Below I’ve included a few more slides form recent Aspen Webinars
Fontan Associated Liver Disease Greg Tiao
Related blog posts:
Acute on Chronic Liver Failure Estella Alonso
Immunosuppression strategies ..and is withdrawal possible Kathleen Campbell
For those who want to view the actual lectures, you can sign up and view the recordings: Aspen Webinar Lecture Series
Below I’ve included a few slides and some notes; my notes may have errors of omission or transcription.
COVID-19 and the Liver — Fred Suchy
Key Points:
How I Manage Patients with Autoimmune Hepatitis -Diagnosis and Treatment Amy Taylor.
Key points:
S Jansson et al JPGN 2020; 71: 40-5. This retrospective study (1998-2008) showed that pediatric patients with extraintestinal manifestations (EIM) had more severe IBD course than patients with IBD without an EIM. EIM often had a temporal relationship with a relapse of IBD as well. Of 333 patients, 14 had an EIM at diagnosis and 47 had an EIM develop during followup.
PA Olivera, JS Lasa et al. Gastroenterol 2020; 158: 1554-73. This systematic review and meta-analysis ultimately included 82 studies with 66,159 patients (including those with IBD and other immune-mediated diseases) exposed to a JAK inhibitor; two-thirds of studies were randomized controlled trials. Key findings:
Loebenstein, JD Schulberg. Gastroenterol 2020; 158: 2069-71. This case report describes a successful alternative anti-TNF rechallenge after infliximab induced Lupus in Crohn’s disease. The authors note that in a previous study, 14 of 20 IBD patents with drug-induced lupus secondary to an anti-TNF agent were rechallenged with an alternative anti-TNF agent and 13/14 tolerated rechallenge without recurrent lupus (Inflamm Bowel Dise 2013; 19: 2778-86).
These images show active disease prior to intervention. The article provides f/u images showing endoscopic remission after re-starting a different anti-TNF agent.
S Harpavat et al. JAMA 2020; 323: 1141-50. Link: Diagnostic Yield of Newborn Screening for Biliary Atresia Using Direct or Conjugated Bilirubin Measurements
This article provides details on how to improve the outcomes of children with biliary atresia by detecting cases at an earlier age. The authors provide details on their 2-stage approach at near-universal screening of 124,385 infants in South Texas/Texas Medical Center from 2015-2018 and compare their results to a prior cohort.
Methods: The authors sought to have all infants have a fractionated bilirubin within the first 60 hours of life. This information can easily be obtained due to preexisting policy of testing total bilirubin in this time-frame. Those with any abnormal direct bilirubin or conjugated bilirubin had a 2nd stage screening at 2 weeks of life. At stage 2, any infant with a direct bilirubin >1 mg/dL or higher than 1st stage were considered abnormal. The stage 2 screening aligned with AAP-recommended 2 week check up. During the screening time-frame (2015-2018), 7 patients were identified with BA (one treated at outside institution), 7 more from nonstudy hospitals who had replicated protocol, and 6 referred due to clinical symptoms.
Key findings:
Discussion:
My take: The best chance for transplant-free survival in biliary atresia involves establishing an early diagnosis. This study shows one way to accomplish this goal -nothing else has worked despite more than 30 years of trying.
Related blog posts:
R Levinson et al. NEJM 2020; DOI: 10.1056/NEJMms2024920. Full Link: Reopening Primary Schools during the Pandemic
An excerpt:
Children miss out on essential academic and social–emotional learning, formative relationships with peers and adults, opportunities for play, and other developmental necessities when they are kept at home. Children living in poverty, children of color, English language learners, children with diagnosed disabilities, and young children face especially severe losses.
School-provided social welfare services support the health of U.S. communities made vulnerable by systemic racism, inadequate insurance, family instability, environmental toxicity, and poorly paid jobs.1 More than 50% of all U.S. school-age children rely on their schools for free or reduced-price daily meals. Despite efforts by school districts to maintain these services even when school was conducted remotely, a majority of children have been unable to access the full nutritional benefits to which they’re entitled.5 Schools also provide physical, mental health, and therapeutic services to millions of students per year. Many of these services have proved inaccessible to children — particularly low-income children of color and children with noncitizen family members — when schools are physically closed.1 Finally, safe and consistently open schools are essential for many parents and guardians (particularly women) to be able to reenter the workforce — including the health care sector…
Most locations (except Israel) whose schools are open had already achieved low community transmission rates (<1 new case per day per 100,000 people) and have remained focused on maintaining population-level infection control…
The safest way to open schools fully is to reduce or eliminate community transmission while ramping up testing and surveillance…These precautions are especially important insofar as 17.5% of teachers are 55 or older…
The fundamental argument that children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial. If we all agree on that principle, then it is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall.
My take: This commentary makes strong arguments for reopening schools; however, in countries where this is succeeding, community transmission of SARS-CoV-2 is low and we are nowhere close to low.
Related blog posts:
Below I’ve included a few slides and some notes from recent Aspen Webinars; my notes may have errors of omission or transcription.
Key Points:
Related blog posts:
Aspen Online Webinar July 14-16, 2020
Below I’ve included some of my notes and slides. There may be errors of omission or transcription.
What’s Hot? NAFLD and NASH Stavra Xanthakos
Related blog posts:
Online Webinar –Annual Aspen Conference —July 14, 2000
Below I’ve included a few slides and some notes; my notes may have errors of omission or transcription.
Biliary Atresia -Prompt Diagnosis and Screening Ronald Sokol
Key Points:
Related blog posts:
Below I’ve included a few slides and some notes; my notes may have errors of omission or transcription.
How I Treat Children with Hepatitis C William Balistreri
Key points:
Related blog posts:
Below I’ve included a few slides and some notes; my notes may have errors of omission or transcription.
Primary Sclerosing Cholangitis: Beyond Anecdotal Medicine Jim Squires
Key points:
Related blog posts:
gutsandgrowth 