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Mona A Al-Zahrani, Mahmoud M Berekaa, Mohammed Al-Warthan, Abdulaziz A AlMulla Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Eastern Province, Saudi ArabiaCorrespondence: Mahmoud M Berekaa, Email mberekaa@iau.edu.saObjective: This study identify the prevalence of sharp object injuries (SOIs) among healthcare workers (HCWs) in Dammam and Jeddah, Saudi Arabia.Methods: Quantitative methodology using a cross-sectional design was applied. Chi-square testing was employed for comparative analyses, and logistic regression encompassing univariate and multivariate models was implemented to ascertain the predictors of SOIs.Results: Prevalence rate of SOIs among hospital HCWs in Dammam and Jeddah cities was 8.40%. Non-Saudi nationals had a rate of 11.9%, while participants who had more than 15 years of experience had a lower rate (9.9%). Gender was identified as a significant predictor of SOIs, with males being two times more likely to experience SOIs than females. The highest rates of injuries were observed among laboratory personnel (29.2%; odds ratios of 8.6 and 7.2 in univariate and multivariate models, respectively).Conclusion: These findings show that HCWs in Dammam have a marginally higher risk of SOIs (prevalence rate 9%) than their counterparts in Jeddah (prevalence rate 7.8%). Further investigations are needed to tailor specific training programs to increase HCWs’ awareness, safety knowledge, and practices to reduce SOIs.Keywords: sharp object injuries, bloodborne pathogens, laboratory personnel, hospitals

Meshari A Al-Zahrani,1 Mohammad Alkhamees,1 Sulaiman Almutairi,1 Ahmed Aljuhayman,1 Sultan Alkhateeb2,3 1Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia; 2Department of Urology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 3College of Medicine, Alfaisal University, Riyadh, Saudi ArabiaCorrespondence: Meshari A Al-ZahraniTeaching Assistant, Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi ArabiaTel +00966569990693Fax +00966164042500Email ma.alzahrani@mu.edu.saAbstract: From the moment the World Health Organization (WHO) declared COVID-19 to be a pandemic disease, COVID-19 began to affect the lives of many healthcare providers worldwide. In response to this pandemic, urology departments and training residency programs implemented urgent measures to reduce outpatient clinics, adopted the use of telemedicine, regulated emergency and outpatient urological procedures, promoted the use of operating theatres, and developed the use of sustainable e-learning alternatives to traditional urology educational activities. We reviewed the response of urologists in Saudi Arabia to the COVID-19 pandemic and how they react to the emerging pandemic both for patients and for healthcare of urologist personnel.Keywords: Saudi Arabia, urology, COVID-19, telemedicine, residency

Mohammad Alkhamees,1 Meshari A Al-Zahrani,1 Sulaiman Almutairi,1 Hammam Alkanhal,1 Mana Almuhaideb,2 Saad M Abumelha3– 5 1Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; 4King Abdullah International Medical Research Center (KAIMRC), Riyadh 11426, Saudi Arabia; 5College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11426, Saudi ArabiaCorrespondence: Mohammad AlkhameesDepartment of Urology, College of Medicine, Majmaah University, Al-Majmaah 11952, Saudi ArabiaTel +966-554463808Fax +966-164042500Email m.alkhamees@mu.edu.saPurpose: This study evaluated the study habits of Saudi urology residents throughout their residency training. It examines the study time and quality of study materials used by Saudi urology residents and identifies ways to maximize study benefits.Patients and Methods: An online questionnaire was distributed to 152 registered residents in regions throughout Saudi Arabia (response rate: 93.4%). The questionnaire addressed study habits throughout training, motivations for studying, preferred study resources, impressions on teaching quality, study preparation methods, and exam preparedness among junior and senior residents.Results: Among all residents, 37.3% read for 2– 5 hours weekly. Juniors read significantly more than seniors (P = 0.034). Marital status affects seniors’ study habits (P = 0.029). For most seniors, preparation for the final board exam is the greatest motivation for studying (P = 0.006). The AUA/EAU guidelines were useful information source for seniors (P = 0.001). Fifty-four percent (54.4%) of residents felt that their residency program did not provide protected study time prior to the board exams. Moreover, the majority (64.8%) felt that the training program did not adequately prepare them for the board exams.Conclusion: We recommend that local program directors implement more effective teaching methods. Structured reading habits and specific study materials were found to be positive predictors of successful performance. Residents should also be educated in balancing working hours, social life, and study.Keywords: resident, study habits, Saudi Arabia, urology

