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  1. Article ; Online: Successful Liver Retransplantation in a Patient With Disseminated Aspergillosis and Nocardiosis: A Case Report.

    Jayawardena, Thisuri / Attree, Chloe / Cole, Sarah / Hui, Siong / Jaques, Bryon / MacQuillan, Gerry / Smith, Briohny / Wallace, Michael / Garas, George / Adams, Leon / Jeffrey, Gary

    Transplantation proceedings

    2024  Volume 56, Issue 1, Page(s) 244–248

    Abstract: Background: Clinical guidelines list active fungal infection and sepsis as contraindications to liver transplantation due to the risk of worsening infection with immunosuppression postoperatively. Mortality from systemic opportunistic infections in ... ...

    Abstract Background: Clinical guidelines list active fungal infection and sepsis as contraindications to liver transplantation due to the risk of worsening infection with immunosuppression postoperatively. Mortality from systemic opportunistic infections in transplant recipients is high, approaching 100% for disseminated aspergillosis. However, the optimal duration of treatment required before transplant is unclear. Additionally, delaying surgery while the infection is treated risks death from hepatic decompensation and physical deconditioning, preventing progression to transplantation.
    Case report: Here, we present a patient who underwent successful repeat liver transplantation for recurrent autoimmune hepatitis and graft rejection while undergoing treatment for disseminated aspergillosis and nocardiosis. He had pulmonary, hepatic, and central nervous system involvement. He had received 2 months of antimicrobials but had ongoing radiologic evidence of infection when listed for retransplantation. He remains well and infection-free 1 year postoperatively.
    Conclusion: Few cases of successful liver transplantation in the setting of disseminated aspergillosis have been reported previously. To our knowledge, this is the first successful liver transplant in a patient with disseminated nocardial infection.
    MeSH term(s) Male ; Humans ; Reoperation ; Aspergillosis/drug therapy ; Liver ; Nocardia Infections/diagnosis ; Nocardia Infections/surgery ; Liver Transplantation/adverse effects
    Language English
    Publishing date 2024-01-13
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 82046-5
    ISSN 1873-2623 ; 0041-1345
    ISSN (online) 1873-2623
    ISSN 0041-1345
    DOI 10.1016/j.transproceed.2023.11.005
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  2. Article ; Online: Delayed Fulminant Hepatic Failure from Dydrogesterone-Related In Vitro Fertilization Therapy Requiring Liver Transplantation During Pregnancy.

    Malherbe, Jacques A J / Garas, George / Khor, Tze S / MacQuillan, Gerry C

    The American journal of case reports

    2020  Volume 21, Page(s) e925690

    Abstract: ... progestogens (e.g. dydrogesterone) is extremely rare and has not been reported in pregnancy. Furthermore ...

    Abstract BACKGROUND Drug-induced liver failure is a rare complication of pregnancy and occasionally requires liver transplantation. However, fulminant liver failure arising from in vitro fertilization (IVF) therapy involving progestogens (e.g. dydrogesterone) is extremely rare and has not been reported in pregnancy. Furthermore, dydrogesterone-mediated hepatic dysfunction has not previously necessitated liver transplantation and is usually conservatively managed. We report the first Australian case of a pregnant woman with delayed fulminant liver failure and in utero fetal death requiring a liver transplant from dydrogesterone use. CASE REPORT A 35-year-old multiparous (G₅P₂) woman presented with painless jaundice and transaminitis (alanine aminotransferase and aspartate aminotransferase of 2800 U/L and 2990 U/L respectively). She was pregnant at 14 weeks' gestation after successful IVF in Thailand four months before involving dydrogesterone therapy. She was diagnosed with delayed, subfulminant liver failure arising from previous dydrogesterone use. Initially, she was not encephalopathic and conservative management strategies were instituted. Her hepatic dysfunction progressed and she deteriorated clinically with encephalopathy, necessitating an emergent liver transplantation. Fetal death was confirmed in utero four days before transplantation. A combined orthotopic liver transplant and hysterotomy with fetal evacuation were performed without complication. CONCLUSIONS Fulminant liver failure in pregnancy due to idiosyncratic drug reactions are rare. Dydrogesterone may cause significant, albeit delayed, liver dysfunction in pregnancy necessitating the need for liver transplantation. Early recognition of progressive liver failure despite best supportive care efforts should prompt early considerations for liver transplantation. Delays in liver transplantation with prolonged hyperbilirubinemia and coagulopathy may exacerbate fetal death in utero.
    MeSH term(s) Adult ; Australia ; Dydrogesterone/adverse effects ; Female ; Fertilization in Vitro ; Humans ; Liver Failure, Acute/chemically induced ; Liver Failure, Acute/surgery ; Liver Transplantation/adverse effects ; Pregnancy ; Thailand
    Chemical Substances Dydrogesterone (90I02KLE8K)
    Language English
    Publishing date 2020-09-17
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2517183-5
    ISSN 1941-5923 ; 1941-5923
    ISSN (online) 1941-5923
    ISSN 1941-5923
    DOI 10.12659/AJCR.925690
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  3. Article ; Online: Comparative Accuracy of Clinical Fibrosis Markers, Hepascore and Fibroscan® to Detect Advanced Fibrosis in Patients with Nonalcoholic Fatty Liver Disease.

