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Iacob S, Gheorghe L, Onica M, Huiban L, Pop CS, Brisc C, Sirli R, Ester C, Brisc CM, Diaconu S, Rogoveanu I, Sandulescu L, Vuletici D, Trifan A. Prospective study of hepatitis B and D epidemiology and risk factors in Romania: A 10-year update. World J Hepatol 2024; 16:640-649. [DOI: 10.4254/wjh.v16.i4.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/24/2024] Open
Abstract
BACKGROUND The global burden of hepatitis D virus (HDV) infection represents a major medical challenge and a public health crisis worldwide. However, there is a lack of accurate data on the epidemiology and risk factors for HDV. Hepatitis B virus (HBV) and HDV coinfection causes the most severe form of viral hepatitis, leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection, including the need for liver transplantation and death.
AIM To investigate the epidemiology, natural history, risk factors and clinical management of HBV and HDV coinfection in Romanian patients.
METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania. All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled. Patients with acute hepatitis or incomplete data were excluded. Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period, 963 met the inclusion criteria. Testing for anti-HDV antibodies and HDV RNA was performed for all participants. Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires. All data were stored in an anonymized online database during the study.
RESULTS The prevalence of HBV was 3.8%; among these patients, the prevalence of HBV/HDV coinfection was 33.1%. The median age of the study population was 54.0 years, and it consisted of 55.1% men. A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years old. Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection (P = 0.03). Multivariate multiple regression analysis identified female gender (P = 0.0006), imprisonment (P < 0.0001), older age at diagnosis (P = 0.01) and sexual contact with persons with known viral hepatitis (P = 0.0003) as significant risk factors for HDV.
CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors. It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.
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Affiliation(s)
- Speranta Iacob
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Liana Gheorghe
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Mirela Onica
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Laura Huiban
- Department of Gastroenterology, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
| | - Corina Silvia Pop
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Medical Oncology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ciprian Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Roxana Sirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Carmen Ester
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Cristina Mihaela Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Sorina Diaconu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Internal Medicine II and Gastroenterology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ion Rogoveanu
- Department of Gastroenterology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Cardiology, Emergency County Hospital, Craiova 200642, Romania
| | - Larisa Sandulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Gastroenterology, Emergency County Hospital, Craiova 200642, Romania
| | - Deiana Vuletici
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
- Department of Gastroenterology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
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Razavi-Shearer D, Child H, Razavi-Shearer K, Voeller A, Razavi H, Buti M, Tacke F, Terrault N, Zeuzem S, Abbas Z, Aghemo A, Akarca U, Al Masri N, Alalwan A, Blomé MA, Jerkeman A, Aleman S, Kamal H, Alghamdi A, Alghamdi M, Alghamdi S, Al-Hamoudi W, Ali E, Aljumah A, Altraif I, Amarsanaa J, Asselah T, Baatarkhuu O, Babameto A, Ben-Ari Z, Berg T, Biondi M, Braga W, Brandão-Mello C, Brown R, Brunetto M, Cabezas J, Cardoso M, Martins A, Chan H, Cheinquer H, Chen CJ, Yang HI, Chen PJ, Chien CH, Chuang WL, Garza LC, Coco B, Coffin C, Coppola N, Cornberg M, Craxi A, Crespo J, Cuko L, De Ledinghen V, Duberg AS, Etzion O, Ferraz M, Ferreira P, Forns X, Foster G, Fung J, Gaeta G, García-Samaniego J, Genov J, Gheorghe L, Gholam P, Gish R, Glenn J, Hamid S, Hercun J, Hsu YC, Hu CC, Huang JF, Idilman R, Jafri W, Janjua N, Jelev D, Jia J, Kåberg M, Kaita K, Kao JH, Khan A, Kim D, Kondili L, Lagging M, Lampertico P, Lázaro P, Lazarus J, Lee MH, Yang HI, Lim YS, Lobato C, Macedo G, Marinho R, Marotta P, Mendes-Correa M, Méndez-Sánchez N, Navas MC, Ning Q, Örmeci N, Orrego M, Osiowy C, Pan C, Pessoa M, Piracha Z, Pop C, Qureshi H, Raimondo G, Ramji A, Ribeiro S, Ríos-Hincapié C, Rodríguez M, Rosenberg W, Roulot D, Ryder S, Saeed U, Safadi R, Shouval D, Sanai F, Sanchez-Avila J, Santantonio T, Sarrazin C, Seto WK, Seto WK, Simonova M, Tanaka J, Tergast T, Tsendsuren O, Valente C, Villalobos-Salcedo J, Waheed Y, Wong G, Wong V, Yip T, Wong V, Wu JC, Yang HI, Yu ML, Yuen MF, Yurdaydin C, Zuckerman E. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories. J Hepatol 2024; 80:232-242. [PMID: 38030035 DOI: 10.1016/j.jhep.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND & AIMS Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.
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Gheorghe L, Trifan A, Pop C, Csiki IE, Iacob S. A portrait of viral hepatitis in the Roma population highlighting potential disparities. J Gastrointestin Liver Dis 2023; 32:416-417. [PMID: 37774226 DOI: 10.15403/jgld-5168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania
| | - Anca Trifan
- Carol Davila University of Medicine and Pharmacy, University Emergency Hospital, Bucharest, Romania
| | - Corina Pop
- Carol Davila University of Medicine and Pharmacy, University Emergency Hospital, Bucharest, Romania
| | | | - Speranta Iacob
- Carol Davila University of Medicine and Pharmacy, Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
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Brunetto MR, Ricco G, Negro F, Wedemeyer H, Yurdaydin C, Asselah T, Papatheodoridis G, Gheorghe L, Agarwal K, Farci P, Buti M. EASL Clinical Practice Guidelines on hepatitis delta virus. J Hepatol 2023; 79:433-460. [PMID: 37364791 DOI: 10.1016/j.jhep.2023.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023]
Abstract
Hepatitis D virus (HDV) is a defective virus that requires the hepatitis B virus to complete its life cycle and cause liver damage in humans. HDV is responsible for rare acute and chronic liver diseases and is considered the most aggressive hepatitis virus. Acute infection can cause acute liver failure, while persistent infection typically causes a severe form of chronic hepatitis which is associated with rapid and frequent progression to cirrhosis and its end-stage complications, hepatic decompensation and hepatocellular carcinoma. Major diagnostic and therapeutic innovations prompted the EASL Governing Board to commission specific Clinical Practice Guidelines on the identification, virologic and clinical characterisation, prognostic assessment, and appropriate clinical and therapeutic management of HDV-infected individuals.
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Stroie T, Preda C, Meianu C, Istrătescu D, Manuc M, Croitoru A, Gheorghe L, Gheorghe C, Diculescu M. Fatigue Is Associated with Anxiety and Lower Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Remission. Medicina (B Aires) 2023; 59:medicina59030532. [PMID: 36984533 PMCID: PMC10058711 DOI: 10.3390/medicina59030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable course and a remitting–relapsing evolution. Fatigue is a frequent complaint in patients with IBD, affecting approximately half of the newly diagnosed patients with IBD. The aim of this study was to analyze fatigue in patients with IBD in remission. Materials and Methods: One hundred nineteen consecutive outpatients diagnosed with IBD for over 3 months that were in corticosteroid-free clinical and biochemical remission at the time of assessment were included in this cross-sectional study. Out of them, 72 (60.5%) were male; the median age was 39 years (IQR 30–47). Seventy-seven patients (64.7%) were diagnosed with Crohn’s disease and forty-two (35.3%) with ulcerative colitis, with a median disease duration of 6 years (IQR 2–10). Fatigue, health-related quality of life (HR-QoL), anxiety and depression were evaluated using the following self-administered questionnaires: FACIT Fatigue, IBDQ 32 and HADS. Results: The mean FACIT-Fatigue score was 41.6 (SD ± 8.62), and 38.7% of patients were revealed as experiencing fatigue when a cut-off value of 40 points was used. The mean IBDQ 32 score was 189.4 (SD ± 24.1). Symptoms of anxiety and depression were detected in 37% and 21% of the patients, respectively. In the multivariate analysis, fatigue was significantly associated with lower HR-QoL (OR 2.21, 95% CI: 1.42–3.44, p < 0.001), symptoms of anxiety (OR 5.04, 95% CI: 1.20–21.22, p = 0.008), female sex (OR 3.32, 95% CI: 1.02–10.76, p = 0.04) and longer disease duration (OR 1.13, 95% CI: 1.01–1.27, p = 0.04). Conclusions: Fatigue is highly prevalent even in patients with inactive IBD and is correlated with lower HR-QoL and anxiety, as well as with clinical factors such as longer disease duration and female sex.
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Affiliation(s)
- Tudor Stroie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Carmen Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Corina Meianu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Doina Istrătescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Manuc
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Croitoru
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Liana Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Diculescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Lupescu IC, Iacob S, Lupescu IG, Pietrareanu C, Gheorghe L. Assessment of Minimal Hepatic Encephalopathy with Brain MRI and EncephalApp Stroop Test. Maedica (Bucur) 2023; 18:4-11. [PMID: 37266463 PMCID: PMC10231161 DOI: 10.26574/maedica.2023.18.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background: Minimal hepatic encephalopathy (MHE) consists of subtle cognitive deficits that are not apparent on a standard neurological examination. Minimal hepatic encephalopathy has been reported in up to 80% of cirrhotic patients and is associated with decreased job performance, poor driving performance, impaired quality of life, and poor survival. In parallel, brain magnetic resonance imaging (MRI) abnormalities are known to occur in liver cirrhotic patients in the form of T1 globus pallidus hyperintensities. In recent years, a new psychometric test for diagnosing MHE has been developed as an app for smartphones and tablets (EncephalApp Stroop test). A translated version of the app is available in Romanian language. Aim:To use EncephalApp Stroop test for MHE diagnosis in our cirrhotic patients; to describe the main brain MRI abnormalities encountered in these patients; and to establish if Stroop test results correlate with imaging findings, clinical neurologic findings, and liver function parameters or prognosis. Material and methods:Cross-sectional study over a one-year period, involving 30 adult patients with liver cirrhosis. Subjects were evaluated through a standard neurological examination, psychometric testing using EncephalApp Stroop test, electroencephalogram and brain MRI. In parallel, 40 adult healthy controls were also recruited and evaluated with the EncephalApp Stroop test using the same methodology. Results:Age distribution was similar between the two groups (p=0.6). The mean age of patients was 50±10 years and that of controls 51±12 years. Mean Stroop result was 171±26 seconds for the patient group and 143±20 seconds for the control group (p<0.0001). There was a direct correlation between Stroop test results and age in the control group (R=0.69, p<0.0001) but not also in the patient group (R=0.28, p=0.13). Statistically significant results were obtained by using the Fischer exact test for both cut-off values: 145 seconds in patients < 45-year-old (p<0.001) and 190 seconds in those ≥45 years-old (p=0.03). MRI T1-hyperintensities of the basal ganglia, blood ammonia levels and electroencephalographic changes were not associated with poorer results. Conclusion:Our pilot study, although small, confirmed that patients with liver cirrhosis may have subtle deficits in cognitive areas like attention, concentration or reaction time. This can be assessed easily with the EncephalApp Stroop test which is readily available for use on smartphones or tablets.
