This study aimed to investigate the prevalence of group A rotavirus (RVA) gastroenteritis and the distribution of the RVA genotypes as well as to determine a possible change in the age of occurrence of the RVA infection in the first 2 years after Rotarix® vaccine introduction in Saudi Arabia. This descriptive study included 850 hospitalized children <5 years of age with acute gastroenteritis (AG) between October 2013 and September 2015. Overall, 78 (9.2%) children were positive for RVA during the study period with a positivity rate ranging from 11.3% in the first year of the study to 6.8% in the second year. G1 (47.4%) was the predominant G type, followed by G2 (28.2%) and G9 (10.3%). The most common P type was P[8] (69.2%) followed by P[4] (25.6%). The decrease in the prevalence of G1P[8] from 51% to 37.1% was associated with an increase in the prevalence of G2P[4] from 21.6% to 33.3% during the 2-year study period. This study demonstrated a significant decrease in the prevalence of RVA-AG cases in the first 2-year period after vaccine introduction, especially in the age group between 1 and 12 months, and a reduction in the circulation of G1P[6]. The parallel rise and spread of G2P[4] in post-vaccination period might pose an impact to long-term vaccine efficacy. Continued surveillance studies in different Saudi regions are crucial to document the effectiveness of Rotarix® vaccine and evaluate the potential emergence of rare/novel RVA genotypes. J. Med. Virol. 89:429-434, 2017. © 2016 Wiley Periodicals, Inc.

This study aims to estimate the knowledge and awareness of physicians about the hazards of radiological examinations on their health and on their patients. 466 questionnaires administered through a Google spreadsheet were answered by physicians from the 20 cities of Saudi Arabia. The sample included 167 radiologists, 106 neonatologists, 19 oncologists, 45 surgeons and 18 orthopaedists, 11 paediatricians and 100 physicians on different specialities. Only 133 of the physicians had received a radiation protection course in the workplace. A total of 73% from participants revealed many gaps in knowledge. For example, 51% of the respondents were unable to classify mammography as ionizing radiation and 69.3% did not know the recommended annual dose limit to the whole body of a radiation worker. The overall knowledge score ranged from 0% to 16.5% (mean 5.3%), with a low score among surgeons and orthopaedists. These results clearly indicate the heterogeneous knowledge for the physicians' and needs to be improved by implementation of pre-employment orientation courses or adding a subject in the under or postgraduate curricula.

Background and Objective: Deficient knowledge on antibiotics causes misuse. This study aimed to investigate parents’ knowledge, attitudes and practices on antibiotic use by children in various cities of Saudi Arabia. Methods: This cross-sectional study was carried out using a previously validated questionnaire. The questionnaire was translated into Arabic and hosted on Google Forms. Parents of children aged ≤14 years, whose contact details were available with the author, were contacted and requested to participate in the study. For those who agreed to participate, the Google Forms link was shared through WhatsApp between July and August 2016. The respondents were also encouraged to share the link with contacts who had children aged ≤14 years. Descriptive and inferential statistical analyses were performed. Results: In total, 544 parents responded from various cities of Saudi Arabia. Of these, about 75% were males (mean age = 49.9 years) and the majority (~68%) had a university degree and above. In the 6 months preceding the study, 431 respondents had taken their children to physicians. Of these, only 7.2% reported not being prescribed any antibiotics, whereas 66.8% were prescribed an oral antibiotic one or two times and 26% were more than three times. In terms of prescription, 373 respondents (68.6%) purchased antibiotics without a prescription, whereas 171 (31.4%) purchased it only after obtaining a prescription. However, only seven (1.3%) followed instructions regarding antibiotic usage, whereas 50% did not receive any advice from their doctor regarding use. All demographic characteristics, except gender and residence, were found to have significant effect on parents’ knowledge on antibiotic use ( P < 0.05). Conclusion: This study found that in various cities of Saudi Arabia, parents’ knowledge, attitudes and practices on antibiotics for their children are poor. These findings highlight the need for parental education programs regarding antibiotic use and for implementing more stringent regulations on antibiotic prescription.

BACKGROUND: Adiposity is associated with high serum levels of adipokines and chemokines which are possibly implicated in a co-existence of obesity and asthma.OBJECTIVES: Elucidate the possible roles of leptin, interleukin (IL)-4, IL-5 and IL-21 in linking obesity with childhood asthma.DESIGN: Cross-sectional, analytical.SETTING: Population of schoolchildren in a small Saudi city.SUBJECTS AND METHODS: The study included a representative sample of Saudi schoolchildren grouped as obese asthmatics, non-obese asthmatics, or obese nonasthmatics, with nonobese nonasthmatics as a control group. An asthma control test was done for the asthmatic groups.MAIN OUTCOME MEASURES: Serum levels of leptin, IL-4, IL-5, and IL-21.SAMPLE SIZE: 345 male schoolchildren with a mean (SD) age of 13.0 (2.3) years.RESULTS: Median serum leptin concentrations in obese asthmatics were significantly higher than in nonobese asthmatics (P<.001). Uncontrolled asthmatics also had significantly higher leptin levels than controlled asthmatic children (P<.002). Leptin levels were weakly but significantly correlated with the cytokines IL-4, IL-5, and IL-21.CONCLUSIONS: Leptin may contribute to a link between obesity and childhood asthma. Differences in IL-21 levels between nonobese and obese asthmatics suggest that the co-existence of asthma and obesity increased IL-21 levels. Leptin plus some proinflammatory cytokines especially IL-21 may be potential predictors for asthma control in children.LIMITATIONS: Blood sampling at different stages of asthma might influence cytokine expression.CONFLICT OF INTEREST: None.

