A Cross-Sectional Study of Celiac Disease Awareness in the Food Industry in the Western Region of Saudi Arabia.

Background The only treatment available for celiac disease (CD), an autoimmune disease, is a gluten-free diet. Restaurant personnel have major roles in understanding the possible risks to consumers with CD, ensuring the availability of and preparing gluten-free foods. We attempted to evaluate the awareness and knowledge of CD among chefs, cooks, restaurant personnel, and owners and assess the availability of gluten-free diet options in the western region of Saudi Arabia. Methods A cross-sectional, questionnaire-based study was conducted in 126 restaurants based in Makkah al-Mukarramah and Jeddah cities. The chefs and owners of the restaurants were interviewed face-to-face to collect data knowledge about CD, gluten sensitivity, food containing gluten, serving gluten-free food, intention to add gluten-free options in the future, and circumstances related to serving gluten-free food. Result Our study showed that 17.5% and 51.6% of the participants had heard about CD and gluten sensitivity, respectively, and 34.1% checked a right answer of gluten-containing food with a mean of 0.68 (±1.02). About 17.5% of the participating restaurants serve gluten-free meal options (mean: 0.63±1.57), 14.7% had protocols for the preparation of gluten-free food, 7.1% displayed signs or notices that they sell gluten-free products, and 50.8% disclosed an intention to add gluten-free options in the future. Furthermore, 82.5% of gluten-free options were more expensive. Education level, being a trained chef, and experience years were significantly associated with awareness about CD or gluten sensitivity (p<0.05). Conclusion There is a general lack of awareness of CD, and most restaurants lack gluten-free options. We recommend adding more gluten-free food options for patients with CD.

Dupilumab: An emerging therapy in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

Ceftriaxone-induced leukocytoclastic vasculitis: a case report and literature review of antibiotic-induced leukocytoclastic vasculitis.

Leukocytoclastic vasculitis (hypersensitivity vasculitis) is defined as small blood vessel inflammation with skin or other systemic manifestations due to infections, drugs, or neoplastic disease. This clinical case report highlights an association between ceftriaxone and leukocytoclastic vasculitis in a 49-year-old female patient with a history of penicillin allergy, on mirtazapine for anxiety disorder. Articles concerning antibiotic-induced leukocytoclastic vasculitis are also reviewed. The patient reported a symptom of upper respiratory tract infection and fever 5 days previously for which she received ceftriaxone for 2 days before presenting to the emergency department with a pruritic skin rash in the upper and lower extremities and swollen lips for 1 day. The rash was erythematous, maculopapular, itchy, and non-tender, with no mucus membrane involvement. Laboratory investigations revealed leukocytosis (white blood cells, 22.3 × 109/L) that was mainly eosinophilic (18.4%). The patient was administered prednisolone and antihistamine after stopping ceftriaxone empirically. A skin biopsy confirmed the diagnosis of leukocytoclastic vasculitis. Significant clinical improvement was observed after treatment initiation. Upon follow-up, the skin rash was resolved entirely with no scars; however, there was skin-peeling over the lower extremities. Recognition of antibiotic-induced leukocytoclastic vasculitis is crucial as many classes of antibiotics can contribute to this condition. Continuation of the offending drug may lead to life-threatening complications.

Nonrespiratory Comorbidities in Asthma.

Asthma is a chronic heterogeneous airway disease. Common comorbid conditions are often disproportionately present in severe asthma. Optimal care of patients with asthma requires the recognition and treatment of these comorbid conditions. This review outlines the pathophysiological mechanisms between nonrespiratory comorbid conditions and asthma and their effect on asthma outcomes. They include: type 2 diabetes mellitus, hypertension, atherosclerotic cardiovascular disease, adrenal and thyroid gland diseases, pregnancy, osteoporosis, adverse effects from medications, and mental health disorders. Studies indicate how poor glycemic control of type 2 diabetes mellitus is associated with not only greater health care utilization but poorer asthma outcomes. Also, a large health care claims database indicates that a substantial proportion of pregnant women have uncontrolled asthma and are prescribed suboptimal controller therapy. Additional data about these nonrespiratory comorbidities and medications known to benefit both nonrespiratory comorbidities and asthma are necessary.

Public Concerns and Mental Health Changes Related to the COVID-19 Pandemic Lockdown in Saudi Arabia.

