Browsing by Author "Vargas Domínguez, José Ignacio"

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    CD4/CD8 ratio as a predictor of the response to HBV vaccination in HIV-positive patients : a prospective cohort study
    (2016) Acuña, P.; Peirano, F.; Fuster, F.; Arab Verdugo, Juan Pablo; Martínez, F.; Sabrina, Soto; Ahumada, Rodrigo; Jensen, Werner; Fuster, F.; Vargas Domínguez, José Ignacio; Jensen, D.; Sarmiento, V.
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    Comparative Efficacy of an Intensified Re-Vaccination Scheme for Hepatitis B Virus Infection Among Patients Infected with HIV (CORE-HIV): A Randomized Controlled Trial. Interim Analysis
    (2016) Vargas Domínguez, José Ignacio; Jensen, Daniela; Martinez, Felipe; Sarmiento, Valeska; Acuna, Pedro; Peirano, Felipe; Fuster, Francisco
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    Direct antivirals for the treatment of chronic hepatitis C virus infection. Experience in 106 patients.
    (2017) Soza Ried, Alejandro; Benítez Gajardo, Carlos Esteban; Barrera Álvarez, Francisco Benjamín; Monrroy Bravo, Hugo Alfonso; Vargas Domínguez, José Ignacio; Arab Verdugo, Juan Pablo; Arrese Jiménez, Marco Antonio; Sarmiento, V.; Fuster, F.
    Background: The availability of direct-acting antivirals (DAA) for the treatment of chronic hepatitis C virus (HCV) infection is just starting to expand in Chile. Aim: To report the initial experience of patients treated with DAA and their evolution after treatment. Material and Methods: Prospective cohort study, from June 2013 to August 2016 of patients treated with DAA for HCV in three clinical centers. The presence of cirrhosis, clinical and laboratory features; adverse events (AE) and post-treatment changes in liver function were evaluated. Sustained viral response at 12 weeks post-treatment (SVR12) was determined. Results: One hundred six patients aged 58 +/- 13 years, 54% males, were included. HCV genotype 1b was present in 88% and 47% had cirrhosis. Treatment regimens were asunaprevir + daclatasvir (DCV) in 17% of patients, paritaprevir / ritonavir / ombitasvir + dasabuvir in 33%, sofosbuvir (SOF) + DCV in 19%, and SOF + ledipasvir in 30%. Twenty five percent of patients used generic drugs. SVR12 was 92.1%, with no differences between generic and brand-name drugs. Serious AE were recorded in 22% of patients, being more common in those with cirrhosis (34% vs 11.5%, p < 0.01). At 12 weeks post-treatment follow-up, there was a decrease in aminotransferase values (p < 0.01), improvement in Child-Pugh score (5.9 vs. 5.5, p = 0.03) and decreased presence of ascites (p = 0.02). Conclusions: In our setting, DAA for HCV was highly effective and safe in non-cirrhotic patients. Hepatic function and inflammation improved at 12 weeks of follow-up. AE were common in patients with cirrhosis, suggesting that these patients should be treated by experienced teams. Generic drugs had similar effectiveness compared to originals.
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    Effectiveness of the implementation of a re-linkage to care strategy in patients with Hepatitis C who were lost of follow-up
    (2021) Mendizabal, Manuel; Thompson, Marcos Andres; Ridruejo, Ezequiel; Gonzalez Ballerga, Esteban; Ruiz Velasco, Jose Antonio Velarde; Palazzo, Ana; Mezzano, Gabriel; Muñoz Espinosa, Linda Elsa; Pessoa, Mario; Cerda Reyes, Eira; Soza, Alejandro; Ruiz, Sandro; Gomez-Aldana, Andres Jose; Gerona, Solange; Fuster, Francisco; Anders, Margarita; Beltran Valdivia, Flor De Maria; Poniachik, Jaime; Schinoni, Maria Isabel; Hernandez, Nelia; Montes, Pedro; Girala, Marcos; Castillo, Lida; Castillo-Barradas, Mauricio; Chavez, Rocio; Cabrera, Cecilia; Tenorio, Laura; Zevallos, Katherine; Garavito, Jorge; Brutti, Julia; Tagle, Martin; Castro Narro, Graciela; Vera Pozo, Emilia; Perazzo, Rosalia; Guillermo Toro, Luis; Varon, Adriana; Ferreiro, Melina; Lazcano, Monserrat; Dolores Murga, Maria; Gomez, Fernando; Hernandez, Larissa; Damasio Moutinho, Bruna; Gandara-Calderon, Julian; Vargas Domínguez, José Ignacio; Simian, Daniela; Silva, Marcelo
