LitCovid-sentences  

PMC:7242013 / 189-15980 JSONTXT 10 Projects

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Id Subject Object Predicate Lexical cue
T4 0-35 Sentence denotes Watch the interview with the author
T5 36-49 Sentence denotes Abbreviations
T6 50-108 Sentence denotes AASLD American Association for the Study of Liver Diseases
T7 109-137 Sentence denotes ALT alanine aminotransferase
T8 138-196 Sentence denotes APASL Asian Pacific Association for the Study of the Liver
T9 197-227 Sentence denotes AST aspartate aminotransferase
T10 228-251 Sentence denotes CHB chronic hepatitis B
T11 252-275 Sentence denotes CHC chronic hepatitis C
T12 276-301 Sentence denotes CLD chronic liver disease
T13 302-335 Sentence denotes COVID‐19 coronavirus disease 2019
T14 336-388 Sentence denotes EASL European Association for the Study of the Liver
T15 389-410 Sentence denotes HBV hepatitis B virus
T16 411-439 Sentence denotes HCC hepatocellular carcinoma
T17 440-461 Sentence denotes HCV hepatitis C virus
T18 462-484 Sentence denotes HCW health care worker
T19 485-509 Sentence denotes LT liver transplantation
T20 510-548 Sentence denotes NAFLD nonalcoholic fatty liver disease
T21 549-582 Sentence denotes NIH National Institutes of Health
T22 583-616 Sentence denotes PPE personal protective equipment
T23 617-675 Sentence denotes SARS‐CoV‐2 Severe Acute Respiratory Syndrome Coronavirus 2
T24 676-705 Sentence denotes TKI tyrosine kinase inhibitor
T25 706-731 Sentence denotes ULD upper limit of normal
T26 732-1054 Sentence denotes To navigate through the stormy unchartered ocean of SARS‐coV‐2 infections and coronavirus disease 2019 (COVID‐19), all practicing hepatologists and other clinicians caring for patients with liver disease need guidance based on the best documented and rapidly evolving knowledge regarding SARS‐CoV‐2 infection and COVID‐19.
T27 1055-1284 Sentence denotes Prevention of SARS‐CoV‐2 transmission requires the redesign of patient workflow and other measures ensuring delivery of elective and emergency hepatology services without compromising the safety of patients and medical personnel.
T28 1285-1561 Sentence denotes 1 , 2 Moreover, prevention of severe COVID‐19 and related mortality requires updating management of persons with chronic liver disease (CLD) to diagnose COVID‐19 and being vigilant for drug‐drug interactions and other potential complications of COVID‐19 in persons with CLD.
T29 1562-1840 Sentence denotes 3 To respond to an urgent need for such information, the Asian Pacific Association for the Study of the Liver (APASL) recently published recommendations of an expert committee to guide infection control and clinical management of patients with CLD during the COVID‐19 pandemic.
T30 1841-2064 Sentence denotes 4 Previously, two other regional liver associations, American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL), convened expert panels with the same objectives.
T31 2065-2303 Sentence denotes 5 , 6 This review summarizes the recommendations of the three liver associations for clinical practices to prevent SARS‐CoV‐2 transmission and protect persons with CLD from health risks posed by the emerging COVID‐19 pandemic (Table 1).
