The purpose of this study was to investigate the effects of thyme oil (TO), chitosan nanoparticles (CS-NPs), and TO-loaded-CS-NPs on controlling Salmonella Typhimurium (S. Typhimurium) infection in broiler chickens when compared to ciprofloxacin (Cip) antibiotic treatment. The CS-NPs and TO-loaded-CS-NPs were initially characterized using a transmission electron microscope. Two hundred and forty broiler chicks were divided into six equal groups. Group 1 was given TO (1ml/4L of the drinking water). However, group 2 and group 3 were given CS-NPs and TO-loaded-CS-NPs in a 2 ml/chick dose by oral gavage. Group 4 was given a Cip (0.5 g/mL of drinking water). Treatments started on the 20th day of age and continued for 5 successive days. Each chicken in groups 1-5 was orally infected with 1 ml of 1 x 109 CFU/ml S. Typhimurium 14 days old. Chickens in group 6 were kept as blank control negative without treatment or infection. All groups were kept for 4 weeks postinfection to record clinical observations, performance parameters, the shedding rate of S. Typhimurium, and the histopathological parameters of different organs. Results showed that the infected untreated group had the lowest performance (BWT: 2164.60 f 31.90), with the highest bacterial count (BC) (8.56 f 0.14) and lesion scores. The best results were obtained in response to TO-loaded-CS-NPs (BWT: 2422.70 f 51.15 and BC: 6.62 f 0.32) and Cip (BWT: 2431.50 f 40.01 and BC: 5.32 f 0.16). Therefore, it is recommended to use TO-loaded-CSNPs as an alternative antibacterial agent in controlling S. Typhimurium infection without taking the risk of developing resistant bacterial strains as with antibiotics.

Abstract Background Lung cancer is a form of cancer that is responsible for the largest incidence of deaths attributed to cancer worldwide. Non-small cell lung cancer (NSCLC) is the most prevalent of all the subtypes of the disease. Treatment with tyrosine kinase inhibitors (TKI) may help some people who have been diagnosed with non-small cell lung cancer. The presence of actionable mutations in the epidermal growth factor receptor (EGFR) gene is a key predictor of how a patient will respond to a TKI. Thus, the frequency of identification of mutations in EGFR gene in patients with NSCLC can facilitate personalized treatment. Objective The objective of this study was to screen for mutations in the EGFR gene and to investigate whether there is a correlation between the screened mutations and various clinical and pathological factors, such as gender, smoking history, and age, in tissue samples from patients with NSCLC. Methods The study comprised 333 NSCLC tissue samples from 230 males and 103 females with an average age of 50 years. Exons 18–21 of the EGFR gene have been examined using real-time PCR. Using SPSS, correlations between clinical and demographic variables were examined, and EGFR mutation and clinical features associations were studied. Results The study’s findings revealed that the incidence rate of EGFR mutation was 24.32% (81/333), with partial deletion of exon 19 (19-Del) and a point mutation of L858R in exon 21 accounting for 66.67% (P < 0.001) and 28.40% (P < 0.001) of the mutant cases, respectively. Patients who had the T790M mutation represent 4.94% (P = 0.004) of total number of patients. Females harbored EGFR mutations (54.32%) with higher frequency than men (45.68%) (P < 0.001), while nonsmokers had EGFR mutations (70.37%) more frequently than current smokers (29.63%) (P < 0.001). Conclusion The screening study conducted in Egypt reported that the EGFR mutations prevalence was 24.32% among Egyptians with NSCLC. The study also found a slight gender bias, with females having an incidence rate of these mutations higher than males. Additionally, nonsmokers had higher rates of mutations in EGFR gene compared to smokers. According to the findings, somatic EGFR mutations can be employed as a diagnostic tool for non-small cell lung cancer in Egypt, and they can be implemented in conjunction with clinical criteria to identify which patients are more likely to respond favorably to TKIs.

