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1. Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation: Position statement of the Saudi association for the study of liver diseases and transplantation

Author

Saleh A Alqahtani, Mazin Barry, Ziad Memish, Almoutaz Hashim, Mona A Alfares, Saad A Alghamdi, Waleed K Al-Hamoudi, Bandar Al-Judaibi, Waleed Alhazzani, Jaffar A Al-Tawfiq, and Faisal Abaalkhail

Subjects
cirrhosis, covid-19, liver disease, sars-cov-2, vaccine, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). Although several studies demonstrated the safety and efficacy of COVID-19 vaccines in the general population, data in CLD patients and liver transplant recipients are lacking. Two COVID-19 vaccines were approved by the Saudi Food and Drug Authority and rolled out to several million recipients in Saudi Arabia. These vaccines are mRNA-based vaccine BNT162b2 from Pfizer/BioNTech and adenovirus-based AZD1222 from Oxford/AstraZeneca from three manufacturing sites (EU Nodes, Serum Institute of India, and South Korea Bio). The Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has reviewed the available evidence and issued interim recommendations for COVID-19 vaccination in CLD and liver transplant recipients. Since there is no evidence contradicting the safety and immunogenicity of the currently approved COVID-19 vaccines in patients with CLD and hepatobiliary cancer and liver transplant recipients, the SASLT recommends vaccination in those patient populations. CLD and hepatobiliary cancer patients and liver transplant recipients should be prioritized depending on the risk factors for severe COVID-19. In transplant recipients, the optimal timing of vaccination remains unknown; however, immunization is recommended after the initial immunosuppression phase. Patients with CLD and liver transplant candidates or recipients should be closely monitored after COVID-19 vaccination. These patient populations should be included in future clinical trials to provide further evidence on the efficacy and safety of COVID-19 vaccines.

Published
2021
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2. Principles of Care for Patients with Liver Disease During the Coronavirus Disease 2019 (COVID-19) Pandemic: Position Statement of the Saudi Association for the Study of Liver Disease and Transplantation

Author

Saleh A. Alqahtani, Abdulrahman A. Aljumah, Almoutaz Hashim, Thamer H. Alenazi, Mohammed AlJawad, Waleed K. Al Hamoudi, and Mohammed Y. Alghamdi

Subjects
Medicine
Abstract

In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.

Published
2020
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3. A cross-sectional survey on the psychological impact of the COVID-19 pandemic on inflammatory bowel disease patients in Saudi Arabia

Author

Mahmoud Mosli, Mansour Alourfi, Amani Alamoudi, Almoutaz Hashim, Omar Saadah, Eman Al Sulais, Turki AlAmeel, Othman Alharbi, Shakir Bakari, Yaser Meeralam, Seigha Alshobai, Majid Alsahafi, Hani Jawa, and Yousif Qari

Subjects
anxiety, depression, inflammatory bowel disease, pandemic, coronavirus, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background/Aims: The coronavirus (COVID-19) pandemic has caused significant disruption to patients with chronic illnesses. We explored the emotional state, perception, and concerns of Saudi patients with inflammatory bowel disease (IBD) during the crisis. Materials and Methods: We conducted a cross-sectional survey from 30 March to 5 April, 2020 using a pre-designed questionnaire distributed through social media platforms to IBD patients. The five-part questionnaire included an assessment of psychological wellbeing using a previously validated Arabic version of the Hospital Anxiety and Depression Scale (HADS), which includes domains for anxiety (HADS-A) and depression (HADS-D). A logistic regression analysis was used to uncover possible associations between patient characteristics and anxiety and depression. Results: The data from 1156 IBD patients were analyzed. Normal, borderline, and HADS-A scores consistent with a diagnosis of anxiety were reported by 423 (36.6%), 174 (15.1%), and 559 (48.4%) patients, respectively. However, 635 (69%) patients had normal scores and 273 (30.1%) had borderline HADS-D scores; no patients reported scores consistent with depression. Based on a multiple logistic regression analysis, patients educated till a high school diploma (OR = 2.57, 95% CI: 0.09–6.05, P = 0.03) and that had indeterminate colitis (OR = 2.23, 95% CI: 1.27–3.89, P = 0.005) were more likely to express anxiety. Conclusions: Many patients expressed symptoms of anxiety, although not depression. Female patients, patients educated till a high school diploma, and those with indeterminate colitis were more likely to have anxiety. IBD patients require greater attention during a pandemic to avoid adverse disease-related outcomes.

Published
2020
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4. Predictors of the Third (Booster) Dose of COVID-19 Vaccine Intention among the Healthcare Workers in Saudi Arabia: An Online Cross-Sectional Survey

Author

Sami Alobaidi and Almoutaz Hashim

Subjects
predictors, COVID-19 vaccine, booster dose, healthcare workers, KSA, Medicine
Abstract

Objective: The COVID-19 pandemic is still continuing throughout the world, with newer genetic variants regularly appearing from different parts of the world. Considering the waning of immunity against COVID-19 infection even with two doses of the COVID-19 vaccine, regulatory authorities have authorised booster COVID-19 vaccination in many countries, especially for vulnerable populations, including healthcare workers. The current study analysed factors predicting the third (booster) dose of COVID-19 vaccine intention, including the health belief model (HBM), among the healthcare workers in Saudi Arabia. Methods: The current study was a cross-sectional online survey performed from 1st October 2021 to 30th November 2021, using a questionnaire prepared in GoogleTM form among healthcare workers in Saudi Arabia. The questionnaire asked demographic factors, COVID-19 experience of participants, subjective assessment of health, intention of COVID-19 booster dose vaccination, preferences for local/foreign-made vaccines, and health belief of the study population related to COVID-19 infection and COVID-19 booster dose. Results: This study received 2059 complete responses. The study population reported mixed health belief with respect to the susceptibility of COVID-19 infection, and higher health belief perception regarding the severity. The perceptions of the study participants regarding the benefits of COVID-19 booster dose were positive. There were few barriers to COVID-19 booster dose expressed by study participants. A total of 1464 (71.1%) study participants reported positive intent for receiving a COVID-19 booster dose. The study showed significant association between definite intention to receive a booster dose and nationality (p = 0.001), marital status (p = 0.017), gender (p < 0.001), education level (p = 0.001), monthly income (p < 0.001), and co-morbid medical illness (p = 0.045). The perception of the COVID-19 booster vaccine as a good idea to minimise worries about getting COVID-19 (OR = 2.28, CI 1.89–2.76), and perceptions that receiving the third (booster) dose reduces the risk of COVID-19 infection and associated complications (OR= 2.69, CI = 2.17–3.34), of the perceived benefit construct of HBM, predicted significantly higher definite intention to receive a booster dose. The concern with the safety of the vaccine (OR= 0.40, CI 0.34–0.47) under the perceived barriers construct of HBM predicted as significantly higher no definite intention to receive a booster dose. Conclusions: The results of the present study can guide policy makers in their efforts to promote booster doses of COVID-19 vaccination among the healthcare workers in Saudi Arabia.

Published
2022
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5. Efficacy of DAAs in the Treatment of Chronic HCV: Real-World Data from the Private Health-Care Sector of the Kingdom of Saudi Arabia

Author

Almoutaz Hashim, Fadia Almahdi, Emad Aldin Albaba, Ohoud Barkia, Reem Alkasam, Asmaa Almahmoud, Ahmed Nabil, Ayman Alsulaimani, and Mahmoud Mosli

Subjects
Hepatitis C virus, treatment, anti-viral, agents, direct acting, real world, Public aspects of medicine, RA1-1270
Abstract

Background and Aim: The hepatitis C virus (HCV) is considered a global health challenge that requires urgent interventions for prevention and control. In this study, we aimed to evaluate the effectiveness of direct-acting antiviral agents (DAAs) for HCV-infected patients in the Kingdom of Saudi Arabia (KSA). Patients and Methods: In this retrospective cohort study, we ascertained data of patients treated with DAA-based regimens for chronic HCV in the private health-care sector hospitals of KSA between April 2015 and December 2017. Data regarding presence or absence of liver cirrhosis, virus genotype, quantitative HCV RNA test, fibrosis stage, and history of liver disease were included. The primary end point of the study was the overall cure rate, defined as the number of patients achieving sustained viral response (SVR) rate at least 12 weeks following completion of treatment, divided by the total number of patients included in the study. Results: A total of 262 patients fulfilled the study inclusion criteria. Adult patients were enrolled, of which 114 (44%) were females and 148 (56%) were males. About 105 of the patients (40%) were cirrhotic and 156 were treatment-naïve patients (60%), 84 patients were interferon (INF) experienced, and 22 patients had previously received new DAAs but failed to achieve SVR. The majority of patients received ledipasvir–sofosbuvir±RBV (57%) with SVR rate of approximately 97%. Conclusions: Our local real-world data indicate an overall HCV cure rate of 97% following treatment with DDA#x2019;s when prescribed in the private sector. This estimate is acquiescence with previously reported global cure rates.

Published
2020
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6. Nonalcoholic fatty liver disease burden – Saudi Arabia and United Arab Emirates, 2017–2030

Author

Khalid Alswat, Abdulrahman A Aljumah, Faisal M Sanai, Faisal Abaalkhail, Mohamed Alghamdi, Waleed K Al Hamoudi, Abdullah Al Khathlan, Huda Al Quraishi, Ahmed Al Rifai, Mohamed Al Zaabi, Mohamed A Babatin, Chris Estes, Almoutaz Hashim, and Homie Razavi

Subjects
Burden of disease, cardiovascular disease, cirrhosis, decompensated cirrhosis, healthcare resource utilization, hepatocellular carcinoma, metabolic syndrome, nonalcoholic fatty liver, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, obesity, type 2 diabetes mellitus, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background/Aim: Due to epidemic levels of obesity and type 2 diabetes mellitus (DM), nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) will be driving factors in liver disease burden in the coming years in Saudi Arabia and United Arab Emirates (UAE). Materials and Methods: Models were used to estimate NAFLD and NASH disease progression, primarily based on changes in adult prevalence rates of adult obesity and DM. The published estimates and expert interviews were used to build and validate the model projections. Results: In both countries, the prevalence of NAFLD increased through 2030 parallel to projected increases in the prevalence of obesity and DM. By 2030, there were an estimated 12,534,000 NAFLD cases in Saudi Arabia and 372,000 cases in UAE. Increases in NASH cases were relatively greater than the NAFLD cases due to aging of the population and disease progression. Likewise, prevalent cases of compensated cirrhosis and advanced liver disease are projected to at least double by 2030, while annual incident liver deaths increase in both countries to 4800 deaths in Saudi Arabia and 140 deaths in UAE. Conclusions: Continued high rates of adult obesity and DM, in combination with aging populations, suggest that advanced liver disease and mortality attributable to NAFLD/NASH will increase across both countries. Reducing the growth of the NAFLD population, along with potential therapeutic options, will be needed to reduce liver disease burden.

