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Ebtissam Saleh Al-Meghaiseeb,1 Abdulrahman A Al-Robayan,1 Mulfi Mubarak Al-Otaibi,1 Misbahul Arfin,2 Abdulrahman K Al-Asmari2 1Department of Gastroenterology, 2Research Centre, Prince Sultan Military Medical City, Riyadh, Saudi Arabia Abstract: Inflammatory bowel disease (IBD) is a complex, multifactorial, chronic inflammatory disorder of the gastrointestinal tract in which immune dysregulation caused by genetic and/or environmental factors plays an important role. The aim of this case–­control study was to evaluate the association of tumor necrosis factor-alpha (TNF-α) (308) and -β (+252) polymorphisms with susceptibility of IBD. A total of 379 Saudi subjects including 179 IBD patients (ulcerative colitis (UC) =84 and Crohn’s disease (CD) =95) and 200 age- and sex-matched healthy controls were recruited. TNF-a and TNF-b genes were amplified using an amplification refractory mutation systems polymerase chain reaction methodology to detect TNF-α (–308) and -β (+252) polymorphisms. The frequency of the GA genotype of TNF-α (–308G/A) was higher, and the frequencies of the GG and AA genotypes were significantly lower in IBD patients compared with those in controls, indicating that genotype GA-positive individuals are susceptible to IBD and that the GG and AA genotypes exert a protective effect. The frequency of allele A of TNF-α (–308G/A) was significantly higher and that of allele G was lower in IBD patients compared with those in controls, indicating an association of allele A with IBD risk in Saudi patients. On stratification of IBD patients into UC and CD, an almost similar pattern was noticed in both the groups. The results of TNF-β (+252A/G) polymorphisms showed a significant increase in the frequency of the GG genotype in IBD patients, suggesting a positive association of GG genotype with IBD risk. On stratification of IBD patients into UC and CD, the genotype GG of TNF-β was associated with susceptibility risk to UC but not CD. The frequencies of alleles and genotypes of both TNF-α and-β polymorphisms are not affected by sex or type of IBD (familial or sporadic). TNF-α (–308G/A) and TNF-β (+252A/G) polymorphisms are associated with risk of developing IBD in Saudi population. Keywords: tumor necrosis factor, polymorphism, inflammatory bowel disease, Saudis, Crohn’s disease, ulcerative colitis

Background The only cure for end-organ failure is transplantation. Unfortunately, there are fewer organ donors than patients. Currently, the majority of organ donations come from live or brain-dead donors. In order to expand the pool of potential organ donors, the emergency department should be utilized effectively. Objectives The primary goal of this research is to determine emergency physicians' knowledge, awareness, and attitude about organ donation. Methodology A cross-sectional study was conducted through different hospitals in Saudi Arabia. It includes 106 physicians in the adult emergency departments. Results The majority (84.9%) of the participants never reported any case in the emergency department as a potential case for organ donation. In addition, 54.8% of the participants report having little to no knowledge of the ethical issues of organ donation. Furthermore, 66.1% of respondents claim to have little to no knowledge of the goals and duties of the SCOT (Saudi Center for Organ Transplantation). It was interesting to see that 96.2% of the participants reported that their organizations do not have any policies or procedures in place regarding organ donations. Regarding education, 99 (93.4%) physicians did not participate in any organ donation course, training, or teaching program about organ donation. At the same time, 67 (63.2%) physicians concurred that participation in a training program is essential. Moreover, 68 (64.2%) physicians believed that organ donation should be a part of every end-of-life case. In order to improve the donation process in the emergency department, 88 (83%) physicians would want a well-established program with defined policies and procedures. Conclusion According to our findings, the emergency physician has inadequate expertise and information on organ donation rules and procedures, which has resulted in a missed opportunity to recruit more potential donors. We recommend instituting clear policy and procedures and educating the physicians and all emergency medicine staff to have better outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Akeely et al.)

