Canadian liver journal最新文献

{"title":"The Use of Technology Platforms for Nutrition Education in Cirrhosis: A Cross-Sectional Study of Patients' Acceptability and Capabilities.","authors":"Manila Sophasath, Mélanie Tremblay, Crystèle Hogue, Alexya Dussault, Chloé Brassard, Catherine Vincent, Christopher F Rose, Chantal Bémeur","doi":"10.3138/canlivj-2024-0058","DOIUrl":"10.3138/canlivj-2024-0058","url":null,"abstract":"<p><strong>Background: </strong>Few nutrition education strategies using technology have been developed and evaluated for patients with cirrhosis. This study aims to describe the receptivity of these patients to technology-based nutrition education, specifically assessing their interest, preferences, Internet attitudes, technological skills with computers and mobile devices, and factors associated with their interest in such educational approaches.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among patients with cirrhosis. Questionnaires included participant characteristics, interest, preferences and ownership of technology, Internet Attitude Scale (IAS), Computer Proficiency Questionnaire-12 (CPQ-12), Mobile Device Proficiency Questionnaire-16 (MDPQ-16), and Household Food Security Survey Module (HFSSM).</p><p><strong>Results: </strong>77 patients were included (mean age 63.1, 57.1% male); 68.8% had post-secondary education, and 11.7% were food insecure. The primary etiologies were mixed (27.3%), metabolic dysfunction-associated steatohepatitis (MASH) (24.7%), and alcoholic liver disease (ALD) (19.5%). Most patients (72.7%) were interested in receiving nutrition education through technology. Interested patients showed higher proficiency and better attitude toward the Internet. ALD was more prevalent among patients not interested in technological nutritional education. Univariate analysis identified proficiency, attitude toward the Internet, ALD diagnosis, and tablet ownership as predictors of interest. Multivariate analysis confirmed tablet ownership and Internet attitude as significant factors. Preferred educational formats were documents (59.7%) and video clips (57.1%) by email, and pre-recorded online courses (57.1%).</p><p><strong>Conclusion: </strong>Patients with cirrhosis are generally receptive to technology-based nutrition education, though barriers may include lower technological proficiency and a negative attitude toward the Internet. Enhancing patients' technological skills could increase their willingness to use technology for educational purposes, particularly among ALD patients.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 2","pages":"309-321"},"PeriodicalIF":0.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Fatal Drug Poisoning Among People Living with HIV-HCV Co-Infection.","authors":"Mélanie Bédard, Erica Em Moodie, Joseph Cox, John Gill, Sharon Walmsley, Valérie Martel-Laferrière, Curtis Cooper, Marina B Klein","doi":"10.3138/canlivj-2024-0060","DOIUrl":"10.3138/canlivj-2024-0060","url":null,"abstract":"<p><strong>Background: </strong>Drug poisoning (overdose) is a public health crisis, particularly among people living with HIV and hepatitis C (HCV) co-infection. Identifying potential predictors of drug poisoning could help decrease drug-related deaths.</p><p><strong>Methods: </strong>Data from the Canadian Co-infection Cohort were used to predict death due to drug poisoning within 6 months of a cohort visit. Participants were eligible for analysis if they ever reported drug use. Supervised machine learning (stratified random forest with undersampling to account for imbalanced data) was used to develop a classification algorithm using 40 sociodemographic, behavioural, and clinical variables. Predictors were ranked in order of importance, and odds ratios and 95% confidence intervals (CIs) were generated using a generalized estimating equation regression.</p><p><strong>Results: </strong>Of 2,175 study participants, 1,998 met the eligibility criteria. There were 94 drug poisoning deaths, 53 within 6 months of a last visit. When applied to the entire sample, the model had an area under the curve (AUC) of 0.9965 (95% CI, 0.9941-0.9988). However, the false-positive rate was high, resulting in a poor positive predictive value (1.5%). Our model did not generalize well out of sample (AUC 0.6, 95% CI 0.54-0.68). The top important variables were addiction therapy (6 months), history of sexually transmitted infection, smoking (6 months), ever being on prescription opioids, and non-injection opioid use (6 months). However, no predictor was strong.</p><p><strong>Conclusions: </strong>Despite rich data, our model was not able to accurately predict drug poisoning deaths. Larger datasets and information about changing drug markets could help improve future prediction efforts.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 2","pages":"295-308"},"PeriodicalIF":0.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Alkaline Phosphatase Associated with Brown Algae and Mushroom Extract-Containing Supplement Use.","authors":"Himain Perera, Christopher McCudden, Curtis L Cooper","doi":"10.3138/canlivj-2025-0005","DOIUrl":"10.3138/canlivj-2025-0005","url":null,"abstract":"<p><strong>Background: </strong>Marked alkaline phosphatase (ALP) elevation as a consequence of drug exposure is uncommon. We report a chronic hepatitis B virus (HBV) positive 47-year-old male patient taking a brown algae and mushroom extract-containing supplement (Umi No Shizuku) with ALP levels almost 7 times the upper limit during routine bloodwork. ALP was 991 U/L (normal 50-112 U/L). All other liver studies were within normal range: alanine aminotransferase (ALT) 32 U/L (normal 10-63 U/L), aspartate aminotransferase (AST) 25 U/L (normal 12-41 U/L), gamma-glutamyl transferase (GGT) 22 U/L (normal 11-105 U/L), and total bilirubin 13 µmol/L (normal ≤ 13 µmol/L).