Dietary assessment of type 2 diabetic patients using healthful plant-based diet score in the Eastern Province of Saudi Arabia.

BACKGROUND: Diabetes mellitus is a chronic disease characterized by a wide range of metabolic problems. The current study sought to assess nutritional habits of Saudi patients with type 2 diabetes (T2D) and to propose recommendations to improve these patients' dietary habits and delay possible disease complications. METHODS: Over a period of three years, (2017-2019) 577 patients with T2D attending the outpatient's diabetic clinics at King Fahd Hospital of the University, Al Khobar, Saudi Arabia were invited to participate in this study. Data of dietary intake were collected by trained nurses using a pretested structured validated semi quantitative food frequency questionnaire. The dietary data were collected using 7-day dietary recall questionnaire. A modified score system that associates dietary habits with glycemic control and lipid profile was used. RESULTS: Overall, a high healthful plant-based diet score was associated with a significant (P = 0.018) reduction in triglycerides (TG) level (mean difference - 3.78%; 95% CI, -0.65% to -6.81%) and a statistically non-significant (P = 0.06) increase in high density lipoprotein (HDL) levels (mean difference 1.87%; 95% CI -0.06-3.84%) in T2D patients from the Eastern Province of Saudi Arabia. Additionally, in our patient group, the prevalence of coronary artery disease, stroke, peripheral artery disease, and chronic kidney disease in T2D patients was 11.3%, 6.2%, 3.3%, and 8.4%, respectively and were higher when compared to the prevalence in the general population. CONCLUSION: The present study showed that adherence to a healthful plant-based diet, when compared to high glycemic index diet, is associated with a favorable outcome in glycemic control and lipid profile in T2D patients. Prior assessment of total diet quality may be beneficial when giving nutritional advice to T2D patients with the possibility of improving glycemic control and lipid profile.

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.

Traumatic Ovarian Artery Pseudoaneurysm Post-ovum Pickup: A Rare Complication.

A uterine/ovarian artery pseudoaneurysm is a rare complication of pelvic surgical interventions such as oocyte retrieval. This complication can be life-threatening due to the risk of rupture and blood extravasation. We report the case of a 30-year-old, nulliparous, married woman with a rare uterine/ovarian artery pseudoaneurysm due to in vitro fertilization. The patient has a history of sickle cell disease and primary infertility with multiple failed ovulation induction. She presented to the emergency department (ED) with hypotension following ovum retrieval for in vitro fertilization. Upon examination, we noted that the patient had tense ascites. A focused assessment with sonography in trauma (FAST) in the ED revealed internal bleeding. The diagnosis of a uterine artery pseudoaneurysm was established. She underwent an exploratory laparotomy to control bleeding due to her instability. Computed tomography and FAST scans help make an accurate diagnosis, and this case highlights that early intervention by embolization is essential to stabilize the patient and improve patient outcomes.

Cyst of Montgomery: An uncommon adolescent breast lump.

Reports of the incidence of the cyst of Montgomery, a rare condition of the breast, affecting mainly adolescent female, are scarce in the literature. This cyst develops from an obstruction of the small papular projections at the edge of the areola called Montgomery tubercles. It could be a simple asymptomatic mass or an inflamed symptomatic mass. We report two cases encountered this year. The first case was a 15-year-old female who complained of bilateral breast pain and a right breast mass. Laboratory tests were unremarkable. A diagnosis of noninflamed Montgomery cyst based on clinical and sonographic examination was made. An antibiotic was recommended. The second case was a 13-year-old female who complained of pain and swelling with redness in the right breast. Laboratory tests were unremarkable. Sonographic examination revealed a right retroareolar cyst containing turbid echogenicity with surrounded hyperemia. A diagnosis of inflamed Montgomery's cyst was made. Medical treatment was successful without any surgical intervention. Both patients had favorable outcomes at follow-up visits. This stresses the importance of a proper recognition of the pathology, incidence, diagnosis and management of the cyst of Montgomery in the pediatric age group.

Exome sequencing of Saudi Arabian patients with ADPKD.

Purpose: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive development of kidney cysts and enlargement and dysfunction of the kidneys. The Consortium of Radiologic Imaging Studies of the Polycystic Kidney Disease (CRISP) cohort revealed that 89.1% had either a PKD1 or PKD2 mutation. Of the CRISP patients with a genetic cause detected, mutations in PKD1 accounted for 85%, while mutations in the PKD2 accounted for the remaining 15%. Here, we report exome sequencing of 16 Saudi patients diagnosed with ADPKD and 16 ethnically matched controls. Methods: Exome sequencing was performed using combinatorial probe-anchor synthesis and improved DNA Nanoballs technology on BGISEQ-500 sequencers (BGI, China) using the BGI Exome V4 (59 Mb) Kit. Identified variants were validated with Sanger sequencing. Results: With the exception of GC-rich exon 1, we obtained excellent coverage of PKD1 (mean read depth = 88) including both duplicated and non-duplicated regions. Of nine patients with typical ADPKD presentations (bilateral symmetrical kidney involvement, positive family history, concordant imaging, and kidney function), four had protein truncating PKD1 mutations, one had a PKD1 missense mutation, and one had a PKD2 mutation. These variants have not been previously observed in the Saudi population. In seven clinically diagnosed ADPKD cases but with atypical features, no PKD1 or PKD2 mutations were identified, but rare predicted pathogenic heterozygous variants were found in cystogenic candidate genes including PKHD1, PKD1L3, EGF, CFTR, and TSC2. Conclusions: Mutations in PKD1 and PKD2 are the most common cause of ADPKD in Saudi patients with typical ADPKD. Abbreviations: ADPKD: Autosomal dominant polycystic kidney disease; CFTR: Cystic fibrosis transmembrane conductance regulator; EGF: Epidermal growth factor; MCIC: Mayo Clinic Imaging Classification; PKD: Polycystic kidney disease; TSC2: Tuberous sclerosis complex 2.

The Prevalence of Hjortsjo Crook Sign of Right Posterior Sectional Bile Duct and Bile Duct Anatomy in ERCP.

AIM: The frequency of the Right Posterior Sectional Bile Duct (RPSBD) hump sign in cholangiogram when it crosses over the right portal vein known as Hjortsjo Crook Sign and the bile duct anatomy are studied. Knowledge of the implication of positive sign can facilitate safe resection for both bile duct and portal vein. METHODS: Prospectively, we included 237 patients with indicated ERCP during a period from March 2010 to January 2015. RESULTS: The mean age (±SD) and male to female ratio were 38.8 (±19.20) and 1 : 1.28, respectively. All patients are Arab from Middle Eastern origin, had biliary stone disease, and underwent diagnostic and therapeutic ERCP. Positive Hjortsjo Crook Sign was found in 17.7% (42) of patients. The sign was found to be equally more frequent in Nakamura's RPSBD anatomical variant types I, II, and IV in 8.4% (20), 6.8% (16), and 2.1% (5), respectively, while rare anatomical variant type III showed no positive sign. CONCLUSION: Hjortsjo Crook Sign frequently presents in RPSBD variation types I, II, and IV in our patients.

Acute epiploic appendagitis: A rare cause of acute abdomen and a diagnostic dilemma.

Acute epiploic appendagitis is a relatively rare cause of lower abdominal pain that clinically mimics other acute abdomen conditions that require surgery such as acute diverticulitis or appendicitis. Here, we report a case of a 50-year-old lady who presented with an unusual lower abdominal pain. Awareness of such a clinical condition with its characteristic imaging findings is important to avoid costly hospitalization, unnecessary antibiotic courses, and the morbidity and mortality associated with surgical procedures.