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Affiliation(s)
- I C Lupescu
- Neurology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - S Iacob
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - I G Lupescu
- Radiology and Medical Imaging Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - C Pietrareanu
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - L Gheorghe
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Gheorghe L, Preda C, Trifan A, Manuc M, Stanciu C, Istratescu D, Popescu CP, Diculescu MM, Tieranu CG, Manuc T, Stroie TG, Iacob SM, Iliescu L. Real World Efficacy and Safety of Sofosbuvir + Velpatasvir + Voxilaprevir in Romanian Patients with Genotype 1b HCV Infection Non-reponders to DAAs Therapy. J Gastrointestin Liver Dis 2022; 31:437-443. [PMID: 36535062 DOI: 10.15403/jgld-4472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS The sofosbuvir (SOF) / velpatasvir (VEL) / voxilaprevir (VOX) combination has been evaluated in more than 800 patients enrolled in phase II and phase III studies, where it demonstrated excellent safety and efficacy, achieving overall sustained viral response (SVR) rates of more than 95%. We aimed to assess the efficacy and safety of SOF/VEL/VOX in a real-world study, including patients previously treated for genotype 1b hepatitis C virus (HCV) infection that did not obtain a sustained viral response with previous direct-acting antivirals (DAAs) therapy. METHODS In Romania, through a nationwide government-funded program in 2019-2020, 213 patients with chronic hepatitis C non-responders to previous DAAs therapy, received treatment with SOF/VEL/ VOX 400/100/100 mg/day for 12 weeks. We performed a retrospective longitudinal study that included 143 individuals who were treated in Bucharest, Iași, Craiova and Constanța clinics, all with genotype 1b HCV infection. Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). Serious adverse events (SAE) were registered. RESULTS Our cohort comprised 53% males with a median age of 60 years (27÷77); 47% were pre-treated with ombitasvir/paritaprevir/ritonavir+dasabuvir ± ribavirin, 40% with ledipasvir/SOF, 13% with elbasvir/ grazoprevir. 42% of patients associated co-morbidities, 45% had compensated liver cirrhosis, 2% had treated hepatocellular carcinoma (HCC) and 1% had hepatitis B virus co-infection. SVR by intention to treat was reported in 139/143 (97.2%) and per protocol in 141/143 (98.6%). No predictive factors for SVR were identified. Rate of liver decompensation in patients with cirrhosis was 6% and was statistically associated in multivariate analysis with Child-Pugh score (p<0.01) and with severe steatosis (p=0.004). Occurrence of new HCC was reported in 3.6% of all patients with cirrhosis and was associated with poor liver function [higher Child-Pugh score (p=0.001) and low albumin levels (p=0.02)]. Serious adverse events related to therapy were reported in 1/143(0.7%). CONCLUSIONS SOF/VEL/VOX was highly efficient in our population of patients with a 97.2% SVR. Liver decompensation occurred in 6% of cirrhotic patients at SVR, related to hepatic dysfunction.
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Affiliation(s)
- Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Carmen Preda
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Anca Trifan
- Gr. T Popa University of Medicine and Pharmacy Iasi, Gastroenterology and Hepatology Department, Gastroenterology and Hepatology Institute, Iași, Romania.
| | - Mircea Manuc
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Carol Stanciu
- Gr. T Popa University of Medicine and Pharmacy Iasi, Gastroenterology and Hepatology Department, Gastroenterology and Hepatology Institute, Iași, Romania.
| | - Doina Istratescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Corneliu Petru Popescu
- Carol Davila University of Medicine and Pharmacy, Virology Department, Victor Babes Hospital, Bucharest, Romania.
| | - Mircea Mihai Diculescu
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Cristian George Tieranu
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Elias Emergency Hospital, Bucharest, Romania.
| | - Teodora Manuc
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Tudor Gheorghe Stroie
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Speranta Maria Iacob
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Laura Iliescu
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Department, Clinic Fundeni Institute, Bucharest, Romania.
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Ratziu V, Anstee QM, Wong VWS, Schattenberg JM, Bugianesi E, Augustin S, Gheorghe L, Zambon V, Reau N. An international survey on patterns of practice in NAFLD and expectations for therapies-The POP-NEXT project. Hepatology 2022; 76:1766-1777. [PMID: 35363906 DOI: 10.1002/hep.32500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS Differences between countries in NAFLD patient care pathways and management need to be understood prior to defining supranational guidelines. APPROACH AND RESULTS We conducted an anonymous survey in France, Germany, Hong Kong, Italy, Romania, Spain, the United Kingdom, and the United States among physicians providing specialist care for patients with NAFLD. Modalities of patient referral, patterns of practice (diagnosis, staging, monitoring, and indications for liver biopsy), therapeutic management, and expectations for future NASH pharmacotherapies were assessed, with 664 physicians completing the survey. Referral to surveyed physicians (SPs) mostly came from primary care. Prior to referral, NAFLD was rarely diagnosed, and noninvasive tests were not performed. Screening for comorbidities by SPs was incomplete and cardiovascular risk not calculated. Elastometry in combination with a serum biomarker was the most common first-line method for fibrosis staging. Liver biopsy, when performed, was often delayed by at least 1 year after diagnosis. It was, however, recommended even if noninvasive methods indicated advanced fibrosis. Frequent, biannual monitoring was conducted, including HCC surveillance in Stage 3 fibrosis. SPs rarely implemented and followed dietary and lifestyle changes themselves, and local availability of such programs was highly heterogenous. SPs favored pharmacotherapy based on mechanism of action adapted to the stage of the disease, including for early stages such as steatohepatitis with mild fibrosis. CONCLUSIONS This international survey revealed major deficiencies and delays in referral pathways, suboptimal screening for comorbidities or managing of lifestyle modifications by SPs, and limited local availability for nonpharmacological interventions. Monitoring practices are not aligned with current guidelines.
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Affiliation(s)
- Vlad Ratziu
- Sorbonne Université, Hospital Pitié-SalpêtrièreParisFrance.,Institute for Cardiometabolism and Nutrition (ICAN)ParisFrance
| | - Quentin M Anstee
- 5994Translational and Clinical Research InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK.,Newcastle NIHR Biomedical Research CentreNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of MedicineUniversity Medical CenterMainzGermany
| | - Elisabetta Bugianesi
- Division of GastroenterologyDepartment of Medical SciencesUniversity of TurinTurinItaly
| | - Salvador Augustin
- Liver UnitDepartment of Internal MedicineVall d'Hebron Hospital UniversitariVall d'Hebron Institut de RecercaVall d'Hebron Barcelona HospitalUniversitat Autònoma de BarcelonaCIBERehdBarcelonaSpain
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver TransplantationFundeni Clinical InstituteCarol Davila University of Medicine and PharmacyBucharestRomania
| | - Vittoria Zambon
- Institute for Cardiometabolism and Nutrition (ICAN)ParisFrance
| | - Nancy Reau
- Section of HepatologyRush University Medical CenterChicagoIllinoisUSA
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9
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Iacob S, Iacob R, Manea I, Uta M, Chiosa A, Dumbrava M, Becheanu G, Stoica L, Popa C, Brasoveanu V, Hrehoret D, Gheorghe C, Gheorghe L, Dima S, Popescu I. Host and immunosuppression-related factors influencing fibrosis occurrence post liver transplantation. Front Pharmacol 2022; 13:1042664. [PMID: 36330082 PMCID: PMC9622773 DOI: 10.3389/fphar.2022.1042664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
Post liver transplantation (LT) fibrosis has a negative impact on graft function. Cytokine production in the host immune response after LT may contribute to the variable CYP3A-dependent immunosuppressive drug disposition, with subsequent impact on liver fibrogenesis, together with host-related factors. We aimed to investigate whether the cytochrome P4503A5*3 (CYP3A5*3) or TBX21 genotypes impact post-LT liver fibrogenesis. Furthermore, the impact of immunosuppressants on cellular apoptosis has been evaluated using human hepatocytes harvested from cirrhotic explanted livers. We have enrolled 98 LT recipients that were followed for occurrence of liver fibrosis for at least 12 months. There was a statistically significant higher trough level of TAC in patients with homozygous CC-TBX21 genotype (7.83 ± 2.84 ng/ml) vs. 5.66 ± 2.16 ng/ml in patients without this genotype (p = 0.009). The following variables were identified as risk factors for fibrosis ≥2: donor age (p = 0.02), neutrophil to lymphocyte ratio (p = 0.04) and TBX21 genotype CC (p = 0.009). In the cell culture model cytometry analysis has indicated the lowest apoptotic cells percentage in human cirrhotic hepatocytes cultures treated with mycophenolate mofetil (MMF) (5%) and TAC + MMF (2%) whereas the highest apoptosis percentage was registered for the TAC alone (11%). The gene expression results are concordant to cytometry study results, indicating the lowest apoptotic effect for MMF and MMF + TAC immunosuppressive regimens. The allele 1993C of the SNP rs4794067 may predispose to the development of late significant fibrosis of the liver graft. MMF-based regimens have a favourable anti-apoptotic profile in vitro, supporting its use in case of LT recipients at high risk for liver graft fibrosis.
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Affiliation(s)
- Speranta Iacob
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Iacob
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Ioana Manea
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
| | - Mihaela Uta
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Andrei Chiosa
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Mona Dumbrava
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Becheanu
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Luminita Stoica
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Codruta Popa
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Brasoveanu
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Doina Hrehoret
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Gheorghe
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Simona Dima
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
- *Correspondence: Simona Dima,
| | - Irinel Popescu
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
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10
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Iacob S, Beckebaum S, Dumitrascu DL, Gheorghe L. Editorial: Sarcopenia, Frailty and Nutrition in Liver Diseases. Front Nutr 2022; 9:929459. [PMID: 35757251 PMCID: PMC9214223 DOI: 10.3389/fnut.2022.929459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Speranta Iacob
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania.,Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Susanne Beckebaum
- Department of Gastroenterology, Hepatology, Endocrinology und Clinical Infektiology, University Hospital Munster, Munster, Germany
| | - Dan Lucian Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania.,Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
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11
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Chitul M, Cerban R, Becheanu G, Gheorghe C, Gheorghe L. Atypical Immunohistochemistry Features in an AFP-producing Colon Cancer. J Gastrointestin Liver Dis 2022; 31:159. [PMID: 35694982 DOI: 10.15403/jgld-4104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mirela Chitul
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania.
| | - Razvan Cerban
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriel Becheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest; Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Christian Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Liana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Stroie T, Preda C, Meianu C, Croitoru A, Gheorghe L, Gheorghe C, Diculescu M. Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Clinical Remission: What Should We Look For? Medicina (Kaunas) 2022; 58:medicina58040486. [PMID: 35454325 PMCID: PMC9028218 DOI: 10.3390/medicina58040486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 12/07/2022]
Abstract
Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable evolution that can have a negative impact on patients’ quality of life (QoL). Even though patients in remission have a better QoL compared to patients with active disease, they still have a lower QoL compared to healthy people. The aim of this study is to identify the factors that are associated with a lower QoL in patients with IBD in clinical remission, in a tertiary IBD center in Romania. Materials and Methods: Ninety-seven adult patients with a current diagnosis of IBD for over 3 months who were in clinical remission were enrolled in this study. Pregnant women, patients with ostomy, perianal disease, extraintestinal manifestations or other significant comorbidities were excluded. Out of the 97 patients, 63.9% were men. The median age was 39 years (IQR 29−47), and the median disease duration was 5 years (IQR 2−10). Disease activity was assessed using the SCCAI score for ulcerative colitis and HBI score for Crohn’s disease. Remission was defined for SCCAI score ≤ 1 and HBI score ≤ 4. The health-related quality of life (HR-QoL) was assessed using the IBDQ32 score. FACIT-Fatigue was used to evaluate the level of fatigue. Patients with symptoms of anxiety or depression were identified with the HADS score. Symptoms of anxiety were considered when HADS-A >7 points and symptoms of depression when HADS-D >7 points. Results: Sixty-five patients (67%) were diagnosed with CD and the remaining 32 (33%) with UC. Ninety-three patients (95.9%) were on biological therapy. The mean IBDQ score (total score) was 190.54 points (SD +/− 8.2). The mean FACIT Fatigue score was 42.5 (SD +/− 8.2), with 6.2% of patients suffering from severe fatigue (FACIT Fatigue < 30 points). A total of 33% of patients had symptoms of anxiety and 16.5% of depression. Exposure to more than one biologic therapy (p = 0.02), fatigue (p < 0.001) and symptoms of anxiety (p < 0.001) were associated with a lower HR-QoL in the multivariate analysis. Female patients, patients with Crohn’s disease, patients with anemia and patients with symptoms of depression also had a lower HR-QoL, but this did not reach statistical significance in our study. Conclusions: Exposure to a higher number of biological agents (patients that switched multiple biologics), the presence of fatigue and symptoms of anxiety impair the HR-QoL of patients with IBD in clinical remission. Further studies should assess in a prospective manner whether early identification of these factors with prompt clinical interventions could lead to a better HR-QoL in these patients.
