Canadian liver journal最新文献

{"title":"Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners.","authors":"Sanjeev Sirpal,&nbsp;Natasha Chandok","doi":"10.3138/canlivj-2021-0032","DOIUrl":"https://doi.org/10.3138/canlivj-2021-0032","url":null,"abstract":"<p><p>Notwithstanding the groundbreaking achievement of hepatitis C curative treatment with direct-acting antiviral therapies, Canada faces an uphill battle in reaching the 2030 goal of viral elimination set forth by the World Health Organization, a goal made more difficult by the COVID-19 pandemic. There is limited understanding of the diagnostic and treatment barriers, and challenges in linkage to care in Canada, especially as it pertains to primary care providers in a community context. Therefore, in this article, the authors conducted a survey study to evaluate the following factors: primary care providers' knowledge of specialist treatment options and the importance of screening and treatment; and patient factors, including transportation, linguistic barriers, and other socio-economic status indicators that impact the screening and management of hepatitis C. The results suggest that public health campaigns that protocolize and/or incentivize screening and referrals may provide solutions to addressing such barriers.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"5 1","pages":"96-100"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231428/pdf/canlivj-2021-0032.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40714618","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":"Hepatotoxicity during legacy cancer chemotherapy in patients infected with hepatitis C virus: A retrospective cohort study.","authors":"Jean-Luc Szpakowski,&nbsp;Lue-Yen Tucker,&nbsp;David M Baer,&nbsp;Mary Pat Pauly","doi":"10.3138/canlivj-2021-0018","DOIUrl":"10.3138/canlivj-2021-0018","url":null,"abstract":"<p><strong>Background: </strong>The rates and causes of significant hepatotoxicity with cancer chemotherapy (CCT) in patients infected with hepatitis C virus (HCV) are incompletely characterized.</p><p><strong>Methods: </strong>We compared rates of grade 3 or 4 hepatotoxicity, defined as elevated transaminases, during CCT in patients who are mono-infected with HCV compared with rates in controls matched on demographics, diagnosis, and rituximab use. We excluded patients with hepatobiliary cancers, hepatitis B virus or human immunodeficiency virus infection. Hepatotoxicity was attributed to a medical cause, cancer progression, or CCT, including HCV flare.</p><p><strong>Results: </strong>Patients with HCV (<i>n</i> = 196) had a higher rate of cirrhosis than the 1,130 matched controls (21.9% versus 4%; <i>P</i> <0.001). Their higher rate of overall hepatotoxicity (8.7% versus 4.5% of controls, <i>P</i> = 0.01) was due to higher rate of CCT-related hepatotoxicity (4.1% versus 1.2%, <i>P</i> = 0.01). On multivariable analysis, the largest risk factor for overall hepatotoxicity was cirrhosis, and the only risk factor for CCT-related hepatotoxicity was HCV infection. Among those with HCV, the only significant risk factor for hepatotoxicity was rituximab use. Hepatotoxicity caused by CCT delayed or altered treatment in only 3 HCV patients and 1 control (1.5% versus 0.1%, <i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>Most patients with HCV can safely be treated with cancer chemotherapy. Cirrhosis and HCV infection contributed to increased hepatotoxicity in subjects on CCT. Among HCV patients, rituximab use was the major risk factor for increased hepatotoxicity. Hepatotoxicity due to CCT itself rarely altered or delayed CCT. Nonetheless, HCV-positive patients should be monitored carefully during CCT.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"5 1","pages":"43-60"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231429/pdf/canlivj-2021-0018.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40714613","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":"Ball three, strike two: Canadian hepatology at full count.","authors":"Gerald Y Minuk","doi":"10.3138/canlivj-2021-1125","DOIUrl":"https://doi.org/10.3138/canlivj-2021-1125","url":null,"abstract":"","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"5 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231427/pdf/canlivj-2021-1125.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40714615","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":"Single Topic Conference on Autoimmune Liver Disease from the Canadian Association for the Study of the Liver.","authors":"Aldo J Montano-Loza, Jessica R Allegretti, Angela Cheung, Maryam Ebadi, David Jones, Nanda Kerkar, Cynthia Levy, Sumera Rizvi, John M Vierling, Fernando Alvarez, Wayne Bai, Susan Gilmour, Aliya Gulamhusein, Orlee Guttman, Bettina E Hansen, Sonya MacParland, Andrew Mason, Fernanda Onofrio, Pere Santamaria, Ashley Stueck, Mark Swain, Catherine Vincent, Amanda Ricciuto, Gideon Hirschfield","doi":"10.3138/canlivj-2021-0006","DOIUrl":"10.3138/canlivj-2021-0006","url":null,"abstract":"<p><p>Autoimmune liver disease (AILD) spans a spectrum of chronic disorders affecting the liver parenchyma and biliary system. Three main categories of AILD are autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). This review condenses the presentation and discussions of the Single Topic Conference (STC) on AILD that was held in Ottawa, Ontario, in November 2019. We cover generalities regarding disease presentation and clinical