Published
2018
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7. Liver Transplantation at KFSHRC: Achievement and Challenges

Author

Mohammed I. Al Sebayel, Faisal A. Abaalkhail, Hamad Al Bahili, Almoutaz Hashim Abdo, Hussein A. Elsiesy, Mohammed S. Al Sofayan, Yasser M. El Sheikh, Bassem S. Hegab, Yasser M. Kamel, Talal T. AlGoufi, Hazem H. Hasssan, Martin M. Burdelski, Mohammad A. Al Shagrani, Mohamed R. Abdelfattah, Khaled M. Attallah, Talat Z. Mahmood, Yahya Z. Saleh, Firas Zahr Eldeen, and Dieter C. Broering

Subjects
Medicine
Abstract

The liver transplantation program at KFSHRC has been active since 2001. More than 450 liver transplants have been performed so far. The program evolved from adult cadaveric transplant to living donor and recently to pediatric and split techniques. The 1-year survival of patients for both pediatric and adult exceeded 90% and the 5-year survival of patients is more than 80%. Associated with this success are challenges that include: organ shortage, quality of organ harvested, inability to meet the growing national need, increased demand of resource to meet the need of the program, and lack of a collaborative national strategy in organ donation and transplantation.

Published
2014
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8. Primary hepatic neuroendocrine tumour requiring live donor liver transplantation: case report and concise review

Author

Ananta Gurung, Eric M. Yoshida, Charles H. Scudamore, Almoutaz Hashim, Siegfried R. Erb, and Douglas L. Webber

Subjects
Neuroendocrine tumour, Liver transplantation, Live donor, Specialties of internal medicine, RC581-951
Abstract

Primary hepatic neuroendocrine tumours are rare tumours effecting relatively young patients. As metastatic neuroendocrine tumours to the liver are much more common, extensive investigations are crucial to exclude a primary tumour elsewhere. We report a case of a 27 year old woman who presented with fatigue, increased abdominal girth and feeling of early satiety and bloating. Extensive work up failed to show tumour at another primary site. Hepatic artery embolization showed no effect, so the patient underwent total hepatectomy and live-donor liver transplant. Grossly the tumour measured 27 cm. Microscopic examination showed bland, monomorphic cells growing in tubuloglandular and trabecular growth patterns. Cells were positive for neuroendocrine (synaptophysin, chromogranin, CD56) and epithelial markers (MOC31, CK7, CK19). Cytoplasmic dense neurosecretory vesicles were seen on ultrastructural examination. Based on the Ki-67 rate, mitotic count, lack of marked nuclear atypia and absence of necrosis, a diagnosis of primary neuroendocrine grade 2 was conferred.

Published
2012
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9. Spontaneous clearance of hepatitis C infection post-liver transplant: A rare but real phenomenon? A case report and review of the literature

Author

Maznar Haque, Almoutaz Hashim, Erica D. Greanya, Urs P. Steinbrecher, Siegfried R. Erb, and Eric M. Yoshida

Subjects
Hepatitis C infection, Spontaneous clearance, Liver transplantation, Specialties of internal medicine, RC581-951
Abstract

Recurrent hepatitis C virus (HCV) infection after liver transplantation is a significant cause of morbidity, mortality and graft loss. Spontaneous clearance of recurrent HCV after liver transplant is a rarely reported phenomenon. We report a case of a 66-year-old woman who underwent liver transplantation for HCV cirr-hosis (treatment-naive genotype 2) under immunosuppression with tacrolimus, mycophenolate mofetil (MMF), and short-term corticosteroids. The patient developed histologically proved severe cholestatic recurrence of HCV hepatitis. Immunosuppression was reduced to tacrolimus monotherapy because of cytopenia. She subsequently became RNA negative at week 44 post-transplant while on tacrolimus and MMF despite no antiviral therapy. A spontaneous sustained virologic clearance was confirmed with subsequent HCV nucleotide testing. Only a few similar cases have been reported in the literature with uninterrupted immunosuppression and subsequent spontaneous clearance. Our experience, and the few other published cases in the literature, suggests that spontaneous clearance of HCV after liver transplantation is a rare but real phenomenon. Better understanding of this phenomenon may help to manage recurrent HCV disease after transplantation.

Published
2010
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11. The Toronto Upper Gastrointestinal Cleaning Score: a prospective validation study

Author

Rishad Khan, Nikko Gimpaya, Jose I. Vargas, Anushka Ramkissoon, Samir Seleq, Reza Gholami, Hisham J. Akhtar, Rishi Bansal, Michael A. Scaffidi, Sunil Amin, Steven Bollipo, Jan Kral, Rashid Lui, Katarzyna M. Pawlak, Dalbir S. Sandhu, Mohammad Bilal, Enrique de-Madaria, Keith Siau, Aline Charabaty, Almoutaz Hashim, Sergio A. Sánchez-Luna, Christopher W. Teshima, Gary R. May, Jeffrey D. Mosko, Catharine M. Walsh, and Samir C. Grover

Subjects
Gastroenterology
Abstract

Background Assessment of mucosal visualization during esophagogastroduodenoscopy (EGD) can be improved with a standardized scoring system. To address this need, we created the Toronto Upper Gastrointestinal Cleaning Score (TUGCS). Methods We developed the TUGCS using Delphi methodology, whereby an international group of endoscopy experts iteratively rated their agreement with proposed TUGCS items and anchors on a 5-point Likert scale. After each Delphi round, we analyzed responses and refined the TUGCS using an 80 % agreement threshold for consensus. We used the intraclass correlation coefficient (ICC) to assess inter-rater and test–retest reliability. We assessed internal consistency with Cronbach’s alpha and item-total and inter-item correlations with Pearson’s correlation coefficient. We compared TUGCS ratings with an independent endoscopist’s global rating of mucosal visualization using Spearman’s ρ. Results We achieved consensus with 14 invited participants after three Delphi rounds. Inter-rater reliability was high at 0.79 (95 %CI 0.64–0.88). Test–retest reliability was excellent at 0.83 (95 %CI 0.77–0.87). Cronbach’s α was 0.81, item-total correlation range was 0.52–0.70, and inter-item correlation range was 0.38–0.74. There was a positive correlation between TUGCS ratings and a global rating of visualization (r = 0.41, P = 0.002). TUGCS ratings for EGDs with global ratings of excellent were significantly higher than those for EGDs with global ratings of fair (P = 0.01). Conclusion The TUGCS had strong evidence of validity in the clinical setting. The international group of assessors, broad variety of EGD indications, and minimal assessor training improves the potential for dissemination.

Published
2022
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12. Enteral Nutrition Prescription in Children and Adults with Inflammatory Bowel Diseases: Gaps in Current Gastroenterology Practice in Saudi Arabia

Author

Sarah M. Ajabnoor, Atheer Attar, Noof BinJahlan, Nawal Almutairi, Shimaa Bashmail, Almoutaz Hashim, Alastair Forbes, and Hani Jawa

Subjects
Nutrition and Dietetics, inflammatory bowel disease, enteral nutrition, exclusive, gastroenterologist, practice, Crohn’s disease, Food Science
Abstract

Background: Evidence for the effectiveness of enteral nutrition (EN) for the management of patients with inflammatory bowel disease (IBD) is well-established. However, there is considerable global variation in EN practices. This study aimed to characterize the practices and perceptions of gastroenterologists regarding the use of EN in patients with IBD in one of the largest countries in the Gulf region. Methods: A cross-sectional study was conducted on pediatric and adult gastroenterologists working in Saudi Arabia who are involved in IBD management. A self-administered web-based survey was distributed via social media platforms and mailing lists of national gastroenterology societies. Results: A total of 80 gastroenterologists completed the survey. However, only 55 reported that they were currently practicing EN in any form. EN was mostly indicated by gastroenterologists who “sometimes” recommend EN for: the prevention and correction of undernutrition (50.9%), preoperative optimization (50.9%), and the induction of remission in patients with active and long-standing CD (36.4%), at initial diagnosis (34.5%), during the management of complications (61.8%), and after failing to respond to pharmacological therapy (58.2%). Exclusive enteral nutrition (EEN) is regularly recommended by 14.5% of gastroenterologists. The prescription of EEN was significantly associated with the pediatric profession (p < 0.01), IBD specialty (p < 0.05), level of nutrition education during training (p < 0.01), and previous training in a unit with regular EN use (p < 0.01). The most reported barriers to using EN were patients’ lack of acceptance (73.8%) and poor adherence (65%). A lack of dietitian support and a lack of standardized protocols were also reported as barriers by many physicians. Pediatric gastroenterologists were more likely to use at least one assessment method to evaluate EN success. Conclusion: EN practices differ between gastroenterologists working in Saudi Arabia. Future EN protocols should be optimized to support both children and adults with IBD. Gastroenterology training programs should offer nutrition support-focused training to help physicians better utilize EN.

Published
2022

13. Gulf Cooperation Council states: On the brink of HBV elimination

Author

Mohamed Farghaly, Faisal M. Sanai, Almoutaz Hashim, Sameer Al-Awadhi, Jeffrey V. Lazarus, Saleh A. Alqahtani, and Henry E. Mark

Subjects
Hepatitis B virus, medicine.medical_specialty, Middle East, Hepatology, Public health, Political science, medicine, Humans, Stigma (botany), medicine.disease_cause, Socioeconomics, Healthcare system
Published
2021
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14. The NAFLD‐MAFLD debate: Eminence vs evidence

Author

Ebada Said, Dina Attia, Shamardan Ezzeldin S. Bazeed, Medhat Elsahhar, Yasser Fouad, Ahmed A. Gomaa, Enas M Kamal, Reda Elwakil, Almoutaz Hashim, and Mai Mehrez

Subjects
Hepatology, Fatty liver, Gastroenterology, Non alcoholic, Disease, Cognitive reframing, Viewpoints, medicine.disease, Epistemology, 03 medical and health sciences, 0302 clinical medicine, Critical thinking, Non-alcoholic Fatty Liver Disease, 030220 oncology & carcinogenesis, medicine, Humans, 030211 gastroenterology & hepatology, Psychology
Abstract

Debates are inevitable in science and could be a powerful tool for addressing controversial topics as it promotes critical thinking and inspires individuals to consider alternate viewpoints. However, debates can help only to identify the issues that need to be clarified to address this question, but it can never help resolve the controversy itself. In the era of evidence-based medicine, the need for an evidence-based debate is mandatory. Polarising opinions and major debate have recently arisen in hepatology on the nomenclature and diagnostic criteria for fatty liver disease associated with metabolic dysfunction (non alcoholic fatty liver disease [NAFLD]-metabolic (dysfunction) associated fatty liver disease [MAFLD] debate). The aim of this viewpoint is to suggest a way to settle the debate through evidence. Descriptive review using PubMed to identify literature on the evidence and eminence-based medicine and studies comparing MAFLD and NAFLD criteria. The emerging studies comparing the performance of diagnostic criteria of NAFLD and MAFLD represent the dawn of a new era for reframing the ongoing debate by acquisition of the mandatory evidence that will both resolve the debate and lead to novel avenues of research. In conclusion, the time has come to hold debate and focus on gathering and building the evidence to settle it. It does not matter who wins the debate and once there is robust evidence, we should all follow it wherever it leads.