    Bertot, Luis C / Jeffrey, Gary P / de Boer, Bastiaan / Wang, Zhengyi / Huang, Yi / Garas, George / MacQuillan, Gerry / Wallace, Michael / Smith, Briohny W / Adams, Leon A

    Digestive diseases and sciences

    2023  Volume 68, Issue 6, Page(s) 2757–2767

    Abstract: Background: Non-invasive tests are widely used to diagnose fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), however, the optimal method remains unclear. We compared the accuracy of simple serum models, a serum model incorporating ... ...

    Abstract Background: Non-invasive tests are widely used to diagnose fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), however, the optimal method remains unclear. We compared the accuracy of simple serum models, a serum model incorporating direct measures of fibrogenesis (Hepascore), and Fibroscan®, for detecting fibrosis in NAFLD.
    Methods: NAFLD patients undergoing liver biopsy were evaluated with Hepascore, NAFLD Fibrosis Score (NFS), FIB-4 and AST-platelet ratio index (APRI), with a subset (n = 131) undergoing Fibroscan®. Fibrosis on liver biopsy was categorized as advanced (F3-4) or cirrhosis (F4). Accuracy was determined by area under receiving operating characteristic curves (AUC). Indeterminate ranges were calculated using published cut-offs.
    Results: In 271 NAFLD patients, 83 (31%) had F3-4 and 47 (17%) cirrhosis. 6/131 (4%) had an unreliable Fibroscan®. For the detection of advanced fibrosis, the accuracy of Hepascore (AUC 0.88) was higher than FIB-4 (0.73), NFS (0.72) and APRI (0.69) (p < 0.001 for all). Hepascore had similar accuracy to Fibroscan® (0.80) overall, but higher accuracy in obese individuals (0.91 vs 0.80, p = 0.001). Hepascore more accurately identified patients with cirrhosis than APRI (AUC 0.85 vs 0.71, p = 0.01) and NFS (AUC 0.73, p = 0.01) but performed similar to FIB-4 and Fibroscan®. For the determination of F3-4, the proportion of patients in indeterminate area was lower for Hepascore (4.8%), compared to FIB-4 (42%), NFS (36%) and APRI (44%) (p < 0.001 for all).
    Conclusions: Hepascore has greater accuracy and a lower indeterminate range than simple serum fibrosis tests for advanced fibrosis in NAFLD, and greater accuracy than Fibroscan® in obese individuals.
    MeSH term(s) Humans ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Liver/diagnostic imaging ; Liver/pathology ; Severity of Illness Index ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/etiology ; Fibrosis ; Biomarkers ; Obesity/complications ; Obesity/pathology ; Biopsy ; Aspartate Aminotransferases
    Chemical Substances Biomarkers ; Aspartate Aminotransferases (EC 2.6.1.1)
    Language English
    Publishing date 2023-03-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-023-07896-3
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  4. Article ; Online: The MAAPE score in intermediate and advanced hepatocellular carcinoma treated with Yttrium-90 resin microsphere radioembolization.

