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Cirrhosis is the fifth leading cause of death in adults. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. If portal pressure exceeds a certain threshold, the patient is at risk of developing life-threatening bleeding from varices. Variceal bleeding has a high incidence among patients with liver cirrhosis and carries a high risk of mortality and morbidity. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiologic interventions. In terms of management, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. We describe the pathophysiology of cirrhosis and PH to contextualize the formation of gastric and esophageal varices. We also discuss the currently available treatments and compare how they fare in each stage of clinical management, with a special focus on drugs that can prevent bleeding or assist in achieving hemostasis.

Background: Prevalence estimates for overweight and obesity in the Gulf Cooperation Council countries, including Saudi Arabia, have increased over the last 4 decades. Although the World Health Organization encourages countries to implement initiatives aimed at controlling obesity, limited research has been published on the impact of such initiatives in Saudi Arabia. Aims: To assess the epidemiology of overweight and obesity in Saudi Arabia, describe and evaluate the effectiveness of past and current interventions, and recommend actions for prevention and control. Methods: A narrative review of data from the Global Health Observatory was used to determine yearly estimates of prevalence of overweight and obesity in Saudi Arabia from 1975 to 2016. Large-scale interventions aimed at controlling obesity and its risk factors in Saudi Arabia were identified and summarized. Results: Prevalence estimates of overweight and obesity among men and women in Saudi Arabia continued to increase from 1990 to 2019. Prevalence among adults was more than 60% and among children and adolescents it was 20–60%, suggesting a continuing trend. Interventions were identified but their impact on the prevention and control of obesity and its risk factors was unclear. Conclusion: Prevalence estimates of overweight and obesity have been steadily increasing in Saudi Arabia since 1975. Integrated, “whole-of-community” approach, with continuous evaluation, is needed to achieve sustainable prevention and control of obesity in the country.

Obesity and type 2 diabetes (T2DM) are increasing in Saudi Arabia (SA). Among other conditions, these risk factors increase the likelihood of non-alcoholic fatty liver disease (NAFLD), which in turn increases risks for advanced liver diseases, such as non-alcoholic steatohepatitis (NASH), cirrhosis and cancer. The goal of this study was to quantify the health and economic burden of obesity-attributable T2DM and liver disease in SA. We developed a microsimulation of the SA population to quantify the future incidence and direct health care costs of obesity-attributable T2DM and liver disease, including liver cancer. Model inputs included population demographics, body mass index, incidence, mortality and direct health care costs of T2DM and liver disease and relative risks of each condition as a function of BMI category. Model outputs included age- and sex-disaggregated incidence of obesity-attributable T2DM and liver disease and their direct health care costs for SA's working-age population (20-59 years) between 2020 and 2040. Between 2020 and 2040, the available data predicts 1,976,593 [± 1834] new cases of T2DM, 285,346 [±874] new cases of chronic liver diseases, and 2,101 [± 150] new cases of liver cancer attributable to obesity, amongst working-age people. By 2040, the direct health care costs of these obesity-attributable diseases are predicted to be 127,956,508,540 [± 51,882,446] USD. The increase in obesity-associated T2DM and liver disease emphasises the urgent need for obesity interventions and strategies to meaningfully reduce the future health and economic burden of T2DM, chronic liver diseases and liver cancer in SA.

Population‐based studies that estimate awareness of nonalcoholic fatty liver disease (NAFLD) in the United States are scant. We aimed to understand public awareness of NAFLD and its temporal trends. Our study included 11,700 adults (18+ years old) from five National Health and Nutrition Examination Surveys (2007‐2016). NAFLD was determined by the improved Fatty Liver Index for the multiethnic U.S. population (US‐FLI) in the absence of secondary causes of liver disease. Overall prevalence of NAFLD, hepatitis C virus, and hepatitis B virus were 36.6%, 1.02% and 0.35%, respectively. From 2007‐2008 to 2015‐2016, awareness of liver disease among adults with NAFLD improved from 4.4% to 6.3% (trend P = 0.026) but 4 to 10 times lower than awareness about viral hepatitis. In 2015‐2016, among adults with NAFLD, awareness of liver disease was lower among young adults (aged 18‐29 years) compared with those aged ≥ 30 years (0% vs. 6.9%) and lower among non‐Hispanic Blacks compared with other races (0.7% vs. 6.6%) (all P < 0.001). In multivariable analysis, young adults (adjusted odds ratio [aOR] = 0.29; confidence interval [CI] 0.10‐0.87) and non‐Hispanic Blacks (aOR = 0.43; CI 0.20‐0.96) were negatively associated with awareness of liver disease among adults with NAFLD, whereas diabetes (aOR = 2.22; CI 1.37‐3.58), advanced fibrosis (aOR = 2.34; CI 1.17‐4.68), and a higher number of health care visits (aOR = 1.33; CI 1.15‐1.50) were positively associated with awareness of liver disease. Nearly 96% of adults with NAFLD in the United States were unaware they had liver disease, especially among young adults and non‐Hispanic Blacks. Findings indicate efforts are needed to improve awareness of NAFLD.

