1
|
Efe C, Lammert C, Taşçılar K, Dhanasekaran R, Ebik B, Higuera-de la Tijera F, Calışkan AR, Peralta M, Gerussi A, Massoumi H, Catana AM, Purnak T, Rigamonti C, Aldana AJG, Khakoo N, Nazal L, Frager S, Demir N, Irak K, Melekoğlu-Ellik Z, Kacmaz H, Balaban Y, Atay K, Eren F, Alvares-da-Silva MR, Cristoferi L, Urzua Á, Eşkazan T, Magro B, Snijders R, Barutçu S, Lytvyak E, Zazueta GM, Demirezer-Bolat A, Aydın M, Heurgue-Berlot A, De Martin E, Ekin N, Yıldırım S, Yavuz A, Bıyık M, Narro GC, Kıyıcı M, Akyıldız M, Kahramanoğlu-Aksoy E, Vincent M, Carr RM, Günşar F, Reyes EC, Harputluoğlu M, Aloman C, Gatselis NK, Üstündağ Y, Brahm J, Vargas NCE, Güzelbulut F, Garcia SR, Aguirre J, Anders M, Ratusnu N, Hatemi I, Mendizabal M, Floreani A, Fagiuoli S, Silva M, Idilman R, Satapathy SK, Silveira M, Drenth JPH, Dalekos GN, N Assis D, Björnsson E, Boyer JL, Yoshida EM, Invernizzi P, Levy C, Montano-Loza AJ, Schiano TD, Ridruejo E, Wahlin S. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. Liver Int 2022; 42:607-614. [PMID: 34846800 DOI: 10.1111/liv.15121] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). PATIENTS AND METHODS Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. RESULTS We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. CONCLUSION Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.
Collapse
Affiliation(s)
- Cumali Efe
- Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey
| | - Craig Lammert
- Department of Medicine Indiana, University School of Medicine Indianapolis, Indianapolis, Indiana, USA
| | - Koray Taşçılar
- Department of Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Renumathy Dhanasekaran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Berat Ebik
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | | | - Ali R Calışkan
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Mirta Peralta
- Hepatology Section, Hospital Francisco J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Alessio Gerussi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Hatef Massoumi
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Andreea M Catana
- Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tugrul Purnak
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Andres J G Aldana
- Gastroenterology and Hepatology Unit, Fundación Santa Fe de Bogotá y universidad de Los Andes, Bogotá, Colombia
| | - Nidah Khakoo
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leyla Nazal
- Gastroenterology and Hepatology Unit, Clínica Las Condes, Santiago de Chile, Chile
| | - Shalom Frager
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Nurhan Demir
- Department of Gastroenterology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Kader Irak
- Department of Gastroenterology, SBU Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | | | - Hüseyin Kacmaz
- Department of Gastroenterology, Adıyaman University, Adıyaman, Turkey
| | - Yasemin Balaban
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kadri Atay
- Departmant of Gastroenterology, Mardin State Hospital, Mardin, Turkey
| | - Fatih Eren
- Departmant of Gastroenterology, Ordu State Hospital, Ordu, Turkey
| | - Mario R Alvares-da-Silva
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura Cristoferi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Álvaro Urzua
- Gastroenterology and Hepatology Unit. Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile
| | - Tuğçe Eşkazan
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bianca Magro
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy
| | - Romee Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands
| | - Sezgin Barutçu
- Department of Gastroenterology, University of Gaziantep Medical Faculty, Gaziantep, Turkey
| | - Ellina Lytvyak
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Godolfino M Zazueta
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | | | - Mesut Aydın
- School of Medicine, Department of Gastroenterology, Van Yuzuncu Yil University, Van, Turkey
| | | | - Eleonora De Martin
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, FHU Hepatinov, INSERM Unit UMR 1193, Univ Paris-Saclay, Gif-sur-Yvette, France
| | - Nazım Ekin
- Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Sümeyra Yıldırım
- Department of Gastroenterology, Erciyes Hospital, Kayseri, Turkey
| | - Ahmet Yavuz
- Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Murat Bıyık
- Division of Gastroenterology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Graciela C Narro
- Gastroenterology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Murat Kıyıcı
- Department of Gastroenterology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Murat Akyıldız
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey
| | | | - Maria Vincent
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA
| | - Rotonya M Carr
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fulya Günşar
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Eira C Reyes
- Hepatology Unit. Hospital Militar Central de México, Ciudad de México, México
| | - Murat Harputluoğlu
- Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey
| | - Costica Aloman
- Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Yücel Üstündağ
- Department of Gastroenterology, Bulent Ecevit University of Medicine, Zonguldak, Turkey
| | - Javier Brahm
- Gastroenterology Unit, Clínica Las Condes, Santiago, Chile
| | - Nataly C E Vargas
- Hepatology Unit Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú
| | - Fatih Güzelbulut
- Department of Gastroenterology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey
| | - Sandro R Garcia
- Gastroenterology Unit, Hospital Víctor Lazarte Echegaray, Trujillo, Perú
| | - Jonathan Aguirre
- Hepatology Unit, Hospital Ángeles Pedregal, Ciudad de México, México
| | - Margarita Anders
- Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Natalia Ratusnu
- Hepatology Unit, Hospital Regional de Ushuaia, Ushuaia, Argentina
| | - Ibrahim Hatemi
- Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Manuel Mendizabal
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Annarosa Floreani
- Scientific Consultant IRCCS Negrar, Verona, Italy.,Senior Scholar, University of Padova, Padova, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy
| | - Marcelo Silva
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sanjaya K Satapathy
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, NY, USA
| | - Marina Silveira
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Nijmegen, The Netherlands
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - David N Assis
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Einar Björnsson
- Department of Internal Medicine, Section of Gastroenterology, Landspitali University Hospital, Reykjavik, Iceland
| | - James L Boyer
- Department of Medicine, Section of Digestive Diseases Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia and Vancouver General Hospital, Vancouver, Canada
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Cynthia Levy
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas D Schiano
- Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, USA
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.,Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Staffan Wahlin
- Hepatology Division, Department of Upper GI Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Bessone F, Hernandez N, Tagle M, Arrese M, Parana R, Méndez-Sánchez N, Ridruejo E, Mendizabal M, Dagher L, Contreras F, Fassio E, Pessoa M, Brahm J, Silva M. Drug-induced liver injury: A management position paper from the Latin American Association for Study of the liver. Ann Hepatol 2022; 24:100321. [PMID: 33609753 DOI: 10.1016/j.aohep.2021.100321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023]
Abstract
Idiosyncratic drug-induced liver injury (DILI) caused by xenobiotics (drugs, herbals and dietary supplements) is an uncommon cause of liver disease presenting with a wide range of phenotypes and disease severity, acute hepatitis mimicking viral hepatitis to autoimmune hepatitis, steatosis, fibrosis or rare chronic vascular syndromes. Disease severity ranges from asymptomatic liver test abnormalities to acute liver failure. DILI has been traditionally classified in predictable or intrinsic (dose-related) or unpredictable (not dose-related) mechanisms. Few prospective studies are assessing the real prevalence and incidence of hepatotoxicity in the general population. DILI registries represent useful networks used for the study of liver toxicity, aimed at improving the understanding of causes, phenotypes, natural history, and standardized definitions of hepatotoxicity. Although most of the registries do not carry out population-based studies, they may provide important data related to the prevalence of DILI, and also may be useful to compare features from different countries. With the support of the Spanish Registry of Hepatotoxicity, our Latin American Registry (LATINDILI) was created in 2011, and more than 350 DILI patients have been recruited to date. This position paper describes the more frequent drugs and herbs-induced DILI in Latin America, mainly focusing on several features of responsible medicaments. Also, we highlighted the most critical points on the management of hepatotoxicity in general and those based on findings from our Latin American experience in particular.