    Wallace, Michael C / Samuelson, Shaun / Khoo, Tiffany / Ooi, Jacob / Tibballs, Jonathan / Ferguson, John / Preen, David B / Knuiman, Matthew / Garas, George / MacQuillan, Gerry / Adams, Leon A / Jeffrey, Gary P

    Journal of gastroenterology and hepatology

    2020  Volume 35, Issue 11, Page(s) 1945–1952

    Abstract: ... 150 IU/L), higher serum Albumin (> 37 g/L), absence of Portal vein tumor thrombus, and better ...

    Abstract Background and aim: Yttrium-90 resin microsphere radioembolization (RE) is not recommended for routine use in intermediate or advanced hepatocellular carcinoma (HCC) by recent guidelines. This study aims to establish pre-treatment variables which predict survival in HCC patients treated with RE to identify those who will benefit most from it, and to inform patient selection for future trials.
    Methods: Single center, retrospective study of consecutive patients with HCC treated with RE from 2007 to 2018. Patients included if undergoing their first RE treatment for intermediate or advanced HCC; a Child-Pugh score of B7 or less; and a performance status of 1 or less. Multivariable Cox regression identified variables that were significantly associated with survival. A predictive score was developed based upon coefficients from the fitted Cox regression model, and cubic spline regression was used to identify prognostic groups.
    Results: One hundred thirteen patients with intermediate (53.1%) and advanced HCC (45.1%) followed for a median of 13.2 months were included. Variables associated with superior survival used to derive the MAAPE score were lower Model for End-Stage Liver Disease score (≤ 7), lower Alpha-fetoprotein (≤ 150 IU/L), higher serum Albumin (> 37 g/L), absence of Portal vein tumor thrombus, and better performance status (Eastern Cooperative Oncology Group = 0). Three survival prognostic groups were identified: good (median overall survival 25.0 months), average (15.3 months), and poor (6.3 months) (overall log-rank test, P < 0.001).
    Conclusion: The MAAPE score accurately identifies HCC patients in whom RE is safe and effective. This will allow for optimal patient selection for future trials of RE versus systemic therapy.
    MeSH term(s) Aged ; Biomarkers, Tumor/blood ; Carcinoma, Hepatocellular/diagnosis ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/radiotherapy ; Embolization, Therapeutic/methods ; Female ; Humans ; Liver Neoplasms/diagnosis ; Liver Neoplasms/mortality ; Liver Neoplasms/radiotherapy ; Male ; Microspheres ; Middle Aged ; Prognosis ; Research Design ; Retrospective Studies ; Safety ; Serum Albumin ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Yttrium Radioisotopes/administration & dosage ; alpha-Fetoproteins
    Chemical Substances Biomarkers, Tumor ; Serum Albumin ; Yttrium Radioisotopes ; alpha-Fetoproteins
    Language English
    Publishing date 2020-02-23
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 632882-9
    ISSN 1440-1746 ; 0815-9319
    ISSN (online) 1440-1746
    ISSN 0815-9319
    DOI 10.1111/jgh.15008
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  5. Article ; Online: Broadening and strengthening the health providers caring for patients with chronic hepatitis C may improve continuity of care.

    Clark, Paul J / Valery, Patricia C / Strasser, Simone I / Weltman, Martin / Thompson, Alex / Levy, Miriam T / Leggett, Barbara / Zekry, Amany / Rong, Julian / Sinclair, Marie / George, Jacob / Bollipo, Steven / McGarity, Bruce / Sievert, William / MacQuillan, Gerry / Tse, Edmund / Nicoll, Amanda / Wade, Amanda / Cheng, Wendy /
    Roberts, Stuart K

    Journal of gastroenterology and hepatology

    2023  Volume 39, Issue 3, Page(s) 568–575

    Abstract: Background: Direct-acting antiviral (DAA) therapies for hepatitis C virus infection (HCV) lead ... Pugh class B/C), and 19.3% had HCV treatment prior to the DAA era. Five hundred and fifteen patients ...

