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Background and Aim: Telehealth interventions may improve access to care, disease-specific, and quality outcomes in chronic liver diseases (CLDs). We aimed to systematically evaluate outcomes of telehealth interventions in CLDs. Materials and Methods: We used key terms and searched PubMed/ EMBASE from inception to January 10, 2022. Two authors independently screened abstracts. Disagreements were resolved by a third reviewer. We included any type of CLD, including posttransplant patients, and extracted outcomes as defined by authors for each etiology of CLD (sustained virological response in HCV or weight loss in NAFLD). Meta-analysis was not performed because of the heterogeneity of data. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for clinical trials.Results: Of 4250 studies screened, 43 met the inclusion criteria. Of these, 28 reported HCV treatment outcomes. All studies showed no statistically significant differences between sustained virological response rates in TH groups compared with control groups or historic cohorts. Eight studies evaluating liver transplant-related processes and outcomes demonstrated improved rates of transplant evaluation and referrals and decreased shortterm readmission rates. Three randomized controlled trials and 1 observational study on NAFLD showed improved weight loss outcomes. One retrospective study showed reduced mortality risk in CLD patients with at least 1 TH encounter.

Introduction: Clinical significance and long-term impacts of Fatty pancreas (FP) on pancreatic parenchyma are not well-recognized. The aim of this study is to assess parenchymal alterations over time in patients with FP. Methods: This is a retrospective study (2014-2021) of patients with diffuse echogenicity of the pancreas, suggestive of FP, on endoscopic ultrasound (EUS). Subjects with subsequent EUS, Magnetic Resonance Imaging (MRI), or Computed Tomography (CT) scan at least two years after the initial EUS were included. Incidence of parenchymal changes and development of chronic pancreatitis (CP) overtime were recorded.Results: A total of 39 patients with a mean age of 51.24 6 12.31 years were enrolled. Mean initial weight was 80.17617.75kg. Diabetes mellitus (DM), fatty liver, and exocrine pancreatic insufficiency (EPI) were present in 15%, 46% and 33% of the patients at baseline, respectively. Patients were followed by EUS (n525), CT scan (n59), and MRI (n55) over an average follow up period of 2.38 6 0.94 years. In 25 patients with available follow up EUS, 16% (n54) progressed to CP and 24% (n56) had additional parenchymal changes without meeting the criteria for CP. Only one patient from the latter group developed new onset DM during the follow up period. No major parenchymal changes were noted in 52% (n513). Of the two remaining patients, one had progressed to diffuse echogenicity of the entire pancreas rather than the body alone, while the other patient was noted to have resolution of FP with minimal hyperechoic strands after weight loss. Average weight was statistically higher at baseline and follow-up in patients with progressive parenchymal changes (92.6 6 5.2 kg[baseline] and 96.26 6.09 kg [follow-up]) in comparison to those with parenchymal appearance (78.43 6 4.6 kg [baseline] and 82.17 6 4.4 kg [follow-up]); p-value 0.032. In multivariate analysis, progressive parenchymal changes on EUS were associated with an increase in weight over time, independent of the effects of gender, alcohol, or tobacco (p-value 5 0.04). (Table ) (Figure) Conclusion: Progressive parenchymal changes was noted in 44%. FP is a potential precursor for chronic pancreatitis and further parenchymal changes. Weight gain may be an independent contributor to the development of further parenchymal changes in patients with FP. Our results suggest that FP is a dynamic process with the possibility of progression or regression over time.

These values were a significant increase from normal the month before. This necessitated up-titration of prednisone and MMF, which normalized her liver enzymes within two months. A 67-year-old female with a past medical history of hypothyroidism was found to have elevated liver enzymes associated with fatigue. Further lab work-up and liver biopsy revealed autoimmune hepatitis. This patient's autoimmune hepatitis was controlled on a regimen of prednisone and MMF for six months. However, three weeks after receiving the third COVID Pfizer vaccine, this patient's labs exhibited AST: 99 and ALT: 105. These values were a significant increase from normal the month before. Her immunosuppressants were up-titrated with an increase in MMF and the addition of cyclosporine. Her labs improved to AST: 73 and ALT: 87 within two months. Discussion: These cases demonstrate that COVID vaccination may play a role in autoimmune hepatitis flares. This can be a challenging situation for many clinicians to navigate, as COVID remains a significant threat to patients' health, and there are many case reports that show that COVID infection itself can precede a flare. Patients with autoimmune liver disease may benefit from closer laboratory evaluation surrounding COVID vaccination.

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