Collapse
Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, Facultad de Medicina, Universidad Nacional de Rosario, Rosario, Argentina.
| | | | - Martin Tagle
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco Arrese
- Pontificia Universidad Católica de chile, Santiago de Chile, Chile
| | | | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Ezequiel Ridruejo
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Buenos Aires, Argentina
| | | | - Lucy Dagher
- Policlínica Metropolitana y CMDLT, Caracas, Venezuela
| | | | - Eduardo Fassio
- Hospital Nacional Prof. Alejandro Posadas, Provincia de Buenos Aires, Argentina
| | | | | | | |
Collapse
|
3
|
Urzúa Á, Araneda G, Venegas M, Arancibia JP, Brahm J, Poniachik J. [Acute hepatitis C. Report of seven cases]. Rev Med Chil 2021; 148:1813-1818. [PMID: 33844748 DOI: 10.4067/s0034-98872020001201813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
Hepatitis C virus infection is a major global public health problem. Treatment with direct-acting antivirals is intended to eradicate the chronic form of this infection by 2030. Although uncommon, the acute form of presentation is increasingly recognized, especially in some high-risk populations, such as men who have sex with men without protection. Its virological and serological diagnosis is not standardized, so clinical suspicion is essential. Its early detection allows a timely treatment. We report seven cases of acute HCV hepatitis in a national reference center, its presentation, diagnosis and treatment. We discuss populations at risk and the change in therapeutics with the use of direct-acting antiviral drugs.
Collapse
Affiliation(s)
- Álvaro Urzúa
- Servicio de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Gonzalo Araneda
- Servicio de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Mauricio Venegas
- Servicio de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Juan Pablo Arancibia
- Servicio de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Javier Brahm
- Servicio de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Jaime Poniachik
- Servicio de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
| |
Collapse
|
4
|
Bessone F, Hernández N, Mendizábal M, Sánchez A, Paraná R, Arrese M, Tagle M, Girala M, Lizarzábal M, Carrera E, Brahm J, Contreras F, Méndez‐Sánchez N, Santos G, Nunes V, Medina‐Cáliz I, Parra‐Martínez C, Sanz‐Villanueva L, Isabel Lucena M, Andrade RJ. [Not Available]. Clin Liver Dis (Hoboken) 2019; 13:S17-S23. [PMID: 31333824 PMCID: PMC6541044 DOI: 10.1002/cld.840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/29/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, Facultad de Ciencias Médicas de la Universidad de RosarioRosarioArgentina
| | | | | | | | - Raymundo Paraná
- Hospital Universitario Prof. Edgard SantosSalvador de BahíaBrasil
| | - Marco Arrese
- Universidad Católica Pontificia de ChileSantiagoChile
| | | | | | | | | | - Javier Brahm
- Universidad Católica Pontificia de ChileSantiagoChile
| | - Fernando Contreras
- Universidad Nacional Pedro Henríquez UreñaSanto DomingoRepública Dominicana
| | | | - Genario Santos
- Hospital Universitario Prof. Edgard SantosSalvador de BahíaBrasil
| | - Vinicius Nunes
- Hospital Universitario Prof. Edgard SantosSalvador de BahíaBrasil
| | - Inmaculada Medina‐Cáliz
- Unidad de Gestión Clínica del Aparato Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaEspaña
| | - Cecilio Parra‐Martínez
- Unidad de Gestión Clínica del Aparato Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaEspaña
| | - Laura Sanz‐Villanueva
- Unidad de Gestión Clínica del Aparato Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaEspaña
| | - María Isabel Lucena
- Unidad de Gestión Clínica del Aparato Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaEspaña
| | - Raúl J. Andrade
- Unidad de Gestión Clínica del Aparato Digestivo y Servicio de Farmacología ClínicaInstituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaEspaña
| |
Collapse
|
5
|
Brahm J, Urzúa A, Poniachik J, Cáceres DD, Carreño L, Venegas M. [Interferon Lambda 4 RS12979860 C>T polymorphism is not associated with liver fibrosis in patients with hepatitis C]. Rev Med Chil 2019; 146:823-829. [PMID: 30534880 DOI: 10.4067/s0034-98872018000700823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Host genetic predispositions may be important determinants of liver fibrosis in patients with chronic hepatitis C (CHC). The association between Interferon-L 4 (IFNL4) rs12979860 C>T polymorphism and risk of liver fibrosis in CHC is contradictory. AIM To evaluate the impact of IFNL4 rs12979860 polymorphism on the risk of fibrosis in patients with CHC. MATERIAL AND METHODS One hundred fifty patients with CHC aged 50 ± 11 years (89 females) were genotyped for IFNL4 rs12979860 using real time PCR. Fibrosis present in liver biopsies was assessed using the METAVIR score, comparing patients with either no fibrosis, mild fibrosis, or intermediate fibrosis (F0+F1+F2, n = 96), with patients with severe fibrosis or cirrhosis (F3+F4, n = 54). RESULTS In F0-F2 patients the distribution of rs12979860 genotypes was 22 CC, 57 CT and 17 TT, whereas in patients F3-F4 the distribution was 10, 29 and 15, respectively. No association between IFNL4 rs12979860 genotype and risk of fibrosis was observed in uni or multivariate analyses. CONCLUSIONS IFNL4 rs12979860 C>T polymorphism is not associated with risk of liver fibrosis in this group of patients with CHC.
Collapse
Affiliation(s)
- Javier Brahm
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Alvaro Urzúa
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Jaime Poniachik
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Dante D Cáceres
- Facultad de Medicina, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile
| | - Laura Carreño
- Departamento de Anatomía Patológica, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Mauricio Venegas
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| |
Collapse
|
6
|
Bessone F, Hernandez N, Mendizabal M, Sanchez A, Paraná R, Arrese M, Tagle M, Girala M, Lizarzabal M, Carrera E, Brahm J, Contreras F, Mendez‐Sanchez N, Santos G, Nunes V, Medina‐Caliz I, Parra‐Martinez C, Sanz‐Villanueva L, Isabel Lucena M, Andrade RJ. When the Creation of a Consortium Provides Useful Answers: Experience of The Latin American DILI Network (LATINDILIN). Clin Liver Dis (Hoboken) 2019; 13:51-57. [PMID: 31139356 PMCID: PMC6465791 DOI: 10.1002/cld.778] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/29/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, University of Rosario School of MedicineRosarioArgentina
| | | | | | | | - Raymundo Paraná
- Hospital Universitario Prof. Edgard SantosSalvador de BahiaBrazil
| | - Marco Arrese
- Universidad Católica Pontificia de ChileSantiagoChile
| | | | | | | | | | - Javier Brahm
- Universidad Católica Pontificia de ChileSantiagoChile
| | | | | | - Genario Santos
- Hospital Universitario Prof. Edgard SantosSalvador de BahiaBrazil
| | - Vinicius Nunes
- Hospital Universitario Prof. Edgard SantosSalvador de BahiaBrazil
| | - Inmaculada Medina‐Caliz
- Unidad de Gestión Clínica de Ap Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de MálagaHospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaSpain
| | - Cecilio Parra‐Martinez
- Unidad de Gestión Clínica de Ap Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de MálagaHospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaSpain
| | - Laura Sanz‐Villanueva
- Unidad de Gestión Clínica de Ap Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de MálagaHospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaSpain
| | - Maria Isabel Lucena
- Unidad de Gestión Clínica de Ap Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de MálagaHospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaSpain
| | - Raul J. Andrade
- Unidad de Gestión Clínica de Ap Digestivo y Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de MálagaHospital Universitario Virgen de la Victoria, Universidad de MálagaMálagaSpain
| |
Collapse
|
7
|
Castro L, Nazal L, Silva G, Brahm J, Segovia R, Ferrario M, Buckel E, Uribe M, Puelma F, Regueira T, Reccius A, Fardella P, Rodríguez MDLÁ, Blamey R. MANEJO DE LA FALLA HEPÁTICA FULMINANTE: PROPUESTA DE PROTOCOLO EN CLÍNICA LAS CONDES. Revista Médica Clínica Las Condes 2019. [DOI: 10.1016/j.rmclc.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
8
|
Navea C, Echeverría M, Romero C, Osse E, Brahm J, Poniachik J. Gastrointestinal and hepatobiliary manifestations in patients with common variable immunodeficiency: In relation to three clinical cases. Gastroenterol Hepatol 2019; 42:110-111. [PMID: 29691086 DOI: 10.1016/j.gastrohep.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/22/2018] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Affiliation(s)
- César Navea
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - César Romero
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Emily Osse
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Javier Brahm
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Jaime Poniachik
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| |
Collapse
|
9
|
Covarrubias N, Naveas P, Miranda J, Hurtado C, Vera DB, Larrondo M, Brahm J, Venegas M. [Hepatitis E virus seroprevalence in blood donors in a university hospital in Chile]. Rev Chilena Infectol 2018; 35:455-457. [PMID: 30534936 DOI: 10.4067/s0716-10182018000400455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/03/2018] [Indexed: 11/17/2022] Open
Abstract
In Chile, there are few studies about seroprevalence of IgG antibodies against hepatitis E virus (HEV) in blood banks, between 4 and 8%. The development of new techniques with greater sensitivity and specificity, account for an increase in the seroprevalence of HEV in various countries, the current status in Chile being unknown. In the present study, we determined the seroprevalence of anti-HEV IgG in blood donors of the Clinical Hospital University of Chile, with last generation ELISA techniques. Out of a total of 186 samples, collected in 2014, 56 (30.1%) were positive, without gender differences, but with a significant increase with age (p < 0.001). These results show an increase in the seroprevalence of HEV in blood donors performed with immunoassays of greater sensitivity.
