Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross –sectional study

ObjectiveIn this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia.MethodsA total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination.ResultsThe mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm²) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants’ followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10– 0.96 (p = 0.015).ConclusionThis study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.     

Sequence analysis of sub-genotype D hepatitis B surface antigens isolated from Jeddah,Saudi Arabia

Little is known about the prevalence of HBV genotypes/sub-genotypes in Jeddah province, although the hepatitis B virus (HBV) was identified as the most predominant type of hepatitis in Saudi Arabia. To characterize HBV genotypes/sub-genotypes, serum samples from 15 patients with chronic HBV were collected and subjected to HBsAg gene amplification and sequence analysis. Phylogenetic analysis of the HBsAg gene sequences revealed that 11 (48%) isolates belonged to HBV/D while 4 (18%) were associated with HBV/C. Notably, a HBV/D sub-genotype phylogenetic tree identified that eight current isolates (72%) belonged to HBV/D1, whereas three isolates (28%) appeared to be more closely related to HBV/D5, although they formed a novel cluster supported by a branch with 99% bootstrap value. Isolates belonging to D1 were grouped in one branch and seemed to be more closely related to various strains isolated from different countries. For further determination of whether the three current isolates belonged to HBV/D5 or represented a novel sub-genotype, HBV/DA, whole HBV genome sequences would be required. In the present study, we verified that HBV/D1 is the most prevalent HBV sub-genotype in Jeddah, and identified novel variant mutations suggesting that an additional sub-genotype designated HBV/DA should be proposed. Overall, the results of the present HBsAg sequence analyses provide us with insights regarding the nucleotide differences between the present HBsAg/D isolates identified in the populace of Jeddah, Saudi Arabia and those previously isolated worldwide. Additional studies with large numbers of subjects in other areas might lead to the discovery of the specific HBV strain genotypes or even additional new sub-genotypes that are circulating in Saudi Arabia.     

Investigation of gut microbial communities associated with indigenous honey bee (Apis mellifera jemenitica) from two different eco-regions of Saudi Arabia

The microbial communities associated with the alimentary tract of honey bees are very important as they help with food digestion, provide essential nutrients, protect the host from pathogens, detoxify harmful molecules, and increase host immunity. In this study, the structural diversity of the gut microbial communities of native honey bees, Apis mellifera jemenitica from two different geographical regions (Riyadh and Al-Baha) of Saudi Arabia was analyzed by culture-dependent methods and 16S ribosomal RNA (rRNA) gene sequencing. In this study, 100 bacterial isolates were cultivated and phylogenetic analyses grouped them into three phyla: Proteobacteria, Firmicutes, and Actinobacteria. Bacteria in the phylum Proteobacteria were the most dominant (17 species), followed by Firmicutes (13 species) and Actinobacteria (4 species). Some of the identified bacteria (Citrobacter sp., Providencia vermicola, Exiguobacterium acetylicum, and Planomicrobium okeanokoites) were reported for the first time in the genus Apis, while others identified bacteria belonged to the genera Proteus, Enterobacter, Bacillus, Morganella, Lactobacillus, and Fructobacillus. To the best of our knowledge, this is the first study on the gut microbiota of the local honey bees in Saudi Arabia.     

Genotyping of Toxoplasma gondii from Rats (Rattus rattus) in Riyadh,Saudi Arabia

Toxoplasma 3 main clonal lineages are designated as type I, II, and III; however, atypical and mixed genotypes were also reported. This study was conducted for detection of Toxoplasma gondii genotypes in rats (Rattus rattus) in Riyadh region, Saudi Arabia. PCR test on T. gondii B1 gene was conducted on ELISA IgM positive samples for confirmation of the infection. However, genetic analysis of the SAG2 locus was performed to determine T. gondii genotypes using PCR-RFLP technique. PCR test on T. gondii B1gene showed that 22 (81.5%) out of the 27 ELISA IgM positive samples have T. gondii DNA. Genotypic analysis shows that, of the total 22 PCR positive samples, only 13 (59.1%) were of type II, 7 (31.8%) were of type III, and 2 (9.1%) were of an unknown genotype. It is obvious that the prevalence of both type II and III is high in rats. No reports have been available on T. gondii genotypes among rats in Riyadh region, and only little is known about its seroprevalence in rats. Future studies on T. gondii genotypes in rats using multi-locus markers is needed in Riyadh region, Saudi Arabia for better understanding of T. gondii pathogenesis and treatment in humans and animals.     

