MARIO GUIMARAES PESSOA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
69 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 69
- Anti-mitochondrial Antibody-Negative Primary Biliary Cholangitis Is Part of the Same Spectrum of Classical Primary Biliary Cholangitis(2022) CANCADO, Guilherme Grossi Lopes; BRAGA, Michelle Harriz; FERRAZ, Maria Lucia Gomes; VILLELA-NOGUEIRA, Cristiane Alves; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; GOMES, Nathalia Mota de Faria; OLIVEIRA, Elze Maria Gomes; ROTMAN, Vivian; OLIVEIRA, Maria Beatriz; CUNHA, Simone Muniz Carvalho Fernandes da; CUNHA-SILVA, Marlone; MENDES, Liliana Sampaio Costa; IVANTES, Claudia Alexandra Pontes; CODES, Liana; BORGES, Valeria Ferreira; PACE, Fabio Heleno de Lima; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; CORAL, Gabriela Perdomo; BITTENCOURT, Paulo Lisboa; LEVY, Cynthia; COUTO, Claudia AlvesBackground Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease in which anti-mitochondrial antibodies (AMA) are the diagnostic hallmark. Whether AMA-negative PBC patients represent a different phenotype of disease is highly debated. Aims The purpose of our study was to compare AMA-positive and AMA-negative PBC patients in a large non-white admixed Brazilian cohort. Methods The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian PBC patients, stratifying data according to AMA status. Results A total of 464 subjects (95.4% females, mean age 56 +/- 5 years) with PBC were included. Three hundred and eighty-four (83%) subjects were AMA-positive, whereas 80 (17%) had AMA-negative PBC. Subjects with AMA-negative PBC were significantly younger (52.2 +/- 14 vs. 59.6 +/- 11 years, p = 0.001) and had their first symptom at an earlier age (43.2 +/- 13 vs. 49.5 +/- 12 years, p = 0.005). Frequency of type 2 diabetes was significantly increased in subjects with AMA-negative PBC (22.5% vs. 12.2%, p = 0.03). Lower IgM (272.2 +/- 183 vs. 383.2 +/- 378 mg/dL, p = 0.01) and triglycerides (107.6 +/- 59.8 vs.129.3 +/- 75.7 mg/dL, p = 0.025) and higher bilirubin (3.8 +/- 13.5 vs. 1.8 +/- 3.4 mg/dL, p = 0.02) levels were also observed in this subgroup. Response to ursodeoxycholic acid varied from 40.5 to 63.3% in AMA-positive and 34 to 62.3% in AMA-negative individuals, according to different response criteria. Outcomes such as development of liver-related complications, death and requirement for liver transplantation were similar in both groups. Conclusions AMA-negative PBC patients are similar to their AMA-positive counterparts with subtle differences observed in clinical and laboratory features.
conferenceObject EFFECTIVENESS OF THE IMPLEMENTATION OF A RE-LINKAGE TO CARE STRATEGY IN PATIENTS WITH HEPATITIS C WHO WERE LOST OF FOLLOW-UP(2021) MENDIZABAL, Manuel; THOMPSON, Marcos Andres; RIDRUEJO, Ezequiel; BALLERGA, Esteban Gonzalez; VELASCO, Jose Antonio Velarde Ruiz; PALAZZO, Ana; MEZZANO, Gabriel; ESPINOSA, Linda Elsa Munoz; PESSOA, Mario; REYES, Eira Cerda; SOZA, Alejandro; RUIZ, Sandro; GOMEZ-ALDANA, Andres Jose; GERONA, Solange; FUSTER, Francisco; ANDERS, Margarita; VALDIVIA, Flor De Maria Beltran; PONIACHIK, Jaime; SCHINONI, Maria Isabel; HERNANDEZ, Nelia; MONTES, Pedro; GIRALA, Marcos; CASTILLO, Lida; CASTILLO-BARRADAS, Mauricio; CHAVEZ, Rocio; CABRERA, Cecilia; TENORIO, Laura; ZEVALLOS, Katherine; GARAVITO, Jorge; BRUTTI, Julia; TAGLE, Martin; NARRO, Graciela Castro; POZO, Emilia Vera; PERAZZO, Rosalia; TORO, Luis Guillermo; VARON, Adriana; FERREIRO, Melina; LAZCANO, Monserrat; MURGA, Maria Dolores; GOMEZ, Fernando; HERNANDEZ, Larissa; MOUTINHO, Bruna Damasio; GANDARA-CALDERON, Julian; VARGAS, Jose Ignacio; SIMIAN, Daniela; SILVA, Marcelo- Uniting to defeat steatotic liver disease: A global mission to promote healthy livers and healthy lives(2023) KRAG, Aleksander; BUTI, Maria; V, Jeffrey Lazarus; ALLEN, Alina M.; BOWMAN, Jacqueline; BURRA, Patrizia; DONNINI, Giacomo; DUSEJA, Ajay; EL-SAYED, Manal H.; GASTALDELLI, Amalia; HAINSWORTH, Ben; KARLSEN, Tom H.; KESSLER, Michael; KORENJAK, Marko; MARK, Henry E.; MANN, Jake P.; MILLER, Veronica; PESSOA, Mario G.; PINEIRO, Daniel; SARIN, Shiv K.; SINGH, Shivaram P.; RINELLA, Mary E.; WILLEMSE, Jose; YOUNOSSI, Zobair M.; FRANCQUE, Sven M.
