Global elimination of hepatitis C virus (HCV) is feasible using existent tools. Reporting the provincial HCV care cascade will contribute to national and global HCV elimination efforts. This observational study was a secondary use of population-level medical record data, including laboratory results for HCV testing and prescription data for HCV treatment in the province of Newfoundland and Labrador (NL). All patients with HCV antibody testing performed between Jan 1, 2017 and Jan 1, 2022 were included. All prescriptions dispensed from a community pharmacy in NL for any HCV treatment during the same period were included. There were 84,252 antibody tests included. Of these, 3,626 (4.3%) tests were positive for HCV antibodies. Seventy eight percent (1,377/1,766) of the individuals with positive antibody tests were tested for HCV RNA. Only 377/1,061 (35.5%) individuals with a positive RNA test were treated, and 257/395 (65.1%) achieved sustained virological response at 12 weeks. NL has successfully identified and treated HCV, but treatment access is low. Targets for improvement include increased screening, reflex testing of positive antibody with RNA, increased linkage to care, change in treatment funding policy, and quicker treatment funding decision.
{"title":"Population-level cascade of care for hepatitis C in Newfoundland and Labrador","authors":"Cindy Whitten, Alison Turner, Kobe Roberts, Brittany Howell, Brooklyn Sparkes, Peter Daley","doi":"10.3138/canlivj-2024-0003","DOIUrl":"https://doi.org/10.3138/canlivj-2024-0003","url":null,"abstract":"Global elimination of hepatitis C virus (HCV) is feasible using existent tools. Reporting the provincial HCV care cascade will contribute to national and global HCV elimination efforts. This observational study was a secondary use of population-level medical record data, including laboratory results for HCV testing and prescription data for HCV treatment in the province of Newfoundland and Labrador (NL). All patients with HCV antibody testing performed between Jan 1, 2017 and Jan 1, 2022 were included. All prescriptions dispensed from a community pharmacy in NL for any HCV treatment during the same period were included. There were 84,252 antibody tests included. Of these, 3,626 (4.3%) tests were positive for HCV antibodies. Seventy eight percent (1,377/1,766) of the individuals with positive antibody tests were tested for HCV RNA. Only 377/1,061 (35.5%) individuals with a positive RNA test were treated, and 257/395 (65.1%) achieved sustained virological response at 12 weeks. NL has successfully identified and treated HCV, but treatment access is low. Targets for improvement include increased screening, reflex testing of positive antibody with RNA, increased linkage to care, change in treatment funding policy, and quicker treatment funding decision.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":" 74","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140991212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.3138/canlivj-2023-0030
Xin Mu, Ziran Meng, Ashley Stueck, Magnus McLeod
Sarcoidosis is a multi-organ inflammatory disease that can have hepatic involvement in up to 80% of cases. Rarely, sarcoidosis can manifest with only confined disease to the liver. While most patients with hepatic sarcoidosis are clinically silent, certain cases can have insidious onset leading to cirrhosis and secondary complications. Here, we describe three cases of isolated hepatic sarcoidosis to illustrate the range of presentations that may be associated with this condition. Clinicians should be vigilant in consideration of hepatic sarcoidosis as a culprit when investigating patients with undifferentiated liver disease.
