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  1. Article ; Online: Risk factors for heat-related illnesses during the Hajj mass gathering: an expert review.

    Yezli, Saber

    Reviews on environmental health

    2021  Volume 38, Issue 1, Page(s) 33–43

    Abstract: Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has ... ...

    Abstract Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has historically been associated with HRIs. Hajj attracts over two million Muslim pilgrims from more than 180 countries to the holy city of Makkah, Kingdom of Saudi Arabia. Several modifiable and non-modifiable factors render Hajj pilgrims at increased risk of developing HRIs during Hajj. These include characteristics of the Hajj, its location, population, and rituals, as well as pilgrims' knowledge of HRIs and their attitude and behavior. Makkah is characterized by a hot desert climate and fluctuating levels of relative humidity. Pilgrims are very diverse ethnically and geographically, with different adaptations to heat. Significant proportions of the Hajj population are elderly, obese, and with low levels of fitness. In addition, many have underlying health conditions and are on multiple medications that can interfere with thermoregulation. Other factors are inherent in the Hajj and its activities, including crowding, physically demanding outdoor rituals, and a high frequency of infection and febrile illness. Pilgrims generally lack awareness of HRIs, and their uptake of preventive measures is variable. In addition, many engage in hazardous behaviors that increase their risk of HRIs. These include performing rituals during the peak sunshine hours with no sun protection and with suboptimal sleep, nutrition, and hydration, while neglecting treatment for their chronic conditions. HRIs preventive plans for Hajj should incorporate measures to address the aforementioned factors to reduce the burden of these illnesses in future Hajj seasons. Lessons from the Hajj can be used to inform policy making and HRIs preventive measures in the general population worldwide.
    MeSH term(s) Humans ; Aged ; Mass Gatherings ; Hot Temperature ; Travel ; Saudi Arabia/epidemiology ; Risk Factors
    Language English
    Publishing date 2021-10-30
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 184450-7
    ISSN 2191-0308 ; 0048-7562 ; 0048-7554
    ISSN (online) 2191-0308
    ISSN 0048-7562 ; 0048-7554
    DOI 10.1515/reveh-2021-0097
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The threat of meningococcal disease during the Hajj and Umrah mass gatherings: A comprehensive review.

    Yezli, Saber

    Travel medicine and infectious disease

    2018  Volume 24, Page(s) 51–58

    Abstract: The Hajj and Umrah mass gatherings represent many of the risk factors for meningococcal disease and have historically been associated with both local and international outbreaks of the disease. The implementation of strict preventative measures including ...

    Abstract The Hajj and Umrah mass gatherings represent many of the risk factors for meningococcal disease and have historically been associated with both local and international outbreaks of the disease. The implementation of strict preventative measures including mandatory meningococcal vaccination with the quadrivalent (A,C,Y,W) vaccine has prevented pilgrimage-associated meningococcal outbreaks and significantly reduced the incidence of the disease at these events. However, meningococcal disease remains an important public health threat at the Hajj and Umrah due in part to the evolving nature of the disease, characterized with diverse and varying geographic trends, fluctuations in incidence and shifts in serogroups and genotypes. In addition, the current Hajj and Umrah meningococcal disease preventative measure do not protect against all invasive serogroups and do not necessarily affect carriage and transmission as the polysaccharide vaccine is still widely used. As a consequence, these events are still susceptible to outbreaks of the disease including those due to serogroups not included in the required vaccines such as serogroups B and X. In this context, despite the global decline in incidence of meningococcal disease, including that cause by serogroup B, the increased predominance of serogroup B disease in many countries, including countries with large Muslim populations, and the emergence of serogroup X in the African meningitis belt, are particularly concerning. Continued and strict surveillance of meningococcal diseases nationally and globally, especially in Muslim countries, is essential in detecting, understanding, and predicting the changes in the epidemiology of the disease and informing appropriate prevention and control strategies during these events. The current meningococcal disease preventative measures for Hajj and Umrah should continue to be strictly implemented, reviewed regularly and updated in accordance with changes in the epidemiology of meningococcal disease and availability of new preventative tools including new vaccines.
    MeSH term(s) Africa, Northern/epidemiology ; Antigens, Bacterial/immunology ; Crowding ; Disease Outbreaks/prevention & control ; Humans ; Incidence ; Islam ; Meningitis, Meningococcal/epidemiology ; Meningitis, Meningococcal/microbiology ; Meningitis, Meningococcal/prevention & control ; Meningitis, Meningococcal/transmission ; Meningococcal Infections/epidemiology ; Meningococcal Infections/microbiology ; Meningococcal Infections/prevention & control ; Meningococcal Infections/transmission ; Meningococcal Vaccines/administration & dosage ; Middle East/epidemiology ; Neisseria meningitidis/isolation & purification ; Public Health ; Risk Factors ; Saudi Arabia/epidemiology ; Serogroup ; Travel
    Chemical Substances Antigens, Bacterial ; Meningococcal Vaccines
    Language English
    Publishing date 2018-05-08
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2170891-5
    ISSN 1873-0442 ; 1477-8939
    ISSN (online) 1873-0442
    ISSN 1477-8939
    DOI 10.1016/j.tmaid.2018.05.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Escalating climate-related health risks for Hajj pilgrims to Mecca.