Background: as COVID-19 spreads in a pandemic manner declare the spreading pattern of other viruses inducing lower respiratory tract infection in children is of high diagnostic value due to interfering symptoms where most common being Respiratory syncytial virus, Rhinovirus, Adenovirus, Influenza, and Parainfluenza viruses.Due to the use of the Pneumococcal conjugate and the Hemophilus influenza type b vaccines, Staphylococcus aureus and H. influenza non-type b are emerging as the most common bacterial organisms causing acute community-acquired pneumonia.In low-and middleincome countries, other bacterial organisms are also reported as Klebsiella pneumoniae, E-coli, and Bordetella pertussis.The most frequent symptoms of COVID-19 are fever, cough, dyspnea, anosmia, and gastrointestinal symptoms.Some children may require intensive care unit admission and mechanical ventilation.Objectives: to detect the most prevalent viral and bacterial agents causing acute community-acquired pneumonia among children in the era of COVID-19, and to assess their hospital stay length and their clinical outcomes.Methodology: This prospective observational study included 100 children presented with community-acquired pneumonia to Cairo University Specialized Pediatric Hospital and 6th October Health Insurance Hospital from October 2020 to September 2021.Respiratory samples were subjected to viral detection by PCR and microbiological isolation.Results: The most prevalent pathogens causing communityacquired pneumonia were viruses (44%) followed by bacteria (40%).The most prevalent virus was Influenza B virus (18%).The most prevalent bacteria was Klebsiella pneumoniae (14%).Conclusions: Viral agents are the most prevalent pathogen causing acute community-acquired pneumonia in children under 5 years during COVID-19.

Background: Competent educational environment for medical postgraduate is crucial to ensure sound clinical outcome. The quality of the educational environment is influenced by many factors, physical, social and intellectual. The current study aimed at assessing the educational environment in a postgraduate Saudi Board for Family Medicine in Jeddah. Methodology: Through cross sectional study design, all residents in the Saudi Board of Family medicine in Jeddah were invited to participate in the study; they were asked to fill a predesigned adopted valid questionnaire based on the Scan of Postgraduate Educational Environment Domain (SPEED) which is used to assess the quality of the Post Graduate Medical Education. Data were collected during gathering of the residents in a usual didactic teaching day. A total of 186 residents responded, making a response rate 93%. Results: Out of all participants (n=186), females formed two thirds of the residents (60.8%), their mean age was 27.6±2.27 years, with an almost equal representation of the four residency levels. The highest scores about the quality of the educational process was observed in the item regarding the supervisors being respectful towards the registrars (mean score 4.1 out of 5), followed by the being approachable and helpful (mean score 4.0). The lowest scores were observed regarding presence of staff in general who have positive impact on the educational environment (mean score 3.2), followed by availability of good clinical supervisors all the time (mean score 3.3). The overall mean score accounted for 3.6± 0.56, although it was higher in females (3.7±0.642) than males (3.5±0.661), and in those in R1 (3.7±0.509) and R4 (3.7±0.605), however, these differences are not statistically significant p>0.05. Also, no statistically significant correlation between and age and overall mean score was observed. Conclusion and recommendations: The Saudi Board residents for Family Medicine considered their educational environment as more positive than negative with potential areas for improvement. Although females perceived the educational environment better than male trainees, no significant changes observed along the different stages of the program. It is recommended to use these findings in reforming the educational environment in the Saudi Board.

