Host genetics, environment, lifestyle and proximity between hosts strongly influence the composition of the gut microbiome. To investigate the association of dietary variables with the gut microbiota, we used 16S rDNA sequencing to test the fecal microbiome of Bedouins and urban Saudis and we compared it to the gut microbiome of baboons living in close contact with Bedouins and eating their leftovers. We also analyzed fermented dairy products commonly consumed by Bedouins in order to investigate their impact on the gut microbiome of this population. We found that the gut microbiomes of westernized urban Saudis had significantly lower richness and biodiversity than the traditional Bedouin population. The gut microbiomes of baboons were more similar to that of Bedouins compared to urban Saudis, probably due the dietary overlap between baboons and Bedouins. Moreover, we found clusters that were compositionally similar to clusters identified in humans and baboons, characterized by differences in Acinetobacter, Turicibacter and Collinsella. The fermented food presented significantly more bacteria genera common to the gut microbiome of Bedouins compared to urban Saudis. These results support the hypothesis that dietary habits influence the composition of the gut microbiome.

Despite having good awareness about DM and its effects on eyes, the patients exhibited a relative lack of awareness about DR. Considering the association of DR with DM, its increasing magnitude is a potential burden on the community and health systems.

Objectives. This study assessed the knowledge and attitudes regarding complementary and alternative medicine (CAM) in medical students in Saudi Arabia. Furthermore, it evaluated their views on the incorporation of CAM in their medical syllabus. Methods. The study was conducted by selecting a cross-sectional sample of senior medical students in the Faculty of Medicine. A validated and reliable self-administered questionnaire was used to explore the knowledge, attitude, and benefits of CAM. It was distributed to a sample of 273 students. Results. The study included 242 students, making the response rate 88.6%. Only two-thirds of students (62.4%) were aware of acupuncture principles and only 17.4% recognized that chiropractic is associated with pain management. The knowledge of common herbs such as St. John's Wort, Echinacea, and Ginkgo biloba was limited among the students. Older students had a positive CAM attitude compared to younger students (p = 0.027). Conclusion. Students attitudes toward CAM learning were encouraging regardless of their limited knowledge on the subject. A high percentage of students agreed that CAM in combination with conventional therapy is beneficial in treating unusual cases, but the choice of CAM should be based on evidence. Furthermore, medical students are still reluctant to have CAM practitioners in their referral network.

Intestinal Parasitic Infections (IPIs) constitute an important worldwide health problem, especially in children in developing countries, resulting in a significant illness in the form of either acute or chronic infections [1,2] but an accurate diagnosis is rarely performed [3]. Intestinal parasites are endemic in many parts of the world. In a rural area in China, about 33% of preschool and 40% of school children were infected with soil-transmitted helminthes [4]. Moreover, endemic IPIs in the United States are even more frequent than is commonly perceived, and IPIs with Giardia, Cryptosporidium, and Dientamoeba were common among children, especially during the summer season. So, endemic IPIs in the United States are not uncommon but are understudied [5]. The effective policy of control and prevention of IPIs depends mainly on determination of local risk factors, particularly among high-risk groups. Severe malnutrition, poor socioeconomic standards, poor educational background, poor hygienic living conditions, and lack of proper personal and environmental sanitation, are the factors frequently related to increased rates of IPIs in school children [6-10]. Intestinal Parasitic Infections affect children more than adults, resulting in malnutrition, malabsorption, growth retardation, and learning disabilities, especially in growing children. An association between IPIs and malnutrition was observed in preschool children in many parts of the world, especially the poorest areas [11,12]. Helminthic infections in children are associated with significant wasting and stunting [4]. Consequently, The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common, to improve nutritional status, hemoglobin, cognition, and overall health of school children [13]. A few studies have been conducted in some regions of Saudi Arabia, such as Abha and Riyadh, to identify the prevalence of IPIs in stool samples of school children. The prevalence of IPIs ranged from about 24% in Abha to 34% in Riyadh. The most common pathogenic parasites detected were Giardia lamblia followed by Entamoeba histolytica. Hymenolepis nana was the commonest intestinal helminth, especially among children from lower social classes. In Riyadh, high infection rate was found in children aged below 12 years, urban areas, non-Saudis, and in people who were drinking water from tanks [14-16]. Regarding our locality of Jeddah, the prevalence of parasitic pathogens among preschool children suffering from acute diarrhea from

Objectives:To estimate the prevalence of emergency cases reporting to Primary Health Care centers (PHC), Jeddah, Saudi Arabia and to explore the barriers facing PHC physicians when dealing with such emergency cases.Methods:A cross-sectional analytic study, where all physicians working in the PHC of the Ministry of Health (MOH) in Jeddah; were invited to participate (n=247). The study period was from July 2013 till December 2013. Data were collected through two sources. 1- A self-administered questionnaire used to determine the physicians’ perceived competence when dealing with emergency cases. 2- A structured observation sheet used to evaluate availability of equipment, drugs, ambulances and other supporting facilities required to deal with emergency cases.Results:The response rate was 83.4%. The physicians’ age ranged between 25 and 60 years with a mean ±SD of 34.4±7.5 years. Majority of them (83.5%) did not attend ATLS courses at all whereas 60.7% never attended ACLS courses. The majority (97.1%) had however attended BLS courses. Physicians in the age group 36-45 years, non-Saudi, those who had SBFM, those who reported experience in working in emergency departments and physicians who reported more working years in PHCCs (>5 years) had a significant higher score of perceived level of competence in performing emergency skill scale than others (P<0.05). The prevalence of emergency cases attending PHC in Jeddah (2013) was 5.2%.Conclusion:Emergency services at PHC in Jeddah are functioning reasonably well, but require fine tuning of services and an upgrade in their quality.

