the immune system is dysfunctional. One approach would be to link the vaccine with attempts to restore the integrity of the immune system, i.e., the delivery of a vaccine in combination with cytokine or cytokines that are known to enhance the immune system. Another approach would be to link the administration of the vaccine with infusion of immunocompetent T cells or B cells to promote the immunogenicity of the vaccine.Therefore, newer methods are necessary to identify who is at highest risk, in order to determine who would benefit the most from vaccination or a combination of vaccination and immunorestorative therapy.