    Yezli, Saber / Ehaideb, Salleh / Yassin, Yara / Alotaibi, Badriah / Bouchama, Abderrezak

    Journal of travel medicine

    2024  

    Abstract: Background: Global temperatures are on the rise, leading to more frequent and severe heatwaves with associated health risks. Heat-related illnesses are an increasing threat for travellers to hot climate destinations. This study was designed to elucidate ...

    Abstract Background: Global temperatures are on the rise, leading to more frequent and severe heatwaves with associated health risks. Heat-related illnesses are an increasing threat for travellers to hot climate destinations. This study was designed to elucidate the interplay between increasing ambient temperatures, incidence of heat-related illnesses, and the effectiveness of mitigation strategies during the annual Hajj mass gathering over a 40-year period.
    Methods: An observational study was conducted utilizing historical records spanning four decades of meteorological data, and the rates of heat stroke and heat exhaustion during the Hajj pilgrimage in Mecca, Saudi Arabia. With an annual population exceeding two million participants from over 180 countries, the study analyzed temporal variations in weather conditions over two distinct Hajj hot cycles and correlated it with the occurrence of heat stroke and heat exhaustion. The effectiveness of deployed mitigation measures in alleviating health vulnerabilities between the two cycles was also assessed.
    Results: Throughout the study period, average dry and wet bulb temperatures in Mecca escalated by 0.4°C (Mann-Kendall p<0.0001) and 0.2°C (Mann-Kendall p=0.25) per decade respectively. Both temperatures were strongly correlated with the incidence of heat stroke and heat exhaustion (p<0.001). Despite the intensifying heat, the mitigation strategies including individual, structural and community measures were associated with a substantial 74.6% reduction in heat stroke cases and a 47.6% decrease in case fatality rate.
    Conclusion: The study underscores the escalating climate-related health risks in Mecca over the study period. The mitigation measures' efficacy in such a globally representative setting emphasizes the findings' generalizability and the importance of refining public health interventions in the face of rising temperatures.
    Language English
    Publishing date 2024-03-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 1212504-0
    ISSN 1708-8305 ; 1195-1982
    ISSN (online) 1708-8305
    ISSN 1195-1982
    DOI 10.1093/jtm/taae042
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: COVID-19 pandemic: it is time to temporarily close places of worship and to suspend religious gatherings.

    Yezli, Saber / Khan, Anas

    Journal of travel medicine

    2020  Volume 28, Issue 2

    MeSH term(s) COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; Humans ; Pandemics ; Physical Distancing ; Religion ; SARS-CoV-2 ; Saudi Arabia
    Keywords covid19
    Language English
    Publishing date 2020-04-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 1212504-0
    ISSN 1708-8305 ; 1195-1982
    ISSN (online) 1708-8305
    ISSN 1195-1982
    DOI 10.1093/jtm/taaa065
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: COVID-19 social distancing in the Kingdom of Saudi Arabia: Bold measures in the face of political, economic, social and religious challenges.

