Usage Behaviour and Adoption Criteria for Mobile Health Solutions in Patients with Chronic Diseases in Gastroenterology.

Introduction: Mobile Health (mHealth) applications allow for new possibilities and opportunities in patient care. Their potential throughout the whole patient journey is undisputed. However, the eventual adoption by patients depends on their acceptance of and motivation to use mHealth applications as well as their adherence. Therefore, we investigated the motivation and drivers of acceptance for mHealth and developed an adapted model of the Unified Theory of Acceptance and Use of Technology (UTAUT2). Methods: We evaluated 215 patients with chronic gastroenterological diseases who answered a questionnaire including all model constructs with 7-point Likert scale items. Our model was adapted from the Unified Theory of Acceptance and Use in Technology 2 and includes influencing factors such as facilitating conditions, performance expectancy, hedonic motivation, social influence factors, effort expectancy, as well as personal empowerment and data protection concerns. Model evaluation was performed with structural equation modelling with PLS-SEM. Bootstrapping was performed for hypothesis testing. Results and Conclusion: Patients had a median age of 55.5 years, and the gender ratio was equally distributed. Forty percent received a degree from a university, college, technical academy, or engineering school. The majority of patients suffered from chronic liver disease, but patients with inflammatory bowel diseases, GI cancers, and pancreatic diseases were also included. Patients considered their general technology knowledge as medium to good or very good (78%). Actual usage of mHealth applications in general was rare, while the intention to use them was high. The leading acceptance factor for mHealth applications in our patient group was feasibility, both in terms of technical requirements and the intuitiveness and manageability of the application. Concerns about data privacy did not significantly impact the intention to use mobile devices. Neither the gamification aspect nor social influence factors played a significant role in the intention to use mHealth applications. Interpretation: Most of our patients were willing to spend time on a mHealth application specific to their disease on a regular basis. Acceptance and adherence are ensured by efficient utilization that requires minimum effort and compatible technologies as well as support in case of difficulties. Social influence and hedonic motivation, which were part of UTAUT2, as well as data security concerns, were not significantly influencing our patients' intention to use mHealth applications. A literature review revealed that drivers of acceptance vary considerably among different population and patient groups. Therefore, healthcare and mHealth providers should put effort into understanding their specific target groups' drivers of acceptance. We provided those for a cohort of patients from gastroenterology in this project.

Epidemiological Characteristics of Chronic Viral Hepatitis in Kazakhstan: Data from Unified Nationwide Electronic Healthcare System 2014-2019.

Background: Viral hepatitis is the leading cause of hepatic cirrhosis and liver-related mortality, yet there are no countrywide epidemiological studies available to date in Kazakhstan. The aim of the study was to perform an estimation of mortality, prevalence and incidence of Hepatitis B and C infections and liver-related complications. Methods: Using centralized healthcare data from the Unified National Electronic Health System (UNEHS) for the period 2014-2019, a total of 82,700 registered patients with chronic viral hepatitis B (HBV), C (HCV) and D (HDV) have been extracted based on ICD -10 codes. Crude rates of incidence, prevalence and mortality, as well as age-, sex- and year-specific rates of incidence and mortality per 100,000 population were estimated. Unadjusted and adjusted hazard ratios were estimated using Cox proportional hazards regression modeling. Results: For the total number of 82,700 patients, 56.6% were represented by chronic HCV infection and 43.4% by HBV infection. The prevalence of coinfection was 10% for HBV+HDV and 3.5% for HBV+HCV. Both HBV and HCV were more prevalent among female patients (56%) and among Kazakh ethnic group (64.8%). Males with HBV had a higher probability of death than females; this trend was stronger among male patients with HCV. Russian ethnic groups infected with HBV had a higher risk of death compared to Kazakh and other ethnic groups. Whereas in HCV-infected patients, Russian ethnic group and other ethnic group had similar risk for death, but higher compared to Kazakhs. Conclusion: During the 2014-2019 period, prevalence, incidence and mortality from chronic HBV and HCV infections increased. Despite the disproportionately higher infection rate among females with chronic viral hepatitis, all-cause mortality was more than two-fold higher among males. Higher death rates in Russian ethnic group compared to other ethnicities need to be evaluated in further studies for other confounding factors and associated comorbidities in this group.

