Navigating the Labyrinth: Intensive Care Challenges for Patients with Acute-on-Chronic Liver Failure.

Acute-on-chronic liver failure (ACLF) refers to the deterioration of liver function in individuals who already have chronic liver disease. In the setting of ACLF, liver damage leads to the failure of other organs and is associated with increased short-term mortality. Optimal medical management of patients with ACLF requires implementing complex treatment strategies, often in an intensive care unit (ICU). Failure of organs other than the liver distinguishes ACLF from other critical illnesses. Although there is growing evidence supporting the current approach to ACLF management, the mortality associated with this condition remains unacceptably high. In this review, we discuss considerations for ICU care of patients with ACLF and highlight areas for further research.

Post-COVID-19 Syndrome: Incidence, Risk Factor, and the Most Common Persisting Symptoms.

INTRODUCTION: The pandemic of the coronavirus disease 2019 (COVID-19) has caused a significant burden worldwide. The most common presentation of coronavirus disease is acute, and most patients recover completely. However, now a substantial proportion of patients experience long-term health effects. Post-COVID-19 syndrome (PCS) is defined as "signs and symptoms that develop after an infection consistent with COVID-19 that persist for more than 12 weeks and have not been explained yet by an alternative diagnosis." We faced a lack of studies regarding PCS in the Gulf area. Therefore, this study aimed to assess the incidence, risk factors, and most common persisting symptoms of PCS in confirmed COVID-19 patients who presented to King Abdulaziz University Hospital (KAUH) in Jeddah between June 1, 2020 and December 31, 2020. METHODS: This retrospective cohort study was conducted via telephone survey, which took place in June 2022 at KAUH. PCS was defined as the presence of one or more symptoms beyond 12 weeks from the onset of the illness. The inclusion criteria were patients aged 18 or above with laboratory-confirmed SARS-CoV-2 infection through positive RT-PCR in KAUH from June 1, 2020 to December 31, 2020, and both genders were included. The exclusion criteria were inability to provide informed consent, death, currently active COVID-19 infection (PCR +ve), and if they did not complete the interview. Medical records were obtained from patients diagnosed with COVID-19 through positive RT-PCR tests from June 1, 2020 to December 31, 2020. RESULTS: Data of 504 patients were analyzed. The incidence of PCS was 45.0% (95%CI, 40.7% to 49.5%). PCS was associated with female gender (OR = 1.71, 95%CI, 1.13 to 2.59, p = 0.011), having three or more co-morbid conditions (OR = 2.37, 95%CI, 1.19 to 4.75, p = 0.014), receiving steroids (OR = 2.13, 95%CI, 1.16 to 3.98, p = 0.016), also patients who experienced congestion (OR = 1.68, 95%CI, 1.05 to 2.71, p = 0.032) and depression (OR = 1.80, 95%CI, 1.03 to 3.18, p = 0.039) during acute COVID-19 infection. The most commonly reported symptoms beyond 12 weeks included fatigue (19.6%), joint pain (14.1%), and decreased exercise tolerance (12.7%). CONCLUSION: In conclusion, the main risk factors to develop PCS are being female, having three or more co-morbidities, receiving steroids, or patients presenting with nasal congestion and/or depression.

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.

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.

Changing trends in liver transplantation indications in Saudi Arabia: from hepatitis C virus infection to nonalcoholic fatty liver disease.

BACKGROUND: Several trend analyses on liver transplantation (LT) indications have been published in the U.S. and in other countries, but there are limited data on LT indication trends in Saudi Arabia (SA), especially since the availability of direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV). This study aimed to analyze trends in the frequency of LT indications among LT recipients in SA over a 19-year period and examine associations between etiologic-specific trends and clinicodemographic characteristics. METHODS: This retrospective study analyzed clinical and surgical data of adult patients (n = 1009) who underwent LT at the King Faisal Specialist Hospital & Research Center (Riyadh, SA) between 2001 and 2019. Spearman's rank correlation, Poisson regression, and Joinpoint regression analysis were employed to assess changes in LT etiologic trends. RESULTS: In the first period (2001-2010), the main LT indications were HCV (41.9%) and hepatitis B virus (HBV) (21.1%), but nonalcoholic steatohepatitis (NASH) (29.7%) surpassed HCV (23.7%) as the leading LT indication in the second period (2011-2019); and the trends were significant in correlation analyses [incidence rate ratio (IRR) = 1.09 (1.06-1.13) for NASH; IRR = 0.93 (0.91-0.95) for HCV]. In the Joinpoint regression analysis, increases in NASH from 2006 to 2012 (+ 32.1%) were statistically significant, as were the decreases in HCV from 2004 to 2007 (- 19.6%) and from 2010 to 2019 (- 12.1%). Similar patterns were observed in LT etiological comparisons before and after the availability of DAAs and within hepatocellular carcinoma stratifications. CONCLUSIONS: Trends in the epidemiology of LT indications among LT recipients in SA have changed over a 19-year period. Most notably, NASH has eclipsed HCV in the country due to the effective treatment strategies for HCV. These trends in NASH now need an aggressive public health response to minimize and avert future onset of additional clinical and economic strains on health care systems and LT centers in SA.

The effect of age on recollection is not moderated by differential estimation methods.

Episodic memory performance declines with increasing age. It has sometimes been reported that this decline is more marked when episodic recollection is estimated by "objective" measures such as source memory performance than when it is estimated by "subjective" measures such as the "Remember/Know" procedure. Here, our main goal was to directly contrast recollection estimates derived from these procedures in the same samples of young and older participants (24 adults per age group, within-subjects manipulation of test procedure). Following identical study phases in which words were paired with either faces or scenes, participants' memories were assessed in separate test blocks using either Remember/Know or source memory procedures. Contrary to several prior reports, the deleterious effects of age on recollection estimates did not differ according to test type. Thus, we found no evidence that age differentially impacts subjective and objective recollection estimates. Additionally, and consistent with prior findings, effects of age on estimates of familiarity-driven recognition were small and non-significant.

Transplant tourism outcome: a single center experience.

BACKGROUND: Transplant tourism is the term used for patients who travel abroad for transplantation. Transplant tourism has always been surrounded with controversy regarding how these organs were obtained, the donor's care after transplantation, and the recipient outcome. Many authors have found that the outcome of the recipients in transplant tourism is inferior to those transplanted in their own countries. However, most these studies were small, with the latest one including only 33 patients. Here, we describe the outcome of 93 patients who were transplanted abroad compared with local transplantation. MATERIAL AND METHODS: All transplant patients who were followed up at our Nephrology Clinic from 1998 until 2008 were identified using our data base system. We selected patients transplanted from 2003 and forward because the computerized system for laboratory and electronic records began operation that year. RESULTS: A total of 165 patients were identified (93 in the tourist group and 72 in the local one). Transplant tourists had a higher rate of acute rejection in the first year compared with local transplantation (27.9% vs. 9.9, P=0.005), higher mean creatinine at 6 months and 1 year (120 vs. 101 micromol/L, P=0.0007, 113 vs. 98 micromol/L, P=0.008). There was no statistical difference in graft or patient survival in 1 or 2 years after transplantation. However, transplant tourist had a higher rate of cytomegalovirus infection (15.1% vs. 5.6%, P=0.05) and hepatitis C seroconversion (7.5% vs. 0%, P=0.02). CONCLUSION: Transplant tourists had a more complex posttransplantation course with higher incidence of acute rejection and infectious complications.