RESUMEN Introducción: La calidad de vida relacionada con la salud medida a través de los “resultados reportados por pacientes”, del inglés: patient reported outcomes (PROs) permite la detección ...efectiva de problemas físicos y psicológicos en pacientes con hepatitis crónica. Objetivo: Describir las dimensiones de calidad de vida más afectadas reportados por pacientes con infección crónica por virus de la Hepatitis C y B. Material y Métodos: Se realizó un estudio descriptivo, transversal desde junio 2018 hasta diciembre 2020 en el Instituto de Gastroenterología (IGE). Entre 1 706 pacientes con diagnóstico VHB y VHC atendidos, la muestra quedó constituida por 366 adultos con infección crónica por los virus de hepatitis B (VHB) y C (VHC). Se registraron los resultados de las encuestas: Evaluación Funcional para el Tratamiento de Enfermedades Crónicas -Fatiga (FACIT-F) y Cuestionario de Impedimento de la Productividad y Actividad Laboral- Problema de salud específico (WPAI-SPH) y parámetros clínico-demográficos. Resultados: Se identificaron 271 (74,0 %) pacientes con diagnóstico de VHC y 95 (26,0 %) de VHB, con edad media 54,0 ± 12,7 años, 209 (57,1 %) mujeres. La puntuación total de la FACIT-F estuvo más afectada en VHC (FACIT-F: HVB: 129,0 ± 15,9 vs. VHC: 111,2 ± 23,5; p<0,0001), quienes a su vez tuvieron mayor deterioro de la actividad laboral (WPAI-SPH: VHB: 0,309 ± 0,312 vs. VHC: 0,386 ± 0,333; p<0,05). Conclusiones: Los pacientes con VHC vivencian una peor calidad de vida que compromete su bienestar, rendimiento laboral y cotidiano.
To investigate the efficacy and safety of Abexol and atorvastatin in patients with non-alcoholic fatty liver disease (NAFLD).Material and methods: The present study had a monocentric, randomized, ...double-blinded, comparative design with 4 parallel groups - group 1 (Abexol), group 2 (atorvastatin), group 3 (combined therapy) and group 4 (placebo) - to which dietary recommendations and physical activity practice were provided twice a day, for 24 weeks. Significant changes in the ultrasound analysis of the liver were considered a primary efficacy variable. Insulin resistance improvement (HOMA2-IR) was considered as a co-primary efficacy criterion. Significant changes in the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lipid profile variables and the anthropometric variables were evaluated as secondary variables of effectiveness. Statistical analysis of all data was according to the intention to treat method.
The groups were statistically homogeneous at baseline conditions. At the end of the 6 months of treatment about 50% of the patients in all groups showed a decrease of at least one degree in echogenicity, while the rest remained the same. There were no significant changes in the values of liver enzymes or anthropometric variables evaluated. Treatment with atorvastatin and combined therapy significantly reduced levels of low-density lipoprotein-cholesterol (LDL-C) and total cholesterol. The treatments were safe and well tolerated, although in the atorvastatin group the number of adverse events reported was greater than in the rest of the groups.
Abexol and atorvastatin showed comparable efficacy and safety in patients with NAFLD, with advantages for treatment with atorvastatin with respect to its effects on the lipid profile of these patients.
The Latin American Association for the Study of the Liver (Asociación Latinoamericana para el Estudio del Hígado; ALEH) represents liver professionals in Latin America with the mission of promoting ...liver health and quality patient care by advancing the science and practice of hepatology and contributing to the development of a regional health policy framework. Fatty liver disease associated with metabolic dysfunction is of specific concern in the ALEH region, where its prevalence is one of the highest globally, second only to the Middle East. A recent consensus from an international panel recommended a new definition of fatty liver disease associated with metabolic dysfunction, including a shift in name from non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD), and adoption of a set of positive criteria to diagnose the disease, independent of alcohol intake or other liver diseases. Given, the importance of this proposal, ALEH invited leading members of regional nations to come to a consensus on it from a local perspective. We reached a consensus to endorse the proposal that the disease should be renamed as MAFLD and that the disease should be diagnosed by the proposed simple and easily applicable criteria. We expect that this change in nosology will result in improvements in disease awareness and in advances in scientific, economic, public health, political, and regulatory aspects of the disease.
