Papers by Cristiane Villela-nogueira
Annals of Hepatology, May 1, 2021
Journal of Viral Hepatitis, Dec 19, 2017
study design; acquisition of data; analysis and interpretation of data; drafting of the manuscrip... more study design; acquisition of data; analysis and interpretation of data; drafting of the manuscript. Cristiane Alves Villela-Nogueira-critical revision of the manuscript for important intellectual content Renata de Mello Perez-critical revision of the manuscript for important intellectual content Henrique Sérgio Moraes Coelho-study concept and design Maria Chiara Chindamo-acquisition of data Guilherme Ferreira da Motta Rezende-acquisition of liver biopsy data Adriana Marques Caroli de Freitas Bottino-analysis and interpretation of pathology data Vera Lucia Nunnes Pannain-analysis and interpretation of pathology data Luiz Fernando Bruzzi Porto-analysis and interpretation of laboratory data Ronir Luiz-statistical analysis
Journal of Clinical Gastroenterology, Mar 1, 2012
Journal of Viral Hepatitis, Jul 23, 2023
Data on the acceptability and usability of hepatitis C virus self‐testing (HCVST) remain scarce. ... more Data on the acceptability and usability of hepatitis C virus self‐testing (HCVST) remain scarce. We estimated the pooled rates of acceptability/feasibility and re‐reading/re‐testing agreement of HCVST using oral fluid tests (PROSPERO‐CRD42022349874). We searched online databases for studies that evaluated acceptability, usability and inter‐reader/operator variability for HCVST using oral fluid tests. Pooled estimates of feasibility, agreement and post‐testing perspectives were analysed. Sensitivity analyses were performed in men who have sex with men (MSM) and people who inject drugs (PWID). Heterogeneity was assessed using the I2 statistics. A total of six studies comprising 870 participants were identified: USA (n = 95 with liver disease), Kenya (n = 150 PWID), Egypt (n = 116 from the general population), Vietnam (n = 104 MSM and n = 105 PWID), China (n = 100 MSM) and Georgia (n = 100 MSM and n = 100 PWID)]. All studies used OraQuick® HCV Rapid Antibody Test. The pooled overall estimates for correct sample collection and for people who performed HCVST without needing assistance in any step (95% confidence interval [CI]) were 87.2% [76.0–95.3] (n = 755; I2 = 93.7%) and 62.6% [37.2–84.8] (n = 755; I2 = 98.0%), respectively. The pooled estimate of agreement for re‐reading was 95.0% [95% CI 91.5–97.6] (n = 831; I2 = 74.0%) and for re‐testing was 94.4% [90.3–97.5] (n = 726; I2 = 77.1%). The pooled estimate of those who would recommend HCVST was 94.4% [84.7–99.6] (n = 625; I2 = 93.7%). Pooled estimates (95% CI) of correct sample collection (72.8% [63.3–81.5] vs. 90.8% [85.9–94.8]) and performance of HCVST without needing assistance (44.1% [14.1–76.7] vs. 78.1% [53.4–95.3]) was lower in PWID compared to MSM. In summary, HCV testing with oral fluid HCVST was feasible and well‐accepted. Oral fluid HCVST should be considered in key populations for uptake HCV testing.
Annals of Hepatology, 2010
Hepatology Research, 2011
BMC Microbiology, 2007
Background: Hepatitis B virus (HBV) isolates have been classified in eight genotypes, A to H, whi... more Background: Hepatitis B virus (HBV) isolates have been classified in eight genotypes, A to H, which exhibit distinct geographical distributions. Genotypes A, D and F are predominant in Brazil, a country formed by a miscegenated population, where the proportion of individuals from Caucasian, Amerindian and African origins varies by region. Genotype F, which is the most divergent, is considered indigenous to the Americas. A systematic molecular characterization of HBV isolates from different parts of the world would be invaluable in establishing HBV evolutionary origins and dispersion patterns. A large-scale study is needed to map the region-by-region distribution of the HBV genotypes in Brazil. Results: Genotyping by PCR-RFLP of 303 HBV isolates from HBsAg-positive blood donors showed that at least two of the three genotypes, A, D, and F, co-circulate in each of the five geographic regions of Brazil. No other genotypes were identified. Overall, genotype A was most prevalent (48.5%), and most of these isolates were classified as subgenotype A1 (138/153; 90.2%). Genotype D was the most common genotype in the South (84.2%) and Central (47.6%) regions. The prevalence of genotype F was low (13%) countrywide. Nucleotide sequencing of the S gene and a phylogenetic analysis of 32 HBV genotype F isolates showed that a great majority (28/32; 87.5%) belonged to subgenotype F2, cluster II. The deduced serotype of 31 of 32 F isolates was adw4. The remaining isolate showed a leucine-to-isoleucine substitution at position 127. Conclusion: The presence of genotypes A, D and F, and the absence of other genotypes in a large cohort of HBV infected individuals may reflect the ethnic origins of the Brazilian population. The
World Journal of Gastroenterology, 2010
Inflammatory myofibroblastic tumor (IMT) occurs infrequently in the liver. It is controversial wh... more Inflammatory myofibroblastic tumor (IMT) occurs infrequently in the liver. It is controversial whether it represents a low grade mesenchymal neoplasm or a reactive inflammatory lesion. Local recurrence and metastasis are rare and some tumors are associated with infectious agents. We report on a case of a large and partially resected IMT with local recurrence and diaphragm and kidney infiltration detected on routine surveillance two years later. Histologically, the tumor showed spindle cells without atypia, mitosis or necrotic areas in a myxoid and collagenized background with inflammatory cells. In the liver portal tracts, granulomatous lesions with viable eggs of Schistosoma mansoni were identified. Immunohistochemistry demonstrated spindle cells which were smooth-muscle actin and vimentin positive. In conclusion, this case points out that these histological patterns do not predict the aggressive biological behavior of the lesion. A reason for the recurrence and the infiltration may be incomplete tumor resection. Further investigation is necessary in order to better clarify an infectious cause in some IMTs.