    Background: In order to achieve the World Health Organization’s ambitious goal of eliminating hepatitis C (HCV), we must implement innovative strategies to diagnose and treat more patients. Therefore, our study aimed to identify patients with chronic HCV infection who lost follow-up and offer them re-linkage to care and treatment with direct-acting antivirals (DAAs). Methods: We conducted an implementation study of a strategy to contact patients with chronic HCV who were not under regular follow-up in 10 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or similar. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined as anti-HCV + and detectable HCVRNA. Identified patients who were not under follow-up by a liver specialist were contacted to offer them a medical reevaluation and, eventually, treatment with DAA. Results: A total of 3,709 patients were classified as HCV, of which 367 (9.9%) presented undetectable HCVRNA, and 148 (4.0%) were wrongly coded. Overall, 3,194 (86.1%) individuals were identified with chronic HCV infection, 49,9% were male, median age was 61 years (IQR 51-69); 166 (5.2%) developed hepatocellular carcinoma, and 117 (3.7%) underwent liver transplantation. Advanced liver fibrosis (F3-F4) was present in 1,361 (42.6%) patients. A total of 1,764 (55.2%) patients were under close care. Of these, 1,371 (74.7%) received antiviral treatment, 70 (5.3%) did not achieve sustained virologic response, 314 (17.8%) were not treated for different reasons and 133 (7.5%) died. We identified 1,430 (44.8%) patients who were lost of follow-up, 564 (39.4%) of whom were finally located. Of those contacted, 402 (71.3%) were candidates to receive DAAs, 108 (19.2%) were treated in other institutions, 12 (2.1%) did not wish to be treated, and 42 (7.4%) died (Figure). Globally, in our study 786/3,194 (24.6%) patients were candidates to receive antiviral therapies. Conclusion: In our cohort, 1 out of 4 patients with chronic HCV could be re-linked to care and treated. This strategy impresses to be effective, accessible and, significantly impact on the HCV cascade to cure.
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    Enterocolonic fistula after endoscopic full-thickness resection of a peri-appendiceal orifice adenoma
    (2020) Vargas Domínguez, José Ignacio; Rowsell, C.; Mosko, J. D.
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    Features of gastrointestinal amyloidosis reply
    (2021) Latorre Selvat, Gonzalo Ignacio; Vargas Domínguez, José Ignacio; Espino Espino, Alberto Antonio
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    Fragmento sérico de citoqueratina-18 como marcador no invasivo de esteatohepatitis no alcohólica en población chilena
    (2017) Arab Verdugo, Juan Pablo; Hernández Rocha, Cristián Antonio; Morales, Carolina; Vargas Domínguez, José Ignacio; Solis, Nancy; Pizarro Rojas, Margarita Alicia; Robles, Camila; Sandoval, Daniela; Ponthus, Simon; Benítez Gajardo, Carlos Esteban; Barrera Martínez, Francisco José; Soza, Alejandro; Riquelme Pérez, Arnoldo; Arrese, Marco
    La esteatohepatitis no alcohólica (EHNA) es la forma más agresiva de hígado graso no alcohólico (HGNA) e involucra el riesgo de progresión a etapas más avanzadas de enfermedad hepática. Se requieren métodos no invasivos para identificar a pacientes con EHNA. Objetivo: Evaluar el rendimiento diagnóstico de la determinación de los niveles séricos de citoqueratina-18 como marcador no invasivo de EHNA en población chilena. Métodos: Se determinaron los niveles séricos de CK-18 en un grupo de 41 pacientes con HGNA-probado por biopsia. El diagnóstico de EHNA se basó en los criterios histológicos recomendados (presencia de balonamiento) y se calculó el puntaje de actividad del HGNA (PAH) y grado de fibrosis. Mediante correlación de Spearman se evaluó la asociación entre CK-18 y PAH. Se confeccionó una curva ROC para evaluar la capacidad de CK-18 como test diagnóstico para EHNA. Además, se evaluó el rendimiento del puntaje de fibrosis en hígado graso no alcohólico (NFS) para pesquisa de fibrosis y EHNA y se lo comparó con CK-18 por regresión lineal simple. Los datos son expresados en medianas [percentil 25-75] y evaluados con test de rangos de Wilcoxon. Resultados: La edad promedio del grupo estudiado (23% hombres) fue de 50,4±11,1 años. Un 34,2% fue diagnosticado con EHNA (PAH≥5). Los niveles de CK-18 fueron mayores en los pacientes con EHNA versus los sin EHNA (183,6 UI/l [97,4-734,4] vs. 117,2 UI/l [83,8-954,8], p=0,016). Los niveles de CK-18 fueron buenos predictores de la presencia de EHNA en la biopsia con un área bajo la curva (AUC) de 0,732 (IC95% 0,572-0,897). Un punto de corte de 130,5 UI/l de CK-18 exhibió una sensibilidad de 92,9% y una especificidad de 63%, con un VPP de 56,5% y un VPN 94,4%, y clasificó correctamente al 73,2% de los pacientes con EHNA. El NFS tuvo un buen rendimiento para diagnóstico de fibrosis avanzada (AUC 0,739, IC95% 0,56–0,91), pero limitado para identificar EHNA (AUC 0,413, IC95% 0,21-0,61). Conclusión: La determinación de CK-18 es un buen marcador no invasivo de EHNA. Si bien, NFS tiene un buen rendimiento en la identificación de pacientes con fibrosis avanzada, no fue de utilidad para diagnosticar EHNA. En pacientes con HGNA, la determinación de CK-18 y NFS es útil en la pesquisa de EHNA y fibrosis hepática respectivamente.