Background: To prevent discomfort from vulvovaginal complaints and as a way of maintaining personal hygiene, women use various cleaning agents for vulvovaginal care. Unfortunately, some of these agents are injurious to the vulvovaginal area. The muco-cutaneous inflammation, often caused by their use may cause further discomfort and increase the risk of acquisition of sexually transmitted infections like HIV. Aim: This study aimed at identifying agents women commonly used for vulvovaginal care with a view of generating public awareness and promoting correct practices thereby reducing risk of acquiring sexually transmitted infections such as HIV, genital chlamydial infection and gonorrhea. Methodology: It was a cross sectional study involving women who presented to the Special Treatment Clinic (STC) of a tertiary healthcare facility in Northwest Nigeria with vulvovaginal symptoms over a 6-month period were recruited. Structured questionnaire was used to collect data on their socio demographic and bio-medical characteristics, symptoms of vaginitis and various vaginal cleaning agents used. Data was analyzed using SPSS version 20.0 and descriptive statistics documented. Results: A total of 351 women attending STC were analyzed. Age range was 15- 65years, with mean age of 28.7±8.5. Majority 247(70.1%) were married, 229 (65.2%) were unemployed while 144(41%) had attained tertiary education. The commonest agent used for vulvovaginal care (52.4%) was water only. Other agents identified included antiseptic soap/solution (8.8%), mild toilet soap (8.5%), herbs (2.8%), local soap (2.3%) and 21.9% used a combination of various agents. Educational level was the only factor associated with type of agents used for cleaning (p=0.002).Conclusion: The high prevalence of use of other agents apart from water underscores the need for creating public awareness about proper vulvovaginal care among young girls and women.

Purpose: Food addiction is defined as “a specific adaptation to one or more regularly consumed foods to which a person is highly sensitive, [which] produces a common pattern of symptoms descriptively similar to those of other addictive processes” (Randolph, 1956). This study sought to measure the prevalence of food addiction and to assess its risk factors among family medicine residents of the joint program in Jeddah 2019.Methodology: This is a cross-sectional study using the modified Yale Food Addiction Scale, Version 2;149 out of 180 candidates were approved to participate.Findings: Most physicians were females (63%), non-smokers (66%), without chronic diseases (95%), single (55%), and living with their families (93%); participants had a mean age of 28 years and a mean body mass index (BMI) of 25. Only 11.4% of the physicians adhered to the diagnostic criteria of food addiction, with 41% experiencing mild food addiction, 24% moderate, and 35% severe. The symptom count had a mean of 1.46, and the most endorsed symptom scored was “persistent desire or repeated unsuccessful attempts to quit.” There was no statistically significant clinical relationship to be found between food addiction and the different determinants, such as gender, age, relationship status, chronic disease, smoking, and BMI in this non-clinical sample.Unique contribution to theory, practice and policy: Our study shows that the prevalence of food addiction among Saudi family physicians in training is similar to other studies targeting non-clinical samples around the world. Up to our knowledge, this is one of the first studies in Saudi Arabia, exploring the prevalence of food addiction. We hope that this study highlights the issue as Saudi Arabia has one of the highest rates of obesity around the world

Background: Coronavirus disease 2019 (COVID-19) is a severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sufficient knowledge, positive attitudes, and correct practices are crucial for the prevention of COVID-19. Aims: This study aimed at assessing the knowledge, attitudes and practices of a sample of Sudanese residents towards COVID-19. Methods: A cross-sectional community-based survey was conducted on 812 participants, including both sexes and aged 18 years and above, with the exclusion of health care workers. Considerable care was taken to include people with different education levels. Results: Among the survey respondents (n=812), 45.8% were women, 40.4% held a bachelor's degree, 5.7% were uneducated, and 51.1% were aged 18-25 years. The overall correct rate of the knowledge questionnaire was 78.2%; 66.9% agreed that religious gatherings and events should be cancelled to prevent the spread of COVID-19; 34.1% of respondents wore medical masks; and 57.9% avoided shaking hands in recent days. Conclusion: This study showed that sampled Sudanese residents have incomplete knowledge and poor practices towards COVID-19. However, we found that women and people aged 18-25 years were more knowledgeable and had more positive attitudes towards COVID-19. We hope that concerned authorities will establish awareness programmes to improve the ability to combat this disease.