Collapse
Affiliation(s)
- Natalia Covarrubias
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Julio Miranda
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carmen Hurtado
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Daniela B Vera
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Milton Larrondo
- Banco de Sangre, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Javier Brahm
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Mauricio Venegas
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| |
Collapse
|
10
|
Urzua A, Mezzano G, Brahm J, Poniachik J, Miranda J, Caceres DD, Carreno L, Venegas M. TM6SF2 rs58542926 Polymorphism is not Associated With Risk of Steatosis or Fibrosis in Chilean Patients With Chronic Hepatitis C. Hepat Mon 2017; 17. [DOI: 10.5812/hepatmon.44365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
11
|
Affiliation(s)
- Javier Brahm
- Latin American Association for the Study of the Liver
| | | | - Jinlin Hou
- Asian Pacific Association for the Study of the Liver
| | - Keith Lindor
- American Association for the Study of Liver Disease
| |
Collapse
|
12
|
Affiliation(s)
| | - Fernando Contreras
- National University Pedro Henríquez Ureña Santo Domingo Dominican Republic
| |
Collapse
|
13
|
Mangia A, De Ledinghen V, Bailly F, Brahm J, Keiss J, Valantinas J, Rasmann N, Messinger D, Tatsch F, Bakalos G, Foster GR. IL28B genotype is associated with cirrhosis or transition to cirrhosis in treatment-naive patients with chronic HCV genotype 1 infection: the international observational Gen-C study. Springerplus 2016; 5:1990. [PMID: 27917361 PMCID: PMC5116020 DOI: 10.1186/s40064-016-3663-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
Abstract
Background and purpose Contradictory data exist on the association between host interleukin-28B (IL28B) rs12979860 genotype and liver fibrosis in patients with chronic hepatitis C (CHC). This large, international, observational study (NCT01675427/MV25600) investigated relationships between IL28B rs12979860 genotype and liver fibrosis stage in CHC patients. Methods A total of 3003 adult, treatment-naive CHC patients were enrolled into the study. Patients made one study visit to provide a blood sample for genotyping; other data were obtained from medical records. Results 2916 patients comprised the analysis population; the majority were enrolled in Europe (n = 2119), were Caucasian (n = 2582) and had hepatitis C virus (HCV) genotype (G)1 infection (n = 1702) (G2 = 323, G3 = 574, G4 = 260). Distribution of IL28B genotypes varied according to region of enrolment, patient ethnicity and HCV genotype. A significant association was observed between increasing number of IL28B T alleles and the prevalence of cirrhosis/transition to cirrhosis (based on biopsy or non-invasive assessments) in G1-infected patients (CC = 22.2% [111/499], CT = 27.5% [255/928], TT = 32.3% [87/269]; p = 0.0018). The association was significant in the large subgroup of European Caucasian G1 patients (n = 1245) but not in the smaller Asian (n = 25), Latin American (n = 137) or Middle Eastern (n = 289) G1 subgroups. IL28B genotype was not associated with liver fibrosis stage in patients with HCV G2, G3 or G4 infection. Conclusion This large, international study found that IL28B rs12979860 genotype is significantly associated with liver fibrosis stage in CHC patients with HCV G1 infection. This association was evident in European Caucasians but not in G1-infected patients from Asia, Latin America or the Middle East. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-3663-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alessandra Mangia
- Liver Unit, IRCCS Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, 71013 Italy
| | | | - François Bailly
- Hepatology Unit, Groupe Hospitalier Nord, CHU Lyon, 69004 Lyon, France
| | - Javier Brahm
- Gastroenterology Department, University of Chile Clinical Hospital, Santiago, 8380456 Chile
| | - Jazeps Keiss
- Latvian Centre of Infectious Diseases, LLC Riga East University Hospital, Riga, 1006 Latvia
| | - Jonas Valantinas
- Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University, 08661 Vilnius, Lithuania
| | - Nele Rasmann
- Center for Infectious Diseases, West Tallinn Central Hospital, 10617 Tallinn, Estonia
| | | | - Fernando Tatsch
- Global Medical Affairs, F. Hoffmann-La Roche Ltd, 4074 Basel, Switzerland ; AbbVie, North Chicago, IL USA
| | - Georgios Bakalos
- Global Product Development Medical Affairs, F. Hoffmann-La Roche Ltd, 4074 Basel, Switzerland
| | - Graham R Foster
- Institute of Cellular and Molecular Sciences, Queen Mary University of London, London, E1 2AT UK
| | | |
Collapse
|
14
|
Affiliation(s)
- Javier Brahm
- Latin American Association for the Study of the Liver
| | | | - Jinlin Hou
- Asian Pacific Association for the Study of the Liver
| | - Keith Lindor
- American Association for the Study of Liver Disease
| |
Collapse
|
15
|
Affiliation(s)
- Javier Brahm
- Latin American Association for the Study of the Liver
| | | | - Jinlin Hou
- Asian Pacific Association for the Study of the Liver
| | - Keith Lindor
- American Association for the Study of Liver Disease
| |
Collapse
|
16
|
Hernández S, Jiménez G, Alarcón V, Prieto C, Muñoz F, Riquelme C, Venegas M, Brahm J, Loyola A, Villanueva RA. Replication of a chronic hepatitis B virus genotype F1b construct. Arch Virol 2015; 161:583-94. [PMID: 26620585 DOI: 10.1007/s00705-015-2702-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
Abstract
Genotype F is one of the less-studied genotypes of human hepatitis B virus, although it is widely distributed in regions of Central and South American. Our previous studies have shown that HBV genotype F is prevalent in Chile, and phylogenetic analysis of its full-length sequence amplified from the sera of chronically infected patients identified it as HBV subgenotype F1b. We have previously reported the full-length sequence of a HBV molecular clone obtained from a patient chronically infected with genotype F1b. In this report, we established a system to study HBV replication based on hepatoma cell lines transfected with full-length monomers of the HBV genome. Culture supernatants were analyzed after transfection and found to contain both HBsAg and HBeAg viral antigens. Consistently, fractionated cell extracts revealed the presence of viral replication, with both cytoplasmic and nuclear DNA intermediates. Analysis of HBV-transfected cells by indirect immunofluorescence or immunoelectron microscopy revealed the expression of viral antigens and cytoplasmic viral particles, respectively. To test the functionality of the ongoing viral replication further at the level of chromatinized cccDNA, transfected cells were treated with a histone deacetylase inhibitor, and this resulted in increased viral replication. This correlated with changes posttranslational modifications of histones at viral promoters. Thus, the development of this viral replication system for HBV genotype F will facilitate studies on the regulation of viral replication and the identification of new antiviral drugs.
