Long-Term Outcomes of Everolimus Therapy in De Novo Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Risk of nephrotoxicity in liver transplant patients on calcineurin inhibitors (CnIs) is a concern. Several controlled trials reported benefit of everolimus (EVR) in minimizing this risk when combined with a reduced CnI dose. BACKGROUND: To systematically review the efficacy and safety of EVR, alone or with reduced CnI dose, as compared to CnI alone post-liver transplantation. METHODS: We searched MEDLINE, Scopus, and the Cochrane Library for randomized controlled trials comparing EVR- and CnI-based regimens post-liver transplantation. Assessment of studies and data extraction were undertaken independently. RESULTS: Eight studies were selected, describing 769 patients. Cockcroft-Gault GFR was higher at one (P = .05), 3, and 5 years (P = .030) in patients on EVR compared to those receiving CnI therapy. The composite endpoint of efficacy failure was similar between the 2 arms after 1, 3, and 5 years of study. More patients discontinued EVR due to adverse effects in 1 year; however, no difference was noted after 3 or 5 years. A higher rates of proteinuria, peripheral edema, and incisional hernia occurred in patients on EVR. CONCLUSIONS: The analysis confirms noninferiority of EVR and reduced CnI combination. Combination regimen resulted in better renal function compared to standard CnI therapy

Regulating the auditing profession in Saudi Arabia The formulation of early auditing standards

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN043448 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Essays on oil and business cycles in Saudi Arabia

Doctor of PhilosophyDepartment of EconomicsWilliam F. BlankenauThis dissertation consists of three chapters. Chapter one presents a theoretical model using a dynamic stochastic general equilibrium (DSGE) approach to investigate the role of world oil prices in explaining the business cycle in Saudi Arabia. This model incorporates both productivity and oil revenue shocks. The results indicate that productivity shocks are relatively more important to business cycles than oil shocks. However, this model has some unfavorable features that are associated with both investment and labor hours. The second chapter presents a modified theoretical model using DSGE approach to examine the role of world oil prices versus productivity shocks in explaining the business cycles in Saudi Arabia. To overcome the unfavorable features of the baseline model, the alternative model adds friction to the model by incorporating investment portfolio adjustment. Thus, the alternative model produces similar dynamics to that of the baseline model but the unfavorable characteristics are eliminated. Also, this chapter conducts sensitivity analysis. The objective of the third chapter is to empirically investigate how real world oil price and productivity shocks affect output, consumption, investment, labor hours, and trade balance/output ratio for Saudi Arabia. This chapter complements the theoretical model of the previous chapters. In addition, this study builds a foundation for future studies in examining the impact of real world oil price shocks on the economies of key trade partners of Saudi Arabia. The results of the third chapter show that productivity shocks matter more for macroeconomic fluctuations than oil shocks for the Saudis’ primary trade partners. Therefore, fears of oil importing countries appear to be overstated. As a whole, this research is important for the following reasons. First, the empirical model is consistent with the predictions of our theoretical model in that productivity is a driving force of business cycles in Saudi Arabia. Second, the policymakers in Saudi Arabia should be more concerned with increasing productivity through adopting new technologies that increase economic prosperity. Therefore, the policymakers should continue diversifying economic resources and reduce their reliance on oil

Sofosbuvir-Based Therapy for Genotype 4 HCV Recurrence Post-Liver Transplant Treatment-Experienced Patients

Background and Aim. This is an open label prospective cohort study conducted at a tertiary care hospital. The primary endpoint is SVR12 in patients treated with sofosbuvir-based therapy in post-liver transplant patients with genotype 4 HCV recurrence. Methodology. Thirty-six treatment-experienced liver transplant patients with HCV recurrence received sofosbuvir and ribavirin ± peginterferon. Results. We report here safety and efficacy data on 36 patients who completed the follow-up period. Mean age was 56 years, and the cohort included 24 males and one patient had cirrhosis. Mean baseline HCV RNA was 6.2 log10 IU/mL. The majority of patients had ≥ stage 2 fibrosis. Twenty-eight patients were treated with pegylated interferon plus ribavirin in addition to sofosbuvir for 12 weeks and the remaining were treated with sofosbuvir plus ribavirin only for 24 weeks. By week 4, only four (11.1%) patients had detectable HCV RNA. Of the 36 patients, 2 (5.5%) relapsed and one died (2.75%). Conclusion. Our results suggest that sofosbuvir + ribavirin ± pegylated interferon can be utilized successfully to treat liver transplant patients with HCV recurrence