Browsing by Author "Hernandez, Nelia"

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    Drug-induced liver injury: A management position paper from the Latin American Association for Study of the liver
    (2021) Bessone, Fernando; Hernandez, Nelia; Tagle, Martin; Arrese, Marco; Parana, Raymundo; Mendez-Sanchez, Nahum; Ridruejo, Ezequiel; Mendizabal, Manuel; Dagher, Lucy; Contreras, Fernando; Fassio, Eduardo; Pessoa, Mario; Brahm, Javier; Silva, Marcelo
    Idiosyncratic drug-induced liver injury (DILI) caused by xenobiotics (drugs, herbals and dietary supplements) is an uncommon cause of liver disease presenting with a wide range of phenotypes and disease severity, acute hepatitis mimicking viral hepatitis to autoimmune hepatitis, steatosis, fibrosis or rare chronic vascular syndromes. Disease severity ranges from asymptomatic liver test abnormalities to acute liver failure. DILI has been traditionally classified in predictable or intrinsic (dose-related) or unpredictable (not dose-related) mechanisms. Few prospective studies are assessing the real prevalence and incidence of hepatotoxicity in the general population. DILI registries represent useful networks used for the study of liver toxicity, aimed at improving the understanding of causes, phenotypes, natural history, and standardized definitions of hepatotoxicity. Although most of the registries do not carry out population-based studies, they may provide important data related to the prevalence of DILI, and also may be useful to compare features from different countries. With the support of the Spanish Registry of Hepatotoxicity, our Latin American Registry (LATINDILI) was created in 2011, and more than 350 DILI patients have been recruited to date. This position paper describes the more frequent drugs and herbsinduced DILI in Latin America, mainly focusing on several features of responsible medicaments. Also, we highlighted the most critical points on the management of hepatotoxicity in general and those based on findings from our Latin American experience in particular. (C) 2021 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U.
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    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; Gonzalez Ballerga, Esteban; Ruiz Velasco, Jose Antonio Velarde; Palazzo, Ana; Mezzano, Gabriel; Muñoz Espinosa, Linda Elsa; Pessoa, Mario; Cerda Reyes, Eira; Soza, Alejandro; Ruiz, Sandro; Gomez-Aldana, Andres Jose; Gerona, Solange; Fuster, Francisco; Anders, Margarita; Beltran Valdivia, Flor De Maria; 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; Castro Narro, Graciela; Vera Pozo, Emilia; Perazzo, Rosalia; Guillermo Toro, Luis; Varon, Adriana; Ferreiro, Melina; Lazcano, Monserrat; Dolores Murga, Maria; Gomez, Fernando; Hernandez, Larissa; Damasio Moutinho, Bruna; Gandara-Calderon, Julian; Vargas Domínguez, José Ignacio; Simian, Daniela; Silva, Marcelo
    Background: In order to achieve the World Health Organization’s ambitious goal of eliminating hepatitis C (HCV), we must implement innovative strategies to diagnose and treat more patients. Therefore, our study aimed to identify patients with chronic HCV infection who lost follow-up and offer them re-linkage to care and treatment with direct-acting antivirals (DAAs). Methods: We conducted an implementation study of a strategy to contact patients with chronic HCV who were not under regular follow-up in 10 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or similar. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined as anti-HCV + and detectable HCVRNA. Identified patients who were not under follow-up by a liver specialist were contacted to offer them a medical reevaluation and, eventually, treatment with DAA. Results: A total of 3,709 patients were classified as HCV, of which 367 (9.9%) presented undetectable HCVRNA, and 148 (4.0%) were wrongly coded. Overall, 3,194 (86.1%) individuals were identified with chronic HCV infection, 49,9% were male, median age was 61 years (IQR 51-69); 166 (5.2%) developed hepatocellular carcinoma, and 117 (3.7%) underwent liver transplantation. Advanced liver fibrosis (F3-F4) was present in 1,361 (42.6%) patients. A total of 1,764 (55.2%) patients were under close care. Of these, 1,371 (74.7%) received antiviral treatment, 70 (5.3%) did not achieve sustained virologic response, 314 (17.8%) were not treated for different reasons and 133 (7.5%) died. We identified 1,430 (44.8%) patients who were lost of follow-up, 564 (39.4%) of whom were finally located. Of those contacted, 402 (71.3%) were candidates to receive DAAs, 108 (19.2%) were treated in other institutions, 12 (2.1%) did not wish to be treated, and 42 (7.4%) died (Figure). Globally, in our study 786/3,194 (24.6%) patients were candidates to receive antiviral therapies. Conclusion: In our cohort, 1 out of 4 patients with chronic HCV could be re-linked to care and treated. This strategy impresses to be effective, accessible and, significantly impact on the HCV cascade to cure.
