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Publications (27)39.17 Total impact

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    ABSTRACT: The hepatitis C virus becomes in leading cause of chronic hepatitis, hepatic cirrhosis, hepatocarcinoma and liver transplant at world level. OBJECTIVE: The aim of present study is to determine the virological, biochemical and histological course of patients presenting with Chronic hepatitis C under a combination of recombinant Interferon alfa-2b plus Ribavirin and to identify the main factors associated with the rates obtained of virological response. METHODS: A non-controlled and multicenter phase IV clinical-therapeutical trial was sponsored by the Institute of Gastroenterology and the Genetics and Biotechnology Engineering Center from May, 2002 to May, 2006. Sample included 122 patients diagnosed with chronic hepatitis C fulfilling the predetermined inclusion and exclusion criteria. Recombinant Interferon alfa-2b (3 millions of t.i.d units) was used plus Ribavirin (1000 or 1200 mg daily depending on the body weight) during 48 weeks. RESULTS: We achieved a sustained biochemical and virological response rate of 32.8 and 50.8 %, respectively at week 72. A 41.3,% from the total of patients had a histological improvement at the expense of reduction of fibrosis and a few changes in inflammation level. CONCLUSIONS: Raking into account the global response rate achieved this combined treatment was considered effectiveness for chronic hepatitis C and we recommended to deepen in the knowledge of infection in Cuba, as well as in more efficient treatment options for this disease.
    No preview · Article · Jun 2010 · Revista cubana de medicina
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    ABSTRACT: The hepatitis C virus becomes in leading cause of chronic hepatitis, hepatic cirrhosis, hepatocarcinoma and liver transplant at world level. OBJECTIVE: The aim of present study is to determine the virological, biochemical and histological course of patients presenting with Chronic hepatitis C under a combination of recombinant Interferon alfa-2b plus Ribavirin and to identify the main factors associated with the rates obtained of virological response. METHODS: A non-controlled and multicenter phase IV clinical-therapeutical trial was sponsored by the Institute of Gastroenterology and the Genetics and Biotechnology Engineering Center from May, 2002 to May, 2006. Sample included 122 patients diagnosed with chronic hepatitis C fulfilling the predetermined inclusion and exclusion criteria. Recombinant Interferon alfa-2b (3 millions of t.i.d units) was used plus Ribavirin (1000 or 1200 mg daily depending on the body weight) during 48 weeks. RESULTS: We achieved a sustained biochemical and virological response rate of 32.8 and 50.8%, respectively at week 72. A 41.3,% from the total of patients had a histological improvement at the expense of reduction of fibrosis and a few changes in inflammation level. CONCLUSIONS: Raking into account the global response rate achieved this combined treatment was considered effectiveness for chronic hepatitis C and we recommended to deepen in the knowledge of infection in Cuba, as well as in more efficient treatment options for this disease.
    No preview · Article · Apr 2010

