Clinical Characteristics of Celiac Disease Patients in Qassim Region.

Objective: It is well known that celiac disease has a negative influence on patients' health and quality of life. It has a wide range of presentation from symptomless to multiple organ dysfunction but mainly gastrointestinal symptoms. Consequently, it is considered a main cause of mortality, morbidity, and health burden. We aim to evaluate the quality of life affected in gluten-free diet and to identify the serological characteristics of celiac disease patients in the Qassim Region of Saudi Arabia and King Fahad Specialist Hospital. Methods: This is a cross-sectional-based study conducted in King Fahad Specialist Hospital, Saudi Arabia, composed of 58 patients with celiac disease for 9 years between August 2011 and August 2020. Results: Fifty-eight patents were included (79.3% females and 65.5% married), who were divided according to their ages into five groups. Abdominal pain, diarrhea, and/or weight loss were the major patient complaints. A total of 64% of the patients had a +ve (tTG) IgA test at the time of diagnosis, while 17% were -ve. Of the studied patients, 78% reported that they had undergone a duodenal biopsy sampling. No other significant abnormalities were detected between females and males or among the five diagnosed age groups. Conclusion: Patients with celiac disease reported poor health-related quality of life across the board. However, social interaction, emotional role functioning, and emotional well-being were the most important factors.

Retraction: Lipoma of the Pancreas: A Rare Incidental Tumor.

[This retracts the article DOI: 10.7759/cureus.20122.].

Prevalence of Iatrogenic Vitamin D Toxicity Among the Saudi Population of Vitamin D Users Due to Overcorrection.

Background Despite abundant sunlight exposure, vitamin D deficiency remains a major challenge in Saudi Arabia. Meanwhile, the widespread use of vitamin D supplements has prompted concerns about toxicity, which although rare, can have severe health consequences. Objective The objective of this cross-sectional study was to analyze the prevalence and associated factors of iatrogenic vitamin D toxicity among the Saudi population of vitamin D users due to overcorrection. Methods An online questionnaire was used to collect data from 1,677 participants across all regions of Saudi Arabia. The questionnaire included responses on the prescription, duration of vitamin D intake, dosage, frequency, history of vitamin D toxicity, symptom onset, and duration. Results One thousand six hundred and seventy-seven responses were included across all regions of Saudi Arabia. A majority of participants were female (66.7%) and around half were aged 18-25 years. A history of vitamin D use was reported by 63.8% of participants, and 48% were still using vitamin D supplements. Most participants (79.3%) consulted a physician, and 84.8% had taken a vitamin D test before using the supplement. Commonly reported motives for taking vitamin D included vitamin D deficiency (72.1%), lack of sun exposure (26.1%), and hair loss (20.6%). Symptoms of overdose were reported by 6.6% of participants, with 3.3% having an overdose and 2.1% experiencing both overdose and symptoms. Conclusion This study showed that although a large portion of the Saudi population is taking vitamin D supplements, the prevalence of vitamin D toxicity is relatively low. However, this prevalence should not be ignored, and further research is needed to understand the factors contributing to vitamin D toxicity in order to minimize its occurrence.

Complicated appendicitis increases the hospital length of stay.

Background: There are insufficient data from Saudi Arabia regarding appendectomy outcomes and hospital length of stay. Further, there is a need to compare the length of stay of Saudi patients and the literature. The purpose is to evaluate the surgical outcomes and hospital length of stay for complicated appendicitis and simple appendicitis. Method: This is a single-center retrospective review of patients who had undergone an appendectomy between 2016 and 2018. The patients were divided into 2 groups: complicated appendicitis versus simple appendicitis. Results: Of 449 patients who underwent appendectomy, 60 (13.4%) had complicated appendicitis. The complicated appendicitis was significantly associated with increased age, pain duration, neutrophilia, high C-reactive protein, fecalith presence, and free fluid. The incidence rate of surgical site infection was 5.8% (identified in 26 patients). Compared to simple appendicitis, complicated appendicitis was associated more with wound infection (1.8% vs 10%, respectively, P = .001), postoperative collection (1.2% vs 11.6%, respectively, P = .001), and readmission within 30 days (2.3% vs 13.4%, respectively, P = .001). By multivariate analysis, factors associated more with increased hospitalization were pain duration (hazard ratio = 2.37, 95% confidence interval = 1.09-5.16, P = .029), operative time (hazard ratio = 2.09, 95% confidence interval = 1.04-4.21, P = .038), and complicated appendicitis (hazard ratio = 6.61, 95% confidence interval = 2.67-14.21, P = .001). Conclusion: Complicated appendicitis correlates with significant morbidity, readmission rate, and 6 times more hospital LOS than simple appendicitis. This review might help in appreciating the burden of complicated appendicitis on hospital length of stay, which needs allocating patients and planning the discharge day for hospitals with limited beds.

