MARIO GUIMARAES PESSOA

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  • article 9 Citação(ões) na Scopus
    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 Alves
    Background 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.
  • article 1 Citação(ões) na Scopus
    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, Michel
    Description: 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.
  • article 36 Citação(ões) na Scopus
    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 Cassia
    Introduction 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.
  • article 1295 Citação(ões) na Scopus
    Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study
    (2018) RAZAVI-SHEARER, Devin; GAMKRELIDZE, Ivane; NGUYEN, Mindie H.; CHEN, Ding-Shinn; DAMME, Pierre Van; ABBAS, Zaigham; ABDULLA, Maheeba; RACHED, Antoine Abou; ADDA, Danjuma; AHO, Inka; AKARCA, Ulus; ALI, Fuad Hasan Al; LAWATI, Faryal Al; NAAMANI, Khalid Al; ALASHGAR, Hamad Ibrahim; ALAVIAN, Seyed M.; ALAWADHI, Sameer; ALBILLOS, Agustin; AL-BUSAFI, Said A.; ALEMAN, Soo; ALFALEH, Faleh Z.; ALJUMAH, Abdulrahman A.; ANAND, Anil C.; Nguyen Thu Anh; ARENDS, Joop E.; ARKKILA, Perttu; ATHANASAKIS, Kostas; BANE, Abate; BEN-ARI, Ziv; BERG, Thomas; BIZRI, Abdul R.; BLACH, Sarah; MELLO, Carlos E. Brandao; BRANDON, Samantha M.; BRIGHT, Bisi; BRUGGMANN, Philip; BRUNETTO, Maurizia; BUTI, Maria; CHAN, Henry L. Y.; CHAUDHRY, Asad; CHIEN, Rong-Nan; CHOI, Moon S.; CHRISTENSEN, Peer B.; CHUANG, Wan-Long; CHULANOV, Vladimir; CLAUSEN, Mette R.; COLOMBO, Massimo; CORNBERG, Markus; COWIE, Benjamin; CRAXI, Antonio; CROES, Esther A.; CUELLAR, Diego Alberto; CUNNINGHAM, Chris; DESALEGN, Hailemichael; DRAZILOVA, Sylvia; DUBERG, Ann-Sofi; EGEONU, Steve S.; EL-SAYED, Manal H.; ESTES, Chris; FALCONER, Karolin; FERRAZ, Maria L. G.; FERREIRA, Paulo R.; FLISIAK, Robert; FRANKOVA, Sona; GAETA, Giovanni B.; GARCIA-SAMANIEGO, Javier; GENOV, Jordan; GERSTOFT, Jan; GOLDIS, Adrian; GOUNTAS, Ilias; GRAY, Richard; PESSOA, Mario Guimaraes; HAJARIZADEH, Behzad; HATZAKIS, Angelos; HEZODE, Christophe; HIMATT, Sayed M.; HOEPELMAN, Andy; HRSTIC, Irena; HUI, Yee-Tak T.; HUSA, Petr; JAHIS, Rohani; JANJUA, Naveed Z.; JARCUSKA, Peter; JAROSZEWICZ, Jerzy; KAYMAKOGLU, Sabahattin; KERSHENOBICH, David; KONDILI, Loreta A.; KONYSBEKOVA, Aliya; KRAJDEN, Mel; KRISTIAN, Pavol; LALEMAN, Wim; LAO, Wai-cheung C.; LAYDEN, Jen; LAZARUS, Jeffrey V.; LEE, Mei-Hsuan; LIAKINA, Valentina; LIM, Young-Suk S.; LOO, Ching-kong K.; LUKSIC, Boris; MALEKZADEH, Reza; MALU, Abraham O.; MAMATKULOV, Adkhamjon; MANNS, Michael; MARINHO, Rui T.; MATICIC, Mojca; MAUSS, Stefan; MEMON, Muhammad S.; CORREA, Maria C. Mendes; MENDEZ-SANCHEZ, Nahum; MERAT, Shahin; METWALLY, Ammal M.; MOHAMED, Rosmawati; MOKHBAT, Jacques E.; MORENO, Christophe; MOSSONG, Joel; MOURAD, Fadi H.; MULLHAUPT, Beat; MURPHY, Kimberly; MUSABAEV, Erkin; NAWAZ, Arif; NDE, Helen M.; NEGRO, Francesco; NERSESOV, Alexander; Van Thi Thuy Nguyen; NJOUOM, Richard; NTAGIRABIRI, Renovat; NURMATOV, Zuridin; OBEKPA, Solomon; OCAMA, Ponsiano; OGUCHE, Stephen; OMEDE, Ogu; OMUEMU, Casimir; OPARE-SEM, Ohene; OPIO, Christopher K.; ORMECI, Necati; PAPATHEODORIDIS, George; PASINI, Ken; PIMENOV, Nikolay; POUSTCHI, Hossein; QUANG, Tran D.; QURESHI, Huma; RAMJI, Alnoor; RAZAVI-SHEARER, Kathryn; REDAE, Berhane; REESINK, Henk W.; RIOS, Cielo Yaneth; RJASKOVA, Gabriela; ROBBINS, Sarah; ROBERTS, Lewis R.; ROBERTS, Stuart K.; RYDER, Stephen D.; SAFADI, Rifaat; SAGALOVA, Olga; SALUPERE, Riina; SANAI, Faisal M.; SANCHEZ-AVILA, Juan F.; SARASWAT, Vivek; SARRAZIN, Christoph; SCHMELZER, Jonathan D.; SCHRETER, Ivan; SCOTT, Julia; SEGUIN-DEVAUX, Carole; SHAH, Samir R.; SHARARA, Ala I.; SHARMA, Manik; SHIHA, Gamal E.; SHIN, Tesia; SIEVERT, William; SPERL, Jan; STARKEL, Peter; STEDMAN, Catherine; SYPSA, Vana; TACKE, Frank; TAN, Soek S.; TANAKA, Junko; TOMASIEWICZ, Krzysztof; URBANEK, Petr; MEER, Adriaan J. van der; VLIERBERGHE, Hans Van; VELLA, Stefano; VINCE, Adriana; WAHEED, Yasir; WAKED, Imam; WALSH, Nicholas; WEIS, Nina; WONG, Vincent W.; WOODRING, Joseph; YAGHI, Cesar; YANG, Hwai-I; YANG, Chung-Lin; YESMEMBETOV, Kakharman; YOSRY, Ayman; YUEN, Man-Fung; YUSUF, Muhammed Aasim M.; ZEUZEM, Stefan; RAZAVI, Homie
