Saeed Hamid

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia–Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22–23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review.

Hepatocellular carcinoma (HCC): a global perspective

Peter Ferenci (chair) (Austria) Michael Fried (Switzerland) Douglas Labrecque (USA) J. Bruix (Spain) M. Sherman (Canada) M. Omata (Japan) J. Heathcote (Canada) T. Piratsivuth (Thailand) Mike Kew (South Africa) Jesse A. Otegbayo (Nigeria) S.S. Zheng (China) S. Sarin (India) S. Hamid (Pakistan) Salma Barakat Modawi (Sudan) Wolfgang Fleig (Germany) Suliman Fedail (Sudan) Alan Thomson (Canada) Aamir Khan (Pakistan) Peter Malfertheiner (Germany) George Lau (Hong Kong) F.J. Carillo (Brazil) Justus Krabshuis (France) Anton Le Mair (The Netherlands)

Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection.

Co-chairs: GW McCaughan, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia M Omata, Tokyo University Hospital, Tokyo, Japan Faculty Members: D Amarapurkar, Bombay Hospital, Mumbai, India S Bowden, Victorian Infectious Diseases Reference Laboratories, Melbourne, Australia WC Chow, Singapore General Hospital, Singapore A Chutaputti, Pramongkutklao Hospital, Bangkok, Thailand G Dore, National Center in HIV Epidemiology and Clinical Research, Sydney, Australia E Gane, NZ Liver Transplant Unit, Auckland, New Zealand R Guan, Mount Elizabeth Medical Center, Singapore SS Hamid, The Aga Khan University, Karachi, Pakistan W Hardikar, Royal Children’s Hospital, Melbourne, Australia CK Hui, Queen Mary Hospital, University of Hong Kong, Hong Kong, China W Jafri, The Aga Khan University, Karachi, Pakistan J-D Jia, Beijing Friendship Hospital, Capital Medical University, Beijing, China M-Y Lai, National Taiwan University Hospital, Taiwan L Wei, Peking University Peoples Hospital, Beijing, China N Leung, The Chinese University of Hong Kong, Hong Kong, China T Piratvisuth, Prince of Songkla University, Hat Yai, Thailand S Sarin, GB Pant Hospital, Delhi, India J Sollano, University Santo Tomas Hospital, Manilla, Philippines R Tateishi, University of Tokyo Hospital, Tokyo Japan

World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

Review Team, Douglas R. LaBrecque, MD, FACP (chair, USA), Zaigham Abbas, MD, MBBS, FCPS, FRCP, FRCPI, FACP, FACG, AGAF (Pakistan), Frank Anania, MD, FACP, AGAF (USA), Peter Ferenci, MD (Austria), Aamir G. Khan, MD (Pakistan), Khean-Lee Goh, MBBS, FRCP (Glasgow, London), MD, FACG, FASGE (Malaysia), Saeed S. Hamid, MD (Pakistan), Vasily Isakov, MD, PhD, AGAF (Russia), Maribel Lizarzabal, MD, PhD (Venezuela), Manuel M. Peñaranda, MD (Colombia), Juan F.R. Ramos, MD (Mexico), Shiv Sarin, MD, DM (India), Davor Stimac, MD (Croatia), Alan B.R. Thomson, MD (Canada), Muhammed Umar, MD, MBBS, MCPS, FCPS (PAK), FACG (USA), FRCP (L), FRCP (G), ASGE-M (USA), AGAF (USA) (Pakistan), Justus Krabshuis, (France), and Anton LeMair, MD (Netherlands)

APASL consensus statements and management algorithms for hepatitis C virus infection

The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the “APASL Consensus Statements and Management Algorithms for Hepatitis C Virus Infection” in December, 2010, in order to revise “Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection (J Gastroenterol Hepatol 22:615–633, 2007)”. The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Makuhari, Chiba, Japan on 19 December 2010. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations are presented in this review.