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    Herbal and Dietary Supplements-Induced Liver Injury in Latin America: Experience From the LATINDILI Network
    (2022) Bessone, Fernando; Garcia-Cortes, Miren; Medina-Caliz, Inmaculada; Hernandez, Nelia; Parana, Raymundo; Mendizabal, Manuel; Schinoni, Maria, I; Ridruejo, Ezequiel; Nunes, Vinicius; Peralta, Mirta; Santos, Genario; Anders, Margarita; Chiodi, Daniela; Tagle, Martin; Montes, Pedro; Carrera, Enrique; Arrese, Marco; Isabel Lizarzabal, M.; Alvarez-Alvarez, Ismael; Caballano-Infantes, Estefania; Niu, Hao; Pinazo, Jose; Cabello, Maria R.; Isabel Lucena, M.; Andrade, Raul J.
    BACKGROUND: Herbal and dietary supplements (HDS) consumption, a growing cause of hepatotoxicity, is a common practice among Latin-American populations. Objectives: To evaluate clinical, laboratory features and outcome in HDS-hepatotoxicity included in the Latin America-Drug Induced Liver Injury (LATINDILI) Network.
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    Impact of Public Health Policies on Alcohol-Associated Liver Disease in Latin America: An Ecological Multinational Study
    (WILEY, 2021) Diaz Piga, Luis Antonio; Idalsoaga Ferrer, Francisco Javier; Fuentes López, Eduardo; Marquez Lomas, Andrea; Ramirez, Carolina A.; Pablo Roblero, Juan; Araujo, Roberta C.; Higuera de la Tijera, Fatima; Guillermo Toro, Luis; Pazmino, Galo; Montes, Pedro; Hernandez, Nelia; Mendizabal, Manuel; Corsi, Oscar; Ferreccio, Catterina; Lazo, Mariana; Brahmania, Mayur; Singal, Ashwani K.; Bataller, Ramon; Arrese Jimenez, Marco Antonio; Arab Verdugo, Juan Pablo
    Background and Aims Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Latin America, yet the impact of public health policies (PHP) on liver disease is unknown. We aimed to assess the association between alcohol PHP and deaths due to ALD in Latin American countries. Approach and Results We performed an ecological multinational study including 20 countries in Latin America (628,466,088 inhabitants). We obtained country-level sociodemographic information from the World Bank Open Data source. Alcohol-related PHP data for countries were obtained from the World Health Organization Global Information System of Alcohol and Health. We constructed generalized linear models to assess the association between the number of PHP (in 2010) and health outcomes (in 2016). In Latin America, the prevalence of obesity was 27% and 26.1% among male and female populations, respectively. The estimated alcohol per capita consumption among the population at 15 years old or older was 6.8 L of pure alcohol (5.6 recorded and 1.2 unrecorded). The overall prevalence of alcohol use disorders (AUD) was 4.9%. ALD was the main cause of cirrhosis in 64.7% of male and 40.0% of female populations. A total of 19 (95%) countries have at least one alcohol-related PHP on alcohol. The most frequent PHP were limiting drinking age (95%), tax regulations (90%), drunk-driving policies and countermeasures (90%), and government monitoring systems and community support (90%). A higher number of PHP was associated with a lower ALD mortality (PR, 0.76; 95% CI, 0.61-0.93; P = 0.009), lower AUD prevalence (PR, 0.80; 95% CI, 0.65-0.99; P = 0.045), and lower alcohol-attributable road traffic deaths (PR, 0.81; 95% CI, 0.65-1.00; P = 0.051). Conclusions Our study indicates that in Latin America, countries with higher number of PHP have lower mortality due to ALD, lower prevalence of AUD, and lower alcohol-attributable road traffic mortality.