diagnosis; mechanistic themes; treatment paradigms; clinical trials, including approaches and challenges to new therapies; and looking beyond traditional disease boundaries. Although these diseases are considered autoimmune, the etiology and role of environmental triggers are poorly understood. AILDs are progressive and chronic conditions that affect survival and quality of life. Advances have been made in PBC treatment because second-line treatments are now available (obeticholic acid, bezafibrate); however, a significant proportion still present suboptimal response. AIH treatment has remained unchanged for several decades, and data suggest that fewer than 50% of patients achieve a complete response and as many as 80% develop treatment-related side effects. B-cell depletion therapy to treat AIH is in an early stage of development and has shown promising results. An effective treatment for PSC is urgently needed. Liver transplant remains the best option for patients who develop decompensated cirrhosis or hepatocellular carcinoma within specific criteria, but recurrent AILD might occur. Continued efforts are warranted to develop networks for AILD aimed at assessing geo-epidemiological, clinical, and biochemical differences to capture the new treatment era in Canada.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"4 4","pages":"401-425"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235119/pdf/canlivj-2021-0006.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9416522","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":"Palbociclib-induced severe hepatitis: A case study and literature review.","authors":"Jessie Jean Hyppolite, Nir Hilzenrat","doi":"10.3138/canlivj-2021-0015","DOIUrl":"10.3138/canlivj-2021-0015","url":null,"abstract":"<p><p>Palbociclib is a selective and reversible CDK4/6 inhibitor approved for patients presenting with HR+ HER2- locally advanced or metastatic breast cancer. Its adverse effect (AE) is mainly reported on the occurrence of leukopenia and fatigue. Even though palbociclib has an extensive hepatic metabolism, there are rare reports about significant liver toxicity. We present the case of a 61-year-old female with metastatic breast cancer treated with palbociclib and an aromatase inhibitor (letrozole). The patient developed a rare AE of severe acute drug-induced hepatitis but improved dramatically after stopping the palbociclib and receiving treatment with <i>N</i>-acetylcysteine (NAC). The treatment with NAC may be a proof of concept for the mechanism of palbociclib liver injury.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" ","pages":"433-437"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235127/pdf/canlivj-2021-0015.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712710","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":"Comparison of public and private payments for direct-acting antivirals (DAAs) across Canada.","authors":"Ahmad Shakeri,&nbsp;Kaleen N Hayes,&nbsp;Tara Gomes,&nbsp;Mina Tadrous","doi":"10.3138/canlivj-2020-0041","DOIUrl":"https://doi.org/10.3138/canlivj-2020-0041","url":null,"abstract":"Author Affiliation 1Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada; 2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; 3Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; 4Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; 5Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" ","pages":"426-429"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235118/pdf/canlivj-2020-0041.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712716","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":"A real-world experience of SARS-CoV-2 infection in a tertiary referral centre of Montréal: Unexpected low prevalence and low mortality.","authors":"Isaac Ruiz,&nbsp;Geneviève Huard,&nbsp;Claire Fournier,&nbsp;Julien Bissonnette,&nbsp;Hélène Castel,&nbsp;Jeanne-Marie Giard,&nbsp;Jean-Pierre Villeneuve,&nbsp;Daphna Fenyves,&nbsp;Denis Marleau,&nbsp;Bernard Willems,&nbsp;Daniel Corsilli,&nbsp;Florence Correal,&nbsp;Victor Ferreira,&nbsp;Dominic Martel,&nbsp;Alexandre Mathieu,&nbsp;Catherine Vincent,&nbsp;Marc Bilodeau","doi":"10.3138/canlivj-2021-0022","DOIUrl":"https://doi.org/10.3138/canlivj-2021-0022","url":null,"abstract":"<p><strong>Background: </strong>The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with chronic liver disease (CLD) and liver transplant (LT) recipients remains a concern. The aim of this study was to report the impact of coronavirus disease 2019 (COVID-19) infection among patients at the tertiary health care centre <i>Centre hospitalier de l'Université de Montréal</i> (CHUM) during the first wave of the SARS-CoV-2 pandemic.</p><p><strong>Methods: </strong>This real-world, retrospective cohort included all patients admitted to our liver unit and/or seen as an outpatient with CLD with or without cirrhosis and/or LT recipients who tested positive to SARS-CoV-2 infection. Cases were considered positive as defined by the detection of SARS-CoV-2 by reverse-transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swabs.</p><p><strong>Results: </strong>Between April 1 and July 31, 2020, 5,637 were admitted to our liver unit and/or seen as outpatient. Among them, 42 were positive for SARS-CoV-2. Twenty-two patients had CLD without cirrhosis while 16 patients had cirrhosis at the time of the infection (13, 2, and 1 with Child-Pugh A, B, and C scores, respectively). Four were LT recipients. Overall, 15 of 42 patients (35.7%) were hospitalized; among them, 7 of 42 (16.7%) required respiratory support and 4 of 42 (9.5%) were transferred to the intensive care unit. Only 4 of 42 (9.5%) patients died: 2 with CLD without cirrhosis and 2 with CLD with cirrhosis. Overall survival was 90.5%.