Middle East respiratory syndrome coronavirus (MERS-CoV): Impact on Saudi Arabia, 2015

Middle East respiratory syndrome is the acute respiratory syndrome caused by betacoronavirus MERS-CoV. The first case of this disease was reported from Saudi Arabia in 2012. This virus is lethal and is a close relative of a severe acute respiratory syndrome (SARS), which is responsible for more than 3000 deaths in 2002–2003. According to Ministry of Health, Saudi Arabia. The number of new cases is 457 in 2015. Riyadh has the highest number of reports in comparison to the other cities. According to this report, males are more susceptible than female, especially after the age of 40. Because of the awareness and early diagnosis the incidence is falling gradually. The pre-existence of another disease like cancer or diabetic etc. boosts the infection. MERS is a zoonotic disease and human to human transmission is low. The MERS-CoV is a RNA virus with protein envelope. On the outer surface, virus has spike like glycoprotein which is responsible for the attachment and entrance inside host cells. There is no specific treatment for the MERS-CoV till now, but drugs are in pipeline which bind with the spike glycoprotein and inhibit its entrance host cells. MERS-CoV and SAR-CoV are from the same genus, so it was thought that the drugs which inhibit the growth of SARS-CoV can also inhibit the growth of MERS-CoV but those drugs are not completely inhibiting virus activity. Until we don’t have proper structure and the treatment of MERS-CoV, We should take precautions, especially the health care workers, Camel owners and Pilgrims during Hajj and Umrah, because they are at a higher risk of getting infected.     

Laboratory Investigation and Phylogenetic Analysis of an Imported Middle East Respiratory Syndrome Coronavirus Case in Greece

Rapid and reliable laboratory diagnosis of persons suspected of Middle East respiratory syndrome coronavirus (MERS-CoV) infection is important for timely implementation of infection control practices and disease management. In addition, monitoring molecular changes in the virus can help elucidate chains of transmission and identify mutations that might influence virus transmission efficiency. This was illustrated by a recent laboratory investigation we conducted on an imported MERS-CoV case in Greece. Two oropharyngeal swab specimens were collected on the 1^st and 2^nd day of patient hospitalization and tested using two real-time RT-PCR (rRT-PCR) assays targeting the UpE and Orf-1a regions of the MERS-CoV genome and RT-PCR and partial sequencing of RNA-dependent RNA polymerase and nucleocapsid genes. Serum specimens were also collected and serological test were performed. Results from the first swab sample were inconclusive while the second swab was strongly positive for MERS-CoV RNA by rRT-PCR and confirmed positive by RT-PCR and partial gene sequencing. Positive serologic test results further confirmed MERS-CoV infection. Full-length nucleocapsid and spike gene coding sequences were later obtained from the positive swab sample. Phylogenetic analysis revealed that the virus was closely related to recent human-derived MERS-CoV strains obtained in Jeddah and Makkah, Saudi Arabia, in April 2014 and dromedary camels in Saudi Arabia and Qatar. These findings were consistent with the patient’s history. We also identified a unique amino acid substitution in the spike receptor binding domain that may have implications for receptor binding efficiency. Our initial inconclusive rRT-PCR results highlight the importance of collecting multiple specimens from suspect MERS-CoV cases and particularly specimens from the lower respiratory tract.     

A pandemic risk assessment of middle east respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia

Since the initial emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, a high incidence rate has been observed in Saudi Arabia. This suggests that the country is at continuous risk. The epidemic level of MERS-CoV infection was examined in Saudi Arabia by the Susceptible-Infectious-Recovered (SIR) model using a Bayesian approach for estimation of time dependent reproduction number (R) across a two-year interval (May, 2013-May, 2015) in five defined clusters, followed by sensitivity analysis of the most significant clusters. Significant MERS-CoV peaks were detected in the period between March and May of each year. Moreover, MERS-CoV infection was highlighted in western (40.8%) and central (31.9%) regions, followed by eastern region (20%). The temporal-based Bayesian approach indicated a sub-critical epidemic in all regions in the baseline scenario (R: 0.85–0.97). However, R potential limit was exceeded in the sensitivity analysis scenario in only central and western regions (R: 1.08–1.12) that denoted epidemic level in those regions. The impact of sporadic cases was found relatively insignificant and pinpointed to the lack of zoonotic influence on MERS-CoV transmission dynamics. The results of current study would be helpful for evaluation of future progression of MERS-CoV infections, better understanding and control interventions.     