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Affiliation(s)
- Tudor Stroie
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Carmen Preda
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Corina Meianu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Croitoru
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania;
- Department of Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Liana Gheorghe
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Diculescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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13
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Iacob S, Mina V, Mandea M, Iacob R, Vadan R, Boar V, Ionescu G, Buzescu D, Gheorghe C, Gheorghe L. Assessment of Sarcopenia Related Quality of Life Using SarQoL® Questionnaire in Patients With Liver Cirrhosis. Front Nutr 2022; 9:774044. [PMID: 35284449 PMCID: PMC8914531 DOI: 10.3389/fnut.2022.774044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Sarcopenia, malnutrition, physical deconditioning, and frailty contribute to a significantly altered quality of life (QoL) in patients with cirrhosis and sarcopenia. Aim To investigate the sarcopenia-linked alterations of QoL by SarQoL® questionnaire in patients with end-stage liver disease. Methods Consecutive patients with liver cirrhosis, admitted to our department between May and August 2021, completed the SarQoL® questionnaire by themselves. They were evaluated for sarcopenia according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) definition [hand grip cut-offs and skeletal muscle index (SMI) calculation at CT scan]. Results A total of 71 patients with liver cirrhosis were included in the study, with a median age of 54 years. Sarcopenia was present in 31.2% of patients with Child-Pugh class A, in 58.3% with class B, and in 93.5% with class C. The SarQoL® score was statistically significant and lower in Child-Pugh class C vs. class B and class A (70.2 vs. 66.5 vs. 52.5 points, p = 0.0002). The SarQoL® score was evaluated according to different complications of cirrhosis, with statistically significant lower scores in patients with sarcopenia (p < 0.0001), in patients with ascites requiring paracentesis (p = 0.0006), and in patients with hepatic encephalopathy (p < 0.0001). A cut-off level of 75.9 points for SarQoL® score can accurately detect sarcopenia in patients with end-stage liver disease [area under the receiver operating characteristic (AUROC) curve of.823, SE of 92.1%, SP of 45.5%, positive predictive value (PPV) and negative predictive value (NPV) of 66 and 83.3%, respectively, correctly classified 73.2% of cirrhotic patients with sarcopenia]. Conclusions The use of SarQoL® questionnaire in cirrhotic patients can, at the same time, evaluate the quality of life and identify subjects with sarcopenia and altered QoL.
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Affiliation(s)
- Speranta Iacob
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Victor Mina
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Dr Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Matei Mandea
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Iacob
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Roxana Vadan
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Voichita Boar
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Dan Buzescu
- Colentina Clinical Hospital, Bucharest, Romania
| | - Cristian Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
- *Correspondence: Liana Gheorghe
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14
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Iacob S, Beckebaum S, Iacob R, Gheorghe C, Cicinnati V, Popescu I, Gheorghe L. Genetic and Life Style Risk Factors for Recurrent Non-alcoholic Fatty Liver Disease Following Liver Transplantation. Front Nutr 2022; 8:787430. [PMID: 35096933 PMCID: PMC8795078 DOI: 10.3389/fnut.2021.787430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
Recurrent or de novo non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) following liver transplantation (LT) is a frequent event being increasingly recognized over the last decade, but the influence of recurrent NASH on graft and patient outcomes is not yet established. Taking into consideration the long term survival of liver transplanted patients and long term complications with associated morbidity and mortality, it is important to define and minimize risk factors for recurrent NAFLD/NASH. Metabolic syndrome, obesity, dyslipidemia, diabetes mellitus are life style risk factors that can be potentially modified by various interventions and thus, decrease the risk of recurrent NAFLD/NASH. On the other hand, genetic factors like recipient and/or donor PNPLA3, TM6SF2, GCKR, MBOAT7 or ADIPOQ gene polymorphisms proved to be risk factors for recurrent NASH. Personalized interventions to influence the different metabolic disorders occurring after LT in order to minimize the risks, as well as genetic screening of donors and recipients should be performed pre-LT in order to achieve diagnosis and treatment as early as possible.
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Affiliation(s)
- Speranta Iacob
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
- *Correspondence: Speranta Iacob
| | | | - Razvan Iacob
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Irinel Popescu
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Center for Digestive Diseases and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
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Iacob S, Florescu M, Gheorghe L. Reply to "Anticoagulant treatment in cirrhotic portal vein thrombosis -how wide can we open the window?". J Gastrointestin Liver Dis 2021; 30:531-532. [PMID: 34941987 DOI: 10.15403/jgld-3082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Speranta Iacob
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Madalina Florescu
- Department of Gastroenterology, Saint Marie Clinical Hospital, Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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Jonaitis L, Marković S, Farkas K, Gheorghe L, Krznarić Ž, Salupere R, Mokricka V, Spassova Z, Gatev D, Grosu I, Lijović A, Mitrović O, Saje M, Schafer E, Uršič V, Roblek T, Drobne D. Intravenous versus subcutaneous delivery of biotherapeutics in IBD: an expert's and patient's perspective. BMC Proc 2021; 15:25. [PMID: 34879868 PMCID: PMC8654488 DOI: 10.1186/s12919-021-00230-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Several biologic treatments are available in addition to intravenous also in subcutaneous form for treatment of chronic diseases. Benefits of the subcutaneous application of drugs include self-administration by the patient, shorter time of application process with less infusion related adverse events and consequently lower healthcare costs. With appropriate education and support patients are able to administer their treatments at home. This leads to improvement of quality of life, reduction of time needed to travel to the healthcare institution and consequently also reduces costs also for the patient. Over one million residents in the USA and 2.5 million in Europe are estimated to have inflammatory bowel disease (IBD), with substantial costs for health care. These estimates do not factor in the ‘real’ price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients. The Virtual Community Meeting, which offered an exchange of experience and opinions from healthcare professionals who are active in treating IBD, and patients with this chronic disease, revealed in-depth arguments and answers to some essential questions: which patients prefer subcutaneous over intravenous dosing; which patients continue to favour intravenous infusions; what are the limitations regarding both applications; what is the patient’s role in therapeutical decision-making and how does IBD affect the patient’s work, finances and quality of life? The aim of this article is to discuss the differences between subcutaneous and intravenous dosing from the health-economic, scientific, and personal perspectives. The meeting offered strong confirmation that most of the patients and healthcare professionals prefer subcutaneous over intravenous drug administration but emphasise the management of risks associated with treatment compliance. Patient education provided by the IBD team in this regard is mandatory. Quality of life of patients is poorer during active disease, but the findings that it can improve over time, including as a result of home- or self-administration of biologics, may be encouraging for individuals with this chronic disease.
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Affiliation(s)
- Laimas Jonaitis
- Gastroenterology clinic, Hospital of Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania
| | - Srdjan Marković
- Department of Gastroenterology, University Hospital Medical Center Zvezdara, Dimitrija tucovica 161, Belgrade, 11000, Serbia
| | - Klaudia Farkas
- Department of Gastroenterology, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Fundeni 258, 022328, Bucharest, Romania
| | - Željko Krznarić
- Department of Gastroenterology, University Hospital Center Zagreb, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Ludvig Puusepa 8, 50406, Tartu, Estonia
| | - Viktorija Mokricka
- Pauls Stradiņš Clinical University Hospital, 13 Pilsoņu iela, Riga, LV, 1002, Latvia
| | - Zoya Spassova
- Clinic of Gastroenterology, University Hospital "St. Ivan Rilski", 1431, Sofia, Bulgaria
| | - Dimo Gatev
- BABKUK Bulgarian patient organization ( Bulgarian Crohn and Ulcerative Colitis Association), Nikolai Kopernik 28-30, 1000, Sofia, Bulgaria
| | - Isabella Grosu
- Romanian IBD Patient Association, Traian 3, 910040, Calarasi, Romania
| | - Anton Lijović
- Patient Organization HUCUK (Hrvatsko udruženje za Crohnovu bolest i ulcerozni colitis), Ulica Kralja Zvonimira 20, 10 000, Zagreb, Croatia
| | - Olga Mitrović
- Clinic for Gynecology and Obstetrics, University Clinical Centar of Serbia, Koste Todorovica 26, Belgrade, 11000, Serbia
| | - Mateja Saje
- Inflammatory Bowel Disease Association (Društvo za kronično vnetno črevesno bolezen), Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital Budapest, Podmaniczky u. 111, Budapest, 1062, Hungary
| | - Viktor Uršič
- Takeda Pharmaceuticals d.o.o, Bleiweisova cesta 30, 1000, Ljubljana, Slovenia
| | - Tina Roblek
- Takeda Pharmaceuticals d.o.o, Bleiweisova cesta 30, 1000, Ljubljana, Slovenia
| | - David Drobne
- University medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia. .,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
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17
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Singeap AM, Girleanu I, Diculescu M, Gheorghe L, Ciocîrlan M, Gheorghe C, Costache A, Tanțău A, Zaharie R, Goldis A, Gheonea D, Dobru D, Dumitru E, Prelipcean CC, Gîlcă-Blanariu GE, Moscalu M, Stanciu C, Trifan A. Risk Factors for Extraintestinal Manifestations in Inflammatory Bowel Diseases - Data from the Romanian National Registry. J Gastrointestin Liver Dis 2021; 30:346-357. [PMID: 34375380 DOI: 10.15403/jgld-3818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors. METHODS We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis. RESULTS The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs. CONCLUSIONS IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment.
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Affiliation(s)
- Ana-Maria Singeap
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania. .
| | - Irina Girleanu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Maria Ciocîrlan
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Cristian Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Adrian Costache
- Carol Davila UMF, Dr. I. Cantacuzino Clinical Hospital, Bucharest.
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj- Napoca, Romania.
| | - Roxana Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Adrian Goldis
- Victor Babeș University of Medicine and Pharmacy, Municipal Emergency Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania.
| | - Dan Gheonea
- University of Medicine and Pharmacy, Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania.
| | - Daniela Dobru
- University of Medicine and Pharmacy, Tg Mures, Emergency County Hospital, Department of Gastroenterology, Târgu-Mureș, Romania.
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanța, Emergency County Hospital, Department of Gastroenterology, Constanta, Romania.
| | | | | | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.
| | - Carol Stanciu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Anca Trifan
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
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Florescu MM, Costache A, Iacob SM, Pietrareanu C, Ester C, Cerban R, Dumitru R, Grasu M, Lupescu I, Gheorghe L. Anticoagulation Therapy for Portal Vein Thrombosis in Patients with Cirrhosis in a Tertiary Center Experience. J Gastrointestin Liver Dis 2021; 30:374-379. [PMID: 34551038 DOI: 10.15403/jgld-3392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS The evidence regarding the use of anticoagulant (AC) agents in portal vein thrombosis (PVT) is increasing and, most patients undergo chronic treatment with low molecular weight heparin (LMWH) or vitamin K antagonists (VKA). Nevertheless, there are no clear data about who should receive antithrombotic therapy, when to initiate it, how long and what dose should be used for this set of patients. The aim of the study was to assess the outcome of patients with cirrhosis and portal vein thrombosis who received AC therapy, in terms of thrombus regression, bleeding events and survival rates. METHODS This observational and retrospective study included 107 cirrhotic patients diagnosed with PVT in a single tertiary center between 2010-2019. 54 received low molecular weight heparin or vitamin K antagonist (AC treatment group) and 53 were untreated. All patients were periodically follow-up to assess the evolution of PVT (regression, progression, stable thrombus) and potential occurrence of bleeding events. RESULTS The regression of portal vein thrombosis was significantly higher in the AC treatment group (OR=2.430; 95% CI=1.11-6.167; p=0.026), more than 50% of on-treatment patients experiencing regression of the thrombus. However, bleeding events were significantly more frequent in the AC treatment group (18.5% vs. 7.5%) and the risk of bleeding was associated with thrombocytes less than 50x103/mm3 (OR=8.266; 95%CI: 2.310-39.211; p=0.002). Survival was better in the AC treatment group (68.4% vs 48.7% at 5 years and 92.7% vs 77.8% at 1 year, p=0.038) and was lower in patients that experienced bleeding events (37.22% survival at 5 years, mean time survival 44 months, p=0.008). CONCLUSIONS In our cohort of cirrhotic patients with PVT more than 50% of patients receiving AC therapy presented regression of the thrombus; most of them obtained partial recanalization. The bleeding complication rate was higher than expected, reaching 18%. The overall mortality was lower in the treated group.