    Abstract Background: Direct-acting antiviral (DAA) therapies for hepatitis C virus infection (HCV) lead to excellent rates of sustained virological response (SVR). However, loss to follow-up (LTFU) for SVR testing remains a challenge. We examine factors associated with LTFU in a real-world setting.
    Methods: Adults who received DAA therapy for HCV in one of 26 centers across Australia during 2016-2021 were followed up for 2 years. Data sources included the patient medical records and the national Pharmaceutical and Medicare Benefits Schemes. Linkage to Medicare provided utilization data of other health-care providers and re-treatment with DAAs. LTFU was defined as no clinic attendance for SVR testing by at least 52 weeks after DAA treatment commencement. Multivariable logistic regression assessed factors associated with LTFU.
    Results: In 3619 patients included in the study (mean age 52.0 years; SD = 10.5), 33.6% had cirrhosis (69.4% Child-Pugh class B/C), and 19.3% had HCV treatment prior to the DAA era. Five hundred and fifteen patients (14.2%) were LTFU. HCV treatment initiation in 2017 or later (adj-OR = 2.82, 95% confidence interval [CI] 2.25-3.54), younger age (adj-OR = 2.63, 95% CI 1.80-3.84), Indigenous identification (adj-OR = 1.99, 95% CI 1.23-3.21), current injection drug use or opioid replacement therapy (adj-OR = 1.66, 95% CI 1.25-2.20), depression treatment (adj-OR = 1.49, 95% CI 1.17-1.90), and male gender (adj-OR = 1.31, 95% CI 1.04-1.66) were associated with LTFU.
    Conclusions: These findings stress the importance of strengthening the network of providers caring for patients with HCV. In particular, services targeting vulnerable groups of patients such as First Nations Peoples, youth health, and those with addiction and mental health disorders should be equipped to treat HCV.
    MeSH term(s) Adult ; Humans ; Male ; Aged ; Adolescent ; Middle Aged ; Hepatitis C, Chronic ; Antiviral Agents/therapeutic use ; National Health Programs ; Hepatitis C/drug therapy ; Hepacivirus ; Sustained Virologic Response ; Patient Care ; Continuity of Patient Care
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2023-12-19
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 632882-9
    ISSN 1440-1746 ; 0815-9319
    ISSN (online) 1440-1746
    ISSN 0815-9319
    DOI 10.1111/jgh.16440
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  6. Article ; Online: The Prognostic Ability of Major Hepatocellular Carcinoma Staging Systems Is Improved by Including a Treatment Variable.

    Wallace, Michael C / Knuiman, Matthew / Huang, Yi / Garas, George / Adams, Leon A / MacQuillan, Gerry / Preen, David B / Jeffrey, Gary P

    Digestive diseases and sciences

    2018  Volume 63, Issue 9, Page(s) 2277–2284

    Abstract: ... information criterion and Harrell's C statistic.: Results: The BCLC, HKLC5, and HKLC9 systems were ...

    Abstract Background and aims: There has been significant debate regarding which hepatocellular carcinoma (HCC) staging system is best able to predict survival. We hypothesized that the prognostic ability of the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) systems would be improved with the addition of an explicit treatment variable.
    Methods: We performed an analysis of a prospectively enrolled cohort of 292 patients undergoing 532 treatment episodes for HCC from 2006 to 2014. BCLC, standard nine-stage HKLC (HKLC9), and modified five-stage HKLC (HKLC5) for each treatment episode were assessed. Overall survival and time to disease progression were calculated for the initial treatment, re-treatment, and overall treatment cohorts. We compared the performance of various prognostic models including staging system alone, treatment alone, and staging system plus treatment using the corrected Akaike information criterion and Harrell's C statistic.
    Results: The BCLC, HKLC5, and HKLC9 systems were significant predictors of survival and time to progression for all treatment cohorts (log rank test, p < 0.001). The addition of a treatment variable significantly improved (p < 0.01) the prognostic ability of the survival and time to progression models compared with those containing only the BCLC or HKLC stage across all treatment cohorts other than survival in re-treatment for BCLC (p = 0.094).
    Conclusions: Adding a treatment variable to major HCC staging systems improves their ability to predict survival and time to progression in initial treatment, re-treatment, and overall.
    MeSH term(s) Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/therapy ; Clinical Decision-Making ; Decision Support Techniques ; Disease Progression ; Female ; Guideline Adherence ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Neoplasm Staging/methods ; Neoplasm Staging/standards ; Practice Guidelines as Topic ; Practice Patterns, Physicians' ; Predictive Value of Tests ; Proportional Hazards Models ; Retreatment ; Risk Factors ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2018-05-28
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-018-5132-2
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  7. Article ; Online: Diabetes impacts prediction of cirrhosis and prognosis by non-invasive fibrosis models in non-alcoholic fatty liver disease.

