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

Pattern of admission to hospitals during muslim pilgrimage [Hajj]

The pattern of medical conditions necessitating admission differs according to the weather condition in that particular year. Previous studies had been conducted during the hot weather, none over the last 10 years, were carried out during, the milder weather we are experiencing. The aim of this study is to establish the pattern of admission during this mild weather and to elucidate the possible risk factors. A prospective study was performed in 4 hospitals in 2 different locations in Al-Mashaer, Kingdom of Saudi Arabia. Data were collected during one working shift in 2 hospitals in Arafat on the 9th of Dhul Hijjah 1422, corresponding to 21st of February 2002, and another working shift in 2 hospitals in Mina on the 10th of Dhul Hijjah 1422, corresponding to 22nd of February 2002. A cohort of 76 patients from Arafat hospitals and 84 patients from Mina' hospitals were included [total 160 Patients]. Males constituted 62% and females 38% with the median age of 60 ' 15years. The respiratory system was the most commonly affected [57%], followed by cardiovascular system [19.4%], and gastrointestinal tract [GIT] in 6.3% of cases. There were only 3 cases of heat-related admissions with only one confirmed case of heat stroke. Similarly, only one case of meningitis was confirmed in this cohort. Pneumonia was encountered in 63 cases [39.4%] and exacerbation of asthma and chronic obstructive pulmonary diseases [COPD] in 23 cases [14.4%]. Pre-existing co-morbid medical conditions had included bronchial asthma and COPD [22.5%], hypertension [17.5%], and Diabetes mellitus [15%]. Short-term follow up [24-48 hours] identified 2 deaths [1.3%], 94 patients [59%] were transferred to other secondary or tertiary care facilities and 64 [40%] were discharged home. Hospital admission during Hajj is related to old age and occurs in patients with associated co-morbid conditions. During this mild weather lower respiratory tract infections and exacerbation of bronchial asthma and COPD are the most commonly encountered diseases during Hajj