Gut microbiota analyses of inflammatory bowel diseases from a representative Saudi population.

BACKGROUND: Crohn's diseases and ulcerative colitis, both of which are chronic immune-mediated disorders of the gastrointestinal tract are major contributors to the overarching Inflammatory bowel diseases. It has become increasingly evident that the pathological processes of IBDs results from interactions between genetic and environmental factors, which can skew immune responses against normal intestinal flora. METHODS: The aim of this study is to assess and analyze the taxa diversity and relative abundances in CD and UC in the Saudi population. We utilized a sequencing strategy that targets all variable regions in the 16 S rRNA gene using the Swift Amplicon 16 S rRNA Panel on Illumina NovaSeq 6000. RESULTS: The composition of stool 16 S rRNA was analyzed from 219 patients with inflammatory bowel disease and from 124 healthy controls. We quantified the abundance of microbial communities to examine any significant differences between subpopulations of samples. At the genus level, two genera in particular, Veillonella and Lachnoclostridium showed significant association with CD versus controls. There were significant differences between subjects with CD versus UC, with the top differential genera spanning Akkermansia, Harryflintia, Maegamonas and Phascolarctobacterium. Furthermore, statistically significant taxa diversity in microbiome composition was observed within the UC and CD groups. CONCLUSIONS: In conclusion we have shown that there are significant differences in gut microbiota between UC, CD and controls in a Saudi Arabian inflammatory bowel disease cohort. This reinforces the need for further studies in large populations that are ethnically and geographically diverse. In addition, our results show the potential to develop classifiers that may have add additional richness of context to clinical diagnosis of UC and CD with larger inflammatory bowel disease cohorts.

Gut microbiota analyses of Saudi populations for type 2 diabetes-related phenotypes reveals significant association.

BACKGROUND: Large-scale gut microbiome sequencing has revealed key links between microbiome dysfunction and metabolic diseases such as type 2 diabetes (T2D). To date, these efforts have largely focused on Western populations, with few studies assessing T2D microbiota associations in Middle Eastern communities where T2D prevalence is now over 20%. We analyzed the composition of stool 16S rRNA from 461 T2D and 119 non-T2D participants from the Eastern Province of Saudi Arabia. We quantified the abundance of microbial communities to examine any significant differences between subpopulations of samples based on diabetes status and glucose level. RESULTS: In this study we performed the largest microbiome study ever conducted in Saudi Arabia, as well as the first-ever characterization of gut microbiota T2D versus non-T2D in this population. We observed overall positive enrichment within diabetics compared to healthy individuals and amongst diabetic participants; those with high glucose levels exhibited slightly more positive enrichment compared to those at lower risk of fasting hyperglycemia. In particular, the genus Firmicutes was upregulated in diabetic individuals compared to non-diabetic individuals, and T2D was associated with an elevated Firmicutes/Bacteroidetes ratio, consistent with previous findings. CONCLUSION: Based on diabetes status and glucose levels of Saudi participants, relatively stable differences in stool composition were perceived by differential abundance and alpha diversity measures. However, community level differences are evident in the Saudi population between T2D and non-T2D individuals, and diversity patterns appear to vary from well-characterized microbiota from Western cohorts. Comparing overlapping and varying patterns in gut microbiota with other studies is critical to assessing novel treatment options in light of a rapidly growing T2D health epidemic in the region. As a rapidly emerging chronic condition in Saudi Arabia and the Middle East, T2D burdens have grown more quickly and affect larger proportions of the population than any other global region, making a regional reference T2D-microbiome dataset critical to understanding the nuances of disease development on a global scale.

Molecular characterization of Helicobacter pylori clinical isolates from Eastern Saudi Arabia.

OBJECTIVES: To describe the frequency of cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA) virulence genes and clarithromycin resistance-associated mutations among Helicobacter pylori (H. pylori) clinical isolates from Eastern Saudi Arabia. METHODS: A cross-sectional study was carried out between July 2020 and June 2021 in a tertiary hospital in AL-Khobar, Saudi Arabia. A total of 34 H. pylori isolates were obtained from gastric biopsies of patients with dyspepsia. The existence of the virulence genes was studied by polymerase chain reaction and the gene fragment of the 23s ribosomal subunit (23s rRNA) gene was sequenced. RESULTS: All isolates harbored the CagA gene. Approximately 97.1% (33/34) isolates were positive using the VacA M primer and 91.2% (31/34) isolates were positive using the VacA S primer. The most frequent allelic combination was S2/M2/cag (60%), followed by S1/M2/cag (26.7%), S1/M1/cag (10%), and S2/M1/cag (3.3%). Approximately 6.5% isolates harbored the A2142G mutation and 29% isolates harbored the A2143G mutation. One isolate contained the mutation T2182C. The phylogenetic analysis showed that 58% isolates clustered with the regional and global isolates while the remaining 42% isolates seemed to be specifically circulating in Saudi Arabia. Most of the patients (73.5%) had already underwent a previous H. pylori eradication therapy. CONCLUSION: We showed that there is a regional variation in the frequency of the virulence genes among H. pylori isolates. Additionally, we showed the frequency of 23s rRNA mutations related to clarithromycin resistance in Saudi Arabia.

Obesity and gastric balloon.