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Affiliation(s)
| | - Adrian Costache
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Dr. Ioan Cantacuzino Clinical Hospital, Bucharest; 4) Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Speranta Maria Iacob
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Corina Pietrareanu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Carmen Ester
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Razvan Cerban
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Radu Dumitru
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Mugur Grasu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Ioana Lupescu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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Gutiérrez-Barrios A, Mialdea-Salmerón D, Cañadas-Pruaño D, Garcia-Molinero D, Zayas-Rueda R, Calle-Pérez G, Vázquez-García R, Toro R, Gheorghe L. Electrocardiographic findings in true acute left main coronary total occlusion a subanalisys from ATOLMA registry. J Electrocardiol 2021; 68:48-52. [PMID: 34333405 DOI: 10.1016/j.jelectrocard.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Acute total occlusion of the left main coronary artery (ATOLMA) usually leads to a catastrophic presentation. Prediction of ATOLMA by electrocardiogram (ECG) may contribute to early detection and reperfusion. Limited data have been reported previously. This study aims to identify the admission 12‑leads ECG features that can predict the presence of ATOLMA and in-Hospital mortality in these patients. METHODS The admission ECGs findings in 24 patients from the previously reported ATOLMA multicenter registry were compared to the ECGs findings in 15 patients with an acute subtotal occlusion of the left main (ASOLMA) and to 15 patients with anterior ST-elevation myocardial infarction of the proximal left anterior descending (LADp-STEMI). RESULTS Some ECG features at presentation can predict an ATOLMA: QRS left axis deviation (-61.17 ± 9 degrees); ST-segment elevation in aVL (1.9 ± 0.65 mm); absence of ST-segment elevation in V1 (0.0 ± 0.6 mm); bifascicular block (58%); fragmented QRS (62.5%); prolongation of QTc interval (465 ± 19 ms) and of QRS interval (136 ± 12 mm). The multivariate analysis found that the independent predictors to distinguish ATOLMA from ASOLMA were aVL ST-segment deviation (OR 5.6(95% CI 1.5-21), p = 0.01) and absence of V1 ST-segment elevation (OR 27(95% CI 1.4-52), p = 0.01); and from LADp-STEMI was QRS width (OR 1.1(95% CI 1.02-1.2), p = 0.02). Fragmented QRS was the only independent predictor of in-hospital mortality in ATOLMA (OR 0.125(95% CI 0.01-0.81), p = 0.03). CONCLUSIONS aVL ST-segment elevation, the absence of V1 ST-segment elevation, left axis deviation, the presence of bifascicular block, and prolongation of QRS and QTc interval are predictors of ATOLMA. Fragmented QRS predicts in-hospital mortality in ATOLMA.
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Affiliation(s)
- A Gutiérrez-Barrios
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain.
| | | | - D Cañadas-Pruaño
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | | | - R Zayas-Rueda
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - G Calle-Pérez
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - R Vázquez-García
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - R Toro
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
| | - L Gheorghe
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Spain
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20
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Iacob S, Gheorghe L. Long Term Follow-up of Liver Transplant Recipients: Considerations for Non-transplant Specialists. J Gastrointestin Liver Dis 2021; 30:283-290. [PMID: 34174051 DOI: 10.15403/jgld-3616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 11/01/2022]
Abstract
Patient and liver graft survival rates have improved significantly in the last decades, leading to complications mainly related to long-term immunosuppression. Prevention of, screening for metabolic syndrome, cardiovascular disease, de novo diabetes mellitus, renal dysfunction, and malignancies and their management are mandatory due to important causes of morbidity and mortality in this patient population. Quality of life (QoL) and functional benefits are clearly better compared to preoperative status; however, post-liver transplantation (LT) complications may impair and alter QoL scores. Individualized immunosuppression managed by transplant physicians and collaboration with other non-transplant specialists for recognition and treatment of medical complications and comorbidities after LT is the key to enhanced QoL and life expectancy of this patient population.
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Affiliation(s)
- Speranta Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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21
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Mennini FS, Marcellusi A, Robbins Scott S, Montilla S, Craxi A, Buti M, Gheorghe L, Ryder S, Kondili LA. The impact of direct acting antivirals on hepatitis C virus disease burden and associated costs in four european countries. Liver Int 2021; 41:934-948. [PMID: 33529499 PMCID: PMC8248004 DOI: 10.1111/liv.14808] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We assessed the clinical and economic impact of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in England, Italy, Romania and Spain. METHODS An HCV progression Markov model was developed considering DAA eligibility and population data during the years 2015-2019. The period of time to recover the investment in DAAs was calculated as the cost saved by avoiding estimated clinical events for 1000 standardized treated patients. A delayed treatment scenario because of coronavirus disease (COVID-19) was also developed. RESULTS The estimated number of avoided hepatocellular carcinoma, decompensated cirrhosis and liver transplantations over a 20-year time horizon was: 1,057 in England; 1,221 in Italy; 1,211 in Romania; and 1,103 in Spain for patients treated during 2015-2016 and 640 in England; 626 in Italy; 739 in Romania; and 643 in Spain for patients treated during 2017-2019. The cost-savings ranged from € 45 to € 275 million. The investment needed to expand access to DAAs in 2015-2019 is estimated to be recovered in 6.5 years in England; 5.4 years in Italy; 6.7 years in Romania; and 4.5 years in Spain. A delay in treatment because of COVID-19 will increase liver mortality in all countries. CONCLUSION Direct-acting antivirals have significant clinical benefits and can bring substantial cost-savings over the next 20 years, reaching a Break-even point in a short period of time. When pursuing an exit strategy from strict lockdown measures for COVID-19, providing DAAs should remain high on the list of priorities in order to maintain HCV elimination efforts.
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Affiliation(s)
- Francesco S. Mennini
- Economic Evaluation and HTACentre for Economic and International Studies(EEHTA‐CEIS) Faculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly,Institute of Leadership and Management in HealthKingston Business SchoolKingston UniveristyLondonUK
| | - Andrea Marcellusi
- Economic Evaluation and HTACentre for Economic and International Studies(EEHTA‐CEIS) Faculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly,Institute of Leadership and Management in HealthKingston Business SchoolKingston UniveristyLondonUK
| | - Sarah Robbins Scott
- Economic Evaluation and HTACentre for Economic and International Studies(EEHTA‐CEIS) Faculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
| | - Simona Montilla
- Department of Economic Strategy of Pharmaceutical ProductsItalian Medicines AgencyRomeItaly
| | - Antonio Craxi
- Gastroenterology and Hepatology UnitDepartment of Internal Medicine and Medical Specialties "PROMISE"University of PalermoPalermoItaly
| | - Maria Buti
- Liver UnitHospital Universitario Valle Hebron and CIBER‐EHD del Insitituto Carlos IIIBarcelonaSpain
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver TransplantationFundeni Clinical InstituteUniversity of Medicine and Pharmacy Carol DavilaBucharestRomania
| | - Stephen Ryder
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS TrustThe University of NottinghamNottinghamUK
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22
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Dimitriu A, Cristian G, Roxana C, Monica C, Gheorghe L. Normal histology, the new target for ulcerative colitis treatment, might not be the cure. J Gastrointestin Liver Dis 2021; 30:170. [PMID: 33723554 DOI: 10.15403/jgld-2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/01/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Anca Dimitriu
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Gheorghe Cristian
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Costache Roxana
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
| | - Cojocaru Monica
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Liana Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Vadan R, Bunduc S, Gheorghe L, Gheorghe C. GAVE: a gastroenterologist challenge. J Gastrointestin Liver Dis 2021; 30:168-169. [PMID: 33723548 DOI: 10.15403/jgld-2921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/02/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Roxana Vadan
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Stefania Bunduc
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Liana Gheorghe
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian Gheorghe
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Gheorghe L, Iacob S, Csiki IE, Huiban L, Cojocaru M, Cojocariu C, Nemteanu R, Girleanu I, Sirli R, Singeap AM, Pop C, Dumitrascu DL, Vadan R, Iacob R, Diculescu M, Trifan A, Sporea I, Gheorghe C. The Prevalence of HCV Infection and Risk Factors in a Hospital- Based Population Screening, a First Step to the Micro-Elimination of HCV Infection in Medical Institutions from Romania - Results of the HepC ALERT Study. J Gastrointestin Liver Dis 2020; 29:587-593. [PMID: 33331354 DOI: 10.15403/jgld-3084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Elimination of hepatitis C worldwide is more feasible if micro-elimination screening strategies are adopted. We aimed to screen hepatitis C virus (HCV) in specific high-risk populations in certain sub-regions of Romania and link them to antiviral treatment. METHODS A multicenter prospective study was conducted among the hospitalized or ambulatory adult patients from March 2019 to March 2020 in more than 20 medical institutions from 4 Romanian cities (Bucharest, Iasi, Timisoara, Cluj-Napoca). A rapid diagnostic test for HCV diagnosis was performed to all admitted patients and the positive ones were sent to gastroenterology departments for confirming the active infection, staging and treatment prescription. RESULTS In total, 25,141 subjects signed the informed consent and were consequently enrolled into the study. The prevalence of anti-HCV antibodies was 1.39% (95%CI: 1.25-1.54) and increased with the number of risk factors presented by one subject. There was a positive association between the presence of anti-HCV antibodies and female gender (p<0.001), rural area of residence (p<0.001), advanced age (p<0.001), as well as a negative association with the education level (p<0.001). CONCLUSIONS In a hospital-based screening micro-elimination program in Romania, HCV prevalence was lower than previously reported. This is a first step towards a cost-effective screening in a well-defined group of persons at risk and provides sufficient capacity to deliver access to HCV treatment and linkage to care in Romania.
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Affiliation(s)
- Liana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. .
| | - Speranta Iacob
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Irma Eva Csiki
- POCU Projects, Fundeni Clinical Institute, Bucharest, Romania
| | - Laura Huiban
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Monica Cojocaru
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Cojocariu
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Roxana Nemteanu
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Irina Girleanu
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
| | - Ana Maria Singeap
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | - Dan L Dumitrascu
- 2 nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Roxana Vadan
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Iacob
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mircea Diculescu
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristian Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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25
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Iacob S, Ghioca M, Csiki IE, Tomescu D, Droc G, Hrehoret D, Brasoveanu V, Pietrareanu C, Iacob R, Gheorghe C, Popescu I, Gheorghe L. Pre and post-liver transplant outcome of cirrhotic patients with acute on chronic liver failure. Medicine (Baltimore) 2020; 99:e22419. [PMID: 33126299 PMCID: PMC7598874 DOI: 10.1097/md.0000000000022419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute on chronic liver failure (ACLF) is a dynamic syndrome, but frequently associated with a high 1 month mortality rate. This is the first study applying the new European Association for the Study of the Liver- chronic liver failure consortium criteria to explore mortality on the waiting list (WL) and early after liver transplantation (LT) in a cohort of Romanian cirrhotic patients that improved or recovered after an episode of ACLF.To assess frequency and waitlist mortality for different grades of ACLF.An observational study was conducted; 257 patients with liver cirrhosis included on the WL between 2015 and 2017 were analyzed. The cumulative incidence of waitlist mortality or removal was calculated for combination of competing events using multivariable competing risks regression.ACLF-1 occurred in 12.07%, ACLF-2 in 7.39% and ACLF-3 in 8.56% of patients. Median Model for End Stage Liver Diseases (MELD) score at the moment of ACLF was 29. The main event while on the WL was death, followed by ACLF; patients with ACLF-3 had a significantly greater subhazard ratio for mortality of 2.25 (1.55-3.26) compared to patients with ACLF-1 or 2. LT proved to be associated with a significantly lower risk of death on the WL at 6 months after inclusion. One and 12 months post-transplant survival of patients with or without ACLF was similar (P = .77).Occurrence of an ACLF episode while on the WL is associated with a significantly high mortality rate, as well as MELD score at inclusion on the WL, renal and liver failure, presence of hepatic encephalopathy. Overall patient short and long term survival after LT is similar to non-ACLF patients in good selected cases.
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Affiliation(s)
- Speranta Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute
- “Carol Davila” University of Medicine and Pharmacy
| | - Mihaela Ghioca
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute
- “Carol Davila” University of Medicine and Pharmacy
| | | | - Dana Tomescu
- “Carol Davila” University of Medicine and Pharmacy
- Department of Anaesthesia and Critical Care
| | - Gabriela Droc
- “Carol Davila” University of Medicine and Pharmacy
- Department of Anaesthesia and Critical Care
| | - Doina Hrehoret
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Brasoveanu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Corina Pietrareanu
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute
| | - Razvan Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute
- “Carol Davila” University of Medicine and Pharmacy
| | - Cristian Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute
- “Carol Davila” University of Medicine and Pharmacy
| | - Irinel Popescu
- Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute
- “Carol Davila” University of Medicine and Pharmacy
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Gutiérrez-Barrios A, Gheorghe L, Camacho-Freire S, Valencia-Serrano F, Cañadas-Pruaño D, Calle-Pérez G, Alarcón de la Lastra I, Silva E, García-Molinero D, Agarrado-Luna A, Zayas-Ruedas R, Vázquez-García R, Serra A. Primary Angioplasty in a Catastrophic Presentation: Acute Left Main Coronary Total Occlusion-The ATOLMA Registry. J Interv Cardiol 2020; 2020:5246504. [PMID: 32774186 PMCID: PMC7403907 DOI: 10.1155/2020/5246504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients. BACKGROUND ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce. METHODS This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI). RESULTS In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1-0.36), p < 0.001). CONCLUSIONS Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.
