Search

Your search keyword '"Juan Pablo Roblero"' showing total 57 results
Start Over Author "Juan Pablo Roblero" Database OpenAIRE
57 results on '"Juan Pablo Roblero"'

2. The immune response as a therapeutic target in non-alcoholic fatty liver disease

Author

Nicolás Ortiz-López, Catalina Fuenzalida, María Soledad Dufeu, Araceli Pinto-León, Alejandro Escobar, Jaime Poniachik, Juan Pablo Roblero, Lucía Valenzuela-Pérez, and Caroll J. Beltrán

Subjects
Carcinoma, Hepatocellular, Non-alcoholic Fatty Liver Disease, Liver Neoplasms, Immunology, Immunity, Humans, Immunology and Allergy, Fibrosis
Abstract

Non-alcoholic fatty liver disease (NAFLD) is a complex and heterogeneous disorder considered a liver-damaging manifestation of metabolic syndrome. Its prevalence has increased in the last decades due to modern-day lifestyle factors associated with overweight and obesity, making it a relevant public health problem worldwide. The clinical progression of NAFLD is associated with advanced forms of liver injury such as fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). As such, diverse pharmacological strategies have been implemented over the last few years, principally focused on metabolic pathways involved in NAFLD progression. However, a variable response rate has been observed in NAFLD patients, which is explained by the interindividual heterogeneity of susceptibility to liver damage. In this scenario, it is necessary to search for different therapeutic approaches. It is worth noting that chronic low-grade inflammation constitutes a central mechanism in the pathogenesis and progression of NAFLD, associated with abnormal composition of the intestinal microbiota, increased lymphocyte activation in the intestine and immune effector mechanisms in liver. This review aims to discuss the current knowledge about the role of the immune response in NAFLD development. We have focused mainly on the impact of altered gut-liver-microbiota axis communication on immune cell activation in the intestinal mucosa and the role of subsequent lymphocyte homing to the liver in NAFLD development. We further discuss novel clinical trials that addressed the control of the liver and intestinal immune response to complement current NAFLD therapies.

Published
2022
Full Text
View/download PDF

4. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure

Author

Carlo Alessandria, Carmine Gambino, Javier Fernández, Hans Van Vlierberghe, Sophie Restellini, Marcos Girala, Luis Colombato, Tae Hee Lee, Nikolaos Pyrsopoulos, Eduardo Fassio, Sang Gyune Kim, Gisela Pinero, Paolo Caraceni, Shivaram Prasad Singh, Do Seon Song, Ji Won Park, Julio Vorobioff, Dong Joon Kim, C. Toledo, Aleksander Krag, Liane Rabinowich, Preetam Nath, Robert A. de Man, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá Pereira, Gustavo Romero, Macarena Simón-Talero, Sung Eun Kim, Michele Bartoletti, Alexander L. Gerbes, Sebastián Marciano, Tony Bruns, Hyoung Su Kim, Ki Tae Suk, Nicolas M. Intagliata, Annette Dam Fialla, Adrià Juanola, Manuela Merli, Rita de Cassia Ribeiro Barea, Laure Elkrief, Rakhi Maiwall, Laurentius A Lesmana, Pere Ginès, Vikas Gautam, E.L. Yoon, M. Marino, Paolo Angeli, Kalyan Ram Bhamidimarri, Victor Vargas, Virendra Singh, Juan Pablo Roblero, François Durand, Cosmas A. Rinaldi Lesmana, M. V. Maevskaya, Gustavo Navarro, Adrian Gadano, Florence Wong, Pramod Kumar, Tae Hun Kim, Daniela Campion, Salvatore Piano, Giacomo Zaccherini, Barbara Lattanz, Jae Seok Hwang, Sun Young Yim, Thomas D. Boyer, Jeong Han Kim, Carlos Brodersen, Wong F., Piano S., Singh V., Bartoletti M., Maiwall R., Alessandria C., Fernandez J., Soares E.C., Kim D.J., Kim S.E., Marino M., Vorobioff J., Barea R.D.C.R., Merli M., Elkrief L., Vargas V., Krag A., Singh S.P., Lesmana L.A., Toledo C., Marciano S., Verhelst X., Intagliata N., Rabinowich L., Colombato L., Kim S.G., Gerbes A., Durand F., Roblero J.P., Bruns T., Yoon E.L., Girala M., Pyrsopoulos N.T., Kim T.H., Yim S.Y., Juanola A., Gadano A., Angeli P., Bhamidimarri K., Boyer T.D., Brodersen C., Campion D., Caraceni P., de Man R.A., Fassio E., Fialla A.D., Gambino C., Gautam V., Gines P., Hwang J.S., Kim H.S., Kim J.H., Kumar P., Lattanz B., Lee T.H., Rinaldi Lesmana C.A., Maevskaya M., Nath P., Navarro G., Park J.-W., Pinero G., Restellini S., Romero G., Seva -Pereira T., Simon-Talero M., Song D.S., Suk K.T., Van Vlierberghe H., and Zaccherini G.

Subjects
Male, 0301 basic medicine, Cirrhosis, Organ Dysfunction Scores, Antibiotic resistance, medicine.medical_treatment, Liver transplantation, Severity of Illness Index, 0302 clinical medicine, ACLF, MDR, Epidemiology, Cross Infection, Mortality rate, Age Factors, Bacterial Infections, Middle Aged, Prognosis, Community-Acquired Infections, Europe, Hospitalization, Female, 030211 gastroenterology & hepatology, Alcohol-Related Disorders, medicine.medical_specialty, Sepsi, India, Risk Assessment, Sepsis, 03 medical and health sciences, Sex Factors, Spontaneous bacterial peritonitis, Internal medicine, medicine, Humans, XDR, Cirrhosi, Hepatology, business.industry, Acute-On-Chronic Liver Failure, medicine.disease, Pneumonia, 030104 developmental biology, antibiotic resistance, liver transplantation, sepsis, business
Abstract

Background & Aims: Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital. Methods: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. Results: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p

Published
2021
Full Text
View/download PDF

6. A Latin American survey on demographic aspects of hospitalized, decompensated cirrhotic patients and the resources for their management

Author

Iván García, Fabián Zárate, María T. Andara, Orelvis Martínez Martínez, Luis Colombato, Alejandro Mateo, Patricio Ruiz González, Teodoro Stieben, Lucía Hernández, Marco Sánchez Hernández, Rosalía P. Marrero, Eduardo Fassio, L. Gaite, José Adi, Juan Pablo Roblero, Martín Garzón, Julio Vorobioff, Pablo Ruiz, Armando Sierralta, Fernando Bessone, Marcela Sixto, Eduardo Diaz, Pedro Montes, Diego San Martín Rodríguez, Juan O. Rojas, Solange Gerona, Violeta Rivas Pacheco, Julieta Pecoraro, Elizabeth Alava, Diana Gibelli, Rodrigo Wolff, Dayron Páez Suárez, Laura Tenorio, Flor Beltran Valdivia, Andrés Ruf, Susana López, Alvaro Urzúa Manchego, Rivardo Hernández Hernández, Sergio de la Barra Barraza, Matías Lafage, Julio Santiago Marcelo, Roxana C. Gallegos, Kenia Torres, Hernán Gómez Darrichon, Manuel Mendizabal, Fátima de la Tijera, Enrique Carrera, Eliana Valdes, Irene Donoso Sierra, José C. Gutiérrez, Guillermo Fernández, Galo Pazmiño, Pamela Yaquich, Rocío Galloso, Edmundo Pessoa López, Mirta Felgueres, Javier Severini, Daniel Lombardo, Mirta Infante, Yoel M. Serrano, Federico Tanno, Ximena Armijos, Miguel Garassini, Carmen M. Villadoniga Reyes, Isabel Veramendi, Fernando Contreras, Gonzalo Benalcazar, and Teresita Pérez González

Subjects
Liver Cirrhosis, Male, Cirrhosis, Specialties of internal medicine, Autoimmune hepatitis, Decompensation, 0302 clinical medicine, Liver Cirrhosis, Alcoholic, Non-alcoholic Fatty Liver Disease, Surveys and Questionnaires, Epidemiology, Survey, Hepatic encephalopathy, Aged, 80 and over, education.field_of_study, Ascites, General Medicine, Bacterial Infections, Middle Aged, Hospitalization, Hepatitis, Autoimmune, RC581-951, 030220 oncology & carcinogenesis, Health Resources, 030211 gastroenterology & hepatology, Female, Gastrointestinal Hemorrhage, Adult, medicine.medical_specialty, Gastrointestinal bleeding, Population, Peritonitis, 03 medical and health sciences, Young Adult, Spontaneous bacterial peritonitis, Age Distribution, medicine, Diabetes Mellitus, Humans, Obesity, Sex Distribution, education, Aged, Hepatology, business.industry, Hepatitis C, Chronic, medicine.disease, Latin America, Hepatic Encephalopathy, Emergency medicine, Etiology, business
Abstract

Introduction & objectives Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. Methods A cross sectional, multicenter survey of hospitalized cirrhotic patients. Results 377 patients, (62% males; 58 ± 11 years) (BMI > 25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR + NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population > 500,000 (n = 45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n = 22). Conclusions The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.