This study aims at investigating the potential of Acacia gerrardii pod for the removal of Cr(VI) in batch system. Effect of solution pH, biosorbent dosage, initial concentration of Cr(VI), contact time on the removal process was examined. Complete removal of hexavalent chromium was achieved at pH values 1.0 and 2.0 whereas maximum removal of total chromium was obtained at pH of 3.0. The study showed that the biosorption and bioreduction mechanisms were involved in the removal process. The time required for complete removal of Cr(VI) using the pod of Acacia gerrardii was shortened with an increase in biomaterial dosage and decrease in Cr(VI) concentration. Kinetic data was well described using Park kinetic model. Freundlich isotherm model adequately fitted the equilibrium data indication multilayer adsorption of total chromium on the surface of biomaterial. The pod of Acacia gerrardii could be used efficiently for the removal of hexavalent chromium from aqueous solutions.

Background: Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills., Materials and Methods: This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables., Results: The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant ( P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding., Conclusion: Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family and Community Medicine.)

The clinical severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may rise because of acquiring a co-infection during the hospital stay of the patients. The rate of hospital co-infection alongside COVID-19 infection remains low. However, the mortality rates and intensive care unit (ICU) admission remains ambiguous. The present study investigates the implications of COVID-19 hospitalised infected patients with co-infection and the clinical outcomes. In this study, 142 patients were included. The eligible patients who tested positive for COVID-19 infection were hospitalised for more than two days. Each patient's characteristics and laboratory results were collected, such as who was admitted to the intensive care unit and who was discharged or expired. The results revealed that out of the 142 hospitalised patients, 25 (17.6%) were co-infection positive, and 12 identified types of co-infection: two Gram-positive bacterial infections, one fungal infection and nine Gram-negative bacterial infections. In addition, 33 (23.2%) were ICU admitted, 21 were co-infection negative and 12 were co-infection positive. Among the 12 ICU admitted with co-infection, 33.4% were discharged. The death rate and ICU admission had a p -value < 0.05, indicating statistical significance for co-infected patients compared to non-co-infected patients. It was concluded that co-infection remains very low within hospitalised COVID-19-infected patients but can have severe outcomes with increased ICU admission and increased mortality rates. Thus, implementing infection preventive measures to minimize the spread of hospital-acquired infections among COVID-19 hospitalised patients.

Objective: This study was done to determine UI prevalence among women in Saudi Arabia and identify the associated risk factors., Patients and Methods: This cross-sectional study was conducted from January 2020 to September 2020 in Saudi women who came to the Urology Department at King Khalid Hospital, Majmaah, Saudi Arabia. In the age group of 20 to 50 years, Saudi women who are not seriously ill or pregnant or in the postnatal period or diagnosed with pelvic organ prolapse were included as participants. A semi-structured questionnaire modified from the International Consultation Incontinence Questionnaire-Short Form was used to collect data on frequency, the severity, consequences, and impact of UI on quality of life. Data were analyzed by SPSS 23 (IBM, Armonk, NY, USA) with the calculation of mean and standard deviation for quantitative variables. Logistic regression analyses were applied to determine the predictors of UI., Results: A total of 451 participants were included in the final analysis. The mean age of the study population was 42.52 years (SD 11.75). Among risk factors, 45 (10%) had diabetes, 56 (12.4%) had hypertension, 36 (8%) had asthma, 80 (17.7%) had UTI/STDs. Out of 451 participants, 188 (41.7%) had urinary incontinence (UI). Sociodemographic characteristics and risk factors like family income, urinary and genital infections (UTI/STDs), pelvic/uterine prolapse, any other disease, and cough were found to have a statistically significant association with urinary incontinence (p-value <0.05)., Conclusions: The prevalence of UI was 41.7% among the study population. The various risk factors associated with UI are older age, parity, multiple vaginal deliveries, hypertension, history of asthma, and chronic cough. Poor health-seeking behavior was observed. Creating awareness and the need for early diagnosis with timely intervention is recommended.