Published
2020
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15. Principles of Care for Patients with Liver Disease During the Coronavirus Disease 2019 (COVID-19) Pandemic: Position Statement of the Saudi Association for the Study of Liver Disease and Transplantation

Author

Mohammed AlJawad, Abdulrahman Aljumah, Waleed Al Hamoudi, Thamer H. Alenazi, Saleh A. Alqahtani, Almoutaz Hashim, and Mohammed Y. Alghamdi

Subjects
Liver Cirrhosis, medicine.medical_treatment, Biopsy, lcsh:Medicine, Disease, Comorbidity, Liver transplantation, Chronic liver disease, medicine.disease_cause, Lopinavir, Liver disease, 0302 clinical medicine, Adrenal Cortex Hormones, Non-alcoholic Fatty Liver Disease, Special Communication, Pandemic, Drug Interactions, 030212 general & internal medicine, Enzyme Inhibitors, Coronavirus, Ultrasonography, Sulfonamides, Alanine, Liver Diseases, Liver Neoplasms, General Medicine, Drug Combinations, Hepatitis, Autoimmune, Pyrazines, 030211 gastroenterology & hepatology, Coronavirus Infections, Immunosuppressive Agents, Hydroxychloroquine, medicine.medical_specialty, Carcinoma, Hepatocellular, Hepatitis, Viral, Human, Pneumonia, Viral, Saudi Arabia, Antiviral Agents, 03 medical and health sciences, Betacoronavirus, medicine, Humans, Janus Kinase Inhibitors, Intensive care medicine, Pandemics, Ritonavir, business.industry, SARS-CoV-2, lcsh:R, COVID-19, medicine.disease, Amides, Adenosine Monophosphate, Liver Transplantation, COVID-19 Drug Treatment, Transplantation, Purines, Azetidines, Pyrazoles, business
Abstract

In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.

Published
2020

16. The Impact of the Pharmaceutical Care Management Model of Hepatitis C Medications on the Cost at Health Insurance Level

Author

Reem J. Alkasam, Emad Aldin M. Albaba, Mahmoud Mosli, Almoutaz Hashim, Fadia B. Almahdi, Ayman F. Alsulaimani, and Ohoud N. Salih

Subjects
Adult, Male, medicine.medical_specialty, Economics, Econometrics and Finance (miscellaneous), Saudi Arabia, Specialty, Antiviral Agents, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Surveys and Questionnaires, Intervention (counseling), Health care, medicine, Humans, 030212 general & internal medicine, Prior authorization, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Retrospective Studies, Insurance, Health, business.industry, 030503 health policy & services, Health Policy, Disease Management, Health Care Costs, Hepatitis C, Middle Aged, medicine.disease, Confidence interval, Pharmaceutical care, Pharmaceutical Services, Emergency medicine, Female, 0305 other medical science, business
Abstract

Objective The aim of this study is to evaluate the impact of adopting a pharmaceutical care model on clinical outcomes, patient satisfaction, and cost at a health payer level. Methods All patients with hepatitis C virus (HCV) who were insured by Bupa Arabia, with a direct-acting antivirals prior authorization drug request between April 2015 and October 2018 were included in this retrospective quasi-experimental study. The clinical outcome was the achievement of a sustained virologic response at least 12 weeks from end of treatment. Economic and patients’ satisfaction outcomes were included in this study. The differences in cost of treatment was analyzed by using the paired t test. Stata statistical software package (StataCorp, College Station, TX) was used for data analysis. Results A total of 371 patients were enrolled in this program of which 74% (n = 273) required clinical intervention. Among those, HCV treatment was modified for 64%. The overall cure rate was 97% among 267 patients for which sustained virologic responses were available. The results of the paired t test show that there was a 38% reduction in the mean direct cost of medications before and after intervention (95% confidence interval, 33%-43%; P Conclusions A structured pharmaceutical care program for HCV patients can guide the use of specialty medications to achieve optimal clinical outcomes, with lower expenditures and high patients’ satisfaction. We can conclude that healthcare insurance can play a key role in managing specialty pharmaceuticals like HCV medications. Because this is a preliminary study, further studies are needed in an experimental design to strengthen the evidence behind the effectiveness of such a program.

Published
2020
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17. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. 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Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. 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A, Derbala, M, Desalegn, H, Desbois-Mouthon, C, Desoky, M, Dev, A, Di Ciaula, A, Diago, M, Diallo, I, Diaz, L, Dirchwolf, M, Dongiovanni, P, Dorofeyev, A, Dou, X, Douglas, M, Doulberis, M, Dovia, C, Doyle, A, Dragojevic, I, Drenth, J, Duan, X, Dulskas, A, Dumitrascu, D, Duncan, O, Dusabejambo, V, Dwawhi, R, Eiketsu, S, El Amrousy, D, El Deeb, A, El Deriny, G, El Din, H, El Kamshishy, S, El Kassas, M, El Raziky, M, Elagamy, O, Elakel, W, Elalfy, D, Elaraby, H, Elawady, H, Elbadawy, R, Eldash, H, Eldefrawy, M, Elecharri, C, Elfaramawy, A, Elfatih, M, Elfiky, M, Elgamsy, M, Elgendy, M, El-Guindi, M, Elhussieny, N, Eliwa, A, Elkabbany, Z, El-Khayat, H, El-Koofy, N, Elmetwalli, A, Elrabat, A, El-Raey, F, Elrashdy, F, Elsahhar, M, Elsaid, E, Elsayed, S, Elsayed, H, Elsayed, A, El-Serafy, M, Elsharkawy, A, Elsheemy, R, Elshemy, E, Elsherbini, S, Eltoukhy, N, Elwakil, R, Emad, O, Emad, S, Embabi, M, Ergenc, I, Ermolova, T, Esmat, G, Esmat, D, Estupinan, E, Ettair, S, Eugen, T, Ezz-Eldin, M, Falcon, L, Fan, Y, Fandari, S, Farag, M, Farahat, T, Fares, E, Fares, M, Fassio, E, Fathy, H, Fathy, D, Fathy, W, Fayed, S, Feng, D, Feng, G, Fernandez-Bermejo, M, Ferreira, C, Ferrer, J, Forbes, A, Fouad, R, Fouad, H, Frisch, T, Fujii, H, Fukunaga, S, Fukunishi, S, Fulya, H, Furuhashi, M, Gaber, Y, Galang, A, Gallardo, J, Galloso, R, Gamal, M, Gamal, R, Gamal, H, Gan, J, Ganbold, A, Gao, X, Garas, G, Garba, T, Garcia-Cortes, M, Garcia-Monzon, C, Garcia-Samaniego, J, Gastaldelli, A, Gatica, M, Gatley, E, Gegeshidze, T, Geng, B, Ghazinyan, H, Ghoneem, S, Giacomelli, L, Giannelli, G, Giannini, E, Giefer, M, Gines, P, Girala, M, Giraudi, P, Goh, G, Gomaa, A, Gong, B, Gonzales, D, Gonzalez, H, Gonzalez-Huezo, M, Graupera, I, Grgurevic, I, Gronbaek, H, Gu, X, Guan, L, Gueye, I, Guingane, A, Gul, O, Gul, C, Guo, Q, Gupta, P, Gurakar, A, Gutierrez, J, Habib, G, Hafez, A, Hagman, E, Halawa, E, Hamdy, O, Hamed, A, Hamed, D, Hamid, S, Hamoudi, W, Han, Y, Haridy, J, Haridy, H, Harris, D, Hart, M, Hasan, F, Hashim, A, Hassan, I, Hassan, A, Hassan, E, Hassan, M, Hassanin, F, Hassnine, A, Haukeland, J, Hawal, A, He, J, He, Q, He, Y, He, F, Hegazy, M, Hegazy, A, Henegil, O, Hernandez, N, Hernandez-Guerra, M, Higuera-de-la-Tijera, F, Hindy, I, Hirota, K, Ho, L, Hodge, A, Hosny, M, Hou, X, Huang, J, Huang, Y, Huang, Z, Huang, A, Huang, X, Hui-ping, S, Hunyady, B, Hussein, M, Hussein, O, Hussien, S, Ibanez-Samaniego, L, Ibdah, J, Ibrahim, L, Ibrahim, M, Ibrahim, I, Icaza-Chavez, M, Idelbi, S, Idilman, R, Ikeda, M, Indolfi, G, Invernizzi, F, Irshad, I, Isa, H, Iskandar, N, Ismaiel, A, Ismail, M, Ismail, Z, Ismail, F, Iwamoto, H, Jack, K, Jacob, R, Jafarov, F, Jafri, W, Jahshan, H, Jalal, P, Jancoriene, L, Janicko, M, Jayasena, H, Jefferies, M, Jha, V, Ji, F, Ji, Y, Jia, J, Jiang, C, Jiang, N, Jiang, Z, Jin, X, Jin, Y, Jing, X, Jingyu, Q, Jinjolava, M, Jong, F, Jucov, A, Julius, I, Kaddah, M, Kamada, Y, Kamal, A, Kamal, E, Kamel, A, Kao, J, Karin, M, Karlas, T, Kashwaa, M, Katsidzira, L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022
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18. DEVELOPMENT AND VALIDATION OF THE TORONTO UPPER GASTROINTESTINAL CLEANING SCORE

Author

Nikko Gimpaya, Rishad Khan, Sam Seleq, Jose Ignacio Vargas Dominguez, Anushka Ramkissoon, Reza Gholami, Sunil Amin, Mohammad Bilal, Steven J. Bollipo, Aline Charabaty, Enrique de-Madaria, Almoutaz Hashim, Jan Král, Katarzyna M. Pawlak, Dalbir S. Sandhu, Rashid Lui, Sergio A. Sánchez-Luna, Keith Siau, Jeffrey D. Mosko, and Samir C. Grover

Subjects
Gastroenterology, Radiology, Nuclear Medicine and imaging
Published
2022
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19. Efficacy of DAAs in the Treatment of Chronic HCV: Real-World Data from the Private Health-Care Sector of the Kingdom of Saudi Arabia

Author

Asmaa Almahmoud, Ohoud Barkia, Emad Aldin M. Albaba, Ayman F. Alsulaimani, Mahmoud Mosli, Ahmed Nabil, Reem J. Alkasam, Almoutaz Hashim, and Fadia B. Almahdi

Subjects
anti-viral, Adult, Male, medicine.medical_specialty, Cirrhosis, 030309 nutrition & dietetics, Hepatitis C virus, Psychological intervention, Saudi Arabia, Health Care Sector, medicine.disease_cause, Antiviral Agents, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, Health care, Global health, Clinical endpoint, Medicine, Humans, 030212 general & internal medicine, Retrospective Studies, 0303 health sciences, treatment, business.industry, lcsh:Public aspects of medicine, real world, Retrospective cohort study, lcsh:RA1-1270, Hepatitis C, Chronic, medicine.disease, agents, direct acting, Treatment Outcome, Female, Private Sector, business, Research Article
Abstract