Waterpipe smoking: not necessarily less hazardous than cigarette smoking

Context

Cigarette smoking has declined over the last years in modern countries. On the contrary, waterpipe smoking has increased, especially among young people visiting waterpipe bars. Unfortunately, most waterpipe smokers seem to know little about the possible cardiovascular and other health consequences of waterpipe smoking.

Objective

To describe by narrative literature review the known adverse consequences for the human body caused by smoking the waterpipe compared with the consequences of smoking normal cigarettes. Also, to get a picture of public awareness of these consequences as deducted from the literature and a small new survey in the Netherlands.

Results/Conclusions

Tobacco smoking is associated with serious adverse (cardiovascular) health effects, and there is no evidence that these effects are less serious if a waterpipe is used. The increasing use together with the limited amount of awareness and attention for the possible health consequences of smoking the waterpipe is worrisome. Especially considering the increasing acceptance and use of the waterpipe among the youth. Therefore we recommend more systematic research into the possible health hazards of waterpipe smoking. In the meantime education campaigns and materials are needed to raise public awareness on the possible health risks of waterpipe use.     

Gastric cancer & prospects of cancer in Saudi Arabia peninsula

Gastric cancer is classified to be an aggressive disease with poor treatment outcome, as most cases remain undetected until later stages, wherein surgery and few chemotherapeutics become the only recommended treatment course. The process of cancer development is multistep involving many stages and types of precancerous lesions, and hence, routine monitoring becomes a necessity in those detected with these or exposed to risk factors. Studying the pattern of gastric cancer for any geographical region is also important to control mortality and focus on implementation of efficient management and treatment guidelines. The cause for gastric cancer can be genetic, racial as well as environmental, and hence the pattern of this malignancy differs across geographical regions and between the developing and the developed nations. In case of the Kindgom of Saudi Arabia, very few hospital-based reports have been published highlighting the pattern of gastric cancer, and the associated incidence and mortality rates. However, classified to be one of the most crucial cancer forms in Saudi Arabia, research pertaining to epidemiology, presentation and pathological features are limited. Studying gastric cancer occurrence from public health viewpoint is important also because eradication of causative agents like those that H. pylori has also shown been not reduce the risk of cancer development among individuals with atrophic metaplastic gastritis. In case of Saudi Arabia, many inherent risks for this malignancy exists like waterpipe smoking and shift in diet pattern from the traditional Mediterranean diet. Our review focusses on pattern of gastric cancer on a global scale in comparison to scenario in Saudi Arabia. The aim is to encompass all of the less stressed upon facts about this malignancy in the Kingdom, paving way for future work in this regards.     

Levels of pesticide residues in breast milk and the associated risk assessment

The aim of this study was to determine the types and levels of organochlorine pesticides (OCPs) present in the human milk collected from cities in eastern and central Saudi Arabia. This study is part of assessment of various persistent organic pollutants (POPs) in human milk in four cities of eastern and central Saudi Arabia, namely, Riyadh, Al-Kharj, Al-Jobail and Al-Dammam. Milk samples were collected from 50 donors according to the WHO/UNEP protocol for monitoring human milk for POPs. The OCPs in each of the 50 milk samples were analyzed using as triple quadrupole gas chromatography mass spectrometry-mass spectrometry detection (GC–MS/MS). Quality assurance included the analysis of blank, spiked and reference samples. Sixteen different OCPs were identified namely: aldrin, dieldrin, endrin, hexachlorobenzene, alpha, beta, gamma and delta hexachlorocycohexame, pp’-,op’-DDT, pp’-DDE, pp’-DDD, alpha and gamma chlordane, heptachlor, mirex and methoxychlor. The results of the analysis OCPs in human milk samples indicated that the tested positive samples for one or more pesticide at the limits of determination used in this study. As required by the Stockholm Convention on POPs, the levels of certain POPs in human milk will serve as an indicator of the effectiveness of the treaty in eliminating or reducing emissions of selected POPs. This study contributes to that effort by providing seline data on current levels of OPCs in human milk in Saudi Arabia.     

Coronavirus and co-infections: A Saudi Arabian perspective

Mortality due to infectious diseases continues to rise globally, despite advances in antimicrobial therapy and supportive care. This is evident with the occurrence of coronavirus disease 2019 (COVID-19) pandemic, instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Saudi Arabia, an eminent country within the Arab region, has had significant impact during global pandemics, concomitant with the fact that millions of Muslims travel to Saudi Arabia for pilgrimages every year. Herein, we discuss the significance of SARS-CoV-1, SARS-CoV-2, as well as the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia with particular reference to global transmission and/or emergence of new variants due to genetic mixing of different strains. Furthermore, we also discuss the role of Saudi Arabia with reference to novel emerging infectious diseases and re-emerging infections, such as Ebola, zika, and monkeypox, as well as in the context on coinfections. Future strategies to limit the spread of viral infections and the pivotal role of Saudi Arabia, are deliberated upon.     

