Hasan A. Alzahrani

Molecular Mechanism Underlying Anti-Inflammatory and Anti-Allergic Activities of Phytochemicals: An Update

The resort worldwide to edible medicinal plants for medical care has increased significantly during the last few years. Currently, there is a renewed interest in the search for new phytochemicals that could be developed as useful anti-inflammatory and anti-allergic agents to reduce the risk of many diseases. The activation of nuclear transcription factor-kappa B (NF-κB) has now been linked to a variety of inflammatory diseases, while data from numerous studies underline the importance of phytochemicals in inhibiting the pathway that activates this transcription factor. Moreover, the incidence of type I allergic disorders has been increasing worldwide, particularly, the hypersensitivity to food. Thus, a good number of plant products with anti-inflammatory and anti-allergic activity have been documented, but very few of these compounds have reached clinical use and there is scant scientific evidence that could explain their mode of action. Therefore, this paper intends to review the most salient recent reports on the anti-inflammatory and anti-allergic properties of phytochemicals and the molecular mechanisms underlying these properties.

Antibacterial and Antioxidant Potency of Floral Honeys from Different Botanical and Geographical Origins

In order to assess their physicochemical and antioxidant properties as well as their antimicrobial potency, four varieties of honey from different botanical and geographical origins were used. The agar incorporation method was used to determine the antimicrobial potency of honeys. The total phenol content was determined by a modified Folin–Ciocalteu method and the free radical scavenging activity by the Fe3+ reducing power (FRAP) assay. Manuka honey was the most effective against Staphylococcus aureus Oxa R and S. aureus Oxa S with a Minimum Inhibitory Concentration (MIC) of 6% and 7%, respectively, whereas wild carrot honey was the most effective against Pseudomonas aeruginosa, with a MIC of 12%. Lavender honey was the least effective against all tested strains, even though was found to have the lowest pH and water content. Manuka honey had the highest content of polyphenols, with 899.09 ± 11.75 mg gallic acid/kg, whereas lavender honey had the lowest, with 111.42 ± 3.54 mg gallic acid/kg. A very significant correlation (r value was 0.9079 at P < 0.05) was observed between the total polyphenolic content and the Fe2+ content formed in the presence of the honey antioxidants. The differences between honey samples in terms of antibacterial and antioxidant activity could be attributed to the natural variations in floral sources of nectar and the different locations.

Evaluation of the antioxidant activity of three varieties of honey from different botanical and geographical origins.

It is well established that honey contains substantial antioxidant compounds that could protect cell components from the harmful action of free radicals. One can speculate that these compounds may strengthen the organism defenses and consequently prevent oxidative stress in humans. Therefore, over time, impaired cells can accumulate and lead to age-related diseases. A comparative study was carried out to assess the antioxidant activity of three varieties of honey from different botanical and geographical (Manuka honey from New Zealand, Acacia Honey from Germany and Wild carrot honey from Algeria). Manuka honey had the highest phenolic content with 899.09 ± 11.75 mg gallic acid/kg. A strong correlation between the antioxidant activities of honeys and their total phenol contents has been noticed.

Prevalence and Correlates of Diabetic Peripheral Neuropathy in a Saudi Arabic Population: A Cross-Sectional Study

The purpose of this cross-sectional study was to investigate the prevalence and correlates of diabetic peripheral neuropathy (DPN) in a Saudi population. The study population consisted of 552 diabetic participants with an average age of 53.4 years. Among this population, 62.7% were male and 94.9% had type 2 diabetes. The average body mass index was 31.1 kg/m2. DPN was diagnosed based on a combination of reduced vibration perception measured by neurothesiometer and/or reduced light touch perception evaluated by the 10-g Semmes-Weinstein monofilament, as well as neurological symptoms. Information on socio-demographic variables, smoking status, duration of diabetes, and medications was obtained through interviews by physicians. Body weight, height, waist circumference, blood pressure and clinical markers were assessed following standard procedures. The prevalence of DPN in this population was 19.9% (95% CI, 16.7%-23.5%). In the multivariable analyses, longer duration of diabetes [odds ratio (OR) for every 5-year increase, 2.49, 95% CI, 1.75-3.53], abdominal obesity (OR, 2.53, 95% CI, 1.41-4.55), and higher levels of fasting blood glucose (OR for every 1 mmol/L increase, 1.05, 95% CI, 0.99-1.12), creatinine (OR for every 10 µmol/L increase, 1.07, 95% CI, 0.99-1.14) and white blood cell count (OR for every 106/L increase, 1.08, 95% CI, 1.01-1.16) were associated with higher odds of DPN, while oral hypoglycemic medication use was associated with a lower odds of DPN (OR, 0.47, 95% CI, 0.26-0.85). In this large Saudi population, several correlates for DPN, in addition to glycemic control and diabetes duration, were identified, including abdominal obesity, creatinine and white blood cell count.