The reduction of the incidence of hepatitis B virus (HBV) infection in Cuba can be attributed to the effectiveness of the national immunization program. However, the number of patients with chronic ...HBV observed in clinical practice is not negligible.
A cross-sectional study was conducted to describe the main clinical characteristics of patients with chronic hepatitis B virus infection.
A total of 146 patients who had at least a 6-month history of hepatitis B surface antigen positivity were recruited between 2013 and 2015. Descriptive statistical analysis of the epidemiologic, clinical, biochemical, and virologic variables was performed.
Men accounted for 67.8% of patients, and the median age was 43 years. The median time since diagnosis of infection was 9 years. Among the patients, 59% had chronic hepatitis, 34% had liver cirrhosis, and 7% were inactive carriers. Concomitant diagnoses demonstrated that 16.4% of patients had malignancies, predominantly lymphoma. Only 64.4% of patients had received antiviral treatment, and lamivudine was the most commonly used (61.6%) drug. Moreover, 70% of patients were identified during an inactive phase.
Patients with chronic HBV infection are still a health problem in the adult Cuban population, especially in patients with concomitant malignancies.
Introduction: The effectiveness of the national immunization program has impacted on the reduction of the incidence of hepatitis B virus (HBV) infection in Cuba; however, the number of chronically ...infected patients is not negligible. These patients are diagnosed in the clinical practice, although the epidemiological studies that indicate the presence of the disease are insufficient. Objective: To describe the main clinical, biomolecular and immunological characteristics of patients with chronic hepatitis B virus infection treated at the National Institute of Gastroenterology, Havana, Cuba.Materials and methods: A total of 97 patients who had at least a 6-month history of chronic HBV infection were recruited at the above mentioned institution from January 2016 to January 2018. Descriptive statistical analyzes were performed to identify the clinical characteristics. Biochemical and virological studies, analysis of both liver stiffness values measured by transient elastography and use of antiviral therapy were also carried out.Results: All patients completed the follow-up. It was observed that 61,9 % of them were male and the median (range) age was 46 (18-84) years. The mean time since the diagnosis of the infection was 11.7 ± 8,9 years. Inactive disease without liver fibrosis or light fibrosis was present in 61,9 %. Only 2 % were negative for hepatitis B surface antigen with quantitative analysis of HBV DNA; also, 81,4 % of patients had detectable viral load and 85,5 % received one or more antiviral treatments, mainly nucleotide analogues. Conclusions: The patients with chronic HBV infection studied are mostly in the inactive phase of their disease, without significant evidence of liver damage and detectable levels of viremia. All of them have received some antiviral treatment.
Introducción: La efectividad del programa nacional de inmunización ha impactado en la reducción de la incidencia del virus de la hepatitis B en Cuba; sin embargo, no es despreciable la cantidad de pacientes infectados crónicos, que por esta causa, se detectan en la práctica asistencial, aunque insuficientes los estudios epidemiológicos que los caracterizan.Objetivo: Describir las principales características clínicas, biomoleculares e inmunológicas de los pacientes con VHB crónica atendidos en el Instituto de Gastroenterología de Cuba.Materiales y métodos: 97 pacientes que tenían al menos un historial de 6 meses de infección crónica con VHB fueron reclutados en la propia institución desde enero 2016 hasta enero 2018. Se realizaron análisis estadísticos descriptivos para las características clínicas, estudios bioquímicos, virológicos, grado de dureza hepática (medido por elastografía transitoria) y terapia antiviral. Resultados: Todos los pacientes completaron el seguimiento; 61,9% eran varones y la mediana (rango) de edad fue de 46 (18-84) años. La media de tiempo desde el diagnóstico de la infección fue de 11,7 ± 8,9 años. El 61,9% tenían enfermedad inactiva sin fibrosis hepática o fibrosis ligera. Solamente el 2% eran negativos para el antígeno de superficie de la hepatitis B con el DNA cuantificable del VHB, el 81,4% tenían carga viral detectable y el 85,5% recibieron uno o más tratamientos antivirales, principalmente los análogos del nucleótido/sido. Conclusiones: Los pacientes con la infección crónica del VHB estudiados, en su mayoría se encuentran en fase inactiva de su enfermedad, sin evidencia significativa de daño hepático, con niveles detectables de viremia y han recibido algún tratamiento antiviral.