Cardiovascular Diabetology, Sep 24, 2021
Background: Liver stiffness measurement (LSM, which reflects fibrosis) and controlled attenuation... more Background: Liver stiffness measurement (LSM, which reflects fibrosis) and controlled attenuation parameter (CAP, which reflects steatosis), two parameters derived from hepatic transient elastography (TE), have scarcely been evaluated as predictors of cardiovascular complications and mortality in individuals with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD). Methods: Four hundred type 2 diabetic patients with NAFLD had TE examination (by Fibroscan ®) performed at baseline. Multivariate Cox analyses evaluated the associations between TE parameters and the occurrence of cardiovascular events (CVEs) and mortality. TE parameters were assessed as continuous variables and dichotomized at low/ high values reflecting advanced liver fibrosis (LSM > 9.6 kPa) and severe steatosis (CAP > 296 or > 330 dB/m). Improvements in risk discrimination were assessed by C-statistic and by the relative Integrated Discrimination Improvement (IDI) index. Results: During a median follow-up of 5.5 years, 85 patients died (40 from cardiovascular causes), and 69 had a CVE. As continuous variables, an increasing LSM was a risk marker for total CVEs (hazard ratio [HR]: 1.05; 95% CI: 1.01-1.08) and all-cause mortality (HR: 1.04; 95% CI: 1.01-1.07); whereas an increasing CAP was a protective factor for both outcomes (HR: 0.93; 95% CI: 0.89-0.98; and HR: 0.92; 95% CI: 0.88-0.97; respectively). As dichotomized variables, a high LSM remained a risk marker of adverse outcomes (with HRs ranging from 2.5 to 3.0) and a high CAP was protective (with HRs from 0.3 to 0.5). The subgroup of individuals with low-LSM/high-CAP had the lowest risks while the opposite subgroup with high-LSM/low-CAP had the highest risks. Both LSM and CAP improved risk discrimination, with increases in C-statistics up to 0.037 and IDIs up to 52%. Conclusions: Measured by hepatic TE, advanced liver fibrosis is a risk marker and severe steatosis is a protective factor for cardiovascular complications and mortality in individuals with type 2 diabetes and NAFLD.
Liver International, Feb 20, 2011
Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in type 2 diabetes ... more Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM). However, data regarding the prevalence and correlates of its histopathological stages are scarce. The aim was to investigate the prevalence and correlates of the more severe histopathological features of NAFLD, nonalcoholic steatohepatitis (NASH) and advanced fibrosis, in T2DM. Methods: From 125 patients with ultrasonographic evidence of NAFLD, 98 patients underwent liver biopsies, which were examined
European Journal of Gastroenterology & Hepatology, Mar 18, 2023
Introduction and objectives Liver stiffness measurement (LSM) by transient elastography has been ... more Introduction and objectives Liver stiffness measurement (LSM) by transient elastography has been validated to predict high-risk varices (HRV). We aimed to evaluate the accuracy of shear-wave elastography (SWE) and platelet count (Baveno VI criteria) to rule out HRV in patients with compensated advanced chronic liver disease (c-ACLD). Methods This retrospective study analyzed data of patients with c-ACLD (transient elastography ≥ 10 kPa) submitted to two-dimensional SWE (2D-SWE) (GE-LOGIQ-S8) and/or point SWE (p-SWE) (ElastPQ) who had a gastrointestinal endoscopy within 24 months. HRV definition was a large size and presence of red wale marks or sequelae from previous treatment. Optimal thresholds of SWE systems for HRV were identified. The proportion of spared gastrointestinal endoscopies and missing HRV considering a favorable SWE Baveno VI criteria were assessed. Results Eighty patients [36% male, median age = 63 (interquartile range, 57–69) years] were included. The prevalence of HRV was 34% (n = 27/80). The optimal thresholds to predict HRV were 10 kPa and 12 kPa for 2D-SWE and p-SWE, respectively. A favorable 2D-SWE Baveno VI criteria (LSM &lt; 10 kPa and platelets count &gt; 150 × 109/mm3) avoided 19% of gastrointestinal endoscopies without missing HRVs. A favorable p-SWE Baveno VI criteria (LSM &lt; 12 kPa and platelets count &gt; 150 × 109/mm3) spared 20% of gastrointestinal endoscopy without missing HRVs. Using a lower threshold of platelet count (&lt;110 × 109/mm3, expanded Baveno VI), 2D-SWE (&lt;10 kPa) avoided 33% of gastrointestinal endoscopy with 8% of missing HRVs, while p-SWE (&lt;12 kPa) avoided 36% of gastrointestinal endoscopy with 5% of missing HRVs. Conclusion LSM by p-SWE or 2D-SWE combined with platelet count (Baveno VI criteria) can spare a considerable number of gastrointestinal endoscopies missing a negligible proportion of HRV.