{"title":"Isolated hepatic sarcoidosis: A case series","authors":"Xin Mu, Ziran Meng, Ashley Stueck, Magnus McLeod","doi":"10.3138/canlivj-2023-0030","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0030","url":null,"abstract":"Sarcoidosis is a multi-organ inflammatory disease that can have hepatic involvement in up to 80% of cases. Rarely, sarcoidosis can manifest with only confined disease to the liver. While most patients with hepatic sarcoidosis are clinically silent, certain cases can have insidious onset leading to cirrhosis and secondary complications. Here, we describe three cases of isolated hepatic sarcoidosis to illustrate the range of presentations that may be associated with this condition. Clinicians should be vigilant in consideration of hepatic sarcoidosis as a culprit when investigating patients with undifferentiated liver disease.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140415414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.3138/canlivj-2023-0026
Mariam Ragheb, M. Grubert Van Iderstine, Gerald Minuk, Nabiha Faisal
Metabolic dysfunction associated steatotic liver disease (MASLD) and metabolic dysfunction associated steatohepatitis (MASH) are rapidly growing public health concerns. Identifying predictive markers for advanced liver disease in MASLD patients is crucial for early intervention. This study investigates the association between autoantibody positivity and risk for severe fibrosis or cirrhosis across various subgroups. We conducted a retrospective study of adult patients diagnosed with MASLD between 1994 and 2019. Autoantibody status (anti-nuclear and anti-smooth muscle antibodies) was assessed using laboratory studies. Hepatic fibrosis or cirrhosis was determined histologically or through accepted non-invasive measures. Logistic regression analyses were employed to evaluate the association between autoantibody positivity and severe fibrosis or cirrhosis. Patients with co-morbid viral and alcohol liver disease were assessed separately. Among 2,749 MASLD patients, 1,425 (51.8%) were males and 1,324 (48.2%) were females, with a mean age of 58.7 years. A total of 541 (19.7%) patients tested positive for autoantibodies. Autoantibody positivity was associated with a higher risk of severe fibrosis or cirrhosis in MASLD patients (odds ratio 1.28, 95% CI [1.0–1.6]). This association persisted across various subgroups, including those with concurrent hepatitis B and C virus infections. In contrast, in alcohol liver disease, autoantibody-positive patients exhibited a lower risk. Autoantibody positivity emerges as a potential predictive marker for advanced liver disease in MASLD patients, facilitating risk stratification and tailored interventions. This study highlights the clinical relevance of autoantibodies in MASLD and underscores the need for prospective validation and mechanistic investigations to refine risk assessment and management strategies.
{"title":"Exploring autoantibodies as predictors of severe fibrosis or cirrhosis in metabolic dysfunction associated steatotic liver disease","authors":"Mariam Ragheb, M. Grubert Van Iderstine, Gerald Minuk, Nabiha Faisal","doi":"10.3138/canlivj-2023-0026","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0026","url":null,"abstract":"Metabolic dysfunction associated steatotic liver disease (MASLD) and metabolic dysfunction associated steatohepatitis (MASH) are rapidly growing public health concerns. Identifying predictive markers for advanced liver disease in MASLD patients is crucial for early intervention. This study investigates the association between autoantibody positivity and risk for severe fibrosis or cirrhosis across various subgroups. We conducted a retrospective study of adult patients diagnosed with MASLD between 1994 and 2019. Autoantibody status (anti-nuclear and anti-smooth muscle antibodies) was assessed using laboratory studies. Hepatic fibrosis or cirrhosis was determined histologically or through accepted non-invasive measures. Logistic regression analyses were employed to evaluate the association between autoantibody positivity and severe fibrosis or cirrhosis. Patients with co-morbid viral and alcohol liver disease were assessed separately. Among 2,749 MASLD patients, 1,425 (51.8%) were males and 1,324 (48.2%) were females, with a mean age of 58.7 years. A total of 541 (19.7%) patients tested positive for autoantibodies. Autoantibody positivity was associated with a higher risk of severe fibrosis or cirrhosis in MASLD patients (odds ratio 1.28, 95% CI [1.0–1.6]). This association persisted across various subgroups, including those with concurrent hepatitis B and C virus infections. In contrast, in alcohol liver disease, autoantibody-positive patients exhibited a lower risk. Autoantibody positivity emerges as a potential predictive marker for advanced liver disease in MASLD patients, facilitating risk stratification and tailored interventions. This study highlights the clinical relevance of autoantibodies in MASLD and underscores the need for prospective validation and mechanistic investigations to refine risk assessment and management strategies.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"109 S129","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.3138/canlivj-2023-0022
Adnan Malik, M. Malik
Curcumin is an anti-inflammatory that is proposed to have a positive impact on patients with NAFLD. We aim to assess the effects of curcumin in patients with NAFLD. Clinical trials from PubMed, Scopus, the Web of Science, and Cochrane CENTRAL with variables: alanine transferase, aspartate transaminase, alkaline phosphatase, glycated hemoglobin (HBA1c), body mass index, waist circumference, total cholesterol, total glycerides, high-density lipoproteins, and low-density lipoproteins were included. Homogeneous and heterogeneous were analyzed under a fixed-effects model and the random-effects model, respectively. Fourteen clinical trials found that curcumin has no statistically significant effect on alanine transferase (MD = −2.20 [−6.03, 1.63], p = 0.26], aspartate transaminase (MD = 1.37 [−4.56, 1.81], p = 0.4), alkaline phosphatase (MD = 3.06 [−15.85, 9.73], p = 0.64), glycated hemoglobin (HBA1c), (MD = −0.06 [−0.13, 0.02], p = 0.16], and body-mass index (MD = 0.04 [−0.38, 0.46], p = 0.86). Curcumin reduced the waist circumference (MD = −4.87 [−8.50, −1.25], p = 0.008). Lipid profile parameters were not significant, except the total glycerides (MD = −13.22 [−24.19, −2.24], p = 0.02). Curcumin significantly reduces total glycerides and waist circumference in NAFLD.
