Protective effect of L-arginine in experimentally induced Necrotizing Enterocolitis in rats

Necrotizing enterocolitis (NEC) is a leading cause of mortality and morbidity in the neonatal intensive care unit which recently the etiology of NEC remains unclear, prevention and treatment strategies are often inadequate. Accordingly, a lot of research was conducted to evaluate L-arginine as one of the effective medications to protect the premature infants, where. The objective of the current study was to test the hypothesis that administration of L-arginine would have a protective effect in experimentally induced necrotizing enterocolitis in rats. The study was conducted on 46 male albino rats which were divided into three main groups:  Control group, L-arginine group, and the experimental group which has been divided into two sub-groups; Group A: received Lipopolysaccharides to induce NEC, Group B: injected by L-arginine prior to the disease induced by endotoxin, asphyxia and cold stress. After the animals had been scarified, histological changes were evaluated, gene expression of both iNOS and IL-12 were measured, and apoptosis also was detected by flowcytometry technique. The findings observed a significant increase in the expression of iNOS gene and IL-12 gene and a noticeable decrease of the apoptosis index. In addition, administration of L-arginine attenuated body weight, body temperature, and the histological changes were altered by LPS/asphyxia. As such, the study was able to demonstrate that L-arginine administration significant protective effect against NEC, but further clinical studies are still required on preterm infant to confirm these results. Key words: Necrotizing enterocolitis, L-arginine, Interleukin-12, Inducible nitric oxide synthase, Lipopolysaccharides, Messenger Ribonucleic acid (mRNA

Protective Impact of L-arginine against Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most common acute surgical disease in preterm infants in intensive neonatal care. Premature infants are infant born prematurely and have a low birth weight. The disease is characterized by an inflammatory process in the intestines, which sometimes worsen and reach the level of necrosis. This process, in the intestinal wall, can destroy and kill the tissue of the intestinal wall and, later, it makes an intestinal perforation. Intestinal contents, in this case, leak to the abdominal cavity, endangering the child's life. Different studies showed that the arginine level in many premature infants is low, and subsequent studies have linked low arginine plasma concentrations with NEC disease. This paper concerned with awareness of this disease, its symptoms and its causes, in addition to L-arginine medication role in necrotizing enterocolitis (NEC) treatment, which is a semi essential cationic amino acid

The Epidemiology and Outcome of Biliary Atresia: Saudi Arabian National Study (2000–2018)

BackgroundThe epidemiology and outcomes of biliary atresia (BA) have been well-documented in national cohorts from two main ethnicities, namely, the Asian Orientals and Caucasians, with incidence ranging from 1 in 5,000 to 1 in 9,000 live births in East Asia and 1 in 15,000 to 19,000 live births in Europe and North America.ObjectiveWe report the first nationwide BA study outside North America, Europe, and East Asia to describe the epidemiology and outcomes of BA in Saudi Arabia.MethodsA national database of BA cases diagnosed between 2000 and 2018 was analyzed. We assessed clearance of jaundice (bilirubin <20 μmol/L) in all cases that underwent Kasai portoenterostomy (KPE). We then estimated survival using the Kaplan–Meier method with endpoints of liver transplantation (LT), death, or survival with native liver (SNL).ResultsBA was diagnosed in 204 infants (106 females; 10% pre-term). The incidence of BA was 1 in 44,365, or 2.254 in 100,000 live births (range, 0.5–4 in 100,000). Polysplenia was diagnosed in 22 cases (11%). The median age at referral was 65 days. A total of 146 children (71.5%) underwent KPE at a median age of 70 days. Clearance of jaundice was achieved in 66 of the 146 (45%) infants. The 10-year SNL after KPE was 25.5%, and the overall 10-year estimated survival was 72.5%. The Kaplan–Meier survival curves for patients undergoing KPE at the age of <60, 61–90, and >90 days showed a SNL rate at 51.6, 33, and 12.5%, respectively, at 5 years (P < 0.001). The 2-, 5-, and 10-year post-LT survival rates were 92.5, 90.6, and 90%, respectively. Undergoing an initial KPE did not impact negatively on the overall LT survival rate when compared to BA cases that underwent primary LT (P = 0.88).ConclusionThe incidence rate of BA in Saudi Arabia is lower than the incidence reported elsewhere. Late referral of BA cases remains a problem in Saudi Arabia; as a result, the SNL rate was lower than reported by other national registries. Hence, national policies devoted to timely referral and earlier age at KPE are needed

The impact of a gluten-free diet on the growth pattern of Saudi children with celiac disease

Objective: To describe the growth pattern of children with celiac disease (CD) after introduction of a gluten-free diet (GFD). Methods: In this retrospective, children 2–16 years old with biopsy-proven CD in 2015–2018 were included in the study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Serial measurements of height-for-age z-score (HAZ) and weight-for-age z-score (WAZ), were recorded at 0, 4, 8, 12, and 16 months. Data on insulin-like growth hormone-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) obtained at diagnosis and during follow-up were retrieved. Clinical, demographic, and laboratory data were extracted from patients' medical files. Results: The median age for the patients was 8.9 years (range, 2.4–16 years). Males constituted 53.2%. The mean WAZ at diagnosis was -2.8±1.9 and the mean HAZ was -3±0.99. Trend analysis indicated a significant time effect for WAZ (p<0.001) and for HAZ (p<0.001). The mean IGF-1 was 133.4±96.8 ng/ml and the mean IGFBP-3 was 3174±1081 ng/ml. There was significant increase in the secretion of IGF-1 (p=0.01) and IGFBP-3 (p=0.004) during the first 8 months of a GFD. Conclusion: The administration of a GFD for Saudi children with CD normalizes their growth parameters within 16 months of follow-up and improves the endogenous secretion of growth factors. Keywords: Celiac disease, growth, child, Continuous..