Impact of optional multidisciplinary tumor board meeting on the mortality of patients with gastrointestinal cancer: A retrospective observational study.

BACKGROUND: Multidisciplinary tumor board meetings (MDTs) have shown a positive effect on patient care and play a role in the planning of care. However, there is limited evidence of the association between MDTs and patient mortality and in-hospital morbidity for mixed cases of gastrointestinal (GI) cancer. AIM: To evaluate the influence of optional MDTs on care of patients with cancer to determine potential associations between MDTs and patient mortality and morbidity. METHODS AND RESULTS: This was a retrospective observational study at the referral center of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Among all adult patients diagnosed with GI cancer from January 2017 to June 2019, 130 patients were included. We categorized patients into two groups: 66 in the control group (non-MDT) and 64 in the MDT group. The main outcome measure was overall mortality, measured by survival analysis. The follow-up was 100% complete. Four patients in the MDT group and 13 in the non-MDT group died (P = .04). The median follow-up duration was 294 days (interquartile range [IQR], 140-434) in the non-MDT group compared with 176 days (IQR, 103-466) in the MDT group (P = .20). There were no differences in intensive care unit or hospital length-of-stay or admission rates. The overall mortality at 2 years was 13% (95% confidence interval [CI], 0.06-0.66) in the MDT group and 38% (95% CI, 0.10-0.39) in the non-MDT group (P = .08). The MDT group showed a 72% (adjusted hazard ratio [HR], 0.28; 95% CI, 0.08-0.90; P = .03) decrease in mortality over time compared with the non-MDT group. CONCLUSIONS: MDTs were associated with decreased mortality over time. Thus, MDTs have a positive influence on patient care by improving survival and should be incorporated into care.

Lipoma of the Pancreas: A Rare Incidental Tumor.

Recent studies have shown a significant increase in the utilization of computed tomography (CT) scans in the emergency department for a broad spectrum of conditions. This had a significant impact on the identification of patients with serious pathologies in a timely manner. However, the overutilization of computed tomography scans leads to increased identification of incidental findings. For example, pancreatic lesions are not uncommon findings that can be identified in imaging studies performed for other indications. Here, we report the case of a 55-year-old male with a history of urinary stone disease who presented with right flank pain and dysuria. The urinalysis findings revealed numerous red blood cells and leukocytes. Non-contrast computed tomography scan of the abdomen was performed to detect urinary stones, but no hyperdense stones were noted, suggesting the possibility of spontaneous passage of the stone. However, a lesion in the pancreatic tail was observed. This exhibited fat attenuation with no solid component in the pancreatic tail representing a pancreatic lipoma. No surgical intervention was made considering the benign nature of the incidentally detected tumor. Pancreatic lipoma is a very rare benign mesenchymal tumor of the pancreas. Recognition of the classic radiological feature of pancreatic lipoma is essential to avoid unnecessary investigation and procedures.

Identifying a Novel DPYD Polymorphism Associated with Severe Toxicity to 5-FU Chemotherapy in a Saudi Patient.

Dihydropyrimidine dehydrogenase (DPD) is the major enzyme in the catabolism of 5-Fluorouracil (5-FU) and its prodrug capecitabine. We report a 65-year-old female with rectal adenocarcinoma who experienced severe toxicities secondary to standard dose 5-FU based chemotherapy. She was found to be heterozygous for rs371313778, c.2434G>A. This finding prompted restarting 5-FU at 50% dose reduction with further titration in subsequent cycles. We herein report the first case of rs371313778, c.2434G>A (p.Val812lle) DPYD polymorphism leading to severe 5-FU toxicities. The patient eventually completed a 6-month course of adjuvant treatment with modification of 5-FU dose.