{"title":"Effects of curcumin in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis","authors":"Adnan Malik, M. Malik","doi":"10.3138/canlivj-2023-0022","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0022","url":null,"abstract":"Curcumin is an anti-inflammatory that is proposed to have a positive impact on patients with NAFLD. We aim to assess the effects of curcumin in patients with NAFLD. Clinical trials from PubMed, Scopus, the Web of Science, and Cochrane CENTRAL with variables: alanine transferase, aspartate transaminase, alkaline phosphatase, glycated hemoglobin (HBA1c), body mass index, waist circumference, total cholesterol, total glycerides, high-density lipoproteins, and low-density lipoproteins were included. Homogeneous and heterogeneous were analyzed under a fixed-effects model and the random-effects model, respectively. Fourteen clinical trials found that curcumin has no statistically significant effect on alanine transferase (MD = −2.20 [−6.03, 1.63], p = 0.26], aspartate transaminase (MD = 1.37 [−4.56, 1.81], p = 0.4), alkaline phosphatase (MD = 3.06 [−15.85, 9.73], p = 0.64), glycated hemoglobin (HBA1c), (MD = −0.06 [−0.13, 0.02], p = 0.16], and body-mass index (MD = 0.04 [−0.38, 0.46], p = 0.86). Curcumin reduced the waist circumference (MD = −4.87 [−8.50, −1.25], p = 0.008). Lipid profile parameters were not significant, except the total glycerides (MD = −13.22 [−24.19, −2.24], p = 0.02). Curcumin significantly reduces total glycerides and waist circumference in NAFLD.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"41 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.3138/canlivj-2023-0023
V. Sood, B. B. Lal, Aniket Deshmukh, R. Khanna, Esha Gahunia, Jamie Strain, Carolina Jimenez Rivera, S. Alam, M. Kehar
Non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease in children. Its prevalence is rising globally, yet it is uncertain if its onset and severity vary between countries. We aimed to compare pediatric NAFLD in two Canadian and Indian tertiary care centers. This study was conducted as a retrospective cohort study and patient related details were retrieved from the electronic records and reviewed. The study analyzed a total of 184 children with NAFLD/MASLD (94 from the Indian site and 89 from the Canadian site) with concordance between NAFLD and MASLD definitions. The Indian children had a higher proportion of symptomatic presentations and family history of metabolic disorders ( p = 0.0001) while the Canadian children had higher median weight, BMI, blood pressure, and waist circumference ( p < 0.05). Indian children had higher hepatic transaminases and low density lipoprotein levels, while the Canadian site had higher serum insulin, blood glucose, homeostasis model assessment of insulin resistance, high density lipoprotein cholesterol levels, liver stiffness, and controlled attenuation parameter values ( p < 0.05). Majority (78%) of the Canadian children who underwent liver biopsy had significant fibrosis (>stage 2). In the overall cohort, waist circumference could be identified as an independent risk factor, irrespective of country of origin, predicting hepatic fibrosis. The study found significant differences between cohorts. Canadian children showed higher obesity grades and greater hepatic steatosis and fibrosis severity. To comprehend the underlying causes, future studies are imperative.