[Prevention of gastrointestinal cancer]. / Prävention gastrointestinaler Tumore.

Throughout the past decades, considerable progress has been made in the (early) diagnosis and treatment of gastrointestinal cancers. However, the prognosis for advanced stages of gastrointestinal tumors remains limited for many patients and approximately one third of all tumor patients die as a result of gastrointestinal tumors. The prevention and early detection of gastrointestinal tumors is therefore of great importance.For this reason, we summarize the current state of knowledge and recommendations for the primary, secondary and tertiary prevention of esophageal, stomach, pancreas, liver and colorectal cancer in the following.

Autoimmune Hepatitis: a Review of Established and Evolving Treatments.

Autoimmune hepatitis (AIH) is a necroinflammatory liver disease commonly presenting with a fluctuating course of activity, presence of circulating autoantibodies, hyperglobulinemia of IgG, and/or response to immunosuppressive drugs. However, the disease displays a considerable heterogeneity. No single clinical or biochemical test may establish diagnosis of AIH. Thus, diagnosis still requires extensive clinical evaluation and experience. Prednisolone and azathioprine are considered standard treatment leading to remission in most patients. However, this standard treatment may not be effective in some patients or not be feasible due to one of these drugs. Over the past two decades additional immunosuppressant drugs for the treatment of AIH have been evaluated and have significantly extended the therapeutic spectrum. Among those novel drugs are mycophenolate mofetil, tacrolimus, everolimus, 6-mercaptopurine, infliximab, rituximab and several others. In this review we summarize the current standard of therapy but also efforts of providing novel therapeutic strategies to AIH patients.

Liver Peliosis: A Life-Threatening Condition With No Clear Indication for Liver Transplant.

We present a 21-year-old patient, remarkable for huge hepatomegaly with the liver, occupying almost the entire abdominal cavity, and mild portal hypertension due to splenic vein compression. After ultrasonography-guided liver biopsy, performed to establish the diagnosis, the patient had bleeding from the liver. Fortunately, emergency laparotomy was started immediately, and the patient was saved. Macroscopically, the liver appeared to be of purple-red color, flabby to the touch, and able to be easily wrinkled with fingers. When all available clinical data were considered, a diagnosis of liver peliosis was made. The patient was recommended close follow-up at the specialized liver surgery clinic with access to emergency surgical procedures, including liver transplant.

Prognosis of Patients Following Liver Transplant From Deceased and Living Donors.

OBJECTIVES: Liver transplant is the only treatment option for patients with end-stage liver disease. MATERIALS AND METHODS: Liver transplant procedures performed from June 2013 to March 2017 were evaluated. We evaluated the postoperative period in recipients of livers from deceased and living donors. RESULTS: Of 31 liver transplant procedures in 30 recipients, 12 were from deceased and 19 from living donors. The final analysis included 24 liver transplants (11 males, 13 females), with 10 from deceased and 14 from living donors. No deaths or life-threatening and debilitating complications were shown in liver donors. All living-donor liver transplants were performed utilizing the right lobe, the volume of which was calculated using contrast-enhanced computed tomography. Most living-donor liver recipients had viral hepatitis, whereas most deceased-donor liver recipients had autoimmune liver disease. Median age of recipients of deceased donations was 39.3 years (median admission duration of 28.1 days), and median age of recipients of donations from living donors was 45.4 years (median admission duration of 36.4 days). All patients were started on an immunosuppression protocol, which included basiliximab on days 0 and 4, tacrolimus, mycophenolate, and prednisolone. Of 24 recipients, 5 were taking prednisolone 10 mg/day or less at discharge. CONCLUSIONS: Most of our liver transplant procedures were living-donor liver transplants (61.3%). Most patients who received living donations had viral hepatitis, with all cases related to autoimmune liver disease receiving deceased donations. This may be related to the possibility of antiviral therapy controlling all stages of liver disease versus no chance of controlling autoimmune liver disease. Living-donor liver transplant recipients required more time to recover to reach initial liver volume; 20.8% of recipients were discharged with prednisolone of 10 mg/day or less. Our results suggest a need for further development of nonsteroidal immunosuppression strategies to minimize infections and steroid-related adverse effects.

Budd-Chiari Syndrome Diagnosed in a Patient Listed for Liver Transplant and Considered to be Contraindicated for the Operation.