The aim of this work was to develop and validate a liquid chromatography-tandem mass spectrometry method for detecting of the main cannabinoids, cannabinol (CBN) and tetrahydrocannabinol (THC) and the primary metabolite 11-nor-9-carboxy-Δ 9 -tetrahydrocannabinol (THC-COOH) in hair samples. Extraction of the cannabinoids was carried out by a polymeric strong anion mixed-mode solid-phase extraction cartridge and then employing methanolic HCl followed by 2-fluoro-1-methylpyridinium-p-toluenesulfonate (FMP-TS) as a derivatization procedure of carboxyl and phenolic groups, respectively, offering enhanced sensitivity for the detection of THC-COOH in hair matrices. Formation of a methyl ester increased its lipophilicity and removed the negative charge on the carboxyl group. Calibration curves were prepared over the range of 0.02-4 pg/mg of hair for THC and CBN and 0.2-12 pg/mg of hair for THC-COOH. The extraction recovery was between 81% and 105% for all compounds. The limit of detection (LOD) and limit of quantification (LOQ) were 2 and 20 pg/mg, respectively, for both CBN and THC and 0.1 and 0.2 pg/mg, respectively, for THC-COOH, which met the society of hair testing recommendation. Intra-assay and interassay precision were always lower than 4% and 11%, respectively for these cannabinoids, whereas intra-assay and interassay bias were between +14% and -18% and +15% and -12%, respectively. Twenty-seven hair specimens from cannabis users were investigated. The concentrations of CBN, THC and THC-COOH gave ranges of (0.022-2.562 ng/mg), (0.049-0.431 ng/mg) and (0.222-4.867 pg/mg), respectively. This new method of derivatization improves the LOD to ensure detection of the metabolite., (© 2021 John Wiley & Sons, Ltd.)

The retention behavior of a series of acidic drugs, namely ketoprofen (KET), naproxen (NAP), diclofenac (DIC), and ibuprofen (IBU), on the heat-resisting ZORBAX 300SB-C 18 column, was studied thermodynamically using high-temperature liquid chromatography (HTLC). A perfect correlation of the compounds' lipophilicity and the calculated thermodynamic indicators evidenced its contribution to the retention behavior. Besides, the steric fitting has a subsidiary effect on IBU retention. Isocratic HTLC separation of the four compounds was achieved using an aqueous mobile phase containing 30% acetonitrile-0.2% acetic acid-0.2% triethylamine at 60 °C. This method has been utilized to monitor the adsorption efficiency of multiwalled carbon nanotubes (MWCNTs) for the removal of the four NSAIDs from water. Different variables affecting the remediation process have been optimized such as the time of contact, pH, ionic strength, temperature, and the mass of MWCNTs. The kinetics and thermodynamics of the adsorption were investigated. The adsorption was evidenced to take place via pseudo-second-order kinetics and the intraparticle diffusion is the rate-controlling step. The thermodynamic investigation showed that the adsorption process is exothermic and enthalpy-driven, and the adsorption is more extensive at a lower temperature. The MWCNTs showed excellent adsorption efficiency of about 76.4 to 97.6% at the optimum conditions. The obtained results are promising and encouraging for the full-scale application of MWCNTs for remediation of NSAIDs-related water pollution. The green analytical chemistry metric "AGREE" and the analytical eco-scale score tool confirmed that the developed protocol is greener and more favorable to the environment and user than most of the reported literature., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: There is a shortage of urology residents in the KSA, and patients may have to wait for nearly three months to seek medical consultation with qualified urologists. According to the literature, urology residents face work-related burnout, which may affect the quality of health services provided to Saudi patients. This study aims to investigate the prevalence of work-related burnout among urology residents in KSA., Methods: A cross-sectional survey was carried out among Saudi urology residents using the Copenhagen Burnout Inventory (CBI), which includes personal, work, and patient-related burnouts. The survey was electronically sent to urology residents registered with the Saudi Commission for Health Specialties (SCFHS). Data were analysed using the SPSS program., Results: Of the 247 selected residents, 215 (87.04%) completed the questionnaire. Concerning personal burnout, 12.6% reported 'always feeling tired', 13% 'always physically exhausted', and 19.1% reported being 'always emotionally exhausted'. In addition, approximately 14% described the work as emotionally exhausting to a very high degree, while 18.6% added that they felt burnt out because of the work to a very high degree. According to the CBI, the mean personal burnout was 57.92, while the mean work-related burnout was 55.26., Conclusions: Urology residents in KSA suffer from a high degree of burnout, and urgent interventions are essential to make their work-life balance less exhausting., (© 2020 The Authors.)