Purpose: The massive spread of the new coronavirus, starting from China, continues to threaten the lives of populations worldwide. With no available treatment or vaccine, precautionary behaviors remain the principle preventive measure against the disease. The current study aimed at exploring the factors predicting adherence and adoption of individuals to the recommended precautionary practice in Saudi Arabia.Methodology: Through a cross-sectional design, using a predesigned questionnaire distributed through social media and targeting general adult Saudi population, 1860 individuals responded in almost two weeks. The used questionnaire included, in addition to demographic characteristics, perception of the respondents to the seriousness of the disease, and their compliance with the recommended protective measures of Covid-19.Findings: The total respondents were 1860, among which 1680 individuals responded within the first week of the study (March 2020). The majority of responders were Saudi (90.4%), with marked dominance of females (74.1%), and their mean age was 39.2± 11.6 years. Slightly more than one-half of the respondents (57.2%) agreed that Covid-19 is a serious disease. The perception of participants about the seriousness of Covid-19 was significantly higher among retired individuals p<0.05. Those who perceived Covid-19 as a serious disease were significantly keener to comply with the recommended protective measures against Covid-19. Two-thirds of the respondents (65.8%) expressed that they are worried that the spread of the disease may become worse, and 15.1% always feel afraid to get the disease. Those who felt fearful of getting the disease were significantly more compliant with the protective measures. The primary source of information about Covid-19 was MOH (1164, 62.6%).Unique contribution to theory, practice and policy: Perception of the seriousness of the disease and fear of getting the disease are significant predictors for compliance with recommended protective measures, although it could be beneficial during pandemics; however, the consequences of long-standing worry and fears should be taken into consideration of the health care providers.

MERS-coronavirus infection is currently responsible for considerable morbidity and mortality in Saudi Arabia. Understanding its burden, as an emerging infectious disease, is vital for devising appropriate control strategies. In this study, the burden of MERS-CoV was estimated over 31months period from June 6, 2012 to January 5, 2015. The total number of patients was 835; 528 (63.2%) patients were male, 771 (92.3%) patients were ≥25 years of age, and 210 (25.1%) patients were healthcare workers. A total of 751 (89.9%) patients required hospitalization. The median duration between onset of illness and hospitalization was 2 days (interquartile range, 0–5). The median length of hospital stay was 14 days (IQR, 6–27). The overall case fatality rate was 43.1%. Basic reproductive number was 0.9. Being Saudi, non-healthcare workers, and age ≥65 years were significantly associated with higher mortality. In conclusion, MERS-CoV infection caused a substantial health burden in Saudi Arabia.

In today’s competitive and media-influenced health care environment, resource utilization is driven by patient outcome. A key criterion to evaluate the quality of health care services is to assess patients’ satisfaction. The objectives of this study were to compare patients’ satisfaction in the first and last quarters after Primary Health Care Centers’ (PHCCs) integration with Ministry of Health (MOH) hospitals in Jeddah, and to identify the factors contributing toward patient’s satisfaction in first and last quarters. This cross-sectional study was conducted among patients visiting PHCCs in the first and last quarters. Randomly selected participants were interviewed using a validated closed-ended questionnaire, part of which also included modified Patient Satisfaction Questionnaire (PSQ18) with its subscales and standard cutoffs. Chi-squared test and multinomial logistic regression analysis were run to find the factors associated with satisfaction. The overall satisfaction in our study participants was 66.3% in the first quarter as compared with 83% in the last quarter. The mean scores of most PSQ18 subscales in the first and last quarters after the integration showed significant difference. Multinomial logistic regression analysis of the first quarter after integration showed three to fourfold increase in satisfaction of individuals who perceive an improvement in registration counters’ load, cleanliness of centers, satisfaction with the staff’s behavior, and ease in referral as compared with non-satisfaction [OR 3.60 (p = 0.018); OR 4.33 (p = 0.001); OR 2.47 (p = 0.055); and OR 4.45 (p = 0.005), respectively]. However, in the last quarter those satisfied with the staff’s behavior (OR 2.48, p = 0.038), and dental facilities (OR 2.74, p = 0.043) had an odds ratio of ≥2. PHCCs integration with the hospitals is an effective strategy, which not only has improved functionality but has a significant effect on patient’s satisfaction. Treating patients served by PHCCs integrated with hospitals is thus recommended.