Published
2020

7. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. Amir, Javier Ampuero, Noha Anas, Pietro Andreone, Soa Fy Andriamandimby, Mahmoud Anees, Peltec Angela, Manal Antonios, Wael Arafat, Jose Moreno Araya, Juan Armendariz-Borunda, Matthew J. Armstrong, Hassan Ashktorab, Patricia Aspichueta, Fathia Assal, Mira Atef, Dina Attia, Hoda Atwa, Reham Awad, Mohyeldeen Abd Elaziz Awad, Sally Awny, Obafemi Awolowo, Yaw Asante Awuku, Ibrahim Ayada, Than Than Aye, Sherif Ayman, Hedy Ayman, Hesham Ayoub, Hosny M. Azmy, Romiro P. Babaran, Omneya Badreldin, Ahmed Badry, İbrahim Halil Bahçecioğlu, Amira Bahour, Jiajia Bai, Yasemin Balaban, Muthuswamy Balasubramanyam, Khaled Bamakhrama, Jesus M Banales, Babu Bangaru, Jianfeng Bao, Jorge Suazo Barahona, Salma Barakat, Sandra Maria Barbalho, Bikwa Barbra, Beatriz Barranco, Francisco Barrera, Ulrich Baumann, Shamardan Bazeed, Eva Bech, Aourarh Benayad, Andreas Benesic, David Bernstein, Fernando Bessone, Susie Birney, Cyrille Bisseye, Martin Blake, Bilal Bobat, Leonilde Bonfrate, Dmitry S Bordin, Francisco Bosques-Padilla, Jerome Boursier, Boushab Mohamed Boushab, David Bowen, Patricia Medina Bravo, Paul N Brennan, Bisi Bright, Ilse Broekaert, Xabier Buque, Diego Burgos-Santamaría, Julio Burman, Luca Busetto, Chris D. Byrne, Patricia Anne I. Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. Dabbous, George N Dalekos, Patricia D'Alia, Li Dan, Viet Hang Dao, Mostafa Darwish, Christian Datz, Milagros B Davalos-Moscol, Heba Dawoud, Blanca Olaechea de Careaga, Robert de Knegt, Victor de Ledinghen, Janaka de Silva, Nabil Debzi, Marie Decraecker, Elvira Del Pozo, Teresa C Delgado, Manuel Delgado-Blanco, Łukasz Dembiński, Adilson Depina, Moutaz Derbala, Hailemichael Desalegn, Christèle Desbois-Mouthon, Mahmoud Desoky, Anouk Dev, Agostino Di Ciaula, Moisés Diago, Ibrahima Diallo, Luis Antonio Díaz, Melisa Dirchwolf, Paola Dongiovanni, Andrriy Dorofeyev, Xiaoguang Dou, Mark W. Douglas, Michael Doulberis, Cecil K. Dovia, Adam Doyle, Ivana Dragojević, Joost PH Drenth, Xuefei Duan, Audrius Dulskas, Dan L Dumitrascu, Oliver Duncan, Vincent Dusabejambo, Rev. Shem N.A. Dwawhi, Sho Eiketsu, Doaa El Amrousy, Ahmed El Deeb, Ghada El Deriny, Hesham Salah El Din, Salwa El Kamshishy, Mohamed El Kassas, Maissa El Raziky, Osama A Elagamy, Wafaa Elakel, Dina Elalfy, Hanaa Elaraby, Heba ElAwady, Reda Elbadawy, Hanaa Hassan Eldash, Manal S. Eldefrawy, Carol Lezama Elecharri, Amel Elfaramawy, Mohammed Elfatih, Mahmoud Elfiky, Mohamed Elgamsy, Mohamed Elgendy, Mohamed A. El-Guindi, Nagi Elhussieny, Ahmed Maher Eliwa, Zeineb Elkabbany, Hesham El-Khayat, Nehal M. El-Koofy, Alaa Elmetwalli, Amr Elrabat, Fathiya El-Raey, Fatma Elrashdy, Medhat Elsahhar, Esraa M. Elsaid, Shimaa Elsayed, Hany Elsayed, Aly Elsayed, Amr M. Elsayed, Hamdy Elsayed, Magdy El-Serafy, Ahmed M. Elsharkawy, Reem Yehia Elsheemy, Eman Elsayed Elshemy, Sara Elsherbini, Naglaa Eltoukhy, Reda Elwakil, Ola Emad, Shaimaa Emad, Mohamed Embabi, Ilkay Ergenç, Tatiana Ermolova, Gamal Esmat, Doaa M. Esmat, Enrique Carrera Estupiñan, Said Ettair, Tcaciuc Eugen, Mohammed Ezz-Eldin, Lidia Patricia Valdivieso Falcón, Yu-Chen Fan, Samah Fandari, Mahmoud Farag, Taghreed Mohamed Farahat, Eman M. Fares, Michael Fares, Eduardo Fassio, Hayam Fathy, Dina Fathy, Wael Fathy, Soheir Fayed, Dan Feng, Gong Feng, Miguel Fernández-Bermejo, Cristina Targa Ferreira, Javier Díaz Ferrer, Alastair Forbes, Rabab Fouad, Hanan M. Fouad, Tove Frisch, Hideki Fujii, Shuhei Fukunaga, Shinya Fukunishi, Hacer Fulya, Masato Furuhashi, Yasmine Gaber, Augusto Jose G. Galang, Jacqueline Cordova Gallardo, Rocío Galloso, Mahmoud Gamal, Reham Gamal, Hadeel Gamal, Jian Gan, Anar Ganbold, Xin Gao, George Garas, Tony Garba, Miren García-Cortes, Carmelo García-Monzón, Javier García-Samaniego, Amalia Gastaldelli, Manuel Gatica, Elizabeth Gatley, Tamar Gegeshidze, Bin Geng, Hasmik Ghazinyan, Salma Ghoneem, Luca Giacomelli, Gianluigi Giannelli, Edoardo G. Giannini, Matthew Giefer, Pere Ginès, Marcos Girala, Pablo J Giraudi, George Boon-Bee Goh, Ahmed Ali Gomaa, Benbingdi Gong, Dina Hilda C. Gonzales, Humberto C. Gonzalez, Maria Saraí Gonzalez-Huezo, Isabel Graupera, Ivica Grgurevic, Henning Grønbæk, Xuelian Gu, Lin Guan, Ibrahima Gueye, Alice Nanelin Guingané, Ozen Oz Gul, Cuma Bulent Gul, Qing Guo, Pramendra Prasad Gupta, Ahmet Gurakar, Juan Carlos Restrepo Gutierrez, Ghada Habib, Azaa Hafez, Emilia Hagman, Eman Halawa, Osama Hamdy, Abd Elkhalek Hamed, Dina H. Hamed, Saeed Hamid, Waseem Hamoudi, Yu Han, James Haridy, Hanan Haridy, David C H Harris Harris, Michael Hart, Fuad Hasan, Almoutaz Hashim, Israa Hassan, Ayman Hassan, Essam Ali Hassan, Adel Ahmed Hassan, Magda Shehata Hassan, Fetouh Hassanin, Alshymaa Hassnine, John Willy Haukeland, Amr Ismael M. Hawal, Jinfan He, Qiong He, Yong He, Fang-Ping He, Mona Hegazy, Adham Hegazy, Osama Henegil, Nelia Hernández, Manuel Hernández-Guerra, Fatima Higuera-de-la-Tijera, Ibrahim Hindy, Keisuke Hirota, Lee Chi Ho, Alexander Hodge, Mohamed Hosny, Xin Hou, Jiao-Feng Huang, Yan Huang, Zhifeng Huang, Yuan Huang, Ang Huang, Xiao-Ping Huang, Sheng Hui-ping, Bela Hunyady, Mennatallah A. Hussein, Osama Hussein, Shahinaz Mahmoud Hussien, Luis Ibáñez-Samaniego, Jamal Ibdah, Luqman Ibrahim, Miada Ibrahim, Ibrahim Ibrahim, Maria E. Icaza-Chávez, Sahar Idelbi, Ramazan Idilman Idilman, Mayumi Ikeda, Giuseppe Indolfi, Federica Invernizzi, Iram Irshad, Hasan Mohamed Ali Isa, Natacha Jreige Iskandar, Abdulrahman Ismaiel, Mariam Ismail, Zulkifli Ismail, Faisal Ismail, Hideki Iwamoto, Kathryn Jack, Rachael Jacob, Fuad Jafarov, Wasim Jafri, Helen Jahshan, Prasun K Jalal, Ligita Jancoriene, Martin Janicko, Hiruni Jayasena, Meryem Jefferies, Vivekanand Jha, Fanpu Ji, Yaqiu Ji, Jidong Jia, Changtao Jiang, Ni Jiang, Zong-zhe Jiang, Xing Jin, Yi Jin, Xu Jing, Qian Jingyu, Maia Jinjolava, FX Himawan Haryanto Jong, Alina Jucov, Ibecheole Julius, Mona Kaddah, Yoshihiro Kamada, Abobakr kamal, Enas Mohamed Kamal, Ashraf Sayed Kamel, Jia-Horng Kao, Maja Karin, Thomas Karlas, Mohammad Kashwaa, Leolin Katsidzira, Eda Kaya, M.Azzam Kayasseh, Bernadette Keenan, Caglayan Keklikkiran, William Keml, Deia K. Khalaf, Rofida Khalefa, Sherin Khamis, Doaa Khater, Hamed khattab, Anatoly Khavkin, Olga Khlynova, Nabil Khmis, Nazarii Kobyliak, Apostolos Koffas, Kazuhiko Koike, Kenneth Y.Y. Kok, Tomas Koller, Narcisse Patrice Komas, Nataliya V. Korochanskaya, Yannoula Koulla, Shunji Koya, Colleen Kraft, Bledar Kraja, Marcin Krawczyk, Mohammad Shafi Kuchay, Anand V Kulkarni, Ashish Kumar, Manoj Kumar, Sulaiman Lakoh, Philip Lam, Ling Lan, Naomi F. Lange, Kamran Bagheri Lankarani, Nicolas Lanthier, Kateryna Lapshyna, Sameh A. Lashen, Konang Nguieguia Justine Laure, Leonid Lazebnik, Didier Lebrec, Samuel S. Lee, Way Seah Lee, Yeong Yeh Lee, Diana Julie Leeming, Nathalie Carvalho Leite, Roberto Leon, Cosmas Rinaldi Adithya Lesmana, Junfeng Li, Qiong Li, Jun Li, Yang-Yang Li, Yufang Li, Lei Li, Min Li, Yiling li, Huiqing Liang, Tang Lijuan, Seng Gee Lim, Lee-Ling Lim, Shumei Lin, Han-Chieh Lin, Rita Lin, Rania Lithy, Yaru Liu, Yuanyuan Liu, Xin Liu, Wen-Yue Liu, Shourong Liu, Ken Liu, Tian Liu, Amedeo Lonardo, Mariana Bravo López, Eva López-Benages, Patricio Lopez-Jaramillo, Huimin Lu, Lun Gen Lu, Yan Lu, John Lubel, Rashid Lui, Iulianna Lupasco, Elena Luzina, Xiao-Hui Lv, Kate Lynch, Hong-Lei Ma, Mariana Verdelho Machado, Nonso Maduka, Katerina Madzharova, Russellini Magdaong, Sanjiv Mahadeva, Amel Mahfouz, Nik Ritza Kosai Nik Mahmood, Eman Mahmoud, Mohamed Mahrous, Rakhi Maiwall, Ammar Majeed, Avik Majumdar, Loey Mak, Madiha M Maklouf, Reza Malekzadeh, Claudia Mandato, Alessandra Mangia, Jake Mann, Hala Hussien Mansour, Abdellah Mansouri, Alessandro Mantovani, Jun qian Mao, Flor Maramag, Giulio Marchesini, Claude Marcus, Rui António Rocha Tato Marinho, Maria L Martinez-Chantar, Antonieta A. Soares Martins, Rana Marwan, Karen Frances Mason, Ghadeer Masoud, Mohamed Naguib Massoud, Maria Amalia Matamoros, Rosa Martín Mateos, Asmaa Mawed, Jean Claude Mbanya, Charles Mbendi, Lone McColaugh, Duncan McLeod, Juan Francisco Rivera Medina, Ahmed Megahed, Mai Mehrez, Iqbal Memon, Shahin Merat, Randy Mercado, Ahmed Mesbah, Taoufik Meskini, Mayada Metwally, Rasha Metwaly, Lei Miao, Eileen Micah, Luca Miele, Vladimir Milivojevic, Tamara Milovanovic, Yvonne L. Mina, Milan Mishkovik, Amal Mishriki, Tim Mitchell, Alshaimaa Mohamed, Mona Mohamed, Sofain Mohamed, Shady Mohammed, Ahmed Mohammed, Viswanathan Mohan, Sara Mohie, Aalaa Mokhtar, Reham Moniem, Mabel Segura Montilla, Jose Antonio Orozco Morales, María María Sánchez Morata, Jose Maria Moreno-Planas, Silvia Morise, Sherif Mosaad, Mohamed Moselhy, Alaa Mohamed Mostafa, Ebraheem Mostafa, Nezha Mouane, Nasser Mousa, Hamdy Mahfouz Moustafa, Abeer Msherif, Kate Muller, Christopher Munoz, Ana Beatriz Muñoz-Urribarri, Omar Alfaro Murillo, Feisul Idzwan Mustapha, Emir Muzurović, Yehia Nabil, Shaymaa Nafady, Ayu Nagamatsu, Atsushi Nakajima, Dan Nakano, Yuemin Nan, Fabio Nascimbeni, Mirella S. Naseef, Nagwa Nashat, Taran Natalia, Francesco Negro, Alexander V. Nersesov, Manuela Neuman, Masolwa Ng'wanasayi, Yan Ni, Amanda Nicoll, Takashi Niizeki, Dafina Nikolova, Wang Ningning, Madunil Niriella, K.A Nogoibaeva, Rozeena Nordien, Catherine O Sullivan, James O'Beirne, Solomon Obekpa, Ponsiano Ocama, Missiani Ochwoto, Michael Promise Ogolodom, Olusegun Ojo, Nana Okrostsvaridze, Claudia P. Oliveira, Raul Contreras Omaña, Omneya M. Omar, Hanaa Omar, Mabroka Omar, Salma Omran, Reham Omran, Marian Muse Osman, Nevin Owise, Theobald Owusu-Ansah, P. Martín Padilla- Machaca, Sirish Palle, Ziyan Pan, Xiao-Yan Pan, Qiuwei Pan, Apostolis Papaefthymiou, Feliciano Chanana Paquissi, Gabriella Par, Arit Parkash, Diana Payawal, Kevork M. Peltekian, Xuebin Peng, Liang Peng, Ying Peng, Rahul Pengoria, Martina Perez, José Luis Pérez, Norma Marlene Pérez, Marcello Persico, Mário Guimarães Pessoa, Salvatore Petta, Mathew Philip, Maria Corina Plaz Torres, Naveen Polavarapu, Jaime Poniachik, Piero Portincasa, Chunwen Pu, Tuğrul Pürnak, Edhie Purwanto, Xiaolong Qi, Xingshun Qi, Zibing Qian, Zhao Qiang, Zengpei Qiao, Liang Qiao, Alberto Queiroz, Atoosa Rabiee, Manal Radwan, Alain Marcel Rahetilahy, Yasmin Ramadan, Dina Ramadan, Anis Safura Ramli, Grant A. Ramm, Ao Ran, Ivan Rankovic, Huiying RAO, Sara Raouf, Sayantan Ray, Nancy Reau, Ahmed Refaat, Thomas Reiberger, Jose M Remes-Troche, Eira Cerda Reyes, Ben Richardson, Ezequiel Ridruejo, Sergio Riestra Jimenez, Ibrahim Rizk, Stuart Roberts, Juan Pablo Roblero, Jorge Alberto Prado Robles, Don Rockey, Manuel Rodríguez, Heriberto Rodríguez Hernández, Eva Román, Fernando Gomes Romeiro, Stefano Romeo, Jose Miguel Rosales-Zabal, Georgina R. Roshdi, Natalia Rosso, Andres Ruf, Patricia Cordero Ruiz, Nelia R. Runes, Andrea Ruzzenente, Marno Ryan, Ahmed Saad, Eman BE Sabbagh, Meriam Sabbah, Shimaa Saber, Reham Sabrey, Ramy Sabry, Maysaa Abdallah Saeed, Dina Said, Ebada M Said, Mohammad Amin Sakr, Yara Salah, Rabab Maamoun Salama, Asmaa Salama, Hussein Saleh, Ahmed Saleh, Ahmed Salem, Ahmed Thabet Salem, Alkassoum Salifou, Aso Faeq Salih, Abdallah Salman, Hanen Samouda, Faisal Sanai, Juan Francisco Sánchez-Ávila, Lakshumanan Sanker, Tomoya Sano, Miquel Sanz, Tobokalova Saparbu, Rohit Sawhney, Fatma Sayed, Sayed A. Sayed, Ashraf Othman Sayed, Manar Sayed, Giada Sebastiani, Laura Secadas, Khawaja Qamaruddin Sediqi, Sameh Seif, Nady Semida, Ebubekir Şenateş, Elena Daniela Serban, Lawrence Serfaty, Wai-Kay Seto, Ikram Sghaier, Min Sha, Hamada M. Shabaan, Lobna Shalaby, Inass Shaltout, Ala I. Sharara, Vishal Sharma, Isaac Thom Shawa, Ahmed Shawkat, Nehal Shawky, Osama Shehata, Sinead Sheils, Abate Bane Shewaye, Guojun Shi, Junping Shi, Shigeo Shimose, Tomotake Shirono, Lan Shou, Ananta Shrestha, Guanghou Shui, William Sievert, Solveig Sigurdardottir, Mostafa Mohamed Sira, Riyadh Siradj, Cecilia Sison, Linda Smyth, Reham Soliman, Jose D Sollano, Roger Sombie, Mark Sonderup, Siddharth Sood, German Soriano, Catherine A M Stedman, Oksana Stefanyuk, Davor Štimac, Simone Strasser, Pavel Strnad, Katherine Stuart, Wen Su, Minghua Su, Yoshio Sumida, Shuji Sumie, Dan-Qin Sun, Jing Sun, Hiroyuki Suzuki, Gianluca Svegliati-Baroni, Mohamed Osman Swar, S. TAHARBOUCHT, Zenab Taher, Saori Takamura, Lin Tan, Soek-Siam Tan, Tawesak Tanwandee, Sara Tarek, Ghelimici Tatiana, Federica Tavaglione, Gina Y. Tecson, Hoi-Poh Tee, Rolf Teschke, Mostafa Tharwat, Vo Duy Thong, Mark Thursz, Tulari Tine, Claudio Tiribelli, Ieva Tolmane, Jing Tong, Marco Tongo, Mamdouh Torkie, Aldo Torre, Esther A Torres, Meri Trajkovska, Sombat Treeprasertsuk, Tsubasa Tsutsumi, Thomas Tu, Josep A. Tur, Dilara Turan, Svetlana Turcan, Svetlana Turkina, Engin Tutar, Christian Tzeuton, Rose Ugiagbe, Ahmet Uygun, Michele Vacca, Pietro Vajro, David Van der Poorten, Laurens A. Van Kleef, Eliza Vashakidze, Carlos Moctezuma Velazquez, Mirtha Infante Velazquez, Sandro Vento, Veronique Verhoeven, Umberto Vespasiani-Gentilucci, Shireene Ratna Vethakkan, Josep Vilaseca, Libor Vítek, Ance Volkanovska, Michael Wallace, Wang Wan, Yan Wang, Ying Wang, Xiaolin Wang, Xuemei Wang, Chengyan Wang, Chunjiong Wang, Mingjie Wang, Pelden Wangchuk, Martin Weltman, MaryFrances White, Johannes Wiegand, Mohamed-Naguib Wifi, Alan Wigg, Markus Wilhelmi, Remon William, Henning Wittenburg, Shengjie Wu, Abdu Mohammed Wubeneh, Hongping Xia, Jian Xiao, Xiao Xiao, Wang Xiaofeng, Wanyuan Xiong, Liang Xu, Jie Xu, Weiguo Xu, Jing-Hang Xu, Keshu Xu, Yumin Xu, Shi-Hao Xu, Meng Xu, Aimin Xu, Chengfu Xu, Hongmei Yan, Jingyi Yang, Rui-Xu Yang, Yating Yang, Qinhe Yang, Naibin Yang, Jia Yao, Justine Yara, Serkan Yaraş, Nimet Yılmaz, Ramy Younes, Huda younes, Sona Young, Farah Youssef, Yanyan Yu, Ming-Lung Yu, Jing Yuan, Zhang Yue, Man-Fung Yuen, Wang Yun, Nonka Yurukova, Serag Zakaria, Samy Zaky, Maia Zaldastanishvili, Rodrigo Zapata, Nazanin Zare, Enver Zerem, Nema Zeriban, Xu Zeshuai, Huijie Zhang, Xuemei Zhang, Yupei Zhang, Wen-Hua Zhang, Xuchen Zhang, Yon-ping Zhang, Yuexin Zhang, Zhan-qing Zhang, Jingmin Zhao, Rong-Rong Zhao, Hongwei Zhao, Chao Zheng, Yijie Zheng, Ruidan Zheng, Tian-Lei Zheng, Kenneth Zheng, Xi Qiao Zhou, Yongjian Zhou, Yu-Jie Zhou, Hong Zhou, Ling Zhou, Yongning Zhou, Long dong Zhu, Yong Fen Zhu, Yueyong Zhu, Pei-Wu Zhu, Ebtesam Ziada, David Ziring, Li Ziyi, Shanshan Zou, Zhengsheng Zou, Huaibin Zou, Roberto Zuart Ruiz, UCL - (SLuc) Service de gastro-entérologie, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, Mendez-Sanchez, N, Bugianesi, E, Gish, R, Lammert, F, Tilg, H, Nguyen, M, Sarin, S, Fabrellas, N, Zelber-Sagi, S, Fan, J, Shiha, G, Targher, G, Zheng, M, Chan, W, Vinker, S, Kawaguchi, T, Castera, L, Yilmaz, Y, Korenjak, M, Spearman, C, Ungan, M, Palmer, M, El-Shabrawi, M, Gruss, H, Dufour, J, Dhawan, A, Wedemeyer, H, George, J, Valenti, L, Fouad, Y, Romero-Gomez, M, Eslam, M, Abate, M, Abbas, B, Abbassy, A, Abd El Ghany, W, Abd Elkhalek, A, Abd ElMajeed, E, Abdalgaber, M, Abdallah, M, Abdallah, N, Abdelaleem, S, Abdelghani, Y, Abdelghany, W, Abdelhalim, S, Abdelhamid, W, Abdelhamid, N, Abdelkader, N, Abdelkreem, E, Abdelmohsen, A, Abdelrahman, A, Abd-elsalam, S, Abdeltawab, D, Abduh, A, Abdulhakam, N, Abdulla, M, Abedpoor, N, Abenavoli, L, Aberg, F, Ablack, O, Abo elftouh, M, Abo-Amer, Y, Aboubkr, A, Aboud, A, Abouelnaga, A, Aboufarrag, G, Aboutaleb, A, Abundis, L, Adali, G, Adames, E, Adams, L, Adda, D, Adel, N, Adel Sayed, M, Afaa, T, Afredj, N, Aghayeva, G, Aghemo, A, Aguilar-Salinas, C, Ahlenstiel, G, Ahmady, W, Ahmed, W, Ahmed, A, Ahmed, S, Ahmed, H, Ahmed, R, Aigner, E, Akarsu, M, Akroush, M, Akyuz, U, Al Mahtab, M, Al Qadiri, T, Al Rawahi, Y, AL rubaee, R, Al Saffar, M, Alam, S, Al-Ani, Z, Albillos, A, Alboraie, M, Al-Busafi, S, Al-Emam, M, Alharthi, J, Ali, K, Ali, B, Ali, M, Ali, R, Alisi, A, AL-Khafaji, A, Alkhatry, M, Aller, R, Almansoury, Y, Al-Naamani, K, Alnakeeb, A, Alonso, A, Alqahtani, S, Alrabadi, L, Alswat, K, Altaher, M, Altamimi, T, Altamirano, J, Alvares-da-Silva, M, Aly, E, Alzahaby, A, Alzamzamy, A, Amano, K, Amer, M, Amin, M, Amin, S, Amir, A, Ampuero, J, Anas, N, Andreone, P, Andriamandimby, S, Anees, M, Angela, P, Antonios, M, Arafat, W, Araya, J, Armendariz-Borunda, J, Armstrong, M, Ashktorab, H, Aspichueta, P, Assal, F, Atef, M, Attia, D, Atwa, H, Awad, R, Awad, M, Awny, S, Awolowo, O, Awuku, Y, Ayada, I, Aye, T, Ayman, S, Ayman, H, Ayoub, H, Azmy, H, Babaran, R, Badreldin, O, Badry, A, Bahcecioglu, I, Bahour, A, Bai, J, Balaban, Y, Balasubramanyam, M, Bamakhrama, K, Banales, J, Bangaru, B, Bao, J, Barahona, J, Barakat, S, Barbalho, S, Barbra, B, Barranco, B, Barrera, F, Baumann, U, Bazeed, S, Bech, E, Benayad, A, Benesic, A, Bernstein, D, Bessone, F, Birney, S, Bisseye, C, Blake, M, Bobat, B, Bonfrate, L, Bordin, D, Bosques-Padilla, F, Boursier, J, Boushab, B, Bowen, D, Bravo, P, Brennan, P, Bright, B, Broekaert, I, Buque, X, Burgos-Santamaria, D, Burman, J, Busetto, L, Byrne, C, Cabral-Prodigalidad, P, Cabrera-Alvarez, G, Cai, W, Cainelli, F, Caliskan, A, Canbay, A, Cano-Contreras, A, Cao, H, Cao, Z, Carrion, A, Carubbi, F, Casanovas, T, Castellanos Fernandez, M, Chai, J, Chan, S, Charatcharoenwitthaya, P, Chavez-Tapia, N, Chayama, K, Chen, J, Chen, L, Chen, Z, Chen, H, Chen, S, Chen, Q, Chen, Y, Chen, G, Chen, E, Chen, F, Chen, P, Cheng, R, Cheng, W, Chieh, J, Chokr, I, Cholongitas, E, Choudhury, A, Chowdhury, A, Chukwudike, E, Ciardullo, S, Clayton, M, Clement, K, Cloa, M, Coccia, C, Collazos, C, Colombo, M, Cosar, A, Cotrim, H, Couillerot, J, Coulibaly, A, Crespo, G, Crespo, J, Cruells, M, Cua, I, Dabbous, H, Dalekos, G, D'Alia, P, Dan, L, Dao, V, Darwish, M, Datz, C, Davalos-Moscol, M, Dawoud, H, de Careaga, B, de Knegt, R, de Ledinghen, V, de Silva, J, Debzi, N, Decraecker, M, Del Pozo, E, Delgado, T, Delgado-Blanco, M, Dembinski, L, Depina, A, Derbala, M, Desalegn, H, Desbois-Mouthon, C, Desoky, M, Dev, A, Di Ciaula, A, Diago, M, Diallo, I, Diaz, L, Dirchwolf, M, Dongiovanni, P, Dorofeyev, A, Dou, X, Douglas, M, Doulberis, M, Dovia, C, Doyle, A, Dragojevic, I, Drenth, J, Duan, X, Dulskas, A, Dumitrascu, D, Duncan, O, Dusabejambo, V, Dwawhi, R, Eiketsu, S, El Amrousy, D, El Deeb, A, El Deriny, G, El Din, H, El Kamshishy, S, El Kassas, M, El Raziky, M, Elagamy, O, Elakel, W, Elalfy, D, Elaraby, H, Elawady, H, Elbadawy, R, Eldash, H, Eldefrawy, M, Elecharri, C, Elfaramawy, A, Elfatih, M, Elfiky, M, Elgamsy, M, Elgendy, M, El-Guindi, M, Elhussieny, N, Eliwa, A, Elkabbany, Z, El-Khayat, H, El-Koofy, N, Elmetwalli, A, Elrabat, A, El-Raey, F, Elrashdy, F, Elsahhar, M, Elsaid, E, Elsayed, S, Elsayed, H, Elsayed, A, El-Serafy, M, Elsharkawy, A, Elsheemy, R, Elshemy, E, Elsherbini, S, Eltoukhy, N, Elwakil, R, Emad, O, Emad, S, Embabi, M, Ergenc, I, Ermolova, T, Esmat, G, Esmat, D, Estupinan, E, Ettair, S, Eugen, T, Ezz-Eldin, M, Falcon, L, Fan, Y, Fandari, S, Farag, M, Farahat, T, Fares, E, Fares, M, Fassio, E, Fathy, H, Fathy, D, Fathy, W, Fayed, S, Feng, D, Feng, G, Fernandez-Bermejo, M, Ferreira, C, Ferrer, J, Forbes, A, Fouad, R, Fouad, H, Frisch, T, Fujii, H, Fukunaga, S, Fukunishi, S, Fulya, H, Furuhashi, M, Gaber, Y, Galang, A, Gallardo, J, Galloso, R, Gamal, M, Gamal, R, Gamal, H, Gan, J, Ganbold, A, Gao, X, Garas, G, Garba, T, Garcia-Cortes, M, Garcia-Monzon, C, Garcia-Samaniego, J, Gastaldelli, A, Gatica, M, Gatley, E, Gegeshidze, T, Geng, B, Ghazinyan, H, Ghoneem, S, Giacomelli, L, Giannelli, G, Giannini, E, Giefer, M, Gines, P, Girala, M, Giraudi, P, Goh, G, Gomaa, A, Gong, B, Gonzales, D, Gonzalez, H, Gonzalez-Huezo, M, Graupera, I, Grgurevic, I, Gronbaek, H, Gu, X, Guan, L, Gueye, I, Guingane, A, Gul, O, Gul, C, Guo, Q, Gupta, P, Gurakar, A, Gutierrez, J, Habib, G, Hafez, A, Hagman, E, Halawa, E, Hamdy, O, Hamed, A, Hamed, D, Hamid, S, Hamoudi, W, Han, Y, Haridy, J, Haridy, H, Harris, D, Hart, M, Hasan, F, Hashim, A, Hassan, I, Hassan, A, Hassan, E, Hassan, M, Hassanin, F, Hassnine, A, Haukeland, J, Hawal, A, He, J, He, Q, He, Y, He, F, Hegazy, M, Hegazy, A, Henegil, O, Hernandez, N, Hernandez-Guerra, M, Higuera-de-la-Tijera, F, Hindy, I, Hirota, K, Ho, L, Hodge, A, Hosny, M, Hou, X, Huang, J, Huang, Y, Huang, Z, Huang, A, Huang, X, Hui-ping, S, Hunyady, B, Hussein, M, Hussein, O, Hussien, S, Ibanez-Samaniego, L, Ibdah, J, Ibrahim, L, Ibrahim, M, Ibrahim, I, Icaza-Chavez, M, Idelbi, S, Idilman, R, Ikeda, M, Indolfi, G, Invernizzi, F, Irshad, I, Isa, H, Iskandar, N, Ismaiel, A, Ismail, M, Ismail, Z, Ismail, F, Iwamoto, H, Jack, K, Jacob, R, Jafarov, F, Jafri, W, Jahshan, H, Jalal, P, Jancoriene, L, Janicko, M, Jayasena, H, Jefferies, M, Jha, V, Ji, F, Ji, Y, Jia, J, Jiang, C, Jiang, N, Jiang, Z, Jin, X, Jin, Y, Jing, X, Jingyu, Q, Jinjolava, M, Jong, F, Jucov, A, Julius, I, Kaddah, M, Kamada, Y, Kamal, A, Kamal, E, Kamel, A, Kao, J, Karin, M, Karlas, T, Kashwaa, M, Katsidzira, L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022
Full Text
View/download PDF