Population-based studies on the clinical course and prognosis of autoimmune hepatitis (AIH) from Caribbean countries are limited.
The aim of this study was to provide information regarding the ...clinical and laboratory findings, histological profile, treatments, and outcomes of patients with AIH with long-term follow-up in a tertiary referral center.
A retrospective study was performed at the National Institute of Gastroenterology in Havana, Cuba, by enrolling 82 patients with a well-documented, long-term clinical course of AIH. Clinical and laboratory findings, histological profiles, treatments, and outcomes were analyzed.
At diagnosis, 73 (89%) patients had AIH type 1, 84.1% were women, and their median age was 46.5 years (range, 17–79 years). The median follow-up period was 84 months (interquartile range, 12–276 months). Clinical onset was mild or subclinical in 72% of patients and asymptomatic in 12.2%. At diagnosis, the Hennes's median score was 6 (range, 3–8). Complications were seen in 44 (53.6%) patients, 42 (51.2%) with liver-related complications and 9 (10.9%) without liver-related complications. Cirrhosis was present at diagnosis in 32 (39%) patients. Cirrhosis was subsequently diagnosed in the other 28 patients who were not cirrhotic at diagnosis, over a median follow-up of 12 (IQR, 2-84) months. During follow-up, 6 patients died (7.3%). Cumulative survival at 5 and 10 years was 98.4% and 89%, respectively. A complete biochemical response was achieved in 79% of patients in a mean (SD) of 11.7 (11.6) months. Side effects due to treatment were reported in 76 (92.7%) patients, and no pretreatment factors were found to predict treatment response.
These Cuban patients with AIH had acceptable disease remission rate and a prompt treatment response. Although most patients had advanced-stage liver disease at diagnosis or developed during follow-up, the cumulative survival rate was high when patients were receiving and complying with treatment.
Abstract Background Autoimmune liver diseases (AILD) comprise a set of entities characterized by tissue damage as a result of the loss of self-tolerance. There are few reports of AILD from Caribbean ...countries. The aim of the study was to investigate the clinical patterns, laboratory findings, and immunological features, treatment responses, and prognoses of AILD in adult patients at a Cuban tertiary referral center. Methods A prospective study was conducted at the National Institute of Gastroenterology in Havana, Cuba from May 2012 to April 2016. Clinical, immunologic, and histologic features of autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), AIH/PBC overlap syndrome, autoimmune cholangiopathy (AIC), and primary sclerosing cholangitis (PSC) were recorded. Response to therapy was assessed by serum ALT and bilirubin levels at 3, 6, 12, and 24 months after treatment-initiation. Results Of the 106 patients included in the study, 85.5% were female. The median age at presentation was 47 years. AIH was the most common AILD and was diagnosed in 60 patients (56.6%), 55 of whom had type 1 AIH. PBC was diagnosed in 22 (20.7%) patients, overlap syndrome in 16 (15%) patients, AIC in 5 (4.71%) patients, and PSC in 3 patients (2.8%). Most patients were symptomatic; 48 (45.2%) patients presented with liver cirrhosis and 14.5% with decompensated cirrhosis. Follow up of treatment was between 6 and 24 months. Prednisone monotherapy was used in 22 AIH patients (36.6%) and a combination of prednisone and azathioprine (AZA) was used in 28 (46.6%) AIH patients. Response to treatment was seen in 41 AIH patients (68.3%), 33 (55%) of whom had a complete response and 8 of whom (24.2%) relapsed after 12 months of maintenance therapy. No or incomplete response to treatment was seen in 18 (30%) patients. In 46 patients with autoimmune cholestasis, ursodeoxycholic acid was used as monotherapy in 25 (54.3%) patients. Conclusion The clinical profile of AILD in a sample of the Cuban population is similar to that reported in South areas. AIH was more frequent than PBC, and usually presented with advanced liver disease that responded poorly to treatment.