    Yezli, Saber / Khan, Anas

    Travel medicine and infectious disease

    2020  Volume 37, Page(s) 101692

    Abstract: Social distancing at its various levels has been a key measure to mitigate the transmission of COVID-19. The implementation of strict measures for social distancing is challenging, including in the Kingdom of Saudi Arabia (KSA) due to its level of ... ...

    Abstract Social distancing at its various levels has been a key measure to mitigate the transmission of COVID-19. The implementation of strict measures for social distancing is challenging, including in the Kingdom of Saudi Arabia (KSA) due to its level of urbanization, its social and religious norms and its annual hosting of high visibility international religious mass gatherings. KSA started introducing decisive social distancing measures early before the first case of COVID-19 was confirmed in the Kingdom. These ranged from suspension or cancelations of religious, entertainment and sporting mass gatherings and events such as the Umrah, temporary closure of educational establishments and mosques and postponing all non-essential gatherings, to imposing a curfew. These measures were taken in spite of their socio-economic, political and religious challenges in the interest of public and global health. The effect of these actions on the epidemic curve of the Kingdom and on the global fight against COVID-19 remains to be seen. However, given the current COVID-19 situation, further bold and probably unpopular measures are likely to be introduced in the future.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Crowding ; Humans ; Islam ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; SARS-CoV-2 ; Saudi Arabia ; Social Isolation ; Travel
    Keywords covid19
    Language English
    Publishing date 2020-04-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2170891-5
    ISSN 1873-0442 ; 1477-8939
    ISSN (online) 1873-0442
    ISSN 1477-8939
    DOI 10.1016/j.tmaid.2020.101692
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: The Jeddah tool. A health risk assessment framework for mass gatherings.

    Yezli, Saber / Khan, Anas A

    Saudi medical journal

    2020  Volume 41, Issue 2, Page(s) 121–122

    Abstract: No Abstract Available]. ...

    Abstract [No Abstract Available].
    MeSH term(s) Crowding ; Humans ; Mass Behavior ; Public Health ; Risk Assessment/methods ; Saudi Arabia
    Language English
    Publishing date 2020-02-04
    Publishing country Saudi Arabia
    Document type Journal Article
    ZDB-ID 392302-2
    ISSN 1658-3175 ; 0379-5284
    ISSN (online) 1658-3175
    ISSN 0379-5284
    DOI 10.15537/smj.2020.2.24875
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The Jeddah tool. A health risk assessment framework for mass gatherings

    Saber Yezli / Anas A. Khan

    Saudi Medical Journal, Vol 41, Iss 2, Pp 121-

    2020  Volume 122

    Abstract: No Abstract Available] ...

    Abstract [No Abstract Available]
    Keywords health risk assessment ; public health ; saudi arabia ; Medicine ; R
    Language English
    Publishing date 2020-02-01T00:00:00Z
    Publisher Ministry of Defence and Aviation
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article: Original Article--Mid-term Clinical and Hemodynamic Outcomes in Middle Age Patients Post Trifecta™ (Abbott) Aortic Valve Replacement: A Single-center Study.

    Khaliel, Feras H / Al Aboud, Mohammed S / Althibait, Suha A / Yezli, Saber / Al Muaythir, Elaf A / Alamro, Bandar / Galzerano, Domenico

    Journal of the Saudi Heart Association

    2024  Volume 36, Issue 1, Page(s) 1–7

    Abstract: Background: Trifecta™ is an externally wrapped bovine pericardial aortic valve with a favorable hemodynamic performance and acceptable rate of freedom from structural valve degeneration. However, recent reports of early Trifecta valve failure question ... ...