非酒精性脂肪肝（NAFLD）或代谢功能障碍相关性脂肪肝（MASLD）是儿童慢性肝病的主要病因。其发病率在全球范围内呈上升趋势，但其发病率和严重程度在不同国家之间是否存在差异尚不确定。我们旨在比较加拿大和印度两家三级医疗中心的小儿非酒精性脂肪肝发病情况。本研究以回顾性队列研究的形式进行，从电子病历中检索并审查了患者的相关详细信息。研究共分析了184名患有非酒精性脂肪肝/MASLD的儿童（94名来自印度，89名来自加拿大），非酒精性脂肪肝和MASLD的定义一致。印度儿童无症状和有代谢紊乱家族史的比例更高（P = 0.0001），而加拿大儿童的体重、体重指数、血压和腰围中位数更高（P < 0.05）。印度儿童的肝脏转氨酶和低密度脂蛋白水平较高，而加拿大儿童的血清胰岛素、血糖、胰岛素抵抗稳态模型评估、高密度脂蛋白胆固醇水平、肝脏硬度和受控衰减参数值较高 ( p < 0.05)。大多数（78%）接受肝活检的加拿大儿童有明显的肝纤维化（>2 期）。在所有队列中，无论原籍国如何，腰围都可被确定为预测肝纤维化的独立风险因素。研究发现不同组群之间存在明显差异。加拿大儿童的肥胖等级更高，肝脏脂肪变性和肝纤维化的严重程度也更严重。要了解其根本原因，今后的研究势在必行。
{"title":"Breaking boundaries: Unraveling metabolic dysfunction-associated steatotic liver disease in children of India and Canada","authors":"V. Sood, B. B. Lal, Aniket Deshmukh, R. Khanna, Esha Gahunia, Jamie Strain, Carolina Jimenez Rivera, S. Alam, M. Kehar","doi":"10.3138/canlivj-2023-0023","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0023","url":null,"abstract":"Non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease in children. Its prevalence is rising globally, yet it is uncertain if its onset and severity vary between countries. We aimed to compare pediatric NAFLD in two Canadian and Indian tertiary care centers. This study was conducted as a retrospective cohort study and patient related details were retrieved from the electronic records and reviewed. The study analyzed a total of 184 children with NAFLD/MASLD (94 from the Indian site and 89 from the Canadian site) with concordance between NAFLD and MASLD definitions. The Indian children had a higher proportion of symptomatic presentations and family history of metabolic disorders ( p = 0.0001) while the Canadian children had higher median weight, BMI, blood pressure, and waist circumference ( p < 0.05). Indian children had higher hepatic transaminases and low density lipoprotein levels, while the Canadian site had higher serum insulin, blood glucose, homeostasis model assessment of insulin resistance, high density lipoprotein cholesterol levels, liver stiffness, and controlled attenuation parameter values ( p < 0.05). Majority (78%) of the Canadian children who underwent liver biopsy had significant fibrosis (>stage 2). In the overall cohort, waist circumference could be identified as an independent risk factor, irrespective of country of origin, predicting hepatic fibrosis. The study found significant differences between cohorts. Canadian children showed higher obesity grades and greater hepatic steatosis and fibrosis severity. To comprehend the underlying causes, future studies are imperative.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"152 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140428560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.3138/canlivj-2023-0028
G. Zacharia, Anu Jacob, Manivarnan Karichery, Abhishek Sasidharan
Treatment of hypercholesterolemia with statins is considered one of the cornerstones in the management of atherosclerotic cardiovascular diseases. Statins exert their hypolipidemic effects by inhibiting HMG-CoA reductase, the key enzyme in cholesterol biosynthesis. Beyond cholesterol reduction, statins exhibit pleiotropic effects, including anti-inflammatory, antioxidant, and antiproliferative actions, making them valuable in mitigating atherosclerotic and non-atherosclerotic diseases. Though concerns of hepatotoxicity have been associated with the use of statins, extensive evidence suggests that the risk of statin-induced liver injury (SILI) is rare, with an incidence of <1%. Hepatic adverse effects include reversible asymptomatic transaminase elevation (most frequent), hepatitis, cholestasis, and rarely acute liver failure. While hepatotoxicity concerns should not be dismissed, the evidence overwhelmingly supports the safety of statins. Contrary to the myth of statin hepatotoxicity, real-world data and extensive research emphasize the safety and benefits of statins. They are therapeutic in various liver-related conditions, mainly non-alcoholic fatty liver disease. This scientific review aims to provide a comprehensive overview of statins, shedding light on their mechanism of action, hepatotoxicity concerns, and therapeutic potential in various liver-related conditions.
