RESUMO
BACKGROUND: Hepatitis C virus (HCV) infection is one of the most frequent causes of liver transplantation (LT) worldwide. Patients with HCV viremia at the time of LT universally develop recurrent HCV in the allograft, leading to accelerated fibrosis and graft loss. Treatment with direct-acting antivirals (DAA) is highly effective and safe in this population. AIM OF THE STUDY: To describe the efficacy and safety of DAA in treating post LT HCV recurrence in a Mexican cohort. METHODS: We designed a retrospective cohort study that included all LT patients from 2000-2019 with HCV recurrence after LT who received DAA. Clinical and biochemical characteristics were collected from clinical records. Patients who received treatment before LT and those who received interferon-based therapies after LT achieving sustained viral response at 12 weeks were excluded; patients who didn´t complete DAA therapy were eliminated. The primary outcome was SVR-12. RESULTS: Fifty-six patients received DAA after the LT with 98% SVR-12. The most frequent genotypes were 1b (54%) and 1a (34%). The most common antiviral scheme used was sofosbuvir/ledipasvir for 12 weeks in 59% of the patients. No severe adverse effects were observed. Ribavirin was used in 82% of the patients, of which 23.9% had adverse effects, mostly mild. The median follow-up after LT was 55 months (IQR 43-51), with a global and graft survival at one and three years of 100%. CONCLUSION: In a Mexican cohort, DAA therapy in LT patients with recurrence of HCV infection showed high efficacy and an acceptable safety profile.
Assuntos
Hepatite C Crônica , Hepatite C , Transplante de Fígado , Antivirais/uso terapêutico , Estudos de Coortes , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Liver biopsy is the recognized gold standard for liver fibrosis staging. The aspartate aminotransferase to platelet ratio index (APRI) has been proposed as a noninvasive and readily available tool for the assessment of liver fibrosis in chronic hepatitis C (CHC). This study aimed to validate, in a Mexican tertiary health care setting, the diagnostic usefulness of APRI in CHC, nonalcoholic fatty liver disease (NAFLD) and autoimmune hepatitis (AIH). In an observational, cross-sectional, comparative and retrolective fashion, consecutive patients with CHC, NAFLD or AIH were evaluated. Fibrosis was staged using the METAVIR scale. Receiver operating characteristic ROC curves were constructed for significant fibrosis, advanced fibrosis and cirrhosis. One-hundred-sixty-four CHC, 30 NAFLD and 42 AIH patients were evaluated. For the diagnosis of significant fibrosis, APRI values delimited an area under de ROC curve (AUC) of 0.776 in CHC, 0.564 in NAFLD, and 0.602 in AIH patients. For advanced fibrosis, the AUCs were 0.803, 0.568 and 0.532 in CHC, NAFLD and AIH patients, respectively. For cirrhosis, AUCs were 0.830 and 0.599 in CHC and AIH patients. In conclusion, APRI can be a useful noninvasive alternative for the diagnosis of significant fibrosis and cirrhosis in our CHC patients. APRI values of < or = 0.3 and < or = 0.5 rule out significant fibrosis and cirrhosis, and a value of > or = 1.5 rules in significant fibrosis. In patients with NAFLD, APRI values tend to increase with the degree of fibrosis, suggesting that it could be useful in this disease. APRI appears to be of no value in patients with AIH.
