ALBERTO QUEIROZ FARIAS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
article 44 Citação(ões) na Scopus Epidemiology of HCC in Brazil: incidence and risk factors in a ten-year cohort(2014) PARANAGUA-VEZOZZO, Denise C.; ONO, Suzane K.; ALVARADO-MORA, Monica V.; FARIAS, Alberto Q.; CUNHA-SILVA, Marlone; FRANCA, Joao I. D.; ALVES, Venancio A. F.; SHERMAN, Morris; CARRILHO, Flair JoseBackground and aim. The lack of information about hepatocellular carcinoma (HCC) in Brazil weakens health policy in preventing deaths from the illness. The aim of this study was to establish the cumulative incidence and the risk factors for hepatocellular carcinoma development in patients under a surveillance program. Material and methods. 884 patients with compensated cirrhosis were prospectively followed up for at least five years, from August 1998 until August 2008, with at least one annual ultrasonography liver examination and serum alpha fetoprotein (AFP) measurement. Results. Among 884 patients, 72 (8.1%) developed a tumor with a median follow up of 21.4 months. In the hepatocellular carcinoma group, hepatitis C virus infection was the major etiological factor (65.3%), 56.9% (41/72) were male and the mean average age was 57 +/- 10 years. The annual incidence of hepatocellular carcinoma was 2.9%. 79.2% (57/72) of HCCs were detected within Milan Criteria, and the mean survival time was 52.3 months, significantly higher than for those outside Milan, with a mean time of 40.6 months (p = 0.0003). Conclusion. The annual incidence of HCC among this large series of Brazilian cirrhotic patients was around 2.9% with a detection rate of 8.1%, or a cumulative incidence rate over five years of 14.3%. The three variables related to HCC risk were low serum albumin [HR: 0.518 (0.46-0.78)], high AFP > 20 ng/mL [HR: 3.16 (1.86-5.38)], and ethnicity (Brazilian-East Asian descendants vs. other mixed Brazilian ethnicities) [HR: 2.86 (1.48-5.53)].conferenceObject Continuous infusion of terlipressin for hepatorenal syndrome therapy: evaluation of efficacy and safety in real-life setting(2020) LINHARES, Fernanda S.; COSTA, Julia G. F.; CUNHA-SILVA, Marlone; PEREIRA, Tiago; FARIAS, Alberto Queiroz; CARRILHO, Flair Jose; MAZO, DanielconferenceObject Endogenous Heparinoid Effects during Bacterial Infections in Patients with Cirrhosis Do Not Impair Thombin Generation: A Prospective Study(2018) MOTTA, Marina; ROCHA, Tania Rubia Flores; MIGITA, Beatriz Yuri; BATISTA, Juliana Medeiros; D'AMICO, Elbio Antonio; D'ALBUQUERQUE, Lutz Augusto Cameiro; CARRILHO, Flair Jose; FARIAS, Alberto Q.article 26 Citação(ões) na Scopus Impact of the severity of end-stage liver disease in cardiac structure and function(2013) SILVESTRE, Odilson Marcos; BACAL, Fernando; RAMOS, Danusa de Souza; ANDRADE, Jose L.; FURTADO, Meive; PUGLIESE, Vincenzo; BELLETI, Elisangela; ANDRAUS, Wellington; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Augusto Carneiro; FARIAS, Alberto QueirozBackground. The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. Material and methods. 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. Results. Left-atrial diameter (r = 0.323; IC 95% 0.190-0.455; p < 0.001), left-ventricular diastolic diameter (r = 0.177; IC 95% 0.033-0.320; p = 0.01) and systolic pulmonary artery pressure (r = 0.185; IC 95% 0.036-0.335; p = 0.02) significantly correlated with MELD score. Patients with MELD 16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores < 16 points. Conclusions. Changes in cardiac structure and function correlate with the severity of ESLD.conferenceObject FRESH FROZEN PLASMA TRANSFUSION IN PATIENTS WITH CIRRHOSIS AND COAGULOPATHY: EFFECT ON CONVENTIONAL COAGULATION TESTS AND THROMBOMODULIN-MODIFIED THROMBIN GENERATION(2019) RASSI, Amanda Bruder; D'AMICO, Elbio Antonio; TRIPODI, Armando; ROCHA, Tania Rubia Flores; MIGITA, Beatriz; FERREIRA, Caroline Marcondes; CARRILHO, Flair Jose; FARIAS, Alberto Q.