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    High prevalence of autoimmune gastropathy, clinical characteristics and association with hypothyroidism: prospective analisys of 921 patients with gastric biopsies by sydney protocol
    (2018) Vargas Domínguez, José Ignacio; Maquilon, Sara; Torres, Javiera; Revelo, Santiago; Vargas, Camila; Garcia-Huidobro, Antonia; Castro, Josefina; Candia, Roberto; Gonzalez, Robinson G.; Baudrand, Rene; Espino, Alberto
    BACKGROUND: The prevalence of autoimmune gastropathy is increasing, and is considered underdiagnosed. The application of the Sydney protocol for gastric biopsies will probably allow to detect more cases at an early stage. AIM: To determine the prevalence of autoimmune gastropathy in gastric biopsies according to Sydney-OLGA protocol, and define its clinical and laboratory characteristics. Explore the association of autoimmune gastropathy with other autoimmune diseases. METHODS: Single center prospective observational study. Evaluation of gastric biopsies according to Sydney protocol between July 2016 and July 2017 to determine prevalence of autoimmune gastropathy. Autoimmune gastropathy was defined by histologic criteria as gastric corporal exclusive or predominant atrophy. Identification of histologic, clinical and laboratory findings of patients with autoimmune gastropathy. Descriptive statistics and inferential analysis comparing histological findings of autoimmune gastropathy and H. pylori-associated gastropathy. RESULTS: 921 gastric biopsies were evaluated. Mean age was 58 years (range 27-87), 58% female gender. The prevalence of autoimmune gastropathy was 8.8% (81/921). Presence of OLGA stages 3-4 was higher in autoimmune gastropathy than in HP-associated gastropathy (33.3 vs 15.8%, p = 0.004). Age was no different between the two groups (p=0.82). In the characterization of patients with autoimmune gastropathy, the prevalence of gastric polyps in autoimmune gastropathy was 11% (9/81), 4 of then were NETs. In patients with autoimmune gastropathy, only 3.3% had a previous diagnosis of pernicious anemia, and in 11% the reasons for endoscopy was the study of anemia. 18.5% had family history of gastric cancer. The prevalence of hypothyroidism was 30% (24/81). Other autoimmune disease was less frequent (13.5%). CONCLUSION: Our study shows a high prevalence of autoimmune gastropathy detected by gastric biopsies with Sydney protocol. In most cases, clinical characteristics of pernicious anemia was absent and the suspicion for this disease prior to endoscopy was low. Presence of advanced stages of gastric atrophy were frequent. The prevalence of thyrogastric syndrome, autoimmune gastropathy associated to hypothyroidism, was also frequent. The use of Sydney protocol for gastric biopsies allows to detect a higher proportion of patients with autoimmune gastropathy at early stages of the disease.
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    Infectious and non-infectious diseases burden among Haitian immigrants in Chile : a cross-sectional study
    (2020) Fuster F.; Peirano F.; Vargas Domínguez, José Ignacio; Cox, Valentina; López Lastra, Marcelo Andrés; Zamora, F. X.; Núñez, R.; Soza, J.; González, K.; Estay, D.; Barchiesi, B.; Fuster, A.; López, I.; Utrera, N.; Landeros, J.; Chandía, J.; Paredes, A.; Reyes, D.; Arias, R.; Padilla, L.; Suárez, H.; Farcas, K.; Cannistra, M.; Muñoz, G.; Rodríguez, I.; Ormazábal, I.; Cortés, J.; Cornejo, B.; Manzur, F.; Reyes, A.; Leiva, Vicente; Raimann, M. V.; Arrau, C.; Soza, Alejandro
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    Management of Periappendiceal Orifice Polyps
    (2020) Vargas Domínguez, José Ignacio; Teshima, C. W.; Mosko, J. D.
