A food product as a potential serious cause of liver injury.

INTRODUCTION: Drug-induced liver injury can be challenging to diagnose, as it can develop following the use of many prescription and nonprescription medications, herbals, and dietary supplements. Food products may not be routinely considered as a potential cause of hepatotoxicity. We describe the clinical features of two cases of acute liver injury following consumption of a smoothie product. CASE PRESENTATIONS: Two patients independently presented to the hospital with epigastric pain and acute liver injury. Both patients had consumed a new smoothie product in the same month that they presented to the hospital, with a recurrence of acute liver injury with further consumption. A diagnosis of drug-induced liver injury was established after the evaluation excluded other causes of liver injury. It was thought that a natural ingredient in the smoothie, tara flour, was the cause of hepatotoxicity based on prior news reports. Both patients stopped drinking the smoothie product with subsequent normalization of liver enzyme activities and no further recurrence of epigastric pain. CONCLUSION: The diagnosis of drug-induced liver injury largely relies on a compatible history and exclusion of other causes of liver injury. We demonstrate the importance of considering new food products in the differential diagnosis of acute liver injury.

Standardized Postpartum Follow-Up for Women with Pregnancy Complications: Barriers to Access and Perceptions of Maternal Cardiovascular Risk.

OBJECTIVE: Certain obstetrical complications are known to increase a woman's risk of future cardiovascular disease (CVD). The Maternal Health Clinic (MHC) provides postpartum cardiovascular risk counselling and follow-up; however, half of women referred do not attend. This study aimed to identify barriers to access, as well as whether attendance at the MHC improved the accuracy of patients' CVD risk perception. METHODS: MHC patients completed a CVD risk perception questionnaire prior to being assessed and 3 months after their appointment ("attendees"). Calculated lifetime CVD risk scores were compared with perceived risk to assess accuracy of risk perception. Patients who did not attend their MHC appointment ("non-attendees") were administered the questionnaire by phone and asked about perceived barriers to access. RESULTS: Sixty-seven of 137 eligible attendees (48.9%) completed both the pre- and post-MHC questionnaires. Significantly more participants accurately estimated their absolute CVD risk after their MHC appointment, although the majority continued to underestimate their risk. Among non-attendees, 81 of 130 women (62.3%) completed the questionnaire. The most common barriers to access cited were being too busy with childcare, accessing follow-up with the patient's family doctor instead, and difficulty attending their appointment. CONCLUSION: Lack of time and inconvenience were two common barriers to accessing the MHC. Improved collaboration with primary care providers and use of telemedicine may help to mitigate these issues. Both attendees and non-attendees appeared to have an inadequate perception of CVD risk. Standardized postpartum CVD risk screening and counselling may be an effective method of providing these women with risk education and improving the accuracy of their risk perception.

Effects of Preeclampsia on Maternal and Pediatric Health at 11 Years Postpartum.

OBJECTIVE: To determine the association of preeclampsia (PE) with the presence of cardiovascular risk (CVR) factors at approximately 11 years postpartum and to assess the longer term effect of PE on childhood development. STUDY DESIGN: A mail-out survey was sent to all women who were previously recruited into the Kingston arm of the Pre-Eclampsia New Emerging Team's prospective cohort (n = 112 PE and n = 150 control). Physical and biochemical CVR markers were compared between the two groups. Physical, social, and cognitive development of the children involved in the pregnancies was evaluated using the Vineland-3 Domain-Level Parent/Caregiver Form. RESULTS: Thirteen PE women and 28 control women returned the study questionnaire. Based on the 2017 American Heart Association High Blood Pressure Clinical Practice Guidelines, 9/13 (69.2%) of the PE women, compared with 6/28 (21.4%) of the control women, have hypertension (p < 0.01). The median percentile rank for overall adaptive functioning was 58 (interquartile range [IQR: 21-73]) in the PE children and 81 (IQR: 61-94) in the control children (p < 0.05). CONCLUSION: The development of PE leads to longer term changes in CVR markers and in childhood development at approximately 11 years postpartum. Pregnancy and the postpartum provide an early window of opportunity for early maternal and child screening and intervention for health preservation and disease prevention.