ABSTRACT
BACKGROUND AND AIMS: Around 750,000 patients per year will be cured of HCV infection until 2030. Those with compensated advanced chronic liver disease remain at risk for hepatic decompensation and de novo HCC. Algorithms have been developed to stratify risk early after cure; however, data on long-term outcomes and the prognostic utility of these risk stratification algorithms at later time points are lacking. APPROACH AND RESULTS: We retrospectively analyzed a cohort of 2335 patients with compensated advanced chronic liver disease (liver stiffness measurement≥10 kPa) who achieved HCV-cure by interferon-free therapies from 15 European centers (median age 60.2±11.9 y, 21.1% obesity, 21.2% diabetes).During a median follow-up of 6 years, first hepatic decompensation occurred in 84 patients (3.6%, incidence rate: 0.74%/y, cumulative incidence at 6 y: 3.2%); 183 (7.8%) patients developed de novo HCC (incidence rate: 1.60%/y, cumulative incidence at 6 y: 8.3%), with both risks being strictly linear over time.Baveno VII criteria to exclude (FU-liver stiffness measurement <12 kPa and follow-up platelet count >150 g/L) or rule-in (FU-liver stiffness measurement ≥25 kPa) clinically significant portal hypertension (CSPH) stratified the risk of hepatic decompensation with proportional hazards. Estimated probability of CSPH discriminated patients developing versus not developing hepatic decompensation in the gray zone (ie, patients meeting none of the above criteria).Published HCC risk stratification algorithms identified high-incidence and low-incidence groups; however, the size of the latter group varied substantially (9.9%-69.1%). A granular "HCC-sustained virologic response" model was developed to inform an individual patient's HCC risk after HCV-cure. CONCLUSIONS: In patients with compensated advanced chronic liver disease, the risks of hepatic decompensation and HCC remain constant after HCV-cure, even in the long term (>3 y). One-time post-treatment risk stratification based on noninvasive criteria provides important prognostic information that is maintained during long-term follow-up, as the hazards remain proportional over time.
ABSTRACT
This report describes findings from epidemiological surveillance of influenza virus in two cities in Argentina (Mar del Plata and Córdoba) from 1987 to 1993. It includes information on reporting and serologic characterization of isolated influenza viruses. In addition, determination was made of the nucleotide sequences of the HA1 subunits of five type A (subtype H3) viral strains isolated in the epidemics of 1990 and 1993. The incidence of illness, type of viruses isolated, and H gene sequences were similar to what has been reported from other parts of the world during the same period. The H3 strains isolated in the 1990 and 1993 seasons were somewhat removed in their molecular characteristics from the strains the World Health Organization recommended for vaccines for those years, and appeared closer to the strains recommended for vaccination in subsequent seasons
Subject(s)
Influenza, Human/virology , Epidemiological Monitoring , Serotyping , ArgentinaABSTRACT
This report describes findings from epidemiological surveillance of influenza virus in two cities in Argentina (Mar del Plata and Córdoba) from 1987 to 1993. It includes information on reporting and serologic characterization of isolated influenza viruses. In addition, determination was made of the nucleotide sequences of the HA1 subunits of five type A (subtype H3) viral strains isolated in the epidemics of 1990 and 1993. The incidence of illness, type of viruses isolated, and H gene sequences were similar to what has been reported from other parts of the world during the same period. The H3 strains isolated in the 1990 and 1993 seasons were somewhat removed in their molecular characteristics from the strains the World Health Organization recommended for vaccines for those years, and appeared closer to the strains recommended for vaccination in subsequent seasons
En este informe se describen los resultados de la vigilancia epidemiológica de virus de gripe en dos ciudades de la Argentina (Mar del Plata y Córdoba) de 1987 a 1993. Se incluye información acerca de la notificación y la caracterización serológica de los virus aisaldos. Además, se determinaron las secuencias de nucleótidos de las subunidades HA1 de cinco cepas tipo A (subtipo H3) aisladas durante las epidemias de 1990 y 1993. La incidencia de enfermedad, los tipos de virus aislados y las secuencias genéticas H fueron similares a las notificaciones del mismo período en otras partes del mundo. En sus características moleculares, las cepas H3 aisladas en las estaciones de 1990 y 1993 se distinguían un poco de las cepas que la Organización Mundial de la Salud recomendó incluir en las vacunas de esos años y se parecían más a las cepas recomendadas para vacunación en estaciones subsecuentes
Subject(s)
Serotyping , Influenza, Human , Epidemiological Monitoring , ArgentinaABSTRACT
El fenómeno del maltrato al menor es universal, tiene relación muy directa con lo que acontece en el mundo en torno a la economía, el manejo político de la economía y de las relaciones internacionales que influyen en los índices de pobreza colombiana con todas sus consecuencias deprivatorias. Desencadena trastornos familiares en donde el menor recibe una descarga permanente de agresividad tanto física como emocional que se refleja a diario en este hospital pediátrico.
Subject(s)
Humans , Child , Child Abuse/classification , Child Abuse/diagnosis , Child Abuse/statistics & numerical data , Child Abuse/mortality , Child Abuse/prevention & controlABSTRACT
Se presentan los resultados del Proyecto de Investigación para Vigilancia Epidemiológica de Influenza, realizado durante la temporada gripal de 1983.Se estudiaron los soldados de la clase 1964 que aquejaron síndrome gripal. Sobre 34 muestras de sueros pareados se obtubieron 24 conversiones serológicas, 14 de las cuales correspondieron a la cepa A/England/333/80 con títulos significativos que podrían señalar la presencia de un brote originado por la misma y otra similar (AU)
Subject(s)
Child , Adolescent , Humans , Male , HISTORY OF MEDICINE, 20TH CENT.ABSTRACT
Se presentan los resultados del Proyecto de Investigación para Vigilancia Epidemiológica de Influenza, realizado durante la temporada gripal de 1983.Se estudiaron los soldados de la clase 1964 que aquejaron síndrome gripal. Sobre 34 muestras de sueros pareados se obtubieron 24 conversiones serológicas, 14 de las cuales correspondieron a la cepa A/England/333/80 con títulos significativos que podrían señalar la presencia de un brote originado por la misma y otra similar