  • No preview · Article · Mar 2010 · Revista cubana de medicina

  • No preview · Article · Mar 2010 · Revista cubana de medicina
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    ABSTRACT: Granular cells tumors are rare and asymptomatic lesions and by general, it is an incidental finding en high or low endoscopy. They were described for the first time by Abrikossoff in 1926. The more frequent locations are the buccal mucosa, dermis and subcutaneous cellular tissue, most of these tumors has a benign origin. This is the case of a woman aged 44 with a pyrosis history from a year ago; by high endoscopy it is noted a 8mm lesion distal to esophagus and confirmed by histological study of granular cells tumor. Elective treatment of this lesion is the endoscopic polypectomy. Despite that the malign potential is low; we suggested a close clinical and endoscopic follow-up.
    No preview · Article · Jan 2010
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    ABSTRACT: The cytotoxic and cancerous action of bile acids on gastric mucosa is a very interesting subject within the gastroduodenal diseases due to they are able to alter the membrane, the cellular metabolism, to give rise to a inflammatory process, to increase the proliferation, the cell apoptosis and the DNA damage, that according to its intensity and persistence, favor the appearance of failures and mutations in cell replication. With the discovery and characterization of Helicobacter pylori it is considered that according to its intensity and the time of persistence in gastric mucosa provokes damages with failures and cellular mutations. In this sense, a prospective and descriptive study was conducted in the Institute of Gastroenterology in patients presenting with duodenogastric and high total bile acids to know the association between the intestinal metaplasia and the presence or not of Helicobacter pylori. Metaplasia was present in the 48.7% of the 39 study patients, that there was a statistically significant association (p< 0.05) in Helicobacter pylori distribution in patients with and without intestinal metaplasia; that patients with duodenogastric reflux, despite of a histological lesion also had a greater frequency of negative results as regards the presence of Helicobacter pylori. In samples with histological diagnosis of severe and atrophic chronic gastritis, 75 %, respectively, had Helicobacter pylori and in consequence, there was a significant association between presence or not of microorganism and the chronic gastritis intensity. Intestinal metaplasia location was higher in antral region (84.3%) and also with a higher ratio of microorganism positivity. In patients with duodenogastric reflux, presence of Helicobacter pylori don't seems to be associated with intense degrees of intestinal metaplasia, although the microorganism is present in all categories, but when there is not Helicobacter pylori, intestinal metaplasia to tend to develop in its less severe degrees. In all cases the Helicobacter pylori density was light.
    No preview · Article · Jan 2010
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    ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is a significant health problem for which there is no universally accepted pharmacological treatment. The combination of weight loss and antioxidant drugs to ameliorate insulin resistance and improve steatosis, inflammation and fibrosis provides the rational for therapeutic trials. To evaluate the efficacy and safety of a nutritional supplement Viusid in association with diet and exercise for NAFLD. A randomized, controlled and parallel-group trial was conducted at a tertiary care academic centre (National Institute of Gastroenterology, Havana, Cuba). We randomly assigned 60 patients with liver biopsy-proven NAFLD to 6 months of treatment with a hypocaloric diet plus aerobic exercise daily and three Viusid sachets daily or a hypocaloric diet and exercise. Endpoints were improvement in the NAFLD activity score (NAS), fibrosis and normalization of serum aminotransferase levels. A significant improvement in steatosis, necroinflammation and fibrosis was seen in each group of treatment (P < 0.01 for each feature). The Viusid group, as compared with the control group, significantly reduced the mean of NAS [from 4.18 to 0.54 points in the Viusid group vs. 4.45 to 2.2 points in the control group (P < 0.001)]. On between-group comparison, Viusid was found to be associated with a significantly greater improvement in steatosis (P < 0.001), ballooning (P = 0.002) and lobular inflammation (P = 0.025), but not in fibrosis (P = 0.07). Viusid was well tolerated. Our results indicate that treatment with diet and exercise leads to a notable improvement in the histological features of NAFLD; however, the administration of Viusid intensifies the improvements of histological findings, especially of steatosis and inflammation.
    Full-text · Article · Aug 2009 · Alimentary Pharmacology & Therapeutics
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    ABSTRACT: To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients. We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52- and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk <or= 8 and high risk > 8). In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52- and 104-wk mortality, respectively. In addition, the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77). Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.
    Full-text · Article · Jul 2009 · World Journal of Gastroenterology

