RESUMO
In this article, we report on a 62-year-old non-cirrhotic male presenting to the emergency department (ED) with chronic abdominal pain, anorexia, and weight loss. Upon initial presentation, physical exam was unremarkable, other than for sarcopenia and splenomegaly. Initial imaging studies revealed a large thrombosis from the iliac vein to the right atrium of the heart. Following discharge, the patient re-consulted to the ED four months later and was re-admitted in renal failure and ascites. The diagnosis of Budd-Chiari syndrome (BCS) was established. Positive immunohistochemistry confirmed a neoplastic ideology of epithelial nature. This case offers a unique perspective on the clinical presentation of secondary BCS, necessitating a consideration in the differential diagnosis of a para-vascular cause. In this case, chronic abdominal pain, often overlooked, may necessitate further workup to establish a clinical diagnosis.
RESUMO
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.
RESUMO
BACKGROUND AND AIMS: Frailty is associated with increased morbidity and mortality, and this is tightly linked to liver decompensation and increased complication rates among liver transplant (LT) candidates. The aim of the study was to evaluate the efficacy of a structured in- and outpatient exercise training program for cirrhotic patients who were referred for liver transplant evaluation. METHODS: We retrospectively reviewed 458 consecutive LT patients. There were 200 patients who underwent LT prior to the implementation of an exercise training program (non-ETP) and 258 LT patients who underwent a comprehensive exercise training program (ETP). Baseline characteristics, readmission rate, and length of hospital stay (LOS) were analyzed and compared between the 2 groups. RESULTS: The ETP group were more likely to have diabetes mellitus and coronary artery disease. However, there was no significant difference in the postoperative complication rates between the 2 groups except for more infections in the ETP group compared to the non-ETP group. There was a trend toward lower 90-day readmission rate in the ETP group (17.9% vs 20%) and shorter LOS (14 vs 17 days). CONCLUSION: There was a trend toward reduced 90-day readmission and shorter length of stay after implementation of an exercise training program.