{"title":"Impact of statins in the liver: A bane or a boon?","authors":"G. Zacharia, Anu Jacob, Manivarnan Karichery, Abhishek Sasidharan","doi":"10.3138/canlivj-2023-0028","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0028","url":null,"abstract":"Treatment of hypercholesterolemia with statins is considered one of the cornerstones in the management of atherosclerotic cardiovascular diseases. Statins exert their hypolipidemic effects by inhibiting HMG-CoA reductase, the key enzyme in cholesterol biosynthesis. Beyond cholesterol reduction, statins exhibit pleiotropic effects, including anti-inflammatory, antioxidant, and antiproliferative actions, making them valuable in mitigating atherosclerotic and non-atherosclerotic diseases. Though concerns of hepatotoxicity have been associated with the use of statins, extensive evidence suggests that the risk of statin-induced liver injury (SILI) is rare, with an incidence of <1%. Hepatic adverse effects include reversible asymptomatic transaminase elevation (most frequent), hepatitis, cholestasis, and rarely acute liver failure. While hepatotoxicity concerns should not be dismissed, the evidence overwhelmingly supports the safety of statins. Contrary to the myth of statin hepatotoxicity, real-world data and extensive research emphasize the safety and benefits of statins. They are therapeutic in various liver-related conditions, mainly non-alcoholic fatty liver disease. This scientific review aims to provide a comprehensive overview of statins, shedding light on their mechanism of action, hepatotoxicity concerns, and therapeutic potential in various liver-related conditions.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"48 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.3138/canlivj-2023-0031
M. Jogendran, Jennifer A. Flemming
The incidence of gynecological and breast cancers is on the rise in addition to a rise in the incidence of cirrhosis among women. Women with cirrhosis are generally excluded from clinical trials therefore little is known about the oncologic and/or liver-related outcomes in this population. The aim of this study was to review the current literature regarding treatment and survival outcomes in females with gynecological or breast cancer with underlying cirrhosis. An electronic search was conducted for studies reporting outcomes among females with cirrhosis and gynecological and breast cancer. References were reviewed for relevant publications. Studies were reviewed and data were extracted from publications. Three thousand one hundred ninety one articles were identified, and five studies were reviewed in full. Thirty unique patients were identified. Ten patients with breast cancer were identified, 9/10 patients did not have cancer recurrence in the follow-up period, and 1/10 did not have follow up. 1/10 patient's received chemotherapy and developed degree II abnormal liver function and bone marrow suppression. 2/9 patients experienced postoperative complications, one had worsening thrombocytopenia and one developed mild encephalopathy. Nienteen patients with ovarian cancer all received surgery and chemotherapy. 10/19 had postoperative complications and 1/19 died in follow-up period. One patient had a neuroendocrine uterine cancer stage IV who died after one cycle of chemotherapy. There is limited data on the outcomes and management of patients with both cirrhosis and gynecological or breast cancers. Therefore, further work is necessary to address these gaps in clinical practice to improve patient care.
{"title":"Outcomes of gynecological and breast cancer among female patients with cirrhosis: Scoping review of the literature","authors":"M. Jogendran, Jennifer A. Flemming","doi":"10.3138/canlivj-2023-0031","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0031","url":null,"abstract":"The incidence of gynecological and breast cancers is on the rise in addition to a rise in the incidence of cirrhosis among women. Women with cirrhosis are generally excluded from clinical trials therefore little is known about the oncologic and/or liver-related outcomes in this population. The aim of this study was to review the current literature regarding treatment and survival outcomes in females with gynecological or breast cancer with underlying cirrhosis. An electronic search was conducted for studies reporting outcomes among females with cirrhosis and gynecological and breast cancer. References were reviewed for relevant publications. Studies were reviewed and data were extracted from publications. Three thousand one hundred ninety one articles were identified, and five studies were reviewed in full. Thirty unique patients were identified. Ten patients with breast cancer were identified, 9/10 patients did not have cancer recurrence in the follow-up period, and 1/10 did not have follow up. 1/10 patient's received chemotherapy and developed degree II abnormal liver function and bone marrow suppression. 2/9 patients experienced postoperative complications, one had worsening thrombocytopenia and one developed mild encephalopathy. Nienteen patients with ovarian cancer all received surgery and chemotherapy. 10/19 had postoperative complications and 1/19 died in follow-up period. One patient had a neuroendocrine uterine cancer stage IV who died after one cycle of chemotherapy. There is limited data on the outcomes and management of patients with both cirrhosis and gynecological or breast cancers. Therefore, further work is necessary to address these gaps in clinical practice to improve patient care.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"10 9‐10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.3138/canlivj-2023-0016
M. Selfridge, T. Barnett, K. Lundgren, K. Guarasci, A. Drost, Chris Fraser
Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment are required to meet this goal. Novel models such as Tayside, Scotland pharmacy-based HCV screening and treatment have proven successful to engage people who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care. This study seeks to determine whether these successes can be replicated at community pharmacies in Victoria BC. Four pharmacies who work with PWUD and provide opioid agonist therapy were trained to provide consent and perform point of care HCV antibody screening. They were supported by study nurse to link to HCV RNA testing when antibody positive patients were identified, with HCV treatment offered to RNA positive participants. Qualitative interviews were conducted with five pharmacy staff to explore experiences and feasibility of pharmacists in HCV care cascade. Pharmacy staff completed 200 HCV OraQuick tests between October 2020 and June 2022: 65 HCV antibody positive, 29 HCV RNA negative (25 previously treated and 4 self-cleared). Of the 26 RNA positive participants, one is awaiting treatment, 25 people have started treatment, 22 achieving SVR. Although the onset of the COVID 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV, and illicit drug use continues to impact this process. This innovative pharmacy-based approach found people with limited connection to primary health care to test and treat HCV but requires more training and support to be more widely feasible.