Assuntos
Aspartato Aminotransferases/análise , Fígado Gorduroso/diagnóstico , Hepatite Autoimune/diagnóstico , Cirrose Hepática/diagnóstico , Contagem de Plaquetas , Adulto , Estudos Cross-Over , Fígado Gorduroso/sangue , Feminino , Hepatite C Crônica/sangue , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Hepatite Autoimune/sangue , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , PrognósticoRESUMO
BACKGROUND/AIMS: Thymalfasin has shown efficacy in the treatment of chronic HCV infection. The aim of this study was to evaluate the efficacy and tolerability of triple therapy with thymalfasin, peginterferon alpha-2a (PEG-IFN alpha-2a), and ribavirin in Hispanic patients with chronic viral hepatitis C who were nonresponders to prior treatment with interferon alfa (IFN-alpha)/ribavirin. METHODS: In this open-label study, 40 subjects received thymalfasin (1.6 mg twice a week), PEG-IFN alpha-2a (180 microg once a week), and ribavirin (800-1,000 mg/day) for 48 weeks. All patients had positive HCV RNA by PCR analysis, abnormal levels of ALT, compensated hepatic disease, and liver biopsy with chronic damage. RESULTS: Viral response was observed in 52.5% patients at week 12 and 50% at week 24. Of the per protocol group, 52.6% showed an end-of-treatment response at week 48 and 21.1% achieved an SVR at week 72. Among genotype 1 patients, 23.5% achieved an SVR at week 72. A reduction of the dose of PEG IFN alpha-2a and ribavirin was required. Thymalfasin was well tolerated without dose reduction. CONCLUSION: Triple therapy with thymalfasin, PEG IFN alpha-2a, and ribavirin is an effective treatment option for difficult-to-treat HCV patients who are refractory to prior conventional treatment, with adequate tolerability.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Antivirais/administração & dosagem , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Timosina/análogos & derivados , Adjuvantes Imunológicos/efeitos adversos , Adulto , Idoso , Antivirais/efeitos adversos , Feminino , Hepacivirus/genética , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Masculino , México , Pessoa de Meia-Idade , Projetos Piloto , Polietilenoglicóis/efeitos adversos , RNA Viral/análise , Proteínas Recombinantes , Ribavirina/efeitos adversos , Terapia de Salvação , Timalfasina , Timosina/administração & dosagem , Timosina/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
AIM: To evaluate the prevalence of metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (CC) and to compare this group with patients with cirrhosis secondary to other causes (disease controls). METHODS: Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis (AIH) served as disease controls. RESULTS: A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years (range, 16-87); 83 (61.9%) patients were female; 53 (39.6%) were Child A, 65 (48.5%) Child B, and 16 (11.9%) were Child C cirrhosis. The prevalence of MS (29.1% vs 6%; P<0.001), obesity (16.4% vs 8.2%; P=0.04) and T2DM (40% vs 22.4%; P=0.013) was higher in CC patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. CONCLUSION: The prevalence of MS, obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis (NASH) plays an under-recognized role in CC.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Cirrose Hepática/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Cirrose Hepática/etnologia , Cirrose Hepática/etiologia , Masculino , Síndrome Metabólica/etnologia , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/etnologia , Prevalência , Sistema de Registros , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
The increasing prevalence of obesity is not only observed in adults. Children are affected by obesity and related diseases, such as chronic liver disease, more frequently than in the past. Nonalcoholic fatty-liver disease is an important cause of chronic liver disease and in the near future will become important worldwide. Considering this phenomenon, it is important for gastroenterologists and hepatologists to be aware of the presence of nonalcoholic fatty-liver disease in pediatric populations and to treat it adequately. This practice will have important benefits for future generations. This review discusses the most important aspects in epidemiology, diagnostics and treatment of nonalcoholic fatty-liver disease in children.
