Spread, circulation, and evolution of the Middle East respiratory syndrome coronavirus

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first documented in the Kingdom of Saudi Arabia (KSA) in 2012 and, to date, has been identified in 180 cases with 43% mortality. In this study, we have determined the MERS-CoV evolutionary rate, documented genetic variants of the virus and their distribution throughout the Arabian peninsula, and identified the genome positions under positive selection, important features for monitoring adaptation of MERS-CoV to human transmission and for identifying the source of infections. Respiratory samples from confirmed KSA MERS cases from May to September 2013 were subjected to whole-genome deep sequencing, and 32 complete or partial sequences (20 were ≥99% complete, 7 were 50 to 94% complete, and 5 were 27 to 50% complete) were obtained, bringing the total available MERS-CoV genomic sequences to 65. An evolutionary rate of 1.12 × 10−3 substitutions per site per year (95% credible interval [95% CI], 8.76 × 10−4; 1.37 × 10−3) was estimated, bringing the time to most recent common ancestor to March 2012 (95% CI, December 2011; June 2012). Only one MERS-CoV codon, spike 1020, located in a domain required for cell entry, is under strong positive selection. Four KSA MERS-CoV phylogenetic clades were found, with 3 clades apparently no longer contributing to current cases. The size of the population infected with MERS-CoV showed a gradual increase to June 2013, followed by a decline, possibly due to increased surveillance and infection control measures combined with a basic reproduction number (R0) for the virus that is less than 1

Neisseria meningitidis nasopharyngeal carriage during the Hajj: A cohort study evaluating the need for ciprofloxacin prophylaxis

Background The annual Muslim pilgrimage has the potential of increase risk for acquisition of Neisseria meningitidis. Here, we evaluate the Hajj impact on the prevalence of N. meningitidis carriage in a paired and non-paired cohort of pilgrims. Secondary objectives were to calculate the compliance with recommended vaccination. Methods This is a prospective paired (arriving and departing), non-paired arriving and non-paired departing cohort study with the collection of nasopharyngeal samples at the start and the end of the Hajj. Results The study included unpaired arriving pilgrims at King Abdul Aziz International Airport (N = 1055), unpaired departing cohort (N = 373), and a paired cohort (N = 628) who were tested on arrival and departure. Meningococcal vaccination was received by all pilgrims, 98.2% received quadrivalent polysaccharide vaccine (ACWY), and 1.8% received meningococcal quadrivalent conjugate vaccine (MCV4). Only 1.61% and 23.03% received pneumococcal and influenza vaccines, respectively. Of the 1055 arriving unpaired pilgrim, 36 (3.4%) tested positive for nasopharyngeal carriage of N. meningitidis, and 24 (66.7%) of these were serogroup B, the remainder were non-groupable. Haemophilus influenza was detected among 45 (4.3%), and 11 (1%) carriers were positive for both N. meningitidis and H. influenzae. Out of 373 in the unpaired departing cohort, 6 (1.61%) tested positive for N. meningitidis, and 34 (9.1%) were positive for H. influenzae. Of the 628 paired cohort pilgrims, 36 (5.7%) pilgrims were positive for N. meningitidis at arrival and 16 (2.5%) pilgrims were positive after the hajj. Conclusion This the largest study of the epidemiology of N. meningitidis among pilgrims. The study showed a significant difference in the carriage between pilgrims from high endemicity and other pilgrims with a predominance of serogroup B. The continued use of ciprofloxacin as prophylactic antibiotics should be reconsidered as well as the consideration to add serogroup B as a required vaccination

Assessment of knowledge, attitude and practice of diabetic people in Najran, Kingdom of Saudi Arabia

Background: This cross-sectional hospital based study aimed at determining the level of knowledge, attitude and practice of diabetes among local people of Najran, Saudi Arabia.Methods: We aimed to investigate the levels of knowledge, attitude and practice among diabetic people in Najran area.Results: 10% of the participants scored >7, 28% scored >5 and 62% scored 5 and less in Knowledge questionnaire. None [0.00%] of the participants scored 7 or more out of the attitude questionnaire. 100% of the participants scored 5 and less out of 12. 100% of the participants scored >6 and 0% scored 12 or more in the practice questionnaire.Conclusions: Our study revealed that the level of knowledge, attitude and practice of diabetes in the area of Najran is very poor. We suggest that a structured educational program to be adopted by the health authorities in Saudi Arabia

Cross-border movement, economic development and malaria elimination in the Kingdom of Saudi Arabia

Malaria at international borders presents particular challenges with regards to elimination. International borders share common malaria ecologies, yet neighboring countries are often at different stages of the control-to-elimination pathway. Herein, we present a case study on malaria, and its control, at the border between Saudi Arabia and Yemen. Malaria program activity reports, case data, and ancillary information have been assembled from national health information systems, archives, and other related sources. Information was analyzed as a semi-quantitative time series, between 2000 and 2017, to provide a plausibility framework to understand the possible contributions of factors related to control activities, conflict, economic development, migration, and climate. The malaria recession in the Yemeni border regions of Saudi Arabia is a likely consequence of multiple, coincidental factors, including scaled elimination activities, cross-border vector control, periods of low rainfall, and economic development. The temporal alignment of many of these factors suggests that economic development may have changed the receptivity to the extent that it mitigated against surges in vulnerability posed by imported malaria from its endemic neighbor Yemen. In many border areas of the world, malaria is likely to be sustained through a complex congruence of factors, including poverty, conflict, and migration