Anti-TNFα antibody infliximab treatment for an infant with fistulising Crohn’s disease

A female infant presented at the age of 4 weeks with dyschezia and bloody streaking of stools which did not improve on elemental formula for proposed cow’s milk protein allergy. At 6 months of age perianal ulceration appeared which evolved into multiple fistulas opening into the perineum. A diagnosis of infantile Crohn’s disease was made after colonoscopy and histopathology examination and exclusion of other conditions. An 8 week trial of total parenteral nutrition, in addition to corticosteroids, salazopyrine, metronidazole, and azathioprine failed to arrest deterioration of the perianal fistulas. Treatment with the anti-TNFα antibody infliximab was started at 5 mg/kg/dose at 9 months of age. She was given three doses at 0, 2, and 6 weeks, respectively. This resulted in significant healing of her fistulas and cessation of fistula output. This improvement was sustained at the time of last follow-up 10 months after treatment

Definisi miopia menggunakan retinoskopi tanpa sikoplegia dalam kalangan pelajar Melayu

Miopia pada kebiasaannya didefinisi sebagai sfera setara ≥ -0.50 D dalam banyak kajian yang dilaporkan. Namun demikian tidak banyak laporan berkaitan kesensitifan dan kekhususan definisi miopia yang dipilih apabila penyelidik melaporkan prevalen dan taburan miopia dalam populasi yang dikaji. Objektif kajian ini adalah membezakan kesensitifan and kekhususan setiap definisi miopia yang dipilih, iaitu -0.50 D, -0.75 D dan -1.00 D dan untuk mengenal pasti kebolehan definisi tersebut meramalkan ralat refraksi miopia pada akuiti penglihatan kurang daripada log MAR 0.3 (6/12) dalam kalangan pelajar Melayu. Seramai 866 orang pelajar Melayu berumur antara 7-10 tahun mengambil bahagian dalam penyelidikan ini. Akuiti penglihatan diukur menggunakan carta log MAR dan ralat refraksi diukur menggunakan retinoskopi tanpa sikloplegia. Keputusan kami menunjukkan kesensitifan dan kekhususan definisi miopia yang dipilih iaitu ≥ -0.50 D adalah 54.5% dan 97.8%, untuk definisi miopia ≥ - 0.75 D adalah 71.1% and 97.5% dan untuk definisi miopia ≥ -1.00 D adalah 83.3% dan 97.2%. Luas lengkok ROC untuk setiap definisi miopia -0.50 D, -0.75 D dan -1.00 D ialah 0.676, 0.839 and 0.957. Kesimpulannya, kajian ini menunjukkan definisi optimum miopia untuk pelajar sekolah Melayu berumur antara 7-10 tahun ialah ≥ -1.00 D, dengan menggunakan kaedah retinoskopi tanpa sikloplegia. Definisi ini boleh mengenal pasti 95.7% pelajar mempunyai akuiti penglihatan kurang daripada log MAR 0.3 dan ia mempunyai gabungan kesensitifan (83.9%) dan kekhususan (95.7%) terbaik

A cross-sectional survey of Saudi gastroenterologists: Transition strategies for adolescents with inflammatory bowel disease

Background/Aims: The transition of adolescents with inflammatory bowel disease (IBD) from pediatric to adult care requires a well-structured standardized protocol to ensure the delivery of optimal healthcare and decrease the risk of nonadherence, hospitalizations, and complications. The aims of this survey are to evaluate current IBD transition practices adopted by gastroenterology services across the Kingdom of Saudi Arabia (KSA) and to identify the major challenges standing in the way of implementing effective transition strategies from the perspectives of pediatric and adult gastroenterologists. Patients and Methods: An online survey was distributed to KSA pediatric and adult gastroenterologists through the Kingdom's national gastroenterology association. The questionnaire included closed-ended questions regarding existing institutional transition strategies and perspectives regarding the impact of different factors on their ability to effectively transition adolescents from pediatric to adult care. Results: A total of 80 adult and pediatric gastroenterologists responded to the survey invitation. Most of the participating gastroenterologists worked at a tertiary care center (82.5%). The majority of gastroenterologist (73.8%) reported that they do not follow a defined protocol for transitioning in their current practices. However, a structured transition program was noted to be “very important” by 78.8% of gastroenterologists. The most favored method of transitioning was joint outpatient clinic attended by patient, caregiver, pediatric gastroenterologist, and adult gastroenterologist (35.9%) and the most commonly reported barrier to transitioning was “lack of proper preparation” for transitioning (53.2%). Conclusions: Although acknowledged by the majority of participants as being “very important,” no standardized IBD transition protocol is followed in the majority of practices across KSA. A well-structured national protocol for transitioning adolescents with IBD is needed