Natural Therapeutics in Aid of Treating Alzheimer's Disease: A Green Gateway Toward Ending Quest for Treating Neurological Disorders.

The current scientific community is facing a daunting challenge to unravel reliable natural compounds with realistic potential to treat neurological disorders such as Alzheimer's disease (AD). The reported compounds/drugs mostly synthetic deemed the reliability and therapeutic potential largely due to their complexity and off-target issues. The natural products from nutraceutical compounds emerge as viable preventive therapeutics to fill the huge gap in treating neurological disorders. Considering that Alzheimer's disease is a multifactorial disease, natural compounds offer the advantage of a multitarget approach, tagging different molecular sites in the human brain, as compared with the single-target activity of most of the drugs so far used to treat Alzheimer's disease. A wide range of plant extracts and phytochemicals reported to possess the therapeutic potential to Alzheimer's disease includes curcumin, resveratrol, epigallocatechin-3-gallate, morin, delphinidins, quercetin, luteolin, oleocanthal, and other phytochemicals such as huperzine A, limonoids, and azaphilones. Reported targets of these natural compounds include inhibition of acetylcholinesterase, amyloid senile plaques, oxidation products, inflammatory pathways, specific brain receptors, etc. We tenaciously aimed to review the in-depth potential of natural products and their therapeutic applications against Alzheimer's disease, with a special focus on a diversity of medicinal plants and phytocompounds and their mechanism of action against Alzheimer's disease pathologies. We strongly believe that the medicinal plants and phytoconstituents alone or in combination with other compounds would be effective treatments against Alzheimer's disease with lesser side effects as compared to currently available treatments.

Nonalcoholic fatty liver disease in lean and obese patients in Saudi patients from a single center.

BACKGROUND: Fatty liver is a disease caused by the accumulation of fat in the liver. It is one of the major risk factors for developing cirrhosis and hepatocellular carcinoma. Saudi Arabia is one of the most prevalent countries in diabetes and obesity; the overall prevalence of diabetes is 23.7% and obesity is 35.6%. AIM: To study the correlation between fatty liver finding on abdominal ultrasound (US) and their clinical and biochemical profile including BMI, blood glucose level, lipid profile, liver function tests, and blood pressure in both group lean and obese patients. METHODS: Cross-sectional study of 346 fatty liver ultrasound-proven patients were enrolled in the study from January to May 2016 in King Saud Hospital- Qassim, Saudi Arabia. RESULTS: Mean age of the participants was 50.3 years. Female participants were 55% of the cohort. Participants were divided based on their BMI: BMI <25 (lean), BMI of 25-30 (overweight and mild obesity), and BMI >30 (morbid obesity). We found that cholesterol (P = 0.007) and low-density lipoprotein (LDL) (P = 0.015) were higher in lean compared to others (5 and 3.1), respectively. Gamma-glutamyl transferase (GGT) was higher in mildly obese patients (113.2) and ALT, which was higher in lean patients (60.4). In addition, 34.5% of the overall patients had Diabetes Mellitus (DM). We found that HbA1c was lower in lean (7.3) compared to morbidly obese patients (7.6). Platelets counts were higher in morbidly obese patients (278) compared to other groups. CONCLUSION: High cholesterol and LDL strongly correlated with lean fatty liver patients. There was a significant relationship between the female gender and the risk of development of fatty liver. However, liver enzymes were within the normal range, except GGT, which was higher in all the groups, with the highest value in mildly obese patients. Therefore, they are not sensitive for diagnosing fatty liver patients.

Prevalence of gastro-esophageal reflux in diabetic patients at a tertiary hospital in Central Saudi Arabia.