8. The establishment of public health policies and the burden of non-alcoholic fatty liver disease in the Americas

Author

Luis Antonio Díaz, Eduardo Fuentes-López, Gustavo Ayares, Francisco Idalsoaga, Jorge Arnold, Andrea Márquez-Lomas, Carolina A Ramírez, María Paz Medel, Francisca Viñuela, Lucas Lacalle, Juan Pablo Roblero, Catterina Ferreccio, Mariana Lazo, Mayur Brahmania, Ashwani K Singal, Melisa Dirchwolf, Nahum Méndez-Sánchez, Norberto Chavez-Tapia, Patricia Guerra, Juan Carlos Restrepo, Claudia P Oliveira, Julissa Lombardo, Abel Sánchez, Martín Elizondo, Martín Tagle, Martín Padilla, Marco Sánchez, Enrique Carrera, Marcos Girala, Omega Chery, Marlen Castellanos-Fernández, Francisco Barrera, Jeffrey V Lazarus, Patrick S Kamath, Ramon Bataller, Marco Arrese, and Juan Pablo Arab

Subjects
Hepatology, Non-alcoholic Fatty Liver Disease, Risk Factors, Health Policy, Gastroenterology, non-alcoholic fatty liver diseases, Humans, nutritional and metabolic diseases, Obesity, Public Health, Americas, the Americas, digestive system diseases
Abstract

Non-alcoholic fatty liver disease (NAFLD) affects 20-25% of the general population and is associated with morbidity, increased mortality, and elevated health-care costs. Most NAFLD risk factors are modifiable and, therefore, potentially amenable to being reduced by public health policies. To date, there is no information about NAFLD-related public health policies in the Americas. In this study, we analysed data from 17 American countries and found that none have established national public health policies to decrease NAFLD-related burden. There is notable heterogeneity in the existence of public health policies to prevent NAFLD-related conditions. The most common public health policies were related to diabetes (15 [88%] countries), hypertension (14 [82%] countries), cardiovascular diseases (14 [82%] countries), obesity (nine [53%] countries), and dyslipidaemia (six [35%] of countries). Only seven (41%) countries had a registry of the burden of NAFLD, and efforts to raise awareness in the Americas were scarce. The implementation of public health policies are urgently needed in the Americas to decrease the burden of NAFLD.