  • No preview · Article · Dec 2008 · Journal of Hepatology

  • No preview · Article · Dec 2008 · Journal of Hepatology

  • No preview · Article · Jun 2008 · Revista cubana de medicina
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    ABSTRACT: It is accepted all over the world that Helicobacter pylori infection increases with age and reaches levels between 40 and 60 % in asymptomatic individuals, and of 70 % in symptomatic patients over 50 with gastroduodenal diseases. Taking into account the relation existing between Helicobacter pylori infection and the gastroduodenal diseases, prevalences and incidences showing a sustained increase with age (50-70 % in patients over 50) are ciphered, and the significant growth of the Cuban population above this age is considered. A prospective and descriptive study was undertaken at the institute of Gastroenterology to know the frequency of this microorganism, as well as the presence of lesions in the gastric mucosa in patients aged 50 and over. It was concluded that 69.6 % of the patients had positive results to Helicobacter pylori in the urease test. Of the 132 fragments of samples taken for biopsies of the gastric mucosa, 37.8 % yielded positive to Helicobacter pylori, of them, 25.7 % were located in the antral region. 68 endoscopic diagnoses were made in those patients positive to Helicobacter pylori by urease test, 64.7 % corresponded to more acute gastritis at the antral level; followed in frequency by pangastrltis, more serious chronic gastritis at the body level, gastric ulcer and duodenal ulcer. No endoscopic lesion of malignant aspect was observed. On studying the colonization density of Helicobacter pylori in 84 histological diagnoses made, 69.0 % presented mild density; 29.9 %, moderate; and 1.1 %, severe. It was observed a tendency towards the colonization density as the histological lesion progressed. It was suggested to continue the study with more patients to characterize the behavior of the infection in patients aged 50 and over in order to take preventive measures to eradicate the bacteria and to improve the quality of life.
    No preview · Article · Apr 2008
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    ABSTRACT: The pathogenesis of chronic hepatitis C (CHC) is associated to severe oxidative stress that leads to necro-inflammation and progression of fibrosis. Previous trials suggested that antioxidative therapy may have a beneficial effect. We evaluated the efficacy and safety of Viusid in combination with interferon alpha-2b (IFN alpha-2b) and ribavirin in patients with CHC. We randomly assigned 100 patients, between October 2002 and December 2004, in two arms: IFN alpha-2b (5 MU on alternate days), ribavirin at a dose of 13 mg/kg daily and Viusid (three sachets daily) vs. IFN alpha-2b (5 MU on alternate days) and ribavirin at a dose of 13 mg/kg daily. Subjects were treated for 48 weeks and then followed for an additional 24 weeks. The primary end point was the histologic response (reduction of at least two points without fibrosis worsening in the total score on the Histological Activity Index). A significantly high proportion of patients who received combined therapy plus Viusid had a histologic response better than those patients who received IFN alpha-2b and ribavirin (57% vs. 37%, P=0.03). The patients with virologic response achieved the highest percentages of histologic response, irrespective of assigned treatment. Among non-responders, the highest reduction in the mean change from baseline score for necro-inflammatory activity (NA) and fibrosis (F) was reported in patients treated with Viusid [NA, -1.50 (Viusid), -1.20 (without Viusid); F, -0.31 (Viusid), 0.00 (without Viusid)]. Sustained normalization of serum alanine aminotransferase concentration was highest in the Viusid group compared with standard therapy (67% vs. 41%, P=0.009). The overall safety profile was similar in both groups, but interestingly, the anemia was less intense in the group with Viusid (P=0.04). Our results suggest that triple therapy with Viusid, IFN alpha-2b and ribavirin was well tolerated and may have a beneficial effect on histologic and biochemical variables. The intensity of anemia is reduced in patients treated with Viusid.
    Full-text · Article · Apr 2007 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Despite the development of potent, new antiviral drugs, the percentage of HBeAg seroconversion is approximately 35%. Immunosuppression before antiviral administration has recently been investigated with contradictory results. We evaluated the safety and efficacy of lamivudine and interferon alfa-2b with prior immunosuppression with prednisone in patients with HBeAg-positive chronic hepatitis B (CHB). A randomized controlled study was conducted in a sample of 44 patients with HBeAg-positive CHB and persistently elevated alanine transferase (ALT) levels. The patients were distributed into two groups: 22 patients received prednisone 40 mg daily for 4 weeks, followed by 2 weeks without treatment, and lamivudine 150 mg daily for 4 weeks; lamivudine plus interferon alfa 2b (10 MIU every other day) was then administered for 24 weeks followed by continuous lamivudine 150 mg daily to complete 58 weeks. A further 22 patients received the same treatment regimen and duration, but without prednisone. Virologic response defined as HBeAg seroconversion plus a decrease of serum HBV DNA < 105 copies/ml 24 weeks after concluding the treatment was observed in 68% of the patients receiving previous immunosuppression compared with 54% of the control group (p = 0.26). Forty-five percent of patients with prednisone priming showed histologic improvement compared with 23% of the control group (p = 0.10). A significant proportion of patient with previous immunosuppression showed improvement in necroinflammatory activity (45% vs 23%) and fibrosis (50 vs 23%) compared with the control group. Virologic response was clinically, but not statistically, superior in the group with prednisone priming. Histologic improvement was notable in the group with previous immunosuppression.
    No preview · Article · Dec 2006 · Gastroenterología y Hepatología
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    ABSTRACT: Introduction Despite the development of potent, new antiviral drugs, the percentage of HBeAg seroconversion is approximately 35%. Immunosuppression before antiviral administration has recently been investigated with contradictory results. We evaluated the safety and efficacy of lamivudine and interferon alfa-2b with prior immunosuppression with prednisone in patients with HBeAg-positive chronic hepatitis B (CHB). Methods A randomized controlled study was conducted in a sample of 44 patients with HBeAg-positive CHB and persistently elevated alanine transferase (ALT) levels. The patients were distributed into two groups: 22 patients received prednisone 40 mg daily for 4 weeks, followed by 2 weeks without treatment, and lamivudine 150 mg daily for 4 weeks; lamivudine plus interferon alfa 2b (10 MIU every other day) was then administered for 24 weeks followed by continuous lamivudine 150 mg daily to complete 58 weeks. A further 22 patients received the same treatment regimen and duration, but without prednisone. Results Virologic response defined as HBeAg seroconversion plus a decrease of serum HBV DNA < 105 copies/ml 24 weeks after concluding the treatment was observed in 68% of the patients receiving previous immunosuppression compared with 54% of the control group (p = 0.26). Forty-five percent of patients with prednisone priming showed histologic improvement compared with 23% of the control group (p = 0.10). A significant proportion of patient with previous immunosuppression showed improvement in necroinflammatory activity (45% vs 23%) and fibrosis (50 vs 23%) compared with the control group. Conclusions Virologic response was clinically, but not statistically, superior in the group with prednisone priming. Histologic improvement was notable in the group with previous immunosuppression.
    No preview · Article · Nov 2006 · Gastroenterología y Hepatología