Managing residual chlorine in large water distribution systems (WDS) to minimize human health risk is a daunting task. In this research, a novel risk-based framework is developed and implemented in a distribution network spanning over 64 km 2 for supplying water to the city of Al-Khobar (Saudi Arabia) through 473-km-long water mains. The framework integrates the planning of linear assets (i.e., pipes) and placement of booster stations to optimize residual chlorine in the WDS. Failure mode and effect analysis are integrated with the fuzzy set theory to perform risk analysis. A vulnerability regarding the probability of failure of pipes is estimated from historical records of water main breaks. The consequence regarding residual chlorine availability has been associated with the exposed population depending on the land use characteristics (i.e., defined through zoning). EPANET simulations have been conducted to predict residual chlorine at each node of the network. A water quality index is used to assess the effectiveness of chlorine practice. Scenario analysis is also performed to evaluate the impact of changing locations and number of booster stations, and rehabilitation and/or replacement of vulnerable water mains. The results revealed that the proposed methodology could facilitate the utility managers to optimize residual chlorine effectively in large WDS.

Background: A lot of studies were directed to explore the relation between drug abuse and neuropsychological functions. Some studies reported that even after a long duration of disappearance of withdrawal or intoxication symptoms, many patients have obvious deterioration of cognitive functions. The aim of this study was to explore the relationship between the substance use disorders and the executive functions., Methods: Two groups were selected for this study. An experimental group consisted of 154 patients and further subdivided according to the substance used into three different subgroups: opioid, amphetamine and alcohol groups which included 49, 56 and 49 patients respectively. The control group was selected matching the experimental group in the demographic characteristics and included 100 healthy persons. Tools used were: Benton visual retention tests, color trail making test, Stroop colors-word test, symbol digit modalities test, the five dots cognitive flexibility test, and TAM verbal flexibility test. All the data were subjected to statistical analysis, Results: The study showed that the group of drug-dependent subjects performed significantly worse than the comparison group on all measures Also, there were significant differences among the subgroups as the alcoholic group was much worse followed by the amphetamine then the opioids groups. Patients with longer duration of dependence and multiple hospital readmissions were much worse in comparison to patients with shorter duration of dependence and less readmission., Conclusion: The study confirmed that the functions of specific brain regions underlying cognitive control are significantly impaired in patients of drug addiction. This impairment was significantly related to type of substance, duration of use and number of hospitalization and may contribute to most of behavioral disturbances found in addicts and need much attention during tailoring of treatment programs.

Background: Mental fitness for work is the ability of workers to perform their work without risks for themselves or others. Mental fitness was a neglected area of practice and research. Mental ill health at work seems to be rising as a cause of disablement. Psychiatrists who may have had no experience in relating mental health to working conditions are increasingly being asked to undertake these examinations. This research was done to explore the relationship of mental ill health and fitness to work and to recognize the differences between fit and unfit mentally ill patients., Methods: This study was cross sectional one. All cases referred to Al-Amal complex for assessment of mental fitness during a period of 12 months were included. Data collected included demographic and clinical characteristics, characteristics of the work environment and data about performance at work. All data was subjected to statistical analysis., Results: Total number of cases was 116, the mean age was 34.5 +/- 1.4. Females were 35.3% of cases. The highly educated patients constitute 50.8% of cases. The decision of the committee was fit for regular work for 52.5%, unfit for 19.8% and modified work for 27.7%. The decision was appreciated only by 29.3% of cases. There were significant differences between fit, unfit and modified work groups. The fit group had higher level of education, less duration of illness, and better performance at work. Patients of the modified work group had more physical hazards in work environment and had more work shift and more frequent diagnosis of substance abuse. The unfit group had more duration of illness, more frequent hospitalizations, less productivity, and more diagnosis of schizophrenia., Conclusion: There are many factors affecting the mental fitness the most important are the characteristics of work environment and the most serious is the overall safety of patient to self and others. A lot of ethical and legal issues should be kept in mind during such assessment as patient's rights, society's rights, and the laws applied to unfit people.

Pulmonary artery aneurysms (PAAs) are uncommon entities. PAAs are caused mostly by trauma (often iatrogenic), infections and Behcet's disease (BD). Less common causes are pulmonary hypertension, congenital heart disease and neoplasm. BD is a multisystem disorder presenting with recurrent oral and genital ulcerations, as well as ocular involvement, and PAA is one of its rare complications. A case of huge PAA, in which the usual criteria for the clinical diagnosis of BD were present, is described. Transcatheter embolization resulted in clinical improvement.