Collapse
Affiliation(s)
- Sergio Hernández
- Laboratorio de Virus Hepatitis, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda República 217, 2do piso, 8370146, Santiago, Chile
| | - Gustavo Jiménez
- Laboratorio de Virus Hepatitis, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda República 217, 2do piso, 8370146, Santiago, Chile
| | - Valentina Alarcón
- Laboratorio de Epigenética y Cromatina, Fundación Ciencia and Vida, 7780272, Santiago, Chile
| | - Cristian Prieto
- Laboratorio de Virus Hepatitis, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda República 217, 2do piso, 8370146, Santiago, Chile
| | - Francisca Muñoz
- Laboratorio de Epigenética y Cromatina, Fundación Ciencia and Vida, 7780272, Santiago, Chile
| | - Constanza Riquelme
- Laboratorio de Virus Hepatitis, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda República 217, 2do piso, 8370146, Santiago, Chile
| | - Mauricio Venegas
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, 8380456, Santiago, Chile
| | - Javier Brahm
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, 8380456, Santiago, Chile
| | - Alejandra Loyola
- Laboratorio de Epigenética y Cromatina, Fundación Ciencia and Vida, 7780272, Santiago, Chile.,Universidad San Sebastián, 7510157, Santiago, Chile
| | - Rodrigo A Villanueva
- Laboratorio de Virus Hepatitis, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda República 217, 2do piso, 8370146, Santiago, Chile.
| |
Collapse
|
17
|
Mezzano G, Rojas R, Morales C, Gazitúa R, Díaz JC, Brahm J. Primary hepatic lymphoma: An infrequent focal liver tumour. Gastroenterol Hepatol 2015; 39:674-676. [PMID: 26547611 DOI: 10.1016/j.gastrohep.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/11/2015] [Accepted: 09/02/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Gabriel Mezzano
- Sección de Gastroenterología, Hospital Clínico, Universidad de Chile, Santiago, Región Metropolitana, Chile.
| | - Rene Rojas
- Sección de Gastroenterología, Hospital Clínico, Universidad de Chile, Santiago, Región Metropolitana, Chile
| | - Claudia Morales
- Departamento de Anatomía Patológica, Hospital Clínico, Universidad de Chile, Santiago, Región Metropolitana, Chile
| | - Raimundo Gazitúa
- Sección de Hematología, Hospital Clínico, Universidad de Chile, Santiago, Región Metropolitana, Chile
| | - Juan Carlos Díaz
- Departamento de Cirugía, Hospital Clínico, Universidad de Chile, Santiago, Región Metropolitana, Chile
| | - Javier Brahm
- Sección de Gastroenterología, Hospital Clínico, Universidad de Chile, Santiago, Región Metropolitana, Chile
| |
Collapse
|
18
|
Simian D, Estay C, Lubascher J, Acuña R, Kronberg U, Figueroa C, Brahm J, Silva G, López-Köstner F, Wainstein C, Larach A, Larach J, Quera R. [Inflammatory bowel disease. Experience in 316 patients]. Rev Med Chil 2015; 142:1006-13. [PMID: 25424673 DOI: 10.4067/s0034-98872014000800008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/30/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence and prevalence of Inflammatory Bowel Disease (IBD) has increased. AIM To determine demographic and clinical characteristics of patients with IBD in a Chilean private hospital. PATIENTS AND METHODS Review of a prospective registry of patients with IBD, started on 2012. It includes clinical, imaging, endoscopical and pathological information of patients. RESULTS Data of 316 patients with IBD, aged 16 to 86 years (56% females), were analyzed. Ulcerative Colitis (UC), Crohn´s and non-classifiable IBD were diagnosed in 230, 77 and 9 patients, respectively. The disease was diagnosed in 82% of patients in the period between 2002 and 2012. There was a peak in the diagnosis of both UC and CD between 20 and 39 years of age, without gender differences. The disease switched from UC to CD in six patients. In four, there was a change in disease behavior. Thirty eight patients were treated with biological therapy. The median lapse between the diagnosis and the use of biological therapy was 1 year in patients diagnosed after 2007, compared with 5.5 years among those patients diagnosed before 2007 (p = 0.001). There was a trend towards a higher requirement of surgery until 2006. Subsequently there was a stabilization of the requirement, concomitant with the incorporation of biological therapy. CONCLUSIONS An adequate registry of IBD patients is necessary to improve demographic and clinical characteristics. A national registry is needed to assess the epidemiological changes of IBD in Chile.
Collapse
|
19
|
Villena R, Zubieta M, Hurtado C, Salgado C, Silva G, Fernández J, Villarroel M, Fernández M, Brahm J, O'Ryan M, Santolaya ME. [Seroconversion in response to a reinforced primary hepatitis B vaccination in children with cancer]. ACTA ACUST UNITED AC 2015; 86:236-43. [PMID: 26298296 DOI: 10.1016/j.rchipe.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Immune response against vaccine antigens may be impaired in children with cancer. The aim of this study was to evaluate the seroconversion response against hepatitis B vaccination (HBV) at the time of chemotherapy onset and/or remission in children with cancer. PATIENTS AND METHOD Prospective, two-centre, controlled, non-randomised study conducted on children recently diagnosed with cancer, paired with healthy subjects. Cases received HBV at time 0, 1 and 6 months with DNA recombinant HBV at a dose of 20 and 40 μg if < or > than 10 years of age, respectively, at the time of diagnosis for solids tumours and after the remission in case of haematological tumours. Controls received the same schedule, but at of 10 and 20 μg doses, respectively. HBs antibodies were measured in serum samples obtained at 2, 8 and 12 months post-vaccination. Protective titres were defined as > 10 mIU/ml at 8th month of follow up. RESULTS A total of 78 children with cancer and 25 healthy controls were analysed at month 8th of follow up. Seroconversion rates in the cancer group reached 26.9%, with no differences by age, gender or type of tumour (P = .13, .29, and .44, respectively). Control group seroconversion was 100% at the 8th month, with P < .0001 compared with the cancer group. At month 12 of follow up, just 31.9% of children with cancer achieved anti-HBs antibodies > 10 mIU/ml. CONCLUSIONS Vaccination against hepatitis B with three doses of DNA recombinant vaccine at an increased concentration, administrated at the time of onset of chemotherapy and/or remission provided an insufficient immune response in a majority of children with cancer. More immunogenic vaccines should be evaluated in this special population, such as a third generation, with more immunogenic adjuvants, enhanced schedules at 0, 1, 2, 6 month, evaluation of antibody titres at month 8 and 12h to evaluate the need for further booster doses.
Collapse
Affiliation(s)
- Rodolfo Villena
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile.