Carbon nanoparticle induced cytotoxicity in human mesenchymal stem cells through upregulation of TNF3, NFKBIA and BCL2L1 genes.

Carbon based nanomaterials, including carbon nanotubes, graphene, nanodiamond and carbon nanoparticles, have emerged as potential candidates for a wide variety of applications because of their unusual electrical, mechanical, thermal and optical properties. However, our understanding of how increased usage of carbon based nanomaterials could lead to harmful effects in humans and other biological systems is inadequate. Our present investigation is focused on the cellular toxicity of carbon nanoparticles (CNPs) on human mesenchymal stem cells (hMSCs). Following exposure to CNPs, cell viability, nuclear morphological changes, apoptosis and cell cycle progression were monitored. Furthermore, the expression of genes involved in both cell death (e.g., P53, TNF3, CDKN1A, TNFRSF1A, TNFSF10, NFKBIA, BCL2L1) and cell cycle regulation (e.g., PCNA, EGR1, E2F1, CCNG1, CCND1, CCNC, CYCD3) were assessed using qPCR. Our results indicated that CNPs reduce cell viability and cause chromatin condensation and DNA fragmentation. Cell cycle analysis indicated that CNPs affect the cell cycle progression. However, the gene expression measurements confirmed that CNPs significantly upregulated the P53, TNF3, CDKNIA, and NFKBIA genes and downregulated the EGR1 gene in hMSCs. Our findings suggest that CNPs reduce cell viability by disrupting the expression of cell death genes in human mesenchymal stem cell (hMSC). The results of this investigation revealed that CNPs exhibited moderate toxicity on hMSCs.

Roles of p53 and caspases in induction of apoptosis in MCF- 7 breast cancer cells treated with a methanolic extract of Nigella sativa seeds.

BACKGROUND: Nigella Sativa (NS) is an herb from the Ranunculaceae family that exhibits numerous medicinal properties and has been used as important constituent of many complementary and alternative medicines (CAMs). The ability of NS to kill cancer cells such as PC3, HeLa and hepatoma cells is well established. However, our understanding of the mode of death caused by NS remains nebulous. The objective of this study was to gain further insight into the mode and mechanism of death caused by NS in breast cancer MCF-7 cells. MATERIALS AND METHODS: Human breast cancer cells (MCF-7) were treated with a methanolic extract of NS, and a dose- and time-dependent study was performed. The IC50 was calculated using a Cell Titer Blue® viability assay assay, and evidence for DNA fragmentation was obtained by fluorescence microscopy TUNEL assay. Gene expression was also profiled for a number of apoptosis-related genes (Caspase-3, -8, -9 and p53 genes) through qPCR. RESULTS: The IC50 of MCF-7 cells was 62.8 µL/mL. When MCF-7 cells were exposed to 50 µL/mL and 100 µL/mL NS for 24 h, 48 h and 72 h, microscopic examination (TUNEL assay) revealed a dose- and time-dependent increase in apoptosis. Similarly, the expression of the Caspase-3, -8, -9 and p53 genes increased significantly according to the dose and time. CONCLUSIONS: NS induced apoptosis in MCF-7 cells through both the p53 and caspase pathways. NS could potentially represent an alternative source of medicine for breast cancer therapy.

Apoptosis-mediated inhibition of human breast cancer cell proliferation by lemon citrus extract.

Dietary phytochemicals have a variety of antitumor properties. In the present study, the antitumor activity of methanolic extract of lemon fruit (lemon extract; LE) (LE) on the MCF-7 breast cancer cell line was investigated in vitro. Apoptotic cell death was analyzed using the TUNEL assay. In addition, the apoptosis mediated by LE extract in the MCF-7 cells was associated with the increased expression of the tumor suppressor p53 and caspase-3. Additionally, the expression of a pro-apoptotic gene, bax, was increased, and the expression of an anti-apoptotic gene, bcl-2, was decreased by LE extract treatment, resulting in a shift in the Bax:Bcl-2 ratio to one that favored apoptosis. The expression of a major apoptotic gene, caspase-3, was increased by LE extract treatment. In light of the above results, we concluded that LE extract can induce the apoptosis of MCF-7 breast cancer cells via Bax-related caspase-3 activation. This study provides experimental data that are relevant to the possible future clinical use of LE to treat breast cancer.