Preference of sweeteners among Saudi diabetes patients from a tertiary health care centre in Riyadh,Saudi Arabia

BackgroundChoice of sweetening options can influence glyceamic control among patients with diabetes. This study aims to investigate the preference of added sweeteners for Saudi patients with diabetes, factors associated with the choice of sweeteners and the attitude of the patients towards the use of artificial sweeteners.MethodsThis was a cross-sectional study conducted at King Saud University Medical City in Riyadh, Saudi Arabia and targeting Saudi patients with type 2 diabetes mellitus. Data was collected via personal interviews accessing medical records of interviewed patients. Patients were asked about consumption of sweeteners and types of consumed soft drinks on daily basis. Bi-variate analysis of the associations between choice of sweeteners and patients characteristics was performed and followed by binary logistic regression to adjust for potential confounders such as age, gender, and education level.ResultsA total of 302 Saudi diabetic patients were recruited in this investigation. Among this sample, frequency of patients reporting weekly consumption of white sugar was the highest (57%), followed by honey (26%) and artificial sweeteners (12% for powder form and 10.5% for tablets). Consumption of white sugar was significantly more frequent among patients with higher level of Body Mass Index (BMI) (P value < 0.05). The frequency of using honey was higher among females while consumption of either sugared or low calorie soft drinks was significantly higher among male patients (P values < 0.05). Upon asking the patients about their attitude towards artificial sweeteners, only 25% of the sample agreed that their use can aid in reduction of caloric intake while 35% of the sample agreed that artificial sweeteners can be harmful to the body.ConclusionsAmong this sample of type 2 diabetes patients, the frequency of white sugar and honey use as a sweetening option is high. These findings generate the need for further research to investigate the effectiveness of health education and nutritional advice among diabetes patients attending similar clinical settings in Saudi Arabia.     

Prevalence of antibodies to Toxoplasma gondii in horses in Riyadh Province, Saudi Arabia

The aim of the present study was to determine the seroprevalence of Toxoplasma gondii in horses used for sporting purposes in the Province of Riyadh, Saudi Arabia. In total, 266 serum samples from clinically healthy horses were analyzed for anti- T. gondii antibodies using the Sabin-Feldman dye test. Antibodies to T. gondii were found in 84 (31.6%) horses, with specific titers of 1∶16 (78 with a prevalence of 29.3%), 1∶64 (4 with a prevalence of 1.5%), and 1∶256 (2 with a prevalence of 0.8%). The number of seropositive horses in Shaqra (43.7%) was considerably higher than in other regions, with the lowest occurring in Al-Majmaah (11.0%). However, the differences in seroprevalence between the 6 locations were not statistically significant (P > 0.05). In contrast, the overall seroprevalence in Riyadh province was higher than that reported in other countries. Horses are not a direct source of infection for human toxoplasmosis in this region. Usually human infection is facilitated via cats, which are the reservoir hosts for this parasite.     

Human Alkhumra hemorrhagic Fever: Emergence,history and epidemiological and clinical profiles

Alkhumra hemorrhagic fever (AHF) is a severe, often fatal hemorrhagic disease in humans. It is caused by Alkhumra hemorrhagic fever virus (AHFV), a newly described flavivirus first isolated in 1995 in Alkhumra district, south of Jeddah City, Saudi Arabia. It is transmitted from infected livestock animals to humans by direct contact with infected animals or by tick bites. In the recent past, the incidence of AHF has increased, with a total of 604 confirmed cases have been reported in Saudi Arabia between 1995 and 2020. Yet, no specific treatment or control strategies have been developed and implemented against this infection. Hence, the likelihood of increased prevalence or the occurrence of outbreaks is high, particularly in the absence of appropriate prevention and control strategies. This narrative review presents an overview of the current knowledge and future concerns about AHF globally.     