Cancer is emerging as a leading cause of morbidity and mortality in Saudi Arabia, with the incidence projected to double in the next 20 years. The health-care system in the country has witnessed considerable reforms over the past four decades, resulting in better control of communicable and non-communicable diseases and, subsequently, longer life expectancies. The Health Sector Transformation Program, a part of the Saudi Vision 2030, aims to strengthen the prevention and control of non-communicable diseases including cancer, improve access to care, deliver high-quality care services, improve patients' quality of life, and increase support for research and innovation. This Series paper highlights the considerable progress of the national cancer control programme, identifying remaining challenges and future opportunities. We envision that this paper will inform the development of the next National Cancer Control Plan to be sustainable, evidence-based, integrated, patient-centred, and value-driven for society.

Proton pump inhibitors (PPIs) are commonly prescribed medications, but their relationship to mortality in colorectal cancer (CRC) remains poorly understood. This study aims to evaluate the association between PPI use and all-cause mortality IN newly diagnosed CRC. This retrospective cohort study utilized electronic medical records from a network comprising over 80 million patients across 57 healthcare organizations in the USA. We identified adult patients with a first-time CRC diagnosis between January 1, 2010, and December 31, 2022, ensuring at least one year of follow-up. Patients were classified as new users or non-users of PPIs at the time of CRC diagnosis. A lag time of 6 months was adopted to minimize protopathic bias. The primary outcome was all-cause mortality. Patients in the study group were matched with patients controls by using 1:1 propensity matching. The analysis included 252,022 patients (126,011 PPI users and 126,011 non-users) matched on propensity scores. PPI users had a higher mortality risk at 1 year (HR = 1.42), 2 years (HR = 1.44), and over the entire follow-up period (HR = 1.40). Sensitivity analyses, which excluded early outcomes, and ancillary analyses, which compared to those on histamine-2 receptor antagonists, confirmed the robustness of these results. Even for former PPI users, the all-cause mortality HR was 1.39. PPI use was associated with an increased risk of all-cause mortality in CRC patients. These findings highlight the need for further research to explore the underlying mechanisms and clinical implications of PPI use in this population. The study indicates that PPIs are associated with increased all-cause mortality in CRC. This highlights the need for careful consideration when prescribing PPIs to this population.

Tracking gas migration geochemically is more challenging than tracking oil migration due to the deficiency in biomarkers and migration tracers, traditionally restricting gas tracking to isotope fingerprinting. This highlights the need for developing new fluid interpretation workflows that maximize the value of reservoir fluid data to constrain gas migration models. Systematic analysis of reservoir PVT fluid properties from 49 wells in a complex carbonate-evaporite sequence across four adjacent Paleozoic gas fields on the eastern part of the Arabian Plate, supported by multivariate statistical analysis, enabled the tracking of gas migration. Results were used to test current basin models, differentiate fault migration from carrier migration, and evaluate the impact of migration style and dynamics on fluid properties and distributions. The first basin model invokes a very long-range migration in excess of 300 km, accumulating first in the northernmost field before spilling over to the south. The second model entails filling from the east via multiple parallel pathways. Regional northward increase in gas-oil ratio and gas maturity, concomitant with enrichment of nitrogen and carbon-13, seemingly supports the north-charging model, but on closer inspection of reservoir fluid properties, the east-charging model is favored. Multiple parallel charging along the eastern flank is reflected in parallel but overlapping fluid maturity and density segregation trends, supported by ratios of reservoir pressure to dewpoint pressure that almost double towards the drier gas in the deeper north due to increased pressurization from more-mature charges coupled with increased hydrocarbon consumption by thermochemical sulfate reduction. The observed patterns in fluid properties are contrary to what would be expected in a single southward fill-spill setting or a single accumulation in equilibrium encompassing the four fields. Migration style played a major control on gas properties and distributions, with carrier migration yielding maturity and density profiles that follow reservoir depth, supplemented in certain areas by fault migration that increased gas dryness and column height. Findings have significant implications for targeting drier gas in stratigraphic and diagenetic traps along the deeper east, particularly where downdip faults meet migration pathways. Similar workflows can be used to constrain reservoir models.