The waterpipe: An emerging global risk for cancer

Tobacco smoking continues to be the leading preventable cause of morbidity and mortality worldwide. Each year more than 5 million smokers die prematurely because of their habit wreaking havoc on the welfare of families and communities worldwide. While cigarettes remain the main tobacco killer worldwide, for many youth tobacco use and addiction is maintained by means other than cigarettes. In particular, over the past decade, waterpipe smoking (a.k.a. hookah, shisha, narghile) has become increasingly popular among youth in the Middle East, and is rapidly spreading globally. Available evidence suggests that waterpipe smoking is associated with many of the known risks of tobacco smoking, particularly cancer. Despite these worrisome signs, policies and interventions to address this emerging public health problem have been lagging behind. In this short review I discuss briefly the evidence generated mostly in the past decade about the global spread of waterpipe smoking and its cancer risk potential.     

A Comparative Study of Clinical Presentation and Risk Factors for Adverse Outcome in Patients Hospitalised with Acute Respiratory Disease Due to MERS Coronavirus or Other Causes

Middle East Respiratory syndrome (MERS) first emerged in Saudi Arabia in 2012 and remains a global health concern. The objective of this study was to compare the clinical features and risk factors for adverse outcome in patients with RT-PCR confirmed MERS and in those with acute respiratory disease who were MERS-CoV negative, presenting to the King Fahad Medical City (KFMC) in Riyadh between October 2012 and May 2014. The demographics, clinical and laboratory characteristics and clinical outcomes of patients with RT-PCR confirmed MERS-CoV infection was compared with those testing negative MERS-CoV PCR. Health care workers (HCW) with MERS were compared with MERS patients who were not health care workers. One hundred and fifty nine patients were eligible for inclusion. Forty eight tested positive for MERS CoV, 44 (92%) being hospital acquired infections and 23 were HCW. There were 111 MERS-CoV negative patients with acute respiratory illnesses included in this study as “negative controls”. Patient with confirmed MERS-CoV infection were not clinically distinguishable from those with negative MERS-CoV RT-PCR results although diarrhoea was commoner in MERS patients. A high level of suspicion in initiating laboratory tests for MERS-CoV is therefore indicated. Variables associated with adverse outcome were older age and diabetes as a co-morbid illness. Interestingly, co-morbid illnesses other than diabetes were not significantly associated with poor outcome. Health care workers with MERS had a markedly better clinical outcome compared to non HCW MERS patients.     

The contribution of gastrointestinal microbiota in the existence of type 2 diabetes in Saudi Arabia: Current information and perspectives

Diabetes mellitus (DM) is a genuine international health issue, with Saudi Arabia ranking among the top nations with the largest diabetes prevalence. Following the International Diabetes Federation (IDF), 3.8 million Saudi Arabian people had diabetes in 2014. The occurrence of diabetes in Saudi Arabia is likely to elevate due to the current trend in the general rise of socio-economic status, which positively correlates with diabetes prevalence. The incidence of Type 2 diabetes (T2D) is highest within the age group ≥ 45 years, especially in Riyadh and Jeddah, the metro cities of Saudi Arabia. Previous studies have shown that the incidence of T2D is larger in urban regions (25.5%) than in rural regions (19.5%). Both Riyadh and Jeddah are urban areas with different food habits and locations in Saudi Arabia. Recent studies have indicated the correlation between altered alimentary tract microbiota with type 2 diabetes. Gut microbiota plays a critical role in degrading undigested dietary compounds and releasing a vast array of metabolites that directly and indirectly affects host health. In the current review, we shed light on the state of information on the realization of the types and functions of the alimentary tract microbiome and how it plays a causative agent in the up growth of T2D.     

Intestinal parasitic infection among foreign housemaids in northwestern Saudi Arabia: A cross-sectional study

Owing to Saudi Arabia's high-income economy many Saudi families hire foreign housemaids. However, since the housemaids are potential carriers of intestinal parasites, hiring them increases the risk of transmission to the Saudi community. In this context, this study aimed to evaluate the prevalence of intestinal parasitic infections in foreign housemaids in northwestern Saudi Arabia. Using direct wet mount and concentration by flotation, the stool samples of 169 housemaids were examined, and eleven parasite species, six helminths and five protozoans, were detected. The overall prevalence of intestinal parasitic infection was 20.11% (34/169). Twelve cases were infected with one intestinal helminth, 12 were infected with one intestinal protozoan, and 10 had polyparasitism. The most common intestinal parasites were Cryptosporidium spp. (n = 10), hookworms (n = 7), and T. Trichiura (n = 7). The findings highlight that intestinal parasites present an important public health concern for foreign housemaids in Saudi Arabia. More vigilance is thus required, and periodic follow-up should be exercised throughout foreign housemaids' stay in the country.     