T32 2304-2418 Sentence denotes Table 1 Selected AASLD, APASL, and EASL Recommendations for Liver Disease Management During the COVID‐19 Pandemic
T33 2419-2454 Sentence denotes Recommendations AASLD APASL EASL
T34 2455-2529 Sentence denotes Limit nosocomial transmission Prioritize patients to limit in‐person care
T35 2530-2676 Sentence denotes On arrival, screen patients for COVID‐19 symptoms, exposures; if suggestive of COVID‐19, refer care per clinic’s protocol for symptomatic patients
T36 2677-2723 Sentence denotes Use telemedicine alternatives for routine care
T37 2724-2772 Sentence denotes Reduce routine laboratory and imaging monitoring
T38 2773-2805 Sentence denotes Prescribe 90 days of medications
T39 2806-2870 Sentence denotes Cancel all elective/nonurgent endoscopic procedures and biopsies
T40 2871-2913 Sentence denotes Limit in‐clinic evaluations for transplant
T41 2914-2972 Sentence denotes Limit clinical trial activity to essential clinical trials
T42 2973-3019 Sentence denotes Limit HCWs providing care or on patient rounds
T43 3020-3103 Sentence denotes HCWs follow recommendations for PPE Use telemedicine alternatives for routine care
T44 3104-3147 Sentence denotes Minimize number of HCWs caring for patients
T45 3148-3189 Sentence denotes Minimize number of HCWs on patient rounds
T46 3190-3247 Sentence denotes Cancel elective, nonurgent endoscopies and liver biopsies
T47 3248-3321 Sentence denotes HCWs follow recommendations for PPE Limit in‐person care to urgent cases
T48 3322-3364 Sentence denotes Remodel clinic space for social distancing
T49 3365-3426 Sentence denotes Use telemedicine for routine care; postpone specialist visits
T50 3427-3487 Sentence denotes Reduce frequency of laboratory monitoring and obtain locally
T51 3488-3523 Sentence denotes HCWs follow recommendations for PPE
T52 3524-3789 Sentence denotes Evaluate and care for patients with COVID‐19 for liver disease Prioritize for COVID‐19 testing: (1) patients with cirrhosis, (2) patients with CLD receiving immunosuppressive medications, and (3) patients with new‐onset encephalopathy or other acute decompensation
T53 3790-3828 Sentence denotes Regularly monitor liver biochemistries
T54 3829-3951 Sentence denotes Consider non‐COVID‐19 etiologies for liver disease: (1) exacerbation of preexisting CLD or (2) drug‐induced hepatotoxicity
T55 3952-4001 Sentence denotes Use acetaminophen 2 g/day as preferred medication
T56 4002-4052 Sentence denotes Use nonsteroidal anti‐inflammatory drugs as needed
T57 4053-4180 Sentence denotes Consult the University of Liverpool document to assess possible drug interactions Follow WHO guidelines for COVID‐19 diagnosis
T58 4181-4238 Sentence denotes Consider NAFLD as a prognostic factor for severe COVID‐19
T59 4239-4286 Sentence denotes Screen patients for hepatitis B surface antigen
T60 4287-4370 Sentence denotes Consider HBV prophylaxis prior to use of anti‐IL‐6, other immunosuppressive therapy
T61 4371-4420 Sentence denotes Monitor liver function tests of patients with CLD
T62 4421-4461 Sentence denotes Be alert to possible drug hepatotoxicity
T63 4462-4541 Sentence denotes Decompensated CLD and ALT >5 times ULD contraindications for remdesivir therapy
T64 4542-4701 Sentence denotes Prioritize persons with CLD for clinical trials Test for COVID‐19 patients with acute decompensation or acute‐on‐chronic liver and per institution’s practices
T65 4702-4780 Sentence denotes Persons with NAFLD likely to have comorbidity risk factors for severe COVID‐19
T66 4781-4855 Sentence denotes Consider patients with CLD/COVID‐19 for early admission and clinical trial
T67 4856-4903 Sentence denotes Use acetaminophen (2–3 g/day is generally safe)
T68 4904-4953 Sentence denotes Limit use of nonsteroidal anti‐inflammatory drugs
T69 4954-5064 Sentence denotes Test for COVID‐19 patients with acute decompensation or acute‐on‐chronic liver and per institution’s practices
T70 5065-5143 Sentence denotes Persons with NAFLD likely to have comorbidity risk factors for severe COVID‐19
T71 5144-5218 Sentence denotes Consider patients with CLD/COVID‐19 for early admission and clinical trial
T72 5219-5266 Sentence denotes Use acetaminophen (2–3 g/day is generally safe)
T73 5267-5316 Sentence denotes Limit use of nonsteroidal anti‐inflammatory drugs
T74 5317-5406 Sentence denotes Manage hepatitis B; hepatitis C Continue HBV and HCV treatment of patients with COVID‐19