Hepatitis B and C: prevalence and risk factors associated with seropositivity among children in Karachi, Pakistan

BackgroundInfections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age.MethodsThe study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology.Results3533 children were screened for HBsAg and anti-HCV. 1826 (52 %) were males. 65 (1.8 %) were positive for HBsAg, male to female ratio 38:27; mean age 10 ± 4 years. 55 (1.6 %) were positive for anti-HCV with a mean age 9 ± 4 years. 3 (0.11%) boys were positive for both HBsAg and anti-HCV. The overall infection rate was 3.3 % in the studied population. Hepatitis BsAg was more prevalent in subjects who received therapeutic injections 45 (69.2%) positive [Odd Ratio OR = 2.2; 95% Confidence interval CI: 1.3–3.6] inspite of using new needle and syringe 44 (67.7%) positive [OR = 2.2; 95% CI: 1.3–3.7] and vaccination in the government healthcare facilities 46 (70.7 %) positive with [OR = 3.0; 95% CI: 1.4–6.4]. These factors were not significant in anti-HCV positive cases.ConclusionThere is a need to educate general population regarding HBV and HCV infection and risks associated with inappropriate therapeutic injections. Hepatitis B vaccine should be administered to all newborns regardless of maternal HBsAg status.

Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia)

BackgroundLiver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who have mild/moderate (ALT 23-300 IU/L) v/s severe acute hepatitis (ALT > 300 IU/L).MethodsA Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (≥ 14 yrs age) admitted with diagnosis of Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS) were included. Chi square test was used to compare categorical variables and fischer exact test where applicable. Survival analysis (Cox regression and log rank) for primary outcome was done. Student t test was used to compare continuous variables. A p value of less than or equal to 0.05 was taken as significant.ResultsSix hundred and ninety nine patients were enrolled, including 87% (605) patients with DF and 13% (94) patients with DHF or DSS. Liver functions tests showed median ALT of 88.50 IU/L; IQR 43.25-188 IU/L, median AST of 174 IU/L; IQR 87-371.5 IU/L and median T.Bil of 0.8 mg/dl; IQR 0.6-1.3 mg/dl. Seventy one percent (496) had mild to moderate hepatitis and 15% (103) had severe hepatitis. Mean length of stay (LOS) in patients with mild/moderate hepatitis was 3.63 days v.s 4.3 days in those with severe hepatitis (P value 0.002). Overall mortality was 33.3% (n = 6) in mild/moderate hepatitis vs 66.7% (n = 12) in severe hepatitis group (p value < 0.001). Cox regression analysis also showed significantly higher mortality in severe hepatitis group (H.R (4.91; 95% CI 1.74-13.87 and P value 0.003) and in DHF/DSS (5.43; CI 1.86-15.84 and P value 0.002). There was a significant difference for the complications like Bleeding (P value < 0.001), Acute Renal failure (ARF) (P value 0.002), Acalculus cholecystitis (P value 0.04) and encephalopathy (P value 0.02) in mild/moderate and Severe hepatitis groups respectively.ConclusionSevere hepatitis (SGPT>300IU) in Dengue is associated with prolonged LOS, mortality, bleeding and RF.

APASL consensus statements and recommendation on treatment of hepatitis C

The Asian-Pacific Association for the Study of the Liver (APASL) convened an international working party on the “APASL consensus statements and recommendation on management of hepatitis C” in March, 2015, in order to revise “APASL consensus statements and management algorithms for hepatitis C virus infection (Hepatol Int 6:409–435, 2012)”. The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations on treatment of hepatitis C are presented in this review.

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL).

Liver fibrosis is a common pathway leading to cirrhosis, which is the final result of injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Liver biopsy has been considered to be the “gold standard” to assess fibrosis. However, liver biopsy being invasive and, in many instances, not favored by patients or physicians, alternative approaches to assess liver fibrosis have assumed great importance. Moreover, therapies aimed at reversing the liver fibrosis have also been tried lately with variable results. Till now, there has been no consensus on various clinical, pathological, and radiological aspects of liver fibrosis. The Asian Pacific Association for the Study of the Liver set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The process for the development of these consensus guidelines involved the following: review of all available published literature by a core group of experts; proposal of consensus statements by the experts; discussion of the contentious issues; and unanimous approval of the consensus statements after discussion. The Oxford System of evidence-based approach was adopted for developing the consensus statements using the level of evidence from 1 (highest) to 5 (lowest) and grade of recommendation from A (strongest) to D (weakest). The consensus statements are presented in this review.

Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan

Background and Aims:  The global epidemiology of hepatitis delta virus (HDV) infection is changing. This study was performed to determine the epidemiology and clinical impact of hepatitis delta in Pakistan.