Prevalence of adenoviruses as ocular disease causatives in Saudi Arabia

Although Human Adenoviruses outbreaks are rare, there still could be a potential chance for those viruses to mutate and spread quickly in human populations with severe public health and socioeconomic consequences. Outbreaks often spread fairly quickly with considerable morbidity/mortality. Saudi Arabia’s geopolitical and religious significance bring with it, millions of pilgrims, and tourists yearly. This presents a significant potential for HAdVs epidemics. This review shows that even with the mushrooming serotypes and genotypes, the scholarly knowledge on the nature, structure, transmission, and management of HAdVs is already well-established. Significant research is ongoing on pharmacological interventions, which, presently remain speculative and lacking in effectiveness. This review similarly uncovers a shortage of literature, both recent and dated, on epidemic keratoconjunctivitis in either Saudi Arabia or the Middle East.     

Children Domestic Accidents Profile in Jazan Region,a call for new policies to improve safety of home environment

High-frequency home accidents draw more attention to the protection of our home environment. WHO has reported that home deaths were among the first 20 causes of death in the 0–14 age group worldwide in 2012. This innovative research was designed to examine children under 15 years of age at home, in 2018 in the Jazan area of Saudi Arabia. Data were collected retrospectively from 19 hospitals in the Jazan area of southern Saudi Arabia during the period from September to December 2019. Data showed that, for the first time, the incidence rate of child home incidents in the Jazan area was 7.4 per 100 children in 2018. Falling, burning, swallowing foreign bodies, and domestic violence were among the most common types of injuries recorded. Home safety continued to be one of the main public health issues in the area with 29,812 home injuries in 1 year, 36.8% bone fractures, 31.6% body distortions, 9.2% distortion fractures and 5.3% child impairment. This study is a crucial step towards addressing the severity of home accidents in Saudi Arabia; troubling figures need further analysis, regular registry, informed policies and well-planned action to avoid these types of accidents.     

Occurrence and distribution of tomato seed-borne mycoflora in Saudi Arabia and its correlation with the climatic variables

One hundred samples of tomato seeds were collected in 2011 and 2012 from tomato-cultivated fields in Saudi Arabia and screened for their seed-borne mycoflora. A total of 30 genera and 57 species of fungi were recovered from the collected seed samples using agar plate and deep-freezing blotter methods. The two methods differed as regards the frequency of recovered seed-borne fungi. Seven fungi among those recovered from tomato seeds, which are known as plant pathogens, were tested for their pathogenicity and transmission on tomato seedlings. The recovery rate of these pathogens gradually decreased from root up to the upper stem, and did not reach to the stem apex. The distribution of tomato seed-borne fungi was also investigated throughout Saudi Arabia. In this concern, Al-Madena governorate recorded the highest incidence of fungal flora associated with tomato seeds. The impact of meteorological variables on the distribution of tomato seed-borne mycoflora was explored using the ordination technique (canonical correspondence analysis). Among all climatic factors, relative humidity was the most influential variable in this regard. Our findings may provide a valuable contribution to our understanding of future global disease change and may be used also to predict disease occurrence and fungal transfer to new uninfected areas.     

Identification of Tomato black ring virus from tomato plants grown in greenhouses in Saudi Arabia

A survey was conducted in Al-Kharj governorate, Riyadh region to identify viruses causing variety of virus-like symptoms on tomato plants. A total of 135 samples were collected from symptomatic tomato plants. Symptoms included mottling, deformation, necrosis of leaves and fruits. Eighteen viruses were tested by DAS-ELISA. Tomato black ring virus (TBRV) was the virus of concern as it was not detected in Saudi Arabia before and was detected in 52.6% of the collected samples in this study. RT-PCR was used to confirm detection of TBRV and to sequence the amplified products to determine molecular characteristics of this virus. In the host range test study that was performed using a purified isolate of TBRV, sixteen out of the twenty two tested plants showed symptoms. Brassica oleracea was not infected by this virus. Gel electrophoreses (2% agarose) yielded fragments of 978 bp of coat protein gene of TBRV. Nucleotide sequences of purified RT-PCR products for three TBRV Saudi isolates were deposited in the GenBank with the following accession numbers MT274656, MT274657, and MT274658. These isolates of TBRV indicated a close Phylogenetic relationship of (99–100%) among themselves and with five isolates from Poland (95–98%) but a distant relationship of 85% with isolates from England and Lithuania deposited in the GenBank. This is the first report for detection and molecular characterization of TBRV infecting tomato plants in Saudi Arabia.     

