Response of the public and restaurant owners to the mandatory menu energy-labelling implementation in restaurants in Saudi Arabia.

OBJECTIVE: Mandatory menu energy-labelling policy in restaurants has received increasing attention worldwide as a useful tool for promoting balanced energy intake and encouraging healthier food selection to reduce obesity prevalence. Therefore, we aimed to evaluate the knowledge, views and observations of the public and restaurant owners towards the mandatory menu energy-labelling policy (introduced in August 2018) in restaurants in Saudi Arabia. DESIGN: In February 2019, we conducted a cross-sectional study using an electronic questionnaire. SETTING: Saudi Arabia. PARTICIPANTS: Saudi individuals (n 1228) aged 18-80 years and forty-one restaurant owners. RESULTS: Most participants identified the correct daily energetic requirements for moderately active men (51 %) and women (69 %), but not for inactive adults (36 %). Although 40 % reported adequate knowledge to select low-energetic meals and 55 % perceived the policy as useful, 51 % reported they would be less likely to eat at restaurants displaying energy. Most participants (76 %) mentioned they would choose lower-energetic meals, and 79 % would feel guilty after consuming high-energetic meals. Moreover, 62 % of participants reported that the new labelling policy affected their food selections, prompting them to order different food items, eat less, change restaurants or eat at restaurants less frequently. Among restaurant owners, half were aware of the reason for the implementation of this policy and supported this measure. However, they did not consider modifying recipes to reduce energy. Sales of low- and high-energetic meals increased and decreased in 44 % and 39 % of restaurants, respectively. CONCLUSIONS: This policy may be an effective public health tool for promoting balanced energy intake and encouraging healthier food selection in Saudi Arabia.

Incidence, Pathotyping, and Antibiotic Susceptibility of Avian Pathogenic Escherichia coli among Diseased Broiler Chicks.

A total of 54 broiler flocks during the first two weeks of life was used to investigate the incidence of avian pathogenic E. coli in Egypt; 28 isolates (51.85%) were revealed by colony morphology and biochemical identification which then investigated for their serogroups and only 18/28 isolates were serotyped. The most prevalent serotypes were O115, O142, O158, O55, O125, O114, O27, O20, and O15. By application of polymerase chain reaction (PCR), 83.3% (15/18) of the serotyped isolates were confirmed to be E. coli, and 93.3% (14/15), 46.6% (7/15), and 20% (3/15) of isolates harbored the iss, iutA, and fimH genes, respectively. Virulence testing of the selected 13 APEC isolates on the specific-pathogen-free (SPF) chicks revealed them to be highly virulent (15.4%), moderately virulent (23.1%), and avirulent (61.5%); however, all isolates (100%) were extremely virulent towards SPF embryonated chicken eggs. Antibiotic resistance (100% of isolates (n = 13)) was observed for ampicillin, amoxycillin-clavulanic acid, and tetracyclines, colistin (92.31%; 12/13), doxycycline and spiramycin (84.62%; 11/13), florfenicol (69.23%; 9/13), cefotaxime (61.54%; 8/13), and ciprofloxacin (53.85%; 7/13). The highest percentage of sensitivity (53.85% of isolates; 7/13) was recorded for ofloxacin and enrofloxacin followed by gentamycin (46.15%; 6/13). The results suggest that the diagnosis of APEC with PCR is rapid and more accurate than traditional methods for E. coli identification; moreover, the presence or absence of iss, iutA, and/or fimH genes is not an indicator of in vivo pathogenicity of APEC. Thus, further studies, including a wider range of virulence genes and gene sequencing, are required. In addition, serotyping has no effect on the virulence of APEC.

Mutational analysis of rare subtypes of congenital adrenal hyperplasia in a highly inbred population.