</p><p><strong>Methods: </strong>Serial bloodwork was conducted to assess liver studies and bone disease markers. Imaging was utilized to exclude liver and bone disease.</p><p><strong>Results: </strong>Bloodwork and imaging all returned values within the normal range. Interrupting the supplement led to rapid normalization of ALP blood levels in the patient.</p><p><strong>Conclusions: </strong>The supplement was the only variable changed in this case, leading us to suspect that it was responsible for the elevated ALP levels.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 2","pages":"290-294"},"PeriodicalIF":0.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Whitten et al.","authors":"Aisha Tariq, Ayesha Nazeef, Huzafa Ali","doi":"10.3138/canlivj-2024-0044","DOIUrl":"10.3138/canlivj-2024-0044","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"5-6"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress Toward Hepatitis C Virus Elimination among People Living with HIV-Hepatitis C Virus Coinfection in Canada.","authors":"Mariam Z El Sheikh, Jim Young, Dimitra Panagiotoglou, Curtis Cooper, Joseph Cox, Valérie Martel-Laferrière, Sharon Walmsley, Marina B Klein","doi":"10.3138/canlivj-2024-0042","DOIUrl":"10.3138/canlivj-2024-0042","url":null,"abstract":"<p><strong>Background: </strong>Direct-acting antivirals (DAAs) for hepatitis C virus (HCV) were approved in Canada in 2013. By 2018, treatment restrictions had been lifted in all provinces, making DAAs universally accessible. Here, we aim to assess progress toward HCV elimination in the DAA era (2014-2022) within the Canadian Co-infection Cohort.</p><p><strong>Methods: </strong>The CCC is a multisite open cohort of people living with HIV-HCV coinfection with cohort visits scheduled biannually. We calculated annual cure rates overall by province and key population: gay bisexual and other men who have sex with men, people who inject drugs, and Indigenous peoples.</p><p><strong>Results: </strong>Among the 952 participants eligible for DAAs, 65% (n = 623) were cured and 3% (n = 26) achieved late clearance without treatment by the end of the study period. Of the 35% (n = 303) who were not cured, 46% (n = 138) were lost to follow-up, 31% (n = 95) died, and 23% (n = 70) had insufficient data to determine their cure status. Annual cure rates increased from 2014 to 2019 and then decreased across the cohort and in all key populations. From 2015 to 2018, gay bisexual and other men who have sex with men had the highest cure rates, but by 2019 people who inject drugs and Indigenous peoples caught up. Annual cure rates dropped in all provinces with the onset of the COVID-19 pandemic (after 2019).</p><p><strong>Conclusions: </strong>Universal accessibility of DAAs was an important step toward HCV elimination among people living with HIV-HCV coinfection, but this is not sufficient alone. Efforts are needed to re-engage those who remain uncured and reduce mortality in people living with HIV-HCV coinfection.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"49-62"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simplified Treatment of Hepatitis C during the COVID-19 Pandemic: Retrospective Analysis of the British Columbia Hepatitis C Network.","authors":"Shirley X Jiang, Jeanette Feizi, Brandon Chan, Edward Tam, Julia MacIsaac, Hin Hin Ko, Alnoor Ramji","doi":"10.3138/canlivj-2024-0016","DOIUrl":"10.3138/canlivj-2024-0016","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic changed the landscape of hepatitis C virus (HCV) treatment in Canada. In this study, we sought to describe the characteristics, management, and outcomes of patients treated during the pandemic.</p><p><strong>Methods: </strong>Retrospective analysis of the British Columbia HCV Network included HCV patients treated from March 17, 2018 to February 22, 2022. Patients who started treatment before and after March 17, 2020 were designated pre-pandemic and pandemic groups, respectively. Patients were followed until sustained virologic response 12 weeks post-treatment (SVR12).</p><p><strong>Results: </strong>A total of 851 patients underwent 854 treatments, with 481 (56%) pre-pandemic and 373 (44%) pandemic. Pandemic patients were younger (median age 57 versus 61 pre-pandemic; <i>p</i> <0.01) and 23% were on opioid agonist therapy (versus 11% pre-pandemic; <i>p</i> = 0.01). Fewer pandemic patients completed transient elastography (36% versus 56% pre-pandemic; <i>p</i> < 0.01). Pandemic patients utilized fewer in-person appointments and more telehealth appointments (<i>p</i> < 0.01). Fewer pandemic patients completed treatment (85% versus 91% pre-pandemic; <i>p</i> = 0.23); the SVR12 rate was 97.8% in those completing treatment and lab work (versus 99.5% pre-pandemic; <i>p</i> < 0.01). Younger age, substance use, and opioid agonist therapy were associated with loss to follow-up during the pandemic.</p><p><strong>Conclusions: </strong>Patients treated for HCV in British Columbia during the pandemic utilized fewer resources and had more loss to follow-up but maintained high SVR12 rates. Transitioning from in-person to telehealth appointments proved effective in a real-world setting. Individualized strategies are required for special populations prone to loss to follow-up.