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Mendizabal M, Thompson M, Gonzalez-Ballerga E, Anders M, Castro-Narro GE, Pessoa MG, Cheinquer H, Mezzano G, Palazzo A, Ridruejo E, Descalzi V, Velarde-Ruiz Velasco JA, Marciano S, Muñoz L, Schinoni MI, Poniachik J, Perazzo R, Cerda E, Fuster F, Varon A, Ruiz García S, Soza A, Cabrera C, Gomez-Aldana AJ, Beltrán FDM, Gerona S, Cocozzella D, Bessone F, Hernández N, Alonso C, Ferreiro M, Antinucci F, Torre A, Moutinho BD, Coelho Borges S, Gomez F, Murga MD, Piñero F, Sotera GF, Ocampo JA, Cortés Mollinedo VA, Simian D, Silva MO. Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America. J Viral Hepat 2023; 30:56-63. [PMID: 36197907 DOI: 10.1111/jvh.13758] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 12/09/2022]
Abstract
To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.
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Affiliation(s)
- Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Marcos Thompson
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Esteban Gonzalez-Ballerga
- Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Margarita Anders
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Graciela E Castro-Narro
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
| | - Mario G Pessoa
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Hugo Cheinquer
- Departamento de Gastroenterología y Hepatología, Universidad Federal do Rio Grande do Sul e do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriel Mezzano
- Sección de Gastroenterología, Hospital El Salvador, Santiago, Chile
| | - Ana Palazzo
- Servicio de Gastroenterología, Sección de Hepatología, Hospital Padilla, Tucumán, Argentina
| | - Ezequiel Ridruejo
- Sección Hepatología, Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Buenos Aires, Argentina
| | - Valeria Descalzi
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Sebastian Marciano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Linda Muñoz
- Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Maria I Schinoni
- Núcleo de Hepatología, Hospital Universitario Prof. Edgard Santos, Universidad Federal de Bahia, Salvador, Brazil
| | - Jaime Poniachik
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Rosalía Perazzo
- Unidad de Gastroenterología, Hospital Miguel Perez Carreño, Caracas, Venezuela
| | - Eira Cerda
- Hospital Central Militar, Escuela Militar de Graduados de Sanidad, Ciudad de México, Mexico
| | - Francisco Fuster
- Unidad de Hepatología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Adriana Varon
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | | | - Alejandro Soza
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Cabrera
- Unidad de Gastroenterología, Hospital Nacional Daniel A. Carrión, Callao, Peru
| | - Andres J Gomez-Aldana
- Unidad de Gastroenterología y Trasplante Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Solange Gerona
- Unidad de Hígado, Hospital de Fuerzas Armadas, Montevideo, Uruguay
| | | | - Fernando Bessone
- Departamento de Gastroenterología, Facultad de Medicina, Hospital Provincial del Centenario, University of Rosario School of Medicine, Rosario, Argentina
| | - Nelia Hernández
- Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - Cristina Alonso
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Melina Ferreiro
- Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Florencia Antinucci
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Aldo Torre
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
| | - Bruna D Moutinho
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Fernando Gomez
- Sección de Gastroenterología, Hospital El Salvador, Santiago, Chile
| | - Maria Dolores Murga
- Servicio de Gastroenterología, Sección de Hepatología, Hospital Padilla, Tucumán, Argentina
| | - Federico Piñero
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Gisela F Sotera
- Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jhonier A Ocampo
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Valeria A Cortés Mollinedo
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
| | - Daniela Simian
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Marcelo O Silva
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
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Mendizabal M, Ridruejo E, Piñero F, Anders M, Padilla M, Toro LG, Torre A, Montes P, Urzúa A, Gonzalez Ballerga E, Silveyra MD, Michelato D, Díaz J, Peralta M, Pages J, García SR, Gutierrez Lozano I, Macias Y, Cocozzella D, Chavez-Tapia N, Tagle M, Dominguez A, Varón A, Vera Pozo E, Higuera-de la Tijera F, Bustios C, Conte D, Escajadillo N, Gómez AJ, Tenorio L, Castillo Barradas M, Schinoni MI, Bessone F, Contreras F, Nazal L, Sanchez A, García M, Brutti J, Cabrera MC, Miranda-Zazueta G, Rojas G, Cattaneo M, Castro-Narro G, Rubinstein F, Silva MO. Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection. Ann Hepatol 2021; 25:100350. [PMID: 33864948 PMCID: PMC8045426 DOI: 10.1016/j.aohep.2021.100350] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. PATIENTS We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. RESULTS Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). CONCLUSIONS SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.
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Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN).