    Background The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate viral hepatitis by 2030. Although no virological cure exists for hepatitis B virus (HBV) infection, existing therapies to control viral replication and prophylaxis to minimise mother-to-child transmission make elimination of HBV feasible. We aimed to estimate the national, regional, and global prevalence of HBsAg in the general population and in the population aged 5 years in 2016, as well as coverage of prophylaxis, diagnosis, and treatment. Methods In this modelling study, we used a Delphi process that included a literature review in PubMed and Embase, followed by interviews with experts, to quantify the historical epidemiology of HBV infection. We then used a dynamic HBV transmission and progression model to estimate the country-level and regional-level prevalence of HBsAg in 2016 and the effect of prophylaxis and treatment on disease burden. Findings We developed models for 120 countries, 78 of which were populated with data approved by experts. Using these models, we estimated that the global prevalence of HBsAg in 2016 was 3.9% (95% uncertainty interval [UI] 3.4-4.6), corresponding to 291 992 000 (251 513 000-341 114 000) infections. Of these infections, around 29 million (10%) were diagnosed, and only 4.8 million (5%) of 94 million individuals eligible for treatment actually received antiviral therapy. Around 1.8 (1.6-2.2) million infections were in children aged 5 years, with a prevalence of 1.4% (1.2-1.6). We estimated that 87% of infants had received the three-dose HBV vaccination in the first year of life, 46% had received timely birth-dose vaccination, and 13% had received hepatitis B immunoglobulin along with the full vaccination regimen. Less than 1% of mothers with a high viral load had received antiviral therapy to reduce mother-to-child transmission. Interpretation Our estimate of HBV prevalence in 2016 differs from previous studies, potentially because we took into account the effect of infant prophylaxis and early childhood vaccination, as well as changing prevalence over time. Although some regions are well on their way to meeting prophylaxis and prevalence targets, all regions must substantially scale-up access to diagnosis and treatment to meet the global targets. Funding John C Martin Foundation.
  • article 3 Citação(ões) na Scopus
    Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study
    (2017) CALLEFI, Luciana Azevedo; VILLELA-NOGUEIRA, Cristiane Alves; TENORE, Simone de Barros; CARNAUBA-JUNIOR, Dimas; COELHO, Henrique Sergio Moraes; PINTO, Paulo de Tarso A.; NABUCO, Leticia Cancella; PESSOA, Mario Guimaraes; FERRAZ, Maria Lucia Cardoso Gomes; FERREIRA, Paulo Roberto Abrao; MARTINELLI, Ana de Lourdes Candolo; CHACHA, Silvana Gama Florencio; FERREIRA, Adalgisa de Souza Paiva; BISIO, Alessandra Porto de Macedo; BRANDAO-MELLO, Carlos Eduardo; ALVARES-DA-SILVA, Mario Reis; REUTER, Tania; ALEXANDRA, Claudia; IVANTES, Pontes; PEREZ, Renata de Mello; MENDES-CORREA, Maria Cassia Jacintho
    OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p < 0.001) and a higher incidence of serious adverse events (50.7% vs. 34.8%, p < 0.001). Multivariate analysis revealed that sustained viral response was associated with the absence of cirrhosis, viral recurrence after previous treatment, pretreatment platelet count greater than 100,000/mm(3), and achievement of a rapid viral response. Female gender, age > 465 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.
