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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 subjects with type 2 diabetes (T2D), in order to propose recommendation 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. Dietary intake data 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 TG level (difference, -3.78%; 95% CI, -0.65% to -6.81%) and a near statistically significant (P = 0.06) increase in HDL levels (difference 1.87%; 95% CI -0.06–3.84%) in T2D patients from the Eastern Province, Saudi Arabia. Additionally, in our patient cohort, 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. Conclusion The present study showed that adherence to a healthful plant-based diet is associated with a favorable outcome in glycemic control and lipid profile in T2D patients in the Eastern Province of Saudi Arabia. Prior assessment of total diet quality may be beneficial when giving nutritional advice to patients with T2D with the objective of improving glycemic control and lipid profile.

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.

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.

BACKGROUND: Breast cancer is the most commonly diagnosed malignancy in women worldwide. Mammography is the best screening method for the early detection of breast cancer in asymptomatic women; however, its results are associated with high false positive/negative rates. One factor that decreases the sensitivity of mammography-based diagnosis of breast cancer is breast density. This study aimed to identify the association between mammographically determined breast density and breast cancer.METHODS: This single-center retrospective study included 2158 female participants in the Eastern Province of Saudi Arabia who underwent mammography between 2016 and 2018. We evaluated baseline information on breast density and its relationship with breast cancer risk and other factors (age, age at first childbirth, menopause status, and family breast cancer history). Mammogram reports were categorized using the Breast Imaging Reporting and Data System lexicon. RESULTS: The majority (39%) of participants showed scattered fibroglandular density and Breast Imaging Reporting and Data System category 2 (62.5%), while the occurrence of extremely dense breasts was low (4.7%). Breast density was found to be associated with age and menopause status (p < 0.0005). Participants with Breast Imaging Reporting and Data System assessment categories 4 (suspicious for malignancy) and 5 (highly suggestive of malignancy) were associated with elevated breast cancer risk (confirmed by biopsy).CONCLUSION: Breast density was not found to be associated with breast cancer risk in this study. However, the proportion of participants with extremely dense breasts was very low (4.7%). Therefore, further studies are warranted with larger sample sizes including extremely dense breasts.

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.

Large-scale gut microbiome sequencing has revealed key links between microbiome dysfunction and metabolic diseases such as 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-T2Dparticipants 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. 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 participants compared to non-diabetic participants, and T2D was associated with an elevated Firmicutes/Bacteroidetes ratio, consistent with previous findings. 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.Author summaryThe rates of Type 2 diabetes (T2D) in Saudi Arabia have risen dramatically in the last several decades due to socio-economic changes resulting in changes in dietary and sedentary lifestyles. This emergence has grown more rapidly and affects larger proportions of the population with estimates of T2D prevalence impacting 25% of the population. There is a paucity of microbiome data from Middle Eastern populations, and previous studies have been conducted on small sample sizes. Here we report on the first-ever characterization of gut microbiota T2D versus non-T2D and largest microbiome study ever conducted in a Middle Eastern country. The datasets from this study are important to create a regional reference T2D-microbiome catalogue which will propel the understanding of regional gut flora which are associated with T2D development. Based on T2D status and quantified glucose levels of Middle Eastern participants, relatively stable differences in stool composition were observed by differential abundance and alpha diversity measures. 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.