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN); Liver Section, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
| | - Margarita Anders
- Latin American Liver Research Educational and Awareness Network (LALREAN); Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Martín Padilla
- Gastroenterology Unit, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Luis G Toro
- Hepatology and Liver Transplant Unit, Hospitales de San Vicente Fundación de Medellín y Rionegro, Medellín, Colombia
| | - Aldo Torre
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, México
| | - Pedro Montes
- Gastroenterology Unit, Hospital Nacional Daniel A. Carrión, Callao, Perú
| | - Alvaro Urzúa
- Gastroenterology Section, Internal Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Esteban Gonzalez Ballerga
- Department of Gastroenterology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Douglas Michelato
- Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia, Salvador de Bahía, Brazil
| | - Javier Díaz
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Mirta Peralta
- Latin American Liver Research Educational and Awareness Network (LALREAN); Intensive Care Unit, Hospital de Infecciosas Francisco J Muñiz, Buenos Aires, Argentina
| | - Josefina Pages
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
| | - Sandro Ruiz García
- Gastroenterology Unit, Hospital de Víctor Lazarte Echegaray, Trujillo, Perú
| | | | - Yuridia Macias
- Department of Medicine, IMSS Hospital General Regional No. 1 "Dr. Carlos Mc Gregor Sánchez", Ciudad de México, Mexico
| | - Daniel Cocozzella
- Latin American Liver Research Educational and Awareness Network (LALREAN); Department of Gastroenterology, Hospital Italiano de La Plata, La Plata, Argentina
| | | | - Martín Tagle
- Gastroenterology Unit, Clínica Anglo-Americana, Lima, Perú
| | | | - Adriana Varón
- Latin American Liver Research Educational and Awareness Network (LALREAN); Liver Unit, Fundación Cardio-Infantil, Bogotá, Colombia
| | - Emilia Vera Pozo
- Hospital Regional Dr. Teodoro Maldonado Carbo del IESS, Guayaquil, Ecuador
| | - Fátima Higuera-de la Tijera
- Department of Gastroenterology and Hepatology, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | | | - Damián Conte
- Unidad de Hígado, Hospital Privado de Córdoba, Córdoba, Argentina
| | - Nataly Escajadillo
- Gastroenterology Unit, Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú
| | - Andrés J Gómez
- Endoscopy and Transplant Service, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Laura Tenorio
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Mauricio Castillo Barradas
- Gastroenterology Unit, Hospital de Especialidades del Centro Médico Nacional La Raza IMSS, Ciudad de México, México
| | - Maria Isabel Schinoni
- Latin American Liver Research Educational and Awareness Network (LALREAN); Department of Gastroenterology, Hospital Alianza, Bahía, Brazil
| | - Fernando Bessone
- Department of Gastroenterology, Hospital Provincial del Centenario, Rosario, Argentina
| | - Fernando Contreras
- Department of Gastroenterology, CEDIMAT, Santo Domingo, Dominican Republic
| | - Leyla Nazal
- Department of Gastroenterology, Clínica Las Condes, Santiago, Chile
| | - Abel Sanchez
- Department of Gastroenterology, Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Matías García
- Liver Section, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | - Julia Brutti
- Department of Internal Medicine, Sanatorio Anchorena, Buenos Aires, Argentina
| | | | - Godolfino Miranda-Zazueta
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, México
| | - German Rojas
- Department of Gastroenterology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maximo Cattaneo
- Gastroenterology Section, Internal Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | | | | | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
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Ruiz García S, Castillo Núñez L, Malca Atoche J, Valderrama Ascoy J, Aguilar Saldaña G. [Predictors of infection and mortality in patients with liver cirrhosis in the high complexity hospital Virgen de la Puerta from Trujillo, Peru]. Rev Gastroenterol Peru 2019; 39:55-63. [PMID: 31042237] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. OBJECTIVE The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. MATERIAL AND METHODS Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. RESULTS The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. CONCLUSIONS High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.
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Affiliation(s)
| | - Lida Castillo Núñez
- Servicio de Gastroenterología, Hospital de Alta Complejidad Virgen de la Puerta. La Libertad, Perú
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Stoker C, Repetti MR, García SR, Zayas MA, Galoppo GH, Beldoménico HR, Luque EH, Muñoz-de-Toro M. Organochlorine compound residues in the eggs of broad-snouted caimans (Caiman latirostris) and correlation with measures of reproductive performance. Chemosphere 2011; 84:311-317. [PMID: 21531435 DOI: 10.1016/j.chemosphere.2011.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/15/2011] [Accepted: 04/01/2011] [Indexed: 05/30/2023]
Abstract
Organochlorine compounds (OCCs), like pesticides (OCPs) and polychlorinated biphenyls (PCBs), are persistent lipophilic chemicals classified as endocrine-disruptors. Caiman latirostris inhabits wetlands throughout north-eastern Argentina and may accumulate OCCs. The aims of this study were to determine OCC residues in the eggs of C. latirostris and to correlate OCC burden with clutch size, hatching success and hatchling survival as measures of reproductive performance. Fourteen caiman clutches were harvested from sites with different degrees of anthropogenic intervention on wetlands surrounding Paraná River tributaries. Two to four eggs by clutch were used to quantify OCCs. OCP residues were found in all clutches. The principal contributors to the OCPs burden were the DDT family (range BDL-153.0 ng g(-1) lipid) and oxychlordane (range BDL-34.3 ng g(-1) lipid). PCBs were present in 92.9% of the clutches (range BDL-136.6 ng g(-1) lipid). Both higher concentrations and higher diversity of pesticides, including endosulfan sulfate, were found in the nests harvested close to croplands. A negative correlation was found between clutch size and ∑OCCs (p=0.02, Pearson r=-0.53, r(2)=0.28), mainly due to the ∑OCPs (p=0.04, Pearson r=-0.54, r(2)=0.30). Since egg OCCs concentrations predict maternal burden, present findings suggest that higher OCCs exposure could lead to smaller clutches. Although, other factors like mother age could influence clutch size. Additionally, as caimans are a long-lived and non-migratory species, the maternal OCCs burden reflects the environmental status throughout their home range; thus, caiman eggs could be useful as a biomonitor of local contamination.
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Affiliation(s)
- C Stoker
- Laboratory of Endocrinology and Hormone-dependent Tumors, School of Biochemistry and Biological Sciences, Universidad Nacional del Litoral, Santa Fe, Argentina
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