ObjectivesPrimary care physicians have an opportunity to support healthy dietary behaviours of patients by providing nutrition care. However, it is unclear whether primary care physicians in the Kingdom of Saudi Arabia (KSA) are sufficiently competent in nutrition. This study aimed to assess the nutrition competence of primary care physicians in KSA and identify whether nutrition competence is associated with the provision of nutrition care to patients living with diet-related chronic disease.DesignA cross-sectional study.SettingChronic disease clinics across 48 primary care centres under the Ministry of Health in the city of Jeddah, KSA.Participants90 primary care physicians completed the survey (response rate: 98%). General practitioners and family medicine residents, specialists, and consultants actively working in chronic disease clinics between February and May 2019 were included.Primary and secondary outcome measuresPrimary outcome measure was nutrition competence of primary care physicians measured via the validated nutrition competence (NUTCOMP) questionnaire.ResultsPrimary care physicians perceived themselves as competent in nutrition care but their reported provision of nutrition care was limited. Confidence in their nutrition knowledge and skills elicited the lowest mean scores of 25.8 (±5.4) out of 35 and 29 (±5.2) out of 40, respectively. The reported provision of nutrition care was closely correlated with physicians’ confidence in their nutrition knowledge (r=0.57) and communication (r=0.52). Three factors were identified as predicting whether physicians provide nutrition care to patients: confidence in counselling about nutrition (p<0.001), having previous nutrition education (p=0.005) and a higher professional qualification (p=0.008).ConclusionsPrimary care physicians felt confident in providing nutrition care to patients living with diet-related chronic disease. Primary care physicians would benefit from higher levels of nutrition knowledge and skills to effectively support patients to improve their dietary behaviours and health conditions, leading to a positive impact on public health.

Background: Major intercontinental outbreaks of invasive meningococcal disease associated with the Hajj occurred in 1987, 2000, and 2001. Mandatory meningococcal vaccination for all pilgrims against serogroups A and C and, subsequently, A, C, W, and Y controlled the epidemics. Overseas pilgrims show excellent adherence to the policy; however, vaccine uptake among domestic pilgrims is suboptimal. This survey aimed to evaluate meningococcal vaccine uptake among Hajj pilgrims and to identify key factors affecting this. Methods: An anonymous cross-sectional survey was conducted among pilgrims in Greater Makkah during the Hajj in 2017-2018. Data on socio-demographic characteristics, vaccination status, cost of vaccination, and reasons behind non-receipt of the vaccine were collected. Results: A total of 509 respondents aged 13 to 82 (median 33.8) years participated in the survey: 86% male, 85% domestic pilgrims. Only 389/476 (81.7%) confirmed their meningococcal vaccination status; 64 individuals (13.4%), all domestic pilgrims, did not receive the vaccine, and 23 (4.8%) were unsure. Among overseas pilgrims, 93.5% certainly received the vaccine (6.5% were unsure) compared to 80.9% of domestic pilgrims (p < 0.01). Being employed and having a tertiary qualification were significant predictors of vaccination adherence (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3-3.8, p < 0.01; and OR = 1.7, CI = 1-2.5, p < 0.05, respectively). Those who obtained pre-Hajj health advice were more than three times as likely to be vaccinated than those who did not (OR = 3.3, CI = 1.9-5.9, p < 0.001). Lack of awareness (63.2%, 36/57) and lack of time (15.8%, 9/57) were the most common reasons reported for non-receipt of vaccine. Conclusion: Many domestic pilgrims missed the compulsory meningococcal vaccine; in this regard, lack of awareness is a key barrier. Being an overseas pilgrim (or living at a distance from Makkah), receipt of pre-Hajj health advice, and employment were predictors of greater compliance with the vaccination policy. Opportunities remain to reduce the policy-practice gap among domestic pilgrims. Author Contributions: Conceptualization, G.R.B., T.A., H.A., and H.R.; data curation, A.-M.B.; formal analysis, A.-M.B. and H.R.; project administration, H.R.; supervision, A.K., R.B., and H.R.; validation, A.-M.B., F.A., W.F., Trop. Med. Infect. Dis. 2019, 4, 127 11 of 13 and A.A.; visualization, A.-M.B.; writing-original draft, A.-M.B., F.A., W.F., A.A., and A.K.; writing-review and editing

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