CONTEXT: Apart from 21 Hydroxylase deficiency, other subtypes of congenital adrenal hyperplasia (CAH) are rare. We studied the clinical features and molecular genetics of a relatively large series of patients with CYP17A1, HSD3ß2 and StAR deficiencies. PATIENTS AND METHODS: We studied 21 patients including 7 patients with CYP17A1, 10 patients with HSD3ß2 and 4 patients with StAR deficiencies. For mutation detection, we isolated DNA from peripheral leucocytes, amplified genes of interest using polymerase chain reaction and directly sequenced the amplicons using Dideoxy Chain Termination method. RESULTS: Regardless of their karyotype, patients with CYP17A1 deficiency presented with normally looking external female genitalia and were raised as females. Hypertension and hypokalemia were prominent features in 4 of 7 patients. Two missense (p.R416H, p.R239Q) and 2 non-sense (p.Y329X, p.Y329X) mutations were found in these 7 cases. In 3 unrelated families with 10 affected siblings with HSD3ß2 mutations, two non-sense mutations were found (p.Q334X, p.R335X). 46XY patients with HSD3ß2 deficiency presented with ambiguous genitalia while 46XX patients presented with normal female external genitalia. Adrenal crisis was common in patients with both karyotypes. In the 4 patients with StAR deficiency, both genetic male and female patients presented with normally looking female external genitalia and adrenal crisis. One previously reported missense mutation (p.R182H) was found in 3 unrelated patients and a novel non-sense mutation (p.Q264X) in the fourth patient. CONCLUSIONS: These cases of rare subtypes of CAH illustrate the heterogeneous phenotypic and genetic features of these subtypes and add unique novel mutations to the previously known ones.

A high rate of novel CYP11B1 mutations in Saudi Arabia.

Despite ethnic variation, 11 ß-hydroxylase deficiency (11ß-OHD) has generally been considered the second most common subtype of congenital adrenal hyperplasia (CAH). We report a high rate of novel mutations in this gene (CYP11B1) in patients from Saudi Arabia. We studied 16 patients with 11ß-OHD from 8 unrelated families. DNA was isolated from peripheral blood. The 9 exons and exon-intron boundaries of CYP11B1 were PCR-amplified and directly sequenced. The novel mutations were functionally characterized using subcloning, in vitro mutagenesis, cell transfection and 11-deoxycortisol: cortisol conversion assays. Six mutations were found in these 8 unrelated families. Three of these mutations are completely novel and two have just been recently described as novel mutations from the same population. These include a single nucleotide insertion mutation in codon 18 (c.53_54insT) leading to frameshift and truncation in 4 siblings, a novel mutation (c.1343G>C, p.R448P) in 3 unrelated families, a novel mutation (c.1394A>T, p.H465L) in 2 siblings, a novel mutation (c.617G>T, p.G206V) in 1 patient, and a recently described non-sense novel mutation (c.780G>A, p.W260X) in another patient. Out of the 6 mutations described in this report, only one mutation (p.Q356X) was reported previously. In vitro functional testing of the 3 missense and nonsense novel mutations revealed complete loss of the 11 hydroxylase activity. We conclude that 11 ß-OHD in Saudi Arabia has a unique genotype with a high rate of novel mutations. The novel p. R448P mutation is the most common mutation in this highly inbred population.

Vectorial competence of Phlebotomus papatasi (Diptera: Psychodidae) to transmit two old world Leishmania species: Leishmania major and L. Tropica.

The vectorial competence of Phlebotomus papatasi for two old world Leishmania species, L. major & L. tropica was investigated. Phlebotomus papatasi originally collected from Suez Governorate, were membrane fed on homogenized hamster's lesion infected with L. major, MHOM/EG/06/RTC-63, and L. tropica, MGER/EG/06/RTC-74 identified from patients with suspected CL in Northern Sinai, Egypt. Fed flies were dissected at different time intervals and examined microscopically to determine the infection rate and parasite intensity. The feeding rate of P. papatasi on L. major (58.69%) was found higher than on L. tropica (45.99%). Infection rate with L. major (60.19%) was significantly higher than that with L. tropica (39.73%). Transmission by bites in case of P. papatasi/L. tropica failed. A characteristic L. major lesion was developed on the foot pads region 120 days post infective bites on healthy hamster. It is therefore concluded that P. papatasi is a much more effective vector for L. major than for L. tropica.