Assuntos
Fígado Gorduroso/epidemiologia , Adolescente , Criança , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/terapia , Humanos , População , PrevalênciaRESUMO
Despite steady progress in therapeutics of liver disease, portal systemic encephalopathy remains to be a great challenge for clinicians because of the heterogeneity of neuropsychiatric symptoms, multiple risk factors and complexity on achieving a sustained response. We aimed to evaluate the efficacy of L-Ornithin, L-Aspartate versus lactulose in Mexican patients with hyperammonemic hepatic encephalopathy. A total of 20 patients were randomly allocated to receive either lactulose(n = 10) or L-ornithine - L-aspartate (n = 10) for 2 weeks. At baseline, patients of both groups were comparable in age (64 +/- 7 versus 60 +/- 6) and degree of hepatic failure according to the Child-Pugh scale (9.2 +/- 1.3 versus 9.2 +/- 1.1). A significant decrease in ammonia levels was observed both in the lactulose group (120.4 +/- 8.1 versus 91.4 +/- 10, p < 0.05) and in the LOLA group (141.6 +/- 9.1 versus 96.9 +/- 9.3, p < 0.05). Moreover, in patients who received LOLA a significant improvement was observed in mental status (1.0 +/- 0.14 versus 0.4 +/- 0.16, p < 0.05), Number Connection Test (184 +/- 43 versus 88 +/- 7, p < 0.05), asterixis (14.6 +/- 2.8 versus 6.7 +/- 1.5, p < 0.05), as well as EEG findings (6.8 +/- 0.6 versus 8.1 +/- 0.2 cycles per second, p < 0.05). Compliance with study medications was similar between the lactulose group (94%) and the LOLA group (100%). No serious adverse events were reported in the two groups; however, in the lactulose group an increase in the number of weekly defecations was reported, as well as a higher incidence of abdominal pain or flatulence. Finally, both patient groups reported an improvement in the Visual Analogue Scale for EuroQol index (51.1 +/- 24.1 versus 61.5 +/- 15.8, p < 0.05, in the lactulose group; 56.5 +/- 24.5 versus 70 +/- 19.4, p < 0.05, in the LOLA group). In conclusion, oral administration of lactulose or L-ornithine - L-aspartate to Mexican patients with cirrhosis and hyperammonemic encephalopathy significantly reduced serum ammonia levels in study groups and additionally improved mental status parameters, number connection test, asterixis scores, and EEG activity in the group receiving L-ornithine-L-aspartate.
Assuntos
Dipeptídeos/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Encefalopatia Hepática/tratamento farmacológico , Hiperamonemia/tratamento farmacológico , Lactulose/uso terapêutico , Administração Oral , Cognição , Dipeptídeos/administração & dosagem , Eletroencefalografia , Feminino , Encefalopatia Hepática/complicações , Humanos , Hiperamonemia/complicações , Lactulose/administração & dosagem , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
AIM: To summarize the evidence available for the clinical effectiveness of insulin sensitizers in the treatment of nonalcoholic fatty liver disease (NAFLD) systematically. METHODS: Relevant articles were located using computer-assisted searches of Medline (1966-March 2006), EMBASE (1988-March 2006), CINAHL (1982-March 2003), Educational Resource Information Center (1966-March 2006), Library, Information Science and Technology Abstracts (1967-March 2006), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (1994-2006), dissertations in ProQuest and FirstSearch databases. Manual searches were made in the abstracts from meetings of the American Gastroenterological Association (1999-2006), and the American Association for the Study of Liver Diseases (2003-2005). Studies were retrieved using the following selection criteria: (1) clinical trials using insulin sensitizers in subjects with NAFLD, (2) adult patients, (3) published as full manuscripts or abstracts, and (4) English, Spanish, German, and French languages only. Data were abstracted independently by two reviewers following standardized procedures. A face-to-face comparison of data was conducted to ensure the completeness and reliability of the abstraction process. RESULTS: Nine studies were included, six using metformin and three using thiazolidinediones. Only two studies were placebo-controlled trials. The median sample size for all studies was 18 subjects. In the placebo-controlled trials, metformin improved insulin resistance markers and liver function tests, but not histological scores. In the single-arm trials, metformin and thiazolidinediones improved insulin resistance markers and liver function tests, and beneficial histological changes were reported. There is limited high-quality information available from which to draw categorical conclusions about the clinical use of insulin sensitizers in NAFLD. CONCLUSION: Current information indicates that the use of insulin sensitizers in NAFLD improves insulin resistance and liver function. Histological changes must be corroborated in randomized controlled trials.
