Emerging evidence suggest association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the development of many liver abnormalities. The overarching aim of this study was therefore to assess the available evidence on the clinical effects of SARS-CoV-2 on the profiles of liver chemistries and coagulation in COVID-19 diagnosed patients. We considered all study designs including epidemiological and observational that reported liver function test abnormalities in patients confirmed with SARS-CoV-2 infection. Medline, Embase databases and Google Scholar as well as relevant reviews were searched to identify appropriate studies from inception to 31st of August 2020. We calculated the pooled mean with 95% confidence intervals (95% CI) through a random-effect model meta-analysis. A total of 35 studies with 10,692 participants were considered for the review from which 23 studies with sufficient quantitative data were included in the meta-analysis. The pooled mean for liver enzymes and coagulation parameters did not significantly change in patients diagnosed with COVID-19 and remained within normal range. Notwithstanding potential bias from confounding factors in interpretation of data in this review, findings from the observational studies and case reports suggest that COVID-19 does not appear to have a significant impact on the transaminases or total bilirubin levels of patients with confirmed SARS-CoV-2 infection. Further controlled studies and larger sample size observational studies are needed with adequate reporting of other liver function parameters are warranted.

Purpose: The introduction of direct-acting antivirals (DAAs) has revolutionized the treatment of chronic hepatitis C viral (HCV) infection. This study aims to establish real-world treatment efficacy of Sofosbuvir-based (SOF-B) and Ombitasvir/Paritaprevir/Ritonavir-based (OPR-B) regimens. Patients and methods: This prospective, non-randomized observational real-life study was conducted in Salmaniya Medical Complex, Bahrain, and included consecutive patients with chronic HCV infection (genotypes 1–4) who were treated with direct-acting antivirals. Sustained virologic response to therapy was assessed at week 12 post end of treatment (SVR12). Results: Of the 167 patients included, 60.5% (n=101) were treated with SOF-B and 39.5% (n=66) with OPR-B regimens for 12 weeks (n=148; 88.6%) or 24 weeks (n=19; 11.4%). SVR12 was achieved in 156 (93.4%) patients, 4 patients failed to achieve SVR despite completion of treatment, and 7 patients discontinued treatment due to non-compliance and were included in the analysis on an intention-to-treat basis. There was no difference between SOF-B and OPR-B regimens (95/101; 94.1%) and (61/66; 92.4%), respectively ( p =0.68). However, SVR12 rates were significantly higher in patients without liver cirrhosis (103/104; 99.0%) compared to patients with cirrhosis (53/63; 84.1%; p <0.001), and in patients who received 12-week-regimen (141/148; 95.3%) compared to those who received 24-week regimen (15/19; 78.9%; p <0.024). However, logistic regression analysis identified cirrhosis at baseline to be the only independent predictor of non-SVR12 (OR: 16.1, 95% confidence interval 1.96–131.91, p =0.01). Apart from Hb, INR, and ALP, all other laboratory parameter improved following treatment ( p <0.05). Conclusion: Both SOF-B and OPR-B regimens achieved high SVR12 rates in this real-life cohort of patients with chronic HCV infection, similar to what is reported in other real-world studies. Cirrhosis was the only independent predictor of poor response.