Do viscid secretions have a role in nasal polyp formation?

OBJECTIVES: We compared histologic findings on light microscopy of viscid secretions found in association with nasal polyps with those found in patients with chronic sinusitis without polyposis (CSWP). The differences might further understanding of nasal polyp pathogenesis. METHODS: In a prospective controlled study, viscid secretions found in association with nasal polyps were collected at endoscopic sinus surgery. Retained secretions in patients with CSWP acted as a control group. Both were fixed in 10% formalin, processed, and examined with a light microscope. RESULTS: Viscid secretions were encountered among nasal polyps in 25 of 132 patients (18.9%). Polyps containing multiloculated cysts filled with viscid secretions were found in 2 of them. Histologic examination of viscid secretions showed variable histologic pictures, ranging from a homogeneous material infiltrated with inflammatory cells, newly formed blood vessels, and bundles of collagen fibers to a well-developed connective tissue core covered with a respiratory epithelium in some areas. Histologic examination of retained secretions in patients with CSWP revealed amorphous material infiltrated with inflammatory cells with no further maturation or epithelial coverage. CONCLUSIONS: Viscid secretions, originating from ruptured mucosal cysts, might represent the initial step in nasal polyp pathogenesis. The variable histologic pictures detected possibly reflect different stages in nasal polyp formation from these secretions. Factors postulated in nasal polyp etiopathogenesis might trigger maturation and changes in the morphological structure of these secretions.

Leishmania infantum MON-98 isolated from naturally infected Phlebotomus langeroni (Diptera: Psychodidae) in El Agamy, Egypt.

Leishmania infantum zymodeme MON-98 was isolated in El Agamy, Egypt. A total of 15 (1.07%) Leishmania-like infections in the anterior midgut and in the head was found in 1,405 Phlebotomus langeroni (Nitzulescu); none of 1,785 Phlebotomus papatasi (Scopoli) was found infected. Four of the 15 cultures (26.7%) were indistinguishable from a reference L. infantum MON-98 strain using cellulose acetate electrophoresis. The isolation and identification of L. infantum MON-98 from naturally infected P. langeroni confirms that this species of sand fly is the vector of visceral leishmaniasis in El Agamy.

The breeding habitats of Phlebotomus sand flies (Diptera:Psychodidae) in El Agamy, Alexandria Egypt.

A prolonged search for the breeding habitats of Phlebotomus sand flies in El Agamy, resulted in the collection of 105 newly emerged P. papatasi and P. langeroni. These flies were from poultry sheds, rubbish on stone piles and rubbish piles.

Sandflies (Diptera: Psychodidae) in Mersa Matruh and Siwa oasis, A.R. Egypt.

Sandflies were surveyed 3 times during 1989 in Mersa Matruh city and Siwa oasis to investigate their status. Only Phlebotomus papatasi was identified from inside houses and outdoor sites. More flies were collected in Mersa Matruh than in Siwa. Results document for the first time the presence of P. papatasi in Mersa Matruh and verify its presence in Siwa oasis.

Investigation of sampling methods for the study of Phlebotomine sandflies in Egypt.

Different sampling field techniques were investigated for the study of the natural behaviour of the sand flies in Egypt (South Sinai and Alexandria). Sampling methods were divided into two groups: the first group is techniques for catching alive flies [Active search (Aspirator), CDC-light trap; funnel trap; Fan trap and catches off bait] and the second group is techniques for collecting dead specimens [sticky traps, and illuminated sticky traps (chemical light sticky trap)]. Comparison between the efficiency of the different trapping methods for collecting sandflies indicated that the CDC light trap was the most productive type for species of the genus phlebotomus followed by the illuminated paper traps and then the sticky paper traps. Members of the Sergentomyia group showed to be more attracted to illuminated/sticky paper followed by the sticky paper and then the CDC light traps. In general, sticky paper traps are the most widely used technique for sand fly outdoor collection as it is easy to be used, unexpensive and convenient for the purpose of sandfly surveys.