Chronic hepatitis B (CHB) infection is one of the most common causes of cirrhosis and liver cancer worldwide. Our aim was to assess clinical and patient‐reported outcome (PRO) profile of CHB patients ...from different regions of the world using the Global Liver Registry. The CHB patients seen in real‐world practices are being enrolled in the Global Liver Registry. Clinical and PRO (FACIT‐F, CLDQ, WPAI) data were collected and compared to baseline data from CHB controls from clinical trials. The study included 1818 HBV subjects (48 ± 13 years, 58% male, 14% advanced fibrosis, 7% cirrhosis) from 15 countries in 6/7 Global Burden of Disease super‐regions. The rates of advanced fibrosis varied (3–24%). The lowest PRO scores across multiple domains were in HBV subjects from the Middle East/North Africa (MENA), the highest – Southeast/East and South Asia. Subjects with advanced fibrosis had PRO impairment in 3 CLDQ domains, Activity of WPAI (p < 0.05). HBV subjects with superimposed fatty liver had more PRO impairments. In multivariate analysis adjusted for location, predictors of PRO impairment in CHB included female sex, advanced fibrosis, and non‐hepatic comorbidities (p < 0.05). In comparison to Global Liver Registry patients, 242 controls from clinical trials had better PRO scores (Abdominal, Emotional, and Systemic scores of CLDQ, all domains of WPAI) (p < 0.05). In multivariate analysis with adjustment for location and clinicodemographic parameters, the associations of PROs with the enrollment setting (real‐life Global Liver Registry vs. clinical trials) were no longer significant (all p > 0.10). The clinico‐demographic portrait of CHB patients varies across regions of the world and enrollment settings. Advanced fibrosis and non‐hepatic comorbidities are independently associated with PRO impairment in CHB patients.
Disfunción cardiaca en la cirrosis hepática Castellanos Fernández, Marlen Ivón; Rogel Marroquín, Belkin Ismael; Rodríguez Martorell, Francisco ...
Revista Cubana de medicina,
04/2014, Letnik:
53, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Objetivo: determinar las alteraciones de la función cardiaca en las personas que padecen cirrosis hepática. Métodos: se desarrolló un estudio descriptivo transversal en el Instituto de ...Gastroenterología durante el período 2011-2012, en 33 cirróticos de causa viral y alcohólica, 57,6 % del sexo masculino, con una edad promedio de 50 años, la mayoría (84,8 %) tenía la enfermedad compensada. Resultados: la disfunción diastólica fue la alteración cardiaca más frecuente (39,3 %) seguida de la prolongación del intervalo QT (12,1 %), disfunción sistólica (6,1 %) y miocardiopatía cirrótica (3 %). No se identificaron rasgos distintivos epidemiológicos y/o clínicos que caracterizara a estos pacientes. La circulación hiperdinámica fue más evidente en los que presentaron disfunción diastólica y en la cirrosis de origen alcohólico; las dimensiones cardiacas fueron normales en todos los casos. Conclusiones: las personas que padecen cirrosis son susceptibles de presentar alteraciones de la función cardiaca, incluso, desde la etapa compensada de la enfermedad, lo que debe considerarse por las implicaciones terapéuticas que demanda este tipo de paciente.
Introducción: La cirrosis hepática (CH) se ubica entre las principales causas de muerte en Cuba, una de sus complicaciones, el carcinoma hepatocelular (CHC), es responsable de la muerte en estos ...pacientes lo que ha motivado un incremento del interés clínico por los aspectos diagnósticos y de tratamiento. Métodos: Se desarrolló un estudio descriptivo, prospectivo con componente analítico, en 203 pacientes con CH, en el Instituto de Gastroenterología, en el período de 2005 a 2007. La muestra estuvo constituida por 105 hombres y 98 mujeres, de 56,4 años de edad promedio, la mayoría de causa viral y en diferentes estadios de progresión de la enfermedad. Se evaluaron las características clínicas y criterios de tratamiento en el momento del diagnóstico mediante métodos estadísticos descriptivos y el análisis de supervivencia se realizó mediante las curvas de Kaplan-Meier. Resultados: La frecuencia de presentación de CHC fue del 15,5 %, la causa más frecuente asociada fue la infección crónica por el virus de la hepatitis C, prevaleció en ambos sexos y en edades avanzadas. Predominaron las lesiones nodulares únicas mayores de 2 cm en el lóbulo hepático derecho, en el 77,7 % de los casos, asociadas a hipertensión portal. La supervivencia al año fue menor de 45 %. Conclusiones: El diagnóstico de la enfermedad se estableció en estadios donde las alternativas de tratamiento y curación fueron escasas. La vigilancia del CHC en los pacientes con CH es insuficiente. La supervivencia pudiera mejorar con el diagnóstico precoz y la aplicación de las opciones terapéuticas pertinentes.
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