    Bertot, Luis C / Jeffrey, Gary P / de Boer, Bastiaan / MacQuillan, Gerry / Garas, George / Chin, Justin / Huang, Yi / Adams, Leon A

    Liver international : official journal of the International Association for the Study of the Liver

    2018  Volume 38, Issue 10, Page(s) 1793–1802

    Abstract: ... by Harrell's C-index and by Kaplan-Meier analysis.: Results: A total of 284 patients (53% diabetic, 15 ...

    Abstract Background & aims: Non-alcoholic fatty liver disease (NAFLD) patients with diabetes are at increased risk of cirrhosis and liver-related death, and thus accurate fibrosis assessment in these patients is important. We examined the ability of non-invasive fibrosis models to determine cirrhosis and outcomes in NAFLD patients with and without diabetes.
    Methods: Non-alcoholic fatty liver disease patients diagnosed between 2006 and 2015 had Hepascore, NAFLD fibrosis score (NFS), APRI and FIB-4 scores calculated at baseline and were followed up for outcomes of overall and liver-related mortality/liver transplantation, hepatic decompensation and hepatocellular carcinoma (HCC). Model accuracy was determined by Harrell's C-index and by Kaplan-Meier analysis.
    Results: A total of 284 patients (53% diabetic, 15% cirrhotic) were followed up for a median of 51.4 months, (range 6.1-146). During follow-up, diabetic patients had a greater risk of liver-related death/transplantation, HR 3.4 (95% CI 1.2-9.1) decompensation, HR 4.7 (95% CI 2.0-11.3) and HCC, HR 2.9 (95% CI 1.2-7.3). Among 241 subjects with a baseline liver biopsy, the accuracy of Hepascore, APRI and FIB-4 for predicting cirrhosis was lower amongst diabetics compared to non-diabetics (P < .005 for all). Model accuracy apart from Hepascore, was also significantly lower for predicting liver death/transplantation in patients with diabetes. No patient with a low fibrosis score and without diabetes developed liver decompensation or HCC, whereas up to 21% of diabetic patients with a low fibrosis score developed liver decompensation and up to 27% developed HCC at 5 years.
    Conclusions: Non-invasive scoring systems are less accurate at predicting cirrhosis and liver-related outcomes in patients with NAFLD and diabetes.
    MeSH term(s) Adult ; Aged ; Australia/epidemiology ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/surgery ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/pathology ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Liver/pathology ; Liver/surgery ; Liver Cirrhosis/complications ; Liver Neoplasms/mortality ; Liver Neoplasms/surgery ; Liver Transplantation ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/pathology ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index
    Language English
    Publishing date 2018-03-31
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2102783-3
    ISSN 1478-3231 ; 1478-3223
    ISSN (online) 1478-3231
    ISSN 1478-3223
    DOI 10.1111/liv.13739
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  8. Article ; Online: Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up.

    Clark, Paul J / Valery, Patricia C / Ward, James / Strasser, Simone I / Weltman, Martin / Thompson, Alexander / Levy, Miriam T / Leggett, Barbara / Zekry, Amany / Rong, Julian / Angus, Peter / George, Jacob / Bollipo, Steven / McGarity, Bruce / Sievert, William / Macquillan, Gerry / Tse, Edmund / Nicoll, Amanda / Wade, Amanda /
    Chu, Geoff / Harding, Damian / Cheng, Wendy / Farrell, Geoff / Roberts, Stuart K

    BMC gastroenterology

    2022  Volume 22, Issue 1, Page(s) 339

    Abstract: Background: First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV ...