Prevalence and Correlates of Lower-Extremity Amputation in Patients With Diabetic Foot Ulcer in Jeddah, Saudi Arabia:

This cross-sectional study investigated the prevalence and correlates of lower-extremity amputation (LEA) in a Saudi population with diabetic foot ulcer. The study population consisted of 91 participants, with a median age of 55.0 years. Biomarkers were measured following standard protocols. Local symptoms of foot ulcer, including peripheral neuropathy (PN), peripheral artery disease (PAD), and foot infection were diagnosed by standard objective diagnostic tools or diagnosed clinically by a specialized surgeon. The severity of foot ulcer was classified according to the Wagner wound classification system. The prevalence of LEA was 29.7% in this population. The odds ratio for LEA comparing extreme tertiles was 2.42 (95% confidence interval [CI] = 0.70-8.45; P for trend = .03) for ulcer size and 0.22 (95% CI = 0.06-0.87; P for trend = .03) for high-density lipoprotein cholesterol. C-reactive protein and homocysteine levels were each positively associated with odds of LEA, but the associations became nonsignificant in multivariable models. Participants with foot infection showed a significantly higher adjusted prevalence of LEA (40.7%, 95% CI = 27.1%-54.3%) compared with those without foot infections (19.3%, 95% CI = 6.0%-32.4%, P = .03). Participants with Wagner grade ≥3 presented a significantly higher prevalence (40.5%, 95% CI = 27.8%-53.2%) than those with Wagner grade of 1 or 2 (16.4%, 95% CI = 2.4%-30.5%, P = .02). Participants with PN and PAD showed nonsignificantly higher prevalence of LEA. We found a relatively high prevalence of LEA as well as several clinical markers and local symptoms associated with LEA in this Saudi population with diabetic foot ulcer.

Predictors of diabetes foot complications among patients with diabetes in Saudi Arabia

AIMS To identify risk factors and clinical biomarkers of prevalent diabetes foot complications, including foot ulcers, gangrene and amputations among patients with diabetes in Jeddah, Saudi Arabia. METHODS 598 diabetes patients from Jeddah participated in the current study. Patients were considered to have diabetes foot complications if they reported diagnosis of foot ulcers or gangrene or amputations in a questionnaire administered by a physician and confirmed by clinical exams. Information on socio-demographic and lifestyle variables was self-reported by patients, and several clinical markers were assessed following standard procedures. RESULTS The prevalence of diabetes foot complications in this population was 11.4%. In the multivariable model without adjustment for PAD (peripheral artery disease) and DPN (diabetes peripheral neuropathy), non-Saudi nationality, longer diabetes duration and insulin use was significantly associated with higher diabetes foot complications prevalence. Each 1g/L increase of hemoglobin was associated with 2.8% lower prevalence of diabetes foot complications. In the multivariable model adjusting for PAD and DPN, the previously observed associations except for nationality were no longer significant. Patients with both DPN and PAD had 9.73 times the odds of diabetes foot complications compared to the patients with neither condition. CONCLUSION In this population, longer diabetes duration, insulin use, lower hemoglobin levels and non-Saudi nationality were associated with higher prevalence of foot complications. These associations were largely explained by the presence of DPN and PAD except for non-Saudi nationality. Diabetes patients with both DPN and PAD had nearly 10-fold increased risk of foot complications than those with neither condition.

Risk factors for peripheral artery disease among patients with diabetes in Saudi Arabia.

