The lowering effect of Gum Arabic on hyperlipidemia in Sudanese patients.

Hyperlipidemia especially low density lipoprotein cholesterol (LDL-C) is a major risk factor for developing ischemic heart disease. Soluble dietary fiber has lipid lowering characteristics. Gum Arabic (GA) is 95% soluble fiber calculated on dry bases. The beneficial effect of GA on lipid profile needs further verification. A case-control study was conducted at Omdurman Hospital, Sudan to assess the effect of G A on serum lipids in patients with hyperlipidemia. Cases received a 20 mg tablet of atorvastatin /day plus 30 mg of GA for 4 weeks while the controls received atorvastatin only. Levels of lipids in serum were assessed according to conventional methods before and 1 month after the trial. There is no significant difference in the basic characteristics between the study and the control groups (55 patients in each arm of the study). While there was no significant difference in the levels of HDL, there was a significant reduction of the total cholesterol (25.9 vs. 7.8%, P < 0.001), triglyceride (38.2 vs. 2.9%, P < 0.001), and LDL (30.8 vs. 8.1%, P < 0.001) before and after the intervention in the study compared to the controls groups.

Menetrier's disease: an excellent response to octreotide. A case report from the Middle East.

Menetrier's disease is a rare acquired cause of protein losing enteropathy, with premalignant potential. Since its first description in 1888, around 300 cases have been reported. This disease occurs more frequently in males aged 30-50 years. We report here the case of a 31 year- old Sudanese female who presented with generalized edema. Laboratory investigations showed hypoproteinemia and hypoalbuminemia without evidence of renal or liver disease. Upper gastrointestinal endoscopy showed giant gastric folds. The histopathological features of biopsies taken from these folds were consistent with Menetrier's disease. Our patient showed excellent response to treatment with subcutaneous octreotide and this may ameliorate the need for surgery as the definitive treatment of this disease.

Prevalence of Helicobacter pylori infection among patients with dyspepsia in South-Western Saudi Arabia.

OBJECTIVE: Helicobacter pylori (H. pylori) infection is a major cause of various upper gastrointestinal (UGI) disorders. The aim of this study was to determine the prevalence of H. pylori among patients with dyspepsia. METHODS: A prospective study was carried out in the Gastroenterology Division, King Fahd Central Hospital, Gizan, Kingdom of Saudi Arabia from January 1995 to December 1998. Four hundred and eighty-eight patients with dyspepsia were consecutively examined using the UGI endoscopy during a 4-year period. Data analyzed included demographic details, clinical indications for the examination, endoscopic findings and results of the histopathologic assessment for H. pylori. RESULTS: Overall, H. pylori were detected in 268 (54.9%) of the gastric biopsies from 488 patients (322 males and 166 females, aged 13-90 years). Helicobacter pylori infection was present in 140 (60.1%) of 253 patients with chronic gastritis diagnosed by endoscopy and in 49 (62.8%) of 78 patients with duodenal ulcers (DU). The rate in DU patients was significantly higher than the rate (43.6%) in patients with normal endoscopic findings (odds ratio [OR]=2.18, 95% confidence interval [CI] 1.02-4.70; p=0.04]. Of 455 biopsies with histologic gastritis, 268 (OR=58.9%, 95% CI 54.2-63.4) were positive for H. pylori and all specimens (n=33) with no histological evidence of gastritis were negative. CONCLUSION: The well-described association of H. pylori with DU and non-ulcer dyspepsia was confirmed by our study. However, the rate of H. pylori in our patients was at the lower end of the range (50-80%), which was previously reported among largely urban populations in Saudi Arabia suggests differences in the prevalence of H. pylori-infections between urbanized and rural populations. Helicobacter pylori negative peptic ulcer disease remains an important entity that may be associated with the use of non-steroidal anti inflammatory drugs and in our environment, the habitual chewing of qat leaves (catha edulis).

Hepatocellular carcinoma in Saudi Arabia: role of hepatitis B and C infection.

BACKGROUND AND AIM: To estimate the risk of hepatocellular carcinoma (HCC) in non-alcoholic patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, 118 patients who were admitted to a regional hospital in Saudi Arabia were compared with 118 age- and sex-matched healthy individuals. RESULTS: The prevalence of HBsAg in HCC patients (67%; 95% confidence interval (CI): 57.7-75.3) was significantly higher than the rate (6.7%; 95%CI: 3.0-12.9) in the controls (OR: 28.4; 95%CI: 12.6-63.9; P < 0.001). There was a high risk of HCC in the presence of HBsAg alone (OR: 34.3; 95%CI: 14.8-79.1, P < 0.001) and anti-HCV alone (OR: 12.2; 95%CI: 3.2-47.2; P < 0.001). Although HBV and HCV were independent risk factors in the development of HCC, there was no interactive relationship between the two viruses. Dual infections occurred in only 3.4% and were associated with only a moderate increase in the risk of HCC (OR: 14.6; 95%CI: 1.57-135.9). In 24.6% of the cases no virus was identified as the etiologic factor. CONCLUSION: Hepatitis B virus constitutes a major risk factor and HCV contributes a less significant role in the development of HCC. The ongoing program of HBV vaccination may significantly decrease the prevalence of HBV-associated HCC in this population.