BACKGROUND: Despite clear evidence indicating the health hazards of water tobacco smoking (WTS), there is a remarkable increase in the frequency of WTS in the Middle East and the Gulf region, particularly among young girls and women. The objective of this survey was to examine the prevalence of and the reasons for addiction to WTS and study in depth the factors contributing to the increased frequency of WTS among Saudi females. MATERIALS AND METHODS: This study was conducted in different cafés and restaurants in Jeddah using a mixed method approach. A quantitative approach was carried out by a cross-sectional design, in which adult WTS Saudi females (n = 332) were selected from ten cafés. In addition, a qualitative approach was pursued involving five focus group discussions and three in-depth interviews of heavy smokers. Frequencies and percentages were calculated for the categorical variables, and Chi-square test and regression analysis were performed to establish association. Key themes were identified and built upon for the qualitative part. RESULTS: The mean age of female water-pipe (WP) smokers was 32.5 ± 11.9 years. Addicted to WTS were 39.6% of the women. Significant predictors of smokers' addiction to WTS according to regression analysis (p < 0.05) were increased frequency of WTS, perception that it improved mood, and insistence on carrying one's own WP to restaurants and cafés. Smoking frequency increased in pleasant weather (p = 0.025) and better mood (p = 0.033). This study showed that students and working women were more addicted to WTS (p < 0.001). Those who smoked daily preferred to smoke at home especially when alone (p < 0.001), while the preferred place for those who smoked weekly was restaurants in the company of their friends (p < 0.001). Most of the participants in this study believed that WTS was less harmful and less addictive than cigarette smoking. The only driving force to quit WTS was the effects on their beauty/skin. CONCLUSION: WTS is a public health problem, especially among young girls. Peer pressure, view that it is a fashion symbol, carrying one's own WP and wrong belief that WP was less harmful, improved mood, and effect of the weather are main factors leading to unintentional dependency on WTS. The only driving force to stop WTS is the effect it has on beauty/skin. It is important to understand the reasons behind the upsurge of WTS in this group for appropriate policy for intervention for its prevention and cessation.

Objective More than half of the world’s population live in areas with a potential risk of acquiring dengue fever (DF). Health education interventions are effective, barring a language communication gap. The objective of this study was to estimate the effect of health education in the knowledge, attitude, and practices (KAP) towards DF control and prevention in public and private schools. Materials and methods We assessed the DF control and prevention strategy KAP of students of eight public and private schools in Jeddah, Saudi Arabia before the dengue health education intervention sessions (pre-I) and three months following the education intervention sessions (post-I) using the same closed-ended validated questionnaire. Schools and students were selected by a multistage stratified random sample method. Statistical analysis was done using the paired and independent T-test in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY). Results We found a significant mean difference in the overall knowledge (pre-I, 7.86 ± 2.61; post-I, 10.94 ± 2.35), attitude (pre-I, 5.16 ± 1.50; post-I 6.23 ± 1.30), and practice (pre-I, 2.96 ± 1.33; post-I, 3.94 ± 1.12) scores. Private schools scored better post-intervention scores in knowledge and practice compared to public schools in local and English language medium. Conclusions Health education programs are essential for DF prevention and management. Institutes whose populations consists of students with various language backgrounds should not be ignored. Bilingual educational sessions are important in such private institutes. Our results indicate additional emphasis is required on putting interventional knowledge into practice.