Seropositivity and awareness of Toxoplasmosis among University students

Toxoplasma gondii is an obligate intracellular parasite that is infecting about one-third of the world population. Awareness about toxoplasmosis and its transmission can help reduce its prevalence. We examined the degree of awareness about toxoplasmosis among female university students. A total of 127 samples were collected, including 44 samples from health colleges students and 83 samples from other colleges. A questionnaire was used to measure the level of awareness about Toxoplasma gondii. Serum samples were analyzed for the presence of anti-Toxoplasma gondii antibody using ELISA technique. Ninety-four (74%) participants were 18-20 years, 27 (21%) were 21-24 years, and 6 (5%) were above 24 years. Only 11 (9%) students eat raw meat and 21 (17%) students had a tendency to eat undercooked meat. Furthermore, only 6 (5%) students received blood transfusion and 33 (26%) students owned a cat at home. Forty-two (33%) students answered that they know about the disease. The majority of participants (n=121, 95%) used bottled water as a source of drinking water. Among the 127 samples collected, only 6 (4.7%) had IgG anti-Toxoplasma gondii antibody. There was statistically significant positive correlation between the level of awareness about toxoplasmosis and the participant's answers about previous knowledge about the disease and a statistically significant negative correlation between the level of awareness about toxoplasmosis and the student's faculty. We recommend that this study is repeated with a larger sample size and a modified questionnaire to include more detailed questions to reveal the true level of awareness

Comparing the Therapeutic Impact of Strain-Counterstrain and Exercise on Low Back Myofascial Pain Syndrome: A Randomized Trial

Ghada Mohamed Rashad Koura,1 Ahmed Mohamed Fathi Elshiwi,2 Mohamed Naeem Selim,3 Amani Abdu Mohammed Asiri,4 Reem Hadi Jowaied Alqahtani,5 Doaa Ayoub Elimy,6 Mohammed Abdullah Alshehri,7 Hani Hassan Alnakhli,1 Sultan Mofreh Assiri,8 Fuzail Ahmad,9 Irshad Ahmad1 1Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia; 2Consultant & Head of Physical Therapy Department, Saudi German Hospital, Aseer, Saudi Arabia; 3Basic Sciences Department, Faculty of Physical Therapy, Beni Suef University, Beni Suef, Egypt; 4Physical Therapy Department, Saudi German Hospital, Aseer, Saudi Arabia; 5Eradh Physical Therapy Center, Aseer, Saudi Arabia; 6Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 7Department of Physiotherapy, Abha International Private Hospital, Abha, Saudi Arabia; 8Department of Physical Therapy, Muhayel General Hospital, Asir Health Affairs, Ministry of Health, Abha, Saudi Arabia; 9Respiratory Care Department, College of Applied Sciences, Almaarefa University, Dirirya, Riyadh, Saudi ArabiaCorrespondence: Irshad Ahmad, Email [email protected]: Background: Strain-Counterstrain (SCS) therapy is a manual therapeutic technique used to treat myofascial pain by addressing tender points through passive positioning. Despite anecdotal evidence, limited peer-reviewed research supports its efficacy in chronic low back pain (LBP). This study evaluates the effects of SCS combined with exercise on pain severity, lumbar range of motion (ROM), and functional disability in patients with chronic LBP.Methods: A randomized controlled trial was conducted with 30 participants aged 45– 55 years, divided into Group A (SCS + Exercise) and Group B (Exercise Only). Outcome measures included pain intensity, lumbar ROM (flexion, extension, side bending), and functional disability (Oswestry Disability Index). Assessments were conducted at baseline and after four weeks of intervention. MANOVA was performed to evaluate group, time, and interaction effects, with detailed univariate follow-ups and effect sizes. Reliability of ROM measurements was ensured using intraclass correlation coefficients (ICC > 0.90).Results: MANOVA revealed statistically significant group, time, and interaction effects for all outcomes (Wilks’ Lambda = 0.065, F (6, 51) = 91.34, p < 0.001). Pain severity decreased by 26.7% in Group A compared to 5.2% in Group B (F (1, 56) = 65.78, p < 0.001, partial η² = 0.77). Lumbar ROM improved significantly in Group A for flexion (10.9%), extension (20.3%), and right-side bending (17.7%) (p < 0.001, partial η² = 0.68– 0.74), with no significant improvement in left-side bending. Functional disability scores reduced by 25.2% in Group A versus 2.3% in Group B (F (1, 56) = 53.45, p < 0.001, partial η² = 0.73).Conclusion: SCS therapy combined with exercise significantly reduces pain, improves lumbar ROM, and enhances functional capacity in patients with chronic LBP compared to exercise alone. These findings highlight SCS as a promising adjunctive treatment for managing chronic musculoskeletal pain. Future studies should investigate long-term outcomes and further refine treatment protocols.Keywords: low back pain, myofascial pain syndrome, strain-counter-strain, myofascial trigger point