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Affiliation(s)
- A. Gutiérrez-Barrios
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - L. Gheorghe
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - S. Camacho-Freire
- Departamento de Cardiología Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | - D. Cañadas-Pruaño
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
- Departamento de Cardiología Hospital de Jerez, Cádiz, Spain
| | - G. Calle-Pérez
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | | | - E. Silva
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - D. García-Molinero
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - R. Zayas-Ruedas
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - R. Vázquez-García
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - A. Serra
- Departamento de Cardiología Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Lupescu IC, Iacob S, Lupescu IG, Gheorghe L, Dulamea AO. From cirrhosis to paraparesis. Ro J Neurol 2019. [DOI: 10.37897/rjn.2019.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Goldiș A, Lupușoru R, Gheorghe L, Gheorghe C, Trifan A, Dobru D, Cijevschi C, Tanțău A, Constantinescu G, Iacob R, Goldiș R, Diculescu M. Geographic Distribution, Phenotype and Epidemiological Tendency in Inflammatory Bowel Disease Patients in Romania. Medicina (Kaunas) 2019; 55:medicina55100704. [PMID: 31635181 PMCID: PMC6843626 DOI: 10.3390/medicina55100704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023]
Abstract
Background and objective: The incidence of inflammatory bowel disease (IBD) over the past years in Romania has been on the rise, but epidemiologic data are lacking. The aim of this study was to define the characteristics of IBD, the trends and phenotype among IBD patients in Romania. Material and methods: We conducted a prospective study over a period of 12 years, from 2006 to 2017. All patients diagnosed with IBD on clinical, radiological, endoscopic and histological features were included. We divided the country into eight regions: west (W), north-east (NE), north-west (NW), south-east (SE), south-west (SW), south (S), central (C) and Bucharest-Ilfov (B), and data were analyzed accordingly. Results: A total of 2724 patients were included in this database, but only 2248 were included in the final analysis, with all data available. Of the 2248 patients, 935 were Crohn's disease (CD), 1263 were ulcerative colitis (UC) and 50 were IBD-undetermined. In UC phenotypes we observed more frequent left-sided colitis (50.5%, p < 0.0001), and in CD phenotype we observed more frequent colonic and ileo-colonic localization (37.8% and 37.6%, p < 0.0001). The region with the most IBD cases was NE (25.1%) and with the least IBD cases was SW (4.9%). UC was found more frequently in NE (32%), while CD was found more frequently in Bucharest (28.6%). Conclusions: In Romania, ulcerative colitis is more frequent than CD. UC is predominant in the northern part of Romania, while CD has become predominant in the southern part of the country. IBD occurs more in the male population, and in urban and industrialized areas. There are differences between the regions in Romania regarding IBD phenotypes, gender distributions, age distribution, treatment, smoking status and complications.
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Affiliation(s)
- Adrian Goldiș
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
| | - Raluca Lupușoru
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
- Department of Functional Sciences, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania.
| | - Liana Gheorghe
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
| | - Cristian Gheorghe
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
| | - Anca Trifan
- Gastroenterology and Hepatology Institute, "Grigore T. Popa" University of Medicine and Pharmacy, 700019 Iași, Romania.
| | - Daniela Dobru
- Municipal Hospital, Gastroenterology, University of Medicine and Pharmacy, 540139 Târgu-Mureș, Romania.
| | - Cristina Cijevschi
- Gastroenterology and Hepatology Institute, "Grigore T. Popa" University of Medicine and Pharmacy, 700019 Iași, Romania.
| | - Alina Tanțău
- "Iuliu Hațieganu" University of Medicine and Pharmacy, 3rd Medical Clinic, 400012 Cluj-Napoca, Romania.
| | - Gabriel Constantinescu
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Floreasca Emergency Hospital, 020021 Bucharest, Romania.
| | - Răzvan Iacob
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
| | | | - Mircea Diculescu
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.
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Yavetskiy R, Doroshenko A, Parkhomenko S, Vorona I, Tolmachev A, Kosyanov D, Vornovskikh A, Zakharenko A, Mayorov V, Gheorghe L, Croitoru G, Pavel N, Multian V, Gayvoronsky V. Microstructure evolution during reactive sintering of Y3Al5O12:Nd3+ transparent ceramics: Influence of green body annealing. Ann Ital Chir 2019. [DOI: 10.1016/j.jeurceramsoc.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sporea I, Popescu A, Dumitrașcu D, Brisc C, Nedelcu L, Trifan A, Gheorghe L, Fierbințeanu Braticevici C. Nonalcoholic Fatty Liver Disease: Status Quo. J Gastrointestin Liver Dis 2019. [PMID: 30574627 DOI: 10.15403/jgld.2014.1121.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nonalcoholic liver disease (NAFLD) is a hot topic for gastroenterologists and hepatologists and clinical practitioners must be kept abreast with the rapid progress of knowledge in this field. The Romanian Society of Gastroenterology and Hepatology (RSGH) has elaborated this review dedicated to evidence-based data on pathogenesis, diagnosis and therapy of this condition. The term NAFLD includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), the second with the highest risk of evolution to cirrhosis and its complications, including hepatocellular carcinoma (HCC). Non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome. Therefore, NAFLD is associated not only with an increase of liver-related mortality, but also of the overall mortality, especially cardiovascular and malignancies. Noninvasive techniques, such as biological tests and elastography can be used for the evaluation of NAFLD patients. Liver biopsy should be recommended in selected cases, for diagnostic, therapeutic and prognostic purposes. Patients with NAFLD would benefit from their lifestyle changes by progressive weight loss through exercise and low fat and sugar diet. Pharmacotherapy should be reserved for patients with NASH, particularly for those with significant fibrosis. Until now, there are no FDA approved therapies for NASH.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Dan Dumitrașcu
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ciprian Brisc
- Department of Medical Disciplines, University of Oradea, Romania
| | - Laurențiu Nedelcu
- Department of Internal Medicine, University Transilvania Brașov, Romania.
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology Iași, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Liana Gheorghe
- Center for Gastroenterology and Hepatology, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Ciocîrlan M, Ciocîrlan M, Iacob R, Tanțău A, Gheorghe L, Gheorghe C, Dobru D, Constantinescu G, Cijevschi C, Trifan A, Goldiș A, Diculescu M. Malnutrition Prevalence in Newly Diagnosed Patients with Inflammatory Bowel Disease - Data from the National Romanian Database. J Gastrointestin Liver Dis 2019; 28:163-168. [PMID: 31204412 DOI: 10.15403/jgld-176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Prevalence of malnutrition in inflammatory bowel diseases (IBD) varies between 16% and 75%. Data on the nutritional status at initial diagnosis of ulcerative colitis (UC) or Crohn's Disease (CD) are scarce. It is believed that more than 50% of IBD patients suffer significant weight loss prior to diagnosis. The aims of our study were to assess malnutrition in patients recently diagnosed with IBD and to determine its predictive factors. METHODS We retrospectively included 625 IBD patients registered in the Romanian "IBD Prospect" database between January 2006 and July 2017. All patients were diagnosed within 6 months prior to registration. We defined malnutrition as weight loss of more than 5% of the initial weight during the 3 months prior to registration. RESULTS There were 361 new cases of UC, 241 CD and 23 cases of unclassified IBD. There was a slight male predominance (M/F=1.2). Prevalence of overall malnutrition was 36.3%. It was significantly more frequent in CD than in UC patients (41.1% vs. 32.4%, p=0.031). In multivariate analysis, malnutrition in UC patients was associated with male gender (p=0.001), more severe disease (p<0.0001) and more extensive disease (p=0.027), while in CD it was associated with younger age (p=0.013) and more severe disease (p<0.0001). CONCLUSIONS About 1 in 3 newly diagnosed IBD patients presents with malnutrition at the time of diagnosis.
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Affiliation(s)
- Maria Ciocîrlan
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Mihai Ciocîrlan
- Carol Davila University of Medicine and Pharmacy, Agrippa Ionescu Clinical Emergency Hospital, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Răzvan Iacob
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj-Napoca, Romania
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Cristian Gheorghe
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Daniela Dobru
- University of Medicine and Pharmacy, Municipal Hospital, Gastroenterology, Târgu-Mureș, Romania
| | - Gabriel Constantinescu
- Carol Davila University of Medicine and Pharmacy, Floreasca Emergency Hospital, Department of Gastroenterology and Hepatology, Bucharest, Romania
| | - Cristina Cijevschi
- Grigore T. Popa University of Medicine and Pharmacy, Gastroenterology and Hepatology Institute, Iași, Romania
| | - Anca Trifan
- Grigore T. Popa University of Medicine and Pharmacy, Gastroenterology and Hepatology Institute, Iași, Romania
| | - Adrian Goldiș
- Victor Babeș University of Medicine and Pharmacy, District Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania
| | - Mircea Diculescu
- Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania
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Iacob S, Cerban R, Pietrareanu C, Ester C, Iacob R, Gheorghe C, Popescu I, Gheorghe L. 100% sustained virological response and fibrosis improvement in real-life use of direct acting antivirals in genotype-1b recurrent hepatitis C following liver transplantation. J Gastrointestin Liver Dis 2019; 27:139-144. [PMID: 29922758 DOI: 10.15403/jgld.2014.1121.272.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nowadays, interferon-free therapy using new direct-acting antivirals (DAA) has dramatically increased the cure rate across different HCV-infected patient populations, including groups traditionally viewed as difficult-to-treat (patients with co-infections, cirrhosis and liver transplant - LT recipients) with marked improvement in safety and tolerability. AIM To present our experience with DAA therapy in LT recipients, as well as to compare pre- and post-treatment liver stiffness (LS) and noninvasive fibrosis scores. METHODS Our cohort consisted of 89 patients with genotype 1 (GT1) recurrent hepatitis C after LT. Seventy six patients received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin and 13 sofosbuvir/ledipasvir+/-ribavirin. Fibroscan®, FIB4 and APRI scores were performed in all patients before and 12 weeks after DAA therapy. RESULTS We analyzed 45 (50.5%) males and 44 (49.5%) females with a mean age of 55+/-7.7 years. Median time since LT was 20.9 months. At baseline, 53 (59.6%) of patients had severe necroinflammation at Fibromax®; advanced fibrosis (F3, F4) was encountered in 35 (39.4%) and grade 3 steatosis in 33 (37.1%) of LT recipients. End of therapy (EOT) virological response (VR) was 100%. Sustained virological response 12 weeks after therapy (SVR12) was 97.7% in the intention-to-treat analysis and 100% in per protocol analysis. There was a significant improvement in LS between antiviral therapy initiation and SVR12: 11.9+/-1.05kPa vs 8.8+/-0.6kPa (p<0.0001), as well as in APRI (2.7+/-0.3 vs 0.4+/-0.05, p<0.0001) and FIB4 (4.6+/-0.5 vs 2.5+/-0.2, p<0.0001) scores. CONCLUSIONS In HCV positive recipients, DAA regimens are highly effective and safe. A significant decrease of LS by transient elastography and fibrosis non-invasive scores can be observed after successful therapy.