OBJECTIVES: To estimate the prevalence of gastro-esophageal reflux disease (GERD) among diabetic patients and to investigate GERD's potential association with diabetic complications, and patients' sociodemographic and clinical characteristics. METHODS: This cross-sectional study used the GERD questionnaire (GerdQ) in 403 diabetic patients attending the outpatient clinics at King Khalid University Hospital, King Saud University Medical City, King Saud University; a tertiary hospital in Riyadh, Saudi Arabia, between January and February 2019. On the basis of a cuto GerdQ score of 8, we distinguished GERD and non-GERD groups. RESULTS: Gastro-esophageal reflux disease prevalence was 44.9%. Of the diabetic patients with GERD, 76.8% were female (pless than 0.001). Gastro-esophageal re ux disease patients were older (mean age: 55.27, p=0.038) and had a slightly higher body mass index (BMI) than non-GERD (32.04 versus, 30.20 p=0.006), respectively. Smokers in the GERD group were 1.7% versus 7.2% in the non- GERD group (p=0.007). Peripheral numbness (p=0.023) and nephropathy (p=0.041) were more prevalent in patients with GERD, while myocardial infarction was more prevalent in non-GERD subjects (p=0.038). On multi variable analysis, the only independent GERD risk factors were female gender (p=0.013) and age more than 65 years (p=0.007). CONCLUSION: Gastro-esophageal reflux disease prevalence in diabetic patients was 45%. Diabetic patients with GERD were more often female and older than 65 years. None of the other tested factors (BMI, smoking status, diabetes mellitus duration, therapeutic plan, or diabetic complications) showed signi cant di erence between GERD and non-GERD groups.

Premarital hepatitis screening. Attitude towards screening and the risk factors for transmission.

OBJECTIVE: To explore all research articles investigating hepatitis premarital screening programs (PSPs) worldwide, considering all different outcomes of such programs, including efficacy, possible limitations to screening, and participants' knowledge and satisfaction regarding the program. Methods: The present systematic review used the databases of PubMed, Ovid Medline, and Google Scholar to search for articles related to both PSPs and the hepatitis viruses. Research articles were identified between October and December 2017, and articles were selected and extracted based on predefined inclusion and exclusion criteria from the year 1957 up to 2017. The review included all full-length original articles related to premarital hepatitis screening in both indexed and non-indexed journals, but reviews, mini-reviews, and letters were excluded. Ultimately, 4 research papers were included. While conducting the search, the project was registered on PROSPERO database.  Results: In all these papers, the participants' attitude toward premarital screening was good, but their level of knowledge about the program and the diseases being screened was low. Pre- and post-test counseling were provided to only a limited number of participants in each of the studies. This emphasizes the need for effective counseling sessions, which may help in decreasing the hepatitis burden in Saudi Arabia and worldwide.  Conclusions: The role of the practicing physician in any screening program is to provide effective pre and post-test counseling and correct any misinformation about the transmission of the hepatitis viruses.

Management of diabetic gastroparesis.

Symptoms suggestive of gastroparesis occur in 5% to 12% of patients with diabetes. Such a complication can affect both prognosis and management of the diabetes; therefore, practicing clinicians are challenged by the complex management of such cases. Gastroparesis is a disorder characterized by a delay in gastric emptying after a meal in the absence of a mechanical gastric outlet obstruction. This article is an evidence-based overview of current management strategies for diabetic gastroparesis. The cardinal symptoms of diabetic gastroparesis are nausea and vomiting. Gastroesophageal scintiscanning at 15-minute intervals for 4 hours after food intake is considered the gold standard for measuring gastric emptying. Retention of more than 10% of the meal after 4 hours is considered an abnormal result, for which a multidisciplinary management approach is required. Treatment should be tailored according to the severity of gastroparesis, and 25% to 68% of symptoms are controlled by prokinetic agents. Commonly prescribed prokinetics include metoclopramide, domperidone, and erythromycin. In addition, gastric electrical stimulation has been shown to improve symptoms, reduce hospitalizations, reduce the need for nutritional support, and improve quality of life in several open-label studies.

Hepatitis B genotyping and its clinical implications.

Hepatitis B is a crucial medical problem in Saudi Arabia. Different hepatitis B virus genotypes have been discovered and have been shown to cluster in different areas of the world. Hepatitis B virus genotyping has received a lot of attention recently, and its clinical implications are being investigated extensively throughout the world. In this review, we will discuss the virology, epidemiology and clinical implications of the different hepatitis B genotypes.