Ghrelin is a peptide hormone with direct or indirect effects on obesity and asthma. More data are required to understand the effect of ghrelin on the control and pathogenesis of these diseases. The aim of this study was to evaluate ghrelin levels in selected groups of children to identify the association between serum ghrelin, obesity, and the severity of asthma. The study included 401 school children selected from the Najran area and grouped into non-obese asthmatics, obese asthmatics, obese non-asthmatics and controls (non-obese non-asthmatics). Blood levels of ghrelin, interleukin (IL)-4, IL-5 and IL-21 were determined by ELISA. The mean ghrelin values were insignificantly increased in obese children compared with non-obese children. The highest blood ghrelin values were in the non-obese asthmatic group. Serum ghrelin, IL-4 and IL-21 levels were significantly increased in asthmatic children compared with non-asthmatic children (p < 0.05), and there were significant positive correlations between ghrelin and IL-4, IL-5, and IL-21 in asthmatic children. Furthermore, ghrelin, IL-4, and IL-21 levels were significantly higher in uncontrolled asthmatics compared with controlled-asthmatic children (p < 0.05). Asthma was the only significant risk factor for high ghrelin values. This study provides evidence supporting the anti-inflammatory role of ghrelin in the pathogenesis of asthma. Asthma might be considered as an important determinant of high ghrelin values in children.

BackgroundPandemic influenza A (H1N1) virus emerged and spread globally in the spring of 2009. We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia. We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome.MethodsWe performed a prospective study in all patients who were hospitalized for at least 48 hours and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction). Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death) was observed. We applied a logistic regression analysis to determine the best predictor of death.ResultsA total of 52 patients (15 males) were adults and 65 were pediatrics (< 12 years of age) (19 males). The common presenting signs and/or symptoms associated with the disease was fever >38.5 ºC (n=85; 72.6%), dry cough (n=81; 69.2%), dyspnea (n=40; 34.5%), tachycardia (n=96; 83.5%) and saturation less than 90% in room air on pulse oximetry (n=65; 55.6%). The complications included pneumonia (40.2 %), intensive care unit admission (19.2%) and death (16.7%).ConclusionsWe found that hypoxia at admission was the most important predictive factor of poor outcome (death) with area under curve of 0.768.

BACKGROUNDZika virus (ZIKV) is a teratogenic flavivirus that can cause microcephaly. Its main vector, Aedes aegypti, has been previously identified in Saudi Arabia, but no ZIKV infection has yet been reported. Nevertheless, the country is at risk from ZIKV because it receives many travelers throughout the year, including pilgrims from ZIKV-endemic countries.OBJECTIVESScreen asymptomatic pregnant mothers and their newborns attending a major hospital in the Najran region for subclinical or past infections with ZIKV, using ELISA and RT-PCR.DESIGNCross-sectional.SETTINGNajran Maternity and Children Hospital (NMCH).SUBJECTS AND METHODSAll pregnant women admitted to NMCH in labor between November 2016 and July 2017 were included in the study. Clinical and demographic data were collected by pre-validated physician-administered questionnaires. Paired umbilical and maternal serum samples were collected and frozen at −60°C, using ELISA to measure anti-ZIKA IgG and IgM antibodies and RT-PCR to further investigate positive samples.MAIN OUTCOME MEASURESMaternal and newborn serum anti-ZIKV IgM and IgG and ZIKV RT-PCR.SAMPLE SIZE410 mother-newborn pairs.RESULTSThe median gestational age was 38.5 weeks (range 33–42). Most (n=342, 83.41%) of the women were from Najran city. All of the newborns had normal growth parameters with no congenital malformations. None of the mothers had symptoms suggestive of ZIKV infection; 3 (0.7%) exhibited a low-grade fever (38°C), but did not test positive for anti-ZIKV antibodies. Thirty-five (8.53%) of mothers had travelled inside Saudi Arabia, but none outside the country. Twenty-four (5.85%) mothers tested positive for anti-ZIKV IgM and 52 (12.68%) tested positive for anti-ZIKV IgG, but all infant samples were negative. All seropositive ZIKV IgM were also ZIKV IgG positive, but RT-PCR testing of all seropositive samples was negative.CONCLUSIONAlthough previous (resolved) ZIKV infection and cross-reactivity of the ELISA method with other flaviviruses cannot be excluded, the study found no confirmed cases of acute ZIKV infection. However, given the presence of the vector in Saudi Arabia, the presence of presumptive positive serology and the ongoing risk of ZIKV entry via a regular influx of travelers from endemic areas, we propose that continuous surveillance be conducted for ZIKV as well for other flaviviruses. Larger-scale nationwide studies are strongly recommended to gain a broader view of the potential threat from ZIKV in the country.LIMITATIONSSmall sample size, unavailability of plaque reduction neutralization tests to confirm serology results, and RT-PCR was only conducted on ELISA-positive serum samples, due to resource constraints.

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