Audit of stool analysis results to ensure the prevalence of common types of intestinal parasites in Riyadh region,Saudi Arabia

The objective of the current study was to determine the incidence of common types of parasites encountered in the Central Region of Saudi Arabia. The current study is a retrospective study which includes the results of 10427 stool sample and occult blood sample. The results obtained during last two years (2005–2007), were compared to the earlier reports on parasites in the Central as well as other regions of Saudi Arabia. Attempts were made to find out the cases of increasing and/or decreasing trend of parasite incidence and to locate any differences between the current study results and the earlier reports.Key words: Intestinal parasites, Stool, Blood, Riyadh region, Saudi Arabia     

Molecular characterization of the Fe‑hydrogenase gene marker in Trichomonas gallinae isolated from birds in Riyadh,Saudi Arabia

Trichomonas gallinae causes avian oropharyngeal trichomonosis. This pathogen affects a large number of bird species and may cause substantial economic losses to the poultry industry. Al-Azizia poultry market in Riyadh, Saudi Arabia is among the largest poultry markets in the Arabian Gulf. Birds traded in this market may be exposed to a variety of T. gallinae strains. Genetic diversity of T. gallinae among birds in the market was examined using Fe‑hydrogenase gene sequences. These sequences were amplified by PCR for twenty-nine isolates of T. gallinae from four different avian species, including 21 feral pigeons, one common mynah, three chickens, and four turkeys. Sequence analysis showed ten variant gene sequences. Nine sequences comprise a new subtype, including A(KSAF1), C(KSAF1) and C(KSAF3) with 34.48% (n = 10), 6.90% (n = 2), 6.90% (n = 2) of the isolates, respectively. Analyses also showed an additional five new sequences (KSAF1.1., KSAF2, KSAF13, KSAF14, KSAF15), representing 17.24% of the isolates. Subtype II (KSAF) was found in four feral pigeons (13.80%). To our knowledge, this report is the first to describe genotypes of T. gallinae from pigeons in Saudi Arabia using Fe‑hydrogenase gene sequences for subtyping. Subtype analysis infers the presence of multiple genotypes of T. gallinae in Saudi avian populations.     

Alkhurma hemorrhagic fever virus

Alkhurma hemorrhagic fever virus (AHFV) was first isolated in Jeddah, Saudi Arabia, in the 1990s from the blood of a butcher. Subsequently, the virus was recognized in many patients in Saudi Arabia and rarely from Egypt and Djibouti. In this review, we summarize the current literature on AHFV globally with special focus on Saudi Arabia.     

Endotoxemia,vitamin D and premature biological ageing in Arab adults with different metabolic states

There are limited studies on the association of endotoxin, a potent mediator of gut-derived inflammation and telomere length (TL). We investigated (1) the influence of adiposity on endotoxin and TL amongst Saudi adults according to type 2 diabetes mellitus (T2DM) status and (2) the influence vitamin D may have on TL attrition. Anthropometric data and fasting blood samples were taken from 775 Saudi adults visiting different primary care centers in Riyadh [387 T2DM and 388 non-T2DM]. TL, derived from peripheral blood mononuclear cells, was analyzed by Quantitative real-time polymerase chain reaction and circulating endotoxin levels by Limulus Amebocyte Lysate assay. Subjects were stratified based on obesity and T2DM status. A significant lower TL was observed in the non-obese T2DM group as compared with their non-obese, non-T2DM counterparts (p = 0.002). Significant inverse associations between TL, endotoxin and endotoxin activity were observed in the cohort with obesity. Regression analysis showed that endotoxin was a significant predictor for TL in all subjects and even after stratification according to subgroups; with variances perceived in circulating TL stronger among non-T2DM obese (10%; p = 0.003) than non-T2DM non-obese (12%; p = 0.007). Also, in the non-T2DM group, TL and HDL-cholesterol predicted 29% of the variances perceived in 25(OH)D (p < 0.001). Taken together these findings show that circulating endotoxin and 25(OH)D are associated with premature biological ageing influenced by adiposity and metabolic state; suggesting future intervention studies to manipulate gut microbiome and or vitamin D levels may offer ways to mitigate premature TL attrition.     

Association of diabetes and microbiota: An update

Diabetes is an emerging health condition globally and is suggested to have a direct connection with the gut microbiota that determine our metabolic outcomes. Sensitivity to insulin and glucose metabolism is normal in healthy people as compared to those people who cannot maintain their glucose metabolism. One of the reasons of the differences is that healthy people have different microbiome that leads to achieve more short chain fatty acids and make up more branched amino acids, while the gut microbiota of the other group of people are more likely to produce compounds that affects glucose metabolism. Herein, this review will present the research related to the impact of gut microbes on diabetes carried out in the past decade. The review focus on the relation between gut microbiota and Type-1 Diabetes (T1D), Type-2 Diabetes (T2D), and how gut microbiota could be an alternative therapy for treatment of diabetes.     

