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Six-minute walking test performance is associated with survival in cirrhotic patients

World Journal of Hepatology 2021年第11期13卷 1791-1801页

作者： Carolina Frade M G Pimentel Ana Cristina de Castro Amaral Adriano Miziara Gonzalez Michelle Lai Danielde Oliveira Mota maria lucia gomes ferraz Wilson Mathias Junior Mario Kondo Department of Medicine Federal University of Sao PauloSao Paulo 04026090Brazil Department of Gastroenterology Federal University of Sao PauloSao Paulo 04023062Brazil Department of Surgery Liver Transplantation ServiceFederal University of Sao PauloSao Paulo 04026090Brazil Department of Medicine Division of Gastroenterology and HepatologyBeth Israel Deaconess Medical CenterBostonMA 02215United States Department of Industrial Engineering University of Sao PauloSao Paulo 05508010Brazil Department of Cardiology Heart InstituteUniversity of Sao PauloSao Paulo 05403900Brazil

BACKGROUND Patients with cirrhosis are at risk of cirrhotic cardiomyopathy,with resulting cardiac dysfunction and exercise *** minute walking test(6MWT)assesses functional status and predicts morbidity and mortality in cardiopulmonary *** To determine if it associates with mortality by analyzing 6MWT performance in patients with liver *** A cohort of 106 cirrhotic patients was evaluated in the outpatient setting with echocardiogram and 6MWT and follow up for one year to document hepatic decompensation and *** distance in meters was recorded at the end of 6 min(6MWD).RESULTS This cohort had a mean age of 51 years and 56%male;patients were staged as Child A in 21.7%,B 66%and C 12.3%.Walk distance inversely correlated with Child scores,and was significantly reduced as Child stages *** who died(10.4%)showed shorter mean 6MWD(P=0.006).Low 6MWD was an independent predictor of mortality(P=0.01).CONCLUSION 6MWT is a noninvasive inexpensive test whose result is related to Child scores and *** is useful to identify patients with liver cirrhosis at high risk of mortality for closer monitoring and potential early intervention.

关键词： Six-minute walking test Liver cirrhosis Hospital admission and mortality Child score

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Central nervous system vasculitis and polyneuropathy as first manifestations of hepatitis C

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World Journal of Gastroenterology 2012年第2期18卷 188-191页

作者： Roberto J Carvalho-Filho Janaína Luz Narciso-Schiavon luciano HL Tolentino Leonardo L Schiavon maria lucia G ferraz Antonio Eduardo B Silva Division of Gastroenterology Hepatitis SectionFederal University of Sao Paulo04037-003 Sao PauloBrazil

Sensory or motor peripheral neuropathy may be observed in a significant proportion of hepatitis C virus (HCV)-infected ***,central nervous system (CNS) involvement is uncommon,especially in cryoglobulin-negative *** describe a case of peripheral neuropathy combined with an ischemic CNS event as primary manifestations of chronic HCV infection without *** improvement was observed after antiviral *** discuss the spectrum of neurological manifestations of HCV infection and review the literature.

关键词： Hepatitis C Central nervous system Poly-neuropathy Interferon-α

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Is autoimmune hepatitis a frequent finding among HCV patients with intense interface hepatitis?

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World Journal of Gastroenterology 2010年第29期16卷 3704-3708页

作者： Rosilene G Badiani Vitória Becker Renata M Perez Carla AL Matos Lara B Lemos Valéria P Lanzoni Luis Eduardo C Andrade Alessandra Dellavance Antonio Eduardo B Silva maria lucia G ferraz Division of Gastroenterology Federal University of Sao Paulo04023-900Sao PauloBrazil Department of Internal Medicine Federal University of Rio de Janeiro21941-913Rio de JaneiroBrazil Department of Pathology Immunology Group Fleury Medicine and Health 不详

AIM:To evaluate the overlap of autoimmune hepatitis in hepatitis C virus(HCV)-infected patients with intense interface ***:Among 1759 patients with hepatitis C submitted to liver biopsy,92(5.2%) presented intense interface *** patients were evaluated regarding the presence of antinuclear antibody(ANA),anti-smooth muscle antibody(SMA) and anti-liver/kidney microsomal antibody(LKM-1),levels of γ-globulin and histological findings related to autoimmune hepatitis(plasma cell infiltrate and presence of rosettes).RESULTS:Among patients with hepatitis C and intense interface hepatitis there was a low prevalence of autoantibodies(ANA=12%,SMA=5%,LKM-1=0%) and the median γ-globulin level was within the normal *** histological findings of autoimmune disease were observed in only two cases(2%).After applying the score for diagnosis of autoimmune hepatitis,only one patient was classified with a definitive diagnosis of autoimmune *** overlap with autoimmune hepatitis was not the explanation for the intense necroinflammatory activity in patients with chronic hepatitis C we sought to identify the variables associated with this *** presence of intense interface hepatitis was associated with more advanced age,both at the time of infection and at the time of the biopsy,and higher prevalence of blood transfusion and alcohol ***:Although possible,overlap with autoimmune hepatitis is a very rare association in HCV-infected patients with intense interface hepatitis,an unusual presentation which seems to be related to other host variables.

关键词： Hepatitis C Liver biopsy Antinuclear antibody Autoimmune hepatitis Interface hepatitis

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Management of hepatitis C in patients with chronic kidney disease

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World Journal of Gastroenterology 2015年第2期21卷 408-422页

作者： Roberto J Carvalho-Filho Ana Cristina CA Feldner Antonio Eduardo B Silva maria lucia G ferraz Division of Gastroenterology Hepatology SectionFederal University of Sao PauloSao PauloSP 04023-900Brazil

Hepatitis C virus(HCV) infection is highly prevalent among chronic kidney disease(CKD) subjects under hemodialysis and in kidney transplantation(KT) recipients, being an important cause of morbidity and mortality in these patients. The vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on managementand treatment decisions. In hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. In KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. In these patients, it is recommended to use pegylated interferon(PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. In these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus.

关键词： Hepatitis C virus Chronic kidney disease End-stage

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