There is conflicting evidence concerning the effect of inflammatory bowel disease (IBD) on COVID-19 incidence and outcome. Hence, we aimed to evaluate the published evidence through a systematic review process and perform a meta-analysis to assess the association between IBD and COVID-19. A compressive literature search was performed in PubMed/Medline, Scopus, Embase, and Cochrane Library from inception to July 2021. A snowball search in Google, Google Scholar, Research Gate, and MedRxiv; and bibliographic research were also performed to identify any other relevant articles. Quantitative observational studies such as cohort, cross-sectional, and case–control studies that assessed the incidence, risk, and outcomes of COVID-19 among the adult IBD patients published in the English language, were considered for this review. The incidence and risk of COVID-19, COVID-19 hospitalization, the severity of COVID-19, and mortality were considered as the outcomes of interest. The Joanna Briggs Institute critical appraisal checklist was used for quality assessment. A subgroup and sensitivity analysis were performed to explore the heterogeneity and robustness of the results, respectively. A total of 86 studies out of 2828 non-duplicate records were considered for this meta-analysis. The studies were single or multicentric internationally from settings such as IBD centres, medical colleges, hospitals, or from the general public. Most of the studies were observed to be of good quality with an acceptable risk of bias. The pooled prevalence of COVID-19, COVID-19 hospitalization, severe COVID-19, and mortality in the IBD population were 6.10%, 10.63%, 40.43%, and 1.94%, respectively. IBD was not significantly (p > 0.05) associated with the risk of COVID-19, COVID-19 hospitalization, severe COVID-19, and mortality. In contrast, ulcerative colitis was significantly associated with a higher risk of COVID-19 (OR 1.37; p = 0.01), COVID-19 hospitalization (OR 1.28; p < 0.00001), and severe COVID-19 (OR 2.45; p < 0.0007). Crohn’s disease was significantly associated with a lesser risk of severe COVID-19 (OR 0.48; p = 0.02). Type of IBD was a potential factor that might have contributed to the higher level of heterogeneity. There was a significant association between ulcerative colitis and increased risk of COVID-19, COVID-19 hospitalization, and severe COVID-19 infection. This association was not observed in patients with Crohns' disease or in those diagnosed non-specifically as IBD.

Background: Despite the effectiveness of several biological agents in the treatment of inflammatory bowel disease (IBD), some patients respond better than others. Such discrepancies are often evident early in the treatment course. The aim of this study is to identify the risks and assess the rate of early biological discontinuation (BD) among IBD patients. Methods: In this retrospective cohort study conducted in Bahrain all IBD patients who were administered biological agents between June 2009 and June 2019 were included. Medical records were reviewed to collect study data and confirm IBD diagnoses. Early discontinuation of biological agents was defined by discontinuation of a biological agent (within 6 months from administration). Montreal classification was used to classify Crohn's disease and ulcerative colitis (UC) according to location and extension, respectively. Results: Ineffectiveness was the most common reason for early BD. Early BD was not related to the type of IBD, biological agent used, or to most patient-related factors (such as gender and family history). Patient age at index biological initiation was the only independent significant predictor of early BD ( P = 0.045, adjusted odds ratios (95% CI): 1.06 (1.001–1.116)] even after correction of two significant factors: comorbid diabetes and marked weight loss at diagnosis. Conclusion: The older the IBD patient at the time of biological therapy initiation, the higher the incidence of early BD. Therefore, caution and close follow-up are required for biological therapy among elderly patients to assess effectiveness and adverse drug reactions.

Emerging evidence suggest association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with development of many liver abnormalities. The overarching aim of this study was therefore to assess the available evidence on the clinical effects of SARS-CoV-2 on liver function laboratory tests and coagulation profile in affected individuals. We considered all study designs including epidemiological and observational that reported liver function test abnormalities in patients diagnosed with SARS-CoV-2 infection. Medline, Embase databases and Google Scholar as well as relevant reviews were searched to identify appropriate studies from inception to April 30th, 2020. We calculated pooled mean with 95% confidence intervals (95%CI) through a random-effect model meta-analysis. A total of 29 studies with 9991 participants were considered for the review from which 20 studies with sufficient quantitative data were included for the meta-analysis. The pooled mean for liver enzymes and coagulation parameters did not significantly change in patients affected by COVID-19 and remained within normal range. Our systematic review and meta-analysis findings of the available evidence suggest that COVID-19 did not have a significant impact on the liver enzymes or coagulation profile of patients with SARS-CoV-2 infection. Future studies need to adequately report all the liver function parameters with event rates.