Consumption of Acidic Water Alters the Gut Microbiome and Decreases the Risk of Diabetes in NOD Mice

Infant formula and breastfeeding are environmental factors that influence the incidence of Type 1 Diabetes (T1D) as well as the acidity of newborn diets. To determine if altering the intestinal microbiome is one mechanism through which an acidic liquid plays a role in T1D, we placed non-obese diabetic (NOD)/ShiLtJt mice on neutral (N) or acidified H₂O and monitored the impact on microbial composition and diabetes incidence. NOD-N mice showed an increased development of diabetes, while exhibiting a decrease in Firmicutes and an increase in Bacteroidetes, Actinobacteria, and Proteobacteria from as early as 2 weeks of age. NOD-N mice had a decrease in the levels of Foxp3 expression in CD4⁺Foxp3⁺ cells, as well as decreased CD4⁺IL17⁺ cells, and a lower ratio of IL17/IFNγ CD4+ T-cells. Our data clearly indicates that a change in the acidity of liquids consumed dramatically alters the intestinal microbiome, the presence of protective Th17 and Treg cells, and the incidence of diabetes. This data suggests that early dietary manipulation of intestinal microbiota may be a novel mechanism to delay T1D onset in genetically pre-disposed individuals.     

Prevalence of non-strongyle gastrointestinal parasites of horses in Riyadh region of Saudi Arabia

This study aimed to provide recent data on the occurrence of non-strongyle intestinal parasite infestation in horses in the Riyadh region of Saudi Arabia as a basis for developing parasite control strategies. We conducted necropsy for 45 horses from September 2006 to November 2007 in the Riyadh region, Saudi Arabia. 39 out of 45 horses were infected with intestinal parasites with an infestation rate of 86.6%. Infestations with seven nematode species and two species of Gasterophilus larva were found. The most prevalent parasites were Strongyloides westeri (64.4%) and Parascaris equorum (28.8%) followed by Habronema muscae (22.2%). Trichostrongylus axei and Oxyuris equi were less common at (11.1%) and (8.8%), respectively. Habronema megastoma and Setaria equine were found in two horses only (4.4%). Gasterophilus intestinalis larvae were recovered from 39 horses (86.6%) and Gasterophilus nasalis larvae were found in 17 horses (37.7%). Season had a significant effect on the prevalence of P. equorum and G. nasalis, while age of horses had a significant effect only on the prevalence of P. equorum. The husbandry in Saudi Arabia appears to be conductive to parasites transmitted in stables or by insects rather than in pasture.     

Impact of novel coronavirus disease (COVID-19) lockdown on ambient air quality of Saudi Arabia

The outbreak of COVID-19 has spread globally affecting human activities but with improvement in ambient air quality. The first case of the virus in the Kingdom of Saudi Arabia was on the 2nd of March 2020. The impact of COVID-19 lockdown on the ambient air quality of the Kingdom of Saudi Arabia for the first time using data from nine cities was determined in this study. Hourly air quality data, based on concentrations of carbon monoxide (CO), particulate matter (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and ozone (O₃), and meteorological conditions (atmospheric temperature, relative humidity, and wind speed) of the nine cities studied were obtained from Saudi Arabian General Authority of Meteorology and Environmental Protection (GAMEP), for the period between January 2019 to May 2020. Significant variation (p < 0.05) was recorded for the five atmospheric pollutants across the cities before and during the lockdown, with lower concentrations during the lockdown except for the concentration of O₃ in Tabuk, Al Qasim, and Haql. This can be a result of NO and O₃ reaction, causing the inability of effective O₃ depletion. The percentage changes in concentrations of CO (33.60%) and SO₂ (44.16%) were higher in Jeddah; PM₁₀ (91.12%) in Riyadh, while NO₂ (44.35%) and O₃ (18.98%) were highest in Makkah. However, even though there was a decrease in pollutants concentrations during the lockdown, the concentrations for CO, PM₁₀, SO₂, NO_2, and O₃ were still above WHO 24 h and annual mean limit levels. The COVID-19 lockdown in the Kingdom of Saudi Arabia revealed the possibility of significant atmospheric pollutant reduction by controlling traffic, activities by industries, and environmentally friendly transportation programs such as green commuting programs.     