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    Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America
    (2023) Mendizabal, Manuel; Thompson, Marcos; Gonzalez-Ballerga, Esteban; Anders, Margarita; Castro-Narro, Graciela E.; Pessoa, Mario G.; Cheinquer, Hugo; Mezzano, Gabriel; Palazzo, Ana; Ridruejo, Ezequiel; Descalzi, Valeria; Velarde-Ruiz Velasco, Jose A.; Marciano, Sebastian; Munoz, Linda; Schinoni, Maria, I; Poniachik, Jaime; Perazzo, Rosalia; Cerda, Eira; Fuster, Francisco; Varon, Adriana; Ruiz Garcia, Sandro; Soza, Alejandro; Cabrera, Cecilia; Gomez-Aldana, Andres J.; de Maria Beltran, Flor; Gerona, Solange; Cocozzella, Daniel; Bessone, Fernando; Hernandez, Nelia; Alonso, Cristina; Ferreiro, Melina; Antinucci, Florencia; Torre, Aldo; Moutinho, Bruna D.; Coelho Borges, Silvia; Gomez, Fernando; Dolores Murga, Maria; Pinero, Federico; Sotera, Gisela F.; Ocampo, Jhonier A.; Cortes Mollinedo, Valeria A.; Simian, Daniela; Silva, Marcelo O.
    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. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.
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    Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease
    (2020) Pablo Arab, Juan; Dirchwolf, Melisa; Alvares-da-Silva, Mario Reis; Barrera, Francisco; Benitez, Carlos; Castellanos-Fernandez, Marlene; Castro-Narro, Graciela; Chavez-Tapia, Norberto; Chiodi, Daniela; Cotrim, Helma; Cusi, Kenneth; Marques Souza de Oliveira, Claudia Pinto; Diaz, Javier; Fassio, Eduardo; Gerona, Solange; Girala, Marcos; Hernandez, Nelia; Marciano, Sebastian; Masson, Walter; Mendez-Sanchez, Nahum; Leite, Nathalie; Lozano, Adelina; Padilla, Martin; Panduro, Arturo; Parana, Raymundo; Parise, Edison; Perez, Marlene; Poniachik, Jaime; Carlos Restrepo, Juan; Ruf, Andres; Silva, Marcelo; Tagle, Martin; Tapias, Monica; Torres, Kenia; Vilar-Gomez, Eduardo; Costa Gil, Jose Eduardo; Gadano, Adrian; Arrese, Marco
    Non-alcoholic fatty liver disease (NAFLD) currently represents an epidemic worldwide. NAFLD is the most frequently diagnosed chronic liver disease, affecting 20-30% of the general population. Furthermore, its prevalence is predicted to increase exponentially in the next decades, concomitantly with the global epidemic of obesity, type 2 diabetes mellitus (T2DM), and sedentary lifestyle. NAFLD is a clinical syndrome that encompasses a wide spectrum of associated diseases and hepatic complications such as hepatocellular carcinoma (HCC). Moreover, this disease is believed to become the main indication for liver transplantation in the near future. Since NAFLD management represents a growing challenge for primary care physicians, the Asociacion Latinoamericana para el Estudio del Higado (ALEH) has decided to organize this Practice Guidance for the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease, written by Latin-American specialists in different clinical areas, and destined to general practitioners, internal medicine specialists, endocrinologists, diabetologists, gastroenterologists, and hepatologists. The main purpose of this document is to improve patient care and awareness of NAFLD. The information provided in this guidance may also be useful in assisting stakeholders in the decision-making process related to NAFLD. Since new evidence is constantly emerging on different aspects of the disease, updates to this guideline will be required in future. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Fundacion Cilnica Medica Sur, A.C.