Published
2022

11. O-21 EVIDENCE OF SUBOPTIMAL PUBLIC HEALTH POLICIES ON HEPATOCELLULAR CARCINOMA IN THE AMERICAS: A HUGE DEBT OF OUR REGION

Author

Luis Antonio Díaz, Gustavo Ayares, Francisco Idalsoaga, Jorge Arnold, Blanca Norero, Oscar Corsi, Gonzalo Pizarro, Sergio García, Eduardo Fuentes-López, Edmundo Martinez, Patricia Guerra Salazar, Roberta C. Araújo, Mario Reis Alvares-Da-Silva, Florencia D. Pollarsky, Nelia Hernandez, Juan Carlos Restrepo, Mirtha Infante, Enrique Carrera, Abel Sanchez, Marcos Girala, Martín Padilla, Javier Díaz, Martín Tagle, Melisa Dirchwolf, Manuel Mendizabal, Mariana Lazo, Catterina Ferreccio, Thomas G. Cotter, Mayur Brahmania, Nahum Méndez-Sánchez, Juan Pablo Roblero, Winston Dunn, Patrick S. Kamath, Ashwani K. Singal, Ramón Bataller, Marco Arrese, and Juan Pablo Arab

Subjects
Hepatology, General Medicine
Published
2023
Full Text
View/download PDF

12. OP-5 ALCOHOL-ASSOCIATED HEPATITIS IN LATIN AMERICA: RESULTS FROM THE AH-LATIN STUDY

Author

Luis Antonio Díaz, Jorge Arnold, Francisco Idalsoaga, Gustavo Ayares, María Ayala-Valverde, Diego Perez, Jaime Gomez, Rodrigo Escarate, Juan Pablo Roblero, Blanca Norero, José Antonio Velarde, Janett Jacobo, Jesús Varela, Scherezada Mejía Loza, Jacqueline Córdova, Rita Silva, Cristina Melo Rocha, Roberta C. Araujo, Gustavo Henrique Pereira, Claudia Couto, Fernando Bessone, Mario Tanno, Gustavo Romero, Manuel Mendizabal, Sebastián Marciano, Melisa Dirchwolf, Pedro Montes, Patricia Guerra Salazar, Geraldine Ramos, Juan Carlos Restrepo, Gabriel Díaz, Luis Guillermo Toro, Enrique Carrera, Brahmania Mayur, Singal Ashwani, Bataller Ramon, Shah Vijay, Kamath Patrick S., Marco Arrese, and Juan Pablo Arab

Subjects
Hepatology, General Medicine
Published
2023
Full Text
View/download PDF

13. O-11 THE PUBLIC HEALTH POLICIES REDUCE THE LONG-TERM BURDEN OF ALCOHOL-ASSOCIATED LIVER DISEASE WORLDWIDE: DEVELOPMENT OF A PREPAREDNESS INDEX

Author

Luis Antonio Díaz, Eduardo Fuentes-López, Francisco Idalsoaga, Jorge Arnold, Gustavo Ayares, Macarena Cannistra, Danae Vio, Andrea Márquez-Lomas, Oscar Corsi, Carolina A. Ramírez, María Paz Medel, Catterina Ferreccio, Mariana Lazo, Juan Pablo Roblero, Thomas Cotter, Anand V. Kulkarni, Won Kim, Mayur Brahmania, Alexandre Louvet, Elliot Tapper, Winston Dunn, Douglas Simonetto, Vijay Shah, Patrick Kamath, Jeffrey V. Lazarus, Ashwani K. Singal, Ramon Bataller, Marco Arrese, and Juan Pablo Arab

Subjects
Hepatology, General Medicine
Published
2023
Full Text
View/download PDF

14. MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis

Author

Luis Antonio Díaz, Eduardo Fuentes-López, Gustavo Ayares, Francisco Idalsoaga, Jorge Arnold, María Ayala Valverde, Diego Perez, Jaime Gómez, Rodrigo Escarate, Alejandro Villalón, Carolina A. Ramírez, Maria Hernandez-Tejero, Wei Zhang, Steve Qian, Douglas A. Simonetto, Joseph C. Ahn, Seth Buryska, Winston Dunn, Heer Mehta, Rohit Agrawal, Joaquín Cabezas, Inés García-Carrera, Berta Cuyàs, Maria Poca, German Soriano, Shiv K. Sarin, Rakhi Maiwall, Prasun K. Jalal, Saba Abdulsada, Fátima Higuera-de-la-Tijera, Anand V. Kulkarni, P Nagaraja Rao, Patricia Guerra Salazar, Lubomir Skladaný, Natália Bystrianska, Ana Clemente-Sanchez, Clara Villaseca-Gómez, Tehseen Haider, Kristina R Chacko, Gustavo A. Romero, Florencia D. Pollarsky, Juan Carlos Restrepo, Susana Castro-Sanchez, Luis G. Toro, Pamela Yaquich, Manuel Mendizabal, Maria Laura Garrido, Sebastián Marciano, Melisa Dirchwolf, Victor Vargas, César Jiménez, Alexandre Louvet, Guadalupe García-Tsao, Juan Pablo Roblero, Juan G. Abraldes, Vijay H. Shah, Patrick S. Kamath, Marco Arrese, Ashwani K. Singal, Ramon Bataller, and Juan Pablo Arab

Subjects
Hepatology, Gastroenterology, Internal Medicine, Immunology and Allergy
Published
2023
Full Text
View/download PDF

15. P-13 PREVALENCE, CHARACTERIZATION, AND SURVIVAL OF ACUTE ON CHRONIC LIVER FAILURE IN A LATIN AMERICAN COHORT: A MULTICENTER STUDY

Author

Francisco Idalsoaga, Luis Antonio Díaz, Gustavo Ayares, Jorge Arnold, Víctor Meza, Franco Manzur, Joaquín Sotomayor, Hernán Rodríguez, Franco Chianale, Sofía Villagrán, Maximilano Schalper, Pablo Villafranca, Maria Jesus Veliz, Paz Uribe, Maximiliano Puebla, Pablo Bustamante, Herman Aguirre, Javiera Busquets, Gabriel Mezzano, Juan Pablo Roblero, and Juan Pablo Arab

Subjects
Hepatology, General Medicine
Published
2023
Full Text
View/download PDF

17. Socioeconomic inequalities in the incidence of alcohol-related liver disease in the Latin American context

Author

Pablo Roblero, Ramon Bataller, Juan Pablo Roblero, Juan Pablo Arab, and Luis Antonio Díaz

Subjects
Latin Americans, Letter, business.industry, Health Policy, Incidence (epidemiology), Context (language use), Oncology, Environmental health, Internal Medicine, Medicine, Alcohol-related liver disease, Public aspects of medicine, RA1-1270, business, Socioeconomic inequalities
Published
2021

18. P-44 TRANSARTERIAL CHEMOEMBOLIZATION IN PATIENTS WITH CONTROVERSIAL INDICATION

Author

Marcelo Salinas, Alejandra Dominguez, Jaime Poniachik, Alvaro Urzúa, Juan Pablo Roblero, Maximo Cattaneo, and Gabriel Puelma

Subjects
medicine.medical_specialty, Hepatology, RC581-951, business.industry, medicine, Specialties of internal medicine, In patient, General Medicine, business, Surgery
Abstract

Introduction: Transarterial chemoembolization (TACE) is considered the therapy of choice in patients with intermediate stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection or tumor ablation. There are discrepancies in the American and European consensus on the treatment of HCC in Child B stage patients, given it is associated with an increased risk of liver failure and death. Objective: To describe the experience of a University Center in the management of patients with HCC and cirrhosis Child B. Methods: Observational, retrospective study. 25 patients were included. Sociodemographic variables, aetiology of cirrhosis, HCC stage, treatment and associated decompensations were included. The analysis was carried out with descriptive statistics. Results: Of the patients, 14 women, 24% with MELD-Na ≥ 15 (15-20). 44% NASH, 20% HCV infection. 56% and 34% in stage A and B of Barcelona. 32% within the Milan criteria and 25% within San Francisco. After the TACE, 16% presented immediate complications, without associated mortality. At 6 months of follow-up, 36% presented an increase in MELD-Na by (2-6) points, 32% presented or increased ascites, 12% progressed to Child C. Survival at 6 months after chemoembolization was 76%. Conclusion: TACE was a safe procedure in patients with Child B, in terms of immediate complications, however, a considerable percentage presented deterioration of liver function at 6 months of follow up. This therapy in Child B patients should be evaluated individually case by case.

Published
2021

19. P-64 THE ALCOHOL-ASSOCIATED LIVER DISEASE PARADOX IN CHILE: AN ASSESSMENT WITH DATA FROM THE NATIONAL HEALTH SURVEY (ENS 2016-2017)

Author

Maximo Cattaneo, Juan Pablo Arab, Pablo Roblero, Luis Antonio Díaz, Alvaro Urzúa, Francisco Idalsoaga, Jaime Poniachik, Gianfranco Oneto, and Juan Pablo Roblero

Subjects
National health, Hepatology, endocrine system diseases, business.industry, Specialties of internal medicine, Alcohol, General Medicine, medicine.disease, chemistry.chemical_compound, Liver disease, chemistry, RC581-951, Environmental health, medicine, business
Abstract

Introduction: It has been observed people with low-income-level (IL). The aim of this study was to evaluate alcohol-associated liver disease (ALD) paradox in Chile. Methods: With data from the ENS 2016-17 (N=2,190; age 25-64) we constructed a logit regression model that estimated the effect hazardous AC (AUDIT≥8) on the probability of presenting ALD (GPT≥40 U/L). We focus on the interaction between hazardous AC and IL, controlling for the presence of metabolic syndrome (MS), diabetes mellitus (T2DM), obesity and tobacco. Results: The average AC was 39g of alcohol per week (13g women IL; 64g men, without differences by IL). In women, hazardous AC only increased ALD among those >IL who presented with obesity or MS in combination with T2DM (+36% obesity+MS+T2DM; pIL is likely associated with higher AC and more harmful consumption patterns.

Published
2021

20. Probiotics-Based Treatment as an Integral Approach for Alcohol Use Disorder in Alcoholic Liver Disease

Author

Catalina Fuenzalida, María Soledad Dufeu, Jaime Poniachik, Juan Pablo Roblero, Lucía Valenzuela-Pérez, and Caroll Jenny Beltrán

Subjects
Alcoholic liver disease, Cirrhosis, Alcoholic hepatitis, RM1-950, Alcohol use disorder, Review, Gut flora, Systemic inflammation, neuroinflammation, medicine, Genetic predisposition, microbiota, Pharmacology (medical), Neuroinflammation, Pharmacology, biology, business.industry, biology.organism_classification, medicine.disease, gut-liver-brain axis, probiotics, Immunology, alcohol craving, Therapeutics. Pharmacology, alcohol addiction, medicine.symptom, business, alcoholic liver disease
Abstract

Alcoholic liver disease (ALD) is one of the leading causes of morbidity among adults with alcohol use disorder (AUD) worldwide. Its clinical course ranges from steatosis to alcoholic hepatitis, progressing to more severe forms of liver damage, such as cirrhosis and hepatocellular carcinoma. The pathogenesis of ALD is complex and diverse elements are involved in its development, including environmental factors, genetic predisposition, the immune response, and the gut-liver axis interaction. Chronic alcohol consumption induces changes in gut microbiota that are associated with a loss of intestinal barrier function and inflammatory responses which reinforce a liver damage progression triggered by alcohol. Alcohol metabolites such as acetaldehyde, lipid peroxidation-derived aldehyde malondialdehyde (MDA), and protein-adducts act as liver-damaging hepatotoxins and potentiate systemic inflammation. Additionally, ethanol causes direct damage to the central nervous system (CNS) by crossing the blood-brain barrier (BBB), provoking oxidative stress contributing to neuroinflammation. Overall, these processes have been associated with susceptibility to depression, anxiety, and alcohol craving in ALD. Recent evidence has shown that probiotics can reverse alcohol-induced changes of the microbiota and prevent ALD progression by restoring gut microbial composition. However, the impact of probiotics on alcohol consumption behavior has been less explored. Probiotics have been used to treat various conditions by restoring microbiota and decreasing systemic and CNS inflammation. The results of some studies suggest that probiotics might improve mental function in Alzheimer’s, autism spectrum disorder, and attenuated morphine analgesic tolerance. In this sense, it has been observed that gut microbiota composition alterations, as well as its modulation using probiotics, elicit changes in neurotransmitter signals in the brain, especially in the dopamine reward circuit. Consequently, it is not difficult to imagine that a probiotics-based complementary treatment to ALD might reduce disease progression mediated by lower alcohol consumption. This review aims to present an update of the pathophysiologic mechanism underlying the microbiota-gut-liver-brain axis in ALD, as well as to provide evidence supporting probiotic use as a complementary therapy to address alcohol consumption disorder and its consequences on liver damage.