  • article 3 Citação(ões) na Scopus
    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 Guimaraes
    OBJECTIVES: 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.
  • article 2 Citação(ões) na Scopus
    National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents
    (2022) FERRAZ, Maria Lucia Gomes; PICCOLI, Leonora de Zorzi; REZENDE, Rosamar; BORBA, Luiz Augusto; PISSAIA JUNIOR, Alcindo; CHEINQUER, Hugo; SILVA, Giovanni Faria; FERREIRA, Paulo Roberto Abrao; VILLELA-NOGUEIRA, Cristiane Alves; MAZO, Daniel Ferraz; SOUZA, Fernanda Fernandes; CODES, Liana; IVANTES, Claudia Alexandra Pontes; GOMIDE, Geisa Perez Medina; PEREIRA, Gustavo Henrique Santos; PESSOA, Mario Guimaraes; FRANCA, Alex Vianey Callado; PINTO, Arlene dos Santos; TEIXEIRA, Rosangela; BITTENCOURT, Paulo Lisboa
    Background and aims: Treatment of hepatitis C with direct antiviral agents (DAA) is associ-ated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, fre-quently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. Patients and methods: Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. Results: As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. Conclusion: The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country. (c) 2022 Sociedade Brasileira de Infectologia.
  • article 43 Citação(ões) na Scopus
    Accuracy of transient elastography-FibroScan (R), acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C
    (2017) RAGAZZO, Taisa Grotta; PARANAGUA-VEZOZZO, Denise; LIMA, Fabiana Roberto; MAZO, Daniel Ferraz de Campos; PESSOA, Mario Guimaraes; OLIVEIRA, Claudia Pinto; ALVES, Venancio Avancini Ferreira; CARRILHO, Flair Jose
    OBJECTIVES: Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan (R), acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C. METHODS: We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, Department of Gastroenterology of University of Sao Paulo School of Medicine, Sao Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (>= F2), advanced fibrosis (>= F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan (R), 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed. RESULTS: A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (>= F2): FibroScan (R) : 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (>= F3): FibroScan (R) : 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan (R) : 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively. CONCLUSION: Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.
  • conferenceObject
    The Impact of HEV Infection on the Disease Severity of Patients with Chronic Hepatitis C
    (2018) ZITELLI, Patricia; GOMES-GOUVEA, Michele; MAZO, Daniel; PINHO, Joo Renato R.; ALVES, Venancio A. F.; TANIGAWA, Ryan Yukimatsu; OLIVEIRA, Claudia S.; CARRILHO, Flair Jose; PESSOA, Mario Guimaraes
  • article 6 Citação(ões) na Scopus
    Fibrates for the Treatment of Primary Biliary Cholangitis Unresponsive to Ursodeoxycholic Acid: An Exploratory Study
    (2022) CANCADO, Guilherme Grossi Lopes; COUTO, Claudia Alves; GUEDES, Laura Vilar; BRAGA, Michelle Harriz; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; FERRAZ, Maria Lucia Gomes; VILLELA-NOGUEIRA, Cristiane Alves; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; OLIVEIRA, Elze Maria Gomes de; ROTMAN, Vivian; MAZO, Daniel Ferraz de Campos; BORGES, Valeria Ferreira de Almeida e; MENDES, Liliana Sampaio Costa; CODES, Liana; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; LEVY, Cynthia; BITTENCOURT, Paulo Lisboa
    Aim: Up to 40% of patients with primary biliary cholangitis (PBC) will have a suboptimal biochemical response to ursodeoxycholic acid (UDCA), which can be improved by the addition of fibrates. This exploratory study aims to evaluate the long-term real-life biochemical response of different fibrates, including ciprofibrate, in subjects with UDCA-unresponsive PBC.Methods: The Brazilian Cholestasis Study Group multicenter database was reviewed to assess the response rates to UDCA plus fibrates in patients with UDCA-unresponsive PBC 1 and 2 years after treatment initiation by different validated criteria.Results: In total, 27 patients (100% women, mean age 48.9 +/- 9.2 years) with PBC were included. Overall response rates to fibrates by each validated criterion varied from 39 to 60% and 39-76% at 12 and 24 months after treatment combination, respectively. Combination therapy resulted in a significant decrease in ALT and ALP only after 2 years, while GGT significantly improved in the first year of treatment. Treatment response rates at 1 and 2 years appear to be comparable between ciprofibrate and bezafibrate using all available criteria.Conclusion: Our findings endorse the efficacy of fibrate add-on treatment in PBC patients with suboptimal response to UDCA. Ciprofibrate appears to be at least as effective as bezafibrate and should be assessed in large clinical trials as a possibly new, cheaper, and promising option for treatment of UDCA-unresponsive PBC patients.