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Affiliation(s)
- Speranta Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Razvan Cerban
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Corina Pietrareanu
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Carmen Ester
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Razvan Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Irinel Popescu
- Dan Setlacec Centre of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Les A, Dimitriu A, Costache R, Gheorghe L, Gheorghe C. Ultrasonographic assessment of Crohn's disease patients: can be easier and more affordable for clinical practice? J Gastrointestin Liver Dis 2019; 28:130-131. [PMID: 30851184 DOI: 10.15403/jgld.2014.1121.281.crh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Anda Les
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
| | - Anca Dimitriu
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
| | - Roxana Costache
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
| | - Liana Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania.
| | - Cristian Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
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Cerban R, Ester C, Iacob S, Grasu M, Pâslaru L, Dumitru R, Lupescu I, Constantin G, Croitoru A, Gheorghe L. Predictive Factors of Tumor Recurrence and Survival in Patients with Hepatocellular Carcinoma treated with Transarterial Chemoembolization. J Gastrointestin Liver Dis 2018; 27:409-417. [PMID: 30574623 DOI: 10.15403/jgld.2014.1121.274.fcr] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS To evaluate the predictive factors for recurrence of the disease and overall survival (OS) after achieving complete response (CR) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). METHODS From January 2013 to December 2017, 168 treatment-naïve patients diagnosed with HCC underwent TACE as a first-line therapy and the gathered data was retrospectively reviewed. We determined the predictive factors for complete response (CR), for recurrence after CR and for survival using the Cox proportional hazard model. RESULTS Median follow-up was 27.4 months (range 4-65 months). The mean patient age was 62.2+/-7.9 years. Eighty-three patients had an α-fetoprotein (AFP) level > 20ng/mL. The median maximal diameter of the tumors was 3.5 cm. Sixty-three patients (37.5%) achieved CR after TACE, and recurrence after CR was detected in 37 patients (58.7%). In multivariate analysis, tumor size (</=4.5 cm) and a single tumor were found to be predictive factors for CR, with hazard ratios (HRs) of 2.352 (p=0.022) and 3.964 (p<0.0001), respectively. After achieving CR the median time to recurrence was 12 months (range 6-24 months). Elevated serum AFP > 25 ng/mL and multiple tumors were demonstrated to have a significant relationship with recurrence after CR, with HRs of 1.650 (p=0.05) and 3.932 (p=0.038), respectively. Increased initial serum AFP > 22 ng/mL, tumor size > 4.5 cm, outside Milan criteria, not receiving a liver transplant and presence of portal vein thrombosis (PVT) were correlated with poor survival. CONCLUSIONS In patients treated with TACE as an initial therapy, tumor size (≤4.5 cm) and single tumor were predictive factors for CR. Multiple nodules and an elevated serum AFP > 25 ng/mL were predictive factors for recurrence after CR. Outside Milan criteria tumors, elevated AFP levels and the presence of PVT were significantly correlated with decreased survival.
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Affiliation(s)
- Razvan Cerban
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carmen Ester
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Speranta Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mugur Grasu
- Center for Interventional Radiology and Medical Imaging, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest,Romania.
| | - Liliana Pâslaru
- Department of Biochemistry, Fundeni Clinical Institute, Bucharest,Romania
| | - Radu Dumitru
- Center for Interventional Radiology and Medical Imaging, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest,Romania
| | - Ioana Lupescu
- Center for Interventional Radiology and Medical Imaging, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest,Romania
| | | | - Adina Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Trifan A, Gheorghe C, Marica Sabo C, Diculescu M, Nedelcu L, Singeap AM, Sfarti C, Gheorghe L, Sporea I, Tanțău M, Scripcariu V, Goldiș A, Gheonea D, Manuc M, Stanciu C, Scarpignato C, Dumitrascu DD. Diagnosis and Treatment of Colonic Diverticular Disease: Position Paper of the Romanian Society of Gastroenterology and Hepatology. J Gastrointestin Liver Dis 2018; 27:449-457. [PMID: 30574628 DOI: 10.15403/jgld.2014.1121.274.rom] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease. METHODS A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus. RESULTS Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement. CONCLUSION This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease.
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Affiliation(s)
- Anca Trifan
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Cristian Gheorghe
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Cristina Marica Sabo
- Iuliu Hatieganu University of Medicine and Pharmacy, 2nd Medical Dept. Cluj-Napoca, Romania
| | - Mircea Diculescu
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | - Ana Maria Singeap
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Cătălin Sfarti
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Liana Gheorghe
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Ioan Sporea
- Victor Babeș University of Medicine and Pharmacy, Dept. Gastroenterology and Hepatology, Timișoara, Romania
| | - Marcel Tanțău
- Iuliu Hatieganu University of Medicine and Pharmacy, Prof. Octavian Fodor Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
| | - Viorel Scripcariu
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Adrian Goldiș
- Victor Babeș University of Medicine and Pharmacy, Dept. Gastroenterology and Hepatology, Timișoara, Romania
| | - Dan Gheonea
- University of Medicine and Pharmacy, Dept. Gastroenterology, Craiova, Romania
| | - Mircea Manuc
- Center of Gastroenterology, Fundeni Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Carol Stanciu
- Grigore T. Popa University of Medicine and Pharmacy, Dept. Gastroenterology, Iasi, Romania
| | - Carmelo Scarpignato
- Clinical Pharmacology and Digestive Pathophysiology Unit, Dept.Clinical and Experimental Medicine, University of Parma, Italy
| | - Dan D Dumitrascu
- Iuliu Hatieganu University of Medicine and Pharmacy, 2nd Medical Dept. Cluj-Napoca, Romania
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Sporea I, Popescu A, Dumitrașcu D, Brisc C, Nedelcu L, Trifan A, Gheorghe L, Fierbințeanu Braticevici C. Nonalcoholic Fatty Liver Disease: Status Quo. J Gastrointestin Liver Dis 2018; 27:439-448. [PMID: 30574627 DOI: 10.15403/jgld.2014.1121.274.quo] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nonalcoholic liver disease (NAFLD) is a hot topic for gastroenterologists and hepatologists and clinical practitioners must be kept abreast with the rapid progress of knowledge in this field. The Romanian Society of Gastroenterology and Hepatology (RSGH) has elaborated this review dedicated to evidence-based data on pathogenesis, diagnosis and therapy of this condition. The term NAFLD includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), the second with the highest risk of evolution to cirrhosis and its complications, including hepatocellular carcinoma (HCC). Non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome. Therefore, NAFLD is associated not only with an increase of liver-related mortality, but also of the overall mortality, especially cardiovascular and malignancies. Noninvasive techniques, such as biological tests and elastography can be used for the evaluation of NAFLD patients. Liver biopsy should be recommended in selected cases, for diagnostic, therapeutic and prognostic purposes. Patients with NAFLD would benefit from their lifestyle changes by progressive weight loss through exercise and low fat and sugar diet. Pharmacotherapy should be reserved for patients with NASH, particularly for those with significant fibrosis. Until now, there are no FDA approved therapies for NASH.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Dan Dumitrașcu
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ciprian Brisc
- Department of Medical Disciplines, University of Oradea, Romania
| | - Laurențiu Nedelcu
- Department of Internal Medicine, University Transilvania Brașov, Romania.
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology Iași, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Liana Gheorghe
- Center for Gastroenterology and Hepatology, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Ester C, Cerban R, Iacob S, Pietrareanu C, Constantin G, Paslaru L, Ichim S, Lita M, Vadan R, Grancea C, Ruta S, Gheorghe C, Popescu I, Gheorghe L. The Role of Beta-7 Integrin and Carbonic Anhydrase IX in Predicting the Occurrence of de Novo Nonalcoholic Fatty Liver Disease in Liver Transplant Recipients. Chirurgia (Bucur) 2018; 113:534-541. [PMID: 30183584 DOI: 10.21614/chirurgia.113.4.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/23/2022]
Abstract
Background: Liver transplant (LT) recipients are at increased risk for developing metabolic syndrome. Early detection of NAFLD and other components of the metabolic syndrome is an important step in reducing morbidity and mortality. Methods: We assessed 60 liver transplant recipients for clinical and biological features, performed abdominal ultrasound and transient elastography (TE) Fibroscan© with controlled attenuation parameter (CAP), calculated non-invasive scoring systems APRI, FIB-4, NAFLD score, cardiovascular risk (Framingham risk score) and for the presence of metabolic syndrome and performed two biomarkers: beta 7 integrin and carbonic anhydrase IX. Results: Sixty liver transplant recipients underwent clinical and biochemical evaluation, abdominal ultrasound and TE with CAP. The median age was 56.5 years and the median time from transplantation 35 months. The Spearman correlation coefficient of beta 7 integrin and the liver stiffness measurement values obtained via Fibroscan© we obtained a moderate correlation r=0.31, but a significant association (p=0.01). The univariate analysis showed significant association between both biomarkers and liver fibrosis assessed with a cut-off value of advanced fibrosis of 8.7 kPa. The carbonic anhydrase IX showed a better correlation when compared to the liver stiffness with a correlation coefficient of 0.43 and p-value=0.0007 and a moderate correlation when compared to both FIB-4 (r=0.27) and APRI (r=0.27) score for liver fibrosis but with a significant p value=0.04, respectively 0.03. CONCLUSION We consider very important for our patients the development of new non-invasive biomarkers for early diagnosis of NAFLD and NASH, as the "gold-standard" of liver biopsy is not easily accepted in clinical practice. Also NAFLD and NASH are dynamic processes that need prospective and repeated assessments, a need that cannot be met by the classical liver biopsy.
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Camacho Freire SJ, Garcia Guimaraes M, Gheorghe L, Bastante T, Gomez Menchero AE, Vera AE, Roa Garrido J, Cuesta J, Leon Jimenez J, Rivero F, Cardenal Piris R, Pedregal Gonzalez M, Diaz Fernandez JF, Alfonso F. P1694Novel risk factors in spontaneous coronary artery dissection: thyroid disorders. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - L Gheorghe
- Hospital Juan Ramon Jimenez, Interventional Cardiology, Huelva, Spain
| | - T Bastante
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | | | - A E Vera
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - J Roa Garrido
- Hospital Juan Ramon Jimenez, Interventional Cardiology, Huelva, Spain
| | - J Cuesta
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - J Leon Jimenez
- Hospital Juan Ramon Jimenez, Interventional Cardiology, Huelva, Spain
| | - F Rivero
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - R Cardenal Piris
- Hospital Juan Ramon Jimenez, Interventional Cardiology, Huelva, Spain
| | | | | | - F Alfonso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
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Ricco G, Popa DC, Cavallone D, Iacob S, Salvati A, Tabacelia D, Oliveri F, Mascolo G, Bonino F, Yuan Q, Xia NS, Gheorghe L, Brunetto MR. Quantification of serum markers of hepatitis B (HBV) and Delta virus (HDV) infections in patients with chronic HDV infection. J Viral Hepat 2018; 25:911-919. [PMID: 29577518 DOI: 10.1111/jvh.12895] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Abstract
The interplay between hepatitis B (HBV) and delta (HDV) viruses is complex and not always characterized during chronic HDV infection. We assessed the clinical usefulness of new quantitative assays for HBV and HDV serum markers in a retrospective cross-sectional study. Sera obtained from 122 HDV genotype 1 and HBV genotype D coinfected, anti-HIV-negative patients (71 males; median age 49.8 [21.7-66.9] years), recruited consecutively in two geographical areas (Italy 69 patients, Romania 53 patients) with different HBV and HDV epidemiology, were tested for HBsAg, HBV-DNA, HBcrAg, total anti-HBc, HDV-RNA, IgM and total anti-HDV using quantitative assays. Cirrhosis, which showed comparable prevalence in the two cohorts, was diagnosed in 97 of 122 (79.5%) patients. At multivariate analysis, cirrhosis was associated with lower total anti-HBc/IgM anti-HDV ratio (OR 0.990, 95% CI 0.981-0.999, P = .038), whereas disease activity was associated with higher total anti-HDV (OR 10.105, 95% CI 1.671-61.107, P = .012) and HDV-RNA levels (OR 2.366, 95% CI 1.456-3.844, P = .001). HDV-RNA serum levels showed a positive correlation with HBV-DNA (ρ = 0.276, P = .005), HBsAg (ρ = 0.404, P < .001) and HBcrAg (ρ = 0.332, P < .001). The combined quantitative profiling of HBV and HDV serum markers identifies specific patterns associated with activity and stage of chronic hepatitis D (CHD). HDV pathogenicity depends on the underlying active HBV infection in spite of the inhibition of its replication. HDV-RNA, IgM anti-HDV, total anti-HDV, total anti-HBc, HBsAg and HBcrAg serum levels qualify for prospective studies to predict progressive CHD and identify candidates to antiviral therapy.