- Hepatitis D double reflex testing of all hepatitis B carriers in low-HBV- and high-HBV/HDV-prevalence countries(2023) RAZAVI, Homie A.; BUTI, Maria; TERRAULT, Norah A.; ZEUZEM, Stefan; YURDAYDIN, Cihan; TANAKA, Junko; AGHEMO, Alessio; AKARCA, Ulus S.; MASRI, Nasser M. Al; ALALWAN, Abduljaleel M.; ALEMAN, Soo; ALGHAMDI, Abdullah S.; ALGHAMDI, Saad; AL-HAMOUDI, Waleed K.; ALJUMAH, Abdulrahman A.; ALTRAIF, Ibrahim H.; ASSELAH, Tarik; BEN-ARI, Ziv; BERG, Thomas; BIONDI, Mia J.; BLACH, Sarah; BRAGA, Wornei S. M.; BRANDAO-MELLO, Carlos E.; BRUNETTO, Maurizia R.; CABEZAS, Joaquin; CHEINQUER, Hugo; CHEN, Pei-Jer; CHEON, Myeong-Eun; CHUANG, Wan-Long; COFFIN, Carla S.; COPPOLA, Nicola; CRAXI, Antonio; CRESPO, Javier; LEDINGHEN, Victor De; DUBERG, Ann-Sofi; ETZION, Ohad; FERRAZ, Maria Lucia G.; FERREIRA, Paulo R. A.; FORNS, Xavier; FOSTER, Graham R.; GAETA, Giovanni B.; GAMKRELIDZE, Ivane; GARCIA-SAMANIEGO, Javier; GHEORGHE, Liliana S.; GHOLAM, Pierre M.; GISH, Robert G.; GLENN, Jeffrey; HERCUN, Julian; HSU, Yao-Chun; HU, Ching-Chih; HUANG, Jee-Fu; JANJUA, Naveed; JIA, Jidong; KABERG, Martin; KAITA, Kelly D. E.; KAMAL, Habiba; KAO, Jia-Horng; KONDILI, Loreta A.; LAGGING, Martin; LAZARO, Pablo; LAZARUS, Jeffrey V.; LEE, Mei-Hsuan; LIM, Young-Suk; MAROTTA, Paul J.; NAVAS, Maria-Cristina; NAVEIRA, Marcelo C. M.; ORREGO, Mauricio; OSIOWY, Carla; PAN, Calvin Q.; PESSOA, Mario G.; RAIMONDO, Giovanni; RAMJI, Alnoor; RAZAVI-SHEARER, Devin M.; RAZAVI-SHEARER, Kathryn; RIOS-HINCAPIE, Cielo Y.; RODRIGUEZ, Manuel; ROSENBERG, William M. C.; ROULOT, Dominique M.; RYDER, Stephen D.; SAFADI, Rifaat; SANAI, Faisal M.; SANTANTONIO, Teresa A.; SARRAZIN, Christoph; SHOUVAL, Daniel; TACKE, Frank; TERGAST, Tammo L.; VILLALOBOS-SALCEDO, Juan Miguel; VOELLER, Alexis S.; YANG, Hwai-I; YU, Ming-Lung; ZUCKERMAN, EliHepatitis D virus (HDV) infection occurs as a coinfection with hepatitis B and increases the risk of hepatocellular carcinoma, decompensated cirrhosis, and mortality compared to hepatitis B virus (HBV) monoinfection. Reliable estimates of the prevalence of HDV infection and disease burden are essential to formulate strategies to find coinfected individuals more effectively and efficiently. The global prevalence of HBV infections was estimated to be 262,240,000 in 2021. Only 1,994,000 of the HBV in-fections were newly diagnosed in 2021, with more than half of the new diagnoses made in China. Our initial estimates indicated a much lower prevalence of HDV antibody (anti-HDV) and HDV RNA positivity than previously reported in published studies. Ac-curate estimates of HDV prevalence are needed. The most effective method to generate estimates of the prevalence of anti-HDV and HDV RNA positivity and to find undiagnosed individuals at the national level is to implement double reflex testing. This re-quires anti-HDV testing of all hepatitis B surface antigen-positive individuals and HDV RNA testing of all anti-HDV-positive in-dividuals. This strategy is manageable for healthcare systems since the number of newly diagnosed HBV cases is low. At the global level, a comprehensive HDV screening strategy would require only 1,994,000 HDV antibody tests and less than 89,000 HDV PCR tests. Double reflex testing is the preferred strategy in countries with a low prevalence of HBV and those with a high prevalence of both HBV and HDV. For example, in the European Union and North America only 35,000 and 22,000 cases, respectively, will require anti-HDV testing annually. & COPY; 2023 The Author(s).