Journal of Hepatology, Jun 1, 2023
Nutrition Metabolism and Cardiovascular Diseases, 2020
Digestive Diseases and Sciences, Jan 29, 2022
FAST score has a good performance for diagnosing the composite of NASH + NAS ≥ 4 + F ≥ 2. However... more FAST score has a good performance for diagnosing the composite of NASH + NAS ≥ 4 + F ≥ 2. However, it has not been evaluated in Latin American individuals with nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the performance of the FAST score in a Brazilian NAFLD population. Cross-sectional study was held in ≥ 18 years NAFLD patients diagnosed by ultrasonography and submitted to liver biopsy (LB). Liver stiffness (LSM) and CAP measurements were performed with FibroScan®, using M (BMI < 32 kg/m2) or XL probes. Area under receiver operating characteristic (AUROC) curves were calculated as well as sensitivity (S), specificity (Spe), positive predictive value (VPP) and negative predictive value (NPV) for the previously established FAST score cut-offs. Among 287 patients included (75% female; mean age 55 ± 10 years), NASH + NAS ≥ 4 + F ≥ 2 was reported in 30% of LB. For the FAST cut-off of 0.35, the S and NPV to rule out NASH + NAS ≥ 4 + F ≥ 2 were 78.8% and 87.8%, respectively. Regarding the cut-off of 0.67, the Spe and PPV to rule-in NASH + NAS ≥ 4 + F ≥ 2 were 89.1%, 61.8%, respectively. The AUROC of FAST for all included patients was 0.78 (95% CI 0.72–0.84) and for those with ≥ 32 kg/m2 was 0.81 (95% CI 0.74–0.88). FAST score has a good performance in a Brazilian NAFLD population, even in patients with higher BMI when the XL probe is adopted. Therefore, FAST can be used as a noninvasive screening tool mainly for excluding the diagnosis of progressive NASH, reducing the number of unnecessary liver biopsies.
Nutrition Metabolism and Cardiovascular Diseases, Sep 1, 2019
Background & aims: Genetic factors may impact nonalcoholic fatty liver disease (NAFLD) severity. ... more Background & aims: Genetic factors may impact nonalcoholic fatty liver disease (NAFLD) severity. We aimed to assess the prevalence of patatin-like phospholipase domaincontaining 3 protein (PNPLA3) gene rs738409 C > G polymorphism in Brazilian individuals with type 2 diabetes and to investigate its association with liver disease severity, diabetic chronic degenerative complications, and metabolic control. Methods and Results: PNPLA3 genotyping was performed and classified as CC, CG, and GG. Clinical and laboratory data were obtained, including chronic degenerative diabetes complications. Liver stiffness and steatosis were evaluated by transient hepatic elastography with CAP using FibroScanÒ. Multiple logistic regression was performed to investigate the association of PNPLA3 G allele with clinical and laboratory variables and with hepatic fibrosis/steatosis. Three hundred three patients were included (118 male, mean age 59 AE 9.5 years). The G allele frequency was 32.5% (CC 47%, CG 41%, and GG 12%). Significant liver fibrosis and severe steatosis were diagnosed in 26% and 43% of patients, respectively. The variables independently associated with the G allele were coronary artery disease (OR: 2.25; 95% CI: 1.03e4.88; p Z 0.04), better glycemic control (OR for having an HbA 1c ! 8% [64 mmol/mol]: 0.53; 95% CI: 0.31e0.89; p Z 0.01), and significant liver fibrosis (OR: 1.82; 95% CI: 1.04e3.17; p Z 0.03). Conclusion: In individuals with diabetes and NAFLD, PNPLA3 gene rs738409 C > G polymorphism is a marker for the risk of significant liver fibrosis and cardiovascular disease and may be associated with better glycemic control.
Liver International, Jun 1, 2021
NAFLD is the most common cause of liver disease worldwide, and its prevalence is significantly in... more NAFLD is the most common cause of liver disease worldwide, and its prevalence is significantly increasing. Studies have shown that it is associated with comorbidities such as diabetes, metabolic syndrome and obesity. Early diagnosis and management are highly important and could modify the prognosis of the disease. Evaluating the possibility of multiple aetiologies and recognizing the additional causes of liver disease should be a part of the patient's initial assessment. There are no approved drug treatments as yet, so the main management strategies should involve lifestyle changes such as physical activity and dietary re‐education.
Digestive Diseases and Sciences
The Brazilian Journal of Infectious Diseases
Uploads
Papers by Cristiane Villela-nogueira