Birth prevalence of non-syndromic orofacial clefts in Saudi Arabia and the effects of parental consanguinity

Objectives:

To describe the characteristics and prevalence of non-syndromic orofacial clefting (NSOFC) and assess the effects of parental consanguinity on NSOFC phenotypes in the 3 main cities of Saudi Arabia.

Methods:

All infants (114,035) born at 3 referral centers in Riyadh, and 6 hospitals in Jeddah and Madinah between January 2010 and December 2011 were screened. The NSOFC cases (n=133) were identified and data was collected through clinical examination and records, and information on consanguinity through parent interviews. The diagnosis was confirmed by reviewing medical records and contacting the infants’ pediatricians. Control infants (n=233) matched for gender and born in the same hospitals during the same period, were selected.

Results:

The prevalence of NSOFC was 1.07/1000 births in Riyadh, and 1.17/1000 births overall; cleft lip (CL) was 0.47/1000 births, cleft lip and palate (CLP) was 0.42/1000 births, and cleft palate (CP) was 0.28/1000 births. Cleft palate was significantly associated with consanguinity (p=0.047, odds ratio: 2.5, 95% confidence interval: 1 to 6.46), particularly for first cousin marriages.

Conclusion:

The birth prevalence of NSOFC in Riyadh alone, and in the 3 main cities of Saudi Arabia were marginally lower than the mean global prevalence. While birth prevalence for CLP was comparable to global figures, the CL:CLP ratio was high, and only CP was significantly associated with consanguinity.Non-syndromic orofacial clefting (NSOFC), including isolated cleft lip (CL), cleft lip and palate (CLP), and isolated cleft palate (CP), is the most common craniofacial defect worldwide with an estimated mean global prevalence of 1.25/1000 live births.1 However, the prevalence of NSOFC varies geographically and across different ethnic groups.2 Although the ethnicity of the Middle East is considered Caucasian,3,4 geographically it is located between 3 continents (Asia, Africa, and Europe), which makes it unique and, in reality, a mixture of 3 ethnicities. A small number of studies have measured the prevalence of NSOFC in Saudi Arabia and neighboring countries with the reported prevalence ranging from 0.3 to 2.19/1000 births,5-9 and a mean value for all studies of 1.25/1000 births.10 In addition, consanguineous relationships have been suggested to increase the prevalence of congenital anomalies.11 These were also reported to be associated with NSOFC in a meta-analysis carried out on 16 studies that assessed the relationship between NSOFC and paternal consanguinity.12 Saudi Arabia, one of the largest countries in the Middle East, has a high rate of consanguineous marriage that varies between regions.13 Riyadh, which is the capital city of Saudi Arabia with a population of approximately 7.5 million and birth prevalence of 38,000/year,14,15 has a consanguinity marriages prevalence of 60%.16 The aims of this study were to 1) describe the characteristics and prevalence of NSOFC (CL, CLP, and CP) in Riyadh (the capital city in the central region of Saudi Arabia), 2) describe the prevalence of NSOFC phenotypes, and 3) the relationship between these and consanguinity in Saudi Arabia.     

Childhood anxiety disorders prevalence in Saudi Arabia

Objectives:To investigate the prevalence of childhood anxiety disorders in Saudi Arabia.Methods:We conducted a cross-sectional study, between September and November 2019, in Saudi Arabia. The study group included the parents of 468 primary school children, aged 6-12 years. Parents completed the Screen for Child Anxiety Related Disorders (SCARED) screening instrument, translated to Arabic. The measured outcome was the prevalence of childhood anxiety disorders, determined from the scores on the SCARED instrument.Results:Childhood anxiety disorders prevalence were as follows: 32.7% had one anxiety, 18.4% had 2, 10.9% had 3, 8.1% had 4, and 7.7% had 5. Of note, 22.2% of children did not have an anxiety disorder.Conclusion:Our results reveal a high prevalence of childhood anxiety disorders among primary school age children in Saudi Arabia. Based on these findings, conducting awareness campaigns and providing educational programs on childhood anxiety disorders might be important to improve the health outcomes of children.     