Date fruit based products are gaining popularity among the consumers in almost all date growing countries due to its added nutritional value. Therefore, novel products were developed by combining two types of foods i.e., soft ripened cheeses and date fruit syrups or date powder. This study is the first to report the surface mold-ripened cheese production with date syrup and date powder. Model cheeses were prepared from pasteurized milk inoculated with Streptococcus thermophilus, Penicillium camemberti and Geotrichum candidum. Date syrup-1, date syrup-2, date powder or the date mixture were added at the stage of curdling. Based on the kinetic growth of the microbial groups in all the treatments, there was no change in the growth of these in various date palm product. On the contrary It may be said that addition of the date fruit product supports their growth. After 35 days, the amounts of total poly phenols were 128.3 ± 1.01, 81.8 ± 1.11, 33.5 ± 2.19, 156.23 ± 1.27 mg GAE/100 g in the cheeses support with date syrup-1, date syrup-2, date powder or the date mixture, respectively. Antioxidant activity of date fruits ranged from 80.13 IC50 (date syrup-2) to 82.23 IC50 (date syrup-1). Based on the chemical characteristics and sensory analysis, the study results showed the potential for innovative application of date products for developing new functional dairy products as an ideal medium for the delivery of biological active compounds with beneficial health effects over.

Aim: To study the association of apolipoprotein E (APOE) polymorphisms with the susceptibility of inflammatory bowel disease (IBD) in Saudi patients., Methods: APOE genotyping was performed to evaluate the allele and genotype frequencies in 378 Saudi subjects including IBD patients with ulcerative colitis (n = 84) or Crohn's disease (n = 94) and matched controls (n = 200) using polymerase chain reaction and reverse-hybridization techniques., Results: The frequencies of the APOE ε2 allele and ε2/ε3 and ε2/ε4 genotypes were significantly higher in IBD patients than in controls (P < 0.05), suggesting that the ε2 allele and its heterozygous genotypes may increase the susceptibility to IBD. On the contrary, the frequencies of the ε3 allele and ε3/ε3 genotype were lower in IBD patients as compared to controls, suggesting a protective effect of APOE ε3 for IBD. The prevalence of the ε4 allele was also higher in the patient group compared to controls, suggesting that the ε4 allele may also increase the risk of IBD. Our results also indicated that the APOE ε4 allele was associated with an early age of IBD onset. No effect of gender or type of IBD (familial or sporadic) on the frequency distribution of APOE alleles and genotypes was noticed in this study., Conclusion: APOE polymorphism is associated with risk of developing IBD and early age of onset in Saudi patients, though further studies with a large-size population are warranted.

The microbial contamination of 60 samples from six date cultivars in the rutab stage purchased from different retail outlets in AL-Hofuf City, Saudi Arabia was studied. All samples were found contaminated with aerobic mesophilic bacteria at loads in the order 10(2) to 10(5) cfu/cm(2) with some significant differences among varieties that can be attributed to differences in the weather conditions during rutab season. Also all samples, except only one, were contaminated with molds and yeasts at loads in the order 10(2) to 10(3) cfu/cm(2). Potentially pathogenic Staphylococcus aureus was detected in 57 samples and A. flavus/parasiticus in 13 samples, while coliforms were detected in 39 samples.

Background and Objectives: Liver abscess (LA) is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom (UK)., Design and Setting: Retrospective review of LA patients from three tertiary care centers (2 from Saudi Arabia and 1 from the UK) over a period of 10 years, from 1995 to 2005., Patients and Methods: Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome., Results: A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean (SD) age was 45.2 (20.3) years for those from Saudi Arabia and 55.4 (18.8) years for those from the UK (P=.022). The majority of the patients were males (70% from Saudi Arabia and 80% from the UK). Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 (80%) patients. Organisms were isolated in 43 (52%) cases and the majority of these were coliforms (58%). Amebic liver abscesses occurred in 19 (23%) patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 (80%) patients with aspiration and/or antibiotics, and 9 (10.8%) patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome (P=.008, .029 and .001, respectively)., Conclusions: Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas.