    Abstract Background: Trifecta™ is an externally wrapped bovine pericardial aortic valve with a favorable hemodynamic performance and acceptable rate of freedom from structural valve degeneration. However, recent reports of early Trifecta valve failure question its durability. Rheumatic valve disease in young population is predominant, there is no data on the Trifecta performance, durability or safety available worldwide over the middle age population, as well as there are no previous similar reports from Middle East region. We report on mid-term clinical and hemodynamic performance of Trifecta valve in middle age population with small aortic annuls, a single center report.
    Methods: A retrospective study of all patients who underwent Trifecta™ SAVR between June 2014 and December 2019 at a cardiac center in Riyadh, Saudi Arabia. Hemodynamic performance was analyzed by longitudinal Doppler echocardiography.
    Results: During a 5.5-year period, a total of 24 patients underwent SAVR with Trifecta™ valves at our heart center. Patients had a median age of 47.1 years (IQR = 37) and male:female ratio of 1:1. Patients had a median EuroScoreII of 2 (IQR = 1). The 19 mm valve was the most frequently used (29.2%) followed by the 21 mm and 23 mm (both 25.0%). Concomitant procedure was (54.2%). All patients survived their operations and most (87.0%) had their symptoms relieved. A 30-day mortality rate of 4.2%. Patients were followed up for a median of 58.5 months (IQR = 38), during which 8.3% required re interventions, giving an overall freedom from re-intervention of 91.7%. The re-intervention after valve implantation was recorded in two (8.3%). These re-interventions were performed 3 years post initial surgery and were due to structural valve deterioration (SVD). The mean gradient reduced significantly from 43.6 ± 23.9 mmHg (median = 41, IQR = 21) at baseline to 13.0 ± 7.4 mmHg (median = 11, IQR = 5) one-week post intervention (p < 0.001). The average mean gradients were stable from post-operation to follow-up (13.0 ± 7.4 vs 14.1 ± 6.4 mmHg).
    Conclusion: Our study confirms excellent mid-term durability, clinical and hemodynamic performance of the Trifecta™ valve in middle age population, despite the fact of non-statically significant trend-up of transvalvular gradient over the follow up period. Further long-term studies with larger sample-size are warranted to confirm these results.
    Language English
    Publishing date 2024-03-03
    Publishing country Saudi Arabia
    Document type Journal Article
    ZDB-ID 2515647-0
    ISSN 1016-7315
    ISSN 1016-7315
    DOI 10.37616/2212-5043.1366
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Pattern of utilization, disease presentation, and medication prescribing and dispensing at 51 primary healthcare centers during the Hajj mass gathering.

    Yezli, Saber / Yassin, Yara / Mushi, Abdulaziz / Almuzaini, Yasir / Khan, Anas

    BMC health services research

    2022  Volume 22, Issue 1, Page(s) 143

    Abstract: Background: The majority of pilgrims seeking healthcare during Hajj are seen at primary healthcare centers (PHCCs). Data on the utilization of these facilities during Hajj can aid in directing optimal health services delivery and allocation of resources ...