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Affiliation(s)
- G Ricco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy.,Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - D C Popa
- Department of Biochemistry, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Bone Marrow Transplant Laboratory, Fundeni Clinical Institute, Bucharest, Romania
| | - D Cavallone
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy
| | - S Iacob
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - A Salvati
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy
| | - D Tabacelia
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - F Oliveri
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy
| | - G Mascolo
- Dia.Pro Diagnostic Bioprobes Srl, Sesto San Giovanni, Milan, Italy
| | - F Bonino
- University of Pittsburgh Medical Center (UPMC) Institute for Health, Chianciano Terme, Siena and Fondazione Italiana Fegato (FIF), AREA Science Park, Trieste, Italy
| | - Q Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, China
| | - N-S Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, China
| | - L Gheorghe
- Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - M R Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Pisa, Italy.,Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Preda CM, Popescu CP, Baicus C, Constantinescu I, Oproiu A, Voiosu T, Diculescu M, Negreanu L, Gheorghe L, Sporea I, Trifan A, Ceausu E, Proca D, Manuc M. Risk of hepatitis B virus reactivation in hepatitis B virus + hepatitis C virus-co-infected patients with compensated liver cirrhosis treated with ombitasvir, paritaprevir/r + dasabuvir + ribavirin. J Viral Hepat 2018; 25:834-841. [PMID: 29397016 DOI: 10.1111/jvh.12872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus may reactivate in patients with chronic hepatitis C treated with direct-acting antivirals. The aim of this study was to investigate the risk of hepatitis B virus (HBV) reactivation in HBV + hepatitis C virus (HCV)-co-infected patients with compensated liver cirrhosis treated with paritaprevir/ombitasvir/ritonavir, dasabuvir with ribavirin. We reviewed prospectively gathered data from a national cohort of 2070 hepatitis C virus patients with compensated liver cirrhosis who received reimbursed paritaprevir/ombitasvir/r, dasabuvir with ribavirin for 12 weeks from the Romanian National Health Agency during 2015-2016. Twenty-five patients in this cohort were HBs antigen positive (1.2%); 15 untreated with nucleotide analogues agreed to enter the study. These patients were followed up: ALT monthly, serology for HBV and DNA viral load at baseline, EOT and SVR at 12 weeks. Hepatitis B virus (HBV)-co-infected patients were all genotype 1b and 52% females, with a median age of 60 years (51 ÷ 74); 76% were pretreated with peginterferon + ribavirin; 72% were with severe necroinflammatory activity on FibroMax assessment; 40% presented comorbidities; and all were HBe antigen negative. Hepatitis C virus (HCV) SVR response rate was 100%. Hepatitis B virus (HBV)-DNA viral load was undetectable in 7/15 (47%) before therapy, and for the other 8 patients, it varied between below 20 and 867 IU/mL. Five patients (33%) presented virological reactivation (>2 log increase in HBV-DNA levels) during therapy. One patient presented with hepatitis associated with HBV reactivation, and two started anti-HBV therapy with entecavir. Hepatitis B virus (HBV) virological reactivation was present in 33% in our patients. Generally, HBV-DNA elevations were mild (<20 000 IU/mL); however, we report one case of hepatitis associated with HBV reactivation.
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Affiliation(s)
- C M Preda
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - C P Popescu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - C Baicus
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - I Constantinescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - A Oproiu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - T Voiosu
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - M Diculescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - L Negreanu
- UMF "Carol Davila" Gastroenterology Department, Emergency Universitary Hospital, Bucharest, Romania
| | - L Gheorghe
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - I Sporea
- UMF Timisoara, Gastroenterology & Hepatology Department, Timisoara Emergency Hospital, Timisoara, Romania
| | - A Trifan
- UMF Gr T Popa Iasi, Gastroenterology & Hepatology Department, Gastroenterology & Hepatology Institute, Iasi, Romania
| | - E Ceausu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - D Proca
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - M Manuc
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
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Sporea I, Lupușoru R, Mare R, Popescu A, Gheorghe L, Iacob S, Șirli R. Dynamics of liver stiffness values by means of transient elastography in patients with HCV liver cirrhosis undergoing interferon free treatment. J Gastrointestin Liver Dis 2018; 26:145-150. [PMID: 28617884 DOI: 10.15403/jgld.2014.1121.262.dyn] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Liver stiffness (LS) measurement by Transient Elastography (TE) has been widely accepted as a tool for fibrosis assessment. The aim of this study was to assess LS dynamics in a group of patients with HCV liver cirrhosis after interferon free treatment (IFT). METHODS This two-center clinical trial included 225 patients with compensated HCV cirrhosis (all genotype 1b), who received IFT for 12 weeks. All patients were evaluated by means of TE at the beginning and at the end of treatment (EOT), and a subgroup (170 patients) also 12 weeks after EOT; all of them had sustained viral response (SVR). Reliable LS measurements (LSM) were defined as a median value of 10 valid LSM, with IQR <30% and SR >/=60%. Both M and XL probes were used. For diagnosing cirrhosis we used a cut-off value of 12kPa as proposed by the Tsochatzis meta-analysis. We considered a decrease or increase of more than 10% in LSM as being significant. RESULTS Out of 225 subjects, reliable measurements were obtained in 93.7%, so that the final analysis included 211 patients. The mean LS values decreased significantly after IFT: 26.4+/-11.7 vs. 23.5+/-13.3 kPa (p=0.01). Most patients, 59.2% (125/211) presented more than 10% decrease in LS values, 24.1% (51/211) had stable LS values, while in 16.4% (35/211) cases, the LS values increased. In the subgroup of 170 patients with LSM also performed 12 weeks after EOT (SVR), the mean LS values were significantly lower as compared to baseline: 21.3+/-11 kPa vs. 27.4+/-11.9 kPa (p<0.0001) and also as compared to EOT: 21.3+/-11 kPa vs. 23.7+/-13.3 kPa (p<0.0001). CONCLUSION In our patients with HCV liver cirrhosis, the mean LS values evaluated by TE significantly decreased after antiviral treatment at EOT and also 12 weeks after EOT as compared to baseline. Overall, about 60% of patients had LS values at EOT lower than at baseline, while 12 weeks after EOT about 75% of patients had LS values lower than at baseline.
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Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology; Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Raluca Lupușoru
- Department of Gastroenterology and Hepatology; Department of Medical Informatics and Biostatistics, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania.
| | - Ruxandra Mare
- Department of Gastroenterology and Hepatology; Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology; Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Liana Gheorghe
- Department of Medical Informatics and Biostatistics, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Speranța Iacob
- Department of Anesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Șirli
- Department of Gastroenterology and Hepatology; Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
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Preda CM, Popescu CP, Baicus C, Voiosu TA, Manuc M, Pop CS, Gheorghe L, Sporea I, Trifan A, Tantau M, Tantau A, Ceausu E, Proca D, Constantinescu I, Ruta SM, Diculescu MM, Oproiu A. Real-world efficacy and safety of ombitasvir, paritaprevir/r+dasabuvir+ribavirin in genotype 1b patients with hepatitis C virus cirrhosis. Liver Int 2018; 38:602-610. [PMID: 28816020 DOI: 10.1111/liv.13550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/10/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Direct antiviral agents (DAA) showed very good results in terms of efficacy and safety in clinical trials, but real-life data are still needed in order to confirm this profile. MATERIAL AND METHODS In Romania, through a nationwide government-funded programme in 2015-2016, approx.5800 patients with virus C cirrhosis received fully reimbursed DAA therapy with OBV/PTV/r+DSV+RBV for 12 weeks. We analysed a national prospective cohort enrolling the first 2070 patients, all with genotype 1b. The only key inclusion criteria was advanced fibrosis (Metavir stage F4) confirmed by Fibromax testing (or liver biopsy/Fibroscan). Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). RESULTS Forty patients stopped the treatment because of hepatic decompensation (1.9%), 21 stopped because of other adverse events and one was lost to follow-up. This cohort was 51% females, mean age 60 years (25÷82), 67% pretreated, 70% associated NASH, 67% with severe necro-inflammation (severity score 3-Fibromax), 37% with comorbidities, 10.4% with Child Pugh A6, 0.5% B7. The median MELD score was 8.09 (6 ÷ 22). SVR by intention-to-treat was reported in 1999/2070(96.6%), 55/2070 failed to respond. Liver decompensation was statistically associated in multivariate analysis with platelets< 105 /mm3 (P = .03), increased total bilirubin (P < .001), prolonged INR (P = .02), and albumin<3.5 g/dL (P = .03). CONCLUSIONS OBV/PTV/r+DSV+RBV proved to be highly efficient in our population of cirrhotics with a 96.6% SVR. Serious adverse events related to therapy were reported in 61/2070(2.9%), most of them liver decompensation (1.9%), related to hepatic dysfunction, and lower platelet count.
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Affiliation(s)
- Carmen M Preda
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Corneliu P Popescu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - Cristian Baicus
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Theodor A Voiosu
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Mircea Manuc
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Corina Silvia Pop
- UMF "Carol Davila" Gastroenterology Department, Emergency Universitary Hospital, Bucharest, Romania
| | - Liana Gheorghe
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Ioan Sporea
- UMF Timisoara, Gastroenterology & Hepatology Department, Timisoara Emergency Hospital, Timisoara, Romania
| | - Anca Trifan
- UMF Gr T Popa Iasi, Gastroenterology & Hepatology Department, Gastroenterology & Hepatology Institute, Iasi, Romania
| | - Marcel Tantau
- UMF I.Hatieganu Cluj, Gastroenterology & Hepatology Department, Medicala III, Cluj County Hospital, Cluj Napoca, Romania
| | - Alina Tantau
- UMF I.Hatieganu Cluj, Gastroenterology & Hepatology Department, Medicala III, Cluj County Hospital, Cluj Napoca, Romania
| | - Emanoil Ceausu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - Doina Proca
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Ileana Constantinescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Simona M Ruta
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - Mircea M Diculescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Alexandru Oproiu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
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Ester C, Gheorghe L, Becheanu G, Lupescu I, Popescu I, Gheorghe C. Early detection of advanced pancreatic cancer after DAA-induced virological cure in a liver transplant recipient with hepatitis C recurrence. J Gastrointestin Liver Dis 2018; 27:104-105. [PMID: 29557425 DOI: 10.15403/jgld.2014.1121.271.daa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Carmen Ester
- Gastroenterology and Liver Transplant Unit, Fundeni Clinical Institute, Bucharest, Romania.
| | - Liana Gheorghe
- Gastroenterology and Liver Transplant Unit, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Becheanu
- Pathology Department, Gastroenterology and Liver Transplant Unit, Fundeni Clinical Institute, Bucharest, Romania
| | - Ioana Lupescu
- Interventional Radiology Department,Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- General Surgery and Liver Transplant Unit, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Gheorghe
- Gastroenterology and Liver Transplant Unit, Fundeni Clinical Institute, Bucharest, Romania
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Marshall AD, Cunningham EB, Nielsen S, Aghemo A, Alho H, Backmund M, Bruggmann P, Dalgard O, Seguin-Devaux C, Flisiak R, Foster GR, Gheorghe L, Goldberg D, Goulis I, Hickman M, Hoffmann P, Jancorienė L, Jarcuska P, Kåberg M, Kostrikis LG, Makara M, Maimets M, Marinho RT, Matičič M, Norris S, Ólafsson S, Øvrehus A, Pawlotsky JM, Pocock J, Robaeys G, Roncero C, Simonova M, Sperl J, Tait M, Tolmane I, Tomaselli S, van der Valk M, Vince A, Dore GJ, Lazarus JV, Grebely J. Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe. Lancet Gastroenterol Hepatol 2018; 3:125-133. [DOI: 10.1016/s2468-1253(17)30284-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 01/15/2023]
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Trifan A, Stanciu C, Gheorghe L, Iacob S, Curescu M, Cijevschi Prelipcean C, Stefanescu G, Girleanu I, Chiriac S, Mihai C, Brisc C, Goldis A, Sporea I, Miftode E, Bataga S, Rogoveanu I, Preda C, Caruntu FA, Singeap AM. Efficacy and safety of paritaprevir/ritonavir, ombitasvir, and dasabuvir with ribavirin for the treatment of HCV genotype 1b compensated cirrhosis in patients aged 70 years or older. Medicine (Baltimore) 2017; 96:e9271. [PMID: 29390377 PMCID: PMC5815789 DOI: 10.1097/md.0000000000009271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 02/05/2023] Open
Abstract
Advanced age has been a major limitation of interferon-based treatment for chronic hepatitis C virus (HCV) infection because of its poor response and tolerability. Direct-acting antiviral (DAA) drug regimens are safe and highly effective, allowing administration of treatment also in elderly. This study aims to assess the efficacy and safety of paritaprevir/ritonavir, ombitasvir, and dasabuvir (PrOD) with ribavirin for the treatment of patients aged ≥70 years with HCV genotype 1b compensated cirrhosis.A total of 1008 patients with HCV genotype 1b compensated cirrhosis were prospectively treated with PrOD + ribavirin for 12 weeks, between December 2015 and July 2016. Sustained virologic response 12 weeks after the end of treatment (SVR12), adverse effects (AEs), comorbidities, discontinuation, and death rates were recorded. Efficacy and safety of therapy were assessed in patients aged ≥70 years and compared with data from patients <70 years.There were 117 patients aged ≥70 years, preponderantly females (58.9%), mean age 73.3 ± 2.8 years (range 70-82), and 37 (31.6%) were treatment-experienced. Comorbidities were reported in 60.6% of patients ≥70 years and in 39.8% of those <70 years (P < .001). SVR12 rates based on intention-to-treat and per-protocol analyses were 97.4% and 100%, respectively, in patients ≥70 years, compared to 97.8% and 99.6%, respectively, in patients <70 years (P = ns and P = ns). Severe AEs were reported in 4 (3.4%) patients ≥70 years, compared to 23 (2.6%) in those <70 years (P = ns). One death was recorded in a patient aged 79 years (0.9%) and 6 deaths (0.8%) in those <70 years (P = ns).Treatment with PrOD + ribavirin in patients 70 years of age or older with HCV genotype 1b compensated cirrhosis proved as effective, safe, and well tolerated, as it did in younger patients.