T75 5407-5494 Sentence denotes Proceed with HBV and HCV treatment in patients without COVID‐19 as clinically warranted
T76 5495-5634 Sentence denotes Do not consider HBV treatment in patients with COVID‐19 unless flare is suspected Continue HBV and HCV treatment of patients with COVID‐19
T77 5635-5722 Sentence denotes Proceed with HBV and HCV treatment in patients without COVID‐19 as clinically warranted
T78 5723-5804 Sentence denotes Do not consider HBV treatment in patients with COVID‐19 unless flare is suspected
T79 5805-5876 Sentence denotes Document discussion with patient regarding CLD diagnosis and management
T80 5877-5989 Sentence denotes Manage patients with HCC Continue HCC surveillance schedule for high‐risk subjects; 2‐month delay is acceptable
T81 5990-6069 Sentence denotes Document discussion of risks and benefits of delaying surveillance with patient
T82 6070-6156 Sentence denotes Proceed with HCC treatments as appropriate Continue therapy for non‐COVID‐19 patients
T83 6157-6298 Sentence denotes For patients with HCC with COVID‐19, postpone elective transplant and resection surgery, withhold immunotherapy Maintain care per guidelines
T84 6299-6335 Sentence denotes Admit early if COVID‐19 is diagnosed
T85 6336-6369 Sentence denotes Consider postponing HCC therapies
T86 6370-6460 Sentence denotes Manage pretransplant and posttransplant patients Screen donors and recipient for COVID‐19
T87 6461-6532 Sentence denotes Do not postpone transplants (an essential medical service, CMS Tier 3b)
T88 6533-6602 Sentence denotes Notify patients of possible extended waiting times on transplant list
T89 6603-6695 Sentence denotes Have low threshold for admitting patients on transplant waiting list diagnosed with COVID‐19
T90 6696-6810 Sentence denotes For posttransplant patients with moderate COVID‐19, consider reduction of immunosuppression therapy as appropriate
T91 6811-6929 Sentence denotes Do not reduce immunosuppressive therapy in patients with mild COVID‐19 disease Test donors and recipient for COVID‐19
T92 6930-6984 Sentence denotes Limit transplant listing to emergency and urgent cases
T93 6985-7072 Sentence denotes Look for SARS‐COV‐2 prior to organ procurement; defer donors with evidence of infection
T94 7073-7146 Sentence denotes Consider specific COVD‐19 consent for patients on transplant waiting list
T95 7147-7260 Sentence denotes For posttransplant patient with moderate COVID‐19, consider reduction of immunosuppression therapy as appropriate
T96 7261-7369 Sentence denotes Do not reduce immunosuppressive therapy in patients with mild COVID‐19 disease Maintain care per guidelines
T97 7370-7443 Sentence denotes Limit transplantation listings to patients with poor short‐term prognosis
T98 7444-7479 Sentence denotes Vaccinate against pneumonia and flu
T99 7480-7525 Sentence denotes Avoid reductions in immunosuppressive therapy
T100 7526-7596 Sentence denotes Do not reduce immunosuppressive therapy in patients with mild COVID‐19
T101 7597-7744 Sentence denotes John Wiley & Sons, Ltd This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response.
T102 7745-7927 Sentence denotes It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.
T103 7929-8021 Sentence denotes How to Protect Medical Personnel and Patients With Liver Diseases From SARS‐CoV‐2 Infection?
T104 8022-8309 Sentence denotes To this end, all three associations recommend physical distancing by limiting face‐to‐face consultations to urgent situations, routine patient contact via telemedicine and phone visits, and use of local laboratories and pharmacies to reduce clinic and hospital visits and patient travel.
T105 8310-8461 Sentence denotes AASLD guidance is most stringent by discouraging clinic entry of anyone with fever or other COVID‐19 symptoms and SARS‐CoV‐2 testing of these patients.
T106 8462-8592 Sentence denotes All recommend COVID‐19 testing of liver transplant donors and recipients and patients with encephalopathy or acute decompensation.
T107 8593-8709 Sentence denotes Recent data showed that many SARS‐CoV‐2–infected patients are asymptomatic, yet capable of transmitting the disease.
T108 8710-8861 Sentence denotes 7 Ideally, all patients with a history of close contact with cases of possible or confirmed COVID‐19 or from high‐prevalence regions should be tested.
T109 8862-8944 Sentence denotes APASL recommends SARS‐CoV‐2 testing based on clinical and epidemiological factors.
T110 8945-8997 Sentence denotes EASL recommends following an institution’s practice.