Hemoglobinopathies: An update on the prevalence trends in Southern Saudi Arabia

Objectives:To investigate trends in hemoglobinopathies following the establishment of a mandatory premarital screening program (MPMSP) in the southern region of Saudi Arabia, where they are considered highly predominant.Methods:A retrospective analysis was performed on data from 32,130 high-performance liquid chromatography (HPLC) tests between November 2017 and October 2020. The data was obtained from the Hematology section, Laboratory Department, Armed Forces Hospital, Southern Region.Results:Despite the establishment of the MPMSP, our data showed that sickle cell disease remains a predominant hemoglobinopathy accounting for more than 7% of total tests in Southern Saudi Arabia. Observed HPLC hemoglobin fractions among the tested population showed a reduction in Hb A mean indicating a high rate of hemoglobin abnormalities. In addition, the prevalence of hemoglobin variants, including sickle cell and thalassemia, was higher in the younger population born after the MPMSP than in older subjects.Conclusion:Even with the implementation of the MPMSP, hemoglobin abnormalities remain prevalent in southern Saudi Arabia. A longer time frame is recommended to verify the validity of the program.     

The prevalence of Chlamydia trachomatis infection among Saudi women attending the infertility clinic in Central Saudi Arabia

Objectives:

To determine the prevalence of Chlamydia trachomatis (C. trachomatis) infection among Saudi women, its clinical presentation, and its association to infertility.

Methods:

This study was conducted between October 2012 and July 2013 at King Khalid University Hospital and King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Female patients aged between 19 and 46 years old with infertility problems seen at both hospitals were recruited to join the study. A separate group of female patients without infertility problems was also recruited from both hospitals to serve as controls for the study. Endocervical swabs were collected from both groups of patients, and samples were analyzed using real time polymerase chain reaction.

Results:

There was a statistically significantly greater prevalence of C. trachomatis infection in infertile women (n=8, 8.0%) compared with the fertile group of women (n=1, 1.0%). The C. trachomatis infection was significantly correlated to infertility.

Conclusion:

A significant association between infertility and increased prevalence of C. trachomatis infection is shown in this study, thus, we suggest that screening for Chlamydial infection to be part of the routine investigation for infertility.Infertility is a worldwide health problem among couples with approximately 15% current global infertility rate, translating to one in 6 couples suffering from this condition.1 It is a public health problem with a major economic impact on the health care system in many countries.2 According to the World Health Organization, there is an estimated 448 million new cases of sexually transmitted infections (STI’s) which are acquired worldwide annually.3 There is a multitude of bacterial, viral, and parasitic pathogens that are transmissible sexually.4 Chlamydia trachomatis (C. trachomatis) is a gram-negative bacteria and is one the most frequently reported STI. It has 3 human serovars; serovar Ab, B, Ba or C, which causes trachoma (an eye infection), serovar D to K which causes pelvic inflammatory diseases (PID), ectopic pregnancy and urethritis, and serovars La to L3 which causes lymphogranuloma venereum (LGV).5-9 The C. trachomatis is increasingly being associated with long-term complications, such as asymptomatic endometritis, cervicitis, PID, and tubal factor infertility.5-9 The association between C. trachomatis infection and infertility has been the subject of several research. A study in Iran10 suggested the significant association between C. trachomatis infection and female infertility with a prevalence rate of 15.3%. The same finding was suggested by a study conducted in India, which confirmed the significant association between infertility and the duration of C. trachomatis infection.11 Furthermore, another study suggested that a positive serology screening result for C. trachomatis is predictive for both tubal damage, and a reduced pregnancy rate.12 A prevalence rate of 9.6% was found in female patients attending the infertility clinic in a study carried out in Nigeria.13 Other prevalence rates include studies carried out in the USA (5-15% prevalence rate),8,14 UK (16%),15 Jordan (3.9%),16 Iran (22%),17 and Brazil (10.9%).18 We conducted this study to determine the prevalence of C. trachomatis infection among women attending the infertility clinic in 2 tertiary hospitals in Central Saudi Arabia.     