- Preservation of platelet function in patients with cirrhosis and thrombocytopenia undergoing esophageal variceal ligation(2020) SOUZA, Evandro de Oliveira; D'AMICO, Elbio Antonio; ROCHA, Tania Rubia Flores da; FERREIRA, Caroline Marcondes; BATISTA, Juliana Medeiros; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair Jose; FARIAS, Alberto QueirozBackground: Thrombocytopenia is a possible risk factor for bleeding after band ligation of esophageal varices. However, elevated von Willebrand factor (VWF) in cirrhosis improves platelet function and could decrease this risk. Our objective was to assess platelet function in patients with cirrhosis undergoing esophageal variceal ligation (EVL). Methods: The assessment consisted of platelet count, antigen and activity of VWF and VWF-cleaving protease ADAMTS-13 activity, and a platelet adhesion and aggregation test simulating vascular flow in vivo (Impact-R (R)) prior to EVL. Results: Totally 111 patients were divided into three groups according to platelet count: (1) < 50 x 10(9)/L (n = 38, 34.2%); (2) 50 x 10(9)/L to 100 x 10(9)/L (n = 47, 42.3%); and (3) > 100 x 10(9) /L (n = 26, 23.4%). No statistically significant difference was found in the aggregate size of platelets [group 1: 41.0 (31.8-67.3) mu m(2); group 2: 47.0 (33.8-71.3) mu m(2); and group 3: 47.0 (34.0-66.0) mu m(2); P = 0.60] and no significant correlation was found between aggregate size and platelet count (Spearman r = 0.07; P = 0.47). Surface coverage was 4.1% (2.8%-6.7%), 8.5% (4.0%-10.0%), and 9.0% (7.1%-12.0%) (P < 0.001) in groups 1, 2 and 3, respectively and correlated with platelet count (Spearman r = 0.39; P < 0.0001). There was no significant difference between groups in VWF or ADAMTS-13. Post-EVL bleeding occurred in six (5.4%) patients (n = 2 in group 1, n = 1 in group 2, and n = 3 in group 3; P = 0.32). Patients with bleeding had higher MELD scores [15.0 (11.3-20.3) versus 12.0 (10.0-15.0); P = 0.025], but no difference was demonstrated for platelet function parameters. Conclusion: Platelet function is preserved even in the presence of thrombocytopenia, including in the patients with post-EVL bleeding.
- Pro-atherosclerotic markers and cardiovascular risk factors one year after liver transplantation(2014) ALVARES-DA-SILVA, Mario Reis; OLIVEIRA, Claudia Pinto Marques Souza de; STEFANO, Jose Tadeu; BARBEIRO, Hermes V.; BARBEIRO, Denise; SORIANO, Francisco G.; FARIAS, Alberto Queiroz; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Augusto CarneiroAIM: To investigate pro-atherosclerotic markers (endothelial dysfunction and inflammation) in patients one year after liver transplantation. METHODS: Forty-four consecutive liver transplant (LT) outpatients who were admitted between August 2009 and July 2010, were followed-up by for 1 year, exhibited no evidences of infection or rejection, all of them underwent tacrolimus-based immunosuppressive regimens were consecutively enrolled. Inflammatory cytokines (TNF alpha, IFN gamma, IL-8, and IL-10), endothelial biomarkers (sVCAM-1, sICAM-1, MPO, adiponectin, PAI-1, SAP, SAA, E-selectin, and MMP-9), high sensitive C-reactive protein, and Framingham risk score (FRS) were assessed. The anthropometric data, aminotransferases, metabolic syndrome features, glucose and lipid profiles, and insulin resistance data were also collected. The LT recipients were compared to 22 biopsy-proven non-alcoholic steatohepatitis (NASH) patients and 20 healthy controls (non-obese, non-diabetics, and non-dyslipidemic). RESULTS: The LT recipients had significantly younger ages and lower body mass indices, aminotransferases, fasting glucose and insulin levels, glucose homeostasis model and metabolic syndrome features than the NASH patients. Classic cardiovascular risk markers, such as Hs-CRP and FRS [2.0 (1.0-8.75)], were lower in the LT patients compared to those observed in the NASH patients (P = 0.009). In contrast, the LT recipients and NASH patients had similar inflammatory and endothelial serum markers compared to the controls (pg/mL): lower IL-10 levels (32.3 and 32.3 vs 62.5, respectively, P = 0.019) and higher IFN gamma (626.1 and 411.9 vs 67.9, respectively, P < 0.001), E-selectin (48.5 and 90.03 vs 35.7, respectively, P < 0.001), sVCAM-1 (1820.6 and 1692.4 vs 1167.2, respectively, P < 0.001), and sICAM-1 (230.3 and 259.7 vs 152.9, respectively, P = 0.015) levels. CONCLUSION: Non-obese LT recipients have similar pro-atherosclerotic serum profiles after a short 1-year follow-up period compared to NASH patients, suggesting a high risk of atherosclerosis in this population.