Background and aim The hepatitis C virus (HCV) is considered a global health challenge that requires urgent interventions for prevention and control. In this study, we aimed to evaluate the effectiveness of direct-acting antiviral agents (DAAs) for HCV-infected patients in the Kingdom of Saudi Arabia (KSA). Patients and methods In this retrospective cohort study, we ascertained data of patients treated with DAA-based regimens for chronic HCV in the private health-care sector hospitals of KSA between April 2015 and December 2017. Data regarding presence or absence of liver cirrhosis, virus genotype, quantitative HCV RNA test, fibrosis stage, and history of liver disease were included. The primary end point of the study was the overall cure rate, defined as the number of patients achieving sustained viral response (SVR) rate at least 12 weeks following completion of treatment, divided by the total number of patients included in the study. Results A total of 262 patients fulfilled the study inclusion criteria. Adult patients were enrolled, of which 114 (44%) were females and 148 (56%) were males. About 105 of the patients (40%) were cirrhotic and 156 were treatment-naive patients (60%), 84 patients were interferon (INF) experienced, and 22 patients had previously received new DAAs but failed to achieve SVR. The majority of patients received ledipasvir-sofosbuvir±RBV (57%) with SVR rate of approximately 97%. Conclusions Our local real-world data indicate an overall HCV cure rate of 97% following treatment with DDA#x2019;s when prescribed in the private sector. This estimate is acquiescence with previously reported global cure rates.

Published
2020

20. Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation: Position statement of the Saudi association for the study of liver diseases and transplantation

Author

Bandar Al-Judaibi, Saad Alghamdi, Waleed Alhazzani, Mona A Alfares, Mazin Barry, Ziad A. Memish, Saleh A. Alqahtani, Faisal Abaalkhail, Jaffar A. Al-Tawfiq, Almoutaz Hashim, and Waleed Al-Hamoudi

Subjects
medicine.medical_specialty, Cirrhosis, COVID-19 Vaccines, medicine.medical_treatment, Population, Saudi Arabia, RC799-869, Liver transplantation, Chronic liver disease, Liver disease, Internal medicine, ChAdOx1 nCoV-19, Special Communication, vaccine, medicine, Humans, education, BNT162 Vaccine, education.field_of_study, business.industry, SARS-CoV-2, Liver Diseases, Gastroenterology, COVID-19, Immunosuppression, Diseases of the digestive system. Gastroenterology, medicine.disease, Liver Transplantation, Vaccination, Transplantation, business, liver disease
Abstract

Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). Although several studies demonstrated the safety and efficacy of COVID-19 vaccines in the general population, data in CLD patients and liver transplant recipients are lacking. Two COVID-19 vaccines were approved by the Saudi Food and Drug Authority and rolled out to several million recipients in Saudi Arabia. These vaccines are mRNA-based vaccine BNT162b2 from Pfizer/BioNTech and adenovirus-based AZD1222 from Oxford/AstraZeneca from three manufacturing sites (EU Nodes, Serum Institute of India, and South Korea Bio). The Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has reviewed the available evidence and issued interim recommendations for COVID-19 vaccination in CLD and liver transplant recipients. Since there is no evidence contradicting the safety and immunogenicity of the currently approved COVID-19 vaccines in patients with CLD and hepatobiliary cancer and liver transplant recipients, the SASLT recommends vaccination in those patient populations. CLD and hepatobiliary cancer patients and liver transplant recipients should be prioritized depending on the risk factors for severe COVID-19. In transplant recipients, the optimal timing of vaccination remains unknown; however, immunization is recommended after the initial immunosuppression phase. Patients with CLD and liver transplant candidates or recipients should be closely monitored after COVID-19 vaccination. These patient populations should be included in future clinical trials to provide further evidence on the efficacy and safety of COVID-19 vaccines.

Published
2021

21. Treatment of Hepatitis C with Glecaprevir/Pibrentasvir in a Patient with Concurrent Stricturing Crohn’s Disease on Adalimumab

Author

Almoutaz Hashim

Subjects
medicine.medical_specialty, Crohn's disease, business.industry, Internal medicine, Adalimumab, Medicine, Hepatitis C, Glecaprevir / pibrentasvir, business, medicine.disease, Gastroenterology, digestive system diseases, medicine.drug
Abstract

A 22-year-old male with long standing, active Crohn’s disease on Adalimumab had presented with increasing levels of his transaminases. A full workup was conducted and the patient was found to have hepatitis C (HCV) based on a positive HCV antibody, polymerase chain reaction (PCR) and genotyping. He was started on a regimen of Glecaprevir/Pibrentasvir with excellent response defined by complete normalization of his transaminitis and an undetectable PCR at the end of 8 weeks of treatment and achieved sustained viral response at 12 weeks of treatment. This is the first case reporting the use of a combination of Glecaprevir/Pibrentasvir and Adalimumab in a patient with HCV and Crohn’s disease. Key words: Hepatitis C, Glecaprevir/Pibrentasvir, Crohn’s Disease

Published
2021
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22. S550 Development of the Toronto Upper Gastrointestinal Cleaning Score: A Delphi Study

Author

Jose Ignacio Vargas Dominguez, Rishad Khan, Sunil Amin, Rashid N. Lui, Keith Siau, Nikko Gimpaya, Samir C. Grover, Enrique de-Madaria, Mohammad Bilal, Jan Kral, Jeffrey D. Mosko, Sergio A. Sánchez-Luna, Aline Charabaty, Almoutaz Hashim, Katarzyna M. Pawlak, Steven Bollipo, and Dalbir S. Sandhu

Subjects
medicine.medical_specialty, Hepatology, business.industry, Family medicine, Gastroenterology, Delphi method, medicine, Upper gastrointestinal, business
Published
2021
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23. The Positive Impact of Weight Management on Liver Cirrhosis

Author

Almoutaz Hashim and Heba Abdulkarim Sanousi

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Cirrhosis, business.industry, 030220 oncology & carcinogenesis, Internal medicine, Weight management, medicine, 030211 gastroenterology & hepatology, medicine.disease, business, Gastroenterology
Abstract

Weight management offers patients with liver cirrhosis significant health benefits. This case study describes the treatment of liver cirrhosis through dietary interventions. A 48-year-old male presented at Doctor Soliman Fakeeh Hospital in Saudi Arabia, Jeddah. The patient was suffering from morbid obesity (BMI= 43.76 kg/m2), non-alcoholic steatohepatitis, and chronic hepatitis B viral infection. Sleeve gastrectomy surgery was not possible due to the patient having liver fibrosis (stage 4). Alternatively, he was offered a healthy lifestyle intervention involving advisement regarding dietary habits and the initiation of a regular exercise routine. FibroScan was repeated seven months after the dietary intervention, where it was observed that the liver fibrosis improved from stage 4 to stage 3 post-treatment. Additionally, the patient lost almost 29% of his original body weight. In this case, weight management through following a healthy, balanced diet and increasing physical activity for one year produced remarkable improvement in the patient's liver cirrhosis related to non-alcoholic steatohepatitis.

Published
2021
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24. The Effect of Male Physicians’ Outfits on the General Population's Perception in Saudi Arabia

Author

Bashair M Magadmi, Yaroub Alganass, Almoutaz Hashim, Mohammed Basheikh, Ahmed Basheikh, Mazen Basheikh, and Murad A Yasawy

Subjects
medicine.medical_specialty, media_common.quotation_subject, Population, education, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, attire, Medical advice, Perception, Dress code, saudi arabia, Medicine, western tie, Social media, white coat, media_common, education.field_of_study, physician, business.industry, White coat, General Engineering, dress code, Clothing, Quality Improvement, Family medicine, traditional, Nationality, western business suit, Public Health, business, 030217 neurology & neurosurgery, Family/General Practice
Abstract

Overview Successful medical care depends on the trust developed between a physician and his patient. Professionally dressed doctors are likely to achieve a higher level of trust from their patients than those with a non-professional appearance.For many years, the physician’s famous white coat has been the standard professional wear around the world. Few studies in Saudi Arabia have been conducted to analyze what kind of physician outfits patients prefer and whether the choice of attire affects the patient’s level of trust. These studies were either done in a single health institute, or in few primary healthcare clinics in one city. This study aims to analyze whether the type of clothing worn by a physician improves the level of trust between a patient and a doctor. Participants were asked about different styles of clothing, including Western business attire, traditional Saudi outfits, and surgical scrubs, and whether wearing the white coat was preferred. Moreover, we sought to establish if differences in age, gender, nationality, or educational background affected the responses. Methods This cross-sectional study was carried out in August and September 2018. Participants living in Saudi Arabia anonymously filled out an electronic questionnaire, distributed by social media, which measured the effect of male physicians’ outfits on the general population's perception in Saudi Arabia. Participants were shown photographs of possible dress styles for physicians. Data were collected on the participants’ demographics, their most and least preferred doctor’s outfits, and the effect of the physician’s attire on their level of trust. Results A total of 8231 participants were included in the survey: 53% males, 87.9% with university-level education or higher, and 93.5% of Saudi nationality; 76.1% of the participants responded “yes” saying that the outfit would have an effect on how a patient might receive medical advice and follow the doctor’s recommendations. The most preferred outfits chosen by the participants were surgical scrubs with a white coat (39.3%), followed by a Western shirt and tie with a white coat (30.3%). The least preferred outfit was the full (traditional) Saudi outfit with a white coat (25.4%), followed by a Western business suit without a white coat (23.2%). The choices of most and least preferred attire were found to be impacted by different demographic factors, such as age, gender, and nationality, but not the educational background. Conclusion Physicians practicing in Saudi Arabia should note that their attire will earn the patient’s trust and encourage compliance with advice or treatment. The most preferred outfits were surgical scrubs with a white coat and a Western shirt and tie worn with a white coat, whereas the least preferred ones were the traditional Saudi thobe, with and without shemagh or ghutra, and the Western business suit without a white coat.