  • No preview · Article · Jun 2006 · Revista cubana de medicina
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    ABSTRACT: The increase of the concentration of total biliary acids in the intestinal light, specially the secondary, due to metabolism disorders, provokes damages at the mucosa level of the whole digestive tract. This confirms its cytotoxic effect on the colon mucosa. The association between the increase of the elevated levels of total and secondary biliary acids and the appearance of inflammation of the colon mucosa, polyps and colorectal cancer is internationally reported. An exploratory study was conducted to determine the presence of hystomorphological colon lesions in patients with elevated levels of biliary acids in feces. It was found that 54 patients presented histomorphological lesions in some of the anatomical segments of the colon. The polyps were the most frequent endoscopically diagnosed lesions, and they were generally localized in the rectosigmoid region. All the patients had unspecific colitis of mild and moderate intensity in some segment of the colon. The most commonly diagnosed polyps were the neoplastic adenomatous polyps, and most of them presented moderate dysplasia. Mild dysplasia was only observed in the tubular adenomas. It was concluded that in those patients with a disorder of the acid biliary metabolism, its determination in feces may serve as a screening test of premalignant or malignant lesions.
    No preview · Article · Mar 2006
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    ABSTRACT: A review was made to explain how the diverse cellular processes occurring in the severely damaged liver tissue and in the mesenteric circulation influence on the different systemic alterations appearing in acute liver failure, and the close relation existing among them. The acute liver failure is a clinical syndrome resulting from a mass liver necrosis generating progressive dysfunction of the organ with the presence of deep alterations in its detoxicating, metabolic, sinthesizing and excreting functions. The hypothesis of critical mass, as well as that on endotoxins-cytokines and vasoactive substances explain somehow the different molecular changes supporting the physiopathological bases of this complex entity.
    No preview · Article · Aug 2004 · Revista cubana de medicina

  • No preview · Article · Oct 2003 · Revista cubana de medicina
  • No preview · Article · Jul 2003 · Microscopy and Microanalysis

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68 Citations
39.17 Total Impact Points

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