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"29-38"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underestimation of Liver Fibrosis Using Vibration-Controlled Transient Elastography on Cirrhosis. Are There Predictors?","authors":"Gloria Horta, Iyiad Alabdul Razzak, Xinyuan Zhang, Xuehong Zhang, Michelle Lai","doi":"10.3138/canlivj-2024-0038","DOIUrl":"10.3138/canlivj-2024-0038","url":null,"abstract":"<p><strong>Background: </strong>Detection of liver fibrosis helps to make therapeutic decisions and with screening in patients with chronic liver diseases. Transient elastography (TE) is an accurate, noninvasive technique to assess liver fibrosis but sometimes it is underestimated. Here we aimed for associations and predictors related to the underestimation of liver fibrosis using TE.</p><p><strong>Methods: </strong>We conducted a prospective cohort study involving adult patients with cirrhosis who underwent TE and had their clinical data analyzed. Patients were categorized into two groups based on liver stiffness measurement (LSM), either ≥10 kPa or <10 kPa, which was considered an underestimation of liver fibrosis. Multivariate analysis and logistic regression models were used to identify predictors and their associated strengths. One-way analysis of variance and multiple Tukey comparisons were used to determine the association with cirrhosis etiology.</p><p><strong>Results: </strong>Of 248 patients included, 29.4% had underestimation of liver fibrosis, and when compared with the ≥10 kPa group, significant differences were found in cirrhosis etiology (<i>p</i> = 0.03) and alanine aminotransferase (ALT; <i>p</i> = 0.03), among others. The main cirrhosis etiologies included nonalcoholic fatty liver disease (30.65%), alcohol-related liver disease (27.02%), and hepatitis C virus (26.21%), with significant liver stiffness mean difference between them. There was a significant association between LSM <10 kPa and cirrhosis etiology (odds ratio 1.147; 95% CI 1.012-1.301) and ALT (odds ratio 1.019; 95% CI 1.005-1.033).</p><p><strong>Conclusions: </strong>Underestimation of liver fibrosis using TE in cirrhosis likely occurs with hepatitis C virus, nonalcoholic fatty liver disease, and low ALT levels.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"18-28"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Annual Canadian Liver Meeting 2025 of the Canadian Association for the Study of the Liver (CASL), the Canadian Network on Hepatitis C (CanHepC) and CanMASLD.","authors":"","doi":"10.3138/canlivj-8.1-abst","DOIUrl":"10.3138/canlivj-8.1-abst","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"92-169"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Retrograde Transvenous Obliteration for Primary Prophylaxis of Gastric Variceal Bleeding.","authors":"Nisha Howarth, Yashasavi Sachar, Derek Hw Little, David Peck, Amol Mujoomdar, Derek W Cool, David Hocking, Anouar Teriaky, Karim Qumosani, Qasim Khan, Ephraim Tang, Anton Skaro, Juan Pablo Arab, Mayur Brahmania","doi":"10.3138/canlivj-2024-0012","DOIUrl":"10.3138/canlivj-2024-0012","url":null,"abstract":"<p><strong>Background: </strong>Retrograde transvenous obliteration is an endovascular interventional radiology procedure demonstrating safety and efficacy for secondary prophylaxis in high-risk gastric varices. However, its efficacy as primary prophylaxis is uncertain. We conducted a systematic review and case series to evaluate the utility of this technique.</p><p><strong>Methods: </strong>A literature search utilized EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved single technique obliteration, known varices, and exclusively primary prophylaxis. The primary outcome was gastric variceal bleeding, with secondary outcomes of technical success, variceal eradication, adverse events, and mortality. A retrospective case series of nine patients who underwent primary prophylaxis at our North American centre was also conducted.</p><p><strong>Results: </strong>Of the 842 articles retrieved, 69 were eligible for full-text review, with the 9 studies included in the final analysis involving balloon-occluded, but not plug-assisted or coil-assisted, techniques. Only 2/9 studies involved comparator groups, with a single prospective non-randomized trial, and there was a high risk of bias in 8/9 studies. The technical success rate of the balloon-occluded obliteration technique ranged from 82% to 100%, and the variceal eradication rate ranged from 88% to 100%. In comparative studies, patients had decreased variceal bleeding and bleeding-related mortality compared with control cohorts. Our case series demonstrated a 78% survival rate with no variceal bleeding. Post-procedure ascites and worsening esophageal varices ranged from 0-55% to 11-80%, respectively.</p><p><strong>Conclusion: </strong>This review summarizes evidence regarding the efficacy of retrograde transvenous obliteration, with available studies demonstrating a high success rate in eradicating varices and preventing bleeding-associated mortality, albeit with concerns of overall quality of existing literature.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"79-89"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Commentary on Whitten et al.","authors":"Cindy Whitten","doi":"10.3138/canlivj-2024-0045","DOIUrl":"https://doi.org/10.3138/canlivj-2024-0045","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"7"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}