Fig. 1. A, Diagnostic MRI and, B, 1 year after treatment shows almost complete involution of an orbital metastasis of a prostatic adenocarcinoma. Case reports Cases 1 and 2A 76-year-old man (patient A) and an 83-year-old man (patient B) were examined in 1993 by the ophthalmologist because of diplopia due to progressive unilateral exophthalmus. CT and MRI in both instances showed locally destructive tumours in the right (patient A) and left (patient B) orbital bony and soft tissues. Biopsies revealed adenocarcinomas, which were positive for PSA and PAP on immunohistochemistry. Both patients had high levels of PSA in the serum, 211 ng/mL in patient A and 131.6 ng/mL in patient B. The serum alkaline phosphatase values were normal, although bone scintigraphy showed multiple 'hot spots'. In both cases, a DRE indicated grossly extra-prostatic disease of TNM-stage T4; moreover, TRUS showed multiple hypoechoic lesions, extracapsular disease and seminal vesicle invasion. The TRUS-guided prostate needle biopsies in both patients revealed poorly differentiated adenocarcinomas. Patient A was treated with bilateral subcapsular orchidectomy. One month later the orbital tumour was clearly regressing and the serum PSA level had decreased to 15.4 ng/mL, with a testosterone level of 0.8 nmol/L. A follow-up MRI scan at one year showed almost complete involution of the orbital metastatic process (Fig. 1) and all the visual variables improved to near normality. However, follow-up bone scintigraphy revealed new 'hot spots' in the lumbar vertebral region, while the patient remained in good condition with no pain and an active daily life. The serum PSA level stabilized, with a final value of 14.0 ng/mL. The total follow-up after diagnosis has been 25 months.Patient B was treated with local radiation of the orbital metastasis and chemical castration using the LHRHanalogue goserelin (Zoladex) in 3.6 mg monthly subcutaneous depots after initial pretreatment with cyproterone acetate (Androcur) 100 mg three times daily for 4 weeks. Several weeks after initiation, the serum PSA level was 62.7 ng/mL and the serum testosterone was 0.6 nmol/L. The impaired visual variables showed no improvement.© 1997 British Journal of Urology 288

Current antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is not standardized and may be inadequate. We aimed to evaluate the efficacy of 3 days of additional oral antibiotics in the prevention of ERCP‐related sepsis. One hundred and fifty‐six patients were randomized prospectively to receive either intravenous ticarcillin and clavulinic acid (Timentin® SmithKline Beecham, Dandenong, Victoria, Australia), pre‐ERCP (group I) or Timentin® and 3 days of oral amoxycillin and clavulinic acid (Augmentin®; SmithKline Beecham, Dandenong, Victoria, Australia), group II). Blood cultures were taken 30 min after the procedure. The occurrence of sepsis, defined as a temperature over 38°C, occurring in the first 7 days was recorded and the risk factors for the development of sepsis were evaluated. Four patients had significant positive blood cultures despite the prior administration of Timentin.® Sepsis occurred in 10% of group I patients, but only 3% of group II patients (relative risk 3.30; 95% confidence intervals 0.74‐14.8). The performance of sphincterotomy and the presence of common bile duct stones were significant risk factors for the development of sepsis. We would recommend 3 days of additional oral Augmentin® after a single dose of intravenous antibiotics in patients at increased risk of sepsis, which would include those with bile duct stones and/or those undergoing a therapeutic procedure.

Background and Aim Hepatitis B e (HBe) antigen (HBeAg) is commonly encountered among hepatitis B patients and is indicative of active infection. There is a lack of data in the literature about the prevalence of HBeAg among hepatitis B patients in Bahrain and its impact on the disease. The aims of this study were to investigate the prevalence of HBeAg among a sample of hepatitis B patients in Bahrain and to analyze their associated laboratory profile, radiological characteristics, comorbidities, and complications. Methods This was a retrospective record‐review study conducted on patients' records at Salmaniya Medical Complex hospital in Bahrain during the period of 2011–2016. All records of hepatitis B patients who had HBeAg tests performed were included in this study. Results Of 323 patients recruited, 18.9% had positive HBeAg. The prevalence of anti‐HBe antibodies and hepatitis B core immunoglobulin G (HBc IgG) differed significantly between patients with positive and negative HBeAg (P < 0.001, P = 0.026, respectively). Alanine transferase and gamma‐glutamyl transferase were significantly higher among patients with positive HBeAg (P = 0.017, P = 0.016, respectively). There was no significant difference with regard to the prevalence of hepatitis C virus, human immunodeficiency virus, hepatocellular carcinoma, or liver transplantation between HBe‐positive and ‐negative patients (P ≥ 0.05). Conclusion HBeAg is prevalent among hepatitis B patients in Bahrain and is associated with a significantly different laboratory profile.