    Abstract Background: First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection.
    Methods: Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016-2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU.
    Results: Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger (p < 0.001), morel likely to reside in most disadvantaged (p = 0.002) and in regional/remote areas (p < 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8%; p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients; p = 0.51) and 'good' adherence (90.0% vs. 86.9%, respectively; p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients (p < 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87-0.99) and treatment initiation in 2018-2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23-21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50-0.99).
    Conclusions: Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed.
    MeSH term(s) Adult ; Aged ; Antiviral Agents/therapeutic use ; Australia/epidemiology ; Follow-Up Studies ; Hepacivirus ; Hepatitis C/drug therapy ; Hepatitis C, Chronic/drug therapy ; Humans ; National Health Programs ; Prospective Studies ; Sustained Virologic Response
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2022-07-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041351-8
    ISSN 1471-230X ; 1471-230X
    ISSN (online) 1471-230X
    ISSN 1471-230X
    DOI 10.1186/s12876-022-02416-5
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  9. Article ; Online: Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort.

    Clark, Paul J / Valery, Patricia C / Strasser, Simone I / Weltman, Martin / Thompson, Alexander J / Levy, Miriam / Leggett, Barbara / Zekry, Amany / Rong, Julian / Angus, Peter / George, Jacob / Bollipo, Steven / McGarity, Bruce / Sievert, William / Macquillan, Gerry / Tse, Edmund / Nicoll, Amanda / Wade, Amanda / Chu, Geoff /
    Harding, Damian / Cheng, Wendy / Farrell, Geoff / Roberts, Stuart K

    Digestive diseases and sciences

    2022  Volume 68, Issue 1, Page(s) 291–303

    Abstract: Background and aims: In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became ... At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2 ...

    Abstract Background and aims: In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia's universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment.
    Methods: 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR).
    Results: At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29-0.61), male gender (adj-OR = 0.49, 95%CI 0.31-0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28-0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36-0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33-0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08-0.80). Consistent results were seen in cirrhotic sub-analysis.
    Conclusions: Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.
    MeSH term(s) Humans ; Male ; Antiviral Agents ; Hepatitis C, Chronic/diagnosis ; Hepatitis C, Chronic/drug therapy ; Hepatitis C, Chronic/complications ; Sustained Virologic Response ; Australia/epidemiology ; Hepatitis C/diagnosis ; Hepatitis C/drug therapy ; Liver Cirrhosis/complications ; Hepacivirus/genetics ; Treatment Outcome
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2022-05-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-022-07483-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Nonalcoholic fatty liver disease-related cirrhosis is commonly unrecognized and associated with hepatocellular carcinoma.

    Bertot, Luis C / Jeffrey, Gary P / Wallace, Michael / MacQuillan, Gerry / Garas, George / Ching, Helena L / Adams, Leon A

    Hepatology communications

    2017  Volume 1, Issue 1, Page(s) 53–60

    Abstract: Determination of cirrhosis in nonalcoholic fatty liver disease (NAFLD) is important as it alters prognosis and management. We aimed to examine whether cirrhosis was diagnosed incidentally or intentionally in patients with NAFLD. We reviewed 100 patients ... ...

    Abstract Determination of cirrhosis in nonalcoholic fatty liver disease (NAFLD) is important as it alters prognosis and management. We aimed to examine whether cirrhosis was diagnosed incidentally or intentionally in patients with NAFLD. We reviewed 100 patients with NAFLD cirrhosis to determine mode of cirrhosis diagnosis (incidental or by intent), severity of liver disease at diagnosis, diagnostician, and previous clinical imaging or laboratory evidence of unrecognized cirrhosis. The majority (66/100) of patients with NAFLD cirrhosis were diagnosed incidentally, with the majority of these (74%) diagnosed with NAFLD simultaneously. Those with incidental cirrhosis diagnoses had more deranged platelet and international normalized ratio levels (
    Language English
    Publishing date 2017-02-27
    Publishing country United States
    Document type Journal Article
    ISSN 2471-254X
    ISSN (online) 2471-254X
    DOI 10.1002/hep4.1018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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