T111 8998-9111 Sentence denotes AASLD and APASL describe the personal protective equipment (PPE) requirements for endoscopy and other procedures.
T112 9112-9184 Sentence denotes Like SARS‐CoV‐2 testing, the limiting factor is the availability of PPE.
T113 9185-9260 Sentence denotes Without adequate supply, many elective procedures will need to be canceled.
T114 9261-9363 Sentence denotes Modifications of the practice of liver transplantation (LT) are recommended by all three associations.
T115 9364-9553 Sentence denotes With the potential risks of SARS‐CoV‐2 transmission, aggravated by the limited supply of PPE and other resources, many governments have restricted elective medical procedures, including LT.
T116 9554-9665 Sentence denotes However, in the United States, LTs are considered “high‐acuity surgery” and can proceed as medically warranted.
T117 9666-9843 Sentence denotes 8 All associations recommend limiting LT to patients with high Model for End‐Stage Liver Disease scores, risk for decompensation, or hepatocellular carcinoma (HCC) progression.
T118 9845-9948 Sentence denotes Should LT be Performed in COVID‐19 Recipients, and Should One Use Organs Procured From COVID‐19 Donors?
T119 9949-10003 Sentence denotes AASLD recommends against LT in patients with COVID‐19.
T120 10004-10096 Sentence denotes LT can proceed 21 days after symptom resolution and negative diagnostic tests in recipients.
T121 10097-10203 Sentence denotes APASL suggests balancing risks of delaying LT against risks of transmission to health care workers (HCWs).
T122 10204-10250 Sentence denotes EASL does not specifically address this issue.
T123 10251-10447 Sentence denotes To minimize the risk to HCWs, APASL recommends LT be performed only in patients with COVID‐19 with at least two consecutive negative SARS‐CoV‐2 nucleic acid results and the presence of antibodies.
T124 10448-10546 Sentence denotes Finally, there is debate whether immunosuppression should be reduced during the COVID‐19 pandemic.
T125 10547-10658 Sentence denotes So far there are no data to suggest that posttransplant immunosuppression is a risk factor for severe COVID‐19.
T126 10659-10741 Sentence denotes In contrast, reducing immunosuppression may increase the risk for graft rejection.
T127 10742-10852 Sentence denotes All three associations recommend against reducing immunosuppressive therapy in LT patients with mild COVID‐19.
T128 10853-11002 Sentence denotes The dose of azathioprine, mycophenolate, and calcineurin inhibitor may be reduced in the setting of severe lymphopenia or worsening pulmonary status.
T129 11004-11086 Sentence denotes What Are the Roles of a Hepatologist in the Management of a Patient With COVID‐19?
T130 11087-11222 Sentence denotes Elevation of serum transaminase levels is commonly observed in patients with COVID‐19, and a hepatologist might therefore be consulted.
T131 11223-11399 Sentence denotes All of the guidance suggests that the underlying cause of liver injury may be related to SARS‐CoV‐2 infections, exacerbation of preexisting CLD, or drug‐induced hepatotoxicity.
T132 11400-11470 Sentence denotes AASLD and APASL provide an algorithm to clinical evaluations (Fig. 1).
T133 11471-11554 Sentence denotes A key question is whether patients with CLD have a higher risk for severe COVID‐19.
T134 11555-11740 Sentence denotes AASLD and APASL suggest nonalcoholic fatty liver disease (NAFLD) as an independent prognostic factor, and patients with CLD should be prioritized as candidates for COVID‐19 drug trials.
T135 11741-11869 Sentence denotes EASL and AASLD mention that patients with NAFLD are more likely than others to have other comorbidity risks for severe COVID‐19.
T136 11870-12046 Sentence denotes To date, there is no evidence that patients with stable CLD due to chronic hepatitis B (CHB) or chronic hepatitis C (CHC) have increased susceptibility to SARS‐CoV‐2 infection.
T137 12047-12196 Sentence denotes It is controversial whether there is an increased risk for flare‐up of CHB or CHC during COVID‐19 and whether prophylactic therapy should be started.
T138 12197-12290 Sentence denotes Both AASLD and APASL recommend continuing treatment for CHB or CHC in patients with COVID‐19.