Published
2020

25. COVID-19 and Canadian Gastroenterology Trainees

Author

Michael A Scaffidi, Almoutaz Hashim, Keith Siau, Catharine M. Walsh, Michał Żorniak, Sergio A. Sánchez-Luna, Katarzyna M. Pawlak, Mohammad Bilal, Andrés F. Rodríguez-Parra, Samir C. Grover, Aline Charabaty, Sunil Amin, Jan Kral, Enrique de-Madaria, Steven Bollipo, Dalbir S. Sandhu, Parul Tandon, Rashid N. Lui, Kirles Bishay, and Rishad Khan

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, COVID-19, Endoscopy, Burnout, medicine.disease, Gastroenterology, Education, Competence (law), 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Pandemic, Medicine, Anxiety, Original Article, 030211 gastroenterology & hepatology, 030212 general & internal medicine, Upper gastrointestinal bleeding, medicine.symptom, business, Personal protective equipment, AcademicSubjects/MED00260
Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has impacted endoscopy services and education worldwide. This study aimed to characterize the impact of COVID-19 on gastroenterology trainees in Canada. Methods An analysis of Canadian respondents from the international EndoTrain survey, open from April 11 to May 2 2020 and distributed by program directors, trainees, and national and international gastroenterology societies’ representatives, was completed. The survey included questions on monthly endoscopy volume, personal protective equipment availability, trainee well-being and educational resources. The primary outcome was change in procedural volume during the COVID-19 pandemic. Secondary outcomes included trainee’s professional and personal concerns, anxiety and burnout. Results Thirty-four Canadian trainees completed the survey. Per month, participants completed a median of 30 esophagogastroduodenoscopies (interquartile range 16 to 50) prior to the pandemic compared to 2 (0 to 10) during the pandemic, 20 (8 to 30) compared to 2 (0 to 5) colonoscopies and 3 (1 to 10) compared to 0 (0 to 3) upper gastrointestinal bleeding procedures. There was a significant decrease in procedural volumes between the pre-COVID-19 and COVID-19 time periods for all procedures (P < 0.001). Thirty (88%) trainees were concerned about personal COVID-19 exposure, 32 (94%) were concerned about achieving and/or maintaining clinical competence and 24 (71%) were concerned about prolongation of training time due to the pandemic. Twenty-six (79%) respondents experienced some degree of anxiety, and 10 (31%) experienced some degree of burnout. Conclusion The COVID-19 pandemic has substantially impacted gastroenterology trainees in Canada. As the pandemic eases, it important for gastrointestinal programs to adapt to maximize resident learning, maintain effective clinical care and ensure development of endoscopic competence.

Published
2020
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26. A cross-sectional survey on the psychological impact of the COVID-19 pandemic on inflammatory bowel disease patients in Saudi Arabia

Author

Almoutaz Hashim, Shakir Bakari, Majid Alsahafi, Turki AlAmeel, Yousif Qari, Mahmoud Mosli, Yaser Meeralam, Omar I. Saadah, Eman Al Sulais, Amani Alamoudi, Hani Jawa, Mansour Alourfi, Othman Alharbi, and Seigha Alshobai

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Cross-sectional study, Pneumonia, Viral, Saudi Arabia, coronavirus, Anxiety, Hospital Anxiety and Depression Scale, Logistic regression, Inflammatory bowel disease, 03 medical and health sciences, Betacoronavirus, Young Adult, 0302 clinical medicine, inflammatory bowel disease, Internal medicine, Surveys and Questionnaires, medicine, Humans, Young adult, lcsh:RC799-869, Pandemics, Depression (differential diagnoses), business.industry, SARS-CoV-2, Incidence (epidemiology), Incidence, pandemic, Gastroenterology, COVID-19, medicine.disease, Inflammatory Bowel Diseases, Cross-Sectional Studies, 030220 oncology & carcinogenesis, depression, 030211 gastroenterology & hepatology, lcsh:Diseases of the digestive system. Gastroenterology, Female, Original Article, medicine.symptom, business, Coronavirus Infections
Abstract

Background/Aims: The coronavirus (COVID-19) pandemic has caused significant disruption to patients with chronic illnesses. We explored the emotional state, perception, and concerns of Saudi patients with inflammatory bowel disease (IBD) during the crisis. Materials and Methods: We conducted a cross-sectional survey from 30 March to 5 April, 2020 using a pre-designed questionnaire distributed through social media platforms to IBD patients. The five-part questionnaire included an assessment of psychological wellbeing using a previously validated Arabic version of the Hospital Anxiety and Depression Scale (HADS), which includes domains for anxiety (HADS-A) and depression (HADS-D). A logistic regression analysis was used to uncover possible associations between patient characteristics and anxiety and depression. Results: The data from 1156 IBD patients were analyzed. Normal, borderline, and HADS-A scores consistent with a diagnosis of anxiety were reported by 423 (36.6%), 174 (15.1%), and 559 (48.4%) patients, respectively. However, 635 (69%) patients had normal scores and 273 (30.1%) had borderline HADS-D scores; no patients reported scores consistent with depression. Based on a multiple logistic regression analysis, patients educated till a high school diploma (OR = 2.57, 95% CI: 0.09–6.05, P = 0.03) and that had indeterminate colitis (OR = 2.23, 95% CI: 1.27–3.89, P = 0.005) were more likely to express anxiety. Conclusions: Many patients expressed symptoms of anxiety, although not depression. Female patients, patients educated till a high school diploma, and those with indeterminate colitis were more likely to have anxiety. IBD patients require greater attention during a pandemic to avoid adverse disease-related outcomes.

Published
2020

27. Impact of COVID-19 on endoscopy trainees: an international survey

Author

Rashid N. Lui, Rishad Khan, Aline Charabaty, Sergio A. Sánchez-Luna, Enrique de-Madaria, Michał Żorniak, Mohammad Bilal, Andrés F. Rodríguez-Parra, Steven Bollipo, Dalbir S. Sandhu, Keith Siau, Katarzyna M. Pawlak, Almoutaz Hashim, Catharine M. Walsh, Sunil Amin, Jan Kral, and Samir C. Grover

Subjects
medicine.medical_specialty, MEDLINE, Burnout, EGD, esophagogastroduodenoscopy, gastrointestinal endoscopy, Article, GAD-7, Generalized Anxiety Disorder-7, 03 medical and health sciences, coronavirus disease 2019, 0302 clinical medicine, DOPS, Direct Observation of Procedural Skills, Interquartile range, well-being, GiECAT, Gastrointestinal Endoscopy Competency Assessment Tool, Pandemic, Medicine, Radiology, Nuclear Medicine and imaging, Personal protective equipment, ANOVA, analysis of variance, IQR, interquartile range, COVID-19, coronavirus disease 2019, training, medicine.diagnostic_test, SE, standard error, business.industry, Gastroenterology, COVID-19, ACE, Assessment of Competency in Endoscopy, Odds ratio, GI, gastrointestinal, ICU, intensive care unit, Endoscopy, OR, odds ratio, Radiology Nuclear Medicine and imaging, 030220 oncology & carcinogenesis, Family medicine, Anxiety, UGIB, upper gastrointestinal bleeding, 030211 gastroenterology & hepatology, medicine.symptom, ASGE, American Society for Gastrointestinal Endoscopy, business, EUS, endoscopic ultrasound, PPE, personal protective equipment, ERCP, endoscopic retrograde cholangiopancreatography, SMART, stress management and resiliency training
Abstract

Background and Aims Although coronavirus disease 2019 (COVID-19) has affected endoscopy services globally, the impact on trainees has not been evaluated. We aimed to assess the impact of COVID-19 on procedural volumes and on the emotional well-being of endoscopy trainees worldwide. Methods An international survey was disseminated over a 3-week period in April 2020. The primary outcome was the percentage reduction in monthly procedure volume before and during COVID-19. Secondary outcomes included potential variation of COVID-19 impact between different continents and rates and predictors of anxiety and burnout among trainees. Results Across 770 trainees from 63 countries, 93.8% reported a reduction in endoscopy case volume. The median percentage reduction in total procedures was 99% (interquartile range, 85%-100%), which varied internationally (P Conclusions The COVID-19 pandemic has led to restrictions in endoscopic volumes and endoscopy training, with high rates of anxiety and burnout among endoscopy trainees worldwide. Targeted measures by training programs to address these key issues are warranted to improve trainee well-being and support trainee education.

Published
2020

28. The Impact of COVID-19 on Gastrointestinal Endoscopy Training in the United Kingdom

Author

Keith Siau, Marietta Iacucci, Paul Dunckley, Ian Penman, Katarzyna M. Pawlak, Jan Kral, Rishad Khan, Sunil Amin, Mohammad Bilal, Rashid N. Lui, Dalbir S. Sandhu, Almoutaz Hashim, ABIM Steven Bollipo, Aline Charabaty, Enrique de-Madaria, Andrés Felipe Rodríguez-Parra, Sergio A. Sánchez-Luna, Michał Żorniak, Catharine M. Walsh, and Samir C. Grover

Subjects
Endoscopic ultrasound, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Gastrointestinal Endoscopy, Pneumonia, Viral, Colonoscopy, Anxiety, EGD, esophagogastroduodenoscopy, Brief Communication, Endoscopy, Gastrointestinal, Coronavirus Disease 2019, Betacoronavirus, Surveys and Questionnaires, medicine, Humans, Training, Burnout, Professional, Pandemics, Gastrointestinal endoscopy, COVID-19, coronavirus disease 2019, Endoscopic retrograde cholangiopancreatography, UGIB, upper gastrointestinal bleed, Hepatology, medicine.diagnostic_test, business.industry, Esophagogastroduodenoscopy, SARS-CoV-2, General surgery, Gastroenterology, COVID-19, colon, colonoscopy, United Kingdom, Education, Medical, Graduate, BSG, British Society of Gastroenterology, General Surgery, UK, United Kingdom, business, Coronavirus Infections, EUS, endoscopic ultrasound, ERCP, endoscopic retrograde cholangiopancreatography
Published
2020

29. Nomenclature and definition of metabolic-associated fatty liver disease: a consensus from the Middle East and north Africa

Author

Necati Örmeci, Fuad Al-Ali, Yousef Ajlouni, Maryam Al Khatry, Khalid Alswat, Abd Elkhalek Hamed, Almoutaz Hashim, Mustapha Benazzouz, Waseem Hamoudi, Nawel Afredj, Reham Soliman, Mohsen Salama, Gamal Shiha, Yasser Fouad, Amir Anushiravani, Imam Waked, Moutaz Derbala, Said A. Al-Busafi, Dina Attia, Ala I. Sharara, Salma Barakat, Nazir Ibrahim, Khaled Bamakhrama, Mohamed Sharaf-Eldin, Meriam Sabbah, and Samy Zaky

Subjects
medicine.medical_specialty, Consensus, MEDLINE, Type 2 diabetes, Disease, 03 medical and health sciences, Middle East, 0302 clinical medicine, Africa, Northern, Non-alcoholic Fatty Liver Disease, Risk Factors, Diabetes mellitus, Terminology as Topic, Health care, medicine, Global health, Prevalence, Humans, Intensive care medicine, Hepatology, business.industry, Fatty liver, Gastroenterology, medicine.disease, Obesity, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business
Abstract

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.

