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Background Lynch syndrome (LS), the most common inherited form of colorectal cancer (CRC), is responsible for 3% of all cases of CRC. LS is caused by a mismatch repair gene defect and is characterized by a high risk for CRC, endometrial cancer and several other cancers. Identification of LS is of utmost importance because colonoscopic surveillance substantially improves a patient’s prognosis. Recently, a network of physicians in Middle Eastern and North African (ME/NA) countries was established to improve the identification and management of LS families. The aim of the present survey was to evaluate current healthcare for families with LS in this region. Methods A questionnaire was developed that addressed the following issues: availability of clinical management guidelines for LS; attention paid to family history of cancer; availability of genetic services for identification and diagnosis of LS; and assessment of knowledge of LS surveillance. Members of the network and authors of recent papers on LS from ME/NA and neighbouring countries were invited to participate in the survey and complete the online questionnaire. Results A total of 55 individuals were invited and 19 respondents from twelve countries including Algeria, Azerbaijan, Cyprus, Egypt, Iran, Jordan, Kuwait, Lebanon, Morocco, Palestine, Tunisia, and Turkey completed the questionnaire. The results showed that family history of CRC is considered in less than half of the surveyed countries. Guidelines for the management of LS are available in three out of twelve countries. The identification and selection of families for genetic testing were based on clinical criteria (Amsterdam criteria II or Revised Bethesda criteria) in most countries, and only one country performed universal screening. In most of the surveyed countries genetic services were available in few hospitals or only in a research setting. However, surveillance of LS families was offered in the majority of countries and most frequently consisted of regular colonoscopy. Conclusion The identification and management of LS in ME/NA countries are suboptimal and as a result most LS families in the region remain undetected. Future efforts should focus on increasing awareness of LS amongst both the general population and doctors, and on the improvement of the infrastructure in these countries.

With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Middle East and north Africa, where its prevalence is greater than that in the rest of the world. Despite the magnitude of the problem, no regional guidelines have been developed to address this disease. This Review describes suggestions of redefining fatty liver disease associated with metabolic dysfunction, including its terminology and criteria for diagnosis. Experts have raised serious concerns on the current nomenclature, which labels the disease as non-alcoholic fatty liver disease (NAFLD), and its diagnostic criteria. The panel reached a consensus that the disease should be renamed as metabolic-associated fatty liver disease (MAFLD) and that the disease should be diagnosed by positive criteria. The aim is now to work with authorities across the region to implement these proposed changes and reflect them in health-care policy and to improve health care for patients in this region.

Colorectal cancer (CRC) has a very high incidence in the western world. Data from registries in the Middle East showed that the incidence of CRC is relatively low in these countries. However, these data also showed that CRC incidence has increased substantially over the past three decades and that a high proportion of cases are diagnosed at an early age (< 50 years). In view of these findings, more attention should be paid to prevention. Because of the often limited financial resources, focused screening of individuals with hereditary CRC, in particular those with Lynch syndrome, appears to be the most cost-effective strategy. During recent meetings of the Palestinian Society of Gastroenterology and the Mediterranean Task force for Cancer Control (MTCC) in Jericho, and the Patient's Friends Society of Jerusalem in Hebron the issue of hereditary CRC in the Middle East was discussed and the idea was conceived to establish a network on hereditary colorectal cancer (HCCN-ME) with the goal of improving care for high-risk groups in the Middle East and (Eastern) Mediterranean Countries.

Background and Aims: CARD15/NOD2 is recognized as a major susceptibility gene for Crohn’s disease. Several mutations of CARD15/NOD2 have been reported in different racial groups. We aimed to investigate the frequency of three common CARD15/NOD2 mutations in a Jordanian Original Research Article Jadallah et al.; BJMMR, 7(2): 93-105, 2015; Article no.BJMMR.2015.312 94 Crohn’s disease cohort. Methodology: Fifty one unrelated Crohn’s disease patients and fifty one ageand sex-matched healthy controls were recruited at two hospitals in Jordan. Demographic and phenotypic characteristics of patients were ascertained. Allele frequencies for three CARD15/NOD2 mutations (G2722C, C2104T, 3020insC) were determined by PCR-RFLP, ARM-PCR, and direct sequencing using allele specific primers. Results: The frequencies of G2722C alleles in Crohn’s disease patients were higher but not statistically significant as compared to healthy controls (5.9% vs. 1.9%; P = 0.32). On the other hand, C2104T and 3020insC mutations have not been detected in Crohn’s disease patients or healthy controls. Conclusion: Our findings indicate that common mutations of CARD15/NOD2 gene in White patients with Crohn’s disease are not associated with Crohn’s disease in the Jordanian population. Further studies are needed to ascertain the effect of these and other mutations on Crohn’s disease susceptibility and behavior in our population.

WOS: 000426979400014, PubMed ID: 28404132, Background The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of-and expansion on-the 2014 analysis, which reported 80 million (95% CI 64-103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1.0% (95% uncertainty interval 0.8-1.1) in 2015, corresponding to 71.1 million (62.5-79.4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections., John C Martin Foundation, John C Martin Foundation.

Objective: To study the clinical, biochemical and virological long-term outcome in chronic hepatitis C patients with a Sustained Virological Response after Pegylated Interferon plus ribavirin combination therapy. Methods: Twenty eight patients with a Sustained Virological Response after treatment with Pegylated Interferon plus ribavirin were included in a 5-year follow-up study in a single Gastroenterology & Hepatology center, based on standard clinical practice. Clinical and ultrasonic evaluation, liver function tests, alpha-fetoprotein and hepatitis C virus RNA by PCR were performed annually for a period of 5 years. Results: The mean follow-up period of the 28 patients was 67 ± 4 months after they obtained a sustained virological response. Eleven patients (39.2%) presented with high fibrosis score (Metavir >3) before treatment. Seventeen patients (60.7%) had genotype 4, nine patients (32.1%) genotype 1, one patient genotype 2 and one patient genotype 3. One patient (3.5%) showed evidence of hepatic decompensation. One patient (3.5%) showed virological relapse after achieving sustained virological response. At the end of the 5-year follow-up there were no deaths, no elevation in liver function tests and no hepatocellular carcinoma. Conclusion: The long-term outcome of patients with sustained virological response to Pegylated Interferon plus ribavirin was maintained in 96.5% with one patient having virological relapse, indicating that Long term recurrence rate to combination therapy was very low.

Background Jordan lacks statistical data regarding prevalence of HCV. Aim To determine the prevalence of HCV in selected areas of Jordan (north, middle and south of Jordan). Methods A random sample of 700 patients attending health centers was used to determine HCV prevalence. ELISA testing was used to determine HCV-Ab positive cases, which were confirmed by PCR testing. Results and conclusion The study concluded that the prevalence of HCV infection in the population recruited from different health centers in Jordan is relatively low and estimates a prevalence of 0.42% among all age groups and 0.56% among those aged >15 years old.