| | - Marcela Zubieta
- Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Fundación Nuestros Hijos, Santiago, Chile
| | - Carmen Hurtado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Laboratorio de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carmen Salgado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile
| | - Gladys Silva
- Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | | | - Milena Villarroel
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Hospital de niños Dr. Luis Calvo Mackenna, Santiago, Chile
| | | | - Javier Brahm
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Laboratorio de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Miguel O'Ryan
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - María Elena Santolaya
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Hospital de niños Dr. Luis Calvo Mackenna, Santiago, Chile
| |
Collapse
|
20
|
Covarrubías N, Hurtado C, Díaz A, Mezzano G, Brahm J, Venegas M. Re-evaluación de seroprevalencia de virus hepatitis E. Rev Chilena Infectol 2015; 32:482-4. [DOI: 10.4067/s0716-10182015000500020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/03/2015] [Indexed: 11/17/2022] Open
|
21
|
Meyer L, Simian D, Lubascher J, Acuña R, Figueroa C, Silva G, Brahm J, Quera R. Eventos adversos en la terapia farmacológica de la enfermedad inflamatoria intestinal. Rev Med Chil 2015; 143:7-13. [DOI: 10.4067/s0034-98872015000100001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022]
|
22
|
Venegas M, Poniachik J, Fuster F, Hurtado C, Villanueva RA, Brahm J. Genotype F of hepatitis B: response to interferon. Antivir Ther 2014; 20:453-6. [PMID: 25321866 DOI: 10.3851/imp2886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The relevance of HBV genotype diversity on interferon (IFN) therapy outcome in chronic hepatitis B patients has recently been highlighted. Data available for genotype F is poor. The aim of this work was to analyse the response of HBV genotype F to treatment with IFN. Additionally, response was analysed according to the role of single nucleotide polymorphisms (SNPs) near to the IL28B gene. METHODS A total of 29 HBeAg-positive patients with chronic infection were included with a median age 47 (18-68) years. Of them, 27 were male. One patient was treated with standard IFN-α for 16 weeks, 6 patients received PEG-IFN-α2a 180 μg weekly for 24 weeks and 22 patients for 48 weeks. Response to treatment was defined as loss of HBeAg, anti-HBe seroconversion and decline of HBV DNA level to below 3 log of baseline (IU/ml) at the 6-month of follow-up. The SNPs rs12979860, rs12980275 and rs8099917 were studied by PCR-RFLP. RESULTS The overall response was obtained in 18 (62%) patients, including one patient who was treated with standard IFN. Additionally, a total of 9 (31%) patients cleared HBsAg, with appearance of anti-HBs. The viral load was undetectable in all of these patients. The same IL28B variants associated with IFN response in HCV infections were also more frequently found in HBV patients compared with non-responders. CONCLUSIONS Our study indicates that treatment with IFN is effective in patients with HBV genotype F.
Collapse
Affiliation(s)
- Mauricio Venegas
- Section of Gastroenterology, Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile.
| | | | | | | | | | | |
Collapse
|
23
|
Arab JP, Candia R, Zapata R, Muñoz C, Arancibia JP, Poniachik J, Soza A, Fuster F, Brahm J, Sanhueza E, Contreras J, Cuellar MC, Arrese M, Riquelme A. Management of nonalcoholic fatty liver disease: an evidence-based clinical practice review. World J Gastroenterol 2014; 20:12182-201. [PMID: 25232252 PMCID: PMC4161803 DOI: 10.3748/wjg.v20.i34.12182] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/27/2014] [Accepted: 04/27/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice. METHODS NAFLD has now reached epidemic proportions worldwide. The optimal treatment for NAFLD has not been established due to a lack of evidence-based recommendations. An expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD therapy. The quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force. A modified three-round Delphi technique was used to reach a consensus among the experts. RESULTS A group of thirteen experts was established. The survey included 17 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 93.8% in the first round and 100% in the second and third rounds. The final recommendations support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies include only vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form of NAFLD), although the long-term safety and efficacy of these therapies have not yet been established. CONCLUSION Current NAFLD management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease, diabetes and cardiovascular events.
Collapse
|
24
|
Torres C, Brahm J, Venegas M. Lambda interferon serum levels in patients with chronic hepatitis C virus infection according to their response to therapy with pegylated interferon and ribavirin. J Interferon Cytokine Res 2014; 34:106-10. [PMID: 24070114 DOI: 10.1089/jir.2013.0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lambda interferon IL-28A/B and IL-29 serum levels have been associated with the course of hepatitis C virus (HCV) infection. However, there is not information about these cytokine in patients with antiviral therapy. We investigated IL-28A/B and IL-29 serum levels in 45 samples from patients chronically infected with HCV genotype 1, and undergoing therapy with PEG-IFN/RBV, at baseline and after 12 weeks of therapy, comparing those that developed a sustained virologic response (SVR) with null responders (NR). IL-28B polymorphisms (rs12979860, rs12980275, and rs8099917) were also considered. We found that, IL-28A/B and IL-29 levels were not significantly different between SVR and NR patients at baseline or after 12 weeks of therapy. TT rs8099917 genotype carriers had significantly higher IL29 levels at baseline (60.5 vs 19.5 pg/mL; p=0.045) and after 12 weeks of therapy (35 vs 16.5 pg/mL; p=0.023) than non-TT carriers. In conclusion, there were no differences in IL-28A/B or IL-29 levels according to response to therapy, suggesting that these cytokines do not play an important role in viral elimination during treatment, at least not during the first 12 weeks of therapy. Genotypes associated with high IL-28B levels may be related to a mechanism of protection against infection but are not involved in the response to antiviral therapy.
Collapse
Affiliation(s)
- Claudio Torres
- Gastroenterology Section, University of Chile Clinical Hospital , Santiago, Chile
| | | | | |
Collapse
|
25
|
Venegas M, Torres C, Urzúa A, Brahm J. [National and regional distribution of hepatitis C virus genotypes in Chile]. Rev Chilena Infectol 2013; 30:566-8. [PMID: 24248175 DOI: 10.4067/s0716-10182013000500017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/01/2013] [Indexed: 11/17/2022] Open
Abstract
Genotyping of hepatitis C virus has an important prognostic value for response to antiviral therapy. The results of hepatits C virus genotyping performed between 1994 and 2012 from 1,766 patients of different regions of Chile are reported. Global genotype (Gt) distribution was as follows: 7.87% Gt1a, 72.71% Gt1b, 1.98% Gt2, 16.53% Gt3a, 0.57% Gt4, 0.28% Gt5a and 0.06% Gt6. In most regions the genotype distribution was similar to the global. However, there were some differences, in particular in the south of our country, where 3a is present in more than 30% in some regions.
Collapse
Affiliation(s)
- Mauricio Venegas
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Chile,
| | | | | | | |
Collapse
|
26
|
Venegas M, Brahm J, Villanueva RA. Genomic determinants of hepatitis C virus antiviral therapy outcomes: toward individualized treatment. Ann Hepatol 2012; 11:827-37. [PMID: 23109445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatitis C virus (HCV) is an important global health problem with an estimated prevalence of more than 170 million infected individuals worldwide. Currently, the standard antiviral therapy, based on pegylated interferon alpha and ribavirin, can achieve a virological response in only nearly 50% of the patients infected with HCV genotype 1, the most widely distributed globally. During the last years, relevant data from genome-wide association studies (GWAS) about the impact and contribution of the patient genomics on viral infection outcomes has suggested the possibility that an individualized antiviral therapy can be considered. In this review, we analyze the existing information on single nucleotide polymorphisms (SNPs) of several host genes and viral factors that influence, as a whole, the outcome of the standard antiviral therapy, and that might be used to predict an individualized antiviral response. We also discuss the clinical data within the most recent context of the triple antiviral therapy.
Collapse
Affiliation(s)
- Mauricio Venegas
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Chile
| | | | | |
Collapse
|
27
|
Hernández S, Venegas M, Brahm J, Villanueva RA. The viral transactivator HBx protein exhibits a high potential for regulation via phosphorylation through an evolutionarily conserved mechanism. Infect Agent Cancer 2012; 7:27. [PMID: 23079056 PMCID: PMC3533737 DOI: 10.1186/1750-9378-7-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 09/20/2012] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED BACKGROUND Hepatitis B virus (HBV) encodes an oncogenic factor, HBx, which is a multifunctional protein that can induce dysfunctional regulation of signaling pathways, transcription, and cell cycle progression, among other processes, through interactions with target host factors. The subcellular localization of HBx is both cytoplasmic and nuclear. This dynamic distribution of HBx could be essential to the multiple roles of the protein at different stages during HBV infection. Transactivational functions of HBx may be exerted both in the nucleus, via interaction with host DNA-binding proteins, and in the cytoplasm, via signaling pathways. Although there have been many studies describing different pathways altered by HBx, and its innumerable binding partners, the molecular mechanism that regulates its different roles has been difficult to elucidate. METHODS In the current study, we took a bioinformatics approach to investigate whether the viral protein HBx might be regulated via phosphorylation by an evolutionarily conserved mechanism. RESULTS We found that the phylogenetically conserved residues Ser25 and Ser41 (both within the negative regulatory domain), and Thr81 (in the transactivation domain) are predicted to be phosphorylated. By molecular 3D modeling of HBx, we further show these residues are all predicted to be exposed on the surface of the protein, making them easily accesible to these types of modifications. Furthermore, we have also identified Yin Yang sites that might have the potential to be phosphorylated and O-β-GlcNAc interplay at the same residues. CONCLUSIONS Thus, we propose that the different roles of HBx displayed in different subcellular locations might be regulated by an evolutionarily conserved mechanism of posttranslational modification, via phosphorylation.