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    Nuevas terapias orales de acción directa para tratamiento de virus de hepatitis C (VHC)
    (2017) Vargas Domínguez, José Ignacio; Arab Verdugo, Juan Pablo; Monrroy Bravo, Hugo Alfonso; Labbé, Pilar; Sarmiento, Valeska; Fuster, Felipe; Barrera Martínez, Francisco Javier; Benitez, Carlos; Arrese Jiménez, Marco; Soza, Alejandro; Fuster, Francisco
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    Presence of anti-HBc is associated to high rates of HBV. resolved infection and low threshold for Occult HBV. Infection in HIV. patients with negative HBsAg in Chile
    (2016) Vargas Domínguez, José Ignacio; Jensen, Daniela; Sarmiento, Valeska; Peirano, Felipe; Acuña, Pedro; Fuster, Felipe; Soto, Sabrina; Ahumada, Rodrigo; Huilcaman, Marco; Bruna, Mario
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    Prospective follow-up of chronic atrophic gastritis in a high-risk population for gastric cancer in latin america
    (2022) Latorre, Gonzalo; Silva, Felipe; Montero, Isabella; Bustamante, Miguel; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Corsi, Oscar; Crispi, Francisca; Espinoza Sepúlveda, Manuel Antonio; Cuadrado, Cristobal; Fuentes-Lopez, Eduardo; Shah, Shailja; Camargo, M. Constanza; Torres, Javiera; Roa, Juan Carlos; Corvalan, Alejandro H.; Candia, Roberto; Aguero, Carlos; Gonzalez, Robinson G.; Vargas Domínguez, José Ignacio; Espino, Alberto; Riquelme, Arnoldo
    Background. Gastric adenocarcinoma (GA) is preceded by premalignant conditions such as chronic atrophic gastritis (CAG) with or without gastric intestinal metaplasia (GIM). Endoscopic follow-up of these conditions has been proposed as a strategy for the detection of early-stage GA. Aim. To describe the risk of progression to gastric dysplasia (GD) and early-stage GA of patients who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies obtained following the updated Sydney System biopsy protocol (USSBP). Methods. We conducted a real-world, multicenter, prospective cohort study. Patients undergoing EGD surveillance with USSBP were enrolled between 2015 and 2021 from three endoscopy units at Santiago, Chile. Patients with prior history of GA or gastric resection were excluded. Follow-up surveillance schedule was determined by gastroenterologist in accordance with the Chilean Digestive Endoscopy Association Guidelines. CAG was confirmed by two expert GI pathologists and categorized by the Operative Link on Gastritis Assessment as stage 0 (normal) through stage IV (advanced stage). The primary endpoint was a composite of GD (low-grade, LGD or high-grade, HGD) or GA, while secondary endpoints were progression in OLGA and separate outcomes of LGD, HGD or GA. Multivariable Cox regression analysis was used to estimate the association between CAG +/- GIM and the outcomes, adjusted for age, sex and Helicobacter pylori (Hp) infection. Results. 600 patients were included in the cohort (64% female; mean age 58 years). At baseline 32.3% (n=194) had active Hp infection. OLGA stage was: 31% (n=184) OLGA 0, 48% (n=291) OLGA I-II and 21% (125) OLGA III-IV. GIM was identified in 52% (n=312) and autoimmune gastritis in 6.2% (n=37). Median follow-up was 28 months (IQR 17-42). During follow-up, 6 early-stage GA, 3 HGD and 6 LGD were observed. No advanced-stage GA was diagnosed. Only 19% (n=35) of baseline OLGA 0 patients progressed to OLGA I-IV, with <2% progressing to OLGA III/IV (Figure 1). Persistence of Hp infection (aOR 2.1; 95%CI 1.1-4.0) was independently associated with increase of at least 1 point in the OLGA scale during follow-up. GA/GD free survival at 3- years for OLGA 0, I-II and III-IV was 99.4%, 97.1% and 91.7%, respectively (p=0.0015) (Figure 2). Based on multivariable Cox regression, OLGA III-IV (vs. OLGA 0) was associated with a 12.1-fold (95%CI 1.5-97.4) higher risk of GA, while GIM was associated with a 13.0-fold (95%CI 1.7-101.2) higher risk, although the CI was wide; this was particularly between 2 and 3 years of follow-up. Discussion: These findings, including the observation that all GAs were early-stage, support endoscopic/histologic surveillance for patients with advanced OLGA stages or GIM, which is a common finding in patients with advanced CAG. Further studies are needed to determine the optimal time interval for surveillance.
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    Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial
    (2018) Monrroy Bravo, Hugo Alfonso; Vargas Domínguez, José Ignacio; Glasinovic, Esteban; Candia, Roberto; Azua, Emilio; Galvez, Camila; Rojas, Camila; Cabrera, Natalia; Vidaurre, Josefa; Alvarez, Natalia; Gonzalez, Jessica; Espino Espino, Alberto Antonio; González Donoso, Robinson; Parra-Blanco
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    Use of Statins in Patients with Chronic Liver Disease and Cirrhosis: Current Views and Prospects
    (2017) Vargas Domínguez, José Ignacio; Arrese Jiménez, Marco; Shah, Vijay H.; Arab Verdugo, Juan Pablo