Published
2020

31. Impact of the COVID-19 Pandemic on Physicians in Residency and Fellowship Programs: Results of an International Survey

Author

Anne Cravero, Nicole J. Kim, Lauren D. Feld, Kristin Berry, Atoosa Rabiee, Najdat Bazarbashi, Sandhya Bassin, Tzu-Hao Lee, Andrew M. Moon, Xiaolong Qi, Peter S. Liang, Elizabeth S. Aby, Mohammad Qasim Khan, Kristen J. Young, Arpan Patel, Karn Wijarnpreecha, Abdallah Kobeissy, Almoutaz Hashim, Allysia Houser, and George N. Ioannou

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Physician burnout, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), International survey, Graduate medical education, medicine.disease_cause, Family medicine, Pandemic, medicine, business, Coronavirus
Abstract

Background: During the novel coronavirus-2019 (COVID-19) pandemic, physicians in residency and fellowshitraining programs are serving as essential healthca

Published
2020
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32. Regional Variation in Organ Donation in Saudi Arabia

Author

H. Al Bahili, W. Al Hamoudi, Hussien Elsiesy, M. Al Sebayel, Dieter C. Broering, T. Mahmoud, Faisal Abaalkhail, Almoutaz Hashim, Mohamed Shoukri, and Hazem Mohamed

Subjects
Transplantation, medicine.medical_specialty, Retrospective review, Tissue and Organ Procurement, business.industry, Saudi Arabia, Transplants, Retrospective cohort study, Organ Transplantation, Organ transplantation, Surgery, Intensive Care Units, Regional variation, Intensive care, Donation, Cadaver, medicine, Humans, Potential donor, Organ donation, business, Needs Assessment, Retrospective Studies, Demography
Abstract

Introduction. There is marked regional variation in organ donation among the different regions of Saudi Arabia. Our aim was to study the dominating factors for these variations to improve organ donation in low-donation areas. Materials and Methods. This study was a retrospective review of the Saudi Center for Organ Transplantation data for cadaveric organ donation from 2006 to 2012, with the number of cases reported, documented, consented, and harvested in various regions (northern, southern, eastern, western, and central). The region, number, and size of contributing intensive care units (ICUs), overall donation rate, and transplanted rate (potential donor and those harvested, respectively) were also reviewed. Results. Between 2006 and 2012, a total of 512 cases were procured and analyzed from Saudi Arabia. From the central region, 393 were acquired, representing 76.7% of the total consented cases. These 393 cases came from 30 of 97 contributing ICUs (31%). The eastern region was ranked second, followed by the western region. The conversion rate for all regions followed a similar trend. Conclusions. There is marked variation with regard to organ donation in different regions throughout Saudi Arabia, from 1.9% in the southern region to 76.7% in the central region. This finding is related to the presence of a Mobile Action Donor Team in the central region. The number of potential donors and the contributing ICUs were strong predictors of the number of actual donors. We suggest that having a mobile donor team in each region will increase the number of donors by at least 3 times within the next 3 to 5 years.

Published
2014
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33. The impact of the pharmaceutical care management model of hepatitis C medications on the cost at the health insurance level

Author

Reem J. Alkasam, Ohoud N. Salih, Almoutaz Hashim, Fadia B. Al Mahdi, Emad Aldin M. Albaba, Mahmoud Mosli, and Ayman F. Alsulaimani

Subjects
medicine.medical_specialty, Multidisciplinary, Pharmaceutical care, business.industry, Family medicine, medicine, Health insurance, Management model, Hepatitis C, medicine.disease, business
Published
2019
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34. Primary hepatic neuroendocrine tumour requiring live donor liver transplantation: case report and concise review

Author

Almoutaz Hashim, Charles H. Scudamore, Siegfried R. Erb, Douglas L. Webber, Eric M. Yoshida, and Ananta Gurung

Subjects
Pathology, medicine.medical_specialty, Necrosis, Liver transplantation, Hepatology, biology, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Chromogranin A, Specialties of internal medicine, General Medicine, Live donor, RC581-951, Biopsy, Neuroendocrine tumour, biology.protein, Synaptophysin, Medicine, Immunohistochemistry, Hepatic artery embolization, Nuclear atypia, medicine.symptom, business
Abstract

Primary hepatic neuroendocrine tumours are rare tumours effecting relatively young patients. As metastatic neuroendocrine tumours to the liver are much more common, extensive investigations are crucial to exclude a primary tumour elsewhere. We report a case of a 27 year old woman who presented with fatigue, increased abdominal girth and feeling of early satiety and bloating. Extensive work up failed to show tumour at another primary site. Hepatic artery embolization showed no effect, so the patient underwent total hepatectomy and live-donor liver transplant. Grossly the tumour measured 27 cm. Microscopic examination showed bland, monomorphic cells growing in tubuloglandular and trabecular growth patterns. Cells were positive for neuroendocrine (synaptophysin, chromogranin, CD56) and epithelial markers (MOC31, CK7, CK19). Cytoplasmic dense neurosecretory vesicles were seen on ultrastructural examination. Based on the Ki-67 rate, mitotic count, lack of marked nuclear atypia and absence of necrosis, a diagnosis of primary neuroendocrine grade 2 was conferred.

Published
2012

35. Strategies to manage hepatitis C virus infection disease burden - volume 3

Author

M. T. Barakat, N. Nugrahini, Andri Sanityoso Sulaiman, S. El Khoury, Béla Hunyady, Y. Al Serkal, Liana Gheorghe, E. S. El Hassan, K. Saeed, M. Siddiq, H. Tarifi, A. Abdou, Homie Razavi, Fadi H. Mourad, Abdul Rahman Bizri, Do Young Kim, Matti Maimets, Devin Razavi-Shearer, S. Gregorcic, Ibrahim Altraif, Chris Estes, A. Salamat, Hamad I. Al-Ashgar, Riina Salupere, Sarah Blach, R. Husni, A. Sibley, F. Al Hosani, P. Aldins, S. Alawadhi, A. Baqir, S. Priohutomo, Mihály Makara, A. Abourached, A. Löve, Ieva Tolmane, Saeed Hamid, B. Karlsdottir, Adrian Goldis, Abdulrahman Aljumah, Samsuridjal Djauzi, Almoutaz Hashim, Laurentius A. Lesmana, Khalid Alswat, Jon G. Jonasson, Danute Speiciene, Young-Suk Lim, Arif Nawaz, M. Taha, R. Al-Hakeem, Abdullah S. Alghamdi, Rino Alvani Gani, Young Seok Kim, Abdullah M. Assiri, J. Videčnik-Zorman, A. Al Rifai, A. Sanityoso Sulaiman, Muhammad S. Memon, H. Fridjonsdottir, M. A. Al Mulla, Faisal M. Sanai, Faisal Abaalkhail, L. Al-Dabal, R. A. Sayegh, A. M. Siddiqui, Gabor Horvath, Moon Suk Choi, Cesar Yaghi, M. Sadik, Irsan Hasan, A. Almessabi, S. Fakhry, Zaigham Abbas, Ala I. Sharara, Evy Yunihastuti, Jacques E Mokhbat, David H. Muljono, Jonas Valantinas, Asad Chaudhry, K. Al Jaberi, H. Al Quraishi, B. Sigurdardottir, Altaf Alam, Mohamed A. Babatin, N. Andrea, F. Al Braiki, Kathryn Razavi-Shearer, Reza Malekzadeh, H. Qureshi, G. Sigmundsdottir, Marwa Sultan, Jonathan Schmelzer, Javed Iqbal Farooqi, Mojca Matičič, Junko Tanaka, S. Olafsson, Behzad Hajarizadeh, Shahin Merat, M. Alzaabi, Valentina Liakina, Adel Alqutub, Seyed M Alavian, G. Tayyab, M. Al Khatry, T. Diab, M. Ud Din, Jessie Gunter, Kwang Hyub Han, Faleh Z. Al-Faleh, Bader Faiyaz Zuberi, Wasim Jafri, P. Rassam, Magnus Gottfredsson, Baiba Rozentale, Agita Jeruma, A. Ghafoor Khan, M. Umar, Ottar M. Bergmann, Z. Koutoubi, and M. A. Yusuf

Subjects
Adult, Male, medicine.medical_specialty, Cure rate, Pediatrics, Asia, Adolescent, Hepatitis C virus, medicine.disease_cause, Antiviral Agents, Infection disease, Middle East, Young Adult, Virology, medicine, Prevalence, Humans, Child, Disease burden, Aged, Aged, 80 and over, Harm reduction, Models, Statistical, Hepatology, business.industry, Diagnostic Tests, Routine, Incidence, Infant, Newborn, Infant, Hepatitis C, Chronic, Middle Aged, Treatment efficacy, Drug Utilization, Surgery, Liver Transplantation, Europe, Infectious Diseases, Child, Preschool, Communicable Disease Control, Female, Birth cohort, business
Abstract

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: increased treatment efficacy while holding the annual number of treated patients constant and increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995).

Published
2015

36. Living donor liver transplant versus cadaveric liver transplant survival in relation to model for end-stage liver disease score

Author

M. Shoukdy, H. Al Bahili, M. Al Sebayel, Almoutaz Hashim, Faisal Abaalkhail, Hussien Elsiesy, and Saleh Alabbad

Subjects
Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Adolescent, medicine.medical_treatment, Saudi Arabia, Kaplan-Meier Estimate, Liver transplantation, Severity of Illness Index, End Stage Liver Disease, Liver disease, Young Adult, Model for End-Stage Liver Disease, Internal medicine, Cadaver, Living Donors, Medicine, Humans, Survival rate, Cause of death, Aged, Retrospective Studies, Aged, 80 and over, Transplantation, business.industry, Graft Survival, Liver Neoplasms, Retrospective cohort study, Transplant Waiting List, Middle Aged, medicine.disease, Surgery, Liver Transplantation, body regions, Survival Rate, Cohort, Female, business
Abstract

Background The Model for End-Stage Liver Disease (MELD) score is universally used to prioritize patients on the liver transplant waiting list. It is potentially used to predict survival as well. There has been conflicting evidence on the use of living donor liver transplantation (LDLT) in patients with high MELD scores. We reported retrospective data comparing survival between LDLT and deceased donor liver transplantation (DDLT) In relation to MELD score in a single-center experience. Methods We retrospectively reviewed our records from 2001 to 2013 for LDLT and DDLT. Data reviewed include the numbers of patients for LDLT and DDLT, age, sex, MELD score, etiology of liver disease, hepatocellular carcinoma, re-transplantation, median follow-up, mortality (with 1 month, 1 year, or after 1 year), and cause of death. Only adults are included in this analysis. Patients were categorized into MELD scores above and below 25. Kaplan-Meier analysis was used for survival, and the log-rank χ 2 test was used for comparison, with a value of P Results The total number of transplanted patients at King Faisal Specialist Hospital, Riyadh, Saudi Arabia, was 491. There were 222 patients for LDLT and 269 patients for DDLT. The median age was 53 years (15–80 years), and 292 were male (59.5%). The overall 1-, 3-, and 5-year Kaplan-Meier survival rates of LDLT and DDLT were 89%, 85%, and 84%, respectively, for MELD score below 25, and 80%,78%, and 77%, respectively, for MELD score greater than or equal to 25. Conclusions Our data showed no difference between the survival rates of the two groups (DDLT versus LDLDT), nor that high MELD score has a negative impact on survival. A larger cohort of patients may be needed to confirm these findings.