Collapse
Affiliation(s)
- Sergio Hernández
- Laboratorio de Virus Hepatitis, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda. República 217, 3er piso, Santiago 8370146, Chile
| | - Mauricio Venegas
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Avda. Santos Dumont 999, Independencia, Santiago 8340457, Chile
| | - Javier Brahm
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Avda. Santos Dumont 999, Independencia, Santiago 8340457, Chile
| | - Rodrigo A Villanueva
- Laboratorio de Virus Hepatitis, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas, Universidad Andrés Bello, Avda. República 217, 3er piso, Santiago 8370146, Chile
| |
Collapse
|
28
|
Brahm J. Caracterización de la ingestión por sobredosis de paracetamol. Rev Med Chil 2012; 140:952; author reply 952-3. [DOI: 10.4067/s0034-98872012000700020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Brahm J, Lessel R, Ditlev S, Schmidt R. Flux of selected body fluid constituents and benzylpenicillin in polyacrylamide hydrogel (PAAG). J Tissue Eng Regen Med 2011; 6:793-802. [PMID: 22052857 DOI: 10.1002/term.485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 01/27/2011] [Accepted: 07/12/2011] [Indexed: 11/09/2022]
Abstract
The polyacrylamide hydrogel (PAAG) Aquamid® (Contura International A/S Soeborg, Denmark) is one of the new macromolecules that are used as implants and tissue fillers in reconstruction and aesthetic surgery. This study showed, by means of radioactive isotope methods, that PAAG can exchange both physiological and non-physiological constituents very efficiently with the surrounding medium. The efflux (J, mole/(cm(2)× s), 25 °C, pH 7.2) of water (4.4 × 10(-5) ), chloride (2.4 × 10(-7) ), urea (1.0 × 10(-9) ), and glucose (1.1 × 10(-9) ) was 3-40x greater than in human red blood cells. PAAG was also accessible to sucrose, inulin, and benzylpenicillin that could not permeate biological cell membranes. The conclusion of the study is that the hydrogel structure created no significant barrier to the exchange of solvent and solutes with the surrounding medium.
Collapse
Affiliation(s)
- J Brahm
- Department of Cellular and Molecular Medicine, University of Copenhagen, DK-2200, Copenhagen, N, Denmark.
| | | | | | | |
Collapse
|
30
|
Venegas M, Villanueva RA, González K, Brahm J. IL28B polymorphisms associated with therapy response in Chilean chronic hepatitis C patients. World J Gastroenterol 2011; 17:3636-9. [PMID: 21987611 PMCID: PMC3180021 DOI: 10.3748/wjg.v17.i31.3636] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/15/2011] [Accepted: 02/22/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the association of three IL28B single nucleotide polymorphisms with response to therapy in Chilean patients infected with hepatitis C virus (HCV). METHODS We studied two groups of patients with chronic HCV infection (genotype 1), under standard combined treatment with pegylated interferon plus ribavirin. One group consisted of 50 patients with sustained virological response, whereas the second group consisted of 49 null responders. In order to analyze the IL28B single nucleotide polymorphisms rs12979860, rs12980275 and rs8099917, samples were used for polymerase chain reaction amplification, and the genotyping was performed by restriction fragment length polymorphism. RESULTS The IL28B rs12979860 CC, rs12980275 AA and rs8099917 TT genotypes were much more frequently found in patients with sustained virological response compared to null responders (38%, 44% and 50% vs 2%, 8.2% and 8.2%, respectively). These differences were highly significant in all three cases (P < 0.0001). CONCLUSION The three IL28B polymorphisms studied are strongly associated with sustained virological response to therapy in Chilean patients with chronic HCV (genotype 1).
Collapse
|
31
|
Pizarro C, Venegas M, Hola K, Smok G, Brahm J. Resultados del tratamiento con peginterferón alfa-2a y ribavirina en pacientes con hepatitis crónica C. Rev Med Chil 2011. [DOI: 10.4067/s0034-98872011000600002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Pizarro C, Venegas M, Hola K, Smok G, Brahm J. [Results of treatment with peginterferon plus ribavirin in patients with chronic hepatitis C]. Rev Med Chil 2011; 139:704-709. [PMID: 22051749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The current treatment recommendation for chronic hepatitis C virus infection is the combination of peginterferon and ribavirin for 24 or 48 weeks, depending on the viral genotype. The aim of the therapy is to obtain a sustained virological response. AIM To report our experience in the treatment of chronic hepatitis C. MATERIAL AND METHODS Analysis of 52 patients treated between September 2000 and June 2009. Patients with genotype 1 or 5 were treated with peginterferon alpha 2a (180 ug/week) and ribavirin (1000 mg/day for those weighing less than 75 kg and 1200 mg/day for those weighing more than 75 kg) during 48 weeks. Patients with genotypes 2 and 3 were treated for 24 weeks with the same dose of peginterferon and ribavirin 800 mg/day. RESULTS Viral genotypes 1, 2, 3 and 5 were present in 81, 4, 11 and 4% of patients, respectively. Twenty four patients (46 %), 18 with genotype 1, achieved a sustained viral response. Age was the only variable that influenced the response to treatment. CONCLUSIONS Approximately half of the patients with chronic hepatitis C, achieve a sustained viral response with peginterferon and ribavirin.
Collapse
Affiliation(s)
- Carolina Pizarro
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | | | | | | |
Collapse
|
33
|
Brahm J, Brahm M, Segovia R, Latorre R, Zapata R, Poniachik J, Buckel E, Contreras L. Acute and fulminant hepatitis induced by flutamide: case series report and review of the literature. Ann Hepatol 2011; 10:93-8. [PMID: 21301018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Flutamide is a non-steroidal anti-androgenic drug, commonly used in the treatment of advanced prostate cancer, acne and hirsutism. This drug may induce various degrees of liver injury, including acute liver failure (ALF), with further need for liver transplantation. Here, we present a report of 10 consecutive patients seen in a period of 14 years, with acute liver toxicity induced by flutamide (in most cases severe hepatotoxicity): 3 men and 7 women, with a mean age of 75 and 29 years old, respectively. All men received flutamide as treatment of advanced prostate carcinoma and they developed hepatotoxicity without ALF, and three months after withdrawal of the drug, they recovered completely. In contrast, in 7 young female with liver toxicity caused by flutamide as treatment of various hyperandrogenic conditions (acne and hirsutism), ALF was observed in 5 patients, all of them requiring urgent liver transplantation, with excellent outcome and survival in 4 of them. Based on the above, we believe that flutamide treatment should be preferentially avoided in young female patients with benign pathologies, or if it is used, patients should be warned of its potential severe complications. Also, serial liver tests should be closely monitored and, in case of elevations, the drug should be immediately withdrawn.
Collapse
Affiliation(s)
- Javier Brahm
- Department of Gastroenterology, Hospital Clínico Universidad de Chile, North Campus, Santiago, Chile.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Valera JM, Smok G, Márquez S, Poniachik J, Brahm J. [Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis]. Gastroenterol Hepatol 2010; 34:10-5. [PMID: 21194803 DOI: 10.1016/j.gastrohep.2010.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 12/13/2022]
Abstract
UNLABELLED Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH). OBJECTIVE To compare initial fibrosis and fibrosis after IT in patients with AIH. METHODS A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28±8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy. RESULTS Fibrosis decreased from 2.9±0.3 to 2.2±0.3 (p=0.005) and histological activity index from 6.8±0.45 to 2.6±0.2 (P<.001). In subgroups, fibrosis decreased from 3.6±0.4 to 1.4±0.3 (P<.001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement. CONCLUSION Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response.