Published
2021

21. P-38 UTILITY OF PUPILLARY REACTIVITY IN THE FUNCTIONAL ASSESSMENT OF THE AUTONOMOUS NERVOUS SYSTEM IN PATIENTS WITH CHRONIC LIVER DISEASE: PRELIMINARY RESULTS

Author

Jaime Poniachik, Abraham I.J. Gajardo, Maximo Cattaneo, Flavia Giubergia, Nicolás Bustos, Christian Lara, Juan Pablo Roblero, and Alvaro Urzúa

Subjects
Hepatology, RC581-951, business.industry, Medicine, Specialties of internal medicine, In patient, General Medicine, Autonomous nervous system, business, Chronic liver disease, medicine.disease, Reactivity (psychology), Bioinformatics
Abstract

Introduction: Autonomic nervous system (ANS) dysfunction in patients with chronic liver disease (CLD) is associated with greater severity. Heart rate variability (HRV) allows the assessment of ANS, but its implementation is complex. Pupillary reactivity (PR) by automatic pupillometry (AP) also provides this information; however its usefulness in patients with CLD is unknown. Objectives: To validate the usefulness of PR in the evaluation of ANS in healthy subjects and patients with CLD through association with HRV. Methods: Cross-sectional study that includes healthy controls (n = 11) and patients with DHC (n = 26). ANS balance was determined by HRV by Holter rhythm of 5 minutes and RP by AP. HRV / RP of healthy subjects and with CLD, and correlation parameters of both measurements were compared. Results: Significant differences were found between both groups in the parameters of both HRV and RP, demonstrating an imbalance of the ANS in CLD patients. Differences were significant in 2 of 3 time parameters, in 2 of 3 frequency parameters in HRV and in 5 of 7 objectified by AP. The imbalance increases directly according to the Child stage (p

Published
2021

22. P-39 EXPERIENCE IN THE MANAGEMENT OF REFRACTORY HEPATIC ENCEPHALOPATHY THROUGH ENDOVASCULAR THERAPY

Author

Jaime Poniachik, Maximo Cattaneo, Nicolas W. Martinez, Claudia Muñoz, Claudia Pavez, Alvaro Urzúa, Patricio Palavecino, Juan Pablo Roblero, and Felipe Ramírez

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, medicine.medical_treatment, Specialties of internal medicine, General Medicine, medicine.disease, Endovascular therapy, Surgery, Refractory, RC581-951, Splenic vein, medicine, Portal hypertension, In patient, Embolization, business, Hepatic encephalopathy
Abstract

Introduction: Hepatic encephalopathy (HE) is the most common neuropsychiatric syndrome secondary to portal hypertension. It usually responds to medical treatment, but sometimes HE is refractory (RHE) to usual treatment. In some patients it may be important to consider management alternatives. Endovascular therapy (ET) could be a therapeutic option in selected cases that is performed with very low frequency and the evidence is scarce. Objectives: To present our experience in the management of RHE with ET. Methods: The pre and post-procedure clinical characteristics of 10 patients with RHE undergoing splenic vein embolization (n: 5) or porto-systemic bypass embolization (n: 5) between 2009-2019 were retrospectively analyzed. Results: 7/10 were men, average age 67 years (62-79), in 70% the cause of cirrhosis was NASH, the Child Pugh average score was B (8 points), (6-11) and MELD-Na was 13 points, (9-20), in 5 patients the ammonia prior to the procedure was 134 mmol / l (range: 90-180, VN

Published
2021

23. P-43 INDICATORS OF RESPONSE TO FIRST TRANSARTERIAL CHEMOEMBOLIZATION (TACE) IN HEPATOCELULLAR CARCINOMA

Author

Juan Pablo Roblero, Maximo Cattaneo, Marcelo Salinas, Javier Ortiz, Patricio Palavecino, Jaime Poniachik, Gabriel Puelma, Alvaro Urzúa, and Alejandra Dominguez

Subjects
medicine.medical_specialty, Hepatology, RC581-951, business.industry, Internal medicine, Carcinoma, Medicine, Specialties of internal medicine, General Medicine, business, medicine.disease, Gastroenterology
Abstract

Introduction: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. Liver transplantation offers good results in its treatment, however the shortage of donors has forced the use of other therapies, such as transarterial chemoembolization (TACE), whose therapeutic scheme is not completely standardized. Objective: To evaluate the response to the first TACE, the indicators of success of the therapy and the decompensations associated with its use. Methods: Retrospective observational study. 76 patients were included. Variables such as sociodemographic, clinical and HCC stages were included. Response to TACE was assessed by post-treatment LIRADS classification. Descriptive statistics were used for the analysis. Results: 60% men, the median age was 64 years (51-81), 63% Child A, average MELD-Na 10 points. 33% associated with NASH. 47% of the patients reached non-viability after the first TACE, 30% required two TACE, 15% three TACE and 7% four TACE. 58% in Barcelona stage A, 43% within the Milan criteria and 60% within the San Francisco criteria. 6% presented decompensations after the 1st TACE. The characteristics of the patients who reached non-viability versus those who remained viable are presented in Table 1. Conclusion: Most patients require two TACEs to achieve tumor non-viability. The main indicators of response to TACE were tumor burden and MELD-Na score> 8.

Published
2021

24. P-67 ULTRASOUND GUIDED TRANSIENT ELASTOGRAPHY FOR THE DIAGNOSIS AND STAGING OF LIVER FIBROSIS

Author

Alexandra Sandoval, Jaime Poniachik, Katherine González, Luis Bustamante Salazar, Alvaro Urzúa, Juan Francisco Rozas, Juan Pablo Roblero, and Maximo Cattaneo

Subjects
Hepatology, business.industry, Liver fibrosis, Ultrasound, Fatty liver, Specialties of internal medicine, General Medicine, medicine.disease, Ultrasound guided, RC581-951, Fibrosis, Liver stiffness, Medicine, business, Transient elastography, Nuclear medicine, Prospective cohort study
Abstract

Introduction: Transient elastography (TE) is a non-invasive method for the evaluation of liver fibrosis. Up to 20% of measurements fail, possibly due to the choice of probe position. Objectives: To evaluate the use of ultrasound as a position guide (UPG) prior to TE to improve the measurement of liver stiffness (LS). Methods: Prospective study of 237 patients (age 54 ± 14 years, 69% women) referred for TE (FibroScan, Echosens). The main indication was non-alcoholic fatty liver disease (52.3%). 65.4% of the patients were overweight or obese. LS was measured in each patient according to the manufacturer's recommendations and at the same appointment, in UPG. Fibrosis staging sections recommended by the manufacturer were used. Statistical analyzes performed with chi-square and t-test (p

Published
2021

25. P-65 CONCORDANCE OF FIB-4 WITH TRANSITION ELASTOGRAPHY IN THE DIAGNOSIS OF ADVANCED LIVER FIBROSIS

Author

Alexandra Sandoval, Juan Pablo Roblero, Jaime Poniachik, Juan Francisco Rozas, Camila Estay, Alvaro Urzúa, Katherine González, and Maximo Cattaneo

Subjects
Pathology, medicine.medical_specialty, Hepatology, medicine.diagnostic_test, Transition (genetics), business.industry, Concordance, Liver fibrosis, Specialties of internal medicine, General Medicine, RC581-951, medicine, Elastography, business
Abstract

Introduction: Transient elastography (TE) and non-invasive scores such as FIB-4 are non-invasive methods to evaluate liver fibrosis. Objectives: To evaluate the concordance between TE and FIB-4 in the diagnosis of advanced fibrosis. Methods: Observational study. 185 patients (53 ± 14 years, 71.4% women) referred for TE (FibroScan, Echosens). The main indication was non-alcoholic fatty liver disease (46%). Fibrosis staging sections recommended by the manufacturer were used. Clinical data and laboratory tests performed in the 30 days prior to the study were recorded. FIB-4 cuts > 3.45 and

Published
2021

26. P-59 LIVER TRANSPLANTATION: SIX YEARS EXPERIENCE IN A UNIVERSITY HOSPITAL OF CHILE

Author

Hiru Chang, Jaime Poniachik, Alvaro Urzúa, Juan Francisco Rozas, Danett Guiñez, Maximo Cattaneo, Juan Pablo Roblero, Víctor Henríquez, and Fodda Chelech

Subjects
medicine.medical_specialty, Hepatology, business.industry, medicine.medical_treatment, Specialties of internal medicine, Retrospective cohort study, General Medicine, Autoimmune hepatitis, Liver transplantation, Chronic liver disease, medicine.disease, digestive system diseases, Transplantation, RC581-951, Internal medicine, Hepatocellular carcinoma, medicine, Etiology, Steatohepatitis, business
Abstract

Introduction Liver transplantation (LT) has improved the quality of life and survival of patients in advanced stages of chronic liver disease (CLD). In the last decade, an increase in non-alcoholic steatohepatitis (NASH) as an indication for LT has been evidenced worldwide. There is little up-to-date information regarding the characteristics of LT performed in our country. Objectives To describe the clinical characteristics of LT performed at the Hospital Clinico de la Universidad de Chile in the last 6 years. Methods Retrospective study. LT performed between September 2013 and September 2019 were included. Clinical data, aetiology of DHC and MELD-Na were recorded at the time of transplantation. Results 145 LT were performed, 60.6% being men, the median age was 59 years (22-72 years). The main etiology of CLD was NASH (39.3%), followed by CLA attributed to alcohol (17.9%) and autoimmune hepatitis (7.6%). 33.1% of the patients had hepatocellular carcinoma (HCC), of which 54% were patients with NASH. The mean MELD-Na at transplantation was 22 ± 9 and the operational MELD 28 ± 5. Conclusions In our center, NASH is the first indication for LT, as well as the etiology most frequently related to the presence of HCC. These data are consistent with projections estimated worldwide. This information reaffirms the need for successful strategies to prevent and reverse the progression of NASH.

Published
2021

27. Alcohol-related liver disease: Clinical practice guidelines by the Latin American Association for the Study of the Liver (ALEH)

Author

Alvaro Urzúa, Fernando Contreras, Juan Pablo Roblero, Helena Cortez-Pinto, Douglas A. Simonetto, Aldo Torre, Vijay H. Shah, Fernando Bessone, Ramon Bataller, Michael R. Lucey, Nahum Méndez-Sánchez, Juan Carlos Restrepo, Fátima Higuera-de la Tijera, Juan G. Abraldes, Juan Pablo Arab, José Altamirano, and Roberta Chaves Araújo

Subjects
Alcoholic liver disease, Pediatrics, medicine.medical_specialty, Alcohol Drinking, medicine.medical_treatment, Alcoholic hepatitis, Specialties of internal medicine, Alcohol use disorder, Liver transplantation, Chronic liver disease, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Risk Factors, Prevalence, medicine, Humans, Corticosteroids, Liver Diseases, Alcoholic, Societies, Medical, Alcohol-related liver disease, Hepatology, business.industry, Gastroenterology, General Medicine, medicine.disease, Transplantation, Latin America, RC581-951, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, 030211 gastroenterology & hepatology, Steatohepatitis, business, Alcohol, Clinical practice guidelines
Abstract

Alcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy.

Published
2019

28. The number of public health policies reduces the burden and mortality of alcohol-associated liver disease worldwide: a call for action

Author

Luis Antonio Diaz, Eduardo Fuentes, Francisco Idalsoaga, Jorge Arnold, Gustavo Ayares, Macarena Cannistra, Danae Vio, Andrea Márquez, Oscar Corsi, Alejandro Villalón, Carolina Ramirez, María Paz Medel, Catterina Ferreccio, Mariana Lazo, Juan Pablo Roblero, Anand Kulkarni, Won Kim, Mayur Brahmania, Alexandre Louvet, Elliot Tapper, Winston Dunn, Douglas Simonetto, Vijay Shah, Patrick S. Kamath, Ashwani Singal, Ramon Bataller, Marco Arrese, and Juan Pablo Arab

Subjects
Hepatology
Published
2022
Full Text
View/download PDF

29. Alcohol associated hepatitis in Latin America: results from the AH-LATIN study

Author

Jorge Arnold, Luis Antonio Diaz, Francisco Idalsoaga, Gustavo Ayares, Eduardo Fuentes, Carolina Ramirez, María Paz Medel, Catterina Ferreccio, Mariana Lazo, Juan Pablo Roblero, Mayur Brahmania, Rodolfo Carbonetti, Sebastián Marciano, Manuel Mendizabal, Fernando Bessone, Gustavo Romero, Ana Palazzo, Estela Florencia Manero, Melisa Dirchwolf, Diego Piombino, María Ayala Valverde, Fernando Cairo, Maria Alejandra Gracia Villamil, Maria Mercedes Rodriguez Gazari, Patricia Gallardo, Geraldine Ramos, Patricia Guerra, Fabio Silveira, Roberta Chaves, Giovanni Silva, Cirley Lobato, Jozelda Lemos, Rogério Alves, Gustavo Pereira, Rita de Cássia Martins Alves da Silva, Liliana Sampaio Costa Mendes, Cláudia Alves Couto, Cristina Melo Rocha, Raul Lazarte, Pamela Yaquich, Blanca Norero, Camila Jure, Alejandra Dominguez, Marta Mac Vicar, Violeta Rivas, Juan Pablo Arancibia, Armando Sierralta, Jose Valera, Sebastian Diaz, Carlos Sanchez, Luis Toro, Adrian Varon, Elizabeth Correa, Juan Carlos Restrepo, Monica Tapias, Ricardo Aguilera Rosales, Mirtha Infante, Galo Pazmiño, Xiimena Armijos, Enrique Carrera, Regina Ligoria, Gerson Avila, Abel Sanchez, Marco Sánchez, Scherezada Mejia, Jacqueline Cordova, Maria De Fatima Higuera de La Tijera, Raul Contreras, Francisco Solis, Jesus Varela, Janett Jacobo, Jose Antonio Velarde-Ruiz Velasco, Julissa Lombardo Quezada, Esther Veramendi, Victor Vela, Claudia Pamo, Donny Puma, Julio Marcelo, Laura Tenorio, Maria Cabrera, Jose Rivera, Pedro Montes, Ramon Bataller, Alexandre Louvet, Vijay Shah, Patrick S. Kamath, Ashwani Singal, Marco Arrese, and Juan Pablo Arab

Subjects
Hepatology
Published
2022
Full Text
View/download PDF

30. Impact of Public Health Policies on Alcohol-Associated Liver Disease in Latin America: An Ecological Multinational Study

Author

Oscar Corsi, Mariana Lazo, Carolina Ramírez, Ashwani K. Singal, Luis Antonio Díaz, Pedro Montes, Ramon Bataller, Juan Pablo Roblero, Juan Pablo Arab, Galo Pazmiño, Mayur Brahmania, Roberta Chaves Araújo, Luis Guillermo Toro, Manuel Mendizabal, Nelia Hernández, Eduardo Fuentes-López, Marco Arrese, Catterina Ferreccio, Andrea Márquez-Lomas, Francisco Idalsoaga, and Fátima Higuera-de-la-Tijera

Subjects
Adult, Male, Alcoholic liver disease, medicine.medical_specialty, Latin Americans, Adolescent, Alcohol Drinking, Population, Alcoholic hepatitis, Young Adult, Alcohol and health, Risk Factors, medicine, Per capita, Diabetes Mellitus, Prevalence, Humans, Obesity, education, Community Support, Liver Diseases, Alcoholic, Aged, Aged, 80 and over, education.field_of_study, Hepatology, business.industry, Ecology, Public health, Health Policy, Middle Aged, medicine.disease, Alcoholism, Latin America, Government Regulation, Female, business
Abstract

BACKGROUND AND AIMS Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Latin America, yet the impact of public health policies (PHP) on liver disease is unknown. We aimed to assess the association between alcohol PHP and deaths due to ALD in Latin American countries. APPROACH AND RESULTS We performed an ecological multinational study including 20 countries in Latin America (628,466,088 inhabitants). We obtained country-level sociodemographic information from the World Bank Open Data source. Alcohol-related PHP data for countries were obtained from the World Health Organization Global Information System of Alcohol and Health. We constructed generalized linear models to assess the association between the number of PHP (in 2010) and health outcomes (in 2016). In Latin America, the prevalence of obesity was 27% and 26.1% among male and female populations, respectively. The estimated alcohol per capita consumption among the population at 15 years old or older was 6.8 L of pure alcohol (5.6 recorded and 1.2 unrecorded). The overall prevalence of alcohol use disorders (AUD) was 4.9%. ALD was the main cause of cirrhosis in 64.7% of male and 40.0% of female populations. A total of 19 (95%) countries have at least one alcohol-related PHP on alcohol. The most frequent PHP were limiting drinking age (95%), tax regulations (90%), drunk-driving policies and countermeasures (90%), and government monitoring systems and community support (90%). A higher number of PHP was associated with a lower ALD mortality (PR, 0.76; 95% CI, 0.61-0.93; P = 0.009), lower AUD prevalence (PR, 0.80; 95% CI, 0.65-0.99; P = 0.045), and lower alcohol-attributable road traffic deaths (PR, 0.81; 95% CI, 0.65-1.00; P = 0.051). CONCLUSIONS Our study indicates that in Latin America, countries with higher number of PHP have lower mortality due to ALD, lower prevalence of AUD, and lower alcohol-attributable road traffic mortality.