Background: Treatment provision and treatment seeking for substance use disorders is a relatively new phenomenon in the Middle East. The present study aims to study these trends among first admissions to the specialized addiction treatment Amal Hospital of Dammam over its first two decades (1986-2006). The main outcome measures were: annual inception number (AIN), relative frequency of substances (RFS), relative frequency of drug combinations (RFDC), mean number of substances (MNS), and sociodemographic changes., Results: A total of 12,743 patients were admitted between 1986 and 2006. The majority were aged 20-39 years (83%), never married (60%), and with low education (81%). In the second decade, subjects were significantly older and less unemployed than in the first decade (28.9 years versus 30.2 years; 27% versus 19%). The mean AIN rose from 509 in the first decade to 765 in the second decade. In the same periods, the RFS increased for amphetamines and cannabis (from 12.1 and 17.5% to 48.1 and 46.5%, respectively), decreased for heroin, sedatives and volatile substances (from 51.1, 15.1, and 6.1% to 22.5, 7.3, and 2.5%, respectively), and remained stable for alcohol (from 27.1 to 26.7%). The overall RFDC increased from 25.5 to 43.2% with significant pair-wise increases of cannabis/amphetamine, alcohol/cannabis and alcohol/amphetamine, and heroin/alcohol. The mean number of substances per subject increased from 1.32 to 1.56%., Conclusions: Significant shifts have occurred in the types and patterns substances use among treatment-seeking subjects. These findings underscore the need for community-based epidemiologic studies and for the establishment of a comprehensive drug information system in Saudi Arabia.

Objective: To assess the amount of healthcare risk waste generated by health establishments in Saudi Arabia, Methods: A healthcare waste management questionnaire was applied in 27 hospitals, and 16 primary health centres and clinics. The total quantity of healthcare risk waste collected in 24 hours in each of these establishments was weighed. Calculations were carried out to get hospitals rate of healthcare risk waste generation and primary healthcare centres risk waste generation. The total national estimate of healthcare risk waste production in kilograms/year for the whole health establishments in the Kingdom was then calculated., Results: The mean hospital healthcare risk waste rate of generation was 1.13+/-0.96 kg/bed/day. The mean primary healthcare centres and clinics healthcare risk waste rate of generation was 0.08+/-0.08 kg/visitor/day. The estimated mean amount of all healthcare risk waste generated in the Kingdom of Saudi Arabia is 25,207 tons/year., Conclusion: Healthcare establishments in Saudi Arabia produce healthcare risk waste. Much care is given by the responsible authorities for the management of that type of waste. A program is being established to formulate standards for healthcare waste management

Introduction: Mass media are very important in health education programmes. Health promoters rely on them to play a crucial role in their campaign., Aim: The aim of the study was to study the patterns of contribution of the Saudi daily newspapers on two international health occasion during the year 1416H (World AIDS Day 1995 and World Health Day 1996)., Material and Methods: The study was retrospective, carried out by reviewing eight daily Saudi newspapers including all issues covering three months before and extending three weeks after each occasion. All newspaper materials concerning the two occasions were specified, and data obtained from them included types of materials, topics and characteristics of the paper., Results: The study revealed that the newspapers gave more coverage to World AIDS Day than on World Health Day. This meant that journalists considered that AIDS was more interesting to the readers than the environmental topic of World Health Day. Most of the materials especially in World Health Day were published in the inner pages. These findings are in consonance with previous work, which showed that Saudi journalists had little interest in environmental issues. Nearly two thirds of the materials were news items about ministerial and activities of other organizations. Informative articles on health education and readers' participation were minimal., Conclusion: It was concluded that newspapers took not much interest on health matters especially health education.