</p><p><strong>Conclusion: </strong>This real-world study demonstrates an unexpectedly low prevalence and low mortality in the context of SARS-CoV-2 infection among patients with CLD with or without cirrhosis and LT recipients.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" ","pages":"391-400"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235123/pdf/canlivj-2021-0022.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712713","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":"Bears, beets, rifaximin.","authors":"Peter L Wang,&nbsp;Jennifer A Flemming","doi":"10.3138/canlivj-2021-0026","DOIUrl":"https://doi.org/10.3138/canlivj-2021-0026","url":null,"abstract":"over-all makeup of the gut flora. In the last 20 years, rifaximin has developed a well-established role in the secondary prevention of HE (3,4), yet surpris-ingly, its efficacy has not been supported for its use in primary prevention (5). One of the major risk factors for the development of HE is undergoing a transjugular intrahepatic portosystemic shunt (TIPS) procedure, typically performed for compli-cations of portal hypertension, including refractory ascites and variceal bleeding. TIPS predisposes","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" ","pages":"438-442"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235125/pdf/canlivj-2021-0026.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712714","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":"Survival and development of health conditions after iron depletion therapy in C282Y-linked hemochromatosis patients.","authors":"Paul C Adams, Lucie Richard, Matthew Weir, Mark Speechley","doi":"10.3138/canlivj-2021-0016","DOIUrl":"10.3138/canlivj-2021-0016","url":null,"abstract":"<p><strong>Background: </strong>We report long-term survival and development of selected health conditions in Ontario-based referred and screened C282Y homozygotes for hemochromatosis treated by phlebotomy compared with an untreated control group known to be without <i>HFE</i> mutations.</p><p><strong>Methods: </strong>Patient characteristics and outcomes (all-cause mortality, liver cancer, diabetes, cirrhosis, hip or knee joint replacement, and osteoarthritis) were ascertained using a linked health administrative database held at ICES. Outcomes were assessed between groups without the outcome at baseline using Cox proportional hazards regression adjusted for age and sex. All C282Y homozygotes with elevated serum ferritin were treated by phlebotomy to reach serum ferritin of 50 µg/L. Our cohort included 527 C282Y homozygotes (311 men, 216 women, mean age 48 years) and 12,879 control participants (5,667 men and 7,212 women).</p><p><strong>Results: </strong>C282Y homozygotes had an increased risk of all-cause mortality (aHR 1.44 [1.19-1.75], <i>p</i> <0.001); hepatocellular carcinoma (aHR 8.30 [3.97-17.34], <i>p</i> <0.001); hip or knee joint replacement (aHR 3.06 [2.46-3.81], <i>p</i> <0.001); osteoarthritis (aHR 1.72 [1.47-2.01], <i>p</i> <0.001); and cirrhosis (aHR 3.87 [3.05-4.92], <i>p</i> <0.001). C282Y homozygotes did not have an increased risk for diagnosis of diabetes) (aHR 0.84 [0.67-1.07], <i>p</i> = 0.16) during follow-up (median 17.7 y).</p><p><strong>Conclusions: </strong>C282Y homozygotes experience higher death and complication rates than individuals without <i>HFE</i> mutations, despite treatment by phlebotomy. Diabetes did not increase after phlebotomy therapy.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" ","pages":"381-390"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235120/pdf/canlivj-2021-0016.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40413619","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":"Acute liver failure in ruptured sinus of Valsalva aneurysm.","authors":"Yaqeen Abduallah,&nbsp;Safaa Azzouz,&nbsp;Kelita Singh,&nbsp;Marc Deschenes,&nbsp;Giada Sebastiani","doi":"10.3138/canlivj-2021-0012","DOIUrl":"https://doi.org/10.3138/canlivj-2021-0012","url":null,"abstract":"<p><p>A sinus of Valsalva aneurysm (SOVA) is a rare cardiac defect in which the aortic root area between the aortic annulus and the sinotubular junction is dilated. We present a case of acute liver failure (ALF) in a 21-year-old man secondary to ruptured SOVA inducing severe ischemic hepatitis. The patient presented clinically with classical ALF. The liver ultrasound reported hepatomegaly with pulsatile portal flow and dilated hepatic veins. A transthoracic echocardiogram revealed focal aneurysmal dilatation of the aortic root with flow across the aneurysm toward the right atrium and elevated right chambers pressures. The surgical repair of the non-coronary SOVA was successful, and post-operatively, liver transaminases improved, and ALF resolved. Given that ruptured SOVA can be surgically repaired, hepatologists should be aware of this diagnosis in a young patient with ALF.</p>","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" ","pages":"430-432"},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235124/pdf/canlivj-2021-0012.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712712","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}