Published
2021

31. Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study

Author

Gustavo Romero, Pierre-Emmanuel Rautou, Saba Abdulsada, Kristina R. Chacko, Roberta Chaves Araújo, Won Kim, Rohit Agrawal, Germán Soriano, Juan Pablo Arab, Inés García-Carrera, Wei Zhang, Juan Pablo Arancibia, Seth Buryska, Andreea Bumbu, Richard D. Parker, Diego Rincón, Pamela Yaquich, Alexandre Louvet, Douglas A. Simonetto, Aldo Torre, Patrick S. Kamath, Tazime Issoufaly, Susana Castro-Sanchez, Felipe Zamarripa, Juan Pablo Roblero, Manuel Mendizabal, Vijay H. Shah, Zohaib Syed Haque, Fernando Bessone, Tej I Mehta, Julio Santiago Marcelo, Ramon Bataller, Carolina A. Ramírez, Tehseen Haider, Muhammad Majeed, Virginia Clark, Veronica Prado, Natalia Baeza, Natalia Bystrianska, Prasun K. Jalal, Rakhi Maiwall, Elizabeth C. Verna, Horia Stefanescu, Michael R. Lucey, Philippe Mathurin, Patricia Guerra Salazar, Berta Cuyàs, Ana Clemente-Sanchez, Maria Laura Garrido, Maria A. Poca, Adelina Horhat, A. Rojo, Luis G. Toro, Luis Antonio Díaz, Juan Carlos Restrepo, Francisco Idalsoaga, Lubomir Skladaný, Dalia Morales-Arraez, Diego Piombino, Guadalupe Garcia-Tsao, Florencia Pollarsky, Juan G. Abraldes, Joseph C. Ahn, Jorge Arnold, María de Fátima Higuera de la Tijera, Edilmar Alvarado-Tapias, Ashwani K. Singal, Eduardo Fuentes-López, Shiv Kumar Sarin, Marcela de Sousa Coelho, Victor Vargas, Robert S. Brown, Winston Dunn, Bashar M. Attar, Joaquín Cabezas, Melisa Dirchwolf, Meritxell Ventura-Cots, Jose A Gonzalez, José Altamirano, Adrián Narvaez, P. Nagaraja Rao, Marco Arrese, Anand V. Kulkarni, and Fernando Cairo

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Alcoholic liver disease, Cirrhosis, Time Factors, Alcohol Drinking, Alcoholic hepatitis, alcoholic hepatitis, Severity of Illness Index, Hepatitis, corticosteroids, Maddrey discriminant function, Cohort Studies, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Internal medicine, medicine, Humans, Retrospective Studies, Hepatology, business.industry, alcohol, cirrhosis, Hazard ratio, Middle Aged, medicine.disease, alcohol-associated liver disease, MELD, 030104 developmental biology, Methylprednisolone, Prednisolone, 030211 gastroenterology & hepatology, Female, Steroids, business, medicine.drug, alcoholic liver disease, steroids
Abstract

Background & Aims: Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH. Methods: We performed a retrospective, international multi-center cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method. Results: In our cohort, median age was 49 (40-56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19-29). Survival was 88% (87-89) at 30 days, 77% (76-78) at 90 days, and 72% (72-74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47-0.74; p 51. The type of corticosteroids used (prednisone, pred-nisolone, or methylprednisolone) was not associated with sur-vival benefit (p = 0.247). Conclusion: Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39. Lay summary: Alcohol-associated hepatitis is a condition where the liver is severely inflamed as a result of excess alcohol use. It is associated with high mortality and it is not clear whether the most commonly used treatments (corticosteroids) are effective, particularly in patients with very severe liver disease. In this worldwide study, the use of corticosteroids was associated with increased 30-day, but not 90-or 180-day, survival. The maximal benefit was observed in patients with an MELD score (a marker of severity of liver disease; higher scores signify worse disease) between 25-39. However, this benefit was lost in patients with the most severe liver disease (MELD score higher than 51). (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Published
2021

33. A new definition for non-alcoholic fatty liver disease

Author

Jaime Poniachik, Juan Pablo Roblero, Maximo Cattaneo, and Alvaro Urzúa

Subjects
medicine.medical_specialty, Hepatology, business.industry, Fatty liver, Non alcoholic, Disease, medicine.disease, Gastroenterology, Non-alcoholic Fatty Liver Disease, Risk Factors, Internal medicine, medicine, Humans, business
Published
2021
Full Text
View/download PDF

34. Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis

Author

Jaime Poniachik, Andrea Jiménez, Rodrigo Cornejo, Sebastián M. Chávez, Alvaro Urzúa, Juan Pablo Roblero, Laura Carreño, and Maximo Cattaneo

Subjects
Adult, medicine.medical_specialty, Herpesvirus 2, Human, medicine.medical_treatment, Acyclovir, Disease, Liver transplantation, medicine.disease_cause, Antiviral Agents, Internal medicine, Humans, case report, Medicine, hepatitis, Clinical Case Report, Hepatitis, business.industry, Incidence (epidemiology), Pharynx, Herpes Simplex, Plasmapheresis, acute liver failure, General Medicine, Liver Failure, Acute, herpes simplex virus, medicine.disease, Herpes simplex virus, medicine.anatomical_structure, Etiology, Female, Tomography, X-Ray Computed, business, Research Article
Abstract

Introduction: Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported. Patient concerns: A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function. Diagnosis: ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood. Interventions: Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated. Outcomes: After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation. Conclusions: ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.

Published
2021
Full Text
View/download PDF

35. P-57 LIVER STEATOSIS AND STEATOHEPATITIS IN LIVER DISEASES OTHER THAN ALCOHOLIC AND NON-ALCOHOLIC FATTY LIVER

Author

Alvaro Urzúa, Jaime Poniachik, Claudio Altschiller, Felipe Contreras, Juan Pablo Roblero, Laura Carreño, Maximo Cattaneo, Ana Jiménez, Andrea Jiménez, Miguel Leiva José, and Nicolás Moreno

Subjects
medicine.medical_specialty, Hepatology, business.industry, Fatty liver, Specialties of internal medicine, General Medicine, Autoimmune hepatitis, medicine.disease, Gastroenterology, RC581-951, Liver steatosis, Fibrosis, Internal medicine, Etiology, Medicine, Steatosis, Steatohepatitis, business, Viral hepatitis
Abstract

Introduction Fatty liver disease (FLD) alcoholic and non-alcoholic are prevalent conditions. The damage is determined by steatosis and steatohepatitis with or without fibrosis. There is little information on its role in the progression to significant fibrosis (SF) of chronic liver diseases (CLD) other than FLD. Objective To describe the frequency of steatosis and steatohepatitis in liver biopsies of patients with CLD other than FLD. Methods Observational, retrospective study with biopsies performed between 2015-2018. The presence and degree of steatosis, steatohepatitis and fibrosis were recorded according to the METAVIR scale; F3-F4 is considered SF. Results 268 biopsies analyzed; 93 with FLD are excluded. 175 are included: 53% autoimmune hepatitis (AIH), 27% primary biliary cholangitis (PBC), 7% viral hepatitis (VH) and 13% others. 74% women; age 52 (18-82) years; 58% had steatosis and 46% had steatohepatitis; 67% fibrosis, which was SF in 61%. Steatosis/steatohepatitis/fibrosis according to etiology: AIH 34%/46%/69%; PBC 19%/9%/53%; VH 77%/15%/39%. When analyzing the presence of SF according to the presence of steatosis or steatohepatitis: in steatosis 36% vs 48% without steatosis; In steatohepatitis there were more SF (65% vs 36%; p = 0.004). According to aetiology SF/non SF: HAI 92%/38% (p = 0.001); PBC 20%/24%; VH 50%/22% (NS). Conclusion There was a high frequency of steatosis and steatohepatitis in patients with CLD. The presence of steatohepatitis is associated with a higher degree of fibrosis in patients with CLD, particularly in AIH, which may have an impact on the evolution and treatment.

Published
2021
Full Text
View/download PDF

36. P-30 IMPACT OF PUBLIC HEALTH POLICIES ON ALCOHOL-ASSOCIATED LIVER DISEASE IN LATIN AMERICA: AN ECOLOGICAL MULTI-NATIONAL STUDY

Author

Mayur Brahmania, Pedro Montes, Carolina Ramírez, Luis Guillermo Toro, Ramon Bataller, Manuel Mendizabal, Nelia Hernández, Ashwani K. Singal, C Araujo Roberta, Antonio Díaz Luis, Juan Pablo Arab, Eduardo Fuentes-López, Andrea Márquez, Marco Arrese, Oscar Corsi, Fátima Higuera-de la Tijera, Mariana Lazo, Juan Pablo Roblero, Galo Pazmiño, Francisco Idalsoaga, and Catterina Ferreccio

Subjects
medicine.medical_specialty, education.field_of_study, Cirrhosis, Hepatology, business.industry, Ecology, Public health, Population, Specialties of internal medicine, Alcohol, General Medicine, medicine.disease, Obesity, chemistry.chemical_compound, Liver disease, RC581-951, chemistry, Alcohol and health, medicine, Per capita, business, education
Abstract

Introduction: Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Latin-America, yet the impact of public health policies (PHP) on alcohol consumption and liver disease is unknown. Objectives: To assess the association between alcohol PHP, alcohol consumption, and cirrhosis in Latin-American countries. Methods: We performed an ecological multi-national study including 20 countries in Latin-America (628,466,088 inhabitants). We obtained country-level socio-demographic information from the World Bank Open Data source. Alcohol-related PHP data for countries in Latin-America were obtained from the World Health Organization (WHO) Global Information System of Alcohol and Health (GISAH). We used a fixed-effects model to estimate proportions and multiple linear regression models to examine the association between the number of PHP and outcomes (alcohol intake, and deaths due to cirrhosis & traffic injuries). Results: The prevalence of obesity was 27% and 26.1% among males and females, respectively. The estimated alcohol per capita consumption (APC) among the population 15 years old was 6.8 liters of pure alcohol (5.6 recorded and 1.2 unrecorded). The countries with the highest APC were Uruguay (10.8 liters), Argentina (9.8 liters), and Chile (9.3 liters). The overall prevalence of alcohol use disorders (AUD) was 4.9%. ALD was the main cause of cirrhosis in 64.7% of males and 40.0% of females. A total of 19 (95%) countries have at least one alcohol-related PHP on alcohol. The most frequent PHP were: limiting drinking age (95%), tax control (90%), alcohol and driving (90%), and government monitoring systems (90%)(Table). A higher number of alcohol-related PHP was associated with a lower odds of AUD (OR 0.83, 95%CI:0.73-0.94; p=0.004), lower mortality due to ALD (OR 0.18, 95%CI:0.07-0.46, p

Published
2021
Full Text
View/download PDF

37. P-62 INFECTIONS IN THE FIRST MONTH POST LIVER TRANSPLANTATION IN A TRANSPLANT CENTER IN CHILE

Author

Gabriel Uribe, Maximo Cattaneo, Alvaro Urzúa, Jaime Poniachik, and Juan Pablo Roblero

Subjects
Aspergillus, medicine.medical_specialty, Hepatology, biology, business.industry, medicine.medical_treatment, Urinary system, Varicella zoster virus, Specialties of internal medicine, Retrospective cohort study, General Medicine, Liver transplantation, biology.organism_classification, medicine.disease, medicine.disease_cause, Virus, Antibiotic resistance, RC581-951, Internal medicine, Bacteremia, medicine, business
Abstract

Introduction Infections are an important cause of morbidity and mortality in the first month after liver transplantation (LT). It is important to know the local microbiology involved and the resistance patterns, to guide treatment appropriately. Objective To characterize infections in the first month after LT in patients from the Hospital Clinico de la Universidad de Chile. Methods Retrospective study of clinical records of 70 consecutive LT between February 2016 and October 2018. Results 20 infectious events in 16 patients (23%). In 75% it was possible to isolate agent. Eight (40%) were bacteria, 5 were fungi and 2 were viruses; 25% were bacteremia, 20% urinary tract, 20% pulmonary, 10% intra-abdominal, and 5% skin. The agents were: K. pneumoniae (2), S. epidermidis (2), E. faecium (1), C. freundii (1), E. coli (1), S. malthophilia (1). Candidas (4), Aspergillus (1), varicella zoster virus (1), respiratory syncytial virus (1). It was not possible to identify a focus in 4 patients. There was antimicrobial resistance in 7 (35%) of the cases, 3 being multi-resistant (2 due to K. pneumoniae and 1 due to S. epidermidis). 4 microorganisms showed antimicrobial resistance (E. coli, C. freundii, E. faecium, and C. glabatra). The infection was the cause of in-hospital mortality in 2 patients. Conclusion Infections in the first month after LT are frequent in our center, the majority of bacterial origin, as reported by international series. More than 1/3 of the patients present an agent with antimicrobial resistance, which should be considered in the choice of empirical therapy.

