Publications by authors named "Mario Pessoa"

Background Aims: Cut-points for non-invasive tests (NITs) for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD) were derived from predominantly non-Hispanic populations. It is unknown if these cut-points perform adequately in Hispanic individuals. We assessed the performance characteristics of current NIT cut-points among Hispanic patients and determined whether they could be further optimized.

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Objective: Primary biliary cholangitis is a chronic and progressive autoimmune liver disease, whose prognosis can be improved by normalizing alkaline phosphatase and bilirubin. While ursodeoxycholic acid (UDCA) is first line standard of care, approximately 40 % of patients exhibit incomplete response. We aimed to identify prognostic markers for deep response to UDCA therapy at presentation.

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Background: This study aimed to assess the frequency and intensity of anxious and depressive symptoms in patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: This is a descriptive and cross-sectional study, resulting from 106 patients from the Hepatology outpatient clinic at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil without a history of alcohol abuse, verified by the alcohol use disorders identification test (AUDIT). These were assessed using the sociodemographic data sheet, Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Scale (HAM-D).

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Article Synopsis
  • Immunosuppressed patients, especially those who have undergone organ transplants, are at risk for severe infections from the parasite Strongyloides stercoralis.
  • This study focused on detecting anti-Strongyloides IgG antibodies in liver transplant patients using two methods: an initial screening with ELISA and confirmation with Western blotting.
  • The results showed a 10.9% reactivity rate in the ELISA test, with a significant portion of positive cases identifying a specific protein fraction, emphasizing the need for routine screening for this infection in liver transplant recipients.
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This review aims to gather and disseminate updated information regarding hepatitis A virus (HAV) in Latin America (LA) in the last 11 years, including seroprevalence, post-vaccination studies, virus detection in aqueous matrices and food samples, and outbreak reports. Only 24 seroprevalence studies were published between 2012 and 2023 with 55%-100% reported prevalences of anti-HAV IgG. Among the 25 LA countries, only eight of them have introduced HAV vaccines into their immunisation programs.

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Objectives: The primary objective was to evaluate Liver-Related Events (LREs), including hepatic decompensation (ascites, hemorrhagic varices and encephalopathy) and Hepatocellular Carcinoma (HCC), as well as changes in liver stiffness during the follow-up period among patients who achieved a Sustained Virological Response (SVR) after treatment for chronic Hepatitis C Virus (HCV) infection.

Methods: A total of 218 patients with HCV were treated, and those who achieved an SVR were followed up for 3-years. Transient Elastography (TE) using FibroScan® was performed at various time points: before treatment, at the end of treatment, at 6-months post-treatment, at 1-year post-treatment, at 2-years post-treatment, and at 3-years post-treatment.

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Background: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), but a significant proportion of patients do not respond adequately, leading to increased risk of adverse outcomes. This study aims to develop a new and straightforward predictive score to identify PBC patients likely to achieve a complete response to UDCA.

Methods: A logistic regression analysis was conducted using a derivation cohort of PBC patients to identify pre-treatment variables associated with response to UDCA.

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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.

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Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time.

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Article Synopsis
  • PBC and AIH/PBC are linked to an increased risk of hepatocellular carcinoma (HCC) and extra-hepatic malignancy (EHM), prompting a study to identify cancer risk factors in these patients.
  • The study analyzed data from 752 PBC patients, finding 87 cancer cases, including 20 HCC and 67 EHM, with notable associations between HCC and factors like cirrhosis, smoking, and certain medications.
  • Cirrhosis, obesity, and past azathioprine therapy were identified as independent risk factors for HCC, while Sjogren syndrome and psoriasis correlated with EHM; overall, EHM prevalence was higher in PBC patients compared to HCC.
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Hepatitis 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.

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Introduction And Objectives: Some studies suggest chronic HCV infection diminishes responses to the anti-HBV vaccine. We evaluated the efficacy of double versus standard dose HBV vaccination among HCV patients without cirrhosis.

Patients And Methods: 141 adults with untreated chronic HCV were randomized to HBV vaccination with double dose (40μg) or standard dose (20μg) at 0, 1 and 6 months; 70 healthy HCV-negative patients given standard dose served as controls.

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Article Synopsis
  • * Since the 2018 KDIGO HCV Guideline, advancements in antiviral therapy and HCV management have prompted a comprehensive review and updates to the guidelines.
  • * The Executive Summary presents revised recommendations focusing on HCV treatment for CKD patients, management strategies pre- and post-kidney transplantation, and addressing kidney diseases linked to HCV infection.
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To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America.

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Introduction And Objectives: The Choosing Wisely (CW) initiative aims to improve daily practice supported by evidence concerning unnecessary medical tests, procedures, and treatments. This philosophy is essential in managing viral hepatitis (VH), which primary care physicians increasingly carry out. It is also essential to achieving disease elimination.

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Background: Response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has been traditionally assessed 1 to 2 years after treatment initiation. With the development of new drugs, some patients may benefit from an earlier introduction of second-line therapies.

Aims: This study aims to identify whether well-validated response criteria could correctly identify individuals likely to benefit from add-on second-line therapy at 6 months.

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Article Synopsis
  • The study assessed the effectiveness of retreatment for hepatitis C in patients who did not respond to previous direct antiviral agents (DAA), highlighting Brazil's adherence to updated health guidelines.
  • The survey gathered clinical and epidemiological data from institutions nationwide, focusing on those previously treated with interferon-free regimens.
  • Results showed a 94.6% sustained virological response rate in patients retreated, indicating that the available retreatment options in Brazil are both effective and safe, supporting efforts to eliminate hepatitis C.
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  • Hepatitis C treatment has evolved from older interferon therapies to newer oral direct-acting antivirals (DAAs), resulting in higher success rates and fewer side effects.
  • This study assessed the effectiveness and safety of DAAs in 532 patients with chronic hepatitis C treated at two university centers in Brazil, focusing on demographic and clinical data alongside treatment outcomes.
  • The results showed a significant overall sustained virologic response rate of 92.6%, with certain factors like hepatic encephalopathy and esophageal varices linked to treatment failure.
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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. 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.

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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.

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Objectives: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil.

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Article Synopsis
  • This study focuses on primary biliary cholangitis (PBC) in non-white populations, specifically analyzing Brazilian patients to assess their clinical features and treatment outcomes.
  • The research included 562 predominantly female patients, revealing that after an average follow-up of 6.2 years, a significant portion experienced advanced liver disease, and most were treated with ursodeoxycholic acid (UDCA), with some requiring additional treatments.
  • Findings indicate that while PBC features in Brazilian patients are similar to those in Caucasian and Asian populations, the response to UDCA therapy was lower than expected and varied widely, highlighting the need for standardization in treatment evaluation.
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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.

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Hepatitis E Virus (HEV) is an infection known worldwide for its asymptomatic and self-limited course in most cases. Some cases progressing to chronicity have been described in immunosuppressed patients, especially in recipients of solid organ transplants. We evaluated laboratory parameters of HEV infection (HEV RNA, anti-HEV IgM and anti-HEV IgG) through enzyme-linked immunosorbent assay (Elisa), confirmed by immunoblotting, in a cohort of 294 patients who received liver transplants at the HCFMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo).

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