This study aimed to estimate the seroprevalence of anti-dengue IgG antibodies in Makkah, Al Madinah, Jeddah, and Jizan; and to identify the associated demographic, clinical, and environmental independent risk factors. A community-based household serosurvey conducted between September 20, 2016 and January 31, 2017. A multi-stage stratified cluster sampling was used to select 6596 participants from Makkah, Madinah, Jeddah, and Jizan. Blood samples were drawn from all participants to detect anti-dengue IgG antibodies. A semi-structured questionnaire was used to collect information on demographic, clinical, and environmental data. Multivariate logistic regression was carried out to identify independent risk factors of dengue seropositivity. The dengue seroprevalence (95% confidence intervalI) was 26.7% (25.6%, 27.8%), with the highest (33.6%) and lowest (14.8%) rates in Jizan and Madinah, respectively, and reaching 50% or more in several districts of the four cities. Demographic predictors of seroprevalence included: dwelling in Makkah (odds ratio [OR] = 2.19, p < 0.001) or Jizan (OR = 2.17, p < 0.001); older age (OR = 3.91, p < 0.001 for age>30 years); housing type (OR = 1.84 and 1.82, p < 0.001 for popular and social houses, respectively); and number of household occupants (OR = 0.86 and 0.71 for 6-10 [p = 0.042] and 11-20 [p = 0.002] occupants, respectively). Environmental predictors included the absence of pest control works in residency area (OR = 1.39, p = 0.002), presence of mosquitoes in the home (OR = 1.39, p = 0.001), and absence of awareness campaigns (OR = 1.97, p < 0.001). One in four inhabitants of the Western region of Saudi Arabia was seropositive for the dengue virus. Implementation of behavior-based educational programs is recommended, involving the population in the identification and eradication of vector sources and promoting appropriate behaviors that prevent the spread.

Background: Irritable Bowel Syndrome is one of the most prevalent gastrointestinal disorders responsible for disability and negative economic impact. Stress had been suggested as one of its predictors, therefore, stressful occupation such as physicians are expected to be at a higher risk. Insufficient information is present for the link between working as a physician and suffering from Irritable Bowel Syndrome. Objectives of the study: To explore the prevalence and possible factors associated with Irritable Bowel Syndrome among physicians working in Primary Health Care centers, Jeddah, KSA. Subjects and methods: Through a cross-section study design, 190 physicians were selected randomly from primary health care centers in Jeddah. They responded to a predesigned valid self-administered questionnaire enclosing information about the prevalence and possible factors associated with Irritable Bowel Syndrome. Chi-square test and Binary logistic regression were used to identify factors and predictors of the syndrome among physicians. Results: Out of all sharing physicians (n=190), more than one quarter (28.4%) reported that they had been diagnosed with Irritable Bowel Syndrome. The prevalence was significantly higher in females (35.3%) with an Odds Ratio of (OR=1.284; 95% CI= 1.084-1.521) and living in rented houses (34.7%) (OR=1.198; 95% CI= 1.001-1.435) p<0.05. Positive family history and exposure to any kind of stress at work were significantly prevalent among cases (94.4%). Also, overweight and obesity (51.9% and 20.4% respectively) and food sensitivity (24.1%) were significantly much frequent among physicians with the syndrome. Logistic regression revealed that stress, positive family history, and high BMI are significant predictors for IBS. Conclusion and recommendations: Irritable Bowel Syndrome is prevalent among physicians in primary health care centers. Its prevalence is significantly higher among females, those who are living in rented houses, who are exposed to any kind of stress at work, who have a positive family history of IBS, with higher BMI values and have a food sensitivity. Further researches are needed to analyze types and sources of work stress in an attempt to plan for ameliorating stress and its consequences in physicians.

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatry disorders in children, it has negative impact on the academic, familial and social functioning of the child. The recent advances in its treatment calls for social intervention including school based activities, which necessitates knowledgeable teachers. Aim: The main aim of this study is to explore the level of knowledge and attitude of the school teachers of female primary schools in Jeddah about ADHD. Subjects and methods: Through a cross sectional design, 376 school teachers were selected by multistage sampling from female primary schools in Jeddah, they were invited to fill a predesigned valid questionnaire reflecting their knowledge and attitude towards ADHD. SPSS ver 21 was used for data entry and statistical analysis which included descriptive as well as analytic analysis using Chi square test. P value<0.05 was considered an indication for significance. Results: Almost one half of the teachers (47.6%) aged between 40-49 years, who were mostly married (81.1%) and having children (84.3%). Out of them, 8.2% reported that they have ADHD child. Although that more than one half of the teachers (54.3%) thought that they had knowledge about ADHD, the true knowledge test questions revealed a much lower percentage (24.5%) who showed good knowledge about ADHD. Only older teachers had significant better knowledge. More than one half of the teachers (57.2%) perceive that the first step in the management policy when suspecting ADHD is the referral of the child to advisor and asking for attendance of the parents. Conclusion and recommendations: Most of the teachers have insufficient level of knowledge about ADHD. There is a tangible need for training programs provided to the teachers about early recognition and policy of care of ADHD children.