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Affiliation(s)
- Anca Trifan
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | | | - Liana Gheorghe
- Gastroenterology, “Carol Davila” University of Medicine and Pharmacy
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest
| | - Speranta Iacob
- Gastroenterology, “Carol Davila” University of Medicine and Pharmacy
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest
| | - Manuela Curescu
- Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy
- Department of Infectious Diseases, “Victor Babes” Hospital for Infectious and Lung Diseases, Timisoara
| | | | - Gabriela Stefanescu
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | - Irina Girleanu
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | - Stefan Chiriac
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
| | - Catalina Mihai
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | - Ciprian Brisc
- Gastroenterology, Oradea University of Medicine and Pharmacy
- Department of Gastroenterology, County Clinical Hospital, Oradea
| | - Adrian Goldis
- Gastroenterology, “Victor Babes” University of Medicine and Pharmacy
- Department of Gastroenterology and Hepatology Timisoara, The County Hospital Timisoara
| | - Ioan Sporea
- Gastroenterology, “Victor Babes” University of Medicine and Pharmacy
- Department of Gastroenterology and Hepatology Timisoara, The County Hospital Timisoara
| | - Egidia Miftode
- Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy
- “Sf. Parascheva” Infectious Diseases Clinical Hospital, Iasi
| | - Simona Bataga
- Gastroenterology, Targu Mures University of Medicine and Pharmacy, Targu Mures
- Department of Gastroenterology, Targu Mures Emergency County Hospital
| | - Ion Rogoveanu
- Internal Medicine, Craiova University of Medicine and Pharmacy
- Internal Medicine Department, Emergency Clinical County Hospital Craiova
| | - Carmen Preda
- Gastroenterology, “Carol Davila” University of Medicine and Pharmacy
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest
| | - Florin Alexandru Caruntu
- Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy
- “Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania
| | - Ana-Maria Singeap
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
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Manuc M, Preda CM, Popescu CP, Baicuș C, Voiosu T, Pop CS, Gheorghe L, Sporea I, Trifan A, Tanțău M, Tanțău A, Ceaușu E, Proca D, Constantinescu I, Ruta SM, Fulger LE, Diculescu M, Oproiu A. New Epidemiologic Data Regarding Hepatitis C Virus Infection in Romania. J Gastrointestin Liver Dis 2017; 26:381-386. [PMID: 29253053 DOI: 10.15403/jgld.2014.1121.264.cvr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Literature data suggest that HCV genotype-1b is present in 93-99% of the Romanian patients infected with hepatitis C virus (HCV). We present the genotyping tests recently performed on patients with HCV and advanced fibrosis eligible for the Direct-Acting Antiviral (DAA) therapy, as well as the prevalence of these cases across Romania. METHODS The genotyping method was performed on 7,421 HCV patients with advanced fibrosis. The detection method was automatic real time PCR platform M2000 (Abbott). Every subject was introduced into a database including age, sex, county and address. RESULTS Genotype 1b was almost exclusively present: 7,392/7,421 (99.6%). Genotype 1b patients were 19.6% from Bucharest, 49% were males, with a median age of 60 years. Genotype non-1b was encountered in 29/7,421 subjects (0.4%), 62% were males, 69% from Bucharest and the median age was 52 years. Most of the subjects (75%) were in the 6th and 7th age decade. The prevalence of these cases varied significantly across Romanian counties: the highest was in Bucharest (61.3/105), Bihor (47/105), Iasi (46/105) and Constanta (43/105), and the lowest in Ilfov (2.8/105), Harghita (3.7/105), Covasna (5.4/105) and Maramures (8.8/105) (p<0.001). CONCLUSIONS Genotype 1b is encountered in 99.6% of patients with chronic hepatitis C and advanced fibrosis from Romania. The presence of genotypes non-1b is more common in Bucharest, in males and at a younger age. There are significant differences regarding the distribution of these cases across Romania: the highest rates are in Bucharest, Bihor, Iasi and Constanta.
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Affiliation(s)
- Mircea Manuc
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carmen M Preda
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Corneliu P Popescu
- Virology Dept., Victor Babes Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian Baicuș
- Internal Medicine Dept., Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Theodor Voiosu
- Internal Medicine Dept., Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Corina S Pop
- Gastroenterology Dept., Emergency Universitary Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Liana Gheorghe
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Sporea
- Gastroenterology and Hepatology Dept., Timisoara Emergency Hospital, University of Medicine and Pharmacy, Timișoara, Romania
| | - Anca Trifan
- Gastroenterology and Hepatology Dept., Gastroenterology and Hepatology Institute, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Marcel Tanțău
- Regional Institute of Gastroenterology and Hepatology, and Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Tanțău
- 4th Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca
| | - Emanoil Ceaușu
- Virology Dept., Victor Babes Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Doina Proca
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ileana Constantinescu
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona M Ruta
- Virology Dept., Victor Babes Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Larisa E Fulger
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mircea Diculescu
- Gastroenterology and Hepatology Dept., Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Gheorghe L, Sporea I, Iacob S, Sirli R, Trifan A, Diculescu M, Stanciu C, Pascu O, Acalovschi M, Brisc C, Cijevschi C, Gheorghe C, Spârchez Z, Rogoveanu I, Dobru D, Dumitrascu DL. Position Paper on Treatment of Hepatitis C in Romania 2017. Part Two. J Gastrointestin Liver Dis 2017; 26:309-317. [PMID: 28922445 DOI: 10.15403/jgld.2014.1121.263.rom] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania, the mean prevalence is about 3%. New treatments have become available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country. METHODOLOGY A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention was created and these were discussed and rated. Decisions were taken by consensus. RECOMMENDATIONS We present here the second part of the Society's recommendations for chronic HCV infection treatment. An agreement between experts was reached regarding the therapy of the special categories of patients infected with HCV, complications and monitoring of the therapy, follow-up of the patients who reached sustained virologic response and re-treatment of the patients with therapy failure. CONCLUSIONS This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to real-life conditions in Romania.
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Affiliation(s)
- Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Speranta Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mircea Diculescu
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Oliviu Pascu
- 3rd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Monica Acalovschi
- 3rd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ciprian Brisc
- Gastroenterology Department, Faculty of Medicine and Pharmacy, Oradea, Romania
| | - Cristina Cijevschi
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Zeno Spârchez
- 3rd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine and Pharmacy, Târgu Mureș, Romania
| | - Dan L Dumitrascu
- 2nd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Gheorghe L, Iacob S, Curescu M, Brisc C, Cijevschi C, Caruntu F, Stanciu C, Simionov I, Sporea I, Gheorghe C, Iacob R, Arama V, Sirli R, Trifan A. Real-Life Use of 3 Direct-Acting Antiviral Regimen in a Large Cohort of Patients with Genotype-1b HCV Compensated Cirrhosis. J Gastrointestin Liver Dis 2017; 26:275-281. [PMID: 28922440 DOI: 10.15403/jgld.2014.1121.263.iac] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Ombitasvir/Paritaprevir/ritonavir/Dasabuvir (OBV/PTV/r+DSV) is one of the elective direct-acting antivirals (DAAs) recommended by international guidelines and the only one covered by the National Insurance System in Romania until November 2016. Our aim was to present the first prospective Romanian cohort evaluating the effectiveness and safety in clinical practice of this 3DAA combination in patients with HCV genotype-1b Child A liver cirrhosis. METHODS 681 patients received OBV/PTV/r+DSV+RBV for 12 weeks and were assessed clinically and biologically at baseline, week 4, 8, 12 (end of treatment, EOT), and 12 weeks after therapy (sustained viral response, SVR). RESULTS Per protocol, EOT virological response was 99.8% and SVR12 rate was 99.4%. Adverse events were present in 36.4% of patients. Permanent discontinuation of 3DAA regimen due to side effects was reported in 11 patients (1.6%). In 47.6% (185/389) of patients, Transient Elastography values were >20kPa (defined as clinically significant portal hypertension, CSPH) at baseline. Independent variables associated with CSPH were: baseline cholesterol level (p=0.003), platelet count <120,000/mm³ (p=0.02), MELD score (p=0.01). Liver stiffness measurement has significantly improved between baseline (26.6+/-12.7kPa) and SVR12 (21.6+/-11.8kPa) (p<0.0001). The same was true for APRI score (2.66+/-0.15 at baseline vs 0.85+/-0.02 at SVR12, p<0.0001) and FIB4 score (5.53+/-0.28 vs 3.24+/-0.08, p<0.0001), but not for Lok score (0.57+/-0.01 vs 0.63+/-0.01, p<0.0001). CONCLUSIONS We report a high efficacy of the 3DAA regimen in a homogeneous compensated HCV genotype-1b liver cirrhosis population, in a real-life setting. Noninvasive fibrosis scores significantly improved at SVR12.
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Affiliation(s)
- Liana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Speranta Iacob
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Manuela Curescu
- Department of Infectious Diseases, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
| | - Ciprian Brisc
- Department of Gastroenterology, University of Medicine, Oradea, Romania
| | - Cristina Cijevschi
- Institute of Gastroenterology and Hepatology, Gr.T. Popa University of Medicine and Pharmacy Iasi, Romania
| | - Florin Caruntu
- Carol Davila University of Medicine and Pharmacy, Bucharest;Matei Bals National Institute of Infectious Diseases, Bucharest, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, Gr.T. Popa University of Medicine and Pharmacy Iasi, Romania
| | - Iulia Simionov
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristian Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Razvan Iacob
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Victoria Arama
- Carol Davila University of Medicine and Pharmacy, Bucharest; Matei Bals National Institute of Infectious Diseases, Bucharest, Romania
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Gr.T. Popa University of Medicine and Pharmacy Iasi, Romania
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Leon Jimenez J, Camacho Freire S, Danduch L, Pino Acereda T, Roa Garrido J, Gomez Menchero A, Cardenal Piris R, Gheorghe L, Gomez Reyes J, De La Torre Hernandez J, Diaz Fernandez J. P4285Characteristics, management and long-term follow-up of iatrogenic coronary dissection: a multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Gheorghe L, Sporea I, Iacob S, Şirli R, Trifan A, Dobru D, Diculescu M, Stanciu C, Pascu O, Acalovschi M, Brisc C, Cijevschi C, Gheorghe C, Spârchez Z, Rogoveanu I, Dumitrascu D. Position paper on treatment of hepatitis C in Romania, 2017. Part one. J Gastrointestin Liver Dis 2017; 26:171-181. [PMID: 28617888 DOI: 10.15403/jgld.2014.1121.262.rom] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C Virus (HCV) infection is a common condition with endemic prevalence in some areas of the world. In Romania the mean prevalence is about 3%. New treatments became available on the market in recent years and new drugs are in the pipeline. A re-evaluation of HCV therapy was considered mandatory. The Romanian Society of Gastroenterology and Hepatology undertook this task for the practitioners of this country. METHODOLOGY A group of recognized experts was created who screened the available literature and the major available guidelines. A list of items requiring attention has been created. These items were discussed and rated. Decisions were taken by consensus. RECOMMENDATIONS We present here the first of the two parts of our Society's recommendations for chronic HCV infection treatment. An agreement was reached regarding the diagnostic tools, the assessment of severity and the up-dated therapy schedules. CONCLUSIONS This Position Paper represents a guide for the assessment and the therapy of HCV infection. The recommendations are in concordance with other guidelines but are applied to the real-life conditions in this country.
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Affiliation(s)
- Liana Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Sporea
- Dept. of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Speranţa Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Roxana Şirli
- Dept. of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine and Pharmacy, Târgu Mureș, Romania
| | - Mircea Diculescu
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Oliviu Pascu
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Monica Acalovschi
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ciprian Brisc
- Gastroenterology Department, Faculty of Medicine and Pharmacy, Oradea, Romania
| | - Cristina Cijevschi
- Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Zeno Spârchez
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania
| | - Dan Dumitrascu
- 2nd Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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