    Abstract Background: The majority of pilgrims seeking healthcare during Hajj are seen at primary healthcare centers (PHCCs). Data on the utilization of these facilities during Hajj can aid in directing optimal health services delivery and allocation of resources during the pilgrimage.
    Method: We investigated the pattern of disease presentation, caseload, and medication prescribing and dispensing at 51 PHCCs during the 2019 Hajj. Data on patients' demographics, diagnoses, and prescribed medications were retrieved from each PHCC's electronic records and analyzed. Data were also used to calculate six of the World Health Organization (WHO) indicators for drug use at these facilities.
    Results: Data were captured for 99,367 patients who were mostly Hajj pilgrims (95.4%), male (69.1%) from the Eastern Mediterranean (60.8%) and had a mean age of 46.6 years (SD = 14.9). Most patients (85.2%) were seen in Mina and towards the end of Hajj. The majority of patients (96.0%) had a single diagnosis; most commonly, respiratory (45.0%), musculoskeletal (17.2%), and skin (10.5%) diseases. Patients were prescribed 223,964 medications, mostly analgesics (25.1%), antibacterials for systemic use (16.5%), anti-inflammatory and antirheumatic products (16.4%), and cough and cold preparations (11.9%). On average, 2.25 (SD = 0.94) medications were prescribed per consultation, with low (1.3%) prevalence of polypharmacy. An antibiotic and an injectable were prescribed in 43.6 and 2.67% of patient encounters, respectively. Most (92.7%) of the prescribed drugs were actually dispensed, in an average time of 8.06 min (SD = 41.4). All PHCCs had a copy of the essential drugs list available, on which all the prescribed drugs appeared.
    Conclusion: Respiratory illnesses are the main reason for PHCCs visits during Hajj, and analgesics and antibiotics are the most common medications prescribed to pilgrims. Our results, including the calculated WHO drug use indicators, contribute to evidence-based optimization of primary healthcare services during Hajj.
    MeSH term(s) Adult ; Delivery of Health Care ; Disease ; Drug Prescriptions/statistics & numerical data ; Drug Utilization ; Drugs, Essential ; Female ; Humans ; Islam ; Male ; Mass Gatherings ; Middle Aged ; Practice Patterns, Physicians' ; Primary Health Care ; Saudi Arabia/epidemiology ; Travel
    Chemical Substances Drugs, Essential
    Language English
    Publishing date 2022-02-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-022-07507-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Human tolerance to extreme heat: evidence from a desert climate population.

    Yezli, Saber / Khan, Altaf H / Yassin, Yara M / Khan, Anas A / Alotaibi, Badriah M / Bouchama, Abderrezak

    Journal of exposure science & environmental epidemiology

    2023  Volume 33, Issue 4, Page(s) 631–636

    Abstract: Background: Ambient temperatures exceeding 40 °C are projected to become common in many temperate climatic zones due to global warming. Therefore, understanding the health effects of continuous exposure to high ambient temperatures on populations living ...

    Abstract Background: Ambient temperatures exceeding 40 °C are projected to become common in many temperate climatic zones due to global warming. Therefore, understanding the health effects of continuous exposure to high ambient temperatures on populations living in hot climatic regions can help identify the limits of human tolerance.
    Objective: We studied the relationship between ambient temperature and non-accidental mortality in the hot desert city of Mecca, Saudi Arabia, between 2006 and 2015.
    Methods: We used a distributed lag nonlinear model to estimate the mortality-temperature association over 25 days of lag. We determined the minimum mortality temperature (MMT) and the deaths that are attributable to heat and cold.
    Results: We analyzed 37,178 non-accidental deaths reported in the ten-year study period among Mecca residents. The median average daily temperature was 32 °C (19-42 °C) during the same study period. We observed a U-shaped relationship between daily temperature and mortality with an MMT of 31.8 °C. The total temperature-attributable mortality of Mecca residents was 6.9% (-3.2; 14.8) without reaching statistical significance. However, extreme heat, higher than 38 °C, was significantly associated with increased risk of mortality. The lag structure effect of the temperature showed an immediate impact, followed by a decline in mortality over many days of heat. No effect of cold on mortality was observed.
    Impact statement: High ambient temperatures are projected to become future norms in temperate climates. Studying populations familiar with desert climates for generations with access to air-conditioning would inform on the mitigation measures to protect other populations from heat and on the limits of human tolerance to extreme temperatures. We studied the relationship between ambient temperature and all-cause mortality in the hot desert city of Mecca. We found that Mecca population is adapted to high temperatures, although there was a limit to tolerance to extreme heat. This implies that mitigation measures should be directed to accelerate individual adaptation to heat and societal reorganization.
    MeSH term(s) Humans ; Extreme Heat/adverse effects ; Risk Factors ; Desert Climate ; Temperature ; Hot Temperature ; Cold Temperature ; Mortality
    Language English
    Publishing date 2023-05-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2218551-3
    ISSN 1559-064X ; 1559-0631
    ISSN (online) 1559-064X
    ISSN 1559-0631
    DOI 10.1038/s41370-023-00549-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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