Little is known about the risk factors for peripheral artery disease (PAD) among diabetic patients in Saudi Arabia. We therefore investigated the association of traditional and non-traditional PAD risk factors, as well as clinical markers, with the prevalence of PAD in 598 diabetic patients in Saudi Arabia. PAD was diagnosed as an ankle–brachial index (ABI) <0.9. Information on socio-demographic variables, smoking status, duration of diabetes, and medication were collected by questionnaire. Body weight, height, blood pressure and clinical markers were also measured. The prevalence of PAD in this population was 23.1%. Hypertension (OR (odds ratio) = 2.13, 95% CI: 1.29–3.52), obesity (OR=1.75, 95% CI: 1.13–2.73) and longer duration of diabetes (OR for ≥20 years vs 2–4 years = 3.30, 95% CI: 1.66–6.58) were independently and significantly associated with a higher prevalence of PAD. Participants with the highest quartile of fasting blood glucose and homocysteine levels had a 67% (OR=1.67, 95% CI: 0.89–3.31) and 78% (OR=1.78, 95% CI: 0.87–3.66) higher prevalence of PAD, respectively. Our study identified several important and largely modifiable risk factors for PAD in this Saudi population with diabetes. These findings underscored the importance of reducing cardiovascular risk factors in patients with diabetes.

Efficacy of shellac, a natural product, for the prevention of wet gangrene

Objective To determine the effects of applying a natural polymer solution (shellac) to dry gangrene, and thereby prevent infection and progression to wet gangrene, in diabetic patients. Methods This randomized, controlled, pilot study included patients with type 2 diabetes mellitus who had unreconstructable peripheral vascular disease and were awaiting autoamputation. Eligible patients were contraindicated for surgery, had a limited life expectancy and/or had refused surgical amputations. All patients received the best possible medical treatment and were randomized to receive either topical shellac or antiseptic application of 10% povidone-iodine (PVP-I) solution to gangrenous areas. Results A total of 26 diabetic patients were eligible for inclusion, of whom 23 completed the study: 13 were treated with shellac and 10 with PVP-I. The amputation rate was higher in the conventional treatment group versus the shellac group (60.0% versus 46.2%, respectively), although this difference was not statistically significant. Conclusions Shellac is a natural solution that may be used to embalm gangrenous tissue in selected diabetic patients. More studies are needed to assess the long-term outcomes of this technique.

Synergistic Effect of Honey and Thymus Ciliatus Against Pathogenic Bacteria

The emergence of pathogenic bacterial strains with resistance to commonly used antibiotics has necessitated a search for novel types of antibacterial agents. The main objective of this study was to investigate the antibacterial activi- ties of the powder of Thymus ciliatus and wild carrot honey when used jointly by the determination of MIC (Minimum In- hibitory Concentration) against three pathogenic bacteria, namely Staphylococcus aureus OxaR ATCC 43300, Es- cherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. The results indicate that the powder of thyme and honey are efficient against the tested strains. Honey MIC values were 10%, 14%, 10% (vol/vol), respectively whereas the MIC values of thyme powder were 0.4%, 2%, 9% (W/vol), respectively. When honey and thyme powder are used jointly, we noticed a decrease of the MIC values which is may be due to their synergistic effect. These preliminary results suggest that honey and thyme could be used together to manage superficial wounds and bacterial infections.

Diabetes-Related Lower Extremities Amputations in Saudi Arabia: The Magnitude of the Problem

BACKGROUND Data on diabetes-related lower extremities amputations in the Kingdom of Saudi Arabia (KSA) and perhaps in all of Middle East and North African (MENA) countries are limited, in view of the absence of national registries. METHODS This review aims to challenge media figures by review of data in the local database of the author, available published data, as well as by analysis of recent annual reports of the Saudi Ministry of Health to estimate the magnitude of the problem. Different methods of analysis are used based on the number of beds, operations and admissions in KSA to generate approximate figures of the annual expected numbers of amputations in KSA and MENA countries. The 2010 International Diabetes Federation IDF comparative prevalence rate of 16.8% was used to standardize the analysis methods. RESULTS Findings of 2 previous studies and 3 analytical methods led me to the prediction that about 325 amputations are likely to occur annually in Jeddah compared to 741 in Riyadh and 3970 in KSA. When we applied the results of KSA to those of MENA countries, 44208 amputations were predicted annually. CONCLUSION Half a million diabetes-related amputations of the lower extremities are likely to occur in KSA and MENA countries over the coming decade. National registries are urgently needed.