Clinicopathological features and prevalence of prostate cancer in Aseer,Saudi Arabia

Objectives:To determine the prevalence and characterize prostate cancer (PC) cases in Aseer, Saudi Arabia.Methods:This study involved 883 patients who consulted physicians in Aseer Central Hospital, Abha, Saudi Arabia, for prostate issues between the years 2008-2018. All patients underwent digital rectal examination and measurement of their serum prostate-specific antigen levels. For patients who presented abnormal digital rectal examination findings and elevated prostate-specific antigen levels, prostate biopsies were recommended. Specimens were histopathologically examined to differentiate between malignant and benign tumors.Results:Among the 883 included patients, 132 (15%) underwent a prostate biopsy and were found to have a tumor. Histopathological examination confirmed malignancy (PC) in 77 (8.7%) patients. The absolute majority of the patients diagnosed with PC (96%) were aged >60 years and almost all of them (92%) were found to have a high prostate-specific antigen level of >4 ng/ml.Conclusion:Prostate cancer appears to be a serious disease in Aseer, Saudi Arabia. Further studies aimed at determining the causes of this type of cancer and understanding its mechanisms are warranted.     

Blindness in Saudi Arabia

The prevalence and etiology of visual loss and of eye diseases were determined in the Kingdom of Saudi Arabia. The sample was a stratified geographic cluster sample of 14,577 persons representing the settled population of Saudi Arabia. A nonstatistical sample of 2,233 bedouins was also examined. The survey revealed that 1.5% of the population are blind and another 7.8% are visually impaired according to the World Health Organization definition. The most common causes of blindness include cataract, trachoma, nontrachomatous corneal scars, refractive errors, congenital anomalies, failed medical or surgical treatment, and glaucoma. Refractive errors, amblyopia, and trauma are also important causes of less severe, and often unilateral, lost vision. About 7% of all Saudi Arabians, and 42% of those older than 40 years, have a cataract or its sequelae. Over 3.5% of the population have corneal scars, about half of which are caused by trachoma.     

Diphyllobothriasis in Saudi Arabia

We described a Saudi patient infected with Diphyllobothrium latum D. latum. A 38-year-old male presented, complaining of passing worms. He had a history of recent travel to Europe and South East Asia. Stools examination revealed typical D. latum eggs. He was treated with praziquantel followed by saline purge, after which he discharged an intact tapeworm. Macroscopic and microscopic examinations of the worm confirmed the diagnosis of D. latum. This is the first case of diphyllobothriasis to be reported in Saudi Arabia. The epidemiology and methods of prevention of diphyllobothriasis are discussed.     

Hyperlipidemia in Saudi Arabia

OBJECTIVE: To determine the prevalence of hyperlipidemia among Saudis of both genders in rural and urban communities. METHODS: Selected Saudis in the age group of 30-70 years were studied over a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history, physical examination, and analysis of fasting plasma lipids. The data were analyzed to classify individuals with hypercholesterolemia (HC) (total cholesterol > or =5.2 mmol/l), and hypertriglyceridemia (HT) (total triglycerides > or =1.69 mmol/l). Logistic regression analysis was performed to provide a risk assessment model and correlation with other coronary artery disease (CAD) risk factors. RESULTS: The number of study samples included in the final analysis was 16,819. The prevalence of HC was 54% with mean cholesterol level of 5.4+/-1.52 mmol/l. Prevalence of HC among males was 54.9% and 53.2% for females, while 53.4% among urban Saudis and 55.3% for rural Saudis. Hypertriglycemia prevalence was 40.3% with mean triglycerides level of 1.8+/-1.29 mmol/l. Males had statistically significant higher HT prevalence of 47.6% compared to 33.7% in females (p<0.0001). CONCLUSION: Hyperlipedimia is reaching higher prevalence rates in KSA. This finding may suggest that CAD will soon be a major health problem. Reduction in obesity by adopting healthier eating habits, and increasing physical activity are of considerable importance to our community.     

Genito-urinary cancer in Saudi Arabia

The incidence of Genito-urinary cancer (GUC) in the Kingdom of Saudi Arabia (KSA) increases with age and is 5-fold higher in men than in women. Genito-urinary cancer accounts for only 9.2% of all cancers in KSA, while the rate in the United States of America (USA) is as high as 24.1%. An epidemiological search on GUC in KSA revealed a relatively low incidence compared to developed countries. This is more evident in prostatic cancer, which is 50 times lower than in the USA. The most common GUC in KSA is bladder, followed by the prostate, kidney, and testicular cancer. Penile cancer is extremely rare. Genito-urinary cancer is not among the 10 most common cancer in KSA, however, bladder cancer ranking tenth. Reviewing the National Cancer Registry data in addition to the available literature on GUC in KSA for the past 50-years showed the changing pattern of this disease over time.