Published
2021
Full Text
View/download PDF

38. P-61 LIVER TRANSPLANTATION IN HEPATOCARCINOMA: SURVIVAL AND RECURRENCE IN TRANSPLANTED PATIENTS WITH HEPATOCARCINOMA

Author

Daniela García, Alvaro Urzúa, Maximo Cattaneo, Alexis Iracheta, Andrea Jiménez, Fodda Chelech, Juan Pablo Roblero, and Jaime Poniachik

Subjects
medicine.medical_specialty, Hepatology, business.industry, medicine.medical_treatment, education, Specialties of internal medicine, General Medicine, Liver transplantation, Gastroenterology, digestive system diseases, RC581-951, Internal medicine, medicine, business
Abstract

Introduction: Hepatocellular carcinoma (HCC) is the most common malignant liver tumor. Liver transplantation (LT) is considered potentially curative, achieving a survival of 70% at 5 years and a tumor recurrence

Published
2021
Full Text
View/download PDF

39. P-58 CONCORDANCE BETWEEN ECOGRAPHY AND THE CONTINUOUS ATTENUATION PARAMETER (CAP) BY TRANSIENT ELASTOGRAPHY FOR THE DIAGNOSIS OF LIVER STEATOSIS

Author

Juan Pablo Roblero, Camila Estay, Jaime Poniachik, Maximo Cattaneo, Alvaro Urzúa, Alexandra Sandoval, Juan Francisco Rozas, and Katherine González

Subjects
RC581-951, Hepatology, Liver steatosis, business.industry, Concordance, Attenuation, Specialties of internal medicine, Medicine, General Medicine, Transient elastography, business, Nuclear medicine
Abstract

Introduction: Abdominal ultrasound is the test of choice for the screening of liver steatosis (LS) however it has a poor performance (20%). Transient elastography (TE) through the Continuous Attenuation Parameter (CAP) has shown an adequate correlation with the degree of steatosis by liver biopsy. Objectives: To evaluate the concordance between abdominal ultrasound and CAP by TE for the diagnosis of LS. Methods: Observational study. 160 patients (age 53 ± 14 years, 66.2% women) referred for TE (FibroScan; Echosens). The main indication was non-alcoholic fatty liver disease (44.4%). A cutoff of 233 dB / m was defined for the diagnosis of CAP steatosis and cuts recommended by the manufacturer were used for staging the grade of LS. Clinical data and reports of abdominal ultrasounds performed in the 90 days prior to the examination were recorded. Statistical analysis by proportion of agreement and kappa index. Results: LS was diagnosed by ultrasound in 85 patients (53.1%) vs 92 patients (57.5%) by CAP. The proportion of concordance between both exams was 74.3%, with a kappa index of 0.529. In patients with LS diagnosed by CAP, 73.9% had a concordant diagnosis by ultrasound, increasing to 82.4% when considering only patients with moderate and severe LS by CAP. Conclusion: There is moderate concordance between CAP and ultrasound for the diagnosis of LS, which increases in moderate and severe steatosis. The CAP could be an alternative tool for the diagnosis of LS, with eventual greater precision in mild cases.

Published
2021
Full Text
View/download PDF

40. P-63 TRENDS IN HOSPITALIZATION AND MORTALITY IN HOSPITALIZED PATIENTS WITH ALCOHOLIC HEPATITIS IN CHILE

Author

Pablo Roblero, Juan Pablo Arab, Juan Pablo Roblero, Jaime Poniachik, Alejandra Dominguez, and Christian Von Muhlenbrock

Subjects
medicine.medical_specialty, RC581-951, Hepatology, Hospitalized patients, business.industry, Internal medicine, medicine, Specialties of internal medicine, Alcoholic hepatitis, General Medicine, medicine.disease, business
Abstract

Introduction: Hospitalizations (H) and mortality by alcoholic hepatitis (AH) have increased in Europe and North America. In Chile we do not have published data. Objectives: To describe the trend in H and mortality of hospitalized patients with AH in Chile. Methods: Descriptive analysis of combination of cross-sections and regression models (STATA 15). Population data from MINSAL-DEIS 2001-2018 hospital discharge databases (HD) were used. HD by AH were identified by ICD-10 code K701. Results: Between 2001-2018 there were 5,678 HD per AH. Average age 50 years. The rate of HD per AH per million inhabitants increased from 12.8 in 2001 to 18.5 in 2018 (44%). A linear estimate suggests that the rate increases by 0.55 points per year. In the population of 20-40 years it stands out that in women it increased by 64%. The only group where the rate of HD per AH increase steadily over time (in the rest the increase was less and less). The proportion by sex remained stable in 83% men and 17% women. In both sexes, 10% HD deceased, although in men a clear upward trend is observed (+0.32% annually, with a minimum of 6.5% HD in 2001 and a maximum of 15.3% HD in 2017), while in women the upward trend shows fluctuations. Conclusions: In Chile in recent years there has been an increase in HD by AH. This increased incidence is reflected in higher mortality in patients hospitalized for AH. The increase in HD was more stable among women aged 20-40 years.

Published
2021
Full Text
View/download PDF

41. P-40 SEVERE AUTOIMMUNE HEPATITIS: CORTICOSTEROID THERAPY OR EARLY ENROLLMENT TO LIVER TRANSPLANTATION

Author

Jaime Poniachik, Maximo Cattaneo, Juan Pablo Roblero, Andrea Jiménez, Alvaro Urzúa, Andrés De la Vega, Eladio González, and Alan Poniachik

Subjects
medicine.medical_specialty, Hepatology, Bilirubin, business.industry, Fulminant, medicine.medical_treatment, Specialties of internal medicine, Retrospective cohort study, General Medicine, Autoimmune hepatitis, Liver transplantation, medicine.disease, Gastroenterology, chemistry.chemical_compound, RC581-951, chemistry, Corticosteroid therapy, Internal medicine, medicine, In patient, business, Hepatic encephalopathy
Abstract

Introduction: Autoimmune hepatitis can present in severe or fulminant acute form (SAH). Only 30-60% of these patients respond favorably to corticosteroids. There is no clarity on its indication and how to evaluate steroid therapy in SAH. Objectives: To evaluate the early response to corticosteroid treatment in patients with SAH (defined as bilirubin> 10 mg / dL or hepatic encephalopathy). Method: Retrospective study of 27 patients with SAH, who received corticosteroids, aged 44 years (20-74), 19 (70%) women. Non-responder (NR) was defined if the patient died or required liver transplantation. Results: 8 patients (30%) were NR, age 49 years (21-72). Bilirubin 22.7 (15-43), INR 2.52 (1.7-3.1), MELD-Na 31 (23-38), UKELD 64 (58-66). Responders (R): 19 (70 %), age 46 years (20 -74). Bilirubin 16 (10-32), INR 1.6 (1-2.8), MELD-Na 23 (17-30), UKELD 59 (54-62). The control at 3 days of R vs NR respectively was bilirubin 10.6 vs 20.3, MELD-Na 19 vs 31, (p

Published
2021
Full Text
View/download PDF

42. P-41 TRENDS IN HOSPITALIZATION, CHARACTERISTICS AND MORTALITY OF HOSPITALIZED PATIENTS WITH CIRRHOSIS IN CHILE

Author

Christian Von Muhlenbrock, Pablo Roblero, Jaime Poniachik, Juan Pablo Roblero, and Juan Pablo Arab

Subjects
medicine.medical_specialty, Cirrhosis, Future studies, Hepatology, business.industry, Hospitalized patients, Specialties of internal medicine, Mean age, General Medicine, medicine.disease, RC581-951, Internal medicine, medicine, Hospital discharge, Population data, business, Cause of death
Abstract

Introduction Cirrhosis is a frequent cause of hospitalization and is the 3rd cause of death in adults in Chile. Objective To describe the trend in hospitalizations and mortality of hospitalized patients with cirrhosis in Chile. Methods Descriptive analysis of combination of cross-sections, regression models (STATA 15). Population data from the MINSAL-DEIS 2001-2018 hospital discharge databases (HD) were used. HD were identified by C by codes K70.3, K743, K745, K746 (ICD-10). Results Between 2001-2018 there were 28,181 HD by cirrhosis. Mean age 60 years; 63% men. 19,174 (68%) were for cirrhosis not associated with alcohol (CNAA) and 9,008 (32%) for alcohol (CAA). 4,903 (17.4%) of the HD were as deceased; these decreased from 521 (20.7%) in 2001 to 178 (12.5%) in 2018. Mortality was higher in CAA (21.4% vs 15.5%). 3 periods with different trends in the rate of HD per C (x100,000) are identified: 2001-2007 decreased by 53%, from 16.2 (2,518 HD) to 8.5 (1,411); 2007-2013 decreased 28% reaching 6.1 (1,067 HD); 2013-2018 increased 24.6%, reaching 7.6% (1,424 HD). The decrease in the second period and the increase in the third period were 3 times greater in CNAA than in CAA. By sex and type of cirrhosis, the third-period increase in CAA / women began in 2017. Conclusion There is an increase in HD due to cirrhosis from 2013, relevant and worrying information. Its cause should be investigated in future studies. The decrease in deceased HD may be due to better knowledge and management of the disease.

Published
2021
Full Text
View/download PDF

44. HEPLA: A multicenter study on demographic and disease characteristics of patients with hepatitis C in Latin America

Author

Sebastián Marciano, Hugo Cheinquer, Jaime Holguin, Luis Viola, Fernando Tatsch, Luis Colombato, Roberto J. Carvalho-Filho, Henrique Sérgio Moraes Coelho, Adriana Varón, Gabriela Bugarin, Maria R. Torres-Ibarra, Juan Pablo Roblero, and Alma M. Pérez-Ríos

Subjects
Estudo observacional, Liver Cirrhosis, Male, Cirrhosis, Latin Americans, Epidemiology, Specialties of internal medicine, HIV Infections, Disease, Comorbidity, Hepacivirus, medicine.disease_cause, Severity of Illness Index, 0302 clinical medicine, América Latina, Observational study, Medicine, Chile, Substance Abuse, Intravenous, Aged, 80 and over, education.field_of_study, Cross Infection, Mental Disorders, General Medicine, Hepatitis C, Middle Aged, Viral Load, RC581-951, Hepatite C, Cardiovascular Diseases, 030220 oncology & carcinogenesis, HCV, RNA, Viral, 030211 gastroenterology & hepatology, LATAM, Female, Brazil, Adult, medicine.medical_specialty, Genotype, Hepatitis C virus, Population, Argentina, Colombia, Antiviral Agents, 03 medical and health sciences, Young Adult, Age Distribution, Hepatitis B, Chronic, Internal medicine, Diabetes Mellitus, Humans, Blood Transfusion, Renal Insufficiency, Chronic, Sex Distribution, education, Epidemiologia, Mexico, Aged, Hepatology, business.industry, Hepatitis C, Chronic, medicine.disease, Latin America, Concomitant, business
Abstract

Introduction and objectives Currently, there are limited data on the epidemiology and disease characteristics of patients with chronic hepatitis C (CHC) in Latin America. The primary objective of this study was to evaluate demographic and disease characteristics of patients with CHC in Latin America. Patients and methods HEPLA was a non-interventional, multicenter study of the epidemiology and disease characteristics of patients with CHC in Argentina, Brazil, Chile, Colombia, and Mexico. Results Of the 817 included patients, the median age was 58 years, 53.9% were female, and 39.3% had cirrhosis. Overall, 41.2% were treatment naive, 49.8% were treatment experienced, and 8.9% were currently undergoing treatment. In patients with available data, genotype 1b accounted for 41.6% of infections, followed by genotype 1a (29.9%) and genotype 3 (11.3%). Probable mode of infection was transfusion in 46.8% of patients. Liver-related comorbidities were present in 26.4% of patients and non-liver-related comorbidities were present in 72.3%. Most patients (71.8%) received concomitant medications, with proton-pump inhibitors (20.8%) being the most commonly reported. Conclusions At the time the HEPLA study was carried out, the data from this cross-section of patients in Latin America showed that the CHC population has variation in disease and viral characteristics, with a minority of patients receiving treatment and many patients having advanced disease. Increased awareness and access to treatment are necessary in Latin America in order to meet the goal of hepatitis C virus elimination by 2030.