Screening for obesity in the offspring of first-cousin consanguineous couples: A Phase-I study in Saudi Arabia

Consanguineous or cousin marriages are very common in Saudi Arabia. However, owing to limited studies and insufficient knowledge about genetic diseases/disorders, many couples are unaware of the increased health risks for their offspring. Among the inherited and complex diseases from parents’ consanguinity, obesity is common; therefore, we examined the prevalence of obesity in the offspring of first-cousin consanguineous couples in Saudi Arabia. In this questionnaire-based study, 657 individuals (mean age = 18.7 ± 10.2 years; age range = 2–65 years) who were residing in Riyadh, Saudi Arabia participated. Among them, almost 90% were native Saudis. Participants mean body mass index (BMI) was 24.5 ± 9.1 kg/m2. Sex- stratified demographic details confirmed a significant association between age and BMI (p < .001). We confirmed that adolescents and adults were more prone to develop obesity. Adults and non-Saudi participants were three times more likely to develop obesity if they had first-cousin consanguineous parents than those who did not. Of the 30% of participants who were obese, 100 will be selected for Phase II, in which we plan to perform exome sequencing.     

Prevalence of dengue fever in Saudi Arabia: Jeddah as a case study

Dengue fever is widespread in tropical and subtropical regions, including Saudi Arabia. Aedes aegypti (Diptera: Culicidae) transmits dengue and many other diseases, including chikungunya and Zika. This study provides an overview of dengue fever in Saudi Arabia since the first case was recorded in the early 1990s. In addition, it focuses on the epidemiological situation in Jeddah as a case study to study the spatial distribution of dengue cases using Geographic Information Systems (GIS) techniques over 5 years, from 2019 to 2023. The first recorded case in Saudi Arabia was in October 1993; however, daily data indicates that 2023 is a major epidemic year. The number of infections has reached 4099 so far during the first half of the year, which indicates a significant increase compared to previous years. GIS analysis has unveiled the locations of high infection rates across multiple municipalities, commonly called hotspots, and identified areas where dengue cases remain relatively low. The Inverse Distance Weighted (IDW) tool was used to determine the severity of infection in different areas of Jeddah. The study concluded that factors such as temperature, rainfall, and septic tanks in areas that lack a proper sanitation network are the most contributing factors to the spread of disease vectors and, thus, dengue. Winter rainfall creates conducive breeding environments for dengue mosquito vectors, increasing transmission rates. On the other hand, summer heat accelerates the mosquito life cycle and enhances viral replication, heightening the risk of dengue transmission.     

Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile

Objectives

To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant.

Methods

A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated.

Findings

The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%.

Conclusion

Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.     

Blood parasites of livestock in certain Regions in Saudi Arabia

Blood samples from camels, sheep, goats and cattle from six Regions in Saudi Arabia were examined for blood parasites. Asir Region camels were disinfected while those of the Eastern, Jazan, Northern Frontiers, Riyadh and Tabouk Regions were infected with Trypanosoma evansi (5–40%), those of Riyadh and the Eastern Regions were infected with Dipetalonema evansi (1–6%) and those of the Eastern, Jazan and Riyadh Regions were infected with Eperythrozoon species (8–20%). Sheep and goats of all tested regions were infected with Theilaria hirci (4–20% and 6–14%, respectively), Theilaria ovis (5–19% and 6–24%, respectively) and Eperthrozoon ovis (2–9% and 2–8%, respectively). Sheep of the Eastern and Northern Frontiers Regions were also infected with Anaplasma ovis (2%) and also those of the Eastern Region were infected with Babesia motasi (4%) as well. Cattle of Asir and Eastern Regions were infected with Anaplasma marginale (1–3.4%) and those of the Eastern, Jazan and Riyadh Regions were infected with Theileria annulata (11.3–25%) and Eperthrozoon wenyoni (1–4%). Moreover, Jazan cattle were infected with Babesia bigemina (6%) and a benign Theileria species (27%). Some of these parasites are recorded in new localities indicating that they are spreading in the country. Also, this is the first report in Saudi Arabia of D. evansi in camels, A. ovis and B. motasi in sheep and A. marginale and B. bigemina in cattle. These parasites may be introduced into the country with infected livestock infested with the vectors of these parasites. The suspected vectors of the detected parasites in Saudi Arabia is discussed. Follow up surveys of blood parasites are recommended to assess their distribution and infection rates in the livestock of all Regions of Saudi Arabia, to make plans for control measures against their vectors.