Collapse
Affiliation(s)
- José Miguel Valera
- Sección de Gastroenterología, Hospital San Juan de La Serena y Universidad Católica del Norte, Coquimbo, Chile
| | | | | | | | | |
Collapse
|
35
|
Abstract
We report the case of a 60-year-old woman with multiple pancreatic nodules found on abdominal computed tomography. Thirteen years earlier she had undergone a left nephrectomy for renal cell carcinoma. The patient underwent surgery with a preoperative diagnosis of multifocal metastatic or neuroendocrine tumor. At surgery, two metastatic nodules of renal cell carcinoma were found and excised. After four years of follow up there is no evidence of recurrence.
Collapse
|
36
|
Zubieta A M, Santolaya ME, Hurtado C, Alvarez AM, Avilés CL, Becker A, Brahm J, Salgado C, Silva P, Topelberg S, Tordecilla J, Varas M, Villarroel M, Viviani T. [Seroprevalence of hepatitis B virus in children with cancer under chemotherapy in 6 hospitals of Santiago, Chile]. Rev Med Chil 2009; 137:906-911. [PMID: 19802418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Children under oncological therapy are at risk of infection by hepatitis B virus (HBV). AIM To determine the prevalence of infection of HBV in children with cancer who have undergone chemotherapy or have had a hematopoietic stem cell transplant. MATERIAL AND METHODS Collaborative, multi-centric study. Serum samples were collected from 281 children with cancer and episodes of febrile neutropenia, from 6 hospitals belonging to the public health network in the Metropolitan Region, between June 2004 and August 2006. These samples were stored at -70 degrees C. In September 2006, 200 samples were randomly chosen and 170 analyzed to determine hepatitis B virus surface antigen (HBsAg) and anticore total antibodies (anti HBc) by fluorescent ELISA (Enzyme Linked Immunosorbent Assay). In five cases in which a low volume of sample was available, only one marker was studied (HBsAg in two and anti HBc in three). RESULTS Samples came from children aged 4 months to 18 years, 104 males (61%). They had received an average of 38 transfusions (range 3-107) from 65 donors (range 3-345). Twelve children were found positive for some marker of HBV: HBsAg in three (1.8%) and anti HBc in ten (7%). In 5 patients that had negative HBsAg and positive anti HBc, anti surface antigen antibodies (anti HBs) were determined and resulted positive in four. CONCLUSIONS The prevalence of HBV in this sample was 7% if both serologic markers are considered and 1.8% if only HBsAg is considered.
Collapse
|
37
|
Zubieta M, Santolaya ME, Hurtado C, Alvarez AM, Avilés CL, Becker A, Brahm J, Salgado C, Silva P, Topelberg S, Tordecilla J, Varas M, Villarroel M, Viviani T. Seroprevalencia de virus hepatitis B en niños con cáncer en tratamiento quimioterápico en 6 hospitales de Santiago de Chile. Rev Med Chil 2009. [DOI: 10.4067/s0034-98872009000700007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
38
|
Galvez M, Brahm J, Miranda M. Movement disorders as a manifestation of metronidazole-induced encephalopathy in a patient with chronic liver disease. Mov Disord 2009; 24:1864-6. [DOI: 10.1002/mds.22624] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
39
|
Muñoz C, Fernández M, Brahm J. Hemobilia traumática: caso clínico y revisión de la literatura médica. Gastroenterología y Hepatología 2008; 31:79-81. [DOI: 10.1157/13116073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
40
|
Miguel Valera J, Hurtado C, Poniachik J, Abumohor P, Brahm J. Estudio de enfermedad celíaca en pacientes con enfermedad por hígado graso no alcohólico y con hepatopatías autoinmunes. Gastroenterología y Hepatología 2008; 31:8-11. [DOI: 10.1157/13114565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
41
|
Cofré P, Valera JM, Smok G, Regonessi C, Brahm J. [Fulminant liver failure associated with T-cell non-Hodgkin's lymphoma and hepatitis C virus: a case report]. Gastroenterol Hepatol 2007; 29:542-5. [PMID: 17129548 DOI: 10.1157/13094349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hematological malignancies can affect the liver, without producing severe hepatic involvement. We report the case of a 57-year-old man with hepatitis C virus infection and mild chronic hepatitis without antiviral treatment, who developed an aggressive T-cell non-Hodgkin's lymphoma confirmed by histological studies including liver, lymph nodes and bone marrow. The patient developed massive hepatic infiltration and acute liver failure. Rescue chemotherapy was administered but the patient died soon after with severe lactic acidosis. The immunopathological features of this association and the few reports of cases presenting with acute liver failure are reviewed.
Collapse
Affiliation(s)
- Pamela Cofré
- Sección de Gastroenterología. Hospital Clínico Universidad de Chile. Santiago de Chile. Chile
| | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by progressive inflammation and fibrosis of the biliary tract, evolving to cirrhosis. It is commonly associated with inflammatory bowel disease (IBD). AIM To communicate the clinical characteristics of patient with PSC seen in two reference centers. PATIENTS AND METHODS Review of medical records of patients with PSC confirmed by liver biopsies. The clinical picture, laboratory abnormalities, imaging studies and treatment were recorded. RESULTS Thirty three patients (aged 16 to 73 years, 64% female) were identified. They corresponded to 1.7% of liver biopsies done between 1991-2003. Clinical presentation was a cholestatic picture in 40%, right upper abdominal pain in 36%, a dysenteric syndrome in 9% and varied symptoms in 15%. Laboratory tests showed cholestasis in 94% and positive anti ANCA, SMA, ANA and AMA antibodies in 28, 18, 15 and 9% of cases, respectively. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography were diagnostic in 43 and 58% of patients, respectively. There was an association with ulcerative colitis in 12% of cases. Liver biopsies showed grade I PSC in 76% and grade II-III in 6% of patients. It also showed a concomitant chronic hepatitis and primary biliary cirrhosis in 12 and 6% of cases, respectively. Treatment consisted on ursodeoxycholic acid (UDCA) in 45%, UDCA plus 5-aminosalicylic acid derivatives in 12% and UDCA plus immunosuppresors in 12% of patients. Two patients had to be transplanted. CONCLUSIONS PSC is an uncommon cause of chronic liver disease. It is suspected in cholestatic patients and confirmed with a liver biopsy. It can be associated with other autoimmune hepatic and extrahepatic diseases.
Collapse
Affiliation(s)
- Ivonne Orellana
- Sección de Gastroenterología, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Valera JM, Merino R, Palavecino P, Sepúlveda L, Smok G, Fernández M, Brahm J. [Hepatocellular carcinoma with cardiovascular invasion. Report of five cases]. Rev Med Chil 2005; 132:1517-22. [PMID: 15743164 DOI: 10.4067/s0034-98872004001200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnosis of hepatocellular carcinoma in cirrhotic patients has increased, mainly due to early detection using newer imaging techniques. The therapeutic approach depends on the tumor staging and the liver function. Cardiac involvement has a very bad prognosis. We report three males aged 59, 75 and 76 years and two females, aged 64 and 79 years. All had cirrhosis of diverse aetiologies with hepatocellular carcinoma and tumoral invasion of the inferior vena cava and right atrium. Three patients died during hospital stay and two were discharged for conservative management at home. This rare complication has to be considered in cirrhosis.
Collapse
Affiliation(s)
- José M Valera
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago
| | | | | | | | | | | | | |
Collapse
|
44
|
Buckel E, Morales J, Brahm J, Fierro MFA, Silva G, Segovia R, Godoy J, González G, Smok G, Herzog C, Santander MT, Calabrán L, Uribe M. Combined Liver and Kidney Transplantation in a Multicenter Transplantation Program in Chile. Transplant Proc 2005; 37:3380-1. [PMID: 16298601 DOI: 10.1016/j.transproceed.2005.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Combined liver and kidney transplantation (CLKT) is an exceptional therapeutic procedure limited to a few diseases with advanced compromise of these organs. Hyperoxaluria type I and polycystic disease are the most frequent indications. The aim of this article was to report our indications and results of CLKT in a multicenter transplantation program in Chile. MATERIAL AND METHODS Our Excel database was reviewed to select patients who were treated with CLKT between 1993 and July 2004. RESULTS Among 242 liver transplantations (LT) and 48 kidney transplantations (KT), 7 were CLKT, representing 2.8% of LT and 14.5% of KT. Four patients were women and 3 were male of average age 46.8 years. One patient was a child. Most frequent indications were chronic renal failure associated with terminal liver disease and polycystic disease. One patient needed liver retransplantation due to hepatic vein thrombosis. One patient had a biliary fistula and another had a urinary fistula, treated conservatively. Acute liver rejection took place in 3 cases, 1 of which required antibodies. Two patients died, 1 due to aspergillosis and the other due to vascular complications in the transplanted liver. Actuarial survival rates were 71.4% at 1 and 5 years. Chronic renal failure is not a contraindication to LT. CONCLUSION CLKT is an acceptable option for these patients.