Published
2014

37. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm

Author

Altaf Alam, K. Saeed, N. Nugrahini, Fadi H. Mourad, Andri Sanityoso Sulaiman, Abdul Rahman Bizri, Jon G. Jonasson, Liana Gheorghe, S. Alawadhi, Ala I. Sharara, Sarah Blach, Rino Alvani Gani, Do Young Kim, M. Alzaabi, Young Seok Kim, Matti Maimets, S. Priohutomo, A. Löve, Saeed Hamid, Abdullah M. Assiri, H. Al Quraishi, Adel Alqutub, G. Tayyab, Junko Tanaka, H. Qureshi, A. Salamat, P. Aldins, M. S. Choi, M. T. Barakat, Reza Malekzadeh, M. Sadik, Kwang Hyub Han, Young-Suk Lim, J. Videčnik-Zorman, A. Abdou, Jacques E Mokhbat, Zaigham Abbas, Khalid Alswat, G. Sigmundsdottir, B. Karlsdottir, Marwa Sultan, K. Al Jaberi, Devin Razavi-Shearer, A. Al Rifai, Chris Estes, Abdullah S. Alghamdi, A. Sanityoso Sulaiman, Béla Hunyady, F. Al Braiki, B. Sigurdardottir, Ieva Tolmane, Kathryn Razavi-Shearer, S. El Khoury, Gabor Horvath, Y. Al Serkal, M. Taha, Hamad I. Al-Ashgar, Cesar Yaghi, Abdulrahman Aljumah, Danute Speiciene, Riina Salupere, Irsan Hasan, S. Fakhry, Homie Razavi, Evy Yunihastuti, F. Al Hosani, M. A. Al Mulla, Faisal M. Sanai, Mohamed A. Babatin, N. Andrea, L. Al-Dabal, S. Gregorcic, Arif Nawaz, R. Al-Hakeem, E. S. El Hassan, R. Husni, M. Siddiq, David H. Muljono, Adrian Goldis, A. Almessabi, Jonathan Schmelzer, Mojca Maticic, Laurentius A. Lesmana, A. Baqir, Ibrahim Altraif, Faisal Abaalkhail, Shahin Merat, Mihály Makara, A. Abourached, Jonas Valantinas, Asad Chaudhry, T. Diab, M. Ud Din, Muhammad S. Memon, Jessie Gunter, R. A. Sayegh, Seyed Moayed Alavian, A. M. Siddiqui, H. Fridjonsdottir, Bader Faiyaz Zuberi, M. Umar, Magnus Gottfredsson, Baiba Rozentale, Agita Jeruma, Samsuridjal Djauzi, Almoutaz Hashim, A. Ghafoor Khan, Ottar M. Bergmann, Z. Koutoubi, M. A. Yusuf, H. Tarifi, A. Sibley, Faleh Z. Al-Faleh, Wasim Jafri, P. Rassam, J. I. Farooqi, S. Olafsson, Behzad Hajarizadeh, Valentina Liakina, M. Al Khatry, Ctr Dis Anal, Natl Liver Inst, JW Goethe Univ Hosp, Univ Calgary, Ankara Univ, Hosp Santo Antonio Capuchos, Med Univ Innsbruck, Universidade de São Paulo (USP), Hop Henri Mondor, Adv Tech Hlth Serv Res TAISS, Ege Univ, Karolinska Inst, Karolinska Univ Hosp, Univ Leipzig, Osped Cantonale, Univ Montreal, Fed Univ State Rio de Janeiro, Arud Ctr Addict Med, Hosp Valle de Hebron, Hosp Puerta Hierro, Univ Fed Rio Grande do Sul, Odense Univ Hosp, Reg Hosp Hovedstaden, Universidade Federal do Rio de Janeiro (UFRJ), Univ Plymouth, Univ New S Wales, Cairo Univ, Orebro Univ Hosp, Univ Orebro, Ain Shams Univ, Dokuz Eylul Univ, Exigo Consultores, Universidade Federal de São Paulo (UNIFESP), Inst Clin & Expt Med, Hosp Carlos III, Univ Copenhagen, Direccao Geral Saude, Universidade Estadual de Campinas (UNICAMP), Wilhelminenspital Stadt Wien, Med Univ Vienna, Masaryk Univ, Univ Manitoba, Hlth Sci Ctr, European Liver Patients Assoc, Istanbul Univ, Univ British Columbia, Aalborg Univ Hosp, Katholieke Univ Leuven, Hosp Santa Maria, Univ Western Ontario, Univ Dusseldorf, Univ Libre Brussels, Univ Hosp, Natl Inst Publ Hlth, Univ Southhampton, Dalhousie Univ & Hepatol Serv, Assembleia Republ, Alfred Hosp, Monash Univ, UCL, Nottingham Univ Hosp NHS Trust, Biomed Res Unit, Ctr Hosp Porto, Cantonal Hosp St Gallen, Univ Toronto, Egyptian Liver Res Inst & Hosp, Monash Hlth, Catholic Univ Louvain, Med Univ Graz, St Vincents Hosp, Univ Melbourne, Charles Univ Prague, Cent Mil Hosp, Univ Antwerp, Deutsch Leberhilfe eV, Ghent Univ Hosp, Univ Ghent, Hannover Med Sch, Copenhagen Univ Hosp, Univ Zurich Hosp, Bihl, Florian, Negro, Francesco, and Semela, David

Subjects
Pediatrics, medicine.medical_specialty, diagnosis, Cost effectiveness, Hepatitis C virus, prevalence, ddc:616.07, medicine.disease_cause, disease burden, Liver disease, Virology, Epidemiology, medicine, Disease burden, ddc:616, treatment, Hepatology, business.industry, Incidence (epidemiology), Hepatitis C, medicine.disease, mortality, Infectious Diseases, HCV, Immunology, incidence, epidemiology, Human medicine, hepatitis C, Viral hepatitis, business
Abstract

Gilead Sciences The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. in addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing. Ctr Dis Anal, Louisville, CO 80027 USA Natl Liver Inst, Menoufia, Egypt JW Goethe Univ Hosp, Frankfurt, Germany Univ Calgary, Liver Unit, Div Gastroenterol & Hepatol, Calgary, AB, Canada Ankara Univ, Dept Gastroenterol, Sch Med, TR-06100 Ankara, Turkey Hosp Santo Antonio Capuchos, Dept Gastroenterol, Ctr Hosp Lisboa Cent, Lisbon, Portugal Med Univ Innsbruck, A-6020 Innsbruck, Austria Univ São Paulo, Sch Med, São Paulo, Brazil Hop Henri Mondor, Serv Hepatogastroenterol, F-94010 Creteil, France Adv Tech Hlth Serv Res TAISS, Madrid, Spain Ege Univ, Izmir, Turkey Karolinska Inst, Dept Med Huddinge, Stockholm, Sweden Karolinska Univ Hosp, Dept Gastroenterol & Hepatol Infect Dis, Stockholm, Sweden Ankara Univ, TR-06100 Ankara, Turkey Univ Leipzig, D-04109 Leipzig, Germany Osped Cantonale, Dept Gastroenterol, Bellinzona, Switzerland Univ Montreal, Dept Med, Liver Unit, Montreal, PQ H3C 3J7, Canada Fed Univ State Rio de Janeiro, Dept Gastroenterol, Rio de Janeiro, Brazil Arud Ctr Addict Med, Zurich, Switzerland Hosp Valle de Hebron, CIBERehd, Barcelona, Spain Hosp Puerta Hierro, Madrid, Spain Univ Fed Rio Grande do Sul, Hosp Clin, Porto Alegre, RS, Brazil Odense Univ Hosp, Dept Infect Dis, DK-5000 Odense, Denmark Reg Hosp Hovedstaden, Copenhagen, Denmark Univ Fed Rio de Janeiro, Dept Clin Med, Rio de Janeiro, Brazil Univ Plymouth, Peninsula Sch Med & Dent, Plymouth PL4 8AA, Devon, England Univ New S Wales, Kirby Inst, Sydney, NSW, Australia Cairo Univ, Cairo, Egypt Orebro Univ Hosp, Dept Infect Dis, Orebro, Sweden Univ Orebro, Sch Hlth & Med Sci, SE-70182 Orebro, Sweden Ain Shams Univ, Cairo, Egypt Dokuz Eylul Univ, Izmir, Turkey Karolinska Inst, Karolinska Univ Hosp, Dept Med Huddinge, Infect Dis Unit, Stockholm, Sweden Exigo Consultores, Alhos Vedros, Portugal Universidade Federal de São Paulo, Div Gastroenterol, São Paulo, Brazil Universidade Federal de São Paulo, Div Infect Dis, São Paulo, Brazil Inst Clin & Expt Med, Dept Hepatogastroenterol, Prague, Czech Republic Hosp Carlos III, CIBERehd, Madrid, Spain Univ Copenhagen, Copenhagen, Denmark Direccao Geral Saude, Lisbon, Portugal Univ Estadual Campinas, Disciplina Doencas Infecciosas, Dept Clin Med, Grp Estudo Hepatites,Fac Ciencias Med,UNICAMP, São Paulo, Brazil Wilhelminenspital Stadt Wien, Dept Internal Med 4, Vienna, Austria Univ São Paulo, Sch Med, Div Gastroenterol & Hepatol, São Paulo, Brazil Med Univ Vienna, Div Gastroenterol & Hepatol, Dept Internal Med 3, Vienna, Austria Masaryk Univ, Univ Hosp Brno, Clin Infect Dis, Brno, Czech Republic Univ Manitoba, Dept Internal Med, Sect Hepatol, Winnipeg, MB, Canada Hlth Sci Ctr, Viral Hepatitis Invest Unit, Winnipeg, MB, Canada European Liver Patients Assoc, St Truiden, Belgium Istanbul Univ, Istanbul, Turkey Univ British Columbia, British Columbia Ctr Dis Control, Vancouver, BC V5Z 1M9, Canada Aalborg Univ Hosp, Dept Med Gastroenterol, Aalborg, Denmark Aalborg Univ Hosp, Sect Mol Diagnost, Aalborg, Denmark Katholieke Univ Leuven, Univ Hosp Leuven, Louvain, Belgium Hosp Santa Maria, Dept Gastroenterol, Ctr Hosp Lisboa Norte, Lisbon, Portugal Univ Western Ontario, Div Gastroenterol, London, ON, Canada Univ Dusseldorf, Dusseldorf, Germany Univ Libre Brussels, Erasme Univ Hosp, Brussels, Belgium Univ Hosp, Div Gastroenterol & Hepatol, Geneva, Switzerland Univ Hosp, Div Clin Pathol, Geneva, Switzerland Natl Inst Publ Hlth, Natl Reference Lab Hepatitis, Prague, Czech Republic Univ Southhampton, Southampton, England Dalhousie Univ & Hepatol Serv, Capital Dist Hlth Author, Queen Elizabeth II Hlth Sci Ctr, Dept Med, Halifax, NS, Canada Dalhousie Univ & Hepatol Serv, Capital Dist Hlth Author, Queen Elizabeth II Hlth Sci Ctr, Dept Surg, Halifax, NS, Canada Univ British Columbia, Dept Gastroenterol, Vancouver, BC V5Z 1M9, Canada Assembleia Republ, Lisbon, Portugal Alfred Hosp, Melbourne, Vic, Australia Monash Univ, Melbourne, Vic 3004, Australia UCL, Div Med, UCL Inst Liver & Digest Hlth, London, England Hop Henri Mondor, Dept Sante Publ, F-94010 Creteil, France Nottingham Univ Hosp NHS Trust, Nottingham, England Biomed Res Unit, Nottingham, England Ctr Hosp Porto, Dept Infect Dis, Oporto, Portugal Cantonal Hosp St Gallen, Div Gastroenterol & Hepatol, St Gallen, Switzerland Univ Toronto, Toronto Gen Hosp, Univ Hlth Network, Toronto, ON M5G 1L7, Canada Egyptian Liver Res Inst & Hosp, Dakahliah, Egypt Monash Hlth, Melbourne, Vic, Australia Catholic Univ Louvain, Clin Univ St Luc, Brussels, Belgium Med Univ Graz, Div Gastroenterol & Hepatol, Dept Internal Med, Graz, Austria St Vincents Hosp, Dept Gastroenterol, Melbourne, Vic, Australia Univ Melbourne, Melbourne, Vic, Australia Charles Univ Prague, Dept Internal Med, Fac Med 1, Prague, Czech Republic Cent Mil Hosp, Prague, Czech Republic Univ Antwerp, B-2020 Antwerp, Belgium Deutsch Leberhilfe eV, Cologne, Germany Ghent Univ Hosp, Ghent, Belgium Univ Ghent, Belgium Hasselt Univ, Dept Hlth Econ & Patient Safety, Diepenbeek, Belgium Hannover Med Sch, Dept Gastroenterol Hepatol & Endocrinol, Hannover, Germany Copenhagen Univ Hosp, Hvidovre, Denmark Univ New S Wales, St George Hosp Clin Sch Med, Sydney, NSW, Australia Univ New S Wales, Sch Med Sci, Sydney, NSW, Australia Univ Zurich Hosp, Swiss HPB Hepatopancreatobiliary Ctr, CH-8091 Zurich, Switzerland Univ Zurich Hosp, Dept Gastroenterol & Hepatol, CH-8091 Zurich, Switzerland Universidade Federal de São Paulo, Div Gastroenterol, São Paulo, Brazil Universidade Federal de São Paulo, Div Infect Dis, São Paulo, Brazil Web of Science