- Hepatitis E virus infection increases the risk of diabetes and severity of liver disease in patients with chronic hepatitis C virus infection(2021) ZITELLI, Patricia Momoyo Yoshimura; GOMES-GOUVEA, Michele; MAZO, Daniel F.; SINGER, Julio da Motta; OLIVEIRA, Claudia P. M. S.; FARIAS, Alberto Queiroz; PINHO, Joao Renato; TANIGAWA, Ryan Yukimatsu; ALVES, Venancio Avancini Ferreira; CARRILHO, Flair Jose; PESSOA, Mario GuimaraesOBJECTIVES: Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS: This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS: Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis >= 3 versus <= 2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of >= 1.45 (p=0.003), and Fibrosis-4 score of >= 3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS: This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection.
conferenceObject Preservation of Thrombin Generation in Cirrhosis Despite Abnormal Results of INR/ Prothrombin Time: Implication for Invasive Procedures(2018) FARIAS, Alberto Q.; FERREIRA, Caroline Marcondes; D'AMICO, Elbio Antonio; SOUZA, Evandro Oliveira; BATISTA, Juliana Medeiros; ROCHA, Tania Rubia Flores; CARRILHO, Flair Jose- Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation(2020) RASSI, Amanda Bruder; D'AMICO, Elbio Antonio; TRIPODI, Armando; ROCHA, Tania Rubia Flores da; MIGITA, Beatriz Yuri; FERREIRA, Caroline Marcondes; CARRILHO, Flair Jose; FARIAS, Alberto QueirozBackground & Aims: The efficacy of fresh frozen plasma (FFP) transfusion in enhancing thrombin generation in patients with cirrhosis and impaired conventional coagulation tests has not been sufficiently explored. Thus, we aimed to assess the effect of FFP transfusion on thrombin generation in these patients. Methods: Fifty-three consecutive patients receiving a standard dose of FFP to treat bleeding and/or before invasive procedures - if international normalized ratio (INR)/prothrombin time (PT) ratio were >= 1.5 - were prospectively enrolled. The primary endpoint was the amelioration of endogenous thrombin potential (ETP) with thrombomodulin (ETP-TM) after transfusion, which corresponds to the total amount of generated thrombin. INR/PT ratio and activated partial thromboplastin time (aPTT) were also assessed before and after transfusion. Results: FFP enhanced ETP-TM by 5.7%, from 973 (731-1,258) to 1,028 (885-1,343 nM x min; p = 0.019). Before transfusion, evidence of normal or high ETP-TM was found in 94% of patients, even in those with bacterial infections. Only 1 (1.9%) patient had ETP-TM values reverting to the normal range after transfusion. Notably, no patients with low ETP-TM had bleeding. The median decrease in ETP-TM was 8.3% and the mean was 12.8% in 18 (34%) patients after transfusion (from 1,225 [1,071-1,537] to 1,124 [812-1,370] nM x min; p <= 0.0001). Similar responses to FFP transfusion were observed in patients with compensated and acute decompensated cirrhosis, acute-on-chronic liver failure, infection or shock. FFP significantly ameliorated INR and aPTT values (p <0.0001), but in a minority of patients the values were reduced to less than the cut-off point of 1.5. Conclusions: FFP transfusion enhanced thrombin generation and ameliorated conventional coagulation tests to normal values in a limited number of patients, and slightly decreased thrombin generation in 34% of cases. Lay summary: Transfusion of fresh frozen plasma in patients with cirrhosis only slightly improves coagulation test values in a limited number of patients and even appears to worsen them in a third of cases. Transfusion for the purpose of preventing or treating bleeding events could cause inherent risks and costs without clear benefits. (C) 2019 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.