The frequency of upper gastrointestinal malignancy in Gizan.

BACKGROUND: Upper gastrointestinal malignancy occurs in variable frequencies among different populations and there is an increasing epidemiological data in The Kingdom of Saudi Arabia. AIM OF THE STUDY: To determine the frequency of upper gastrointestinal malignancy in an endoscopic population in Gizan. PATIENTS AND METHODS: A retrospective analysis of 63 patients who had esophageal or gastric malignancy among 2572 patients evaluated in a 6-year period ( July 1992 to June 1998) at King Fahad Central Hospital in Gizan. RESULTS: Esophageal cancer was found in 39 patients (20 males and 19 females), whereas gastric malignancy in 24 (22 males and two females). The majority of the patients were in their seventh and eighth decade of life with male predominance. Seven patients had primary gastric lymphoma and one patient had primary malignant melanoma of the esophagus. CONCLUSION: Upper gastrointestinal malignancy represented 2.4% of 2572 endoscoped patients, occurring more commonly among elderly male.

The decline of hepatitis B viral infection in South-Western Saudi Arabia.

OBJECTIVE: Hepatitis B virus (HBV) infection is endemic in the Kingdom of Saudi Arabia (KSA). The Jizan region in the South-Western area of the country was noted for a high prevalence of hepatitis B surface antigen (HbsAg) carrier rate. The study was carried out to determine the prevalence of HBsAg and other markers of HBV among residents of Jizan and evaluate the impact of the measures adopted in the last decade, to control HBV. METHODS: The study was carried out between 1995 and 1998. The subject were studied in 4 groups: Group A consisted of voluntary blood donors (n=14883) tested within the blood banking system during the time period June 1995 to June 1997, Group B were patients treated in the hospitals (n=4692) during the period June 1995 to June 1996, Group C consisted of volunteers recruited from the community (n=1172) and Group D children aged <10 years (n=229). Serum samples were obtained from the subjects tested for HBsAg, total antibody to hepatitis B core antigen, antibody to HBsAg and antibody to hepatitis C virus. RESULTS: Hepatitis B surface antigen was positive in 5.4% of 14883 voluntary blood donors (Group A) and in 5.1% of 1172 persons recruited from the community (Group C) 40.2% were positive for at least one marker of HBV. The prevalence of HBsAg in-patients in Group B was 9.7% (456 of 4692). These prevalence rates are significantly lower than the prevalence of 12% and 32% reported in 1985 and 1986. Only 2 (0.9% of 229) children in Group D were positive for HBsAg, indicating a major decline from the rate of 8.8% observed in an earlier survey. CONCLUSION: The low prevalence of HBsAg in children, provides evidence for the effectiveness and efficacy of the integration of hepatitis B vaccination into the extended program of immunization in KSA. The significant decline of HBV markers among unvaccinated Saudi adults indicated an indirect effect of other factors (for example health education and socio-economic progress) on the prevalence and transmission of HBV in Jizan. In areas of high endemicity, the epidemiological characteristics HBV are modified significantly by the combination of HBV vaccination and other complimentary control strategies.

Epidemic Rift Valley fever in Saudi Arabia: a clinical study of severe illness in humans.

We describe the clinical patterns and case-fatality rate associated with severe Rift Valley fever (RVF) in patients who were admitted to the Gizan regional referral hospital during an outbreak of RVF in Saudi Arabia from September through November 2000. A total of 165 consecutive patients (136 men and 29 women) were prospectively studied; all were identified according to a strict case definition, were confirmed to have RVF by serologic testing, and were treated according to a predetermined protocol. The major clinical characteristics of RVF included a high frequency of hepatocellular failure in 124 patients (75.2%), acute renal failure in 68 patients (41.2%), and hemorrhagic manifestations in 32 patients (19.4%). Sixteen patients had retinitis and 7 patients had meningoencephalitis as late complications in the course of the disease. A total of 56 patients (33.9%) died. Hepatorenal failure, shock, and severe anemia were major factors associated with patient death.