Background Since the first COVID-19 patient in Saudi Arabia (March, 2020) more than 338,539 cases and approximately 4996 dead were reported. We present the main characteristics and outcomes of critically ill COVID-19 patients that were admitted in the largest Ministry of Health Intensive Care Unit (ICU) in Saudi Arabia. Methods This retrospective study, analyzed routine epidemiologic, clinical, and laboratory data of COVID-19 critically ill patients in King Saud Medical City (KSMC), Riyadh, Saudi Arabia, between March 20, 2020 and May 31, 2020. Severe acute respiratory syndrome coronavirus-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction assays performed on nasopharyngeal swabs in all enrolled cases. Outcome measures such as 28-days mortality, duration of mechanical ventilation, and ICU length of stay were analyzed. Results Three-hundred-and-fifty-two critically ill COVID-19 patients were included in the study. Patients had a mean age of 50.63 ± 13.3 years, 87.2% were males, and 49.4% were active smokers. Upon ICU admission, 56.8% of patients were mechanically ventilated with peripheral oxygen saturation/fraction of inspired oxygen (SpO 2 /FiO 2 ) ratio of 158 ± 32. No co-infections with other endemic viruses were observed. Duration of mechanical ventilation was 16 (IQR: 8–28) days; ICU length of stay was 18 (IQR: 9–29) days, and 28-day mortality was 32.1%. Multivariate regression analysis showed that old age [Odds Ratio (OR): 1.15, 95% Confidence Intervals (CI): 1.03–1.21], active smoking [OR: 3, 95% CI: 2.51–3.66], pulmonary embolism [OR: 2.91, 95% CI: 2.65–3.36), decreased SpO 2 /FiO 2 ratio [OR: 0.94, 95% CI: 0.91–0.97], and increased lactate [OR: 3.9, 95% CI: 2.4–4.9], and d -dimers [OR: 2.54, 95% CI: 1.57–3.12] were mortality predictors. Conclusion Old age, active smoking, pulmonary embolism, decreased SpO 2 /FiO 2 ratio, and increased lactate and d -dimers were predictors of 28-day mortality in critically ill COVID-19 patients.

Chronic infections with either hepatitis B or C virus (HBV or HCV) are among the most common risk factors for developing hepatocellular carcinoma (HCC). The hepatocarcinogenic potential of these viruses is mediated through a wide range of mechanisms, including the induction of chronic inflammation and oxidative stress and the deregulation of cellular pathways by viral proteins. Over the last decade, effective anti-viral agents have made sustained viral suppression or cure a feasible treatment objective for most chronic HBV/HCV patients. Given the tumorigenic potential of HBV/HCV, it is no surprise that obtaining sustained viral suppression or eradication proves to be effective in preventing HCC. This review summarizes the mechanisms by which HCV and HBV exert their hepatocarcinogenic activity and describes in detail the efficacy of anti-HBV and anti-HCV therapies in terms of HCC prevention. Although these treatments significantly reduce the risk for HCC in patients with chronic viral hepatitis, this risk is not eliminated. Therefore, we evaluate potential strategies to improve these outcomes further and address some of the remaining controversies.

Artificial intelligence (AI)-powered chatbots, such as Chat Generative Pretrained Transformer (ChatGPT), have shown promising results in healthcare settings. These tools can help patients obtain real-time responses to queries, ensuring immediate access to relevant information. The study aimed to explore the potential use of ChatGPT-generated medical Arabic responses for patients with metabolic dysfunction-associated steatotic liver disease (MASLD). An English patient questionnaire on MASLD was translated to Arabic. The Arabic questions were then entered into ChatGPT 3.5 on November 12, 2023. The responses were evaluated for accuracy, completeness, and comprehensibility by 10 Saudi MASLD experts who were native Arabic speakers. Likert scales were used to evaluate: 1) Accuracy, 2) Completeness, and 3) Comprehensibility. The questions were grouped into 3 domains: (1) Specialist referral, (2) Lifestyle, and (3) Physical activity. Accuracy mean score was 4.9 ± 0.94 on a 6-point Likert scale corresponding to \"Nearly all correct.\" Kendall's coefficient of concordance (KCC) ranged from 0.025 to 0.649, with a mean of 0.28, indicating moderate agreement between all 10 experts. Mean completeness score was 2.4 ± 0.53 on a 3-point Likert scale corresponding to \"Comprehensive\" (KCC: 0.03-0.553; mean: 0.22). Comprehensibility mean score was 2.74 ± 0.52 on a 3-point Likert scale, which indicates the responses were \"Easy to understand\" (KCC: 0.00-0.447; mean: 0.25). MASLD experts found that ChatGPT responses were accurate, complete, and comprehensible. The results support the increasing trend of leveraging the power of AI chatbots to revolutionize the dissemination of information for patients with MASLD. However, many AI-powered chatbots require further enhancement of scientific content to avoid the risks of circulating medical misinformation.