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    Nitrofurantoin-induced liver injury: long-term follow-up in two prospective DILI registries
    (2023) Bessone, Fernando; Ferrari, Antonella; Hernandez, Nelia; Mendizabal, Manuel; Ridruejo, Ezequiel; Zerega, Alina; Tanno, Federico; Reggiardo, Maria Virginia; Vorobioff, Julio; Tanno, Hugo; Arrese, Marco; Nunes, Vinicius; Tagle, Martin; Medina-Caliz, Inmaculada; Robles-Diaz, Mercedes; Niu, Hao; Alvarez-Alvarez, Ismael; Stephens, Camilla; Lucena, M. Isabel; Andrade, Raul J.
    Nitrofurantoin is a synthetic antibiotic that is recommended as first-choice treatment for uncomplicated urinary tract infections. The prescription of this drug has increased dramatically, especially in Latin American countries. We described the demographics, clinical characteristics, biochemical features, and outcome of nitrofurantoin-induced liver injury. We analyzed 23 cases from the Latin American DILI Network (LATINDILI) and the Spanish DILI Registry. Causality was assessed with the RUCAM and RECAM scale. Of the 23 DILI cases included in our series, 96% patients were women, and the mean age of the whole cohort was 61 years. The median time of drug exposure was 175 days (interquartile range [IQR] 96-760), with 11 patients who were prescribed nitrofurantoin for more than six months. Hepatocellular damage was the most frequent pattern of liver injury (83%), and nearly half of the patients had an asymptomatic presentation (52%). Neither death nor liver transplantation was documented in this series. Overall, 65% of the patients (n = 15) presented with positive autoantibody titres. The median time to resolution was 81 days (IQR 57-141), and 15 patients (83%) recovered within six months. Five patients (22%) developed nitrofurantoin-induced autoimmune-like hepatitis (NI-AILH), of whom two were characterized by a persistent increase in transaminases that required immunosuppressive treatment to achieve normalization of liver enzymes. Clinicians who prescribe nitrofurantoin should be aware that patients who had taken nitrofurantoin for a long term may be at risk of developing nitrofurantoin-induced autoimmune-like hepatitis.
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    Serious liver injury induced by Nimesulide: an international collaborative study
    (2021) Bessone, Fernando; Hernandez, Nelia; Mendizabal, Manuel; Ridruejo, Ezequiel; Gualano, Gisela; Fassio, Eduardo; Peralta, Mirta; Fainboim, Hugo; Anders, Margarita; Tanno, Hugo; Tanno, Federico; Parana, Raymundo; Medina-Caliz, Inmaculada; Robles-Diaz, Mercedes; Alvarez-Alvarez, Ismael; Niu, Hao; Stephens, Camilla; Colombato, Luis; Arrese, Marco; Reggiardo, M. Virginia; Ono, Suzane Kioko; Carrilho, Flair; Lucena, M. Isabel; Andrade, Raul J.
    Nimesulide is a non-steroidal anti-inflammatory drug still marketed in many countries. We aim to analyze the clinical phenotype, outcome, and histological features of nimesulide-induced liver injury (nimesulide-DILI). We analyzed 57 cases recruited from the Spanish and Latin American DILI registries. Causality was assessed by the RUCAM scale. Mean age of the whole case series was 59 years (86% women) with a median time to onset of 40 days. A total of 46 patients (81%) were jaundiced. Nimesulide-DILI pattern was hepatocellular in 38 (67%), mixed in 12 (21%), and cholestatic in 7 (12%) cases. Transaminases were elevated with a mean of nearly 20-fold the upper limit of normality (ULN), while alkaline phosphatase showed a twofold mean elevation above ULN. Total bilirubin showed a mean elevation of 13-fold the ULN. Liver histology was obtained in 14 cases (25%), most of them with a hepatocellular pattern. Median time to recovery was 60 days. Overall, 12 patients (21%) developed acute liver failure (ALF), five (8.8%) died, three underwent liver transplantation (5.3%), and the remaining four resolved. Latency was <= 15 days in 12 patients (21%) and one patient developed ALF within 7 days from treatment initiation. Increased total bilirubin and aspartate transaminase levels were independently associated with the development of ALF. In summary, nimesulide-DILI affects mainly women and presents typically with a hepatocellular pattern. It is associated with ALF and death in a high proportion of patients. Shorter (<= 15 days) duration of therapy does not prevent serious nimesulide hepatotoxicity, making its risk/benefit ratio clearly unfavorable.