Introducing inter-professional education in curricula of Saudi health science schools: An educational projection of Saudi Vision 2030

Recently, the Saudi government initiated plans to improve both the health care system and health profession education. Providing optimal care in health care institutions requires health care providers from different services to collaborate and interact. Evidence-based research has shown that optimizing the interactions and communication between health care workers improves patient outcomes and reduces medical errors. The use of interprofessional education [IPE] in undergraduate health profession programmes in some Western universities has been found to be an effective tool for improving communication and interaction between health care providers. This paper addresses the possibility of introducing IPE into health profession education in KSA to support Saudi Vision 2030

Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis

Hypergammaglobulinemia is frequently observed in patients with chronic liver disease [CLD] of different causes. On the other hand, elevated levels of serum immunoglobulin G [IgG] are the best diagnostic marker for autoimmune hepatitis [AIH]. Thus, the ability to distinguish AIH patients from patients with other liver disease, especially patients with advanced liver cirrhosis, is important since most AIH patients will a have favorable treatment response if diagnosed properly. We conducted this study to evaluate the significance of elevated IgG levels in patients with nonautoimmune CLD and to compare these IgG levels with those in patients with AIH upon diagnosis. Setting and study population: The serum IgG levels in 27 patients with AIH determined at the time of diagnosis were compared to the serum IgG levels in 27 patients with other CLDs of variable severity at the King Abdul Aziz University Hospital in Jeddah, Saudi Arabia. Severity of the disease was evaluated in all patients. We found that the patients in the CLD group with decompensated cirrhosis had significantly higher serum IgG levels compared to the compensated CLD patients [p<0.02]. In addition, the AIH patients had significantly higher serum IgG levels than the non-autoimmune hepatitis CLD patients and the decompensated cirrhosis patients in the CLD group [p<0.001 and p<0.044, respectively]. Most patients with elevated serum IgG of the AIH group [67%] and the CLD group [75%] had significant hypergammaglobulinemia, not just isolated elevated IgG levels. Elevated serum IgG levels with hypergammaglobulinemia are commonly found in patients with advanced CLD. The differentiation of such cases from AIH is important in order to avoid misdiagnosis and confusion with AIH

Autoimmune hepatitis: single-center experience of clinical presentation, response to treatment and prognosis in Saudi Arabia

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. 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. 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%. Decompensated 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. 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