conferenceObject YSTRATEGIES TO ELIMINATE HEPATITIS C VIRUS INFECTION IN THE AMERICAS(2023) DIAZ, Luis Antonio; GARCIA, Sergio; AYARES, Gustavo; URIBE, Javier; IDALSOAGA, Francisco; FUENTEALBA, Jose Miguel; FUENTES-LOPEZ, Eduardo; MEDEL, Maria Paz; RAMIREZ-CADIZ, Carolina A.; KHAN, Rayan; LAZO, Mariana; FERRECCIO, Catterina; MENDIZABAL, Manuel; DIRCHWOLF, Melisa Melisa; SALAZAR, Patricia Guerra; OLIVEIRA, Claudia P. M. S.; PESSOA, Mario G.; ALVARES-DA-SILVA, Mario R.; SEBASTIANI, Giada; BRAHMANIA, Mayur; RAMJI, Alnoor; NIAZI, Mina; KO, Hin Hin; FELD, Jordan J.; RESTREPO, Juan Carlos; QUESADA, Wagner Enrique Ramirez; ALFARO, Omar; FERNANDEZ, Marlen Ivon Castellanos; ESTUPINAN, Enrique Carrera; AGUIRRE, Jose Roberto; MALDONADO, Katherine; SANCHEZ, Abel; SANCHEZ, Marco; SR., Teresa Andara; CASTRO-NARRO, Graciela Elia; CHAVEZ-TAPIA, Norberto Carlos; MENDEZ-SANCHEZ, Nahum; ADAMES-ALMENGOR, Enrique; LOMBARDO, Julissa; SR., Marcos Girala; MORAN, Elias; PADILLA-MACHACA, Martin; FERRER, Javier Diaz; TAGLE, Martin; MAINARDI, Vitoria; HERNANDEZ, Nelia; MARTINEZ, Edmundo; ALVARADO-TAPIAS, Edilmar; LEON, Roberto; TALAL, Andrew; THOMAS, Emmanuel; SPRINGER, Sandra; SICILIA, Mauricio Garcia Saenz de; ZHANG, Wei; BAJAJ, Jasmohan S.; TAPPER, Elliot B.; IZZY, Manhal; GISH, Robert G.; ATTAR, Bashar M.; COTTER, Thomas G.; LUCEY, Michael R.; KAMATH, Patrick S.; SINGAL, Ashwani K.; BATALLER, Ramon; MEZZANO, Gabriel; SOZA, Alejandro; LAZARUS, Jeffrey V.; ARRESE, Marco; ARAB, Juan Pablo- Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2022 Clinical Practice Guideline(2023) AWAN, Ahmed Arslan Yousuf; BERENGUER, Marina C.; BRUCHFELD, Annette; FABRIZI, Fabrizio; GOLDBERG, David S.; JIA, Jidong; KAMAR, Nassim; MOHAMED, Rosmawati; PESSOA, Mario Guimaraes; POL, Stanislas; SISE, Meghan E.; BALK, Ethan M.; GORDON, Craig E.; ADAM, Gaelen; CHEUNG, Michael; EARLEY, Amy; MARTIN, Paul; JADOUL, MichelDescription: The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 clinical practice guideline on prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease (CKD) is an update of the 2018 guideline from KDIGO.Methods: The KDIGO Work Group (WG) updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and used expert judgment to develop recommendations. New evidence led to updating of recommendations in the chapters on treatment of hepatitis C virus (HCV) infection in patients with CKD (Chapter 2), management of HCV infection before and after kidney transplant (Chapter 4), and diagnosis and management of kidney disease associated with HCV infection (Chapter 5). Recommendations in chapters on detection and evaluation of hepatitis C in CKD (Chapter 1) and prevention of HCV transmission in hemodialysis units (Chapter 3) were not updated because of an absence of significant new evidence.Recommendations: The 2022 updated guideline includes 43 graded recommendations and 20 ungraded recommendations, 7 of which are new or modified on the basis of the most recent evidence and consensus among the WG members. The updated guidelines recommend expanding treatment of hepatitis C with sofosbuvir-based regimens to patients with CKD glomerular filtration rate categories G4 and G5, including those receiving dialysis; expanding the donor pool for kidney transplant recipients by accepting HCV-positive kidneys regardless of the recipient's HCV status; and initiating direct-acting antiviral treatment of HCV-infected patients with clinical evidence of glomerulonephritis without requiring kidney biopsy. The update also addresses the use of immunosuppressive regimens in such patients.