Assuntos
Fígado Gorduroso/tratamento farmacológico , Fígado Gorduroso/fisiopatologia , Insulina/fisiologia , Ensaios Clínicos Controlados como Assunto , Dieta com Restrição de Carboidratos , Fígado Gorduroso/patologia , Humanos , Hipoglicemiantes/uso terapêutico , Resistência à Insulina/fisiologia , Fígado/fisiopatologia , Metformina/uso terapêutico , Tiazolidinedionas/uso terapêuticoRESUMO
Secondary lymphomas involving the breast, although uncommon, represent the largest group of metastasic tumors to the breast. Primary non-Hodgkin lymphomas (NHLs) of the breast are also rare, accounting for 1.7% to 2.2% of extranodal NHL cases and 0.38 to 0.7% of all NHLs. Approximately 300 cases have been reported in the Medical literature. Mammographic appearances are described as round or oval areas of opacity. The breast mass may appear homogeneous or inhomogeneous. The lesion may be very well defined and may be mistaken for a benign process, most notable in patients younger than 35 years of age. Ultrasonographic appearance is described as a sharply defined mass with low or medium echoes. The posterior aspect of the mass is well defined (possibly with slight acoustic enhancement but with no associated posterior shadowing). In summary, the mammographic appearance of the breast lymphoma is nonspecific, but the diagnosis can possibly be excluded if calcifications or a desmoplastic reaction are present. Prominent lymph vessels in a patient with a breast mass should raise the suspicion of breast lymphoma. The most critical aspect in the workup of a breast mass is the tissue biopsy, since radiographically lymphomatous lesions are indeterminate. We present the case of a 79-year-old woman with abdominal pain and a palpable breast mass; we also make a brief summary of the clinical features and main imaging findings of NHL (plain radiograph, mammography, breast ultrasound and thorax tomography).
Assuntos
Neoplasias da Mama/secundário , Linfoma de Células B/patologia , Neoplasias do Mediastino/patologia , Idoso , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Radiografia , UltrassonografiaRESUMO
Los linfomas secundarios con afectación de la glándula mamaria, aunque raros, representan el grupo más grande de tumores metastásicos de la mama. El linfoma no Hodgkin primario de la mama es también raro, representando del 1.7%-2.2% de los casos de linfoma no Hodgkin extranodal y del 0.38-0.7% de todos los linfomas no Hodgkin. Aproximadamente 300 casos han sido reportados en la literatura. El aspecto mamográfico ha sido descrito como áreas redondeadas u ovales con densidad aumentada. Las masas mamarias pueden aparecer homogéneas o heterogéneas. Las lesiones pueden ser muy bien definidas y ser confundidas con procesos benignos, esto último más probable en pacientes menores de 35 años de edad. Los hallazgos ultrasonográficos son descritos como masas de márgenes bien definidos con ecos de intensidad baja a moderada. Las paredes posteriores de la masa suelen estar bien definidas, probablemente con ligero reforzamiento acústico pero sin sombra posterior asociada. En resumen, el aspecto mamográfico del linfoma mamario no es específico, pero el diagnóstico puede ser excluido si hay presencia de calcificaciones o reacción desmoplásica. El tejido linfoide prominente en un paciente con masas mamarias debería despertar la sospecha de linfoma mamario. El aspecto más crítico en el estudio de una masa de la mama es la biopsia del tejido, puesto que una lesión linfomatosa tiene radiográficamente patrones indeterminados. Presentamos el caso de una mujer de 79 años con dolor abdominal y una masa palpable en la mama derecha; realizamos un breve resumen de las características clínicas y principales hallazgos por imagen del linfoma no Hodgkin con afección a la glándula mamaria (radiografía de tórax, mastografía, ultrasonido mamario, y tomografía de tórax).