T139 12291-12408 Sentence denotes APASL recommends prophylactic hepatitis B therapy for those planned for anti‐IL‐6 or other immunosuppressive therapy.
T140 12409-12472 Sentence denotes Initiating prophylactic hepatitis C therapy is not recommended.
T141 12473-12622 Sentence denotes If there is any suggestion of a flare‐up, therapy should be initiated in patients who are not already receiving hepatitis B or hepatitis C treatment.
T142 12623-12708 Sentence denotes Fig 1 Approach to the patient with COVID‐19 and elevated serum liver biochemistries.
T143 12709-12752 Sentence denotes Reproduced with permission from Hepatology.
T144 12753-12825 Sentence denotes 5 Copyright 2020, American Association for the Study of Liver Diseases.
T145 12826-13047 Sentence denotes On May 1, 2020, remdesivir, a nucleotide RNA polymerase inhibitor, was authorized by the US Food and Drug Administration under Emergency Use Authorization for treatment of those patients hospitalized with severe COVID‐19.
T146 13048-13184 Sentence denotes 9 APASL and AASLD recommend close monitoring of liver function in patients, especially those with CLD, who are treated with remdesivir.
T147 13185-13332 Sentence denotes Patients with decompensated CLD and those with alanine aminotransferase (ALT) >5 times upper limit of normal should not be treated with remdesivir.
T148 13334-13387 Sentence denotes How Should We Modify Management of Patients With HCC?
T149 13388-13513 Sentence denotes To avoid SARS‐CoV‐2 exposures, all associations recommend reducing patient visits and a delay in HCC ultrasound surveillance.
T150 13514-13797 Sentence denotes It is uncertain whether HCC treatment should be deferred or started as usual in patients with COVID‐19 with newly diagnosed HCC, and whether tyrosine kinase inhibitors (TKIs) or checkpoint inhibitors should be stopped in patients with COVID‐19 who are already receiving such therapy.
T151 13798-14067 Sentence denotes Delaying or withdrawing treatment increases the risk for HCC progression with detrimental outcomes, whereas surgical resection may increase risk for transmission to health care personnel, and checkpoint inhibitors might worsen COVID‐19 by exacerbating a cytokine storm.
T152 14068-14115 Sentence denotes AASLD recommends HCC treatments should proceed.
T153 14116-14258 Sentence denotes EASL recommends locoregional therapies should be postponed whenever possible and immune‐checkpoint inhibitor therapy be temporarily withdrawn.
T154 14259-14325 Sentence denotes TKI in nonsevere COVID‐19 should be taken on a case‐by‐case basis.
T155 14326-14568 Sentence denotes APASL recommends postponing elective transplant/resection surgery, whereas radiofrequency ablation, transcatheter arterial chemoembolization, TKI, or immunotherapy can be initiated with change of immunotherapy schedules to every 4 to 6 weeks.
T156 14570-14601 Sentence denotes How to Conduct Clinical Trials?
T157 14602-14733 Sentence denotes Both APASL and AASLD recommend using alternative physical distancing processes for study assessments to reduce SARS‐CoV‐2 exposure.
T158 14734-14992 Sentence denotes APASL specifically recommends seeking local regulators and institutional review board approval of the contingency measures during the COVID‐19 pandemic, obtaining trial participant’s consent, and documentation of all deviations from the contingency measures.
T159 14993-15118 Sentence denotes These recommendations align with US National Institutes of Health (NIH) revised guidance for NIH‐supported clinical research.
T160 15119-15121 Sentence denotes 10
T161 15123-15130 Sentence denotes Summary
T162 15131-15280 Sentence denotes APASL, AASLD, and EASL strongly recommend changes in patient workflow and clinical procedures to protect HCWs and patients from SARS‐CoV‐2 infection.
T163 15281-15558 Sentence denotes Similarly, the associations generally agree on approaches to evaluation and treatment of patients with COVID‐19 for liver disease, and management of patients with HCC and post–liver transplant patients with slight differences in the populations targeted for SARS‐CoV‐2 testing.
T164 15559-15669 Sentence denotes These recommendations will evolve with further clinical experience and data from randomized controlled trials.
T165 15670-15791 Sentence denotes For now, the liver associations provide the best available advice for the management of CLD during the COVID‐19 pandemic.