- Direct-acting antivirals for chronic hepatitis C treatment: The experience of two tertiary university centers in Brazil(2022) LOURENCO, Mariana Sandoval; ZITELLI, Patricia Momoyo Y.; CUNHA-SILVA, Marlone; OLIVEIRA, Arthur Ivan N.; OLIVEIRA, Claudia P.; SEVA-PEREIRA, Tiago; CARRILHO, Flair Jose; PESSOA, Mario G.; MAZO, Daniel F.BACKGROUND Hepatitis C virus (HCV) treatment has undergone major changes in recent years. Previous interferon-based therapies have been replaced by oral direct-acting antivirals (DAA) regimens, with high sustained virologic response (SVR) rates, and a lower incidence of adverse events (AEs). AIM To evaluate the efficacy and safety of DAAs for HCV treatment in subjects from two tertiary university centers in Brazil. METHODS This is a multicenter retrospective cohort study of 532 patients with chronic hepatitis C (CHC), undergoing treatment with interferon-free regimens from November 2015 to November 2019. The therapeutic regimen was defined by the current Brazilian guidelines for HCV management at the time of treatment. Demographic, anthropometric, clinical, and laboratory variables were evaluated. SVRs were assessed at 12 to 24 wk after therapy by intention-to-treat (ITT), and modified ITT (m-ITT) analysis. AEs and serious adverse events (SAEs) were registered. In the statistical analysis, a P value of < 0.05 was considered significant. RESULTS The mean age was 56.88 years, with 415 (78.5%) being HCV genotype 1, followed by genotype 3 (20.1%). Moreover, 306 (57.5%) subjects had cirrhosis, and a third of them had decompensated cirrhosis. Sofosbuvir (SOF) plus daclatasvir ribavirin was the most frequently used treatment (66.9%), followed by SOF plus simeprevir (21.2%). The overall ITT SVR was 92.6% (493/532), while the m-ITT SVR was 96.8% (493/509). Variables associated with treatment failure via ITT evaluation were hepatic encephalopathy (OR: 4.320; 95%CI: 1.920-9.721, P = 0.0004), presence of esophageal varices (OR: 2.381; 95%CI: 1.137-4.988, P = 0.0215), previous portal hypertensive bleeding (OR: 2.756; 95%CI: 1.173-6.471, P = 0.02), higher model for end-stage liver disease scores (OR: 1.143, 95%CI: 1.060-1.233, P = 0.0005), lower serum albumin levels (OR: 0.528, 95%CI: 0.322-0.867, P = 0.0115), higher serum creatinine (OR: 1.117, 95%CI: 1.056-1.312, P = 0.0033), and international normalized ratio (INR) levels (OR: 5.542, 95%CI: 2.023-15.182, P = 0.0009). AEs were reported in 41.1% (211/514) of patients, and SAEs in 3.7%. The female gender, higher body mass index, esophageal varices, higher INR values, and longer treatment duration were independently associated with AE occurrence. CONCLUSION Treatment with oral DAAs attains a high SVR rate, with fewer SAEs in a real-life cohort of subjects with CHC, from two tertiary university centers in Brazil.
- Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach(2019) BENZAKEN, Adele Schwartz; GIRADE, Renato; CATAPAN, Elisa; PEREIRA, Gerson Fernando Mendes; ALMEIDA, Elton Carlos de; VIVALDINI, Simone; FERNANDES, Neide; RAZAVI, Homie; SCHMELZER, Jonathan; FERRAZ, Maria Lucia; FERREIRA, Paulo Roberto Abrao; PESSOA, Mario Guimaraes; MARTINELLI, Ana; SOUTO, Francisco Jose Dutra; WALSH, Nick; MENDES-CORRE, Maria CassiaIntroduction and aim: Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO). Methods: A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024. Results: An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025-2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality. Conclusion: Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers. (C) 2019 Sociedade Brasileira de Infectologia.
conferenceObject 2-YEAR RESULTS OF TELBIVUDINE (LDT) ROADMAP STUDY VERIFY THE OPTIMAL EFFICACY AND SAFETY RESULTS IN HBEAG POSITIVE CHRONIC HEPATITIS B (CHB) PATIENTS(2012) PIRATVISUTH, T.; KOMOLMIT, P.; TANWANDEE, T.; SUKEEPAISARNJAROEN, W.; CHAN, H. L.; PESSOA, M. G.; FASSIO, E.; ONO-NITA, S.; BESSONE, F.; DARUICH, J.; ZEUZEM, S.; CHEINQUER, H.; DONG, Y.; TRYLESINSKI, A.Background and Aims: The roadmap concept based on Week 24 HBV DNA levels was prospectively validated with 1year results of Roadmap study (A2410) as previously reported. The 2 year results are reported here. Patients and Methods: All patients were HBeAg positive and started LDT monotherapy from baseline and Tenofovir (LDT) was added to patients with detectable (≥300 copies/ml) HBV DNA at 24w until 104w. Results: 105 patients were enrolled and 100 patients were eligible for modified ITT (mITT) analysis (1 patient with baseline M204I mutation, 2 lost follow-up and 2 didn’t follow roadmap concept). At 24w, 55 patients achieved undetectable HBV DNA and 45 patients with detectable HBV DNA added with TDF (73% of the 45 patients with baseline HBV DNA > 9log10 copies/ml). At 104w, 94% had undetectable HBV DNA, 50%/44% HBeAg loss/seroconversion, 7%/4% HBsAg loss/seroconversion. One patient in LDT mono-treated arm had Virologic Breakthrough (VB) at Week 72 and detected M204I mutation; achieved undetectable HBV DNA 8wks after TDF add-on. One LDT mono-treated patient had one time of HBV DNA increase of 1 log10 above nadir (assessment ongoing). Both patients had baseline HBV DNA > 9log10 copies/ml. In the overall safety population, Serious Adverse Events (SAEs) was reported in 6/105 (5.7%) patients and all unrelated to treatment. No case of myopathy/myositis was reported. Overall GFR (by MDRD formula) improvement was +6.4 and +8.6ml/min/1.73m2 in LDT mono and LDT+TDF group respectively. In patients with abnormal baseline GFR (60–90ml/min/1.73m2), GFR improvement at 2yr was +12.0 and +1.5ml/min/1.73m2 in LDT and LDT+TDF respectively. 50% and 40% of patients with abnormal baseline GFR (60–90ml/min/1.73m2) in LDT and LDT+TDF group respectively shifted to normal (>90ml/min/1.73m2) at 2yr. Only 1 patient in TDF add-on group had once creatinine increase to 232 μmol/L at Week 96, and returned to 91 μmol/L within 4 days. Conclusion: Telbivudine roadmap with tenofovir add-on at 24 weeks in patients with detectable HBVDNA improved GFR in both LDT and LDT+TDF treated patients, as well as favorable efficacy and safety profiles.- Biomarkers in Hepatocellular Carcinoma: Diagnosis, Prognosis and Treatment Response Assessment(2020) PINERO, Federico; DIRCHWOLF, Melisa; PESSOA, Mario G.Hepatocellular carcinoma (HCC) is one of the main cancer-related causes of death worldwide. Thus, there is a constant search for improvement in screening, diagnosis, and treatment strategies to improve the prognosis of this malignancy. The identification of useful biomarkers for surveillance and early HCC diagnosis is still deficient, with available serum biomarkers showing low sensitivity and heterogeneous specificity despite different cut-off points, even when assessed longitudinally, or with a combination of serum biomarkers. In contrast, HCC biomarkers used for prognostic (when associated with clinical outcomes) or predictive purposes (when associated with treatment response) may have an increased clinical role in the near future. Furthermore, some serum biomarkers are already implicated as a treatment selection tool, whether to provide access to certain therapies or to assess clinical benefit after treatment. In the present review we will discuss the clinical utility and foreseen future of HCC biomarkers implicated in surveillance, diagnosis, prognosis, and post-treatment assessment.