Autoimmune Hepatitis: Single-center Experience of Clinical Presentation, Response to Treatment and Prognosis in Saudi Arabia

Background /Aim:

Autoimmune hepatitis (AIH) is a common cause of end-stage liver disease worldwide. It is a disease prevalent in children and adults, with female predominance and variable clinical presentations. AIH has favorable responses to steroids and immunomodulators. Diagnosis of AIH is based on clinical and laboratory criteria, as suggested by the International Autoimmune Hepatitis Group. Data on the disease pattern of AIH from the Middle East countries is scarce.

Materials and Methods:

In this retrospective analysis, we studied clinical and laboratory features, immunological data, radiological findings, liver biopsy findings and response to therapy in patients with AIH from the hepatology clinics of King Abdul Aziz, University Hospital, Jeddah, from 1994 to 2008.

Results:

We diagnosed 41 patients with AIH, and 33 were included in the analysis. The mean age was 32.3 years, with female predominance of 75.7%. De-compensated cirrhosis at presentation was found in 45.5% of the patients. Acute hepatitis was associated with significantly higher levels of the serum ALT and bilirubin (P=0.001 and P=0.03, respectively). All our patients had type 1 AIH. Treatment with prednisolone and azathioprine resulted in complete or partial remission in majority of the patients (54.8%). However, patients with advanced disease showed a poorer response to treatment (P=0.016). Six patients with poor compliance had relapse of AIH. Two patients had a flare of the disease during pregnancy, and they responded well with prednisolone. The longest follow-up was 14 years and the shortest was 2 months. Four patients died from liver disease.

Conclusion:

AIH patients in Saudi Arabia are likely to present with advanced disease at a young age and would have a poorer response to therapy as compared with patients in other countries worldwide.     

G6PD deficiency in autism

Autism is a neurodevelopmental disorder characterized by a pattern of social and communication deficits. Although it occurs in all cultures and countries, most of the published research has come from Western industrialized countries. In particular, relatively little is known about its clinical correlates and comorbidity in African and Middle Eastern countries. In this paper, we report two cases of G6PD deficiency with autism, recruited as part of a larger study on the occurrence of autism in Saudi Arabia. These findings suggest that a different set of medical conditions may be associated with autism in developing countries. Saleh M. Al-Salehi, M.D., is a developmental pediatrician at King Fahd Medical City Hospital, Riyadh, Saudi Arabia. Mohammad Ghaziuddin, M.D., is on the faculty of child psychiatry at the University of Michigan, Ann Arbor, USA.     

The Saudi Arabian national demographic and health survey, 2017: Study design and oral health-related influences

ObjectiveTo describe the study design, and the distal and proximal influences on oral health reported in the national demographic and health survey (DHS) of the Kingdom of Saudi Arabia (KSA) in 2017.MethodsThe 2017 KSA DHS used an innovative multistage stratified random-sampling technique to select the population sample by using primary health care centers’ (PHCs) catchment areas as the primary sampling unit. Over 45,000 household heads plus a family member were interviewed. A conceptual framework for distal and proximal oral health influences specific to the KSA was adapted based on the oral health surveillance model. Cross-tabulation and Chi-square tests were performed with consideration for sample weights to provide estimates representative for the KSA population. Frequencies and weighted percentages for each variable reflecting each construct were reported.ResultsThe total number of individuals included in the analysis was n = 55,511, ages ranging between 2 and > 65 years. Lack of dental care when needed was reported for 22.5 % of the population (males = 20.8 %/females = 24.7 %). Proportion of population from Central, West, East, South, and North regions who reported available dental care services when needed was 62.3 %, 58.0 %, 58.9 %, 62.3 %, and 60.1 %, respectively. PHCs were the most regular source for dental care (55.1 %). In total, 48.3 % visited the dentist at least once last year (males = 49.4 % /females = 46.8 %). Dental pain was the most common reason for last dental visit (69.0 %), while only 6.4 % reported visited the dentist for routine visit. Only 15.3 % reported brushing their teeth at least twice per day (males = 14.6 % /females = 16.4 %).ConclusionTwo major oral health influences previously reported to have a significant negative influence on oral health, namely, limited routine dental check-up visits and inadequate oral hygiene, were present among KSA residents. Further inferential study is needed to investigate such influence on oral health status within the KSA population.     

Self-reported and the actual involvement of community pharmacy professionals in the management of acute childhood diarrhea in Jazan Province,Saudi Arabia: Simulated patient visits and survey study

BackgroundAcute childhood diarrhea is one of the most common causes of dehydration, and if severe, can potentially lead to death as well. The present study was aimed at evaluating the knowledge and attitudes of community pharmacy professionals towards the management of acute childhood diarrhea and comparing them with their actual practices in Jazan Province, Kingdom of Saudi Arabia (K.S.A).MethodsSimulated patient visits and a cross-sectional survey making use of a 27-item self-report questionnaire were conducted amongst a sample of 303 community pharmacy professionals (51.2 % male and 48.8 % female) with an age range of 25–56 years, between August 1 and December 1, 2021, in Jazan Province, Saudi Arabia. Convenience sampling technique was used for the recruitment of the participants.ResultsSignificant positive correlations were seen between knowledge score (self-report survey) and practice score (simulated patient visit) regarding patients’ history taking (r = 0.65; p < 0.01), drug recommendations (r = 0.71; p < 0.01) and providing information regarding food and fluid intake (r = 0.44; p < 0.01). The alpha coefficients for all the items of the survey instrument were noted to be greater than (or) equal to the 0.70 threshold for almost all sections, hence indicating good reliability and internal consistency of the developed scale.ConclusionIn the present study, even though we observed improved participants’ performance during the self report survey, their performance level greatly dropped in actual practice. This warrants for a need for educational programs to improve their actual dispensing practices. The present study has also shown simulated patient visits to be a reliable, simple and a robust method of assessing the actual dispensing practices of community pharmacy professionals.     