Abdulaziz Al-Sharydah,1 Abdulrahman Al-Abdulwahhab,1 Sari Al-Suhibani,1 Afnan Al-Muhanna,1 Abdullah Abohimed,2 Abdulmonem AlSharidah,3 Faisal Alabbas3 1Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia; 2Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi ArabiaCorrespondence: Abdulrahman Al-AbdulwahhabDiagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 31952 (4398), Al-Khobar City, Eastern Province, Saudi ArabiaTel +966502333711Email ahAbdulwahab@iau.edu.saPurpose: Basilar artery tip aneurysms can have fatal consequences and poor prognostic outcomes in case of rupture. We investigated the standard parameters used to evaluate aneurysmal morphology to predict aneurysm rupture.Patients and Methods: We measured the differences between ruptured and unruptured basilar bifurcation aneurysms in terms of morphological features, including aneurysm size, size ratio, aneurysm height, perpendicular height, aneurysm width, bottleneck ratio, aspect ratio, and present daughter domes, using 3D angiography.Results: Among 34 patients, 21 (61.8%) and 13 (38.2%) had ruptured and unruptured basilar tip aneurysms, respectively. In the ruptured group, the mean aneurysm size, and aspect, size, and bottleneck ratios were 6.8 ± 1.9 mm, 3.2 ± 1.0, 2.3 ± 0.5, and 2.2 ± 0.4, respectively, compared to 4.5 ± 1.5 mm, 4.4 ± 2.0, 1.6 ± 0.4, and 2.7 ± 0.7, respectively, in the non-ruptured group. Univariate analysis showed a larger aneurysmal cross-sectional diameter (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.5– 5.392; p 

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

Background: Acute chest syndrome is a major cause of pulmonary disease and mortality in sickle cell disease patients. Its diagnosis can be delayed due to differing imaging patterns between children and adults. Objective: The purpose of this study was to describe the pulmonary and extrapulmonary imaging findings in sickle cell disease patients with acute chest syndrome and determine differences in findings between adult and pediatric patients. Patients and Methods: This retrospective study analyzed the data of all sickle cell disease patients who were admitted with a diagnosis of acute chest syndrome to King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between January and June 2015 (n = 150). After grouping the patients into adults and pediatrics, the pulmonary and extrapulmonary characteristics were identified and the digital radiography, computed tomography and laboratory findings were compared. Results: A total of 116 patients with 163 acute chest syndrome episodes met the inclusion criteria, of which 69 (60%) were adults. In both adult and pediatric patients, the most frequent pulmonary finding was consolidation of the lung parenchyma. The right lung was most frequently involved: the lower lobe in adult patients and the middle lobe in pediatric patients. In addition, pleural effusion was observed in both age groups. Extrapulmonary radiological findings, such as avascular necrosis and cardiomegaly, were significantly more common in adult patients than in pediatric patients (P < 0.05). Compared with adults, pediatric patients had significantly lower hemoglobin levels (P = 0.001) and oxygen tension fraction in arterial blood (P = 0.007). Conclusions: Pediatric and adult sickle cell disease patients with acute chest syndrome typically exhibited similar pulmonary characteristics, whereas extrapulmonary findings were more prominent in adult patients. Furthermore, low levels of hemoglobin and oxygen tension fraction were dependent predictors of acute chest syndrome.

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.

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.

Objective: To assess the relationship between smoking and alcohol use (separately and combined) on arterial stiffness in patients with essential hypertension. Materials and Methods: We assessed never-treated newly diagnosed patients with essential hypertension (n = 446) aged 18–80 years (52% males). Measurements included aortic stiffness, assessed as pulse wave velocity (PWV) (Complior), wave reflection (augmentation index [AIx]), and transit time [T R] SphygmoCor). Results: The 446 patients were categorized as: non-smokers (n = 204), ex-smokers (n = 121), current smokers (n = 121), non-drinkers (n = 59), moderate drinkers (n = 281), heavy drinkers (n = 106). Both AIx and PWV were significantly higher in current smokers than in ex-smokers and non-smokers [(p < 0.02), (p < 0.01), respectively]. AIx and PWV were higher in non-drinkers followed by heavy drinkers and moderate drinkers [(p < 0.003), (p < 0.008), respectively]. Among current and ex-smokers there was no significant difference in PWV or AIx by alcohol consumption (p = NS), while in non-smokers AIx was significantly (p < 0.001) higher in the non-drinkers followed by heavy drinkers and those with moderate alcohol consumption and PWV was significantly (p < 0.001) higher in heavy drinkers followed by non-drinkers and those with moderate alcohol consumption. Conclusion: Moderate alcohol consumption exerts a favorable effect on arterial stiffness in essential hypertensive patients. However, the combined effect of smoking cancels this favorable effect.