A facile approach for the synthesis of stable aqueous dispersion of silver nanoparticles (AgNPs) using glucose as the reducing agent in water/micelles system, in which cetyltrimethylammonium bromide (CTAB) was used as capping agent (stabilizer) is described. The evolution of plasmon band of AgNPs was monitored under different conditions such as (a) concentration of sodium hydroxide, (b) concentration of glucose, (c) concentration of silver nitrate (d) concentration of CTAB, and (e) reaction time. AgNPs were characterized by UV-visible spectroscopy, transmission electron microscopy (TEM), fluorescence spectroscopy and FT-IR spectroscopy. The results revealed an easy and viable strategy for obtaining stable aqueous dispersion of AgNPs with well controlled shape and size below 30 nm in diameter., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Hepatic steatosis in hepatitis C virus (HCV)-infected patients has been shown to enhance the progression of liver fibrosis and decrease the response to antiviral therapy., Aims: We aimed to determine the role of HCV genotype 4 (HCV-G4) in the prevalence of hepatic steatosis, its impact on antiviral therapy, and its associations and predictive factors in comparison to HCV-G1-infected patients., Methods: Treatment-naïve HCV patients who were started on pegylated interferon a-2b plus ribavirin therapy in two centers in Saudi Arabia were included. The severity of steatosis was assessed using the METAVIR and NAS (non-alcoholic fatty liver disease [NAFLD] activity score) scoring systems. Sustained virological response (SVR) was studied in relation to the degree of steatosis. Associations between steatosis and multiple demographic, laboratory, and virological factors were examined. HCV-G1 and HCV-G4 patients were compared., Results: A total of 116 patients (HCV-G4 85 [73.3%]; HCV-G1 31 [26.7%]) were included. The mean age was 50.4±10.7 years and 56.9% were males. In terms of steatosis grading using the NAS scoring system, 50% had steatosis grade 0, 26.7% grade 1, 14.7% grade 2, and 8.6% grade 3, while the overall staging of steatosis revealed that 43.1% had mild steatosis, 42.2% moderate, and 14.7% severe. Gamma-glutamyl transpeptidase (GGT), platelet count, body mass index (BMI), cholesterol level, presence of hyperlipidemia, liver histology stage, and grade were significantly correlated with hepatic steatosis in one or more of the statistical analyses. Twenty-two out of 55 patients (40.0%) had an SVR in the mild steatosis group, compared to 52.7% in the moderate group and 7.3% in the severe group (P=0.03). The HCV genotype did not correlate with steatosis or SVR., Conclusion: Our study confirms the high prevalence of steatosis in HCV-G4 and HCV-G1 patients, but with no difference in the grade or score of steatosis between the two genotypes. The grade of steatosis correlates with GGT, platelet count, and BMI, while the NAS score of steatosis correlates with response to antiviral therapy.

This study demonstrated that both chymosin and salt-in-moisture (SM) were important factors for proteolysis in the manufacture of ultrafiltrated white-salted cheese, with significant effects on water-soluble nitrogen and nitrogen soluble in trichloroacetic acid. In contrast, the levels of free amino acids were not significantly affected by chymosin and salt treatments. The cheeses made, using high levels of chymosin with low SM had lower levels of residual alpha(S1)- and beta-casein at the end of ripening. On texture profile analysis, the hardness and fracturability of the cheeses significantly increased with SM and decreased during ripening. Increases in chymosin significantly contributed to the overall weakening of the structure throughout ripening. Bitter flavour was detected after 12 weeks in the cheese made with the higher chymosin level and lower SM, which could be the result of accumulation of gamma-casein fractions. The sensory data indicated that the hedonic responses for low chymosin with low SM cheeses were good and acceptable in flavour, which may be due to the moderate levels of proteolysis products.

We report an unusual case of cecal carcinoma presenting first time as retroperitoneal abscess. As the patient was septic on presentation and the underlying cancer was not clear, she was treated initially by extraperitoneal drainage of the abscess. She later underwent a palliative right hemicolectomy. She presented a month later with recurrence at the drainage site. This case highlights this unusual initial presentation of right colonic cancer, the diagnostic dilemma and the poor prognosis associated with it.