Published
2019

45. Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

Author

Florence Wong, Luis Colombato, Giacomo Zaccherini, Dong Joon Kim, Rita de Cassia Ribeiro Barea, Adrià Juanola, Aleksander Krag, Julio Vorobioff, Javier Romaní Fernández, Jae Seok Hwang, Richard Moreau, Salvatore Piano, Gustavo Romero, Juan Pablo Roblero, Adrián Gadano, Gustavo Navarro, Rakhi Maiwall, Cosmas A. Rinaldi Lesmana, E.L. Yoon, Virendra Singh, M. Marino, Shiv Kumar Sarin, Carlos Brodersen, Carlo Alessandria, François Durand, Victor Vargas, Carmine Gambino, Ji Won Park, Pramod Kumar, Sophie Restellini, M. V. Maevskaya, Nikolaos Pyrsopoulos, Eduardo Fassio, Marcos Girala, Macarena Simón-Talero, Tony Bruns, Paolo Caraceni, Vikas Gautam, Laure Elkrief, Tae Hee Lee, Manuela Merli, Hyoung Su Kim, Tae Hun Kim, Preetam Nath, Ki Tae Suk, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá-Pereira, Paolo Angeli, C. Toledo, Sebastián Marciano, Barbara Lattanzi, Robert A. de Man, Annette Dam Fialla, Gisela Pinero, Sung Eun Kim, Nicolas M. Intagliata, Hans Van Vlierberghe, Pere Ginès, Kalyan Ram Bhamidimarri, Liane Rabinowich, Do Seon Song, Shivaram Prasad Singh, Michele Bartoletti, Alexander L. Gerbes, Marco Sacco, Laurentius A. Lesmana, Sang Gyune Kim, Jeong Han Kim, Sun Young Yim, Thomas D. Boyer, Piano, Salvatore, Singh, Virendra, Caraceni, Paolo, Maiwall, Rakhi, Alessandria, Carlo, Fernandez, Javier, Soares, Elza Cotrim, Kim, Dong Joon, Kim, Sung Eun, Marino, Monica, Vorobioff, Julio, de Cassia Ribeiro Barea, Rita, Merli, Manuela, Elkrief, Laure, Vargas, Victor, Krag, Aleksander, Singh, Shivaram Prasad, Lesmana, Laurentius Adrianto, Toledo, Claudio, Marciano, Sebastian, Verhelst, Xavier, Wong, Florence, Intagliata, Nicola, Rabinowich, Liane, Colombato, Lui, Kim, Sang Gyune, Gerbes, Alexander, Durand, Francoi, Roblero, Juan Pablo, Bhamidimarri, Kalyan Ram, Boyer, Thomas D, Maevskaya, Marina, Fassio, Eduardo, Kim, Hyoung Su, Hwang, Jae Seok, Gines, Pere, Gadano, Adrian, Sarin, Shiv Kumar, Angeli, Paolo, and Gastroenterology & Hepatology

Subjects
Liver Cirrhosis, Male, 0301 basic medicine, Time Factors, Cirrhosis, Cross-sectional study, medicine.medical_treatment, Resistance, Antibiotics, Drug Resistance, GLOBAL, resistance, sepsis, stewardship, Liver Cirrhosis/epidemiology, Liver transplantation, Global Health, 0302 clinical medicine, Risk Factors, Drug Resistance, Multiple, Bacterial, Epidemiology, Prevalence, Hospital Mortality, Prospective Studies, Incidence (epidemiology), Global, Sepsis, Stewardship, Adult, Aged, Anti-Bacterial Agents, Bacterial Infections, Cross-Sectional Studies, Female, Humans, Liver Transplantation, Middle Aged, Mycoses, Prognosis, Bacterial, Gastroenterology, sepsi, 030211 gastroenterology & hepatology, Multiple, medicine.medical_specialty, medicine.drug_class, 03 medical and health sciences, Spontaneous bacterial peritonitis, Internal medicine, medicine, Hepatology, business.industry, medicine.disease, Anti-Bacterial Agents/therapeutic use, 030104 developmental biology, Mycoses/epidemiology, business, Bacterial Infections/epidemiology
Abstract

Background & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. Conclusions: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

Published
2019
Full Text
View/download PDF

46. Determinants of clinical efficacy of empirical antibiotic treatment in patients with cirrhosis and bacterial infections: Results from the ICA global study

Author

Doo-Man Kim, Luis Colombato, Carlos Brodersen, Sang Gyune Kim, Julio Vorobioff, Sebastián Marciano, Shivaram Prasad Singh, Virendra Singh, Laurentius A. Lesmana, Manuela Merli, C. Alessandria, Nicolas M. Intagliata, R. de Cassia Ribeiro Barea, P. Angeli, Salvatore Piano, Liane Rabinowich, Alexander L. Gerbes, S.E. Kim, Juan Pablo Roblero, Adrián Gadano, M. Marino, Rakhi Maiwall, J.H. Kim, J.R. Fernandez, L. Elkrief, Aleksander Krag, V.M.V. Blasco, Do Seon Song, Florence Wong, C. Toledo, Paolo Caraceni, Robert A. de Man, Elza Cotrim Soares, S.K. Sarin, F. Durand, and V. Xavier

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, medicine.drug_class, Internal medicine, Antibiotics, medicine, In patient, Clinical efficacy, medicine.disease, business
Published
2018
Full Text
View/download PDF

47. Epidemiology, predictors and outcomes of multi drug resistant (MDR) bacterial infections in patients with cirrhosis across the world. Final results of the 'Global study'

Author

Nicolas M. Intagliata, Salvatore Piano, Luis Colombato, Xavier Verhelst, M. Marino, Carlo Alessandria, Javier Fernández, Julio Vorobioff, Juan Pablo Roblero, Adrián Gadano, K.R. Bhamidimarri, Alexander L. Gerbes, S.E. Kim, L. Elkrief, S.K. Sarin, Aleksander Krag, Shivaram Prasad Singh, Paolo Caraceni, M. Maevskaya, J.-S. Hwang, Laurentius A. Lesmana, Liane Rabinowich, Eduardo Fassio, E.C. Soares, Virendra Singh, Florence Wong, C. Toledo, Sang Gyune Kim, R. Ribeiro Barea, Thomas D. Boyer, Manuela Merli, H.S. Kim, Doo-Man Kim, Paolo Angeli, Rakhi Maiwall, F. Durand, Victor Vargas, and Sebastián Marciano

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, business.industry, Gastroenterology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, Epidemiology, medicine, Multi drug resistant, 030211 gastroenterology & hepatology, In patient, business
Published
2018
Full Text
View/download PDF

48. Ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin is safe and effective in HCV-infected patients in a real-life cohort from Latin America

Author

Andrés Ruf, Claudia Vujacich, Margarita Anders, Adriana Varón, Alejandro Soza, Mirta Peralta, Jhon Prieto, Roberto Pérez Ravier, Manuel Mendizabal, Nelia Hernández, Alberto Muñoz, Leila Haddad, Mariano Cartier, Patricia E. Gallardo, Alejandro. Ferrada, Raúl Adrover, Gabriel Aballay Soteras, Marcelo Silva, Julio Vorobioff, Fernando Gruz, Edmundo Aravena, Ezequiel Ridruejo, Maria Virginia Reggiardo, Juan Pablo Roblero, Gustavo Romero, Daniel Coccozella, and Daniel Poncino

Subjects
Adult, Male, CIENCIAS MÉDICAS Y DE LA SALUD, Cirrhosis, Drug-Related Side Effects and Adverse Reactions, Genotype, Medicina Clínica, PUBLIC POLICY, Hepacivirus, Antiviral Agents, 03 medical and health sciences, chemistry.chemical_compound, Young Adult, 0302 clinical medicine, ANTIVIRAL AGENTS, Virology, purl.org/becyt/ford/3.2 [https], medicine, Humans, 030212 general & internal medicine, Adverse effect, DISEASE CONTROL, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Ribavirin, HEPATITIS C VIRUS, Hepatitis C, Chronic, Middle Aged, medicine.disease, Ombitasvir, Discontinuation, Infectious Diseases, Latin America, Treatment Outcome, chemistry, Paritaprevir, Cohort, 030211 gastroenterology & hepatology, Ritonavir, purl.org/becyt/ford/3 [https], Drug Therapy, Combination, Female, Medicina Critica y de Emergencia, business, medicine.drug
Abstract

Information about the use of ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin (OBV/PTV/r/DSV ± RBV) in real-clinical practice in Latin America is scarce. We aimed to confirm safety and effectiveness of OBV/PTV/r/DSV ± RBV therapy in real-world setting. We analyzed a cohort of patients with genotype 1 infection treated with OBV/PTV/r/DSV ± RBV. Data on demographics, clinical features, safety, and virological response were retrospectively collected from 21 centers in Latin America. A total of 96 patients received OBV/PTV/r/DSV, associated with RBV in 68% of the cases. Most were genotype 1b (80%), 56 (58%) had cirrhosis, and 45 (47%) failed prior HCV treatment. Adverse events occurred in 62% of patients. The most common adverse events were pruritus (21%), hyperbilirubinemia (17%), and asthenia (17%). Five patients discontinued therapy prematurely due to hepatic decompensation, three of them were Child-Pugh B at baseline and one patient died due to multi-organ failure. Follow up HCV-RNA 12 weeks after completion of therapy was evaluated in all the patients and sustained virologic response rate was 97%. No virologic breakthrough was detected. Our study confirms that OBV/PTV/r/DSV treatment is highly effective in patients with chronic HCV without cirrhosis or with Child-Pugh A cirrhosis in non-European populations. Adverse events were often mild and rarely led to treatment discontinuation except for patients with Child-Pugh B cirrhosis or with previous history of hepatic decompensation. These results can support the development of public strategies to expand the access of OBV/PTV/r + DSV and other DAAs combinations in order to reduce the burden of HCV infection in our region. Fil: Mendizabal, Manuel. Hospital Universitario Austral; Argentina Fil: Haddad, Leila. Hospital Italiano; Argentina Fil: Gallardo, Patricia E.. Fundación Sayani; Argentina Fil: Ferrada, Alejandro. Hospital Clinico San Borja Arriaran; Chile Fil: Soza, Alejandro A.. Universidad Católica de Chile; Chile. Pontificia Universidad Católica de Chile; Chile Fil: Adrover, Raul. Centro de Hepatología; Argentina Fil: Aravena, Edmundo. Hospital Clinico San Borja Arriaran; Chile Fil: Roblero, Juan P.. Hospital Clinico San Borja Arriaran; Chile Fil: Prieto, Jhon. Clínica Universitaria Colombia y Centro de Enfermedades Hepáticas y Digestivas; Colombia Fil: Vujacich, Claudia. Fundacion Centro de Estudios Infectologicos; Argentina Fil: Romero, Gustavo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; Argentina Fil: Muñoz, Alberto. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; Argentina Fil: Anders, Margarita. Hospital Alemán; Argentina Fil: Hernández, Nelia. Hospital de Clinicas Dr. Manuel Quintela; Uruguay Fil: Coccozella, Daniel. Centro de Hepatología; Argentina Fil: Gruz, Fernando. Fundación Favaloro; Argentina Fil: Reggiardo, Maria V.. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina Fil: Ruf, Andres E.. FUNDIEH; Argentina Fil: Varón, Adriana. Instituto de Cardiologia; Colombia Fil: Cartier, Mariano. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología ; Argentina Fil: Pérez Ravier, Roberto. Instituto Universidad Escuela de Medicina del Hospital Italiano; Argentina Fil: Ridruejo, Ezequiel. Hospital Universitario Austral; Argentina. Centro de Educación Medica E Invest.clinicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas ; Argentina Fil: Poncino, Daniel. Sanatorio Municipal Dr. Julio Méndez; Argentina Fil: Vorobioff, Julio. Universidad Nacional de Rosario; Argentina Fil: Aballay Soteras, Gabriel. Sanatorio Mitre; Argentina Fil: Silva, Marcelo O.. Hospital Universitario Austral; Argentina

Published
2016

49. Resultados del tratamiento de la hepatitis crónica por virus C en un hospital público, en Chile

Author

Edmundo Aravena, Marcela González Z, Andrea Alejandra Pinto Pinto, Juan Pablo Roblero, and Iturriaga H

Subjects
Hepatitis C, chronic, medicine.medical_specialty, Univariate analysis, business.industry, Peginterferon alfa-2b, Ribavirin, Peginterferon alfa-2a, Alpha interferon, General Medicine, Hepatitis C, medicine.disease, Gastroenterology, Surgery, chemistry.chemical_compound, chemistry, Internal medicine, medicine, business, Viral load, Body mass index, medicine.drug
Abstract

BACKGROUND: Chronic hepatitis C is an important health problem in Chile. In 2005, the Ministry of Health started a pilot treatment program with peg interferon and ribavirin, to be developed in public hospitals all over the country. AIM: To report the results of hepatitis C treatment obtained at our institution. PATIENTS AND METHODS: Between 2005 and 2009, 63 patients were referred for treatment. In all, the viral load and genotype were determined. Peg interferon alpha-2a or alpha-2b plus ribavirin were used for therapy for up to 48 weeks in genotypes (G) 1 or 4 or 24 weeks in genotypes 2 or 3. If at the end of treatment, viral load measured by polymerase chain reaction (PCR) was negative, it was repeated 6 months later. A negative viral load at that time was considered a sustained viral response (SVR). RESULTS: Among the 51 patients who started treatment, 42 (80.4%) were G1,1 was G2,1 was G4 and 7 were G3. A SVR was reached in 51.1% of G 1 and 4 and in 87.5% in G 3 and 2. In a univariate analysis, the variables significantly associated with a positive viral response were the degree of fibrosis and body mass index. CONCLUSIONS: These results are similar to those obtained in other international series, demonstrating that Hispanic ethnicity does not influence the response to treatment. Our good results could be explained by the excellent compliance of the patients to the treatment. A higher degree of fibrosis and a higher BMI were associated with a poor response.

Published
2012
Full Text
View/download PDF

50. Conversion to Everolimus in Liver Transplant Patients With Renal Dysfunction

Author

Roberto Segovia, T. Pérez, Juan Pablo Roblero, R. Estela, and L. Castro

Subjects
Adult, Graft Rejection, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Calcineurin Inhibitors, Urology, Renal function, Kidney, chemistry.chemical_compound, Pharmacotherapy, medicine, Humans, Everolimus, Prospective Studies, Chile, Prospective cohort study, Sirolimus, Transplantation, Creatinine, Drug Substitution, business.industry, TOR Serine-Threonine Kinases, Immunosuppression, Recovery of Function, Middle Aged, Liver Transplantation, Surgery, Calcineurin, Treatment Outcome, chemistry, Drug Therapy, Combination, Female, Kidney Diseases, business, Biomarkers, Immunosuppressive Agents, Glomerular Filtration Rate, medicine.drug
Abstract

Calcineurin inhibitor (CNI) immunosuppressive therapy post-liver transplantation (OLT) is important to reduce graft rejection episodes. However, these drugs show important side effects, particularly renal dysfunction (RDF). Changing from CNI to a nonnephrotoxic drug, as mammalian target of rapamycin (mTOR) inhibitor may solve the problem. Our objective was to evaluate renal function (RF) among liver transplant patients initially receiving CNI, among whom the patients with RDF were converted completely or partially to an mTOR inhibitor like everolimus (EVE). We performed a prospective study in liver transplant patients from 2000 to 2009. Creatinine levels and creatinine clearances (Cockroft-Gault) expressed as mean values ± standard deviations were measured pre- and postswitch for comparisons using Wilcoxon nonparametric tests. Six patients were converted fully or partially to EVE. Their mean age at the moment of introducing the new therapy was 52.2 ± 13.6 years (range = 28-60). Immunosuppression time prior to switching from CNI to EVE was 23.8 ± 26.6 months (range = 6-70). Postconversion follow-up was 25.8 ± 16.5 months (range = 8-42). All patients showed improvement in RF. The creatinine level improvement was significant (P = .03) namely, from a mean of 2.26 ± 0.49 to 1.21 ± 0.57 mg/dL. Glomerular filtration rate improved from a mean of 40 ± 15.13 to 72.60 ± 17.3 mL/min/m(2) (P = .03). Conversion from CNI to EVE improved creatinine concentrations and creatinine clearances with long-term effects free of graft rejection.

Published
2011
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results