Secondary lymphomas involving the breast, although uncommon, represent the largest group of metastasic tumors to the breast. Primary non-Hodgkin lymphomas (NHLs) of the breast are also rare, accounting for 1.7% to 2.2% of extranodal NHL cases and 0.38 to 0.7% of all NHLs. Approximately 300 cases have been reported in the Medical literature. Mammographic appearances are described as round or oval areas of opacity. The breast mass may appear homogeneous or inhomogeneous. The lesion may be very well defined and may be mistaken for a benign process, most notable in patients younger than 35 years of age. Ultrasonographic appearance is described as a sharply defined mass with low or medium echoes. The posterior aspect of the mass is well defined (possibly with slight acoustic enhancement but with no associated posterior shadowing). In summary, the mammographic appearance of the breast lymphoma is nonspecific, but the diagnosis can possibly be excluded if calcifications or a desmoplastic reaction are present. Prominent lymph vessels in a patient with a breast mass should raise the suspicion of breast lymphoma. The most critical aspect in the workup of a breast mass is the tissue biopsy, since radiographically lymphomatous lesions are indeterminate. We present the case of a 79-year-old woman with abdominal pain and a palpable breast mass; we also make a brief summary of the clinical features and main imaging findings of NHL (plain radiograph, mammography, breast ultrasound and thorax tomography).
Assuntos
Idoso , Feminino , Humanos , Neoplasias da Mama/secundário , Linfoma de Células B/patologia , Neoplasias do Mediastino/patologia , Neoplasias da Mama , Neoplasias da MamaRESUMO
BACKGROUND: In the last decades it has been suggested that the main cause of liver cirrhosis in Mexico is alcohol. Currently in Western countries hepatitis C virus stage liver disease and liver transplantation. In Mexico, we have no data relative to the etiology of liver cirrhosis. The aim of this study was to investigate the main causes of liver cirrhosis in Mexico. METHODS: Eight hospitals located in different areas of the country were invited to participate in this study. Those hospitals provide health care to different social classes of the country. The inclusion criteria were the presence of either an histological or a clinical and biochemical diagnosis of liver cirrhosis. RESULTS: A total 1,486 cases were included in this study. The etiology of liver cirrhosis was alcohol in 587 (39.5%), HCV 544 (36.6%), cryptogenic 154 (10.4%), PBC 84 (5.7%), HBV 75 (5.0%) and other 42 (2.8%). There was no statistical difference between alcohol and HCV. CONCLUSIONS: We conclude that the main causes of liver cirrhosis in Mexico are alcohol and HCV.
Assuntos
Cirrose Hepática/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Criança , Estudos Transversais , Feminino , Hepatite B/complicações , Hepatite C/complicações , Humanos , Cirrose Hepática/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Development of multiple antigens in combined vaccines offers the advantages of reducing costs, increasing compliance and provides dual protection. Hepatitis A is an endemic disease in Mexico and hepatitis B, notwithstanding low prevalence, confers risk of progression to cirrhosis, hepatocellular carcinoma, and high medical costs in consequence. OBJECTIVE: Determine immunogenicity and reactogenicity of a combined vaccine when compared with use of conventional vaccines simultaneously. METHODS: The present study was a prospective, open, and randomized trial; 73 healthy children and adolescents were included, all with negative serologic markers. They were assigned to one of the following groups: Group 1, combined vaccine (n = 49) Twinrix (HAV 720 UE/HBV 20 micrograms), and group 2, separate vaccines (n = 24) Engerix B 20 micrograms/Havrix 720 UE. Both groups were given two-dose series at months 0 and 6. Geometric titles of antibody production (GMT) anti-HAV and anti-HBV were determined in months 1, 2, 6 and 7. Adverse reactions were registered during the study. RESULTS: No difference was observed between the two groups in age or gender. Immunogenicity anti-HAV: 100% of vaccines in both groups reached seroprotective levels (> or = 33 mUI/mL). Antibody titles in group 1 were three times higher than those in group 2 (9,696 mIU/mL vs. 3,940 mIU/mL [p = 0.003]) at the end of the study. Immunogenicity anti-HBV: All subjects in both groups reached seroprotective levels (> or = 10 mIU/mL) with similar antibody titles at the end of the study (group 1: 5,603 mIU/mL vs. group 2: 5,201 mIU/mL [p = 0.55 NS]). Reactogenicity: No serious adverse reactions were observed; main were local, and frequency and characteristics were similar in both groups. CONCLUSIONS: Seroprotective levels and reactogenicity obtained from use of a combined vaccine against hepatitis A/B are acceptable when compared with use of conventional vaccines administered separately.