{"title":"‘I just never wanted them to feel uncomfortable’ – Barriers to pharmacy-based identification and treatment of hepatitis C in Victoria, Canada","authors":"M. Selfridge, T. Barnett, K. Lundgren, K. Guarasci, A. Drost, Chris Fraser","doi":"10.3138/canlivj-2023-0016","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0016","url":null,"abstract":"Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment are required to meet this goal. Novel models such as Tayside, Scotland pharmacy-based HCV screening and treatment have proven successful to engage people who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care. This study seeks to determine whether these successes can be replicated at community pharmacies in Victoria BC. Four pharmacies who work with PWUD and provide opioid agonist therapy were trained to provide consent and perform point of care HCV antibody screening. They were supported by study nurse to link to HCV RNA testing when antibody positive patients were identified, with HCV treatment offered to RNA positive participants. Qualitative interviews were conducted with five pharmacy staff to explore experiences and feasibility of pharmacists in HCV care cascade. Pharmacy staff completed 200 HCV OraQuick tests between October 2020 and June 2022: 65 HCV antibody positive, 29 HCV RNA negative (25 previously treated and 4 self-cleared). Of the 26 RNA positive participants, one is awaiting treatment, 25 people have started treatment, 22 achieving SVR. Although the onset of the COVID 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV, and illicit drug use continues to impact this process. This innovative pharmacy-based approach found people with limited connection to primary health care to test and treat HCV but requires more training and support to be more widely feasible.","PeriodicalId":9527,"journal":{"name":"Canadian liver journal","volume":"95 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140477196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24DOI: 10.3138/canlivj-2023-0011
K. Ismond, Christofer Cruz, A. Limon-Miro, Gavin Low, Carla M Prado, John C Spence, Maitreyi Raman, Margaret McNeely, Puneeta Tandon
Nutrition and exercise are the mainstay of therapy for the prevention and treatment of frailty in cirrhosis. This pilot study assessed feasibility of the online delivery of an app-based semi-supervised nutrition and exercise intervention in this population. The 11-week pilot recruited adults with cirrhosis who owned internet-connected devices. Patients were encouraged to participate in exercise sessions 3× per week including a combination of online group exercise (weekly) and home-based follow-along exercise (biweekly). They also participated in group nutrition classes (five sessions) and one-to-one exercise and nutrition check-ins delivered through the app. Primary outcome measures pertained to program feasibility: recruitment, retention, adherence, and satisfaction. Exploratory measures included physical performance (liver frailty index [LFI], 6-minute walk test [6MWT]), health behaviour domains, and quality of life. Twenty three patients completed baseline measures. Of these, 18 (72%) completed end of study measures (mean MELD-Na, 9.2; female, 44.4%). Over 70% of participants fulfilled 75% or more of the feasibility criteria. Satisfaction with the program was high (mean, 89%). Exercise program modifications were required for 17 patients to accommodate health events or abilities. Exploratory evaluation showed improvement in the LFI and the 6MWT by −0.58-units (95% CI: −0.91 to −0.25) and 46.0 m (95% CI: 22.7–69.3) respectively without changes in quality of life or health behaviour domains. Outcomes demonstrate feasibility of the app-based delivery of programming with promising exploratory impact on efficacy for physical performance. Findings can guide the design of a large-scale app-based randomized controlled trials in cirrhosis.
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