BACKGROUND: The obesity epidemic, which is among the most common nutritional disorders, is rising rapidly worldwide. It leads to several health problems such as metabolic disorders, stroke, and even cancer. Efforts to control obesity with exercise and diet have a limited value in obese patients and different approaches to do this have been tried. In this paper, we share our experience with bioenteric intragastric balloon (BIB) in treating obesity: Its safety, tolerability, and its efficacy in weight reduction. MATERIALS AND METHODS: From January 2009 to September 2012, a total of 190 gastric balloons was inserted on patients at the endoscopy unit in King Fahd Hospital of the University, Al-Khobar. This is an evaluation of the first 100 patients. All the patients had a body mass index of over 30 kg/m(2) and were within the age range of 17-55 with a mean age of 32 years. After consent, preballoon investigation tests and anesthesia evaluation, BIB was inserted under monitored anesthesia care sedation in the endoscopy suite. The balloon was filled with 500-700 mls of stained saline. All patients' were given an analgesic and antiemetic for a week and antisecretory proton pump inhibitor's for 6 months. Diet and the importance of the exercise were part of the preballoon insertion phase and protocol. The balloon was removed after 6-12 months. RESULTS: The weight loss response to BIB in the 100 patients are classified into four groups: In the uncooperative, noncompliant patients - the maximum weight loss was 7 kg, while in the most compliant patients the weight loss reached up to 39 kg. In addition, there was significant improvement into diabetes mellitus, hypertension, dyslipidemia, and fatty liveras. Its safety and tolerability were extremely acceptable. CONCLUSION: Our data indicates that in well-selected patients, BIB is an effective device, which with minimum complications helps to achieve body weight loss and resolve many obesity related morbidities in cooperative and dedicated obese patients.

The self-limiting nature of statin-induced rhabdomyolysis.

Statins have come to the forefront of treatments for hyperlipidemias, coronary artery diseases and strokes. They have been shown to cause myotoxicity and rhabdomyolysis. In most cases, rhabdomyolysis is self-limiting and needs supportive therapy. Two cases of statin-induced rhabdomyolysis are reported emphasizing the definition, risk factors, clinical features and the self-limiting nature of the disorder.

Prevalence of gastroesophageal reflux disease and its association with Helicobacter pylori infection in chronic renal failure patients and in renal transplant recipients.

BACKGROUND/AIMS: The prevalence of gastroesophageal reflux disease (GERD) in chronic renal failure patients and in renal transplant recipients (RTR) has been a subject of discussion in the last few years. Our aims are to clarify this association and its relation to Helicobacter pylori infection, and also to identify possible pathogenic factors in the development of this disease in both groups. METHODS: The study involved 40 end-stage renal disease (ESRD) patients with upper gastrointestinal (GI) symptoms (group I), 36 patients who had undergone kidney transplantation and had similar symptoms (group II), and 44 age- and sex-matched controls with the same upper GI symptoms (group III). All patients were subjected to esophagogastroduodenoscopy, and biopsies were obtained from the antrum for histological evaluation and identification of H. pylori. RESULTS: The prevalence of GERD in the first two groups was similar (77.5 vs. 75.0%, P = 0.412), while it was significantly lower in the control group (38.6%, P < 0.01). H. pylori infection was present in 40.0, 36.1 (P > 0.05) and 75% (P < 0.01 and < 0.001) of the patients in groups I, II, and III, respectively. Multivariate logistic regression analysis in groups I and II showed that high serum creatinine (Odds ratio [OR] = 6.78, 95% Confidence Interval (CI) = 1.12-45.82), immunosuppressive therapy (OR = 5.78, 95% CI = 1.01-32.5), and absence of H. pylori infection (OR = 3.58, 94% CI = 1.11-18.6) were significantly associated with GERD. The duration of ESRD correlated significantly with the prevalence of GERD in group I. CONCLUSIONS: This study showed a similar prevalence of H. pylori infection and GERD in ESRD and RTR patients. GERD prevalence was higher in these two groups than in the controls. Renal transplantation, chronic renal disease, immunosuppressive therapy, and the absence of H. pylori infection seem to be risk factors for the development of GERD.

Coexisting malignant lymphoma of the duodenum and adenocarcinoma of the colon.

Synchronous malignant mucosa associated lymphoid tissue MALT-lymphoma of the small bowel and adenocarcinoma of the colon in the same patient is a scarce rarity. Only few cases have been reported so far. Thus, it might be of interest to report such a case of coexisting malignant MALT-lymphoma of the duodenum and adenocarcinoma of the large bowel.

Saphenoperitoneal shunt for intractable ascites.

OBJECTIVE: Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt (SPS) was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. We present our experience with this procedure with some modification in the technique. METHODS: We performed a prospective study on 11 patients with intractable ascites admitted to the Vascular Unit, Suez Canal University Hospital, Egypt from June 2001 to October 2003. We divided the long saphenous vein approximately at 15 cm distally. We turned the proximal cut end upwards and tunneled under the skin towards the midline in the suprapubic region where we anastomosed it to the peritoneum. RESULTS: One patient died from liver failure 8 days after the operation. Two patients died during follow-up, one at 3 months from liver failure, and the other at 4 months from variceal hemorrhage. We lost one patient to follow up. Seven patients remained alive with patent shunt up to 6 months follow up. CONCLUSION: The SPS is a safe and effective procedure in the management of intractable ascites.

Hospital generated waste: an assessment of the awareness of hospital staff.

BACKGROUND: The provision of healthcare generates waste which can be detrimental to health and environment. Staff who provide healthcare ought to be aware of the proper handling and the system of management of healthcare waste used by different hospitals. MATERIALS AND METHODS: A survey of doctors, nurses and allied medical staff for their awareness of the hospital generation and handling of waste was conducted. A self-administered questionnaire was used. RESULTS: Lack of awareness, ignorance of policy and procedure on the handling of healthcare waste and failure to attend educational activities were major defects found among healthcare staff in the study. CONCLUSION: There is a need for a plan to improve the awareness of healthcare workers about hospital generated waste and its proper handling.