We report the clinical case of 23-year-old patient with liver cirrhosis of unknown genesis, significant resistant ascites, and 2 episodes of bleeding from esophageal varices. Evaluation did not find any cause of liver disease, and the patient was placed on the transplant wait list due to subcompensated liver function (Model for End-Stage Liver Disease score of 16, Child-Pugh class B) and poorly controlled severe portal hypertension. After treatment with diuretics, largevolume paracentesis, antibiotics, and vasoconstrictors, hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved significantly. Because the patient showed consistently good liver function and resistant portal hypertension, liver transplant was delayed with decision to perform transjugular intrahepatic portosystemic shunting instead. During the attempt of shunting, occlusive thrombosis of the iliac veins, inferior vena cavae, and hepatic veins were diagnosed and the procedure was stopped. Therefore, considering preserved liver function and severe portal hypertension, diagnosis of Budd-Chiari syndrome with subsequent development of liver cirrhosis was made. The patient was recommended to undergo evaluation to exclude thrombophilia as a cause of thrombosis.

First Case in Kazakhstan of Successful Therapy With 2 Consecutive Direct-Acting Antiviral Regimens in a Patient with Hepatitis C Virus-Induced Decompensated Liver Cirrhosis on a Liver Transplant Wait List.

A 40-year-old man, diagnosed with decompensated liver cirrhosis because of hepatitis C virus, was on the wait list for a liver transplant when he began treatment with the direct-acting antivirals simeprevir 150 mg and sofosbuvir 400 mg. The patient demonstrated end of treatment virologic response at week 12, normal bilirubin, and alanine aminotransferase levels, resolution of ascites, with downgrading to subcompensated liver cirrhosis, and was removed from the liver transplant wait list. However, the patient did not comply with the recommended duration of the antiviral treatment of at least 16 weeks, which resulted in hepatitis C virus relapse at posttreatment week 12. Later, the patient started an alternative regimen that included a combination of ombitasvir 12.5 mg, paritaprevir 75 mg, ritonavir 50 mg, and dasabuvir 250 mg for 24 weeks and achieved a sustained virologic response. However, despite undetectable hepatitis C virus, the patient began to deteriorate again and was again put on the liver transplant wait list. This first described clinical case in Kazakhstan of successful antiviral therapy with 2 consecutive directacting agents demonstrates the importance of virus eradication of pretransplant survival extension and delaying the need for liver transplant.

Liver Transplant Outcomes in a Newly Started Program.

OBJECTIVES: Kazakhstan is experiencing a high demand for liver transplants. More than 1000 patients have end-stage liver disease in the country, and liver transplant is the only viable option for their treatment. MATERIALS AND METHODS: Liver transplant patients, treated from February 2013 to December 2014, were included in this retrospective analysis. RESULTS: From February 2013 to December 2014, seven patients received a liver transplant in our center (1 pediatric patient was excluded). Deceased liver recipients' (n = 3) median age was 52 years and median Model for End-Stage Liver Disease score 9. The indication for transplant was uncontrolled portal hypertension due to autoimmune liver disease. Cadaveric donors' median age was 45 years. Recipients' intensive care unit stay was > 5 days, time on inotropic support was > 3 days. Mean cold ischemic time was > 6 hours, and secondary ischemic time was 67 minutes. One patient in the deceased donor transplant group died during postoperative week 1 from hepatic artery thrombosis. Living donor liver recipients' (n = 3) median age was 47 years (43-48 y) and median Model for End-Stage Liver Disease score was 17 (range 14-20). Liver disease was hepatitis virus related (hepatitis C virus in 1 patient and hepatitis B and D virus in 2 patients). Mean cold ischemic time was 0.43 hours, and mean secondary ischemic time was 64 minutes. One recipient in the living donor liver group died early in the postoperative period from hemorrhage. CONCLUSIONS: Our experience was insufficient to adequately assess morbidity and survival rates in patients for whom the longest follow-up was 25 months. However, no episodes of rejection were observed. Survival rates between living and deceased donor recipients were equivalent, although cadaveric-donor liver conditions were imperfect. This analysis demonstrates the necessity for timely diagnosis of surgical complications, which accounted for all mortality incidence in our series.