Published
2014
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38. Invasive Mucormycosis in a Patient With Liver Cirrhosis: Case Report and Review of the Literature

Author

Mohamed Saad, Mohamed Al Sebayel, Faisal Abaalkhail, Khalid Selim, Waleed Al Hamoudi, Almoutaz Hashim, Mahmoud Shorman, Hussien Elsiesy, and Samir S. Amr

Subjects
Liver Cirrhosis, Gangrene, medicine.medical_specialty, Cirrhosis, Mucor infection, Hepatology, business.industry, Opportunistic infection, medicine.medical_treatment, Mucormycosis, Case Report, medicine.disease, Kowsar, Surgery, Infectious Diseases, Amputation, medicine, In patient, business
Abstract

Introduction Cutaneous Mucormycosis is a rare opportunistic infection caused by Zygomycetes class of fungi that is often fatal, requiring aggressive local control as well as systemic therapy. Few cases of mucormycosis were described in patients with liver cirrhosis, mostly rhino-orbital. To our knowledge, only two cases of upper extremity involvement was reported in cirrhosis while a few cases were reported in the post-transplant setting. We report herein the third case of upper extremity mucor infection in the setting of liver cirrhosis. Case Presentation We described a rare case of forearm infection originating in a traumatic intravenous access portal in a 25 year-old woman with liver cirrhosis secondary to autoimmune hepatitis. Discussion She developed acute on chronic liver failure during the last trimester of pregnancy, which was terminated. Painful, erythematous lesion was noted on her right forearm in the area of intravenous access, which later became necrotic. Extensive debridement was done and histopathological examination confirmed the diagnosis of mucormycosis. The patient started on Amphotericin B. Her condition continued to deteriorate and ended up with above elbow amputation followed by right shoulder disarticulation. She died two days later due to multi-organ failure. In conclusion, forearm mucromycosis in liver cirrhosis can be fatal.

Published
2013
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42. Revising the upper limit of normal for levels of serum alanine aminotransferase in a Middle Eastern population with normal liver histology

Author

Hussien Elsiesy, Hatem Khalaf, Ayman A. Abdo, Saleh A. Alqahtani, M. Al-Sebayel, Mohammed Al-Sofayan, Bassem Hegab, Nasser Al-Masri, Dieter C. Broering, Hamad Al-Bahili, Faisal Abaalkhail, Waleed Al-Hamoudi, Almoutaz Hashim, and Safiyya Ali

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Physiology, Population, Saudi Arabia, Biology, Gastroenterology, Young Adult, Internal medicine, Liver tissue, medicine, Humans, Alanine aminotransferase, education, education.field_of_study, medicine.diagnostic_test, Alanine Transaminase, Normal liver histology, Hepatology, Tissue Donors, Liver, Liver biopsy, Liver donors, Female, Body mass index
Abstract

Recently, the upper limits of normal (ULN) for alanine-aminotransferase (ALT) has been recommended to be lowered to ≤ 30 U/l in men and ≤ 19 U/l in women.To evaluate the ALT concentrations in a healthy Middle Eastern population with biopsy-proven normal liver tissue.ALT values were calculated from 175 consecutive Saudi potential living liver donors who underwent a liver biopsy as part of a stepwise pretransplant workup.The mean age of the 110 potential donors with normal liver histology was 27 ± 6.2 years for men and 38.6 ± 7.1 years for women. The mean body mass index (BMI) levels were 23.0 ± 3.5 kg/m(2) for men and 24.7 ± 3.25 kg/m(2) for women, and the ALT levels were higher in male patients (22.6 ± 9 vs. 16.4 U/l ± 8, p value = 0.003). Multivariate linear regression showed that BMI and sex were independent variables that were positively associated with the levels of ALT (p0.0001). Moreover, when we analyzed donors according to the Prati criteria, 63 (36.0 %) of the individuals were classified into this subgroup. The mean ALT concentration was 12.9 U/l ± 4.5 in women and 19.7 U/l ± 6.9 in men, and these values were significantly lower than those obtained from subjects who did not fit the Prati criteria (19.4 U/l ± 1.8, p = 0.04 for women and 29.0 U/l ± 12.1, p =0.0001 for men). Thus, we calculated healthy ALT values of 33 IU/l for men and 22 IU/l for women.The ULN for ALT levels in Middle Eastern populations should be lowered, including separate values for males and females. Furthermore, metabolic parameters were shown to have a significant effect on ALT levels.

Published
2012

43. Spontaneous clearance of hepatitis C infection post-liver transplant: A rare but real phenomenon? A case report and review of the literature

Author

Mazhar, Haque, Almoutaz, Hashim, Erica D, Greanya, Urs P, Steinbrecher, Siegfried R, Erb, and Eric M, Yoshida

Subjects
Liver Cirrhosis, Time Factors, Biopsy, Remission, Spontaneous, Hepacivirus, Viral Load, Hepatitis C, Liver Transplantation, Treatment Outcome, Recurrence, Humans, RNA, Viral, Drug Therapy, Combination, Female, Immunosuppressive Agents, Aged
Abstract

Recurrent hepatitis C virus (HCV) infection after liver transplantation is a significant cause of morbidity, mortality and graft loss. Spontaneous clearance of recurrent HCV after liver transplant is a rarely reported phenomenon. We report a case of a 66-year-old woman who underwent liver transplantation for HCV cirrhosis (treatment- naive genotype 2) under immunosuppression with tacrolimus, mycophenolate mofetil (MMF), and short-term corticosteroids. The patient developed histologically proved severe cholestatic recurrence of HCV hepatitis. Immunosuppression was reduced to tacrolimus monotherapy because of cytopenia. She subsequently became RNA negative at week 44 post- transplant while on tacrolimus and MMF despite no antiviral therapy. A spontaneous sustained virologic clearance was confirmed with subsequent HCV nucleotide testing. Only a few similar cases have been reported in the literature with uninterrupted immunosuppression and subsequent spontaneous clearance. Our experience, and the few other published cases in the literature, suggests that spontaneous clearance of HCV after liver transplantation is a rare but real phenomenon. Better understanding of this phenomenon may help to manage recurrent HCV disease after transplantation.

Published
2010

44. Liver Transplantation at KFSHRC: Achievement and Challenges

Author

Al Sebayel, Mohammed I., primary, Abaalkhail, Faisal A., additional, Al Bahili, Hamad, additional, Abdo, Almoutaz Hashim, additional, Elsiesy, Hussein A., additional, Al Sofayan, Mohammed S., additional, El Sheikh, Yasser M., additional, Hegab, Bassem S., additional, Kamel, Yasser M., additional, AlGoufi, Talal T., additional, Hasssan, Hazem H., additional, Burdelski, Martin M., additional, Al Shagrani, Mohammad A., additional, Abdelfattah, Mohamed R., additional, Attallah, Khaled M., additional, Mahmood, Talat Z., additional, Saleh, Yahya Z., additional, Eldeen, Firas Zahr, additional, and Broering, Dieter C., additional

Published
2014
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46. 171 Sorafenib for Advanced Hepatocellular Carcinoma

Author

Alan Weiss, Eric M. Yoshida, Mazhar Haque, Almoutaz Hashim, Michael W. Suen, Alexandra Shingina, and Sharlene Gill

Subjects
Sorafenib, Hepatology, business.industry, Hepatocellular carcinoma, Gastroenterology, medicine, Cancer research, business, medicine.disease, medicine.drug
Published
2012
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47. 1072 LOWER CUT-OFF LIMIT FOR ALANINE TRANSAMINASE IS NOT EFFECTIVE IN EXCLUDING SIGNIFICANT HISTOLOGICAL DISEASE IN CHRONIC HEPATITIS C (HCV)

Author

M.H. Rajab, M. Al-Quaiz, Paul Marotta, C.S. Dale, Ahmed Helmy, Ayman A. Abdo, Faisal M. Sanai, K. Katada, H. AlMana, Khalid I. Bzeizi, Hamad I. Al-Ashgar, H. Al-Husseini, and Almoutaz Hashim

Subjects
medicine.medical_specialty, Hepatology, biology, business.industry, Disease, Virology, Gastroenterology, Alanine transaminase, Chronic hepatitis, Internal medicine, biology.protein, medicine, Limit (mathematics), business
Published
2010
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