Molecular characterization of Haloxylon salicornicum Moq. in Saudi Arabia

The purpose of write this paper is to study the genetic variability between and within different Halosylon salicornicum populations in different regions of Saudi arabia Kingdom, using the determination of genetic fingerprint method by Inter Simple Sequence Repeat (ISSR). Because this plant highly vulnerable to depletion by humans in all places of existence, it is an economically valuable plant where raft is an important pastoral resource in central and northern Arabia. It also has multiple medical uses. It is a plant that can withstand abiotic stresses such as drought and high temperature, making it suitable for cultivation in marginal lands in arid areas. All of the above was a catalyst for plant characterization using a number of Haloxylon salicornicum samples, collected from different regions of Saudi Arabia to find out the genetic variation of species, genetic diversity in knowing the plant community is an essential step towards the design of programs for plant breeding as well as preserved from extinction. This was done using the Inter Simple Sequence Repeat (ISSR). The results showed there were significant differences and molecular differences between plant samples. The average polymorphism between the genetic inputs of the studied Haloxylon salicornicum samples was 53.7%, and this percentage of genetic variability is significant for progress in growth and plant regeneration in the face of unfair practices against it, in addition to adverse environmental conditions in most years. As evidenced by the percentage of matrix similarity. The ISSR results indicate that the genotype between five different regions genotypes ranged from 0.365 to 0.527, indicating that Haloxylon salicornicum is a local plant capable of surviving and adapting to the environmental conditions in Saudi Arabia through the positive change in the genetic makeup of this species.     

A Truncated Receptor-Binding Domain of MERS-CoV Spike Protein Potently Inhibits MERS-CoV Infection and Induces Strong Neutralizing Antibody Responses: Implication for Developing Therapeutics and Vaccines

An emerging respiratory infectious disease with high mortality, Middle East respiratory syndrome (MERS), is caused by a novel coronavirus (MERS-CoV). It was first reported in 2012 in Saudi Arabia and has now spread to eight countries. Development of effective therapeutics and vaccines is crucial to save lives and halt the spread of MERS-CoV. Here, we show that a recombinant protein containing a 212-amino acid fragment (residues 377-588) in the truncated receptor-binding domain (RBD: residues 367–606) of MERS-CoV spike (S) protein fused with human IgG Fc fragment (S377-588-Fc) is highly expressed in the culture supernatant of transfected 293T cells. The purified S377-588-Fc protein efficiently binds to dipeptidyl peptidase 4 (DPP4), the receptor of MERS-CoV, and potently inhibited MERS-CoV infection, suggesting its potential to be further developed as a therapeutic modality for treating MERS-CoV infection and saving the patients’ lives. The recombinant S377-588-Fc is able to induce in the vaccinated mice strong MERS-CoV S-specific antibodies, which blocks the binding of RBD to DPP4 receptor and effectively neutralizes MERS-CoV infection. These findings indicate that this truncated RBD protein shows promise for further development as an effective and safe vaccine for the prevention of MERS-CoV infection.     

Saudis’ Attitudes toward Chemical Pollution of the Environment,Al-Baha Region,Saudi Arabia

The results of a public opinion survey were used to assess the variation in attitudes toward the chemical pollution of the environment among Saudi residents of the Al-Baha region, Saudi Arabia. A total of 17 statements were given to respondents, addressing general opinions about health risks from chemical pollution. The main findings of this study are: (1) Most Saudis consider the place where they live unhealthful; (2) there was substantial concern about exposure to chemicals with more than 77% of respondents indicating a conscious effort to avoid chemicals in their daily life; (3) chemicals were seen as predominantly being “dangerous” and leading to more harm than good, and they see that the more a person is exposed to chemicals causing cancer the more likely he/she will get cancer; (4) Respondents see that chemicals in the environment are less harmful than chemicals from lifestyle factors and they disagree with the statement that “use of chemicals has improved their health more than it has harmed them”; (5) Saudis are not prepared to accept some health risks in order to benefit the economy. The study did not find any potential relationship between gender, age range, place of residence, and education level and attitude toward chemical pollution among Saudi residents.