BACKGROUND: Public measures to confine the spread of the novel coronavirus disease 2019 (COVID-19) infection involves partial or full lockdown by some countries including Saudi Arabia. Social isolation, and financial insecurity are potential risk factors for mental changes. This study aimed to address public concerns, and assess mental health changes, and the factors associated with mental health burden in response to the COVID-19 outbreak in Saudi Arabia after the full lockdown is widely employed. METHODS: This cross-sectional study was conducted between 30th of April, and 10th of May, 2020 by posting an online survey on social media platforms (WhatsApp, and Twitter) to collect data on participants' demographics, concerns and worries related to the COVID-19 pandemic, and mental health changes using a validated Arabic version of the self-rated Hospital Anxiety and Depression Scale (HADS). RESULTS: A total of 1,921 responded to the questionnaire. Of them, 1,429 (74.5%) were ≤ 45 years old, and 967 (50.3%) were males. Reported public concerns included disturbed lifestyle, getting self or family member infected, loss job or part of income, difficult access to routine health care, and 55.8% reported negative impact on their mental health. Hospital anxiety and depression scale revealed high rates of depression [717 (37.3%)], and anxiety [508 (26.4%)]. Binary logistic regression revealed that female gender, working for the private sector, smokers, and people with chronic diseases were at increased risk of mental illnesses (p < 0.05). CONCLUSIONS: This study addressed serious public concerns, and substantially high rates of depression and anxiety related to the COVID-19 pandemic, and lockdown.

Elevated Testosterone Is Associated with Decreased Likelihood of Current Asthma Regardless of Sex.

BACKGROUND: Asthma prevalence decreases postpuberty in males. Testosterone inhibits airway smooth muscle contraction and attenuates type 2 inflammation. OBJECTIVE: To investigate the relationship between serum testosterone and current asthma prevalence and lung function in a nationally representative data set. METHODS: Serum testosterone and self-reported physician-diagnosed current asthma data were obtained from 7584 participants aged 6 to 80 years from the cross-sectional 2011-2012 National Health and Nutrition Examination Survey. We used logistic regression to test associations between testosterone and current asthma, adjusting for demographic characteristics and stratifying by sex and age; linear regression to evaluate correlations between testosterone and lung function among patients with asthma; and interaction terms to test for effect modification by blood eosinophils and fractional exhaled nitric oxide. RESULTS: Serum testosterone inversely associated with odds of current asthma in both men and women, but this association was nonlinear. Similar protective effect sizes were observed for both sexes after log2-transformation of serum testosterone. For every 1-unit increase in log2 testosterone, the odds of current asthma decreased by 11% in men and 10% in women, although the association was statistically significant in women only among those 12 years or older after multiple imputation. Serum testosterone did not associate with current asthma prevalence among those younger than 12 years. Testosterone associated with increases in FEV1 in participants with asthma of both sexes. Neither blood eosinophils nor fractional exhaled nitric oxide modified the association between testosterone and current asthma. CONCLUSIONS: Serum testosterone inversely associates with current asthma prevalence regardless of sex and correlates with better lung function in a nationally representative database. Androgen therapy for asthma should be further investigated.

Approaches to patients with variants in RAG genes: from diagnosis to timely treatment.

Introduction: Patients with primary immunodeficiency secondary to abnormal recombinase activating genes (RAG) can present with broad clinical phenotypes ranging from early severe infections to autoimmune complications and inflammation. Immunological phenotype may also vary from T-B- severe combined immunodeficiency to combined immunodeficiency or antibody deficiencies with near-normal T and B cell counts and even preserved specific antibody response to pathogens. It is not uncommon that RAG variants of uncertain significance are identified by serendipity during a broad genetic screening process and pathogenic RAG variants are increasingly recognized among all age groups, including adults. Establishing the pathogenicity and clinical relevance of novel RAG variants can be challenging since RAG genes are highly polymorphic. This review paper aims to summarize clinical phenotypes of RAG deficiencies and provide practical guidance for confirming the direct link between specific RAG variants and clinical disease. Lastly, we will review the current understanding of treatment option for patients with varying severity of RAG deficiencies. Area covered: This review discusses the different phenotypes and immunological aspects of RAG deficiencies, the diagnosis dilemma facing clinicians, and an overview of current and advancement in treatments. Expert opinion: A careful analysis of immunological and clinical data and their correlation with genetic findings helps to determine the significance of the genetic polymorphism. Advances in functional assays, as well as anti-cytokine antibodies, make it easier to resolve the diagnostic dilemma.