Aspirin Use among Saudi Adults: The Prevalence and Users’ Characteristics

IntroductionDespite the public routine use of aspirin as cardio-prophylaxis agent, its use is only recommended in particular situations, and not as usual primary prevention. Only few local studies investigate the use of aspirin in patients with certain diseases, but not within the public population. The purpose of this study was to evaluate the prevalence of aspirin use and identify the demographic and clinical characteristics among Saudi users.MethodologyA cross-sectional study targeting Saudi adults in Saudi Arabia was conducted over a period of four months in 2021 using online Google forms. The study collected data to assess the prevalence of use, use of aspirin according to prevention type, users’ characteristics and comorbidities. Additionally, a self-assessment of knowledge, perception, reasons and attitude towards aspirin use among Saudi adults was conducted. A chi-square test was used to determine the association between the variables. A P-value ≤ 0.05 was considered statistically significant.ResultsThe prevalence of aspirin use was 47%. Regarding the self-assessed aspirin knowledge, the majority of the respondents (n = 481; 62.4 %) found to have good knowledge. Less than half of the participants (n = 341; 44%) use aspirin as primary prevention agent while only 23 participants (2.9%) use aspirin as secondary prevention agent. There was a significant difference between gender and user type (p = 0.001). With regards to comorbidities, hypertension, hyperlipidemia, diabetes, and obesity were common among the primary users of aspirin. Significant associations were found (p = 0.001) between participant’s user type and the following characteristics such as smoking status, past medical history, presence of comorbidities.ConclusionAspirin use is commonly prevalent Saudi population with good level of knowledge of the therapy; however, its popular use as primary preventive agent for CVD may necessitate medical advice based on the level of cardiovascular risk.     

Glaucoma among Saudi Arabian population: a scoping review

Despite its high risk of leading to permanent visual dysfunction, glaucoma remains underdiagnosed in primary care settings. About 11% of glaucoma patients in Saudi Arabia end up with bilateral blindness. This scoping review investigates and presents results on the glaucoma profile, including its prevalence, knowledge, attitude, and practice of Saudi Arabians towards the disease. An online search using four databases through online software (www.rayyan.ai) was performed to extract the relevant articles. Out of 76 records, 21 articles were eligible for the analysis. All included studies were published between the years 2014 and 2022. Most studies were in Riyadh city, followed by Jeddah. All participants (n=11 388) were adults >18 years old, and male participants were generally higher than females. The findings showed poor knowledge of glaucoma among the general population, while the knowledge among glaucoma patients was acceptable. The attitude was positive, while the compliance and practice were fair. More educational programs about glaucoma, its risk to the eyes, and the overall quality of life are highly recommended.     

Pattern of disability among patients attending Taif Rehabilitation Center, Saudi Arabia

Purpose. Despite the growing awareness of the community about the economic, psychological and medical impact of disability, limited research has been carried out to determine the pattern of disabilities in Saudi Arabia.

Methods. This is a cross-sectional study of hospital records of patients who were admitted to Armed Forces Rehabilitation Center, Taif, Saudi Arabia, during the period from 1999 - 2005. A total of 850 patient records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analyses were performed to determine predictors of long stay at the hospital.

Results. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle age patients (16 - 45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, patients with traumatic accidents and patients with paralytic types of disability were significantly more likely to stay longer at the hospital (≥6 months).

Conclusions. The home care program should be expanded to minimize duration of stay at the rehabilitation centers with lower cost as well as health education of the public would help in encouraging disabled patients to adapt to daily life activities.     

Hepatic granuloma: decreasing trend in a high‐incidence area

Background: Hepatic granuloma (HG) has a high reported incidence in Saudi Arabia (14.6%). We aimed to identify the incidence of HG in our centres and review its presenting features and underlying aetiology. Methods: A total of 5531 liver biopsies were screened through a computer database over 13 years. Sixty‐six (1.2%) patients fulfilled our inclusion criteria. The patients were then divided into three groups according to the aetiology. Group 1, tuberculosis (n=26); Group 2, viral hepatitis B and C (n=11); and Group 3, idiopathic (n=9). The demographical data and the clinical and biochemical features of all the groups were analysed. Results: Infections comprised of 72.2% of HG. The incidence of tuberculosis was 42.6%, viral hepatitis 16.3% and idiopathic 14.8%. Fever (47.5%), weight loss (42.6%) and fatigue (45.9%) were commonly found symptoms. Fever and weight loss were significantly more frequently presenting symptoms in Group 1 than in Groups 2 and 3 (P=0.0002, 0.04, 0.001 and 0.02 respectively). The mean bilirubin levels in Group 1 were significantly lower than in Groups 2 and 3 (P=0.04 and 0.03 respectively). The mean albumin levels were significantly lower in Group 3 compared with Group 2 (P=0.002), and Group 1 had lower levels compared with Group 2 (P=0.018). Conclusion: The incidence of HG is much lower than reported previously from this region. Tuberculosis and viral hepatitis are the most common causes and, contrary to previous reports, schistosomiasis is rare. Fever and weight loss distinguished tuberculous HG.