The flagellum of Leishmania major promastigotes has an intraflagellar structure known as the paraxial rod (PAR) which extends from a point halfway in the flagellar pocket to the tip of the flagellum, lying opposite the axonemal microtubule doublets 4-7. An expansion of the axonemal plasma membrane envelops the PAR and may provide desmosomal attachment at the orifice of the flagellar pocket. The complex organization of the 4-6 nm thick filaments in the PAR was studied by us in cross, oblique, longitudinal and tangential sections by electron microscope. These filaments are disposed in two parallel lamellae, one alongside the axoneme (ca. 45 nm thick), and the other alongside the plasma membrane (ca. 65 nm thick), with an interlamellar gap of about 22-28 nm. In each lamella, 8-12 parallel series of longitudinal filaments at ca. 30 nm intervals interdigitate with coplanar parallel series of oblique filaments at ca. 25 nm intervals and inclined to the long axis of the flagellum at ca. 48 degrees, and ca. 55 degrees, in the inner (paraxonemal) and outer lamella, respectively. The parallel filaments in each of the longitudinal and oblique series are spaced at ca. 8 nm intervals. They are cross-striated at ca. 30 nm intervals by transverse filaments which terminate occasionally on adjacent axonemal microtubules 5 and 6 in the inner lamella, and the plasma membrane in the outer lamella. Extending across the interlamellar gap is a set of parallel rows of 7-12 nearly parallel filaments at ca. 20 nm intervals. The part of the flagellar plasma membrane enclosing the PAR has a subplasmalemmal cytoskeleton consisting of a layer of longitudinal 2 nm filaments at 8 nm intervals, obliquely striated by parallel 2 nm filament doubles at ca. (-65) degrees with the long axis of the flagellum and ca. 20 nm periodicity. Each filament doublet stria apparently gives origin to collinear short filament doublet extensions that curve into juxtaposed meshes of the outer lamella. Microtubules of the axonemal doublets 5 and 6 are connected to electron-dense (ca. 12 nm thick) strips of the inner lamella of the PAR by longitudinal series of ca. 4 nm cross-links across a ca. 12 nm cleft.

Twenty-two black rats (Rattus rattus) were captured in houses where parasitologically confirmed cases of human visceral leishmaniasis had been recorded in Al-Arda Emara, Gizan province, south-west Saudi Arabia. Four of the rats were found to be infected with Leishmania; isoenzyme characterization showed that 3 were infected with L. donovani sensu lato zymodeme LON42 and the fourth with L. infantum zymodeme LON49. L. donovani s.l. LON42 has also been isolated from human visceral leishmaniasis patients living in this area, while dogs, but not humans, have been found to be infected with L. infantum LON49 in this part of Saudi Arabia.

Kala-azar (VL), mainly affecting infants and young children, is being increasingly reported in the south-west of Saudi Arabia, 305 cases being diagnosed in 1988. Most cases arise in scattered locations in the foothills west of the Asir mountains at altitudes between about 500 and 1000 m, although case clusters are apparent in some villages. Some cases also occur between the foothills and the Red Sea coast. The incidence in the south-west was calculated to be of the order of 6 to 8/10,000 population per year, but a random serological survey using the enzyme-linked immunosorbent assay and direct agglutination techniques indicated a seropositivity rate of about 3.7% in 706 apparently healthy children. Most patients are Saudi or Yemeni and cases are being increasingly identified also in the Yemen Arab Republic. In the foothills of both countries the causative organism is Leishmania donovani s.l. zymodeme LON-42, which also occurs on the eastern littoral of Ethiopia. By isoenzyme electrophoresis, it is readily separated from L. infantum, which has been identified in feral dogs, the 2 organisms being sympatric. The infection was found in 6.7% of 89 dogs, but their seropositivity rate was 19.3%. Although L. infantum has not yet been recognized in man in Saudi Arabia, it has been identified in a child in the coastal plain of the Yemen Arab Republic. Further research needed to provide a rational basis for control is discussed.

Cutaneous leishmaniasis (CL) is common on the high plateaux and foothills of the Asir range in the south-west of Saudi Arabia and Yemen. In 1987 1198 and 1104 cases were reported among the Saudi populations of Asir and Al-Baha provinces, representing an estimated annual incidence of 12 and 38 per 10,000 respectively. The incidence rises from October to December, then declines to a minimum between May and August. The prevalence of Phlebotomus sergenti, a proven local vector in the highlands, is roughly in inverse proportion. Cases occur at all ages, over 60% have only a single lesion, and the head and neck are most commonly affected. Apart from a few patients who develop leishmaniasis recidivans, most respond well to sodium stibogluconate, or self-heal. Of 44 isolates typed by isoenzyme electrophoresis, 42 were Leishmania tropica belonging to 5 distinctive zymodemes. LON-72 (34 isolates), LON-73 (1), LON-71 (2) and LON-10 (2) were found at altitudes around 2000 m, 3 of them in a single village. Three isolates of LON-63 were found at altitudes between 600 and 1000 m in widely separated foci. L. tropica LON-10 and LON-71 have been isolated also from P. sergenti from highland foci. LON-72 failed to produce lesions in BALB/c mice and gave rise to only transitory lesions in the footpads of hamsters.(ABSTRACT TRUNCATED AT 250 WORDS)