This study was conducted to develop a method for improving tenderness and overall qualities of tough camel's meat using plant proteolytic enzymes. 3x3 cm uniform-sized from Semitendinosus muscle of old female camel's meat Camelus dromedaries (over 7 years) were marinated with 7% freshly prepared ginger extract, 0.7% papain extract and mixture of papain extract (0.6%) and freshly prepared ginger extract (5%) then kept at 4°C for 3 days. The tenderized as well as the control samples were subjected to analysis in the due time in terms of sensory, bacterial, physicochemical, ultrastractural and electrophoretic examinations. Improvement of sensory scores and significant (P< 0.05) decreased APC, Coliforms, Fecal Coliforms were observed in all enzyme treated samples. Physico-chemical parameters showed significant(P< 0.05) reduction in collagen content, MFD, TBA value, shear force and significant (P< 0.05) increase total soluble protein, collagen solubility %, MFI and SL in all enzyme treated samples compared to control. Electrophoretic pattern of muscle proteins also revealed extensive proteolysis and reduction in number of protein bands in all treated samples. While, histological evaluation showed significant changes in the ultrastructure of connective tissue and muscle fiber. Mixture of both enzymes induced the most obvious effect on camel's meat tenderness followed by papain extract and finally ginger extract.

Introduction: The current study aims to assess the level of patients' satisfaction and the factors contributing to patients' satisfaction toward family physicians (FPs) consultation, visiting primary healthcare centers (PHCCs) working under Ministry of Health, Jeddah. Materials and Methods: In this cross-sectional study conducted in Jeddah from November 1, 2016 to March 1, 2017, we used consultation satisfaction questionnaire and its four subscales with standard cutoffs. These subscales include general satisfaction, professional care, depth of relationship, and length of consultation. Mean scores along with standard deviation of these subscales were measured. Independent sample t-test, ANOVA, and multivariate regression analysis were performed to test the association between satisfaction level and predictors. Results: Overall, patients' satisfaction was 60%. Around 74% of patients were satisfied with the professional care and 58% with the depth of the relationship. Around 60% of patients need more consultation time with the physicians. Knowledge about the presence of FP in the nearest PHCCs was around 70%. Multivariate regression analysis for the overall high satisfaction showed that the most important predictors of this high satisfaction level are regular visits to a particular FP (P < 0.001), distance from the PHCC (P = 0.044) and gender of the patient (P = 0.027). Conclusion: This study concluded that satisfaction with the FP's consultation is acceptable but needs improvement. Lower satisfaction was reported among males, patients living at a distance from PHCC and who had less knowledge about the presence of FP in their nearest PHCC. Such study data are vital for any corrective measures to boost satisfaction in patients attending PHCCs.

Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p <0.001), unorganized patients flow to clinics (p=0.021), more paperwork (p<0.001), and less co-operative colleague doctors (p=0.045) were the significant predictors for high emotional exhaustion. A positive correlation was noted between the number of patients per day and burnout. The patient’s pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient’s pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician’s burnout.

The transmission routes and risk factors for zoonotic Middle East respiratory syndrome coronavirus (MERS-CoV) infections are still unknown. We used the World Health Organization questionnaire for MERS-CoV case-control studies to assess risk factors for human MERS-CoV seropositivity at a farm complex in Qatar. Nine camel workers with MERS-CoV antibodies and 43 workers without antibodies were included. Some camel-related activities may pose a higher risk of MERS-CoV infection, as may cross-border movements of camels, poor hand hygiene, and overnight hospital stays with respiratory complaints. The risk factors identified in this study can be used to develop infection prevention and control measures for human MERS-CoV infections.