Collapse
Affiliation(s)
- E Buckel
- Programa Trasplante Hepático Clinica Las Condes, Hospital Luis Calvo Mackenna, Lo Fontecilla 441, Las Condes, Santiago, Chile.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Uribe M, Buckel E, Ferrario M, Segovia R, González G, Hunter B, Godoy J, Berwart F, Brahm J, Silva G, Cavallieri S, Calabrán L, Santander MT, Herzog C. ABO-incompatible liver transplantation: a new therapeutic option for patients with acute liver failure in Chile. Transplant Proc 2005; 37:1567-8. [PMID: 15866675 DOI: 10.1016/j.transproceed.2004.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Different ways have been suggested to expand donor numbers for liver transplantation. Transplantation using ABO-incompatible hepatic grafts has recently been a controversial issue due to the high risk of hyperacute rejection mediated by preformed anti-ABO antibodies. We report three patients with acute liver failure who were transplanted with ABO-incompatible livers: A to O in two patients and A to B in one case. We used pre- and posttransplant total plasma exchange, splenectomy, and triple immunosuppression. All three patients are alive; one graft was lost, probably secondary to thrombotic microangiopathy with low isohemagglutinin titers of 1:8. One patient developed acute cellular rejection that was reversed with a bolus of methylprednisolone. No antibody-mediated rejection occurred. Financial and infectious considerations have to be considered. In our series, the final liver transplantation cost was higher than average for acute liver failure. Plasmapheresis has the highest cost of all the additional procedures. ABO-incompatible liver transplantation, because of the splenectomy it requires, has been associated with more infections due to encapsulated organisms. However, with splenectomy in our three patients, none had infections due to these bacteria. In our country, we do not consider ABO-incompatible liver transplantation as a first-line option, except for highly selected patients.
Collapse
Affiliation(s)
- M Uribe
- Liver Transplantation Program, Clínica Las Condes-Hospital Luis Calvo MacKenna, Santiago, Chile.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
BACKGROUND Hepatitis E virus is the main enterically transmitted non A non B hepatitis agent. The host IgM response in the acute infection phase is short lived. Therefore, only IgG antibodies against E virus are usually investigated. AIM To measure IgM antibodies against virus E in serum samples. MATERIAL AND METHODS IgM antibodies against virus E were measured by ELISA in 35 positive and 18 negative serum samples for IgG antibodies against hepatitis virus E, without evidence of infection with hepatitis A, B or C virus. Measurement of the same antibodies in 25 additional samples positive for IgM antibodies against hepatitis A virus but without study for hepatitis virus B or C. RESULTS IgM antibodies against virus E were detected in 12 of the 35 samples positive for IgG antibodies (34%) and in five of the 25 samples positive for antibodies against virus A (20%). CONCLUSIONS An acute hepatitis E virus infection was detected in 34% of samples positive for IgG antibodies against this virus. The absence of IgM antibodies in the rest of the IgG positive samples could be due to an old or a recent virus E infection in the stage of antibody titer reduction. The detection of IgM antibodies against virus E in samples positive for virus A antibodies, could be due to co infection by virus A and E or a cross reaction of assays.
Collapse
Affiliation(s)
- Carmen Hurtado
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile.
| | | | | |
Collapse
|
47
|
Silva G, Quera R, Fluxá F, Sanhueza E, Segovia R, Brahm J, Muñoz C, Morales A, Muñoz L, Urzúa L, Biagini L. [Octreotide administration and/or endoscopic treatment in cirrhotic patients with acute variceal bleeding: a multicentric study]. Rev Med Chil 2005; 132:285-94. [PMID: 15376564 DOI: 10.4067/s0034-98872004000300002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute variceal bleeding in cirrhotic patients is an emergency with a high risk of rebleeding and death. Endoscopic procedures such as sclerotherapy or banding, combined or not with drugs such as octreotide could be considered. AIM To assess the value of octreotide in the control of acute variceal bleeding. PATIENTS AND METHODS Ninety-two patients were randomized into three groups: endoscopic therapy plus octreotide 50 microg/h bolus and continuous infusion for 5 days (n=36); octreotide (same dosage) (n=13) and endoscopic therapy only (banding and/or sclerotherapy) (n=43). RESULTS Haemostasis at 24 hours was achieved in 97% of patients with combined treatment, 69% of patients receiving octreotide, and 93% of patients with endoscopic therapy (p=0.2). Three patients with combined treatment, four patients receiving octreotide and eight patients with endoscopic therapy, rebled during the first five days (p=0.15). The mean of blood units transfused was similar in the three groups. No differences were observed in hospital days and side effects. At 42 days of follow up, eight patients with endoscopic therapy, one patients with combined therapy and 2 patients receiving octreotide, died (p=NS). CONCLUSIONS Octreotide is useful in the management of acute variceal bleeding. The absence of important side effects, renders it as a safe adjuvant treatment associated with endoscopic treatment.
Collapse
|
48
|
Abstract
Celiac sprue (CS) has been described in association with hepatitis C virus (HCV) as another immunologic manifestation of this infectious disease. We report 2 patients, a 42-year-old woman and a 59-year-old man, with chronic HCV hepatitis. Upper digestive endoscopy and duodenal biopsy were performed to investigate diverse symptoms. The results of histological analysis and serological study were compatible with CS. The association between both diseases, including immunological aspects and the implications of anti-HCV treatment, is discussed.
Collapse
Affiliation(s)
- I Aguancha
- Servicio de Gastroenterología, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | | | | | | | | |
Collapse
|
49
|
Valera JM, Nei Lu C, Smok G, Fernández M, Regonesi C, Brahm J. [Hepatic veno-occlusive disease, idiopathic ulcerative colitis and portal thrombosis. Report of one case]. Rev Med Chil 2004; 132:1091-5. [PMID: 15543766 DOI: 10.4067/s0034-98872004000900010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a previously healthy 29 years old man, presenting with a sudden episode of abdominal pain, mild jaundice, hepatomegaly and ascites. Magnetic resonance imaging study and liver biopsy were compatible with veno-occlusive disease. Incidentally, an ulcerative colitis and portal vein thrombosis were diagnosed. Anticoagulant treatment was started, with good clinical and radiological response. Veno-occlusive disease of the liver must be suspected In cases of liver failure and ascites associated to procoagulant conditions.
Collapse
Affiliation(s)
- José M Valera
- Sección de Gastroenterología, Hospital Clinico Universidad de Chile, Santiago
| | | | | | | | | | | |
Collapse
|
50
|
Alegría S, Buckel E, Ferrario M, Ceresa S, Smok G, Brahm J. [Chronic hepatitis and cirrhosis caused by C virus before and after liver transplantation. Report of one case]. Rev Med Chil 2004; 132:479-84. [PMID: 15382520 DOI: 10.4067/s0034-98872004000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a girl with a chronic hepatitis caused by C virus diagnosed at the age of nine, unsuccessfully treated with interferon and ribavirine. Two years later, she was subjected to a liver transplantation. She maintained elevated viral loads with a normal pathological study of the liver until 22 months after transplantation. She was treated again with combined antiviral therapy, for 6 months, without response and experienced a progressive deterioration liver function, dying three years after transplantation.
Collapse
|